Chapter 3 Flashcards
Angina Pectoris
- Acute ischemic (holding back blood flow) in chest pain
- insufficient blood flow to the heart muscle from narrowing of coronary artery
Eitology of Angina Pectoris
-ischemia to the myocardium from arteriosclerotic (plaque formation)disease
Signs and Symptoms of Angina Pectoris
- sudden onset of severe and sharp pain usually in the chest, neck, shoulder or left arm
- often occurs from overexertion, emotional stress or extreme weather exposure
Medical Intervention for Angina Pectoris
- Nitroglycerin pills (vasodilators)
- Nitroglycerin patch (continuous dose) ex. Unstable angina
- CABG (Coronary Artery Bypass Graft)
- Angioplasty
Physical Therapy for Angina Pectoris
-if angina occurs during treatment, patient must be asked to rest and inform the PT or nurse
Aortic Atherosclerosis
- build up of plaque in aorta
- a “silent disease” (no symptoms)
- hardening of the wall of the aorta
Etiology of Aortic Atherosclerosis
-familial tendency
Signs and Symptoms of Aortic Atherosclerosis
- frequently asymptomatic
- HTN (hypertension)
- aneurysm commonly in the abdominal aorta
Medical Intervention for Aortic Atherosclerosis
-surgical repair of aneurysm
Physical Therapy for Aortic Atherosclerosis
-strengthening program after repair
Atherosclerosis
- hardening of the arteries
- leads to thickening of the vessels accompanied by loss of elasticity, flexibility, and contractility
What is Atrial fibrillation?
- rapid, quivering of the heart mms
- some mms fibers are contracted and some are not
- strength is weak
Cyanosis
-lack of oxygen causing bluish tint
Peripheral cyanosis
- seen in distal parts of the body (digits)
- pertaining to a heart condition
- cause bc heart is weak and it doesn’t create enough pressure to supply to distal areas of body
- corrected by using heat in distal areas to open up blood vessels
Central cyanosis
- due to respiratory conditions
- seen in lips, tongue, mucous membrane
- only way to correct is by supplying supplemental oxygen
- pulse excementer will read 90% or lower
Dyspnea on exertion
-difficulty breathing during exercises
Edema
- swelling in feet, hands & abdominal area
- bilateral, means it’s related to a heart condition
Fatigue
- lack of energy
- has to be associated with the other signs and symptoms of cardiac disease to be heart related
Heart block
- dealing with nerve conduction to the heart
- If SA node malfunctions there is a back up system of the ventricles that contracts at a slower pace 40 bpm
- it’s not sufficient to supply blood to the body
- may lead to losing conscience or heart to completely stop
Intermittent claudication
- on/off pain
- pain in calf mms that is relieved by resting
- caused by a blocking or narrowing in the popiplital artery so mms aren’t getting proper nourishment and/or oxygen
Pain
- left chest pain (angina) & left arm pain, left shoulder, neck, right side of chest, jaw
- sometimes pain between scapula
Palpitations
-irregular, pounding heartbeat
Premature ventricular contractions
- when there not suppose to contract causing an irregularity
- sometimes can lead to instant death
Reduced ejection fraction
- normal volume of blood being squeezed by heart is 55-75% ejection fraction
- anything less is reduced ejection fraction
Syncope
- fainting, dizziness
- blood not going into brain area
Orthopnea
- Difficulty breathing upon supine lying
- when they lay down, there is a increase venous return to the heart
- feels like their drowning
- they instinctively sit up
- the use of gravity reduces the return to the heart
What happens to blood in heart if it is going through atrial fibrillation?
- Sit there and coagulate
- thicken up and clot
- usually the start of someone getting a heart attack or stroke
SA node
- Pace maker of heart
- normal is 70 beats per minute
General signs and symptoms of cardiac disease.
Atrial fibrillation Cyanosis Dyspnea Edema Fatigue Heart block Intermittent claudication Pain Palpitations Premature ventricular contractions Reduced ejection fraction Syncope Ventricular fibrillation
If a person has a ejection fraction of 40% what can you say about this person’s heart? Physical therapy treatment?
- weak
- won’t be able to put them through physical therapy exertion
- provide them therapy on patient education on energy conservation techniques
Normal heart rate?
60-100 bpm
- higher than 100 tachycardia
- lower than 60 bradycardia
- average is 70
Normal SV?
70 ML
Cardiac output (CO)
HR x SV = CO
Normal cardiac output?
5 L per minute
Cardiac catheterization
- catheter gets inserted in the inguinal femoral artery or the radial artery
- it can show how severe the CAD is and whether there is valve disease, an aneurysm, myocardial infarction, or pericardial disease
Angiography
- insert dye through catheter and take picture of it
- goes to the coronary arteries
- person undergoes this if experiencing chest pain
- determines if there is a blockage in the coronary arteries and how much
Echocardiography
- noninvasive procedure
- a reading is taken of the heart and coronary blood vessels by bouncing sound waves off the heart
- it can detect the size of the heart, valve function, thickness of the walls of the heart, CAD, and ischemia of the heart muscle
Electrocardiogram
- looking for electro conductivity of heart
- ECG strip
- records the way the heart beats
ECG strips
- readings from a electrocardiogram that measures heart rhythm and rate and can indicate hypertrophy and infarction of heart muscle
- P wave- corresponds to atrial depolarization/contraction
- QRS complex- corresponds to ventricles
- T wave- corresponds to ventricular relaxation/repolarization
Flattened P wave in ECG strip?
-May mean person is in atrial fibrillation
QRS complex elevation in ECG strip?
-may mean person is having a MI(heart attack)
Holter monitoring test
- portable EKG
- use it for 24 hours
PET Scan
- test making use of nuclear imaging
- scan of the heart
Exercise Stress Test
-person goes through an exercise and specialist monitors heart rate
Chemical stress test
-someone who can’t exercise ex.pt with osteoarthritis in the knees
Levine sign?
-Person pounding chest
Stable Angina
- most common
- appears when person is exercising
Unstable Angina
-no activity and angina shows up
Circle of Willis
- arteries in the head
- supplies blood to brain
Atherosclerosis
-hardening of the arteries
Arteriosclerosis
- hardening of the walls of the arterioles in the extremities or organs
- arteries become narrowed and blood flow decreases
- the plaque build up first starts in the aorta
Atherosclerosis and Arteriolsclerosis
-both conditions lead to thickening of the vessels accompanying by loss of elasticity, flexibility and contractility
Etiology of Atherosclerosis and Arteriosclerosis
- changes in the walls of the arteries due to hypertension, diabetes, cigarette smoking, family tendency, hypothyroidism, hypercholesterolemia
- other causes may be from lack of exercise, obesity, and use of oral contraceptives
Signs and symptoms of Atherosclerosis and Arteriosclerosis
- no outward signs and symptoms
- angina
- CVA (stroke)
- HTN
- intermittent claudication, ulcers, end stage renal diseases, gangrene, DVT(deep vein thrombosis) or CVA from a thrombus(clot)
Medical intervention for Atherosclerosis and Arteriosclerosis
- anticoagulants such as ASA(acetal salicylic acid) aspirin
- anti cholesterol and antihypertensive medications
- carotid endarterectomy using saphenous vein(leg) or internal mammary artery
- bypass graft
- lifestyle change
Transient Ischemic Attack (TIA)
- precursor to a stroke
- symptoms of a stroke
- symptoms don’t last more than 24 hours
Physical therapy for Atherosclerosis and Arteriosclerosis
-none but watch for complications from clot formation
Cardiac arrest/heart attack/myocardial infraction
- sudden stopping of the heart
- the side the is usually effected is the left ventricle
- the cause of this is complete inclusion of blood supply to ventricle
Infarction
-death
Etiology of Cardiac arrest/heart attack/myocardial infraction
- myocardial infarction (MI)
- loss of blood to the heart secondary to a systemic shock
- injury causing massive loss of blood
- electric shock or drowning
What coronary artery is affected with MI?
Left anterior descending coronary artery
Signs and symptoms of Cardiac arrest/heart attack/myocardial infraction
- angina
- dyspnea
- pain in neck, crushing pain on left/right arm
- sweating, pallor, nausea, rapid pulse
- sudden onset of tachycardia or bradycardia
- may have loss of consciousness
Medical Intervention for Cardiac arrest/heart attack/myocardial infraction
- CPR as needed
- rest, oxygen supplement
- pain medications
- Thrombolytic agents, anticoagulants (blood thinner), antihypertensives, anti-cholesterol medications
- angioplasty
- CABG
- lifestyle changes
Physical therapy for Cardiac arrest/heart attack/myocardial infraction
- cardiac rehabilitation
- Phase I: inpatient (hospital)
- Phase II: outpatient (SNF, Home)
- Phase III: on their own
Congestive Heart Failure
- in the ventricles
- a condition where the heart is no longer able to pump enough blood to meet the body’s needs
- left ventricular failure
Etiology of CHF
- infarction of L ventricle - MI
- aortic stenosis (narrowing of the aorta)
- HTN
- hyperthyroidism
Etiology of R ventricular failure (cor pulmonale)
- infarction of R ventricle
- pulmonary valve stenosis
- lung disease
Signs and symptoms of CHF
- pulmonary edema bc alevoli filled with fluid, feel like they are drowning
- pleural effusion leading to dyspnea
- central cyanosis
- easily fatigued, lethargic
- dyspneic (dry, nonproductive) with a cough bc of pulmonary edema
- oliguric (reduced urine formation)
- anasarca (general body edema)
- weight gain overnight, usually more than 2lbs
Right ventricular failure (cor pulmonale)
- dependent edema on LE - swelling of the feet- bilateral - back up of blood in the right ventricle, right atrium, & vena cava causes the swelling
- hepatomegaly, splenomegaly
- distention of jugular vein bc of increased pressure of backed up blood from vena cave going into jugular vein
- ascites - in alcoholics - retention of fluid in liver
Medical intervention for Right ventricular failure (cor pulmonale)
- beta blockers and digitalis medicines to increase the pumping ability of the heart
- ACE inhibitors and vasodilators open blood vessels reducing resistance to blood flow - controls blood pressure
- diuretics to remove excess water and sodium
- heart transplant in severe cases
Physical therapy for Right ventricular failure (cor pulmonale)
- to increase endurance and strength
- safety with gait
- lifestyle change
- cardiac rehab
Hypertension and hypertension heart disease
-normal blood pressure exceeds a certain amount
Normal systolic and diastolic blood pressure
-systolic:
Prehypertension systolic and diastolic blood pressure
- systolic: 120-139
- diastolic: 80-89
Stage 1 hypertension systolic and diastolic blood pressure
- systolic: 140-159
- diastolic: 90-99
Stage 2 hypertension systolic and diastolic blood pressure
- systolic: 160 and up
- diastolic: 100 and up
Etiology of hypertension and hypertensive heart disease
- primary or essential hypertension is idiopathic
- secondary hypertension can be due to kidney disease, adrenal tumors, adrenal tumors, psychological factors, pain killers, oral contraceptives
- labile HTN is a rare form of essential HTN not responsive to any intervention
Signs and symptoms of hypertension and hypertensive heart disease
- systolic BP is 140 or higher or diastolic BP is 90 or higher
- prehypertension is systolic BP between 120 and 139 or diastolic BP between 80 and 89
- no physical signs
Medical intervention for hypertension and hypertensive heart disease
- anti hypertensives
- diuretics- bc of the retention of fluid which causes increase pressure
- diet and lifestyle modification
Complications of hypertension
- cardiomegaly - bc of increased resistance to blood vessels so the heart has to pump against it
- cor pulmonale (R ventricular hypertrophy)
- CHF
- atherosclerosis
- hypertensive encephalopathy - increased blood pressure brain disease
- blindness from retinal affectation - arteries to the eyes are sensitive so if blood pressure is high it can affects it
Physical therapy for hypertension
- BP monitoring
Coronary artery bypass graft
- a procedure that provide a bypass for the blood and restore arterial blood to the myocardium
- uses saphenous vein or internal mammary artery
- re establish circulation
Heart transplant
- maybe orthotopic(replace heart that’s bad) or heterotopic(transplant heart connected to your bad heart)
- candidates must have end-stage CAD(coronary artery disease)
- factors considered are survival rate, quality of life, relief of symptoms
Open heart surgery
- used for any procedure in which the heart muscle must be open to provide access for surgical intervention
- most commonly done in mitral valve replacement
- incision is known as median sternotomy
Pacemaker insertion
- cardiac pacemaker taking over function of the SA node when it is not functioning normally
- pacemakers may be unipolar or bipolar
- on-demand pacemakers vs fixed rate pacemakers
- contraindicated in use of ES bc it will alter the frequency of the pacemaker
Percutaneous transluminal coronary artery angioplasty
- performed on vessels with atherosclerosis when the artery is not completely occluded
- stent may be used
- atheromas(plaques) may be surgically removed
Peripheral vascular disease (PVD)
- used to describe atherosclerosis of the peripheral arteries mainly of the LE bc they are more distal to the heart
- commonly results from DM(diabetes), HTN, hypercholesterolemia
Etiology of Peripheral vascular disease (PVD)
- hx of trauma
- secondary to DM, HTN, hypercholesterolemia
Signs and symptoms of Peripheral vascular disease (PVD)
- reduced kidney function resulting in HTN, oliguria in affectation of arteries to the kidneys
- constipation or malabsorptions in affectation of arteries to intestines
- intermittent claudication in affectation of LEs
- ulcers on lateral leg(bc of artery problem), gangrene and necrosis
If a pt has a ulcer on the medial side of leg what problem do they have?
-venous problem
Medical intervention for Peripheral vascular disease (PVD)
- amputation in cases of gangrene
- angioplasty or bypass grafts
- statin medications - anti cholesterol medications for hypercholesterolemia
- antiplatelet medications
Physical therapy for Peripheral vascular disease (PVD)
- no direct heating - bc the blockage won’t be able to supply the increase needs
- no massage - bc you could dislodge the plaque and cause an embolus
- patient education (raise head of bed, smoking cessation, diet, discipline with medications, nightly skin inspections, no compression stockings)
Thrombophlebitis and DVT
-Inflammation and clotting within the veins
Etiology of Thrombophlebitis and DVT
Infection, trauma, surgery to area, prolonged immobilization
-surgery to area and prolonged immobilization can lead to DVT(deep venous thrombosis)
Signs and symptoms of Thrombophlebitis and DVT
- fever, tenderness, erythema(red blood cells inflammation)
- induration (hardening of the tissue)
- pain and tightness in the area
- (+) homan’s sign
Medical intervention for Thrombophlebitis and DVT
- bed rest
- anticoagulants
- compression garments -gives pressure to assist blood back
- compression pumps
Physical therapy for Thrombophlebitis and DVT
-early mobilization for prevention
Lymphedema
-a chronic edema resulting from an increase in lymphatic fluid
Etiology of Lymphedema
- damage to the lymph nodes from neoplasms, cellulitis, trauma, post surgical complications, extensive burns, post radiation treatment
- parasites filariasis in tropical countries
Signs and symptoms of Lymphedema
-swelling of involved arm or leg
Medical intervention for Lymphedema
- lymphedema management
- skin and wound care
- will need constant treatment
Pt who has a reduced ejection fraction, what kind of physical therapy treatment do they get?
-Pt education on energy conservation techniques
Homan’s sign
- it’s a sign of DVT
- characterized by pain in the calf when the foot is passively or actively dorsiflexed
+ Homan’s sign
- is when you grab pts calf and dorsiflex the foot and they say it’s painful
- means there is a clot
