Module 5 Flashcards
What are the 2 main structures of the cardiovascular system ?
Heart and blood vessels
Heart pumps 100,000 times a day.
What is the general pathway of blood between body and heart?
12 pieces
Body capillaries, Venules, veins, heart, pulmonary artery, lungs, lung capillaries, pulmonary vein, aorta, artery, arterioles, capillaries
What cavity is the heart located ?
In the thoracic cavity
Specifically in the pericardial cavity (this space is also called the mediastinum)
Where is the mediastinum located?
In the space between the two pleural cavities and contains organs between the pleural cavities .
What are the three layers of the heart?
Endocardium, myocardium, pericardium
Describe the 3 layers of the heart
Endocardium: inner lining of heart
Myocardium: muscular middle layer
Pericardium: outer sac that surrounds heart and decreases friction between heart and surrounding structures
Function of the right side of the heart?
Left side of the heart?
Right side: pumps blood from body tissue to the lungs
Left side : pump blood from lungs to the body tissues
What structure divides the 2 sides of the heart?
Septum
What are the 2 chambers of the heart?
Atrium and ventricle
Left and right atrium
Left and right ventricle
What structures brings blood to the right atrium ?
Superior vena cava
inferior vena cava
Function of right ventricle?
Right lower portion
Receives blood from right atrium and pumps it into the pulmonary trunk and the right and left pulmonary arteries
Function of left atrium ?
Left upper portion
Receives oxygenated blood from the right and left pulmonary veins
Function of the Left ventricle?
Left lower portion
Received blood from the left atrium and pumps it out the large artery, the aorta.
What are the four valves of the heart?
Tricuspid valve
Pulmonary valve
Mitral valve (bicuspid valve)
Aortic valve
Purpose of heart valves?
Separates the four chambers
- located at the exit and entrance of each ventricle
- controls the flow of blood from one area to another
Located between right atria and right ventricle
Tricuspid valve
Located at the exit of the right ventricle and controls blood flow from right ventricle to the pulmonary trunk
Pulmonary valve
Located between left atrium and left ventricle
Mitral valve
Located at the exit of the left ventricle
Aortic valve
Explain blood circulation journey in the heart.
-blood enters heart from superior/inferior vena cava into the right atria
-travels through tricuspid valve into the right ventricle
-leaves right ride of heart through pulmonary valve into left/right pulmonary artery into the lungs
-oxygenated blood removed from lungs via right/left pulmonary veins
-enters left side of heart at the left atrium
-travels through the mitral valve into the left ventricle
-leaves heart through aortic valve and enters aorta
- from aorta, blood is dispersed to the body tissues
Large veins that drain all blood from upper and lower body to right atrium
Superior and inferior vena cava
Only artery to carry deoxygenated blood
Right and left pulmonary artery
Only vein to carry oxygenated blood
Pulmonary vein
Blood vessels that carry blood away from heart to the body tissues
Arteries
Smallest arteries, only consisting of one to two cell layers of muscle cells
Arterioles
Capillary bed
Microscopic blood vessels where o2 and nutrients are delivered to the cells of the body and co2 and other waste products are removed from the cells of the body.
Connects arterioles to venules
Capillary bed
Smallest veins, one to two muscle cell layers thick
Venules
Blood vessels that return the blood to the heart
Veins
Major arteries of the body (19)
-Right/left common carotid artery
-right/left subclavian artery
-ascending aorta
-aortic arch
-brachial artery
-renal artery
-abdominal aorta
-radial artery
-ulna artery
- common/internal/external iliac artery
-femoral artery
-anterior/posterior tibial artery
-popliteal artery
-perineal artery
Major veins of the body (25)
-internal/external jugular vein
-superior/inferior vena cava
-hepatic portal vein
-superior mesenteric vein
-ulnar vein
-radial vein
-common/internal/external iliac vein
-digital veins
-femoral vein
-great saphenous vein
-popliteal vein
-posterior/anterior tibial vein
-fibular vein
-subclavian vein
-right/left brachiocephalic veins
-cephalic vein
-brachial vein
-basilic vein
-median cubital vein
-renal vein
Heartbeat
-Coordinated contraction of the heart
-begins 5-6 weeks after conception
Stimulates the heart muscle to contract continuously and rhythmically
Neuromuscular tissue
List of neuromuscular tissue of the conduction system ?
Sinoatrial node
Atrioventricular node
Bundle of his
*purkinje fibers
Sinoatrial node (SA node)
Pacemaker of the heart, made of a dense collection of purkinje fibers at the upper part of the right atrium
Describe the Pathway of electrical impulses (6)
Sinoatrial node
Intermodal pathway
Atrioventricular node
Bundle of his
Bundle branches
Purkinje fibers
Electrocardiogram (EKG,ECG)
What is its purpose?
Measures electrical activity of the heart
Diagnostic tool used to detect abnormalities in the heart, such as ischemia or arrhythmias.
Most common site to measure the pulse? Where is it located?
Radial pulse
Located on the thumb side of the wrist
Carotid pulse
Easiest pulse to palpate and is commonly used in an emergency
Dorsalis pedis pulse
Located on dorsal surface of the foot
Used to assess peripheral artery disease
Normal pulse
60-100 BPM
Common pulse points (7)?
Temporal
Carotid
Brachial
Radial
Femoral
Popliteal
Dorsalis pedis
Blood pressure
Measurement of the pressure that the blood exerts against the arterial wall as the heart pumps and the resistant force of the arterial wall against that blood flow.
Two measurements for blood pressure?
Systolic and diastolic blood pressure
Explain Systolic and diastolic blood pressure?
Systolic: measurement of pressure when heart contracts and blood is pumped to the body
Diastolic: measurement when heart is relaxed
Normal blood pressure
Less than 120/80 mmHg
Measures blood pressure
Sphygmomanometer
Explain the process and physiology of checking blood pressure?
Arrhythmia
Change in or lost of the regular rate and rhythm of the heartbeat
Another name for arrhythmias
Dysrhythmias
Symptoms of arrhythmias (5)
Syncope or near syncope
Dizziness
Fatigue
Palpitations
Asymptomatic
Consequences of arrhythmias
Sudden Cardiac death
Severe decrease in cardiac output that can damage heart and brain
Sinus arrhythmias
Arrhythmia that is a normal finding in a patient ; typically do not cause severe symptoms
Sinus tachycardia
Irregularity in heart rate where heart rate is greater than 100 BPM
This is typically a normal response to exercise
Common causes of sinus tachycardia
Exercise
Infection
Pain
Anxiety
Anemia
Thyroid disease
Heart disease
Sinus bradycardia
Defined as heart rate below 60 BPM
Normal for pts who exercise regularly
In patients with underlying heart disease or elderly patients, A problem with the SA node or a side effect of a medication
Some causes of sinus bradycardia
Atrial fibrillation
Irregular heart rhythm where the electrical conduction of the heart no longer begins at the SA node, but the start of the electric conduction of the heart comes from many different locations throughout the atria.
-Fast arrhythmia
-Atria twitches irregularly , and the ventricles respond irregularly.
Most common chronic arrhythmia
Atrial fibrillation
Symptoms of atrial fibrillation
Short of breath
Palpitations
Increased risk of developing stroke
May not feel arrhythmia at all
Ventricular tachycardia
Arrhythmia where contraction is initiated in the ventricles , rather than the atria
Fast, over 100 BPM
Symptoms of ventricular tachycardia
Palpitations
Dyspnea
Lightheadedness
Death, if not treated properly
Treatment for ventricular tachycardia
Cardioversion
Cardioversion
Medical procedure to treat life threatening arrhythmias
Regular heart rate and rhythm are restored after an electric shock is applied to the heart
Treatment for atrial fibrillation
Medications to slow heart rate as well as cause the blood to not clot as easily
Surgical ablation
Pacemakers
Ablation
Destroys part of atria that are sending irregular electric signals
Pacemakers
Devices surgically implanted in patients Chet cavity to stimulate the heart with electronic impulses.
Imitates a heartbeat where the SA node is not working properly
Coronary Artery Disease
Result from atherosclerosis, which is the build up of fatty material or plaques in the arteries of the heart.
Most common type of heart disease
Number one cause of death in the USA
Coronary Artery Disease
Risk factors of coronary artery disease
Positive family history
Male sex
Abnormal blood lipids
Diabetes mellitus
Hypertension
Physical inactivity
Abdominal obesity
Cigarette smoking
Alcohol
Poor diet
Ways to prevent coronary artery disease
Exercise
Healthy diet
Weight loss
Smoking cessation
Medications to treat conditions such as high cholesterol
Myocardial infarction
Result of obstructed blood flow to the heart muscle.
Symptoms of myocardial infarction
Chest pain at rest with sweating, weakness, anxiety
Lightheaded, short of breath, nauseated
1/3 of patient will not feel chest pain
Treatment approach for myocardial infarction
-emergent transfer to hospital for assessment and emergent intervention
-assessment with bloodwork and Electrocardiogram (electrical conduction through the heart will change ad the heart muscle die)
What can a ECG show during a myocardial infarction
Non-ST segment elevation (NSTEMI)
ST segment elevation myocardial infarction (STEMI)
These results indicate amount of damage the heart as sustained and risk for additional adverse effects.
Treatments for patient with STEMI?
Percutaneous coronary intervention
Angioplasty
Stenting
Coronary artery bypass graft (CABG)
Percutaneous coronary intervention
Procedure where catheter is inserted into a large artery then threaded to the heart to examine the coronary artery and discover where blockage is located
Interventions during a PCI?
Angioplasty
Stenting
Angioplasty
A balloon is inflated at the site of blockage to compress fatty plaque against the artery wallls
Stenting
An expandable metal mesh is inserted into the artery to hold the artery open
Coronary artery bypass graft (CABG)
Surgical procedure where the veins are removed from the pts legs and then inserted onto the heart to provided a new route for the blood to travel to the heart.
Hypertension
Elevated blood pressure
Systolic pressure above 140 or diastolic pressure above 90 on two readings or two doctors office visits.
Increases risk of developing heart attack, heart failure, or stroke.
Risk factors for hypertension
-interactions of the pts genetics with environment
Obesity,sleep apnea,increased salt intake,excessive alcohol use,polycythemia,smoking, NSAID medication, low potassium intake, sedentary lifestyle
Treatments for hypertension
Weight reduction
Low sodium diet
Exercise
Decrease alcohol intake
Hypertensive medications
Heart failure
Failure of one or both sides of the heart to pump blood effectively, either to the body tissues or the lung or both
Commonly associated with aging
Associations with heart failure
Aging (most patients diagnosed over the age of 65)
75% of patients with heart failure are also diagnosed with hypertension
Left sided heart failure/ congestive heart failure
Heart fails to move blood from lungs to body tissue
Symptoms of left sided heart failure
Dyspnea and other symptoms with poor cardiac output
Explain the causes of left sided heart failure
Systolic dysfunction: left ventricle is unable to contract normally
Diastolic dysfunction: left ventricle wall are unable to relax and fill with blood
Right sided heart failure
Increased pressure from the fluid backup in the lungs increases the amount of pressure in the right side of the heart, ultimately damaging the right side of the heart.
Symptoms of right sided heart failure
Edema of lower extremities
Liver enlargement
Distended neck veins
Symptoms of heart failure
Edema of lower limbs
Upright posture/leaning forward
Anxiety
Skin cyanotic
Rapid breathing
Fast heart rate
Persistent cough
Ejection fraction
Percent of blood pumped out of ventricles with each heartbeat.
Normal: 55-70%
HF: less than 40%
-as ejection fraction reaches less than 35%, pts is at risk for life threatening conditions
Treatments of heart failure
-diuretics
-medications normally used for hypertension and arrhythmias
-implanted defibrillators
-heart transplantation
Peripheral artery disease
Atherosclerotic plaque build up in the arteries outside the heart
Can restrict blood flow the various body parts and cause pain and dysfunction
Can occur in the arteries leading to the arms, legs, feet, kidneys, and stomach .
Intermittent claudication
Where patient experienced pain or cramping in the legs and buttock while walking that resolves with rest.
Treatments for peripheral artery disease
Exercise
Healthy diet
Smoking cessation
Blood thinning medication
Stenting and angioplasty
Valvular disease
When the valves of the heart becomes diseased and damaged
Most affected valve in valvular disease
Aortic valve
Common causes of valvular disease
Aging
Hypertension
History of rheumatic fever
Infections of the inner lining of the heart
Congenital heart disease
Regurgitation
When blood leaks back through the valve to the chamber of the heart where it came from.
- when valve no longer closes completely
Stenosis
When blood flow is restricted because a valve is stiff and narrow
Prolapse
A floppy or loose valve
Aortic stenosis
Stiffening of the aortic valve due to calcium deposits that develop
Pts develop left sided heart failure, dyspnea, and syncope as the valve becomes narrower
Treatments of valvular disease
Valvuloplasty or valvoplasty
Valvotomy
Valvular replacement surgery
Valvular replacement surgery
When entire valve is replaced either via a catheter through an artery or through open-heart surgery.
Valve may be replaced with metal valve or a tissue valve.
Main organs of the respiratory system (6)?
Pharynx
Nose
larynx
Trachea
Bronchi
Lungs
Pulmonologist and pulmonology
- physician that specializes in the diagnosis and treatment of pulmonary disorders
-study of the respiratory system
Function of nose in respiratory system?
-entry point for air to enter the respiratory system
-air passageway that warms and moistens the air
Respiratory structures in nose (5)
Central septum
Conchae
Mucous membrane
Nasal mucosa
Nerve receptors
Conchae
Three Shell-like passageway located in each of the 2 nasal cavities
Covered with a mucous membrane
Pharynx
Tube starting at the posterior section of the nose and extends to the esophagus.
Three parts of the pharynx
Nasopharynx: behind the nose
Oropharynx: behind the mouth
Laryngopharynx: behind the larynx
Accessory organs of lymphatic system within the pharynx?
Tonsils
Adenoids
Palatine and lingual tonsils
Location of adenoids and palatine & lingual tonsils?
Adenoids: in the Nasopharynx
Palatine and lingual tonsils: Oropharynx
Function of tonsils
Filters out bacteria and other substances form the lymph fluid located in the head and the neck.
Larynx
Contains the entrance to the trachea and the esophagus
Called the voice box, contains vocal folds or cords
Vocal cords
Fold of tissue at the top of the trachea
Vibrates and produces speech as air passes through
Epiglottis
In the larynx, made out of cartilage
Covers entrance of trachea so food does not enter while swallowing.
Trachea
Windpipe
Carry’s air to and from the lungs
Starts at larynx and extend down to bronchi
Function of cartilage in the trachea
Hold trachea open for breathing
Function of cilia in the trachea
Sweep foreign substances up and out the trachea
Cover the surface of the trachea
Bronchi
Left and right bronchi
Provide passage for air to the right and left lungs
What do the bronchi divide into?
Bronchus
Bronchioles
Alveolar ducts
Alveoli
-Tiny air sacs surrounded by capillaries.
-Site of gas exhange
Pleura
Membrane with several layers that function to decrease friction around the lungs
Lobes
Divisions within the lung
Right lung: 3 lobes
Left lung: 2 lobes
Apex and base ?
Apex: superior portion of lungs
Base: inferior part of the lungs
What is respiration and How is respiration controlled
Act of breathing
Controlled by nerve impulses of the pons and medulla oblongata of the brain stem.
Diaphragm
Muscle at the base of the lungs that help draw the air into the lungs and pushes air out of the lungs
Movement of diaphragm during inspiration and expiration
Inspiration : diaphragm contracts and flattens
Expiration: diaphragm relaxes, rises, and air is pushed out of lungs
Respiratory rate
Number of breaths taken every minute
Respiratory rate by age
Newborn: 30-60
1-3: 20-40
3-6: 22-34
6-12: 18-30
13-18: 12-16
Adult: 16-20
Asthma
Disease where triggers such as duct, infection, pollutants, or certain drugs trigger a spasm in the bronchial tree.
More common in children and affect 10% of population
Subtypes of asthma
Allergic asthma
Occupational asthma
Symptoms of asthma attack
Cough
Chest tightness
Shortness of breath
Examination will reveal wheezing and prolonged expiration
What happens to the bronchioles during asthma?
Swollen and full of excessive amount of mucus
Decreases flow of air to the lungs
Spirometry
Measures forced expiratory volume of the lungs in 1 second and the forces vital capacity.
Measurement taken before and after treatment with a bronchodilator
Bronchiodilator
Inhaled medication that dilate the bronchioles to improve the flow of air
Inhaled corticosteroids
Steroid medications inhaled to control inflammation in the airway.
Treatment for asthma
Bronchiodilators
Inhaled corticosteroids
Systemic steroids
Pneumonia
Bacterial infection of the lungs
Can be described by where the infection was obtained
Community acquired pneumonia
Pneumonia that occurs outside of the hospital
Nosocomial
Relating to a hospital
Two types of nosocomial infections
Hospital acquired pneumonia
Ventilator acquired pneumonia
Most common bacterial species that causes community pneumonia
S pneumoniae
Symptoms of pneumonia
Fever
Cough
shortness of breath
Sweating
Chills
Chest pain
Myalgia
Headaches
Abdominal pain
Physical examination symptoms of pneumonia
Fever
Tachypnea
Tachycardia
Decrease in oxygen saturations
Decreased breathing sounds over area of infection
Respiratory crackles
Respiratory crackles
Short sharp or rough breath sounds caused by excessive fluid in the lungs
Diagnosis method of pneumonia
Chest X-ray
Pneumonia will appear as a cloudy consolidation on the chest x ray
Treatment for pneumonia
Antibiotics
Thoracentesis
Process of thoracentesis
Needle is placed in pleural space and fluid is removed
Allows lungs to further expand and allows medical team to perform bacterial culture and sensitivity on the pleural fluid.
COPD
Preventive lung disease where air flow is limited to the airway and alveoli
Third cause of death worldwide
Cause of COPD damage
Exposure to cigarette smoke
Commonly develops between the age of 50-60 years old.
Symptoms of COPD
Excessive cough
Sputum production
Shortness of breath
Cyanosis
Two types of COPD
Emphysema
Bronchitis
Emphysema
Type of COPD where the walls of the alveoli becomes distended and damaged
Difficulty exhaling air from lungs
Dead space ventilation
Where air is trapped in the damaged alveoli and is unable to leave the lungs
Breathing technique for patients with emphysema
Accessory muscles will be used to help with breathing
Bronchitis
Inflammation of the bronchioles
Pts may experience exacerbations of their Dyspnea due to frequent infections
Symptoms of bronchitis
Chronic coughing with excessive sputum production
Cyanosis
Peripheral edema
Lung examination of bronchitis
Rhonchi
Wheezing
Treatment for COPD
Smoking cessation to prevent further damage
Supplemental oxygen
Bronchodilators
Lung transplant ( for severe COPD)
Pneumothorax
Condition where air collects in the pleural space
Four types of pneumothorax and characteristic
Spontaneous : no underlying lung disease or trauma
Secondary: there is a underlying lung disease
Traumatic: caused by trauma
Iatrogenic : results from adverse outcome of a procedure
Symptoms and examination of pneumothorax
Short of breath
Chest pain on the side of the pneumothorax
Chest X-ray will show air in pleural space
Treatment for pneumothorax
Spontaneous: observation; resolves as air is absorbed from the pleural space
Large pneumothorax: placement of chest tube with a water seal and is attached to suction.
How does chest tube work in testing pneumothorax?
ARDS
Respiratory distress after an inciting event.
Epithelial cells of alveoli and the capillaries are damaged and lungs cannot complete gas exchange, leading to hypoxemia and alveolar collapse.
Examples of inciting events leading to ARDS
Trauma
Burns
Drugs and drug overdose
Near drowning
Sepsis and shock
Severe pneumonia
CABG surgery
Aspiration of stomach contents into the lungs
Symptoms of ARDS
Severe shortness of breath 12-48 hours after inciting event
Labored breathing
Tachypnea
Crackles
Intercostal retractions
Intercostal retractions
Accessory muscles of breathing between the ribs will pull in as the patient breathes.
Examination of ARDS
Chest X-ray will show patchy diffuse infiltrates throughout the lung or complete white out where infiltrates cover the entire lung .
Treatment for ARDS
Treating inciting event and the respiratory distress
Intubation
Mechanical ventilation
Tracheostomy (if pts fails to Improves )
Intubation
Procedure where a Endotracheal tube is entered through mouth into the bronchial tree.
Attached to a mechanical ventilator
Mechanical ventilator
Machines that forces air into the lungs and assists with breathing
Tracheostomy
Surgical cut into the trachea and placement of the Endotracheal tube directly into the trachea of the neck.
This is a semi-permanent placement of the et tube and an indication that mechanical ventilation is required for a longer period
