Week 9 Cardiovascular and Pulmonary Implications Flashcards
ALS cardiac involvement
Sympathetic nervous system involvement – sudden cardiac death or arrhythmia
Decreased myocardial mass
Decreased EF
Myocardial fibrosis in 25%
ALS respirator involvement
Both paresis of respiratory muscles respiratory failure and pneumonia can increase speed at which mortality occurs
What is the most common cause of mortality in ALS
Pulmonary complications
Bulbar ALS can result in
difficulty with secretion management, but also difficulty with PFT’s due to weakness/spasticity
A ALS model including increasing age, longer time to diagnose, bulbar disease, lower FVC, more functional limitations, and the presence of respiratory symptoms was
strongly predictive of respiratory insufficiency at 6 months
MS cardiac involvement
Increased risk of CAD/CVD
Increased risk of ACS, MI, a fib
Lesions in ANS affecting areas involved in cardiac function
Cardiotoxicity of certain medications
MS pulmonary involvement
rare
Contributions to cardiovascular dysfunction in patients with MS include
Lack of mobility
Changes to myocyte structure
Changes to endothelial function
increased risk of CVD
ANS involvement
Inflammation
Parkinson’s disease cardiac involvement
Cardiac dysautonomia – HTN, orthostatic hypotension
Medication toxicity
Structural dysfunction – L ventricular hypertrophy, diastolic dysfunction, heart failure, arrhythmias
Parkinson’s disease pulmonary involvement
Common cause of mortality
Respiratory dyskinesia
Restrictive dysfunction
Chest wall rigidity
Aspiration
PD peripheral
respiratory muscles, posture, airways
PD central
brain centers for respiratory control
Myasthenia gravis
Autoimmune disorder in which antibodies attack neuromuscular junction and result in muscle weakness
Myasthenia gravis commonly affects
ocular and bulbar musculature, but may affect pulmonary organs/functions
Muscular Dystrophy
Series of genetic mutations resulting in progressive muscle weakness/atrophy
Respiratory muscle weakness -> poor cough, hypercapnia
Restrictive pulmonary dysfunction
Sleep-disordered breathing
Aspiration -> hypoxia, hypercapnia
Dilated cardiomyopathy
Arrhythmias and electrical abnormalities
Guillain-Barre Syndrome
Acute inflammatory demyelinating polyneuropathy
Guillain-Barre syndrome has 20-30% of cases require ventilatory surgery
Bulbar involvement most associated with need for mechanical ventilation
Higher mortality rate (41%) with MV compared to non-MV (7%) in one study
_____% of patients with Guillain-bare syndrome develop respiratory complications
50
Guillain-Bare Syndrome risk of complications
Sepsis, PE, Pulmonary infections like pneumonia
Guillain-Bare Syndrome symptoms
Dyspnea, poor/weak cough, dysphagia, weakness of inspiratory and expiratory muscles, aspiration, atelectasis
has decreased vital capacity
Post-polio syndrome
bulbar or muscle dysfunction resulting in restrictive pulmonary presentation
Myotonic dystrophy
arrhythmias, sudden cardiac death
Amyloidosis
build up of the protein in on organs/tissues
Amyloidosis associated dx
Lung infiltrates and plaques
Diaphragm weakness
Respiratory failure
Cardiomyopathy
Diastolic dysfunction
MI
Arrhythmia
