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Cardiopulmonary > Cardiopulmonary Implications of Specific Diseases > Flashcards

Cardiopulmonary Implications of Specific Diseases Flashcards

1
Q

Name the 3 P’s in T1DM

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

*Also may see weight loss

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2
Q

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

A

T1DM

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3
Q

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?

A

Diabetic Ketoacidosis!

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

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4
Q

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?

A

T2DM

*May also see acanthosis nigricans or skin tags

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5
Q

Type 1.5 or Latent Diabetes of Adults

A

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

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6
Q

What is the gold standard for measuring blood glucose levels?

A 
Glycosylated Hemoglobin (HbAlc or Alc)
*Goal is less than 5.9%, test provides 3 months overview of glucose
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7
Q

HbA1c level of 6.0

A

Abnormal, need to start Metformin

*Normal: 4.6-5.7

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8
Q

HbA1c level of 7.0

Average glucose 170

A

At increased cardiac risk, need to start Metformin

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9
Q

HbA1c level 8.0

Average glucose of 205

A

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

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10
Q

HbA1c level 10 or 11

A

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

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11
Q

Name the 3 major actions of insulin

A
  1. ) Suppression of glucose production by liver
  2. ) Promotion of glucose transport into cells
  3. ) Synthesis of fat, protein, glycogen
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12
Q

What hormones act in the opposite way of insulin?

A
  1. ) Cortisol
  2. ) Growth Hormone
  3. ) Glucagon
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13
Q

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

A

Heart disease

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14
Q

Diabetics are 2-4 times more likely to suffer from

A

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

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15
Q

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

A

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

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16
Q

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

A

IGT or undiagnosed disabetes

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

17
Q

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

A
  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
18
Q

DM is an equivalent to what disease?

T2DM is an equivalent to what?

A
  1. )Cardiovascular Disease

2. ) Coronary Heart Disease

19
Q

What are some complications from Hyperglycemia and Vascular Disease

A
  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
20
Q

What is the recommended BP for ppl w/ diabetes?

A

Systolic: Less than 130
Diastolic: Less than 80

21
Q

Microalbuminuria is…

A

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

22
Q

Recommendations for Aspirin for decreasing clot formation/thrombus

A
  • Aspirin 81 mg every evening

- Aspirin 325 mg if heart hx

23
Q

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

A
  1. ) HTN
  2. ) Endothelial Dysfunction
  3. ) Microalbuminuria
  4. ) Dyslipdaemia
  5. ) Vascular Inflammation
24
Q

Patients w/ CAD should have what tested?

A

Oral glucose tolerance test is diabetic status is unknown

25
Q

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

A

CAD

26
Q

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

A

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

27
Q

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?

A

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
28
Q

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???

A

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

29
Q

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

A

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

30
Q

Signs of Neuroglycopenic

A
  • Blurred Vision (sign of T2DM)
  • Headache
  • Weakness
  • blurred vision
  • confusion/impaired concentration
  • coma
  • death
31
Q

Anemia (Hematologic Disorder)

A
  • Decreased O2 carrying capacity

- Decreased blood volume

32
Q

Sickle Cell Disease

A
  • 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)
33
Q
  • 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?

A

Anorexia Nervousa

34
Q
  • Electrolyte disorders > arrhythmia (hypkalemia)
  • Aspiration pneumonia
  • Esophageal Rupture
  • Chronic Ipeac use can cause cardiomyopathy

Is this Anorexia Nervousa or Bulimia Nervosa?

A

Bulimia Nervosa

Cardiopulmonary (7 decks)

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