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OTA 200 - Phys Rehab Conditions > Coronary Artery Disease > Flashcards

Coronary Artery Disease Flashcards

1
Q

Cardiac Cycle

A

Complete heartbeat from the generation of the heartbeat to the beginning of the next beat (includes diastole, systole, and intervening pause). Occurs in 2 phases: Input (diastole) and output (systole). Frequency of cardiac cycle is the heart rate, expressed as beats/minute.

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2
Q

Input/Diastole Phase of Cardiac Cycle

A

Rest phase. Blood flows through atria, which contract/pushe blood into ventricles. When pressure equalizes, input valves (tricuspid and mitral/bicuspid) close. Ventricles then contract, increasing ventricular pressure. When that pressure exceeds blood vessels beyond, output valves (pulmonary and aortic) open and diastolic blood pressure (BP) is attained.

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3
Q

Output/Systole Phase of Cardiac Cycle

A

Beat phase. Ventricles continue to contract/squeeze blood under increasing pressure into pulmonary/body circulation. Systolic BP attained when pressure in emptying ventricles falls below pressure in blood vessels beyond, causing output valves to close.

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4
Q

Heart Rate Fluxuations

A

Increased HR with exercise/anxiety, and decreased HR with relaxation/deep breathing. The heart (namely, the sinoatrial node that controls the heart rate) responds to vagal and sympathetic nervous system input.

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5
Q

Ischemic Heart Disease

A

When part of the heart is temporarily deprived of sufficient oxygen to meet its demand. Most common cause is coronary artery disease (CAD), also the most common form of heart disease in the US. Develops over many years without symptoms. Internal wall of artery can become injured/damaged, and more prone to plaque or platelet build-up. Artery narrows, allowing smaller vol to pass. Process is called artherosclerosis. Person may be symptom-free, but have angina (chest pain) on exertion. Angina can be remedied with rest or meds, but it is a warning sign! Chest pain that cannot be relieved can indicate myocardial infarction (MI)/heart attack, which can cause part of the heart to die. Cardiac arrest occurs when a substantial section is damaged.

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6
Q

Blood Pressure (BP) Readings

A

BP = pressure that blood exerts against walls of any vessel as heart beats. Highest in left ventricle during systole. First/top number is systolic BP, or how much pressure the blood exerts on artery walls when heart beats. Second/bottom number is diastolic BP, or how much pressure blood exerts on artery walls when heart rests between beats.

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7
Q

Myocardial Infarction (MI)

A

Heart attack. Chest pain is felt that cannot be relieved by rest or nitroglycerin. Requires emergency medical help! Substernal chest pain is a warning sign that one or more coronary arteries are blocked. If heart is deprived of oxygen, the heart will begin to die, which is the MI. It will stop pumping entirely (cardiac arrest) if a substantial section is damaged.

During heart attack, metabolic waste accumulates in damaged myocardium and make it prone to irregularities (ie: premature ventricular contractions). Safe level of activity must be maintained to allow the myocardium to heal after an MI.

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8
Q

Therapy for those with cardiac compromise

A

How to maintain balance of rest/activity to allow heart to heal while sustaining strength of healthy part of the heart to improve output. Also: how to watch for signs of fatigue, when rest breaks are needed, and how to perform activities safely.

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9
Q

6 Weeks After MI

A

Scar tissue forms and risk of extending MI decreases. Scarred part of the heart is not elastic/does not contract with beats, so it does not pump as well. Graded exercise program can strengthen healthy part of heart to improve output.

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10
Q

Congestive Heart Failure (CHF)

A

Congestive Heart Failure: follows CAD or infections. Develops over time, heart becomes weaker as it’s unable to pump effectively and fluid backs up into lungs/body, causing shortness of breath and greater workload on heart. Heart can become enlarged because heart thickens (hypertrophy) from heavier work. Diuretics can help remove fluid through urinary system; low-sodium diet/fluid restrictions; diet/meds/rest to prolong a full life. OT can help guide pt to optimal level of function with graded tasks/gradual resumption of activity. Can lead to things like limb/pulmonary edema, renal failure, etc.—multi-organ, systemic failure.

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11
Q

Damaged Heart Valves

A

Two complications can occur due to valves not closing properly and blood regurgitating:

1) Volume Overload: fibrous mitral valve; fluid accumulates in lungs, causing SOB. Increases potential for atrial fibrillation (irregular/ineffective contractions of atria). Blood flow through heart slows and blood clots may develop in ventricles. Can lead to CVA.
2) Pressure Overload: aortic valve narrows (aortic stenosis), causing left ventricle to work harder to open the sticky valve, becoming enlarged and decreasing cardiac output. Can lead to ventricular arrhythmia, cerebral insufficiency, confusion, syncope (fainting), or even sudden death.
* Surgery to repair/replace damaged valves often recommended for these.

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12
Q

Arrhythmia

A

Abnormal heartbeat (too quickly = tachycardia; too slowly = bradycardia; irregularly = atrial fibrillation). Happens as result of damage to heart muscles, which disrupts the electrical signals controlling the heart. May cause milder symptoms (palpitations, fatigue) all the way up to being life-threatening (heart block where signals cannot travel or cardiac arrest). May be controlled with meds or insertion of pacemaker.

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13
Q

Percutaneous Transluminal Coronary Angioplasty (PTCA)

A

Also called “Balloon Angioplasty.” Catheter is inserted into femoral artery and guided through circulatory system into coronary arteries. Radioactive dye injected, and site of lesion pinpointed. Balloon then inflated at site of lesion to push plaque against the arterial wall. When it’s deflated/removed, circulation improves. May include a wire mesh stent to keep artery open.

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14
Q

Coronary Artery Bypass Graft (CABG)

A

Used when lesion is too large or artery recloses after PTCA. Diseased section of coronary arteries is bypassed with healthy blood vessels (taken from other parts of body), improving circulation. Requires opening of chest (sternotomy) to perform surgery (and use of sternal precautions for 6-8 wk). High likelihood of 10 year survival afterward (dep on # of grafts, sex, and vein/artery used for graft).

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15
Q

Pacemaker

A

Used when meds cannot control arrhythmias. Wires run from pacemaker to specific spots on heart to deliver small electrical impulse to set pace of electrical conduction. May deliver regular impulse, or set to send impulse only if heart rate drops a certain # of beats/min. Can also monitor BP and temperature.

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16
Q

Implantable Cardioverter-Defibrillator (ICD)

A

Used to treat cardiac arrhythmias. Can both pace the heart muscle and deliver high-energy impulse to reset heart muscle if certain dangerous arrhythmias develop.

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17
Q

Cardiac Ablation

A

Medical procedure used to destroy small areas of the heart that are emitting dangerous signals causing abnormal contraction. Small catheters are threaded through a vein to the heart. Dysfunctional cardiac tissue is reached and electrical impulse is sent to site, destroying the abnormal tissue. Electrocardiogram or increased heart rate/racing (showing something going awry) can diagnose the need for this. Younger patients will have this procedure due to early signs/beginning of CAD, such as misfiring heart, and it’s not as invasive. When global picture of heart is worse, more involved surgeries (ie CABG, pacemakers) are used.

18
Q

List of Common Cardiac Meds

A

1) Anticoagulants
2) Antiplatelet agents
3) Angiotensin-converting Enzymes (ACE Inhibitors)
4) Angiotensin II Receptor Blockers/Inhibitors
5) Angiotensin-receptor Neprilysin Inhibitors (ARNIs)
6) Beta Blockers
7) Calcium Channel Blockers
8) Cholesterol Lowering Meds
9) Digitalis Preparations
10) Diuretics
11) Vasodilators

19
Q

Antiplatelet Agents

A

Meds used to prevent clots after MI; with unstable angina, ischemic stroke, plaque

20
Q

ACE Inhibitors

A

Angiotensin-Converting Enzymes
• Treatment of hypertension or heart failure.
ALSO: Angiotensin II Receptor Blockers

21
Q

ARNIs

A

Angiotensin-Receptor Neprilysin Inhibitors

• Tx of heart failure.

22
Q

Beta Blockers

A

Tx of abnormal cardiac rhythms, chest pain, or to prevent recurrent heart attacks or lower blood pressure.

23
Q

Calcium Channel Blockers

A

Used to treat high BP, angina, some arrhythmias

24
Q

Digitalis Preparations

A

Tx of heart failure, arrhythmias, or atrial fibrillation

25
Q

Vasodilators

A

Ease chest pain (ie: nitroglycerin).

26
Q

Phases of Cardiac Rehab

A

Acute Phase: 1-3 days after MI; condition is stabilized, followed by period of early mobilization.

Phase 1: Inpatient cardiac rehab; monitored low-level physical activity/self-care, reinforcement of cardiac/post-surgical precautions, instruction on energy conservation/graded activity, establishment of guidelines for activity levels at d/c. Averting ill effects of prolonged inactivity while addressing medical problems, poor responses to meds, and atypical chest pain.

Phase 2: Outpatient cardiac rehab; begins at d/c. Exercise advances while pt is closely monitored on outpt basis.

Phase 3: Community-based exercise programs (or tx in place of residence if not able to tolerate outpt therapy).

27
Q

Signs of Cardiac Distress

A

1) ANGINA: chest pain, substernal, may radiate to arms/jaw/neck/back.
2) DYSPNEA: SOB with activity or at rest. At rest with >30 breaths/min could be acute congestive heart failure; may need ER.
3) ORTHOPNEA: Dyspnea brought on by lying supine. Count # pillows to breathe comfortably during sleep.
4) NAUSEA/EMESIS: Vomiting/signs of feeling sick to stomach
5) DIAPHORESIS: Cold, clammy sweating.
6) FATIGUE: Generalized exhaustion. Borg Rate of Perceived Exertion Scale can be utilized to measure. Accompanying cerebral signs (ataxia, dizziness, confusion, fainting) indicate brain not getting enough oxygen.
7) ORTHOSTATIC: Drop in systolic BP and hypotension of > 10 mm Hg with change in position from supine-to-sit/sit-to-stand.

28
Q

Sternal Precautions

A

Precautions to prevent trauma to new graft sites, incisions, and sternum. Last about 8 weeks after surgery. OTP helps educate/assess. Includes:
• Do not lift more than 8 lb
• Do not push/pull with arms when getting in/out of bed or chair
• Do not bring elbows above shoulders
• Avoid twisting/deep bending
• Hug a pillow when coughing or sneezing
• Do not drive until cleared by surgeon
• Report clicking/popping noises to surgeon

29
Q

Response to Activity (after MI)

A

Assessing pt’s response to work; symptoms indicate if tolerating. Assessment can include:

1) **Heart Rate (HR): Feel pulse at radial, brachial, or carotid sites. Note irregularities. Should not rise in response to activity.
2) **Blood Pressure (BP): Stethoscope to measure systolic/diastolic.
3) Rate-Pressure Product (RPP): Measurement of workload or oxygen demand; more accurate indication of how well heart is pumping. Product of HR and systolic BP (RPP = HR x SBP). Recorded as 3 digits (drop last 2). RPP should rise at peak of activity and return to baseline in recovery (5-10 min of rest).
4) Electrocardiogram (ECG): Shows heart’s electrical activity (graph). Not available in most non-acute settings; requires lots of training to read proficiently.

(**=OTP’s concerns, plus respiratory rate.)

30
Q

Stats on Heart Disease

A
  • Leading cause of death in US
  • 1 person dies every 37 sec in US
  • 1 in every 4 deaths/year
  • Costs $219 billion each year in health care, meds, and lost productivity
  • Coronary Heart Disease most common type of heart disease
  • 6.7% of adults 20+ have CAD
  • 2/10 deaths from CAD are in adults <65
31
Q

Cardiac Diseases

A
  1. Cardiac artery disease (CAD)
  2. Myocardial Infarction (MI)
  3. Heart Valve Disease
  4. Abnormal Heart Rhythm - Atrial Fibrillation
  5. Cardiomyopathy (disease of heart muscle)
  6. Congestive Heart Failure
32
Q

Order of Blood Flow Through Heart

A 
Right atrium (tricuspid valve) > 
Right ventricle (pulmonary valve) > Pulmonary artery > Lungs > 
Pulmonary veins > 
Left atrium (bicuspid valve) > 
Left ventricle (aortic semilunar valve) > Aorta > Body
33
Q

Best short description of MI

A

MI is not relieved by rest and blood flow to the heart muscle is interrupted.

34
Q

Good first thing to teach pt before mobilizing out of bed after CABG

A

Do NOT push back and down with your arm/hands. (Opens the chest if you reach back.)

35
Q

Best short description of CAD

A

Develops over a period of years, characterized by cardiac ischemia, damage to internal walls of the heart, and a disease process called atherosclerosis. Shape of heart changes, as does its efficiency.

36
Q

Ejection Fraction (EF)

A

Measures how well your heart is pumping blood out/in. NOT heartrate. Heart’s efficiency/size at end of diastole/systole. The lower the Ejection Fraction (percent) is, the worse the heart is functioning. Normal is 50-75%.

37
Q

Input vs. Output Valves of Heart

A

INPUT: Tricuspid and Mitral/Bicuspid

OUTPUT: Pulmonary and Aortic

38
Q

Artery vs. Vein

A

ARTERY = carry oxygen-rich blood away from heart to the body.

VEINS = carry blood low in oxygen from body back to heart for reoxygenation.

39
Q

Heart’s Epicardial Arteries

A

Run along the outer surface of the heart; receive blood from aorta to supply to heart.

RIGHT CORONARY ARTERY = to right side of heart (which regulates heart rhythm)

LEFT CORONARY ARTERY = to left side of heart (heart’s major pumping chamber)

40
Q

ECG or EKG

A

Electrocardiogram. Records electrical signals from the heart to check for different conditions such as arrhythmias, blocked/narrowed coronary arteries, or pacemaker function. Electrodes on chest attached to computer/monitor.

41
Q

Ventricular Assist Device (VAD)

A

Implantable mechanical pump that helps pump blood from the lower chambers of your heart (the ventricles) to the rest of your body. A VAD is used in people who have weakened hearts or heart failure, often while waiting for heart transplant, or in end-stage heart failure patients.

*Often placed in left ventricle and called Left Ventricular Assist Device (LVAD)

OTA 200 - Phys Rehab Conditions (12 decks)

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