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78 Cards in this Set
- Front
- Back
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What is a normal ABI and how do you take it
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normal ranges from 0.95-1.12
Take it by dividing the LE/UE at the brachial and dorsal pedal/ tib post |
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What is an ABI for MOD and SEVERE
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0.75-0.94 Min
0.5-0.74 Mod < Severe |
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What does it mean if the ABI is positive
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If ABI is <1.15 -1.00 that is normal if it is 1.12 or more than it is either due to failure of occluding or arterial disease`
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Baby HR and RR are usually around 2x that of adult
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true
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T/F You should always test venous before arterial blood vessels
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True
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Trendelenberg Test
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Tests the deep veins by occluding the superficial
Raise LE up 60* and for then lower and see how long it takes to return >30s = venous issues |
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BRUIT sound
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Blowing sound. Usually found in femoral arterial = artherosclerosis
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Arterial Exams
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Rubor of Dependence
Venous Filling Time Exam for Intermittent claud |
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Rubor of dependency
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Elevate pt foot and see if pa;or develops
Place foot in dependent position and it will get red = Arterial insuficiency if lasting longer than 30s |
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Pulse Strength normal is what on the scale
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3+ as opposed to reflexes which would be 2+
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Delayed venous filling time
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To test elevate patient LE to 45* and then wait and place patient in dependent position . Delayed filling time would be anything >15 seconds
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Venous Filling time
Arterial Filling time |
Venous Normal FIlling time <15s
Arterial filling time <30s |
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Intermittent claudication usually develops where?
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Calves but can develop in thigh, dorsum of foot and hips
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To test for claudication by treadmill
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Have pt walk at 1 mile/hour on tread - Stop test if claud pain presents
Note time of test Use subjective Rating Grade I - min Grade II -mod Grade III -intense - patien cannot be diverted Grade IV - excrciating and unearable |
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Trophic changes with arterial insufficiency
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coldness, numbness or palllor of legs; loss of hair on anterior and tibial area
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Thallium is used for what
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injected in blood to look for ischemia - THallium 201 scan
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Cardiac Cath looks at
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Anatoy of heart and great vessels, ventricular function, abnormal wall movements
Allows for determination of ejection Fraction |
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Normal Ejection fraction
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60-70%
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Central Line AKA Swan Ganz
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Inserted through vessels into right side of heat and measures Central venous Pressure, Pulm Artery pressure, Pulm capillary wedge pressures
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Enzymes for MI (3)
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SGOT
CK or CPK LDH |
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SGOT
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Enzyme that increases with MI and peaks at 24-48 hours
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CK or CPK
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Creatine phosphokinase - present with breakdown of muscle and peaks at 24 hours
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CK-MB
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peaks earlier at 12-24
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LDH
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enzyme elevated with MI that peaks 306 days
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Cholesterol Levels
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<200 if 240 HIGH RISK
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HDL
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>60
35-60 mod risk <35 HIGH RISK |
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LDL
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>160 low risk
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Triglycerides
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<165 desirable
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LDL/ HDL Ration
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Acceptable 0.5-3.0
>6.0 high risk |
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Levines Sign
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Patient clenches fist over sternum
Assoiciated with angina and is seen with CAD |
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Rate Pressure Product
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Used to predict Stable Angina
HRxBP |
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T/F It is acceptable to use RPP for unstable angina
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FALSE
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Name the ECG Finding
Inverted T Wave |
Zone of Ischemia
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Name the ECG Finding
pathological Q waves |
Central Zone of infarct
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Name the ECG Finding
ST Segment Depression |
Zone of Injury
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Name the ECG Finding
ST Segment Depression |
ANgina or ischemia
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Q wave can differentiate between transmural (full thick MI) vs nontransmural
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True
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With an anterior MI
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will have Lower conductive issues and is due to left anterior descending
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Lateral MI
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Circumflex Artery will cause ventricular FOCI
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Inferior MI
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Upper conduction abnormalities and R ventricular issues due to RCA
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What will impaired ventricle tests show
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Decrease - EF, stroke volume, CO
Increased - End diastolic volume pressure |
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Right Heart Failure
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Inability of the R ventricle to pump blood into the lungs
Blood is not adequetly returned from the systemic circ Due to failure of R ventricle you will see increase in pressure in pulm arteries |
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Right Heart Failure Symptoms
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Increase in Pulm Artery Pressure
Peripheral Edema Anorexia Nausea |
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Left Heart Failure
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Failure of the Heart to pump OUT to systemic System
Will see increases in end ventricular diastolic pressure and left atrial pressures including Pulmonary Edema and artery pressures increase Pulmonary Signs - cough, dyspnea, orthopena |
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Mainstay treatment for CHF
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Digitalis - Increase in contractility without increase in HR (actually decreases
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Signs of PVD
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Pulses - Diminished or Absent
Color - Pale on elevation/ Rubor Dependent Early Stages - patient exhibits intermittent claud. Pain bearing aching, crmamping, tightness LAte - ischemia and rest pain, ulceration anf gangrene as wel as tophic changes |
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PVD involves small arteries T/F
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False - Buergers Disease
* Is of the small vessles Occurs in young adults |
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Raynaulds Phenomenon
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Vasocontriction of smaller vessels typically in females and exacerbated by the cold or emotional stress
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DVT is associated with venous stasis
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TRUE
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What is the best prophylaxis for DVT
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Early Ambulation
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Sign of DVT
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Homans sign - calf pain with dorsiflexion of ankle. limited dx reliability
Maybe assymptomatic at first but tenderness, skin discoloration, warmth, pain and tenderness |
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Rx for DVT
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Bed rest
Streptokinase (thrombolytics), anticoag therapy (heparin) May see Pulm Emboli which will show chest pain with dyspnea, diaphoresis, cough and apprehension |
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Deep Chronic Insufficiency
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Pain - none to aching on dependency
Pulse - Normal - may be difficult with edema Color - normal or syanotic Venous Valv insufficiency Musle pump dysfunction Edema |
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Classification of Deep Vein Insufficiency
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I - mild aching, min edema, dilated superficial veins
II increased edema, multiple dialted veins Venous Claudication - severe edema |
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What is the typical intensity prescribed to individuals in cardiac rehab
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60-70%
ranges from 40-85% |
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If a person is prescribed for no work Above 6 METS what type of activity is contraindicated
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Resistive
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When prescribing intensity to resistive training what % og max voluntary contraction should you aim for
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40%
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What is the best value to look at when monitoring an individual for resistive exercise?
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RPP RatePressure product
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Which exercise increases HR and puts more pressure on the Heart LE or UE Erg
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UE erg
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How do we adjust MAX HR for UE Ergs
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220 - Age - 11 is appropriate
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True or False
To achieve 60-80% of functional capacity you can aim at 70-85% of HRmax |
True
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When would you want to use the Karnoven Formula as opposed to the estimated max HR
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Pacemakers
Beta Blockers Environmental extremes, heavy arm work, isometric exercise, and Valsalva |
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Important Borg Scale Values
12-13 = what HR and is labeled 16 = what HR and is labeled |
12-13 - Somewhat hard = 60% HR range
16 = Hard and correlated to 85% HR So try not to go over 16 |
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What is the problem with using METS only to prescribe exercise
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1. Some activities (high intensity) require discontinous Run 5 min Jog 3 minutes
2. SKill level of person will change met expenditure 3. Does not take into acount Environmental stresses |
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For moderate intensity exercise the duration for conditioning should be _____
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20-30 minutes
Increase intensity decreased duratin |
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Duration-
Severely compromised individuals may benefit from ____, ____exercises sessions spaced throughout the day |
Multiple, short 3x day at 10 minutes
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Warm up duration is constant and is 5-10 minutes
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True
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Frequency is dependent on
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Duration and Intensity
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Frequency is usually
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3-5x per week with METS >5 METS
If METS is <5 than short duration and increased frequency (daily or multiple sessions) |
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How long should you wait to prescribe exercise for a person post PTCA percutaneus transluminal coronary angioplasty
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2 WEEKS to allow inflammation subside
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Exercise Prescription post CABG
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Limit UE activity while sternal incision is healing
Avoid lifting, pushing m puling for 4-6 weeks |
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Contraindication for admittance to Cardiac Rehab
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Unstable Angina
BP > 200 or resting diastolic 110 is evaluated on case bases Orthostatic Hypotension Critcial aortic stenosis Acute systeic illnes or fever unctrolled atrial or ventricl dyshthmias Uncontrolled sinus tachycardia CUncompensated CHF Thrid Defree AV heart block (without pacemake) Active pericarditis or myocarditis Recent emboli Thrombphlebitis Resting ST segment displace (>2mm) Uncontrolled diabletes (resting at>300 or >250 with ketones) Sever orthoedic problems Acute thyroiditis, hytperke |
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Uncontrolled Tachycardia is defined as
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HR >120 BPM and is a contraindication to Cardiac Rehab
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METS prescribed to Cardiac Rehab 1
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Initial 2-3 than 3-5 by d/c
RPE in fairly light Range only HR increase 10-20 bpm |
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WHEN TO STOP EXERCISE
5 Reasons |
1. >110 Diastolic
2. Drop in 10 or more mmHg Systolic BP 3. Severe Dysrythmias (a or V) 4. Signs and symptoms of exercise intolerance including ischemia on ECG, marked dyspnea, angina 5. 2nd or 3rd degree heart block |
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How many mets is necassary for resumption of most daily activities
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5 METS
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What is a goal for METS for phase
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2 rehab = 9 METS
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What phase do u start resistive exercise
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2
3 weeks post cardiac rehab 5 weeks post MI 8 Weeks CAPG Elastic bands 1-3 lb 12-15 reps |
