Block 1 Unit 3 Cardiovascular System Flashcards
What is the Pericardium?
A double walled membranous sac that encapsulates the heart
(Peri-around)
What layer is the Epicardium and what does it provide?
2nd layer, provides a smooth surface for the heart to contract and relax within the pericardium with minimal friction
What layer is the myocardium and what is it composed of?
It is the 3rd layer and the thickest layer of the heart, composed of cardiac muscles ( cardiomyocytes )
What is the cardiomyocyte responsible for?
It is the cell responsible for the contraction of the heart
What layer is the endocardium and it’s responsibility?
Internal lining of the myocardium; continuous endothelium that lines all the arteries, veins and capillaries of the body creating a continuous, closed circulatory system
How many layers does the pericardium have?
It is a double walled membranous sac that encapsulates the heart
What does the pericardium prevent?
Prevents displacement of the heart during acceleration and deceleration and acts as physical barrier that protects the heart from infection and inflammation from the lungs and pleural space.
The pericardium contains ______\ and _____ that causes changes in BP and HR
Pain receptors, mechano receptors
How much fluid is in the Pericardial space?
20mL of pericardial fluid
What’s the purpose of pericardial fluid?
Lubricates the membranes that allows them to slide smoothly over one another with minimal friction as the heart beats
What is Automaticity?
Ability to spontaneously depolarize/ initiate impulses regularly
What is excitability?
Ability to depolarize in response to a stimulus
What is conductivity?
Ability to transmit impulses from cell to cell
What is Rhythmicity?
The regular generation of an action potential by the hearts conduction system
What is contractility?
Ability to respond to a stimulus by shortening
What is the SA node BPM rate?
60-100 bpm
What is the AV node BPM rate?
40-60 BPM
What is the bundle of his BPM rate?
30-40 BPM
What is the Purkinje fibers BPM rate?
15-40 BPM
What are some Cardiac disease Hx you should look out for?
-Rheumatic fever
-Cardiac murmurs
-HLD
-Congenital heart disease
-HTN
What are some risk factors for cardiac issues
-Tobacco use
-Alcohol
-Nutrition
-Exercise
-illicit drug use
What does a full set of vitals entail?
-BP on both arms
-Pulse pressure ( SBP-DBP= mmHg)
-Temp
-HR
-RR
-O2 saturation
What is a pulse pressure?
The difference between the SBP and the DBP ( SBP-DBP= PP)
What does pulse pressure reflects?
-Stroke volume
-Ejection velocity
-Systemic vascular resistance
What causes a widened pulse pressure?
Usually related to Vascular stiffening evident in..
-Sinus bradycardia
-Complete heart block
-Aortic regurgitation
-Anxiety
-Catecholamine infusion ( dobutamine, dopamine, epinephrine)
-Age
-Atherosclerosis
-HTN
-Fever
-Hot environnement
-Exercise
What causes a narrow pulse pressure?
Insufficient preload leading to decreased cardiac output. E.g.
-Aortic valve stenosis
-Cardiac tamponade
-Hypovolemic shock
What does a high pulse pressure, bradycardia, and irregular breathing indicate?
Increased ICP ( Cushing triad)
What is the function of the coronary arteries?
Vessels that supply the heart structures with oxygenated blood and then return the blood to the general circulation via coronary veins.
Where does the coronary arteries being at?
Begins at base of aorta, openings are called Ostia
What 2 branches does the LCA divide into?
LAD and the Circumflex artery
What areas of the heart does the LAD supplies oxygenated blood to?
The septum, anterior, and inferior wall of the L ventricle
Who’s nickname is the “widow maker” and why?
LAD artery due to the large amount of cardiac tissue receiving blood supply from this vessel
What area of the heart does the Circumflex artery supplies to?
L atrium and L arterial ventricular wall
What area of the heart does the RCA perfuses to?
R atrium, SA and AV nodes
What are the 3 branches that branches off the RCA ?
-Conus
-R marginal branch
-Posterior descending branch
What area of the heart does the Conus perfuses?
Upper R ventricle
What area of the heart does the R marginal branch perfuses?
R vertical to the apex
What is the posterior descending branch?
Smaller coronary branches to both ventricles
What is the mnemonic to help remember the order of heart sounds?
APEs To Man
Where can you listen to listen to the Aotric sound?
2nd intercostal space R sternal border
Where can you listen to listen to the pulmonic sound?
2nd Intercostal space L sternal border
Where can you listen to listen to the erb’s point?
3rd intercostal space L sternal border
Where can you listen to listen to the tricuspid?
4th intercostal space L sternal border
Where can you listen to listen to the mitral?
5th intercostal space at midclavicular line
What is troponin?
Regulatory proteins in cardiac muscles released with damage
What is the initial elevation of Troponin after a MI
3-6 hrs
When is the peak elevation of Troponin after a MI?
12-47 hrs
How many days can a person Troponin be elevated for?
5-10 days
What cardiac biomarker is the most clinically accurate marker of a MI?
Troponin
What cardiac biomarkers is used to to determine damage to the heart?
Troponin and Creatinine Kinase Myocardial Band (CKMB)
What cardiac biomarker shows the protein found in the cardiac and skeletal muscle?
CKMB
What cardiac biomarker rises 4 to 8 hrs after a MI?
CKMB
What cardiac biomarker peaks 15-24 hrs after a MI?
CKMB
What cardiac biomarker can be elevated for 2-3 days after a MI?
CKMB
What cardiac biomarker usually gets 3 samples at the 6 or 8 hour intervals?
CKMB
What cardiac biomarker shows the peptide secreted by ventricle in response to excessive stretching by heart muscle?
B-type Natriuretic Peptide (BNP)
What cardiac biomarker is going to be higher in pts with renal failure?
BNP
What cardiac biomarker used to assist in determining CHF severity?
BNP
What can be used to dx cardiac tamponade and assess coronary circulation?
CT scan
A chest X-ray can show you what?
Cardiomegaly and fluid in places it shouldn’t be e.g. empyema and pleural effusions
What is a EP study?
A test used to evaluate the heart’s electrical system and to check for abnormal heart rhythms.
How is a EP study performed?
Wire electrodes are threaded into the heart via a vein in the groin, wrist, or neck. Electrical signals are sent through said wires to stimulate the heart in order to find the cause of the abnormal rhythm.
What types of pts would you anticipate needing an Echo?
-New murmurs/ valve status
-New arrhythmias/ heart pumping status
-HF
-Heart valve disease
-cardiomyopathy/ EF
-Pericardial effusion/ tamponade
What is a bubble study used for?
It can identify potential blood flow issues inside the heart.
You are doing a bubble test and you see your bubbles appear on the L side of the heart, what does this entail?
This is a positive test and indicates the presence of a hole in the heart
What is a cardiac catheterization?
A catheter inserted into the radial or femoral arty.
cardiac catheterization can aid in the dx of what?
-Heart disease
- EF
What’s the purpose of a PAC?
Diagnostic, used to…
-detect HF or sepsis
-monitor therapy
-evaluate effects of drugs
-blood flow and pressures in and around the heart
Pt is presenting to the ED w/ sudden excruciating pain located at the posterior chest between their scapula, Dypnea, extremity weakness and episodes of syncope. When taking vitals you noticed a 23mmHg difference between the right and left arm. Provider orders a chest X-Ray and the image reveals a widening of the mediastinum. What would the Dx be?
Aortic Dissection
When does a Aortic Dissection occur?
When the intimai aortic wall is disrupted and blood extends into the aortic vessel.
What are some of the causes of Aortic Dissection?
-Trauma
-Atherosclerosis
-Hx of thoracic or abdominal aneurysms
-Marfan’s syndrome ( inherited disorder that affects connective tissue)
-FHx
-HTN
What’s the difference between Type A and Type B Aortic Dissection?
Type A-doesn’t involve ascending aorta
Type B- involves ascending aorta
What’s the Tx for Type B Aortic Dissection?
Typically managed by controlling the pts BP with a beta blocker
What’s the Tx for Type A Aortic Dissection?
Will require a graft ( graft is inserted to reinforce the walls of the artery Andy prevent them from stretching further and possibly popping)
