H&D Test 3: Ch. 13-16 & 23-24

P-Wave:

Contraction & depolarization of the atria.

QRS Complex:

Contraction of the Ventricles.

T-Wave:

Recovery (repolarization) of the ventricles.

One cardiac cycles comprises:

One heartbeat.

A cardiac cycle occurs how many times per minute at rest in normal adults?

60-100 times.

Cardiac Output:

Volume of blood ejected by a ventricle in 1 min (healthy heart = 60-100 mL)

Cardiac Reserve:

The hearts ability to increase output in response to increased demand.

Preload:

Venous Return.

Afterload:

Amount left in ventricle after contraction controlled by the peripheral resistance to the opening of the SL values.

Ejection Fraction: EF

Percentage of blood that your heart’s main pumping chamber (left ventricle) pumps out to your body with each heartbeat.

Normal Range EF:

50-70%

Mildly Reduce Range EF:

41-49%

Reduced Range (HFrEF):

40% or lower.

What are some common signs & symptoms of Cardiac Disease?

Chest pain

Edema

Shock

Fever

Fainting

Electrocardiogram (Diagnostic Test):

Uses electrodes & an electrocardiograph to record amplified electrical impulses from the heart.

Auscultation (Diagnostic Test):

Uses a stethoscope to detect valvular abnormalities or abnormal shunts of blood that cause murmurs.

Stress test (Diagnostic Test):

Used to assess general function & check for exercise-induced problems.

Chest X-rays (Diagnostic Test):

Show the heart’s shape, size, & possible evidence of pulmonary congestion.

Positron Emission Tomography scan(PET) (Diagnostic Test)

Nuclear medicine imaging techniques that produce 3-D body images.

Cardiac Catheterization (Diagnostic Test);

Involves passing a catheter through vein/artery into a ventricle to determine heart function.

Coronary Angiography (Diagnostic Test):

Catheter is threaded into a coronary artery. Contrast medium is injected to visualize blood flow in the coronary arteries.

Doppler Ultrasonography (Diagnostic Test):

Assesses blood flow in peripheral vessels via handheld transducer that records blood flow sounds when placed over a blood vessel.

Blood Test (Diagnostic Test):

Used to assess serum triglyceride and cholesterol levels, as well as other blood components.

Arterial Blood Gas Determination (Diagnostic Test):

Determines how well the lungs are moving oxygen into the blood & removing carbon dioxide from it.

Landscape Rule:

White (clouds) goes over Green (grass) on the pt’s right side.

Black (smoke) goes over Red (fire) on the pt’s left side.

Brown (chocolate/dirt) sits right in the middle on the chest.

Phase 1 of Cardiovascular Rehab:

Hospital (Exercise, gait training, pt education)

Phase 2 of Cardiovascular Rehab:

Outpatient (Pt education, stationary bike riding, treadmills, upper body exercise.)

Phase 3 of Cardiovascular Rehab:

After discharge (Continuing fitness programs in the community or at home.)

Some diseases cause rhythm of heartbeats to become irregular which results in:

Chest Pain

Heart Failure

Shock

Jaw pain

Abdominal Pain

Edema

Discoloration

Coronary Artery Disease (CAD):

Involves the arteries supplying the myocardium, they are marked by atherosclerotic deposits with a thrombus blocking them, which causes a temporary cardiac ischemia and eventually myocardial infection.

Progression of CAD:

First symptom is usually angina pectoris (chest pain) with a more severe pain shows an ECG can show a visible change in functionIA

In the Progression of CAD, the arteries narrow and develop what due to plaque deposits in the interiors of arteries:

Atherosclerosis

Atherosclerosis:

AKA hardening of the arteries & causes constriction of the coronary, leading to reduced blood flow and increasing the risk of heart attack or stroke.

CAD Treatment:

Treatment involves attempts to restore adequate blood flow to the myocardium. Vasodilators (medicine) & Angioplasty (Surgical option).

Angie Pectoris:

Angina Chest Pain is the most common defined as chest pain after exertions. Results from reduced oxygen supply to the myocardium.

The three stages of Angina would be the:

Stable (Exertional)

Unstable

Can occur

Pinzmetal’s

Stable (Exertional)

The most common form, it occurs when an ornery artery is narrow due to severe build up of plaque. Rest improves symptoms.

Unstable:

Requires emergency treatment and can occur without physical exertion & unrelieved by rest of medication.

Prinzmetal’s (Variant)

Rarest type; caused by a spasm in a coronary artery and may occur with or without CAD.

Signs of Life-Threatening Chest Pain:

Sudden pressure, tightening, squeezing, or crushing pain in the center of the chest, last for more than a few mins.

Tx of Angina Pectoris:

Tx includes ceasing strenuous activity & placing nitroglycerin tablets under the tongue, if it persists after 20+ mins of tx, immediate medical attention is required.

Myocardial Infraction:

Sudden death of a segment of the heart muscle caused by an abrupt interruption of blood flow to part of the heart. Caused by an occlusion of a coronary artery resulting in ischemia and infarct of the myocardium.

Somethings that occur beside chest pain in MI:

Dyspnea, irregular heartbeat, & sweating.

Development of MI:

Insufficient oxygen supply often due to occlusion by atherosclerotic plaque, thrombus, or myocardial muscle spasm.

What is the most common cause of MI (Myocardial Infarction):

Coronary Thrombosis

If ischemia is not reversed within 6 hours, what happens in Myocardial Infarction?

Cardiac muscle dies. This is known as myocardial necrosis, leading to permanent damage to the heart tissue.

Treatment of MI:

Administration of oxygen & morphine to control pain; aspirin is given to reduce risk of additional ischemic damage; vasodilation is attempted with a nitroglycerin drip; lidocaine is given by IV drip to help control arrhythmias; thrombolytic drugs may be administered.

Role of PTA after MI:

Monitor vital signs throughout treatment; Aerobic and light resistance exercises of large muscles of legs are less stressful to the heart than only arm exercises.  Blood vessels in arm are smaller and provide greater resistance to blood flow.

Arrhythmia:

Any deviations from normal heartbeat; commonly referred to as irregular heartbeats and result from interference with the hearts conduction system.

Symptoms of an Arrhythmia:

Palpitations

Tachycardia or Bradycardia

Skipped heartbeats

Syncope

Fatigue

Tx of Arrhythmia:

Depends on cause; for those caused by medications/drugs, usually stop once substances are removed.

Anticoagulants may be given to prevent possible thromboembolism.

If heart rhythm doesn’t stabilize, may be fatal.

Role of PTA with Arrhythmia:

Be aware of current rhythm status; utilize talk test by making sure patient can carry out conversation while exercising, slow treatment or stop if they can’t. Pt should be able to tolerate mild exercise with proper supervision.

Congestive Heart Failure:

Acute or Chronic inability of the heart to pump enough blood to meet the body’s demands for homeostasis, usually develops silently.

Right-sided CHF:

The liver & spleen enlarge, edema in legs.

Left-sided CHF

May be related to aortic valve stenosis, hypertension, hyperthyroidism, or infarction of the left ventricle, pulmonary edema.

Etiology/Diagnosis of CHF:

Myocardial Infarction

Cardiac Valve Damage

Arrhythmias

Cardiomyopathy

Hypertension

CAD

COPD

Tx of CHF:

Tx is directed at reducing the hearts workload & increasing its efficiency.

Includes: Digitalis, Beta-Blockers, ACE inhibitors, Diuretics.

Digitalis:

Improves force of heart contraction

Beta-Blockers:

Slows HR & lowers BP.

ACE Inhibitors:

Vasodilator blood vessels & lowers BP.

Diuretics:

Lower blood volume decreasing/lowers BP.

Role of PTA with CHF

PTA provides education on ways to decrease load on heart, supine to sitting with legs elevated to reduce heart load; ankle pumps to help return blood flow to heart; self monitoring of HR.

Exercise with large muscle aerobic activity 3 x week at 40-50% THR. Strength training can be done 2-3 days a week for both upper and lower extremities.

Cardiac Arrest:

Sudden, unexpected cessation of cardiac activity that is truly life threatening.

If the pt is unresponsive with no palpable pulse and no respiratory effort, what does this mean they are experiencing?

Cardiac Arrest

Some causes of Cardiac Arrest:

Arrhythmia

Respiratory arrest

Myocardial infarction

Drowning

Electrocution

Tx of Cardiac Arrest:

4-6 minutes, CPR must be instituted; Defibrillation should be attempted by trained people. Medications used would be Epinephrine, Isoproterenol, Dobutamine, and Antiarrhythmic such as lidocaine & bretylium.

Epinephrine:

Increases BP

Isoproterenol:

Increases HR

Dobutamine:

Increases BP

Antiarrhythmic Drugs:

Medications used to treat abnormal heart rhythms by restoring a normal rhythm or preventing arrhythmias.

Cardiomyopathy:

Group of heart muscle diseases that weaken or thicken the heart muscle, impairing its ability to pump blood effectively which results in the enlargement of the myocardium and ventricular dysfunction.

What is the 2nd most common direct cause of sudden death?

Cardiomyopathy

What can Diagnose Cardiomyopathy?

ECG, MRI, Chest Xray, Blood Test, Genetic Testing

Tx of Cardiomyopathy:

ACE inhibitors (relax the art/veins by lowering BP)

Diuretics (Lower blood volume/BP)

Other treatments similar to those of CHF/MI

Carditis:

Inflammation of heart tissue due to infection or an immune system problem.

Pericarditis:

Acute or Chronic Inflammation of the Pericardium (serosa)

Myocarditis:

Inflammation of the muscular walls of the heart.

Endocarditis:

Inflammation of the lining & valves of the heart.

Heart Valve Disease:

An acquired or congenital disorder that potentially harms any of the heart’s four valves.

What does the Heart Valve Disease affect most often?

Affects the Mitral Valve (Between L atria & L vent)

But may also affect the aortic valve (between aorta & L vent).

HVD Insufficiency:

Failure of the valves to close completely.

HVD Stenosis:

Hardening of the cusps of the valves, preventing complete opening or impeding blood flow.

Peripheral Arterial Disease (PAD):

Plaque buildup in the arteries.

Peripheral Venous Disease (PVD):

Plaque buildup in the veins.

Atherosclerosis:

Plaque Buildup

Claudication:

Condition where narrowed arteries in the legs reduce blood flow.

Claudication Symptoms:

Cramping or pain in calf, thigh, or buttocks that occur during walking or other physical activity. Symptoms subside with rest.

Essential or Primary Hypertension:

Chronic condition of abnormally high blood pressure in the arterial system.

Symptoms of Essential Hypertension:

Nosebleed

Headaches

Lightheadedness

Syncope

Treatment of Essential Hypertension:

Beta-blockers

ACE inhibitors

Diuretics

Vasodilators

Malignant Hypertension:

Severe & life-threatening condition where sudden severe headaches, blurred vision, and dyspnea occurs.

Treatment of Malignant Hypertension:

IV Vasodilators

Constant Monitoring

Drug therapy throughout life

Role of PTA in Essential HTN:

Education on sodium intake, healthy diet, smoking cessation, BP self monitoring, adequate forms of exercise, stress management-mediation, etc.

Role of PTA in Malignant HTN:

See pt only when stable, follow strict regimen, MONITOR BLOOD PRESSURE.

Orthostatic Hypotension:

Systolic BP decrease of 20 mm Hg or more upon standing from a sitting or supine position OR decrease of 10 mm Hg or more in systolic and diastolic BP with pulse increase of 15 bpm or more upon standing from a sitting or supine position

Signs & Tx of Orthostatic Hypotension:

Blurring or loss of vision; dizziness and fainting

Sitting up and exercising in bed

Rising slowly

Adequate hydration

Limit or avoid alcohol

Exercise as much as possible

Avoid standing for long periods

Elastic stockings

Shock:

Extremely low blood pressure that leads to decreased tissue perfusion, a clinical syndrome that eventually leads to organ failure.

Anaphylactic Shock:

Allergic reactions

Cardiogenic Shock:

Heart Failure

Hypovolemic Shock:

Much Blood/Fluid Loss