Exam 2 Flashcards
(188 cards)
1
Q
What is normal cardiac output
A
5-6 liters of blood per minute
2
Q
Efficiency of the cardiovascular system depends on what four things?
A
- Heart’s ability to pump
- Patency of the blood vessels
- Quality of the blood
- Quantity of the blood
3
Q
What is happening during the “P” wave?
A
Impulse travels through the atria
4
Q
What happens during the QRS complex?
A
Impulse travels through the ventricles
5
Q
What happens during the “T” wave
A
Re-polarization of the ventricles
6
Q
When does re-polarization of the atria occur?
A
Somewhere during the QRS complex
7
Q
What is polarization?
- Where is sodium
- Where is potassium
A
Ready or resting state
- Na+ is extracellular
- K+ is intracellular
8
Q
What is depolarization?
- Where is sodium
- Where is potassium
A
Contraction
- Na moves into the intracellular
- K+ moves into the extracellular
9
Q
What is repolarization?
- Where is sodium
- Where is potassium
A
- Na moves back extracellular
- K moves back intracellular
10
Q
Role of the autonomic nervous system in control of the heart
A
PSNS slows heart (negative chronotropic, negative inotropic)
SNS compensates heart that is giong to slow (positive chronotropic, positive inotropic, positive dromotropic)
11
Q
Two types of hormones that affect the heart
A
- Catechonlamines (Adrenergic responses)
- Thyroid hormone
12
Q
Two types of catecholamines that affect the heart
A
Norepinephrine
Epinephrine
13
Q
How does Thyroid hormone affect the heart rate
A
Increased thyroid hormone –> increases BMR –> Increases HR
14
Q
WBCs originate from (3)
A
- Bone marrow
- Spleen
- Lymph
15
Q
Role of albumin
A
Exerts osmotic pressure intravascularly
16
Q
Role of fibrinogen
A
Hemostasis in the plasma
17
Q
Role of globulins
A
Defense
18
Q
General composition of blood
A
55% plasma
45% solid particles
19
Q
Composition of plasma (9)
A
90% water
10% albumin, fibrinogen, globulins, nutrients, oxygen, carbon monoxide, antibodies
20
Q
What solid particles are in the blood?
A
- Leukocytes
- Erythrocytes
- Thrombocytes
21
Q
Normal leukocyte level in the blood
A
5,000 - 10,000
22
Q
Normal hematocrit levels
- Males
- Females
A
- Males: 42-50%
- Females: 40-48%
23
Q
Normal hemoglobin levels:
- Males
- Females
A
- Males: 13-18
- Females: 12-16
24
Q
Normal hemoglobin and hematocrit: Females
A
Hemoglobin: 12-16
Hematocrit: 40-48%
25
Normal hemoglobin and hematocrit: Males
Hemoglobin: 13-18
Hematocrit: 42-50%
26
Functions of the blood (5)
- Transports O2 and Nutrients to the cell
- Transports CO2 and waste away
- Leukocytes and antibodies help fight microorganisms
- Promotes hemostasis (platelets)
- Circulates hormones
27
Hemostasis: Def
Bringing platelets to the site of injury
28
Normal platelet count (thrombocytes)
100,000 - 400,000
29
Location of the aortic valve
2nd intercostal space, right sternal boarder
30
Location of pulmonic valve
2nd intercostal space, left sternal boarder
31
Location of Tricuspid valve
4th intercostal space, left sternal border
32
Location of Mitral valve
5th intercostal space, midclavicular line
33
Stroke volume (def)
The amount of blood ejected from the heart with each contraction
34
Heart rate (def)
Beats per minute
35
Cardiac output (equation)
CO = SV x HR
36
Average SV
~70
37
Average HR
~80
38
Average CO
5.6L / minute
39
When you think preload, think _______.
VOLUME
40
When you think afterload, think ______.
PRESSURE
41
How do you lower preload? (4)
- Vasodilators
- Blood loss
- Diuretics
- FVD
42
How do you raise preload? (4)
- Vasoconstrictors
- Blood donation
- FVE
- Valve regurg
43
How do you lower afterload? (3)
- Vasodilatators
- Nitroglycerine
- Hypertrophied left ventricle
44
How do you raise afterload? (4)
- Vasoconstrictors
- HTN
- Epinephrine
- Dopamine
45
Arterial pressure must counteract ________
Ventricular systole.
46
Indirect measurements of CO: Appendages (3)
- 2+ pulses
- Skin is warm and dry
- Good capillary refill
47
Indirect measurements of CO: Vital signs (3)
- BP WNL
- HR WNL
- RR WNL, breath sounds clear
48
Indirect measurements of CO: CNS
A&Ox3
49
Direct measures of CO (2)
- Swan-Ganz / R heart catheter
| - Cardiac catheterization
50
Role of a Swan Ganz / R Heart catheter (2)
1) Monitors fluid load (CVP)
| 2) Thermester Coupler (2nd lumen) - measures CO
51
Two locations of baroreceptors
- Aortic arch
| - Carotid sinus
52
Role of baroreceptors
Respond to changes in BP
53
What do the baroreceptors do when BP rises? + 2 results
Stimulate PSNS
- Vasodilitation
- Decreased HR (Neg Inotrope, Neg chronotrope)
54
What do the baroreceptors do when BP falls? + 2 results
SNS is stimulated
- Increased HR (positive chronotrope)
- Increased contractility (positive inotrope)
55
Two locations of chemoreceptors
- Aortic arch
| - Carotid sinus
56
Chemoreceptors respond to changes in... (3)
1) Acidosis (pH 45)
2) Hypercapnia
3) Hypoxia
57
When stimulated, chemoreceptors will increase... (3)
- RR
- HR
- CO
58
Left ventricle has to over come pressures in the _______
aorta
59
Right ventricle has to overcome pressures in the ______
pulmonary system
60
Cor Pulmonale (def)
Right ventricular Failure
61
Diagnostic cardiac tests (7)
1) Electrocardiogram
2) Echocardiogram
3) Stress Test
4) Radionucleotide imagery
5) Cat scan
6) Positron Emission
7) Chest X-Ray
62
Holter Monitor
- What is it
- Function
- Type of portable ECG
| - Shows us the 24-hour ECG while patient goes about normal activity
63
What is a trans esophageal echo (TEE)?
| -Indications
Patient swallowsa transducer to get an echocardiogram
| - For very obese patients
64
What is the difference between an Echocardiogram and an Electrocardiogram?
An echocardiogram is a moving picture of structures of the heart -- looks at mechanics of valves and walls.
An electrocardiogram (ECG) looks at the electrical activity of the heart only.
65
How much do arteries expand during stress?
4x larger!
66
Two types of stress test
- Exercise (pt on treadmill)
| - Pharmacological (vasodilator mimics effect of exercise)
67
What is Bruce's protocol?
- Increase the speed and incline of the treadmill every 3 minutes (Stress test)
68
Contraindications of stress test (4)
- Severe aortic stenosis
- Acute MI
- Severe hypertension
- Atherosclerosis
69
Why is severe aortic stenosis contraindicated with stress test?
Patient cannot get enough blood volume out to perfuse coronary arteries, brain
70
Why is an acute MI contraindicated with stress test?
Patient already has increased oxygen demand and inability to deliver it
71
Why is severe hypertension contraindicated with stress test?
Increases risk for stroke, MI
72
Complications of stress test (4)
- MI
- CHF (congestive heart failure)
- Cardiac arrest
- Arrhythmias
73
What is a negative stress test?
| What does this mean?
- No symptoms at target heart rate
| - Means that signs and symptoms probably not coming from the heart
74
What is a positive stress test?
| What does this mean?
- Symptomatic: Pain, light-headedness
| - Stop immediately
75
What is the target heart rate
80-90% of max predicted for patient's age level
76
Indications for an echocardiogram (2)
Suspect aortic stenosis
| Suspect mitral valve regurg
77
Pros of echocardiogram
- Non-invasive
| - No prep needed
78
Radionucleotide imagery (def)
Diagnostic test that uses isotopes to detect coronary artery perfusion or infracted areas of the heart.
More blood volume indicated by more visible isotopes.
79
Recommendations for diabetes medications and CAT scans
High contrast dye increases risk of renal failure when contrast dye is combined with metformin or glucophage -- hold these meds for 24-48 hours while pt is treated and kidney levels are monitored, plus gie plenty of fluids to flush
80
What is a CAT scan? What can be observed?
- Narrow beams of x-ray that enables cross-sectional views of STRUCTURE
- Can look at calcium plaques, atherosclerosis
81
One cat scan is equal in radiation to _______ times X-Rays
100-250x
82
What is the difference between a CAT scan and a PET scan?
a CAT scan looks at STRUCTURE
| a PET scan looks at FUNCITON
83
Indications for a PET scan
- Looking for cancer or metastasis of cancer
84
Which is most accurate: TEE, Thalium scan, or PET scan
PET scan
85
Why are two isotopes used in the PET scan?
- One shows circulation
| - The other shows metabolic function (by showing which cells take up the most isotopes - hence cancer diagnosis).
86
What does a chest x-ray look at?
| What doesn't it look at?
Looks at size, contour, position of the heart
| Does not give info on coronary arteries
87
What type of enzymes are very specific to organ?
Iso-enzymes
88
What tests would you draw up in an acute situation?
- CK-MB
- Troponin
- Myoglobin
- CBC
89
Creatinine Kinase
An enzyme that comes from many types of tissues
90
CK-MB
Contractile protein specific to myocardium
91
Troponin
Most cardiac specific contractile protein. Gold standard; found only in cardiac muscle
92
Normal troponin levels (2)
Troponin I: <0.2 mcg/L
93
Troponin: Definitive MI diagnosis (levels)
>2.3 mcg/L
94
- When does Troponin elevate?
- When does it peak?
- How long does it remain elevated?
- Elevates within 2-4 hours of an MI
- Peaks within 4-24 hours
- Remains elevated about a week
95
What is myoglobin?
Heme protein that helps transport O2
96
Where is myoglobin found
In cardiac AND skeletal muscles
97
- When does myoglobin elevate?
| - When does it peak?
Elevates early: Within 30-60 minutes
| Peaks within 6 hours
98
Role of myoglobin diagnostically
Doesn't confirm that a patient has MI, but negative results can help RULE OUT MI.
99
When are iso-enzyme levels taken?
| What is the goal?
Immediately, then three hours later.
| Goal = 2 negative results.
100
What is CRP?
| When is it produced?
- An abnormal serum glycoprotein
| - Produced by the liver in response to inflammation
101
What does C-Reactive Protein tell you about cardiac function?
- Not cardiac specific, but a risk factor (correlational)
102
What is homocysteine?
An amino acid that increases as the result of B vitamin deficiencies
103
What releases BNP and when?
- Secreted by ventricles
| - In response to high preload
104
When is BNP assessed?
To determine if problem is cardiac or respiratory (rises if cardiac)
105
What is BNP (def)
Neurohormone that helps regulate BP and fluid volume
106
Goal of BNP (and mechanism)
- To decrease fluid
| - Stop renin-aldosterone-angiotensin
107
Functions of cholesterol (3
- Hormone synthesis
- Cell membrane formation
- Brain / nerve cells
108
Sources of cholesterol
- Dietary (animal and trans fats)
| - Liver
109
When is a lipid profile taken?
At FASTING levels (8-12 hours after a meal)
110
Lipid profile normals:
- Cholesterol
- Triglycerides
- LDLs
- HDLs
- Cholesterol: <40
111
What are triglycerides
Fatty acids made with glycerol
112
High levels of triglycerides are associated with:
- Meals
- Stress
- Obesity, Poorly controlled diabetes
- Heavy alcohol use
113
_____ often directly correlated with high LDL levels
High triglyceride levels
114
Where are triglycerides stored? How are they transported?
- Stored in fatty tissue
| - Transported in lipoproteins
115
LDLs: What do they cause
Form deposits on artery walls --> atherosclerosis --> CAD
116
Role of HDLs
Help remove fat from arterial wall, brings it to liver for breakdown, excretion
117
LDLs v HDL
"Lousy and Low" versus "Healthy and High"
118
Four things that will help increase HDLs
- Stop smoking
- Control DM
- Attain or maintain normal weight
- Increase physical activity
119
What is Cardiac Catheterization / Angiogram?
Invasive test to diagnose CV disease through direct visualization
120
How is Cardiac Catheterization done?
Percutaneous stick into femoral vein, dye goes through. Or done through femoral artery.
121
What should you do before an angiogram? (4)
- Administer some sedation
- Assess pulses distal from site
- Assess skin
- Assess ROM
122
What should you do after an angiogram? (4)
- Stand over patient holding pressure for 20 minutes
- Leg or limb immobilized for 2-8 hours
- HOB raised no more than 30 degrees
- Plenty of fluids to wash out dye
- Assess Q15
123
What should you assess before and after an angiogram?
- Vital signs
- Distal pulses
- Temp of limbs
- Color of limbs
124
Potential complications of an angiogram (6)
- MI (assess for chest pain)
- Bleeding from insertion site
- Clots: Pt may be losing circulation distal to insertion site
- Higher risk for pulmonary emobli
- Higher risk for stroke
- Allergic reaction to contrast dye
125
Three options if blockage is found during an angiogram
- Tx with meds
- Put in a stint
- Send patient to OR for bypass graft.
126
Intrinsic rates:
- SA node
- AV node
- Ventricles
- SA node: 60-100 bpm
- AV node: 40-60 bpm
- Ventricles: 20-40 bpm
127
Define irritability
A group of cells along the conduction pathway start speeding up; override the higher pacemaker site for control
128
Irritability: Common cause
Often due to hypoxia of myocardium
129
Effects of high calcium on the heart
High: Irritability
130
Effects of low calcium on the heart
Low: Tetany in skeletal muscles (not as much on heart)
131
Effects of high potassium on the heart (3)
- Peaked T wave
- irregular heart beat
- Slow / weak HR
132
Effects of low potassium on the heart (1)
- Low T wave
133
Electrical flow of lead 2
- From right arm to left leg
| - P & QRS are all upright
134
How much time is represented by every little ECG box?
.04 seconds
135
How long is an average PR interval?
3-5 boxes
| 0.12 - 0.2 seconds
136
How long is an average QRS complex?
- 3 small boxes or less
| - 0.12 seconds or less
137
SINUS BRADYCARDIA
- Rate:
- Rhythm:
- P wave:
- PRI:
- QRS:
- What does it look like?
- Rate: <60
- Rhythm: Normal
- P wave: Present
- PRI: 0.16 seconds (normal)
- QRS:0.08 (normal)
- Normal, just slow
138
Causes of sinus bradycardia (5)
- Digoxin
- Beta blockers
- Cholinergics
- Severe visceral pain
- Athletes
139
What would you assess with a SINUS BRADYCARDIA patient?
- Primary: Inadequate perfusion to brain: CNS issues: Lightheaded, change in LOC, restless
- Secondary: Cold pale skin
140
Intervention for a patient with sinus bradycardia -- symptomatic
- Identify cause
- Atropine
- Pacemaker
141
Sinus Tachycardia
- Rate:
- Rhythm:
- P wave:
- PRI:
- QRS:
- What does it look like:
- Rate: 120
- Rhythm: Normal
- P wave: Present
- PRI: 0.16 (normal)
- QRS: 0.08
- Normal, just fast
142
(Non-medicine) Causes of sinus tachycardia (5)
- Fever
- Pain
- Shock
- Anxiety
- Meds
143
What would you assess with SINUS TACHYCARDIA?
- Restless ness, change in LOC
| - Skin is cool, pale (unless feverish)
144
Interventions for a patient with sinus tachycardia (2 categories, 2 interventions each)
1) Innervate PSNS (carotid massage, valsalva)
| 2) Meds (beta blockers, calcium channel blockers)
145
Premature atrial contractions
- Rate:
- Rhythm:
- P wave:
- PRI:
- QRS:
- What does it look like:
- Rate: Normal
- Rhythm: Irregular
- P wave: Not regular -- varying sizes and shapes
- PRI: Elongated (0.24 seconds)
- QRS:Normal (0.08, regular)
- High QRS, irregular
146
How do you know if a premature atrial contraction is atrial or ventricular
QRS is higher with ventricular
147
Causes of Premature Ventricular Contraction (2)
- Spontaneous
| - After heart surgery
148
Atrial flutter
- Rate:
- Rhythm:
- P wave:
- PRI:
- QRS:
- What does it look like:
- Rate: Normal
- Rhythm: Regular
- P wave: Not regular
- PRI: Not measurable
- QRS:0.08, WNL
- What does it look like:
- Sawtooth P&T; atrial rates can be up to 250 per minute
149
Atrial flutter: Treatment
1) Intervention
2) Meds (3)
1) CARDIOVERSION -- machine is set to synchronize with patient's QRS: Stop heart, allow SA node to take over again
2) Meds:Beta blockers, digoxin, calcium channel blockers
150
Atrial fibrillation
- Rate:
- Rhythm:
- P wave:
- PRI:
- QRS:
- What does it look like:
```
- Rate:
If 100 = rapid ventricular response
- Rhythm: Irregular
- P wave: Not distinct
- PRI: Not distinct
- QRS: WNL 0.08
- What does it look like: Atria is chaotic; atrial rate can be up to 350/min; ventricular rate may be <100
```
151
Symptoms of rapid ventricular response
- Lightheadedness, changes in LOC, restlessness
152
Atrial fibrillation increases _______.
Risk of clot formation in atria --> Increased risk for MI, ischemic stroke
153
Prophylactic treatment for atrial fibrilation
Coumadin, Warfarin
154
Normal PT
| Therapeutic PT
Normal PT: 12-13
| Therapeutic = 18 (1.5x)
155
Normal INR
| Therapeutic INR
Normal: 0.8-1.2
| Therapeutic = 2.0-3.0
156
Hallmarks of PVC (3)
1) QRS is wide, bizarre
2) QRS comes early
3) Compensatory pause
157
Premature ventricular contraction
- Rate:
- Rhythm:
- P wave:
- PRI:
- QRS:
- What does it look like:
- Rate: Depends on underlying rhythm
- Rhythm: Variable
- P wave: Absent
- PRI: No P wave
- QRS:Wide and bizarre
- What does it look like: Compensatory pause after the PVC
158
What is the big danger with PVC?
R on T phenomenon
159
What is the R on T phenomenon?
If there is another impulse from elsewhere in the heart during the refractory period, can throw patient into vtach or vfib
160
How can you tell if a PVC is unifocal or multifocal?
- If PVCs look alike, source is the same group of cells: UNIFOCAL
- If PVCs look different --> different sites: MULTIFOCAL
161
R on T phenomenon: Treatment
Amnioderone (Anti-arrhythmic) if frequent
162
Define Couplet
PVCs occur in pairs
163
Define Bigeminy
Every other beat is a PVC
164
Define Trigeminy
Every third beat is a PVC
165
Define Quadrigeminy
Every fourth beat is a PVC
166
When is the absolute refractory period?
Just before Q to partway through T
167
When is the relative refractory period?
Second half of T
168
Ventricular Tachycardia:
- Rate:
- Rhythm:
- P wave:
- PRI:
- QRS:
- What does it look like:
- Rate: 140
- Rhythm:
- P wave: None
- PRI: None
- QRS: Cannot distinguish from T
- What does it look like:No atria firing
169
What will you assess with a Vtach patient who is hemodynamically compromised?
- Loss of consciousness
- Decreased or absent HR
- Emergency
170
What would you do to treat a VTach patient?
- Pulse
- Pulseless
Pulse: Cardiovert and / or use meds
Pulseless: Defibrilate
171
Why would you cardiovert with a VTach patient?
Because of R on T phenomenon
172
Ventricular Fibrillation
- Rate:
- Rhythm:
- P wave:
- PRI:
- QRS:
- What does it look like:
- Rate: X
- Rhythm: X
- P wave: X
- PRI: X
- QRS:X
- What does it look like:
CHAOTIC! Ectopic beats from ventricles. Nothing to be analyzed! Can't even determine rate because there is no R wave.
173
Ventricular Fibrillation : Treatment (2)
- CPR
| - Defibrillate if shockable rhythm
174
What would you assess on a VFib patient? (2)
- Unconscious
| - No pulse
175
Ventricular standstill (Asystole)
NO ELECTRICAL ACTIVITY
176
Treatment of Ventricular Standstill (2)
- CPR
| - Atropine
177
How do chances of survival change with asystole?
For every minute of ventricular standstill, chances of survival drop.
After 10 minutes, chances of survival are 0.
178
Most blocks are _________.
Bradycardic
179
First degree A-V block
- Rate:
- Rhythm:
- P wave:
- PRI:
- QRS:
- What does it look like:
- Rate: Slow
- Rhythm: Regular
- P wave: Present
- PRI: Consistantly elongated (>.20)
- QRS:WNL (0.08)
- What does it look like:
180
Hallmark of First degree AV block
PRI is >.20
181
How would you treat a symptomatic AV block patient (2)
- Atropine
| - Pacemaker
182
Second degree heart block: MOBITZ TYPE I = WENCKEBACH
| - Hallmark
"GOING, GOING, GONE!"
- Gradually lengthening PR intervals until you have a P with no QRS to follow
183
Treatment for Wenckebach (2)
- Atropine
| - Pacemaker
184
Second degree heart block: MOBITZ TYPE II = CLASSICAL
- Rate:
- Rhythm:
- P wave:
- PRI:
- QRS:
- What does it look like:
- Rate: Usually bradycardic
- Rhythm: R-R can be regular
- P wave: More Ps than QRS
- PRI: Elongated
- QRS: Sometimes absent
- What does it look like: More Ps than QRS
185
Second degree heart block: MOBITZ TYPE I = WENCKEBACH
- Rate:
- Rhythm:
- P wave:
- PRI:
- QRS:
- What does it look like:
- Rate: Usually bradycardic
- Rhythm: Going, going GONE.
- P wave: Present
- PRI: Elongates until QRS disappears
- QRS:Occasionally absent
- What does it look like: Going, gone, gone.
186
Third degree AV block (complete)
- Rate:
- Rhythm:
- P wave:
- PRI:
- QRS:
- What does it look like:
- Rate: Ventricular rate is slow
- Rhythm: Regular P-P, regular R-R
- P wave:
- PRI:
- QRS: Wider than normal
- What does it look like:
187
Treatment for 3rd degree (complete) block (2)
- Needs pacemaker immediately (emergency)
| - Atropine alone will not change much: Would speed up atria, but not change the blockage.
188
What would you assess with a 3rd degree AV block patient?
Decreased LOC
| Hemodynamically compromised
