Cardiovascular Flashcards
Basic Anatomy:
Mediastinum
- the central compartment of the thoracic cavity contains: - heart & its vessels - esophagus - trachea - phrenic n. & cardiac n. - thoracic duct - thymus - lymph nodes of the central chest
Basic Anatomy - pericardium
the membrane that encloses the heart and protects it from infection and trauma
Basic Anatomy - epicardium
the outermost layer of the heart
also protects from infection and trauma
Basic Anatomy - myocardium
cardiac muscle tissue
provides the major pumping force of the ventricles
Basic Anatomy - endocardium
lines the inner surface of the heart, valves, chordae tendinae, and papillary muscles
Basic Anatomy - tricuspid valve
- R atrium/ventricle
- prevents backflow during ventricular systole
Basic Anatomy - bicuspid/mitral valve
- L atrium/ventricle
- prevents backflow during ventricular systole
What type of pressure system is the R side of the heart?
low pressure system
What type of pressure system is the L side of the heart?
high pressure system
What occurs during atrial systole?
the period of atrial emptying
includes atrial kick
What occurs during atrial diastole?
filling of the atrium
What occurs during ventricular systole?
ventricular contraction
1st reading of BP
What occurs during ventricular diastole?
filling of the ventricles
2nd reading of BP
What is ejection fraction?
the percentage of end diastolic volume ejected during systole
normal: 60%
What are the components of the perfusion triangle?
- heart (pump)
- blood vessels (container)
- blood (content)
What occurs when the perfusion triangle has a pump dysfunction?
CHF
cardiogenic shock
What occurs when the perfusion triangle has a container dysfunction?
septic shock
anaphylactic shock
What occurs when the perfusion triangle has a content dysfunction?
hypovolemic shock
bleeding
gastric bleeding
cerebral hemorrhage
What factors may adversely affect cardiac output?
preload
Frank-Starling mechanism
afterload
How might preload adversely affect cardiac output?
it effects the amount of tension on ventricular walls before contraction
How might the Frank-Starling mechanism adversely affect cardiac output?
FSM is the length tension relationship that enables ventricular filling and contraction to create an adequate SV
more blood returns during diastole, increased volume –> increased pressure –> more blood ejected during systole
adversely affected by CHF
How might afterload adversely affect cardiac output?
it determines the force against which cardiac muscles must contract
Key factors:
- vascular compliance
- vascular resistance (BP)
What is responsible for cardiac conduction?
SA node
PNS
ANS
What does the SA node do?
it is the pacemaker of the heart
What is the normal value for MAP?
at least 75% indicates adequate perfusion
What is the normal value for EF?
60%
What would an ST depression on an ECG indicate?
ischemia
What would ST elevation on an ECG indicate?
MI
What would an inverted T wave on an ECG indicate?
MI
What would a prominent Q wave on an ECG indicate?
MI
What would a wide QRS complex on an ECG indicate?
bundle branch block
What is a Premature Ventricular Contraction (PVC)?
a rhythm disturbance associated with CVD, drugs, anxiety, exercise, etc…
- relatively normal for older adults
What is ventricular tachycardia?
HR >100bpm
usually a regular rhythm
most common after an acute MI
What is ventricular fibrillation?
A chaotic rate and rhythm which will lead to death if untreated
may need AED to shock the heart back into a regular rhythm
What is an AV block?
a rhythm disturbance where electrical conduction from atria to ventricles is partially or completely blocked
What causes an AV block?
- age and heart disease
- myocarditis
- acute infection
- MI
What is an agonal rhythm?
an irregular HR <20bpm
typically near death
What is valvular heart disease?
stenosis, regurgitation, or prolapse affecting one or more of the 4 valves in the heart
What is myocardial heart disease?
aka: cardiomyopathy
a disease of the heart muscle tissue
What is pericardial heart disease?
aka: pericarditis
affects the pericardium and includes cardiac tamponade
What is cardiac tamponade?
a hemorrhage around the heart due to trauma
- causes fluid accumulation which compresses the heart and prevents the ventricles from completely refilling
What is associated with cardiac tamponade?
JVD
muffled heart sounds
narrowing pulse pressure
- decreased SBP, increased DBP
What is heart failure?
a pump dysfunction that reduces CO
What is the most common cause of heart failure?
cardiomyopathy
What are the different types of heart failure?
Left Right High output Low output Systolic Diastolic
What is thrombolytic therapy?
an acute management strategy for patients experiencing MI
Includes:
- fibrin selective agents
- fibrin non-selective agents
When is thrombolytic therapy indicated?
For:
- chest pain suggesting MI
- elevated ST segment
- bundle branch block
What is the timing for thrombolytic therapy?
Varied protocols
- some within 3hrs of onset of chest pain
- may be within 6-24hrs of onset of symptoms
When is thrombolytic therapy contraindicated?
in patients at risk for excessive bleeding
What are other considerations for thrombolytic therapy?
it is typically used in conjunction with other medications
What is percutaneous revascularization?
a balloon tipped catheter is threaded into an occluded artery and then inflated to make the artery patent once again
What are other considerations for percutaneous revascularization?
- An endoluminal stent may be placed to maintain patency
- often an OP procedure
What is a Coronary artery bypass graft?
A vascular graft used to revascularize the myocardium when a coronary artery is occluded
What are the typical vasculature used for a coronary artery bypass graft?
- saphenous vein
- internal mammary artery
- radial artery
What are the different types of approach for a coronary artery bypass graft?
Standard Approach:
- median sternotomy: a transection from sternal notch to xiphoid process
Minimally Invasive Approach:
- no sternal precautions
What are the post-op possibilities for coronary artery bypass graft?
- mediastinal chest tube
- external pacemaker
- intravascular catheter
What are cardiac ablation procedures?
- removal or isolation of ectopic foci in order to reduce rhythm disturbances
- also radiofrequency ablation
How does radiofrequency ablation work?
uses alternating low and high power frequency to destroy cardiac tissue
What is a maze procedure?
used to ablate atrial fibrillation
**the leg used for this procedure must remain straight and immobile for 3-4hrs
What is cardioversion?
restores normal heart rhythm in tachycardia arrhythmic conditions
- includes electric shock and medications
What should be monitored for cardioversion?
- activity response with HR and BP
- if a device does rate modulation (and what its upper limit is)
What does a cardiac pacemaker implantation do?
provides pacer function to ensure regular heart rhythm
What does an automatic implantable cardiac defibrillator do?
Manages ventricular arrhythmia by defibrillating the myocardium as needed to restore normal rhythm
- delivers a shock if abnormal rhythm is detected
- battery powered device under the skin that monitors heart rate
What should be considered for automatic implantable cardiac defibrillators?
- not all devices provide rate modulation
- a patient’s HR may not change with activity during PT
What is a life vest?
a personal external defibrillator worn by patients at high risk of sudden cardiac arrest
- includes garment and monitor
What is a ventricular assist device (VAD)?
a device used to unload R or L ventricle and support pulmonary/systemic circulation which can be used as terminal treatment
What are precautions for VAD?
- know emergency procedures in case of battery failure
- maintain patency of drive lines with external pump
- monitor hemodynamics
What are complications of VAD?
- thrombus formation
- CVA
- hemorrhage
- line infection
- renal or hepatic insufficiency
What are sternal precautions?
- no UE pushing/pulling
- no overhead reaching >90deg
- no lifting objects > 10#
- no resistive exercises of UE
- driving is restricted
What is the purpose of sternal precautions?
to reduce the risk for sternal dehiscence
How long are sternal precautions?
usually 8 weeks but depends on surgeon
What are the risk factors for sternal dehiscence?
obesity COPD DM Smoking PVD Repeat thoracotomy Female Pendulous breasts
What is stable angina
usually predictable, episodic, triggered by physical and/or psychological stressors
- occurs with constant frequency over time
- not relieved by rest or nitroglycerin
What is unstable angina
new onset, occuring at rest or minimal exertion
progressive in nature with increased frequency of episodes
refractory to previously effective medicine
more likely to lead to MI
What do you do if a patient reports chest pain?
- stop the activity
- let the patient rest in a position of comfort
- monitor vital signs (BP, HR, SaO2, RR, telemetry)
- use Angina Rating Scale/Canadian Cardiovascular Society classification of angina
- determine if pain is cardiogenic vs non-cardiogenic or stable vs unstable
- have the patient take nitroglycerin if prescribed
- educate patients on stable vs unstable chest pain
What types of telemetry are used to monitor patient activity tolerance for cardiac conditions?
BP MAP HR RR SaO2
What is telemetry used for?
allows for continuous monitoring of HR and rhythm along with respiratory rate
How does telemetry work?
- 5 color coded leads placed on chest
- electrical signals are converted to radio waves and allow for central monitoring at a nurse’s station
What should be considered for telemetry?
- frequently can become “unstuck” with activity
- PT activities may alter rate/rhythm (artifacts)
- watch the monitor while patient is at rest prior to initiating any activity
- may be able to put telemetry on hold or take portable box with pt
What are the general guidelines for Rate of Percieved Exertion (RPE)?
intensity is
- 5 or less on a 10 point scale
OR
- 13 or less on a 6-20 point scale
What are the MET values for various tasks?
Sitting - 1.3 Standing - 1.8 Home activity (folding/putting away laundry) - 2.3 Home activity (moderate cleaning) - 3.5 Brisk walk - 4.3 Yard work - 5.0 Running - 23
Describe the Cardiac PT Intervention Guidelines
- Low level or high level
- check with nurse before tx and report pt status after tx
- tx tailored to what will get that pt out of bed and transitioned to a lower level of care
Describe the phases of cardiac interventions
- warm up
- conditioning
- cool down
- education
Describe the cardiac intervention warm-up phase
performed at lower level of activity than exercise program
Describe the cardiac intervention conditioning phase
functional mobility training and aerobic based conditioning
Describe the cardiac intervention cool down phase
may consist of stretching or deep breathing
Describe the cardiac intervention patient education phase
promote self-monitoring and symptom recognition, establish safe and sustainable exercise program, lifestyle modifications, medication management
Describe the goal of cardiac rehabilitation
- Achieve optimal physical, psychosocial, and functional status within limits of heart disease
- establish safe exercise and activity parameters
Describe Phase I cardiac rehabilitation
- started as soon as the patient is stable
- begins in inpatient (acute care, TCU, subacute, SNF)
- GOAL: to tolerate ADLs, walking, climbing stairs
- education about risk factors and lifestyle modifications
Describe Phase II cardiac rehabilitation
- early OP rehab
- usually about 2 weeks after cardiac event
- continued patient education
- progression of activities and exercise
Describe Phase III cardiac rehabilitation
- maintenance and prevention
- usually begins 2-3 months after cardiac event
Describe cardiac patient d/c considerations
- prognosis
- PLOF
- social situation
- home set up
- equipment
What is an appropriate outcome measure for cardiovascular patients?
Marburg Heart Score
What is the Marburg Heart Score?
an outcome measure that predicts the likelihood of diagnosis of CAD
- includes:
- age 55+ in men/ 65+ in women
- known CAD or cardiovascular disease
- pain not reproducible by palpation
- pain worse with exercise
- patient’s assumption that pain is cardiogenic in origin
