Cardiovascular Pathologies Flashcards
1
Q
Specific things/symptoms to look for in the history for cardiovascular issues
A
- Chest pain, SOB, palpitations
- Fatigue
- Syncope and dizziness
- Risk factors for cardiovascular disease
2
Q
Specific things to look for in the chart for cardiovascular patients
A
- lab values
- ABGs, EKGs
- Medications
3
Q
Examination for cardiovascular screening
A
- Bluish skin
- pulses
- vitals (BP, SpO2)
- heart and lung sounds
- chest wall motion and palpation
- rhythm: EKG
- Circulation and lymphatic system
4
Q
what is pericarditis
A
inflammation of the pericardium (usually serous pericardium) or pericardial fluid
5
Q
what is pericarditis caused by
A
usually viral infection but can also be from systemic diseases or trauma
6
Q
what are the signs and symptoms of pericarditis
A
- Sharp Retrosternal chest pain (may radiate to back or L trap)
- Increases with cough or deep breathing
- decreases with sitting upright and leaning forward
7
Q
diagnostic tool for pericarditis
A
auscultation - friction rub
8
Q
medical work up for pericarditis
A
increases WBC, Sed rate, C-reactive protein, and troponins initially but will not continue to increase.
9
Q
management for pericarditis
A
acute (not lasting longer then 3 weeks)
- rest, pain medication with anti-inflammatory drugs or steroids)
Chronic
- IV antibiotics or pericardial drainage
10
Q
what is constrictive pericarditis
A
chronic pericarditis or pericardial effusion that results in the thickening and scarring of the pericardium
11
Q
symptoms of Constrictive Pericarditis
A
- dyspnea
- LE and abdominal swelling
- dizziness or syncope
- retrosternal chest pain
- Jugular venus distention
12
Q
what is pericardial effusion
A
accumulation of fluid in the pericardial space
13
Q
symptoms of pericardial effusion
A
fullness in chest, cough, hoarseness, dysphagia
14
Q
medial work up for pericardial effusion
A
- muffles heart and lung sounds
- dullness to percussion of left lung at angle of the scapula
- enlarged cardiac silhouette
- echocardiography
15
Q
Cardiac Temponade
A
accumulation of fluid in the pericardial space that exerts pressure on the heart
16
Q
symptoms of Cardiac Tamponade
A
becks triad (Hypotension, JVD with pulsus paradoxus, decreased heart sounds)
17
Q
treatment for cardiac tamponade
A
cut a cardiac window or pericardial window
18
Q
Endocarditis
A
Infection of the endocardium from bacteria or fungi
19
Q
cause of endocarditis
A
bacteria travels from another part of the body
20
Q
signs and symptoms of endocarditis
A
- flu like symptoms, pain with breathing, SOB, swelling, fever
- may hear mitral valve regurgitation on ausculation
21
Q
people at highest risk for endocarditis
A
- artificial hear valves
- damages heart valves or congenital heart defect
22
Q
medial workup for endocarditis
A
- increase WBC, sed rate, C-reactive protein, and blood cultures to isolate organism
- EKG
- ECHO
23
Q
treatment for endocarditis
A
- High dose long term IV ABX
- Possible valve replacement
24
Q
Myocarditis (inflammatory cardiomyopathy)
A
infection or inflammation of the heart wall/muscle
25
what is myocarditis caused by
viral or bacterial infection (streptococcal most common). in rare cases; drug induced
26
what does myocarditis affect
both pump and electrical conduction
27
signs and symptoms of myocarditis
weakens pump action: SOB, diffuse chest pain, fatigue, edema) and arrhythmias
28
if myocarditis is untreated what can it lead to
- heart failure due to damaged cardiac muscle and decreased pump function
- MI or CVA due to pooling of blood in ventricles
- Arrhythmia (possible sudden cardiac death)
29
Cardiovascular disease definition
is the umbrella term for all types of diseases that affect the heart or blood vessels, including coronary artery disease, which can cause heart attacks, stroke, heart failure, and peripheral artery disease
30
hypertension
blood pressure readings that are consistently over established guidelines
31
coronary artery disesase
a buildup of atherosclerotic plaque formation in the vessel lumen that leads to impairment in blood flow and O2 delivery to the myocardium
32
Modifiable cardiovascular disease risk factors
- Cholesterol levels
- stress
- diabetes
- diet
- HTN
- weight (BMI over 30kg/m2)
- Physical activity level
- tobacco usage
33
non-modifiable cardiovascular disease risk factors
- Age: over 65 for everyone; over 45 for men and over 55 for women
- family history; intermediate family member male cardiac event younger then 55 y.o. and female younger then 65 y.o.
- genetics
- gender: Male> premenopausal females
- race: african americans at greater risk
- chronic kidney disease
- low SES
34
prevalence of cardiovascular disease (CVD)
- more then 83 million americans have 1 or more forms of cardiovascular disease (1 in 3 adults)
- 25% of those with HTN are undiagnosed
35
what are some things that HTN can lead to
-heart failure
- myocardial ischemia and infarction
- aortic aneurysm and dissection
- stroke
- nephrosclerosis and renal failure
- retinopathy
36
what does chronic hypertension do to the L ventricle
- produces an overload
- can lead to heart failure with reduced ejection fraction
- L ventricle not able to supply enough O2
37
hypertensive heart disease
chronic HTN that produces an overload onto the L ventricle
38
symptoms of hypertensive heart disease
- dizziness
- dyspnea
- impaired exercise tolerance
39
HTN management
- weight loss
- Aerobic exercise
- limit sodium intake
- reduce alcohol
- stop smoking
- treat sleep apnea
40
prescribtion medications for HTN
- thiazide Diuretic
- Long acting Ca channel blocker
- ACE inhibitors
- Beta blockers
41
ACSM guidelines for exercise
- aerobic ex: 5-7days at 60-80% THR or 6-11 RPE
- Resistance training: 2-3 days a week at 60-80% 1RM
- Flexibility training: 2-3 days 10-30 secs
42
PT role in HTN
- screen for risk factors
- take BP accurately
- prescribe appropriate EBP exercises
- educate pt on risk factor management and lifestyle changes
43
Orthostatic hypotension
drop in blood pressure by 20 systolic or 10 diastolic with positional changes within 3-6 mins.
44
common symptoms of orthostatic hypotension
lightheadedness, dizziness, falls, LOC, visual and cognitive disturbances, weakness, and fatigue
45
tx for orthostatic hypotension
- prevention
- education
- avoid dehydration
- exercise
- mobility training
- compression socks
- avoid alcohol and heavy meals
46
POTS
postural orthocstic tachycardia syndrome
rapid increase in HR more then 30 bpm in adults or 40 bpm in adolescents or if HR exceeds 120 bpm within 10 minutes of rising
47
tx for POTS
targeting low blood volume, Na+, hydration, and some medication
48
PT implications for postural orthostatic
move LE before standing, move segmentally, valsalva if not contraindicated, and using pressure socks.
49
PT implications for POTS
aerobic re-conditioning with some strength training to LE
-can start in a recumbent position at 75% Max HR for 30 minutes 3-4 times a week
50
CAD - Coronary Artery disease major contributor
- atherosclerosis "hardening of the arteries"
51
what is atherosclerosis
thickening and narrowing of the intimal layer of the blood vessel wall from accumulation of lipids, platelets, monocytes, and plaque
52
what are the major risk factors for CAD
- men over the age of 45; women over 55
- family history or cardiac event; male less then 55, women less then 65
- smoker
- BMI greater then 30
- HTN
- Dyslipidemia: LDL greater then 130 and HDL greater then 40
- Diabetes
- inflammation
53
HDL
High density lipoproteins
"good Cholesteral'
54
HDL goal values
men less then 40 and women less then 50
55
what behaviors raise the values of HDL
weight loss, stopping smoking, increased aerobic exercise
56
LDL
low density lipoproteins
"bad cholesterol"
57
LDL values that are a high risk for MI
160-189 mg/dL
58
LDL values that are a borderline risk for MI
130-159mg/dL
59
optimal LDL values
less then 100 mg/dL
60
what is the optimal LDL values in people with heart disease, stroke, vascular disease, aneurysm, or type 2 diabetics?
less then 75mg/dL
61
PT role in CAD
- risk factor stratification
- increase exercise
- arobic: 150 minutes of moderate to vigorous intensity spread 3-5 times a week
- HIIT
- Volume better then intensity
62
angia pectoris
uncomfortable sensation in the chest and neighboring anatomy as a result of myocardial ischemia
63
Ischemic heart disease
mismatch between myocardial O2 demand and supply resulting in cardiac hypoxia and accumulation of waste products most often the result of CAD
64
Stable angia pain patterns
- predictable pattern of chest discomfort including pressure, tightness, squeezing, burning, heaviness
- does not vary with breathing
- releaved when stopping activity
65
levine sign
clenched fist over the sternum: a sign for angina
66
Stabile angina cause
fixed, obstructive plaque in one or more arteries, causing stenosis
67
common triggers for stabile angina
- high bp
- anemia
- stress
- extreme cold
- heavy meals
- physical exertion
68
1 + on anginal scale
light and barely noticeable
69
2+ on anginal scale
moderate and bothersome
70
3+ on anginal scale
severe, very uncomfortable
71
4+ on anginal scale
most severe pain ever experienced
72
PT implications for stabile angina
- know your pt anginal picture
- know pt medications
- cardiac rehab
- risk factor stratification and life style modification eduction
73
PT exercise prescription with stabile angina
- 30-60 mins of moderate intensity 5 days a week
- resistance training 2 days a week at moderate intensity
- avoid valsalva
- longer warm up and cool down
- low impact aerobic exercise
- focus more on LE
74
Varient or Prinzmetal Angina
- develops due to coronary artery spasm NOT due to O2 demand mismatch
- more common in women, smokers and cocaine users
- angina discomfort
- pain at rest or the middle of the night
- may or may not have associated CAD
75
Silent ischemia
asymptomatic episodes, detected on EKG or labs
76
unstable Angina
- progression of ischemic heart disease (most often a rupture of atherosclerotic plaque and thrombus)
- often a precursor to MI
- variable angina symptoms
- lower physical and emotional threshold
- chest pain at rest or not relieved by rest
- change in anginal pattern
77
Unstable Angina PT implications
- get physician clearance
- know meds
- lifestyle modifications
- self monitoring of symptoms
- extend warm up and cool down
- 30-40% THR STOPPING WITH ONSET OF ANGINA SYMPTOMS
- no HIIT
78
Ischemic heart diseases
stable and unstable angina
79
myocardial infarction (MI) most common cause
- atherosclerotic plaque rupture in an already blocked artery
- 02 demand > 02 supply = ischemia and tissue death
80
what are the two types of MI
1) SNTEMI: non ST elevation
2) STEMI: ST elevated
81
clinical features of myocardial infarction
- unstable angina
- severe, "crushing" substernal pain
- dyspnea
- diaphoresis cool and clammy skin
- nausea and vomiting
- pulmonary rales and crackles
- EKG abnormalities
82
how is a MI diagnosed
- presenting symptoms, EKG changes, serum biomarkers (elevated troponins)
83
what time provides the best outcomes for MI
- 90 minutes onset of symptoms to cathlab table
- MI reversible within 20 min
84
thrombolysis in myocardial infarction (TIMI) risk score
1) age > 65
2) more then 3 CAD risk factors
3) known coronary artery stenosis greater then 50% prior to angiography
4) ST segment deviations on EKG at presentation
5) 2+ angina episodes in the last 24 hours
6) use of aspirin in the last week
7) elevated troponin or CK
85
what does the thrombolysis in myocardial infarction risk score do
predicts the likelihood of death or subsequent ischemic event
86
Complications after MI
- recurrent ischemia
- arrythmias
- heart failure
- cardiogenic shock
- right ventricular infarction
- mechanical complications
- acute pericarditis due to inflammation
- thromboembolism
87
Post MI PT
- check vitals
- check labs for troponin (must be trending down) and creatine phosphokinase
- meds
- imaging
- early mobilizations monitoring EKG
- low level aerobic and low intensity strength training
- pt education
88
what is Cardiac Muscle Dysfunction?
there is a dysfunction in the heart muscles structure and function limiting its ability to pump therefore not able to meet the bodies metabolic demands.
89
what is the most common manifestation of Cardiac Muscle dysfunction?
Congestive Heart Failure
90
what are the different causes of congestive heart failure?
- HTN
- coronary artery disease
- cardiac dysrhythmias
- renal insufficiency
- cardiomyopathy
- heart valve abnormalities
- pericardial effusion
- pulmonary embolism
- pulmonary HTN
- spinal cord injury
- age-related changes
91
how could HTN lead to cardiac muscle dysfunction/heart failure?
increased arterial pressure leads to left ventricular hypertrophy which leads to overstretched fibers and a less-effective pump.
92
how could cardiomyopathy lead to cardiac muscle disfunction/heart failure?
due to the contraction and relaxation of the myocardial muscle fibers being impaired secondary to pathological process (born with it) of the heart muscle or systemic disease processes.
93
what are the 3 main types of cardiomyopathy?
1) Dilated
2) Hypertonic
3) Restrictive
94
Dilated cardiomyopathy definition
enlarged ventricle, systolic dysfunction
95
Hypertonic cardiomyopathy definition
abnormal left ventricular wall thickness, diastolic dysfunction
96
Restrictive cardiomyopathy definition
abnormal left ventricular stiffness but not thickness, diastolic dysfunction.
97
Dilated cardiomyopathy causes
- idiopathic (genetic?)
- uncontrolled HTN
- family history
- myocarditis
- toxic
- metabolic
- pregnancy
98
Hypertrophic cardiomyopathy causes
- genetic
- autosomal dominate mutations
99
restrictive cardiomyopathy causes
- infiltrates
- hemochromatosis
- metabolic diseases
- radiation therapy
- scleroderma
- fibrotic tissue in the heart
100
signs and symptoms of dilated cardiomyopathy
- same symptoms as heart failure with reduced EF
- S3 heart sound and mitral valve regurgitation
- crackles/rales and dullness to percussion
- imaging showing an enlarged heart
101
signs and symptoms of hypertrophic cardiomyopathy
- symptoms vary widely
- average age of progression is 20 (takes 20 years to show symptoms)
- Dyspnea and angina (due to thick wall having to work hard and needing more 02)
- Arrhythmia and syncope
- S4 heart sound
102
signs and symptoms of restrictive cardiomyopathy
- decreased CO
- fatigue and decreased exercise tolerance
- systemic edema leading to pulmonary congestion
- arrhythmias
103
How could heart valve dysfunction be a cause of cardiac muscle dysfunction/heart failure?
- blocked valves cause heart muscle to have to contract more forcefully
- associated with myocardial dilation and hypertrophy
104
How could pulmonary HTN be a cause of cardiac muscle dysfunction/ heart failure?
- usually only seeing in R. sided heart failure
- increases the pressure on the right side of the heart making it harder for the right side to pump volume out.
- abnormal if less then 25 mm Hg or COPD pts less then 20mm Hg
105
How could pulmonary embolism be a cause of cardiac muscle dysfunction/heart failure?
- elevated pulmonary artery pressures increase right ventricular work
106
what are some age related changes that could be the cause of cardiac muscle dysfunction/heart failure?
- altering contraction and relaxation of the cardiac muscle
- higher prevalence/risk for heart disease and HTN
107
what is HF with reduced EF (HFrEF)
heart failure with a Left Ventricular ejection fraction less then 40%
108
what is HF with mildly reduced EF (HFmrEF)
- heart failure with a Left Ventricular ejection fraction between 41-49%
- systolic dysfunction
- pump problem
- often times see lower BP
109
what is HF with preserved EF (HFpEF)
- heart failure with a left ventricular ejection fraction greater then 50%
- diastolic dysfunction
- ventricule unable to relax and fill due to ventricular wall stiffness
- increased HR and BP
110
what is HF with improved EF (HFimpEF)
heart failure with a baseline left ventricle ejection fraction of less then 40% a 10-point increase from baseline left ventricle ejection fraction, and a second measurement of left ventricular ejection fraction less then 40%
111
At risk (stage A) heart failure
pt at risk for HR, but without current or prior symptoms or signs of heart failure and without structural cardiac changes or elevated biomarkers of heart disease
112
Pre-HF (stage B)
patients without current signs or symptoms of heart failure but have one of the following; structural heart disease, abnormal cardiac function, elevated natriuretic peptide or troponin levels
113
HF (stage C)
pts with current or prior symptoms and/ or signs of HF caused by structural and/or functional cardiac abnormality
114
Advanced HF (stage D)
severe symptoms and/or signs of HF at rest, recurrent hospitalizations despite GDMT, requiring advanced therapies, transportation, medical circulatory support or palliative care.
115
what are the 3 categories that you can group heart failure etiologies into?
1) impair in cardiac contractility
2) increase afterload
3) impair ventricular relaxation and filling
116
pathology of right ventricular heart failure
reduction in right ventricular cardiac output ability results in venous congestion. will systemic issues
117
pathology of left ventricular heart failure
reduces CO leads to an accomulation of fluid in the left atrium with pulmonary and peripheral congestion
118
pathology of biventricular heart failure
left ventricles over load leading to pulmonary issues and right ventricle overloads leading to systemic issues.
119
signs and symptoms of left sided heart failure
- dyspnea
- cardiac asthma
- pulmonary edema
- hemoptysis
- ex intolerance
- fatigue
- decreased physical and mental performance
- PND
- Orthopnea
- moist rales
- wheezing
- abnormla sputum cytology
120
signs and symptoms of right sided heart failure
- peripheral edema
- LE edema
- increased central venous pressure
121
findings in left-sided and right-sided heart failure
- emboli
- tachypnea
- tachycardia
- emboli
- pleural effusion
- cachexia
122
NYHA class 1 identification of HF
no limitation or symptoms with physical activity
123
NYHA class 2 identification of HF
comfortable at rest but slight limitation and symptoms of SOB, fatigue, palpation, and dyspnea with physical activity
124
NYHA class 3 identification of HF
limitation in physical activity with less than ordinary physical activity causing symptoms to SOB, fatigue, palpation, and dyspnea. No symptoms at rest.
125
NYHA class 4 identification of HF
unable to carry on any physical activity without discomfort and symptoms of HF at rest. Pt cannot do any ADLs without an increase in symptoms.
126
NYHA class A identification of HF
no evidence of cardiovascular disease. no symptoms and no limitation to physical activity
127
NYHA class B identification of HF
evidence of minimal cardiovascular disease. mild symptoms and slight limitation during ordinary activity. No symptoms at rest
128
NYHA class C identification of HF
evidence of moderately severe cardiovascular disease. limitation and symptoms in less- then ordinary activity. Comfortable only at rest
129
NYHA class D identification of HF
evidence of severe cardiovascular disease. severe activity limitations and experiences symptoms even at rest.
130
ACC/AHA stage A classification of HF
pt at risk for HF but have yet to develop structural heart changes
131
ACC/AHA stage B classification of HF
pt with structural heart disease but has yet to develop any symptoms.
132
ACC/AHA stage C classification of HF
pt who have developed HF
133
ACC/AHA stage D classification of HF
pt with refractory HF requiring advanced intervention
134
what is the main difference between NYHA and ACC/AHA scales
NYHA can move forward and backward, ACC/AHA only has forward progression.
135
compensated heart failure
pt with dx HF but not exhibiting signs or pulmonary or peripheral congestion.
NYHA I-III
ACC/AHA stages A-C
136
Acute Uncompensated Heart Failure (ACHF)
the presence of new or worsening signs/symptoms of dyspnea, fatigue, or edema that lead to hospitalization or unscheduled medical care
137
what are some signs of increased congestion
- edema
- dyspnea
- weight gain
- chest pain
- exercise intolerance
138
how is the renal system affected by HF
- decreased CO results in fluid and sodium being retained
- causes extra work loads on the kidneys
- kidneys poorly perfuses with 02 blood
139
how is the pulmonary system affected by HF
- increased fluid in the lungs impairs gas exchange
- increased pulmonary capillary wedge pressure damaging them resulting in global respiratory impairment
140
how is hepatic function affected by HF
- fluid overload congests the hepatic vein
- poor perfusion to the hepatic tissue can lead to cirrhosis of the liver.
141
how is the MSK system affected by HF
- fluid overload increases the weight of the limbs
- poor perfusion
- type 1 and 2 atrophy
- poor exercise tolerance
142
how is the pancreatic function affected by HF
- reduced blood flow to the pancreas
- impairs insulin secreation
- reduces energy metabolism from glucose makes the heart work harder
143
medical management/ therapy goals for stage A HF
- help pt manage risk factors and make lifestyle changes
- prescribe ACEI or ARB medications
144
medical management/ therapy goals for stage B HF
- help pt manage risk factors and make lifestyle changes
- ACEI or ARB medications
- Beta-blockers
145
medical management / therapy goals for stage C HF
- help pt manage risk factors and make lifestyle changes
- dietary salt restrictions
- medications: Diuretics for fluid retention, ACEI, beta-blockers, aldosterone antagonist, Digitals, hydralazine/nitrates
- potential for device implant/ surgical intervention
146
medical management/ therapy goals for stage D HF
- same measures as in A-C
- addition considerations in: end of life care/hospice, transplant, chronic inotropes, permanent mechanical support, experimental surgery or drugs.
147
what are some things to look for in a PT eval of someone with HF
- vitals and imaging (know ventricular function and EF)
- breathing rate and rhythm
- orthopnea (unable to lie flat)
- heart and lung sounds (S3 and Crackles)
- peripheral edema and ascites
- assess for exercise tolerate and functional capacity
- assess cognition
- quality of life measurements
- nutritional status
148
Green zone HF signs and symptoms
no symptoms
149
PT recommendations for green zone HF
continue activity and therapy as tolerated
150
yellow zone HF signs and symptoms
- weight gain or 2-3 lbs in 24 hrs.
- increased cough
- peripheral edema
- increased SOB c activity
- orthopnea: increase in the number of amount of pillows needed
151
PT recommendations for yellow zone HF
symptoms may indicate an adjustment in medications and therefore warrants communications c MD
152
Red zone HF signs and symptoms
- SOB at rest
- unrelieved chest pain
- wheezing or chest tightness at rest
- paroxysmal nocturnal dyspnea: has to sit in chair to sleep
- weight gain or loss of more then 5 lbs in 3 days
- confusion
153
PT recommendations for red zone HF
immediate visit to the ER or physician office
154
Cochrane review on HR for rehabilitation
- exercise has no effect on mortality
- exercise reduces the amount of hospitalization and improve quality of life
- prescription: 40-80% RPE 6-20, frequency 1-3 x/week (overall just get patients to MOVE!)
155
benefits of exercise for HF
- improve exercise tolerance
- improved coronary artery flow and protection against ischemia
- improved quality of life
- is safe
156
Cochrane Review rehabilitation recommendations for HF pt
- interval training at low to moderate intensities (3-5 on modified RPE)
- prolonged warm up and cool down
- resistive exercises with light weights (avoid valsalva)
157
ACSM guidelines for HF
- light to moderate exercise (RPE 3-6)
- 150 minutes per week
- aerobic > resistance
- light intensity resistance
- prolonged warm up and cool down
158
what is lifes simple 7
- 7 modifiable risk factors changeable through behavior modification
1) physical activity
2) cholesterol
3) diet
4) BP
5) BMI
6) blood glucose
7) smoking status
159
what are the most important aspects of the simple 7
glucose, smoking, BMI, activity level, and BP
160
what lifestyle/ life simple 7 score led to a 47% risk reduction in HF
(8-14) intermediate life style
161
moderating EKG and BP reading for PT
NYHA class 1-2: monitor until pt can self-manage
NYHA class 2-3: monitor for 12 sessions
162
what is the recommendations for pt with implantable devices?
THR 20 beats lower then ICD threshold
163
what is the primary indication for a CABG
cardiovascular disease and reduce cardiac-related mortality. Goal to reperfuse the coronary arteries
164
what are the 3 ways in which a CABG is performed
- Emergently: after an event
- Urgently: presenting with angina symptoms
- Electively: blockage found on stress test but not current symptoms
165
what are some class 1 indications for a CABG
- 50% of left coronary stenosis
- 70% stenosis of the LAD and circumflex
- x3 vessels disease in asymptomatic pts
- 3x vessel disease with LAD stensosis with poor LV function
-1x, 2x vessel disease and a large area of viable myocardium in a high risk area
- 70% proximal LAD stenosis and an EF below 50%
166
differences between CABG an PTCA
CABG $$, CABG has lower risk for CA or MI, CABG has a higher morbidity rate and longer recovery
167
what are the three approches for a CABG
1) sternotomy : on or off pump
2) anterior thoracotomy : to LAD off pump
3) lateral thoracotomy: to small vessels off pump
167
what are muscles that can be impacted my a CABG
- traps
- lat
- teres major
- serratus anterior
- Rhomboid major
168
CABG on pump
connected to a heart machine. Heart stops pumping
168
advantages of a CABG on pump
- gives the surgeon more time for complicated cases
- more complete vascularizations
169
disadvantages of CABG on pump
- "pump" head or post operative cognitive decline
170
CABG off pump
the heart is not connected to a heart mechine and is continuing to pump on its own
171
disadvantages of CABG off pump
- requires a specially trained cardio surgeon
- formation of clots
- kidney issues due to lack of perfusion
- hypoperfusion
- higher risk of incomplete revascularization
172
advantages of CABG off pump
- no need to stop the heart so no POCD
- shorter hospital stays
173
what are some of the most common harvest sites for CABG
1) saphenous vein
2) left internal thoracic mammary artery
3) radial artery
4) right internal thoracic mammary artery
5) short staph
6) cephalic vein or UE vein
174
what are some of the pulmonary complications of post thoracic surgery
- atelectasis
- pneumothorax
- pulmonary embolism
- pneumonia or COVID
- respiratory failure
- endotracheal tube complications
- fluid overloads
175
what is a stenotic valve
a stiff valve due to atherosclerotic plaque build up and increased after load
176
what is a incompetent or "leaky" valve
allows for back flow or regurgitation
177
what is the most common type of valve issues
AV- stynosis
mitral - regurgitation
178
what are the types of valve replacements/repairs
- Annuloplasty
- Mechanical
- biotissue
- transcatheter aortic valve replacement
- transcatheter mitral valve replacement
179
Annuloplasty valve repair
replaces the ring of the valve but the leaflets are intact
180
mechanical valve replacement
- ball or disc mechanism
- usually indicated on younger pts
- anticoagulants for life
181
biotissue valve replacement
- tuman, bovine or porcine
- lifetime anticoagulation not needed
- older pts
182
what are some medications for post operative CABG or valve replacement
- anti-platelet : prevent clogging
- beta blockers : reduce demand on heart
- nitrates : vasodilation
- ACE inhibitors : decrease BP
- lipid lowering therapy : halt progression of atherosclerosis
183
sternal precautions
- no lifting, pulling or pushing more then 10 lbs
- no use of UE for a sit to stand and keep shoulders neutral
- counter pressure with valsalva
- no driving 2-4 weeks
- no horizontal abduction of scapular retraction
- no lifting higher then 90
184
what are the populations that have an increase risk in having a sternal infection
1) women
2) diabetes
3) obesity
4) bilateral mammary artery harvesting
5) re operation procedures
6) increased blood product requirement
185
a 0 on the sternal instability scale
clinically normal sternum - no detectable motion
186
a 1 of the sternal instability scale
minimally separated sternum. slight increase in motion when special testing
187
a 2 on the sternal instability scale
partially separated sternum - moderate increase in movement at special testing
188
a 3 on the sternal instability scale
completely separated sternum- marked increase in motion when special testing
189
what are ACSM guidelines for movement with sternal precautions
- 5-8 weeks: lifting should be limited to 5-8 lbs
- ROM exercises and lifting 2-3 lbs
- pts adversed to limit ROM within the onset of feelings of pulling on the incision or mild pain
190
Post operative recommendations after CABG
- avoid stretching both arms backwards at the same time(10 days)
- keep elbows close to the body (8weeks)
- move within a pain free range
- use leg rolling when getting out of bed
- self hug when coughing
- wear supportive bra with big breasted women
191
PT considerations for post op CABG
- monitor vitals
- monitor cognition
- signs of PICS
- lab values for anti-coagulation and infection
- lines and tubes
- infection control and healing promotion
- deep breathing, coughing and pulmonary hygiene
- functional mobility
- discharge planning
192
what is an abdominal aortic aneurysm
dilation of the abdominal aorta 50% larger than normal due to a weekend vessel wall
193
risk factors for AAA abdominal aortic aneurysm
- smoking
- male
- age
- Caucasian
- atherosclerosis
- family history
- other aerial aneurysms
- connective tissue disorders
- prior hx of aortic dissection
- prior hx of aortic surgery or instrumentation
194
a ruptured AAA
high mortality rate. more common in women
195
pain location of someone with AAA
abdominal, back, flank, pelvis, groin, or thigh
may present with general malaise
196
AAA treatment
1) abdominal aortic aneurysmectomy
2) endovascular repair
197
reasons for getting a heart transplant
- end stage heart disease
- NYHA class 3 and 4 or AHA stage D uncompensated
- poor quality of life
198
absolute contraindications for heart transplant
- organ or blood malignancy in the past 5 years
- substance abuse within the last 6m0
- HIV
- SLE, Sarcoidosis, Amyloidosis, with multisystem involvement still active
- irreversible hepatic or renal dysfunction
- COPD
- pulmonary HTN
- Cerebrovascular disease
- Hep B or C infection
199
relative heart transplant contraindications
- over 70
- active infection
- active peptic ulcer
- severe DM with end organ damage or poor glycemic control
- severe PVD limiting rehab and revascularization not possible
- AAA
- BMI over 35
- HTN
- dementia or poor social support
200
what are the surgical techniques for heart replacement
1) heterotypic heart transplantation - piggyback
2) total transplantation
3) biatrial technique
4) orthotopic/biatrial
201
heterotypic heart transplantation - piggyback
native heart is not removed
donor heart is connected to the native heart via the atria
202
biatrial technique
biatrial anastomoses whereby donor and recipient atrial cuffs are sewn together
203
orthotopic/biatrial
leaves the recipient SA node intact and functional while donor heart SA is denervated
- 2 separate P waves will be seen
204
PT considerations for a heart transplant pt
- infection control
- aerobic endurance
- vitals - ex BP
- denervated heart: extended warm up and cool down, use RPE, SV lower then normal
205
heart transplant rejection signs and symptoms
- low grade fever
- myalgia and fatigue
- Hypotension with activity by hypertension at rest
- decreased exercise tolerance and dyspnea
- arrhythmias
- weight gain
- decreased fluid output
206
PT dosing considerations post heart transplant
- aerobic power at q year 40-50% of age matched norms
- peak ex CO 30-40% lower then age matched controls
- innunosuppressant drugs have effect on skeletal muscle
