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CVP Misc Flashcards

1
Q

Mitral Valve Prolapse Triad

A

Dysnpena, Fatgue, Palpiations
Due to Flaps go intruding on left atrium

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2
Q

Name the difference between each level of heart block

A

Normal PR is 0.12-0.2 (3-5 squares)

1st degree heart block - PR interval too large (>0.2)
Usually no big deal

2nd degree heart block mobitz 1 - PR increases each time, drops beat, then restarts

2nd degree mobitz 2 - Conistent PR then drop
Worse than mobitz 1

3rd degree mobitz - Random relationship with PR interval, no order, really large PR intervals. Will be symptomatic, should stop because serious

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3
Q

Describe the difference between pectus carinatum and pectus excavatum

A

Excavatum = sunken chest, smaller, posterior displaced sternum

Carinatum is opposite = More space and ant placed sternum, barrel chest is an example due to emphysema, other obstructive diseases that cause hyperinflation

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4
Q

Cardiac Biomarkers

A

CK-MB,
Myoglobin
Troponin
Lactic dehydrogenase

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5
Q

Signs of lung issues (obstructive) on imaging

A

Increased air would cause radiolucent (darker) b/c light not absorbed by air

Hyperinflated lungs and flattened diaphragm

Increased I:E ratio because E increases

blunted costophrenic angle (less sharp)

Increased subcostal angle b/c less air is pushing on it

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6
Q

Mediate percussion vs percussion

A

Mediate percussion to assess sound with middle finger and other hand as mediator

Percussion is just cup hand hitting against body for postural drainage

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7
Q

UE vs LE exercise

A

Higher BP and HR for UE doe to smaller muscle mass.

LE has greater Vo2 mac/oxygen consumption, UE greater DEFICIT

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8
Q

Fremitus = Egophany

A

Fluid in lungs (increased) more clearly heard due to fluid (e.g pulm edema)

Fluid outside of lungs (decreased). Cannot hear vowels as clear due to Hyperinflation. More muffled than normal level (e.g COPD)

if E sounds like A due to fluid accumulation

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9
Q

Pursed lip breathing

A

Good for obstructive diseases
Lowers respiratory rate
Prevents airway collapse for better gas exchange

Inhale through nose and blow out with pursed lips keeps air pressure inside airways

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10
Q

Huffing and Active Cycle of Breathing

A

Huffing: Coughing against closed glottis to mobilize secretions (think steam on mirror “ha”)

ACBT
Controlled (rested) breathing
followed by
3-4 Deep breaths
followed by
Huffing to move secretions

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11
Q

Segmental Breathing

A

Inflate specific part of lung through tactile cueing

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12
Q

Incentive spirometry

A

Biofeedback device for after surgery, restrictive diseases, SCI, atelectasis after surgery

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13
Q

Glossopharyngeal breathing

A

Gulp breathing with face

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14
Q

Inspiratory hold

A

Breathe in and hold w/o valsalva inflates poorly ventilated lungs, helps with cough

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15
Q

Assisted cough

A

Press on epigastric area

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16
Q

Autogenic drainage

A

Airway clearance through adjusted rates and depth of breathing to mobilize secretions (self)

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17
Q

High frequency chest wall oscillation and acapella device

A

airway clearance for cystic fibrosis

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18
Q

What causes blunted costophrenic angle

A

Pleural effusion (buildup at bottom), Chronic atelectasis

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19
Q

Cardiac Rehab Phases

A

Acute (inpatient) = 4-6 METS, Only 20-30 over HR rest, Borg of less than 13/20

Outpatient = Activities less than 90% of ischemic RPP, Target 55-90% HR Max, 12-16 on Borg (light to somewhat hard), 5-9 METS

Community Program =6-12 months self regulated

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20
Q

METS,

A
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21
Q

Systole vs Diastole

A

Systole = pumping of blood from the respective region (e.g atrial systole is pumping blood into ventricles, ventricular systole is ventricles pushing blood into the pulmonary artery and aorta)

Diastole = Refilling of respective region of heart

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22
Q

Pre load

A

Volume of blood in L ventricle after diastole, based on venous filling , pressure

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23
Q

After load

A

The pressure required for the heart to pump blood out of ventricles into periphery, based on the aorta, peripheral pressures, and blood viscosity

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24
Q

Normal SV

A

60-80

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25
Cardiac output
4-5 L up to 25 L/min during exercise
26
Hypovolemia
Low blood volume signs include ortho hypotension, tachycardia, increased temp
27
Hypervelima
High blood vol usually due to excessive fluid intake like IV, and sodium or fluid retention due to heart failure or kidney disease Signs are swelling, fluid in lungs, ascites, etc. = buildup of fluid
28
Primary muscles of inspiration
Diaphargm (C3, c4, c5...) and External intercostals *Diaphragm contraction (flattens) and causes the chest to expand longitudinally and LOWER ribs ELEVATE
29
Accessory muscles of inspiration
SCM, scalene (lifts 1st and 2nd rib), pec major, pec minor, SA
30
Exhalation
Passive recoil in nomral breathing (TV 10 percent breathing) For forced expiration (abdominals and obliques depress ribs and push diaphragm for quicker emptying )
31
ERV summary
Maximum amount that can be expired after Tidal exhalation approx 15 percent or 1 L
32
FEV
FEV1 as example max airexhaled in specific time like 1 sec Should be 80 percent if healthy for FEV1
33
Vital capacity
Volume change that occurs between max inspiration and exhalation Everything except the residual volume so 75% or 4.5 L therefore forced vital capacity is the vol exhaled during FEV AFTER a max inspiration
34
Residual volume
Doesnt leave lungs 25 % so 1.5 L
35
Inspiratory reserve volume
Max you can inhale after TV 50 percent or 3 liters Would decrease with Restrictive lung diseases and neuromuscular diseases
36
Restrictive lung diseases cause decrease in
IRV, TLC, and VC simply b/c you are taking in less air Everything decrease except ratio therefore, decreased breath sounds
37
FEV1/FVC ratio
Normal is above 0.7 Increases with restrictive lung diseases (b/c VC goes down) do math Decreases with obstructive diseases (b/c FEV goes down)
38
Tidal volume
10 percent
39
Inspiratory capcitiy
TV + IRV = 60 percent
40
Functional residual (after exhalation) capacity
ERV + RV = 40 percent
41
Restrictive diseases
Interstitial diseases (causing pulmonary fibrosis, less compliance) e.g Idiopathic Pulmonary Fibrosis (IPF) Sarcoidosis Pneumoconiosis (e.g., asbestosis, silicosis, coal workers' pneumoconiosis) Hypersensitivity Pneumonitis e.g Any neuro disease b/c muscles weaker so think about how interventions would be directed at that vs actual CVP Spine issues like scoliosis, kyphosis, anklyosing Pneumo or hemothorax because literally cany inflate
42
Obstructive diseases
asthma Sleep apnea CPOD bronchitis CYSTIC fibrosis b/c fluid Excessive use of accessory muscles (may cause hypertrophy) Hypersonnance (loud low pitched sound) Anything "forced" out is decreased (FVC, FEV1, ratio decreases less than 70) Residual volume and TLC increased b/c trapped air
43
Anatomic dead space
Would increase with lung collapses
44
Atrial septal defect
Atrial Septal Defect (ASD) Notes Definition: Congenital heart defect with an opening in the atrial septum; allows left-to-right blood shunting. Key Issues: Increased pulmonary blood flow, potential pulmonary hypertension, right atrial/ventricular hypertrophy. Symptoms Asymptomatic early; later: fatigue, poor exercise tolerance, dyspnea. Severe cases: cyanosis (with Eisenmenger syndrome).
45
Coarctation of Aorta
Coarctation of the Aorta (CoA) Notes Definition: Narrowing of the aorta, increasing afterload and causing left ventricular hypertrophy. Symptoms High BP in arms, low BP in legs. Weak/absent femoral pulses, fatigue, leg cramping with exercise. Physical Therapy Considerations Monitor: Blood pressure in both arms and legs; avoid excessive exertion. Exercise: Low/moderate intensity; avoid heavy resistance training or Valsalva. Post-Surgery: Gradual activity increase, monitor for hypertension. NPTE Tip: Know BP differences, exercise precautions, and post-surgical rehab protocols. Not always a problem and may not be noticed until later on
46
Ventricular septal defect
Ventricular Septal Defect (VSD) Notes Definition: Congenital defect with an opening in the ventricular septum; causes left-to-right shunting of blood. Symptoms Small VSD: Often asymptomatic. Large VSD: Fatigue, dyspnea, poor growth, frequent respiratory infections. Severe: Pulmonary hypertension, cyanosis (with Eisenmenger syndrome). Physical Therapy Considerations Monitor: Signs of fatigue, dyspnea, or cyanosis during activity. Exercise: Low/moderate intensity; avoid Valsalva or high-intensity in uncorrected cases. Post-Surgery: Gradual return to activity, focus on endurance. NPTE Tip: Recognize signs of heart strain, manage post-surgical rehab, and adjust intensity for uncorrected VSD.
47
Tetralogy of fallot
Definition: Congenital heart defect with 4 components: Ventricular septal defect (VSD). Pulmonary stenosis. Right ventricular hypertrophy. Overriding aorta.
48
Cor pulmonale
R sided heart failure due to high BP in lungs so sx are swelling distended jugular ascites etc.
49
Inpatient phase of Cardiac rehab (phase 1)
Think hospital Early mon ADLs Mobilize Patient ed Low cardiac training like walking in hall way (2-3 METS) Discharge is around 5 METS but may be a bit less in reality STARTS AFTER 24 hours or when safe
50
Phase 2 (many issues so covers what you would think. Besides considering rule for MI
Outpatient Goal is to get normal Strength training Start after 3 weeks (unless MI 5 weeks or CABG 8 weeks b/c stenral precautions) very light weight or bands to start progress to 12-14 lbs ALWAYS start 40-50 percent of MAX HR, then after 3 good weeks progress by 10bpm per week 5x week is ideal ASCM guidelines, but at least 3x Discharge goal is 9 METS ALWAYS DO NEED WARM UP AND COOL DON
51
Post MI (heart attack) KNOW THISSSSSS
Limited to 70 percent of max HR (220-age) or 5 METS for 6 weeks
52
Sternal precautions
8-10 weeks No pushing or pulling No scapular adduciton No UE resitive above 90 NO UE asstiance with sts Sternal splint with coughing laughing sneezing
53
UE vs LE
UE have greater hemodynamic response so higher BP and HR (bigger oxygen deficit due to smaller muscles etc.) LE less response but greater cardiac output and greater VO2 max/oxygen consutpion
54
Maintenance phase 3
strength training moderate now Cardiac to 70-85 percent of HR 20-30 min moderate intensity or 40-60 of low intensity 3-4 times per week
55
Rule of thumb For progression of cardiac rehab
Always think duration first to change and progress Less intensity, longer duration and vice versa
56
oxygen therapy
Indicated if PaO2 less than 55 or sao2 less than 88 or slightly higher with presence of cor pulmonale or polcythemia
57
Agina pain scale
1-4 (worst pain ever)
58
Hypertensive crisis
180 + systolic or 120+ diastilic
59
valves ausculation
APTM
60
S1
lub 1st heart sound reflects AV VALVE CLOSURE, systole (ventricles filling) High frequency, lower pitch sound, longer duration
61
S2
dub 2nd heart sound, diastole, pulm and aortic valves closing high frequency, high pitch
62
S3
Ventricular gallop, early diastole CHF athletes normal in healthy children vibrations of passive blood flow from atria
63
S4
Atrial gallop, late diastole MI, stenosis, hypertension
64
New York heart association levels
All in respect to normal activity, third level is issues with all activities that don't include rest 4th is issues even at rest (symptoms)
65
Right side lying can
decrease pleural friction/irritation, decrease visceral pain but increase MSK pain
66
BP changes with exercise
Systolic should go up Diastolic should not change or slightly decrease + or - 5 is not significant drop in systolic 20 or mote is not okay and requires termination
67
Normal lung sounds
Tracheal, Bronchial sounds - Loud, tubular sounds over the trachea Inspiratory phase shorter (upper airways) Vesicular - Low pitched breezy sounds in distal airway Inspiratory is longer These are respective to location and if not then are abnormal
68
Abnormal (adventitious breath sounds)
General abnormal with inhale or exhalation
69
Crackle (rales)
- High-pitched popping, typically on inspiration - For many diseases. Obstructive or restrictive - Due to movement of secretions (peripheral airways) or sudden opening of the closed airway - Distinguish wet vs dry based on pathology
70
Pleural friction rub
- Dry crackling sound with inhalation and exhalation - Due to irritation, inflamed pleura/viscera - In the painful spot - e.g pleural effusion
71
Rhonci
- Continuous low-pitched snoring/gurgling - Due to inflammatory-related obstructions airway - e.g bronchospasm
72
Stridor
- High-pitched wheeze due to UPPER AIRWAY OBSTRUCTION only - like swallowing something or throat infection
73
Wheeze
- Musical or whistling - e.g asthma, bronchospasm
74
Bronchial breath sounds
- abnormal IF where vesicular sounds should be present (in distal aiways) - pneumonia
75
Decreased breath sounds
Severe congestion, emphysema, HYPOventilation
76
Absent lung sounds
Pneumothorax, lung collapse
77
Increased sounds or egophany, bronchophony etc.
due to consolidation, atelectasis, fibrosis Shows up more white on imaging b/c Denser fluids, blood, pus etc. instead of air If sounds are less, than more air like pneumothorax copd
78
Tympanic sound
with hyperinflated lungs
79
Adventitious sound for consolidation
Crackles
80
Think of diaphagm breathing
as a coordination, relaxation, awareness, or strengthening vs pursed lip is actually to keep airways open vs upper chest inhibiting for those who use accessory muscles too much
81
Guidelines
Cardio 90-150 min a week for healthy High intensity 45-90 min (75 min a week is sweet spot) 150 min aerobic and 150 of high intensity, so do the math 35 min 90-95 VO2 max 2-3 time per week, duration 8-12 weeks ) e.g Heart class,
82
Obesity Guidelines
two daily sessions of 30 minutes at 45-70% VO2Max to start out
83
Diaphragm moves
down with inspiration and flattens, which can cause respiratory compromise
84
Rib biomechanics
With inspiration, Head of rib goes down while lateral part goes up So superior mob of head if stuck after inspiration Generally goes outward and upward
85
Decreased mediate percussion
is due to consolidation
86
Increased would be due to
air (emphysema, pneumothorax)
87
Calcium channnel blockers
Vaasodilate and decrease myocardial contraction Use RPE like with beta blockers PINES
88
Ace inhibitors
A PRIL decrease afterload and BP FATIGUE IS PRONBLEM WITH THIUS AND AVOID RAPID SUDDEN CHANGE IN POSITION
89
Exercise enhances
statins/anti hyperlipidemia drugs and improves HDLS

NPTE Prep (44 decks)

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