NPTE Cardiovascular Examination Review

Stroke Volume (SV)

The volume of blood ejected by the left ventricle per beat.

Normal Ejection Fraction (EF)

55% to 70% of blood ejected per beat.

Rate Pressure Product (RPP) Formula

RPP = Heart Rate (HR) × Systolic Blood Pressure (SBP).

Rate Pressure Product (RPP) Clinical Significance

Measures myocardial oxygen demand.

when we exercise how is HR, CO, and BP changing, such as what is increasing, decreasing, etc

Heart rate and cardiac output

• Increases linearly with increasing work rate • Reaches plateau at 100% VO2 max

Blood pressure • Mean arterial pressure increases linearly ̶Systolic BP increases ̶Diastolic BP remains fairly constant

Elevated Blood Pressure (AHA 2025)

Systolic 120-129 mm Hg AND diastolic less than 80 mm Hg.

Stage 1 Hypertension (AHA 2025)

Systolic 130-139 mm Hg OR diastolic 80-89 mm Hg.

Stage 2 Hypertension (AHA 2025)

Systolic at least 140 mm Hg OR diastolic at least 90 mm Hg.

Hypertensive Crisis (AHA 2025)

Systolic over 180 mm Hg and/or diastolic over 120 mm Hg.

Steady State VO2 indicates what?

Indicates that adenosine triphosphate (ATP) demand is being met aerobically.

What does it mean when VO₂ reaches steady state during constant-load, submaximal exercise?

Early in exercise: ATP demand is greater than aerobic ATP production, so the body temporarily relies on anaerobic energy systems (ATP-PC and anaerobic glycolysis).

At VO₂ steady state: Oxygen delivery and oxygen utilization become sufficient to meet the ATP demand aerobically.

Key point: ATP demand is now being met aerobically, so reliance on anaerobic metabolism decreases.

when is lactic acid produced

anaerobically, low o2

Why do endurance athletes often "train high, compete low"?

At high altitude, there is less oxygen available in the air.

The body adapts by producing more red blood cells (RBCs), increasing hemoglobin and oxygen-carrying capacity.

More RBCs = more oxygen delivered to muscles.

Athletes then compete at sea level, where oxygen is plentiful, allowing for improved aerobic performance and endurance.

Initial Cardiovascular Responses to Altitude

Increased heart rate, increased cardiac output, and increased blood pressure.

Initial Stroke Volume Response to Altitude

No significant change.

how long does it take to acclimatize

3 wks

what happens to HR, BP, CO, and SV when acclimated

HR-inc

BP-normal

CO-normal

SV-dec

Aquatic Therapy: Heart Rate Effect

Heart rate decreases.

Aquatic Therapy: Cardiac Output Effect

Cardiac output increases.

Aquatic Therapy: Stroke Volume Effect

Stroke volume increases.

Aquatic Therapy: Vital Capacity Effect

Vital capacity decreases.

Aquatic Therapy: Weight-Bearing Effect

Weight-bearing decreases due to buoyancy.

How does hydrostatic pressure benefit patients during aquatic therapy?

Water exerts equal pressure on the body from all directions.

↓ Swelling (edema) by promoting venous and lymphatic return.

↑ Circulation.

Hydrostatic = Hugs the body."💧 Water "squeezes" fluid back into circulation.

How does water resistance improve strength and endurance?

Water provides constant resistance to movement.

Resistance increases as speed of movement increases.

Improves muscle strength and muscular endurance.

🧠 Memory Trick: "Move Faster → More Resistance."

How does water temperature affect the body during aquatic therapy?

Warm water:

Muscle relaxation

↓ Muscle spasm

↑ Flexibility

Cold water:

↓ Pain

↓ Inflammation

How do beta-blockers work?

Compete with epinephrine (Epi) and norepinephrine (NE) for β₁-adrenergic receptors in the heart.

Result:

↓ Heart rate (HR)

↓ Contractility (force of contraction)

↓ Myocardial oxygen (O₂) demand

🧠 Memory Trick: "Beta BLOCKERS block the heart from adrenaline."

Why are beta-blockers prescribed?

They are commonly prescribed for:

❤️ Coronary artery disease (CAD)

🩸 Hypertension (HTN)

Also used for heart failure and certain arrhythmias.

Why?

Slows the heart.

Reduces the heart's workload.

Decreases oxygen demand.

🧠 Memory Trick: "Block = Break for the heart."

How do beta-blockers affect exercise?

↓ Resting HR

↓ Submaximal exercise HR

↓ Maximal HR

Blunts the normal HR response to exercise.

Clinical implication: HR is not a reliable measure of exercise intensity.

🧠 Memory Trick: "Beta-blockers = Blunted Beat."

Why are beta-blockers important for exercise prescription?

Because heart rate is artificially lowered:

❌ Do not rely solely on target HR formulas.

✅ Use:

RPE (Rating of Perceived Exertion) (preferred)

Talk test

Symptoms

Workload

🧠 NPTE Tip: If a patient is taking a beta-blocker, RPE is more accurate than heart rate for prescribing exercise intensity.

which meds ending in -lol are

beta blockers!

Aortic Auscultation Landmark

Second intercostal space at the right sternal border.

Pulmonic Auscultation Landmark

Second intercostal space at the left sternal border.

Tricuspid Auscultation Landmark

Fourth intercostal space at the left sternal border.

Mitral Auscultation Landmark

Fifth intercostal space at the left midclavicular line.

S1 Heart Sound ("lub")

Closure of mitral and tricuspid valves at onset of systole.

S2 Heart Sound ("dub")

Closure of aortic and pulmonary valves at onset of diastole.

S3 Heart Sound ("ventricular gallop")

Associated with ventricular filling and heart failure.

S4 Heart Sound ("atrial gallop")

Abnormal sound associated with ventricular filling and atrial contraction.

Loudest Location for S2 Sound

Base of the heart.

Loudest Location for S1 Sound

Apex of the heart.

Erb's Point Sound Characteristic

S1 and S2 heart sounds are equally loud.