Midterm Exam Flashcards
Describe pulmonary function
Transportation and distribution of essential nutrients
Removal of byproducts from cellular metabolism
What is the significance of the angle of louis
In palpation corresponds to second costal cartilage
Posteriorly corresponds to T4, T5 vertebrae
Describe normal fluid levels in the pericardial space and what is the name of the condition when this is elevated
10-20 ml
Pericardial effusion
During what phase does the heart receive blood
Diastole
What is the conduction system of the heart and their pace values
SA node - 60-100
AV node - 40-60
Bundle of his
Purkinje
What are the extrinsic and intrinsic regulatory factors on the heart
In - Sa and AV node
Ext - neural
- Symp - increase HR, vasodilates coronary arteries
- Para - slows HR, vasoconstricts coronary arteries
Describe the chronotropic effects on the heart
+ HR increases
- HR decreases
Describe the Inotropic effects on the heart
+ is increased contractility
- is decreased contractility
What is the equation for CO
CO = SV x HR
What is normal ejection fraction
60-70%
Describe rate pressure product
Index of myocardial O2 consumption
Reflects cardiac fitness
Describe the equation for RPP and interpretation of results
RPP = (HR x systolic BP) / 1000 0-12 = normal 12-17= risk 17-21= danger above 21 = very dangerous
Differentiate between coronary artery disease and coronary heart disease
Artery - problems with blood vessels and flow to the heart but no damage to heart muscles
Heart - damage to the heart muscles
What can coronary artery disease progress to
Coronary artery disease
Describe how the coronary arteries protect against occlusion
will vasodilate to help perfusion
If unsuccessful, will cause heart attack
What damages endothelium
LDLs
Smoking
HTN
What is the difference between atherosclerosis, arteriosclerosis and arteriolosclerosis
Athero - platelet aggregation
Arterio - hardening arteries
Arteriolo - hardening of arterioles seen in HTN and DM
Differentiate between STEMI and NON-stemi
STEMI - transmural infarction
Non-STEMI - nontransmural or subendocardial region infarction
What are the risk factors for something
Elevated homocysteine
Hematological factors
Inflammatory markers - elevated C reactive protein
What can HTN lead to in the heart
LV hypertrophy
Atherosclerosis
Systemic damage
What is stenosis and regurg
Stenosis - murmur when valve is open
Regurg - murmur when valve is closed
What cardiac diseases lead to HF
CAD
HTN
MI
Cardiomyopathies
Describe Cardiomyopathy
sudden death
1/4 of al sudden deaths are attributed to cardiomyopathies
1 in every 500 cases
How can renal insufficiency affect the heart
Overload the heart with fluid
Describe the medical professional’s goals when it comes to preventing HF
Prevent or delay with meds, diet, lifestyle changes and exercises
How does the PT help prevent HF
Educate the patient about exercise and report abnormal symptoms
What is mPAP
mean arterial pressure
measure of pulmonary hypertension
> 25 mmhg is abnormal
> 20 is abnormal in patients with COPD
Describe some symptoms of left sided heartfailure
Dry cough
Fatigue
Pulmonary rales
Describe some symptoms of right sided heart failure
Dependent edema
Jugular distension
Increased right atrial pressure
Peripheral effects
What is the affect of CHF on the muscles
decreased diameter of type 1 and 2 muscle fibers
Isometric strength is decreased (50%)
How do patients with CHF present when exercising
HR increases rapidly with submax load
Blunted systolic BP
Decreased O2 sat
Elevated CO2 in blood
What are some signs of HF
Sudden weight gain
pulmonary edema
worsening dyspnea
Describe BNP
Brain natriuretic peptide strong predictor of poor prognosis for heart failure less than 100 is normal 100 - 400 are of concern above 400 indicate HF
Describe the stages of pulmonary edema
stage 1 - increased lymph flow, fluid in gravity dependent positions
stage 2 - tachypnea, elevated PCWP
stage 3 - flooding of alveoli, hypercapnia, hypoxemia
How do you dose a patient with CHF
5- 10 mins walking per day, progress to 30 mins
goal is 5-7 times per week
3-5 RPE / 10
65-85% of 1rm
Diaphragmatic breathing and pursed lip breathing 2 times per day
Describe the 6 minute walk test
Poor prognosis if unable to ambulate 468 m or 1535 feet
If they cannot walk 300m it predicts mortality
Greater than 750 feet means shorter hospital stays
What is the “pace” of the SA, AV and Pukinje fibers
SA - 60-100
AV - 40-100
Pukinje 20-40
What are the methods to determine heart rate
1500/ # of small boxes
300, 150, 100, 75, 60, 50
Describe depolarization as it relates to the ion channels
Opening of sodium and calcium channels
Describe repolarization as it relates to the ion channels
Opening of potassium channels and closing of sodium channels
What is a plateau
When calcium channels are still open, after calcium channels close more potassium opens
What is the duration of the P wave, QRS and PR interval
P - 2 small boxes
QRS - 2 small boxes
PR - 5 small boxes
What is a long PR interval and what does it mean
Greater than .2 sec\
Means there is a block
What does it mean when a QRS is greater than .1 seconds
Impulse if from the ventricles or abnormal ventricular conduction system
What does a deeply inverted q wave mean
MI and is getting worse
will remain that way for months
ST will return to normal
What does it mean when the ST segment elevates or depresses
Elevation - STEMI - MI, hypothermia
Depression - NON-STEMI / ischemia
What happens on the EKG in a STEMI and what is the pain like
ST elevation Q is 1/3 the size of the QRS T wave inversion will not be evident initially Severe pain More serious
What does T wave inversion indicate
Ischemia
Injury
Pulmonary embolism
Describe what is NON-STEMI is
Subendocardial block
Not full thickness
less severe chest pain when compared to a STEMI
Can lead to fatal arrhythmias
How do you identify a NON-STEMI
ST depression greater than 1mm
T wave inversion will be variable
What on an EKG suggests ischemia
ST depression with biphasic negative-positive T wave
What indicates a pulmonary embolism
Troponin
Deep t wave inversion on leads 1-4
What can digitalis cause on an EKG
large QRS complex
What is the difference between atrial flutter and atrial fibrillation
Flutter - saw toothed
Fibrillation - coarse waves
Is it safe to exercise a patiet durring A FIB
Yes
Is it safe to exercise a patient durring V fib
No
This is an emergency
Ready the AED if necessary
What is considered V TAK
3 or more PVS’s in a row
Describe a first degree AV block
Elongated PR interval
Describe second degree AV blocks
type 1 - Wenckebach - Progressive lengthening of PR then QRS drop
type 2 - Mobitz - 2-4 P waves before a QRS
Describe a 3rd degree AV block
No relationship between P and QRS, they are firing independently of one another
Describe PET
Gold standard for blood flow
Visualization and direct measurements of metabolic function
When do you use a PET
when the patient is not exercising
How early can you administer a PET
2-10 days after MI
What are some disadvantages of a PT
Very expensive
Compare MRI to PET
MRI is similar to PET but less expensive
Who are not good candidates for MRI
Stent Pacemaker Artificial joint sx clips Heart valve Any metallic device
Describe cardiac catheterization
Invasive
Patient awake but under anesthesia
Brachial or femoral area
Measures chamber pressures
How long is bed rest after cardiac catheterization and why
4-6 hours
To avoid bleeding
Pseudoaneurysm
How are the sides of the hart accessed during cardiac catheterization
Right - veins
Left arteries
Describe a CABG
Vessels used to bypass area causing infarct
Describe traditional CABG
Median sternotomy
use of heart lung machine
heart stopped poorer outcomes
Describe MIDCAB
Minimally invasive Lower risk Less traumatic Shorter recovery time Not for high risk patients Only for single artery involvement
Describe Echocardiogram
Uses ultrasound to evaluate the functioning of the heart
Real time images of the heart beating
Describe Holter monitoring
continuous 24 hour EKG monitoring
Used for diagnosis and management of arrhythmias
Describe angiogram
Dye injected to show blood vessels
Describe percutaneous coronary intervention
Improves blood flow to the heart for revascularization
Restored blood Flow in patients with MI
Describe an electrophysiological study
Checks conduction system of the heart
Used after sudden death with revival
8 hour procedure with patient heavily sedated
Describe a ventricular assist device
Mechanical pump that helps failing ventricle, provides bridge until donor can be identified
Exercise can improve pre-op condition
Left more common than right
requires sternotomy
Describe the indications for a heart transplant
Progressive terminal CP disease
Inpatients with heart transplant how do you monitor exercise response
BP and RPE
Not HR
What is the purpose of a central line and where can they be placed
Measures arterial pressure, draws blood
Femoral, brachial, radial
Describe the uses of a central venous line
Blood samples
Medications
Rehydration
What is the purpose of a SWAN-GANZ catheter
Measure R atrium, R ventricle, pulmonary artery and L atrium filling pressure
What are the norm values for a SWAN-GANZ catheter
R atria - 0-5
R ventricle 5-12
PA - 20-30 / 5-12
Capillary wedge - 5-18
What should you do when moving a patent with a line or SWAN-GANZ line
Manually measure blood pressure
Describe a PICC line
Used for long term therapies
What are some advantages of a PICC line
easy to insert
Low risk of bleeding
can be left in for a long time
Describe an intra-aortic balloon pump
Pulls blood out of left ventricle
Describe an IAPB
balloon in the thoracic aorta, inflates and deflates with the heart
What are the used of IV lines
Rehydration
Meds
blood transfusions
At what Pulse ox measurement should you avoid exercise
if below 92%
What enzymes corelate to MI
CPK
LDH
Troponin - gold standard for MI
at what troponin level is a heart attack probable
above .4 ng/ml
Describe the homocysteine levels and their meaning
less than 10 is desirable < 6.3 = < 1 x cardiac risk < 6.6 = 1x risk 10 = 2x risk 15 = 4x risk 20 = 9x risk
What are the classic cardiac symptoms
Chest pain Chest tightness Palpitations indigestion Burning
What are the classic pulmonary symptoms
Dyspnea Wheezing Cough Increased RR sputum
What are some risk factors of heart disease
HTN Smoking High cholesterol family history Stress Sedentary lifestyle Older age Obesity Diabetes
What are some protocols for exercise testing
Bruce - most common
Bruce low level
Balke - most common with athletes
What are the absolute criteria for exercise testing termination
Drop is SBP > 10 Moderately severe angina Signs of poor perfusion Sustained V tach Request of patient
What are the relative criteria for exercise testing termination
ST or QRS changes Arrhythmias Fatigue, SOB, claudication Increasing chest pain Hypertensive response - 250/115
Describe FAI
Functional aerobic impairment
% difference of VO2 max in similarly aged healthy person
What are the numerical interpretation for FAI
Mild - 27-40%
Moderate - 41-54%
Marked - 55-68%
Extreme - >68%
What are the contraindications for exercise testing
Recent MI Acute pericarditis or myocarditis Resting or unstable angina Aortic stenosis Serious ventricular or rapid atrial arrhythmias
Describe finger nail clubbing
fingers look like drumsticks
8% of clubbing is due to cardiopulmonary issues
Describe the angina scale
1 - light, barely noticeable
2 - moderate, bothersome
3 - severe, very uncomfortable
4 - most severe pain ever experienced
What is the dyspnea scale
0 - no trouble breathing
1 - SOB with hurrying or walking up gradual hill
2 - walks slower than people of same age, has to stop for breath
3- stops for breath after 100 meters, or after a few minutes
4 - cannot leave house, SOB with dressing
Describe the dyspnea level test
Count to 15 in 8 seconds 0 - single breath 1 - two breaths 2 - 3 breaths 3 - 4 breaths 4 - unable to count
Describe the function of organic nitrates
Dilate coronary blood vessels and reduces blood pressure
Describe the function of calcium channel blockers
reduces electrical conduction, force of contraction, dilates blood vessels, reduced BP
(…pine)
Describe Cardiac glycosides
Increase contraction but not HR
…in
Describe beta blockers
reduce HR, contractility and BP, vasodilator
…olol
Describe an ACE inhibitor
Vasodilator, decreases BP
…pril
What is optimal cholesterol
less than 200
What is optimal LDL, what is considered High
less than 130-160
High is more than 160
What is considered good HDL
the more the better
Describe Cardiac rehab phase 1
Monitoring phase
What is the goal of cardiac rehab phase 1
Maintain and stabilize cardiovascular function
What is the criteria to exit cardiac rehab phase 1
ADLS performed 5 METS
Describe cardiac rehab phase 2
up to 12 weeks
supervised exercise
may live at home
What is exercise prescription like during cardiac rehab phase 2
20-60 mins
2-3 times per week
40-60% max HR
What can yo begin during cardiac rehab phase 2 other than cardio exercise
light resistance exercise
What is the exit criteria for cardiac rehab phase 2
9 METS
Describe cardiac rehab phase 3
Maintenance phase
What intensity of resistance training may begin in cardiac rehab phase 3, how to progress
50% 1 RM
progress UE - 2-5 lbs, LE 5-10
What does cardio exercise intensity look like in cardiac rehab phase 3
70-85% max HR
11-14 RPE
What does cardiac monitoring look like at cardiac rehab phase 3
intermittent or no monitoring
What can resume after cardiac rehab phase 3
Patient may return to work
What is the formula for Max HR
220 - age
what is the formula for HRR
subtract resting HR from Max HR
What is the formula for target heart rate (karvonen)
((Max HR - RHR) x target) + RHR
Describe the intensity frequency relationship for cardio exercise
low to mod intensity - 5-7 days per week
Higher intensity - 3-5 days per week
