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54/64 Unit 1 > Cardiac Structure And Function > Flashcards

Cardiac Structure And Function Flashcards

1
Q

Primary function of the heart

A

Generate pressure to drive blood flow to tissues

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2
Q

The sequence of events with each heartbeat including diastole and systole

A

Cardiac Cycle

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3
Q

The total blood flow per minute in the cardiovascular circuit

A

Cardiac Output (CO)

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4
Q

Cardiac output equation

A

CO = HR x SV

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5
Q

What are the four chambers of the heart?

A

R atrium, R ventricle, L atrium, L ventricle

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6
Q

The _____ side of the heart pumps blood to the lungs, while the _____ side of the heart pumps blood to the body

A

Right; left

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7
Q

Structures that travel away from the heart carrying oxygenated blood to the tissues

A

Arteries

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8
Q

Oxygen is transferred to tissues through

A

Diffusion

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9
Q

The movement of molecules from an area of high concentration to an area of lower concentration

A

Diffusion

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10
Q

Diffusion of water across a semipermeable membrane

A

Osmosis

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11
Q

Deoxygenated blood returns to the _____ system

A

Venous

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12
Q

Structures that travel towards the heart carrying deoxygenated blood

A

Veins

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13
Q

What are the three layers of the heart wall?

A

Epicardium, myocardium, endocardium

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14
Q

Visceral layer of the serous pericardium

A

Epicardium

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15
Q

The middle and most prominent layer of the heart wall composed of cardiac muscle

A

Myocardium

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16
Q

Why is the left side of the heart thicker than the right?

A

It pumps blood to the rest of the body, so it requires more muscle

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17
Q

Layer of the heart wall that lines the cardiac chambers

A

Endocardium

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18
Q

Structures that open and close valves

A

Papillary muscles

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19
Q

The papillary muscles are connected to the heart valves via the

A

Chordae tendineae

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20
Q

AV valves

A

Mitral and tricuspid

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21
Q

Semilunar valves

A

Pulmonary and aortic

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22
Q

Which valves close to make the S1 or “lub” sound?

A

Tricuspid and mitral

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23
Q

Which valves close to make the S2 or “dub” sound?

A

Aortic and pulmonic

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24
Q

Tips for listening to heart sounds

A

Concentrate, avoid auscultating through clothing or dressing, keep stethoscope tubing off body and other surfaces

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25
Q

S1 or “Lub” marks the beginning of

A

Systole (contraction)

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26
Q

S2 or “dub” marks the beginning of

A

Diastole (relaxation/filling)

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27
Q

Flow of blood through the heart

A

Superior and inferior vena cava, right atrium, tricuspid valve, right ventricle, pulmonic valve, pulmonary artery to lungs, pulmonary veins, left atrium, mitral valve, left ventricle, aortic valve, aorta, body

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28
Q

Which valve controls blood flow from the left atrium to the left ventricle?

A

Mitral (left AV valve)

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29
Q

Which valve controls blood flow from the right atrium to the right ventricle?

A

Tricuspid (Right AV valve)

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30
Q

Which valve controls blood flow from the right ventricle to the pulmonary artery and lungs?

A

Pulmonic valve

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31
Q

Which valve controls blood flow from the left ventricle to the aorta?

A

Aortic valve

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32
Q

Cardiac impulses pass from the atrium to the ventricles though the

A

Conduction pathway

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33
Q

Cardiac conduction pathway

A

SA node, AV node, bundle of his, left and right bundle branches, purkinje fibers

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34
Q

Spontaneous electrical activity generates

A

Regular rhythm of muscle contractions or heart rate

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35
Q

The heart’s pacemaker

A

Sinoatrial (SA) node

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36
Q

Typical rate of the SA node

A

60-100 bpm

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37
Q

Typical rate of the atrioventricular (AV) node

A

40-60 bpm

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38
Q

Function of AV node

A

Slows impulse conduction between atrium and ventricle, allowing atrium to fill ventricles with blood before ventricles contract

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39
Q

If SA and AV nodes fail, ventricles can generate their own impulse at a rate of

A

20-40 bpm

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40
Q

What shows electrical activity of the heart recorded by skin electrodes?

A

ECG

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41
Q

When the heart cells are resting or negatively charged on the inside, they are __________

A

Polarized

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42
Q

What causes contraction?

A

The movement of sodium inside cells due to increase permeability as a result of electrical changes.

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43
Q

After contraction, sodium moves back out of cells causing relaxation or __________

A

Repolarization

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44
Q

Concentration of ions inside and outside of cells

A

Primarily sodium (Na) outside, potassium (K) inside

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45
Q

What does a P-Wave represent?

A

Atrial depolarization

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46
Q

Normal duration of P-Wave

A

<0.8 seconds

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47
Q

PR interval is measured from

A

The beginning of P-Wave to the beginning of QRS

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48
Q

What does the PR interval represent?

A

The time the electrical impulse takes to travel from SA node through AV node, His-pukinje system, to activate ventricular myocardial cells

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49
Q

Normal duration of PR interval

A

120-200 ms OR 0.12-0.20 seconds

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50
Q

What does a longer PR interval indicate?

A

AV block (1st degree)

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51
Q

What does a shorter PR interval indicate?

A

The impulse is bypassing the AV node (ex: WPW syndrome)

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52
Q

PR interval is typically _____, but may be depressed in pericarditis

A

Flat

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53
Q

What does the QRS complex represent?

A

Ventricular depolarization

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54
Q

Normal duration of QRS complex

A

0.06-0.10 seconds

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55
Q

What does a longer QRS complex suggest?

A

Disruption of conduction system (BBB, ventricular rhythms), and metabolic issues such as hyperkalemia and TCA OD

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56
Q

The point at which QRS complex finished and ST segment begins

A

J point

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57
Q

Negative deflections of QRS complex

A

Q (1st), S

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58
Q

Positive deflection of QRS complex

A

R

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59
Q

What does the ST segment represent?

A

The period when ventricles remain depolarized

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60
Q

The ST segment is usually isoelectric, but may be depressed with

A

Ischemia, infarction, pericarditis

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61
Q

What does the T-Wave represent?

A

Ventricular repolarization

62
Q

T-Waves are generally

A

Upright

63
Q

Inverted T-Waves can be a sign of

A

ischemia, LVH, metabolic abnormalities

64
Q

Peaked T-Waves can be a sign of

A

Hyperkalemia or very early MI

65
Q

Normal duration of T-Wave

A

<160 ms

66
Q

Beginning of QRS complex to end of T-Wave

A

QT interval

67
Q

Normal duration of QT interval

A

<440 ms

68
Q

Prolonged QT interval is risk factor for

A

Ventricular arrhythmias and sudden death

69
Q

Causes of prolonged QT interval

A

Genetics or SE of certain medications

70
Q

What does a U-Wave represent?

A

Papillary mm repolarization

71
Q

What is happening during systole?

A

Ventricles contract, increasing BP in ventricles closes AV valves and opens pulmonic and aortic valves ejecting blood from ventricles into pulmonary artery and aorta

72
Q

What is happening during diastole?

A

Ventricles empty and relax, AV valves open and semilunar valves close, blood leaves atria and fills ventricles

73
Q

When pressure in ventricles exceeds pressure in atria, ___ valves close and _____ begins

A

M/T; systole

74
Q

When pressure in the ventricles decreased ___ valves close

A

A/P

75
Q

What causes valves to open?

A

Rising pressure

76
Q

Ventricular contraction (systole) accounts for ___ of the cardiac cycle

A

1/3

77
Q

Ventricular relaxation (diastole) accounts for ___ of the cardiac cycle

A

2/3

78
Q

How do you know when systole has occurred on a EKG?

A

Pulse is present

79
Q

What effect does rapid heart rate have on diastole?

A

Diastole is shortened inhibiting adequate ventricular filling and ejection

80
Q

The cardiac cycle is both electrical and mechanical. Which happens first?

A

Electrical

81
Q

Physical signs of cardiac cycle

A

Pulse, heart sounds, hemodynamic waveforms (correlated with EKG)

82
Q

5 step process for rhythm interpretation

A

Determine is rhythm is regular/irregular, determine rate, is there a P Wave for every QRS?, is the PR interval regular?, measure the QRS interval

83
Q

What does the width/appearance of QRS indicate?

A

Ventricular conduction

84
Q

Normal sinus rhythm

A

60-100 bpm

85
Q

HR less than 60 bpm originating from the sinus node

A

Sinus bradycardia

86
Q

Characteristics of sinus bradycardia

A

Regular rhythm, P wave for each QRS, regular PR interval

87
Q

HR greater than 100 bpm originating from the SA node

A

Sinus tachycardia

88
Q

Characteristics of sinus tachycardia

A

Normal conduction/activity just faster at a rate between 100-180 bpm, P Wave for each QRS, regular PR interval

89
Q

Causes of sinus tachycardia

A

Fever/infection, stress, exercise, fear/anxiety, drugs, pain, anemia, low BP

90
Q

Sinus tachycardia treatment

A

Treat the cause

91
Q

Disorganized, uncoordinated twitching of atria muscles caused by rapid production of atrial impulses

A

Atrial fibrillation

92
Q

Characteristics of atrial fibrillation

A

Irregular rate (rapid/uncontrolled or slower/controlled), non-identifiable P-Wave, immeasurable PR interval, irregular baseline (“irregularly irregular”), no A/V synchrony (atrial and ventricle contraction), narrow QRS

93
Q

Causes of atrial fibrillation

A

Atherosclerosis, HF, congenital heart disease, COPD, hypo/hyperthyroidism

94
Q

Atrial fibrillation S/S

A

May be asymptomatic, palpitations, dyspnea, pulmonary edema, dizziness

95
Q

Atrial fibrillation management

A

Decrease ventricular rate <100, eliminate/treat cause, may try to convert to NSR, anticoagulation may be necessary

96
Q

The patient’s perception that they are having trouble breathing

A

Dyspnea

97
Q

Atrial fibrillation increases the risk for

A

Stroke

98
Q

Loss of AV synchrony results in decreased

A

Ventricular filling

99
Q

Abnormal rhythm that occurs in the atria in which atrial rhythm is regular, but fast

A

Atrial flutter

100
Q

Characteristics of atrial flutter

A

Sawtooth appearance, atrial rate 250-400 bpm, uniform QRS but irregular in rate (more Ps than QRS), no AV synchrony

101
Q

Causes of atrial flutter

A

HR, tricuspid or mitral valve disease, PE, inferior MI, carditis, dig. Toxicity

102
Q

Management for unstable atrial flutter with rate >150 bpm

A

Synchronized cardioversion

103
Q

Management for stable atrial flutter

A

Drug therapy such as CCB & BB (for rate control) and anticoagulants (due to pooling of blood in atria)

104
Q

Conduction defects within the AV junction that impair conduction of atrial impulses to ventricular pathways

A

AV blocks

105
Q

Types of AV blocks

A

1st degree, 2nd degree (type I and II), 3rd degree

106
Q

Rhythms that originate above the AV junction usually have a __________ QRS. Those that originate below are usually _________.

A

Narrow; wide

107
Q

Characteristics of 1st degree AV blocks

A

Regular, rate usually 60-100 bpm, regular but prolonged PR interval (>0.2 sec), asymptomatic

108
Q

Causes of 1st degree AV block

A

Inferior wall MI or ischemia, hyper/hypokalemia, digoxin toxicity, hypoxemia, some medications

109
Q

1st degree AV block management

A

Correction of underlying cause, atropine if symptomatic bradycardia develops

110
Q

Medications that inhibit AV node conduction

A

BB, CCB, digoxin, amiodarone

111
Q

Characteristics of 2nd Degree AV block Type I/Mobitz I

A

Regular atrial rhythm, irregular ventricular rhythm, PR interval progressively lengthens with each cycle until QRS is dropped for a cycle

112
Q

Causes of 2nd degree AV block Type I/Mobitz I

A

Inferior wall MI, cardiac surgery, vagal stimulation, myocarditis, medications

113
Q

S/S of 2nd degree AV Block Type I/Mobitz I AND Type II/Mobitz II

A

Asymptomatic, weakness, irregular pulse, vertigo

114
Q

2nd degree AV Block Type I/Mobitz I management

A

Treat underlying cause, atropine or temporary pacemaker if symptomatic, discontinue digoxin if appropriate

115
Q

Characteristics of 2nd degree AV block Type II/Mobitz II

A

Regular atrial rhythm, regular or irregular ventricular rhythm (depending on degree), constant PR interval, QRS periodically absent or disappears

116
Q

Causes of 2nd degree AV block Type II/Mobitz II

A

Severe CAD, MI, idiopathic fibrosis, cardiac surgery, infections/inflammation, hyperkalemia, autoimmune disease

117
Q

2nd degree Type II/Mobitz II management

A

Transvenous or transcutaneous pacemaker, atropine, epinephrine, and dopamine if needed

118
Q

Why is a pacemaker needed for 2nd degree AV block Type II/Mobitz II?

A

This rhythm can, and frequently does, progress to a third degree heart block (due to structural damage to conduction system of heart)

119
Q

Characteristics of 3rd degree heart block

A

Regular atrial rhythm, regular ventricular rhythm slower than atrial rate, no relation between P waves and QRS (usually more P waves), no constant PR interval, QRS normal or wide/bizzare

120
Q

Cause of 3rd degree heart block

A

Hypoxia, MI, dig. Toxicity, congenital abnormality, rheumatic fever

121
Q

S/S of 3rd degree heart block

A

Hypotension, angina, HF

122
Q

3rd degree heart block management

A

Atropine, epinephrine, dopamine for bradycardia, pacemaker

123
Q

Characteristics of junctional rhythm

A

Originates from AV node —> narrow QRS, absent P Wave, retrograde, behind QRS, or with short PR interval, loss of AV synchrony

124
Q

Typical junctional escape rhythm

A

40-60 bpm

125
Q

Junctional bradycardia

A

<40 bpm

126
Q

Junctional tachycardia

A

> 100 bpm

127
Q

Accelerated junctional rhythm

A

60-100 bpm

128
Q

Junctional rhythm S/S

A

Asymptomatic, dizziness, dyspnea, syncope, fatigue

129
Q

Junctional rhythm management

A

Treat cause if possible, medications, may require permanent pacemaker

130
Q

Causes of junctional rhythm

A

Chest trauma, sick sinus syndrome, myocarditis, radiation therapy, medications, hypothyroidism, sleep apnea, increased ICP, neuromuscular disorders

131
Q

Medications that can cause junctional rhythm

A

BB, CCB, digoxin, opioids, clonidine, adenosine, lithium, amitriptyline

132
Q

Any rhythm faster than 100 bpm with 3 or more irregular beats in a row that originates distal to the bundle of his

A

Ventricular tachycardia

133
Q

General characteristics of ventricular tachycardia

A

Fast rate, loss of atrial contraction resulting in incomplete ventricular filling, can be with or without pulse; responsible for most of the sudden cardiac deaths in US

134
Q

Characteristics of short periods of ventricular tachycardia

A

Asymptomatic, can cause dizziness, CP, palpitations, hypotension, or other s/s of poor perfusion

135
Q

Characteristics of longer periods of ventricular tachycardia

A

Dangerous, can lead to cardiac arrest and death

136
Q

Causes of ventricular tachycardia

A

CAD, valve abnormalities, cardiomyopathy, electrolyte imbalance, MI, medications

137
Q

Ventricular tachycardia WITH pulse management

A

Medications or synchronized cardioversion

138
Q

Ventricular tachycardia WITHOUT a pulse management

A

IMMEDIATE defibrillation

139
Q

Disordered electrical activity causing ventricles to quiver instead of contracting normally resulting in the inability of ventricles to pump blood forward

A

Ventricular fibrillation

140
Q

Characteristics of ventricular fibrillation

A

Chaotically irregular pattern, initially course (easier to convert), becomes finer, fatal within minutes without treatment

141
Q

Causes of ventricular fibrillation

A

CAD/ischemia, MI, scarring, cardiomyopathy, drug toxicity, electrical injury, heart surgery, extreme hypo/hyperkalemia,

142
Q

Ventricular fibrillation S/S

A

Loss of consciousness, no pulse/respiration

143
Q

Ventricular fibrillation management

A

Immediate defibrillation, followed by anti-arrhythmic medications. Survivors will likely require placement of implantable cardioverter-defibrillator (ICD)

144
Q

Common dysrhythmia occurring in patient with/without heart disease caused by an ectopic cardiac pacemaker in the ventricle

A

Premature ventricular contractions (PVCs)

145
Q

Characteristics of premature ventricular contractions (PVCs)

A

Premature and bizzarely shaped QRS complexes that are unusually long and appear wide on ECG, not preceded by P Wave; most often asymptomatic

146
Q

Causes of premature ventricular contractions (PVCs)

A

Hypoxia, ischemia, myocarditis, CM, meds/illicit substances, electrolyte abnormalities

147
Q

Premature ventricular contractions (PVCs) treatment

A

Treat causes, may require medication

148
Q

Contractions of the atria that are triggered by atrial myocardium, but do not originate from SA nodes

A

Premature atrial contractions

149
Q

Characteristics of premature atrial contractions

A

Typically have normal QRS, commonly idiopathic, often discovered incidentally

150
Q

Causes of premature atrial contractions

A

CAD, CM, valvular heart disease, medications, CHF, MI, COPD

151
Q

Premature atrial contractions S/S

A

Often asymptomatic, may experience SOB, anxiety, palpitations

54/64 Unit 1 (9 decks)

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