Cardiovascular Disorders and Perfusion Disorders Flashcards
Exam 2
Anatomy of the Heart: What are the two major groups of valves?
- Atrioventricular valves
- Semilunar valves
Anatomy of the Heart: What are atrioventricular valves?
- Tricuspid
- Bicuspid (mitral)
Anatomy of the Heart: What are semilunar valves?
- Pulmonic
- Aortic
How does blood flow through the heart?
Rigth atrium–> Right Ventricle –> lungs–> oxygenated blood goes to Left atrium to Left ventricle
What initiates the contractility of the heart?
SA node
What is the rate the SA node generates impulses?
60-100 bpm
When the SA node fires, where are the impulses spread?
SA node fires.
Impulses spread through the atrial myocardium
If SA node fails to send impulses, what takes over?
AV node takes over (rate is 40-60 bpm)
After electrical impulse spreads through atrial myocardium, where does it go?
Impulse travels to the AV node
How does impulse leave the AV node in a normal functioning heart?
Impulse leaves the AV node through the bundle of His
After the impulse leaves the Bundle of His, where does it travel?
Impulse travels through the bundle branches
After the impulse leaves the bundle branches, where does it go?
Impulse extends into the ventricular tissue through the Purkinje fibers
Electrocardiogram: What are the components of the waves?
P wave
P R interval
P R segment
Q R S complex
Q R S interval
T wave
Q T interval
P wave
corresponds with atrial depolarization
The P wave is a record of the electrical activity through the upper heart chambers (atria).
PR interval: Where does it start and end?
Starts at the start of the P wave up to the beginning of QRS complex
PR interval: What does it represent?
It represents the time for electrical activity to move between the atria and the ventricles.
From SA node –> ventricular myocardium of the heart
What does the QRS interval represent?
Ventricular depolarization
Atrial repolarization
What does the T wave represent?
Ventricular repolarization
What is included in the cardiac cycle?
Diastole
Systole
Blood Pressure
Diastole- What is occurring?
The ventricles are filling
The ventricles are relaxes
How is the pressure in atria v ventricles in diastole?
Blood pressure is higher in the atrium than the ventricles
Systole- What is occurring
When the ventricles are contracting
How does the atrial pressure compare to the ventricular pressure in systole?
Atrial pressure is lower in systole
What is cardiac output?
The number in which the heart ejects blood from the left ventricle in 1 minute
Formula for cardiac output
CO= HR x SV
What is the range of cardiac output?
4-8 L per minute
How should cardiac output be in rest compared to exercising?
CO should be higher while exercising than at rest
Heart Rate
number of beats per minute
What is a normal HR?
60-100
Stroke Volume
The amount of blood ejected with each ventricular contraction
What is stroke volume effected by?
Preload
Afterload
Contractility
Preload
The amount of blood in the ventricles at the end of diastole
Afterload
the resistance that the ventricles need to overcome to open the semilunar valves.
Contractility
Refers to the force of the mechanical contraction
When would contractility be decreased?
During hypoxia or acidotic state
Assessment
History
Current health problems
Physical Assessment – General assessment
Physical Assessment – General assessment
includes:
Color
Diaphoresis
Edema
Restlessness
Agitation
Confusion
Weight
Shortness of breath
Mobility
Vital signs
Assessment : What are you inspecting for?
Cyanosis, Capillary refill time, Edema, Distention of jugular veins, Clubbing of fingers/toes
Palpation- What are you palpating for?
Skin temperature, Pulses
What are you Auscultating for?
Heart sounds, Lung sounds
Diagnostic Studies include:
Laboratory Markers as Predictors of Heart Disease
Markers of Acute Cardiac Damage or Injury
EKG
Radiology
Echocardiogram
Diagnostic Studies:
Laboratory Markers as Predictors of Heart Disease
Lipid panel
Diagnostic Studies:
Laboratory Markers as Predictors of Heart Disease: Lipid panel includes
Total cholesterol
Low-density lipoprotein
High-density lipoprotein
Triglycerides
High-Density Lipoproteins (HDLs)
Scavengers- cause reuptake in the liver.
Is good cholesterol
What is the good ranges for HDLs?
Greater than 60 but 40 is acceptable
What are good LDL levels?
Less than 100
Diagnostic Studies:
Markers of Acute Cardiac Damage or Injury include:
Creatinine kinase
Troponin
Myoglobin
Brain natriuretic peptide
Creatinine kinase
Just a general marker of cellular injury, is not specific to the heart
CKMB
It is specific to the heart and specific to cardiac damage.
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.
Myoglobin- What is it and is it specific to the heart?
Protein released when there is muscle damage
What markers of acute cardiac damage are specific to the heart?
Troponin levels
Diagnostic Studies: Radiology
Chest
x-ray
Diagnostic Studies: Electrocardiography
Assesses electrical conduction system
Diagnostic Studies: Echocardiography includes
Transthoracic
Trans-esophageal
Transesophageal echocardiogram (TEE): How is it done?
Transducer on the patient’s esophageal region.
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.
Transthoracic echocardiogram (TTE)
Place transducer on patient’s chest (thoracic area)
Diagnostic Studies: Cardiac Stress Test- What are the types?
Regular Stress Test
Isotope (nuclear) stress test
Catheterization and Angiography includes
Cardiac catheterization
Coronary angiography
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
Why would a chemical stress be done?
For someone who is unable to do the exercise required for a regular stress test
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
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
Cardiac catheterization
Invasive procedure where a catheter is advanced to evaluate cardiac filling pressures
Cardiac catheterization- What does it measure?
Cardiac output
Cardiac angiography-what is it used for?
TO get a good visualization of the vessels
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.
Complications of cardiac angiography?
Bleeding
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
Cardiac Dysrhythmia: What is it a problem with?
Conduction system
What is a cardiac rhythm of the heart electrical current starting at the SA node?
sinus rhythm
Dysrhythmias- Clinical manifestations include?
Palpitation
Hypotension
Diaphoresis
Shortness of breath
Syncope
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
Sinus Bradycardia- bpm? how does it appear?
Less than 60 beats per min
Symtomatic
Nonsymtomatic
Treatment
When would we treat a patient for sinus brady?
When they are symptomatic
What is the treatment for sinus bradycardia if the patient is symptomatic?
1 mg of atropine IV push
Causes of sinus bradycardia:
- Athlete
- Hypothermia
- Hypoxia
- Sleeping
Sinus Tachycardia
Regular rhythm with greater than 100 bpm
Sinus Tachycardia: causes
Fever
Anemia
hypovolemia
PE
Hypotension
MI
Treatment for Sinus Tach?
Finding cause of sinus tach
Or give a beta blocker or calcium channel blocker
Premature Atrial Contraction (PAC)
Is an early impulse or beat
What is the treatment of PACs? What can be the cause?
find cause and eliminate cause
excessive stimuli like caffeine or med
Atrial Fibrillation (Afib)- What are characteristics of it?
No defined p-wave
Irregularly irregular
What kind of Afib do we treat? What kind do we not?
Spontaneous Afib is not treated.
Non-spontaneous or persistent Afib is treated.
Causes of Afib:
Obesity
Hypothyroidism
Diabetes
Kidney Disease
Afib treatments
Beta blockers,
Calcium channel blockers
Digoxin
Atrial flutter- What are characteristics?
No p waves
Sawtooth pattern
Range for Aflutter?
250-350 bpm
Treatment for Aflutter?
Controlling the ventricular rate by giving a beta blocker or a calcium channel blocker.
Only treat when patient is symptomatic
Supraventricular Tachycardia
Rapid heart rate
Supraventricular Tachycardia- Where does it originate?
What are characteristics?
Originates above the ventricle
Regular, narrow QRS
Treatment for SVT?
Look at causes
Only do cardioversion if they are symptomatic?
PVCs?
Wide and atypical QRS complex
No p wave
Can be unifocal or multifocal
Two pvcs in a row? Every third ? Every other pvc?
Couplet
Trigeminy
Bigeminy
Ventricular Tachycardia?
Three or more PVCs in a row that is greater than 150 bpm
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
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
After initiating CPR and defibrillator in pulseless vtach patient, what do you administer?
Amiodarone and Epinephrine
Asystole
No measure of electrical activity
Asystole- treatment
Chest compressions
if full code, initiate epinephrine
