Cardiovascular Conditions - DPT 611 Spring 2025

Seating Arrangement Instructions

• Sit in a different part of the room with a different seatmate.

Cardiovascular Conditions

• Aneurysm, Valve Disease, Cardiomyopathy (DPT 611 spring 2025)

Learning Objectives

• Describe risk factors, presentation, and pathophysiology of aneurysms, valve disease, and cardiomyopathy
• Describe diagnostic tests and medical/surgical interventions for aneurysms, valve disease, and cardiomyopathy
• Describe physical therapy implications for aneurysms, valve disease, and cardiomyopathy, and make treatment/referral/emergency care decisions.
• Identify factors contributing to health disparities in people with cardiovascular diseases

Aneurysm

• Weakening in a vessel wall that causes it to bulge or balloon out.
• Can dissect or tear, leading to life-threatening bleeding and/or death.
• True aneurysm: fusiform ballooning out of vessel wall on all sides, or saccular ballooning out on one side.
• False aneurysm: enlargement of any blood vessel layers, often due to a tear in the intima from trauma or surgery. Blood fills the space between layers.
• Dissecting aneurysm: tear separates the three layers of the vessel wall.

Types of Aneurysms

• Diagram showing different types (true, dissection, false)

Aneurysm Risk Factors

• Hypertension (HTN)
• Atherosclerosis
• Genetic conditions (Marfan Syndrome, Ehlers-Danlos syndrome, Turner's syndrome)
• Trauma
• Older age
• Smoking
• Untreated infections
• Bicuspid aortic valve

Aneurysm Locations

• Most common in the aorta, particularly the thoracic aorta.
• Can also occur in the abdominal aorta (AAA), common iliac, femoral, popliteal, and brain.

Aneurysm Symptoms

• Symptoms depend on location. Asymptomatic cases exist.
• AAA: constant pain in abdomen, low back, groin
• Cerebral: severe headache, vomiting/nausea, visual disturbances
• Iliac: pain in abdomen, back, groin
• Femoral or popliteal: lump palpating with a pulse.

Aneurysm Diagnosis and Treatment

• Radiograph, CT, echocardiogram, MRI
• Small or slowly evolving aneurysm: watch and wait, medication to manage risk factors.
• Surgery: median sternotomy or endovascular surgery to reinforce weakened wall or close false lumen.

Physical Therapy Implications (Acute Care)

• Sternotomy precautions
• Mobility
• Exercise tolerance and medication effectiveness
• Prescribing home exercise, and lifelong behavior change
• Medications to lower blood pressure and myocardial workload.
• No official activity guidelines for patients after repair. Avoid lifting more than half your body weight and isometrics. Consult the surgeon for activity parameters.

Heart Valve Dysfunction

• Atrial ventricular (AV) valves:
• Mitral/bicuspid
• Tricuspid
• Semilunar valves:
• Pulmonic/pulmonary
• Aortic
• Valve closure during ventricular systole and why
• What do S1 and S2 represent?
• When do you feel the pulse, before, after, or between S1 and S2?

Valve Disease Types

• Stenosis: narrowing
• Prolapse: ballooning/bulging
• Regurgitation: leaking

Cardiomyopathy

• Myocardial cell disorder
• Decreased aerobic capacity due to mitochondrial dysfunction.
• Ineffective heart pump leads to higher LVEDV & pressure which reduces L ventricular performance
• Dilated, Hypertrophic, and Restrictive types.

Dilated Cardiomyopathy (DCM)

• Idiopathic, ischemia, toxins, pregnancy, ETOH
• Increased cardiac mass
• Dilation of 4 chambers
• No wall thickening
• Systolic dysfunction
• Higher volumes, but lower contractility.

Hypertrophic Cardiomyopathy (HCM)

• Heredity, HTN
• Increased cardiac mass
• Diastolic dysfunction (abnormal LV relaxation, increased LV pressures).

Restrictive Cardiomyopathy (RCM)

XRT, amyloid, DM

• "Stiff' ventricles
• Decreased Ventricular filling and compliance
• Increased pressure in upstream chambers
• Decreased stroke volume
• Normal or slightly reduced contractility

Myocarditis & Pericarditis

• Myocarditis: inflammation of myocardial wall. Often caused by viral infections
• Pericarditis: inflammation of pericardium.
• Chest pain is not dependent on body position or activity

Pericardial Effusion

• Fluid buildup in pericardial space
• Quick versus slow accumulation
• Tamponade: decreased venous return, decreased ventricular filling, significantly decreased cardiac output, shock, or death
• Pericardial friction rub
• Pericardiocentesis

Exercise Snack Instructions

• Stand up for your exercise snack.

Simulation Information (Next Class)

• Advance practice and proficiency with patient management in acute care setting
• Gain practice with environmental management
• Gain practice with mobilizing patients with sternal precautions
• Arrive early, stand outside assigned room
• Review chart, take notes
• Simulation starts as soon as you enter room
• Assess cardiovascular status, mobility, cardiovascular response to activity, sternal stability, and educate patient about sternal precautions.

This quiz covers key concepts related to aneurysms, valve disease, and cardiomyopathy. Students will explore risk factors, diagnostic tests, and treatment options while considering health disparities in cardiovascular diseases. Understanding the implications for physical therapy interventions is also emphasized.