Cardiac 11 and beyond
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Ischemia, injury and infarction shown via electrical conduction: (Objective 11)
______ zone: inverted T wave (or ST depression)- myocardium is contractile but hypokinetic
______ zone: (ST depression) or elevated ST wave: myocardium is noncontractile, but may heal.
______ zone: infarcted zone: pathological Q wave-myocardium is noncontractile, akinetic, and necrotic
- Ischemic Zone
- Injury Zone
- Infarcted Zone
(Objective 11-12) This stuff seems completely ridiculous, and we didn't really talk about it. Reading ECG.
______: ST depression or Twave inversion. Ths would be the "stop testing" point for an ETT.
______: ST elevation
______: abnormal Q wave.
Objective 13- look at pharmacology tool kit b.s. for CV drugs. They most likely suck, but I'm avoiding it.
(objective 14) we didn't talk about this one nor did we get quized over it so I would say read it. it is a lot about stuff we will never do because we aren't medical doctors and I'm not really willing to memorize any of it.
i'll just miss those points.
(Objective 15) ______ ______: widening, bulge, or ballooning out of a portion of the aorta, usually a weak spot in the aortic wall, causing the vessel to progressively expand to at least 1.5 times beyond its normal diameter of one inch.
Obj 15 The symptoms of an _______ aortic aneurysm (most common) include pain in the low back or abdomen, palpable "bounding" pulse above the navel, symptoms are worse in the spine.
The symptoms of a ______ aortic aneurysm often do not surface until the aneurysm is quite large. However, once enlarged, the aneurysm can cause the aorta to put pressure on the surrounding organs in the mediastinum, and ches wall (upper back pain, coughing and wheezing, hoarse voice, difficulty swallowing, swelling in the neck or arms, horner's syndrome-constricted pupils, ptosis and dry skin on one side of the face.)
- abdominal aortic aneurysm
- thoracic aortic aneurysm
Ejection fraction: (EF) OBJ 16
___-___: mild LV dysfunction
___-___: moderate LV dysfunction
<___: severe LV dysfunction
- >55% normal
- 40-55% mild LV dysfunction
- 30-40% moderate LV dysfunction
- <30% severe LV dysfunction
obj 17: T obe a conadidate for _____, the diseased arteries must not be fully occluded, but generally at least 70% blocked. A fully occluded artery may be treated by CABG surgery, or left untreated.
PTCA- percutaneous translumenal coronary angioplasty
Phase __ cardiac rehab: early cardiac rehabilitation activities start while the patient is still hospitalized. Levels 1-6 culminate with ascending and descending a flight of stairs (? mets)
Phase __ cardiac rehab: Outpatient rehab programs begin after hospital dishcarge in as little as a week (PTCA) or 4-6 weeks for (CABG). Starting time for post-MI patient would depend on the type of MI and the amount of injury(2-4 wks), since healing time mus be allowed for scar tissue to form in the zone of necrosis. What conditions qualify?
Phase__: maintenance; graduates are encouraged to continue ciming ot rehab gym, however they will not receive direct supervion or telemetry. Typically not reimbursed and the person will pay out of pocket.
- Phase 1-culminates 4-5 mets-means you can "do it" again
- Phase 2- use telemetry/must be within 6 months of event in order to covered by insurance. - Post-MI, CABG, Stable Angina, sometimes PTCA- not CHF
- Phase 3
_____ ETT: test terminated becuase Angina occured.
_____ ETT: test terminated because patient reported fatigue or dyspnea.
(Obj 18) Formula for RPP= ___x____/100
-Strategy for progression: Increase _____ until a cumulative minutes goal is met. Only after increasing this should you begin to increase ______, all the while maintaining the same RPE (typically what level?).
-Physiologically: The person is building thier MET level and Vo2 level, while staying in the same safe RPE level. Musces are being trained to do what? (two things).
- Most people start rehab at ____-_____% of their ETT max/ischemic threshold. Use circuit training to accumulate minutes.
-The long term goal is to accumulate ___-___ minutes from fewer intervals of longer duration between briefer rest breaks, all at the same RPE. This ultimately builds the minutes to a total of __-__ hours/wk.
- -increase duration, then increase intensity (RPE 12-13)
- -Physiologically: oxygen extraction (mitochondrial level), increased myoglobin levels
- - rehab at 50-65%
- -LTG accumulate 30-45 minutes/3-5 hours/wk
(Obj 18): Resistance exercise is started by weeks _-_ of phase 2. Do not 1 rep max test. Use light weights and full body AROM movements and progress. Consider CABG lifting limitations for _-_ wks.
weeks 2-4 and 6-8 wks for sternal precautions
(Obj 19): CV system changes with aging:
- increased _____ of arteries (increases TPR with elevated SBP)
- slight increase of _ ______ wall thickness and stiffness (decreased compliance); but not resulting in significant change of size of heart chamber; reduction in the density of conduction fibers.
-____ valve sclerosis slows L ventricular filling rate which decreases SV and CO.
-Conduction system degeneration can lead to _______.
-Decreased baroreceptor reflex response possibly leading to _______ ______.
- -calcification of arteries (arteriosclerosis)
- -L ventricular
- -Mitral valve
- -orthostatic hypotension
-resting HR in the normally aging older adult may be ______ due to fiber loss in the conduction system.
-in the elderly population, HR resonse to exercise can be _____, and also will not _____ to peak HR as compared to younger.
-___ is often not a realiable measure. REly more on Borg RPE scales and BP response.
- Karvonen HRR=?
- -delayed or slowed and will not rise to as high of a peak HR
- -HRR=[(220-age or max HR)-Rest HR)x____%)]+Rest HR
It is not accurate to simply list age or sex as a risk factor. Both male and female have cardiac risk, but begin at different ages.
(Obj 21)T or F:If patient's resting BP is elevated beyond what is normal for them, ask them if this is a normal day or if there have been stressfull things going on lately.
True: autonomic nervous drive can persist a long time once activated, espcially if uninteruupted.
(Obj 22): CAbG is performed when coronary arteries are fully occluded and therefore a _____ is not appropriate. These patients will be sore from the sternootomy, and also possibly from the removal of the _____ vein or ______ artery. All incicsion sites should be monitored for signs of infection. Use of the left or right _______ would not result in secondary wound harvest site and wounds and these patients would have an improved V/Q match, aerobic capacity, and less dyspnea.
- -saphenous vein or radial artery
- -internal mammary artery
(Obj 22): CABG patients should get "early and fast mobilization" in spite of the fact that they are sore from major surgery, where as MI patients that require "safe and slow mobilization" so that the nrcrotic zone can form scar tissue without being overly stressed and extending the infarct beyond the current boundary. True or False
(Obj 22): Typical sternotomy precations: __ - ___ wks:
*do not lift more than __ lbs
*do not let people......
*you may move your arms in a......, but avoid_____.
*you may use your arms getting in or out of bed, but try.....
*you (can or can't?) bend forward and do things like tie your shoes
- -pull you up by your arms
- -pain free range but avoid backwards
- -try to keep your arms close to your side
- -can bend forward
Cardiac Pump ______ is defined as: hypertnsive response to exercise and an EF of 30-50%
Cardiac pump ____ is defined as: a drop in SBP in response to exercise, complex ventricular arrhythmias, and an EF of <30%.
- pump dysfunction
- pump failure
__ heart failure associated signs and symptoms: fatigue, cyanosis, S3 heart sound,(DYSPNEA, TACHYPNEA, ORTHOPNEA,RALES),mitral regurg, cardiomegaly, and cerebral hypoxia.
__ heart failure associated signs and symptoms: fatigue, cyanosis, (S3) heart sound, (EDEMA), ascites,(JUGULAR VEIN DISTENSION, WEIGHT GAIN), tricuspid regurg, hepatomegaly.
- L heart failure
- R heart failure
i wrote down to memorize this table in my notes
(Obj 23): R heart failure is associated with 4 signs and symptoms:
L heart failure is associated with 5 signs and symptoms:
- R: S3, jugular vein distension, weight gain, edema (especially edema)
- L: S3, Dyspnea, Tachypnea, Orthopnea, Rales
NYHA Classfication system:
Level_: no symptom limitation with ordinary physical activity: mets _-_
Level_: ordinary physical activity somewhat limited by dyspnea (long distance walking, two flights of stairs): mets _-_.
Level_: exerciese limited by dyspnea with moderate workload (short distances walking, climbing one flight of stairs) mets _-_.
Level_: dyspnea at rest or with very little exertion. mets _-_
- Level 1: 6-10 mets
- Level II: 4-6 mets
- Level III: 2-4 mets
- Level IV: <2 mets
(Obj 23) For a person with stage IV CHF according to NYHA, the associated signs and symptoms are ______.
For a person with NYHA stages 2or3, the sighs and symptoms will be _____ and be brough on by too high of a MET levle of activity for their aerobic capacity.
PT Intervention for CHF (obj 23)
1. Everyday is _____. Unpredictable.
2. _____ training. Exercise a little....rest a little...exercise more. (protocol for phase II of cardiac rehab could be applied)
3. increase ____ first.
4. increasing _____ may not be possible and would only happen after patient shows stable increase inthe duration of cumulative minutes with goood tolerance of the activity that doesn't exacerbate any S&S's.
5. Respect _____ (just as in COPD and RLD)
6. Check ___ daily and monitor edema.
- 1. different
auscultation of heart valves:
- 1. left 2-3 intercostal space close to sternum
- 2. right 2-3 intercostal space close to sternum
- 3. right 4-5 intercostal space close to sternum
- 4. left 4-5 intercostal space close to sternum
___ heart sound due to poor ventricular compliance and incresed EDV which causes audible turbulence during filling phase (diastole)- associated with CHF
__ heart sound due to turbulence heard from an exaggerated atrial kick late in diastole. Associated with HTN or MI.
Documenting BP and Pulse
- BP: 1.R or L 2.Position 3.mmHG
- HR: site, LorR, Position, Rate, Rhythm, Quality
(obj 26): When is it safe to resume sexual activity in terms of MET levels following heart issues?
-ascending and descending a flight of stairs, one step at a time 4-5 METS- but counsel about MET level intensity and expected Duration
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