cardiopulm exam 1/18 (ptfe) Flashcards
what pathology? • Fatigue, pulmonary edema • Fluid weight gain • Dyspnea • S3 heart sound • Crackles in lung (fluid in lung) • Orthopnea
L sided CHF
what pathology? • Fatigue, edema rest of body • jugular distension • Fluid weight gain • S3 heart sound • Orthopnea
R sided CHF
what used to test DVT?
wells criteria
homans sign - squeeze calf
DVT pop?
women more than men, esp. over 50 y.o.
what pathology? • Often asymptomatic • Pain in the region • Unilateral swelling, tenderness, and pain • Warmth and discoloration • Homan’s sign
deep vein thrombosis
• blood clots in pelvis, leg, or major UE veins
how DVT diagnosed?
how treated?
ultrasonography
anticoagulants
what pathology? • Dyspnea • Pleuritic, sharp, localized chest pain • Diffuse chest discomfort • Persistent cough • Hemoptysis • Tachypnea, tachycardia • Apprehension, anxiety, restlessness
pulmonary embolism
- Pulmonary vascular obstruction by displaced thrombus
symptoms:
• Bruit heard over swollen area (listen with stethoscope)
• Abdominal/back/flank pain
• Leg pain, claudication
• Poor distal pulses
• Pulsating mass in the abdominal area (sometimes)
Abdominal Aortic Aneurysm
what heart sound?
AV valve closure (onset of systole)
S1
what heart sound? Semilunar valve (pulmonary/aortic) closure (onset of diastole)
S2
what heart sound?
heard in early diastole associated with CHF, athletes (“Kentucky”)
S3
what heart sound?
heard in late diastole associated with MI or hypertension (“Tennessee”)
S4
What nerve?
primary innervator of PNS for most of viscera
what action?
Vagus CNX
• Decreases heart rate
• Decreases blood pressure
how to stimulate CN X?
- Carotid sinus massage
- Valsalva maneuver
- Pain
signs of CN X lesion
dysphagia, difficulty swallowing
gag reflex, uvula deviates to strong side
what maneuver?
Intrathoracic pressure increased against a closed glottis
what effects?
valsalva
• Collapsed veins reduce BP and HR
• Overshoot of ↑ BP and ↓HR
when to use valsalva maneuver?
supraventricular tachycardia
muscles contract to elevate ribs during inspiration
external intercostal
muscle contracts to to expand thoracic cavity, flattens when contract
diaphragm
accessory muscle for inspiration
- contracts to elevate sternum
SCM
accessory muscle for inspiration
- contracts to pull ribs outward
pec minor
muscle contracts to to contract pull ribs down during expiration
internal intercostals
quadratus lumborum
muscle relaxes to reduce thoracic cavity during expiration
diaphragm
accessory muscle for expiration
- contracts to compress abdomen
abdominals
contralateral tracheal deviation
space occupying:
Tension Pneumothorax
Pleural effusion
Space-occupying lesion
tracheal ipsilateral deviation
collapse:
Pneumonectomy
Pleural Fibrosis
Atelectasis (collapse of part/all of lung)
what pathology?
- life-threatening condition
- air leaks into the space between the lungs and chest wall
- air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function
Tension Pneumothorax
what pathology?
“water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs.
Pleural effusion
right pneumonectomy - which way does trachea deviate?
right deviated trachea
what kind of breath sound?
caused by CHF, air bubbles, fluid in the alveoli
Crackles (rales)
what kind of breath sound?
• Pulmonary edema,
pulmonary fibrosis,
infection of small bronchioles
Crackles (rales)
what kind of breath sound?
High-pitched wheezing
Wheezes
what kind of breath sound?
Asthma, partially obstructed bronchi/bronchioles
Wheezes
what kind of breath sound?
Low pitched wheezing, sonorous sleeping/snoring
Rhonchi, snoring rhino
what kind of breath sound? • Pneumonia, bronchitis, cystic fibrosis, COPD, secretions in larger airways
Rhonchi snoring rhino
what kind of breath sound?
High-pitched wheezing, upper airway blockage/object
Stridor
what kind of breath sound? Tracheal Stenosis (narrowing of your trachea) or object obstruction
Stridor
what kind of breath sound?
rapid breathing followed by apnea/cardiac failure
- end of life
Cheyne-stokes Respirations
Xray passes through
- air is black
radiolucent
Xray cannot pass through
- bone, metal is white
radioopaque
lung so full of fluid shows up white on Xray
- air that usually fills the small airways in your lungs is replaced with something else, eg. fluid, such as pus, blood, or water
Consolidated lung
which breathing technique?
• Unresisted inspiration
• Exhalation through pursed lips
• Prevents airway collapse, better gas exchange
pursed lip breathing
which breathing technique?
• To mobilize secretions (e.g. Cystic Fibrosis)
• Exhaling through open mouth (as if to steam a mirror)
• “HAA” “HAA”
huffing
which breathing technique?
- Breathing control (relaxed)
- Deep breathing (thoracic expansion) Deep breath with 3- second hold
- Huffing maneuver to mobilize secretions
Active Cycle Breathing
what pathology? • Smoking, occupational exposures, pollutants • Hypoxemia, hypercapnia • Hyperinflation “barrel chest” • Cyanosis, nail clubbing
COPD
Chronic airway obstruction
what pathology?
• C8, T1, T2 Dermatome paresthesias (similar thoracic outlet)
• horner’s syndrome (Miosis, ptosis, enophthalmos)
• Sharp shoulder pain, axilla, subscapular area
• Pulmonary symptoms - Dyspnea, cough, hemoptysis
what is it mistaken for?
Pancoast’s Tumor- Apical tumor of lung
mistaken for: thoracic outlet syndrome, OA, or impingement
what pathology?
- miosis (constriction of the pupil),
- ptosis (drooping of the upper eyelid),
- anhidrosis (absence of sweating of the face)
- Enophthalmos is the posterior displacement of the eyeball within the orbit
cause?
horner’s syndrome
- caused by damage to the sympathetic nerves of the face.
what patholoyg?
- muscles of the forearm, wrist and hand are most affected
- caused by a birth injury to the neck and shoulder due to a difficult vaginal delivery, tumor of the lung or shoulder, or trauma to the arm and shoulder.
- brachial plexus nerves may be stretched or torn, causing weakness, pain or numbness.
Klumpke’s palsy
what breathing pattern?
large breaths with periods of apnea
Biots
what breathing pattern?
rapid breaths with periods of apnea, near end of life
Cheyne-stokes
what breathing pattern?
in response to acidosis, body tries to breathe acid (CO2) out
- think boy scout blowing to start fire
Kussmaul
AHA classification for BP:
normal
<120 mmHG AND <80 mmHG
AHA classification for BP:
Elevated
120-129 mmHG AND <80mmHG
AHA classification for BP:
Stage 1 Hypertension
130-139 mmHG OR 80-89 mmHG
AHA classification for BP:
Stage 2 Hypertension
≥140 mmHG OR ≥ 90 mmHG
what term?
amount of blood in ventricle at the end of diastole (LVEDV)
Preload
what term?
force the LV must generate to overcome aortic pressure
Afterload
what term?
amount of blood ejected with each contraction
Stroke volume
what term?
% of blood ejected from total volume of ventricle
normal?
how to calculate?
Ejection fraction
• Normal 55-75%
- calculate with echosonogram
what do you expect in patient with low Ejection fraction? eg. 12%
expect fatigue, dyspnea, multiple rest breaks for ADL
CV response to exercise
increased O2 demand and increased external load
- HR increases linearly
- SBP increases linearly
- DBP limited changes (+/- 10 mmHg)
- Tidal volume and respiratory rate increase
UE or LE?
has increased sympathetic activity during exercise, greater increase in HR
UE 30-40% more than LE
UE or LE?
increase O2 demand during exercise
LE more muscle mass
UE or LE?
Lower mechanical efficiency
more energy cost
Needs to recruit additional stabilizing postural muscles
UE (LE has more mass)
what protein further the vasoconstriction in all non-working muscles during sympathetic activity?
catecholamines
normal or abnormal response to exercise? • Moderate to severe, increasing angina Marked dyspnea • Dizziness, light-headedness, ataxia • Cyanosis/pallor • Excessive fatigue
abnormal
normal or abnormal response to exercise?
• BP response 150/120
abnormal, Hypertensive
>180/>110
normal or abnormal response to exercise?
SBP rise 10mmHg
normal
normal or abnormal response to exercise?
SBP drop 10-15mmHg
abnormal
normal or abnormal response to exercise?
Significant change in EKG rhythm
next steps?
abnormal
wait to return to baseline
If ST elevation = emergency, call 911
normal or abnormal response to exercise?
• Blunted BP response
abnormal
normal if on metoprolol, beta blocker
normal or abnormal response to exercise?
• Leg cramps, claudication
abnormal
if angina, what medication to take?
how to take it?
what next steps if no response?
nitroglycerin - vasodilator, a medicine that opens blood vessels to improve blood flow and angina symptoms
- sublingual, under the tongue
1 tab every 5 mins, up to 3x
- call 911 if unrelieved
what pathology?
• chest pressure doesn’t change w position, etc
• Occurs at rest without precipitating factors
• Requires immediate medical intervention
unstable angina
what pathology?
• ischemic chest pain
• Experienced at predictable workloads/effort
stable angina
what pathology?
• Vasospasm, responds to nitroglycerin treatment
• Need referral for calcium channel blocker
• occurs at rest
Prinzmetal angina
related to what pathology?
• Decreased O2 perfusion
• Tissue injury and infarction
Myocardial infarction - heart attack
related to what pathology?
• Insufficient BP to heart and vital organs
MI • Cardiogenic shock
related to what pathology?
• Pt complaints- chest pain, radiate to L arm, jaw, thorax, fatigue, weakness
• ECG
• Cardiac enzymes (• Creatine kinase-myocardial band • Lactic dehydrogenase • Troponin • Myoglobin)
MI acute coronary syndrome
patient complaints for MI
- Intense chest pressure “elephant on my chest”
- pounding headache
- Radiating pain to left arm, jaw, and thorax
- Compromised cardiac output, dizziness, light headed, sweating
- Fatigue, weakness
female complaints for MI that can be different than men?
symptoms relieved by?
- Mental status changes (older female)
- Dyspnea
- Weakness, lethargy
- GERD pain
- Anxiety, Depression
- Sensation of inhaling “cold air”
- Achiness, heaviness, weakness of UE’s
- Symptoms relieved by antacids
what medication used?
• hyperlipidemia with coronary artery disease
statin
side effects of what drug? • Myalgia, myopathy • Liver impairment (Asterixis, Carpal tunnel syndrome, Ascites, etc.) • Rhabdomyolysis • Fever • Nausea/vomiting
statin
what situation? - rapid skeletal muscle breakdown, - goes to kidney work overtime to filter out, - dark brown urine what causes?
rhabdomyolysis
causes - overtraining, crush injury MVA, statin electrical injury
what symptom of liver impairment?
clonus of wrist, extension cause flapping
asterixis
what pathology?
symptoms mimic MI
no tissue death
improve with change in position- valsalva, lean forward/quadruped
pericarditis
causes of inflammation of pericardium
pericarditis
• Trauma
• Autoimmune, radiation
• Idiopathic
what pathology? symptoms: • Chest pain/dyspnea • Pain aggravated by trunk movement • Fever, chills, cough • LE edema • Pain relieved by holding breath or leaning forward/ sitting upright/ kneeling on all fours
pericarditis
what pathology?
pericardial sac filled with fluid, crush heart
cardiac tamponade
what pathology? caused by • Hypertension • coronary artery disease • Dysrhythmias • Valve abnormalities • Pericardial pathology • Cardiomyopathies results: bad heart pumping action, low cardiac output, renal dysfunction because kidneys detect less fluid
CHF
endocrine disorder most common cause of exophthalmos.
Graves’ disease
