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