Cardiac

Atrial Kick: last 20-30% of blood during ventricular diastole

Right Coronary Artery: 60% of SA Node Left Circumflex 40% of SA node
Conduction: SA node (both atria) AV node bundle of His purkinje fibers ventricles
Preload: left ventricular end diastolic volume, greater the preload greater the amount of
blood pumped (may be problematic for dilating the ventricle)
Cardiac Output: amount of blood ejected from left/right ventricle = HR X SV
Ejection Fracture: normal is >55% (SV/LVEDV)
Right Atrial filling pressure: decreased during ventricular contractions increase in atrial
filling
Decreased during inspiration increase in atrial filling
Myocardiac Oxygen Demand: energy cost to myocardium, increases with increased
HR/BP/activity
Arterioles: primary site of vascular resistance
Venous Circulation: increased with inspiration
Lymph travels from vessels to ducts to left subclavian vein
Parasympathetic Stimulation: stimulated by Vagus nerve, causes coronary vasoconstriction,
but peripheral vasoconstriction of cutaneous arteries
Sympathetic Stimulation: stimulated by T1-T4, causes coronary vasodilation, but
vasoconstriction of cutaneous arteries
Baroreceptors: controls heart rate
Circulatory Reflex: increase in BP causes decreased HR/force of
contraction/peripheral resistance by sympathetic inhibition
Increase in right atrial pressure increases heart rate
Chemoreceptors:
Increase in CO2/decrease in O2 increase in HR
Increase body temperature increases HR
Hyperkalemia: increase in K+ decreases HR/force of contraction, widened PR, QRS, flattened
p-wave, peak T-wave
Hypokalemia: cause heart arrhythmia progress to ventricular fibrillation, prolongs PR and QT
intervals, produces U-wave, flattens t-wave, leg cramps
Hypercalemia: increases HR, widen QRS, shortens QT
Hypocalemia: decreases HR, prolongs QT
Hypermagnesemia: Ca2+ blocker, leads to arrhythmias/cardiac arrest
Hypomagnesemia: ventricular arrhythmias, coronary artery vasospasm, sudden death
Hypothermia: elevates ST segment, slows rhythm
Increased peripheral resistance increases arterial blood volume and pressure
Signs of CHF: fatigue, productive cough, cyanosis, sob, dependent edema
Signs of MI: radiating UE pain, SOB, diaphoresis
Ischemic Pain: diffuse retrosternal pain, tightness, dyspnea, sweating, indigestion, dizziness,
syncope, anxiety
Carotid Artery: assess one side to reduce risk for bradycardia
Brachial Artery: best to palpate in infants
Children HR: 60-140 Newborn HR: 90-164 New Born Average: 127 bpm
Children BP: <2 years 106-110/59-63 3-5: 113-116/67-74
Children Respiratory Rate: 20-30 Newborn: 30-40
Postural Tachycardia Syndrome: sustained increase in >30 beats within 10 minutes of standing
Bounding Pulse: shortened ventricular systole, aortic insufficiency, decreased peripheral
pressure
S1: decreased in 1st degree heart block S2: decreased in aortic stenosis
S3: Left CHF S4: CAD, MI, aortic stenosis, chronic HTN leads to atelectasis, pulmonary
edema, crackles on auscultation
Systolic Murmur: may be normal Diastolic Murmur: valvular disease
Thrill: caused by murmur, felt on palpation
Serious PVC: >6 per minute, absent p-waves
Non-sustained V-tach: 3+ PVC terminating within 30 seconds Sustained: >30 seconds
Atrial Arrhythmia: tachycardia flutter fibrillation (irregular R-R intervals), abnormal p-
waves, cardiac output is usually maintained may precipitate ventricular failure
Premature Atrial Complex: R wave closer to preceding R-wave
rd
3 Degree Heart Block: require pacemaker
Digitalis: depresses ST, flattens T, shortens QT interval, increase contractility, decrease HR
treats CHF
Nitrates/Nitroglycerin: increases HR, decrease preload, peripheral vasodilation, reduce oxygen
demand, dilate coronary arteries, improve coronary blood flow
Quinidine: treats arrhythmias, QT lengthens, QRS lengthens, T wave flattens
All Antiarrhythmic agents: prolong QRS
Diuretics: decrease preload and afterload
Aspirin: may prevent MI
Mean Arterial Pressure: 70-110
Hypoxemia: <90% SaO2, PaO2 of 60
Adult Female Hematocrit: 38% - 47%, Anemia <38%
Metabolic Syndrome: Triglyceride >150, Glucose >100, BP >130/85, insulin resistance
Men: HDL <40, waist >40 inches
Women: HDL <50, waist >35 inches
Decreased Risk: LDL < 100 if high risk for cardiac disease, LDL <160 if no risk for CAD, BMI 18-
25, HgA1C <7%
Stemmers Sign: dorsal skin folds of finger/toes resistant to lifting fibrosis/lymphedema
Examine venous system before arterial
Venous Insufficiency: percussion test + Trendelenburg test + venous filling time + air
plethysmography
Venous Filling: elevate leg lower to dependent position delayed filling > 15 seconds
venous insufficiency
Trendelenburg Test: should take 30 seconds for filling in standing
ABI <0.9 increased risk for cardiovascular events, <0.5 increased risk for progression to
severe ischemia, >1.4 indicates non-compliant arteries
Clinically Significant Change: 0.15 or 0.10 with symptoms
Arterial Rubor on dependency: >30 seconds Arterial insufficiency
Lymphadema: decreased ROM, loss of functional mobility, fibrotic tissue changes, paresthesias
may be present
Cardiac Catheterization: invasive, determine ejection fracture
Central Line/Swan-ganz catheter: right side of heart, measures pulmonary pressure, central
venous pressure, pulmonary capillary wedge pressure
MI: Troponin, increase in CPK/CK
Normal Prothrombin 11-15 seconds INR: 0.9-1.1
PaCO2: 35-45 pH: 7.4
Therapeutic with anticoagulation: 2-3, >3 is at risk for bleeding during activity
Hematocrit Male: 45-52% Women: 37-48%
Hb Male: 13-18 Women: 12-16
Platelet: 150,000 450,000 RBC: 4-6 x106 WBC: 4300-10,800
Levines Sign: patient clenches fist over sternum Angina
Variant/Prinzmetals Angina: vasospasm of coronary arteries with NO occlusive disease,
relieved by NTG/prolonged calcium blocker
Inferior MI: right coronary artery Lateral MI: circumflex artery
Anterior MI: left anterior descending artery
Impaired Ventricular Function: increased end diastolic ventricular pressures (preload)
Left CHF: pulmonary congestion/edema, dyspnea, S3 heart sound orthopnea, PND
Right CHF: high pulmonary pressure or lung disease
Signs: jugular venous distention, peripheral edema, ascites, liver enlargement, weight
gain, right sided S3 sounds
Other CHF symptoms: muscle wasting, osteoporosis, myopathies
Compensated heart failure: reduced cardiac output with normal heart function
-Sympathetic stimulation, Left ventricular hypertrophy, cardiac dilatation, arterial
vasoconstriction. Anaerobic metabolism
Ace Inhibitors: -pril Beta Blockers: -olol decrease HR/contractility, treats HTN
Thromboangiitis obliterans/Buergers Disease: inflammatory disease of small arteries, begins
distally proximally both UE/LE, signs of paresthesia + arterial insufficiency
Diabetic Angiopathy: accelerated atherosclerosis
PE: sudden chest pain, dyspnea, diaphoresis, cough, apprehension, leads to pulmonary HTN
right CHF
Submaximal: symptom limited prior to start of phase 2 outpatient rehab, evaluate early
recovery after MI, CABG 85% of HR max
Maximal ETT: 220-age for predicted max HR
Step Test: workload increases 2-3 minute, ALLOWS steady state
Ramp Test: workload increases every 1 minute, does NOT allow steady state
6 Minute Walk Test: patient takes as many breaks as needed
HR: plateaus just before maximal oxygen uptake
Rate Pressure Product: index of myocardial oxygen consumption
RPE: used for patients who do not exhibit normal HR response
Normal ECG in healthy patients: tachycardia, shortening of QT interval, single PVC, ST
depression <1mm, reduced R-wave, increased Q-wave, single PVCs
ECG in MI/CAD: tachycardia at low intensities, arrhythmias, ST depression >1mm
Delayed Abnormal Response: prolonged fatigue, insomnia, sudden weight gain, hypotension
Arm Exercise Only: higher HR, SBP, DPB, lower stroke volume
Early Training: interval training, frequent rest period
Typical Resistive Exercise for stable patients: 60-80% 10 rep max
Average Conditioning: 20-30 minutes for moderate intensities of 60-80% functional capacity,
3-5x/week, longer duration for lower intensity (<60% or <5 MET) 30-60 minutes, 5-7x/week
Progression: duration is increased first then intensity
PTCA: wait 2 weeks to exercise vigorously
Post-CABG: limit UE exercise 6 weeks post surgery
Indications to Terminate Exercise: moderate-severe angina, decrease in SBP >10, technical
difficulties, desire to stop, ST elevation >1 mm, arrhythmias, fatigue, SOB, leg cramps, chest
pain, BP >250/115
PTCA: wait 2 weeks or 3 weeks following procedure for resistance training
Phase 1 Rehab: after stable for 24 hours, low intensity 2-3 MET, progress to 5 by discharge
Post-MI limited to 70% Max HR, lifting restricted for 6 weeks, low-moderate duration 10-15
minutes, 2-3x per day increase in duration and decrease in frequency
CHF: begin 40-60% functional capacity
Phase 2 Rehab: require submaximal exercise testing, 2-3x/week, progress to full resumption of
ADL, 30-60 minutes, 5-10 warm-up/cool-down, exit point at 9 MET
Strength Training: elastic bands, 1-5 lbs, 12-15 reps, 11-13 RPE, after 3 weeks cardiac
rehab, 5 weeks MI, 8 weeks CABG
Phase 3 Rehab: require 5 MET for entry, 3-4x/week, 45 minutes, 50-85% functional capacity
Post-MI: resistance training must remain <70% HR max or 5 METS for 6 weeks post
Cardiac Surgery: LE resistance may begin immediately, UE wait 6-8 weeks to allow healing
Cardiac Transplant: HR alone is not enough due to denervation, use RPE + HR + BP + METs
Diabetes: use submaximal ETT arm ergometry if PAD/neuropathy
Intermittent Claudication Exercise: 2-3x/day, 5x/week, exercise to point of claudication level 2
for 30-60 minutes, Warfarin may improve claudication
Modified Buerger-Allen exercises: ankle pumps + postural exercises, during and after to
improve blood flow
Resistive Calf Exercises: MOST EFFECTIVE IN INCREASING BLOOD FLOW
Venous Insufficiency: positioning 18 cm above heart, avoid mechanical compression if ABI <0.8
Lymphedema Exercise: activate muscles from proximal distal performed with compression
bandages on
***Contraindicated: ice/heat, hydrotherapy, paraffin, compression garments at Phase I,
electro greater than 30 Hz increase lymphatic load
CPR: 100 compressions/min, push 2 inch into chest, 30:2 breaths, 1 breath every 6-8 seconds
Shock Capillary Refill test: nail bed does not refill in 2 seconds blood is shunted to organs
***Shock Elevate the legs 12 inches
Maximum O2 uptake: in UE is 30-40% lower
Weight Loss: <60% max HR, 45-60 minutes, 5-7x/week
Minimum training intensity is 60% max HR for asymptomatic patients
Valsalva: slowing of pulse, increase in venous pressure/decrease return
Early Rehab: interval training with rest periods,