Download Cardiology

Cardiology
Ischemic heart disease

Inadequate oxygen supply to heart, at rest
or under stress
Angina pectoris
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Chest pain when the heart muscle is
ischemic
Miocardial infarction (MI)

The death of miocardial cells when
ischemia causes irreversible necrosis
Coronary thrombossis
Occlusion of coronary artery as a result of
thrombosis
 One of causes
of MI

Arrhytmia
Ischemic heart = abnormal rhythms
 Some harmless (ventricular ectopic beats)
 Others ↑ ischemia by ↓ coronary blood
flow and ↑ oxygen demand (ventricular
tachycardia)
 Can cause sudden death by stopping
pump action of the heart (ventricular
fibrillation)

Risk factors
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Family history
↑ cholesterol
High blood pressure
Smoking
Other factors:
Inactivty
Personality
Stress
Concentration clotting factors
Obesity
Patophysiology

Damage to coronary artery with deposition
of lipids, fibrous tissue and calcification

Lesion = atheroma

Sudden occlusion of artery as a result of
thrombosis
Clinical picture
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In weeks before MI – patients don’t feel
well
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Complain of being tired, indigestion,
shortness of breath an chest pain
Precautionary measures
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No static exercises
No exercises with bilateral arms above the
head, can do unilateral
Don’t exercise in positions where the patient is
bent forward
CHECK HEART RATE
After MI heart rate not higher than 8-14/min,
later 20/min
Precautionary measures
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Don’t over exert patient – pallor or sweat on
upper lip
Dyspnoea or angina – stop exercising
Patients on beta-blockers – heart rate does not
increase tempo (Borg-scale)
Look for signs fatigue, if they say they are tired,
believe them
If patient can’t talk or talks with difficulty – stop
exercising
Heart failure
Definition

Heart can’t maintain circulation
↓ cardiac output
↑ ventricular filling pressure
Decreased cardiac ouput

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Cardiac output = heart rate x stroke volume
Normal = ± 5 l / minute
Cardiac index = Cardiac output
Body surface
= 3l / min. / m2
Stroke volume = amount of blood pumped
out per heart beat
Heart rate

With bradicardia in sick heart = ↓ cardiac output

Tachycardia = ↓ ventricular filling = ↓ cardiac
output
Stroke volume
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Preload
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Afterload
resistance at aorta
resistance at peripheral vascular
network
viscosity of blood

Contractility of heart muscle fibers
Increased
ventricular filling
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Storke volume
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Circulating blood
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Compliance of heart
Medical treatment

↓ ventricular filling pressure by ↑ cardiac
output = stronger contraction of heart

↓ ventricular filling pressure by ↓ preload =
give diuretic
Cardiac imaging
Thoracic imaging

Chest x-ray

ECG

Exercise ECG
Thoracic imaging

Electrophysical studies – electrodes within
the heart chambers
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Radioisotope studies – gamma camera
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Echocardiography - ultrasound
Thoracic imaging
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Cardiac catheterization
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MRI
Electrocardiogram
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Recording, from body surface, of electrical
activity of the heart
P wave = atrial depolarization
QRS complex = ventricular depolarization
T wave = ventricular repolarization
ST segment elevation = MI
ST segment depression / T wave inversion =
angina
Cardiac
condustion system
Cardiac arrhythmias
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Abnormality of the cardiac rhythm
Can cause sudden death, syncope,
dizziness, palpatations or no symptoms
24-hour monitoring
Two main types:
bradicardia
tachycardia
Sinus rhythms
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Sinus arrhythmia = inspiration and expiration
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Sinus bradicardia = sleep and athletes
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Sinus tachycardia = exercise and excitement
Pathalogical bradycardias
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Sinus node dysfunction
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Atrioventricular block = delayed conduction
Pathalogical tachycardias
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Atrial ectopic beats

Atrial flutter = disease of the heart (saw tooth
waves)
Rx = cardioversion
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Pathalogical tachycardias
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Atrial fibrillation = “atrial activity is chaotic and
mechanically ineffective”
No clear P wave, ventricular response fast and
irregular
Ventricular arrythmias
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Ventricular ectopic beats (extrasystoles)
Ventricular arrythmias
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Ventricular tachycardia and ventricular
fibrillation = heart disease
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Ventricular tachycardia = 3 or more consecutive
ventricular beats at 120/min or more
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Rx: cardioversion, medication, implantable
defibrillator
Ventricular arrythmias
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Ventricular fibrillation = rapid, irregular, no
cardiac output
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Rx: cardioversion
References
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Pryor, J.A. and Prasad, S.A. 2009.
Physiotherapy for respiratory and cardiac
problems. Adult and paediatrics. Edinburgh:
Churchill Livingstone
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