Cardiac Flashcards
(70 cards)
1
Q
Heart layers
A
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2
Q
Heart chambers
A
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3
Q
Heart valves
A
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4
Q
Circulation
A
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5
Q
Conduction system
A
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6
Q
Baroreceptors
A
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7
Q
Blood pressure
A
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8
Q
Electrical system pic
A
Pic
9
Q
HTN
A
Hypertension - high blood pressure
- systolic: pressure exterted by the heart when it contracts
- diastolic: pressure in arteries and arterioles between heart beats
10
Q
HTN Pic
A
Pic
11
Q
HTN S&S
Risk factors
A
S&S
- most are asymptomatic - dull headaches - dizziness - nose bleeds - sweating (diaphoresis) - flushing - blurred vision - BP >140/90
Risk factors
- genetics - family history - age - stress -lifestyle - diet (high Na+ intake, ETOH) - pre-existing conditions - pre-hypertension (1/3 Americans)
12
Q
HTN treatment
A
Only 54% have it under control
- Lifestyle changes: weight loss, exercise, relaxation techniques, and decrease alcohol consumption, smoking, caffeine intake
- Medications: diuretics, ACE inhibitors, beta blockers, calcium channel blockers
13
Q
Diuretics
A
Removes excess sodium and water through kidneys, blocks their reabsorption
- water pills
- useful in tax of HTN and CHF, increases urine output, reduces blood volume, and edema
- also removes potassium, requires a replacement
- lasix
14
Q
ACE inhibitors
A
Angiotensin-converting enzyme
- prevents an enzyme from producing angiotensin II, a substance that narrows blood vessels and releases hormones that can raise blood pressure
- this narrowing can cause high blood pressure
- captopril, vasotec
15
Q
Beta blockers
A
Block the beta-adrenergic receptors in the heart to prevent increased heart activity
- blocks effects of the hormone epinephrine (adrenaline)
- heart beats more slowly and with less force, reducing blood pressure
- beat blockers also help blood vessels open up to improve blood flow
- very important for us to know when a pt is on this, because HR wont increase with exercise!
- atenolol, lopressor
16
Q
Calcium channel blockers
A
Prevents calcium form entering cardiac and smooth muscle cells (blood vessels), results in lower blood pressure
- relax and widen blood vessels by affecting muscle cells in the arterial walls
- decreases cardiac contactility, helping to prevent arrhythmia
- cadizem
17
Q
CHD
A
Coronary artery (heart) disease
- lack of adequate blood flow to cardiac muscle tissue
- includes angina pectoris, MI, and arteriosclerosis
- risk factors: smoking, high cholesterol, HTN, DM, stress, family history, obesity, and sedentary lifestyle
18
Q
Arteriosclerosis
A
Hardening of the arteries
- idiopathic (multi-factorial)
- over time and too much pressure: walls of the arteries lose their elasticity and become thick and hard
- often associated with HTN
19
Q
Atherosclerosis
A
Most common form of arteriosclerosis
- presence of plaques inside walls of large arteries
- plaque made up of fat, cholesterol, calcium, and other substances found in the blood
- over time plaque hardens and narrows arteries, limits oxygen-rich blood to organs and other parts of the body
- slow, progressive disease
- no symptoms until 75% blockage
20
Q
Risk factors for atherosclerosis
Treatment
A
Age - gender - family history - lifestyle - cigarette smoking - diet - DM - HTN
Treatment
- Lowering cholesterol through diet and/or medication
- decrease sodium intake
- control of high blood pressure
- smoking cessation
- possible surgical intervention
21
Q
Diagnostic test for arteriosclerosis and/or atherosclerosis
A
- blood work to check cholesterol levels
- exercise stress test
- angiogram
22
Q
Cardiovascular changes
A
- Coronary atherosclerosis: most common cause of hospitalization and death in US
- aging: cardiac fibrosis, decreased mochetas and capillary density
- female hearts: smaller, anatomically and hypertrophic stimuli different, left ventricle mass increases with age (estrogen is cardio protective)
23
Q
Angina pectoris
A
Sub sternal chest pain after exertion
- pain or tightness typically on the left side of the chest may radiate to left arm/back/jaw
- dyspnea
- BP may also increase
- pallor
- diaphoresis
- nausea
- cyanosis (blue lips and nails)
- typically a symptom of MI
24
Q
Angina pectoris
- etiology
- precipitating factors
- treatment
A
- Etiology: insuffficient myocardial blood supply, vasospasm, myocardial hypertrophy, respiratory disease, sever anemia
- Precipitating factors: increased activity, emotions, respiratory infection, extreme weather/pollution, large meals
- Treatment: rest, vasodilators, nitroglycerin, avoid stressors, anti-anxiety and stress edu
25
MI S&S
Myocardial infarction
- chest pain - sense of heaviness in chest - nausea/vomiting - arrhythmia - sweating - hypotension - weakness - shortness of breath - light-headedness - Levine sign
26
MI etiology
Most heart attacks are caused by a blood clot that blocks one of the coronary arteries
- most common cause is atherosclerosis
- infarction may develop in 3 ways:
1. Thrombus builds up to obstruct artery
2. Vasospasm occurs
3. Part of the thrombus breaks away forming an embolus
27
MI pathophysiology
- coronary artery is totally obstructed
- heart tissue becomes necrotic
- necrotic zone - area of injury, inflammation, and ischemia around nectroci tissue
- myocardial contractility and conduction lost quickly as O2 supply is depleted
28
MI treatment
- cardiac rehabilitation: exercise program and lifestyle modification
- possible surgery: coronary artery bypass surgery and coronary angioplasty
- medications: aspirin, blood thinners, nitroglycerin, beta blockers, ACE inhibitors, CA channel blockers
29
CABG
Coronary artery bypass graft (open heart surgery)
- veins from pt’s leg grafted to replace damaged coronary artery
- sternal precautions: per surgeon, limites on pulling, pushing, overhead reaching, and driving for 2 months
30
PT for CHD
Be aware of pt’s medications, need for oxygen (at rest and during exercises/activities), dietary restrictions
- DNR do not resuscitate
- DNI do no intubate
31
Phase 1 of cardiac rehab
- takes place in the hospital
- pt edu about life changes
- encourage family support
- educate pt in bed mobility skills
- ankle pumps to prevent DVT’s
- transfer training following sternal precautions
- gait training
32
Phase 2 of cardiac rehab
- takes place in outpatient settings
- education for self monitoring of vitals
- ADLs
- upper body AROM exercises
- treadmill activities
- stationary bike
33
Phase 3 of cardiac rehab
- takes place when the pt is discharged from outpatient PT, but continues in a community based program or voluntary program of a pt’s choice
- pt continues a fitness program and activities of their choice in the community or at home
- progressing after precautions are lifted to resistance exercises
34
Deep vein thrombosis
- most common CV disease after acute conornary artery and stroke
- 30-60% major surgery, CV pathology develop DVT up to 4 weeks after operation or incident
- risk factors: immobility, trauma, lifestyle, hyper-coagulation, >60, DM, genetics (virchow’s triad)
- Tx: anti-coagulation, 24 hours bedrest, compression, heparin, avoid straining activities
- can lead to PT, venous stasis, insufficiency
35
Wells prediction rule
- active cancer (treatment within 6 months or palliation) 1 pt
- paralysis, paresis, or immobilization of lower extremity 1 pt
- bedridden for more than 3 days because of surgery (within 4 weeks) 1 pt
- localized tenderness along distribution of deep veins 1 pt
- entire leg swollen 1 pt
- unilateral calf swelling of greater than 3 cm (below tibial tuberosity) 1 pt
- unilateral pitting edema 1 pt
- collateral superficial veins 1 pt
- alternative diagnosis as likely as or more likely than DVT -2 pt
0 pt = 3% chance
1-2 pt = 17% chance
3+ = 75% chance
36
CHF
Congestive heart failure
- no a specific disease but a complication of HTN and ischemia
- results in the inability of the heart to pump enough blood
- blood backs up into the pulmonary veins
37
CHF
| S&S and treatment
S&S: dyspnea - orthopnea - tachypnea - anxiety - bilateral leg edema - cough - fatigue - diaphoresis - restlessness - confusion
Treatment: exercise - low sodium diet - medications (ACE inhibitor, beta blockers, diuretics in later stage)
38
Valve disorders
| - etiology
When working properly, valves prevent backflow of blood
- tricuspid
- bicuspid / mitral
- aortic and pulmonary SL valves
- etiology: congenital defect into e valve structure, infection or inflammation due to infection, results in inefficient blood flow through the heart and decreased cardiac output
39
Valve disorders S&S
- individuals my be asymptomatic
- fatigue
- heart murmur
- abnormal hear sound
- possible tachycardia
- treatment: valve replacement and meds
40
Endocarditis
1. etiology:
- defective heart valves low virulent (strep) = subacute
- normal valves highly virulent organism (staph) = acute
2. Signs
- subacute: heart murmur, low grade fever, fatigue, anorexia
- acute: sudden spiking fever, chills, drowsiness
3. Diagnosis: blood culture
4. Treatment: anti-microbial drugs, support heart function
41
Arrhythmia
Electrical disturbances
- deviations from normal cardiac rate or rhythm d/t damage to the heart’s conduction system
- arrhythmia reduce the efficiency fo the heart’s pumping cycle
42
Electrocardiogram
A graphical recording of the cardiac cycle
- conduction of impulses in the heart produces an electric current that is picked up by electrodes placed on the skin
- 5 or 12 lead
43
ECG/EKG
Electrocardiogram shows
- speed of heart rate
- rhythm of the heart beat (steady or irregular)
- the strength and timing of electrical signals as they pass through each part of the heart
44
Pic
Pic
45
Bradycardia
Slower than normal heart rate, typically under 60 bpm
- caused by parasympathetic or vagus nerve stimulation
- fainting may occur with sinus bradycardia
- may need a pacemaker
46
Syncope
Fainting
- cardiac syncope: arrhythmias, orthostatic hypotensin, aortic dissection, hypoglycemia, CAD
- vasovagal syncope: systemic vasodilation resulting in cerebral hypoperfusion (abnormal reflex); occurs after prolonged sitting or standing
47
Sinus tachycardia
Rapid firing of the sinoatrial (SA) node
- in response to exercise, exertion, excitement, pain, fever, excessive thyroid hormone, ow blood oxygen (hypoxia), or stimulant drugs (such as caffeine and amphetamines), etc.
- typically over 100 bpm
48
Ventricular tachycardia
Abnormal, rapid heart rhythm originating from the ventricle
| - likely to reduce cardiac output because the filling time is reduced
49
Sinus arrhythmia
A slight variation in cycling of the sinus rhythm
- a normal finding in children and young adults, tends to diminish or disappear with age
- more prominent with fluctuation in the respiratory cycle as heart rate accelerates with inspiration, slows with experiration
50
Atrial fibrillation
Atria beat chaotically and irregularly, out of coordination with the ventricles
- irregular and often rapid heart rate that commonly causes poor blood flow to the body
- common symptoms: heart palpitations, shortness of breath and weakness
51
Premature venricular contraction (PVC)
Extra abnormal heartbeats that begin in one of the two ventricles
- these extra beats disrupt the regular rhythm, sometimes causing a flip-flop or skipped beat
- no preceded by a p wave
52
Ventrículo fibrillation
Life threatening
- abnormal irregular heart rhythm
- very rapid, uncoordinated, fluttering contractions of the ventricles
- most commonly associated with heart attacks or scarring of the heart muscle from previous heart attack
- causes severe hypoxia in the cardiac muscle
53
Echocardiogram
Echo
- ultrasound waves create a moving picture of the heart
- more detailed than a plain x-ray image, no radiation exposure
- see how the heart is beating and pumping blood
- can detect congenital heart defects in unborn babies
54
Cardiac catheterization
Checks for blockages in coronary arteries
- catheter inserted in artery or vein groin, neck or arm, threaded through blood vesssels to heart
- used to located narrowing, aneurysm or blockages in blood vessels by injecting dye
- post op precautions:
1. Prevent bleeding and infection on first day bathroom privileges only
2. For 2 days: no driving, lifting >20 lbs, deep knee bends, or pushing/pulling
55
Angiogram
Die in the heart to see shit
56
Exercise stress test
Max or sub max
- how the heart responds to exertion
- treadmill or pedaling stationary bike at increasing levels of difficulty, while electrocardiogram, heart rate, and blood pressure are monitored
- astrand-rhyming bruce, YMCA, 6 MWT, step test
57
Vasodilators
Dilate coronary blood vessels, reducing peripheral resistance
- work directly on artery wall muscles, preventing them from tightening and narrowing
- results in improved balance between O2 supply and demand; blood flows more easily through the arteries, the heart doesn’t need to pump as heard and blood pressure is reduced
- nitroglycerin
58
Digoxin
To for heart failure and atrial dysrhthmias
- slows conduction of impulses and pulse
- improves efficiency by increasing contractility
- narrow range between efffective and toxic
59
Anticoagulants
Blood thinners
- reduces risk of blood clots in coronary or systemic arteries
- tend to prevent new clots from forming or an existing clot from enlarging
- the don’t dissolve a blood clot
- aspirin, Coumadin
60
Pericarditis
Inflammation of pericardium
1. Pathogenesis: epicardium and parietal pericardium rub together due to edema cardiac tamponase (compression of the heart)
2. Etiology: trauma, viral/bacterial infection, neoplasms, radiation-induced
3. Symptoms: sharp chest pain, aggravated by coughing or in supine
4. Signs: fever, SOB, friction rub (sound)
5. Diagnostic: abnormal ECT, echocardiogram
6. Therapy: rest, anti-inflammatories, NO EXERCISE
61
Myocarditis
- inflammation of heart muscle
- etiology: viral/bacterial/fungal infection
- S&S: chest pain, abnormal heart ear, fatigue, fever, bilateral leg swelling, SOB
- therapy: decrease activities, medications (antibiotic, inflammatory, diuretics)
62
Cardiomyopathy
Disease of heart muscle - enlarged, thick and rigid heart muscle
- etiology: acquired or inherited
- treatment: surgery, devices, lifestyle changes
63
Aortic aneurysm
Dilation and weakening of arterial wall
- etiology: atherosclerosis, trauma, syphilis, infections, congenital HTN
- S&S: palpable pulsating, dysphasia, severe pain
- Diagnosis: radiography, US, CT, MRI
- treatment: surgery, graft, avoid exertion, stress
64
Peripheral vascular disease
1. Arteries: vasculitis, buerger’s disease, arteritis
| 2. Veins: DVT, varicose veins, chronic venous insufficiency, raynaud’s
65
PVD info
- etiology: atherosclerosis
- S&S: intermittent claudicación ( pain with min activity) and wounds
- Surgical treatment: revascularization (by-pass)
- medical treatment: ACE inhibitors, statins, antiplatelet agents
- PT to: supervised exercise training significantly improves walking ability
66
Lymphatic system components
Secondary circulation
- tonsils
- spleen
- thymus gland
- lymph nodes
- lymphatic vessels
67
Lymphatic system functions
Prevents interstitial edema
- assists in the digestion of fats
- immunological functions
- makes WBC
- drains all but CNS tissue in regions
68
Lymphedema defined
- abnormal accumulation of protein rich fluid in the interstitium
- results in chronic inflammation and reactive fibrosis of the tissues
- progressive
- primary
- secondary
69
lymphedema S&S
- onset may be slow or rapid
- progressive
- pitting (varies)
- often starts distally: squaring of toes, stemmer’s sign positive, loss of anatomicalal contours, asymmetrical
- cellulitis
- discomfort is common (heavy, achy)
- skin changes (later stages- hyperkeratosis, papilloma)
- ulceration are unusual
- in contrast with venous disease the skin maintains hydration and elasticity for longer in the disease process
70
5 components of complete decongestive therapy
1. Manual lymph drainage
2. Compression bandaging
3. Exercise
4. Skin and nail care
5. Instructive in self-care
