cardiopulm midterm (first half) Flashcards by Victoria Caridi

what is the cardiac cycle

the period b/w the start of one heartbeat and the beginning of the next

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what does the cardiac cycle include

diastole (filling phase)

systole (pressure development and ejection phase)

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how many seconds is impulse delayed going from SA to AV node

0.1 s

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what does the delay b/w SA and AV node allow the heart to do

allows the atria to contract and pump an additional volume of blood into the ventricles

atrial kick

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atrial kick

the last 20% of blood ejected into the ventricle

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what does atrial kick result in

right and left ventricle end diastolic pressure

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depolarization

contraction (systole)

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repolarization

relaxation (diastole)

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at rest approx ____% of ventricular filling occurs before the _____ contracts

80%

atria

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isovolumetric contraction

phase in systole where aortic pressure remains high

aortic valve remains closed

ventricles does not empty despite contraction

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amount of blood remaining in each ventricle at the end of ventricular ejection phase is normally about

35%

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when ventricular pressure exceeds aortic pressure

aortic valve opening

ventricular ejection begins

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blood is fully ejected from the ventricles after systole

false

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how much blood is ejected from the ventricles after a contraction –> normal heart

65%

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end systolic volume

amount of blood remaining after ejection

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end diastolic volume

amount of blood in the ventricles just prior to systole

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EDV is directly proportional to _______, when?

force of contraction

during ventricular systole

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purpose of the EDV

stretch the wall to optimal range

to have a good ejection fraction

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normal ejection fraction of the heart

65%

100% of blood comes in, 65% goes out

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in normal ejection fraction, how much blood remains in the heart

35%

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cardiac output

volume of blood ejected by the ventricle in 1 min

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CO =

HR x SV

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stroke volume

volume ejected from each ventricle w/ one systolic contraction

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preload

amount of tension in the ventricles before they contract

described by EDV

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what occurs when there is an increased preload and a decreased preload

CHF = increased preload ventricular hypertrophy = decreased preload

what is preload directly proportional to

venous return

afterload

the load or pressure against which the ventricle pumps

what is inversely related to afterload

factors that increase the hearts contractility

positive inotropic effects

what drug has a positive ionotropic effect

digitalis (+)

what drug has a negative ionotropic

propranolol (-)

how is ejection fraction calculated

SV/EDV

an ejection fraction lower than 35% results in

serious CHF the heart fails to pump out enough blood --> increases preload

what is considered a significantly abnormal ejection fraction

<20%

5 topographic areas of auscultation

aortic area pulmonic area erb's point tricuspid area mitral area (PMI)

aortic area location

2nd intercostal space on the right closest to the sternum

pulmonic area location

2nd intercostal space on the left of the sternum

erb's point location

3rd intercostal space on the left at sternal border

tricuspid area location

4th-5th intercostal space on the left at sternal border

mitral area is also called

PMI

mitral area location

5th intercostal space on the left at the midclavicular line

which heart sounds signal the onset of ventricular systole

what is S1

closure of the mitral and tricuspid valves when ventricular pressure exceeds atrial pressure

what heart sounds are considered abnormal

S3 and S4

the sound of the mitral and tricuspid valve closing

S1 heart sound LUB

in which area is S1 heard best

apex/mitral area

a loud S1 sound is produced by

mitral stenosis short diastolic filling time

the sound of aortic and pulmonary valve closure

S2 heart sound (DUB)

where is the S2 heart sound heard best

base of heart pulmonic area

what are the 2 heart sounds that S2 is broken down into

A2P2 A2= aortic closure P2 = pulmonic closure

when is splitting of A2P2 heart sounds increased

during inspiration d/t increased venous return

splitting of A2P2 occurs at the end of expiration

false A2P2 occurs simultaneously (no split during expiration)

when is splitting of S2 considered abnormal

stays split for entire respiratory cycle

what does the ventricular gallop represent (S3)

altered state of ventricular compliance produced by tightening of papillary muscles at end of rapid diastolic filling blood hits the wall and causes an S3 heart sound

in which popular is S3 normal heart sound

children less than 5 world class athletes under 30 pregnant women in 3rd trimester

where is S3 & S4 heart sounds heard loudest

apex in the LLD position

S3 heart sound is specific too

left sided heart failure

S4 is initiated by

atrial kick

order of heart sounds

S4, S1, S2, S3

presence of all 4 heart sounds

summation gallop

heart murmurs are typically caused by

abnormal, turbulent blood flow w/in the heart from dz of heart valves and structures

3 types of heart murmurs

systolic diastolic continuous

what heart sound do you hear systolic murmur

heard b/w S1&S2 swish sound lub-psh-dub

what heart sound do you hear diastolic murmur

heard immediately after S2 b/w S2 and S1 lub-dub-pa

what heart sound do you hear continuous murmur

continuous murmur throughout systole and diastole

systolic murmur causes

aortic/pulmonic stenosis MVP mitral/tricuspid regurgitation

diastolic murmur causes

aortic/pulmonic regurgitation mitral stenosis

3 shapes of murmurs

crescendo decrescendo cresecendo-decrescendo

crescendo murmur

worst usually systolic and requires repair increases in volume

decrescendo murmur

decreased in volume

crescendo-decrescendo

usually aortic valve murmur gets louder then lower

where is a aortic stenosis (mid systolic) murmur heard

aortic area

where does an aortic stenosis murmur typically radiate to

to neck contraindication for PT

where is an aortic regurgitation (early systolic) murmur heard

erbs point at end of expiration while leaned forward in sitting position

what could an aortic regurgitation murmur occur from

leads to left sided CHF contraindication for PT

what is chest wall pain syndrome induced by

intermittent stabbing pain induced by movement

what is chest wall pain syndrome aggravated by

deep inspiration

if you press on the chest and the sxs get worse, this is considered angina pain

false considered chest wall pain

which class according to heart failure NY health associated classification system cannot be treated by PTs

class 4

class 4 --> unable to get PT

unable to carry out any physical activity w/o discomfort sxs of cardiac insufficiency at rest w/o any PA, discomfort is increased

some causes of left ventricular failure

intrinsic heart dz increased workload on the heart cardiac arrythmias

consequences of right ventricular failure

increased right ventricular EDV jugular venous distention

jugular venous distention

external jugular veins 3-5 cm above the angle of louis

primary sign for systolic heart failure

EF (SV/EDV) < 50%

tx for systolic heart failure

want to decrease afterload ADD

ADD

ace inhibitors diuretics digoxin

tx for diastolic heart failure

ADD ace inhibitors diuretics decrease salt intake --> (<2g per day)

what makes digitals/digoxin unique

only frug that decreases HR but increases force of contraction

what drug makes diastolic heart failure worse

digoxin

what is diastolic heart failure associated w/

hypertrophic cardiomyopathy decreased SV and EDV

angina pectoris (Stable angina) is the classical sxs of

myocardial ischemia

ischemia threshold

aka angina threshold HR at which pt gets chest pain

target HR for a pt w/ angina pectoris should exercise at

10 beats below the ischemic threshold

a pt w/ chest pain at rest (unstable angina) is suitable for PT

false chest pain at rest is a contraindication

ischemic cardiac pain that occurs at rest is

prinzmetal's angina

most common type of cardiomyopathy

dilated cardiomyopathy

chronic rheumatic fever may lead to

mitral valve/aortic dz

class signs of a MI for a female

emotional pain stomach pan and lethargy

class signs of a MI for a male

physical exertion typical cardiac signs levine sign (clutching chest)

which type of MI is only the inner surface of heart infarcted

subendothelial MI non q-wave

which type of MI requires an aggressive PT approach

full thickness MI Q wave