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CardioPulm > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

B-1 agonists do what to the heart?

A

increase cardiac contractility

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2
Q

Positive inotropic agents do what to the heart?

A

increase force of contraction of myocytes that leads to increased CO
- increase contractility and CO

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3
Q

What type of patients would be on ionotropic agents (dopamine and dobutamine)?

A

severe heart failure
- probably on the heart transplant list

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4
Q

What does digitalis do to the heart?

A

increases cardiac contractility
- directly affects movement of calcium in the cells
- direct inotropic effects

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5
Q

What patients would be using digitalis?

A

atrial fibrillation, atrial tachycardia HF

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6
Q

beta blockers (B-1 antagonists) do what to the heart?

A

reducing the work of the heart

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7
Q

adverse effects of beta blockers (B-1 antagonists)

A
  • bronchoconstriction
  • excessive depression of cardiac function - reduced peak HR
  • OH (vasodilation)
  • depression, lethargy, and sleep disorders
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8
Q

What do calcium channel blockers do to the heart?

A

decrease contractility and decrease energy demands of the heart
- also decrease CO

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9
Q

What is double product?

A

HR x static pressure (systolic BP)
- index of myocardial oxygen consumption

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10
Q

How do you reduce double product? What does this cause?

A
  • increase the radius of vessels which decreases afterload
  • reducing radius of vessels reduces the workload on the heart
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11
Q

alpha-1 receptor blockers result in what?

A

peripheral vasodilation
- smooth muscle relaxation
- decreases blood flow resistance

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12
Q

adverse effects of alpha 1 receptor blockers

A

reflex tachycardia secondary to hypotension
- too much dilation
- can also cause OH

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13
Q

What do centrally acting agents do to HR?

A

decrease HR and contractility

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14
Q

adverse effects of centrally acting agents

A

-dry mouth
- dizziness
- drowsiness
- hypotension

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15
Q

diuretics effect on blood volume

A

decrease blood volume which decreases preload

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16
Q

adverse effects of diuretics

A
  • dehydration
  • electrolyte imbalance
  • OH/falls precaution
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17
Q

Risk factors for CHD

A
  • increasing age
  • family history of CVD
  • male
  • uncontrolled HTN
  • elevated total cholesterol
  • uncontrolled diabetes
  • smoking/components of cigarette smoke
  • physical inactivity
  • obesity
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18
Q

BMI cutoffs

A

Normal - 18.5-24.9
overweight - 25-30
Obese - > 30-40
morbidly obese > 40

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19
Q

total cholesterol numbers

A

normal - < 200 mg/dl
borderline high - 200-239 mg/dl
high - > 240 mg/dl

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20
Q

men normal and at risk ranges for HDL

A

normal - > 60
at risk - < 40 mg/dl

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21
Q

women normal and at risk ranges for HDL

A

normal - > 60
at risk - < 50 mg/dl

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22
Q

What can increase HDL concentrations?

A

aerobic exercise

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23
Q

What forms atherosclerotic plaque?

A

LDL

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24
Q

normal fasting ranges of LDL

A

100 mg/dl or less
- less is better

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25
Q

What should the cholesterol ratio be?

A

total cholesterol/HDL
- 4:1
- lower the ratio, the lower your risk of heart disease
- the higher to ratio, the higher the risk of heart disease

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26
Q

normal and abnormal triglycerides normal

A

normal < 150
anything above 150 will catch MD eye

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27
Q

diabetes is a disease of ______________

A

hyperglycemia

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28
Q

What type of heart dysfunction do diabetes patient exhibit?

A

LV diastolic dysfunction

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29
Q

normal creatine kinase levels

A

0-175 IU/L
- high means MI/cardiac insult

30
Q

normal troponin levels

A

0-3 mg/mL
- high means cardiac muscle injury

31
Q

________ leaks into the body when damage to cardiac cells

A

myoglobin
- only found in blood stream after muscle injury

32
Q

normal myoglobin level

A

25-72 ng/mL

33
Q

Why is a liver panel of interest post MI?

A

Cardiac pump dysfunction leads to reduced liver perfusion leading to passive congestion leading to increases in the components of a liver panel

34
Q

What does atrial natriuretic peptide (ANP) result in? What is it a biomarker for?

A

vasodilation and diuresis - leads to decrease in preload and afterload which decreases work load on the heart
- biomarker for heart failure
- secreted from cardiac atria in response to atrial distention

35
Q

Where is atrial natriuretic peptide (ANP) released?

A

atria

36
Q

Where is brain natriuretic peptide (BNP) produced and released?

A

ventricles

37
Q

What is the gold standard for measurement of heart failure?

A

BNP levels
- they are elevated with heart failure

38
Q

What does BNP do?

A

Decreases vascular resistance - decreases BP - decreases afterload of heart
- Helps to promote diuresis

39
Q

normal BNP levels

A

< 100 pg/mL

40
Q

Class 1 NY heart association classification

A

cardiac disease
- no symptoms and no limitation in ordinary PA

41
Q

Class 2 NY heart association classification

A

mild symptoms (SOB and/or angina) and slight limitation during ordinary activity

42
Q

Class 3 NY heart association classification

A

marked limitation in activity due to symptoms
- comfortable only at rest

43
Q

Class 4 NY heart association classification

A

severe limitations
- symptomatic at rest
- bedbound

44
Q

C reactive protein (CRP) normal level

A

< 1.0 mg/L

45
Q

What does a high CRP level mean?

A

increased inflammatory states
- atherosclerosis
- CHF
- cancer
- infections
- liver dysfunctions (liver secretes CRP)

46
Q

normal serum creatinine level. What does an elevated level mean?

A

< 1.5 mg/dL
- elevated level suggests kidney dysfunction secondary to reduced renal perfusion
- could mean HF due to decreased CO which decreases renal perfusion

47
Q

What do PET scans detect?

A

cardiac tissue viability
- Not quality of movement nor anatomy

48
Q

What do echocardiograms detect?

A
  • abnormal cardiac anatomy
  • volumes of L ventricle
  • estimate stroke volume and EF
  • analyze motion of valves and heart muscle
49
Q

What is radionuclide perfusion imaging (nuclear stress test) used for?

A
  • assess ongoing chest pain/diagnosis of CAD
  • post MI heart muscle damage
  • assess blood flow after bypass
  • look for scar tissue in heart
50
Q

What evaluates cardiac morphology, valvular disease, cardiac shunts, cardiac blood flow and coronary artery anatomy?

A

MRI

51
Q

What is a standard test to test a patient for occluded coronary artery?

A

coronary angiography

52
Q

What patients cannot have a coronary angiography done?

A

kidney disease patients
- dye is toxic to the kidneys

53
Q

major complications of coronary angiography?

A
  • serious bleeding
  • heart attack
  • stroke
  • kidney failure
54
Q

PT implications with left heart catheterization

A
  • bed rest for 6-8 hours
  • knee immobilizer to minimize hip flexion and risk of opening incision
  • monitor for groin hematomas and pain
55
Q

PT implications with right heart catheterization

A

no activity restrictions
- incision site is via the external jugular vein

56
Q

What is used to look at the arteries that supply blood to the heart?

A

CT scan
- used to diagnose and treat blood vessel diseases and conditions

57
Q

What is used to convert heart rhythm when a patient has an unstable heart and is a scheduled procedure?

A

cardioversion

58
Q

PT implications after cardioversion

A

withhold care for 24 hours or until the patient can tolerate activity

59
Q

PT considerations after cardiac ablation

A
  • hemodynamic stability - sinus rhythm and vitals are stable as they change positions
  • bleeding at the site of catheter insertion
60
Q

What is cardiac tamponade?

A

Reduced cardiac function due to fluid accumulation in the pericardial cavity. A restrictive cardiac pathology
- this is a medical emergency

61
Q

What is an intra-aortic balloon pump?

A

mechanical device that increases coronary perfusion
- deflates during ventricular systole
- inflates during ventricular diastole

62
Q

PaO2 levels - normal, mild, moderate, severly hypoxemic

A

normal - 80-100 mmHg on room air
mildly hypoxemic - 60-80 mmHg
moderately hypoxemic - 40-60 mmHg
severely hypoxemic - < 40 mmHg

63
Q

What is semi-fowler’s position?

A

supine with head of bead raised
- Used to help with breathing and decrease amount of returning fluid that may be overworking the heart

64
Q

What is professorial position?

A
  • bent over with arms stabilizing chest
  • stabilizes 1st rib to allow lungs to open more
65
Q

central cyanosis is caused by what?

A

heart or lungs, or abnormal hemoglobin
- discoloration is systemic

66
Q

peripheral cyanosis is caused by what?

A

decreased local circulation
- discoloration is regional

67
Q

S1 heart sound

A

closure of mitral and tricuspid valves
- onset of ventricular systole

68
Q

S2 heart sound

A

closure of aortic and pulmonary valves
- start of ventricular diastole

69
Q

S3 heart sound

A
  • occurs when diastole when ventricle is filling rapidly
  • typically indicative of CHF b/c heart can’t keep up with blood flow
  • can be normal in children
70
Q

S4 heart sound

A
  • occurs late in diastole, just before S1
  • increased resistance of ventricular filling
  • stiff wall of heart and blood hitting it
  • HTN, coronary artery disease, or pulmonary disease
71
Q

What systolic pressure change during a supine to sit to stand suggests positional hypotension?

A

Systolic drops >/= 20 mmHg or diastolic drops >/= 10 mmHg

72
Q

What diastolic and systolic pressure changes during a supine to sit to stand maneuver suggests positional hypotension?

A

Systolic drops >/= 40 mmHg or diastolic drops >/= 20 mmHg

CardioPulm (7 decks)

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