cardiacrehab

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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)
–
2
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
•
-Author/s (Year)
3
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.
-Author/s (Year)
4
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).
-Author/s (Year)
5
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.
-Author/s (Year)
6
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.
-Author/s (Year)
7
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.
-Author/s (Year)
8
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.
9
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.
10
11
12
MYOCARDIAL INFARCTION
13
CONGESTIVE HEART FAILURE
•
•
•
•
Dyspnea
Orthopnea
Cough
Pulmonary
edema
• Cerebral hypoxia
• Fatigue/Muscle
crampingor
weakness
• Nocturia
-Author/s (Year)
14
Heart Failure
15
CARDIAC VALVULAR DISEASE
16
RHEUMATIC FEVER
17
ENDOCARDITIS
18
MITRAL VALVE PROLAPSE
19
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
-Author/s (Year)
20
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.
-Author/s (Year)
21
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)
-Author/s (Year)
22
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
•
-Author/s (Year)
23
24
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.
-Author/s (Year)
25
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.
-Author/s (Year)
26
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.
-Author/s (Year)
27
-Author/s (Year)
28
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
•
-Author/s (Year)
29
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.
-Author/s (Year)
30
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.
-Author/s (Year)
31
PHYSICAL THERAPY
INTERVENTIONS
•
•
•
•
Aerobic Exercise
Strength Training
Ventilatory Muscle Training
Activity Pacing and Energy
Conservation Technique
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