FINALS: Cardiac Eval Flashcards

1
Q

A 55-year-old patient with a history of hypertension presents with chest discomfort and shortness of breath during exercise. On examination, blood pressure is 150/95 mmHg and heart rate is 85 bpm. What initial cardiac assessment parameters should be monitored before, during, and after exercise?

A

Blood Pressure (BP)
Heart Rate (HR)
Rate Pressure Product (RPP): HR x Systolic BP to determine myocardial oxygen demand.
Cardiac Output (CO): HR x Stroke Volume (SV).

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2
Q

An athlete is training at high altitude. Initially, their heart rate and blood pressure have increased. What physiological changes will occur with acclimatization?

A

Initial Responses:
Heart Rate (HR): Increases.
Blood Pressure (BP): Increases.
Cardiac Output (CO): Increases.
Stroke Volume (SV): Stays normal initially.
Acclimatization:
HR & BP: Normalize.
CO: Normalizes.
SV: Decreases over time.

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2
Q

A 65-year-old patient with coronary artery disease is on beta-blockers (-olol). During an exercise test, their heart rate response is lower than expected. Why is this happening, and what method should be used to monitor exercise intensity?

A

Reason: Beta-blockers block beta-adrenergic receptors, reducing HR and contractility.
Monitoring Method: Use Rate of Perceived Exertion (RPE) instead of relying on HR, as HR response is blunted.

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2
Q

A patient transitioning from rest to exercise exhibits increasing heart rate and cardiac output. What changes occur in cardiac function from rest to exercise and then to recovery?

A

From Rest to Exercise:
Cardiac Output (CO): Increases.
Stroke Volume (SV): Increases.
Heart Rate (HR): Increases.
During Sustained Exercise:
CO, SV, HR: Plateau.
During Recovery:
CO, SV, HR: Gradually decrease to resting levels.

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2
Q

A patient reports difficulty breathing after swimming in warm water. What respiratory effects might explain this?

A

Decreased Vital Capacity
Increased Work of Breathing
Hydrostatic Pressure on Chest

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3
Q

During a stress test, BP and HR increase linearly. What cardiac response is expected?

A

Heart Rate: Increases with work rate.
Systolic BP: Increases.
Diastolic BP: Remains constant.

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3
Q

An athlete feels fatigued at high altitude. Why might this happen?

A

Lower Oxygen Availability: Increased HR and BP.
Body Adjusts: Produces more RBCs over time.

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3
Q

What is considered normal blood pressure according to new guidelines?

A

Less than 120/80 mmHg

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3
Q

A person on beta-blockers wants to exercise safely. What should be used to guide intensity?

A

RPE Scale: Monitor perceived exertion.
Avoid HR Monitoring: Beta-blockers lower HR response.

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4
Q

A patient’s BP is 140/92 mmHg. What stage is this, and what action is needed?

A

Stage 2 Hypertension
Intervention: Medication adjustment, lifestyle change.

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5
Q

What defines elevated blood pressure?

A

Systolic: 120-129 mmHg
Diastolic: Less than 80 mmHg

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5
Q

Criteria for Stage 1 Hypertension?

A

Systolic: 130-139 mmHg
OR
Diastolic: 80-89 mmHg

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5
Q

What is Stage 2 Hypertension?

A

Systolic: At least 140 mmHg
OR
Diastolic: At least 90 mmHg

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5
Q

Define a Hypertensive Crisis.

A

Systolic: Over 180 mmHg
AND/OR
Diastolic: Over 120 mmHg
Requires urgent medical attention.

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6
Q

What does the T wave indicate?

A

Ventricular repolarization.
Reflects the heart’s recovery phase.

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6
Q

What is a 1st-degree AV block?

A

Delayed conduction from SA node to ventricles.
PR interval > 0.2 seconds.
Generally benign, can continue exercise.

6
Q

What does an ECG record?

A

The electrical activity of the heart.
Tracks waves like P wave, QRS complex, and T wave.

6
Q

Describe the P wave in an ECG.

A

Represents atrial depolarization.
Indicates atrial contraction.

7
Q

Features of 2nd-degree AV block (Type 1)?

A

Progressive PR interval increase until a QRS drop.
Exercise with caution, monitor symptoms.

7
Q

Ventricular depolarization.
Atrial repolarization occurs simultaneously.

A

QRS complex

7
Q

Normal PR interval, but random QRS drops.
Stop exercise and monitor closely.

A

2nd-degree AV block (Type 2)

7
Q

Complete disconnection between atria and ventricles.
No relationship between P waves and QRS.
Stop exercise and activate EMS.

A

3rd-degree AV block

8
Q

Criteria for stopping exercise due to PVCs?

A

More than 2 PVCs together (couplet).
3 or more consecutive PVCs (ventricular tachycardia).
Stop and call 911 if needed.

8
Q

What are premature ventricular contractions (PVCs)

A

Early heartbeat from Purkinje fibers.
Can lead to skipped beats or palpitations.

8
Q

Difference between ischemia and infarction on ECG?

A

Ischemia: ST segment depression, inverted T wave.
Infarction: ST segment elevation, indicates cell death.

9
Q

What is the Karvonen formula?

A

Target HR = (HR max - HR rest) × % intensity + HR rest
Used to set exercise intensity.

9
Q

Equation for predicting max heart rate?

A

HR max = 220 - age
Alternative: HR max = 207 - 0.7 × age

9
Q

Frequency: 2-3 sessions/week.
Intensity: 70-85% of peak achieved.
Time: 30-60 minutes/session.

A

Guidelines for Cardiac Rehab Phase 3?

10
Q

Components of Cardiac Rehab Phase 1?

A

Frequency: 2-3 short sessions/day.
Intensity: 50-70% HR max.
Type: ADLs, supervised ambulation

10
Q

Case: Patient’s ECG shows ST-segment depression during a treadmill session.
Question: Continue, modify, or stop treatment?

A

Stop exercise immediately.
Rationale: ST-segment depression suggests myocardial ischemia.

10
Q

Case: You are a PT working with a patient in cardiac rehab (Phase 2). During a low-intensity cycling session, the patient’s ECG monitor shows a sudden onset of 2nd-degree AV block (Type 2), with a stable blood pressure but occasional skipped QRS complexes. The patient reports feeling light-headed.
Question: Do you:

Continue exercise at the same intensity
Lower exercise intensity and monitor
Stop exercise and call the physician
Stop exercise and activate EMS?

A

Stop exercise immediately and call the physician.
Rationale: 2nd-degree AV block (Type 2) is serious and can worsen. Continuous monitoring and physician intervention are necessary.

11
Q

Patient experiences a single PVC with no symptoms during a moderate-intensity session.
Question: Continue, modify, or stop treatment?

A

Continue but monitor closely.
Rationale: Single PVCs can be benign if asymptomatic.

12
Q

Patient in Phase 3 cardiac rehab has a blood pressure of 240/90 mmHg.
Question: Continue, modify, or stop treatment?

A

Stop exercise and reassess.
Rationale: Hypertensive crisis requires immediate attention.

12
Q

Review how to read ECG

A

:))

12
Q

Key response criteria for exercise termination?

A

SBP > 240 mmHg or hypotension.
Unusual heart rate or symptoms.
ECG abnormalities like ST changes.