Exam I Flashcards
(263 cards)
1
Q
what is the leading cause of death in the US?
A
heart disease
2
Q
what is the outer layer of the coronary artery called? what supplies blood flow to this area (arterial walls)?
A
(1) adventitia
(2) vasa vasorum
3
Q
what is the middle layer of the coronary artery called?
A
media
4
Q
what is the inner layer of the coronary artery called?
A
intima
5
Q
what structures border the media?
A
(1) internal elastic lamina
(2) external elastic lamina
6
Q
what are 3 rules of fluid dynamics as it relates to the heart?
A
(1) fluid flows from high pressure areas to low pressure areas
(2) fluids follows path of least resistance
(3) collaterals vasodilate if there’s a blockage and expand
7
Q
what is diastolic blood pressure?
A
primary driving force moving blood into myocardial tissue
8
Q
what is vasomotor tone?
A
determines volume of blood shunted to tissue (ex. exercise would cause more blood to flow to working muscles)
9
Q
what commonly causes a resistance to blood flow within the body?
A
atherosclerosis
10
Q
what are three components of atherosclerosis? what is associated with each?
A
(1) atherosis: fatty streaks in subendothelial cells, causing platelet aggregation and thrombus formation
(2) sclerosis: reduced blood vessel compliance by formation of fiborous cap over thrombus
(3) vasospasm: hyperplasia of intimal smooth muscle causing spasms
11
Q
what are the risk factors for cardiovascular disease? (11)
A
(1) smoking
(2) inactivity
(3) obesity
(4) poor diet
(5) HTN
(6) dyslipidemia
(7) diabetes
(8) family history
(9) age
(10) gender (males > risk until menopause (55 y/o) where it’s equal)
(11) stress
12
Q
what is considered low HDL for men and women?
A
Men < 40 mg/dL
Women < 50 mg/dL
13
Q
what can increase HDL levels?
A
exercise
14
Q
what is considered high triglycerides?
A
> 150 mg/dL
15
Q
what does the AHA recommend for exercise per week?
A
(1) 150 min / week of moderate exercise
(2) 75 min / week of vigorous exercise
16
Q
what are a few acute coronary syndrome (ACS) can present?
A
(1) unstable angina
(2) ST segment elevation myocardial infarction (STEMI)
(3) cardiac muscle dysfunction
17
Q
what are the most common causes of sudden cardiac death?
A
(1) ventricular tachycardia
(2) ventricular fibrillation
18
Q
what are the two major risk factors associated with sudden cardiac death?
A
(1) undiagnosed CHD
2) diagnosed CHD (decreased LVEF <35%
19
Q
what is angina?
A
imbalance in supply and demand of myocardial O2
20
Q
how does classic stable angina present?
A
(1) tightness, pressure, indigestion anywhere above the waist
(2) typically presents during exertional activities and improves with rest or nitroglycerin
21
Q
what are some common clinical presentations for women experiencing angina?
A
(1) nausea, indigestion, discomfort between the shoulder blades, and fatigue
22
Q
what may a diabetic person present with when clinical experiencing angina?
A
shortness of breath
23
Q
how does unstable angina present?
A
(1) chest discomfort accelerating in frequency or intensity
(2) can occur at rest (rest and nitroglycerin don’t help)
(3) could be the first angina attack
24
Q
how does prinzmetal angina present?
A
(1) mainly due to vasospasm
(2) ST segment elevation (instead of depression)
(3) typically occurs in the morning and at rest (not due to increased O2 demand)
25
how does pericarditis present?
(1) pain at rest; not relieved by rest or nitroglycerin
| (2) responds to anti-inflammatory medication
26
how does chest wall pain (musculoskeletal) present?
pain with palpation of the chest wall
27
how does pulmonary / pleuritic pain present?
pain increases with breathing
28
how do bronchospasms present?
(1) induced by exertion or cold
| (2) improved by rest or bronchodilation
29
what are some factors that contribute to unstable angina? (4)
```
(1) catecholamine
levels
(2) increased plasma viscosity
(3) increased platelet activation
(4) changes in atherosclerotic plaques
```
30
what is the main difference between a STEMI and a non-STEMI?
(1) a STEMI is occlusion of a major coronary artery
| (2) a non-STEMI is occlusion of non-major coronary artery, or partial occluison of a major coronary artery
31
how does an ECG present with a STEMI and a non-STEMI?
(1) STEMI: develops abnormal Q wave
| (2) non-STEMI: does NOT develop abnormal Q wave
32
what type of infarction is considered a transmural infarction?
STEMI
33
what type of infarction is considered a subendocardial region infarction?
Non-STEMI
34
the zone of perfusion converts to what following myocardial necrosis?
zone of necrosis
35
what is the time frame required for arterial re-perfusion to prevent myocardial necrosis?
within 20 minutes
36
what is the primary concern for management of acute coronary syndrome?
reperfuse the area of the heart not receiving enough blood and O2
37
what is a major concern when 40% of the left ventricle is affected by an infarct?
death; this is a very severe infarct
38
what happens when >15% of the left ventricle is affected by an infarct?
(1) drop in stroke volume
| 2) elevated LV end diastolic volume (reduced perfusion to the heart
39
what are 3 factors that affect ventricular remodeling?
(1) size of infarct
(2) ventricular load
(3) patency (how open) of the artery that was infarcted
40
what is considered normal BP?
< 120 systolic
| < 80 diastolic
41
what is considered pre-hypertension?
120-139 systolic
| 80-89 diastolic
42
what is stage 1 and stage 2 hypertension?
```
STAGE 1
140-159 systolic
90-99 diastolic
STAGE 2
160+ systolic
100+ diastolic
```
43
what are the two major determinants of BP?
(1) cardiac output
| (2) total peripheral resistance
44
generally speaking, what happens with hypertensive heart disease?
(1) pressure overload on LV leads to LV hypertrophy, which leads to diastolic dysfunction
45
what is systolic dysfunction?
an impaired ventricular contraction leading to increased end systolic volume; called heart failure with reduced ejection fraction (HFREF)
46
what is diastolic dysfunction?
an impaired ventricular filling and increased end diastolic pressure; called heart failure with preserved ejection fraction (HFPEF)
47
how is BP normalized and LVH reversed?
(1) pharmacological therapy
| (2) lifestyle modifications
48
how much is exercise capacity decreased in patients with HTN?
15-30%
49
what BP is exercise contraindicated and the patient should be referred to a physician?
(1) SBP >200 mm Hg
| (2) DBP >100 mm Hg
50
what are a few ways to reduce the risk of cerebrovascular disease?
(1) aspirin
(2) lipid-lowering medication
(3) antihypertensive medication
51
what should the PT intervention include for patients with cerebrovascular disease?
(1) monitor patients' BP at rest and with all new activities
| (2) patient education
52
what is another name for peripheral artery disease (PAD)?
atherosclerotic occlusive disease (AOD)
53
what is peripheral artery disease?
artheromatous plaque obstructing large or medium dized arteries supplying blood to the extremities
54
what are some signs and symptoms of peripheral artery disease? (6)
(1) dry, shinny skin
(2) hair loss
(3) thick toe nails
(4) muscle atrophy
(5) decreased pulse
(6) impaired sensation
55
what is commonly impaired with peripheral artery disease?
walking; this is due to the inability to produce normal blood flow to the LE
56
how should exercise be prescribed for patients with peripheral artery disease?
perform exercise as short as 1 to 5 minutes at a time with alternating rest periods (gradually increasing exercise length overtime)
57
should the legs be elevated in patients with PAD while laying down?
NO; they already have insufficient perfusion to the legs, elevating it would make this even worse
58
when are DVTs most common?
following periods of inactivity; such as post-surgery or after a 14-hour plane flight
59
how is the Well's Clinical Decision Rule scored?
```
Score 1 point for:
(1) active cancer
(2) previous DVT
(3) immobilization
(4) paralysis
(5) entire leg swollen
(6) pitting edema
(7) tenderness
(8) calf swelling
(9) dilated veins
Score -2 if alternative diagnosis exists
```
60
what are the steps for PT management of a DVT?
(1) does oatient have an inferior vena cava filter? IF YES, mobilize
(2) was diagnostic testing performed? IF YES and negative, mobilize; IF NO consult medical staff
(3) are they on anti-coagulants? IF NO, consult physician
61
once a patient has been given novel oral anticoagulants, how much time must pass to mobilize the patient?
>3 hours
62
once a patient has been given low molecular weight Heparin, how much time must pass to mobilize the patient?
>5 hours
63
once a patient has been given unfractionated Heparin, how much time must pass to mobilize the patient?
>48 hours
64
at what INR level should the PT consult with a physician due to the possibility of excessive bleeding?
INR >5
65
what are the most common causes of cardiac muscle dysfunction (CMD)? (5)
(1) HTN
(2) coronary artery disease (CAD)
(3) cardiac arrhythmias
(4) renal insufficiency
(5) cardiomyopathy
66
how does HTN affect the heart? (2)
(1) left ventricular hypertrophy
| 2) less effective pump (overstretched contractile fibers
67
what are 4 classes of medications for HTN?
(1) ace inhibitors
(2) beta blockers
(3) calcium-channel blockers
(4) diuretics
68
are ventricular or artial arrhythmias more life threatening?
ventricular
69
what effect of renal insufficiency causes cardiac muscle dysfunction?
fluid overload
70
what is a common treatment for renal insufficiency?
decreased reabsorption of fluid from kidneys; treated with diuretics such as Lasix
71
what is cardiomyopathy?
impaired contraction and relaxation of myocardial muscle fibers
72
what is the difference between a primary and secondary cause of cardiomyopathy?
(1) primary: occurs within the heart (ex. congenital condition, heart valve issues)
(2) secondary: result of systemic disease (ex. amylodosis, toxicity, inflammatory)
73
what condition can be caused by a rare disease, leading to sudden death in otherwise healthy athletes?
cardiomyopathy
74
what is amylodosis?
abnormal protein produced in the bone marrow which is deposited within the heart and kidney
75
what occurs with dilated cardiomyopathy?
(1) the heart muscle is stretched and typically involves the left ventricle; myocardial mitochondrial dysfunction may also be present (lack of ATP for ventricular function)
(2) the stretched heart leads to an inability to pump and then failure
76
what occurs with hypertrophic cardiomyopathy?
(1) development of non-functional muscle
| (2) excess muscle can cause stiffened valves
77
what occurs with restricted cardiomyopathy?
(1) walls of the ventricles have decreased compliance
| (2) this leads to the inability to stretch and impaired heart function
78
how do heart valve abnormalities affect the heart?
blocked valves or incompetent valves cause muscle to contract more forcefully; causes myocardial dilation and hypertrophy
79
what is pericarditis? what can it cause?
inflammation of the pericardial sac; can cause pericardial effusion and cardiac tamponade
80
what is cardiac tamponade?
elevated intracardiac pressure, which causes limited diastolic filling, reducing the SV
81
how do pulmonary embolisms affect the heart?
increased workload of the right ventricle (due to elevated pulmonary artery pressure)
82
what values of mean pulmonary artery pressure (mPAP) are considered abnormal?
(1) healthy population: >25 mmHg
| (2) COPD patients: >20 mmHg
83
what conditions most commonly cause RIGHT ventricular hypertrophy?
pulmonary conditions
84
how could a spinal cord injury (SCI) cause cardiac muscle function?
imbalances in parasympathetic and sympathetic control (common in cervical spine injuries)
85
what is a very common clinical manifestation of heart failure?
pulmonary edema
86
what is the most common cause of increased pulmonary capillary pressure?
left ventricular failure
87
what effect on the liver does heart failure have?
venous congestion which can lead to cirrhosis
88
what effect on the brain does heart failure have?
increased sympathetic stimulation
89
what is the general idea of the Frank-Starling mechanism?
the more venous return (preload) the more the heart stretches; the more the heart stretches the more forceful a contraction can occur
90
what hormones are released in response to the heart being stretched?
natriuretic peptides:
(1) ANP
(2) BNP
91
what are the effects of natriuretic peptides?
reduce fluid volume (minor effect) by increasing the excretion of Na+ and fluid
92
how are BNP levels used to diagnose and manage heart disease?
BNP levels are increased with heart disease, heart failure, and acute coronary syndrome
93
what are the 3 stages of cardiogenic pulmonary edema?
-LVHF causes pulmonary edema in the following stages
Stage 1: interstitial edema, increased capillary pressure (13-18 mmHg)
Stage 2: early alveolar edema (18-28 mmHg)
Stage 3: complete alveolar flooding (>28 mmHg)
94
what receptors do epi and norepi act on?
(1) alpha-adrenergic receptors
95
what effect do alpha 1 and alpha 2 receptor stimulation have on cardiac function?
(1) alpha 1: increases inotropic effect
| (2) alpha 2: ihibitory G protein is activated, which decreases inotropic effect
96
what effect do beta 1 and beta 2 receptor stimulation have on cardiac function?
(1) beta 1: vasodilation of capillary bed and relaxes bronchial tracts
(2) beta 2: increase HR and myocardial force of contraction
97
are G proteins inhibitory or stimulatory? what about adenylate cyclase?
(1) G protein: either inhibitory or stimulatory
| (2) adenylate cyclase: stimulatory
98
what is the relationship between the RGC complex and heart failure?
heart failure contributes to the failure of the RGC complex
99
how is live function affected with heart failure?
causes increased fluid volume, leading to hepatomegaly
100
what happens to muscle fibers in patients with CHF WITHOUT cardiomyopathy?
decreased average diameter of type I and type II fibers
101
what happens to muscle fibers in patients with CHF WITH cardiomyopathy?
type I and type II muscle atrophy
102
how much is the maximal isometric muscle strength reduced in patients with CHF?
50% reduction
103
how is pancreatic function affected with CHF?
reduced blood flow causing impaired insulin secretion and glucose tolerance
104
what is the difference between cardiac muscle dysfunction and congestive heart failure?
CHF is a multi-system derangement leading to
105
where is edema in right sided failure? what about left sided failure?
(1) right sided failure edema in the periphery
| 2) left sided failure edema in the lungs (pulmonary
106
what is the difference between systolic heart failure and diastolic heart failure?
(1) systolic: impaired contraction during systole; decreased SV and EF
(2) diastolic: impaired filling; impaired relaxation
107
what is paroxysmal nocturnal dyspnea (PND)?
supine position increases fluid return
108
what is orthopnea?
dyspnea in the recumbent position
109
what are the main ways CHF is managed from a medical standpoint?
(1) treat underlying causes
(2) improve heart pump
(3) reduce workload
(4) control Na+ intake
110
an ejection fraction of what would indicate the need for and ICD implant?
< 35% (with mild to moderate symptoms)
111
what occurs during the two phases of an ECG cycle (electrically and mechanically?
(1) electrically: depolarization and repolarization
| (2) mechanically: systole and diastole
112
at rest what are the heart cells from an electrical standpoint?
polarized (charged)
113
with contraction what are the heart cells from an electrical standpoint?
depolarized
114
what are the charges inside and outside of the cell during rest?
(1) inside: negative
| (2) outside: positive
115
when depolarization occurs, what are the charges inside and outside of the cell?
(1) inside becomes more positive
| (2) outside becomes more negative
116
why is the SA node considered autonomous?
it sends electrical signals automatically
117
what is the path that the electrical impulse takes to cause a contraction of the heart?
(1) SA node
(2) AV node
(3) bundle of His
(4) right and left bundle branches
(5) purkinje fibers
118
why is there a delay from the SA node to the AV node?
allows for ventricular filling
119
what occurs during the p-wave? how long should it normally last?
(1) atrial depolarization
| 2) < 0.11s (2 small boxes
120
what occurs during the PR interval? how long should this normally last?
(1) ventricular filling (beginning of p-wave to beginning of r-wave)
(2) 0.12 - 0.2s (5 small boxes)
121
what occurs during the QRS complex? how long should this normally last?
(1) ventricular depolarization
| 2) 0.06 - 0.1s (2 small boxes
122
how much time is each small box and large box on an ECG?
(1) small boxes: 0.04s
| (2) large boxes: 0.20s
123
what occurs during the ST segment?
no electrical activity (pause after QRS)
124
what occurs during the T wave?
ventricular repolarization
125
when do the atria repolarize?
during the QRS complex
126
what occurs during the QT interval? how long should this normally last?
(1) time of ventricular activity including both depolarization and repolarization
(2) 0.32 - 0.4s
127
how many precordial (chest) leads are there with an ECG? how many are limb leads?
(1) 6 precordial leads
| (2) 6 limb leads
128
when does an upward deflection on an ECG lead occur?
when a positive charges comes near a skin electrode
129
what are the x and y each represent with an ECG?
x-axis: time
| y-axis: voltage
130
how fast does an ECG record?
25 mm/sec
131
what is the most accurate method to determine HR using an ECG?
1500 / # of small boxes between 2 R-waves
132
what is a normal sinus rhythm (NSR)?
normal ECG with a HR between 60-100 without abnormalities
133
what is sinus bradycardia?
HR below 60 bpm (with normal sinus rhythm)
134
what is sinus tachycardia?
HR above 100 bpm (with normal sinus rhythm)
135
what are the two main causes of arrhythmias?
(1) alteration in impulse formation (impulse originating from somewhere other than SA node)
(2) alteration of impulse conduction (normal conduction pathway isn't followed)
136
what are ectopic foci?
abnormal pacemaker sites within the heart (outside of the SA node)
137
what is an atrial flutter? how does it present on an ECG?
(1) rapid (single) atrial ectopic focus
| 2) abnormal P waves (flutter waves or saw-toothed pattern
138
what is atrial fibrillation? how does it a present on an ECG?
(1) multiple atrial foci (chaotic); the atria twitches and contracts haphazardly
(2) p-waves unidentifiable (fibrillatory waves) and irregular ventricular RR intervals
139
what is a risk associated with atrial fibrillation?
the static blood in the atria that isn't pumped can form blood clots
140
what are premature ventricular contractions (PVCs)? how does it a present on an ECG?
(1) premature contraction of the ventricle (decreased CO because the ventricles didn't have time to fill)
(2) abnormally wide QRS complex
141
what is the difference between bigeminy, trigeminy, couplet, triplet PVCs?
(1) bigeminy: PVC every other beat
(2) trigeminy: PVC every third beat
(3) couplet: two consecutive PVCs
(4) triplet: three consecutive PVCs
142
what is the difference between unifocal and multifocal PVCs?
(1) unifocal: one ectopic foci (looks exactly the same on ECG)
(2) multifocal: multiple ectopic foci
143
what can several consecutive PVCs lead to?
increased HR; decreased time to fill the ventricles causing, causing decreased CO and possible ischemia
144
what is considered ventricular tachycardia?
3 or more consecutive PVCs
145
what is ventricular fibrillation? how does it present on an ECG?
(1) ventricles twitch (NO CARDIAC OUTPUT)
| 2) no normal ECG complexes (looks like a bag of worms
146
what is asystole? how does it present on an ECG?
(1) absence of electric activity in ventricles (flat line)
| (2) straight line
147
can you shock somebody who has asystole?
NO; you need medications or other means to restore a more normal heart rhythm
148
what types of rhythms can be shocked?
(1) v-tach
| (2) v-fib
149
what does ST segment depression indicate?
myocardial ischemia (transient)
150
how is transient myocardial ischemia determined?
(1) ST segment depression greater than 1 mm; lasting longer than .08 seconds
(2) T-wave inversion is variable
151
what is a Non-STEMI?
(1) Non-ST segment elevation MI
| 2) subendocardial myocardial infarction (NOT a full thickness MI
152
what classifies an event as a Non-STEMI?
(1) ST segment depression (PERSISTENT) greater than 1 mm; lasting longer than .08s
(2) T-wave inversion is variable
153
what is a STEMI?
(1) ST segment elevation MI
| 2) transmural myocardial infarction (full thickness MI
154
what classifies an event as a STEMI? what are the stages?
- Acute
(1) ST segment elevation
(2) Abnormal Q wave (0.04s wide or >1/3 height of QRS)
- Days Later
(1) ST segment normalizes
- Weeks Later
(1) T wave normalizes
(2) Q wave persists
155
what are the 4 phases of Cardiac Rehab? what is the goal of each phase?
(1) Phase I: Acute phase (Monitoring)
(2) Phase II: Subacute (Conditioning)
(3) Phase III: Training and Maintenance (Intensive rehab)
(4) Disease Prevention (Prevention Program)
156
what is the primary role of the PT during Phase I of cardiac rehab? (3)
(1) early mobilization
(2) identify what ADLs patient can do safely
(3) determine rehab options after discharge
157
how long is the average length of stay for a post-op cardiac patient?
3-5 days
158
what is the purpose of incentive spirometers?
improve lung function and prevent pulmonary diseases, such as pneumonia
159
what are sternal precautions following open heart surgery?
(1) avoid pressure on sternum
(2) encourage pillow use when coughing
(3) avoid bilateral shoulder flexion >90
(4) no arm use for resisted activity
(5) avoid valsalva maneuver
(6) no driving or sitting in passenger seat for 4 weeks
160
what should be considered for the graft site following heart surgery?
(1) WBAT for both LE
(2) no ROM if healing normal
(3) compression garments
(4) elevate involved LE
(5) perform LE AROM
(6) avoid crossing legs
161
during what phase of cardiac rehab are patients easily influenced and educated due to fear and anxiety about health and longevity?
Phase II
162
what should two main components of cardiac rehab involve?
(1) exercise training
| (2) behavioral training
163
what are 3 main modes of exercise that can be utilized in cardiac rehab?
(1) aerobic training: stationary bike and walking
(2) circuit / interval training
(3) low-level resistance training
164
what should the initial intensity for a cardiac rehab program be? when and how should it be progressed?
(1) 40-60%
(2) if pt. demonstrates appropriate responses to exercise for 2-3 weeks, target HR can be increased 10 bpm each week after
165
what should the initial frequency for a cardiac rehab program be?
(1) 3x per week under supervision
(2) home exercise after 1-2 weeks
Total Sessions: 5-7x per week is recommended
166
what should the initial time for a cardiac rehab program be?
(1) 10-15 minutes of LISS exercise (sometimes intervals of 2-5 minutes broken up by rest may be required initially)
(2) progress to 20-30 min LE continuous and 10-15 UE continuous during weeks 2-4
167
what should always be performed both before and after exercise is prescribed to a cardiac patient?
Warm-up and Cool-down
168
what is required to discharge a patient from Stage II cardiac rehab?
(1) medically stable (no ECG)
(2) independent self monitoring
(3) compliant with HEP
(4) symptom limited exercise test
169
what is the recommended intensity for patients in Stages III and IV of cardiac rehab?
(1) 60-70% funcional capacity
(2) 70-85% max HR
(3) 60-75% HR reserve
170
what are 3 ways intensity can be prescribed for patients in Stages III and IV of cardiac rehab?
(1) HR
(2) MET
(3) RPE
171
how is target HR calculated as percentage of max HR?
Intensity * estimated max (220-age)
172
how is HR calculated using the Karvonen's formula?
(max HR - resting HR) * (intensity) + resting HR
173
what is 1 MET equivilent to?
3.5 ml O2/kg/min
174
how is intensity calculated using METs?
multiply maximal METs achieved during exercise test by the intensity
175
what patients would be ideal for using RPE to set intensity fr exercise?
patients on beta blockers and Ca+ blockers
176
what is the recommended duration for patients in Stages III and IV of cardiac rehab?
(1) moderate intensity: 20-30 minutes
| (2) low intensity: 40-60 minutes
177
what is the recommended frequency for patients in Stages III and IV of cardiac rehab?
(1) low to mod intensity: 5-7 days per week
| (2) high intensity: 3-5 days per week
178
how does echocardiography work?
uses ultrasound to evaluate functioning of the heart; provides real time images of the beating heart
179
what are two values that can be determined using an echocardiogram?
(1) stroke volume
| (2) ejection fraction
180
what can a PET scan of the heart be used to determine?
(1) visualization and direct measurement of metabolic functioning of the heart
(2) can detect jeopardized myocardium without exercise
181
what can a CT scan of the heart be used to determine?
(1) identify masses in the CV system
(2) detect aortic aneurysms
(3) pericardial thickening
182
what can an MRI of the heart be used to determine?
(1) morphology
(2) cardiac blood flow
(3) myocardial contractility
183
what can a single-photo emission CT scan of the heart be used to determine?
perfusion defects of the heart (using radioisotopes)
184
what can an electron beam CT scan of the heart be used to determine?
(1) detect calcium in the coronary arteries
(2) arteries that have atherosclerotic changes
(identify patients at high risk for MI or CAD)
185
what can multigated acquisition imaging of the heart be used to determine?
calculates LVEF (non-invasive)
186
what is Holter monitoring?
continuous 24-hour ECG monitoring of a patient’s heart rhythm (diagnostic purposes)
187
what is a cardiac stress test?
looks at physiological responses to an increased workload
188
what is an angiogram?
a radiograph (x-ray) to record the size, shape, and location of the heart and blood vessels (radio-opaque contrast is injected prior to x-ray)
189
what is a cardiac catheterization?
insertion of a catheter into the CV system to measure pressure of perform angiography
190
A catheter placed into the femoral artery can access which side of the heart? What about a catheter placed into the femoral vein?
(1) femoral artery: left side of the heart
| (2) femoral vein: right side of the heart
191
what information can be obtained from a cardiac catheterization?
(1) blood flow
(2) EF
(3) chamber pressures
192
What is the purpose of a percutaneous coronary intervention (PCI) (AKA angioplasty)? What conditions can this improve?
(1) revascularization (improve blood flow)
| (2) improve symptoms of CAD (angina and SOB); used during MI to restore blood flow
193
what is the purpose of an electrophysiological study? how is this conducted?
(1) map the conduction system of the heart
| (2) pt. is heavily sedated; procedure takes about 8 hours
194
what is the purpose of a coronary artery bypass graft (CABG)?
the use of a vessel from another part of the body is used to bypass an area of occlusion or infarct
195
what are the two types of CABG surgeries? how do they differ?
(1) Traditional CABG: sternum is split, the heart is stopped, and a heart lung machine is used during the surgery
(2) Mid CABG: less invasive procedure that uses a small incision and avoids splitting the sternum
196
what is the difference between an on-pump and off-pump heart surgery?
(1) On-pump: heart is stopped; peripheral circulation occurs using a machine
(2) Off-pump: heart is beating
197
how do the outcomes differ for on-pump and off-pump heart procedures?
patients have better outcomes, shorter stays and progress faster after having an off-pump procedure compared to an on-pump procedure
198
what are the limitations to a Mid CABG procedure?
(1) higher risk patients who can’t have the more invasive procedure
(2) can only bypass a single artery (not multiple)
199
what is a ventricular assistive device used for? how does it function?
(1) provides a bridge for patients who are waiting for a heart donor
(2) it’s a mechanical pump that provides support for a failing ventricle; can be used for the left (LVAD) or right (RVAD) ventricle
200
what should be used to monitor exercise in patients who have had a heart transplant and why?
(1) blood pressure and RPE should be used to monitor the heart, NOT HR
(2) this is because the heart is denervated
201
where are the locations used for an arterial or A line?
(1) femoral
(2) brachial
(3) radial
202
what are the purposes of an arterial line?
(1) measure arterial pressure
(2) to draw blood
(3) invasive way to measure BP
203
what are the purposes of a central venous line?
(1) measure R atrial pressure (catheter placed in R atria)
(2) peripheral venous access
a. blood samples
b. administer medications
c. rehydration
d. placement of Swan-Ganz catheter
204
where is the Swan-Ganz catheter inserted? what is its purpose?
(1) pulmonary artery
| (2) diagnostic: used to determine heart failure, sepsis, monitor therapy and evaluate the effects of drugs
205
what is the normal pressure of the R atria?
0-5 mmHg
206
what is the normal pressure of the R ventricle?
5-12 mmHg
207
what is the normal pressure of the pulmonary artery?
20-30 / 5-12 mmHg
208
what is the normal pressure of the pulmonary capillary wedge?
5-18 mmHg
209
how should blood pressure be taken in patients with a Swan-Ganz catheter?
ALWAYS be measured manually
210
what is a PICC line used for? what are two of the most common treatments that utilize a PICC line?
(1) peripheral intravenous central catheter; used for long-term therapy
(2) chemotherapy & antibiotic therapy
211
What are the advantages of using a PICC line?
(1) easy to insert (brachial vein most common and pushed to R atrium)
(2) low risk of bleeding
(3) can be left in for long periods of time
212
what is an intra-aortic balloon pump (IABP) used for?
mechanical device to assist the L ventricular function by increasing coronary blood flow
213
what are the main functions of intravenous lines (IV’s)?
(1) rehydration
(2) administering medications
(3) blood transfusions
214
What are normal and abnormal O2 saturation levels when a person is at rest and during exercise?
```
Rest
(1) Normal: 98-100%
(2) Abnormal: <98%
Exercise
(1) Normal: No change
(2) Abnormal: Decreases with activity (<92%)
```
215
what are the 3 main enzymes that appear following a MI?
(1) CPK
(2) LDH
(3) Troponin
216
how long after an MI can the enzymes be observed?
36 hours
217
What has homocysteine been linked to?
CVD, PAD, stroke (promotes atherosclerosis and clots)
218
what does C-reactive protein in the blood indicate?
vascular inflammation; strong indicator of CV events
219
what are normal hemoglobin levels for men and women? what levels are critical high and low ranges?
(1) men: 14-18
(2) women: 12-16
(3) critical low: <5-7
(4) critical high: >20
220
what hemoglobin level would be a red flag for out of bed activities?
<8 g/100 mL
221
what are normal HTC levels for men and women? what levels are critical low and high?
(1) men: 42-52
(2) women: 37-48
(3) critical low: <15-20
(4) critical high: >60
222
What are normal levels for BUN? What do elevated levels of BUN indicate?
(1) 8-23 mg/dL
| (2) heart or renal failure
223
what are normal Na+ levels?
135-145 mEq/L
224
what are normal K+ levels?
<3.5 mEq/L are too low; >5.0 mEq/L are too high
225
What glucose levels are considered normal?
100-110
226
what pathology is most common in the pericaridum?
cardiac tamponade
227
what pathology is most common in the myocardium?
myocardial infarction
228
what pathology is most common in the endocardium?
endocarditis
229
what does the right coronary artery supply blood to? (3)
(1) right atrium
(2) right ventricle
(3) inferior wall of left ventricle
230
what does the left anterior descending artery supply blood to? (1)
(1) anterior wall of left ventricle
231
what does the circumflex artery supply blood to? (2)
(1) left atrium
| (2) lateral / posterior walls of left ventricle
232
what does stenosis cause in the heart?
blood flow impedance
233
what regurgitation / insufficiency
retrograde blood flow
234
what artery supplies the SA node?
(1) R coronary artery: 55% of people
| (2) left circumflex artery: 45% of people
235
what artery supplies the AV node?
(1) R coronary artery: 90% of people
| (2) left circumflex artery: 10% of people
236
what are the 3 stages of HTN?
Stage 1: 130-139 / 80-89
Stage 2: >=140 / >=90
Stage 3: >180 / >120
237
what percentage of occlusion causes ischemia?
70%
238
how does HTN cause increased atherosclerosis?
HTN causes mechanical damage to vascular endothelial cells which facilitates the atherogenic process increasing the risk for plaque formation
239
what is the average age of initial MI for men and women?
Men: 65
Women: 72
240
what is the most common cause of unstable angina?
atherosclerotic plaque rupture
241
what is an acute myocardial infarction?
clinical event resulting in myocardial necrosis due to ischemia (can be classified as STEMI or Non-STEMI)
242
an infarct to the right coronary artery affects what part of the heart? where are ECG changes observed?
(1) inferior
| (2) II, III, aVF
243
an infarct to the left main coronary artery affects what part of the heart? where are ECG changes observed?
(1) anterior / lateral
| (2) V1-V6, I, aVL
244
an infarct to the LAD artery affects what part of the heart? where are ECG changes observed?
(1) anterior
| (2) V1-V4
245
an infarct to the circumflex artery affects what part of the heart? where are ECG changes observed?
(1) lateral
| (2) V5, V6, aVL, I
246
what is the most important factor for prognosis following a myocardial infarction?
remaining LV function
247
how is HR estimated using the box method?
```
Count big boxes between R intervals
300
150
100
75
60
50
```
248
what is the normal duration for the PR interval?
0.12 - 0.20
249
what is the normal duration for the QRS interval?
0.06 - 0.10
250
what are the S1 and S2 heart sounds?
S1: closing of the mitral and tricuspid valves
S2: closure of the aortic and pulmonic valves
251
what is a first degree AV heart block? where is the block?
(1) stable prolongation of the PR interval to more than 200 ms
(2) delay in conduction at the AV node
252
what is a second degree (type 1) AV heart block? what does it indicate?
(1) progressive prolongation of the PR interval before an atrial impulse fails to stimulate ventricle
(2) occurs at AV node level
253
what is a second degree (type 2) AV heart block? what does it indicate?
(1) fixed PR interval with some P waves not conduced
| (2) below bundle of his and may be a bilateral bundle branch block
254
what is a third degree AV heart block? what does it indicate?
(1) absence of AV conduction (complete block)
| (2) disassociation of atrial and ventricular rhythms
255
if the SA node fails, what is the pacemaker of the AV node?
40-60 bpm
256
is an AV block more dangerous near the SA node or near the apex of the heart?
the further from the SA node, the more dangerous the block
257
what are contraindications to PT treatment in cardiac patients?
(1) decompensated CHF
(2) >10 PVCs / minute
(3) multifocal PVCs
(4) unstable angina,
(5) ECG changes associated w/ ischemia
(6) dissecting aortic aneurysm
(7) new onset (<24 hrs) a-fib w/ RVR >100 bpm
(8) 2nd degree heart block w/ PVCs
(9) third degree heart block
258
what are precuations to PT treatment in cardiac patients?
(1) resting tachycardia
(2) HTN resting >160/90
(3) hypotensive SBP <80
(4) MI within previous 2 days
(5) ventricular ectopy at rest
(6) chronic a-fib w/ RVR
(7) uncontrolled DM
(8) psychosis
259
what condition accounts for 50% of pacemakers in the US?
sick sinus syndrome
260
what are some post-op precautions following a surgery to implant a pace maker?
(1) ipsilateral shoulder AROM <90 degrees for 4 weeks
| (2) increased likelihood of frozen shoulder in patients with DM
261
what is an ICD? what is it's purpose?
(1) implanted cardioverter defibrillator
| (2) automaticlly deliver shock to treat V-tach or V-Fib
262
what are normal WBC levels?
5,000 - 10,000
263
what are normal BNP levels?
<100
