Cardiovascular Diseases Flashcards
Cardiovascular Diseases
(5)
- Acute Coronary Syndrome
- Congestive Heart Failure
- Pulmonary Edema
- Pulmonary Embolism
- Peripheral Vascular Disease
Acute Coronary Syndrome
Definition
A term used to describe a spectrum of clinical presentations which result from impairments in the blood supply to the heart
Conditions include: myocardinal ischemia & myocardial infarction
Myocardial Ischemia
(3)
Insufficient blood flow to the myocardium
- Typically presents with angina pectoris - chest pain / pressure due to insufficient blood flow
- When no symptoms are present it is referred to as silent myocardinal ischemia
Angina
(3)
Diffuse retrosternal pressure, heaviness, rightness or constriction in the chest caused by reduced blood flow to the myocardium
- Patient may clench their fist over their sternum (Levine sign) - fist or claw
- May radiate to the LT jaw, LT arm, &/or upper back between the scapula
What is the Levine Sign?
When a patient may clench their fist over their sternum
Angina: Types
(3)
1. Stable Angina
- Precipitated by activities that increase myocardial oxygen demand (ie physical activity, secual activity, emotional stress, cold (vasoconstriction > prevent heat loss by constricting), or lying down in supine (INC venous return = INC preload).
- Relieved by rest or nitroglycerin (NTG) - oral (sublingual) or spray
- Demand > supply
Stress = release of hormones (cortisol & adrenline) > INC BP - vessels vasoconstrict… 2 affects:
1. Peripheral vasoconstriction= INC BP & heart has a harder time pumping out blood because of INC resistance = contracting harder = need fore more O2 > need more energy
2. Coronary arteries constrict = DEC supply of blood to the heart mm = DEC supply of oxygen to heart mm
2. Unstable Angina - Chronic mismatch
- Occurs at rest without any obvious precipitating factors or with minimal exertion
- Not relieved by rest - tissue is still alive but VERY ischemic
- May not be relieved by nitroglycerin (NTG)
- Required immediate medical attention as there is a high risk for myocardial infarction
3. Varient Angina
- Vasospasm of coronary arteries
- Does not respond to NTG
Frank-Sterling Law
Frank-Sterling Law
INC EDV = INC SV independent of everything else = greater CO
Myocardial Infarction
Death of cardiac mm cells d/t lack of blood flow - tissue death b/c lack of O2 = necrosis
- Caused by a sudden complete occlusion of one or more coronary arteries
- The term injury refers to acutely injured myocardial tissue during a sudden heart attack
- The term infarction referes to myocardial tissue that was injured & progressed to irreversible dead tissue as seen in old heart attacks
MI: Evaluation Triad
(3)
- Symptoms
- ECG changes
- Cardiac Biomarkers
Symptoms
(7)
- Angina pectoris
- Anxiety
- Diaphoressi (unusal amount of sweating)
- Dyspnea
- Dizziness
- Fatigue
- Nausea
MI: ECG changes
(3 Scenarios)
Electro-cardio-gram
If ischemia (decreased perfusion) is present:
- ST-segment depression
- Inverted T-wave
** Only present while the heart is ischemic
Small acute MI w/ no injury to myocardial tissue:
- No ST-segment change (small = not going to show a visual representation)
- Referred to as non-ST segment elevation myocardial infarction (NSTEMI) or non-Q-wave myocardial infarction (NQMI)
Large acute MI w/ injury to myocardial tissue:
- 1st = ST-segment elevation > once the infract is not acute…
- Pathological Q-wave (hours or days following the acute process)
- Referred to as ST segment elevation myocardial infarction (STEMI) or Q-wave myocardial infarction (QMI) ** May not even have a Q-wave (pathological)
MI: Cardiac Biomarkers
(4)
The following cardiac biomarkers found in blood work may determine the presence of a MI:
1. Troponin I
2. Troponin T
3. Myoglobin
4. Creatine kinase - Myocardial Band (CK-MB)
MI: Medical Management
(2)
Percutaneous Transluminal Coronary Angioplasty (PTCA)
- Stunt in the artery - keeping the vessel open
Coronary Artery Bypass Graft (CABG)
- Take a vessel from somewhere else in the body - used to pass the coronary artery - this provides a new way to provide blood to the area
Donor Vessels:
- Saphenous vein
- Internal throacic artery
- Radial artery of nondominant arm
MI: Medications
(6)
Vital signs will be impacted by these medications
- Betablockers
Less energy required by the heart = DEC HR & contractility - Calcium Channel Blockers
DEC BP & prevent smooth mm vasospam - Nitrates
Vasodilator = INC BF to myocardial & less resistance for the heart to overcome - Angiotensin-converting enzyme (ACE) Inhibitors
Inhibit/ prevent vasoconstriction = DEC BP - Angiotensin Receptor Blockers (ABR)
Inhibit vasoconstriction & sympathetic activity = DEC BP - Supplemental oxygen
Myocardium may need more O2 along w/ other organs (muscles)
Common theme = decrease BP
MI: Physical Therapy Management -
Goals
(5)
- Improve exercise capacity (ability to do more work)
- Improve exercise efficiency (ability to do same work with less cost)
- Improve exercise tolerance (ability to do same work with less signs & symptoms)
- Improve self-management
- Improve quality of life
Cardiac Rehabilitation
Definition
A comprehensive exercise, education, & lifestyle modification program designed to optimize physical, psychological, social, and vocational functioning
Beneficial to reduce disability. Not only exercise training but EDUCATION
Phases of Cardiac Rehabilitation
(4)
Phase I: Acute/ Inpatient Phase
Phase II: Subacute/ Conditioning
Phase III: Intensive Rehabilitation Phase
Phase IV: Maintenance Phase
Phase I: Acute / Inpatient Phase
(5)
- Traditionally begun in the acute hospital or rehab setting
- Role of PT is to prepare for discharge, monitor activity tolerance, support risk factor modification techniques, provide emotional support, build self-efficacy, & educated the patient on how to recognize adverse signs & symptoms w/ activity, and collaborate with other members on the team
- All aspects of education should be initated in Phase I
- Focus on interventions is on assessing hemodynamic responses to activity, & indpendence in functional mobility activities (ie bed mobility, transfers, ambulation, stair climbing, & ADLs)
- Vital signs should be monitored before and after (& during if possible)
- INTENSITY should be low level
Phase I: Acute / Inpatient Phase -
LEVELS
(4)
Level 1 (1 METs)
- Patient in ICU & has been medically stable for 24 hours
- Bed rest but allow gentle AROM exercises for upper & lower extremities & DP
Level 2 (2 METs)
- Allow sitting up in a chair for meals, performing ADLs, and walking to the bathroom or inside the rom (up to 50ft) a few times a day
Level 3 (3 METs)
- Ambulate up to 250 ft a few times a day
Level 4 (4 METs)
- Perform ADLs independently & ambulate up to 1000 ft a few times a day
- Allow climbing of 1 flights of stairs
General guidelines & standards for goal setting
Continuum
Phase II: Subacute / Conditioning Phase
(2)
- Typically begins after discharge from the hospital in the outpatient setting
- Conditioning exercises are done with close cardiac monitoring
Phase III: Intensive Rehab Phase
(2)
- Exercise in large groups
- Resistance training typically initiated in this phase
RT > Phase III
Phase IV: Maintenance Phase
(1)
- Patient is encouraged to continue exercise training in a group setting or self-monitored program
Education for Patients w/ Heart Disease
List (7)
- Activity Guidelines
- Self-Monitoring
- Symptom Recognition & Response
- Nutrition
- Medications
- Sexual Activity
- Psychological/ Social Issues
Page 76-77 for more details
Congestive Heart Failure
Definiton & Epidemiologu
A syndrome characterized by impairment in the heart pump function (LT or RT ventricle)
Epi:
- Leading cause of cardiac deaths in North America
- Most frequent cardiac diagnosis for hospital admissions
- M>F