CPT I - EXAM Flashcards
1
Q
What is VO2? What units is it measured in?
A
The rate of oxygen consumption in aerobic metabolism.
Absolute: L/min
Relative: ml/kg/min
2
Q
What is the average resting VO2?
A
3.5 mL/kg/min (1 MET)
3
Q
What is the average Max VO2?
A
30-40 mL/kg/min (10 METs)
4
Q
When does the anaerobic metabolism come into play?
A
It works a little bit at rest but starts to work harder when the oxygen transport system can’t keep up with demand.
5
Q
What is VO2 a function of?
A
CO x (a-vO2)
Cardiac output x how much oxygen consumed
6
Q
What is a-vO2?
A
Oxygen in arteries - oxygen in veins
Ie, how much oxygen consumed by mitochondria in muscles
7
Q
What are the pleural cavities composed of?
A
Visceral pleura
Pleural fluid
Parietal pleura
8
Q
What is parenchyma?
A
Spongy structure of lung surrounding airways
9
Q
What are the functions of the upper airways? What are the complications if they can’t do those functions?
A
Gets air from outside to lower airways
Warm, filter, humidify air
Higher risk for aspiration, pneumonia, dried out secretions, inability to talk or cough
10
Q
What is the purpose of the epiglottis?
A
Protects the airways by preventing food from entering the trachea when swallowing
Provides an effective cough (creates pressure after deep breath in)
11
Q
What is the glottis?
A
The opening to the trachea from the larynx. Contains the vocal cords.
12
Q
What is the carina?
A
The bifurcation point where the trachea splits into the right/left main stem bronchus.
13
Q
Which lung (R/L) is more likely to have pathology? Why?
A
More likely on the right because the right main stem bronchus is more straight than the left (greater chance of aspiration).
14
Q
What happens to the diaphragm in neuro/spinal cord injuries? Clinical indication?
A
No abdominal musculature to support organs that hold the diaphragm up - sits lower.
Patients can’t breathe effectively, at risk for pneumonia.
15
Q
What happens to the diaphragm in COPD?
A
Patients have an expanded chest that forces the diaphragm to sit lower.
16
Q
Primary muscles of inhalation?
A
Diaphragm, external intercostals
17
Q
Accessory muscles of inhalation?
A
SCM, scalenes, abdominals
18
Q
Muscles of active exhalation?
A
Internal intercostals, abdominals
19
Q
How do we work speech and cough?
A
Speech - eccentric contraction of diaphragm to control flow
Cough - isometric epiglottis and abdominals to concentric contraction
20
Q
Lung Volume: TV
A
Tidal Volume
Volume of air inspired or expired per breath
21
Q
Lung Volume: IRV
A
Inspiratory Reserve Volume
From end of tidal inspiration to max inspiration
22
Q
Lung Volume: ERV
A
Expiratory Reserve Volume
From end of tidal expiration to max expiration
23
Q
Lung Volume: RV
A
Residual Volume
Volume of air in lungs after max expiration
24
Q
Lung Volume: TLC
A
Total Lung Capacity
Volume in lungs at end of max inspiration
25
Lung Volume: VC
Vital Capacity
Volume from max inspiration to max expiration
26
Lung Volume: IC
Inspiratory Capacity
Volume from tidal expiration to max inhalation
27
Lung Volume: FRC
Functional Capacity
Volume after tidal expiration
28
FEV1/FVC ratio
What is the average? What is FEV1 indicative of?
Forced Expiratory Volume in 1 Second
Forced Vital Capacity
Reflects pulmonary expiratory power and overall resistance to air movement upstream in lungs. Measures ability to sustain a high airflow level.
Average should be 0.75-0.8 (75-80% of air in 1 second). FEV1 is air in upper airways.
29
FEF 25-75%
Forced Midexpiratory Flow
Average flow rate during middle phase of max expiration. Gives better idea about small airway disease (goes from upper --> lower airway flow)
30
What is anatomical dead space?
Normal/fixed area where no gas exchange occurs. Includes conducting zones and upper airways.
1/3 of individual’s resting tidal volume
31
What is physiologic dead space?
An area that could or should be exchanging gas, but is not.
Normal - alveolar sacs not in use at rest (IRV)
Abnormal - fixed disease (cystic fibrosis)
32
What is 2/3 resting tidal volume?
Air movement to alveoli
33
What are the 3 forms of resistance to lung airflow?
Compliance - ability to expand
Elasticity - back to original shape after deformation, no energy required
Airway resistance - radius/diameter
34
Healthy Work of Breathing (WOB) is low. This is affected by? (5)
```
Compliance
Elasticity
Resistance
Ventilatory demand
Number of intact alveoli
```
35
What is minute ventilation (VE)? What is maximum voluntary ventilation (MVV)?
VE = TV x RR
Volume of air moved in or out of lungs per minute.
MVV = TVmax x RRmax
36
What is V/Q matching? What is the average V/Q?
V/Q matching is attaining an adequate combination of V/Q for gas exchange.
Alveolar ventilation / cardiac output
4 L/min / 5 L/min = 0.8
37
What is Ventilatory Index?
VI = VE/MVV
Minute ventilation at any time divided by maximum voluntary ventilation. Should be very small at rest.
38
What is your breathing reserve?
MVV - VE
How much air is left at any time.
39
What is the VI during exercise? At VO2max? Dyspnea? Fatigue? Non-sustainable?
```
60% MVV at exercise, typically
80% at VO2max
50% for dyspnea
70% for fatigue
90% for unsustainable
```
40
Will a patient with pulmonary pathology have a higher or lower MVV? What does this do to their VI?
Have a lower MVV which gives them a high VI (SOB with walking)
41
What are the 4 factors of gas exchange (passive diffusion)?
Partial pressures
Surface area
Diffusibility of membrane
Time (1/4s at rest)
42
What is the hypercapnic drive?
Primary drive in healthy ppl. Central chemoreceptors in the medulla detect CO2 levels and increase ventilation when levels are high.
43
What is the hypoxic drive?
Secondary drive in which peripheral chemoreceptors in carotid bifurcation and arch detect low levels of O2 to increase ventilation.
44
What is the sympathetic response to the airways?
Bronchodilation with decreased mucus production.
45
When HgB is fully saturated (100%), how much oxygen will it carry?
How much HgB does a person have on average?
HgB carries 1.34 mL O2 / g HgB
Average HgB: 15 g/dL blood
46
What is the oxygen carrying capacity of blood (CaO2)? What does this measure?
```
CaO2 = (1.34) x (15) x (.98)
CaO2 = Amount of O2 x Amount of HgB x Saturation of HgB
```
Measures how well gas is exchanged.
47
How much oxygen does the body extract from what is delivered to it (at rest)?
25%
48
What determines whether oxygen is picked up or dropped off? What affects this?
Affinity of HgB for O2 (high = picked up)
Affect Affinity: acidity, temp, level of O2
49
What is the main transport of metabolic CO2?
Bicarbonate
50
What creates non-metabolic CO2?
During anaerobic metabolism, the body accumulates lactic acid.
Lactic acid + bicarbonate = CO2
51
What is stroke volume? Average?
SV - volume of blood ejected by heart per beat
End Diastolic Vol - End Residual Vol
Avg: 70 mL
52
What is venous return?
Volume of blood that returns to heart per beat
53
What is cardiac output?
Volume of blood pumped by heart per minute
CO = HR x SV
54
What side of the heart is low/high pressure?
Right side: low pressure (pulmonary)
Left side: high pressure (systemic)
55
During exercise, we lose time in diastole (ventricular filling), how do we maintain stroke volume (cardiac output)?
Increased venous return (fill up ventricles faster)
56
What is the ejection fraction? What is the average?
Volume ejected from the amount available.
SV/EDV
Avg: 60-70%
57
What is the average cardiac output?
```
CO = SV x HR
CO = 70 ml x 70 bpm = 5 L/min
```
58
What are the determinants of stroke volume?
Preload - tension before heart contraction; determined by EDV
Afterload - load against which heart contracts (right and left side); determined by vascular resistance (state of dilation/constriction)
Contracility - positive inotropic effect increases contractility
59
What happens to the 3 determinants of SV during exercise?
Preload - increases (venous return)
Afterload - decreases (vasodilation)
Contractility - increases (SNS)
60
What are the 3 determinants of HR?
Intrinsic conduction system (automaticity, rhythmicity, intercalated discs)
Autonomic NS - chronotropic effect
Chemical/hormonal response - norepi and epi from adrenal glands
61
What is the primary pace maker? How fast?
SA Node (60-100 bpm)
62
What is the secondary pacemaker? How fast? What else does it do?
AV Node (40-60 bpm). Delays impulse for fraction of a second which allows the atria to contract and complete ventricular filling.
63
What is the rest of the conduction system after the SV and AV nodes?
Bundle of His - left/right bundle branches through interventricular septum
Purkinje fibers - L/R ventricles; beats 20-40 bpm
64
What vessels determine vascular resistance?
Arterioles (resistance vessels)
65
What kind of vessels increase during aerobic training? Why?
Capillaries - to increase blood flow and O2 delivery and remove waste products.
66
What are the 2 main branches of the left coronary artery?
Circumflex
| Left Anterior Descending (LAD)
67
Why does coronary perfusion decrease during exercise?
Heart gets its blood supply during diastole, which is shortened during exercise.
68
What is Mean Arterial Pressure (MAP)? What is the average?
MAP = DBP + PP/3
Pressure that maintains tissue perfusion, detected by kidneys.
PP is pulse pressure (SBP - DBP)
Avg = 93 mmHg
69
BP =?
BP = CO x TPR
70
If TPR decreases during exercise, why would SBP increase?
CO increases
71
What is the difference between the effects of the autonomic NS and hormonal response on cardiovascular function?
Autonomic has an immediate effect while hormonal takes time to kick in.
72
What is the parasympathetic influence on the heart? Sympathetic influence?
PNS: Negative chronotropic effect
SNS: Positive chronotropic and inotropic effects
73
What releases norepinephrine? Epinephrine?
Sympathetic NS releases NE from the adrenergic fibers.
NE stimulates adrenal release of epinephrine.
74
If the SNS causes vasoconstriction, why is their vasodilation during exercise?
Exercise (metabolism and PaO2) overrides the SNS response
75
What is the RPP?
Rate-Pressure Product
RPP = HR x SBP
Myocardial oxygen demand. This is why we measure both HR and BP to assess patient.
76
A patient has a BP of 150/84. What kind of HTN is this considered?
Stage I because of the SBP of 150.
77
Why is the Valsalva maneuver dangerous for cardiopulmonary patients?
It is an acute drop in blood pressure secondary to drop in venous return.
78
What are the 3 factors of assessing tissue perfusion?
Heart rate
Strength of pulse
Rhythm
79
How do you assess a patient’s reaction to exercise?
Before activity
During activity
After activity at 1 min intervals until back to baseline
80
What is the difference between the bell and the diaphragm on a stethoscope?
Diaphragm detects high frequency sounds
Bell detects low frequency sounds (better for diastolic BP)
81
How fast do you release air from the BP cuff?
2 mmHg per second
82
What are Korotkoff sounds?
```
Phase 1: 1st appearance of sounds (SBP)
Phase 2: Murmur or swishing
Phase 3: Crisp and louder
Phase 4: Muffling
Phase 5: Sounds disappear (DBP)
```
83
What are you assessing for respiration?
Rate
Depth
Rhythm
Quality
84
What is the average body fat % for males/females?
Males: 12-15%
Females: 25-28%
85
What is body mass index?
BMI = body mass (kg) / Stature (m2)
86
What are the body’s goals during exercise?
Deliver oxygen at a rate needed to meet energy demand
Eliminate waste products at rate equal or greater than production
Dissipate heat, regulate body temp
Deliver hormones
87
What is the difference between absolute and relative intensity?
Absolute - actual intensity person is tested at
Relative - % of max capacity; relative to the individual
88
What is APMHR?
Age Predicted Max Heart Rate
| APMHR = 220 - Age
only use for healthier individuals
89
What is the state of vasodilation during aerobic exercise?
Vasodilation throughout workout
90
What is the state of vasodilation during anaerobic exercise?
No vasodilation until recovery. TPR and therefore BP rises.
91
During aerobic exercise, what kind of TPR drop occurs if you are just working out arms, just legs, or both?
Arms: less of a drop (less area to dilate)
Legs: higher drop (more mass than arms)
Both: lowest BP response
92
What is SaO2? Does it change at max exercise?
Saturation of HgB molecule - ability for diffusion across alveolar membrane. Does not change at max exercise except for a couple % points. Delivery/consumption decreases, however.
93
What is typical anaerobic threshold?
40-60% VO2 max (4-6 METS)
94
What is ventilatory efficiency?
How much CO2 released (the more the better)
95
What is the difference between VO2max and VO2peak?
VO2max - leveling of VO2 with increasing intensity
VO2peak - exercise is stopped before seeing the O2 consumption leveling off (reach APMHR, RER > 1.15, anaerobic metab., stopped exercise)
96
What are the 4 principles of training?
1. Overload
2. Specificity
3. Individual differences
4. Reversibility
97
What are the 5 (or 4) exercise prescription components?
```
Mode
Intensity
Duration
Frequency
Progression
```
Frequency
Intensity
Time
Type
98
Why aerobic training?
Enhance delivery and utilization of oxygen.
99
Physiologic effects of training
```
Increased VO2 max
Decreased VE at submax intensity
Decreased HR/BP at submax intensity
Increased capillary density
Increased anaerobic threshold
Enhanced metabolism
Reduction of risk factors
Decrease morbidity/mortality
```
100
What is the respiratory quotient?
RQ = VCO2/VO2
CO2 production vs. O2 consumption during aerobic exercise (metabolic CO2).
101
What is respiratory exchange ratio?
RER = VCO2/VO2
CO2 production vs. O2 consumption during anaerobic exercise (metabolic and lactic acid buffering CO2)
102
If RER is > 1, what state is the person in?
Anaerobic metabolism
103
What non-exercise demands can stimulate the oxygen transport system?
Infection, disease, injury
104
If the quality of blood in SV is poor, what is the compensation?
HR increase (for CO)
105
If a patient has weakness if the cardiovascular system, what other systems should be improve to compensate and take away some physiologic stress on the body?
Ventilatory pump system
Neuromuscular system
(parts of the O2 transport system)
106
If there is an inability to increase CO and/or (a-vO2) is limited, what are the consequences?
```
Decreased VO2 max
Early onset anaerobic metabolism
Inability to reach anaerobic threshold (SOB)
Increased physiologic stress
System failure
```
107
What increases metabolic demand?
```
Movement
Stress, fear, yelling
Resistance/intensity
Anticipation
Anxiety
Pain
```
108
What limits the Oxygen Transport System response?
```
Disease
Deconditioning
Inactivity
Bedrest
Medications
Neural control
```
109
Where is a voluntary ventilator tube placed? Clinical implication?
At the jugular notch
Affects upper airways
110
Which ribs articulate with the manubrium?
1 and 2
111
What does the sternal angle articulate with? What lies directly behind it?
Rib #2 is on either side of it
Carina and T3 vertebra are directly posterior
112
How many true ribs / false ribs / floating ribs?
True: 7
False: 3
Floating: 2
113
Which ribs does the body of the sternum articulate with?
Ribs 2-7
114
Which ribs articulate at the junction between the sternum body and xiphoid process? What structures are directly lateral to this junction?
Articulate with ribs 6-7
Rib 5 and the apex of the heart are lateral to this junction
115
What is the clinical implication of ribs 8-10 articulating with cartilage only?
Gain mobility here for rib expansion
116
What is FRC? How are the ribs angled?
Functional Residual Capacity - volume of air left in lungs after normal resting exhalation.
Ribs are angled downward (sagittal view) less than 90 deg. Ribs are angled downward (posterior view) about 45 deg.
117
You palpate the T4 spinous process. Which vertebral body is anterior to that?
T5
118
Rib 7 articulates with what structures?
Inferior facet of T6
Superior facet of T7
Transverse process of T7
119
Why do connective tissue disorders (RA, lupus) impact ventilation? What is a good stretch to increase ventilation?
Joints are made up of connective tissue. If costovertebral/costotransverse joints are limited, their ability to expand is limited.
Stretch: deep breath with lateral side bend
120
What are the 3 steps of effective breathing?
Belly rise
Lateral expansion
Chest rise
121
What are Type 1 and Type 2 alveoli cells?
Type 1: anatomical structure of alveoli (stability)
Type 2: produce surfactant
122
What is surfactant? When does this start to develop in utero?
Fluid that breaks up the surface tension of the alveoli and allows them to expand.
Produced at 26-28 weeks but doesn’t mature until 36.
123
What do collateral ventilatory pathways do?
Bypass occluded airways
| Decrease resistance to airflow
124
What are the 3 types of collateral ventilation?
Channels of Martin - 2 bronchioles
Channels of Lambert - bronchiole to alveoli
Alveolar pores of Kohn - 2 alveoli
125
How much of VO2max goes toward the work of breathing?
10% (increased surface area aids in diffusion)
126
What is PO2 in venous blood, alveolus, and arterial blood?
Venous: 40 mmHg
Alveolus: 100 mmHg
Arterial: 100 mmHg
127
What is PCO2 in venous blood, alveolus, and arterial blood?
Venous: 45 mmHg
Alveolus: 40 mmHg
Arterial: 40 mmHg
128
```
Arterial blood gas (at rest):
pH range?
PaCO2 range?
PaO2 range?
HCO3 range?
```
pH: 7.35-7.45
PaCO2: 35-45
PaO2: >80
HCO3: 22-26
129
```
Venous blood gas (at rest):
pH range?
PaCO2 range?
PaO2 range?
HCO3 range?
```
pH: 7.31-7.41
PaCO2: 41-51
PaO2: 35-40
HCO3: 22-26
130
Why does bicarbonate levels remain unchanged between arterial blood gas and mixed venous blood gas?
It is affected by kidneys, not ventilation
131
Why is there residual volume when you force air out of the lungs? What is the clinical implication of pulmonary disease?
When air is forced out, pressure around airways increases and collapses them.
Someone with pulmonary disease starts out with narrowed airways, so they are collapsed earlier which results in less total lung capacity.
132
Which volumes are studied to determine how well a patient can get air out of their lungs?
Forced Vital Capacity (FVC)
Forced Expiratory Volume in 1 Sec (FEV1)
Forced Midexpiratory Flow (FEF 25-75%)
Peak Expiratory Flow (PEF)
133
What happens to PEF in those with asthmatic attack?
Peak Expiratory Flow is a person’s maximum speed of expiration. PEF drops in those with pulmonary issues.
134
Why is increasing volume more effective than breathing faster?
Increased surface area (decreased physiologic dead space). Breathing faster decreases more anatomical dead space instead of physiologic dead space.
135
What is the inhale:exhale ratio at rest? During exercise?
At rest: 1:2 (elastic recoil slower)
Exercise: 1:1 (active exhale)
136
What is Work of Breathing? How is efficiency determined?
WOB: ventilatory requirement determined by VO2 demand and ventilatory efficiency.
Efficiency is how much air is moving per how much CO2 is removed (VE/VCO2)
137
What are the 3 types of V/Q mismatching?
1. Ventilation in excess of perfusion (increased V without Q) - air is sent to area with no blood supply (ex: pulm embolism obstructs blood flow).
2. Perfusion in excess of ventilation (increased Q without V) - send blood to area without ventilation (ex: secretions block airflow)
3. Absence of perfusion and ventilation (ex: tumor obstructing V and Q).
138
Why should you assess someone’s vital signs when you reposition them?
Positioning can affect V/Q ratio. You need to make sure they are stable in the new position.
139
How does a patient with pulmonary disease develop secondary pulmonary hypertension?
If vasoconstriction does not occur in areas of dead space, they have perfusion in excess of ventilation which leads to pulmonary HTN.
140
What are the voluntary and involuntary CNS controls of ventilation?
Voluntary: motor cortex
Involuntary: Hypercapnic drive, hypoxic drive, peripheral mechanoreceptors (muscles)
141
Why is the yawn/sigh reflex so important?
It forces you to breathe into your reserve volume which prevents secretion buildup and subsequent infection.
142
What is pleural effusion?
Pleural fluid buildup in the potential space between visceral and parietal pleura. This can collapse the lung or prevent expansion.
143
What is the point of maximal impulse?
The apex of the heart
144
How does an increased afterload lead to heart failure?
The heart increases contractility to compensate which overloads the heart.
145
SBP reflects which determinant of SV? What else does it represent in regards to the heart?
Represents afterload
Also represents contractility (how hard the heart is working)
146
DBP is a good indicator of what? Why? High DBP indicates what?
DBP is good indicator of cardiac perfusion because it is the time that coronary arteries are supplied with blood.
High DBP can indicated trouble filling the arteries.
147
What is the normal increase in SBP during aerobic exercise? DBP?
SBP: 10 mmHg per MET level
DBP: rises very little
148
What is SpO2?
How well oxygen gets from alveolar membrane to the blood stream
149
What are the criteria for low, moderate, and high risk people for cardiopulmonary disease?
Low: asymptomatic, 0-1 risk factors
Moderate: asymptomatic, 2+ risk factors
High: symptomatic, known disease
150
What are symptoms of cardiovascular disease?
```
Angina
Claudication
Orthopnea/PND
DOE/cough
Dizziness/syncope
Palpitations
Edema/skin color
```
151
What is angina?
A conglomerate of symptoms, not just chest pain.
Can be any symptom above the waist as a result of an imbalance between myocardial oxygen supply (coronary circulation) and demand (HR and SBP).
152
What is claudication?
Lack of blood flow to peripheral muscles which causes cramping.
153
What is orthopnea? PND?
SOB, trouble breathing in supine. Associated with heart failure. Supine increases venous return which increases preload.
Orthopnea - happens as soon as lay down
Paroxysmal Nocturnal Dyspnea - can handle initial rise in preload but can't over handle it over time.
154
What is DOE?
Dyspnea on Exertion
155
What is syncope? Caused by?
Fainting, transient loss of consciousness
Result of decreased BP, CO, blood flow to brain
156
What are symptoms of pulmonary disease?
```
SOB/DOE
Cyanosis - nails, lips, eyes
Wheezing
Cough
WOB
Sputum production
Pain
```
157
How does edema present when it is associated with heart failure? Which side is the heart failure?
Standing up - peripheral edema due to gravity
Laying down - fluid backs up the SVC and causes jugular venous distension
Right-sided heart failure
158
What is digital clubbing a sign of?
Chronic hypoxia
159
Which muscles would exhibit atrophy in cardiopulmonary disease? Hypertrophy?
Atrophy - peripheral muscles, pecs, abs
Hypertrophy - SCM, upper traps, scalenes
160
Why is there peripheral atrophy in patients with CPD?
It's hard to eat (takes too much energy just to breathe) and there is an increased metabolic demand to breath.
161
How wide/deep should the chest be? What does the barrel shape indicate?
Chest should be 2x as wide as it is deep.
Increased AP diameter (barrel shape) indicates obstructive disease - lungs are hyperinflated because can't get air out.
162
What is a Cheyne-Stokes breathing rate?
Crescendo/decrescendo
Breathing with rhythmic waxing and waning of depth of breaths and regularly recurring apneic periods.
163
What is Biot's breathing rate/pattern?
Slow rate and depth
Irregular rhythm
Rapid, short breathing with pauses of several seconds, indicating increased intracranial pressure.
164
What is paradoxical breathing?
That in which all or part of a lung is deflated during inhalation and inflated during exhalation, such as in flail chest or paralysis of the diaphragm.
165
What is psychogenic dyspnea?
Dyspnea that occurs in a background of emotionally stress, characterized by irregular breathing and prominent deep sighs; severe PD may be marked by hyperventilation, light-headedness, tingling of hands and feet, tachycardia, T wave inversion, syncope.
166
What are the 4 major vital signs?
Blood pressure
Heart rate
SpO2
Respiratory rate
167
What part of the stethoscope do use to listen to S1/S2?
S3/S4/murmurs?
1/2: diaphragm
3/4: bell
168
What is the S1 sound?
Closure of the AV valves (systole)
169
What is the S2 sound?
Closure of the SV valves (diastole)
170
What is the S3 sound?
Ventricular gallop after S2. Indicates CHF
171
What is the S4 sound?
Atrial gallop before S1.
172
What does a murmur indicate? Where is it loudest?
Indicates valvular dysfunction. Loudest at the valve it is affecting.
173
What part of the stethoscope do you use to listen to breath sounds?
Diaphragm
174
Where is tracheal/bronchial sound normal?
manubrium
175
where is the bronchovesicular sound normal?
mainstem bronchi
176
where is the vesicular breath sound normal?
peripheral lung areas
177
What are wheeze sounds? what do they indicate?
high pitched sounds usually on inhalation. indicate narrowing of airways
178
what are crackle lung sounds? indicate?
also called ronchi
bubbles/popping of air through fluid or airway opening up.
caused by fluid backup or secretions
179
what is the pleural rub lung sound? indicates?
grating/friction that is painful. caused by inflammation that causes the visceral and parietal fluid to rub together
180
what does increased voice sound mean?
increased lung density
181
what is bronchophony?
increased transmission of voice sound caused by alveoli filled with fluid or replaced by solid tissue
182
what is egophony?
bleating sound often by lung consolidation and fibrosis
183
what is whispered pectoriloquy?
increased loudness of whispering in areas of lung consolidation (pneumonia, cancer)
184
what does a weak pulse mean?
poor perfusion
185
what is tactile fremitus?
feeling for vibrations when patient says voice sound (assessing density)
186
what would mediate percussion pick up?
alterations in lung density
187
what is the dyspnea index? what is it used for?
how many breaths it takes to count to 15.
used to figure out exercise intensity during treatment
188
what are the vascular tests that are used to determine perfusion (peripheral arterial disease)
```
Ankle Brachial Index
Rubor of dependency
Venous filling time
Homan's sign
Claudication time
```
189
What is electrocardiography? What can it diagnose?
12-leads (10 electrodes) that provide different views of the heart and measure electrical activity (4-beat reading).
Diagnostic for heart rate, rhythm, axis, hypertrophy, infarction, and ischemia
190
What does a holter monitor do?
Provides 24-hour monitoring of heart rate and rhythm using 1 or 2 leads
191
When is pharmacologic stress testing used? What are the typical medications?
If patient unable to reach at least 85% of predicted max HR on standard exercise testing
Adenosine or Persantine
192
What does isotope imaging or radionuclide perfusion imaging test for? What are the typical medications?
Reversible vs. irreversible ischemia
Thalium or Technetium (cardiac tracers that light up on CT in coronary arteries)
If pt is ischemic during stress but perfused at rest, they have reversible ischemia
193
What is echocardiography? What does it look for?
Ultrasound of the heart
Assesses valvular function, coordination of contraction, thickness of heart muscle, estimated ejection fraction, and estimated pulmonary artery pressure
194
What does a cardiac catheterization look for?
Pressure in the chambers, stroke volume, ejection fraction, Pulmonary Vascular Resistance (PVR), Total Peripheral Resistance (TPR), coronary artery perfusion
195
What are the precautions of a patient who just had a cardiac catheterization?
Patient should be on bedrest for at least 1 hour due to risk of infarction or stroke.
196
What is Central Venous Pressure (CVP)?
Pressure in the right atrium
197
Which has a higher pressure: right atrium or left atrium?
Left atrium
198
Which has a higher pressure: right ventricle or left ventricle?
Left ventricle
199
What is the normal measure of diffusion? What does this test?
25-30 mL/min/mmHg
Tests how fast Carbon Monoxide gets from alveoli to blood
200
What is normal peak flow? What is it like during an asthma attack?
9-10 L/sec
Decreased in asthma attack
201
What is the difference between reversible and irreversible ischemia?
Reversible: ischemia
Irreversible: necrosis due to prolonged ischemia
202
What is the sign for ischemia on electrocardiogram?
S-T segment depressions
203
What are the signs for infarction on electrocardiogram? (3)
Presence of pathologic Q waves
S-T segment elevations
T wave changes
204
Should heart rhythm change during exercise?
No
205
What are the tools in the metabolic cart used for?
Differentiating between heart issue, lung issue, vascular issue, or deconditioning
206
A max VO2 of how many METs would determine disability?
3 METs
207
If a patient has a patent foramen ovale and had pulmonary hypertension, what direction would blood flow inside the heart? Implications?
Right to Left (low to high pressure)
Deoxygenated blood into left ventricle and periphery which dilutes the oxygen out of the blood. Patient will experience hypoxymia during exercise.
208
What kind of study would they do with an echocardiogram to figure out if there is a R --> L shunt?
Bubble study (radio isotope injected on venous side)
209
How would the diaphragm appear in a patient with COPD? With a flaccid diaphragm? With a spastic diaphragm?
COPD: flat (hyperinflation)
Flaccid: higher
Spastic: lower
210
What is more accurate: echocardiogram or cardiac catheterization?
Cardiac catheterization
211
Where does a cardiac catheterization lead travel when assessing the right side of the heart? Left side?
Right: subclavian vein
Left: femoral artery
212
What is the normal mean PAP (Pulmonary Arterial Pressure)?
15 mmHg
213
What can a V/Q scan diagnose?
Pulmonary embolism
214
What does a bronchoscope assess?
Abnormal tissue or secretions
215
What is a bronchogram?
Glorified chest x-ray - inhale a gas that lines airways to visualize on x-ray
216
What is a (+) Bronchogram Sign?
When you can view the airways on a regular x-ray (shouldn't be able to). Indicates consolidation of secretions, increased density, or abnormal pathology.
217
What do pulmonary function tests look for?
Restrictive vs. obstructive lung disease
218
Why take sputum cultures?
Figure out what organisms are contributing to infection and select appropriate antibiotic.
219
BP reading error: bladder too narrow
high BP
220
BP reading error: arm below heart
high BP
221
BP reading error: arm above heart
low BP
222
BP reading error: back unsupported
high BP
223
BP reading error: legs dangling
high BP
224
BP reading error: slow inflation rate
DBP too high
225
BP reading error: fast deflation rate
SBP too low, DBP too high
226
BP reading error: slow deflation rate
DBP too high
227
What is the Origin, Insertion, and Innervation of the Diaphragm?
Origin: xiphoid process, lower 6 costal cartilages, anterior surfaces of lumbar vertebrae
Insertion: central tendon
Innervation: phrenic nerve (C3-4-5)
228
What innervates the upper trap and the SCM?
Spinal Accessory Nerve (CN XI)
229
What nerve segments innervates the scalenes?
C4-C8
230
What nerve segments innervate the abdominals?
T5-L1
231
Normal Tidal Volume?
600 (M) 500 (F) mL
232
Normal Total Lung Capacity?
6000 (M) 4200 (F) mL
233
Normal Residual Volume?
1200 (M) 1000 (F) mL
234
Normal Functional Residual Capacity?:
2400 (M) 1800 (F) mL
235
Normal Forced Expiratory Volume in 1 Sec?
75-80% FVC (forced vital capacity)
236
Normal FEV1/FVC ratio?
75-80%
237
Normal Peak Expiratory Flow?
9-10 L/sec
238
Which valves are open/closed during isovolumetric relaxation?
AV valves open, SL valves closed
239
What valves are closed during isovolumetric contraction?
All 4 until ventricular pressure > aortic pressure - SL valves open
240
What is the "lub" sound? "Dub"?
Lub: AV valves close (start systole)
Dub: SL valves close (start diastole)
241
What is the EF and functional capacity of a low-risk cardiac patient?
EF > 50%
| FC: > 7 METS
242
What is the EF and functional capacity of a moderate risk cardiac patient? When do signs/symptoms occur?
EF: 40-49%
FC: < 5 METs
S/S at high levels of exertion (> 7 METs)
243
What is the EF of a high risk cardiac patient? When do signs/symptoms occur?
EF: < 40%
S/S at low levels of exertion (< 5 METs)
244
When does Phase I of cardiac rehab begin?
When the patient is medically stable.
245
What are the goals of Phase I cardiac rehab?
Return to independent function
Educate on cardiac rehab & risk factors
Prevent physio/psycho effects of event
Provide home exercise program
246
What kind of exercise occurs during Phase I cardiac rehab?
Mode: functional activities
Intensity: low level, focus is on duration not intensity
Target HR: RHR + 20 (not > 120)
Frequency: 30 min/day most days
247
How long can Phase II cardiac rehab last?
Up to 36 weeks
248
What test should be performed before beginning phase II?
GXT (sub-maximal)
249
What are the goals of Phase II cardiac rehab?
Progress from low-level to moderate-level
Promote safe return to activity/exercise
Indepth education on condition management
Initiate lifestyle changes
250
What kind of exercise occurs during Phase II cardiac rehab?
Mode: traditional aerobic/resistive
Intensity: high enough to have training effect but low enough not to evoke signs and symptoms; usually 40-50% VO2R or HRR
Frequency: 3-5 x/week
Duration 20-60 min accumlated
251
What are the upper limits for exercise intensity in phase II cardiac rehab?
HR 10 bpm below onset of symptoms
RPP below onset of symptoms
Abnormal BP response (drop or rise > 200/100)
Certain "bad" dysrythmias
252
What are some ways to prescribe exercise without a GXT?
Pharmacologic stress test
Duke Activity Status Index
253
What are the parameters for exercising patients without a GXT?
Must be conservative and closely monitor pt
Start low at 2-4 METS, RHR+20
254
How is activity progressed during phase II?
Initial phase
Improvement phase
Maintenance phase
3-6 month period of progressing from low level to moderate-vigorous level
255
How long does Phase III/IV cardiac rehab last?
Forever, otherwise cardiac status will deteriorate again.
256
What are the guidelines for progression to independent exercise?
Functional capacity > 8 METs
Stable VS response
No abnormal signs/symptoms
Pt demonstrates knowledge of risk factors, abnormal s/s, and disease management
257
What are the guidelines for resistive training?
2-3 x/week
Higher reps (8-15) with lower weight
RPE: 11-14
Do not exceed RPP where s/s occur
Avoid valsalva
Use proper form with slow, controlled movements
258
What is the general target of exercise in a stage III/IV cardiac patient?
Mode: aerobic
Intensity: 40-80% VO2R or HRR
Frequency: 3-7x/week
Duration: 30-60 min
Interval training may be effective
259
A patient with CAD is at higher risk factor for MI over what MET level?
6 METs
260
A person who had a CABG should not perform what activities that would damage the chest wound?
Shoulder restrictions:
- No push up to stand
- No pulling on bed rails
261
What should you keep in mind if exercising a patient with angina?
```
Pt must be stable
FC must be > 3 METs
Goal is to increase anginal threshold
Prolonged warmup, cooldown
THR 10 bpm < anginal threshold
RPP below symptom level
Lower body exercises
Monitoring
Use nitroglycerin
```
262
What should you keep in mind if exercising a patient with MI?
Consider size/location of MI
How is it being managed
Allow for it to heal (6-8 weeks)
Monitor for chest pain
263
Can you exercise a patient with heart failure?
Only if they have stable/compensated heart failure.
GXT with direct gas exchange measurement is indicated. Symptoms can be used to grade intensity since they may be chronotropically incompetent.
264
What is a way to differentiate between neurogenic and vascular PAD?
Forward flexion that relieves the pain was neurogenic (foramen opened up and relieved compression on nerve root).
265
What is the main indication of peripheral artery disease?
Claudication, especially in the calf.
266
All patients with PAD also have...?
CAD
267
How should you exercise a patient with PAD?
Start exercise to elicit symptoms in 3-5 minutes and allow pain to reach level 3 on claudication scale followed by rest.
Promote circulation.
268
What neurotransmitter stimulates cholinergic receptors?
Acetylcholine
269
What neurotransmitter stimulates adrenergic receptors?
Norepinephrine
270
What receptors do cholinergic drugs target?
Muscarinic cholinergic receptors (parasympathetic NS)
271
Stimulation of Alpha-1 adrenergic receptors does...?
Vasoconstriction of arterioles which increases BP and workload on heart
272
Stimulation of Alpha-2 adrenergic receptors does...?
Decreases BP by inhibiting NE
273
Stimulation of the Beta-1 adrenergic receptors does...?
Increases HR and contracility
274
Stimulation of Beta-2 adrenergic receptors does...?
Bronchodilation and decreased mucus production
275
A cholinergic stimulant is also called what?
Parasympathomimetic
276
An anti-cholinergic is also called?
Parasympatholytic
277
An adrenergic stimulant is also called?
Sympathomimetic
278
An anti-adrenergic is also called?
Sympatholytic
279
A Beta-2 agonist would do what?
Bronchodilation and decreased mucus production
280
What is a side effect of a beta-blocker used to decrease HR?
Bronchoconstriction
281
What do cardiovascular medications do?
```
Decrease MVO2
Increase myocardial oxygen supply
Control rhythm
Enhance cardiac function
Decrease clotting
Control BP
Lower cholesterol
```
282
What kind of medication is Nitroglycerin?
Nitrate/Vasodilator
283
What is the function of nitrates?
```
Systemic arterial/venous vasodilation
Decreased preload
Decreased afterload
Decreased cardiac workload and MVO2
Coronary vasodilation
```
284
Why would a nitroglycerin cause reflex tachycardia?
The decreased preload decreases SV and CO which is sensed by the body. This decreases BP which causes HR to increase in order to maintain CO.
285
Why does nitroglycerin cause dependent edema? What can be done to counteract this?
Decreased venous tone - blood cannot overcome pull of gravity.
TX: lift legs, ankle pumps
286
What is the procedure for sublingual nitroglycerin (NTG)?
Can be taken 3x total within 15 minute window (5 minute intervals) as long as BP doesn't drop below 100 (in normotensive pt) or drop by 25% (in hypo/hypertensive pt).
If patient has cardiac event during exercise, sit them down and have them take NTG. Assess vitals and call 911 if symptoms persist.
287
What medications end in "-olol"?
Beta-blockers
288
What are the functions of beta-blockers?
```
Decrease HR
Decrease contractility
Decrease lipid metabolism
Decrease insulin sensitivity
Bronchoconstriction if non-selective
Decrease myocardial oxygen consumption
```
289
What are the rehab concerns of beta-blockers?
Blunted HR response
Improved tolerance but still less than normal
Watch for s/s of CHF/CMD and dysrhythmias
290
What are the functions of Calcium channel blockers?
Block entrance of calcium to vascular smooth ms (increase vasodilation)
Improve coronary blood flow
Decrease preload/afterload
Prolong AV node refractory period (decreases HR)
291
What are the rehab concerns of Ca channel blockers?
Some HR blunting, but not signif
Normal BP/HR response
Use HR to monitor exercise
292
Where are drugs metabolized?
Liver and kidneys
293
What are Digoxin and Digitalis?
Cardiac Glycosides
294
What are the functions of cardiac glycosides?
Increase contractility in impaired heart (CHF)
Inhibit Na/K pump
Intracellular Ca results
Slowing of AV node conduction (increased ventricular filling time)
295
Cardiac glycosides have a low therapeutic index, what does this mean?
The therapeutic dose is close to the toxic dose.
296
What are the rehab concerns of cardiac glycosides?
Improved ejection fraction
Improved exercise tolerance
Can use HR/BP for monitoring
Watch for digitoxiicity
297
What are the symptoms of Digtoxicity?
```
Nausea
Vomiting
Diarrhea
CNS changes
Syncope
Dysrhythmias
```
298
What medications end in "-pril"?
ACE inhibitors
299
What is ACE?
Angiotensin Converting Enzyme
300
What is the function of an ACE inhibitor?
Prevents conversion of angio I --> II
| Vasodilation decreases preload and afterload
301
What are the rehab concerns of ACE inhibitors?
Minimal side effects (ACE cough)
Takes longer to affect exercise tolerance
Decreased MAP and PAP
Increased CO
302
What are sodium channel blockers?
Anti-arrythmics
303
What are the classifications of sodium channel blockers?
Ia - slow phase 0, slow conduction, prolongs refractory period (increased ventricular filling)
Ib - minimal slowing of phase 0, minimal slowing of conduction, shortened refractory period
Ic - significant slowing of phase 0, moderate effect on conduction, no effect on refractory period
304
What ions regulate action potentials?
Ca2+, Na+, K+, Cl-
305
Why would you use beta-blockers as anti-arrhythmics?
Decrease automaticity
Prolong refractory period
Slow HR and conduction
Used in atrial dysrhythmias
306
What does Amiodarone do?
Prolongs repolarization. Commonly used for A-fib.
307
What is the problem with using Amiodarone as an anti-arrhythmic?
May induce dysrhythmias before reaching therapeutic effect. May also cause liver damage
308
What kind of drugs are Dopamine and Dobutamine?
Sympathomimetics
309
What are the functions of sympathomimetics?
Stimulate B1 - increase Ca influx, SA node activity, conduction, and contractility
Stimulate B2 - dilation of smooth muscle in bronchioles
Stimulate alpha receptors - increase peripheral vasoconstriction to increase BP
310
What are Alpha-1 blockers usually used for?
Hypertension
311
What are the functions of alpha adrenergic blockers?
Decrease TPR (vasodilation)
Cause arteriole relaxation
Decrease afterload
312
What are the rehab concerns of alpha blockers?
Hypotension
BP may be lower
BP should have normal rise with activity
313
What kind of drug is Atropine?
Anti-cholinergic
314
What does an anti-cholinergic do?
Increase HR, block parasympathetic outflow (vagal stimulation).
Used in bradycardias and other dysrhythmias.
315
What kind of drug is lasix?
Diuretic
316
What does a diuretic do?
Decreases BP
Fluid released from kidney which decreases blood volume and therefore preload.
317
What are the 3 types of diuretics?
Loop-Diuretic - acts on ascending loop of Henle (Lasix)
Thiazides - inhibit Na+ resorption
K sparing - weaker, excretes fluid but spares K+
318
Why is important that diuretics are taken on schedule?
Orthostatic hypotension
Electrolyte imbalance
Weakness, fatigue, irritability
Lower BP but should respond appropriately to exercise
319
Patients with artificial valves are at risk for what complication?
Clots
320
What are anticoagulants?
Blood thinners - prevent clots
321
How does Heparin work?
Inactivates thrombin
322
What are the 2 types of Heparin? Which one is better?
Unfractionated Heparin - IV, more unpredictable
Low molecular weight Heparin - preferred; subcutaneous injection; immediate effect and easier to reach therapeutic level; can mobilize pt with DVT earlier
323
How does Coumadin work?
Oral anti-coagulant. Inhibits K+ function.
324
What are you at risk for when you are on anti-coagulants?
Bleeding
325
What are anti-thrombotics? Name 2.
Blood thinners
Aspirin and Plavix
326
What are thrombolytics? Name 2.
Clot busters
Streptokinase
Tissue Plasminogen Activator (tPA)
327
What are "-statins"?
Lipid lowering medications. Lower LDLs
328
What are fibric acids?
Lower triglycerides
329
What are the rehab concerns with statins?
Neuromuscular problems (myopathy, pain, weakness, paresthesais) or GI upset
330
Beta blockers
Ca channel blockers
Nitrates
Decrease O2 demand
331
```
Thrombolytics
Antithrombotics
Anticoagulants
Ca channel blockers
Nitrates
```
Increase O2 supply
332
Diuretics
ACE inhibitors
Cardiac glycosides
Beta-blockers
Treat heart failure
333
```
Diuretics
ACE inhibitors
Sympatholytics
Vasodilators
Ca channel blockers
Alpha-2 adrenergic
```
Anti-hypertensives
334
Class I: Na channel blockers
Class II: beta-blockers
Class III: drugs prolong repolarization
Class IV: Ca channel blockers
Anti-arrythmics
335
If a patient is gaining 2 lbs per day... what could this indicate?
Fluid retention --> heart failure
336
What are the 4 types of organ transplant medications?
Corticosteroids
Cyclosporine
Tacrolimus
Azathioprine
337
What are the side effects of corticosteroids?
Osteoporosis, muscle wasting, mood changes, glucose control more difficult
338
What is the #1 cause of death?
Heart disease
339
What is Class I heart disease?
No limitation in physical activity
340
What is a Class II heart disease?
Slight limitation in activity, no problem at rest
341
Class III heart disease?
Marked limitation, symptoms with minimal activity, no problem at rest
342
Class IV heart disease?
Symptoms at rest with ANY activity
343
How prevalent is primary hypertension? What is it?
95% of all cases
Systemic HTN with no known cause
344
What is secondary HTN?
HTN with known underlying disease
345
What are the lifestyle modifications for HTN?
```
DASH eating plan
Weight reduction
Physical activity
Sodium reduction
Limit alcohol consumption
```
346
What is a relative contraindication for exercise (resting BP)
Resting BP 165-180/89-100
347
What is an absolute contraindication for exercise (resting BP)
Resting BP > 180/100
Stop exercise if 200/100
348
What is idiopathic pulmonary arterial hypertension (IAPH)?
Primary pulmonary HTN - no known cause
349
What is secondary PHTN
Secondary pulmonary HTN with known cause, commonly pulmonary disease (excessive vasoconstriction due to decreased O2 levels)
350
What happens to the aorta from atherosclerosis?
Thinning of the media, weakening of the wall, aneurysm, rupture
351
What is the atherosclerotic process?
Increased permeability to lipoproteins at intima layer of vessel (lesion of intima)
"Response to injury" cycle (platelet aggregation, increased permeability, thrombus formation)
352
What are risk factors for cardiovascular disease?
```
Cholesterol
Smoking
HTN
Inactivity
Diabetes
Obesity
Family history
Age
Gender
Stress
```
353
What do HDLs do?
Remove cholesterol, block LDLs from smooth muscle wall
354
What are the target numbers for total cholesterol, triglycerides, LDL, HDL?
Total cholesterol: < 200 mg/dL
Triglycerides: < 150
LDL: < 100
HDL: > 60
355
How does smoking lead to CVD?
Chemicals in tobacco + alterations in blood gases damage vessels and increase permeability to LDLs (lowers HDLs)
356
How does stress lead to cardiovascular disease?
Increased circulating catecholamines
357
What is stable angina?
Symptoms are reproducible at certain workloads (easier to predict what intensity to avoid)
358
What is unstable angina?
Symptoms are unpredictable, occur at random
359
What is Prinzmetal's angina?
Occur due to coronary vasospasm
360
What is silent angina?
Coronary insufficiency without pain
361
What is the anginal scale?
1. Light, barely noticeable
2. Moderate, bothersome
3. Severe, very uncomfortable
4. Most severe pain ever
362
How is myocardial infarction diagnosed?
EKG and cardiac enzymes
363
What is subendocardial MI?
Non-Q Wave MI - involves small area of inner layer of heart; particularly susceptible to ischemia
ST depression
364
What is trans-mural MI?
Q-Wave MI - associated with atherosclerosis involving major coronary artery. Extends through whole thickness of heart muscle and usually results in complete occlusion
ST elevation and Q waves
365
How do echocardiogram and cardiac cath look at MI?
Echo - ejection fraction, contraction quality
Cath - extent of damage
366
What is medical management for CAD/MI?
Acute - supportive measures, restore blood flow and prevent damage
Meds to increase myocardial oxygen supply
Meds to decrease/limit oxygen demand
367
What are the surgical procedures that treat MI?
Percutaneous transluminal coronary angioplasty (PTCA)
Coronary artery bypass graft (CABG)
368
What are the PT considerations of CABG?
```
No lifting more than 5-10 lbs
Limited shoulder ROM
No driving
Hug me pillow
Pain/bronchial hygiene (get pt to cough)
```
369
Where are pacemakers placed?
Infraclavicular fossa into the SVC
370
What are the types of placing of pacemakers?
Atrial
Ventricular
Atrial and ventricular
Biventricular
371
What are the 5 pacemaker codes?
```
Pacing location
Sensing location
Response to pacing
Programmability
Anti-tachyarrythmic function
```
372
What are acute pacer precautions?
Arm sling 24-48 hours
No shoulder elevation above 90 deg for 2 wks
No lifting 5-10 lbs for 2 weeks
373
What are internal defibrillators (AICD)?
Similar to pacemaker
| Detect lethal arrhythmias and defibrillate to correct
374
An ejection fraction of what percent has an increased risk for lethal arrhythmias or sudden death?
< 30%
375
What are AICD precautions?
Same as pacemaker but longer
| Know settings and avoid rate that causes it to fire
376
If the ICD fires, what do you do?
```
Stop and assess
Provide reassurance
Note what pt was doing
Single shock - consult with doc
Multiple or s/s - ER
```
377
What are the 3 types of valvular dysfunction?
Prolapse (balloons backwards but still closed)
Regurgitation (inadequate seal or closes too slowly)
Stenosis (abnormal narrowing or stiffening)
378
What is Cardiac Muscle Dysfunction?
Impaired ability of the heart to EJECT and/or ACCEPT blood
379
What is Congestive Heart Failure?
Decreased ability to maintain cardiac output secondary to CMD
380
What is normal cardiac index?
2.7-4.0 L/min/m2
| < 2.2 = cardiogenic shock
381
What is systolic dysfunction?
Inefficient expulsion of blood
382
What is diastolic dysfunction?
Decreased ventricular filling
383
CMD is caused by?
HTN and CAD
384
HTN leads to...?
Excessive workload and over time leads to heart failure
385
CAD leads to...
Ischemia and/or MI
386
What is treatment for cardiomyopathy?
Heart transplant
387
What is cardiomyopathy?
Contraction/relaxation is impaired
Dilaterd (ventricle becomes floppy)
Hypertrophic (dysfunctional ms)
Restrictive
388
What are the PT considerations of heart transplant patient?
It is a denervated heart
Sternal precautions
Elevated resting HR from lack of parasympathetic input (100-120 bpm)
Use RPE scale for monitoring
SBP same, DBP elevated
Needs longer warmup/cooldown
389
What is PAD?
Peripheral Arterial Disease
Obstruction of the large or medium sized arteries
S/S: intermittent claudication, skin changes, necrosis/amputation
390
Venous insufficiency leads to...?
Incompetent veins
LE edema (dependent)
Stasis ulcers
Poor healing
391
DVT is a risk for...?
Pulmonary embolism
392
S/S of metabolic syndrome?
```
Elevated waist circumference
Elevated triglycerides
Decreased HDLs
Elevated BP
Elevated fasting blood glucose
```
