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Advanced Pathophysiology > Cardiac PreLecture > Flashcards

Cardiac PreLecture Flashcards

1
Q

Cardiac disease is the leading cause of ______ in the US

A

Mortality

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2
Q

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

A

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

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3
Q

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

A

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

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4
Q

Name the 4 cardiac valves and their purpose

A

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

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5
Q

What does the Pericardial sac do

A

Protects the heart

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6
Q

Which valves have Chordae tendineae

A

The Mitral and Tricuspid

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7
Q

Three layers of the heart

A

Endocardium Myocardium (Thickest L > R) Pericardium

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8
Q

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

A

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

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9
Q

Definition of cardiac cycle

A

Interval from one heartbeat to the next is cardiac cycle

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10
Q

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

A

Closure of the AV valves (tricuspid and mitral valves)

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11
Q

What causes the second heart sound (DUB, S2)

A

Closure of the semilunar valves (pulmonic and aortic valves)

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12
Q

Each heartbeat is composed of

A

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

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13
Q

Systole

A

LUB - Pushing the blood through the body

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14
Q

Diastole

A

DUB - Filling of the chambers

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15
Q

Stroke Volume

A

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

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16
Q

End Diastolic Volume

A

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

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17
Q

End Systolic Volume

A

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

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18
Q

Ejection Fraction

A

SV/EDJ; Normal is 60-80%

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19
Q

Cardiac Output

A

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)

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20
Q

How does HR affect Cardiac Output

A

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)

21
Q

What does the coronary arteries supply and where are they located

A

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

22
Q

Review the Left Main coronary artery

A

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

23
Q

Where in the heart does the Left Anterior Descending LAD supply

A

LAD supplies the: Septal Anterior Apical Areas

24
Q

Where in the heart does the Circumflex supply

A

Circumflex supplies the: Lateral and Posterior Left Ventricles

25
Q

What does the Right Coronary Artery supply

A

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

26
Q

Widow Maker

A

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

27
Q

Coronary Artery Perfusion

A
28
Q

Cardiac Anatomy

A
29
Q

Rate of rhythmic discharge is determined by

A

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

30
Q

What is the pacemaker of the heart

A

Pacemaker of the heart is the SA node

SA node has the fastest rate of spontaneous depolarization

31
Q

Action Potiental

A

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

32
Q

Electrical impulse

A

Shortens cardiac muscle fibers and causes contraction

33
Q

P wave

A

atrial depolarization

contraction

34
Q

QRS complex

A

ventricular depolarization

contraction

35
Q

T wave

A

ventricular repolarization

recovery

36
Q

U wave

A

happens in slow heart rate and low potassium

37
Q

Normal excitation pathway of the heart

A

Normal excitation pathway of the heart

  • SA node-provides atrial “kick”
  • Atrial internodal pathways
  • AV node
  • Bundle of His
  • Ventricular bundle branches
  • Purkinje fibers
38
Q

Electrical Conduction

A
39
Q

ELECTRICAL COMPLEX

A
40
Q

Geriatric Consideration with the Cardiac System

A

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)
41
Q

5 types of Pleural Effusion

A
  • 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)
42
Q

Pneumothorax

Classification

Primary Pneumothorax

Secondary Pneumothorax

Traumatic Pneumothorax

A

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
43
Q

Pneumothorax

Pathogenesis

A

Tension pneumothorax: lung on ipsilateral (same) side collapses and forces mediastinum toward the contralateral (opposite) side

Decreases venous return and cardiac output

44
Q

Pneumothorax

Clinical Manifestations

A

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

45
Q

Diagnosis

Pneumothorax

A

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

46
Q

Acute Respiratory Distress Syndrome

A
  • 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
47
Q

ARDS

Clinical manifestations

A
  • Sudden or slow development
  • Early signs: tachypnea, dyspnea, and tachycardia
  • Course crackles in lung sounds
  • Sx of multiple organ dysfx syndrome
48
Q
A

Advanced Pathophysiology (8 decks)

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