CVS Flashcards
1
Q
What are the three linings of the heart?
A
Endocardium, myocardium, and epicardium
2
Q
What is the deoxygenated blood flow route?
A
In through the superior/inferior vena cava, right atrium, tricuspid valves, right ventricle, semilunar valve, out through the pulmonary artery to be oxygenated
3
Q
What is the oxygenated blood flow route?
A
In through the pulmonary vein, the right atria, bicuspid valve, right ventricle, aortic valve, out the aorta
4
Q
What is the route of conduction in the heart?
A
SA node -> AV node -> crosses to the bundle of His -> down through purkinje fibers
5
Q
Normal rhythm of the heart can also be called?
A
Sinus rhythm
6
Q
What does the P wave signify on an ECG?
A
SA node is firing and depolarization of the atria (contraction)
7
Q
What does the QRS complex signify on an ECG?
A
AV node electrical pulse and depolarization of the ventricles (contraction)
8
Q
At what phase of an ECG does atrial repolarization happen?
A
QRS complex
9
Q
What does the T wave signify in an ECG?
A
Repolarization of the ventricles
10
Q
What do the intervals between ECG segments/waves indicate?
A
They indicate how long it takes for the conduction to travel from one area of the heart to another
11
Q
What six factors effect cardiac output?
A
HR, SV, preload, afterload, atrial kick, and cardiac reserve
12
Q
Define SV
A
Amount of blood ejected by the left ventricle during each systolic contraction
13
Q
What effects SV?
A
affected by preload, contractility, and afterload
14
Q
Define CO
A
amount of blood pumped by the ventricles in one minute
15
Q
Define preload
A
The volume of blood in the ventricles at the end of diastole, before the next contraction
In addition, the amount of stretch placed on the myocardial fibres
16
Q
The amount of stretch on myocardial fibres may also be classified as?
A
Preload
17
Q
Describe Starling’s law
A
The more fibers are stretched (i.e., the greater the preload), the greater is their force of contraction/contractility and recoil, within a physiological range
18
Q
Often in HF, the heart becomes overstretched and cannot recoil. This causes risk of?
A
Blood pooling and clotting
19
Q
What is one way to increase preload? One way to decrease it?
A
A fluid bolus would increase preload and diuretics will decrease it due to reduced blood volume
20
Q
Define afterload
A
The peripheral resistance that the left ventricle must pump against (ventricle size, wall tension, and arterial BP)
21
Q
Are enlarged or smaller ventricles more effective for contractility?
A
Enlarged ventricles are ineffective to contractility, we want smaller ventricles
22
Q
Define atrial kick
A
Occurs in the final phase of atrial systole, where the atria contract and eject a bolus of blood into the ventricles
23
Q
Define cardiac reserve
A
The CVS may increase its workload/rate by 3-4x to meet demand during heightened/high epinephrine situations
24
Q
Is the cardiac reserve a sustainable source over time?
A
No
25
Define/briefly describe arteries, arterioles, capillaries, veins, and venules
Arteries – thicker, elastic, larger ones have smooth muscle
Arterioles – little elastic tissue and more smooth muscle
Capillaries – thin, endothelial cells, no elastic or muscle tissues
Veins – large diameter, thin walled, larger ones have semi-lunar valves
Venules – small, small amount of muscle and connective tissue
26
What are the two locations of baroreceptors?
The aortic arch and carotid sinus
27
What are baroreceptors sensitive to and where do they transmit their feedback?
They are sensitive to stretch and pressure and they send their feedback to the brainstem
28
An increase in CO will ___ (stretch/constrict) the periphery and create a ___ (decrease/increase) in HR due to an (increase/decrease) in blood volume
Stretch, decrease, increase
29
Where are chemoreceptors located?
aortic arch and carotid bodies
30
What are chemoreceptors sensitive to?
They create responses based on hypoxia (decreased arterial oxygen), hypercapnia (increased arterial CO2), and acidosis (decreased plasma pH)
31
What is the formula for BP?
BP = CO x SVR (systemic vascular resistance)
32
What is the formula for pulse pressure?
SBP - DBP
33
What do the following diagnostic/blood studies indicate? CBC, troponin, creatine kinase
CBC - complete blood; indicates counts of WBC, RBC, and platelets
Troponin - measurements of contractile proteins (released after an MI)
Creatine kinase (CK) - measurement of enzyme found in skeletal and heart muscle, and the brain (indicates muscle injury or death)
34
What do the following diagnostic/blood studies indicate? Serum creatinine, BUN, CRP
Serum creatinine - indicates waste product of protein breakdown, approximates GFR
BUN - measurement of nitrogen in the blood from waste product of urea
CRP - measurement of a marker of inflammation
35
What blood study can be predictive of the risk of cardiac disease, inflammation, and cardiac events?
CRP
36
What do the following diagnostic/blood studies indicate? BNP, triglycerides, cholesterol, HDL, LDL
BNP - measurement of a peptide that causes natriuresis (sodium in the urine)
Triglycerides - measurement of mixture of fatty acids
Chol - measurement of blood lipid
HDL - measurement of a form of cholesterol that helps remove other forms
LDL - measurement of the form of the bodies of major cholesterol
37
What diagnostic/blood study indicates the presence of HF and may help distinguish cardiac vs respirator related dyspnea?
BNP
38
BNP is released when the ___ swell?
Ventricles
39
What is Holter monitoring?
recording of an ECG rhythm over a 24-48 hour period
40
What is a cardiac stress test?
Studies the effect of exercise tolerance on the CVS
41
What is cardiac angiography?
Procedure that assesses the coronary circulation
42
How do baroreceptors respond to an increased blood pressure?
Respond to stretch due to increased BP and blood volume, send an inhibitory impulse to the brainstem which results in decreased HR, force of contraction, and vasodilation
43
How do baroreceptors respond/adjust to continuous hypertension?
Baroreceptors adjust to the higher rates of BP and recognize these levels as normal
44
What is the vascular endothelium? What can happen to it to cause issues with BP?
A single cell layer that lines the blood vessels
It can be potentially narrowed from deposits of lipids and cholesterol
45
How does the body compensate for deposits of lipids and cholesterol lining the vascular endothelium?
The body will add fibrin around the deposits to try and wall them off
46
How does the RAAS system affect blood pressure?
It determines whether to conserve or excrete water, which will modify the blood volume - an increase of sodium will increase water intake
47
What enzyme do the kidneys release when they require greater amounts of fluid and blood?
Renin
48
What three hormones are released by the endocrine system to increase BP?
ADH - increased of ADH increase ECF, which in turn increases blood vol. and BP
Epinephrine - increases CO, HR, and myocardial contraction
Aldosterone - stimulates the kidneys to retain sodium and water, which increases BP and CO
49
What does RAAS stand for?
Renin angiotensin-aldosterone system
50
What value is considered hypertensive? What is stage one and stage two values?
140/90 mmHg
Stage one - 140-159/90-99
Stage two - 160/100
51
What is isolated systolic hypertension?
A medical emergency of sustained elevated SBP equal to or greater than 140
52
What is the difference between primary and secondary hypertension?
Primary - we do not know the cause
Secondary - we can determine the cause (i.e., tumour)
53
What is a stepped approach with primary hypertension?
When administering medications, we always want to start low and work our way up
54
Can primary hypertension be inherited?
Yes, and we do not know the direct cause
55
What 7 pathophysiological factors can lead to primary hypertension?
1. Gene
2. Sodium and water retention (diet and exercise are fundamental)
3. Altered RAAS (kidneys are excreting high amounts of renin)
4. stress and increased SNS
5. insulin resistance and hyperinsulinemia
6. endothelial cell dysfunction (may result in deposits of cholesterol)
7. obesity
56
What are 5 concerning complications of chronic hypertension?
1. Hypertensive heart disease (CAD, cardiac hypertrophy, HF)
2. Cerebrovascular disease (arteriosclerosis)
3. Peripheral arterial disease
4. Nephrosclerosis (hardening of kidneys)
5. Retinal blood vessel damage
57
What is ambulatory blood pressure monitoring?
Recording blood pressure over 24 hours, where the machine goes off at random times of the day - pt should continue normal routine and ADLs
58
What are 6 lifestyle modifications that can be made for hypertension management?
1. Nutrition (specifically, reduce sodium)
2. Weight reduction
3. Modify alcohol consumption
4. Physical activity
5. Avoidance of tobacco
6. Stress management
59
What are the three levels/steps of medications for medication management of hypertension?
Begin with diuretics, then antihypertensives, and lastly move to cholesterol-lowering agents
60
What will hypertensive lab work show for triglycerides, HDLs, and LDLs
Labs will show high triglycerides, low HDLs, or high LDL
61
What does the PR segment indicate on an ECG?
Time taken for the impulse to spread through the atria, AV node, bundle of His, bundle of branches, and Purkinje fibres
62
What does the ST segment indicate on an ECG?
Time between ventricle depolarization and depolarization, should be flat
63
Should the ST segment be peaked or flat in normal sinus rhythm?
Flat
64
What is normal sinus bradycardia?
Conduction pathway is the same as sinus rhythm, but the SA node fires at a slower rate (i.e., slower HR)
65
What are some normal/non disease clinical associations of sinus bradycardia?
Athlete, sleeping, valsalva maneuver, medications
66
How would a patient present if symptomatic with sinus bradycardia?
Pallor, low BP, cold skin, weakness, angina, syncope (dizziness), confusion, and SOB
67
What is syncope?
Sudden, brief loss of consciousness
68
What medication would you administer to someone in sinus bradycardia in an emergency?
Atropine - an anticholinergic to rapidly increase the HR
69
What surgical intervention could be administered to someone who is sinus bradycardic?
Insertion of a pacemaker
70
What is normal sinus tachycardia?
The conduction pathway is the same as that in sinus rhythm, but rate from SA node is increased (i.e., increased HR)
71
What are some clinical associations of sinus tachycardia?
Stress, panic attack, exercise, fever, infection, acute pain, anemia, caffeine
72
Hypovolemia would lead to sinus bradycardia or tachycardia? Why?
Hypovolemia (loss of water, blood, and electrolytes) will lead to tachycardia due to the body wanting to compensate
73
Low BP, hypoxia, hypoglycaemia will all lead to sinus tachycardia or bradycardia?
Sinus tach
74
What are the three main symptoms of sinus tachycardia?
Dizziness, headache, and SOB
75
How do we treat sinus tachycardia?
Entirely dependent on the cause - increase sugar, reduce pain, vagal maneuvers, cardioversion
76
What is reduced ejection fraction r/t HF?
The pushing/contraction from atria and ventricles is reduced, causing lowered blood volume
77
What is the difference between reduced and preserved ejection fraction?
Reduced - caused by impaired contractile function, leaving the left ventricle with inability to generate enough pressure to eject blood through aorta
Preserved - inability of the ventricles to relax and fill during diastole
78
List the 4 compensatory mechanisms the heart uses in HF
1. SNS
2. Neurohormonal
3. Ventricular dilation
4. Ventricular hypertrophy
79
How does the SNS compensate in HF?
Epinephrine release, which increases BP, HR, contractility, and vasoconstriction
80
Does epinephrine have an effect on ejection fraction?
No
81
Which compensatory mechanism in HF is the least effective of the 4?
SNS
82
How does the neurohormonal system compensate in HF?
The RAAS system is activated (aldosterone and ADH are released) to absorb more sodium and water, which in turn increases blood volume and BP
83
How does ventricular dilation compensate in HF?
Ventricles enlarge, which leads to overstretched muscle that ineffectively contract
84
How does ventricular hypertrophy compensate in HF?
Increases in muscle mass and cardiac wall thickness in response to overwork and strain - eventually they need more oxygen and increase CO
85
How do natriuretic peptides (BNP) effect HF?
BNP is released from the ventricles in response to increased blood volume in the heart, which helps to counter the adverse effects of the SNS and RAAS system
86
What are the two types of HF? Briefly explain each
Right-sided - Backward blood flow to the right atrium and venous circulation, we see peripheral edema, JVD, and poor circulation to the lungs
Left-sided - Left ventricular dysfunction causes blood to back up through the left atrium and into the pulmonary veins, we see pulmonary congestion, pink/frothy sputum, cyanotic extremities, cold skin, and poor circulation to the body
87
What are the 9 clinical manifestations of HF?
Fatigue, dyspnea, tachycardia, edema, nocturna, skin changes (dry, cracked, pallor), behavioural changes (agitation, depression, frustration), chest pain, weight changes
88
What is the most common form of initial HF?
Left-sided HF
89
What is one of the earliest symptoms of HF?
Fatigue
90
What is brawny edema?
Edema that is so full that it cannot be displaced
91
What would a HF patient's BP and O2 sats be?
Hypotensive and low O2 sats
92
What are 8 complications associated with HF?
1. Pleural effusion (accumulation of fluid in the pleura)
2. Conduction abnormalities
3. Left ventricular thrombus (LVT)
4. Stroke
5. Pulmonary thrombosis
6. Ascites
7. Enlarged liver
8. Renal failure
93
What is the underlying goal in all HF patients?
Preserve and manage current cardiac function
94
Would a pacemaker be an effective intervention for a HF patient?
Yes, it would
95
What is peripheral artery disease (PAD)?
The thickening of artery walls from increased deposits of cholesterol and lipids in vessels, which results in the narrowing of upper and lower arteries
96
What is the greatest risk factor for PAD?
Aging, specifically greater than 70 years
97
What are seven other related risk factors for PAD?
Diabetes (excess glucose and thicker blood), smoking, uncontrolled hypertension, family history, diet, stress, and PA
98
When do symptoms of PAD begin to present?
See symptoms when vessels are 60-75% blocked
99
What is collateral circulation?
In PAD patients, the blocked vessels will develop alternate pathways for circulation
100
What are six complications associated with PAD?
1. Intermittent claudication
2. Paresthesia
3. Pallor
4. Reactive hyperaemia
5. Pain at rest
6. Critical limb ischemia
101
What is intermittent claudication in PAD?
Aching precipitated by exercise, which resolves with rest
Exercise could be walking or ADLs
102
What is paresthesia in PAD?
Numbness and tingling in the toes or feet due to nerve tissue suffering from ischemia
103
What is pallor in PAD?
Blanching of the foot with elevation
104
What is reactive hyperaemia in PAD?
Redness of the foot in dependent position (below the level of the heart)
105
Does pain in lower limbs worsen at night in PAD patients?
Yes, intense leg pain due to the them being at the level of the heart and reduced CO
106
What is critical limb ischemia in PAD?
Limbs are not receiving blood flow that they need - can lead to rest pain greater than 2 weeks, leg ulcers, and gangrene
107
What are four diagnostic tools for PAD?
1. Doppler ultrasound
2. Segmental BP
3. Ankle-brachial index
4. Computed tomographic angiogram
108
What does a doppler ultrasound test in PAD?
Measures the diameter of the vessel and highlights area of obstruction
109
What does a segmental BP test in PAD?
Blood pressure cuffs attached to various areas, observing BP as it moves through cuffs
110
What does an ankle-brachial index test in PAD?
BP taken on the ankle and foot
111
What does a computed tomographic angiogram test in PAD?
Detects any areas of decreased or no perfusion
112
What are six risk modifications that are important to PAD?
Healthy weight, regular PA program, diet, smoking cessation, BP control, and blood sugar control
113
What lifestyle behaviour is pertinent to manage in PAD patients?
Smoking cessation
114
What type of medication is necessary and preventative for PAD patients?
Anti-platelets to reduce blood clots from sluggish blood
115
What is the recommended exercise program for PAD patients?
Walking 30 to 40 mins per day, 3-5x per day
116
What type of diet/nutrition is recommended for PAD patients?
High in fruits and grains, low in cholesterol, fats, and sodium
117
Interventional radiological catheter-based procedures are useful for what in PAD patients?
Stents keep the vessels open
118
What is peripheral vascular disease (PVD)?
Similar to PAD, but is of concern with diabetic patients
119
How is PVD preventable?
It is preventable through tight management of diabetes
120
Describe good foot care in diabetics and why it is important
1. Check their feet every day
2. Ensure appropriate sock wear (NO SEAMS)
3. Appropriate footwear
4. Nail trimming
121
What type of socks should diabetics wear?
No seams
122
What is appropriate nail trimming for diabetics?
Straight across or seek professional
