Term
of the 9 million people in the US with angina, _____ are actually being treated. |
|
Definition
|
|
Term
what is the cause of angina? |
|
Definition
an imbalance between oxygen supply and demand |
|
|
Term
how could you distinguish heart burn and angina? |
|
Definition
angina occurs when you are exerting yourself and can be subtle |
|
|
Term
what is VO2? is myocardial VO2 high at rest? |
|
Definition
the body's ability to extract and get oxygen
near max even at rest |
|
|
Term
what do medications have a general affect on the body's oxygen supply and demand? |
|
Definition
increase supply and reduce demand |
|
|
Term
what is angiogenesis? when will this occur? are there drugs that can help? |
|
Definition
sprout new blood vessels that will bypass a blockage
takes years to occur
making drugs that will induce this |
|
|
Term
with coronary blood flow, what causes chest pain? |
|
Definition
|
|
Term
with coronary vascular resistance, how do drugs help relieve chest pain? |
|
Definition
|
|
Term
what is diastolic filling time? how can you increase this? what kind of drug? |
|
Definition
the time it takes for the left ventricle to fill with blood
increase diastole by decreasing HR
beta-blockers |
|
|
Term
what effect does increasing HR have on oxygen demand? |
|
Definition
|
|
Term
what are the four features of myocardial blood flow? |
|
Definition
1)5% of cardiac output 2)diastolic flow greatest 3)extraction of oxygen about 75% at rest 4)flow controlled by autoregulation |
|
|
Term
what are the four determinants of oxygen supply? |
|
Definition
1)coronary blood flow 2)vascular resistance 3)collateral blood flow 4)diastolic filling time |
|
|
Term
what are the four determinants of oxygen demand? |
|
Definition
1)heart rate 2)contractility 3)afterload 4)preload |
|
|
Term
if you ____ preload, you will _____ oxygen demand. |
|
Definition
|
|
Term
what are the three different types of angina? |
|
Definition
vasospastic angina exertional angina partially occlusive transient platelet thrombus |
|
|
Term
explain vasospastic angina. typical or atypical? is this associated with exertion? can drugs help this? |
|
Definition
spastic contraction of SMC that clamps down on the coronary artery and reduces blood flow
atypical
no
yes |
|
|
Term
explain exertional angina. will drugs help this angina? |
|
Definition
slow progressive narrowing of the blood vessel due to atherosclerosis which causes a reduction in blood flow that results in typical angina during exertion
yes |
|
|
Term
explain partially occlusive transient platelet thrombus angina. will anti-anginal drugs help this? if not, what will? |
|
Definition
plaque will throw a clot, which causes pain and then the clot breaks up
no, but a blood thinner will |
|
|
Term
what are treatment strategies for angina? |
|
Definition
behavior modification nitrates calcium channel blockers beta-blocking agnets surgical (angioplasty, CABG) |
|
|
Term
what is nitroglycerine's effect on the arteries? what won't it affect? what are the side effects? |
|
Definition
dilation
the 10-15% of the population that already have dilated arteries
headaches |
|
|
Term
Nitrates are exclusively used for angina, they dilate the veins and arteries, which causes what? and then what? |
|
Definition
reduction in preload-> lowers oxygen demand decreased blood pressure->reduces oxygen demand increase c-GMP->relaxation of SMC decreased contractility->lowers oxygen demand |
|
|
Term
T/F in 85%-90% of people nitrates cause vasodilation, which increases oxygen supply. |
|
Definition
|
|
Term
T/F nitrates decrease blood pressure, which decrease oxygen demand and ultimately decrease heart work. |
|
Definition
|
|
Term
T/F nitrates increase filing pressure, which decreases heart work. |
|
Definition
false decreases filling pressure to decrease heart work |
|
|
Term
if a healthy individual were to take a nitrate, what would happen? |
|
Definition
it would reduce ability and performance |
|
|
Term
in relation to exercise, what do nitrates do for someone with angina? |
|
Definition
allow the individual to workout longer and harder before the onset of angina increase exercise performance |
|
|
Term
what are the side effects of nitrates? what is the cause of each side effect? |
|
Definition
headaches by dilation of the blood vessels in the brain dizziness by orthostatic hypotension reflex tachycardia by reflex activation of the sympathetic neurons in a response to a drop in BP |
|
|
Term
what is orthostatic hypotension? |
|
Definition
less blood is pumped to the brain which can cause fainting |
|
|
Term
any medication that decreases HR or systolic blood pressure will _____ oxygen demand. |
|
Definition
|
|
Term
nitrates affect oxygen supply by: ____coronary blood flow, ____vascular resistance, ____collateral blood flow, and ____diastolic filling time. |
|
Definition
increase decrease increase decrease |
|
|
Term
nitrates affect oxygen demand by: ___heart rate, ___contractility, ___afterload, and ___preload. |
|
Definition
increase increase decrease decrease |
|
|
Term
what is the major affect of nitrates? |
|
Definition
|
|
Term
nitrates dilate the coronary arteries which causes___? |
|
Definition
an increase in the blood supply |
|
|
Term
what are the two beneficial effects of nitrates for treatment of vasospastic angina? |
|
Definition
1)relaxation of the coronary artery spasm which increases the blood flow to the heart muscle 2)reductions in preload and afterload |
|
|
Term
what are nitrates prescribed for? |
|
Definition
|
|
Term
what are the major uses of calcium channel blockers? |
|
Definition
angina hypertension arrhythmias |
|
|
Term
what does the heart use make a more forceful contraction? |
|
Definition
|
|
Term
what is the mechanism of action of calcium channel blockers? |
|
Definition
inhibit the movement of calcium from the extracellular fluid into the intracellular fluid by blocking the channels |
|
|
Term
what affect does calcium channel blockers have on vascular smooth muscle? |
|
Definition
|
|
Term
what affect do calcium channel blockers have on cardiac muscle? what can too much do? |
|
Definition
slow down electrical signal to the AV node and decrease the contrail state of the atrial and ventricular muscles
cause cardiac depression |
|
|
Term
calcium channel blockers affect oxygen supply by: ___coronary blood flow and ___vascular resistance. |
|
Definition
|
|
Term
calcium channel blockers affect oxygen demand by ____ after load and contractility? |
|
Definition
|
|
Term
what are the side effects of calcium channel blockers? |
|
Definition
dizziness headache cardiac depression (rare) |
|
|
Term
T/F it is commonly seen for pair a calcium channel blocker with a beta blocker. |
|
Definition
|
|
Term
how do beta blockers work? |
|
Definition
block the beta receptor for sympathetic nerves, specifically beta1 |
|
|
Term
what would be the effect if you were to block the Beta2 receptors on the veins and arteries? |
|
Definition
there would be little to no effect because the Alpha1 receptor is important on the blood vessels |
|
|
Term
what are non-selective beta blockers? |
|
Definition
block both beta 1 and 2 receptors |
|
|
Term
what are selective beta blockers? |
|
Definition
just target the beta1 receptors |
|
|
Term
what are the major uses of beta blockers? |
|
Definition
angina arrhythmias hypertension |
|
|
Term
T/F blocking the beta-receptors within the heart leads to an increase in heart rate and contractility. |
|
Definition
|
|
Term
Beta blockers _____ the work load and thus the demand for oxygen by the heart. |
|
Definition
|
|
Term
T/F if you decrease HR, you will increase diastolic filling time, and increase oxygen supply. |
|
Definition
|
|
Term
how do beta-blockers help with exercise? |
|
Definition
higher exercise levels can be attained before the patient experiences angina |
|
|
Term
T/F it is uncommon for beta-blockers to be paired with nitrates. |
|
Definition
|
|
Term
what do beta blockers decrease your risk of? |
|
Definition
decrease sympathetic activity which decreases arrhythmias may reduce congestive heart failure |
|
|
Term
if you just have high blood pressure and you are taking a beta blocker what will this increase your risk for? |
|
Definition
|
|
Term
what are the side effects of beta-blockers? |
|
Definition
headache orthostatic hypotension erectile dysfunction increase triglycerides decrease HDL levels bronchiospasm masks symptoms of hypoglycemia cause differential AV block |
|
|
Term
what are the uses of diuretics? |
|
Definition
|
|
Term
what is the action of diuretics? |
|
Definition
altering renal function resulting in an increased excretion of electrolytes and fluid |
|
|
Term
Diuretics help individuals with coronary artery disease because of what? |
|
Definition
reduction of blood pressure and venous return which reduces the work of the heart and ultimately reduces oxygen demand |
|
|
Term
T/F diuretics help exercise. |
|
Definition
false they do not influence the exercise capacity but rather produce a toxic affect that may show on the EEG. |
|
|
Term
vasodilators are primarily used for the treatment of ____. |
|
Definition
|
|
Term
vasodilators cause the relaxation of SMC which causes what? |
|
Definition
reduction of blood pressure |
|
|
Term
what are ACE inhibitors used for? |
|
Definition
treatment of hypertension |
|
|
Term
what controls long term blood pressure regulation? |
|
Definition
|
|
Term
explain how angiotensinogen becomes active. |
|
Definition
-renin is released when the sympathetic nerves are active, which cuts angiotensinogen into angiotensin 1 (inactive) -as angiotensin 1 circularities ACE changes angiotensin 1 to angiotensin 2 (active) -angiotensin 2 binds to the blood vessels and causes vasoconstriction, which increases blood pressure -angiotensin 2 also causes adrenal glands to secrete aldosterone which causes the kidneys to retain sodium, which increases blood pressure |
|
|
Term
what three drugs affect the Renin Angiotensin Aldosterone System? |
|
Definition
ace inhibitor angiotensin 2 binding blockers aldosterone receptor blockers |
|
|
Term
how do ACE inhibitors work? |
|
Definition
block conversion of angiotensin 1 to angiotensin 2 |
|
|
Term
how do angiotensin 2 binding blockers work? |
|
Definition
blocks the binding of angiotensin 2 to the blood vessel |
|
|
Term
how do aldosterone receptor blockers work? |
|
Definition
block aldosterone receptors in the kidneys |
|
|
Term
in a patient that has had a heart transplant, why would a longer warm up be appropriate? |
|
Definition
the nerves are cut therefore HR will take longer to increase to meet demands because hormones take longer to exhibit effect |
|
|
Term
if your goal is to calculate net calories what should you do? |
|
Definition
leave off the 3.5 from the beginning equation when calculating VO2 |
|
|
Term
1 watt is equal to ___kgm/min |
|
Definition
|
|
Term
what are the mechanism of action for nitrates? (Hint:3) |
|
Definition
reduces venous return and end-diastolic volume dilates the coronary arteries reduces SBP |
|
|
Term
T/F ACE inhibitors are not effective in decrease BP when paired with a calcium channel blocker. |
|
Definition
|
|
Term
elevated levels of aldosterone are associated with what? |
|
Definition
vasotoxicity CHF renal disease |
|
|
Term
what are the primary uses of Digitalis? |
|
Definition
increase myocardial contractility reduces supraventricular arrhythmias |
|
|
Term
T/F the correct dosage of digitalis is easy to find. |
|
Definition
|
|
Term
|
Definition
opens calcium channels in people with weak hearts |
|
|
Term
what is the issue with anti-coagulants? |
|
Definition
you could potentially bleed to death |
|
|
Term
|
Definition
anti-inflammatory anti-coagulant |
|
|
Term
|
Definition
reduce intraplaque lipids stabilize atherosclerotic plaque improve vasomotor function anti-inflammatory |
|
|
Term
how do you find a percent of VO2R? |
|
Definition
resting Vo2= 3.5 ml/kg/min subtract resting from max is the VO2R then multiply by % |
|
|
Term
what are the goals of a cardiac rehabilitation program? |
|
Definition
1)increase caloric expenditure 2)improve aerobic fitness 3)maintain or improve functional ability 4)increase muscular strength 5)improve vocational or recreational performance 6)optimize ability to perform ADLs 7)MAINTAIN INDEPENDENCE |
|
|
Term
T/F initial exercise Rx for a cardiac rehab patient should be based on risk stratification. |
|
Definition
|
|
Term
a graded exercise test should be performed when dealing with patients with cardiac disease in order to: |
|
Definition
assess functional capacity to aid in risk stratification identify problems and effectiveness evaluate medications provide the basis for the exercise Rx |
|
|
Term
a patient in cardiac rehab should start at ___ METS and progress ___ MET per stage. |
|
Definition
|
|
Term
what is the recommended frequency for a patient in cardiac rehab? |
|
Definition
3 days, but there is no reason they cannot do more, insurance will only pay for 3 days a week, multiple day sessions is ideal |
|
|
Term
what is the recommended duration for patient in cardiac rehab? |
|
Definition
minimum of 15 minutes most patients exercise 20-40 minutes |
|
|
Term
the warm up for a cardiac rehab patient has been shown to___. |
|
Definition
increase the time to the onset of angina |
|
|
Term
explain the intensity for someone in cardiac rehab? what if there was no GXT? |
|
Definition
should start at 40/50% HRR should start +20-30 beats above resting HR |
|
|
Term
what are some important points for intensity for a patient in cardiac rehab? |
|
Definition
1)workload on the heart is determined by the product of the HR and SBP 2)HR & BP can vary greatly between different modes of exercise 3)inadequate warm-up may result in patient experiencing angina at lower HR than normal |
|
|
Term
what are the limitations of using RPE to assess intensity for a patient in cardiac rehab? |
|
Definition
HR, BP and other may vary drastically between different modes of exercise at the same RPE
patients figure out very quickly what happens when they report a lower RPE |
|
|
Term
what can be used to set the upper limit for a patient in cardiac rehab? |
|
Definition
1)onset of angina 2)plateau or decrease in SBP 3)>1mm ST-segment 4)radionucleide evidence of left ventricular dysfunction 5)increase frequency of arrhythmias 6)significant EEG disturbances 7)other signs and symptoms that limit exercise (non cardiac related) |
|
|
Term
how would you progress an individual in cardiac rehab? |
|
Definition
if the patient cannot do 15 minutes of continuous exercise progress to 20-30 minutes
increase duration 10-30% per week |
|
|
Term
why does chest pain delay with exercise? |
|
Definition
|
|
Term
T/F you can increase duration and intensity in the same week. |
|
Definition
false duration should be increased before intensity |
|
|
Term
why is a prolonged cool down recommended? |
|
Definition
to minimize risks of post-exercise hypotension and arrhythmias, not to mention DOMS |
|
|
Term
can someone in cardiac rehab do strength training? |
|
Definition
only very light resistance teach them to how the machines work |
|
|
Term
what is the titration method? |
|
Definition
add small amounts at the a time |
|
|
Term
what are some ways to make strength training safer for patients in cardiac rehab? |
|
Definition
spot the person at the beginning as well as end of the lift don't take the set to fatigue perform exercise with one limb at a time don't grip too tightly |
|
|
Term
what are some examples of COPD? |
|
Definition
asthma bronchitis emphysema |
|
|
Term
COPD is characterized by___. |
|
Definition
expiratory flow limitations |
|
|
Term
T/F 30 million people are diagnosed with COPD. |
|
Definition
|
|
Term
T/F COPD is the 2nd leading reason for "at home" care after CHF. |
|
Definition
false 3rd leading cause after CHF and stroke |
|
|
Term
T/F COPD patients are more likely to be admitted into the hospital compared with age and gender matched patients with other illnesses. |
|
Definition
|
|
Term
T/F in 2011 was the 11th consecutive year in which men exceeded woman in he number of deaths due to COPD. |
|
Definition
|
|
Term
T/F women are twice as likely to be diagnosed with chronic bronchitis than men. |
|
Definition
|
|
Term
what is the estimated total economic cost of COPD in 2010? |
|
Definition
|
|
Term
what is the leading cause of hospitalization in our aged population? |
|
Definition
|
|
Term
T/F 51% of individuals say that their COPD limits their ability to do work. |
|
Definition
|
|
Term
asthma and EIA are characterized by reactivity to various stimuli such as:
reaction to these stimuli cause what? |
|
Definition
pollen or other allergens pollution cold or dry air exercise or emotional stress
bronchospasm excessive mucus production |
|
|
Term
explain asthma. onset? usual etiology? course? airflow limitation? clinical features? inflammatory cell? responses to steroids? |
|
Definition
onset: anytime usual etiology: immunologic stimuli, family history course: usually intermittent airflow limitation: largely reverse able clinical features: wheeze, chest tightness, couch, dyspnea inflammatory cell: marcophages responses to steroids: inhibits inflammation |
|
|
Term
what is bronchitis characterized by? |
|
Definition
chronic cough excessive mucus production enlargement of mucus glands thickening of airway walls |
|
|
Term
what is emphysema characterized by? |
|
Definition
loss of lung tissue increased proteolytic activity loss of lung elasticity expiratory flow limitations increase in Vd and impaired gas diffusion |
|
|
Term
restrictive lung diseases are characterized by____. |
|
Definition
decreased inspiratory flow or capacity |
|
|
Term
give examples of restrictive diseases that effect the ribcage and the spine. |
|
Definition
kyphoscoliosis anklyosing spondylitis |
|
|
Term
give examples of restrictive diseases that effect the respiratory muscle and nerves. |
|
Definition
SCI stroke neuromuscular disorders |
|
|
Term
give examples of restrictive lung diseases that effect the pleura. |
|
Definition
effusion chronic pleuritis pleural fibrosis |
|
|
Term
give examples of restrictive lung diseases that effect the alveoli and parenchyma. |
|
Definition
interstitial fibrosis alevolitis |
|
|
Term
T/F obesity has an effect on the lungs as a restrictive disease. |
|
Definition
|
|
Term
spirometry of someone with COPD would have: ___TLC, ___FVC, ___RLV, ___IC, ___FEV1, ___FEV1/FVC ratio, and ___MVV. what is the dead give away? |
|
Definition
normal or increased modestly decreased increased decreased markedly decreased decreased markedly decreased
DECREASED FEV1/FVC RATIO |
|
|
Term
spirometry of someone with restrictive lung disease would have: ___TLC, ___FVC, ___IC, ___FEV1, ___FEV1/FVC ratio, and ___MVV. what is the dead give away? |
|
Definition
markedly decrease markedly decrease markedly decrease modestly decreased normal or above normal modestly decreased
INCREASED FEV1/FVC RATIO |
|
|
Term
someone with COPD would have ____ Ve, Ve/CO2 and Ve/O2 at rest and during exercise. |
|
Definition
|
|
Term
T/F someone with COPD may reach the upper limits of MVV. |
|
Definition
|
|
Term
someone with restrictive disease would have ____ Ve, Ve/CO2 and Ve/O2 at rest and during exercise. |
|
Definition
|
|
Term
T/F someone with restrictive disease may reach the upper limits of IC. |
|
Definition
|
|
Term
what are some commonly prescribed medications for someone with COPD? |
|
Definition
bronchodilator-theophylline albuterol; prevents bronchospasm and symptoms of EIA, cromolyn sodium: prevents chemical mediators from triggering asthma corticosteroids: anti-inflammatories |
|
|
Term
what medications protect patients in the late-phase COPD? |
|
Definition
bronchodilators phosphodiesterase-4 inhibitors |
|
|
Term
what medications protect patients in early-phase COPD? |
|
Definition
inflammatory mediators antioxidants antiproteases retinoids |
|
|
Term
what is Tiotropium? what does it do? |
|
Definition
new-generations anticholinergic agent slows dissociation from the muscarinic receptor found on the bronchial smooth muscle |
|
|
Term
what does a patient assessment include? (Hint: 10) |
|
Definition
1)patient interview 2)medical history 3)physical exam 4)diagnostic test 5)symptom assessement 6)musculoskeletal and exercise assessment 7)nutritional assessment 8)educational assessment 9)psychosocial assessment 10)goal development |
|
|
Term
what are recommended tests for potential lung issues? |
|
Definition
spirometry O2 saturation at rest and walking chest radiograph ECG field test of exercise capacity screening assessment of anxiety and depression CBC |
|
|
Term
what kind of exercise test would you put someone with lung issues though? |
|
Definition
mostly cycle test are performed but the test should look like everyday activities GXTs constant work rate tests |
|
|
Term
what are the advantages of a simple walking test? disadvantage? |
|
Definition
simple and reproducible
learning effect must be controlled for limited ability to measure physiological variables |
|
|
Term
what are the advantages of GXT for someone with lung issues? disadvantages? |
|
Definition
the measurement of any physiological variable more reliable
influenced by patient motivation may be of limited use in severely disabled patients |
|
|
Term
what are the advantages of constant work rate tests? disadvantages? |
|
Definition
allows for the measurement of physiological variables under the same conditions useful as an adjunct to GXT
learning effect is a limitation |
|
|
Term
T/F malnutrition is a problem in 20-30% of moderate to severe COPD patients. |
|
Definition
|
|
Term
what BMI is associated with an increase overall mortality, independent of the degree of airway obstruction? |
|
Definition
|
|
Term
hypoxia and hypercapnia, in relation to COPD____. |
|
Definition
related to severe COPD and linked with malnutrition |
|
|
Term
T/F overweight and even obesity are related to improved survival of patients with severe COPD. |
|
Definition
|
|
Term
higher body weight correlates to better what? |
|
Definition
exercise capabilities and diffusion capacity |
|
|
Term
T/F obesity relates to a low FEV1. |
|
Definition
|
|
Term
what are the points to goal development? |
|
Definition
establish short term and long term goals realistic goals involve significant others assess goals frequently and change as needed document progress to goals each session |
|
|
Term
explain the mode for exercise Rx for patients with lung issues. |
|
Definition
aerobic exercise involving large muscle groups strength training may help to maintain or increase muscle mass as well as improve strength and endurance |
|
|
Term
T/F exercise involving upper body for patients with lung issues is ok. |
|
Definition
false may increase respiratory demands/ distress |
|
|
Term
what is the recommended frequency for patients with lung issues? |
|
Definition
|
|
Term
what is the recommended duration for patients with lung issues? |
|
Definition
progression to 20-30 minutes total exercise time using intermittent/interval training techniques |
|
|
Term
what is the recommended intensity for patients with lung issues? |
|
Definition
no clear consensus moderate intensity has shown improvements |
|
|
Term
what is the best way to determine intensity in a patient with lung issues? |
|
Definition
ratings of dyspnea O2 saturation |
|
|
Term
explain what each level on the dyspnea scale means. 1? 2? 3? 4? |
|
Definition
1-mild, noticeable to patient, not to observer 2-some difficulty, noticeable to observer 3-moderate difficulty, but can continue 4-severe difficulty patient cannot continue |
|
|
Term
what should be incorporated into an exercise program for someone with lung issues? |
|
Definition
controlled breathing techiques |
|
|
Term
when would supplemental oxygen be necessary? |
|
Definition
if a patient is desaturating |
|
|
Term
what does CPAP stand for? what is it? what does it help to prevent? |
|
Definition
continuous positive airway pressure reduces excessive elastic recoil associated with hyperinflation
reduces mechanical load on breathing muscles prevents collapse of smaller airways |
|
|
Term
what can pursed lip breathing help? |
|
Definition
the maintenance of positive airway pressure |
|
|
Term
what does UBRT stand for? what is it? are the results consistent? |
|
Definition
upper body resistance training ADLs involving the upper body
no |
|
|
Term
what does RIMT stand for? what cases has it been successful? |
|
Definition
resistive inspiratory muscle training
patients who don't respond to other therapy patients with decreased respiratory muscle strength absence of severe hyperinflation |
|
|
Term
what are the benefits and goals of exercise training with someone with lung issues? |
|
Definition
improved aerobic capacity increased muscle strength improved ventilatory muscle strength improved neuromuscular coordination desensitization to dyspnea reduced respiratory symptoms achieve some degree of independence and significantly improve their quality of life |
|
|