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</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</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</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</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</p> Signup and view all the answers

    What is one common lifestyle adaptation recommended for managing POTS?

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

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

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

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

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

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

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

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

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

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

    <p>Visual blurring</p> Signup and view all the answers

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

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

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

    <p>Aspirin</p> Signup and view all the answers

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

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

    Which maneuver could help reduce symptoms of orthostatic hypotension?

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

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

    <p>Flu-like symptoms</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</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%</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</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</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</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</p> Signup and view all the answers

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

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

    What symptom is NOT commonly associated with endocarditis?

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

    Which of the following treatments is typically recommended for pericarditis?

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

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

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

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

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

    What is a common symptom of POTS?

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

    What is NOT a typical treatment strategy for myocarditis?

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

    Which condition is characterized by inflammation of the pericardial sac?

    <p>Pericarditis</p> Signup and view all the answers

    What is considered essential for diagnosing POTS?

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

    In which age group and gender is POTS primarily diagnosed?

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

    What condition could result from chemotherapy and radiation treatment?

    <p>Cardiomyopathy</p> Signup and view all the answers

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

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

    What is a significant consequence of autonomic dysfunction?

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

    What is a characteristic symptom of myocarditis?

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

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

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

    How long should strength training sessions last for POTS patients?

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

    What dietary change is recommended for individuals with POTS?

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

    Which lifestyle adaptation is NOT recommended for managing POTS symptoms?

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

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

    <p>Exercise conditioning</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</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</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</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</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</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</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</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%</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</p> Signup and view all the answers

    Which group is more likely to develop Long COVID?

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

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

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

    What percentage of Americans reportedly experience Long COVID symptoms?

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

    What is a common symptom of orthostatic hypotension?

    <p>Dizziness</p> Signup and view all the answers

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

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

    What lifestyle modification is recommended for managing orthostatic hypotension symptoms?

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

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

    <p>Midodrine</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</p> Signup and view all the answers

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

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

    Which statement accurately describes the treatment approach for orthostatic hypotension?

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

    Which symptom is commonly associated with endocarditis?

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

    What is a common treatment for pericarditis?

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

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

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

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

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

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

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

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

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

    What is the main treatment for symptomatic pericarditis?

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

    What intervention may help in managing symptoms of autonomic dysfunction?

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

    Which condition is least likely to result from chemotherapeutic agents?

    <p>Hypotension</p> Signup and view all the answers

    What is a typical symptom of pericarditis?

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

    Which autoimmune disease is known to contribute to autonomic dysfunction?

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

    Which aspect is crucial for diagnosing POTS?

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

    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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    Description

    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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