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Cardiopulmonary Diagnostics > Test weeks 4-8 > Flashcards

Test weeks 4-8 Flashcards

1
Q

Heart Sounds

A

S1 - mitral and tricuspid valves
S2 - systole ends, pulmonic and aortic valves close
Normal Lub Dub

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2
Q

Heart Sounds

A

S3 - suggest CHF
S4 - cardiac abnormality MI or cardiomegaly
Both hard to hear

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3
Q

Murmur

A

Abnormal heart sound caused by turbulent flow

  • valve defects or congenital abnormalities
  • blood pushed through abnormal opening, like a shunt
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4
Q

ECG or EKG

electrocardiogram

A

indirect measurement of the hearts electrical activity

12 lead is 12 different angles of the heart

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5
Q

What does the EKG show?

A

blocks, ST and T changes, MI vs injury, disrhythmias, change in medication and electrolytes

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6
Q

Indications for EKG

A

Signs/symptoms of CHF, Angina, Acute MI

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7
Q

SA Node

A

Main pacer of the heart 60 - 99 bpm

P with every QRS means SA is firing

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8
Q

AV Node

A

secondary pacer if SA fails
PR is measured beginning of P to beginning of Q
40 - 60 bpm

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9
Q

Internodal and interatrial pathways

A

AV Node
Bundle of HIS
Perkinje Fibers

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10
Q

1st - Depolarization

A

Contraction

P and QRS wave

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11
Q

2nd - Repolarization

A

Relaxation
returning to polarized position
T wave

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12
Q

Automaticity

A

Cardiac cells depolarize without stimulation of nerve

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13
Q

Conduction system

A

responsible for controlling rate at which the heart contracts

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14
Q

ST segment

A

Beginning of S to beginning of T

*when not enough O2, ST seg will be depressed

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15
Q

Normal Sinus Rhythm

A 
Regular
60 - 100 bpm
QRS Normal 
Pwave visible before each QRS
PR interval normal
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16
Q

Sinus arrhythmia

A 
60 - 100 bpm
irregular
P wave uniform and upright
PR interval 0.12 - 0.20 sec
QRS < 0.10 sec
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17
Q

Super Ventricular Tachycardia

A 
Rate > 150 bpm
Narrow QRS
P & T close together
"Bear Down" vagal response
(amiodarone)
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18
Q

Atrial Flutter

A 
Regular
Rate around 110 bpm
QRS normal
P wave replaced w/multiple F (flutter) waves ratio 2:1
(2F:1QRS)
P wave 300 bpm
PR interval not measurable
sometimes sawtooth
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19
Q

1st Degree AV block

A 
Regular
Rate normal
QRS normal
P wave 1:1, normal rate
PR interval prolonged (>5 small squares)
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20
Q

2nd Degree Block Type 1 (Wenkebach)

A 
Regularly irregular
Rate normal or slow
QRS normal
P wave 1:1, normal rate, faster than QRS
PR interval progressive lengthening until QRS is dropped
*decreased CO
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21
Q

2nd Degree Block Type 2

A

Regular
Rate normal or slow
QRS prolonged
P wave 2:1 or 3:1, normal rate, faster than QRS
PR interval normal or prolonged but constant
*ischemia

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22
Q

3rd Degree Block (Complete)

A 
Regular 
Rate slow
QRS prolonged
P wave unrelated, normal rate, faster than QRS
PR interval variation
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23
Q

Complete AV block

A

no atrial impulses pass through the atrioventricular node and the ventricles generate their own rhythm

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24
Q

Premature Ventricular Contractions

A 
Regular
Rate normal
QRS normal
P wave 1:1, normal rate, same as QRS
PR interval normal
*Ventricle fires early, one up, one down
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25
Q

Ventricular Tachycardia

A 
Regular
180 - 190 bpm
QRS prolonged
P wave not seen
*decreased CO, BP, cardiovert
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26
Q

Ventricular Fibrillation

A 
Irregular
300+ bpm
QRS not recognizable
Pwave not seen 
DEFIBRILLATE!
heart is quivering
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27
Q

Asystole

A 
Rhythm flat
Rate 0
QRS none
P wave none
*carry out cpr, check leads!
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28
Q

Bundle Branch Block

A

an impulse is blocked as it travels through the bundle branches

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29
Q

Right Bundle Branch Block

A

branch defective so that the electrical impulse cannot travel through it to the right ventricle, activation reaches right ventricle by proceeding from the left ventricle
Travels through septal and right ventricular muscle mass

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30
Q

Left Bundle Branch Block

A

Activation of left ventricle is delayed, which results in the left ventricle contracting later than the right ventricle
LBBB is seen in lead V5 and V6

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31
Q

Junctional

A

AVN firing faster than SN resulting in a regular narrow complex rhythm
Maybe demonstrate retrograde P waves, or not present
rates 40 - 60 bpm
LOOKS NORMAL, OR PWAVE MISSING OR INVERTED

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32
Q

Symptoms of Junctional

A 
Palpitations
Fatigue
Light Headed
Dyspnea
Poor exercise tolerance
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33
Q

Holter Monitor

A

Detects arrythmias not seen on resting EKG
Take home EKG
outpt procedure
Provides continuous electrical recording 24-48 hrs
Activity, Sleep, Rest
Combines EKG during ADL

34
Q

Echocardiogram

A 
Non-invasive, uses sound waves
Observes heart structures
Function of the heart
ventricular and valve
Blood flow, direction, amount
35
Q

Why Echo?

A

Pericardial effusion/pericarditits
Valvular heart disease
Cardiac tumors/blood clots
Septal wall defects - VSD, ASD, congenital

36
Q

Types of Echo tests

A

M-Mode echocardiogram
2D
Color doppler (red and blue indicate flow direction)
Trans-esophageal (TEE) (better visualization, no bones or lungs, visualize back of the heart)

37
Q

Cardiopulmonary Exercise Test (CPET)

A

Graded or steady exercise test with EKG and pulmonary gas exchange assessment
Mouthpiece or face mask collects exhaled gas

38
Q

Pulmonary parameters measured during CPET

A

Minute vent
SpO2, ABG, PETCO2, Vd/Vt
CO2 production, O2 consumption
FVC and FEV1 measurements pre and post exercise

39
Q

Cardiac parameters measured during CPET

A

HR and rhythm, BP

40
Q

Indications for CPET

A 
Explain dyspnea and limiting activity
Rule out cardiac disease w/lung disease
Establish occupational disability
Rule out exercise induced hypoxemia
Obtain baseline exercise level
41
Q

Other indications for CPET

A

Pre-evaluation assessment

  • Pulmonary rehab
  • Cardio - thoracic surgery
  • Fitness program
  • Endurance training
42
Q

Relative contraindications for CPET

A 
Physical limitations
-Arthritis, osteoarthritis of lower extremities
-Recent surgery of lower extremities
-Hip, knee, joint pain
Cerebral vascular disease
Syncope
Pulmonary Related
-FEV1 < 30% predicted
-PaO2 < 40 mmHg on RA
-PaCO2 > 70 mmHg
-Recent pulmonary embolus
-Severe pulmonary hypertension
43
Q

Absolute Contraindications for CPET

A 
Cardiac Related 
-recent MI
-Unstable chest pain suspicious of cardiac pain
Uncontrolled hypertension
-SBP > 200 mmHg, DPB > 110 mmHg
COPD exacerbation
Rapid atrial or vent arrhythmias
Recent systemic embolus
Severe CorPulmonale
44
Q

Personnel for CPET

A

2 experienced clinicians and MD

  • BLS/ACLS certified
  • RT
  • RN
  • Exercise physiologist
45
Q 
Testing parameters for CPET
Minute Ventilation (Ve)
A

Ve increases directly with increasing workload and increase in CO2 production
-Predicted Ve max (MVV) = FEV1 x 35
Measured by electronic flow transducer
At rest 6 - 12 lpm
-during exercise >/= 100 lpm (avg sedentary)
->/= 200 lpm conditioned athlete

46
Q 
Testing parameters for CPET
Oxygen Consumption (Vo2)
A

Volume consumed or used during exercise
Single best measure of work being performed
-Normal resting Vo2 is 3.5 ml/min
-To measure Vo2, exhaled gas is accumulated
Vo2 = FeO2-FeCO2/FiO2

47
Q

Metabolic Equivalents (METS)

A

Amount of oxygen being consumed to perform a particular activity
Resting metabolism = 1 MET (Vo2 3.5 ml/kg)
Healthy sedentary should be able to work up to 7 METS

48
Q

VO2 Max

Maximum Oxygen Consumption

A

Highest amount of oxygen extracted by the body from the volume of air breathed into the lungs
-Level at which symptoms become overwhelming

49
Q

Predicted VO2 max

A 
Based on age, height, gender
-Young adults 80 ml/kg
-Seniors 30 ml/kg
-Presence of disease < 30 ml/kg
Vo2 max (act) / Vo2 max (pred) = % pred
Normal is >/= 80% predicted
50
Q

VcO2

Carbon Dioxide Production

A

Reflection of metabolism during activity

  • measured via exhaled gas sampling
  • VcO2 = (FeCO2 - 0.0003) x Ve
  • VcO2 rises directly with workload
  • Ve rises directly with VcO2 and lactic acid production
51
Q

Normal exercise physiology

A

Exercise increases metabolic need of the tissues for O2 (aerobic metabolism)

  • both the lungs and cardiac system must be able to meet these demands
  • Pulm system increase oxygen availability by increasing Ve (IRV) and Zone 1 and 2 perfusion
  • Cardiac system increases oxygen delivery by
  • -increasing HR and SV = Increasing CO
52
Q

Normal exercise physiology (cont’d)

A

As workload is steadily increased, O2 consumption continues to rise until Vo2 max is reached

  • VcO2 continues to rise until the body cannot perform work aerobically
  • Body then switches to anaerobic metabolism (anaerobic threshold - AT)
53
Q

Anaerobic Threshold (AT)

A

Anaerobic metabolism

  • Producing work without oxygen
  • Producing more CO2 than consuming O2
  • Occurs at about 60 - 70% of Vo2 and Ve Max
  • can only maintain continued exercise for a short duration (exhaustion)
  • Occurs where Ve rises sharply in contrast to VO2 consumption
  • Point where Ve breaks away from the linear relationship with Vo2
54
Q

Respiratory Exchange Ratio (RER)

A

RER = VcO2/VO2

  • Normal aerobic RER will be 0.7 - 0.9
  • RER increases from 0.7 (at rest) with increasing workload as CO2 production increases
Anaerobic metabolism (AT) the RER will be > 1.0 due to CO2 production 
 - Good indicator of maximal effort by patient during testing
55
Q

Treadmill Protocols

A
  • Use of standard walking treadmill (more natural)
  • Work (METS) are increased by
    • Increasing treadmill speed and grade
    • Graded levels are usually spaced 2-3 minutes
  • Work levels are increased until
    • Pt cannot tolerate
    • Abnormal response occurs
    • VO2 Max or HR Max achieved
56
Q

Stationary Cycle Ergometry

A

Increase workloads expressed as “watts”
- Wheel belt tension increased every 30 seconds to 4 minutes making pedaling more difficult

In most people, cycling does not produce a high VO2 as the treadmill

  • set supports pt’s weight
  • Pts with difficulty ambulating, obese pt
57
Q

Advantages

A

Treadmill - natural form of exercise, Higher Vo2 Max

Cycle - Safer than treadmill, easier to monitor, easier to obtain ABG

58
Q

Disadvantages

A

Treadmill - Risk of accident, pt. anxiety, motion artifact, ABG difficulty

Cycle - Legs fatigue more quickly, Lower VO2 Max

59
Q

Testing procedure

A 
Baseline Data
 - 3 minute resting data
Active exercise data
 - VO2, VCO2, Ve, HR, RR, SpO2, RER
 - Parameters taken at 1 minute intervals during staging
Cool down and Recovery Care
 - ABG, spirometry, B2 if needed
60
Q

Indications for test termination

A

Patient exhaustion, fatigue, dyspnea, pain
Vo2 Max or AT has been reached
Heart Rate and rhythm changes
- Reaches predicted HRmax (220 - age)
- ST segment decreases by 2 mm
- Chest pain
- Blood pressure changes
- systolic drops by 20 mmHg or no increase
- systolic > 250; diastolic > 120 mmHg

61
Q

Normal Response to Test

A

Predicted VE Max is reached
- Ve will increase at onset of anaerobic metabolism due to the increased CO2 production
Cardiac
- Increase systolic blood pressure
- Minimal to no increase in diastolic pressure
- HR increases with Vo2 until max HR is reached

62
Q

Normal Response to Test (con’t)

A 
Increase in 
 - SpO2 slightly
 - PaO2
 - Lactic Acid
 - BP & HR 
 - RR & Ve
 - Vo2 & VCO2
Decrease in 
 - pH
 - Vd/Vt
 - PaCO2
63
Q

Normal Response to Test (cont’d)

A
  • Exercising causes HR to increase linearly

- HR will continue to increase linearly until max predicted HR is reached

64
Q

Sedentary Response

A

HR will increase linearly with VO2, however it is greater at each level of VO2 (outside the normal range)

BP and SpO2 will have a normal response

65
Q

Pulmonary Interpretation

A

Pulmonary Limited Exercise

  • Vent limited
  • did not reach VO2 Max due to breathing impairment
  • Did not achieve anaerobic threshold
  • Ve max is greater than 70% of their MVV
  • Increased Vd/Vt
  • PaO2 will decrease
  • PA-aO2 will increase
  • EKG normal
  • HR max is less than 85% predicted HR at completion
66
Q

Pulmonary Limited Exercise Prescription

A

Pt. should spend 5 minutes in warm up activities
Pt. should exercise 20 min at target HR
- target = (Max HR - Resting HR) .70 + Resting
Pt. should spend 5 minutes in cool down activities

67
Q

Benefits of Exercise Program

A

COPD pt will have increased

  • exercise tolerance
  • overall strength
  • oxygen use efficiency
  • quality of life

Decreased dyspnea

68
Q

Cardiac Interpretation

A

Cardiac Disease Limited

  • Circulation (CO) Limited
  • HR max achieved sooner than Ve max or VO2 Max predicted
  • Ve max is less than 50% of their MVV
  • EKG shows arrhythmia, ST changes, or both
  • Systolic pressure drops
  • Diastolic pressure increases
69
Q

Deconditioned Interpretation

A

Deconditioned subjects

  • have same response as CV except the EKG is normal
  • HR max reached before Vo2 max
  • Dyspnea limitation
  • Leg cramping
70
Q

What does Neurological assessment evaluate?

A
  • Mental Status
  • Cranial nerve function
  • Motor system
  • Coordination
  • Sensory pattern
  • Reflexes
    Meaningful neurologic assessment requires adequate stimulation
71
Q

Nervous System

A
  • Afferent (periphery to CNS)
  • Efferent (CNS to rest of body)
  • Review brain
  • Brainstem
72
Q

BIS

A 
band on forehead
monitors sedation
LOC > 60 not sedated enough
Brain waves measure electrical activity
< 20 - 10 too much sedation
73
Q

Brainstem

A

Midbrain
Locus coeruleus
Pons
Medulla

74
Q

Hypothalamus

A

Temperature

75
Q

LOC

A

Level of consciousness

76
Q

Lethargic

A

sleepy, but can awake and answer questions

77
Q

Obtunded

A

needs more stimulation

can do simple commands

78
Q

Stupor

A

constant pain stimulation to answer

no commands

79
Q

Persistent vegetative state (coma)

A

unresponsive to stimulation

80
Q

Glasgow Coma Scale

A

Assesses the LOC after head injury
tests verbal, motor, eye opening, etc.
12 - 15 good, non-icu
<9 Coma

Delirium - longer stay in icu, 60 - 80% of MV pts.

Cardiopulmonary Diagnostics (6 decks)

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