Module 3 Flashcards
Blood flow to the heart (right side) anatomy
- superior and inferior vena cava streams blood into the right atrium–> through the tricuspid valve—> letting blood into the right ventricles–> the blood shoots up into the pulmonary valve and then to the pulmonary artery–> which sends deoxygenated blood to the LUNGS. “Tri it before you bi it”
Blood flow to the heart (left side) anatomy
- enters back through the pulmonary veins oxygenated–> left atrium—> shot through the bicuspid (mitral or atrioventricular valve) valve—> then into left ventricle–> goes into the aortic valve—> and then shoots up into aorta and into the BODY “A comes before V so Atriam is on top and ventricles are on the bottom”
A&P for the vascular system
Cardiac Conduction System
Perfusion
the passage of blood, blood substitutes, or other fluids through a vessel into the organs and tissues
Cardiac output
amount of blood being pumped by each ventricle in L/min
Stroke volume
amount of blood ejected with each heartbeat (the average is 70mL)
Ejection fraction
the fraction of blood present in the ventricles that is ejected with each heartbeat (normal EF of Left ventricle is 50-70%)
Stroke volume factors
stroke volume x heart rate
1. Preload- the pressure at the end of diastole and the resultant stretching of the muscle fibers (how much blood comes through the atria)
2. Afterload- total resistance to ejection of blood from the ventricle
3. Contractility- the force that causes the myocardium to contract under any given condition(
Heart auscultation
rewatch lecture for slide 14
Diagnostic Evaluation
rewatch lecture for slide 15
Diagnostic testing for the heart
ECG, stress test, echocardiography, doppler, central venous, pulmonary artery, and intra-arterial blood pressure monitoring
Hypertension
BP of <120/80 is considered normal
BP of 120-139/80-89 is considered prehypertension
BP of 140/90 or higher is considered hypertension
(Peripheral vascular resistance related to the diameter of the blood vessel and the viscosity of the blood) (Blood pressure is the product of the cardiac output multiplied by cardiac resistance)
Risk factors for HTN
sleep apnea, renal changes, oral contraceptive use, possibly insulin resistant, diet high in Na and K
Clinical Manifestations of HTN
CAD, left ventricular hypertrophy, changes in the kidneys, retinal changes, cerebrovascular involvement
Dietary modifications
slide 24
Coronary Atherosclerosis
plaque build up in the vessels, a thrombus are possible to form and therefore cut off the blood flow and cause an MI
Modifiable risk factors for atherosclerosis
diabetes HTN, smoking, high cholesterol,
Manifestations of atherosclerosis
- ischemia- inadequate blood flow that deprives the cardiac muscle of O2
- angina pectoris- chest pain brought by myocardial ischemia
- myocardial ischemia- acute onset of chest pain, SOB, diaphoresis, N/V, extreme fatigue
Management of CAD and angina
Nitrates (nitroglycerin)
HMG-CoA reductase inhibitors (statins)
Antiplatelet medications & anticoagulants (aspirin and heparin or warfarin)
Bile acid-sequestrants (cholestyramine)
Oxygen administration
Ca+ channel blockers (diltiazem)
Beta-blockers (metoprolol)
CABG
rewatch lecture for slide 39
Diagnosis of MI
based on ECG changes and analysis of cardiac biomarkers
1. unstable angina
2. ST-segment elevation MI
3. Non-ST-segment elevation MI
Medications for MI
nitroglycerin, morphine, beta-blockers, ACE inhibitors, statins, thrombolytics, analgesics, therapy and rehabilitation, clopidogril-reduces ability of platelets to stick together, therefore preventing clots from forming
Heart failure
the inability of the heart to pump sufficient blood to meet the needs of the tissues for O2 and nutrients (systole- the contraction of the heart, diastole- filling of the heart)
Classes of heart failure
Class 1: exhibits no symptoms with activity
Class 2: symptoms with ordinary exertion
Class 3: symptoms with minimal exertion
Class 4: symptoms at rest
Types of heart failure
systolic- weakened heart muscle, the inability of the heart to contract, EF is low
diastolic- stiff and non-compliant heart muscle, the inability of the left ventricle to relax or fill, and stroke volume decreased
Right-sided heart failure
(rest of the body) increased backup of blood to the body and decreased blood to the lungs.
Manifestations:
JVD, polyuria, pitting edema, weight gain, SOB, ascites, nausea/anorexia
Treatment: is (positive inotropic) such as digoxin which helps the muscle to squeeze (check apical pulse)
EDEMA (with right-sided heart failure)
enlarged liver
distended neck veins
enlarged spleen
most edema in LE
ascites and anorexia
Left-sided heart failure
decreased perfusion, weak thready pulse, increased cap refill, decreased EF, crackles,
Manifestations:
S3 gallop, oliguria, fatigue, increased Na and water retention which results in increased preload, orthopnea, SOB, decreased O2 sat
Treatment: diuretics (lasix, aldosterone)
DYSPNEA (with left-sided heart failure)
dyspnea
cyanosis
S3 gallop low O2 sat
pulmonary congestion, pink frothy sputum
nasal flaring
elevation in respiratory rate
anxiety or activity intolerance
Risk factors of heart failure
age, male gender, HTN, left ventricular hypertrophy, MI, valvular heart disease, obesity, cardiomyopathy
Normal sinus rhythm (NSR)
originates in the SA node, HR 60-100, normal p wave, PRI, and QRS, and rhythm is normal
Sinus bradycardia
HR is less than 60, everything else stays the same
Sinus tachycardia
HR is more than 100 to 150 bpm, sometimes p wave is peaked and tall, and can sometimes be partially hidden
Atrial fibrillation
no discernable p waves, when controlled the rate is <100 when uncontrolled the rate is >100, rhythm is irregular
Vascular disease
stenosis- narrowing of the valve causing a forced flow of blood
regurgitation- it causes backflow of the blood and is also an insufficiency
Peripheral arterial disease (PAD)
a common manifestation is an atherosclerosis, symptoms are seen in the end organs they will complain of intermittent claudication (walking and say pain in their legs and then when sitting it goes away) no hair on their legs, and rubor color (purple)
The Ps of PAD
pain, pallor, pulselessness, poikilothermia (cool temperature), paresthesia (numbness and tingling), paralysis
Raynauds disease
vasospasms of the fingers, change in color of the fingertips, coldness, tingling, or numbness (could be from long-term use of beta blockers)
