Exam 1 Flashcards
B-1 agonists do what to the heart?
increase cardiac contractility
Positive inotropic agents do what to the heart?
increase force of contraction of myocytes that leads to increased CO
- increase contractility and CO
What type of patients would be on ionotropic agents (dopamine and dobutamine)?
severe heart failure
- probably on the heart transplant list
What does digitalis do to the heart?
increases cardiac contractility
- directly affects movement of calcium in the cells
- direct inotropic effects
What patients would be using digitalis?
atrial fibrillation, atrial tachycardia HF
beta blockers (B-1 antagonists) do what to the heart?
reducing the work of the heart
adverse effects of beta blockers (B-1 antagonists)
- bronchoconstriction
- excessive depression of cardiac function - reduced peak HR
- OH (vasodilation)
- depression, lethargy, and sleep disorders
What do calcium channel blockers do to the heart?
decrease contractility and decrease energy demands of the heart
- also decrease CO
What is double product?
HR x static pressure (systolic BP)
- index of myocardial oxygen consumption
How do you reduce double product? What does this cause?
- increase the radius of vessels which decreases afterload
- reducing radius of vessels reduces the workload on the heart
alpha-1 receptor blockers result in what?
peripheral vasodilation
- smooth muscle relaxation
- decreases blood flow resistance
adverse effects of alpha 1 receptor blockers
reflex tachycardia secondary to hypotension
- too much dilation
- can also cause OH
What do centrally acting agents do to HR?
decrease HR and contractility
adverse effects of centrally acting agents
-dry mouth
- dizziness
- drowsiness
- hypotension
diuretics effect on blood volume
decrease blood volume which decreases preload
adverse effects of diuretics
- dehydration
- electrolyte imbalance
- OH/falls precaution
Risk factors for CHD
- increasing age
- family history of CVD
- male
- uncontrolled HTN
- elevated total cholesterol
- uncontrolled diabetes
- smoking/components of cigarette smoke
- physical inactivity
- obesity
BMI cutoffs
Normal - 18.5-24.9
overweight - 25-30
Obese - > 30-40
morbidly obese > 40
total cholesterol numbers
normal - < 200 mg/dl
borderline high - 200-239 mg/dl
high - > 240 mg/dl
men normal and at risk ranges for HDL
normal - > 60
at risk - < 40 mg/dl
women normal and at risk ranges for HDL
normal - > 60
at risk - < 50 mg/dl
What can increase HDL concentrations?
aerobic exercise
What forms atherosclerotic plaque?
LDL
normal fasting ranges of LDL
100 mg/dl or less
- less is better
What should the cholesterol ratio be?
total cholesterol/HDL
- 4:1
- lower the ratio, the lower your risk of heart disease
- the higher to ratio, the higher the risk of heart disease
normal and abnormal triglycerides normal
normal < 150
anything above 150 will catch MD eye
diabetes is a disease of ______________
hyperglycemia
What type of heart dysfunction do diabetes patient exhibit?
LV diastolic dysfunction
normal creatine kinase levels
0-175 IU/L
- high means MI/cardiac insult
normal troponin levels
0-3 mg/mL
- high means cardiac muscle injury
________ leaks into the body when damage to cardiac cells
myoglobin
- only found in blood stream after muscle injury
normal myoglobin level
25-72 ng/mL
Why is a liver panel of interest post MI?
Cardiac pump dysfunction leads to reduced liver perfusion leading to passive congestion leading to increases in the components of a liver panel
What does atrial natriuretic peptide (ANP) result in? What is it a biomarker for?
vasodilation and diuresis - leads to decrease in preload and afterload which decreases work load on the heart
- biomarker for heart failure
- secreted from cardiac atria in response to atrial distention
Where is atrial natriuretic peptide (ANP) released?
atria
Where is brain natriuretic peptide (BNP) produced and released?
ventricles
What is the gold standard for measurement of heart failure?
BNP levels
- they are elevated with heart failure
What does BNP do?
Decreases vascular resistance - decreases BP - decreases afterload of heart
- Helps to promote diuresis
normal BNP levels
< 100 pg/mL
Class 1 NY heart association classification
cardiac disease
- no symptoms and no limitation in ordinary PA
Class 2 NY heart association classification
mild symptoms (SOB and/or angina) and slight limitation during ordinary activity
Class 3 NY heart association classification
marked limitation in activity due to symptoms
- comfortable only at rest
Class 4 NY heart association classification
severe limitations
- symptomatic at rest
- bedbound
C reactive protein (CRP) normal level
< 1.0 mg/L
What does a high CRP level mean?
increased inflammatory states
- atherosclerosis
- CHF
- cancer
- infections
- liver dysfunctions (liver secretes CRP)
normal serum creatinine level. What does an elevated level mean?
< 1.5 mg/dL
- elevated level suggests kidney dysfunction secondary to reduced renal perfusion
- could mean HF due to decreased CO which decreases renal perfusion
What do PET scans detect?
cardiac tissue viability
- Not quality of movement nor anatomy
What do echocardiograms detect?
- abnormal cardiac anatomy
- volumes of L ventricle
- estimate stroke volume and EF
- analyze motion of valves and heart muscle
What is radionuclide perfusion imaging (nuclear stress test) used for?
- assess ongoing chest pain/diagnosis of CAD
- post MI heart muscle damage
- assess blood flow after bypass
- look for scar tissue in heart
What evaluates cardiac morphology, valvular disease, cardiac shunts, cardiac blood flow and coronary artery anatomy?
MRI
What is a standard test to test a patient for occluded coronary artery?
coronary angiography
What patients cannot have a coronary angiography done?
kidney disease patients
- dye is toxic to the kidneys
major complications of coronary angiography?
- serious bleeding
- heart attack
- stroke
- kidney failure
PT implications with left heart catheterization
- bed rest for 6-8 hours
- knee immobilizer to minimize hip flexion and risk of opening incision
- monitor for groin hematomas and pain
PT implications with right heart catheterization
no activity restrictions
- incision site is via the external jugular vein
What is used to look at the arteries that supply blood to the heart?
CT scan
- used to diagnose and treat blood vessel diseases and conditions
What is used to convert heart rhythm when a patient has an unstable heart and is a scheduled procedure?
cardioversion
PT implications after cardioversion
withhold care for 24 hours or until the patient can tolerate activity
PT considerations after cardiac ablation
- hemodynamic stability - sinus rhythm and vitals are stable as they change positions
- bleeding at the site of catheter insertion
What is cardiac tamponade?
Reduced cardiac function due to fluid accumulation in the pericardial cavity. A restrictive cardiac pathology
- this is a medical emergency
What is an intra-aortic balloon pump?
mechanical device that increases coronary perfusion
- deflates during ventricular systole
- inflates during ventricular diastole
PaO2 levels - normal, mild, moderate, severly hypoxemic
normal - 80-100 mmHg on room air
mildly hypoxemic - 60-80 mmHg
moderately hypoxemic - 40-60 mmHg
severely hypoxemic - < 40 mmHg
What is semi-fowler’s position?
supine with head of bead raised
- Used to help with breathing and decrease amount of returning fluid that may be overworking the heart
What is professorial position?
- bent over with arms stabilizing chest
- stabilizes 1st rib to allow lungs to open more
central cyanosis is caused by what?
heart or lungs, or abnormal hemoglobin
- discoloration is systemic
peripheral cyanosis is caused by what?
decreased local circulation
- discoloration is regional
S1 heart sound
closure of mitral and tricuspid valves
- onset of ventricular systole
S2 heart sound
closure of aortic and pulmonary valves
- start of ventricular diastole
S3 heart sound
- occurs when diastole when ventricle is filling rapidly
- typically indicative of CHF b/c heart can’t keep up with blood flow
- can be normal in children
S4 heart sound
- occurs late in diastole, just before S1
- increased resistance of ventricular filling
- stiff wall of heart and blood hitting it
- HTN, coronary artery disease, or pulmonary disease
What systolic pressure change during a supine to sit to stand suggests positional hypotension?
Systolic drops >/= 20 mmHg or diastolic drops >/= 10 mmHg
What diastolic and systolic pressure changes during a supine to sit to stand maneuver suggests positional hypotension?
Systolic drops >/= 40 mmHg or diastolic drops >/= 20 mmHg
