Week 2 Flashcards
(100 cards)
1
Q
How prevalent is atherosclerotic cardiovascular disease (ASCVD, CVD)? What can complicate it?
A
2
Q
Define atherosclerosis heart disease (ASHD, ASCVD), coronary artery disease (CAD), and coronary heart disease (CHD)
A
3
Q
What can this lead to?
A
4
Q
What gradient determines fluid flow? What are the determinant of myocardial blood flow?
A
5
Q
Explain
A
6
Q
What are the modifiable/non modifiable risk factors of ASCVD?
A
7
Q
What are the age and gender risk factors of ASCVD?
A
8
Q
Given the possible complications of ASCVD, how can they affect the brain, eyes, heart, BP, and kidneys?
A
9
Q
What is the clinical presentation for CHD?
A
10
Q
Explain sudden cardiac death
A
11
Q
How to differentiate between chronic stable angina, acute coronary syndrome (ACS), and cardiac muscle dysfunction?
A
12
Q
Explain acute coronary syndrome
A
13
Q
Explain angina
A
14
Q
What regions of the body display symptoms of a heart attack?
A
15
Q
Differentiate between chronic stable angina and unstable angina
A
16
Q
What happens when there is an interruption of blood supply to an area of the myocardium?
A
17
Q
Explain the causes and symptoms of myocardial infarction (MI)
A
18
Q
What is the normal troponin level?
A
<0.03 ng/mL
Trend is most important in decision to provide PT
19
Q
What is the NYHA classification and treatment implications for BNP levels: A) <100 pg/mL, B) 100-300 pg/mL, C) >300 pg/mL, D) >600 pg/mL, E) >900 pg/mL
A
20
Q
What are the reference values for creatine kinase (CK)? Males/females?
A
21
Q
What are the treatment implications for: 1) CK1-BB Brain Tissue, 2) CK2-MB Cardiac Muscle, 3) CK3-MM Skeletal Muscle
A
22
Q
What are the types of myocardial infarction?
A
23
Q
Label the issue
A
24
Q
What condition can ACS without ST elevation lead to? With ST elevation?
A
25
What is MI treatment?
26
What is the medical management for MI?
27
What is the percutaneous coronary intervention (PCI)? Indications?
28
Explain coronary artery bypass graft
29
What are the complications from: 1) decreased pumping ability of the heart, 2) >15% of L ventricle, 3) >25% of L ventricle, 4) >40% of L ventricle
30
What is the prognosis and PT implications regarding MI?
31
What are the vital signs recommendations for stable angina, stable and/or down trending troponins, stable ECG, to indicate that a PT intervention is appropriate?
32
Explain possible activity adjustments that address aerobic and flexibility components using the F.I.T.T. Principle
33
List reasons to stop PT intervention
34
Explain peripheral artery disease (PAD)
35
How is max O2 consumption and anaerobic threshold affected in patients with AOD?
36
What are the symptoms of PAD (AOD)?
37
What are the PT implications for PAD (AOD)?
38
Explain the issues
39
What are the VTE risk factors?
40
What are VTE and PE symptoms?
41
What are the components of WELLS DVT score? Meaning?
42
What are the unique characterstics of veins?
43
What are the risk factors and symptoms of venous insufficiency?
44
What can chronic venous insufficiency lead to?
45
Label
46
What are the PT implications for venous insufficiency?
47
List the issue that would arise from occlusion at 4, 6, 11, 12, 14
48
All fluids flow according to ____? Myocardial perfusion occurs primarily in ____?
49
What are the characteristics of “stable” and “vulnerable” coronary atherosclerotic lesions?
50
Explain
51
starts with endothelial damage then plaque formation
52
53
What conditions fall under coronary artery disease?
54
1) describe the difference between chronic stable angina and unstable angina. 2) myocardial infractions are diagnosed by ____, _____, and ______.
55
What are the common symptoms of MI? Describe the difference between STEMI vs NSTEMI
56
What are the indications for a PCI stenosis?
> (70%) of a coronary artery
57
Develop an example of an exercise session for a patient post MI, s/p PCI x1 to LAD, post-op day 1 in hospital
58
59
Explain the clinical decision promoting early progressive mobility in individuals with acute coronary syndrome if 1) troponin is >0.03 ng/mL, 2) troponin is NOT >0.03 ng/mL
60
Explain how a PT would approach each of these scenarios
A. Mrs. K – Post-MI, s/p CABGx3
Presentation: Crushing chest pain, hypertensive crisis, elevated troponins (96 → 3000), multivessel CAD, underwent CABGx3.
PT Approach:
* Wait for Medical Clearance: Since she underwent CABGx3, wait for post-op day 1–2 clearance depending on hemodynamic stability.
* Monitor closely: Track vitals (HR, BP, SpO2), pain, RPE, and signs of hemodynamic instability.
* Early Mobility Goals: Bed mobility → sitting EOB → short ambulation in room/hallway.
* Education Focus: Sternal precautions, incentive spirometry, deep breathing, and posture.
* Contraindications: Avoid if unstable vitals, arrhythmias, or post-op complications are present.
⸻
B. Mr. P – Post-cardiac arrest, ICU
Presentation: VT/Vfib arrest, CPR, intubated, transferred to ICU; troponins high (53 → 6916); not catheterized yet.
PT Approach:
* Hold Therapy: Patient is critically ill and sedated; not appropriate for PT until medically stable.
* Observation Phase: Wait for sedation to wear off and neurologic status to be evaluated.
* Re-evaluation Needed: After stabilization, reassess motor function, cognition, and hemodynamic tolerance.
* Consult Team: Coordinate with ICU, cardiology, and nursing staff regarding mobility readiness.
⸻
C. Mr. T – NSTEMI suspected, ICU
Presentation: 2-day non-exertional chest pain, troponins elevated (12,073 → 8,908), ACS protocol initiated, nitro and heparin in use, plan for LHC.
PT Approach:
* Hold Until Troponin Downtrend Is Clearer: Though trending downward, wait for full downtrend confirmation and cardiology clearance.
* Monitor closely: Especially since nitro drip is still intermittently used.
* Early Mobility Prep: Begin with breathing exercises and positioning education in bed.
* Mobilize Once Stable: Progress to upright positioning, EOB activity, then hallway ambulation once LHC is complete and vitals remain stable.
* Education: Address risk factors (HTN, HLD), reinforce cardiac precautions.
61
What doe R sided HF lead to?
62
What doe L sided HF lead to?
63
Explain the effects as a result of decreased cardiac output: 1) increased sympathetic nervous system, 2) increased renin-angiotensin system, 3) increased antidiuretic hormone
64
1) define CHF, 2) _____ is the most common symptoms of CHF, 3) _____________ is a sudden, unexplained episode of SOB when a pt assume supine. 4) describe the rationale of hearing crackles/rales during lung auscultation in a pt who is admitted for CHF exhaustion
65
1) What is the hallmark heart sound of HF? 2) describe a pt who is said to be in decompensated HF. 3) why might these patients have a decreased exercise tolerance?
3) Due to impaired CO, skeletal muscle changes (atrophy), and early onset of anaerobic metabolism, patients experience fatigue and dyspnea with minimal exertion
66
Explain the signs/symptoms and PT recommendations of these zones of HF: 1) green zone, 2) yellow zone, 3) red zone
67
What is the prevalence of cardiac muscle dysfunction (CMD) and heart failure (HF)?
68
Explain CMD and HF
69
Is HF a progressive condition?
70
What are the structural and functional subtypes of HF?
71
Explain R vs L sided HF, HF with reduced/preserved ejection fraction, systolic/diastolic HF
72
Explain L sided HF
73
Explain R sided HF
74
Explain biventricular HF
75
Explain the effects of HF with reduced/preserved ejection fraction
76
What is the issue?
1) systolic dysfunction
2) diastolic dysfunction
77
Explain ACC/AHA stages of HF
78
Explain the NYHA classes of HF
79
What are the causes of HF?
80
What is cardiomyopathy differentiated by?
81
Explain dilated cardiomyopathy
82
Explain hypertrophic cardiomyopathy
83
Explain restrictive cardiomyopathy
84
What are the clinical manifestations of CHF?
85
In relation to CHF, What are the abnormal heart sounds? peripheral edema? Jugular venous distension? Weight gain?
86
Explain sinus tachycardia and decreased exercise tolerance
87
Explain
88
What is the medical management of CHF?
89
What is the PT management of CHF?
90
Does STEMI or NSTEMI have elevated troponins?
Both
91
During diastole, the pressure in the left ventricle is __________ the pressure in the left atrium.
less than
92
You are performing a chart review on a patient who was admitted for an MI. He described his symptoms as severe chest pain, difficulty breathing, SOB, pain in his left shoulder. His ECG showed an elevated ST segment. What else would you expect to find in his chart that would confirm an MI has occurred?
Troponin T 0.08
Troponin I 8,000
BNP 500
BNP 70
Troponin I at 8,000 ng/mL
93
An MI that affected the apex of the left ventricle. Based on the area of the heart that was affected, which coronary artery is most likely occluded?
LAD
94
A 56-year-old male patient was admitted for chest pain and difficulty breathing. He has COPD, a smoking history, recent 10-lb weight gain, pleural effusion, bilateral lower extremity edema, JVD, and ascites. What best describes his condition?
R sided HF
95
You are examining a patient diagnosed with heart failure. You ask the patient to relax and breathe normally while you listen to his heart sounds. What would you expect to hear that would confirm heart failure, and which part of the stethoscope would you use?
S3 & S4
Bell
96
Patients with hypertension are often prescribed ACE inhibitors to keep their blood pressure low. What would result from the action of ACE inhibitors?
decreased blood volume
97
Systemic venoconstriction can increase central venous pressure. What would occur with an increase in central venous pressure?
increase end diastolic volume
* Central venous pressure (CVP) reflects the filling pressure of the right atrium.
* An increase in CVP (due to systemic venoconstriction) results in more blood returning to the heart, increasing right ventricular preload.
* This increased preload translates to an increased end-diastolic volume (EDV) in the ventricles.
Frank-Starling mechanism
98
A 58-year-old male with a history of DM, HTN, HLD, and CAD begins experiencing chest pain during outpatient PT. He takes nitroglycerin, but the pain does not resolve after 15 minutes and two doses. What is the correct diagnosis of the chest pain and next action?
Unstable angina, call the ambulance to transport him to the ER
99
You are reviewing a chart for a patient admitted with decompensated heart failure. He has LV hypertrophy with a thickened wall and reduced chamber size. Ejection fraction is 65%. What best describes his condition?
Diastolic HF
This describes Heart Failure with Preserved Ejection Fraction (HFpEF), also known as diastolic heart failure.
100
Patients with bradycardia are sometimes given atropine, an anticholinergic medication, to return their heart rate back to normal. What type of agent is atropine?
Chronotropic
Atropine is used to increase heart rate, especially in cases of bradycardia, by blocking the parasympathetic (vagal) influence on the heart.
* A chronotropic agent affects the rate of heart contraction.
* Atropine is a positive chronotropic agent because it increases heart rate.
