OT 303 Lecture Notes on Cardiopulmonary PDF

OT 303: Occupational Therapy in Physical Health: Evaluation and Intervention in Adult and Geriatric Population I (Musculoskeletal, Cardiopulmonary and other General Medical Conditions) Prepared by: Cathryn Meave M. Gonzaga BSOT-4 Intern Batch 2025...

OT 303: Occupational Therapy in Physical Health: Evaluation and Intervention in Adult and Geriatric Population I (Musculoskeletal, Cardiopulmonary and other General Medical Conditions) Prepared by: Cathryn Meave M. Gonzaga BSOT-4 Intern Batch 2025 CARDIOPULMONARY CONDITIONS Cardiac Conditions: Pulmonary Conditions: 1. Coronary Artery Disease 1. Emphysema 2. Myocardial Infarction 2. Chronic Bronchitis 3. Congestive Heart Failure 3. Asthma 4. Valvular Disease 4. Cystic Fibrosis 5. Cardiomyopathy 5. Bronchiectasis 6. Tuberculosis CARDIOVASCULAR CONDITIONS CORONARY ARTERY DISEASE MC in older adults A. Definition Commonly seen in individuals a.k.a. Coronary heart disease with risk factors: Characterized by the hypertension, diabetes, narrowing or blockage of the obesity, and smoking coronary arteries due to C. Etiology atherosclerosis, which Most common cause: reduces blood flow to the Atherosclerosis — a condition heart where plaque made of B. Epidemiology cholesterol, fat, calcium, and Leading cause of death other substances sticks to the globally inner lining of arteries that M>F 1  are taking oxygen-rich blood Differences: pericardium, due from the heart to the body to infections, and sharp pain D. Basic Medical Sciences I. Laboratory Tests Heart - pump blood and Blood tests oxygen around the body Result(s)/Finding(s) Blood vessels ○ Elevated cholesterol ○ Artery – carry blood or troponin levels away from the heart Relevance/Conclusion: ○ Veins – carry blood ○ High cholesterol levels back toward the heart = atherosclerosis risk ○ Capillaries – connect ○ Elevated troponins = arteries and veins myocardial damage Coronary arteries – supply Electrocardiogram oxygenated blood to the Result(s)/Finding(s): muscles and structures of the ○ ST-segment heart depression or E. Pathophysiology elevation Accumulation of lipids and Relevance/Conclusion: inflammatory cells in the ○ ECG changes help in arterial wall, leading to diagnosing ischemia plaque formation, arterial or infarction. stenosis, and decreased J. Special Tests blood flow Stress Test Atherosclerosis - hardening ○ Procedure: px of arteries caused by the exercise on a damaged of the endothelium treadmill or F. Signs & Symptoms stationary bike while Levine’s Sign - indicates that monitoring heart px experiences angina activity Shortness of breath ○ Interpretation: (+) Fatigue with exertion reduced blood flow to Palpitation the heart during Jaw pain exertion G. Course & Prognosis Coronary Angiography Variable course – depending ○ Procedure: contrast upon surgery, compliance to dye is injected into therapy and meds, and coronary arteries to lifestyle modifications) visualize blockages Good prognosis = early via X-ray treatment or implement ○ Interpretation: lifestyle changes identifies the location H. Differential Diagnosis and severity of Acute Pericarditis blockages Similarities: Chest pains, K. Medical/Surgical Intervention common in Males Statins 2  Action: to lower cholesterol formation of a thrombus that levels, reduce plaque blocks blood flow formation A blood vessel to the heart is Side effects: muscle pain blocked = no oxygen in heart Precautions: liver muscle tissue = dysfunction damage/death to that tissue Contraindications: history of D. Basic Medical Sciences liver disease Heart - contract and pump Beta-blockers oxygenated blood to the Action: to reduce heart rate body and deoxygenated and oxygen demand blood to the lungs Side effects: bradycardia Coronary arteries – supply Precautions: hypotension oxygenated blood to the Contraindications: asthma muscles and structures of the Coronary Artery Bypass Grafting heart Grafting a vessel to bypass E. Pathophysiology blocked coronary arteries, Results from an imbalance in restoring blood flow oxygen supply and demand caused by plaque rupture with thrombus formation in the coronary artery, resulting MYOCARDIAL INFARCTION in a reduction of blood A. Definition (Trombly) supply to the myocardium a.k.a heart attack F. Signs & Symptoms Occurs when blood flow to a Chest pain/pressure part of your heart decreases (radiating to teeth, jaw, ear, or stops , causing damage or arm, or midback) necrosis to the heart muscle Diaphoresis B. Epidemiology Shortness of breath Leading cause of death Nausea worldwide Vomiting Predominantly affects older Fatigue adults = males G. Course & Prognosis According to the American (Atchison) Heart Association’s 2009 Prognosis for recovery statistics report, someone in depends on the amount of the United States has a heart cardiac tissue that was attack every 34 seconds, with damaged during the time of approximately 16% of those the blockage and the length dying from that event of time it took to receive (Atchison) medical attention C. Etiology Good prognosis = caught and Rupture of an atherosclerotic treated early plaque in a coronary artery = H. Differential Diagnosis Cardiac Arrest 3  Similarities: fatal, chest pains Aspirin Differences: malfunction in Action: inhibits platelet the heart’s electrical system, aggregation, reducing clot not breathing formation I. Laboratory Tests Side effects: Troponin Levels Precautions: gastrointestinal Result(s)/Finding(s): bleeding ○ Elevated troponin Contraindications: active indicates myocardial bleeding disorders damage Coronary Artery Bypass Grafting Relevance/Conclusion: Grafting a vessel to bypass ○ Troponin is highly blocked coronary arteries, specific for restoring blood flow myocardial injury and helps confirm the diagnosis of M CONGESTIVE HEART FAILURE Creatine Kinase-MB (CK-MB) A. Definition Result(s)/Finding(s): a.k.a. Heart failure ○ Elevated levels chronic, non-curable suggest myocardial condition where the heart injury does not beat strongly Relevance/Conclusion: enough to maintain ○ CK-MB levels rise adequate blood flow to all within a few hours of body systems (Atchison) an MI and are used B. Epidemiology alongside troponin. Approximately 5.8 million J. Special Tests people in the US have CHF Electrocardiogram with about 670,000 people ○ Procedure: measures diagnosed each year the electrical activity About 300,00 deaths each of the heart year ○ Interpretation: MC: older adults with ST-segment prevalence increasing with elevation/depression age indicates acute MI M=F Echocardiography Higher incidence with a ○ Procedure: uses history of myocardial ultrasound to infarction, hypertension, or visualize heart diabetes function and structure C. Etiology ○ Interpretation: can Myocardial scarring and identify areas if remodeling reduced motion or Often the result of other damage due to MI conditions that weaken the K. Medical/Surgical Intervention 4  heart – CAD, hypertension, or and following medical cardiomyopathy management D. Basic Medical Sciences H. Differential Diagnosis Heart – responsible to pump Myocardial Infarction blood to the whole body Similarities: can be caused by Cardiac output coronary artery disease → ○ Volume of blood Atherosclerosis pumped out per min Differences: Heart failure is ○ HR x Stroke volume often a chronic condition (EDV120- ESV50) caused by underlying heart ○ Normal = 5-6L problems, while a heart E. Pathophysiology attack is an acute event Heart muscle becomes caused by a sudden blockage stretched beyond its ability I. Laboratory Tests (Pedretti) to contract, resulting in the B-type Natriuretic Peptide (BNP) collection of fluid in the lungs Result(s)/Finding(s): or the extremities ○ Elevated BNP levels Can happen due to indicate heart failure hypertension, incompetent Relevance/Conclusion: valves and cardiomyopathy ○ BNP is released in F. Signs & Symptoms response to (Trombly) ventricular stretching Sudden weight gain and pressure, making Inability to sleep lying down it a marker for CHF flat (orthopnea) Chest X-ray Persistent dry hacking cough Result(s)/Finding(s): Shortness of breath ○ Shows pulmonary Swelling in ankles/feet/legs congestion or an Fatigue with activity enlarged heart Lack of appetite Relevance/Conclusion: Difficulty in attention ○ Helps confirm the G. Course & Prognosis (Atchison) diagnosis of CHF by Condition progresses slowly visualizing fluid over time depriving the body buildup in the lungs of needed oxygen and J. Special Tests eventually leading to death Electrocardiogram Shortness of breath = 1st ○ Procedure: measures symptom the electrical activity Decrease endurance and of the heart increase difficulty in Echocardiography breathing worsens as the ,. ○ Procedure: uses condition progresses ultrasound to Good prognosis = eating visualize heart right, avoiding salt, regular function and structure exercise, avoiding smoking, K. Medical/Surgical Intervention 5  Diuretics backflow from RV to Action: reduces fluid the pulmonary artery overload by increasing urine Mitral valve output ○ Allows blood to flow Side effects: electrolyte and prevents imbalances backflow from LA to Precautions: dehydration the LV Contraindications: Aortic valve hypotension ○ Allows blood to flow Coronary Artery Bypass Grafting and prevents Grafting a vessel to bypass backflow from LV to blocked coronary arteries, the aorta restoring blood flow E. Pathophysiology Stenosis ○ Narrowing of the VALVULAR HEART DISEASE heart valve → limits A. Definition the flow of blood Group of conditions where through the valve → one or more heart valves chamber behind the is/are damaged or diseased. valve pathologically B. Epidemiology hypertrophies to Prevalence increases with pump against the age, such that 13% of people obstruction 75 y.o. At least moderate Prolapse aortic or mitral valve disease ○ one/more leaflets of C. Etiology a heart valve are Rheumatic heart disease floppy and bulge Congenital abnormalities backward → leaflets Metabolic or enzymatic and support abnormalities mechanisms of the Active infective endocarditis valve are destroyed Rheumatic Fever → valve droops down Giant blood cysts (rare) → prolapse progress D. Basic Medical Sciences to regurgitation Heart valves - responsible for Regurgitation controlling the direction and flow of ○ Incomplete valve blood through the heart (Pedretti) closure → forward Tricuspid valve and backward ○ Allows blood to flow movement of the and prevents blood → regurgitation backflow from the RA of blood into the to the RV chamber behind the Pulmonary valve pathological valve ○ Allows blood to pump F. Signs & Symptoms and prevents Chest pain 6  Palpitations = irregular While not specifically heartbeats designed for VHD, Fatigue ECG can help identify Dizziness underlying heart low /high blood pressure conditions, such as Shortness of breath arrhythmias or heart Abdominal pain enlargement, which Swollen leg may be associated G. Course & Prognosis with VHD Symptoms of mitral stenosis J. Medical / Surgical Intervention usually manifest during the Beta-blockers 3rd or 4th decade of life Action: to reduce symptoms Patients are generally of heart valve disease by asymptomatic at rest during controlling the heart rate and the early stage of the mitral help prevent abnormal heart stenosis. rhythms Factors that increase heart Side effects: fatigue, dizzy, rate such as fever, severe lightheaded, cold anemia, thyrotoxicosis, fingers/toes exercise, excitement, Precautions: heart and lung pregnancy, and atrial problem fibrillation may result in Contraindications: diabetes, dyspnea, which can worsen COPD, and asthma the disorder Valve Replacement Surgery – To H. Differential Diagnosis replace a heart valve, a surgeon Coronary Artery Disease removes the heart valve and Similarities: same symptoms replaces it with a mechanical valve and risk factors or a valve made from cow, pig or Differences: VHD - damage human heart tissue. of the heart valves; CAD narrowing/blockage of the coronary arteries CARDIOMYOPATHY I. Laboratory Tests & Special Tests A. Definition Echocardiogram Disease in the heart muscle ○ Provides images of that makes it harder for the the heart, valves, and heart to pump blood to the surrounding body structures to assess B. Epidemiology their function and M>F identify Dilated CM – middle-aged abnormalities. men; MC cause of heart Electrocardiogram (ECG or failure EKG): Hypertrophic CM – ○ Records the electrical childhood activity of the heart. 7  Restrictive CM – least Breathlessness with exertion common; older people or at rest Arrhythmogenic CM – rare; Swelling of the legs, ankles, & sudden death in young feet athletes Bloating of abdomen due to C. Etiology fluid buildup Unknown but has Cough while lying down contributing factors such as: Fatigue ○ Hypertension Rapid heartbeats ○ Heart tissue damage Chest discomfort ○ Rapid heart rate Dizziness, lightheadedness & ○ Metabolic disorders fainting ○ Genetic factors G. Course & Prognosis D. Basic Medical Sciences Progressive Myocardium - muscular May lead to heart failure, layer of the heart blood clots, valve problems, E. Pathophysiology sudden cardiac arrest DCM Poor prognosis because of Enlargement of LV (muscle complications fibers stretch and become 50% of patients die within 2 tight) impaired contraction ↓ years ejection fraction For those with advanced S3 gallop forms of heart failure, nearly HCM 90% die within 1 year Abnormal thickening of the H. Differential Diagnosis LV less blood in the ventricle Myocarditis during diastole ↓ stroke Similarities: both affects volume ↓ cardiac output; heart muscles and same smaller space for LV signs & symptoms RCM Differences: inflammation of Muscle becomes rigid and the heart muscle and often inelastic bc of abnormal caused by viral infection tissue > less filling ↓ stroke I. Laboratory Tests volume ↓ cardiac output ACM Chest X-ray Muscle in RV replaced by fat Enlarged heart and fibrous tissue abnormal Dilation, hypertrophy of electrical signal wrong myocardium direction heart beats too fast J. Special Tests out of sync Electrocardiogram ACM ○ Procedure: measures Genetic; when fats and extra the electrical activity fibrous tissue replace the of the heart muscle K. Medical / Surgical Intervention F. Signs & Symptoms Beta-blockers 8  Action: Cause the heart to Contraindications: diabetes, beat more slowly and with COPD, and asthma less force which lowers BP Biventricular Pacemaker (block effects of epinephrine) Device sends out electrical Side effects: fatigue, cold signals to control toes/fingers, dizziness contractions between the Precautions: heart and lung heart’s left and right problem ventricles PULMONARY CONDITIONS EMPHYSEMA oxygen and CO2 during the A. Definition process of breathing in and “Pink puffers” out; located at the end of the Progressive lung disease, a bronchioles form of chronic abnormal E. Pathophysiology pulmonary disease (COPD), Smoking → inflammatory wherein the air sacs (alveoli) response (secretes neutrophil are damaged & macrophages) → ↑ B. Epidemiology protease activity 4th leading cause of death in (antiprotease cannot catch the world up) → damage to the Higher incidence in areas alveolar walls → ↓ elasticity with high pollution and structural integrity → Prevalent in Men = 45-65 y.o. airways collapse during Who have history of chronic exhalation → air trapping → bronchitis Barrel Chest (increases in C. Etiology expiratory volume) alveoli walls are deflated or F. Signs & Symptoms damaged → which reduces Cough the amount of gas exchange Wheezing (Atchison) Shortness of breath D. Basic Medical Sciences Barrel-shaped chest Lungs - important for Chest tightness respiration that bring oxygen Fatigue into our bodies Pink puffers = pursed lips (inspiration/inhalation) and when exhaling & pink skin send carbon dioxide out of Muscle wasting the body Weight loss (expiration/exhalation) G. Course & Prognosis Alveoli - where the lungs Not curable and worsens and the blood exchange over time 9  Rate of decline may be 4th leading cause of death in modified (lifestyle the world modifications) M>F H. Differential Diagnosis Common among 50 years old Chronic Bronchitis and older Similarities: COPD, similar C. Etiology signs & symptoms, same Bronchial tubes become major risk factors inflamed and thickened Differences: experiences making it difficult to breath cyanosis and is overweight MC source of irritants = I. Laboratory Tests cigarette smoking CT Scan + Air pollution, smoke, dust, ○ Presence of localized chemicals areas of abnormally D. Basic Medical Sciences low attenuation w/o Lungs - primary organ for surrounding walls or respiratory system with very thin Bronchial tubes - airways ○ Damaged alveolar that carry air to and from the walls (↓ elastin and air sacs (alveoli) in the lungs collagen) are inflamed or irritated J. Special Tests causing sticky mucus to build Pulmonary Function Test up ○ Total volume of air E. Pathophysiology exhaled from your Smoking causes hypertrophy lungs = Forced Vital (enlarged) and hypoplasia Capacity (inadequate or K. Medical / Surgical Intervention underdeveloped) of bronchial PDE-4 Inhibitors mucinous gland and goblet Action: suppress immune cells → overproduction of system to reduce mucus → if the cilia has too inflammation much mucus → it Side effects: anorexia, sleep shortens/damaged → disturbances, diarrhea inflammation → have Precautions: depression difficulties in pushing out Contraindications: hepatic mucus out of bronchioles → insufficiency airway is obstructed → chronic bronchitis F. Signs & Symptoms Frequent cough CHRONIC BRONCHITIS Wheezing A. Definition Shortness of breath “Blue bloaters” Blue bloaters = cyanotic and Inflammation and irritation overweight of the bronchial tubes B. Epidemiology 10  ○ Low O2 level, lungs = Forced Vital excessive CO2 in Capacity blood K. Medical / Surgical Intervention G. Course & Prognosis Bronchodilators Gradually progresses if Action: relaxes muscles in the constant exposure to lungs & widen airways smoking or air pollution Side effects: hand trembling, Prognosis - not curable and dry mouth, headaches worsens over time, however Precautions: high BP depends on the lifestyle Contraindications: diabetes Stage 1: mild, FEV1 > 80% of Lung Volume Reduction Surgery - normal to remove small wedges of damaged Stage 2: moderate, FEV1 = lung tissue 50-79% of normal Stage 3: severe, FEV1 = 30-49% of normal ASTHMA Stage 4: very severe, FEV1 A. Definition