Cardio Examination Flashcards
Heart rate and cardiac output increases with exercise
Increases linearly with increasing work rate
Reaches plateau at 100% VO2max
Blood pressure increases with exercise
Mean arterial pressure increases linearly
- systolic BP increases
- diastolic BP remains fairly constant (+/- 10mmHg)
Rate pressure product (RPP) aka double pressure product
Myocardial O2 demand
HR x SBP
Blood pressure guidelines: normal
Less than 120/80 mmHg
Blood pressure guidelines: elevated
Systolic 120-129 AND diastolic less than 80
Blood pressure guidelines: stage 1
Systolic 130-139 OR diastolic 80-89
Blood pressure guidelines: stage 2
systolic at least 140 OR diastolic at least 90
Blood pressure guidelines: hypertensive crisis
Systolic >180 AND/OR diastolic >120
Patient requires prompt change in medications if no other indications of problems
or immediate hospitalization if there are signs of organ damage
Sympathetic nervous system
fight or flight
increases HR, BP
“sympathetic to your plight - flight or fight”
Parasympathetic nervous system
rest and digest
decreases HR, BP
Steady state exercise
Initially, ATP is produced by anaerobic pathways and after steady state is reaching ATP is produced aerobically. O2 volume needs to be sufficient to meet ATP demands.
Physiologic changes at altitude with exercise: initial exposure
HR - increases
BP - increases
CO - increases
SV - no change
Physiologic changes at altitude with exercise: acclimatization
HR - increases
BP - normal
CO - normal
SV - decreases
stroke volume
the amount of blood ejected from the ventricle with each cardiac cycle
end systolic - end diastolic = SV
weight bearing at different levels of immersion in water
c7 - 10%
xiphoid - 33%
ASIS - 50%
Cardiovascular effects of aquatic therapy
HR - decreases
BP - decreases
Rate of oxygen uptake (VO2) - decreases
cardiac output - increases
stroke volume - increases
Decreased swelling and improved circulation due to the hydrostatic pressure exerted by water
Respiratory effects of aquatic therapy
vital capacity - decreases
work of breathing - increases
MSK effects of aquatic therapy
Weighbearing - decreases
edema - decreases
Improved muscle strength and endurance due to resistance to mvmt in water
Beta blockers and heart rate
beta-adrenergic blocking drugs - end in “-lol”
- compete with epinephrine and norepinephrine for beta adrenergic receptors in the heart
- reduced HR and contractility (lowers the myocardial oxygen demand)
Prescribed for patients with CAD and hypertension
Will lower HR during submaximal and maximal exercise
Borg RPE 6-20
NEVLSHVEM, S = 13
6 - no exertion at all
7.5 - extremely light
9 - very light
11 - light
13 - somewhat hard
15 - hard
17 - very hard
19 - extremely hard
20 - maximal exertion
Factors that regulate cardiac output
CO = HR x SV
HR
- PNS decreases
- SNS increases
SV
- SNS increases contraction strength, increases SV
- end-diastolic volume (preload) increases
- stretch/frank-starling increases
- mean arterial pressure decreases
Heart sounds
S1 - “lub”, closure of mitral and tricuspid valves, onset off systole
S2 - “dub”, closure of aortic and pulmonary valves, onset of diastole
S3 - “ventricular gallop”, ventricular filling, associated with heart failure
S4 - “atrial gallop”, abnormal, ventricular filling and atrial contraction
Auscultation landmarks
APT-M 2245
Aortic - 2nd IC space, R sternal border
Pulmonary - 2nd IC space, L sternal border
Tricuspid - 4th IC space, L sternal border
Mitral - 5th IC space, L midclavicular line
Heart sound locations
S2 loudest at base of heart
S1 and S2 equally loud at Erb’s point
S1 loudest at apex of heart
