Cardiovascular Flashcards
BP=
- Cardiac output (stroke volume+ heart rate)/
Total Peripheral Resistance
Normal BP
Normal *less than 130 *less than 85
High normal BP
*130-139 *85-89
Hypertension
*Stage 1 (mild)
*140-159 *90-99
Stage 2 (moderate)
*160-179 *100-109
Red Flags/Precautions
- Presentation of risk factors
- Fatigue/laboured breathing
- Headache during exercise
- Intermittent claudication
- Chest pain
- History of heart attack/heart disease
- Client unwilling to make changes to health
- Unknown health status
- Congestive heart failure (need to speak with Dr)
When to refer to Dr.
Undiagnosed hypertension-refer to their Dr.
* Stage 3 or 4 hypertension
Risk factors for Hypertension
- Anyone over the age of 45
- Over half the population over 65 has some
degree of hypertension (according to Rattray) - Family history
- Diabetes
- Obesity
- Lifestyle
factors-Smoking/diet/stress/sedentary - **If new client presents with risk factors, take
BP reading before tx
Techniques and modalities should not:
- Increase the work of the heart: e.g. by dramatically increasing
venous return - Increase the risk of local tissue damage: e.g. XFF can cause
prolonged bleeding in malnourished tissue - Interact with the use of medications: e.g. vasodilators and
hydrotherapy - Increase the risk of a secondary systemic complication: e.g.
dislodging a thrombus
THROMBOANGITIS OBLITERANS
BUERGER’S DISEASE
- Inflammatory lesions of the peripheral blood vessels are accompanied by thrombus formation and vasospasm occluding blood vessels.
- A vasculitis, i.e. an inflammatory and thrombotic process, affecting both arteries and vein, primary in the extremities
- Inflammatory lesions of the peripheral are accompanied by THROMBUS formation and vasospasm occluding and eventually OBLITERATING (destroying) small and medium vessels of the feet and hands
THROMBOANGITIS OBLITERANS (BUERGER’S DISEASE):
Demographics:/Symptoms:
- Usually found in men younger than 40 who smoke heavily
- Symptoms are episodic and segmental (i.e. come and go intermittently over time and
appear in different, asymmetrical anatomic locations) - Intermittent claudication in the arch of the foot or the palm of the hand is often the first symptom
- Symptoms include pain at rest, edema, cold sensitivity, rubor (redness of the skin from dilated capillaries under the skin), cyanosis, and thin, shiny, hairless skin (trophic changes) from chronic ischemia
THROMBOANGITIS OBLITERANS (BUERGER’S DISEASE):
Tx goals
Include increasing circulation to the hand or foot
ARTERIOSCLEROSIS OBLITERANS:
- Proliferation of the intima causes complete obliteration of the lumen of the artery
- A.k.a. peripheral arterial disease
- Most common occlusive disease (about 95% of cases)
ARTERIOSCLEROSIS OBLITERANS: Symptoms
- Bilateral, progressive INTERMITTENT CLAUDICATION is usually present in muscles
- Primary symptom may be a sense of weakness or muscular “tiredness”, both the pain and weakness/fatigue are relieved by rest
- Pain at rest indicated more sever involvement; may be relieved by dangling limbs (usually leg) over the edge of the bed to use gravity to encourage circulation (dependent position)
ARTERIOSCLEROSIS OBLITERANS
Treatment Goals:
- Preventive skin care is a primary goal in treatment; avoid minor injuries, infections and ulceration
- Exercise to increase collateral circulation and improved function
- Diabetic neuropathy with diminished sensation of the toes or feet often occurs, predisposing the patient to injury or pressure ulcers that may progress because of poor blood flow and ongoing loss of sensation
Chronic Arterial Disease General treatment goals
- Improve local/collateral circulation
- Improve exercise tolerance for ADL’s and decrease the incidence of intermittent claudication
- Relieve pain at rest
- Prevent joint contractures and muscle atrophy
- Prevent skin ulcerations
RAYNAUD’S (DISEASE AND PHENOMENON)
- Intermittent episodes of small artery or arteriole constriction of the
extremities causing temporary pallor and cyanosis of the digits (usually
fingers) - These episodes occur in response to the cold temperature or strong
emotion (anxiety or excitement) - Arterial vasospasm in the skin 🡪 constriction 🡪 pale cold skin 🡪
blood pools in surrounding tissues 🡪 bluish/purplish skin 🡪 white 🡪
red (as vessels relax and blood flows in) 🡪 warm red skin (may
experience throbbing, swelling and paresthesia) - Raynaud’s disease: primary condition, vasospastic disorder (idiopathic)
RAYNAUD’S DISEASE Demographics, Etiology:
- 80% of people with it are women aged 20-49 years old
- Idiopathic; seems to be caused by hypersensitivity of digital
arteries to cold, release of serotonin, and congenital
predisposition to vasospasm - Accounts for 65% of people affected by Raynaud’s
- More “annoying than medically serious”
History Questions Raynauds
Has this been diagnosed, is it secondary to an
underlying health concern
* Are you currently having an attack?
* What are your triggers?
* Is the skin cracked, thin, or ulcerated? (may
observe)
* Skin integrity is major concern for arterial insuf.
The Allen Test
Since the normal ulnar artery is frequently not palpable,
the Allen Test may be useful. It tests the patency of the
ulnar and radial arteries in turn.
* Ask the patient to rest his/her hands on the table. Place
your thumbs over their radial arteries and ask them to
clench fists tightly. Compress the radial arterial firmly, then
ask the patient to open hands into a relaxed position.
Observe the colour of the palms. Normally they should turn
pink promptly. Repeat occluding the ulnar arteries.
* Persistence of pallor when one artery (e.g. the radial) is
manually compressed indicates occlusion or compromise of
the other (e.g. the ulnar).
