Cardio Test/Numbers Flashcards
Arterial Blood Gases (ABG)
- collected to evaluate acid-base (pH), ventilation (PaCO2), and oxygenation of arterial blood (PaO2)
PaCO2 (norms and what is it)
Partial pressure of carbon dioxide in arterial blood; ventilation
PaCO2 - 40 mmHG (35-45mmHG)
- info on how well the lungs are able to remove the CO2.
- changes directly affect the balance of pH in the body.
PaCO2 <30 mmHG = alveolar hyperventilation
PaCO2 >50 mmHG = hypoventilation (failure)
PaO2 (norms and what is it)
oxygenation of arterial blood; partial pressure of O2 in arterial blood
PaO2 - 97 mmHg (80-100mmHg)
SaO2 (what is it and what is the norm)
percent oxygen saturation of hemoglobin
SaO2 - 95-98%
- provides information about how well the lungs are functioning to oxygenate blood.
SaO2 (what is it and what is the norm)
percent oxygen saturation of hemoglobin
SaO2 - 95-98%
- provides information about how well the lungs are functioning to oxygenate blood.
HCO3-
Bicarbonate. An important component of the chemical buffering system that keeps the blood from becoming too acidic or basic and is often part of the ABG test.
- HCO3-: 24 mEq/L (22-26 mEq/L)
if normal than no primary metabolic problem or metabolic compensation for respiratory problem
Normal pH
7.4 (7.35-7.45)
Acidemia
elevated acidity of the blood (pH<7.35)
Alkalemia
decreased acidity of blood (pH>4.5)
Eucapnia
normal level of CO2 in arterial blood
PaCO2 (35-45 mmHg)
Hypercapnia
elevated level of CO2 in arterial blood
PaCO2 (>45 mmHg)
Hypocapnia
low level of CO2 in arterial blood
PaCO2 (<35 mmHg)
PaCO2 relation to pH
PaCO2 >45 mmHg and pH<7.40 = respiratory acidosis
PaCO2 >45 mmHg and pH>7.40 = retention of CO2 to compensate for metabolic alkalosis
PaCO2 <35 mmHg and pH <7.4 = elimination of CO2 to compensate for metabolic acidosis.
PaCO2 < 35 mmHg and pH >7.4 = respiratory alkalosis.
HCO3- in relation to pH
HCO3- < 22 mEq/L and pH < 7.40 = metabolic acidosis
HCO3- < 22 mEq/L and pH > 7.40 = renal compensation for a respiratory alkalosis
HCO3- > 26 mEq/L and pH > 7.40 =metabolic alkalosis
HCO3- > 26 mEq/L and pH < 7.40 = renal compensation for respiratory acidosis
Pulmonary Function Testing (PFT)
- testing the volume or flow of air during inhalation and exhalation
- Tests: FVC, PEF, FEV1, and mid-expiratory flow (FEF 25-75%)
Procedure
* Exhales in spirometer as hard and as fast as possible for 6 seconds until no more air
*compared to those of same height, sex, height, weight, and race
Obstructive vs Restrictive pulmonary function test results
Obstructive ventilatory impairment:
* decreased expiratory flow, airway narrowing during exhale, FEV1/FEV <70% is the primary indicator of an obstructive impairment.
* (asthma, emphysema, and chronic bronchitis)
Restrictive ventilatory impairment:
* Reduced lung volumes (TLC, FVC, FEV1) and relatively normal expiratory flow rates
* Can be inferred from spirometry when FVC is reduced and FEV1/FVC is normal or >80%
* (interstitial lung disease, pleural disease, chest wall deformities, obesity , pregnancy, neuromuscular disease, and tumor)
Levels of Obstruction (%)
> 100% = possibly normal variant
70-100% = mild obstruction
60-70% = moderate obstruction
50-60% = moderate to sever obstruction
<50% = sever obstruction
Resting respiratory rates for healthy individuals
Newborn: 33-45 breaths/min
1 year: 25-35 breaths/min
10 yr: 15-20 breaths/min
Adult: 12-20 breaths/min
Rating of Perceived Exertion (RPE)
- used to quantify the subject’s overall sense of effort during activity.
- 2 scales used: 6-20 or 1-10. aka Borg Scale
Interpretation
* 13-14 = 70% of maximum HR during exercise on a treadmill or cycle ergometer
*11-13 = upper limit of prescribed training HR early in cardiac rehab
* RPE can substitute for HR in prescribing the intensity of exercise when.
Thoracentesis
A procedure that includes removal of fluid from the pleural space with a needle for a micro biologic, and cytologic studies 
Venograhy
A radiopaque die is injected into a vein, while an x-ray procedure creates an image of the vein to detect a clot or blockage 
Oral pharyngeal airway
A plastic tube shaped to fit the curvature of the soft palate and tongue that holds the tongue away from the back of the throat and maintains the patency of the airway.
Nasal pharyngeal airway
A latex or rubber tube inserted through the nose to allow for nasotracheal suctioning.
Endotracheal tube
A plastic tube inserted in the trachea from the mouth or nose to provide an airway and to allow for mechanical ventilation.
Tracheostomy tube
An artificial airway inserted into the trachea from an incision in the neck below the vocal cords used in patients needing prolonged mechanical ventilation.
Bullectomy
A surgical procedure in which one or more of the large air spaces called bulla that form when the alveoli are destroyed by emphysema are removed. The procedure can improve breathing.
Lung Volume Reduction Surgery
Removing a portion of the damaged lung tissue.
Tissue was damaged by emphysema
Creates more space in the chest for the remaining lung tissue and the diaphragm to work more efficiently, enabling them to breathe easier
Blood pressure numbers (hypertension classifications)
Normal:
SBP <120
(and)
DBP <80
Elevated:
SBP 120-129
(and)
DBP <80
Stage 1:
SBP 130-139
(or)
DBP 80-89
Stage 2:
SBP at least 140
(or)
DBP at least 90
Auscultation points for Heart Sounds
ALL POINTS TAKE MONEY
Aortic - 2nd intercostal space on the R sternal border
Pulmonic - 2nd intercostal space at the L sternal border
Tricuspid - 4th intercostal space at the L sternal border
Mitral - 5th intercostal space at the midclavicular line
Interpretation of Auscultation of the Heart Sounds (S1, S2, S3, S4)
S1 (lub)
*1st heart sound - closure of the mitral and tricuspid (atrioventricular) valves at the onset of ventricular systole.
S2 (dub)
* 2nd heart sound - closure of the aortic and pulmonic (semilunar) valves at the onset of ventricular diastole.
S3
* 3rd heart sound - vibrations of the distended ventricle walls due to passive flow of blood from the atria during the rapid filling phase of diastole.
* normal in kids, pregnant women, and athletes
S4 -
* 4th heart sound - pathological sound of vibration of the ventricular wall with ventricular filling and atrial contraction.
Heart Murmur
- Vibrations of longer duration than the heart sounds
- Often due to disruption of blood flow past a stenotic or regurgitant valve;
- Sounds are variably described as soft, blowing or swishing.
- When the leaflets of the heart valves are thickened, the forward flow of blood is restricted; when the leaflets lose competency and fail to close tightly, blood can flow backwards (regurgitation).
Pleural Friction Rub
- Dry, crackling sound heard during both inspiration and expiration.
- Occurs when inflamed visceral and parietal pleurae rub together.
Rhonchi
- Continuous low-pitched sounds described as having a “snoring” or “gurgling” quality that may be heard during both inspiration and expiration.
- Caused by air passing through an airway which is obstructed by inflammatory secretions or liquid, bronchial spasm or neoplasms in the smaller or larger airways.
Wheeze
- Continuous “musical” or whistling sound composed of a variety of pitches.
- Heard during both inspiration and/or expiration, but variable from minute to minute and area to area.
- Arise from turbulent airflow and the vibrations of the walls of small airways due to narrowing by bronchospasm, edema, collapse, secretions, neoplasm or foreign body.
Voice Sounds (normal)
- Transmission of spoken sounds is usually muffled;
- Whispered words are faint and the syllables are not distinct, except over the main bronchi.
- Increases in loudness and distinctness indicate consolidation, atelectasis or fibrosis, all of which improve transmission of vibrations through lung tissue.
- Whispered and spoken voice sounds are somewhat more valuable than breath sounds in detecting pulmonary consolidation, infarction, and atelectasis.
Voice sounds (abnormal)
Bronchophony, egophony, whispered pectoriloquy
- Bronchophony. Increased vocal resonance with greater clarity and loudness of spoken words (e.g., “99*).
- Egophony. A form of bronchophony in which the spoken long “E” sound changes to a long, nasal-sounding “A.”
- Whispered pectoriloquy Recognition of whispered words *1, 2, 3.
A 65-year-old man attends physical therapy complaining of progressive shortness of breath and lower leg swelling. During the examination the physical therapist identifies signs of increased jugular venous pressure, an S3 gallop, and moderate lower extremity edema. On auscultation of the patient’s lungs, which of the following sounds would the therapist MOST expect to hear?
Bilateral crackles
Explanation: Patients in left ventricular failure often have cardiogenic pulmonary edema due to an increase in hydrostatic pressure in the pulmonary capillaries. Fluid initially accumulates in the airways, progresses to the alveolar interstitium, and ultimately to the alveolar space. Crackles or wet rales along with decreased breath sounds are common auscultation findings.
What is the purpose of an exercise stress test?
- To determine physiological responses during increasing workloads.
- Determines the exercise capacity of a individual and detects presence of ischemia.
- Serves as a basis for exercise prescription. (admin prior to phase II of cardiac rehab)
- Screening measure for CAD in asymptomatic individuals
- can use a pharmacological stress test if they can’t perform regular ETT. Using a radionuclide perfusion with imaging to determine decreased blood flow to the myocardium
Main ways of testing Exercise tolerance test (ETT)/stress test?
- Treadmill and cycle ergometry (allows for precise calibration of exercise workload)
- Step test (upright or sitting) can also be a screening in healthy populations.
Different types of exercise tolerance tests (ETT)/stress tests?
- Maximal ETT – target endpoint HR. Only performed where there is ACLS trained individuals.
- Submaximal ETT – symptom-limited or terminated at 85% of age predicted HR max. Considered safe in all settings. Used to evaluate recovery of pts after MI, coronary bypass, or coronary angioplasty
- Continuous ETT – workload steadily progressed
Step test: workload increases every 2-3 min to reach steady stay between
Ramp test: workload increased every min so the pt isn’t allowed to reach steady rate.
Positive ETT is/means…
- myocardial O2 supply is inadequate to meet the myocardial oxygen demand. (+) for ischemia
Negative ETT is/means…
- indicates every tested physiological workload there is balanced oxygen supply and demand
False-positive ETT is/means…
- test is interpreted as positive but pt doesn’t have ischemia
False-negative ETT is/means…
- interpreted as negative but the pt has ischemia.
ABI
0.3 - severe arterial ischemia(pain will be at rest.)
0.5 - moderate peripheral arterial disease (LE pain with walking and at rest.)
0.8 - mild peripheral arterial disease (some form of intermittent claudication with walking but not at rest.
.90-.99 Borderline
1.0 - 1.3: normal
