Cardiovascular Flashcards
Increased BP results in what?
parasympathetic stimulation
- decreased rate and force of cardiac contraction
- sympathetic inhibition
- decreased peripheral resistance
Decreased BP results in what?
sympathetic stimulation
- increased HR and BP
- vasoconstriction of peripheral blood vessels
- increased right atrial pressure causes reflex acceleration of heart rate
Increased CO2 or decreased O2 cause what?
increase HR
hyperkalemia - what changes will be seen on ECG?
increased concentration of K+
- decreases rate of force of contraction
- widened PR interval and QRS, tall T waves
hypokalemia - what changes will be seen on ECG?
decreased K+
- flattened T waves, prolonged PR adn QT intervals
- arrhythmias that may progress to ventricular fibrillation
hypercalcemia
increased calcium concentration increases heart actions
hypocalcemia
decreased calcium concentrations depresses heart actions
hypermagnesemia
increased magnesium is a calcium blocker which can lead to arrhythmias or cardiac arrest
hypomagnesemia
decreased magnesium causes ventricular arrhythmias, coronary artery vasospasm, and sudden death
non-modifiable increased CVD risk factors
men > 45 and women > 55
cardiac event in 1st degree male relative < 55, or female relative < 65
African American
men > pre-menopausal women, after menopause, the risk equalizes
modifiable risk factor for CVD - cholesterol goals
total cholesterol < 200
LDL <160 if low risk
< 130 if moderate risk
< 100 if high risk, have CVD or diabetes
HDL > 40 in men, > 50 in women
triglycerides < 150
Grading scale for peripheral pulses
0 - absent
1+ - pulse dimenished, barely perceptible
2+ - normal
3+ - full pulse, increased strength
4+ - bounding pulse
POTS
sustained HR increase >/= 30 beats per minute within 10 min of standing (>/= 40 beats per min in teenagers)
weak, thready pulse means what
low stroke volume, cardiogenic shock
bounding, full pulse means what
shortened ventricular systole and decreased peripheral pressure; aortic insufficiency
auscultation landmarks - aortic valve
2nd right intercostal space at the sternal border
auscultation landmarks - pulmonic valve
2nd left intercostal space at the sternal border
auscultation landmarks - tricuspid valve
4th left intercostal space at the sternal border
auscultation landmarks - mitral valve
5th left intercostal space at the midclavicular area
S1 sound
when is it decreased?
“lub”
- normal closure of mitral and tricuspid valves; marks beginning of systole
decreased in 1st degree heart block
S2 sound
when is it decreased?
“dub”
- normal closure of aortic and pulmonary valves; marks end of systole
decreased in aortic stenosis
P wave
atrial deplolarization
P-R interval
time required for impulse to travel from atria through conduction system to Purkinje fibers
QRS wave
ventricular depolarization
ST segment
beginning of ventricular repolarization
T wave
ventricular repolarization
QT interval
time for electrical systole
V-tach
run of 4 or more PVCs sequentially
v-fib
pulseless, emergency, CPR
bizarre, erratic activity w/o QRS complexes
normal MAP
70-110 mmHg
what type of angina responds well to nitroglycerin
variant agina (Prinzmetal)
- vasospasm in absense of occlusive disease
left sided HF signs
- pulmonary congestion
- edema
- low cardiac output due to backup of blood from LV to LA and lungs
R sided HF signs
increased pressure load on RV
- hallmark signs of jugular vein distention and peripheral edema
Activity restrictions after acute MI
activity can be increased once the acute MI has stopped
limit to 5 METs or 70% of HRmax for 4-6 weeks
Activity restrictions for acute heart failure
O2 demand should NOT be increased in patients w/ acute or decompensated HF
Peripheral artery disease (PAD) early and late signs
early - intermittent claudication
late - rest pain, muscle atrophy, trophic changes
RPE has ________ reliability over time, but not ________ reliability
intra-rater reliability over time, but no inter-user reliability
metabolic conditions where cardiac rehab is contraindicated
- acute thyroiditis
- hypokalemia
- hyperkalemia
- hypovolemia
exercise prescription for post-PTCA (precutaneous transluminal coronary angioplasty)
- wait to exercise vigorously ~ 2 weeks post-PTCA
- use post-PTCA exercise test to perscribe exercise
exercise prescription for post-CABG
- limit UE exercise while sternal incision is healing
- avoid lifting, pushing, pulling 4-6 weeks post-surgery
acute cardiac rehab initial activities
- low intensity (2-3 METs)
- post MI limited to 70% max HR for 6 weeks
- short sessions, 2-3 x per day
HEP for acute cardiac rehab
gradual increase ambulation time
- goal is 20-30 min, 1-2 x per day, 4-6 days per wk
Subacute (phase 2) cardiac rehab exercise guidelines
2-3 x per week
30-60 min w/ 5-10 warm-up and cool-down
strength training guidelines during subacute (phase 2) cardiac rehab
After 3 weeks of cardiac rehab, 5 weeks post-MI, or 8 weeks post CABG
- start w/ elastic bands and light hand weights (1-3lbs)
- progress to moderate loads, 12-15 comfortable reps
What should be avoided after pacemaker and automatic implantable cardioverter defibrillators placement
UE aerobic or strengthening exercises for 4-6 weeks after implant to allow the leads to scar down
contraindications for compression therapy
- ABI <0.8
- signs of active cellulitis or infection
- systemic arterial pressure <80 mmHg
- advanced peripheral neuropathy and uncontrolled congestive heart failure
S&S of lipedema
- swelling stops at ankles and wrists
- affects mainly women
- stemmer’s sign is negative; often painful on pinching
lymphedema management: What pressures are contraindicated for compression
> 45 mmHg
Class 2 & 3 HF exercise prescription: aerobic exercise
time - 20-60 min
intensity - 50-90% peak VO2
frequency - 3-5 x wk
duration - 8-12 wks
Class 2 & 3 HF exercise prescription: HIIT
time - >35 min
intensity - 90-95% peak VO2
frequency - 2-3 x wk
duration - 8-12 wks
Class 2 & 3 HF exercise prescription: UE and LE resistance training
time - 45-60 min
intensity - 60-80% 1 RM
frequency - 3 x wk
duration - 2-3 sets per muscle group, 8-12 wks
Class 2 & 3 HF exercise prescription: Inspiratory muscle training (IMT)
time - 30 min
intensity - >30% of MIP
frequency - 3 x wk
duration - 8-12 wks
Patients with heart failure can have a ____ heart sound
S3
S4 heart sound signifies
rapid ventricular filling after atrial contraction and is consistent with a presentation of systemic hypertension, cardiomyopathy or coarctation of the aorta
