Midterm Exam Flashcards
(131 cards)
1
Q
Describe pulmonary function
A
Transportation and distribution of essential nutrients
Removal of byproducts from cellular metabolism
2
Q
What is the significance of the angle of louis
A
In palpation corresponds to second costal cartilage
Posteriorly corresponds to T4, T5 vertebrae
3
Q
Describe normal fluid levels in the pericardial space and what is the name of the condition when this is elevated
A
10-20 ml
Pericardial effusion
4
Q
During what phase does the heart receive blood
A
Diastole
5
Q
What is the conduction system of the heart and their pace values
A
SA node - 60-100
AV node - 40-60
Bundle of his
Purkinje
6
Q
What are the extrinsic and intrinsic regulatory factors on the heart
A
In - Sa and AV node
Ext - neural
- Symp - increase HR, vasodilates coronary arteries
- Para - slows HR, vasoconstricts coronary arteries
7
Q
Describe the chronotropic effects on the heart
A
+ HR increases
- HR decreases
8
Q
Describe the Inotropic effects on the heart
A
+ is increased contractility
- is decreased contractility
9
Q
What is the equation for CO
A
CO = SV x HR
10
Q
What is normal ejection fraction
A
60-70%
11
Q
Describe rate pressure product
A
Index of myocardial O2 consumption
Reflects cardiac fitness
12
Q
Describe the equation for RPP and interpretation of results
A
RPP = (HR x systolic BP) / 1000 0-12 = normal 12-17= risk 17-21= danger above 21 = very dangerous
13
Q
Differentiate between coronary artery disease and coronary heart disease
A
Artery - problems with blood vessels and flow to the heart but no damage to heart muscles
Heart - damage to the heart muscles
14
Q
What can coronary artery disease progress to
A
Coronary artery disease
15
Q
Describe how the coronary arteries protect against occlusion
A
will vasodilate to help perfusion
If unsuccessful, will cause heart attack
16
Q
What damages endothelium
A
LDLs
Smoking
HTN
17
Q
What is the difference between atherosclerosis, arteriosclerosis and arteriolosclerosis
A
Athero - platelet aggregation
Arterio - hardening arteries
Arteriolo - hardening of arterioles seen in HTN and DM
18
Q
Differentiate between STEMI and NON-stemi
A
STEMI - transmural infarction
Non-STEMI - nontransmural or subendocardial region infarction
19
Q
What are the risk factors for something
A
Elevated homocysteine
Hematological factors
Inflammatory markers - elevated C reactive protein
20
Q
What can HTN lead to in the heart
A
LV hypertrophy
Atherosclerosis
Systemic damage
21
Q
What is stenosis and regurg
A
Stenosis - murmur when valve is open
Regurg - murmur when valve is closed
22
Q
What cardiac diseases lead to HF
A
CAD
HTN
MI
Cardiomyopathies
23
Q
Describe Cardiomyopathy
A
sudden death
1/4 of al sudden deaths are attributed to cardiomyopathies
1 in every 500 cases
24
Q
How can renal insufficiency affect the heart
A
Overload the heart with fluid
25
Describe the medical professional's goals when it comes to preventing HF
Prevent or delay with meds, diet, lifestyle changes and exercises
26
How does the PT help prevent HF
Educate the patient about exercise and report abnormal symptoms
27
What is mPAP
mean arterial pressure
measure of pulmonary hypertension
> 25 mmhg is abnormal
> 20 is abnormal in patients with COPD
28
Describe some symptoms of left sided heartfailure
Dry cough
Fatigue
Pulmonary rales
29
Describe some symptoms of right sided heart failure
Dependent edema
Jugular distension
Increased right atrial pressure
Peripheral effects
30
What is the affect of CHF on the muscles
decreased diameter of type 1 and 2 muscle fibers
| Isometric strength is decreased (50%)
31
How do patients with CHF present when exercising
HR increases rapidly with submax load
Blunted systolic BP
Decreased O2 sat
Elevated CO2 in blood
32
What are some signs of HF
Sudden weight gain
pulmonary edema
worsening dyspnea
33
Describe BNP
```
Brain natriuretic peptide
strong predictor of poor prognosis for heart failure
less than 100 is normal
100 - 400 are of concern
above 400 indicate HF
```
34
Describe the stages of pulmonary edema
stage 1 - increased lymph flow, fluid in gravity dependent positions
stage 2 - tachypnea, elevated PCWP
stage 3 - flooding of alveoli, hypercapnia, hypoxemia
35
How do you dose a patient with CHF
5- 10 mins walking per day, progress to 30 mins
goal is 5-7 times per week
3-5 RPE / 10
65-85% of 1rm
Diaphragmatic breathing and pursed lip breathing 2 times per day
36
Describe the 6 minute walk test
Poor prognosis if unable to ambulate 468 m or 1535 feet
If they cannot walk 300m it predicts mortality
Greater than 750 feet means shorter hospital stays
37
What is the "pace" of the SA, AV and Pukinje fibers
SA - 60-100
AV - 40-100
Pukinje 20-40
38
What are the methods to determine heart rate
1500/ # of small boxes
| 300, 150, 100, 75, 60, 50
39
Describe depolarization as it relates to the ion channels
Opening of sodium and calcium channels
40
Describe repolarization as it relates to the ion channels
Opening of potassium channels and closing of sodium channels
41
What is a plateau
When calcium channels are still open, after calcium channels close more potassium opens
42
What is the duration of the P wave, QRS and PR interval
P - 2 small boxes
QRS - 2 small boxes
PR - 5 small boxes
43
What is a long PR interval and what does it mean
Greater than .2 sec\
| Means there is a block
44
What does it mean when a QRS is greater than .1 seconds
Impulse if from the ventricles or abnormal ventricular conduction system
45
What does a deeply inverted q wave mean
MI and is getting worse
will remain that way for months
ST will return to normal
46
What does it mean when the ST segment elevates or depresses
Elevation - STEMI - MI, hypothermia
| Depression - NON-STEMI / ischemia
47
What happens on the EKG in a STEMI and what is the pain like
```
ST elevation
Q is 1/3 the size of the QRS
T wave inversion will not be evident initially
Severe pain
More serious
```
48
What does T wave inversion indicate
Ischemia
Injury
Pulmonary embolism
49
Describe what is NON-STEMI is
Subendocardial block
Not full thickness
less severe chest pain when compared to a STEMI
Can lead to fatal arrhythmias
50
How do you identify a NON-STEMI
ST depression greater than 1mm
| T wave inversion will be variable
51
What on an EKG suggests ischemia
ST depression with biphasic negative-positive T wave
52
What indicates a pulmonary embolism
Troponin
| Deep t wave inversion on leads 1-4
53
What can digitalis cause on an EKG
large QRS complex
54
What is the difference between atrial flutter and atrial fibrillation
Flutter - saw toothed
| Fibrillation - coarse waves
55
Is it safe to exercise a patiet durring A FIB
Yes
56
Is it safe to exercise a patient durring V fib
No
This is an emergency
Ready the AED if necessary
57
What is considered V TAK
3 or more PVS's in a row
58
Describe a first degree AV block
Elongated PR interval
59
Describe second degree AV blocks
type 1 - Wenckebach - Progressive lengthening of PR then QRS drop
type 2 - Mobitz - 2-4 P waves before a QRS
60
Describe a 3rd degree AV block
No relationship between P and QRS, they are firing independently of one another
61
Describe PET
Gold standard for blood flow
| Visualization and direct measurements of metabolic function
62
When do you use a PET
when the patient is not exercising
63
How early can you administer a PET
2-10 days after MI
64
What are some disadvantages of a PT
Very expensive
65
Compare MRI to PET
MRI is similar to PET but less expensive
66
Who are not good candidates for MRI
```
Stent
Pacemaker
Artificial joint
sx clips
Heart valve
Any metallic device
```
67
Describe cardiac catheterization
Invasive
Patient awake but under anesthesia
Brachial or femoral area
Measures chamber pressures
68
How long is bed rest after cardiac catheterization and why
4-6 hours
To avoid bleeding
Pseudoaneurysm
69
How are the sides of the hart accessed during cardiac catheterization
Right - veins
| Left arteries
70
Describe a CABG
Vessels used to bypass area causing infarct
71
Describe traditional CABG
Median sternotomy
use of heart lung machine
heart stopped poorer outcomes
72
Describe MIDCAB
```
Minimally invasive
Lower risk
Less traumatic
Shorter recovery time
Not for high risk patients
Only for single artery involvement
```
73
Describe Echocardiogram
Uses ultrasound to evaluate the functioning of the heart
| Real time images of the heart beating
74
Describe Holter monitoring
continuous 24 hour EKG monitoring
| Used for diagnosis and management of arrhythmias
75
Describe angiogram
Dye injected to show blood vessels
76
Describe percutaneous coronary intervention
Improves blood flow to the heart for revascularization
| Restored blood Flow in patients with MI
77
Describe an electrophysiological study
Checks conduction system of the heart
Used after sudden death with revival
8 hour procedure with patient heavily sedated
78
Describe a ventricular assist device
Mechanical pump that helps failing ventricle, provides bridge until donor can be identified
Exercise can improve pre-op condition
Left more common than right
requires sternotomy
79
Describe the indications for a heart transplant
Progressive terminal CP disease
80
Inpatients with heart transplant how do you monitor exercise response
BP and RPE
| Not HR
81
What is the purpose of a central line and where can they be placed
Measures arterial pressure, draws blood
| Femoral, brachial, radial
82
Describe the uses of a central venous line
Blood samples
Medications
Rehydration
83
What is the purpose of a SWAN-GANZ catheter
Measure R atrium, R ventricle, pulmonary artery and L atrium filling pressure
84
What are the norm values for a SWAN-GANZ catheter
R atria - 0-5
R ventricle 5-12
PA - 20-30 / 5-12
Capillary wedge - 5-18
85
What should you do when moving a patent with a line or SWAN-GANZ line
Manually measure blood pressure
86
Describe a PICC line
Used for long term therapies
87
What are some advantages of a PICC line
easy to insert
Low risk of bleeding
can be left in for a long time
88
Describe an intra-aortic balloon pump
Pulls blood out of left ventricle
89
Describe an IAPB
balloon in the thoracic aorta, inflates and deflates with the heart
90
What are the used of IV lines
Rehydration
Meds
blood transfusions
91
At what Pulse ox measurement should you avoid exercise
if below 92%
92
What enzymes corelate to MI
CPK
LDH
Troponin - gold standard for MI
93
at what troponin level is a heart attack probable
above .4 ng/ml
94
Describe the homocysteine levels and their meaning
```
less than 10 is desirable
< 6.3 = < 1 x cardiac risk
< 6.6 = 1x risk
10 = 2x risk
15 = 4x risk
20 = 9x risk
```
95
What are the classic cardiac symptoms
```
Chest pain
Chest tightness
Palpitations
indigestion
Burning
```
96
What are the classic pulmonary symptoms
```
Dyspnea
Wheezing
Cough
Increased RR
sputum
```
97
What are some risk factors of heart disease
```
HTN
Smoking
High cholesterol
family history
Stress
Sedentary lifestyle
Older age
Obesity
Diabetes
```
98
What are some protocols for exercise testing
Bruce - most common
Bruce low level
Balke - most common with athletes
99
What are the absolute criteria for exercise testing termination
```
Drop is SBP > 10
Moderately severe angina
Signs of poor perfusion
Sustained V tach
Request of patient
```
100
What are the relative criteria for exercise testing termination
```
ST or QRS changes
Arrhythmias
Fatigue, SOB, claudication
Increasing chest pain
Hypertensive response - 250/115
```
101
Describe FAI
Functional aerobic impairment
| % difference of VO2 max in similarly aged healthy person
102
What are the numerical interpretation for FAI
Mild - 27-40%
Moderate - 41-54%
Marked - 55-68%
Extreme - >68%
103
What are the contraindications for exercise testing
```
Recent MI
Acute pericarditis or myocarditis
Resting or unstable angina
Aortic stenosis
Serious ventricular or rapid atrial arrhythmias
```
104
Describe finger nail clubbing
fingers look like drumsticks
| 8% of clubbing is due to cardiopulmonary issues
105
Describe the angina scale
1 - light, barely noticeable
2 - moderate, bothersome
3 - severe, very uncomfortable
4 - most severe pain ever experienced
106
What is the dyspnea scale
0 - no trouble breathing
1 - SOB with hurrying or walking up gradual hill
2 - walks slower than people of same age, has to stop for breath
3- stops for breath after 100 meters, or after a few minutes
4 - cannot leave house, SOB with dressing
107
Describe the dyspnea level test
```
Count to 15 in 8 seconds
0 - single breath
1 - two breaths
2 - 3 breaths
3 - 4 breaths
4 - unable to count
```
108
Describe the function of organic nitrates
Dilate coronary blood vessels and reduces blood pressure
109
Describe the function of calcium channel blockers
reduces electrical conduction, force of contraction, dilates blood vessels, reduced BP
(...pine)
110
Describe Cardiac glycosides
Increase contraction but not HR
| ...in
111
Describe beta blockers
reduce HR, contractility and BP, vasodilator
| ...olol
112
Describe an ACE inhibitor
Vasodilator, decreases BP
| ...pril
113
What is optimal cholesterol
less than 200
114
What is optimal LDL, what is considered High
less than 130-160
| High is more than 160
115
What is considered good HDL
the more the better
116
Describe Cardiac rehab phase 1
Monitoring phase
117
What is the goal of cardiac rehab phase 1
Maintain and stabilize cardiovascular function
118
What is the criteria to exit cardiac rehab phase 1
ADLS performed 5 METS
119
Describe cardiac rehab phase 2
up to 12 weeks
supervised exercise
may live at home
120
What is exercise prescription like during cardiac rehab phase 2
20-60 mins
2-3 times per week
40-60% max HR
121
What can yo begin during cardiac rehab phase 2 other than cardio exercise
light resistance exercise
122
What is the exit criteria for cardiac rehab phase 2
9 METS
123
Describe cardiac rehab phase 3
Maintenance phase
124
What intensity of resistance training may begin in cardiac rehab phase 3, how to progress
50% 1 RM
| progress UE - 2-5 lbs, LE 5-10
125
What does cardio exercise intensity look like in cardiac rehab phase 3
70-85% max HR
| 11-14 RPE
126
What does cardiac monitoring look like at cardiac rehab phase 3
intermittent or no monitoring
127
What can resume after cardiac rehab phase 3
Patient may return to work
128
What is the formula for Max HR
220 - age
129
what is the formula for HRR
subtract resting HR from Max HR
130
What is the formula for target heart rate (karvonen)
((Max HR - RHR) x target) + RHR
131
Describe the intensity frequency relationship for cardio exercise
low to mod intensity - 5-7 days per week
| Higher intensity - 3-5 days per week
