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Cardiopulmonary I > Abnormal CV patient physiology > Flashcards

Abnormal CV patient physiology Flashcards

1
Q

concerning vitals in a CVP patient:
– HR
– BP
– SpO2

A

– < 50 or > 120 at rest ; uncontrolled/new arrhythmia
– > 180/90, < 90/60, MAP < 60
– < 90% at rest ; acute change in O2 demand/device

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2
Q

what could cause bradycardia in your patient?

A

heart block
adverse drug reaction
metabolic dysfunction
post surgery
medications
myocarditis
lab abnormalities
abnormal breathing patterns

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3
Q

what could cause tachycardia in your patient?

A

medications
anemia
hypotension
infection
anxiety/fear
ETOH use
pain
substance abuse

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4
Q

what are two things that could cause HR to go too high or too low?

A

ischemia to SA node
decrease in myocardial contractility

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5
Q

true or false. there ARE some normal conditions where HR dropping with increased workload is normal.

A

false - there are NO normal conditions where HR drops with increased workload

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6
Q

the following are all abnormal HR responses to exercise:
– ____ or _____ rate of rise not correlated to inc. workload
– ____ rhythm not present at rest (but present w/ exercise)
– _____ rhythm present at rest

A

– severely exaggerated or minimal
– irregular
– worsening

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7
Q

what is chronotropic incompetence?

A

slow or absent rise in HR with increased workload

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8
Q

what pathology is chronotrophic incompetence most likely associated with? why?

A

patients with CAD
it is a defense mechanism to maintain coronary artery blood flow in presence of CAD
signifies advanced CAD w/ poor prognosis, high morbidity & mortality

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9
Q

what would cause hypotension in a patient?

A

medications
acute blood loss
diastolic dysfunction
bradycardia
shock
position changes
dehydration
arrhythmias

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10
Q

what could cause hypertension in a patient?

A

lifestyle factors
high BMI
smoking
comorbidities
pain
anxiety
substance abuse

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11
Q

abnormal BP is caused by:
1. damaged ventricle will rapidly reach maximal _____
OR
2. rapid increase in ___ + ____

A
  1. SV (lower than it should be)
  2. HR + SV = CO (higher than it should be)
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12
Q

what are the 3 main abnormal SBP responses to exercise?
1. rising response
– > _____ mmHg
2. flat response
– __(does/does not)__ rise in correlation with increased workload
3. falling response
– SBP ______ with increased workload

A

– > 20-30 mmHg
– does NOT
– drops

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13
Q

your patient is not on any anti-HTN medications. You are doing max exercise testing with the patient today and notice SBP < 140 PLUS an SBP drop. what are they at higher risk for?

A

sudden cardiac death

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14
Q

what is an abnormal DBP response to exercise?

A

> 10 mmHg rise or drop with increased workload
any big shift of DBP is concerning

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15
Q

what is an abnormal MAP response to exercise?

A

< 60 – concerned for end organ hypoperfusion

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16
Q

what could cause hypoexmia in a patient?

A

blood loss
hypoventilation
heart or lung disease
infection/sepsis
anemia
pulmonary embolism
sleep apnea

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17
Q

two systemic abnormal responses to exercise:
1. autonomic dysfunction
– ______ HR/BP responses that don’t correlate to workload
2. ineffective redistribution of blood flow to working muscles
– _____ nervous system dysfunction
– inability to adequately ____ or ______

A

– exaggerated
– sympathetic
– vasodilate or vasoconstrict

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18
Q

what is an arrhythmia?

A

abnormality in site of origin of impulse, its rate, regularity or conduction

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19
Q

tachyarrhythmia:
bradyarrhythmia:

A

HR > 100 bpm
HR < 60 bpm

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20
Q

causes of arrhythmias: (7)

A

other areas of the heart contain ectopic foci that are suppressed by the dominant SA node
medications
infection
electrolytes
age
comorbidities
substance abuse

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21
Q

sinus bradycardia:

A

HR < 60 bpm
R intervals farther apart

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22
Q

sinus tachycardia:

A

HR > 100 bpm
R intervals close together

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23
Q

atrial flutter:

A

regular atrial quivering
atrial contracting out of sync with ventricles
** High P wave

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24
Q

atrial fibrillation:

A

lower amplitude, irregular atrial quivering
elimination of atrial kick
absent P wave

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25
unifocal pre-ventricular contraction (PVC):
premature ventricular depolarization ectopic foci in ventricle fires with an impulse generated in Purkinje fibers instead of SA node ** one QRS complex goes down
26
2 simultaneous PVCs is called a ____
couplet
27
multifocal PVC:
PVCs look different --> the electrical activity has different origins More severe electrical conductivity problems Higher cardiac irritability
28
you walk into your patient's room and see a multifocal PVC on their ECG. what is your next course of action? a. treat them b. don't treat c. see them later in the day d. let them decide if they want to participate today
b. don't treat -- absolute contraindication to exercise
29
bigeminy:
PVC every other normal beat
30
trigeminy:
PVC every 3rd normal beat
31
AFib with Rapid Ventricular Response (RVR):
abnormal ventricular response to irregular atrial contractions HR > 120 bpm No P wave w/ more R intervals
32
Supraventricular Tachycardia (SVT):
HR > 150 being set by SA node and not slowed by AV node Absent T wave, Has P wave Short R intervals
33
Ventricular Tachycardia (VTach):
Wide QRS complex tachycardia absent P waves 6 consecutive PVCs no atrial contraction
34
Torsades de Pointes:
specific type of VTach with rotation around an axis of electrical activity caused by hypomagnesia
35
ventricular fibrillation (VFib):
ventricles quiver inconsistently, no true contraction very disorganized electrical activity rapid loss of CO
36
what is the only arrhythmia that is considered a shockable rhythm for AED use?
VFib
37
Asystole:
dead no atrial or ventricular contraction
38
what is atrioventricular heart block? -- where does this occur?
abnormality in the electrical conduction between atria and ventricles -- PR interval --> time between atrial and ventricular contractions
39
first degree AV heart block:
delayed impulse conducted from atria to ventricles prolonged PR interval consistent PR intervals > 0.20 seconds common cause of resting bradycardia --> technically an arrthymia
40
type I 2nd degree heart block = Mobitz I = Wenckebach
PR interval gets progressively longer, then QRS drops atrial impulse gets predictably blocked "skipped beat"
41
Type II 2nd degree heart block = Mobitz II
PR interval is normal/consistent, then QRS drops atrial impulse to ventricle gets unpredictably dropped
42
3rd degree heart block = complete/total HB: -- all atrial impulses are blocked at the ___ node, and none get transmitted to the ventricles -- SA & AV node are conducting electrical impulses in _______ from one another -- __ & ___ intervals are consistent with one another BUT not in coordination with one another -- atria works _____ from ventricles
-- AV -- complete disconnection -- P and R -- isolated --> work fine but not working together
43
what is the most common symptom of 3rd degree heart block? what is the medical treatment for it?
passing out pacemaker
44
troponins: -- correlated to ___ -- cTnT normal value -- cTnI normal value -- troponin ____ more sensitive than troponin ___ -- no exertion until _____
-- cardiac ischemia -- < 0.1 -- < 0.03 -- T ; I -- down trending and stable
45
BNP: (brain naturatic peptide) -- correlated to ___ -- BNP normal value -- BNP value indicative of heart failure -- associated symptoms -- contraindication?
-- myocardial tissue damage from over-stretching -- < 100 -- > 400 -- fluid overload, dyspnea, severe exercise intolerance -- none - symptom limited
46
CBC - Hemoglobin: -- Males normal value -- Females normal value -- Hgb ____ - transfusion parameters -- strongly correlated with ___
-- 14-18 -- 12-16 -- < 7 -- symptoms
47
CBC - Hematocrit: -- Males normal value -- Females normal value -- ___ limited
-- 42-52% -- 37-47% -- symptom
48
CBC - WBC: -- normal values -- indicative of ____ -- ____ limited
-- 5,000-10,000 -- multisystem infection/pathology -- symptom
49
CBC - Platelets: -- normal values -- low values put pt at high risk for ___ -- high values put pt at high risk for ___ -- value indicating no resistive exercise -- value indicating consultation with provider
-- 150-400 -- bleeding -- clot formation -- < 50 -- < 20
50
CBC - others that indicate abnormal: -- decrease in RBC, WBC, & Platelets -- dec. in platelets -- inc. in platelets -- dec. in all WBCs -- dec. in RBC -- inc. in RBC
-- pancytopenia -- thrombocytopenia -- thrombocytosis -- neutropenia -- anemia -- polycythemia
51
normal levels of: -- sodium -- potassium -- calcium -- magnesium
-- 135-145 -- 3.5-5.0 -- 9-10.5 -- 1.3-2.1
52
Coagulation lab values (clotting function) - PT: -- normal values -- high values lead to ___ -- > 20 = high risk for ____
-- 11-12.5 sec -- increased bleeding/bruising -- bleeding into tissues
53
Coagulation lab values (clotting function) - PTT: -- normal values -- high values lead to ___ -- > 70 = high risk for ____ -- common in _______ disorders
-- 21-35 sec -- increased bleeding/bruising -- spontaneous bleeding -- inherited bleeding
54
Coagulation lab values (clotting function) - INR: -- normal values (but variability) -- high values lead to ___ -- low values lead to ____ -- > 5.5 = high risk for ____
-- 0.8-1.2 -- increased bleeding/bruising -- increased clotting, VTE -- spontaneous bleeding
55
Renal lab values: CK: -- normal values BUN: -- normal values Creatinine: -- normal values
-- 30-170 -- 10-20 -- 0.5-1.2
56
your patient has lab values drawn to test their renal function. They all came back abnormal but their symptoms are mild at this time. What should you do? a. treat them b. don't treat c. leave it up to them d. see them in the morning only
a. treat them - no direct contraindications for any renal lab values, all symptom & medical stability limitations
57
what are absolute contraindications to activity?
new onset AFib sustained VTach complete heart block inc. PVCs, esp. multifocal inc. ventricular arrhythmias new onset chest pain uncontrolled arrhythmias causing hemodynamic instability or symptoms unstable angina temporary pacemaker VTach storming
58
what are relative contraindications to activity?
pending pacemaker interrogation cardiac symptoms drop in HR with activity drop in BP with activity arrhythmias with rate control thrombocytopenia --> platelets < 50 no resistance exercises anemia hgb < 7 abnormal INR
59
Blood gases: -- pH is sensitive to ____ and ____ -- ___ is controlled by lungs and can be altered quickly -- ___ controlled by kidneys but cannot be altered quickly -- what does compensation indicate?
-- CO2 and HCO3 -- CO2 -- HCO3 -- the body is responding to the abnormality
60
respiratory acidosis: -- ____ventilation -- inc. ____, dec ____
hypo CO2 ; pH
61
respiratory alkalosis: -- ____ventilation -- dec. ____, inc. _____
-- hyper -- CO2, pH
62
metabolic acidosis: -- ___, ___, ____ dysfunction -- dec. ____ and _____
GI, endocrine, renal HCO3 & pH
63
metabolic alkalosis: -- ______ dysfunction -- ___volemia -- inc. _____ and ____
-- renal/hepatic -- hypo -- HCO3, pH

Cardiopulmonary I (25 decks)

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