Intro to PT chapter 11 Flashcards
1
Q
CVD
A
Number one cause of death\
647,000 deaths in US 2017
351 billion in costs
2
Q
of more than 2.7 million people
who died in 2017
A
24% died of CVD
3
Q
Estimated direct and indirect costs for 2014 & 2015 CVD
A
$350 billion for American adults
4
Q
AHA statement
A
40.5% of population is projected to have CVD by 2030.
5
Q
Direct medical costs of CVD
A
tripple by 2030
6
Q
Indirect costs of CVD
A
60% increase by 2030.
7
Q
US Adults with hypertension
A
46%
8
Q
Percent of highschool smokers
A
15%
9
Q
Coronary Heart Disease CHD
A
48% of all CVD deaths -
most common cause of death for CVD
10
Q
Myocardial Infaction, MI
A
790,000 a year US.
11
Q
Percutaneous Coronary Interventions per year
A
480,000
12
Q
coronary artery bypass per year
A
371,000
13
Q
Pacemakers per year
A
411,000
14
Q
COPD
A
16 million people in US
4th leading cause of death.
15
Q
COPD gender
A
Women twice as likely as men
16
Q
COPD race
A
greatest prevelence in non-hispanic black or african american individuals
17
Q
Anual cost of COPD
A
49 billion by 2020 – 32 billion in 2010
18
Q
Pericardial sac
A
Fibbrous tissue that surrounds the heart.
19
Q
Myocardium
A
Muscle tissue of the heart, cross striated with layers of muscle fibers arranged in multiple directions.
20
Q
Superior and inferior vena cava
A
Right atrium recieves blood from here
21
Q
Right ventricle
A
recieves blood from right atrium through tricuspid valve
22
Q
Right Ventrical sends blood too
A
left and right pulminary arteries for oxigination. Must go through the pulminary valve ( right semilunar valve).
23
Q
oxiginated bloods returns through pulminary veins.
A
And into left atrium.
24
Q
From left atrium
A
blood flows through the mitral valve into the left ventrical
25
From the left ventrical
blood flows out the aortic vlave into the aorta and distributed throughout the body.
26
Nodal or Purkinje fibers
special types of tissue responsible for conducting the electrical impulses and sychronizing the heartbeat.
27
Sinoatrial (SA node)
Initiates the impulse (sinus rythm) - pacemaker
28
Atriventricular (AV) node
Transports this signal to bundle of His.
29
Bundle of His
where Purkinje fibers start to spread out into muscle fibers.
30
Two major arteries supplying blood to myocardium
left and right coronary arteries.
31
A blockage in a coronary artery
myocardial infarction
32
Arterioles another name
Resistence vessels
| elasticity and smooth muscles can change diameter and resistence.
33
Arteriosclerosis
"hardening of the arteries" thick and stiff walls. Higher resistence to blood flow.
34
Capillaries
one cell thick "exchange vessels" Nutrients and wastes exchange here.
35
Viens hold a significant percentage of our blood supply
larger viens are called
capacitance vessels.
36
Respiration
exchange of oxygen and carbon dioxide between the air we breath and blood cells passing through lungs.
37
Ventilation
process of exchanging air between the atmosphere and the lungs through inspiration and expiration.
38
inspiration
diaphram contracts. - lungs expand
39
expiration
diaphram relaxes.
- lung volume decreases expelling air.
40
Nose, pharynx and larynx
Upper conducting airways. Cleans and humidifies air.
Terminates at begining of trachea.
41
Trachea and bronchiole system
System of tubes starting with trachea and branching out left and right with the bronchiole system into a many fine tubes.
42
end of conduction system
Alveoli - small sacks where oxygen and carbon dioxide are exchanged.
| Alveolar ducts- the part right before the sac, can also have exchange
43
Pleura
membrane surround lungs.
44
Ischemia
inadequate oxygenation of tissues that occurs due to insufficient blood flow as a result of a blocked blood vessel.
45
Coronary Heart Desease
another word for arteriosclerosis
46
Angina
chest pain occurs from ischemia of the heart muscle.
47
Risk factors for CHD
* age
* family history
* cigarette smoking
* sedentary lifestyle
* obesity
* hypertension
* elevated cholesterol (LDL, total - HDL is fine)
* prediabetes.
| HDL is a negative risk factor.
48
Heart failure
disease process or congenital defect causes a decrease in the pumping capability of the heart. Accute or gradual.
49
MI
accute change to pumping capability of heart
50
MI cause
embolus blocking a coronary artery
51
major complication of MI
abnormal heart rythm.
(abnormal conduction)-
inneficient heart contraction.
52
Congestive Heart Failure (CHF)
**Right ventricle isn't contracting efficiently. **
* Blood volume backs up into venous system.
* fluid collects in abdomen liver and legs.
* abnormal amount of blood in lungs.
* Fluid collects in lungs.
* Even harder to push blood through lungs. so RV has to work harder.
* Blood doesn't oxygenate as well.
53
Obstructive lung disease
pathologic changes lung cause abnormality in airflow through the bronchial tubes
54
restrictive lung disease
pathologic changes cause the volume of air in lungs to be reduced.
55
Common lung diseases cause both
obstructive and restrictive lung disease
56
dyspnea
shortness of breath.
57
COPD
chronic productive cough, excessive mucuus, changes in sound produced when air passes through bronchial tubes - dyspnea
58
# In COPD
chronic bronchitis
inflamation of the bronchial tubes.
59
# in COPD
emphysema
trapping of air in the alveoli
60
# In COPD
peripheral airway disease
collapse of terminal bronchioles
61
# In COPD
bronchial asthma
smasm like contraction of bronchi, resulting in trapped air.
62
# In COPD
Cystic Fibrosis
disfunction of mucus glands causing blockage of bronchi
63
# In COPD
decrease lumen size and alveolar destruction
causes air trapped in lungs. - overinflation - decreased air exchange.
64
# IN COPD
Trapped air also causes
increase in size of thorax and difficulty for breathing muscles to work
65
# In COPD
hypoxemia
changes in heart, blood pressure and thickness of blood leading to respiratory failure.
66
Causes of restrictive lung disease
* coal dust
* , silicon
* , asbestos,
* pneumonia,
* cancer of lung,
* and changes in heart function**
67
diseases of nerve supply or trauma to nerve supply to the muscles of ventilation
can cause restrictive lung disease
68
S/S restrictive lung disease
* shortness of breath
* cronic cough - non productive
* tachypnea - increased rate of breath
* weight loss
* hypoxemia
69
cardiac catheterization
passing a catheter into artery of leg until it reaches the heart... coronary arteries or pulmonary veins.
Pressure measure tip.
Dye can be released for an imaging technique to demonstrate where blockages are.
small camera
70
Echocardiography
use of high frequency sound to assess the size of the heart chambers, the thickness of the chamber walls, and the bumping ability and motion of the chamber walls and heart valves.
71
transesophageal echocardiography
transducer is placed in esophagus.
72
electrocardiogram
non invasive evaluation of heart function
73
# electrocardiogram
P-wave:
Represents atrial depolarization, which is the electrical activity that initiates atrial contraction (systole). During this phase, blood is pushed from the atria into the ventricles.
74
# electrocardiogram
P-R Interval:
Encompasses the time from the start of atrial depolarization to the start of ventricular depolarization. It reflects the time taken for the electrical impulse to travel from the atria through the AV node, where there is a slight delay, allowing the ventricles to fill with blood before they contract.
75
# electrocardiogram
QRS Complex:
Represents ventricular depolarization, which triggers the contraction of the ventricles (ventricular systole). This contraction pumps blood out of the heart—into the pulmonary artery from the right ventricle and into the aorta from the left ventricle.
76
# electrocardiogram
ST Segment:
Represents the period between ventricular depolarization and repolarization. It's a short phase where the ventricles are still contracting but no further electrical activity is occurring. It is part of the plateau phase in the action potential, keeping the ventricles contracted.
77
# electrocardiogram
T-wave:
Represents ventricular repolarization, or the recovery phase, where the ventricles relax (diastole). This allows the ventricles to start filling with blood again in preparation for the next cycle.
78
# electrocardiogram
Q-T Interval:
Encompasses the entire period of ventricular depolarization and repolarization, essentially covering the start of ventricular contraction to the completion of ventricular relaxation.
79
Exercise stress testing
* noninvasive method of determining how the cariovascular and pulmonary systems respond to controlled increases in activity.
* common to diagnose suspected or established CVD.
* Performance after MI, coronary bipass, or heart valve replacement
80
Other uses for Exercise stress testing
* assess someone's functional status,
* evaluate the effectiveness of treatment,
* to help prescribe limitations for occupational activities.
* can be used to guide an exercise program
81
Methods of exercise stress test
walking on a treadmill
riding a bicycle ergometer.
includes:
* continous EEG
* Heart rate monitorinig
* blood pressure monitoring
* feedback from pt reporting symptoms
| may include analysis of expired gasses from lungs.
82
Bruce Treadmill Protocol for exercise Stress test.
Stage Time (min) Speed (mph) Grade (%)
1 0 - 3 1.7 10
2 3 - 6 2.5 12
3 6 - 9 3.4 14
4 9 - 12 4.2 16
5 12 - 15 5.0 18
6 15 - 18 5.5 20
7 18 - 21 6.0 22
83
Radiographs
x-ray of chest
84
computed tomography
CT - x-rays are used to take pictures of small slices of the chest and lungs
85
magnetic resonance imaging (MRI)
pictures of small slices of chest and lungs by displacing hyrdrogen atoms with magnetic rays.
86
Ventilation-perfusion scan (V/Q ratio)
inhale radioactive isotopes.
87
CT pulmonary angiography (CTPA)
radiocontrast agent injection - ct image of pulmonary arteries.
88
Bronchoscopy
flexible fiber-optic tube placed in bronchial trree to perrit visualization of the structure and suctioning of any accumulated secretions.
89
Pulmonary Function test
Use a spirometer to measure volume and airflow rates
tidal volume and other measures.
90
Spirometer
measures the various volumes and airflow rates
* Tidal Volume (TV): The amount of air inhaled or exhaled in a normal breath at rest.
* Inspiratory Reserve Volume (IRV): The additional amount of air that can be inhaled after a normal inhalation.
* Expiratory Reserve Volume (ERV): The additional amount of air that can be exhaled after a normal exhalation.
* Residual Volume (RV): The amount of air remaining in the lungs after a maximal exhalation (cannot be measured directly by spirometry but is often estimated).
* Vital Capacity (VC): The total amount of air that can be exhaled after a maximal inhalation, calculated as TV + IRV + ERV.
* Inspiratory Capacity (IC): The maximum amount of air that can be inhaled after a normal exhalation, calculated as TV + IRV.
* Functional Residual Capacity (FRC): The amount of air remaining in the lungs after a normal exhalation, calculated as ERV + RV.
* Total Lung Capacity (TLC): The maximum amount of air the lungs can hold, calculated as TV + IRV + ERV + RV.
| From A&P flashcards.
## Footnote
`
91
Blood Gas Analysis
assessing arterial blood to deterrine the concentration of oxygen and carbon dioxide.
92
major way to treat heart and lung disease
pharmacologic management.
93
# drugs
For cardiac conditions
drugs are used to alter rate,
rhythm, or strength of contraction or improve blood
flow.
94
# drugs
For pulmonary conditions
drugs are used to
promote bronchodilation and decrease inflammation.
95
PT completes detailed evaluation
Assesses signs, symptoms, or syndromes resulting from the pathologic condition
Develops a prognosis estimating maximum level of improvement the patient will experience
Develops plan of care
Develops goals to enhance movement and function
Estimates frequency and duration of treatment
Develops criteria for discharge
96
# Surgical management: cardiac conditions
Percutaneous coronary interventions (PCI)
* Insert tube into coronary artery and dilate the artery by inflating a balloon (inserted through artery in leg most often.)
* May insert a stent to maintain the opening
97
# Surgical management: cardiac conditions
percutaneous transluminal coronary angioplasty
name for PCI with balloon.
98
# Surgical management: cardiac conditions
coronary laser angioplasty
name for PCI with laser to destroy plaque.
99
# Surgical management: cardiac conditions
Coronary artery bypass graft (CABG)
surgically opening chest wall and grafting a small artery or leg vein between the aorta nd a point beyond the blockage or plaque.
100
# Surgical management: cardiac conditions
Valve replacement
can invove repair or complete replacement.
101
# Surgical management: cardiac conditions
cardiac pacemaker
electronic device that produces a pulse to control heart depolarization. Replaces function of SA node.
-careful monitoring of pt in exercise at maximum intensity is manditory for PT-PTA
102
# Surgical management: cardiac conditions
Heart transplant
Only in end-stage disease
103
Surgical management: pulmonary conditions
Resection of entire of part of lung
used for tumors or treatment of fungal infections
Lung transplantation
performed for end stage lung disease.
104
atelectasis
collapse of alveoli
105
# Functional classifications of patients with heart disease & HF
Class I
| functional classification
patients with cardiac disease but without resulting limitations of physical activity
Ordinary physical capacity does not cause undue fatigue, palpitation, dyspnea or anginal pain.
106
# Functional classifications of patients with heart disease & HF
Class II
| functional classification
Patients with cardiac disease resulting in slight limitation of physical activity
patients are comfortable at rest
ordinary physical activity results in fatiqgue, palpitation, dyspnea or pain.
107
# Functional classifications of patients with heart disease & HF
Class III
| functional classification
Pts with cardiac disease resulting in marked limitation of physical activity
Pts are comfortable at rest
Less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain.
108
# Functional classifications of patients with heart disease & HF
Class IV
| functional classification
Patients with cardiac disease resulting in an inability to cary out any physical activity without discomfort
Smptoms of cardiac insufficiency or anginal syndrome may be present even at rest
If any physical activity is undertaken, discomfort is increased.
109
# Functional classifications of patients with heart disease & HF
Stage A
| stages of HF
Pts at high risk of developing HF because of conditions that are strongly associated with the development of HF
Such pts have no identified structural or functional abnormalities of the pericardium, myocardium, or cardiac valves, and have never shown signs or symptoms of HF
110
# Functional classifications of patients with heart disease & HF
Stage B
| stages of HF
Patients who have developed structural heart disease that is strongly associated with the development of HF but who have never shown signs or symptoms of HF
111
# Functional classifications of patients with heart disease & HF
Stage C
| stages of HF
Pts who have current or prior symptoms of HF associated with underlyinjg structural heart disease.
112
# unctional classifications of patients with heart disease & HF
Stage D
| stages of HF
Pts. with advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and who require specialized interventions.
113
FITT principle
Frequency, Intensity, time and Type of exercise
- - Inpatient rehabilitation recommendations follow this.
- pt involved in education activities-risk factor modification - understading of the medications prescribed, and discharge planning.
114
# FITT recomendations for cardiac Rehab
Aerobic Frequency
Mobilization 2-4 times per day for the first 3 days.
115
# FITT recomendations for cardiac Rehab
Aerobic Intensity
* Seated or standing resting HR +20 bpm for pts with an MI.
* resting HR+30 for pts with heart surgury - upper limit <120 bpm exertion <13 on scale of 6 to 20.
116
# FITT recomendations for cardiac Rehab
Aerobic Time
3-5 min as tolerated.; progressivly increasing durration.
rest period may be slower walk or complete rest
attempt 2:1 exercise to rest ratio
progress to 10-15 min of continous walking.
117
# FITT recomendations for cardiac Rehab
Aerobic Type
Walking. Other modes are useful... treadmil, cycle
118
# FITT recomendations for cardiac Rehab
Flexibility - frequency
Minimally once per day but as often as tolerated
119
# FITT recomendations for cardiac Rehab
flexibility - Intensity
Very mild stretch discomfort
120
# FITT recomendations for cardiac Rehab
flexibility time
All major joints with at least 30s per joint.
121
# FITT recomendations for cardiac Rehab
Flexibility Type
Focus on ROM and dynamic movement
Pay particular attention to lower back and posterior thigh regions. Bedbound pts may benifit from passive stretching.
122
Cardiac Rehab divided into four phases
phase I - IV
123
# Cardiac Rehab
phase 1
acute - inpatient phase.
124
# Cardiac Rehab
Phase II
subacute - begining of outpatient phase - close physician management is always available
supervised training sessions 3-4 times a week for 10 to 12 weeks.
125
# Cardiac Rehab
Phase III and Phase IV
Intensive rehabilitation - Ongoing rehabilitation
More independen and agressive activities.
Individual must be able to self monitor.
126
quantifying exercise
HR reserve
ratings of percieved exertion (RPE)
Percentage of age-predicted heart rate
percentage of oxygen uptake
Metabolic equivalents (METs)
127
Target heart rate
([HRmax-HR rest] * intensity desired) +HR rest
128
PT and PTA must monitor
vital signs and
cardiovascular response to exercise
129
training zone
minimum and maximum hrs that must be achieved to produce an aerobic training effect.
130
# Pulmonary Rehab
postural drainage for mucus removal
131
# Pulmonary Rehab
Percussion
promotes movement of mucus through the bronchial tubes - trendelenburg right after and cough.
132
# Pulmonary Rehab
cough - breathing exercies
* strengthening both primary and secondary muscles of ventilation
* changing the breathing patern
* use diffeerent devices to support the chest wall so that the expiration force generated during coughing is enhanced.
133
# Pulmonary Rehab
Aerobic performance occurs
when muscles get all the oxigen they need
-- appropriate intensity from examination
-- must monitor patient's cardiovascular response
134
# The Well Individual
PTs can provide information on modifiable risk
factors.
| Strategies to prevent disease
Nutrition
Regular exercise
Weight control
Blood pressure control
Cholesterol management
Smoking avoidance
PT examination and intervention apply to well
individuals (clients).
