Cardio D/D Flashcards
Describe L CHF?
PULMONARY EDEMA
-CRACKLES, RALES, OPACITIES IN X RAY
-orthopnia- SOB recumbent
-Parosysmal nocturnal dyspnea - SOB at night
-Fatigue
-Tachycardia, intolerance to COLD
-Decreased CO
Describe R CHF?
PERIPHERAL EDEMA, JUGULAR DISTENTION, BILATERAL SWELLING (ANKLE, LB GAIN, FULLNESS IN ABDOMEN, PITTING EDEMA)
-Venous HTN
-Fatigue
-Decreased CO
What are the 3 types of anginas?
-Stable, unstable and variant
What is stable angina?
Classic exertional angina occurring during exercise or activity; occurs at a predictable RPP (HR x BP), relieved with rest and or nitroglycerin
Unstable angina?
(Preinfarction)
-coronary insufficiency at any time w/o any precipitating factors or exertion. Chest pain increases in severity, frequency, and duration; refractory to trx.
-Increases risk for myocardial infarction or lethal arrhythmia; pain is difficult to control
Variant angina?
Prinzmetals angina
-caused by vasospasm of coronary arteries in the absence of occlusive disease.
-Responds well to nitro or calcium channel blockers long term
What is the angina scale?
0- no angina
1- mild barely noticeable
2- moderate, bothersome
3- moderate severe, very uncomfortable
4- most severe or intense pain ever experienced
What is a myocardial infarction?
Prolonged ischemia, injury and death of an area of the myocardium caused by occlusion of one or more of the coronary arteries
-precipitating factors: atherosclerotic heart disease w/ thrombus formation, coronary vasospasm, or embolism, cocaine
What are the zones of infarction?
- Zone of infarction: consists of necrotic, no contractile tissue; electrically inert; on the ECT St segment deviation >1mm
- Zone of injury: area immediately adjacent to central zone, tissue is noncontractile, cells undergoing metabolic changes; electrically unstable on ECG, elevated ST segment
- Zone of ischemia: outer area, cells also undergoing metabolic changes, electrically unstable, on ECG T wave inversion
What is Myocardial ischemia?
ST segment depression
Phase one cardiac rehab?
-Initiate early return to ADL’s after 24 hours or stable for 24 hours
-3-5 days in hospital for uncomplicated MI
-Early supervised ambulation
-Initial activities: low intensity (2-3 METs) progressing to >= to 5 METs by DC
-Post MI: limited to 70% HR and/or 5 METs until 6 week post MI
-Short exercise sessions 2-3x a day (gradually increase duration and decrease frequency)
What is the HEP for stage 1 inpatient cardiac rehab?
Low risk pt’s may be safe candidates for unsupervised exercise at home
-Gradual increase in ambulation time: goal of 20-30 minutes, 1-2x/day at 4-6 weeks post MI
-UE and LE mobility exercises
Outpatient Cardiac Rehab phase 2?
-Frequency: 2-3 sessions per week
-Duration: 30-60 minutes with 5-10 minutes of WARM UP AND COOL DOWN
-TM, cycle ergometer, arm ergometer, strength training
-Suggested exit point 9 METs (5 MEts is needed for resumption of safe ADL’s)
Strength training:
-After 3 weeks cardiac rehab; 5 weeks post-MI, or 8 weeks post CABG
-begin with use of elastic bands and light hand weights 1-3 lbs**
-Progress to moderate loads 12-15 repetitions
Phase 3 cardiac rehab?
Maintenance phase
-Community centers YMCA or clinical facilities
-Entry level criteria: functional capacity of 5 MEts, clinically stable angina, medically controlled arrhythmias during exercise
-Progression to 50-85% of functional capacity, 3-4x/week, 45 minutes or more / session
-DC typically 6-12 months
What is the patient criteria for resistance training in phase 3 of cardiac rehab?
-American Association of Cardiovascular and Pulmonary Rehab Guidelines
-Post MI: resistance training permitted if remain under 70% maxHR or 5 METs for 6 weeks post MI, be cautious of valsalva maneuver
-Cardiac surgery: LE resistance training can be initiated immediately in the absence of peri-operative MI. AVOID UE resistance training until soft tissue and bony healing has occurred: 6-8 weeks
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