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NPTE > Cardiovascular > Flashcards

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
Q

ABI Values:

<0.90

A

Abnormal

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26
Q

Stages of Lymphedema

Stage 3

A
  • Elephantias
  • Fibrotic deep skinfolds
  • Skin may change color
  • Skin changes may limit mobility
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27
Q

Stages of Lymphedema

Stage 1

A
  • Reversible
  • Early accumulation of fluid w/ visible swelling, pitting edema
  • Resolves w/ elevation (reversible pitting edema)
  • Stemmer’s sign negative
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28
Q

Edema Grading Scale: 2+

A
  • Moderate
  • Easily Identified Depression
  • Returns to Normal Within 15 Seconds
  • 1/4-1/2 Inch Pitting
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29
Q

Signs of a MI

A
  • 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
Q

Edema Grading Scale: 4+

A
  • Very Severe
  • Depression lasts for >30 seconds or more
  • >1 Inch Pitting
31
Q

ECG Changes w/ Exercise

Individuals w/ MI or CAD

A
  • 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
Q

American College of Cardiology Foundation/American Heart Association Stages:

Stage D

A

Refractory HF requiring specialized interventions

33
Q

Zone of Injury

A
  • Area Immediately Adjacent to Central Zone
  • Tissue is noncontractile
  • Cells Undergoing Metabolic Changes
  • Electrically Unstable
  • Elevated ST Segments Over Injured Area
34
Q

Venous Stasis/Incompetence

Grade II

A
  • Increased Edema
  • Multiple Dilated Veins
  • Changes in Skin Pigmentation
35
Q

ABI Values: 0.91-0.99

A

Borderline

36
Q

ECG Changes: Hypercalcemia

A
  • Widens QRS
  • Shortens QT Interval
37
Q

Early Stage PAD

A
  • Intermittent Claudication
  • Burning, Searing, Aching, Tightness, or Cramping Pain
  • Occurs Regularly/Predictably w/ Walking
  • Relieved by Rest
38
Q

ECG Changes: Hypothermia

A
  • Elevates ST Segment
  • Slows Rhythm
39
Q

ABI Values:

<0.50

A
  • Severe Arterial Disease
  • Risk for Critical Limb Ischemia
  • May Have Pain at Rest
40
Q

Strength Training in Phase 2 Programs

A
  • 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
Q

Aortic Valve Auscultation Landmark

A

2nd Right Intercostal Space at the Sternal Border

42
Q

Subjective Ratings of Pain

w/ Intermitten Claudication

Grade IV

A

Excruciating/Unbearable Pain

43
Q

ECG Changes: Digitalis

A
  • Depresses ST Segment
  • Flattens or Inverts T Wave
  • QT Shortens
44
Q

Stages of Lymphedema

Stage 2

A
  • Spontaneously irreversible
  • Increase in swelling
  • Elevation does not reduce swelling
  • Positive Stemmer’s sign
45
Q

Zone of Ischemia

A
  • Outer Area
  • Cells Undergoing Metablic Changes
  • Electrically Unstable
  • T Wave Inversion
46
Q

Tricuspid Valve Auscultation Landmark

A

4th Left Intercostal Space at the Sternal Border

47
Q

Relative Contraindications to Start Exercise

A
  • 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
Q

Absolute Indications to Arrest Exercise

A
  • 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
Q

Thrill

A
  • An abnormal tremor accompanying a vascular or cardiac murmur
  • Felt on palpation
50
Q

New York Heart Association Stage

Class II

A
  • Slight HF
  • Slight limitation in physical activity
    • Up to 4.5 METs
  • Comfortable at rest
  • Ordinary PA causes
    • Fatigue
    • Palpitation
    • Dyspnea
    • Anginal Pain
51
Q

Right Ventricular Failure

A
  • 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
Q

Mean Arterial Pressure (MAP)

A
  • Arterial pressure within large arteries over time
  • Normal MAP is 70-110 mm Hg
  • (SBP + 2DBP)/3
53
Q

Diastolic Murmurs

A
  • Falls between S2 and S1
  • Usually indicates valvular disease
54
Q

Critical Stenosis PAD

A
  • Resting/Nocturnal Pain
  • Skin Ulcers
  • Gangrene
55
Q

Ankle Brachial Index (ABI)

A

Ratio of LE Presuure Divided by UE Pressure

56
Q

American College of Cardiology Foundation/American Heart Association Stages:

Stage A

A

At high risk for HF but without structural heart disease or symptoms

57
Q

Edema Grading Scale: 1+

A
  • Mild
  • Barely Perceptible Indentation
  • <1/4 Inch Pitting
58
Q

Absolute Contraindications to Start Exercise

A
  • 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
Q

Subjective Ratings of Pain

w/ Intermitten Claudication

Grade II

A

Moderate Discomfort or Pain

Paitent’s Attention Can Be Diverted

60
Q

New York Heart Association Stage

Class I

A
  • 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
Q

American College of Cardiology Foundation/American Heart Association Stages:

Stage C

A

Structural Heart Disease w/ prior or current symptoms of HF

62
Q

ABI Values: >1.40

A

Indicates Non-Compliant Arteries

63
Q

ECG Changes: Hyperkalemia

A
  • Widens QRS
  • Flattens P Wave
  • Peaked T Wave
64
Q

Exercise Prescription

Post-CABG

A
  • Limit UE exercise while sternal incision is healing
  • Avoid lifting, pushing, pulling for 4-6 postsurgery
65
Q

ECG Changes: Antiarrhythimic Agents

A
  • May Prolong QRS/QT Intervals
66
Q

New York Heart Association Stage

Class IV

A
  • Severe HF
  • Unable to perform any PA w/o discomfort
    • 1.5 METs
  • Ischemia, dyspnea, anginal pain at rest
    • Increases w/ Exercise
67
Q

Systolic Murmur

A
  • Falls between S1 and S2
  • May indicate valvular disease
    • Mitral valve prolapse
  • May be normal
68
Q

Mitral Valve Auscultation Landmark

A

5th Left Intercostal Space at the Midclavical Area

69
Q

Left Ventricular Failure

A
  • 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
Q

Relative Indications to Arrest Exercise

A
  • 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
Q

ECG Changes: Nitrates

A
  • Increases HR

NPTE (19 decks)

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