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536 > Final Exam (wk 1-4) > Flashcards

Final Exam (wk 1-4) Flashcards

1
Q

Which 3 cardiac vessels make up 3-vessel disease

A

CAD in R coronary artery
LAD artery
L circumflex artery

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2
Q

What structures does the R coronary artery supply (6)

A

-R atrium and ventricle
-some L ventricle
-AV node
-SA node (60%)
-Bundle of his

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3
Q

What is the equation for cardiac output? Describe each component

A

CO = HR x SV

CO: amount of blood ejected from L ventricle per min

HR: beats per min

SV: amount of blood ejected from L ventricle per beat

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4
Q

What is preload?

A

Pre-stx to allow blood in

Increased preload —> increased SV

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5
Q

What is afterload?

A

Force of L ventricle to overcome aortic pressure to open aortic valve

Increased after load —> decreased SV

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6
Q

What is ejection fraction? What is the equation?

A

% of blood emptied from ventricle during systole

EF = SV/LVEDV

LEVDV: volume of blood before contraction

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7
Q

What are the 4 stages of the cardiac cycle?

A

Atrial contraction, isovolumetric contraction, ventricular ejection, isovolumetric relaxation

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8
Q

Describe the first stage of the cardiac cycle (atrial contraction)

A

-SA node sends signal to AV node, causing R atrium to contract
-pushes leftover blood (20%) into ventricle
-atrioventricular valves close

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9
Q

Describe the second stage of the cardiac cycle

A

-ventricles fill with blood, but not enough to push blood out
-electrical signal from bundle of his travels to R and L branches and purkinje fibers
-semilunar valves open

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10
Q

Describe the third stage of the cardiac cycle

A

-isovolumetric contraction helps ventricles contract and push blood through semilunar valves
-semilunar valves close and ventricles relax

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11
Q

Describe the fourth stage of the cardiac cycle

A

-semilunar valves closed but atrioventricular valves slightly open allowing ventricles to fill passively

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12
Q

Describe the BF to lungs

A

Deoxygenated blood from vena cava
R atrium
Via tricuspid valve
R ventricle
Via pulm valve
Pulm ARTERIES
Lungs

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13
Q

Describe BF to periphery

A

O2 blood from lungs
Pulm VEINS
L atrium
Via mitral valve
L ventricle
Via aortic valve
Aorta

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14
Q

6 layers of the heart (inner to outer)

A

Endocardium
Myocardium
Epicardium
Pericardial cavity
Parietal pericardium
Fibrous pericardium

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15
Q

How is myocardium different from skeletal muscle?

A

Automaticity; pacemaker cells keep the heart moving w/o conscious voluntary control

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16
Q

What are the 8 sections of the respiratory zone? Which are in the conducting and respiratory zone?

A

Conducting zone: Trachea, primary bronchus, bronchus, bronchi, bronchioles

Respiratory zone: respiratory bronchioles, alveolar ducts, alveolar sacs

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17
Q

What innervates the parietal pleura?

A

Phrenic and intercostal nerves

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18
Q

What muscles are involved with inspiration

A

SCM, scalenes, pec major, external intercostals, diaphragm

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19
Q

What muscles are involved with expiration

A

Internal intercostals, abdominals (rectus abd, external and internal oblique)

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20
Q

What is hemoglobin made of?

A

4 iron molecules (hemes)
4 protein molecules (globins)

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21
Q

What is pericarditis? What is the most common cause?

A

Inflammation of pericardium (usually serous pericardium) or pericardial fluid

Viral infection

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22
Q

S/S of acute pericarditis

A

-retrosternal chest pain (sharp/stabbing), might radiate to back and L mid trap
-intensifies w/ cough, deep breathing (pleuritic pain) or supine
-relieved w/ sitting up and leaning forward
-general malaise and fever (d/t infection)

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23
Q

What would you hear during auscultation in acute pericarditis pt?

A

Friction rub

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24
Q

What will reveal acute inflammation for pericarditis?

A

-labs: C reactive protein, troponin (will not continue to increase)
-echocardiography

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25
Q

What is constrictive pericarditis?

A

Chronic pericarditis or pericardial effusion —> results in thickening/scarring of pericardium

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26
Q

S/S of chronic pericarditis. Which is the most important to know?

A

-dyspnea and fatigue d/t reduced CO
-LE and abdominal swelling
-dizziness and syncope
-vague retrosternal chest pain

Jugular venous distention

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27
Q

How much fluid is in the pericardial sac?

A

15-50 mL

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28
Q

What is cardiac tamponade?

A

Lots of fluid in pericardial space exerts pressure on heart (medical emergency)

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29
Q

S/S of cardiac tamponade

A

-decreased BP
-hypoTN, shock
-decreased CO: dyspnea, fatigue, syncope, dizziness (cough, tachycardia, tachypnea)

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30
Q

What is Beck’s triad?

A

hypoTN, JVD, decreased heart sounds

Signs of cardiac tamponade

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31
Q

Tx for cardiac tamponade

A

-cardiac/pericardial window
-cut a hole in fibrous pericardium to allow fluid to drain and relieve pressure

Pericardiocentesis —> draw fluid out by inserting a needle/catheter

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32
Q

What is endocarditis? Causes?

A

Infection from bacteria or fungi

Dental work, GI/urinary procedures, catheters, IV, tattoos, drug abuse, rheumatic fever

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33
Q

S/S of endocarditis

A

-flu like symptoms: pain with breathing, SOB, swelling, fever
-rapid onset for acute
-possible mitral valve regurgitation on auscultation

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34
Q

Endocarditis tx

A

high dose long term IV abx

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35
Q

What is myocarditis?

A

-Inflammation of heart wall/mus
-affects pump and electrical

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36
Q

8 modifiable risk factors for CVD

A

-cholesterol
-stress
-diabetes
-diet
-HTN
-weight
-activity level
-tobacco

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37
Q

7 non-modifiable risk factors for CVD

A

-age
-fam hx
-genetics
-gender
-race
-chronic kidney disease
-low socioeconomic status

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38
Q

What type of event is stroke?

A

CV

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39
Q

What is white coat HTN? Who is it common among? When is it significant?

A

-elevated BP in office but normal at home
-common in older adults, females, non
-significant: >20/10 mmHg

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40
Q

What is masked HTN?

A

Office BP reading normal but home consistently above normal

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41
Q

3 symptoms of decreased CO

A

Dizziness, dyspnea, impaired ex tolerance

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42
Q

How do beta blockers impact HTN pts?

A

-impair thermoregulation
-blunt HR (won’t increase w/ ex)
-possible hypoglycemia

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43
Q

What is postural orthostatic tachycardia syndrome (POTS)?

A

Orthostatic intolerance disorder; rapid increase in heartbeat
-30bpm for adults
-40bpm for adolescents
-120 bmp within 10 mins of rising

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44
Q

S/S of POTs

A

Dizziness, lightheaded mess, fainting

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45
Q

What are 3 ways to help limit POTS?

A

-move LE before standing, move segmentally
-valsalva if not contraindicated
-pressure garments

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46
Q

Goal values for HDL levels in men and women

A

-men: >40mg/dL
-women: >50mg/dL

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47
Q

What are the 3 categories and values for LDL

A

-high risk: 160-189mg/dL
-borderline: 120-159mg/dL
-optimal: < 100 mg/dL

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48
Q

How to calculate the ration for total cholesterol? Higher/lower mean greater risk?

A

Total cholesterol/HDL

Higher ratio —> higher risk

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49
Q

What is more beneficial for CAD pts, exercise volume or intensity?

A

Volume

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50
Q

S/S of stable angina

A

-Levine sign
-tachycardia
-diaphoresis
-nausea
-dyspnea

51
Q

Common triggers for stable angina

A

-high BP
-anemia (lack of O2, not enough Hgb)
-stress
-extreme cold
-heavy meals
-physical exertion

52
Q

Stable angina PT implications

A

-30 to 60 min mod intensity (40-60% THR, 3-6 METS)
-avoid valsalva
-train major mus groups
-long warm up/cool down

53
Q

S/S of MI

A

-chest pain >20 mins w/o relief w/ decreasing act or nitroglycerin
-dyspnea
-diaphoresis, cool, clammy skin
-n/v, weakness
-pulmonary rates/crackles (if HF present)

54
Q

What are the 3 main types of cardiomyopathy. Briefly describe each

A

-dilated (ischemic or non-ischemic): enlarged L ventricle, systolic dysfxn

-hypertrophic: abnormal L ventricular wall thickness, diastolic dysfxn

-restrictive: abnormal L ventricular wall stiffness, diastolic dysfxn

55
Q

Risk factors for dilated cardiomyopathy

A

Idiopathic, uncontrolled HTN, fam hx, inflam myocarditis, alcohol, metabolic, pregnancy related

56
Q

Risk factors for hypertrophic cardiomyopathy

A

Genetic, autosomal dominant mutations

57
Q

Risk factors for restrictive cardiomyopathy

A

Infiltrates; radiation therapy, scleroderma, fibrotic tissue (something damaged mus)

58
Q

S/S of dilated cardiomyopathy

A

-decreased ejection fraction
-S3 heart sound and mitral valve regurgitation
-crackles/rales, dullness to percussion
-enlargement of heart in imaging (silhouette)

59
Q

S/S of hypertrophic cardiomyopathy

A

-avg age 20
-dyspnea and angina (not d/t CAD)
-arrhythmias and syncope
-S4 sound

60
Q

S/S of restrictive cardiomyopathy

A

-decreased CO
-fatigue and decreased ex tolerance
-systemic edema —> pulmonary congestion
-JVD, peripheral edema, hepatomegaly (lg liver)
-arrhythmias

61
Q

How do you define HFrEF

A

reduced ejection fraction
HF w/ LVEF <40%

62
Q

How do you define HFmrEF

A

mildly reduced EF
HF w/ LVEF 41-49%

63
Q

How do you define HFpEF

A

HF w/ LVEF >50%

64
Q

How do you define HFimpEF

A

HF w/ baseline LVEF of <40% a 10 point increase from baseline LVEF, and a second measurement of LVEF of >40%

65
Q

9 common etiologies of HF

A

-HTN
-CAD/ischemia/MIA
-cardiac dysrhythmias
-cardiomyopathy
-valve abnorm
-chronic pericardial effusion
-PE
-pulm HTN

66
Q

2 hallmark symptoms of L sided HF

A

Dyspnea and cough

67
Q

4 hallmark symptoms of R sided HF

A

-jugular vein distention
-peripheral edema
-ascites and pleural effusion
-wt gain

68
Q

3 signs of pulmonary congestion

A

Moist rales, wheezing, abnormal sputum

69
Q

4 symptoms of L sided HF d/t diastolic dysfxn

A

-dyspnea
-cardiac asthma
-pulm edema
-hemoptysis (coughing up frothy stuff)

Orthopnea

70
Q

Describe Class I of pt symps from NYHA

A

-No limitation of physical act
-no undue fatigue, palpitation, dyspnea

71
Q

Describe Class II of pt symps from NYHA

A

Slight limitation; comfy at rest; ordinary PA causes fatigue, palpitation, dyspnea

72
Q

Describe Class III of pt symps from NYHA

A

Marked limitation; comfy at rest; less ordinary act causes fatigue, palpitation, dyspnea

73
Q

Describe Class IV pt symps from NYHA

A

Discomfort w/ PA; HF symps at rest

74
Q

Compensated vs uncompensated HF

A

-pt dx w/ HF but not expressing signs of pulm/peripheral congestion vs. presence of new/worsening S/S that lead to unscheduled med care

75
Q

What are 4 things to keep in mind when rehabbing HF

A

-interval training at low-mod intensity effective -prolonged warm up/cool down
-avoid valsalva
-LG mus groups, LE > UE for resistance

76
Q

ACSM RPE for HF

A

6-11

77
Q

CABG vs PTCA (percutaneous transluminal coronary angioplasty)

A

CABG: better long term outcomes, lower risk of CVA or MI, higher morbidity rate, longer recovery, more expensive

78
Q

What is the most common CABG approach?

A

Sternotomy

79
Q

Advantages of on pump (ONCAB)

A

-gives surgeon more time
-more complete vascularization
-better for emergent CABG

80
Q

Disadvantages of on pump (ONCAB)

A

-“pump head”; post op cognitive decline
-S/S: delirium, cog changes, brain fog
-short lived 10-14 days
-can delay DC

81
Q

Disadvantages of off pump (OFCAB)

A

-requires specially trained CV surgeon
-formation of clots
-arrhythmias
-kidney issues from loss of perfusion
-global hypoperfusion
-increased mortality risk
-higher risk of incomplete vascularization

82
Q

Disadvantages of off pump (OFCAB)

A

-no need to stop the heart
-lower risk of clotting, arrhythmias, need for transfusions
-shorter hospital stays

83
Q

Which harvest site is the best/“worst” for CABG?

A

Best: L internal thoracic (mammary) artery

Worst: saphenous vein (high re-occlusion rate)

84
Q

Describe what a stenotic valve is and what it causes

A

-valve is stiff and won’t open d/t atherosclerotic plaque
-increases after load and work of heart

85
Q

Describe what an incompetent valve is and what it causes. Which valves are the most common?

A

-“leaky”; allows back flow or regurgitation
-AV and mitral are most common

86
Q

Risk factors associated w/ sternal wound complications (CABG PPT)

A

-obesity
-COPD
-internal mammary artery grafting
-DM
-increased blood loss/# transfused units
-high disability classification
-smoking
-prolonged cardiopulmonary bypass/surgical/time
-PVD
-prolonged mechanical vent
-female w/ large breasts

87
Q

Between which two structures does an abdominal aortic aneurysm usually occur?

A

Aortic bifurcation and renal arteries

88
Q

Abdominal aortic aneurysm risk factors

A

-SMOKING
-male > female
-atherosclerosis
-fam hx
-Caucasian

89
Q

Absolute contraindications for heart transplant

A

-malignancy in last 5 years
-tobacco use < 6 months
-HIV
-significant COPD
-fixed pulm HTN
-hep b or c

90
Q

Relative contraindications for heart transplant

A

-age >70
-active infection
-severe DM w/ end organ damage or poor glycemic control
-severe PVD
-BMI >35 kg/m^2
-severe HTN
-severe pulm dysfxn

91
Q

What are the 3 surgical techniques for heart transplant

A

-heterotopic heart transplantation (piggyback)
-total transplantation
-biatrial technique

92
Q

What is heterotopic heart transplantation — piggyback heart transplant

A

Native heart not removed, donor heart connected to native heart via R/L atria

93
Q

What happens during a total heart transplantation

A

Complete excision of recipient atria w/ complete AV transplantation, bicaval and pulm venous anastomoses

94
Q

Describe the biatrial heart transplant technique

A

Biatrial anastomoses where donor and recipient atrial cuffs are sewn together

Recipient’s SA node intact, donor’s is denervated

2 separate P waves on ECG

95
Q

PT considerations with heart transplant pt

A

-infection control
-denervated heart (extended warm up/cool down)
-use RPE if HR is blunted
-SV and LVEF lower than norm

96
Q

What are some rejection S/S of heart transplant? (7)

A

-low grade fever
-myalgia and fatigue
-hypoTN w/ activity but HTN w/ rest
-decreased ex tolerance and dyspnea
-arrhythmias
-wt gain d/t fluid retention
-decreased urine output

97
Q

5 PT priorities post cardiac surgery

A

-pulm hygiene
-vitals
-wnd mg
-mobility
-DC planning

98
Q

3 types of pacemakers

A

transcutaneous, transatrial, transvenous

99
Q

Describe what a transcutaneous pacemaker is and use

A

-electrodes placed on chest wall
-short term, painful for pt

100
Q

Describe what a transatrial pacemaker is

A

-electrodes placed on atrial
-not common

101
Q

Describe what a transvenous pacemaker is

A

-electrodes placed on ventricle
-femoral a to vena cava through atria to ventricle

102
Q

5 common indications for pacemaker

A

-SA node dysfxn (most common)
-2nd degree AV block w/ symp bradycardia
-3rd degree AV block w/ (symp brady, CHF, atrial fib or flutter)
-acute anterior MI
-severe bundle branch blocks

103
Q

7 conditions that may warrant a pacemaker

A

-syncope
-dizziness
-CHF
-mental confusion
-palpatations
-dyspnea
-ex intolerance

104
Q

What are the 3 modes of pacing for pacemaker? Briefly describe each

A

-fixed: preset rate
-demand: fires only when HR falls below preset value
-rate-responsive: fires depending on pt’s lvl of act

105
Q

What is an ICD? Use?

A

-implantable cardioverter defibrillator
-shocks heart when life threatening arrhythmia detected

106
Q

What is a CRT? Use?

A

-cardiac resynchronization device
-used w/ CHF, paces B ventricles at once

107
Q

Pt edu for pacemakers and ICDS

A

avoid prolonged contact w/ electrical devices

108
Q

3 post implant “protocols”

A

-sling on L arm x24 hrs
-avoid sh flex and ABD >90
-lift < 5lbs

109
Q

What is another name for a holter monitor? Use?

A

-ambulatory electrocardiography device
-monitors electrical activity of hear for 24+ hrs

110
Q

What is an LVAD? Use?

A

-L ventricular assist device
-mechanical pump that takes over damaged ventricle to restore norm BF

111
Q

Describe the 2 types of LVADs

A

-pulsatile: older, noisy
-axial flow: continuous flow, quite, popular

112
Q

2 main indications for LVAD

A

-bridge to transplant: heart transplant candidates waiting for heart
-destination therapy: long term, implant permanent

113
Q

6 criteria for VAD implant

A

-at least 2 admissions to hospital
-not improving with meds
-hyponatremic
-hypovolemic
-ionotrope dependent
-EF < 35%

114
Q

3 main purposes of ventricular assist devices

A

-restores CO and BP
-reduces L ventricle work and prevents further damage
-improves perfusion

115
Q

What is the speed for heartMATE II?

A

8,000-10,000 rpm

116
Q

What is the speed for heartMATE III?

A

5,200-6,400 rpm

117
Q

3 descriptions for +++ pump flow

A

-BF moving over 10L/min
-lg pts
-could be indicative of clot forming in pump (let med team know immediatly)

118
Q

3 descriptions for — pump flow

A

-BF moving less than 2.5L/min
-sm pts
-pt is hypovolemic and requires fluid bolus

119
Q

When to stop tx and notify med team when working w/ pt on VAD?

A

if +++ or — is sustaining

120
Q

What is an impella mechanical circulatory assist device?

A

-mini VAD that pumps blood from L ventricle into aorta

121
Q

One type of pt an impella good for?

A

MI complicated by cardiogenic shock or needs circulatory support w/ CAD tx

122
Q

Contraindications to PT with VAD

A

-VAD malfunction
-intra aortic balloon pump
-open chest
-active bleeding
-hemodynamic instability
-full ventilator support

123
Q

PT after VAD placement; 6 things to do an look out for

A

-focus on fxn
-strict sternal precautions (no move in the tube)
-pulm care; careful w/ trendelenburg and percussion
-kyphotic posture -> decrease O2 flow
-HR may be blunted
-battery life

124
Q

Exercise rx mgt for VAD placement

A

-RPE 11-13
-stop if symps of angina appear, dyspnea >5 on borg dyspnea scale

536 (9 decks)

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