Rehabilitation for Long COVID and POTS
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Questions and Answers

Which assessment tool is used for evaluating cognition in patients?

  • Medical Research Council Sum Score
  • EQ-5D-5L
  • St Louis University Mental Status Examination (correct)
  • PROMIS Global 10

What is essential to monitor during a rehabilitation session for a patient recovering from Long COVID?

  • Vital signs throughout the session (correct)
  • Patient's medication adherence
  • Patient's mood state
  • Patient's nutrition intake

Which intervention is appropriate for patients experiencing POTS symptoms?

  • Strict bed rest
  • Avoidance of all physical activity
  • Increased hydration without restrictions
  • Autonomic Conditioning Therapy (correct)

What should be assessed to determine the impairments in a Long COVID patient?

<p>Medical history related to COVID illness (A)</p> Signup and view all the answers

Which of the following is NOT a component of the progressive activity/exercise program for Long COVID patients?

<p>Strict regimen without variations (C)</p> Signup and view all the answers

What is a common physical symptom experienced by individuals with POTS?

<p>Red-blue discoloration of the legs (C)</p> Signup and view all the answers

Which of the following medications may be used to alleviate symptoms of POTS?

<p>Midodrine to increase blood pressure (A)</p> Signup and view all the answers

What is the initial exercise recommendation for individuals with POTS?

<p>Gradually progress from seated to upright exercise (B)</p> Signup and view all the answers

What is one common lifestyle adaptation recommended for managing POTS?

<p>Consume smaller meals (A)</p> Signup and view all the answers

How long should strength training be performed per session for individuals with POTS?

<p>15-40 minutes (D)</p> Signup and view all the answers

Which intervention may help reduce symptoms during upright activity in POTS patients?

<p>Compression garments (B)</p> Signup and view all the answers

What is an initial goal for aerobic training frequency in POTS management?

<p>3-4 times a week (A)</p> Signup and view all the answers

How much fluid intake is typically recommended for POTS patients daily?

<p>2-3 liters (A)</p> Signup and view all the answers

What is considered a decrease in blood pressure to diagnose orthostatic hypotension?

<p>Decrease of 20 mmHg in SBP or more and more than 10 mmHg of DBP (C)</p> Signup and view all the answers

Which factor is NOT listed as a cause of orthostatic hypotension?

<p>Increased physical activity (B)</p> Signup and view all the answers

Which of the following symptoms is classified as common for orthostatic hypotension?

<p>Visual blurring (A), Dizziness (B)</p> Signup and view all the answers

What is a recommended non-pharmacological treatment for orthostatic hypotension?

<p>Elevate the head of the bed (A)</p> Signup and view all the answers

Which medication is NOT typically used in the treatment of orthostatic hypotension?

<p>Aspirin (C)</p> Signup and view all the answers

What type of lifestyle modification may help manage orthostatic hypotension symptoms?

<p>Avoiding large meals and alcohol (A)</p> Signup and view all the answers

Which maneuver could help reduce symptoms of orthostatic hypotension?

<p>Changing positions slowly (B)</p> Signup and view all the answers

What consideration should be taken when monitoring a patient with orthostatic hypotension?

<p>Monitor vital signs during position changes and activity (D)</p> Signup and view all the answers

Which of the following symptoms is classified as mild COVID-19?

<p>Flu-like symptoms (A)</p> Signup and view all the answers

What is a significant factor in determining early mobility for patients with critical illness due to COVID-19?

<p>The patient’s response to mobility (A)</p> Signup and view all the answers

What is the recommended SpO2 level to maintain during rehabilitation of patients with COVID-19?

<p>Above 88-90% (D)</p> Signup and view all the answers

What role did personal protective equipment (PPE) shortages play during initial COVID-19 rehab interventions?

<p>Caused delays in service delivery (C)</p> Signup and view all the answers

According to the WHO, when do Post-COVID-19 conditions typically begin to manifest?

<p>3 months from the onset of COVID-19 (A)</p> Signup and view all the answers

Which group of individuals is at higher risk for developing Long COVID?

<p>Those who did not receive the COVID vaccine (C)</p> Signup and view all the answers

What type of physical therapy intervention is NOT typically utilized in the early stages of COVID-19 rehabilitation?

<p>Advanced athletic training (A)</p> Signup and view all the answers

Which of the following conditions is often associated with Long COVID?

<p>Psychological disabilities (D)</p> Signup and view all the answers

What symptom is NOT commonly associated with endocarditis?

<p>Chest pain that improves with leaning forward (D)</p> Signup and view all the answers

Which of the following treatments is typically recommended for pericarditis?

<p>Anti-inflammatory medications (D)</p> Signup and view all the answers

What is the primary risk factor associated with cardiotoxicity from cancer treatments?

<p>Cancer treatments themselves (A)</p> Signup and view all the answers

Which cardiovascular disorder is least likely to be associated with cancer treatment?

<p>Aortic stenosis (B)</p> Signup and view all the answers

What is a common symptom of POTS?

<p>Excessive tachycardia upon standing (B)</p> Signup and view all the answers

What is NOT a typical treatment strategy for myocarditis?

<p>Surgery to repair heart valves (D)</p> Signup and view all the answers

Which diagnostic method is used for assessing heart function post-cancer treatment?

<p>Troponin I or T test (A)</p> Signup and view all the answers

Which condition is characterized by inflammation of the pericardial sac?

<p>Pericarditis (A)</p> Signup and view all the answers

What is considered essential for diagnosing POTS?

<p>A 10-minute standing test (C)</p> Signup and view all the answers

In which age group and gender is POTS primarily diagnosed?

<p>Females aged 15-50 (A)</p> Signup and view all the answers

What condition could result from chemotherapy and radiation treatment?

<p>Cardiomyopathy (D)</p> Signup and view all the answers

Which cardiovascular test is NOT typically used during cancer treatment evaluation?

<p>Complete blood count (D)</p> Signup and view all the answers

What is a significant consequence of autonomic dysfunction?

<p>Decreased heart rate variability (C)</p> Signup and view all the answers

What is a characteristic symptom of myocarditis?

<p>Fatigue and arrhythmias (B)</p> Signup and view all the answers

What is the recommended initial frequency for aerobic training in POTS management?

<p>3-4 times/week for 25-30 minutes (A)</p> Signup and view all the answers

Which treatment is suggested to help reduce heart rate and symptoms during upright activity for POTS patients?

<p>Compression garments (D)</p> Signup and view all the answers

Which of the following exercises should be avoided initially for POTS patients?

<p>Upright exercises (A)</p> Signup and view all the answers

How long should strength training sessions last for POTS patients?

<p>15-40 minutes (D)</p> Signup and view all the answers

What dietary change is recommended for individuals with POTS?

<p>Increase salt intake (B)</p> Signup and view all the answers

Which lifestyle adaptation is NOT recommended for managing POTS symptoms?

<p>Consuming caffeine (B)</p> Signup and view all the answers

What effect does short-term exercise have on patients with POTS after three months?

<p>Increased blood volume (A)</p> Signup and view all the answers

What type of training is emphasized as fundamental in the treatment of POTS?

<p>Exercise conditioning (C)</p> Signup and view all the answers

What aspect of patient assessment is crucial when monitoring for Long COVID symptoms during a rehabilitation session?

<p>Vital signs response to activity (C)</p> Signup and view all the answers

Which component should be individualized in a progressive activity/exercise program for patients recovering from Long COVID?

<p>Symptoms experienced by the patient (B)</p> Signup and view all the answers

Which rehabilitation strategy helps manage fatigue for patients recovering from Long COVID?

<p>Teaching pacing and energy conservation (A)</p> Signup and view all the answers

What is an important intervention for patients experiencing an exacerbation of symptoms following exertion?

<p>Implementation of post-exertional monitoring (C)</p> Signup and view all the answers

Which assessment tool is specifically designed to evaluate endurance in patients recovering from COVID-related illness?

<p>2-Minute Step Test (D)</p> Signup and view all the answers

What was a primary reason for the delay in rehabilitation services during the initial COVID period?

<p>Limited knowledge about COVID-19 (C)</p> Signup and view all the answers

Which symptom is considered part of the mild category of COVID-19?

<p>Loss of smell or taste (C)</p> Signup and view all the answers

What is the recommended oxygen saturation level to maintain during rehabilitation for COVID-19 patients?

<p>Above 88-90% (C)</p> Signup and view all the answers

What is a common long-term effect experienced by individuals recovering from COVID-19?

<p>Post-COVID-19 condition (D)</p> Signup and view all the answers

Which group is more likely to develop Long COVID?

<p>Those with underlying health conditions (C)</p> Signup and view all the answers

What factor might influence early mobility interventions for critically ill COVID-19 patients?

<p>Patient's response to mobility (C)</p> Signup and view all the answers

What is NOT a recommended physical therapy intervention for COVID-19 recovery?

<p>Aggressive aerobic training (A)</p> Signup and view all the answers

What percentage of Americans reportedly experience Long COVID symptoms?

<p>10-15% (D)</p> Signup and view all the answers

What is a common symptom of orthostatic hypotension?

<p>Dizziness (C)</p> Signup and view all the answers

Which of the following is NOT considered a potential cause of orthostatic hypotension?

<p>Muscle strain (B)</p> Signup and view all the answers

What lifestyle modification is recommended for managing orthostatic hypotension symptoms?

<p>Stay well-hydrated (D)</p> Signup and view all the answers

Which treatment option is advised to monitor for adverse effects in patients with orthostatic hypotension?

<p>Midodrine (C)</p> Signup and view all the answers

When experiencing symptoms of orthostatic hypotension, what position change is advisable to minimize symptoms?

<p>Change positions slowly (A)</p> Signup and view all the answers

What is a critical consideration when treating a patient with orthostatic hypotension?

<p>Evaluate for reversible conditions (C)</p> Signup and view all the answers

Which of the following patients is most at risk for developing orthostatic hypotension?

<p>An elderly individual with autonomic dysfunction (B)</p> Signup and view all the answers

Which statement accurately describes the treatment approach for orthostatic hypotension?

<p>Dietary modifications may complement pharmacological treatment (D)</p> Signup and view all the answers

Which symptom is commonly associated with endocarditis?

<p>Red spots or nodes on hands/feet (A)</p> Signup and view all the answers

What is a common treatment for pericarditis?

<p>Anti-inflammatory medications and pain relief (D)</p> Signup and view all the answers

Which of the following is a recognized risk factor for cardiotoxicity from cancer treatments?

<p>Administering anthracycline drugs (D)</p> Signup and view all the answers

How long should physical activity be avoided in cases of myocarditis?

<p>3-6 months (D)</p> Signup and view all the answers

Which diagnostic test is NOT typically used during or after cancer treatments?

<p>Neurovascular assessment (C)</p> Signup and view all the answers

What is a symptom of postural orthostatic tachycardic syndrome (POTS)?

<p>Excessive tachycardia when standing (D)</p> Signup and view all the answers

Which of the following can be a consequence of cancer treatments?

<p>Cardiomyopathy or heart failure (C)</p> Signup and view all the answers

What is the main treatment for symptomatic pericarditis?

<p>Antibiotics if bacterial infection is present (D)</p> Signup and view all the answers

What intervention may help in managing symptoms of autonomic dysfunction?

<p>Fluid and electrolyte management (B)</p> Signup and view all the answers

Which condition is least likely to result from chemotherapeutic agents?

<p>Hypotension (C)</p> Signup and view all the answers

What is a typical symptom of pericarditis?

<p>Chest pain worsened by lying flat (A)</p> Signup and view all the answers

Which autoimmune disease is known to contribute to autonomic dysfunction?

<p>Rheumatoid arthritis (A)</p> Signup and view all the answers

Which aspect is crucial for diagnosing POTS?

<p>Sustained increased heart rate when upright (D)</p> Signup and view all the answers

Flashcards

Acrocyanosis in POTS

A bluish-red discoloration of the legs in people with POTS, often cold to the touch, when standing.

POTS treatment: exercise

Gradually increasing aerobic exercise, like rowing or swimming, then progressing to upright activities like biking or jogging, combined with strength training, is crucial for POTS management.

POTS treatment: exercise duration

Start with short exercise sessions, gradually increasing to 25-30 minutes, then 45-60 minutes, 3-4 times per week. Aim for 75% Max HR. Interval training may help.

POTS treatment: strength training

Strength training, 1-2 times a week, focused on legs and core, using body weight or seated machines, is often part of POTS management.

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POTS treatment: salt intake

Gradual increase in salt intake up to 10 grams per day is a common intervention for POTS,

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POTS treatment: fluid intake

Increased fluid intake (2-3 liters per day) is usually recommended for individuals with POTS

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POTS treatment: lifestyle adaptations

Eating smaller meals, increasing protein, limiting caffeine and alcohol, avoiding prolonged standing, heat exposure, and maintaining good sleep hygiene is key for POTS.

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POTS treatment: physical counter maneuvers.

Physical counter maneuvers help reduce venous pooling in the legs, which can alleviate Postural Orthostatic Tachycardia Syndrome (POTS) symptoms.

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Orthostatic Hypotension (OH)

A decrease in systolic blood pressure (SBP) of 20 mmHg or more and a decrease in diastolic blood pressure (DBP) of 10 mmHg or more within 3 minutes of standing

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Causes of OH

Dehydration, blood loss, certain medications, neurologic disorders (e.g., Parkinson's), cardiovascular disorders, and endocrine disorders (e.g., diabetes mellitus)

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OH Risk Factors

Prolonged bed rest, volume depletion, use of vasodilators or antihypertensives, central or peripheral nervous system disease (e.g., Parkinson's, spinal cord injury), and aging.

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OH Symptoms (Common)

Dizziness, lightheadedness, dimming/blurring vision, weakness/buckling of legs, fatigue, headache, palpitations, nausea, and cognitive slowing.

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OH Treatment (Lifestyle)

Increasing fluid intake, avoiding large meals and alcohol, exercising before meals, increasing salt intake, avoiding hot showers, elevating the head of the bed, and using compression stockings or abdominal binders.

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OH Treatment (Medication)

Midodrine, fludrocortisone, and pyridostigmine are common medications used in OH treatment.

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Physical Counter-Maneuvers

Techniques to reduce venous pooling in the legs, and to help reduce symptoms of Orthostatic Hypotension.

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OH Monitoring

Regularly monitoring a patient's vital signs, especially while standing or performing activities of daily living (ADLs), is essential when dealing patients with OH.

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Endocarditis

Inflammation of the inner lining of the heart, especially the heart valves.

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Pericarditis

Inflammation of the pericardium, the sac surrounding the heart.

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Myocarditis

Inflammation of the heart muscle.

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Cardiomyopathy

Disease of the heart muscle.

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Heart Failure

Inability of the heart to pump blood sufficiently.

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Cardiotoxicity

Damage to the heart from treatment.

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POTS (Postural Orthostatic Tachycardia Syndrome)

An autonomic disorder causing excessive heart rate increase upon standing.

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Orthostatic hypotension

A sudden drop in blood pressure upon standing.

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Autonomic Nervous System (ANS)

Part of the nervous system controlling involuntary processes like heart rate and digestion.

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Sympathetic Nervous System

Part of the ANS preparing the body for stress or action.

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Parasympathetic Nervous System

Part of the ANS calming the body and promoting rest.

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Head-up tilt table test

Medical test used in diagnosis of POTS (Postural Orthostatic Tachycardia Syndrome).

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Sinus tachycardia

Fast heart rate from the sinus node.

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Blood pooling

Blood accumulating in the lower parts of the body when standing up.

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Cardiac tests

Tests used to examine the heart, such as EKG, echocardiogram, or cardiac MRI.

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Acute COVID Stage (1st 5 weeks)

The initial stage of COVID-19, lasting approximately the first five weeks, characterized by diverse symptoms and potential severe complications like ARDS and multi-organ failure.

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Long COVID

A condition where individuals experience symptoms lasting at least two months, three months post-COVID-19. It's not explained by another illness.

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Long COVID Risk Factors

Severe COVID illness, pre-existing health conditions, and lack of COVID vaccination increase the likelihood of experiencing long-term COVID symptoms.

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Early Mobility (COVID)

Individualized mobility planning tailored to the patient's response. Vital signs are closely monitored.

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Acute Care Setting

Medical care provided in a hospital or similar institution for acute or urgent medical needs.

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Outpatient Setting

Medical care provided outside of a hospital or similar institution.

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COVID-19 Rehab Delays

Rehab services often postponed during COVID due to PPE shortages, uncertainty about the disease, isolation protocols, and staff limitations.

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COVID-19 Rehab Increase

Rehab services usage gradually increased as knowledge about the disease improved, and patients became eligible for rehabilitation.

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What are common assessments for cognition in Post-COVID rehab?

The St Louis University Mental Status Examination (SLUMS) is a frequently used instrument for assessing cognitive function in individuals recovering from COVID-19.

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What are some objective measures of physical function in Post-COVID rehab?

The Short Physical Performance Battery (SPPB) is a test commonly used to evaluate balance, gait speed, and the ability to rise from a chair, providing insight into functional mobility.

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How is endurance assessed in Post-COVID rehab?

The 2-Minute Step Test is frequently used to assess endurance in patients recovering from COVID-19, gauging their ability to perform repetitive movements for a sustained period.

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What are some important aspects to monitor during Post-COVID rehab sessions?

Vital signs, such as oxygenation, heart rate response, and signs of exercise intolerance or fatigue, should be carefully monitored throughout the rehabilitation session.

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What is Autonomic Conditioning Therapy?

Autonomic Conditioning Therapy is a specialized program focused on improving the functioning of the autonomic nervous system, which can be affected in Post-COVID syndrome. It aims to reduce symptoms like fatigue, dizziness, and orthostatic intolerance.

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POTS Treatment: Salt & Fluids

Increasing salt intake up to 10 grams/day and consuming more fluids (2-3 liters/day) are common interventions to help regulate blood volume and blood pressure.

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POTS Treatment: Compression Garments

Wearing compression garments, such as leg compression stockings or an abdominal binder, can help reduce venous pooling and alleviate symptoms, particularly during upright activities.

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POTS: What is it?

Postural Orthostatic Tachycardia Syndrome (POTS) is an autonomic disorder that causes an excessive increase in heart rate upon standing, often leading to dizziness, lightheadedness, and fatigue.

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POTS: Acrocyanosis

A bluish-red discoloration of the legs, often cold to the touch, in people with POTS, which occurs when standing.

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POTS Treatment: Medications

While there are no medications specifically approved for POTS, some medications can be used to manage symptoms, such as midodrine to raise blood pressure and propranolol to lower heart rate.

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Postural Orthostatic Tachycardia Syndrome (POTS)

An autonomic disorder causing a rapid increase in heart rate upon standing, without a drop in blood pressure.

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BNP and NT-ProBNP

Blood tests used to measure levels of specific proteins associated with heart strain and failure.

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Cardioprotective Strategies

Measures taken to reduce the risk of heart damage during cancer treatments, like using certain medications or modifying lifestyle.

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What is Orthostatic Hypotension?

Orthostatic Hypotension (OH) is a sudden drop in blood pressure that occurs when you stand up quickly. It's caused by poor blood flow to your brain, usually due to dehydration or medication side effects.

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What are the Symptoms of OH?

Common OH symptoms include dizziness, lightheadedness, blurred vision, weakness, and fatigue. Less common symptoms include chest pain, neck/shoulder pain, shortness of breath, and even seizures.

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Who is at Risk for OH?

People at risk for OH include those on bed rest, those who are dehydrated, those taking vasodilators or antihypertensives, and those with neurological disorders like Parkinson's disease.

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Physical Counter Maneuvers for OH

Physical counter maneuvers help reduce venous pooling in the legs, which can improve blood flow and reduce OH symptoms. These include slowly changing positions, avoiding prolonged standing, and using compression stockings.

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How to Monitor a Patient with OH

Caregivers should regularly monitor patients with OH, focusing on their vital signs, especially during position changes, ambulation, and ADLs. Be prepared to teach physical maneuvers to manage OH symptoms.

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OH Treatment: Safety First!

Ensure the patient with OH is safe to go home by making modifications for ADLs and providing appropriate assistive devices for mobility. Encourage safe physical activity to prevent deconditioning.

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Acute COVID Stage

The first 5 weeks after COVID-19 infection, marked by various symptoms and potential complications like ARDS and multi-organ failure.

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Who's more likely to develop Long COVID?

Individuals with severe COVID-19, pre-existing health conditions, and those who didn't get vaccinated.

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What are COVID rehab monitoring points?

Vital signs such as oxygenation, heart rate response, and signs of fatigue during sessions.

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What are the different phases of COVID recovery?

COVID recovery is divided into two stages: the acute phase (lasting 5 weeks) and the long COVID phase (lasting at least 2 months after initial illness).

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What are the key differences between the acute and long COVID phases?

The acute COVID phase is marked by acute symptoms and potential complications. Long COVID involves persistent symptoms extending beyond the acute phase.

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What are some rehab objectives in the acute COVID phase?

Rehab during the acute COVID phase focuses on early mobility, individualizing care based on symptoms and response to activity, and closely monitoring vital signs.

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What are some rehab objectives for long COVID?

Long COVID rehab involves progressive activity, personalized exercise programs, addressing autonomic dysfunction, and teaching energy conservation techniques.

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Why is Autonomic Conditioning Therapy important for Long COVID?

Autonomic Conditioning Therapy focuses on improving autonomic nervous system function, which can be affected in Long COVID, helping manage common symptoms like fatigue, dizziness, and orthostatic intolerance.

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Study Notes

Cardiac Pathophysiology & Intervention

  • Cardiac pathophysiology and intervention, presented by Heidi Tymkew PT, DPT, MHS, CCS
  • Topics covered include inflammatory disorders of the heart, endocarditis, pericarditis, myocarditis, oncology-related heart disorders, autonomic dysfunction, orthostatic hypotension, COVID-19 and rehab, and long COVID

Inflammatory Disorders of the Heart

  • Focuses on conditions affecting the heart's lining and surrounding membranes
  • Includes endocarditis (inflammation of inner lining) and pericarditis (inflammation of the pericardium)
  • Myocarditis (inflammation of the heart muscle) is discussed as well.

Endocarditis

  • Symptoms: Chills, fever, joint and muscle pain, red spots/nodes on hands/feet, shortness of breath, fatigue, swelling
  • Treatment: IV antibiotics, surgery if heart valves are damaged, exercise limitation during acute phase

Pericarditis

  • Description: Inflammation of the pericardial sac around the heart.
  • Causes: Often idiopathic but can also result from injury (e.g., post-CABG surgery), heart attack, autoimmune diseases, or viral infections
  • Symptoms: Chest pain (sharp/stabbing, worse with coughing, swallowing, deep breaths, and lying flat, better when sitting and leaning forward), pericardial rub
  • Treatment: Anti-inflammatory medications, steroids, pain medication, antibiotics (if bacterial infection), surgery (rarely) - pericardial window to drain inflamed lining, limited physical activity for 1-3 months

Myocarditis

  • Causes: Infections (viruses, bacteria, parasites), drugs/vaccines (cancer therapies, immune checkpoint inhibitors, clozapine, COVID-19 vaccine, smallpox vaccine), and autoimmune diseases (Lupus, Sarcoidosis)
  • Symptoms: Irregular heart rhythm, chest pain, heart failure, shortness of breath, fatigue, palpitations, leg swelling
  • Treatment: No standard treatment, treat heart failure and arrhythmias, avoid physical activity for 3-6 months, cardiologist clearance needed
  • Some cancer treatments can injure the heart muscle and blood vessels, increasing the risk of cardiovascular disease.
  • Cardiotoxicity is damage to the cardiovascular system from cancer treatments.
  • Examples of Chemotherapy Treatments: Anthracyclines (doxorubicin, daunorubicin), Cisplatin
  • Examples of Oncology Heart Issues: Cardiomyopathy, coronary artery disease/MI, valvular heart disease, arrhythmias, pericarditis, myocarditis, hypertension, stroke, blood clots (DVT or PE), peripheral artery disease.
  • Risk of heart attack/stroke is 2-6 times higher in cancer patients than those without cancer.

Cardiac Tests Used In/After Cancer Treatments

  • BNP, NT-proBNP, Troponin I or T, Lipid profile, EKG, Echocardiogram, Cardiac MRI
  • Cardioprotective strategies to reduce impact of cancer treatments: Dexrazoxane, ACE Inhibitors, Beta-blockers

Autonomic Dysfunction

  • The autonomic nervous system (ANS) controls involuntary physiologic processes.
  • Includes the sympathetic (SNS) and parasympathetic (PNS) nervous systems.
  • The SNS and PNS work together to maintain homeostasis.

Causes of Autonomic Dysfunction

  • Hereditary causes: Familial dysautonomia, Hereditary sensory neuropathy Type 3
  • Acquired/idiopathic causes: Neurocardiogenic syncope, POTS, Multisystem Atrophy, Pure autonomic failure.
  • Result of a pre-existing condition: DM, autoimmune diseases (e.g., RA, lupus), neurogenic orthostatic hypotension, Parkinson's disease, Dementia with Lewy Bodies, Medications, Trauma

Normal Response to Position Change

  • In a healthy individual, the body regulates blood volume redistribution when changing posture from supine to standing.
  • Blood shifts from the lower body to the upper body
  • Heart rate and peripheral vasoconstriction increase to maintain cardiac output.

Postural Orthostatic Tachycardia Syndrome (POTS)

  • An autonomic disorder characterized by excessive tachycardia upon standing, in the absence of orthostatic hypotension and other medical conditions.
  • Primary affects females 15-50 years old.
  • Symptoms: Lightheadedness/dizziness, headaches, visual problems, anxiety, shortness of breath, GI problems (nausea, vomiting, diarrhea), shakiness, hypoglycemia, fast heartbeat, acrocyanosis (red-blue discoloration of legs in standing).
  • Diagnosed by 10-minute standing test/tilt-table test; sustained heart rate increase >30 bpm with no blood pressure change. Symptoms should also be present for 6 months.

Long COVID (Post-Acute Sequelae of COVID-19)

  • Long Covid is a post-infection condition, usually 3 months after viral infection.
  • Symptoms continue for 2+ months.
  • Long COVID symptoms often include fatigue, brain fog, headache, difficulty concentrating, sleep problems, breathing problems, chest pain, muscle pain, gastrointestinal problems (e.g., bloating, nausea, diarrhea), and/or low back pain, physical exertion and stress are common triggers for symptom exacerbation.

COVID-19 and Rehab

  • Rehab services were often delayed during the early COVID-19 pandemic due to PPE shortages.
  • Usage of rehab services increased after the pandemic.
  • Early mobility needs to be based on the patient's response to mobility.
  • Close monitoring of vital signs, including oxygenation levels (SpO2).
  • May need to titrate oxygen to maintain the patient's SpO2 above 88%-90%.
  • PT intervention should include proning, airway clearance, early mobility, and strengthening activities.

Orthostatic Hypotension (OH)

  • A decrease in systolic blood pressure by 20 mmHg or more, and a decrease in diastolic blood pressure by 10 mmHg or more, within 3 minutes of standing from supine position.
  • Increases in older adults.
  • Causes: Dehydration, blood loss, certain medications, neurological disorders, cardiovascular disorders, endocrine disorders (e.g., diabetes), prolonged bed rest, volume depletion, antihypertensive meds.
  • Symptoms: Dizziness, lightheadedness, visual symptoms, weakness, fatigue, headache, nausea, cognitive slowing, syncope, chest pain, neck/shoulder pain, dyspnea, seizure-like movements
  • Treatment: Correct any reversible conditions (drug side effects, hypovolemia), pharmacological therapy (Midodrine, Fludrocortisone, Pyridostigmine).
  • Monitor for supine hypertension.
  • Other interventions: Diet (exercise prior to meals, avoid alcohol and large meals, adequate hydration, limit exposure to hot showers/baths and weather), using compression stockings and/or abdominal binders with head-of-bed elevated 15-20 degrees.
  • Physical Counter Maneuvers: Help reduce venous pooling, help to reduce symptoms, avoid straining and static standing and change positions slowly.
  • Tips when treating a patient with OH: monitor vital signs, be aware of medications used, teach physical maneuvers, make the patient safe to go home (modify ADLs).

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Cardiac Pathophysiology & Intervention PDF

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This quiz focuses on assessment tools and interventions for patients recovering from Long COVID and experiencing POTS symptoms. Test your knowledge on essential monitoring practices and appropriate rehabilitation strategies. Ideal for healthcare professionals and students in the medical field.

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