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Medsurg > Cardiovascular Disorders and Perfusion Disorders > Flashcards

Cardiovascular Disorders and Perfusion Disorders Flashcards

Exam 2

1
Q

Anatomy of the Heart: What are the two major groups of valves?

A
  1. Atrioventricular valves
  2. Semilunar valves
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2
Q

Anatomy of the Heart: What are atrioventricular valves?

A
  1. Tricuspid
  2. Bicuspid (mitral)
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3
Q

Anatomy of the Heart: What are semilunar valves?

A
  1. Pulmonic
  2. Aortic
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4
Q

How does blood flow through the heart?

A

Rigth atrium–> Right Ventricle –> lungs–> oxygenated blood goes to Left atrium to Left ventricle

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5
Q

What initiates the contractility of the heart?

A

SA node

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6
Q

What is the rate the SA node generates impulses?

A

60-100 bpm

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7
Q

When the SA node fires, where are the impulses spread?

A

SA node fires.

Impulses spread through the atrial myocardium

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8
Q

If SA node fails to send impulses, what takes over?

A

AV node takes over (rate is 40-60 bpm)

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9
Q

After electrical impulse spreads through atrial myocardium, where does it go?

A

Impulse travels to the AV node

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10
Q

How does impulse leave the AV node in a normal functioning heart?

A

Impulse leaves the AV node through the bundle of His

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11
Q

After the impulse leaves the Bundle of His, where does it travel?

A

Impulse travels through the bundle branches

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12
Q

After the impulse leaves the bundle branches, where does it go?

A

Impulse extends into the ventricular tissue through the Purkinje fibers

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13
Q

Electrocardiogram: What are the components of the waves?

A

P wave
P R interval
P R segment
Q R S complex
Q R S interval
T wave
Q T interval

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14
Q

P wave

A

corresponds with atrial depolarization

The P wave is a record of the electrical activity through the upper heart chambers (atria).

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15
Q

PR interval: Where does it start and end?

A

Starts at the start of the P wave up to the beginning of QRS complex

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16
Q

PR interval: What does it represent?

A

It represents the time for electrical activity to move between the atria and the ventricles.

From SA node –> ventricular myocardium of the heart

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17
Q

What does the QRS interval represent?

A

Ventricular depolarization

Atrial repolarization

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18
Q

What does the T wave represent?

A

Ventricular repolarization

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19
Q

What is included in the cardiac cycle?

A

Diastole

Systole

Blood Pressure

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20
Q

Diastole- What is occurring?

A

The ventricles are filling

The ventricles are relaxes

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21
Q

How is the pressure in atria v ventricles in diastole?

A

Blood pressure is higher in the atrium than the ventricles

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22
Q

Systole- What is occurring

A

When the ventricles are contracting

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23
Q

How does the atrial pressure compare to the ventricular pressure in systole?

A

Atrial pressure is lower in systole

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24
Q

What is cardiac output?

A

The number in which the heart ejects blood from the left ventricle in 1 minute

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25
Formula for cardiac output
CO= HR x SV
26
What is the range of cardiac output?
4-8 L per minute
27
How should cardiac output be in rest compared to exercising?
CO should be higher while exercising than at rest
28
Heart Rate
number of beats per minute
29
What is a normal HR?
60-100
30
Stroke Volume
The amount of blood ejected with each ventricular contraction
31
What is stroke volume effected by?
Preload Afterload Contractility
32
Preload
The amount of blood in the ventricles at the end of diastole
33
Afterload
the resistance that the ventricles need to overcome to open the semilunar valves.
34
Contractility
Refers to the force of the mechanical contraction
35
When would contractility be decreased?
During hypoxia or acidotic state
36
Assessment
History Current health problems Physical Assessment – General assessment
37
Physical Assessment – General assessment includes:
Color Diaphoresis Edema Restlessness Agitation Confusion Weight Shortness of breath Mobility Vital signs
38
Assessment : What are you inspecting for?
Cyanosis, Capillary refill time, Edema, Distention of jugular veins, Clubbing of fingers/toes
39
Palpation- What are you palpating for?
Skin temperature, Pulses
40
What are you Auscultating for?
Heart sounds, Lung sounds
41
Diagnostic Studies include:
Laboratory Markers as Predictors of Heart Disease Markers of Acute Cardiac Damage or Injury EKG Radiology Echocardiogram
42
Diagnostic Studies: Laboratory Markers as Predictors of Heart Disease
Lipid panel
43
Diagnostic Studies: Laboratory Markers as Predictors of Heart Disease: Lipid panel includes
Total cholesterol Low-density lipoprotein High-density lipoprotein Triglycerides
44
High-Density Lipoproteins (HDLs)
Scavengers- cause reuptake in the liver. Is good cholesterol
45
What is the good ranges for HDLs?
Greater than 60 but 40 is acceptable
46
What are good LDL levels?
Less than 100
47
Diagnostic Studies: Markers of Acute Cardiac Damage or Injury include:
Creatinine kinase Troponin Myoglobin Brain natriuretic peptide
48
Creatinine kinase
Just a general marker of cellular injury, is not specific to the heart
49
CKMB
It is specific to the heart and specific to cardiac damage.
50
How are CK-MB levels in an injury? For how long?
elevated within four hours of the injury, and it stays elevated for at least ten days.
51
Myoglobin- What is it and is it specific to the heart?
Protein released when there is muscle damage
52
What markers of acute cardiac damage are specific to the heart?
Troponin levels
53
Diagnostic Studies: Radiology
Chest x-ray
53
Diagnostic Studies: Electrocardiography
Assesses electrical conduction system
54
Diagnostic Studies: Echocardiography includes
Transthoracic Trans-esophageal
55
Transesophageal echocardiogram (TEE): How is it done?
Transducer on the patient's esophageal region.
56
Transesophageal echocardiogram (TEE): What is not allowed during TTE?
Patient should not be eating or drinking anything for 8 hours- should be NPO. Meds should be given but with a small sip of water only.
57
Transthoracic echocardiogram (TTE)
Place transducer on patient's chest (thoracic area)
58
Diagnostic Studies: Cardiac Stress Test- What are the types?
Regular Stress Test Isotope (nuclear) stress test
59
Catheterization and Angiography includes
Cardiac catheterization Coronary angiography
60
What are cardiac stress tests done for?
These are done to evaluate the function of the heart during increased work. Also used to gage a person's symptoms if they have chest pain to see what if they have any type of dysrhythmias
61
Why would a chemical stress be done?
For someone who is unable to do the exercise required for a regular stress test
62
What drugs should not be given during a nuclear stress test?
Certain bp meds like beta blocker should not be given. Beta blockers blocker certain things from being seen
63
For a nuclear stress test, how should a patient prepare?
The patient should not smoke or caffeine the day before the procedure. They should not eat four hours before the procedure
64
Cardiac catheterization
Invasive procedure where a catheter is advanced to evaluate cardiac filling pressures
65
Cardiac catheterization- What does it measure?
Cardiac output
66
Cardiac angiography-what is it used for?
TO get a good visualization of the vessels
67
What does a patient need to do during a cardiac angiography?
The patient needs to lay flat because then getting up can increase the pressure and cause bleeding.
68
Complications of cardiac angiography?
Bleeding
69
After a cardiac angiography what do you need the patient to do?
Need the patient to lay flat anywhere between 2-6 hours and monitor their vital signs. Ask if they have any chest pain=bad make sure they don't have signs of stroke
70
Cardiac Dysrhythmia: What is it a problem with?
Conduction system
71
What is a cardiac rhythm of the heart electrical current starting at the SA node?
sinus rhythm
72
Dysrhythmias- Clinical manifestations include?
Palpitation Hypotension Diaphoresis Shortness of breath Syncope
73
Risk Factors for dysrhythmias?
Age Myocardial infarction (M I) Hypertension (H T N) Heart valve disease Heart failure (H F) Cardiomyopathy (C M) Infections Diabetes mellitus Sleep apnea Heart surgery (and procedures) Electrolyte disturbances Recreational drug use such as cocaine, alcohol, or tobacco Medication toxicities such as digoxin toxicity
74
Sinus Bradycardia- bpm? how does it appear?
Less than 60 beats per min Symtomatic Nonsymtomatic Treatment
75
When would we treat a patient for sinus brady?
When they are symptomatic
76
What is the treatment for sinus bradycardia if the patient is symptomatic?
1 mg of atropine IV push
77
Causes of sinus bradycardia:
1. Athlete 2. Hypothermia 3. Hypoxia 4. Sleeping
78
Sinus Tachycardia
Regular rhythm with greater than 100 bpm
79
Sinus Tachycardia: causes
Fever Anemia hypovolemia PE Hypotension MI
80
Treatment for Sinus Tach?
Finding cause of sinus tach Or give a beta blocker or calcium channel blocker
81
Premature Atrial Contraction (PAC)
Is an early impulse or beat
82
What is the treatment of PACs? What can be the cause?
find cause and eliminate cause excessive stimuli like caffeine or med
83
Atrial Fibrillation (Afib)- What are characteristics of it?
No defined p-wave Irregularly irregular
84
What kind of Afib do we treat? What kind do we not?
Spontaneous Afib is not treated. Non-spontaneous or persistent Afib is treated.
85
Causes of Afib:
Obesity Hypothyroidism Diabetes Kidney Disease
86
Afib treatments
Beta blockers, Calcium channel blockers Digoxin
87
Atrial flutter- What are characteristics?
No p waves Sawtooth pattern
88
Range for Aflutter?
250-350 bpm
89
Treatment for Aflutter?
Controlling the ventricular rate by giving a beta blocker or a calcium channel blocker. Only treat when patient is symptomatic
90
Supraventricular Tachycardia
Rapid heart rate
91
Supraventricular Tachycardia- Where does it originate? What are characteristics?
Originates above the ventricle Regular, narrow QRS
92
Treatment for SVT?
Look at causes Only do cardioversion if they are symptomatic?
93
PVCs?
Wide and atypical QRS complex No p wave Can be unifocal or multifocal
94
Two pvcs in a row? Every third ? Every other pvc?
Couplet Trigeminy Bigeminy
95
Ventricular Tachycardia?
Three or more PVCs in a row that is greater than 150 bpm
96
What does it mean when a patient has vtach with a pulse? What is the treatment?
They are able to maintain a blood pressure. Amiodarone and replacement of electrolytes
97
What does it mean if a patient is vtach and pulseless? What is the treatment?
This patient is in cardiac arrest Immediately initiate CPR and defibrillation
98
After initiating CPR and defibrillator in pulseless vtach patient, what do you administer?
Amiodarone and Epinephrine
99
Asystole
No measure of electrical activity
100
Asystole- treatment
Chest compressions if full code, initiate epinephrine

Medsurg (21 decks)

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