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Applied- Anatomy And Physiology > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

1
Q

What is a pulse?

A

Rhythmic expansion of an artery, which corresponds to each contraction of a ventricle

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2
Q

What is a heart rate (HR)?

A

Speed if the heart contractions
Measured in beats per minute (bpm)

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3
Q

What is stroke volume (SV)?

A

Volume of blood pumped out of the ventricles with each heart beat (70ml)

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4
Q

What is total peripheral resistance (TPR/SVR)?

A

Amount of force exerted on vessel walls around the body by circulating blood

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5
Q

Name the three factors that affect total peripheral resistance (TPR)

A

1- autonomic activity
2- blood viscosity
3- medication

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6
Q

Describe ‘autonomic activity’ as a factor that affects TPR

A

Part of the ‘sympathetic system’- rest and digest
Regulates certain bodily processes such as blood pressure and rate of breathing
Handles unconscious tasks
It controls cardiac muscle contraction, constricting the peripheral arteries and therefore the resistance they experience to create a TPR

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7
Q

Describe ‘blood viscosity’ as a factor that affects TPR

A

To do with thickness of blood
HIGHER thickness of blood leads to HIGHER total peripheral resistance (TPR)
(It’s like trying to pump custard vs water through a tube)
Hyper coagulable = dehydrated = harder to move

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8
Q

Describe ‘medications’ as a factor that affects TPR

A

Vasoconstrictors and vasodilator drugs
Main one is epinephrine (adrenaline):
-used a lot during cardiac arrests
-tightens the blood vessels, increases BP, increases resistance so that blood can be pumped further
-it’s an alpha-beta agonist (increases BP)

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9
Q

What is cardiac output (CO)?

A

The amount of blood the heart pumps out in a given period of time
Normally measures in litres per minute

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10
Q

How do we measure CO? Give the calculation used

A

CO = SV x HR
Cardiac output = stroke volume x heart rate
(ml/minute) = (ml/beat) x (beats/minute)

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11
Q

What does a low CO mean, and what indications does it give us about the state of the body?

A

Low cardiac output means that an inadequate amount of blood is being pumped to the brain and other parts of the body
Therefore the body isn’t getting enough oxygen
There will be an imbalance between oxygen supply and demand in the tissues
Symptoms= shortness of breath, light-headedness, fatigue, low urine output
Could signal towards potential heart failure
Particularly critical for the brain as the brain needs constant diffusion of oxygen and it will start to die after just 3 minutes without blood supply

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12
Q

Describe how the heart is a pump and how this related to CO

A

The heart is a single organ but it acts as a double pump carrying blood around two different circuits in the body
Circuit one- carries oxygen-poor blood to the lungs to pick up oxygen and drop-off carbon dioxide. It then delivers oxygen back to the heart
Circuit two- delivers oxygen-rich blood to the entirety of the body

Related to CO…
Of the body signals a need for more oxygen then cardiac output will increase!
By increasing it means that more oxygen is available throughout the body by increasing HR and SVR via vasoconstriction
This then increases BP too

Blood also delivers hormones, glucose and proteins along with oxygen

The body perceives a need for more oxygen, e.g. by exercising, chemoreceptors in the brain detect this requirement and implement relevant changes

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13
Q

Explain the cardiac cycle of the heart

A

Heart goes through a rhythmic cycle of relaxation and contraction
Ventricular contraction= systole
Ventricular relaxation= diastole

1- atrial systole
2- ventricular systole
3- atrial diastole
4- ventricular diastole

Diastole is the abuse when blood is filling in so it isn’t as relevant as the systole

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14
Q

When do we take a BP measurement within the cardiac cycle?

A

We take the measurement of BP at the end of systole (millimetres of mercury)

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15
Q

Name and describe the five stages of the cardiac cycle

A

1- Atrial systole begins
Atrial contraction forces blood into the ventricles
2- Ventricular systole (first phase)
Ventricular contraction pushed the AV valves closed
3- Ventricular systole (second phase)
Semilunar valves open and blood is ejected
4- Ventricular diastole (early)
Semilunar valves close and blood flows into atria
5- Ventricular diastole (late)
Chambers relax and blood fills ventricles passively

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16
Q

Why is diastole important for long term health?

A

Not as important on the short-term because it’s the pause when blood is filling in the chambers
But, in the long-term we need to consider the health of the diastole because it lets us know that the heart is definitely getting what it needs over periods of time

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17
Q

What does ECG stand for?

A

Electrocardiogram

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18
Q

What does an ECG look at? How does it work?

A

Looks at the hearts electrical conduction system- this describes the state of the heart beating on its own…
SA nodes, AV nodes, bundle of ‘his’, pukinje fibres

The ECG records the electrical signals within the heart
Electricity makes the heart beat, so to monitor health we need to know the manor in which it is doing this
Looks at heart rate, rhythm and electrical activity
Can also indicate an enlargement of the heart (cardiomyopathy) and evidence of a previous heart attack
Different sensors are attached to the skin to detect the electrical activity- there are 12 leads that we attach to patients (4 to the limbs and 8 to the chest)

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19
Q

Why are ECGs important?

A

The heart beats on its own, so monitoring any other areas of the body wouldn’t allow us to accurately monitor heart health

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20
Q

Why are ECGs used a lot in practise?

A

They’re a quick, cheap and easy method of assessment

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21
Q

What do we mean by ‘ectopics’?

A

Extra heartbeats!
Sometimes these are normal- e.g. during exercise

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22
Q

What complex is used to read ECGs?

A

PQRST complex

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23
Q

How does the PQRST complex correlate to the cardiac cycle?

A

Starts with a diastole where both the atria and ventricles are relaxed
P-wave: depolarisation of the atria, it is then followed by atrial systole (contraction). Without this p-wave we wouldn’t get appropriate filling (‘atrial fibrillation’)
QRS Complex: atrial systole continues to the end of the QRS complex and the point where the atria relax, the QRS complex shows the relaxation of the ventricles and is followed by ventricular systole (contraction)
T-wave: represents further depolarisation (re-polarisation) and makes the start of ventricular relaxation

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24
Q

What can an ECG tell us?

A

Heart rhythm
Heart rate
Check for abnormalities, such as lack of p-wave or arrhythmias (irregular beats)
Any evidence of damage (ischemia- restricted blood flow to parts of the body, MI- myocardial infarction/heart attack)

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25
Q

Name the four types of waves we see in ECG readings. Briefly describe them

A

There are four different types of waves to show evidence of ischaemic heart damage
-ST elevation- raised
Trace is abnormally high above the baseline
-ST depression- depressed
Trace is abnormally below the baseline
-T-wave Inversion- flipped
-T-wave Flat- Flattened

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26
Q

What do any of the four abnormal ECG waves give indication of?

A

-ST elevation
Indicates a total blockage of the coronary artery and that the heart muscle is currently dying
-ST depression
Indicates severe coronary lesions (MI, left bundle branch block, hypokalaemia)
-T wave inversion (flipped)
Right or left ventricular overload or MI
-T wave flat
Ischaemia, electrolyte abnormality (e.g. hypokalaemia)

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27
Q

What does BP measure?

A

A measure of the force that moves blood around your body
Generated by heartbeat
The force of blood pushing against the walls of your arteries is what we measure during BP measurements

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28
Q

What is meant by arterial BP?

A

The pressure measured within the large arteries in the systemic circulation
The number splits into systolic and diastolic BP
We normally measure the brachial artery (adults)
Sometimes we measure the radial or femoral artery hood for measuring lower BP)

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29
Q

What two factors does BP measurement involve?

A

Cardiac output (CO)
Total peripheral resistance (TPR)

BP = CO x TPR

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30
Q

Name the two methods we use to read BP

A

Electronic BP reading
Manual BP reading (we listen for the systole then the diastole)

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31
Q

Give some downsides of electronic BP measurements

A

-They’re not always entirely accurate
-They’re very dependent on choosing the correct cuff size

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32
Q

What is the average BP reading?
What is a good indicator that we use to determine if a BP reading is healthy or not?

A

120/80
Systole/Diastole

A good indicator is 100 age of the patient. If the reading is relatively in line with this then we know that the BP reading is healthy

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33
Q

Broadly, what are the two ways in which we control BP?

A

Short-term control- baroreceptors
Long-term control- RAAS

34
Q

How do we control BP in the short term?

A

Baroreceptors
Via the baroreflex receptors found in the carotid sinus and the aorta
These receptors detect changes in BP
They then vasoconstrict or dilate the vessels accordingly
To decrease BP- innervates the parasympathetic system (vasodilation and slow HR)
To increase BP- innervates the sympathetic system (vasoconstriction and increase HR)

35
Q

How do we control BP in the long term?

A

RAAS (Renin-angiotensin-Aldosterone System)
= a hormonal system that controls BP

36
Q

What does RAAS stand for?

A

Renin-angiotensin-aldosterone system

37
Q

What is the RAAS?

A

A hormone system in the body used to control BP

38
Q

Describe the process of the RAAS

A

Baroreceptors in the aorta detect a need for change
Renin is released from the kidneys into the blood stream
Converts into angiotensin
Angiotensin is released from the liver into angiotensin 1 (AT 1)
AT 1 is converted into angiotensin 2 (AT 2)
This is done via angiotensin converting enzymes (ACE) in the lungs and kidneys
AT 2 binds to AT 2 receptors on tissues to elicit a response
a range of medications act on this pathway
if you medicated here then the pathway would be stopped and ADH would not be released
AT 2 stimulates the release of Antidiuretic hormone (ADH) and aldosterone

39
Q

What does RAAS do?

A

-Causes systemic vasoconstriction- increase in SVR and increase in CO
In other words, it tightens all of the blood vessels throughout the body
-AT 2 stimulates aldosterone release from the adrenal glands. This causes a thirst response and reduces urinary output (causes more fluid to be retained within the system). This will increase BP and CO

40
Q

When can the RAAS become a problem?

A

-Overactive RAAS= hypertension (high BP)
-Inappropriately activated RAAS= hypertension (high BP)
-RAAS is a frequent target for anti hypertensive drugs
E.g. ACE inhibitors and angiotensin receptor blockers are common hypertension treatment
-Other treatments for hypertension target different areas
E.g. Beta blockers will reduce BP by decreasing HR and therefore CO, subsequently reducing SVR too
-Nurses need to be aware of the action that antihypertensive drugs have. It is crucial that we monitor patients BP before and after they are given so it remains at a stable rate
(If we give BP reduction medication for another condition but don’t consider the RAAS and push the BP system to its limits we could push pressure too high or low and potentially cause death!)

41
Q

What is meant by ‘hypertension’?

A

High BP

42
Q

What is meant by ‘hypotension’?

A

Low BP

43
Q

What is meant by ‘normotension/normotensive’?

A

Normal BP

44
Q

What is meant by ‘postural hypotension’?

A

Also called orthostatic hypotension
It is a drop in BP when standing or sitting up for the first time in a while, it makes people suddenly feed dizzy
The body quickly picks up CO to regain a normal BP and prevent fainting
It is a common problem in the elderly who’s CO can’t pick back up as easily or quickly

45
Q

What is meant by ‘malignant hypotension’?

A

An extremely high BP that develops really rapidly and causes some type of organ damage
It is bad! Should be treated as a medical emergency
Common in stroke patients or people with neurological problems
When BP is raised above 180/120 (normal is 120/80)

46
Q

List the four ways that hypertension affects the heart

A

1- Reduces elasticity
2- Reduces muscle function of arteries
3- Heart Attack
4- Heart Failure

47
Q

Explain how hypertension ‘reduces elasticity’

A

-Aortic muscle is made up of:
Tunica externa (outer layer)
Tunica media (middle layer)
Tunica intima (inner layer)
-Elastic fibres live within the tunica media (middle layer of muscle), they allow the large arteries to expand and recoil under systolic and diastolic pressure
-Heart muscles are built to stretch (expand and recoil)
-If they overstretch all the time then they loose elasticity
-If this happens then they go big and baggy and face risk of rupture
-If the aorta ruptures (delivering blood to the heart)= heart attack!

48
Q

Explain how hypertension ‘reduces muscle function of arteries’

A

-Constant flow of blood creates friction against the inside of the artery walls
-The tunica intima is the inner most layer of artery muscle and withstands the majority of the friction
-Constant expansion creates an inability for contraction
-‘Cardiac Hypertrophe’= enlarged heart muscle
-Thick heart walls mean there is less space on the inside, this creates less filling and an inability to close. Because of this there is therefore an inability for the heart to beat effecively

49
Q

Explain how hypertension can cause ‘heart attack’

A

Also called Myocardial Infarction (MI)
-High BP damages the tunica intima
-Cholesterol forms plaque in the artery walls
-A heart attack can occur when the plaque and blood clot block the flow of blood to the muscles in the hearts ventricle walls
-Cholesterol= fatty plaque in the arteries
-Atheroscleroma= fatty substance within the heart
-Hypertension can also cause the artery walls to become thick and stuff, this can lead to heart failure

50
Q

What is another term we use for heart attack?

A

Myocardial Infarction (MI)

51
Q

Explain how hypertension can cause ‘heart failure’

A

-Under normal BP the ventricle walls stretch to fill and contract to pump
-BP against the artery walls is generated as the ventricles contract to pump blood around the body
-The constant increased BP against the walls of the heart can cause them to stretch and become either baggy or stiff
-This then leads to the heart pumping led efficiently and in severe cases can cause heart failure
-Heart failure= where the heart is unable to meet the needs of the body for an increase in CO, it causes significant symptoms

52
Q

List the nine most common heart conditions

A

1- Acute Coronary Syndrome (ACS)
2- Coronary Heart Disease (CHD)
3- Angina
4- Unstable Angina
5- Arrhythmias (irregular heart beats)
6- Atrial Fibrillation (AF)
7- SupraVentricular Tachycardia (SVT)
8- Ventricular Tachycardia (VT)
9- Ventricular Fibrillation (VF)

53
Q

What is ‘Acute Coronary Syndrome’ (ACS)? What are the symptoms?

A

=Reduced blood flow to the heart
-Could be caused by a blockage or spasm of the vessels
-Symptoms: chest pain (angina) which is worsened on exertion, nausea, sweating/shivering, referred pain (e.g. jaw, left sided chest pain, women often report no chest pain), severe indigestion (women often report indigestion), shortness of breath

54
Q

What is Coronary Heart Disease (CHD)?

A

=Where the hearts blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries
This could be a fatty plaque build up or a blood clot

55
Q

How many people are living with and die from CHD?

A

-Approximately 2.3 million people in the UK are living with CHD
-More men than women have CHD (1.5 million men vs 830,000 women)
-Approximately 160,000 people doe every year from CHD related complications (this works out at around 460+ everyday)

56
Q

What can CHD lead to?

A

-CHD can lead to a myocardial infarction (MI)/heart attack

57
Q

How are death rates from CHD changing?

A

-Death rate from CHD and MI has been falling since the 1960’s. This is due to improvements in diet, medication (such as statins), treatment, public awareness and reduction in harmful behaviours (like smoking, diet and exercise)

58
Q

What is ‘angina’?

A

=A pain or discomfort in the arm, chest, neck, stomach or jaw
It happens when the blood supply to the heart becomes restricted because if arteries becoming narrowed
This clogging is called ‘atheroma’

59
Q

How is angina related to CHD?

A

Angina is a symptom of CHD, not an illness in itself

60
Q

What is ‘unstable angina’?

A

=Where angina symptoms occur unrelated to an increase in activity
Can be an indication of ‘acute coronary syndrome’ (ACS)

61
Q

What are ‘arrhythmias’?

A

=Irregular heartbeats
They can occur naturally but irregular heart rates can often be a sign or symptom of underlying illness or disease

62
Q

What is ‘atrial fibrillation’ (AF)?

A

=Where damage to the atria or disease has caused the atrium to beat irregularly
It inhibits filling and emptying of the heart chambers
Increases the risk of developing thrombosis (blood clotting)

63
Q

What is ‘Supra Ventricular Tachycardia’ (SVT)?

A

=Can be a life threatening condition where the ventricles are stimulated to beat faster than normal
Normal rate= 60-100bpm
SVT rate= 120-220bpm
Some causes include stress, coffee, other stimulants or anxiety
It is a lot more common in women due to hormonal changes
If it does not resolve quickly it can be life threatening
Occurs due to… damage or irritation of the SA node , causing abnormal stimulation of the cardiac muscle relating in a significantly fast arrhythmia
Improper filling = improper emptying = reduced CO

64
Q

Is we see a shockable rhythm what must we do?

A

It must be treated!
(By defibrillation)

65
Q

What are the names of the two life threatening arrhythmias?

A

Ventricular tachycardia (VT)
Ventricular fibrillation (VF)

66
Q

What is ‘Ventricular Tachycardia’ (VT)?

A

Causes the ventricles to beat fast
160 bpm+
This causes insufficient time for cardiac filling to occur, CO falls, therefore the amount of oxygen pumped to the brain and body falls

67
Q

What is ‘Ventricular Fibrillation’ (VF)?

A

Where the ventricles are unable to beat correctly
This causes insufficient filling and emptying
The ventricles fibrillate (wobble), are unable to pump and therefore the heart and the rest of the body are starved of oxygen
This is a cardiac arrest!

68
Q

Of we see a curve on an ECG reading what does it mean?

A

There is no PQRST complex
It means a patient is in cardiac arrest or is about to go into cardiac arrest

69
Q

What is the ratio for CPR as a rule?

A

30:2
Compressions:Beats

Meta-analysis show that compressions are much more effective than breaths
-we need to upkeep the BP and resistance in the vessels to increase the CO

70
Q

List the main risk factors for heart conditions

A

Obesity (especially visceral fat)
High cholesterol (hypercholesterolaemia)
High BP (hypertension)
Inactivity
Smoking
Diabetes
Family history
Sex
Age
Sleep apnoea (breathing repeatedly stops and starts whilst you sleep)
Diet

71
Q

What are the roles of general nurses for patients with heart conditions?

A

Lifestyle advice and risk factor modification
Medication advice
Reassurance
Rehabilitation

72
Q

What are the roles of specialist nurses for patients with heart conditions?

A

Managing caseload of patients with cardiac conditions
Booking and interpreting scans and diagnostic tests
Supporting patients living with a new diagnosis or ongoing illness
Health promotion

73
Q

Define tachycardia

A

Fast HR
Any HR that is above 100 bpm (normal is between 60-100 bpm)
Many types of irregular heart rhythms (arrhythmias) can cause tachycardia
It’s not always a concern, e.g. during exercise

There are 3 types of tachycardia:
SupraVentricular Tachycardia- signals misfire, HR speeds up, can’t fill before contraction, reduces flow to the rest of your body
Ventricular- rapid HR starting in lower chambers. Electrical signals fire the wrong way, HR speeds up, can’t fill before contraction, reduces flow to the rest of your body
Sinus Tachycardia- when your hearts natural pacemaker sends out signals faster than normal. Your ticker beats fast, but it beats the way it should

Causes:
Exercise, fever, stress, anxiety, medication, drugs
More common in women and children
Structural problems of the heart, e.g. cardiomyopathy

Symptoms:
Dizziness, lightheaded, fatigue, chest pain, shortness of breath

74
Q

Define bradycardia

A

Slow HR
Less than 60 bpm
Means that the heart can’t pump enough oxygen rich blood around the body
Not always a cause for concern, e.g. normal during sleep

Causes:
Heart tissue damage related to aging, tissue damage due to heart disease or attack, congenital heart defect present at birth, hypothyroidism, obstructive sleep apnea, medications (such as sedatives and opioids)

Symptoms:
Chest pain, confusion and memory problems, dizziness, fatigue, fainting, shortness of breath

75
Q

Define sinus rhythm

A

The rhythm that originates from the depolarisation of the cardiac muscle at the sinus node
Describes the characteristic rhythm of a healthy human heart

Characterised by the presence of a correctly oriented P wave on an ECG

76
Q

What are baroreceptors and where are they located?

A

Baroreceptors are a type of mechanoreceptor
They allow for the relay if information derived from BP
Operate within the ANS

Spray-type nerve endings located within vessel walls and the heart
They’re stimulated by changes in arterial BP
Very abundant in the internal carotid arteries and the aortic arch
Main site of termination of baroreceptors is the NTS relay station in the brain (sensory info)

77
Q

What is the role of baroreceptors?

A

Information is passed in a rapid sequence
It alters the TPR and CO to maintain BP within a normal range
Main function: maintain systemic BP at a constant and healthy level, this is especially important when we change body position

2 types of baroreceptors:
HIGH-PRESSURE BARORECEPTORS
Increased BP stretched the baroreceptors, increasing activity of the vagal nerve and projecting signals. It inhibits sympathetic outflow and ultimately leads to decreased HR and BP
Decreased signal output from baroreceptors leads to decreased BP
LOW-PRESSURE BARORECEPTORS
Involved with regulation of blood volume, blood volume determines the mean pressure throughout the system
Circulatory and renal effects. They produce changes on hormone secretion

78
Q

What is the medullary cardiovascular centre, where is it located and what is its role?

A

Part of the human brain found in the medulla oblongata within the brainstem
It is responsible for regulation of cardiovascular output
Normally the heart beats in its own, however, in some situations such as exercise and major trauma, the cardiovascular centre is responsible for altering HR
It also mediates respiratory sinus arrhythmia

79
Q

How does atrial natriuretic peptide (ANP) control BP?

A

It is a hormone secreted from the cardiac atria
It acts acutely to reduce plasma volume in three ways:
1- increased renal excretion of salt and water
2- vasodilation
3- increased vascular permeability

When blood sodium levels and pressure are increased, ANP is secreted from the heart. It binds to its receptor in the kidneys and blood vessels, promotes salt excretion and lowers blood volume to relax the vessel

80
Q

Explain how the RAAS and atrial natriuretic peptide work together to control BP

A

Both are functionally antagonistic circulating hormones involved in regulating BP and bodily fluid
They’re two opposing systems to allow fine-tuning of volume and pressure by the body
ANP is the endogenous antagonist of the RAAS (a compound naturally produced by the body which binds to and activates that receptor)

Applied- Anatomy And Physiology (10 decks)

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