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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
Q

unifocal pre-ventricular contraction (PVC):

A

premature ventricular depolarization
ectopic foci in ventricle fires with an impulse generated in Purkinje fibers instead of SA node
** one QRS complex goes down

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26
Q

2 simultaneous PVCs is called a ____

A

couplet

27
Q

multifocal PVC:

A

PVCs look different –> the electrical activity has different origins
More severe electrical conductivity problems
Higher cardiac irritability

28
Q

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

A

b. don’t treat – absolute contraindication to exercise

29
Q

bigeminy:

A

PVC every other normal beat

30
Q

trigeminy:

A

PVC every 3rd normal beat

31
Q

AFib with Rapid Ventricular Response (RVR):

A

abnormal ventricular response to irregular atrial contractions
HR > 120 bpm
No P wave w/ more R intervals

32
Q

Supraventricular Tachycardia (SVT):

A

HR > 150 being set by SA node and not slowed by AV node
Absent T wave, Has P wave
Short R intervals

33
Q

Ventricular Tachycardia (VTach):

A

Wide QRS complex tachycardia
absent P waves
6 consecutive PVCs
no atrial contraction

34
Q

Torsades de Pointes:

A

specific type of VTach with rotation around an axis of electrical activity
caused by hypomagnesia

35
Q

ventricular fibrillation (VFib):

A

ventricles quiver inconsistently, no true contraction
very disorganized electrical activity
rapid loss of CO

36
Q

what is the only arrhythmia that is considered a shockable rhythm for AED use?

A

VFib

37
Q

Asystole:

A

dead
no atrial or ventricular contraction

38
Q

what is atrioventricular heart block?
– where does this occur?

A

abnormality in the electrical conduction between atria and ventricles
– PR interval –> time between atrial and ventricular contractions

39
Q

first degree AV heart block:

A

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
Q

type I 2nd degree heart block = Mobitz I = Wenckebach

A

PR interval gets progressively longer, then QRS drops
atrial impulse gets predictably blocked
“skipped beat”

41
Q

Type II 2nd degree heart block = Mobitz II

A

PR interval is normal/consistent, then QRS drops
atrial impulse to ventricle gets unpredictably dropped

42
Q

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

A

– AV
– complete disconnection
– P and R
– isolated –> work fine but not working together

43
Q

what is the most common symptom of 3rd degree heart block?
what is the medical treatment for it?

A

passing out
pacemaker

44
Q

troponins:
– correlated to ___
– cTnT normal value
– cTnI normal value
– troponin ____ more sensitive than troponin ___
– no exertion until _____

A

– cardiac ischemia
– < 0.1
– < 0.03
– T ; I
– down trending and stable

45
Q

BNP: (brain naturatic peptide)
– correlated to ___
– BNP normal value
– BNP value indicative of heart failure
– associated symptoms
– contraindication?

A

– myocardial tissue damage from over-stretching
– < 100
– > 400
– fluid overload, dyspnea, severe exercise intolerance
– none - symptom limited

46
Q

CBC - Hemoglobin:
– Males normal value
– Females normal value
– Hgb ____ - transfusion parameters
– strongly correlated with ___

A

– 14-18
– 12-16
– < 7
– symptoms

47
Q

CBC - Hematocrit:
– Males normal value
– Females normal value
– ___ limited

A

– 42-52%
– 37-47%
– symptom

48
Q

CBC - WBC:
– normal values
– indicative of ____
– ____ limited

A

– 5,000-10,000
– multisystem infection/pathology
– symptom

49
Q

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

A

– 150-400
– bleeding
– clot formation
– < 50
– < 20

50
Q

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

A

– pancytopenia
– thrombocytopenia
– thrombocytosis
– neutropenia
– anemia
– polycythemia

51
Q

normal levels of:
– sodium
– potassium
– calcium
– magnesium

A

– 135-145
– 3.5-5.0
– 9-10.5
– 1.3-2.1

52
Q

Coagulation lab values (clotting function) - PT:
– normal values
– high values lead to ___
– > 20 = high risk for ____

A

– 11-12.5 sec
– increased bleeding/bruising
– bleeding into tissues

53
Q

Coagulation lab values (clotting function) - PTT:
– normal values
– high values lead to ___
– > 70 = high risk for ____
– common in _______ disorders

A

– 21-35 sec
– increased bleeding/bruising
– spontaneous bleeding
– inherited bleeding

54
Q

Coagulation lab values (clotting function) - INR:
– normal values (but variability)
– high values lead to ___
– low values lead to ____
– > 5.5 = high risk for ____

A

– 0.8-1.2
– increased bleeding/bruising
– increased clotting, VTE
– spontaneous bleeding

55
Q

Renal lab values:
CK:
– normal values

BUN:
– normal values

Creatinine:
– normal values

A

– 30-170
– 10-20
– 0.5-1.2

56
Q

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

a. treat them - no direct contraindications for any renal lab values, all symptom & medical stability limitations

57
Q

what are absolute contraindications to activity?

A

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
Q

what are relative contraindications to activity?

A

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
Q

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?

A

– CO2 and HCO3
– CO2
– HCO3
– the body is responding to the abnormality

60
Q

respiratory acidosis:
– ____ventilation
– inc. ____, dec ____

A

hypo
CO2 ; pH

61
Q

respiratory alkalosis:
– ____ventilation
– dec. ____, inc. _____

A

– hyper
– CO2, pH

62
Q

metabolic acidosis:
– ___, ___, ____ dysfunction
– dec. ____ and _____

A

GI, endocrine, renal
HCO3 & pH

63
Q

metabolic alkalosis:
– ______ dysfunction
– ___volemia
– inc. _____ and ____

A

– renal/hepatic
– hypo
– HCO3, pH

Cardiopulmonary I (22 decks)

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