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Flashcards in Cardiovascular Conditions Deck (54)
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1

The ability of the heart to pump depends on what?

  1. Automaticity
  2. Excitability
  3. Conductivity
  4. Contractility
  5. Rhythmicity

2

List the components of the Perfusion Triangle and some potential dysfunctions impacting each corner

  1. Heart (Pump function)
    • pump dysfunction → CHF
  2. Blood vessles (Container function)
    • Container dysfunction → HTN causes vasoconstriction and ischemia. Anaphylaxis and septic shock cause vasodilation leading to lethal hypotension 
  3. Blood (Content function)
    • Content dysfunction → any kind of sustained hemorrhaging will cause loss of blood content. Gastric or slow cerebral bleeding can cause "silent" loss of blood content

 

3

List 4 coronary reflexes that help maintain CO

  1. Baroreceptors → mechanoreceptors located in IC, stimualtion results in vasodilation, decreased HR, and decreased contractility
  2. Bainbridge reflex → located in R atrial myocardium. Inc volume of right atrium = inc pressure on atrial walls. Results in increased HR and contracility
  3. Chemoreceptors → in carotid and aortic bodies can increase rate and depth of ventilation in response to CO2 levels and can also have cardiac effects
  4. Ergoreceptors → regulate hemodynamics by activating mechanosensitive afferents that can inhibit sustained vagal effects on the heart caused by increased HR during physical loading

 

 

4

During the cardiac eval what type of info about cardiac dysfunction should you ask for?

  1. presence of chest pain
  2. location, quality, characteristics of pain
  3. Angina
  4. Previous MI
  5. Medications
  6. History of cardiac conditions
  7. Syncope, dizziness
  8. Cardiac risk factors 

 

5

What is included in the PT cardiac physcial examination ?

  1. Observation
  2. Palpation
  3. Edema Pitting scale
  4. Telemetry:
    • BP
    • MAP = (HR * SV) * SVR
    • HR
    • RR
    • Pulse ox
  5. Asculation

 

 

6

Things to keep in mind when taking BP

  1. Pt position is important
  2. use same extremity for serial recordings
  3. be aware if pt has restrictions on UE for taking BP
  4. Measure for OH as indicated
  5. record preexertion, paraexertion, postexertion BP for ID BP response to activity
  6. be aware of meds that affect BP

 

7

What do you eval during the cardiac ascultation?

  1. valvular function
  2. rate
  3. rhythm
  4. valvular compliance
  5. ventricular compliance

 

8

Saying to help you remember where telemetry leads go (if they ever disconnect)

White on Right

White clouds over green grass

Black smoke over red fire

Chocolate in the middle close to the heart

9

List some ECG interpretations 

  1. ST depression of 1-2 mm = ischemia
  2. ST elevation = MI
  3. T wave inversion = MI
  4. Prominent Q wave = MI
  5. Wide QRS = bundle branch block

 

10

why is A-Fib a concerning ECG finding?

it can lead to blood clots, HF and other complications

11

how does V-tach and V-Fib differ on an ECG strip?

V-tach is just a fast rate that looks relatively uniform

V-fib is erratic and quick and not uniform (it is also more dangerous)

12

What are PVCs and do you have to stop therapy if a pt has one?

PVCs - premature ventricular contraction 

if they are unifocal that's relatively normal in adults >65 so therapy can continue

if they multifocal you need to stop and let the pt rest as they can lead to V-tach

13

Elevated BNP is usually indicative of ______

Heart Failure

14

what is the difference between SaO2 and PaO2?

SaO2 = saturation of peripheral oxygen

PaO2 = parital pressure of O2, measurement of oxygen in arterial blood 

 

In general keep SaO2 92% and higher (STOP activity if 89% or lower)

15

List some various classes of cardiac medications

  1. Antiarrhythmic agents
  2. Anticoagulants
  3. Antihypertensives
  4. Combo drugs for HTN
  5. Antiplatelet agents
  6. Lipid-lowering agents
  7. Positive iontrophes (pressors)
  8. Thrombolytics (i.e fibrinolytics)

 

16

List some common cardiac conditions

  1. Ischemia
    • HTN
    • ACS
      • CAD
      • Angina
      • MI
  2. Rhythm and Conduction Disturbance
  3. Heart disease (valvuar, myocardial, pericardial)
  4. Heart Failure

 

17

What is ACS?

Acute Coronary Syndrome → includes a constellation of disorders that result in MI

CAD → Angina → MI

18

List and describe various types of rhythm and conduction disturbances

  1. Agonal rhythm → irregular <20 bpm, near death
  2. A-fib → most common arrthythmia. Can lead to syncope due to no atrial kick.
  3. V-tach → rate > 100 bpm, usually regular rhythm, most common after acute MI
  4. V-fib → choatic rate and rhythm, will lead to death if untreated
  5. Multifocal VT (torsades de pointes) → irregular rhythm and rate >150 bpm
  6. AV blocks → rhythm disturbance where electrical conduction from atria to ventricles is partially/completely blocked

 

19

what are some common causes of A-fib?

  1. CHF
  2. CAD
  3. HTN

 

20

there are several degrees to AV blocks, what is a significant cut off point we are interested in as PTs?

Second degree Type II and up have a higher risk for hemodynamic instability → PT is contraindicated at this point due to how unstable the patient is

21

List and describe specific cardiac conditions impacting the valves, myocardium, and pericardium

  1. Valvular disease → affects one or more of the 4 valves in the heart
    • stenosis 
    • regurgitation
    • prolapse 
  2. Myocardial heart disease (cardiomyopathies) → affect heart muscle tissue
    • dilated
    • restrictive
    • hypertrophic 
  3. Pericardial herat disease → affect pericardium (pericarditis)
    • cardiac tamponade 

 

22

differentiate between the 3 different cardiomyopathies

  1. Dilated → ventricle is dilated, with marked contractile dysfunction of myocardium 
  2. Restrictive → endocardial scarring of ventricles, decreased compliance during diastole and decreased contracile force during systole
  3. Hypertrophic → thickened ventricular myocardium, less compliant to filling, thus decreased filling during diastole 

23

what is cardiac tamponade?

fluid collects between pericardial sac and myocardium which prevent the ventricles from filling, which become life threatening 

normally caused by blunt trauma like a MVC 

Beck's triad results

24

what is Beck's Triad?

  1. Jugular venous distension
  2. hypotension and elevated systemic venous pressure
  3. muffled heart sounds 

25

what is heart failure?

pump dysfunction that reduces CO

most common etiology = cardiomyopathy

Classifications:

  1. L-sided HF
  2. R-sided HF
  3. High-output failure
  4. Low-output failure
  5. Systolic dysfunction
  6. Diastolic dysfunction

 

26

list some S/S of HF

  1. Cold, pale, possiblly cyanotic extremities
  2. Weight gain
  3. peripheral edema
  4. Jugular venous distension
  5. Tachypnea
  6. Crackles (rales)
  7. decreased exercise tolerance
  8. dyspnea
  9. paroxysmal noctural dyspnea
  10. orthopnea
  11. cough
  12. fatigue

27

List some methods for cardiac management of cardiac disease

  1. Revascularization and reperfusion of myocardium
  2. Ablation procedures
  3. Cardioversion
  4. Life vest
  5. Valve replacement
  6. AVR
  7. Cardiac transplant

 

28

list some methods used to achieve cardiac revascularization and reperfusion to the myocardium

  1. Thrombolyic therapy
  2. Percutaneous revascularization
  3. CABG

 

29

describe thrombolytic therapy as well as some indications and contraindications

  1. used for acute management strategy for pts experiencing MIs
  2. Indications → chest pain suggesting MI, elevated ST segment, bundle branch block
  3. Contraindicated in pts at risk for excessive bleeding

 

**typically used in conjunction w/other meds

30

What is percutaneous revascularization?

aka PTCA (percutaneous transluminal coronary angioplasty)

  • balloon-tipped catheter threated into occluded artery
  • balloon inflated to make artery patent once again
  • endoluminal stent may be used to maintain patency
  • rehab → often OP procedure
  • consider these pts high risk