Cardiac Flashcards
Which side of the heart is considered the low pressure system (pulmonary system)?
The right side
What side of the heart is considered the high pressure pump (systemic circulation)?
The left side
When the left ventricle contracts, it creates an impulse palpable at the apex of the heart called what?
apical pulse
The apical pulse is also called ________, because it’s where the heartbeat is most strongly felt.
Point of maximal impulse (PMI)
Where is the PMI located?
Left anterior chest at fifth intercostal space along the midclavicular line
What is made of thick cardiac muscle tissue and is responsible for contraction and ejection of blood from the heart?
Myocardium
The left main coronary arteries divides into what sections?
Left anterior descending artery (LAD) and the circumflex artery (Cx)
Where does the LAD supply blood to?
Anterior surface of left ventricle
Lateral side of left ventricle
Interventricular septum
Branches of the right coronary artery supply blood to the ….?
Walls of right atrium
Walls of the right ventricle
Inferior left ventricle
SA node
Atrioventricular bundle
What are the six parts of the cardiac conduction system?
SA node
Atrioventricular node
Bundle of His
Right and Left bundle branches
Purkinje fibers
Stimulation of _______ strengthens the force of contraction and increases the heart rate.
sympathetic (accelerator) nerves
Stimulation of the ____________ slows the rate of discharge of the SA node, slows conduction through the atrioventricular nose, weakens the atrial contraction and causes small reduction in the ventricular contraction.
Parasympathetic (inhibitory)
What are cardiac conditions caused by an abrupt reduction in blood flow through the coronary artery?
Acute coronary syndromes (ACSs)
What are three major ACS’s?
unstable angina
Non-ST segment elevation myocardial infarction (NSTEMI)
ST segment elevation myocardial infarction (STEMI)
What are common chief complaints of patients experiencing an ACS?
chest pain, dyspnea, fainting, palpitations and fatigue
A pt with multiple symptoms, it’s important to ask …?
Which symptom started first and which bothers them the most
What is chest discomfort that occurs when the heart muscle does not receive enough oxygen (myocardial ischemia)?
Angina pectoris
What medication do patients with CAD (coronary artery disease) commonly take?
NTG - Nitro
Severe ischemia may result in radiation to the _____?
right chest, right arm and back
Where does chest discomfort associated with myocardial ischemia usually begin?
central or left chest that radiates to the arm (little finger[ulnar] side of left arm), wrist, jaw, epigastrium, left shoulder and between the shoulder blades
What are medications or procedures used to open a blocked coronary artery?
reperfusion therapy
How long do anginal symptoms usually last?
20 minutes or less
Chest discomfort that lasts for hours may also be seen in patients with ____ & ____?
Pericarditis and aortic dissection
Chest discomfort associated with AMI lasts about ?
20 minutes to several hours
Dyspnea that occurs on exertion or at rest suggests the presence of?
COPD or left ventricular failure
Dyspnea that develops suddenly suggests?
pulmonary embolism, pneumothorax, acute pulmonary edema, pneumonia, airway obstruction
In patients who have _____, fluid build up that leads to dyspnea often develops slowly over weeks or months.
left ventricular failure
Patients who have dyspnea when resting horizontally may have ________ because blood pools in the lungs when the patient lies down?
chronic heart failure
Dyspnea that is relieved by a change in position is called?
orthopnea
Paroxysmal nocturnal dyspnea is associated with _____ and usually begins 2-4 hours after on the onset of sleep?
left ventricular failure
PND with LVF have what type of symptoms that are improved with sitting or standing up?
coughing, wheezing, sweating
Pulmonary edema is usually accompanied by what type of sputum?
frothy, pink-tinged sputum
What type of electrolyte disorder is a common cause of generalized weakness and fatigue?
high or low potassium levels
What type of medications may also cause fatigue?
Beta blockers, diuretics, antihypertensives
What are two types of vasodilators?
Nitro (Nitrostat) and Isosorbide (Isordil)
What is another word for hypoperfusion?
shock
Where does the right atrium receive blood low in oxygen from?
superior vena cava, inferior vena cava and coronary sinus
Where does the left atrium receive oxygenated blood from?
lungs via the right and left pulmonary veins
What does the right ventricle pump?
Deoxygenated blood to the lungs
Where does the left ventricle pump?
Oxygenated blood throughout the body
Bilateral pitting edema may be a sign of what?
Right Ventricle Failure (RVF)
What are the BP vitals in Stage 2 hypertension?
SBP 140mm Hg or higher
DBP 90mm Hg
Are widened pulse pressures an early or late signs of shock?
late sign
S1 heart sounds occur when…?
Tricuspid and mitral valve closes
Decreased S1 sounds indicate?
fibrotic and calcified mitral valve, obesity, emphysema, cardiac tamponade
Decreased S2 heart sounds occur when…?
pulmonary and aortic valves close
Decreased S2 heart sounds indicate?
loud: HTN or pulmonary HTN
decreased: hypotension
split: right bundle branch
S3 heard sounds are caused by…?
ventricular wall vibrations
Decreased S3 heart sounds can indicate?
heart failure
Which heart sound is heard just before S1 and is caused by turbulent filling of a stiff ventricle?
S4
What can be heard from turbulent blood flow through the valves?
heart murmurs
What happens to the muscle fibers during depolarization?
They are stimulated to contract through changes in concentrations of electrolytes
When does repolarization begin?
Closing of sodium and calcium channels
What cardiac action potential phase does the cell depolarize and begin to contract?
Phase 0
What cardiac action potential phase is the resting phase?
Phase 4
What cardiac action potential phase do the cells begin to repolarize?
Phase 1
What cardiac action potential phase completes repolarization?
Phase 3
What cardiac action potential phase does the Na+ and Ca++ enter the cell and Potassium flow out?
Phase 2
What phases consist of the absolute refractory period? (have not sufficiently repolarized to enable another depolarization)
Phase 0 to the middle of Phase 3
What phases represent the relative refractory period? (some cells have repolarized sufficiently to depolarize again)
(middle of phase 3 to the beginning of phase 4)
Where is the SA node located?
right atrium
Where does the SA node receive blood from?
RCA
What is the most common cause of sudden cardiac arrest?
V-fib
Impulses generated on the SA node spread across the atria and internodal pathways: what are those pathways?
anterior internodal
middle internodal
thorel tract
What type of breath sounds will you hear with pt’s with CHF?
crackles
Where is the AV node located?
floor of the right atrium behind the tricuspid valve
What is dependent edema?
swelling of the feet and ankles
When an SA impulse enters the AV node, it is delayed by how many seconds?
0.12 seconds
What does the delay between the nodes allow?
Allows the atria to empty blood into the ventricles
What medications can be given for the treatment of CHF?
ACE inhibitors, beta blockers, and diuretics
What position would be used to treat CHF
upright/Fowlers
What can be used to treat respiratory distress with CHF?
CPAP
What happens when an atrial rate becomes rapid?
fewer impulses reach the ventricle
unequal radial or femoral pulses are a good indication of what type of cardiac emergency?
Aortic Aneurysm
Commotio Cordis is what type of Ventricular dysrhythmia?
V-Fib
What systolic BP is considered as a hypertensive emergency?
180 mmHG
When a cell is at rest, what leaks out?
Potassium
When the inside of the cell is more negative than the outside, it is?
polarized
The P wave on an EKG signifies?
atrial depolarization
What is another word for the middle internodal tract?
Wenckebach
What is the ability of the pacemaker cells to initiate an electrical impulse without being stimulated from another source
automaticity
Decreased concentrations of Potassium and calcium in the blood causes the automaticity to increase or decrease?
Increase
Increased concentrations of K+, Na+, Ca+++, decreases or increases automaticity?
decreases
The ability of cardiac cells to shorten causing cardiac muscle contraction in response to an electrical stimulus?
contractility
Geographically similar areas of the myocardium which help localize areas of ischemia, injury or infarction are called what type of leads?
contiguous leads
Very large (hyperacute) T waves may indicate?
myocardial ischemia, injury and infarction
Tall, pointed (peaked) T waves indicate?
hyperkalemia
A clot that develops in a vein near the surface of the skin
Superficial thrombophlebitis
The development of a blood clot in an inflamed or damaged vein
Thrombophlebitis
What are two examples of coronary heart disease?
angina pectoris and AMI (acute myocardial infarction)
Counting the number of QRS complexes in a 6 second strip and multiplying it by 10 can help you measure what?
heart rate
What does SCD stand for?
Sudden cardiac death
Where do most out of hospital cardiac deaths occur?
homes- public settings - nursing homes
What are the three roles of the cardiovascular system?
To deliver oxygenated blood and nutrients to the cells, deliver chemical messengers(hormones) and transport waste products to appropriate sites.
Where does the atrium receive blood low in oxygen?
superior vena cava, inferior vena cava and coronary sinus
What is the coronary sinus?
It is a large vein that on the posterior side of the heart that collects blood from the great cardiac vein, small coronary veins and drains it into the right atrium.
Where does the left atrium receive fresh oxygenated blood from?
right and left pulmonary veins
Where does the right ventricle pump deoxygenated blood to?
the lungs
Where does the left ventricle pump oxygenated blood to?
the rest of the body
What valve do the atria pump blood through?
AV valve (atrioventricular)
What does the interatrial septum separate?
right and left atrium
What layer of the heart is the middle layer that is responsible for cardiac contraction and efficient ejection of blood from the heart?
myocardium
Which coronary artery is the largest in diameter and the shortest myocardial blood vessels?
left main coronary artery (LMCA)
Is the baseline, the isoelectric (TP segment, isometric line) line, positive, negative or neutral?
electrically neutral
An electrical impulse moving in the direction of a negative electrode produces what type of deflection?
deflection below the baseline
Perpendicular movement of an impulse toward a positive electrode produces what type of waveforms?
biphasics waves
What is the amplitude of a p wave?
less than 2.5mm tall
what is the duration of a p wave?
0.11 seconds or less
what does a p wave represent?
atrial depolarization
What does a calibration box inform you of?
The paper speed and amplitude
What is the length of a normal PR interval?
0.12-0.20 seconds (3-5 small boxes)
What does the PR interval represent?
time required for an impulse to traverse the atria and AV junction
What does the PR segment represent?
amount of time the AV node delays transmission of atrial activity to the ventricles
When does atrial repolarization take place?
During the PR segment
What does the QRS segment represent?
ventricular depolarization
What condition is alleviated when sitting forward?
perocarditis
What are the signs and symptoms of pericarditis?
-positional chest pain
-SOB
-recent infection or fever
-diffused concave ST elevation ( no more than 5mm), depressed or down sloping PR segments, absence of reciprocal ST depression
True or False: Reciprocal ST depression is never seen with pericarditis?
True
What is the most common cause of accelerated idioventricular rhythms?
AMI- acute myocardial infarction
What is the pattern for stable angina?
chest pain, pressure, discomfort induced by exertion
Unstable is not relieved by what?
rest and/or nitroglycerin
If a pt is experiencing angina, what should you expect to see on the 12-lead?
ST segment depression or T wave inversion
How does right-sided heart failure manifest?
JVD and peripheral edema
What is the normal duration of a QRS complex?
011 seconds or less
