Screening and prevention in primary cardiovascular disorders

Question 1

How do we know that physical inactivity is bad

Answer 1

• saltin et al
• normal subjects (healthy) were on bedrest
• they lost 33% of functional capacity in 3 weeks
• regular exercise can help patients return to or exceed their pre-injury state

Question 2

Inactivity in a patient who had a DVT?

Answer 2

• ambulation vs bed rest (Gay et al)
• requirements for ambulation = anticoagulation, compression garments
• early ambulation showed no increase risk for recurrent thrombosis, helped withquality of life, improvement of venous stasis, decreased incidence of post-thrombotic syndrome

Question 3

What is post-thrombotic syndrome

Answer 3

• pain or tenderness of calf
• cramping of calf muscles
• chronic edema; may have redness or other changes in pigmentation, induration
• venous ectasia, pruritus
• assoicated with recurrent DVT

Question 4

Is physical activity always good?

Answer 4

• not always but usually
• some exercise is beter than others
• if a patient has a primary problem affecting cardiovascular = make sure they can tolerate exercise

Question 5

What are some absolute contraindications to exercise/exercise testing

Answer 5

• recent MI (less than 4 to 6 weeks after the MI for a maximal, symptom-limited test) in most clinical settings
• Acute pericarditis or myocarditis
• Resting or unstable angina
• Serious ventricular or rapid atrial arrhythmias (e.g., ventricular tachycardia, couplets, atrial fibrillation, or atrial flutter)
• Untreated second- or third-degree heart block
• Overt congestive heart failure (pulmonary crackles, third heart sound, or both)
• Any acute illness

Question 6

what is first degree heart block and can you treat the patient?

Answer 6

• rate lower than normal
• noted the prolonged PR interval measures
  mild conduction delay in AV node
• identification: look at the p wave if its consistently longer than 1 big box?
• you can treat they may be tired == relying on atria to help expand the ventricles during atrial kick which is missing in these patients

Question 7

what is second degree heart block type 1

Answer 7

• progressive prolonging PR interval until QRS is dropped
• increase risk of clot/poor tolerance to exercise;
• can get on medication to increase contractility (will not exercise if untreated)

Question 8

what is second degree heart block type 2

Answer 8

• fixed PR interval with every third P wave capturing a QRS complex
• more consistently skipped beats
• no exercising

Question 9

what is third degree AV block

Answer 9

• cannot exercise
• fixed P-P interval, the fixed R-R interval and variable PR interval,
• indicating complete dissociation between atria and ventricles

Question 10

how to identify PVC

Answer 10

• wide and weird QRS
• 6/min or more is not a good thing

Question 11

Relative contraindications to exercise and exercise testing

Answer 11

• Aortic stenosis
• Known left main coronary artery disease (CAD; or its equivalent)
• Severe hypertension (defined as systolic blood pressure >165 mm Hg at rest, diastolic blood pressure >110 mm Hg at rest, or both)
• Idiopathic hypertrophic subaortic stenosis
• Severe depression of the ST segment on the resting electrocardiograph
• Compensated heart failure

Question 12

Signs of heart failure

Answer 12

• Extremities cold, pale or cyanotic
• Weight gain
• Peripheral edema
• Hepatomegaly
• JVD
• Crackles
• S3 heart sound
• Sinus tachycardia
• Decreased exercise tolerance

Question 13

symptoms of heart failure

Answer 13

• Dyspnea
• Tachypnea
• PND
• Orthopnea

Question 14

guidelines for interventions for patients with cardiac issues

Answer 14

• vital sign response to exercise and activity

if abnomral decrease activity level

• focus on conditioning to help increase tolerance to activity
• take vitals and use RPP (HRxSBP)
• heart and lung auscultation

Question 15

Isometric exercise with CHF

Answer 15

• compared isometric exercise response in CHF and A-fib or CHF and sinus rhythm (gauld et al)
• CHF w/ SR = increase in sympathetic response
• CHF w/ AF: minimal sympathetic response

Question 16

explain how UE vs LE exercises have a difference on BP

Answer 16

• UE: vasodilation in smaller BV and constriction in Larger BV (of the LE)
• it takes more pressure to get blood in these arteries even though they are dilated therefore
• UE exercises increase bp more than LE

HTN patients could focus on LE exercise

Question 17

CHF and A-fib implications for PT

Answer 17

• CHF and A-fib is assoicated with increased mortality
• didnt do as well with exercise becuase of decreased perfusion and abnormal BP response
• isometric: impairment in heart function and increase in a-fib

Question 18

exercise training with implantable cardioverter defibrillators

Answer 18

• often these patients are afraid to exercise
• have a higher incidence of depresison
• if they are standing and are defibrillated they will fall
• studies showed that they are less likely to be shocked while exercising
• also shown to improve aerobic fitness, effects on quality of life, depression and anxiety

Question 19

Exercise and hemoglobin

Answer 19

• post-op anemia patients without transfusion
• advantages to walking early = getting them up but patients usually dont feel good
• walking with decreased HBG showed no significant difference with lower hbg (not lower than 8)
• showed no increase in adverse events and no increase in rehab Length of stay

Question 20

pre-op PT for cardiac surgery

Answer 20

• reduces risk of post-op surgical pulmonary complications (pulmonary tx)
• reduce post-op length of stay
• DOES NOT decrease incidence of some complications such as death, pneumothorax or prolonged ventilation

Question 21

non-aerobic post op (Cardiac) exercise

precautions/considerations with incisions

Answer 21

• maintain sternal precautions if there was a larger incision
• smaller incision = make want to encourage some movement