Cardiac PreLecture

Question 1

Cardiac disease is the leading cause of ______ in the US

Answer 1

Mortality

Question 2

Base is located at the ____ of the heart and the apex is located at the _____ of the heart

Answer 2

The base is located at the top of the heart and the apex is at the bottom of the

Question 3

At the apex it has a characteristic thrust called the ____ __ _____ at the __ intercostal space ______.

Answer 3

At the apex it has a characteristic thrust called the point of maximal impulse (PMI) at the 5th intercostal space mid clavicular line

Question 4

Name the 4 cardiac valves and their purpose

Answer 4

Tricuspid Pulmonic Mitral Aortic Toilet Paper My Ass To control blood flow

Question 5

What does the Pericardial sac do

Answer 5

Protects the heart

Question 6

Which valves have Chordae tendineae

Answer 6

The Mitral and Tricuspid

Question 7

Three layers of the heart

Answer 7

Endocardium Myocardium (Thickest L > R) Pericardium

Question 8

Explain the circulatory system from the right-sided chambers to the left-sided chambers

Answer 8

Circulatory System Right-sided heart chambers pump deoxygenated (venous) blood through the lungs. Left-sided heart chambers pump oxygenated blood through the systemic circulation.

Question 9

Definition of cardiac cycle

Answer 9

Interval from one heartbeat to the next is cardiac cycle

Question 10

What causes the first sound of the heart (LUB, S1)

Answer 10

Closure of the AV valves (tricuspid and mitral valves)

Question 11

What causes the second heart sound (DUB, S2)

Answer 11

Closure of the semilunar valves (pulmonic and aortic valves)

Question 12

Each heartbeat is composed of

Answer 12

Each heartbeat is composed of a period of ventricular contraction (systole) followed by a period of relaxation (diastole)

Question 13

Systole

Answer 13

LUB - Pushing the blood through the body

Question 14

Diastole

Answer 14

DUB - Filling of the chambers

Question 15

Stroke Volume

Answer 15

Amount of blood ejected with each contraction of the ventricle SV=EDV-ESV ex. EDV 120ml

Question 16

End Diastolic Volume

Answer 16

Volume of blood in the ventricle prior to ejection (fill volume 120ml)

Question 17

End Systolic Volume

Answer 17

Amount of blood that remains in the ventricle after ejection (small volume 50ml)

Question 18

Ejection Fraction

Answer 18

SV/EDJ; Normal is 60-80%

Question 19

Cardiac Output

Answer 19

How much blood is pumped out of the heart each minute Normal 5-6L/min CO = SV x HR (SV 50 HR 100 = 5000 or 5L)

Question 20

How does HR affect Cardiac Output

Answer 20

Increase in HR or volume = increased CO Decrease in HR or volume = decreased CO *A change in one will cause the other to compensate (up to a point)

Question 21

What does the coronary arteries supply and where are they located

Answer 21

The heart muscle. Right and Left coronary artery opening are located at the base of the aortic root immediately after the aortic valve

Question 22

Review the Left Main coronary artery

Answer 22

Left main coronary artery separates into the Left Anterior Descending and the Circumflex (Widow Maker)

Question 23

Where in the heart does the Left Anterior Descending LAD supply

Answer 23

LAD supplies the: Septal Anterior Apical Areas

Question 24

Where in the heart does the Circumflex supply

Answer 24

Circumflex supplies the: Lateral and Posterior Left Ventricles

Question 25

What does the Right Coronary Artery supply

Answer 25

The RCA supplies the right atrium/ventricle and posterior left ventricle

Question 26

Widow Maker

Answer 26

Widow Maker is caused from a blockage before the separation into the LAD/Circumflex

Question 27

**Coronary Artery Perfusion**

Answer 27

Question 28

## Footnote **Cardiac Anatomy**

Answer 28

Question 29

Rate of rhythmic discharge is determined by

Answer 29

Rate of rhythmic discharge is determined by the relative influx of sodium and calcium vs the efflux of potassium How much Na and Ca is going in vs K leaving

Question 30

What is the pacemaker of the heart

Answer 30

Pacemaker of the heart is the SA node SA node has the fastest rate of spontaneous depolarization

Question 31

Action Potiental

Answer 31

Starts at the pacemaker site and spreads throughout the myocardium, electrical current is transmitted to the body surface

Question 32

Electrical impulse

Answer 32

Shortens cardiac muscle fibers and causes contraction

Question 33

P wave

Answer 33

atrial depolarization contraction

Question 34

QRS complex

Answer 34

ventricular depolarization contraction

Question 35

T wave

Answer 35

ventricular repolarization recovery

Question 36

U wave

Answer 36

happens in slow heart rate and low potassium

Question 37

Normal excitation pathway of the heart

Answer 37

Normal excitation pathway of the heart * SA node-provides atrial “kick” * Atrial internodal pathways * AV node * Bundle of His * Ventricular bundle branches * Purkinje fibers

Question 38

Electrical Conduction

Answer 38

Question 39

ELECTRICAL COMPLEX

Answer 39

Question 40

Geriatric Consideration with the Cardiac System

Answer 40

Geriatric Considerations * Decrease in myocytes * Decrease in heart contractibility * Fibrotic changes in the cardiac valves * Less responsiveness of the SA node * Decrease stroke volume (SV) and cardiac output (CO)

Question 41

5 types of Pleural Effusion

Answer 41

* Transudates * low protein (ratio \<0.5) * severe heart failure * increased hydrostatic or decreased oncotic pressure * Exudates * high protein (\>0.5 mg/dL) * increased permeability of pleural membrane * impaired lymphatic drainage * Causes malignancies, infections, pulmonary embolism, sarcoidosis, MI syndrome, pancreatic disease * Empyema caused by infection in the pleural space * High protein exudative effusion * Hemothorax * Presence of blood in pleural space * Result of chest trauma * Contains blood and pleural fluid: hemorrhagic * Chylothorax or lymphatic * Exudative process that develops from trauma (milky white)

Question 42

Pneumothorax Classification Primary Pneumothorax Secondary Pneumothorax Traumatic Pneumothorax

Answer 42

Primary Pneumothorax * Spontaneous rupture of small blebs in apical lung fields with deep inhalation or change in atmospheric pressure * Air enters the lung space, lung collapses * Tall, thin men 20-40 yo * Cigarette smoking increases risk Secondary Pneumothorax * Happens from complications from preexisting diseases TB, pneumonia or Cystic Fibrosis can develop into tension pneumothorax Traumatic Pneumothorax * Traumatic origin * Results from penetrating (open) or nonpenetrating (closed) injury or may also be iatrogenic causes

Question 43

Pneumothorax Pathogenesis

Answer 43

Tension pneumothorax: lung on ipsilateral (same) side collapses and forces mediastinum toward the contralateral (opposite) side Decreases venous return and cardiac output

Question 44

Pneumothorax Clinical Manifestations

Answer 44

Small pneumothoraces (\<20%) not detectable on exam Sudden chest pain on the affected side Hyperresonance sounds on percussion of the affected side (drum like) **Tension and large spontaneous pneumothorax are emergencies** **Tracheal shift to contralateral (opposite) side -** **severe tachycardia - hypotension - hyper resonance** **subcutaneous emphysema**

Question 45

Diagnosis Pneumothorax

Answer 45

Chest x-ray Expiratory films show better demarcation of pleural line than inspiratory Depression of hemidiaphragm on side of pneumothorax Decreased PaO2 acute respiratory alkalosis

Question 46

Acute Respiratory Distress Syndrome

Answer 46

* Sudden failure of the respiratory system * Massive alveolar-capillary membrane injury * Acute lung inflammation * Conditions precipitating ARDS * Hypotensive shock, burns, smoke inhalation * Transfusion-related acute lung injury

Question 47

ARDS Clinical manifestations

Answer 47

* Sudden or slow development * Early signs: tachypnea, dyspnea, and tachycardia * Course crackles in lung sounds * Sx of multiple organ dysfx syndrome