Cardiac Anatomy and Physiology

Question 1

atelectasis

Answer 1

alveoli collapse and cannot expand

- mediastinum shifts towards part of collapsed lung

Question 2

air in pleural cavity

Answer 2

mediastinum shifts away from affected side

Question 3

pericarditis

Answer 3

fluid build up between parietal and visceral

- limits expansion of heart

Question 4

cardiac temponade

Answer 4

build up of fluid in parietal pericardium is too much(emergency situation)

Question 5

oxygen transport

Answer 5

vena cava –> right atrium –> right ventricle –> pulmonary artery –> lungs –> pulmonary vein –> left atrium –> left ventricle –> aorta

Question 6

SNS adrenergic receptors

Answer 6

vessels = alpha receptors(vasoconstriction)
myocardium = beta1 receptors(increase rate and contractility)
vessels = beta2 receptors(vasodilation)
- lungs(small vessels)

Question 7

PNS cholinergic receptors

Answer 7

vessels = cholinergic(vasodilation)
myocardium = cholinergic(decrease rate and contractility)

Question 8

RCA supplies

Answer 8

SA node, AV node, R atrium, R ventricle, inferior wall of L ventricle

Question 9

LAD supplies

Answer 9

anterior wall of L ventricle

- blockage is serious

Question 10

LCX supplies

Answer 10

L atrium, lateral and posterior walls of L ventricle

Question 11

PDA supplies

Answer 11

posterior intraventricular septum and inferior wall of L ventricle

Question 12

RPP

Answer 12

Rate-pressure product
- myocardial oxygen consumption
RPP = HR x SBP

Question 13

when coronary arteries receive most of blood

Answer 13

during diastolic phase

Question 14

Heart sounds

Answer 14

1st sound = A-V valve closes

2nd sound = aortic and pulmonary valves close

Question 15

Cardiac output

Answer 15

an indicator of pump performance
Q = SV x HR
- blood pumped per minute

Question 16

Factors that affect Q

Answer 16

1) preload
2) contractility(strength of heart muscle)
3) afterload(valvular resistance)
4) heart rate
- increased Q = increased preload, increased contractility, decreased afterload, increased HR

Question 17

preload

Answer 17

volume of blood in the ventricle at the completion of filling(EDV)

Question 18

CVP

Answer 18

central venous pressure

• filling pressure of R atrium
• reflects the preload of right ventricle

Question 19

Factors affect venous return

Answer 19

muscle pumping
position(gravity) = lying down better
respiration
venous tone
blood volume
competent venous valves

Question 20

PCWP

Answer 20

pulmonary capillary wedge pressure

- reflects the filling pressure and preload of L atrium and ventricle

Question 21

myocardium contractility

Answer 21

increased contractility = increased SV

Question 22

afterload

Answer 22

related to vascular resistance or arterial blood pressure

• increased afterload = decreased SV
• factors that affect arterial resistance:
  
  • diameter
  • volume of blood
  • viscocity

Question 23

SVR

Answer 23

systemic vascular resistance

SVR = MAP - CVP/Q x 80

Question 24

PVR

Answer 24

pulmonary vascular resistance

PVR = mean PAP - PCWP/Q x 80

Question 25

Fick Equation

Answer 25

VO2 = Q x (a-v)O2 difference

Question 26

Grading pulses

Answer 26

0 = absent
1+ = weak, thready
2+ = normal
3+ = full, moderately increased
4+ = bounding(markedly increased)

Question 27

Taking BP

Answer 27

Optimal BP = less than 120/80
Normal BP = less than 130/85
high normal(pre-hypertension) = 130-139 or 85-89
oversized BP cuff = low blood pressure reading
undersized BP cuff = high blood pressure reading

Question 28

capillary refill test

Answer 28

1) press finger/toe pad until blood exits the area and skin blanches
2) remove pressure, normal refill is less than 3 seconds
- longer indicate arterial insufficiency

Question 29

elevation pallor and rubor of dependency test

Answer 29

1) supine patient, legs elevated 35 to 45
2) legs in dependent position, quick, pink flush in legs and feet = normal arterial circulation
- arterial insufficiency = discoloration(deep, red color) after 30 seconds

Question 30

claudation time test

Answer 30

intermittent claudication = leg pain that occurs with walking

1) patient walks on treadmill level surface
2) record time until pt complains of claudication and unable to continue

Question 31

claudication scale

Answer 31

0 = no claudication pain
1 = initial, minimal claudication pain
2 = moderate, bothersome pain
3 = intense pain
4 = maximal pain, cannot continue

Question 32

Homan’s sign

Answer 32

1) pt in supine
2) PT squeezes gastroc will forcing dorsiflexing, if feel tenderness or pain in calf area = positive acute thrombophlebitis

Question 33

area of auscultation

Answer 33

1) 4th or 5th intercostal space and L sternum border = Tricuspid valve
2) 5th intercostal space and mid clavicular line = mitral valve
3) 2nd intercostal space and R sternal border = aortic valve
4) 2nd intercostal space and L sternal border = pulmonary valve

Question 34

S1 heart sound

Answer 34

“lub”

• first heart sound = closure of the mitral and tricuspid valves
  
  • onset of ventricle systole

Question 35

S2 heart sound

Answer 35

“dub”

• second heart sound = closure of the aortic and pulmonary valves
  
  • onset of ventricle diastole

Question 36

S3 heart sound

Answer 36

occurs early in diastole phase while the ventricle is rapidly filling

- immediately after S2 and sounding like

“

lub-dub-dub

”

- sign of CHF
- result of rapid blood flow during diastole meeting a non-distensible overfilled left ventricular wall

Question 37

S4 heart sound

Answer 37

occurs late in diastole

- just before S1 and sounding like "la-lub-dub"
- associated with an increased resistance to ventricular filling

Question 38

aortic stenosis murmur

Answer 38

swishing sound(RED-FLAG)

• associated with restriction of blood flow through the aortic valve during systole
• a rough coarse sound which is heard best in Rt 2nd ICS

Question 39

pericardial friction rub

Answer 39

RED FLAG

• heard post bypass surgery
• associated with pericarditis or inflamed lung pleura
• contraindication to exercise
• best heard in middle of chest(xiphoid process)