medical and surgical mgmt cardiopulm conditions

cardiac s/s

chest pain/discomfort, palpitations, dyspnea, syncope, fatigue, cough, cyanosis, edema (central or peripheral)

vascular s/s

peripheral edema, claudication, discoloration, integument changes

pulmonary s/s

cough, dyspnea, abnormal sputum, chest pain, hemoptysis, cyanosis, digital clubbing, altered breathing patterns

noninvasive echocardiography

performed transthoracic, evaluates heart function in real time
measures sizes of structures, SV, EF, valve motion

calcium score test

CT imaging that calculates presence of calcifications or buildup within coronary arteries
0 normal, < 100 mild CAD, < 400 mod CAD, > 400 strong proof CAD

ankle-brachial index

doppler comparison of systolic BP ratio between UE and LE
indicator of atherosclerosis, CV risk, overall mortality rate

ABI ranges

1-1.4 normal
.9-1 borderline
< .9 PAD: .5-.8 mod, < .5 severe

rubor dependency test

assessment of arterial circulation compromise using positional changes, PAD
observe skin color in supine then elevate one LE, if light pink normal but if chalky white/painful abnormal
lower extremities into dependent position and observe: return to pink < 15 sec normal, deep red transition 20-30 sec abnormal

invasive echocardiography

performed transesophageal view, eval heart function in real time
measures size of structures, SV, EF, valve motion
better to visualize pulmonic valve, RA, obese pts

cardiac catheterization

catheter through one of main arteries to measure cardiac and pulm function (CO, pressures, EF, angiography)
risk of vascular compromise at insertion site, bedrest for 6 hrs to reduce risk of bleed or pseudoaneurysm

exercise/stress testing

systematically and progressively increasing oxygen demand and evaluating body’s physiologic response through standardized method
walking up/down steps, stationary bike, ergometry, treadmill, 6MWT

exercise/stress test pharm procedures

physiologic response induced by vasodilating agent to mimic exercise
for pts who cannot physically tolerate upright exercise, impaired or disabled by comorbidity, inc age with dec aerobic capacity, cannot achieve at least 85% APMHR

noninvasive pulm diagnostic tests

xray, CT, MRI, V/Q scan, US

CAD and MI mgmt

revascularization and reperfusion of myocardium
thrombolytic therapy and percutaneous revascularization (PCI, laser angioplasty, directional atherectomy)

CABG

when other mgmt fails or not indicated, vascular graft to revascularize myocardium

valvular disease mgmt

repair: modifies, sutures, adapts defect to restore normal function
replacement: mechanical or biologic

lung tissue resection

partial or total removal of lung tissue for malignancy, trauma, necrosis, other lesions
creates restrictive lung disease

cardiothoracic surgical approaches

thoracotomy: VATS or RATS (arthroscopic)
open thoracotomy, median sternotomy, clamshell

sternal precautions

vary, current EBP is keep your move in the tube in WB, NWB use pain level as guide
ADs: walker, bilat devices, no crutches

risk factors for sternal dehiscence

obesity, COPD, diabetes, redo sternotomy, smoking, PVD, large breast tissue

thoracotomy precautions

likely WBAT, pain as guide and full ROM ok, no bony disruption

transcatheter approach

endovascular heart valve surgery, less invasive
increased pt eligibility
not as many restrictions, may require AD

ablation

radiofrequency zaps to correct SVT, afib, aflutter, some vtach

cardioversion

restore normal rhythm due to tachycardic arrhythmias
electric or meds (amiodarone)

pacemaker

unipolar or bipolar electrode implantation for mgmt of bradycardia, AV disorders, SVT, frequent ectopy
fixed rate: paces regardless of HR, less common
demand rate: activates or inhibits activity based on underlying rhythm/other bodily responses

AICD

manages uncontrollable, life threatening vtach or vfib by working on demand

pacemaker and ICD precautions

for up to 6 wks following placement for traditional implant with leads, short period of bedrest and arm sling
shoulder AROM < 90, no lifting > 5-10 lbs
no e-stim

atherosclerosis mgmt

resection, stent, graft, bypassing for revascularization of limb

carotid endarterectomy

removal of plaque and stenting to improve perfusion to brain
risk of causing stroke

role of PT in cardiopulm rehab

education on recognition, prevention, tx
reduce risk factors, structured progressive physical activity, return to activity counseling, ADL and functional training

phases of cardiac rehab

I: acute or hospital, when pt is medically stable following event/surgery
II: early outpatient or intensive monitoring phase, after d/c, secondary prevention of disease
III: training or maintenance phase, exercise in larger groups and progress through program
IV: disease prevention program