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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