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Cardiovascular
| Term | Definition |
|---|---|
| Signs and Symptoms of cadrio Disease | Chest/Neck/UE Pain or Discomfort, Palpitations, SOB/Dyspnea, Syncope, Fatigue, Cough, Cyanosis, Claudication |
| What is Claudication? | Symptom of vascular component consisting of edema & LE pain. Peripheral edema hallmark of right ventricular failure Skin discoloration, trophic changes (thin, dry, hairless skin) cool skin = vascular obstruction warm skin = inflammation/infection |
| Aging of the cardiovascular system | THE HEART:Reduction in myocytes & conduction cells, less capillaries, impaired autonomic control of heart rate ARTERIES: Deterioration of walls. Stiffwalls, increased BP = arterial damage (cycle) Lowered functional capacity, esp. during exercise |
| Exercise and the cardiovascular system | Lowers resting HR, Lowers BP, Improves endurance/cardiac efficiency, Reduces incidence of diseases that are risk factors for CV disease, |
| Gender differences | CAD is the leading cause of death in U.S. women, Higher incidence of bleeding with thrombolytics, Estrogen is protective in heart disease, AMI: 1stc/o is often nausea! |
| Ischemic Heart Disease( CAD/ CHD) | Myocardium not receiving adequate 02, Form of above; atheromas & fatty streaks develop. Fibrous plaque, rupture, & thrombosis can result in coronary arteries Arteriosclerosis, Atherosclerosis |
| Modifiable Risk factors of heart disease | Smoking - #1 preventable cause of CAD, HTN, Blood Lipids, Obesity, Diabetes Mellitus, Metabolic Syndrome (“diabesity”) |
| Sternal precautions | No lifting over 8-10 lbs, No push/pull with arms, Walking – HHA best, cane worst, No reaching behind back, Hug pillow during cough/sneeze. Move in the Tube: Goal = Shortened lever arm for load-bearing movements |
| PT Rehab of Cardic pt. | Great research: improved exercise tolerance without adverse outcome, Imperative to MONITOR VITALS!, Angina, N&V, severe dyspnea, pallor, coldmoist skin, HR over 130bpm or under 40. |
| Beta Blockers | Lopressor (metroprolol), Inderal (propranolol),Tenormin (atenolol) Goal: Lower BP....Relax blood vessels in heart; decline in force of contraction and HR. Side effects: Insomnia, nausea, fatigue, bradycardia, weakness |
| Calcium-Channel Blockers | Norvasc (amlodipine), Procardia (nifedipine) Goal: Lower BP......Dilate coronary arteries to lower BP & suppress some arrthymias Side Effects: fluid retention, palpitations, HA, dizziness. |
| Diuretics | Lasix (furosemide), Hydrodiuril (hydrochlorothiazide Goal: Increase excretion of sodium & water to control HTN and fluid retention Side Effects: drowsiness, dehydration, electrolyte imbalances, muscle cramps & fatigue, dizziness. |
| Angina | Cardiac workload exceeds 02 supply to myocardial tissue Chronic stable angina: Classic, predictable, no pain at rest Unstable angina: Nocturnal, Chronic, Resting/Decubitus PT: Reduce activity or rest with stable angina. |
| Hypertension/HTN | Blood Pressure = Force of Blood exerted on arterial walls. Regulated by 2 factors: 1. Blood flow (determined by cardiac output) 2. Peripheral vascular resistance: diameter of vessels & viscosity of blood |
| Hypertension blood pressure levels | 120/80 mm Hg: normal resting adult 130/80 mm Hg: Stage 1 Hypertension 140/90 mm Hg: Stage 2 Hypertension |
| Orthostatic Hypotension | Gravity causes venous pooling in LE therefore a reduction in the pressure of the heart Cause: Prolonged recumbency, Medication side effects, After physical exertion PT: Testing, Pt. ed:rise slowly, ankle pumps, ESSENTIAL to cool-down after exercise. |
| Myocardial Infarction Etiology | Ichemia with resultant necrosis of myocardial tissue 80-90% from atherosclerotic stenosis & coronary thrombus Goal: reperfusion therapy (thrombolytic; IV heparin) within 1sthour. |
| Treatment of MI | Prognosis –60% mortality rate if over the age of 80 Post-MI Complications: Arrhythmias, CHF, pericarditis. Rehab Implications: Gentle mobility begins within 24 hrs, elemetry, may need 02, No aquatics, WP, hot tubs for 6 week. |
| Congestive Heart Failure | Condition where heart is unable to pump sufficient blood to supply the body’s needs Blood backs up into pulmonary veins→ congestion & pulmonary hypertension Left ventricular failure = CHF•Right ventricular failure = cor pulmonale |
| S/S of CHF | Exertional Dyspnea, Fatigue, Muscular weakness, Renal Changes, Right-sided Heart Failure |
| CHF Rehab | Exercise improves functional capacity, reduces symptoms, Early mobilization in acute care, Monitor vitals; watch for return to baseline (≤ 3 min), High Fowler’s position (HOB ↑) |
| Cardiomyopathy | Group of conditions affecting the heart muscle itself; contraction/relaxation of myocardial muscle fibers impaired, Ischemia from CAD most common cause Prognosis & tx. depend on type & severity Cardiac transplant only cure |
| Types or Cardiomyopathy | Dilated Cardiomyopathy• disease (risks include obesity, smoking, ETOH abuse, systemic HTN); or idiopathic Hypertrophic•Genetic; sudden death in young competitive athletes Restrictive•Myocardial fibrosis, hypertrophy |
| Arrhythmia | Disturbance of rate or rhythm caused by abnormal electrical impulse generation by SA node or abnormal conduction of impulses |
| Arrhythmia Etiology | Classified by:•Origin(ventricular or supraventricular)•Pattern(fibrillation or flutter)•or Rate(tachycardia, bradycardia) Cause – Often Multi-factorial•HTN, h/o MI, valvular heart disease, degeneration of conductive tissue |
| Types of Arrhythmias | Atrial Fibrillation – most common chronicarrhythmia•Blood remains in atria & ventricles don’t fill properly Ventricular Fibrillation (v-fib) •Freq. cause of cardiac arrest; must depolarize quickly |
| Rehab of Arrhythmias | Treatment: cardioversion, meds PT: Most arrhythmias asymptomatic, If symptomatic: syncope, dizziness, chest pain, Increased by exercise (& often during recovery) –monitor MRIs & diathermy CONTRAINDICATED |
| Aneurysm | Abnormal dilation in wall of vessel or heart with diameter ≥ 50% than normal Etiology:injury to tunica media (atherosclerosis, trauma) Pathogenesis: plaque erodes vessel wall, layers stretch & weaken |
| Types of Aneurysm | Dissecting:layers of vessel wall separate AAA:below diaphragmatic border most common Cerebral:CVA Peripheral arterial aneurysms: femoral & popliteal arteries |
| Aneurysm PT implications | Detection usually by accident; many asymptomatic; often monitored if under 5cm Rehab: Invasive sx. – high risk for pulmonary complications, Proper lifting techniques, avoid Valsalva |
| Peripheral Vascular Disease | Pathologic condition of vessels supplying blood to the extremities & major organs (intestines & kidneys) Arteries & veins; LEsmore common than UEs PAD is MOST COMMON reason for AMPUTATION |
| PVD classifications | Arterial occlusive – most common (PAD) Inflammatory (vasculitis) Venous (DVT, PE, CVI) Vasomotor (Raynaud’s) |
| Peripheral Arterial Disease (PAD) | Most common arterial occlusive disease Arteriosclerosis Lumen of artery narrows and then is eliminated Progressive; causes ulcers of LEs, feet Risk Factors: •Smoking #1•Others: same as atherosclerosis |
| PAD: INTERMITTENT CLAUDICATION | Intermittent Claudication– Classic PAD-Begins when vessel ~50% narrowed; generally in calves Predictable Resolves with rest PAD graded by distance person can walk before pain |
| The 5 P's for PAD | 1. Pain 2. Pallor 3. Paresthesia 4. Paralysis 5. Pulselessness |
| Rehab for PAD | Progressive conditioning: intermittent exercise to near-maximal pain, rest until pain subsides Wound healing – complicated by DM |
| CHRONIC VENOUS INSUFFICIENCY (CVI) | aka Venous Stasis Damaged valves = ↓venous return = ↑venous pressure & venous stasis Chronic blood pooling = cell damage Risk Factors: •h/o DVT, LE trauma, varicose veins, immobility, ↓nutrition |
| CVI S/S | Chronic leg ulcers (medial malleolus) Edema Thick, coarse skin; brown pigmentation near ankles Dermatitis & cellulitis can develop |
| CVI PT implications | Avoid prolonged sit/stand, leg crossing, Compression hose during day; LE elevation, Avoid tight garments popliteal area, Compression wraps/devices•ABI First! If CHF must monitor closely Skin assessment, wound care•Whirlpool 1-2 sessions MAX |
| VENOUS THROMBOSIS | aka Thrombophlebitis Partial or complete occlusion of a vein by a thrombus with 2º inflammatory reaction in the wall of the vein •Deep vein thrombosis (DVT) most common 90% found in LEs, 10% UEs Proximal DVTs much more likely to become PEs* |
| Venous Thrombosis Risk Factors | Immobility (venous stasis): bed rest, air travel Trauma (venous damage): sx, trauma, childbirth Lifestyle: pregnancy, smoking, OCs Hypercoagulation: neoplasm, hereditary thrombolytic dz Other: DM, obesity, previous DVT, over 60 |
| DVT Rehab/Prevention | Prevention•Early mobilization•Prophylactic use of anticoagulants •TED hose post-op patients Rehab Implications•Often 24 hour PT hold s/p DVT•Watch pt’s with anticoagulant therapy for bleeding:•Hematuria, blood in stool, gum bleeding |
| Skin care for Vessel Disorders | Examine regularly, seek immediate assistance with any breaks Avoid dry skin; no lotion between toes, no scratching NO barefoot, prevent blisters Misc.•No razor blades•Avoid caffeine•Avoid crossing LEs |
Created by:
SamuelD