Cardic Rehab

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Cardic Rehab
2011-11-08 08:44:23
Med Conditions Fall2011

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  1. Normal EKG
    • P wave- atrial Depolarization
    • PR - interval - time required for conduction to go from SA node to AV node
    • QRS complex - atrail repolarization and ventricle depolarization
    • ST segment - delay before repolarization of ventricle, useful in assessing mycardial ischemia
    • T wave - ventricular repolarization
  2. Cardiac Output
    • The amount of blood pumped out of the heart through the aorta each min
    • Normal adult 5.6 (female 10% less)
    • CO_ SV x HR
  3. Stroke Volume
    Amount of blood ejected from the ventricles each contraction
  4. Venous Return
    The amount of blood returning to the right atrium each minute similar in volume to cardiac output
  5. Primary Hypertension
    • Unknown cause
    • approximately 90-95%
  6. Secondary Hypertension
    • Related to another medical Problem
    • Kidney disease
    • Kidney failure
  7. Pathophysiology of HNT
    • An increase prssure load fon the left ventricle leading to left ventricular hypertropy
    • Increased dependence on ative "atrial kick" for left ventricle filling. IF inadequate L ventricle filling, stroke volume is decreased, leading to symptoms of decreased CO and pumonary congrestion
  8. Conplication to HNT
    CVA, CHF, ASHD, renal failure, aneurysm, PVD or retinopaty

    • Generally Asymptomatic
    • Adults do not know what their BP usually is
  9. Treatment for HNT
    • weight reduction
    • salt restriction
    • aerobic exericse - at least 20mins 3-5 times per week has been shown to decrease BP
    • Stress reduction/relaxation training
    • Medication "anit-pyertensive" - beta blockers, diuretics, alpha adregergic blockers, calcium channel blockers. ACE inhibitors
  10. Implication for Rehab for Pt with HNT
    • Many Pts are undiagnosed
    • Need to monitor BP at rest and exercise - terminate exercise if SBP 220-250 or DBP 110
    • Be aware of side effects of anit - hypertensive medicatons
  11. Coronary Artery Disease (CAD) Pathology
    • Atheroclerotic process
    • Vasospasm
    • Otehr disease processes taht affect coronary arteries
  12. Clinical Presentation of CAD
    • 1. myocardiao ischemia (angina)
    • 2. Myocardial Infarction
    • 3. CHF
    • 4. Sudden Death
  13. Myocardial Ischemia Pathology and Manifestations
    • Patho - mayocardial O2 demand exceeds O2 supply
    • Manifextations -
    • Angina Pectoris
    • Chest pain described as pressure, heaviness, tightness,
    • last for minutes, relieve by rest and use of nitroglycerin
    • Precipiated by exertion, stress, emotions, large meal
  14. Myocardial Infarction Manifestations
    • Severes crushing pain with possible radiatin to shoulder, throat, jaw, arms or back
    • lasts more than 30mins not relieved by rest or nitro
    • Sweating, dyspnea, nausea/ vomiting, lightneaded, syncope, apprehension, weak, fatigues, DENIAL
  15. MI Diagnosis
    • The Pt has classic S&S
    • EKG changes - ST elevation with transural MI
    • May see St depression with subendocradail MI
    • Serum Enzymes
  16. Conservative Treatment of CAD
    • Lifestyle Modifications - weight reduction, salt restriciton, aerobic exercise, stress reduction / relaxation training
    • Medications - anti - angianl, anti- platelet, Anti -arthythmia, Thrombolytic Therapy
  17. Surgial Treatment of CAD
    • PTCA - precutaneous transluminal coronary angioplasty (balloon)
    • CABG
    • Pacemaker
    • AICD: automatic implantable cardiac defibillator
    • Intracoronary atents
    • Arhrectomy
  18. Implications for Rehab with CAD
    • UE activities may cuase more symptoms than LE
    • Use rest periods to decrease intensity of strenuous activites
    • Use energy conservation techniques
  19. Sternal Precautions
    • NO not lift more than 8 lbs (a gallon of milk)
    • Do not push of pull with your armswhen moving in bed and getting out of bed
    • DO not flex of extend your shoulder over 90
    • Avoid reaching too far across your body
    • Avoid twisting or deep bending
    • Do not hold your breath during activity
    • Brace your chest when caughing or sneezing
    • No driving
    • Avoid long periods of over the shoulder activity
    • If you feel any pulling or stretching in your chest, stop what you are doing
    • Report any clicking or popping noise around your chest bone to your surgeon right away
  20. Conservative Treatment for CHF
    • Lifestyle modifications
    • rest
    • Sodium restriction
    • Phlebotomy if HCT. 55-65%
    • Thoracentese - for pleural effusions
    • Exercise training to improve peripheral efficiency
    • Meds - diuretics, vasodiliators
    • Supplemental O2
  21. Surgical Options for CHF
    • Cardiomyoplasty - wrap a portion of latismus around heart to increase contractility
    • Organ Transplants
  22. Implications for Rehab
    • Physiological responses to activity need to be carefully monitored
    • Side effects of med may cuase problems
    • Activity modification may be indicated
    • Exercise low level and slow progression
    • Frequent rest breaks
    • Use energy conservation techniques
    • GRADUAL exercise training
  23. Valves of the Heart
    • Aortic - between the left ventricle and the aorta
    • Mitral - between the left atrium and left ventricle
    • Pulmonary - between the right ventricle and pulmonary artery
    • Tricuspid - bwtween the right atrium and right ventricle
  24. Valvular Stenosis
    A restriced valve opening that creates a pressure load on the chamber preceding the abnoral valve which then develops compensatory hypertrophy
  25. Valvual Insufficiency
    • Incomplete valve closer creates a volume load on the chambers or vessels on both sides of the affected valve
    • Compensatory Hypertrophy
  26. Treatment for Valve Disease
    • Meds - digitalis, diurestics
    • Salt resistriction
    • Cardioversion - if arrhythmia is a problem
    • Surgery - to repair or replacement
  27. Clinical S&S for Valve disease
    • Asymptomatic for years
    • Aortic and mitral valve disease can produce S&S of left heart failure (pulmonary)
    • Pulmonary and tricuspids valve disease can produce S&S of right side heart failure
  28. Implications for Rehab for a person with Valve disease
    • Activity and exercise precautions may be indicated
    • Start Slow and Progress gradually
    • Exercise training can improve functional status
  29. What do abnormal rhythms cause
    • Increaed HR
    • Decreased HR and possible decreased CO
    • lack of effective atrial contractions
    • Loss of effective ventricular contraction
  30. Clinical S&S of Arrhythmias
    • May be asymptomatic
    • Palpitations skipped beats, fluttering
    • Symptoms of decreased CO - lightheaded, weak, dyspnea, syncope, confusion
    • Symptoms of MI or cardiac arrest
  31. Treatment of Arhythmia
    • No treatment may be necessary
    • Treat the underlying cause
    • Antiarrhyghmic drugs
    • Cardioversion
    • Pacemaker
    • Automatic implantable cardioverter
    • Defibrillatory
    • Chemical or surgical ablation
    • Surgical excision
  32. Cardiac Rehab INdications
    • Stable ANgina
    • MI, CABG
    • Compensated heart failure
    • Cardiac surgery
    • High risk for coronary heart disease
    • High risk for hypertension
    • End stage renal disease
    • Status post pacemaker insertion
    • Cardiomyopathy
    • PVD
    • Heart transplant
    • High Risk for Diabetes
  33. Contraindicationf for Cardiac Rehab
    • Uncontrolled arrhythmias, unstable angina
    • Recent diagnosis of emmbolis
    • Resking DPB > 110 or SBP > 200
    • Thrombophlebities
    • Orthostatic BP
    • Acute Infection
    • Resting ST segment displacement >2mm
    • Uncompensated CHF
  34. Cardiac Rehab inpatient sessions
    • inital assessment of vitals
    • warm up
    • Exercise (ambulate or bike)
    • Cool down
    • Monitor vitals S&S
    • Pt Ed
    • Rest -vitals, warm -up, training -vitals, cooldown -vitals
    • Abnormal HR taht increase 50BPM with low level eercise
    • SBP > 210 pr DBP 110
    • Decrease in SBP with low level exercise
    • any ST segment changes
    • Severe LE claudication
    • Angina, mental confusion, extreme fatigues
    • Ventricular gallop
  36. Cardiac Rehab Phase 1
    • Referred to cardiac rehab when medically stable
    • Initiate risk factor education and need for lifestyle modification
    • Initiate self care activities progress from sitting to standing
    • Provide an orthostatic challenge to the pt
    • Begin a supervied ambulation program
    • AROM
  37. Exercise Intensity Goals for Phase 1
    • Target HR 18-24 bpm increase with ex
    • RPE scale
    • Monitoring the S&S of exercise intolerance
    • Last 3-5 days while inpatient
  38. Pt Educations topics for phase 1
    • Risk factors & lifestyle modification
    • How to take own HR and monitor exercise intensity
    • Graded ambulation program
    • Normal vs. adverse response and what to do if they have an adverse response
  39. Phase 2 goals
    • Increasing function capacity through eercise
    • Continued patient education about risk factors, modification and self monitorying
    • Beings immediately after hospitalization
    • Lasts 2-12 weeks
    • Frequency 2-3 times per week
  40. Phase 3
    • Last 6-8 weeks and once a week
    • Exercise training, physical fitness, level of endurance and risk factor modivication are typical goals
  41. Phase 4
    • last thoughout the patients lifetime
    • Designed to promote optimal health
    • Maintencance activities