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Flashcards in Exam 2 Deck (188):
1

What is normal cardiac output

5-6 liters of blood per minute

2

Efficiency of the cardiovascular system depends on what four things?

- Heart's ability to pump
- Patency of the blood vessels
- Quality of the blood
- Quantity of the blood

3

What is happening during the "P" wave?

Impulse travels through the atria

4

What happens during the QRS complex?

Impulse travels through the ventricles

5

What happens during the "T" wave

Re-polarization of the ventricles

6

When does re-polarization of the atria occur?

Somewhere during the QRS complex

7

What is polarization?
- Where is sodium
- Where is potassium

Ready or resting state
- Na+ is extracellular
- K+ is intracellular

8

What is depolarization?
- Where is sodium
- Where is potassium

Contraction
- Na moves into the intracellular
- K+ moves into the extracellular

9

What is repolarization?
- Where is sodium
- Where is potassium

- Na moves back extracellular
- K moves back intracellular

10

Role of the autonomic nervous system in control of the heart

PSNS slows heart (negative chronotropic, negative inotropic)

SNS compensates heart that is giong to slow (positive chronotropic, positive inotropic, positive dromotropic)

11

Two types of hormones that affect the heart

- Catechonlamines (Adrenergic responses)
- Thyroid hormone

12

Two types of catecholamines that affect the heart

Norepinephrine
Epinephrine

13

How does Thyroid hormone affect the heart rate

Increased thyroid hormone --> increases BMR --> Increases HR

14

WBCs originate from (3)

- Bone marrow
- Spleen
- Lymph

15

Role of albumin

Exerts osmotic pressure intravascularly

16

Role of fibrinogen

Hemostasis in the plasma

17

Role of globulins

Defense

18

General composition of blood

55% plasma
45% solid particles

19

Composition of plasma (9)

90% water
10% albumin, fibrinogen, globulins, nutrients, oxygen, carbon monoxide, antibodies

20

What solid particles are in the blood?

- Leukocytes
- Erythrocytes
- Thrombocytes

21

Normal leukocyte level in the blood

5,000 - 10,000

22

Normal hematocrit levels
- Males
- Females

- Males: 42-50%
- Females: 40-48%

23

Normal hemoglobin levels:
- Males
- Females

- Males: 13-18
- Females: 12-16

24

Normal hemoglobin and hematocrit: Females

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