Lecture 15: Cardiovascular Medical Conditions II

Question 1

When is strength training avoided in Cardiac disease?

Answer 1

Avoid strength training during the inpatient phase (phase I)

Question 2

What bad exercise habit should be avoided in cardiac patients?

Answer 2

Valsalva Maneuver (because it causes large changes in BP)

Question 3

What type of strength training should be avoided in cardiac patients?

Answer 3

Isometric exercises

Question 4

What type of strength training is preferred in cardiac patients?

Answer 4

dynamic resistance exercise

Question 5

What is one way to reduce BP response if typical strength training exercise is still producing excessive BP responses?

Answer 5

Instead of doing bilateral strength training exercise. Focus on single limb exercises.

Question 6

What are the four pathologies lumped under the Heart failure categories?

Answer 6

1. Right heart failure
2. Chronic Bronchitis
3. CHF
4. Left heart failure

Question 7

What is an example of right heart failure?

Answer 7

Cor pulmonale

or a lung disease that causes a back up of pressure into the right heart.

Question 8

Why is chronic brochitis lumped under heart failure?

Answer 8

Because low O2 content will lead to the entire lung vasculature to vasoconstrict resulting in back up of pressure resulting in hypertension –> right heart failure.

Question 9

Need to insert a card about CHF but find the paper thingy to do that

Answer 9

My ass is lazy and I don’t feel like getting up to get that right now

Question 10

When should a heart failure patient call their MD (3)?

Answer 10

1. Gain 3 pounds over-night or gain more than 5 pounds in 3 days
2. Onset or increase in SOB
3. Paroxysmal nocturnal dyspnea - PND

Question 11

What (besides exercise) should a heart failure patient do every day?

Answer 11

weigh themselves

Question 12

What is another trigger for PND besides heart failure?

Answer 12

Stress

Question 13

Why is the dyspnea worse at night in PND?

Answer 13

Venous return is increased in the supine position and the heart is unable to manage this increase in return, so fluid leaks into the interstitial space.

Question 14

What are the four implications for PT that should be considered when working with a patient with heart failure?

Answer 14

1. Keep them as active as possible for as long as possible throughout the duration of their life
2. Ongoing management of fluids
3. Heart failure clinics are common
4. Depression and anxiety

Question 15

When can you work with a patient with heart failure? (3)

Answer 15

1. Respiratory rate of less than 30 breaths/minute
2. Resting HR <120 bpm
3. If crackles are below halfway up the back (usually the scapulae are the cut-off point)

Question 16

What are some (5) of the guidelines for monitoring exercise intensity for patients with heart failure?

Answer 16

1. Monitor HR, BP closely
2. Target exercise towards Modified borg scale at a 3 (moderate)
3. Longer warm-up
4. If the patient cannot count to 5 while exercising, then decrease the exercise intensity
5. Chronotropic incompetence may occur

Question 17

What is chronotropic incompetence?

Answer 17

HR does not increase appropriately with exercise

Question 18

When do you stop exercise in a heart failure patient?

Answer 18

1. If the crackles are at/above scapulae
2. If RPE gets to a 4 (12-13)
3. RR is more than 40 bpm
4. If crackles on auscultation are higher than they were at rest
5. Develop S3 heart sound during activity (it is okay to exercise only if S3 was present at baseline)
6. SBP falls more than 10 mmHg

Question 19

What is cardiomyopathy?

Answer 19

Permanent damage to cardiac muscle cells

Question 20

What is primary cardiomyopathy? What is an example of this?

Answer 20

Direct damage to the cardiac muscle cells (CAD)

Question 21

What is secondary cardiomyopathy? What is an example of this?

Answer 21

Damage to cardiac muscle cells caused by another pathology. Ex: Muscular dystrophy, chronic alcohol use.

Question 22

What are the three types of cardiomyopathy?

Answer 22

1. Dilated
2. Hypertrophic.
3. Restrictive

Question 23

What is dilated cardiomyopathy?

Answer 23

When the ventricle is dilated due to a loss of contractile tissue (thin muscle)

Question 24

What are two types of pathologies that can lead to dilated cardiomyopathy?

Answer 24

Viral infection and chronic alcohol use

Question 25

What is hypertrophic cardiomyopathy?

Answer 25

When there is an excessive increase in thickness of the ventricle which can limit diastolic filling and therefore, limit SV (very thick muscle)

Question 26

What are two etiologies that can cause hypertrophic cardiomyopathy?

Answer 26

Steroid abuse or genetic factors

Question 27

What is restrictive cardiomyopathy?

Answer 27

When there is scarring, fibrosis of cardiac muscle causing low ventricular compliance.

Question 28

What are four PT implications when working with an individual with cardiomyopathy?

Answer 28

1. Low level, interval training is suggested 2. Exercise-rest-exercise-rest 3. RPE needs to be the primary determinant of exertion during exercise 4. Using a pulse oximeter is recommended to monitor SaO2

Question 29

What is the main etiology of Wolf-Parkinson White Syndrome?

Answer 29

Congenital

Question 30

What is the finding on the EKG with Wolf-Parkinson White Syndrome?

Answer 30

EKG shows a Delta wave which causes a slurring of the QRS complex. This prolongs the QRS duration

Question 31

What is the congenital defect in the ventricle that is Wolf Parkinson White?

Answer 31

An accessory conducting pathway that causes part of the ventricles to be depolarized early

Question 32

What three things can Wolf Parkinson White Syndrome lead to?

Answer 32

1. Premature Atrial Contractions 2. Rapid heart Rate 3. Atrial Fibrillation

Question 33

What are three signs and symptoms of Wolf-Parkinson White Syndrome?

Answer 33

1. SOB during activity 2. Heart palpatations during rest or activity 3. May be asymptomatic