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CI1 > Cardiovascular Dysfunction > Flashcards

Cardiovascular Dysfunction Flashcards

1
Q

What is the scope of physio in CV dysfunction?

A
  • Management of acute surgical/medical patients
  • Cardiac rehab & community care
  • Cardiac transplantation
  • Research
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2
Q

What are some of the investigations used for CV dysfunction?

A
  • History taking
  • Physical examination
  • ECGs
  • Echocardiography
  • Exercise testing
  • Myocardial perfusion imaging
  • MRI
  • PET
  • Cardiac catheterisation
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3
Q

What two factors determine blood pressure?

A
  • Total peripheral resistance (TPR)
  • Cardiac output (CO)

Mean arterial pressure (MAP) = CO x TPR

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4
Q

How is pulmonary vascular resistance different to systemic?

A

TPR is much lower than vascular

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5
Q

What causes the difference in blood pressure between systemic and pulmonary circulation?

A

Differences in vascular resistance mediated by SNS in smooth muscle in the arterioles - increases vasoconstriction & BP

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6
Q

How is blood pressure regulated acutely?

A

Baroreceptor reflex

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7
Q

Where are baroreceptors located in the heart?

A
  • Carotid sinus

- Aortic arch

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8
Q

What effect does the vagus nerve have on the heart?

A
  • Efferent nerve for the heart

- Slows contractility, heart rate etc

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9
Q

How is a decrease in arterial blood pressure regulated by baroreceptors?

A
  • Central control (medulla/hypothalamus)
  • Decreased PNS outflow
  • Increased SNS outflow
  • Increased HR
  • Vasoconstriction
  • Increased forced cardiac contraction
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10
Q

How can bed rest affect blood pressure?

A

24 hours bed rest reduces SNS activity in response to orthostatic (upright) stimulus

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11
Q

What are the symptoms of orthostatic intolerance (low BP)?

A
  • Light headedness
  • Dizziness
  • Yawning
  • Nausea
  • Feeling warm
  • Abdominal discomfort
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12
Q

What are the reasons for orthostatic intolerance after bed rest (low BP)?

A
  • SNS dysfunction
  • Reduced plasma volume
  • Cardiac atrophy
  • Arrhythmia (bradycardia, tachycardia etc)
  • Drugs
  • Vaso-vagal syncope (pain, emotion, medical procedure)
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13
Q

What are the consequences of hypertension?

A

Major risk factor for

  • Heart failure
  • Myocardial ischaemia & infarction
  • Stroke
  • Retinopathy
  • Nephrosclerosis & renal failure
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14
Q

What are the two main things hypertension effects?

A
  • Mediates arterial damage

- Increases afterload (direct pressure load on left ventricle)

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15
Q

What does increased after load cause?

A
  • Systolic dysfunction
  • Diastolic dysfunction
  • Increased myocardial O2 demand
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16
Q

What does arterial damage cause?

A
  • Accelerated atherosclerosis

- Weakened vessel wall

17
Q

What are some of the other CHD risk factors hypertension interacts with?

A
  • Cholesterol
  • HDL
  • Smoking
  • Diabetes
  • LVH
18
Q

What is the main cause of hypertension?

A

Essential (no definitive cause, 95% of cases)

19
Q

What are the characteristics of essential hypertension (EH)?

A
  • 80% have stage 1

- Genetics important

20
Q

What are the non-pharmacological treatments of hypertension?

A
  • Weight reduction
  • Adopt DASH eating plan
  • Dietary sodium reduction
  • Physical activity
  • Moderation of alcohol consumption
21
Q

What are some of the pharmacological treatments of hypertension?

A
  • Diuretics
  • Anti-adrenergic agents
  • Ca channel blockers
  • ACE inhibitors
  • Angiotensin-II receptor blockers
  • Vasodilators
22
Q

What is heart failure?

A

When the heart cannot pump enough blood to meet the requirements of the tissues

23
Q

What are the types of heart failure?

A
  • Systolic vs diastolic

- Right vs left

24
Q

What happens in left sided congestive heart failure?

A
  • LV weakens, cannot empty
  • Decreased CO
  • Decreased renal blood flow (body starts retaining fluid)
  • Backup of blood into pulmonary vein
  • High pressure in pulmonary capillaries
  • Can cause pulmonary oedema
25
Q

What happens in right sided congestive heart failure?

A
  • RV weakens, cannot empty
  • Decreased CO
  • Decreased renal blood flow
  • Backup of blood into systemic veins
  • Increased venous pressure causes swelling in legs & organs
  • High venous pressure causes distended neck vein & cerebral oedema
26
Q

What are the causes of heart failure?

A
  • CHD (LV)
  • Cardiomyopathy (both)
  • HT (LV)
  • Aortic valve stenosis (LV)
  • Coarctation of aorta (LV)
  • Pulmonary HT (RV)
  • Pulmonary valve stenosis (RV)
  • Atrial fibrillation (both)
  • Constrictive pericarditis (RV)
27
Q

What is the most common cause of right heart failure?

A

Left heart failure

28
Q

What are some of the conditions that cause right heart failure?

A
  • Right ventricular infarction
  • COPD
  • Interstitial lung disease
  • Pulmonary embolism
29
Q

How does decreased renal blood flow affect blood pressure?

A
  • Stimulates renin-angiotensin & aldosterone secretion
  • Increased thirst
  • Systemic vasoconstriction
  • Renal sodium & fluid retention
30
Q

What symptoms are associated with left sided heart failure?

A
  • Dyspnoea
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • Fatigue
31
Q

What symptoms are associated with right sided heart failure?

A
  • Peripheral oedema

- Right upper quadrant discomfort (due to enlargement of liver)

32
Q

How is heart failure classified?

A

Class I: No limitation of physical activity
Class II: Slight limitation, dyspnoea & fatigue with moderate activity
Class III: Marked limitation, dyspnoea with minimal activity
Class IV: Severe limitation of activity, symptoms at rest

33
Q

What are the cautions to exercise in heart failure?

A
  • Fever/acute systemic illness
  • Unresolved/unstable angina
  • Resting SBP>200, DBP>110
  • Significant unexplained drop in BP
  • Symptomatic hypotension
  • Resting/uncontrolled tachycardia
  • New/recurrent symptoms of dyspnoea, lethargy, palpitations, dizziness
  • Unstable heart failure
  • Unstable/uncontrolled diabetes
34
Q

What are the vital signs that can be measured?

A
  • Heart rate
  • Blood pressure
  • Temperature
  • Respiratory rate
35
Q

What are the CV signs?

A
  • Normal HR: 60-100bpm
  • Tachycardia: >100bpm
  • Bradycardia: <60bpm
  • Hypertension: >145/95
  • Hypotension: <90/60
  • Postural/orthostatic hypotension: Drop of more than 5mmHg when going from lying to sitting/standing
36
Q

Where can the pulse be taken from?

A
  • Radial artery
  • Carotid artery
  • Brachial artery
  • Femoral artery
  • Temporal artery
37
Q

What characteristics should be noted when measuring pulse?

A
  • Rate: Normal, low, high
  • Rhythm: Regular, regularly irregular, irregularly irregular
  • Changes in amplitude of beats, are these related to respiration (pulses paradoxus)

CI1 (21 decks)

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