Arterial Structure - intima, media, adventitia

Coronary Blood Flow

Collateral Circulation

Atherosclerosis - lipid deposition, endothelial injury, inflammartory process

Clinicl Manifestations of CAD

Clinical Manifestations of CAD

Sudden Death

Angina - stable, unstable, and variant

Myocardial Infarction 

Pharmacologic - beta blockers, ACE inhibitors

Lifestyle modification

Percutaneous Transluminal Coronary Angioplasty

Stent

Atherectomy

Coronary Artery Bypass Graft

Classification of diseases that result in dysfunction of the myocardium's ability to contract and expel blood (systole)

-may also affect the myocardiums ability to accept blood

-this leads to a diminished CO of the heart

Hypertension

Dysrhythmia

Cardiomyopathy - dilated, hypertrophic, restrictive

Spinal Cord Injury

Aging

Renal Insufficiency

This takes longer to occur.

Point of origin is the systemic circulation

Backs up out of the vena cava 

Volume is gravity dependent

The swelling will be B/L and symmetrical LE edema 

Fatigue

Peripheral Edema

Ascites (rx is lasix)

Weight gain (in the belly)

Occurs first

Has higher pressure and forces

Venous return comes back and EF comes down so the RV goes up

The vasculatur doesn't stop filling the heart and the overstretch continues, the volume keeps coming in, but the heart is full so the fluid spills over to the point of origin aka the lungs (fills the alveoli)

Dyspnea

Fatigue

Cough

Orthopnea (change postition and get SOB)

Tachycardia

Weight gain

Correct causitive factor

Need to address cardiac performance

Medications - digitalis, beta blockers, ACE inhibitors

Pacemakers

Control of water levels

COnditioning exercises

Energy conservation

Surgical 

Prolapse

Regurgitation

Stenosis 

When the valve is closed and creates a nice tight seal the retrograde of bulging of leaflets, no real leakage.

More common in women 

Usually mitral valve

incomplete leaflet closure, retrograde leak

Greater resistance in the ventricles

What you hear is the heart murmur

Mitral valve

leaflet thickening and stiffening, increased force required

Becomes very hypertrophied and fibrotic

At risk for cardiac muscle dysfucntion because have deminished EF and compromised CO

Aortic valve, will need to be replaced

Pericarditis

Myocarditis

Endocarditis 

Inflammation of the pericardial sac

May be infectious, autoimmune, or associated with other systemic disease (RA, Lupus)

Wide range of symptoms

Pain may be relieved when lean forward

May lead to pulmonary effusions, cardiac tamponade

Inflammation of the myocardial wall

Caused by many different pathogens

Pt may complain of dyspnea, palpations, nondescriptive chest pain, fatigue

(can progress to cardiac muscle dysfunction)

Infection of heart valves

Clinical manifestations variable due to involvment of other organ systems by bacteria

Symptoms similar to flue or CHF

May require a heart transplant 

Prophylactic antibiotics (Dentist!)

Devervated heart - the SNS will not be reconnected and the ANS will lose the ability to quickly change your HR. Need long warm up and cool down

Ischemia and rejection may only become apparent during increased activity 

Exercise at 3 months indicative of capability at 12 months 

Anemia

Blood pressure

Hypertension 

Peripheral Vascular Disease 

Occlusive disorders

Vasomotor disorders

Leukocyte Disorders (WBCs)

Reduction in O2 carrying capacity of blood

-decreased hemoglobin and hematocrit

Men Hgb <14, Hct <41%

Women: Hgb <12, HCT<37%

Blood Loss - NSAIDs (GI bleed)

Increased destruction of RBC

Decreased destruction of RBC

GI blood loss

Chronic or inflammatory disease

Malnutrition

Infectious disease

Neoplastic disease

Fatigue (malaise)

Weakness

DOE

Pallor

Tachycardia

CNS signs

Transfusion

Supplements (Iron)

O2

Splenectomy

Immunosupressive agents

Erythropeitin

Bone marrow transplant 

Expect fatiguability

May need to alter exercise RX

Be careful of bruising and bleeding

Possible delayed wound healing

CNS changes

Tachycardia may be the first sign

NO exericse is Hgb <8

Systolic BP is the only direct

way to measure Cardiac Output

Diastolic is a reflection of Total peripheral resistance

Barorecptors - pressure receptors, participate when we exercise

Chemoreceptors - chemical receptors that measure the concentration of things in our blood

CNS

ANS - parasympathetic lowers BP, sympathetic increases BP

Renin-angiotensin-aldosterone 

90% is essential

>140

>90

Asymptomatic

Headache

Vertigo

Facial flushing

Blurred vision (may be a TIA)

Peripheral Artery Disease

Thrombus

Venous Thromboembolic Disease (DVT)

VaricousVeins

Chronic Venous Insufficiency

Raynaud's Disease

Thrombocytopenia

Leukocyte Disorders (WBCs)

Lymphedema 

Partial or complete occlusion of a vein by a thrombus 

May be superficial (less concerning), or deep (more concerning)

More proximal is worse

Best treatment is prevention 

Bedrest, sedintary, inactive

Cigarette smoking/tobacco

Fractures (the immobility portion)

Up to 6 months postpartum

Medication

Obestiy

Recent surgery

Sitting for long periods of time

Hypercoaguable blood - Type A

Cancer

Polycythemia- become hypoxemic 

Homans sign - don't use!

Wells Clinical Decision RUle

Doppler Ultrasound

Venography

D-dimer level 

Is patient receiving adequate medical treatment?

Will ambulation increase risk of acute PE?

If PE occurs, can the pt withstand it?

Do the effects of bedrest outweight the effects of ambulation?

Is there evidence of existing PE?

What was thier risk factor?

What was their Wells SCore?

Determines if edema will be present or not

-balance between absorpition and filtration 

-edema is on the side of more filtration 

Big capacity breath

Deep breath in

amount of air left in your lungs at the end of a normal exhalation.

Gives you a steady stream of O2 at any point of respiratory cycle

Obstuctive DIsorders

Restrictive Disorders 

Diseases which produce an obstruction to airflow 

Decrease in the size of the bronchial lumen

Loss of elastic recoil

Tendency for bronchiolar collapse

Air trapping resulting in hyperinflation (increases dead space, FRC is higher, Tidal volume is smaller, elevated WOB)

Chronic COugh

Mucous Production

Wheezing

Dyspnea

Suscpetible to infections

Increased WOB

PFT changes - decreased expiratory flow rates, increased residual volume

Chronic Bronchitis

Emphysema

Bronchiectasis

Asthma

Cystic Fibrosis

Begins with disease in the large airways and progresses to smaller

Result of exposure to an irritant

Smoke causes them to produce more mucus and paralyzes the cilia

Hypertrophy and hyperplasia of goblet cells

Increased WOB - hypercapnia 

V/Q mismatch (shunt)

CO2 retention

Blue bloaters

Hypertrophy of SCM

Risk of Cor Pulmonale

Stocky build 

Cyanosis

Prolonged exhalation

Chronic Cough

Wheezing

Retractions

Dyspnea

Peripheral edema

Desaturation with exercise

Avoid irritants

FLuids

Medication

Breathing retraining

Exercise

O2

Airway clearing techniques 

Dyspnea

Barrel chest

Increased use of accessory muscles

Thin

Difficulty with exhalation

Cor Pulmonale

Decreased breath sounds

-this is a dry disease

Fluids

O2

Meds - to keep bronchdilated

Airway clearance

Breathing retraining

COndtioning 

Chronic Bronchitis 

+

Emphysema 

Rapid RR

Increased use of accessory muscles

Audible wheezing

Chest tightness

Frequent cough

Hypoxemia

Hypercapnia

Cyanosis

Death 

-Acute bronchospasm, inflammatory phase

Persistant cough or wheezing

Recurrent infections

Poor weight gain

salty sweat

barrel chest

clubbing

Volume of gas exchange reduced

-trouble getting air in, their volumes are deminished, something is limiting the volume, so no air trapping

-tidal volume and vital capcity will be smaller

-FRC and flow rates will be fine

-need to breath faster, increased WOB

-significantly elevated RR

-decreased volumes and capacities 

Adult Respiratory Distress Syndrome (ARDS)

Idiopathic Pulmonary Fibrosis

Atelectasis

Pneumonia

Pleural Effusion

Pulmonar edema

Pulmonary embolism

Pneumothorax

Scoliosis

Rib fractures

Chest wounds (potential for pneumothorax)

Burns (scar will become a stricture)

Obstructive:

-problem with exhalation

-decreased flow rates

-hyperinflation

-increased WOB

Restrictive:

-problem with inhalation

-decreased volujmes and capacities

-problem with compliance

-increased WOB