cardiac assessment unit 1 Flashcards by Laura Van Epps

normal intracardiac pressures

RA, RV, PA, LA, LV, AO

RA-0.8 MMHG (CVP)
RV- 15-28/0-8
PA- 12-22
LA 12 MMHG
LV 12 MMHG
AO 120/80

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AV VALVES AND FUNCTIONS

MITRAL & TRICUSPID
anchored to papillary muscles and chordae tendineae
open during diastole
closed with systole = Dub sound
(ventricle contraction)

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Semilunar Valves & actions

Pulmonic and Aortic valves
Open during systole (from pressure of ventricles contracting)
Closed during diastole (atrial contraction/ atrial kick)
Lub sound

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Stroke Volume

amount of blood ejected with each HB

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Ejection Fraction

% of blood ejected during systole

normal = 45%

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Cardiac Output

amt of blood ejected each min

CO = HR X SV

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Factors affecting blood flow

pump, volume, vessels
pressure
resistance
neural control of SVR
velocity
vascular compliance

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Cardiac output
Influenced by:
Interaction of:

Influenced by: activity level, metabolic rate, stressors, age, body size
Interaction of: HR, preload, afterload, contractility

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Cardiac Reserve

ability to respond to body’s changing needs

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Cardiac Index

Takes into consideration height and weight

more specific indicator of circulation

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HR controlled by:

Sympathetic NS
Parasympathetic NS
Baroreceptors (pressure sensing) in response to BP

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Preload

Pressure created by incoming volume of ventricles at the end of diastole
influenced by venous return and compliance of ventricles
Starlings Law
Toomuch/Too little:
-overstretching increases preload
- decreased preload, stroke vol, and cardiac output

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Afterload

The amount of force needed to eject blood from the ventricles
Factors:
RV = PVR
LV = SVR

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Starlings Law

The greater the volume, the greater the force, the greater the fibers contract to accomplish emptying

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RCA- Right Coronary Artery

encircles the heart and descends toward apex of RV
supplies blood to: RA, RV, & inferior portion of LV

about 1/2 of pop, the RCA supplies blood to SA node
Nearly everyone, it supplies blood to AV node

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Left Coronary Artery

Divides into two branches:
Left anterior descending (LAD)
Left circumflex coronary artery (LCX)

Lt anterior descending artery

descends towards lt anterior wall and apex of LV
it supplies blood to portions of :
LV, 
Ventricular septum, 
chordae tendinae,
Papillary muscles
 and some to rt ventricle

Left Circumflex coronary artery (LCX)

descends towards the lateral wall of LV and apex
supplies blood to LA, lateral & posterior surfaces of LV
sometimes portions of the interventricular septum

about 1/2 of people - supplies blood to SA node

in a very small # of people- supplies to AV node

Diastole

Atrial contraction - causes ventricular filling
relaxation period is right before contraction

normally 2/3 of cardiac cycle

Systole

Ventricular contraction
pushing blood to lungs and system
atrial filling

S1 sound

Systole / Lub
sound of AV valves closing (mitral and tricuspid)
low pitches, longer than S2
Best heard @ PMI

S2 sound

Diastole / DUB
sound of Semilunar valves closing (aortic and pulmonic valves)
Higher pitched and shorter duration than S1
Best heard over aortic area

Contractility

ability of heart muscle to shorten and contract

Increased : increases cardiac output, decreases preload, will eventually overtax the heart
Decreased: Reduces forward flow of blood, increases preload, reduces cardiac output

Drugs:
Increase- Digoxin
Decrease- Beta-blockers, calcium channel blockers

Visual Clues to Low Output blood flow

Decreased BP
Decreased LOC
Decreased urinary output
Decreased bowel sounds

Symptoms of High output

Septic Fever increased HR high or low BP

Depolarization

Spread of electrical activity through cells

SA node & AV node | Function and BPM

SA node - normal pacemaker of heart 60-100 bpm AV nod slows pulse allowing blood to enter ventricles 40-60 bpm

Action potential

Exchange of Na, K, and Ca across the cell membrane that causes a positive state (depolarization)

Depolarization

Myocardial contraction

Repolarization

Myocardial relaxation

P wave QRS complex T wave

P- depolarization of the atria QRS- depolarization of the ventricles T wave- Repolarization of the ventricles

Assessing Chest Pain

``` Location character/quality Timing, onset, duration, frequency precipitating factors, setting intensity , severity 1-10 aggravating factors relieving factors associated symptoms ```

Troponin

a myocardial muscle protein released into bloodstream with injury to the myocardium Troponins T and I are specific Elevate in about 3-6 hrs after injury quicker than CK-MB, but not as specific, can have small rises without heart attack

Creatine Kinase (CK)

``` CK-MB Myocardial muscle Rises and falls during 3 days after injury, peaks in 12-24 hrs MOST SPECIFIC MARKER OF MI start seeing about 6 hrs after injury ```

Myoglobin

Found in myocardial and skeletal muscle, rapid decline after 7 hrs

Grading Murmurs

``` I - Barely heard II - Quietly heard III - Clearly heard IV - Loud V - Very loud VI - Loudest, heard without steth, thrill ```

Systolic vs Diastolic murmurs

Systolic Diastolic Pulmonic stenosis regurge Aortic stenosis regurge Tricuspid regurge stenosis Mitral regurge stenosis

Adrenergic

will stimulate the sympathetic nervous system

Systemic Vascular Resistance

(SVR) The dilated/restricted diameter of vessels normal SVR range = 800-1200 dimers the higher number is more restricted