Lecture 8: CV Implications with Oncology, Pregnancy, and Other

Question 1

CV implications with ALS

Answer 1

ANS dysfunction; loss of baroreflexes due to changes in preganglionic sympathetic ganglia

arrhythmias

decreased myocardial mass

decreased EF

myocardial fibrosis

respiratory complications can induce CV changes

Question 2

CV implications for Parkinson’s disease

Answer 2

motor impairments decrease activity tolerance and overall activity levels

ANS dysfunction = higher change of OH, labile BP, HR variability

structural dysfunctions = LV hypertrophy, diastolic/filling dysfunctions

increased risk of HF and MI

Question 3

MS CV implications

Answer 3

higher risk of cerebrovascular disease (59%) and acute coronary syndromes (28%)

acute and chronic inflammation = endothelial dysfunction increases risk for all CVD

increased risk of HF and MI

ANS dysfunction if lesions affect areas of ANS that impact CV functions

Question 4

muscular dystrophy CV implications

Answer 4

dilated CM
- leading cause of death
- same cause of progressive skeletal mm weakness affects myocardium

arrhythmias

acute or chronic inflammation; endothelial dysfunction increases risk for all CVD

Question 5

anticipated hemodynamic changes associated with pregnancy

Answer 5

bounding pulse
systolic murder
loud S1
presence of S3 (from volume changes)
sinus tachycardia
ectopy
peripheral edema
elevated JVP in late stages

Question 6

CV implications of pregnancy

Answer 6

HTN is most common medical compliance in pregnancy; known up regulation of RAAS that leads to increased sodium and fluid retention

poor pre natal/natal care increases risk of CV complications

any underlying CV conditions exacerbated by physical stress of pregnancy

shifting hormone levels can have CV implications although estrogen is cardioprotective

Question 7

what is pre-eclampsia

Answer 7

dangerous increase in BP that can affect mother and baby

treated by delivery

Question 8

what is permpartum/postpartum cardiomyopathy

Answer 8

severe HF that develops in the last month of pregnancy or up to 5 months post partum; LV EF less than 45%

no known cause

risk factors = HTN, preeclampsia, advanced maternal age, genetics, multiple pregnancies

medically managed just like HF (diuretics, ACE/ARBs, BBs)

recovery of normal EF occurs in 61-72%

10% mortality rate, 13% have persistent S&S of severe HF

Question 9

PT implications of pregnancy

Answer 9

aerobic exercise generally tolerated well and recommended during pregnancy

awareness of exacerbated preexisting CV conditions

monitoring for CV S&S/conditions that can develop

close monitoring of BP at rest and with activity

avoid hot environments

utilize longer warm up and cool downs

low-moderate grade compression to help manage edema and improve distal venous return as long as not otherwise contraindicated