CARDIO EXAM 1

Question 1

Arteries rely on pressure and contain _______ which is responsible for vasodilation and vasoconstriction.

Answer 1

Smooth Muscle

Question 2

Veins rely on ________to send blood back to the heart.

Answer 2

Muscle Pump

Question 3

Explain the pathway of blood

Answer 3

Heart–> arteries–> arterioles–>capillaries (gas exchange)–> venules–>veins (muscle pump)–>Heart

Question 4

What vessel has the highest pressure?

Answer 4

Aorta, coronary arteries rely on the pressure in the aorta, because coronary arteries fill with blood during diastole.

Question 5

What is considered Pre-Hypertension?

Answer 5

120-139/80-89

Question 6

Stage 1 HTN

Answer 6

140-159/90-99 at this stage want to get the patient on medication

Question 7

Stage 2 HTN

Answer 7

> 159/>99
High BP increases the risk of stroke/MI/HF because it makes the heart work harder, BP wears the endothelial layer of the artery allowing plaque to build up in the walls.

Question 8

What is the function of the Lympthmatic System? And relies on what to function?

Answer 8

Removes waste from tissue. Relies on muscle pump, edema will form if lymphatic system is blocked.

Question 9

What two system relies on muscle pump?

Answer 9

venous and lymph

Question 10

Grading Pitting Edema

Answer 10

1+: Barely perceptible pit
2+: Skin rebounds in less or equal to 15s
3+: Skin rebound in 15-30 s

Question 11

Where are Baroreceptors found and what do they do?

Answer 11

Found in Aortic Arch/Carotid Sinus

When Baroreceptors sense a decrease in BP, there is an increase in sympathetic input increasing HR. Involves CNs 9/10

Question 12

Narrowing of the aorta or aortic valve block, can decrease cardiac output and is normally diagnosed via Heart Catheter. Name the heart condition.

Answer 12

Aortic Stenosis

Question 13

When blood leaks back down into the L ventricle which can lead to decrease in cardiac output and can eventually back up into the L VENTRICLE, causing it to expand leading to ventricular problems. Name the heart condition.

Answer 13

Aortic Regurgitation

Question 14

What heart condition can happen when the valve doesn’t open fully thus restricting blood flow into the L ventricle. The restricting flow causes extra blood to stay in the L atrium, leading to blood backing up into the lungs. Decreasing blood and leading to Pulmonary Edema. Name this Heart condition.

Answer 14

Mitral Valve Stenosis

Question 15

Describes what occurs to the heart when a patient presents with a LEFT Myocardial Infarction near a valve.

Answer 15

Muscle tissue death occurs in an MI, and turns into scar tissue leading to poor contractility and decreases CO. If the MI occurred near a valve or papillary muscles in which hold the valve open this can lead to mitral valve dysfunction.

Question 16

What two valves are most prone to dysfunction?

Answer 16

Mitral and Aortic

Question 17

Blockage of the Circumflex artery can result in what type of disorder? And what will the examiner hear upon palpation?

Answer 17

Damage to Circumflex artery suppilies lateral wall and papillary muscles that hold the valve open and can cause a dysfucntion in the valve itself. If the papillary muscles can’t function the mitral vlave may cause leakage during contraction of the L ventricle causing blood to travel in reverse.

Diagnostically we can assess this condition by auscultating patient’s heart sound. Examiner would hear ‘LUSH DUB” after S1

Question 18

Heart Sound: S1

Answer 18

Closing of the tricuspid and mitral valve corresponds with systole, ventricular contraction. S1 is heard louder at the APEX of the heart

Question 19

Heart Sound: S2

Answer 19

Closing of the Aortic and Pulmonic Valves, corresponds with Diastole or ventricular filling, DUB at the 2nd intercostal space

Question 20

Heart Sound: S3

Answer 20

Extra Heart sound after the lub-dub (indicative of HF)

Question 21

Where are the SA and AV node found and note the importance of the location?

Answer 21

R atrium, so problems with atria will most likely produce an arrhythmia

Question 22

RCA (Posterior Descending and R Marginal A) supplies what part of the heart?

Answer 22

RA, Both ventricles (more RV) and back of the septum

Question 23

Leads II, III and aVF correspond with

Answer 23

RCA

Question 24

Blockage of the RCA can lead to?

Answer 24

Increase risk of AV block or arrythmias, 50% of patients have a R ventricle infract

Question 25

Left Main Coronary Artery Supplies what part of the heart?

Answer 25

Anterior and Lateral

Question 26

LAD supplies

Answer 26

70% of left ventricle and anterior portion of the heart

Question 27

Circumflex supplies

Answer 27

the lateral portion of the heart (papillary muscles)

Question 28

Leads V1-V6, I, aVL correspond with

Answer 28

Left Main Coronary Artery

Question 29

Leads V5,V6, aVL, I

Answer 29

Circumflex artery

Question 30

Leads V1-4

Answer 30

LAD

Question 31

Which arteries if damaged can lead to pump dysfunction or failure?

Answer 31

Left main coronary artery/LAD

Question 32

Which artery if damaged can lead to mitral valve regurgitation?

Answer 32

circumflex

Question 33

P wave corresponds with

Answer 33

Atrial Contraction

Question 34

QRS wave corresponds with

Answer 34

Ventricular contraction/Atrial Repolarization

Question 35

T wave corresponds with

Answer 35

Ventricular Repolarizaiton

Question 36

What % of blood fills the heart during passive filling?

Answer 36

80% and 20% of blood comes into the heart during atrial contraction

Question 37

Cardiac output is defined as how much blood the heart pumps tot he body per heart beat, what is normal resting CO?

Answer 37

5L/min

Question 38

Cardiac output is defined as how much blood the heart pumps to the body per heart beat, what is CO with exercise?

Answer 38

25-30 L/min

Question 39

End volumetric pressure that stretches the R/L ventricle. Amount of blood sitting in the heart right before it contracts is defined as

Answer 39

Preload

Question 40

An increase in preload will do what to SV and CO? Decrease blood volume will do what to preload?

Answer 40

increase, decrease

Question 41

What is the Rate Pressure Product and what does it determine?

Answer 41

SBPxHR, determines the myocardial oxygen demand on the heart. If patient can't meet the work load demands then they can develop ischemic pain.

Question 42

Name that factors that affect stroke volume?

Answer 42

Change in position because blood rushes towards the legs, fluid intake, dehydration, strength of pump

Question 43

Alpha 1 receptors are located in

Answer 43

the vasculature

Question 44

Beta 1 Receptors are located in

Answer 44

the heart

Question 45

Beta 2 Receptors are located in

Answer 45

the lungs, stimulation causes bronchodilation

Question 46

What value do we want to keep total cholesterol under?

Answer 46

under 200

Question 47

What is the optimal LDL value?

Answer 47

less than 100, above 190 is very high

Question 48

What leads to plaque formation because they stick to the walls of the vasculature, causing blockages.

Answer 48

LDL

Question 49

Known as the "Pac-man" What helps clean up plaque and debri in the arterial walls and then carries it to the liver. And if low levels are found in the patient's blood can lead to greater plaque formation?

Answer 49

HDL

Question 50

Increased levels of this lipid can lead to increased deposits on arterial walls forming plaque like lesions that can occulde the lumen?

Answer 50

Triglycerides

Question 51

Increased levels of glucose can be indicative of what two problems?

Answer 51

diabetes or acute MI, can lead to plaque formation

Question 52

This lab value is indicative of Myocardial Damage

Answer 52

CK-MB

Question 53

What are considered the 2 cardiac enzymes?

Answer 53

Ck-MB, Troponin

Question 54

Which of the 2 cardiac enzymes is the fastest indicator that there is heart damage?

Answer 54

troponin Shows up quicker in the blood around 15 minutes

Question 55

Percent of red blood cells in the blood important for oxygen transport to the tissues.

Answer 55

Hct

Question 56

Oxygen-transport protein in the blood, if low hinders oxygen transport

Answer 56

Hb

Question 57

This lab value is known as the chemical purines found in substances like alcohol, most is dissolved in the blood and travels to the kidneys to be passed through the urine, if high indicative of kidney failure? And in what condition is this usually high?

Answer 57

Uric Acid

Question 58

Low Na/K are indicative of what?

Answer 58

low electrolyte imbalance. Note water follows sodium so if there is a decrease in sodium there is most likely a decrease in blood volume and in turn a decrease in BP. Body wants to maintain H20 in order to maintain adequate blood volume levels.

Question 59

High BUN indicates

Answer 59

Descreased kidney function

Question 60

What is considered the "gold standard of HF" specific to the ventricles also can be released in CAD where there is ischemia.

Answer 60

BNP

Question 61

What level of BNP is considered decompensated heart failure?

Answer 61

700

Question 62

PT/PTT if increase what does that mean

Answer 62

the time it takes for blood to clot, common increase in blood clotting time due to patients taking anti-congualnts.

Question 63

What lab value if increased is indicative of liver damage?

Answer 63

Bilirubin

Question 64

What lab value if decreased is indicative of a liver issue, malnutrition, or decreased absorption in the GI?

Answer 64

Albumin

Question 65

Restriction of blood supply to the myocardium resulting in decreased oxygen to the tissue is defined as ?

Answer 65

Ischemia

Question 66

Cardiac cell death is defined as?

Answer 66

Myocardial Infarct

Question 67

The heart is unable to provide the sufficient pump action to maintain blood flow to meet the demands of the body is defined as?

Answer 67

congestive heart failure

Question 68

List the common ischemia symptoms for MEN?

Answer 68

- ->Left or R arm pain, Numbness - ->Jaw pain - -->chest tightness (angina)

Question 69

Pain above the chest that doesn't go away is known as an

Answer 69

infarct

Question 70

Pain above the chest that goes away with rest

Answer 70

ischemia

Question 71

Ischemia symptoms for Women?

Answer 71

Number 1 symptom is fatigue (that is not specific) Pain between the scapulas Unexplained weakness GI issues

Question 72

Ischemia symptoms for Diabetics?

Answer 72

SOB (due to decreased sensation diabetics don't report chest pain)

Question 73

STEMI (Segment Elevation Myocardial Infarction) what is it and what is noted?

Answer 73

Due to complete occlusion of coronary artery, full thickness damage. Seen: ST Elevation Q wave Tissue damage through entire thickness of muscle tissue, results in complete occlusion of artery

Question 74

Non STEMI Transmural (MI) what is it and what's noted?

Answer 74

ST depression, T wave inversion, No Q wave

Question 75

Patient walks into your clinic complaining of generalized "heavy pain" that is rarely sharp in shoulder and jaw region. He also complains of chest tightness and pressure? What type of pain is this?

Answer 75

Cardiac pain

Question 76

Patient walks into your clinic and tells you they have pain when taking deep breaths in. What type of pain is this?

Answer 76

Lung pain

Question 77

Pain that is localized and is usually increased with palpation over the chest wall is

Answer 77

musculoskeletal in nature

Question 78

What is the difference between unstable angina and stable angina?

Answer 78

unstable angina patient has pain at rest and stable angia just has pain with exertion

Question 79

Can you mobilize patient's with decompensated HF?

Answer 79

no, because they are symptomatic at rest! (compensated HF they are asymptomatic at rest)

Question 80

Positive Iontotrope

Answer 80

Improves Heart Contractility (caffeine)

Question 81

Positive Chronotrope

Answer 81

Increases HR

Question 82

Peripheral Edema is a sign of what type of HF?

Answer 82

Right HF

Question 83

Pulmonary Edema is a sign of what type of HF?

Answer 83

LEFT

Question 84

What are the 3 Anti-Angina Meds?

Answer 84

Beta Blockers (allows more time for ventricles to fill) Nitrates Ca Channel Blockers

Question 85

Cardiac Failure Cocktail of Drugs?

Answer 85

Diuretics Ace Inhibitors Beta Blockers/glycosides

Question 86

Diagnosing an MI (name 3 things you want to look for)

Answer 86

- symptoms greater than 20 minutes - Changes in ECG - Heart Enzymes released (seen in lab values)

Question 87

List 5 main signs of Heart Failure

Answer 87

1. Rapid Breathing at rest 2. Rales with pulmonary EDEMA (L) 3. S3 Heart sounds (heard after S2) 4. Jugular venous Distension with R HF 5. Weight gain greater than 3 pounds in a day due to peripheral edema (R HF)

Question 88

Patient presents with irregular beats, palpable skipped beats and is symtompatic. The PT is concerned and would like to assess the patient's arrhythmias during a 24 hour period. What is the best assessment tool?

Answer 88

Holter Monitor (portable device for continous moonitoring of electrical activity of the CV system)

Question 89

Examiner has patient walk on a treadmill for 3 minutes then has the patient walk faster on an incline and use ECG and BP to note the response what test is he performing?

Answer 89

Exercise Stress test

Question 90

A non-invasive procedure that looks at the size of ventricles, valve function and Ejection fraction?

Answer 90

Echo

Question 91

What type of diagnostic test is considered a routine procedure upon hospital admission?

Answer 91

Chest -XRay (heart should be 1/3 the width of the chest) also note shape of diaphragm, costodiaphragmatic angle to assess fluid in the lungs or hyperinflation of the lungs.

Question 92

This diagnostic test is used to look at the hearts electrical activity currently or to not what past events affected the conductivity?

Answer 92

12-lead ECG

Question 93

This test looks at blockages of the arteries directly and id done usually after an abnormal stress test or abnormal ECG as it is more invasive

Answer 93

Coronary Catheritization (can also put a camera or US on top of a cath to view vessel blockage)

Question 94

This test is used for lung assessment during inspiration?

Answer 94

Incentive Spirometry

Question 95

CABG surgery is usually done by grafting what type of vessel into the damaged artery?

Answer 95

Radial Artery has 92% patency after sx, note when PTs work with these patient and you are moblizing them they may have wrist pain due to the sx so becareful when using a walker.

Question 96

What is the most Common complication after CABG sx besides infection?

Answer 96

Plueral Effusion, the sternal incision makes it harder for patient to take deep breathes.

Question 97

ON PUMP vs. OFF PUMP procedure

Answer 97

On PUMP: Stop heart, use machine to circulate major complication is blood flow to the brain. Want to assess cognitive condition of these patient's OFF-PUMP: Heart is still beating, can't do on everyone because it depends on where the patient needs the bypass surgery. This procedure needs to be done in a certain about of time.

Question 98

Catheter with balloon attached to flatten plaque build up along the arterial walls

Answer 98

Angioplasty

Question 99

Wire/Mesh structures that keep arteries open after angioplasty

Answer 99

STENT

Question 100

Allows for pressure to stay up in aorta, inflates during diastole. The increased pressure in the aorta and increasing blood flow back into the coronary arteries which increases oxygen profusion to the myocardium. Can't mobilize if placed in LE

Answer 100

IABP

Question 101

Name 4 Sternal Percautions

Answer 101

1. No ABD/Flex greater than 90 2. No lifting 5-10 lbs 3. No driving 4. Everything bilateral use * *refer to recommendations of surgeon

Question 102

Used with patients that have life threatening arrhtymias

Answer 102

AICD (implantable internal defib)

Question 103

For DVTs what 2 main assessments or tests would help you determine if the patient has a DVT.

Answer 103

Doppler/US and RISK ASSESSMENT!