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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

A

DECd SBP

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
Q

Beta Blockers and HR
What are they doing? and What will happen as a result?

The “LOLs”

A
  • 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
Q

Beta Blockers compete w/ epi and NE (inc HR) to block adrenergic receptors (Lower HR)
Prescribed for what pts?

A

CAD and HTN**

27
Q

Practice!
54yo pt on beta-blockers 5yrs. PRior to ex program, pt should receive explnation of?

A

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
Q

Why RPE 6-20?

A
  • 60= RHR most people
  • 200= MHR most people
  • Just add zero to RPE==HR

NOTE: 11-13 for Cx and pregnancy
17- obesity

29
Q

How to remember RPE:

A

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
Q

Factors that regulate CO

CO=HR x SV

A

CO=
- Cardiac rate (HR)–> Parasympa nerves/Sympa nerves
- Stroke Volume (SV)–> Contraction strength, EDV (preload), Mean Arterial Pressure (afterload)

31
Q

Fit vs Unfit-Cardiac Ouput

How can you clarify or define the table?

Untrained vs Trained male

A

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
Q

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?

A

The time it takes for HR to RETURN to baseline–> Fitness measure

33
Q

Transition from REST to EXERCISE to RECOVERY

A

see pics but ALL should INC w/ EXERCISE, then steady slow decline
NOTE: in UNfit it takes HR LONGER to return to baseline!!!

34
Q

Practice!
PT admin’ing 6MWT to assess aerobic capacity of pt w/ 4yr hx of COPD. Which statement MOST accurate?

A

“Warmup” or practice test should NOT be performed immed before test!
- bc measures functional capacity, NOT dyspnea
- NO pre-test!

35
Q

Ausculutation:
Heart Sounds

how do you remember?

A

APT-M 2245
- AoRtic: 2nd IC space, Right 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
Q

Heart Sounds (S1-S4)
What are the two NORMAL?

A

S1: “Lub”; closure of mitral/tricupsid valves (S1T), onset of SYSTOLE
S2: “Dub”, closure of **aortic/pulmonary valves (S2AP), **onset of DIASTOLE

37
Q

Heart Sounds (S1-S4)
Abnormal?

A

S3: Ventricular gallop,ventricular filling, assocd w/ HF
S4: Atrial gallop, ventricular filling and atrial contraction, assocd w/ HTN and MI

38
Q

BEST site for auscultation if S3 present

A

MITRAL VALVE
5th IC space, midclavicular line, Left

39
Q

Mitral site best for auscultation if _ present

A

S3!
Ventricular gallop, vent filling, assocd w/ HF

40
Q

S2 sound loudest HERE

A

Aortic/Pulmonic valves–Base of heart

41
Q

S1 sound loudest here–>

A

Tricuspid/Mitral valves–> Apex of heart

42
Q

S1 and S2 sounds loudest just think REVERSE OF HEART POSITIONS

A

S1 (#1) heard loudest @ APEX (bottom)– Tricuspid/Mitral
S2 (#2) heard loudest @ BASE (top)– Atrial/Pulmonary valves

43
Q

S1 sound heard where?

A

APEX (bottom)– Tricuspid/Mitral
Remember “S1TM”

44
Q

S2 sound heard where?

A

BASE (top)– Aortic/Pulmonic
S2AP “SAP”

45
Q

S3 and S4 heard where?

A

APEX (Abnormal sounds @ Apex (bottom))
Mitral valve specifically (makes sense since this is PMI)

S3–CHF
S4–HTN/MI

NPTE Final Frontier (19 decks)

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