Exam 1 Flashcards
1
Q
ello mate, what is a mediastinum?
A
the space between the lungs that holds the heart, aorta, and vena cava….. DUH.
2
Q
percardium?
A
the membrane enclosing the heart, consisting of an outer fibrous layer and an inner double layer of serous membrane.
3
Q
cardiac innervation is…
A
regulation of the heart… done by: The autonomic division of the PNS, via the Vagus nerve (Xth cranial)
4
Q
cardiac innervation regulates what 3 things?
A
Heart rate
Force of each contraction
Cardiac output
5
Q
what is sympathetic innervation?…3 things
A
Increases heart rate
Increases the force of contraction
“Fight or flight response”
6
Q
Parasympathetic Innervation…3 things
A
Decreases heart rate
Reduces force of contraction
Constricts the coronary arteries
7
Q
talk to me about the Primary Sinuatrial Node»_space;>4
A
- it is a group of cells positioned on the wall of the right atrium
- the node generates depolarization, which spreads across atrium and causes the muscles to contract
- cells in the SA node spontaneously depolarize, resulting in a contraction of approximately 100 times a minute
- this native rate is constantly modified by the activity of sympathetic and parasympathetic nerve fibres, so that the average resting cardiac rate in adults is about 70 beats per minute
8
Q
heart rate… FACTS! 3 OF THEM, in fact.
A
- describes frequency of cardiac cycle
- the most common vital sign (which includes HR, blood pressure, respiratory rate, temperature)
- calculated by number of heart contractions in one minute (bmp)
9
Q
factors affecting heart rate… 8 hahahah
A
Age Gender Environmental Temperature Infection Physical Activity Emotional Status Medications Cardiopulmonary Disease
10
Q
resting heart rate ranges
A
- The reference range is between 60 bpm (less is bradycardia) and 100 bpm (greater is tachycardia)
- When resting, the adult human heart beats at about 70bpm (males) and 75bpm (females), but varies among people
- heart rate adapts depending on need for oxygen
11
Q
resting heart rate…. tidbits haaaaa 4
A
- best time to find it, right in the morning!
- usually rises higher with age
- lower in athletes
- is used to determine someone’s training target heart rate zone
12
Q
infant, toddler, and adolescent» resting heart rate
A
infant- 130-150 bmp
toddler-100-130 bmp
older toddler-90-110 bmp
adolescent-80-100 bmp
13
Q
heart rate- MAXIMUM
3 facts
A
HR Max is conventionally calculated as 220 – age = theoretical maximum based on age
- HR Max can also be determined during a maximal stress test
- Used in the calculation of Target Heart Rate Zone (THR zone) for training
14
Q
Cardiac Arrythmias… let’s talk about it.
A
- muscle contraction is either irregular or faster/slower than normal
- some arrythmias are life-threatening and can cause cardiac arrest and sudden death
- others only cause aggravating symptoms, such as different heart beat, palpitations (benign and normal)
15
Q
pulse points-3
A
carotid- between SCM and trachea
femoral pulse- groin area
popliteal pulse-behind popliteal fossa while holding knee bent
16
Q
pulse points… 2 more, ho ho ho!
A
radial pulse- radial side of the wrist
brachial pulse-in the cubital fossa just medial to the biceps tendon, used for infants
17
Q
pulse points…. footsies
A
Dorsalis pedis pulse- on top of the foot
Tibialis posterior pulse- back of the ankle behind the medial malleolus
18
Q
pulse quality
A
described according to:
rate, rhythm, volume
19
Q
words used to describe pulse
A
Strong and Regular
Weak and Regular
Irregular
Thready
20
Q
4 facts about cardiac pacemakers
A
electronic device that analyzes function of the heart
when necessary, pacemaker sends timed electrical signals to the heart on demand
most pacemakers are designed to correct bradycardia
the battery life is usually 8 years
21
Q
ICD
A
Implantable Cardioverter Defibrillator (ICD)
- small device placed in chest or abdomen
- uses electrical impulses or shocks to control life threatening arryhythmias, (especially those that could cause sudden cardiac death due to ventricular fibrillation)
22
Q
Implantable Cardioverter Defibrillator maximum output
A
At maximum output, a defibrillator can deliver about 830 volts in a tenth of a second to restore the heart rhythm back to normal
23
Q
normal blood pressure
A
Systolic between 90 and 135mmHg
Diastolic between 50 and 90mmHg
24
Q
abnormal readings of bp
A
If a person has higher readings it is termed hypertension and lower readings is called hypotension
25
measuring blood pressure...4
- mercury manometer is used for blood pressure measurement
- cuff must be properly sized to circumference of arm (cuffs are marked with min and max)
- cuff is inflated to a pressure of excess of the systolic blood pressure)
- the pressure is then gradually released over a period of about 30 seconds while auscultating the brachial artery
26
measuring blood pressure.. nil or unimpeded
When blood flow is nil (cuff pressure exceeding systolic pressure) or unimpeded (cuff pressure below diastolic pressure), cuff pressure will be essentially constant
27
measuring blood pressure...restricted
When blood flow is present, but restricted, the cuff pressure, which is monitored by the pressure sensor, will vary oscillate in synchrony with the cyclic expansion and contraction of the brachial artery
28
common types of blood pressure medication...4
diuretics- water pills, work in the kidney to flush excess water and sodium from body
beta-blockers-reduce nerve impulses to heart and blood vessels (makes heart beat slower and with less force) bp drops and heart works less hard
ACE inhibitors- (angiotensin converting enzymes) inhibitors prevent formation of angiotensin II, which normally causes blood vessels to narrow. ACE inhibitors cause vessels to relax and blood pressure goes down
calcium channel blockers- (CCBs) keep calcium from entering the muscle cells of the heart and blood vessels. this causes the blood vessels to relax and pressure goes down.
29
pulse oximetry
- simple, non-invasive method of monitoring the percentage of haemoglobin (Hb) which is saturated with oxygen
- probe is attached to finger or ear lobe which is linked to computerized unit. the unit displays percentage of Hb saturated with oxygen along with audible signal for each pulse beat, a calculated heart rate
30
more on pulse oximetry
- oximeter detects hypoxia before the patient becomes clincally cyanosed
- oxygen saturation should always be higher than 95% (patients with long standing respiratory disease or cyanotic congenital heart disease may have lower readings and reflect severity of underlying disease)
31
Some Cardiac Evaluation Tools...6
History
Heart rate, pulse and blood pressure
Auscultation
Laboratory tests i.e. Chest Xrays EKG, cholesterol, echocardiogram
Cardiac Stress Testing: Maximal, Sub Maximal
Fitness Testing
32
Cardiac Auscultation..2
- reveals the normal audible cardiac cycle, which allows the clinician to assess the heart rate, rhythm, and regularity
- cardiac murmurs that have characteristic sounds within the phases of the cardiac cycle can be demonstrated
33
Coronary Artery Disease (CAD)...4
- Occlusion of a major coronary artery leads to an inadequate oxygenation of an area of myocardium and cell death (i.e. myocardial infarction). The severity depends on the size and location of the artery involved and whether or not the blockage is complete.
- Partial blockages may produce pain (angina) during or after exercise.
- Several procedures are now available to improve blood flow in partially or completely occluded coronary arteries
34
Angina....2
- it's not a disease, it's a symptom of an underlying heart problem
- usually a symptom of CAD, the most common type of heart disease
35
stable angina
Stable angina is chest pain or discomfort that typically occurs with activity or stress. The pain usually begins slowly and gets worse over the next few minutes and usually quickly goes away with medication or rest
36
unstable angina
Unstable angina, was first used 3 decades ago and was meant to signify as less stable form of angina which can be a warning sign of an impending heart attack.
37
Congenital Heart Defects....2
most common: occurs in ventricular septum--- ventriculoseptal defect (VSD)
-these lesions allow blood to move blood from the left ventricle (higher pressure) to the right ventricle (lower pressure)
38
valve problems..2 types and (WHAT!!!!)
incompetence: as a result of poorly functioning valves
stenosis: or narrowing caused by the valve's inability to open fully
(valve disease can affect either the mitral or the aortic valves)
39
Mitral Valve Prolapse
.... is characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole (contraction)
40
cardiomegaly
....refers to an enlarged heart due to hypertrophy by overwork
41
cor pulmonale
enlargement of the right side of the heart due to high blood pressure in the pulmonary blood vessels, usually caused b chronic lung disease
42
Congestive Heart Failure......3
- a condition in which the heart cannot pump enough blood to the body's other organs
- the "failing" heart keeps working but not as efficiently as it should. people with heart failure can't exert themselves because they become short of breath and tired.
- the most common signs of congestive heart failure are swollen legs or difficulty breathing
43
coronary artery bypass surgery
graft: a procedure to bypass a blocked section of a coronary artery and to deliver the oxygen to the heart
- one end of the blood vessel is attached to the aorta
- other end is attached to the coronary artery at a point below the area of blockage
44
KGH Sternal Precautions.......why
- before operation (before pt. are groggy)
- mini-mental test pre-op so team members are aware of patients cognitive functioning and ability to follow sternal precautions safely and correctly
45
6 sternal precautions, wahahaha.
- avoid reaching behind you (this includes putting your arm in your shirt sleeve. With arms tight to your side the shirt must be flipped over your head using both hands so the shirt is draped over both shoulders to get your arms in the sleeves without reaching behind you or over your head.)
- avoid reaching out to your side (this does not include reaching for tub grab bars)
- avoid stretching your arms above your head
- avoid heavy lifting (anything over 5lb)
- avoid pushing or pulling over 5lb
- remember, two hands are better than one
46
4 lovely lovely facts about sternal precautions
- the sternum was cut for surgery and treated like a healing fracture
- in some cases, if there is a concern about the bones ability to heal, a small band of wire is secured around the sternum to help hold it together
- while standing up always hold a pillow to your chest to hold the breastbone stable
- precautions are in place for 8-12 weeks
47
cardiac stress test....... 4 things to know, hehehe
- some forms of cardiac disease are easily missed when the patient is at rest, because at rest the patient's physical examination and ECG are often entirely normal
- the stress test is used to evaluate the heart and vascular system during exercise or load
- mainly used to diagnose coronary artery disease (ischemic heart muscle often causes chest discomfort or angina, characteristic changes on the ECG)
- it can also cause changes in the heart rhythm (arythmia) or in the blood pressure
48
Sub Maximal Cardiac Stress Test.....4
- patient exercises only until a pre-determined level of exercise is attained
- These tests are used in patients with known coronary artery disease, to measure whether a specific level of exercise can be performed safely
- The patient is attached to an ECG machine, and a blood pressure cuff is placed on one arm. After a baseline ECG is obtained, the patient begins to perform a low level of exercise, either by walking on a treadmill, or pedaling a stationary bicycle
- Every three minutes, the level of exercise is increased. At each "stage" of exercise, the pulse, blood pressure and ECG are recorded, along with any symptoms the patient may be experiencing (Bruce Protocol)
49
Maximal Stress Test...2 things ya just must know!
- Maximal stress tests should be performed when the goal is to diagnose the presence or absence of coronary artery disease
- Maximal stress tests can also determine the actual maximum heart rate rather than estimating by calculation
50
Heart Rate Variability (HRV) ...3
- variation of beat-to-beat intervals
- a healthy heart has a large HRV, while decreased or absent variability may indicate cardiac disease
- HRV has been the focus of increased research to use it as a physiological marker to classify different pathological disorders
51
Heart Rate Recovery
- One aspect of heart rate variability can be used as a measurement of fitness, specifically the speed at which one's heart rate drops upon termination of vigorous exercise.
- The speed at which a person's heart rate returns to resting is faster for a fit person than an unfit person.
52
Heart rate Recovery NUMBASSS
A drop of 20 beats in a minute is typical for a healthy person. A drop of less than 12 beats per minute after maximal exercise has been correlated with a significant increase in mortality*.
53
Heart Rate Reserve (HRR)...3 tidbits
- Heart rate reserve (HRR) is a term used to describe the difference between a person's resting heart rate and maximum heart rate.
- Some methods of measurement of exercise intensity measure percentage of heart rate reserve.
- Additionally, as a person becomes fit, as their HRrest will drop, the heart rate reserve will increase.
54
calculation of heart rate reserve
HRR = HRmax − HRrest
55
Astrand Cycle Ergometer... what the truck is it.
Description: Athletes pedal on a cycle ergometer at a constant workload for 7 minutes. Heart rate is measured every minute, and the steady state heart rate is then looked up on published tables to determine an estimation of VO2max.
.................Equipment required: cycle ergometer, stopwatch, heart rate monitor, ECG (optional)
56
Astrand Cycle Ergometer. adv, disadv... and validity
- Advantages: simple test to administer, reasonably accurate and appropriate for ECG monitoring during exercise.
- Disadvantages: This test may underestimate the fitness of those with a high maximum heart rate, and overestimate fitness with advancing age (as max HR reduces with age). As it is performed on a cycle ergometer, it would favour cyclists.
- Validity: correlation to VO2max approximately 0.85-0.9
57
Waist Hip Ratio
method:
- use a non-stretchable tape: make it level around the body, parallel to the floor, and tighten it without depressing the skin.
- Measure the waist at its narrowest point width-wise, (above the belly button.)
- Measure the hips around the widest part of the hip bones. Then divide the waist measurement by the hip measurement.
58
waist hip ratio interpretation
interpretation:
| A WHR of 0.7 for women and 0.9 for men have been shown to correlate strongly with general health
59
another measurement of health
skin fold testing
60
VO2 Max......4 points
- measuring fitness by the volume of oxygen you can consume while exercising at your maximum capacity
- VO2 max is the maximum amount of oxygen in milliliters, one can use in one minute per kilogram of body weight
- Mean value of VO2 max for male athletes is about 3.5 litres/minute and for female athletes it is about 2.7 litres/minute
- Those who are fit have higher VO2 max values and can exercise more intensely than those who are not as well conditioned.
61
how to increase your VO2 Max
....by working out at an intensity that raises your heart rate to between 65 and 85% of its maximum for at least 20 minutes three to five times a week.
62
Cardiac Rehabilitation ----> what is it? purpose?
- a supervised program that includes exercise, lifestyle changes, education, and emotional support for people who have had a heart attack or bypass surgery or who have other heart problems.
- Programs are medically supervised and individually designed to enhance your quality of life.
63
It is important to be aware of several factors when monitoring CV exercise including:..9
```
Medical status of the patient
Contraindications for exercise
Orthopedic conditions
THR Zone
Pulse rate
Respiratory rate
Perceived exertion
Signs of distress such as skin color, chest pain, excessive sweating, balance problems
Possible signs of myocardial infarct
```
64
ALWAYS....... if concerned
report, report, report
65
Grading Exercise Intensity.....determined by 3 things
The grading of exercise intensity is usually determined by: load, duration and frequency
66
There are several methods of measuring exercise intensity including:
```
Borg Perceived Exertion Scale
Talk Test
Training Heart Rate Zone
Metabolic Equivalent
Self-monitoring of signs and symptoms
```
67
Borg Perceived Exertion Scale
Perceived exertion is how hard you feel like your body is working. It is based on the physical sensations a person experiences during physical activity, including increased heart rate, increased respiration or breathing rate, increased sweating, and muscle fatigue.
68
borg scale
```
6 No exertion at all
7 Extremely light (7.5)8
9 Very light
10
11 Light
12
13 Somewhat hard
14
15 Hard (heavy)
16
17 Very hard
18
19 Extremely hard
20 Maximal exertion
```
69
Interpretation of borg scale.....9,13,17,19
9 corresponds to "very light" exercise. For a healthy person, it is like walking slowly at his or her own pace for some minutes
13 on the scale is "somewhat hard" exercise, but it still feels OK to continue.
17 "very hard" is very strenuous. A healthy person can still go on, but he or she really has to push him- or herself. It feels very heavy, and the person is very tired.
19 on the scale is an extremely strenuous exercise level. For most people this is the most strenuous exercise they have ever experienced.
70
Borg Perceived Exertion Scale
Practitioners generally agree that perceived exertion ratings between 12 to 14 on the Borg Scale suggests that physical activity is being performed at a moderate level of intensity
71
Borg Perceived Exertion Scale accuracy, 2 points
- Although this is a subjective measure, a person's exertion rating may provide good estimate of the actual heart rate during physical activity
- A high correlation exists between a person's perceived exertion rating times 10 and the actual heart rate during physical activity (so a person's exertion rating may provide a fairly good estimate of the actual heart rate during activity)
72
Borg Perceived Exertion Scale...... example of prediction
For example, if a person's rating of perceived exertion (RPE) is 12, then 12 x 10 = 120; so the heart rate should be approximately 120 beats per minute.
73
Target Heart Rate
- Target heart rate (THR) is a desired range of heart rate reached during Aerobic exercise which enables one's heart and lungs to receive the most benefit from a workout in a safe way
- range varies based on one's physical condition, age, and previous training
74
Target Heart Rate methods & %?!
- There are at least two ways to calculate one's Target Heart Rate. In each of these methods, there is an element called "intensity" which is expressed as a percentage.
- THR can be calculated by using a range of 50%–85% intensity.
75
THR simple method
THR = HRmax × %Intensity
Example for someone with a HRmax of 180:50% Intensity: 180 × 0.50 = 90 bpm
85% Intensity: 180 × 0.85 = 153 bpm
76
Karvonen Method
-more accurate
THR = ((HRmax – HRrest) × %Intensity) + HRrest
Example for someone with a HRmax of 180 and a HRrest of 70:
50% intensity: ((180 − 70) × 0.50) + 70 = 125 bpm
85% intensity: ((180 − 70) × 0.85) + 70 = 163 bpm
77
Cardiovascular Training Zones..... 3 things to know, bro
- Patients are generally given a target heart zone in which to exercise aerobically
- This zone can vary depending on the intended purpose of the exercise
- Athletes often train in all three zones
78
Healthy Heart Zone (Warm up)
- 50–60% of maximum heart rate: The easiest zone and probably the best zone for people just starting a fitness program. It can also be used as a warm up for more serious walkers.
- This zone has been shown to help decrease body fat, blood pressure and cholesterol. It also decreases the risk of degenerative diseases and has a low risk of injury. Fats are 85% of food energy burned in this zone.
79
Fitness Zone (Fat Burning)
- 60–70% of maximum heart rate: This zone provides the same benefits as the healthy heart zone, but is more intense and burns more total food energy.
- The percent of food energy from fat is still 85%.
80
Aerobic Zone (Endurance Training)
- 70–80% of maximum heart rate: The aerobic zone will improve your cardiovascular and respiratory system and increase the size and strength of your heart.
- This is the preferred zone if you are training for an endurance event. More food energy is burned with 50% from fat.
81
Anaerobic Zone (Performance Training)
- 80–90% of maximum heart rate: Benefits of this zone include an improved and thus an improved cardiorespiratory system, and a higher lactate tolerance ability which means your endurance will improve and you'll be able to fight fatigue better.
- This is a high intensity zone burning more food energy but only 15% from fat.
82
Red Line (Maximum Effort)
- 90–100% of maximum heart rate: Although this zone burns the highest amount of food energy, it is very intense.
- Most people can only stay in this zone for short periods. You should only train in this zone if you have a very high fitness level and have been cleared by a physician to do so.
83
Metabolic Equivalent....... talk to me heeeh.
Another method measuring physical activity intensity is by the metabolic equivalent, or MET, level.
1 MET = the energy (oxygen) used by the body as you sit quietly, perhaps while talking on the phone or reading a book.
84
Metabolic Equivalent....3
- The harder your body works during the activity, the higher the MET.
- Any activity that burns 3 to 6 METs is considered moderate-intensity physical activity.
- Any activity that burns > 6 METs is considered vigorous-intensity physical activity.
85
Light-Intensity Activities:.....7
```
Walking slowly
Golf, powered cart
Swimming, slow treading
Gardening or pruning
Bicycling, very light effort
Dusting or vacuuming
Conditioning exercise, light stretching or warm up
```
86
Moderate-Intensity Activities.....lots
```
Walking briskly
Golf, pulling or carrying clubs
Swimming, recreational
Mowing lawn, power motor
Tennis, doubles
Bicycling 5 to 9 mph, level terrain, or with a few hills
Scrubbing floors or washing windows
Weight lifting, Nautilus machines or free weights
```
87
Vigorous-Intensity Activities
```
Race walking, jogging or running
Swimming laps
Mowing lawn, hand mower
Tennis, singles
Bicycling more than 10 mph, or on steep uphill terrain
Moving or pushing furniture
Circuit training
```
