Cardio Pulmonary Exam Flashcards
Sleep apnea
Daytime sleepiness and objective findings of airways narrowing/obstructing at night
Sleep apnea hallmark
Airway narrow at night and collapse
Three types o f sleep apnea
central, obstructive, mixed
Central sleep apnea
altered chemosensitivity, decreased signals to respiratory muscle
Brain injury, encephalopathy
Premature infants < 40 weeks conceptual age
Obstructive Sleep apnea syndrome
repeated episodes of apnea > 10 seconds
Partial or complete pharyngeal collapse during sleep, leading to either reduction (hypopnea) or cessation (apnea) of breathing.
What happens do the pressure of muscles for someone who has OSAS?
Negative pressure during inspiration triggers a reflex which results in relaxation of pharyngeal muscles
What happens to the chemoreceptors for sleep apnea?
Dampening of the chemoreceptors during sleep, worsening the loss of airway tone
Classifications of Sleep Apnea:
● SEVERE: >30 episodes per night
● MODERATE: 15-30 episodes per night
● MILD: 5-14 episodes per night
sleep apnea risk factors (Adults)
Age, family, gender, Elevated BMI
Neck circumference:
Men greater than 17 inches
women greater than 16 inches
Sleep apnea risk factors (kids)
boys more than girls, increase CMI, african american, large adenoids or tonsils, low tone children, craniofacial abnormalities, chronic nasal obstruction
Signs and symptoms for adults with OSAS
⦿ Bed partner complaints ⦿ Sleep disturbances ⦿ Feel tired, groggy despite “sleeping” a full 8 hours ⦿ Morning headaches ⦿ Irritability ⦿ Diminished memory ⦿ Dry mouth ⦿ Car accidents
Signs and symptoms: children
Hyperactivity (primary symptom; opposite from adults)
Difficulty concentrating
Poor school performance
Long term consequences OSAS
HTN, coronary artery disease, heart failure, dysrhythmias, cerebrovascular disease (stroke, dementia, TIA, depression, erectile dysfunction)
Untreated OSAS have a higher death rate by how much?
3x higher
What is Obesity hypoventilation syndrome?
daytime hypercapnia PaCO2 > 45 mmHg and sleep disorder breathing
Altered breathing results in daytime low PaO2 and Daytime Elevated PCO2
Signs and symptoms hypoventilation syndrome?
Sleepiness Depression SOB with activity Irritability Signs of Cor Pulmonale
OHS risks:
HTN Cor Pulmonale Sexual dysfunction Dysrhytmia Polycythemia CVA
Treatment of Sleep Apnea with non invasive ventilation .
Goal : airway stenting
Goal: increase functional residual capacity
Increases VT by 25% and decreases by 30%
What is functional residual capacity?
the volume in the lungs after a normal expiration
- limits or decreases “de-recruitment” of alveoli
Continuous Positive Airway Pressure does what and how?
constant pressure during expiration to prevent patient from exhaling all the volume of lungs
Bilevel positive airway pressure
has two different pressures during inhale and exhale
Higher pressure during inhale for stenting
Lower pressure during exhale to facilitate blowing off of CO2
Indications for lung transplant
- Adv lung disease functional class 3/4
- progressive lung disease
- refractory to maximum medical intervention
- estimate survival chance of <50% in 2 years
Contraindications for Lung Transplant
- active malignancy w/I last 2-5 years
adv and untreatable disease of any organ
significant chest wall or spine deformity
documented non compliance
Untreatable psychiatric condition
no reliable social support
susbstance abuser
Relative contraindications for lung transplant
Age > 75 years
poor functional status with low potential for rehab
colonization with high resistant micro-ogranisms
obesity (BMI >30)
severe symptomatic osteoporosis mechanical ventilation
