Quiz 2 Flashcards
1
Q
Quiz 2 is on cardio-pathology, a little bit on evaluation, and auscultation
10 ?’s on Quiz 2
BELOW ARE FLASHCARDS ON THE EXAM/EVALUATION POWER POINT
A
ok
2
Q
T or F: When doing an exam or evaluation, you need to know normative values in order to pick up on “red flags”
A
True
3
Q
What are some Cardio-Pulm “red flags”
A
- SOB (shortness of breath)
- Dizziness, lightheaded (orthostatic hypotension)
- HTN (hypertension)
- Heavy chest / chest pain (angina)
- Dyspnea (heavy difficult breathing)
- Increased RR, HR, BP
- Orthopnea (difficulty breathing laying flat)
- Paroxysmal Nocturnal Dyspnea (PND)
- Cyanosis (blue coloring from difficulty breathing / lack of O2) … digital clubbing
- Distended jugular veins (backup fluid/blood from heart failure)
- Etc…
4
Q
Review two statements below … and explain:
EVERY patient is a multi-system patient
EVERY patient is a cardiopulmonary patient
With that said, what are the MAIN systems we as a PT will primarily work with:
A
Don’t just look at problem, diagnosis, or musculoskeletal. Every issue has a cardio-pulm element, and look at cura personalis … the whole person and big picture.
- Muscular
- Skeletal
- Neuro
- Integumentary
- Cardio-pulm
- (Communication / Cognition)
5
Q
** NO MATTER WHAT, with EVERY PATIENT, you will ALWAYS do what:
A
- VITALS
- Observation
6
Q
When you are observing, what are you looking for:
A
- Appearance
- Cyanosis (blue skin)
- Breathing (labored, heavy, SOB)
- Dyspnea
- Talking (breathlessness)
- RR
- Jugular vein distention
- Posture (symmetry, deformities)
- Pain
- Cognition
7
Q
What is Cyanosis:
What is Body Habitus:
What is Cachectic: (how to remember)
What is Panniculus: (how to remember)
A
Cyanosis: A BLUISH discoloration of the skin, tongue, or nails resulting from POOR CIRCULATION or inadequate oxygenation of the blood. (Cyanide is pale blue color … really :)
Body habitus: The physique or body build (strong and healthy or weak and frail, overweight) (Good body habits = good physique)
Cachectic: Body wasting away due to poor health (CASH = wasting away)
Panniculus: Excessive abdominal body fat (PAN handle around belly)
8
Q
What is Digital Clubbing:
Why?
A
Enlargement of tips of fingers / toes. Nails emerge.
This is from prolonged cyanosis. Lack of O2 (POOR CIRCULATION) over long time means nail will deteriorate.
9
Q
What is pursed lip breathing:
Why would someone do it?
A
Pursed-lip breathing (inhale/exhale against resistance with mouth).
If you create more pressure by closing more of the lips/mouth (by closing lips slightly) is pushes larynx open more which opens the airways allowing more air to get in, and more of the trapped air to forcefully get pushed out.
10
Q
What is COPD:
If a patient had COPD, what are a few signs you’d notice that would indicate this:
A
COPD: Chronic obstructive pulmonary disease. It is a general term for many obstructive disorders/conditions of difficulty breathing (pneumonia, asthma, bronchitis, emphazima) where an object gets lodged in airway, or more commonly the airways get inflammed, mucous buildup, or airway / alveoli get damaged.
- Pale skin (cyanosis)
- SOB
- Difficulty breathing (dyspnea)
- Difficulty talking
- Wheezing, coughing
- Coughing up sputum
- Protruding SCM muscles (help compensate to breath)
- Posture
- Fatigued
11
Q
What is Pectus excavatum:
What is Pectus carinatum:
(how to remember)
A
Caved IN chest/sternum between pecks (go IN to the cave)
Sternum protrudes out – chest out (go OUT to the carnival)
(go IN to the cave)
(go OUT to the carnival)
12
Q
What is Professorial posture:
Why would someone do it?
A
Leaning Forward / flexed with UEs braced on knees or other support surface.
To open up thoracic cavity because they can’t breathe well.
13
Q
Review:
Kyphosis:
Lordosis:
Scoliosis:
(How to remember)
A
Kyphosis: Thoracic spine is protruding BACK
Lordosis: Lumbar spine sticks forward
Scoliosis: Curved spine laterally
(L = L … Lordosis = Lumbar = Lower on back, and Lords need to be out in front).
14
Q
How does posture and/or positioning impact breathing?
What’s a simple exercise a pt can do to help with posture … thus help with breathing
A
Posture makes a HUGE difference in your ability to breathe, and breathe properly. If you are slunched over, your lungs can’t fully expand, and your diaphragm can’t fully contract (since abdominal contents would be scrunched as well) so your lungs can’t expand as much, which means less air in, less O2, less gas exchange, etc.
You could do some scapular retraction exercises to open up those lungs / thorax.
15
Q
Know in general (don’t memorize) these terms in relation to cognition:
A
Conscious: Alert and functional cognitively
Confused: can’t think clearly
Delirious: Disturbed state of mind
Somnolent: Sleepy / drowsy (Somber)
Obtunded: dull the sensitivity out, deaden (ObtunDEAD = deaden)
Stuporous: lacks mental function - stupid
Comatose: deep uncounsiousness
Tremor: involuntary quivering
16
Q
What is Jugular Venous Distension (JVD)
Why might someone have distended jugular veins?
A
Jugular veins are protruding out from neck and buldged
Lymphatic or cardiac problems where fluid is obviously backing up from heart into the neck.
17
Q
When you are observing breathing, what are you looking for:
A
- SOB
- Diaphragm or upper chest breathing
- Labored / exerted or not
- What moves 1st, 2nd, or 3rd
- Breathless when they talk?
- Loud or soft breathing
- Adventitious sounds
- RR
- Thorax movement and expansion
- Dyspnea
- Cyanosis
18
Q
If you are observing, what do you document
A
ONLY document things that are abnormal
19
Q
Normal RR’s are:
Increased RR is called:
Decreased RR is called:
Increased HR is called:
Decreased HR is called:
A
Normal respiratory rates are: 12-20 b/p/m
More than 20 = Tachypnea
So less than 12 = Bradypnea
More than 100 bpm = Tachycardia
Less than 60 bpm = Bradycardia
20
Q
Define these terms:
Pnea - Penia - Eupnea – Apnea – Tachypnea – Bradypnea – Dyspnea – Orthopnea - Paroxysmal Nocturnal Dyspnea -
A
Pnea - Breathing
Penia - lacking or less
Eupnea – normal breathing cycle (Euphoric)
Apnea – temporary halt in breathing
Tachypnea – rapid, shallow breathing pattern (20+ bpm)
Bradypnea – less than 12 bpm (slow breathing)
Dyspnea – sensation of breathlessness / difficulty breathing
Orthopnea - Difficulty breathing while laying down
Paroxysmal Nocturnal Dyspnea - can’t / difficulty breathing at night
21
Q
What are the MAIN 4 vital signs:
What are some other vital signs:
Do you take vital signs once or many times?
First set of vitals taken is called:
A
MAIN 4:
- BP
- HR
- RR
- SpO2
OTHERS:
- Temp
- RPE
- Pain
- Dyspnea
- Urine Output
- Gait speed
Multiple times. Before, during, after, or if worried. Need at least 2 sets of vitals to show trending
Baseline vitals
22
Q
Difference between HR and Pulse?
Normal HR range:
Bradycardia =
Tachycardia =
A
- HR is how many times the heart actually beats.
- Pulse is what you feel distal to the heart … when you feel blood going through an artery distal to the heart.
Normal: 60-100 beats/min
Bradycardia = slow (below 60) Tachycardia = fast (over 100)
23
Q
O2 saturation measures what:
What is the range:
What is red flag range?
A
How much O2 is in blood
Should be 95-99% range.
Below 85-90% is red flag
24
Q
What is RPD:
What is talk test:
What is Orthopnea:
What is Paroxysmal Nocturnal Dyspnea:
A
Rate of perceived dyspnea
You talk to patient to hear how they are doing with respiration … gives insight into respiratory health.
Orthopenea: you feel short of breath when laying down
Paroxysmal Nocturnal Dyspnea: You suddenly wake up at night and feel short of breath (probably a heart problem creates this)
25
Review ... what is a MET
What are MET ranges?
“MET” is another name for metabolic equivalent; a measurement of ENERGY EXPENDITURE ... exercise intensity based on oxygen consumption. More specifically, a single MET is defined as the amount of oxygen a person consumes (or the energy expended) per unit of body weight during 1 minute of rest.
1-3 MET's is light activity
3-6 is moderate activity
6+ METS is vigorous activity
26
What are the 4 phases of coughing?
Which one is the most important step?
1) Inhalation
2) Holding
3) Pressure or force
4) Expulsion
(3 and 4 are often together)
Step 1 is most important. The effectiveness of the cough is directly related to the INHALATION. The more/better you inhale, the better your cough.
27
Why is hydration important for coughing?
i/o =
Hydration is important to get secretions up (they need to be wet). So the more they can stay hydrated the more they can cough properly and clear airways to help breathe.
input and output (of liquids into and out of body)
28
If you ask a patient to hold a vowel sound as long as they can, what are you doing?
How long should they at least be able to do that (below what level is a red flag?)
I am measuring their lung / pulmonary function and respiratory health (or lung VITAL CAPACITY). If someone can go 15 secs or longer, they are great or have good respiratory health.
But if they can barely hold a sound for 5 seconds, that is red flag showing weakness in lungs.
29
Remember and review auscultation.
- How would you auscultate heart?
- How would you auscultate lungs?
- With Lungs: after listening, then what do you do and what are the MAIN points to remember:
And what is Fremitus:
HEART:
- find sternal angle, then aortic is just to right of sternum (my right looking down on chest) in 2nd intercostal space; pulmonary is just to left of sternum in 2nd intercostal space; tricuspid is 5th intercostal space to left of sternum; mitral is 5th intercostal space left of sternum out 2 or so inches at midclavicular line.
LUNGS:
- There are 3 lobes on the RIGHT lung, so put stethoscope over each of 3 areas/lobes anteriorly, then listen laterally, and then posteriorly (although posterior you won't get middle lobe)
- There are 2 lobes on LEFT lung (same as above)
- Listen for breathing, raspiness, crackling, condensation. Have them say "99" ... it should sound muffled (clear means consolidation). Have them say "E" and it should sound muffled (not like an "A")
- COMPARE right side to left side ... remembering the left side is a bit muffled due to heart / mediastinum tissue
- Normal sounds during auscultation are MUFFLED. It is ABNORMAL to hear clear words / sounds.
Fremitus: If you don't have a stethescope on you, you can do auscultating by palpating with your hands. Palpating chest / lobes of lungs for VIBRATION or sounds. Patient says the "99" of "E" and you feel vibrations. Anything not symmetrical or off, is red flag. Increased fremitus = consolidation. Decreased fremitus means absent breath sounds (emphasema or poor lung capacity)
30
Difference between continuous and discontinous with auscultating lung sounds:
Continuous
- Wheezes – high pitched, “shrill”
- Rhonchi – low pitched wheezes, “snoring”
Discontinuous
- Crackles or Rales
31
With regard to heart sounds, what are:
S1
S2
S3 (S3 = Ken-tu-cky)
S4
Where would you auscultate to hear S1, S2, S3?
These are the heart sounds:
S1: AV valves closing (lub)
S2: Semilunar valves closing (dub)
S3: Early diastole phase of rapid VENTRICULAR REFILLING. Quick sound right after S2 (Ken-tu-cky). Associated with CHF
S4: Late diastole right before atria contract (Ten-nes-see). Not heard often at all.
S1 down at Mitral valve (5th intercostal space 2 inches left of sternum)
S2 at aortic or pulmonary valve (just left of sternal angle 2nd intercostal space)
S3 and S4: Apex of heart (near mitral valve place)
32
Tital volume vs. vital capacity:
Tital volume: is normal breathing in
Vital capacity: is expire everything out, then maximal inspiration (TV + max inhalation and max exhalation .. or VC = TV + IRV + ERV).
33
BELOW ARE FLASHCARDS ON CARDIAC PATHOPHYSIOLOGY:
ok
34
1) What is the most common cause of hospitalization and death in the older Americans
2) T or F: Cardiovascular diseases claim more lives than all forms of cancer combined.
3) Is Chronic Heart Failure a synonymous term for CVD?
1) Cardiovascular Disease (CVD)
In 2008, cardiovascular deaths represented 30 percent of all global deaths, with 80 percent of those deaths taking place in low- and middle-income countries.
About 2,150 Americans die each day from these diseases, one every 40 seconds.
2) TRUE
3) YES
35
Why is knowing about CVD important to a PT?
Almost 1 in 3 Americans have some form of CVD ... it is so prevalent and most common cause of death.
People are living longer now, and most CVD is among geriatrics, and we'll see geriatric patients all the time.
Majority of hospitalizations are from heart diseases, so PTs WILL treat patients with it, and need to know about s/s and how to treat.
And to know what to do / not to do with regards to exercise for these types of patients.
36
What is an LVAD:
LVAD = Left Ventricular Assistive Device ... a machine that pumps the LV for you
37
What is #1 and #2 killer among women?
```
#1: CVD
#2: Breast cancer
```
38
What is the Framingham Heart Study:
In 1948 there was little known about CVD. So they did a study. The researchers in Framinham Mass. enrolled the entire town in the study, and followed them, their lifestyle, weight, habits, diet, etc. So from this study, we learned about the relationship between genetics and CVD, and exercise (and other) impacts on CVD.
The study is still going (2nd generation was enrolled, and now the 3rd generation is), and we still are learning and don’t know everything about CVD.
This study has produced 1,200+ scholarly articles ... and has provided the fundamental / foundational info. we have on CVD.
39
What are the risk factors for someone getting CVD:
- Age
- Genetics (gender, race)
- Family history
- Diet (sugars, sodium, cholesterol)
- Exercise / inactivity
- Obesity
- High BP (HTN)
- Diabetes
- Smoking
- Stress
40
What is acronym for Hypertension:
What is exact definition of Hypertension:
What is blood pressure:
What is difference between diastolic BP (DBP) and systolic BP (SBP):
What is new value for pre-hypertension?
HTN (or HBP)
High blood pressure. But ... Persistent elevation of diastolic BP (>80mmHg), systolic BP (>130 mmHg), or both measured on at least 2 separate occasions at least 2 weeks apart.
Pressure exerted against artery walls when heart contracts / relaxes (systolic / diastolic)
Diastolic: pressure against arteries walls during diastole or heart relaxation
Systolic: pressure against arteries walls when heart is contracting.
130+/80+
Normal: Less than 120/80 mm Hg;
Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80;
Stage 1: Systolic between 130-139 or diastolic between 80-89;
Stage 2: Systolic at least 140 or diastolic at least 90 mmHg;
Hypertensive crisis: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.
41
What is the WHO
What is the CDC
World Health Organization
Center for Disease Control (and Prevention)
42
1) If you take someone's blood pressure and it is high, what could be the reason?
2) IF you get a high BP measurement, does it mean they have HTN?
2A) If you measure BP once and it is high, what should you do to confirm it actually being high? Or how do you actually diagnose HBP?
1)
- White coat effect
- Drank a lot of caffeine before
- Are stressed / scared (sympathetic n.s. response)
- Ran in to the appt
- CVD, CAD, weak/overworked heart muscle
- Valve / Artery stenosis (atherosclerosis)
- Actual hypertension and HBP
2) No. BUT ... remember that if you measure someone’s BP and it is high, be aware and concerned, but don’t freak out. They might have white coat factor, have drunk too much caffeine, are stressed, etc. Just be calm and take it again later in the appt to double check.
2A) So, take BP at least twice over a few days to double check to get a real value. To diagnose with high BP, must take BP on 2 separate occasions, 2 weeks apart. And PT's don't diagnose HBP
43
What is "primary hypertension"
How many of the cases of high BP fall under this category?
It is essential hypertension ... do NOT know the cause. Probably heart issue, but we don't know.
Most of them ... 90-95% of the time
44
What is "secondary hypertension"
Secondary HTN = we know why you have HTN, its a result (secondary) to some other issue like ... being pregnant, renal failure, just ran 10 miles, other diagnosis or disease, etc.
It is high BP that is secondary to some OTHER issue that causes the high BP.
45
1) What is Labile Hypertension:
2) Is this normal?
(how to remember)
1) Labile HTN =
A BP that FLUCTUATES and is not consistent. One day it is 150/80 but two days later it is 110/70. It goes all over the place. It fluctuates between hypertensive and normal BP readings.
2) Not really. Be concerned ... you do NOT want to ignore it
(Remember: LAB results vary every time and are all over the place)
46
What is isolated Hypertension:
Examples:
One isolated event causes the high BP. 1 off event.
Examples: Car accident, fearful event, white coat effect, nervous, marathon
47
What is Atherosclerotis / Arteriosclerosis
What is PVD:
What is Retinopathy:
What is an Aneurysm: (how to remember)
What is a Stenosis: (how to remember)
What is a Thrombus:
What is an Embolism:
Plaque build up in arteries from fats, cholesterol, etc. It is hardening or thickening of the arteries through accumulation of plaque buildup.
Pulmonary Vascular Disease: Any condition that affects the blood vessels along the route between the heart and lungs. Where an artery/vein from heart to lungs gets blocked or narrowed and reduces blood flow.
Retinopathy: A complication of diabetes that effects the eye
Aneurysm: WEAKened or ballooned artery wall (so a ruptured aneurysm is when it ruptures) (Annual = WEAK)
Stenosis: NARROWING of an artery wall (If you have to put a STENT in a vessel, you need to widen it, so stenosis is a narrowing of the vessel).
Thrombus: blood clot
Embolism: blood clot that travels and gets lodged in a distant artery from where the clot originated.
48
Why is a diet high in sodium so bad for your heart:
As sodium accumulates, the body holds onto water to dilute or break down the sodium (salt is Na and Cl and in order to dilute salt and breakdown this molecule, it needs water). This increases both the amount of fluid surrounding cells and the volume of blood in the bloodstream. ... Over time, the extra work and pressure on the heart from increased fluids can stiffen blood vessels, weakened heart muscles (myopathies), higher BP, leading to heart attack, and stroke.
49
T or F: Most people with high blood pressure are a-symptomatic, meaning they show NO signs.
Besides taking someone's BP, how might you know if they had high blood pressure (were Hypertensive):
TRUE
- Dizzy / lightheaded
- Fatigued
- Headaches
- Vertigo
- Orthostatic hypotension
- Blurred vision
50
What is the BEST way to reduce high blood pressure:
- Change diet (including reducing sodium/salts, sugars)
- EXERCISE
- Lose weight
- HTN medications (antihypertensive / vasodilator medications, beta blockers, diuretics)
51
In class we went over 3 main categories, and several examples in each of those 3 main categories of Antihypertensive drugs. What are they:
1) Beta blocker:
- Beta blockers, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. When you take beta blockers, your heart beats more slowly and with less force, thereby reducing blood pressure.
- Blocks norepinephrine/epinephrine so it reduces HR so sympathetic system won’t work. SO you and heart calm down.
- For patient: you want patient to exercise, but their sympathetic response (increased HR) won’t work ... so be careful.
2) Diuretics:
- A diuretic is any substance that promotes DIURESIS, the increased production of urine. They work on your kidneys by increasing the amount of salt and water that comes out through your urine. Too much salt can cause extra fluid to build up in your blood vessels (because salt needs lots of water to get diluted, so more water retention causes heart to work harder = HTN), raising your blood pressure. Diuretics lower your blood pressure by flushing the salt out of your body, which takes this unwanted extra fluid out with it (which can relax the heart).
- Decrease fluid volume (so it reduces SV to reduce BP)
- Why would I care if a patient is on a diuretic … they could be dehydrated and have a lower SV
3) Vasodialaters:
- Vasodilator drugs relax the smooth muscle in blood vessels, which causes the vessels to dilate. Dilation of arterial (resistance) vessels leads to a reduction in systemic vascular resistance, which leads to a fall in arterial blood pressure.
EXAMPLES:
- Calcium channel blockers
- ACE inhibitor
- Nitroglycerin ****
- It is a vasodialater to keep someone’s BP down
ARB (angiotensin receptive blockers)
52
*** What does it mean to be Ischemic
Difference between Ischemia and Hypoxic:
= lack of blood and thus O2 to tissues
Ischemia is the decrease of blood supply to a tissue. It can be local, caused locally by a thrombus or embolus, or global due to a low perfusion pressure.
Hypoxia is lack of oxygen to a tissue from any cause.
53
What is CAD
Explain it ... and why it is so dangerous.
Coronary Artery Disease
It is atherosclerosis of the actual heart vessels where plaque builds up in coronary arteries. This build up causes an aneurism (weak vessel) and stenosis (narrowing of vessel), which could lead to a thrombus and embolism, and thus a MI. If your coronary arteries get an aneurism by buldging and weakening (or narrowed = stenosis from plaque build up) then blood supply is limited to myocardial muscle of heart. If a thrombus (blood clot) clogs it (embolism) and blood and O2 can't get though to myocardial muscle ... over time the coronary artery hardens or weakens and ruptures or gets a block/clot, and you get MI or stroke (cardiac muscle dies).
54
MI =
CVA =
Myocardial infarction (heart attack)
Cerebral Vascular Accident (Stroke)
55
With Cholesterol, do you want HDL or LDL
| how to remember
You want HDL, but reduce LDL.
| remember: You want an HD big screen TV
56
T or F: You can get atherosclorosis in any artery?
T or F: If you have atherosclerosis in one area / artery of the body, it is typically isolated to only that area?
Where do you typically get atherosclerosis MOST?
```
#1 site of an atherosclerosis:
#2 site of an atherosclerosis:
```
True
False. If you have CAD and atherosclerosis (or plaque build up) in heart, you probably have it also happening in brain, kidney, or other places, etc.
Coronary arteries and brain arteries since they are smaller
```
#1: Brain
#2: Coronary arteries
```
57
Typically how long does it take for plaque to build up during atherosclerosis to result in a MI or CVA?
The stenosis of the artery has to get to what % before you start to see s/s:
Decades. Could take 30-40 years.
Generally requires at least 70% stenosis (narrowing) before s/s occur. IN other words, s/s of CVD isn't until long long time down the road of plaque building up (it takes a while ... that is why you see MI often in older adults).
58
How can you reverse an atherosclerosis:
*** Remember, you can't reverse atheroslcerosis. But you can do things and change things to minimize it's growth.
```
Exercise and diet (lose weight)
Change lifestyle
Stop smoking
CABG = Bypass surgery (graft)
Stent surgery (widen vessel)
Medications
```
59
What is Angina:
Does cell death occur with angina?
Where would you feel the pain from Angina (what specific parts of the body)?
Chest pain resulting from heart problems (CAD, atherosclerosis, CVD, cardiomyopathies)
NO, cell death doesn't happen (yet). It is just the pain from a blocked coronary artery. Cell death comes after a MI or CVA and blood/O2 is actually blocked/occluded from getting to the heart muscle (ischemia). But you'll have a lot of pain (angina) up to that point.
In chest area, but it also radiates and becomes referred pain in left upper extremity, radiates down left arm, neck and jaw, and chest area (front and back). Mainly chest and left shoulder/arm.
60
There are 3 types of Angina. Briefly explain each:
1) Chronic stable angina: Comes from over-exertion from exercise, it is PREDICTABLE.
2) Unstable angina: Can happen during rest, or exercise, or anytime. It is UNPREDICTABLE, and usually happens in the MORNING.
3) Prinzmetal’s angina (vasospastic):
61
1) What is RPP
2) What is the equation
3) What does it predict
1) Rate Pressure Product: it measures the workload or oxygen demand of the heart.
2) RPP = HR X SBP
3) Predictor of angina
62
What does Nitroglycerin do?
Nitroglycerin is what type of drug?
How is the drug used?
(how to remember?)
Nitroglycerin is a VASODILATER, a medicine that opens blood vessels to improve blood flow (from a stenosis/atherosclerosis). It is used to treat and help prevent angina symptoms, such as chest pain or pressure, that happens when there is not enough blood flowing to the heart.
Vasodilater
You put it under the tongue (let is dissolve) during Angina symptoms. Wait 5 mins. If they don’t have a relief of Angina symptoms (chest pain), CALL 911. If symptoms do go away, you may have angina. So call your Dr.
(Nitro power up your heart)
63
What is a CABG
What is a triple bypass?
What is a PTCA (how to remember)
Coronary Artery Bypass Graft (surgery to graft in another artery/vein in coronary arteries that are damaged)
Person had 3 coronary artery grafts.
PTCA = Percutaneous Transluminal Coronary Angioplasty
Go up femoral artery up to coronary artery and put in a STENT
64
Another term for Angina:
Acute Coronary Syndrome ... where blood gets blocked to the heart.
65
Other names for a MI:
What is a MI? Define it:
Does a MI take a few seconds, or several hours?
T of F: More likely to have a MI in the evening after dinner?
Is there more or less MI's during the holidays?
- Heart Attack
- Coronary
MI = ischemia of heart muscle which results in muscle tissue death (necrosis) from coronary artery getting blocked and heart muscle thus not getting blood / O2 and dying. Heart muscle doesn't regenerate (it dies).
Typically it takes a few hours and it is muscle death occurring during that entire time.
False. Most likely to have a MI in the morning.
Less (why? ... ????)
66
What are two types or severities of MI:
2 types of STEMI:
Transmural Infarction: FULL thickness necrosis (cell death) through the entire ventricular wall from endocardium (deep) to epicardium (superficial). So, all of the layers of the heart muscle are impacted / dead.
Subendocardial Infarction- PARTIAL thickness on the subendocardial portion of ventricular wall –
(epicardial aspect of muscle tissue is spared and doesn't die so there is LESS tissue damage).
A STEMI or ST-elevation myocardial infarction is caused by a sudden complete (100%) blockage of a heart artery (coronary artery). (=INFARCTION)
A non-STEMI (NSTEMI) is usually caused by a severely narrowed artery but the artery is usually not completely blocked (=ISCHEMIA).
67
A full occlusion of the left coronary artery is called ... or MI to LCA (left coronary artery) is:
WIDOW MAKER
68
RCA (right coronary artery) mainly supplies blood to what areas of the heart:
LCA mainly supplies
RV (and RA, SA node)
LA, LV, Interventricular septum
69
What is an Arrhythmias (or Dysarrhythmia)
A condition in which the heart beats with an irregular or abnormally rhythm (too fast = tachycardia, or too slow = bradycardia).
70
After someone has had an MI, how long does it take after for heart muscle to fully recover or die?
If a person dies, how could you tell if they had a MI?
A MI may take hours to happen. But depending on how bad the MI was, most likely the area that was ischemic or lost blood will never really recover. After a few hours that muscle (because it gets no blood supply) is dying.
** If you see TROPONIN in blood after, that person had an MI
71
# Define these terms:
- Infarction:
- Injury:
- Ischemia:
- Hypoxic:
- Anemic:
- Infarction: Area where no/little blood flow results in cardiac muscle tissue death (necrosis)
- Injury: Area of or around necrotic tissue
- Ischemia: Area of tissue with insufficient blood supply (so not getting enough O2).
- Hypoxic: Not getting enough O2
- Anemic: Not enough RBC's, so not getting enough O2
72
What are some s/s of MI:
- CHEST PAIN (heavy chest) ... Angina
- Referred pain in chest and upper left extremity (Angina)
- Dyspnea
- Nausea / vomiting
- "impending doom"
- Pale (cyanosis)
- HTN
- Pain, weak, fatigued
73
T or F: The severity of the chest pain (during MI) is an indication of the severity of the MI?
T or F: Some patients report only minimal discomfort or no pain at all
T or F: 1 in 4 people who had a MI are asymptomatic and it goes unrecognized?
T or F: If someone had a MI, chances are likely they won't have another one?
T or F: People die from a MI
False. Severity of pain has NOTHING to do with severity of damage (and opposite is true).
True
True
False: If you've had an MI, chances are high you'll have another one down the road.
False: People don't die from a MI, they die from a resulting issue that arose from the MI
74
How do you treat a MI:
- Educate patient on diet, exercise, sodium intake, lifestyle change
- Vasodialaters (medications)
- CABG
75
What is ACS:
Another term for ACS:
HF:
Acute coronary syndrome
Angina
Heart Failure
76
Another name for Congestive Heart Failure (CHF)
| how to remember
Cardiac Muscle Dysfunction
| if the heart fails, it is due to the MUSCLE failing
77
T or F: Heart failure is a disease?
FALSE
Heart failure is not a disease but rather represents a group of clinical manifestations caused by inadequate pump performance from either the cardiac valves or the myocardium.
78
What is the most common cause of hospitalization?
Congestive/Chronic Heart Failure
79
T or F: The ventricles can work in isolation to each other?
T or F: The ventricles can work in isolation to the atria?
T or F: Damage to one ventricle will effect the other ventricle
What is A-Fib
NO. They are not isolated. They both receive same innervation / conduction and contract at same time. PLUS ... they share the same septal wall that gets the same conduction from purkinjie fibers.
TRUE (if in a heart rhythm abnormality ... it's not good, but it can happen)
TRUE
A-fib is when ATRIUM's beat irregularly compared to ventricles. Electrical signals are going crazy in and around atria.
80
There are 4 ways heart disease is characterized. What are they:
Class I: patients with cardiac disease
Without limitations to Physical Activity (PA)
Class II: Slight limitations to PA
Class III: Marked limitation in PA and
Uncomfortable at rest
Class IV: can’t do PA without
Discomfort.
81
HFrEF =
What is Ejection Fraction:
Equation for Ejection Fracture
Does a healthy heart squeeze out all the blood from the ventricles?
Heart Failure with reduced Ejection Fraction
Remember: SV is the AMOUNT of blood pumped out during contraction (measured in mL), but Ejection Fraction is a measurement of the PERCENTAGE of blood leaving your heart each time it contracts. (SV = amount; EF = %)
EF = EDV-ESV (take that amount and divide it by EDV)
And, even a healthy heart does NOT squeeze out all the blood.
82
What is typical Ejection Fraction (EF) amounts:
So these would be:
30-50% =
20-30% =
<20% =
If someone has a low EF, what will that mean?
50-60%
```
30-50% = MILD
20-30% = MODERATE
<20% = SEVERE (severely low EF)
```
That person will obviously get less blood pumped = less O2 = more fatigued = hypoxic/ischemic.
83
What might be some etiologies of heart failure:
```
Age / Ethnicity / Family history / Genetics
Diet / Exercise
Hypertension
Coronary Artery Disease
Ischemia
Anemia
Cardiomyopathies
Congenital Heart Diseases
Arrhythmias/Dysrhythmias
```
84
Explain Systolic Dysfunction:
What is Diastolic Dysfunction:
Systolic: It is a common type of heart failure where blood pumped out during systole is less (EF is less), so more blood is left in LV, which creates LV hypertrophy and pulmonary edema.
Diastolic: From slowed or delayed ventricular relaxation so venous pressure increases and gets backed up into atrium / veins / lungs.
85
Right sided heart failure is called:
How to remember?
What is it?
If CHF happens on the RIGHT side ... what are ramifications?
COR PULMONALE
The RIGHT side pumps to the PULMonary system.
Abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels. ... where RV gets weak (ischemic, hypertrophy, atrophy) and can't empty/pump properly. So blood/fluid gets backed up and less blood into pulmonary system.
Ramifications:
- Venous pressure increases (distented jugular veins)
- Venous back up (leading to edema)
- Less blood pumped to lungs and thus systemic = less O2 to tissues (decreased Cardiac Output)
- Less renal blood flow
86
If CHF happens on the LEFT side ... what are ramifications?
- LV gets weak and can't pump properly
- Decreased CO = less O2 to tissues = fatigue
- Decreased renal blood flow
- Backflow into pulmonary veins causing pulmonary edema / congestion or higher pressure in lungs
87
Difference between acute and chronic HF
Which one is reversible?
Acute: new onset or current (newly developed)
Chronic: ongoing
Acute
88
What can cause acute heart failure:
HTN, CAD, dysrhythmias, heart valve abnormalities, effusions, PE, cardiomyopathies, pulmonary HTN, Spinal Cord Injury, trauma, multisystem failure
89
Would an EF of less than 35% be a sign of chronic heart failure?
T or F: s/s of right, left, chronic, or acute HF are pretty much the same
Yes, of course
True
90
SOB =
= shortness of breath
91
*** What is Paroxysmal nocturnal dyspnea
*** What is Orthostatic hypotension
*** What is Orthopnea
*** What is tachypnea
*** What is Cyanosis
When you go to sleep and wake up very short of breath
When you get up from a lying down position and are dizzy/lightheaded and low BP
Difficulty breathing while lying down (supine)
Increased breathing (RR)
Bluish pale coloring of skin from poor circulation
92
s/s of heart failure:
- SOB
- Paroxysmal nocturnal dyspnea
- Orthopnea
- Dyspnea
- Chest pain (angina)
- Swelling / edema
- Fatigued (decreased activity)
- Weight gain
- Distended jugular veins
- S3 heart beat
- Cyanosis
93
1) What is an S3 heart beat:
2) Where / what pts do you typically hear S3 heart sounds in?
3) Is S3 and S4 normal sounds?
4) What is Ken-tu-cky?
1) The third heart sound (S3), also known as the “VENTRICULAR GALLOP” - occurs just after S2 when the mitral valve opens (early diastole), allowing passive filling of the left ventricle. ...
2) CHF
3) A S3 can be a normal finding in children, pregnant females and well-trained athletes ... and CHF pt's; however, a S4 heart sound is almost always abnormal.
4) That is how the S3 heart sound would sound in a stethoscope.
94
What is Ascites
| how to remember
Abdominal fluid build up
| A** is near pan ... fat around abdomen ... but this is fluid in abdomen
95
Medical treatment of heart failure:
- Surgery (valve replacement, CABG, Pace maker, stent / balloon pump, PCTA)
- Medications (vasodilators, diuretics)
- Diet, lifestyle, and exercise changes
- PT intervention and education
96
What is Acute decompensated heart failure (ADHF)
Most serious form of heart failure.
They are breathing heavy, or their cough is bloody, wheezes, tachycardia, hypo/hypertension, increase in RR
CALL 911
97
What are cardiomyopathies or myocardial diseases
So cardiomyopathy is:
Problems with the actual heart muscle itself that effect the heart muscle contraction or relaxation of the muscle fibers.
Cardiomyopathy is a group of conditions affecting the heart muscle impacting contraction and/or relaxation of myocardial muscle fibers
98
3 ways to classify cardiomyopathies ... what are they and why would they be bad:
1) Dialated
- What: Ventrical space itself is dialated
- Why bad: if it is too dialated, it can't produce as strong of a contraction / squeeze as much blood out
2) Hypertrophic
- What: Larger heart muscle - it thickness.
- Why bad: EDV is less, so SV and EF is less, so less O2 pumped out = fatigue
3) Restrictive
- What: heart muscle become stiff and uncompliant (maybe from a scarred ventricular wall)
- Why bad: Won't contract normally, or as well, or as much.
99
How could you diagnosis a Cardiomyopathy:
- MRI or xray
- Echocardiogram
- Blood test
100
For VALVE DYSFUNCTION:
1) What is VHD =
2) What is Valvular Stenosis:
3) What is valve insufficiency / regurgitation =
1) VHD = Valvular heart disease
2) Stenosis is NARROWING, so valvular stenosis is narrowing of valve caused by CALCIFICATION, plaque, or scar on valve ... so the valve narrows and stiffens (and doesn't work or close properly and can thus regurgitate and can't get enough blood through to ventricle/aorta). So heart has to work so hard to get blood through (it reduces blood flow) so you get fatigued and less blood to tissues, higher BP/HTN, etc.
3) Valve doesn't CLOSE properly. So Regurgitation = Valve doesn’t close properly and blood leaks backwards.
101
The most common valve dysfunction is:
Mitral valve dysfunction
102
What is Mitral Stenosis
What causes it:
What are s/s:
It leads to:
Medical treatment:
Hardening / narrowing of mitral valve from plaque build up (stenosis).
RHEUMATIC FEVER ****
LV hypertrophy
Plaque buildup
s/s: dyspnea, fatigue, angina, paroxysmal nocturnal dyspnea, tachycardia
Lead to: BP HTN and pulmonary HTN, cardiomyopathy, pulmonary edema, reduced CO
Medical treatment: moderate exercise (not intense) ... and exercise doesn't reduce plaque on valve but improves overall cardiac fitness/health (limits plaque build up further), medications (vasodilater), surgery (valve replacement).
103
What is Rheumatic Fever:
When you get rheumatic fever, it can lead to:
When a child gets strep, they get the fever. This Rheumatic fever causes inflammation, especially of the heart (valves), blood vessels, and joints. If untreated, it can permanently damage the heart.
Rheumatic valvular heart disease = mitral valve dysfunction. It can lead to endocarditis.
May cause scarring and deformity of the heart valves
104
Can medication reduce stenosis of a valve or artery?
NO. You can't take medicine to reduce stenosis from a removal of plaque standpoint, but you can take a vasodilator to dilate the vessel, and you can change diet/exercise to limit continued plaque build up.
105
What is aortic regurgitation:
If valves don't CLOSE properly (valve insufficiency) due to a stenosis of valve or injury to valve somehow. Blood will thus flow back down from aorta into LV, causing lower EF, lower CO, increased LV hypertrophy and dilation and thus less contraction, leading to less O2 delivered, fatigue, dyspnea, etc.
106
itis suffix =
Pericarditis:
Myocarditis:
Endocarditis:
itis = inflammation
Pericarditis: Inflammation of the pericardium
Myocarditis: Inflammation of the myocardium
Endocarditis: Inflammation of the endocardium
107
Are heart disease and cardiovascular heart disease synonymous?
Are the terms coronary artery disease and coronary atherosclerosis synonymous?
Are MI (myocardial infarction) and heart attack synonymous?
NO. Heart disease is any kind of disease that affects the heart. That could be heart failure, angina, arrhythmia, valvular heart disease, cardiomyopathies, and coronary artery disease (CAD) or other conditions. Heart disease is the same thing as cardiac disease, but it is not the same thing as cardiovascular disease (CVD) which is specific to the actual heart vessels /coronary arteries.
YES. Coronary artery disease, coronary heart disease and coronary atherosclerosis are the same thing. They occur when plaque builds up on the inside of coronary arteries. Coronary atherosclerosis is a serious condition that can lead to heart attacks (also called acute myocardial infarction) or stroke
YES
108
T or F: Regardless of the type of heart disease, the risk factors are quite similar, including high blood pressure, high cholesterol, overweight or obesity, smoking, lack of physical activity, diet high in saturated fat / sugar / sodium and family history. Diabetes is a huge risk factor.
TRUE
109
RIGHT ventricular hypertrophy or dilation in response to chronic lung disease is called:
COR PULMONALE
110
Are the terms dysrhythmias and arrhythmia synonyms?
YES - same thing. Just an abnormal heart beat/rhythm (whether slow or fast)
111
What is Atrial Fibrillation (A-fib)
The heart's upper chambers (atria) beat out of coordination with the lower chambers (ventricles). But out of control impulses in atria.
112
What is intubation
What is a tracheostomy
What is an infultrate
Placement of a flexible plastic tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs.
A trach. An incision in the windpipe made to relieve an obstruction to breathing.
Fluid accumulation in lungs (pneumonia)
113
What are contractures
| This is not part of cardio pulm :
A contracture deformity is the result of stiffness or constriction in the connective tissues of your body. This can occur in your muscles, tendons, ligaments, and skin. ... Contracture deformity restricts normal movement.
A condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints.
114
Cardiovascular Disease (CVD) is the most common cause of hospitalizations.
Chronic/Congestive Heart Failure is most common cause of hospitalizations.
Is this true? Are these synonymous?
True ... they are synonymous
