i bc27f85be50b71b1 (18 page)

44 ActITE CARE HANDBOOK FOR PHYSICAL THERAPISTS

A common form of rhythm disturbance is a PVC, which also can

be referred to as a ventricular premature beat. These abnormalities

originate from depolarization of a cluster of cells in the ventricle (an

ectopic (oci), which results in ventricular depolarization. From the

term ectopic (oci, PVCs may be refered to as velltricular ectopy.

Valvular Heart Disease

Valvular heart disease encompasses valvular disorders of one or more of

the four valves of the hearr. The following three disorders can occllr4�:

1 . Stenosis involves the narrowing of the valve.

2.

Regurgitation, the back flow of blood through the valve,

occurs wirh incomplete valve closure.

3.

Prolapse involves enlarged valve cusps. The cusps can

become floppy and bulge backward. This condition may progress

to regurgitation.

Over time, these disorders can lead to pumping dysfunction and,

ultimately, heart failure.

Refer to Table 1 - 1 4 for common valvular heart diseases and a

description of their signs and symptoms.

Myocardial a"d Pericardial Heart Disease

MyocardiaL heart disease affects the myocardial muscle tissue and can

also be referred to as cardiomyopathy; pericardial hearr diseases

affect the pericardium. Refer to Tables 1 - 1 5 and 1 - 1 6 for common

myocardial and pericardial diseases.

Heart Fail"re

Hearl (ailllre, a decrease of CO, can be caused by a variety of cardiac

pathologies. Because CO is not maintained, life cannot be sustained if

heart failure continues without treatment. Heart failure results in the

congestion of the pulmonary circulation and, in certain cases, even the

systemic circulation. Therefore, it is commonly referred to as CHF. The

CARDIAC SYSTEM

45

Table 1-14. Signs and Symptoms of Valvular Heart Diseases

Disease

Symptoms

Signs

Aortic

Angina, syncope or near

Elevated left ventricular wall

stenosis

syncope, signs of left

pressure, decreased subenventricle failure (dysp·

docardial blood flow, sysnea, orthopnea, cough).

rolic murmur, ventricular

hypertrophy

Chronic aortic

Angina, symptoms of left

Dilared aortic roor, dilated

regurgitation

ventricular failure.

lefr ventricle, diasrolic

murmur, lefr ventricular

hypertrophy

Acute aortic

Rapid progression of

5inus tachycardia to compenregurgitation

symptoms of left vensate for decreased stroke

tricular failure, pulmovolume. loud 53, diastolic

nary edema, angina.

murmur, signs of ventricular failure

Mitral

Symptoms of pulmonary

Left atrial hyperrrophy, pulstenosis

vascular congestion

monary hypertension,

(dyspnea, orthopnea), If

arrial fibrillarion, can have

patienr develops pulmoembolus formation (espenary hyperrension

cially if in atrial fibrilla

(which can cause

tion), long diastolic

hypoxia, hypotension),

murmur

he or she may have

angina, syncope.

Chronic

Symptoms of pulmonary

Lefr atrial enlargement, atrial

mitral

vascular congestion,

fibrillation, elevated left

regurgitation

angina, syncope, farigue.

atrial pressure

Acute mitral

Rapid progression of

5inus tachycardia, presence

regurgitation

symproms of pulmonary

of 53 or 54, pulmonary

vascular congesrion.

edema

Mitral valve

Most commonly asymptom

Systolic click, may have rachprolapse

aric, fatigue, palpiration.

yarrhythmia syncope

Sources: Data from SL Woods, ES Sivarajian-Froelicher, 5 Underhill-Moner (eds). Cardiac Nursing (4th ed). Philadelphia: Lippincorr. 2000; and MD Cheidin, M Sokolow, MB Mcilroy. Clinical Cardiology (6th cd). Norwalk, Cf: AppletOn & Lange, 1993.

46

ACUTE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Table 1-15. Myocardial Diseases-Cardiomyopathies

Functional Classification

Cardiomyopathy

Dysfunction

Description

Dilated

Systolic

Ventricle is dilated, and there is marked

contractile dysfunction of myocardium.

Hypertrophic

Diastolic

Thickened ventricular myocardium,

less compliant to filling, and therefore decreased filling during diastole.

Restrictive

Systolic and

Endocardial scarring of ventricles,

diastolic

decreased compliance during diastole, and decreased contractile force

during systole.

Etiologic Classification

Etiology

Examples

Etiology

Examples

Inflammatory

Viral infarction,

Infiltrative

Sarcoidosis, neoplastic

bacterial

Hemaco

Sickle cell anemia

infarction

logic

Alcohol, bleomycin

Metabolic

e1enium defi

Toxic

Heat stroke, hypo-

ciency, diabe

Physical

thermia, radiation

res mellitus

agents

Postpartum cardio

Fibroplasric

Carcinoid fibro

Miscellamyoparhy, obesity

sis, end om yoneous

Status POSt myocardial

cardial fibrosis

acquired

infarction

Hypersensiriviry

Cardiac trans

Ischemic

plant rejection,

methyldopa

Generic

Hypertrophic Cardiomyopathy,

Duchenne's

muscular dystrophy

Idiopathic

Idiopathic hypertrophic cardiomyopathy

Source: Adapred from L Cahalin. Cardiac Muscle Dysfunction. In EA Hillegass, HS Sadowsky (cds). Essentials of Cardiopulmonary Physical Therapy (2nd cd). Philadelphia: Saunders, 200 I .