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Peripartum Cardiomyopathy (PT Evaluation (Functional Mobility (Gait…
Peripartum Cardiomyopathy
ICF
Environmental Factors
Lives with husband and children/infant
1 step to enter with no rails, 12 steps to second floor w/1 rail on right
2 Story House with bed/bath upstairs
Personal Factors
34 y.o female
Stay at home mom, currently unable to work
Stress (family, medical hx, children)
Anxiety/depression
High BMI
Smoker
Activity of Limitations
Fatigue with ADL's
SOB with ambulation
Fatigue with stair negotiation
Difficulty sleeping
Difficulty showering
Restriction in Participation
Unable to care for her family and newborn baby
Unable to practice yoga
Unable to work
Unable to perform household chores
Body Function/Structure
Swelling of the ankles and jugular veins
Angina
Palpitations
Weakness
Medical Management
Medication
Beta blockers/ACE Inhibitors
Statins
Blood thinners
Diuretics
Anticoagulants
Digitalis
Milrinone Infusions
Surgery
Heart Transplant
Placed on the donor list, increase wait time due to blood type and body habitus
Risk of Infection, organ rejection, blood clots
Implanted Devices
Pacemaker
LVAD*
Benefits
Improves Organ Function
Better QOL
Increase Cardiac Output
Internal and external components
External pump and power source sits on/next to your heart’s left ventricle
Internal mechanism takes blood from the left ventricle to the pump, then from the pump to the aorta via a connecting tube.
Delivers oxygen-rich blood throughout the body, keeping up with a continuous flow
No palpable heart beat, BP, EKG reading, pulse oximeter reading.
Contraindications
MRI
Avoid getting system wet
Chest compressions
CABG
Diagnostic Testing
Auscultation of the lungs and heart
Echocardiogram
Kidney, liver, thyroid function tests
Chest X-ray
Enlarged heart expected
Pulmonary Edema
BNP
Endomyocardial Biopsy
Diagnostic Criteria:
2) Ejection fraction (EF) less than 45%
3) No other cause for heart failure w/ reduced EF found
1) Heart failure develops in the last month of pregnancy or within 5 months of delivery.
Classification by the New York Heart Association
Class II - Mild symptoms/effect on function or symptoms only with extreme exertion
Class III - Symptoms with minimal exertion
Class I - Disease with no symptoms
Class IV - Symptoms at rest**
Pathophysiology
Heart chamber enlarges and muscles of the heart weaken
Decreased ejection fraction of blood from the left ventricle
Fluid back up leading to increased preload
Increased blood in periphery
Increased vascular resistance
Blood pressure increases
Deoxygenated blood remains in peripheral tissues
Tissue Ischemia, Muscle Atrophy
Vital organs in the body do not receive enough oxygen/nutrients, and the body's wastes are removed slowly. Vital systems can begin to break down.
Hepatic
Pancreatic
Pulmonary
Neural
Renal
Risk Factors
Women older than 30
Obesity
History of cardiac issues
African-American descent
Preeclampsia
Multiple pregnancies
Smoking
Alcoholism
Poor nourishment
PT Evaluation
Sensation
MMT
Pain scale
ROM
Peripheral pulses
6 MTW/Gait Analysis
Vital signs (pre&post)
Postural Screen
Functional Mobility
Gait training
Balance
Stair training
PHASE II CARDIAC REHAB
Auscultation of lungs and heart
PT Intervention
Education
Check/preserve incision site
Hydration
LVAD Management: self-test/maintenance
Family Education
Symptoms of overexertion
Abdominal Precautions
Psychosocial Support
Functional Mobility Training
Cardiovascular Endurance training: treadmill, stationary bike
Signs of intolerance
RPE
Doppler Reading- arterial blood pressure
Patient Report
Light resistance strengthening
HEP
Walking Program
Relaxation Techniques
Muscle ache/pain reducing exercises
Scar mobilization
Muscle endurance
Breathing techniques
