1
Q
Angina Pectoris
A
- Acute ischemic (holding back blood flow) in chest pain
- insufficient blood flow to the heart muscle from narrowing of coronary artery
2
Q
Eitology of Angina Pectoris
A
-ischemia to the myocardium from arteriosclerotic (plaque formation)disease
3
Q
Signs and Symptoms of Angina Pectoris
A
- sudden onset of severe and sharp pain usually in the chest, neck, shoulder or left arm
- often occurs from overexertion, emotional stress or extreme weather exposure
4
Q
Medical Intervention for Angina Pectoris
A
- Nitroglycerin pills (vasodilators)
- Nitroglycerin patch (continuous dose) ex. Unstable angina
- CABG (Coronary Artery Bypass Graft)
- Angioplasty
5
Q
Physical Therapy for Angina Pectoris
A
-if angina occurs during treatment, patient must be asked to rest and inform the PT or nurse
6
Q
Aortic Atherosclerosis
A
- build up of plaque in aorta
- a “silent disease” (no symptoms)
- hardening of the wall of the aorta
7
Q
Etiology of Aortic Atherosclerosis
A
-familial tendency
8
Q
Signs and Symptoms of Aortic Atherosclerosis
A
- frequently asymptomatic
- HTN (hypertension)
- aneurysm commonly in the abdominal aorta
9
Q
Medical Intervention for Aortic Atherosclerosis
A
-surgical repair of aneurysm
10
Q
Physical Therapy for Aortic Atherosclerosis
A
-strengthening program after repair
11
Q
Atherosclerosis
A
- hardening of the arteries
- leads to thickening of the vessels accompanied by loss of elasticity, flexibility, and contractility
12
Q
What is Atrial fibrillation?
A
- rapid, quivering of the heart mms
- some mms fibers are contracted and some are not
- strength is weak
13
Q
Cyanosis
A
-lack of oxygen causing bluish tint
14
Q
Peripheral cyanosis
A
- seen in distal parts of the body (digits)
- pertaining to a heart condition
- cause bc heart is weak and it doesn’t create enough pressure to supply to distal areas of body
- corrected by using heat in distal areas to open up blood vessels
15
Q
Central cyanosis
A
- due to respiratory conditions
- seen in lips, tongue, mucous membrane
- only way to correct is by supplying supplemental oxygen
- pulse excementer will read 90% or lower
16
Q
Dyspnea on exertion
A
-difficulty breathing during exercises
17
Q
Edema
A
- swelling in feet, hands & abdominal area
- bilateral, means it’s related to a heart condition
18
Q
Fatigue
A
- lack of energy
- has to be associated with the other signs and symptoms of cardiac disease to be heart related
19
Q
Heart block
A
- dealing with nerve conduction to the heart
- If SA node malfunctions there is a back up system of the ventricles that contracts at a slower pace 40 bpm
- it’s not sufficient to supply blood to the body
- may lead to losing conscience or heart to completely stop
20
Q
Intermittent claudication
A
- on/off pain
- pain in calf mms that is relieved by resting
- caused by a blocking or narrowing in the popiplital artery so mms aren’t getting proper nourishment and/or oxygen
21
Q
Pain
A
- left chest pain (angina) & left arm pain, left shoulder, neck, right side of chest, jaw
- sometimes pain between scapula
22
Q
Palpitations
A
-irregular, pounding heartbeat
23
Q
Premature ventricular contractions
A
- when there not suppose to contract causing an irregularity
- sometimes can lead to instant death
24
Q
Reduced ejection fraction
A
- normal volume of blood being squeezed by heart is 55-75% ejection fraction
- anything less is reduced ejection fraction
25
Syncope
- fainting, dizziness
| - blood not going into brain area
26
Orthopnea
- Difficulty breathing upon supine lying
- when they lay down, there is a increase venous return to the heart
- feels like their drowning
- they instinctively sit up
- the use of gravity reduces the return to the heart
27
What happens to blood in heart if it is going through atrial fibrillation?
- Sit there and coagulate
- thicken up and clot
- usually the start of someone getting a heart attack or stroke
28
SA node
- Pace maker of heart
| - normal is 70 beats per minute
29
General signs and symptoms of cardiac disease.
```
Atrial fibrillation
Cyanosis
Dyspnea
Edema
Fatigue
Heart block
Intermittent claudication
Pain
Palpitations
Premature ventricular contractions
Reduced ejection fraction
Syncope
Ventricular fibrillation
```
30
If a person has a ejection fraction of 40% what can you say about this person's heart? Physical therapy treatment?
- weak
- won't be able to put them through physical therapy exertion
- provide them therapy on patient education on energy conservation techniques
31
Normal heart rate?
60-100 bpm
- higher than 100 tachycardia
- lower than 60 bradycardia
- average is 70
32
Normal SV?
70 ML
33
Cardiac output (CO)
HR x SV = CO
34
Normal cardiac output?
5 L per minute
35
Cardiac catheterization
- catheter gets inserted in the inguinal femoral artery or the radial artery
- it can show how severe the CAD is and whether there is valve disease, an aneurysm, myocardial infarction, or pericardial disease
36
Angiography
- insert dye through catheter and take picture of it
- goes to the coronary arteries
- person undergoes this if experiencing chest pain
- determines if there is a blockage in the coronary arteries and how much
37
Echocardiography
- noninvasive procedure
- a reading is taken of the heart and coronary blood vessels by bouncing sound waves off the heart
- it can detect the size of the heart, valve function, thickness of the walls of the heart, CAD, and ischemia of the heart muscle
38
Electrocardiogram
- looking for electro conductivity of heart
- ECG strip
- records the way the heart beats
39
ECG strips
- readings from a electrocardiogram that measures heart rhythm and rate and can indicate hypertrophy and infarction of heart muscle
- P wave- corresponds to atrial depolarization/contraction
- QRS complex- corresponds to ventricles
- T wave- corresponds to ventricular relaxation/repolarization
40
Flattened P wave in ECG strip?
-May mean person is in atrial fibrillation
41
QRS complex elevation in ECG strip?
-may mean person is having a MI(heart attack)
42
Holter monitoring test
- portable EKG
| - use it for 24 hours
43
PET Scan
- test making use of nuclear imaging
| - scan of the heart
44
Exercise Stress Test
-person goes through an exercise and specialist monitors heart rate
45
Chemical stress test
-someone who can't exercise ex.pt with osteoarthritis in the knees
46
Levine sign?
-Person pounding chest
47
Stable Angina
- most common
| - appears when person is exercising
48
Unstable Angina
-no activity and angina shows up
49
Circle of Willis
- arteries in the head
| - supplies blood to brain
50
Atherosclerosis
-hardening of the arteries
51
Arteriosclerosis
- hardening of the walls of the arterioles in the extremities or organs
- arteries become narrowed and blood flow decreases
- the plaque build up first starts in the aorta
52
Atherosclerosis and Arteriolsclerosis
-both conditions lead to thickening of the vessels accompanying by loss of elasticity, flexibility and contractility
53
Etiology of Atherosclerosis and Arteriosclerosis
- changes in the walls of the arteries due to hypertension, diabetes, cigarette smoking, family tendency, hypothyroidism, hypercholesterolemia
- other causes may be from lack of exercise, obesity, and use of oral contraceptives
54
Signs and symptoms of Atherosclerosis and Arteriosclerosis
- no outward signs and symptoms
- angina
- CVA (stroke)
- HTN
- intermittent claudication, ulcers, end stage renal diseases, gangrene, DVT(deep vein thrombosis) or CVA from a thrombus(clot)
55
Medical intervention for Atherosclerosis and Arteriosclerosis
- anticoagulants such as ASA(acetal salicylic acid) aspirin
- anti cholesterol and antihypertensive medications
- carotid endarterectomy using saphenous vein(leg) or internal mammary artery
- bypass graft
- lifestyle change
56
Transient Ischemic Attack (TIA)
- precursor to a stroke
- symptoms of a stroke
- symptoms don't last more than 24 hours
57
Physical therapy for Atherosclerosis and Arteriosclerosis
-none but watch for complications from clot formation
58
Cardiac arrest/heart attack/myocardial infraction
- sudden stopping of the heart
- the side the is usually effected is the left ventricle
- the cause of this is complete inclusion of blood supply to ventricle
59
Infarction
-death
60
Etiology of Cardiac arrest/heart attack/myocardial infraction
- myocardial infarction (MI)
- loss of blood to the heart secondary to a systemic shock
- injury causing massive loss of blood
- electric shock or drowning
61
What coronary artery is affected with MI?
Left anterior descending coronary artery
62
Signs and symptoms of Cardiac arrest/heart attack/myocardial infraction
- angina
- dyspnea
- pain in neck, crushing pain on left/right arm
- sweating, pallor, nausea, rapid pulse
- sudden onset of tachycardia or bradycardia
- may have loss of consciousness
63
Medical Intervention for Cardiac arrest/heart attack/myocardial infraction
- CPR as needed
- rest, oxygen supplement
- pain medications
- Thrombolytic agents, anticoagulants (blood thinner), antihypertensives, anti-cholesterol medications
- angioplasty
- CABG
- lifestyle changes
64
Physical therapy for Cardiac arrest/heart attack/myocardial infraction
- cardiac rehabilitation
- Phase I: inpatient (hospital)
- Phase II: outpatient (SNF, Home)
- Phase III: on their own
65
Congestive Heart Failure
- in the ventricles
- a condition where the heart is no longer able to pump enough blood to meet the body's needs
- left ventricular failure
66
Etiology of CHF
- infarction of L ventricle - MI
- aortic stenosis (narrowing of the aorta)
- HTN
- hyperthyroidism
67
Etiology of R ventricular failure (cor pulmonale)
- infarction of R ventricle
- pulmonary valve stenosis
- lung disease
68
Signs and symptoms of CHF
- pulmonary edema bc alevoli filled with fluid, feel like they are drowning
- pleural effusion leading to dyspnea
- central cyanosis
- easily fatigued, lethargic
- dyspneic (dry, nonproductive) with a cough bc of pulmonary edema
- oliguric (reduced urine formation)
- anasarca (general body edema)
- weight gain overnight, usually more than 2lbs
69
Right ventricular failure (cor pulmonale)
- dependent edema on LE - swelling of the feet- bilateral - back up of blood in the right ventricle, right atrium, & vena cava causes the swelling
- hepatomegaly, splenomegaly
- distention of jugular vein bc of increased pressure of backed up blood from vena cave going into jugular vein
- ascites - in alcoholics - retention of fluid in liver
70
Medical intervention for Right ventricular failure (cor pulmonale)
- beta blockers and digitalis medicines to increase the pumping ability of the heart
- ACE inhibitors and vasodilators open blood vessels reducing resistance to blood flow - controls blood pressure
- diuretics to remove excess water and sodium
- heart transplant in severe cases
71
Physical therapy for Right ventricular failure (cor pulmonale)
- to increase endurance and strength
- safety with gait
- lifestyle change
- cardiac rehab
72
Hypertension and hypertension heart disease
-normal blood pressure exceeds a certain amount
73
Normal systolic and diastolic blood pressure
-systolic:
74
Prehypertension systolic and diastolic blood pressure
- systolic: 120-139
| - diastolic: 80-89
75
Stage 1 hypertension systolic and diastolic blood pressure
- systolic: 140-159
| - diastolic: 90-99
76
Stage 2 hypertension systolic and diastolic blood pressure
- systolic: 160 and up
| - diastolic: 100 and up
77
Etiology of hypertension and hypertensive heart disease
- primary or essential hypertension is idiopathic
- secondary hypertension can be due to kidney disease, adrenal tumors, adrenal tumors, psychological factors, pain killers, oral contraceptives
- labile HTN is a rare form of essential HTN not responsive to any intervention
78
Signs and symptoms of hypertension and hypertensive heart disease
- systolic BP is 140 or higher or diastolic BP is 90 or higher
- prehypertension is systolic BP between 120 and 139 or diastolic BP between 80 and 89
- no physical signs
79
Medical intervention for hypertension and hypertensive heart disease
- anti hypertensives
- diuretics- bc of the retention of fluid which causes increase pressure
- diet and lifestyle modification
80
Complications of hypertension
- cardiomegaly - bc of increased resistance to blood vessels so the heart has to pump against it
- cor pulmonale (R ventricular hypertrophy)
- CHF
- atherosclerosis
- hypertensive encephalopathy - increased blood pressure brain disease
- blindness from retinal affectation - arteries to the eyes are sensitive so if blood pressure is high it can affects it
81
Physical therapy for hypertension
- BP monitoring
82
Coronary artery bypass graft
- a procedure that provide a bypass for the blood and restore arterial blood to the myocardium
- uses saphenous vein or internal mammary artery
- re establish circulation
83
Heart transplant
- maybe orthotopic(replace heart that's bad) or heterotopic(transplant heart connected to your bad heart)
- candidates must have end-stage CAD(coronary artery disease)
- factors considered are survival rate, quality of life, relief of symptoms
84
Open heart surgery
- used for any procedure in which the heart muscle must be open to provide access for surgical intervention
- most commonly done in mitral valve replacement
- incision is known as median sternotomy
85
Pacemaker insertion
- cardiac pacemaker taking over function of the SA node when it is not functioning normally
- pacemakers may be unipolar or bipolar
- on-demand pacemakers vs fixed rate pacemakers
- contraindicated in use of ES bc it will alter the frequency of the pacemaker
86
Percutaneous transluminal coronary artery angioplasty
- performed on vessels with atherosclerosis when the artery is not completely occluded
- stent may be used
- atheromas(plaques) may be surgically removed
87
Peripheral vascular disease (PVD)
- used to describe atherosclerosis of the peripheral arteries mainly of the LE bc they are more distal to the heart
- commonly results from DM(diabetes), HTN, hypercholesterolemia
88
Etiology of Peripheral vascular disease (PVD)
- hx of trauma
| - secondary to DM, HTN, hypercholesterolemia
89
Signs and symptoms of Peripheral vascular disease (PVD)
- reduced kidney function resulting in HTN, oliguria in affectation of arteries to the kidneys
- constipation or malabsorptions in affectation of arteries to intestines
- intermittent claudication in affectation of LEs
- ulcers on lateral leg(bc of artery problem), gangrene and necrosis
90
If a pt has a ulcer on the medial side of leg what problem do they have?
-venous problem
91
Medical intervention for Peripheral vascular disease (PVD)
- amputation in cases of gangrene
- angioplasty or bypass grafts
- statin medications - anti cholesterol medications for hypercholesterolemia
- antiplatelet medications
92
Physical therapy for Peripheral vascular disease (PVD)
- no direct heating - bc the blockage won't be able to supply the increase needs
- no massage - bc you could dislodge the plaque and cause an embolus
- patient education (raise head of bed, smoking cessation, diet, discipline with medications, nightly skin inspections, no compression stockings)
93
Thrombophlebitis and DVT
-Inflammation and clotting within the veins
94
Etiology of Thrombophlebitis and DVT
Infection, trauma, surgery to area, prolonged immobilization
| -surgery to area and prolonged immobilization can lead to DVT(deep venous thrombosis)
95
Signs and symptoms of Thrombophlebitis and DVT
- fever, tenderness, erythema(red blood cells inflammation)
- induration (hardening of the tissue)
- pain and tightness in the area
- (+) homan's sign
96
Medical intervention for Thrombophlebitis and DVT
- bed rest
- anticoagulants
- compression garments -gives pressure to assist blood back
- compression pumps
97
Physical therapy for Thrombophlebitis and DVT
-early mobilization for prevention
98
Lymphedema
-a chronic edema resulting from an increase in lymphatic fluid
99
Etiology of Lymphedema
- damage to the lymph nodes from neoplasms, cellulitis, trauma, post surgical complications, extensive burns, post radiation treatment
- parasites filariasis in tropical countries
100
Signs and symptoms of Lymphedema
-swelling of involved arm or leg
101
Medical intervention for Lymphedema
- lymphedema management
- skin and wound care
- will need constant treatment
102
Pt who has a reduced ejection fraction, what kind of physical therapy treatment do they get?
-Pt education on energy conservation techniques
103
Homan's sign
- it's a sign of DVT
| - characterized by pain in the calf when the foot is passively or actively dorsiflexed
104
+ Homan's sign
- is when you grab pts calf and dorsiflex the foot and they say it's painful
- means there is a clot
Cardiovascular Pathologies
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