4229904
Description
Flashcards by clingenhoel, updated more than 1 year ago
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Created by clingenhoel
over 8 years ago
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| Question | Answer |
| Heart cycle | Right Atrium receives blood from superior and inferior vena cava--tricuspid>Right ventricle-->lungs via pulmonary artery-->Left atrium--bicuspid>Left ventricle -->aorta to the body |
| Conduction of the heart | SA node impulse spreads throughout atria which contact together-->impulse stimulates AV node, transmitted down bundle of His to Purkinje fibers; impulse spreads to ventricles which contract together |
| Cardiac output | Q= SV x HR normally 4-5 L/min |
| Ejection fraction | % of blood emptied from ventricle during systole; clinical measure of LV function EF=SV/ left ventricular end diastolic volume(LVEDV) |
| Lymphatic system | Drains lymph from bodily tissues and returns it to venous circulation. All travel to left subclavian vein. Contributes to immune system fx: lymph nodes collect cellular debris and bacteria; remove excess fluid, blood waste and protein, and produce antibodies |
| Parasympathetic stimulation (cholinergic) | Control in medulla oblongata Via vagus nerve (CN X), cardiac plexus; innervates all myocardium; releases acetylcholine. causes artery vasoconstriction |
| Sympathetic stimulation (adrenergic) | Control in medulla oblongata Via cord seg T1-T4 Releases epinephrine and norepinephrine. Fight or flight |
| Baroreceptors (pressoreceptors) | Main mechanism controlling HR |
| Circulatory reflex | Respond to changes in BP 1) Increased BP results in parasympathetic stim, dec rate and force ; sympathetic inhibition, decreased peripheral resistance 2) Decreased BP results in sympathetic stimulation, inc HR and BP and vasoconstriction of peripheral blood vessels |
| Chemoreceptors | Sensitive to O2. CO2, lactic acid. Inc CO2, lowers pH, inc HR Inc O2, decreased HR (less needed cycle of O2/min) |
| Hyperkalemia | Inc K+ ions widen PR interval and QRS, tall T waves |
| Hypokalemia | dec K+ ions flattened T waves, prolonged PR and QT intervals-->ventricular fibrillation |
| Normal HR | Adult: 60-100 Children: 60-140 Newborns: 90-164 |
| Heart sounds (normal) | Lub: normal closure of mitral and tricuspid valves (beginning of systole) Dub: normal closure of aortic and pulmonary valves (end of systole) |
| Normal RR | Adult: 12-20 b/m Child: 20-30 b/m Newborn: 30-40 b/m |
| Ankle brachial index (ABI) | The ratio of LE pressure / UE pressure 1.00-1.40- normal <0.90 = 2-4 fold increased risk for cardiovascular event/death < 0.50 =inc risk for limb ischemia in 1 yr Clinically significant change = > 0.10-0.15 in patient with symptoms |
| STEMI | Tissue death full thickness of myocardium ST elevated MI (STEMI) or Q wave |
| Heart failure: heart is unable to maintain circulation of the blood to meet needs of the body | Left sided (CHF): pulmonary congestion, edema and low Q due to backup of blood from left ventricle to left atrium and lungs. (From excessive workload from the heart, hypertension) Right sided: Increased pressure load on R ventricle with heir pulmonary vascular pressures. Jugular vein distention and peripheral edema *Can have biventricular |
| REDUCE BP ACE inhibitors Angiotension II receptor blockers | ACE: Decreases Na retention and peripheral vasoconstriciton to decrease BP*- lisinopril Angiotension 2: blocks binder of angio 2 at muscle level, decrease BP*-losartan |
| CONTROL ANGINA Nitrates (nitroglycerin) | Dec preload through peripheral vasodilation, reduce myocardial oxygen demand, reduce angina*, dilate coronary arteries to improve BF |
| Beta-adrenergic blocking agents | reduce myocardial demand by reducing HR and contractility; control arrhythmias, chest pain; reduce BP*-lopressor, toprol XL, propranolol |
| Calcium channel blocking agents (Cardizem, pericardia, norvasc) | Inhibit flow of Ca+, decrease HR, decrease contractility, dilate coronary arteries, reduce BP, control arrythmias, chest pain |
| Diuretics | decrease myocardial work, control hypertension |
| Activity restriction Acute MI/ Acute heart failure | activity increased after acute MI has stopped Activity should be limited to 5 METs or 70% of HR max for 4-6 wks -No increase in oxygen demand for patients in acute or decompensated heart failure* |
| Peripheral arterial disease (PAD) | Chronic, occlusive arterial disease of medium/large vessels, the result of peripheral atherosclerosis -Diminished BF to affected extremities -Early: intermittent claudication, pain burning aching cramping. Late: trophic changes (hair loss, skin and nail changes), muscle atrophy |
| Thromboangiitis obliterates (Buerger's disease) | Chronic, inflammatory vascular occlusive disease of small vessels Common in young adults, smokers Progresses distal to proximal in UE/LE Symp: paresthesia or pain, cyanotic cold extremity, dec temp sensation, risk of ulceration/gangrene |
| Diabetic Angiopathy | An inappropriate elevation of blood glucose levels and accelerated atherosclerosis -Neuropathy Neurotrophic ulcers, may lead to gangrene/amputation |
| Superficial vein thrombophlebitis | Clot formation and acute inflammation in superficial vein -usually saphenous vein |
| Deep vein thrombophlebitis (DVT) | Clot formation and acute inflammation in deep vein. May precipitate PE: chest pain, SOB, cough, diaphoresis *ambulation and mobility encouraged after 1 dose of heparin |
| Venous Valvular insufficiency | Fibroelastic degeneration of vale tissue, venous dilation Grade 1: mild aching, minimal edema, dilated superficial Grade 2: increased edema, multiple dilated, changes in shin pigmentation Grade 3: Venous claudication, severe edema, cutaneous ulceration |
| Lymphedema | Mechanical insufficiency of lymph system Primary: congenital condition with abnormal lymph node or vessel Secondary: acquired |
| max/target HR calculation | 208-0.7 x age HR range 60-80%(HR max-RHR) + RHR = target HR |
| ECG Changes with exercise | Tachycardia Rare-related shortening of QT interval ST segment depression, upsloping, less than 1 mm Reduced R wave, inc Q wave Exertional arrhythmias: rare, single PVCs |
| ECG changes with exercise, a pt with MI or CAD | 1. Significant tachycardia 2. Exertional arrhythmias: inc frequency of ventricular 3. ST segment depression; horizontal or downslope, greater than 1 mm below baseline |
| MET | 3.5 mL/kg per minute |
| Relationship between HR max and functional capacity VO2max | 70-85% HR max to 60-80% functional capacity VO2max |
| Absolute indications for terminating exercise | 1. drop in systolic BP >10 mmHg 2. Moderate to severe angine 3. Inc nervous system symptoms 4. Signs of poor perfusion 5. Technical difficulties 6. Subjects desire to stop 7. Sustained VT 8. ST elevation >1.0 |
| Relative Indications for terminating exercise | 1. ST or QRS changes 2. Arrhythmias other than sustained VT 3. Fatigue, SO, leg cramps, claudication 4. Bundle branch block 5. Increasing angina 6. Hypertensive response (>250/>115 mmHg) |
| Cardiac rehab: Phase 1 | ADLs, selected arm and leg exercises, ambulation. low intensity 2-3 METs, >5 by discharge Post MI: limited to 70% HR max Short sessions 2-3x/day Restrictions for lifting with sternal incision Goals: Ambulation 20-30 min, 1-2x/day 4-6days/week |
| Cardiac Rehab: Phase 2 | Progress to full ADLs, occupational activities 2-3x/week, 30-60 min Continuous, circuit training, strength training 9 MET functional capacity Strength training: after Phase 1, 5 wks post MI, 8 weeks post CABG |
| Cardiac rehab: Phase 3 | Usually Home 50-85% functional capacity, 3-4x/week, 45+ min/session Entry level criteria: functional capacity of 5 METs, stable angina, controlled arrhythmias |
| Rehab for arterial disease | Interval training: ambulation and rest when claudication gets moderate (2) Can do non-weight bearing activity Improve BF with PF/DF with resistance (Modified Buerger-Allen exercises) |
| Rehab for Venous DIsease | DVT: Activity limited until dose of heparin Chronic venous insufficiency: Positioning- UE/LE elevation Compression Red clad: consider consequences of compression therapy to a limb with ABI < 0.8* or with active cellulitis or infection - Exercise: active ankle exercises, cycle ergometry, early ambulation |
| Guidelines for Lymphatic Disease | Short-stretch compression bandages (worn 24 hrs/day) excessively high pressures will occlude superficial lymph capillaries and restrict fluid absorption Manual lymph drainage (MLD)* Functional activities Red Flag: Strenuous activities exacerbate Meticulous skin care: hygiene, nail care Compression pumps: pressures >45 mm Hg CONTRAINDICATED* Contraindications to modalities: heat/ice cause vasodilation and inc lymphatic load of water, no electrotherapy >30 Hz. |
| CPR | 100 compressions/min 30:2 single rescuer 15:2 with 2 rescuers (children) |
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