Cardiovascular system and MET levels Flashcards
Blood flow
RA to RV –> lungs for oxygenation –> LA receives oxygenated blood from lungs –> LV –> pumps blood to the body via aorta
SA node
pacemaker of the heart
systole (contraction) diastole (relaxation)
controls blood flow and normal perfusion
SA node dysfunction: irregular heart rhythm, atrial fibrillation, and increases risk of stroke
arteries
transport oxygenated blood from areas of high pressure to low pressure in body tissues
capillaries
blood vessels that connect arteries and veins
exchange nutrients and fluid between blood and tissues
veins
transport dark, unoxygenated blood from tissues back to the heart
hyperkalemia
increase in potassium usually greater than 5.0 mEq/L to 5.5 mEq/L
produces EKG changes
may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis
hypokalemia
decrease in potassium (less than 2.5 mmol/L)
EKG changes, arrhythmias, ventricular fibrillation
hypercalcemia
increase in calcium
more than 12 mg/d
increases HR
hypocalcemia
decrease in calcium
depresses heart action
less than 8.8 mg/dL
most commonly include paresthesia, muscle spasms, cramps, tetany, circumoral numbness, and seizures.
CAD: Atherosclerosis
plaques/lesions on arteries
thickening of blood vessel wall
risk factors: age, fam history, smoking, high BP, high cholesterol, diabetes, obesity, sedentary
symptoms of CAD
angina (chest pain) - pressure/ache near left arm and chest
can be stable or unstable
myocardial infarction
prolonged ischemia, injury, and death of an area of the myocardium caused by occlusion of 1 or more coronary arteries, leads to necrosis of heart tissue
*pain may be misinterpreted as indigestion
chest pain, dyspnea, nausea (women are more likely to have symptoms mistaken for something else like flu or acid reflux)
chronic heart failure (CHF)
- heart is unable to maintain circulation
- causes: CAD, hypertension, congenital heart disease
- left or right sided
classification of heart failure
based on functional capacity
Class I - no limitation
Class II - slight limitation with activity, comfort at rest
Class III - moderate limitation
Class IV - inability to do physical activity
classes of objective assessment of CVD
Class A - no evidence of cardiovascular disease, no symptoms
Class B - objective evidence of minimal disease, mild symptoms
Class C - moderate - severe disease, marked limitations
Class D - severe disease, symptoms even at rest
diagnostic procedures
chest x ray, ECG, holter monitor (ECG over 24 hrs), echocardiogram (ultrasound to see sizes of vessels), stress test, catherization, pulmonary function test
interventions for CFH
- dietary and lifestyle (low salt and cholesterol)
- medications to manage specific aspects of cardiac function
side effects for OT to be aware of - anticoagulants (blood thinners)
brushing or cuts (may take longer to stop bleeding)
side effects for OT to be aware of - beta blockers (reduce HR)
may not have the expected inc in HR/BP during activity
adjust parameters and utilize the rate of perceived exertion (RPE) scales
surgical interventions
angioplasty (get rid of obstruction), stents, revascularization, transplant, ventricular devices, pace makers
peripheral vascular disease (PVD) - arterial
arterial: occlusive (PAD), inflammatory (Buerger’s)
raynauds (spasm of small arteries, vasoconstriction)
s/s PVD
pain (usually LEs)
skin changes
ulcers
venous diseases PVD
- varicose veins
- DVTs: can lead to CVA, early mobility is important, leg pumps
lymphedema PVD
chronic and progressive disorder
accumulation of fluid from obstructed lymphatics
Stage 0: no visible changes in limbs, slight tingling
Stage 1: reversible, limb is soft and pitting
Stage 2: irreversible, risk for infection
Stage 3: (elephantiasis) extreme, skin changes
MET levels
metabolic equivalent levels
determine the energy expenditure required for activity performance
<1.5 METs
very light activities
kissing, hugging, folding a towel while seated, knitting, reading
1.5 - <3 METs
light activities
grooming while seated, making the bed 1.5
ADLs standing
stretching
putting away groceries
sexual activity 2.8
3 - <6 METs
moderate activities
sweeping, vacuuming, changing linens 3.3
meal prep and cooking
moderate yard work
mowing a lawn 5.5
6 to <10 METs
vigorous activities
scrubbing a bathroom 6.5
carrying boxes/furniture up stairs 9.0
10+ METs
very vigorous activities
cross country skiing
running
swimming
rehab for lymphedema
measurement of lymphedema swelling (circumferential girth measurement - volumeter)
short stretch compression bandages (worn 24 hrs/day)
manual lamp drainage - massage and passive range of motion to assist with lymph flow
elevation to drain
low-mod exercise, relaxation, deep breathing
phase 2: self management and daily home program
o Edema not impacted my humidity or time of day, it is what it is
o Volumeter procedure: place arm in and don’t move it because that would impact results
Buerger’s disease
also known as thromboangiitis obliterans
affects blood vessels in the body, most commonly in the arms and legs. Blood vessels swell, which can prevent blood flow, causing clots to form. This can lead to pain, tissue damage, and even gangrene (the death or decay of body tissues)
grading scale for peripheral pulses
0 - absent pulse
1+ diminished pulse
2+ normal pulse, easily palpable
3+ full pulse, increased strength
4+ bounding pulse
grading scale for edema
1+ mild, small indentation, less than 1/4in pitting
2+ moderate, easily identified, returns to normal within 15 sec, 1/2in pitting
3+ severe, 15-20 sec rebound, 1 in pitting
4+ very severe, over 30 sec, 1+in pitting
contraindications for lymphedema rehab
no strenuous activities, jogging, ballistic movements, or rotational motions because they will exacerbate lymphedema
pressures >45mmHg are contraindicated (compression pumps - limited benefits)
