CVP Misc Flashcards
Mitral Valve Prolapse Triad
Dysnpena, Fatgue, Palpiations
Due to Flaps go intruding on left atrium
Name the difference between each level of heart block
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
Describe the difference between pectus carinatum and pectus excavatum
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
Cardiac Biomarkers
CK-MB,
Myoglobin
Troponin
Lactic dehydrogenase
Signs of lung issues (obstructive) on imaging
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
Mediate percussion vs percussion
Mediate percussion to assess sound with middle finger and other hand as mediator
Percussion is just cup hand hitting against body for postural drainage
UE vs LE exercise
Higher BP and HR for UE doe to smaller muscle mass.
LE has greater Vo2 mac/oxygen consumption, UE greater DEFICIT
Fremitus = Egophany
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
Pursed lip breathing
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
Huffing and Active Cycle of Breathing
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
Segmental Breathing
Inflate specific part of lung through tactile cueing
Incentive spirometry
Biofeedback device for after surgery, restrictive diseases, SCI, atelectasis after surgery
Glossopharyngeal breathing
Gulp breathing with face
Inspiratory hold
Breathe in and hold w/o valsalva inflates poorly ventilated lungs, helps with cough
Assisted cough
Press on epigastric area
Autogenic drainage
Airway clearance through adjusted rates and depth of breathing to mobilize secretions (self)
High frequency chest wall oscillation and acapella device
airway clearance for cystic fibrosis
What causes blunted costophrenic angle
Pleural effusion (buildup at bottom), Chronic atelectasis
Cardiac Rehab Phases
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
METS,
Systole vs Diastole
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
Pre load
Volume of blood in L ventricle after diastole, based on venous filling , pressure
After load
The pressure required for the heart to pump blood out of ventricles into periphery, based on the aorta, peripheral pressures, and blood viscosity
Normal SV
60-80
Cardiac output
4-5 L
up to 25 L/min during exercise
Hypovolemia
Low blood volume
signs include ortho hypotension, tachycardia, increased temp
Hypervelima
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
Primary muscles of inspiration
Diaphargm (C3, c4, c5…)
and
External intercostals
*Diaphragm contraction (flattens) and causes the chest to expand longitudinally and LOWER ribs ELEVATE
Accessory muscles of inspiration
SCM, scalene (lifts 1st and 2nd rib), pec major, pec minor, SA
Exhalation
Passive recoil in nomral breathing (TV 10 percent breathing)
For forced expiration (abdominals and obliques depress ribs and push diaphragm for quicker emptying )
ERV summary
Maximum amount that can be expired after Tidal exhalation
approx 15 percent or 1 L
FEV
FEV1 as example
max airexhaled in specific time like 1 sec
Should be 80 percent if healthy for FEV1
Vital capacity
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
Residual volume
Doesnt leave lungs 25 %
so 1.5 L
Inspiratory reserve volume
Max you can inhale after TV
50 percent or 3 liters
Would decrease with Restrictive lung diseases and neuromuscular diseases
Restrictive lung diseases cause decrease in
IRV, TLC, and VC simply b/c you are taking in less air
Everything decrease except ratio
therefore, decreased breath sounds
FEV1/FVC ratio
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)
Tidal volume
10 percent
Inspiratory capcitiy
TV + IRV = 60 percent
Functional residual (after exhalation) capacity
ERV + RV = 40 percent
Restrictive diseases
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
Obstructive diseases
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
Anatomic dead space
Would increase with lung collapses
Atrial septal defect
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).
Coarctation of Aorta
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
Ventricular septal defect
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.
Tetralogy of fallot
Definition: Congenital heart defect with 4 components:
Ventricular septal defect (VSD).
Pulmonary stenosis.
Right ventricular hypertrophy.
Overriding aorta.
Cor pulmonale
R sided heart failure
due to high BP in lungs
so sx are swelling distended jugular ascites etc.
Inpatient phase of Cardiac rehab (phase 1)
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
Phase 2 (many issues so covers what you would think. Besides considering rule for MI
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
Post MI (heart attack)
KNOW THISSSSSS
Limited to 70 percent of max HR (220-age) or 5 METS for 6 weeks
Sternal precautions
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
UE vs LE
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
Maintenance phase 3
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
Rule of thumb For progression of cardiac rehab
Always think duration first to change and progress
Less intensity, longer duration
and vice versa
oxygen therapy
Indicated if PaO2 less than 55 or sao2 less than 88 or slightly higher with presence of cor pulmonale or polcythemia
Agina pain scale
1-4 (worst pain ever)
Hypertensive crisis
180 + systolic or 120+ diastilic
valves ausculation
APTM
S1
lub
1st heart sound reflects AV VALVE CLOSURE, systole (ventricles filling)
High frequency, lower pitch sound, longer duration
S2
dub
2nd heart sound, diastole, pulm and aortic valves closing
high frequency, high pitch
S3
Ventricular gallop, early diastole
CHF
athletes
normal in healthy children
vibrations of passive blood flow from atria
S4
Atrial gallop, late diastole
MI, stenosis, hypertension
New York heart association levels
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)
Right side lying can
decrease pleural friction/irritation, decrease visceral pain
but increase MSK pain
BP changes with exercise
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
Normal lung sounds
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
Abnormal (adventitious breath sounds)
General abnormal with inhale or exhalation
Crackle (rales)
- 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
Pleural friction rub
- Dry crackling sound with inhalation and exhalation
- Due to irritation, inflamed pleura/viscera
- In the painful spot
- e.g pleural effusion
Rhonci
- Continuous low-pitched snoring/gurgling
- Due to inflammatory-related obstructions airway
- e.g bronchospasm
Stridor
- High-pitched wheeze due to UPPER AIRWAY OBSTRUCTION only
- like swallowing something or throat infection
Wheeze
- Musical or whistling
- e.g asthma, bronchospasm
Bronchial breath sounds
- abnormal IF where vesicular sounds should be present (in distal aiways)
- pneumonia
Decreased breath sounds
Severe congestion, emphysema, HYPOventilation
Absent lung sounds
Pneumothorax, lung collapse
Increased sounds or egophany, bronchophony etc.
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
Tympanic sound
with hyperinflated lungs
Adventitious sound for consolidation
Crackles
Think of diaphagm breathing
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
Guidelines
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,
Obesity Guidelines
two daily sessions of 30 minutes at 45-70% VO2Max to start out
Diaphragm moves
down with inspiration and flattens, which can cause respiratory compromise
Rib biomechanics
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
Decreased mediate percussion
is due to consolidation
Increased would be due to
air (emphysema, pneumothorax)
Calcium channnel blockers
Vaasodilate and decrease myocardial contraction
Use RPE like with beta blockers
PINES
Ace inhibitors
A PRIL
decrease afterload and BP
FATIGUE IS PRONBLEM WITH THIUS AND AVOID RAPID SUDDEN CHANGE IN POSITION
Exercise enhances
statins/anti hyperlipidemia drugs and improves HDLS
