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DPT 629: Cardio > PT Exam and Assessment of the Cardiac System > Flashcards

PT Exam and Assessment of the Cardiac System Flashcards

1
Q

what is a part of the medical chart review?

A

exam, eval, diagnosis, prognosis, and intervention

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2
Q

what is involved in the exam?

A

pt hx, systems review, tests and measures

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3
Q

what is involved in the eval?

A

eval of data to make a clinical judgement

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4
Q

what is the point of the diagnosis?

A

to classify a pt within a specific practice pattern and indicates the primary dysfunctions

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5
Q

what is the point of the prognosis?

A

to determine the predicted level of optimal functioning

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6
Q

what are the classic cardiac signs?

A

chest pain, tightness, pressure, SOB, palpitations, indigestion (esp in females), burning sensation

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7
Q

what are the 3 cardinal signs of HF?

A

SOB, weight gain, edema bc of accumulation of fluid

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8
Q

what are risk factors for heart disease?

A

HTN, smoking, elevated cholesterol, family hx of early heart disease, stress, sedentary lifestyle, older age, obesity, and DM

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9
Q

what age is considered early heart disease for females?

A

younger than 65

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10
Q

what age is considered early heart disease for males?

A

younger than 55

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11
Q

what is relevant social hx specific to cardiac disease?

A

excessive alcohol, cigarette smoking, illicit drug use

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12
Q

what cardiac issues does excessive alcohol consumption put you at risk for?

A

cardiomyopathy

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13
Q

what cardiac issues does cigarette smoking put you at risk for?

A

heart disease

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14
Q

what cardiac issues does illicit drug use put you at risk for?

A

coronary artery spasms, MI, and severe arrythmias

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15
Q

what info does electrocardiograms and serial monitoring give us?

A

the state of the heart muscle and rhythm

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16
Q

t/f: electrocardiograms and serial monitoring predicts the future and can give us info on the coronary anatomy

A

false

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17
Q

what are the causes of sinus bradycardia?

A

well-trained athletes, B-blockers

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18
Q

what are the implications for sinus bradycardia?

A

if pathology exists, it can cause inadequate cardiac output (CO)

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19
Q

sinus bradycardia will have long ____ _____

A

RR intervals

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20
Q

what is the definition of cardiac output (CO)?

A

volume of blood ejected out of the LV in a minute

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21
Q

what is the calculation for CO?

A

SV x HR = CO

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22
Q

what is the average CO at rest for adequate tissue perfusion?

A

4-6 L/minute

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23
Q

with exercise, should CO, HR, and SV increase or decrease?

A

increased

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24
Q

what are the signs of inadequate CO?

A

syncope, dizziness, angina, and diaphoresis (excessive sweating)

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25
Q

what are the causes of sinus tachycardia?

A

exercise (non pathological), anxiety, hypovolemia, anemia, fever, infection, meds, low CO, caffeine (non pathological)

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26
Q

what are the implications for sinus tachycardia?

A

typically asymptomatic unless extremely high HR

concerned at or close to max HR

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27
Q

does sinus tachycardia or bradycardia have a smaller RR interval?

A

sinus tachycardia

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28
Q

does sinus tachycardia or bradycardia have a larger RR interval?

A

sinus bradycardia

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29
Q

why are we concerned with sinus tachycardia that is at max HR?

A

bc they may not be able to meet CO needs

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30
Q

what are the implications of a sinus pause?

A

frequent decrease in CO

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31
Q

what is a sinus pause?

A

normal sinus rhythm that suddenly has a very long RR interval and then back to normal

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32
Q

1-2 minutes of sinus pause is not going to affect a pt, but the concern is when?

A

when having multiple in a minute or multiple spaced closely together leading to decreased CO

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33
Q

what are the causes of premature ventricular contraction (PVC)?

A

caffeine, nicotine, stress, over-exertion, electrolyte imbalances, ischemia, CHF, acute infarction, irritation of the myocardium, chronic lung disease, PE, some meds

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34
Q

what are the symptoms of PVCs?

A

typically asymptomatic if infrequent

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35
Q

what are the characteristics of PVCs?

A

inverted or abnormal QRS complex and no p wave

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36
Q

1-2 PVCs is not a concern, when is there concern?

A

when there are 6 or more PVCs than the pt’s baseline PVCs

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37
Q

PVCs are serious or life-threatening when…

A

paired together

multifocal

more than 6 from their baseline

landing on t waves

present in triplets (ventricular tachycardia)

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38
Q

what are multifocal PVCs?

A

PVCs coming from multiple areas of the ventricle causing more myocardial damage

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39
Q

how do we know PVCs are multifocal?

A

bc the QRS complexes will all look different from each other

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40
Q

what is ventricular tachycardia?

A

3 or more PVCs in a row

MEDICAL EMERGENCY

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41
Q

what rhythms are a medical emergency?

A

ventricular tachycardia

ventricular fibrillation

asystole

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42
Q

ventricular tachycardia left untreated can lead to what?

A

v-fib

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43
Q

what is ventricular fibrillation?

A

random rhythms on the EKG due to quivering of the ventricles

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44
Q

when someone’s EKG shows us they are in v-fib, but they are talking to us, what should we do?

A

check the lead placement bc they may just be off bc most pts in v-fib will already be in syncope and no able to communicate

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45
Q

what is atrial flutter?

A

classic sawtooth appearance bw R waves

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46
Q

what are the implications of atrial flutter?

A

typically safe if HR is less than 100 bpm

can decrease CO at high HR

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47
Q

t/f: an increase in HR with atrial flutter can decrease CO

A

true

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48
Q

what can atrial flutter lead to?

A

a-fib

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49
Q

what are the implications of atrial fibrillation?

A

20% decrease in CO

controlled AFib needs to be monitored with exercise

uncontrolled AFib needs a lot of caution

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50
Q

what is controlled AFib?

A

<100 bpm

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51
Q

what is uncontrolled Afib?

A

> 100 bpm

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52
Q

what is atrial fibrillation?

A

multiple dif p waves w jagged uneven appearance from multiple areas of the atria contracting a different times

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53
Q

t/f: a fib may be controlled at rest and uncontrolled with activity

A

true

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54
Q

how do we deal with controlled a fib at rest that becomes uncontrolled with activity?

A

start with minimal activity and work up as the are able to tolerate without symptoms of uncontrolled a fib

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55
Q

what is the main measure of CO that we use as PTs?

A

BP

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56
Q

if HR is high and BP is stable, is CO able to keep up with increased HR?

A

yes

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57
Q

if HR is high and BP is decreased, is CO able to keep up with increased HR?

A

no

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58
Q

what is the HR of rapid ventricular response (RVR)?

A

> 120 bpm

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59
Q

what is premature atrial contraction (PAC)?

A

ectopic atrial foci outside of the SA node causing early atrial defibrillation

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60
Q

what would PAC look like on EKG?

A

early p wave appears different to other p waves and may be hidden in the t wave

may be followed by a pause

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61
Q

t/f: one PAC alone isn’t enough to change CO in a minute, but with multiple we may see effects on CO

A

true

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62
Q

what is another name for atrial tachycardia?

A

supraventricular tachycardia (SVT)

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63
Q

what is atrial tachycardia (SVT)?

A

3 or more PACs in a row

HR>100bpm

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64
Q

t/f: atrial tachycardia (SVT) can decrease CO at high HR

A

true

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65
Q

when would normal sinus rhythm with artifact often be seen?

A

when a pt is using an electrical toothbrush

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66
Q

what EKG patterns would be a contraindication to exercise?

A

sustained ventricular tachycardia

2nd/3rd degree heart block

new onset SVT, a fib, or a flutter

new onset tachycardia or bradycardia with hemodynamic compromise

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67
Q

what EKG patterns would be relative contraindications for exercise?

A

new onset tachycardia or bradycardia w/o hemodynamic compromise

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68
Q

what EKG patterns would be precautions for exercise?

A

many rhythms have the potential to reduce CO or to progress to more serious rhythms so closely monitor s/s, progress activity slowly, and if the pt is on continuous EKG monitoring stop activity with any new arrythmia

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69
Q

what are radiological studies?

A

chest radiographs, CT scans, MRIs, and scintigraphy

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70
Q

what does a CTA (CT angiogram) look for?

A

blood flow, esp PEs

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71
Q

t/f; we can treat crackles heard on auscultation the same whether it is caused by pulmonary issues or mucus

A

false, we would do airway clearance techniques with mucus, but these would not work for pulmonary edema

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72
Q

what is an echocardiogram?

A

US of the heart in real time

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73
Q

what are the two types of echocardiograms?

A

TEE (transesophageal) and TTE (transthoracic)

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74
Q

what is the difference bw TEE and TTE?

A

TTE is less invasive and can be done at the bedside

TEE requires sedation but give more clear images

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75
Q

what can echocardiograms show us?

A

valve dysfxn, chamber sizes, muscle wall thickness, ejection fraction

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76
Q

if the inferior vena cava is dilated, this could indicate ___ sided dysfxn

A

right

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77
Q

what could cause a dilated inferior vena cava?

A

regurgitation

blood not adequately getting pumped from the R side of the heart

RV not working

increased resistance through the lungs

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78
Q

what info can we get from cardiac catheterization?

A

the anatomy of the coronary arteries

dynamic assessment of cardiac muscle

heart and valve damage

ARTERIES!!!!!

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79
Q

where does a L cardiac catheter go through?

A

brachial or femoral artery –> aorta–> L heart

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80
Q

where does a R cardiac catheter go through?

A

basilic or femoral vein–>vena cava–> R heart

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81
Q

what are the implications of mitral valve stenosis?

A

decreased CO (not getting full amount of blood to the ventricles)

backup into the lungs

pulmonary HTN and edema

R sided HF

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82
Q

what are the implications of systemic HTN?

A

LV hypertrophy from working harder to pump blood into the aorta against increased peripheral pressure

L sided dysfxn

increased pressure gradient gains the aortic valve can cause dysnfxn (stenosis or regurgitation)

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83
Q

what data can be gained from cardiac cath?

A

CO, shunt detection, coronary angiography, L and R pressures, pulmonary artery pressure, ventricular ejection fraction

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84
Q

what are the two part of the cardiac cath?

A

the camera and the pressure sensor

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85
Q

what does the camera of the cardiac cath show us?

A

visualize how the heart is working and contracting, see the valves, and see the ARTERIES

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86
Q

what is the main benefit of using cardiac cath?

A

visualization of the arteries !!!

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87
Q

what dx can be made from cardiac cath?

A

presence and severity of coronary artery disease!!!!!

presence of LV dysfxn

presence and severity of valvular heart disease

presence of pericardial disease

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88
Q

what valvular heart diseases can be picked up on a cardiac cath?

A

aortic valve stenosis or regurgitation

mitral valve stenosis, regurgitation, or prolapse

tricuspid valve dysfxn

pulmonary valve dysfxn

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89
Q

what procedures can be done during a cardiac catheterization?

A

cardiac biopsy

percutaneous coronary intervention (balloon angioplasty, stent implantation, thrombectomy, arthrectomy)

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90
Q

what are the 2 values for myocardial damage?

A

CKMB and troponins

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91
Q

lab monitoring for myocardial damage must be in a series of ____

A

2-3

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92
Q

can CKMB or troponins be elevated with any form of damage to the muscle tissues?

A

CKMB

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93
Q

what is the gold standard lab value for myocardial damage?

A

troponins

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94
Q

is CKMB or troponins more specific to myocardial damage?

A

troponins

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95
Q

what is the range for CKMB?

A

<5% of total CK

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96
Q

when is the onset of the rise of CKMB?

A

4-6 hours

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97
Q

when is the peak of CKMB?

A

12 hours

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98
Q

when does CKMB return to normal?

A

1-2 days

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99
Q

what is the range for troponin T?

A

<0.1

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100
Q

what is the range for troponin I?

A

<0.03

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101
Q

what is the range for high sensitivity cardiac troponin for women?

A

<14

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102
Q

what is the range for high sensitivity cardiac troponin for men?

A

<22

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103
Q

when is the onset of the rise of troponin T?

A

2-3 hours

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104
Q

when is the onset of the rise of troponin I?

A

2-3 hours

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105
Q

when is the peak for troponin T?

A

10-24 hours

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106
Q

when is the peak for troponin I?

A

10-24 hours

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107
Q

when does troponin T return to normal

A

4-7 days

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108
Q

when does troponin I return to normal?

A

10-14 days

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109
Q

troponin values have a decreased reliability when a pt has what disease?

A

renal failure

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110
Q

what are the causes of upward trending troponin?

A

myocardial injury

MI

cardiac trauma, HR, HTN, hypotension, PE, renal failure, myocarditis

111
Q

what are the clinical implications of upward trending troponin?

A

initiate PT intervention when troponins are stable and/or down trending!!!!!

monitor for unstable status

monitor VS (RR>40, drop in HR>10, drop in SBP>10, SpO2<90%)

112
Q

what is the lab test associated with HF?

A

BNP (brain natriuretic peptides)

113
Q

t/f: BNP increases with severity of HF

A

true

114
Q

what does BNP tell us?

A

the severity of HF

115
Q

if BNP values are <100 PG/mL, what is the HF classification?

A

no HF

116
Q

if BNP values are normal with SOB, is HF likely?

A

nope

117
Q

if BNP values are bw 100-300 pg/mL, what is the HF classification?

A

class 1

118
Q

what are the HF class 1 symptoms?

A

cardiac disease, no s/s, no limitations in ordinary activity

119
Q

if BNP values are >300 pg/mL, what is the HF classification?

A

class 2

120
Q

what are the HF class 2 symptoms?

A

mild s/s, slight limitations w/ordinary activity

121
Q

if BNP values are >600 pg/mL, what is the HF classification?

A

class 3

122
Q

what are the HF class 3 symptoms?

A

marked limitations bc of s/s, even less than ordinary activity

123
Q

if BNP values are >900 pg/mL, what is the HF classification?

A

class 4

124
Q

what are the class 4 HF symptoms?

A

severe limitations, experiencing symptoms at rest

125
Q

what are the causes of upward trending BNP?

A

HF, MI, systemic HTN, cor pulmonale, heart transplant rejection

126
Q

what are the clinical implications of upward trending BNP?

A

monitor for s/s of worsening HF

monitor s/s of hypotension

Borg RPE or dyspnea scale should be used

127
Q

what are the s/s of worsening HF?

A

exercise intolerance

s3 heart sound

pulmonary crackles

change in heart rhythm

128
Q

what is measured in a basic electrolyte/metabolic panal (BMP)?

A

sodium, potassium, calcium, chloride, phosphate, magnesium

129
Q

what 3 electrolytes cause altered excitability of neurons, cardiac tissue, and skeletal muscle?

A

sodium, potassium, and calcium

130
Q

what does high sodium cause?

A

tachycardia, hypotension

131
Q

what does low sodium cause?

A

OH

132
Q

what are the normal values for sodium?

A

136-145

133
Q

what are the critical values for sodium?

A

<120, >160

134
Q

what are the causes of high sodium?

A

hypovolemia, sodium overload, endocrine disorder

135
Q

what is the presentation with high sodium?

A

thirst, confusion, irritability, hyperreflexia, seizure, coma, tachycardia, hypotension, oliguria

136
Q

what are the causes of low sodium?

A

hyper/hypovolemia, severe GI loss, dehydration, diuretics, renal/hepatic disease, GI disorders, hypotonic IV administration

137
Q

what is the presentation of low sodium?

A

headache, lethargy, hyporeflexia, seizure, coma, OH, pitting edema, confusion, weakness, nausea

138
Q

what electrolyte are we most concerned about?

A

potassium

139
Q

which electrolyte has the highest potential for adverse cardiac event and why?

A

potassium bc just a small concentration change can lead to large effects on cardiac stability

140
Q

what results from high or low potassium?

A

arryhthmias, acute cardiac event

141
Q

what are the normal values for potassium?

A

3.5-5.0

142
Q

what are the critical values for potassium?

A

<2.5, >6.5 (don’t even let it get it this point)

143
Q

t/f: potassium instability should be monitored on continuous EKG

A

true

144
Q

t/f: changes in potassium can lead to decrease activity tolerance

A

true

145
Q

what causes an increase in potassium (hyperkalemia)?

A

excessive K supplementation

renal failure

metabolic acidosis

diabetic acidosis

blood transfusion

146
Q

what is the presentation of someone with hyperkalemia?

A

muscle weakness or paralysis

muscle tenderness

paresthesia

dysrhythmia

bradycardia

147
Q

what are the causes of low potassium (hypokalemia)?

A

fluid overload, renal dysfxn, GI disorder, diuretics, alcoholism, hormonal/endocrine disorders, CF

148
Q

what is the presentation of someone with hypokalemia?

A

extremity weakness, hyporeflexia, paresthesia, leg cramps, dysryhtmias, hypotension

149
Q

what are the normal values for calcium?

A

9-10.5

150
Q

what are the critical values for calcium?

A

<6, >13

151
Q

what does calcium affect?

A

muscle contractions

152
Q

t/f: changes in calcium can lead to decreased exercise tolerance

A

true

153
Q

what does increased calcium cause?

A

ventricular dysrythmias

154
Q

what does decreased calcium cause?

A

dysrhythmias

155
Q

what causes low calcium (hypocalcemia)?

A

chronic kidney disease, sepsis, malnutrition, malabsorption, pancreatitis, laxative use

156
Q

what is the presentation of someone with hypocalcemia?

A

confusion, muscle cramps, hyperreflexia, dysrhythmias, paresthesia, agitation, seizure, fatigue

157
Q

what causes high calcium (hypercalcemia)?

A

excessive release of calcium into the blood, dehydration, endocrine/hormonal disorders, GI disorders, excessive vitamin D, supplement/antacids, cancer, immobilization

158
Q

what is the presentation of someone with hypercalcemia?

A

hyporeflexia, muscles weakness, ventricular dysrhythmia, lethargy, constipation, nausea/vomiting, bone pain

159
Q

what results from high magnesium?

A

bradycardia, dysrhythmia, hypotension

160
Q

what results from low magnesium?

A

dysrhythmias

161
Q

what are the normal values for magnesium?

A

1.3-2.1

162
Q

what are the critical values for magnesium?

A

<.5, >5

163
Q

t/f: changes in magnesium can lead to decreased exercise tolerance

A

true

164
Q

what are the causes of high magnesium?

A

renal failure, oliguria, increased magnesium intake, endocrine disorder, diabetic ketoacidosis

165
Q

what is the presentation of someone with high magnesium?

A

nausea/vomiting, hyporeflexia, hypotonia, somnelence, bradycardia, dysrhythmia, hypotension, respiratory depression

166
Q

what are the causes of low magnesium?

A

malnutrition, malabsorption, tremors, chronic alcohol use, diuretics, chronic renal disease, diabetic acidosis

167
Q

what is the presentation of someone with low magnesium?

A

hypertonia, hyperreflexia, tremors, muscle cramping, seizures, apathy, nystagmus, dysrhythmias

168
Q

what do we want to know about a pt’s surgical hx?

A

how long ago it was

169
Q

how long do we use precautions with pacemaker placement?

A

about 3 weeks

170
Q

how long do we use precautions with surgeries?

A

4-12 weeks

171
Q

if chest pain is reproducible with palpation, is it more likely cardiac or noncardiac cause?

A

non cardiac cause

172
Q

if chest pain is not reproducible with palpation, is it more likely cardiac or noncardiac cause?

A

cardiac cause

173
Q

if chest pain is associated with activity level, is it more likely cardiac or noncardiac cause?

A

cardiac cause

174
Q

if chest pain is not associated with activity level, is it more likely cardiac or noncardiac cause?

A

non cardiac cause

175
Q

if chest pain is associated with other s/s like a sense of doom, cold sweats, and SOB, is it more likely cardiac or noncardiac cause?

A

cardiac cause

176
Q

what is compensated HF?

A

the absence of S/S of vascular congestion and not showing outward signs of HF

stability

177
Q

what is stability in HF?

A

probability of remaining in a compensated state

178
Q

when HF pts can exert themselves w/appropriate VS response and can return to baseline in a reasonable time, are they compensated or decompensated?

A

compensated

179
Q

what are the s/s of decompensated HF?

A

new/worsening dyspnea

new/worsening fatigue

new/worsening edema (pulmonary or peripheral)

weight gain

chest pain

180
Q

t/f: pts with decompensated HF need medical attention

A

true

181
Q

what are the 3 components of the physical exam of all pts with HF?

A

heart auscultation for S3 heart sounds (lub-da-dub)

crackles on lung auscultation

JVD

182
Q

if a pt has a weight gain of 3 or more pounds in 2 days, increased cough, increased swelling, increased SOB with activity, increased # of pillows needed, or anything else unusual that bothers you, what may this indicate?

A

need for an adjustment in meds, and communication with the physician

183
Q

if a HF pt has unrelieved SOB at rest, unrelieved chest pain, wheezing or chest tightness at rest, need to sit in a chair to sleep, weight gain or lose of more than 5 pounds in 2 days, or confusion, what may this indicate?

A

overt decompensation, immediate ED visit or call to physicians office

184
Q

what is involved in the physical examination of pts w HF?

A

inspection for JVD

palpation for edema

girth measurements

heart and lung auscultation

185
Q

how do we inspect for JVD?

A

with the pt in recumbent position with HOB at 45 deg, chin tucked and turned towards the opposite side, see if the vein becomes above the level of the clavicles

186
Q

what a (+) test for JVD?

A

vein distends above the level of the clavicles

187
Q

what does a (+) JVD indicate?

A

increased venous volume and may indicate R HF

188
Q

does JVD indicate R or L HF?

A

R HF

189
Q

where is pitting edema typically found?

A

and the ankles and pre-tibial areas

190
Q

describe edema associated with CHF

A

pitting and BL

191
Q

what does edema indicate?

A

fluid retention

192
Q

what things may cause fluid retention in edema?

A

cardiac pump dysnfxn, liver dysfxn, kidney dysfxn, malnutrition

193
Q

what is the palpation technique for edema?

A

apply firm pressure for 10-20 sec

time how long it takes the skin to rebound to it’s og shape

194
Q

what are possible locations for edema?

A

feet, lower legs, thighs, abdomen

195
Q

if edema palpation shows barely perceptible depression, what is the score?

A

1+

196
Q

if edema palpation shows easily identified compression and rebounds in <15 seconds, what is the score?

A

2+

197
Q

if edema palpation shows easily identified compression and rebounds in 15-30 seconds, what is the score?

A

3+

198
Q

if edema palpation shows easily identified compression and rebounds in >30 seconds, what is the score?

A

4+

199
Q

what is edema girth measurements used for?

A

monitoring of exacerbation of condition and success of intervention

200
Q

what is the technique for girth measurements of edema?

A

take circumferential measurements around the affected limb using a tape measure starting 5 cm from the floor and continue proximally in 5 cm increments

201
Q

if girth measurements start decreasing, what can this indicate?

A

improving heart condition

202
Q

why don’t we want to use wraps, massage, etc for edema in pts with HF?

A

bc it will just push fluid back into the vascular system that already cant handle the fluid inside it

203
Q

what are the rules of auscultation?

A

it can’t be done over clothes

make sure you are using the correct side of the stethoscope

try not to knock the tubing

204
Q

do we use the diaphragm or the bell of the stethoscope for heart auscultation?

A

both

205
Q

what are the 4 topographic areas for heart auscultation?

A

at the aortic and pulmonary areas (at the 2nd intercostal space R and L respectively)

tricuspid area (4th intercostal space)

mitral area (5th intercostal space)

206
Q

what should we note with heart auscultation?

A

the intensity, timing, a presence of any splitting, extra sounds, or murmurs

207
Q

what is “normal heart sounds”?

A

“lub-dub”

S1
S2

208
Q

what is S1 heart sound?

A

normal heart sound

“lub”

closure of the mitral and tricuspid valves

209
Q

what is S2 heart sound?

A

normal heart sound

“dub”

closure of the aortic and pulmonary valves

210
Q

what are abnormal heart sounds?

A

S3
S4
heart murmurs

211
Q

what is S3 heart sound?

A

“lub-da-dub”

occurs immediately following S2 (early diastole)

212
Q

what heart sound is a key sign of CHF?

A

S3 heart sound

213
Q

what is S4 heart sound?

A

“La-lub-dub”

just b4 S1 (late diastole)

214
Q

what heart sound is associated with atrial contraction?

A

S4

215
Q

how are heart murmurs classified?

A

by timing, quality, intensity, pitch, location, and radiation

216
Q

what are the 3 classifications of heart murmurs?

A

(1) murmurs caused by high rates of flow through normal or abnormal valves

(2) murmurs caused by forward flow through constricted (stenotic) or deformed valves or by backwards flow through a valve (regurgitation)

(3) murmurs caused by backwards flow through a valve (regurgitation)

217
Q

what is pericardial friction rub?

A

abnormal “creak” sound associated with each heartbeat that indicated pericarditis

218
Q

what does pericardial friction rub indicate?

A

pericarditis

219
Q

what is the location to auscultate S1 heart sounds?

A

tricuspid area

mitral area

220
Q

what is the location to auscultate S2 heart sounds?

A

aortic area

pulmonary area

221
Q

what is the location to auscultate S3 heart sounds?

A

mitral area (with pt laying in 45 degrees forward L S/L)

222
Q

what is the location to auscultate S4 heart sounds?

A

mitral area

223
Q

is S1 best heard with the bell or diaphragm of the stethoscope?

A

diaphragm

224
Q

is S2 best heard with the bell or diaphragm of the stethoscope?

A

diaphragm

225
Q

is S3 best heard with the bell or diaphragm of the stethoscope?

A

bell

226
Q

is S4 best heard with the bell or diaphragm of the stethoscope?

A

bell

227
Q

what is the corresponding event for S1?

A

onset of ventricular systole

228
Q

what is the corresponding event for S2?

A

onset of ventricular diastole

229
Q

what is the corresponding event for S3?

A

early diastole

230
Q

what is the corresponding event for S4?

A

late diastole (immediately prior to S1)

231
Q

what is involved in the activity evaluation?

A

assessment of vitals at rest, sitting, standing, ADLs, ambulation, and stairs

232
Q

what vital signs are involved in the activity evaluation?

A

HR, heart rhythm, BP, O2, RR, RPE, and dyspnea

233
Q

how is HR measured?

A

by palpation, ECG, or pulse ox

234
Q

t/f: pulse ox readings of HR are not always accurate in the case of irregular heart rhythms, darker skin, and nail polish

A

true

235
Q

what is a normal HR response to increased work?

A

a gradual rise w/an increase in workload

236
Q

what is a normal HR response to endurance activity?

A

after initial rise, steady state

237
Q

when would we see a blunted HR response?

A

in highly trained athletes and in PT on HR/rhythm control meds

238
Q

what is an abnormal HR response to increased work?

A

rapid rise

blunted rise

decrease rate (not usually true decrease in rate, but rather rhythm)

239
Q

what is an abnormal HR response to endurance activity?

A

progressive increase

significant drop

240
Q

what is a rapid rise in HR with activity a sign of?

A

severe deconditioning

CV condition with limited SV

241
Q

what is a flat rise in HR without rhythm control meds in response to activity a sign of?

A

CV condition

242
Q

is a decreased HR by palpated pulse more likely a true decrease in rate or a change in rhythm?

A

a change in rhythm

243
Q

how do we measure heart rhythm?

A

by palpation or ECG

244
Q

what is the only way to dx a heart rhythm abnormality?

A

with ECG

245
Q

what is a normal heart rhythm response to increased work?

A

the rhythm remains regular with activity
OR
if irregular at rest, there is no change in irregularity

246
Q

what is an abnormal heart rhythm response to increased work?

A

a change from regular to irregular

an increase in frequency of irregular rhythm

a change from one type of irregularity to another

247
Q

how is BP measured?

A

with a-line (invasive in the ICU), automatic cuff, manual cuff

248
Q

what is a normal SBP response to increased work?

A

gradual rise with increased workload

249
Q

what is a normal SBP response to endurance activity?

A

after initial rise, maintains steady state

250
Q

what is considered hypertensive SBP?

A

a rise of >8-12 mmHg/MET of activity

251
Q

what is hypertensive SBP a sign of?

A

increased vascular resistance

252
Q

what is considered hypotensive SBP?

A

normal SBP rise with submaximal exercise then a sudden and progressive drop with increased workload

253
Q

what is considered blunted BP response?

A

a small increase with low exertion and failure to rise further with increased work

254
Q

what is hypotensive SBP response a sign of?

A

coronary disease

255
Q

what is blunted SBP response a sign of?

A

failure of CO (cardiac output)

256
Q

what are abnormal SBP responses to increased work?

A

rapid rise

blunted rise (if not on beta blockers)

decreased with increased workload

257
Q

what is considered abnormal SBP response to endurance activity?

A

progressive rise

decrease and symptomatic with decrease

258
Q

what is considered a normal BP response to activity (SBP and DBP)?

A

gradual increase in SBP with increased workload

no more than 10 mmHg change in DBP with increased workload

259
Q

what is an abnormal DBP response to increased work?

A

more than 10 mmHg rise or fall

260
Q

what is considered an abnormal DBP response during the recovery phase?

A

sustained elevation

261
Q

how do we measure peripheral oxygenation?

A

pulse ox

262
Q

what does a pulse ox assess about O2?

A

the O2 saturation of hemoglobin (98-100%)

263
Q

pts with ____ or _____ often desaturate with activity

A

chronic pulmonary dysfxn, CHF

264
Q

exercise shouldn’t be continued if O2 sat drops below ___%

A

88

265
Q

how do we measure exertion?

A

Borg RPE scale (of or revised)

266
Q

what scale is widely used to monitor activity and exercise intensity?

A

RPE

267
Q

what is RPE a measure of?

A

perceived workload

268
Q

t/f: RPE is useful to monitor in pts with a blunted HR response

A

true

269
Q

the og Borg scale is from __ to __

A

6-20

270
Q

the revised Borg scale is from __ to __

A

1-10

271
Q

the og Borg scale is preferred in what pts?

A

cardiac pts

272
Q

why is the og Borg scale preferred in cardiac pts?

A

bc it can tell us where their HR should be without meds (add a zero to whatever number they score)

273
Q

the revised Borg scale is preferred in what pts?

A

pulmonary pts

274
Q

which RPE is easier for people to understand, the og or the revised?

A

the revised Borg scale

DPT 629: Cardio (11 decks)

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