Recorded Lecture: Cardio Examination

Heart rate (HR)

Number of heartbeats per minute

Stroke volume (SV)

Blood ejected by left ventricle per beat

Cardiac output (CO)

Blood pumped per minute (CO = HR x SV)

Ejection fraction (EF)

% of blood ejected from the ventricle per beat (normal: 55-70%)

Systole

Heart contraction phase (blood ejected)

Diastole

Heart relaxation phase (chambers fill)

Contractility

The force of myocardial contraction

Blood pressure (BP)

Force of blood against vessel walls; —> systolic = contraction; diastolic = relaxation

Describe the sequence of cardiac tests/measures you would take for a patient who walks into the clinic.

• Blood pressure

• Heart rate

• Rate product pressure

• Auscultation

• Heart sounds

Describe how HR, CO, and BP change over time during exercise.

• HR & CO increases linearly with increasing work rate, reaches plateau at 100% VO2max

• BP mean arterial pressure increases linearly, SBP increases, DBP remains fairly constant

What is the most appropriate measure for metabolic demand placed on the heart?

Rate product pressure = myocardial O2 demand; RPP = HR x SBP, used to determine myocardial O2 demand of a patient at the onset of chest pain symptoms

How should a patient prep for a 6MWT?

No warm-up or practice test immediately before, should be at rest for about an hour before

What are the AHA BP guidelines?

• Normal: less than 120/80 mmHg

• Elevated: SBP between 120-129 AND DBP <80

• Stage I HTN: SBP between 130-139 OR DBP 80-89

• Stage II HTN: SBP > 140 OR DBP >90

• Hypertensive crisis: SBP >180 OR DBP > 120 w/ patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization (911) if there are symptoms

Describe the difference between SNS and PNS.

• SNS - fight or flight —> increases HR, BP

• PNS - rest and digest —> decreases HR, BP