Cardiovascular and lymphatic system Flashcards
1
Q
What does the left atrium receive from the lungs and four pulmonary veins?
A
oxygenated blood
2
Q
When do the semilunar valves prevent backflow of blood into the ventricles?
A
during diastole
Pulmonary valve prevents right backflow
Aortic valve prevents left backflow
3
Q
When do the AV valves prevent backflow of blood into the atria?
A
During systole
4
Q
What is systole?
A
Period of ventricular contraction
End-systolic volume: amount of blood in the ventricles after systole
–> approx. 50mL
5
Q
What is diastole?
A
Period of ventricular relaxation and filling
End-diastolic volume: volume of blood remaining in the ventricles after diastole; 120 mL
6
Q
When does atrial contraction occur? What does it do?
A
a. During the last 1/3 of diastole
b. completes ventricular filling
Last 20-30% of end diastolic volume
7
Q
Where does the RCA provide bloodflow?
A
- right atrium
- right ventricle
- inferior wall of left ventricle
- AV node –> SA node
- bundle of his
8
Q
What artery provides the sinoatrial node with blood 60% of the time?
A
RCA
9
Q
What artery supplies the SA node 40% of the time?
A
Left circumflex artery (LCx)
10
Q
What are the two divisions of the LCA?
A
- Left anterior descending (LAD)
- circumflex artery
11
Q
What does the left anterior descending artery provide blood to?
A
- left ventricle
- interventricular septum
- inferior apex
May also branch off to the right ventricle
12
Q
Where does the left circumflex artery provide blood to?
A
Lateral and inferior walls of the left ventricle and atrium
13
Q
Where does the coronary sinus receive blood from?
A
heart
14
Q
Where does the coronary sinus empty into?
A
Right atrium
15
Q
What does the SA node do?
A
Initiates pulse at a rate of 60-100 bpm
“pacemaker of the heart”
16
Q
What is the intrinsic firing rate of the AV node?
A
40-60 bpm
17
Q
What is the intrinsic firing rate of purkinje fibers?
A
20-40 bpm
18
Q
(true/false) Striated muscles fibers have less mitochondria compared to smooth muscle fibers
A
False
More muscle fibers
19
Q
What is normal stroke volume?
A
50-100 mL/beat
20
Q
What is preload?
A
Amount of blood left in the left ventricle at the end of diastole
21
Q
(true/false) the greater the preload, the greater the amount of blood pumped
A
true
22
Q
What is afterload?
A
Force of the left ventricle that generates during systole to overcome aortic pressure and open the aortic valve
23
Q
Definition
Amount of blood discharged from the left or right ventricle per minute
A
Cardiac output
Stroke volume: amount of blood discharged from the ventricle during each contraction
24
Q
What is the normal range of cardiac output per minute?
A
4-5 L/minute
25
How is cardiac output calculated?
SV x HR
## Footnote
Regular cardiac index (CO divided y body surface area) : 2.5-3.5 L/min
26
# definition
Percentage of blood emptied from the ventricle during systole
EF
27
How do you calculate EF?
SV / left ventricular end-diastolic volume
28
What is normal EF?
>55%
29
What percent of EF is indicative of heart failure?
< 40%
| The lower the EF, the more impaired the left ventricle is
30
(true/false) Intrathoracic pressure affects atrial filling pressure
True
31
# definition
Represents the energy cost to the myocardium
myocardial oxygen demand (MVO2)
## Footnote
clinically measured as the product of HR and systolic BP (Rate pressure produce (RPP))
32
What arteries DO NOT transport oxygenated blood from areas of high-pressure to low-pressure in tissues?
1. umbilical vein (in utero)
2. pulmonary veins
33
What creates an anastomosis network?
when arterioles connect to capillaries
| Function: exchange of nutrients and fluids between blood and tissues
34
There are (more/less) arteries than veins
Less arteries
35
Venous walls are (thinner/thicker) than arteries
thinner
| Have one-way valves
36
Where do the lymphatic vessels and ducts empty?
Left subclavian vein
## Footnote
Body tissue --> veins --> lymphatic capillaries --> vessels --> lymphatic ducts --> left subclavian vein
37
Where is parasympathic stimulation controlled from?
Medulla oblongata -- cardioinhibitory center
## Footnote
- Causes coronary artery vascocontriction
- via vagus nerve and caridac plexus (innervates the SA and AV node which releases ACh and slows myocardial contraction)
38
Where is sympathetic stimulation controlled from?
Medulla oblongata - cardioacceleratory center
## Footnote
- via T1-T4, upper thoracic to superior cervical chain ganglia (innervates SA and AV nodes releasing epinephrine and noepinephrine)
- increases HR
- coronary artery vasodilation
39
What is the name of drugs that increase sympathetic functioning?
Sympathomimetics
40
What is the name of drugs that decrease sympathetic functioning?
sympatholytics
41
What are baroreceptors the main mechanism for in the heart?
controlling HR
## Footnote
- located in aortic arch and carotid sinus
- Responds to changes in BP (circulatory reflexes)
42
Where are chemoreceptors located in the heart?
carotid body
43
What receptors are sensitive to changes in blood chemicals: O2, CO2, and lactic acid?
chemoreceptors
## Footnote
- Decreased pH results in an increased HR
- Increased pH results in a decreased HR
44
What is hyperkalemia?
Increased potassium
| Hypokalemia: decreased potassium
45
What does hyperkalemia cause within the cardiovascular system?
decreases the rate and force of contraction
46
What ECG changes are observed with hyperkalemia?
1. Widened PR interval and QRS
2. flattened P waves
2. Tall/peaked T-waves
47
What ECG changes are observed with hypokalemia?
1. flattened T-waves
2. Prolonged PR and QT intervals
3. "U wave"
| arrythmias may progress to V-fib
48
Hypercalcemia (increases/decreases) heart action.
increases
49
What can hypermagnesemia result in?
1. arrythmia
2. cardiac arrest
## Footnote
Increased magnesium is a calcium channel blocker
50
What can hypomagnesemia cause?
1. ventricular arrythmias
2. coronary artery vasospasm
3. sudden death
51
# Definition
Sustained HR increase >30 bpm within 10 minutes of standing
| 40 bpm increase in teenagers
Postural tachycardia syndrome
52
What causes a weak, thready pulse?
- low stroke volume
- cardiogenic shock
53
What can cause a bounding, full pulse?
- Shortened ventricular systole and decreased peripheral pressure
- aortic insufficiency
54
What intercostal space is the pulmonic and aortic valves found in?
2nd
55
What intercostal space is the bicuspid valve in?
5th
56
What intercostal space is the tricuspid valve in?
4th
57
What creates S1 sound?
Closing of bicuspid and tricuspid valves
| Marks the beginning of systole
58
What creates the S2 sound?
closure of the aortic and pulmonic valves
| **marks the end of systole**
## Footnote
Decreased with aortic stenosis
59
What is a systolic murmur? When does it occur? What can it indicate?
a. Extra sound that occurs between S1 and S2
b. can indicate possible valve disease
| Can be normal
60
What is a diastolic murmur? When does it occur? What can it indicate?
a. extra sound between S2 and S1
b. indicates valve disease
61
What is the scale for heart murmurs?
1 (soft audible murmur)
to
6 (audible w/o use of stethoscope)
62
What is a trill?
abnormal tremor accompanying a vascular or cardiac murmur that is felt on palpation
63
What is bruit? Where is it commonly heard? What is it indicative of?
a. sound/murmur of arterial or venous origin
b. femoral and/or carotid arteries
c. indicative of atherosclerosis
64
# definition
Heart rhythm with three sounds in each cycle
gallop rhythm
| S3 and/or S4
65
What is S3 sound associated with? What can it be indicative of in older adults?
a. ventricular filling
b. Left ventricular heart failure (CHF)
66
What is S4 associated with? What is it indicative of?
a. ventricular filling and atrial contraction
b. cardiac pathology (CAD, MI, aortic stenosis, chronic HTN)
67
What is the P-R interval?
time required for impulse to travel from the atria to the purkinje fibers
68
What is the ST segment?
Beginning of ventricular repolarization
69
What is the QT interval?
time of electrical systole
70
(true/false) PVCs do not occur in normal population
False
| They do occur in the majority of the normal population
71
What is observed on a ECG when a PVC is present?
- no P wave
- wide and premature QRS
- long compensatory pause
72
What is indicative of a serious PVC?
>6 PVC/minute, in sequential runs, and multifocal
73
What is ventricular tachycardia?
4+ sequential PVCs at a very rapid rate (150-200 bpm)
| Compromised CO
74
What is ventricular tachycardia usually the result of?
ischemic ventricle
75
What is observed on an ECG when ventricular tachycardia is present?
- no P waves
- wide QRS waves
76
What is non-sustained ventricular tachycardia (NSVT)?
4+ consecutive beats that spontaneously terminate within 30 seconds
77
What is sustained ventricular tachycardia (SVT)?
ventricular tachycardia lasting >30 seconds
and/or
requiring termination due to hemodynamic compromise in less than 30 seconds
78
# definition
Pulseless, emergency situation requiring CPR, Defibrillization, and/or medication.
- Characterized by chaotic activity of ventricle originating from multiple foci
- no effective CO is present
V-fib
79
(true/false) you are able to determine HR when V-fib is present.
False
80
What is observed on an ECG when V-fib is present?
- erratic activity
- no QRS complex
81
How long does it take for clinical death to occur when v-fib is present?
4-6 minutes
82
What is observed on an ECG when atrial arrythmias are present?
- abnormal shape of P waves or absence of P waves
- irregular rhythm (chronic or paroxysmal)
83
What is the common HR when atrial tachycardia is present?
140-250 bpm
84
What is the common HR when atrial flutter is present?
250-350 bpm
85
What is the common HR when atrial fibrillation is present?
>300 bpm
86
(true/false) With atrial arrythmias, cardiac output is maintained as long as the patient's HR is controlled
true
| May precipitate ventricular failure in an abnormal heart
87
What are AV blocks?
abnormal delay or failure of normal electrical conduction within the heart
88
If ventricular rate is slowed, CO is (increased/decreased)
decreased
89
What degree of heart block is life-threatening requiring surgical implantation of a pacemaker and use of medications (atropine)?
3rd degree AV block (complete heart block)
90
What ECG changes are observed with hypercalcemia?
1. wide QRS
2. short QT interval
91
What ECG changes are observed with hypocalcemia?
Prolonged QT interval
92
What ECG changes are observed with hypothermia?
1. elevated ST segment
2. decreased rhythm
93
What ECG changes can be observed when using digitalis?
1. depressed ST segment
2. Flattened T wave (or inverted)
3. shortened QT interval
94
What ECG changes can be observed when using quinidine (anti-arrythmic)?
1. lengthened QT interval
2. Flattened T wave (or inverted)
3. wide QRS
95
What cardiac changes can be observed when using beta blockers?
decreased HR
96
What ECG changes can be observed when using antiarrythmic agents?
1. prolonged QRS
2. prolonged QT intervals
97
(true/false) Medications are prescribed for all stages of HTN
False- not usually prescribed for stage I HTN...
**Exception**: prescribed for stage I HTN if pt has already had a heart attack, stroke, or is at high risk of heart attack or stroke with the presence of DM, CKS, or atheroclerosis.
98
What MAP is indicative of hypotension?
< 50
99
What BP changes indicates orthostasis?
SBP decreases > 20 mmHg
and/or
DBP decreases > 10 mmHg
## Footnote
s/s: lightheadedness, LOB, leg weakness, dizziness
100
What BP measurements are considered as stage I HTN?
SBP 130-139 mmHg
or
DBP 80-89 mmHg
101
What BP measurements are considered as stage II HTN?
SBP > 140 mmHg
or
DBP >90 mmHg
102
What BP measurements are indicative of hypertensive crisis?
SBP > 180 mmHg
and/or
DBP > 120 mmHg
103
# definition
Arterial pressure within large arteries over time that is dependent upon the mean blood flow and arterial compliance
MAP
## Footnote
MAP = SBP + 2(DBP) / 3
104
What is a normal MAP?
70-110 mmHg
105
What is the normal RR of a child?
20-30
106
# definition
RR > 22 breaths/min
tachypnea
107
# definition
RR < 10 breaths/min
bradypnea
108
# definition
Increase in the depth and rate of breathing
hyperpnea
109
# definition
inability to breathe when reclined or in supine
orthopnea
110
# definition
sudden inability to breathe during sleep
paroxysmal nocturnal dyspnea (PND)
111
What commonly causes crackles/rales?
secretions within the lungs
112
what are the levels of the anginal scale?
1+ : light, barely noticeable
2+ : moderate, bothersome
3+ : severe, very uncomfortable
4+ : most severe pain experienced
113
# definition
low level of O2 within the tissues
hypoxia
114
# definition
complete lack of O2
anoxia
115
Symptoms of angina occurs more in (men/women/equally)
women
116
Where can cardiac pain refer to?
- neck
- jaw
- back
- shoulders
- arms
| Pain referred to the back can occur with dissecting aortic aneurysms
117
What cardiac diagnosis can cause pallor or rubor?
PAD
118
What is clubbing of the nails associated with?
## Footnote
Curvature of fingernails w/ soft tissue enlargement at the base of the nail
1. chronic oxygen deficiency
2. chronic pulmonary disease
3. heart failure
119
What is stemmer's sign?
Dorsal skin folds of the toes or fingers are resistant to being lifted
120
What is stemmer's sign used to identify?
1. fibrotic changes
2. lymphedema
121
What causes intermittent claudication?
PAD
122
# definition
Pain, cramping, and LE fatigue that occurs during exercise and is relieved by rest
intermittent claudication
123
What diagnosis is bilateral edema associated with?
congestive heart failure
124
What is the venous percussion test used for?
determines the competence of the greater saphenous vein
## Footnote
if pulse is felt by lower hand (20 cm below percussive hand), the intervening valves are incompetent
125
What is the grading scale for edema?
1+ : mild indentation; < 1/4 inch of pitting
2+ : moderate depression that returns to normal within 15 seconds; 1/4 to 1/2 inch of pitting
3+ : severe depression that takes 15-30 seconds to rebound; 1/2 to 1 inch of pitting
4+ : very severe depression that lasts for > 30 seconds; 1+ inch of pitting
126
What is the venous trendelenburg test used for?
| (retrograde filling test)
determines the competence of communicating veins and saphenous system
## Footnote
1. supine with LEs at 60 degrees elevation
2. place tourniquet on proximal thigh
3. patient stands
4. observe if veins fill in normal pattern (takes approx 30 seconds)
127
What venous filling time is indicative of venous insufficiency?
delayed filling for > 15 seconds
128
How is ABI calculated?
ABI = LE pressure / UE pressure
## Footnote
1. pt is supine at rest for 5 mins
2. BP is taken at the brachial artery and posterioral tibial and dorsalis pedis arteries
129
What is ABI used for?
calculating the risk for cardiovascular disease
130
What ABI indicates non-compliant arteries?
1.4 +
131
What ABI is considered as abnormal peripheral arterial circulation?
<0.9
132
What ABI is indicative of severe arterial disease and/or is high risk for critical limb ischemia?
<0.5
133
What is a clinically significant change in ABI?
Without symptoms: >0.15
With symptoms: >0.1
134
What does a central line measure?
| Swan-Ganz catheter
- venous pressure
- pulmonary artery pressure
- pulmonary capillary wedge pressure
135
What is the primary lab measure of myocardial infarction? What must it be accompanied by?
a. cardiac troponin
b.
- symptoms of ischemia
- new or presumed ST segment change
- loss of myocardium and/or new wall motion abnormality on imaging
- evidence of intracoronary thrombus
136
What is a heteroptics transplantation?
Leaving the natural heart along and allowing it to "piggyback" on the donor heart
137
What is a orthotopic transplant?
Heart is removed and a new heart is placed
138
After an acute MI, the patient should be limited to _______ METS or ____% of age-predicted HRmax for 4-6 wks after the MI
5 mets or 70% HRmax
139
What common medications increase cardiac demand?
- adenosine (increases HR) - anti-arrythmic
- dobutamine (increases contractility) - bp medication
- persantine (vasodilates) - blood thinner
140
(true/false) submaximal ETT is safe in all settings to evaluate the early recovery of patients after experiencing a MI, coronary bypass, or coronary angioplasty.
True
- limited to 85% of HRmax
- terminate if symptoms arise
141
What does a positive exercise tolerance test indicate?
myocardial oxygen supply is inadequate to meet the myocardial oxygen demand
(+) for ischemia
| Negative ETT indicates balanced oxygen supply and demand during exercise
142
Increased myocardial oxygen consumption (MVO2) is the result of what?
increased coronary blood flow
## Footnote
RPP = Product of SBP and HR
143
What is an important measure for individuals who do not exhibit the typical rise in HR with exercise?
RPE scale
## Footnote
Borg: rates exercise intensity on a 6-20scale
Borg CR 10: rates exercise intensity using numbers from 1-10
144
What ECG changes will be seen in an individual with myocardial ischemia and CAD?
1. significant tachycardia
2. exertional arrythmias
3. ST segment depression (horiz. or downward depression > 1 mm below baseline is indicative of myocardial ischemia
145
What is transtelephonic ECG monitoring used for?
Monitor patients as they exercise at home
146
What is the minimal number of METs required to promote endurance?
3-4 mets if continous and if target HR is reached
147
What are adverse responses to inpatient exercise leading to exercise termination?
- diastolic BP is = or > than 110 mmHg
- Systolic **decrease** of > 10 mmHg
- significant ventricular or atrial dysrhythmias with or without associated s/s
- 2nd or 3rd degree heart block
- s/s of exercise intolerance (dyspnea, angina, ECG changes indicating ischemia)
148
When should exercise be initiated after a patient experiences a percutaneous transluminal coronary angioplasty (PTCA)?
Walking program can be initiated immediately using an ETT for prescription
- no vigorous exercise until after 2 weeks post-PTCA
149
What are the guidlines for exercise prescription post-CABG?
1. limit UE exercise during sternal incision healing
2. avoid lifting, pushing, and pulling for 4-6 weeks
150
What are the contraindications for cardiac rehab?
| (16)
1. unstable angina
2. resting SBP > 200 and/or DBP >110 mmHg
3. orthostatic BP drop of > 20 mmHg and presence of symptoms
4. critical aortic stenosis
5. acute systemic illness or fever
6. unctonrolled atrial or ventricular dysrhythmias
7. uncontrolled sinus tachycardia
8. uncompensated CHF
9. 3rd degree AV block w/o pacemaker
10. pericarditis or myocarditis
11. recent embolism
12. thrombophlebitis
13. resting ST-segment depression or elevation (>2 mm)
14. uncontrolled DM
15. severe orthopedic conditions that prohibit exercise
16. metabolic conditions (acute thyroiditis, hypokalemia, hyperkalemia, hypovolemia)
151
How many METs can be achieved in phase I (inpatient/acute) of cardiac rehab?
2-3 METs initially and progress to =/> 5 METs by d/c
152
What are the limitations of MI during phase I of acute rehab?
- limit exercise to 70% HRmax and/or 5 METs until 6 weeks post-MI
- 2-3 short exercise sessions/day
- no lifting activities for at least 6 weeks
153
What are the exercise/activity guidlines for phase II of cardiac rehab?
frequency: 2-3 x/wk
duration: 30-60 minutes (incl. 5-10 minute warm up/down)
METs: 9 MET functional capacity
154
How many METs are needed for safe resumption of most daily activities post-cardiac diagnosis?
=/> 5 METS
155
When can strength training begin during phase II of cardiac rehab?
- 3 weeks after initiation of phase II
- 5 weeks post-MI (=/< 70% HRmax or =/< 5 METs)
- 8 weeks post-CABG
156
When can you start resistance exercises post-transcatheter procedure (PTCA)?
Not until at least 3 weeks after procedure with at least 2 weeks of consistent participation in a supervised cardiac rehab endurance program
157
What are the exercise guidelines for resistance training in cardiac populations?
- low resistance (1 x 10-15 reps)
- slow progression
- RPE 11-13 (light to somewhat-hard)
- RPP not exceeding what is prescried during endurance exercise
158
What are signs of decomposition?
- increased SOB
- sudden weight gain
- abdominal swelling
- increased edema
- increased pain
- fatigue
- pronounced cough
- dizziness
159
Use caution exercising in ____ or ____ positions due to increased risk of orthopnea/SOB.
supine or prone
160
(true/false) HR is an appropriate independent measure of exercise intensity after heart transplant
false
| heart is denervated and tachycardic
## Footnote
combination of RPE, METs, dyspnea scale, HR, and BP
161
What are side effects of immunosuppressive drug therapy?
- hyperlipidemia
- HTN
- obesity
- DM
- leg cramps
- proximal muscle weakness
162
Describe NYHA class I.
Mild HF
- no limitation
- comfortable at rest
- activity does not cause fatigue, palpitations, dyspnea, or angina
163
Describe NYHA class II.
Slight HF
- slight limitation in physical activity up to 4.5 METs
- comfortable at rest
- ordinary activity results in fatigue, palpitations, dyspnea, or anginal pain
164
Describe NYHA class III.
marked HF
- marked limitation of physical activity up to 3 METs
**- comfortable at rest
**- less than ordinary activity causes fatigue, palpitations, dyspnea, or angina
165
Describe NYHA class IV.
Severe HF
- unable to carry out any physical acyivity w/o discomfort
- symptoms of ischemia, dyspnea, and angina at rest
- symptoms increase with exercise
166
Describe Stage A of the AHA heart failure classifications.
At risk for HF but w/o structural heart disease or symptoms of HF
167
Describe Stage B of the AHA heart failure classifications.
structural heart disease without s/s of HF
168
Describe Stage C of the AHA heart failure classifications.
Structural heart disease with prior and/or current symptoms of HF
169
Describe Stage D of the AHA heart failure classifications.
Refractory HF requiring specialized interventions
170
(true/false) pacemakers are always programmed to have a upper HR limit.
False: upper HR limit is rare but lower HR limit should always be set
171
(true/false) With a pacemaker in place, as workload increases, HR increases
true
172
What is an AICD?
Automatic implantable cardioverter defibrillator
- delivers an electric shock if HR exceeds the set limit and/or a ventricular arrythmia is detected
173
(true/false) ST segment depressions are common with pacemakers and AICDs.
true
174
How long should you avoid **UE** aerobic or strengthening exercises after implantation of a pacemaker or AICD?
4-6 weeks to allow for the leads to scar
175
When a patient is exercising with a pacemaker/AICD, make sure the patient's HR remains at least ___ beats below the ICD shock and anti-tachycardia pacing threshold
=/> 10 beats below threshold
176
At what age is risk of CVD increased?
Men > 45 yrs
Females > 55 yrs
- Risk increases further with a PMH of younger age of onset, number of past events, and how close genealogically the relative is
177
Men have a (lesser/greater/equal) risk of CVD than pre-menopausal women
Greater risk
| Equal risk once menopause occurs
178
What is the goal for overall cholestrol to reduce risk of CVD?
< 200 mg/dL
179
What is the goal for **LDL** cholestrol to reduce risk in those **who have a low risk** of developing CVD?
< 160 mg/dL
180
What is the goal for **LDL** cholestrol to reduce risk in those **who have a moderate risk** of developing CVD?
< 130 mg/dL
181
What is the goal for **LDL** cholestrol to reduce risk in those who have a high risk of developing CVD, already has CVD, or has DM?
< 100 mg/dL
182
What is the goal for HDL in men?
> 40 mg/dL
183
What is the goal for HDL in women?
> 50 mg/dL
184
What is the goal for triglycerides to reduce risk of CVD?
< 150 mg/dL
185
If a person has diabetes, what is the goal for HgA1C when reducing risk of CVD?
< 7%
## Footnote
HgA1C: Tests for blood sugar control; measures what percentage of Hgb proteins are coated in sugar (glycated)
186
What is the normal HgA1C level?
< 5.7%
187
What is the range of HgA1C for a prediabetic?
5.7-6.4%
188
What waist circumference puts a person at higher risk of CVD?
Males: > 40 inches
females: > 35 inches
189
What BMI puts a person at a lower risk of CVD?
< 24.9 kg/m2
190
What exercise prescription is used for patients with PAD?
Walking until the pt cannot tolerate pain - interval program with intermittent stops for a total of 30-60 minutes (3-5x/wk)
| Record time of pain onset and duration
191
What medication for PAD can decrease time to claudication **or** worsen symptoms when treating CVD and/or HTN?
Beta blockers
192
What medications may improve time to claudication?
- pentoxifylline
- dipyridamole
- aspirin
- warfarin
193
What LE exercise is the most effective for increasing blood flow?
Resistive calf exercises
194
What are buerger-allen exercises?
postural exercises to promote blood flow
## Footnote
Positions:
1. supine with LE elevated 45-90 degrees until feet blanch
2. sitting with LEs in dependent position until pink/red
3. supine for 3 minutes
195
(true/false) The effects of buerger-allen exercises are more pronounced in those with PAD.
false (less pronounced)
196
What medications are commonly used in those with vasospastic disease?
calcium channel blockers
197
When can you initiate ambulation and leg muscles in a person with VTE?
Once therapeutic levels of medication are achieved
198
What level of mmHg compression garmets should be used for venous diseases?
30-40 mmHg
199
What duration is used for compression pump therapy?
1-2 hours
2x daily
200
What is optimal positioning for patients managing edema?
Extremity elevation with a minimum of 18 inches above the heart
201
What are the contraindications for compression therapy?
- ABI < 0.8
- active cellulitis or infection
- systemic arterial pressure < 80 mmHg
- advanced peripheral neuropathy
- uncontrolled congestive heart failure
202
What organs are included in the lymphatic system?
1. spleen
2. tonsils
3. thymus
4. bone marrow
203
# Diagnosis
chronic disorder with excessive accumulation of lymph fluid due to mechanical insufficiency of the lymphatic system
- lymph volume exceeds the transport capacity/capability of lymph vessels
- results in swelling of soft tissues of the UEs and LEs
lymphedema
204
# diagnosis
Congenital or hereditary disorder with abnormal lymph nodes or lymph vessel formation leading to excessive accumulation of lymph fluid
primary lymphedema
205
# diagnosis
Acquired insult to the lymphatic system leading to the accumulation of exccessive lymph fluid
## Footnote
Possible causes: surgery, tumors, trauma, infection involving lymphatic structures
secondary lymphedema
206
What are the stages of lymphedema?
0 (pre-clinical or latent stage): at risk; swelling not yet evident
1: clear accumulation of fluid with visible swelling; pitting edema at **resolves with elevation**; negative stemmer's sign
2: spontaneously irreversible edema: increase in swelling with **no improvement with elevation**; positive stemmer's sign
3: elephantitis; fibrotic deep skinfolds; possible skin color changes may limit mobility
207
What stage of lymphedema is there a positive stemmer's sign?
3
208
What stage of lymphedema is there reversible pitting edema?
Stage 1
209
# diagnosis
- excessive subcutaneous fat deposition
- normal lymphatic system function
- **Symmetrical** swelling of extermities
- **negative** stemmer's sign
- seen more commonly in women
lipedema
210
# Diagnosis
Enlargement of lymph nodes with or without tenderness that is typically caused by infection
lymphadenopathy
211
What is generalized lymphadenopathy?
enlargement of lymph nodes in 2+ body regions
212
What is lymphadenitis?
lymphadenopathy accompanied by signs on inflammation such as redness and tenderness
213
# diagnosis
acute bacterial or viral infection that spreads within the lymphatic system
lymphangitis
214
What is the typical presentation of lymphangitis?
Red streaks seen in the skin proximal to the site of infection
215
What are the symptoms of patients who are at risk of developing secondary lymphedema?
- swelling
- sensation of tightness, heaviness, or fullness in the affected area
- aching sensation
216
What are the risk factors for primary lymphedema?
congenital anormalities (hypoplasia, hyperplasia, aplasia)
217
What are risk factors for secondary lymphedema?
- cancer (common: breast and cervical)
- venous disease
- trauma
- cardiac disease
- dependent edema
- filariasis (mosquito-borne illness)
218
When assessing lymphedema, unilateral lymphedema is considered present if there is a > ___% increase from the contralateral side
> 10%
219
What is used primarily to determine bilateral lipedema vs. bilateral lymphedema?
bioimpedance
220
# definition
Dilation of lymph vessels that may appear as blister-like protuberances
lymphangiectasia
221
# definition
leakage of lymph from the skin
lymphorrea
222
# definition
development of wart-like growths on the skin that contains dilated lymph vessels and fibrous tissue
papillomatosis
223
# definition
thickening and hardening of subcutaneous tissue and brown skin discoloration. Associated with chronic venous insufficiency. When severe, can damage lymph tissue
lipodermatosclerosis
224
What sign is used for lymphedema indicated by the presence of a thickened fold of skin at the base of the 2nd toe or finger?
stemmer's sign
(+) if skin cannot be lifted
225
(true/false) BP is affected on the side of lymphedema.
FALSE
226
When palpating lymph nodes, what is a sign of inflammation and/or infection?
lymph nodes that move easily
227
When palpating lymph nodes, what is a sign of possible metastatic cancers?
hard, immobile lymph nodes
228
What kind of background pain is present with lymphedema?
intermittent or continuous pain at rest
229
(lymphedema/lipedema) Which is associated with hormonal imbalances? What hormone?
a. lipedema
b. estrogen-related at the start of hormonal changes (pregnancy, puberty)
230
(lymphedema/lipedema) Which may be congenital or result from damage to the lymphatic system?
lymphedema
## Footnote
- Primary: congenital
- secondary: injury to lymphatic vessels or parasitic infection
231
(lymphedema/lipedema) Which mainly affects women?
lipedema
- lymphedema affects males and females equally
232
(lymphedema/lipedema) which can result from inadequate lymphatic drainage?
lymphedema
| can also be congenital or result from damage to lymphatic system
233
(lymphedema/lipedema) Which involves the trunk, head, neck, genitalia, LEs, and/or UEs?
a. lymphedema
b. lipedema only involves symmetrical bilateral swelling in the UEs and/or LEs
234
(true/false) Stemmer's sign will be positive with lipedema.
FALSE
- stemmer's sign may be positive with **lymphedema** and will not be painful
235
(lymphedema/lipedema) Which results in excessive subcutaneous fat deposition?
lipedema
236
What can lymphedema develop into if it is not treated?
- fibrosis
- chronic infection
- loss of limb function
237
What diagnostic tests can be used to identify lymphedema?
- CT
- MRI
- doppler US
- radionuclide imaging
238
What are the treatments for lymphedema?
- complete decongestive therapy (CDT)
- compression bandages
- decongestion exercises
- walking and cycling programs
- aquatics
239
What can you NOT do when taking vitals on those with lymphedema?
Do not take BP on affected side
240
Those with lymphedema must avoid temperatures over _____ degrees and extreme cold.
over 102 degrees
241
Emphasis of CDT must start proximally in the affective area and lead to the _______ for right-sided UE involvement.
right lymphatic duct
242
Emphasis of CDT must start proximally in the affective area and lead to the _______ for involvement of the left UE, trunk, and LEs
thoracic duct
243
How long are short-stretch compression bandages applied for when treating lymphedema?
24 hours/day
244
The use of compression garments may account for ___% of improvement of lymphedema symptoms
50%
245
What can occur when a person with lymphedema endures excessively high pressures?
Occluding superficial lymph capillaries and restrict fluid absorption
246
What Physical activities are contraindicated for lymphedema? Why?
- strenuous activities
- ballistic movements
- rotational motions
--> likely to exacerbate lymphedema
247
What are the symptoms of lymph overload?
1. discomfort
2. aching
3. pain in proximal lymph areas
4. change in skin color
| discontinue activity when present
248
What are contraindicated modalities for lymphedema?
1. those that cause vasodilation or increase lymph load
2. electrotherapeutic modalities greater than 30 Hz
249
What are the risks of using pneumatic compression pumps?
1. high pressures can damage lymph nodes
2. may remove water instead of proteins
3. use on LEs can result in genital lymphedema
| Low pressure pumps are preferred
250
You can only use pneumatic compression pumps in what stages of lymphedema?
Stage I only
| unless there are skin changes, increased inflammation and fibrosis
251
Pressures over ___ mmHg is contraindicated for those with lymphedema
> 45 mmHg
