Aneurysm, Valve Disease, Cardiomyopathy PDF

Sit in a different part of the room with a different seat mate ANEURYSM, VALVE DISEASE, CARDIOMYOPATHY, DPT 611 spring 2025  Learning Objectives ◦ At the end of this module, students should be able to: ◦ Describe risk factors for, presentation of, and pathophysiology of a...

Sit in a different part of the room with a different seat mate ANEURYSM, VALVE DISEASE, CARDIOMYOPATHY, DPT 611 spring 2025  Learning Objectives ◦ At the end of this module, students should be able to: ◦ Describe risk factors for, presentation of, and pathophysiology of aneurysms, valve disease, and cardiomyopathy ◦ Describe the diagnostic tests and med/surg interventions for aneurysms, valve disease, and cardiomyopathy. ◦ Describe PT implications for aneurysms, valve disease, and CM, and make decisions about treatment, referral, or emergency care ◦ Identify factors that contribute to health disparities in people with cardiovascular diseases  Aneurysm ◦ Weakening in a vessel wall that causes it to bulge or balloon out ◦ Aneurysms can dissect or tear that can lead to life threatening bleeding and/or death ◦ True aneurysm: fusiform ballooning out of vessel wall on all sides of vessel or saccular where it balloons out on one side. ◦ False aneurysm enlargement of any blood vessel layers. Usually, a tear in the intima from trauma, surgery. Blood fills in between layers of blood vessel. ◦ Dissecting: tear separates the three layers of the wall Aneurysm Risk Factors Genetic conditions HTN Atherosclerosis Marfan Syndrome Untreated infections Ehlers-Danlos syndrome Turner’s syndrome Trauma Older age Smoking Bicuspid aortic valve  Aneurysms ◦ Most common is in aorta ◦ Next most common is thoracic ◦ Can also occur in: ◦ Abdomen (triple A or AAA) Abdominal Aortic Aneurysm ◦ Common iliac ◦ Femoral ◦ Popliteal ◦ Brain Symptoms – depend on location ◦Asymptomatic ◦AAA – constant pain in abdomen, low back, groin ◦Cerebral – severe HA, vomiting/nausea, visual disturbances ◦Iliac: pain in abdomen, back, groin ◦Femoral or popliteal – palpation of lump that has a pulse  ◦ Radiograph, CT, echocardiogram, MRI ◦ Small or slowly evolving aneurysm: watch and wait; medications for risk factor management DX and RX ◦ Median sternotomy or endovascular surgery ◦ Patch to reinforce the weakened wall ◦ Patch or hooks to close the “false lumen” PT Implications Acute care: Sternotomy precautions Mobility Exercise tolerance & medication effectiveness related to function Prescription of home exercise and lifelong behavior change Medications to lower BP and myocardial workload* *No official guidelines for activity After repair, it’s generally recommended not to lift >1/2 your weight Avoid isometrics due to elevations in BP Speak with the surgeon to get parameters Heart valve dysfunction ◦ AV (atrial ventricular ◦ Which valves are closed valves) during ventricular systole ◦ Mitral or bicuspid and why? ◦ Tricuspid ◦ What do S1 and S2 represent? ◦ Semi-lunar valves ◦ When can you feel the pulse? Before or ◦ Pulmonic or after S1? S2? In between S1 and S2? pulmonary ◦ aortic Stand Up! ◦ Student 1 – Gently grab student 2s wrist. I said gently!! ◦ Student 2 – try to pull away and break free (don’t use your other hand) ◦ Chordae Tendineae & Papillary muscles ◦ Students 1 & 2 – stand close to each other (hip to hip) without touching (stenosis) ◦ Students 1 & 2 – get in the “run away” positions again. This time, student 2 should make a little progress in getting away (prolapse) ◦ Students 1 & 2 – stand hip to hip with no spaces (valve closure) and now separate just a little (regurgitation) Types of valve disease Stenosis: narrowing Prolapse: Ballooning/Bulging Regurgitation: Leaking https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.merckmanuals.com%2Fhome%2Fmultimedia%2Ftable%2Fundersta nding-stenosis-and- regurgitation&psig=AOvVaw1Jy_S8gC2j9upb24ZIPGtm&ust=1706991838437000&source=images&cd=vfe&opi=89978449&ved=0 CBMQjRxqFwoTCIjLoqe-jYQDFQAAAAAdAAAAABAd https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.mottchildren.org%2Fconditions-treatments%2Fped- heart%2Fconditions%2Fmitral-valve- prolapse&psig=AOvVaw0k7E5zDi2uXH7rVg6R2OAx&ust=1706991917665000&source=images&cd=vfe&opi=899 78449&ved=0CBMQjRxqFwoTCPCNvs--jYQDFQAAAAAdAAAAABAE  Risk Factors & Symptoms Risk Factors Symptoms ◦ HTN ◦ Asymptomatic ◦ MI ◦ Angina ◦ Older age ◦ Palpitations ◦ Ischemia to papillary muscles ◦ SOB ◦ Infective endocarditis ◦ Decreased activity tolerance ◦ Heart failure ◦ Lightheadedness/syncope ◦ Congenital malformation of valves ◦ Peripheral edema (sign of heart ◦ Radiation to chest wall – childhood failure) cancer ◦ Rheumatic fever  DX & RX DX RX ◦ Auscultation ◦ Medications to reduce risk factors ◦ When there is valve dysfunction, blood ◦ Valve Repair flow is turbulent and can be heard ◦ Balloon valvuloplasty for stenosis ◦ Determine if the abnormal sound occurs during systole or diastole ◦ Valve replacement (stenosis, regurg) ◦ Many murmurs are benign, so need to ◦ Mechanical valve (lifelong anti- correlate with symptoms coagulation) ◦ Tissue valve (human or animal) ◦ Echocardiogram ◦ Transcatheter aortic valve replacement or ◦ Valve structure TAVR or TAVI (I for implantation) for ◦ Direction of blood flow Aortic valve stenosis ◦ Estimation of ejection fraction ◦ *thread up new valve and sit it on top of the old valve VIDEO: https://youtu.be/-kKKo9i3GlA Cardiomyopathy ◦ Disorder of myocardial cells ◦ Myocardial mitochondrial dysfunction → decreased aerobic capacity ◦ Ineffective pump → ↑ LVEDV & pressure → ↓ L ventricular performance ◦ Dilated, Hypertrophic, Restrictive  DCM ◦ Dilated (idiopathic, ischemia, toxins, pregnancy, ETOH) ◦ increase in cardiac mass ◦ dilation of 4 chambers ◦ no wall thickening ◦ systolic dysfunction ◦ Higher volumes but lower contractility www.niaaa.nih.gov/ Hypertrophic Cardiomyopathy ◦ Heredity, HTN ◦ Increased cardiac mass ◦ Diastolic Dysfunction ◦ abnormal LV relaxation ◦ increased LV pressures  Restrictive CM ◦ XRT, amyloid, DM ◦ “Stiff” ventricles ◦ Decreased V. Filling, compliance ◦ Back pressure to upstream chambers ◦ Decreased SV ◦ Less volume, normal or slightly reduced contractility Myocarditis & Pericarditis ◦ Myocarditis ◦ inflammation of myocardial wall ◦ Pericarditis ◦ inflammation of pericardium chest pain not position or activity dependent  Pericardial Effusion ◦ Fluid buildup in potential space ◦ Quick accumulation vs. Slow accumulation ◦ Tamponade – Decreased venous return – Decreased ventricular filling – CO significantly drops – Shock/death – Pericardial friction rub – Pericardiocentesis Stand up for your exercise snack while we talk about simulation 2. Simulation - next class! ◦ Goals: ◦ Advance practice and proficiency with management of a patient in the acute care setting ◦ Gain practice and proficiency with environmental management ◦ Gain practice and proficiency with mobilizing the patient with sternal precautions ◦ Arrive early and stand outside of the room you were assigned ◦ Review the chart and take notes ◦ The simulation begins as soon as you step in the room. ◦ Goal is to assess cardiovascular status, mobility, cardiovascular response to activity, sternal stability, and to educate patient on sternal precautions