CARDIO EXAM 1 Flashcards
Arteries rely on pressure and contain _______ which is responsible for vasodilation and vasoconstriction.
Smooth Muscle
Veins rely on ________to send blood back to the heart.
Muscle Pump
Explain the pathway of blood
Heart–> arteries–> arterioles–>capillaries (gas exchange)–> venules–>veins (muscle pump)–>Heart
What vessel has the highest pressure?
Aorta, coronary arteries rely on the pressure in the aorta, because coronary arteries fill with blood during diastole.
What is considered Pre-Hypertension?
120-139/80-89
Stage 1 HTN
140-159/90-99 at this stage want to get the patient on medication
Stage 2 HTN
> 159/>99
High BP increases the risk of stroke/MI/HF because it makes the heart work harder, BP wears the endothelial layer of the artery allowing plaque to build up in the walls.
What is the function of the Lympthmatic System? And relies on what to function?
Removes waste from tissue. Relies on muscle pump, edema will form if lymphatic system is blocked.
What two system relies on muscle pump?
venous and lymph
Grading Pitting Edema
1+: Barely perceptible pit
2+: Skin rebounds in less or equal to 15s
3+: Skin rebound in 15-30 s
Where are Baroreceptors found and what do they do?
Found in Aortic Arch/Carotid Sinus
When Baroreceptors sense a decrease in BP, there is an increase in sympathetic input increasing HR. Involves CNs 9/10
Narrowing of the aorta or aortic valve block, can decrease cardiac output and is normally diagnosed via Heart Catheter. Name the heart condition.
Aortic Stenosis
When blood leaks back down into the L ventricle which can lead to decrease in cardiac output and can eventually back up into the L VENTRICLE, causing it to expand leading to ventricular problems. Name the heart condition.
Aortic Regurgitation
What heart condition can happen when the valve doesn’t open fully thus restricting blood flow into the L ventricle. The restricting flow causes extra blood to stay in the L atrium, leading to blood backing up into the lungs. Decreasing blood and leading to Pulmonary Edema. Name this Heart condition.
Mitral Valve Stenosis
Describes what occurs to the heart when a patient presents with a LEFT Myocardial Infarction near a valve.
Muscle tissue death occurs in an MI, and turns into scar tissue leading to poor contractility and decreases CO. If the MI occurred near a valve or papillary muscles in which hold the valve open this can lead to mitral valve dysfunction.
What two valves are most prone to dysfunction?
Mitral and Aortic
Blockage of the Circumflex artery can result in what type of disorder? And what will the examiner hear upon palpation?
Damage to Circumflex artery suppilies lateral wall and papillary muscles that hold the valve open and can cause a dysfucntion in the valve itself. If the papillary muscles can’t function the mitral vlave may cause leakage during contraction of the L ventricle causing blood to travel in reverse.
Diagnostically we can assess this condition by auscultating patient’s heart sound. Examiner would hear ‘LUSH DUB” after S1
Heart Sound: S1
Closing of the tricuspid and mitral valve corresponds with systole, ventricular contraction. S1 is heard louder at the APEX of the heart
Heart Sound: S2
Closing of the Aortic and Pulmonic Valves, corresponds with Diastole or ventricular filling, DUB at the 2nd intercostal space
Heart Sound: S3
Extra Heart sound after the lub-dub (indicative of HF)
Where are the SA and AV node found and note the importance of the location?
R atrium, so problems with atria will most likely produce an arrhythmia
RCA (Posterior Descending and R Marginal A) supplies what part of the heart?
RA, Both ventricles (more RV) and back of the septum
Leads II, III and aVF correspond with
RCA
Blockage of the RCA can lead to?
Increase risk of AV block or arrythmias, 50% of patients have a R ventricle infract
Left Main Coronary Artery Supplies what part of the heart?
Anterior and Lateral
LAD supplies
70% of left ventricle and anterior portion of the heart
Circumflex supplies
the lateral portion of the heart (papillary muscles)
Leads V1-V6, I, aVL correspond with
Left Main Coronary Artery
Leads V5,V6, aVL, I
Circumflex artery
Leads V1-4
LAD
Which arteries if damaged can lead to pump dysfunction or failure?
Left main coronary artery/LAD
Which artery if damaged can lead to mitral valve regurgitation?
circumflex
P wave corresponds with
Atrial Contraction
QRS wave corresponds with
Ventricular contraction/Atrial Repolarization
T wave corresponds with
Ventricular Repolarizaiton
What % of blood fills the heart during passive filling?
80% and 20% of blood comes into the heart during atrial contraction
Cardiac output is defined as how much blood the heart pumps tot he body per heart beat, what is normal resting CO?
5L/min
Cardiac output is defined as how much blood the heart pumps to the body per heart beat, what is CO with exercise?
25-30 L/min
End volumetric pressure that stretches the R/L ventricle. Amount of blood sitting in the heart right before it contracts is defined as
Preload
An increase in preload will do what to SV and CO? Decrease blood volume will do what to preload?
increase, decrease
What is the Rate Pressure Product and what does it determine?
SBPxHR, determines the myocardial oxygen demand on the heart. If patient can’t meet the work load demands then they can develop ischemic pain.
Name that factors that affect stroke volume?
Change in position because blood rushes towards the legs, fluid intake, dehydration, strength of pump
Alpha 1 receptors are located in
the vasculature
Beta 1 Receptors are located in
the heart
Beta 2 Receptors are located in
the lungs, stimulation causes bronchodilation
What value do we want to keep total cholesterol under?
under 200
What is the optimal LDL value?
less than 100, above 190 is very high
What leads to plaque formation because they stick to the walls of the vasculature, causing blockages.
LDL
Known as the “Pac-man” What helps clean up plaque and debri in the arterial walls and then carries it to the liver. And if low levels are found in the patient’s blood can lead to greater plaque formation?
HDL
Increased levels of this lipid can lead to increased deposits on arterial walls forming plaque like lesions that can occulde the lumen?
Triglycerides
Increased levels of glucose can be indicative of what two problems?
diabetes or acute MI, can lead to plaque formation
This lab value is indicative of Myocardial Damage
CK-MB
What are considered the 2 cardiac enzymes?
Ck-MB, Troponin
Which of the 2 cardiac enzymes is the fastest indicator that there is heart damage?
troponin Shows up quicker in the blood around 15 minutes
Percent of red blood cells in the blood important for oxygen transport to the tissues.
Hct
Oxygen-transport protein in the blood, if low hinders oxygen transport
Hb
This lab value is known as the chemical purines found in substances like alcohol, most is dissolved in the blood and travels to the kidneys to be passed through the urine, if high indicative of kidney failure? And in what condition is this usually high?
Uric Acid
Low Na/K are indicative of what?
low electrolyte imbalance. Note water follows sodium so if there is a decrease in sodium there is most likely a decrease in blood volume and in turn a decrease in BP. Body wants to maintain H20 in order to maintain adequate blood volume levels.
High BUN indicates
Descreased kidney function
What is considered the “gold standard of HF” specific to the ventricles also can be released in CAD where there is ischemia.
BNP
What level of BNP is considered decompensated heart failure?
700
PT/PTT if increase what does that mean
the time it takes for blood to clot, common increase in blood clotting time due to patients taking anti-congualnts.
What lab value if increased is indicative of liver damage?
Bilirubin
What lab value if decreased is indicative of a liver issue, malnutrition, or decreased absorption in the GI?
Albumin
Restriction of blood supply to the myocardium resulting in decreased oxygen to the tissue is defined as ?
Ischemia
Cardiac cell death is defined as?
Myocardial Infarct
The heart is unable to provide the sufficient pump action to maintain blood flow to meet the demands of the body is defined as?
congestive heart failure
List the common ischemia symptoms for MEN?
- ->Left or R arm pain, Numbness
- ->Jaw pain
- –>chest tightness (angina)
Pain above the chest that doesn’t go away is known as an
infarct
Pain above the chest that goes away with rest
ischemia
Ischemia symptoms for Women?
Number 1 symptom is fatigue (that is not specific)
Pain between the scapulas
Unexplained weakness
GI issues
Ischemia symptoms for Diabetics?
SOB (due to decreased sensation diabetics don’t report chest pain)
STEMI (Segment Elevation Myocardial Infarction) what is it and what is noted?
Due to complete occlusion of coronary artery, full thickness damage.
Seen:
ST Elevation
Q wave
Tissue damage through entire thickness of muscle tissue, results in complete occlusion of artery
Non STEMI Transmural (MI) what is it and what’s noted?
ST depression, T wave inversion, No Q wave
Patient walks into your clinic complaining of generalized “heavy pain” that is rarely sharp in shoulder and jaw region. He also complains of chest tightness and pressure? What type of pain is this?
Cardiac pain
Patient walks into your clinic and tells you they have pain when taking deep breaths in. What type of pain is this?
Lung pain
Pain that is localized and is usually increased with palpation over the chest wall is
musculoskeletal in nature
What is the difference between unstable angina and stable angina?
unstable angina patient has pain at rest and stable angia just has pain with exertion
Can you mobilize patient’s with decompensated HF?
no, because they are symptomatic at rest! (compensated HF they are asymptomatic at rest)
Positive Iontotrope
Improves Heart Contractility (caffeine)
Positive Chronotrope
Increases HR
Peripheral Edema is a sign of what type of HF?
Right HF
Pulmonary Edema is a sign of what type of HF?
LEFT
What are the 3 Anti-Angina Meds?
Beta Blockers (allows more time for ventricles to fill)
Nitrates
Ca Channel Blockers
Cardiac Failure Cocktail of Drugs?
Diuretics
Ace Inhibitors
Beta Blockers/glycosides
Diagnosing an MI (name 3 things you want to look for)
- symptoms greater than 20 minutes
- Changes in ECG
- Heart Enzymes released (seen in lab values)
List 5 main signs of Heart Failure
- Rapid Breathing at rest
- Rales with pulmonary EDEMA (L)
- S3 Heart sounds (heard after S2)
- Jugular venous Distension with R HF
- Weight gain greater than 3 pounds in a day due to peripheral edema (R HF)
Patient presents with irregular beats, palpable skipped beats and is symtompatic. The PT is concerned and would like to assess the patient’s arrhythmias during a 24 hour period. What is the best assessment tool?
Holter Monitor (portable device for continous moonitoring of electrical activity of the CV system)
Examiner has patient walk on a treadmill for 3 minutes then has the patient walk faster on an incline and use ECG and BP to note the response what test is he performing?
Exercise Stress test
A non-invasive procedure that looks at the size of ventricles, valve function and Ejection fraction?
Echo
What type of diagnostic test is considered a routine procedure upon hospital admission?
Chest -XRay (heart should be 1/3 the width of the chest) also note shape of diaphragm, costodiaphragmatic angle to assess fluid in the lungs or hyperinflation of the lungs.
This diagnostic test is used to look at the hearts electrical activity currently or to not what past events affected the conductivity?
12-lead ECG
This test looks at blockages of the arteries directly and id done usually after an abnormal stress test or abnormal ECG as it is more invasive
Coronary Catheritization (can also put a camera or US on top of a cath to view vessel blockage)
This test is used for lung assessment during inspiration?
Incentive Spirometry
CABG surgery is usually done by grafting what type of vessel into the damaged artery?
Radial Artery has 92% patency after sx, note when PTs work with these patient and you are moblizing them they may have wrist pain due to the sx so becareful when using a walker.
What is the most Common complication after CABG sx besides infection?
Plueral Effusion, the sternal incision makes it harder for patient to take deep breathes.
ON PUMP vs. OFF PUMP procedure
On PUMP: Stop heart, use machine to circulate major complication is blood flow to the brain. Want to assess cognitive condition of these patient’s
OFF-PUMP: Heart is still beating, can’t do on everyone because it depends on where the patient needs the bypass surgery. This procedure needs to be done in a certain about of time.
Catheter with balloon attached to flatten plaque build up along the arterial walls
Angioplasty
Wire/Mesh structures that keep arteries open after angioplasty
STENT
Allows for pressure to stay up in aorta, inflates during diastole. The increased pressure in the aorta and increasing blood flow back into the coronary arteries which increases oxygen profusion to the myocardium. Can’t mobilize if placed in LE
IABP
Name 4 Sternal Percautions
- No ABD/Flex greater than 90
- No lifting 5-10 lbs
- No driving
- Everything bilateral use
* *refer to recommendations of surgeon
Used with patients that have life threatening arrhtymias
AICD (implantable internal defib)
For DVTs what 2 main assessments or tests would help you determine if the patient has a DVT.
Doppler/US and RISK ASSESSMENT!
