Cardiovascular

Question 1

Increased BP results in what?

Answer 1

parasympathetic stimulation
- decreased rate and force of cardiac contraction
- sympathetic inhibition
- decreased peripheral resistance

Question 2

Decreased BP results in what?

Answer 2

sympathetic stimulation
- increased HR and BP
- vasoconstriction of peripheral blood vessels
- increased right atrial pressure causes reflex acceleration of heart rate

Question 3

Increased CO2 or decreased O2 cause what?

Answer 3

increase HR

Question 4

hyperkalemia - what changes will be seen on ECG?

Answer 4

increased concentration of K+
- decreases rate of force of contraction
- widened PR interval and QRS, tall T waves

Question 5

hypokalemia - what changes will be seen on ECG?

Answer 5

decreased K+
- flattened T waves, prolonged PR adn QT intervals
- arrhythmias that may progress to ventricular fibrillation

Question 6

hypercalcemia

Answer 6

increased calcium concentration increases heart actions

Question 7

hypocalcemia

Answer 7

decreased calcium concentrations depresses heart actions

Question 8

hypermagnesemia

Answer 8

increased magnesium is a calcium blocker which can lead to arrhythmias or cardiac arrest

Question 9

hypomagnesemia

Answer 9

decreased magnesium causes ventricular arrhythmias, coronary artery vasospasm, and sudden death

Question 10

non-modifiable increased CVD risk factors

Answer 10

men > 45 and women > 55

cardiac event in 1st degree male relative < 55, or female relative < 65

African American

men > pre-menopausal women, after menopause, the risk equalizes

Question 11

modifiable risk factor for CVD - cholesterol goals

Answer 11

total cholesterol < 200

LDL <160 if low risk
< 130 if moderate risk
< 100 if high risk, have CVD or diabetes

HDL > 40 in men, > 50 in women

triglycerides < 150

Question 12

Grading scale for peripheral pulses

Answer 12

0 - absent
1+ - pulse dimenished, barely perceptible
2+ - normal
3+ - full pulse, increased strength
4+ - bounding pulse

Question 13

POTS

Answer 13

sustained HR increase >/= 30 beats per minute within 10 min of standing (>/= 40 beats per min in teenagers)

Question 14

weak, thready pulse means what

Answer 14

low stroke volume, cardiogenic shock

Question 15

bounding, full pulse means what

Answer 15

shortened ventricular systole and decreased peripheral pressure; aortic insufficiency

Question 16

auscultation landmarks - aortic valve

Answer 16

2nd right intercostal space at the sternal border

Question 17

auscultation landmarks - pulmonic valve

Answer 17

2nd left intercostal space at the sternal border

Question 18

auscultation landmarks - tricuspid valve

Answer 18

4th left intercostal space at the sternal border

Question 19

auscultation landmarks - mitral valve

Answer 19

5th left intercostal space at the midclavicular area

Question 20

S1 sound

when is it decreased?

Answer 20

“lub”
- normal closure of mitral and tricuspid valves; marks beginning of systole

decreased in 1st degree heart block

Question 21

S2 sound

when is it decreased?

Answer 21

“dub”
- normal closure of aortic and pulmonary valves; marks end of systole

decreased in aortic stenosis

Question 22

P wave

Answer 22

atrial deplolarization

Question 23

P-R interval

Answer 23

time required for impulse to travel from atria through conduction system to Purkinje fibers

Question 24

QRS wave

Answer 24

ventricular depolarization

Question 25

ST segment

Answer 25

beginning of ventricular repolarization

Question 26

T wave

Answer 26

ventricular repolarization

Question 27

QT interval

Answer 27

time for electrical systole

Question 28

V-tach

Answer 28

run of 4 or more PVCs sequentially

Question 29

v-fib

Answer 29

pulseless, emergency, CPR bizarre, erratic activity w/o QRS complexes

Question 30

normal MAP

Answer 30

70-110 mmHg

Question 31

what type of angina responds well to nitroglycerin

Answer 31

variant agina (Prinzmetal) - vasospasm in absense of occlusive disease

Question 32

left sided HF signs

Answer 32

- pulmonary congestion - edema - low cardiac output due to backup of blood from LV to LA and lungs

Question 33

R sided HF signs

Answer 33

increased pressure load on RV - hallmark signs of jugular vein distention and peripheral edema

Question 34

Activity restrictions after acute MI

Answer 34

activity can be increased once the acute MI has stopped limit to 5 METs or 70% of HRmax for 4-6 weeks

Question 35

Activity restrictions for acute heart failure

Answer 35

O2 demand should NOT be increased in patients w/ acute or decompensated HF

Question 36

Peripheral artery disease (PAD) early and late signs

Answer 36

early - intermittent claudication late - rest pain, muscle atrophy, trophic changes

Question 37

RPE has ________ reliability over time, but not ________ reliability

Answer 37

intra-rater reliability over time, but no inter-user reliability

Question 38

metabolic conditions where cardiac rehab is contraindicated

Answer 38

- acute thyroiditis - hypokalemia - hyperkalemia - hypovolemia

Question 39

exercise prescription for post-PTCA (precutaneous transluminal coronary angioplasty)

Answer 39

- wait to exercise vigorously ~ 2 weeks post-PTCA - use post-PTCA exercise test to perscribe exercise

Question 40

exercise prescription for post-CABG

Answer 40

- limit UE exercise while sternal incision is healing - avoid lifting, pushing, pulling 4-6 weeks post-surgery

Question 41

acute cardiac rehab initial activities

Answer 41

- low intensity (2-3 METs) - post MI limited to 70% max HR for 6 weeks - short sessions, 2-3 x per day

Question 42

HEP for acute cardiac rehab

Answer 42

gradual increase ambulation time - goal is 20-30 min, 1-2 x per day, 4-6 days per wk

Question 43

Subacute (phase 2) cardiac rehab exercise guidelines

Answer 43

2-3 x per week 30-60 min w/ 5-10 warm-up and cool-down

Question 44

strength training guidelines during subacute (phase 2) cardiac rehab

Answer 44

After 3 weeks of cardiac rehab, 5 weeks post-MI, or 8 weeks post CABG - start w/ elastic bands and light hand weights (1-3lbs) - progress to moderate loads, 12-15 comfortable reps

Question 45

What should be avoided after pacemaker and automatic implantable cardioverter defibrillators placement

Answer 45

UE aerobic or strengthening exercises for 4-6 weeks after implant to allow the leads to scar down

Question 46

contraindications for compression therapy

Answer 46

- ABI <0.8 - signs of active cellulitis or infection - systemic arterial pressure <80 mmHg - advanced peripheral neuropathy and uncontrolled congestive heart failure

Question 47

S&S of lipedema

Answer 47

- swelling stops at ankles and wrists - affects mainly women - stemmer's sign is negative; often painful on pinching

Question 48

lymphedema management: What pressures are contraindicated for compression

Answer 48

> 45 mmHg

Question 49

Class 2 & 3 HF exercise prescription: aerobic exercise

Answer 49

time - 20-60 min intensity - 50-90% peak VO2 frequency - 3-5 x wk duration - 8-12 wks

Question 50

Class 2 & 3 HF exercise prescription: HIIT

Answer 50

time - >35 min intensity - 90-95% peak VO2 frequency - 2-3 x wk duration - 8-12 wks

Question 51

Class 2 & 3 HF exercise prescription: UE and LE resistance training

Answer 51

time - 45-60 min intensity - 60-80% 1 RM frequency - 3 x wk duration - 2-3 sets per muscle group, 8-12 wks

Question 51

Class 2 & 3 HF exercise prescription: Inspiratory muscle training (IMT)

Answer 51

time - 30 min intensity - >30% of MIP frequency - 3 x wk duration - 8-12 wks

Question 52

Patients with heart failure can have a ____ heart sound

Answer 52

S3

Question 53

S4 heart sound signifies

Answer 53

rapid ventricular filling after atrial contraction and is consistent with a presentation of systemic hypertension, cardiomyopathy or coarctation of the aorta