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Critical Care > Cardiac System > Flashcards

Cardiac System Flashcards

1
Q

Name the 3 component of the CV system

A

heart, blood vessels, blood

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2
Q

Name the chambers of the heart

A

right atrium, right ventricle, left atrium, left ventricle

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3
Q

What are the heart valves

A

aortic valve, mitral valve, pulmonic valve, tricuspid valve

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4
Q

Coronary circulation

A

aorta (main supplier to the body) branches off into two main coronary blood vessels (also called the arteries). these coronary artereries branch off into smaller artereies, which supply oxygen rich blood into the entire heart muscle,the right coronary artery supplies blood mainly to the right side of the heart. The right side is smaller because it only pumps to the lungs. The left cornonary artery (which branches off into the left anterior descending artery and circumflex artery) supplies blood to the left side of the heart. The left side is larger and more muscular because it pumps to the rest of the body

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5
Q

3 Physiologic characteristics of cardiac tissue

A
  • The heart beats powerfully and continuously throughout an entire lifetime without any rest, so cardiac muscle has evolved to have incredibly high contractile strength and endurance
  • At the ends of each cell is a region of overlapping, finger-like extensions of the cell membrane known as intercalated disks. The intercalated disks form tight junctions between the cells so that they cannot separate under the strain of pumping blood and so that electrochemical signals can be passed quickly from cells to cell.
  • Another feature that is unique to cardiac muscle tissue is autorhythmicity. Cardiac muscle tissue is able to set its own contraction rhythm due to the presence of pacemaker cells that stimulate the other cardiac muscle cells.
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6
Q

CV blood flow throughout the body

A

deoxygenated blood from the body returns to the heart via the superior and inferior vena cava—empties into the RA–through the tricuspid valve–into the RV–through the pulmonic valve–into the pulmonary artery–lungs through pulmonary circulation, contracting alveoli, and exchanging gasses–to the pulmonary vein—into the LA—through the mitral valve—into the LV—through the aortic valve—into the aorta—then to the capillary beds throughout the whole body for gas exchange

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7
Q

What is the normal pacemaker of the heart

A

the SA node is the normal pacemaker that initiates each heart beat

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8
Q

What is CO

A

Cardiac Output= SVxHR. It is the total volume of blood pumped through the heart in 1 minute. Normal CO is 4-7 L/min

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9
Q

relationship between pressure, flow, and resistance

A

pressure=flow x resistance
pressure is force exerted on the liquid (mmHg)
flow is the amount of fluid moved over time (L/min or mL/min)
resistance is a measure of the ease with which the fluid flows through the lumen of a vessel

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10
Q

Define hemodynamics…what happens with instability

A

Hemodynamics is the study of blood movement; when this movement is compromised you get hemodynamic instability. If left untreated, it will cause multi-organ failure and death.

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11
Q

Signs and symptoms related to decreased cardiac output

A

Reduced blood pressure, Weakness, Fatigue,Exercise intolerance, ECG changes, Abnormal heart rhythm, Rapid breathing, Abnormal arterial blood gases, Edema
Weight gain, Dizziness, Reduced urine output ,Fainting, Restlessness,Anxiety,Cold clammy skin,Reduced peripheral pulse,Altered mental status,Chest pain,Confusion

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12
Q

what is preload

A

the volume of blood stretching the left ventricle at the end of diastole. Preload is determined by the total circulating blood volume and is increased by an increased by an increase in venous return to the heart.

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13
Q

what is afterload

A

the force against which the heart has to pump to eject blood from the left ventricle. Factors and conditions that would impede blood flow increase the left ventricle afterload

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14
Q

what is contractility

A

the inherent ability of the myocardium to alter the contractile force and velocity. Sympathetic stimulation increase myocardial contractility, so SV increases. Conditions that decrease myocardial contractility reduce SV.

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15
Q

what is systole

A

the phase of contraction of the heart, especially of the ventricles, during which blood is pushed to the aorta and pulmonary artery

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16
Q

what is diastole

A

the phase of the cardiac cycle in which the heart relaxes between contractions. Represents the period of time when the two ventricles are dilated by blood flowing to them.

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17
Q

what is depolarization

A

an electrical cell generates and electrical impulse, this electrical impulse causes the ions to cross the cell membrane and causes the action potential

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18
Q

what is repolarization

A

return of ions to their previous resting state, which corresponds to relaxation of the myocardial muscle

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19
Q

What are the 5 basic properties of cardiac muscle

A

Contractility, rhythmicity, conductivity, automatacity, excitability

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20
Q

normal heart sound

A

S1 is heard as the AV close and is heard loudest at the apex. S2 is heard loudest as the semilunar valves close and is heard loudest at the base

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21
Q

abnormal heart sounds

A

S3 may be heard if ventricular wall compliance is decreased and structures in the ventricular wall vibrate. Can occur in heart failure or valvular regurgitation may be normal in an individual younger than 40.
S4 may be heard on atrial systole if resistance to ventricular filling is present; abnormal finding! Causes include cardiac hypertrophy disease, or injury to the ventricular wall

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22
Q

what are baroreceptors

A

specialized nerve endings affected by changes in arterial BP located in walls of the aortic arch and carotid sinuses

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23
Q

location of aortic area on assessment

A

second ICS, right sternal border

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24
Q

location of pulmonic area on assessment

A

second ICS, left sternal border

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25
Q

location of Erbs point on assessment

A

3rd ICS, left sternal border

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26
Q

location of Tricuspid area on assessment

A

4th of 5th ICS left sternal border

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27
Q

location of mitral area or apex on assessment

A

5th ICS left MCL

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28
Q

what heart sound occurs with ventricular systole

A

S1 (lubb)

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29
Q

what heart sound occurs with ventricular diastole

A

S2 (dubb)

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30
Q

is s1 or s2 softer at the base

A

s1

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31
Q

is s1 or s2 louder at the apex

A

s1

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32
Q

is a physiological split normal or abnormal

A

it is a normal variation

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33
Q

what is a physiological split

A

it is related to the respiratory cycle. Split occurs at the height of inspiration. Heard best with the diaphragm at the pulmonic area

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34
Q

is s3 heard best with diaphragm or bell

A

bell

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35
Q

what is s3 a sign of

A

heart failure..heard in some pts with heart block or increased venous return

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36
Q

is s4 heard best with diaphragm or bell

A

bell

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37
Q

when do you often hear s4? why is it heard?

A

often occurs after a MI. a forceful atrial contraction is what causes you to hear it

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38
Q

normal potassium range

A

3.5-5.5 mEq/L

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39
Q

normal sodium range

A

135-145 mEq/L

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40
Q

normal magnesium range

A

1.5-2.5 mEq/L

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41
Q

normal calcium range

A

9-11 mg/dL

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42
Q

normal cholesterol

A

less than 200 mg/dl

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43
Q

normal triglycerides

A

40-190 mg/dl

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44
Q

normal LDL

A

if no CAD or less than 2 risk factors less than 160 mg/dl. If CAD then

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45
Q

normal HDL

A

greater than 35 mg/dl

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46
Q

normal PT

A

11-16 sec 1.5-2.5 x normal

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47
Q

normal INR

A
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48
Q

normal PTT

A

60-70 sec 1.5-2.5 x normal

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49
Q

normal APTT

A

30-40 seconds 1.5-2.5 x normal

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50
Q

BP=

A

BP=flow x vessel resistance

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51
Q

what are high pulse pressures associated with

A

arterial damage and ventricular stress

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52
Q

what is MAP a good estimator of

A

overall organ perfusion

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53
Q

MAP=

A

MAP= systolic BP + 2 x diastolic BP/ 3

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54
Q

normal CO

A

4-8 L/min

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55
Q

normal SV

A

60-100 ml/concentration

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56
Q

normal ejection fraction

A

60-70%

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57
Q

CI=

A

CI= CO/body surface area

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58
Q

increased blood viscosity ______ blood flow

A

decreased

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59
Q

What are chemoreceptors sensitive to

A

Changes in the partial pressure of arterial oxygen, the partial pressure of carbon dioxide, and the ph blood levels

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60
Q

What is S1 caused by

A

The closing of the tricuspid and mitral valves

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61
Q

What is S2 caused by

A

Closure of the pulmonic and aortic valves

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62
Q

What is a TEE

A

Transesophageal echocardiography. Provides ultrasonic imaging of the heart from a view behind the heart. Inserted into the posterior pharynx and advanced into the esophagus

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63
Q

Nursing care after a cardiac catheterization and angiography

A

Bed rest, extremity used for catheter immobile, observe insertion site for bleeding or hematoma, assess for bruits, HOB no higher than 30 degrees, monitor peripheral pulses, color, and sensation distal to insertion site, monitor intake and output, observe for adverse reaction to dye, assess for chest pain, back pain, sob and notify provider

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64
Q

4 key electrolytes

A

Sodium, magnesium, calcium, potassium

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65
Q

What is Creatine Kinase

A

A enzyme that increases 2-5 hours after the onset of myocardial muscle damage. Peak levels occur 18-36 hours and levels return to baseline in 3-6 days.

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66
Q

Troponin I and T

A

Serum troponin levels are useful in the early diagnosis of AMI. Levels are normally undetectable in healthy people and elevate as early as 1 hours after myocardial cell injury. Normal value for Troponin I is less than 0.5 mcg/L and troponin T is less than 0.1 mcg/L

67
Q

Myoglobin

A

Serum myoglobin is released writhing 30-60 minutes after AMI. Normal values are less than 72 mg/ml in men and less than 58 ng/ml in females

68
Q

When does stable angina occur

A

Occurs on exertion and is relived by rest

69
Q

Unstable angina

A

Pain often more severe, occurs at rest, and requires more nitrate therapy

70
Q

What are the most common medications for Angina

A

Nitrates they are direct acting smooth muscle relaxants that cause vasodilation of the peripheral or systemic vascular bed

71
Q

How are AMI classified

A

Acute myocardial infarctions are classified as STEMI or NSTEMI. STEMI usually occurs because plaque rupture leading to complete occlusion of the artery. NSTEMI usually results from a partially occluded coronary vessel.

72
Q

Who is more likely to have atypical signs of a AMI

A

Women the signs are fatigue, diaphoresis, indigestion, arm or shoulder pain, N/V

73
Q

What is one common treatment for STEMI

A

Thrombolytic therapy

74
Q

What is the one risk factor for CAD that you want to change first in people

A

Smoking

75
Q

What is the main action of nitrates

A

Smooth muscle relaxant they vasodilate and decrease oxygen demand

76
Q

What is the action of beta blockers

A

They decrease oxygen demand on the heart by lowering Bp and slowing heart rate

77
Q

What is the main action of calcium channel blockers

A

Inhibit the flow of calcium which increases coronary blood flow and increase myocardial perfusion

78
Q

What is the action of ASA

A

Platelet aggregate makes platelets slippery and might decrease clotting

79
Q

When should you get a new supply of NTG

A

Every 6 months because they lose potency

80
Q

When should you not give NTG

A

Is MAP drops below 60 or systolic Bp drops below 90

81
Q

What is going on with a AMI

A

Imbalance between myocardial oxygen supply and demand, from decreased coronary artery perfusion

82
Q

If there is prolonged ischemia greater than ___ hours in a AMI then some of the myocardial cells die

A

3 hours

83
Q

Skin during a AMI

A

Cool, clammy, pale, diaphoretic

84
Q

What is MONA

A

Used for MI. Morphine, oxygen, NTG, aspirin

85
Q

Why is morphine given for MI

A

Pain control, decrease anxiety, smooth muscle relaxant decreases preload and after load

86
Q

aspirin given for MI

A

Try to give patient 2-4 baby aspirin have pt chew them so they have rapid onset through the buccal route

87
Q

When are thrombolytics used with MI

A

Must be symptomatic for less than 6 hours with chest pain greater than 20 minutes unrelieved by nitro and with ST segment elevation

88
Q

Administration guidelines for NTG

A

Check BP- hold if systolic less than 100
If using spray do not shake; spray under tongue
If using tablets check expiration date and protect from light

89
Q

Innermost layer of artery

A

Intima

90
Q

When do coronary arteries full

A

During diastole

91
Q

When are thrombolytics given for a AMI

A

Patient must be symptomatic for less than 6 hours and chest pain greater than 20 minutes unrelieved by nitro with ST segment elevation. Also have no contraindications to thrombolytics

92
Q

What do ace inhibitors do

A

Decrease SVR

93
Q

What does dopamine do

A

Stimulates adrenergic receptors. Treatment of low CO

94
Q

What does dobutamine do

A

Sympathomimetic. Direct action inotropic agent that enhances myocardial contractility, SV, CO, renal blood flow and UO

95
Q

What are treatments for CAD and AMI

A

PTCA (percutaneous transvenous coronary angioplasty) and stents

96
Q

A Patient just got a stent and needs a MRI . Can you schedule it?

A

NO! cannot have MRI for 4-6 weeks after stent placement

97
Q

What does automaticity mean

A

The cells can generate a stimulus or action potential without outside stimulation

98
Q

What is the primary function of myocardial cells

A

Mechanical - primary property is contractility

99
Q

What is the primary function of pacemaker cells

A

Electrical- primary property is automaticity/conductivity

100
Q

What may be performed to slow the heart rate

A

Vagal maneuver

101
Q

What detect changes in BP

A

Baroreceptors

102
Q

What is atrial kick

A

Amount of blood pumped into the ventricles as a result of atrial contraction; contributes approx 30% of total cardiac output

103
Q

What do chemoreceptors detect

A

Changes in ph, O2, and CO2 levels in the blood

104
Q

When does filling of coronary arteries happen

A

Diastole

105
Q

Diastole is ____ as long as systole

A

Twice

106
Q

What is the charge of myocardial cell at rest

A

-90 mv

107
Q

Does systole or depolarization happen first?

A

Depolarization

108
Q

Does repolarization or diastole happen first?

A

Repolarization

109
Q

Does a ECG provide information about the mechanical function of the heart?

A

NO!

110
Q

What is a normal PR interval

A

0.12-0.20 seconds

111
Q

What is blood flow affected by

A

Blood vessel changes(veins change most), turbulence, heart rate and contractility changes, renin/angiotensin/aldosterone cascade

112
Q

What does JVP estimate

A

Intravascular volume (indirect measurement of CVP or RA volume)

113
Q

What could a elevated JVP mean

A

Fluid overload, HF, R ventricular dysfunction

114
Q

Normal lactate levels

A

0.5-1.6 mEq.L

115
Q

What do lactate levels give us information about

A

Tissue perfusion

116
Q

Who is pulmonary artery pressure monitoring done on

A

Sick of the sickest. High risk but does have benefits

117
Q

How many mlHg are needed to cancel out atmospheric pressure

A

300mLhg

118
Q

RA pressure=__________

A

CVP pressure

119
Q

Where is the phlebostatic axis

A

4th ICS midaxilary line

120
Q

What is the phlebostatic axis an approximate measurement of?

A

Right atrium

121
Q

Normal value for right arterial pressure

A

2-6 mmHg

122
Q

When do you read right arterial pressure

A

At the end of expiration because intrathoracic pressure we only want to read the pressure in the chamber

123
Q

What does pulmonary artery pressure monitoring reflect

A

Left ventricular function

124
Q

What is a normal systolic/diastolic and mean for pulmonary artery pressure monitoring

A

Systolic-25 mmHg
Diastolic- 10mmHg
Mean-15 mmHg

125
Q

What is the Dicrotic notch

A

Happens when the aortic valve is closing

126
Q

What is diastolic filling time determined by

A

Heart rate

127
Q

What is a normal SvO2

A

60-75%

128
Q

What is a normal ScvO2

A

65-85%

129
Q

What are the sites for arterial pressure monitoring

A

Radial , brachial, femoral

130
Q

Myocardial cell at REST

A

-90 mc

131
Q

What does the P wave represent

A

Atrial depolarization

132
Q

Normal PR interval

A

0.12-0.20 seconds

133
Q

Normal QRS complex

A

0.06-0.12 seconds

134
Q

What does QRS complex show

A

Ventricular depolarization

135
Q

The ST segment is usually _______

A

Isoelectric

136
Q

What does the T wave show

A

Ventricular repolarization

137
Q

What could change the shape of a T wave

A

Electrolyte imbalance

138
Q

Where is atrial repolarization

A

Hidden in QRS complex

139
Q

One big box =

A

0.20 seconds

140
Q

One little box =

A

0.04 seconds

141
Q

How do you find heart rate on a 6 second strip

A

of R x 10

142
Q

What does a PR Interval grater than 0.20 seconds mean

A

Conduction delay or AV block

143
Q

Why is morphine administered to a patient with a MI

A

It decreases myocardial oxygen demand. Will also decrease pain and anxiety while causing sedation but those are not the primary reasons

144
Q

What complication is indicated by S3

A

Ventricular dilation. Rapid filling of the ventricles causes vasodilation

145
Q

What is the most common complication of a MI

A

Arrhythmias

146
Q

In which type of cardiomyopathy does cardiac output remain the same

A

Hypertrophic

147
Q

What class of drug is the most widely used treatment of cardiomyopathy

A

Beta blockers because they improve myocardial filling and cardiac output which decrease heart rate and contractility

148
Q

What does the pulmonary Avery pressure monitoring reflect

A

Left ventricular function

149
Q

What are treatments of sinus Bradycardia

A

Atropine 0.5-1 mg or synchronized cardioversion (only given if patient is symptomatic!)

150
Q

What is a PAC

A

Premature atrial contraction-site within the atria fires before the sa mode impulses is due to fire

151
Q

What do you see in a PAC

A

Early p wave that is a different contour from previous and a noncompensatory pause because the sa mode is trying to reset itself

152
Q

Is a PAC an entire rhythm?

A

No it’s a single beat

153
Q

Rate for a fib

A

400-600 Bpm

154
Q

What drug is used for rhythm control with a fib

A

Cardizem

155
Q

What drugs can be used for rate control of a fib

A

Beta blockers, digoxin, ca channel blockers

156
Q

What is used for persistent a fib

A

Amiodarone

157
Q

Rate of a flutter

A

250-300 Bpm SAW TOOTH

158
Q

Where does a SVT happen

A

Above the Bundle of his

159
Q

When is cardioversion used

A

Unstable a-fib, a flutter, and sometimes v tach

160
Q

What wave is shocked with cardioversion

A

Synchronized delivery on R wave

161
Q

How many joules for cardioversion

A

50

162
Q

If the PR interval is greater than 0.20 what is it

A

Av block

163
Q

If the QRS is greater than 0.12 what is it

A

Bundle branch block

164
Q

When is atropine used

A

Symptomatic bradycardia

Critical Care (4 decks)

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