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NPTE Final Frontier > Cardio Exam > Flashcards

Cardio Exam Flashcards

1
Q

Pt walks into Drs Office
Sequence of what we wanna measure

A
  • BP, HR, RPP (HR x SBP), Heart sounds, Auscultation, CO (HR x SV, blood/min)
  • NOTE: SV= Blood/beat aka blood w/ every “stroke” of heart
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2
Q

More on RPP
HR x SBP

A

Metabolic demands on heart

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3
Q

Incremental Exercise
What happens to **HR and CO? **

CO= HRxSV

A
  • Incs LINEARLY w/ INCing work rate
  • Reaches plateau @ 100% VO2max
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4
Q

Incremental Exercise
BP–what happens/Normal response?

Overall Mean Arterial Pressure (MAP)

A
  • SBP INC’s
  • DBP remains fairly constant (-10 to +10 is OK
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5
Q

Practice!
PT doing ex. stress test 45yo male. Pt resting vitals are BP 130/90 (stage I HTN). HR 75, RR 24. ABNORM response to ex?

A

If SBP DECs to 100mmHg
**SHOULD INC w/ inc workload and linearly w/ HR

NOTE: >20 mmHg drop==SERIOUS CONCERN

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6
Q

PRACTICE!
Pts PMH includes hypercholesterolemia, T2DM. SBP is 122 DBP is 77. What stage HTN?
122/77

A

Elevated BP

NOTE that “Pre-HTN” no longer a thing!!!

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7
Q

BP Guidelines!!!

A
  • Normal= SBP <120 and DBP <80
  • Elevated= SBP 120-129 and DBP <80
  • Stage I HTN= SBP 130-139 or DBP 80-89
  • Stage II HTN= SBP at least 140 or DBP at least 90
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8
Q

BP Guidelines:
Hypertensive Crisis

A

SBP >180 and/or DBP >120, w/ pts needing prompt changes in meds if there are no other indications of probs, or immediate hospitalization if there are no signs of organ damage

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9
Q

Nervous System Regulation of HR
Things to note

A

SNS== Fight or Flight
- Sympathetic N. sends signal to SA and AV node
PNS== Rest and Digest
- Parasympathetic Vagus (CN X) sends signal to SA node and AV node

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10
Q

Practice!!!
32yo healthy male working on stationary bike in OPPT. After 4 mins of constant-load, sub-max ex, VO2 reaches steady state: indicates that?

A

ATP demand being met aerobically
Steady State VO2–>Plateau in O2 uptake attained w/in 1-4mins CONSTANT exercise.

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11
Q

What should you think about when thinking about **Altitude training? **

A

Raul’s first date!!! Very NERVOUS! High SNS activity!! EVERYTHING IS HEIGHTENED!!!
Ex. First date, NPTE== INC SNS

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12
Q

Terms to know

A
  • BP
  • HR–Tachy= fast >100; Brady= slow <60
  • SV=blood/beat or stroke
  • CO= HR x SV
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13
Q

Altitude training===

A

Think first exciting thing you did!!!
INC SNS**

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14
Q

Practice!
30yo male visits town 9000ft above sea lvl (altititude). INITIAL CV responses during first week?

EVERYTHING heightened!!

A

A: Incd BP, INCd CO w/ TACHYcardia and no sig change in SV
CO=HRxSV

Rationale: Bc INC HR will raise CO–so SV stays relatively stable

SV does not have to raise since HR already incd CO

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15
Q

Altitude changes
Ex. to remember?

A

Rahul goes to the mnt for his GF–NERVOUS= INC SNS

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16
Q

Altitude Changes
Initial vs Acclimatization (takes ~3wks)

A

Initial
- HR inc
- BP inc
- CO inc
- SV NO change (doesnt have to raise since HR incd CO)

Acclimatization
- HR inc
- BP norm
- CO norm
- SV DECs– no need for INC since CO now normal

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17
Q

Acute hypoxia (Initial altitude change)
SNS Activation response?

A

INC HR
INC CO
INC BP
INC myocardial contraction velocity

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18
Q

Aquatic Therapy
What should you remember?

A

Rahul goes to the BEACH w/ his GF!
Heart is HAPPY
- HR Dec
- BP Dec
- SV Inc (bc more efficient)
- CO Inc (bc more blood flow) = HRxSV

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19
Q

Aquatic Tx and Hydrostatic Pressure

Relation?

A
  • Hydrostatic pressure causes more blood pumped more efficiently===>
  • INC SV
  • INC CO
20
Q

Practice!
PT using aquatic tx to tx 29yo w/ recent ACL repair (rule of 6- 6wks, 12wks, 6mos). Pt is immersed to lvl of sternoclavicular notch (fully submerged). MOST expecetd physiological response?

Everything decd except SV and CO

21
Q

Summary of Aquatics and Response to Aquatic Tx

A
  • DEC SBP–> INC venous return–> INC CO
  • INC SV
  • HR Dec
  • DEC SBP
  • Dec VO2
  • INCd work of breathing
  • DECd vital capacity
  • Higher RR
22
Q

Summary of Aquatics and Response to Aquatic Tx
Cardiovascular effects

REmember Rahul went to beach now heart happy (unlike the mountain)

A
  • HR DECs
  • BP DECs
  • SV INCs
  • CO INCs
23
Q

Summary of Aquatics and Response to Aquatic Tx
Respiratory effects

A
  • VC DECs
  • Work of breathing INCs
24
Q

Summary of Aquatics and Response to Aquatic Tx
MSK effects

A

WB DECs (better on jts)
Edema DECs (bc INC venous return)

25
Beta Blockers and HR **What are they doing? and What will happen as a result?** | The "LOLs"
- Beta-adrenergic blocking drugs (LOLs)--> compete w/ **epi and NE (both want to INC HR) for beta adrenergic receptors in heart**--> OVERALL beta blocks REDUCE HR AND CONTRACTILITY (block adrenergic receptors)--> LOWER myocardial O2 demand - **Will LOWER HR during submax and max exercise---aka "blunted HR response" - Important in Ex. Rx. USE RPE!!! **
26
Beta Blockers compete w/ epi and NE (inc HR) to block adrenergic receptors (Lower HR) **Prescribed for what pts?**
CAD and HTN**
27
Practice! 54yo pt on beta-blockers 5yrs. PRior to ex program, pt should receive explnation of?
NEED to use measures OTHER THAN HR to det. intensity of exercise Ex. Borg RPE | NOTE: Borg RPE is 6-20 scale that **correlates w/ HR**
28
Why RPE 6-20?
- 60= RHR most people - 200= MHR most people - **Just add zero to RPE==HR** | NOTE: 11-13 for Cx and pregnancy 17- obesity
29
How to remember RPE:
Start @ lucky 13: **somewhat hard. The spell SHVEM** - 13: Somwhat hard - 15: Hard - 17: Very hard - 19: Extremely hard - 20: Max exertion Then when going in OPP direction, just the OPP of SHVEM: (alwasy start @ 13) - 13: Somewhat hard - 11: Light - 9: Very light - 7.5: Extremely light - 6: No exertion @ all
30
Factors that regulate CO | CO=HR x SV
CO= - Cardiac rate (HR)--> **Parasympa nerves/Sympa nerves** - Stroke Volume (SV)--> **Contraction strength, EDV (preload), Mean Arterial Pressure (afterload)**
31
Fit vs Unfit-Cardiac Ouput | How can you clarify or define the table? ## Footnote Untrained vs Trained male
Untrained male-- 72 HR (**heart has to beat faster bc unfit)** x 70 SV= 5.00L/min (CO) (Q) Trained male (**LOWER HR, INC SV)**-- 50 HR x 100 SV (**bc heart more efficient)**= 5.00 L/min (CO) (Q) Untrained (UNfit)--> HR will always be HIGHER w/ LOWER SV vs Trained (fit) Trained (Fit)--> HR will be LOWER and SV HIGHER (bc heart more efficient) HR (bpm), SV (ml/beat), CO (Q) (L/min)
32
Practice! 45yo male w/ BMI of 38 kg/m2 (>30=obese) enrolled in 6wk fitnes program. Which is MOST approp measrue to assess change in fitness from pre and post-training?
The **time** it takes for **HR to RETURN to baseline**--> Fitness measure
33
Transition from REST to EXERCISE to RECOVERY
see pics but ALL should INC w/ EXERCISE, then steady slow decline **NOTE: in UNfit it takes HR LONGER to return to baseline!!!**
34
Practice! PT admin'ing 6MWT to assess aerobic capacity of pt w/ 4yr hx of COPD. Which statement MOST accurate?
"Warmup" or practice test should NOT be performed immed before test! - bc measures **functional capacity, NOT dyspnea - NO pre-test!**
35
Ausculutation: **Heart Sounds** | how do you remember?
**APT-M 2245** - **AoRtic:** 2nd IC space, **R**ight sternal border - **Pulmonic: **2nd IC space, Left sternal border - **Tricuspid: **4th IC space, Left sternal border - **Mitral (PMI): **5th IC space, midclavicular line (left)
36
Heart Sounds (S1-S4) **What are the two NORMAL?**
S1: "Lub"; closure of **mitral/tricupsid valves (S1T),** onset of **SYSTOLE** S2: "Dub", closure of **aortic/pulmonary valves (S2AP), **onset of **DIASTOLE**
37
Heart Sounds (S1-S4) **Abnormal?**
S3: **Ventricular gallop,**ventricular filling, **assocd w/ HF** S4: **Atrial gallop,** ventricular filling and atrial contraction, **assocd w/ HTN and MI**
38
BEST site for auscultation if **S3 present**
MITRAL VALVE 5th IC space, midclavicular line, Left
39
Mitral site best for auscultation if _ present
S3! Ventricular gallop, vent filling, **assocd w/ HF**
40
S2 sound loudest HERE
Aortic/Pulmonic valves--**Base of heart**
41
S1 sound loudest here-->
Tricuspid/Mitral valves--> **Apex of heart**
42
S1 and S2 sounds loudest just think REVERSE OF HEART POSITIONS
S1 (#1) heard loudest @ APEX (bottom)-- Tricuspid/Mitral S2 (#2) heard loudest @ BASE (top)-- Atrial/Pulmonary valves
43
S1 sound heard where?
APEX (bottom)-- Tricuspid/Mitral Remember "S1TM"
44
S2 sound heard where?
BASE (top)-- Aortic/Pulmonic S2AP "SAP"
45
S3 and S4 heard where?
APEX (**A**bnormal sounds @ **A**pex (bottom)) **Mitral valve specifically (makes sense since this is PMI)** S3--CHF S4--HTN/MI

NPTE Final Frontier (19 decks)

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