Lecture 9: Cardiac complications

Question 1

Answer 1

d

Question 2

You don’t need a cardiopulmonary issue to treat cardiopulmonary

Question 3

Obesity = BMI of

Answer 3

> 30 kg/m^3

weight (kg)/Height(m2)

x 701 to convert to inches

Question 4

over wt bmi

Answer 4

> 25

Question 5

BMI = very genetic/environmentally linked

Question 6

waist circumference for obesity
* men
* women

Answer 6

men = >40 inches
women = >35 inches

Question 7

waist to hip ratio obesity
* men
* women

Answer 7

1.0

0.8

Question 8

Question 9

Question 10

obesity = linked to mental health problems

obesity = corrleated w/ depression

males impacted more by obesity in the realm of fertility

Question 11

dont need to know classes of obesity, just know 30+ = obesity

25+ = over wt

know the waist measurements

Question 12

tx for obesity

Question 13

PT implications

CV risk factors, phsyiological response to exercise, BP elevated at first, must include endurance training; moderate intensity to truely make an impacted on body composition

brain natruietic peptide (BNP) and N-terminal pro-BNP levels (screening tool for LV dysfunction) are inversely propertional to BMI, regardless of the presence of severity of HF
* thus BNP levels are decreased in obese individuals even when the LV end-diastolic pressure is elevated, and their levels are less likely to be useful for diagnosis and monitoring of LV dysfunction - so BNP stops being a good screening tool for obese - less useful in monitoring LV dysfunction

Question 14

not must know medications - this will come back in multisystems

last 2 used for anxiety/depression as well

Question 15

Diabetes mellitus
* metabolic disorder or disorder of endocrine system
* primarily diagnosed from lab values
* Type 1 = genetic, environmental (virus); immune system attacks pancreas - virus can lead to this
* Type 2: cells resist the action of insulin; pancreas cant produce enough insulin and glucose builds up

EX helps muscles become more sensitive to insulin

Lab values
* Hva1c or hemoglobin a1c - gives you a track record of glucose use over time
* fasting glucose = gives you snapshot of that day

Question 16

Diabetes mellitus

NIDDM - non-insulin depdent DM - may turn into insulin depdnents if not involved
* turns into insulin depdent
* typically T2DM
* pancreas decreases in size

IDDM - Insulin depdent DM

leads to other metabolic problems: kidneys, eyes, cholesterol, neuropathies

increased blood viscosity; decreased BF; glucose damages nerves - which is why we get peripheral neuropathy

Question 17

What should fasting blood glucose be?

Answer 17

100 or less

Question 18

what hba1c is at increased risk of diabetes?

Answer 18

5.7-6.4%

Question 19

which hba1c is diabetes?

Answer 19

> 6.5%

Question 20

long term compliations of diabetes mellitus:
* retinopathy, neuropathy, cad, cardiac muscle dysfunction, autonomic neuropathy

what pt education can you provide for someone w/ an hba1c of 6.0%?
* so this is high but not diabeteic value
*

Question 21

DM life expectancy

type 1 - 15% die before 40 due to cad

type 2 = 10 years off life expectancy

Question 22

may have issues w/ ketones like diabetic ketoacidosis

Question 23

ACE inhibitors for diabetes - reduce morbidity/mortality, lowers BPm prevents kidney dysfunction; primarily prescribed
* primarily described for someone who has hypertension/diabetes - so if they have diabetes w/ the hypertension this is the one were going to use - not just diaretics

beta blockers - for BP; hypoglycemic response to ex
* MOA: block sympathetic response
* if pt has diabetes and is on a beta blocker you won’t get the same response to ex because of hypoglycemia - they will not show the common symptoms of hypoglycemia because of the beta blockers - so monitor blood glucose levels more carefully

Question 24

Metabolic syndrome
* what is it?
* how many risk factors needed? what are they

Answer 24

Group of risk factors that raise risk for heart disease, diabetes, and stroke

Endocrine organ dysfunction, also called inslin resistance

Individuals may have DM and other disorders

Need three of more of these to have metabolic syndrome:
* increased waist circumference
* elevated triglycerides
* reduced HDL
* elevated BP
* elevtaed fasting glucose

Question 25

anginia equilivant = anything other than chest pain that occurs sob my indciate myocardial ischemia

Question 26

remember sympathetic ns impacted c???

Question 27

asymptomatic stages 1/2 diagnosis through lab values * diagnosed by microalbuminuria and glomerular filtration rate stage 5 = when you start seeing all the physical symptoms * severe diet restrictions including limiting protein because liver cant filter it out

Question 28

showing how interlinked kidney disease is w/ cad

Question 29

dialisis = stage 4/5

Question 30

ra = autoimmune = dont ex w/ flare ups systemic lupus erythematosus = chronic pain/lymphedema scleroderma = hardening of connective tissue (think skin becoming restrictive) * restrictive lung disiease * happens throughout bdoy = cvd problems

Question 31

Hemochromatosis

Answer 31

Disorser of iron metabolism that leads to iron deposits in various organs * CVP implication = cardiomyopathy and arrythmias

Question 32

Sarcoidosis

Answer 32

chronic inflammatory diease w/ granulomas in multiple organs * CVP implication = ventricular tachy, cardiomyopathies; all only 10% of pts

Question 33

Amyloidosis

Answer 33

overproduction of certain proteins leading to deposits of amyloid fibrils in various organs * CVP implications: cardiomyopathy (rest or dilated), atrial arrhythmias, orthostatic hypotension, bradycardia, tachy, MI, and sudden death

Question 34

these impact cardiopulmonary system

Question 35

POTS diagnosed via a tilt table dehibiliating because you get OH pretty randomly (w/ changing in positions) diagnosed when theres no other identifiable causes of symptoms need symptoms at least 6 months to be diagnosed symptoms: * HR > 30 bpm within 5-10 minutes of quite standing or upright tilt * absence of OH * frequent symptoms that occur w/ standing gold standard for diagnosis = tilt table test

Question 36

if you have pots you likely have one of these mast cell activation disorder = basically you're allergic to everything they all turn on

Question 37

Answer 37

3

Question 38

reduced circulating rbc mass relative to an individuals gender adn age * fatigue and weakness, diminshed ex tolerance, exertional dyspnea, and palpatations; pallor; angina

Answer 38

anemia would do hematocrit

Question 39

structurally abnormal hb resulting in rbcs that become crescent - or sickle shaped during deoxygenation

Answer 39

sickle cell disease multiple organs are affected, leading to progressive systemic vasculopathy and chronic organ failure * vaso-occlusive crisis cant bind to o2 so they become stuck

Question 40

lymphomas and other malignancies = impaired immune function, anemia, thrombocytopenia

Question 41

HIV = virus/infection * leads to aquired immune deficiency syndrome means body starts to attack itself HAART = tx * minimized viral replication complications due to immune deficiency = body attacks itself = fluid buildup = pulmonary hypertension/myocarditits

Question 42

Question 43

Bleomycin = main drug she wants us to know * pulmonary toxicity = 20% of pts

Question 44

cardiotoxixity = due to some anti biotics

Question 45

anytime we get radiation around abdominal cavity, radiation fibrosis, radiation induced pulmonary toxicity, acute radiation pneumonitits, late radiation fibrosis all these means is that when you have scaring from radiation = scaring = restrictive lung disease * think lung cancer/breast cancer - anything that ristricts abdominal cavity late radaition fibrosis = restricive lung disease down the road due to the previous radaition they intook vlvular banormalitites = due to the radaition * cannot dilinaite between healthy and cancer cell Radiation inducated or accelerated CAD and MI * **may be silent due to radiation-induced nerve damage** * so cardiac symptoms not present ebcause nerves are there (no agngia) - need to look at angina equivilants

Question 46

biological agents developed from body elements have side effects

Question 47

Question 48

Answer 48

a