Exam 2 review Flashcards
What is the outermost layer of the heart called?
Epicardium
The epicardium is a thin, serous membrane that provides a smooth surface for the heart.
What are the main functions of the epicardium?
- Provides a smooth surface
- Part of the pericardial sac
- Contains blood vessels, lymphatics, and fat
- Reduces friction during heart contractions
It also contains nerves from the sympathetic and parasympathetic systems.
What is the thickest layer of the heart called?
Myocardium
The myocardium is responsible for the contractile force that propels blood throughout the circulatory system.
What type of muscle cells make up the myocardium?
Specialized cardiac muscle cells (myocytes)
These cells are involuntary and striated.
Which ventricle has the thickest myocardium and why?
Left ventricle
It pumps oxygenated blood to the entire body, requiring higher pressure and greater force.
What is the innermost layer of the heart?
Endocardium
This layer is a thin endothelial membrane that lines the heart chambers and covers the heart valves.
What are the main functions of the endocardium?
- Ensures smooth blood flow
- Prevents clot formation
- Contains specialized Purkinje fibers
The endocardium is susceptible to infections like infective endocarditis.
What is the function of the pericardium?
- Protects the heart
- Lubricates to prevent friction
- Limits overexpansion
It consists of visceral and parietal layers and contains pericardial fluid.
What is a common condition associated with inflammation of the pericardium?
Pericarditis
This condition can lead to pericardial effusion and potentially cardiac tamponade.
Where is the carotid pulse located?
Between the trachea and the sternocleidomastoid muscle
It is assessed for symmetry, rate, and amplitude.
What is the normal rate for a carotid pulse?
60-100 bpm
Athletes may have a lower resting rate.
What does a weak or absent carotid pulse indicate?
Shock, arterial occlusion, or decreased cardiac output
A bounding pulse could indicate hypertension or aortic regurgitation.
Where is the brachial pulse palpated?
At the antecubital fossa
It is located on the medial side of the arm near the elbow.
What is the normal finding for the brachial pulse?
Equal bilaterally, strong, and regular
Amplitude should be 2+.
What is the purpose of capillary refill assessment?
To evaluate tissue perfusion and circulatory status
It helps detect dehydration, shock, and poor blood flow.
What is considered a normal capillary refill time?
Less than 2 seconds
Prolonged refill time may indicate decreased perfusion.
What factors can affect capillary refill time?
- Cool environment
- Smoking
- Peripheral edema
- Anemia
- Dehydration
These conditions can influence the accuracy of the test.
What is the optimal patient positioning for cardiovascular assessment?
Supine with the head of the bed at 30 degrees
This position allows for better assessment of jugular venous distention and heart sounds.
What causes the S1 heart sound?
Closure of the atrioventricular (AV) valves
S1 occurs at the start of systole.
What is a split S2 heart sound?
A normal physiological finding affected by respirations
It occurs during inspiration when the pulmonic valve closure is delayed.
What defines a heart murmur?
A swishing or unusually prolonged sound indicating turbulent blood flow
Murmurs can be classified as systolic or diastolic.
What are the two main types of heart murmurs?
- Innocent (physiologic) murmurs
- Abnormal (pathologic) murmurs
Innocent murmurs are not caused by heart disease, while abnormal murmurs are associated with heart disease.
What is the grading scale for murmur intensity?
1 to 6 based on loudness
Grade 1 is faint, while Grade 6 is extremely loud.
What is dyspnea?
An uncomfortable sensation of breathlessness
It can indicate various underlying health issues.
What are the two types of murmurs and their characteristics?
Systolic murmurs may be benign or pathological; diastolic murmurs are always abnormal
How are murmurs graded?
By intensity, pitch, and quality
What is Dyspnea?
An uncomfortable awareness of breathing
What are common descriptions patients use for Dyspnea?
- Shortness of breath (SOB) * Difficulty breathing * A feeling of chest tightness
What causes Cardiac Dyspnea?
Inadequate cardiac output leading to poor tissue oxygenation
What is Orthopnea?
Shortness of breath when lying flat, relieved by sitting or standing
What is Paroxysmal Nocturnal Dyspnea (PND)?
Episodes of severe shortness of breath occurring during sleep
What triggers Dyspnea on Exertion (DOE)?
Physical activity, indicating possible heart failure or other conditions
What is a Pulmonary Embolism (PE)?
A medical emergency caused by a blood clot blocking blood flow to the lungs
What are classic signs of Pulmonary Embolism?
- Dyspnea * Tachypnea * Pleuritic chest pain
What are key questions to assess Dyspnea in patients?
- Do you experience shortness of breath? * What relieves or worsens it? * Does a specific position help? * How far can you walk before feeling short of breath? * Do you use supplemental oxygen?
What are clinical signs of severe Dyspnea?
- Difficulty speaking in full sentences * Use of accessory muscles * Retractions * Cyanosis * Tachypnea
What is the definition of Coronary Artery Disease (CAD)?
A condition characterized by narrowing or blockage of the coronary arteries due to atherosclerosis
What is Atherosclerosis?
The most common form of arteriosclerosis, characterized by cholesterol, lipid, and calcium deposits in artery walls
What are the stages of Atherosclerosis progression?
- Endothelial Damage * Fatty Streak Formation * Plaque Development * Plaque Rupture and Clot Formation
What are nonmodifiable risk factors for CAD?
- Age * Gender * Genetics * Ethnicity
What are modifiable risk factors for CAD?
- Smoking * High Cholesterol * Hypertension * Diabetes * Obesity * Sedentary Lifestyle * Poor Diet
What are common symptoms of CAD?
- Angina (chest pain) * Shortness of breath * Fatigue * Heart attack (myocardial infarction)
What tests are used to diagnose CAD?
- Lipid Panel * Electrocardiogram (EKG) * Echocardiogram * Stress Test * Coronary Angiography
What lifestyle modifications can prevent CAD?
- Quit smoking * Adopt a heart-healthy diet * Exercise regularly * Manage stress
What medications are used for CAD prevention?
- Statins * Beta-Blockers * ACE Inhibitors * Aspirin * Nitrates
What are surgical interventions for severe CAD cases?
- Angioplasty and Stent Placement * Coronary Artery Bypass Graft (CABG)
What is Acute Myocardial Infarction (AMI)?
A heart attack occurring when blood flow to the heart muscle is blocked
What are classic symptoms of AMI?
- Chest pain * Pain radiation * Shortness of breath * Cold sweat * Nausea and vomiting * Dizziness * Feeling of impending doom
What are atypical symptoms of AMI more common in women?
- Fatigue * Indigestion or heartburn * Pain in the upper abdomen * Shortness of breath * Dizziness or fainting
What mnemonic can help recall symptoms of a heart attack?
PULSE: Pain, Unexplained shortness of breath, Lightheadedness, Sweating, Extreme fatigue
What immediate actions should be taken for suspected AMI?
Call 911
What does the ‘P’ in the PULSE acronym stand for?
Pain (chest pain)
What does the ‘U’ in the PULSE acronym represent?
Unexplained shortness of breath
What does the ‘L’ in the PULSE acronym indicate?
Lightheadedness or dizziness
What does the ‘S’ in the PULSE acronym refer to?
Sweating profusely
What does the ‘E’ in the PULSE acronym signify?
Extreme fatigue
What is a key assessment question regarding chest pain?
When did the pain start?
What immediate action should be taken in case of suspected Acute Myocardial Infarction (AMI)?
Call 911
What is the purpose of administering Aspirin (160-325 mg) in AMI?
Helps prevent clot expansion
What oxygen saturation level indicates the need for oxygen therapy?
O2 saturation < 94%
What is the purpose of Nitroglycerin in the treatment of AMI?
Relieves chest pain by dilating coronary arteries
What is the ‘MONA’ acronym used for in hospital treatment of AMI?
Morphine, Oxygen, Nitroglycerin, Aspirin
What are thrombolytics used for in the context of AMI?
Dissolves clots, used in early AMI
What is Peripheral Artery Disease (PAD)?
Narrowing or occlusion of arteries outside the heart and brain due to atherosclerotic plaque buildup
What is the single most significant contributor to PAD?
Smoking
How much does diabetes increase the risk for PAD?
4 times
What are common symptoms of PAD?
Intermittent claudication, rest pain, weak or absent pulses, skin changes, delayed wound healing
What is the Ankle-Brachial Index (ABI) used for?
Assesses circulation by comparing ankle and arm blood pressures
What is the risk of Critical Limb Ischemia (CLI) in PAD?
Increases the risk of non-healing ulcers and gangrene
What lifestyle modification can reduce PAD risk by 50% within 1 year?
Smoking cessation
What is the definition of Hypertension?
Systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg
What is the classification for Hypertension Stage 1?
SBP 130-139 mmHg and DBP 80-89 mmHg
What are the nonmodifiable risk factors for hypertension?
- Age
- Genetics
- Sex
- Ethnicity
What is a common symptom of severe hypertension?
Headaches
What lifestyle changes can help manage hypertension?
- Dietary changes (DASH Diet)
- Regular exercise
- Weight management
- Smoking cessation
- Limit alcohol
What is Peripheral Vascular Disease (PVD)?
Conditions causing partial or complete obstruction of blood flow in arteries or veins outside the chest
What are symptoms of arterial insufficiency in PVD?
- Pain (Intermittent Claudication)
- Pallor (Pale Skin)
- Cool Skin Temperature
- Weak or Absent Pulses
- Ulcers on Toes/Feet
What should patients with PVD do for foot care?
- Inspect feet daily
- Avoid walking barefoot
- Wear well-fitted shoes
What lifestyle modifications are recommended to prevent PVD progression?
Foot care, regular exercise, a healthy diet, and smoking cessation
These modifications help improve circulation and overall vascular health.
What daily foot care practices should patients with PVD follow?
Inspect feet for wounds, use a mirror for soles, avoid barefoot walking, and wear well-fitted shoes
Diabetics should also monitor blood sugar levels to prevent poor wound healing.
How does regular exercise benefit patients with PVD?
It improves circulation and helps prevent venous insufficiency
Patients should aim for at least 30 minutes of activity most days.
What dietary recommendations are made for patients at risk of PVD?
Low-fat, low-sugar diet rich in fruits and vegetables
Controlling hypertension and cholesterol levels is also important.
What are varicose veins?
Dilated, twisted veins in the lower extremities caused by incompetent valves
What should patients do if they experience pain during exercise?
Immediately stop exercising
What treatments are available for severe varicose veins?
Surgical treatments such as vein stripping or laser therapy
What is the primary cause of Peripheral Vascular Disease (PVD)?
Arterial or venous blockages affecting circulation
What major risk factors contribute to PVD?
- Smoking
- Diabetes
- Obesity
- Hypertension
What is a Holter monitor used for?
To record cardiac electrical activity for 24 to 48 hours
List some common indications for using a Holter monitor.
- Palpitations
- Dizziness or fainting
- Chest pain
- Unexplained fatigue
- Post-heart attack monitoring
What is an echocardiogram?
A noninvasive ultrasound that creates moving images of the heart’s structures
What types of echocardiograms exist?
- Transthoracic Echocardiogram (TTE)
- Transesophageal Echocardiogram (TEE)
- Stress Echocardiogram
- Doppler Echocardiogram
What does an exercise stress test evaluate?
Heart function and rhythm under physical stress
What is the main purpose of an electrocardiogram (ECG/EKG)?
To record the electrical activity of the heart
What are the key components of a heart-healthy diet?
- Increase fruits & vegetables
- Choose whole grains
- Select lean proteins
- Limit saturated and trans fats
- Reduce sodium intake
How often should cholesterol screening occur starting at age 20?
Every 4-6 years
What is the correct order of assessment for the respiratory system?
Inspection, Palpation, Percussion, Auscultation (IPPA)
What are alveoli?
The smallest air sacs of the lungs, primary site of gas exchange
What is the function of surfactant in the lungs?
Reduces surface tension in alveoli, preventing collapse
What is a normal respiratory rate for adults?
12–20 breaths per minute
What does a barrel chest indicate?
An AP-to-transverse ratio of 1:1, often seen in COPD
What does pursed lip breathing help with?
Prolongs exhalation and reduces airway collapse
What respiratory condition is indicated by tachypnea?
More than 20 breaths per minute, can be associated with fever or anxiety
What is the significance of the costal angle in a normal respiratory assessment?
It should be less than 90 degrees
What does intercostal or accessory muscle use suggest?
Airway obstruction or increased respiratory effort
Indicates the patient is struggling to breathe effectively.
What is pursed lip breathing and when is it seen?
Patient exhales through pursed lips to prolong expiration and improve ventilation, seen in COPD
A technique to help manage breathlessness.
Define tachypnea.
> 20 breaths per minute, shallow breathing
Often associated with fever, anxiety, pneumonia.
Define bradypnea.
<12 breaths per minute, slow breathing
Common causes include drug overdose, increased ICP, diabetic coma.
What is Cheyne-Stokes respiration?
Gradual increase in depth, then gradual decrease, followed by apnea
Associated with heart failure, brain injury, dying patients.
What characterizes Biot’s respirations?
Irregular breathing pattern with variable depth and periods of apnea
Typically indicates brain damage or meningitis.
What is Kussmaul breathing?
Deep, rapid, labored breathing
Commonly seen in diabetic ketoacidosis (DKA) and metabolic acidosis.
What does apnea refer to?
Absence of breathing for >20 seconds
Associated with respiratory failure or cardiac arrest.
What is cardiac dyspnea?
Difficulty breathing related to inadequate cardiac output
Common in conditions like congestive heart failure and myocardial infarction.
What are key signs of cardiac dyspnea?
- Exertional dyspnea
- Orthopnea
- Paroxysmal nocturnal dyspnea
These signs indicate worsening breathing related to heart function.
Define expiratory dyspnea.
Difficulty breathing that primarily occurs during exhalation
Usually caused by Chronic Obstructive Pulmonary Disease (COPD).
What are key signs of expiratory dyspnea?
- Wheezing
- Prolonged expiration
- Accessory muscle use
- Pursed-lip breathing
Characteristic of COPD-related breathing difficulties.
What is paroxysmal nocturnal dyspnea (PND)?
Sudden shortness of breath during sleep, causing the patient to sit upright
Often a sign of left ventricular heart failure.
What are common causes of paroxysmal nocturnal dyspnea?
- Left ventricular heart failure
- Pulmonary congestion
- Orthopnea
- History of heart failure symptoms
Symptoms like waking up gasping for air are common.
What does pulse oximetry measure?
Continuously measures oxygen saturation (SpO₂)
Normal SpO₂ is ≥95%, accuracy may be affected by external factors.
What is arterial blood gas (ABG) testing used for?
Measures levels of oxygen (O₂) and carbon dioxide (CO₂) in the blood
Evaluates respiratory function and acid-base balance.
What is bronchoscopy?
Diagnostic or therapeutic procedure to visualize the larynx, trachea, and bronchial tree
Can be used to detect obstructions, infections, or tumors.
What is thoracentesis?
Insertion of a needle into the thoracic cavity to remove or analyze pleural fluid
Used for both diagnostic purposes and therapeutic relief of pleural effusion.
Who should receive the pneumonia vaccine?
- Adults 65+
- Individuals with chronic respiratory diseases
- Immunocompromised patients
Recommended to reduce the risk of pneumonia.
What are the primary functions of the pancreas?
- Endocrine function: Secretes insulin
- Exocrine function: Releases pancreatic juices for digestion
Disorders can lead to metabolic dysfunction.
What enzymes are measured to detect pancreatic disorders?
- Amylase
- Lipase
Elevated levels indicate obstruction or inflammation.
What do glucose levels indicate in pancreatic diagnostics?
Assess insulin function related to islets of Langerhans
Critical for diagnosing diabetes and other metabolic disorders.
