CardioPulm Flashcards
Both of these signs are normal responses to the stress test.
P wave increases in height, and the S-T segment upslopes
Beta blockers work on the beta-adrenergic receptors to decrease
sympathetic responses to stress, primarily the heart rate.
Create back-pressure in the airways to ease airflow via what technique
pursed lip breathing
A Swan-Ganz catheter is a diagnostic tool used to
detect blood pressure in the right side of the heart.
Changes after heart transplant?
no longer any sympathetic innervation to the heart, blunting the effect of exercise on heart rate. After several minutes of activity, the heart will then respond to circulating catecholamines and increase gradually.
ABI values less than ? indicate PAD
0.90
S??? is created from the closure of the mitral and tricuspid valves during ventricular systole.
1
abdominal swelling and is a symptom of right-sided heart failure
Ascites
generalized swelling and is a symptom of right-sided heart failure
Anasarca
Hepatomegaly is a symptom of
R side heart failure
? sided heart failure leads to swelling in the lungs as the blood backs up, causing Dyspnea
Left
irregular ECG signals that are turbulent and asynchronous = ?
V fillibration (EMERGENCY)
? are air pockets in the lung that form from tissue destruction as a result of cancer, COPD, emphysema, etc.
Bullae
removal =
Bullectomy
procedure in which the involved lobe with part of the main stembronchus is removed; indicated for central tumors of the lung
Sleeve lobectomy
surgical procedure to remove a lung
Pneumonectomy
removal of a portion of diseased lung
lobectomy
Have the patient inhale deeply, and then assist exhalation with firm pressure applied to the chest wall.
What type of tx?
Segmental breathing;
requires manual assistance from the therapist to facilitate full exhalation of the targeted segments.
High x blood pressure does not allow the blood to be pumped efficiently out of the heart and subsequently reduces stroke volume.
diastolic
define Preload
Preload is the end-diastolic pressure and drives blood into the atria.
define Afterload
afterload is the amount of pressure that the heart needs to exert to eject the blood during ventricular contraction.
A patient with congestive heart failure is having great difficulty with activities of daily living. Which cardiac factor is MOST likely the cause of such difficulty?
Afterload
a high-pitched breath sound emanating from the patient’s upper bronchi during inspiration which can be a medical emergency and indicates obstruction of the upper airways.
Stridor
Describe Rhonchi
continuous gurgling or bubbling sounds typically heard during both inhalation and exhalation. These sounds are caused by movement of fluid and secretions in larger airways (asthma, viral URI)
short, explosive sounds. They can also sound like bubbling, rattling, or clicking. are generated by small airways snapping open on inspiration. predominantly inspiratory. Can be high or low pitched. Indicate…
Crackles aka Rales
Indicate pnumonia
x refers to the high-pitched whistle-like sound heard during exhalation as air moves through a narrow or obstructed airway. may also be lower-pitched, having a snoring or moaning quality in which they are referred to as rhonchi.
Wheeze
appropriate ratio of chest compressions to rescue breaths for infants
30:2 for 1 rescuer and 15:2 for 2 rescuers.
Posterior segment R upper lobe percussion occurs in what position?
What segment?
Pt turned 1/4 from prone on R with bed elevated 45 deg.
Post L upper lobe
What lobe?
1/4 turn to R from supine, bed elevated 12 inches percussion on L below axilla
L lingula upper lobe
Pt supine w bed flat, bil percussion below clavicle
anterior R/L upper lobes
Foot of bed elevated 12 inches, 1/4 turn on L; percussion @ R axilla
R mid lobe
Bed flat, pt prone; bil percussion @ inf border
Superior segment of lower lobes
Patient is prone with foot of bed elevated 18 inches, bilateral percussion on lower ribs
Posterior basal segments of lower lobes
Patient is supine with the foot of the bed elevated 18 inches, bilateral percussion over anterior lower ribs
Anterior basal segments of lower lobes
For whom is diaphragmatic breathing contraindicated or precaution
Moderate to severe COPD
Patients with paradoxical breathing
What is a good cue to facilitate the diaphragm
Sniffing
What are the expected outcomes of diaphragmatic breathing
Decreased respiration rate, decreased use of accessory muscles of inspiration, increased tidal volume, improvements of tolerance for activity
what wave segment is “key” to screening for MI? what changes alert for MI?
S-T is key! Elevation OR depression, downslope greater than 1mm change from baseline
is a very serious type of heart attack during which one of the heart’s major arteries (one of the arteries that supplies oxygen and nutrient-rich blood to the heart muscle) is blocked
ST-Elevation Myocardial Infarction (STEMI)
What ratio should q wave be to R wave?
Less than 1/3 of R wave
what does it mean when P wave is absent? what results expected?
SA node inactive
AV or HIS taking over = lower HR, progression of HF
normal resting HR for adults
60-100
lower for athletes
QT interval should be about what #
below 400 to 440 in men, up to 460 in women
lower HR results in a longer ???
QT interval AKA the time it takes to fire an impulse through the ventricles and then recharge
lower chamber of the heart beats too fast to pump well and the body doesn’t receive enough oxygenated blood
what is this arrythmia called?
V tach
What produces sawtooth pattern on ECG? What risks increase? Causes?
Atrial flutter
can lead to blood clots, over time weakens heart
Binge drinking, being overweight, caffeine OD
dif between a-fib and flutter?
In atrial fibrillation, the atria beat irregularly. In atrial flutter, the atria beat regularly, but faster than usual and more often than the ventricles, so you may have four atrial beats to every one ventricular beat.
Normal time for P R interval?
.12-20 ms
same for QRS wave
To carry out the activities of daily living an exercise intensity of at least ? METs is required
5
Contraind for ex testing
Acute myocardial infarction (within 4-6 days)
Unstable angina= pain @ rest in previous 48 hours
Uncontrolled heart failure
Acute myocarditis or pericarditis
Acute systemic infection
Deep vein thrombosis
Uncontrolled hypertension (systolic blood pressure >220 mm Hg, diastolic >120 mm Hg)
Severe aortic stenosis
Severe hypertrophic obstructive cardiomyopathy
Untreated life threatening arrhythmia
Dissecting aneurysm
Recent aortic surgery
expected outcome of exercise on BP
systolic blood pressure rises up to 225 mm Hg (more in athletes)
Diastolic blood pressure tends to FALL slightly
what is j point on ecg and what is expected in exercise
The J point (the point of inflection at the junction of the S wave and ST segment) becomes depressed during exercise, with maximum depression at peak exercise. Influences upslope of ST seg.
j point marks the end of V depolarization and beginning of repolarization
Uncontrolled hypertension = what levels
systolic blood pressure >220 mm Hg
diastolic >120 mm Hg
normal ECG changes in exercise
P wave increases in height
J point becomes depressed
ST segment upslopes
Q-T + PR interval shortens
T wave + R wave DECREASE in height
Hypotension during exercise, defined as a drop of more than ??? during exercise, may signify severe cardiac ischemia
10 mm Hg in the systolic blood pressure
what change in diastolic blood pressure during the postexercise period is not unusual and is considered physiologic
A 10 mm Hg decrease
What s/s considered abnormal on cardiac stress test
Exercise-induced hypotension
Exercise-induced angina or anginal equivalents
Appearance of an S3, S4 or heart murmur during exercise
large (more than 2 to 3 mm) ST-segment depressions depression during exercise indicate what pathology?
Cardiac arterial disease
The appearance during exercise of an S3, S4 or murmur indicates what
cardiac muscle dysfunction and therefore ischemia
Nonsignificant Findings During Exercise Stress Testing
Fatigue, dyspnea, diaphoresis, flushing
Incremental increase in blood pressure and heart rate
Shortening of QT + P-R interval
Functional J point depression ≤ 0.2 mV
