Cardiac 32 Flashcards
(184 cards)
0
Q
Fibroserous sac around heart
A
Pericardium
1
Q
Layers of the heart
A
Endocardium
Myocardium
Epicardium
2
Q
Amount of pericardial fluid between layers of the heart that prevents friction between the surfaces as the heart contracts
A
10 to 15mL
3
Q
Path of blood flow through the heart
A
Inferior and superior venae cavae ➡️ right atrium ➡️ right ventricle ➡️ lungs by pulmonary artery ➡️ returned left atrium by pulmonary vein ➡️ left ventricle ➡️ aorta ➡️ systemic circulation
4
Q
Valve between the right atrium and right ventricle
A
Tricuspid valve
5
Q
Valve between right ventricle and pulmonary artery
A
Pulmonary valve
6
Q
Blood flows from the lungs to the left atrium via
A
Pulmonary veins
7
Q
Valve between left atrium and left ventricle
A
Mitral valve
8
Q
Valve from left ventricle into the aorta
A
Aortic valve
9
Q
What does the P wave mean?
A
Depolarization of the atria
10
Q
What does the QRS complex represent?
A
Depolarization of the ventricles
11
Q
What does the T wave represent?
A
Repolarization of the ventricles
12
Q
What does the U wave represent (if present)?
A
Repolization of the Purkinje fibers or maybe associated with hypokalemia
14
Q
What do the intervals between the waves (PR, QRS, and QT intervals) reflect?
A
the time it takes an impulse to travel from one area of the heart to another
15
Q
the electrical impulse is initiated by what?
A
the SA node (aka pacemaker of the heart)
16
Q
Electrical impulse travels from the atria to the AV node via?
A
intermodal pathways
17
Q
From the AV node, where does the electrical impulse travel?
A
through the bundle His and the left and right bundle branches
18
Q
what are the two fascicles of the left bundle brach?
A
anterior and posterior
19
Q
What do Purkinje fibers do?
A
diffuse the electrical impuse through both ventricles
20
Q
what is the climax of the cardiac cycle?
A
ejection of blood into the pulmonary and systemic circulations
21
Q
how does the conduction system “end”?
A
the repolarization- when the contractile fiber cells and conduction pathway cells regain their polarized condition
22
Q
depolarization triggers ___________?
A
mechanical activity
23
Q
define systole
A
contraction of myocardium which results in ejection of blood from the ventricles
24
Q
define diastole
A
relaxation of myocardium, allowing for filling of ventricles
25
define cardiac output
the amount of blood pumped by each ventricle in 1 minute
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how is cardiac output calculated?
stroke volume times heart rate
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what is the range for "normal" CO
4 to 8 L/min
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define stroke volume?
the amount of blood ejected from the ventricle with each heartbeat
29
how is Cardiac index calculated?
Cardiac output divided by BSA
30
what is the normal CI (Cardiac index) range?
2.8 to 4.2 L per minute per meter squared
31
define preload
the volume of blood in the venricles at the ends of the distole, before the next contraction
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define afterload
the peripheral resistance against which the left ventricle must pump
33
define cardiac reserve
the ability of the cardiovascular system to respond to the demands created by health and illness by altering CO threefold or fourfold
34
What does preload determine?
preload determines the amount of stretch placed on myocardial fibers
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what affects afterload?
size of the ventricle, wall tension and aterial blood pressure
36
what regulates heart rate?
autonomic nervous system
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name factors effecting Stroke volume
preload, contractility, and afterload
38
heart rate can increase to what rate for short periods of time without harmful effects?
180 beats/minute
39
increasing of the workload of the myocardium does what?
increases the oxygen demand
40
name the three types major blood vessels
arteries, veins, capillaries
41
what do arteries do?
carry blood away from the heart and except for the pulmonary artery, carry oxygenated blood
42
what do veins do?
carry blood towards the heart and except for the pulmonary vein, carry deoxygenated blood
43
name the order of blood vessels starting from the left side of the heart
arteries, arterioles, capillaries, venules and veins then back to the right side of the heart
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large arteries are composed of?
elastic tissue and some smooth muscle
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why is elastic tissue important in arteries?
cushions the impact of pressure created by ventricular contraction and preovides recoil that propels blood forward into the circulation
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examples of large arteries include?
aorta and pulmonary artery
47
describe arterioles compaired to arteries
less elastic tissue and more smooth muscle
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what controls arterial blood pressure and distribution of blood flow?
arterioles
49
name two conditions that cause arterioles that cause dilation or constriction
low oxygen or increased CO2
50
what is the inner most lining of the artery called
endothelium
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what does endothelium do?
maintains hemostatsis, promote blood flow, and under normal conditions inhibit blood coagulation
52
describe a capillary
thin wall, no elastic or muscle tissue, where exchange of nutrients and metabolic end producs take place
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describe a vein
large diameter thin walled vesses that return blood to the right atrium
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describe the venous system
low pressure, high volume system
55
what type of valves do large veins have
semilunar
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what are semilunar valves for?
to help maintain blood flow toard the heart and prevent backward flow
57
the amount of blood in the venous system is affected by
arterial flow, compression of veins by skeletal muscle, alterations in thoracic and abdominal pressures and right atrial pressure
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largest veins
superior vena cava and inferior vena cava
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superior vena cava
returns blood to the heart from the head, neck, and arms
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inferior vena cava
returns blood from the lower part of the body
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what affects veins
the pressure in the right side of the heart
62
a resistance to blood flow may result in
distended neck veins or liver engorgement
63
venules are
relatively small vessels made up of small muscle and connective tissue
64
the autonomic nervous system consists of
the sympathetic nervous system and the parasympathetic nervous system
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stimulation of the sympathetic nervous system
increases HR, the speed of impulse conduction through the AV node, and force of atrial and ventricular contractions
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what sites on the heart mediate the stimulation of the sympathetic nervous system
beta adrenergic receptors
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beta adregergic receptors are affected by
norepi and epi
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parasympathetic system is mediated by
vagus nerve
69
parasympathetic stystem stimulation causes
decrease in HR, by slowing SA node rate thus conduction through AV node
70
the source of nerual control of blood vessels is
the sympathetic nervous system
71
where are alpha 1 adrenergic receptors located?
vascular smooth muscles
72
stimulation of alpha 1 adrengeric receptors cause
vasoconstriction
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decreased stimulation of alpha 1 adregneric receptors cause
vasodilation
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blood vessels in skeletal muscle do not receive parasympathetic input because
parasympathetic nerves have selective distrubtion in blood vessels
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baroreceptors are found in
the aortic arch and carotid sinus (at the origin of the carotid artery)
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what do baroreceptors do?
sensitive to stretch or pressure within the arterial system
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what does stimulation of baroreceptors do
send information to vasomotor center in the brainstem which temporary inhibits sympathetic nervous system and ehances the parasympathetic
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decreased arterial pressure causes
increased HR and peripheral vasoconstriction
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increased arterial pressure causes
decreased HR and peripheral vasodilation
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chemoreceptors are located
in the aorta and carotid bodies
81
what do chemoreceptors do?
initiate changes in HR and arterial pressure in response to increased arterial CO2 pressure and (to a lesser degree) decreased arterial O2 pressure and decreased pH
82
when chemoreceptor reflexes are stimulated, they also stimulate
the vasomotor center to increase cardiac activty
83
define aterial BP (aka BP)
measure of pressure exerted by blood against the walls of the arterial system
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SBP
peak pressure exerted against arteries when heart contracts
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DBP
residual pressure in the arterial system during ventricular relaxation (or filling)
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two main factors influencing BP
CO and SVR (systemic vascular resistance)
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Systemic vasuclar resistance
is the force opposing the movement of blood (created in small arteries and arteriols)
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Normal BP
SBP <80
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invasive BP meausrement
catheter into an artery, attached to a transducer
90
noninvasive BP measurement
sphygmomanometer and stethoscope. Use brachial artery
91
pulse pressure
difference between SBP and DBP (normally approx 1/3 of SBP)
92
what causes an increase of pulse pressure?
during exericise or individuals with atherosclerosis of larger arteries
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what causes a decrease of pulse pressure?
heart failure or hypovolemia
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MAP - mean arterial pressure
average pressure within the arterial system, remember diastole is longer than systole at normal HRs
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equation for MAP
(SBP+2DBP)/3
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greatest risk for cardiovascular dz
age
97
leading cause of death of adults older than 85
cardiovascular dz
98
most common cardiovascular dz
coronary artery dz secondary to atherosclerosis
99
Age related difference in assessment findings for kyphosis
altered chest landmarks for palpation, percussion and ausculation, distant heart sounds
100
Age related difference in assessment findings for myocardial hypertrophy
decreased cardiac reserve, heart failure
101
Age related difference in assessment findings for downward displacement of heart
difficulty in isolating apical pulse
102
Age related difference in assessment findings for decreased CO, HR, SV in response to stress or exercise
slowed, decreased response to exercise and stress, slowed recovery from activity
103
Age related difference in assessment findings for cellular aging and fibrosis of conduction system
decreased amplitude of QRS complex and slight lengthening of PR, QRS, and QT intervals, irregular cardiac rhythms, decreased maximal HR, decreased HR variability
104
Age related difference in assessment findings for valvular regidity from calcification, sclerosis, or fibrosis, impending complete closure of valves
systolic murmor, possible w/o indication of Cardiovascular pathology
105
Age related difference in assessment findings for arterial stiffening caused by loss of elastin in arterial walls, thickening of intim of arteries and progressive fibrosis of media
increase in SBP and possible increase or decrease of DBP, widened pulse pressure, diminshed pedial pulses, increase intermittent claudication
106
Age related difference in assessment findings for venous tortuosity increased
inflamed, painful, or cordlike caricositie, dependent edema
107
age related change at the SA node
number of pacemaker cells decrease
108
orthostatic hypertension (how common and why?)
more than 30% of patients over 70 with systolic HTN, maybe related to meds or decreased baroreceptor function
109
age related change regarding autonomic nervous system control
number and function of B-adrenergic receptors in heart decrease
110
postprandial hypotension is
decrease in BP of at least 20mmHg that occurs 75 minutes after eating
111
Past medical history related to cardiovascular
ask patient about hx of chest pain, SOB, fatigue, alcoholism and tobacco use, anemia, rhematic fever, strept throat, congential heart dz, stroke, palpations, dizziness, syncope, HTN, thrombophlembitis, intermittent claudication, varicosities and edema
112
major cardiovascular risk factors
elevated serum lipid, HTN, tobacco use, sedientary lifestyle, obesity
113
what is a necessary question prior to any cardiac cath
any allergy to selfish (iodine dye)
114
ADR: anticancer drugs- daunorubicin/doxorubicin
dysrthythmias, cardiomyopathy
115
ADR: antipsych- chlorpromazine/haloperidol
dysrthythmias, orthostatic hypotension
116
ADR: corticosteroids- cortisone/prednisone
hypotension, edema, K+ depletion
117
ADR: herbal supplements: ma haung
HTN, tachycardia, palpitations, angina
118
ADR: HRT/OCP: estrogen+progestin
MI, thromboembolism, stroke, HTN
119
ADR: NSAIDs
HTN, MI, stroke
120
ADR: psychostimulants- cocaine, amphetamines
tachycardia, angina, MI, HTN, dysrhythmias
121
ADR: tricyclic antidepressants- amitiriptyline, doxepin
dysrthythmias, orthostatic hypotension
122
Normal orthostatic bp (change) and HR
20mmHg drop from sitting to standing in BP, no more than 20 beats per minute from sitting to standing
123
Edema in extremities may be caused by
Gravity, interruption of venous return, right sided heart failure
124
What is a thrill?
Palpable vibration of a blood vessel
125
What is a bruit?
The buzzing or humming caused by abnormal blood flow
126
What causes distended neck veins?
Elevated right atrial pressure, right sided heart failure
127
Possible cause of central cyanosis
Inadequate O2 sat of arterial blood due to pulmonary or cardiac disorders
128
Possible cause of peripheral cyanosis
Reduced blood flow because of heart failure, vasoconstriction, cold environment
129
Possible cause of splinter hemorrhages (small red to black streaks under fingernails)
Infective endocarditis
130
Possible causes of clubbing of nail beds
Endocarditis, congenital defects, prolonged O2 deficiency
131
What causes ulcers?
Poor venous return, varicose veins, incompetent venous
132
possible causes for bounding pulse
hyperkinetic state, anemia, hyperthyroid
133
possible causes for thready pulses
blood loss, decreased CO, aortic valve dz, peripheral arterial dz
134
possible causes for irregular pulses
cardiac dysrhythmias
135
possible causes for pulsus alternans
heart failure, cardiac tamponade
136
possible causes for absent pulse
atherosclerosis, trauma, embolus
137
possible causes for a thrill
aneurysm, aortic regurgitation, arteriovenous fistula
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possible causes for for venous rigidity
atherosclerosis
139
possible causes for tachycardia
exercise, anxiety, shocck, need for increased CO, hyperthyroidism
140
possible causes for bradycardia
rest/sleep, SA or AV node damage, athletic conditioning, side effect of drug, hypothyroidism
141
possible causes for displaced point of maximal impulse
left ventricular dilation
142
possible causes for unusually warm extremities
possible thyrotoxicosis
143
possible causes for cold extremities
intermittent claudication, peripheral arterial obstruction, low CO, severe anemia
144
possible causes for pitting edema
interruption of venous return to the heart, fluid in tissues
145
possible causes for abnormal cap refill
possibly reduced arterial capillary perfusion, anemia
146
possible causes for asymmetry in limb circumference
VTE, varicose veins, lymphedema
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possible causes for abnormal cardiac borders
cardiac enlargement due to coronary heart dz, heart failure, cardiomyopathy
148
possible causes for pulse deficit
cardiac dysrhythmias, most commonly a fib
149
possible causes for arterial bruit
arterial obstruction or aneurysm
150
possible causes for a third heart sound
left ventricular failure, volume overload, mitral, aortic or tricuspid regurgitation, HTN (possible)
151
possible causes for a forth heart sound
foreceful atrial contraction from resistance to ventricular filling
152
possible causes for cardiac murmurs
cardiac valve disorders, abnormal blood flow patterns
153
possible causes for pericardial friction rub
pericarditis
154
description of CK-MB
cardiospecific isozyme that is released in the presence of myocardial tissue injury
155
normal results for CK-MB
less than 4%-6% of total CK
156
Nursing teaching for CK-MB
explain to the patient the purpose of serial sampling (every 6-8 hr x3) in conjunction with serial ECGs
157
description of troponin (cardiac)
contractile proteins that are released following an MI, both troponin T and troponin I are highly specific to cardiac tissue
158
normal interval for Troponin I
less than 0.5ng/mL
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normal interval for Troponin T
less than 0.1 ng/mL
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nursing teaching for Troponin
rapid point of care assays are available. Serial sampling often done in conjuction with CK-MB and ECGs
161
description for myoglobin
low molecular weight protein that is 99%-100 sensitive for myocardial injury.
162
how long for serum myoglobin concentration to rise following MI
30-60 minutes
163
normal results for myoglobin
15.2-91.2 mcg/L (male), 11.1-to 57.5 mcg/L (female)
164
nursing teaching for myoglobin
cleared from the circulation rapidly and most diagnostic if measured within first 12 hours of onset of chest pain
165
description of C-reactive protein
marker of inflammation that can predict the risk of cardiac dz and cardiac events even in patients with normal lipid values
166
Risk level and value for CRP
c-reactive protein lowest risk less than 1mg/L, moderate risk 1-3 mg/L, high risk above 3 mg/L
167
nursing teaching for CRP
stable levels that can be measured nonfasting and anytime during the day. May be more predictive risk factor of cardiac dz than LDL in women
168
description of homocysteine
aminio acid produced during protein catabolism that has been identified as a risk factor for cardiovascular dz. May cause damange to endothelium or have a role in formation of thrombi
169
normal values for homocysteine
male: 5.2 to 12.9 micromol/L, female: 3.7 to 10.4 micromol/L
170
nursing teaching for homocysteine
hyperhomocysteinemia resulting from dietary deficiencies is treated with folic acid, vit B6, and vit B12 supplements
171
describe serum lipid: cholesterol
blood lipid, elevated cholesterol is considered a risk factor for atherosclerotic heart dz
172
nursing teaching for cholesterol
cholesterol levles can be obtained in a nonfasting state
173
describe serum lipid: triglycerides
triglycerides are mixtures of fatty acids. Elevation are assocated with cardiovascular dz and diabetes
174
triglycerides reference intervals
less than 150mg/dL
175
nursing teaching for triglycerides
must be obtained fasting (at least 12 hours) and alcohol should be withheld for 24 hours before testing
176
HDL reference value
male above 40mg/dL, female above 50 mg/dL- above 60 low risk for CAD, below 40 high risk CAD
177
LDL reference value
less than 100mg/dL optimal, near optimal 100-129mg/dL, moderate risk for CAD: 130-159 mg/dL, high risk for CAD: above 160 mg/dL
178
nursing responsibility for lipoproteins
risk for cardiac dz is assessed by dividing the total cholesterol levels by the HDL level and obtaining a ratio. Low risk, less than 3, average 3-5, high above 5
179
description of chest x ray
x ray where two upright positions to examine the lung fields and size of the heart
180
nursing responsibility regarding chest x ray
inquire about frequency of x ray and possible pregnancy. Provide lead shielding, remove any metal that block the view
181
ECG
monitor and record cardiac electrical activity from different views. Can detect rhythm of the heart, activity, of pacemake, conduction abnormalities, position of heart, size of atria and ventricles, presence of injury and hx of MI
182
ECG nursing responsibility
prepare skin, apply electrodes and leads. Inform patient of there should be no discomfort. Instruct not to move
183
holter monitor teaching
tell patient that no bath or shower can be taken during monitoring and skin irriration may develop from electrodes. Keep a diary of activites and symptoms
184
Th auscultatory area in the left midclavicular line at the level of the fifth ICS is the
Mitral area
