Cardiovascular Physical Therap

7/30/2019 Cardiovascular Physical Therap

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1. 1+ Pitting edema scale

- Barely perceptible identation ( 0 - 1/4

inch pitting)


- Easily identified depression; returns to

normal within 15 seconds. (1/4 > 1/2

inch pitting)


- Depression takes 15- 30 seconds to

rebound (1/2 > 1 inch pitting)


- Depression lasts for 30seconds (>

1inch pitting)

5. 40-60% of

functional

capacity

Patients with CHF should exercise at low

intensity and with interval training

(increasing duration with frequent rest

periods). What intensity level should CHF

exercise in terms of percentage offunctional capacity?

6. 40-70% of

VO2max, 2-3

times/day, 3-

7days/week

A walking program is recommended for

patients with PVD. what intensity should

it be?

7. 60-80% of V02

max

How is 70 - 85% of HR max correlates to

VO2 max?

8. 60% of HR range An RPE value of 12 - 13 (Somewhat hard)

correspond to how much percentage of

HR range?

9. 85% of HR range An RPE value of 16 (Hard) correspond to

how much percentage of HR range?

10.Anoxia Complete lack of oxygen

11.Anterior MI ECG changes with MI

A PT working in a hospital is asked to

treat a patient with known cardiac

problems. When he looks at the ECG

strips in the chart, he sees Q waves in

leads V1 - V4; what condition is the PT

suspecting?

12.Antiarrhythmics Identify the following medication based

on description?- Four main classes., Alter conductivity,

restore normal heart rhyth,control

arrhythmias, improve cardiac output

e.g., quinidine, procainamide

13.Arteriosclerosis

obliterans

(atherosclerosis): Chronic, occlusive

arterial disease of medium and large sized

vessels, the result of peripheral

atherosclerosis.

- Associated with hypertension and

hyperlipidemia; patient may also exhibit

CAD, Cerebrovascular disease, diabetes- Pulses: decreased or absent

- Color: pale on elevation,dusky red on

dependency

- Early stages: Intermitten claudication.

Pain described as burning,searing,aching,

tightness or cramping

- Late stages: Ischemia and rest pain;

ulcerations and gangrene, trophic changes

- Affect primarily the lower extremities.

14.Aspirin Identify the following medication based on

description?

- Decreases platelet aggregation; mayprevent myocardial infarction, considered

a blood thinner.

15. Beta-adrenergic

blockers

Identify the following medication based on

description?

- reduce myocardial demand by reducing

heart rate and contractility; control

arrhythmias, chest pain, reduce blood

pressure

e.g., propanolol[inderal]

16. CAD, MI, aortic

stenosis,

chronic

hypertension

S4 is associated with ventricular filling

and atrial contraction. it occurs just before

S1. Which conditions is S4 associated

with?

17. Calcium

channel

blockers

Identify the following medication based on

description?

- Inhibit flow of calcium ions, decrease

heart rate, decrease contractility,dilate

coronary arteries, reduce BP, control

arrhythmias, chest pain.

e.g., Cardizem, Procardia,diltiazem

18. Cheyne-Stokes

respirations

Defined as a period of apnea (no

breathing) lasting for 10 - 60 seconds

followed by gradually increasing depthand frequency of respirations;

accompanies depression of frontal lobe

and diencephalic dysfunction. May also be

seen in advance left sided heart failure

19. Clubbing Curvature of the fingernails with soft tissue

enlargement at base of nail; Associated

with chronic oxygen deficiency, heart

failure

20. Compression

therapy is

contraindicated

ABI Index value = 0.79 - 0.50;

Compression therapy recommendation?

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21. Compression therapy is

contraindicated

ABI Index value < 0.50;

Compression therapy

recommendation?


contraindicated

A therapist obtains a value of

0.49 of a measure of the Ankle-

Brachial index. What does this

value represents in terms of

using compression therapy?


contraindicated






24. Compression therapy

with caution






25. Compression therapy

with caution

ABI Index value = 0.99 - 0.80;

Compression therapy

recommendation?

26. Congestive heart failure

(CHF)

Defined as a condition in which

the heart is unable to maintian

adequate ciruculation of the

blood to meet the metabolic

needs of the body. When with

this condition edema is present

is called?

27. Congestive Left heart

failure

Gallop or S3, is an abnormal

heart rhythm with three sounds

in each cycle. It occurs soonafter S2. Which condition is S3

is associated with?

28. Cyanosis Bluish color related to decreased

cardiac output or cold; especially

lips, fingertips, nail beds

29. DBP 110mmHg,

decrease in SBP > 10

mmHg, significant

ventricular/atrial

arrhythmias, 2nd-3rd

degree AV Block, s/s of

exercise intolerance

If a patient is exercising in a

Inpatient Cardiac Rehabilitation

program, what conditions would

lead to exercise discontinuation?

30. Decreased stroke

volume, cardiac output

and ejection fraction,

but also increased end

diastolic ventricular

pressures

Impaired ventricular function

results in:

31. Deep vein

thrombophlebitis

(DVT)

Defined as clot formation and acute

inflammation in a deep vein

- Usually occurs in lower extremity,

associated with venous stasis (bed rest,

lack of leg exercise)

- Hyperactivity of blood coagulation, and

vascular trauma

- Early ambulation is prophylactic, helps

eliminate venous stasis

32. Diabetic

angiopathy

Defined as inappropirate elevation of

blood glucose levels and accelerated

atherosclerosis

- Neuropathy a major problem

- Neurotrophic ulcers, may lead to

gangrene and amputation

33. Diastole The period of ventricular relaxation and

filling of blood

34. Digitalis (cardiac

glycosides)

Identify the following medication based

on description?

- Increases contractility and decreasedheart rate (bradycardia)

- Mainstay in the treatment of CHF (e.g.,

digoxin)

35. Discontinous When performing Exercise Tolerance

Test (ETT) to determine functional

capacity of an individual, How ETT

should be performed for patients with

more pronounced CAD?

36. Discontinue

activity, elevate

limb and apply

cold packs

A patient is presenting with any of the

signs of lymph overlad: discomfort,

aching or pain in proximal lymph areas

(axillar or inguinal), change in skin

color as a result of activities being

perform in the rehab session. What

should the PT do?

37. Diuretics Identify the following medication based

on description?

- Decrease myocardial work (reduce

preload and afterload)

- Control hypertension (e.g. , furosedide

[lasix],hydrochlorothiazide[Esidrix]

38. Do not apply

compression

A PT is working a hospital and he's

given orders to apply compression to apatient with chronic venous insufficiency

as part of management of LE edema. The

PT looks at the chart and reads the ABI

index to be < 0.8 (mild arterial disease)

with evidence of cellulitis or infection.

What's the Next thing to do?


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39. Do not apply

compression

therapy

A therapist wants to apply compression

therapy as part of management of edema

on a patient with chronic venous

insufficiency. The therapist performs an

Ankle-Brachia l test. the values is

0.68,which is < .80 according to the

index values. What should this therapist

do with regards to compression therapy?

40. Do not remove

any cloth or

towel, and add

additional layers,

and elevate the

part if possible

unless it's

deformed or

causes pain

when elevated

A PT is trying to control external

bleeding (arterial bleed) for a football

player who has severely injured. The PT

attempts to stop the bleeding by putting a

clean cloth or towel over it and apply a

firm pressure. The PT notices that the

blood is soaking through the cloth or

towel. What's the next thing he should

do to contain the bleeding?

41. End diastolic

volume

The amount of blood in the ventricles

after diastole ( 120mL)

42. End systolic

volume

The amount of blood in the ventricles

after systole ( 50mL)

43. Exercise is

contraindicated

What can be safely assumed in term of

exercise in individuals with: poor LEFT

ventricular function, ischemic changes

on ECG (ST segment depression > 1mm)

during ETT, Functional capacity < 6

METs, uncontrolled hypertension or

arrhythmias?

44. Falsely elevated,

arterial disease,

diabetes

ABI Index value > 1.2

45. Grade 1 A patient presents with intermittent

claudication when walking on the

treadmill. When asked with regards to

his pain in LE, he states it is minimal

discomfort. What grade this represent in

the intermittent claudication scale?




his pain in LE, he states it is moderate

discomfort, and his attention can bediverted with conversation. What grade

this represent in the intermittent

claudication scale?




his pain in LE, he states he cannot

continue because the pain is intense

(Patient 's attention cannot be diverted).

What grade this represent in the

intermittent claudication scale?

48. Grade 4 A patient presents with

intermittent claudication when

walking on the treadmill.

Shortly after the patient stops

the treadmill and states that

his pain is excrutiating and

unbearable. What grade this

represent in the intermittent

claudication scale?

49. Heart failure Defined as a condition in

which the heart is unable to

maintian adequate ciruculation

of the blood to meet the

metabolic needs of the body.

50. Heteroptics Cardiac transplantation is used

in end-stage myocardial

disease e.g.,

cardiomyopathy,ischemic heart

disease, valvular disease.

When transplantation involves

leaving the natural heart and

piggy-backing the donor heart

this is called?

51. HR > 115bpm In patients with CHF, exercise

HR should be limited to RHR +

10-20bpm. What exercise HR

is generally contraindicated in

individuals with Congestive

heart failure?

52. HR increases directly

proportional to exercise

intensity, Rate relatedshortening of QT interval,

decrease R wave and

increase Q wave,

arrhythmias rare: single

PVCs, ST segment

depression < 1mm

What are ECG changes with

exercise in healthy individuals

?

53. Hypercalcemia Increased concentration of

calcium ions increases heart

actions

54. Hyperkalemia What condition might be

suspected in the following

description?

- increased concentration of

potassium ios decreased the

rate and force of heart

contraction

- ECG changes such as:

Widened PR intervals, QRS

and tall T waves?

55. Hypocalcemia decreased concentration of

calcium ions decreases heart

actions


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56. Hypokalemia What condition might be suspected in the

following description?

- decreased concentration of postass ium ions

produce

57. hypokalemia leg cramps may also result from diuretic use

that reduce K ion concentration. this

condition is called:

58. Hypoxemia Abnormally low amount of oxygen in theblood (Osat < 90%)

59. Hypoxia Low oxygen level in the tissues

60. Increase

duration

first, and

then

intensity

As training progress in rehabilitation, you

should:

61. Inferior MI ECG changes with MI

A PT working in a hospital is asked to treat a

patient with known cardiac problems. When

he looks at the ECG strips in the chart, he seesQ waves in leads II, III, AVF. What

conditions is the PT suspecting?

62. Interval

training or

discontinous

protocol at

moderate

level

Exercise training for patient with PVD may

result in improved functional capacity,

improved peripheral blood flow and muscle

oxidative capacity. what type of

training/protocol is recommended?

63. Lateral MI ECG changes with MI

A PT working in a hospital is asked to treat a

patient with known cardiac problems. When

he looks at the ECG strips in the chart, he seesQ waves in leads 1, AVL. What condition is

the PT suspecting?

64. Left heart

failure or

forward HF)

Defined as whe blood is not adequately

PUMPED into systemic circulation;due to an

inability of LEFT ventricle to pump,increases

in ventricular end-diastolic pressure and left

atrial pressure with:

- Increased pulmonary artery pressures, and

pulmonary edema

- Pulmonary signs & symptoms: cough,

dyspnea, orthopnea(shortness of breath

(dyspnea) which occurs when lying flat)- Weakness, fatigue

65. Left sided

heart failure

These signs & symptoms are associated with

what type of heart failure (right/left)?

- Fatigue, cough

- Shortness of breath, Dyspnea on exertion

- Orthopnea, Paroxysmal Nocturnal Dyspnea

(PND)

- Diaphoresis

- Cheyne-Stokes respirations (advanced

failure)

66. Mild arterial

disease, intermittent

claudication

ABI Index value = 0.99 - 0.80

67. Mild peripheral

artery disease

A therapist obtains a value of 0.92 of

a measure of the Ankle-Brachial

index. What does this value

represents?

68. Moderate arterialdisease, and pain at

rest

ABI Index value = 0.79 - 0.50

69. Moderate peripheral

artery disease




represents?

70. Moderate peripheral

artery disease




represents?

71. Moderate peripheralartery disease

A therapist obtains a value of 0.74 ofa measure of the Ankle-Brachial


represents?

72. Modified Buerger-

Allen exercises

Name of these exercises for PVD

patients (arterial disease)

- Postural exercises + active

plantaflexion and dorsiflexion of the

ankle

73. Modified Buerger-

Allen exercises, and

resistive calf

exercises

What LE exercises are recommended

for patients of PVD (arterial

disease)?

74. Modify exercise

prescription

- HR < THR for a given exercise

intensity

- RPE < for a given exercise intensity

(exercise is preceived as easier)

- Symptoms of ischemia (i.e.,

angina) do not appear at a given

exercise intensity

If any of this conditions occurs in

your plan of care, you should:

75. Myocardial

perfusion imaging

Diagnostic test use to diagnose and

evaluate ischemic heart disease,

myocardial infraction

76. Nitroglycerin Identify the following medication

based on description?

- Decrease preload through

peripheral vasodilation, reduce

myocardial oxygen demand

- Reduce chest discomfort (angina)

- may also dilate coronary arteries,

improve coronary blood flow

(nitrates)

77. Normal ABI Index value = 1.0 - 1.20


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78. Normal A therapist obtains a value of 1.0 of a

measure of the Ankle-Brachial index.

What does this value represents?

79. Orthopnea Inability to breathe when in a

reclining position

80. Orthotopic Cardiac transplantation is used in

end-stage myocardial disease e.g.,

cardiomyopathy,ischemic heartdisease, valvular disease. When

transplantation involves removing te

diseased heart and replacing it with

a donor heart, this is called?

81. Pallor Absence of rosy color in light-

skinned individuals, associated with

decreased peripheral blood flow,

PVD

82. Paroxysmal

nocturnal dyspnea

Sudden inability to breathe occurring

during sleep

83. Percussion test What test determines the competenceof greater saphenous vein?

84. Percussion test What test is being explained?

- In standing, palpate one segment of

vein while percussing ven

approximately 20 cm higher. If pulse

wave is flet by lower hand, the

intervening vals are incompetent

85. Persisten dyspnea,

dizziness or

confusion, angina,

severe leg

claudication,excessive fatigue,

pallor, cold sweat,

ataxia, pulmonary

rales

Signs & Symptoms of Exercise

intolerance

86. Poor arterial

perfusion

A PT examines a patient in the

clinic. The PT notices that the

superficial temperature of one of the

LE is lower compared to opposite

side. This condition can be attributed

to:

87. Posterior MI ECG changes with MI

A PT working in a hospital is asked

to treat a patient with known cardiac

problems. When he looks at the ECG

strips in the chart, he sees Large R

waves in leads V1-V3, ST segment

depression V1,V2, or V3. What

conditions is the PT suspecting?

88. Pressures >

45mmHg

When using compression pumps

what pressures are contraindicated

as they can cause lymphatic

collapse?

89. Raynaud's disease Episodic spasms of small

arteries and arterioles.

Abnormal vasoconstriction

reflex exacerbated by exposure to

cold or emotional stress.

Tip of fingers develop pallor,

cyanosis, numbness and

tingling

90. Raynaud's disease or

phonomenon

Defined as episodic spasm of

small arteries and arterioles

- Abnormal vasoconstrictor

reflex exacerbated by exposure to

cold or emotional stress; tips of

fingers develop pallor, cyanosis,

numbness, and tingling

- Affects largely females

- Occlusive diesease is not

usually a factor

91. Resistive calf exercises What is the MOST effective

method of increasing blood flow

in LE in patients with PVD

(arterial disease)?

92. Resistive exercise is

contraindicated

A patient would like to beging a

resistive training program.

Patient has a diagnosis of poor

left ventricular function,

ischemic changes on ECG

during exercise tolerance test

(ETT) and his functional

capacity is less than 6 mets.

What can be said with regards

to perform resistive exercise

program?

93. Resting SBP > 200mmHg

or Resting DBP >

110mmHg, Orhosthatic

BP drop > 20 mmHg

with symptoms, ST

segment depression >

2mm, uncontrolled

diabetes: glucose level

300mg/dL pr >

250mg/dL with ketones

present

What conditions are considered

Absolute contraindications to

participation in Inpatient

and/or Outpatient cardiac

rehabilitation program?

94. Right heart failure or

backward HF

Defined as when blood is not

adequately RETURNED from the

systemic circulation to the

heart;due to failure or

RIGHTventricule, increased

pulmonary artery pressures,

with:

- Peripheral edema: weight gain,

venous stasis

- Nausea, anorexia


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95. Right sided heart failure These signs & symptoms are

associated with what type of

heart failure (right/left)?

- Nausea, anorexia

- Weight gain, ascites,

Right upper quadrant pain

- Increased right arterial

pressure (RAP), Central

venous pressure (CVP)- Jugular venous distention

- Peripheral edema

96. Rubor Dependent redness wih

PVD

97. Severe arterial disease ABI Index value < 0.50

98. Severe arterial disease,

critical limb ischemia, and

for rest pain

A therapist obtains a value

of 0.48 of a measure of the

Ankle-Brachia l index. What

does this value represents?

99. Significant tachycardia

occurs at lower level of

exercise, Exertional

arrhythmias during

exercise and recovery, ST

segment depression > 1mm

below baseline

What are ECG changes with

exercise in individuals with

CAD Myocardial Ischemia?

100. Stemmer's sign Dorsal skin folds of the

ltoes or fingers are resistant

to lifting

Indicative of fibrotic

changes and lymphedema

101. Stop exercise A patient is taken to thecardiac rehabiliation

inpatient center to exercise.

If any of the following

occurred, what is the next

thing to do with regards to

exercise?

- Patient's DBP 110

mmHg

- Decrease in SBP > 10

mmHg

- Significant ventricular or

atrial dysrhythmias

- 2 or 3 heart block

- signs & symptoms of

exercise intolerance,

including: angina,marked

dyspnea, and

electrocardiogram changes

suggestive of ischema such

as: ST depression > 1mm

102. Strenous

activities such as

jogging, and

ballistic

movements

Activities that are CONTRAINDICATED

to patients with lymphedema as they are

likely to exacerbate this condition are:?

103. Superficial vein

thrombophlebitis

Defined as clot formation and acute

inflammation in a superficial vein.

Localized pain; usually in saphenous in

a deep vein

104. Swan-Ganz

catheter

What the name of the central line

catheter that is inserted through vessels

into right side of heart,and it is used to

measure

- Central venous pressure (CVP)

- Pulmonary artery pressure (PA)

- Pulmonary capillary wedge pressures

(PCWP)?

105. Systole The period of ventricular contraction

106. Thromboangiitis

obliterans

(Buerger's disease): Chronic,

inflammatory vascular occlusive disease

of small arteries and also veins

- Occurs commonly in young adults,

largely males, who smoke.

- Begins distally and progresses

proximally in both upper and lower

extremities

- Patient exhibit paresthesias or pain,

cyanotic cold extremity,diminished

temperature sensation, fatigue, risk of

ulceration and gangrene

107. Trendelenburg's

test

(retrograde filling test) What test is

being explained ?

- Patient is positioned in supine with

legs elevated 60 (empties venous blood)

- Tourniquet is then placed on proximal

thigh (occludes venous flow in the

superficial veins)

- Patient is then asked to stand

- Examiner notes if veins fill in normal

pattern. Should take approximately 30

seconds.

108. Venous filling

time

What test is being explained?

- Patinet in supine, passively elevate LEs

to approximately 45 for 1 minute, then

place in dependent position.

- note time for veins to refil

- delayed filling (> 15 seconds) is

indicative of venous insufficiency

109. Venous

insufficiency

A therapist performs a venous filling

time test. Veins takes 25 seconds to

refill. This venous filling time may be

indicative of what condition?


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110. Ventricular assist devices (VADs) Defined as an implanted device (accessory pump) that improves tissue perfusion and

maintians cardiogenic circulation;used with severely involved patients e.g.,

cardiogenic shock unresponsive to medications, severe ventricular dysfunction

111. Weight gain, edema in LE Exercise may exacerbate CHF, therefore check for delayed reponses of:

112. Work trunk and limb girdle muscles first,

then limb muscles from proximal to

distal with compression bandage on

What sequence of exercise is indicated for patients with lymphedema?

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