PTA 2.3 Flashcards
1
Q
whats heart rate reserve + use for?
A
MHR - RHR = HRR
calculates target HR (THR), ideal range in which your heart should be beating for a given intensity
use karvonen formula to calcualte this
THR = (HRR x %intensity) + RHR
e.g. moderate intent: 40-59% of HRR
high intensity 60-89% of HRR
e.g. for me
MHR = 195
RHR = 50
HRR= 145
For
moderate : (145 x 0.59 ) + 50= 135.5 (using upper limit, 59% mod int)
vigorous: (145 x 0.89) + 50 = 179
2
Q
modifiable risk factors heart diseases?
A
- BP
- Cholesterol
- Smoking
- Overweight
- Diabetes
- Physical activity
- Stress
3
Q
suggestions for heart failure therapy
A
- maintain condition
- lose weight, decrease cardiac output
- minimalize salt ingestion
- restrict fluids <2L a day
- stop smoking
- limit alcohol
4
Q
what effect does losing weight have on cardiac output?
A
lower cardiac output
5
Q
does salt increase or decrease cardicac load?
A
increase
6
Q
when do you use ACE inhibitors and why
A
medications that help relax the veins and arteries to lower blood pressure.
use after loading, exercising to decrease BP, dilate arteries for easier transport of blood and less stress on the heart
7
Q
signs of heart failure
A
- shortness of breath
- swelling feet and legs : disbalance in the body of fluids
- chronic lack of energy
- difficulty sleeping at night due to breathing problems
- swollen or tender abdomen with loss of appetite
- confusion, impaired memory
- increased urination at night
- cough with frequent sputum
8
Q
red flags: heart failure
A
loss of weight >3 kg within a few days
cognitive problems
9
Q
strength training protocol for cardiac patients?
A
3x a week, 3sets x 10-15 reps at 40-65% 1RM
10
Q
woudl you use ACBt + IMT post- or preop?
A
preop
11
Q
whats pericarditis?
A
inflammation of pericardium
12
Q
whats endocarditis?
A
inflammation of inner wall of the heart
13
Q
angina pectoralis?
A
chest pain or heart spasms
14
Q
heart valve problems?
A
heart valve is narrowed or lacking
15
Q
name modifiable factors for cardiac problems
A
smoking, alco, poor diet, high cholesterol high BP, increasing clotting of blood, overweight, diabetes, low PA
16
Q
name non-modifiable factors for cardiac problems?
A
gender:M
age >60
hereditary
CVD at young age
history of CVD
17
Q
what causes bronchitis / bronchi obstruction
A
- hypersecretion of mucus
- decreased airway diameter
- collapse of airways
18
Q
describe each term
1. bronchitis
2. asthamtic bronchitis
3. emphysema
A
- hypersecretion of mucus
- decreased airway diameter due to inflammation, swelling of airways
- collapse of airways eg due to change in intrapleural pressure
19
Q
how is COPD recognized? whats the first symtom that gives it away?
A
increased inflammatory response to inhaled toxic particles and gasses
20
Q
whats alfa1-antitrypsin deficiency?
A
a certain protein in blood that protects body usually against certain enzymes, the protein is missing so enzyme attacks lungs
21
Q
prognostic factors for exacerbation (COPD, asthma)?
A
- smoking
- inactivity
- airway responsiveness
- comorbidities
- body weight
- dyspnea
- functional exercise capacity - 6MWT
lower FEV1
22
Q
what is Cor pulmonale?
A
right sided heart failure, hypertrophy of right ventricle due to increased resistance in pulmonary arteries, more workload R ventricle has to do
23
Q
systemic effects of COPD?
A
- depression
- metabolic diseases
- bone diseases
- CVD diseases
- skeletal muscle weakness, loss of muscle mass
24
Q
atopy: asthma, explain
A
predisposition to develop specific antibodies (IgE) against innocent triggers
25
differences between asthma and COPD: what happens to FEV1 after BD, the inhaler?
in asthma: 12% increase in FEV1
in COPD: no change
26
pattern of symptoms: asthma?
- 1+ symptom (shortness of breath, cough)
- Symptoms worse at night and early morning
- Symptoms vary over time and in intensity
- Triggered by viral infections (colds), exercise, allergens, exposure
27
asthma prognostic factors?
Smoking, inactivity, bodyweight (overweight), therapy adherence
28
symptoms of respiratory system problems
- coughing
- wheezing
- dyspnoea
- mucus
- haemoptysis (cough up blood)
- cyanosis - blue purple skin
- headaches, drowsiness
- decreased exercise capacity
- chest pain
29
name 9 global targets for 2023 by WHO
10 % decrease in alcohol and physical inactivity
25% decrease in mortality and hypertension
30% decrease in salt intake and tobacco use
50% receiving drug therapy to prevent heart attacks
half the rise in obesity and diabetes
80% availability of affordable basic technologies and essential medicines
30
whats a risk factor
any characteristic or exposure of an individual that increases likelihood of developing a disease
31
consequences of high blood pressure?
plaque formation - causes blockage
endothelial damage
kidney failure
heart infarction
32
what leads to high levels of LDL?
saturated fatty acids
33
whats a normal cholesterol value?
whats a slightly increased cholesterol value?
severe increase?strong increase?
5.0mmol/liter
- 6.4
6.5-7.9
>=8mmol / l
34
effect of smoking on cholesterol?
reduces HDL cholesterol
35
BMI: overweight
25 - 29.9 kg /m2
36
ideal BMI?
18.5-24.9
37
ideal waist size per gender?
ideal body fat %?
M <102, <20%
F: <88cm, <30%
38
function of insulin?
stimulates absorption of glucose from the bloodstream; converts glucose into glycogen, lowers blood glucose
39
type 1 diabetes mellitus: describe
autoimmune disease, body unable to produce insulin
40
T2DM: describe
increase in blood sugar, body has become less sensitive to insulin - increases insulin resistance, decreases sensitivity
41
normal blood sugar values?
4 - 8mmol /l
42
most frequent side effects of hyperglycemia?
increases thirst, frequent urination
43
what is metabolic syndrome?
combo of high waist cirucmference; hypertension; insulin resistance, increased triglycerides in blood, lowered LDL
44
main reason for PAD?
atherosclerosis, build up of plaques, narrowing of arteries (large or medium large), not enough O2 to msucles
45
life expectancy with PAD?
<10 years because many get infarct or stroke after PAD diagnosis
many have cerebro or cardiovascular diseases
46
explain Fontain classification syte
sPAD classification based on claudication severity
1: asymptomatic
2a: mild claudication
2b: severe claudication
3: rest pain
4: ulceration, tissue loss, gangrene
47
whats ABPI
ankle brachial pressure index
dividing systolic BP in leg (dorsalis pedis or tibialis posterior) by systolic BP in a. brachialis (arm)
48
is BP usually higher in leg or arm?
leg, ankle
49
normal values for ABPI?
1 - 1.4
50
what value would you expect with PAD diagnosis in ABPI?
<0.9
severe PAD: 0.5
51
Supervised exercise programme for PAD: describe
2hrs per week for 3 months
encourage maximal pain during exercising (push through)
52
important to cheeck during screening`; sPAD
wounds
skin
colour temp
odema
53
explain graded treadmill test
speed: 3.2km. /h
start with 0 incline, increase by 2% every 2mins til 10incline.
go max til 30mins. assess functional and maximal walking distance
54
explain how ACSm grading scale is used during graded treadmill testing
grade1: light discomfort
grade 2: moderate pain
grade 3: intense pain, attention cant be diverted
grade 4: unbearable pain
55
QoL questionnaire for PAd patients?
EuroQoL 5D
56
interventions in PAD?
walking through the pain - pain tolerance improvement
development of collaterals
aerobic metabolism
57
minimze objective limitations: interventions
walk at grade 3-4 acsm
minimum 6months
3x a week
>30mins
58
explain by weeks intense training: chronic care net
starting phase: 3x / week, for 4 weeks,
self training phase: 1-2/week for 8wks
maintenance phase 1-2x a month for 40 wks
59
is it better for a sPAD patient to walk 1x1.5hr or 3x .0.5?
3x 0.5hr
60
describe venous odema
faulty valves
inhibits return of deoxy blood back to heart
often in combi w lymphoedema
61
describe lipoedema
fat swelling, irregular distirbution of fat
62
what is lymphoedema
abnormal accumulation of tissue fluid, malfunction of lymph system
63
hows manual lymphatic drainage useful?
massage technique, stimulates lymph system and allows for fluid to travel thru alternative routes
64
when is lymphapress used
for long lasting oedema, stiff hardly movable edema
65
which clinimetrics is used on identifying frailty?
TFI: tilburg frailty index
66
geriatric giants
incontinence
falls
confusion
impaired homeostasis
iatrogenic disorders
67
NNGB and fitnorm
NNGB: >=5 days a week of moderate intensity of >=30mins
Fitnorm at leat 3 days of 20mins heavy intensity
68
whats poylpharmacy
use of more than 5 kind of meds
69
DOS score
delirium observation screening
70
describe angina pectoris scale class 1-4
class 1:angina only during HIIT
class 2: slight limitations, angina during vigorous activities
class 3: symptoms with everyday activities
class 4- inability to perform any activities *angina also at rest*
71
what is angina?
chest pain (insufficient blood flow to the heart)
72
cholesterol norm values
150 mg / dl
LDL: <150
HDL >45
73
BP for a grade 3 hypertension
>=180 and >=110
74
describe isolated systolic hypertension
S >=140
D: <90
75
normal P top frequency
50 - 99 bpm
76
sinus bradycardia:
slower hr
<50 pbm
77
sinus tachycardia
P wave freq >100 bpm
78
sinus arrhythmia
irregular occurence of identical P -tops
79
atrial extra systole
P wave has a different form / peak in the grraph
80
atrial flutter
no normal P waves
freq >300
81
atrial fibrillation
irregular P waves
82
ventricular extrasystole
QRS complex not normal
no P wave beforeQRS
83
ventricular extrasystole
QRS complex not normal
no P wave beforeQRS
84
ventricular tachycardia
no p wave
very fast WRS >140
abnormal qrs complex
85
ventricualr fibrillation
chaotic graph, no normal waves just peaks
86
increase in co2 leads to vaso ..
vasodilatation
87
is bradycardia an example of PNS or SNS activity?
PNS (slower heartrate)
88
which structure detects changes in blood pressure?
baroreceptors in wall of aorta and internal carotid artery
89
if Co doesnt change but PR icnreases, what happens to BP?
increases
90
CO = ..?
SV x HR
91
BP = ..?
CO x PR
92
name 3 diseases/ events atherosclerosis can lead to
myocardial infarction
PAD
angina pectoris (coronary heart disease)
93
describe blood's content (55 % ... and 45%...)
55%- plasma so h2o, proteins, AA
45% - cells so leukocytes, erythrocytes, thrombocytes
94
describe norma values for CPET (what youd expect)
BP <220/90
Vo2peak >=85%of pred vo2max
anaerobic threshold >40% of vo2max pred
HRpeak >90% pred
HRR <15
VEpeak <85% pred of MVV
ventil reserve >11l/min
95
name criteria for a maximal test CPET
-Wmax achieved of pred.
-HRmax achieved of pred.
-VO2peak achieved of predicted
-VEpeak>=85% of predicted MVV
Borg >9
RER=1.15
96
how do you calculate mvv (L/min) if you have FEV1?
MVV = 3.75 x FEV1
97
at VT1 what happens to metabolism?
switches to partially anaerobic , production of lactic acid. slope becomes steeper.
increase in VCO2 >VO2
98
if cardiac ceiling is reached, what do you expect regarding HRR?
no HRR left,
99
explain treatment , aerobic training for a cardiac patient
divides into endurance and HIIT
use VO2max for intensity
endurance
first 2wks: 3x a week, 30mins, at 40-50% of VO2max
then 2 weeks: 3x a week of 30mins, at 50-80% of VO2max
HIIT
3x a week at 80-90% of VO2max
4x4mins w 3min active recovery breaks at 40-50% VO2max
100
if someone is going into a CABG or valve replacement, explain the steps (KNGF guildeines) regarding rehav
1. preop phase - screen for PPC complications - if risk high, do IMT, breathing, airway clearance -> then into surgery-> then rest-> mobilisation -> 3-4MET mod int activities
101
explain preop (CABG) and postop techniques used in rehab
preop
- IMT
- Active CYCLC of Breathing Techniques
Postop
- ACBT
mobilise
inform and advise
102
other ways of doing cardiac rehab than 30mins running (HIIT or endurance)? - starts 4 weeks after after registration
circuit training, 1hr, 2x a week
103
clinimetrics for a cardiac patient
6mwt
PSC
steep ramp test - submax test
borg scale
1RM
104
exercise restrictions after ICD implant?
6-8weeks cant do much
105
strength training protocol for cardiac patients?
3x10 start w 30-40% of 1RM
build up to 80%
106
name most important pulmonary diseases ?
COPD, asthma
107
describe COPD and ASTHMA
COPD: treatable disease, with persistent respiratory symptoms and airflow limitations due to airway or alveolar abnormalities - usually caused by signif. exposure to noxious particles eg from smoking
108
COPD and bronchi- whats the relation?
obstruction of bronchi (lower airways)
due to
- hypersecretion of mucus (bronchitis)
- decreased airway diameter due to eg inflammation (asthmatic bronchitis)
- collapse of airways - emphysema due to changes in intrapleural pressure (emphysema)
109
pathophysiology of COPD
increased inflammatory response to inhaled noxious particles and gasses
110
name 2 things that happen to lung parenchyma in COPD patients
loss of alveolar attachments and loss of elasticity
111
GOLD stages describe what? and what type of patients is this system used for
for COPD patients
describes airways restrictions
stage 1 - FEV1 %pred >80
stage 2 - FEV1%pred 50-80
stage 3 30-50
stage <30
112
in NL patients are most commonly GOLD stage _ ?
stage 2 so FEV1 50-80^%predicted
113
whats an exacerbation
sudden worsening, beyond normal day to day variations
114
whats airtrapping
extra air trapped in lungs, thorax stays in a position of inspiration-> functional weakening of the diaphragm
115
whats atelectasis?
collapse of alveoli behind obstruction
116
whats cor pulmonale
right sided heart failure.
enlargement of R ventricle due to high BP in lungs
117
atopy
predisposition to develop specific antibodies (IgE) to innocent trigger
118
is hayfever a specific or nonspecific reaction? how about cold, viral infections, smoke?
hayfever: specific
the rest: non specific, no interference of IgE
119
what do u use to open airways in asthma patients and how does this work regarding FEV1?
bronchodilators
FEV1 increases
120
in asthma is FEV1 lower or higher in mornings?
lower
121
3 mechanisms to alleviate dyspnea
1. decrease airway resistance
2. strengthen respiratory muscles
3. strengthen cardiorespiratory system
122
how can you decrease airway resistance
Bronchodilators (opens airways) + rehab (endurance) -> best endurance capacity results
123
whats hyperinflation
trapping of air inside the lungs
124
describe Pursed Lip breathing: cons, pros, function
- increases resistance when you breath out BUT generate pressure in airways so prevent collapse
improves physical capacity, moderate effect on dyspnea
125
weak inspiratory muscles: what do you use to determine this?
MIP device : maximal inspiratory pressure
if its <70% of predicted then need IMT (need to train pressure inside airways)
tools: breath against resistance- trains inspiratory muscles:
powerbreath
threshold
126
IMT: FITT?
F: 5x a week, 2x a day, minimum for 4 weeks
I: 30-50% PImax
T: deep fast inhalations, i:out 1:3
total ±5mins
127
explain postural adjustments
bending forward a bit: to lengthen diaphragm; use accessory breathing muscles - if ure sitting means also lower load on legs so can be used in breathing
128
Oxygen saturation and max exercise test
if theres >4% drop in SpOs - possible candidate for O2 supplementation
start exercising only if resting SpO2>=90%
if during exercising SpO2 <85% = refer to GP
SpO2 <90% after exercising: monitor
129
hows mucus and mucus glands in COPD patients?
mucus: much thicker
mucus glands: hypertrphic
130
how does physical exercise contribute to mucus transport?
increases airflow, ventilation
increases excursion of lung tissue
stimulates lung parenchyme and airways
131
name 3 relaxation methods
1-5
jacobson: muscle tension relax
guided imagery- happy place
132
3 types of skills associated with health literacy
functional
communicative - interactive
critical
133
functional skills and red flags
- understand wrriten, verbal info, own health, illness, can follow instructions
red flags
- doesnt want to fill out forms
-confuses dates, times of appointments
- never has questions about any info
134
communicative HL and red flags
- can describe own health; ask the right questions at the right time; uses professinoal as a support not know-it-all person
red flags
- patient looks confused or annoyed but doesnt have real questions
- patient doesnt chekc if he understands correctly
135
critical HL
this is more assessing the right info, relevance and reliability of info and making informed choices regarding one's health
red flags:
- patient is overconfident even tho theres evidence opposing it
- patient relies fully on your opinion and what you say as an expert
- patient doesnt follow treatment bc someone had a bad experience with it
