Cardiovascular Flashcards
Coronary Perfusion Pressure normal range
60-80mmHg
Coronary blood flow remains constant when MAP is between…
60-140 (MAP)
- Middle layer of the heart muscle and 2. Muscle type
Myocardium; cardiac muscle
- Innermost layer of the heart and 2. Muscle type
Endocardium; smooth muscle
Fluid filled sac around heart
Pericardium
Cardiac tamponade is an extreme/potentially fatal presentation of…
Pericardial effusion
Coronary arteries stem from where?
First branch off the aorta, closest to the aortic valve
AtrioVentricular valves (in order)
TRI-cuspid before you BI-cuspid (Mitral)
What is happening when you hear S1, lub?
AV valves closing
AV valves close during…
Systole
What is happening when you hear S2, dub?
Semilunar valves closing
What are the semilunar valves?
Pulmonic and Aortic
Semilunar valves close during…
Diastole
VO2 refers to…
The actual volume of O2 in mL consumed per minute
Gold standard measurement of cardio fitness in athletes?
VO2 max
Coronary perfusion primarily occurs during what phase of the heart cycle?
Diastole
What artery is commonly referred to as the “widow maker?”
Left Coronary Artery (LCA) or Left main artery
What is the dominant supply of the AV node in 90% of the population?
RCA, right coronary artery
What is the intrinsic rate of the Purkinje fibers?
20-40 bpm
What is the intrinsic rate of the AV node?
40-60 bpm
What is the intrinsic rate of the SA node?
60-100 bpm
Autonomic nervous system consists of…
Sympathetic and parasympathetic nervous systems
Sympathetic NS: Neuro and chemical receptors called “__________” receptors which are stimulated by chemical messengers known as “______________”
Adrenergic; catecholamines
2 catecholamines in the Sympathetic NS
ADRENALine/epinephrine (hormone); NORepinephrine (primarily a NEUROtransmitter released in the brain but also released by adrenal* gland)
3 types of adrenergic receptors:
Alpha, Beta I, Beta II
Where are alpha receptors located?
Primarily on the vessels
Sympathomimetic drugs (5) that stimulate alpha receptors (vasoconstriction)
Phenylephrine, norepinephrine, epinephrine, dopamine GREATER than 10mcg/kg/min, angiotensin II (synthetic)
Beta I receptors are located primarily…
In the heart (you have 1 heart)
Sympathomimetic drugs (3) that stimulate beta I receptors: (inotropic)
Epinephrine, DOPamine LESS than 10mcg/kg/min, DOButamine
Beta II receptors are located where?
Bronchial and vascular smooth muscle (2 lungs)
Beta II stimulants (4) that produce __________ and ________….
Bronchodilation; vasodilation; Epinephrine, dobutamine, albuterol, isoproterenol
Parasympathetic system is controlled by what nerve?
Vagus nerve, cranial nerve 10
What node in the heart does the vagus nerve innervate?
SA node
What neurotransmitter activates the vagus nerve/parasympathetic system?
Acetylcholine (ACh)
5 ways to stimulate the vagal response:
Gagging, holding breath, bearing down, immersing face in ice water, carotid sinus massage
Anticholinergic (drug) means…
Inhibiting the parasympathetic system, vagolytic
This anticholinergic drug treats what?
Atropine; symptomatic BRADYCARDIA
How much atropine is given during ACLS?
0.5mg IVP
Pressure =
Flow X resistance
BP =
CO X Systemic Vascular Resistance
Normal Cardiac Output (CO)
4-8 L/min
Preload
Stretch on myofibrils at the end of diastole
Right heart Preload is measured as…
CVP or right atrial pressure
Left heart preload is measured as…
PAOP (pulmonary artery occlusive pressure) or Wedge pressure
Factors that increase PAOP or Wedge pressure
Left heart issues (cardiac tamponade…)
PAOP will be inaccurate if the PEEP is greater than…
10
Afterload is the pressure that…
The ventricles must push against to open the semilunar valves
Surprising pulmonary vasodilator:
Oxygen
Hyperthermia temperature threshold
> 38.5 degrees (101.3F)
Normal EF range
55%-75%
Normal MAP
70-105 (>65 goal)
Pulse pressure =
Difference between systolic and diastolic pressure
Normal pulse pressure range
30-50
Example of an event causing narrowed pulse pressure
Cardiac tamponade
What happens during the P wave
SA node fires, atrial depolarization, atrial contraction
What happens during QRS
AV node fires, ventricular depolarization and systole/contraction
What happens during T wave
Ventricular REpolarization, relaxation, diastolic filling
ST segment is time from…
Ventricular depolarization to complete repolarization
ST elevation indicates
Myocardial injury
ST depression indicates
Myocardial ischemia
Rewatch which video
electrocardiography
S3 sound, ventricular gallop
Lub-dup-da (slo-shing IN)
S3 happens when…
Blood is being forced into a distended ventricle, suggests fluid overload, CHF
S4 sound, atrial gallop
Da- lub dup (A stiff-wall)
S4 happens when…
Blood is being forced into a stiff hypertrophic ventricle
Order of murmur locations
A, P, T, M (upardonme)
Lub - Murmur - Dup
Systolic murmur
Lub - Dup - Murmur
Diastolic murmur
Normal CVP values
2-8 mmHg
PA waves
A, C, V
PA A wave indicates
Left atrial contraction
PA C wave indicates
Closure of mitral valve
PA V wave indicates
Left ventricular systole, passive filling of left atrium during atrial diastole
Elevated V wave indicates
Mitral regurgitation (pressure in left atrium)
PAOP measures pressure in what chamber of the heart
Left atrium
CVP money
Nickel
RVP money
Quarter / nickel
PAP money
Quarter / dime
PAOP money
Dime
LVP money
1 dollar / dime
What is the fifth vital sign?
SvO2 (mixed venous oxygen saturation)
SvO2 is drawn off of what line?
PA catheter
Normal SvO2 range
60-80%
High SvO2 values (>80%) indicate what?
Body is not consuming enough oxygen or it is receiving too much
4 causes of decreased oxygen extraction at tissue level
Early sepsis, cyanide toxicity, left shift/high PH, hypothermia
High pH makes blood ______ for ______
Sticky; oxygen
IABP both augments ____________, and improves ________ blood flow
Diastolic BP; coronary
2 types of pulmonary edema
Cardiogenic; non cardiogenic
PAP, MPAP, or PAOP >__mmHg are HIGH
> 30
Cardiac related causes of pulmonary edema
LV dysfunction; hypertensive crisis (huge after-load impedes forward flow)
After carotid endarterectomy, BP should stay below:
160mmHg (between 100 and 150)
Hallmark signs of cardiac tamponade (“______ triad”)
Beck’s triad; elevated CVP/JVD, HoTn, Muffled heart sounds
Pulsus paradoxus (seen in cardiac tamponade)
DECREASE in SBP (>10mmHg) during INSPIRATION
Normal Cardiac index:
2.5-4.o L/min/m2
Wedge pressure greater than ___ indicates a degree of _______________________
> 15mmHg; left sided heart failure
Normal level of BNP
125
Aldosterone is excreted by the Renal ______ and causes the renal tubules to retain ___ and ______
Cortex; sodium and water (And excrete potassium to maintain electrolyte balance)
BNP serves as a counter-regulatory system for the ____
RAAS (renin angiotensin aldosterone system)
Avoid _________ with HOCM (hypertrophic obstructive cardiomyopathy)
Inotropes
Main 3 ways to manage heart failure
Reduce preload, reduce afterload, improve contractility