Cardiac and Pulmonary Disease

Week 6

Ischemic Heart Disease

Heart is temporarily deprived of sufficient oxygen to meet its demand

• Coronary artery disease

• Myocardial infarction

• Congestive Heart Failure

Coronary Artery Disease (CAD)

Artery wall builds up with plaque, causing platelets to get stuck and
eventually blocks blood flow

Myocardial infarction (MI)

Heart attack, heart unable to move blood

Congestive Heart Failure (CHF)

Heart does not pump effectively to meet the demand. Fluid build up

Valvular Disease

Two complications: volume overload and pressure overload
• Mitral valve results in volume overload - fluid accumulates in the lungs
• Aortic valve –pressure overload –cardiac output decreases

Coronary Artery Bypass Graft Surgery (CABG)

Diseased section of coronary arteries bypassed with healthy blood vessels. Chest wall by cracking the sternum & spreading ribs

Cardiac Ablation

Destroy areas of the heart that are emitting dangerous signals causing abnormal contractions

Medical Management

Coronary artery bypass graft surgery

Pacemaker

Cardiac Ablation

Sternal Precautions

Do not lift more than 8 lbs

Do not push or pull with arms when getting in/out of bed or up from chair

Do not bring elbows above shoulders

Avoid twisting and deep bending

Hug a pillow when coughing or sneezing

Do not drive until cleared by surgeon

Monitoring Response to Activity

• Borg Rate of Perceived Exertion Scale

• Heart Rate (not just beats, quality)

• Blood Pressure: parameters set by dr.

• Rate pressure product (RPP) measurement of workload or oxygen demand

• ex. HR and systolic BP (RPP = HR x SBP)

Chronic Lung Disease

Chronic obstructive pulmonary disease (COPD): emphysema and chronic bronchitis
• Dyspnea, mucus production, chronic cough, & airway constriction
• Humidity, pollution, temperature extremes, and stagnant air have negative effects on persons with respiratory ailments

Medical Management of Chronic Lung Disease

Medication: inhalers, both preventative and rescue, steroids
• Oxygen Therapy: Specific flow rate; too high results in CO2 retention
• Mechanical ventilation

Intervention Techniques

Dyspnea control postures

Pursed lip breathing (PLB)

Diaphragmatic breathing

Progressive muscle relaxation

Dyspnea Control Postures

Bending slightly at waist supporting upper body by leaning on forearms

Pursed lip breathing (PLB)

In through nose, out through mouth

Diaphragmatic Breathing

Increased use of diaphragm improving chest volume

Metabolic Equivalent of Task (MET)

Energy costs of an activity or occupation

Using METs leads to safe progression of activity or occupation

Duration of sustained physical activity must be accounted for

6 Variables that increase oxygen demand

1. increased rate/speed

2. increased resistance

3. increased use of large muscles

4. Increased involvement of the trunk musculature

5. raising one's arms

6. isometric work