Cardiopulmonary Implications of Specific Diseases

Question 1

Name the 3 P’s in T1DM

Answer 1

1. ) Polyuria
2. ) Polydypsia
3. ) Polyphagia

*Also may see weight loss

Question 2

Type of DM where there is autoimmune destruction of beta cells of the pancreas. Complete lack of insulin production. Occurs 10-25 y.o

Answer 2

T1DM

Question 3

Your patient c/o abdominal pain, having N/V and very dry skin. They have a previous dx of T1DM. What do you think is going on in this pt?

Answer 3

Diabetic Ketoacidosis!

*Hyperglycemia, N/V, ketotic breath, abd pain, dry skin and kussmaul breathing (rapid, deep)

Question 4

You are seeing a pt who c.o fatigue, weakness, dizziness and blurred vision. They are obese, age 44 and have a desk job. What are you thinking?

Answer 4

T2DM

*May also see acanthosis nigricans or skin tags

Question 5

Type 1.5 or Latent Diabetes of Adults

Answer 5

Between type 1 and 2
Type 1 Signs: Caused by autoimmune destruction of beta cells and BMI is less than 25
Type 2 Signs: Peak onset is 30-50 y/o, lack a family hx of DM, and lacks insulin resistance

Question 6

What is the gold standard for measuring blood glucose levels?

Answer 6

Glycosylated Hemoglobin (HbAlc or Alc)
*Goal is less than 5.9%, test provides 3 months overview of glucose

Question 7

HbA1c level of 6.0

Answer 7

Abnormal, need to start Metformin

*Normal: 4.6-5.7

Question 8

HbA1c level of 7.0

Average glucose 170

Answer 8

At increased cardiac risk, need to start Metformin

Question 9

HbA1c level 8.0

Average glucose of 205

Answer 9

Add insulin to current meds (Metformin + basal insulin) Deadly side effects!

Question 10

HbA1c level 10 or 11

Answer 10

At very high risk for CV event (Metformin+basal insulin+mealtime insulin regimen)

Question 11

Name the 3 major actions of insulin

Answer 11

1. ) Suppression of glucose production by liver
2. ) Promotion of glucose transport into cells
3. ) Synthesis of fat, protein, glycogen

Question 12

What hormones act in the opposite way of insulin?

Answer 12

1. ) Cortisol
2. ) Growth Hormone
3. ) Glucagon

Question 13

Ppl w/ diabetes are twice as likely to have what?

Answer 13

Heart disease

Question 14

Diabetics are 2-4 times more likely to suffer from

Answer 14

strokes (2-4x more likely to have a recurrence)

Question 15

Diabetic patients w/o previous myocaridal infarction have as high of a risk of myocardial infarction as…

Answer 15

non-diabetic patients w/ PREVIOUS MI—this provides rationale for treating CV risk factors in diabetic pts as aggressively as in non-diabetic pts w. prior MI

Question 16

Almost 70% of patient’s w/ first MI have…

Answer 16

IGT or undiagnosed disabetes

~2 out of 3 pts w/ MI have diabetes or pre-diabetes

Question 17

T2DM is a Progressive Disease. What are some of the progressions?

Answer 17

1. ) Obesity—to Impaired Glucose Tolerance–to diabetes–to uncontrolled hyperglycemia
2. ) Inadequet B-cell functioning—decresed B-cell functioning–
3. ) Increased post-prandial glucose—to elevated fasting BG

Question 18

DM is an equivalent to what disease?

T2DM is an equivalent to what?

Answer 18

1. )Cardiovascular Disease

2. ) Coronary Heart Disease

Question 19

What are some complications from Hyperglycemia and Vascular Disease

Answer 19

1. ) Coagulation is impaired
2. ) Platelets are hypersensitivity to stimuli and clot lysis is inhibited
   * Hyperglycemia=endothelial inflammation/damage, leading to increasing thrombus / clot formation

Question 20

What is the recommended BP for ppl w/ diabetes?

Answer 20

Systolic: Less than 130
Diastolic: Less than 80

Question 21

Microalbuminuria is…

Answer 21

an early indicator of diabetic nephropathy. This is the presence of small particles of protein in urine/allows passage of protein through the glomeruli.

If presence of microalburminuria is urinalysis indicates a 16.5X increased risk of CV mortality over 3.6 years

Question 22

Recommendations for Aspirin for decreasing clot formation/thrombus

Answer 22

• Aspirin 81 mg every evening

- Aspirin 325 mg if heart hx

Question 23

Insulin Resistance is linked to what CVD risk factors (5)

Answer 23

1. ) HTN
2. ) Endothelial Dysfunction
3. ) Microalbuminuria
4. ) Dyslipdaemia
5. ) Vascular Inflammation

Question 24

Patients w/ CAD should have what tested?

Answer 24

Oral glucose tolerance test is diabetic status is unknown

Question 25

Patient's w/ DM should be screened for what?

Answer 25

CAD

Question 26

What is the major precaution in PT when you have pts with DM and you want to exercise them?

Answer 26

They must have a thorough medical evaluation by their PCP prior to exercise greater than brisk walk intensity *Autonomic dysfunction is common

Question 27

You take your pt's resting HR and it is 115 bpm. You take their BP supine and then again 2 minutes after standing and the SBP decreased from 130 to 95. What are you thinking this patient has?

Answer 27

Cardiovascular Autonomic Neuropathy - RHR >100bpm - BP Response to Standing: If SBP decreases by greater than 30 or DBP decreases more than 10 - DBP Response to Sustained Isometric Exercise: Decreases by more than 10 after grip dynamometer 5x

Question 28

You patient shows signs of sweating, weakness, and is very irritable. You take their HR and it is 125bpm...what is going on with your patient???

Answer 28

They are hypoglycemic! -Tremor, nervousness, tachycardia, palpitations, sweating, hunger, irritability, weakness, dizziness, N/T of lips or tongue

Question 29

Your patient is complaining of achiness, being thirsting and needing to use the bathroom frequently. What is going on with your patient?

Answer 29

They are hyperglycemic! -Frequent urination, dry mouth/thirst, hunger, facial flushing, achiness, dry skin, N/V, abdominal pain, kussmaul breathing

Question 30

Signs of Neuroglycopenic

Answer 30

- Blurred Vision (sign of T2DM) - Headache - Weakness - blurred vision - confusion/impaired concentration - coma - death

Question 31

Anemia (Hematologic Disorder)

Answer 31

- Decreased O2 carrying capacity | - Decreased blood volume

Question 32

Sickle Cell Disease

Answer 32

- Shortened life span of RBC (10-12 days vs. 120) - Pain w/ occlusion of small vessels - Bi-ventricular hypertrophy due to compensatory overload w/ chronic anemia - Acute Chest Syndrome: Leading cause of death (pulmonary fat embolism from infarcted marrow)

Question 33

- Mortality rate 15% in 15 years - Death often due to cardiac arrhythmia - Wasted cardiac muscle and reduced LV mass - MVP due to mismatch of valve size versus atrophied heart Is this Anorexia Nervousa or Bulimia Nervosa?

Answer 33

Anorexia Nervousa

Question 34

- Electrolyte disorders > arrhythmia (hypkalemia) - Aspiration pneumonia - Esophageal Rupture - Chronic Ipeac use can cause cardiomyopathy Is this Anorexia Nervousa or Bulimia Nervosa?

Answer 34

Bulimia Nervosa