Cardio 2 Exam 1

When does the heart form and from what tissue

18-19 days after fertilization from mesoderm

When does the embryonic heart begin to beat and pump blood?

21-22 days

When does blood circulation start?

27 days

Primitive heart tube is formed by the fusion of

cardiogenic cords

Truncus arteriosus becomes the

ascending aorta and pulmonary trunk

Bulbus cordis becomes the

right ventricle

Primitive ventricle becomes the

left ventricle

Primitive artium becomes the

anterior portion of right and left atria

Sinus venosus becomes the posterior portion of the

posterior right atrium and SA node

Foramen ovale forms by day

27-37

Ductus arteriosus forms a connection between these

pulmonary trunk and aorta

Heart development is complete by week

10

Ductus arteriosus closes __ hours after birth

10-15

Incidence of congenital heart defects

40,000/year

Prevalence of congenital heart defects

1 million kids, 1.4 million adults

Arterial and ventricular septal defects are a _ *to* _ shunt

left to right

With eisenmenger syndrome the VSD shunt is *_ to _*

right to left

Coarctation of the aorta results in what BP changes

high UE BP then LE BP

Most common cyanotic defect

tetralogy of fallot

4 defects present in tetralogy of fallot

pulmonary stenosis, VSD, overriding aorta , right ventricle hypertrophy

Newborn heart rate should be

100-180

Valsalva maneuver will increase _ pressure on LV

afterload

__ impacts mood more than severity of CHD

functional status

Marfan Syndrome is autosomal

dominant

Usual cause of death in someone with Marfan Syndrome

aneurysm

A 1% A1c reduction results in

40% less cardiac risk

Normal A1c

2\.5%-6%

Goal A1c for those with DM

Type _ *diabetics use insulin and are at risk of* _

1, hypoglycemia

Exercise contraindicated if SBP > *_ or DBP >* _

200, 100

Aerobic activity guidelines for those with DM

F- 3-6 days/week

I- mod to vigorous

T- 150 mins/week

T- prolonged large muscle groups (cycling, walking)

This BMI is considered obese

30 kg/m2

Obese class 1 BMI

30- < 35

Obese class 2 BMI

35 -

Obese class 3 BMI

40 or more

Normal BMI

18\.5 - 25

Overweight BMI

25 -

Top 3 consequences of obesity

low quality of life

mental illness

body pain

Obesity hypoventilation syndrome

difficulty breathing during the day

Top 2 pulmonary complications of obesity

obstructive sleep apnea, obesity hypoventilation syndrome

Reduction of breathing

hypopnea

Completely stop breathing

apnea

Obstructive sleep apnea breathing pauses occur _ *to* _ times a night

5-30

\# of breathing pauses for mild sleep apnea

5-15

\# of breathing pauses for moderate sleep apnea

15-30

\# of breathing pauses for severe sleep apnea

>30

Neck circumference risk factor for sleep apnea

female 16 cm, male 17 cm

Common sign of sleep apnea

feeling tired despite getting 8 hours of sleep

Death rate of those with untreated sleep apnea is _ higher than those without

3x

Obesity hypoventilation syndrome has this while obstructive sleep apnea does not

daytime hypercapnia

Hypercapnia CO2 level

>45

CPAP stands for

continuous positive airway pressure

Most common bariatric surgery

gastric bypass and sleeve

2 most important aspects of pt history with obese population

past exercise experience, attitude

What to do if unable to palpate radial pulse

auscultate in left side lying

_ is more important than intensity regarding exercise prescription of the obese

duration

Normal walker can handle _ pounds

< 300

Bariatric walker for those _ pounds

< 500

Metabolic syndrome means pt has 3 out of 5 of these

abdominal obesity

elevated triglycerides > 150

low HDL cholesterol

high BP

fasting blood sugar >100

waist circumference for men & women to be considered abdominal obesity

men > 40”

women > 35”

low HDL cholesterol for men & women

men < 40

women < 50

high BP considered

> 135 / 85

Top risk of developing metabolic syndrome

overweight/obesity and lack of activity

NYHA class 1

cardiac disease, no symptoms, no limitation in regular activity

NYHA class 2

mild symptoms, slight limitation of regular activity

NYHA class 3

significant limitation of activity, comfortable only at rest

NYHA class 4

severe limitations, symptoms at rest

ACC/AHA stage A

high risk of heart failure

ACC/AHA stage B

structural heart disease, no symptoms of heart failure

ACC/AHA stage C

structural heart disease, current or past symptoms

ACC/AHA stage D

heart failure not responding to typical treatments

Effect of positive inotropes

increase pumping of heart

1A transplant status

urgent, on life support

1B transplant status

depend on IV meds or mechanical assistive device

2 transplant status

stable on oral meds, waiting at home

7/Inactive transplant status

temporarily unsuitable for transplant

Most common cause of death within 30 days of transplant

nonspecific graft failure

diuretic purpose

optimize preload

positive inotrope purpose

increase pumping of heart

Pre heart transplant rehab should focus on

remain active as possible

hemodynamic stability

minimal exertion

Heterotopic heart transplant done when

mix match in size

Biatrial orthotopic heart transplant

keep pt’d SA node

Indicator of acute rejection

hypotension with activity

Key to post transplant exercise program

long warm-up and cool down

Post transplant pt’s often are on corticosteroids for 1-2 years, what are the indications of this when planning an exercise program

do weight bearing exercises to help bone density

Post transplant surgical precautions

5-10lbs limit

move in tube

no both arms over head

no driving

6-8 weeks

PT goals for inpatient therapy post transplant

pulmonary hygiene

chest wall mechanics

UE /trunk strength and ROM

exercise tolerance

What should be used to monitor exercise intensity post transplant?

RPE

Men older than _ *and women older than* _ are at increased risk of CVD

45, 55

Dementia would be considered a _ flag for cardiac rehab

yellow

FITT

frequency, intensity, time, type

1 met = _ oxygen at rest

3\.5ml

Proper nutrition can _ *and* _ chronic disease

prevent and treat

6 essential nutrients

carbs, fats, protein, water, minerals, vitamins

Recommended Dietary Allowance

daily intake required to meet needs of healthy people

Top 4 lacking vitamins in US

vit D, calcium, iron, potassium

Protein needed for a sendentary adult per day

0\.8g

Protein needed for a moderately active adult per day

1 - 1.2g

Most effective type of protein during an injury

whey

leucine

stimulates muscle protein synthesis