Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
110 Cards in this Set
- Front
- Back
|
Left Anterior Descending A. Circulation
|
-ant. L ventricle
-ant. IV septum -adj. R ventricle -prox/inf ventricles and apex |
|
|
Right Coronary A. Circulation
|
-R atrium
-post. R ventricle -SA, AV node, bundle of HIS |
|
|
Right Marginal A. Circulation
|
-post R ventricle
-diaphragmatic margin of both ventricles |
|
|
Right Posterior Descending A. Circulation
|
-post IV septum
-inf L ventricle |
|
|
What are the factors that affect cardiac function?
|
-preload
-afterload -contractility -ventricular compliance -energy |
|
|
What is the cardiovascular response to standing upright?
|
-increase HR
-venoconstriction => both increase venous return |
|
|
What are the benefits of an active cooldown?
|
-facilitates blood flow
-removes metabolic waste products such as lactic acid |
|
|
What are the intrinsic regulators of heartbeat?
|
-SA node
-AV node |
|
|
What are the extrinsic regulators of heartbeat?
|
-neural (ANS)
-peripheral (mechanical compression -cortical (emotions) |
|
|
What effect does training have on HR regulation?
|
-decreases HR due to an increase in parasympathetic stimulation of the SA node
|
|
|
According to Poiseuille's Law, what is the most important factor determining blood flow?
|
-radius of blood vessels, because blood vessel length and blood viscosity are constant
|
|
|
What causes vasodilation of blood vessels on the local level?
|
-hypoxia
-adenosine -inc. temperature -carbon dioxide -acidity -MG & K ions => all are products of increased metabolism |
|
|
What sympathetic neurotransmitters affect vasomotor tone? What effect do they have on vascular smooth muscle?
|
-NE causes vasoconstriction (adrenergic fibers)
-Ach causes vasodilation (cholinergic fibers) |
|
|
What causes vasodilation during exercise?
|
-reduced sympathetic tone
-products of metabolism |
|
|
What are the 3 phases of exercise?
|
-anticipation
-initiation -adjustment |
|
|
What responses occur during the anticipatory phase of activity? What stimulates these changes?
|
-inc HR
-inc BP (systolic) -inc CO -inc venous resistance =>due to sympathetic outpouring |
|
|
What responses occur during the initiation phase of exercise?
|
-inc HR
-dec TPR -inc CO -inc SV -inc arterial pressure |
|
|
What responses occur during the adjustment phase of exercise?
|
-various potential adjustments can occur to ensure supply = demand
|
|
|
What is the Fick Equation?
|
CO = VO2/(A - V O2) X 100
|
|
|
What is the average SV of an adult at rest while standing?
How much blood is ejected from the heart per minute at rest? |
- 60 mL to 80 mL per stroke
- ~5 L per min |
|
|
What factor of cardiac output is affected by training/ deconditioning? How does this manifest in CHF patients?
|
-SV
-dec SV in CHF patients leads to inc HR for compensation to maintain CO |
|
|
What percentage of O2 remains bound to Hb at rest? During exercise?
|
- at rest = 75% bound
- w/ exercise = 85% extraction |
|
|
What factors affect VO2?
|
-capacity to divert BF
-microcirculation -muscle ability to generate energy aerobically |
|
|
What 2 Ischemic conditions were discussed in lecture?
|
-CAD
-CHD |
|
|
What differentiates CAD from CHD?
|
-CAD limits blood flow without inhibiting heart muscle fxn
-CHD results from obstruction that damages heart muscle below the level of lesion, which inhibits fxn |
|
|
What 3 layers comprise arterial walls?
|
-adventitia
-media -intima |
|
|
What is atherosclerosis? Where does it occur in the arterial wall?
|
-fatty streaks and platelets deposit in the arterial wall forming a thrombus resulting in vessel hardening and decreased compliance
=> between intima and media |
|
|
What are the s/s of variant (prinzmetal) angina?
|
-ST segment elevation
-occurs at rest in the morning, without exertion -not associated with myocardial oxygen consumption -relieved w/ vasodilator or NG |
|
|
What are possible presentations of CHD?
|
-sudden death
-chronic angina -unstable angina -MI -cardiac muscle dysfxn |
|
|
What causes angina?
|
-insufficient myocardial oxygen
|
|
|
What are the characteristics of chronic (stable) angina?
|
-predictable
-associated w/ exertion -Rx includes decreasing activity level or sublingual NG administration |
|
|
What are the characteristics of unstable angina?
|
-sx in absence of demand
-higher mortality rate -angina at rest -not relieved w/ decreasing activity |
|
|
What s/s may indicate development of unstable angina?
|
-angina at rest
-s/s onset at lower levels of activity -deterioration of stable angina |
|
|
What are the effects of cardiac muscle dysfxn?
|
-impairs pump
-impairs LV acceptance of blood -dec CO -dec tolerance to exertion -most common cause of CHF |
|
|
How can the effects of cardiac muscle dysfxn be treated?
|
-supplemental O2 to offset ischemia & improve contractility
-alter body position to affect venous return |
|
|
What factor must be accounted for when treating a CHF patient with changing body position?
|
-medication
=>diuretics dec BV, inc VR may be beneficial, however, excess VR w/ CHF may overload weak heart |
|
|
What are the symptoms of CHF?
|
-dyspnea
-paroxysmal nocturnal dyspnea -orthopnea (difficulty in recumbent position) |
|
|
What are the signs of CHF?
|
-tachypnea
-Cheyne-Stokes respiration -rales -peripheral edema -jugular distention -peripheral cyanosis -dec exercise tolerance -sinus tachycardia |
|
|
What methods are used to treat CHF?
|
-diet (dec sodium)
-meds -surgery (CABG,valve) -exercise training -ventilatory muscle training |
|
|
What are the clinical implications of treating a patient w/ HTN?
|
-BP taken in every eval
-know BP response to exercise and position change -know med effects -know precautions/contraindications -exercise is beneficial |
|
|
What are the clinical implications of CAD?
|
-pt to bring NTG to PT
-monitor response to activity -know anginal threshold -know med effects -frequent breaks may be necessary |
|
|
Name the 3 types of cardiomyopathies.
|
-dilated
-hypertrophic -restrictive |
|
|
What are the characteristics of dilated cardiomyopathy?
|
-ventricle dilation & cardiac muscle dysfxn
-inc mass w/out wall thickening -result of mitochondrial dysfxn and subsequent energy deficit |
|
|
What are the effects of dilated CM?
|
-inc LVEDV, LVEDP causing dilation
-dec energy => dec pumping -dec SV => inc HR to compensate -progress results in insufficient CO during exertion -eventual LV => RV failure |
|
|
What are the clinical manifestations of dilated CM?
|
-dyspnea w/ exertion (then @ rest)
-dry cough at night -s/s LV failure -exertional angina -resting tachycardia -cardiomegaly -systolic murmur |
|
|
What are the characteristics of hypertrophic CM?
|
-inc cardiac mass w/out cavity dilation
-impaired ventricular filling -inc LVEDP |
|
|
What are the effects of hypertrophic CM?
|
-disorganized, hypercontractile muscle
-dec LV compliance, rapid ejection -inc ejection fraction -may cause ischemia due to inc O2 demand & inc pressures |
|
|
What are the characteristics of restrictive CM?
|
-diastolic dysfxn
-dec ventricular filling due to wall rigidity resulting from disease |
|
|
What are the clinical manifestations of restrictive CM?
|
-exercise intolerance
-weakness -dyspnea -jugular distension, edema, hepatomegaly, -CHF symptoms |
|
|
What is pericarditis?
|
-inflammation of the pericardial sac resulting from infection
-may progress to pericardial effusion |
|
|
What is pericardial effusion? What are its effects?
|
-pericardial sac fluid accumulation
-cardiac compression -may lead to cardiac tamponade |
|
|
What is cardiac tamponade?
|
-elevated intracardiac pressure
-dec ventricular filling -dec SV and CO |
|
|
What are the s/s of cardiac tamponade?
|
-angina
-dyspnea -friction rub (creaking sound) -ECG abnormality |
|
|
EKG: P-wave
|
-atrial depolarization
- <.11 seconds |
|
|
EKG: P-R Interval
|
-beginning of P to beginning of QRS
-AV conduction time - .12-.20 seconds |
|
|
What is the significance of the P-R interval?
|
-AV node "pause" that allows ventricular filling
|
|
|
EKG: QRS Complex
|
-represents ventricular depolarization
- <.10 seconds |
|
|
EKG: ST segment
|
-pause after QRS complex
|
|
|
EKG: T-wave
|
-ventricular repolarization
|
|
|
What Q-wave abnormalities indicate MI?
|
-represents myocardial necrosis
-abnormal if > .04 seconds and/or > 1/3 QRS height |
|
|
What does ST segment elevation indicate?
|
-infarction in progress
-ischemia |
|
|
What does T-wave inversion indicate?
|
-possible MI or ischemia
|
|
|
What ECG features denote Sinus Rhythm?
|
-60-100 bpm
-regular rhythm -PR interval = .12-.20 sec -QRS = <.10 sec |
|
|
What ECG features denote Sinus Bradycardia?
|
- <60 bpm
-PR interval = .12-.20 sec -QRS = <.10 sec |
|
|
What ECG features denote Sinus Tachycardia?
|
- >100 bpm
-PR interval = .12-.20 sec |
|
|
What ECG features denote Atrial Flutter?
|
-230-430 bpm
-PR interval usually >.20 sec -QRS <.10 sec -SAWTOOTH pattern |
|
|
What ECG features denote Atrial Fibrillation?
|
-atria up to 400-500 bpm
-absent P-wave -QRS .12-.20 sec -irregular R-R interval -irregular QRS amplitude |
|
|
What ECG features denote Premature Ventricular Contraction?
|
-irregular rhythm
-broad QRS -ST segment/T-wave directed opposite QRS |
|
|
What are the types of PVCs?
|
-unifocal
-multifocal -couplet, triplet, etc -bigeminy -trigeminy |
|
|
Define Bigeminy.
|
-PVC occurs every other beat
|
|
|
Define Trigeminy.
|
-PVC occurs every third beat
|
|
|
What ECG features denote Ventricular Tachycardia?
|
-3+ consecutive PVCs, usually unifocal in nature
-rate >100 bpm -broad QRS, >.14 sec |
|
|
What ECG features denote Ventricular Fibrillation?
|
-erratic fibrillatory line with no discernible QRS
-"bag of worms" |
|
|
What indicates a pathological Q-wave? Why is this significant?
|
- >1mm in width (.04 sec)
-approximately 1/3 the height of R-wave =>used to indicate MI |
|
|
What is the effect of beta blockers on heart rate & BP response to exercise?
|
-blunted HR response
-decrease contractility -blunted SBP response |
|
|
How do beta blockers affect heart function?
|
-block sympathetic nervous activity to beta receptors of the heart
|
|
|
What is the normal BP response to aerobic exercise?
|
-systolic BP rises linearly with exercise intensity (7-10 mmHg per 1 MET)
-diastolic BP decreases slightly due to peripheral vasodilation |
|
|
Who should be evaluated for cardiac conditions?
|
-all pts over 40 yo
-younger pts with: ~risk factors ~symptomology ~other disease |
|
|
What are the components of a cardiac assessment?
|
-chart review
-pt/family interview -physical assessment |
|
|
What are the components of cardiac physical assessment?
|
-appearance
-resting vitals -ROM, strength, mobility -activity eval -endurance eval |
|
|
What are the components of activity evaluation?
|
-vitals w/ positional change
-ROM -ADL |
|
|
What should be monitored during endurance assessment?
|
-vitals
-RPE -O2 Sat -ECG |
|
|
What are the effects of smoking on the cardiovascular system?
|
-sticky endothelium
-dec O2sat due to CO-Hb -inc TPR due to vasoconstriction |
|
|
What is the role of the MD in exercise testing of pts with high risk? Moderate? Low?
|
-high = MD must be present
-mod = MD available by phone -low = no MD supervision |
|
|
What are the types of exercise tests used?
|
-S/S limited tests
-exercise echocardiography -nuclear testing (thallium scan) -pharmacologic testing |
|
|
What are the aspects of informed consent?
|
-procedure
-possible risks -pt may withdraw at any time |
|
|
What are the 3 most typical modes of GXT?
|
-treadmill
-cycle ergometry -arm ergometer |
|
|
What values are measured during GXT?
|
-HR
-BP -ECG Changes -RPE -expired gases |
|
|
What are the components of exercise prescription?
|
-warmup
-endurance phase -recreation phase -cool down |
|
|
What comprises the warm up phase of exercise?
|
-5-10 min of progressive aerobic exercise
-5-10 min stretching |
|
|
What comprises the endurance phase of exercise?
|
-20-60 min of continuous or intermittent aerobic activity
-duration is inversely proportional to intensity -consider health related and skill related fitness |
|
|
Why include recreational activity to exercise?
|
-inc compliance
-maximize success |
|
|
What factors of cardiorespiratory fitness can be manipulated?
|
-frequency
-intensity -time (duration) -type (mode) |
|
|
What are the phases and supervision level of cardiac exercise prescription?
|
phase I - inpatient
phase II - 12 wks, supervised OP exercise/educ following d/c phase III - variable length, less ECG monitor, under supervision phase IV - no ECG, limited supervision |
|
|
What is the recommended intensity for exercise of cardiac pts?
|
-40-50% of VO2 reserve (HR reserve) using Karvonen
-RPE phase I-II: 11-13; fairly light -RPE phase III-IV: 12-15 |
|
|
What is the recommended frequency and duration of exercise for cardiac rehab pts?
|
-3-5 days per week
-20-60 min varied by intensity |
|
|
What are possible sites of entry for A-lines? What are they used to measure?
|
-femoral, brachial, radial a.
-arterial pressure, draw blood, invasive BP measurement |
|
|
What is an EPS? What does it measure?
|
-electrophysiological study
-measures conduction pathway |
|
|
What are precautions for a pt s/p CABG?
|
-no shldr flexion
-no push/pull -no valsalva in bathroom -use pillow brace for sneeze/cough/hiccup/transer |
|
|
What is on-pump open heart surgery? How does this affect pt outcome?
|
-heart stopped and filled w/ cardioplea, then restarted
-pts lethargic, lose memory, inc length of stay |
|
|
What is off-pump open heart surgery? How does this affect pt outcome?
|
-surgeon operates on beating heart
-dec length of stay, faster progression, better outcomes |
|
|
What is MIDCAB?
|
-minimally invasive direct coronary artery bypass
=> No fracture |
|
|
What does a Swanz-Ganz catheter measure? What are possible sites of entry?
|
-all chamber pressures
-CO =>usually subclavian a., femoral less frequent |
|
|
What is an IABP? What is its function?
|
-intra-aortic balloon pump
-assists L ventricle function |
|
|
What are the benefits of IABP during diastole?
|
-closed during diastole allowing greater systemic/coronary perfusion
|
|
|
What are the benefits of IABP during systole?
|
-opens creating vacuum to decrease resistance to L vent ejection
-inc SV & CO -dec required myocardial/systemic VO2 |
|
|
What patients are given IABP? What therex is indicated?
|
-pts awaiting surgery, very deconditioned
-ROM of unaffected extremities -cervical ROM -education and circulatory exercise |
|
|
What factors dec O2sat? Why are they significant?
|
-inc temperature, CO2, and pH resulting from anaerobic metabolism
=>indicates high intensity activity, reduce intensity to increase O2sat... |
|
|
What monitors can be used to assess treatment tolerance?
|
-ECG changes (HR, arrhytmia)
-BP abnormality -O2sat changes |
|
|
What enzymes are primarily evaluated to determine cardiac muscle damage?
|
-CPK-MB
-troponin |
