Flashcards in CCRN CARDIOLOGY Deck (57):
Atrial pressure is reflective of the end-diastolic pressure for _________________
the respective ventricles in the absence of AV valve disease
Right atrial pressure (RAP) reflects
Right Ventricular Preload
Left atrial pressure (LAP) reflects
Left Ventricular Preload
Pulmonary artery occlusive pressure (PAOP ) is an indirect measurement of?
Left atrial pressure (LAP) and therefore left ventricular end-diastolic pressure
Normal Pulmonary artery occlusive pressure (PAOP )
8 to 12mmHg
Pulmonary artery systolic pressure (PAs) is reflective of
The right ventricle because it is the pressure generated by the right ventricle to open the pulmonic valve
Pulmonary artery dyastolic pressure (PAd) is reflective of
The pulmonary valsculature because it is the pressure in the pulmonary artery
What is monoamine oxidase (MAO) inhibitor?
Prevents the enzyme from removing neurotransmitters norepinephrine, serotonine and dopamine from the brain making the chemicals available to effect changes in both cells and circuits that have been impacted by depression.
What kind of test is helpful to show myocardial damage
Why would myocardial contusion cause dysrythmias?
trauma -> inflammation -> irritability
ASA inhibits what
How does a BETA BLOCKER decrease myocardial O2 consumption?
decreasing heart rate and contractility
How does a NITRATES decrease myocardial O2 consumption?
decreasing preload primarily and maybe afterload (depends on the dosage)
How does a CALCIUM CHANNEL BLOCKER decrease myocardial O2 consumption?
decreasing preload and afterload
What is preload?
The volume of blood in the ventricle at the end of diastole also known as the end diastolic pressure
What is sterling's law of the heart
preload determines the stretch on the myofibrils (filaments that run parallel to form muscle fibers) and the subsequent force of the next contraction
What is afterload?
The pressure against which the ventricle must pump. The pressure required to open the semilunar valve.
1st line of management to treat chronic HTN
diuretics and/or beta blockers
What is the 2nd line of tx for chronic HTN?
ACE inhibitor or angiotensin receptor blocker
What is the goal in treating hypertrophic cardiomyopathy?
Decrease contractility and afterload
Hypertrophy of the heart muscle results in what?
Left ventricular outflow tract obstruction.
What class of meds is frequently prescribed in hypertrophic cardiomyopathy
Calcium channel blockers - verapamil (calan)
Beta Blockers - propranolol (inderal)
All murmurs are load except
mitral and tricuspid stenosis
What causes the murmur of mitral valve prolapse?
Describe the sound of mitral regurgitation murmurs
high pitched blowing systolic murmur
loudest at apex
radiates to axilla
midsystolic click heard apex
murmur follows the click i.e S1, click, murmur, S2
Where is the apex of the heart?
Left inferior anterior
5th left intercostal space @ MCL
Where is the base of the heart?
Right superior posterior
2nd intercostal space
Where is the heart located?
in the mediastinum between the sternum and spine
What are the layers of the heart?
pericardium - outer wall of pericardial cavity (serous & firbous)
epicardium - cover outer surface of heart (visceral pericardium)
myocradium - muscle portion of heart
endocardium - covers inner surface of heart
Flow of blood through heart
superior/inferior venae cavae, R atrium, tricuspid valve, R ventricle, pulmonic valve, pulmonary artery, pulmonary capillary, pulmonary veins, L atrium, mitral valve, L ventricle, aortic valve, aorta, arteries, arterioles, capillaries, venules, veins
What are the AV valves?
tricuspid and mitral
What are the semilunar valves?
aortic and pulmonic
What causes the first heart sound?
Closure of AV valves
AV valves open and close during
Open passively during diastole
Close during systole when heart contracts
What causes the second heart sound?
Closure of semilunar valves
Semilunar valves open and close during
Push open with systole
Close during diastole
Where are coronary arteries located?
On the epicardium but penetrates to myocardium and subendocardium.
What determines the blood flow through the coronary arteries?
autoregulation in response to metabolic needs of myocardium
What's the percentage of of cardiac output received by myocardium?
Myocardial blood flow is increased by
Dilation of coronary arteries
Coronary artery perfusion pressure (CAPP) is equal to
the diastolic BP minus the pulmonary artery occlusive pressure (PAOP)
Normal CAPP value
What determines myocardial O2 demand
What determines myocardial O2 supply?
O2 extraction (Hgb and SaO2)
imbalances between supply and demand
A split S2 is abnormal during which one? Inspiration or expiration?
Which drug is an alpha- and noncardioselective beta-blocker that is used for heart failure?
Which drug is an alpha- and noncardioselective beta-blocker used most often for hypertension?
Which facial nerve is checked after carotid endarterectomy and how do you assess it?
Cranial nerve VII (facial nerve)
Ask patient to smile and check for symetry
What are the therapeutic goals in acute heart failure?
To decrease preload, To decrease afterload, To increase contractility
To decrease myocardial oxygen demand.
Which medication is given during acute heart failure to cause venodilation and to reduce preload?
Which heart sound is an indication of diastolic dysfunction?
which is caused by ventricular noncompliance (inability of the heart to fill adequately)
Which heart sound is an indication of systolic dysfunction?
Which heart sound is an indication of intracardiac turbulence such as a septal defect or valve problem?
Which heart sound is an indication mitral valve prolapse?
A great way to remember what happens in the heart during diastole is to remember that
diastole equals filling
What are signs of cardiac tamponade?
Pulsus paradoxus Hypotension
Jugular venous distention