Cardiovascular
calcified ABI value
>/= 1.40
hypertensive crisis
>180 and/or >120
intensity for phase 1 cardiac rehab
MET: 2-3 to 3-5 HR: 10-20 above resting RPE: 11/20
intensity for phase 2 cardiac rehab
MET: 5-9 HR: 40-80%
EKG changes for myocardia ischemia
ST depression and inverted t wave
EKG changes for MI
ST elevation >1 mm (new) or >2 mm (MI history)
diastolic dysfunction
abnormalities in ventricular diastolic properties causing impaired ventricular filling and impaired relaxation
PaCO2 is (acidic/basic)
acidic
when is the S2 heart sound heard
at the end of systole
HCO3 is (acidic/basic)
basic
when is the S3 heart sound heard
beginning of diastole
when is the S1 heart sound heard
beginning of systole
sx of R heart failure
dependent edema, ascites, liver enlargement, jugular vein distension
when is the S4 heart sound heard
end of diastole
systolic dysfunction
impairment in ventricular contraction leading to a decrease in stroke volume and ejection fraction
where can the pulmonic valve be auscultated
left 2nd intercostal space, left sternal border
where can the mitral valve be auscultated
left 5th intercostal space, medial to midclavicular line
where can the tricuspid valve be auscultated?
lower left sternal border, 4th intercostal space
normal hemoglobin
male: 13-18 female: 12-16
normal hematocrit
male: 45-52% female: 37-48%
sx of L heart failure
pulmonary sx: dyspnea, orthopnea, pink frothy sputum, pulmonary rales and wheezing
what to do with bifocal PVCs
stop exercise and monitor
which heart failure type leads to low ejection fraction
systolic heart failure
aortic stenosis is typically associated with which type of murmur
systolic murmur
when is a diastolic murmur heard
ventricular diastole
when is a systolic murmur heard
ventricular systole
what heart rhythms are medical emergencies
-3rd degree block -V tach -V fib -ST elevation >1 mm
what conditions cause S3 heart sound
-CHF -mitral valve prolapse -pregnancy -excessive fluid in body/systolic failure
which arrythmias are contraindications to exercise
-brady and tachy dysrhythmias -SSS -multifocal PVCs -second or third degree heart block -those that compromise cardiac function
what conditions cause S4 heart sounds
-diastolic heart failure -chronic HTN -aortic stenosis -MI -ventricular hypertrophy -pulmonary hypertension
precautions to cardiac rehab/exercise
-hematocrit <25% -hemoglobin 8-10 g/dL -WBC >500/mm3 -platelet count 5000-10000/mm3 -drop in SBP >20 mmHg or below pre-exercise level -SBP >250 mmHg or <90 mmHg -DBP >120 mmHg -HR <30-35 bpm or >150-180 -RR >40
when are PVCs considered life threatening
-paired -multifocal ->6/min -land on T wave -triplets or more
absolute indications to terminate exercise
-severe chest pain, dizziness, dyspnea, etc. -serious arrythmias ->20 mmHg drop in SBP -SBP >300 mmHg -DBP >140 mmHg -SpO2 <85%
contraindications to exercise
-unstable MI, angina, arrythmias -acute pericarditis, endocarditis, myocarditis -uncompensated heart failure -PE, DVT, thrombophlebitis -aneurysm of heart or aorta -uncontrolled HTN, asthma -ICP >20 mmHg
borderline PAD ABI
0.91-0.99
pulse amplitude classification
0: absent 1+: diminished 2+: normal 3+: moderately increased 4+: markedly increased/bounding
pitting edema scale
1+ trace: barely perceptible 2+ mild: easily identified depression, skin rebounds in <15 seconds 3+ moderate: rebounds in 15-30 seconds 4+: rebounds in >30 seconds
anginal scale
1+: light, barely noticable 2+: moderate, bothersome 3+: severe, very uncomfortable 4+: most severe pain ever experienced
normal ABI
1.00-1.40
elevated BP
120-129 and less than 80
HTN stage 1
130-139 or 80-89
HTN stage 2
140+ or 90+
normal platelet count
150,000-400,000
normal PaCO2
35-45 mmHg
normal WBC
4300-10,800 cells/mm3
normal pH
7.35-7.45
what ABI indicates severe arterial disease and high risk for critical limb ischemia and rest pain
</= 0.5
abnormal ABI (associated with PAD)
</=0.9
intensity for phase 3 cardiac rehab
HR: 50-85% of max capacity
where can the aortic valve be auscultated
R 2nd intercostal space, right sternal border
