Cardiovascular 1 & 2 Flashcards
1
Q
In adults, what is the rate that the electrical impulses of the heart occur?
A
60-100 times per minute.
2
Q
What is the process where the electrical impulses travel from the SA node through the atria to the atrioventricular AV node called?
A
Conduction.
3
Q
What happens to the impulse at the AV node?
A
The AV node slows the impulse from the SA node, giving the atria time to contract and fill the ventricles with blood.
4
Q
What is electrical relaxation called?
A
Repolarization
5
Q
What is the electrical stimulation called?
A
Depolarization.
6
Q
What is the mechanical contraction called?
A
Systole
7
Q
What is the mechanical relaxation called?
A
Diastole.
8
Q
What is the heart rate influenced by?
A
The autonomic nervous system which consists of sympathetic and parasympathetic fibers.
9
Q
What are the sympathetic nerve fibers attached to the heart and arteries also called?
A
Adrenergic fibers.
10
Q
What does stimulation of the sympathetic system result in?
A
Positive Chronotropy - Increased HR
Positive Dromoptropy - Increased AV conduction
Positive Inotropy - Increased force of myocardial contraction.
Constriction of peripheral blood vessels which leads to increased BP.
11
Q
What effect does Parasympathetic stimulation have on the heart & arteries?
A
Negative chronotropy - reduced HR
Negative Dromoptropy - reduced AV conduction
Reduced force of myocardial contraction.
Dilation of arteries which leads to lowered BP.
12
Q
What negative effect may happen with increased sympathetic stimulation?
A
Sympathetic stimulation caused by exercise, anxiety, fear, fever, administration of catecholamines such as dopamine, aminophylline or dobutamine may increase incidence of arrythmias.
13
Q
What positive effect may happen with decreased sympathetic stimulation?
A
decreased sympathetic stimulation caused by rest, anxiety reduction methods such as therapeutic communication or medication or administration of Beta blockers may decrease incidences of arrythmias.
14
Q
Why should we not clean a patients skin with alcohol prior to placing ECG nodes?
A
Cleansing the skin with alcohol removes any oily residue from the skin, it also increases the skin’s electrical impedance and hinders detection of the cardiac electrical signal.
15
Q
how many leads are used on a standard ECG, and where are they placed?
A
12 leads.
6 on chest and 4 on the limbs.
The limb electrodes are placed on areas that are not bony and that do not have significant movement.
16
Q
On the ECG strip, what is measured on the horizontal axis?
A
Time and rate.
17
Q
On the ECG strip, what is measured on the vertical axis?
A
Amplitude and voltage.
18
Q
What is the name of the wave that represent the electrical impulse stating in the SA node and spread through the atria?
A
The P wave. The P wave represent atrial depolarization.
19
Q
What is the normal height and duration of the P wave?
A
Normally 2.5 mm or less in height and 0.11 seconds or less in duration.
20
Q
What is the name of the wave that represent ventricular depolarization?
A
QRS complex.
The Q wave is the first negative deflection after the P wave.
The R wave is the first positive deflection after the P wave
The S wave is the first negative deflection after the R wave.
21
Q
What is the normal duration of the QRS complex?
A
Less than 0.12 seconds in duration.
22
Q
Which wave represent ventricular repolarization?
A
The T wave.
23
Q
Why can we not see atrial repolarization on the ECG?
A
It occurs at the same time as ventricular depolarization which is blocking its view on the ECG strip.
24
Q
What wave represent repolarization of the Purkinje fibers?
A
The U wave.
25
The U wave is rare, when are we most likely to see it?
It sometimes appears in patients with hypokalemia, hypertension or heart disease. If present it follows the T wave.
26
What generates the sinus rhythm?
The electrical conduct that begins in the SA node.
27
What 6 characteristics does a normal sinus rhythm have?
Ventricular and atrial rate: 60 to 100 bpm in the adult
Ventricular and atrial rhythm: Regular
QRS shape and duration: Usually normal, but may be regularly abnormal
P wave: Normal and consistent shape; always in front of the QRS
PR interval: Consistent interval between 0.12 and 0.20 seconds
P:QRS ratio: 1:1
28
What 3 types of Sinus node arrythmias are there, where do they originate from?
Sinus Bradycardia
sinus tachycardia
Sinus arrythmia
All originate in the SA node.
29
When does sinus bradycardia occur?
When the SA node create impulses at a slower than normal rate.
30
What are some causes of sinus bradycardia?
lower metabolic needs (e.g., sleep, athletic training, hypothyroidism), vagal stimulation (e.g., from vomiting, suctioning, severe pain), medications (e.g., calcium channel blockers [e.g., nifedipine, amiodarone], beta-blockers [e.g., metoprolol]), idiopathic sinus node dysfunction, increased intracranial pressure, and coronary artery disease, especially myocardial infarction (MI) of the inferior wall.
31
What's normally the cause for unstable and symptomatic badrycardia?
Hypoxemia
32
What are the 6 most common characteristics of Bradycardia?
Ventricular and atrial rate: Less than 60 bpm in the adult
Ventricular and atrial rhythm: Regular
QRS shape and duration: Usually normal, but may be regularly abnormal
P wave: Normal and consistent shape; always in front of the QRS
PR interval: Consistent interval between 0.12 and 0.20 seconds
P:QRS ratio: 1:1
33
What separates bradycardia from normal sinus rhythm ?
The rate.
34
What is sick sinus syndrome?
SA node dysfunction.
35
Explain how we would treat Bradycardia?
Resolving causative agent.
If clinical symptoms occur such as alteration in metal status, chest discomfort or hypotension then we may give 0.5mg of atropine as IV bolus and repeat Q3-5 min until max does of 3mg.
If unresponsive to atropine we may give Dopamine, isoproterenol or epinephrine.
36
What is Sinus tachycardia?
When the sinus node create impulses faster than the normal rate.
37
What are some causes of Tachycardia?
Physiologic of psychological stress e.g acute blood loss, anemia, shock, hypervolemia, hypovolemia, HF, pain, hypermetabolic states, fever exercise, anxiety.
Medication that stimulate sympathetic response (catecholamines, aminophylline, atropine) Coffee, nicotine and illicit drugs such as amphetamine, cocaine, ecstasy.
Autonomic dysfunction resulting in postural orthostatic tachycardia syndrome (POST) - characterized by tachycardia without hypotension, palpitations, lightheadedness, weakness and blurred vision with sudden postural changes.
38
What are 6 common characteristics of tachycardia?
Ventricular and atrial rate: Greater than 100 bpm in the adult, but usually less than 120 bpm
Ventricular and atrial rhythm: Regular
QRS shape and duration: Usually normal, but may be regularly abnormal
P wave: Normal and consistent shape; always in front of the QRS, but may be buried in the preceding T wave
PR interval: Consistent interval between 0.12 and 0.20 seconds
P:QRS ratio: 1:1
39
What may happen as the heart rate is increasing with tachycardia?
The diastolic filling time decreases, possibly resulting in reduced cardiac output and subsequent symptoms of syncope (fainting) and low blood pressure. If the rapid rate persists and the heart cannot compensate for the decreased ventricular filling, the patient may develop acute pulmonary edema.
40
Waht are some ways we will try to manage tachycardia?
Vagal maneuvers such as carotid sinus massage, gagging, bearing down against a close glottis, forceful and sustained coughing, and applying a cold stimulus to the face.
Administration of adenosine.
Synchronized cardioversion
IV beta blockers or calcium blockers
41
Explain what Sinus Arrythmias are?
Sinus arrhythmia occurs when the sinus node creates an impulse at an irregular rhythm; the rate usually increases with inspiration and decreases with expiration.
42
What are 6 common characteristics of Sinus Arrythmias?
Ventricular and atrial rate: 60 to 100 bpm in the adult
Ventricular and atrial rhythm: Irregular
QRS shape and duration: Usually normal, but may be regularly abnormal
P wave: Normal and consistent shape; always in front of the
QRS PR interval: Consistent interval between 0.12 and 0.20 seconds P:QRS ratio: 1:1
43
How are Sinus Arrythmias usually treated?
Sinus arrhythmia does not cause any significant hemodynamic effect and therefore is not typically treated
44
Where does Atrial Arrythmias originate from?
Atrial arrhythmias originate from foci within the atria and not the SA node. These include aberrancies such as premature atrial complexes (PACs) as well as atrial fibrillation and atrial flutter.
45
What is a PAC?
A PAC is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node. The PAC may be caused by caffeine, alcohol, nicotine, stretched atrial myocardium (e.g., as in hypervolemia), anxiety, hypokalemia (low potassium level), hypermetabolic states (e.g., with pregnancy), or atrial ischemia, injury, or infarction.
46
Waht are the most common characteristics of a PAC?
Ventricular and atrial rate: Depends on the underlying rhythm (e.g., sinus tachycardia)
47
When are PACs often seen on the ECG?
With Sinus tachycardia.
Ventricular and atrial rhythm: Irregular due to early P waves, creating a PP interval that is shorter than the others. This is sometimes followed by a longer-than-normal PP interval, but one that is less than twice the normal PP interval. This type of interval is called a noncompensatory pause
QRS shape and duration: The QRS that follows the early P wave is usually normal, but it may be abnormal (aberrantly conducted PAC). It may even be absent (blocked PAC)
P wave: An early and different P wave may be seen or may be hidden in the T wave; other P waves in the strip are consistent
PR interval: The early P wave has a shorter-than-normal PR interval, but still between 0.12 and 0.20 seconds
P:QRS ratio: Usually 1:1
48
Atrial fibrillation is a serious public health concern because it is associated with __________ ?
Aging
49
What does A-Fib result from?
Atrial fibrillation happens when the heart's upper chambers (atria) start beating in a fast and irregular way because the electrical signals controlling them aren’t working properly. Instead of a normal, steady heartbeat, the atria shake or quiver, making the heart beat unevenly. This can cause symptoms like a fast heartbeat, dizziness, or trouble breathing. It can also lead to blood clots because the blood isn't flowing as smoothly as it should.
50
What are the 6 common characteristics of A-Fib?
Ventricular and atrial rate: Atrial rate is 300 to 600 bpm; ventricular rate is usually 120 to 200 bpm in untreated atrial fibrillation
Ventricular and atrial rhythm: Highly irregular
QRS shape and duration: Usually normal, but may be abnormal
P wave: No discernible P waves; irregular undulating waves that vary in amplitude and shape are seen and referred to as fibrillatory or f waves PR interval: Cannot be measured
P:QRS ratio: Many:1
51
Patients with A-Fib are at an increased risk of what?
Heart failure, myocardial ischemia, and embolic events such as stroke
52
Patients with A-fib may exhibit a pulse deficit, explain what this means.
A pulse deficit is a numeric difference between apical and radial pulse rates. The shorter time in diastole reduces the time available for coronary artery perfusion, thereby increasing the risk of myocardial ischemia with the onset of anginal symptoms
53
In patients with A-fib, what promotes the formation of thrombi?
The erratic nature of atrial contraction, alterations in ventricular ejection, and atrial myocardial dysfunction. . The origin of embolisms resulting in stroke for patients with nonvalvular atrial fibrillation is most often the left atrial appendage (LAA)
54
What is used to verify A-fib?
A 12 lead ECG.
55
What blood tests are used to screen for disease that are known to increase the risk of A-fib?
Thyroid, renal and hepatic functions.
56
What additional tests can be made w/ suspicion and diagnosis of A-fib?
chest x-ray (to evaluate pulmonary vasculature in a patient suspected of having pulmonary hypertension), exercise stress test (to exclude myocardial ischemia or reproduce exercise-induced atrial fibrillation), Holter or event monitoring.
57
How do we manage permanent A-fib medically?
Medical management revolves around preventing embolic events such as stroke with anticoagulant medications, controlling the ventricular rate of response with antiarrhythmic agents, and treating the arrhythmia as indicated so that it is converted to a sinus rhythm (i.e., cardioversion)
58
What pharmacological therapy can be used to manage A-fib?
Antithrombotic drugs may include anticoagulants and antiplatelet drugs.
Patients with atrial fibrillation with valvular heart disease or bioprosthetic heart valves may be prescribed warfarin, or a direct-acting oral anticoagulant, or a Factor Xa inhibitor.
59
Which medications may be given to achieve pharmacologic cardioversion from a-fib to sinus rhythm and whihc medication is the most preferred and why?
flecainide, dofetilide, propafenone, amiodarone, and IV ibutilide.
Dofetilide is a preferred medication because it is highly effective at converting atrial fibrillation to sinus rhythm, has fewer drug-to-drug interactions, and is better tolerated by patients than other medications.
60
What cholesterol lowering medications have proved to be effective to prevent new onset a-fib following cardiac surgery?
Statins (HMG-CoA reductase inhibitors)
61
What is the leading cause of death in the U.S?
Cardiovascular disease.
62
Which is the most prevalent type of cardiovascular disease in adults?
Coronary artery disease (CAD)
63
What is the most common cause of cardiovascular disease in the U.S?
Atherosclerosis.
64
Define Atherosclerosis.
Abnormal accumulation of lipid, or fatty substances, and fibrous tissue in the lining of arterial blood vessel walls. These substances block and narrow the coronary vessels in a way that reduces blood flow to the myocardium.
65
How does the inflammatory response involved with the development of atherosclerosis begin?
With injury t the vascular endothelium. The injury may be initiated by smoking or tobacco use, hypertension, hyperlipidemia, and other factors.
66
What does CO stand for, explain what CO is.
Cardiac Output.
CO= SV x HR
67
What is stroke volume?
The volume of blood that is being pushed out primarily by the left ventricle.
68
What is HR?
Hear Rate, how many beats per minute.
69
What is Preload?
Preload refers to the degree of stretch in the ventricles of the heart at the end of diastole, just before contraction.
In heart failure, increased preload can lead to congestion and fluid overload due to the heart’s inability to effectively pump out the extra volume.
70
What is afterload?
The resistance that the ventricles have to pump against / overcome.
71
What is ejection fraction?
(EF) The amount of blood ejected from the left ventricle during systole. Blood pumped out with each contraction.
Total volume would never be pumped out w/ each cotnraction.
72
What is the normal ejection fraction for a healthy adult?
50-70%
73
Explain hear failure with preserved ejection fraction (HFpEF)
This would be an example of diastolic failure - Left ventricular relaxation is impaired. This is the bodies attempt to compensate for dysfunction.
74
With HFpEF, what percentage usually determines that a person has got this?
more than 50%
75
Waht are some cuases of HFpEF?
* Hypertrophic cardiomyopathy (smaller ventricular volume)
* Restrictive cardiomyopathy (stiff ventricular walls)
* Myocardial fibrosis
* Pericardial constriction
76
Explain hear failure with reduced ejection fraction (HFrEF)
This is an example of systolic failure - Left ventricular contraction is impaired.
77
With HFrEF, what percentage usually determines that a person has got this?
Ejection fraction of less than 40%
78
What are the most common causes of HFrEF?
* Coronary Artery Disease
* volume Overload
- Dilated cardiomyopathy - ventricles stretched too much
- Valvular disease regurgitation - heart stretches but not valves, and valves cannot close properly.
* Increased Afterload - Increase in pressure
- Aortic or pulmonic stenosis
* Arrythmias - ventricles stretch and so does nerve endings.
79
Explain hear failure with midrange ejection fraction (HFmrEF)
Almost normal. This is a form of systolic failure, however the person may be asymptomatic.
80
With HFmrEF, what percentage usually determines that a person has got this?
40-49%
81
What can high EF (>75%) result in?
Hypertrophic cardiomyopathy.
82
What does a decrease in perfusion mean?
Cellular death or infarction.
83
If the heart is unable to pump enough blood to meet the body's demands or needs, then they're are said to be _______________
In heart failure.
84
When there is a problem with the contraction of the heart, it is a _________________ dysfunction.
systolic
85
When there is a problem with the filling of the heart, it is a _________________ dysfunction.
diastolic
86
What is the reason some patients experience diastolic dysfunction and some experience systolic dysfunction?
Reason is currently unknown.
87
Explain Cardiac compensation.
When there is an increase in oxygen demand in the body the heart tries to compensate for this.
88
Hoe does the Sympathetic nervous system compensate for increased oxygen demand via the heart?
Increases HR and force of contraction - faster and stronger contractions.
89
Explain increased preload in terms of cardiac compensation.
The heart does this bye dilated cardiomyopathy - the ventricles dilates to hold more blood - this often leads to weaker contractions due to prolonged stretch of the ventricles by blood volume. - good at first but then becomes a problem.
90
Why does Myocardial hypertrophy cause an increase in oxygen demand?
An increase in heart muscle mass = increase in oxygen demand of the heart - good at first but then becomes a problem.
91
What are the 3 non-modifiable risk factors of HF?
* Age > 60
* Male
* African American or Hispanic.
92
What are the 6 modifiable risk factors for HF?
* Smoking cessation
* Obesity
* Diabetes management
* ETOH - alcohol reduction
* Poor Diet
* Sedentary lifestyle.
93
True/False
Heart failure is almost always secondary to something else.
TRUE
94
What are some common causes of HF?
Coronary Artery Disease (CAD)
DM
HTN, PAH (Pulmonary arterial hypertension)
Cardiomyopathy
- Dilated cardiomyopathy (DCM)
- Hypertrophic cardiomyopathy (HCM)
Valvular Disorder
95
What does ADHF stand for?
Acute Decompensated Heart Failure.
96
Explain ADHF.
A = Acute
Decompensated = Deterioration of a structure or system previously working with the help of compensatory mechanisms.
Heart = organ that circulates blood
Failure = a state of insufficiency or declined performance leading to dysfunction of a body system.
97
Waht signs and symptoms will we see with ADHF?
* Tachypnea and SOB (shortness of breath)
* Pulmonary edema or flash pulmonary edema - lungs working against too much fluid build up around lungs.
* Pulmonary edema w / Hemoptysis (bloody sputum) - medical emergency
- crackles
- tachycardia
- Hypotension
- Severe dyspnea - shortness of breath.
- Orthopnea
- Use of accessory muscles to breathe
98
What is the most common cause of right sided HF?
Left sided HF
99
What are 2/3 of left sided HF the result of?
Systolic dysfunction (pumping)
Left ventricle cannot pump enough blood to go into systemic circulation, this increases the patients end diastolic pressure - fluid and pressure is forced back into the pulmonary system (this is why left causes right) - leading to pulmonary edema and flash pulmonary edema and impaired gas exchange.
100
Explain right sided HF.
Right ventricle cannot effectively pump blood into pulmonary circulation. The elevated pressure in the the pulmonary system reduces the amount of blood entering pulmonary circulation which leads to fluid backup in the systemic circulation.
101
What are 3 symptoms that right sided HF may cause?
Liver - Hepatomegaly
Abdomen - Ascites
Increased venous pressure (JVD & increased hydrostatic pressure in venous system)
102
Right sided HF is normally caused by left sided HF, but it can also be caused by ________________________ ?
Chronic lung disease (COPD) or cor pulmonale.
103
What are some clinical manifestations of left sided HF?
* Pulmonary congestion, crackles/rales
* S3 (lub dee dub) or "ventricular gallop", tachycardia
* DOE (dyspneic of excretion) , SOB (shortness of breath), orthopnea
* Low o2 sat - due to impaired gas exchange
* Dry, non productive cough initially
* Oliguria
* Paroxysmal nocturnal dyspnea
* Fatigue, lethargy
104
What are some clinical manifestations of right sided HF?
* Visceral and peripheral congestion - fluid build up in organs and tissue
* Increased CVP (central venous pressure)
* Jugular venous distention (JVD)
* Peripheral edema - blood backing up in body
* Hepatomegaly
* Ascites
* Weight gain - fluid retention.
105
Is Congestive Heart failure usually right sided or left sided?
It is usually both.
106
With congestive heart failure, where do we normally see the congestion?
Lungs - pulmonary edema
Liver - Portal hypertension
Abdomen - ascites
107
To diagnose HF, what labs do we use?
BNP
CMP
Urinalysis
108
With suspicion of HF, what might a chest X-ray show?
Cardiomegaly - an enlarged heart.
109
What are some collaborative problems that patients may experience with HF?
* Pulmonary edema
* Hypotension, poor perfusion and cardiogenic shock
* arrythmias
* Thromboembolism
* Pericardial effusion
110
What are some ways that we can mange HF medically?
* Oral and IV medications
* Lifestyle modifications
* supplemental O2
* Surgical interventions : ICD, valve repair and heart transplant.
111
Why would we administer diuretics to a patient with HF?
To decrease fluid volume - we need to ensure that we are however monitoring electrolytes closely.
112
Why would we administer Angiotensin-converting enzyme (ACE) inhibitors to patients with HF?
They help reduce afterload by vasodilation, preload by reducing excess blood volume, and cardiac remodeling
113
Why would we administer Angiotensin II receptor blockers (ARB's) to patients with HF?
Angiotensin II receptor blockers (ARBs) are used in heart failure (HF) treatment as an alternative to ACE inhibitors when patients cannot tolerate them (usually due to a persistent dry cough or angioedema). They provide similar hemodynamic and survival benefits by blocking the renin-angiotensin-aldosterone system (RAAS) but through a different mechanism.
114
Why would we administer Beta blockers (ARB's) to patients with HF?
May be prescribed in addition to ACE inhibitor - may take several weeks to take effect. They counteracting the harmful effects of chronic sympathetic nervous system (SNS) activation - slows the heart rate
115
Explain the drug Ivabradine and why we give it to patients with HF?
Reduces the rate of conduction through the SA node - important to monitor patient for decreased HR and BP
116
Explain the drug Hydralazine and isosorbide dinitrate and why we give it to patients with HF?
Used as an alternative to ACE inhibitors - observe for decreased BP
117
Explain the drug Digitalis and why we give it to patients with HF?
Improves contractility - monitor for digitalis toxicity especially if patient is hypokalemic.
118
With patients hospitalized with ADHF, what drugs would we administer to them?
* Dopamine
* Dobutamine
* Milrinone
* Vasodilators
119
Explain why we would give Dopamine to a patient with ADHF.
This is a vasopressor to increase BP and myocardial contractility - should be used as an adjunct to loop diuretics to excrete extra fluid volume.
120
Explain why we would give Dobutamine to a patient with ADHF.
Used for patients with left ventricular dysfunction, it increased cardiac contractility and renal perfusion - helps heart beat stronger.
121
Explain why we would give Milrinone to a patient with ADHF.
Decreased preload and afterload, causes hypotension and may increase the risk of dysrhythmias.
122
Explain why we would give Vasodilators to a patient with ADHF.
IV nitro, nitroprusside, nesiritide - enhances symptom relief.
123
Older people may not present with the same symptoms of HF as younger people, what are some of the atypical symptoms that we may see with older patients?
Fatigue, weakness and somnolence.
124
What is the reason why diuretics may not be as effective in treating HF in older patients as it is with younger patients?
Older patients may have decreased renal function which may make the resistant to diuretic and more sensitive to changes in fluid volume. We may need to try different types of diuretics.
125
Why is it important to monitor older men on diuretics more closely?
They need to be observed for bladder distention caused by urethral obstruction from an enlarged prostate gland (BPH)
126
What goals should we set with patients with HF?
* Promote activity and reduce fatigue
* Relieve fluid overload
* Decrease anxiety
* Education for pt and family
* optimize treatment of co-morbidities.
127
What should the diet look like for patients with HF?
Low-sodium diet and fluid restriction.
128
What is normally the cause of Pulmonary Edema?
Left HF, blood begins backing up into the pulmonary system which will result in pulmonary edema.
129
Why does Pulmonary edema lead to hypoxemia?
All the fluid that is surrounding the lungs will impair the gas exchange at the alveolar level.
130
what are the clinical manifestations of Pulmonary Edema?
* Restlessness
* Anxiety
* Tachypnea
* Dyspnea
* Cool and clammy skin
* Cyanosis
* Weak and rapid pulse
* Cough
* Lung congestion
* increased sputum production
* decreased level of consciousness - CO2 buildup
131
how would we manage PE?
Prevention is easier than treatment.
Monitor lung sounds for signs of decreased activity tolerance and increased fluid retention.
Minimize exertion and stress
Provide oxygen via NRB ( non-rebreather), CPAP or BIPAP
Medication such as furosemide or vasodilators such as Nitroglycerin,
132
What nursing interventions should we do when caring for patients with PE?
* Positioning - sit them up to promote circulation.
* Psychological support
* Monitoring medications
* I&O
133
What is a Thromboembolism?
A thromboembolism is a condition where a blood clot (thrombus) forms in a blood vessel, dislodges, and travels through the bloodstream, blocking another vessel (embolism). This can lead to serious complications depending on where the clot lodges.
134
What is the reason patients with HF are at a greater risk of a thromboembolism?
More at risk for an arterial and venous thromboembolism. Because the blood isn't moving properly it can form cloths due to coagulation. This may happen especially in patients with A-fib
135
With a pulmonary embolism, where does the clot normally come from?
The leg.
136
What does A-fib normally cause?
Strokes.
137
What is Pericardial Effusion?
The accumulation of fluid in the pericardial sac.
138
What is cardiac tamponade?
The restriction of heart function because of pericardial effusion, resulting in decreased venous return and decreased CO.
139
What are the clinical manifestations of Pericardial effusion ?
diffused chest pain or fullness
Pulsus paradoxus - what your hearing isn't what you are feeling
Engorged neck veins
Labile or low BP - blood pressure changes rapidly
shortness of breath.
140
What are the cardinal signs of cardiac tamponade?
Sudden chest pain
Falling systolic BP
Narrowing pulse pressure
Rising venous pressure
Distant heart sound - due to fluid buildup.
141
How do we manage Pericardial effusion and cardiac tamponade medically?
Pericardiocentesis
Pericardiotomy
142
Explain Pericardiocentesis
Puncture of the pericardial sac to aspirate pericardial fluid
143
Explain Pericardiotomy
144
What is acute coronary syndrome?
A constellation of signs and symptoms due to the rupture of atherosclerotic plaque and resultant partial or complete thrombosis within a diseased coronary artery
## Footnote
Acute coronary syndrome includes conditions such as unstable angina and myocardial infarction.
145
What does afterload refer to?
The amount of resistance to ejection of blood from the ventricle
## Footnote
Afterload is influenced by systemic vascular resistance and arterial compliance.
146
Where is the apical impulse normally palpated?
At the fifth intercostal space, left midclavicular line
## Footnote
The apical impulse is caused by contraction of the left ventricle.
147
What is the function of the atrioventricular (AV) node?
Secondary pacemaker of the heart
## Footnote
It is located in the right atrial wall near the tricuspid valve.
148
What are baroreceptors?
Nerve fibers located in the aortic arch and carotid arteries responsible for control of blood pressure
## Footnote
They help regulate blood pressure through feedback mechanisms.
149
What is cardiac catheterization?
An invasive procedure used to measure cardiac chamber pressures and assess patency of the coronary arteries
## Footnote
It can also be used for interventions like angioplasty.
150
What does the cardiac conduction system do?
Generates and coordinates the transmission of electrical impulses to myocardial cells
## Footnote
This system includes structures such as the SA node, AV node, and bundle of His.
151
Define cardiac output.
Amount of blood pumped by each ventricle in liters per minute
## Footnote
Cardiac output is calculated as heart rate multiplied by stroke volume.
152
What is a cardiac stress test?
A test used to evaluate the functioning of the heart during increased oxygen demand
## Footnote
It may be initiated by exercise or medications.
153
What is contractility?
Ability of the cardiac muscle to shorten in response to an electrical impulse
## Footnote
Increased contractility enhances cardiac output.
154
What does depolarization refer to?
Electrical activation of a cell caused by the influx of sodium into the cell while potassium exits
## Footnote
This process is crucial for the generation of action potentials in cardiac cells.
155
What occurs during diastole?
Period of ventricular relaxation resulting in ventricular filling
## Footnote
Diastole is essential for adequate blood volume in the ventricles.
156
What is ejection fraction?
Percentage of the end-diastolic blood volume ejected from the ventricle with each heartbeat
## Footnote
It is a key measurement in assessing heart function.
157
What is hemodynamic monitoring?
Use of pressure monitoring devices to directly measure cardiovascular function
## Footnote
It helps in assessing the severity of cardiac conditions.
158
Define hypertension.
Blood pressure that is persistently greater than 130/80 mm Hg
## Footnote
Hypertension increases the risk of cardiovascular disease.
159
What is hypotension?
A decrease in blood pressure to less than 90/60 mm Hg that compromises systemic perfusion
## Footnote
It can lead to symptoms like dizziness and fainting.
160
What are murmurs?
Sounds created by abnormal, turbulent flow of blood in the heart
## Footnote
Murmurs can indicate underlying heart conditions.
161
What is myocardial ischemia?
Condition in which heart muscle cells receive less oxygen than needed
## Footnote
It can lead to chest pain or angina.
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What is the myocardium?
Muscle layer of the heart responsible for the pumping action of the heart
## Footnote
It is the thickest layer and is essential for cardiac function.
163
What are normal heart sounds?
Sounds produced when the valves close; normal heart sounds are S1 and S2
## Footnote
S1 corresponds to the closure of the atrioventricular valves, and S2 corresponds to the closure of the semilunar valves.
164
What are opening snaps?
Abnormal diastolic sounds generated during the opening of rigid atrioventricular valve leaflets
## Footnote
They can indicate conditions such as mitral stenosis.
165
What is orthostatic hypotension?
A significant drop in blood pressure (20 mm Hg systolic or more or 10 mm Hg diastolic or more) after an upright posture is assumed
## Footnote
This condition can lead to dizziness or fainting when standing up quickly.
166
Define preload in the context of cardiac function.
Degree of stretch of the cardiac muscle fibers at the end of diastole
## Footnote
Preload is an important determinant of stroke volume.
167
What does pulmonary vascular resistance refer to?
Resistance to blood flow out of the right ventricle created by the pulmonary circulatory system
## Footnote
This resistance affects the workload of the right ventricle.
168
What is pulse deficit?
The difference between the apical and radial pulse rates
## Footnote
This may indicate issues with cardiac output or rhythm.
169
What are radioisotopes?
Unstable atoms that give off small amounts of energy in the form of gamma rays as they decay; used in cardiac nuclear medicine studies
## Footnote
They help visualize cardiac function and blood flow.
170
What is repolarization in cardiac physiology?
Return of the cell to resting state, caused by reentry of potassium into the cell while sodium exits the cell
## Footnote
This process is crucial for the cardiac cycle and electrical activity of the heart.
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What does S1 represent in heart sounds?
The first heart sound produced by closure of the atrioventricular (mitral and tricuspid) valves
## Footnote
It marks the beginning of systole.
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What does S2 indicate?
The second heart sound produced by closure of the semilunar (aortic and pulmonic) valves
## Footnote
It marks the end of systole.
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What is S3?
An abnormal heart sound detected early in diastole as resistance is met to blood entering either ventricle; most often due to volume overload associated with heart failure
## Footnote
It is often heard in patients with heart failure.
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What does S4 signify?
An abnormal heart sound detected late in diastole as resistance is met to blood entering either ventricle during atrial contraction; most often caused by hypertrophy of the ventricle
## Footnote
It is associated with stiff ventricles.
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What is the sinoatrial (SA) node?
Primary pacemaker of the heart, located in the right atrium
## Footnote
It initiates the electrical impulses that dictate heart rhythm.
176
Define stroke volume.
Amount of blood ejected from one of the ventricles per heartbeat
## Footnote
It is a key component of cardiac output.
177
What is a summation gallop?
Abnormal sounds created by the presence of an S3 and S4 during periods of tachycardia
## Footnote
It indicates significant cardiac issues.
178
What does systemic vascular resistance mean?
Resistance to blood flow out of the left ventricle created by the systemic circulatory system
## Footnote
It influences blood pressure and cardiac workload.
179
What is systole?
Period of ventricular contraction resulting in ejection of blood from the ventricles into the pulmonary artery and aorta
## Footnote
It is a critical phase of the cardiac cycle.
180
What is a systolic click?
Abnormal systolic sound created by the opening of a calcified aortic or pulmonic valve during ventricular contraction
## Footnote
It often indicates valve pathology.
181
Define telemetry in a medical context.
The process of continuous electrocardiographic monitoring by the transmission of radio waves from a battery-operated transmitter worn by the patient
## Footnote
It allows for real-time monitoring of cardiac activity.
182
What is ablation?
Purposeful destruction of heart muscle cells, usually in an attempt to correct or eliminate an arrhythmia
## Footnote
Ablation is often used in cases where other treatments for arrhythmias are ineffective.
183
Define arrhythmia.
Disorder of the formation or conduction of the electrical impulse within the heart, altering the heart rate, heart rhythm, or both
## Footnote
Also referred to as dysrhythmia.
184
What is an artifact in ECG?
Distorted, irrelevant, and extraneous electrocardiographic waveforms
## Footnote
Artifacts can lead to misinterpretation of heart activity.
185
What does automaticity refer to in cardiac cells?
Ability of the cardiac cells to initiate an electrical impulse
## Footnote
Automaticity is essential for the heart's rhythmic function.
186
What is cardiac resynchronization therapy (CRT)?
Biventricular pacing used to correct interventricular, intraventricular, and atrioventricular conduction disturbances in patients with heart failure
## Footnote
CRT helps improve heart function and symptoms in heart failure patients.
187
Define cardioversion.
Electrical current given in synchrony with the patient’s own QRS complex to stop an arrhythmia
## Footnote
This method is often used for atrial fibrillation or flutter.
188
What does chronotropy measure?
Rate of impulse formation
## Footnote
It indicates how fast the heart beats.
189
What is conduction in the context of the heart?
Transmission of electrical impulses from one cell to another
## Footnote
Proper conduction is critical for coordinated heartbeats.
190
What is defibrillation?
Electrical current given to stop an arrhythmia, not synchronized with the patient’s QRS complex
## Footnote
Defibrillation is used in life-threatening arrhythmias.
191
Define depolarization.
Process by which cardiac muscle cells change from a more negatively charged to a more positively charged intracellular state
## Footnote
Depolarization is vital for initiating heart contractions.
192
What does dromotropy refer to?
Conduction velocity
## Footnote
It affects how quickly electrical impulses travel through the heart.
193
What is an electrocardiogram (ECG)?
A record of a test that graphically measures the electrical activity of the heart, including each phase of the cardiac cycle
## Footnote
ECGs are crucial for diagnosing heart conditions.
194
What is an implantable cardioverter defibrillator (ICD)?
A device implanted into the chest wall to treat arrhythmias
## Footnote
ICDs monitor heart rhythms and deliver shocks if dangerous arrhythmias occur.
195
What does inotropy indicate?
Force of myocardial contraction
## Footnote
Inotropic agents can increase or decrease the strength of heart contractions.
196
What does the P wave represent in an ECG?
Conduction of an electrical impulse through the atrium; atrial depolarization
## Footnote
The P wave is the first deflection in the ECG cycle.
197
Define paroxysmal arrhythmia.
Arrhythmia that has a sudden onset and terminates spontaneously; usually of short duration, but may recur
## Footnote
Such arrhythmias can be distressing but often resolve on their own.
198
What is the PP interval in an ECG?
The duration between the beginning of one P wave and the beginning of the next P wave; used to calculate atrial rate and rhythm
## Footnote
It helps assess atrial function.
199
What does the PR interval reflect?
Conduction of an electrical impulse from the sinoatrial node through the atrioventricular node
## Footnote
Prolongation of the PR interval can indicate heart block.
200
What does the QRS complex represent in an ECG?
Conduction of an electrical impulse through the ventricles; ventricular depolarization
## Footnote
The QRS complex is crucial for assessing ventricular function.
201
Define QT interval.
The time from ventricular depolarization through repolarization
## Footnote
A prolonged QT interval can lead to serious arrhythmias.
202
What is repolarization?
Process by which cardiac muscle cells return to a more negatively charged intracellular condition, their resting state
## Footnote
Repolarization prepares the heart for the next contraction.
203
What is the RR interval?
The duration between the beginning of one QRS complex and the beginning of the next QRS complex; used to calculate ventricular rate and rhythm
## Footnote
It is essential for determining heart rate.
204
What is sinus rhythm?
Electrical activity of the heart initiated by the sinoatrial node
## Footnote
Sinus rhythm is the normal rhythm of the heart.
205
What does the ST segment reflect in an ECG?
The part of an ECG that reflects the end of the QRS complex to the beginning of the T wave
## Footnote
Changes in the ST segment can indicate ischemia.
206
What does the T wave indicate?
Repolarization of the ventricles
## Footnote
The T wave's shape and size can provide important diagnostic information.
207
What is the TP interval in an ECG?
The time between the end of the T wave and the beginning of the next P wave; used to identify the isoelectric line
## Footnote
It is important for assessing the baseline of the ECG.
208
What does the U wave represent?
May reflect Purkinje fiber repolarization; usually not seen unless a patient’s serum potassium level is low
## Footnote
The U wave's presence can indicate electrolyte imbalances.
209
What tends to form in the atrial appendage in patients with A-fib?
Clots.
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