Week 2 Flashcards
(129 cards)
1
Q
What results from the Narrowing or Blocking of Blood Vessels?
A
It makes it harder for blood to flow properly
2
Q
What is Progressive narrowing called?
A
Atherosclerosis
3
Q
What happens with Atherosclerosis?
A
Fatty deposits (called plaques) slowly build up inside your arteries over time - flow of blood gets smaller and slower
4
Q
What is atherosclerosis a type of?
A
It is a type of arteriosclerosis, general terms for stiff, thick arteries
5
Q
What types of substances build up in the inner lining of arteries?
A
Fat, cholesterol, and other substances
6
Q
What is the buildup in atherosclerosis called?
A
Plaque (or atheroma)
7
Q
What can atherosclerosis cause?
A
It can cause narrowing of an artery, block blood flow, and weaken the artery wall
8
Q
Where does atherosclerosis happen?
A
Mostly in large elastic arteries (like the aorta) AND medium and large muscular arteries (like coronary / carotid / leg arteries
9
Q
How does atherosclerosis build up?
A
Intimal thickening (inner artery wall gets thick) –> Lipid accumulation (fats get trapped inside) –> Together they form a plaque / atheroma
10
Q
Atherosclerosis: How it starts and progresses
A
- Injury to endothelium (inner lining of the artery) - caused by high BP, smoking, or high cholesterol
- Chronic inflammation follows
- LDL cholesterol sneaks into the wall
- Body responds with immune cells –> forms plaque
- Plaque grows, hardens, and narrows the artery
11
Q
What is Sudden Complete Blockage known as?
A
Thrombus (blood clot)
12
Q
What happens in a thrombus?
A
A clot forms and totally blocks the vessel, stopping blood from getting through - no blood passing
13
Q
What results from the Weakening of the Blood Vessels?
A
It makes vessels more fragile or floppy
14
Q
Dilation
A
Aneurysm: The wall of the blood vessel weakens and bulges out like a balloon with the risk of popping/rupturing if it gets too big
15
Q
Rupture
A
The blood vessel wall tears or bursts open which can lead to internal bleeding or stroke, depending where it happens
16
Q
Myocardial Infarction (MI): What is it?
A
A heart attack happens when a part of the heart muscle (myocardium) dies due to lack of blood flow (ischemia) –> leads to necrosis (tissue death)
17
Q
How MI happens?
A
- Atherosclerosis plaque builds up in a coronary artery
- The plaque ruptures, and blood clot (thrombus) forms
- The clot blocks the artery, cutting off blood to part of the heart
- No blood = no oxygen = heart muscle dies (MI)
18
Q
Where does MIs happen most?
A
-Left Anterior Descending (LAD): 40-50%
-Right Coronary Artery (RCA): 30-40%
-Left Circumflex Artery: 15-20%
The location of the blockage determines which part of the heart is affected
19
Q
How do you diagnose MI?
A
-History: chest pain, SOB, nausea, etc.
-EKG: Q waves, ST segment elevation (STEMI)
-Troponin T or I: protein released when heart muscle is damaged (Most Sp)
-CK-MB: heart-specific enzyme; rises with MI
-Angiography: imaging to see blocked coronary arteries
20
Q
Treatment options for MI
A
-Medications: TPA, beta-blockers, ACE inhibitors, diuretics, anti-arrhythmics
-Procedures: angioplasty (open up the blocked artery), CABG (bypass surgery), aortic balloon pump (helps the heart pump), LVAD (helps pump blood), ICD ( shocks heart if dangerous rhythm occurs)
-Lifestyle Changes: diet, exercise, quit smoking
21
Q
What are troponins?
A
Proteins found in heart muscle cells that help the heart contract properly
22
Q
What are the 2 types of troponin found in the heart and why are they important?
A
Troponin T and I
They are used in medical testing because they are specific to the heart. When heart muscle is damaged (as in MI), troponin leaks into the blood
23
Q
Troponin is like a smoke signal - Explain this statement
A
If the heart is hurt, troponin goes up in the blood. The higher the level, the more damage there may be
24
Q
What other conditions can also elevate troponin?
A
Severe heart failure, sepsis, or kidney disease
25
If patient has chest pain and their troponin is high, is it a red flag for MI (heart attack)?
YES!
26
What does elevated troponin indicate?
Myocardial injury (MI, but not always)
27
What does a trending upward troponin mean?
Active damage is likely ongoing
28
What does a stable or trending downward troponin mean?
May be safe to begin therapy, with precautions
29
Clinical Implications for Physical Therapy - Initiate PT when:
Troponins are stable or trending down
Patient is medically cleared
Vital signs are stable
30
Clinical Implications for Physical Therapy - Proceed with Caution:
Recent diagnosis of MI or myocardial injury
Pending tests (e.g., angiography, echo)
Unstable arrhythmias
Patient is receiving supportive meds (vasopressors, anti-arrhythmics)
31
What is true about elevated troponins?
Elevated troponins don’t always mean MI, but they do always require caution.
Always trend the values, check for clinical stability, and communicate with the medical team before beginning or progressing PT.
32
What is Angina Pectoris?
Angina is a chest pain that happens when the heart muscle doesn't get enough oxygen, usually because of reduced blood flow due to a narrowed coronary arteries
33
Define Ischemia
Low oxygen due to poor blood supply
34
What does it mean by "Anginas are transient and reversible"?
Means they come and go - it's not permanent damage like a MI
35
T/F There are 3 types of Angina.
True; Stable, Variant, and Unstable Angina
36
Stable Angina (Most common)
Triggered by: physical activity or emotional stress
Cause: fixed narrowing of a coronary artery (~75% or greater)
Symptoms: chest pain with exertion
Goes away with rest or nitroglycerin (vasodilator)
37
Variant Angina (Prinzmetal's Angina)
Triggered by: rest, especially at night or early morning
Cause: spasm of coronary artery
Symptoms: sudden chest pain even when relaxed
Relieved by vasodilators (nitroglycerin, calcium channel blockers)
38
Unstable Angina (Medical Emergency)
Warning sign of a possible MI
Triggered by: minimal activity or even at rest
Increasing pain: more frequent, longer-lasting, or stronger
Not always relieved by rest or meds
NEEDS immediate medical attention!!!
39
Angina Scale
0 - No angina
1 - Light, barely noticeable
2 - Moderate, bothersome
3 - Severe, very uncomfortable
4 - Most pain ever experienced
40
What does Ischemic Heart Disease (IHD) mean?
The heart isn't getting enough oxygen-rich blood because something is blocking or narrowing the coronary arteries
41
An imbalance between what causes Ischemic Heart Disease?
Between:
Oxygen demand (how much the heart needs)
Oxygen supply (how much the blood is delivering)
42
What are other names for Ischemic Heart Disease?
Coronary Heart Disease (CHD)
Coronary Artery Disease (CAD) *Most used
43
What is the Main cause of Ischemic heart disease?
Atherosclerosis
44
What are 4 major syndromes ischemic heart failure can lead to?
Angina Pectoris: temporary chest pain from low oxygen
Acute MI: Heart attack - permanent damage
Sudden Cardiac Death: heart stops suddenly due to dangerous rhythms
Chronic Ischemic Heart Disease: long-term oxygen shortage leads to heart failure (CHF)
45
Who's at risk for IHD?
Hypertension (HTN): damages arteries
Diabetes (DM): speeds up atherosclerosis
Smoking: damages vessel wall
High LDL cholesterol: builds plaques
Genetics: family history increases risk
46
How does IHD develop?
1. Atherosclerosis: fatty plaques develop and narrow the arteries
2. Acute plaque changes: plaque can rupture, making it unstable
3. Coronary artery thrombosis: blood clot forms on the broken plaque and blocks blood flow
4. Coronary artery vasospasm: artery squeezes shut suddenly (spasm), which also limits blood flow
47
What is Congestive Heart Failure (CHF)?
It happens when the heart can't pump (eject) blood well enough to meet the body's needs
48
Why might be impeding the heart to pump blood well enough in CHF?
Blood starts to back up into the lungs or body causing fluid buildup (congestion) in the veins, lungs, and tissues
*Think of it like a traffic jam in the heart and blood vessels
49
Why does blood back up happen?
The ventricle fails - either it can't squeeze well (systolic) or can't relax/fill properly (diastolic)
Leading to:
1. Less blood ejected
2. Increased end-diastolic pressure (EDP)
3. Venous congestion
50
What are the 4 types of CHF?
Systolic, Diastolic, Left-sided and Right-sided HF
51
Systolic HF
Contractile failure of the myocardium
52
Diastolic HF
Increased pressures are required to maintain adequate cardiac output despite normal contractile function
-heart failure with preserved ejection fraction
53
Left-sided HF
Left ventricle can no longer maintain normal cardiac output
54
Right-sided HF
Right ventricular dysfunction due to left sided failure OR pulmonary disease (cor pulmonale)
55
Ejection Fraction (EF)
Amount/percentage of blood that is pumped (or ejected) out of the ventricles (esp. Left) with each contraction (beat)
56
Normal EF
55-70%
57
Slightly below normal EF
40-54%
58
Moderately below normal EF
35-39%
59
Severely below normal EF
< 35%
Risk of sudden death, heart transplant possible
60
Common causes of CHF
High BP (HTN)
Heart attacks (Ischemic heart disease)
Valve problems (mitral or aortic stenosis/ regurgitation)
61
Morphology of Left-sided HF
Blood backs up into the lungs
Leads to: pulmonary congestion, pulmonary edema (fluid in lungs), SOB, Crackles on lung auscultation
62
Morphology of Right-sided HF
Blood backs up into the systemic circulation (body)
Leads to: Jugular vein distension (JVD), Liver enlargement (hepatic congestion), Ascites (fluid in abdomen), Peripheral edema (swollen legs and feet)
63
Pitting Edema Scale
1+: Indentation is barely detectable.
2+: Slight indentation visible when skin is
depressed, returns to normal in 15 seconds.
3+: Deeper indentation occurs when pressed
and returns to normal 15 - 30 seconds.
4+: Indentation lasts for more than 30
seconds
64
AHA/ACC CHF Staging (2001)
Stage A
Patients at high risk for development of HF, but no apparent structural abnormality of the heart
65
AHA/ACC CHF Staging (2001)
Stage B
Structural abnormality of heart with no symptoms of HF
66
AHA/ACC CHF Staging (2001)
Stage C
Structural abnormality and current or previous symptoms of HF
67
AHA/ACC CHF Staging (2001)
Stage D
End-stage symptoms that are refractory to standard treatment
68
What is Peripheral Vascular Disease (PVD)?
Refers to any disease affecting blood vessels outside the heart and brain - especially the legs, arms, and abdominal organs
69
What does PVD include?
Both Arteries and Veins
70
What is Peripheral Artery Disease (PAD)?
PAD is a type of PVD, but people often use the terms interchangeably
71
Types of PAD
Functional & Organic
72
Functional PAD
No permanent damage to the vessel
Usually caused by temporary narrowing or spasm
Comes and goes
Ex: Raynaud's Disease (fingers/toes turn white in cold)
73
Organic PAD
Caused by physical changes to the blood vessel wall (narrowing, inflammation, plaque buildup)
Ex: Atherosclerosis in leg arteries --> reduced blood flow
74
What is Arteriosclerosis Obliterans?
Pad caused by atherosclerosis:
Fatty plaques narrow the arteries in the legs
Blood can't reach the muscles, especially during activity
75
Intermittent Claudication
Classic early symptom of PAD
Cramping, fatigue, or pain in the legs/buttocks during walking
Pain goes away with rest
76
Symptoms of PAD
Leg pain with walking - intermittent claudication
Pain at rest (feet/toes) - late-stage PAD
Cold feet or legs - Poor circulation
Numbness, tingling, weakness - nerve ischemia
Sores/Wounds that won't heal - poor blood flow
Skin color changes - Pale, bluish (cyanosis), or mottled skin
Loss of hair on legs - sign of long-term low circulation
77
Severe PAD = Limb-Threatening Ischemia
Signs of emergency:
Paralysis (muscles can't move)
Paresthesia (numbness/tingling)
Pulselessness (no pulse felt)
Mottling (fishnet pattern skin)
Cold limb
Gangrene (tissue death)
78
If you see any of the signs of emergency for PAD, what should you do?
👉 These require immediate medical referral — may need surgery or amputation if untreated
79
How is PAD diagnosed?
Primary tool is the Ankle-Brachial Index (ABI) a non-invasive and reliable test to check how well blood is flowing to the legs
80
How does the ABI works?
1. A blood pressure cuff is placed on the arm and ankle.
2. A Doppler ultrasound (special stethoscope) is used to hear blood flow.
3. Measure the systolic blood pressure at both locations.
4. ABI = Ankle Systolic BP ÷ Arm Systolic BP
81
ABI Interpretation
Normal: 1.0 - 1.4
Moderate: 0.5 - 0.8
Severe: < 0.5
82
What does an ABI of > 1.4 mean?
Noncompressible arteries; likely vessel calcification --> refer to vascular specialist
83
Post-Exercise ABI
If ABI is borderline or symptoms are present:
ABI may appear normal at rest but drop after exercise.
Post-exercise ABI testing or imaging (like duplex ultrasound or CTA/MRA) is done to confirm PAD.
84
UPPER EXTREMITY DISEASE – Atherosclerosis in the Arms
Mostly affects the proximal large arteries (like subclavian or axillary arteries)
Rarely involves the brachial, radial, or ulnar arteries
Often asymptomatic
Red flag: A large blood pressure difference between arms (>10-15 mmHg) may suggest vascular disease
✅ Always measure BP in both arms during assessment
85
2 classic arterial diseases
1. 🚬 Buerger Disease (Thromboangiitis Obliterans)
2. ❄️ Raynaud’s Disease
86
Buerger Disease
Affects medium and small arteries: esp. radial (arm) and tibial (leg)
Involves arteries, veins, and nerves
Strongly linked to heavy smoking
Presents with: pain, ulcers, cold hands/feet, gangrene
87
Raynaud’s Disease
Sudden vasospasm (narrowing) of small arteries
Affects fingers and toes
Triggered by cold or stress
Classic color changes: white -> blue -> red
Can be: primary (benign) or secondary (associated with autoimmune disease)
88
Aneurysm - Localized Dilation
Localized, permanent widening of a blood vessel or heart chamber caused by atherosclerosis, weakening of arterial wall, HTN, trauma, or genetic conditions
89
Abdominal Aortic Aneurysm (AAA)
Caused by Atherosclerosis, HTN, genetics
90
Possible complications of AAA
Rupture into abdomen (life-threatening)
Obstruction of nearby arteries (renal, iliac, mesenteric)
Embolism (clot or plaque breaks off)
Compression of other organs (ureter)
91
Size and Surgical risk for AAA
> 5cm: surgical repair recommended
< 5cm: monitored unless growing
92
Varicose Veins
Swollen, twisted, and enlarged veins, usually in the LE caused by prolonged pressure inside the vein (standing too long) or weakening of the vessel wall and valve failure
93
What happens in varicose veins?
Blood pools -> venous stasis, edema, pain, and possible clots
94
Complications of Varicose veins
Incompetent valves
Risk for thrombosis -> can lead to embolism
95
What is edema?
Fluid buildup in tissues
96
Types of edema
Pitting edema: pressing leaves a dent or pit
Non-pitting edema: skin is tight, shiny, and firm -no dent
Brawny edema: seen in chronic venous insufficiency (skin becomes thickened, hard, and brownish
97
Venous Ulcers
Location: near the medial malleolus
Shape: irregular edges, superficial
Drainage: moderate to heavy
Skin signs: dry, scaly skin
98
Why do venous ulcers happen?
Due to poor venous return -> pressure builds up -> fluid leaks out -> skin breaks down
99
Deep Vein Thrombosis (DVT)
When a blood clot forms in a deep vain, usually in the legs
100
Why is a DVT dangerous?
It can break off and travel to the lungs, causing pulmonary embolism (PE) - a medical emergency
101
What are some risk factors for DVT?
Virchow's Triad:
1. Venous stasis
2. Endothelial (vascular) injury
3. Hypercoagulability
102
Venous stasis
(;alterations in blood flow; slow/none)
Bed rest, surgery, long travel, paralysis, post-op (TKA/THA)
103
Vascular endothelium damage
(vessel wall damage)
Fractures, trauma, central lines, surgery
104
Hypercoagulable state
(blood clots too easily)
Cancer, pregnancy, estrogen (oral contraceptives), genetic clotting disorders, autoimmune diseases (lupus, Crohn's, RA), smoking, obesity
105
Who are at high-risk for DVT?
-Orthopedic patients (especially after hip/knee replacement)
-Medical patients with immobility, cancer, or infection
-ICU patients
-Pregnant or postpartum individuals
106
What are some tests used to diagnose DVT?
-D-Dimer: measures fibrin breakdown
-Duplex Ultrasound: visualizes clot in vein
-Wells score: clinical prediction tool*
107
Wells Score
Combines signs, risk factors, and likelihood
≥ 3 : High (75%)
1–2 : Moderate (17%)
0 or less : Low (3%)
108
What are some DVT signs?
Pain, tenderness (esp. calf)
Swelling (one leg)
Redness or warmth
Homan’s sign: pain on dorsiflexion (low accuracy)
Often asymptomatic
109
What are some PE signs (if clot travels to lungs)?
Sudden shortness of breath (dyspnea)
Fast breathing (tachypnea)
Chest pain (worse with deep breaths)
Cough, hemoptysis (coughing blood)
Fast heart rate, low BP
Anxiety, sweating, possible collapse
110
What treatments are used for DVT/PE?
-Anticoagulants: prevent clot from growing/moving
-Thrombolytics: dissolve clots (rare, high-risk cases)
-Vena Cava Filter: stops clots from traveling to lungs
-Compression: stockings or devices for prevention
111
What is Prothrombin Time (PT)
Measures how long it takes blood to clot (via the extrinsic and common pathway of coagulation cascade)
Used to screen for bleeding disorders and to monitor Warfarin (Coumadin) therapy
112
What is a normal PT?
11-12.5 sec
113
What does Prolonged PT suggest?
Liver disease (liver makes clotting factors)
Vitamin K deficiency (needed to produce clotting factors)
Coagulation factor deficiencies
114
What is Activated Partial Thromboplastin Time aPTT/PTT?
Measures the intrinsic and common pathway of the clotting cascade. Often used to monitor heparin therapy.
Normal 30-40sec
115
Standardized version of PT for patients on Warfarin (Coumadin)
INR (International Normalized Ratio)
No units - it's a ratio; Used to monitor anticoagulation
Normal INR: 1.0 when not on meds
116
When should a PT NOT mobilize a patient regarding INR?
> 5.5: high bleeding risk
117
What are the main functions of the Lymphatic System?
1. Fluid Balance
2. Infection Control
118
Fluid Balance
~18 liters of fluid leaves the capillaries into tissues each day.
80-90% is reabsorbed into veins
The remaining 2-4 liters is picked up by the lymphatic system and returned to circulation
119
Infection Control
Lymph nodes filter pathogens, cancer cells, and debris
Lymphocytes (T and B cells) help mount an immune response
120
What is lymphedema?
Swelling caused by impaired drainage of lymph fluid, leading to fluid accumulation in tissues
It occurs when the lymphatic system can't keep up with fluid removal from tissues
121
Lymphedema Statistics (Post-Cancer)
Breast cancer: 23–45%
Ovarian cancer: 21%
Endometrial cancer: 28%
Prostate cancer: up to 70%
122
Lymphedema Patients Common Complaints
Limb heaviness
Tightness in skin
Aching or paresthesias
Poor ROM, cosmesis, or clothing fit
Reduced ADLs
123
Primary Lymphedema
10% of all cases
Congenital malformation or impairment of lymphatics
LE affected most often
124
Secondary Lymphedema
90% of cases
Acquired
Disruption of or damage to lymphatics
Much more common: Filariasis (parasitic infection)
Cancer treatment
Chronic venous insufficiency
125
What is Lipidemia?
BIL, symmetrical increase in adipose tissue deposition that affects the abdomen, buttocks, LE but spares the feet
126
Stage 0 Lymphedema - Latent
No edema present
Reduced lymph system transport capacity
Most commonly due to radiation or surgery
127
Stage 1 Lymphedema - Reversible
Pitting edema
Greatly or completely reduces with elevation
No secondary skin changes
128
Stage 2 Lymphedema - Spontaneously irreversible
Does not pit
Does not substantially reduce with elevation
Skin becomes brawny and fibrotic
May have frequent skin infections
129
Stage 3 Lymphedema - Lymphostatic elephantiasis
Extreme increase in limb volume
Deep skin folds
Papillomas present
Frequent skin infections
