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CardioPulmonary > Lecture 13: Assessing Cardiac Function II > Flashcards

Lecture 13: Assessing Cardiac Function II Flashcards

1
Q

What are the 7 PT implications of EKG/ECG rhythms?

A 
Asystole/flat-line
V-Fib
V-Tach
A-Fib
Atrial flutter
ST elevation/depression
PVC (premature ventricular contraction)
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2
Q

Where is the the Q wave on an ECG and what’s the normal value? (Please specify the magnitude not the length)

A

Downward dip before R wave

Normally small <1mm, 1 box high or absent

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3
Q

What EKG changes are most predictive of ischemia?

A

ST segment depression

T wave may invert

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4
Q

What’s an ST segment depression?

A

Base line taken from p wave

Horizontal or down-sloping

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5
Q

Can a T wave invert?

A

Yes
Concerning as it may indicated that heart is unable to receive proper oxygen it needs.
May indicated Myocardial Infarction (MI) in process (returns to normal after MI is over)

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6
Q

Myocardial Infarctions (MIs) can be categorized as….

A

STEMI (ST segment elevated MI)

Non-STEMI (non segment elevated MI)

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7
Q

What does “STEMI” (ST segment elevated MI) mean? What does it indicate?

A

An infarct that is effecting an entire wall of the heart
Indicative of:
-Non Q-wave MI
-Q-wave MI

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8
Q

What are some older terms for “STEMI”?

A

Q wave MI

Transmural MI

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9
Q

What are some older terms for “Non-STEMI”?

A

Non Q wave MI
Non Transmural MI
Subendocardial MI

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10
Q

What does “Non-STEMI” (Non ST segment elevated MI) mean? What does it indicate?

A 
No ST elevation
Instead of ST segment may be "flat" or "depressed"
Indicative of:
-Unstable angina
-Non Q-wave MI
-Q-wave MI
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11
Q

What are EKG changes with MIs?

A
  • EKG changes will depend on how much of heart is damaged
  • ST elevations (seen in first few hours, may merge with T-wave)
  • Large Q wave indicated (STEMI) aka Transmural MI
  • Progressive changes in T wave (inverted, then return to normal T wave)
  • Old MI - ST segment may return to baseline at beginning of P waves
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12
Q

What are included with EKG monitoring?

A

Telemetry

Holder monitor

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13
Q

What’s EKG monitoring device for telemetry?

A

Patient is not connected to monitor.
Patient doesn’t need all 10 electrodes - few views from heart.
Electrodes connected to transmitter worn by patient.
Real time monitoring.

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14
Q

What’s EKG monitoring device Holter monitor?

A

Electrodes connected to box on a strap (all 12 electrodes in place).
EKG recording for 24-36 hours.
Patient keeps activity log so that symptoms and activity can be correlated with EKG.

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15
Q

What are cardiac markers used for?

A

To sample the venous blood after suspected MI (every 4 hours).

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16
Q

What are normal values for cardiac markers?

A

CK-MB: 0-3%
LDH1: 14-26%
LDH2: 27-37%
Troponin I and T: <100 ng/mL

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17
Q

What’s Creatine Kinase, myocardial band (CK-MB)?

A

an enzyme that is important in determining if someone has had damage to cardiac cells.

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18
Q

Why do we care about cardiac markers?

A

If the cardiac enzyme (CK-MB and troponin) are:

  • Higher than they were 4 hours before = put the pt. on hold
  • Plateaued = you can see the patient!
  • Lower than they were 4 hours before = then you can of course see the patient!
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19
Q

What’s an Echocardiogram?

A

A non-invasive method that uses US waves to diagnose what’s going on!

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20
Q

Where do you place the Echocardiogram sound heads?

A

On chest wall or Transesophageal (put sound head in the esophagus) which is better because the US is closer to the heart and it will be seen in the chart as TEE (TransEsophageal Echocardiogram).

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21
Q

What can an Echocardiogram evaluate?

A

Ventricular wall motion
Cardiac value function
Ejection fraction can be estimated

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22
Q

What can an Ultrafast CT scan?

A

Detects calcium deposits in coronary arteries (early signs of atherosclerosis) but it is not common.

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23
Q

What is cardiac catheterization?

A

An invasive method done by putting the catheter into the left ventricle via femoral artery.

24
Q

What is the other name for cardiac catheterization?

A

Left ventriculography

25
Q

When can PTs work with patients who just got cardiac catheterization?

A

Until 24 hours after because patients may have a reaction to the contrast dye.

26
Q

What can cardiac catheterization evaluate?

A 
Coronary artery anatomy
Ventricle size
Ventricular pressure
Ventricular wall motion
Cardiac output
Ejection fraction
27
Q

What are some therapeutic uses for cardiac catheterization?

A

Percutaneous transluminal coronary angioplasty (PTCA) and thrombolytic (clot busting) agents.

28
Q

What’s percutaneous transluminal coronary angioplasty (PTCA)?

A

Opens an occluded artery without opening the chest such as a coronary artery.
Frequently includes stent placement where the stent is coated with vasodilating medication and/or thrombolytic (clot busting) agents.

29
Q

What are segmental wall motions?

A

Would see this on a surgical or catheterization report.
Apical area contracts slightly before the rest of the heart because you want to push blood towards the aorta. Not a good area to have damage in! (just saying)

30
Q

What’s an akinetic segmental wall motion?

A

No movement of part of the heart.

31
Q

What’s a hypokinetic segmental wall motion?

A

Less movement of the part of the heart.

32
Q

Differentiate Stent vs. CABG.

A

Medically controlled is preferred before a CABG is done.

CABG is done if patient has unstable angina.

33
Q

What could be considered “unstable angina”?

A

Angina that occurs at rest.
Angina that occurs unpredictably (such as at night - which is not expected).
Angina that is changing in frequency.

34
Q

What can cause unstable angina?

A

Coronary Artery Vasospasm

35
Q

What are PT considerations for an exercise tolerance test (ETT)?

A

Used to determine cardiopulmonary response to exercise.

  • Diagnose cause o dyspnea.
  • Determine when cardiac ischemia and/or arrhythmia develops.
36
Q

What’s another name for an exercise tolerance test (ETT)?

A

Graded exercise test (GXT).

37
Q

What are PT consideration symptoms for “ischemic threshold”?

A

Angina: chest pressure, radiating arm pain.
Anginal equivalent: any symptom that may be caused by cardiac ischemia (unusual SOB or significant decrease in BP during ETT)
Dyspnea
ST segment depression during GXT/ETT

38
Q

What is an “ischemic threshold”?

A

When the HR and BP at the point in the exercise test when the person developed coronary ischemia

39
Q

What is the equation for RPP (rate-pressure product)?

A

RPP = [(HR) x (SBP)] / 1000

40
Q

If HR is 100 and BP is 100/84, what is the RPP?

A

RPP = 10

(100 x 100) / 1000 = 10

41
Q

What kind of information can RPP give us?

A

Information about myocardial VO2 (or MVO2)

42
Q

What is the normative values for RPP?

A

There are NO normative values for RPP! (Trick question!) ha ha ha :)

43
Q

What is the purpose of a Thallium ETT?

A

To determine if any areas of the heart have decreased perfusion during exercise. Radio-opaque substance (injected IV) that is taken up by cardiac cells.
Are these defects reversible (temporary) or irreversible (permanent)?

44
Q

What will the Thallium ETT show?

A

Areas of good blood flow

Areas of bad blood flow (ischemia or infarct)

45
Q

What are “cold spots” at rest indicate?

A

Ischemic area of the heart tissue that is there all the time.

46
Q

What is indicated by “cold spots” at the apex of the heart during exercise and good blood flow (no cold spots at rest)?

A

Exercise induced ischemia (reversible defect).

47
Q

What is indicated by “cold spots” during rest?

A

Infarct (irreversible defect).

48
Q

When will a Persantine or Dobutamine ETT be performed?

A

If a patient cannot perform an exercise test. These medications mimic exercise effects on coronary and systemic vasculature. (increase SV and decrease peripheral vascular resistance).

49
Q

What happens if coronary arteries don’t dilate during a Persantine/Dobutamine ETT?

A

Ischemia may occur.

50
Q

What can the Persantine/Dobutamine ETT be coupled with?

A

Thallium ETT.

51
Q

How much bpm do you want to stay below ischemic threshold?

A

10 bpm

52
Q

Is an ST segment considered normal? When is an ST segment considered clinically significant?

A

ST segment depression is not normal but isn’t

considered clinically significant until >1mm magnitude AND >0.08 sec duration

53
Q

What does a Q wave reflect?

A

Reflects depolarization of interventricular septum.

54
Q

What value of a Q wave is abnormal and what does it indicate?

A

> 1 Abnormal

May indicated cardiac infarction

55
Q

What is the “J” point?

A

Beginning of the ST segment

56
Q

What does an ST segment depression indicate?

A

Ischemia

CardioPulmonary (13 decks)

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