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CardioPulm > Cardiac Exam 1 > Flashcards

Cardiac Exam 1 Flashcards

1
Q

what forms the sternocostal surface of heart?

A

right atrium and ventricle

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2
Q

what forms the diaphragmatic surface of heart?

A

left and right ventricles

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3
Q

what forms the posterior surface of the heart?

A

mostly left atrium; some right atrium. also called the base of the heart

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4
Q

what is the apex of the heart?

A

left ventricle

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5
Q

where would you hear mitral valve closing?

A

apex; fifth rib at mid clavicular line

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6
Q

location of base of heart

A

third rib; where the great vessels are

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7
Q

where can endocarditis pain be felt?

A

low back pain

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8
Q

what is acute mitral regurgitation?

A

during left heart failure; L ventricle gets bigger; papillary muscles move farther away from valve; which can cause cordae tendinae to rupture

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9
Q

what is functional syncytium

A

group of cells acting as one unit; atria contract together; ventricles contract together

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10
Q

inherent pace of SA node

A

60-100 bpm; most unstable resting potential; easiest to depolarize; and repolarizes quickly

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11
Q

inherent pace of AV node

A

40-60 bpm

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12
Q

inherent pace of ventricles

A

20-40 bpm

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13
Q

what does the tricuspid valve separate?

A

right atrium and ventricle

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14
Q

what does the mitral valve separate?

A

left atrium and ventricle

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15
Q

how much does the atria contracting contribute to ventricular filling?

A

20-30%

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16
Q

when do coronary arteries fill?

A

right after valves close; ventricular diastole

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17
Q

what does the right coronary artery supply?

A

Right atrium and ventricle; inferior and posterior portion of L ventricle; posterior 1/3 of interventricular septum; SA (55% of ppl) and AV node; bundle of His; posterior fascicle of left bundle branch

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18
Q

what does LAD supply (left anterior descending branch of coronary artery)

A

anterolateral left ventricle; anterior 2/3 of septum; most of right bundle branch; anterior fascicle of left bundle branch; part of posterior fascicle of left bundle branch

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19
Q

what does Cx supply (circumflex branch of left coronary artery)

A

Left atrium; anterolateral and posterolateral left ventricular wall; SA node in 45% of ppl

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20
Q

A-VO2 difference in skeletal and cardiac muscle at rest

A

skeletal: 25%
cardiac: 70-80%

increased by increased blood flow

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21
Q

what does the SNS do to vessels?

A

vasoconstrict! Tissues in use vasodilate in response to local factors (nitric oxide) released from working cells

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22
Q

what fuel does cardiac muscle prefer at rest?

A

fatty acids; but will use anything.

heart helps to clear lactate during heavy exercise

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23
Q

heart rate changes during heart failure

A

increased

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24
Q

beta 1 receptors

A

sympathetic control to heart

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25
alpha receptors
sympathetic control (vasoconstriction) in periphery
26
beta 2 receptors
sympathetic control in coronary arteries; vasodilate
27
normal range for potassium
3.5 - 5 mEq/L
28
biggest influencer of afterload
vasular resistance
29
resting ejection fraction
50-60%
30
atrial stretch reflex
causes diuresis on bedrest | increases atrial naturetic factor; decreases ADH and renin
31
coronary blood flow driving pressure
systemic diastolic pressure-left ventricular end diastolic pressure
32
ideal left ventricular end diastolic pressure
less than 12
33
why would diastolic pressure increase with exercise?
coronary artery disease; increasing diastolic pressure increases driving pressure to increase perfusion to heart
34
what is rate pressure product
heart rate * systolic blood pressure measure of the O2 demand on heart; decreases at a given workload with training
35
normal p-r interval
0.12-0.20; 3-5 little boxes
36
box size on ecg
small boxes: 0.04s | big box: 0.2s (5 small boxes)
37
normal QRS duration
0.06-0.10 sec
38
what can cause ST elevation/depression?
supply or demand of O2
39
what can inverted T wave mean?
ischemia
40
what part of ecg changes with exercise?
QT interval - onset of ventricular depolarization to end of repolarization
41
Mean Arterial Pressure
average blood pressure; normal 70-110.
42
normal hemoglobin
12-17; lower in females
43
normal hematocrit
36-51% lower in females
44
SVO2
venous oxygen saturation; measured by central catheter; shouldn't drop more than 10% with exercise; should go back up in 3 min
45
beginning of coronary artery disease
endothelial damage precedes morphological changes; decreases nitric oxide
46
EDRF
endothelial derived releasing factor (nitric oxide)
47
goal for cholesterol numbers
less than 200 total LDL less than 100 HDL>50-60 TC/HDL>4.5
48
amount of exercise that vastly decreases mortality
even just 1 mile/day is not much better than 8 mile/day
49
hemocystene
lower is better; high levels lead to endothelial damage; tends to be high in ppl with hypertension
50
S3 heart sound
early sign of CHF; extra sound after S2; can be brought on by exercise; normal in young (less than 40) aerobically trained ppl; may have in supine because of increased venous return
51
S1 heart sound
systolic sound; mitral and tricuspid valve closing
52
S2 heart sound
pulmonary and aortic valves closing; ventricular diastole
53
S4 heart sound
atrial gallop; heard before S1
54
"hemodynamic significance"
what effect does the variable have on cardiac output
55
what does a weak pulse indicate?
low stroke volume or increased peripheral resistance
56
bradycardia during exercise
usually sign on severe CAD or heart block
57
RPE of lactate threshold
13; most ppl will self select this level for a workout/run
58
heart rate recovery post exercise
max exercise HR-HR after 1-2 min of recovery; >12 beat decrease within first minute normal
59
hypertension
Systolic >140mmHg
60
blood pressures to not exercise
systolic >200 or less than 80; diastolic >110 esp/or if it is really different than their normal
61
normal BP response to exercise
Systolic increase 7-10mmHg/MET little to no change in diastolic BP will increase more with resistance exercise vs. endurance
62
pulse pressure
systolic-diastolic | normally >20; good 30-40
63
exercise recommendations for Hemoglobin
less than 8 g/dl: only essential ADL's as long as not symptomatic 8-10: light aerobics; light weights >10: ambulation and resistance exercise as tolerated
64
exercise recommendations for Hematocrit
less than 25%: only essential ADL's as long as not symptomatic 25-35%: light aerobics; light weights >35%: ambulation and resistance exercise as tolerated
65
INR
international normalized ratio; measure of clotting time normal 0.9-1.1 normally higher when on cumodin or DVT aFib; 2.3-3.5 for mechanical valves
66
INR and exercise
INR less than 4: perform regular PT and OT; delay increasing intensity INR 4-5: no resistive exercise; RPE5: no exercise; may transfer INR >6: may be on bed rest
67
immediate signs and symptoms to stop exercise
S3 onset; abnormal BP response; 2nd or 3rd degree heart block; lightheaded/dizzy peak exercise HR should be 10bpm below symptoms
68
what is the first test performed to diagnose valve problems
echocardiogram/ultrasound; also estimates stroke volume and ejection fraction; can add doppler to look at blood flow velocities
69
PET scan
nuclear; measure metabolism of heart and myocardial perfusion; is the injury reversible? Can add Dipyridamole to vasodilate coronary arteries to get a better idea of how good coronary artery blood flow is
70
spiral CT
detects coronary calcification (part of plaque); aortic aneurysm; pericardial thickening; masses
71
SPECT
single photon emission computed tomography; usually do echo first; detects perfusion and contractility defects
72
EBCT
electron beam computed tomography; detects calcium in coronary arteries; quantify athersclerosis
73
MUGA
multigated acquisition imaging; inject tagged blood and track it to caclulate ejection fraction
74
MRI for cardiac diagnoses
used to detect coronary artery obstruction; wall movement abnormalities; valve disease; cardiac blood flow
75
Radionuleotide studies
inject radioactive labeled agents which is taken up by tissues; looking for "cold spots" where material isn't taken up indicating lack of blood flow and ischemia; inject just before end of exercise scan then and again 4 hours later to assess if damage is still there; if it is damage is likely permanent
76
pharmacologic stress testing
Dipyridamole vasodilates; used when person is unable to do exercise test
77
coronary angiography
catheters inserted into coronary arteries with injection of contrast material; determines location of lesion; degree of obstruction; presence of collateral circulation; extent of disease in distal artery bed
78
ventriculography
contrast material injected into ventricle to visualize how well heart wall moves
79
arterial line implications for PT
don't do ROM to kink line; sometimes don't get out of bed with femoral line; pressure is calibrated with R atrium at level of transducer; for every inch away from this level BP will be ~2mmHg higher or lower
80
pulmonary artery catheter
usually inserted into R jugular vein; can inject bolus of cold fluid to measure cardiac output
81
pulmonary capillary wedge pressure
balloon inflated and floats until it gets stuck in lung; pressure pushing back is theoretically the same as the left ventricular diastolic pressure; if wedge pressure is high would be concerned that driving pressure is low; normal 4-12mmHg
82
normal right atrial pressures
0-8mmHg
83
normal right ventricular pressures
systolic 15-30mmHg | diastolic 0-8mmHg
84
normal pulmonary artery pressures
systolic 15-30mmHg | diastolic 5-15mmHg
85
cardiac index
cardiac output/sq meter | 3.5L/min/m2 normal
86
Intra-aortic balloon counterpulsation
assistive device for the heart; increases coronary blood flow; inserted into femoral artery (or axillary) to aorta just distal to left subclavian orifice; inflates during diastole; no hip flexion past 15-30 deg could push balloon proximal and block blood flow to UE

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