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Cardio Examination & EKG Flashcards

1
Q

Rate Pressure Product: equation & definition

A

RPP = HR * SBP
Estimation of myocardial workload & O2 demand.

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2
Q

Cardiac Output: equation & definition

A

CO = HR * SV
Amount of blood pumped in 1min.

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3
Q

Stroke Volume definition

A

Amount of blood pumped in 1 beat.

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4
Q

Venous Return definition

A

Amount of blood returning to the heart (usually equal to CO)

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5
Q

Normal BP

A

SBP <120
AND
DBP <80

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6
Q

Elevated BP

A

SBP 120-129
AND
DBP <80

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7
Q

Stage 1 HTN

A

SBP 130-139
OR
DBP 80-89

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8
Q

Stage 2 HTN

A

SBP >140
OR
DBP >90

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9
Q

Hypertensive Crisis

A

> 180/120

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10
Q

HR and CO changes with exercise

A

Increases linearly with increased work rate.
Plateaus at 100% VO2max.

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11
Q

BP changes with exercise

A

SBP increases.
DBP remains constant (+/-10mmHg is ok).

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12
Q

How do vitals change INITIALLY with high altitude (acute hypoxia)?

A

HR: increase
BP: increase
CO: increase
SV: no change
RR: increase

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13
Q

How do vitals change once ACCLIMATIZED to high altitude?

A

HR: increase
BP: normal
CO: normal
SV: decrease
RR: normal

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14
Q

How do vitals change with aquatic?

A

HR: decrease
BP: decrease
VO2: decrease
Vital Capacity: decrease
CO: increase
SV: increase
Work of Breathing: increase

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15
Q

Nervous system response to high altitude & aquatic:
a) Altitude causes PNS activation. Aquatic causes PNS activation.
b) Altitude causes SNS activation. Aquatic causes SNS activation.
c) Altitude causes SNS activation. Aquatic causes PNS activation.
d) Altitude causes PNS activation. Aquatic causes SNS activation.

A

c) Altitude causes SNS activation. Aquatic causes PNS activation.

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16
Q

Beta-Blockers are prescribed for..

A

CAD
HTN

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17
Q

How do vitals change with Beta-Blockers?

A

Reduced HR, contractility, and myocardial O2 demand.
Lower HR during both submax & max exercise (still increases from resting HR, but lower compared to no meds).

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18
Q

How to determine exercise intensity with beta-blockers?

A

RPE!

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19
Q

Borg RPE Scale

A

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 = max exertion

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20
Q

Recommended RPE for cancer

A

11-13

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21
Q

Recommended RPE for obesity

A

up to 17

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22
Q

Recommended RPE for pregnancy

A

11-13

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23
Q

Recommended RPE for diabetes

A

11-13, progress to 12-16

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24
Q

Auscultation landmark: aortic valve

A

Right 2nd IC space, sternal border

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25
Auscultation landmark: pulmonary valve
Left 2nd IC space, sternal border
26
Auscultation landmark: tricuspid valve
Left 4th IC space, sternal border
27
Auscultation landmark: mitral valve
Left 5th IC space, midclavicular line
28
S1 heart sound
Normal "lub" Beginning of systole Closing of mitral & tricuspid
29
S2 heart sound
Normal "dub" Beginning of diastole Closing of aortic & pulmonary
30
S3 heart sound
Abnormal, ventricular gallop Occurs after S2 in early diastole Indicates overly compliant LV Common with CHF
31
S4 heart sound
Abnormal, atrial gallop Occurs before S1 in late diastole Indicates non-compliant LV Common with MI or HTN
32
Order of electrical flow through the heart
SA > AV node > AV bundle > bundle branches > Purkinje fibers > ventricular walls
33
What does the P-wave represent?
atrial DEpolarization
34
What does the QRS Complex represent?
ventricular DEpolarization & atrial REpolarization
35
What does the T-wave represent?
ventricular REpolarization
36
How to calculate HR from EKG
1. Count 30 large boxes (6 seconds). 2. Count number of R waves. 3. Multiply by 10.
37
Large box on EKG represents how many seconds?
0.2
38
1st Degree AV Block: what's happening physiologically?
Delay in conduction. May be seen in athletes with increased vagal tone.
39
2nd Degree AV Block: what's happening physiologically?
Partially blocked conduction. Mobitz Type 1 = disease of AV node. Mobitz Type 2 = disease of Bundle of His & Purkinje Fibers.
40
3rd Degree AV Block: what's happening physiologically?
fully blocked conduction. Issue of ventricles.
41
1st Degree AV Block: what does it look like?
-Long PR interval (>0.2 sec). -Always a QRS after each P-wave.
42
2nd Degree Mobitz Type 1 AV Block: what does it look like?
-Long PR interval (>0.2 sec). -Each PR gets longer leading up to QRS drop. -At least 1 QRS drops.
43
2nd Degree Mobitz Type 2 AV Block: what does it look like?
-Normal PR intervals. -QRS drops suddenly.
44
3rd Degree AV Block: what does it look like?
-P wave & QRS complex independent of each other (atrial & ventricular rates not communicating). -PR interval constantly changing, no pattern. -QRS wide & abnormal looking.
45
1st Degree AV Block: appropriate course of action
Continue exercise (benign issue).
46
2nd Degree Mobitz Type 1 AV Block: appropriate course of action
Continue exercise at a lower intensity & monitor sxs.
47
2nd Degree Mobitz Type 2 AV Block: appropriate course of action
Stop exercise & refer to MD.
48
3rd Degree AV Block: appropriate course of action
STOP & CALL 911
49
Ischemia vs Infarction: definitions
Ischemia: decreased blood supply. Infarction: complete occlusion of blood supply.
50
Ischemia vs Infarction: appearance on EKG
Ischemia: ST depression (at least 2mm), T-wave flat or inverted. Infarction: ST elevation (at least 1mm). *Note: 1 small box = 1mm.
51
Ischemia vs Infarction: appropriate course of action
STOP & CALL 911 (for both)
52
Supraventricular Arrhythmias: definition/pathophysiology & list examples
-Abnormal atrial rate. -Occurs when 1 contraction is not strong enough to push blood into ventricle. 1. Premature Atrial Contraction (PAC). 2. Atrial Tachycardia (A-tach). 3. Atrial Flutter. 4. Atrial Fibrillation (A-fib).
53
Are any Supraventricular Arrhythmias a 911 issue?
Nope!
54
PAC: EKG appearance
-P wave too early. -T wave may be cut short or not happen at all.
55
A-tach: EKG appearance
-Atrial rate 100-250bpm. -1 QRS after each P-wave.
56
Atrial Flutter: EKG appearance
-Atrial rate 250-350bpm. -Sawtooth pattern (multiple P-waves btwn each QRS).
57
A-fib: EKG appearance
-Atrial rate 400-600bpm. -No pattern of P-waves (random squiggles btwn each QRS). -Irregular QRS rate.
58
PAC: appropriate response
Continue at lower intensity & monitor sxs.
59
A-tach: appropriate response
Continue at lower intensity & monitor sxs.
60
Atrial Flutter: appropriate response
Asymptomatic: continue at lower intensity & monitor sxs. Symptomatic: stop exercise & refer to MD.
61
A-Fib: appropriate response
Stop exercise
62
Premature Ventricular Contraction: definition/pathophysiology
Heartbeat initiated by Purkinje fibers, skips atria & goes straight into ventricular contactions.
63
Premature Ventricular Contraction: EKG appearance
-P-wave absent. -QRS wide & bizarre looking.
64
Single PVC types
-Bigeminy: 1 normal beat, 1 PVC. -Trigeminy: 2 normal beats, 1 PVC.
65
Single PVC appropriate response
Lower intensity & monitor. If >6 PVCs in 1min: STOP & CALL 911.
66
Multiple PVC types & EKG appearances
-Multifocal: more than 1 PVC & they don't look similar. -Couplet: 2 PVCs in a row (no normal beat btwn them). -V-Tach: 3 or more PVCs in a row. -V-Fib: thin squiggles.
67
Multiple PVC appropriate response
-Multifocal: STOP & CALL 911. -One Couplet: stop exercise & refer to MD. -2 or more Couplets: STOP & CALL 911. -V-Tach: STOP & CALL 911. -V-Fib: STOP & CALL 911.
68
EKG: when do we call 911?
-3rd degree AV block. -6 or more PVCs in 1min. -2 or more couplets in 1min. -V-Tach. -V-Fib. -Myocardial Ischemia (ST depression). -Myocardial Infarction (ST elevation).
69
EKG: when do we stop & refer to MD?
-2nd Degree Mobitz Type 2 AV Block. -A-Fib. -Symptomatic A-Flutter. -One Couplet.

NPTE (28 decks)

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