Lecture 3- abnormal physiology Flashcards by Caitlyn Griffin

what vital signs are concerning for a CV pt

HR: <50 or >120, uncontrolled arrhythmia
BP: >180/90 or <90/60, MAP <60
SpO2: <90% at rest

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what could cause bradycardia

heart block
drug reactions
metabolic dysfunction
post sx
myocarditis
abnormal breathing

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what could cause tachycardia

meds
anemia
hypotension
infection
anxiety
alcohol use
pain
substance abuse

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what is the physiology for HR

ischemia to SA node
decrease in myocardial contractibility

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what are red flags for HR

decrease HR with increase workload
irregular rhythm at rest
worsening rhythm at rest

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what is chronotropic incompetence

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what causes hypotension

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

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what causes hypertension

lifestyle factors
high BMI
smoking
co-morbidities
pain
anxiety
substance abuse

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what is the physiology for abnormal BP

ischemic ventricle rapidly reaches max SV
or
abnormal rapid increase in CO, increases SVR

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what are red flags for SBP

rise: >20-30 mmHG
flat: SBP doesn’t rise with increase workload
fall: SBP drops with increase workload, associated symptoms

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what are red flags for DBP and MAP

> 10 mmHG drop with increase workload

<60 for end organ hypoperfusion

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what is the most common diagnosis for a drop in MAP

spinal cord shock

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what could cause a patient to be hypoxemia

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

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what is an arrhythmia

disturbance in cardiac rhythm
abnormal in site of origin of impulse, rate, regularity, or conduction

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what is tachyarrhythmia

> 100 BPM

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what is bradyarrhythmia

<60 BPM

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what can cause arrhythmias

ectopic foci suppressed by SA node
meds
infection
electrolytes
age
co-morbidities
substance abuse

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what is in the 5 step ECG analysis

rate
rhythm (R wave)
regular/consistent QRS
P wave?
T wave?

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what is an atrial flutter

regular atrial quivering
atrial contracting out of sync with ventricles

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what is a-fib

irregular atrial quivering, lower amplitude
elimination of atrial kick= decrease CO
absent P wave

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what is unifocal pre-ventricular contraction (PVC)

premature ventricular depolarization
ventricle fires from ectopic foci through purkinje fibers

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what are 2 simultaneous PVC

couplet
no adequate CO

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what is multifocal PVC

higher cardiac irritability
severe electrical conductivity

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what arrhythmia is a contraindication for activity

multifocal PVC

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what is bigeminy

PVC every other beat 50% of L ventricular activity is not providing good CO

what is trigeminy

PVC every 3rd normal beat

what is a-fib with RVR

abnormal ventricular response to irregular atrial contractions HR >120 more concerning than a-fib

what is the tx for a-fib RVR

electric shock or cardioversion

what is supraventricular tachycardia

HR >150 set by SA node and not slowed by AV node absent T wave

why is an absent T wave in SVT so crucial

no ventricular relax so no fill decrease CO

how can we treat SVT

valsalva maneuver

what is ventricular tachycardia

wide QRS with tachy absent P waves no atrial contraction

what is torsades de pointes

specific v tach with rotation around an axis of electrical activity

what causes torsades

hypomagnesium

what is v fib

ventricles quiver inconsistently no true contraction rapid loss of CO

what is the only rhythm an AED can shock

v fib

what is an AV heart block

abnormality in electrical conduction between atria and ventricles PR interval

what is a first degree heart block

impulse conducted between atrial and ventricles is delayed consistent PR intervals >.20 secs

what arrhythmia is a very common cause of bradycardia

first degree AV heart block

what is type I 2nd degree heart block

PR interval gets progressively longer, then QRS drops atrial is predictably blocked

what is type II 2nd degree heart block

PR interval is consistent, then QRS drop atrial impulse to ventricle is unpredictable

what is a 3rd degree heart block

atrial impulse blocked at AV node SA and AV node are disconnected P and R intervals are not consistent with each other

what arrhythmia is an absolute contraindication to exercise

3rd degree heart block

what biomarker is correlated to cardiac ischemia

toponins

when is exertion recommended when looking at troponins

down trend and stable

what biomarker is correlated to myocardial tissue damage from over-stretch

BNP

what BNP level indicates HF

>400

what are symptoms of higher BNP

fluid overload dyspnea severe exercise tolerance

what lab value is indicative of multisystem infection

WBC

if patient has low values of platelets, they are at risk for

bleeding

if patient has high values of platelets, they are at risk for

clot formation

platelet count is <50, what is therapeutic recommendation

no resistive exercise

platelet count is <20, what is therapeutic recommendation

consult provider

what is the risk for high PT

increase bleed/bruise >20 bleed into tissues

if value is >70 for PTT what is the risk

spontaneous bleeding inherited bleeding disorders

if value is >5.5 for INR, what is the risk

spontaneous bleeding high= bleed low= clot

What is this arrhythmia

tachycardia

What is this arrhythmia

a flutter

What is this arrhythmia

a fib

What is this arrhythmia

unifocal PVC

What is this arrhythmia

multifocal PVC

What is this arrhythmia

bigeminy

What is this arrhythmia

trigeminy

What is this arrhythmia

a fib RVR

What is this arrhythmia

SVT

What is this arrhythmia

torsades de pointes