2. CARDIO CONDITION/AX/REHAB Flashcards
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
What is the pattern of the referred pain on a heart disease?
it will always follow the ulnar nerve distribution
What is the response of the unstable angina to rest and nitrates?
(-) rest response
(-) nitrates response
What is the innervation of the heart?
C3-T4
referred pain are felt in these dermatomal areas
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
Other term for chronic stable angina
Predictable angina
This stable angina is secondary to ____
- Physical exertion
- Emotional stress
The chronic stable angina responds to or is relieved by ____
rest and nitrates
The chronic stable angina is secondary to ____
- Physical exertion
- Emotional stress
The chronic stable angina responds to or is relieved by ____
rest and nitrates
What is the mode of administration of nitrates
sublingual
what is the maximum tablets a patient can take?
3 tablets
What is the interval of the administration of nitrates?
every 5 mins
What is the effect of nitrates?
vasodilation
What is the interval of the administration of nitrates?
1 tablet every 5 mins
What is the effect of nitrates?
vasodilation
Patients who took nitrates are prone to ____
orthostatic hypotension due to the vasodilation of the blood vessels
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
Other terms for unstable angina
Pre-infarction angina
Progressive angina
Crescendo Angina
This type of angina is contraindicated to exercise
unstable angina
What is the normal duration of unstable angina
20-30 mins
What is the normal duration of unstable angina
20-30 mins
This type of angina is triggered by exertion caused by dreams
nocturnal angina
Nocturnal angina is common in what condition?
Congestive Heart Failure(CHF)
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
- right sided heart failure
- 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
- unstable angina
- active pericarditis
- Acute systemic illness (fever)
- Resting BP 200/100mmHg
- Recent embolism
- Uncontrolled DM
- Uncontrolled arrhythmias (palpitations)
- 2nd to 3rd degree heart block
- ST segment displacement >= 2mm
- 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