2. CARDIO CONDITION/AX/REHAB Flashcards by Jewel Jace

Common signs and symptoms of patient with heart disease

Angina- always accompanied by (+) Levine sign(when the patient makes a fist over the sternum
Referred pain-jaw, neck, upper traps, chest area, shoulders, (L) arm
Palpitations
Dyspnea
Cardiac Syncope
cyanosis
Fatigue

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What is the pattern of the referred pain on a heart disease?

it will always follow the ulnar nerve distribution

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What is the response of the unstable angina to rest and nitrates?

(-) rest response
(-) nitrates response

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What is the innervation of the heart?

C3-T4

referred pain are felt in these dermatomal areas

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Types of Angina

Chronic stable angina AKA predictable angina
Unstable angina aka pre-infarction angina, progressive angina, crescendo angina
Nocturnal Angina

4.Prinzmetal Angina AKA variant angina

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Other term for chronic stable angina

Predictable angina

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This stable angina is secondary to ____

Physical exertion
Emotional stress

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The chronic stable angina responds to or is relieved by ____

rest and nitrates

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The chronic stable angina is secondary to ____

Physical exertion
Emotional stress

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The chronic stable angina responds to or is relieved by ____

rest and nitrates

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What is the mode of administration of nitrates

sublingual

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what is the maximum tablets a patient can take?

3 tablets

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What is the interval of the administration of nitrates?

every 5 mins

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What is the effect of nitrates?

vasodilation

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What is the interval of the administration of nitrates?

1 tablet every 5 mins

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What is the effect of nitrates?

vasodilation

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Patients who took nitrates are prone to ____

orthostatic hypotension due to the vasodilation of the blood vessels

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Patients who took nitrates are prone to ____

orthostatic hypotension due to the vasodilation of the blood vessels therefore rest the pt for 5-10 mins upon taking nitrates

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Other terms for unstable angina

Pre-infarction angina

Progressive angina

Crescendo Angina

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This type of angina is contraindicated to exercise

unstable angina

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What is the normal duration of unstable angina

20-30 mins

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What is the normal duration of unstable angina

20-30 mins

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This type of angina is triggered by exertion caused by dreams

nocturnal angina

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Nocturnal angina is common in what condition?

Congestive Heart Failure(CHF)

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What artery is affected in prinzmetal angina ?

Coronary artery

What artery is affected in prinzmetal angina? what happens to the artery?

Coronary artery spasm

The prinzmetal angian is common in what demographic?

F>M

This type of angina is the only type of angina that is purely vasospasm

Prinzmetal angina

This is excessive heart beat

Palpitations or arrhythmias

This is the bluish discoloration of the lips, toes, & nailbeds

cyanosis

This is also known as ischemic heart disease

CAD or coronary artery disease

This condition is secondary to atherosclerosis affecting the entire coronary artery

CAD or coronary artery disease

What is the effect of nicotine in veins

vasoconstrictors

What does the nicotine stimulates?

fibrinogen

This is clotting factor #1

fibrinogen

How many clotting factors are there?

13 but clotting factor 6 does not exist

An activated fibrinogen will activate to what? this signifies what?

Fibrin, this is the start of the clot formation

Fibrinogen is activated through what?

physical trauma

suffixes of medicines to control high blood pressure

-olol & -ipine

suffixes of medicines to control high cholesterol

-statin

What demographics is atherosclerosis common in?

>65y/o M>F *menopause: M=F due to decrease of estrogen african american

which female hormone stimulates the LDL receptor?

Estrogen

what is the bad cholesterol?

Low density lipoprotein *masama pag mababa good pag mataas

Other term for myocardial infarction

Heart attack or Coronary occlusion

This is the death of myocardium

Myocardial infarction

Measurement in ECG which determines the true myocardial infarction

ST segment elevation & increase in the cardiac enzymes

Other term fo r congestive heart failure

Cardiac decompensation

This is the inability of ventricle to contract effectively

Congestive heart failure AKA Cardiac decompensation

This is the most serious complication of the myocardial infarction

Congestive heart failure

2 types of congestive heart failure

1. right sided heart failure 2. Left sided heart failure

this is the inability of the right ventricle to contract effectively

Right sided heart failure

Common symptom of patients with right sided heart failure

congestion in the periphery and the organs Bipedal edema Ascites ( due to the accumulation of fluids in the abdomen) Hepatomegaly Distension of the jugular veins cyanosis

Heart condition where there is only one sided LE edema

PAD

Common symptom of patients with left sided heart failure

pulmonary edema cough dyspnea orthopnea (difficulty breathing in a supine position) PND (paroxysmal nocturnal dyspnea) cerebral hypoxia (due to decreased oxygenated blood distributed) fatigue (ramdam sa lahat ng heart disease pero mas ramdam sa left sided heart failure)

Manifestation of right sided heart failure is found where?

in the system

Manifestation of left sided heart failure is found where?

lungs

Functional classifications of patients with diseases of the heart Class with no limitation of physical activity

Class 1

Functional classifications of patients with diseases of the heart In class 1, the ordinary physical activity does not cause which signs & symptoms?

angina, palpitation, dyspnea, & fatigue

Functional classifications of patients with diseases of the heart Maximum METS for class1

6.5METS

Functional classifications of patients with diseases of the heart Class with slight limitation of physical activity

Class 2

Functional classifications of patients with diseases of the heart In class 2, the ordinary physical activity causes ___

anginal pain, palpitation, dyspnea, fatigue

Functional classifications of patients with diseases of the heart Maximum METS for Class 2

4.5 METS

Functional classifications of patients with diseases of the heart Class with Marked limitation of physical activity

Class 3

Functional classifications of patients with diseases of the heart In class3, less than the ordinary physical activity results in what?

Anginal pain, palpitations, dyspnea, & fatigue

Functional classifications of patients with diseases of the heart maximum METS in class 3

3.0 METS

Functional classifications of patients with diseases of the heart Class with inability to carry on any physical activity without discomfort

Class4

Functional classifications of patients with diseases of the heart What symptoms are present in class 4

(+) symptoms of cardiac insufficiency & anginal pain even at rest increases discomfort during physical activity

Functional classifications of patients with diseases of the heart maximum METS in class 4

1.5 METS

This is the inflammation of the pericardium secondary to bacterial/ viral agent

pericarditis

Aggravating factor to mimic chest pain in pericarditis is ____

Trunk movements (esp. side to side)

Relieving factor to chest pain in pericarditis is ____

Leaning forward or leaning on all 4's

3 possible reasons for congenital anomalies

hereditary shunts are not closing mother: (+) German Measles

A heart condition with a defect on the interatrial septum

Atrial septal defect

shunt of atrial septal defect

left to right shunt

Atrial septal defect: cyanosis or acyanosis

acyanosis

A heart condition with a defect on the interventricular septum

Ventricular septal defect

shunt of ventricular septal defect

left to right shunt

ventricular septal defect: cyanosis or acyanosis

acyanosis

This is the construction of proximal and distal aorta

coarctation of the aorta

What is the manifestation of coarctation of the aorta

increased BP in the UE

Condition where there is still a connection between the pulmonary artery and aorta

Patent Ductus Arteriosus

This structure connects the pulmonary artery to the aorta during the fetal stages

ductus arteriosus

shunt of blood in Patent Ductus Arteriosus

left to right shunt

Patent Ductus Arteriosus: cyanosis or acyanosis

acyanosis

4 defects of Tetralogy of Fallot

P-Pulmonary artery stenosis A- Overriding of aorta R- Right ventricular hypertrophy AKA cor pulmonale I- Interventricular septal defect

This condition is the true blue baby

tetralogy of fallot

shunt in tetralogy of fallot

Right to left

This is the inability of the valves to open fully

stenosis (description in exams is usually "blood passes with difficulty")

this is the inability of the valves to fully close

insufficiency/ regugitation (description in exams is usually "there is backflow of blood")

This is the excessive bulging of the cusp of the valve

prolapse

This condition is secondary to the weakness of the cusp of valve

prolapse

Most common valve affected in prolapse

mitral/ bicuspid valve

Other terms for prolapse if mitral valve is affected

Mitral valve prolapse barlows syndrome floppy valve syndrome Click murmur syndrome

Cardiac Enzymes that increases during heart attack

SGOT- Serum glutamic-oxalo acetic transaminase CPK- Creatinine Phosphokinase CK-MB- Creatine Kinase Myocardial Band LDH- Lactate dehydrogenase

When is the peak of Serum glutamic-oxalo acetic transaminase

24-48hrs

Peak of Creatinine Phosphokinase

24 hrs

Peak of Creatine Kinase Myocardial Band

12-24hrs

Peak of Lactate dehydrogenase

3-6 days

The first cardiac enzyme to rise during a heart attack is ______

CK-MB- Creatine Kinase Myocardial Band

This diagnostic tool is to assess the size of the heart

chest x-ray

This diagnostic tool is for the movements of the walls and the valves of the heart

echocardiogram

Other name for thallium stress test

Nuclear stress test

This diagnostic tool using a treadmill with an injecting of a radioactive agent (thallium) at the peak of the exercise

thallium stress test

In the thallium stress test, where does the thallium attach to?

it attaches to the normal tissues (tissues with blood supply)

This diagnostic tool involves an insertion of the catheter via the femoral artery

Cardiac catherization

In the Cardiac catherization, in what artery is the catheter inserted?

femoral artery

Other term for the Central line

Swan Ganz catheter

This diagnostic tool measures the pressure inside the heart

Swan ganz catheter/ central line

this is the insertion of a ballooning tip catheter

percutaneous transluminal coronary angioplasty

Cardiac intervention using a Wire pliable mesh to keep the lumen of the blood vessel open

Intravascular stent (IV stent)

Blood vessels in Coronary artery bypass graft (CABG) used as a bypass

great saphenous vein Internal mammary artery (IMA) Internal thoracic artery (ITA) Radial artery

most common blood vessel used in Coronary artery bypass graft (CABG) as a bypass

great saphenous vein

least common blood vessel used in Coronary artery bypass graft (CABG) as a bypass

radial artery

(Braddom) Terms used for phase 1 of cardiac rehab

Acute phase or in patient

(Braddom) phase to prevent deformities and complications Family education

Phase 1: Acute phase or in patien

(Braddom) discharge METS for phase 1

5 METS

(Braddom) Terms used for phase 2 of cardiac rehab

convalescent phase/transitional phase

Braddom) phase to promote a strong scar formation

Phase 2:convalescent phase/transitional phase

(Braddom) activities done for phase 2 patients

walking bicycling

(Braddom) discharge METS for phase 2

9METS

(Braddom) Other term used for phase 3

Training/ out patient

(Braddom) This is the most vigorous phase in the cardiac rehab

Phase 3: training/ outpatient

(Braddom) activities done for phase 3 patients

stretching aerobics plyometrics calisthenics

(Braddom) phase which is the most important cardiac rehab for the life long routine of the patient

phase 4: maintenance

(Sullivan) goal of phase 1: in patient

prepare the pt for discharge ecg/ vital signs monitoring

(Sullivan) What is the phase 1 level 1METS and activities?

1-1.5 METS arm support for every meal Bed exercises

(Sullivan) What is the phase 1 level 2 METS and activities?

1.5-2 METS (SLRC) Sitting Leg exercises Reclining upright chair commode privileges

(Sullivan) What is the phase 1 level 3 METS and activities?

2-2.5METS bathroom privileges Room/hall ambulation for 5mins

(Sullivan) What is the phase 1 level 4 METS and activities?

2.5-3METS trunk exercises room/hall ambulation 5-7mins

(Sullivan) What is the phase 1 level 5 METS and activities?

3-4METS Arm exercise Room/hall ambulation 8-10mins

(Sullivan) What is the phase 1 level 6 METS and activities?

4-5METS progressive ambulation

(Sullivan) Phase with actual exercise traiing program

Phase 2 outpatient

(Sullivan) Target heart rate karvonens formula

60 to 80% (HRmax-HRrest) +HRrest

(Sullivan) HRmax formula (if not given)

220-age

(Sullivan) phase with endurance training and life/risk modifications continues

Phase 3 maintenance

Criteria for terminating exercise

1. unstable angina 2. active pericarditis 3. Acute systemic illness (fever) 4. Resting BP 200/100mmHg 5. Recent embolism 6. Uncontrolled DM 7. Uncontrolled arrhythmias (palpitations) 8. 2nd to 3rd degree heart block 9. ST segment displacement >= 2mm 10. increase diastolic blood pressure

Degree of heart block with prolonged PR interval

1st degree heart block

Degree of heart block with progressive lengthening of the PR interval

2nd degree heart block

Degree of heart block with absence of QRS complex

3rd degree heart block

reaction of systolic and diastolic BP as exercise intensity increases

systolic BP increases Diastolic BP remains the same

reaction of systolic and diastolic BP as exercise intensity decreases

systolic BP decreases Diastolic BP remains the same

What are the early warning signs of heart attack?

Shortness of breath, confused, fatigue

What comorbidity is prone ot silent ischemia?

diabetes

What is attached to the patient post MI with DM during exercise

ECG

What is the best initial exercise for patients post MI with claudication and CHF

Walking 10-15 mins daily

What are the conditions to giving resistive training to patients post MI

>= 5METS no angina