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PTA 230 Final > 16. Cardiology > Flashcards

16. Cardiology Flashcards

1
Q

Abnormal heart sounds:
___ is heard in early diastole associated with ___.

___ is heard in late diastole associated with _____ or _______.

A

S3; CHF

S4; MI; Hypertension

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2
Q

When should blood pressure be taken when exercising a patient aerobically? What position?

A
  • Before and immediately after exercise

- In the same position from the same arm

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3
Q

Ambulatory Goals:
- Patients should increase the frequency and time of their walks at a comfortable leisurely pace. Progress walk times up to 10 minutes as tolerated.

A

Phase 1 - Inpatient (Level 4-6)

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4
Q

Pain in…

  • Left Jaw
  • Left/Right Chest
  • Left Medial Extremity
  • Right Medial Arm (to elbow)
  • Bilateral Back (between scapula)
A

Distribution of Pain in Myocardial Ischemia (MI)

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5
Q

_____ influences the heart and blood vessels through direct neural and indirect neurohormonal mechanisms.
_____ receptors of the heart are primarily beta-adrenergic receptors on the ___ ___. This will increase the HR and force of heart contraction with concomitant vasodilation of the coronary arteries.
_____ ______ to the blood vessels causes vasoconstriction.
_____ ______ will cause similar and more lasting results than the sympathetic stimuli.
Drugs that mimic the sympathetic system include ______, ______, and _____. The first two increase _____ _____. The later increases ____.
__________ are used to counteract sympathetic stim. Beta-blockers for HTN.

A 
ANS
Sympathetic; SA Node
Sympathetic stimulation
Adrenal Cortex
Dopamine; Epinephrine; Atropine 
Cardiac Output (CO); HR
Sympatholytics
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6
Q

What patient condition(s) are more likely at risk of dehiscence (burst open) of incision after CABG? (4)

A

COPD
Diabetes
Obesity
Pendulous Breast

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7
Q

What is indicated to rule out the potential for brachial plexus injuries in a S/p CABG?

A

Examination of sensory/motor

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8
Q

For each ____ increment of maximal HR, the systolic BP should increase ___ - ____ ____. Higher incremental increases in systolic BP with increasing workloads are representative of a _______ exercise response.

A

10%; 12-15 mmhg;hypertensive

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9
Q

What is the formula for Rate Pressure Product (RPP)? What is it also known as?

A

RPP = HR x SPB

- RPP = MVO2

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10
Q

How is CHF viewed?

A

Radiography

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11
Q

3 types
_____; when it occurs during exercise or activity.
_____: at rest, pre-infarction
_____; (Prinzmetal) vasospasm. Will respond to ____ (short term) or _____ ______ long term.

A

Stable Angina
Unstable Angina
Variant Angina; NTG; Beta Blocker (Calcium Channel Blocker)

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12
Q

When are Bronchopulmonary hygience procedures (vibration and percussions) contraindicated?

A

When valvular dysfunction is present due to infections that create vegetations and blood clots. (blood clots that sit on the valves may become dislodged)

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13
Q

______ ______ causes less blood to be pumped from the ______, the ______ have less blood to work with which leads to failure. Therapist should monitor _____ and _____ levels to see _______ function.

A

Heart Failure; heart; kidneys

BUN; Creatinine; kidney

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14
Q

Ambulation: Borg RPE

- Gradually increase their ambulation. Use time instead of distance.

A

Phase 1 - Inpatient (Level 3)

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15
Q

Activity guideline: guide pt/family through indicated and contraindicated exercises including rest and leisure.

Self monitoring

  • Teach them how to monitor pulse and use RPE.
  • Symptom recognition and response
  • Nutrition. Decrease fat intake, monitor salt and fluid intake
  • Medications. (Be careful of cold, sinus, allergy or anti-inflammatory meds because of interactions with prescription meds.)
  • Lifestyle issues: Resumption of sexual activity can be a concern. May need a prophylactic NTG before sexual activity.
A

Education for pt with Heart Disease

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16
Q
  • Begin with elastic bands, 12 – 15 reps
  • Exercise large mm. groups before small
  • Stress exhalation with exertion
  • Avoid a sustained tight grip
  • Focusing on the Borg RPE 11 – 13.
  • Using slow, controlled movements
  • Stop exercise with uncomfortable signs and symptoms
A

Strength Training for S/p MI or CABG

17
Q
  • Beta-blockers (decrease sympathetic activity)
  • Calcium-channel blocker (decrease workload of the heart and prevent coronary artery spasms)
  • Nitrates (potent vasodilators)
    Are what type of drugs?
  • ACE inhibitors
    Are what type of drugs?
A
  • Anti-Ischemic

- Afterload reducers

18
Q

What does an EKG look like during a MI (Myocardial Infarction)?

A

ST segment elevation

19
Q

What does an EKG look like during a Reversable Cardiac Ischemia (myocardial ischemia)?

A

ST segment Depression

20
Q

OOB: Monitor vitals, use BORG.

  • Look for orthostatic hypotension (Supine to sit)
  • Support feet on a stool to control swelling (Sitting EOB)
  • Sit upright in a chair for 30 minutes, a few times per day.
  • LE exercises; ankle pumps, knee extensions, marching in place.
A

Phase 1 - Inpatient (Level 2)

21
Q

• Failure of the systolic pressure to rise as exercise continues
• A hypertensive BP response, including a systolic pressure of greater than 200 mm Hg and/or a diastolic pressure greater than 110 mm Hg
• A progressive fall in systolic pressure of 10–15 mm Hg
• A significant change in cardiac rhythm detected either by palpation or by ECG monitoring (e.g., arrhythmias, ST-T wave changes).
These symptoms during aerobic exercise mean…

A

Terminate Exercise

22
Q

• Moderately severe or increasing angina
• Marked dyspnea
• Dizziness, light-headedness, or ataxia
• Cyanosis or pallor
• Excessive fatigue
• Leg cramps or claudication
These symptoms during aerobic exercise mean…

A

Terminate Exercise

23
Q

Normal heart sounds:

S1 = \_\_\_ (and \_\_\_\_) valve closing.
S2 = \_\_\_ (and \_\_\_\_) valve closing
A

Mitral; Tricupid

Aortic; Pulmonic

24
Q

What are the sternal precautions for S/p CAGB? (2)

A
  • When pushing up from a chair with a sit-to-stand transfer (separation greatest)
  • Splint with a pillow when laughing, coughing or sneezing
25
Q

Regular exercise may improve functional status, quality of life and exercise capacity and decrease symptoms:
- Can speak without signs of dyspnea, RR less than 30 b/min
- Less than moderate fatigue
- RHR less than 120 bpm
- Crackles in less than one half of the lungs
3 times per week for 60 minutes.
Diaphragmatic breathing exercise
- Activity pacing
- Frequent rests
- Timing of activities
- Plan ahead to see if you need to avoid activities
- Alternate easy and difficult tasks with rest intervals.
- Adjust the environment to make it easier.

A

Congestive Heart Failure: Interventions

26
Q
  • Fatigue, dyspnea, edema, fluid weight gain, S3 heart sound and renal dysfunction.
  • Pulmonary edema may be evident on - chest x-ray or auscultation of adventious sounds.
  • Peripheral edema noted with pitting edema.
  • S3 Heart sound.
  • Dyspnea
  • Orthopnea
  • Early onset muscle fatigue (could be from sleep apnea)
A

Congestive Heart Failure (Signs and Symptoms)

27
Q

As with HR, a linear increase in ______ _____ is expected with increasing levels of work.

A

Systolic BP

28
Q

Within Phase 2: Outpatient S/p Resistance training should not begin until the patient has been in a cardiac rehab program for at least ______ and is at least ______ post MI or ____ post ____.

A

3 weeks; 5 weeks; 8 weeks; CABG

29
Q
  • For the next 4 – 6 weeks, patient goes home.
  • Patient needs to keep moving and change position at least once every two hours during the day.
  • Should walk 20 – 30 minutes one to two time per day for the next 4 – 6 weeks after MI.
  • May need to walk indoors with foul weather. (below 40 degree, over 80 degrees, high humidity or poor air quality)
A

HEP for S/p MI

30
Q

Is it contraindicated to exercise a patient with a new angioplasty?

A

No, but best to wait 1-2 weeks (low intensity only)

31
Q
  • Objective activity date, including time period and distance ambulated
  • Type of sitting and standing exercises, and stair climbing (number of steps); number and duration of rests.
  • Patient’s vital sign response to each activity; including a statement that addresses patient performance with respect to vital signs (e.g. “Patient ambulated 6 minutes covering 500 ft and climbed 10 steps foot over foot using handrail with adaptive VS response without signs or symptoms of hemodynamic compromise”)
  • Education provided and response of patient, family and caregivers.
A

Documentation for S/p MI

32
Q

After an MI, ________ with _____ (need more than ____ occlusion).

A

Angioplasty; stents; 70%

33
Q
  • Patients given sx-limited maximal stress test (ETT) at 4 – 6 weeks s/p MI.
  • If patient is free of ischemia (-); prescription is 70 – 85% Max HR of peak achieved on the test. *Although 65% - 80% would also be effective.
  • If positive ischemia (+), you will need to keep the Max VO2 below the patient’s ischemic MVO2.
  • Clinical MVO2 = HR X SBP and is known as RPP (rate pressure product). (RPP = HR X SBP) For example; if a patient has an HR of 100 bpm and a BP of 140/80 mm Hg while exercising on the treadmill, and an HR of 100 bpm and a BP of 160/80 mmHg while exercising on the stationary bicycle, the bicycle is costing the myocardium more energy than the treadmill, even though the HR is the same. It is possible that angina may occur on the bicycle, but not on the treadmill.
  • A good safety tip is not to exceed 90% of the ischemic RPP.
A

Phase 2 - Outpatient

34
Q

Left-sided heart failure occurs with ___ insult. Fluid will back up into the ___ and lungs. Patient will have ____ and _____.
Right-sided heart failure occurs with insult to the ___. Usually from conditions that elevate ______ ______ pressure. (* See jugular venous distention and peripheral edema)
Bi-ventricular failure. Caused from severe _____ _____ heart failure.

A

LV; LA
SOB; Coughing
RV;PA
Left Sided

35
Q

Which phase and level should we observe in Rehab for MI…
ICU:
- Cannot begin until 24 hours after patient is stable.
- Cardiac enzymes should be returning to normal. Should be on beta-blockers.
- Monitor vital signs before and after (even during) activity. Borg Scale; should be “fairly light”
- Activity during the first 24 hours should include: ankle pumps, deep-breathing, using a commode if possible. Use Borg Scale.

A

Phase 1 - Inpatient (Level 1)

36
Q

Systole occurs between ___ and ___. (Ventricular Ejection)

Diastole occurs between ____ and ____. (Ventricular Filling)

A

S1 “Lub” ; S2 “Dub”

S2 : S1

PTA 230 Final (8 decks)

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