Last Couple Day Studying Flashcards
What is the biggest problem with valve stenosis
Decreased cardiac output, decrease blood pressure will be evident
Note: regurgitation of valve causes decreased cardiac output over time but not immediately
The more stretched the atria and ventricles are, the more _____ levels in the blood
BNP
What are the classic symptoms of pericarditis?
Chest pain with lying down that is relieved by sitting up and leaning forward
Severe pericarditis that limits cardiac output is called
Cardiac tamponade
Endocarditis can cause ____ problems
Valve
Dental procedures can cause….
Endocarditis
Pulmonary embolus comes from the ____ and gets stuck in the
Veins
Pulmonary artery
What side of the heart typically fails if you have a pulmonary embolus
Right sided heart failure \ R Side heart hypertrophy
when pulmonary embolus causes R side ventricular heart failure this can be called
Cor pulmonale
You’ll see swelling, jugular vein distention, and weight gain
What is a D-dimer test
Test for DVT by looking for certain proteins
T or F Pulmonary pressure can normally be 20+ during exercise
T
When oxygen levels of the lung decrease you see reflexive ______
Vasoconstriction to shunt blood to areas with better ventilation/perfusion ratio
Dehydration increases what electrolyte that can cause arrhythmias
Increases sodium
Aldosterone causes retention and excretion of what
Retain sodium
Excrete potassium
Patient’s with thoracotomy have a risk of developing ____ in the lung
Pneumonia
-bc difficulty clearing phlegm
Why does a patient hold a pillow on their incision when they cough?
To provide counterpressure bc of the increased intra-abdominal pressure
With any percutaneous procedure you are concerned about ______ for the first couple days
Bleeding
If a patient you’re already seeing is now going for a valve replacement procedure and will be back to your outpatient PT soon, what will you do when they get back?
Listen to heart sounds before and after activity
When someone’s light headed/dizzy how can you increase venous return to resolve this?
Have them lay down with legs up
If the vascular of the extremities is constricted in order to increase BP during heart failure, what will the patient’s extremities feel like?
Cold
Ejection fraction less than _____ indicates heart failure
40
-sartan suffix
Angiotensin receptor blocker
-ril suffix
Ace Inhibitor
What are the effects of angiotension 2
Constricts Arterioles
Causes release of ADH (helps to retain water)
INCREASE BLOOD PRESSURE
ACE Inhibitors and angiotensin receptors can affect _________ and cause (hypo/hyper)_____________ which can cause arrythmias
electrolytes (potassium)
hyperkalemia
Patient’s on ACE inhibs and ARBs might have (low or high BP) with an (increased/decreased) HR
Low BP
Increased HR
might experience orthostasis when standing up
What kind of inotropic medication will be taken in an outpatient setting?
Dijoxin/digitalis
Dijoxin makes you feel….
SICK
Why is Dijoxin used for Atrial fibrillation
Increases PR interval
T or F, a patient with dijoxin needs their heartrate taken for a whole minute
T
Angioplasty risks?
Arrythmias
No vigorous exercise 5-7 d/t bleeding
How to stop a stent from becoming reoccluded?
drug eluting stent
What do you do to help with the healing of an angioplasty
10lb sandbag placed over femoral artery puncture site for 6 hours
Arthrectomy vs Angioplasty
Arthectomy uses a drill and is typically used for coronary artery stenosis because the blockage is bigger
Typical CABG precautions?
Sternal
CABG complications?
Arrythmias
MI
Cardiac stunning
Bleeding
Renal Failure
CVA
Infection
MOST COMMON: Pleural effusion due to decreased cardiac output
Should you mobilize a patient after a CABG?
Yes it is very important to prevent serious complications
How to prevent infection for a CABG patient
make sure bandages are clean and dry and check for drainage
IABP risks?
Could potentially damage kidneys
Stroke
Infection
Ischemia
Metal valve replacement complications?
Increase risk of stroke
patient needs blood thinners for rest of life
Why would a patient be fatigued after a valve replacement?
They were temporarily put on a heart/lung machine
Patients will typically need _____ after a cardiac ablation procedure
4-7 days of rest
Bipolar pacemakers are typically used for…
Ventricular arrythmias
Pacemaker/ICD precautions
No lifting arm overhead past 90 degrees for 4 weeks, no shoulder ext or HABD (for ICD or pacemaker)
No lifting 10+ pounds
PT needs to be aware of what rate sets it off and work 10-20 beats below that (for ICD only)
Need to know what kind of pacemaker/ICD it is
Carotid endarterectomy is indicated for…
symptomatic patients w/ 50% blockage
or
asymptomatic patients w/ 60% blockage
-This procedure is done due to stroke risk.
Carotid Endarectomy precautions
No aggressive side bending or turning of head
Abdominal Aortic Anuerysm repair precautions
NO trunk extension, no twisting
Dont encourage flexion either
patient needs to heal in an upright position
-no coughing or huffing early on
-encourage bronchial hygene techniques
-teach patient to logroll
Bronchoscopy risks
Pain limits breathing -> risk of collapsed lung -> teach patient breathing exercises
What are the 3 kinds of lung resection
Wedge- piece of lung
Lobectomy- whole lobe
Pneumonectomy - whole 1 lung
Thoracotomy precautions
-no coughing/huffing early on
-pt needs to be taught breathing exercises, risk of collapsed lung
-shoulder pain is common
-no stretching surgical scar areas
-dont activate the muscles involved in the surgical area too aggressively
From what leads is T wave inversion normal?
Lead 3, Lead V1, and Lead AVR
(note: children may have inversion in V1, V2, and V3)
P wave inversion on a lead that is not lead 3, AVR, or V1 V2 could potentially mean:
Heart block with a junctional rhythm
A ventricular triplet is also called…..
Nonsustained ventricular tachycardia
What leads look at the anterior wall of the heart?
V3 V4
What leads look at the lateral wall of the heart?
V5 V6
What kind of medication is lasix?
Loop diuretic (most potent)
Why would a patient present w/ high heartrate after taking a nitrate?
Reflexive tachycardia
What is orthostatic hypotension
drop of SBP 20
DBP drops 10
HR increases 30bpm
What is the difference between ACE and ARBs
ACE works on the enzymes whereas ARBs works on the receptors
What is Entresto/Neprolysin Inhibitor
Special kind of ARB
Reduces abnormal remodeling of vasculature
promotes diuresis/ vasodialation/ NA excretion and K retention (opposite of aldosterone)
What medicine causes angioedema?
ARBs / ACE inhib
What are the effects of aldosterone antagonists
Mild diuretic
Decreases renal fluid and NA retention (excretes NA)
Side effects: Possible hyperkalemia since aldosterone normally excretes potassium
What are the 3 classes of positive inotropes?
Cardiac Glyocosides (seen in outpatient)
Sympathomimetics ( Acute care)
Phosphodiasterase inhibitors (Acute care)
Dopamine/Inotropin is considered a…..
Sympathomimetic
Which of the following is NOT a vasodilator:
Ca+ Blocker
ACE inhibitor
Beta Blockers
Nitrates
Beta Blockers
What is a potential side effect of vasodilators
reflexive tachycardia
What is Nipride?
Arterial and Venous Dilator
Rapid Onside
-effective in treatment of Severe HF
What medication is often taken to control the side effects of vasodilators?
Beta blockers (to prevent sympathetic compensation)
Which of the following is not an antihypertensive:
B blocker
Aldosterone Antagonist
Cardiac Glycoside
Ca+ Blocker
ARB/ACE inhib
Vasodilator
DIuretics
Cardiac Glycoside
What is Xylocaine and how does it work?
Class 1 Antiarythmic medication, reduces influx of Na+ into cell
Beta blockers are class ____ antiarythmcis and calcium channel blockers are class ______
Beta Blockers: 2
Calcium channel blockers: 4
How to betablockers help arrhythmias
Block sympathetic excitation
Why does hyperkalemia cause arrythmias?
Because it lowers the threshold required for excitation of the myocardium
(more potassium= easier to excite and cause an AP)
How does digitalis/digoxin help arrhythmias
Slows HR by extending PR interval (depresses AV node conduction)
What is adenosine?
Drug given by IV for supraventricular tachycardias
slows conduction pathway through AV node
What is Atropine
Medicine for bradydysrhythmias
blocks cholinergic receptors on cardiac muscle
Why is MMT not reliable in the ICU
-Sedation
-Limited Ability to communicate
what is considered high PEEP?
15+
what is considered high pressure support
20+
What is considered high FiO2?
60+
What is considered high Rate Pressure Product at rest?
10,000
What is considered low MAP?
below 60
What is normal Cardiac ejection fraction and what’s considered heart failure?
Normal: 55-70
failure: below 40
Which ventilator is not for weaning?
Assist-Control
On a ventilator, excessive PEEP may ________ cardiac output
reduce
If a patient has paradoxical breathing, what does this mean?
Accessory muscles being used
diaphram is tired
what device delivers the fastest flow of oxygen?
High Flow Humidification system
What is it?
Reservoir nasal cannula
What is the purpose of this mask?
Turns medication into mist for inhalation
Bundle branch blocks are a sign of…
Worsening condition (not necessarily a fatal problem on their own)
What is worse: Ventricular bigemini or trigemini
bigemini
How do calcium channel blockers help arrythmias
Blocks Ca+ channels into cells that normally cause excitation
