PT Exam and Assessment of the Cardiac System Flashcards
(274 cards)
1
Q
what is a part of the medical chart review?
A
exam, eval, diagnosis, prognosis, and intervention
2
Q
what is involved in the exam?
A
pt hx, systems review, tests and measures
3
Q
what is involved in the eval?
A
eval of data to make a clinical judgement
4
Q
what is the point of the diagnosis?
A
to classify a pt within a specific practice pattern and indicates the primary dysfunctions
5
Q
what is the point of the prognosis?
A
to determine the predicted level of optimal functioning
6
Q
what are the classic cardiac signs?
A
chest pain, tightness, pressure, SOB, palpitations, indigestion (esp in females), burning sensation
7
Q
what are the 3 cardinal signs of HF?
A
SOB, weight gain, edema bc of accumulation of fluid
8
Q
what are risk factors for heart disease?
A
HTN, smoking, elevated cholesterol, family hx of early heart disease, stress, sedentary lifestyle, older age, obesity, and DM
9
Q
what age is considered early heart disease for females?
A
younger than 65
10
Q
what age is considered early heart disease for males?
A
younger than 55
11
Q
what is relevant social hx specific to cardiac disease?
A
excessive alcohol, cigarette smoking, illicit drug use
12
Q
what cardiac issues does excessive alcohol consumption put you at risk for?
A
cardiomyopathy
13
Q
what cardiac issues does cigarette smoking put you at risk for?
A
heart disease
14
Q
what cardiac issues does illicit drug use put you at risk for?
A
coronary artery spasms, MI, and severe arrythmias
15
Q
what info does electrocardiograms and serial monitoring give us?
A
the state of the heart muscle and rhythm
16
Q
t/f: electrocardiograms and serial monitoring predicts the future and can give us info on the coronary anatomy
A
false
17
Q
what are the causes of sinus bradycardia?
A
well-trained athletes, B-blockers
18
Q
what are the implications for sinus bradycardia?
A
if pathology exists, it can cause inadequate cardiac output (CO)
19
Q
sinus bradycardia will have long ____ _____
A
RR intervals
20
Q
what is the definition of cardiac output (CO)?
A
volume of blood ejected out of the LV in a minute
21
Q
what is the calculation for CO?
A
SV x HR = CO
22
Q
what is the average CO at rest for adequate tissue perfusion?
A
4-6 L/minute
23
Q
with exercise, should CO, HR, and SV increase or decrease?
A
increased
24
Q
what are the signs of inadequate CO?
A
syncope, dizziness, angina, and diaphoresis (excessive sweating)
25
what are the causes of sinus tachycardia?
exercise (non pathological), anxiety, hypovolemia, anemia, fever, infection, meds, low CO, caffeine (non pathological)
26
what are the implications for sinus tachycardia?
typically asymptomatic unless extremely high HR
concerned at or close to max HR
27
does sinus tachycardia or bradycardia have a smaller RR interval?
sinus tachycardia
28
does sinus tachycardia or bradycardia have a larger RR interval?
sinus bradycardia
29
why are we concerned with sinus tachycardia that is at max HR?
bc they may not be able to meet CO needs
30
what are the implications of a sinus pause?
frequent decrease in CO
31
what is a sinus pause?
normal sinus rhythm that suddenly has a very long RR interval and then back to normal
32
1-2 minutes of sinus pause is not going to affect a pt, but the concern is when?
when having multiple in a minute or multiple spaced closely together leading to decreased CO
33
what are the causes of premature ventricular contraction (PVC)?
caffeine, nicotine, stress, over-exertion, electrolyte imbalances, ischemia, CHF, acute infarction, irritation of the myocardium, chronic lung disease, PE, some meds
34
what are the symptoms of PVCs?
typically asymptomatic if infrequent
35
what are the characteristics of PVCs?
inverted or abnormal QRS complex and no p wave
36
1-2 PVCs is not a concern, when is there concern?
when there are 6 or more PVCs than the pt's baseline PVCs
37
PVCs are serious or life-threatening when...
paired together
multifocal
more than 6 from their baseline
landing on t waves
present in triplets (ventricular tachycardia)
38
what are multifocal PVCs?
PVCs coming from multiple areas of the ventricle causing more myocardial damage
39
how do we know PVCs are multifocal?
bc the QRS complexes will all look different from each other
40
what is ventricular tachycardia?
3 or more PVCs in a row
MEDICAL EMERGENCY
41
what rhythms are a medical emergency?
ventricular tachycardia
ventricular fibrillation
asystole
42
ventricular tachycardia left untreated can lead to what?
v-fib
43
what is ventricular fibrillation?
random rhythms on the EKG due to quivering of the ventricles
44
when someone's EKG shows us they are in v-fib, but they are talking to us, what should we do?
check the lead placement bc they may just be off bc most pts in v-fib will already be in syncope and no able to communicate
45
what is atrial flutter?
classic sawtooth appearance bw R waves
46
what are the implications of atrial flutter?
typically safe if HR is less than 100 bpm
can decrease CO at high HR
47
t/f: an increase in HR with atrial flutter can decrease CO
true
48
what can atrial flutter lead to?
a-fib
49
what are the implications of atrial fibrillation?
20% decrease in CO
controlled AFib needs to be monitored with exercise
uncontrolled AFib needs a lot of caution
50
what is controlled AFib?
<100 bpm
51
what is uncontrolled Afib?
>100 bpm
52
what is atrial fibrillation?
multiple dif p waves w jagged uneven appearance from multiple areas of the atria contracting a different times
53
t/f: a fib may be controlled at rest and uncontrolled with activity
true
54
how do we deal with controlled a fib at rest that becomes uncontrolled with activity?
start with minimal activity and work up as the are able to tolerate without symptoms of uncontrolled a fib
55
what is the main measure of CO that we use as PTs?
BP
56
if HR is high and BP is stable, is CO able to keep up with increased HR?
yes
57
if HR is high and BP is decreased, is CO able to keep up with increased HR?
no
58
what is the HR of rapid ventricular response (RVR)?
>120 bpm
59
what is premature atrial contraction (PAC)?
ectopic atrial foci outside of the SA node causing early atrial defibrillation
60
what would PAC look like on EKG?
early p wave appears different to other p waves and may be hidden in the t wave
may be followed by a pause
61
t/f: one PAC alone isn't enough to change CO in a minute, but with multiple we may see effects on CO
true
62
what is another name for atrial tachycardia?
supraventricular tachycardia (SVT)
63
what is atrial tachycardia (SVT)?
3 or more PACs in a row
HR>100bpm
64
t/f: atrial tachycardia (SVT) can decrease CO at high HR
true
65
when would normal sinus rhythm with artifact often be seen?
when a pt is using an electrical toothbrush
66
what EKG patterns would be a contraindication to exercise?
sustained ventricular tachycardia
2nd/3rd degree heart block
new onset SVT, a fib, or a flutter
new onset tachycardia or bradycardia with hemodynamic compromise
67
what EKG patterns would be relative contraindications for exercise?
new onset tachycardia or bradycardia w/o hemodynamic compromise
68
what EKG patterns would be precautions for exercise?
many rhythms have the potential to reduce CO or to progress to more serious rhythms so closely monitor s/s, progress activity slowly, and if the pt is on continuous EKG monitoring stop activity with any new arrythmia
69
what are radiological studies?
chest radiographs, CT scans, MRIs, and scintigraphy
70
what does a CTA (CT angiogram) look for?
blood flow, esp PEs
71
t/f; we can treat crackles heard on auscultation the same whether it is caused by pulmonary issues or mucus
false, we would do airway clearance techniques with mucus, but these would not work for pulmonary edema
72
what is an echocardiogram?
US of the heart in real time
73
what are the two types of echocardiograms?
TEE (transesophageal) and TTE (transthoracic)
74
what is the difference bw TEE and TTE?
TTE is less invasive and can be done at the bedside
TEE requires sedation but give more clear images
75
what can echocardiograms show us?
valve dysfxn, chamber sizes, muscle wall thickness, ejection fraction
76
if the inferior vena cava is dilated, this could indicate ___ sided dysfxn
right
77
what could cause a dilated inferior vena cava?
regurgitation
blood not adequately getting pumped from the R side of the heart
RV not working
increased resistance through the lungs
78
what info can we get from cardiac catheterization?
the anatomy of the coronary arteries
dynamic assessment of cardiac muscle
heart and valve damage
ARTERIES!!!!!
79
where does a L cardiac catheter go through?
brachial or femoral artery --> aorta--> L heart
80
where does a R cardiac catheter go through?
basilic or femoral vein-->vena cava--> R heart
81
what are the implications of mitral valve stenosis?
decreased CO (not getting full amount of blood to the ventricles)
backup into the lungs
pulmonary HTN and edema
R sided HF
82
what are the implications of systemic HTN?
LV hypertrophy from working harder to pump blood into the aorta against increased peripheral pressure
L sided dysfxn
increased pressure gradient gains the aortic valve can cause dysnfxn (stenosis or regurgitation)
83
what data can be gained from cardiac cath?
CO, shunt detection, coronary angiography, L and R pressures, pulmonary artery pressure, ventricular ejection fraction
84
what are the two part of the cardiac cath?
the camera and the pressure sensor
85
what does the camera of the cardiac cath show us?
visualize how the heart is working and contracting, see the valves, and see the ARTERIES
86
what is the main benefit of using cardiac cath?
visualization of the arteries !!!
87
what dx can be made from cardiac cath?
presence and severity of coronary artery disease!!!!!
presence of LV dysfxn
presence and severity of valvular heart disease
presence of pericardial disease
88
what valvular heart diseases can be picked up on a cardiac cath?
aortic valve stenosis or regurgitation
mitral valve stenosis, regurgitation, or prolapse
tricuspid valve dysfxn
pulmonary valve dysfxn
89
what procedures can be done during a cardiac catheterization?
cardiac biopsy
percutaneous coronary intervention (balloon angioplasty, stent implantation, thrombectomy, arthrectomy)
90
what are the 2 values for myocardial damage?
CKMB and troponins
91
lab monitoring for myocardial damage must be in a series of ____
2-3
92
can CKMB or troponins be elevated with any form of damage to the muscle tissues?
CKMB
93
what is the gold standard lab value for myocardial damage?
troponins
94
is CKMB or troponins more specific to myocardial damage?
troponins
95
what is the range for CKMB?
<5% of total CK
96
when is the onset of the rise of CKMB?
4-6 hours
97
when is the peak of CKMB?
12 hours
98
when does CKMB return to normal?
1-2 days
99
what is the range for troponin T?
<0.1
100
what is the range for troponin I?
<0.03
101
what is the range for high sensitivity cardiac troponin for women?
<14
102
what is the range for high sensitivity cardiac troponin for men?
<22
103
when is the onset of the rise of troponin T?
2-3 hours
104
when is the onset of the rise of troponin I?
2-3 hours
105
when is the peak for troponin T?
10-24 hours
106
when is the peak for troponin I?
10-24 hours
107
when does troponin T return to normal
4-7 days
108
when does troponin I return to normal?
10-14 days
109
troponin values have a decreased reliability when a pt has what disease?
renal failure
110
what are the causes of upward trending troponin?
myocardial injury
MI
cardiac trauma, HR, HTN, hypotension, PE, renal failure, myocarditis
111
what are the clinical implications of upward trending troponin?
initiate PT intervention when troponins are stable and/or down trending!!!!!
monitor for unstable status
monitor VS (RR>40, drop in HR>10, drop in SBP>10, SpO2<90%)
112
what is the lab test associated with HF?
BNP (brain natriuretic peptides)
113
t/f: BNP increases with severity of HF
true
114
what does BNP tell us?
the severity of HF
115
if BNP values are <100 PG/mL, what is the HF classification?
no HF
116
if BNP values are normal with SOB, is HF likely?
nope
117
if BNP values are bw 100-300 pg/mL, what is the HF classification?
class 1
118
what are the HF class 1 symptoms?
cardiac disease, no s/s, no limitations in ordinary activity
119
if BNP values are >300 pg/mL, what is the HF classification?
class 2
120
what are the HF class 2 symptoms?
mild s/s, slight limitations w/ordinary activity
121
if BNP values are >600 pg/mL, what is the HF classification?
class 3
122
what are the HF class 3 symptoms?
marked limitations bc of s/s, even less than ordinary activity
123
if BNP values are >900 pg/mL, what is the HF classification?
class 4
124
what are the class 4 HF symptoms?
severe limitations, experiencing symptoms at rest
125
what are the causes of upward trending BNP?
HF, MI, systemic HTN, cor pulmonale, heart transplant rejection
126
what are the clinical implications of upward trending BNP?
monitor for s/s of worsening HF
monitor s/s of hypotension
Borg RPE or dyspnea scale should be used
127
what are the s/s of worsening HF?
exercise intolerance
s3 heart sound
pulmonary crackles
change in heart rhythm
128
what is measured in a basic electrolyte/metabolic panal (BMP)?
sodium, potassium, calcium, chloride, phosphate, magnesium
129
what 3 electrolytes cause altered excitability of neurons, cardiac tissue, and skeletal muscle?
sodium, potassium, and calcium
130
what does high sodium cause?
tachycardia, hypotension
131
what does low sodium cause?
OH
132
what are the normal values for sodium?
136-145
133
what are the critical values for sodium?
<120, >160
134
what are the causes of high sodium?
hypovolemia, sodium overload, endocrine disorder
135
what is the presentation with high sodium?
thirst, confusion, irritability, hyperreflexia, seizure, coma, tachycardia, hypotension, oliguria
136
what are the causes of low sodium?
hyper/hypovolemia, severe GI loss, dehydration, diuretics, renal/hepatic disease, GI disorders, hypotonic IV administration
137
what is the presentation of low sodium?
headache, lethargy, hyporeflexia, seizure, coma, OH, pitting edema, confusion, weakness, nausea
138
what electrolyte are we most concerned about?
potassium
139
which electrolyte has the highest potential for adverse cardiac event and why?
potassium bc just a small concentration change can lead to large effects on cardiac stability
140
what results from high or low potassium?
arryhthmias, acute cardiac event
141
what are the normal values for potassium?
3.5-5.0
142
what are the critical values for potassium?
<2.5, >6.5 (don't even let it get it this point)
143
t/f: potassium instability should be monitored on continuous EKG
true
144
t/f: changes in potassium can lead to decrease activity tolerance
true
145
what causes an increase in potassium (hyperkalemia)?
excessive K supplementation
renal failure
metabolic acidosis
diabetic acidosis
blood transfusion
146
what is the presentation of someone with hyperkalemia?
muscle weakness or paralysis
muscle tenderness
paresthesia
dysrhythmia
bradycardia
147
what are the causes of low potassium (hypokalemia)?
fluid overload, renal dysfxn, GI disorder, diuretics, alcoholism, hormonal/endocrine disorders, CF
148
what is the presentation of someone with hypokalemia?
extremity weakness, hyporeflexia, paresthesia, leg cramps, dysryhtmias, hypotension
149
what are the normal values for calcium?
9-10.5
150
what are the critical values for calcium?
<6, >13
151
what does calcium affect?
muscle contractions
152
t/f: changes in calcium can lead to decreased exercise tolerance
true
153
what does increased calcium cause?
ventricular dysrythmias
154
what does decreased calcium cause?
dysrhythmias
155
what causes low calcium (hypocalcemia)?
chronic kidney disease, sepsis, malnutrition, malabsorption, pancreatitis, laxative use
156
what is the presentation of someone with hypocalcemia?
confusion, muscle cramps, hyperreflexia, dysrhythmias, paresthesia, agitation, seizure, fatigue
157
what causes high calcium (hypercalcemia)?
excessive release of calcium into the blood, dehydration, endocrine/hormonal disorders, GI disorders, excessive vitamin D, supplement/antacids, cancer, immobilization
158
what is the presentation of someone with hypercalcemia?
hyporeflexia, muscles weakness, ventricular dysrhythmia, lethargy, constipation, nausea/vomiting, bone pain
159
what results from high magnesium?
bradycardia, dysrhythmia, hypotension
160
what results from low magnesium?
dysrhythmias
161
what are the normal values for magnesium?
1.3-2.1
162
what are the critical values for magnesium?
<.5, >5
163
t/f: changes in magnesium can lead to decreased exercise tolerance
true
164
what are the causes of high magnesium?
renal failure, oliguria, increased magnesium intake, endocrine disorder, diabetic ketoacidosis
165
what is the presentation of someone with high magnesium?
nausea/vomiting, hyporeflexia, hypotonia, somnelence, bradycardia, dysrhythmia, hypotension, respiratory depression
166
what are the causes of low magnesium?
malnutrition, malabsorption, tremors, chronic alcohol use, diuretics, chronic renal disease, diabetic acidosis
167
what is the presentation of someone with low magnesium?
hypertonia, hyperreflexia, tremors, muscle cramping, seizures, apathy, nystagmus, dysrhythmias
168
what do we want to know about a pt's surgical hx?
how long ago it was
169
how long do we use precautions with pacemaker placement?
about 3 weeks
170
how long do we use precautions with surgeries?
4-12 weeks
171
if chest pain is reproducible with palpation, is it more likely cardiac or noncardiac cause?
non cardiac cause
172
if chest pain is not reproducible with palpation, is it more likely cardiac or noncardiac cause?
cardiac cause
173
if chest pain is associated with activity level, is it more likely cardiac or noncardiac cause?
cardiac cause
174
if chest pain is not associated with activity level, is it more likely cardiac or noncardiac cause?
non cardiac cause
175
if chest pain is associated with other s/s like a sense of doom, cold sweats, and SOB, is it more likely cardiac or noncardiac cause?
cardiac cause
176
what is compensated HF?
the absence of S/S of vascular congestion and not showing outward signs of HF
stability
177
what is stability in HF?
probability of remaining in a compensated state
178
when HF pts can exert themselves w/appropriate VS response and can return to baseline in a reasonable time, are they compensated or decompensated?
compensated
179
what are the s/s of decompensated HF?
new/worsening dyspnea
new/worsening fatigue
new/worsening edema (pulmonary or peripheral)
weight gain
chest pain
180
t/f: pts with decompensated HF need medical attention
true
181
what are the 3 components of the physical exam of all pts with HF?
heart auscultation for S3 heart sounds (lub-da-dub)
crackles on lung auscultation
JVD
182
if a pt has a weight gain of 3 or more pounds in 2 days, increased cough, increased swelling, increased SOB with activity, increased # of pillows needed, or anything else unusual that bothers you, what may this indicate?
need for an adjustment in meds, and communication with the physician
183
if a HF pt has unrelieved SOB at rest, unrelieved chest pain, wheezing or chest tightness at rest, need to sit in a chair to sleep, weight gain or lose of more than 5 pounds in 2 days, or confusion, what may this indicate?
overt decompensation, immediate ED visit or call to physicians office
184
what is involved in the physical examination of pts w HF?
inspection for JVD
palpation for edema
girth measurements
heart and lung auscultation
185
how do we inspect for JVD?
with the pt in recumbent position with HOB at 45 deg, chin tucked and turned towards the opposite side, see if the vein becomes above the level of the clavicles
186
what a (+) test for JVD?
vein distends above the level of the clavicles
187
what does a (+) JVD indicate?
increased venous volume and may indicate R HF
188
does JVD indicate R or L HF?
R HF
189
where is pitting edema typically found?
and the ankles and pre-tibial areas
190
describe edema associated with CHF
pitting and BL
191
what does edema indicate?
fluid retention
192
what things may cause fluid retention in edema?
cardiac pump dysnfxn, liver dysfxn, kidney dysfxn, malnutrition
193
what is the palpation technique for edema?
apply firm pressure for 10-20 sec
time how long it takes the skin to rebound to it's og shape
194
what are possible locations for edema?
feet, lower legs, thighs, abdomen
195
if edema palpation shows barely perceptible depression, what is the score?
1+
196
if edema palpation shows easily identified compression and rebounds in <15 seconds, what is the score?
2+
197
if edema palpation shows easily identified compression and rebounds in 15-30 seconds, what is the score?
3+
198
if edema palpation shows easily identified compression and rebounds in >30 seconds, what is the score?
4+
199
what is edema girth measurements used for?
monitoring of exacerbation of condition and success of intervention
200
what is the technique for girth measurements of edema?
take circumferential measurements around the affected limb using a tape measure starting 5 cm from the floor and continue proximally in 5 cm increments
201
if girth measurements start decreasing, what can this indicate?
improving heart condition
202
why don't we want to use wraps, massage, etc for edema in pts with HF?
bc it will just push fluid back into the vascular system that already cant handle the fluid inside it
203
what are the rules of auscultation?
it can't be done over clothes
make sure you are using the correct side of the stethoscope
try not to knock the tubing
204
do we use the diaphragm or the bell of the stethoscope for heart auscultation?
both
205
what are the 4 topographic areas for heart auscultation?
at the aortic and pulmonary areas (at the 2nd intercostal space R and L respectively)
tricuspid area (4th intercostal space)
mitral area (5th intercostal space)
206
what should we note with heart auscultation?
the intensity, timing, a presence of any splitting, extra sounds, or murmurs
207
what is "normal heart sounds"?
"lub-dub"
S1
S2
208
what is S1 heart sound?
normal heart sound
"lub"
closure of the mitral and tricuspid valves
209
what is S2 heart sound?
normal heart sound
"dub"
closure of the aortic and pulmonary valves
210
what are abnormal heart sounds?
S3
S4
heart murmurs
211
what is S3 heart sound?
"lub-da-dub"
occurs immediately following S2 (early diastole)
212
what heart sound is a key sign of CHF?
S3 heart sound
213
what is S4 heart sound?
"La-lub-dub"
just b4 S1 (late diastole)
214
what heart sound is associated with atrial contraction?
S4
215
how are heart murmurs classified?
by timing, quality, intensity, pitch, location, and radiation
216
what are the 3 classifications of heart murmurs?
(1) murmurs caused by high rates of flow through normal or abnormal valves
(2) murmurs caused by forward flow through constricted (stenotic) or deformed valves or by backwards flow through a valve (regurgitation)
(3) murmurs caused by backwards flow through a valve (regurgitation)
217
what is pericardial friction rub?
abnormal "creak" sound associated with each heartbeat that indicated pericarditis
218
what does pericardial friction rub indicate?
pericarditis
219
what is the location to auscultate S1 heart sounds?
tricuspid area
mitral area
220
what is the location to auscultate S2 heart sounds?
aortic area
pulmonary area
221
what is the location to auscultate S3 heart sounds?
mitral area (with pt laying in 45 degrees forward L S/L)
222
what is the location to auscultate S4 heart sounds?
mitral area
223
is S1 best heard with the bell or diaphragm of the stethoscope?
diaphragm
224
is S2 best heard with the bell or diaphragm of the stethoscope?
diaphragm
225
is S3 best heard with the bell or diaphragm of the stethoscope?
bell
226
is S4 best heard with the bell or diaphragm of the stethoscope?
bell
227
what is the corresponding event for S1?
onset of ventricular systole
228
what is the corresponding event for S2?
onset of ventricular diastole
229
what is the corresponding event for S3?
early diastole
230
what is the corresponding event for S4?
late diastole (immediately prior to S1)
231
what is involved in the activity evaluation?
assessment of vitals at rest, sitting, standing, ADLs, ambulation, and stairs
232
what vital signs are involved in the activity evaluation?
HR, heart rhythm, BP, O2, RR, RPE, and dyspnea
233
how is HR measured?
by palpation, ECG, or pulse ox
234
t/f: pulse ox readings of HR are not always accurate in the case of irregular heart rhythms, darker skin, and nail polish
true
235
what is a normal HR response to increased work?
a gradual rise w/an increase in workload
236
what is a normal HR response to endurance activity?
after initial rise, steady state
237
when would we see a blunted HR response?
in highly trained athletes and in PT on HR/rhythm control meds
238
what is an abnormal HR response to increased work?
rapid rise
blunted rise
decrease rate (not usually true decrease in rate, but rather rhythm)
239
what is an abnormal HR response to endurance activity?
progressive increase
significant drop
240
what is a rapid rise in HR with activity a sign of?
severe deconditioning
CV condition with limited SV
241
what is a flat rise in HR without rhythm control meds in response to activity a sign of?
CV condition
242
is a decreased HR by palpated pulse more likely a true decrease in rate or a change in rhythm?
a change in rhythm
243
how do we measure heart rhythm?
by palpation or ECG
244
what is the only way to dx a heart rhythm abnormality?
with ECG
245
what is a normal heart rhythm response to increased work?
the rhythm remains regular with activity
OR
if irregular at rest, there is no change in irregularity
246
what is an abnormal heart rhythm response to increased work?
a change from regular to irregular
an increase in frequency of irregular rhythm
a change from one type of irregularity to another
247
how is BP measured?
with a-line (invasive in the ICU), automatic cuff, manual cuff
248
what is a normal SBP response to increased work?
gradual rise with increased workload
249
what is a normal SBP response to endurance activity?
after initial rise, maintains steady state
250
what is considered hypertensive SBP?
a rise of >8-12 mmHg/MET of activity
251
what is hypertensive SBP a sign of?
increased vascular resistance
252
what is considered hypotensive SBP?
normal SBP rise with submaximal exercise then a sudden and progressive drop with increased workload
253
what is considered blunted BP response?
a small increase with low exertion and failure to rise further with increased work
254
what is hypotensive SBP response a sign of?
coronary disease
255
what is blunted SBP response a sign of?
failure of CO (cardiac output)
256
what are abnormal SBP responses to increased work?
rapid rise
blunted rise (if not on beta blockers)
decreased with increased workload
257
what is considered abnormal SBP response to endurance activity?
progressive rise
decrease and symptomatic with decrease
258
what is considered a normal BP response to activity (SBP and DBP)?
gradual increase in SBP with increased workload
no more than 10 mmHg change in DBP with increased workload
259
what is an abnormal DBP response to increased work?
more than 10 mmHg rise or fall
260
what is considered an abnormal DBP response during the recovery phase?
sustained elevation
261
how do we measure peripheral oxygenation?
pulse ox
262
what does a pulse ox assess about O2?
the O2 saturation of hemoglobin (98-100%)
263
pts with ____ or _____ often desaturate with activity
chronic pulmonary dysfxn, CHF
264
exercise shouldn't be continued if O2 sat drops below ___%
88
265
how do we measure exertion?
Borg RPE scale (of or revised)
266
what scale is widely used to monitor activity and exercise intensity?
RPE
267
what is RPE a measure of?
perceived workload
268
t/f: RPE is useful to monitor in pts with a blunted HR response
true
269
the og Borg scale is from __ to __
6-20
270
the revised Borg scale is from __ to __
1-10
271
the og Borg scale is preferred in what pts?
cardiac pts
272
why is the og Borg scale preferred in cardiac pts?
bc it can tell us where their HR should be without meds (add a zero to whatever number they score)
273
the revised Borg scale is preferred in what pts?
pulmonary pts
274
which RPE is easier for people to understand, the og or the revised?
the revised Borg scale
