Q1 - Arterial Supply of the Heart
A. Right coronary artery: It originates from the right aortic sinus of the ascending aorta
It gives the following branches:
1) Right posterior descending artery branch (RPDA).
2) Sinu-atrial nodal branch.
3) Right marginal branch.
4) Atrial branch.
B. Left coronary artery: It originates from the left aortic sinus of the ascending aorta.
It gives the following branches:
1) Left anterior descending artery branch (LADA).
2) Circumflex branch.
3) Left marginal artery.
Q2- Regulation of the Heart
•
Intrinsic regulation: Results from normal functional characteristics, not on neural or hormonal
regulation
– Starling’s law of the heart
•
Extrinsic regulation: Involves neural and hormonal control
– Parasympathetic stimulation
•
Supplied by Vagus nerve, decreases heart rate, acetylcholine secreted
– Sympathetic stimulation
•
Supplied by cardiac nerves, increases heart rate and force of contraction,
epinephrine and norepinephrine released
Q3- physical examination of cardiac patient
1) Examine pulse
2) Examine heart sound
3) Examine heart rhythm
4) Blood pressure
5) Rate and depth of respiration
6) Oxygen saturation
7) Examine pain
Q4- Sign or Symptom of Cardiovascular diseases
1. Chest pain or discomfort
2. Claudication due to peripheral arterial disease with mismatch between peripheral O2 supply and
demand
3. Clubbing of digits due to right-to-left shunting in congenital heart disease
4. Cough due to acute pulmonary edema, Mitral stenosis(MS)
5. Cyanosis due to right-to-left shunting in congenital heart disease, significant decrease cardiac
output
Q5- Functional Classification of Heart Disease
 CLASS I (6 –10 METs)
– Patient with cardiac disease but without any resulting limitations of physical activity;
–
ordinary physical activity does not cause undue fatigue, palpitations, dyspnea, or anginal pain
 CLASS II (4–6 METs)
– Slight limitations of physical activity;
– comfortable at rest,
– but ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal pain
 CLASS III (2–3 METs)
– Marked limitation of physical activity;
–
comfortable at rest,
– but less than ordinary physical activity causes fatigue, palpitations, dyspnea, or anginal pain
 CLASS IV (<2 METs)
– Unable to carry out any physical activity without discomfort;
–
symptoms of cardiac insufficiency or of angina may be present even at rest;
– if exertion is undertaken, discomfort increase
Q6- Uses of Ambulatory/Holter Monitoring
It is useful for the diagnosis of cardiac arrhythmias
for the diagnosis of myocardial ischemia ( MI)
the evaluation of efficacy of antiarrhythmic drug therapy,
the assessment of artificial pacemaker function.
the therapist may be able to anticipate the rhythm changes that may occur during activity and can
inform the physician about any changes in the patient’s status and the effectiveness of treatment.
Q7- Respiratory Acidosis
DECREASE pH,
INCREASE CO2 ,
DECREASE Ventilation
Causes
1) CNS depression
2) Lung diseases like COPD, Pneumothorax,
Q8- Respiratory Alkalosis
INCREASE
pH,
DECREASE CO2,
INCREASE Ventilation
Causes
1) Intra cerebral hemorrhage (Head injury)
2) Cirrhosis of the liver
Q9- Metabolic Acidosis
DECREASE
pH,
DECREASE HCO3
 Causes
1. Lactic acidosis
2. Keto acidosis
3. Chronic diarrhea
Q10- Metabolic Alkalosis
INCREASE
pH,
INCREASE
HCO3
 Causes
1) Vomiting
2) Diuretics
Q11- The 12-Lead System
the 12-lead ECG, consists of the following
12 leads, which are:
I , II , III
aVR , aVL , aVF
 3 Augmented Leads
 3 Limb Leads
 6 Chest Leads
V1 ,V2 ,V3 ,V4 ,V5 ,V6
Q12- Indications for Stress Testing
1. Evaluation of patients with suspected coronary artery disease (CAD).
2. Evaluation of patients with known coronary artery disease (CAD).

After myocardial infarction

After intervention
3. Evaluation of exercise capacity
Q13- Normal Response to Stress Testing
1) Heart rate increases
2) Blood pressure increases
3) Cardiac output increases
4) Total peripheral resistance decrease
Q14- Normal ECG Response to Stress Testing
1) QRS complex decreases in size
2) ST segment returns to baseline by 80 millisecond
3) R amplitude may decrease at rates
4) T wave decreases
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Q15 –EXPLAIN PHASE III OF CARDIAC REHABILITATION
 Last up to 6-12weeks.
 Required minimum equipment monitoring.
 Aerobic, strengthening and endurance training.
 Frequency: 1-2 times per week at supervised rehabilitation, twice-weekly independent home exercise, the
remaining days walking.
 Timing: increase time to 20-30 minutes
 Intensity: THR =60-80%(MHR-RHR) + RHR
Q16- Goals of Cardiac Rehab
•
•
Identify, modify, and manage risk factors to reduce disability/morbidity and mortality
Improve functional capacity
•
Alleviate/lessen activity related symptoms
•
Educate patients about the management of heart disease
•
Improve quality of life
Q17- EXPLAIN methods of training that challenge the aerobic system:
1) Continuous.
2) Interval (work relief).
3) Circuit.
4) Circuit interval.
Q18- A-Preoperative education OF CARDIAC PATIENTS
•
Breathing exercises, coughing techniques, opening of the sternum,
•
Early mobilization, techniques for getting in and out of bed,
•
Lower limb exercises and thrombosis preventive exercises.
Q19- Sternal precautions recommended for the healing period during the first postoperative weeks after
cardiac surgery
patients are not allowed to:
*Use arms to push up from a lying to a sitting position.
*Use arms to push up from sitting to standing.
*Use stomach muscles to raise themselves from a lying to a sitting position .
*Use arms and shoulders, full active movement with 1-2 kg weights .
*Use a walker or crutches.
Q20- DISCUSS YOUR MEASURES TO PREVENTIN CORONARY HEART DISEASE
1. Stop Smoking
2. Exercise Regularly
3. Keep Weight Low
4. Eat a Low-Fat Diet
5. Keep Cholesterol Levels Low
6. Keep Blood Pressure Low
7. Control Diabetes
8. Take Daily Aspirin
Q21- EXPLAIN Level 1 of physical therapy role after myocardial infarction
Complete Bed Rest — Day of admission)
•
Relaxation
•
Breathing exercises
•
Active range of motion exercises (Ankle foot movements and finger and wrist movements) performed
five times, twice daily
Q22- DISCUSS Level 3:
(Up and About — Days 3 – 5)
Level 3(a)
•
Walk-standing: lower limb flexion (five repetitions thrice a day)
•
Stride-standing: hip and knee flexion (five repetitions thrice a day)
•
Walking outside the room (twice a day)
Level (3b)
•
Bend standing — elbow circling
•
Trunk bending
•
Walking outside the room with arm swings
•
Climbing one flight of steps
Q23- DISCUSS LEVEL 2
Level 2: (Partial Bed Rest — Days 1 and 2)
a. Sitting (1 – 2 hours / day) and self-feeding
Relaxation
Breathing exercises
Active range of motion exercises to hip and knee (five repetitions, thrice day)
Sitting — arm bending / stretching up / bending (five repetitions, thrice a day)
b. Level 2 (a) — progress sitting time (3 – 4 hours / day)
Independent in toileting (bedside)
Alternate heel drags
Static quadriceps and glutei (do not hold breath)
Static + spinal extension (five repetitions, thrice a day)
Q24- LIST THE COMPLICATION OF MI
1. Shock: cardiogenic, neurological shock
2. Heart failure
3. Dysrhythmia
4. Myocardial rupture
5. Sudden death
Q25- DISCUUS THE TYPES OF ASD
 Three major types
1. Ostium secundum
• most common , In the middle of the septum
2- Ostium primum
• Low position
3- Sinus venosus
• Least common, Positioned high in the atrial septum
Q26- EXPLAIN THE Tetralogy of Fallot
This malformation consists the following tetralogy:
•
(1) Pulmonary artery Stenosis
•
(2) Interventricular defect
•
(3) Deviation of the origin of the aorta to the right
•
(4) Hypertrophy right ventricle
Q27-Discuss Physical therapy MANAGENENT for aneurysm
•
The goals of your program should be to
 Increase your endurance level,
 Joint range of motion and
 Ability to perform activities of daily living.
•
Choose activities that are comfortable and well-tolerated, such as
•
Walking, swimming, or low-intensity sports such as bowling.
•
Start slowly and emphasize duration over intensity.
•
Gradually progress to exercising 15 to 20 minutes,
•
Frequency: Three or more days per week.
•
Intensity: training should be performed at moderate to-low intensity
Q28- DISCUSS conservative treatment of varicose veins
a) Avoid - prolonged standing, sitting, obesity, constricting garments.
b) Avoid Shower or bathe in the evening.
c) Apply well—fitted support stockings (20 - 40 mm Hg) before ambulating in the morning or exercising.
d) Elevate the feet 10-15 minutes, 3-4 times daily
e) Avoid trauma to varicose veins
Q29- Explain physical therapy management for varicose veins
•
Aims
1- Assist venous return
2- Avoid venous stasis and its complications
•
Methods
1. Positioning
2. Bandaging
3. Pneumatic compression therapy
4. Electromagnetic therapy
5. Exercise
Q30- DISCUSS Physical Therapy Components of a Decongestive Lymphatic Therapy Program
1. Elevation
2. Manual lymphatic drainage
3. Compression bandaging and Garment
4. Exercise
5. Pneumatic Pumps
6. Electro modalities
7. Skin care
8. Daily living precautions
Q31- LIST Signs and symptoms of lymphedema
•
Swelling of the arms or legs.
•
Swelling get worse during the day and better at night.
•
Redness and Warmth in the extremity.
•
A feeling of tightness and weakness in the affected extremity.
•
Bracelets, rings, or shoes may become tight.
•
Tends to occur distal to proximal
•
Increased pigmentation/superficial veins
•
Secondary cellulitis
Q32- LIST Measurement Methods of lymphedema
1. Water displacement – “gold standard”
2. Circumference
3. Perometry
4. Bioelectrical impedance
Q33- EXPLAIN Manual Lymphatic Drainage





Slow, very light, repetitive stroking and circular massage movements performed
Limb elevated whenever possible.
Proximal congestion in the trunk, groin, buttock, or axilla is cleared first.
Direction of massage is towards specific lymph nodes.
Usually involves distal to proximal stroking.
Q34- explain exercise therapy for lymphedema
* Active range of motion, stretching, circulatory and low-intensity resistance exercise
* Exercises should be performed with compressive bandages or garment
* Exercises are performed in a specific sequence, often with the limb elevated
* Low-intensity cardiovascular/pulmonary endurance activities.
* Deep breathing and relaxation.