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Cardiopulmonary practice > CVD > Flashcards

CVD Flashcards

1
Q

Major causes of CVD

A

Atherosclerosis
Thrombo-embolism
Vasculitis

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2
Q

Modifiable risk factors for CVD

A 
HTN
Tobacco use
Elevated blood glucose 
Physical inactivity 
Overweight/obesity
Cholesterol/lipids (<180 mg/dL is optimal; HDL 40-60; LDL 100-129)
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3
Q

“Paste” “hardening”
Commonly known as “hardening of the arteries”
Dynamic chronic inflammatory condition
Pathogenesis involves lipids, thrombosis, elements of vascular wall, and immune cells

A

Atherosclerosis

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4
Q

Characteristics of atherosclerosis

A 
Slow, progressive 
Starts in 2nd or 3rd decade 
Very long incubation period 
Often undetectable 
Initial plaques are sparsely distributed 
Increased in number and size over time 
Can affect ANY artery
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5
Q

Common sites for atherosclerosis to form

A 
Femoral branches 
Popliteus 
Carotid branches 
Coronary arteries 
Common iliac 
(Whenever you see turbulent flow)
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6
Q

Developmental stage of atherosclerosis: fibrous plaque

A

Lipoproteins transport LDLs into arterial intima
Fatty streak is covered by collagen and calcium deposits forming a fibrous plaque that appears grayish or whitish
Result= narrowing of the vessel lumen

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7
Q

Developmental stage of atherosclerosis: fatty streaks

A

Characterized by lipid-filling smooth muscle cells

Potentially reversible

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8
Q

Developmental stage of atherosclerosis: complicated lesion/unstable plaques

A

Continued inflammation can result in plaque instability, ulceration, and rupture.
Lipid core is exposed to the blood stream, platelets accumulated, and thrombus forms.
Result = narrowing of lumen or thromboembolic event

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9
Q

Complications of atherosclerosis

A 
Calcification of atherosclerotic plaque
Rupture or ulceration
Hemorrhage into the plaque —> further narrowing 
Embolization 
Weakening of vessel wall —> aneurysm
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10
Q

a condition that occur then the vein wall and/or valves in the leg do not work effectively, which impairs the ability for blood to return to the heart from the legs, resulting in venous-stasis

A

chronic venous insufficiency

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11
Q

3 systems affected by CVI

A

superficial– lesser and greater saphenous
deep– ant/post tibial, peroneal, popliteal, deep femoral, superficial femoral, and iliac veins
perforating or communicating veins

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12
Q

CVI may result from…

A

vein wall degeneration, post-thrombotic valvular damage, chronic venous obstruction, or dysfunction of the muscular pumps

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13
Q

clinically apparent increase in the interstitial fluid volume
-develops when starling forces are altered so that there is increased flow of fluid from the vascular system into the interstitium

A

edema

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14
Q

Edema

A

due to increase in capillary pressure usually results from an elevation of venous pressure caused by obstruction to venous and/or lymphatic drainage

  • imbalance of starling forces
  • generalized: HF, hypo-albumenia, nephrotic syndrome, Cirrhosis, sepsis
  • localized: musculoskeletal injury, DVT
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15
Q

Grading for pitting edema

A

1+ barely detectable impression when finger is pressed into skin
2+ slight indentation, 15 seconds to rebound
3+ deeper indentation. 30 sec to rebound
4+ > 30 sec to rebound

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16
Q

PT implications for CVI

A

Elastic pressure stockings
compression pump
Unna boot
Edema Massage: contraindications–uncompensated CHF, untreated infection or cellulitis, active cancer, renal failure, sever pulmonary problems.

17
Q

A persistent discontinuity in the integrity of the skin despite sufficient time for healing

A

ulcer

18
Q

Venous Ulcer

A

maleolar location (usually medial)
irregular margins
browning
varicose veins and pitting edema

19
Q

Arterial ulcer

A

dorsal or distal location (toes)
sharp margins
painful
pallor, loss of hair, nail dystrophy

20
Q

Neuropathic ulcer

A

plantar location
“punched out” margins, correspond to pressure point
insensate, pt often has DM with neuropathy
may have arterial insufficiency sxs

21
Q

Differences between venous and arterial disorders

A

VENOUS:
symptoms–aching, burning, heaviness, fatigue while standing
Elevation–lessens symptoms
walking–lessens symptoms
limb size– swollen in chronic disease
Skin temp- Normal
skin color– hyperpigmented
skin appearance–cellulitis, dermatitis
pulses– normal but may be hard to palpate
ulcers–near med malleolus, irregular border, pink base
ARTERIAL:
symptoms–aching, cramping that is predictable with activity and elevation
Elevation–worsens symptoms, dependency improves symptoms
walking–aching begins at specific time/distance, improves with rest
limb size– decreased due to muscle wasting
Skin temp- cool
skin color– cyanotic or pale, dependent rubor
skin appearance–reduced hair, thick/brittle nails, shiny skin
pulses– may be decreased or absent, bruits
ulcers–pale base, discrete borders, high-pressure sites like heal or toes

22
Q

Wells score for DVT

A

> 2.0– high
1.0-2.0– moderate
< 2.0– low
+1 – active cancer, calf swelling >3 cm, swollen unilateral superficial veins, unilateral pitting edema, previous DVT, swelling of whole leg, localized tenderness along veins, paralysis, paresis or recent immobilization, recently bedridden or major surgery w/ anesthetic in past 12wks
-2– alternative diagnosis just as likely

23
Q

Wells score for PE

A 
Clinically suspected DVT-3
Alternative diagnosis is less likely than PE-3
tachycardia-1.5
immobilization in previous 4 wks-1.5
history DVT or PE-1.5
Hemoptysis-1
malignancy or palliative-1 
Scoring:
> 6.0--high
2.0-6.0--moderate
< 2.0-- low 
> 4--PE likely 
4 or less-- PE unlikely
24
Q

Ischemic syndromes

A 
Angina Pectoris
stable angina
variant angina
unstable angina
silent ischemia
myocardial infarction
25
Q

condition of imbalance between myocardial O2 supply and demand often caused by atherosclerosis of the coronary arteries

A

ischemia

26
Q

chest pain or discomfort caused due to cardiac ischemia
sxs:
heaviness, tightness, pressure
discomfort gradually builds
gradually subsides
episode lasts 1-15 min
often confused with digestive disturbances

A

Angina

27
Q

Pain easily described, precisely located, and usually experienced as a sharp sensation is attributed to _____ pain fibers

A

Somatic

28
Q

Pain more difficult to describe and locate, often described as discomfort, heaviness, or aching is attributed to _____ pain fibers

A

Visceral

29
Q 
Type of Angina:
discomfort gradually builds
occurs with exercise at a predictable and consistent intensity
gradually subsides with rest
typically lasts (2-5 minutes)
improve with nitroglycerin
A

Stable Angina

30
Q

Type of Angina:
Recent or acceleration of angina threshold; new onset < 2 mo
symptoms at rest > 15-20 min
gradually worsens in crescendo-like pattern
may not respond to nitroglycerin or rest
often precursor to MI

A

Unstable MI

31
Q

Populations at special risk for angina

A

Elderly–more likely to present with atypical symptoms
Diabetic–may not be able to accurately sense or describe pain
Women–more commonly report nausea, emesis, jaw pain, neck pain, and back pain
Pt’s on multiple medications, drugs, or alcohol can alter their ability to perceive discomfort
Cultural differences and language barriers

32
Q

cell death in the heart muscle caused by complete and prolonged occlusion of coronary artery

A

myocardial infarction

33
Q

What must be present in order to qualify as MI

A

biomarkers

ST elevation without biomarkers is just ischemia

34
Q

Factors that increase the likelihood of MI

A 
radiation to right arm or shoulder
radiation to both arms or shoulders
associated with exertion
radiation to left arm
associated with diaphoresis
associated with nausea or vomiting
worse than previous angina or similar to previous MI
described as pressure
35
Q

Factors that decrease the likelihood of MI

A 
described as pleuritic
described as positional
described as sharp
reproducible by palpation
inframammary location
not associated with exertion
36
Q

Clinical implications for PT with chest pain

A
  • patients should always have their NTG during exercise sessions
  • if symptoms persist 5 mins after NTG, does can be repeated 2 more times with 5 min intervals between doses
  • if symptoms persist further, seek prompt medical attention
  • NTG can be used prophylactically 5-10 mins before exercise
  • physiologic responses should be monitored (HR, BP, RPP)

Cardiopulmonary practice (3 decks)

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