Midterm Flashcards
Risk factors for PAD:
ncreasing age, sex (Males>Females), DM, smoking, HTN, hyperlipidemia, hypertriglyceridemia, and hyperhomocystinemia
ABI > 1.10
normal
ABI 0.5-1.0
claudication
pain in calf with ambulation
ABI 0.2-0.5
critical limb ischemia
atrophic changes
rest pain
wounds
ABI < 0.2
severe ischemia
gangrene
severe necrosis
Absolute stop test indicators for exercise stress test
Drop in SBP>10mmHg from baseline w/ ischemia moderate to severe angina ataxia, dizziness, presyncope cyanosis or pallor sustained VT ST segment elevation subject requests to stop
Relative stop test indicators for exercise stress test
Drop in SBP >10mmHg in absence of ischemia
fatigue, SOB, wheezing, leg cramps or claudication
increasing chest pain
hypertensive response (SBP>250, DBP>115)
ST or QRS changes such as ST segment depression
Arrhythmias
Development of bundle brance block
Expected ECG Changes in the Normal Heart
▪ RR interval decreases
▪ P-wave amplitude and morphology undergo minor changes
▪ Septal Q-wave amplitude increases
▪ R-wave height increases from rest to submaximal exercise and then reduces to a minimum at maximal exercise
▪ The QRS complex experiences minimal shortening
▪ J-point depression occurs
▪ Tall, peaked T waves occur (high interindividual variability)
▪ ST segment becomes upsloping
▪ QT interval experiences a rate-related shortening
▪ Superimposition of P waves and T waves on successive beats may be observed
Hypoglycemia S/S:
o Tremor/shakiness/anxiety o Tachycardia o Increased sweating o Hunger o Irritability o Weakness o Dizziness o Numbness or tingling of mouth and face o Nausea/vomiting o Headache o Lethargy o Drowsy
Hyperglycemia S/S
o ncreased/frequent urination o Dry mouth/increased thirst o Weakness or fatigue o Hunger o Flu-like achiness o HA o Facial flushing o Nausea or vomiting o Fruity breath
Ketoacidosis S/S
▪ Facial flushing ▪ Dry skin ▪ N/V ▪ Abdominal pain ▪ Deep, rapid breathing ▪ Fruity smelling breath ▪ Coma Death
R ventricular failure S/S
- Dependent edema
- JVD
- Weight gain
- Liver engorgement, abdominal pain
- Ascites
- Anorexia, nausea, bloating
- Cyanosis
- Right sided S3
L ventricular failure S/S
♣ pulmonary congestion • Dyspnea, dry cough • Orthopnea • Paroxysmal nocturnal dyspnea • Pulmonary rales, wheezing • s/s of acute pulmonary edema (dyspnea, pallor or cyanosis, diaphoresis, tachycardia, anxiety, agitation) ♣ low cardiac output • Hypotension • Tachycardia • Lightheadedness, dizziness • Fatigue, weakness • s/s of peripheral hypoperfusion (weak, thready pulse, vasoconstriction) • poor exercise tolerance • S3 and sometimes S4 (3rd heart sound or ventricular gallop, 4th heart sound or atrial gallop)
Stage A CHF:
at high risk for HF but w/out structural heart disease or symptoms of HF
Therapy goals and drugs for stage A:
treat HTN smoking cessation regular exercise treat lipid disorder ACE or ARB
Stage B CHF:
structural heart disease but without signs or symptoms of HF
Therapy goals and drugs for stage B:
therapy same as stage A
ACE or ARB
beta-blockers in some
Stage C CHF
structural heart disease with prior or current symptoms of HF
SOB, reduced exercise tolerance
Therapy goals and drugs for stage C:
all measures under A and B
sodium restrictions
ACE, beta-blockers, diuretics
selected: digoxin, nitrates, ARB, aldosterone
Stage D CHF:
refractory HF requiring specialized interventions
Therapy goals and drugs for stage
symptoms at rest
appropriate measures for A,B,C,D
end of life care
What levels of resting BP require referral to MD?
SBP> 200 or DBP> 100
Medical clearance for PT if bp is:
SBP >180 & DBP > 110)
Exercise testing should be terminated if BP:
SBP >250 or DBP >115
Orthostatic hypotension
SBP drop of >20 or DBP drop >10
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
S3
abnormal ventricular gallop
loss of ventricular compliance
early diastole
S4
increased resistance to ventricular filling
heard in hypertensive cardiac disease, CAD
just before S1
Exercise recommendations for PAD
short intervals (1-5 mins), alternating with rest increase intervals and decrease rest longer warm up time for colder climates sensory exam before exercise footwear and hygiene emphasized
Hypertrophic cardiomyopathy:
diastole dysfunction
risk of sudden death in athletes
thickened left ventricular wall
Dilated cardiomyopathy
enlargement of all chambers
systolic dysfunction
most common
Restrictive cardiomyopathy:
rigid ventricular walls
diastolic dysfunction
least common
Stage I of Pulmonary edema in CHF
redistribution
PCWP 13-18
cardiomegaly
Stage 2 of Pulmonary edema in CHF
interstitial edema PCWP 18025 kerley lines peribronchial cuffing hazy contour of vessels
Stage 3 of Pulmonary edema in CHF
alveolar edema
PCWP>25
consolidation
pleural effusion
Left anterior descending artery
anterior ventricular septum
anterior left ventricle
the apex
Left circumflex
left atrium
left ventricular lateral wall
left ventricular posterior wall
Sinus node
right atrium
Right marginal artery
right ventricle
Posterior descending artery
posterior ventricular septum inferior wall of left ventricle
