Cardiovascular physical therapy (exerpts)

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1.

1+

Pitting edema scale - Barely perceptible identation ( 0 - 1/4 inch pitting) Pitting edema scale - Easily identified depression; returns to normal within 15 seconds. (1/4 > 1/2 inch pitting) Pitting edema scale - Depression takes 15- 30 seconds to rebound (1/2 > 1 inch pitting) Pitting edema scale - Depression lasts for 30seconds (> 1inch pitting) Patients with CHF should exercise at low intensity and with interval training (increasing duration with frequent rest periods). What intensity level should CHF exercise in terms of percentage of functional capacity? A walking program is recommended for patients with PVD. what intensity should it be? How is 70 - 85% of HR max correlates to VO2 max? An RPE value of 12 - 13 (Somewhat hard) correspond to how much percentage of HR range? An RPE value of 16 (Hard) correspond to how much percentage of HR range? Complete lack of oxygen ECG changes with MI A PT working in a hospital is asked to treat a patient with known cardiac problems. When he looks at the ECG strips in the chart, he sees Q waves in leads V1 - V4; what condition is the PT suspecting? Identify the following medication based on description? - Four main classes., Alter conductivity, restore normal heart rhyth,control arrhythmias, improve cardiac output e.g., quinidine, procainamide

13.

Arteriosclerosis obliterans

2.

2+

3.

3+

4.

4+

5.

40-60% of functional capacity

(atherosclerosis): Chronic, occlusive arterial disease of medium and large sized vessels, the result of peripheral atherosclerosis. - Associated with hypertension and hyperlipidemia; patient may also exhibit CAD, Cerebrovascular disease, diabetes - Pulses: decreased or absent - Color: pale on elevation,dusky red on dependency - Early stages: Intermitten claudication. Pain described as burning,searing,aching, tightness or cramping - Late stages: Ischemia and rest pain; ulcerations and gangrene, trophic changes - Affect primarily the lower extremities. Identify the following medication based on description? - Decreases platelet aggregation; may prevent myocardial infarction, considered a blood thinner. Identify the following medication based on description? - reduce myocardial demand by reducing heart rate and contractility; control arrhythmias, chest pain, reduce blood pressure e.g., propanolol[inderal] S4 is associated with ventricular filling and atrial contraction. it occurs just before S1. Which conditions is S4 associated with? Identify the following medication based on description? - Inhibit flow of calcium ions, decrease heart rate, decrease contractility,dilate coronary arteries, reduce BP, control arrhythmias, chest pain. e.g., Cardizem, Procardia,diltiazem Defined as a period of apnea (no breathing) lasting for 10 - 60 seconds followed by gradually increasing depth and frequency of respirations; accompanies depression of frontal lobe and diencephalic dysfunction. May also be seen in advance left sided heart failure Curvature of the fingernails with soft tissue enlargement at base of nail; Associated with chronic oxygen deficiency, heart failure ABI Index value = 0.79 - 0.50; Compression therapy recommendation?

14.

Aspirin

6.

40-70% of VO2max, 2-3 times/day, 37days/week 60-80% of V02 max 60% of HR range

15.

Beta-adrenergic blockers

7.

8.

16.

9.

85% of HR range Anoxia Anterior MI

CAD, MI, aortic stenosis, chronic hypertension Calcium channel blockers

10. 11.

17.

18.

12.

Antiarrhythmics

Cheyne-Stokes respirations

19.

Clubbing

20.

Compression therapy is contraindicated

21.

Compression therapy is contraindicated Compression therapy is contraindicated

ABI Index value < 0.50; Compression therapy recommendation? A therapist obtains a value of 0.49 of a measure of the AnkleBrachial index. What does this value represents in terms of using compression therapy? A therapist obtains a value of 0.78 of a measure of the AnkleBrachial index. What does this value represents in terms of using compression therapy? A therapist obtains a value of 0.92 of a measure of the AnkleBrachial index. What does this value represents in terms of using compression therapy? ABI Index value = 0.99 - 0.80; Compression therapy recommendation? Defined as a condition in which the heart is unable to maintian adequate ciruculation of the blood to meet the metabolic needs of the body. When with this condition edema is present is called? Gallop or S3, is an abnormal heart rhythm with three sounds in each cycle. It occurs soon after S2. Which condition is S3 is associated with? Bluish color related to decreased cardiac output or cold; especially lips, fingertips, nail beds If a patient is exercising in a Inpatient Cardiac Rehabilitation program, what conditions would lead to exercise discontinuation?

31.

Deep vein thrombophlebitis (DVT)

22.

23.

Compression therapy is contraindicated

Defined as clot formation and acute inflammation in a deep vein - Usually occurs in lower extremity, associated with venous stasis (bed rest, lack of leg exercise) - Hyperactivity of blood coagulation, and vascular trauma - Early ambulation is prophylactic, helps eliminate venous stasis Defined as inappropirate elevation of blood glucose levels and accelerated atherosclerosis - Neuropathy a major problem - Neurotrophic ulcers, may lead to gangrene and amputation The period of ventricular relaxation and filling of blood Identify the following medication based on description? - Increases contractility and decreased heart rate (bradycardia) - Mainstay in the treatment of CHF (e.g., digoxin) When performing Exercise Tolerance Test (ETT) to determine functional capacity of an individual, How ETT should be performed for patients with more pronounced CAD? A patient is presenting with any of the signs of lymph overlad: discomfort, aching or pain in proximal lymph areas (axillar or inguinal), change in skin color as a result of activities being perform in the rehab session. What should the PT do? Identify the following medication based on description? - Decrease myocardial work (reduce preload and afterload) - Control hypertension (e.g., furosedide [lasix],hydrochlorothiazide[Esidrix] A PT is working a hospital and he's given orders to apply compression to a patient with chronic venous insufficiency as part of management of LE edema. The PT looks at the chart and reads the ABI index to be < 0.8 (mild arterial disease) with evidence of cellulitis or infection. What's the Next thing to do?

32.

Diabetic angiopathy

24.

Compression therapy with caution

33.

Diastole Digitalis (cardiac glycosides)

34.

25.

Compression therapy with caution Congestive heart failure (CHF)

26.

35.

Discontinous

27.

Congestive Left heart failure

36.

Discontinue activity, elevate limb and apply cold packs

28.

Cyanosis

37.

Diuretics

29.

DBP 110mmHg, decrease in SBP > 10 mmHg, significant ventricular/atrial arrhythmias, 2nd-3rd degree AV Block, s/s of exercise intolerance Decreased stroke volume, cardiac output and ejection fraction, but also increased end diastolic ventricular pressures

38.

Do not apply compression

30.

Impaired ventricular function results in:

39.

Do not apply compression therapy

A therapist wants to apply compression therapy as part of management of edema on a patient with chronic venous insufficiency. The therapist performs an Ankle-Brachial test. the values is 0.68,which is < .80 according to the index values. What should this therapist do with regards to compression therapy? A PT is trying to control external bleeding (arterial bleed) for a football player who has severely injured. The PT attempts to stop the bleeding by putting a clean cloth or towel over it and apply a firm pressure. The PT notices that the blood is soaking through the cloth or towel. What's the next thing he should do to contain the bleeding? The amount of blood in the ventricles after diastole ( 120mL) The amount of blood in the ventricles after systole ( 50mL) What can be safely assumed in term of exercise in individuals with: poor LEFT ventricular function, ischemic changes on ECG (ST segment depression > 1mm) during ETT, Functional capacity < 6 METs, uncontrolled hypertension or arrhythmias? ABI Index value > 1.2

48.

Grade 4

40.

Do not remove any cloth or towel, and add additional layers, and elevate the part if possible unless it's deformed or causes pain when elevated End diastolic volume End systolic volume Exercise is contraindicated

A patient presents with intermittent claudication when walking on the treadmill. Shortly after the patient stops the treadmill and states that his pain is excrutiating and unbearable. What grade this represent in the intermittent claudication scale? Defined as a condition in which the heart is unable to maintian adequate ciruculation of the blood to meet the metabolic needs of the body. Cardiac transplantation is used in end-stage myocardial disease e.g., cardiomyopathy,ischemic heart disease, valvular disease. When transplantation involves leaving the natural heart and piggy-backing the donor heart this is called? In patients with CHF, exercise HR should be limited to RHR + 10-20bpm. What exercise HR is generally contraindicated in individuals with Congestive heart failure? What are ECG changes with exercise in healthy individuals ?

49.

Heart failure

50.

Heteroptics

41.

42.

43.

51.

HR > 115bpm

44.

Falsely elevated, arterial disease, diabetes Grade 1

52.

45.

A patient presents with intermittent claudication when walking on the treadmill. When asked with regards to his pain in LE, he states it is minimal discomfort. What grade this represent in the intermittent claudication scale?
53.

HR increases directly proportional to exercise intensity, Rate related shortening of QT interval, decrease R wave and increase Q wave, arrhythmias rare: single PVCs, ST segment depression < 1mm Hypercalcemia

46.

Grade 2

A patient presents with intermittent claudication when walking on the treadmill. When asked with regards to his pain in LE, he states it is moderate discomfort, and his attention can be diverted with conversation. What grade this represent in the intermittent claudication scale? A patient presents with intermittent claudication when walking on the treadmill. When asked with regards to his pain in LE, he states he cannot continue because the pain is intense (Patient 's attention cannot be diverted). What grade this represent in the intermittent claudication scale?

Increased concentration of calcium ions increases heart actions What condition might be suspected in the following description? - increased concentration of potassium ios decreased the rate and force of heart contraction - ECG changes such as: Widened PR intervals, QRS and tall T waves? decreased concentration of calcium ions decreases heart actions

54.

Hyperkalemia

47.

Grade 3

55.

Hypocalcemia

56.

Hypokalemia

What condition might be suspected in the following description? - decreased concentration of postassium ions produce leg cramps may also result from diuretic use that reduce K ion concentration. this condition is called: Abnormally low amount of oxygen in the blood (O sat < 90%) Low oxygen level in the tissues As training progress in rehabilitation, you should:

66.

Mild arterial disease, intermittent claudication Mild peripheral artery disease

ABI Index value = 0.99 - 0.80

67.

57.

hypokalemia

A therapist obtains a value of 0.92 of a measure of the Ankle-Brachial index. What does this value represents? ABI Index value = 0.79 - 0.50

58.

Hypoxemia Hypoxia Increase duration first, and then intensity Inferior MI

68.

59. 60.

Moderate arterial disease, and pain at rest Moderate peripheral artery disease

69.

A therapist obtains a value of 0.56 of a measure of the Ankle-Brachial index. What does this value represents? A therapist obtains a value of 0.50 of a measure of the Ankle-Brachial index. What does this value represents? A therapist obtains a value of 0.74 of a measure of the Ankle-Brachial index. What does this value represents? Name of these exercises for PVD patients (arterial disease) - Postural exercises + active plantaflexion and dorsiflexion of the ankle What LE exercises are recommended for patients of PVD (arterial disease)? - HR < THR for a given exercise intensity - RPE < for a given exercise intensity (exercise is preceived as easier) - Symptoms of ischemia (i.e., angina) do not appear at a given exercise intensity If any of this conditions occurs in your plan of care, you should: Diagnostic test use to diagnose and evaluate ischemic heart disease, myocardial infraction Identify the following medication based on description? - Decrease preload through peripheral vasodilation, reduce myocardial oxygen demand - Reduce chest discomfort (angina) - may also dilate coronary arteries, improve coronary blood flow (nitrates) ABI Index value = 1.0 - 1.20

70.

61.

ECG changes with MI A PT working in a hospital is asked to treat a patient with known cardiac problems. When he looks at the ECG strips in the chart, he sees Q waves in leads II, III, AVF. What conditions is the PT suspecting? Exercise training for patient with PVD may result in improved functional capacity, improved peripheral blood flow and muscle oxidative capacity. what type of training/protocol is recommended? ECG changes with MI A PT working in a hospital is asked to treat a patient with known cardiac problems. When he looks at the ECG strips in the chart, he sees Q waves in leads 1, AVL. What condition is the PT suspecting? Defined as whe blood is not adequately PUMPED into systemic circulation;due to an inability of LEFT ventricle to pump,increases in ventricular end-diastolic pressure and left atrial pressure with: - Increased pulmonary artery pressures, and pulmonary edema - Pulmonary signs & symptoms: cough, dyspnea, orthopnea(shortness of breath (dyspnea) which occurs when lying flat) - Weakness, fatigue These signs & symptoms are associated with what type of heart failure (right/left)? - Fatigue, cough - Shortness of breath, Dyspnea on exertion - Orthopnea, Paroxysmal Nocturnal Dyspnea (PND) - Diaphoresis - Cheyne-Stokes respirations (advanced failure)

Moderate peripheral artery disease

71.

Moderate peripheral artery disease

62.

Interval training or discontinous protocol at moderate level Lateral MI

72.

Modified BuergerAllen exercises

63.

73.

Modified BuergerAllen exercises, and resistive calf exercises Modify exercise prescription

74.

64.

Left heart failure or forward HF)

75.

Myocardial perfusion imaging Nitroglycerin

65.

Left sided heart failure

76.

77.

Normal

78.

Normal

A therapist obtains a value of 1.0 of a measure of the Ankle-Brachial index. What does this value represents? Inability to breathe when in a reclining position Cardiac transplantation is used in end-stage myocardial disease e.g., cardiomyopathy,ischemic heart disease, valvular disease. When transplantation involves removing te diseased heart and replacing it with a donor heart, this is called? Absence of rosy color in lightskinned individuals, associated with decreased peripheral blood flow, PVD Sudden inability to breathe occurring during sleep What test determines the competence of greater saphenous vein? What test is being explained? - In standing, palpate one segment of vein while percussing ven approximately 20 cm higher. If pulse wave is flet by lower hand, the intervening vals are incompetent Signs & Symptoms of Exercise intolerance

89.

Raynaud's disease

79.

Orthopnea Orthotopic

80.

Episodic spasms of small arteries and arterioles. Abnormal vasoconstriction reflex exacerbated by exposure to cold or emotional stress. Tip of fingers develop pallor, cyanosis, numbness and tingling Defined as episodic spasm of small arteries and arterioles - Abnormal vasoconstrictor reflex exacerbated by exposure to cold or emotional stress; tips of fingers develop pallor, cyanosis, numbness, and tingling - Affects largely females - Occlusive diesease is not usually a factor What is the MOST effective method of increasing blood flow in LE in patients with PVD (arterial disease)? A patient would like to beging a resistive training program. Patient has a diagnosis of poor left ventricular function, ischemic changes on ECG during exercise tolerance test (ETT) and his functional capacity is less than 6 mets. What can be said with regards to perform resistive exercise program? What conditions are considered Absolute contraindications to participation in Inpatient and/or Outpatient cardiac rehabilitation program?

90.

Raynaud's disease or phonomenon

81.

Pallor

82.

Paroxysmal nocturnal dyspnea Percussion test Percussion test

91.

Resistive calf exercises

83.

84.

92.

Resistive exercise is contraindicated

85.

Persisten dyspnea, dizziness or confusion, angina, severe leg claudication, excessive fatigue, pallor, cold sweat, ataxia, pulmonary rales Poor arterial perfusion

93.

86.

A PT examines a patient in the clinic. The PT notices that the superficial temperature of one of the LE is lower compared to opposite side. This condition can be attributed to: ECG changes with MI A PT working in a hospital is asked to treat a patient with known cardiac problems. When he looks at the ECG strips in the chart, he sees Large R waves in leads V1-V3, ST segment depression V1,V2, or V3. What conditions is the PT suspecting? When using compression pumps what pressures are contraindicated as they can cause lymphatic collapse?

87.

Posterior MI

Resting SBP > 200mmHg or Resting DBP > 110mmHg, Orhosthatic BP drop > 20 mmHg with symptoms, ST segment depression > 2mm, uncontrolled diabetes: glucose level 300mg/dL pr > 250mg/dL with ketones present Right heart failure or backward HF

94.

88.

Pressures > 45mmHg

Defined as when blood is not adequately RETURNED from the systemic circulation to the heart;due to failure or RIGHTventricule, increased pulmonary artery pressures, with: - Peripheral edema: weight gain, venous stasis - Nausea, anorexia

95.

Right sided heart failure

These signs & symptoms are associated with what type of heart failure (right/left)? - Nausea, anorexia - Weight gain, ascites, Right upper quadrant pain - Increased right arterial pressure (RAP), Central venous pressure (CVP) - Jugular venous distention - Peripheral edema Dependent redness wih PVD ABI Index value < 0.50 A therapist obtains a value of 0.48 of a measure of the Ankle-Brachial index. What does this value represents? What are ECG changes with exercise in individuals with CAD Myocardial Ischemia?

102.

Strenous activities such as jogging, and ballistic movements Superficial vein thrombophlebitis

Activities that are CONTRAINDICATED to patients with lymphedema as they are likely to exacerbate this condition are:?

103.

Defined as clot formation and acute inflammation in a superficial vein. Localized pain; usually in saphenous in a deep vein What the name of the central line catheter that is inserted through vessels into right side of heart,and it is used to measure - Central venous pressure (CVP) - Pulmonary artery pressure (PA) - Pulmonary capillary wedge pressures (PCWP)? The period of ventricular contraction (Buerger's disease): Chronic, inflammatory vascular occlusive disease of small arteries and also veins - Occurs commonly in young adults, largely males, who smoke. - Begins distally and progresses proximally in both upper and lower extremities - Patient exhibit paresthesias or pain, cyanotic cold extremity,diminished temperature sensation, fatigue, risk of ulceration and gangrene (retrograde filling test) What test is being explained ? - Patient is positioned in supine with legs elevated 60 (empties venous blood) - Tourniquet is then placed on proximal thigh (occludes venous flow in the superficial veins) - Patient is then asked to stand - Examiner notes if veins fill in normal pattern. Should take approximately 30 seconds. What test is being explained? - Patinet in supine, passively elevate LEs to approximately 45 for 1 minute, then place in dependent position. - note time for veins to refil - delayed filling (> 15 seconds) is indicative of venous insufficiency A therapist performs a venous filling time test. Veins takes 25 seconds to refill. This venous filling time may be indicative of what condition?

104.

96.

Rubor Severe arterial disease Severe arterial disease, critical limb ischemia, and for rest pain Significant tachycardia occurs at lower level of exercise, Exertional arrhythmias during exercise and recovery, ST segment depression > 1mm below baseline Stemmer's sign

Swan-Ganz catheter

97. 98.

105. 106.

Systole Thromboangiitis obliterans

99.

100.

Dorsal skin folds of the ltoes or fingers are resistant to lifting Indicative of fibrotic changes and lymphedema A patient is taken to the cardiac rehabiliation inpatient center to exercise. If any of the following occurred, what is the next thing to do with regards to exercise? - Patient's DBP 110 mmHg - Decrease in SBP > 10 mmHg - Significant ventricular or atrial dysrhythmias - 2 or 3 heart block - signs & symptoms of exercise intolerance, including: angina,marked dyspnea, and electrocardiogram changes suggestive of ischema such as: ST depression > 1mm
107.

101.

Stop exercise

Trendelenburg's test

108.

Venous filling time

109.

Venous insufficiency

110.

Ventricular assist devices (VADs)

Defined as an implanted device (accessory pump) that improves tissue perfusion and maintians cardiogenic circulation;used with severely involved patients e.g., cardiogenic shock unresponsive to medications, severe ventricular dysfunction Exercise may exacerbate CHF, therefore check for delayed reponses of: What sequence of exercise is indicated for patients with lymphedema?

111. 112.

Weight gain, edema in LE Work trunk and limb girdle muscles first, then limb muscles from proximal to distal with compression bandage on