my heart
what are some of the post opp complications to keep n mind after a open heart surgery?
(hint: think what wound stunt/delay recovery)
1. unstable sternum ( stapled so it needs to heal)
2. arrythmias ( prone to arrythmias post opp)
3. cardiogenic shock ( while in shock there is Low BP and organs arent getting enough blood because of cardiac issues
4. wound closure (whereever the grafts were taken from)
what causes an MI
1. any prolonged obstruction of blood flow to the heart ( can be due to a build up or just lack of o2 that causse tissue damage)
what type of elevation in the PQRST waves will you see in a STEMI?
nstemi?
ST elevation
- you dont have an elevation in the T wave = ischemia
(hint: think first aid first..)
1. EMS or CPR
2. oxygen administration
3. IV access so blood can be drawn or antiarrhytmics are needed
4. EKG
5. Baby asprin
6. determine if they need thrombolytic therapy (Drug that breaksdown clots)
7. pain relief
8. treat arrhytmia
after an MI, what risk factors should a PT keep in mind?
what should you avoid?
(hint: think acute care facility)
1. bed rest puts the clietn at risk of complications - a person UE raises 02 demands more than walking so its silly to have them do UE exercises.
2. start mobility!! 24 hr post surgery - early dangling, deep breathing and ambulation !!
3. carefully monitor HR, BP, breath sounds, heart sounds
4. avoid valsalva maneuver & look out for signs of poor tolerance to exercise
what are some of the neurological side effects pst bypass?
1. CVA - when you clamp off the aorta and unclamp it, the CA that is built up in most ppl in their arteries can disrupt one of these clots and it can log somewhere else ex: in brain or lungs
2. brachial plexus injury - seperating the sternum can cause a traction injury to brachial plexus
3. anoxia (absence of oxygen) - the bypass machine doesnt deliver blood as effectively as the heart would so they might get anoxia
what is the zone of infarction?
its the area where the tissue becomes necrotic
- it immediately dies becaues its completely deprived of oxygen
hint: think of heart depolarization
P wave = atrial depolarization
QRS= ventricular depolarization
ST seg & T wave = repolarization
when trying to reprefuse the heart (reperfusion), what kind of drugs breaks down the clot ?
thrombolyiss is a drug that breaks up a clot
when would you NOT want someone who has had an MI to exercise?
1. unstable angina 2. new ECG signs of MI
3. PAO2<60
4. 02 stats <80
5. severe aortic outflow obstruction
6. severe HTN
7. uncontrolled DM
8. digoxin toxicity ( common drug used in HF)
how can you prevent someone from having pulmonary complications within the post opp 34 hr time span?
2.monitor HR, BP, EEG, o2 saturation, heart & lung sounds
3. watch for orthostatic hypotension (drop in BP when they stand)
is an area that had some injury but if we are able to revascularize it, it may bounce back
- if it doesn't get revascularized, it will continue to be necrotic
1. presenting symptoms ( SOB, diaphoresis (sweating) , cool clammy skin, nausea , vomitting, urge to void, not all ppl have chest pain)
2. physical exam
3. EKG changes
4. CBC (complete blood count becaue you want to make sure they dont have anemia)
5. chest x-ray
7. coagulation profile (whats their clotting profile look like?)
what do beta blockers do to the heart during an MI?
they will decrease the HR and contractility
a 63 yr old women presents with epigastric and arm pain, nausea and is very anxious stating " i really do not feel well". EMS make preliminary dx of Acute coronary syndrome ACS.
1. what criteria did they use to make this?
2. what could be possibly occurring?
3. what other conditions could contribute to her sympts?
4. why was ACS considered over the other potential issues first?
1. nausea and arm pain are signs and symptoms of ACS
2. angina, MI (could be STEMI or NSTEMI), ischemia
3. arrythmia can cause it, unhelathy lifestyle, smoking, hTN, high cholesterol, GI issue (ulcer)
4. becaues you need to rule out the most dangerous first that needs to be treated first
what are some sternal precautions for PTs to note after open heart surgery?
1. avoid pressure/ strain on sternum
2. no lifting , pulling or pushing anything over 10 pounds for 6-8 wks
3. sit to stand without UE push off
4. tub precautions
what is acute coronary syndrome?
acute coronary syndrome is any condition that causes a sudden decrease in blood flow to the heart
- can include STEMI and NSTEMI (non typical ECG changes that you see in MI)
1. what are the normal levels for CK-MB?
2. what are normal levels for I&T troponin levles
CK-MB is basically CPK which is usually shown when you have any type of tissue damage . 25-200
I&T troponin levles are the cardioselevtice ones and they usually start to peak quickly after tissue damage (w/n an hour or 2). if the troponin level is elevated, it is highly predicitve that they had an MI and then they go to the catherter lab
2. I = .1
3. T= 3.1
what do nitrates do to the heart during an MI?
decrease afterload
for the case above ( 63 yr old lady, "dont feel well", arm pain, nausea, etc) , what happens if:
1. the EKG shows no ST seg changes but the troponin is elevated. what could it be?
2. if she did have an MI, what do they want to do for her?
1. NSTEMI because there is NO EKG change **
2. stent/revascularization w/n 45 mins
t/f: Myocardial infarction (MI) aka heart attacks are the development of ischemia with resultant necrosis of the myocardial tissue
T
whats the difference between STEMI (transmural) and ATEM (subendocardial) damage?
transmural means it effects the whole heart, typically the ST segment
subendocardial means it no typical changes are seen
1. if someone is having a STEMI, they will have the tall peaked __ waves?
2. progressive elvation in __ segments in leads facing the infarctio and __ segmenet depression in areas opposite infarcation
3. if someone has a STEMI over weeks or months, the __ segements normalize but develop something called a pathological __.
4. _ Wave is the hallmark of transmural MI
1. T.
2. ST
3. ST , Q. and the pathological Q wave will remain for the rest of their life
4. Q wave
what do ACE inhibitors & CA channel ANTAGONIST do for the heart during an MI
decrease contraction of the heart
what lab test is used to dx an acute MI within the 1st few hours?
a) troponin I b) homocystein c) LDH d) CPK
a)