Cardiovascular

Question 1

Tricuspid valve

Answer 1

-R AV valve

Question 2

Bicuspid valve

Answer 2

-L AV valve (mitral)

Question 3

End systolic volume

Answer 3

• blood left in ventricles after systole

- about 50mL

Question 4

End diastolic volume

Answer 4

• blood left in ventricles after filling

- about 120 mL

Question 5

Right coronary artery

Answer 5

• supplies R atrium, most of R ventricle, AV node

- supplies SA node 60% of time

Question 6

Left coronary artery

Answer 6

• two divisions
• Left anterior descending supplies L ventricle and IV septum
• Circumflex supplies lateral and inferior walls of L ventricle, and SA node 40% of time

Question 7

Cardia Output

Answer 7

• HR x SV

- normal adults is 4-5 L/min

Question 8

Cardia Index

Answer 8

• CO/ body surface area

- normal is 2.5-3.5 L/min

Question 9

Myocardial oxygen demand (MVO2)

Answer 9

• represents energy cost to myocardium

- HR x SBP = RPP

Question 10

Hyperkalemia

Answer 10

• increased [ ] of K+ ions
• decreases rate and force of contraction
• ECG changes (wide PR and QRS, tall T)

Question 11

Hypokalemia

Answer 11

• Decreased [ ] of K+ ions

- ECG changes, may cause V fib (flat T, prolonged PR/QT)

Question 12

CV disease risk factors

Answer 12

• Men >45, women >55
• Cardiac event in 1st degree family male <55, female <65
• African American
• Cholesterol, DM, HTN, Obesity, smoking, physical inactivity

Question 13

Heart sounds

Answer 13

• aortic valve = 2nd R intercostal space
• Pulmonic valve= 2nd L intercostal space
• Tricuspid valve = 4th L intercostal space
• Mitral valve = 5th L intercostal space at midclavicle

Question 14

S1 sound

Answer 14

• closure of mitral and tricuspid valves

- beginning of systole

Question 15

S2 sound

Answer 15

• closure of aortic and pulmonary valves

- end of systole

Question 16

S3

Answer 16

• Occurs after S2

- CHF in elderly

Question 17

S4

Answer 17

• before S1

- indicative of pathology (CAD, MI)

Question 18

Orthostatic hypotension criteria

Answer 18

• SBP drops >20

- DBP drops >10

Question 19

Mean arterial pressure

Answer 19

(2DBP+SBP)/3

-normal is 70-110

Question 20

Ankle brachial index

Answer 20

>1.40 non compliant arteries
1.0-1.40 normal
0.91-0.99 borderline
<0.90 abnormal
<0.50 severe arterial disease

Question 21

L sided HF

Answer 21

• pulmonary congestion, edema and backup from L ventricle to L atrium
• agitation

Question 22

R sided HF

Answer 22

• mitral valve disease
• chronic lung disease
• jugular vein distension and peripheral edema

Question 23

ACE inhibitors

Answer 23

• captOPRIL, enalOPRIL, lisinOPRIL
• inhibit conversion of angiotensin 1 to 2
• decreases Na retention and peripheral vasoconstriction to decrease BP

Question 24

Angiotension 2 receptor blockers

Answer 24

• Losartan, cozaar

- decreases BP

Question 25

Nitrates

Answer 25

- decrease preload through peripheral vasodilation - decreases myocardial O2 demand - dilates coronary arteries, improves coronary BF

Question 26

Beta adrenergic blocking agents

Answer 26

- atenOLOL, metoprOLOL (lopressor) | - decrease myocardial O2 demand by decreasing HR and contractility

Question 27

Ca channel blockers

Answer 27

- diltiazem, cardizem, amlodipine | - inhibits flow of Ca, decrease HR

Question 28

Acute MI activity restriction

Answer 28

- peak in troponin levels indicates MI stopped | - limit to 5 METs or 70% AMPHR for 4-6 weeks

Question 29

ECG exercise healthy individual

Answer 29

- tachycardia - QT interval shortening - ST segment depression, upsloping, less than 1mm

Question 30

ECG exercise myocardial ischemia, CAD

Answer 30

- significant tachy - exertional arrhythmias - ST segment depression, horizontal/downsloping, greater than 1mm = myocardial ischemia

Question 31

Absolute terminate exercise

Answer 31

- drop in SBP > 10mm w/ increased work - moderate-severe angina - nervous system sxs - sustained VT - ST elevation >1.0mm

Question 32

Phase 1 cardiac rehab

Answer 32

- low intensity (2-3 METs) progress to 5 METs by d/c - Limited to 70% HRmax and/or 5 METs for 6 weeks - short therex sessions 2-3/day gradually increase duration and decrease frequency - lifting activities restricted

Question 33

Phase 1 cardiac rehab HEP

Answer 33

gradual increase in ambulation goal of 20-30 mins | 1-2 x/day for 4-6 weeks

Question 34

Phase 2 cardiac rehab (subacute)

Answer 34

2-3 sessions/week 30-60 mins 5-10 mins warm up and cooldown -9 METs for d/c, 5 METs for most ADLs

Question 35

Heart Failure

Answer 35

- assess for sxs of decompensation= increased SoB, sudden weight gain, LE or abdominal swelling/edema, increased pain/fatigue - HR response may be tolerated - begin w/ 40-60% functional capacity

Question 36

Cardiac Transplant

Answer 36

- increased fx risk d/t long term corticosteroid use | - HR alone is not good measure of exercise intensity

Question 37

PAD walking program

Answer 37

-walk until report 1 on claudication scale for 3-5 mins, stop when reach 2 30-60 mins for 3-5x/week

Question 38

Lymphe node palpation

Answer 38

- Soft TENDER lymph nodes that move easily is sign of inflammation/infection. Ask about known illness, if not refer to PCP - Hard, immobile lymph nodes = metastatic cancer and refer to physician

Question 39

Lipedema

Answer 39

symmetrical bilateral swelling of LEs that stops at ankles | -pain and bruising are prominent features

Question 40

Lymphedema

Answer 40

- apply moisturizer, avoid sunburn, avoid injuries - avoid sports w/ impact/golf/tennis - no BP checks on affected side - SHORT stretch bandages for 24 hrs/day

Question 41

CPR

Answer 41

- compressions first then airway and breathing (CAB) - push 2" in chest - 100 compressions/min

Question 42

Internal bleeding sxs

Answer 42

- ecchymosis over injured area - body part/abdomen may be swollen - skin is blue, gray, pale, cool or moist