Coronary Artery Disease Management Quiz

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Questions and Answers

Which of the following is NOT a typical medical intervention for managing Coronary Artery Disease (CAD) or Myocardial Infarction (MI)?

Use of medications to lower heart rate

Optimization of physical activity

Employing a percutaneous transluminal coronary angioplasty (PTCA) (correct)

Medications to reduce blood pressure

What is the primary purpose of a stent in the context of treating CAD?

To directly remove plaque from the artery

To surgically bypass blocked arteries

To reduce cholesterol levels

To reduce the risk of re-stenosis after PTCA (correct)

Which type of vessel is LEAST likely to be used for a Coronary Artery Bypass Graft (CABG)?

Internal mammary artery

Brachial Vein

Saphenous vein

Ulnar artery (correct)

What is the main purpose of medications that optimize myocardial oxygen demand?

To lower heart rate and/or lower contractility Signup and view all the answers

Besides a saphenous vein, which of the following can be used as a conduit in a CABG?

Internal Thoracic artery Signup and view all the answers

Which of the following is a primary indication for a MID-CAB procedure?

One or two blocked arteries on the anterior surface of the heart Signup and view all the answers

What is a key advantage of the MID-CAB procedure over traditional coronary artery bypass grafting?

Shorter length of hospital stay Signup and view all the answers

In the context of sternal instability assessment, what does "contrary shoulder movement" refer to?

Moving one shoulder forward while the other moves backward. Signup and view all the answers

Which of the following is NOT a standard sternal precaution?

Bilateral shoulder elevation past 90 degrees is allowed for 8 weeks. Signup and view all the answers

Which of the following would NOT be a primary focus of a physical therapy examination following a MID-CAB procedure?

Evaluating range of motion in the upper extremities Signup and view all the answers

According to the provided content, what is the main premise behind "Move in the Tube" modified sternal precautions?

Patients should confine their movements within a specific range of motion, allowing for some activities while restricting others. Signup and view all the answers

Which of the following is considered a risk factor for sternal dehiscence following cardiac surgery?

Diabetes Signup and view all the answers

Which of these represents a Grade 3 Sternal Instability?

Marked increase in motion upon special testing, with a complete separation of the sternum along its entire length. Signup and view all the answers

During a physical therapy examination, which special test would be used to assess circulation in the periphery?

Capillary refill Signup and view all the answers

When assessing sternal instability, palpating between the sternal halves using the 2nd, 3rd and 4th digits, which of the following movements should be performed?

Shoulder flexion, trunk lateral flexion, and coughing or deep breathing. Signup and view all the answers

What specific instructions are given for coughing during sternal precautions?

Cough only when absolutely necessary, and do so with the assistance of a pillow. Signup and view all the answers

Which movement is NOT allowed within the first 10 days following sternotomy according to "Move in the Tube" precautions?

Bilateral shoulder elevation past 90 degrees. Signup and view all the answers

What is the purpose of the "Move in the Tube" approach to sternal precautions?

To allow for a wider range of motion and activities within a designated safe zone. Signup and view all the answers

How long should patients generally keep their upper arms close to the body following surgery?

6-8 weeks Signup and view all the answers

Which of the following actions should patients perform when coughing or sneezing in the initial weeks after surgery?

Use a splinted cough technique while holding a pillow over the incision. Signup and view all the answers

Which of these conditions would MOST strongly suggest a patient needs to wear a supportive vest following surgery?

A BMI equal to or greater than 35 Signup and view all the answers

For patients with large breasts, what type of bra is recommended post-surgery?

A supportive bra that fastens in the front. Signup and view all the answers

Which of the following is NOT an element of movement assessment?

Patient's shoe size Signup and view all the answers

What level of assist is required when a patient performs 75% of the movement on their own?

Minimal Assist (Min A) Signup and view all the answers

Which functional measure helps in determining the impact of surgery on a patient's function?

Six Minute Walk Test Signup and view all the answers

What does the abbreviation CGA stand for in the context of level of assist?

Contact Guard Assist Signup and view all the answers

What is the correct percentage of movement a patient in 'Maximum Assist' can perform on their own?

25% Signup and view all the answers

Which best describes the function of functional measures in rehabilitation?

Determine functional status Signup and view all the answers

What is the MCID for the Six Minute Walk Test in patients with MI/CAD?

25 m Signup and view all the answers

What level of assistance would a patient require if they need the clinician to perform the entire transfer?

Dependent (D) Signup and view all the answers

During the 'five times sit to stand' test, what does it primarily assess?

Strength and endurance Signup and view all the answers

What does the 2-minute step test primarily measure?

Exercise capacity Signup and view all the answers

Which age group for women shows below average if they step fewer than 60 times in the 2-minute step test?

85-89 Signup and view all the answers

What is one disadvantage of the 2-minute step test?

Low correlation to VO2 Signup and view all the answers

In the 2-minute step test, how is performance judged for men aged 70-74?

Less than 80 hits is below average Signup and view all the answers

What is a key strength of the 2-minute step test?

It can be conducted anywhere Signup and view all the answers

Which scoring method is used for evaluating the results of the 2-minute step test?

Count the number of right knee hits only Signup and view all the answers

Which quality of life measure is included in the assessment of physical well-being?

SF-36 Signup and view all the answers

What is a limitation identified with the data on the 2-minute step test?

No data on responsiveness Signup and view all the answers

Study Notes

Patient Positioning for Assessments

Sit in a new part of the room next to someone you do not normally sit with

Ischemic Conditions and Med/Surg Management

Medical Management

Patients with CAD and/or MI may be managed medically.
Optimize blood pressure through medications, weight loss, and exercise.
Optimize myocardial oxygen demand through medications that lower heart rate and/or lower contractility.
Optimize coronary blood flow through medications that thin blood.
Manage cholesterol.
Optimize physical activity.

Surgical Interventions for CAD & MI

PTCA (Percutaneous Transluminal Coronary Angioplasty): Balloon angioplasty using a balloon-tipped catheter to compress plaque in an occluded coronary artery, restoring blood flow.
Stent: Used in conjunction with PTCA to prevent re-stenosis. Blood thinners are also used.

Surgical Interventions - CABG

CABG (Coronary Artery Bypass Graft): A surgical procedure that uses a harvested blood vessel (saphenous vein, internal mammary/internal thoracic artery, or brachial vein) to bypass an occluded coronary artery, restoring blood flow.

Surgical Treatments: Coronary Artery Bypass Graft (CABG)

Harvest a vessel from the body (saphenous vein, ulnar artery).
Connect vessel from aorta to distal area of occlusion.

Mid-CAB: Indications and Contraindications

Indications: 1-2 blocked arteries on the anterior surface of the heart.
High risk for bypass surgery.
Benefits: No sternotomy (less functional impairment), shorter length of stay, lower risk than with heart-lung machine.

Chart Review: Surgery

Look for type of surgery, method of surgery, where vein was harvested, and anything unusual in the perioperative or operative period.

PT Examination

Cardio-vascular screen: Heart auscultation, observation of color/perfusion.
Sternal stability and precautions teaching.
Tests for cardiorespiratory fitness, education about risk factor reduction.
Referral to cardiac rehabilitation.
Vital sign or cardiorespiratory response to activity.
ECG/telemetry.

Examination Continued: Special Tests CV

Special Test: Heart Auscultation
Special Test: Capillary Refill
Special Test: Peripheral pulse strength
Special Test: Lung Auscultation
Special Test: Blood Pressure (orthostatic hypotension)
Special Test: Sternal stability

Examination - Sternal Incision

Wound evaluation (color, odor, discharge—more to come in fall P2).
Sternal Stability.
Risk factors for dehiscence: older age, smoking, diabetes, overweight or obese, poor nutritional status.

Sternotomy

Different types (median, mid-lateral, anterior, lateral, interior) CAB.

Sternal Instability

Palpate between sternal halves, noting motion, bony gap, and tenderness.
Further challenging the sternum with alternate shoulder movements, and recording the grade of motion.
Sternal Instability Scale: 0-Clinically stable sternum (no detectable motion), 1- Minimally separated sternum (slight increase in motion), 2-Moderately separated sternum (moderate increase in motion), 3-Completely separated sternum (marked increase in motion).

Sternal Precautions

No pushing, pulling, lifting, or carrying > 5-10 pounds for 8 weeks.
No bilateral shoulder elevation past 90 degrees for 8 weeks.
Unilateral unweighted shoulder elevation past 90 degrees is allowed within pain limits.
No reaching behind back, splinted coughing.
No driving x 8 weeks.

Modified Sternal Precautions "Move in the Tube"

Alternative to traditional precautions in several institutions.
Patients to keep their moves within the "tube" or green area.
Allowed to move out of the green area for open chain activities such as ADLs.

Sternal Precautions – Move in the Tube

General Instructions

Bilateral arm movements in the horizontal plane, backwards, or over the shoulder level.
Only within pain-free limits for the first 10 days after sternotomy.
Loaded movements of the arms should only be done at a pain-free level.
Keep upper arms close to body for 6-8 weeks.
Patients with BMI ≥35 need a supportive vest to protect sternum for 6-8 weeks.
Splinted coughing is needed (a pillow over incision).
Sternal vest for patients who cough frequently.
Supportive bra for patients with large breasts.

Functional Measures

1. Determining functional status.
1. Determining impact of medications and/or surgery on function
1. Risk stratification for mortality, re-admissions, falls.
1. Baseline data for home exercise program.

Aerobic Capacity

Six Minute Walk Test (25 m MCID, time to move)
Two Minute Marching/Step Test.
Functional Activities: 5 times sit to stand, 30 second sit to stand

Ready, Set, Go!

Stand up straight next to wall, mark on wall midway between patella and iliac crest.
March for two minutes lifting knees to designated height/90 degrees.
Resting allowed, subjects may hold onto wall or chair.
Count the number of times right knee hits the mark.

Men's and Women's Results

Average scores for senior fitness test protocol

2 Minute Step Test

Pros: Alternative to 6MWT, no equipment needed.
Cons: Low correlation to VO2, insufficient data for reliability and responsiveness.

Documenting Level of Assist

Independent (I)
Supervision (S)
Contact Guard Assist (CGA)
Minimal Assist (Min A)
Moderate Assist (Mod A)
Maximum Assist (Max A)
Dependent (D)

QOL

SF-36: Physical functioning, Role physical, Bodily pain, General health, Vitality, Social functioning, Role emotional, Mental health
Seattle Angina Questionnaire

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Description

Test your knowledge on the medical interventions related to Coronary Artery Disease (CAD) and Myocardial Infarction (MI). This quiz covers various aspects of treatments, surgical procedures, and key concepts in cardiac health management. Perfect for healthcare professionals and students alike.