PVD/ Exercise Physiology

Question 1

PVD:

• 3 mechanisms? Cause what?
• Arterial stenosis is worse with?
• True aneurysm? Big risk if? 2 problems occurring? Why is wall weakening? Risk factors? (5) Can’t be found by? Treatment? (2)
• Aortic dissection: Blood flows in what manner?
• VT: Why does leg swell? What may help? What places person at increased risk?

Answer 1

1. ) Athero: Arterial occlusive disease
2. ) Altered arterial wall: Aneurysm/ dissection
3. ) Thrombosis: Local occlusion of veins/ PE
   - Higher flow velocities
   - all 3 layers effected; >50% enlarged; collagen and elastin in adventitia, inflamm, stress, enzymes; male, age, smoking, family hx, size of aorta
   - Open = add tube and see-saw vessel; longer recovery
   - Endovascular = Stent via catheter; more common leaks
   - Spiral
   - Venous return is not working; compression; triad

Question 2

• Exercise Physio:
• Ficks principle connects respiratory VO2 with? Equations? (2)
• Stroke volume equation? EF?
• SV with exercise? Elite athletes?
• CO with exercise: 50%? Elite athletes?
• Flow equation? (2) With exercise? MAP?
• BP with exercise: Acute? Chronic? SBP? DBP?
• Redistribution with exercise? Coronaries? Heat?

Answer 2

• Delivery and extraction; CO = VO2 / [O2A] - [O2V]; [HgB] * 1.34 * 5 O2 sat
• LVEDV - LVESV; SV/EDV
• Increased venous return and inotropy; doubles with exercise; higher SV at rest
• Both HR and SV; Only HR; Increase SV at max HR
• Q=P/R; Q=Pr^4/8lU; MAP = DBP + 1/3(SBP-DBP); decrease vascular resistance
• SNS; kidneys via baroreceptors; increases; same
• Vaso at active muscles; increase Q; skin vasodliate

Question 3

• Oxygen delivery equation?
• Extrinsic way to increase O2 delivery? (3) Intrinsic?
• LaPlace equation?
• Myocardial supply? (3) Demand? (3)
• Factors that decrease supply? (3)
• Exercise used for what in CAD?
• RPP equations? (3)
• RPP helps determine? Related to?
• What is ischemic threshold? With therapy?
• Training does what? Possible mechanisms?
• VO2 max used for? (2) Measure LV systolic function how?

Answer 3

• O2 delivery = Q * Arterial content ([HgB] * 1.34 * O2 sat)
• Training, doping, high altitude training
• Wall Stress = P*r/2h
• BF, Perfusion pressure, resistance; HR, wall stress, inotropy
• Hypotension, lower content, lower blood flow
• RPP = HRmax * SBPmax = HR^2 * SV * SVR; SVR = MAP/CO
• RPP where ischemia occurs; threshold same but more work
• Increase exercise intensity, higher capacity without increased flow; collaterals or improved dysfunction
• CV prognosis and transplant; CO response and peripheral extraction with exercise

Question 4

• CHD: Epi? Gender? Other differences?
• Risk factors? (3)
• Epi: Rank the 5 in commonality order?
  1. ) PDA: Present with? Exam? Murmur? Treatment: Symptomatic neonate? Child? Untreated can lead to?
  2. ) ASD: 2 mechanisms? Shunt? Presentation? Murmur? Systolic? Diastolic? Also? Treatment: Infants? Children?

Answer 4

• 1/100; male more; no
• Boys, maternal diabetes (3x); family hx
• VSD, PDA, T of F; ASD; Coarction
  1. ) hoarse cry; wide pulse pressure, palpable palmar pulses; continous machine; Indomethancin/ NSAID’s; percutaneous occlusion
  2. ) Ostium secundum too big; inadequate development of secundum; L –> R; rarely noticed at birth; NOT related to flow; too much flow across PV; Tricuspid; wide patho split S2; Diuretics to relieve symptoms; surgery or percutaneous closure

Question 5

3. ) VSD: Due to? Most common type? Second? Shunt? Pulmonary return? Murmur? Bigger hole? Big concern? (2) Progression of Eisenmengers syndrome?
4. ) T of F: Most common what? Monology? 2 types? Tet spells due to? Cyanosis worsens as what? ECG? (2)
5. ) Coarction: Due to? Common with? BF to head? Body? Key sign? ECG in kids? Child? Adult? 3 signs?

Answer 5

3. ) 4 endocardial pouches; perimembranous; muscular; L to R; increased; holosytolic; softer murmur; stuck valve, pulm disease leading to R to L shunt; L to R, Higher pulm flow, pulm htx, high RV pressure, R to L shunt
4. ) Cyanotic defect; abnormal development of clonal cests resulting in outlet displaced anteriorly, rightward and upward; infundibular spasm; DA closes; RAD, RVH
5. ) Narrowing of aortic lumen; Turners; Increased; decreased; No femoral pulses; RAD and RVH; LVH; ST depession; Aortic knob, coarction, post stenotic dilation