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49 Cards in this Set
- Front
- Back
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Life's Simple 7 |
- Get Active - Eat Healthier - Lose Weight - Stop Smoking - Control Cholesterol - Manage Blood Pressure - Reduce Blood Sugar |
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Genetic Cardiomyopathy |
- hypertrophic cardiomyopathy |
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Mixed Cardiomyopathy |
- dilated cardiomyopathy - restrictive cardiomyopathy |
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Acquired Cardiomyopathy |
- inflammatory cardiomyopathy |
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Hypertrophic Cardiomyopathy |
- Autosomal dominant - Disproportionate thickening of the interventricular septum |
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Hypertrophic Cardiomyopathy Symptoms |
- syncope - palpitation - dyspnea - BP response inappropriate to exercise |
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Dilated (Congestive) Cardiomyopathy: Characteristics |
- Ventricular dilation and impaired systolic function - Thinning of L ventricle - Fluid back to the lungs - S/S: similar to CHF |
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Dilated (Congestive) Cardiomyopathy: Etiology |
- 50% idiopathic - Chronic alcohol abuse - Chemotherapy, rheumatic fever |
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Restrictive Cardiomyopathy |
- Infiltrative disease of the myocardium - L ventricle wall - normal size - Normal systolic function, but with diastolic dysfunction - Rigid and noncompliant - Increased atrial pressure, fluid back to the lungs >> more effort to pump blood out - Rx:treating its underlying diseases |
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Valvular Heart Disease: Causes |
- infection - congenital deformity - disease - any issue with valves, didn’t open well or didn’t close completely |
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Valvular Heart Disease: Types |
- stenosis - insufficiency/ regurgitation |
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Rheumatic Fever |
- “Strept“ throat; scarlet fever - Autoimmune response to group A beta hemolytic streptococcus - 2-3weeks later symptoms appear - Increase in the 6-15year age group |
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Rheumatic Fever: Treatment |
- treat original infection >> outcomes: may have mitral valve dysfunction, or HF - Medications: >> Antibiotics: Take for full 7- 10 days. >> ASA or Motrin >> corticosteroids |
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Mitral Valve Prolapse |
- floppy valve syndrome (click murmur syndrome) - Blood that leaks back into LA not significant - Most patients asymptomatic - No significant tx needed |
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Valvular Heart Disease: Treatment |
- commissurotomy - annuloplasty - valve replacement |
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Commissurotomy: |
- open up stenotic valve |
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Annuloplasty: |
- put in a ring to help the valve close |
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Valve Replacement: |
- take out valve & put a new one >> artificial: thrombus tends to form >> from animal: need to be on anti-depressants? |
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Heart Failure (HF): Define |
- the heart is unable to pump blood at a rate commensurate with the requirements of the metabolizing tissues, or can do so only from an elevated filling pressure |
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Heart Failure (HF): Characterized by... |
symptoms: - dyspnea & fatigue signs: -edema, râles on physical examination |
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Heart Failure (HF): Etiology/ Risk Factors |
- Myocardial disease including HFpEF, HFrEFu - Valvular heart disease - Congenital heart disease - Constriction & pure restrictive cardiomyopathy - Thyrotoxicosis, AV fistula, Paget’s disease |
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RV Failure |
- Peripheral dependent edema - Jugular venous distention(JVD) - Weight gain - Abdominal distention - hepatomegaly: ascites, jaundice - Splenomegaly - Nocturnal diuresis - Anorexia, nausea - Fatigue, weakness |
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LV Failure |
- Dyspnea - Tachypnea - Crackles in the lungs - Paroxysmal Nocturnal Dyspnea (PND) - Dry hacking cough - Fatigue - Pulmonary edema - Weakness |
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Tachypnea |
- increased breathing rate |
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Paroxysmal Nocturnal Dyspnea (PND) |
- during night, pt has to sit up bc hard to breath |
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Systolic Dysfunction |
- enlarged ventricles fill w/ blood - the ventricles pump out <40-50% of the blood |
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Diastolic Dysfunction |
- stiff ventricles fill with less blood than usual - ventricles pump out ~60% of the blood, but the amount may be lower than normal |
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Systolic vs. Diastolic Dysfunction |
- Systolic dysfunction -> ejection fraction is reduced - can pump out, but cannot dilate |
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Screening for HF: FACES |
- do you ever feel Fatigue - have you experienced an altered Activity or exercise pattern? - do you feel any Congestion in your chest? - do you ever get Edema? - are you ever Short of breath? |
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Pathogenesisof CHF: 1st Compensatory Mechanism |
- (neurohormonal hypothesis) - Failure to propel blood forward >> ventricular dilation >> congestion in pulmonary circulation >> SOB,flooding of air spaces in lungs >> pulmonary congestion (pulmonary edema) |
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Pathogenesis of CHF: 2nd Compensatory Mechanism |
- sympathetic NS response: >> Inc HR, force of contraction >> ventricular hypertrophy - release of: Endothelin, Antidiuretic, Atrial natriuretic hormone |
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Pathogenesis of CHF: 3rd Compensatory Mechanism |
- Activation of the Renin-Angiotensin-Aldosterone System(RAAS) - Reduced blood from theheart >> reduced blood to kidney >> renin-angiotensin system activated >> kidneys retain water and sodium >> inc blood volume >> tissue edema exacerbates |
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Congestive Heart Failure: Diagnosis |
- elevated BNP (should be <100) - echocardiogram - chest X-ray |
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BNP Levels |
- should be <100 - 300-600 minor HF - 600-900 moderate HF - 900+ severe HR |
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NYHA Functional Classification: Class 1 |
- no limitation of physical activity - ordinary physical activity does not cause undue symptoms |
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NYHA Functional Classification: Class 2 |
- slight limitation of physical activity - ordinary physical activity results in fatigue, dyspnea,etc. |
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NYHA Functional Classification: Class 3 |
- marked limitation of physical activity - comfortable at rest, but less than ordinary physical activity causes symptoms |
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NYHA Functional Classification: Class 4 |
- unable to carry on any physical activity without discomfort - symptoms present at rest and with physical activity |
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Management of HF |
- control risk factors - disease treatment - exercise - symptom treatment - other |
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Management of HF: Risk Factors |
- Treat HTN, diabetes, hyperlipidemia, thyroid disease - Treat CAD, myocardia ischemia - Eliminate alcohol and tobacco use - ie. treat underlying problems, control risk factors |
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Management of HF: Disease Treatment |
- ACE inhibitors - Adrenergic receptor blockers (ARB) - beta-blockers |
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Management of HF: Exercise |
- aerobic exercise - inspiratory muscle training |
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Management of HF: Symptom Treatment |
- Na+ restricted diet - Limited fluid intake >> +/-digoxin |
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Management of HF: Other |
- emotional and physical rest (acute) - surgery: transplantation (last resort) |
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Quality of Life with CHF: |
Minnesota Questionnaire - Used to evaluate effects of pharmacological agents and exercise training in CHF - Depression is associated with increased risk of functional decline |
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PT considerations for patients with HF: Hospitalization Period |
- Early mobilization: >> prevent complications from bed rest - Monitor BP, RPE(3-4/10), S/S - Head of bed elevated - Use ratings of perceived exertion - Avoid exercise immediately after eating or taking vasodilators, ACE inhibitors |
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PT considerations for patients with HF: Recovery & Chronic Phases |
•Resistive ex. Training •Aerobic exercise training(40-60%VO2 max), short duration as tolerated •IMT training (inspiratory muscle training) |
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PI values (Inspiratory Pressure) |
- Normal PI max: greater than 100 cmH20 (negative pressure) - Minimal training threshold: 30% PImax - Normal person: can train up to 80%max |
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Patient Education: Self-Management Techniques |
- assisting the patient with taking responsibility for own health >> monitoring weight daily at same time every day >> monitoring symptoms with activity and being aware of increasing symptoms with activity - optimization of medical therapy - Vigilant follow-up with PCP etc.¨ - Early attention to fluid overload >> watch daily weight and contact physician with changes >> watch amount of pillows neededfor sleeping >> *if need more than 2 pillows, then condition may be worsening |
