Cardio - exam Flashcards
(83 cards)
1
Q
Blood Pressure (BP)
A
Definition: Force of blood against arterial walls
BP = CO × TPR (Cardiac Output × Total Peripheral Resistance)
2
Q
Systolic
A
Pressure during heart contraction
top number
3
Q
Diastolic
A
Pressure during heart relaxation
bottom number
4
Q
Heart Rate (HR)
A
Number of heart beats per minute (bpm)
5
Q
Normal Resting HR:
A
Adults: 60–100 bpm
Athletes: 40–60 bpm
6
Q
↑ HR =
A
sympathetic activation, fever, stress
7
Q
↓ HR =
A
parasympathetic tone, medications (e.g., beta-blockers)
8
Q
Rate Pressure Product (RPP)
A
Index of myocardial oxygen demand
RPP = HR × SBP (systolic BP)
Used in: Cardiac rehab, angina thresholds
9
Q
Higher RPP =
A
↑ cardiac workload
heart is pumping harder to meet increased demands
In a healthy individual, this is a positive training response
Over time, regular aerobic exercise lowers resting RPP — a sign of improved cardiac efficiency
10
Q
Heart Sounds
A
S1
S2
S3
S4
11
Q
S1
A
(“lub”)
Closure of mitral and tricuspid valves (start of systole)
12
Q
S2
A
(“dub”)
Closure of aortic and pulmonic valves (start of diastole)
13
Q
S3
A
Early diastole — may be normal in young athletes or indicate CHF
14
Q
S4
A
Late diastole — associated with stiff ventricle, e.g., HTN or MI
15
Q
Auscultation Sites
A
aortic valve
pulmonic valve
tricuspid valve
mitral valve
16
Q
Aortic valve:
A
2nd right intercostal space, sternal border
17
Q
Pulmonic valve:
A
2nd left intercostal space
18
Q
Tricuspid valve:
A
4th L intercostal, sternal border
19
Q
Mitral valve (apex):
A
5th L intercostal, midclavicular line
20
Q
Cardiac Output (CO)
A
Volume of blood pumped per minute
CO = HR × SV (stroke volume)
21
Q
Cardiac Output (CO)
increases:
decreases:
A
Normal: ~4–6 L/min at rest
Increases with: Exercise, sympathetic activity
Decreases with: Heart failure, blood loss
22
Q
Incremental Exercise Response
🫀 Heart Rate (HR)
A
Increases linearly with increasing work rate
Driven by sympathetic activation and reduced parasympathetic tone
Plateaus near VO₂ max (usually ~100% max effort)
23
Q
Incremental Exercise Response
💧 Cardiac Output
A
Increases linearly with work rate
Initially due to ↑ stroke volume
Later stages mainly due to ↑ HR
Plateaus at max exercise (typically coincides with HR plateau)
24
Q
Incremental Exercise Response
🩸 Blood Pressure
A
Systolic BP = Increases linearly (More forceful contraction → higher pressure during systole)
Diastolic BP = Stays relatively stable (±10 mmHg)
Mean Arterial Pressure (MAP) = Increases slightly with intensity
25
What is the MOST APPROPRIATE to measure the increased metabolic demand placed on the heart?
Rate Pressure Product (RPP)
It directly reflects myocardial oxygen consumption (MVO₂).
26
"Which of the following values is MOST useful for assessing peripheral vascular resistance at rest?"
Diastolic Blood Pressure
Diastolic BP is more influenced by total peripheral resistance (TPR)
Useful for identifying conditions like hypertension or arterial stiffness
27
"Which of the following is MOST appropriate to monitor exercise intensity in a healthy adult during submaximal aerobic exercise?"
Heart Rate
Heart rate increases in direct proportion to exercise intensity
Commonly used in target HR zone training and RPE monitoring
28
"Which of the following is MOST appropriate to monitor the cardiovascular system's pressure response to exercise?"
Systolic Blood Pressure
Systolic BP reflects the force the heart generates to pump blood during contraction
It increases linearly with exercise and helps assess hemodynamic response
29
6MWT
measures submaximal aerobic endurance, and the distance walked is the key outcome (400-700m = norm)
can quantify functional limitation and aerobic capacity, but not diagnose the cause of dyspnea
commonly used in CHF, COPD, post-COVID, and transplant rehab
30
Normal BP =
Less than 120/80 mm Hg
31
Elevated BP =
Systolic between 120-129 and diastolic less than 80
32
Stage 1BP =
Systolic between 130-139 or diastolic between 80-89
33
Stage 2 BP =
Systolic at least 140 or diastolic at least 90 mm Hg
34
Hypertensive crisis:
Systolic over 180 and/or diastolic over 120, with patients
needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage
35
Sympathetic Nervous System (SNS)
"Fight or Flight" = ↑ HR & BP
Beta-1 adrenergic receptors in the heart
NT: Norepinephrine (NE)
↑ Heart rate (chronotropy)
↑ Contractility (inotropy)
↑ Conduction velocity (dromotropy)
Kicks in during exercise, stress, emergencies
Increases cardiac output to meet metabolic demand
36
Parasympathetic Nervous System (PNS)
"Rest and Digest" = ↓ HR & BP
Muscarinic (M2) receptors
NT: Acetylcholine (ACh)
↓ Heart rate (chronotropy)
↓ Conduction velocity
Dominant at rest
Acts mostly on the SA and AV nodes, not ventricles
37
Balance Between the Two Nervous Systems:
At rest: PNS is dominant
With activity: PNS withdraws first, then SNS activates
Max HR is largely sympathetically driven
38
After the first few minutes of constant-load, submaximal exercise, VO₂ reaching steady state indicates that:
The body's oxygen consumption has plateaued to match the energy (ATP) demands
The aerobic system is fully active, and anaerobic contribution is minimal
This is a normal physiological response in healthy individuals during submaximal exercise
39
Anaerobic
No Oxygen Required
Duration: seconds to minutes
Speed: Very fast, immediate energy
fuel: PC, glucose
Quick fatigue
Examples: Sprint, lifting, HIIT
40
Aerobic
Oxygen Required
Duration: >2–3 minutes (sustainable)
Speed: Slower, but much more ATP per molecule
fuel: Glucose, fat, protein
Delayed fatigue
Examples: Distance running, cycling, swimming, walking
41
The transition from ___ to ___ occurs as oxygen availability increases, typically ___ minutes of continuous, moderate exercise.
anaerobic
aerobic
after the first 2–3
42
Why Train at Altitude?
At higher elevations (typically ≥ 2,000 meters or ~6,500 feet), barometric pressure drops
Lower partial pressure of oxygen (PaO₂)
Less oxygen available for diffusion into the blood
43
Body’s response to training at altitude:
↑ Erythropoietin (EPO) = Stimulates RBC production
↑ Red blood cell (RBC) count = Improves oxygen-carrying capacity
↑ Hemoglobin concentration = More O₂ per volume of blood
↑ Capillary density = Improves tissue oxygen delivery
↑ Mitochondrial efficiency = Enhances aerobic metabolism
44
Altitude Training Benefits for Athletes:
Greater aerobic endurance after return to sea level
Improved VO₂ max and oxygen delivery
Common in distance runners, cyclists, triathletes
"Train high, compete low" is the ideal:
Train at altitude to gain blood-based adaptations, then perform at sea level for higher O₂ availability and peak performance.
45
Short-Term Limitations
Altitude Training:
↓ VO₂ max and exercise performance initially at altitude
↑ HR and ventilation at rest and submaximal exercise
Altitude sickness risk >8,000 ft
Takes ~3 weeks (21–24 days) for meaningful adaptations
46
At altitude, the body compensates for decreased oxygen availability by ____ to enhance oxygen transport.
increasing erythropoietin (EPO) and red blood cell production
47
Altitude Changes
initial response:
HR increases
BP increases
CO increases
SV stays the same
48
Altitude Changes
acclimatization:
HR increases
BP normal
CO normal
SV decreases
49
Initial Phase (First Few Days):
Acute hypoxia activates peripheral chemoreceptors →
↑ Ventilation
↑ Sympathetic nervous system activity → ↑ HR, ↑ BP, ↑ CO
SV stays relatively unchanged early on
50
Acclimatization Phase (After ~1–3 weeks):
Body adapts by:
Increasing red blood cells & hemoglobin via erythropoietin (EPO)
Improving oxygen delivery efficiency
Plasma volume drops, so SV decreases even though HR stays up
CO normalizes because of the balance between ↓ SV and sustained ↑ HR
51
When a patient is immersed to the sternoclavicular notch in water (i.e., neck-deep), ___ pressure dramatically increases.
hydrostatic
this pressure:
Compresses the peripheral vasculature
Promotes venous return to the heart
Enhances preload (blood returning to the heart)
Leads to increased stroke volume and cardiac output
Due to this, heart rate actually decreases or remains stable, not increases
52
Weight-Bearing with Immersion:
C7 (neck): ~10% of body weight
Xiphoid (mid chest): ~33% of body weight
ASIS (hip level): ~50% of body weight
Buoyancy offsets gravity → more immersion = less weight on joints
53
Hydrostatic pressure =
↑ venous return = ↑ stroke volume = ↓ HR
54
Aquatic Therapy
Cardiovascular Effects
HR: ↓
BP: ↓
Rate of oxygen uptake (VO2): ↓
CO: ↑ (more blood coming from veins)
SV: ↑
55
Aquatic Therapy
Respiratory Effects
vital capacity: ↓
work of breathing: ↑
56
Aquatic Therapy
MSK Effects
weight bearing: ↓
edema: ↓
57
Aquatic Therapy
Other Physiological Effects
Decreased weight-bearing due to
increased buoyancy in water
Decreased swelling, and
improved circulation due to
hydrostatic pressure exerted by
water
Improved muscle strength, and
endurance due to resistance to
movement in water
Temperature: Warm water causes
relaxation whereas cold water
reduces pain and inflammation
58
Beta-adrenergic blocking drugs (beta-blockers)
Block β1-adrenergic receptors in the heart
Compete with epinephrine and norepinephrine
↓ Heart rate (HR)
↓ Contractility
↓ Blood pressure (BP)
↓ Myocardial oxygen demand
Reduces cardiac workload = less risk of ischemia or angina
Used in patients with:
Coronary artery disease (CAD)
Hypertension
Arrhythmias
Heart failure (certain types)
59
Effect of Beta-Blockers During Exercise:
resting HR - ↓ Lower than normal
submax HR - ↓ Blunted response
max HR - ↓ Significantly reduced
RPE - ✅ Must be used instead of HR zones
VO2 max - ↓ Often slightly reduced
60
Borg Rating of Perceived Exertion (RPE) Scale
12–14 ("somewhat hard") = typical target RPE for moderate aerobic training
Used in place of HR zones for patients on beta-blockers, pacemakers, or when HR monitoring is unreliable
RPE is subjective, but correlates well with VO₂ and HR
RPE × 10 ≈ HR (rough approximation, not always valid with beta-blockers)
61
RPE
SHVEM
13 - Somewhat hard
15 - Hard
17 - Very hard
19 - Extremely hard
20 - Max exertion
6 - no exertion
7.5 - extremely light
9 - very light
11- light
62
Factors Affecting Heart Rate (Cardiac Rate):
sympathetic nerves: ↑ HR (via β1 receptors)
parasympathetic nerves: ↓ HR (via vagus nerve, M2 receptors)
63
Factors Affecting Stroke Volume (SV):
End-Diastolic Volume (EDV)
Stretch
Contraction strength
Mean Arterial Pressure (MAP)
64
End-Diastolic Volume (EDV)
Also called preload
↑ EDV = ↑ SV via Frank-Starling Law
65
Frank-Starling Mechanism
More blood returning to the heart (↑ EDV) stretches the myocardium → stronger contraction → ↑ SV
66
Stretch
Greater stretch of cardiac muscle fibers = ↑ force of contraction
67
Contraction strength
Influenced by sympathetic stimulation (positive inotropy)
68
Mean Arterial Pressure (MAP)
Affects afterload
↑ MAP = ↑ resistance = ↓ SV
69
Beta-blockers ↓ sympathetic drive →
↓ HR and ↓ contractility → ↓ CO
70
In heart failure, SV may be impaired →
HR compensates to maintain CO
71
Exercise increases CO by →
↑ both HR and SV (up to ~50% VO₂max, then SV plateaus and HR drives further ↑)
72
transition from rest to exercise to recovery:
Cardiac output (CO = HR × SV) ↑ quickly during exercise to supply working muscles with oxygen.
SV increases first, then plateaus → HR continues to rise to keep increasing CO.
During recovery, HR and SV decline, reducing CO back to baseline.
Faster HR recovery = better cardiovascular fitness
73
Delayed HR recovery =
sign of poor autonomic control or increased mortality risk in cardiac patients
74
Auscultation Landmarks
Aortic: 2nd IC space, right sternal border
Pulmonic: 2nd IC space, left sternal border
Tricuspid: 4th IC space, left sternal border
Mitral: 5th IC space, left midclavicular line
75
heart sound - S1
“lub”
closure of mitral and tricuspid valves, onset of systole
76
heart sounds - S2
“dub”
closure of aortic and pulmonary valves, onset of diastole
77
heart sounds - S3
“ventricular gallop”
ventricular filling, associated with heart failure
78
heart sounds - S4
“atrial gallop”
abnormal, ventricular filling and atrial contraction
79
splitting of S2 heard during ____ at ____ site
inspiration
pulmonary
80
___ site best for auscultation if S3 present
mitral
81
S2 sound the loudest at:
base of heart
82
S1 sound the loudest at:
apex of heart
83
S1 and S2 sound equally loud at:
Erb's Point
