Cardiology Flashcards
cardiovascular disease (CVD)
disease affecting the heart, peripheral blood vessels or both
where is the heart located in the chest?
in the centre of the chest in the mediastinum
endocardium
the innermost layer that lines the chambers
myocardium
the middle layer with its unique ability to generate and conduct electrical impulses causing the heart to contract
pericardium
the protective sac surrounding the heart
what do valves control?
the flow of blood through the heart
where is the aortic valve located
between the left ventricle and aorta
where is the pulmonary valve located
between the right ventricle and the pulmonary artery
what does the right atrium receive
deoxygenated blood from the body via the superior and inferior vena cava
what does the right atrium send
deoxygenated blood to the lungs via the pulmonary artery
oxygenated blood is returned from…
lungs to the left atrium via the pulmonary veins
the left ventricle pumps …
oxygenated blood to the body via the aorta
oxygenated blood is pumped from …
the heart to the tissues via the arteries
deoxygenated blood is transported from the tissues back..
to the heart via the veins
what do the capillaries connect?
arteries and veins
where do the exchange of oxygen and carbon dioxide with the body tissues take place?
through the very thin capillary walls
what does the left coronary artery supply?
left ventricle, interventricular septum, part of the right ventricle, and the conduction system.
what does the right coronary artery supply?
a portion of the right atrium and right ventricle and part of the conduction system.
diastole
the relaxation phase that takes place at the end of a cardiac contraction
systole
the contraction phase
stroke volume depends on three things
preload, cardiac contractility and afterload
bipolar leads
ECG leads applied to the arms and legs that contain two electrodes of opposite ( + and - ) polarity; leads i, ii, iii
einthoven’s triangle
the triangle around the heart formed by the bipolar leads
augmented leads
another term for unipolar leads, reflecting the fact that the ground lead is disconnected which increases the amplitude of deflection on the ECG tracing
unipolar leads
ECG leads applied to the arms and legs, consisting of one polarized (+) electrode and a nonpolarized reference point that is created by the ECG machine combining two additional electrodes; also called augmented limb leads; leads a aVR, aVL, and aVF
precordial leads
ECG leads applied to the chest in a pattern that permits a view of the horizontal plane of the heart; leads V1, V2, V3, V4, V5, and V6
Normal interval durations
P-R = 0.12 - 0.20 sec QRS = 0.08 - 0.12 sec QT = 0.33 - 0.42 sec
refractory period
the period of time when myocardial cells have not yet completely repolarized and cannot stimulate again
absolute refractory period
the period of the cardiac cycle when stimulation will not produce any depolarization whatever
relative refractory period
the period of the cardiac cycle when a sufficiently strong stimulus may produce depolarization
coupling interval
distance between the preceding beat and the PVC
bundle of kent
an accessory AV conduction pathway that is thought to be responsible for the ECG findings of pre-excitation syndrome
Angina Pectoris
chest pain that results when the blood supply’s oxygen demands exceed the hearts
prinzmetal’s angina
variant of angina pectoris caused by vasospasm of the coronary arteries, not blockage per se; also called vasospastic angina or atypical angina
Assessing a patient with Angina
- chief complaint - sudden onset of chest discomfort
- the pain may radiate or be localized to the chest
- patient usually denies chest pain, as they have had the pain before.
- usually last 3-5 minutes but sometimes as long as 15 minutes
- relieved with rest/nitroglycerin
- MOST common ECG finding is S-T depression.
management for angina
- place patient in comfortable position
- administer high flow oxygen
- establish an IV but without delayed transport
- can give ASA or a spray of nitro
myocardial infarction
death and subsequent necrosis of the heart muscle caused by inadequate blood supply; also acute myocardial infarction. often associated with atherosclerotic heart disease
transmural infarction
myocardial infarction that affects the full thickness of the myocardium and almost always results in a pathological Q wave in the affected leads
subendocardial infarction
myocardial infarction that affects only the deeper levels of the myocardium; also called non-Q-wave infarction because it typically does not result in a significant Q wave in the affected lead
assessing a patient with a MI
- breathing may be laboured or not
- look for evidence of shock
- take blood pressure; usually elevates during the episode and normalizes later
- Chief complaint is CHEST PAIN
- chest discomfort usually lasts longer than 30 minutes
- pain can radiate to the arms (primarily the left), the neck and posterior to the back or down to epigastric region of the abdomen
- often confirm of an acute onset of nausea and vomiting
- pallor and diaphoresis
managing a patient with an MI
- administer high-flow oxygen
- establish at least 1 IV
- administer medication as protocol
heart failure
clinical syndrome in which the heart’s mechanical performance is compromised so that cardiac output cannot meet the body’s needs.
left ventricular failure
occurs when the left ventricle fails as an effective forward pump, causing back pressure of blood into the pulmonary circulation, which often results in pulmonary edema. the left ventricle cannot eject all of the blood that the right heart delivers to it via the lungs. left atrial pressure rises and is subsequently transmitted to the pulmonary veins and capillaries. when pulmonary pressure becomes to high, it forces the blood plasma in the alveoli resulting in pulmonary edema. progressive fluid accumulation in the alveoli decreases the lungs’ oxygenation capacity and can cause death from hypoxia.
right ventricular failure
the right ventricular fails as an effective forward pump, resulting in back pressure of blood into the systemic venous circulation and venous congestion. the MOST common cause of right ventricular failure is LEFT ventricular failure. pulmonary hypertension and cor pulmonale result from the effects of COPD. These problems are related to increased pressure in the pulmonary arteries, which results in right ventricular enlargement, right atrial enlargement, and if untreated, right heart failure.
Pulmonary embolism
blood clot in one of the pulmonary arteries
congestive heart failure
condition in which the heart’s reduced stroke volume causes an overload of fluid in the body’s other tissues
what is the most common symptom of CHF
laboured breathing
assessing a CHF patient
history of patient will usually consist of SOB and PND
laboured breathing
usually in the tripod position
if the patient sleeps with A LOT of pillows, the problem is worse.
managing CHF
dont let the patient lie flat
administer high flow oxygen
connect ECG
administer nitro if meets ALS requirements
cardiac tamponade
accumulation of excess fluid inside the pericardium
what is the chief complaint in a patient who is suffering from a cardiac tamponade
chest pain or dyspnea
hypertensive emergency
an acute elevation of blood pressure that requires the blood pressure to be lowered within on hour; characterized by end-organ changes, such as hypertensive encephalopathy, renal failure, or blindness
hypertensive encephalopathy
a cerebral disorder of hypertension indicated by severe headache, nausea, vomiting, and altered mental status. neurological symptoms may include blindness, muscle twitches, inability to speak, weakness and paralysis.
what would systolic be in a hypertensive emergency?
usually anything >130mmHg
what are some symptoms that come with hypertensive emergencies?
restlessness confusion blurred vision nausea vomiting
what are some symptoms that come with hypertensive encephalopathy?
severe headache vomiting visual disturbances paralysis seizures stupor coma
can you give nitro if BP contraindict’s the conditions in the ALS even after you correct the BP issue?
No, you can correct BP but once a contraindication is fixed you would need to patch and ask.
cardiogenic shock
the inability of the heart to meet the metabolic needs of the body, resulting in inadequate tissue perfusion. it is the MOST SEVERE for of pump failure.
when does cardiogenic shock usually occur?
usually happens after extensive myocardial infarction
what is the body doing in cardiogenic shock
the body tries to compensate either by increasing the contractile force, by improving preload, by reducing the peripheral resistance or by all three.
sudden death
death within one hour after the onset of symptoms
down time
duration from the beginning of the cardiac arrest until effective CPR is established
total down time
duration from the beginning of the cardiac arrest until the patients delivery to the emergency department
resuscitation
provision of efforts to return a spontaneous pulse and breathing
return of spontaneous circulation (ROSC)
resuscitation results in the patient’s having a spontaneous pulse
Atherosclerosis
a progressive degenerative disease of the medium-sized and large arteries
what does atherosclerosis affect?
aorta and its branches, the coronary arteries and the cerebral arteries among others.
arteriosclerosis
a thickening, loss of elasticity, and hardening of the walls of the arteries from calcium deposits.
claudication
severe pain in the calf muscle due to inadequate blood supply. it typically occurs with exertion and subsides with rest
aneurysm
the ballooning of an arterial wall, resulting from a defect or weakness in the wall
dissecting aortic aneurysm
aneurysm caused when blood gets between and separates the layers of the aortic wall
cystic medial necrosis
death or degeneration of a part of the wall of an artery
acute pulmonary embolism
blockage that occurs when a blood clot or other particle lodges in a pulmonary artery
acute arterial occlusion
the sudden occlusion of arterial blood flow
Signs and Symptoms of Abdominal Aortic Aneursym
abdominal pain
back and flank pain
hypotension
urge to defecate, caused by the retroperitoneal leakage of blood
signs and symptoms of acute pulmonary embolism
sudden onset of severe and unexplained dyspnea that may or may not be associated with chest pain.
MAY have a recent history of immobilization from a hip fracture, surgery or other debilitating illness
vasculitis
inflammation of blood vessels
peripheral arterial atherosclerotic disease
a progressive degenerative disease of the medium-sized and large arteries
deep venous thrombosis
a blood clot in a vein
varicose veins
dilated superficial veins, usually in the lower extremity
what are the 5 P’s of acute arterial occlusion
pallor pain pulselessness paralysis parethesia
signs/symptoms of peripheral arterial atherosclerotic disease
extremity usually appears normal, but pulses will be reduces or absent. as ischemia worsens the extremity becomes painful, cold, numb, ulceration, gangrene and necrosis. there will be no edema
signs/symptoms of deep venous thrombosis
gentle palpation of the thigh and calf may reveal tenderness.
discomfort behind the knee
the skin may be warm and red
signs/symptoms of varicose veins
usually lower extremities
