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