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Phalen 12-lead ECG in ACS > Chapter 1 - Basics > Flashcards

Chapter 1 - Basics Flashcards

1
Q

The space between the lungs in the middle of the chest.

A

Mediastinum

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2
Q

The upper portion of the heart, formed mainly by the left atrium and small amount of right atrium.

A

the base

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3
Q

The base of the heart lies at approximately:

A

the 2nd intercostal space, immediately anterior to esophagus and descending aorta

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4
Q

The lower portion of the heart, formed by the tip of the left ventricle:

A

apex

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5
Q

The apex of the heart lies at approximately:

A

5th intercostal space, midclavicular line

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6
Q

Two upper chambers of the heart

A

atria

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7
Q

Two lower chambers of the heart

A

ventricles

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8
Q

The right atrium receives blood low in oxygen from:

A

superior vena cava
inferior vena cava
coronary sinus

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9
Q

The left atrium receives blood low in oxygen from:

A

lungs (right and left pulmonary veins)

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10
Q

Right atrium thickness

A

2 mm

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11
Q

Left atrium thickness

A

3 mm

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12
Q

Valves through which blood is pumped from atria to ventricles

A

atrioventricular (tricuspid/mitral)

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13
Q

The purpose of the ______________ is to pump blood.

A

ventricles

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14
Q

The right ventricle pumps blood to the:

A

lungs

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15
Q

The left ventricle pumps blood out to the:

A

body

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16
Q

The outside of the heart has grooves called:

A

sulci

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17
Q

The _________ _________ and their major branches lie in these grooves.

A

coronary arteries

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18
Q

This groove encircles the outside of the heart separates the atria from the ventricles and contains the coronary blood vessels and epicardial fat.

A

coronary sulcus

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19
Q

The right and left sides of the heart are separated by an internal wall of connective tissue called a:

A

septum

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20
Q

This portion of the septum separates the right and left atria.

A

interatrial septum

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21
Q

This portion of the septum separates the right and left ventricles.

A

interventricular septum

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22
Q

The septa separate the heart into two functional:

A

pumps

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23
Q

The job of the right side of the heart is to pump unoxygenated blood from the body to and through the lungs to the left side of the heart. This is called:

A

pulmonary circulation

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24
Q

The right side of the heart is a ____-______ system.

A

low-pressure

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25
Q

The left side of the heart is a ____-_______ pump.

A

high-pressure

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26
Q

The job of the left heart is to receive oxygenated blood from the lungs and pump it out to the rest of the body. This is called the:

A

systemic circulation

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27
Q

Blood is carried from the heart to the organs of the body through:

A

arteries
arterioles
capillaries

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28
Q

Blood is returned through the right heart through:

A

venules

veins

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29
Q

Right ventricle thickness

A

3-5 mm

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30
Q

Left ventricle thickness

A

13-15 mm

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31
Q

Because the wall of the left ventricle is much thicker than the right, the interventricular septum normally:

A

bulges to the right

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32
Q

Each ventricle holds ~______ of blood when it is full.

A

150 mL

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33
Q

Each ventricle normally ejects about ________ with each contraction.

A

70-80 mL (about half)

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34
Q

The amount of blood ejected from a ventricle with each heartbeat:

A

stroke volume

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35
Q

The percentage of blood pumped out of a ventricle with each contraction:

A

ejection fraction

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36
Q

Ejection fraction is used as a measure of:

A

ventricular function

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37
Q

A normal Ejection fraction is between:

A

50-65%

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38
Q

A person is said to have impaired ventricular function when the ejection fraction is less than:

A

40%

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39
Q

Examples of patients who may have a poor ejection fraction include those with:

A

congestive heart failure (CHF)
severe cardiomyopathy
myocardial damage from previous heart attack

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40
Q

The walls of the heart are made up of three tissue layers:

A

endocardium
myocardium
epicardium

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41
Q

The heart’s innermost layer:

A

endocardium

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42
Q

Thin, smooth layer of epithelium and connective tissue in the heart; line the heart’s inner chambers, valvues, chordae tendineae, and papillary muscles:

A

endocardium

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43
Q

The endocardium is continuous with the innermost layers of the _______, _____, and ____________ of the body, completing a continuous, closed circulatory system.

A

arteries, veins, and capillaries of the body

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44
Q

The middle layer of the heart is a thick, muscular layer that consists of cardiac muscle fibers (cells) responsible for the pumping action of the heart:

A

myocardium

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45
Q

The myocardium is divided into two areas:

A

subendocardial area

subepicardial area

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46
Q

The muscle fibers of the myocardium are separated by connective tissues that have a rich supply of _______ and __________.

A

capillaries

nerve fibers

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47
Q

The variation in thickness of the myocardium that varies from one heart chamber to another is related to the amount of ____________________ that must be overcome to pump blood out of the different chambers.

A

resistance

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48
Q

The heart’s outermost layer is the

A

epicardium

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49
Q

The epicardium is continuous with the inner lining of the _____________ at the heart’s apex

A

pericardium

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50
Q

The epicardium contains (4):

A

blood capillaries
lymph capillaries
nerve fibers
fat

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51
Q

The ____ ________ ______ lie on the epicardial surface of the heart.

A

main coronary arteries

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52
Q

The main coronary arteries feed this area first, before entering the myocardium and supplying the heart’s inner layers with oxygenated blood.

A

epicardium

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53
Q

Decreased supply of oxygenated blood to a body part or organ

A

ischemia

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54
Q

The heart’s ________ ________ is at the greatest risk of ischemia because this area has a high demand for oxygen and is fed by the most distal branches of the coronary arteries.

A

subendocardial area

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55
Q

The double-walled sac that encloses the heart and helps protect it from trauma and infection:

A

pericardium

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56
Q

The rough outer layer of the pericardial sac is called the

A

fibrous parietal pericardium

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57
Q

The parietal pericardium anchors the heart to some of the structures around it, such as the sternum and diaphragm, by means of:

A

ligaments

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58
Q

The inner layer of the pericardium consists of two layers:

A

parietal

visceral

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59
Q

The parietal layer of the pericardium lines the inside of the

A

fibrous pericardium

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60
Q

The visceral layer of the pericardium adheres to the outside of the heart and forms the outer layer of the:

A

heart muscle

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61
Q

The visceral layer of the pericardium is also called the:

A

epicardium

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62
Q

The pericardial space lies between:

A

the visceral and parietal layers of the pericardium

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63
Q

The pericardial space normally contains about ___ mL of serous fluid

A

20

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64
Q

This fluid acts as a lubricant, preventing ______ as the heart beats

A

friction

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65
Q

Inflammation of the pericardium is called

A

pericarditis

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66
Q

Pericarditis can elicit the secretion of

A

more serous fluid

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67
Q

Pericarditis can be caused by (4)

A

bacterial or viral infection
rheumatoid arthritis
destruction of the heart muscle in heart attack
other causes

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68
Q

There are two types of valves in the heart:

A

atrioventricular (AV) valves

semilunar (SL) valves (pulmonic/aortic) - also known as tricuspid and bicuspid

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69
Q

The purpose of valves in the heart is to ensure blood flows in one direction through the heart’s chambers and to prevent the:

A

backflow of blood

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70
Q

The term used to describe a malfunctioning heart vale:

A

valvular heart disease

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71
Q

Types of valvular heart disease (3)

A

Valvular stenosis
valvular prolapse
valvular regurgitation

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72
Q

If a valve narrows, stiffens, or thickens, the valve is said to be:

A

stenosed

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73
Q

The heart must work harder to pump blood through a

A

stenosed valve

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74
Q

If a valve flap inverts, it is said to be

A

valvular proplapse

75
Q

Valvular Prolapse can occur (2)

A

if one valve flap is larger than the other

if the chordae tendineae stretch markedly or rupture

76
Q

Blood can flow backward, or _____________, if one or more of the heart’s valves do not close properly.

A

regurgitate

77
Q

Valvular regurgitation is also known as valvular (2)

A

incompetence

insufficiency

78
Q

____________ valves separate the atria from the ventricles.

A

Atrioventricular (AV) valves

79
Q

The AV valve that lies between the right atrium and right ventricle is:

A

tricuspid

80
Q

The tricuspid has how many flaps?

A

3

81
Q

The tricuspid valve is larger in diameter and thinner than the

A

mitral valve

82
Q

the mitral valve is also called

A

bicuspid

83
Q

the bicuspid has how many flaps?

A

2

84
Q

The bicuspid lies between the

A

left atrium and left ventricle

85
Q

The AV valves open when a forward pressure gradient forces blood in a:

A

forward direction

86
Q

The AV valves close when a backward pressure gradient pushes blood:

A

backward

87
Q

The AV valves require almost no backflow to cause

A

closure

88
Q

About 70% of the blood returning from the SVC and IVC flows directly through the atria and into the ventricles before the atria contract. This is called:

A

passive filling

89
Q

As the atria fill with blood, the pressure with the atrial chamber:

A

rises

90
Q

Pressure in the atrial chamber forces open the tricuspid and mitral valves and the ventricles begin to fill, gradually increasing ___________ in the ventricles.

A

pressure

91
Q

When the atria contract, an additional 10-30% of the returning blood in the atria is added to filling of the ventricles. This additional blood contribution is called

A

the atrial kick

92
Q

The tricuspid and mitral valves completely close when the pressure within the _________________ exceeds that of the _______.

A

ventricles; atria

93
Q

Dysrhythmias such as ___________ and __________ negatively affect normal atrial contraction.

A

Atrial flutter

atrial fibrillation

94
Q

Ineffectual atrial contraction can result in a (3)

A

loss of atrial kick
decreased stroke volume
subsequent decrease in cardiac output

95
Q

Chordae tendineae are thin strands of

A

connective tissue

96
Q

One each end, chordae tendineae are attached to:

A

papillary muscles

underside of the AV valves

97
Q

Papillary muscles project inward from the lower portion of the

A

ventricular walls

98
Q

Papillary muscles contract and relax with

A

the ventricles

99
Q

Papillary muscles adjust their tension on the chordae tendineae, preventing them as well as valve cusps from bulging too far into

A

the atria

100
Q

The chordae tendineae and papillary muscles serve as

A

anchors

101
Q

The pulmonic and aortic valves are called

A

semilunar (SL) valves

102
Q

The SL valves have how many cusps?

A

3

103
Q

The cusps of the SL valves are shaped like?

A

half-moons

104
Q

The openings of the SL valves are ______ and ______ than the AV valves

A

smaller; thicker

105
Q

Unlike the AV valves, the SL valves are not attached to

A

chordae tendineae

106
Q

When the ventricles contract, the SL valves

A

open

107
Q

The SL valves close as ventricular contraction ends and the pressure in the pulmonary artery and aorta exceeds that of the

A

ventricles

108
Q

Blood from the tissues of the head, neck, and upper extremities is emptied into the

A

superior vena cava

109
Q

Blood from the lower body returns via the

A

inferior vena cava

110
Q

The right atrium receives blood from (3)

A

inferior vena cava
superior vena cava
coronary sinus

111
Q

The largest vein that drains the heart is the

A

coronary sinus

112
Q

The repetitive pumping process that includes all of the events associated with blood flow through the heart is the

A

cardiac cycle

113
Q

The cardiac cycle has two phases for each heart chamber:

A

systole

diastole

114
Q

The period during which the chamber is contracted and blood is being ejected

A

systole

115
Q

The period of relaxation during which the chambers are allowed to fill

A

diastole

116
Q

The myocardium receives its fresh supply of oxygenated blood from the coronary arteries during

A

ventricular diastole

117
Q

The cardiac cycle depends on (2)

A

ability of the cardiac muscle to contract

the condition of the heart’s conduction system

118
Q

The efficiency of the heart as a pump may be affected by abnormalities of the (3)

A

cardiac muscle
valves
conduction system

119
Q

During atrial diastole, blood from the superior and inferior ____ ____ and the coronary _____ enter the right atrium.

A

vena cava

sinus

120
Q

As the right atrium fills and distends (during atrial diastole), the ____________valve is pushed open allowing blood to fill the right ________.

A

tricuspid valve

ventricle

121
Q

During atrial diastole, the left _____ received blood from the four pulmonary veins (two from right and two from left). The flaps of the ______ valve open as the left atrium fills allowing blood to flow into the left _________.

A

atrium
mitral
ventricle

122
Q

The __________ circulation consists of coronary arteries and veins.

A

coronary

123
Q

With normal activity, ___ - ___ % of the fresh oxygen in blood is taken out by the myocardium by means of the coronary arteries.

A

65-75%

124
Q

The coronary removal rate of oxygen is the highest of any tissue during normal activity and one that cannot be:

A

significantly improved

125
Q

The only way the heart can improve its oxygen uptake is by increasing:

A

coronary blood flow

126
Q

With strenuous activity, coronary blood flow can increase significantly to ensure there is an adequate supply of oxygen to the:

A

myocardium

127
Q

At rest, coronary blood flow averages about:

A

250 mL/min

4-5% of the total cardiac output

128
Q

The main coronary arteries lie on the __________ surface of the heart.

A

epicardial

129
Q

Coronary arteries that run on the surface of the heart are called

A

epicardial coronary arteries

130
Q

Branches of the main coronary arteries penetrate the heart’s muscle mass and supply the _____________ with blood.

A

subendocardium

131
Q

The diameter of the coronary arteries supplying the subendocardium is much smaller - and are often referred to as “feeder branches” or

A

collateral circulation

132
Q

The freshly oxygenated blood is supplied to the heart itself by two main vessels:

A

right coronary artery

left coronary artery

133
Q

The LCA & RCA are the very first branches off the base of the

A

aorta

134
Q

The openings of the LCA & RCA lie just beyond the cusps of the

A

aortic SL valve

135
Q

When the heart contracts, blood flow to the tissues of the heart is significantly _________ because the heart’s blood vessels are compressed.

A

reduced

136
Q

The coronary arteries fill when the ventricles are relaxed in

A

diastole

137
Q

The three major coronary arteries include the

A

Left anterior descending (LAD)
Circumflex (CX) artery
Right coronary artery (RCA)

138
Q

A person is said to have CAD if there is more than _____ % diameter narrowing (stenosis) in one or more of these vessels.

A

50

139
Q

The RCA originates from the right side of the

A

aorta

140
Q

The RCA travels along a groove between the _______ and _____________

A

right atrium

right ventricle

141
Q

A branch of the RC supplies the (6):

A

Right atrium
Right ventricle
Inferior surface of the left ventricle in about 85% of population
Posterior surface of the left ventricle in about 85% of population
SA node in about 60% of population
AV node in 85-90% of population

142
Q

In ~90% of the population, the RCA forms the posterior descending artery and supplies the inferior wall of the left ventricle. In the remaining 10% of the population, the __________ artery forms the PDA.

A

CX artery

143
Q

The left coronary artery (LCA) originates from the left side of the

A

aorta

144
Q

The first segment of the LCA is called the left main coronary artery. It is about the width of a soda straw and less than

A

1” long

145
Q

The LMCA supplies oxygenated blood to its two primary branches:

A

LAD (aka anterior interventricular)

CX

146
Q

The LAD can be seen on the epicardial surface on the front of the heart. It travels along the groove that lies between the right and left ventricles and is called:

A

anterior interventricular sulcus

147
Q

In more than 75% of patients, the LAD travels around the apex of the left ventricle and ends along the left ventricle’s:

A

inferior surface

148
Q

In 25% of patients, the LAD stops at or before the heart’s

A

apex

149
Q

The major branches of the LAD are

A

septal artery

diagonal artery

150
Q

The septal branches of the LAD supply blood to the

A

interventricular septum

151
Q

The LAD supplies blood to (3):

A

Anterior surface of left ventricle
Part of lateral surface of left ventricle
Most of interventricular septum

152
Q

The ___________ artery circles around the left side of the heart.

A

CX

153
Q

The CX is embedded in the _____________________________ on the back of the heart.

A

epicardium

154
Q

The CX supplies blood to (6):

A

Left atrium
Lateral surface of the left ventricle
Inferior surface of the left ventricle in 15% of pop
Posterior surface of the left ventricle in 15% of pop
SA node in ~40% pop
AV node in 10-15% pop

155
Q

Blockage of the LMCA is commonly called _____________ because of its association with SCA when occluded

A

the widow maker

156
Q

The coronary (cardiac) veins travel alongside the

A

arteries

157
Q

Blood that has passed through the myocardial capillaries is drained by branches of the cardiac veins that join the

A

coronary sinus

158
Q

The coronary sinus is the largest vein that drains the

A

heart

159
Q

The coronary sinus lies in the _______ that separates the atria and the ventricles

A

sulcus

160
Q

The coronary sinus receives blood from the great, middle, and small cardiac veins; a vein of the left atrium; and the ________ vein of the left ventricle

A

posterior

161
Q

The coronary sinus drains into the right

A

atrium

162
Q

The anterior cardiac veins do not join the coronary sinus but empty directly into the right

A

atrium

163
Q

A condition caused by a similar sequence of pathologic events - a temporary or permanent blockage of a coronary artery.

A

Acute coronary syndrome(s) (ACSs)

164
Q

The usual cause of an ACS is the rupture of an

A

atherosclerotic plaque

165
Q

A chronic disease of the arterial system characterized by abnormal thickening and hardening of the vessel walls:

A

arteriosclerosis

166
Q

A form of arteriosclerosis in which the thickening and hardening of the vessel walls are caused by a buildup of fatlike deposits (plaque) in the inner lining of large- and middle-sized muscular arteries.

A

atherosclerosis

167
Q

Vascular pathways that serve as an alternate route for blood flow around the blocked artery to the heart muscle.

A

collateral circulation

168
Q

The presence of collateral circulation that builds over time, may prevent an MI, despite complete blockage of a

A

primary artery

169
Q

As the heart chambers fill with blood, the heart muscle is

A

stretched (Frank Starling law of the heart

170
Q

The most important factor determining the amount of blood pumped out by the heart (stroke volume) is the amount of blood flowing into the right heart from the systemic circulation or

A

venous return

171
Q

The mechanical activity of the heart is reflected by the _______ and _______ ____________.

A

pulse

blood pressure

172
Q

The force exerted by the circulating blood volume on the walls of the arteries

A

blood pressure

173
Q

The resistance to the flow of blood determined by blood vessel diameter and the tone of the vascular musculature

A

peripheral vascular resistance (PVR)

174
Q

The term that may be used when referring to the normal state of balanced tension in body tissues.

A

tone

175
Q

BP is equal to CO X

A

PVR

176
Q

BP is affected by any condition that increases:

A

PVR or CO

177
Q

An increase in either CO or PVR typically results in an increase in

A

BP

178
Q

A decrease in either CO or PVR will result in a decrease in

A

BP

179
Q

The amount of blood pumped into the aorta each minute by the heart is

A

cardiac output

180
Q

Cardiac output is defined as the stroke volume multiplied by the

A

heart rate

181
Q

nL CO in avg. adult

A

~4-8 L/min

182
Q

CO at rest is

A

~5 L/min

183
Q

Because the ___________________________________ system is a closed system, the volume of blood leaving one part of the system must equal that entering another part.

A

cardiovascular

Phalen 12-lead ECG in ACS (1 decks)

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