Cardio mid term revise

Cardio Revise

• Cardio Revise - title of learning material

Stage of Respiration

• Stage 1: Ventilation - mechanical process of air movement in and out of the body
• Stage 2: External Respiration - exchange of gases (O2 and CO2) between the alveoli and blood
• Stage 3: Gas Transport - movement of gases in the blood
• Stage 4: Internal Respiration - exchange of gases between the blood and body cells

Anatomical Aspects

• Upper Respiratory Tract - nose, pharynx, larynx, and trachea
• Lower Respiratory Tract - bronchi, bronchioles, and alveoli

Functional Aspects

• Conducting Zone - from nose to bronchioles, responsible for gas conduction
• Respiratory Zone - alveoli ducts to alveoli, site of gas exchange

Pressure Relationships

• Atmospheric Pressure (Patm) - pressure of the air surrounding the body
• Intrapulmonary Pressure (Ppul or Palv) - pressure within the lungs
• Intrapleural Pressure (Pip or Ppl) - pressure in the pleural cavity, always slightly lower than intrapulmonary pressure
• Transpulmonary Pressure - difference between intrapulmonary and intrapleural pressures; crucial for lung expansion

Additional Aspects

• Pulmonary Surfactant - mixture of phospholipids and proteins, reducing surface tension in alveoli, essential for lung function
• Airway Bypass - alternate airway to bypass blocked airways in the lung; vital for removing secretions
• Ventilation-Perfusion Mismatch - situation where ventilation and blood flow in different sections of the lungs do not match, resulting in inadequate gas exchange
• Non-dependent Ventilation - higher compliance, more blood flow to the base
• Dependent Ventilation - higher compliance, less blood flow to the base

Added Sounds During Auscultation

• Continuous Sounds (Wheezes) - high-pitched (narrowed airway) or low-pitched (rhonchi-thick secretions)
• Discontinuous Sounds (Crackles) - fine (fibrosis/fluid-late inspiratory) or coarse(secretions)
• Normal Lung Sounds

Normal Vital Signs and Arterial Blood Gas Values

• Blood Pressure (SBP, DBP)
• Heart Rate
• Respiratory Rate
• SpO2 (Oxygen Saturation)

Normal and abnormal Acid-base disturbances

• Respiratory Acidosis/Alkalosis - related to the level of CO2
• Metabolic Acidosis/Alkalosis - related to the level of bicarbonate (HCO3)

Respiratory Failure

• Type 1 - hypoxemia (low oxygen) with normal or low carbon dioxide
• Type 2 - hypercapnia (high CO2) with low oxygen

Oxygen Therapy

• Limitation - by hemoglobin (anemia)
• Secondary Polycythemia - increased blood viscosity leading to stroke
• Hypoxic Vasoconstriction

Absorption Atelectasis

• Cause - too much oxygen intake removes nitrogen, collapsing alveoli

Oxygen-Induced Hypercapnia

• COPD patients at risk of worsening V/Q mismatch.
• Management - maintaining SpO2 around 88-92%, with 24-28% O2

Breathing Devices

• Incentive Spirometry - improves lung expansion
• PEP/OPEP - prevents collapse, facilitates secretion clearance

Inspirational Muscle Training (IMT)

• Resistance training to strengthen inhalation muscles
• Advantages - improve inspiratory muscle strength and endurance for better breathing.

Pneumonia

• Cause - inflammation or infection in airways (bronchitis) or lungs (alveoli)
• Diagnosis - X-ray reveals consolidation or patchy airspace opacities, white blood cell count is elevated, and C-reactive protein is elevated

Asthma vs COPD

• Bronchodilator response used to diagnose asthma from COPD
• Reversible airway disease .

Interstitial Lung Disease (ILD)

• Presentation- progressive shortness of breath and/ or cough, often worse with exertion.
• Cause - inflammation of lung tissue resulting in scarring

Acute Lung Injury (ALI) / Acute Respiratory Distress Syndrome (ARDS)

• Cause - rapid onset respiratory failure due to lung parenchyma or lung blood vessel injury (inflammation)
• Classification - based on the level of oxygenation (PaO2/FiO2 ratio) and pulmonary artery wedge pressure

Treatment of ALI/ARDS

• Stabilization of abnormal gas exchange, hemodynamics and hypoxia.
• Mechanical ventilation may be required including lung-protective ventilation strategy.
• Prone positioning and ECMO
• Corticosteroids

Pneumothorax

• Definition - presence of air/gas in the pleural space
• Cause - trauma or spontaneous (secondary or primary), due to underlying conditions (COPD, asthma, TB)
• Types - simple (without mediastinal shift), tension (with mediastinal shift), or open
• Clinical presentation- sudden chest pain, shortness of breath, rapid breathing, decreased blood pressure, and/or altered mental status
• Treatment - urgent treatment for tension pneumothorax, insertion of a chest tube to drain air

Pleural Effusion

• Definition - a fluid accumulation in the pleural space
• Causes - various underlying lung/heart/kidney diseases, infections, tumours
• Presentation - dyspnea, chest pain, dry cough (often associated with other underlying conditions)

Pulmonary Rehab Program

• Structure - 6-12 supervised weekly sessions (at least 12 sessions)
• Focus - cardiovascular and respiratory fitness, activity progression, and education
• Components - assessment (6MWT/Spirometry/CAT), exercises, education, self-management

Assessment of Dyspnea and COPD

• MMRC grading used to assess the severity of dyspnea in COPD
• BODE Index measures the severity of COPD based on several factors (BMI, dyspnea, exercise capacity, and presence of exacerbations).

Breathing Exercises

• Diaphragmatic Breathing - to improve efficacy of oxygen (increases lung capacity) and tidal volume.
• Pursed Lip Breathing - to create a positive pressure in the airway to facilitate breathing exhalation, relieves SOB.

Abnormal Signs in Exercise

• Heart rate - insufficient increase or delay to decrease after exercise.
• Blood Pressure (SBP and DBP) - elevated values that do not return to baseline after exercising

Burn Injuries

• Types of burns- epidermal, dermal, and subdermal
• Clinical presentation- variable depending on the degree and area of involvement
• Initial management - involves immediate airway support, thermal protection, and pain control
• Role of physiotherapy- assessment, management of airway clearance and sputum, and nebulization

Stages of Lung Cancer

• Non-small cell lung cancer (NSCLC) - more common, tends to be adenocarcinoma or squamous cell carcinoma.
• Small cell lung caner (SCLC) - less common, grows rapidly and spreads quickly
• Staging is done using tumor size, lymph node involvement, and presence of metastasis.

Cancer Treatment & Rehabilitation

• Prehabilitation before treatment
• Rehabilitation involves aerobic and strengthening exercises, education and support, and setting for supervised exercises.

Post-Operative Care

• High Fowler’s position - sitting upright and elevating the head to improve chest expansion postoperatively
• Breathing exercises - to prevent or resolve atelectasis, improve gaseous exchange, and facilitate secretion clearance.