Chronic Disease and Obesity

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Chronic Disease and Obesity
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2010-10-26 00:24:17
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Mid-term Exam
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  1. Premature Atrial Contraction (PAC)
    slightly widened QRS complex after P'
  2. Premature Junctional Contraction (PJC)
    slightly widened QRS complex, INVERTED P WAVE
  3. Premature Ventricular Contraction (PVC)
    VERY WIDE QRS, great amplitude
  4. Atrial Flutter
    SAWTOOTHED P Wave
  5. Atrial Fibrillation
    • NO DISCERNABLE P WAVE
    • Irregular R to R intervals
  6. Ventricular Fibrillation
    • Rhythm is extremely irregular
    • 1 of 2 SHOCKABLE RHYTHMS(other is pulse-less V-Tach)
  7. 1st Degree AV Block
    • PR Interval greater than 0.2 seconds(5 blocks or more)
    • The PR Interval stays the same elongated length
  8. 2nd Degree AV Block
    Mobitz 1
    Wenckebach
    PR Interval increasingly prolonged until QRS complex is dropped
  9. 2nd Degree AV Block
    Mobitz 2
    PR Interval unchanged, QRS Complex SUDDENLY MISSING
  10. 3rd Degree Block
    • P Wave normal, but NOT associated with QRS complex
    • Atrial rate faster than Ventricular rate
  11. Right Bundle Branch Block (RBBB)
    "BUNNY EARS" in V1 or V2
  12. Left Bundle Branch Block (LBBB)
    "BUNNY EARS" in V5 or V6
  13. Atrial Hypertrophy
    Right Atrial Hypertrophy - large diphasic P Wave with tall initial component

    Left Atrial Hypertrophy - large diphasic P Wave with wide terminal component
  14. BMI Classifications
    • Underweight: < 18.5
    • Normal: 18.5 to 24.9
    • Overweight: 25.0 to 29.9
    • Obesity Class 1: 30.0 to 34.9
    • Obesity Class 2: 35.0 to 39.9
    • Obesity Class 3: > 40
  15. Prevalence of Overweight and Obese in Adults
    NHANES 2004
    Overweight 66.2%


    Obese 32.9%
  16. Heart Disease
    Encompasses many disease states, general disease of the heart
  17. Cardiovascular Disease
    Any disease of the vascular system
  18. Arteriosclerosis
    Natural hardening of the arteries
  19. Atherosclerosis
    Process of fatty substances, cholesterol, cellular waste products, calcium and fibrin building up on the inner lining of an artery

    It is an inflammatory disease
  20. Response to Injury Theory
    • Hyperinsulenemia; Hypertension; Hyperlipidemia; Smoking
    • Endothelial Injury
    • Inflammatory Response
    • LDL oxidized
    • Macrophages adhere to intima
    • Macrophages turn into FOAM CELLS
    • FOAM CELLS turn into FATTY STREAKS
  21. Effect of HDL
    • Promote cholesterol efflux
    • Inhibit oxidation of LDL

    Key Point - Every mg. of HDL increase, there is a lowering of CHD by 2 to 3%
  22. Poisuelle's Law
    MAP = CO x Peripheral Resistance

    MAP = SV x HR x PR
  23. Regulation of Blood Pressure
    • Nervous System
    • SNS
    • Constricts blood vessels(NE or Epi)
    • Humoral
    • Renin-Angiotensin System (kidneys)
    • Aldosterone
    • Increases SODIUM reabsorption and POTASSIUM secretion by kidneys
  24. Renin-Angiotensin System
    Low plasma sodium and low blood pressure cause kidneys to release Renin, which aids in forming Angiotensin 2, a potent vasoconstrictor
  25. ACE Inhibitors / Calcium Channel Blockers
    ACE Inhibitors - block Angiotensin Converting Enzyme, which converts Angiotensin 1 to Angiotensin 2. Angiotensin 2 is a potent vasoconstrictor, which means blood pressure would decrease

    Calcium Channel Blockers - slow the heart rate, thus dropping blood pressure

    Remember: BP = SV x HR x PR
  26. Diabetes Diagnostic Criteria
    Diabetes Mellitus - Fasting Blood Glucose > 126 mg/dL

    Impaired Fasting Glucose - 100 -125 mg/dL "Pre-diabetic"

    Impaired Glucose Tolerance - Glucose between 140 and 199 mg/dL two hours after taking an OGTT
  27. Hyperglycemia Symptoms
    • Excessive thirst
    • Excessive hunger
    • Fatigue
    • Increase Urine production
    • Weight loss
    • Blurred vision
    • Sores that won't heal
  28. Hypoglycemia Symptoms
    • Headache
    • Shaking
    • Sweating
    • Feeling tired
    • Weakness
    • Hunger
  29. Hemoglobin A1c (HgA1c)
    Measure of 3 month level of blood glucose level
  30. Normal Action of Insulin
    Once insulin attaches to its receptors, GLUT 4 translocates to cell membrane, which allows glucose to enter into the cell

    Key Point: exercise makes 1. more GLUT 4 cells, and 2. GLUT 4 translocates to cell membrane w/o insulin
  31. Micro and Macrovascular Complications of Diabetes
    • Microvascular
    • Retinopathy
    • Neuropathy - diabetic foot
    • Nephropathy - kidney failure

    • Macrovascular
    • CAD
    • Peripheral Vascular Disease
  32. Ornish Diet
    Only diet to show reversal of Atherosclerosis
  33. Metabolic Syndrome (NCEP ATP III)
    • Must have 3 or more of the following:
    • Abdominal obesity: men > 40, women >35 inches at waist
    • Triglycerides > 150 mg/dL
    • HDL men < 40, women < 50
    • Blood Pressure > 130 / > 85 mmHg
    • Fasting Glucose > 110 (ACSM says > 100)
  34. Ischemia
    Inverted T Wave that is also symmetrical

    ST Segment Depression
  35. Necrosis
    Significant Q Wave is at least 1mm wide or Q Wave is 1/3 the amplitude or more of the QRS Complex
  36. ST Segment Elevation
    Acute Injury, MI is happening RIGHT NOW
  37. Overdrive Suppression
    SA Node 60 - 100 bpm

    Atrial Foci 60 - 80 bpm

    Junctional Foci 40 - 60 bpm

    Ventricular Foci 20 - 40 bpm
  38. Methods to Determine Rate
    Large Box - 300, 150, 100, 75, 60, 50...

    6 Second Strip - # R Waves multiplied by 10

    • Small Box - (rhythm MUST be REGULAR), count # of small boxes between 2 R's then divide 1500 by the number of small boxes.
    • aka 1500 Method
  39. Determine Axis Quadrant
    Look for AVF and Lead I to determine axis by looking at QRS Complex

    • Both negative = ERAD
    • Both positive =Normal
    • Lead I negative, AVF positive = RAD
    • Lead I positive, AVF negative = LAD
  40. EKG Seconds / Blocks
    • P Wave .08 - .12 = 2 to 3 blocks
    • PR Interval .12 - .20 = 3 to 5 blocks
    • QRS Complex .06 - .10 = 11/2 to 21/2 blocks
    • ST Segment .12 = 3 blocks
    • T Wave .16 = 4 blocks
    • QT Interval .36 - .44 = 9 to 11 blocks
  41. Determining Rhythm and Regularity
    • Is the source the SA Node?
    • if not, what is the source?
    • Does the R to R Interval look regular?
    • P before every QRS
    • QRS after every P
    • Check PR and QRS Intervals
    • Does the P Wave look normal
  42. Ventricular Hypertrophy
    • Right Ventricular Hypertrophy
    • R Wave > S in V1

    • Left Ventricular Hypertrophy
    • S Wave in V1 + R Wave in V5 > 35 mm.

    Also, Inverted T Wave

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