Perfusion Flashcards by Brooke Blackstock

Afterload

The force the ventricles must overcome to eject their blood volume. R Ventricle must generate enough tension to open the pulmonary valve & eject it’s vol. into the low-pressure pulmonary arteries. R Ventricle Afterload is measured as pulmonary vascular resistance. L Ventricular ejects its load by overcoming the pressure behind the aortic valve. L Ventricular Afterload is measured as systemic vascular resistance.

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Action Potential

Electrical impulse that stimulates muscle contraction, and produces the waveforms represented on electrocardiogram (EEG) strips

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____________ pressures are much higher than ______________ pressures; thus the _______ ventricle has to work much harder than the _______ ventricle. ~Alterations in vascular tone affect afterload & ventricular work.

Arterial/Pulmonary Left/Right

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Cardiac output adjusted for the client’s body surface area (BSA), _____________provides beneficial data regarding the heart’s ability to perfuse the tissues. ___________is also an accurate indicator of the effectiveness of the circulation. *same answer for both blanks

Cardiac Index

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The process that returns the cell to it’s resting, polarized state.

Repolarization

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Stroke Volume / end-diastolic volume and represents the fraction of percent of the diastolic volume that is ejected from the heart during systole. Normal range: 50%-70%

Ejection Fraction

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Average adult Cardiac Output range

4-8 L/min

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HR x SV =

Cardiac Output

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Central perfusion

*Generated by cardiac output *Propels blood to organs in their tissues *Clinical manifestations are systematic when impaired (meaning the entire body is affected)

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Tissue perfusion

*volume of blood that flows through the tissues *supplied by blood flow from arteries to capillaries *Poor central perfusion or a problem within the organ itself can cause impaired tissue perfusion

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What happens with impaired central perfusion?

Hypotension, tachycardia, change in mental status, shortness of breath, change in heart rhythm, peripheral edema, and S1, S2, S3, S4, or murmurs

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What happens with impaired tissue perfusion?

Lower extremities: pale, cool skin, less hair on legs, diminished dorsalis pedal and posterior Tibial pulses, slowed capillary refill Kidneys: decreased urine output Brain: depends on the extent of ischemia and areas affected

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First heart sound (S1) the “lub”

Produced by closure of the AV valves, start of systole (phase of ventricular contraction)

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Closure of the semilunar valves when the ventricles empty their blood into the aorta and pulmonary arteries. Start of diastole (ventricular relaxation)

Second heart sound (S2) the “dub” sound

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Closure of the Aortic Valve (AV) produces _________ that is characterized by the syllable “lub.”

Auscultation Site _________

Side of stethoscope used during assesment_______

3 answers

First Heart Sound (S₁)
Auscultation site: Apex
using the disphram of Stethoscope

~ Cardiac Cycle: Start of Systole, high-pitched, patients positioning does not affect sound.

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Sound produced by the closure of the Semilunar Valves amd characterized by the syllable “dub”__________ with an ausculatating site of __________ using the ___________?

Second heart sound (S₂)
Both in Second Intercostal space (ICS), with the pulmonary component best at left sternal boarder (LSB) and aortic component at right sternal border (RSB)
Heard best with diaphram

~Cardiac Cycle Timing: End of systole, positioning: sitting or supine, high-pitched

Phase of ventricular contraction that begins with the closure of AV Valves.

Systole

~In Systolic Phase ventricles are filled then contract to expel blood into the aorta & pulmonary arteries.

The phase of ventricular relaxation begins with the closure of semilunar valve(S₂) and ends at the closure of AV valves (S₁).

Diastole

Most commonly heard in children & pregnant women in the third trimester.

Third Heart Sound (S₃)

~Heard after S₂ using the bell at apex and termed ventricular gallop, When AV valves open the blood flow into vemtricles causes vibrations which produce the S₃sound during diastole.

May be heard in children, well-conditioned athletes, & healthy older adults without cardiac disease.

Fourth Heart Sound S₄

~caused by atrial contraction & ejection of blood during late diastole and is termed atrial gallop

~Heard best at apex with bell during early diastole right after S₂ Low-pitched

Heard in pt. with Valvular disease in early systole

Clicks & Snaps

May be heard in mitral stenosis in early systole

Opening Snap

Occur in damaged pulmonary & aortic valves (SL Valves)

Ejection Clicks

Heard in prolapse of mitral valve

Nonejection Clicks

Results from inflamation of the pericadial sac, the surfaces of the parietal & visceral layers of pericadium can't slide smoothly producing a rubbing or grating sound.

**Friction Rubs**

Harsh blowing sounds, caused by disruptive blood flow into the heart, into the chambers, or from heart to pulmonary or aortic systems.

**Heart Murmur**

Left & Right coronary arteries originate at the base of the __________ and branch out to encircle the \_\_\_\_\_\_\_\_\_\_\_\_.

**AORTA & MYOCARDIUM**

JUST NOTES: Volume of Murmurs are on a scale of 1-6

* Grade 1: Barely audible with stethscope; often considered physiological * Grade 2: Very soft but distinctly audible * Grade 3: Moderatly loud; no thrill or thrushing motion is associated * Grade 4: Distinctly loud, in addition to a palpable thrill. * Grade 5: Very loud, can hear with diaphram off the chest; palpable thrust & thrill are present. * Grade 6: Loudest, can hear w/ dialhram off chest; visible thrill & thrust.

During diastole, the volume in the ventricles increases to approximatley 120 mL (\_\_\_\_\_\_\_\_\_\_\_\_), and at the end of systole the volume in the vemtricles decreases to approximatly 50 mL (\_\_\_\_\_\_\_\_\_\_\_\_\_).

* End-diastolic Volume * End-systolic Volume

Difference between End-diastolic Volume and End-systolic Volume is the \_\_\_\_\_\_\_\_\_\_\_\_?

**Stroke Volume** ## Footnote ~Ranges from 60-100 mL/beat with an aversge of 70mL/beat in an adult.

The amount of blood pummped by the ventricles into the pulmonary & systemic circulstions in 1 minute.

**Cardiac Output**

Average adult CO?

* Ranges from 4-8 L/min * CO is and indicator of the hearts ability to function as a pump. * If the heart can't pump effectivley, CO & tissue perfussion are decreased leading to ischmic tissues, ultimatly causing necrosis in cells.

**CO influencing factors**

* **4 Most Important Factors of CO** 1. Heart rate 2. Preload 3. Afterload 4. Contractility ~with activity level, metabolic rate, physiological & psychological stress responses, age, & body size all influencing CO as well.

The hearts ability to respond to an increase of strenuous activity & adjust it's CO is called\_\_\_\_\_\_\_\_\_?

**Cardiac Reserve**

The ability of the arteris to contract & expand is called?

**Compliance**

Factors affecting Pulse

1. Age: As age ⬆ pulse rate gradually ⬇ overall 2. Gender: After puberty, the average males PR is slightly lower than the average female's. 3. Excercise: The PR normally ⬆ with activity. The rate of increase in a prof. athleteis often less than in the average individual bc of greater cardiac size, strength, & efficiency.