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NPTE-PT > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Right coronary artery

A

supplies right atrium, most of the right ventricle, and in most individuals, the inferior wall of the left ventricle, AV node, and bundle of His; supplies the SA node 60% of the time

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2
Q

Left coronary artery

A

supplies most of the left ventricle; has two main divisions:

  1. left anterior descending
  2. left circumflex artery
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3
Q

Left anterior descending

A

supplies the left ventricle and the interventricular septum, and in most individuals, the inferior areas of the apex; it may also give off branches to the right ventricle

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4
Q

Left circumflex artery

A

supplies blood to the lateral and inferior walls of the left ventricle and portions of the left atrium; supplies SA node 40% of the time

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5
Q

Which aspect of the heart receives venous blood from the heart?

A

coronary sinus

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6
Q

What is the impulse rate of the SA node?

A

60 – 100 bpm

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7
Q

What is the impulse rate of the AV node?

A

40 – 60 bpm

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8
Q

Cardiac Index

A

Cardiac output divided by body surface area; normal is 2.5 - 3.5 L/min

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9
Q

Ejection Fraction (EF)

A

SV/LVEDP

Normal = >55%

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10
Q

Why might someone exhibit an irregular pulse?

A

variations in force and frequency; may be due to arrhythmias or myocarditis

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11
Q

Why might someone exhibit a weak, thready pulse?

A

low stroke volume or cardiogenic shock

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12
Q

Why might someone exhibit a bounding, full pulse?

A

shortened ventricular systole and decreased peripheral pressure; aortic insufficiency

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13
Q

Where is the place to auscultate each of the heart valves?

A
  • aortic: right 2nd intercostal space at the sternal border
  • pulmonic: left 2nd intercostal space at the sternal border
  • tricuspid: left 4th intercostal space at the sternal border
  • bicuspid: right 5th intercostal space at the mid-clavicular border
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14
Q

What do the “lub-dub” sounds signify?

A

“lub” - closure of the tricuspid and mitral valves; marks the beginning of ventricular systole

“dub” - closure of the aortic and pulmonic valves; marks the end of ventricular systole

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15
Q

S3

A

associated with ventricular filling; occurs soon after S2; in older individuals may be indicative of congestive (left ventricular) heart failure

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16
Q

S4

A

associated with ventricular filling and atrial contraction; occurs just before S1. Indicative of pathology (i.e. CAD, MI, aortic stenosis or chronic hypertension

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17
Q

What conditions can cause arrhythmias?

A

ischemic conditions of the myocardium, electrolyte imbalance, acidosis or alkalosis, hypoxemia, hypotension, emotional stress, drugs, alcohol, caffeine

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18
Q

When are PVCs indicative of a serious cardiac event?

A

> 6 per minute, paired or in sequential runs, multifocal

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19
Q

Ventricular Tachycardia

A

a run of three or more PVCs occurring sequentially; very rapid rate (150-200 bpm)

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20
Q

What is the influence of hyperkalemia on the ECG?

A

widens QRS, flattens P wave, T wave bceoms peaked

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21
Q

What is the influence of hypokalemia on the ECG?

A

flattens T wave (or inverts), produces a U wave

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22
Q

What is the influence of hypercalcemia on the ECG?

A

widens QRS, shortens QT interval

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23
Q

What is the influence of hypocalcemia on the ECG?

A

prolongs QT interval

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24
Q

What is the influence of hypothermia on the ECG?

A

elevates the ST segment; slows rhythm

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25
What is the influence of digitalis on the ECG?
depresses the ST segment, flattents T wave (or inverts), QT shortens
26
What is the influence of quinidine on the ECG?
QT lengthens, T wave flattens (or inverts), QRS lengthens
27
What is the influence of beta blockers on the ECG?
decreases HR, blunts HR response to exercise
28
What is the influence of nitrates on the ECG?
increases HR
29
What is the influence of antiarrhythmic agents on the ECG?
may prolong QRS and QT intervals
30
Mean Arterial Pressure
[SBP + ( DBPx2 )] / 3 Normal MAP is 70 - 110 mmHg
31
AHA Blood Pressure Guidelines
Normal: systolic <120 and/or diastolic <80 Prehypertension: systolic 120-139 and/or 80-89 Stage 1: systolic 140-159 and/or 90-99 Stage 2: systolic ≥160 and/or ≥100 Hypertensive crisis: systolic ≥180 and/or diastolic ≥110
32
Pallor
an absence of rosy color in light-skinned individuals, associated with decreased peripheral blood flow, PAD
33
Rubor
dependant redness with PAD
34
Stemmer's sign
dorsal skin folds of the fingers and toes are resistant to lifting; indicative of fibrotic changes and lymphedema
35
What are the three major types of angina?
- stable angina - unstable angina - variant angina
36
Stable angina
occurs at a predictable RPP; relieved with rest
37
Unstable angina
unpredictable; difficult to control; chest pain increases in severity, frequency, and duration; refractory to treatment. Increases risk for future MI or lethal arrhythmia; pain is difficult to control
38
Variant angina
caused by vasospasm of coronary arteries in the absence of occlusive disease; responds well to nitro or calcium channel blockers long-term
39
What are the three zones associated with a myocardial infarction?
1. zone of infarction 2. zone of injury 3. zone of ischemia
40
What would an ECG look like over the zone of infarction?
pathological Q wave is present
41
What would an ECG look like over the zone of injury?
elevated ST segment is observed
42
What would an ECG look like over the zone of ischemia?
T wave inversion is present
43
Left-sided heart failure
characterized by pulmonary congestion, edema, and low cardiac output due to the backup of blood from the left ventricle to the left atrium
44
Right-sided heart failure
characterized by increased pressure load on the right ventricle with higher pulmonary vascular pressures; mitral valve disease or chronic lung disease; produces hallmark signs of jugular vein distension and peripheral edema
45
Compensated heart failure
the heart returns to normal function with reduced cardiac output and exercise tolerance. Achieved by: SNS stimulation, LV hypertrophy, anaerobic metabolism, cardiac dilatation, arterial vasoconstriction, and medical therapy
46
ACE inhibitors
inhibit the conversion of angiotensin I to angiotensin II, decreases Na retention and peripheral vasoconstriction in order to decrease blood pressure
47
Angiotensin II receptor blockers
blocks binding of angiotensin II at the tissue/smooth muscle level, decreasing blood pressure
48
Nitrates
decrease preload through peripheral vasodilation, reduce myocardial oxygen demane, reduce chest discomfort, may also dilate coronary arteries, improve coronary blood flow
49
Beta-adrenergic blocking agents
reduce myocardial demand by reducing heart rate and contractility; control arrythymias, chest pain; reduce blood pressure
50
Calcium channel blocking agent
inhibit flow of calcium ions, decrease heart rate, decrease contractility, dilate coronary arteries, reduce BP, control arrythmias, chest pain
51
Antiarrhythmias
alter conductivity, restore normal heart rhythm, control arrhythmias, improve cardiac output
52
Digitalis
increased contractility and decreases heart rate
53
Diuretics
decrease myocardial work (reduce preload and afterload), control hypertension
54
Aspirin
decreases platelet aggregation, may prevent MI
55
Tranquilizers
decrease anxiety, sympathetic effects
56
Hypolipidemia agents
reduce serum lipid levels when diet and weight reduction are not effective
57
How long should activity be limited for patients following an MI?
should be limited to 5 METs or 70% of age predicted HRmax for 4-6 weeks
58
Heteroptics
involves leaving the natural heart and piggybacking the donor heart
59
Orthotopic
involves removing the diseased heart and replacing itwith a donor heart
60
Heart and lung transplantation
involves removing both organs and replacing them with donor organs
61
What is the grading scale for edema?
1+ = mild, barely perceptible indentation; < 1/4 inch pitting 2+ = moderate, easily identified depression; returns to normal within 15 seconds; 1/4-1/2 inch pitting 3+ = severe, depression takes 15-30 seconds to rebound; 1/2-1 inch pitting 4+ = very severe, depression lasts for >30 seconds or more; >1 inch pitting
62
Wells Criteria for DVT
- active cancer (treatment ongoing, or within 6 mo or palliative care) = +1 - paralysis, paresis, or recent cast immobilization of the lower extremity = +1 - bedridden recently for > 3 days or longer or major surgery within four weeks = +1 - localized tenderness along the distribution of the deep venous system = +1 - entire leg swollen = +1 - calf swelling at least 3 cm larger than the asymptomatic side = +1 - pitting edema, confined to the symptomatic side = +1 - previously documented DVT = +1 - alternative diagnosis to DCT as likely or more likely = -2
63
Chronic postthrombotic syndrome
symptoms include pain, intractable edema, limb heaviness, skin pigmentation changes, and leg ulcers
64
What are the grades of chronic venous insufficiency
- Grade I: mild aching, minimal edema, dilated superficial veins - Grade II: increased edema, multiple dilated veins, changes in skin pigmentation - Grade III: venous claudication, severe edema, cutaneous ulceration
65
Age predicted maximum heart rate
220 - 0.7(age)
66
Submaximal heart rate testing
testing is stopped when 85% of maximal heart rate is obtained or patient reports symtoms of ischemia
67
T/F: ST segment, horizontal or downsloping depression, greater than 1 mm below baseline is indicative of myicardial ischemia
True
68
How should resistive exercise be prescribed in individuals during a cardiac rehab program?
60%-80% of 1 repetition or 10 repetition maximal voluntary contraction
69
When progressing a training program for an individual in cardiac rehab how should you progress?
duration of exercises, followed by intensity
70
When should exercise be terminated?
Abdolute indications: - drop in systolic BP > 10 mmHg with increased workload - moderate to severe angina - increasing nervous system symptoms (i.e. ataxia, dizziness, 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
71
Relative indications for terminating exercise
- ST or QRS changes - arrhythmias other than sustained VT - fatigue, shortness of breath, wheezing, leg cramps, or claudication - development of bundle branch block that can't be distinguished from VT - increasing chest pain - hypertensive response (systolic BP >250 mmHg or diastolic >115 mmHg)
72
What are the absolute contraindications for cardiac rehab?
- acute MI (w/in 2 days) - unstable angina not previously stabilized by medical therapy - uncontrolled cardiac arrhythmias causing symptoms or hemodynamic response - acute PE or pulmonary infarction - acute myocarditis or pericarditis - acute aortic dissection
73
What are the relative contraindications for cardiac rehab?
- left main coronary stenosis - moderate stenotic valvular heart disease - electrolyte abnormalities - severe arterial hypertension - tachyarrythmias or bradyarrhythmias - hypertrophic cardiomyopathy and other forms of outflow tract obstruction - mental or physical impairment leading to inability to exercise adequately - high-degree AV block
74
Cardiac Rehab: Phase 1
- low-intensity (2-3 METs), progressing to ≥5 METs by discharge - limited to 70% max HR and/or 5 METs until 6 weeks post-MI
75
Cardiac Rehab: Phase 2
- 2-3 sessions per week - 30-60 minutes with 5-10 minutes of warm-up and cool-down - suggested exit point: 9 MET functional capacity - strength training is initiated after 3 weeks of cardiac rehab, 5 weeks post-MI, or 8 weeks s/p CABG
76
Cardiac Rehab: Phase 3
- entry level criteria: functional capacity of 5 METs, clinically stable angina, medically controlled arrhythmia - progression to 50%-85% of functional capacity 3-4 times per week, 45 minutes of more/session - regular medical check ups and periodic ETT generally required - discharge typically in 6-12 months
77
Strength training for patients during cardiac rehab
- start with low resistance (one set of 10-15 reps); progress slowly - weights, 50% of more of maximum weight used to complete 1 RM - RPE should not exceed 11-13 - RPP should not exceed that prescribed during endurance exercise
78
Signs of decompensated heart failure
- increased SOB, sudden weight gain, increased LE edema or abdominal swelling, increased pain or fatigue, pronounced cough, lightheadedness or dizziness
79
Signs of decompensated heart failure
- increased SOB, sudden weight gain, increased LE edema or abdominal swelling, increased pain or fatigue, pronounced cough, lightheadedness or dizziness
80
Walking program guidelines for arterial insufficiency
- intensity such that patient report 1 on claudication scale after 3-5 minutes, stopping if they reach a 2 (until pain subsides), total of 30-60 minutes, 3-5 days per week - record time of onset and duration

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