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TRI 4 - CP > Midterm Exam > Flashcards

Midterm Exam Flashcards

1
Q

Describe pulmonary function

A

Transportation and distribution of essential nutrients

Removal of byproducts from cellular metabolism

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2
Q

What is the significance of the angle of louis

A

In palpation corresponds to second costal cartilage

Posteriorly corresponds to T4, T5 vertebrae

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3
Q

Describe normal fluid levels in the pericardial space and what is the name of the condition when this is elevated

A

10-20 ml

Pericardial effusion

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4
Q

During what phase does the heart receive blood

A

Diastole

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5
Q

What is the conduction system of the heart and their pace values

A

SA node - 60-100
AV node - 40-60
Bundle of his
Purkinje

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6
Q

What are the extrinsic and intrinsic regulatory factors on the heart

A

In - Sa and AV node
Ext - neural
- Symp - increase HR, vasodilates coronary arteries
- Para - slows HR, vasoconstricts coronary arteries

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7
Q

Describe the chronotropic effects on the heart

A

+ HR increases

- HR decreases

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8
Q

Describe the Inotropic effects on the heart

A

+ is increased contractility

- is decreased contractility

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9
Q

What is the equation for CO

A

CO = SV x HR

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10
Q

What is normal ejection fraction

A

60-70%

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11
Q

Describe rate pressure product

A

Index of myocardial O2 consumption

Reflects cardiac fitness

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12
Q

Describe the equation for RPP and interpretation of results

A 
RPP = (HR x systolic BP) / 1000
0-12 = normal
12-17= risk
17-21= danger
above 21 = very dangerous
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13
Q

Differentiate between coronary artery disease and coronary heart disease

A

Artery - problems with blood vessels and flow to the heart but no damage to heart muscles
Heart - damage to the heart muscles

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14
Q

What can coronary artery disease progress to

A

Coronary artery disease

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15
Q

Describe how the coronary arteries protect against occlusion

A

will vasodilate to help perfusion

If unsuccessful, will cause heart attack

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16
Q

What damages endothelium

A

LDLs
Smoking
HTN

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17
Q

What is the difference between atherosclerosis, arteriosclerosis and arteriolosclerosis

A

Athero - platelet aggregation
Arterio - hardening arteries
Arteriolo - hardening of arterioles seen in HTN and DM

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18
Q

Differentiate between STEMI and NON-stemi

A

STEMI - transmural infarction

Non-STEMI - nontransmural or subendocardial region infarction

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19
Q

What are the risk factors for something

A

Elevated homocysteine
Hematological factors
Inflammatory markers - elevated C reactive protein

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20
Q

What can HTN lead to in the heart

A

LV hypertrophy
Atherosclerosis
Systemic damage

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21
Q

What is stenosis and regurg

A

Stenosis - murmur when valve is open

Regurg - murmur when valve is closed

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22
Q

What cardiac diseases lead to HF

A

CAD
HTN
MI
Cardiomyopathies

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23
Q

Describe Cardiomyopathy

A

sudden death
1/4 of al sudden deaths are attributed to cardiomyopathies
1 in every 500 cases

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24
Q

How can renal insufficiency affect the heart

A

Overload the heart with fluid

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25
Q

Describe the medical professional’s goals when it comes to preventing HF

A

Prevent or delay with meds, diet, lifestyle changes and exercises

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26
Q

How does the PT help prevent HF

A

Educate the patient about exercise and report abnormal symptoms

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27
Q

What is mPAP

A

mean arterial pressure
measure of pulmonary hypertension
> 25 mmhg is abnormal
> 20 is abnormal in patients with COPD

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28
Q

Describe some symptoms of left sided heartfailure

A

Dry cough
Fatigue
Pulmonary rales

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29
Q

Describe some symptoms of right sided heart failure

A

Dependent edema
Jugular distension
Increased right atrial pressure
Peripheral effects

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30
Q

What is the affect of CHF on the muscles

A

decreased diameter of type 1 and 2 muscle fibers

Isometric strength is decreased (50%)

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31
Q

How do patients with CHF present when exercising

A

HR increases rapidly with submax load
Blunted systolic BP
Decreased O2 sat
Elevated CO2 in blood

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32
Q

What are some signs of HF

A

Sudden weight gain
pulmonary edema
worsening dyspnea

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33
Q

Describe BNP

A 
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
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34
Q

Describe the stages of pulmonary edema

A

stage 1 - increased lymph flow, fluid in gravity dependent positions
stage 2 - tachypnea, elevated PCWP
stage 3 - flooding of alveoli, hypercapnia, hypoxemia

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35
Q

How do you dose a patient with CHF

A

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

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36
Q

Describe the 6 minute walk test

A

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

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37
Q

What is the “pace” of the SA, AV and Pukinje fibers

A

SA - 60-100
AV - 40-100
Pukinje 20-40

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38
Q

What are the methods to determine heart rate

A

1500/ # of small boxes

300, 150, 100, 75, 60, 50

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39
Q

Describe depolarization as it relates to the ion channels

A

Opening of sodium and calcium channels

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40
Q

Describe repolarization as it relates to the ion channels

A

Opening of potassium channels and closing of sodium channels

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41
Q

What is a plateau

A

When calcium channels are still open, after calcium channels close more potassium opens

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42
Q

What is the duration of the P wave, QRS and PR interval

A

P - 2 small boxes
QRS - 2 small boxes
PR - 5 small boxes

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43
Q

What is a long PR interval and what does it mean

A

Greater than .2 sec\

Means there is a block

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44
Q

What does it mean when a QRS is greater than .1 seconds

A

Impulse if from the ventricles or abnormal ventricular conduction system

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45
Q

What does a deeply inverted q wave mean

A

MI and is getting worse
will remain that way for months
ST will return to normal

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46
Q

What does it mean when the ST segment elevates or depresses

A

Elevation - STEMI - MI, hypothermia

Depression - NON-STEMI / ischemia

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47
Q

What happens on the EKG in a STEMI and what is the pain like

A 
ST elevation
Q is 1/3 the size of the QRS
T wave inversion will not be evident initially
Severe pain
More serious
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48
Q

What does T wave inversion indicate

A

Ischemia
Injury
Pulmonary embolism

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49
Q

Describe what is NON-STEMI is

A

Subendocardial block
Not full thickness
less severe chest pain when compared to a STEMI
Can lead to fatal arrhythmias

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50
Q

How do you identify a NON-STEMI

A

ST depression greater than 1mm

T wave inversion will be variable

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51
Q

What on an EKG suggests ischemia

A

ST depression with biphasic negative-positive T wave

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52
Q

What indicates a pulmonary embolism

A

Troponin

Deep t wave inversion on leads 1-4

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53
Q

What can digitalis cause on an EKG

A

large QRS complex

54
Q

What is the difference between atrial flutter and atrial fibrillation

A

Flutter - saw toothed

Fibrillation - coarse waves

55
Q

Is it safe to exercise a patiet durring A FIB

A

Yes

56
Q

Is it safe to exercise a patient durring V fib

A

No
This is an emergency
Ready the AED if necessary

57
Q

What is considered V TAK

A

3 or more PVS’s in a row

58
Q

Describe a first degree AV block

A

Elongated PR interval

59
Q

Describe second degree AV blocks

A

type 1 - Wenckebach - Progressive lengthening of PR then QRS drop
type 2 - Mobitz - 2-4 P waves before a QRS

60
Q

Describe a 3rd degree AV block

A

No relationship between P and QRS, they are firing independently of one another

61
Q

Describe PET

A

Gold standard for blood flow

Visualization and direct measurements of metabolic function

62
Q

When do you use a PET

A

when the patient is not exercising

63
Q

How early can you administer a PET

A

2-10 days after MI

64
Q

What are some disadvantages of a PT

A

Very expensive

65
Q

Compare MRI to PET

A

MRI is similar to PET but less expensive

66
Q

Who are not good candidates for MRI

A 
Stent
Pacemaker
Artificial joint
sx clips
Heart valve
Any metallic device
67
Q

Describe cardiac catheterization

A

Invasive
Patient awake but under anesthesia
Brachial or femoral area
Measures chamber pressures

68
Q

How long is bed rest after cardiac catheterization and why

A

4-6 hours
To avoid bleeding
Pseudoaneurysm

69
Q

How are the sides of the hart accessed during cardiac catheterization

A

Right - veins

Left arteries

70
Q

Describe a CABG

A

Vessels used to bypass area causing infarct

71
Q

Describe traditional CABG

A

Median sternotomy
use of heart lung machine
heart stopped poorer outcomes

72
Q

Describe MIDCAB

A 
Minimally invasive
Lower risk
Less traumatic
Shorter recovery time
Not for high risk patients
Only for single artery involvement
73
Q

Describe Echocardiogram

A

Uses ultrasound to evaluate the functioning of the heart

Real time images of the heart beating

74
Q

Describe Holter monitoring

A

continuous 24 hour EKG monitoring

Used for diagnosis and management of arrhythmias

75
Q

Describe angiogram

A

Dye injected to show blood vessels

76
Q

Describe percutaneous coronary intervention

A

Improves blood flow to the heart for revascularization

Restored blood Flow in patients with MI

77
Q

Describe an electrophysiological study

A

Checks conduction system of the heart
Used after sudden death with revival
8 hour procedure with patient heavily sedated

78
Q

Describe a ventricular assist device

A

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

79
Q

Describe the indications for a heart transplant

A

Progressive terminal CP disease

80
Q

Inpatients with heart transplant how do you monitor exercise response

A

BP and RPE

Not HR

81
Q

What is the purpose of a central line and where can they be placed

A

Measures arterial pressure, draws blood

Femoral, brachial, radial

82
Q

Describe the uses of a central venous line

A

Blood samples
Medications
Rehydration

83
Q

What is the purpose of a SWAN-GANZ catheter

A

Measure R atrium, R ventricle, pulmonary artery and L atrium filling pressure

84
Q

What are the norm values for a SWAN-GANZ catheter

A

R atria - 0-5
R ventricle 5-12
PA - 20-30 / 5-12
Capillary wedge - 5-18

85
Q

What should you do when moving a patent with a line or SWAN-GANZ line

A

Manually measure blood pressure

86
Q

Describe a PICC line

A

Used for long term therapies

87
Q

What are some advantages of a PICC line

A

easy to insert
Low risk of bleeding
can be left in for a long time

88
Q

Describe an intra-aortic balloon pump

A

Pulls blood out of left ventricle

89
Q

Describe an IAPB

A

balloon in the thoracic aorta, inflates and deflates with the heart

90
Q

What are the used of IV lines

A

Rehydration
Meds
blood transfusions

91
Q

At what Pulse ox measurement should you avoid exercise

A

if below 92%

92
Q

What enzymes corelate to MI

A

CPK
LDH
Troponin - gold standard for MI

93
Q

at what troponin level is a heart attack probable

A

above .4 ng/ml

94
Q

Describe the homocysteine levels and their meaning

A 
less than 10 is desirable
< 6.3 = < 1 x cardiac risk
< 6.6 = 1x risk
10 = 2x risk
15 = 4x risk
20 = 9x risk
95
Q

What are the classic cardiac symptoms

A 
Chest pain
Chest tightness
Palpitations
indigestion
Burning
96
Q

What are the classic pulmonary symptoms

A 
Dyspnea
Wheezing
Cough
Increased RR
sputum
97
Q

What are some risk factors of heart disease

A 
HTN
Smoking
High cholesterol
family history
Stress
Sedentary lifestyle
Older age
Obesity
Diabetes
98
Q

What are some protocols for exercise testing

A

Bruce - most common
Bruce low level
Balke - most common with athletes

99
Q

What are the absolute criteria for exercise testing termination

A 
Drop is SBP > 10
Moderately severe angina
Signs of poor perfusion
Sustained V tach
Request of patient
100
Q

What are the relative criteria for exercise testing termination

A 
ST or QRS changes
Arrhythmias
Fatigue, SOB, claudication
Increasing chest pain
Hypertensive response - 250/115
101
Q

Describe FAI

A

Functional aerobic impairment

% difference of VO2 max in similarly aged healthy person

102
Q

What are the numerical interpretation for FAI

A

Mild - 27-40%
Moderate - 41-54%
Marked - 55-68%
Extreme - >68%

103
Q

What are the contraindications for exercise testing

A 
Recent MI
Acute pericarditis or myocarditis
Resting or unstable angina
Aortic stenosis
Serious ventricular or rapid atrial arrhythmias
104
Q

Describe finger nail clubbing

A

fingers look like drumsticks

8% of clubbing is due to cardiopulmonary issues

105
Q

Describe the angina scale

A

1 - light, barely noticeable
2 - moderate, bothersome
3 - severe, very uncomfortable
4 - most severe pain ever experienced

106
Q

What is the dyspnea scale

A

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

107
Q

Describe the dyspnea level test

A 
Count to 15 in 8 seconds
0 - single breath
1 - two breaths
2 - 3 breaths
3 - 4 breaths
4 - unable to count
108
Q

Describe the function of organic nitrates

A

Dilate coronary blood vessels and reduces blood pressure

109
Q

Describe the function of calcium channel blockers

A

reduces electrical conduction, force of contraction, dilates blood vessels, reduced BP
(…pine)

110
Q

Describe Cardiac glycosides

A

Increase contraction but not HR

…in

111
Q

Describe beta blockers

A

reduce HR, contractility and BP, vasodilator

…olol

112
Q

Describe an ACE inhibitor

A

Vasodilator, decreases BP

…pril

113
Q

What is optimal cholesterol

A

less than 200

114
Q

What is optimal LDL, what is considered High

A

less than 130-160

High is more than 160

115
Q

What is considered good HDL

A

the more the better

116
Q

Describe Cardiac rehab phase 1

A

Monitoring phase

117
Q

What is the goal of cardiac rehab phase 1

A

Maintain and stabilize cardiovascular function

118
Q

What is the criteria to exit cardiac rehab phase 1

A

ADLS performed 5 METS

119
Q

Describe cardiac rehab phase 2

A

up to 12 weeks
supervised exercise
may live at home

120
Q

What is exercise prescription like during cardiac rehab phase 2

A

20-60 mins
2-3 times per week
40-60% max HR

121
Q

What can yo begin during cardiac rehab phase 2 other than cardio exercise

A

light resistance exercise

122
Q

What is the exit criteria for cardiac rehab phase 2

A

9 METS

123
Q

Describe cardiac rehab phase 3

A

Maintenance phase

124
Q

What intensity of resistance training may begin in cardiac rehab phase 3, how to progress

A

50% 1 RM

progress UE - 2-5 lbs, LE 5-10

125
Q

What does cardio exercise intensity look like in cardiac rehab phase 3

A

70-85% max HR

11-14 RPE

126
Q

What does cardiac monitoring look like at cardiac rehab phase 3

A

intermittent or no monitoring

127
Q

What can resume after cardiac rehab phase 3

A

Patient may return to work

128
Q

What is the formula for Max HR

A

220 - age

129
Q

what is the formula for HRR

A

subtract resting HR from Max HR

130
Q

What is the formula for target heart rate (karvonen)

A

((Max HR - RHR) x target) + RHR

131
Q

Describe the intensity frequency relationship for cardio exercise

A

low to mod intensity - 5-7 days per week

Higher intensity - 3-5 days per week

TRI 4 - CP (4 decks)

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