Cardiac Investigations

Transthoracic Echocardiogram (TTE) is a non-invasive procedure which uses ultrasound wave to scan the heart

• True

• False

Transthoracic Echocardiogram's (TTE) and Transoesophageal Echocardiogram's (TEE) are used to give you information about the electrical activity of the heart

• True

• False

A TTE is performed for a patient for the first time. The report states they have a Regional Wall Motion Abnormality (RWMA). As an OT you should...

(Multiple Correct Answers)

• Hold off mobility & exertion while awaiting on subsequent medical plan

• Hold off all therapy while awaiting CVM review

• Proceed with cognitive assessment, education on activity precaution and energy conservation strategies
  
  

• Proceed with therapy as per normal
  

Cardiac Valves Regurgitation occurs when there is incomplete closure of valve, leading to retrograde flow of blood to previous heart chamber. In severe cases patient may undergo valve replacements.

With this group of patients, during OT session we should...

(Multiple Correct Answers)

• Educate on energy conservation to prevent heart strain

• Hold off therapy as patients cannot exert themselves at all

• OT PRN as PTs will educate patients on any activity restrictions they may need to comply with

• Educate on reduced activity tolerance and energy conservation

Pericardial effusions are accumulation of fluid in the pericardial space. Significant pericardial effusion can compress the heart, affecting its ability to fill and pump blood effectively.

If a patient has a mild pericardial effusion, during therapy we should...

• Hold off therapy while pending decision for intervention

• Hold off therapy while awaiting CVM review

• Apply activity precautions

• Continue therapy as per normal

What are some potential medical treatments for the presence of a Thrombus/Vegetations, and their associated implications for OTs?

(Multiple correct answers)

• Antibiotics

  Monitor for symptoms of reduced cardiac output and apply activity precautions

• IV heparin

  Hold off therapy for the first 24 hours to reduce risk of clot dislodging. Continue therapy when INR is within therapeutic range 

• Oral anticoagulant/ antiplatelet

  Continue therapy once initiated. Monitor for Hb drop due to increased risk of bleeding

• Thrombolysis/

  Thrombectomy

  Hold off therapy and continue therapy once procedure done. Afterwards, Monitor for symptoms of reduced cardiac output and apply activity precautions

12-lead ECG, Holter and Telemetry all monitor the electrical activity of the heart

• True

• False

The WH Telemetry screen will give you information regarding heart rate, PVCs and wave forms. If no other information is given in the patient's medical notes, you should hold off therapy when you see which of the following on the telemetry screen...

(Multiple correct answers)

• Persistent HR > 120

• PVC ≥ 5

• SpO2 < 88%

• PVC < 3

Atrioventricular (AV) blocks reflect either a delay or an interruption of impulse transmission from the atria to the ventricles resulting in delayed/reduced ventricular contraction. This can result in reduced cardiac output.

Which of the following statements are true:

(Multiple correct answers)

• You need to hold off therapy whenever you see AV Blocks in a medical report

• In 3rd degree complete AV block, no impulses from the atria reaches the ventricles

• AV block can result in a patient requiring a PPM

• In 2nd degree AV block (Type 1) and 3rd degree AV block you should hold off therapy and trace medical intervention plans

Avoiding overhead reaching, heavy lifting >10kg, driving and valsalva manoeuvre are all cardiac activity precautions that aim to reduce the strain on the heart. When educating patients on cardiac activity precautions we should always give examples that patients can apply in their everyday life.

Which of the following are examples of valsalva manoeuvre's that you should avoid?

(Multiple Correct Answers)

• Restrict ingyour sneeze

• Holding your breath during exertion

• Straining while opening bowels

• Hold the overhead railing on the bus