Cardiopulm Flashcards
heart conduction pathway
SA node, AV node, Bundle of His, Purkinje fibers
Stroke volume
blood ejected per contraction: 55-100mL/beat
Preload
LV end diastolic volume, increases quantity of blood pumped, frank-starling law
afterload
force LV must generate to overcome aortic pressure to open aortic valve
Cardiac Output
amount of blood from L or R ventricle per min (4-5 L/min)
HR x Stroke Volume
Ejection fraction
SV/EDV
>55% is normal
atrial filling pressure changes during strong ventricular contraction
decreases - enhances atrial filling
Atrial filling pressure - def
diff bet venous and atrial pressures
R atrial filling pressure affected by changes in intrathoracic pressure - how
decreases during insp (increased atrial filling)
increases during cough (decreased atrial filling)
venous return increases when blood volume expands or decreases?
expands
venous return decreases or increases with hypovolemic shock?
decreases
lymph gets dumped back into venous system where?
L subclavian vein
lymph in R arm gets dumped through
R lymphatic duct
lymph in L arm gets dumped through
thoracic duct
Lymph in legs gets dumped through
thoracic duct
Cholinergic is symp or parasymp
parasymp
adrenergic is symp or parasymp
symp
parasymp control (brain, nerve)
medulla, vagus nerve
symp control (brain, nerve)
medulla, T1-T4, releases epi & norepi
baroreceptors located where and for what
aortic arch walls, carotid sinus
main mechanisms for ctrlling HR
Circulatory response to changes in BP: inc BP results in what stimulation? causing what response?
parasymp, dec HR & F of cardiac contraction
symp inhibition, dec peripheral resistance
Circulatory response to changes in BP: dec BP results in what stimulation? causing what?
symp, inc HR & BP, vasoconstriction of peripheral blood vessels
Inc R Atrial pressure causes what?
reflex acceleration of HR
Chemoreceptors found where? for what?
carotid body, sense O2, CO2, lactic acid
increased CO2, decreased O2, or decreased pH (lactic acid) leads to increased HR
temp effect on HR
inc temp, inc HR
dec temp, dec HR
Hyperkalemia what and causes?
Inc potassium K, dec rate and F of contraction, ECG widened PR interval & QRS, tall T waves
Hypokalemia what and causes?
dec K, flattened T, prolonged PR & QT intervals, arrythmia, v fib
Hypercalcemia what and causes what?
inc Ca+, increases heart actions
Hypocalcemia what and causes what?
dec Ca+, depress heart actions
Hypermagnesemia what and causes what?
inc Mg is a calcium blocker, arrythmias or cardiac arrest
Hypomagnesemia what and causes what?
dec Mg, causes ventricular arrythmias, coronary artery vasospasm, sudden death
apical pulse is palpable where?
5th intercostal midclavic line
normal HR adult? children, newborn?
60-100
60-140
90-164 (ave 127)
tachycardia, bradycardia
> 100, <60
aortic valve auscultation
2nd R intercostal space sternal border
Pulmonic valve auscultation
2nd L intercostal space sternal border
Tricuspid valve auscultation
4th L interconstal space sternal border
Mitral valve auscultation
5th L intercostal space midclavicular line
S1 is?
lub, closing of mitral and tricuspid valves
start of systole, decreased in 1st degree heart block
S2 is?
dub, closing of aortic and pulmonary valves
end of systole, decreased in aortic stenosis
murmur: systolic where? what?
between S1 & S2, may be normal, may be valve
murmur: diastolic where? what?
between S1 & S2, usu valvular disease
grade 1-6
Bruit is?
blowing sound of arterial or venous origin, atherosclerosis
S3 is?
soon after S2, ventricular filling
LV/congestive heart failure
S4 is?
just before S1, ventricular filling and atrial contraction;
CAD, MI, aortic stenosis, chronic HTN
P wave is?
atrial depolarization
P-R interval time is?
time required for impulse to travel from atria through purkinje fibers
QRS wave is?
ventricular depolarization
ST segment is?
beginning of ventricular repolarization
T wave is?
ventricular repolarization
QT interval is?
time for electrical systole
PVCs are? serious PVCs are?
premature beat from ventricle, no P wave, wide QRS;
>6/min, paired or in sequential runs, multifocal, very early
ventricular tachycardia is?
run of 3+ PVCs rapidly, usu the result of an ischemic ventricle
non sustained ventricular tachycardia
3+ PVCs consecutive, terminating spontaneously in 30s
sustained ventricular tachycardia
> 30s in duration
Edema grading scale
1+ mild, barely palpable
2+ moderate, easily identified depression, returns to normal in 15 seconds
3+ severe, takes 15-30 seconds to rebound, 1/2-1inch pitting
4+ very severe, depression lasts for >30 seconds or more
How many breaths per minute should a therapist administer when performing rescue breathing on an infant?
12-20
Which condition would maintain a normal heart rate of 60-100 beats per minute?
PAC
Which breath sound is a continuous adventitious sound comprised of a very high-pitched wheeze that can be heard with inspiration and expiration?
Stridor
Which value would be most representative of an adult’s normal resting cardiac output?
5 L
Hematocrit values
Hematocrit refers to the percentage of packed red blood cells in total blood volume. The normal hematocrit value for males is 40-54 mL/dL and for females is 37-47 mL/dL.
ABI values
An ankle-brachial index value of .5 or lower is indicative of severe arterial disease and as a result, exercise would be unrealistic. A value of .7 is indicative of moderate arterial disease and would likely permit limited exercise activity. Values greater than .9 and less than 1.1 are within the acceptable range of the ideal value of 1.0.
Vital capacity volume
Vital capacity is the maximal volume forcefully expired after a maximal inspiration. Normal vital capacity for an adult is 4,000-5,000 mL.
Vital capacity is the maximal volume forcefully expired after a maximal inspiration. Normal vital capacity for an adult is 4,000-5,000 mL. Normal values for forced expiratory volumes are as follows: forced expiratory volume in one second = 83% of vital capacity; forced expiratory volume in two seconds = 94% of vital capacity; forced expiratory volume in three seconds = 97% of vital capacity.
ACE inhibitor
Action: ACE inhibitor agents decrease blood pressure and afterload by suppressing the enzyme that converts angiotensin I to angiotensin II.
Indications: hypertension, congestive heart failure
Side effects: hypotension, dizziness, dry cough, hyperkalemia, hyponatremia
Implications for PT: Avoid sudden changes in posture due to the risk of dizziness and fainting from hypotension. Patients with heart failure should avoid rapid increases in physical activity.
Examples: Capoten (captorpril), Vasotec (enalapril), Prinivil (lisinopril), Altace (ramipril)
Nitrates
Action: Nitrate agents decrease ischemia through smooth muscle relaxation and dilation of peripheral vessels. My also dilate coronary arteries and improve blood flow
Indications: angina pectoris
Side effects: headache, dizziness, orthostatic hypotension, reflex tachycardia, nausea, vomiting
Implications for PT: Patients must be educated to come to a standing position slowly to minimize the risk of orthostatic hypotension. Sublingual administration of nitroglycerin is the preferred method to treat an acute angina attack.
Examples: Nitrostat (nitroglycerin), Isordil (isosorbide dinitrate), Amyl nitrite solution for inhalation
Beta blockers
Action: Beta blocker agents decrease the myocardial oxygen demand by decreasing heart rate and contractility by blocking ß-adrenergic receptors.
Indications: hypertension, angina, arrhythmias, heart failure, migraines, essential tremor
Side effects: bradycardia, cardiac arrhythmias, fatigue, depression, dizziness, weakness, blurred vision
Implications for PT: Heart rate and blood pressure response to exercise will be diminished. Rate of perceived exertion may be used to monitor exercise intensity. Closely monitor patients during positional changes due to an increased risk for orthostatic hypotension.
Examples: Tenormin (atenolol), Lopressor (metoprolol), Inderal (propanolol)
Calcium channel blockers
Action: Calcium channel blocker agents decrease the entry of calcium into vascular smooth muscle cells resulting in diminshed myocardial contraction, vasodilation, and decreased oxygen demand of the heart.
Indications: hypertension, angina pectoris, arrhythmias, congestive heart failure
Side effects: dizziness, headache, hypotension, peripheral edema
Implications for PT: Heart rate and blood pressure response to exercise will be diminished. Monitor patient closely when moving to an upright position secondary to dizziness and/or orthostatic hypotension. Observe the patient for signs and symptoms of congestive heart failure such as worsening peripheral edema, dyspnea or weight gain.
Examples: Norvasc (amlodipine), Procardia (nifedipine), Calan (verapamil), Cardizem (diltiazem)
Digitalis
Action: Positive inotropic agents increase the force and velocity of myocardial contraction, slow the heart rate, decrease conduction velocity through the AV node, and decrease the degree of activation of the sympathetic nervous system.
Indications: heart failure, atrial fibrillation
Side effects: cardiac arrhythmias, gastrointestinal distress, dizziness, blurred vision
ECG changes characteristic: gradual downsloaping ST segment, flat T wave, shortened QT interval
Leads to decreased HR and increased exercise capacity. BP will be unchanged.
Implications for PT: Therapists should monitor heart rate during activity, teach the patient and family to take the patientʼs pulse, and seek health care providerʼs advice for rates less than 60 beats/minute or more than 100 beats/minute.
Examples: Lanoxin (digoxin)
classifications of heart failure NY vs AHA
NY:
1: Mild HF. no limitations in physical activity (up to 6.5 mets)
2: Slight HF. up to 4.5 mets. comfortable at rest but ordinary physical activity results in fatigue, palp, dysp, or angina
3: marked HF. marked limitation. up to 3 mets. comfortable at rest. less than ordinary physical activity results in symptoms
4: severe HF. unable to carry out physical activity (1.5 mets)
AHA stages
A: at high risk for HF but without structural heart disease or symptoms of HF
B: Structural heart disease but without symptoms of HF
C: Structural heart disease with prior or current symptoms of HF
D: Refractory HF requiring specialized interventions
normal adult pH
7.35-7.45
normal paO2 and paCo2
O2: 80-100 mmhg
CO2: 35-45 mmhg
Crackles
Crackle (formerly rales)
An abnormal, discontinuous, high-pitched popping sound heard more often during inspiration. May be associated with restrictive or obstructive respiratory disorders.
Typically represents the movement of fluid or secretions during inspiration (wet crackles) or occurs from the sudden opening of closed airways (dry crackles). Crackles that occur during the latter half of inspiration typically represent atelectasis, fibrosis, pulmonary edema or pleural effusion. Crackles due to the movement of secretions are usually low-pitched and can be heard during inspiration and/or expiration like the sound of hairs being rubbed together between the thumb and forefinger.
Pulmonary edema may produce fine crackles as air bubbles through fluid in the distal small airways.
Often heard in the bases of lungs with interstitial lung disease, atelectasis, pneumonia, bronchiectasis, and pulmonary edema.
Plural friction rub
Pleural friction rub
Dry, crackling sound heard during both inspiration and expiration.
Occurs when inflamed visceral and parietal pleurae rub together.
Heard over the spot where the patient feels pleuritic pain.
Rhonchi
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 (sibilant rhonchi) or larger (sonorous rhonchi) airways.
Stridor
Continuous high-pitched wheeze heard with inspiration or expiration.
Indicates upper airway obstruction.
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.
MET activities
Light (< 3 METs)
Moderate (3-6 METs)
Vigorous (>6 METs)
Walking, Jogging, Running Walking slowly at home or office = 2.0 Walking 3 mph = 3.0 – 4.0 Walking 4 mph = 4.5 – 7.0 Walking 4.5 mph = 6.3 Jogging 5 mph = 8.0 Running 7 mph = 11.5
Self-care, Household, and Occupation Toileting = 1.0 – 2.0 Driving a car = 1.0 – 2.0 Working at a computer or desk = 1.5 Making bed, washing dishes = 2.0 Bathing = 2.0 – 3.0 Cooking = 2.0 – 3.0 Washing windows or car = 3.0 Sweeping, vacuuming = 3.0 – 3.5 Light gardening = 3.0 – 4.0 Carrying, stacking wood = 5.5 Power lawn mowing = 5.5 Shoveling = 7.0 Carrying heavy loads = 7.5 Heavy farm work = 8.0 Digging ditches = 9.5
Leisure Time and Sports Playing cards, arts, and crafts = 1.5 Playing musical instrument = 2.0 – 2.5 Fishing (sitting) = 2.5 Slow dancing = 3.0 Table tennis = 4.0 Fast dancing = 4.5 Basketball shooting around = 4.5 Sexual intercourse = 4.0 – 5.0 Golf (walking) = 4.0 – 7.0 Swimming = 4.0 – 8.0 Tennis doubles = 5.0 Backpacking = 5.0 – 11.0 Basketball game = 8.0 Bicycling (flat) 10-12 mph = 6.0 Bicycling (flat) 12-14 mph = 8.0 Bicycling (flat) 14-16 mph = 10.0
homans sign
associated with DVT. pain in calf on forceful abrupt DF
