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Spring 2022 classes > cvp cardiac part 2 > Flashcards

cvp cardiac part 2 Flashcards

1
Q

jugular venous distension is measured with ______, positioned _______, and shows

A

ruler, 45 degrees laying back, elevated if seen above clavicle which means an increase in volume of the venous system

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2
Q

a normal heart sound is described as “lub-dub” which includes S1 then S2. S1= and S2=

A

mitral and tricuspid valves close
atrial and pulmonary valves close

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3
Q

what happens during disatole

A

PV and AV close, TV and MV open for filling (includes atrial kick)

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4
Q

what happens during systole

A

TV and MV close, ventricle pressure is higher than the aorta causing the pulmonary artery adds pressure on the AV and PV causing them to open

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5
Q

what is the pattern of auscultation of the heart from 1-4

A

aortic, pulmonic, tricuspid, mitral
all physicians take money

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6
Q

aortic valve is auscultated where

A

R 2nd intercostal space

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7
Q

pumonic valve is auscultated where

A

L 2nd intercostal space

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8
Q

tricuspid valve is auscultated where

A

L 4/5 intercostal space

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9
Q

mitral valve is auscultated where

A

5th intercostal space, includes point of maximum impulse and is usually heard as the loudest sound

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10
Q

what does mitral regurgitation mean

A

mitral or tricuspid valve not closing properly

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11
Q

when is mitral regurgitation heard

A

systole, b/w S1 and S2

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12
Q

when is aortic regurgitation heard

A

during diastole after S2

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13
Q

when is mitral/tricupsid stenosis heard

A

during diastole before S1

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14
Q

when is aortic/pulmonic stenosis heard

A

systole between S1 and S2

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15
Q

what kind of patient would have S3 sound

A

heart failure

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16
Q

what kind of patient would have S4

A

LV hypertrophy or long standing HTN

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17
Q

what does S4 cause

A

late diastole

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18
Q

what does S3 cause

A

prolong filling

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19
Q

w/ aortic stenosis:
SV ___, afterload ____, preload ____, atrial pressure _____, aortic pulse pressure _____, left atrium

A

decrease. increase. decrease. increase. decrease. enlarged

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20
Q

w/ aortic regurgitation
____ EDV, _____ EDP, ____ preload _____, mitral regurgitation _____ ,LA blood _____, LA pressure ______, ____ SV

A

increase. increase. increase. quicker. increase. increase

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21
Q

what is the pnemonic to remember heart murmurs

A

MRS. ARD. MSD. ASS

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22
Q

SA node rythm ____
AV node rythm ____
bundle of his rythm ____

A

60-100 bpm
40-60 bpm
20-40 bpm

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23
Q

representation of EKG graph
large box ____
small box ______
normal PR ______
normal QRS _____

A

0.2 sec
0.04 sec
<0.2
<0.12 or 3 small squares

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24
Q

how can you measure HR on 6 sec strip

A

10 x # QRS

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25
Q

if only one segment on the EKG is regular how do you identify it

A

normal except ….

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26
Q

what does fibrillation mean

A

ventricle not contracting well causing irregular PR interval

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27
Q

early QRS means

A

premature ventricular/atrial contraction, depends on what else is irregular

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28
Q

what does junctional EKG mean

A

p wave is not before the QRS

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29
Q

1st degree AV block means

A

prolong PR, everything else is normal

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30
Q

2nd degree AV block/type 1/wenkelbach

A

prolong PR that is PROGRESSIVELY lengthening, QRS DROPS

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31
Q

2nd degree AV block type 2

A

shortened PR that has a suddent QRS DROP

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32
Q

3rd degree AV block type 3

A

complete block= PR interval not defined, atria and ventricles don’t communicate

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33
Q

p wave
t wave
QRS wave

A

depoloarization atria
repolarization ventricles
depolarization ventricles and repolarization atria

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34
Q

3 types of SA node rhythms

A

NSR, sinusbradycardia, sinustachycardia

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35
Q

5 types of atrial dysrythmia

A

premature atrial contraction, atrial tachycardia, atrial bradycardia, atrial flutter, atrial fibrillation

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36
Q

junction dysrythmis is of what node

A

AV node

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37
Q

4 types of AV node dysrythmia

A

premature junctional contractions, junction bradycardia, accelerated junctional rhythm, junctional tachycardia

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38
Q

junctional
___ bradycardia
____ junctional
____accelerated
____ tachycardia

A

<40
40-60
60-100
>100

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39
Q

5 types of ventricle dysrhtmias

A

premature ventricular contraction, ventricular fibrillation, ventricular tachycardia, ventricular escape, polymorphic ventricular tachycardia

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40
Q

ventricle
____ bradycardia
____ ventricular rate
____ accelerated
____ tachycardia

A

<20
20-40
40-100
>100

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41
Q

what parts of the heart are associated with RCA

A

RA, RV, inferior LV, SA node, AV node

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42
Q

what parts of the heart are associated with LCX

A

posterior LV, lateral LV

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43
Q

what parts of the heart are associated with LAD

A

anterior LV, lateral LV, septum

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44
Q

how is ischemia identified on an EKG 12 lead

A

ST depression (appears as horizontal or downslopping)= NSTEMI if > 0.5mm at J point in 2 or more consecutive leads

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45
Q

what does t wave inversion mean

A

may be NSTEMI or previous MI

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46
Q

what vascular disease is also atherosclerosis

A

PAD

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47
Q

what are some risks for a patient with PAD

A

stroke, MI, thrombosis

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48
Q

what would a patient with PAD usually complain of

A

intermittent claudation= pain in leg that gets worse w/ exercise and better with rest

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49
Q

what is a medical emergency associated with PAD

A

critical limb ischemias

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50
Q

what are the 6 p’s of critical limb ischemias

A

pallor, pain, paresthesia, paralysis, pulselessness, pokilothermia (unable to regulate temperature)

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51
Q

what is a diagnostic imaging PTs can use for PAD

A

ankle brachial index

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52
Q

what does ankle brachial index mean

A

ankle BP / arm BP and look at ratio to determine how severe and at risk the patient is

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53
Q

what would indicate a more severe PAD

A

lower ratio

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54
Q

what does >1.3 of ankle/brachial BP indicate

A

non-compressible: pulse is unable to obliterate

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55
Q

what BP indicates you shouldn’t do ankle/brachial index b/c BP is too high

A

250 mmHg

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56
Q

what is the gold standard for dx PAD

A

angiography

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57
Q

possible pharm tx for PAD

A

PDE 3 inhibitator, pentoxifyline, xanthine, vasolates, anti-HTN, anti-platelet, cholesterol lowering

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58
Q

surgical tx PAD

A

stent, angioplasty, thrombectomy, open surgical bypass

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59
Q

what is the typical PT exercise tx for PAD pts: called SET and covered by medicare

A

30-45 min sessions, 3x/week, 12 weeks total

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60
Q

what instrument should be used for differential diagnosis of vascular disease

A

ultrasound

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61
Q

what are s/s of venous insufficiency

A

LE edema, skin changes, discomfort, pitting edema, dilated veins

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62
Q

primary vs secondary venous insufficiency

A

no precipitating event vs response to previous DVT

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63
Q

what kind of disease is venous insufficiency

A

progressive. can get worse and develop ulcers and skin changes

64
Q

3 parts of virchow’s triad- how likely a pt is to develop vascular disease

A

stasis, hypercoagulability, vessel wall injury

65
Q

can MRI and CT dx DVT

A

no, they can’t be used to r/i or r/o

66
Q

what does AAA mean

A

vessel diameter > 3cm

67
Q

what vascular disease may cause LBP and can be confused with MSK pain

A

aortic dissection

68
Q

what are the 2 largest lymphatic trunks

A

r lymph duct and thoracic duct
r lymph: R arm and R side of head
thoracic duct: rest of the body

69
Q

what is the primary pathway for removing excess fluid in the lung

A

mediastinal lymph system

70
Q

what stages of lymphedema are still reversible

A

0-1

71
Q

what stages of lymphedema have a + stemmer sign

A

2-3

72
Q

what is the most common type of lymphoma

A

non-hodgkin’s: slow and agressive

73
Q

what type of swelling is most common in LE of women in a symmetrical pattern found PROXIMALLY

A

lipedema

74
Q

what kind of swelling is most commonly found in the extremities and found unilaterally

A

lymphedema

75
Q

does primary or secondary lyphedema have an unknown cause

A

primary. secondary is caused by damage to lymph vessels and nodes

76
Q

what does a positive stemmer sign mean

A

when pinching the dorsum of the foot/ hand you’re unable to separate the skin from the bone aka there’s too much fat

77
Q

examples of PT interverntion for lymphedema

A

compression, manual lymph drainage, exercise to increase muscle pump activity and facilitate decompression, low impact CV exercise

78
Q

what is the difference b/w HF and cardiomyopathy

A

HF= diagnosis
cardiomyopathy= etiology

79
Q

what causes systolic heart failure

A

LV is dilated and can’t contract efficiently

80
Q

what causes diastolic heart failure

A

LV is stiff and can’t easily relax causing thickening of the LV

81
Q

how are hormones related to HF

A

overactive RAAS and sympathetic NS to prevent heart from failing causes diminished natriuretic peptides leading to an imbalance of hormones furthering the decline in heart function

82
Q

4 physiological causes of cardiorenal syndrome due to overactivation of SNS

A

vasoconstriction, tachycardia, sodium retension, renin released

83
Q

RV failure 3 causes

A

-pHTN or high pressure in the lungs caused by disease or L side HF
-tricuspid pathology or RV dysfunction
-pericardium effusion

84
Q

why is right side HF systemic symptoms

A

blood can’t even reach L side since it starts as deoxygenated in the R side

85
Q

why is left side HF only pulmonic symptoms

A

blood can’t get through to the lungs themselves

86
Q

examples of decompensated HF symptoms

A

hypotension, JVD, altered mental status, weight gain

87
Q

what is the most common type of cardiomyopathy

A

ischemic

88
Q

3 types of non-ischemic cardiomyopathy

A

dilated LV: most common, caused by virus, postpartum, toxic
restrictive LV: very rare
hypertrophic VALVE: very rare, usually athletes

89
Q

why is cardiogenic shock a medical emergency

A

very low BP that may be so severe and cause organ damage
CI <2.2

90
Q

what is BNP

A

brain nateruretic peptide: identifies heart STRETCH, if the heart is stretched BNP will be increased

91
Q

what lab value determines HF that is compensated or decompensated

A

BNP

92
Q

what would a CXR and echo of someone w/ HF look like

A

enlarged heart, wedge pressure >15, abnormal EF

93
Q

if a heart has mitral regurgitation what would happen to the atria

A

dilated b/c excess blood

94
Q

if LV hypertrophy what would likely happen to the pulmonary pressure

A

increase in pressure

95
Q

3 types of short term surgical tx for HF

A

ECMO, IABP, impella

96
Q

venovenous support is for ______
venoatrial support is for ______

A

lungs. heart

97
Q

where is IABP located

A

proximal descending aorta and commonly inserted in the primary femoral artery

98
Q

what happens to the IABP during systole _____ and diastole _____

A

deflated. inflate. the purpose is to assist with diastole inflation

99
Q

purpose of IABP

A

decrease afterload and improve CO by filling arteries better and more efficiently

100
Q

who can be candidate for IABP

A

acute cardiogenic shock, advanced HF waiting surgery, severe coronary disease

101
Q

3 indications for lvad

A

-stage 4 heart failure according to NYHA
-LV EF of <25%
-inotrope dependent

OR
-CI <2.2 not on ionotropes w/ optimal medical management or advanced HF for 2 weeks

102
Q

3 lvad designations

A

destination therapy, bridge to transplant, bridge to recovery

103
Q

LVAD is _____ dependent and _____ sensitive

A

preload, afterload

104
Q

4 parameters for LVAD

A

speed, flow, pulsatility index, power

105
Q

pulsitality index

A

native heart’s ability to pump blood and contribute to CO, higher= heart is pulsing on its own, lower= heart isn’t pulsing as much on its own

106
Q

3 LVAD hemodynamics

A

native LV contributon, volume status, IV meds

107
Q

after pt is on LVAD do they get to stop taking meds?

A

no, they must continue taking meds to keep their immune system and body functioning properly

108
Q

orthotopic heart transplant (OHT) requirements

A

<70 yo, end stage heart disease, signficiant risk mortality, no active infection, no cancer, no organ impairment, BMI <35, abstain from alcohol and tobacco, medical and financial support

109
Q

methylprednusolone

A

glucocorticoid, anti-inflammatory by reversing capillary permeability, used in IV after surgery, SE: acne, adrenal suppression, fluid retention (all hormone related)

110
Q

prednisone

A

PO, anti-inflammatory, SE: anaphylaxis, bradycardia, moon face

111
Q

what happens with OHT hemodynamics

A

no parasympathetic or sympathetic input so pts will have an increase in resting HR and rely on catecholamines to increase HR during activity

112
Q

rejection of transplant symptoms and why are they important

A

usually similar to HF symptoms so pts may not be as quick to report them to us: fatigue, edema, irregular heartbeat, decreased activity tolerance

113
Q

goals of HF meds

A

either increase contractility to decrease HR OR decrease afterload to reach euvolemia (neutral volume)

114
Q

group of guideline directed medical therapy drugs

A

ACEI/ARB, beta blocker, aldosterone antagonists, nitrates

115
Q

how does ACEI treat HF

A

decrease afterload, decrease preload, increase CO by dilating vessels

116
Q

how does beta blocker treat HF

A

only used for stable HF b/c blocks SNS system to decrease ionotropy and increase preload

117
Q

how does aldosterone antagonist treat HF

A

very common K+ sparing drug which prevent arrythmias. PT related: risk for hypotension, dehydration, hyperkalemia

118
Q

how do nitrates treat HF

A

dilate vessels to decrease afterload and increase SV b/c allows heart to function better

119
Q

NY classes of HF class 3 compared to class 4

A

3= symptoms only during activity and not at rest
4= symptoms at rest and during activity

120
Q

what are loop diuretics good for HF tx

A

decrease edema (symptom relief), causes vessel walls to become less dilated since there’s less fluid there, also increases risk for dehydration

121
Q

why would vasopressors be used to treat HF

A

they do vasoconstriction so are good for tx of cardiac arrest, septic shock, hypotension

122
Q

alpha receptor
beta 1 receptor
beta 2 receptor

A

significant vasoconstrictor
heart: some vasoconstriction
lungs: vasodilation

123
Q

doses of epinephrine differences in reaction

A

beta= lower dose = dilates= decrease BP
alpha= higher dose= constrict= increase BP

124
Q

norepinephrine

A

most commonly used vasopressor= increase systemic vascular resistance, increase BP

125
Q

why is vasopressin given exogenously

A

with septic shock vasopressin stores are depleted by 96 hours

126
Q

dopamine doses

A

low= vasodilation
medium= increase HR and ionotrophy
high= vasoconstriction

127
Q

what does iontrope do

A

assist with contractility

128
Q

when would iontrope be given

A

end stage HF, cardiogenic shock, CI < 2.2

129
Q

primacor

A

positive ionotrope, vasodilator, decreases afterload, increases SV

130
Q

dobutrex

A

catecholamine. vasodilates. increases contractility

131
Q

other drugs that can be used as iontrope

A

digoxin, epinephrine low, dopamine medium dose

132
Q

what’s a CI for 6MWT

A

unstable angina recently

133
Q

high risk 6 MWT

A

<200 m predictive of hospitalization or mortality COPD
<300 m predictive HF

134
Q

if a patient is on O2 can they titrate their own

A

yes, they can

135
Q

SPBB

A

for 3 physical performance tests designed to capture limitations in lower extremity functioning that relate to gait, balance, strength

136
Q

what is considered an angina equivalent

A

dizziness

137
Q

SPBB results mean

A

<9 considered frail
helpful for screening LVAD pts to see how frail they are

138
Q

FITT components

A

frequency, intensity, time, type

139
Q

mod intensity
vigorous intensity
exercise

A

50-70% HRR
75-90% HRR

140
Q

MET =

A

metabolic equivalent (energy cost at rest)

141
Q

borg RPE scale

A

6-20

142
Q

cardiac rehab purposes

A

improve aerobic condition, decrease risk disease, decrease symptoms, improve knowledge and self management of disease, decrease hospitalization

143
Q

3 types of cardiac rehab

A

inpatient, supervised, unsupervised

144
Q

phase 2 cardiac rehab

A

supporting physician is immediately available, only specific diagnoses are allowed: acute MI, stable angina, valve replacement, stable chronic HF, heart/lung transplant

145
Q

who prescribes exercise in cardiac rehab

A

physician

146
Q

stable chronic heart failure def

A

LVEF <35% or NYHA class 2+, not hospitalization in past 6 weeks

147
Q

difference in billing cardiac rehab

A

whether or not EKG monitoring was used continuously

148
Q

most commonly used outcome measure cardiac rehab

A

RPE

149
Q

easiest and non-invasive way to diagnose CHD

A

echo

150
Q

cyanotic CHD
acyanotic CHD

A

right to left shunting, s/s hypoxia, SPO2 is low
left to right shunting, s/s heart failure

151
Q

most common CHD

A

ventricular septal defect, can lead to pHTN and RV failure

152
Q

7 symptoms of cyanotic CHD

A

tetralogy of fallot, transposition of the great vessels/arteries, tricuspid atresia, truncus anteriosus, total anomalous pulmonary venous return, pulmonary atresia, hypoplastic LH syndrome

153
Q

most common cyanotic defect

A

tertralogy of fallot

154
Q

tetralogy of fallot examples

A

squatting, cyanosis, clubbing, syncope

155
Q
A

Spring 2022 classes (21 decks)

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