chapter 11 Flashcards by Desiree Namou

heart coverings
________ (double walled sac)
_________ (visceral layer of pericardium covering myocardium)

pericardium

epicardium

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layers of heart wall

epicardium, myocardium, and endocardium

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heart has four chambers:

right atrium
left atrium
right ventricle
left ventricle

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right side of the heart is the _______ pump
left side of the heart is the ________ pump
_____: receiving chambers, thin walled, relatively small

pulmonary
systemic
atria

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blood enters the ____ via three veins
1. _______ - from body regions above diaphgragm
2. _______ - from body areas below diaphragm
3. ________ - collects blood that drains from myocardium
blood enters ____ via four pulmonary veins

RA
superior vena cava
inferior vena cava
coranary sinus
LA

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blood flow
from the body \_\_\_\_\_\_\_\_
to the lungs \_\_\_\_\_\_
from the lungs \_\_\_\_\_\_\_\_
to the body \_\_\_\_\_\_\_

RA
RV
LA
LV

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right heart circulation blood to lung

pulmonary circulation

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left heart circulates blood to peripheral tissues

systemic circulation

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fundamental blood supply of the heart
the _____ circulation in the body
the myocardium is too ______ to make diffusion a practical means of nutrient delivery
-the _____ branches to the right coronary arteries and the left coronary, which carry ______ blood to the heart when it is __________

coronary circulation
shortest
thick
aorta
arterial 
relaxed

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coronary circulation contd.
________: anterior descending artery supplies the anttier wall and anterior part of inter ventricular septum
-____ artery supplies the lateral wall
____________: supplies the posterior wall and posterior part of interventricular septum

left coronary artery
circumflex
right coronary artery

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conduction of the heart

SA node —> AV node —> AV bundle (bundle of His) —> right and left branches –> purkinje fibers

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ECG

atrial depolarization

P wave

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ECG

AV nodal delay

PR segment

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ECG
Ventricular depolarization (atria repolarizing simultaneously)

QRS complex

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ECG

time during which ventricles are contracting and emptying

ST segment

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ECG

ventricular repolarization

T wave

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ECG

time during which ventricles are relaxing and filling

TP interval

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blood pressure
the highest pressure is reached during ventricular contraction (_______ pressure)
- the pressure is the lowest when ventricles are relaxed (_____ pressure)
cardiac output: typically __ L/min is amount of blood pumped out by each ventricle

systolic
diastolic
5

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arise during embryogensis (usually weeks __ through __); seen in 1% of live births
causes:
-german ______, ____ syndrome, and other undetermined causes
- defective heart _____ partitions
_______ cardiac valves
oftern result in ____ between left (______) and right (_______) circulations
Some congenital abnormalities can be corrected surgically, others are compatible with life, and others are fatal in the neonatal period
• Prevention is to attempt to protect the developing fetus from intrauterine injury

congential heart disease
3, 8
measles, down
chamber
malformed
shunting
systemic
pulmonary

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caused by a failure of proper closure of the foramen _____ or by a defect in the septum
- most common type is _____________ (90% of cases), ________ associated w down syndrome
- blood moves from the left atrium into the right atrium because of the pressure differences
-makes up __% of all congential heart defects
clinical symptoms:
recurrent ____ infections, heart ____, and _______
-fixed, widely split second heart _____

atrial septal defect (ASD)
ovale
ostium secundum
ostium primum
10
chest
failure
arrythmias
sound

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failure of fusion of the interventricular septum
blood shunts through a hole in the interventricular septum
-makes up ___% of all congenital heart lesions
clinical features:
heart _____, failure to _____, recurrent ____ infections

ventricular septal defect (VSD)
30
failure, thrive, chest

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characterized by
a. _____ of the right ventricular outflow tract
b. right ventricular ________
c. ____
and d. overriding _____
right to left shunt leads to early ______; degree of _____ determines the extent of shunting and cyanosis
patients learn to _____ in response to cyanotic spell; increased arterial resistance decreases ________ and allows more blood to reach the lungs
______ shaped heart on xray

tetralogy of fallot
stenosis
hypertrophy
VSD
aorta
cyanosis
stenosis
squat
shunting
boot shaped

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systemic complication of pharyngitis due to group A (B-hemolytic) streptococci
affects children 2-3 weeks after an episode of streptococcal pharyngitis (_______)
-caused by ______. Bacterial ___ protein resembles proteins in human tissue. Presence of _______ bodies (granulomatous lesion) in myocardium and _______ cells (multinucleated macrophages)
-clinical diagnoses based on Jones criteria (one to two major) and one minor.
-Major includes _____, previous ________, streptococci (elevated ___ & ______, ______ (swelling/pain in joints) and ______ (rash). —–Minor includes ____ and ___ changes
-acute attack usually resolves but may progress to chronic rheumatic heart disease and repeated exposure to group A (B-hemolytic) streptococci results in relapse of the _____ phase and increases risk for chronic disease
-treatment: _____ and ________ for fever

valvular heart disease
acute rheumatic fever
strep throat
molecular mimicry
M
aschoff
antischkow
carditis
group A (B-hemolytic) streptococci
ASO
anti-DNAse titer
polyarthritis
erythema
fever
ECG 
acute
antibiotic
salicylates

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valve scarring that arises as a consequence of rheumatic fever.
usually seen after __+ years after ARF. results in _______ with a classic ____mouth apeparance and may also affect the ____ valve. complications include infectious _______
treatment: endocarditis ________ and valve _______ if necessary for severe diseases

valvular heart diseases
CHRONIC RHEUMATIC HEART DISEASE
20+
mitral stenosis
fish
aortic
endocarditis
prophylaxis
replacement

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inflammation of endocardium that affects the surface of cardiac valves; usually due to: ______ infection (streptococcus ______) divided into two groups: 1. ___________ endocarditis: caused by organisms of low virulence, small vegetations that do not destroy the valve and associated with mild symptoms of infection 2. _________ endocarditis: highly virulent organism (staphylococcus _____). high virulence organism that infects normal valves, most commonly the ______ valve. results in large vegetations that destroy the valve. -staphylococcus ________ is associated with endocarditis of prosthetic valves -streptococcus _____ is associated with endocarditis in patients with underlying ______carcinoma 1. _______ endocarditis is due to sterile vegetations that arise in association with ____ clinical symptoms and treatment: acute: sudden high fever with _____; new onset of ____. broad spectrum antibiotics; may need surgical treatment if severe subacute: _____ onset with low grade fever broad spec antibiotics; prohylaxis of ______ with antiobiotics in susceptible individuals before dental procedures

``` endocarditis bacterial viridans subacute infective acute infective aureus tricuspid epidermis bovis colorectal libman-sacks SLE chills murmur insidious SBE ```

endocarditis antibiotic is taken __ mins to __ hour before patients dental cleaning or surgical procedure. the antibiotic helps protect the ______ and the ____ from becoming infected by any bacteria that may be released into the blood during the procedure. the dose of antibiotic is usually much ____ than what is given for a typical infection, but only needs to be taken __ time prior to the procedure

``` 30, 1 bloodstream heart larger 1 ```

``` causes of pericarditis _____ (most common ____________ _____ and ______ surgery symptoms: ___ pain worsening with inspiration and supine position. diffuse concave ___ elevations with ___ depression in most ECG leads and normal ___ - MB ```

``` viruses traveling overseas bacteria open heart chest ST PR CK (creatine kinase) ```

``` causes of infectious myocarditis viruses (most common ________ A/B) ____ and ______ diffuse myocardial _______ and necrosis with _______ _______ infiltrate - treat the ______ cause ```

``` coxsackievirus parasites, protozoa degeneration mononuclear inflammatory underlining ```

primary myocardial disease two types: 1. ________: inflammation heart muscle, mostly caused in US by _____; onset ___, may lead to ____ heart failure 2. ________ -__________: dilation of all four chambers of the heart & most common form. results in ____ dysfuction (ventricles cannot pump) causes: idiopathic, genetic ______, _______, _______, ____ abuse - _____________: massive hypertrophy of the ____ ventricle and due to the genetic mutations in ______ proteins; most common form is ____ dominant. diastolic failure due to ____ in cardiac output. sudden death due to ventricular ________'; common cause of sudden death in young _____ syncope with exercise. biopsy shows _______ hypertrophy with disarray. -____________: decreased compliance of the ventricular endomyocardium that restricts filling during diastole. causes include _______. results in _____ heart failure, with decrease ____ amplitude.

``` myocarditis viruses abrupt acute cardiomyopathy dilated cardiomyopathy systolic mutation, myocarditis, pregnancy, alcohol hypertrophic cardiomyopathy left sarcomere autosomal decreased arrthymias athletes myofiber restrictive cardiomyopathy amyloidosis congestive QRS ```

valvular heart disease can be caused by a __________ aortic valve abnormality or by _____aortic stenosis severe aortic stenosis places a great strain on the ___ ventricle, and eventual heart failure. aortic stenosis is caused by degenerative changes in valve _______________, followed by _______, which restricts valve ______. resulting in __________: overload of the right ventricle of the heart resulting from pulmonary hypertension

``` nonrheumatic aortic stenosis congential bicuspid calcified left leaflet connective tissue calcifaction mobility cor pulmonale ```

coronary heart disease caused by _________ of the large coronary arteries, where the arteries narrow owing to accumulation of fatty materials - the _____ Deposits, consisting of neutral fat and cholesterol, accumulat ein the arteries by diffusion from the bloodstream other risk factors that play a less important role: - ______ accompanied by high blood lipids and elevated blood pressure - _______: type A, which is aggressive, hard driving, and competitive - _____ induced arrythmias and myocardial infarcts; the heart beats faster and more forcefuly, increasing myocardial oxygen requirements

``` atherosclerosis lipid obesity personality cocaine ```

bad cholesterol | carries cholestrol from the bloodstream to the cells

LDL low density protein

good cholesterol | removes cholesterol from the cells, carrying it to the ____ for excretion in the bile

HDL high density protein | liver

vitamin __ and _____ are necessary to metabolize this; elevated _____ levels is a risk factor for atherosclerosis comparable to high lipids, smoking and hypertension higher in ___ then in premenopausal women but increase in menopausal women

homocysteine (amino acid) B, folic acid men

manifestations of CAD also referred to as ______ heart disease - it is related to a _______ in blood supply to the heart muscle caused by _______ or ________ of the coronary arteries - the clinical manifistations are quite _______ some individuals are free of symptoms. some experience chest ______ that may radiate into _____ or _____ a more severe and prolonged myocardial ischemia may precipiate an acute episode called a ____________

``` ischemic decrease narrowing obstruction variable oppression neck arms heart attack ```

the pain which is caused by myocardial ischemia is called

angina pectoris

pain occurs on exertion, subsides with rest, and is relieved by _________. due to atherosclerosis of coronary arteries with >__% stenosis; decreased blood flow is not able to meet the metabolic demands of the myocardium during exertion. no necrosis of ________. presents as chest pain (lasting

``` stable angina nitroglycerine 70 myocytes 20 ST segment ```

pain occurs more frequently, lasts longer, and are less relieved by nitro. suaully due to rupture of an atherosclerotic plaque with thrombosis and incomplete occlusion of a coronary artery. higher chance of __

unstable angina | Myocardial infarction

occurs at rest and caused by coronary artery spasm. relieved by nitrocycerin or _________ blockers

prinzmental's angina | calcium channel

treatment of angina:

oxygen baby aspirin nitroglycerin morphine

most often involves left & right ventricles: _____, ______, _____ walls - occlusion of left anterior descending artery leads to infarction of the _______ wall and ______ septum of the LVD; LAD is most commonly involved artery in MI - occlusion of right coronary artery leas to infarction of the ________ wall, _______ septum, and _____ muscles of the LV; RCA is the 2nd most commonly involved artery in MI -occlusion of the left circumflex artery leads to infarction of the _____ wall of the LV two types: _____ (90%) and ______ (10%)

``` myocardial infarction anterior, lateral, posterior anterior, anterior posterior, posterior, papillary lateral regional diffuse ```

unexpected death due to cardiac disease; occurs without symptoms or <1 hour after symptoms arise due to _________ most common etiology is acute _____; 90% of patients have preexisting severe atherosclerosis -poor myocardial function due to chronic ischemic damage (with our without infarction; progreses to _________

sudden cardiac death fatal ventricular arrythmia ischemia congestive heart failure (CHF)

acute myocardial infarction most common symptom is __________ -crushing chest pain typically felt just beneath the _______ (> 20 mins) -described as heavy, squeezing, crushing, or tight -unconsciously ________ when describing pain -patient may mistake the pain for _________ -not every AMI patient has chest pain

chest pain sternum clenches fist indigestion

``` acute myocardial infarction (women) symptoms -women presents differently than men - nausea -lightheadedness -_______ burning -sudden onset of _______ or unexplained _______ -many women ____ their symptoms ```

epigastric weakness tiredness ignore

myocardial ______ causes ST segment depression with or without T wave inversion as result of altered repolarization

Zone of Ischemia

myocardial ______ causes ST segment elevation with or without loss of R wave

zone of injury

myocardial _______ causes deep Q waves as result of absence of depolarization current from dead tissue and receding currents from opposite side of heart

zone of infarction

occurs by developing a complete occlusion of a minor coronary artery or a partial occlusion of major coronary artery previously affected by atherosclerosis. This causes a partial thickness damage of heart muscle

NSTEMI

occurs by developing a complete occlusion of a major coronary artery affected by atherosclerosis. this causes a full thickness damage of heart muscle

STEMI

there is no difference between NSTEMI and STEMI in ______ presentation. in both cases patients usually present with similar type of symptoms such as chest pain, nausea, vomiting, sweating, breathing difficulty

clincal

the usual ECG findings of NSTEMI are _______ depression or ______ inversion. NSTEMI does not show ST segment ______ in ECG (due to partial thickness injury of heart muscle) and later does not progress to a ____ wave. for this reason it is also called a non __ wave myocardial infarction (NQMI)

``` ST segment T wave elevation Q Q ```

``` Ventricular Tachycardia (Vtach) rate: ______ rhythm: _______ pacemaker site: ______ P waves: _________ PRI: _____ QRS: ______ ```

``` 100-250 usually regular ventricle if present, not associated w QRS none >0.12 seconds, bizarre ```

``` Ventricular Fibrillation (Vfib) rate: ______ rhythm: _______ pacemaker site: ______ P waves: _________ PRI: _____ QRS: ______ ```

``` no organized rhythm no organized rhytm numerous ventricular foci usually absent none none ```

``` Atrial Fibrillation (AFib) rate: _______ rhythm: _______ pacemaker site: ______ P waves: ________ PRI: ________ QRS: _______ ```

``` 350-750, ventricular rate varies irregularly irregular none discernible none normal ```

cardiac tamponade pathophysiology: -result of ____ accumulation between _____ pericardium and _____ pericardium. increased ___ pericardial pressure impairs ______ filling -typically worsens progressively until corrected -epidemiology -acute onset typically the result of trauma or MI -benign presentations may be caused by ______, _______, ____ disease, and _________ -patient history: relates a history of ____ and ______ exam: rapid, weak pulse, JVD, decreasing ______ pressure, _______: elevated _____ pressure, ______ heart spunds & ______or shock

``` fluid visceral parietal intra diastolic cancer, pericarditis, renal disease, hypothyroidism dyspnea orthopnea systolic Beck's triad venous muffled hypotension ```

``` cardiac tamponade mangement: -maintain _____ -administer ______ -establish __ access -consider medication admin: - _______ - ______ - ______ - __________ is a procedure where fluid is aspirated from the pericardium ```

``` airway oxygen IV morphine sulfate furosemide (Lasix) dopamin pericardiocentesis ```

myocardial infarction diagnosis ________: heart muscle is rich in enzymes and proteins that regulate its activities, that leak from the ______ cells into _______ when muscle becomes infarcted -most importantly 1. ________ and _______ (proteins concerned with muscle contractions) 2. ________ CK-MB (heart muscle enzyme): days 3. ___________ (heart muscle enzyme)

``` enzyme tests necrotic circulation troponin T, troponin I creatine-kinase lactic dehydrogenase ```

myocardial infarction: treatment ______ therapy: time is myocardium: - dissolve the occluding _______, restoring circulation to the ischemic _______ -the sooner ______ therapy begins (w/in 6 hrs, the better chance for saving the affected distal myocardium -agent activates the body's own _______ for dissolving clots -_________ - ________ - may lead to ________ - ______ and ______ criteria

``` thrombolytic blood clot heart fibrinolytic internal system recanalization reperfusion bleeding inclusion, exclusion ```

myocardial infarction: treatment ___________: dilates areas of narrowng within coronary arteries, rather than by bypassing them (major surgery) - a guided catheter introduced through skin and into large artery in the arm or leg threaded under fluoroscopic control into the narrowed coronary artery, and positioned at the site of that narrowing. then a baloon cathether is inflated under very ___ pressure, which smashes the plaque and pushes it into the arterial wall, enlarging the ____ of the artery surgical treatment: myocardial __________ procedures _________: bypasses the obstructions in the coronary arteries usually by means of segments of saphenous veins obtained from the patient’s legs

``` coronary angioplasty high lumen revascularization bypass surgery ```

myocardial infarction: post treatment to reduce the coagubility of blood, decreasing the likelihhood of thrombus and emboli

anticoagulant drugs

myocardial infarction: post treatment reduce myocardial irritability, often given to patients after recovering from MI

beta-blockers

myocardial infarction: post treatment small amount to inhibit platelet function, therefore making them less likely to adhere to roughened atheromatous plaques that can initiate a thrombosis

aspirin

myocardial infarction: post treatment to decrease the irritability of the heart muscle

antiarrhythmia drugs

myocardial infarction: post treatment if complete heart block develops

cardiac pacemaker

dilation of the wall of an artery or an outpouching of a portion of the wall ___________: causes weakening of the vessel wall (most are acquired as a result of arteriosclerosis) __________: the splitting (dissection) of the media (thick middle layer of aorta) by blood due to degenerative changes that cause layers to loose their cohesiveness and separate

aneurysms arteriosclerotic aneurysm dissecting aneurysm of aorta

``` - often the result of atherosclerosis signs and symptoms: - _____pain -_____ pain -hypotension -urge to defecate ```

abdominal aortic aneurysm abdominal black/flank

``` AMI onset of pain: __________ severity of pain: ______ timing of pain: _______ location of pain: _______ clinical signs: _________ ```

gradual, with - prodromal symptoms - increases with time - may wax and wane - substernal; back is rarely involved - peripheral pulseas equal

``` onset of pain: __________ severity of pain: ______ timing of pain: _______ location of pain: _______ clinical signs: _________ ```

- abrupt, without prodromal symtoms - maximal from the outset - does not abate once it has started - back is often involved, between the shoulder blades - blood pressure discrepency between arms and decrease in a femoral or carotid pulse

results from excessive vasoconstriction of small arterioles throughout the body, which raises the ______ blood pressure, high _____ resistance forces the heart to increase the force of ______ contraction in order to supply blood to the tissues, which produces a comensatory increase in the ____ pressure - cardiac effects: _____ is enlarged - vascular effects: _____ wear out prematurely, accelerates atherosclerosis - renal effects: narrowing of renal ______ decreases blood supply to kidneys

``` hypertension diastolic peripheral ventricular systolic heart vessels arterioles ```

``` primary hypertension (90%) - cause is __________ secondary hypertension: ______, ______, ______, _______ ```

arterial hypertension unknown renal, endocrine, neurogenic, drugs

Heart is unable to pump powerfully enough or fast enough to empty its chambers. – Blood backs up into the systemic circuit, the pulmonary circuit, or both. – More than 2 million people in the United States have this – An additional 500,000 cases are diagnosed each year. – Nearly half die within _____ of diagnosis.

congestive heart failure | 1

Left ventricle is most commonly damaged during an ____ and in chronic _______. – If the patient’s condition is advanced enough, _____ may become evident. – Increasing interstitial pressure causes narrowing of the ______ – Air passing through narrowed bronchioles creates _____ noises. – Air bubbling through the fluid-filled alveoli produces ______ – Results in increased back pressure into the pulmonary circulation—pulmonary ____ – Presence of _______ cells – Decreased flow to kidneys leads to activation of ________system. Fluid retention aggravates ____

``` left sided heart failure AMI hypertension cyanosis interstitial wheezing crackles edema heart failure renin-angiotensin system CHF ```

left sided heart failure: treatment Management of left-sided heart failure • Improve ______and decrease the ______ of the heart. • Reduce the volume of _____ blood. • Administer 100% supplemental oxygen. • Sit the patient up, with the feet ______ • Start IV with _______ • _______ may be ordered as a vasodilator. • ________: Laxis and ACE inhibitors • ______ sulfate • _________drugs

``` oxygenation workload venous dangling normal saline nitroglycerin furosemide morphne sulfate bronchodilator ```

Result of left-sided heart failure or cor pulmonale – Right side is unable to keep up with the increased workload. – Pulmonary _______ or ______ – Blood backs up behind the right _______: Results in increased back pressure into the ______ venous circulation.

``` right sided heart failuire embolism COPD ventricle systemic ```

right heart failure signs and symptoms ``` Extreme restlessness and agitation • ________: Signs of labored breathing. • _____ positioning. • “Number of ______.” • Tachypnea and Tachycardia • _____ blood pressure • Crackles and possibly wheezes • Frothy, pink ______ • Painful hepato-splenomegaly with characteristic _____liver & may lead to cardiac _____ • Pitting ______ ```

``` severe dyspnea tripod pillows elevated sputum nutmeg cirrhosis edema ```

heart failure - monitor ECG treatment: 1. ________: promote excretion of excess salt and water by kidneys 2. ________: increase the efficiency of ventricular contractions 3. ________: block an enzyme called ____________ enzyme, which is involved ina renal regulatory mechanism that promotes retention of salt and water

diuretic drugs digitalis ACE inhibitors angiotensin converting enzyme

diseases of the veins _______: blockage of a vein by clots ________: inflammation of a vein 1. _________ and _________: occur most commonly in leg veins but also elsewhere 2. ________ of the ______ extremities: dilated, tortuous veins, most often in ___ veins 3. _______ in other locations besides the leg veins

``` thrombosis phlebitis venous thrombosis and thrompophlebitis varicose veins, lower extremities leg veins variocose veins ```

pressure with in ventricles at the end of diastole (pressure which fills left ventricle)

pre load

resistance against which the heart pumps

after load

heart rate

chronotropic

cardiac contractile force

inotropic

speed of impulse transmission

dromotrophic

chapter 11 Flashcards

(82 cards)