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Pathology for the Physical Therapist Assistant > Cardiovascular Pathologies > Flashcards

Cardiovascular Pathologies Flashcards

1
Q

Heart Valves

A
  • Left heart (from Pulmonary Veins to Aortic Artery)
    Mitral valve and Aortic Semilunar valve
  • Right heart (from Vena Cava to Pulmonary Artery)
    Tricuspid valve and Pulmonary Semilunar valve
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2
Q

ECG curves

A
  • P wave: atrial contraction (depolarization).
  • Atrial Kick: Atria push blood into ventricles.
  • P-R interval: from start of P wave to start of QRS complex.
  • QRS complex: ventricular contraction (depolarization).
  • ST segment: ventricles prepare to repolarize.
  • T wave: repolarization of the ventricles.
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3
Q

Normal Heart sounds

A
  • S1: atrioventricular valve closes.
  • S2: closure of semilunar valves.
  • S3: normal in children and young adults but abnormal in adults over 40.
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4
Q

Abnormal Heart sounds

A
  • S3: faint sound
  • S4: dull sound; heard before S1; ventricles filling after atrial contraction
  • Murmurs:
  • Systolic murmurs
  • Diastolic murmurs
  • Continuous murmurs
  • Pericardial friction rub: squeaky sound
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5
Q

Cardiac Output (CO)

A

Amount of blood pumped out by a ventricle in a 1’ period.

Depends on the HR and the Stroke Volume (amount pumped from one ventricle during one contraction).

Normal CO is ~5 l/min.

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6
Q

Blood Pressure (BP)

A

Pressure exerted against the walls of the peripheral or systemic arteries.

Systolic = contraction of the L ventricle (~120)

Diastolic = relaxation of the ventricles (~80)

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7
Q

Rate-Pressure Product (RPP)

A

Heart rate multiplied by the systolic blood pressure.

RPP = HR x Systolic BP

Gives an indication of the aerobic exercise condition of the patient. Is taken into consideration when developing an exercise protocol. The lower the better.

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8
Q

Ejection Fraction (EF)

A

Ratio between the Stroke Volume (SV) and the preload.

Measures the ability of the heart to contract.

Normal = 55%-75%

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9
Q

Stroke Volume (SV)

A

Amount of blood pumped from the heart in one contraction. Normally refers only to the L ventricle. To measure it, they use an ECG subtracting the amount of blood that remains in the ventricle after the beat (End-Systolic Volume, ESV) from the total amount of blood in the ventricle before the beat (End-Diastolic Volume, EDV).

Normal = ±70ml per heartbeat

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10
Q

Heart Diseases

A
  • Congestive Heart Failure (CHF)
  • Coronary Artery Disease (CAD)
  • Dyspnea On Exertion (DOE)
  • Premature Ventricular Contraction (PVC)
  • Myocardial Infarction (MI)
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11
Q

Angina Pectoris (definition)

A

Acute ischemic chest pain. Caused by ischemia to myocardium and related to arteriosclerotic heart disease.

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12
Q

Aortic Atherosclerosis (definition)

A

Plaque builds up in the aorta. “Silent” disease.

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13
Q

Atherosclerosis / Arteriosclerosis (definition)

A

Atherosclerosis = hardening of the arteries.

Arteriosclerosis = hardening of the walls of the smaller arterial vessels (arterioles).

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14
Q

Cardiac Arrest (definition)

A

Sudden stopping of the heart. Can be caused by many different factors.

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15
Q

Cardiac Shock / Cardiac Failure / Heart Failure (definition)

A

All terms used for same condition.

This condition occurs when some cardiac muscle is weak and some is not working at all. The heart is unable to pump blood to the extremities, the peripheral tissue becomes ischemic, and there is cardiac failure.

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16
Q

Cardiomyopathy (definition)

A

Is not a disease but a group of them. The heart muscle or myocardium is damaged, it may hypertrophy or dilate.

17
Q

Congestive Heart Failure (CHF) (definition)

A

The heart is no longer able to pump enough blood to meet the body’s needs. Two types of CHF: right and left ventricular failure.

Left = pulmonary edema.

Right = peripheral edema evident in the lower legs.

18
Q

Endocarditis (definition)

A

Bacterial infection of the lining of the heart that can lead to cardiac failure. Mitral valve is most commonly affected.

19
Q

Hypertension

A

If systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg.

Pre-hypertension = Systolic 120-139 / Diastolic 80-89

20
Q

Ischemic Heart Disease (definition)

A

Group of diseases including:

  • Angina Pectoris
  • Acute MI (Myocardial Infarction)
  • Sudden cardiac arrest and death
  • Chronic ischemic heart disease accompanied by CHF

In all these conditions the heart is deprived of blood supply because of damage or inefficiency of the coronary circulation that supplies blood to the muscle of the heart.

21
Q

Ischemic Heart Disease (PT treatment)

A

Progressive cardiac rehab, starting with treatment during initial hospitalization and progressing through the rehab process.

22
Q

Myocarditis

A

Inflammation of the myocardium (muscle of the heart). Rare condition. No PT indicated.

23
Q

Pericarditis

A

Inflammation of the pericardium. Often occurs in association with myocarditis. No PT indicated.

24
Q

Rheumatic Heart Disease and Rheumatic Fever

A

Only a problem in developing countries. No PT indicated.

25
Q

Valve Diseases (3 major types)

A
  • Stenosis: narrowing, inability to fully open.
  • Insufficiency: or regurgitation, caused by the valve failing to close fully.
  • Prolapse: in the mitral valve is fairly common and involves enlargement of the cusps of the valve that project into the LA.
26
Q

Valve Diseases (PT intervention)

A

Mild valve problems do not usually prevent a person from participating in exercise.

If patients start coughing after vigorous exercise, it could mean they have pulmonary congestion resulting from valve disease. Exercise should be stopped.

If patients have weakness, fatigue, and become pale, exercise should be stopped.

27
Q

Cerebrovascular Disease (CVD) (definition)

A

Atherosclerosis in the arteries of the brain or the carotid artery that leads to the brain.

Major cause for stroke or cerebrovascular accident (CVA).

28
Q

Peripheral Vascular Disease (PVD) (definition)

A

Atherosclerosis of the peripheral arteries, mainly of the lower extremities.

29
Q

Major aspects of PVD for the PT

A
  1. Arterial disease results in lack of O2 → occlusion, gangrene.
  2. Intermittent claudication in the LL is a general symptom.
  3. Because of the lack of O2 in the tissue, it’s important to avoid heating. Arteries will be unable to cope with normal circulation and tissue will be damaged.
  4. Massage is CONTRAINDICATED because it places too much demand on arteries.
  5. Advice to patient should include always ways to ↓effects of arterial insufficiency (raising the head end of the bed when sleeping).
  6. Buerger-Allen exercises can be taught to encourage the development of collateral circulation.
  7. A progressive exercise routine can be taught, encouraging short bouts, increasing in time as tolerance improves. Rest must be included.
  8. Skin inspection techniques should be taught. Regular skin inspection is important for the distal LL to identify early warning signs of skin breakdown.
  9. Atherosclerosis problems are made worse by constrictive garments.
  10. Treatment of arterial ulcers in whirlpool should be done with cool (33º) or neutral (35º) water. Any debridement of necrotic tissue should be done so the area has sufficient arterial supply to allow the wound to heal.
30
Q

Raynaud’s Disease or Syndrome

A
  • Patients can’t tolerate exposure to the cold. Is a peripheral vascular disease that affects the blood vessels, but there’s a neurological component too.
  • Affects women > men, 20-49 yo
  • Don’t apply cold packs. Aquatic therapy is not possible unless water at ≥ body temp.
31
Q

Thrombophlebitis and Deep Venous Thrombosis

A
  • Inflammation and clothing of veins. Usually affects either the deep or superficial veins of the LL.
  • Symptoms include: fever, tenderness, erythema over the area of the vein, induration (hardening), and pain and tightness of the area.
32
Q

Blood disorders

A
  • Leukocytosis: ↑ in white cell count, often related to infection.
  • Leukopenia: ↓ in white cell count in the blood below normal levels. Leukocytes < 1000/µl = reduction of immune system’s ability to fight off infections.
  • Polycythemia: ↑ in red blood cells (occurs in certain types of lung disease and heart disease). Increases viscosity of blood → ↑ incidence of thrombosis and embolism.
  • Thrombocytopenia: ↓ in number of platelets.
33
Q

Lymphangitis and Lymphadenitis

A
  • Acute inflammation of the lymphatic vessels.
  • Inflammation of the lymph nodes.
  • Both caused by infection of the lymphatic system.
  • PT might detect enlarged lymph nodes within the musculature of the neck in patients with cervical problems due to this condition.
34
Q

Lymphedema (or elephantiasis)

A
  • Chronic edema resulting from an increase of lymphatic fluid.
  • Symptoms: the skin becomes thickened in the affected area.
  • 10-15% patients that undergo radical mastectomy will have it on the same side as the surgery.
  • PT intervention: is a specialized field of PT. Involves clearing the proximal areas of the lymphatic system to stimulate the lymphatic system drainage.
  • PT treatment: elevation of the limb; use of compressive; elastic garments; specific exercise programs; special systems of massage.
35
Q

PT treatment/role in Cardiac and Circulatory Conditions

A
  1. Patients in ICU or CCU are likely to be attached to cardiac monitors. When performing exercises, leads may become loose.
  2. Try to coordinate treatment time with the schedule for pain medications, and other activities. Patient should be as comfortable as possible when receiving PT.
  3. Patients with cardiac conditions tend to fatigue rapidly. A few exercises and a short walk may be all they can tolerate at the early stages of rehab. Check BP and PRE.
  4. Keep patient under close observation and monitor HR carefully before, during and after treatment.
  5. Return patients to their room after treatment and leave the room as you found it.
36
Q

Outpatient Cardiac Rehabilitation

A
  • Phase I / Acute: not outpatient.
  • Phase II / Sub-Acute: from 1-2 days of hospital discharge up to 6/52 (frequency 2-3/week). Mostly performed at PT practice or hospital.
  • Phase III / Intensive Rehabilitation: usually lasts for 6/52 with progressively more intense exercises (frequency 1-2/week). Mostly performed at home.
  • Phase IV / Ongoing Rehabilitation: lasts for up to 1y after onset of the program. Patient exercises regularly with weights, performs a walking program, and follows a heart-healthy lifestyle.

Pathology for the Physical Therapist Assistant (18 decks)

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