Test 2 Flashcards
1
Q
V1-V6
A
precordial leads
2
Q
ammonia sulfur dioxide chlorine nitrogen dioxide ozone phosgene
A
irritant gases
3
Q
pulmonary fibrosis diseases of the spine and chest wall diseases of the neuromuscular system
A
restrictive lung diseases
4
Q
decreased exercise tolerance
decreased oxygen consumption
loss of muscle strength
sedentary
abnormal HR response
A
chronic renal failure and exercise
5
Q
Give radioactive agent at peak of stress test then while patient is at rest 4 hours later if cold spot is still present after 4 hours of rest the tissue is dead and blood flow did not return after stress
A
Radionuclide perfusion testing with SPECT
6
Q
normal QRS characteristics
A
.07-.11 sec in width should not be smaller than 6 mm in leads I, II and III should not be taller than 25-30 mm in precordial leads
7
Q
posterior curvature of spine
A
kyphosis
8
Q
normal p wave
A
no wider than .11 sec under 3 mm positive and rounded
9
Q
refers to the direction of depolarization or vector of the QRS complex
A
axis
10
Q
placed in the 4th left intercostal space at the sternal border
A
V2
11
Q
Unipolar leads all other leads are averaged together to make a reference
A
augmented voltage leads
12
Q
ABI, Ultrasound, exercise studies
A
Vascular diagnostic testing
13
Q
normal creatine
A
<1.5 mg/dL
14
Q
types of emphysema
A
centriacinar panacinar
15
Q
V1-V6
A
precordial leads
16
Q
objectives of stres test: quantitatively and accurately assess;
A
chronotropic capacity and HR recovery
aerobic capacity
myocardial aerobic capacity;
RPP exertional symptoms
changes in electrical function
17
Q
Used gamma rays to detect myocardial blood flow 3d 360 rotating camera `
A
SPECT Single photon emission computed tomography
18
Q
normal PR interval
A
.12-.2 sec ( no longer than 1 large box)
19
Q
funnel chest
A
pectus excavatum
20
Q
Left atrial enlargemennt
A
a broad (sometimes m shaped) p wave in Lead II or/and a diphasic p wave (sine wave) in V1
21
Q
sequel to V tach life threatening emergency situation
A
v fib
22
Q
fasting serum glucose normal
A
70-100 100-125 prediabetes >126 diabetes
23
Q
holter monitor, 12 lead EKG, exercise EKG
A
HR rhythm abnormalities
24
Q
A chronic lung disease of unknown cause chronic slow progressive dyspnea chronic inflammation and fibrosis 50% of pts live 5 more yrs after dx
A
idiopathic pulmonary fibrosis
25
significant improvement on health in people with obesity
5-10% weight loss
26
normal p wave
no wider than .11 sec under 3 mm positive and rounded
27
progressive prolongation of PR interval culminating in a non conductive p wave generally asymptomatic causes: right CAD or infarct, digoxin toxicity, and excessive beta blocker
Second degree type 1
28
represents repolarization of the ventricles should have the same polarity as the QRS complex very fickle and not as reliable as ST depression or elevation in diagnosis of ishemia
T wave
29
Lead 1
left arm + right arm -
30
m shaped r and r prime see in V1 and V2
Right BBB
31
normal Q wave
present only in leads I aVL V5 and V6 less than .04 sec not deeper than 1/3 of QRS
32
begins at the end of the p wave and ends with the onset of the QRS complex should be isoelectric and flat can be elevated with atrial infarct or pericarditis
PR segment
33
II, III, aVF
inferior left ventricle
right atrium
left atrium
34
regular HR \>100 p waves that do not originate from the sinus node but from another site in the atria same causes as PAC but also includes pulmonary HTN, altered pH and COPD
Atrial tachycardia
35
Lead III
left leg + left arm -
36
what do you count when calculating HR in 6 sec period
cycles not r waves
37
V4, V5, V6
anterolateral LV
38
diet, fluid balance, BP management, reduce symptoms of uremia
goals with chronic renal failure
39
represents depolarization of the atrial myocardium
p wave
40
normal Q wave
present only in leads I aVL V5 and V6 less than .04 sec not deeper than 1/3 of QRS
41
refers to the direction of depolarization or vector of the QRS complex
axis
42
\<5 Mets or considerable below anticipated peak: increase gradually (2-3 min stages)
assess functional status
Promote client confidence and reassurance normal activities can be undertaken safely
Low level exercise testing
43
represents atrial depolarization plus the normal delay at the AV node
PR interval
44
special considerations
PAD or DM: know precautions
adjust by 1 met increments
minimum frequency of training; 3 nonconsecutive days/wk education
45
Normal BUN
8-18 mg/dL
46
Lead II
left leg + right arm -
47
bradycardia
\>60
48
optimize medical management end point may be a MET level= work or ADL
therapeutic (with or w/o meds)
49
ectopiic focus in either atria initiates and impulse before the next impulse initiated by the SA node
when frequency increased, atrial tachy or a-fib may result
compensitory pause
premature atrial contraction
50
emphysema chronic bronchitis asthma CF
COPD
51
rate of each line to calculate HR
300 150 100 75 60 50
52
Lead II
left leg + right arm -
53
represents repolarization of the ventricles should have the same polarity as the QRS complex very fickle and not as reliable as ST depression or elevation in diagnosis of ishemia
T wave
54
rate is 30-45 QRS complexes are wide no p wave
idioventricular rhythm
55
dyspnea (on exertion) fatiigue chronic cough wheezing and/or rhonchi expectoration of mucus
COPD physical symptoms
56
contraction of bronchial smooth muscle denuded cilia increased secrrethins swelling of mucosa
Chronic bronchitis
57
the acute form of inflammatory polyneuritis of unknown cause effects peripheral nerves ascending paralysis (1-3 wks, recovery 2-4 wks)
Guillan barre
58
T1-T11
intercostals
59
V2, V3, V4
anterior and apical LV
60
left axis deviation
more - than 30
61
V1, V2
right ventricle, RA, LA and ateroseptal LV
62
T8-T12
abdominals
63
represents the time when ventricular cells are in the plateau phase starts at the j point should be isoelectric
ST segment
64
lobar bronchi segmental bronchi subsegmental bronchi
chronic bronchitis
65
place in the midaxillary line at the same horizontal plane as V4
V6
66
The heart rate varies due to reflex changes in vagal tone during the different stages of the respiratory cycle
sinus arrythmia
67
tacycardia
\>100
68
affects airspaces distal to the respiratory bronchile lower loves most affects generally in alpha-1 antitrypsin deficiency
panlobular
69
specific organ dysfunction, cough, dyspnea, and generalized weakness, fatigue, weight loss, malaise, and fever
sarcoidosis
70
a very stretched out unit inceased risk of blow out and increase in pressure cough can cause a blow out
bollous
71
Cuases: ischemia, acute infarct, hypertensive heart disease, reaction to meds (digoxin) Q and blood pressure greatly diminished symptoms are light-headedness and syncope, weak thready pulse, disorientation
V tach
72
tacycardia
\>100
73
respiratorly brochioles alveolar ducts alveolar sacs
emphysema
74
chronic productive cough (generally clear mucus unless infection overweight blue is color to lips and nailbeds peripheral edema in LE d.t Right side heart failure rhonchi and wheezes expiratory phase increased
chronic bronchitis
75
pathologic conditions of the respiratory tract that result directly form the inhalation of gas or particulate matter in the air
environmental lung diseases
76
Chest x ray, MUGA, echo
Ventricular size and EF
77
normal in athletes beta blockers, decreased function of SA node generally asymptomatic unless pathologic may c/o dizziness syncope, angina
sinus bradycardia
78
associations with increased frequency of PVCs
filling time of ventricles is decreased
decreased pre load
decrease SV
Decreased Q (dizziness, SOB)
patient activity can be compromised
exercise should be monitored if pt having isolated or couplet PVCs should be considered serious and can be life threatening Can lead to v-tach
79
Placed in the 4th R intercostal space at the sternal border
V1
80
a negative wave preceding the R wave not all lead record represents septal deviation pathologic indicated MI
Q wave
81
a negative wave preceding the R wave not all lead record represents septal deviation pathologic indicated MI
Q wave
82
C5-C6
Scalenes
83
chronic autoimmune neuromuscular disease varying degrees of weakness of the skeletal muscles of the body weakness increases during levels of activity and improves with rest
myasthenia gravis
84
contraction of bronchial smooth muscle denuded cilia increased secrrethins swelling of mucosa
Chronic bronchitis
85
Bipolar leads
Limb leads
86
MI, CVA, Heart failure fluid overload increases pressure
end stage renal disease
87
P wave is going to be harder to see bc t wave is bigger and can disrupt the p wave visibility generally benign fear anxiety, caffeine, nicotine, amphetamines, or demand so o2 are higher
sinus tachycardia
88
represents the time when ventricular cells are in the plateau phase starts at the j point should be isoelectric
ST segment
89
flow of air is impeded trouble getting air out a long expiratory time
obstructive
90
problems assiciated with a fib
no atrial kick (30% of Q) (last amount of blood from atria to ventricles) if ventricular rate is less than 100 bpm at rest, should monitor with exercise for Q compensation If ventricular rate is greater than 100 bpm at rest, monitoring should be assessed during all activites and engaged in with caution (likely to have Q decompensation)
91
places in the anterior axillarry line at the same horizontal plane as V4
V5
92
left axis deviation
more - than 30
93
indeterminant
between -90 and 180
94
normal finding in children and tall thin adults
R ventricular hypertrophy
chronic lung disease
anterolateral myocardial infaction
left posterior hemiblock
pulmonary embolus
atrial septal defect
ventricular septal defect
causes of R axis deviation
95
C3-C5
diaphragm
96
Placed halfway between V2 and V4
V3
97
Atrial tachycardia has the same causes as PAC but also includes
pulmonary HTN, altered pH and COPD
98
decrrease BP increase performance
ACE inhibitors
99
Unipolar leads all other leads are averaged together to make a reference
augmented voltage leads
100
loss of normal elastic recoil air trapping promotes hyperinflation decreased ERV increased RV decreased bronchial lumen (increase mucus production, inflammed lining, bronchial spasm) respiratory muscle must work harder
COPD phatho
101
erratic quivering of the atria multiple ectopic foci emit electircla impulses no true depolarization of the atria AV not acts to control ventricles
atrial fibrilation
102
all lung disease wheather obstructive or restrictive may lead to
pneumonia
103
Injury
Elevated ST segment greater than 1 mm
104
a systemic autoimmune disease with varied clinical manifestations most common in women of child bearing age chronic with remission and exacerbations
lupus
105
normal finding in children and tall thin adults R ventricular hypertrophy chronic lung disease anterolateral myocardial infaction left posterior hemiblock pulmonary embolus atrial septal defect ventricular septal defect
causes of R axis deviation
106
delayed signal to AV node causes: CAD, infarct, reaction to dig generally asymptomatic unless bradycardia exists can progress
first degree heart block
107
If Q compromise is prolonged
dizziness fatigue SOB
108
left anterior hemiblock
Q waves of inferior myocardial infaction
artificial cardiac pacing
emphysema
hyperkalemia
causes of left axis deviation
109
emphysema
hyperkalemia
lead transposition
artificial caridac pacing
ventricular tachycardia
extreme axis causes
110
how to calculate irregular HR
6 second period
111
a disease cuased by the inhalation of inorganic dust treat sign and symp
pneumoconioses
112
I, aVL
high lateral LV
113
represents depolarization of the atrial myocardium
p wave
114
seen with myocardial ischemia
ST deviation and T wave abnormalities
115
what leads do you look at for axis
I on hoizontal aVF on vertical
116
identify cardiovascular response to exercise low lever GXT prior to d/c from hospital stop at 4-6 METS or 75% APHRM comfortabel walking speed
functional testing with meds
117
non invasive test to determine pumping function of ventircles radioactive tracer injected and gamma camera detects radiation highly accurate
Multi gated acquisition scan (MUGA)
118
normal axis
between -30 and 90
119
represents depolarization of the ventricular myocardium
QRS complex
120
alveolar parenchymal disease enlargement of airspaces distal to terminal bronchiles
Emphysema
121
normal hematocrit
F: 38-47% M: 35-44%
122
emphysema hyperkalemia lead transposition artificial caridac pacing ventricular tachycardia
extreme axis causes
123
a systemic disease with pleuropulmonary manifestations 50% of cases female\> male treat signs and symptoms
rheumatoid disease
124
originates int he AV junction and occurs early or prematurely before the next expected P wave no p wave before 1 complex
premature junctional contraction
125
Echocardiography, contrast echo, cardiac cath
valve integrity
126
normal axis
between -30 and 90
127
batman hat r and r prime see in V5 and V6
Left BBB
128
MUGA, Echo, Ventriculography
cardiac muscle pump
129
a disease that primarily involves the blood vessels and connective tissues resulting in fibrosis of organs F\>M autoimmune problem, no satisfactory tx
scleroderma (progressive systemic sclerosis)
130
may cause hyeremia edema epithelial injury mucosal sloughing coughing dyspnea cyanosis
inhalation of irritant gasses
131
Bipolar leads
Limb leads
132
ischemia
symmetrical T wave inverstion greater than 3 mm in two adjacent leads (greater than 3 mm, diagnositc tests
133
individuals may experience symptoms with this if they are frequent or more serious in nature (decreased Q)
PVC premature ventricular contraction
134
rate of each line to calculate HR
300 150 100 75 60 50
135
lung tissue becomes thickened, stiff and scarred typically strikes people over the age of 65 mean survival is two to three years after diagnosis
pulmonary fibrosis
136
Placed halfway between V2 and V4
V3
137
Advanded age, CHF, ischemia or infarction, cardiomyopathay, digoxin toxicity, drug use, stress pain, renal failure
atrial fibrilation causes
138
starts off primarily negative in V1 and gradually becomes primarily positive with the tallest in V5, V6 If this does not happen may represent infarction or injury of the anterior LV and carries almost as much significance as Q waves
R wave progression
139
hypoxemia (pulmonary arterial hypertension) phycythemia (increased RBC count, increase hemoglobin to increase oxygen content0 viscosity (increased resistance) cor pulmonale respiratory failure
S and S of COPD
140
what info is essential for conducting GXT
medical history
risk factor appraisal
determine level of supervision
absolute vs relative contraindications for GXT
mode and extent of GXT
141
lateral curvature of spine
scoliosis
142
normal PR interval
.12-.2 sec ( no longer than 1 large box)
143
Lead III
left leg + left arm -
144
batman hat r and r prime see in V5 and V6
Left BBB
145
placed in the 5th left intercostal space in the midclavicular line
V4
146
infarct
Q waves that are at least .04 sec wide or 1/3 of the entire QRS
147
how to calculate irregular HR
6 second period
148
pigeon chest
pectus carinatum
149
types of environmental pulmonary pathogns
infections agents
organic dusts
inorganic dusts
gases
150
CHF exercise testing end points
serious dysrhythmias
t wave inversion with significant ST change
Hypotensive resonse
perceived shortness of breath and fatigue
VO2 pead and ventilatory threshold
151
failure of the airways to clear mucus lung function progresses from obstruction to the addition of a restrictive component
CF
152
inflammatory or neoplastic disease of the spinal cord
ALS
153
bradycardia
\>60
154
normal for SA node
60-100 bpm
155
represents atrial depolarization plus the normal delay at the AV node
PR interval
156
Left ventricular hypertrophy calculation
add millimeters of height of the S wave in V1 or V2 with the R wave in V5 or V6 LVH if sum is greater than 35 mm or/ and R wave in aVL is greater than 11 mm
157
what leads do you look at for axis
I on hoizontal aVF on vertical
158
specific organ dysfunction, cough, dyspnea, and generalized weakness, fatigue, weight loss, malaise, and fever
sarcoidosis
159
breathing techniques for COPD
pursed lip tripod educate energy conservation focus on ADLs
160
may decrease bp
diuretics
161
volume of air is reduced trouble getting air in
restrictive
162
place in the midaxillary line at the same horizontal plane as V4
V6
163
Right atrial enlargement
a peaked pointy p wave in II which is greater than or equal to 2.5 mm
164
low levels stress the heart
hemoglobin
165
T8-T12
abdominals
166
diffuse ST effects may increase performance
digoxin
167
intermittent non conducted p waves without progressive prolongation of the PR interval, PR interval is normal and comes at consistent intervals occurs with MI, ishemia/infarct of AV node, digoxin toxicity, symptomatic when HR is low and Q is compromised
second degree type 2
168
begins at the end of the p wave and ends with the onset of the QRS complex should be isoelectric and flat can be elevated with atrial infarct or pericarditis
PR segment
169
time: 1 mm= 1 large box =
.04 sec .2 sec
170
SOA and DOE wheezing audibly coughing caused by hypersensitivity to extrinsic and intrinsic stimuli results in air trapping and increasing RV, increaseing CO2 and decreasing O2 reduction of FEV1 and peak flow (reversible)
asthma
171
thought to be cause by increased air flow and drying of airways can experience without hisitory of diagnosed asthma prevent with proper warm up and pharmacological therampy
exercise induced bronchospasm
172
dry non productive cough skin and bones all energy is used to breathe absent breath sounds espiratory phase increased
emphysema
173
multi system auto immune disease increase production of autoantibodies
systemic lupus erythematosus
174
persistent cough frequent lung infections wheezing or SOB very salty-tasting skin poor growth/weight gain frequent greasy, bulky stools or difficulty in bowel movements
CF
175
represents depolarization of the ventricular myocardium
QRS complex
176
Right ventricular hypertrophy
R wave is bigger than the S wave in V1 and gets progressively smaller through the precordial leads
177
affects respiratory bronchioles, sparing distal alveoli worse in upper loves, particularly apices
centrilobular
178
an acute inflammatory process that effects the gas exhange units of the lungs fluid and RBCs pour into alveoli in response to inflammation
pneumonia
179
starts off primarily negative in V1 and gradually becomes primarily positive with the tallest in V5, V6 If this does not happen may represent infarction or injury of the anterior LV and carries almost as much significance as Q waves
R wave progression
180
Indicators of and adverse prognosis
ishemic ST segment depression at a low lwevel of exercise (heart not meeting demands) functional capacity
181
Elevated= indication of heart failure or renal failure, retention of urea Decreased= starvation, dehydration or organ dysfunction
BUN
182
fasting serum glucose normal
70-100 100-125 prediabetes \>126 diabetes
183
persistent cough frequent lung infections wheezing or SOB very salty-tasting skin poor growth/weight gain frequent greasy, bulky stools or difficulty in bowel movements
CF
184
typically the patient will have severee bradycardia with independent atrial and ventricular rates causes: acute MI, digoxin toxicity, degeneration of conduction system if slow HR, Q diminished, pt may c/o dizziness, SOB and possibly chest pain
third degree heart block
185
reduced lung volumes with normal expiratory flow rates identified by diffuse bilateral persistent interstitial densities
Restrictive lung disease
186
viscosity
hematocrit
187
major complications HTN, pericarditis, bleeding disorders, renal osteodystrophy, proximal myopathy, peripheral neuropathy, immunosuppression
chronic renal failure
188
right axis deviation
more + than 90
189
measure of renal efficiency
\>4 indicated renal insufficiency or failure
creatine
190
Lead 1
left arm + right arm -
191
placed in the 4th left intercostal space at the sternal border
V2
192
what do you count when calculating HR in 6 sec period
cycles not r waves
193
normal for SA node
60-100 bpm
194
chronic autoimmune neuromuscular disease varying degrees of weakness of the skeletal muscles of the body weakness increases during levels of activity and improves with rest
myasthenia gravis
195
time: 1 mm= 1 large box =
.04 sec .2 sec
196
indeterminant
between -90 and 180
197
Placed in the 4th R intercostal space at the sternal border
V1
198
an inherited chronic disease that affects the lung and digestive system (do not process sodium) produce unusually thick, sticky mucus that clogs the lungs and obstructs the pancrreas usually diagnosed by age 2
cystic fibrosis
199
placed in the 5th left intercostal space in the midclavicular line
V4
200
left anterior hemiblock Q waves of inferior myocardial infaction artificial cardiac pacing emphysema hyperkalemia
causes of left axis deviation
201
There are no p waves at all (40-60 bpm) with exercise SOB and chest pain decreased HR: low Q results in dizziness, fatigue
junctional escape rhythm
202
Right ventricular hypertrophy secondary to abnormalities of lung structure and function developing pumlmonary disease results in increasing hypoxemia- constricts the pulmonary system vasoconstircion causes pulmonary hypertension- causes right heart to work harder (peripheral edema)
cor pulmonale
203
places in the anterior axillarry line at the same horizontal plane as V4
V5
204
malaise chills fever cough chest pain dyspnea adjacent pleural lining may gent involved= pleural effusion with destructive changes, fibrous scar tissue develops and there may be measurable loss of lung function
pneumonia
205
instructions before a graded exercise testq
avoid caffeine no meals before wear shorts and comfy shoes
206
normal hemoglobin
F: 12-15.8g/100mL M: 13.3-16.2g/100mL
207
a disease of the neuromuscular junction muscular weakness and fatigue autoimmune disorder may involve respiratory muscles
myasthenia gravis
208
represents repolarization of the ventricles should have the same polarity as the QRS complex very fickle and not as reliable as ST depression or elevation in diagnosis of ishemia
T wave
209
may increase HR but little or no effect on performance
antiarrhythmics
210
caused by pathologic conditions: mitral valve disease, CAD, infarction, stress, renal failure, pericarditis, rheumatic heart disease, MI rapid rate d/t the firing of an ectopic source int eh atria AV node is crucial blocks the signal from getting to ventricles every time asymptomatic
Atrial flutter
211
a chronic productive cough for 3 mo/yr for \>2 consecutive years proliferation of submucosal glands and goblet cells gland to wall thickness \>8:10
chronic bronchitis
212
cardiac enzymes, resting EKG
Acute MI
213
reversible bronchospasm wheezing, obstruction, coughing inflammatory disease
asthma
214
right axis deviation
more + than 90
215
a granulomatous disease of unknown etiology kveim antigen causes development of grnulomas at the site of injection (skin test) fibrosis, slveolitis, scarring, honeycombing per chest x ray
sarcoidosis
216
same causes as PAC but also includes
pulmonary HTN,
altered pH and
COPD
atrial tachycardia
217
causes: right CAD or infarct, digoxin toxicity, and excessive beta blocker
second degree type 1
