Cardiovascular Flashcards
Perfusion triangle in a nutshell
heart blood and vessels
Heart - pump
Blood - contents
Vessels - containers
when one of these go out this results in hemodynamic instability
ways can cardiac output be adversely affected?
HR and SV increase or decrease
MAP - define
average arterial pressure throughout one cardiac cycle
Norms MAP and what decreased values indicate
Normal: 70 – 100 mmHg
Decreased: not enough blood flow to major organs → can lead to permanent damage
Ejection fraction define
percentage of blood pumped per ventricular contraction
Non stemi or Stemi which is more severe
stemi ( ST elevation) is more serious than nstemi ( ST depression)
indicates MI
Normal EF values and decrease in EF indicates
60 %
decreased = cardiomyopathy, weak heart muscles
ST elevation indicates
MI
ST depression of 1-2mm indicates
ischemia
know how to ID BP, MAP, HR, RR, SpO2
GREEN: HR
RED: BP
PURPLE: this is also BP (from a cuff) and shows last 5 readings
YELLOW: this measures pulmonary artery pressure (PAP) via a Swan Ganz catheter.
BLUE: oxygen saturation
WHITE: RR
What does this ECG show? can lead to?
AFIB
most common heart arrhythmia; can lead to syncope due to no atrial kick
Found with CHF, CAD, HTN, other cardiac conditions
What does this ECG show? can lead to?
V tach- Some blood filling in ventricles
most common after acute MI
What does this ECG show? can lead to?
V fib
chaotic rate and rhythm; will lead to death if untreated
What does this ECG show? can lead to?
Pt. reports skipped beat
If it continues = insufficient pumping of blood
Agonal Rhythm
irregular, < 20bpm, near death
AV Blocks
rhythm disturbance where electrical conduction from atria to ventricles is partially or completely blocked
Valvular heart disease
affects one or more of the 4 valves in the heart
stenosis - narrowing
regurgitation- backflow of blood
prolapse- valve not holding
Myocardial heart disease
affect heart muscle tissue, referred to as cardiomyopathy
Pericardial heart disease:
affects the pericardium, may be referred to as pericarditis
Cardiac tamponade
fluid in pericardium , ventricles cant expand, affects EF + SV
Thrombolytic Therapy indications and contraindications
chest pain suggesting MI, elevated ST segment, bundle branch block
NOT FOR pts who are risk for bleeding
PTCA (percutaneous transluminal coronary angioplasty)
PT consideration
Pt. had reduced circulation – monitor vitals
Coronary Artery Bypass Graft (CABG)
used post MI
Vascular graft is used to REVASCULARIZE myocardium when coronary artery is occluded
saphenous veins, internal mammary artery, or radial artery
Sternal Precautions
- no UE pushing or pulling
- overheadreaching (>90 degrees)
- no lifting objects >10 lbs, 4. Driving is usually restricted as well.
Automatic Implantable cardiac defibrillator
purpose and PT consideration
manages ventricular arrhythmia by defibrillating myocardium
** watch HR and BP
AICD/ICD (Automatic implantable cardiac defibrillator)
Battery powered device under skin monitors heart rate
Delivers shock if abnormal rhythm detected
** pts heart rate may change with physical activity ( may not have rate modulation)
External defibrilator - life vest
Worn by patients at high risk of sudden cardiac arrest
VAD (Ventricular assist device)
used to support pulmonary /systemic circulation
can be for terminal treatment
precautions VAD
emergency procedures in case of battery failure, maintain patency of drive lines with external pump,
MONITOR HEMODYNAMICS
precautions VAD
emergency procedures in case of battery failure, maintain patency of drive lines with external pump, monitor hemodynamics
precautions VAD
emergency procedures in case of battery failure, monitor hemodynamics
stable vs. unstable angina
stable angina - predictable and triggered by exercise , relieved by rest or nitroglycerin
unstable angina - occurs at rest, more likely to lead to an MI
Marburg Heart Score used for
Predicts likelihood of dx of CAD
Heart rate activity level monitoring general recommendation?
average population: 20 to 30 beat increase
HR activity level monitoring for pts on beta blockers?
do not exceed 20 beats above resting HR
AICD HR activity level monitoring
target HR 20-30 beats below threshold rate on defibrillator
Post heart transplant activity
HR not an accurate measure
HHR (HR recovery) define
difference between peak HR with exercise minus HR at 60 seconds
Normotensive systolic blood response
increase 5-12 mm Hg per increase in METs
What are MET values
metabolic equivalents
how many calories you burn during physical activity
abnormal response in BP
Systolic decrease of 10 mm Hg below resting
Systolic response of > 180 mm Hg
Diastolic response of > 110 mm Hg
Know METs <4
sitting - 1.3
standing - 1.8
home activity ( folding laundry and putting it away) - 2.3
Home activity (moderate effort of cleaning): 3.5
Know METs ≥4
walking: 4.3
yardwork : 5.0
running: 23.0
RATE OF PERCEIVED EXERTION (RPE) modified borg scale
Borg RPE Scale (6-20)
Onset of murmurs, S3 heart sounds, S4 heart sounds indicates
potential cardiac decline
Presence or increase in bibasilar crackles
potentially indicates CHF
cardiac rehabPhase I
what setting
Started as soon as patient is stable
Begins in inpatient setting (acute care, TCU, subacute, SNF)
cardiac rehab Phase I goal
= tolerate ADLs,
= walking functional distances,
climbing stairs (1-4 METS) with appropriate VS
no cardiovascular symptoms
= Education about risk factors and lifestyle modifications ESSENTIAL
cardiac rehab Phase II
what setting
what is continued and progressed
Early outpatient rehab
Usually starts about 2 weeks after cardiac event
Continues patient education
Progresses exercises and activities
cardiac Phase III - setting and goal
Maintenance and prevention
Usually begins 2-3 months after cardiac event
What is Auscultation
evaluate valve function, rate, and rhythm, valve compliance, and
ventricular compliance
Pitting Edema scale know generally
1 to 4
mild to severe
