Specific Cardiac Disorders

Atherosis

fatty streak that consists of lipid-laden macrophages and smooth muscle cells

PVD (peripheral vascular disease)

general term used to describe any disorder that interferes w/ arterial or venous blood flow

CHF (congestive heart failure)

heart is unable to pump its required amount of blood, blood and fluid back up in lungs (lung congestion)

Major Cardiovascular Diseases

ischemic (coronary) heart disease, hypertension, heart failure, cerebrovascular disease

dyssynchrony

lack of proper synchrony in contractions

akinesis

no contraction

Venous Insufficiency data collection

pain, hemosiderin, skin breakdown, sensation, swelling and pitting edema, effect of position on swelling, anthropometric measurements

Arterial Insufficiency data collection

pain, pallor, decreased hair growth, skin breakdown, decreased capillary refill tests, decreased sensation, peripheral pulses, ABI, turgor, dryness, effect of positioning on circulation

Lymphedema data collection

pain, swelling, extremity length and girth, measurements, skin appearance and integrity, sensation, effect of position on lymphedema, anthropometric measurements

hypokinesis

reduction in strength of contraction

Sclerosis

responsible for reduction of blood vessel compliance, organization of "fibrous cap" of thrombi over advanced plaques that have developed in the endothelial lining

Chronic Stable Angina

result of lack of blood supply to meet the metabolic demand. bring under control by reducing Ex intensity or by taking sublingual nitroglycerin

Clinical presentation CHD

sudden cardiac death (40-50%), ventricular tachycardia and fibrillation, angina, chronic stable angina

acute coronary syndrome (ACS)

sudden symptoms of insufficient blood supply to the heart indicating unstable angina or acute myocardial infarction, discomfort lasting > 20 minutes

atherectomy

surgical removal of plaque buildup from the interior of an artery

angioplasty

surgical repair of a blood vessel

Lymphedema

swelling due to an abnormal accumulation of lymph fluid within the tissues

Hyperplasia

the enlargement of an organ or tissue because of an abnormal increase in the number of cells in the tissues

venous insufficiency

the inability of the veins to adequately return blood from the lower extremities (this can cause varicose veins)

Venous Filling Time Test

the time taken for the veins to refill following elevation of the limb for one minute (or until to veins have drained) is recorded. Normal venous filling time is 5-15 seconds. >15 sec = venous insufficiency

Non-STEMI

does not develop a Q wave on ECG (referred to nontransmural or subendocardial region infarction)

Inner Layer of coronary Arteries

Intima, lipoproteins and fibrinogen are mostly likely to accumulate in intima which leads to myocardial ischemia

Ex Intervention for CAD w/out MI

-3X week for 12 or more weeks -70-85% of max -Based on FITT equation (frequency, intensity, time, type) -more deconditioned 50-60% of max

Angina - General Treatment Measures

-aspirin -control of cardiac pain (nitrates, morphine, beta blockers) -use of Oxygen -Prophylaxis for arrhythmias (lidocaine or amiodarone) -pacemaker -treatment of L ventricular dysfunction

Considerations with CHF

-elevate head of bed to improve breathing - do not perform LE Ex in supine w/ legs up -perform Ex in upright position -NO intermittent venous compression and other techniques which move fluid toward the heart until CHF is medically stabilized

Arterial Insufficiency clinical presentation

-majority of pt have diabetes -wound base usually necrotic and pale lacking granulation tissue -decreased pulses -wounds often located on lower extremities: lateral malleoli, dorsum of feet, toes

CABG sternal precautions

-no pulling, pushing, or lifting greater than 10 lbs -avoid activities that make you reach overhead or towards your back -if you have a lower pillow use pillows in the seat -do not push with arms when standing, lean forward and use legs

Venous Insufficiency clinical presentation

-unilateral or bilateral swelling os LEs -complaints of itching, fatigue, aching -hemosiderin staining -fibrous dermis -increase in skin temperature of lower legs -S & Sx of lymphedema

orthopnea

difficulty breathing when lying down

Prinzmetal angina

A variant of angina pectoris that occurs at rest, associated with ST-segment elevation

Outer Layer of Coronary Arteries

Adventitia, basic support structure

adequate exercise

CDC reports that the lack of _______ _______ is the most prevalent risk factor for CHD.

Rate Pressure Product (RPP)

HR x SBP

Vasospasm

Hyperplasia of intimal smooth muscle cells is hallmark of advanced atherosclerosis creating a coronary artery that is prone to spasm

Middle Layer of Coronary Arteries

Media, multiple layers of smooth muscle, makes adjustments to luminal diameter

CABG (Coronary Artery Bypass Graft)

Open heart surgery involving arterial bypass using a transplanted vein

Rubor Dependency Test

Supine with LEs elevated to 45 degree angle Note color of skin Quickly move to dependent position Normal = quick pink feet Abnormal = deep red color 30 seconds

Raynaud's disease

disorder that is characterized by vasospasm in response to cold, pallor in fingers

Chronic Venous Insufficiency (CVI)

a condition in which venous circulation is inadequate due to partial vein blockage or leakage of venous valves

dyskinesis

abnormal movement during contraction

paroxysmal nocturnal dyspnea

awakening from sleep with SOB and needing to be upright to achieve comfort

PTCA (percutaneous transluminal coronary angioplasty)

balloon angioplasty with stent placement

Atherosclerosis

condition in which fatty deposits called plaque build up on the inner walls of the arteries causing hardening and narrowing

STEMI

develops Q wave on ECG in subsequent 24 to 48 hrs (transmural infarction), ST elevation, persistent angina and arrhythmias

CHD risk factors

diabetes, obesity, family history, increased age, gender, stress