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Clin Med Exam 2 > valvular diseases > Flashcards

valvular diseases Flashcards

1
Q

mitral stenosis

A

a thickening of mitral valve d/t rheumatic heart diseases that primarily affects women

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2
Q

clinical manifestations of mitral stenosis

A

symptomatic pts NOT candidates for exercise programs

mild: asymptomatic

moderate: dyspnea, fatigue, as left atrial pressure rises and mechanical obstruction of filling of left ventricle reduces cardiac output

severe: left atrial pressure is high enough to produce pulmonary venous congestion at rest and reduce cardiac output

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3
Q

diagnosis/treatment of mitral stenosis

A

surgical procedures include valve repair, replacement w/ an artificial valve, or balloon valvotomy (provides excellent relief w/ prolonged benefits)

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4
Q

mitral regurgitation

A

during left ventricular systole, the mitral leaflets do not close normally, and blood is ejected into the left atrium as well as through the aortic valve

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5
Q

clinical manifestations of mitral regurgitation

A

mitral valve involvement from ischemic heart disease accounts for half of all cases

individuals can remain asymptomatic until sever and often irreversible left ventricular dysfunction occurs causing exertional dyspnea and exercise induced fatigue

heart murmur heard through auscultation

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6
Q

prognosis mitral regurgitation

A

mitral valve repair has better outcome than replacement

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7
Q

PT mitral valve regurgitation

A

avoid isometric exercises

b/t pts tend to hold their breath

pt is already not getting enough oxygen

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8
Q

mitral valve prolapse

A

characterized by a slight variation in the shape or structure of the mitral valve

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9
Q

clinical manifestations of mitral valve prolapse

A

profound fatigue that cannot be correlated w/ exercise or stress, palpitations, and dyspnea

therapist likely to see individual w/ MVP associated w/ connective tissue disorders or MVPs with autonomic dysfunction

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10
Q

diagnosis/prognosis MVP

A

discovered during routine cardiac auscultation or when echocardiography is performed for another reason

MVP/MVPs is a benign condition in the majority of people

can participate in all sports activities by symptoms of fatigue and dyspnea may limit activity

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11
Q

aortic stenosis

A

disease of aging

commonly caused by progressive valvular calcification either superimposed on a congenitally bicuspid valve or in the older adult, involving a previously normal valve following rheumatic fever

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12
Q

pathogenesis aortic stenosis

A

orifice of the aortic valve narrows causing increase resistance to blood flow from the left ventricle into the aorta

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13
Q

clinical manifestations aortic stenosis

A

most common sign is systolic ejection murmur radiating to the neck

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14
Q

diagnosis aortic stenosis

A

hypertrophy and calcified aortic valve

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15
Q

treatment aortic stenosis

A

valve replacement

balloon valvulopathy

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16
Q

prognosis aortic stenosis

A

adults w/ aortic stenosis who are asymptomatic have normal life expectancy

once symptoms appear –> prognosis is poor w/o surgery

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17
Q

aortic regurgitation

A

insufficiency

leakage of blood during diastole back into the left ventricle

LV compensates by both dilation and hypertrophy –> eventually the left ventricle fails to stand up under chronic overload and symptoms develop

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18
Q

clinical manifestations aortic regurgitation

A

enlargement of left ventricle

wide pulse pressure

systolic hypertension

resulting in exertional dyspnea

fatigue

excessive perspiration w/ exercise (similar to symptoms in a heart attack)

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19
Q

treatment of aortic regurgitation

A

surgical reconstruction or replacement of the valve

vasodilators to reduce severity of regurgitation

digoxin (slows HR) to stabilize or improve symptoms

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20
Q

arrythmias

A

disturbance of HR or rhythm caused by an abnormal rate of electrical impulse generation by the SA node or the abnormal conduction of impulses

rate arrythmias

rhythm arrythmias

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21
Q

rate arrythmias

A

tachycardia

bradycardia

ventricular tachycardia

ventricular fibrillation

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22
Q

tachycardia

A

heart beats too fast (more than 100 bpm)

develops in presence of increased sympathetic stimulation or oxygen demand

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23
Q

bradycardia

A

less than 50 bpm

normal in well trained athletes

also common in those taking beta-blockers, w/ a TBI or brain tumors, those experiencing increased vagal stim

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24
Q

ventricular tachycardia

A

always stop activity after 3 beats of v-tach

CALL MD

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25
ventricular fibrillation
EMERGENCY CAN BECOME ASYSTOLE
26
rhythm arrythmias
variations from the normal rhythm of the heart can be lethal symptomatic or asymptomatic dangerous b/c they reduce CO
27
types of rhythm arrythmias
sinus ventricular fibrillation heart block sick sinus syndrome holiday heart syndrome
28
sinus arrythmia
irregularity in rhythm that may be normal variation in athletes, children, and older people may be caused by an alteration in vagal stimulation
29
ventricular fibrillation (rhythm)
electrical phenomenon that results in involuntary uncoordinated muscular contractions of the ventricles
30
heart block
disorder of the heart beat caused by an interruption in the passage of impulses through the heart's electrical system
31
sick sinus syndrome
brady-tachy complex cardiac arrythmia and conduction disturbance that is associated w/ advanced age, CAD or drug therapy
32
holiday heart syndrome
may occur when the heart responds to the increase in catecholamines brought on by excessive alcohol intake
33
arrythmias diagnosis
atrial fibrillation: lots of P-waves, rate can be irregular, potential for clotting, increased risk of stroke PVC (premature ventricular complex): when the spike in ventricular systole geos down b/c it is firing too quickly can lead to ventricular tachycardia of fibrillation
34
arrythmias treatment
goal is to control ventricular rate, prevent thromboembolism and restore normal sinus rhythm return to normal heart rhythm (cardioversion) can happen spontaneously, through electrical stimulation (defibrillator) pharmacologic treatment, pacemaker about 1/2 of individuals with arrythmias will spontaneously convert to normal sinus rhythm within 24-48 hours
35
pharmacology of CV system
class 1 class 2 class 3 class 4 class 5
36
class 1 drugs
sodium channel blockers normalize the rate of sodium entry into cardiac tissues and thereby help control cardiac excitation and conduction
37
class 2 drugs
beta-blockers DECREASE the excitatory effects of the sympathetic nervous system and catecholamines on the heart most effective for treating atrial tachycardia
38
class 3 drugs
drugs that prolong repolarization delays the repolarization of cardiac cells, thus slowing and stabilizing the HR, used to trat ventricular arrythmias
39
class 4 drugs
calcium channel blockers decrease the rate of discharge of the SA node and inhibit conduction velocity through the AV node most successful in treating arrythmias caused by atrial dysfunction
40
common beta blockers
end in -olol acebutolol (Sectra) atenolol (tenormn) bisprolol (zebeta) metoprolol (lopressor) nadolol (cogard) propanol
41
implication for PT for arrythmias
assessment for balance and risk of falls until arrythmia is controlled, activity isn't recommended after pacemaker: limit activity for several weeks, scar mobilization
42
endocarditis
infective endocarditis is a bacterial infection of the endocardium (the lining inside the heart) most commonly damages the mitral valve followed by aortic, tricuspid and pulmonary valves inflammation of cardiac endothelium w/ destruction of the connect tissue
43
risk factors of endocarditis
the w/ previous valvular damage prosthetic heart valves injection drug users immunocompromised women who have had suction abortion or pelvic infection post cardiac surgery
44
clinical manifestations of endocarditis
fever cardiac murmur petechial lesions of the skin conjunctiva oral mucosa (may not always be present)
45
diagnosis of endocarditis
blood cultures to identify specific pathogens echocardiography to confirm
46
endocarditis: rheumatic fever and heart disease
one form of endocarditis caused by streptococcal group A bacteria can be fatal and lead to rheumatic heart disease
47
rheumatic heart disease
a chronic condition caused by scarring and deformity of the heart valves
48
endocardial inflammation
causes swelling of the valve leaflets
49
clinical manifestations of endocarditis: rheumatic fever and heart disease
step throat carditis acute migratory polyarthritis chorea (involuntary movement)
50
prognosis for endocarditis: rheumatic fever and heart disease
mortality for acute rheumatic fever is low persistent rheumatic activity w/ complications is associated w/ long term morbidity and mortality
51
pericarditis
inflammation of the pericardium may be a primary condition or secondary to other diseases and circumstances
52
most common types of pericarditis
will be drug induced or those associated w/ autoimmune diseases, after MI, in conjunction w/ renal failure, after open heart surgery and after radiation therapy
53
constrictive pericarditis
fibrotic, thickened, and adherent pericardium that is compressing the heart
54
pericardial effusion
refers to fluid accumulation within the pericardial sac
55
clinical manifestations of pericarditis
pleuritic chest pain (pain upon inhalation) pain is substernal and may radiate to the neck, shoulders, upper back, upper trap, left supraclavicular area, epigastrium or down left arm
56
diagnosis of pericarditis
classic sign is the pericardial friction rub heard on auscultation X-ray ECG CT MRI
57
treatment of pericarditis
pericardiocentesis pericardial fluid analysis pericardioscopy epicardial and pericardial biopsy analyses all have permitted early specific diagnosis
58
diseases of the aorta
aneurysm: an abnormal stretching in the wall of an artery, vein or the heart w/ a diameter that is at least 50% greater than normal CHROMOSOME 11 AND 15
59
what is the most common arterial aneurysm
aorta
60
thoracic aortic aneurysms
most frequently occur in men 40-70 yrs old
61
abdominal aortic aneurysm
occur 4x more frequently than thoracic aneurysms
62
peripheral arterial aneurysms
affect the femoral and popliteal arteries
63
clinical manifestations of aneurysms
early warning signs of impending rupture may include abdominal heartbeat
64
implications for PT
patient at risk of pulmonary complications after surgical repair activities restricted, therapist involved in bedside exercises to prevent thromboembolism always palpate abdomen for a pulsating mass before performing anterior or abdominal therapy monitor vital signs and pulses w/ increase throbbing pain
65
athletic heart syndrome
heart is enlarged d/t significant amounts of exercise increase in left ventricular mass as a result of intensive training
66
essential hypertension
persistent elevating of diastolic BP (>90 mmHg), systolic BP (>140mmHg) or both measure on at least 2 separate occasions at least 2 weeks apart **DIAGNOSIS CANNOT BE MADE FROM ONE READING**
67
prolonged hypertension
the elastic tissue in arterioles is replaced by fibrous collagen tissue offering greater resistance to blood flow leading to decreased perfusion of heart, kidney and brain tissue
68
risk factors of essential hypertension
genetics smoking obesity high cholesterol African American descent
69
clinical manifestations of essential hypertension
often asymptomatic symptoms may include headache, vertigo, flushed face, spontaneous epistaxis, blurred vision and nocturnal urinary frequency
70
guidelines for PTs w/ essential hypertension
hypertension is most common primary diagnosis in the US and is a major risk factor for coronary heart disease, stroke, renal failure
71
treatment for essential hypertension
controlling BP = most effective way to prevent stroke
72
prognosis of essential hypertension
life expectancy decreases with rise in diastolic or systolic pressure
73
congenital heart disease
an anatomic defect in the heart that develops in utero during the 1st trimester present at birth anything that interferes during the first 8-10 weeks of pregnancy
74
congenital heart disease types
cyanotic acyanotic
75
cyanotic
defects result from obstruction of blood flow to the lungs or mixing of venous and arterial blood w/in the chambers of the heart transposition of great vessels (TGV) Tetralogy of Fallot Tricuspid atresia
76
transposition of great vessels (TGV)
no communication b/w systemic and pulmonary circulations aorta exits right ventricle pulmonary trunk exits left ventricle
77
tetralogy of fallot
pulmonary stenosis large ventricular septal defect aortic communication w/ both ventricles right ventricular hypertrophy
78
tricuspid atresia
failure of tricuspid valve to develop lack of communication from the right atrium to right ventricle
79
acyanotic
defects involve primarily left-to-right shunting through an abnormal opening ventricular septal defect atrial septal defect coarctation of the aorta patent ductus arteriosus
80
ventricular septal defect
abnormal opening b//w right and left ventricles
81
atrial septal defect
abnormal opening b/w atria allowing blood from higher pressure left atrium to flow into the lower pressure right atrium
82
coarcatation of the aorta
narrowing near the insertion of the ductus arteriosus resulting in increased pressure to the head, upper extremities, and decreased pressure to the body and LEs
83
patent ductus arteriosus
failure of the fetal ductus arteriosus to close
84
peripheral vascular diseases
encompasses pathologic conditions of blood vessels supplying the extremities and the major abdominal organs
85
general manifestations of peripheral vascular diseases
pain described as cramping or tightness = claudication (comes on w/ exertion and relieved by rest)
86
thromboangitis obliterans
Buerger's disease a vasculitis affecting the peripheral blood vessels primarily in the extremities can be classified as inflammatory or arterial occlusive disorders cause is unknown but most often found in men younger than 40 who heavily smoke
87
thromboangitis obliterans clinical manifestations
edema cold sensitivity rubor cyanosis thin, shiny, hairless skin from chronic ischemia
88
thromboangitis obliterans diagnosis
definitive diagnosis determined by histologic examination of blood vessels (micro-abscesses)
89
thromboangitis obliterans treatment
intervention should begin w/ cessation of smoking
90
Raynaud's disease and phenomenon
intermittent episodes of small artery constriction of the extremities causing temporary pallor and cyanosis of the digits and changes in skin temp constriction of blood vessels limits O2 to affects areas
91
clinical manifestations of Raynaud's disease and phenomenon
ischemia from vasospastic attacks causes cyanosis numbness sensation of cold in the digits
92
Raynaud's disease
when condition is primary vasospastic disorder affects women more than men ages 20-49 appears to be caused by hypersensitivity to cold, release of serotonin and genetic susceptibility to vasospasm
93
Raynaud's phenomenon
when disorder is secondary to another disease or underlying cause problem for 10-20% of population affects women 20x more than men, ages 15-40 often associated w/ Buerger's disease, connective tissue disorders, occlusive arterial diseases and neurologic lesions associated w/ a disturbance in the control of vascular reflexes
94
Raynaud's disease diagnosis
diagnosed by a history of symptoms for at least 2 years with no progression and no evidence of underlying cause
95
Raynaud's disease treatment
prevention of alleviation by avoiding stimuli that trigger attacks, physical or occupational therapy calcium channel blockers
96
raynaud's phenomenon treatment
treatment of underlying cause
97
venous thrombosis
an occlusion of a vein by a clot (thrombus) with secondary inflammation reaction in the wall of the vein trauma to the endothelium of the vein wall exposes subendothelial tissues to platelets and clotting factors initiating thrombosis
98
mural thrombosis
where thrombosis is attached to the wall of the vein but does not occlude the vessel lumen
99
occlusive thrombosis
begins by attachment to the vessel wall and progresses to occlude the vessel
100
superficial venous thrombosis
most commonly occur in the saphenous vein
101
deep venous thrombosis (DVT)
usually of the femoral or iliac veins of LE 3rd most common cardiovascular disease
102
clinical manifestations of venous thrombosis
leg or calf swelling pain or tenderness dilation of superficial veins pitting edema skin temp changes cyanosis
103
diagnosis of venous thrombosis
utilization of the wells and colleagues clinic decision rule (CDR) cluster signs, symptoms and risk factors
104
prevention of venous thrombosis
anticoagulants use of knee elastic stockings
105
prognosis of venous thrombosis
DVT is a common frequent cause of PE PE is a frequent cause of RIP
106
PAD/PVD PT intervention
regular physical activity*** interval treadmill walking arm ergometry training smoking cessation avoiding of cold
107
why is exercise important for PAD and PVD
prevents progressions of plaques increases dilation capacity increases collateral blood flow increase capillarity increase skeletal muscle metabolism
108
varicose veins
an abnormal dilating of veins, usually in the LE leading to twisting and turning of the vessel incompetence of the valves and a propensity to thrombosis
109
varicose veins risk factors
inherited trait periods of high venous pressure associated w/ heavy lifting or prolonged sitting or standing hormonal changes
110
varicose veins pathogenesis
valves become incompetent or veins more elastic the veins become engorged with stagnant feeling of fatigue
111
varicose veins clinical manifestations
dilated, tortuous, elongated veins beneath the skin dull aching heaviness, tension, feeling of fatigue
112
varicose veins interventions
vein stripping radiofrequency to seal off vein sclerotherapy (controlled atrophy) laser therapy
113
lymphedema
accumulation of excessive lymph fluid and swelling of subcutaneous tissue d/t obstruction, destruction, or hypoplasia of lymph vessels
114
primary lymphedema
present at birth (congenital lymphedema) occur at puberty (lymphedema precox) later in life (lymphedema tarda) usually unilateral worse in summer months, before menstruation edema is diffuse, forms mounds on foot or hand, mildly pitting, no skin changes
115
secondary lymphedema
infection, malignancy, following radiotherapy edema is pitting with skin changes
116
lymphedema with infection
fever, chills, red hot swollen leg lymphatic streaks may be seen, lymph nodes are enlarged
117
treatment of lymphedema
antistreptococcal antibiotics elevation surgery to replace lymph nodes
118
PT intervention for lymphedema
complete decongestive therapy

Clin Med Exam 2 (9 decks)

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