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NPTE Prep > CVP Misc > Flashcards

CVP Misc Flashcards

1
Q

Mitral Valve Prolapse Triad

A

Dysnpena, Fatgue, Palpiations
Due to Flaps go intruding on left atrium

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2
Q

Name the difference between each level of heart block

A

Normal PR is 0.12-0.2 (3-5 squares)

1st degree heart block - PR interval too large (>0.2)
Usually no big deal

2nd degree heart block mobitz 1 - PR increases each time, drops beat, then restarts

2nd degree mobitz 2 - Conistent PR then drop
Worse than mobitz 1

3rd degree mobitz - Random relationship with PR interval, no order, really large PR intervals. Will be symptomatic, should stop because serious

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3
Q

Describe the difference between pectus carinatum and pectus excavatum

A

Excavatum = sunken chest, smaller, posterior displaced sternum

Carinatum is opposite = More space and ant placed sternum, barrel chest is an example due to emphysema, other obstructive diseases that cause hyperinflation

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4
Q

Cardiac Biomarkers

A

CK-MB,
Myoglobin
Troponin
Lactic dehydrogenase

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5
Q

Signs of lung issues (obstructive) on imaging

A

Increased air would cause radiolucent (darker) b/c light not absorbed by air

Hyperinflated lungs and flattened diaphragm

Increased I:E ratio because E increases

blunted costophrenic angle (less sharp)

Increased subcostal angle b/c less air is pushing on it

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6
Q

Mediate percussion vs percussion

A

Mediate percussion to assess sound with middle finger and other hand as mediator

Percussion is just cup hand hitting against body for postural drainage

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7
Q

UE vs LE exercise

A

Higher BP and HR for UE doe to smaller muscle mass.

LE has greater Vo2 mac/oxygen consumption, UE greater DEFICIT

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8
Q

Fremitus = Egophany

A

Fluid in lungs (increased) more clearly heard due to fluid (e.g pulm edema)

Fluid outside of lungs (decreased). Cannot hear vowels as clear due to Hyperinflation. More muffled than normal level (e.g COPD)

if E sounds like A due to fluid accumulation

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9
Q

Pursed lip breathing

A

Good for obstructive diseases
Lowers respiratory rate
Prevents airway collapse for better gas exchange

Inhale through nose and blow out with pursed lips keeps air pressure inside airways

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10
Q

Huffing and Active Cycle of Breathing

A

Huffing: Coughing against closed glottis to mobilize secretions (think steam on mirror “ha”)

ACBT
Controlled (rested) breathing
followed by
3-4 Deep breaths
followed by
Huffing to move secretions

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11
Q

Segmental Breathing

A

Inflate specific part of lung through tactile cueing

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12
Q

Incentive spirometry

A

Biofeedback device for after surgery, restrictive diseases, SCI, atelectasis after surgery

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13
Q

Glossopharyngeal breathing

A

Gulp breathing with face

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14
Q

Inspiratory hold

A

Breathe in and hold w/o valsalva inflates poorly ventilated lungs, helps with cough

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15
Q

Assisted cough

A

Press on epigastric area

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16
Q

Autogenic drainage

A

Airway clearance through adjusted rates and depth of breathing to mobilize secretions (self)

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17
Q

High frequency chest wall oscillation and acapella device

A

airway clearance for cystic fibrosis

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18
Q

What causes blunted costophrenic angle

A

Pleural effusion (buildup at bottom), Chronic atelectasis

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19
Q

Cardiac Rehab Phases

A

Acute (inpatient) = 4-6 METS, Only 20-30 over HR rest, Borg of less than 13/20

Outpatient = Activities less than 90% of ischemic RPP, Target 55-90% HR Max, 12-16 on Borg (light to somewhat hard), 5-9 METS

Community Program =6-12 months self regulated

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20
Q

METS,

A
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21
Q

Systole vs Diastole

A

Systole = pumping of blood from the respective region (e.g atrial systole is pumping blood into ventricles, ventricular systole is ventricles pushing blood into the pulmonary artery and aorta)

Diastole = Refilling of respective region of heart

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22
Q

Pre load

A

Volume of blood in L ventricle after diastole, based on venous filling , pressure

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23
Q

After load

A

The pressure required for the heart to pump blood out of ventricles into periphery, based on the aorta, peripheral pressures, and blood viscosity

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24
Q

Normal SV

A

60-80

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25
Q

Cardiac output

A

4-5 L
up to 25 L/min during exercise

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26
Q

Hypovolemia

A

Low blood volume
signs include ortho hypotension, tachycardia, increased temp

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27
Q

Hypervelima

A

High blood vol usually due to excessive fluid intake like IV, and sodium or fluid retention due to heart failure or kidney disease

Signs are swelling, fluid in lungs, ascites, etc. = buildup of fluid

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28
Q

Primary muscles of inspiration

A

Diaphargm (C3, c4, c5…)
and
External intercostals

*Diaphragm contraction (flattens) and causes the chest to expand longitudinally and LOWER ribs ELEVATE

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29
Q

Accessory muscles of inspiration

A

SCM, scalene (lifts 1st and 2nd rib), pec major, pec minor, SA

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30
Q

Exhalation

A

Passive recoil in nomral breathing (TV 10 percent breathing)

For forced expiration (abdominals and obliques depress ribs and push diaphragm for quicker emptying )

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31
Q

ERV summary

A

Maximum amount that can be expired after Tidal exhalation
approx 15 percent or 1 L

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32
Q

FEV

A

FEV1 as example
max airexhaled in specific time like 1 sec

Should be 80 percent if healthy for FEV1

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33
Q

Vital capacity

A

Volume change that occurs between max inspiration and exhalation

Everything except the residual volume
so 75% or 4.5 L

therefore forced vital capacity is the vol exhaled during FEV AFTER a max inspiration

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34
Q

Residual volume

A

Doesnt leave lungs 25 %
so 1.5 L

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35
Q

Inspiratory reserve volume

A

Max you can inhale after TV
50 percent or 3 liters

Would decrease with Restrictive lung diseases and neuromuscular diseases

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36
Q

Restrictive lung diseases cause decrease in

A

IRV, TLC, and VC simply b/c you are taking in less air

Everything decrease except ratio

therefore, decreased breath sounds

37
Q

FEV1/FVC ratio

A

Normal is above 0.7
Increases with restrictive lung diseases (b/c VC goes down) do math
Decreases with obstructive diseases (b/c FEV goes down)

38
Q

Tidal volume

A

10 percent

39
Q

Inspiratory capcitiy

A

TV + IRV = 60 percent

40
Q

Functional residual (after exhalation) capacity

A

ERV + RV = 40 percent

41
Q

Restrictive diseases

A

Interstitial diseases (causing pulmonary fibrosis, less compliance)

e.g Idiopathic Pulmonary Fibrosis (IPF)
Sarcoidosis
Pneumoconiosis (e.g., asbestosis, silicosis, coal workers’ pneumoconiosis)
Hypersensitivity Pneumonitis
e.g Any neuro disease b/c muscles weaker so think about how interventions would be directed at that vs actual CVP

Spine issues like scoliosis, kyphosis, anklyosing

Pneumo or hemothorax because literally cany inflate

42
Q

Obstructive diseases

A

asthma
Sleep apnea
CPOD
bronchitis
CYSTIC fibrosis b/c fluid

Excessive use of accessory muscles (may cause hypertrophy)
Hypersonnance (loud low pitched sound)

Anything “forced” out is decreased (FVC, FEV1, ratio decreases less than 70)

Residual volume and TLC increased b/c trapped air

43
Q

Anatomic dead space

A

Would increase with lung collapses

44
Q

Atrial septal defect

A

Atrial Septal Defect (ASD) Notes
Definition: Congenital heart defect with an opening in the atrial septum; allows left-to-right blood shunting.
Key Issues: Increased pulmonary blood flow, potential pulmonary hypertension, right atrial/ventricular hypertrophy.
Symptoms
Asymptomatic early; later: fatigue, poor exercise tolerance, dyspnea.
Severe cases: cyanosis (with Eisenmenger syndrome).

45
Q

Coarctation of Aorta

A

Coarctation of the Aorta (CoA) Notes
Definition: Narrowing of the aorta, increasing afterload and causing left ventricular hypertrophy.
Symptoms
High BP in arms, low BP in legs.
Weak/absent femoral pulses, fatigue, leg cramping with exercise.
Physical Therapy Considerations
Monitor: Blood pressure in both arms and legs; avoid excessive exertion.
Exercise: Low/moderate intensity; avoid heavy resistance training or Valsalva.
Post-Surgery: Gradual activity increase, monitor for hypertension.
NPTE Tip: Know BP differences, exercise precautions, and post-surgical rehab protocols.

Not always a problem and may not be noticed until later on

46
Q

Ventricular septal defect

A

Ventricular Septal Defect (VSD) Notes
Definition: Congenital defect with an opening in the ventricular septum; causes left-to-right shunting of blood.
Symptoms
Small VSD: Often asymptomatic.
Large VSD: Fatigue, dyspnea, poor growth, frequent respiratory infections.
Severe: Pulmonary hypertension, cyanosis (with Eisenmenger syndrome).
Physical Therapy Considerations
Monitor: Signs of fatigue, dyspnea, or cyanosis during activity.
Exercise: Low/moderate intensity; avoid Valsalva or high-intensity in uncorrected cases.
Post-Surgery: Gradual return to activity, focus on endurance.
NPTE Tip: Recognize signs of heart strain, manage post-surgical rehab, and adjust intensity for uncorrected VSD.

47
Q

Tetralogy of fallot

A

Definition: Congenital heart defect with 4 components:
Ventricular septal defect (VSD).
Pulmonary stenosis.
Right ventricular hypertrophy.
Overriding aorta.

48
Q

Cor pulmonale

A

R sided heart failure
due to high BP in lungs
so sx are swelling distended jugular ascites etc.

49
Q

Inpatient phase of Cardiac rehab (phase 1)

A

Think hospital
Early mon
ADLs
Mobilize
Patient ed

Low cardiac training like walking in hall way (2-3 METS)

Discharge is around 5 METS but may be a bit less in reality

STARTS AFTER 24 hours or when safe

50
Q

Phase 2 (many issues so covers what you would think. Besides considering rule for MI

A

Outpatient
Goal is to get normal

Strength training
Start after 3 weeks (unless MI 5 weeks or CABG 8 weeks b/c stenral precautions)
very light weight or bands to start progress to 12-14 lbs

ALWAYS start 40-50 percent of MAX HR, then after 3 good weeks progress by 10bpm per week
5x week is ideal ASCM guidelines, but at least 3x

Discharge goal is 9 METS

ALWAYS DO NEED WARM UP AND COOL DON

51
Q

Post MI (heart attack)
KNOW THISSSSSS

A

Limited to 70 percent of max HR (220-age) or 5 METS for 6 weeks

52
Q

Sternal precautions

A

8-10 weeks

No pushing or pulling
No scapular adduciton
No UE resitive above 90
NO UE asstiance with sts
Sternal splint with coughing laughing sneezing

53
Q

UE vs LE

A

UE have greater hemodynamic response so higher BP and HR (bigger oxygen deficit due to smaller muscles etc.)

LE less response but greater cardiac output and greater VO2 max/oxygen consutpion

54
Q

Maintenance phase 3

A

strength training moderate now

Cardiac to 70-85 percent of HR

20-30 min moderate intensity

or 40-60 of low intensity

3-4 times per week

55
Q

Rule of thumb For progression of cardiac rehab

A

Always think duration first to change and progress
Less intensity, longer duration
and vice versa

56
Q

oxygen therapy

A

Indicated if PaO2 less than 55 or sao2 less than 88 or slightly higher with presence of cor pulmonale or polcythemia

57
Q

Agina pain scale

A

1-4 (worst pain ever)

58
Q

Hypertensive crisis

A

180 + systolic or 120+ diastilic

59
Q

valves ausculation

A

APTM

60
Q

S1

A

lub
1st heart sound reflects AV VALVE CLOSURE, systole (ventricles filling)
High frequency, lower pitch sound, longer duration

61
Q

S2

A

dub
2nd heart sound, diastole, pulm and aortic valves closing
high frequency, high pitch

62
Q

S3

A

Ventricular gallop, early diastole
CHF
athletes
normal in healthy children

vibrations of passive blood flow from atria

63
Q

S4

A

Atrial gallop, late diastole
MI, stenosis, hypertension

64
Q

New York heart association levels

A

All in respect to normal activity, third level is issues with all activities that don’t include rest

4th is issues even at rest (symptoms)

65
Q

Right side lying can

A

decrease pleural friction/irritation, decrease visceral pain

but increase MSK pain

66
Q

BP changes with exercise

A

Systolic should go up
Diastolic should not change or slightly decrease + or - 5 is not significant

drop in systolic 20 or mote is not okay and requires termination

67
Q

Normal lung sounds

A

Tracheal, Bronchial sounds - Loud, tubular sounds over the trachea
Inspiratory phase shorter (upper airways)

Vesicular - Low pitched breezy sounds in distal airway
Inspiratory is longer

These are respective to location and if not then are abnormal

68
Q

Abnormal (adventitious breath sounds)

A

General abnormal with inhale or exhalation

69
Q

Crackle (rales)

A
  • High-pitched popping, typically on inspiration
  • For many diseases. Obstructive or restrictive
  • Due to movement of secretions (peripheral airways) or sudden opening of the closed airway
  • Distinguish wet vs dry based on pathology
70
Q

Pleural friction rub

A
  • Dry crackling sound with inhalation and exhalation
  • Due to irritation, inflamed pleura/viscera
  • In the painful spot
  • e.g pleural effusion
71
Q

Rhonci

A
  • Continuous low-pitched snoring/gurgling
  • Due to inflammatory-related obstructions airway
  • e.g bronchospasm
72
Q

Stridor

A
  • High-pitched wheeze due to UPPER AIRWAY OBSTRUCTION only
  • like swallowing something or throat infection
73
Q

Wheeze

A
  • Musical or whistling
  • e.g asthma, bronchospasm
74
Q

Bronchial breath sounds

A
  • abnormal IF where vesicular sounds should be present (in distal aiways)
  • pneumonia
75
Q

Decreased breath sounds

A

Severe congestion, emphysema, HYPOventilation

76
Q

Absent lung sounds

A

Pneumothorax, lung collapse

77
Q

Increased sounds or egophany, bronchophony etc.

A

due to consolidation, atelectasis, fibrosis

Shows up more white on imaging b/c

Denser fluids, blood, pus etc. instead of air

If sounds are less, than more air like pneumothorax copd

78
Q

Tympanic sound

A

with hyperinflated lungs

79
Q

Adventitious sound for consolidation

A

Crackles

80
Q

Think of diaphagm breathing

A

as a coordination, relaxation, awareness, or strengthening
vs pursed lip is actually to keep airways open
vs upper chest inhibiting for those who use accessory muscles too much

81
Q

Guidelines

A

Cardio 90-150 min a week for healthy

High intensity 45-90 min (75 min a week is sweet spot)

150 min aerobic and 150 of high intensity,

so do the math

35 min 90-95 VO2 max 2-3 time per week, duration 8-12 weeks )

e.g Heart class,

82
Q

Obesity Guidelines

A

two daily sessions of 30 minutes at 45-70% VO2Max to start out

83
Q

Diaphragm moves

A

down with inspiration and flattens, which can cause respiratory compromise

84
Q

Rib biomechanics

A

With inspiration, Head of rib goes down while lateral part goes up

So superior mob of head if stuck after inspiration

Generally goes outward and upward

85
Q

Decreased mediate percussion

A

is due to consolidation

86
Q

Increased would be due to

A

air (emphysema, pneumothorax)

87
Q

Calcium channnel blockers

A

Vaasodilate and decrease myocardial contraction

Use RPE like with beta blockers

PINES

88
Q

Ace inhibitors

A

A PRIL
decrease afterload and BP

FATIGUE IS PRONBLEM WITH THIUS AND AVOID RAPID SUDDEN CHANGE IN POSITION

89
Q

Exercise enhances

A

statins/anti hyperlipidemia drugs and improves HDLS

NPTE Prep (45 decks)

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