Cardiovascular Dysfunction Flashcards Preview

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Flashcards in Cardiovascular Dysfunction Deck (37):
1

What is the scope of physio in CV dysfunction?

- Management of acute surgical/medical patients
- Cardiac rehab & community care
- Cardiac transplantation
- Research

2

What are some of the investigations used for CV dysfunction?

- History taking
- Physical examination
- ECGs
- Echocardiography
- Exercise testing
- Myocardial perfusion imaging
- MRI
- PET
- Cardiac catheterisation

3

What two factors determine blood pressure?

- Total peripheral resistance (TPR)
- Cardiac output (CO)

Mean arterial pressure (MAP) = CO x TPR

4

How is pulmonary vascular resistance different to systemic?

TPR is much lower than vascular

5

What causes the difference in blood pressure between systemic and pulmonary circulation?

Differences in vascular resistance mediated by SNS in smooth muscle in the arterioles - increases vasoconstriction & BP

6

How is blood pressure regulated acutely?

Baroreceptor reflex

7

Where are baroreceptors located in the heart?

- Carotid sinus
- Aortic arch

8

What effect does the vagus nerve have on the heart?

- Efferent nerve for the heart
- Slows contractility, heart rate etc

9

How is a decrease in arterial blood pressure regulated by baroreceptors?

- Central control (medulla/hypothalamus)
- Decreased PNS outflow
- Increased SNS outflow
- Increased HR
- Vasoconstriction
- Increased forced cardiac contraction

10

How can bed rest affect blood pressure?

24 hours bed rest reduces SNS activity in response to orthostatic (upright) stimulus

11

What are the symptoms of orthostatic intolerance (low BP)?

- Light headedness
- Dizziness
- Yawning
- Nausea
- Feeling warm
- Abdominal discomfort

12

What are the reasons for orthostatic intolerance after bed rest (low BP)?

- SNS dysfunction
- Reduced plasma volume
- Cardiac atrophy
- Arrhythmia (bradycardia, tachycardia etc)
- Drugs
- Vaso-vagal syncope (pain, emotion, medical procedure)

13

What are the consequences of hypertension?

Major risk factor for
- Heart failure
- Myocardial ischaemia & infarction
- Stroke
- Retinopathy
- Nephrosclerosis & renal failure

14

What are the two main things hypertension effects?

- Mediates arterial damage
- Increases afterload (direct pressure load on left ventricle)

15

What does increased after load cause?

- Systolic dysfunction
- Diastolic dysfunction
- Increased myocardial O2 demand

16

What does arterial damage cause?

- Accelerated atherosclerosis
- Weakened vessel wall

17

What are some of the other CHD risk factors hypertension interacts with?

- Cholesterol
- HDL
- Smoking
- Diabetes
- LVH

18

What is the main cause of hypertension?

Essential (no definitive cause, 95% of cases)

19

What are the characteristics of essential hypertension (EH)?

- 80% have stage 1
- Genetics important

20

What are the non-pharmacological treatments of hypertension?

- Weight reduction
- Adopt DASH eating plan
- Dietary sodium reduction
- Physical activity
- Moderation of alcohol consumption

21

What are some of the pharmacological treatments of hypertension?

- Diuretics
- Anti-adrenergic agents
- Ca channel blockers
- ACE inhibitors
- Angiotensin-II receptor blockers
- Vasodilators

22

What is heart failure?

When the heart cannot pump enough blood to meet the requirements of the tissues

23

What are the types of heart failure?

- Systolic vs diastolic
- Right vs left

24

What happens in left sided congestive heart failure?

- LV weakens, cannot empty
- Decreased CO
- Decreased renal blood flow (body starts retaining fluid)
- Backup of blood into pulmonary vein
- High pressure in pulmonary capillaries
- Can cause pulmonary oedema

25

What happens in right sided congestive heart failure?

- RV weakens, cannot empty
- Decreased CO
- Decreased renal blood flow
- Backup of blood into systemic veins
- Increased venous pressure causes swelling in legs & organs
- High venous pressure causes distended neck vein & cerebral oedema

26

What are the causes of heart failure?

- CHD (LV)
- Cardiomyopathy (both)
- HT (LV)
- Aortic valve stenosis (LV)
- Coarctation of aorta (LV)
- Pulmonary HT (RV)
- Pulmonary valve stenosis (RV)
- Atrial fibrillation (both)
- Constrictive pericarditis (RV)

27

What is the most common cause of right heart failure?

Left heart failure

28

What are some of the conditions that cause right heart failure?

- Right ventricular infarction
- COPD
- Interstitial lung disease
- Pulmonary embolism

29

How does decreased renal blood flow affect blood pressure?

- Stimulates renin-angiotensin & aldosterone secretion
- Increased thirst
- Systemic vasoconstriction
- Renal sodium & fluid retention

30

What symptoms are associated with left sided heart failure?

- Dyspnoea
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Fatigue

31

What symptoms are associated with right sided heart failure?

- Peripheral oedema
- Right upper quadrant discomfort (due to enlargement of liver)

32

How is heart failure classified?

Class I: No limitation of physical activity
Class II: Slight limitation, dyspnoea & fatigue with moderate activity
Class III: Marked limitation, dyspnoea with minimal activity
Class IV: Severe limitation of activity, symptoms at rest

33

What are the cautions to exercise in heart failure?

- Fever/acute systemic illness
- Unresolved/unstable angina
- Resting SBP>200, DBP>110
- Significant unexplained drop in BP
- Symptomatic hypotension
- Resting/uncontrolled tachycardia
- New/recurrent symptoms of dyspnoea, lethargy, palpitations, dizziness
- Unstable heart failure
- Unstable/uncontrolled diabetes

34

What are the vital signs that can be measured?

- Heart rate
- Blood pressure
- Temperature
- Respiratory rate

35

What are the CV signs?

- Normal HR: 60-100bpm
- Tachycardia: >100bpm
- Bradycardia: <60bpm
- Hypertension: >145/95
- Hypotension: <90/60
- Postural/orthostatic hypotension: Drop of more than 5mmHg when going from lying to sitting/standing

36

Where can the pulse be taken from?

- Radial artery
- Carotid artery
- Brachial artery
- Femoral artery
- Temporal artery

37

What characteristics should be noted when measuring pulse?

- Rate: Normal, low, high
- Rhythm: Regular, regularly irregular, irregularly irregular
- Changes in amplitude of beats, are these related to respiration (pulses paradoxus)