right coronary artery supplies? left coronary artery supplies??
right coronary aretry supplies the SA node (60 percent of time), RA, RV, inferior wall of left ventricle, and bundle of his, AV node and the prejunkie fibers and the left supplies the LV, has two divisions the LAD supplies the LV and intraventricular septum and inferior area of the apex. and may give off branches to Circumflex artery as well and this supplies blood to the lateral and inferior walls of LV and supplies blood to SA node 40 percent of the time.
What do the following DI tests look for in the cardiovascular system
chest x rays
Myocradial perfusion imagining
Chest x rays- give us abnormalities of lung fluids, heart shape such as caridomegaly or aneurysms? well at least according to the book.
MPI - ischemic tissue or MI
Echocardiograms- size of chambers, EF, movement of valves, septum width, and abnormal wall movements
Central line: measures central venous pressure, pulmonary aretry pressure, pulmonary capillary wedge pressure
Cardiac MRI: creates 3d images of the heart to investigate coronary arteries, aorta, pericardium, and myocardium
Where is the SA node located?? How fast does the AV node beat in terms of BPM How fast do the purkinje fibers fire?
junction of the RA and superior vena cava. 40-60 beats per minute from the AV node. Purkinje fibers fire at a rate of 20-40 beats per minute.
what is stroke volume? What is preload?
the amount of blood ejected with each myocardial contraction. Typically 55-100 mL are ejected. Preload is the amount of blood that is contained within the left ventricle after diastole.
What is afterload?? What is CO
the force needed to overcome the aortic pressure to open the valve. Amount of blood ejected from the R or L ventricle per minute usually 4-5 L. or HR x SV = CO
What is cardiac index??
CO / body surface area
what is the ejection fraction
amount of blood put out by the LV during systole. Not to be confused with Cardiac Output which is both the right and left ventricles and is more SV/ LVEDV
what is myocardial oxygen demmand?
represents the energy cost to the myocardium- clinical measured by the product of heart rate times the SBP known as rate pressure product.
Where is the primary site of vascular resistance?? arteries, arterioles, capillaries, and veins
lymphatic vessels different ways lymph gets pumped thorugh the body.
- parasympathetic and sympathetic contratctions via nerve impluses 2. contraction of adjacent 3. abdominal and thoracic cavity pressure changes. 4. mechanical stimulation of dermal tissues 5. volume changes within each lymphatic vessel.
parasympathetic control (cholinergic) sympathetic ( adrenergic) where are the control centers of these two located?
both located in the medulla oblongota stimulate. However the T1-T4 upper thoracic to superior cervical chain ganglia; innervates all but the ventricular myocardium.; releases epinephrine and norepinphrine.
where are the pressure receptors of the circulatory system located?
cartoid artery and the main ones are located in the aortic arch and controls if the BP rises or falls via the parasympathetic and sympathetic neural pathways.
hyperkalemia - what is its on effects on the heart what about hypokalemia, hypercalcemia, hypocalemia, hypermagnesemia, hypomagnesemia.
hyperkalemia- increased ion concentration of potassium ions decrease HR (widen PR interval, and QRS, Tall T wave Hypokalemia- decreased concentrations of potassium ions in blood casues ventricular fib (flat t wave, produces a U wave. prolonged PR and QT intervals) hypercalcemia- produces high heart rate and is increased calcium in blood (QRS widens) hypocalcemia- leads to depressed heart actions prolongs Qt interval hypermagensium- is a calcium channel blocker therefore leading to cardiac arrest in some instances hypomagensium- coronary artery spasm, ventricular arrhythmias.
Review of Risk factors for Cardiovascualr disease
Modifiable cholestrol - total want it at 200 LDL - less than 160 and HDL > 40 for men and greater than 50 for women Triglycerides - < 150 mg/dL Diabettes - HgA1C < 7 diet - want to it be low salt, with balance of fruits and veggies, grains, and meats of freaking course hypertension- Systolic - 140mmHG Diastolic < 40 inches physical inactivity - at least 30 mintues of activity 5-7 days per week. Tobacco- do as much as possible ( jk reduce smoking as much as possible and other forms of tobbacco)
Peripheral Pulse grades Pulses based on age what is it for infants, children and adults
0 - absent 1+ - pluse dimished barely percipitable, thready 2+ easily palable, NORMAL 3+ full pulse increased strength 4+ bounding pulse adults- 60-100 childern - 60-140 Newborns 90-164
Where to hear heart sounds
Aortic valve - second right intercostal space Pulmonary valve- second left intercostal space Tricuspid valve- 4 to 5th intercostal space left of sternal border Mirtal valve- 5th intercostal space (midcalvicular line)
reasons for pluse abnormalities
1) irregular pulse- variatioons in force and frequency may be due to arrythmyias, myocarditis, 2) weak or thready - low stroke volume, caridogenic shock 3) bounding or full pluse- may be due to decreased peripheral resistance, aortic insuffciency
normal heart sounds - S1 and S2 and what do they mean???
S1 lub- the AV valves closing S2 dub- is the Pulmonic and Aorta valves closing. S3- congestive heart failure S4- CAD, MI, aortic stenosis, or chronic hypertension
what is a bruit
is a murmur sometimes indicative of arethrosclerosis
what is the PR interval in an EKG
time for the atria to fire and reach the purkinje fibers
ST segement and T wave
ST segment - the begining of the ventricular repolarization and the T wave is ventricular repolarization
how to calculate rythm in an EKG
count the number of QRS complexes in a six second strip and muliply by 10 or use the solid red line and count in terms 300, 150, 100, 75, 60, 50 between each solid line. each little box is .04 seconds and . 2 second between each dark line because there is 5 little boxes between the 2 big red lines.
Premature ventricular contractions
they are ectopic focuses arising from outside of the heart and usally have a wide and bizzare QRS complex that can have an R onto T phemonemon one or two in a row is not a big deal but, like greater than 6 per minute is a big deal.
pluseless emergency requires immediate medical treatment and has ventricular pluses coming from multiple foci. no QRS complexes!!!!!
supraventricular p - waves are abnormal , atrial tachycardia (140-250) atrial flutter (250 -300) atrial fib (300).
Right BBB Initial force due to left to right activation of the septum is normal, after the septum is depolarized the impulse travels through the mass of the left ventricle…after the left ventricle has been partially depolarized, the right ventricle depolarizes Triphasic impulse (rabbit ears=R’R wave) 1st degree and second is ok but, 3rd degree entire branch is blocked and you are gonna need a surgical implantion such as a pacemaker. ventricular rate is usually slowed because the impluse is not being administered to the purkinje fibers to stimulate the ventricles. Left BBB Initial force travels across the septum from right to left, there is an initial negative deflection in lead V1 and an initial upright deflection in V6 The EKG may not be used to ascertain ischemic changes during exercise
ST segment changes -
can be upsloping, downsloping or horizontal. an upsloping or downsloping of more than 1 mm is considered abnormal in two consecutive leads Acute Elevation of the ST segment and peaking of the T wave Within hours or days the T wave inverts Recent ST segment returned to baseline, but T wave remains and there is a significant Q wave
if systolic goes drops 20 mmHG or diastolic goes below 10 mmHG upon standing then the Pt. is consider to have OHTN.
normal breathe rates
12-20 for adults, kids (20-30), infant (30-40)
mean arterial pressure
the arterial pressure within the large arteries over time; dependent upon mean blood flow and arterial compliance. Calculated by taking the SBP+ taking the Diastolic BP twice /3 and this number should be around 70-110 mmHG and this is a very important measure in critical care.
BP for kids and babies
kids- 3-5 years of age - 113-116 systolic and 67-74 diastolic Infants anyone less than 2 years of age. SBP (106-110) - (59-63) adults obviously 120/80
levels for hypertension
Normal 120 and anything less than 80 for DBP prehypertension (120-139) and DBP 80-89 stage 1 (140-160) and DBP (90-99) stage 2 (160-180) and DBP (100-110) stage 3 (hypertensive crisis) (180-200) and DBP (110- or anything above these numbers
Physical examination: Peripheral vascular disease review section: clubbing of nails: indicates what? curvature of the fingernails with soft tissue enlargement at the base of the nail.: chronic oxygen deficiency, chronic pulmonary disease or heart failure. Trophic changes in the skin Fiborosis: abnormal pigmentation? temperature:
clubbing of nails: indicates what? curvature of the fingernails with soft tissue enlargement at the base of the nail.: chronic oxygen deficiency, chronic pulmonary disease or heart failure. trophic changes: pale shiny skin indicates PAD fibrosis; tissues are thick, firm and steamers sign is present (dorsal skin folds of the toes or fingers) can be indicative of lymphedema abnormal pigmentation: ulceration, dermatitis, gangrene is associated with PAD
How can you detect intermittent claudication
pain and cramping with activity and relief with rest. Pain is typically in calf. If arterial blood supply is severely deficient may have pain at rest especially in the forefoot and at night.
Tests for peripheral venous circulation
percussion test; determines the competence of the great saphenous vein: Pt. is standing and the vein is held at the bottom and the top part of the vein is precussed 20 cm higher and if the vibration is felt by the lower hand the valves are incompetent. Venous filling test ( elevate the legs 45 degrees for one minute and then let the legs hang over the edge of the table if the color takes longer than 15 seconds to refill then this can be indicative of PVD.