Please enable JavaScript.

Coggle requires JavaScript to display documents.

Q1: Ms. Marshall goes from rest to mod intensity exercise, Q2: Mr.…

- - - - Buildup of tissue metabolism
        
        Endothelial Sheer Stress :smiley:Nitrous Oxide and also buildup of metabolites, CO2, H+, Adenosine
        
        Prime Movers Muscles: Vasodilation occurs (needs oxygen and more bloodflow so it VD
        
        If O2 and glucose isn't sufficiently delivered, it VD
        
        Local substances compete with the neural side, norepinephrine on alpha-adrenergic receptors to VC
        
        the Neural side must ensure still enough BP to perfuse the brain
        
        Functional sympatholysis
        
        Smaller vessels is autoregulation (arterioles and precap sphincters), Larger is flow mediated dilation (Nitrous oxide)
    - - Detect need for more O2 if hypoxic and VD Vice Versa. Self-regulating Mechanism
- - - - Special Considerations?
        
        use RPE, or angina scale since he is on Beta Blockers
        
        Be on the lookout for Thrombus and Re-stenosis
        
        Avoid too many valsalvas, watch for ischemic threshold, and dyspnea. Use symptom Limited.
      - Start GXT 1-2 DAYS after sx
      - Make it a Functional stress test, we don't need it to be a diagnostic.
- - - - Cardiac Output has dropped, decreased driving pressure
        
        Decreased Arterial blood pressure
        
        Unloading of Baroreceptors
        
        CV Control Center
        
        Sympathetic Nervous System
        
        Norepinephrine: causes peripheral vasoconstrction ( we don't want pooling of blood)
        
        2 more items...
        
        Epinephrine: incr. Contractility of Heart
        
        Less afferrent traffic
        
        Decreased Renal Pressure
        
        Kidneys excrete more renin
        
        Angiotensinogen
        
        Angiotensin 1 + ACE
        
        1 more item...
        
        Less O2 Delivery to muscle tissues
        
        Decreased Functional capacity
        
        Early OBLA
        
        Exercise Intolerance and atrophy
        
        Type 2A's to Type 2X's
        
        Reduced Capillary density, reduce oxidative enzymes, reduced mitochondrial density
        
        Further Deconditioning
      - Decreased Contractility
- - - - Don't use this if they already have a heart block
    - - only for symptomatic LV dysf
        
        May cause hypokalemia
    - - Low therapeutic index and risk. can lead to 1st degree AV block
      - Only for patients with symptomatic HF( LV dysfunction with Afib)
  - - - More electrolytes
  - - - Late
        
        Aldosterone Antagonist
        
        VAD, transplantation
        
        Revascularization (PCAT, CABG)
        
        More Ionotropes