Term
| Basic technique for ANGIOPLASTY |
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Definition
| catheter is put into the femoral artery up until its in the coronal arteries, and then keep going to see the blockage, then advance the catheter to the blockage. Balloon tipped tube is inserted into the coronary artery and balloon is inserted and expanded several times |
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Term
| What are the problems with basic ANGIOPLASTY? |
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Definition
-it could cause a rupture
-30-40% restinosis in about 6 months time
-1/3 people who had the procedure had restenosis |
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Term
| Basic technique of a stent? |
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Definition
| Regular angioplasty, but with a stent with wire mesh around the balloon. When the balloon expands, the wire cage props open and stays open squishing the plaque |
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Term
| Problems with a basic stent |
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Definition
| plaque started growing into the area |
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Term
| What is the Drug eluting? |
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Definition
| They took angioplasty using the stent, and embedded a drug on the wire lattice and placed into the plastic matrix, and the drug is released over time that inhibits the smooth muscle cells from proliferating. |
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Term
| What is a risk of any version of the angioplasty? |
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Definition
| if the artery is leeking, will bleed traumatically. after pulling out catheter, nurse compress and pushes down for 20min, then person holds for next 30min, then left on gurney for 3-4hrs |
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Term
|
Definition
-people with blockage in coronary artery
-people with single vessel disease
-increasingly used more for multi-vessel disease
-during heart attack (first hour) |
|
|
Term
|
Definition
|
|
Term
| Basic technique for ANGIOPLASTY |
|
Definition
| catheter is put into the femoral artery up until its in the coronal arteries, and then keep going to see the blockage, then advance the catheter to the blockage. Balloon tipped tube is inserted into the coronary artery and balloon is inserted and expanded several times |
|
|
Term
| What are the problems with basic ANGIOPLASTY? |
|
Definition
-it could cause a rupture
-30-40% restinosis in about 6 months time
-1/3 people who had the procedure had restenosis |
|
|
Term
| Basic technique of a stent? |
|
Definition
| Regular angioplasty, but with a stent with wire mesh around the balloon. When the balloon expands, the wire cage props open and stays open squishing the plaque |
|
|
Term
| Problems with a basic stent |
|
Definition
| plaque started growing into the area |
|
|
Term
| What is the Drug eluting? |
|
Definition
| They took angioplasty using the stent, and embedded a drug on the wire lattice and placed into the plastic matrix, and the drug is released over time that inhibits the smooth muscle cells from proliferating. |
|
|
Term
| What is a risk of any version of the angioplasty? |
|
Definition
| if the artery is leeking, will bleed traumatically. after pulling out catheter, nurse compress and pushes down for 20min, then person holds for next 30min, then left on gurney for 3-4hrs |
|
|
Term
|
Definition
-people with blockage in coronary artery
-people with single vessel disease
-increasingly used more for multi-vessel disease
-during heart attack (first hour) |
|
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Term
| CABG (coronary artery bypass graph) |
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Definition
| graph is placed around the blocked area by taking apiece of saphenous vein from the leg and tie it into the other end of the heart, it will bypass the blockage |
|
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Term
| What arteries can be used for a bypass graph |
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Definition
-most common is saphenous vein
-internall mammary artery (don't need to tie onto aorta because already attached: just need to attach to end of the blockage
-radial artery |
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Term
| Which ismore possible for restenosis from CABG? Vein or artery? |
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Definition
| Vein graft will more actively grow restenosis because blood pressure is only 5-10mmHG, while arterial is 20-80mmHg |
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Term
| Which tends to develop artherosclerosis quicker? veins or arteries? |
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Definition
|
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Term
| Rank surgeries from worst (most likely for restenosis) to best |
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Definition
Poor: plain balloon angioplasty
Better: angioplasty with stent, bypass graft with ven
Best: Angioplasty with a drug eluding stent, bypass graft with an artery |
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Term
|
Definition
-more common for multi-vessel disease than angioplasty
-more common for severe CHD (multi-vessel disease), blockage in left vein, blockage in proximal anterior descending artery
-if can't do angioplasty (can't reach site with catheter)
-if artery is damaged during angioplasty |
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Term
|
Definition
-sign blockage in left vein (lose whole left side of heart)
-blockage in proximal anterior descending artery (will loose left ventricle) |
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Term
| Percentage of angioplasty to bypass and how prevalent? |
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Definition
about 1million a yaer
-60%angioplasty
-40% bypass |
|
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Term
|
Definition
| less invasive, less recovery, less expensive |
|
|
Term
|
Definition
-lower stenosis rate
-if severe level of Coronary artery disease, bypass is better in long term prognosis |
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|
Term
|
Definition
-aspirin
-beta-blockers
-nitrate
-ACE inhibitors |
|
|
Term
|
Definition
-reduces clotting, effecting platelets
-reduces inflammatory response
-even people at risk are encouraged to take |
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Term
| Use of beta-blockers on CHD |
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Definition
-drug that inhibits action of sympathetic nervous system of heart
-lower heart rate
-lower contractility |
|
|
Term
| what does the lower contractility do from beta-blockers |
|
Definition
-advantage in terms of stress on heart
-could have mood disturbances
-could reduce ability to exercise |
|
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Term
|
Definition
-Can be used as a patch giving small doses through day
-can be injected via IV
-most common used as a sublingual tablet (put under tongue, absorbed and dissolved and causes vasodilation of coronary vessels and relieves angina) |
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Term
| Use of ACE inhibitors (Angiotensin Converting Enzyme Inhibitor) |
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Definition
-old technique of getting rid of excess fluid with high bp is to give diurhetic
-ACE is a good drug to keep fluid down and bp down
-most cardiac patients will be on this to reduce the amt of work the heart does |
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Term
| Describe calcium channel blockers |
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Definition
clocks calcium going in
-causes vasodilation
-reduces arythmia |
|
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Term
|
Definition
-inhibit key enzymes in liver that produce cholesterol
-if blocks liver producing cholesterol, won't get too high and keep LDL down
-will slightly raise HDL
-reduces inflammation
-has been shown to actually reduce the blockage, makes plaque smaller
-clearly reduces number of events heart patients have
-very powerfull and effective, but does have side effects |
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Term
|
Definition
-liver damage
-muscle damage |
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Term
| Describe Ornish lifestyle heart trial |
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Definition
-28 patients put on 1 year program, compared to 20 control in usual care
-control group averaged 30% fat in diet
-those in experimental group were on lactoovovegetarian diet (only skim milk products,only egg whites allowed, and everything else vegan
-did at least 30min exercise daily of moderate intensity and 1 hr of yoga everyday
Rechecked after 5 years |
|
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Term
| Ornish experimental group results |
|
Definition
-total cholesterol dropped significantly
-LDL dropped
-91% reduction in angina
-1.8 increase in coronary stenosis |
|
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Term
| Ornish control group results |
|
Definition
-no change in total cholesterol or LDL
-165% increase in angina
-2.3$ increase in coronary stenosis |
|
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Term
| Onish experimental group after 5 years |
|
Definition
-blockages still getting smaller
-60% fewer events |
|
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Term
|
Definition
-56 patients put on 1 year program
-exp group advised to reduce LDL diet and weren't monitored, but told to exercise
-control group given a bike for their home |
|
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Term
|
Definition
-those with increase in blockaged averaged 1000kcal a week in exercise
-those with no change averaged 1500kcals a week
-those with shrinking blockage averaged 2000kcal a week
-MORE EXERCISE DONE, MORE LIKELY TO HAVE REGRESSION |
|
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Term
|
Definition
-300 MI patients put on mediterranean diet, 300 put on "prudent" diet for 4 years
-Mediterranean diet had MORE FISH, LESS RED MEAT, MORE PLANTS |
|
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Term
| Mediterranean study results |
|
Definition
-total fat didn't change
-sat fat went down
-omega-3 in diet was trippled
-total cholesteral slightly down
-LDL down
-6ppl died in exp grou, 19 in control group
-twice as many events in controol group
-Omega-3 had a significant effect on death/MI |
|
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Term
| Mechanism for reduction in cardiac events |
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Definition
-lipid-lowering and lifestyle trials result in significant reduction of cardiac events
-Exercise icnreases endothelial derived relaxing factor
-omega-3 fatty acids reduced platelet aggrigation, reduced arrythmias
-rupture prone status of plaques (became firmer) |
|
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Term
|
Definition
-improve functional capacity
-reduce activity related symptoms
-reduce disability, foster return to work
-identify and modify risk factors (can affect course of disease) |
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Term
| Phase I of cardiac rehab (in-patient) |
|
Definition
-living in hospital (staying for 24hrs a day for next 3-4 days)
-while living in hospital, will get ex prescription and exercise conditioning |
|
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Term
| Phase II of cardiac rehab (out-patient) |
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Definition
-released and sent home
-given advised, but better for patient to come back to clinical site and do exercise in a supervised setting
>decrease risk of signs/problems
.doesn't necessarily have to be at a clinical site (hospital), but needs to have physician supervising
>usually paid for by insurance for about 12 weeks |
|
|
Term
|
Definition
-go to a facility that specifically does exercise for cardiac patients
-usually in a community setting
-phase IV is considered no supervision needed but comes in and completes exercise anyway |
|
|
Term
| problems with implementing phase II cardiac rehab |
|
Definition
-insurance only pays up to 12 weeks
-less than half of eligible patients do it |
|
|
Term
| why do less than half patients do phase II cardiac rehab? |
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Definition
-employed and trying to get back to work
-cardiology community doesn't really get it and aren't really into rehab portion so don't implement very well |
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Term
| Class A of Cardiac patients |
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Definition
|
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Term
| Class B of Cardiac patients characteristics |
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Definition
-Do not have any heart failure
-if they had any ischemia or angina that only occurs when exercising above 6 METs |
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Term
| Class B of Cardiac patients Activity |
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Definition
-need a professional exercise prescription
-should have supervision until can self-regulate
-would be nice to have a monitoring of BP, and electrocardiogram while exercising (insurance may not pay for it) |
|
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Term
| Class C of cardiac patients Characteristics |
|
Definition
-at moderate to high risk for complications during exercise
-might have heart failure, but controled
-may have ischemia or angina during exercise at less than 6 METs
-when exercising, systolic BP might fall
>if goes down, means left ventricle isn't pumping well
-ventricular tachycardia during exercise that is non-sustained (electrical stability of heart is not good at risk of V-fib
-Previous cardiac arrest |
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Term
| Class C of Cardiac Patients Activity |
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Definition
-Cardiac rehab with a professional exercise prescription
-Supervision until it is safe for them to exercise on their own, and when they can sel-regulate
-supervision NEEDS blood pressure and ECG monitoring |
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Term
| Class D of Cardiac Patients Characteristics |
|
Definition
-uncontrollale heart failure (congestive heart failure)
-ischemia or angina at rest
-uncontrolled arythmias
-severe valvular disorder
-at severe level of aortic stenosis, blood pumping so hard just to get past it that high risk for heart attack |
|
|
Term
| Class D of Cardiac Patients Activity |
|
Definition
-RESTRICTED ACTIVITY PERIOD
-Even daily living is slightly restricted depending |
|
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Term
| How many items put you into a risk category? |
|
Definition
|
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Term
|
Definition
-horizontal positioning removes orthostatic stress due to venous pooling
-chronically raises sympathetic and decreases parasympathetic drive
-circulating blood volume and central venous pressure is reduced
-VO2max is reduced to due to decrease in maximal SV
-BECOME SEVERELY DECONDITIONED, AND ORTHOSTATICALLY INTOLERANT |
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Term
| Almost every person with some type of CVD should do what? |
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Definition
|
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Term
| Types of CVD that should NOT exercise? |
|
Definition
-uncontrolled diabetes
-unstable angina
-uncontrolled arrhythmia
-Uncontrolled congestive heart failure
-aortic stenosis |
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Term
| Activity guide for phase I (first 48 hours) |
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Definition
-Learn to take care of themselves (wash, brusth teeth)
-Arm and Leg ROM activities
-work on posterochange (go from lying down to sitting up, to moving to bathroom) |
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Term
| Activity guide for phase I (further progression) |
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Definition
-walk up and down hallway
-distances gradually get longer, and gradually can do independently |
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Term
| Frequency of activity for Phase i |
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Definition
-initially 3-4 times per day
-gradually 2 tiems a day per minimum |
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Term
| Intensity of activity for Phase I |
|
Definition
-use RPE scale keeping intensity faily low (less than 13)
-Find HR prescription by finding standing HR and add 20 for MI, and 30 for CABG |
|
|
Term
| Time of activity for Phase I |
|
Definition
|
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Term
| Activities for CVD patients to avoid |
|
Definition
-valsalva maneuver (especially during bowl movements)
-no driving for a month
-no heavy lifting for 3 months |
|
|
Term
| Guidelines for sexual activity of CVD patients |
|
Definition
| if you can climb two flights of stairs |
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Term
| Emotional issues of CVD patients |
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Definition
-cabin fever
-depression
-anger |
|
|
Term
|
Definition
|
|
Term
| In which phase II cardiac case do you treat like phase I and how? |
|
Definition
| -if have low exercise capacity (5 METs or less):intermittent bouts of low intensity |
|
|
Term
| In which phase II cardiac case do you treat normally? |
|
Definition
| if their exercise capacity is not 5 METs or less |
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