Midterm Flashcards
(41 cards)
Risk factors for PAD:
ncreasing age, sex (Males>Females), DM, smoking, HTN, hyperlipidemia, hypertriglyceridemia, and hyperhomocystinemia
ABI > 1.10
normal
ABI 0.5-1.0
claudication
pain in calf with ambulation
ABI 0.2-0.5
critical limb ischemia
atrophic changes
rest pain
wounds
ABI < 0.2
severe ischemia
gangrene
severe necrosis
Absolute stop test indicators for exercise stress test
Drop in SBP>10mmHg from baseline w/ ischemia moderate to severe angina ataxia, dizziness, presyncope cyanosis or pallor sustained VT ST segment elevation subject requests to stop
Relative stop test indicators for exercise stress test
Drop in SBP >10mmHg in absence of ischemia
fatigue, SOB, wheezing, leg cramps or claudication
increasing chest pain
hypertensive response (SBP>250, DBP>115)
ST or QRS changes such as ST segment depression
Arrhythmias
Development of bundle brance block
Expected ECG Changes in the Normal Heart
▪ RR interval decreases
▪ P-wave amplitude and morphology undergo minor changes
▪ Septal Q-wave amplitude increases
▪ R-wave height increases from rest to submaximal exercise and then reduces to a minimum at maximal exercise
▪ The QRS complex experiences minimal shortening
▪ J-point depression occurs
▪ Tall, peaked T waves occur (high interindividual variability)
▪ ST segment becomes upsloping
▪ QT interval experiences a rate-related shortening
▪ Superimposition of P waves and T waves on successive beats may be observed
Hypoglycemia S/S:
o Tremor/shakiness/anxiety o Tachycardia o Increased sweating o Hunger o Irritability o Weakness o Dizziness o Numbness or tingling of mouth and face o Nausea/vomiting o Headache o Lethargy o Drowsy
Hyperglycemia S/S
o ncreased/frequent urination o Dry mouth/increased thirst o Weakness or fatigue o Hunger o Flu-like achiness o HA o Facial flushing o Nausea or vomiting o Fruity breath
Ketoacidosis S/S
▪ Facial flushing ▪ Dry skin ▪ N/V ▪ Abdominal pain ▪ Deep, rapid breathing ▪ Fruity smelling breath ▪ Coma Death
R ventricular failure S/S
- Dependent edema
- JVD
- Weight gain
- Liver engorgement, abdominal pain
- Ascites
- Anorexia, nausea, bloating
- Cyanosis
- Right sided S3
L ventricular failure S/S
♣ pulmonary congestion • Dyspnea, dry cough • Orthopnea • Paroxysmal nocturnal dyspnea • Pulmonary rales, wheezing • s/s of acute pulmonary edema (dyspnea, pallor or cyanosis, diaphoresis, tachycardia, anxiety, agitation) ♣ low cardiac output • Hypotension • Tachycardia • Lightheadedness, dizziness • Fatigue, weakness • s/s of peripheral hypoperfusion (weak, thready pulse, vasoconstriction) • poor exercise tolerance • S3 and sometimes S4 (3rd heart sound or ventricular gallop, 4th heart sound or atrial gallop)
Stage A CHF:
at high risk for HF but w/out structural heart disease or symptoms of HF
Therapy goals and drugs for stage A:
treat HTN smoking cessation regular exercise treat lipid disorder ACE or ARB
Stage B CHF:
structural heart disease but without signs or symptoms of HF
Therapy goals and drugs for stage B:
therapy same as stage A
ACE or ARB
beta-blockers in some
Stage C CHF
structural heart disease with prior or current symptoms of HF
SOB, reduced exercise tolerance
Therapy goals and drugs for stage C:
all measures under A and B
sodium restrictions
ACE, beta-blockers, diuretics
selected: digoxin, nitrates, ARB, aldosterone
Stage D CHF:
refractory HF requiring specialized interventions
Therapy goals and drugs for stage
symptoms at rest
appropriate measures for A,B,C,D
end of life care
What levels of resting BP require referral to MD?
SBP> 200 or DBP> 100
Medical clearance for PT if bp is:
SBP >180 & DBP > 110)
Exercise testing should be terminated if BP:
SBP >250 or DBP >115
