CLINICAL SIGNS AND
SYMPTOMS
• Cardinal Symptoms
– chest neck and/or arm
pain or discomfort
– Palpitation
– Dyspnea
– Syncope
– Fatigue
– Cough
– Diaphoresis
– Cyanosis
– Edema and leg
pain/claudication(vascu
lar component)
–
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CHEST PAIN AND DISCOMFORT
common presenting symptom of cardiovascular
disease
• cardiac or noncardiac in origin
• radiate to the neck, jaw, upper trapezius muscle,
upper back, shoulder, or arms
*most common on left arm
• follows the pattern of ulnar nerve distribution.
• can be experienced in the somatic areas because the
heart is supplied by the C3-T4 spinal segments
•
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PALPITATION
• presence of an irregular heartbeat, may also
be referred to as arrhythmia or dysrhythmia,
which may be caused by a relatively benign
condition
• a bump, pound, jump, flop, nutter, or racing
sensation of the heart.
• may include lightheadedness or syncope
• as if the heart "skipped" a beat.
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DYSPNEA
• also referred to as breathlessness or
shortness of breath
• Can vascular or pulmonary in origin
• unexplained episodes of shortness of
breath frequently accompany congestive
heart failure (CHF).
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CARDIAC SYNCOPE
• Cardiac syncope (fainting) or more mild
lightheadedness can be caused by
reduced oxygen delivery to the brain
• Syncope that occurs without any warning
period of lightheadedness, dizziness, or
nausea may be a sign of heart valve or
arrhythmia problems.
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EDEMA
• Edema in the form of a 3-pound or
greater weight gain or a gradual,
continuous gain over several days that
results in swelling of the ankles,
abdomen, and hands combined with
shortness of breath, fatigue, and dizziness
may be red-flag symptoms of CHF.
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ANGINA
• Acute pain in the chest, called angina
pectoris, results from the imbalance
between cardiac workload and oxygen
supply to myocardial tissue. Angina is a
symptom of obstructed or decreased
blood supply to the heart muscle primarily
from a condition called atherosclerosis.
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TYPES OF ANGINA PECTORIS
•
•
Chronic Stable Angina –
occurs at a predictable
level of physical or
emotional stress and
responds promptly to rest
or to nitroglycerin
Resting Angina (Angina
Decubitis)- occurs at rest in
the supine position, pain is
neither brought on by
exercise nor relieved by
rest.
•
Unstable Angina(Cresendo
angina)- abrupt change in
the intensity and frequency
of symptoms or decreased
threshold of stimulus, such
as the onset of chest pain
while at rest.
– duration of these attacks is
longer than the usual 1 to 5
minutes; they may last for
up to 20 to 30 minutes.
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TYPES OF ANGINA PECTORIS
•
•
Nocturnal Angina- may
awaken a person from sleep
with the same sensation
experienced during exertion.
During sleep this exertion is
usually caused by dreams.
Atypical Angina- unusual
symptoms (e.g., toothache or
earache) related to physical
or emotional exertion. These
symptoms subside with rest
or nitroglycerin
• Prinzmetal's angina produces symptoms similar to
those of typical angina but is
caused by coronary artery
spasm. These spasms
periodically squeeze arteries
shut and keep the blood from
reaching the heart.
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MYOCARDIAL INFARCTION
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CONGESTIVE HEART FAILURE
•
•
•
•
Dyspnea
Orthopnea
Cough
Pulmonary
edema
• Cerebral hypoxia
• Fatigue/Muscle
crampingor
weakness
• Nocturia
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Heart Failure
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CARDIAC VALVULAR DISEASE
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RHEUMATIC FEVER
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ENDOCARDITIS
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MITRAL VALVE PROLAPSE
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PHARMACOLOGIC
MANAGEMENT
• Diuretics OR "water pills“
– lower blood pressure by eliminating sodium and
water and thus reducing the blood volume.
• Beta-blockers
– relax the blood vessels and the heart muscle by
blocking the beta receptors on the sinoatrial node
and myocardial cells, producing a decline in the
force of contraction and a reduction in heart rate
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PHARMACOLOGIC
MANAGEMENT
•
Alpha-1 blockers
•
Angiotensin-converting enzyme (ACE) inhibitors
•
Calcium channel blockers
– lower the blood pressure by dilating blood vessels.
– improve cardiac function in individuals with heart failure
and are used for persons with diabetes or early kidney
damage.
– inhibit calcium from entering the blood vessel walls
– Side effects may include swelling in the feet and ankles,
orthostatic hypotension, headache, and nausea.
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CARDIAC REHAB POST-MI
• Divided into 3 stages/Phases
– Phase I (Acute Phase)
• Phase Ib (Inpatient Rehabilitation Phase
– Phase II (training Phase)
– Phase III (Maintenance Phase)
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Acute Phase (Phase I)
Education about cardiopulmonary risk factor
modification is introduced at the time of acute
hospitalization.
• Post-MI heart rate increase with activity should
be kept to within 20 beats per minute of baseline,
and SBP kept within 20 mm Hg of baseline
• A decrease of 10 mm Hg or more is indicative of
further medical issues and exercise should be
halted.
• The target intensity at the end of the phase I
program exercise is to a level of four METs
•
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Inpatient Rehabilitation Phase
(Phase IB)
• The guidelines for exercise are the same
as they are for patients in phase 1, but
with a longer recovery period extending
their hospitalized care to an acute or
subacute rehabilitation setting before
discharge.
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Training Phase (Phase II)
•
•
•
•
•
starts after a symptom limited full level ETT for patients with cardiac
disease or a CPET for patients with complex pulmonary disease.
allows for setting target heart rates and target exercise intensity
from the exercise.
three sessions per week for 8 to 12 weeks.
Patients need to learn to begin exercise with a stretching session,
then a warm-up session, a period of training exercise at designated
intensity, followed by a cool-down period.
The principles of specificity of training need to be remembered
because training benefits generally are seen in the specific muscles
exercised.
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Maintenance Phase (Phase III)
•
•
The benefits of a phase 2 program can be lost in as little time
as a few weeks if a patients ceases to exercise. Because of this,
patient education of the importance of making exercise a part
of their new health habits has to be emphasized and the patient
needs to integrate exercise as a part of a healthy lifestyle.
To maintain capacity, patients should perform moderate
exercise at the target intensity learned in their rehabilitation
program for at least 30 minutes three times a week. With lowlevel exercise, the frequency has to be increased to five times a
week for maintenance of gains.
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Exercise Intensity
prescribed by either HR or by subjective
report, a rating of perceived exertion
(RPE). Subjective ratings of intensity of
exertion have been used to quantify effort
during exercise.
• A common aerobic exercise prescription
based on HR is 70% to 85% of HRmax
•
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Exercise Frequency
• commonly prescribed three to five times
per week. The patient should not
experience increased fatigue as a result
of exercise. If fatigue does occur, the
frequency and/or intensity of exercise
should be decreased.
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Exercise Duration
• The goal of 30 to 40 minutes of aerobic
exercise with an additional 5 to 10
minutes of warm-up and an adequate
cool-down is appropriate.
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PHYSICAL THERAPY
INTERVENTIONS
•
•
•
•
Aerobic Exercise
Strength Training
Ventilatory Muscle Training
Activity Pacing and Energy
Conservation Technique
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