NPTE cardio exam

What is the normal % of blood ejected from the ventricle per beat (EF)?

55-70%

What is contractility?

force of myocardial contraction

What is rate product pressure (RPP, or double product pressure [DPP])?

What is it used for?

HR x SBP

• to measure myocardial workload & O2 demand of the heart

What happens with incremental exercise in terms of HR, Q, & BP?

HR, Q, & MAP increases linearly w/ increasing work rate

• HR & Q plateaus at 100% VO2max or HRmax

• SBP increases, DBP remains fairly intact

What is the new AHA/ACC High BP Guidelines?

• normal: <120/80

• elevated: SBP 120-129 AND DBP <80

  • Tx: healthy lifestyle & diet

• stage 1: SBP 130-139 OR DBP 80-89

  • Tx: same as above, and meds in case of high risk

• stage 2: SBP ≥140 OR DBP ≥90

  • Tx: meds

• hypertensive crisis: SBP >180 AND/OR DBP >120

  • need prompt ∆s in meds or immediate hospitalization if Sx’s present

  • Sx’s: chest pain, back pain, SOB, numbness, weakness, vision ∆s, difficulty speaking

  • medical emergency

What is hypotension?

What can cause this?

SBP <90 OR DBP <60, inadequate blood flow to heart, brain, & other organs

• bed rest, drugs, arrhythmia, blood loss or shock, MI

What is orthostatic hypotension?

How can you assess this?

drop in SBP >20 or DBP >10

• assess BP & HR when pt has been supine for 5 min

• then have pt stand up, then reassess BP & HR after 3 min of standing

• if pt is symptomatic, have them sit down and maybe w/ legs elevated to a reclined position

What are the effects of altitude initially & after acclimatization?

• initial: increased HR, Q, BP, normal SV

• acclimatization: increased HR, normal Q & BP, reduced SV

What are the CV effects of aquatic therapy?

• decreased HR, BP, VO2

• increased SV, Q

• cephalad redistribution of blood flow

What are the respiratory effects of aquatic therapy?

challenges chest expansion

• decreased IRV, VC

• increased WOB

What are the MSK effects of aquatic therapy?

• decreased WB, edema d/t hydrostatic pressure exerted by water

• increased mm strength & endurance d/t water resistance

What are the % WB with immersion of C7, xiphoid process, & ASIS?

• C7 = 10% BW

• xiphoid process = 33%

• ASIS = 50%

What are the effects of warm water & cold water with aquatic therapy?

• warm: relaxation

• cold: reduce pain & inflammation

What are beta blockers?

What does it do and who is it used for?

beta-adrenergic blocking drugs (-olol)

• compete w/ epinephrine & norepinephrine for beta adrenergic receptors in the heart

• reduce HR & contractility (lower myocardial O2 demand)

  • will blunt HR during exercise

• for pts w/ CAD & HTN

Mnemonic for Borg RPE rating?

13 SHVEM

• 13 = somewhat hard

• 15 = hard

• 17 = very hard

• 19 = extremely hard

• 20 = maximal exertion

What is preload?

L ventricular end-diastolic pressure (LVEDP); the amt. of ventricular stretch at the end of diastole

What is afterload?

systemic vascular resistance (SVR); the amt. of resistance the heart must overcome to open the aortic valve and push blood out

• higher afterload is not good for us

What are the 5 auscultation landmarks and their locations?

• aortic: 2nd IC space, R sternal border

• pulmonic: 2nd IC space, L sternal border

• Erb point: 3rd IC space, L sternal border

  • heart murmurs

• tricuspid: 4th IC space, L sternal border

• mitral (apical): 5th IC space, L midclavicular line

  • best site if S3 present

  • point of maximal impulse

What are the S1, S2, S3, S4 heart sounds?

• S1: lub, closure of tricuspid & mitral valves (AV valves) → onset of systole

• S2: dub, closure of pulmonary & aortic valves (semilunar valves) → onset of diastole

• S3: ventricular gallop (S1-S2-S3), ventricular filling into overloaded ventricle after AV valves open

  • low-frequency turbulence, heard during early diastole

  • hallmark sign of CHF

• S4: atrial gallop (S4-S1-S2), ventricular filling & atrial contraction into stiff ventricle

  • low-frequency turbulence, heard during late diastole

  • common in HTN, pulmonary HTN, MI, LV hypertrophy, increased LVEDP, aortic or pulmonary stenosis

What are heart murmurs?

What are the grades?

whooshing or swishing sounds of turbulent blood flow d/t valve disorders

• grade 1 = softest

• grade 6 = audible w/o stethoscope

What are systolic murmurs?

“lush” instead of “lub”; turbulence b/w S1-S2

• d/t valve disease (mitral valve prolapse), aortic stenosis, or may be normal

What are diastolic murmurs?

turbulence b/w S2-S1

• d/t aortic & pulmonary regurgitation, mitral stenosis

What is thrill?

abnormal, palpable tremor w/ vascular or cardiac murmur

What is the difference b/w stenotic valve & regurgitant valve?

• stenotic valve: impaired opening

• regurgitant valve: impaired closing

What is bruit?

Where is this most commonly found?

adventitious sound or murmur (blowing sound) of arterial or venous origin

• turbulent blood flow d/t atherosclerosis or partially blocked artery

• common in carotid or femoral arteries

What is pericardial friction rub?

high-pitched heartbeat, leathery, scratchy quality

• d/t inflammation of the pericardial sac

• post-MI pericarditis (Dressler syndrome)