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Patho > Cardiovascular system > Flashcards

Cardiovascular system Flashcards

1
Q

Anatomy of heart

A

-4 chambers

3 layers: endocardium, myocardium, epicardium

visceral and parietal pericardium

Left ventrical is 2-3x thicker than right

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2
Q

bloodflow through heart

A

SVC/IVC –> RA –> tricusp –> RV –> pulmonic valve –> pulmonary artery –> lungs –> pulmonary veins –> LA –> bicsup –> LV –> aortic valve –> systemic

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3
Q

chordae tendinae

A

anchored to papillary muscles –> keep mitral and tricuspid valve from going into atria during ventricular contraction

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4
Q

Coronary circulation

A

Left coronary artery
-Left anterior descending artery
-Left circumflex artery
-supply blood to LA, LV, interventricular septum, and part of RV

Right coronary artery
-supplies blood to RA, RV, part of posterior LV
-AV node and bundle of His –>imp for conduction

Coronary veins –> drain into coronary sinus

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5
Q

Conduction system

A

-specialized tissue creates and transports electrical impulses resulting in depolarization causing hear muscle contraction

SA node –> interatrial pathways –> atrial contraction –> AV node –> internodal pathways –> bundle of His –> left and right bundle branches –> Purkinje fibers –> ventricular contraction

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6
Q

Repolarization
Absolute refractory period
Relative refractory period

A

-contractile and conduction pathway cells regain resting polarized condition

-heart muscle doesn’t respond to any stimuli

-heart muscle gradually returns to normal

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7
Q

ECG waves and intervals

A

P wave = firing of SA node and depolarization of atria
QRS complex = depolarization from AV node throughout ventricles
T wave = repolarization of ventricles
U wave = repolarization of Purkinje fibers (big one= hypokalemia)

PR, QRS, QT intervals = travel time of signal from one area of heart to another

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8
Q

Mechanical system

A

Systole = contractin of heart muscles and ejection of blood from ventricles

Diastole = relaxation of heart muscles and ventricles fill with blood

Stroke volume = amt of blood ejected with each beat

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9
Q

Cardiac output and Cardiac index

A

CO = amt of blood pumped in a minute
-CO = SV x HR
-Normal = 4-8 L/min

Index = CO/BSA (body surface area)
-normal 2.8-4.2 L/min/m^2

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10
Q

Factors affecting CO

A

Stroke volume
-preload
-contractility
-afterload

Heart rate
-contolled by ANS
-sustained rapid HR = reduced diastolic filling and coronary artery perfusion

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11
Q

Preload

A

volume of blood stretching ventricles at end of diastole
-Frank starling law: increased stretch = increased force of contraction

**increased by HTN, aortic valve disease, and hypervolemia

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12
Q

Contractility

A

Increased with epinephrine and NE from SNS

Increased contractility raises SV by increasing ventricular emptying

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13
Q

Afterload

A

-peripheral resistance against which left ventricle must pump

*depends on size of ventricle, wall tension, and BP
*increased BP increases resistance = higher workload = hypertrophy (w/o change in chamber area or CO)

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14
Q

Cardiac Reserve

A

Ability of CV system to alter CO in response to situations like exercise, stress, and hypovolemia

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15
Q

Arteries
Arterioles
Endothelium

A

Arteries
-thick walls of elastic tissue to handle pressure; recoil propels blood forward
*large arteries (aorta/pulm art) also have smooth muscle

Arterioles = more smooth muscle
-major control of arterial BP and blood flow distribution through dilation and constriction

Endothelium = inner lining
-maintain homeostasis, promote blood flow, inhibits coagulation
-disruption results in coagulation and fibrin clot

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16
Q

Capillaries

A

Thin wall of endothelial cells –> no elastic or muscle
-connect arterioles and venules
-exchange nutrients and metabolic end products

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17
Q

Veins and Venules

A

Veins
-thin wall; large diameter
-low pressure; high volume
-intermittent valves move blood towards heart
-blood volume in venous sytem affected by: arterial flow, compression of veins by skeletal muscles, changes in thoracic and abdominal pressure, RA pressure (SVC=neck veins; IVC = liver engorgement)

Venules
-small muscle and CT
-collect blood from capillary beds to larger veins

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18
Q

ANS effect on CV syst

A

Effect on heart
-Sympathetic stimulation increases HR and speed of impulse thru AV node and force of contractions –> mediated by beta adrenergic receptors
-parasymp stimulation slows HR and impluse f/ SA to AV –> mediated by vagus nerve

Effects on blood vessels
-sympathetic stimulation of alpha adrenergic receptors causes vasoconstriction; decreased stimulation causes vasodilation

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19
Q

ANS: Baroreceptors

A

-Aortic arch and carotid sinus
-sensitive to stretch or pressure in arterial system
-stimulation sends message to vasomotor center in brainstem to inhibit SNS and enhance PNS to decrease HR and cause peripheral vasodilation
-decreased stretch/pressure does opposite

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20
Q

ANS: chemoreceptors

A

-aortic and carotid bodies and medulla
-increased CO2 = higher RR and changes in BP

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21
Q

Blood Pressure

A

Pressure exerted by blood on arterial walls

SBP = peak pressure during vent contraction –> under 120

DBP = residual pressure in arteries during vent relaxation –> under 80

Influencing factors: CO and SVR
-SVR = force opposing movement of blood
-BP = CO*SVR

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22
Q

Measurement of Bp

A

Invasive technique = catheter into artery –> attached to transducer

Noninvasive technique = sypygmomanometer and stethosope
-automated device
-doppler ultrasonic flowmeter

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23
Q

Pulse pressure and mean arterial pressure

A

Pulse pressure
-dif bt SBP and DBP
-Normally ab 1/3 of SBP

Mean arterial pressure
-average pressure w/in arterial system that’s felt by organs in body
-(SBP + 2DBP) / 3
-needs to be over 60 to perfuse vital organs

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24
Q

Gerontologic considerations

A

Risk for CVD increases with age
-CAD due to atherosclerosis is most common

CVD is leading cause of death in adults over 65

CV changes result of aging, disease, enviro, lifetime behaviors

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25
Q

Age related changes to CV system

composition
exercise
valves
pacemakers
beta adrenergic receptors

A

Increased collagen- decreased elastin
-myocardial hypertrophy

Decreased response to stress/exercise
-slower recovery HR, SV, CO

Heart valves become thick and stiff –> murmurs

Number of pacemaker cells decrease –> dysrhythmias; heart block

Decrease in number and func of beta adrenergic receptors –> decreased stress response and sensitivity to beta adrenergic agonists

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26
Q

Age related changes

blood vessels
venous valves
bp
spine

A

Blood vessels thicken and less elastic –> increase in SBP and decrease or no change in DBP

Incompetent venous valves –> dependent edema

Orthostatic hypotension and postprandial hypotension (fall risk)

kyphosis

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27
Q

Assessment of CV system: history

A

Direct or indirect CV issues, all symptoms and allergies
-diabetes, alc/tobacco, angina, strep, rheumatic fever…

past and current meds –> prescription, OTC, herbal, noncardiac

surgeries or other treatments

28
Q

Assessment of CV functional health patterns

health management
nutrition
elimination
activity/exercise

A

Health management
-risk factors, allergies, genes

Nutrition
-weight and salt/fat

Elimination pattern
-diuretics, swelling, constipation (don’t do valsalva maneuver if heart probs)

Activity/exercise
-SOB, chest pain, claudication

29
Q

Assessment of CV syst: Functional health patterns

sleep/rest
cognitive
self-perception

A

Sleep/rest
-SOB, orthopnea, sleep apnea, nocturia
-HF = paroxysmal nocturnal dyspnea and Cheyne-stokes

Cognitive
-syncope, language/memory probs, pain

Self perception
-body image, activity level

30
Q

Assessment of CV syst: Functional health patterns

role/relationship
sexuality
coping
values/belief

A

role/relationship
-support systems; areas of stress/conflict

sexuality
-fear of death, fatiguem chest pain SOB
-ED = symptom of PVD or side effect of meds for CVD
-HT for women poses risks

coping
-sources of stress and support

Values
-culture and religion

31
Q

Genetic risk alert!

A

Coronary artery disease
-lipoprotein gene links

Cardiomyopathy
-autosomal and X-linked dominant mutations

HTN
-genetic, environmental, and ifestyle factors

32
Q

Assessment of peripheral vascular system

A

Inspect
-skin color, hair distribution, venous pattern, edema, clubbing, lesions
-jugular vein distension

Palpate
-Temp, moisture, edema (1+-4+)
-pulse (0 to 3); thrill
-capillary refill <2 secs

Auscultation
-bruit

33
Q

Physical examination of thorax

A

Auscultatory areas: aortic, pulmonic, tricuspid, mitral, and Erb’s point

Epigastric area: abdominal aorta

Precordium: look for heaves

Point of maximal impulse (apical pulse) = mitral fifth ICS, MCL

34
Q

Auscultation

A

S1 = closure of tricuspid and mitral valves, “lubb”, beginning of systole

S2 = closure of aortic/pulmonic valves; “dupp”; beginning of diastole

use diaphragm

Pulse defecit = dif bt apical and radial pulses –> dysrhythmia

35
Q

where in ECG to lubb and dupp occur?

A

lubb = QRS

dupp = post T

36
Q

Extra sounds

A

Spit S2 = pulmonic area
-normal during inspiration; abnormal if during expiration

S3 or S4 = low frequency vibrations
-lean forwards and listen to 2nd ICS aortic and pulmonic
-left side-lying - listen to mitral

S3 = ventricular gallop
-from left HF or mitral regurgitation

S4 = atrial gallop
-from CAD, cardiomyopathy, LV hypertrophy, or aortic stenosis

37
Q

Murmurs and friction rubs

A

Murmurs
-graded on 6 pt Roman numeral scale of loudness

Pericardial friction rubs: pericarditis
-inflamed surfaces of the pericardium move against each other; high-pitched, scratchy sounds
-may be intermittent and last days to hours
-listen at apex with patient upright, leaning forward, and holding breath

38
Q

abnormal sounds

A

record timing, location, and position of patient when sounds occur

39
Q

Cardiac biomarkers

A

injured cells release enzymes and proteins into blood
-consider time from onset of symptoms of ACS
-Troponin, Copeptin, and creatine kinase

40
Q

Cardiac biomarker: troponin

A

Troponin T
Troponin I

Myocardial infarction or injury

Rises w/in 4-6 hrs; peaks 10-24 hrs; detected for 10-14 days

41
Q

Cardiac biomarker: copeptin

A

substitute biomarker for arginine vasopressin AVP
-detected immediately with MI
-copeptin and troponin = rapid diagnosis of acute MI
-high levels with HF patients = increased mortality

42
Q

Cardiac biomarker: creatine kinase

A

-3 isoenzymes
-CK-MB cardiac specific –> increases with MI or injury

-rises in 3-6 hrs, peaks in 12-24 hrs, returns to baseline w/in 12-48 hrs

43
Q

C-reactive protein (CRP)

A

marker from liver for inflammation
-inked to atherosclerosis and first heart event –> predicts risk of future heart events

44
Q

Homocysteine (Hcy)

A

protein catabolism
-hereditary or dietary deficiency of vits B6, B12, or folate
-high levels = increased risk for CVD, PVD, and stroke

45
Q

Cardiac natriuretic peptide markers

A

3 kinds: ANP, BNP (heart failure), CNP

Increased levels f BNP distinguishes cardiac vs respiratory cause of dyspnea

NT-pro-BNP (HF)

Increased DBP leads to release of BNP and NT-pro-BNP –> leads to increased urinary excretion of Na+

46
Q

Serum lipids and lipoprotein

A

Serum lipids
-triglycerides = storage form of lipids
-cholesterol = absorbed from food and made in liver
-phospholipids = glycerol, fatty acids, phosphates, and nitrogenous compound

Lipoprotein
-serum lipids bind to protein to circulate in blood

47
Q

4 classes of ipoprotein

A
  1. chylomicrons
  2. low density lipoproteins
  3. high density lipoproteins
  4. very low density lipoproteins

Increased triglycerides and LDL = CAD risk

Increased HDL = decreased risk of CAD

Cholesterol:HDL measures risk

48
Q

Other serum lipoproteins used as predictors of risk for CAD

A

apolipoprotein A-I = HDL protein
Apolipoprotein B = LDL protein
Lipoprotein (a) + lactate dehydrogenase = atherosclerosis
Lipoprotein-assos phospholipase A2 = atherosclerotic placques

49
Q

ECG

A

-12 lead ECG
-ambulatory ECG monitoring (Holter)
-Exercise or stress testing

50
Q

Event monitor or loop recorder

A

External = electrodes worn for a month –> activated by patient when symptoms occur

Internal = for serious, infrequent dysrhythmias; continuous monitor when symptoms occur or when HR increases or decreases from set rate

51
Q

Functional studies

A

Exercise or stress testing
-hehart symptoms with activity –> increased O2 demand
-assess CVD; set limits for exercise
-patients walk or ride bike while ECG and BP monitored

6 min walk test
-for general fitness
-flat surface; baseline response to treatment and PT

Noninvasive hemodynamic monitoring
-monitors SV, CO, and BP by finger cuff or thoracic bioreactance; used during complex surgery

52
Q

iMAGING

A

Chest xray
-hear is displaced or enlarged
-pericardial effusion
-pulmonary congestion

53
Q

Echocardiogram

A

-ultrasound waves record movement of heart structures with or without contrast

Determines abnormalities of:
-valve structures and motion
-heart chamber size and contents
-ventricular and septal motion and thickness
-pericardial sac
-ascending aorta

Measures eection fraction = % of end diastolic blood volume ejected during systole

54
Q

Echocardiogram

Mmode
2D
Doppelr
Color flow/ duplex

A

Motion made
-single beam
-motion, wall thickness, and chamber size

2D
-sweeping beam
-shows spatial relationships of structures

Doppler
-uses sound evaluation of flow or motion of scanned object

color/duplex
-combo of 2D and doppler –> shows speed and direction of blood flow

55
Q

Echocardiogram

real time 3D
Stress echocardiography

A

Real time 3D
-multiple 2Ds
-shows how structures change throughout cardiac cycle

Stress echocardiography
-computer compares images or wall motion and function before and after exercise
-if uable to exercise, use IV dobutamine and dipyridamole to stress heart

56
Q

Echocardiogram TEE

A

better visualization of heart with endoscope

-requires NPO, sedation; check gag reflex after

Evaluates: mitral valve disease, endocarditis vegetation, thrombus before cardioeversion, source of heart emboli, intraoperative heart function, and aortic dissection

Complications: perforation of esophagus, hemorrhage, dysrhythmias, vasovagal reactions, transient hypoxemia

57
Q

Tomography

A

Cardiac CT
-looks at heart anatom, coronary circulation, and great vessels

CT angiography
-noninvasive; less risky than cardiac catheterization, but not as good; must have NSR

Calcium scoring screening
-identifies calcium deposits in coronary arteries
-confirms CAD and predicts future issues
-Electron beam CT

58
Q

Cardiovascular magnetic resonance imaging (CMRI)

A

no radiation
-3D view of MI
-Assess EF
-predicts recovery from MI
-diagnosis of congenital heart and aordic disorders and CAD

59
Q

Nuclear cardiology

A

-Multigated acquisition: MUGA scan
-looks at wall motion, heart valves, and EF

Stress perfusion imaging
-looks at blood flow changes with exercise and diagnoses CAD
-differentiates bt viable heart tissue versus scar tissue
-determines success of interventions
-IV meds to dilate coronary arteries and stimulate exercise effects
-SPECT = size of infarction
-PET stress testing = myocardial ischemia and viability

60
Q

Interventional studies

A

Cardica catheterization: contrast and fluiroscopy
-CAD, coronary spasm, congenital and calcular heart disease, ventricular func, intracardiac pressure and O2, CO, and EF
-Right sided to measure pressure from vena cava to pulmonary artery
-Left sides = arterial insertion to evaluate coronary arteries; coronary angiography to identify location and severity of blockage (involves dye)

61
Q

Complications of cardiac catheterization

A

bleeding or hematoma at puncture site
allergic rxn to contrast
looping/kinging of catheter
infection
thrombus formation
aortic dissection
dysrhythmias
MI
stroke
puncture of ventricles/septum/lung tissue

62
Q

Pre catheterization

A

-assess allergies (esp to dye)
-VS, pulse ox, heart and breath sounds, NV assessment of extremeties
-NPO 6-12 hrs
-assess labs
-educate ab anesthesia, flushed feeling with dye, fluttering of heart
-give sedation and other meds

63
Q

post catheterization

A

-baseline assessments compare to pre procedure
-note hypo or hyper tension or signs of PE
-NV status again
-compression on arterial site for hemostasis; observe for hematoma and bleeding every 15 mins for 1 hr then per agency policy
-bed rest as ordered
-monitor ECG, pain, IV/oral fluid I and O
-educate ab activity limits

64
Q

Intravascular ultrasound

A

-Intracoronary ultrasound done in cath lab
-also uses coronary angiography to provide 2D or 3D view of coronary artery walls
-evaluate vessel response to stent placement and atherectomy

65
Q

Electrophysiology study

A

Electrodes placed in heart to record and manipulate electrical activity of heart, SA node, AV node, and ventricular conduction –> info regarding source and treatment of tachydysrhythmias

Patho (44 decks)

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