Cardiopulmonary review Flashcards
network of progressively smaller vessels that carry oxygenated blood to the myocardium
coronary arteries
valve between Right atria and Right ventricle
tricuspid
valve between Left atria and Left ventricle
mitral (bicuspid)
valve between Left ventricle and aorta
aortic
valve between Right ventricle and pulmonary artery
pulmonary valve
vein that returns blood from lower body and viscera to Right atrium
inferior vena cava
veins that carry oxygenated blood from Right and Left lungs to Left atrium
pulmonary veins
vein that returns venous blood from head, neck, arms to Right atrium
superior vena cava
arteries that carry deoxygenated blood from Right ventricle to Left and Right lungs
pulmonary arteries
lowest part of heart formed by inferolateral part of Left ventricle; at level of 5th intercostal space
apex
upper border of heart involving Left atrium, part of Right atrium, parts of great vessels; at level of 2nd intercostal space
base
thick contractile middle layer of muscle cells; forms bulk of heart wall
myocardium
double-walled connective tissue sac that surrounds outside of heart and great vessels
pericardium
body’ largest artery; arch, thoracic, abdominal
aorta
valve function
maintain unidirectional blood flow
normal pacemaker of heart
SA node
innervation to heart
vagus (parasympathetic), sympathetic nerves
sympathetic effects on heart
Name the neurotransmitters
increased rate, increased force of contraction
epinephrine and norepinephrine
parasympathetic influence on heart (via vagus nerve)
Name the neurotransmitter
slow HR-through influence on SA node
acetylcholine
closure of mitral and tricuspid valves
S1 (lub)
closure of aortic and pulmonary valves (dub)
S2
normal in healthy young children; abnormal in adults (may be associated with heart failure)
AKA?
S3
ventricular gallop
4th heart sound: may be associated with HTN, stenosis, hypertensive heart disease or MI
AKA?
S4
atrial gallop
at least 140 mmHg SBP OR at least 90 mmHg DBP
Stage 2 hypertension
130-139 mmHg SBP OR at least 80-89 mmHg DBP
Stage 1 hypertension
120-129 mmHg SBP AND <80 mmHg DBP
elevated BP
<120 mmHg SBP AND <80 mm Hg DBP
Normal BP
greater than 180 mmHg SBP and/or greater than 120 mmHg DBP
Hypertensive crisis
refers to tension in ventricular wall at end of diastole; reflects venous filling pressure that fills left ventricle during diastole
preload
refers to forces that impede flow of blood out of heart- primarily the pressure in the peripheral vasculature, compliance of the aorta, and mass and viscosity of blood
afterload
atrial systole
contraction of right and left atria pushing blood into ventricles
atrial diastole
period between atrial contractions when atria are repolarizing
ventricular systole
contraction of right and left ventricles pushing blood into pulmonary arteries and aorta
ventricular diastole
period between ventricular contractions when ventricles are repolarizing
stroke volume
refers to volume of blood ejected by each contraction of left ventricle; normal ranges from 60-80 ml–depends on age, sex, activity
cardiac output
amount of blood pumped from left or right ventricle per minute; equal to product of stroke volume and heart rate.
normal CO for adult male at rest=4.5-5.0 L/min (your text has slightly wider range), women slightly less
Can increase to 25 L/min during exercise
amount of blood that returns to Right atrium per minute
CV is closed loop, so this amount returning must equal CO when averaged over time
venous return
reflexes by which BP is maintained; these detect changes in pressure
baroreceptor
forced expiration against a closed glottis; sets off reflexes
Valsalva
moderate, bothersome angina
2 on anginal pain scale
most severe or intense chest pain ever experienced
4 on angina scale
mild, barely noticeable chest pain
1 on angina pain scale
moderately severe, very uncomfortable chest pain
3 on angina pain scale
normal pH range
7.3-7.45 (7.4)
indications for arterial blood gas assessment
evaluate acid-base status (pH), ventilation PaCO2), oxygenation of arterial blood (SaO2)
adult normal range for SaO2
95-98%
low level of O2 in arterial blood (PaO2<80mmHg)
hypoxemia
low level of O2 in tissue despite adequate perfusion of tissue
hypoxia
elevated level of CO2 in arterial blood (PaCO2>45mmHg)
hypercapnia
low level of CO2 in arterial blood (PaCO2<35mmHg)
hypocapnia
normal level of CO2 in arterial blood (PaCO2 35-45 mmHg)
eucapnia
normal hemoglobin in adult males
13.3-16.2 gm/dL
normal hemoglobin in adult females
12.0-15.8 gm/dL
desirable total serum cholesterol (mg/dL)
<200
HDL (“good” cholesterol–helps carry away “bad” cholesterol)
high-density lipoprotein
LDL (“bad” cholesterol–associated with buildup of fatty plaques within arteries which reduce blood flow)
low-density lipoprotein
percentage of red blood cells in total blood volume; low number may indicate anemia, blood loss, vitamin/mineral deficiencies
hematocrit
INR; calculation based on prothrombin time (PT) test results; most often used to see how well warfarin (Coumadin) is working
international normalized ratio
radiologic examination that injects contrast medium into blood vessels; can show locations of plaques in coronary arteries and extent of occlusion; a cardiac cath procedure
angiography
used to visualize location, size, shape of heart/lungs/blood vessels/ribs/bones of spine; can revewl fluid in lungs or pleural space
chest radiograph
thin catheter inserted into artery in arm or leg, advanced to coronary arteries where contrast dye is injected; can evaluate narrowing or occlusion of coronary arteries and measure BP in heart, also O2 in blood; some treatments are performed using this procedure
cardiac catheterization
procedure for direct visualization of bronchial tree-for diagnostic and therapeutic purposes; can also remove tissue specimens by biopsy or bronchoalveolar lavage
bronchoscopy
diagnostic test that uses an X-ray that rotates around a patient lying on a table-creates picture of organ and surrounding tissue (slices)
computed tomography (CT scan)
uses high frequency sound waves non-invasively to evaluate functioning of heart; can provide info on size and function of ventricles, thickness of septums, functions of walls/valves/chambers
echocardiogram
uses magnetic field and radio waves to create 3D images of heart and blood vessels to assess size and function of chambers, thickness and movement of walls, extent of damage caused by myocardial infarction or heart disease, structural problems in aorta, presence of plaques/blockages in blood vessels; also to image masses in mediastinum
magnetic resonance imaging (MRI)
placed in pulmonary artery; measures pulmonary artery wedge pressure of left atrium (sensitive indirect measure of left ventricular function) and right atrial pressure
Can estimate left sided heart pressures (left-side measurements are more difficult/risky)
Swan-Ganz catheter (balloon catheter, pulmonary artery catheter)
measures pressure in vena cava or right atrium
CVP line (central venous pressure)
SOB in recumbent position
orthopnea
substernal chest pressure, ofter accompanied by Levine sign (clutching chest over sternum)
angina
sudden episode of SOB at night
paroxysmal nocturnal dyspnea
1 MET equivalent
3.5 mL O2 /kg/min
sternal precautions (general considerations-will vary by physician and possibly patient!)
applying sternal counter pressure (splinting) with cough/laugh/sneeze
limit driving
minimize/avoid UE use with sit to stand and reverse
avoid lifting/pushing/pulling >10pounds
limit shld flex/abd above 90 degrees when weighted
encourage shld pain-free AROM
avoid scap retraction past neutral
avoid trunk flex/rotation with supine to sit
hemoglobin level at which caution should be used when exercising (stop or lower intensity)
8
major complications following MI
recurrence of ischemia
LV failure
ventricular arrhythmias
chest pain occurs at rest
unstable angina Pre-infarction, crescendo)
chest pain occurs during exercise or activity
stable angina
non-ST elevation myocardial infarction
NSTEMI
ST elevation myocardial infarction
STEMI
3 common presentations of ACS
- angina
2.injury (presence of new acute MI) - infarction (old heart attack with dead tissue that cannot be reversed–irreversible changes start to appear 20 minutes -2 hours from onset of myocardial ischemia)
ACS
acute coronary syndrome (coronary artery disease or CAD is older term)
condition in which blood flow (and thus oxygen) is restricted or reduced in a part of the body
ischemia
positions to relieve dyspnea
forward leaning
forward leaning with arm support
reverse Trendelenberg (decreases weight of abdominal contents on diaphragm)
Semi-Fowlers (esp for CHF, other cardiac)
technique to reduce respiratory rate, relieve dyspnea, maintain small positive pressure in bronchioles/prevent airway collapse
What is best position to begin?
PLB
Semi-Fowlers
PTA applying firm pressure at end of exhalation over area of limited chest wall movement, then ask patient to inhale deeply attempting to expand rib cage under PTA’s hand
Can teach patient to do this!
segmental breathing
3 phases of Active Cycle of Breathing technique
- breathing control
- thoracic expansion exercises
- forced expiratory technique
QRS
ventricular depolarization
P wave
atrial depolarization
T wave
completion of ventricular repolarization
9 on original Borg RPE scale
very light
value that represents 70% max HR on Borg original RPE
13-14
blood pressure that is consistently elevated at medical practitioner office readings but does not meet diagnostic criteria for hypertension based upon out-of-office home readings
White coat hypertension
diagnosed when there is no known cause for the elevation in BP values and exists in approximately 90% to 95% of all patients with HTN
primary or essential hypertension
irreversible changes start to appear how long after onset of ischemia
20 minutes to 2 hours from the onset of myocardial ischemia
common symptom experienced with left-side heart failure; associated with pulmonary edema
dyspnea
narrowing of a heart valve limiting the flow of blood through the valve
stenosis
refers to the forward and backward movement of blood resulting from incomplete valve closure
regurgitation
A run of four or more PVCs in a row
ventricular tachycardia (V tach)
characterized by quivering of the ventricles resulting from inadequate electrical stimulation
ventricular fibrillation
Room or hall ambulation up to 5 min as tolerated 3–4 times/day
2-2.5 METS
refers to the performance of any activity within the limits or boundaries of that patient’s breathing capacity
activity pacing