cardiopulm Flashcards
which intercostal muscles elevate the ribs?
external intercostals
which accessory muscles help with exhalation?
TA and rectus abdominis
how many lobes does each lung have?
3 on R, 2 on L
layers of the heart from inside to out
endocardium (lining), myocardium (muscle), epicardium
what are the two structural categories of myocardial cells? and function
mechanical: for pumping
conductive: self-excitation and transmission of AP
RA receives blood from the
body, through inferior and superior vena cava, and coronary sinus
which valve separates the RA and RV?
tricuspid valve
LA receives blood from the
lungs
which valve separates the LA and LV?
mitral valve
normal pressure in the heart by location
RA: 0-8
RV: 15-20/0-8
LA: 4-12
LV: 90-140/4-12
left ventricle is about ___ times thicker than the RV
left ventricle 7x thicker
conduction system of the heart
SA node AV node bundle of his R and L bundle branches purkinje fibers
two main branches of the left coronary artery and what they supply
Left anterior descending: anterior wall of LV
left circumflex: LA and lateral/post wall of the LV
what does the Right coronary Artery supply?
RA, RV, and inferior wall of LV
each molecule of hemoglobin can bind ___ molecules of oxygen
4
increased PaO2 leads to _____ hemoglobin binding of oxygen
increased (like in the lungs)
about 100 mmHg –> 80-100% binding
what is albumin (plasma protein) important for?
fluid movement, keeping fluid inside the vessels
the ____ is the pacemaker of the heart
the SA node
what happens if the LAD artery is blocked?
no blood pumped out of the heart to the body
if a valve of the heart is stiff, what does it do to CO?
it decreases it
what does systole mean?
contraction
EF=
SV/EDV
what is the norm for EF?
55-70%
what is the best predictor of cardiac function?
ejection fraction
normal CO
4-6 L/min
cardiac index use and norm
clinical indicator of pump performance, accounts for body size
norm: 3L/min/m^2
what intrinsic factor affects stroke volume?
myocardial cell length
what does the frank-starling mechanism tell us?
if the heart muscle can stretch a lot –> the force will be higher
preload
clinical concept, effect of myocardial stretch prior to contraction (EDV)
afterload
resistance the heart has to overcome to eject the blood
if afterload is too high, what happens?
you get hypertrophy of the ventricle
three main cerebral arteries
anterior, middle, and posterior cerebral arteries
VO2 is a measure of…
the amount of oxygen actually utilized by tissues
how many METs is walking?
2
how many METs should a patient be able to tolerate before going home?
3-4
abnormal HR responses to exercise
rapid increase
decrease in HR
no change in HR
development of arrhythmias
abnormal response of systolic BP during exercise
above 200
falls more than 20 most alarming
abnormal diastolic BP response to exercise
decrease more then 10
increase more than 10
exertion hypotension
decrease in SBP below baseline towards end of exercise test or increase and then falls 20
need to change intensity or duration
requires medical follow-up
rate-pressure product definition and use
HR x SBP
good for its with heart disease as indicator of cardiac function
want it to go down
normal SpO2
95-100%
stop exercise if below 90% in acutely ill and 85% in chronic lung disease
hypoxemia levels
mild: 90-95%
mod: 80-90
severe: 70-80
atherosclerosis
low-grade inflammatory state of the inner layer of medium sized arteries, accelerated by high BP, high cholesterol, smoking, diabetes, genetics
angina
pain in chest, dyspnea, tightness, pressure in L arm, jaw, back
silent ischemia
ischemia without angina
___% occlusion provokes symptoms for myocardial ischemia
70
stable angina
more than 50% occlusion
exertion
resolves with rest or nitrates
less than 10 minutes
unstable angina
more than 7-% occlusion
rest/meds do not resolve, more than 10 min
acute coronary syndrome: may lead to MI
prinzmental/variant angina
vasospastic disorder, spontaneous, common at night, more common in females, small increase in troponins
clinical signs of myocardial ischemia for women
fatigue, back pain, SOB
myocardial infarction
from prolonged myocardial ischemia, sudden onset of chest pain can radiate to arms, neck, throat, back
zones for MI
infarction: dead
hypoxic injury: less seriously damaged
ischemia: reversible zone
gold standard for finding coronary blockage
coronary angiography
uncomplicated MI is a small infarction with an EF of ____% or better
40%
complicated MI has an EF of ____ % or lower for moderate risk
30%
acute coronary syndrome defines
unstable angina or acute MI (NSTEMI or STEMI)
ACS, when do you see increased enzymes?
NSTEMI and STEMI (way more)
difference between STEMI and NSTEMI, which is worse
STEMI you see ST elevation, in NSTEMI it actually goes down
STEMI is worse complete occlusion for 2-4 hours
sudden cardiac death
death within 1 hour of symptoms for pts. w/ coronary heart disease
Vtach or Vfib
abdominal aorta aneurisms are more likely to be ____ the renal arteries
BELOW
AAA can cause numbness in the LE T/F
true,
can also cause decreased distal pulses
systolic heart failure
less blood pumped out of ventricles, can’t squeeze well
diastolic heart failure
less blood fills the ventricles, stiff heart can’t relax normally
Left sided backward failure
pulmonary edema, hypoxemia, dry cough, orthopnea, SOB at night, crackles
Right sided backward failure
jugular venous distension, ascites, nausea, vomiting, LE edema
forward failure
cold extremities, pale, clammy
NYHA heart failure classification
1: normal
2: comfy at rest, slight limitation of PA, ordinary activity causes symptoms
3: comfy at rest, marked limitation of PA, less than ordinary cause symptoms
4: severe limitation, symptoms present at rest
compensated HF
HF, but controlled on meds, not symptomatic at resst
decompensated HF
may be on meds, but not controlled, symptomatic at rest
classifications of cardiomyopathies
dilated
hypertrophic
restrictive (restricts filling)
valvular heart disease types
stenosis –> doesn’t open
insuffiiciency –> leakage back into heart
acute myocarditis
inflammation of myocardial walls from infection
pericardial effusion –>
cardiac tamponade: elevated intracardiac pressure, decreased filling, decreased SV
EMERGENCY
Which type of HF leads to HFpEF (preserved ejection fraction)
diastolic because less filling and less pumping
hypertension
elevated: 120-29/less than 80
stage 1: 130-39/80-89
stage 2: 140+/90+
hypertensive crisis: 180+/120+
obstructive diseases cause
difficulty exhaling
restrictive diseases cause
difficulty inhaling
conditions that make up COPD
emphysema, chronic bronchitis, asthma
what causes COPD
long-term exposure to particles and gasses
genetics
emphysema
destruction of terminal bronchioles, alveolar ducts, and walls resulting in enlarged air spaces
chronic bronchitis
productive cough for 3 months 2 years in a row
bronchiectasis
dilation of 1 or more bronchi w/ chronic inflammation and infection (cough w/ sputum or blood, chronic lung infection, dyspnea and tiredness)
cor pulmonale
right sided HF
response to alveolar hypoxia is vasoconstriction (pulmonary HTN)
cystic fibrosis
mucus stasis affecting epithelial cells
asthma
chronic inflammatory disorder –> hypertrophy of bronchial wall
symptoms of asthma
wheezing, SOB, chest tightness
signs of restrictive lung disease
increased RR hypoxemia decreased lung volume cyanosis clubbing decreased chest wall expansion wasting
idiopathic pulmonary fibrosis
scarring and destruction of lung architecture, unknown cause, older adults, lethal
sarcoidosis
alveoli’s, round or oval granulomas, pulmonary fibrosis
young adults
can affect many organ systems
infectious causes of restrictive lung disease
pneumonia (inflammation of parenchyma)
empyema (pus in pleural space)
pneumothorax
presence of air in the pleural cavity
atelectasis
incomplete expansion results in lung parenchyma collapse
acute respiratory distress syndrome (ARDS)
inflammatory disease leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated tissue
what does increased BUN mean
heart or renal failure
what does decreased BUN mean
dehydration, liver
blood sugar norms
70-100
normal blood pH
7.35-7.45
normal PaCO2
35-45
normal HCO3
22-26
5 lead EKG neumonic
snow over grass
smoke over fire
chocolate on the stomach
what is gold standard measurement of HR?
EKG
needs to be regular heart rhythm
normal size of QRS waves?
less than 3 small squares
normal size of P-R interval
3-5 small squares, 0.2 seconds
SA node spontaneously depolarizes at ____-____ bpm
60-100 bpm
ectopic focus
an area within the myocardium that can spontaneously depolarize
PAC
premature atrial contractions
can be isolated, bigeminal, trigeminal, paired
causes and treatment for PAC
causes: emotional stress, nicotine, caffeine, alcohol, hypoxemia, benign arrhythmias
traeatment: none needed if frequency is low
atrial flutter
one ectopic focus firing repeatedly and rapidly, AV node can’t keep up
on EKG: multiple P waves to every QRS complex
difference of atrial flutter vs. fibrillation on EKG
flutter the P waves look consistent
fibrillation you see “chaos” because of multiple ectopic foci
atrial fibrillation
multiple ectopic foci, all firing at random
no real P waves, weird T waves
how should new a-fib be treated immediately?
anticoagulation because there is an increased risk for embolism
junctional rhythms
SA node is silent, so AV takes over, no P wave
AV node rate is 40-60 bpm
only concerned for PT if HR is too low
premature ventricular contraction
ectopic focus in ventricle
most commonly due to MI (more worried), more likely to cause decreased SV
ventricular tachycardia
more than three PVCs in a row faster than 100 bpm
NO EXERCISE, CALL FOR HELP
defibrillation
ventricular fibrillation
Vtach can become Vfib
no organization of EKG waveform
CALL CODE AND START CPR
heart blocks
problem with initiation or flow of depolarization through the conduction system
which type of heart block requires a pacemaker?
3rd degree because the AV and SA are acting separately
which surgical approach is used for bilateral lung transplant?
anterolateral thoracotomy
atelectasis:
collapsed lung, can be from anesthesia
what is likely to happen if there is afib?
embolism, happens in a lot of bypass patients
how soon after acute coronary syndrome should treatment be performed?
90 minutes
Three types of percutaneous coronary interventions
angioplasty: balloon
atherectomy: removing the clot
stenting
why bypass graft instead of PCI?
more than 3 vessels are obstructed
pacemaker placement precautions
no lifting of 10 lbs, no raising UE on side above shoulder
leading causes of death for heart transplant
- infection
2. rejection
what does an A line do and what is an important clinical note
it monitors BP, the monitor needs to be at heart level to be accurate
normal RR in adults
12-20 bpm
normal breath sounds
vesicular: periphery, low pitch
bronchial: sternum, high pitched
bronchovesicular: between scapulae, blowing sound
cardiac auscultation
All PTs Move A: aortic P: pulmonic T: tricuspid M: mitral
normal heart sounds
S1 and S2
S3 heart sound
kentucky
normal in kids, athletes, and pregnant women
S4 heart sound
Tennessee late diastole (right before S1)
precautions for postural drainage
pulmonary edema hemoptysis massive obesity large pleural effusion massive ascites
relative contraindications for postural drainage
increased intracranial pressure hemodynamically unstable recent esophageal anastomosis recent spinal fusion or injury recent head trauma diaphragmatic hernia recent eye surgery
how do drugs reduce BP
diuretics: decrease blood volume
beta blockers: decrease cardiac stimulation
alpha blockers: decrease vasoconstriction
ACE inhibitors: decrease angiotensin 1 –> 2
angiotensin 2 receptor blockers: dont let it bind
ca channel blockers: weakened smooth muscle contraction
vasodilators: act directly on smooth muscle or vascular endothelium
which drugs help with hyperlipidemia
statins
what are nitrates used for?
to help vasodilation in the coronary arteries, to improve O2 delivery
what does digitalis do?
increases strength of heart contraction, used for HF, causes slow HR
normal INR
0.8-1.2 (bleeding risk: 3.6+)
normal prothrombin time
11-13 seconds
normal partial thromboplastin time (PTT)
21-34 seconds, spontaneous bleeding is 70+
expectorants
increase secretion of thin, watery sputum in the upper respiratory tract, so you can cough it up
methylxanthines
found in coffee, causes bronchodilator and increased force of diaphragm
why does pregnancy cause decreased BP
elevated NO production –> vasodilation
relaxin –> reduced peripheral resistance
preeclampsia
increased Bp 140+/90+
