FINALS: Cardiac Eval Flashcards
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?
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).
An athlete is training at high altitude. Initially, their heart rate and blood pressure have increased. What physiological changes will occur with acclimatization?
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.
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?
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.
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?
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.
A patient reports difficulty breathing after swimming in warm water. What respiratory effects might explain this?
Decreased Vital Capacity
Increased Work of Breathing
Hydrostatic Pressure on Chest
During a stress test, BP and HR increase linearly. What cardiac response is expected?
Heart Rate: Increases with work rate.
Systolic BP: Increases.
Diastolic BP: Remains constant.
An athlete feels fatigued at high altitude. Why might this happen?
Lower Oxygen Availability: Increased HR and BP.
Body Adjusts: Produces more RBCs over time.
What is considered normal blood pressure according to new guidelines?
Less than 120/80 mmHg
A person on beta-blockers wants to exercise safely. What should be used to guide intensity?
RPE Scale: Monitor perceived exertion.
Avoid HR Monitoring: Beta-blockers lower HR response.
A patient’s BP is 140/92 mmHg. What stage is this, and what action is needed?
Stage 2 Hypertension
Intervention: Medication adjustment, lifestyle change.
What defines elevated blood pressure?
Systolic: 120-129 mmHg
Diastolic: Less than 80 mmHg
Criteria for Stage 1 Hypertension?
Systolic: 130-139 mmHg
OR
Diastolic: 80-89 mmHg
What is Stage 2 Hypertension?
Systolic: At least 140 mmHg
OR
Diastolic: At least 90 mmHg
Define a Hypertensive Crisis.
Systolic: Over 180 mmHg
AND/OR
Diastolic: Over 120 mmHg
Requires urgent medical attention.
What does the T wave indicate?
Ventricular repolarization.
Reflects the heart’s recovery phase.
What is a 1st-degree AV block?
Delayed conduction from SA node to ventricles.
PR interval > 0.2 seconds.
Generally benign, can continue exercise.
What does an ECG record?
The electrical activity of the heart.
Tracks waves like P wave, QRS complex, and T wave.
Describe the P wave in an ECG.
Represents atrial depolarization.
Indicates atrial contraction.
Features of 2nd-degree AV block (Type 1)?
Progressive PR interval increase until a QRS drop.
Exercise with caution, monitor symptoms.
Ventricular depolarization.
Atrial repolarization occurs simultaneously.
QRS complex
Normal PR interval, but random QRS drops.
Stop exercise and monitor closely.
2nd-degree AV block (Type 2)
Complete disconnection between atria and ventricles.
No relationship between P waves and QRS.
Stop exercise and activate EMS.
3rd-degree AV block
Criteria for stopping exercise due to PVCs?
More than 2 PVCs together (couplet).
3 or more consecutive PVCs (ventricular tachycardia).
Stop and call 911 if needed.
What are premature ventricular contractions (PVCs)
Early heartbeat from Purkinje fibers.
Can lead to skipped beats or palpitations.
Difference between ischemia and infarction on ECG?
Ischemia: ST segment depression, inverted T wave.
Infarction: ST segment elevation, indicates cell death.
What is the Karvonen formula?
Target HR = (HR max - HR rest) × % intensity + HR rest
Used to set exercise intensity.
Equation for predicting max heart rate?
HR max = 220 - age
Alternative: HR max = 207 - 0.7 × age
Frequency: 2-3 sessions/week.
Intensity: 70-85% of peak achieved.
Time: 30-60 minutes/session.
Guidelines for Cardiac Rehab Phase 3?
Components of Cardiac Rehab Phase 1?
Frequency: 2-3 short sessions/day.
Intensity: 50-70% HR max.
Type: ADLs, supervised ambulation
Case: Patient’s ECG shows ST-segment depression during a treadmill session.
Question: Continue, modify, or stop treatment?
Stop exercise immediately.
Rationale: ST-segment depression suggests myocardial ischemia.
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?
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.
Patient experiences a single PVC with no symptoms during a moderate-intensity session.
Question: Continue, modify, or stop treatment?
Continue but monitor closely.
Rationale: Single PVCs can be benign if asymptomatic.
Patient in Phase 3 cardiac rehab has a blood pressure of 240/90 mmHg.
Question: Continue, modify, or stop treatment?
Stop exercise and reassess.
Rationale: Hypertensive crisis requires immediate attention.
Review how to read ECG
:))
Key response criteria for exercise termination?
SBP > 240 mmHg or hypotension.
Unusual heart rate or symptoms.
ECG abnormalities like ST changes.
