Stressors to Coronary Circulation Part 1/Test 2 Flashcards

(64 cards)

1
Q

What is the order of the circulation of the heart?

A
Venous capillaries
Veins
Heart
Arteries
Arterioles
Arterial capillaries
Venules
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2
Q

Purpose of the heart

A
  • returning oxygen poor blood from body to right heart
  • Pumped into lungs
  • Exchanged for oxygen rich blood returning to Left heart
  • Pumped into systemic circulation
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3
Q

Heart structures

A

-2 pumps
–R-pulmonic circulation
–L- systemic circulation
4 valves
–AV- Mitral & Tricuspid
–SL- Pulmonic & Aortic
3 Layers
–Epicardium
–Myocardium
–Endocardium
Electrical system

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4
Q

Conduction system

A
  • An electrical impulse is initiated by the SA node, which is the hearts pacemaker (intrinsic rate of 60-100 bpm); this causes depolarization of the cells & contraction of the atria
  • It then travels to the AV node (intrinsic rate 40-60 bpm) and moves through the bundle of His & the left right bundle branches
  • The action potential diffuses widely through the walls of both ventricle by means of the Purkinje fibers (intrinsic rate of 20-40 bpm), triggering ventricular contraction
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5
Q

Right and left branch off the aorta

A

Grip the heart and feed from the surface inward. They dilate with exercise

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6
Q

Functioning of circulation depends on

A
  • Pump
  • Electricity
  • Volume
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7
Q

Oxygenation: Decreased cardiac output=

A

Ineffective tissue perfusion which leads to Impaired gas exchange which leads to Activity intolerance= Hypoxia

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8
Q

Cardiac output=

A

Heart rate x Stroke volume

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9
Q

Ejection Fraction

A

Percentage of blood ejected from the heart during systole- 60-80% normal

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10
Q

Preload

A

The degree of fiber stretch at the end of diastole- determined by volume returning to the heart.

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11
Q

Afterload

A

The pressure or resistance the ventricles must overcome to eject blood through the SL valves

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12
Q

PVR or SVR

A

Resistance of the arterial walls. If B/P is increased-PVR is decreased

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13
Q

Neuro Regulation: Sympathetics

A

Stimulate Alpha 1-peripheral

Beta 1- Cardiac

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14
Q

Neuro Regulation: Parasympathetic

A

Inhibits valves

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15
Q

Neuro Regulation: Receptors in aortic and carotid

A

Stretch sensitive, acid and oxygen sensitive. When stretched by volume, B/P is high

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16
Q

Cardiac Regulation

A

The autonomic nervous system consists of the sympathetic nervous system and the parasympathetic nervous system.

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17
Q

Parasympathetics

A

Receptor are muscarinic and are located in smooth muscle; activation (as in vagal stimulation) causes decreased HR ans slower conduction

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18
Q

Sympathetics

A

Increase HR , speed of impulse conduction and the force of contractions a (in heart)- increased contractility a (in smooth muscle)- vasoconstriction. B (in heart)- increased HR, increased conduction, increased contractility. Dopaminergic (located in coronary, renal, mesenteric, and visceral vessels)- increased dilation.

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19
Q

Cardiac regulation/Hormonal response- Angiotensin

A

as CO decreases, kidneys release renin= angiotensinogen which causes vasoconstriction (increased BP) and release of aldosterone

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20
Q

Cardiac regulation/Hormonal response- Aldosterone

A

Causes Na+ retention, which makes body retain water to increase blood volume to increase CO

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21
Q

Cardiac regulation/Hormonal response- Antidiuretic Hormone

A

hold unto urine, so volume increases

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22
Q

Circulation assessment basics:

A
BP
---normal 120-80
---HTN- >139/89
---Hypotension- <90/60
HR
---normal rate & regularity
---tachycardia
---bradycardia
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23
Q

Sound heard when valves close:

A

S1/S2

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24
Q

S1 lub closure of

A

Mitral and Tricuspid

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25
S2 dub closure of
Aortic and Pulmonic
26
Extra Sounds:
Gallops S3 S4
27
S3
Early filling phase
28
S4
Late filling phase
29
Pericardial rub
Inflammation of visceral and pericardial sack
30
Murmurs
Incompetent valves- swoosh
31
Murmur: Systolic
Closure of aortic and pulmonary
32
Murmur: Dyastolic
Closure of mitral and tricuspid
33
Assessment of peripheral arteries
``` Pulses: Location Head/toe Quality of grading +1 +2 +3 color movement sensation claudication presenceof edema document ```
34
Assessment and aging
``` HR BP Heart size Conduction Vessels Decreased reserve ```
35
Assessment/aging
``` Fatigue Fluid retention Irregular heartbeat Dyspnea Pain Calf tenderness Syncope Neuro changes Leg pain ```
36
Risk factors: Modifiable
Habits- smoking, diet, weight, exercise, coping w/stress Increased cholesterol HTN Increased BG
37
Risk factors: Nonmodifiable
Age Gender Presence of DM/Disease Family
38
Diagnostics for coronary circulation
Cholesterol Lipids, LDL, HDL, Triglycerides, CK-MB, Troponin, Echocardiagram, TEE, Stress test, Angiography, Coag panel, INR, EKG 12 lead, BNP, Potassium, Chest xray, ABG's, CBC
39
Diagnostics: Serum studies-lipid studies
LDL's-bad ones-CAD s- good ones- great if elevated Total cholesterol- keep 140-200 Triglycerides- keep 40-190
40
Diagnostics: Isoenzyme
CKMB >5-6% positive for MI
41
Diagnostics: Troponin
2.3 positive for MI
42
Brain Natriuretic Peptide
Used with symptoms of CHF Differentiates cardiac from pulmonary causes of dyspnea 0-100 pg/ml normal 100-400 patient should respond well to treatment >400 will be more difficult and take longer for positive response
43
Coagulation
``` Normal values Pt- 11-13 seconds PTT- 25-32 seconds INR usually <1 Platelets 150-400 thousand ```
44
PT control
1 1/2-2 times Coumadin
45
PTT control
1 1/2- 2 1/2 times- Heparin
46
INR
2.-3.0 Coumadin If mechanical valve patient then 2.5-3.5
47
Diagnostics Echocardiogram
US checks fluid movement through the heart, valve function, ejection fraction
48
TEE
Invasive-see posterior wall of heart, can identify and clots that develop with Afib
49
Reversal of coumadin
Vit K and aquamafitin
50
With a TEE you can see
the posterior wall of the heart and identify any clot formation as well
51
It's important to check for clots before cardioversion because
You don't want to break the clot loose
52
For cardioversion, pt needs to be
NPO for 4-6 hrs before and will remain NPO until gag reflux returns
53
MUGA Scan
Stands for multi-unit gated analysis A gated pool scan that uses radioisotope dye to show how blood pools in your heart during rest, exercise, or both Also good for EF
54
Stress test
Exercise- Thallium | Chemical- Adenosine
55
Vessels should _____to give extra cardiac output needed during exercise
Dilate
56
For stress test patient needs to
``` be NPO or clear fluids Wear good walking shoes Baseline VS attached to telemetry should report pain, SOB, dizzyness staff monitor for changes in heart rhythm, ie PVCs, and other symptoms of decreased CO ```
57
Cardiac cath post procedure
Assess VS, distal pulse, site q15m x 4 then q30 min x2, then qh x 4, or protocol given by MD, keep flat for several hours as ordered , minimum 15-30 degree elevation while eating. Let finish at least 1 liter of IV fluids to help rid body of dye and its hyperosmotic effect Report any changes keep on telemetry if no problems discharge teaching
58
Complications of Cardiac cath
dysrhythmias hemmorrhage thrombus formation infection
59
Angioplasty
Cath with inflatable balloon on tip to flatten the plaque
60
Stent insertion
do angioplasty after angioplasty insert the stent to keep the vessel open post procedure- follow the basic cardio cath protocol
61
Venography
Evaluates for DVT's. Dye injected into the venous side and traced with flouroscopy
62
D= Dimer blood test
Assess for increased fragmin = DVT
63
Doppler US
detects reflection of increased RBC's in arteries and veins, produces a wave form or audible sound =DVT
64
CVP
(5-11 mm Hg) done with central line in place. Tells you volume without being super invasive