Hypertension is a condition in which the force of blood against artery walls is consistently too high.
Special considerations with hypertension
Each 20 mmHg increase in systolic & 10 mmHg increase in diastolic doubles the risk of cardiac disease for those aged 40-70.
Modifiable risk factors for hypertension are: tobacco use, non-insulin dependent diabetes, high cholesterol, alcoholism, obesity, sedentary lifestyle, stress, and poor nutrition
Non-modifiable risk factors for hypertension are: African American ethnicity, >60 years old, postmenopausal status, family history of cardiovascular disease
Signs & symptoms of hypertension are: occipital headache, vertigo, flushed face, epistaxis, visual changes, and nocturnal urinary frequency
Blood pressure values at rest:
Normal: less than 120/80
Elevated: 120-129 and 80
Stage 1 Hypertension: 130-139 or 80-89
Stage 2 Hypertension: 140-149 or 90-99
Hypertensive Crisis: Higher than 180 and/or higher than 120
PTA implication for initiating therapy for hypertensive individuals:
Normal: No intervention changes
Pre HTN: Ok to initiate therapy. Monitor for signs/symptoms with exercise.
Stage1: Do not start therapy. Refer patient back to supervising physical therapist and/or primary care physician
Stage 2: Do not start therapy. Refer patient back to supervising physical therapist and/or primary care physician
Hypertensive crisis: Medical emergency- call 911
Orthostatic hypotension
Symptoms of orthostatic hypotension
Lightheadedness
Dizziness
Fainting
Pallor
Blurred vision
Lack of concentration
Cold, clammy skin
PTA interventions for orthostatic hypotension
Acute orthostatic hypotension
Patient should be returned to previous position in which they did not have symptoms
Patients blood pressure should be checked 1 minute after return to previous position
Chronic orthostatic hypotension
Use of abdominal binder to assist with increasing intra-abdominal pressure and thus increased blood pressure
Use of compression socks to bilateral lower extremities to assist with increasing peripheral pressure and thus increase blood pressure
Use of tilt table
Typically used for patients with symptomology becoming present with small positional changes (i.e. become dizzy when head of bed elevated)
Head injuries are contraindicated for use of tilt table
Use of medication- Midodrine
Medication is used to assist with increasing blood pressure for those with chronic orthostatic hypotension as noted in spinal cord injury (used when all other modalities listed above do not work to resolve symptoms)
POTS
Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia characterized by an abnormal increase in heart rate upon standing. It affects the autonomic nervous system, leading to poor regulation of blood flow and heart rate.
Mechanism of POTS
When standing
Gravity pulls blood into the lower body.
Normally, the body responds by:
Constricting blood vessels
Increasing heart rate slightly
This maintains stable blood pressure and brain perfusion.
Symptoms of POTS
Dizziness or lightheadedness
Shortness of breath
Palpitations (racing heartbeat)
Fatigue and exercise intolerance
Brain fog or poor concentration
Nausea and headaches
Difficulty concentrating
Fainting or near-fainting
Purple hands/feet (dependent cyanosis)
Sleep disturbances
Causes and risk factors of POTS
Impaired autonomic nervous system
Overactive sympathetic response
Small fiber neuropathy
Low blood volume (hypovolemia)
Poor venous return
PTA management of POTS
Begin with recumbent or semi-recumbent exercises:
Recumbent cycling
Rowing machine
Swimming or water aerobics
Supine resistance exercises
Progress to upright activities as tolerated:
Seated to standing transitions
Walking programs
Focus on building lower extremity muscle tone to improve venous return.
Angina pectoris
Symptoms of angina
Crushing, pressing sternal ache
Shortness of breath
Fatigue
Diaphoresis
Generalized weakness
Syncope
Nausea/vomiting
Types of angina
Stable: symptoms occur with exertion and typically relieved with rest and/or nitroglycerin
Unstable: chest pain has unpredictable pattern; can occur at rest or with exertion
No relieving factors as pain increases over a period of time and intensifies
Crucial aspects of angina
Angina left untreated will evolve into myocardial infarction
Nitroglycerin when used is taken sublingually and only three (3) can be taken within 15 minutes
If the three are not effective when taken, the patient needs to go to the emergency room as myocardial infarction is likely to have occurred.
Physical therapy assistant clinical considerations for heart failure
Green Zone- Continue with activity and therapy as tolerated
No shortness of breath
No swelling
No weight gain
No chest pain
No change in ability to perform normal activities
Yellow zone- Symptoms need to be reported to physician as adjustments may need to be made to medications
Weight gain of 2-3 lbs in 24 hours
Increased cough
Peripheral edema
Increased in shortness of breath and activity
Orthopnea
Red zone- Symptoms indicate medical emergency
Shortness of breath without exertion
Unrelieved chest pain
Paroxsymal nocturnal dyspnea
Confusion
Weight gain of more than 5 lbs in 3 days
Pericarditis
Causes:
Viral or bacterial infections
Chest injuries
Symptoms:
Fevers
Chills
Weakness
Substernal pain
Cough
Tachycardia
Pain with laughing, coughing, belching, swallowing
Peripheral vascular diseases
Peripheral vascular disease refers to a condition where blood vessels outside of the heart and brain (specifically in the limbs and organs) are affected by narrowing, blocking, or spasms, which reduces blood flow. There are two types: arterial and venous insufficiency
