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NPTE > Cardiovascular and lymphatic system > Flashcards

Cardiovascular and lymphatic system Flashcards

1
Q

Where does blood get directed to from the right ventricle? Why?

A

Pulmonary artery to get oxygenated

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2
Q

What is the pathway of the low-pressure pump of the heart?

A

Right ventricle –> pulmonary artery –> lungs

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3
Q

What is the high-pressure pump of the heart?

A

Left ventricle –> aortic artery –> systemic circulation

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4
Q

What does the left atrium receive from the lungs and four pulmonary veins?

A

oxygenated blood

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5
Q

When do the semilunar valves prevent backflow of blood into the ventricles?

A

during diastole

Pulmonary valve prevents right backflow
Aortic valve prevents left backflow

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6
Q

When do the AV valves prevent backflow of blood into the atria?

A

During systole

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7
Q

What is systole?

A

Period of ventricular contraction

End-systolic volume: amount of blood in the ventricles after systole
–> approx. 50mL

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8
Q

What is diastole?

A

Period of ventricular relaxation and filling

End-diastolic volume: volume of blood remaining in the ventricles after diastole; 120 mL

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9
Q

When does atrial contraction occur? What does it do?

A

a. During the last 1/3 of diastole
b. completes ventricular filling

Last 20-30% of end diastolic volume

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10
Q

Where does the RCA provide bloodflow?

A
  1. right atrium
  2. right ventricle
  3. inferior wall of left ventricle
  4. AV node –> SA node
  5. bundle of his
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11
Q

What artery provides the sinoatrial node with blood 60% of the time?

A

RCA

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12
Q

What artery supplies the SA node 40% of the time?

A

Left circumflex artery (LCx)

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13
Q

What are the two divisions of the LCA?

A
  1. Left anterior descending (LAD)
  2. circumflex artery
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14
Q

What does the left anterior descending artery provide blood to?

A
  1. left ventricle
  2. interventricular septum
  3. inferior apex

May also branch off to the right ventricle

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15
Q

Where does the left circumflex artery provide blood to?

A

Lateral and inferior walls of the left ventricle and atrium

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16
Q

Where does the coronary sinus receive blood from?

A

heart

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17
Q

Where does the coronary sinus empty into?

A

Right atrium

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18
Q

What does the SA node do?

A

Initiates pulse at a rate of 60-100 bpm

“pacemaker of the heart”

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19
Q

What is the intrinsic firing rate of the AV node?

A

40-60 bpm

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20
Q

What is the intrinsic firing rate of purkinje fibers?

A

20-40 bpm

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21
Q

(true/false) Striated muscles fibers have less mitochondria compared to smooth muscle fibers

A

False

More muscle fibers

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22
Q

What is normal stroke volume?

A

50-100 mL/beat

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23
Q

What is preload?

A

Amount of blood left in the left ventricle at the end of diastole

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24
Q

(true/false) the greater the preload, the greater the amount of blood pumped

A

true

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25
Q

What is afterload?

A

Force of the left ventricle that generates during systole to overcome aortic pressure and open the aortic valve

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26
Q

Definition

Amount of blood discharged from the left or right ventricle per minute

A

Cardiac output

Stroke volume: amount of blood discharged from the ventricle during each contraction

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27
Q

What is the normal range of cardiac output per minute?

A

4-5 L/minute

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28
Q

How is cardiac output calculated?

A

SV x HR

Regular cardiac index (CO divided y body surface area) : 2.5-3.5 L/min

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29
Q

definition

Percentage of blood emptied from the ventricle during systole

A

EF

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30
Q

How do you calculate EF?

A

SV / left ventricular end-diastolic volume

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31
Q

What is normal EF?

A

> 55%

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32
Q

What percent of EF is indicative of heart failure?

A

< 40%

The lower the EF, the more impaired the left ventricle is

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33
Q

What affects atrial filling pressure?

A

Intrathoracic pressure

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34
Q

definition

Represents the energy cost to the myocardium

A

myocardial oxygen demand (MVO2)

clinically measured as the product of HR and systolic BP (Rate pressure produce (RPP))

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35
Q

What arteries DO NOT transport oxygenated blood from areas of high-pressure to low-pressure in tissues?

A
  1. umbilical vein (in utero)
  2. pulmonary veins
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36
Q

What creates an anastomosis network?

A

when arterioles connect to capillaries

Function: exchange of nutrients and fluids between blood and tissues

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37
Q

There are (more/less) arteries than veins

A

Less arteries

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38
Q

Venous walls are (thinner/thicker) than arteries

A

thinner

Have one-way valves

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39
Q

Where do the lymphatic vessels and ducts empty?

A

Left subclavian vein

Body tissue –> veins –> lymphatic capillaries –> vessels –> lymphatic ducts –> left subclavian vein

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40
Q

Where is parasympathic stimulation controlled from?

A

Medulla oblongata – cardioinhibitory center

  • Causes coronary artery vascocontriction
  • via vagus nerve and caridac plexus (innervates the SA and AV node which releases ACh and slows myocardial contraction)
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41
Q

Where is sympathetic stimulation controlled from?

A

Medulla oblongata - cardioacceleratory center

  • via T1-T4, upper thoracic to superior cervical chain ganglia (innervates SA and AV nodes releasing epinephrine and noepinephrine)
  • increases HR
  • coronary artery vasodilation
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42
Q

What is the name of drugs that increase sympathetic functioning?

A

Sympathomimetics

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43
Q

What is the name of drugs that decrease sympathetic functioning?

A

sympatholytics

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44
Q

What are baroreceptors the main mechanism for in the heart?

A

controlling HR

  • located in aortic arch and carotid sinus
  • Responds to changes in BP (circulatory reflexes)
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45
Q

Where are chemoreceptors located in the heart?

A

carotid body

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46
Q

What receptors are sensitive to changes in blood chemicals: O2, CO2, and lactic acid?

A

chemoreceptors

  • Decreased pH results in an increased HR
  • Increased pH results in a decreased HR
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47
Q

What is hyperkalemia?

A

Increased potassium

Hypokalemia: decreased potassium

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48
Q

What does hyperkalemia cause within the cardiovascular system?

A

decreases the rate and force of contraction

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49
Q

What ECG changes are observed with hyperkalemia?

A
  1. Widened PR interval and QRS
  2. flattened P waves
  3. Tall/peaked T-waves
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50
Q

What ECG changes are observed with hypokalemia?

A
  1. flattened T-waves
  2. Prolonged PR and QT intervals
  3. “U wave”

arrythmias may progress to V-fib

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51
Q

Hypercalcemia (increases/decreases) heart action.

A

increases

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52
Q

What can hypermagnesemia result in?

A
  1. arrythmia
  2. cardiac arrest

Increased magnesium is a calcium channel blocker

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53
Q

What can hypomagnesemia cause?

A
  1. ventricular arrythmias
  2. coronary artery vasospasm
  3. sudden death
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54
Q

What is normal HR in Newborns? Children?

A

Newborns: 90-164

Children: 60-140

Adults 60-100

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55
Q

Definition

Sustained HR increase >30 bpm within 10 minutes of standing

40 bpm increase in teenagers

A

Postural tachycardia syndrome

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56
Q

What causes a weak, thready pulse?

A
  • low stroke volume
  • cardiogenic shock
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57
Q

What can cause a bounding, full pulse?

A
  • Shortened ventricular systole and decreased peripheral pressure
  • aortic insufficiency
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58
Q

What intercostal space is the pulmonic and aortic valves found in?

A

2nd

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59
Q

What intercostal space is the bicuspid valve in?

A

5th

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60
Q

What intercostal space is the tricuspid valve in?

A

4th

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61
Q

What creates S1 sound?

A

Closing of bicuspid and tricuspid valves

Marks the beginning of systole

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62
Q

What creates the S2 sound?

A

closure of the aortic and pulmonic valves

marks the end of systole

Decreased with aortic stenosis

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63
Q

What is a systolic murmur? When does it occur? What can it indicate?

A

a. Extra sound that occurs between S1 and S2

b. can indicate possible valve disease

Can be normal

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64
Q

What is a diastolic murmur? When does it occur? What can it indicate?

A

a. extra sound between S2 and S1

b. indicates valve disease

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65
Q

What is the scale for heart murmurs?

A

1 (soft audible murmur)

to

6 (audible w/o use of stethoscope)

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66
Q

What is a trill?

A

abnormal tremor accompanying a vascular or cardiac murmur that is felt on palpation

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67
Q

What is bruit? Where is it commonly heard? What is it indicative of?

A

a. sound/murmur of arterial or venous origin
b. femoral and/or carotid arteries
c. indicative of atherosclerosis

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68
Q

definition

Heart rhythm with three sounds in each cycle

A

gallop rhythm

S3 and/or S4

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69
Q

What is S3 sound associated with? What can it be indicative of in older adults?

A

a. ventricular filling
b. Left ventricular heart failure (CHF)

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70
Q

What is S4 associated with? What is it indicative of?

A

a. ventricular filling and atrial contraction
b. cardiac pathology (CAD, MI, aortic stenosis, chronic HTN)

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71
Q

What creates a P-wave?

A

Atrial depolarization

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72
Q

What creates the QRS wave?

A

ventricular depolarization

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73
Q

What is the P-R interval?

A

time required for impulse to travel from the atria to the purkinje fibers

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74
Q

What is the ST segment?

A

Beginning of ventricular repolarization

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75
Q

What creates a T-wave?

A

ventricular repolarization

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76
Q

What is the QT interval?

A

time of electrical systole

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77
Q

definition

Premature beat arising from the ventricles

A

premature ventricular contractions (PVCs)

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78
Q

(true/false) PVCs do not occur in normal population

A

False

They do occur in the majority of the normal population

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79
Q

What is observed on a ECG when a PVC is present?

A
  • no P wave
  • wide and premature QRS
  • long compensatory pause
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80
Q

What is indicative of a serious PVC?

A

> 6 PVC/minute, in sequential runs, and multifocal

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81
Q

What is ventricular tachycardia?

A

4+ sequential PVCs at a very rapid rate (150-200 bpm)

Compromised CO

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82
Q

What is ventricular tachycardia usually the result of?

A

ischemic ventricle

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83
Q

What is observed on an ECG when ventricular tachycardia is present?

A
  • no P waves
  • wide QRS waves
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84
Q

What is non-sustained ventricular tachycardia (NSVT)?

A

4+ consecutive beats that spontaneously terminate within 30 seconds

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85
Q

What is sustained ventricular tachycardia (SVT)?

A

ventricular tachycardia lasting >30 seconds
and/or
requiring termination due to hemodynamic compromise in less than 30 seconds

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86
Q

definition

Pulseless, emergency situation requiring CPR, Defibrillization, and/or medication.
- Characterized by chaotic activity of ventricle originating from multiple foci
- no effective CO is present

A

V-fib

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87
Q

(true/false) you are able to determine HR when V-fib is present.

A

False

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88
Q

What is observed on an ECG when V-fib is present?

A
  • erratic activity
  • no QRS complex
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89
Q

How long does it take for clinical death to occur when v-fib is present?

A

4-6 minutes

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90
Q

What is observed on an ECG when atrial arrythmias are present?

A
  • abnormal shape of P waves or absence of P waves
  • irregular rhythm (chronic or paroxysmal)
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91
Q

What is the common HR when atrial tachycardia is present?

A

140-250 bpm

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92
Q

What is the common HR when atrial flutter is present?

A

250-350 bpm

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93
Q

What is the common HR when atrial fibrillation is present?

A

> 300 bpm

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94
Q

(true/false) With atrial arrythmias, cardiac output is maintained as long as the patient’s HR is controlled

A

true

May precipitate ventricular failure in an abnormal heart

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95
Q

What are AV blocks?

A

abnormal delay or failure of normal electrical conduction within the heart

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96
Q

If ventricular rate is slowed, CO is (increased/decreased)

A

decreased

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97
Q

What degree of heart block is life-threatening requiring surgical implantation of a pacemaker and use of medications (atropine)?

A

3rd degree AV block (complete heart block)

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98
Q

What ECG changes are observed with hypercalcemia?

A
  1. wide QRS
  2. short QT interval
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99
Q

What ECG changes are observed with hypocalcemia?

A

Prolonged QT interval

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100
Q

What ECG changes are observed with hypothermia?

A
  1. elevated ST segment
  2. decreased rhythm
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101
Q

What ECG changes can be observed when using digitalis?

A
  1. depressed ST segment
  2. Flattened T wave (or inverted)
  3. shortened QT interval
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102
Q

What ECG changes can be observed when using quinidine?

A
  1. lengthened QT interval
  2. Flattened T wave (or inverted)
  3. wide QRS
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103
Q

What cardiac changes can be observed when using beta blockers?

A

decreased HR

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104
Q

What ECG changes can be observed when using antiarrythmic agents?

A
  1. prolonged QRS
  2. prolonged QT intervals
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105
Q

(true/false) Medications are prescribed for all stages of HTN

A

False- not usually prescribed for stage I HTN…

Exception: prescribed for stage I HTN if pt has already had a heart attack, stroke, or is at high risk of heart attack or stroke with the presence of DM, CKS, or atheroclerosis.

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106
Q

What MAP is indicative of hypotension?

A

< 50

107
Q

What BP changes indicates orthostasis?

A

SBP decreases > 20 mmHg
and/or
DBP decreases > 10 mmHg

s/s: lightheadedness, LOB, leg weakness, dizziness

108
Q

What BP measurements are considered as stage I HTN?

A

SBP 130-139 mmHg
or
DBP 80-89 mmHg

109
Q

What BP measurements are considered as stage II HTN?

A

SBP > 140 mmHg
or
DBP >90 mmHg

110
Q

What BP measurements are indicative of hypertensive crisis?

A

SBP > 180 mmHg
and/or
DBP > 120 mmHg

111
Q

After what age are levels defining high BP the same as adults?

A

After age 13

112
Q

(true/false) BP in children varies among age, height, and gender

A

true

113
Q

definition

Arterial pressure within large arteries over time that is dependent upon the mean blood flow and arterial compliance

A

MAP

MAP = SBP + 2(DBP) / 3

114
Q

What is a normal MAP?

A

70-110 mmHg

115
Q

What is the normal RR of a newborn?

A

30-40

116
Q

What is the normal RR of an adult?

A

12-20

117
Q

What is the normal RR of a child?

A

20-30

118
Q

definition

RR > 22 breaths/min

A

tachypnea

119
Q

definition

RR < 10 breaths/min

A

bradypnea

120
Q

definition

Increase in the depth and rate of breathing

A

hyperpnea

121
Q

definition

inability to breathe when reclined or in supine

A

orthopnea

122
Q

definition

sudden inability to breathing during sleep

A

paroxysmal nocturnal dyspnea (PND)

123
Q

What commonly causes crackles/rales?

A

secretions within the lungs

124
Q

what are the levels of the anginal scale?

A

1+ : light, barely noticeable

2+ : moderate, bothersome

3+ : severe, very uncomfortable

4+ : most severe pain experienced

125
Q

definition

low level of O2 within the tissues

A

hypoxia

126
Q

definition

complete lack of O2

A

anoxia

127
Q

Symptoms of angina occurs more in (men/women/equally)

A

women

128
Q

Where can cardiac pain refer to?

A
  • neck
  • jaw
  • back
  • shoulders
  • arms

Pain referred to the back can occur with dissecting aortic aneurysms

129
Q

What cardiac diagnosis can cause pallor or rubor?

A

PAD

130
Q

What is clubbing of the nails associated with?

Curvature of fingernails w/ soft tissue enlargement at the base of the nail

A
  1. chronic oxygen deficiency
  2. chronic pulmonary disease
  3. heart failure
131
Q

What is stemmer’s sign?

A

Dorsal skin folds of the toes or fingers are resistant to being lifted

132
Q

What is stemmer’s sign used to identify?

A
  1. fibrotic changes
  2. lymphedema
133
Q

What causes intermittent claudication?

A

PAD

134
Q

definition

Pain, cramping, and LE fatigue that occurs during exercise and is relieved by rest

A

intermittent claudication

135
Q

What diagnosis is bilateral edema associated with?

A

congestive heart failure

136
Q

What is the venous percussion test used for?

A

determines the competence of the greater saphenous vein

if pulse is felt by lower hand (20 cm below percussive hand), the intervening valves are incompetent

137
Q

What is the grading scale for edema?

A

1+ : mild indentation; < 1/4 inch of pitting

2+ : moderate depression that returns to normal within 15 seconds; 1/4 to 1/2 inch of pitting

3+ : severe depression that takes 15-30 seconds to rebound; 1/2 to 1 inch of pitting

4+ : very severe depression that lasts for > 30 seconds; 1+ inch of pitting

138
Q

What is the venous trendelenburg test used for?

(retrograde filling test)

A

determines the competence of communicating veins and saphenous system

  1. supine with LEs at 60 degrees elevation
  2. place tourniquet on proximal thigh
  3. patient stands
  4. observe if veins fill in normal pattern (takes approx 30 seconds)
139
Q

What venous filling time is indicative of venous insufficiency?

A

delayed filling for > 15 seconds

140
Q

How is ABI calculated?

A

ABI = LE pressure / UE pressure

  1. pt is supine at rest for 5 mins
  2. BP is taken at the brachial artery and posterioral tibial and dorsalis pedis arteries
141
Q

What is ABI used for?

A

calculating the risk for cardiovascular disease

142
Q

What ABI indicates non-compliant arteries?

A

1.4 +

143
Q

What ABI is considered as abnormal peripheral arterial circulation?

A

<0.9

144
Q

What ABI is indicative of severe arterial disease and/or is high risk for critical limb ischemia?

A

<0.5

145
Q

What is a clinically significant change in ABI?

A

Without symptoms: >0.15
With symptoms: >0.1

146
Q

What does a central line measure?

Swan-Ganz catheter

A
  • venous pressure
  • pulmonary artery pressure
  • pulmonary capillary wedge pressure
147
Q

What is the primary lab measure of myocardial infarction? What must it be accompanied by?

A

a. cardiac troponin

b.
- symptoms of ischemia
- new or presumed ST segment change
- loss of myocardium and/or new wall motion abnormality on imaging
- evidence of intracoronary thrombus

148
Q

What is a heteroptics transplantation?

A

Leaving the natural heart along and allowing it to “piggyback” on the donor heart

149
Q

What is a orthotopic transplant?

A

Heart is removed and a new heart is placed

150
Q

After an acute MI, the patient should be limited to _______ METS or ____% of age-predicted HRmax for 4-6 wks after the MI

A

5 mets or 70% HRmax

151
Q

What common medications increase cardiac demand?

A
  • adenosine (increases HR)
  • dobutamine (increases contractility)
  • persantine (vasodilates)
152
Q

(true/false) submaximal ETT is safe in all settings to evaluate the early recovery of patients after experiencing a MI, coronary bypass, or coronary angioplasty.

A

True

  • limited to 85% of HRmax
  • terminate if symptoms arise
153
Q

What does a positive ETT indicate?

A

myocardial oxygen supply is inadequate to meet the myocardial oxygen demand

(+) for ischemia

Negative ETT indicates balanced oxygen supply and demand during exercise

154
Q

Increased myocardial oxygen consumption (MVO2) is the result of what?

A

increased coronary blood flow

RPP = Product of SBP and HR

155
Q

What is an important measure for individuals who do not exhibit the typical rise in HR with exercise?

A

RPE scale

Borg: rates exercise intensity on a 6-20scale

Borg CR 10: rates exercise intensity using numbers from 1-10

156
Q

What ECG changes will be seen in an individual with myocardial ischemia and CAD?

A
  1. significant tachycardia
  2. exertional arrythmias
  3. ST segment depression (horiz. or downward depression > 1 mm below baseline is indicative of myocardial ischemia
157
Q

What is transtelephonic ECG monitoring used for?

A

Monitor patients as they exercise at home

158
Q

What is the minimal number of METs required to promote endurance?

A

3-4 mets if continous and if target HR is reached

159
Q

What are adverse responses to inpatient exercise leading to exercise termination?

A
  • diastolic BP is = or > than 110 mmHg
  • Systolic decrease of > 10 mmHg
  • significant ventricular or atrial dysrhythmias with or without associated s/s
  • 2nd or 3rd degree heart block
  • s/s of exercise intolerance (dyspnea, angina, ECG changes indicating ischemia)
160
Q

When should exercise be initiated after a patient experiences a percutaneous transluminal coronary angioplasty (PTCA)?

A

Walking program can be initiated immediately using an ETT for prescription

  • no vigorous exercise until after 2 weeks post-PTCA
161
Q

What are the guidlines for exercise prescription post-CABG?

A
  1. limit UE exercise during sternal incision healing
  2. avoid lifting, pushing, and pulling for 4-6 weeks
162
Q

What are the contraindications for cardiac rehab?

(16)

A
  1. unstable angina
  2. resting SBP > 200 and/or DBP >110 mmHg
  3. orthostatic BP drop of > 20 mmHg and presence of symptoms
  4. critical aortic stenosis
  5. acute systemic illness or fever
  6. unctonrolled atrial or ventricular dysrhythmias
  7. uncontrolled sinus tachycardia
  8. uncompensated CHF
  9. 3rd degree AV block w/o pacemaker
  10. pericarditis or myocarditis
  11. recent embolism
  12. thrombophlebitis
  13. resting ST-segment depression or elevation (>2 mm)
  14. uncontrolled DM
  15. severe orthopedic conditions that prohibit exercise
  16. metabolic conditions (acute thyroiditis, hypokalemia, hyperkalemia, hypovolemia)
163
Q

How many METs can be achieved in phase I (inpatient/acute) of cardiac rehab?

A

2-3 METs initially and progress to =/> 5 METs by d/c

164
Q

What are the limitations of MI during phase I of acute rehab?

A
  • limit exercise to 70% HRmax and/or 5 METs until 6 weeks post-MI
  • 2-3 short exercise sessions/day
  • no lifting activities for at least 6 weeks
165
Q

What are the exercise/activity guidlines for phase II of cardiac rehab?

A

frequency: 2-3 x/wk
duration: 30-60 minutes (incl. 5-10 minute warm up/down)
METs: 9 MET functional capacity

166
Q

How many METs are needed for safe resumption of most daily activities post-cardiac diagnosis?

A

=/> 5 METS

167
Q

When can strength training begin during phase II of cardiac rehab?

A
  • 3 weeks after initiation of phase II
  • 5 weeks post-MI (=/< 70% HRmax or =/< 5 METs)
  • 8 weeks post-CABG
168
Q

When can you start resistance exercises post-transcatheter procedure (PTCA)?

A

Not until at least 3 weeks after procedure with at least 2 weeks of consistent participation in a supervised cardiac rehab endurance program

169
Q

What are the exercise guidelines for resistance training in cardiac populations?

A
  • low resistance (1 x 10-15 reps)
  • slow progression
  • RPE 11-13 (light to somewhat-hard)
  • RPP not exceeding what is prescried during endurance exercise
170
Q

What are signs of decomposition?

A
  • increased SOB
  • sudden weight gain
  • abdominal swelling
  • increased edema
  • increased pain
  • fatigue
  • pronounced cough
  • dizziness
171
Q

Use caution exercising in ____ or ____ positions due to increased risk of orthopnea/SOB.

A

supine or prone

172
Q

(true/false) HR is an appropriate independent measure of exercise intensity after heart transplant

A

false

heart is denervated and tachycardic

combination of RPE, METs, dyspnea scale, HR, and BP

173
Q

What are side effects of immunosuppressive drug therapy?

A
  • hyperlipidemia
  • HTN
  • obesity
  • DM
  • leg cramps
  • proximal muscle weakness
174
Q

Describe NYHA class I.

A

Mild HF
- no limitation
- comfortable at rest
- activity does not cause fatigue, palpitations, dyspnea, or angina

175
Q

Describe NYHA class II.

A

Slight HF
- slight limitation in physical activity up to 4.5 METs
- comfortable at rest
- ordinary activity results in fatigue, palpitations, dyspnea, or anginal pain

176
Q

Describe NYHA class III.

A

marked HF
- marked limitation of physical activity up to 3 METs
- comfortable at rest
- less than ordinary activity causes fatigue, palpitations, dyspnea, or angina

177
Q

Describe NYHA class IV.

A

Severe HF
- unable to carry out any physical acyivity w/o discomfort
- symptoms of ischemia, dyspnea, and angina at rest
- symptoms increase with exercise

178
Q

Describe Stage A of the AHA heart failure classifications.

A

At risk for HF but w/o structural heart disease or symptoms of HF

179
Q

Describe Stage B of the AHA heart failure classifications.

A

structural heart disease without s/s of HF

180
Q

Describe Stage C of the AHA heart failure classifications.

A

Structural heart disease with prior and/or current symptoms of HF

181
Q

Describe Stage D of the AHA heart failure classifications.

A

Refractory HF requiring specialized interventions

182
Q

(true/false) pacemakers are always programmed to have a upper HR limit.

A

False: upper HR limit is rare but lower HR limit should always be set

183
Q

(true/false) With a pacemaker in place, as workload increases, HR increases

A

true

184
Q

What is an AICD?

A

Automatic implantable cardioverter defibrillator

  • delivers an electric shock if HR exceeds the set limit and/or a ventricular arrythmia is detected
185
Q

(true/false) ST segment depressions are common with pacemakers and AICDs.

A

true

186
Q

How long should you avoid UE aerobic or strengthening exercises after implantation of a pacemaker or AICD?

A

4-6 weeks to allow for the leads to scar

187
Q

When a patient is exercising with a pacemaker/AICD, make sure the patient’s HR remains at least ___ beats below the ICD shock and anti-tachycardia pacing threshold

A

=/> 10 beats below threshold

188
Q

At what age is risk of CVD increased?

A

Men > 45 yrs
Females > 55 yrs

  • Risk increases further with a PMH of younger age of onset, number of past events, and how close genealogically the relative is
189
Q

Men have a (lesser/greater/equal) risk of CVD than pre-menopausal women

A

Greater risk

Equal risk once menopause occurs

190
Q

What is the goal for overall cholestrol to reduce risk of CVD?

A

< 200 mg/dL

191
Q

What is the goal for LDL cholestrol to reduce risk in those who have a low risk of developing CVD?

A

< 160 mg/dL

192
Q

What is the goal for LDL cholestrol to reduce risk in those who have a moderate risk of developing CVD?

A

< 130 mg/dL

193
Q

What is the goal for LDL cholestrol to reduce risk in those who have a high risk of developing CVD, already has CVD, or has DM?

A

< 100 mg/dL

194
Q

What is the goal for HDL in men?

A

> 40 mg/dL

195
Q

What is the goal for HDL in women?

A

> 50 mg/dL

196
Q

What is the goal for triglycerides to reduce risk of CVD?

A

< 150 mg/dL

197
Q

If a person has diabetes, what is the goal for HgA1C when reducing risk of CVD?

A

< 7%

HgA1C: Tests for blood sugar control; measures what percentage of Hgb proteins are coated in sugar (glycated)

198
Q

What is the normal HgA1C level?

A

< 5.7%

199
Q

What is the range of HgA1C for a prediabetic?

A

5.7-6.4%

200
Q

What waist circumference puts a person at higher risk of CVD?

A

Males: > 40 inches
females: > 35 inches

201
Q

What BMI puts a person at a lower risk of CVD?

A

< 24.9 kg/m2

202
Q

What exercise prescription is used for patients with PAD?

A

Walking until the pt cannot tolerate pain - interval program with intermittent stops for a total of 30-60 minutes (3-5x/wk)

Record time of pain onset and duration

203
Q

What medication for PAD can decrease time to claudication or worsen symptoms when treating CVD and/or HTN?

A

Beta blockers

204
Q

What medications may improve time to claudication?

A
  • pentoxifylline
  • dipyridamole
  • aspirin
  • warfarin
205
Q

What LE exercise is the most effective for increasing blood flow?

A

Resistive calf exercises

206
Q

What are buerger-allen exercises?

A

postural exercises to promote blood flow

Positions:
1. supine with LE elevated 45-90 degrees until feet blanch
2. sitting with LEs in dependent position until pink/red
3. supine for 3 minutes

207
Q

(true/false) The effects of buerger-allen exercises are more pronounced in those with PAD.

A

false (less pronounced)

208
Q

What medications are commonly used in those with vasospastic disease?

A

calcium channel blockers

209
Q

When can you initiate ambulation and leg muscles in a person with VTE?

A

Once therapeutic levels of medication are achieved

210
Q

What level of mmHg compression garmets should be used for venous diseases?

A

30-40 mmHg

211
Q

What duration is used for compression pump therapy?

A

1-2 hours
2x daily

212
Q

What is optimal positioning for patients managing edema?

A

Extremity elevation with a minimum of 18 inches above the heart

213
Q

What are the contraindications for compression therapy?

A
  • ABI < 0.8
  • active cellulitis or infection
  • systemic arterial pressure < 80 mmHg
  • advanced peripheral neuropathy
  • uncontrolled congestive heart failure
214
Q

What organs are included in the lymphatic system?

A
  1. spleen
  2. tonsils
  3. thymus
  4. bone marrow
215
Q

Diagnosis

chronic disorder with excessive accumulation of lymph fluid due to mechanical insufficiency of the lymphatic system

  • lymph volume exceeds the transport capacity/capability of lymph vessels
  • results in swelling of soft tissues of the UEs and LEs
A

lymphedema

216
Q

diagnosis

Congenital or hereditary disorder with abnormal lymph nodes or lymph vessel formation leading to excessive accumulation of lymph fluid

A

primary lymphedema

217
Q

diagnosis

Acquired insult to the lymphatic system leading to the accumulation of exccessive lymph fluid

Possible causes: surgery, tumors, trauma, infection involving lymphatic structures

A

secondary lymphedema

218
Q

What are the stages of lymphedema?

A

0 (pre-clinical or latent stage): at risk; swelling not yet evident

1: clear accumulation of fluid with visible swelling; pitting edema at resolves with elevation; negative stemmer’s sign

2: spontaneously irreversible edema: increase in swelling with no improvement with elevation; positive stemmer’s sign

3: elephantitis; fibrotic deep skinfolds; possible skin color changes may limit mobility

219
Q

What stage of lymphedema is there a positive stemmer’s sign?

A

3

220
Q

What stage of lymphedema is there reversible pitting edema?

A

Stage 1

221
Q

diagnosis

  • excessive subcutaneous fat deposition
  • normal lymphatic system function
  • Symmetrical swelling of extermities
  • negative stemmer’s sign
  • seen more commonly in women
A

lipedema

222
Q

Diagnosis

Enlargement of lymph nodes with or without tenderness that is typically caused by infection

A

lymphadenopathy

223
Q

What is generalized lymphadenopathy?

A

enlargement of lymph nodes in 2+ body regions

224
Q

What is lymphadenitis?

A

lymphadenopathy accompanied by signs on inflammation such as redness and tenderness

225
Q

diagnosis

acute bacterial or viral infection that spreads within the lymphatic system

A

lymphangitis

226
Q

What is the typical presentation of lymphangitis?

A

Red streaks seen in the skin proximal to the site of infection

227
Q

What are the symptoms of patients who are at risk of developing secondary lymphedema?

A
  • swelling
  • sensation of tightness, heaviness, or fullness in the affected area
  • aching sensation
228
Q

What are the risk factors for primary lymphedema?

A

congenital anormalities (hypoplasia, hyperplasia, aplasia)

229
Q

What are risk factors for secondary lymphedema?

A
  • cancer (common: breast and cervical)
  • venous disease
  • trauma
  • cardiac disease
  • dependent edema
  • filariasis (mosquito-borne illness)
230
Q

When assessing lymphedema, unilateral lymphedema is considered present if there is a > ___% increase from the contralateral side

A

> 10%

231
Q

What is used primarily to determine bilateral lipedema vs. bilateral lymphedema?

A

bioimpedance

232
Q

definition

Dilation of lymph vessels that may appear as blister-like protuberances

A

lymphangiectasia

233
Q

definition

leakage of lymph from the skin

A

lymphorrea

234
Q

definition

development of wart-like growths on the skin that contains dilated lymph vessels and fibrous tissue

A

papillomatosis

235
Q

definition

thickening and hardening of subcutaneous tissue and brown skin discoloration. Associated with chronic venous insufficiency. When severe, can damage lymph tissue

A

lipodermatosclerosis

236
Q

What sign is used for lymphedema indicated by the presence of a thickened fold of skin at the base of the 2nd toe or finger?

A

stemmer’s sign

(+) if skin cannot be lifted

237
Q

(true/false) BP is affected on the side of lymphedema.

A

FALSE

238
Q

When palpating lymph nodes, what is a sign of inflammation and/or infection?

A

lymph nodes that move easily

239
Q

When palpating lymph nodes, what is a sign of possible metastatic cancers?

A

hard, immobile lymph nodes

240
Q

What kind of background pain is present with lymphedema?

A

intermittent or continuous pain at rest

241
Q

(lymphedema/lipedema) Which is associated with hormonal imbalances? What hormone?

A

a. lipedema

b. estrogen-related at the start of hormonal changes (pregnancy, puberty)

242
Q

(lymphedema/lipedema) Which may be congenital or result from damage to the lymphatic system?

A

lymphedema

  • Primary: congenital
  • secondary: injury to lymphatic vessels or parasitic infection
243
Q

(lymphedema/lipedema) Which mainly affects women?

A

lipedema

  • lymphedema affects males and females equally
244
Q

(lymphedema/lipedema) which can result from inadequate lymphatic drainage?

A

lymphedema

can also be congenital or result from damage to lymphatic system

245
Q

(lymphedema/lipedema) Which involves the trunk, head, neck, genitalia, LEs, and/or UEs?

A

a. lymphedema

b. lipedema only involves symmetrical bilateral swelling in the UEs and/or LEs

246
Q

(true/false) Stemmer’s sign will be positive with lipedema.

A

FALSE

  • stemmer’s sign may be positive with lymphedema and will not be painful
247
Q

(lymphedema/lipedema) Which results in excessive subcutaneous fat deposition?

A

lipedema

248
Q

What can lymphedema develop into if it is not treated?

A
  • fibrosis
  • chronic infection
  • loss of limb function
249
Q

What diagnostic tests can be used to identify lymphedema?

A
  • CT
  • MRI
  • doppler US
  • radionuclide imaging
250
Q

What are the treatments for lymphedema?

A
  • complete decongestive therapy (CDT)
  • compression bandages
  • decongestion exercises
  • walking and cycling programs
  • aquatics
251
Q

What can you NOT do when taking vitals on those with lymphedema?

A

Do not take BP on affected side

252
Q

Those with lymphedema must avoid temperatures over _____ degrees and extreme cold.

A

over 102 degrees

253
Q

Emphasis of CDT must start proximally in the affective area and lead to the _______ for right-sided UE involvement.

A

right lymphatic duct

254
Q

Emphasis of CDT must start proximally in the affective area and lead to the _______ for involvement of the left UE, trunk, and LEs

A

thoracic duct

255
Q

How long are short-stretch compression bandages applied for when treating lymphedema?

A

24 hours/day

256
Q

The use of compression garments may account for ___% of improvement of lymphedema symptoms

A

50%

257
Q

What can occur when a person with lymphedema endures excessively high pressures?

A

Occluding superficial lymph capillaries and restrict fluid absorption

258
Q

What Physical activities are contraindicated for lymphedema? Why?

A
  • strenuous activities
  • ballistic movements
  • rotational motions

–> likely to exacerbate lymphedema

259
Q

What are the symptoms of lymph overload?

A
  1. discomfort
  2. aching
  3. pain in proximal lymph areas
  4. change in skin color

discontinue activity when present

260
Q

What are contraindicated modalities for lymphedema?

A
  1. those that cause vasodilation or increase lymph load
  2. electrotherapeutic modalities greater than 30 Hz
261
Q

What are the risks of using pneumatic compression pumps?

A
  1. high pressures can damage lymph nodes
  2. may remove water instead of proteins
  3. use on LEs can result in genital lymphedema

Low pressure pumps are preferred

262
Q

You can only use pneumatic compression pumps in what stages of lymphedema?

A

Stage I only

unless there are skin changes, increased inflammation and fibrosis

263
Q

Pressures over ___ mmHg is contraindicated for those with lymphedema

A

> 45 mmHg

NPTE (20 decks)

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