CV exam II Flashcards
If a patient has pale, shiny, dry skin with loss of hair, you should suspect..
PAD
Intermittent claudication is
Pain, cramping, and LE fatigue occurring during exercise & RELIEVED BY REST
What is the percussion test & what is it used to detect?
Palpate one section of vein then percuss another 20 cm higher, IF PULSE WAVES FELT BY LOWER HAND, The intervening valves are incompetent
-TESTS THE COMPETENCE of the GREATER SAPHENOUS VEIN
With the trendelenberg test, when patient is asked to stand their vein should refill after ..
30 sec
What is APG used for ? (Air plethysmography)
Measures patience of venous system
ABI is ..
- what value marks “abnormal”
LE pressure/UE pressure
-
Rubor of dependency is., and indicates.,
Red limb when hanging foot and pallor with elevation ; indicates arterial insufficiency
If a patient has a platelet count of 20,000- 30,000c what can they do ?
LIGHT exercise only
What is normal HgB for a male?
13-18 g/dL
At what WBC count should you use a mask?
WBCs
If a patient has a platelet count of
AROM, ADLs only
Typical INR Is :
- in patients with DVTs, PE, mechanical valves, a-fib on ANTICOAGULATION THERAPY , their targeT INR is ..
Typical : 0.9-1.1
-ANTICOAGULATION : 2-3
pH of blood should be ..
7.35-7.45
If a patient has COPD they are In a state of respiratory..
Acidosis (hypo ventilation, etc)
Unstable angina is indicative of ..
Incr risk of MI or lethal arrhythmia ; no precipitating factors involved
Variant angina is caused by..
Vasospasm of coronary arteries in the ABSENCE OF occlusive disease
-BUT responds well to nitroglycerin or ca channel blocker long term
Older adults when experiencing an MI may exhibit atypical symptoms :
No chest pain, but dyspraxia, diaphoresis, vomiting and syncope
What is the qualification for very severe (4+) edema?
Depression lasts >30 sec, >1 inch pitting
on an ECG, you will see an elevated ST segment in leads over what type of injury?
zone of injury (a zone of infarction)
-tissue is non-contractile
a “STEMI” is..
ST elevated MI, full thickness of myocardium involved
CHF is also known as ..
LEFT sided heart failure
what is the actual result in the heart of CHF?
backup of blood from the LV to the LA and lungs
-causes pulmonary congestion, edema and low CO
what is the clinical presentation of right-sided heart failure?
increased pressure load on the R ventricle
-SIGNS: jugular vein distention & peripheral edema
what is the main pharmacological intervention for CHF? what are its effects?
digitalis
-increases contractility and decreases HR
what do Ca channel blocking agents do?
decrease HR, dilate coronary arteries, decr BP, control arrythmias & chest pain
quinidine is a type of..
anti-arrythmitic drug
what do ACE inhibitors and angiotension II receptor blockers both do?
both work at teh level of angiotension II to decrease BP (both decr peripheral vasoconstriction & Na retention)
diuretics work to..
decrease myocardial work (via decr pre and afterload) and control HTN
when can activity begin after an acute MI?
can be increased once the acute MI has stopped, aka after the peak in cardiac troponin levels
-limited to 5 METs or 70% of age predicted HR max for 4-6 weeks following an MI
If you hear an S3 heart sound, it MAY be indicative of..
heart failure - L or R
A CABG is..
circumvention of an obstruction in a coronary artery to improve coronary blood flow and improve LV function
a PTCA is..
percutaneous transluminal coronary angioplasty
-surgical dilation of a blood vessel which relieves obstructed blood flow in acute angina or acute MI
intravascular stents are used to..
prevent restenosis and occlusion in coronary or peripheral arteries
heteroptic vs orthotopic heart transplants:
heteroptic - leaves the natural heart and piggy backs the donor heart
orthotopic - removes diseased heart and replaces it with donor
what is a VAD?
Ventricular assist device
- implanted device (accessory pump) that improves tissue perfusion and maintains cardiogenic circulation
- SEVERE CASES ie cardiogenic shock unresponsive to meds
thrombolytic therapy is administered for..
acute MI - dissolve clot and restore coronary blood flow
how many METs is walking considered?
4-5 METs
how many METs is running (5.5 mph) or bicycling at 13 mph considered?
8-9 METs
what is BUerger’s disease?
chronic inflammaory vascular occlusive disease of small arteries & veins
- often in smokers
- pain/paresthesias, cyanotic extremities, decr temp discriminiation, ulcers, fatigue, gangrene risk
intermittent claudication is present in PVD or PAD?
PAD - chronic occlusive arterial disease of MEDIUM AND LARGE SIZED VESSELS
what are the clinical signs of a PE?
abrupt presentation, with chest pain & dyspnea, diaphoresis, cough, apprehension
LIFE THREATENING
what mmHg is recommended for compression stockings after a DVT?
30-40 mmHg assist wth pain and reduce risk of post-thrombolytic syndrome
if a pt p/w dark, cyanotic, thickened brown skin you can suspect..
chronic venous insufficiency
which is more common in WOMEN : chronic VENOUS insufficiency or chronic ARTERIAL insufficiency?
VENOUS
if a patient has chronic venous insufficiency, you can suspect they may develop ulcers WHERE?
sides of ankles esp near medial malleolus w irreg borders
those with a h/o Smoking, DM, and HTN are more likely to have which : chronic VENOUS or ARTERIAL insufficiency?
arterial
what causes lymphedema?
excessive accumulation of fluid either 2/2 obstruction of lymphatics OR removal of lymph nodes
the most accurate way to determine age predicted max HR is..
208 - 0.7 x age
a positive ETT indicates that..
you have ischemia (imbalanced oxygen supply)
“somewhat hard” on the Borg scale is..
13
what occurs to the ST segment during normal exercise?
depresses (but is upsloping) less than 1 mm
-greater than 1 mm below baseline is indicative of MYOCARDIAL ISCHEMIA
when dealing w a pt w HEART FAILURE, what is the concern hours after exercise? .
may experience HYPOTENSION
HOW LONG should warm up & cool down last?
5-10 min
what is considered “moderate intensity” strength training?
60-80% of 1 rep max ; also considered moderate is 5 METs
resistive exercises can be dangerous after a cardiac event due to the risk of..
Valsalva - esp w uncontrolled HTN, sub acute MI, etc
if a PPM is fixed, what is the HR response to exercise
HR does not rise normally
how long after an uncomplicated MI can a patient ambulate/return to activities?
24 hours after OR until the pt is stable for 24 hrs
the MET goal for a patient in acute care after an uncomplicated MI for d/c is..
5 MET capacity (walking 3.5 mph, bicycling 8 mph)
after an MI, what are the HR and MET limitations?
how long after an MI are lifting activities restricted/
6 weeks
suggested MET criterion for d/c from OP cardiac rehab ?
9 METs (running 5.5 mph)
after cardiac surgery, how long are sternal precautions in place? WHY?
6-8 weeks to allow for bony and soft tissue healing
-no UE resistance training!!
