Cardiac eval Flashcards
Angina rating scale (ACSM)
0-no pain
1-mild, barely noticeable
2-mod, bothersome
3-mod severe, very uncomfy
4-most severe or intense pain ever experienced
Labs specific to pt with cardiopulmonary dysfunc
-blood lipids
-CBC
-BUN, creatine, arterial blood gases
-coagulation studies (ability blood to clot)
-electrolyte screening panels
-glucose tolerance tests (sensitivity to insulin)
Radiologic tips
-denser material, lighter it appears on xray
-dense (bone) will appear white
-air is black, and muscle, fat, fluid is gray
Medicare guideline O2
Resting PO2 of <55 mmHg on room air or O2 % saturation of <88% should be considered for supplemental O2
if pt has low PO2 but NOT <55 on room air OR low PO2 on O2, pt may need supplemental O2
Arterial blood gases (PaO2)
norm: 80-100 on room air
mildly hypoxemic: 60-80
mod hypoxemic: 40-60
Severe hypoxemic: <40
blood draw to determine total dissolved O2
General appearance
Body posture and position may affect respiration
Kyphosis and scoliosis [limit vital capacity and hence exercise capacity]
Assuming the professorial position
Often unable to lie in a flat, supine position
Typically assume a semi-Fowler’s position
-skin tone can indicate level of O2 and perfusion of periphery
-cyanosis of skin is due to lack of O2 in blood (mostly in lips and fingernail beds)
Central cyanosis
caused by diseases of heart or lungs or abnormal hemoglobin
discoloration systemic (they will be totally blue)
Peripheral cyanosis
caused by decreased local circulation and increased extraction of O2 in peripheral tissues
discoloration regional
First heart sound/S1
-lub
-associated w/ closure of mitral and tricuspid valves
-corresponds w/ onset of ventricular systole
-results from reverberation within blood associated w/ sudden block of flow reversal by valves
second heart sound/S2
-dub
-closure of aortic and pulm valves
-corresponds with the start of ventricular diastole
-results from reverberation within blood associated w/ sudden block of flow reversal
Third sound /S3
-lub dub dub
-occurs in early diastole while ventricle is rapidly filling
-norm in healthy children or young adults
-older people- indicates loss of ventricular compliance
-called ventricular gallop
Fourth sound/S4
-la-lub-dub
-occurs late in diastole before S1
-atrial gallop
-associated with increased resistance to ventricular filling
-hypertensive cardiac disease, CAD, pulmonary disease
Murmurs
-results from vibrations from turbulent blood flow
stenosis: aortic or pulmonary valve cant fully open
regurg: mitral/tricuspid valve cant fully close
mitral valve prolapse/regug is most common valvular condition
Pitting edema scale
0-no depression
1+ : barely detectable depression
2+ : slight indentation. <15 secs rebound
3+ : deeper indentation. 15-30 secs rebound
4+ : >30 secs to rebound
Activity eval
-mode of activity (walk, cycle, etc)
-intensity, work level, rate of activity (mph, % grade, etc)
-duration of activity at each intensity level
*Eval terminated if and when an abnormal response identified
Abnorm CV response to increased func demand
-spike in HR w/ increased workload (norm is 10 bpm)
-flat rate of rise <10 bpm
-decrease in HR
SBP >250 (norm is increase 10)
>10 change DBP either up or down
desaturation: fall below 90% is abnorm
Rubor dependency test
-assesses LE arterial circulation using skin color and positional changes
-begin supine with legs elevated to 35-45 for 1 min
-legs assessed and then placed in dependent position
-norm: see rapid pink flush in feet. arterial insuff: deep red color after 30 secs in this position (also elevation pallor)
Rubor is good for?
-PAD
but cant rule it out if rubor not present
Ankle brachial index
-compares BP obtained with Doppler probe in dorsalis pedis (or post tib) to BP in higher of two brachial pressures
-ABI >0.9 considered normal
-ABI <0.5 suggests severe arterial occlusive disease
PAD/PVD
-commonly caused by atherosclerosis -decreases bf to limbs
dx: angiogram, ABI, magnetic imaging, treadmill test, rubor
sxs: shiny hairless skin, gangrene, weak pulses, wounds, numbness, intermittent claudication
tx: exercise, medicines to improve bf, vascular sx (bypass), angioplasty
A decrease in HR may indicate…
an increase in arrhythmias
BP cuffs
-lose accuracy after multiple measurements
-if possible, monitor during activity. BP should drop quickly after stopping activity
-HR drops sharply in 1st min post exercise. should recover around 20 bpm after this
RPE
0-no effort
1 very easy
2 somewhat easy
3 mod
4 somewhat hard
5 hard
7 very hard
10 very very hard
S+S exercise intolerance
syncope
new onset angina
-N/V
-marked dyspnea
-severe fatigue
-ataxia, mental confusion
-severe claudication pain
-face shows distress
-cyanosis/pallor
cold sweat
SBP >250
DBP >110
drop in DBP >20
presence of arrhythmias
-excess fatigue 2+ hrs after exertion
