Cardio Exam Flashcards
Pt walks into Drs Office
Sequence of what we wanna measure
- 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
More on RPP
HR x SBP
Metabolic demands on heart
Incremental Exercise
What happens to **HR and CO? **
CO= HRxSV
- Incs LINEARLY w/ INCing work rate
- Reaches plateau @ 100% VO2max
Incremental Exercise
BP–what happens/Normal response?
Overall Mean Arterial Pressure (MAP)
- SBP INC’s
- DBP remains fairly constant (-10 to +10 is OK
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?
If SBP DECs to 100mmHg
**SHOULD INC w/ inc workload and linearly w/ HR
NOTE: >20 mmHg drop==SERIOUS CONCERN
PRACTICE!
Pts PMH includes hypercholesterolemia, T2DM. SBP is 122 DBP is 77. What stage HTN?
122/77
Elevated BP
NOTE that “Pre-HTN” no longer a thing!!!
BP Guidelines!!!
- 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
BP Guidelines:
Hypertensive Crisis
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
Nervous System Regulation of HR
Things to note
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
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?
ATP demand being met aerobically
Steady State VO2–>Plateau in O2 uptake attained w/in 1-4mins CONSTANT exercise.
What should you think about when thinking about **Altitude training? **
Raul’s first date!!! Very NERVOUS! High SNS activity!! EVERYTHING IS HEIGHTENED!!!
Ex. First date, NPTE== INC SNS
Terms to know
- BP
- HR–Tachy= fast >100; Brady= slow <60
- SV=blood/beat or stroke
- CO= HR x SV
Altitude training===
Think first exciting thing you did!!!
INC SNS**
Practice!
30yo male visits town 9000ft above sea lvl (altititude). INITIAL CV responses during first week?
EVERYTHING heightened!!
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
Altitude changes
Ex. to remember?
Rahul goes to the mnt for his GF–NERVOUS= INC SNS
Altitude Changes
Initial vs Acclimatization (takes ~3wks)
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
Acute hypoxia (Initial altitude change)
SNS Activation response?
INC HR
INC CO
INC BP
INC myocardial contraction velocity
Aquatic Therapy
What should you remember?
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
Aquatic Tx and Hydrostatic Pressure
Relation?
- Hydrostatic pressure causes more blood pumped more efficiently===>
- INC SV
- INC CO
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
DECd SBP
Summary of Aquatics and Response to Aquatic Tx
- DEC SBP–> INC venous return–> INC CO
- INC SV
- HR Dec
- DEC SBP
- Dec VO2
- INCd work of breathing
- DECd vital capacity
- Higher RR
Summary of Aquatics and Response to Aquatic Tx
Cardiovascular effects
REmember Rahul went to beach now heart happy (unlike the mountain)
- HR DECs
- BP DECs
- SV INCs
- CO INCs
Summary of Aquatics and Response to Aquatic Tx
Respiratory effects
- VC DECs
- Work of breathing INCs
Summary of Aquatics and Response to Aquatic Tx
MSK effects
WB DECs (better on jts)
Edema DECs (bc INC venous return)
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!!! **
Beta Blockers compete w/ epi and NE (inc HR) to block adrenergic receptors (Lower HR)
Prescribed for what pts?
CAD and HTN**
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
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
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
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)
Fit vs Unfit-Cardiac Ouput
How can you clarify or define the table?
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)
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
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!!!
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!
Ausculutation:
Heart Sounds
how do you remember?
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)
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
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
BEST site for auscultation if S3 present
MITRAL VALVE
5th IC space, midclavicular line, Left
Mitral site best for auscultation if _ present
S3!
Ventricular gallop, vent filling, assocd w/ HF
S2 sound loudest HERE
Aortic/Pulmonic valves–Base of heart
S1 sound loudest here–>
Tricuspid/Mitral valves–> Apex of heart
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
S1 sound heard where?
APEX (bottom)– Tricuspid/Mitral
Remember “S1TM”
S2 sound heard where?
BASE (top)– Aortic/Pulmonic
S2AP “SAP”
S3 and S4 heard where?
APEX (Abnormal sounds @ Apex (bottom))
Mitral valve specifically (makes sense since this is PMI)
S3–CHF
S4–HTN/MI
