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Cardiovascular Flashcards

1
Q

Venous Stasis/Incompetence

Grade I

A
  • Mild Aching
  • Minimal Edema
  • Dilated Superficial Veins
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2
Q

Variant Angina (Prinzmetal’s Angina)

A
  • Caused by vasospasm of coronary arteries in absence of occlusive diease
  • Responds well to nitroglycerin or calcium channel blocker long term
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3
Q

ECG Changes: Hypokalemia

A
  • Flattens or Inverts T Wave
  • U Wave
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4
Q

ECG Changes: Beta Blockers

A
  • Decreases HR
  • Blunts HR Response to Exercises
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5
Q

Pulmonic Valve Auscultation Landmark

A

2nd Left Intercostal Space at the Sternal Border

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6
Q

Late Stage PAD

A
  • Pain at Rest
  • Muscle Atrophy
  • Tropic Changes
    • Hair Loss
    • Skin/Nail Changes
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7
Q

Stable Angina

A
  • Classic exertional angina occuring during exercise/activity
  • Occurs at a predictable rate-pressure product
    • RPP=HRxBP
  • Relieved w/ rest and/or nitroglycerin
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8
Q

Stages of Lymphedema

Stage 0

A
  • At risk
  • Swelling not yet evident despite reduced transport capacity
  • Also called latent or pre-clincal stage
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9
Q

Zone of Infarction

A
  • Consists of Necrotic/Non-Contractile Tissue
  • Electraically Inert
  • Pathological Q Waves
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10
Q

Exercise Prescription

Post-PTCA (Percutaneous Transluminal Coronary Angioplasty)

A
  • Wait to exercise vigorously ≈2 weeks
  • Walking program can be initiated immediately
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11
Q

Common ECG Changes w/ Exercise

A
  • Tachycardia
  • Rate-related shortening of QT Interval
  • ST segment depressing/upsloing less than 1 mm
  • Reduced R wave/Increased Q wave
  • Exterional arrhythmias: rare, single PVCs
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12
Q

Subjective Ratings of Pain

w/ Intermitten Claudication

Grade I

A

Minimal Discomfort or Pain

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13
Q

ABI Values: 1.00-1.40

A

Normal

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14
Q

Bruit

A
  • An adventitious sound or murmur (blowing sound) of arterial or venous origin
  • Common in carotid or femoral artiers
  • Indivative of atherosclerosis
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15
Q

New York Heart Association Stage

Class III

A
  • Marked HF
  • Marked Limitation of PA
    • Up to 3.0 METs
  • Comfortable at Rest
  • Less than ordinary activity causes:
    • Fatigue
    • Palpitation
    • Dyspnea
    • Anginal Pain
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16
Q

ECG Changes: Hypocalcemia

A
  • Prolongs QT Interval
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17
Q

Subjective Ratings of Pain

w/ Intermitten Claudication

Grade III

A

Intense Pain

Patient’s Attention Cannot Be Diverted

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18
Q

Levine’s Sign

A

Patient Clenches Fist Over Sternum

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19
Q

Venous Stasis/Incompetence

Grade III

A
  • Venous Claudication
  • Severe Edema
  • Cutaneous Ulceration
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20
Q

Signs/Symptoms of Excessive Effort/Exertional Intolerance

A
  • Persistent Dyspnea
  • Dizziness or Confusion
  • Anginal Pain
  • Severe Leg Claudication
  • Excessive Fatigue
  • Pallor/Cold Sweat
  • Ataxia/Incoordination
  • Pulmonary Rales
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21
Q

Unstable Angina (Preinfarction, Crescendo Angina)

A
  • Coronary Insufficiency at any time without any precipitating factors or exertion
  • Chest pain increases in severity, frequency, and duration
  • Refractory to treatment
  • Increases risk for MI or lethal arrhythmia
  • Pain is difficult to control
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22
Q

ECG Changes: Quinidine

A
  • QT Lengthens
  • Flattens or Inverts T Wave
  • QRS Lengthens
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23
Q

Edema Grading Scale: 3+

A
  • Severe
  • Depression takes 15-30 seconds to rebound
  • 1/2-1 Inch Pitting
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24
Q

American College of Cardiology Foundation/American Heart Association Stages:

Stage B

A

Structural heart disease but without signs/symptoms of HF

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25
ABI Values: \<0.90
Abnormal
26
Stages of Lymphedema Stage 3
* Elephantias * Fibrotic deep skinfolds * Skin may change color * Skin changes may limit mobility
27
Stages of Lymphedema Stage 1
* Reversible * Early accumulation of fluid w/ visible swelling, pitting edema * Resolves w/ elevation (reversible pitting edema) * Stemmer's sign negative
28
Edema Grading Scale: 2+
* Moderate * Easily Identified Depression * Returns to Normal Within 15 Seconds * 1/4-1/2 Inch Pitting
29
Signs of a MI
* Rise and fall of cardiac troponin (primary measure) w/ one of the following: * Symptoms of ischemia * New/presumed new ST changes * Developmental pathological Q wave * New loss of viable myocardium and/or new wall motion abnormality on imaging * Evidence of intracoronary thrombus via catherization or autopsy * CK/CPK * Peaks between 12-24 hours
30
Edema Grading Scale: 4+
* Very Severe * Depression lasts for \>30 seconds or more * \>1 Inch Pitting
31
ECG Changes w/ Exercise Individuals w/ MI or CAD
* Significant Tachycardia * Exertional Arrhythmias * Increased frequency of ventricular arrhythmias during exercise and/or recovery * ST Segment Depression; horizontal or downsloping depression, greater than 1 mm below baseline, indicative of MI
32
American College of Cardiology Foundation/American Heart Association Stages: Stage D
Refractory HF requiring specialized interventions
33
Zone of Injury
* Area Immediately Adjacent to Central Zone * Tissue is noncontractile * Cells Undergoing Metabolic Changes * Electrically Unstable * Elevated ST Segments Over Injured Area
34
Venous Stasis/Incompetence Grade II
* Increased Edema * Multiple Dilated Veins * Changes in Skin Pigmentation
35
ABI Values: 0.91-0.99
Borderline
36
ECG Changes: Hypercalcemia
* Widens QRS * Shortens QT Interval
37
Early Stage PAD
* Intermittent Claudication * Burning, Searing, Aching, Tightness, or Cramping Pain * Occurs Regularly/Predictably w/ Walking * Relieved by Rest
38
ECG Changes: Hypothermia
* Elevates ST Segment * Slows Rhythm
39
ABI Values: \<0.50
* Severe Arterial Disease * Risk for Critical Limb Ischemia * May Have Pain at Rest
40
Strength Training in Phase 2 Programs
* After 3 weeks cardiac rehab * 5 weeks post-MI * 8 weeks post-CABG * Begin with use of elastic bands and light hand weights (1-3 lb) * Progress to moderate loads, 12-15 comfortable repetitions
41
Aortic Valve Auscultation Landmark
2nd Right Intercostal Space at the Sternal Border
42
Subjective Ratings of Pain w/ Intermitten Claudication Grade IV
Excruciating/Unbearable Pain
43
ECG Changes: Digitalis
* Depresses ST Segment * Flattens or Inverts T Wave * QT Shortens
44
Stages of Lymphedema Stage 2
* Spontaneously irreversible * Increase in swelling * Elevation does not reduce swelling * Positive Stemmer's sign
45
Zone of Ischemia
* Outer Area * Cells Undergoing Metablic Changes * Electrically Unstable * T Wave Inversion
46
Tricuspid Valve Auscultation Landmark
4th Left Intercostal Space at the Sternal Border
47
Relative Contraindications to Start Exercise
* Left main coronary stenosis * Moderate stenotic valvular heart disease * Electrolyte abnormalitis * Severe arterial hypertension * Tach/Bradyarrhthmias * Hypertrophic cardiomyopathy and other forms of outflow tract obstruction * Mental or physical impairment leading to inability to exercise adequately * High-degree artrioventricular block
48
Absolute Indications to Arrest Exercise
* Drop is SBP \> 10 mm hg * Moderate to severe angina * Increasing nervous system * Ataxia, Dizzines, Near Syncope * Signs of poor perfusion * Technical difficulties in monitoring ECG or BP * Subject's desire to stop * Sustained VT * ST elevation \> 1.0 mm
49
Thrill
* An abnormal tremor accompanying a vascular or cardiac murmur * Felt on palpation
50
New York Heart Association Stage Class II
* Slight HF * Slight limitation in physical activity * Up to 4.5 METs * Comfortable at rest * Ordinary PA causes * Fatigue * Palpitation * Dyspnea * Anginal Pain
51
Right Ventricular Failure
* Pulmonary Congestion * Dependent Edema * Weight Gain * Ascites * Liver Engorgement (Hepatomegaly) * Low Cardiac Output * Anorexia/Nausia/Bloating * Cyanosis (Nail Beds) * RUQ Pain * Juglar Vein Distension * Right-Sided S3 Sounds * Murmurs of Pulmonary Valve * Tricuspid Insufficiency
52
Mean Arterial Pressure (MAP)
* Arterial pressure within large arteries over time * Normal MAP is 70-110 mm Hg * (SBP + 2DBP)/3
53
Diastolic Murmurs
* Falls between S2 and S1 * Usually indicates valvular disease
54
Critical Stenosis PAD
* Resting/Nocturnal Pain * Skin Ulcers * Gangrene
55
Ankle Brachial Index (ABI)
Ratio of LE Presuure Divided by UE Pressure
56
American College of Cardiology Foundation/American Heart Association Stages: Stage A
At high risk for HF but without structural heart disease or symptoms
57
Edema Grading Scale: 1+
* Mild * Barely Perceptible Indentation * \<1/4 Inch Pitting
58
Absolute Contraindications to Start Exercise
* Acute MI (within 2 day) * Unstable angina not previously stablized by medical therapy * Uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise * Acute PE or pulmonary infarction * Acute myocarditis or pericarditis * Acute aortic dissection
59
Subjective Ratings of Pain w/ Intermitten Claudication Grade II
Moderate Discomfort or Pain Paitent's Attention Can Be Diverted
60
New York Heart Association Stage Class I
* Mild HF * No Limitation in physical activity * Up to 6.5 METs * Comfortable at rest * Ordinary activity does not cause: * Fatigue * Palpitation * Dyspnea * Anginal Pain
61
American College of Cardiology Foundation/American Heart Association Stages: Stage C
Structural Heart Disease w/ prior or current symptoms of HF
62
ABI Values: \>1.40
Indicates Non-Compliant Arteries
63
ECG Changes: Hyperkalemia
* Widens QRS * Flattens P Wave * Peaked T Wave
64
Exercise Prescription Post-CABG
* Limit UE exercise while sternal incision is healing * Avoid lifting, pushing, pulling for 4-6 postsurgery
65
ECG Changes: Antiarrhythimic Agents
* May Prolong QRS/QT Intervals
66
New York Heart Association Stage Class IV
* Severe HF * Unable to perform any PA w/o discomfort * 1.5 METs * Ischemia, dyspnea, anginal pain at rest * Increases w/ Exercise
67
Systolic Murmur
* Falls between S1 and S2 * May indicate valvular disease * Mitral valve prolapse * May be normal
68
Mitral Valve Auscultation Landmark
5th Left Intercostal Space at the Midclavical Area
69
Left Ventricular Failure
* Pulmonary Congestion * Dyspenia/Dry Cough * Orthopenea * Paroxysmal Nocturnal Dyspnea * Pulmonary Rales/Wheezing * Low Cardiac Output * Hypotension * Tachycardia * Lightheadedness/Dizzines * Cerebral Hypoxia * Irritability * Restlessness * Confusion * Impaired Memory * Sleep Disturbances * Fatigue/Weakness * Poor Exercise Tolerance * Enlarged Heart on X-Ray * S3 Sound, Maybe S4 * Murmurs of Mitral * Tricuspid Regurgitation
70
Relative Indications to Arrest Exercise
* ST or QRS changes (excessive ST depression) or marked axial shift * Arrhythmias other than sustained VT * Multifocal PVCs, triplets, SCT, heart block, bradyarrhythmias * Fatigue, SOB, wheezing, leg cramps, or claudication * Development of bundle branch block that cant be distinguished from VT * Increase chest pain * Hypertensive response * SBP \> 250 or DBP \>115
71
ECG Changes: Nitrates
* Increases HR

NPTE (19 decks)

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