Lecture 24 - Cardiac Disease & Acute Cardiac Care Flashcards
Describe heart failure and the different types
- Systolic heart failure: aren’t pumping blood with enough force
-Smaller and weaker
-Hard to pump blood to the body - Diastolic failure: filling issue
-Diastole: heart fills with blood
-Muscles are larger and taking up more space leaving less space for blood to fill in the ventricles - Isolated
-Only on one side of the heart
-L sided usually first then leads to the right side
-L: pumps out to the body, coming in from lungs
->Not pumping efficienty so gets backed up into the lungs
->Fluid build up in the lungs (congestion)-congestive heart failure
-R: pumps to lungs comes from the body
->Congestion/fluid build up in the body - Cardiac output
-Total blood every minute
-5L/min is normal
-SV: blood pumped out every beat
-Multiple by HR (bpm)= Q - Compensation: squeezing harder or beating faster
-Compensate for decreased supply
-But the muscles become over worked
-The cells need more O2 to do this
What are common cardiac diagnoses
Ischemic Heart disease
-Caused by narrowing of coronary artery (plaques)
-Heart muscle is impaired
Valvular Heart Disease
Valve does not open or close properly
-Open: stenosis (Lumen kept small)
-Does not close: regurgitation (causes Heart murmur)
Cardiomyopathy
- Dilated: heart looks like a big baggy heart
-Enormous heart: heart muscle becomes thin and ineffective pumping mechanism - Hypertrophic: large
-Chambers are small
-Blood filling ventricles is reduced - Restrictive: heart looks the same size, muscle same bulk
-Muscle is less compliant and does not fill nicely or contract nicely
-Reduces contraction
-Diastolic and systolic issues
Dysrhythmias
-Electrical system of the heart
-Death of cardiac muscle from MI or congenital
-Impacted firing and electrical impulses going through here
-May need to create infarction to change pathways of abnormal firing
Congenital Heart Disease
Septal : holes in the heart
-Mixing of oxygenated and deoxygenated blood
-Surgery needed
Symptoms of heart disease
Describe Angina
What are risk factors for cardiac disease
What are some cardiac surgeries and procedures
Describe coronary artery bypass grafting (CABG)
Describe valve replacement
Describe percutaneous coronary intervention (PCI)
Describe pacemakers
Describe implantable cardiac defibrillator (ICD)
Describe Left Ventricular Assist Device (LVAD)
Describe some common cardiac medications
What are some things to monitor for the acute care patient by the physio
What should the initial assessment of the acute cardiac patient consist of
What does the treatment progression look like for acute cardiac patient
What is the criteria for termination of exercise for the acute cardiac patient
Case Study 1
- Vitals
-HR: normal range but slightly higher end
->HR sits higher: body is trying to compensate
-BP: low
->Check back on what his normal is
->Give vasodilators
->BP lower reduces the work on the heart
-SPO2: low
->On supplemental O2
->Most likely will not have to go home with O2 - Several days later, develops chest pain while walking in the hallway
-Stop and sit down if they need it
-Ask how are you feeling, is the symptom going away
-What do we need to do
-Spray nitroglycerin
-As long as the symptoms reside you can continue - What to do?
-Chart review
-Check vitals
-Ask how they are feeling
-Tell them why you are there
-Have you gotten up with the nurse yet, how did it go
-Sit up on the side of the bed
-IPPA
-Stand up
->Think about gait aid and supervision needed
-> Look at colour, posture, how well it went
->BP, HR, sats and how well that went
-Get them top chair
-Movement on their feet
-Mobilize around the room, take them for a walk
Case Study 2
- POD #3 pt develops uncontrolled atrial fibrillation
-POD1: deep breathing
-POD2: up to chair - Ongoing atrial fibrillation, but controlled now and pt started cardiac rehab
-Atrium fibrillates and does not have a clear contraction to fill the ventricle
-Can come and go
-Sometimes it may need to be shocked back into a normal sinus rhythm
-Hard to take a normal pulse: atrium quivering- not an effective count of how hard the heart is actually pumping
Case Study 3
- Dilated cardiomyopathy, muscular dystrophy
- HR 90, BP 85/60
- Cardiac ejection fraction 10% (normal 50-70%)
-Water bottle pinch
-Not ejecting a whole lot of blood with every pump - Sudden drop in BP while exercising to 60/35
-Understand their limits and prescribe exercise in relation to their case - Goals for pre-transplant exercise
- Even in the sickest of cardiac cases we have a role to try to keep people mobile
-Yes to exercise within parameters that prevent damage or injury
