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npte > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Atrial Systole is…

A

The contraction of the right and left atria pushing blood into the ventricles

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2
Q

Atrial Diastole

A

The period between atrial contractions when the atria are repolarising

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3
Q

Ventricular systole

A

Contraction of the right and left ventricles pushing blood into the pulmonary artery and aorta

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4
Q

Ventricular diastole

A

period between ventricular contractions when the ventricles are repolarising

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5
Q

Ventricular PVCs are

A 
Preventricular contractions characterised by:
- Absent p wave
- wide QRS
Can occur in isolation or grouped. 
Serious when >6 per minute
Unifocal PVC - look the same
Multifocal PVC - more than one shape. 
Trigeminal - every third rhytm
Bigeminal every other beat
Couplet - occur in pairs
Triplet - three in a row
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6
Q

Ventricular fibrillation is characterised by

A

Absent p-wave and no QRS complex. Generally irregular

Pulseless emergency situation

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7
Q

Ventricular Tachycardia

A

Absent pwave, Fast rate. Wide and bizarre QRS. Run of 3 or more PVCs occurring sequentially

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8
Q

Atrial flutter

A

Saw tooth pattern - 250-350 for atrial rate. Ventricular often slower.

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9
Q

Atrial tachycardia

A

P wave- merged with T wave

150-250 bpm

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10
Q

Atrial fibrillation

A

Pwave absent or erratic
>350 but ventricular rate may be normal. If HR and BP are stable can still exercise.
if resting HR is above 115 or the patient is uncomfortable or responding poorly then stop and seek medical consult.

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11
Q

Abnormal heart enzymes

A

CK-MB - 2-4hours –> 12-24 hours –> 2-3 days
Cardiac troponin (normal <0.03) 2-4 hours –> 24-48 hours –> 14 days
CK 6 hours –> 12 hours –> 2-3 days

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12
Q

Preload

A

Tension in the ventricular wall at the end of diastole. Venous filling pressure of the left ventricle during diastole

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13
Q

Afterload

A

forces that impede the flow of blood out of the heart. Peripheral vascular pressure. Inversely proportional to stroke volume.

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14
Q

Stroke volume

A

volume of blood ejected by each contraction. Average 60-80ml.

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15
Q

Cardiac output

A

Amount of blood pumped from the left or right ventricle per minute 4.5-5L/min at rest. Product of SV and HR

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16
Q

Venous return.

A

Amount of blood returned to the right atrium each minute

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17
Q

S1 Heart sound

A

Normal, low pitch ‘Lub’ sound. Closure of the AV valves

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18
Q

S2 Heart sound

A

Normal higher pitched ‘dub’

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19
Q

S3 Heart sound

A

Abnormal - ventricular gallop. Passive flow of blood from atria during diastole.

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20
Q

S4 Heart sound

A

Abnormal - atrial gallop, ventricular filling and atrial contraction

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21
Q

Bruit

A

Abnormal blowing sound - atherosclerosis

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22
Q

Murmurs

A

Between S1 and S2 or S2 and S1 - valvar disease

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23
Q

Thrills

A

blood passing obstruction - occurs soon after S2

24
Q

What are the locations of auscultation for the heart

A

Aortic Valve - 2nd space, (R) sternal border
Pulmonary Valve - 2nd space (L) sternal border
Tricuspid valve - 4th space (L) sternal border
Mitral valve - 5th space (L) mid clavicular

25
Q

What are the absolute contraindications to exercise stress testing?

A
  • Recent ECG change suggesting infarct or significant cardiac change
  • Recent complicated MI
  • Unstable angina
  • uncontrolled ventricular arrhythmia
  • atrial arrhythmia that compromises cardiac function
  • 3rd degree AV heart block w/o pace maker
  • acute congestive HF
  • severe aortic stenosis
  • Suspected or known dissecting aneurysm
  • thromboplebitis or intra cardiac thrombi
  • recent systemic or pulmonary embolus
  • acute infections
  • significant emotional distress (psychosis)
26
Q

What are the relative contraindications to exercise

A
  • Resting DBP > 115 or SBP > 200
  • Moderate valvular heart disease
  • Known electrolyte abnormalitis (hypokalemia, hypomagnesaemia)
  • Frequent or complex ventricular ectopy, ventricular aneurysm
  • uncontrolled metabolic disease, chronic infectious disease
  • neuromusc, MS or Rheymatoid disorders exacerbated by ex
  • advanced or complicated pregnancy
27
Q

Karvonens formula

A

Target heart rate 60-80%= intensity % (max-resting) + resting HR

28
Q

Adenosine and persantine are used for what

A

Chemical/Pharmacological stimulation for those who cannot perform exercise stress testing

29
Q

Electrical activity of the heart occurs how

A

Atrial depolarisation via the SA node, Ventricular depolarisation via the AV node. Signal travels to the bundle of his and purkinje fibers

30
Q 
Pwave: 
PR interval:
PR Segment:
QRS complex:
QT interval:
ST segment:
T wave:
A

Pwave: Atrial depolarisation
PR interval: Time of atrial depolarisation from SA to AV 0.12-.20s
QRS complex: Ventricular depolarization and atrial repolarization 0.04-0.10s
QT interval: Time for ventricular depolarisation and repolarisation 0.32-.40s
ST segment: time ventricles are depolarised (isoelectric)
T wave: Ventricular repolarision

31
Q

Normal heart rate for babies and children

A

Babies: 100-160

Children aged 1-10: 60-140

32
Q

Weak pulse can indicate

A

Low stroke volume and cardiogenic shock

33
Q

Bounding pulse can indicate

A

Aortic insufficiency. Decreased peripheral pressure

34
Q

1st degree heart block

A

Lengthened PR interval >0.2 seconds

Delayed conduction from atria to ventricles through AV node.

35
Q

2nd degree heart block (type 1)

A

Progressively long PR interval to the point where QRS is dropped. often asymptomatic - presyncope may occur, may manifest as bradycardia on physical exam

36
Q

2nd degree heart block (type 2)

A

Decrease of distal conduction system. PR interval steady, occasional dropped QRS complex

37
Q

3rd degree heart block

A

Block in His-purkinje system. Life threatening. Requires ATROPINE and pacemaker. Associated with fatigue, dizziness, lightheaded, syncope and bradycardia.

38
Q

Central line (swan-Ganz Catheter):

A

Measures central venous pressure, pulmonary artery pressure and pulmonary capillary wedge pressures

39
Q

Signs and symptoms of cardiac distress

A

Angina, Dyspnea, Diaphoresis, Orthopnea, Blood pressure drop, Dizziness, Nausea/emesis, Ataxia, Xyanosis, Pallor, VT

40
Q

ABI

A

Normal 0.95-1.2

Brachial artery in the arm and the dorsal pedis or the tibial posterior artery in the lower limb

41
Q

Phase 1 of Cardiac rehab focuses on… and requires monitoring via… with a MET target of….

A

Strength focus with active assisted and active exercises aim for minimal assist with ADLs. Starting with lower extremities. Target 60-75% of maximal effort. Monitoring via telemetry ECG. Initial 1-2Mets progressing to 5 Mets by d/c

42
Q

Phase 2 of Cardiac rehab focuses on… and requires monitoring via… With a MET target of

A

Focus on Strength. Exercises for UL and LL. 200ft ambulation by the end of the phase. Typically 4-6 weeks. Monitoring via vital signs and pulse oximeter during ex but not at rest. 9 METs by the end of phase.

43
Q

Phase 3 of Cardiac rehab focuses on… and requires monitoring via… with a MET target of….

A

Focus on endurance. Monitoring before and after ex. End of phase when patient can moniotr their own vital signs and increase workloads to an appropriate stress level
5-9+ METs

44
Q

Congestive heart failure stages are as follows:

A

Stage one: minimal problem completing 6.5Mets
Stage 2: moderate limitations completing 4.5 METs
Stage 3: marked limitation completing 3 METs
Stage 4: severe/unable to carry out activity up to 1.5 METs

45
Q

Sternal precautions include

A

No pulling up in bed - must roll to sidelying
No pushing/pulling/lifting more than 10Lb for 6 weeks
No driving for 4 weeks
Avoid pushing up to stand with hands
Full neck, shoulder and torso ROM permitted - provided no skin or muscle flap present - if so <90 degrees at shoulder
Avoid Habd with ER
more conservative if DM or osteoporosis

46
Q

Adverse responses to inpatient exercise leading to exercise termination

A 
DBP > 110
Decrease in SBP >10mmHg
Ventricular or atrial dysrhythmia
Second or third degree heart block
angina, marked dyspnea, ECG changes indicative of ischemia
47
Q

Common cardiac changes due to aging

A

Changes due to inactivity and disease not age itself.
- Cardiac hypertrophy
decreased coronary blood flow
Thickening and stiffening valves
resting BP rises
Blunted CV response to ex
Max HR declines
Arteries thicken, slowed exchange through capillary walles, increased peripheral resistance.
Decreased SV due to decreased myocardial contractility
CO decreases 1% per year after age 20

48
Q

Left sided heart failure occurs when and causes what

A 
The heart cannot adequately pump blood into circulation - fluid backs up into the lungs
- Fatiuge
- dyspnea
- persistent cough
- Paroxysmal nocternal dyspnea
- Orthopnea
- Tachycardia
Weakness
- pulmonary oedma
- weight gain
- Cool dry skin
49
Q

Right sided heart failure occurs when and causes what

A

The right side of the heart cant pump venous blood in the pulmonary circulation - fluid backs up into the body

  • dependent edema
  • cyanosis
  • right upper quadrant pain
  • fatigue
  • jugular vein distension
  • hepatomegaly
50
Q

Venous insufficency

A

Occurs when there is inadequate drainage of venous blood from a body part. Leads to edema and skin abnormalities

51
Q

Arterial insufficiency

A

Lack of adequate blood flow

52
Q

Reading an ECG you should take the following 5 steps

A
  1. Rhythm - regular/irregular
  2. Heart rate (300, 150, 100, 75, 60)
  3. P wave
  4. PR interval (normal 3-5 small squares)
  5. QRS complex
53
Q

Calcium channel blockers

A
  • reduced calcium intake into smooth muscle - relax and widen blood vessels = Decreased HR, Decreased BP.
    Use RPE. OH problematic
    Pines - Amlodipine, felodipine, isradipine

Not atropine - used for 3rd degree heart block.

54
Q

Betablockers

A

treatment for cardiac arrhythmia. Decreased myocardial Oxygen demand. Decreased HR, decreased contractility.
Decreased HR and BP.
Atenolol bisoprolol, metoprolol

55
Q

Ace inhibitors

A

Treatment of HTN and CHF - reduced BP. may cause hyperkalemia. Benazepril, lisinopril, perindopril

56
Q

Positive ionotropic agents

A

Increase force of contraction. Increases BP, slows HR - digitalis. Digitalis may cause muscle weakness.

npte (19 decks)

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