Ischeamic Heart Disease Flashcards
(23 cards)
What is Ischaemic heart disease?
Any condition in which the oxygen supply to the heart is inadequate whether in rest or in distress
What is Angina pectoris?
A temporary heart pain felt when the heart isn’t receiving enough oxygen
What is Angina pain caused by?
Physical exertion-when o2 demands by the myocardium
Exposure to cold there’s vasoconstriction,BP increases and O2 demand increases
Heavy meals where there’s increased blood flow to mesenteric area
Stress which increases heart rate
Aortic stenosis
What are the clinical manifestations of Angina pectoris?
Chest tightness
Feeling weak or numb in the upper extremities
Pain usually localized and radiates to neck,shoulders or inner extremities of arm
Pain is felt in chest behind and upper and middle third of sternum
How is Angina Pectoris diagnosed?
Patients medical history
ECG
Stress test
What ate the complications of Angina pectoris surgical management?
Myocardial infarction
Aterial dissection or rupture
Abrupt occlusion of atert through a clot or spasm
What is a myocardial infarction?
Necrosis with loss of function of the myocardium because of inadequate o2
What are the clinical manifestations?
Pain starts over sternal region and upper abs
Radiates to shoulders usually left upper limb
Gallop rhythm
Pulse is rapid
Not relieved by Nitroglycerin
What is the pre op management?
Emotional support
Physical assessment
Physio
What is the post op management?-Acute phase
No treatment Is given on this day
Isometric exercises are contraindicated
Vasalva maneuver
What is the post op management?-Day 1
Auscultation-Breathing exercises
Gentle vibrations-Supported coughing and huffing (usually in lying or half lying)
ROM exercises of upper and lower extremities
O2 mask can only be removed for expectiration
What is the post op management?-Day 2
Same as day 1
Take few steps as pt is able to tolerate
Assist with ADLs
What is the post op management?-Day 3
Continue as Day 2
Distance and speed of ambulation increased
What is the post op management?-Day 4
Same as Day 3
Stair climb
What is the post op management?-Day 5,6
Trunk mobility exercises
Increase distance of ambulation and stair climbing
What is the post op management?-Day 7
Ready to go home and ambulate at least 15 min and complete on stairs
What should a physio watch out for?
Chest pain
Dyspnea
Weakness and fatigue
Increased heart rate S&S of shock
What is the post op management?-Convalescent phase
Home exercises including Breathing exercises and coughing
Neck and upper extremity (shoulder and trunk exercises)
Increase walking 2-4km
Pt should not drive for 6 weeks
Sex should be avoided for 4 weeks or if abnormal symptoms persists
Walking up stairs after a night’s sleep
What is the post op management?Maintainance phase
Endurance promoting exercises
Rhythmic and repetitive exercises
Resume part time or light work after 2 months and heavy duty after 3 months
What is the pre op management?
-Explaining to the patient about the importance of clearing secretions and also importance of huffing and breathing exercises
-Moving in bed-Showing patient how to move himself up in bed taking his weight on his unaffected arm so that he can be mobile without pulling on drainage tubes and causing pain
-Emotional support-They might be dying and also be in alot of pain and have the fear of the unknown
-Physical assessment-It’s history,CXR and ECG
-Upper and Lower extremity exercises-As this assists in circulation and prevents post op venous thrombosis and also loss of joint range and mobility. Early shoulder girdle and arm exercises should be practiced
Breathing exercises-Helping the lung tissue hyperinflate and aids to remove secretions(diaphragmatic breathing to train diaphragm,Apical expansion and unilateral thoracic expansion for both sides
What is a precaution of a median sternotomy?
-Log Roll
-Supported caughing with pillows when performing techniques
-Also only the modified PD should be done(alternate with side lying head up to drain apical,middle and some basal
-Observe vital signs when performing techniques to determine stability of patient
What are the contraindications of a median sternotomy?
Not continuing treatment if patient becomes to unstable
No shaking close to the would site (however gentle vibrations away from would to release secretions can be done)
Not shoulder retraction
Do not cross legs to prevent necrosis at the would sight
No trunk rotation or side flexion
What tests can be done to tell if someone has MI?
-ECG changes 2 to 12 hours after an MI
-Seen with elevation of serum enzymes when enzymes released from all cell as they die.Isoenzymes specifically reflect death of a Cardiac muscle
