Cardiopulmonary & Lymph

• apex: lowest part of the heart
• base: upper part of the heart
• endocardium: lines interior of heart chamber
• epicardium: contains coronary arteries and veins, autonmic nerves, lymphatics
• myocardium: contractile middle layer forming heart wall
• pericardium: connective tissue sac surrounding outside of heart & vessels

inferior vena cava (lower body & viscera) & superior vena cava (head, neck, & arms) --> right ventricle -->tricuspid valve --> right atrium --> pulmonary valve --> pulmonary artery --> lungs --> pulmonary vein --> left ventricle --> mitral valve --> left atrium --> aortic valve --> give da body some blood

• SA node: normal pacemaker of heart
• AV node: back up pacemaker
• AV merges with bundle of His  and then terminate in purkinge fibers which then spreadys impulse throughout the ventricles so they contract together
• Sympathetic influence: epinephrine & norepinephrine make heart beat FASTER and STRONGER
• Parasympathetic influence: acetylcholine from vagus nerve SLOW heart rate through influence on SA node

• atrial systole: R and L atria pushing blood into ventricles
• atrial diastole: between atrial contraction- atria repolarization
• ventricular systole: contraction of right & left ventricle pushing blood into pulm. arteries & aorta
• ventricular diastole: period between ventricular contractions- ventricular repolarization
• preload: tension in ventricular wall at end of diastole
• afterload: forces impeding flow of blood out of heart
• stroke volume: volume of blood ejected by each contraction of L ventricle
• cardiac output: amount of blood pumped from L or R ventricle per minute (SV x HR)
• ejection fraction: % of blood emptied from ventricle during systole, normal EF is 60-70%
• venous return: amount of blood returning to R atrium each minute

• plasma: liquid component of blood (water, electrolytes and protein), helps regulate blood pressure & temp
• red blood cells: 40% blood volume, contain hemoglobin, enables O2 to bind to blood, anemia = too low, polycythemia = too high and blood is too thick
• blood platelets (thrombocytes): assist in blood clotting, thrombocytopenia = too low increasing risk for bruising, thrombocythemia = too high and increase risk for thrombosis
• white blood cells: protect aainst infection

• Primary muscle: diaphragm- chest expansds longitudinally & lower ribs elevate
• internal & external intercostals: muscles elevate the ribs
• Accessory muscles: SCM, scalenes, pec major & minor, serratus anterior

• passive recoil
• forceful breathing: rectus abdominis, internal/external oblique, transverse abdominis

• Upper: apical, anterior, posterior
• Middle: medial and lateral
• Lower: superior, medial basal, anterior basal, lateral basal, posterior basal

• Upper: superior (anterior segmental & apicoposterior segment) and inferior (lingular- superior & inferior))
• Lower: superior, lateral basal, posterior basal, anteromedial basal

• abnormal dialation of blood vessel (thoracic or abdominal aorta or brain)
• cause: weakness of wall of vessel (chronic hypertension) or connective tissue disease (marfans), or trauma
• S/S: pulsations near navel for AAA, cerebral aneurysm has stiff neck, N/V, diploplia
• treatment: antihypertensive meds

• stable angina: predictable level of exertion, responds to rest or nitro
• unstable angina: lasts longer, precipitated by less exertion, occurs spontaneously at rest, is progressive
• prinzmetal (variant) angina: occurs with coronary artery spasms
• S/S of angina: presure, heaviness, fullness, burning/aching behind sternum, pain in neck/back/jaw/shoulder, difficulty breathing
• acute treatment: supplemental nitro (up to 3 every 5 minutes), rest, oxygen
• chronic treatment: long acting nitrates, beta blockers, calcium channel blockers

• progressive accumulation of fatty plaques on inner walls of arteries
• cause: HTN, high cholesterol, smoking, DM
• S/S: angina may occur, numbness/weakness of arms, slurred speech
• treatment: lifestyle changes, surgery, exercises, diet, stress management

• group of conditions impairing the ability of the heart to contract and relax
• S/S: breathlessness, leg/feet swelling, abdominal bloating, dizzy, lightheadedness
• types: dilated, hypertrophic, restrictive)

• veins and valves in the LE are damaged and can't keep blood flowing back to heart, so veins remain filled with blood
• cause: damaged valves inside the veins
• S/S: leg swelling, varicose veins, cramping, itching
• treatment: compression stockings (30-40 mmHg) & leg elevation

• Atrial septal defect: hole in the wall of the heart seperating the R and L atria
• Coarctation of the aorta: aorta narrowed near ductus arteriosus, usually have surgical repair
• Patent ductus arteriosus: area that shunts blood from pulm. artery to descending aorta in utero does not close after birth
• Ventricular septal defect: hole in the septum separating the R and L ventricles
• Tetralogy of Fallot: 4 heart defects (ventricular septal defect, pulmonary stenosis, R ventricular hypertrophy, aorta overriding the ventricular septal defect

• pulmonary heart disease: hypertrophy of the R ventricle (R sided heart failure)
• fatigue, palpitations, chest pain, LE swelling, dizziness, syncope
• maintain SaO2> 90% and PaO2 >60 mmHg, use diuretics and anticoagulation

• narrowing or blockage of the coronary arteries due to plaue from causing diminished blood flow
• cause: damage to inner wall of coronary artery so plaque accumulates there then if that rupture platelets will clump there and block artery causing heart attach
• risk factors: high LDL >130, low HDL <40, type 2 DM, smoking, inactivity, BMI >30, age (men >45, women >55)
• S/S: angina, SOB, sometimes can't tell until 70% blocked
• treatment: antiplatelet agents, ACE inhibitors, angiotensins II receptor blockers, statins

• blood clot forms in deep veins
• can break loose causing pulmonary embolism
• S/S: pain, redness, warmth
• treatment: anti-coagulants, thrombolytic agents, filts in the vena cava

• inflammation of endothelium lining the heart & cardiac valves
• causes: bacteria entering blood through needles, dental work, STD, IBS
• S/S: fever, chills, heart murmur, fatigue, SOB, weight loss, blood in urine, skin petechiae

• heart cannot maintain a normal CO to meet the body's demands for blood and O2, ventricles weak and can no longer pump because of excessive dialation
• S/S: shortness of breath, fatigue, S3 heart sound
• treatment: anticoagulants, antiHTNs, digitalis to increase strength of contraction

• aortic valve: 2nd R intercostal at sternal border
• pulmonic valve: 2nd L intercostal space at sternal border
• tricuspid valve: 4th L intercostal space at sternal border
• mitral valve: 5th L intercostal space at midclavical area
• S1: lub, closure of mitral and tricuspic, end of diastole
• S2: dub, closure of aortic and pulmonary, end of systole
• S3: ventricular gallop, normal in young kids- not in adults, associated with heart failure
• S4: atrial gallop, vibration of ventricular walls with filling & atrial contraction, happens with HTN, stenosis, MI

• Normal < 120/80
• Prehypertensize  120-139/80-89
• Stage 1 hyper  140-159/90-99
• Stage 2 hyper >160/100
• S/S: S4 heart sound early sign, cardiovascular symptoms, renal involvement

• Accumulation of lymph in extremities
• S/S: swelling with restricted motion of UEs and LEs, aching, heaviness, brawny, fibrous, non-pitting edema
• treatment: reduce swelling, control pain, gentle active exercises, bandages, massage, compression (20-30 mmHg)

• S/S: pressure, squeezing, pain, SOB, upper body discomfort, shoulder/neck/back/jaw pain, N/V, palpitations
• chest pain most common S/S

• inflammation and weakness of the myocardium
• can lead to heart failure
• S/S: arrhythmia, chest pain, SOB, faitgue, fever

• inflammation of pericardium of heart
• as that becomes inflammed it increased the fluid between the two layers leading to pericardial effusion
• cardiac tamponade: complication that can occur that creates pressure on the heart from excessive fluid in pericardium that prevents the heart from properly filling with blood

• stenotic, occlusive, aneurysmal diseases of the aorta & peripheral arteries
• causes: artherosclerosis & thromboembolic processees
• S/S: fatigue, numbness/pain in butt/thigh/calf/foot, poorly healing wounds of LEs, distal hair loss

• complication from poorly treated strep throat- streptococcus
• damages heart valves- causing heart failure

heart valve damaged causing regurgitation or stenosis of blood flow, blood leaks backward through damaged valve

• sudden respiratory failure due to fluid accumulation in alveoli
• fatal to 25-40% that get it, usually effects critically ill
• fluid leaking from smallest blood vessels in the lungs into the alveoli
• get oxygen into the lungs- first goal of treatment

• chronic inflammation of airways caused increased hypersensitivity to various stimuli
• S/S: wheezing, chest tightness, slight SOB
• obstructive disease
• increased respiratory rate & minute ventilation
• PFTs show impaired flow rates

• one or more lungs collapse or do not inflate properly
• decreased breath sounds, SOB, increased breathing rate and HR
• work on deep breathing, changing positions and airway clearance

• any epithelial carcinoma occuring in brochopulmonary tree
• smoking is primary cause
• S/S: new cough or changes in chronic cough, SOB, wheezing, weight loss, bone pain

• progressive/irreversible obstructive lung disease producing abnormal dilation of bronchus from weakened bronchial walls
• S/S: consistent productive cough, hemoptysis, weight loss, anemia, crackles, wheezing, loud breath sounds
• excessive sputum production

• inflammation of the bronchi characterized by hypertrophy of mucus secreting glands & insufficient oxygenation from mucus blocking
• smoking is main cause of chronic bronchitis
• treatment: warm/moist air, cough suppressants, acetaminophen/asprin

• bronchial tree is narrowed causing decreased airflow
• emyphsema and chronic bronchitis are two main conditions
• excessive mucus production, chronic cough, wheezing, SOB, fatigue, reduced exercise capacity
• treatment: bronchodilators, inhaled steroids, oxygen, antibiotics
• decreased FEV1, decreased FVC, increased FRC and RV

• autosomal recessive disease of exocrine glands affecting lungs, pancreas, liver, intestines, sinuses, and sex organs
• excessive amounts of thick, sticky mucus
• salty tasting skin, persistent coughing, frequent lung infections, wheezing SOB, poor growth/weight gain

• alveolar walls destroyed and alveoli turned into large, irregular pockets with gaping holes
• elacstic fibers are destroyed so bronchioles cannot be help open so they collapse during exhalation causing permanently overinflated alveoli and dead space increased
• S/S: SOB, wheezing, chronic coughing, orthopnea, barral chest, increased use of accessory muscle, increased RR, fatiuge

• Build up of fluid in pleural space which can push against the lung and make it hard to breathe
• caused by viral infection, pneumonia, PE, autoimmune disease
• decreased breath sounds over effusion
• mediastinal shift away from large effusion

• inflammation of the lungs
• S/S: fever, cough, SOB, sweating, shaking, chills, chest pain fluctuating / breathing, headache, muscle pain, fatigue

• fluid collects in the alveoli within the lungs making it hard to breathe
• feeling of suffocating or drowning, wheezing/gasping, anxiety, restlestness, coughing, frothy-blood tinged sputum, rapid irregular pulse, severe drop in BP

• one or more arteries in the lungs becomes blocked
• LIFE THREATENING
• S/S: sudden SOB, coughing up bloody or blood streaked sputum, cyanosis

• microscopic damage (irreversible) to alveoli causes irreversible scarring of interstital tissue
• normally tissue is very elastic but the scarring makes it very stiff and thick so breathing is difficult
• S/S: SOB during or after physical activity, dry cough, fatigue, unexplained weight loss, crackles, clubbing, cyanosis
• PFT= reduction in vital capacity, functional residual capactity, and total lung capacity
• treatment: corticosteroids and immunosuppresive agents

• abnormal reduction in lung expansion and pulmonary ventilation
• S/S: dyspnea on exertion persistent, non-productive cough, increased RR, hypoxemia, abnormal breath sounds, decreased vital capacity

• pH: 7.4 (7.35-7.45)
• PaCO2: 40 mmHg (35-45)
• PaO2: 97 mmHg (80-100) (<55mmHg need supplemental O2)
• HCO3: 24 mEq/L (22-26)
• SaO2: 95-98% (<88% need supplemental O2)

• Creatine phophokinase: appears in blood 4 hours after infarction, peaks at 12-24 hrs, and declines over 48-72 hours
• cardiac troponin-l: remains elevated for 5-7 days

• Respiratory Acidosis: PaCO2 > 45mmHg, pH <7.40
• Respiratory Alkalosis: PaCO2 <35mmHg, pH >7.40
• Metabolic Acidosis: HCO3 <22, pH <7.40
• Metabolic Alkalosis: HCO3 >26, pH >7/40

• PTT: 26.3-39.4 seconds
• Hemoglobin: 12-16 (<8 exercise contraindicated)
• INR: 1-2
• Total cholesterol: <200
• LDL Cholesterol: <100
• HDL Cholesterol: 40-60
• Triglyceride: <150

• Angiography: examination of blood vessels injected with contrast, shows plaque in coronary arteries
• Bronchoscopy: direct visualization of bronchial tree, identifying tumors, bronchitis, and bleeding
• Cardiac Catheterization: catheter inserted into leg or arm with contrast dye showing narrowing or occlusion
• Carotid US: sound waves examine & visualize the structure & function of carotid artereies
• Chest Radiograph: visualizes location, shape/size of heart, lungs, blood vessels, ribs
• CT Scan: x-ray machine creating a picture of organ & surrounding structures
• Echocardiography: high frequency sound waves (non-invasive) evaluate the function of the heart
• Electrophysiologic Testing: evaluates rhythm or electrical conduction abnormalities of the heart using catheters threaded through the heart
• Fluoroscopy: continuous X-ray showing heart and lungs, gives high does of radiation, replace with echo
• Invasive Hemodynamic Monitoring: intraarterial catheters & IV lines measure pressure, volume and temp (Swan Ganz measure pulm. artery pressure and left atrial pressure)
• MRI: 3D images of heart & blood vessels to assess size and function of chambers
• Myocardial Perfusion Imaging: redionuclide stress test shows how the heart muscle is perfused at rest and under exercise stress, shows reduced blood supply
• Pharmacologic Stress Test: cardiovascular stress test induced by medications
• Phonocardiography: graphic record of sounds produced by heart and vessels
• Pleuroscopy: examines lungs surfaces, pleura, and pleural space
• Positron Emission Tomography: small amount of radiogractive material is injected, inhaled or swallowd, and evaluates heart disease and cancer
• Thoracentesis: removes fluid from pleural space
• Venography: radiopaque dye injected in vein to detect clot or bloackage
• Ventilation-Perfusion Scan: radioactive material to study airflow and blood flow within the lungs, diagnose pulmonary embolism

• Alpha adrenergic antagonist agents: reduce peripheral vascular tone, causing dilation, indicated for HTN, *orthostatic hypotension*
• ACE inhibitor: decrease blood pressure and afterload, indicated for HTN & CHF, *postural hypotension*
• Angiotensin II Receptor Antagonist: limits vasoconstriction & stimulation of vascular tissue, indicated for HTN and CHF
• Antiarrhythmic Agents: sodium channel blockers, beta blockers, potassium blockers, calcium channel blockers, indicated for arrhythmias
• Anitcoagulatn Agents: inhibit platelet aggregation and thrombus formation, *increased risk of bleeding*
• Antihyperlipidemia agents: beark down LDL, decrease triglycerides and increase HDL, indicated for hyperlipidemia, atherosclerosis, *headache, GI issues*
• Antithrombotic Agents: inhibit platelet aggregation and clot formation
• Beta blocker Agents: decrease myocardial oxygen demand by decreased HR and contractility, indications for HTN/angina/arrhythmias/HF, *HR and BP response diminished*
• Calcium Channel Blocker: decrease myocardial contraction, vasodialation & decreased O2 demand on heart, indicated for HTN/angina/arrhythmia/CHF, *HR and BP response diminished*
• Diuretic Agents: reduces plasma volume decreasing BP; indicated for HTN/HF edema/pulm. edema, *electrolyte imbalance*
• Nitrate Agents: decrease ischemia through dialation of peripheral vessels, indicated for angina, *orthostatic hypotension*
• Positive Inotropic Agents: increase heart contraction & slow HR, indicated for HF and atrial fibrillation
• Thrombolytic Agents: facilitate clot dissolution, indication for acute MI/PE/ischemic stroke

• Antihistamine: blocks histamine resulting in decrease nasal congestion, mucosal irritation & symptoms of common cold, indicated for seasonal allergies/common cold, *postural hypotension*
• Anti-Inflammatory: prevent inflammatory-mediated bronchoconstriction reducing airway edema, indicated for bronchospasm/asthma
• Bronchodilator Agents: cause bronchial smooth muscle relaxation or by blocking the receptors that trigger bronchoconstriction, indicated for bronchospasm/wheezing/SOB in asthma & COPD, *want to take before going to PT*
• Expectorant Agents: increase respiratory secretions to loosen mucus and increase sputum volume, *perform airway clearnace techniques*
• Mucolytic Agents: decrease viscosity of mucus so they are easy to get out, indicated for pneumonia/emphysema/chronic bronchitis/cystic fibrosis, *perform airway clearance techniques

• compares systolic BP of ankle and arm
• LEG/ARM
• arm BP: taken over brachial artery
• leg BP: taken over tibialis posterior arteries using sphygmomanometer and doppler US
• >1.3= rigid arteries
• 1-1.3= normal
• .8-.99= mild blockage
• <.4 severe blockage

• unclothed chest, breathe in and out through mouth, listen for one cycle
• tracheal/bronchial: normal over trachea, bronchial over distal airways are abnormal and mean consolidation
• vesicular: high pitch breezy sound, normal over healthy lung tisue, inspiratory longer than expiratory w/out pause
• adventitious: abnormal, heard with inspiration/expiration, conintuous/discontinuous
• crackle (rales): heard more often w/ inspiration, may be restrictive or obstructive, heard w/ atelectasis, fribrosis, pulm. edema, or pleural effusion
• pleural friction rub: dry, crackling sound heard in inspiration/expiration, inflamed viscera & parietal plurae rub
• rhonci: low pitched snoring or gurgling in inspiration/expiration, air passes through an airway that is obstructed by secretions or liquid
• stridor: high pitch wheeze, inspiration/expiration, upper airway obstruction
• wheeze: musical or whistling sound, inspiration/expiration, caused by vibrations of small airways from bronchospasm, edema, collapse, secretions, neoplasm
• bronchial breath sounds: abnormal breath sounds heard where vesicular sounds are normally, usually pneumonia
• absent breath sounds: pneumothorax *medical emergency*
• decreased or diminished sounds: severe congestion, emphysema, hypoventilation
• voice sounds: brochophony (99 with great clarity & loud), egophony (E sounds like A), whispered pectoriloquy (1,2,3 is understandable), all usually mean consolidation, atelectasis or fibrosis

• weight/height
• 18.5-24.9= normal
• 25-29.9= overweight
• >40 extremely obese

• pressure over nail bed until blanches, release pressure
• normal: full color < 2 seconds
• abnormal: >2 seconds indicates compromised capillary blood flow

• measurements every 5-10 cm
• 7 circumferences measured
• compare normal side to abnormal
• mild lymphedema: <3 cm
• severe: >5 cm

• P wave: atrial depolarization
• PR Interval: atrial depolarization, conduction from SA node to AV node (.12-.2 seconds)
• QRS complex: ventricular depolarization and atrial repolarization
• OT interval: ventricular depolarization and repolarization
• ST segment: isoelectric period
• T wave: ventricular repolarization

• Premature atrial contraction: initiates impulse before the SA node, premature P wave, can progress to atrial flutter
• Atrial Flutter: very rapid atrial tachycardia, 250-350 beats per minute, can cause palpitations, lightheadedness & angina
• Atrial Fibrillation: atria depolarized to 350-600 times/min; occurs w/ coronary artery disease, HTN, and valvular disease
• 1st Degree AV block: PR interval is longer
• 2nd Degree AV block: impulses between the atria & ventricles fail intermittently (mobitz 1 and mobitz 2 (2 is more serious))
• 3rd Degree AV Block: atria and ventricles are paced independently, atria rate > ventricular rate, *MEDICAL EMERGENCY*
• Premature ventricular complex (PVC): premature depolarization arising in ventricles due to ectopic focus
• V-tach: 3 or more consecutive PVCs at rate of >10, LIFE THREATENING
• V-fibrillation: can come from V-tach, no cardiac output so patient becomes unconcious, MEDICAL EMERGENCY
• Ventricular asystole: no rhythm, straight line, requires immediate defibrillation
• ST depression: sign of ischema, digitalis toxicity, or hypokalemia
• ST elevation: acute infarction
• Q wave: significant or longer Q wave is indicative of MI
• T wave inversion: occurs hours or days after MI

• Absolute: drop in SBP > 10 with evidence of ischemai, moderately/severe angina, poor perfusion, sustained v-tach, 1.00 mm ST elevation
• Relative: drop in SBP >10 w/out evidence of ischemia, >2mm ST segment depression, PVCs, fatigue, SOB, wheezing, HTN response >250/115)
• Determine regular rhymthm by dividing 300 by R to R

• Normal rhythm: 15 seconds x 4
• Irregular rhythm: 60 seconds
• Child: take at brachial artery (normal 80-100 bpm)
• Adult: take at radial (normal (60-100)
• 2+ = normal pulse, 3+ = bounding, 1+ =reduced

• measures volume of air during inhalation and exhalation
• FEV1/FVC <70% is indicator of obstructive impairment
• 70-100%= mild obstruction
• FEV1 (forced expiratory voulme in 1 second)
• Restrictive ventilatory: reduced lung volume (total lung capacity, FVC, FEV1) with normal expiratory flow, FEV1/FVC >80%

• adult: 12-20 breaths
• child: 15-20 breaths
• newborn: 33-45 breaths
• normal: inspiration:expiration, 1:2
• COPD: longer expiration, 1:3 or 1:4

• 6-20 scale, or 0-10 (6 or 0 = nothing)
• 13-14 represents 70% of max HR
• 11-13 represent upper limit of cardiac rehab

• measure around abdomen at iliac crest
• increased risk for type 2 DM, CV disease >40 inches for men, >35 inches for women
• if waist circumference is greater than above values then person should be listed one risk category above that for BMI

• Active Cylce of Breathing: relaxed breathing x 10 seconds, thoracic expansion by 3-4 deep & slow inhalations w/ passive exhalation (can have percussion or vibration on exhale), forced expiratory technique by one or 2 huffs at mid to low lung volumes
• Autogenic draining: three phases- unsticking phase (slow breathing through nose at low-lung volumes follow by 2-3 second hold then exhale into expiratory reserve volume), collecting phase (breathe at tidal volume interspersed by 2-3 second hold), evacuating phase (deeper inspiration fro low to mid inspiratory reserve volume & breath holding followed by huff)
• Cough: inhale maximally, close breath & hold 2-3 seconds, then cough 2-3 times w/ slightly open mouth
• Huff: inhald deeply through open mouth, Ha Ha Ha
• Flutter or Acapella (high frequency airway oscillation): put device in mouth, inhale to 75% full breath and breathe x 2-3 seconds, exhale through device for 3-4 seconds, remove device and cough
• Postural drainage, percussion, vibration

• Diaphragmatic breathing: get in semi-fowlers position, sniffing can help, put hand on chest and diaphragm and feel diaphragm lift, *CONTRAINDICATION- mod to severe COPD & hyperinflationof lungs
• Inspiratory muscle training: strengthen diaphragm & intercostal muscles, and breathe in through device, 5-15 minutes a day
• Paced breathing: prevent pt from holding breath, inhale during resting or less active and exhale during movement
• Purse Lipped Breathing: reduce respiratory rate and dyspnea, maintaining small positive pressure, in semi fowlers breathe in through nose and out through puckered lips
• Segmental breathing: Sidelying with affected lung up then put firm pressure at end of exhalation to help with chest wall mobility and expand collapsed alveoli
• Sustained Max Inhalation with incentive spirometer: exhale then inhale around mouthpiece breathing in slowly & deeply, encourage use of diaphragm & not upper chest

• forward leaning with arm support
• reverse trendelenburg (head above LEs)
• semi-fowler: head of bed elevated with pillow under knees

• heat stroke: disorientation, dizziness, apathy, HA, N/V, hyperventilation
• heat exhaustion: low BP, elevated HR and RR, wet and pale skin
• heat syncope: decreased HR and RR, pale skin, weakness, vertigo
• heat cramps: localized muscle spasms

• reduces partial pressure of oxygen in air, causing decreased arterial oxygen levels
• increased ventilation and HR and decrease in performance

• compression, airway, breathing
• compression rate: 100/min
• compression depth: 2 inches for adults and kids (1/3 AP depth for kid and infants)
• airway: head tilt, chin lift
• breaths: 30:2