cardiovascular assessment

Question 1

cardiovascular assessments

Answer 1

• blood pressure
• hydrostatic pressure
• ## ECG

Question 2

blood pressure

Answer 2

• systolic is less than 160 mmHg and diastolic is less than 90 mmHg, it is good
• if both are greater than, physician clearance is recommended

Question 3

what is blood pressure influenced by

Answer 3

• blood volume (contracted vs expanded)
• vascular resistance (dilation vs. constriction)
• cardiac output ( exercise increases CO)

Question 4

afterload

Answer 4

• the pressure the heart needs to work against to eject blood during systole
• higher afterload = increased work
• elevated BP increases the afterload on the heart
• stroke work = sv x mean arterial pressure
• cardiac work = sw x hr
• elevated bp can also damage small vessels/ capillaries in end-organs = leakage

Question 5

auscultation method

Answer 5

• listening to bodily sounds using a stethoscope
• krotokop sounds
• pumping cuff –> 0 blood flow, reducing pressure to allow blood flow to get back in.
• vibration is the blood flow through the arteries (bracial)
• highest pressure = systolic
• no more sound = diastole

Question 6

Korotkoff sounds

Answer 6

phase 1: clear “tapping” (systolic pressure)
phase 2: softer tapping
phase 3: clear tapping ( mean arterial pressure)
phase 4: muffled tapping
phase 5: tapping disappears (diastole)

Question 7

mercury monometer

Answer 7

• used for calibration
• measures using mmHg

Question 8

bp machine (fancy computer)

Answer 8

• continuous measure of bp
• 5 minute intervals
• picks up bp every single heart beat
• $$$

Question 9

automated cuffs

Answer 9

• sensors that pick up vibrations in brachial artery
• searches for peak MAP
• doesn’t actually measure systolic and diastolic pressures

Question 10

intravenous catheter

Answer 10

• hooks up to pressure catheter
• measures pressure inside artery
• calibrated first
• complicated and invasive
• have to be trained to use

Question 11

BP considerations

Answer 11

• individuals should be seated and relaxed, legs not crossed, not talking
• as soon as the lower limbs are engaged, it increased cardiac output, impeded venous return
• normally taken from the brachial artery, if no arm taken from lower leg
• cuff size should be appropriate
• inflated to 30mmHg above systolic pressure
• deflated at a rate of 2-3 mmHg/s (gives time to pick up sounds)
• systolic bp tends to be underestimated b/c you are waiting for a sound on beat
  diastolic is usually overestimated
• repeated measures should be separated by 1+ min, back-back could cause stress and blood clots

Question 12

hydrostatic gradient

Answer 12

• relation to the heart
• amount of pressure exerted by a fluid column
• relationship to position of the heart
• because the artery is closer to the heart, hydrostatic gradient is decreased

Question 13

hydrostatic pressure

Answer 13

• pressure = p (density of blood liquid) x gravity(9.81) x height
• +-0.8mmHg for every cm
• above arm = lower than actual by +-0.8mmHg
• below arm = higher than actual for ever cm
• important for arm amputees

Question 14

heart rate cutoffs

Answer 14

• if bpm is 99 or less at rest, proceed with appraisal
• if bpm is greater than 99bpm after second reading, physician clearance is recommended

Question 15

electrocardiography

Answer 15

• ECG=EKG
• the machine
• electrocardiogram is the tracing
• measures the electrical activity of the heart along different vectors
• uses to assess basic abnormalities in the heart

Question 16

Scope of practice with ECGs

Answer 16

• a CSEP-CPT is not sanctioned by CSEP to use an ECG for any purpose ( not part of training )
• can not diagnose pathology based on assessment or observation
• can only find the HR and the normal range
• CANNOT see if the rhythm is regular, if the waves are in their proper form

Question 17

what CAN the CSEP-CEP do under scope of practice

Answer 17

• measure and monitor HR
• monitor electrical activity of the heart using ECG
• measure BP at rest , during exercise, and post-exercise
• can identify irregularities during rest, sub-maximal, and maximal exercise .

Question 18

lead

Answer 18

• consists of two terminals (pair of electrodes) that form an axis to provide a different view or tracing of the heart’s electrical activity
• is directional and aligned with a particular vector from the (-) electrode TOWARDS the (+) electrode
• the orientation of the lead (vector) in relation to the electrical current of the heart is what produces the ECG waveform
• leads can change, electrodes directions DO NOT

Question 19

12-lead ECG

Answer 19

• also called precordial leads
• provides spatial information about the heart’s electrical activity in 3 orthogonal plans
• goes around the heart in a horizontal plane
• right –> left
• superior –> inferior
• anterior –> posterior
• leads are unipolar
• measure the change in electrical potential along a vector from the heart towards the electrode

Question 20

3 limb lead ECG

Answer 20

• creates 6 vectors derived from the “limb” electrodes
• creates an ECG limb pattern through the atrium of the heart down through the ventricle
• geta finer look on different depolarizations in the heart
• different angles allow for this (aVF, aVR, aVL)
• purpose is to pick up different functions of the heart
• different for re and de polarization

Question 21

bipolar leads

Answer 21

• 2 electrodes creating the leads
• the usual standard
• leads 1-3 on a 3 limb lead are considered bipolar

Question 22

augmented (unipolar) limb leads

Answer 22

• use two electrodes to create a “null point” which is halfway compared to the third electrode

Question 23

aVR

Answer 23

• augmented vector right
• pattern travels from the left atrium and leg lead as the initial , to meet in the middle/halfway to go to the right atrium

Question 24

aVL

Answer 24

• augmented vector left
• pattern travels from the right atrium and the leg lead as the initial, to meet half way to reach the left atrium

Question 25

aVF

Answer 25

• augmented vector foot
• pattern travels from the right atrium and the left atrium as the initial, to meet halfway to reach the leg lead

Question 26

waves of the electrocardiography

Answer 26

• P = atria depolarization
• ORS = ventricle depolarization
• T = ventricle repolarization
• U = repolarization of purkinje cells and or/ papillary muscle of valves (hard to differentiate to pick up)
• R-R = 1 heart beat

Question 27

extra waves if an electrocardiograph

Answer 27

• J point = transition point between the QRS complex and the ST segment
• PR interval = 0.12 - 0.20 sec, <2.5 mm in size
• QRS interval = 0.07 - 0.11 sec, 6-25-30mm in size
• ST segment= ventricular refractory period which should be smooth and gradual before repolarization , can be elevated ad depressed depending on what lead you are looking at
• QT interval = should be <1/2 the distance of RR interval, the ECG part that shortens during exercise

Question 28

how to see measure the time of a HR

Answer 28

• gird divided into large and small squares where 1 large square = 5 small squares
• standard chart recorder speed : 25mm/sec
• one large square = 0.20s (one row)
• one small square = 0.04s
  OR
• count the number of boxes between a full cycle (RR)

Question 29

equations for measuring HR

Answer 29

RR interval = (number of big boxes x 0.2) + (2 x 0.04) = s/beat

Method 2: 1500/ number of small boxes btw RR

Question 30

tachycardia

Answer 30

• type of arrythmia
• rapid beating greater than 100 bpm at rest in an untrained adult

Question 31

bradycardia

Answer 31

• beating less than 60 bpm at rest in an untrained adult
• symptomatic is less than 50 bpm

Question 32

arrythmia

Answer 32

• abnormal rate, rhythm or conduction of electrical impulse in the heart
• multiple causes
• related to fever, dehydration, shock, hormonal imbalance, stress, cardiac abnormalities, and heart failure

Question 33

premature ventricular contraction

Answer 33

• caused by the depolarization of the ventricle before atria can contract
• absence of P wave before another QRS complex
• extra beats occur under the influence of autorhythmic cells other than the SA node
• QRS and T waves look abnormal
• need to be treated when they occur as greater than 6 per/min

Question 34

sinus pause

Answer 34

• failure of SA node firing
• no P wave
• usually fire because AV node picks up

Question 35

third degree heart block

Answer 35

• no P wave
• AV node is off
• SA + AV node not coordinating
• ## usually signs of stress

Question 36

S-T depressions

Answer 36

• unsloping, horizontal, and downsloping depressions
• depression/elevation of greater than 1.0mm 0.08s after J point
• can tell you about the arteries in the heart
• possible heart attack ( myocardial ischemia )

Question 37

fibrillation

Answer 37

• uncoordinated atria or ventricle contractions caused by re-entry of electrical impulses and requires defibrillation
• EMERGENCY
• no RQRS waves
• some or no coordination/contraction

Question 38

when to use ECG

Answer 38

• with untrained, older, or diseased individuals
• establishes a resting ECG looking for abnormalities
• record a tracing every workload during exercise for stress tests
• difficult however to obtain clear traces during high intensity exercise
• breathing may even cause oscillation in heart

Question 39

normal EGC response in healthy individuals

Answer 39

• slight increase in P wave amplitude
• shortening of P-R interval
• shift to the right of QRS axis
• S-T segment depression of less than 1.0mm
• decreased T wave amplitude
• single or rare PVCs during exercise and recovery
• single or rare PVCs or PACs

Question 40

abnormal ECG response with CHD

Answer 40

• appearance of bundle branch block at a critical HR
• recurrent of multifocal PVCs during exercise and recovery
• ventricular tachycardia
• appearance of bradyarrhythmias, tachyarrhythmias
• S-T segment depression/elevation of greater than 0.1mm 0.08s after J point
• exercise bradycardia
• submaximal exercise tachycardia
• increase in frequency of severity of any of above