Chapter 9.2

Question 1

Angina pectoris is

Answer 1

pain that occurs in the chest region during ischemic heart disease

Question 2

Describe the clinical presentation of angina pectoris

Answer 2

Attacks of angina pectoris begin suddenly and are often described as a sensation of intense compression and tightness in the retrosternal region, with pain sometimes radiating to the jaw or left arm.

Question 3

State the basic problem in angina pectoris that leads to myocardial ischemia

Answer 3

the basic problem in angina pectoris is that the supply of oxygen to the heart is insufficient to meet myocardial demands at a given point in time, which results in an imbalance between myocardial oxygen supply and demand.

Question 4

State the reason nitroglycerin is usually not given by the oral route

Answer 4

If you swallow nitroglycerin, it will go to the liver first and little of that drug doesn’t survive the liver.

Question 5

State the mechanism of action of nitrates in the management of angina pectoris, that is, how they impact myocardial oxygen supply and demand.

Answer 5

dilate peripheral vasculature and produce NO which causes vasodilation.

Question 6

State the onset and duration of action for the sublingual and transdermal patch dosage forms of nitroglycerin.

Answer 6

30-60 min for sublingual and 8-24 hours for transdermal patch

Question 7

State the common management strategy used with nitrate patches to avoid nitrate tolerance.

Answer 7

the nitrate patches are worn when the patients have the most angina attacks

Question 8

List the common adverse effects of nitrates.

Answer 8

KNOW HEADACHES, dizziness, orthostatic hypotension

Question 9

State the mechanism of action of beta blockers in the management of angina pectoris, that is, how they impact myocardial oxygen supply and demand

Answer 9

By antagonizing beta-1 receptors on the myocardium, beta blockers tend to decrease heart rate and the force of myocardial contractions

Question 10

State the mechanism of action of calcium channel blockers in the management of angina pectoris, that is, how they impact myocardial oxygen supply and demand

Answer 10

By blocking calcium entry into coronary artery smooth muscle, these drugs mediate coronary vasodilation, with a subsequent increase in the supply of oxygen to the myocardium

Question 11

List the non-pharmacological treatments of angina pectoris

Answer 11

Lifestyle changes, including exercise, weight control, smoking cessation, and stress management, may also be helpful in decreasing or even eliminating the need for antianginal drugs.

Question 12

List the special concerns for physical therapists working with patients treated for angina pectoris

Answer 12

For the patient with stable angina taking nitroglycerin at the onset of an anginal episode, therapists must make sure the drug is always nearby during therapy sessions.

Question 13

Define arrhythmia

Answer 13

An arrhythmia can be broadly defined as any significant deviation from normal cardiac rhythm

Question 14

List some of the consequences of untreated arrhythmias.

Answer 14

If untreated, disturbances in normal cardiac rhythm result in impaired cardiac pumping ability, and certain arrhythmias are associated with cerebrovascular accidents, cardiac failure, and other sequelae that can be fatal

Question 15

Define SA node and AV node

Answer 15

The action potential originates in the SA node and is conducted throughout both atria via the atrial muscle cells. From the AV node, the action potential is passed on to the ventricles via a specialized conducting system known as the bundle of His. The SA and AV nodes are pacemakers for the heart.

Question 16

List the four drug classes of antiarrhythmic drugs.

Answer 16

sodium channel blockers, beta blockers, drugs that prolong repolarization and calcium channel blockers

Question 17

Place the following drugs into their antiarrhythmic drug class: lidocaine, propranolol, amiodarone, and diltiazem.

Answer 17

Lidocaine is a sodium channel blocker (class IB)
Propranolol: is a beta blocker (class II)
Amiodarone: is a drug that prolongs repolarization (class III)
Diltiazem: is a calcium channel blocker (class IV)

Question 18

List the common adverse effects of the following antiarrhythmic drugs: lidocaine and amiodarone

Answer 18

lidocaine side effects: increase rhythm disturbances (proarrhythmic effects)
Amiodarone side effects: can increase bronchoconstriction in patients with asthma and chronic obstructive pulmonary disease.

Question 19

State the primary concern with the use of antiarrhythmic drug therapy.

Answer 19

proarrhythmic effect

Question 20

List the common non-pharmacologic treatment of arrhythmias

Answer 20

development of better implantable devices (pacemakers, cardioverter defibrillators) and surgical interventions (electrode catheter ablation)

Question 21

List the special concerns for physical therapists working with patients treated for cardiac arrhythmias

Answer 21

Hypotension may occur with some agents, dizziness and orthostatic hypotension

Question 22

Define congestive heart failure.

Answer 22

Congestive heart failure is a chronic condition in which the heart is unable to pump a sufficient quantity of blood to meet the needs of peripheral tissues

Question 23

List the primary symptoms of congestive heart failure

Answer 23

The primary symptoms associated with congestive heart failure are peripheral edema and a decreased tolerance for physical activity.

Question 24

State the rationale for using positive inotropes in the management of systolic heart failure

Answer 24

A positive inotropes drug can increase cardiac output and reduce symptoms

Question 25

List the special concerns for physical therapists working with patients treated for congestive heart failure

Answer 25

Therapists should remain alert for signs of acute congestive heart failure such as increased cough, difficulty in breathing (dyspnea), abnormal respiratory sounds (rales), and frothy sputum.
Therapists may help detect serious metabolic and electrolyte imbalances that result from problems with diuretic drugs. Finally, use of vasodilators often causes hypotension and postural hypotension. Therapists must use caution when patients suddenly sit up or stand up