MedSurg: Cardiovascular Flashcards
What is the position of your heart?
It is slightly shifted to the left, it lies in the mediastinum. It sits on top of the diaphragm and behind the sternum and incased within the ribcage and behind the lungs.
It is the broader portion of the heart?
Base of the heart
It is the sharp portion or tip point of the heart?
Apex
Heart is incased in a sac called?
Pericardium
What is the function of pericardial fluid in the heart.
- It acts as a lubricant to prevent friction and acts as a shock absorber.
What are the 2 parts of a pericardium?
Fibrous and Parietal
What is the thick part of the pericardium?
Fibrous
What part of the pericardium contains pericardial fluid?
Parietal
There are cases in which the pericardial fluid is in excess, thus squishing the heart. This surgical procedure involves making a hole to a pericardium to draw or remove the pressure in the heart.
Pericardial Window
What are the three parts of the heart?
Epicardium, Pericardium, Myocardium and Endocardium
What are the 2 chambers of the heart?
Atria and Ventricles
This term is use to describe the contraction of the atria and ventricle?
Systole
It is a term use to denote the relaxation phase of the atria and ventricles.
Diastole
What are the Atrioventricular Valves?
Tricuspid and Bicuspid/Mitral Valve
What are the semilunar valves?
Pulmonary and Aortic Valve
It perfuses blood toward the right atrium, right ventricle, inferior portion of the LV and posterior
septal wall, SA node, and AV node. Main highway of blood going into your heart.
Right Coronary Artery
It supplies blood to the
anterior wall of LV, anterior ventricular septum.
Left Coronary Artery
It provides blood to LA, lateral and posterior surfaces of LV, occasionally the posterior interventricular septum.
Circumflex Artery
It is a low pressure system because it has a short pathway.
Pulmonary Circulation
It is the ability of the cardiac cells to initiate impulse spontaneously and repetitively without external neurohormonal control.
Automaticity
They are the cheerleader of the cardiac cells, they are the stimuli for the conduction system. They basically start the whole conduction system and the other cells would then follow until it goes back.
Pacemaker
It is the ability of the cardiac muscles to depolarize in response to stimulus.
Excitability
It is the ability of the heart muscles to propagate electrical impulses along and across cell membranes.
Conductivity
It is the ability to develop force at a given muscle length.
Contractility
The action potential initiates muscle contraction releasing _______ through the transverse tubules of cell membrane.
calcium
What are the most important electrolytes in the conduction of the heart?
Potassium, sodium and calcium
It is the inability of the heart to respond to a new stimulus while in a a state of depolarization from an earlier stimulus.
Refractoriness
Refractoriness develops when the ______ channels of the cardiac cell membrane become inactivated and unexcitable during an action potential.
Sodium
What are the steps in the heart conduction system.
- Sinoatrial Node
- Atrioventricular Node
- Bundle of His
- Bundle Branches
- Purkinje Fibers
List down the corresponding electrical impulses of each node.
SA - 60-100
AV - 40-60
Bundle branches - 20-40
Purkinje Fiber - 20-40
What type of cell primarily comprise the heart muscle myocardium?
Myocytes
It is a phase in which cellular depolarization is initiated as positive ion influx into the cell.
Phase 0
In the Phase 0, what electrolyte moves into the myocyte cells?
Sodium
It is the early cellular repolarization as potassium exits the intracellular phase.
Phase 1
What is needed for the depolarization of SA and AV nodes?
Calcium
This phase is called the plateau phase because the rate of repolarization slows and calcium ions enter the intracellular space.
Phase 2
It marks the completion of repolarization and returns the cell to its resting phase. Calcium ion channels close, potassium channels stay open.
Phase 3
It is considered as the resting phase before the next depolarization.
Phase 4
What are the 3 stages of cardiac cycle?
Atrial Systole, Ventricular Systole and Diastole
Contraction of the atrial walls pumps the blood into the ventricles.
Atrial Systole
Contraction of the ventricle walls pumps the blood upwards into the arteries.
Ventricular Systole
All four chamber of the heart relax and elastic recoil causes an increase in volume to allow blood to flow in from veins.
Diastole
During systole there is ______ contraction or the ______ relaxation
Ventricular; atrial
It is a term use to denote an arterial pressure when ventricles squeeze out blood under high pressure.
Systolic blood pressure
It is ventricular relaxation or the atrial contraction.
Diastole
What valves closes during S1?
Tricuspid and mitral valves
What valves closes during S2?
Aortic and Pulmonic Valves
What percent of blood goes into the pulmonary circulation?
10%
What percent of blood goes to the heart?
5%
What percent of blood goes to arteries?
15%
What percent of blood goes to capillaries?
5%
What percent of blood goes to veins?
65%
What is the volume of blood in normal Adults?
5 liters
How many percent of blood does the brain needs in order to function?
15
How many percent of blood does the heart needs in order to function?
5
How many percent of blood does the skeletal muscle needs in order to function?
25
How many percent of blood does the kidney needs in order to function?
25
How many percent of blood does the GI tract needs in order to function?
25
It is the total volume of blood ejected by the heart per minute, it is the amount of blood reaching the tissues.
Cardiac Output
How to solve for the cardiac output?
HR x SV
What is the normal CO per minute?
4 to 8 L
it is the number of times the heart contracts each minute normal is 60 to 100 bpm?
Heart Rate
It is the amount of blood ejected from the left ventricle.
Stroke Volume
It is the percentage of blood expelled from the left ventricle with every contraction.
Ejection Fraction
What is the normal Ejection Fraction?
50-70 percent
Lower than ____ % of EF means that the heart is not functioning well or the conduction of the heart is bad.
50
It is the amount of blood returned to the right side of the heart at the end of the diastole.
Preload
It is the pressure of the left ventricle has to pump against the resistance it must overcome to circulate the blood.
Afterload
This law states that the stroke volume of the left ventricle will increase as the left ventricular volume increase due to the myocyte stretch causing a more forceful diastolic contraction.
Frank-Starling Law
What is the normal Cardiac Index?
2.5-4 L/min/m3
What is the normal central venous pressure?
2-8 mmHg
What is the mean arterial pressure?
70-100 mmHg
What is the normal systemic vascular resistance?
800-1200 dynes/sec/cm
It shows how much pressure from the blood is returned to the right atrium from the superior vena cava.
Central Venous Pressure
How to solve for the men arterial pressure?
1 systole + 2 diastole/3
It is the resistance it takes to push blood through the circulatory system to create blood flow.
Systemic vascular resistance
The parasympathetic nervous system releases ________ which has inhibitory effects.
Acetylcholine
The sympathetic nervous system releases _______.
Norepinephrine
What are the 5 types of receptor?
Alpha 1-adrenergic receptor
Alpha 2-adrenergic receptor
Beta 1-adrenergic receptor
Beta 2-adrenergic receptor
Beta 3-adrenergic receptor
It is located primarily in peripheral arteries and veins, when stimulated it produces a dramatic vasoconstrictive response.
Alpha 1-adrenergic receptor
Located in some tissues, action include contraction of some
vascular smooth muscle, inhibition
of lipolysis, inhibition of
neurotransmission and promotion
of platelet aggregation.
Alpha 2-adrenergic receptor
Predominantly Located in the
heart when stimulated, causes an
increase in heart rate, AV Node
conduction and myocardial
contractility.
Beta1 adrenergic receptor
Located in the bronchioles and
bronchial walls stimulated causes
smooth muscle to dilate producing
vasodilation. Bronchodilator.
Beta2 adrenergic receptor
Located in adipose tissue where
they promote lipolysis.
Beta3-adrenergic receptor
What are the hormonal influence and other factors affecting the heart?
- Other hormones involved indirectly
regulating output by controlling
bòdy fluid volume includes ADH
and the renin-angiotensin-aldosterone
mechanism - Other factors that can influence
Cardiac activity and blood pressure
includes cerebral cortical input
From anger, fear, pain, or
excitement. - Gender, age, temperature, and
exercise
They carry the deoxygenated blood back to the heart.
Vein
Carries oxygenated blood away from the heart.
Artery
What are the 3 layers of blood vessels?
Tunica Intima, Tunica Media, Tunica Externa
It is the innermost portion and the most fragile part of the blood vessel.
Tunica Intima
It is composed of smooth muscles.
Tunica Media
It is the most fibrous part of the vein and the arteries.
Tunica Externa
It is the collection of very small blood vessels, this is where blood vessels get blood supply.
Vasa vasorum
What are the 3 different cardiac receptor?
Arterial receptor
Stretch receptor
Chemoreceptor
What is the ph of the blood?
Slightly alkaline (7.35 - 7.45)
What is the volume of blood in the body?
4-5 liters
What is the normal RBC Count?
Man - 4.6 to 6 million/mm3
Female - 4.0 to 5.0 million/mm3
What is the normal value of hemoglobin.
M- 13.8 to 18 g/dl
F - 12 to 15 g/dl
What is the normal value of hematocrit?
M - 40 to 54%
F - 36 to 46%
If _______ is decreased, it could indicate a viral disease, leukemia. But increased value signifies infection.
neutrophil
What is the normal value for the mean corpuscular volume?
Male - 80 to 98 um3
Female - 78 to 102 um3
What is the normal value for mean corpuscular hemoglobin?
25 to 35 pg
What is the normal value for mean corpuscular hemoglobin concentration?
31 to 37%
What is the normal white blood cell count?
4,500 to 11,000 /mm3
What is the shape of Red Blood Cells?
Circular biconcave non-nucleated
What is the lifespan of RBC?
120 days
What is the shape of white blood cell?
Amoeboid nucleated
What is the life span of white blood cell?
10 to 13 days
What are the 2 types of white blood cell?
Granular and Agranular
What are the Granular WBC?
Neutrophils, Acidophils and Basophils
What are the 2 kinds of Granular WBC?
Lymphocytes and Monocytes
What is the shape of the platelet?
Circular Biconvex Non-nucleated
What is the life span of platelet?
5-9 days
It is a type of bone marrow that is active in generating blood.
Red marrow
It is a type of bone marrow that is less active in hematopoeisis.
Yellow marrow
What is the leading killer for both men and women among all racial and ethnic groups in the world?
Cardiovascular disease
What are the key components of assessment?
- health history
- Physical Assessment
- Monitoring of a variety of laboratory and diagnostic test results.
What are the 5 areas for listening to the heart?
Aortic, Pulmonic, Erb’s Point, Tricuspid and mitral
Where is the aortic pulse located?
at the right 2nd intercostal space
Where is the pulmonic pulse located?
At the 2nd left intercostal space
Where is the Erb’s point located?
Left 3rd intercostal space
Where is the tricuspid pulse located?
At the lower left sternal border of 4th
Where is the mitral pulse located?
5th left intercostal space, medial to the midclavicular line
If you can see pulsations of aneurysm in the abdomen, what should you avoid to do?
Do not attempt to palpate and percuss
It is a type of heart sound that is a physiological occurrence normal in children and fit adults less than 30 years of age?
S3
What part of the stethoscope must be used in order to hear S3 and S4?
Bell
This heart sound indicates backflow of blood.
Murmur
This type of murmur happens between S1 and S2
Systolic Murmurs
This type of disease involves the narrowing of either pulmonary artery or aorta?
Stenosis
It is when the reflex is weak where the blood is able to backflow.
Regurgitation
Instead of meeting together to close the gap, the muscle weakens where the mitral valve can no longer close together, so the blood will keep switching back and forth.
Mitral Valve prolapse
There is a problem with your septum where there is a hole in your septum, thus the deoxygenated blood coming from the right will be mixed with the oxygenated blood from the left.
Ventral Septal Defect
What are the common signs and symptoms of cardiovascular disease?
- Chest pain
- Dyspnea
- Peripheral Edema
- Weight gain
- Abdominal Distention
- Palpitations
- Unusual fatigue
- Dizziness
- Syncope
- Changes in the level of consciousness
It is a term use to denote a generalized edema?
Anasarca
What do you call the condition where the heart is tilted to the right?
Dextrocardia
It starts in the middle then the pain will radiate to the Chest, can also radiate to arm, neck and jaw . It lasts for about 5 to 15 minutes?
Angina Pectoris
If an angina pectoris is happening for more than 15 minutes then it is an indication of what?
Myocardial Infarction
It is the inflammation of the pericardium?
Pericarditis
Pericarditis can generate pain that radiates to what area of the body?
Neck, Arms and Back
Pain that arises from the inferior portion of the pleura, may be referred to costal margins or upper abdomen.
Pleuritic Pain
Most common in patients with hernia, substernal pain may be projected around the chest to shoulders accompanied by a warm feeling.
Esophageal pain
The pain over the chest may be variable. Does not radiate. Patients may complain numbness and tingling sensation of hands and mouth/ May last from 2 to 3 minutes.
Anxiety
What is the meaning of PQRST?
Provocation, Quality, Radiation, Severity and Time
What are the 6 Ps of assessment?
Pain
Pulse
Pallor
Poikilothermia
Paralysis
Paresthesia
What test is used to assess nail clubbing?
Schamroth window test
Myocardial cells that become necrotic from prolonged ischemia or trauma releases specific enzymes. What are these enzymes?
Creatinine Kinase (CK), Ck Isoenzymes (CK-MB), and Proteins (myoglobin, troponin T and Troponin 1)
What is the best indicator of acute myocardial infarction?
Troponin 1
These troponins are not the best for detecting MI because of muscles?
Troponin C and T
Troponin I is detected from the time when your chest pain starts about __ to __ hours after?
2 - 6
What should be the value of Troponin I?
< 0.03 nanograms/mL
What should be the value of troponin T?
<0.01 nanograms/mL
What is the critical value for Myocardial Infarction?
> 1.5 nanograms/mL
This type of troponin binds to calcium to activate muscle contraction?
Troponin C
These types of troponin are specific for cardiac muscles?
Troponin I and T
When is troponin I and T detected?
2-6 hours
When do troponin I and T peak?
10-24 hours
When does troponin I start to fall?
5-9 days
When does troponin T stars to fall?
7-14 days
This type of creatinine kinase is isolated within the myocardium?
MB
This type of creatinine kinase is found in skeletal muscles?
MM
This type of creatinine kinase is found in brain.
BB
It is a cardiac specific enzyme but is less reliable than troponin?
Creatinine Kinase-MB
When will CK MB be detected?
3-6 hours
What is the normal value of CK MB?
o to 5 mg/mL
M - 38 to 170 m/L
F - 26 to 140 m/L
It is less reliable than troponin and is not a specific indicator of an acute MI.
Myoglobin
It is the earliest cardiac enzyme to elevate after an injury, that is why it is still used even if it is not most reliable?
Myoglobin
Myoglobin peaks ___ to ___ hours after an injury.
1 to 2
Myoglobin peaks only for ___ to ___ hours and after ___ to ___ hours it will normalize.
2 to 6; 12 to 24
What is the normal range for myoglobin?
5-70 nanograms/mL
Myoglobin would provide a false positive result if you have a problem with ____ or ____.
Kidney, muscle
What is the meaning of LDH?
Lactic Acid Dehydrogenase
If _____ is greater than _____ then patient is positive for MI.
LDH1, LDH2
Increase in level of LDH occurs ____ to _____ hours after the onset of symptoms.
48 to 72
What is the normal value of LDH?
100 to 225 mU/mL
It is synthesized in the ventricular myocardium and release as a response to increased wall stress.
B-type natriuretic peptide
What is the normal range for BNP?
<100pg/mL or 100 nanograms/L
It is an inflammatory marker that may be an important risk factor for atherosclerosis and ischemic heart disease.
C-Reactive Protein
What is the normal range for C-reactive protein?
< 1.0 mg/L
What serum electrolytes are vital to cellular depolarization and repolarization?
Sodium, potassium and calcium
What is the normal value for sodium?
125-135 mEq/L
What is the normal value for Potassium?
3.5 to 5.0 mEq/L
What are the different ways to decrease potassium level in the blood?
Diuretics (Spironolactone - potassium wasting), hemodialysis and Kayexalate
This condition is characterized by excess in potassium which can cause muscle cramps and weakness.
Hyperkalemia
What are the signs and symptoms for hyperkalemia?
Urine Abnormalities
Respiratory Distress
Decreased cardiac Contractility
EKG changes
Hyporeflexia
It is a deficit in the potassium level of the blood causing weakness of the muscles, decrease reflexes, shallow breathing and slowing of GI system (constipation).
Hypokalemia
What is the normal Calcium level?
9-11 mg/dL
It is an end product of protein metabolism and is excreted by the kidneys.
Blood Urea Nitrogen Level
What is the Normal Value for BUN?
280 to 300 mOsm/kg
It is important to monitor, because many patients with cardiac disease also have diabetes mellitus?
Serum glucose level
What are the test for Serum Glucose level?
CBG
HgbA1C
FBS
Is the monitoring of blood sugar especially in the capillaries?
CBG
Is a laboratory test that reflects how well you blood glucose level has been controlled for the past three to four months. It does not need fasting.
HgbA1C
It is where an amino acid is linked to the development of atherosclerosis because it can damage the endothelial lining.
Homocysteine
Elevated blood level indicate a high risk for?
CAD
stroke
Peripheral vascular disease
This test is used to monitor anticoagulant - Heparin.
Activated partial thromboplastin time
What is the normal APTT?
30 to 40 seconds w/o anticoagulant
1.5 to 2 x the normal rate w/ coagulant
It is used to monitor anticoagulant - Warfarin?
Prothrombin Time
What is the normal prothrombin time?
10 to 12 seconds (1.5 to 2 x normal value).
If INR is ____ then the coagulation is fast, but if INR is ____, then the coagulation is slow.
low, high
If _____ is low, then you are at risk of bleeding out, but if it is high you are at risks of forming clots.
Fibrinogen
If this is high, then it signifies that you have many clots in your body.
D-Dimer
Normal range of INR?
1
D-dimer normal range
< 259 mcg/L
Fibrinogen normal range
200 to 400 mg/dL
What are the different noninvasive Diagnostic procedures used in determining problems with the cardiovascular system?
Radiology and imaging
Fluoroscopy
ECG
Continuous elctrocardiographic monitoring
Ambulatory Electrocardiography
Transtelephonic monitoring
Cardiac OR Exercise Stress test
Pharmacologic Stress testing
Echocardiography (transesophageal)
Doppler
Myocardial Perfusion Imaging
Computed Tomography
Magnetic Resonance Angiography
What are the invasive cardiac diagnostic procedure?
Cardiac Catheterization
Right Heart Catheterization
Angiography
Hemodynamic Monitoring
Pulmonary Artery Pressure Monitoring
Intra-arterial blood pressure monitoring
It is obtained to determine size, contour and position of the heart.
Radiology and imaging
Is an x-ray imaging technique that allows visualization of the heart on screen.
Fluoroscopy
It is a graphic recording of the electrical activity of the heart, can be recorded with 12, showing the activity from those different points.
Electrocardiography
Where are the electrodes placed?
Upper right arm
Upper left arm
Lower right leg
Lower left leg
V1 - 4th intercostal space to the right of the sternum
V2 - 4th intercostal space to the left of the sternum
V3 - Directly between the leads V1 and V4
V4 - 5th intercoastal space at midclavicular line
V5 - Level with V4 at left anterior axillary line
V6 - Level with V5 at midaxillary line
What type of Lead is used for monitoring?
5 Lead EKG
What Lead is used to check for flatline of patient?
Long Lead II
Standard for patients who are at risk for dysrhythmias.
Continuous electrocardiographic monitoring
Electrodes are connected with lead wires to a cable that is inserted into a portable recorder that records the ECG onto a digital memory device.
Ambulatory electrocardiography (holter monitoring)
The patient attaches a specific lead system for transmitting the signals and places a line telephone mouthpiece over the transmitter box.
Transtelephonic Monitoring
In an exercise stress test the patient walks on a treadmill or pedals a stationary bicycle or arm crank.
Cardiac or exercise stress test
What are the vasodilating agents used in a pharamacologic stress testing?
Dipyridamole, adenosine and dobutamine
It is a particularly useful tool of diagnosing pericardial, effusions, determining the etiology of hear murmurs, evaluation the function of prosthetic heart valves.
Echocardiography (transesophageal)
What are the nursing interventions for patients undergoing echocardiography?
Instruct them to not eat or drink anything for 6 hours prior the study and checks informed consent has been obtained.
Inserts an IV line or assesses IV for patency and asks the patient to remove full or partial dentures
Provides emotional support and monitors level of consciousness
During the recovery period, the patient must maintain bed rest with the head of the bed elevated to 45 degrees
Food and oral fluids are withheld until the patient is fully alert and if the gag reflex is intact, the nurse begins feeding with sips of water, then advances to the preprocedural diet.
Can be used to evaluate arterial and peripheral venous patency a well as valvular competency?
Doppler
In combination with stress testing to compare images obtained when the heart is resting to images of the heart in a stressed state resulting from exercise or medications.
Myocardial Perfusion Imaging
Is a form of cardiac imaging that uses x rays to provide accurate anatomic images of the four chamber of the heart valves, arteries veins and pericardium.
Computed tomography
It uses a powerful magnetic field and computer-generated pictures to image the heart and great vessels.
Magnetic Resonance Imaging
It is an invasive diagnostic procedure in which a catheter is introduced into the heart and blood vessels to measure oxygen concentration, saturation, lesion and pressure in the various heart chambers, detect shunts, provide blood samples for analysis and determine CO and pulmonary blood flow?
Cardiac Catheterization
What is administered to the patient with iodine allergy before starting heart catheterization?
Antihistamines or Methylprednisolone
It is nephrotoxic, so the patient should have a normal creatinine.
IV contrast testing
What medication should be given to a patient with high creatinine before undergoing IV contrast testing?
N-acetylcysteine
What should be avoided post op for patient undergoing cardiac catheterization?
Do not flex the legs
Passage of a catheter from an antecubital or femoral vein into the right atrium right ventricle, pulmonary artery and pulmonary arterioles.
Right Heart Catheterization.
Is interventional diagnostic procedure in which a radio contrast is injected directly into the coronary arteries, allowing visualization and quantification o stenosis and or obstruction.
Angiography
A type of monitoring used for critically ill patients that requires continuous assessment of their cardiovascular system to diagnose and manage their complex medial conditions.
Hemodynamic Monitoring
This monitoring is used in critical care of assessing left ventricular function.
Pulmonary Artery Pressure Monitoring
It is used to obtain direct and continuous BP measurements in critically ill patients who have severe hypotension and hypertension.
Intra-arterial Blood Pressure monitoring
What are the possible complications of this invasive procedures?
Pneumothorax
Infection
Air Emboli
