Cardiopulm Quiz 3

Front 1

P wave refers to

Back 1

atrial depolarization

Front 2

QRS complex

Back 2

ventricular depolarization

Front 3

ST segment

Back 3

manifests MI, ischemia (problems with blood flow)
-elevated
-depressed

Front 4

J point

Back 4

beginning of ST segment. (junctional point, where deflection changes from vertical to horizontal)

Front 5

EKG rhythm determined by

Back 5

counting from one R to the next; looking for atrial and ventricular regularity

Front 6

EKG rate determined by

Back 6

count QRS complexes in a minute (or estimate).

Front 7

if EKG rate is irregular?

Back 7

count for a full minute!

Front 8

measuring conduction from EKG: PR interval

Back 8

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)

Front 9

how to calculate PR conduction?

normal values?

Back 9

multiply baby boxes by .04

normal is 0.12-.2

Front 10

measuring conduction at QRS:

normal values

Back 10

beginning of Q to end of S (multiply by .04)

.04-.10

Front 11

downward sloping ST segments

Back 11

bad

Front 12

upward sloping ST segment

Back 12

not so bad

Front 13

PVC characteristics (3)

Back 13

-no P wave
-widened QRS complex
-compensatory pause

Front 14

when is PVC significant?

Back 14

there are more than 6/min., or they're multifocal (unidentical)

Front 15

upside down T wave indicates?

Back 15

ischemia, Mi (T wave flips weeks afterward)

Front 16

cholesterol levels:
normal?
high?

Back 16

120-200
>240

Front 17

HDL desirable value?
at risk for CAD?

Back 17

>60
<40

Front 18

LDL desirable?
high?

Back 18

<100
>160

Front 19

triglycerides?
normal value
high value

Back 19

<150
>200 mg/dL

Front 20

predictive triglyceride levels in women?
-optimal?
-in men?

Back 20

total: high
<5:1
High LDLs

Front 21

homocysteine levels
>___ = increased risk for heart disease
what drops homocysteine?

Back 21

>12
folic acid

Front 22

C-reactive protein:
<___mg/L is considered low risk
>____mg/L =high risk of developing CAD

Back 22

<1.0
>3.0

Front 23

Anthropometrics/BMI
-underweight?
-normal?
overwt?
-obese?

Back 23

<18.5
18.5-24.9
25-29.9
>30

Front 24

minimum exercise parameters for at-risk for CAD individuals?

those with HTN?

Back 24

aerobic, 20-30mins/day, 3-5x/week, intensity 70-85%max HR

calculate exact max HR

Front 25

HTN can lead to? (3)

Back 25

hypertrophied L ventricle
stroke (cerebral arteries)
coronary arteries (Heart trauma)

Front 26

for diagnosis of HTN, must have ?

Back 26

140/90

Front 27

medical intervention for HTN (5)

Back 27

ace inhibitors
diuretics
beta blockers
ca channel blockers
vasodilators

Front 28

during systole:

Back 28

great valves open, mitral and bicuspid valves close.

Front 29

during diastole

Back 29

AV valves open, great vessel valves close.

Front 30

pathophysiology of valvular heart disease:
-infectious?
-congenital?

Back 30

Rheumatic Fever (strep inf)

decreased leaflets,
mitral valve prolapse

Front 31

symptoms:
SOB
syncope
dizziness
fatigue
slow onset over period of yrs

Back 31

Left sided valvular heart disease

Front 32

symptoms:
venous distention
tissue hypoxia without hypoxemia
syncope
dizziness
fatigue
slow onset of symptoms

Back 32

Right sided valvular heart disease

Front 33

signs:
forward failure
backward failure
murmur on heart sounds
normal EKG

Back 33

valvular heart disease

Front 34

Litotes

Back 34

* Deliberate understatement of an idea
* By denying the contrary of the idea being affirmed
* Opposite of hyperbole

Hint 34

e.g. "War is not healthy for children and other living things.";

Front 35

signs:
no crackles
adequate SaO2
cold extremities
decreased functional capacity

Back 35

right sided heart failure

Front 36

Grading murmurs:
1/6
2/6
3
4
5

Back 36

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

Front 37

mitral stenosis:

heard as:

Back 37

failure of mitral valve to open completely.

diastolic murmur

Front 38

signs and symptoms:
SOB, CHF
orthopnea
PND
exercise intolerance
palpitations
syncope
dyspnea on exertion
peripheral edema w/R sided heart failure

Back 38

mitral stenosis

Front 39

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?

Back 39

mitral valve stenosis or regurgitation

Front 40

mitral regurgitation will be heard as?

Back 40

murmur during systole

Front 41

signs and symptoms:
SOB, CHF
orthopnea
PND
exercise intolerance
palpitations
light headedness, dizziness
syncope
DOE
peripheral edema w/right sided Hrt failure

Back 41

mitral valve regurgitation

Front 42

distinction b/w mitral stenosis and regurgitation?

Back 42

listen to heart sounds! when in cardiac cycle the murmur occurs

Front 43

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)

Back 43

aortic stenosis or regurgitation

Front 44

dysrrhythmias, endocarditis, and LV hypertrophy are complications of..

Back 44

aortic stenosis

Front 45

L ventricle failure
pulmonary edema
endocarditis

..complications of?

Back 45

aortic regurgitation

Front 46

intervention for valvular disease?
-drug therapy (2)

Back 46

anticoagulants
vasodilators (decrease afterload)

Front 47

intervention for valvular heart disease (surgical (3))

Back 47

balloon valvuloplasty (thru foramen ovale)
annuloplasty (repair-ring around valve)
valvular replacement

Front 48

PT intervention for valvular heart disease

Back 48

exercise (karvonen's for intensity; low end of range-long term sickness)
diet evaluation
education

Front 49

exercise contraindicated in which valv. disorder?

Back 49

aortic stenosis

Front 50

symptoms:
skips a beat
SOB
headache
fatigue
dizziness
syncope
chest pain

Back 50

dysrrhythmia

Front 51

finding in EKG evidence can be done via:

Back 51

at rest
Holtens (24/48 monitor)
King of hearts (pt presses button when symptoms come on)
during exercise

Front 52

electrophysiologic studies are used when:

Back 52

you think you can't catch dysrrhythmia on EKG and you think it might be lethal problem

Front 53

dysrrhythmias : medical mgmt of:
pharmacology (2)
pacemakers(2)
other(2)

Back 53

antiarrhythmics, beta blockers (decr HR)
pacemakers, Internal Cardiac defibrillator
Radiofrequency Catheter ablation (scars heart takes out defective loop)
revascularization

Front 54

considerations for exercise prescription in pts with dysrrhythmias

Back 54

Mode
frequency
duration
intensity (use karvonen no matter what-not to exceed rate of AICD)-stay at least 20 bpm below

Front 55

PT intervention considerations for dysrrhythmic pts:

Back 55

basic diet eval
stress reduction
education (about devices; if you feel arrhythmia coming on, sit down, call for help; don't drive)

Front 56

common atrial arrhythmias:

Back 56

atrial fibrillation
a-fib with slow ventricular response
a-fib with rapid response

Front 57

can person w/atrial arrhythmia exercise?

Back 57

yes, as long as it's not rapid, pt is on coumadin, and if BP holds

Front 58

common arrhythmias: atrial waves are slower than a-fib, can actually see them, (p waves) (sawtooth appearance)

Back 58

a flutter

Front 59

uncommon arrhythmias: 4 or more beats consecutively:

Back 59

v-tach

Front 60

if person has atherosclerosis, he likely has (3)

Back 60

Cerebral vascular disease
coronary artery disease
peripheral vascular diseae

Front 61

angina occurs when

Back 61

demand of heart exceeds supply of heart (can be blood volume or content issue)

Front 62

angina exam: symptoms

Back 62

have patient use words to describe

Front 63

angina exam: occurrence

Back 63

unstable vs stable (indicates predictability)

Front 64

medical intervention for angina:
pharmacology :

Back 64

nitro!

Front 65

angina med intervention: revascularization route:

Back 65

PTCA
arthrectomy
CABG
transmyocardial revascularization

Front 66

PT intervention for angina:

Back 66

exercise: mode, duration, frequency, intensity: karvonen's, keep below RPP threshold, symptoms: describe pain, nitr: have it with them; keep BP cuff with you!

Front 67

karvonen's formula

Back 67

(max HR-rest HR)x(40-85%) +HR rest

Front 68

outside of ex, PT intervention for angina:

Back 68

smoking cessation
diet eval
stress reduction
education

Front 69

Ex prescription for angina:

Back 69

20-30 mins, 3-5x/week, intensity: low end of karvonen

Front 70

NYHA functional capacity w/angina/cardiac disease
I:
II:
III:
IV:

Back 70

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.

Front 71

signs/symptoms:
pain/angina
SOB
nausea
light headedness
sense of doom
abnormally high or low HR and BP
Diaphoresis (cold, clammy skin)

Back 71

MI

Front 72

medical intervention (drug therapy for MI)

Back 72

antianginals
decrease afterload
decreaes HR (-alols); beta blockers -obligatory for those who've infarcted; except asthma pts
increase contractility
lysing agents
anticoagulants

Front 73

MI medical intervention:

Back 73

PTCA (w/stent)
arthrectomy (shaving off plaque from arterial wall)
revascularization surgery (CABG, MIDCABG, offpump)

Front 74

PT intervention for MI;

Back 74

diet evaluation
stress reduction
pt education
exercise-freq, mode, duration, intensity-use karvonen's -must calculate exact HR, and RPE scale

Front 75

During hospitalization, MI referrals: PT's role is: (5)

Back 75

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

Front 76

examination procedure for MI

Back 76

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

Front 77

during hospitalization: levels of function:

Back 77

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

Front 78

during hospitalization: stop activity if:
-hypertension?
-hypotension?
-narrowing of pulse pressure to?
-EKG abnormalities?
-angina?
-fatigue?
-dyspnea?

Back 78

>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

Front 79

during hosp: pt is home ready when:
-RPE and HR
ex
ex progression
pt and famliy ed
OP CR

Back 79

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

Front 80

cardiomyopathy defn:

EF<___?

Back 80

poor contractility of all myocardial segments

<25%

Front 81

5 causes of cardiomyopathy:

Back 81

extensive multi-vessel CAD
viral
toxic
post-partum
congenital

Front 82

2 types of cardiomyopathy:

Back 82

ischemic, nonischemic

Front 83

ischemic cardiomyopathy:

Back 83

results from heart ms damage from CAD

Front 84

nonischemic (3) cardiomyopathy:

Back 84

dilated
hypertrophic
restrictive

Front 85

dilated cardiomyopathy: chambers dilated, fibers pulled apart, lengthened, interspace too large for effective contraction:
vent volume__
ven mass__
systolic fcn__
diastolic fcn__

Back 85

incr
decr
decr
stiffness incr, filling pressure incr

Front 86

signs/symptoms:
fatigue
weakness
SOB
DOE
orthopnea
edema
wt gain
arrhythmias
systolic murmur S3
echo: englarged chamber size
cardiac cath
EKG: arrhythmias

Back 86

dilated cardiomyopathy

Front 87

treatment for cardiomyopathy (drug therapy (5))

Back 87

digoxin
diuretic
vasodilator
beta blocker
calcium channel blocker

Front 88

treatment for dilated cardiomyopathy (surg)

Back 88

LVAD
pacemaker
AICD
ventriculectomy
transplant

Front 89

hypertrophic cardiomyopathy

Back 89

chamber size gets smaller, spetal wall blocks aorta, and blood can't get out. (diastole is ok, systole is problem)

Front 90

hypertrophic cardiomyopathy:
-vent volume:
-vent mass:
-systolic fcn:
diastolic fcn:

Back 90

decr
incr
EF normal, outflow obstruction
stiffness increased, filling pressure increased

Front 91

signs/symptoms:
SOB
dizziness
fainting
angina
cardiac arrhythmias that can lead to sudden death
heart murmur can be heard

Back 91

hypertrophic cardiomyopathy

Front 92

hypertrophic cardiomyopathy intervention:
-alcohol ablation
-myectomy

Back 92

-produces chem MI (subaortic) thins septum to enlarge outflow tract
-area of ms removed to increase chamber size

Front 93

restrictive cardiomyopathy
-vent volume
-vent mass
-systolic fcn
-diastolic fcn

Back 93

same
rigidity
EF decreases
stiffness increased, decreased vent filling, filling PRESSURE increased

Front 94

Prior conditions of
cardiac ischemia/infarction
valvular dysfunction
pulmonary disease
cardiomyopathy
..can lead to?

Back 94

chronic heart failure

Front 95

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

Back 95

chronic heart failure

Front 96

chronic heart failure drug therapy: (5)

Back 96

beta blockers
digoxin
vasodilators
diuretics
ca channel blockers

Front 97

PT intervention in chronic heart failure:

Back 97

exercise: intensity karvonen's, stress reduction, eduation, diet eval

Front 98

revascularization surgeries for chronic heart failure:

Back 98

CABG
balloon angioplasty (PTCA)
TMR

Front 99

Revascularization: balloon angioplasty:

Back 99

tip of catheter into groin thru fem A, adcanced to obstr, and inflated and released, increasing bl flow

Front 100

Post surgery: quick PT assessment of pt:

Back 100

vital signs with mobility
sensation
pain mgmt
bs
cough ability
functional assessment/early amb
active motion

Front 101

main issues w/post-operative care:

Back 101

pulmonary
mobility
teaching
home-ex program

Front 102

valvular surgeries:

Back 102

commissurotomy
balloon valvuloplasty
valvular repair
valvular replacement

Front 103

surgeries for cardiac arrhythmias

Back 103

ablation
AICD

Front 104

surgical mgmt of heart failure (3)

Back 104

LVAD
Jarvik (pump attached to L vent; pumps oxygenated bl throughout body)
ventriculectomy

Front 105

surgical mgmt of hypertrophic cardiomyopathy:

Back 105

ethynol ablation (takes off piece of septum)

Front 106

pharmacology:
lipid reduction category:

Back 106

antihyperlipidemics,
all end in -statin
adverse effects: stressed GI

Front 107

for triglyceride reduction
lifestyle changes:

Back 107

smoking cessation
control of Bl glucose
limit/cease alcohol consumption

Front 108

risk factor mod for pts w/HTN

Back 108

stop smoking
stop alcohol
exercise
maintain healthy bodyweight
healthy diet
manage stress

Front 109

pharmacology for HTN:

Back 109

ACE inhibitor (#1 antihypertensive)
diuretic
beta blockers
ca channel blockers
angiotensin

Front 110

CAD pharmacology

Back 110

HTN drugs (ace, diuretic, beta blockers, ca channel blockers, angiotensin)
nitro
anticoagulants
thrombolytics
cardiotonics (incr contractility)

Front 111

intervention for valvular disorders:
-lifestyle:
-pharm:

Back 111

surgical repair (no lifestyle)

diuretics
anticoagulants
antiarrhythmics (if atria is separating)
cardiotonics
antibiotics (vegetation?)

Front 112

pharm for dysrrhythmias:
-lifestyle
-pharm

Back 112

none
beta blockers, anticoagulants, ca channel blockers, antiarrhythmics (awful drug; last resort)

Front 113

lifestyle mods for chronic heart failure and cardiomyopathy:

Back 113

sodium
sat fat, cholesterol
limit alcohol
exercise
stop smoking
weigh daily (>3 lbs rapidly=fluid ret'n; call doc)
reduce stress

Front 114

Risk factors for CAD (9)

Back 114

HTN
smoking
cholesterol
family history
obesity
sedentary lifestyle
diabetes
gender

Front 115

S1:
___:
S2:
___:

Back 115

mitral and tricuspids close
systole
great vessel valves close
diastole

Front 116

aortic heard best where?

Back 116

at base of R

Front 117

pulmonic heard best where?

Back 117

at base of L

Front 118

S3 sound:

Back 118

abnormal; best heard w/light pressure over apex during early diastole (rapid filling); reflects decreased ventricular compliance or increased ventricular diastolic volume .

Front 119

S3 heard with:

Back 119

CHF, CAD, incomplete valves, VSD, PDA)

Front 120

S4 sound:

Back 120

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

Front 121

auscultation of lungs in assessing cardiac fcning?

Back 121

important! crackles at bases? is cardiac system affecting the lungs?

Front 122

C-reactive protein:

Back 122

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

Front 123

CK:
abnormal:

Back 123

marker of cell death (ms, heart, brain)
>200

Front 124

CK-MB:
abnormal:

Back 124

marker of myocardial cell death
>10

Front 125

CK-MB index:
abnormal:

Back 125

differentiating noncardiac and cardiac sources of elevated Ck-MB
>6

Front 126

troponin:

Back 126

no "normal" amt is present in blood. more immediate indicator than cks. indicates cell death in cardiac cycle.
.01-.1; >.1 is significant.

Front 127

BNP

Back 127

brain natriuretic peptide: used to diagnose heart failure. differentiate b/w heart and lungs. (may be low in pts w/ACE, beta blockers)

Front 128

St elevation or depression and T wave inversion are signs of:

Back 128

ischemia/infarction

Front 129

significant Q waves:

Back 129

long term marker of MI (chronic); don't look for these acutely

Front 130

MIBI vs thallium

Back 130

same effect; looking for perfusion, though MIBI is rid from system quicker.