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162 Exam #2 -- JS > Perfusion > Flashcards

Perfusion Flashcards

1
Q

what is the essential function of the cardiovascular and pulmonary systems?

A

to provide a continuous supply of oxygenated blood to every cell in the body

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2
Q
  • a double layer of fibroserous membrane that covers the heart
  • anchors the heart to surrounding structures
A

pericardium

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3
Q

what is the name of the outermost layer of the pericardium?

A

parietal pericardium

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4
Q

what is the name of the innermost layer of the pericardium?

A

visceral pericardium (aka epicardium)

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5
Q

which layer of the pericardium adheres to the heart’s surface?

A

the visceral pericardium or epicardium

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6
Q

what is the small space between the visceral and parietal pericardium called?

A

pericardial cavity

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7
Q

what is contained in the pericardial cavity?

A

a serous lubricating fluid that cushions the heart as it contracts

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8
Q

how many layers of tissue does the heart wall consist of?

A

three layers: epicardium, myocardium, endocardium (from outer to inner)

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9
Q

what does the myocardium consist of?

A

specialized cardiac muscle cells

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10
Q

what does the endocardium consist of?

A

thin membrane composed of three layers

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11
Q

what is the middle layer of the heart wall called?

A

myocardium

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12
Q

what is the inner layer of the heart wall called?

A

endocardium

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13
Q

how many hollow chambers does the heart have?

A

four

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14
Q

what are the names of the four hollow chambers that the heart contains?

A

the right atrium, the left atrium, the right ventricle and the left ventricle

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15
Q

what separates the left side of the heart from the right?

A

the interventricular septum

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16
Q

what valve separates the left atria from the left ventricle?

A

the mitral (or bicuspid) valve

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17
Q

what valve separates the right atria from the right ventricle?

A

the tricuspid valve

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18
Q

what valve allows blood to exit the right ventricle (and move into the pulmonary artery)?

A

pulmonary valve

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19
Q

what valve allows blood to exit the left ventricle (and move into the aortic artery)?

A

aortic valve

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20
Q

what types of valves separate the atria from the ventricles?

A

atrioventricular valves (AV valves)

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21
Q

what does the closure of the heart valves create?

A

heart sounds

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22
Q

what heart valve closure produces S1 (lub)?

A

the AV valves

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23
Q

what heart valve closure produces S2 (dub)?

A

the semilunar valves (pulmonary and aortic valves)

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24
Q

what types of valves separate the ventricles from the pulmonary artery/aortic artery?

A

semilunar valves

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25
Q

which heart sound is produced by the AV (bicuspid/mitral or tricuspid) valves?

A

the S1 or “lub” sound

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26
Q

which heart sound is produced by the semilunar (pulmonary and aortic valves) valves?

A

the S2 or “dub” sound

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27
Q

when do the AV valves close?

A

when the ventricles have been filled

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28
Q

when do the semilunar valves close?

A

when the ventricles have emptied their blood into the aortic or pulmonic arteries

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29
Q

what is the phase of ventricular contraction also referred to as?

A

systole

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30
Q

what is the phase of ventricular relaxation also referred to as?

A

diastole

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31
Q

when does systole begin?

A

with the closure of the AV valves (S1)

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32
Q

when does systole end?

A

with the closure of the pulmonic and aortic (semilunar) valves (S2)

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33
Q

when does diastole begin?

A

with the closure of the pulmonic and aortic (semilunar) valves (S2)

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34
Q

when does diastole end?

A

with the closure of the AV valves (S1)

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35
Q

why does a splitting of S2 occur in some individuals?

A

results from a slight difference in the time it takes the semilunar valves to close due to intrathoracic pressure during inspiration

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36
Q

what is another name for the third heart sound (S3)?

A

ventricular gallop

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37
Q

what causes a ventricular gallop (S3 sound)?

A

when the av valves open, blood flow into the ventricles may cause vibrations which create the S3 sound during diastole

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38
Q

what is another name for the fourth heart sound (S4)?

A

atrial gallop

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39
Q

what causes an atrial gallop (S4)?

A

caused by atrial contraction and ejection of blood into the ventricles in late diastole (heard before S1)

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40
Q

when is an atrial gallop (S4) hears?

A

before the “lub” (S1) sound

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41
Q

which heart sounds may be associated with pathological conditions such as MI or HF?

A

S3 or S4

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42
Q

when does systole occur?

A

between S1 and S2

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43
Q

when does diastole occur?

A

between S2 and S1

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44
Q

what may be auscultated in clients with valvular disease?

A

clicks and snaps may be heard as the valves open (in a healthy heart, valves opening should be silent)

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45
Q

what can result from inflammation of the pericardial sac?

A

friction rubs

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46
Q

harsh, blowing sounds caused by disruption of blood flow into the heart, between the chambers of the heart, or from the heart into the pulmonary or aortic systems

A

heart murmurs

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47
Q

why would an ejection click be heard in the heart?

A

due to damage to the aortic or pulmonic valve

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48
Q

why would a nonejection click be heard in the heart?

A

due to prolapse of the mitral valve

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49
Q

what kind of “snap” would signify mitral stenosis?

A

an opening snap

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50
Q

where in the heart does pulmonary circulation occur?

A

the right side of the heart

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51
Q

where in the heart does systemic circulation occur?

A

the left side of the heart

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52
Q

what does pulmonary circulation consist of?

A
  • right side of the heart
  • pulmonary artery
  • pulmonary capillaries
  • pulmonary vein
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53
Q

what does systemic circulation consist of?

A
  • the left side of the heart
  • aorta and its branches
  • capillaries that supply the brain and peripheral tissues
  • systemic venous system
  • vena cava
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54
Q

which circulation system(s) is a high pressure system?

A

systemic circulation

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55
Q

which circulation system(s) is a low pressure system?

A

pulmonary circulation (& coronary circulation ??)

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56
Q

pressure within the pulmonary blood vessels that must be overcome in order for blood to flow through the vessel

A

pulmonary vascular resistance

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57
Q

the force or resistance of the blood in the body’s blood vessels that helps return blood to the heart

A

systemic vascular resistance

58
Q
  • an opening between the atria in the fetal heart

- allows blood to flow from the right atria to the left atria and then into the left ventricle

A

foramen ovale

59
Q

how does the foramen ovale close?

A
  • after the umbilical cord is cut, increased pressure in the left atrium stimulates closure of the foramen ovale
  • flaps of the foramen ovale close and fibrin deposits seal the opening
60
Q

the fetal vascular channel between the umbilical vein and the inferior vena cava

A

ductus venosus

61
Q

the fetal vascular channel between the pulmonary artery and the aorta (sends most fetal blood into circulation rather than to the lungs)

A

ductus arteriosus

62
Q

what are the three different structures that occur in the fetal heart as compared to the heart after birth?

A

foramen ovale
ductus arteriousus
ductus venosus

63
Q

the contraction and relaxation of the heart = one heart beat… this is also known as ….

A

a cardiac cycle

64
Q
  • the difference between the end diastolic volume and the end systolic volume
  • ranges from 60 to 100mL/beat
A

stroke volume

65
Q

the amount of blood pumped by the ventricles into the pulmonary and systemic circulations in 1 minute

A

cardiac output

66
Q

what is the formula to calculate cardiac output?

A

stroke volume X heart rate = cardiac output

67
Q

represents the fraction or percent of diastolic volume that is ejected from the heart during systole

A

ejection fraction

68
Q

how do you calculate the ejection fraction?

A

stroke volume / end diastolic volume = ejection fraction

69
Q

deprived of oxygen

A

ischemic

70
Q

when do the cardiac arteries primarily fill?

A

during diastole

71
Q

the inherent capability of the cardiac muscle fibers to shorten

A

contractility

72
Q

what occurs with poor heart contractility?

A
  • reduces the forward flow of blood from the heart
  • increases ventricular pressures from the accumulation of blood volume
  • reduces cardiac output
73
Q

what occurs with increased heart contractility?

A

stresses the heart

74
Q
  • the amount of cardiac muscle fiber tension (or stretch) that exists at the end of diastole, just before contraction of the ventricles
  • influenced by venous return and compliance of the ventricles
A

preload

75
Q
  • the force the ventricles must overcome to eject their blood volume
  • the pressure in the arterial system ahead of the ventricles
A

afterload

76
Q

what is afterload measured as in the right ventricle?

A

pulmonary vascular resistance

77
Q

what is afterload measured as in the left ventricle?

A

systemic vascular resistance

78
Q
  • cardiac output adjusted for the client’s body size (BSA)
  • provides more meaningful data about the heart’s ability to perfuse the tissues and is a more accurate indicator of the effectiveness of circulation
A

cardiac index

79
Q
  • specialized area of myocardial cells that exert a controlling influence in the electrical pathway of the heart
  • located at the junction of the superior vena cava and the right atrium
  • acts as “pacemaker” for the heart (usually generates an impulse 60-100 times a minute)
A

sinoartrial node (SA node)

80
Q

what does the SA node stimulate?

A

-creates an impulse that travels through the heart, depolarizing the cells and results in myocardial contraction

81
Q
  • movement of ions across cell membranes causing an electrical impulse that stimulates muscle activity
  • produces waveforms that are represented on an ECG/EKG
A

action potential

82
Q
  • the phase when the heart contracts, resulting from the functions of two types of ion channels
  • fast sodium channels and slow calcium channels
A

depolarization

83
Q
  • the process that returns the cell to its resting, polarized state
  • fast sodium channels close abruptly and the cell begins to regain its negative charge
A

repolarization

84
Q

in what way do depolarization and repolarization coordinate with a cardiac cycle?

A

one depolarization and one repolarization occur during each cardiac cycle (heart beat)

85
Q

what are the three main anatomical landmarks for assessing the cardiovascular system?

A
  • sternum
  • clavicle
  • ribs
86
Q

-a wave of blood created by the left ventricle of the heart

A

pulse

87
Q

what factors can affect a pulse rate?

A
  • age (as age increases, pulse decreases)
  • gender (after puberty males have slightly lower pulses than females)
  • exercise (increases with activity)
  • fever
  • medications
  • hypovolemia
  • stress
  • position changes
  • pathology
88
Q
  • measurement of the pressure exerted by blood as it flows through the arteries
  • because blood moves in waves there are two pressures measures
A

blood pressure (BP)

89
Q
  • pressure of the blood as a result of the contraction of the ventricles
  • higher pressure
A

systolic pressure

90
Q
  • pressure of the blood when the ventricles are at rest
  • lower pressure
  • present at all times in the arteries
A

diastolic pressure

91
Q

the difference between the diastolic and systolic pressure

A

pulse pressure

92
Q

what should a normal pulse pressure average?

A

40mmHg

93
Q

what unit is blood pressure measured in?

A

mmHg (millimeters of mercury)

94
Q

what factors determine arterial blood pressure?

A
  • pumping action of the heart
  • peripheral vascular resistance
  • blood volume and viscosity
95
Q

a condition where the elastic and muscular tissues of the arteries are replaced with fibrous tissue, causing the arteries to lose much of their ability to constrict and dilate

A

arteriosclerosis

96
Q

the proportion of red blood cells to blood plasma

A

hematocrit

97
Q

what factors can affect blood pressure?

A

age, exercise, stress, race, obesity, gender, medications, diurnal variations, disease processes

98
Q

when does the heart muscle fully develop?

A

5 yrs of age

99
Q

when does the systolic BP of a child reach that of an adult?

A

by puberty

100
Q

why is an infant’s heart rate so high?

A

because at birth an infant’s metabolic rate and oxygen rate double, so the heart rate must be high to maintain cardiac output and adequate oxygen transport

101
Q
  • decrease in hematocrit during pregnancy
  • plasma volume increases (50%)
  • erythrocytes increase (30%)
  • because the erythrocyte increase is less than the plasma volume increase, the hematocrit goes down
A

physiologic anemia of pregnancy

102
Q

why does a pregnant woman’s hematocrit go down?

A

because there is more of an increase in plasma than there is in erythrocytes

103
Q

why is there an increase in iron levels for pregnant women?

A

because there is an increase in erythrocytes

104
Q

why is there an increased chance of developing venous thrombosis during pregnancy?

A
  • increase in clotting factors (fibrin & fibrinogen - hypercoaguable state)
  • venous stasis in late pregnancy
105
Q

what is the issue with a pregnant woman lying supine?

A
  • the enlarging uterus may press onto the vena cava, decreasing venous return to the right atrium and lowering BP
  • also known as maternal hypotension
106
Q

how much of an increase in blood volume occurs during pregnancy?

A

50% increase

107
Q

how much does the red blood cell count increase during pregnancy?

A

30% increase

108
Q

what factors affect how a person ages? (3)

A
  • genetics
  • physical factors
  • social environment
109
Q
  • an increase in the size of muscle cells of the myocardium

- causes change in the function of the left ventricular wall and ventricular septum

A

myocardial hypertrophy

110
Q

aging and the heart:

what happens to the vascular system as we age?

A
  • endothelial layer becomes more irregular, more connective tissue
  • lipid deposits and calcification
  • decreased elasticity or hardening of arterial walls
111
Q

aging and the heart:

what pulmonary changes that occur with aging can affect the heart?

A
  • decreased chest wall compliance
  • ciliary function is decreased (higher susceptibility to pneumonia)
  • airway closure, decreased diffusing capacity, increased lung volume, changes in alveolar structure can lead to lower arterial oxygen tension (PaCO2)
112
Q

with pediatric patients what is the most common cardiac issue?

A

congenital defects & anomalies

113
Q

aging and the heart:

what happens to the myocardium?

A

decrease in efficiency and contractility

114
Q

aging and the heart:

what happens to the sinoatrial node?

A
  • increase in thickness of shell surrounding node

- decrease in number of pacemaker cells

115
Q

aging and the heart:

what happens in the left ventricle as we age?

A
  • slight hypertrophy
  • prolonged isometric contraction phase and relaxation time
  • increase in time for diastolic filling and systolic emptying cycle
116
Q

aging and the heart:

what happens to valves and blood vessels?

A
  • aorta is elongated and dilated
  • valves are thicker and more rigid
  • resistance to peripheral blood flow increases by 1% each year
117
Q

aging and the heart:

what effect do the kidneys have on the heart as we age?

A
  • decline in renal function > lower filtration rate
  • clearance rate for chemicals, medications is reduced
  • decreased levels of renin and aldosterone leads to increase in sodium levels > leads to increase in body water levels > increased load on heart
118
Q

why does blood pressure tend to increase as we age?

A
  • stroke volume may increase to compensate for tachycardia

- compensation for increase in peripheral vascular resistance and decreased cardiac output

119
Q

common cardiovascular illnesses of aging:

  • plaque builds within coronary artery
  • reduction of blood flow to cardiac muscle
  • angina or complete blockage occurs (MI)
  • often asymptomatic until significant cardiac muscle reduction
A

coronary artery disease (CAD)

120
Q

common cardiovascular illnesses of aging:

  • inflammation of the cardiac muscle
  • increase in size and decrease in function
  • can be primary or secondary
  • symptoms vary with classification
A

cardiomyopathy

121
Q

common cardiovascular illnesses of aging:
-irregular electrical pattern seen on ECG that may be result of tissue damage (MI), creating new conduction path, or a malfunction with conduction system

A

dysrhythmia

122
Q 
common cardiovascular illnesses of aging:
-can involve any valve
-involves stenosis or insufficiency
-symptoms depend on severity
-
A

valve disease

123
Q

common cardiovascular illnesses of aging:
-inadequate perfusion of the tissues as a result of blood loss, infection, destruction, or inadequate production of blood cells, reduced cardiac output caused by cardiac disease or systemic vasodilation

A

shock

124
Q

common cardiovascular illnesses of aging:

  • increased pressure in arterial blood vessels > causes heart to pump with more force to overcome higher pressures
  • can be primary or secondary
  • often asymptomatic until HTN is significant
A

hypertension (HTN)

125
Q

common cardiovascular illnesses of aging:

  • BP elevates
  • causes damage to nephrons with leakage of proteins into urine
  • BP continues to rise, can result in fetal demise, seizures, stroke, death.
A

pregnancy induced hypertension (PIH)

also known as pre-eclampsia??

126
Q

common cardiovascular illnesses of aging:
-can result from blood clot in small vessel in brain blocking blood flow to neurons or from rupture of a blood vessel with bleeding into the tissues, resulting in pressure and damage to nephrons (though i suspect this should actually be neurons, as why would it be nephrons??? BOB!!!)

A

stroke

127
Q

a palpable vibration over the precordium or an artery

A

a thrill

128
Q
  • when the radial pulse falls behind the apical rate

- indicates weak, ineffective contractions of the left ventricle

A

pulse deficit

129
Q

a pattern of gradual increase and decrease in heart rate that is within the normal range and that correlates with inspiration and expiration

A

sinus arrythmia

130
Q

what can cause an accentuated S1 heart sound to occur?

A
  • tachycardia
  • states in which cardiac output is high (fever, anxiety, stress, anemia, hyperthyroidism)
  • complete heart block
  • mitral stenosis
131
Q

what can cause a diminished S1 heart sound to occur?

A
  • first degree heart block
  • mitral regurgitation
  • CHF
  • CAD
  • pulmonary or systemic HTN
  • intensity decreases with obesity, emphysema, pericardial effusion
132
Q

when does abnormal splitting of S1 occur? (*in some cases a splitting of S1 can be normal)

A
  • right bundle branch block

- premature ventricular contractions

133
Q

where is S1 loudest?

A

at apex of heart

134
Q

where is S2 loudest?

A

at base of heart

135
Q

what can cause an accentuated S2 heart sound to occur?

A
  • HTN
  • exercise
  • excitement
  • conditions of pulmonary HTN (CHF or cor pulmonale)
136
Q

what can cause a diminished S2 heart sound to occur?

A
  • aortic stenosis
  • a fall in systolic BP (shock)
  • increased anteroposterior chest diameter
137
Q

what can cause a splitting of S2 to occur?

A
  • delayed emptying of the right ventricle, resulting in delayed pulmonary valve closure (mitral regurgitation, pulmonary stenosis, right bundle branch block) [wide splitting]
  • right ventricular output is greater than left ventricular output and pulmonary valve closure is delayed (atrial septal defect, right ventricular failure) [fixed splitting]
  • closure of the aortic valve is delayed (left bundle branch block) [paradoxic splitting]
138
Q

when is a midsystolic click heard?

A

with mitral valve prolapse

139
Q

when are ejection sounds/clicks heard?

A

opening of deformed semilunar valves

140
Q

what can cause a ventricular gallop (S3) to occur?

A
  • myocardial failure

- ventricular volume overload (CHF, mitral or tricuspid overload)

141
Q

what can cause an atrial gallop (S4) to occur?

A

-increased resistance to ventricular filling after atrial contraction (HTN, CAD, aortic stenosis, cardiomyopathy)

162 Exam #2 -- JS (12 decks)

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