Week 3 Flashcards
Automaticity
the heart has the ability to initiate its own electrical impulse
Excitability
heart’s ability to respond to electrical stimulus
Conductivity
allows the heart to transmit electrical impulse from cell to cell of the myocardium
Contractility
heart needs to function as one unit, so contractility allows the heart to stretch as a single unit, then passively recoil while actively contracting – ability to function as a whole unit
Rhythmicity
the heart needs to repeat is cycle in synchrony and with regularity – will have issues getting enough blood down to the heart (arrythmia) – treatment is medication or pacemaker
Which side of the heart is a low pressure system? high pressure system?
Right side of heart: low pressure system
Left side of heart: high pressure system
atrial systole
period of atrial emptying, includes atrial kick – try to make sure atrium is completely empty
atrial diastole
period of atrial filling
What is the 1st reading of BP?
ventricular systole - period of ventricular contraction
What is the 2nd reading of BP?
ventricular diastole - period of ventricular filling
What is heart pump dysfunction?
congestive heart failure
What is container dysfunction?
dysfunction of blood vessels
- HTN will cause vasoconstriction and ischemia
What does anaphylaxis and septic shock cause and lead to?
causes massive vasodilation leading to lethal hypotension
- also known as distributive shock
What is content dysfunction?
dysfunction of blood
- any kind of sustained bleeding or hemorrhaging will cause a loss of blood content
What is mean arterial pressure and what should it be?
measure of tissue perfusion - > 75 mmHg
P wave
atrial depolarization
PR interval
elapsed time between atrial depolarization and ventricular depolarization
QRS complex
ventricular depolarization and atrial repolarization
ST segment
elapsed time between end of ventricular depolarization and beginning of repolarization
QT interval
elapsed time between beginning of ventricular repolarization and end of repolarization
T wave
ventricular repolarization
What does ST depression of 1-2 mm mean?
ischemia
What does ST elevation mean?
MI
What does T wave inversion mean?
MI
What does prominent Q wave mean?
MI
What does a wide QRS mean?
bundle branch block
A-fib EKG
QRS wave is down
V-fib EKG
squiggly mountains
- would need AED to shock rhythm back into rhythm
V-tack EKG
sharp QRS wave up
More than ______ PVS in a minute – stop exercising! Why?
6
- ventricles are not filling all the way and less blood is getting to the tissues
What lab value is used to ID congestive heart failure? What is the cutoff value?
Brain natriuretic peptide (BNP)
- anything under 100 is normal
SaO2 vs PaO2
SaO2 - saturation of peripheral O2 - percentage of available binding sites on hemoglobin that are bound with oxygen in arterial blood
PaO2 - partial pressure of O2 - amount of O2 in arterial blood
What is normal PaO2 and PaCO2?
PaO2 - > 80 mmHg
PaCO2 - 35-45 mmHg
What happens during carbon monoxide poisoning? What device shouldn’t be used and why?
CO bumps O2 off hemoglobin and using a pulse ox will give you a false thinking that the person has O2 in blood
Agonal rhythm
irregular, < 20bpm, near death
Atrial fibrillation - what does it lead to?
most common arrhythmia
- can lead to syncope due to no atrial kick
- found w/ CHF, CAD, HTN, and other cardiac conditions
Ventricular tachycardia
rate > 100 bpm, usually regular rhythm, most common after acute MI
Ventricular fibrillation
chaotic rate and rhythm, will lead to death if untreated
- need shock from AED
Multifocal VT (torsades de pointes)
irregular rhythm and rate > 150 bpm
AV block
rhythm disturbance where electrical conduction from atria to ventricles is partially or completely blocked
What type of tachycardia is a product of exertion and which one is pathological after MI?
exertion - Atrial tachycardia
pathological - V-tach
What position should be avoided with CHF?
supine
What precautions are used after a CABG?
sternal precautions for 8 weeks
What are PT considerations after cardioversion/pacemaker?
closely monitor activity response w/ HR and BP
- know if device has rate modulation
What is AICD/ICD? What are precautions?
automatic cardiac defibrillator
- patient can’t use that arm that pacemaker is on for 1-3 days post surgery
What type of patient uses a life vest? What should you do if walking and it notifies it will apply a shock?
- patient who is high risk for cardiac arrest - awaiting heart transplant or not a candidate for a heart transplant
- If walking a patient and it alerts, sit them down and figure out if shock is necessary or not – can manual override
What is VAD? What are rehab and precautions?
ventricular assist device
- rehab - phase 1-2 cardiac rehab
- precautions - know emergency procedures in case of battery failure, maintain patency of drive lines w/ external pump, monitor hemodynamics
What predicts likelihood of discharge of CAD?
Marburg Heart Score
55+ in men, 65+ in women Known CAD or cardiovascular disease Pain not reproducible by palpation Pain worse with exercise Patient’s assumption that pain is cardiogenic in origin
Cardiac PT Interventions goals
- assess hemodynamic response
- maximize activity tolerance
- patient/caregiver education for activity/behavior modification
Absolute Indications and withhold treatment
- decompensated CHF
- 2nd degree heart block w/ PVC
- 3rd degree heart block
- > 10 PVC/min at rest
- chest pain w/ new ST segment changes
- New onset A-fib w/ rapid ventricular response at rest (HR > 100 bpm)
Relative Indications to modify or withhold treatment
resting HR > 100 bpm
resting HTN > 160 systolic and > 90 diastolic
hypotension at rest (<80 systolic)
ventricular ectopy at rest
A-fib w/ rapid ventricular response at rest (HR > 100 bpm)
psychosis/unstable psych condition
How many beats over resting HR is generally safe intensity level?
20-30 bpm
Patients on beta-blockers: do not exceed____ beats above resting HR
20
AICD: target HR ______ beats below threshold rate on defibrillator
20-30
T/F: You can use HR to prescribe exercise post-heart transplant
False - You CANNOT use HR to prescribe exercise after heart transplant
What is HHR (HR recovery)?
difference between peak HR w/ exercise minus HR at 60 seconds
What is an abnormal response to BP?
- systolic decrease of 10 mmHg below resting
- systolic response >180 mmHg
- diastolic response > 110 mmHg
What is goal of phase 1 cardiac rehab? When does it start?
starts as soon as patient is stable
goal is to tolerate ADL’s, walking functional distances, climbing stairs
- education is essential
What is goal of phase 2 cardiac rehab? When does it start?
starts about 2 weeks after cardiac event
continue patient education and progresses exercises and activities
When does phase 3 of cardiac rehab begin?
usually begins 2-3 months after cardiac event
As O2 stats drop, the patient becomes more what?
acidotic