Cardiopulmonary System Flashcards
1
Q
What are the 2 layers of the pericardium
A
Epicardium 2nd layer (unnamed)
2
Q
What does the epicardium do
A
facilitates contraction and relaxation (outer later)
3
Q
What does the 2nd layer do
A
directly surrounds heart muscle
4
Q
What is the myocardium
A
middle later of heart
5
Q
what is the endocardium
A
the inner layer of the heart
6
Q
What does the endocardium do
A
helps mediate flow
7
Q
What is the function of heart valves
A
controls blood flow from atria to ventricles and the ventricles into 2 larger arteries
8
Q
Heart valves
A
Tricuspid
Pulmonary
Mitral
Aortic
9
Q
Where is the tricuspid valve
A
right side b/t right atrium and the right ventricle
10
Q
Where is the pulmonary valve
A
right side of the heart b/t right ventricle and the entrance to the pulmonary artery which carries blood to the lungs
11
Q
Where is the mitral valve
A
left side of heart b/t the left atrium and the left ventricle
12
Q
Where is the aortic valve
A
left side of the heart b/t the left ventricle and the entrance to the aorta which carries blood to the body
13
Q
What is the cardiac cycle
A
sequence of events occurring during one complete heartbeat or contraction-relaxation sequence
14
Q
What is systole
A
contract and eject
15
Q
what is diastole
A
relax and filling
16
Q
Order of the cardiac cycle
A
- 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
17
Q
What is not in cardiac muscle
A
nerves
18
Q
What is in cardiac muscle instead of nerves
A
structures that assist the ventricles to contract
19
Q
Where do conduction pathways originate
A
SA (sinoatrial) node
20
Q
What is the SA node
A
Hearts natural pacemaker
21
Q
What does the SA node do
A
generates the 1st impulses initiating the cardiac cycle a basic rate
22
Q
What is the basic heart rate known as
What is it
A
Sinus rhythm
70 beats/min
23
Q
What happens upon contraction of the SA node
A
both atria contract forcing blood into the ventricles. Impulses then pass to the AV node
24
Q
Where does the AV node pass the impulse
A
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
25
What stimulates the ventricles to contract
impulse from the purkinje fibers
26
What is a ECG/EKG
Test electrical activity in the heart
27
What does depolarization do
takes away from the resting membrane potential
28
What does repolarization do
Taking back to resting potential
29
What is HR and force of contraction controlled by
the medulla
30
What is tachycardia
increase in HR caused by sympathetic NS
31
What is bradycardia
Decrease in HR caused by parasympathetic NS or vagus N stimulation
32
What factors contribute to increased HR
increase in body temp, env temp
exercise
smoking
any stimulation of the CNS
33
What is normal blood pressure
Systolic= less than 120
| Diastolic=less than 80
34
What is prehypertension BP range
```
systolic= 120-139
Diastolic= 80-89
```
35
What are the ranges for stage 1 high BP
```
systolic= 140-159
diastolic= 90-99
```
36
What are the BP ranges for stage 2 high BP
```
systolic= 160 or higher
diastolic= 100 or higher
```
37
What is coronary artery disease secondary to
atherosclerosis (narrowing of the coronary arteries due to build up of plaque)
38
What does coronary artery disease lead to
reduced blood flow, reduction of nutrients and oxygen to the heart
39
What is the leading cause of death in the US
Coronary artery disease
40
What are risk factors for coronary artery disease
```
genetics/fam hx
obesity
smoking
sedentary lifestyle
diabetes
hypertension
combination of oral contraceptives
smoking
```
41
What are the clinical manifestations of coronary artery disease
```
Angina
Nausea/vomiting
diaphoresis (excessive sweating)
fatigue
pallor
cool extremities
SOB
```
42
What is angina
pressure, tightness, squeezing in the chest, chest pain can be felt in jaw, neck, left arm
43
When does angina occur
when there is a deficit of oxygen to the heart muscle
44
What is the tx for angina
rest
medication
avoidance of exertion and precipitating events
45
What are the 2 types of angina
Stable
| unstable
46
What is stable angina
most common
usually associated with an activity
resolves after a few min of rest/meds
47
What is unstable angina
no pattern
not triggered by an activity
doesn't resolves
emergent care required (may be signaling a heart attack)
48
What is atherosclerosis
plaque builds up inside the walls of larger arteries (aortic or pulmonary)
49
What is arteriosclerosis
build up of plaque in the small blood vessels which feed the heart
50
What is the etiology of athero/arteriosclerosis
```
age
men
genetics
obesity
smoking
sedentary lifestyle
diabetes
hypertension
oral contraceptives and smoking together
```
51
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)
52
Where does an aortic aneurysm occur
upper part of the aorta
53
Where does an abdominal aorta occur
lower part of the aorta
54
Med intervention and tx for athero/arteriosclerosis
diet/exercise
lifestyle changes
control of diabetes/hypertension
surgery
55
Kinds of surgery for athero/arteriosclerosis
Endartectomy
angioplasty
bypass (CABG)
56
What is a endartectomy
scraping and cleaning out plaque in artery
57
What is an angioplasty
use a balloon to open blockage in artery, then place stent to keep artery open
58
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
59
What are the 2 most common veins used in bypass
saphenous
| mammary artery
60
What is myocardial infarction
Heart attack
61
When does Myocardial infarction occur
when a coronary artery is totally obstructed (due to plaque) leading to prolonged ischemia and cell death
62
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)
63
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)
```
64
What is the prognosis for myocardial infarction
of those who die, 60% do in the 1st hour
| long term based n preexisting conditions
65
How long can it take to heal heart muscle
4-8weeks
66
what should early activity be like after MI
Not exceed 1-2 mets
67
What do nitrates do
increase o2 to heart
68
what do beta blockers do
reduce workload of heart
69
what do calcium channel blockers do
decrease BP
70
What are normal resting heart rates
60-100 bpm
71
what is the etiology of cardiac arrhythmias
```
damage to heart
electrolyte abnormalitiesfever
hypoxia
stress
infection
drug toxicity
caffeine
```
72
What is atrial flutter
| how do you treat it
HR 250-350 BPM
| treat w/ meds, cardioversion (shock heart)
73
What is atrial fibrillation
rates over 350 BPM
74
What is the most common sustained arrhythmia
atrial fibrillation
75
What is atrial fibrillation associated w/
CHF
76
How to tx atrial fibrillation
pacemaker
meds
cardioversion
ablation (rake off diseased heart muscle)
77
What is ventricular flutter and fibrillation
rapid rhythm 250 r more bpm
| originating in ventricles
78
What is ventricular flutter and fibrillation associated with
MI
79
How to treat ventricular flutter and fibrillation
```
CPR
defibrillation (aed)
```
80
What is flutter
still some blood being ejected from heart
81
what is fibrillation
no blood being ejected leading to cardiac death
82
What is tachycardia
abnormal rapid rhythm
| sinus rhythm exceeding 100 beat/min
83
What causes tachycardia
response to stress
excessive caffeine and tobacco use
heart disease
84
What are the clinical manifestations of tachycardia
```
palpitations
lightheaded
dizzy
chest pain
fatigue
```
85
Tx fro tachycardia
```
stress management
decrease tobacco caffeine use
sedation
vagal stim (slows hr through implanted device)
meds
```
86
what is the prognosis of tachycardia
good in absence of heart disease
87
What is bradycardia
hr of less that 60 beats/min
88
when does badycardia occur
naturally duing rest and sleep
89
signs and symptoms of bradycardia
usually asymptomatic
confusion
hypotension
90
When does congestive heart failure occur
when cardiac output isn't sufficient to meet the metabolic demands of the body
secondary to another condition
91
CHF is what kind of condition
Chronic
92
Risk factors for CHF
aging
disorders of heart and other organs
abnormal congenital anatomy
93
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)
```
94
etiology of CHF
increased pre-load
decreased pre-load
increased after loading
decreased contractibility
95
What is increased pre-load
fluid backs up into lungs (edema may be present in ankles and feet)
96
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
97
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)
98
What are causes of decreased contractibility
atherosclerosis
degenerative changes of aging
necrosis of myocarium due to MI
99
What is a result of CHF
increased metabolic demands
| affects kidneys ability to dispose of sodium and water which leads to furhter edema
100
Tests for CHF
radiographs (chest xray)
| arterial blood gases
101
What do arterial blood gases do
used to determine how well your lungs move o2 into the blood and remove CO2 from the blood
102
Tx for CHF
```
tx underlying problems as able
meds
counseling and edu regarding lifestle
life style changes (diet/exercise)
ronary artery bypass graft, angioplasty
```
103
What is cardiomyopathy
impairment of cardiac contraction due to primary diesease of myocardium
weakened and enlarged heart muscle
104
What causes cardiomyopathy
```
virus
alcohol consumption
pregnancy (last trimester, proteins leak from uterine muscles)
long standing HTN
infection
```
105
Clinical manifestations of Cardiomyopathy
same as CHF
| often asymptomatic
106
Prevention and tx for cardiomyopathy
lifestlye changes
| tx underlying problems
107
What is hypertension
BP consistently over 140/90
108
Three categories of hypertension
primary or essential
secondary
malignant
109
What causes primar hypertension
idiopathic
110
what causes secondary hypertension
from renal or endocrine disease, pregnanc
111
What causes malignant hypertension
uncoontrollable
severe
progressive
112
What causes hypertension
```
age 60+
men
african american
excessive alcohol intake
obesity
prolonged or recurrent stroke
genetic
```
113
Signs and symptoms of hypertension
```
asymptomatic
fatigue
malaise
headache
elevated BP
high risk for CVA, PVD
```
114
What is rate of perceived exertion
allows pt to self monitor how they tolerate activities or exercise
ordinal scale from 6-20
115
What is the most widely used RPE scles
Borgs
116
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
```
117
Cardiac rehab phases
Phase 1- in pt
phase 2- formal out pt rehab
phase 3- ongoing more independent exercise
118
What are the layers of the heart
Pericardium
Myocardium
Endocardium
