General Cardiopulmonary Flashcards
Name 3 modifiable risk factors for cardiopulmonary disease.
Smoking
Hypertension
High Cholesterol
Physical Inactivity
Name 3 non-modifiable risk factors for cardiopulmonary disease
Genetics
Male sex
Aging
Reduced circulating red blood cell mass relative to an individual’s gender and age. Results in impaired RBC production and could be due to dietary deficiency
Anemia
- Can have hemolysis
- Can be caused by chronic inflammation, neoplasms, bone marrow diseases
S/S of this sided heart failure(left or right) secondary to pulmonary congestion includes: dyspnea, dry cough, orthopnea, wheezing, pulmonary edema, cyanosis, diaphoresis, tachycardia.
Left ventricular failure
S/S of this sided heart failure(left or right) secondary to low cardiac output include: hypotension, tachycardia, dizziness, fatigue, peripheral hypoperfusion
Left ventricular failure
T/F S3 heart sound can be heard with left ventricular failure
True- ventricular gallop
T/F S4 cannot be heard with left ventricular failure
False- 4th heart sound is atrial gallop, can sometimes be heard
What is the most common cause of R ventricular failure?
Left ventricular failure
This sided lung failure involves the following s/s:
Jugular vein distention, fatigue, weight gain, ascites, dependent edema, increased venous peripheral pressure
Right sides ventricular failure
Cor pulmonale is another name for:
Right ventricular failure
Would you heard S3 or S4 with right sided heart failure?
S3
Which side, right or left, presents with more of a pulmonary presentation?
Left: orthopnea, wheezes, cough, tachpnea, dyspnea,
Define orthopnea
SOB/dyspnea relieved with upright position
Define paroxysmal nocturnal dyspnea
SOB that awakens you from your sleep often in conjunction with heart failure
Patient presents with dyspnea, rales, jugular venous distention, peripheral edema, and fluid in the lungs. What could they have?
CHF
The following are all symptoms of CHF except:
a. paroxysmal nocturnal dyspnea
b. weight gain
c. pulsus alterans
d. sinus bradycardia
e. peripheral edema
D. Sinus bradycardia
Will have sinu tachycardia
What heart sound indicated a non-compliant left ventricle?
S3
What heart sound is associated with CHF, left ventricular failure, and right ventricular failure?
S3
Described as tightness, indigestion, pressure in chest that diminishes with rest or nitroglycerin
Classic Stable Angina
Female patient enters clinic with c/o nausea, indigestion, discomfort between the shoulder blades and excessive fatigue. It is possible she had:
a. CHF
b. Heartburn
c. Prinzmetal Angina
d. Stable Angina
e. Pericarditis
D. Stable angina
Patient presents with chest discomfort that changes in frequency and severity. He reports he has had this pain while sitting down. What type of angina may he have?
Unstable Angina, not responsive to nitroglycerin
You read a ECG and see an elevated ST segment. The patient states the pain in his chest is most prevalent in the morning and does not precede activity(increase in myocardial O2 demand). What type of angina may he have?
a. Stable
b. Unstable
c. Prinzmetal
C. Prinzmetal- does not occur during predictable level of activity
This type of angina occurs during a predictable level of activity and often associated with an increase in myocardial O2 demand?
Stable
Patients pain appears at rest and worsens with activity. Does not respond to nitroglycerin but does respond NSAIDS.
Pericarditis- not relieved with rest of NTG
Patient has pain/discomfort that is increased with palpation over the chest wall. What might he have? a. pericarditis b. chest wall pain c. pleuritic pain
chest wall pain- MSK in nature
Patient has pain or discomfort with changes of breathing. This pain may be:
a. pleuritic
b. chest wall apin
c. pericarditis
pleuritic
Patient experiences SOB and chest pain with activity that increases in extreme cold whether. Patient requires a bronchodilator or to stop exercises. What might they have?
a. pleuritic pain
b. bronchospasms
c. peircarditis
b
Chest pain described as substernal pressure that can refer to right or left arm, jaw, cervical spine, or between shoulders
Angina
Unstable angina is also called:
Acute Coronary Syndrome/ Acute Myocardial Infarction - chest discomfort accelerating in frequency or severity
Angina is often a precursor to what major cardiac dysfunction?
Heart attack- prolonged symptoms can lead to this, lightheadedness, and squeezing pressure sensation.
What happens to SV, HR, and CO for a hypertensive patient performing exercises?
Increased SV, decreased HR, decreased CO
Exercise is beneficial for HTN patient because it decreased Systolic, Diastolic, or Both?
Both
At what Systolic BP should you terminate exercises?
SBP >250
At what Diastolic BP should you terminate exercises?
DPB >115
Orthostatic HTN occurs when SBP drop more than ___ and DBP drops more than ___
20, 10
Normal BP
<120/<80
Prehypertension BP
120-139/80-89
HTN Stage 1 BP
140-159/90-99
Thiazide diuretics, ACE inhibitor, angiotensin II, Beta blocker, CCB
HTN Stage 2 BP
> 159/>99
Two drug combo
Disease where there is a destruction of pancreatic beta cells, decreasing ability to create insulin
Type I DM
Disease where hyperglycemia causes insulin resistance and progressive decline in beta cell function.
Type II DM
Function of insulin
Suppresses glucose production by the liver and promotes glucose transport across the cell membrane
Major concern while DM patient exercises
Hypotension, hypglycemia
Exercises benefits DM patient by providing:
glycemic control
What intensity should a DM patient with mild-mod hyperglycemia perform their exercises?
Low-mod intensity exercises increases glucose uptake
Which type of DM would have a higher concern for hypoglycemia?
Type 1
T/F Insulin should be injected near the exercising muscle to decrease hypotension during exercise..
False, avoid being near the exercising muscle
Frequent urination, dry mouth, increased thirst, and weakness are S/S of what?
Hyperglycemia
Increased hunger, flue like aches, HA, and blurred vision are S/S of what?
Hyperglycemia
Facial flushing, dry skin, N/V, abdominal pain, deep rapid breathing and coma are S/S of what?
Ketoacidosis
This organ controls extracellular fluid volume, electrolyte and acid balance and secretion of hormones
Kidneys
Impairment of glomerular filtration results in ____ insufficiency
renal/kidney
Patient on dialysis for kidney dysfunction is more likely to ave right or left sided heart problems?
Left ventricular problems
What is the treatment of ESRD?
Hemodialysis- leads to pulmonary complications(decreased arterial PA02)
Name that Stage!
Kidney Failure
Stage 5, GFR <15
Name that Stage!
Severely decreased GRF
Stage .4. GRR 15-29
Name that Stage!
Kidney Damage with normal or increased GFR
Stage 1, GFR >90
Name that Stage!
Kidney damage with mildly decreased GFR
Stage 2, GFR 60-89
Name that Stage!
Moderatley decreased GFR
Stage 3, GFR 30-59
GFR for the differing kidney stages increases by what each stage? And how many stages are there for kidney disease?
5 stages, 30 each time
Exercises compliance is highest when sessions are performed _____ the dialysis treatment?
a. a day before
b. during
c. a day after
d. right before
During
T/F PVD and PAD are normally used interchangeably
True
Name major S/S of PAD
Painful walking (intermittent claudication)
Elevated foot develops increased pallor
Venous filling developed following foot elevation
Redness of distal limb (dependent rubor)
Death of tissue (gangrene)
Should the intervals of exercises be short or long with PAD patients?
Short: 1-5 minutes with rest periods
Normal prothrombin time and what it is
11.6-13 seconds, time it takes to form a clot
A high INR woul indicate:
Thinner blood
A low INR would indicate:
Thicker blood
Normal INR:
<1.1
Therapeutic range for INR:
2.0-3.0 for people of Warfin(to prevent venous thrombus or PE)
Normal troponin level
Troponin of >.4 indicates
Diagnostic for MI(acute, recent, or evolving)
Name 3 contraindications for exercise:
• Contraindications to low level testing
o Unstable angina or angina at rest
o Severe heart failure (overt left ventricular failure on exam with pulmonary rales and S3 heart sound)
o Serious arrhythmias at rest
o Second or third degree heart block
o Disabling musculoskeletal abnormalities
o Valvular heart disease
o BP > 180/105 mmHg
o Pt refuses to sign consent form
• Absolute contraindications to exercise testing
o Recent MI
o Acute pericarditis or myocarditis
o Resting or unstable angina
o Serious ventricular or rapid arterial arrhythmias
o Tachycardia a-fib
o Unrelated second or third degree heart block
o Any acute illness
• Relative contraindications
o Aortic stenosis
o Known left main coronary artery disease
o Severe HTN
o Idiopathic hypertrophic subaortic stenosis
o Severe depression of ST segment on resting ECG
o Compensated heart failure
Beta blockers, CCB, nitrates are all considered what type of drug?
Anti-ischemic
o Event – closing of tricuspid and mitral valve
o Corresponding event – onset of ventricular systole
o Location to auscultate – tricuspid ( 4th and 5th intercostal space, L sternal border) mitral (L 5th intercostal space midclavicular line)
o Best heard with – diaphragm
S1
o Event – closing of the aortic and pulmonic valves
o Corresponding event – start of ventricular diastole
o Location to auscultate – aortic (2nd intercostal space at R sternal border) pulmonic (2nd intercostal space at L sternal border)
o Best heard with – diaphragm
S2
Event – possible CHF indicative of ventricular dysfunction
o Corresponding event – early diastole
o Location to auscultate – apex of the heart (pt L sidelying 45 deg forward)
o Best heard with – bell
Abnormal
Ventricular gallop
S3
Abnormal
atrial gallop
o Event – increase resistance to ventricular filling
o Corresponding event – late diastole (just before S1)
o Location to auscultate – apex of the heart
o Best heard with – bell
S4
Best heard at erb’s point – 3rd L intercostal space
murmurs
