Exam 2 - ExRx for those with Cardiovascular and Pulmonary Diseases Questions With Correct Solutions, Already Passed!!

Where in the blood vessels are clots most likely? - Where there is branching? Cardiac Rehabilitation (CR) • Ex and lifestyle interventions • Currently, ........... insurance reimburses for CR for MI/acute coronary syndrome, CABG, PTCA, stable angina, valve repair/replacement, CHF, and heart transplant. Injury to the endothelium (many causes) → ....... -2 main causes? - endothelial dysfunction... -high Blood Pressure (results in higher turbulent flow - excessive pounding on endothelial cells) -glycosolated haemoglobin = HbA1c (% of Hb that has glycogen attached) (spikes of the glucose rake the endothelial layer causing it to become damaged) Endothelial dysfunction causes ..... -5 step process? - -disturbed blood flow which causes -endothelial cell activation (since the cells have been damaged) -recruitment of inflammatory cells to vessel wall (WBCs arrive here) -cell signaling facilitates LDL retention in tunica intima (LDL is used to help the endothelial layer heal but if too much LDL is retained, it can lead to blood clotting). -oxidative modification by ROS and inflammatory enzymes What is the problem with hypertension/diabetes in terms of the effect on endothelial dysfunction? - Can cause accumulation of lipids as endothelial layer is constantly being damaged Accumulation of lipids -5 step process? - ↳ monocytes become macrophages which try to digest mLDL. When the macrophages cannot digest any more mLDL, they become foam cells↳endoplasmic reticulum stress triggers foam cell apoptosis (organised programmed cell death) ↳Efferocytic program (burying of cells) cannot keep up with source of apoptotic formation ↳Apoptotic cells that aren't being destroyed properly undergo secondary necrosis forming necotic core = atherosclerotic plaque (purple blob on my pic) •Unstable and vulnerable to disruption. 2 effects of atherosclerotic plaques developing - -can cause clotting at site of plaque in response to internal bleeding -plaque can break off and travel in blood to cause clotting elsewhere • ..... and ..... (2 phases of CR) - -Medicare/private -Inpatient and Outpatient Inpatient Cardiac Rehabilitation: Guidelines • Current clinical status .......... • Mobilization • Identification and provision of information regarding modifiable ..... factors and ..... • Discharge planning with a home ..... and ..... • Referral to .......... CR - -assessment -risk; self-care -PA; ADL (activities of daily living) -outpatient Inpatient Cardiac Rehabilitation: Guidelines • ........ Assessments ￮ Note: diagnosis, current medical status, comorbidities, CVD risk factors, personalized goals, as well as readiness for PA and learning. • Supervised daily ....... ￮ Intermittent ....... or ........ 12-24hrs after MI⁃ purpose of this? ⁃ Should include documentation of ..... • Individual education on modifiable ..... factors ￮ After physical ability and psychological willingness is ...... - • Clinical • ambulation (moving/walking) ￮ sitting; standing ⁃ "prevent" exercise performance decrements ⁃ vital signs • risk ￮ known Inpatient Cardiac Rehabilitation: Guidelines • Before discharge: ￮ Need to know ........ activities (Heavy lifting, climbing stairs, yard work, etc) ￮ Need to have a ..... plan of exercise ￮ Individuals should know how to identify ...... signs and symptoms ￮ Individuals should be strongly encouraged to participate in .......... - -permissible (what they can do and what they want to do and help them achieve these things) -safe -abnormal -outpatient CR program American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) Parameters for Inpatient Cardiac Rehabilitation Daily Ambulation - No new or recurrent ....... in previous 8 h- Stable or falling ................. (indicative of damage if CK high) and troponin values - No indication of decompensated (worsening of) .............. (e.g., resting dyspnea and bibasilar rales) - Normal cardiac rhythm and stable electrocardiogram for previous ..... hours - - chest pain - creatine kinase - heart failure - 8 hours Indications and Contraindications for Inpatient and Outpatient Cardiac Rehabilitation *Indications = conditions with which you SHOULD got to CR outpatient* • Medically ...... postmyocardial infarction • ...... angina • Coronary artery ......... graft (surgery) • Percutaneous transluminal coronary angioplasty - what is this? • Stable .......... caused by either systolic or diastolic dysfunction (cardiomyopathy) • ...... transplantation • ......... heart disease/surgery • .......... arterial disease • At risk for ............. artery disease with diagnoses of diabetes mellitus, dyslipidemia, hypertension, or obesity • Other individuals who may benefit from structured exercise and/or individual education based on ......... referral and consensus of the .......... team - • stable • Stable • bypass • a minimally invasive procedure that opens blocked coronary arteries to improve blood flow to the heart muscle • heart failure• Heart • Valvular • Peripheral • coronary • physician; rehabilitation Indications and Contraindications for Inpatient and Outpatient Cardiac Rehabilitation: *Contraindications (if you have these conditions you should NOT got to cardiac rehab)* • ......... angina • ............. hypertension (resting systolic blood pressure ........ mm Hg and/or resting diastolic blood pressure ......... mm Hg) • Orthostatic blood pressure drop (decrease in BP after sitting or lying down) of ...... mm Hg ..... symptoms • ......... aortic stenosis (aortic valve area <1.0 cm?) • Uncontrolled atrial or ventricular ............... • ............. sinus tachycardia (.......beats • min i)