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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
Q

ventricular fibrillation

A

EMERGENCY

CAN BECOME ASYSTOLE

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26
Q

rhythm arrythmias

A

variations from the normal rhythm of the heart

can be lethal

symptomatic or asymptomatic

dangerous b/c they reduce CO

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27
Q

types of rhythm arrythmias

A

sinus

ventricular fibrillation

heart block

sick sinus syndrome

holiday heart syndrome

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28
Q

sinus arrythmia

A

irregularity in rhythm that may be normal variation in athletes, children, and older people

may be caused by an alteration in vagal stimulation

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29
Q

ventricular fibrillation (rhythm)

A

electrical phenomenon that results in involuntary uncoordinated muscular contractions of the ventricles

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30
Q

heart block

A

disorder of the heart beat caused by an interruption in the passage of impulses through the heart’s electrical system

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31
Q

sick sinus syndrome

A

brady-tachy

complex cardiac arrythmia and conduction disturbance that is associated w/ advanced age, CAD or drug therapy

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32
Q

holiday heart syndrome

A

may occur when the heart responds to the increase in catecholamines brought on by excessive alcohol intake

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33
Q

arrythmias diagnosis

A

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

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34
Q

arrythmias treatment

A

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

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35
Q

pharmacology of CV system

A

class 1

class 2

class 3

class 4

class 5

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36
Q

class 1 drugs

A

sodium channel blockers

normalize the rate of sodium entry into cardiac tissues and thereby help control cardiac excitation and conduction

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37
Q

class 2 drugs

A

beta-blockers

DECREASE the excitatory effects of the sympathetic nervous system and catecholamines on the heart

most effective for treating atrial tachycardia

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38
Q

class 3 drugs

A

drugs that prolong repolarization

delays the repolarization of cardiac cells, thus slowing and stabilizing the HR, used to trat ventricular arrythmias

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39
Q

class 4 drugs

A

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

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40
Q

common beta blockers

A

end in -olol

acebutolol (Sectra)

atenolol (tenormn)

bisprolol (zebeta)

metoprolol (lopressor)

nadolol (cogard)

propanol

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41
Q

implication for PT for arrythmias

A

assessment for balance and risk of falls

until arrythmia is controlled, activity isn’t recommended

after pacemaker: limit activity for several weeks, scar mobilization

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42
Q

endocarditis

A

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

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43
Q

risk factors of endocarditis

A

the w/ previous valvular damage

prosthetic heart valves

injection drug users

immunocompromised

women who have had suction abortion or pelvic infection

post cardiac surgery

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44
Q

clinical manifestations of endocarditis

A

fever

cardiac murmur

petechial lesions of the skin

conjunctiva

oral mucosa (may not always be present)

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45
Q

diagnosis of endocarditis

A

blood cultures to identify specific pathogens

echocardiography to confirm

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46
Q

endocarditis: rheumatic fever and heart disease

A

one form of endocarditis caused by streptococcal group A bacteria

can be fatal and lead to rheumatic heart disease

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47
Q

rheumatic heart disease

A

a chronic condition caused by scarring and deformity of the heart valves

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48
Q

endocardial inflammation

A

causes swelling of the valve leaflets

49
Q

clinical manifestations of endocarditis: rheumatic fever and heart disease

A

step throat

carditis

acute migratory polyarthritis

chorea (involuntary movement)

50
Q

prognosis for endocarditis: rheumatic fever and heart disease

A

mortality for acute rheumatic fever is low

persistent rheumatic activity w/ complications is associated w/ long term morbidity and mortality

51
Q

pericarditis

A

inflammation of the pericardium

may be a primary condition or secondary to other diseases and circumstances

52
Q

most common types of pericarditis

A

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
Q

constrictive pericarditis

A

fibrotic, thickened, and adherent pericardium that is compressing the heart

54
Q

pericardial effusion

A

refers to fluid accumulation within the pericardial sac

55
Q

clinical manifestations of pericarditis

A

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
Q

diagnosis of pericarditis

A

classic sign is the pericardial friction rub heard on auscultation

X-ray

ECG

CT

MRI

57
Q

treatment of pericarditis

A

pericardiocentesis

pericardial fluid analysis

pericardioscopy

epicardial and pericardial biopsy analyses

all have permitted early specific diagnosis

58
Q

diseases of the aorta

A

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
Q

what is the most common arterial aneurysm

A

aorta

60
Q

thoracic aortic aneurysms

A

most frequently occur in men 40-70 yrs old

61
Q

abdominal aortic aneurysm

A

occur 4x more frequently than thoracic aneurysms

62
Q

peripheral arterial aneurysms

A

affect the femoral and popliteal arteries

63
Q

clinical manifestations of aneurysms

A

early warning signs of impending rupture may include abdominal heartbeat

64
Q

implications for PT

A

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
Q

athletic heart syndrome

A

heart is enlarged d/t significant amounts of exercise

increase in left ventricular mass as a result of intensive training

66
Q

essential hypertension

A

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
Q

prolonged hypertension

A

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
Q

risk factors of essential hypertension

A

genetics

smoking

obesity

high cholesterol

African American descent

69
Q

clinical manifestations of essential hypertension

A

often asymptomatic

symptoms may include headache, vertigo, flushed face, spontaneous epistaxis, blurred vision and nocturnal urinary frequency

70
Q

guidelines for PTs w/ essential hypertension

A

hypertension is most common primary diagnosis in the US and is a major risk factor for coronary heart disease, stroke, renal failure

71
Q

treatment for essential hypertension

A

controlling BP = most effective way to prevent stroke

72
Q

prognosis of essential hypertension

A

life expectancy decreases with rise in diastolic or systolic pressure

73
Q

congenital heart disease

A

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
Q

congenital heart disease types

A

cyanotic

acyanotic

75
Q

cyanotic

A

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
Q

transposition of great vessels (TGV)

A

no communication b/w systemic and pulmonary circulations

aorta exits right ventricle

pulmonary trunk exits left ventricle

77
Q

tetralogy of fallot

A

pulmonary stenosis

large ventricular septal defect

aortic communication w/ both ventricles

right ventricular hypertrophy

78
Q

tricuspid atresia

A

failure of tricuspid valve to develop

lack of communication from the right atrium to right ventricle

79
Q

acyanotic

A

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
Q

ventricular septal defect

A

abnormal opening b//w right and left ventricles

81
Q

atrial septal defect

A

abnormal opening b/w atria

allowing blood from higher pressure left atrium to flow into the lower pressure right atrium

82
Q

coarcatation of the aorta

A

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
Q

patent ductus arteriosus

A

failure of the fetal ductus arteriosus to close

84
Q

peripheral vascular diseases

A

encompasses pathologic conditions of blood vessels supplying the extremities and the major abdominal organs

85
Q

general manifestations of peripheral vascular diseases

A

pain described as cramping or tightness = claudication

(comes on w/ exertion and relieved by rest)

86
Q

thromboangitis obliterans

A

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
Q

thromboangitis obliterans clinical manifestations

A

edema

cold sensitivity

rubor

cyanosis

thin, shiny, hairless skin from chronic ischemia

88
Q

thromboangitis obliterans diagnosis

A

definitive diagnosis determined by histologic examination of blood vessels

(micro-abscesses)

89
Q

thromboangitis obliterans treatment

A

intervention should begin w/ cessation of smoking

90
Q

Raynaud’s disease and phenomenon

A

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
Q

clinical manifestations of Raynaud’s disease and phenomenon

A

ischemia from vasospastic attacks causes
cyanosis

numbness

sensation of cold in the digits

92
Q

Raynaud’s disease

A

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
Q

Raynaud’s phenomenon

A

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
Q

Raynaud’s disease diagnosis

A

diagnosed by a history of symptoms for at least 2 years with no progression and no evidence of underlying cause

95
Q

Raynaud’s disease treatment

A

prevention of alleviation by avoiding stimuli that trigger attacks, physical or occupational therapy

calcium channel blockers

96
Q

raynaud’s phenomenon treatment

A

treatment of underlying cause

97
Q

venous thrombosis

A

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
Q

mural thrombosis

A

where thrombosis is attached to the wall of the vein but does not occlude the vessel lumen

99
Q

occlusive thrombosis

A

begins by attachment to the vessel wall and progresses to occlude the vessel

100
Q

superficial venous thrombosis

A

most commonly occur in the saphenous vein

101
Q

deep venous thrombosis (DVT)

A

usually of the femoral or iliac veins of LE

3rd most common cardiovascular disease

102
Q

clinical manifestations of venous thrombosis

A

leg or calf swelling

pain or tenderness

dilation of superficial veins

pitting edema

skin temp changes

cyanosis

103
Q

diagnosis of venous thrombosis

A

utilization of the wells and colleagues clinic decision rule (CDR) cluster signs, symptoms and risk factors

104
Q

prevention of venous thrombosis

A

anticoagulants

use of knee elastic stockings

105
Q

prognosis of venous thrombosis

A

DVT is a common frequent cause of PE

PE is a frequent cause of RIP

106
Q

PAD/PVD PT intervention

A

regular physical activity***

interval treadmill walking

arm ergometry training

smoking cessation

avoiding of cold

107
Q

why is exercise important for PAD and PVD

A

prevents progressions of plaques

increases dilation capacity

increases collateral blood flow

increase capillarity

increase skeletal muscle metabolism

108
Q

varicose veins

A

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
Q

varicose veins risk factors

A

inherited trait

periods of high venous pressure associated w/ heavy lifting or prolonged sitting or standing

hormonal changes

110
Q

varicose veins pathogenesis

A

valves become incompetent or veins more elastic

the veins become engorged with stagnant feeling of fatigue

111
Q

varicose veins clinical manifestations

A

dilated, tortuous, elongated veins beneath the skin

dull aching heaviness, tension, feeling of fatigue

112
Q

varicose veins interventions

A

vein stripping

radiofrequency to seal off vein

sclerotherapy (controlled atrophy)

laser therapy

113
Q

lymphedema

A

accumulation of excessive lymph fluid and swelling of subcutaneous tissue d/t obstruction, destruction, or hypoplasia of lymph vessels

114
Q

primary lymphedema

A

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
Q

secondary lymphedema

A

infection, malignancy, following radiotherapy

edema is pitting with skin changes

116
Q

lymphedema with infection

A

fever, chills, red hot swollen leg

lymphatic streaks may be seen, lymph nodes are enlarged

117
Q

treatment of lymphedema

A

antistreptococcal antibiotics

elevation

surgery to replace lymph nodes

118
Q

PT intervention for lymphedema

A

complete decongestive therapy

Clin Med Exam 2 (9 decks)

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