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Year 3: CardioPulm Rehab > Lecture 3: Abnormal Physiology > Flashcards

Lecture 3: Abnormal Physiology Flashcards

1
Q

HR values that would be concerning for CVP pt

A

<50 or >120 at rest

uncontrolled/new arrhythmia

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2
Q

BP values that would be concerning for CVP pt

A

> 180/90

<90/60

MAP <60

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3
Q

SPO2 values that would be concerning for CVP pt

A

<90% at rest

acute change in O2 demand/device

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4
Q

what could cause bradycardia in a pt

A

heart block
adverse drug reaction
metabolic dysfunction
post sx
meds
myocarditis
lab abnormalities
abnormal breathing patterns

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5
Q

what could cause tachycardia in a pt

A

meds
anemia
hypotension
infection
anxiety/fear
ETOH use
pain
substance abuse

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6
Q

overall mechanism of abnormal HR

A

ischemia to SA node

decrease in myocardial contractility

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7
Q

Things to watch out for with HR changes that are NOT normal

A

HR drops with increase work

severely exaggerated rise in HR with increased work

minimal rise with increased work

irregular rhythm that is not present at rest

worsening rhythm that is present at rest

CONTEXT IS IMPORTANT

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8
Q

What is chronotropic incompetence

A

small % of pts with CAD

to have this pt cannot be on any meds that limit HR (chronotropic meds)

max symptom = limiting HR with exertion that is well below age predicted max

defense mechanism to maintain coronary aa blood flow in presence of CAD

signifies advanced CAD with poor prognosis, high morbidity and mortality

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9
Q

what could cause a pt to be hypotensive

A

meds
acute blood loss
diastolic dysfunction
bradycardia
shock
position change
dehydration
arrhythmias

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10
Q

what could cause a pt to be hypertensive

A

lifestyle
high BMI
smoking
comorbidities
pain
anxiety
substance abuse

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11
Q

2 overall mechanisms for abnormal BP

A

ischemic/damaged ventricle will rapidly reach max stroke volume (lower than it should be for correlated increase in work)

OR

abnormal/rapid rise in HR and stroke volume = higher cardiac output (higher than expected for work load); altered CO will alter SVR which leads to abnormal BP response

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12
Q

different abnormal responses for SBP

A

rising response >20-30 mmHg

flat response = SBP doesn’t rise linearly with work (context important)

falling response = SBP drop with increased work (context important); associated S&S make response more concerning

if pt is not on any anti HTN meds and has a SBP drop + SBP <140 during max exercise = higher rate of sudden cardiac death

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13
Q

falling response with SBP can be associated with…

A

pronounced ST segment depression
angina
cardiomyopathy
large MI
low EF

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14
Q

abnormal diastolic response to exercise

A

> 10 mmHg rise or drop with increased work

any massive shift in DBP is concerning; will likely accompany abnormal SBP changes

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15
Q

abnormal MAP response to exercise

A

<60 is concerning for end organ perfusion

context is important

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16
Q

what could cause a pt to have hypoxemia

A

blood loss
hypoventilation
heart or lung disease
infection/sepsis
anemia
PE
sleep apnea

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17
Q

what response to exercise may indicate autonomic dysfunction

A

exaggerated HR/BP responses that do not correspond to workload

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18
Q

ineffective redistribution of blood flow to working mm could be caused by

A

sympathetic nervous system dysfunction

inability to adequately vasodilator/constrict

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19
Q

what is an arrhythmia

A

disturbance ein cardiac rhythm

abnormality in site of origin impulse, rate, regularity, or conduction

tachyarrhythmia = HR >100bpm

bradyarrhythmia = HR <60

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20
Q

causes of arrhythmias

A

other areas of heart contain ectopic foci (cells with automaticity) that are suppressed by dominant SA node

meds

infection

electrolytes

age

comorbidities

substance abuse

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21
Q

what is atrial flutter

A

regular atrial quivering

atrial contracting out of sync with ventricles

high amplitude P wave

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22
Q

what is atrial fibrillation

A

lower amplitude, irregular atrial quivering

elimination of atrial kick

absent P wave (no P wave = no PR interval)

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23
Q

what is a univocal Pre-Ventricular Contraction (PVC)

A

premature ventricular depolarization

ectopic foci in ventricles fires with an impulse generated in Purkinje fibers instead of SA node

2 simultaneous PVCs = couplet

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24
Q

how many simultaneous PVCs = VTACH

A

6 times

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25
Q

what is a multifocal PVC

A

PVCs that originate in different ectopic foci with different electrical configurations

suggestive of more severe electrical conductivity problems

higher cardiac irritability

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26
Q

what is a bigeminy

A

PVC every other normal beat

more concerning than trigeminy; 50% ventricular contraction is abnormal

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27
Q

what is a trigeminy

A

PVC every 3rd normal beat

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28
Q

what is an AFib with rapid ventricular response (RVR)

A

abnormal ventricular response to irregular atrial contractions (Afib alone the ventricles still work normal and HR is normal)

HR >120 bpm

29
Q

what is supra ventricular tachycardia (SVT)

A

HR > 150 being set by SA node and not slowed by AV node

absent T wave

not getting full ventricular filling with fast HR = not getting full ejection

30
Q

what is ventricular tachycardia (VTach)

A

wide QRS complex tachycardia

absent P waves

31
Q

what is tornadoes de pointes

A

specific type of VTach with rotation around an axis of electrical activity

caused by hypo magnesia

rogue clusters of cells that rotate back and forth for control of electrical activity

32
Q

what is ventricular fibrillation (VFib)

A

ventricles quiver inconsistently, no true contraction

very disorganized electrical activity

rapid loss of CO

only arrhythmia that an AED is successful with

33
Q

what is asystole

A

no heart beat

34
Q

what is atrioventricular heart block

A

abnormality in electrical conduction between atria and ventricles

PR interval = time between atrial and ventricular contractions

35
Q

first degree AV heart block

A

impulse conducted from atria to ventricles is delayed

consistent PR intervals >0.20 seconds

very common cause of resting bradycardia

36
Q

what is type I 2nd degree heart block = Mobitz I = Wenckebach

A

PR interval gets progressively longer then QRS drops

atrial impulse gets predictably blocked

37
Q

what is type II 2nd degree heart block = Mobitz II

A

PR interval is consistent then QRS drops

atrial impulse to ventricle gets unpredictably dropped

still have a skipped beat but not as predictable

38
Q

what is 3rd degree heart block = complete/total HB

A

all atrial indexes are blocked at AV node and none get transmitted to ventricles

SA and AV node are conducting electrical impulses in complete disconnection from one another

P intervals are consistent with each other, R intervals are consistent with each other, but these are not in coordination with one another

absolute contraindication to activity

39
Q

what is Troponin and its importance as well as normal/abnormal values

A

most important biomarker correlated to cardiac ischemia

cTnT <0.1 = normal

cTnI <0.3 = normal

Troponin T is more sensitive than Troponin I

drawn serially until peaked

no exertion until down trending and stable

40
Q

what is BNP (B type Natriuretic Peptide) and normal values

A

important biomarker correlated to myocardial tissue damage from overstretch

BNP <100 = normal

BNP > 400 indicative of heart failure

fluid overloaded, dyspnea, severe exercise intolerance

no direct contraindication, all symptom limited

41
Q

normal Hemoglobin values

A

M = 14-18

F = 12-16

most transfusion parameters is Hgb <7

strong correlation with symptoms needed to make clinical decisions

42
Q

normal hematocrit values

A

M = 42-52%
F = 37-47%

abnormalities indicate other problems/pathologies

symptom limited

43
Q

WBC normal values/indications

A

5000-10000

indicative of multi-system infection/pathology

symptom limited

44
Q

platelet normal values and meaning

A

150-400

low values = pt at higher risk for bleeding

high values = pt at higher risk for clot formation

<50 = no resistance exercise

<20 = consult with provider

45
Q

what is pancytopenia

A

decrease in RBC, WBC, and platelets

46
Q

what is thrombocytopenia

A

decrease in platelets

47
Q

what is throbscytosis

A

increase in platelets

48
Q

what is neutropenia

A

decrease in all WBCs

49
Q

what is anemia

A

decrease in RBCs

50
Q

what is polycythemia

A

increase in RBCs

51
Q

normal sodium levels and function in CP system

A

135-145

“sodium swells” to maintain BP, volume, and pH

52
Q

normal potassium levels and function in CP system

A

3.5-5.0

“P pumps” heart and mm

53
Q

normal magnesium levels and function in CP system

A

1.3-2.1

M mellows the mm

54
Q

normal calcium levels and function in CP system

A

9-10.5

Keeps the “3 Bs” strong (bones, blood, beats)

55
Q

what is normal prothrombin time (PT) and what do high values indicate

A

11-12.5 sec

higher = increased bleeding/bruising

> 20 = high risk for bleeding into tissues

56
Q

what is normal partial thromboplastin time and what do high values indicate

A

21-35 sec

higher = increased bleeding/bruising

> 70 = high risk for spontaneous bleeding

common with inherited bleeding disorders

57
Q

what is normal INR and what do high/low values indicate

A

0.8-1.2

variability in normal range based on pathology

high values = increased bleeding/bruising

low values = increased clotting/VTE

> 5.5 = high risk for spontaneous bleeding

58
Q

normal Creatine Kinase levels and contraindications if any

A

30-170

no direct contraindication; all symptom and medical stability limits

59
Q

normal blood urea nitrogen levels and contraindications if any

A

10-20

no direct contraindication; all symptom and medical stability limits

60
Q

normal creatine levels and contraindications if any

A

0.5-1.2

no direct contraindication; all symptom and medical stability limits

61
Q

absolute contraindications to activity

A

new onset AFib

sustained VTach

complete heart block

increased PVCs (especially multifocal)

increased ventricular arrhythmias

new onset chest pain

uncontrolled arrhythmias causing hemodynamic instability or S&S

unstable angina

temporary pace maker

VTach storming

62
Q

relative contraindications to activity

A

pending pacemaker interrogation

cardiac S&S

drop in HR with activity

drop in BP with activity

arrhythmias with rate control

Thrombocytopenia (platelets <50)

Anemia (Hgb <7)

Abnormal INR

63
Q

pH is sensitive to what compounds that can alter blood gas levels

A

CO2 = controlled by lungs (respiratory); can be altered quick

HCO3 = controlled by kidneys (metabolic); cannot be altered quick

compensation = body is responding to abnormality

64
Q

what happens with respiratory acidosis

A

hypoventilation

increase in CO2, decrease in pH

65
Q

what happens with respiratory alkalosis

A

hyperventilation

decrease in CO2, increase in pH

66
Q

what happens with metabolic acidosis

A

GI, endocrine, and renal dysfunction

decrease in both HCO3 and pH

67
Q

what happens with metabolic alkalosis

A

renal/hepatic dysfunction, hypovolemia

increase in both pH and HCO3

68
Q
A

Year 3: CardioPulm Rehab (21 decks)

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