Term
| List the three layers of lining around the heart. |
|
Definition
pericardium - outermost layer
epicardium - inner layer of pericardium
endocardium - lines inner surface & cavities of heart |
|
|
Term
| The RA receives blood from _____. |
|
Definition
| inferior & superior vena cava |
|
|
Term
| The RV is known as the ____ pressure pulmonary pump. |
|
Definition
|
|
Term
| The LA receives oxygenated blood from the _____. |
|
Definition
| lungs & four pulmonary veins. |
|
|
Term
| The LV is known as the ___ pressure systemic pump. |
|
Definition
|
|
Term
| T/F. The LV walls are thicker and stronger than the RV. |
|
Definition
|
|
Term
|
Definition
tricuspid (3 cusps) - right AV valve
bicuspid (2 cusps) - left AV valve |
|
|
Term
| The AV valves are anchored by _____ to _____ muscles. The valves close when the _____ contract. |
|
Definition
chordae tendinae; papillary muscles
ventricles |
|
|
Term
| Name the two semilunar valves. |
|
Definition
pulmonary valve - prevents backflow into R ventricle
aortic valve - prevents backflow into L ventricle |
|
|
Term
| Systole is the period of _____ contraction. |
|
Definition
|
|
Term
| ESV is the amt. of blood in the ventricles after ____; usually ____. |
|
Definition
|
|
Term
|
Definition
| ventricular relaxation & filling of blood |
|
|
Term
| EDV is the amount of blood in the ventricles after _____; usually ____. |
|
Definition
|
|
Term
| When does atrial contraction occur? |
|
Definition
| during the last 1/3 of diastole; completes ventricular filling. |
|
|
Term
| List the structures supplied by the RCA. |
|
Definition
right atrium, most of right ventricle
in most people, inferior wall of left ventricle, AV node, & bundle of His; 60% of the time supplies the SA node |
|
|
Term
| List the structures supplied by the LCA. |
|
Definition
most of the left ventricle
LAD - supplies left ventricle & interventricular septum, & inferior apex & right ventricle
Circumflex - lateral & inferior walls of left ventricle & portions of left atrium - 40% of time supplies SA node |
|
|
Term
| The _____ sinus receives venous blood from the heart and empties it into the _____. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| The SA node is located at the junction of the ____ & ____. |
|
Definition
|
|
Term
| T/F. SA node has parasympathetic & sympathetic innervation. |
|
Definition
|
|
Term
| The AV node is located at the junction of the ___ & ___. |
|
Definition
|
|
Term
| Describe the conduction of a heart beat. |
|
Definition
origin is in the SA node - impulse spreads to both atria, which contract together
impuse stimulates AV node, transmitted down bundle of His to Purkinje fibers - impulse spreads to both ventricles, which contract together. |
|
|
Term
| myocardial metabolism is ____, sustained by continuous O2 delivery from the coronary arteries |
|
Definition
|
|
Term
| myocardial tissue is ____; blood vessel walls have ____ muscle |
|
Definition
|
|
Term
| Define stroke volume & list normal value. |
|
Definition
amount of blood pumped from the LV with each myocardial contraction
55-100 mL/beat |
|
|
Term
| What three factors influence SV? |
|
Definition
LVEDV (preload)
contractability
afterload - the force the LV must generate during systole to overcome aortic pressure & open aortic valve |
|
|
Term
| What is the Frank-Starling law? |
|
Definition
| the greater the diastolic filling, the greater the quantity of blood pumped |
|
|
Term
| Define CO and list normal value. |
|
Definition
amt. of blood pumped from LV per minute.
normal is 4-5 L/min. |
|
|
Term
|
Definition
|
|
Term
|
Definition
CO divided by body surface area
normal range is 2.5-3.5 L/min. |
|
|
Term
|
Definition
pressure in the L ventricle during diastole
normal range is 5-12 mm Hg |
|
|
Term
|
Definition
|
|
Term
| What are normal values for EF? |
|
Definition
|
|
Term
| Right atrial filling pressure is ____ during inspiration & ____ during expiration. |
|
Definition
|
|
Term
| venous return is _____ when blood volume is increased. |
|
Definition
|
|
Term
| Diastolic filling rate is _____ with increased HR & heart disease. |
|
Definition
|
|
Term
|
Definition
myocardial oxygen demand - energy cost to myocardium
MVO2 = HRxSBP aka RPP (rate pressure produce) |
|
|
Term
| Arteries transport oxygenated blood from areas of ___ to ___ pressure. |
|
Definition
|
|
Term
| ___ veins accompany arteries; ____ do not. |
|
Definition
|
|
Term
| venous circulation is influenced by what 4 things? |
|
Definition
| muscle contraction, gravity, respiration (increased return with inspiration), & compliancy of right heart |
|
|
Term
| what bodily organs are involved in the lymphatic system? |
|
Definition
| spleen, lymph nodes, tonsils, thymus, & thoracic duct |
|
|
Term
| lymph travels from the lymphatic capillaries to lymphatic ducts to the _____. |
|
Definition
|
|
Term
| List the major lymph nodes. |
|
Definition
| submaxillary, cervical, axillary, mesenteric, iliac, inguinal, popliteal, & cubital |
|
|
Term
| List the function of sympathomimetics & sympatholytics. |
|
Definition
sympathomimetics - increase sympathetic functioning
sympatholytics - decrease sympathetic functioning |
|
|
Term
| Where are baroreceptors located? What do they control? |
|
Definition
walls of aortic arch & carotid sinus
control HR |
|
|
Term
| List the changes to the parasympathetic & sympathetic systems, rate & force of cardiac contraction, & peripheral resistance with increased BP. |
|
Definition
parasympathetic - stimulation
sympathetic - inhibition
decreased rate & force of contraction
decreased peripheral resistance |
|
|
Term
| List the changes to the sympathetic & parasympathetic systems, heart rate, BP, & peripheral resistance with a decrease in BP |
|
Definition
sympathetic - increase
parasympathetic - decrease
HR - increase
BP - increase
peripheral resistance - increase (vasoconstriction) |
|
|
Term
| increased ____ causes reflex acceleration of HR. |
|
Definition
|
|
Term
| Where are chemoreceptors located? |
|
Definition
|
|
Term
| Increased CO2 or decreased O2, or decreased pH (increased lactic acid) results in an ____ in HR. |
|
Definition
|
|
Term
| Increased O2 levels result in a ___ in HR. |
|
Definition
|
|
Term
| Increased body temp. causes an ____ in HR. |
|
Definition
|
|
Term
| Define hyperkalemia and what it does to an ECG. |
|
Definition
increased potassium - decreased rate & force of contraction
produces widened PR interval & QRS, & tall T waves |
|
|
Term
| Define hypokalemia & what it does to an ECG. |
|
Definition
decreased concentration of potassium
flattened T wave, prolonged PR & QT intervals, arrythmias, could progress to V-fib |
|
|
Term
| Describe what hyper & hypo-calcemia do to the heart |
|
Definition
hypocalcemia - depresses heart actions
hypercalcemia - increases heart actions |
|
|
Term
| Describe what increased & decreased peripheral resistance do to blood volume & blood pressure. |
|
Definition
increased - increase blood volume & BP
decreased - decreases blood volume & BP |
|
|
Term
| List the value for an impaired fasting blood glucose level. |
|
Definition
|
|
Term
| List when obesity & waist girth measurements become a risk factor. |
|
Definition
BMI >30 kg/m
waist girth >100 cm |
|
|
Term
| What is an ideal level for HDL cholesterol? |
|
Definition
|
|
Term
| How long should you palpate for a regular vs. irregular rhythm to obtain a pulse? |
|
Definition
regular - 30 sec.
irregular - 1-2 minutes |
|
|
Term
| Describe finding an apical pulse. |
|
Definition
Pt. in supine - 5th intercostal space, midclavicular vertical line (apex of heart) - could be displaced laterally by CHF, cardiomyopathy, or ischemic heart disease
could be displaced upwards by high diaphragm or pregnancy |
|
|
Term
| Where do you palpate for the carotid artery? Why can you not palpate B/L? |
|
Definition
on anterior neck between SCM & trachea
palpating bilaterally causes bradycardia secondary to stimulation of carotid sinus baroreceptors which produces a reflex drop in pulse rate or BP |
|
|
Term
| Where do you palpate for the brachial artery? |
|
Definition
| medial to antecubital fossa |
|
|
Term
| When palpating the popliteal artery, what position should the knee be in? |
|
Definition
|
|
Term
| List normal adult HR, BP, RR, & SaO2. |
|
Definition
70 bpm (60-80)
120/80
12-20
96-100 |
|
|
Term
| List normal pediatric HR, BP, RR, & SaO2. |
|
Definition
120 bpm (70-170)
<2 yrs 106-110/59-63
3-5 113-116/67-74
30-60 breaths/min
96-100% |
|
|
Term
| Define tachycardia & bradycardia. |
|
Definition
|
|
Term
| List the causes of a weak, thready pulse. |
|
Definition
| low stroke volume, cardiogenic shock |
|
|
Term
| List the causes of a bounding, full pulse. |
|
Definition
| shortened ventricular systole & decreased peripheral pressure or aortic insufficiency |
|
|
Term
| Where would you place the stethoscope if you wanted to locate the following heart landmarks: aortic valve, pulmonary valve, tricuspid valve, mitral valve. |
|
Definition
aortic valve: R 2nd IC space at sternal border
pulmonary valve: L 2nd IC space at sternal border
tricuspid: L 4th IC space at sternal border
bicuspid L 5th IC space at midclavicular line |
|
|
Term
| What is the S1 & S2 heart sounds? When are they decreased? |
|
Definition
S1 - closing of tricuspid & mitral valves
S2 - closing of aortic & pulmonary valves
S1 decreased with a first-degree heart block
S2 decreased with aortic stenosis |
|
|
Term
| Define a systolic & diastolic murmur |
|
Definition
systolic - falls between S1 & 2 - may indicate valvular disease
diastolic - falls between S2 & S1 - usually indicates valvular disease |
|
|
Term
| Describe the grades of heart murmurs. |
|
Definition
| Grade 1 is softest audible murmur to murmur audible with stethoscope off the chest |
|
|
Term
|
Definition
| an abnormal tremor accompanying a vascular or cardiac murmur; felt on palpation |
|
|
Term
|
Definition
| an adventitious sound or murmur (blowing sound) of arterial or venous origin; common in carotid or femoral arteries; indicative of atherosclerosis |
|
|
Term
|
Definition
abnormal heart rhythm with three sounds in each cycle, resembles the gallop of a horse
S3 - associated with ventricular filling - occurs soon after S2 - could be indicative of CHF of LV in older adults
S4 - associated with atrial contraction & ventricular filling - occurs just before S1 - indicative of pathology (CAD, MI, aortic stenosis, or chronic hypertension) |
|
|
Term
| Define the P wave, P-R interval, & QRS segment. |
|
Definition
P wave - atrial depolarization
P-R interval - time required for impulse to travel from the atria to the Purkinje fibers
QRS segment - ventricular depolarization |
|
|
Term
| Define the S-T segment, the T wave, and the QT interval. |
|
Definition
S-T segment - beginning of ventricular repolarization
T wave - ventricular repolarization
Q-T interval - time for electrical systole |
|
|
Term
| How do you calculate heart rate from an ECG? |
|
Definition
| count the number of intervals between QRS complexes in a 6 second strip & multiply by 10 |
|
|
Term
| What is affected with ventricular arrythmias? |
|
Definition
| CO adversely affected - pulseless situation - requires CPR, defibrillation, medication |
|
|
Term
| Define PVC's. What does it look like on a ECG? |
|
Definition
premature beat arising from the ventricle - on ECG - no P wave - bizarre and wide QRS that is premature, followed by a long compensatory pulse
Serious PVC's are greater than 6/min. or a very early PVC (R on T phenomena) |
|
|
Term
|
Definition
ventricular tachycardia: a run of 3 or more PVC's occuring sequentially at a very rapid rate
usually the result of an ischemic ventricle |
|
|
Term
| Define V-fib and what it looks like on an ECG. |
|
Definition
| chaotic activity of ventricle originating from multiple foci - unable to determine rate. On ECG: bizarre, erratic activity without QRS complexes - clinical death within 4-6 minutes - no effective CO. |
|
|
Term
| Define atrial arrythmias & describe what it looks like on ECG. |
|
Definition
rapid & repetitive firing of 1 or more ectopic foci in the atria
On ECG, p wave is abnormal or not identifiable
CO is maintained - could precipitate ventricular failure
HR rapid with atrial tachycardia - 140-250 bpm
atrial flutter - 250-350 bpm |
|
|
Term
| Which A-V block is life-threatening? |
|
Definition
| third-degree, complete block - requires medications (atropine) & surgical implantation of pacemaker |
|
|
Term
| With impaired coronary artery perfusion (ischemia or injury) the ____ segment becomes depressed. |
|
Definition
| S-T - can be upsloping, downsloping, or horizontal |
|
|
Term
| List the 3 possible ECG mechanisms for an MI. |
|
Definition
increased Q wave
T wave inverted
ST elevated |
|
|
Term
| Describe what Hyperkalemia & Hypokalemia do to an ECG. |
|
Definition
Hyperkalemia: widens QRS, flattens P, T becomes peaked
Hypokalemia - flattens T wave, produces a U wave |
|
|
Term
| Describe what happens to an ECG from Hypercalcemia & Hypocalcemia. |
|
Definition
Hyper - widens QRS, shortens QT
Hypo - prolongs QT interval |
|
|
Term
| Describe how hypothermia changes an ECG. |
|
Definition
| elevates ST segment, slows rhythm |
|
|
Term
| Describe what digitalis does to an ECG reading. |
|
Definition
| depresses ST segment, flattens T wave (or inverts), QT shortens |
|
|
Term
| Describe what Quinidine does to an ECG. |
|
Definition
| QT lengthens, T wave flattens, QRS lengthens |
|
|
Term
| Describe what beta blockers do to an ECG. |
|
Definition
| decreases HR, blunts HR response to exercise |
|
|
Term
| What is the purpose of nitrates? |
|
Definition
|
|
Term
| Describe what antiarrhythmic agents do to an ECG. |
|
Definition
| can prolong QRS & QT intervals |
|
|
Term
| List the values for prehypertension, & the 3 stages of hypertension. |
|
Definition
Prehypertension: systolic = 120-130; diastolic = 80-89
Stage I: systolic 130-140; diastolic 90-100
Stage II: systolic 140-160; diastolic 100-110
Stage III: systolic >160; diastolic >110 |
|
|
Term
| Differentiate between primary & secondary hypertension. |
|
Definition
primary - no identifiable cause
secondary - cause is determined. |
|
|
Term
| List the procedure for taking orthostatic BP measurements. |
|
Definition
Pt. in supine for at least 5 min. Take a BP in supine.
Repeat BP at 1 min. & 3 min. after patient moves into standing or sitting position.
Drop of systolic BP of more than 20 mm Hg or standing BP less than 100 mm Hg is significant |
|
|
Term
|
Definition
arterial pressure within the large arteries over time, dependent on mean blood flow & arterial compliance. MAP = (SBP + 2DBP)/3
or
MAP = DBP + 1/3PP
where PP = SBP-DBP |
|
|
Term
| Define tachypnea & hyperpnea. |
|
Definition
tachypnea: an increase in rate of breathing >20 breaths/min.
hyperpnea: increase in depth & rate of breathing |
|
|
Term
|
Definition
| paroxsymal nocturnal dyspnea |
|
|
Term
| Crackles may be due to _____. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| curvature of the fingernails with soft tissue enlargement at the base of the nail: associated with chronic oxygen deficiency & heart failure |
|
|
Term
| Trophic changes of the skin are associated with which heart condition? |
|
Definition
|
|
Term
|
Definition
| dorsal skin folds of the toes or fingers are resistant to lifting; indicative of fibrotic changes & lymphadema |
|
|
Term
| IC with pain, cramping & fatigue occurring during exercise & relieved by rest is associated with ____. |
|
Definition
|
|
Term
| IC is related to _____ insufficiency. |
|
Definition
|
|
Term
| Why should you examine the venous system before the arterial? |
|
Definition
| venous insufficiency can validate some tests |
|
|
Term
| Describe the percussion test. |
|
Definition
| in standing, palpate one segment of greater saphenous vein while percussing vein approximately 20 cm. higher - if a pulse wave is felt by the lower hand, the intervening valves are incompetent. |
|
|
Term
| Describe Trendelenberg's test. |
|
Definition
Tests retrograde filling - determines competence of communicating veins & saphenous system
Pt. in trendelenberg position (legs elevated) to empty venous blood
tourniquet placed on proximal thigh
Pt. asked to stand
note if veins fill in normal pattern - should take approx. 30 sec. |
|
|
Term
| What is considered "delayed filling" for venous insufficiency with the venous filling time test? |
|
Definition
|
|
Term
| Describe teh air plethysmography (APG) test. |
|
Definition
pneumatic device calibrated to measure patency of venous system; volume
cuff is inflated around the calf & is attached to a pressure transducer & microprocessor
occludes venous return & permits arterial inflow; recorder registers increasing volume with cuff; time to return to baseline with cuff deflation |
|
|
Term
|
Definition
BP LE/BP UE
1.0 - normal
.8-1 - mild PAD
.5-.8 - moderate PAD, IC, compression therapy contraindicated
<.5 - severe PAD, + for IC at rest, compression therapy contraindicated |
|
|
Term
| List the grading scale for pulses. |
|
Definition
0 - absent
1+ - diminished, barely perceptible
2+ - normal, easily palpated
3+ - full pulse, increased strength
4+ - bounding |
|
|
Term
| List the grading scale for edema. |
|
Definition
1+ - mild, barely perceptible indentation
2+ - moderate, easily identified impression; returns to normal within 15 sec. - up to 1/2 in. of pitting
3+ - severe - depression takes 15-30 seconds to rebound - 1/2 to 1 in. pitting
4+ - very severe, depression lasts >30 sec with >1 in. pitting |
|
|
Term
| List & describe the 3 tests used in myocardial perfusion imaging. |
|
Definition
Thallium-201 scan: tallium is injected into blood via IV; radioisotopes concentrate in normal tissue but not in ischemic or infarcted tissues (cold spots)
Thallium stress test - used with an exercise test - injected at peak exercise
PET scan - uses radioactive markers (18F-fluoredeoxyglucose (FDG)) |
|
|
Term
| Describe a Swan-Ganz Catheter. |
|
Definition
| a.k.a. pulmonary artery catheter - inserted into large vein - often internal jugular, subclavian, or femoral vein - threaded into RA, RV, & into pulmonary artery - measures CVP, pulmonary artery pressure (PA), pulmonary capillary wedge pressures (PWCP) - catheter can provide an indirect measurement of the pressure in the left atrium of the heart & LVEDP |
|
|
Term
| List the enzyme changes associated with myocardial infarction. |
|
Definition
Elevations in SGOT (serum-glutamic-oxaloacetic transaminase) - peaks at 24-48 hours
Elevations in CPK - serum creatine phosphokinase - peaks at 24 hours
Elevations in CK-MG - peaks at 12-24 hours
Elevations in LDH (serum lactate dehydrogenase) - peaks at 3-6 days |
|
|
Term
| List normal PaO2 & PaCO2 values, and their clinical significance. |
|
Definition
PaO2 - 80-100 mm Hg
PaCO2 - 35-45 mm Hg
PaO2 - increased in hyperventilation; decreased in cardiac decompensation, COPD, & some neuromuscular disorders
PaCO2 - increased in COPD; decreased in pregnancy, pulmonary embolism, & anxiety |
|
|
Term
| List the normal values for blood pH & the clinical significance. |
|
Definition
7.35-7.45
decreased in Respiratory acidosis; COPD, respiratory depressants, myasthenia
increased in Respiratory alkalosis; hyperventilation, sepsis, liver disease, fever
decreased in Metabolic acidosis: increased acidic intake - alcohol, loss of alkaline body fluids, renal failure
Increased in Metabolic Alkalosis; vomiting, potassium depletion, diuretics, volume depletion |
|
|
Term
| List normal values for PT, PTT, INR, & bleeding time & list clinical significance of each. |
|
Definition
PT - 11-15 sec. (clotting); prolonged in deficiencies of factor X, hemorrhagic disease, cirrhosis, hepatitis drugs; if 2.5x greater than normal, PT contraindicated
PTT (partial thromboplastin time) - 25-40 seconds; increased if there's a deficiency of factor VIII, IX, & X
INR (international normalized ratio) - ratio of PT to reference range; .9-1.1; INR <2 desirable; >2 - consult with M.D. for increased risk of bleeding; INR >3 - increased risk of hemorrhage
Bleeding time: 2-10 minutes; increased in platelet disorders, thrombocytopenia |
|
|
Term
| List normal values & clinical significance of WBC's, RBC's, & erythrocyte sedimentation rate. |
|
Definition
WBC: 5-10,000; increased with infection & corticosteroids; decreased in aplastic anemia, B12 or folate deficiency - >5000 (light ex. only); <5000 w/ fever ex. contraindicated; <1,000 use mask & standard precautions
RBC's: males 4.7-6.1 x10^6/mm^3
females: 4.2-5.4 x10^6/mm^3; increased with polycythemia, decreased in anemia
ESR: males up to 15 mm/hr
females up to 20 mm/hr; increased with infection & inflammation: rheumatic or pelvic inflammatory disease, osteomyelitis; used to monitor effects of treatment (RA, SLE, Hodgkin's disease) |
|
|
Term
| List the normal values & clinical significance of Hematocrit, Hemoglobin, Platelet count, & fibrinogen. |
|
Definition
Hct: Male 42-52%; Female 37-47% - increases in erthryocytosis, dehydration, & shock
decreases in severe anemias & acute hemorrhage
>25% but less than normal: light ex. only
<25% ex. contraindicated
Hgb: Males 14-18 g/dL; Females 12-16 g/dL
low values result in decreased exercise tolerance, increased fatigue, & tachycardia - light only (8-10)
<8 g/dL - ex. contraindicated
Platelets: 150,000-450,000 cells/mm^3
increased in chronic leukemia, hemoconcentration, decreased in cancer chemotherapy
<20,000 - AROM, ADL's only
20,000-30,000: light only
30-40,000 - moderate exercise
Fibrinogen, plasma
175-433 mg/dL; increased in inflammatory states, pregnancy, oral contraceptives
decreased in cirrhosis, hereditary diseases |
|
|
Term
| List desirable and high risk cholesterol & triglycerides values. |
|
Definition
desirable <200 mg/dL; borderline 200-230; high risk >240
HDL: low risk >60; mod risk 35-60; high risk <35
LDL: >100 with multiple risk factors; >160 for low risk individuals
Trigylcerides <165 desirable
LDL/HDL ratio: low risk .5-3.0, mod risk 3.0-6.0, high >6.0 |
|
|
Term
|
Definition
| patient clenches fist over chest with angina. |
|
|
Term
| Describe the possible causes of angina. |
|
Definition
increased demands on the heart
vasospasm, symptoms may be present at rest |
|
|
Term
| Differentiate between Stable & unstable angina. |
|
Definition
stable - classic exertional angina; occurs at a predictable rate-pressure product, RPP (HRxBP)
unstable angina - coronary insufficiency with risk for MI or sudden death - pain is difficult to control without any predictable RPP |
|
|
Term
| List & describe the 3 zones of infarction with an MI. |
|
Definition
central zone - consists of necrotic, noncontractile tissue - electrically inert - see pathologic Q wave
zone of injury - area immediately adjacent to central zone - tissue is non-contractile, cells undergoing metabolic changes - electrically unstable - on ECG, see elevated ST segments in leads of injured area
zone of ischemia: outer area, cells also undergoing metabolic changes, electrically unstable - on ECG, see T wave inversion |
|
|
Term
| Differentiate between transmural & nontransmural (non Q wave infarctions) |
|
Definition
Transmural = full thickness of myocardium
Non-transmural - subendocardial, subepicardial, intramural infarctions |
|
|
Term
| An inferior MI is in the _____ & causes disturbances of the upper conduction system - caused by a blockage in the ____. |
|
Definition
|
|
Term
| A lateral MI causes damage in the _____ & is caused by damage to the _____ artery. |
|
Definition
ventricular ectopy
circumflex artery |
|
|
Term
| An anterior MI causes damage to the _____ & is a result of damage to the _____ artery. |
|
Definition
| lower conduction system; LAD |
|
|
Term
| Impaired ventricular function results in _____ SV, ____ CO, ____ EF, & ____ end diastolic ventricular pressure. |
|
Definition
| decreased, decreased, decreased, & increased |
|
|
Term
| Describe what happens with R heart failure. |
|
Definition
| blood is not adequately returned from the systemic circulation to the heart - causes peripheral edema, weight gain, venous stasis, nausea, & anorexia |
|
|
Term
| Describe what happens with L sided heart failure. |
|
Definition
increased pulmonary artery pressures & pulmonary edema
pulmonary signs & symptoms: cough, dypsnea, orthopnea, weakness, fatigue |
|
|
Term
| decreased CO results in pre-failure of what organ? |
|
Definition
|
|
Term
| Anorexiaa, Weight gain, ascites, increase in RAP, CVP, jugular venous distention, + hepatojugular reflex, & murmur of tricuspid insufficiency are all signs of what sided heart failure? |
|
Definition
|
|
Term
| cough, SOB, DOE, paroxysmal nocturnal dypsnea, crackles, pulsus alterans, decreased urine output, Cheyne stokes respirations, & murmur of mitral insufficiency are all known characteristics of ___ sided heart failure |
|
Definition
|
|
Term
| List the actions of nitrates. |
|
Definition
| decrease preload through peripheral vasodilation, reduce myocardial oxygen demand, reduce chest discomfort, & may also dilate coronary arteries & increase coronary blood flow |
|
|
Term
| List the actions of beta blockers. |
|
Definition
| decrease myocardial demand by decreasing HR & contractility, control arrhythmias, & reduce BP |
|
|
Term
| List the actions of calcium channel blocking agents. |
|
Definition
| inhibit flow of calcium ions - decreases HR, contractility, dilates coronary arteries, reduces BP, controls arrhythmias & CP |
|
|
Term
| List the actions of antiarrhythmics |
|
Definition
| restores normal heart rhythm, improve CO |
|
|
Term
| List the actions of antihypertensives. |
|
Definition
| control hypertension - goal is to maintain a diastolic pressure <90 mm Hg - decreases afterload, reduces myocardial oxygen demand |
|
|
Term
| List the actions of digitalis. |
|
Definition
| increases contractility & decreases HR; mainstay in tx of CHF |
|
|
Term
| List the actions of diuretics. |
|
Definition
| decreases myocardial work, controls hypertension |
|
|
Term
| List the actions of aspirin |
|
Definition
| decreases platelet aggregation, may prevent MI |
|
|
Term
| List the action of tranquilizers. |
|
Definition
| decrease anxiety, sympathetic effects |
|
|
Term
| List the actions of hypolipidemic agents. |
|
Definition
| reduces serum lipid levels when diet & weight reduction are not effective |
|
|
Term
| List examples of beta blockers. |
|
Definition
|
|
Term
| List examples of calcium channel blocking agents. |
|
Definition
| diltiazem (cardizem, Procardia) |
|
|
Term
| List examples of anti-arrhythmics. |
|
Definition
|
|
Term
| List examples of antihypertensives |
|
Definition
|
|
Term
| List examples of diuretics. |
|
Definition
| Lasix, furosemide, hydrocholorothiazide, Esidrix |
|
|
Term
| LIst examples of hypolipidemic agents. |
|
Definition
| cholestyramine (Questram, colestipol (Colestid), simvastatin (Zocor), & lovastatin (Mevacor) |
|
|
Term
| Differentiate between heterotopic & orthotopic heart transplantation. |
|
Definition
heterotopic - original heart left - donor heart used to piggy back of original heart
orthotopic - remove disease heart & replase with donor heart |
|
|
Term
| Describe Buerger's disease. |
|
Definition
chronic inflammatory vascular occlusive disease of small arteries & also veins
occurs in young adults, largely males who smoke
begins distally & progresses proximally in both upper & lower extremities
patients exhibit paresthesias or pain, cyanotic cold extremity, diminished temperature sensation, fatigue, risk of ulceration & gangrene |
|
|
Term
| Describe Diabetic angiopathy. |
|
Definition
| inappropriate elevation of blood glucose levels - leads to accelerated atherosclerosis. |
|
|
Term
| Describe Raynaud's disease. |
|
Definition
abnormal vasoconstrictor reflex exacerbated by exposure to cold or emotional stress - episodic spasm of small arteries & arterioles
tips of fingers dvelop pallor cyanosis, numbness & tingling - affects largely females - occlusive disease is usually not a factor |
|
|
Term
|
Definition
| distended, swollen superficial veins; tortuous in appearance; may lead to varicose ulcers |
|
|
Term
| Describe superficial vein thrombophlebitis. |
|
Definition
| clot formation & acute inflammation in a superficial vein - localized pain; usually in a saphenous vein. |
|
|
Term
| Describe chronic venous insufficiency. |
|
Definition
pain: none to aching on dependency
pulses normal
color normal or cyanotic on dependency
venous valvular insufficiency: form fibroelastic degeneration of valve tissue to venous dilation
have muscle pump dysfunction
edema |
|
|
Term
| List the 3 stages of chronic venous insufficiency. |
|
Definition
Grade I: mild aching, minimal edema, dilated superficial veins
Grade II: increased edema, multiple dilated veins, changes in skin pigmentation
Grade III: venous claudication, severe edema, cutaneous ulceration |
|
|
Term
| Differentiate between primary & secondary lymphadema. |
|
Definition
primary: congenital condition with abnormal lymph node or lymph vessel formation
secondary: acquired, d/t injury of one or more parts of the lymphatic system
- can occur as a result of surgery, paralysis & disuse, or in tropical & subtropical areas, results from filariasis (nematode worm larvae in the lymphatic system. |
|
|
Term
|
Definition
|
|
Term
| Define max ETT & submaximal ETT. |
|
Definition
maximal ETT: defined by target endpoint heart rate age-adjusted = 220-age
use max HR with Karvonen's formula: Take 220-age = max HR
max HR - resting HR = target HR (HRR)
HRRx60% & HRRx80% = target training range
add HRR(60) & HRR(80) to resting HR to get target ranges during ex.
symptom limited: used to evaluate the early recover of patients after MI, coronary bypass, or coronary angioplasty Continuous: workload steadily progressed in 2-3 min. stages Discontinuous: allows rest in between stages; used for patients with more pronounced CAD |
|
|
Term
| During exercise, list the changes to the following: HR, systolic BP, diastolic BP, & RPP. |
|
Definition
HR - increases linearly - plateaus just before VO2 max
systolic BP - increases
diastolic BP - stays the same or decreases
RPP - increases |
|
|
Term
|
Definition
rate pressure product = SBP x RHR
(RHR = resting heart rate) |
|
|
Term
| Angina is usually perceived at a given ____. |
|
Definition
|
|
Term
| The ratings of perceived exertion scale was created by who? |
|
Definition
|
|
Term
| The RPE is most useful with what populations? |
|
Definition
| when HR response is blunted by medications (ie medications) or a pacemaker. |
|
|
Term
| Describe the grading for the Borg Ratings of Perceived Exertion Scale. |
|
Definition
6-20
descriptors like very, very light to somewhat hard (13) to very, very hard (19) |
|
|
Term
| List ECG changes with exercise in a healthy individual. |
|
Definition
shortening of QT interval
ST segment depression, upsloping, less than 1 mm
exertional arrhythmias - rare, single PVC's |
|
|
Term
| List ECG changes in an individual with myocardial ischemia & CAD. |
|
Definition
significant tachycardia
exertional arrhythmias - increased frequency
ST segment depression - horizontal or downsloping; greater than 1 mm below baseline indicative of myocardial ischemia |
|
|
Term
|
Definition
| amount of oxygen consumption at rest; equal to 3.5 mL/kg per minute |
|
|
Term
| MET levels can be directly determined during _____. How is this achieved? |
|
Definition
| during steady stage exercise, max VO2 achieved on ETT is divided by resting VO2 |
|
|
Term
| Dynamic arm exercise results in a _____ VO2 max, ____ HR, _____ SV, & ____ systolic & diastolic BP. |
|
Definition
| lower, increased, lower, increased |
|
|
Term
| Describe exercise prescription for early cardiac rehab. |
|
Definition
discontinous (interval training)
frequent rest periods
continuous training used later
low intensity
5-10 min. durations
warm up/cool down
Intensity usually 60-70% functional capacity - should be between 40-85% based on initial level of fitness |
|
|
Term
| If resistance exercises are used in cardiac rehab, what intensities are used, how is the patient monitored, and what should be avoided? |
|
Definition
moderate (40% of MVC)
RPP monitoring
valsalva, breath-holding |
|
|
Term
| What cardiac patients should not perform resistance exercises? |
|
Definition
| poor left ventricular function, ischemic changes on ECG during ETT, functional capacity less than 6 METs, & uncontrolled hypertension or arrhythmias |
|
|
Term
| List how percentage of max HR is calculated when performing UE exercise vs LE exercise. |
|
Definition
LE HR max = 220-age
UE HR max = 220-age-11 |
|
|
Term
| 70-85% HR max closely corresponds to ____. |
|
Definition
| 60-80% functional capacity or VO2max |
|
|
Term
| RPE values of ____ correspond to 60% HR. |
|
Definition
|
|
Term
| RPE of ____ corresponds to 85% HR. |
|
Definition
|
|
Term
| List 2 problems with the RPE scale. |
|
Definition
Patients with psychological problems (depression) could affect ratings
Patients unfamiliar with the scale could affect selection of ratings |
|
|
Term
| List the best exercise prescription for severely compromised individuals. |
|
Definition
| multiple, short exercise sessions spaced throughout the day (3-10 minute sessions) |
|
|
Term
| List indications to modify exercise prescription. |
|
Definition
HR is lower than target HR for a given intensity
RPE is lower for a given exercise
symptoms of ischemia |
|
|
Term
| As cardiac training progresses, ____ is increased first, then ____. |
|
Definition
|
|
Term
| List exercise prescription for post-PTCA (percutaneous transluminal coronary angioplasty) |
|
Definition
| wait to exercise approx. 2 weeks post-PTCA to allow inflammatory processes to subside |
|
|
Term
| List the exercise prescription post CABG. |
|
Definition
limit UE exercise while sternal incision is healing
avoid lifting, pulling, pushing for 4-6 weeks post-surgery |
|
|
Term
| Describe Phase I cardiac rehab. |
|
Definition
During acute hospital stay
usually 3-5 days
-initiates early return to independence in ADL's
initial activities are low intensity (2-3 METs) progressing to 3-5 METs by D/C
RPE in light range; HR increase of 10-20 bpm above resting, depending on medications
short exercise sessions, 2-3x/day |
|
|
Term
| Post-surgical patients are typically progressed more ______ than post-MI. |
|
Definition
|
|
Term
| Greater emphasis is placed on UE ROM with _____ patients. |
|
Definition
|
|
Term
| List some adverse response to inpatient exercise that would lead to exercise discontinuation. |
|
Definition
Diastolic BP >110 mm Hg
Decrease in SBP >10 mm Hg
Significant ventricular or atrial dysrhythmias
second or third degree heart block
signs/symptoms of exercise intolerance, including angina, marked dyspnea, & ECG changes suggestive of ischemia |
|
|
Term
| List the end-goal of Phase I Cardiac rehab. |
|
Definition
| 20-30 minutes of exercise, 1-2x/day at 4-6 weeks post MI |
|
|
Term
| Describe Phase 2 Cardiac Rehab. |
|
Definition
outpatient cardiac rehab (subacute)
insurance usually approves for 3x/week for 12 weeks
progress towards full resumption of ADL's - habitual & occupational activites
3-4 sessions/week - 30-60 min. w/ 5-10 minutes of warm-up & cool down
pt's gradually weaned to spot checks & self-monitoring
Suggested end-point = 9 MET
begin with use of elastic bands & light weights (1-3 lbs) & progress to moderate loads, 12-15 comforable repetitions |
|
|
Term
| Is ESRD an indication or contraindication for inpt. & outpt. cardiac rehab? |
|
Definition
|
|
Term
| Describe Phase 3 cardiac rehab. |
|
Definition
Community exercise programs: post-acute, post-D/C from phase 2
promote self-regulation of exercise programs
location - community centers, YMCA, or clinical facilities
entry level criteria - functional capacity of 5 MET (safe resumption of most ADLs), clinically stable angina, medically controlled arrythmias
progression to 50-85% of functional capacity, 3-4x/wk, 45 min. or more per session
D/C typically in 6-12 mo. |
|
|
Term
| List patient criteria for resistance training with cardiac rehab. |
|
Definition
Post-MI or cardiac surgery: minimum of 5 weeks
post-transcatheter prodecure: minimum of 3 weeks following procedure & 2 weeks of consistent participation in a supervised CR endurance training program |
|
|
Term
| With a resistance exercise program for cardiac rehab patients, the RPE scale should range from ____. |
|
Definition
| 11-13 (light to somewhat hard) |
|
|
Term
| T/F.With a resistance exercise program in cardiac rehab, the RPP should not exceed that prescribed during endurance exercise. |
|
Definition
|
|
Term
| Describe the characteristics of CHF. |
|
Definition
| significant ventricular dysfunction, decreased CO, low functional capacity. |
|
|
Term
| Describe the four classes of CHF. |
|
Definition
Class I: mild CHF: no functional limitations (can perform up to 6.5 mets)
Class II: mild limitations in function (up to 4.5 mets); comfortable at rest
Class III: marked CHF, marked limitation of physical activity (up to 3.0 METS), comfortable at rest - less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain
Class IV: severe CHF - unable to carry out any physical activity (1.5 METs) - anginal pain present even at rest |
|
|
Term
| Describe exercise training for CHF patients. |
|
Definition
use low intensities (40-60% functional capacity) - gradually increase durations, with frequent rest periods
RPE should be between 12-14
HR response may be impaired if patients are on digoxin
check for delayed responses of weight gain, edema lower extremities
NO resistance training with patients with capacities under 6.0 METS |
|
|
Term
| Describe characteristics and exercise prescription for patients with cardiac transplant. |
|
Definition
pt's may have side-effects from immunosuppressive drug therapy: hyperlipidemia, hypertension, obesity, diabetes, leg cramps, decreased LE strength, increased fx risk secondary to prolonged corticosteroid use
HR alone inappropriate measure of exertion (heart is denervated) - use RPE, MET's dypsnea scale |
|
|
Term
| What should be avoided initially after implantation of pacemakers and defibrillators? |
|
Definition
| UE aerobic or strengthening exercises |
|
|
Term
| What can inadvertently cause a pacemaker or defibrillator to D/C? |
|
Definition
| electromagnetic devices (anti-theft devices) |
|
|
Term
| List the effects of physical training on SV, MVO2, respiratory capacity, functional capacity, glucose tolerance, & fibrinolytic activity. |
|
Definition
SV: increased
MVO2: increased
respiratory capacity: improved
functional capacity: improved
glucose tolerance: improved
fibrinolytic activity: increased (increased coagulability) |
|
|
Term
| Describe the difference if you respond to a sudden collapse vs. unconscious victim. |
|
Definition
sudden collapse: call 911 first
unconscious victim: give five cycles of CPR (2 minutes) first, then call 911 |
|
|
Term
| LIst compression-ventilation ratio for adults, children, & infants. |
|
Definition
30:2 for adults & children
15:2 for infants |
|
|
Term
| List the appropriate compression depth for adults, infant, & child. |
|
Definition
adult = 1.5-2.0 inches
child = .5-1 inch
infant = .5 inch |
|
|
Term
| Blood typically clots within ____. |
|
Definition
|
|
Term
| List changes to RR, pulse rate, BP, & LOC with internal bleeding. |
|
Definition
RR - increases
pulse rate - increases
BP - decreased
LOC - declines |
|
|
Term
|
Definition
| Failure of the circulatory system to perfuse vital organs |
|
|
Term
| Define Hemorrhagic shock. |
|
Definition
| severe internal or external bleeding |
|
|
Term
| Define psychogenic shock. |
|
Definition
| extreme stress - pulls blood to pool away from brain. |
|
|
Term
| Describe metabolic shock. |
|
Definition
| loss of body fluids from heat or severe vomiting/diarrhea |
|
|
Term
| Describe Cardiogenic shock. |
|
Definition
| MI or cardiac arrest results in pump failure |
|
|
Term
| Describe respiratory shock. |
|
Definition
| Respiratory illness or arrest results in insufficient oxygenation of blood |
|
|
Term
|
Definition
| severe infections can cause blood vessels to dilate |
|
|
Term
| Describe neurogenic shock. |
|
Definition
| TBI/SCI/other neural trauma causes disruption of autonomic nervous system resulting in disruption of blood vessel dilation/constriction |
|
|
Term
| How soon should capillary refill return? What could be a possible cause of reduced capillary refill? |
|
Definition
| 2 seconds; shock - blood being shunted away from periphery to vital organs to maintain core temp. |
|
|
Term
| Beta blockers for treatment of hypertension or cardiac disorders may _____ time to claudication or ____ symptoms. |
|
Definition
|
|
Term
| Pentoxifyline, dipyridamole, aspirin, & warfarin may ______ time to claudication. |
|
Definition
|
|
Term
| Describe Modified Buerger-Allen exercises. |
|
Definition
| postural exercises plus active plantar & DF of ankle; active exercises improve blood flow during and after exercise; effects less pronounced in patients with PVD |
|
|
Term
| what strengthening exercise is most effective in increasing blood flow? |
|
Definition
| calf muscle strengthening |
|
|
Term
| List medications for arterial disease. |
|
Definition
medications to decrease blood viscosity, prevent thrombus formation (heparin)
Vasodilators (controversial)
calcium channel blockers when vasospasm is involved. |
|
|
Term
|
Definition
positioning: extremity elevation min. of 18 cm above heart - avoid dependent positioning
compression therapy - bandages applied withing 20 min. of rising
paste bandages (Unna boot) - Gauze impregnanted with zinc oxide, gelatin, & glycerine - applied for 4-7 days
graduated Jobst compression stockings, compression pump therapy, used for a 1-2 hours session 2x/daily |
|
|
Term
| DO NOT use compression therapy to a limb with an ABI ____ or evidence of _____. |
|
Definition
| <.8, active cellulitis, infection |
|
|
Term
| Lymphadema bandages have ____ resting pressure & _____ working pressure. |
|
Definition
|
|
Term
| emphasis of manual lymph drainage is to decongest _____ segments first, then _____, ______to ______. |
|
Definition
| proximal; extremities - distal to proximal |
|
|
Term
| WIth exercise prescription for lymphadema, what muscles should be worked & in what order? |
|
Definition
| work trunk & limb muscles first, then limb muscles from proximal to distal - performed with compression bandages on |
|
|
Term
| What exercises are contraindicated for patients with lymphadema? |
|
Definition
| strenous activities, jobbing, & ballistic movements - likely to exacerbate |
|
|
Term
| Compression garments are utilized at the end of _____ for lymphadema management. |
|
Definition
|
|
Term
| What will high pressures do to a patient with lymphadema? |
|
Definition
| occlude superficial lymph capillaries & restrict fluid absorption |
|
|
Term
| Pressures higher than ____ are contraindicated as they can cause lymphatic collapse; contraindicated with soft tissue injury. |
|
Definition
|
|
Term
| Describe Phase I vs. Phase II management of lymphadema. |
|
Definition
Phase I: management of edema secondary to lymphatic dysfunction
Phase II management: self-management |
|
|
Term
| During aquatic therapy, changes occur as a result of hydrostatic pressure & include a cephalad redistribution of blood flow. List changes to SV, CO, HR. |
|
Definition
SV & CO increase
HR remains the same or slightly decreases |
|
|
Term
| How do diuretics work? Who shouldn't take diuretics? |
|
Definition
inhibit tubular reabsorption of sodium & chloride in kidney, which inhibits water reabsorption & increases urine volume - decreased vascular resistance
elderly patients & patients with kidney failure should avoid thiazides - loop diuretics (furosemide, lasix are ok) |
|
|
Term
| List side effects of diuretics. |
|
Definition
| hyperglycemia, hypokalemia, hyperuricemia, increase in LDL levels, hypercalcemia |
|
|
Term
| List drug interactions with diuretics. |
|
Definition
| increases lithium absorption - can have lithium & digoxin toxicity |
|
|
Term
| What is a side effect of potassium-sparing diuretics that is different from all of the others? |
|
Definition
| can cause hyperkalemia rather than hypokalemia, especially if taking ACE inhibitors or potassium supplements |
|
|
Term
| Beta 1 receptors are located primarily in the _____ & Beta 2 receptors are in the _____. |
|
Definition
|
|
Term
| What is the mechanism for beta blockers? |
|
Definition
| inhibit renin release from kidneys & decreases CO by lowering HR |
|
|
Term
| Who shouldn't take beta-blockers? |
|
Definition
| anyone with angina, COPD, & DM - should never discontinue use with a risk of sudden death from anginal attack |
|
|
Term
| What are side effects of beta blockers? |
|
Definition
| sleep disturbances, mental status changes, cold extremities |
|
|
Term
| What is the mechanism of calcium channel blockers? What are the side effects? What are possible drug interactions? |
|
Definition
inhibit calcium ions - contractile process is inhibited, allowing vasodilation in coronary arteries & decreased peripheral resistance to blood flow
side effects: bradycardia, peripheral vasodilation - flushing, HA, ankle swelling, & reflex tachycardia
drug interactions: Verapamil can result in digoxin toxicity
Verapamil & beta blockers can cause cardiac depression & AV block |
|
|
Term
| What do alpha 1 & alpha 2 blockers do? |
|
Definition
alpha 1 receptors are found in smooth muscle - inhibits smooth muscle allowing vasodilation in arteries & veins
alpha 2 blockers decrease SNS signals with decreased HR, peripheral resistance, & BP |
|
|
Term
| What are side effects of alpha 1 & alpha 2 blockers? |
|
Definition
1 - syncope, headaches, & palpitations
2 -dry mouth, sedation, depression |
|
|
Term
| What are adverse effects of alpha 2 blockers? |
|
Definition
with clonidine, risk of rebound hypertension on sudden withdrawal
with aldomet, decrease mental acuity & hemolytic anemia |
|
|
Term
| What are side effects of nitro? |
|
Definition
| dizziness, flushing and HA, reflex tachycardia |
|
|
Term
| What is the mechanism of ACE inhibitors? What are they used for? |
|
Definition
inhibits conversion of angiotensin I to angiotensin II, which inhibits vascular smooth muscle contraction - also inhibits secretion of aldosterone by adrenal cortex - decreased sodium & water retention - get arterial vasodilation, decreased peripheral resistance, & increased blood flow
used as first step in L ventricular failure |
|
|
Term
| What are side effects & adverse effects of ACE inhibitors? |
|
Definition
nonproductive dry cough, decreased taste perception
adverse effects - hypotension, hyperkalemia, angioedema |
|
|
Term
| What are the four steps to treating CHF? |
|
Definition
step 1 - ACE inhibitors
2 - loop diuretics
3 - nonselective beta blockers & selective alpha 1 andrenergic blocker
4 - Digoxin |
|
|
Term
| List side effects of digoxin & signs of digoxin toxicity. |
|
Definition
side effects: fatigue, HA, muscle weakness, bradycardia, arrythmias, V-fib
toxicity: any cardiac arrythmia, anorexia, nausea, vomiting, mental status change, hallucinations, blurred vision |
|
|
Term
| What are side effects of vasodilators? |
|
Definition
| GI disturbances, HA, flushing, nasal congestion |
|
|
Term
| What is Ticlopidine (Ticlid)? What are adverse effects? |
|
Definition
same mechanism as aspirin - prevents TIA & stroke
side effects: GI symptoms, dizziness, neutropenia which can lead to agranulocytosis
- inhibits enzymes that break down dilantin & theophylline (bronchodilator) - can increase levels of both |
|
|
