Cardiovascular and Pulmonary Exam Flashcards

Flashcards for review of cardiovascular and pulmonary physiology and pathophysiology, including medical devices and ICU management.

What is a hallmark of atherosclerosis development?

Retention of cholesterol-rich LDL and other apoB-containing lipoproteins within the arterial wall.

What causes plaque build-up in atherosclerosis?

Build up of LDL in the endothelium.

Where is cholesterol an important structural component?

Plasma membranes and several hormones.

Where does LDL carry cholesterol?

Peripheral tissues.

What is systolic heart failure caused by?

Abnormality of ventricular emptying due to impaired contractility or excessive afterload; systolic dysfunction.

What are the specific mechanisms leading to systolic heart failure?

Impaired contractility or volume overload, increased afterload, dilated cardiomyopathies.

What is diastolic heart failure caused by?

Abnormalities of diastolic relaxation or ventricular filling; diastolic dysfunction.

What are the specific conditions that cause diastolic heart failure?

LV hypertrophy, restrictive cardiomyopathy, myocardial fibrosis.

What is a common result of diastolic heart failure?

Blood backs up into the lungs, right heart, and periphery.

What is unstable angina?

No tissue death but preceding a bad event; patient can fully recover; no occlusion.

What is NSTEMI?

Partial occlusion with necrosis.

What is STEMI?

Complete occlusion with necrosis.

What are gallops?

Abnormal sounds heard with the bell of a stethoscope.

What is S3 heart sound?

Ventricular gallop heard in younger people, athletes, and pregnancy with increased compliance.

What is S4 heart sound?

Atrial gallop increased LV stiffness due to scar tissue or thick/stiff ventricle.

What does the electrical axis of the heart represent?

The average of all instantaneous vectors in the mean vector.

How do you determine the heart's electrical axis is normal on an ECG?

Lead I and aVF show positive QRS complexes.

What conditions can cause an abnormal electrical axis?

Hypertrophy and MI.

What is atrial fibrillation?

Most common arrhythmia.

What is atrial flutter?

Generated by a single constant atrial reentrant circuit; 2nd most common arrhythmia.

What is the P wave rate in atrial flutter?

250-350 bpm.

What does the PR interval measure?

Measures time from start of atrial depolarization to start of ventricular depolarization.

What is a normal PR interval duration?

120-200 msec (0.12-0.2sec).

What are some differences in hypertension presentation in Black patients?

Black patients have a greater prevalence of low-renin, salt-sensitive hypertension and may be more predisposed to hypertension-mediated organ damage.

What treatments are particularly useful in black patients with hypertension?

Salt restriction, thiazide/thiazide-like diuretics, and CCBs appear particularly useful.

In combination therapy for hypertension in Black patients, what might be more effective; ARB or ACEI?

ARB may be better than ACEI (less edema).

Give an example of medication for management of high cholesterol

Atorvastatin

Which drug is typically first line in those with HTN and kidney disease?

ACEI or ARB

Which drug is a positive inotropic agent?

Digoxin

Which drug should be administered during an acute bout of stable angina?

Nitroglycerine, venodilator

Which class of CCB is most selective for heart muscle?

Non-DHP "-pine"

Which drug is used for the management of DVT with effectiveness measured by INR?

Warfarin

Which drugs are given in hypotensive emergencies (cardiogenic shock following MI)?

Norepinephrine, epinephrine, dopamine, and vasopressin

What are normal lung sounds?

Bronchial, vesicular, bronchovesicular

Describe bronchial lung sounds.

Heard over the trachea and main stem; turbulent airflow, harsh/loud high pitched; pause 1:1.

Describe bronchovesicular lung sounds.

Intermediate pitch; heard over central large airways; no pause 1:1.

Describe vesicular lung sounds.

Faint, soft, and low pitched; no pause 3:1.

Describe absent or diminished lung sounds.

Little or no sound.

Describe crackles (rales) lung sounds.

Discontinuous, intermittent, nonmusical sounds.

Describe wheezes/rhonchi lung sounds.

Commonly heard on exhalation, musical high pitched, continuous sounds.

Describe stridor lung sounds.

Continuous monophonic wheezes, indicates upper airway obstruction.

Describe pleural rub lung sounds.

Produced when the visceral pleura rubs against the parietal pleura during insp/expir; usually painful.

What is the key ABG characteristic of Type 1 respiratory failure?

PO2 <60 mmHg.

What is the key ABG characteristic of Type 2 respiratory failure?

CO2 >50 mmHg.

What is the primary characteristic of respiratory acidosis?

Too much CO2.

What is the primary characteristic of respiratory alkalosis?

Too little CO2.

What is the primary characteristic of metabolic acidosis?

Too little HCO3-.

What is the primary characteristic of metabolic alkalosis?

Too much HCO3-.

What are the normal ranges for pH, PaCO2, PaO2, and HCO3-?

pH = 7.35-7.45, PaCO2 = 35-45, PaO2 = 80-100, HCO3- = 22-26

What happens to lung compliance with COPD?

Increased compliance.

What are the key features of emphysema?

Destruction of alveolar walls and enlargement of air spaces distal to terminal bronchioles.

What are typical PFT results in emphysema?

Decreased FVC, FEV1, FEV1/FVC; increased TLC, RV.

What are the indications for long-term oxygen therapy in emphysema?

PaO2

What are the key features of chronic bronchitis?

Obstruction of airway and mucus plugging.

How is chronic bronchitis defined clinically?

Presence of chronic productive cough for 3 months in each of two successive years.

What are typical PFT results in chronic bronchitis?

Decreased FVC, FEV1, FEV1/FVC; increased TLC, RV.

What is bronchiectasis?

Irreversible dilation of bronchi with chronic inflammation and infection.

What are typical PFT results in bronchiectasis?

Decrease FVC, FEV1, FEV1/FVC; increased TLC, RV.

What are contraindications for postural drainage techniques?

Unstable CVD, aortic aneurysm, recent esophageal surgery, untreated pneumothorax, anxiety, weak diaphragm, abdominal distension, risk of aspiration.

Describe the vibration airway clearance technique.

Side to side applied throughout expiration; pressure encourages deep expiration; Aids with full expiration.

What is autogenic drainage?

Self-treatment to move secretions from peripheral to central airways.

What are the stages of autogenic drainage?

Unsticking phase, collection phase, evacuation phase.

Where are chest tubes placed and why?

Placed in pleural space to drain air, fluid, or blood from pleural cavity.

What are the chambers of a chest tube system?

Collection chamber, water seal chamber, suction control chamber.

What are precautions during PT mobilization with a chest tube?

Collection device should remain BELOW level of chest tube; Check for air bubbles in underwater seal compartment; Discuss with care provider before disconnecting suction or placing patient on portable suction.

Why might chest tubes be placed at the mediastinum?

To drain pericardium and exit chest at surgical incision.

What does an arterial line measure?

Provides continuous measurement of systolic, diastolic, and MAP.

What is an acceptable MAP range?

70-110 mm Hg.

What should the transducer be leveled with?

Phlebostatic axis.

What is a PICC line used for?

Provides central venous access, used for blood draws and total parenteral nutrition (TPN).

What is the path of the pulmonary artery catheter?

Central vein → vena cava → R atrium → R tricuspid valve → R ventricle → pulmonary valve → pulmonary artery.

What does PA catheter allow for?

Measurement of central venous pressure (CVP), Direct measurement of R atrial pressure (RAP), Direct measurement of pulmonary arterial pressure (PAP), Indirect measurement of L atrial pressure (LAP) via pulmonary capillary wedge pressure

What is ECMO?

Circulatory support device used when no other form of treatment has been successful for management of cardiac or pulmonary failure.

What RASS scores indicate that a patient is not safe to mobilize?

+4 (combative) and +3 (very agitated).

What does the 'A' stand for in the ABCDEF ICU bundle?

Assess, prevent and manage pain.

What does the 'B' stand for in the ABCDEF ICU bundle?

Both spontaneous awakening trials and spontaneous breathing trials.

What does the 'C' stand for in the ABCDEF ICU bundle?

Choice of analgesia and sedation.

What does the 'D' stand for in the ABCDEF ICU bundle?

Delirium: assess, prevent and manage.

What does the 'E' stand for in the ABCDEF ICU bundle?

Early mobility and exercise.

What does the 'F' stand for in the ABCDEF ICU bundle?

Family engagement and empowerment.

What are expected physiological changes after a heart transplant?

Denervation occurs, Delayed reaction to stimulus of activity, Decreased heart rate response to activity.

What substitute should be used for HR in heart transplant recipients?

RPE or ventilatory response.

What is a significant blood pressure concern after heart transplant?

Hypertension.

What is the typical HR response in a denervated heart?

The denervated heart increases from rest and has a delayed response.

What is the initial CV response to exercise in a denervated heart?

HR does not change; SV increase to increase cardiac output (Frank-starling mechanism).

What is the VO2 max achievement in heart transplant recipients?

Between 50-70% of gender and age matched controls.

How can transplant rejection be detected?

Suspected as complication when exhibiting signs and symptoms of exercise and activity intolerance, confirmed with endomyocardial biopsy.

What are complications post-LVAD implantation?

Readmission to hospital, LVAD infection, Pump thrombosis, Neurological complications.

What can high LVAD pump speeds lead to?

Suction events (due to LV unloading).

What can low LVAD pump speeds lead to?

Left heart failure.

What is the INR goal after LVAD if taking antithrombotic therapy?

Goal of 2.0-3.0

What is the primary source of LVAD infections?

Skin flora.

How can LVAD infections be prevented?

Follow aseptic precautions and ensure sterility of driveline exit.

Why is oral health and hygiene important after LVAD transplant?

Oral health / hygiene is very important (infection).

How long after LVAD transplant can the patient drive?

3 months after LVAD transplantation

What is an acyanotic congenital heart defect?

Blood shunted from L side of the heart to the R side; oxygenated blood still circulates to the body; cyanosis typically absent.

What is a cyanotic heart defect?

Blood is shunted from the R side of the heart to the L side; deoxygenated blood bypasses the lungs and enters systemic circulation, causing cyanosis; O2 sats < 90%.

Give some examples of acyanotic defects.

Patent Ductus Arteriosus (PDA), Atrial Septal Defect (ASD), Ventricular Septal Defects (VSD), Coarction of Aorta

Give some examples of cyanotic defects.

Tetralogy of Fallot (TOF)

What occurs during the Pseudoglandular period of respiratory development?

6-16 weeks; additional airways form (terminal bronchi level - no respiratory bronchioles or alveoli).