Exam 1 Flashcards
quiz 1 plus this
87% of CVAs are due to _____
ischemia
t/f: a patient with a TIA are at increased risk for CVA within 90 days
true
t/f: TIA symptoms resolve within 24 hours
true
t/f: CVA deficits result after 24 hours
true
are patients with atherosclerosis at increased risk of coronary artery disease?
yes
is carotid stenosis more predictive of MI or stroke?
MI
what can carotid duplex ultrasonography identify?
plaque
stenosis
occlusions
how is cerebrovascular disease diagnosed?
CTA (computed tomographic angiography)
MRA (magnetic resonance angiography)
how is cerebrovascular disease medically managed?
decrease risk factors
decrease BP
pharmacological
what are pharmacological ways to manage cerebrovascular disease?
aspirin
anti-coagulation
lipid-lowering
glycemic control
anti-hypertensives
stations
what is renal artery disease?
atherosclerosis of one or both renal arteries
what is the gold standard for diagnosing renal artery disease?
renal angiography
what are the signs of renal artery disease?
HTN
decreased kidney function
edema of the legs, feet, or ankles
darkened skin
weight loss
what are the symptoms of renal artery disease?
increase/decrease in urination
drowsiness/tiredness
generalized itching or numbness
dry skin
headaches
loss of appetite
nausea and vomiting
sleep problems
trouble concentrating
muscle cramps
t/f: sign of renal artery disease are often absent until severe
true
what lab values determine kidney function in people at risk for developing or have known kidney disease?
creatinine and BUN (blood urea nitrogen)
what does creatinine levels show?
direct measurement of glomerular filtration rate and renal function
what does increased creatinine levels indicate?
decreased glomerular filtration rate which indicates renal insufficiency
if glomerular filtration rate decreases, creatinine will ______, indicating ______ ______
increase, renal insufficiency
what level of creatinine indicates serious impairment of renal function?
> 4.0 mg/dL
what are normal creatinine levels?
male: 0.6-1.2 mg/dL
female: 0.5-1.1 mg/dL
what is creatinine?
a catabolic product creatine phosphokinase which is used in skeletal muscle contraction and is excreted entirely by the kidneys
what is BUN?
the nitrogen portion of urea that measures metabolic function of the liver and excretory function of urea
elevated BUN indicates _____ _____ and _____
renal failure, uremia
what could cause decreased BUN?
starvation, dehydration, or organ dysfunction like liver disease
what is renal angiography?
x-ray that shows the blood vessels in the kidneys
why is renal angiography sometimes not the best option for a patient?
the contract used can increase creatinine levels in patients with kidney dysfunction
how is renal artery disease medically managed?
pharmacological
BP control
risk factor modification
surgical management
what are common pharmacologic managements of renal artery disease?
angiotensin-converting enzyme (ACE) inhibitors
angiotensin receptor blockers (ARBs)
diuretics
calcium channel or beta blockers
cholesterol lowering meds
anti-coagulation
what are 2 common surgical treatments of renal artery disease?
angioplasty stenting and endarterectomy/bypass surgery
what is angioplasty and stenting?
using a catheter to place a balloon and stent into an artery to flatten the plaque and keep the artery open
what is an endarterectomy or bypass surgery?
plaques cleaned out of the artery - endarterectomy
using a vein/synthetic tube b/w the kidney and aorta to bypass the occlusion
what can renal artery disease lead to?
increased BP
increased protein levels in urine
decreased kidney function
ankle and foot swelling
what can untreated prolonged renal artery disease lead to?
chronic kidney disease
kidney failure
pulmonary edema
stroke
what is the most common aneurysm?
brain aneurysm
are aortic aneurysms more common in men or women?
men
history of smoking accounts for ___% of cases of aortic aneurysms
75%
what are some causes of aneurysms?
atherosclerosis
PAD
cardiovascular disease
traumatic injuries to arterial wall
tobacco use
vasculitis
what is an aneurysm?
weakness in the arterial wall due to pressure that causes a bulge/ballooning of the wall
what are the changes in body structure and function in aneurysms?
damage to the arterial wall that causes permanent dilation
destruction of elastin in the artery so it can’t go back to normal and stays dilated
loss of smooth muscle cells due to formation of intraluminal thrombus
weakening of the tunica media layer
neutrophils, RBCs, and platelets attach to the thrombus along with fibrinogen and lipoprotein
what are the primary locations for aneurysms?
brain, aorta, abdomen, thorax, and extremities
aneurysms have a dilated arterial wall of more than ____ % normal diameter
50
aneurysms are described by their ____, ______, ______ _____, and ______
location, size, morphological appearance, origin
when is an aneurysm at risk for rupture?
when it increases more than 5 cm
if a cerebral aneurysm ruptures, what does it cause?
a hemorrhagic stroke
t/f: an aortic aneurysm can occur at any segment of the aorta coming off the heart
true
what aneurysm is life-threatening if it ruptures?
abdominal aneurysm
is a thoracic aneurysm above or below the diaphragm?
above the diaphragm
what is the most common peripheral aneurysm?
popliteal
what are the common locations of peripheral aneurysms?
popliteal
femoral
illiac
t/f: peripheral aneurysms are very rare
true
what are pseudoaneurysms?
a breach in the arterial wall causes blood to leak and be contained by the adventitia
what are the signs of an aneurysm?
bruit over the swollen area in the abdomen
pulsating tumor/mass in the abdominal area
pressure on surrounding parts such as low back
poor/absent distal pulses below the level of the aneurysm
what are the symptoms of an aneurysm?
severe chest pain from back to front
LBP
leg pain/claudication
numbness in LEs
excessive fatigue
what is the difference b/w a rupture and a dissection?
a rupture goes through all 3 layers of the aorta or cerebral artery
a dissection is a tear in the intima layer causing separation b/w the intima and media layer where blood flows into the separation
both life threatening
2/3 of people with an aortic dissection have ____
HTN
an aortic dissection most commonly involves what structures of the aorta?
ascending aorta
descending aorta
aortic arch
abdominal aorta
what are the s/s of an abdominal dissection?
sudden, severe sharp pain in the chest/upper back
SOB
faintness/dizziness
LBP
diastolic heart murmur, muffled heart sounds
rapid, weak pulse
heavy sweating
confusion
loss of vision
stroke symptoms/weakness/paralysis on one side of the body/trouble talking
what are ways to medically manage an aneurysm?
pharmacologics, monitoring, surgical repair
what drugs are used to manage aneurysms?
beta blockers
angiotensin 2 receptor blockers
statins
if in the early stages, ____ will be used
monitoring
how is monitoring used in aneurysm management?
imaging done every 6 months following diagnosis
what imaging techniques are used to manage aneurysms?
echocardiogram
CT scan
MRA
what are surgeries done to manage aneurysms?
repair of the aneurysm/dissection where it occurs
open heart surgery
abdominal aortic aneurysm repair
cerebral aneurysm clipping or endovascular coiling
peripheral vascular surgery
what is open heart surgery?
aortic arch or root replacement or repair
thoracic aneurysm repair (open or TEVAR)
is an AAA repair always open surgery?
no, it can be TEVAR
what cause the structural changes in PAD?
degenerative conditions
infection
inflammation
narrowing of the vascular lumen in PAD is affected by what 3 things?
atherosclerosis
thrombosis
inflammation
symptoms appear in PAD when the athroma is so large it interferes with what?
blood flow to distal tissues
why does PAD cause pain with exercise?
bc the demand for blood flow to the skeletal muscles of the LE increases with exercise but the arteries can’t provide adequate supply due to stenosis and obstructions
when do symptoms of PAD occur?
when the blood flow isn’t adequate to meet the demands of peripheral tissues
what are changes in body structure and function related to decreased blood flow to peripheral tissues?
denervation to muscle
loss of muscles fibers
limb ischemia
limb ischemia leads to increased risk for what?
limb loss
what impairments can result from decreased blood flow to peripheral tissues?
decreased muscle strength w/atrophy
decreased sensation
decreased muscle and aerobic endurance
what is claudication?
muscle pain that develops as a result of ischemia in limbs from decreased blood flow
what percent of pts with PAD have clinically significant CAD?
40%
as PAD progresses, pts can develop…
pain at rest
skin changes
tissue necrosis
what are the signs of PAD?
dry, shiny skin
hair loss
thick toenails
muscles atrophy
rubor on dependency
round wounds with regular borders
increased pallor in the foot with elevation
nectrotic tissue in toes and feet
decreased pulse below blockage
what are the symptoms of PAD?
intermittent claudication
impaired sensation
pain in lower leg w/activity or at rest
how is PAD diagnosed?
using the ankle brachial index, pulse volume recordings, arterial duplex US, rubor on dependency, or exercise studies
what is the ankle brachial index?
non invasive means of quantifying degree of arterial insufficiency
requires a Doppler and BP cuff
divide the SBP of the ankle by SBP of brachial artery
in the ABI is the ankle or brachial pressure normally higher?
ankle
what is a normal ABI?
greater than 0.9
what ABI score would be suggestive of severe occlusive disease?
less than 0.5
what are pulse volume recordings?
measurement of volume changes along the segment using BP cuffs along the limb compressing the veins but not arteries
sensors in the cuffs detect arterial pulsation w/o venous interference
what is arterial duplex US?
noninvasive way to visualize and assess the extent of stenosis and reduction of blood flow
can identify the width of a blood vessel and reveal arterial blockages
what is the rubor on dependency test?
way to assess arterial circulation using skin over color changes and postural changes
what is a positive rubor on dependency test?
the limbs turn dark red w/in 30 seconds from supine to dependent over the EOB and turn very white when elevated
what is a normal response to the rubor on dependency test?
the feet turn a pink flush
what are exercise studies?
used to elicit symptoms of claudication
measure ankle pressure b4 and after
what is a positive result from an exercise study?
if the post exercise pressure DROPS, confirming arterial disease
what are surgical intervention for PAD?
revascularization
angioplasty
arterial stent
what is revascularization surgery?
LE arterial bypass surgery to restore blood flow to distal tissues through use of saphenous vein or prosthetic graft as bypass
what is angioplasty surgery?
utilizing a catheter to balloon open the artery and push the plaque against the artery wall to increase lumen and restore blood flow
what is arterial stent surgery?
utilizing a catheter to deploy a stent in artery to open the lumen and restore blood flow
what are the venous diseases?
venous insufficiency
venous stasis ulcers
venous thromboembolism (VTE)
what are the risk factors for venous insufficiency?
advanced age
genetics
obesity
prolonged standing
sedentary lifestyle
smoking
female hormones
the venous system holds what percent of blood in the body?
65-70%
what are spider veins?
dilated veins in dermal layer of skin
what are varicose veins?
superficial subcutaneous veins appear knotted, swollen, twisted, and protrude more
what are the changes in body structure and function in PVD?
damage to valves
obstruction to flow
failure of veins to pump
what factors lead to PVD?
degeneration of valves
infection
inflammation
thrombosis (VTE)
what are the signs of chronic venous insufficiency?
swelling
bulging of veins
wounds
dermatitis
hemosiderin staining in limb
what are the symptoms in chronic venous insufficiency?
dull ache
limb heaviness
itching
tingling
cramping of extremity
what is raynaud’s phenomenon?
vasospastic disease of digital arteries
extreme vasoconstriction response temporarily occluding vascular lumen
occurs in cold temps and stress
what are the signs of raynaud’s?
initially finger and toes blanche white as blood flow is interrupted, followed by cyanosis as desaturated Hgb accumulates and then a ruddy color as blood flow returns
what are the symptoms of raynaud’s
numbness, parasthesia, and pain in affected digits
what is primary raynaud’s
primarily in fingers in women 20-40
only 40% in toes
what is secondary raynaud’s
secondary to other health conditions
how is raynaud’s diagnosed?
venous duplex US
venous filling time
Trendelenburg test
what is venous duplex US?
uses high frequency sound waves (US) to capture images of internal views of veins that return blood to the heart
way to assess for varicose veins, valve dysfunction, and venous thrombosis
what is venous filling time?
way to assess for arterial and venous blood flow
what is the trendelenburg test?
a way to assess valvular competency of superficial and deep veins
what happens during exercise in pts with PAD?
atherosclerosis prevents blood flow and O2 delivery to skeletal muscles
ischemia develops when blood supply cna’t meet demands
drop in pressure across area of stenosis/occlusion
impairment in endothelial function of the artery
production and accumulation of lactic acid
what is intermittent claudication?
onset with particular amount of activity/exercise that is relieved with rest
intermittent claudication symptoms in the calf reflect what?
femoral/popliteal artery disease
intermittent claudication symptoms in the thigh/hip/buttocks reflect what?
aortoiliac arterial disease
what works better to improve symptoms of PAD, supervised exercise or surgical intervention?
supervised exercise
improvements in symptoms due to exercise are a result of what?
increased walking efficiency
increased peripheral blood flow through collateral circulation
reduced blood viscocity
regression of athrosclerosis
increased pain threshold
improved skeletal muscle metabolism
why should PTs monitor SBP in pts with PAD?
bc pts with PAD have significant rise in BP w/exercise
PTs should exercise to what grade ____ for optimal symptomatic benefit over time
3
what is a non-invasive means of monitoring cardiac conduction
ECG
when are 12 lead ECGs utilized?
primarily for medical diagnosis, formal stress testing, and formal exercise testing
when are 5 lead ECGs utilized?
by PTs, telemetry units
what does a 5 lead ECG tell us?
HR
rhythm
arryhthmias
what does a 12 lead ECG tell us?
HR
rhythm
arrhythmias
hypertrophy
infarction
ischemia
what are the 3 properties of cardiac muscles?
automaticity, rhythmaticity, conductivity
what is automaticity?
the heart’s ability to continue to generate a signal without neuronal input
what is rhythmaticity?
the heart’s ability to maintain regularity
what is the order of signal flow through the heart?
SA–>AV–>Bundle of HIs–>l left and right bundle branch –> Purkinjie fibers
what is the role of the SA node?
pacemaker of the heart that creates the impulse that paces the heart
what is the intrinsic rate of the SA node?
60-100 bpm
what is the role of AV node?
slows the impulse to allow ventricular filling
what is the intrinsic rate of the AV node?
40-60 bpm
which bundle branch is much thinner with fewer branches, the left or right?
right
what happens when the Purkinjie fibers are stimulated?
ventricular contraction
what nerve provides parasympathetic input to the heart?
vagus nerve
what does the vagus nerve innervate?
the SA and AV nodes
t/f: there is very little parasympathetic input to the ventricles
true
vagus stimulation is _____ and leads to _____BP
inhibitory, decreased
what is the sympathetic innervation of the heart?
cardiac nerves that influence the heart via E and NE
sympathetic cardiac control is ____ and leads to ____HR, contractility, and BP
excitatory, increased
does sympathetic, parasympathetic, or both reach the atria?
both
does sympathetic, parasympathetic, or both reach the ventricles?
just sympathetic mostly
what has more control on the heart, sympathetic or parasympathetic control?
sympathetic control
what influences how the heart contracts?
electrolyte balance
what electrolytes contribute to electrolyte balance in the cardiac system?
sodium, calcium, potassium, magnesium
what does sodium do in the heart?
nerve and muscles function
keeps fluid in balance
what does calcium do in the heart?
controls permeability of the cell membrane
drives myocardial contraction
what does potassium do in the heart?
reactive in water and allows the heart to conduct electrical signals
what does magnesium do in the heart?
regulates heart beat, normal nerve and muscle function, immune responses, and normal blood glucose
where does the SA node go?
posterior wall of the right atria
where does the AV node go?
b/w the atria and ventricles and the floor of the right atria
what is the intrinsic rate of the bundle of His and Purkinjie fibers?
30-40 bpm
what is the intrinsic rate of the bundle branches?
20-40 bpm
what does the P wave represent?
atrial depolarization
what does the PR interval represent?
the time from atrial depolarization to ventricular depolarization
what does a prolonged PR interval show?
decreased HR
atrial fibrillation
what does a shortened PR interval show?
junctional rhythm
what does the QRS complex represent?
ventricular depolarization and contraction
what does the ST segment represent?
the time b/w ventricular depolarization and repolarization
what does the T wave represent?
ventricular repolarization
what does the QT interval represent?
the entire ventricular activity (contraction through repolarization)
what does a prolonged QT interval indicate?
electrolyte imbalance (Ca2+, K+) which puts you at risk for developing an arrythmia
what portion of the ECG wave is important in MIs?
ST segment
ECGs provide info on…
conduction disturbance
ventricular thickness
ischemia
effects of meds
electrical impulses
heart function
myocardium and cell function
what does the horizontal axis on an ECG represent?
time
what does the vertical axis on an ECG represent?
changes
how long is a normal PR interval?
0.12-0.20 sec
how long is a normal QRS complex?
0.06-0.10 sec
how long is a normal QT interval?
0.32-0.40 sec
what generates normal sinus rhythm?
the SA node
when do we see sinus bradycardia?
when sleeping
in highly trained athletes
in pts on beta blockers
in pts with a pacemaker
in pts with sinus 6 syndrome
with parasympathetic activity
in pts with hypothyroidism
when do we see sinus tachycardia?
with anxiety, stress, fear, caffeine, nicotine, fever, hypoxemia, hyperthyroidism, w/drawal from substances, severe dehydration/low blood volume
what is a sinus pause/block?
rhythm generated by the SA node with a pause missing the QRS complex
when does a sinus pause/block become pathologic?
when it becomes more frequent it can lead to decreased CO output leading to lightheadedness, dizziness, slow HR, and may need a pacemaker
what is atrial rhythm?
heart rhythm generated by ectopic foci in the atria resulting is abnormal or absent p wave
what are the 3 types of atrial rhythms?
- pre-mature atrial contractions (PACs)
- atrial tachycardia
- atrial fibrillation and flutter
what is a pre-mature atrial contraction (PAC)?
indictive of heart disease and can lead to fibrillation/flutter
p wave directly after the t wave and a weak QRS complex
when is atrial tachycardia seen?
in pts with COPD or following acute MI
what is atrial tachycardia?
increased HR
abnormal p waves
atria contracting quickly
what is atrial fibrillation?
generated by ectopic foci
absent p wave
no PR interval
normal QRS
irregular RR interval
varying HR
t/f: a fib with a lower more controlled HR is not as severe
true
what is paroxysmal a fib?
going in and out of a fib
what is atrial flutter?
multiple p waves b4 QRS complex
variable HR
variable RR interval
atria depolarizing at a high rate
what are junctional rhythms?
rhythms originating in the AV node
absent, hidden, or inverted p wave
normal QRS
HR: 40-60 bpm
short, absent, or retrograded PR interval
very pathologic
what is junctional tachycardia?
increased HR
shortened RR interval
absent/buried p wave
decreased CO
what causes heart blocks?
blocks to the AV node
what is a 1st degree heart block?
can be caused by meds
start in SA node and is blocked to AV node
prolonged PR interval
stand alone p wave
normal/dropped QRS complex
varying HR
what is a type 1 2nd degree heart block?
dropped QRS complex
varied RR interval
varied HR
stand alone p wave
can progress to 3rd degree
what is a type 2 2nd degrees heart block?
no conduction to the ventricles
block below the bundle of His
normal/prolonged PR interval
wide QRS complex
associated with ischemia or acute MI
can quickly lead to 3rd degree
what is a 3rd degree heart block?
life threatening
block at/below AV node
p wave has no relationship to QRS complex
atrai and ventricles fire at dif times
very wide QRS complex
varied PR interval
L coronary artery ischemia likely
requires pacemaker
decreased CO (pts may faint/fall)
what is a bundle branch block?
wide QRS complex
knotched appearance
M feature on top
often seen after MI or with CAD
what generates ventricular rhythms?
ectopic foci in the ventricles
what are ventricular rhythms?
no p wave
bizzare, wide QRS complex
agonal: drops BP below 20 bpm, terminal, usually precedes asystole
what are the 3 types of ventricular rhythms?
- pre-mature ventricular contractions
- ventricular tachycardia
- ventricular fibrillation
what is a pre-mature ventricular contraction (PVC)?
normal rhythm very quickly followed by inverted ventricular contraction w/o repolarization
premature wide beat
missed beat
when do PVCs become a concern?
when they become more frequent
what is ventricular tachycardia?
3 PVCs in a row
electrolyte abnormalities
clinically significant arrhythmia
no p wave
bizzare, wide QRS
long QT interval
what are the 3 types of ventricular tachycardia?
- supraventricular (SVT)
- sustained VT
- non sustained VT
what is supraventricular tachycardia caused by?
anxiety or chest pain
what is sustained VT?
> 30 sec of consecutive PVCs
what is non-sustained VT?
3 beats in 30 sec
when is ventricular tachycardia benign?
when the are <6 PVCs per minute
what is ventricular fibrillation?
irratic quivering of ventricles
no CO
no ventricular depolarization/ repolarization
rapid intervention is necessary
shockable heart rhythm
what method(s) can be used to determine HR of a regular rhythm?
counting large boxes or counting small boxes
what method(s) can be used to determine HR of an irregular rhythm?
6 sec method
what is the importance of ECGs?
know baseline, during activity, and post activity tolerance
discover real-time arrhythmias
know yellow and red flags and how to respond
recognize clinically significant rhythms
knowing when to cease therapy
