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Med-Surg 2 > Cardiovascular Assessment > Flashcards

Cardiovascular Assessment Flashcards

(72 cards)

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1
Q

Right side (unoxygenated)

A

SVC and IVC to right
atrium to tricuspid
valve to right
ventricle to
pulmonic valve to
pulmonary artery to
lungs

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2
Q

Left side (oxygenated)

A

Pulmonary veins to
left atrium to mitral
valve to left ventricle
to aortic valve to
systemic circulation
2

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3
Q

How many chambers of the heart?

A

Four

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4
Q

Heart Valves

A
  • Mitral
  • Tricuspid
  • Chordae tendineae
  • Papillary muscle
  • Pulmonic
  • Aortic
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5
Q

Systole

A

Contraction of heart muscle
Ejection of blood from ventricles

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6
Q

Diastole

A

Relaxation of heart muscle
Ventricles fill with blood

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7
Q

Stroke volume (SV)

A

Amount of blood
ejected with each heart beat

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8
Q

Cardiac output (CO)

A

Amount of blood
pumped by each ventricle in 1 minute

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9
Q

Cardiac output equation

A

CO = SV × HR

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10
Q

Cardiac output normal

A

4 to 8 L/min

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11
Q

Vascular System

A

Blood vessels
* Blood circulates from left side
of heart

Arteries, arterioles
* Carry oxygenated
blood

Capillaries
* Venules, veins
* Carry deoxygenated
blood

  • Right side of heart
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12
Q

Sympathetic stimulation increases

A

HR, speed of impulse through
AV node, and force of contractions; a-adrenergic receptors

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13
Q

Parasympathetic stimulation slows

A

HR, impulse conduction from
SA to AV node; vagus nerve

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14
Q

Autonomic nervous system effect on blood vessels

A

Sympathetic stimulation of -adrenergic receptors causes
vasoconstriction; decreased stimulation causes vasodilation

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15
Q

Baroreceptors

A

Sensitive to stretch or
pressure in arterial system

Stimulation sends
message to vasomotor
center in brainstem to
inhibit SNS and enhance
PNS to decrease HR and
peripheral vasodilation;
decreased stretch or
pressure does opposite

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16
Q

Chemoreceptor

A

Aortic and carotid bodies
and medulla

Increased CO2 results in
changes in RR and BP

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17
Q

Systolic blood pressure (SBP)

A

Peak pressure against arteries during ventricular contraction.
Normal = less than 120 mm Hg

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18
Q

Diastolic blood pressure (DBP)

A

Residual pressure in arteries during ventricular relaxation. Normal =
less than 80 mm Hg

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19
Q

Influencing factors for blood pressure

A

Cardiac output (CO) and systemic vascular
resistance (SVR)

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20
Q

SVR

A

Force opposing movement of blood

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21
Q

BP Equation

A

BP = CO x SVR

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22
Q

Pulse Pressure

A

Difference between SBP and DBP
Normally about 1/3 of the SBP

  • Increased with exercise,
    atherosclerosis
  • Decreased with heart failure,
    hypovolemia
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23
Q

Mean Arterial Pressure (MAP)

A

Average pressure within arterial system
MAP = (SBP + 2 DBP) ÷ 3

MAP must be greater than 60 mm Hg to
perfuse vital organs or they will become
ischemic

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24
Q

S1

A

closure of tricuspid and mitral
valves; “lubb”; beginning of systole

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25
S2
closure of aortic and pulmonic valves: “dupp”; beginning of diastole
26
Pulse deficit
Palpate radial pulse when listening to apical
27
Split S2
Pulmonic area Normal inspiration; abnormal expiration
28
S3
Ventricular gallop Left heart failure or mitral regurgitation
29
S4
Atrial gallop CAD, cardiomyopathy, LV hypertrophy, aortic stenosis
30
Murmurs
Graded on a six-point Roman numeral scale (I to VI) of loudness and recorded as a ratio
31
Pericardial friction rubs—pericarditis
* Inflamed surfaces of the pericardium move against each other; high-pitched, scratchy sounds * May be intermittent and last days to hours * Listen at apex with patient upright, leaning forward and holding breath
32
CO
volume of blood pumped by heart in 1 minute
33
CI
CO adjusted for body surface area (BSA)
34
SV
volume ejected with each heartbeat
35
SVI
SV adjusted for BSA
36
Preload
Volume of blood within ventricle at end of diastole
37
PAWP
reflects left ventricular end- diastolic pressure
38
CVP
reflects right ventricular end- diastolic pressure
39
Afterload
Forces opposing ventricular ejection
40
Left Ventricular Afterload
SVR and arterial pressure indices
41
Right Ventricular Afterload
PVR and pulmonary arterial pressure indices
42
Vascular resistance
Systemic (SVR) and pulmonary (PVR) Reflect afterload
43
Contractility
Strength of ventricular contraction No direct clinical measures
44
Troponin
* Rises within 4 to 6 hours, peaks 10 to 24 hours, detected for up to 10 to 14 days * High-sensitivity troponin (hs-cTnT, hs-cTnI) assays may detect a heart event within 1-3 hours
45
Copeptin
* Substitute marker for arginine vasopressin (AVP) * Detected with acute MI, ischemic stroke, HF * Copeptin + troponin = rapid diagnosis of acute MI * High copeptin levels = increased mortality with acute MI
46
Creatine kinase (CK); 3 isoenzymes
* CK-MB cardiac specific; increased with MI or cardiac injury * Rises in 3 to 6 hours, peaks in 12 to 24 hours, returns to baseline within 12 to 48 hours * Rarely used for diagnosis of acute MI
47
C-reactive protein (CRP)
* Marker for inflammation * Linked to atherosclerosis and first heart event; predict risk of future heart events
48
Homocysteine (Hcy)— protein catabolism
* Hereditary or dietary deficiency of vitamins B6, B12, or folate * High levels—increased risk for CVD, PVD, stroke
49
Cardiac natriuretic peptide markers
B-type natriuretic peptide (BNP)—heart failure Diagnostic Studies
50
Triglycerides
storage form of lipids
51
Cholesterol
absorbed from food and made in liver
52
Phospholipids
glycerol, fatty acids, phosphates, and nitrogenous compound
53
Lipoprotein
* Serum lipids bind to protein to circulate in blood * Low-density lipoproteins (LDLs) * High-density lipoproteins (HDLs) * Increased Triglycerides and LDL—CAD risk factor
54
Increased HDL decreases risk
decreased risk of CAD
55
HDL ratio
risk assessment
56
Echocardiogram
* Ultrasound waves record movement of heart structures; with or without contrast * Determines abnormalities of heart Measures ejection fraction Real time 3-D
57
Ejection Fraction (EF)
% of end- diastolic blood volume ejected during systole
58
Stress echocardiography
* Computer compares images or wall motion and function before and after exercise * No exercise—use IV dobutamine and dipyridamole for pharmacologic stress
59
Transesophageal echocardiography (TEE)
* Better visualization of heart with endoscope * Requires NPO, sedation; check gag afterward * Complications: perforation of esophagus, hemorrhage, dysrhythmias, vasovagal reactions, transient hypoxemia
60
Cardiac computed tomography
Heart anatomy, coronary circulation, great vessels (multidetector CT scanning—MDCT)
61
CT angiography (CTA)
* Noninvasive; faster, less risky, less radiation exposure than cardiac catheterization; must have NSR * Requires contrast
62
Cardiovascular magnetic resonance imaging (CMRI)—no radiation
* 3-D view of MI; assess EF * Predicts recovery from MI * Diagnosis of congenital heart and aortic disorders and CAD * Patients with stents can undergo CMRI 6 weeks after placement
63
Multigated acquisition—MUGA scan
Nuclear cardiology Wall motion, heart valves, EF
64
Stress perfusion imaging
Nuclear cardiology * Blood flow changes with exercise diagnoses CAD * Viable heart tissue versus scar tissue * Determine success of interventions (e.g., CABG or PCI) * IV medications to dilate coronary arteries and simulate exercise effects * SPECT—size of infarction * PET stress testing—myocardial ischemia and viability
65
Cardiac catheterization- contrast
Complications: bleeding; allergic reaction to contrast; kinking of catheter; infection; thrombus formation; aortic dissection; dysrhythmias; MI; stroke; puncture of ventricles, septum, or lung tissue
66
Pre-Procedure Cardiac Catheterization
* Assess allergies; contrast dye (hold metformin 48 hrs before) * Baseline assessment: VS, pulse oximetry, heart and breath sounds, neurovascular assessment of extremities * NPO for 6 to 12 hours * Assess lab
67
Patient Education Pre Cardiac Catheterization
* Procedure—local anesthesia, flushed feeling when dye injected; fluttering of heart * Administer sedation and other meds as ordered
68
Post-procedure Cardiac Catheterization
* Baseline Assessment: note hypotension or hypertension; signs of PE * Assess neurovascular status of extremity * Compression device over arterial site for hemostasis; observe for hematoma and bleeding every 15 minutes for 1 hour then per agency policy * Bed rest as ordered * Monitor: ECG, chest pain, IV/oral fluid intake and urine output
69
Patient Education Post Cardiac Catheterization
discharge instructions, activity limits
70
Intravascular ultrasound (IVUS)
* Intracoronary ultrasound (ICUS); done in cath lab * Also uses coronary angiography to provide a 2-D or 3-D view of the coronary artery walls * Evaluate vessel response to stent placement and atherectomy
71
Electrophysiology study (EPS)
Electrodes placed in heart to record and manipulate electrical activity of heart; SA node, AV node, and ventricular conduction— information regarding source and treatment of tachydysrhythmias
72

Med-Surg 2 (9 decks)

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