Cardiopulmonary System Flashcards
What are the 2 layers of the pericardium
Epicardium 2nd layer (unnamed)
What does the epicardium do
facilitates contraction and relaxation (outer later)
What does the 2nd layer do
directly surrounds heart muscle
What is the myocardium
middle later of heart
what is the endocardium
the inner layer of the heart
What does the endocardium do
helps mediate flow
What is the function of heart valves
controls blood flow from atria to ventricles and the ventricles into 2 larger arteries
Heart valves
Tricuspid
Pulmonary
Mitral
Aortic
Where is the tricuspid valve
right side b/t right atrium and the right ventricle
Where is the pulmonary valve
right side of the heart b/t right ventricle and the entrance to the pulmonary artery which carries blood to the lungs
Where is the mitral valve
left side of heart b/t the left atrium and the left ventricle
Where is the aortic valve
left side of the heart b/t the left ventricle and the entrance to the aorta which carries blood to the body
What is the cardiac cycle
sequence of events occurring during one complete heartbeat or contraction-relaxation sequence
What is systole
contract and eject
what is diastole
relax and filling
Order of the cardiac cycle
- Venous blood flows from the R atrium through tricuspid and into the R ventricle during diastole
- During systole blood from R ventricle is pushed through the pulmonic valve into pulmonary arterial circulation where it’s oxygenated
- oxygenated blood returns through pulmonary veins to L atrium
- Then through mitral valve into L ventricle during diastole
- During systole, L ventricular volume is ejected through the aortic valve into aorta and systemic arterial circulation
What is not in cardiac muscle
nerves
What is in cardiac muscle instead of nerves
structures that assist the ventricles to contract
Where do conduction pathways originate
SA (sinoatrial) node
What is the SA node
Hearts natural pacemaker
What does the SA node do
generates the 1st impulses initiating the cardiac cycle a basic rate
What is the basic heart rate known as
What is it
Sinus rhythm
70 beats/min
What happens upon contraction of the SA node
both atria contract forcing blood into the ventricles. Impulses then pass to the AV node
Where does the AV node pass the impulse
To the bundle of His. There’s a slight delay to allow ventricles to fill. From the bundle of his fibers branch off into R and L bundles and split into Purkinje fibers
What stimulates the ventricles to contract
impulse from the purkinje fibers
What is a ECG/EKG
Test electrical activity in the heart
What does depolarization do
takes away from the resting membrane potential
What does repolarization do
Taking back to resting potential
What is HR and force of contraction controlled by
the medulla
What is tachycardia
increase in HR caused by sympathetic NS
What is bradycardia
Decrease in HR caused by parasympathetic NS or vagus N stimulation
What factors contribute to increased HR
increase in body temp, env temp
exercise
smoking
any stimulation of the CNS
What is normal blood pressure
Systolic= less than 120
Diastolic=less than 80
What is prehypertension BP range
systolic= 120-139 Diastolic= 80-89
What are the ranges for stage 1 high BP
systolic= 140-159 diastolic= 90-99
What are the BP ranges for stage 2 high BP
systolic= 160 or higher diastolic= 100 or higher
What is coronary artery disease secondary to
atherosclerosis (narrowing of the coronary arteries due to build up of plaque)
What does coronary artery disease lead to
reduced blood flow, reduction of nutrients and oxygen to the heart
What is the leading cause of death in the US
Coronary artery disease
What are risk factors for coronary artery disease
genetics/fam hx obesity smoking sedentary lifestyle diabetes hypertension combination of oral contraceptives smoking
What are the clinical manifestations of coronary artery disease
Angina Nausea/vomiting diaphoresis (excessive sweating) fatigue pallor cool extremities SOB
What is angina
pressure, tightness, squeezing in the chest, chest pain can be felt in jaw, neck, left arm
When does angina occur
when there is a deficit of oxygen to the heart muscle
What is the tx for angina
rest
medication
avoidance of exertion and precipitating events
What are the 2 types of angina
Stable
unstable
What is stable angina
most common
usually associated with an activity
resolves after a few min of rest/meds
What is unstable angina
no pattern
not triggered by an activity
doesn’t resolves
emergent care required (may be signaling a heart attack)
What is atherosclerosis
plaque builds up inside the walls of larger arteries (aortic or pulmonary)
What is arteriosclerosis
build up of plaque in the small blood vessels which feed the heart
What is the etiology of athero/arteriosclerosis
age men genetics obesity smoking sedentary lifestyle diabetes hypertension oral contraceptives and smoking together
What are the clinical signs of athero/arteriosclerosis
lead to CAD
peripheral artery disease (narrowing of limbs and pelvis)
CVA
HTN
Aneurysms (thoracic aortic or abdominal aortic)
Where does an aortic aneurysm occur
upper part of the aorta
Where does an abdominal aorta occur
lower part of the aorta
Med intervention and tx for athero/arteriosclerosis
diet/exercise
lifestyle changes
control of diabetes/hypertension
surgery
Kinds of surgery for athero/arteriosclerosis
Endartectomy
angioplasty
bypass (CABG)
What is a endartectomy
scraping and cleaning out plaque in artery
What is an angioplasty
use a balloon to open blockage in artery, then place stent to keep artery open
What is bypass
use a healthy blood vessel from another part of the body and connect the artery to other arteries in the heart so blood is able to pass around the blocked area
What are the 2 most common veins used in bypass
saphenous
mammary artery
What is myocardial infarction
Heart attack
When does Myocardial infarction occur
when a coronary artery is totally obstructed (due to plaque) leading to prolonged ischemia and cell death
Signs and symptoms of myocardial infarction
pain (below sternum, chest, left arm, neck, steady and severe)
pallor, sweating, nausea, dizziness, weakness, dyspenea
marked anxiety and fear
hypotension, rapid pulse
low grade fever
enzymes from damaged/dead myocardial cells aer released into blood (one way to dx after it occurred)
Prevention and tx of myocardial infarction
modify risk factors low does aspirin daily drugs to decrease lipid levels coronary bypass surgery immediate coronary angioplasty meds (nitrates, beta blockers, calcium channel blockers)
What is the prognosis for myocardial infarction
of those who die, 60% do in the 1st hour
long term based n preexisting conditions
How long can it take to heal heart muscle
4-8weeks
what should early activity be like after MI
Not exceed 1-2 mets
What do nitrates do
increase o2 to heart
what do beta blockers do
reduce workload of heart
what do calcium channel blockers do
decrease BP
What are normal resting heart rates
60-100 bpm
what is the etiology of cardiac arrhythmias
damage to heart electrolyte abnormalitiesfever hypoxia stress infection drug toxicity caffeine
What is atrial flutter
how do you treat it
HR 250-350 BPM
treat w/ meds, cardioversion (shock heart)
What is atrial fibrillation
rates over 350 BPM
What is the most common sustained arrhythmia
atrial fibrillation
What is atrial fibrillation associated w/
CHF
How to tx atrial fibrillation
pacemaker
meds
cardioversion
ablation (rake off diseased heart muscle)
What is ventricular flutter and fibrillation
rapid rhythm 250 r more bpm
originating in ventricles
What is ventricular flutter and fibrillation associated with
MI
How to treat ventricular flutter and fibrillation
CPR defibrillation (aed)
What is flutter
still some blood being ejected from heart
what is fibrillation
no blood being ejected leading to cardiac death
What is tachycardia
abnormal rapid rhythm
sinus rhythm exceeding 100 beat/min
What causes tachycardia
response to stress
excessive caffeine and tobacco use
heart disease
What are the clinical manifestations of tachycardia
palpitations lightheaded dizzy chest pain fatigue
Tx fro tachycardia
stress management decrease tobacco caffeine use sedation vagal stim (slows hr through implanted device) meds
what is the prognosis of tachycardia
good in absence of heart disease
What is bradycardia
hr of less that 60 beats/min
when does badycardia occur
naturally duing rest and sleep
signs and symptoms of bradycardia
usually asymptomatic
confusion
hypotension
When does congestive heart failure occur
when cardiac output isn’t sufficient to meet the metabolic demands of the body
secondary to another condition
CHF is what kind of condition
Chronic
Risk factors for CHF
aging
disorders of heart and other organs
abnormal congenital anatomy
clinical manifestations of CHF
Fatigue and weakness dyspenea (SOB) exercise intolerance cold intolerance tachycardia pallor daytime oliguria (decreased urine output) cough edema in feet and legs hepatomegaly (enlarged liver) splenomegaly (enlarged spleen) headaches flushed face paroxysmal nocturnal dyspnea (frothey blood stained sputum)
etiology of CHF
increased pre-load
decreased pre-load
increased after loading
decreased contractibility
What is increased pre-load
fluid backs up into lungs (edema may be present in ankles and feet)
what is decreased pre-laod
fluid continues to back u causing the ehart to pump out less fluid and heart starts to enlarge. L ventricle pumps out less fluid and theres more back up into the body and heart
What is increased after loading
heart unable to eject fluid comlpetely which results in decreased o2 to heart, enlargement of heart. (LEFT VENTRICLE BECOMES WEAKER FORCE)
What are causes of decreased contractibility
atherosclerosis
degenerative changes of aging
necrosis of myocarium due to MI
What is a result of CHF
increased metabolic demands
affects kidneys ability to dispose of sodium and water which leads to furhter edema
Tests for CHF
radiographs (chest xray)
arterial blood gases
What do arterial blood gases do
used to determine how well your lungs move o2 into the blood and remove CO2 from the blood
Tx for CHF
tx underlying problems as able meds counseling and edu regarding lifestle life style changes (diet/exercise) ronary artery bypass graft, angioplasty
What is cardiomyopathy
impairment of cardiac contraction due to primary diesease of myocardium
weakened and enlarged heart muscle
What causes cardiomyopathy
virus alcohol consumption pregnancy (last trimester, proteins leak from uterine muscles) long standing HTN infection
Clinical manifestations of Cardiomyopathy
same as CHF
often asymptomatic
Prevention and tx for cardiomyopathy
lifestlye changes
tx underlying problems
What is hypertension
BP consistently over 140/90
Three categories of hypertension
primary or essential
secondary
malignant
What causes primar hypertension
idiopathic
what causes secondary hypertension
from renal or endocrine disease, pregnanc
What causes malignant hypertension
uncoontrollable
severe
progressive
What causes hypertension
age 60+ men african american excessive alcohol intake obesity prolonged or recurrent stroke genetic
Signs and symptoms of hypertension
asymptomatic fatigue malaise headache elevated BP high risk for CVA, PVD
What is rate of perceived exertion
allows pt to self monitor how they tolerate activities or exercise
ordinal scale from 6-20
What is the most widely used RPE scles
Borgs
What to do for OT
eval and analyze pt occupations psychosocial adjustment (may have depression, fear, anxiety) edu/lifestye changes work simplification energy conservation raelaxation/stress mngmt edu/prevention home program 9strength and endurance) monitor BP, HR, vitals
Cardiac rehab phases
Phase 1- in pt
phase 2- formal out pt rehab
phase 3- ongoing more independent exercise
What are the layers of the heart
Pericardium
Myocardium
Endocardium
