Patient Profile: Cardiovascular
Browse resources on patients with cardiovascular conditions that are commonly observed in the acute inpatient rehab setting.
Please click on a topic or see what catches your interest down below.
Cardiovascular Collection
Conditions
From the authors: "Patients with atrial fibrillation are at increased risk of a number of complications, most notably stroke, heart failure, dementia and all-cause mortality. Several risk factors for atrial fibrillation have been established including age, sex, diabetes, coronary heart disease, heart failure, smoking, alcohol, obesity, low physical activity and possibly high intensity physical activity."
+ Aune D, Mahamat-Saleh Y, Kobeissi E, Feng T, Heath AK, Janszky I. Blood pressure, hypertension and the risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies. Eur J Epidemiol. 2023;38(2):145-178. doi:10.1007/s10654-022-00914-0
From the authors: "Cardiac arrest is an important public health issue...A great proportion of these deaths occur after resuscitation due to post-cardiac arrest syndrome. PCAS is a complex occurrence that is characterized by the ischemia-reperfusion injury that affects the whole body...Despite advances in cardiopulmonary resuscitation (CPR) maneuvers, post-resuscitation care, which is started immediately after the sustained return of spontaneous circulation (ROSC), is of fundamental importance."
+ Lazzarin T, Tonon CR, Martins D, et al. Post-Cardiac Arrest: Mechanisms, Management, and Future Perspectives. J Clin Med. 2022;12(1):259. Published 2022 Dec 29. doi:10.3390/jcm12010259
From the authors: "Endothelial dysfunction, which precedes coronary sclerosis by many years, is the first step of a vicious cycle culminating in overt atherosclerosis, significant coronary artery disease (CAD), plaque rupture, and, finally, myocardial infarction. In addition to classic risk factors, such as hypertension, smoking, diabetes mellitus, and hypercholesterolemia, physical inactivity has been identified as an independent predictor for the development of CAD."
+ Winzer EB, Woitek F, Linke A. Physical Activity in the Prevention and Treatment of Coronary Artery Disease. J Am Heart Assoc. 2018;7(4):e007725. Published 2018 Feb 8. doi:10.1161/JAHA.117.007725
From the authors: "DVT is a serious, yet potentially preventable, medical condition that occurs when a thrombus forms in a deep vein, most commonly in the calf, thigh, or pelvis but which can also occur in veins of the upper extremities...risk factors for thrombosis formation are best described through Virchow’s Triad of vascular stasis, endothelial injury, and/or hypercoagulability. These factors can trigger the coagulation cascade and the formation of a blood clot."
+ Ellen Hillegass, Kathleen Lukaszewicz, Michael Puthoff, Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline 2022, Physical Therapy, Volume 102, Issue 8, August 2022, pzac057, https://doi.org/10.1093/ptj/pzac057
From the authors: "Diabetes mellitus is...characterized by elevated blood glucose levels resulting from the body’s inability to produce insulin, resistance to insulin action, or both. This group of conditions consists of 4 clinically distinct types: (1) type 1 diabetes, which results from autoimmune beta-cell destruction in the pancreas and is characterized by a complete lack of insulin production; (2) type 2 diabetes, which develops when there is increased resistance to the action of insulin and the body cannot produce enough insulin to overcome the resistance; (3) gestational diabetes, which is a form of glucose intolerance that affects some women during pregnancy; and (4) a group of other types of diabetes caused by specific genetic defects of beta-cell function or insulin action, diseases of the pancreas, drugs, or chemical toxicity."
+ Harris-Hayes M, Schootman M, Schootman JC, Hastings MK. The Role of Physical Therapists in Fighting the Type 2 Diabetes Epidemic. J Orthop Sports Phys Ther. 2020;50(1):5-16. doi:10.2519/jospt.2020.9154
From the authors: "HF is a chronic and progressive condition in which the heart loses the ability to efficiently pump blood to the extremities, organs, and skin."
+ Michael J Shoemaker, Konrad J Dias, Kristin M Lefebvre, John D Heick, Sean M Collins, Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure, Physical Therapy, Volume 100, Issue 1, January 2020, Pages 14–43, https://doi.org/10.1093/ptj/pzz127
From the authors: "The etiology of acute myocardial infarction is decreased coronary blood flow. The available oxygen supply cannot meet oxygen demand, resulting in cardiac ischemia. Decreased coronary blood flow is multifactorial. Atherosclerotic plaques classically rupture and lead to thrombosis, contributing to acutely decreased blood flow in the coronary. Other etiologies of decreased oxygenation/myocardial ischemia include coronary artery embolism, which accounts for 2.9% of patients, cocaine-induced ischemia, coronary dissection, and coronary vasospasm."
+ Mechanic OJ, Gavin M, Grossman SA. Acute Myocardial Infarction. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan
From the authors: "Orthostatic hypotension is defined as a sustained drop of at least 20 mmHg in systolic blood pressure (SBP) or 10 mmHg in diastolic blood pressure (DBP) within 3–5 minutes of going from a supine to a standing position. In patients with associated supine hypertension, the criteria for orthostatic hypotension allows for a drop of at least 30 mmHg in systolic blood pressure or 15 mmHg in diastolic blood pressure."
+ Wahba A, Shibao CA, Muldowney JAS, Peltier A, Habermann R, Biaggioni I. Management of Orthostatic Hypotension in the Hospitalized Patient: A Narrative Review. Am J Med. 2022;135(1):24-31. doi:10.1016/j.amjmed.2021.07.030
From the authors: "HF precipitates and perpetuates CKD via a reduction in renal blood flow, impaired renal haemodynamics and resultant ischaemic injury. Conversely, CKD contributes to progressive left ventricular (LV) remodelling, fibrosis and cardiac dysfunction as a result of fluid overload, anaemia, uraemia, excessive renin–angiotensin–aldosterone and sympathetic activation among other factors."
+ Ryan DK, Banerjee D, Jouhra F. Management of Heart Failure in Patients with Chronic Kidney Disease. Eur Cardiol. 2022;17:e17. Published 2022 Jul 26. doi:10.15420/ecr.2021.33
Treatments
The Wearable Cardioverter Defibrillator
From the authors: "Multiple studies demonstrate that internal cardiac defibrillators (ICDs) are effective in treating SCD because they defibrillate life-threatening arrhythmias, such as ventricular tachycardia and ventricular fibrillation."
+ Lauren Perillo, Greg Sweeney, The Wearable Cardioverter Defibrillator: A Case Study Illustrating Physical Therapy Implications and Management in the Inpatient Setting, Physical Therapy, Volume 98, Issue 12, December 2018, Pages 973–979, https://doi.org/10.1093/ptj/pzy106
Left Atrial Appendage Closure Device
From the authors: "The device is delivered through a catheter and permanently implanted at the opening of the left atrial appendage, which has been found to be the source of thrombus formation in 90% of patients with nonvalvular atrial fibrillation who have experienced stroke.3 The procedure takes about one hour to complete, and patients typically remain in hospital for 24 hours following the procedure. By closing the left atrial appendage, the risk of thromboembolism is thought to be reduced."
+ Health Quality Ontario . Left Atrial Appendage Closure Device With Delivery System: A Health Technology Assessment. Ont Health Technol Assess Ser. 2017;17(9):1-106. Published 2017 Jul 4.
From the authors: "Aside from heart transplantation, recent interventions include: high-risk coronary artery bypass surgery (CABG), transmyocardial revascularization (TMR), dynamic cardiomyoplasty (DCM), partial left ventriculectomy (PLV), and the use of a left ventricular assist device (LVAD). Patients undergoing these procedures are potentially candidates for exercise rehabilitation."
+ Reed Humphrey, Ross Arena, Surgical Innovations for Chronic Heart Failure in the Context of Cardiopulmonary Rehabilitation, Physical Therapy, Volume 80, Issue 1, 1 January 2000, Pages 61–69, https://doi.org/10.1093/ptj/80.1.61
From the authors: "Aortic stenosis (AS) is caused by progressive calficiation of the valve and is the most common cause of left ventricular outflow tract obstruction. Once moderate AS is present, there is a high liklihood of progression to severe AS. Surgical aortic valve replacement has been the standard treatment for patients with severe symptomatic AS. Previously, patients determined to be at high risk for surgery could only be offered diuretics and balloon valvuloplasty which served as palliative treatment and had no effect on long-term outcomes. The development of transcatheter aortic valve replacement (TAVR) has emerged as a lifeline for patients considered to be inoperable providing both improvement in symptoms and statistically significant mortality benefit."
+ Mahmaljy H, Tawney A, Young M. Transcatheter Aortic Valve Replacement. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431075/
From the authors: "Selected patients with poor left ventricular function, although at higher mortality risk, may benefit from coronary revascularization. The large magnitude of coronary artery disease and associated myocardial damage for many patients with CHF due to ischemia limits widespread use of CABG in this population. Historically, surgery was deferred for patients with severe CHF due to the poor benefit-to-risk ratio."
+ Reed Humphrey, Ross Arena, Surgical Innovations for Chronic Heart Failure in the Context of Cardiopulmonary Rehabilitation, Physical Therapy, Volume 80, Issue 1, 1 January 2000, Pages 61–69, https://doi.org/10.1093/ptj/80.1.61
From the authors: "The leadless pacemaker (LP) is a novel alternative consisting of a capsule‐like device containing a generator and electrode system that is implanted into the right ventricle via a percutaneously inserted femoral venous catheter. By omitting the need for a generator pocket and transvenous leads, a LP may avoid many of the lead‐ and generator pocket–related complications typically associated with a TVP."
+ Ngo L, Nour D, Denman RA, et al. Safety and Efficacy of Leadless Pacemakers: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2021;10(13):e019212. doi:10.1161/JAHA.120.019212
From the authors: "Catheter ablation is increasingly offered to relieve AF-related symptoms,2–4 based on evidence illustrating its efficacy compared with antiarrhythmic drug therapy.5–9 There is less evidence supporting AF ablation in persistent AF, although small studies suggest better maintenance of sinus rhythm."
+ Kirchhof P, Calkins H. Catheter ablation in patients with persistent atrial fibrillation. Eur Heart J. 2017;38(1):20-26. doi:10.1093/eurheartj/ehw260
From the authors: "A build-up of plaque in the carotid artery can lead to atherosclerosis and stenosis of the artery, which may or may not be symptomatic clinically. Such carotid artery disease increases a person’s risk for cerebrovascular disease and stroke. Carotid endarterectomy (CEA) is a surgery performed to decrease the risk of stroke in a patient with known cerebrovascular atherosclerotic disease. The procedure entails removing plaque from the common carotid artery and/or internal carotid artery to improve blood flow and remove potential embolic material, restoring more normal cerebral blood flow.
+ DaCosta M, Tadi P, Surowiec SM. Carotid Endarterectomy. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470582/
From the authors: "Used as a bridge to candidacy, the VAD allows time for the patient to become eligible for cardiac transplantation by, for example, decreasing body mass index, achieving a required cancer-free period, or securing financial and family support."
+ Chris L. Wells, Physical Therapist Management of Patients With Ventricular Assist Devices: Key Considerations for the Acute Care Physical Therapist, Physical Therapy, Volume 93, Issue 2, 1 February 2013, Pages 266–278, https://doi.org/10.2522/ptj.20110408
From the authors: "Heart transplantation remains the primary intervention for people with end-stage CHF. Although heterotopic transplants (the recipient's heart is not removed, and the donor heart is anastomosed in parallel) may be done in selected patients, orthotopic transplantation (removal of the recipient's heart and replacement with the donor heart) is associated with better survival and is most widely used."
+ Reed Humphrey, Ross Arena, Surgical Innovations for Chronic Heart Failure in the Context of Cardiopulmonary Rehabilitation, Physical Therapy, Volume 80, Issue 1, 1 January 2000, Pages 61–69, https://doi.org/10.1093/ptj/80.1.61
Rehabilitation
Effectiveness of Preoperative Physical Therapy for Elective Cardiac Surgery
From the authors: "...preoperative physical therapy reduced atelectasis and pneumonia and specifically reduced the length of postoperative hospitalization for patients undergoing elective cardiac surgery."
+ Reed Humphrey, Daniel Malone, Effectiveness of Preoperative Physical Therapy for Elective Cardiac Surgery, Physical Therapy, Volume 95, Issue 2, 1 February 2015, Pages 160–166, https://doi.org/10.2522/ptj.20130323
Cardiac Rehabilitation and Physical Performance in Patients after Myocardial Infarction
From the authors: "CR significantly improves exercise tolerance in patients after MI at two time-points of observation (in the 3rd month and in the 6th month after MI). Younger patients benefit more from cardiac rehabilitation than older patients."
+ Grochulska A, Glowinski S, Bryndal A. Cardiac Rehabilitation and Physical Performance in Patients after Myocardial Infarction: Preliminary Research. J Clin Med. 2021;10(11):2253. Published 2021 May 22. doi:10.3390/jcm10112253
From the authors: "The population of patients who benefit from both cardiac and pulmonary rehabilitation is increasing as the population ages and heart disease remains a leading cause of global morbidity and mortality. The principles of exercise physiology when applied to this population can reverse deconditioning, build cardiopulmonary reserve, and ultimately reduce morbidity and mortality in these populations."
+ Bartels MN, Prince DZ. Acute Medical Conditions: Cardiopulmonary Disease, Medical Frailty, and Renal Failure. Braddom's Physical Medicine and Rehabilitation. 2021;511-534.e5. doi:10.1016/B978-0-323-62539-5.00027-8
Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review
From the authors: "Knowledge of ICR and a belief in the importance and necessity of the intervention were highlighted as key factors that influence the provision and uptake of ICR. For patients, knowledge and attitudes emerged as having the potential to both challenge or facilitate the uptake of ICR. Namely, when patients were aware of and convinced of the benefits of ICR, they were more likely to participate in the intervention. Conversely, when patients lacked knowledge, interest or motivation to participate in ICR, uptake was lower."
+ Wasilewski M, Vijayakumar A, Szigeti Z, et al. Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review. J Multidiscip Healthc. 2023;16:2361-2376. Published 2023 Aug 16. doi:10.2147/JMDH.S418803
From the authors: "In our study, the implementation of the LR approach, Keep Your Move in the Tube, had no adverse effect on outcomes 2 to 3 weeks following median sternotomy. Although no statistically significant differences were noted for all outcomes, patients with the LR approach reported less difficulty with functional mobility."
+ Caitlyn Holloway, Neeti Pathare, Jean Huta, Dana Grady, Andrea Landry, Claire Christie, Patricia Pierce, Charity Bopp, The Impact of a Less Restrictive Poststernotomy Activity Protocol Compared With Standard Sternal Precautions in Patients Following Cardiac Surgery, Physical Therapy, Volume 100, Issue 7, July 2020, Pages 1074–1083, https://doi.org/10.1093/ptj/pzaa067
An Evidence-Based Perspective on Movement and Activity Following Median Sternotomy
From the authors: "Following median sternotomy, typical guidelines involve limiting arm movement during loaded lifting, pushing, and pulling for 6 to 8 weeks. This perspective paper proposes that there is robust evidence to support early implementation of upper body activity and exercise in patients recovering from median sternotomy while minimizing risk of complications."
+ Doa El-Ansary, Tanya Kinney LaPier, Jenny Adams, Richard Gach, Susan Triano, Md Ali Katijjahbe, Andrew D Hirschhorn, Sean F Mungovan, Ana Lotshaw, Lawrence P Cahalin, An Evidence-Based Perspective on Movement and Activity Following Median Sternotomy, Physical Therapy, Volume 99, Issue 12, December 2019, Pages 1587–1601, https://doi.org/10.1093/ptj/pzz126
Inspiratory Muscle Training in Patients With HF: What Is New? Systematic Review and Meta-Analysis
From the authors: "For people with heart failure, IMT by itself, without being combined with other exercise, can improve ease of breathing, increase the amount of distance that they can walk, and improve quality of life. Inspiratory training with higher loads might be helpful for those with respiratory muscle weakness who are unable to do conventional exercise."
+ Aline de Cassia Meine Azambuja, Luma Zanatta de Oliveira, Graciele Sbruzzi, Inspiratory Muscle Training in Patients With Heart Failure: What Is New? Systematic Review and Meta-Analysis, Physical Therapy, Volume 100, Issue 12, December 2020, Pages 2099–2109, https://doi.org/10.1093/ptj/pzaa171
Effect of a Virtual Reality–Enhanced Exercise Protocol After Coronary Artery Bypass Grafting
From the authors: "These study outcomes clearly support the notion that incorporating a VR environment into cardiac rehabilitation programs will accelerate maximum recovery of patients’ cardiovascular function."
+ Tien-Yow Chuang, Wen-Hsu Sung, Hwa-Ann Chang, Ray-Yau Wang, Effect of a Virtual Reality–Enhanced Exercise Protocol After Coronary Artery Bypass Grafting, Physical Therapy, Volume 86, Issue 10, 1 October 2006, Pages 1369–1377, https://doi.org/10.2522/ptj.20050335
From the authors: "Because having an active lifestyle is essential in managing cardiac risk factors and reducing mortality, future research should focus on finding successful interventions to achieve and maintain an active lifestyle."
+ Nienke ter Hoeve, Bionka M.A. Huisstede, Henk J. Stam, Ron T. van Domburg, Madoka Sunamura, Rita J.G. van den Berg-Emons, Does Cardiac Rehabilitation After an Acute Cardiac Syndrome Lead to Changes in Physical Activity Habits? Systematic Review, Physical Therapy, Volume 95, Issue 2, 1 February 2015, Pages 167–179, https://doi.org/10.2522/ptj.20130509
From the authors: "The application of a graded mobilization program using a mobile leg press and a hydraulic-assist platform walker was safe and feasible, and appeared to expedite the patient's recovery process while decreasing the amount of manual lifting for the therapists."
+ Darin W. Trees, James M. Smith, Steven Hockert, Innovative Mobility Strategies for the Patient With Intensive Care Unit–Acquired Weakness: A Case Report, Physical Therapy, Volume 93, Issue 2, 1 February 2013, Pages 237–247, https://doi.org/10.2522/ptj.20110401
Effects of Exercise Training on Heart Rate Variability After Coronary Angioplasty
From the authors: "The parasympathetically modulated HRV of the subjects in the exercise group increased significantly compared with the HRV of subjects in the control group. The effects of training on HRV were independent of angioplasty type (balloon or stent) and were unrelated to whether the subjects had received previous PTCA."
+ Mei-Wun Tsai, Wei-Chu Chie, Terry BJ Kuo, Ming-Fong Chen, Jen-Pei Liu, Tony Hsiu-Hsi Chen, Ying-Tai Wu, Effects of Exercise Training on Heart Rate Variability After Coronary Angioplasty, Physical Therapy, Volume 86, Issue 5, 1 May 2006, Pages 626–635, https://doi.org/10.1093/ptj/86.5.626
From the authors: "These findings suggest that initiation of antihypertensive and statin medication is associated with lifestyle changes, some favorable and others unfavorable. Weight management and physical activity should be encouraged in individuals prescribed these medications."
+ Korhonen MJ, Pentti J, Hartikainen J, et al. Lifestyle Changes in Relation to Initiation of Antihypertensive and Lipid-Lowering Medication: A Cohort Study. J Am Heart Assoc. 2020;9(4):e014168. doi:10.1161/JAHA.119.014168
Postural Progressions: Orthostatic Hypotension
From the authors: "Without doubt, management of OH optimally involves a multidisciplinary, patient-centered, often, individualized approach to arrive at an appropriate diagnosis, address underlying etiologies and accompanying conditions, and to provide tailored and potentially effective pharmacological and non-pharmacological treatment strategies."
+ Fedorowski A, Ricci F, Hamrefors V, et al. Orthostatic Hypotension: Management of a Complex, But Common, Medical Problem [published correction appears in Circ Arrhythm Electrophysiol. 2023 Aug;16(8):478]. Circ Arrhythm Electrophysiol. 2022;15(3):e010573. doi:10.1161/CIRCEP.121.010573
From the authors: "The use of an electrocardiogram has expanded from simple heart rate and essential rhythm monitoring to interpreting complex arrhythmias, myocardial infarction, and other ECG abnormalities. The rapid detection of myocardial infarction has substantially reduced the door-to-balloon time for reperfusion therapy."
+ Sattar Y, Chhabra L. Electrocardiogram. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549803/
Prediction of Postoperative Pulmonary Complications in Patients Who Had Undergone CABG Surgery
+ Erik HJ Hulzebos, Nico LU Van Meeteren, Rob A De Bie, Pieter C Dagnelie, Paul JM Helders, Prediction of Postoperative Pulmonary Complications on the Basis of Preoperative Risk Factors in Patients Who Had Undergone Coronary Artery Bypass Graft Surgery, Physical Therapy, Volume 83, Issue 1, 1 January 2003, Pages 8–16, https://doi.org/10.1093/ptj/83.1.8