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130 Cards in this Set
- Front
- Back
- 3rd side (hint)
P wave refers to
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atrial depolarization
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QRS complex
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ventricular depolarization
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ST segment
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manifests MI, ischemia (problems with blood flow)
-elevated -depressed |
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J point
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beginning of ST segment. (junctional point, where deflection changes from vertical to horizontal)
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EKG rhythm determined by
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counting from one R to the next; looking for atrial and ventricular regularity
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EKG rate determined by
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count QRS complexes in a minute (or estimate).
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if EKG rate is irregular?
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count for a full minute!
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measuring conduction from EKG: PR interval
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time from when SA node fires, and when it gets through entire atria and fibrous band (beginning of P wave to beginning of ventricular depolarization)
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how to calculate PR conduction?
normal values? |
multiply baby boxes by .04
normal is 0.12-.2 |
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measuring conduction at QRS:
normal values |
beginning of Q to end of S (multiply by .04)
.04-.10 |
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downward sloping ST segments
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bad
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upward sloping ST segment
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not so bad
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PVC characteristics (3)
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-no P wave
-widened QRS complex -compensatory pause |
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when is PVC significant?
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there are more than 6/min., or they're multifocal (unidentical)
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upside down T wave indicates?
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ischemia, Mi (T wave flips weeks afterward)
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cholesterol levels:
normal? high? |
120-200
>240 |
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HDL desirable value?
at risk for CAD? |
>60
<40 |
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LDL desirable?
high? |
<100
>160 |
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triglycerides?
normal value high value |
<150
>200 mg/dL |
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predictive triglyceride levels in women?
-optimal? -in men? |
total: high
<5:1 High LDLs |
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homocysteine levels
>___ = increased risk for heart disease what drops homocysteine? |
>12
folic acid |
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C-reactive protein:
<___mg/L is considered low risk >____mg/L =high risk of developing CAD |
<1.0
>3.0 |
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Anthropometrics/BMI
-underweight? -normal? overwt? -obese? |
<18.5
18.5-24.9 25-29.9 >30 |
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minimum exercise parameters for at-risk for CAD individuals?
those with HTN? |
aerobic, 20-30mins/day, 3-5x/week, intensity 70-85%max HR
calculate exact max HR |
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HTN can lead to? (3)
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hypertrophied L ventricle
stroke (cerebral arteries) coronary arteries (Heart trauma) |
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for diagnosis of HTN, must have ?
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140/90
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medical intervention for HTN (5)
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ace inhibitors
diuretics beta blockers ca channel blockers vasodilators |
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during systole:
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great valves open, mitral and bicuspid valves close.
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during diastole
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AV valves open, great vessel valves close.
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pathophysiology of valvular heart disease:
-infectious? -congenital? |
Rheumatic Fever (strep inf)
decreased leaflets, mitral valve prolapse |
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symptoms:
SOB syncope dizziness fatigue slow onset over period of yrs |
Left sided valvular heart disease
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symptoms:
venous distention tissue hypoxia without hypoxemia syncope dizziness fatigue slow onset of symptoms |
Right sided valvular heart disease
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signs:
forward failure backward failure murmur on heart sounds normal EKG |
valvular heart disease
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Litotes
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* Deliberate understatement of an idea
* By denying the contrary of the idea being affirmed * Opposite of hyperbole |
e.g. "War is not healthy for children and other living things.";
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signs:
no crackles adequate SaO2 cold extremities decreased functional capacity |
right sided heart failure
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Grading murmurs:
1/6 2/6 3 4 5 |
1can only be heard w/careful listening
2-readily audible with stethoscope 3-a little louder than 2 4-as loud as 3, but with vibration attached 5-audible with edge of stethoscope 6-audible with naked ear |
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mitral stenosis:
heard as: |
failure of mitral valve to open completely.
diastolic murmur |
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signs and symptoms:
SOB, CHF orthopnea PND exercise intolerance palpitations syncope dyspnea on exertion peripheral edema w/R sided heart failure |
mitral stenosis
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a-fib (due to atrial enlargement)
systemic embolism CHF exercise intolerance infection may have R sided heart failure as well with peripheral edema ..complications of? |
mitral valve stenosis or regurgitation
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mitral regurgitation will be heard as?
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murmur during systole
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signs and symptoms:
SOB, CHF orthopnea PND exercise intolerance palpitations light headedness, dizziness syncope DOE peripheral edema w/right sided Hrt failure |
mitral valve regurgitation
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distinction b/w mitral stenosis and regurgitation?
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listen to heart sounds! when in cardiac cycle the murmur occurs
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signs and symptoms:
SOB, CHF orthopnea PND ex intolerance palpitations light headedness syncope DOE peripheral edema w/R sided heart failure angina (due to LV hypertrophy) |
aortic stenosis or regurgitation
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dysrrhythmias, endocarditis, and LV hypertrophy are complications of..
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aortic stenosis
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L ventricle failure
pulmonary edema endocarditis ..complications of? |
aortic regurgitation
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intervention for valvular disease?
-drug therapy (2) |
anticoagulants
vasodilators (decrease afterload) |
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intervention for valvular heart disease (surgical (3))
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balloon valvuloplasty (thru foramen ovale)
annuloplasty (repair-ring around valve) valvular replacement |
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PT intervention for valvular heart disease
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exercise (karvonen's for intensity; low end of range-long term sickness)
diet evaluation education |
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exercise contraindicated in which valv. disorder?
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aortic stenosis
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symptoms:
skips a beat SOB headache fatigue dizziness syncope chest pain |
dysrrhythmia
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finding in EKG evidence can be done via:
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at rest
Holtens (24/48 monitor) King of hearts (pt presses button when symptoms come on) during exercise |
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electrophysiologic studies are used when:
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you think you can't catch dysrrhythmia on EKG and you think it might be lethal problem
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dysrrhythmias : medical mgmt of:
pharmacology (2) pacemakers(2) other(2) |
antiarrhythmics, beta blockers (decr HR)
pacemakers, Internal Cardiac defibrillator Radiofrequency Catheter ablation (scars heart takes out defective loop) revascularization |
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considerations for exercise prescription in pts with dysrrhythmias
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Mode
frequency duration intensity (use karvonen no matter what-not to exceed rate of AICD)-stay at least 20 bpm below |
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PT intervention considerations for dysrrhythmic pts:
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basic diet eval
stress reduction education (about devices; if you feel arrhythmia coming on, sit down, call for help; don't drive) |
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common atrial arrhythmias:
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atrial fibrillation
a-fib with slow ventricular response a-fib with rapid response |
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can person w/atrial arrhythmia exercise?
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yes, as long as it's not rapid, pt is on coumadin, and if BP holds
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common arrhythmias: atrial waves are slower than a-fib, can actually see them, (p waves) (sawtooth appearance)
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a flutter
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uncommon arrhythmias: 4 or more beats consecutively:
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v-tach
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if person has atherosclerosis, he likely has (3)
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Cerebral vascular disease
coronary artery disease peripheral vascular diseae |
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angina occurs when
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demand of heart exceeds supply of heart (can be blood volume or content issue)
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angina exam: symptoms
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have patient use words to describe
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angina exam: occurrence
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unstable vs stable (indicates predictability)
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medical intervention for angina:
pharmacology : |
nitro!
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angina med intervention: revascularization route:
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PTCA
arthrectomy CABG transmyocardial revascularization |
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PT intervention for angina:
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exercise: mode, duration, frequency, intensity: karvonen's, keep below RPP threshold, symptoms: describe pain, nitr: have it with them; keep BP cuff with you!
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karvonen's formula
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(max HR-rest HR)x(40-85%) +HR rest
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outside of ex, PT intervention for angina:
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smoking cessation
diet eval stress reduction education |
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Ex prescription for angina:
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20-30 mins, 3-5x/week, intensity: low end of karvonen
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NYHA functional capacity w/angina/cardiac disease
I: II: III: IV: |
I: no limitation, often pt doesn't even know
II: slight limitation of physical activity, comfortable at rest III: marked limitation of phys activity, comfortable at rest IV: inability to carry on ay physical activity w/out discomfort. symptoms of heart failure /angina may present at rest, and increase on PE. |
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signs/symptoms:
pain/angina SOB nausea light headedness sense of doom abnormally high or low HR and BP Diaphoresis (cold, clammy skin) |
MI
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medical intervention (drug therapy for MI)
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antianginals
decrease afterload decreaes HR (-alols); beta blockers -obligatory for those who've infarcted; except asthma pts increase contractility lysing agents anticoagulants |
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MI medical intervention:
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PTCA (w/stent)
arthrectomy (shaving off plaque from arterial wall) revascularization surgery (CABG, MIDCABG, offpump) |
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PT intervention for MI;
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diet evaluation
stress reduction pt education exercise-freq, mode, duration, intensity-use karvonen's -must calculate exact HR, and RPE scale |
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During hospitalization, MI referrals: PT's role is: (5)
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assess pt's hemodynamic response to activity
assess efficacy of medical mgmt pt and family education ascertain clinical data for prognosis/mgmt identify/modify cardiac risk factors |
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examination procedure for MI
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musculoskel/neuro screen
symptoms (angina pattern-know this before you move them at all) Take vitals in supine, sit, stand, peak, and recovery home situation |
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during hospitalization: levels of function:
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1: bed positioning, PROM
2: bed to chair transfer 2+: bed to chair transfer, AAROM 3:warm up exercises, 50 ft amB 3+100 ft amB 4: 250 ft 5:500 ft, i flight stairs |
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during hospitalization: stop activity if:
-hypertension? -hypotension? -narrowing of pulse pressure to? -EKG abnormalities? -angina? -fatigue? -dyspnea? |
>180/100
drop of 10-15mmHg within 20 mmHG of each other couplets, triplets, v-tach, a-fib, >10pvcs/min, change in rhythm angina indicates need for medical mgmt fatigue dyspnea: record RR and SaO2 |
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during hosp: pt is home ready when:
-RPE and HR ex ex progression pt and famliy ed OP CR |
accurate self monitoring of RPE and HR
ex prescribed based on IP performance w/mode, intensity, freq, adn duration is written ed completed referral to OP CR given |
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cardiomyopathy defn:
EF<___? |
poor contractility of all myocardial segments
<25% |
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5 causes of cardiomyopathy:
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extensive multi-vessel CAD
viral toxic post-partum congenital |
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2 types of cardiomyopathy:
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ischemic, nonischemic
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ischemic cardiomyopathy:
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results from heart ms damage from CAD
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nonischemic (3) cardiomyopathy:
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dilated
hypertrophic restrictive |
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dilated cardiomyopathy: chambers dilated, fibers pulled apart, lengthened, interspace too large for effective contraction:
vent volume__ ven mass__ systolic fcn__ diastolic fcn__ |
incr
decr decr stiffness incr, filling pressure incr |
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signs/symptoms:
fatigue weakness SOB DOE orthopnea edema wt gain arrhythmias systolic murmur S3 echo: englarged chamber size cardiac cath EKG: arrhythmias |
dilated cardiomyopathy
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treatment for cardiomyopathy (drug therapy (5))
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digoxin
diuretic vasodilator beta blocker calcium channel blocker |
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treatment for dilated cardiomyopathy (surg)
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LVAD
pacemaker AICD ventriculectomy transplant |
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hypertrophic cardiomyopathy
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chamber size gets smaller, spetal wall blocks aorta, and blood can't get out. (diastole is ok, systole is problem)
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hypertrophic cardiomyopathy:
-vent volume: -vent mass: -systolic fcn: diastolic fcn: |
decr
incr EF normal, outflow obstruction stiffness increased, filling pressure increased |
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signs/symptoms:
SOB dizziness fainting angina cardiac arrhythmias that can lead to sudden death heart murmur can be heard |
hypertrophic cardiomyopathy
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hypertrophic cardiomyopathy intervention:
-alcohol ablation -myectomy |
-produces chem MI (subaortic) thins septum to enlarge outflow tract
-area of ms removed to increase chamber size |
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restrictive cardiomyopathy
-vent volume -vent mass -systolic fcn -diastolic fcn |
same
rigidity EF decreases stiffness increased, decreased vent filling, filling PRESSURE increased |
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Prior conditions of
cardiac ischemia/infarction valvular dysfunction pulmonary disease cardiomyopathy ..can lead to? |
chronic heart failure
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symptoms/signs:
fatigue cold extrems SOB decreased ability to perform ADLs orthopnea PND mottling of skin peripheral edema PaO2 decreased decreased fcnl capacit crackles cardiac wheezing s3 maybe s4 |
chronic heart failure
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chronic heart failure drug therapy: (5)
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beta blockers
digoxin vasodilators diuretics ca channel blockers |
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PT intervention in chronic heart failure:
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exercise: intensity karvonen's, stress reduction, eduation, diet eval
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revascularization surgeries for chronic heart failure:
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CABG
balloon angioplasty (PTCA) TMR |
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Revascularization: balloon angioplasty:
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tip of catheter into groin thru fem A, adcanced to obstr, and inflated and released, increasing bl flow
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Post surgery: quick PT assessment of pt:
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vital signs with mobility
sensation pain mgmt bs cough ability functional assessment/early amb active motion |
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main issues w/post-operative care:
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pulmonary
mobility teaching home-ex program |
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valvular surgeries:
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commissurotomy
balloon valvuloplasty valvular repair valvular replacement |
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surgeries for cardiac arrhythmias
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ablation
AICD |
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surgical mgmt of heart failure (3)
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LVAD
Jarvik (pump attached to L vent; pumps oxygenated bl throughout body) ventriculectomy |
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surgical mgmt of hypertrophic cardiomyopathy:
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ethynol ablation (takes off piece of septum)
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pharmacology:
lipid reduction category: |
antihyperlipidemics,
all end in -statin adverse effects: stressed GI |
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for triglyceride reduction
lifestyle changes: |
smoking cessation
control of Bl glucose limit/cease alcohol consumption |
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risk factor mod for pts w/HTN
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stop smoking
stop alcohol exercise maintain healthy bodyweight healthy diet manage stress |
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pharmacology for HTN:
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ACE inhibitor (#1 antihypertensive)
diuretic beta blockers ca channel blockers angiotensin |
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CAD pharmacology
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HTN drugs (ace, diuretic, beta blockers, ca channel blockers, angiotensin)
nitro anticoagulants thrombolytics cardiotonics (incr contractility) |
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intervention for valvular disorders:
-lifestyle: -pharm: |
surgical repair (no lifestyle)
diuretics anticoagulants antiarrhythmics (if atria is separating) cardiotonics antibiotics (vegetation?) |
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pharm for dysrrhythmias:
-lifestyle -pharm |
none
beta blockers, anticoagulants, ca channel blockers, antiarrhythmics (awful drug; last resort) |
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lifestyle mods for chronic heart failure and cardiomyopathy:
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sodium
sat fat, cholesterol limit alcohol exercise stop smoking weigh daily (>3 lbs rapidly=fluid ret'n; call doc) reduce stress |
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Risk factors for CAD (9)
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HTN
smoking cholesterol family history obesity sedentary lifestyle diabetes gender |
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S1:
___: S2: ___: |
mitral and tricuspids close
systole great vessel valves close diastole |
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aortic heard best where?
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at base of R
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pulmonic heard best where?
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at base of L
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S3 sound:
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abnormal; best heard w/light pressure over apex during early diastole (rapid filling); reflects decreased ventricular compliance or increased ventricular diastolic volume .
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S3 heard with:
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CHF, CAD, incomplete valves, VSD, PDA)
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S4 sound:
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occurs just before 1st heart sound (late diastolic filling, when atria contract). usually developed by those who've just ahd heart attack. causes: HTN, aortic stenosis, L vent MI
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auscultation of lungs in assessing cardiac fcning?
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important! crackles at bases? is cardiac system affecting the lungs?
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C-reactive protein:
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inflammation marker; used to predict new coronary events in pts w/unstable angina and acute MI. increased in indvs w/recent tissue injury, or generalized infection
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CK:
abnormal: |
marker of cell death (ms, heart, brain)
>200 |
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CK-MB:
abnormal: |
marker of myocardial cell death
>10 |
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CK-MB index:
abnormal: |
differentiating noncardiac and cardiac sources of elevated Ck-MB
>6 |
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troponin:
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no "normal" amt is present in blood. more immediate indicator than cks. indicates cell death in cardiac cycle.
.01-.1; >.1 is significant. |
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BNP
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brain natriuretic peptide: used to diagnose heart failure. differentiate b/w heart and lungs. (may be low in pts w/ACE, beta blockers)
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St elevation or depression and T wave inversion are signs of:
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ischemia/infarction
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significant Q waves:
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long term marker of MI (chronic); don't look for these acutely
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MIBI vs thallium
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same effect; looking for perfusion, though MIBI is rid from system quicker.
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