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ntpe > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Where does blood get directed to from the right ventricle? Why?

A

Pulmonary artery to get oxygenated

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2
Q

What is the low-pressure pump of the heart?

A

Right ventricle –> pulmonary artery –> lungs

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3
Q

What is the high-pressure pump of the heart?

A

Left ventricle –> aortic artery –> systemic circulation

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4
Q

What does the left atrium receive from the lungs and four pulmonary veins?

A

oxygenated blood

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5
Q

When do the semilunar valves prevent backflow of blood into the ventricles?

A

during diastole

Pulmonary valve prevents right backflow
Aortic valve prevents left backflow

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6
Q

When do the AV valves prevent backflow of blood into the atria?

A

During systole

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7
Q

What is systole?

A

Period of ventricular contraction

End-systolic volume: amount of lood in the ventricles after systole
–> approx. 50mL

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8
Q

What is diastole?

A

Period of ventricular relaxation and filling

End-diastolic volume: volume of blood remaining in the ventricles after diastole; 120 mL

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9
Q

When does atrial contraction occur? What does it do?

A

a. During the last 1/3 of diastole
b. completes ventricular filling

Last 20-30% of end diastolic volume

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10
Q

Where does the RCA provide bloodflow?

A
  1. right atrium
  2. right ventricle
  3. inferior wall of left ventricle
  4. AV node –> SA node
  5. bundle of his
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11
Q

What artery provides the sinoatrial node with blood 60% of the time?

A

RCA

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12
Q

What artery supplies the SA node 40% of the time?

A

Left circumflex artery (LCx)

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13
Q

What are the two divisions of the LCA?

A
  1. Left anterior descending (LAD)
  2. circumflex artery
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14
Q

What does the left anterior descending artery provide blood to?

A
  1. left ventricle
  2. interventricular septum
  3. inferior apex

May also branch off to the right ventricle

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15
Q

Where does the left circumflex artery provide blood to?

A

Lateral and inferior walls of the left ventricle and atrium

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16
Q

Where does the coronary sinus receive blood from?

A

heart

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17
Q

Where does the coronary sinus empty into?

A

Right atrium

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18
Q

Where is the SA node located?

A

Junction of the SVC and right atrium

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19
Q

What does the SA node do?

A

Initiates pulse at a rate of 60-100 bpm

“pacemaker of the heart”

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20
Q

(true/false) The SA node and AV node have sympathetic and parasympathetic innervation

A

true

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21
Q

Where is the AV node located?

A

Junction of the right atrium and the right ventricle

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22
Q

What does the AV node merge with?

A

Bundle of His

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23
Q

What is the intrinsic firing rate of the AV node?

A

40-60 bpm

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24
Q

Where does conduction of the heart terminate?

A

SA node –> AV node –> bundle of his –> purkinje fibers

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25
Q

What is the intrinsic firing rate of purkinje fibers?

A

20-40 bpm

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26
Q

Describe the pathway of conduction within the heart.

A
  1. SA node sends and impulse throughout the atria (contract together)
  2. AV node is stimulated
  3. impulse travels down bundle of his to the purkinje fibers
  4. impulse spreads throughout the ventricles (contract together)
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27
Q

(true/false) Striated muscles fibers have less mitochondria compared to smooth muscle fibers

A

False

More muscle fibers

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28
Q

What is normal stroke volume?

A

50-100 mL/beat

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29
Q

What is preload?

A

Amount of blood left in the left ventricle at the end of diastole

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30
Q

(true/false) the greater the preload, the greater the amount of blood pumped

A

true

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31
Q

What is afterload?

A

Force of the left ventricle that generates during systole to overcome aortic pressure and open the aortic valve

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32
Q

Definition

Amount of blood discharged from the left or right ventricle per minute

A

Cardiac output

Stroke volume: amount of blood discharged from the ventricle during each contraction

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33
Q

What is the normal range of cardiac output?

A

4-5 L/minute

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34
Q

How is cardiac output calculated?

A

SV x HR

Regular cardiac index (CO divided y body surface area) : 2.5-3.5 L/min

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35
Q

definition

Percentage of blood emptied from the ventricle during systole

A

EF

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36
Q

How do you calculate EF?

A

SV / left ventricular end-diastolic volume

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37
Q

What is normal EF?

A

> 55%

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38
Q

What percent of EF is indicative of heart failure?

A

< 40%

The lower the EF, the more impaired the left ventricle is

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39
Q

definition

Difference between the atrial pressure and venous pressure.

A

Atrial filling pressure

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40
Q

When is right atrial filling pressure decreased?

A

During ventricular contraction

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41
Q

What affects atrial filling pressure?

A

Intrathoracic pressure

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42
Q

Venous return increases when blood volume (increases/decreases)

A

increases/expands

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43
Q

Diastolic filling time (increases/decreases) with elevated HR

A

decreases

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44
Q

definition

Represents the energy cost to the myocardium

A

myocardial oxygen demand (MVO2)

clinically measured t the product of HR and systolic BP (Rate pressure produce (RPP))

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45
Q

When does MVO2 increase?

A
  • actvitiy
  • increased HR
  • increased BP
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46
Q

What arteries DO NOT transport oxygenated blood from areas of high-pressure to low-pressure in tissues?

A
  1. umbilical vein (in utero)
  2. pulmonary veins
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47
Q

Where is the primary site of vascular resistance?

A

Arterioles

Terminal branches of arterues that attach to capillaries

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48
Q

What creates an anastomosis network?

A

when arterioles connect to capillaries

Function: exchange of nutrients and fluids between blood and tissues

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49
Q

There are (more/less) arteries than veins

A

Less arteries

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50
Q

Venous walls are (thinner/thicker) than arteries

A

thinner

Have one-way valves

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51
Q

Where do the lymphatic vessels and ducts empty?

A

Left subclavian vein

Body tissue –> veins –> lymphatic capillaries –> vessels –> lymphatic ducts –> left subclavian vein

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52
Q

What are the major lymph nodes?

A
  1. sumaxillary
  2. cervical
  3. axillary
  4. mesenteric
  5. iliac
  6. inguinal
  7. popliteal
  8. cubital
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53
Q

Where is parasympathic stimulation controlled from?

A

Medulla oblongata – cardioinhibitory center

  • Causes coronary arter vascocontriction
  • via vagus nerve and caridac plexus (innervates the SA and AV node which releases ACh and slows myocardial contraction)
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54
Q

Where is sympathetic stimulation controlled from?

A

Medulla oblongata - cardioacceleratory center

  • via T1-T4, upper thoracic to superior cervical chain ganglia (innervates SA and AV nodes releasing epinephrine and noepinephrine)
  • increases HR
  • coronary artery vasodilation
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55
Q

What is the name of drugs that increase sympathetic functioning?

A

Sympathomimetics

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56
Q

What is the name of drugs that decrease sympathetic functioning?

A

sympatholytics

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57
Q

What are baroreceptors the main mechanism for?

A

controlling HR

  • located in aortic arch and carotid sinus
  • Responds to changes in BP (circulatory reflexes)
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58
Q

Where are chemoreceptors located?

A

carotid ody

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59
Q

What receptors are sensitive to changes in lood chemicals: O2, CO2, and lactic acid?

A

chemoreceptors

  • Decreased pH results in an increased HR
  • Increased pH results in a decreased HR
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60
Q

What is hyperkalemia?

A

Increased potassium

Hypokalemia: decreased potassium

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61
Q

What does hyperkalemia cause within the cardiovascular system?

A

decreases the rate and force of contraction

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62
Q

What ECG changes are observed with hyperkalemia?

A
  1. Widened PR interval and QRS
  2. flattened P waves
  3. Tall/peaked T-waves
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63
Q

What ECG changes are observed with hypokalemia?

A
  1. flattened T-waves
  2. Prolonged PR and QT intervals
  3. “U wave”

arrythmias may progress to V-fib

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64
Q

Hypercalcemia (increases/decreases) heart action.

A

increases

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65
Q

What can hypermagnesemia result in?

A
  1. arrythmia
  2. cardiac arrest

Increased magnesium is a calcium channel blocker

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66
Q

What can hypomagnesemia cause?

A
  1. ventricular arrythmias
  2. coronary artery vasospasm
  3. sudden death
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67
Q

What is normal HR in Newborns? Children?

A

Newborns: 90-164

Children: 60-140

Adults 60-100

68
Q

Definition

Sustained HR increase >30 bpm within 10 minutes of standing

40 bpm increase in teenagers

A

Postural tachycardia syndrome

69
Q

What causes a weak, thready pulse?

A
  • low stroke volume
  • cardiogenic shock
70
Q

What can cause a bounding, full pulse?

A
  • Shortened ventricular systole and decreased peripheral pressure
  • aortic insufficiency
71
Q

What intercostal space is the pulmonic and aortic valves found in?

A

2nd

72
Q

What intercostal space is the bicuspid valve in?

A

5th

73
Q

What intercostal space is the tricuspid valve in?

A

4th

74
Q

What creates S1 sound?

A

Closing of bicuspid and tricuspid valves

Marks the beginning of systole

75
Q

What creates the S2 sound?

A

closure of the aortic and pulmonic valves

marks the end of systole

Decreased with aortic stenosis

76
Q

What is a systolic murmur? When does it occur? What can it indicate?

A

a. Extra sound that occurs between S1 and S2

b. can indicate possible valve disease

Can be normal

77
Q

What is a diastolic murmur? When does it occur? What can it indicate?

A

a. extra sound between S2 and S1

b. indicates valve disease

78
Q

What is the scale for heart murmurs?

A

1 (soft audible murmur)

to

6 (audible w/o use of stethoscope)

79
Q

What is a trill?

A

abnormal tremor accompanying a vascular or cardiac murmur that is felt on palpation

80
Q

What is bruit? Where is it commonly heard? What is it indicative of?

A

a. sound/murmur of arterial or venous origin
b. femoral and/or carotid arteries
c. indicative of atherosclerosis

81
Q

definition

Heart rhythm with three sounds in each cycle

A

gallop rhythm

S3 and/or S4

82
Q

What is S3 sound associated with? What can it be indicative of in older adults?

A

a. ventricular filling
b. Left ventricular heart failure (CHF)

83
Q

What is S4 associated with? What is it indicative of?

A

a. ventricular filling and atrial contraction
b. cardiac pathology (CAD, MI, aortic stenosis, chronic HTN)

84
Q

What creates a P-wave?

A

Atrial depolarization

85
Q

What creates the QRS wave?

A

ventricular depolarization

86
Q

What is the P-R interval?

A

time required for impulse to travel from the atria to the purkinje fibers

87
Q

What is the ST segment?

A

Beginning of ventricular repolarization

88
Q

What creates a T-wave?

A

ventricular repolarization

89
Q

What is the QT interval?

A

time of electrical systole

90
Q

definition

Premature beat arising from the ventricles

A

premature ventricular contractions (PVCs)

91
Q

(true/false) PVCs do not occur in normal population

A

False

They do occur in the majority of the normal population

92
Q

What is observed on a ECG when a PVC is present?

A
  • no P wave
  • wide and premature QRS
  • long compensatory pause
93
Q

What is indicative of a serious PVC?

A

> 6 PVC/minute, in sequential runs, and multifocal

94
Q

What is ventricular tachycardia?

A

4+ sequential PVCs at a very rapid rate (150-200 bpm)

Compromised CO

95
Q

What is ventricular tachycardia usually the result of?

A

ischemic ventricle

96
Q

What is observed on an ECG when ventricular tachycardia is present?

A
  • no P waves
  • wide QRS waves
97
Q

What is non-sustained ventricular tachycardia (NSVT)?

A

4+ consecutive beats that spontaneously terminate within 30 seconds

98
Q

What is sustained ventricular tachycardia (SVT)?

A

ventricular tachycardia lasting >30 seconds
and/or
requiring termination due to hemodynamic compromise in less than 30 seconds

99
Q

definition

Pulseless, emergency situation requiring CPR, Defibrillization, and/or medication.
- Characterized by chaotic activity of ventricle originating from multiple foci
- no effective CO is present

A

V-fib

100
Q

(true/false) you are able to determine HR when V-fib is present.

A

False

101
Q

What is observed on an ECG when V-fib is present?

A
  • erratic activity
  • no QRS complex
102
Q

How long does it take for clinical death to occur when v-fib is present?

A

4-6 minutes

103
Q

What is observed on an ECG when atrial arrythmias are present?

A
  • abnormal shape of P waves or absence of P waves
  • irregular rhythm (chronic or paroxysmal)
104
Q

What is the common HR when atrial tachycardia is present?

A

140-250 bpm

105
Q

What is the common HR when atrial flutter is present?

A

250-350 bpm

106
Q

What is the common HR when atrial fibrillation is present?

A

> 300 bpm

107
Q

(true/false) With atrial arrythmias, cardiac output is maintained as long as the patient’s HR is controlled

A

true

May precipitate ventricular failure in an abnormal heart

108
Q

What are AV blocks?

A

abnormal delay or failure of normal electrical conduction within the heart

109
Q

If ventricular rate is slowed, CO is (increased/decreased)

A

decreased

110
Q

What degree of heart block is life-threatening requiring surgical implantation of a pacemaker and use of medications (atropine)?

A

3rd degree AV block (complete heart block)

111
Q

What ECG changes are observed with hypercalcemia?

A
  1. wide QRS
  2. short QT interval
112
Q

What ECG changes are observed with hypocalcemia?

A

Prolonged QT interval

113
Q

What ECG changes are observed with hypothermia?

A
  1. elevated ST segment
  2. decreased rhythm
114
Q

What ECG changes can be observed when using digitalis?

A
  1. depressed ST segment
  2. Flattened T wave (or inverted)
  3. shortened QT interval
115
Q

What ECG changes can be observed when using quinidine?

A
  1. lengthened QT interval
  2. Flattened T wave (or inverted)
  3. wide QRS
116
Q

What cardiac changes can be observed when using beta blockers?

A

decreased HR

117
Q

What ECG changes can be observed when using antiarrythmic agents?

A
  1. prolonged QRS
  2. prolonged QT intervals
118
Q

(true/false) Medications are prescribed for all stages of HTN

A

False- not usually prescribed for stage I HTN…

Exception: prescribed for stage I HTN if pt has already had a heart attack, stroke, or is at high risk of heart attack or stroke with the presence of DM, CKS, or atheroclerosis.

119
Q

What MAP is indicative of hypotension?

A

< 50

120
Q

What BP changes indicates orthostasis?

A

SBP decreases > 20 mmHg
and/or
DBP decreases > 10 mmHg

s/s: lightheadedness, LOB, leg weakness, dizziness

121
Q

What BP measurements are considered as stage I HTN?

A

SBP 130-139 mmHg
or
DBP 80-89 mmHg

122
Q

What BP measurements are considered as stage II HTN?

A

SBP > 140 mmHg
or
DBP >90 mmHg

123
Q

What BP measurements are indicative of hypertensive crisis?

A

SBP > 180 mmHg
and/or
DBP > 120 mmHg

124
Q

After what age are levels defining high BP the same as adults?

A

After age 13

125
Q

(true/false) BP in children varies among age, height, and gender

A

true

126
Q

definition

Arterial pressure within large arteries over time that is dependent upon the mean blood flow and arterial compliance

A

MAP

MAP = SBP + 2(DBP) / 3

127
Q

What is a normal MAP?

A

70-110 mmHg

128
Q

What is the normal RR of a newborn?

A

30-40

129
Q

What is the normal RR of an adult?

A

12-20

130
Q

What is the normal RR of a child?

A

20-30

131
Q

definition

RR > 22 breaths/min

A

tachypnea

132
Q

definition

RR < 10 breaths/min

A

bradypnea

133
Q

definition

Increase in the depth and rate of breathing

A

hyperpnea

134
Q

definition

inability to breathe when reclined or in supine

A

orthopnea

135
Q

definition

sudden inability to breathing during sleep

A

paroxysmal nocturnal dyspnea (PND)

136
Q

What commonly causes crackles/rales?

A

secretions within the lungs

137
Q

what are the levels of the anginal scale?

A

1+ : light, barely noticeable

2+ : moderate, bothersome

3+ : severe, very uncomfortable

4+ : most severe pain experienced

138
Q

definition

low level of O2 within the tissues

A

hypoxia

139
Q

definition

complete lack of O2

A

anoxia

140
Q

Symptoms of angina occurs more in (men/women/equally)

A

women

141
Q

Where can cardiac pain refer to?

A
  • neck
  • jaw
  • back
  • shoulders
  • arms

Pain referred to the back can occur with dissecting aortic aneurysms

142
Q

What cardiac diagnosis can cause pallor or rubor?

A

PAD

143
Q

What is clubbing of the nails associated with?

Curvature of fingernails w/ soft tissue enlargement at the base of the nail

A
  1. chronic oxygen deficiency
  2. chronic pulmonary disease
  3. heart failure
144
Q

What is stemmer’s sign?

A

Dorsal skin folds of the toes or fingers are resistant to being lifted

145
Q

What is stemmer’s sign used to identify?

A
  1. fibrotic changes
  2. lymphedema
146
Q

What causes intermittent claudication?

A

PAD

147
Q

definition

Pain, cramping, and LE fatigue that occurs during exercise and is relieved by rest

A

intermittent claudication

148
Q

What diagnosis is bilateral edema associated with?

A

congestive heart failure

149
Q

What is the venous percussion test used for?

A

determines the competence of the greater saphenous vein

if pulse is felt by lower hand (20 cm below percussive hand), the intervening valves are incompetent

150
Q

What is the grading scale for edema?

A

1+ : mild indentation; < 1/4 inch of pitting

2+ : moderate depression that returns to normal within 15 seconds; 1/4 to 1/2 inch of pitting

3+ : severe depression that takes 15-30 seconds to rebound; 1/2 to 1 inch of pitting

4+ : very severe depression that lasts for > 30 seconds; 1+ inch of pitting

151
Q

What is the venous trendelenburg test used for?

(retrograde filling test)

A

determines the competence of communicating veins and saphenous system

  1. supine with LEs at 60 degrees elevation
  2. place tourniquet on proximal thigh
  3. patient stands
  4. observe if veins fill in normal pattern (takes approx 30 seconds)
152
Q

What is delayed venous filling time is indicative of venous insufficiency?

A

delayed filling for > 15 seconds

153
Q

How is ABI calculated?

A

ABI = LE pressure / UE pressure

  1. pt is supine at rest for 5 mins
  2. BP is taken at the brachial artery and posterioral tibial and dorsalis pedis arteries
154
Q

What is ABI used for?

A

calculating the risk for cardiovascular disease

155
Q

What ABI indicates non-compliant arteries?

A

1.4 +

156
Q

What ABI is considered as abnormal peripheral arterial circulation?

A

<0.9

157
Q

What ABI is indicative of severe arterial disease and/or is high risk for critical limb ischemia?

A

<0.5

158
Q

What is a clinically significant change in ABI?

A

Without symptoms: >0.15
With symptoms: >0.1

159
Q

What does a central line measure?

Swan-Ganz catheter

A
  • venous pressure
  • pulmonary artery pressure
  • pulmonary capillary wedge pressure
160
Q

What is the primary lab measure of myocardial infarction? What must it be accompanied by?

A

a. cardiac troponin

b.
- symptoms of ischemia
- new or presumed ST segment change
- loss of myocardium and/or new wall motion abnormality on imaging
- evidence of intracoronary thrombus

161
Q

(true/false) a decrease of CK or CPK can be indicative of myocardial infarction.

A

FALSE - an increase can be indicative of MI

Peaks within 12-24 hours

162
Q

What surgical intervention uses fluoroscopy and surgical dilation of a blood vessel with a balloon-tipped catheter inside the lumen?

Relieves obstructed blood flow in acute angina or acute MI

A

Percutaneous transluminal coronary angioplasty (PTCA)

163
Q

What is a heteroptics transplantation?

A

Leaving the natural heart along and allowing it to “piggyback” on the donor heart

164
Q

What is a orthotopic transplant?

A

Heart is removed and a new heart is placed

165
Q

What are the major complications of transplants?

A
  • rejection
  • infection
166
Q

After an acute MI, the patient should bbe limited to _______ METS or ____% of age-predicted HRmaz for 4-6 wks after the MI

A

5 mets or 70% HRmax

ntpe (13 decks)

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