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Year 3: CardioPulm Rehab > Lecture 3: Abnormal Physiology > Flashcards

Lecture 3: Abnormal Physiology Flashcards

1
Q

HR values that would be concerning for CVP pt

A

<50 or >120 at rest

uncontrolled/new arrhythmia

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2
Q

BP values that would be concerning for CVP pt

A

> 180/90

<90/60

MAP <60

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3
Q

SPO2 values that would be concerning for CVP pt

A

<90% at rest

acute change in O2 demand/device

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4
Q

what could cause bradycardia in a pt

A

heart block
adverse drug reaction
metabolic dysfunction
post sx
meds
myocarditis
lab abnormalities
abnormal breathing patterns

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5
Q

what could cause tachycardia in a pt

A

meds
anemia
hypotension
infection
anxiety/fear
ETOH use
pain
substance abuse

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6
Q

overall mechanism of abnormal HR

A

ischemia to SA node

decrease in myocardial contractility

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7
Q

Things to watch out for with HR changes that are NOT normal

A

HR drops with increase work

severely exaggerated rise in HR with increased work

minimal rise with increased work

irregular rhythm that is not present at rest

worsening rhythm that is present at rest

CONTEXT IS IMPORTANT

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8
Q

What is chronotropic incompetence

A

small % of pts with CAD

to have this pt cannot be on any meds that limit HR (chronotropic meds)

max symptom = limiting HR with exertion that is well below age predicted max

defense mechanism to maintain coronary aa blood flow in presence of CAD

signifies advanced CAD with poor prognosis, high morbidity and mortality

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9
Q

what could cause a pt to be hypotensive

A

meds
acute blood loss
diastolic dysfunction
bradycardia
shock
position change
dehydration
arrhythmias

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10
Q

what could cause a pt to be hypertensive

A

lifestyle
high BMI
smoking
comorbidities
pain
anxiety
substance abuse

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11
Q

2 overall mechanisms for abnormal BP

A

ischemic/damaged ventricle will rapidly reach max stroke volume (lower than it should be for correlated increase in work)

OR

abnormal/rapid rise in HR and stroke volume = higher cardiac output (higher than expected for work load); altered CO will alter SVR which leads to abnormal BP response

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12
Q

different abnormal responses for SBP

A

rising response >20-30 mmHg

flat response = SBP doesn’t rise linearly with work (context important)

falling response = SBP drop with increased work (context important); associated S&S make response more concerning

if pt is not on any anti HTN meds and has a SBP drop + SBP <140 during max exercise = higher rate of sudden cardiac death

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13
Q

falling response with SBP can be associated with…

A

pronounced ST segment depression
angina
cardiomyopathy
large MI
low EF

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14
Q

abnormal diastolic response to exercise

A

> 10 mmHg rise or drop with increased work

any massive shift in DBP is concerning; will likely accompany abnormal SBP changes

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15
Q

abnormal MAP response to exercise

A

<60 is concerning for end organ perfusion

context is important

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16
Q

what could cause a pt to have hypoxemia

A

blood loss
hypoventilation
heart or lung disease
infection/sepsis
anemia
PE
sleep apnea

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17
Q

what response to exercise may indicate autonomic dysfunction

A

exaggerated HR/BP responses that do not correspond to workload

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18
Q

ineffective redistribution of blood flow to working mm could be caused by

A

sympathetic nervous system dysfunction

inability to adequately vasodilator/constrict

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19
Q

what is an arrhythmia

A

disturbance ein cardiac rhythm

abnormality in site of origin impulse, rate, regularity, or conduction

tachyarrhythmia = HR >100bpm

bradyarrhythmia = HR <60

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20
Q

causes of arrhythmias

A

other areas of heart contain ectopic foci (cells with automaticity) that are suppressed by dominant SA node

meds

infection

electrolytes

age

comorbidities

substance abuse

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21
Q

what is atrial flutter

A

regular atrial quivering

atrial contracting out of sync with ventricles

high amplitude P wave

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22
Q

what is atrial fibrillation

A

lower amplitude, irregular atrial quivering

elimination of atrial kick

absent P wave (no P wave = no PR interval)

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23
Q

what is a univocal Pre-Ventricular Contraction (PVC)

A

premature ventricular depolarization

ectopic foci in ventricles fires with an impulse generated in Purkinje fibers instead of SA node

2 simultaneous PVCs = couplet

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24
Q

how many simultaneous PVCs = VTACH

A

6 times

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25
what is a multifocal PVC
PVCs that originate in different ectopic foci with different electrical configurations suggestive of more severe electrical conductivity problems higher cardiac irritability
26
what is a bigeminy
PVC every other normal beat more concerning than trigeminy; 50% ventricular contraction is abnormal
27
what is a trigeminy
PVC every 3rd normal beat
28
what is an AFib with rapid ventricular response (RVR)
abnormal ventricular response to irregular atrial contractions (Afib alone the ventricles still work normal and HR is normal) HR >120 bpm
29
what is supra ventricular tachycardia (SVT)
HR > 150 being set by SA node and not slowed by AV node absent T wave not getting full ventricular filling with fast HR = not getting full ejection
30
what is ventricular tachycardia (VTach)
wide QRS complex tachycardia absent P waves
31
what is tornadoes de pointes
specific type of VTach with rotation around an axis of electrical activity caused by hypo magnesia rogue clusters of cells that rotate back and forth for control of electrical activity
32
what is ventricular fibrillation (VFib)
ventricles quiver inconsistently, no true contraction very disorganized electrical activity rapid loss of CO only arrhythmia that an AED is successful with
33
what is asystole
no heart beat
34
what is atrioventricular heart block
abnormality in electrical conduction between atria and ventricles PR interval = time between atrial and ventricular contractions
35
first degree AV heart block
impulse conducted from atria to ventricles is delayed consistent PR intervals >0.20 seconds very common cause of resting bradycardia
36
what is type I 2nd degree heart block = Mobitz I = Wenckebach
PR interval gets progressively longer then QRS drops atrial impulse gets predictably blocked
37
what is type II 2nd degree heart block = Mobitz II
PR interval is consistent then QRS drops atrial impulse to ventricle gets unpredictably dropped still have a skipped beat but not as predictable
38
what is 3rd degree heart block = complete/total HB
all atrial indexes are blocked at AV node and none get transmitted to ventricles SA and AV node are conducting electrical impulses in complete disconnection from one another P intervals are consistent with each other, R intervals are consistent with each other, but these are not in coordination with one another absolute contraindication to activity
39
what is Troponin and its importance as well as normal/abnormal values
most important biomarker correlated to cardiac ischemia cTnT <0.1 = normal cTnI <0.3 = normal Troponin T is more sensitive than Troponin I drawn serially until peaked no exertion until down trending and stable
40
what is BNP (B type Natriuretic Peptide) and normal values
important biomarker correlated to myocardial tissue damage from overstretch BNP <100 = normal BNP > 400 indicative of heart failure fluid overloaded, dyspnea, severe exercise intolerance no direct contraindication, all symptom limited
41
normal Hemoglobin values
M = 14-18 F = 12-16 most transfusion parameters is Hgb <7 strong correlation with symptoms needed to make clinical decisions
42
normal hematocrit values
M = 42-52% F = 37-47% abnormalities indicate other problems/pathologies symptom limited
43
WBC normal values/indications
5000-10000 indicative of multi-system infection/pathology symptom limited
44
platelet normal values and meaning
150-400 low values = pt at higher risk for bleeding high values = pt at higher risk for clot formation <50 = no resistance exercise <20 = consult with provider
45
what is pancytopenia
decrease in RBC, WBC, and platelets
46
what is thrombocytopenia
decrease in platelets
47
what is throbscytosis
increase in platelets
48
what is neutropenia
decrease in all WBCs
49
what is anemia
decrease in RBCs
50
what is polycythemia
increase in RBCs
51
normal sodium levels and function in CP system
135-145 "sodium swells" to maintain BP, volume, and pH
52
normal potassium levels and function in CP system
3.5-5.0 "P pumps" heart and mm
53
normal magnesium levels and function in CP system
1.3-2.1 M mellows the mm
54
normal calcium levels and function in CP system
9-10.5 Keeps the "3 Bs" strong (bones, blood, beats)
55
what is normal prothrombin time (PT) and what do high values indicate
11-12.5 sec higher = increased bleeding/bruising >20 = high risk for bleeding into tissues
56
what is normal partial thromboplastin time and what do high values indicate
21-35 sec higher = increased bleeding/bruising >70 = high risk for spontaneous bleeding common with inherited bleeding disorders
57
what is normal INR and what do high/low values indicate
0.8-1.2 variability in normal range based on pathology high values = increased bleeding/bruising low values = increased clotting/VTE >5.5 = high risk for spontaneous bleeding
58
normal Creatine Kinase levels and contraindications if any
30-170 no direct contraindication; all symptom and medical stability limits
59
normal blood urea nitrogen levels and contraindications if any
10-20 no direct contraindication; all symptom and medical stability limits
60
normal creatine levels and contraindications if any
0.5-1.2 no direct contraindication; all symptom and medical stability limits
61
absolute contraindications to activity
new onset AFib sustained VTach complete heart block increased PVCs (especially multifocal) increased ventricular arrhythmias new onset chest pain uncontrolled arrhythmias causing hemodynamic instability or S&S unstable angina temporary pace maker VTach storming
62
relative contraindications to activity
pending pacemaker interrogation cardiac S&S drop in HR with activity drop in BP with activity arrhythmias with rate control Thrombocytopenia (platelets <50) Anemia (Hgb <7) Abnormal INR
63
pH is sensitive to what compounds that can alter blood gas levels
CO2 = controlled by lungs (respiratory); can be altered quick HCO3 = controlled by kidneys (metabolic); cannot be altered quick compensation = body is responding to abnormality
64
what happens with respiratory acidosis
hypoventilation increase in CO2, decrease in pH
65
what happens with respiratory alkalosis
hyperventilation decrease in CO2, increase in pH
66
what happens with metabolic acidosis
GI, endocrine, and renal dysfunction decrease in both HCO3 and pH
67
what happens with metabolic alkalosis
renal/hepatic dysfunction, hypovolemia increase in both pH and HCO3
68

Year 3: CardioPulm Rehab (22 decks)

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