Exam 2 - Alterations Of Cardiac Function Flashcards
1
Q
Two types of valves in the heart and where is each kind located?
A
AV Valves (inside the heart) Semilunar valves (open to outside of heart)
2
Q
What are the two AV valves?
A
Tricuspid
Mitral
3
Q
What are the two semilunar valves?
A
Aortic
Pulmonary
4
Q
Why are the AV valves important?
A
They prevent backflow
5
Q
Why are the semilunar valves important?
A
Anything that’s pushed out of them affects the rest of the body
6
Q
List the path the blood takes through the heart
A
Superior vena cava Right atrium Tricuspid valve Right ventricle Pulmonary valve Lungs Left atrium Mitral valve Left ventricle Aorta
7
Q
Amount of blood ejected from the heart each minute
A
Cardiac output
8
Q
Where does blood ejected from the heart go?
A
To aorta (from left ventricle) To pulmonary trunk (from right ventricle)
9
Q
2 factors that regulate cardiac output
A
Stroke volume
Heart rate
10
Q
What is stroke volume?
A
Volume of blood pumped by the ventricle each heart beat
11
Q
What is heart rate?
A
Number of heart beats per minute
12
Q
3 factors that regulate stroke volume
A
Preload
Contractility
Afterload
13
Q
Why are the 3 factors that regulate stroke volume so important for nurses?
A
We administer drugs that affect all 3 factors
We also measure them
14
Q
What is preload?
A
STRETCH of the heart before it contracts
15
Q
What is preload based on?
A
Volume
16
Q
How is preload measured?
A
Pressure generated in the left ventricle at the end of diastole
17
Q
What is contractility?
A
STRENGTH of contraction at any given preload
18
Q
How is contractility measured?
A
Degree of myocardial fiber shortening
19
Q
What is afterload?
A
PRESSURE that must be exceeded before ejection of blood from the ventricles can begin
20
Q
What is afterload measured by?
A
Resistance to ejection of blood from the left ventricle
21
Q
If diastolic BP # is extremely low or extremely high, there is an issue with what?
A
Preload
22
Q
What does preload affect?
A
Contractility
23
Q
What does contractility affect?
A
Afterload
24
Q
What is systole?
A
Contraction that propels blood out of the ventricles and into circulation
25
What is diastole?
Ventricular relaxation; blood fills the ventricles
26
What is blood pressure?
Pressure that is exerted on the walls of the arteries
27
What does blood pressure measure?
The pressure of blood in the arteries when ventricles contract (systole) and when ventricles relax (diastole)
28
What is ejection fraction?
Amount of blood ejected from ventricle with each heart beat
29
What is a normal ejection fraction?
60-70%
30
Why can ejection fraction never be higher than 70%?
Because the rest of the blood volume is out in the tissues
31
What should you ask a patient who you suspect has a low ejection fraction?
“How far can you walk without getting short of breath?”
32
Why does a low ejection fraction cause shortness of breath?
Not enough blood going out to tissues
33
What does a low ejection fraction indicate?
Pt at rist for ventricular failure
34
What is ventricular failure?
Ventricles fail to squeeze out all of the blood they have
35
What would a heart likely look like in someone who has a suffering ejection fracture?
Dead heart muscle (due to myocardial infarction)
| Bigger ventricle because of more workload over time
36
Two types of resistance
Peripheral vascular resistance
| Systemic vascular resistance
37
What is peripheral vascular resistance?
Resistance to blood flow determined by:
Vascular muscle tone
Diameter of blood vessels (vascular tone)
38
What is systemic vascular resistance?
Resistance the left ventricle must overcome to pump blood through the systemic circulation
39
What happens to SVR when someone has hypotension?
The peripheral blood vessels constrict, so the SVR increases
40
What is hypertension?
Consistent elevation of systemic arterial blood pressure
41
What causes hypertension?
Increased volume of cardiac output
Increased total peripheral resistance
(Or both)
42
Who is more at risk of hypertension?
Men
African americans
(Prevalence increases with age as well)
43
Why are African Americans more at risk for hypertension than caucasions?
- Genetic predisposition
- Compliance
- Background
44
What is secondary hypertension?
Hypertension caused by systemic disease
45
What systemic disease usually causes secondary hypertension?
Kidney disease
46
Causes of secondary hypertension?
- Renal disease
- Adrenal disorders
- Vascular disease
- Drugs
- Any condition that raises peripheral vascular resistance or cardiac output
47
Why is kidney disease so likely to cause secondary hypertension?
Kidneys are key component in blood pressure and fluid volume in general
48
Causes of hypotension
- Anatomic variation
- Altered body chemistry
- Antihypertensive and antidepressant therapy
- Prolonged immobility due to illness
- Starvation
- Physical exhaustion
- Fluid volume depletion
- Venous pooling
49
Why can antihypertensive and antidepressant drugs cause hypotension?
BP too low if have too much of drug. If stopped immediately, would have rebound high BP. So need to wean off of these medications
50
Signs and symptoms of low blood volume:
- Decreased blood pressure
- Increased heart rate (body trying to get volume back up)
- Pallor
- Turger > 3 sec. (= dry skin)
51
Why does venous pooling cause hypotension?
A lot of blood out in vascular space that can’t get back
52
How is hypotension treated?
Add fluids
| Hydrate pt with isotonic solution
53
What is an aneursym?
- Weakness in large vessel that causes bulging
54
What does an aneursym change?
Cardiac output and other measures
55
Which vessle is most susceptible to an aneursym and why?
Aorta because it’s under constant stress
56
Where do most aneursyms occur in the body?
3/4 are in abdomen (where the aorta is)
57
Most common cause of aneursyms?
Atherosclerosis
58
2nd most common cause of aneursyms?
Syphilis and other infections
59
Types of aneurysms?
True (AKA fusiform AKA circumferential)
| False (AKA saccular)
60
What is a true aneurysm?
Involves all three layers of vessel (and usually goes all the way around)
61
What is a false aneurysm?
Extravascular hematoma
| Communicates with intravascular space
62
Symptoms of an aneurysm
Both types are asymptomatic until they rupture
| Can see prominent mass pulsating in abdomen
63
Symptoms of a ruptured aneurysm
Extreme pain
Dysphagia (can’t swallow)
Dyspnea (can’t get oxygen b/c losing RBCs)
Pressure builds up in abdomen
64
What happens when a person has an aortic aneurism rupture?
- Blood squirts out of aorta into abdomen with each heart pump
(Aorta holds 20% of blood, so this is a lot of blood going into abdomen)
65
What is an aortic dissection?
A hole develpos in aorta
| Basically the same thing as a rupture
66
What is a thrombus?
A clot that remains attached to vessel wall
67
What is a thromboembolism?
A detached thrombus
68
What happens when someone has a thromboembolism?
Clot gets caught in heart (heart attack) or brain (stroke)
69
How does a thromboembolism develop?
When someone has a condition that promotes coagulation or the clotting cascade
Ex: chronic inflammation
70
What is thrombophelbitis?
Inflammation of vein (with or without an associated clot)
71
What can cause thrombophlebitis to develop?
Some drugs we give through IVs
72
What is an embolus?
Bolus circulating in the bloodstream
73
What can the bolus of an embolus be made of?
```
Air bubble
Amniotic fluid
Fat
Bacteria
Cancer cells
Foreign substance
```
74
What happens to the bolus of an embolus?
Travels in the bloodstream until it reaches a vessel it cannot fit
75
Clinical manifestations of an embolism
Ischemia or infarction distal to obstruction
| Life threatening
76
What is arteriosclerosis?
Chronic disease of arterial system
77
Characteristics of arteriosclerosis
Abnormal thickening and hardening of vessel walls
78
Patho of arteriosclerosis
Smooth muscle cells and collagen fibers migrate into part of vessel causing stiffness and thickness
79
What does arteriosclerosis do to the arteries?
Decreases the arteries ability to change lumen size
AKA:
- Decreases contractility
- Increases resistance
80
What is atherosclerosis?
A form of arteriosclerosis
| Where intraarterial fat and fibrin collect (like a clot)
81
What are the forms of atherosclerosis dependent upon?
Anatomic vessel location
Age and genetic predisposition; physiologic status
Risk factors (habits)
82
Risk factors for atherosclerosis
```
Smoking
Hypertension
Diabetes
Hyperdyslipidemia
Autoimmune phenomenon (chronic inflammation issues)
Long term infection
```
83
What is atherosclerosis the leading contributor to?
Coronary artery disease
| Stroke
84
What is coronary artery disease?
Any vascular disease that narrows or occludes the coronary arteries
85
Most common cause of coronary artery disease
Atherosclerosis
86
Why are we so worried about clots getting into the coronary arteries?
- They feed the muscle tissue of the heart (located on outside of heart)
- They’re small so easier for clots to get stuck
87
What are the nonmodifiable risk factors of coronary artery disease?
Genetics
Family history
Gender
88
What does modifiable risk factor mean?
Risk factor that can be changed to some degree
89
Modifiable risk factors of coronary artery disease
```
Hyperlipidemia
Hypertension
Cigarette smoking
Diabetes
Obesity
Sedentary life-style
Estrogen deficiency
Heavy alcohol consumption
Personality
```
90
What is myocardial ischema in a large area?
Impared blood flow to myocardiam
| Develops within 10 seconds of deprivation
91
Patho of myocardial ischemia?
Insufficient coronary blood flow to meet the needs of the heart
92
Reasons for reduced blood supply to the heart that causes myocardial ischemia
```
Decreased blood volume
Tachycardia
Low hemoglobin
Shock
Increased demand:
- Hypertension, stress, hyperthyroidism, anemia
```
93
Most common cause of myocardial ischemia?
Atherosclerosis
94
Three types of local myocardial ischemia:
Stabile angina
Prinzmetal angina
Silent ischemia
95
What is prinzmetal angina related to?
Spasms in coronary artery
96
What is silent ischema?
Silent chest pain (pts don’t realize or relate it to chest pain)
97
Acute inflammation of pericardium?
Acute pericarditis
98
Top cause for acute pericarditis?
Infection
99
Clinical manifestations of acute pericarditis?
```
Sudden onset of severe chest pain
Pain worsens with breathin and laying down
Dysphagia
Restlessness (can’t get comfortable)
Anxiety
Weakness
Malaise (feeling blah)
Low-grade fever
Tachycardia
```
100
Accumulation of fluid in the pericardial cavity
Pericardial effusion
101
What fluid can be caught in pericardial cavity with pericardial effusion?
Serous
| Exudate
102
Complication that can happen due to pericardial effusion
Tamponade (cardiac compression)
| Because the fluid causes more pressure on the heart
103
Clinical manifestations of pericardial effusion
Muffled or distant heart sounds (bc listening through fluid)
Dyspnea on exertion
Dull chest pain
104
How to treat pericardial effusion
Drain
| Make pericardial window
105
What is cardiomyopathy?
Diverse group of diseases affecting myocardium
106
What do all of the diseases affecting the myocardium (cardiomyopathy) cause?
- Remodeling of myocardium secondary to long-term hypertension and ischemic heart disease (because of excess fluid over time)
107
What can cardiomyopathy be caused by?
Infection
Exposure to toxins
Nutritional deficiencies
108
Types of cardiomyopathy
- Dilated
- Hypertrophic (excessive blood flow b/c they’re being overused)
- Restrictive
109
What would the ejection fraction look like for the different types of cardiomyopathy?
Dilated and hypertrophic would have the same EF
| Restrictive would have a lower EF
110
Treatment for cardiomyopathy?
Treat symptoms and try to lower volume
111
Types of valvular dysfunction
Stenosis
| Regurgitation
112
What is stenosis?
Valvular dysfunction:
- constricted and narrowed valve
- so blood does not flow forward
- workload in front of diseased valve is increased
113
What is regurgitation?
Valvular dysfunction:
- failure of valve to shut completely
- allows blood flow to continue when valve should be closed
114
Difference between stenosis and regurgitation valvular dysfunctions?
```
Stenosis = narrowed
Regurgitation = incompetent
```
115
What are the results of regurgitation?
Increased volume the heart must pump
| Increased workload of atrium and ventricle
116
Causes of aortic valve stenosis?
Inflammatory damage from rheumatic heart disease
Congenital malformation
Degeneration of aortic wall resulting from calcification
117
Clinical manifestations of aortic valve stenosis
Decreased stroke volume
Reduced systolic blood pressure
Narrowed pulse pressure (BP #s get closer together)
Bradycardia
Hypertrophy develops to compensate
118
Cause of mitral stenosis
Acute rheumatic fever
| Bacterial endocarditis
119
Patho of mitral stenosis
Narrowing of orifice occurs as inflammatory leasions heal resulting in long term scarring
120
Clinical manifestations of mitral valve stenosis
- Chamber dilation and hypertrophy
| - Decreased cardiac output during exertion
121
What happens if mitral valve stenosis is left untreated?
Hypertension
Edema
Right ventricular failure
122
What causes aortic valve regurgitation?
```
Acute or chronic lesions of rheumatic fever
Bacterial endocarditis
Syphilis
Connective tissue disorders
Atherosclerosis
Hypertension
```
123
Causes of mitral valve regurgitation
```
Mitral valve prolapse
Rheumatic heart disease
Infective endocarditis
CAD
Connective tissue disorders
Congestive cardiomyopathy
```
