Cardiovascular Disease

how much does blood volume increase with pregnancy

doubles

most common medical complication in pregnancy

hypertension

what type of exercise is recommended during pregnancy

aerobic exercise

considerations for physical therapists

- be aware of any preexisting CV conditions

- be aware of conditions that can develop in pregnancy

- regularly check BP in pregnant patients both at rest and in response to activity

- report elevated BP to physician immediately

which hormone is shown to be cardioprotective

estrogen

estrogen significantly (INCREASES/DECREASES) in postmenopausal women

decreases

menopause and oophorectomy result in (INCREASED/DECREASED) CVD incidence and severity (INCREASED/DECREASED) prevalence of CAD

increased, increased

most common causes of premature delivery

maternal hypertension or preeclampsia

a decrease in chest wall compliance is caused by (INCREASED/DECREASED) downward excursion of the diaphragm

decreased

expiratory reserve volume (ERV) is decreased by what percent in pregnancy

8-40%

work of breathing is (INCREASED/DECREASED) during pregnancy

increased

what position is contraindicated for pregnant women after 20 weeks gestation

supine

what two positions are associated with decreased cardiac output

supine and prolonged periods of motionless standing

development of respiratory system begins in what week of gestation

4

4 periods of lung maturation

- pseudo glandular period

- canalicular period

- terminal saccular period

- alveolar period

pseudo glandular period timeline

6-16 weeks gestation

canalicular period timeline

16-26 weeks gestation

terminal saccular period timeline

26 weeks to birth

alveolar period timeline

32 weeks gestation to 8 years

APGAR scale

appearance, pulse, grimace, activity, respiratory

what APGAR score is reassuring

>7/10

history taken during pediatric evaluation

- child's gestational age at birth

- type of delivery

- APGAR score

- NICU stay and other hospitalizations

- history of intubations and airway support

- surgical history

- feeding

earliest development appearing in week 3 of gestation

pair of endothelial strands (angioblastic cords)

when in gestation do cords form heart tubes

day 21

heartbeat heard by what days in gestation

22-23

circulating blood by what day in gestation

27

what week of gestation does the atrium begin to separate into right and left atria with the sequential growth of two septa

middle of the 4th week

what week of gestation does the dorsal part of the septum deteriorate, forming a new right to left shunt through the foramen secundum

5th

what week of gestation do the ventricles divide equally

7th

what week of gestation does the septum secundum grow from the ventrocranial wall of the atrium on the right side of the septum primum

near the end of the 8th week

what week of gestation is cardiac development is primarily complete

10th

in fetal circulation, most of the blood bypasses what organ and reaches the left ventricle via the foramen ovale or ductus arteriosus

lungs

what does the fetus use to obtain oxygen and to get rid of carbon dioxide

the placenta

# of arteries and veins contained in the umbilical cord

2 arteries, 1 vein

the blood vessels of pulmonary circulation are (VASOCONSTRICTED/VASODILATED) in the fetus

vasoconstricted

CHDs affect nearly what percent of births per year in the US

1% (~40,000)

incidence of moderate and severe forms of CHD in live births

6 / 1,000

babies shouldn't eat/breastfeed for more than how many minutes at a time

30 minutes

two types of CHDs

cyanotic and acyanotic

acyanotic CHD

- normal O2 saturation

- increased pulmonary blood flow

- left to right shunting

symptoms of acyanotic CHD

sweating, increased RR, heart failure

problems associated with acyanotic CHD

- low PaO2 to periphery

- low systemic stroke volume

- increased work on heart

types of acyanotic lesions

- atrial septal defect (ASD)

- patent ductus arteriosus (PDA)

- ventricular septal defect (VSD)

- atrioventricular septal defect

- coarctation of aorta

atrial septal defect (ASD)

caused by patent foramen ovale

allows oxygen rich blood to mix with oxygen poor blood

ventricular septal defect (VSD)

one or more small openings in the wall separating the ventricles

may cause higher pressure in the heart or reduced oxygen to the body

coarctation of the aorta

obstruction of left ventricular outflow because of narrowing of the aorta

- may cause high BP or heart damage

complete atrioventricular canal defect

- a large hole in the center of the heart affecting all four chambers where they would normally be divided

- the hole allows blood to mix and prevents the chambers and valves from properly routing the blood to each station of circulation

cyanotic CHD

- decreased arterial O2 saturation

- right to left shunting (most of the blood bypasses the lungs)

- signals increase for red blood cell formation, resulting in polycythemia

- increased risk for cerebrovascular insult

types of cyanotic lesions

- tetralogy of fallot

- hypoplastic left heart syndrome

- transposition of the great arteries

- tricuspid atresia

- pulmonary atresia

- truncus arteriosus

- total anomalous pulmonary venous return

- pediatric heart failure

tetralogy of fallot

- heart defect featuring four problems: (1) pulmonary stenosis, (2) VSD, (3) overriding aorta, and (4) right ventricular hypertrophy

- often seen in children with down syndrome

tricuspid atresia

- there is no tricuspid valve so blood can't flow normally from the right atrium to the right ventricle which causes the right ventricle to be small and not develop fully

- survival depends on there being an opening in the wall between the atria (atrial septal defect) and usually an opening in the wall between the ventricles (ventricular septal defect)

hypoplastic left heart syndrome

- an underdeveloped left side of the heart

- the aorta and left ventricle are too small and the holes in the artery and septum do not properly mature and close

- poor prognosis, those that survive undergo multiple surgeries

- most children with this condition require a heart transplant

pulmonary atresia

- no pulmonary valve exists so blood can't flow from the right ventricle into the pulmonary artery and on to the lungs

- the right ventricle and tricuspid valve are often poorly developed

- can cause very severe cyanosis and symptoms may develop soon after birth

truncus arteriosus

- rare, congenital, cyanotic heart defect characterized by a ventricular septal defect, a single truncal valve, and a common ventricular outflow tract

- systemic venous blood and pulmonary venous blood mix at the VSD level and the resulting desaturated blood is ejected

which type of CHD typically requires surgery early on, sometimes even in utero

cyanotic

Eisenmenger syndrome

- irregular blood flow in the heart and lungs that causes the blood vessels in the lungs to become stiff and narrow, raising BP (pulmonary arterial hypertension)

- permanently damages the blood vessels in the lungs

ventricular assist device (VAD)

- mechanical pump that helps blood flow through the body

- used to bridge to candidacy for heart transplant, recovery from illness, or destination therapy (last effort)

- PT with VAD placement ahs shown improvements in function, exercise capacity, and acceleration in recovery from transplant

what percent of babies born with non-critical CHD are expected to survive to 1 year of age

~97%

what percent of babies born with critical CHD are expected to survive to 1 year of age

~75%

the population of people with CHDs is (INCREASING/DECREASING)

increasing

apnea of prematurity

defined as cessation of breathing for 20 seconds or longer in an infant born at <37 weeks gestation causing bradycardia, cyanosis, or both

persistent pulmonary hypertension (PPHN)

- characterized by increased pulmonary vascular resistance

- usually appears within the first 12 hours of life

- associated with cyanosis, tachypnea, intercostal retractions, nasal flaring, or grunting

meconium aspiration syndrome (MAS)

- occurs when a baby has their first bowel movement in the womb or during delivery and inhales it

- caused by fetal stress (uncommon)

- treated with IV antibiotics

respiratory distress syndrome (RDS)

- also known as hyaline membrane disease

- caused by deficient amount of pulmonary surfactant that causes the overall retractive forces of the lungs to be greater than normal

- decreases lung compliance

- increases the work of breathing

- leads to progressive diffuse micro atelectasis, alveolar collapse, increased ventilation-perfusion mismatching, and impaired gas exchange

characteristics of respiratory distress syndrome

- "white out" on x-ray imaging

- airless alveoli

- inelastic lungs

- RR >60 breaths per minute

- nasal flaring

- intercostal and subcostal retractions

- grunting on expiration

- peripheral edema

ABC of safe sleeping

alone, on back, in a crib

sudden infant death syndrome (SIDS)

- sudden, unexpected death of an otherwise healthy infant during sleep

- may be linked with respiration

bronchopulmonary dysplasia (BPD)

- chronic respiratory disorder characterized by scarring of lung tissue, thickened pulmonary arterial walls, and mismatch between lung ventilation and perfusion

- persistence of respiratory symptoms after 1 month, abnormal radiographic findings, dependence on supplemental O2

ECHMO

- external heart-lung bypass machine used as advanced life support

- indicated when cardiac or respiratory failure is not responding to maximal medical intervention

- removes blood, adds oxygen and removes CO2 from the blood, and then returns the blood back into the child/infant

two types of ECHMO

- venovenous (V-V) for when the lungs need assistance in functioning

- venoarterial (V-A) for when both the heart and lungs need assistance

what is cystic fibrosis (CF)

- genetic autosomal recessive disease that affects exocrine gland function

- multisystem disorder that affects every organ system with epithelial surfaces

- mucus stasis occurs int he conducting airways of the lung, nasal sinuses, sweat glands, small intestine, pancreas, and biliary system (most prominent in pulmonary, intestine, and pancreas)

- pulmonary system is affected by chronic airway obstruction and inflammation, thick tenacious mucus, and recurrent bacterial infections

- intestine develops thick mucus that interferes with nutrient absorption resulting in malnourishment and low weight

- pancreas develops exocrine pancreatic insufficiency

PT implications for patients with CF

- secretion clearance techniques

- controlled breathing techniques

- exercise (endurance and strength training)

- inspiratory muscle training

- thoracic stretching exercises

- postural reeducation to avoid round-shouldered postures

what is asthma

- chronic inflammatory disorder of the airways

- involves abnormal accumulation of eosinophils, lymphocytes, mast cells, macrophages, dendritic cells, and myofibroblasts

- causes recurrent episodes of wheezing, dyspnea, chest tightness, and coughing

four treatment recommendations for asthma

- use objective measures of pulmonary function to assess severity and monitor therapy effectiveness

- identify and eliminate factors that worsen symptoms, precipitate exacerbations, or promote ongoing airway inflammation

- provide pharmacologic therapy to reverse bronchoconstriction and to reverse and prevent airway inflammation

- create a therapeutic partnership between the patient and care provider

PT implications for patients with asthma

- secretion clearance techniques

- controlled breathing techniques

- exercise and strength training

- thoracic stretching exercises

- postural reeducation to avoid round-shouldered posture

- review of medications and timing of medications

VATER

vertebral defects, imperforate anus, tracheoesophageal fistula, radial and renal dysplasia

VACTERL

vertebral defects, imperforate anus, tracheoesophageal fistula, renal and limb and cardiac anomalies

Marfan syndrome

autosomal dominant CT disease commonly associated with aortic aneurysm and aortic/mitral insufficiency

primary ciliary dyskinesia

rare disease in which mucociliary clearance is impaired because of defective motility of cilia

Williams syndrome

- involves deletion of the long arm of chromosome 7

- associated with supravalvular aortic stenosis and supravalvular pulmonary stenosis

fetal alcohol syndrome

- results from chronic alcohol exposure in utero

- commonly associated with the cardiac anomalies of VSD, TOF, pulmonary valve stenosis, and PDA

possible causes of decreased activity level or impairments to breathing mechanics in children

- muscle weakness

- abnormal muscle tone

- motor planning and learning deficits

- medical fragility

common pediatric diagnoses that may lead to pulmonary system impairments

CP, spina bifida, muscular dystrophy, spinal muscular atrophy (SMA), Arnold-Chiari type II malformation, spinal cord injury

infants and young children has a (HIGHER/LOWER) baseline HR

higher

infants and young children has a (HIGHER/LOWER) stroke volume

lower

common cardiac conditions that warrant pharmacologic intervention in pediatric patients

heart failure, BP and lipid abnormalities, arrhythmias

medication used in premature babies to keep HR up (treat arrhythmias)

caffeine