CV System - Part 1 Flashcards
Can we separate the CV system from the respiratory system?
NO! They are highly interlinked.
What is the hole in between the atrias called in the embryonic heart?
Foramen secundum
What is the foramen secundum called after birth?
Foramen ovale
If the foramen secundum does not properly close after birth what happens?
May form patent foramen ovale or atrial-septal defect (ASD)
What is the hole in between the ventricles called int he embryonic heart?
Interventricular foramen
What happens if the Interventricular foramen does not properly close after 7th week of fetal development?
May form interventricular septal defect (VSD)
Where does gas exchange happen for the fetus?
Placenta!
What does the umbilical vein carry?
Oxygenated blood from placenta
Describe what happens in week 4 of heart development?
Partitioning of aorta-ventricular canals
What happens at birth in regards to the heart development?
Final separation between systemic and pulmonary circulation
What are some conditions that can arise if embryonic holes do not close?
Arterial septal defect - most common
Patent ductus arteriosus - not as serious but can lead to SOB and pulm. Hypertension
What are the types of shunts someone can have?
Right->Left shunt
Left->Right shunt
When blood is moving to one side of the heart from the other that shouldn’t be happening
What are Left —> Right Shunts?
EX: atrial septal defect, ventricular septal defect, patent ductus arteriousus
Blood is moving from the left side of the heart to the right
What are Right —> Left shunts?
Ex: Tetralogy of fallot: transposition of great arteries, persistent truncus arteriosus, tricuspid atresia, anomalous pulmonary venous connection
What is the S/S of L —> R shunts?
No cyanosis
Pulmonary HTN
Pulmonary Artery Changes
R heart hypertrophy
What is the S/S of a R —> L shunt?
Cyanosis
Severe shortness of breath
Hypoxemia
Difference between stenosis and artesia?
Stenosis is the narrowing of a vessel
Artesia is the obstruction of a vessel
Both cause increased resistance which causes chamber hypertrophy/dilation.
What are examples of obstructions in the CV system?
Coarcation of Aorta - most common
Pulmonary stenosis or atresia
What is the function of the heart and blood vessels?
Transport nutrients and O2
ENDOCRINE fx: regulation of fluid balance and growth
What are the classifications of vessels?
- Elastic arteries — aorta, carotids. (Distributing arteries)
- Muscular arteries — usually branches of elastic arteries (resistance arteries)
- Capillaries — venules. (Exchange vessels)
- Veins — capacitance
Function of elastic arteries?
Aid in conduction of flow and smooth flow
Function of muscular arteries?
Regulation of flow and to alter resistance
Function of capillaries?
Nutrient and waste exchange between tissues and blood
What is the structure of veins?
Veins assist in moving blood by one way valves to prevent back flow. They are located in beds where compression by muscles causes blood to flow back to the heart.
What assists with venous return?
Negative pressure in thoracic cavity during inhalation
Describe the gas exchange within the capillary
Gradient forms along the length of the capillary so in the beginning there is net filtration and at the end net absorption.
Results in an equilibrium and fluid balance over the whole length of the capillary
What are the landmarks to find the apex of the heart?
5th rib + mid clavicular line
What is the auscultation point to listen to the aorta?
2nd intercostal space + R eternal border
What is the auscultation point to listen to the mitral area?
5th Intercostal space + Mid clavicular line
What is the auscultation point to listen to the pulmonic area?
2nd intercostal space + left sternal border
What is the auscultation point to listen to the tricuspid area?
4-5 intercostal space + Left sternal border
What 2 arteries come off of the aorta for the coronary circulation?
R and L Coronary Arteries
What arteries come off of the R Coronary Artery?
Sinoatrial artery
AV branch
Posterior Interventricular Artery
R Marginal Artery
What arteries come off of the L Coronary Artery?
Anterior Interventricular Artery
Circumflex Artery
L Marginal Artery
Which two heart valves have 3 cusps as their structure?
Aortic and Pulmonic valves (both semilunar valves)
Which two heart valves have leaflets?
Mitral Valve and Tricuspid Valve (both AV valves separating the atrias from the ventricles)
What is the purpose of the heart valves?
Prevent regurgitation or back flow of blood
AV valves specifically during ventricular contraction
What attaches the heart to the diaphragm?
The pericardium at the base
Describe the myocardium
- Cardiomyocytes organized in fascicles and bundles of fascicles invested in connective tissue
- Layers of muscle are woven in a complex patter with a swirling twist which allows for a wringing motion during contraction.
What is the sequence of events during the excitation contraction coupling process?
- AP causes Ca2+ channels to open
- Extracellular Ca2+ triggers SR to release Ca2+ (calcium induced calcium release)
- Ca2+ binds to troponin, triggering actin myosin interaction
- Tension develops
- Relaxation occurs when Ca2+ is taken back by SR
What is the sequence of conduction for the heart?
SA node -> AV node -> Bundle of His -> R + L bundle branches -> purkinje system
Which node is the pacemaker of the heart?
SA Node
What is the sympathetic innervation of the heart responsible for?
Increase in strength, rate of contraction, and rate and extent of relaxation
What is the parasympathetic innervation of the heart responsible for?
Decrease in rate of contraction, slow conduction, decrease strength of contraction, and slow rate of relaxation
What does the first lub heart sound represent?
Closure of the AV valves
Correlates with QRS complex
What does the second dub heart sound represent?
Aortic valve closes
If you hear an abnormal sound between the lub and the dub it makes you think??
Problem is in systole
If you hear a problem after the dub and before the new lub what does that make you think?
Problems in diastole
Is a rise in BP due to age considered pathological?
Nope
A decrease in vascular elasticity with aging causes what?
INCREASE IN BP
LV Hypertrophy with aging results in?
Decrease ventricle compliance
Decrease in adrenergic response with aging results in?
Decrease exercise HR
Diastolic dysfunction due to aging results in?
Impaired ventricular filling —> increased cardiac preload and CHF
Decrease in lean body mass due to aging results in?
Decrease in muscular strength and peak O2 consumption
How do you choose the correct cuff size for measuring BP?
Measure the circumference of the arm where you will be measuring?
What is the result of using an incorrect BP cuff size?
An inaccurate BP reading by 10-40mmHg
What is Orthostatic Hypotension?
Decrease in blood pressure when going from supine to sitting OR sitting to standing
What is orthostatic hypotension strongly associated with?
Ca2+ channel blockers - procardia
What are some things that can cause decreased blood pressure and flow to the brain?
- Delay/insensitivity in baroreceptor reflex
- Dehydration
- Pooling of blood
When does OH typically happen?
- After prolonged bed rest
- Patients with generalized hypotension
- Heart failure
How much does the blood pressure need to change to be diagnosed as orthostatic hypotension?
Drop in SBP by >20 mmHg OR drop in DBP by >10 mmHg
How long should the patient lay quietly before standing up to test for OH?
At least 5 minutes
How do you assess for Jugular Venous Distensión?
- Examine patient with head up at a 45 degree angle
- Compress the SCM and note if the vein is distended above the level of the clavicle
- If it is - indicates elevated venous pressure and R Heart failure
What are the risk factors for peripheral arterial disease?
Smoking
HTN
Atherosclerosis
DM
High cholesterol
Over 60yo
What are the S/S of peripheral arterial disease?
Intermittent claudication
Pain/aches with walking
Muscle atrophy
Hair loss
Smooth shiny skin or skin that is cool
DECREASED or absent pulses in feet
Cold/numb toes
Sores or ulcers in the legs or feet that do not heal
What is the medical management for peripheral arterial disease?
Aspirin or similar antiplatlet, statins, other meds to reduce atherosclerosis
- also include meds to treat HTN
- quit smoking
- potential surgery
What is the PT management for peripheral arterial disease?
EXERCISE!!!!
- Walking is optimal but also any aerobic exercise is great
What should you feel for when assessing peripheral pulses?
- Texture of artery wall
- Rhythm
- Regularity
- Force - is it weak or threads? Strong or bounding?
Where do you assess radial pulse?
Compress the radial artery under your index finger at distal radius
Where do you assess the brachial pulse?
Compress the brachial artery medial to the insertion of the biceps at the distal humerus
Where do you assess the carotid pulse?
Slide index finger and middle fingers lateral from cricoid cartilage on the trachea to jugular groove on either side
What is Carotid Bruit?
Whooshing or murmur sound heard over the carotid artery
- Most cases it happens over the clavicle and indicates a carotid blockage
Where do you asses the pedal pulse?
Anterior surface of the foot, between maleoli and just lateral to the extensor hallicus longus tendon
What are the pulse grades you can assign when measuring peripheral pulses?
Absent (0)
Thread (1+)
Weak (2+)
Normal (3+)
Bounding (4+)
All based on the strength of the pulse
What is associated with arterial insufficiency?
Painful ulcers
Cramps
Gangrene
Exercise intolerance
CAD
CVA
What is associated with venous insufficiency?
Infection
Ulcers
VTE
DVT
Cramps
Leg pain
How do you assess ABI??
- Measure the BP at the ankle using the dorsalis pedís pulse or the posterior tib pulse - record the pulse as the top number
- Measure the BP at the brachial pulse - record the pulse as the bottom number
- Take the fraction and interpret results
What does rubor dependency test indicate if positive?
Arterial insufficiency
What does reperfusion that takes longer than 30 seconds and observation of dark red color in the ankle tell you about the rubor dependency test?
Positive for severe ischemic disease
What are some factors that predispose someone to VTE/DVT?
- cancer
- bed rest
- muscle wasting
- immobilization
- burn or other wounds
- edema
- heart failure
What has been shown to result in a lower rate of VTE/DVT?
- when medication is combined with mobility
- Study that showed people that engaged in ambulation with a prophylactic enoxaparin had lower rates of VTE
What are non pharm treatments for VTE/DVT?
Mobilization but not until they are anticoagulated
Who is the Padua prediction score recommended for?
Risk assessment model for VTE/DVT
Hospitalized patients
Cancer patients
Patients that underwent trauma or other serious conditions
Who is the Khorana score recommended for?
Patients with cancer to assess for VTE/DVT
It allocates points based on 5 clinical and pre chemo treatment lab values (primary tumor site, platelet count, hemoglobin, leukocyte count, BMI)
Lush - Dub may indicate what
A murmur obscuring S1 so could be problem with mitral and tricuspid valves
Lub-Lush may indicate what
A heart murmur obscuring S2 so aortic and pulmonary valves may be affected
What does an S3 heart sound indicate?
In young people or athletes = normal, athletes heart (ventricular hypertrophy)
In people over 40 = abnormal, indicates heart failure and cardiac hypertrophy
What does an S4 heart sound indicate?
ALWAYS PATHOLOGICAL
Associated with HTN, cardiomyopathy, cardiac hypertrophy
What is a heart murmur associated with?
Altered blood flow either due to a narrowed aorta or regurgitation through leaky valves.
