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
2
Q
- a double layer of fibroserous membrane that covers the heart
- anchors the heart to surrounding structures
A
pericardium
3
Q
what is the name of the outermost layer of the pericardium?
A
parietal pericardium
4
Q
what is the name of the innermost layer of the pericardium?
A
visceral pericardium (aka epicardium)
5
Q
which layer of the pericardium adheres to the heart’s surface?
A
the visceral pericardium or epicardium
6
Q
what is the small space between the visceral and parietal pericardium called?
A
pericardial cavity
7
Q
what is contained in the pericardial cavity?
A
a serous lubricating fluid that cushions the heart as it contracts
8
Q
how many layers of tissue does the heart wall consist of?
A
three layers: epicardium, myocardium, endocardium (from outer to inner)
9
Q
what does the myocardium consist of?
A
specialized cardiac muscle cells
10
Q
what does the endocardium consist of?
A
thin membrane composed of three layers
11
Q
what is the middle layer of the heart wall called?
A
myocardium
12
Q
what is the inner layer of the heart wall called?
A
endocardium
13
Q
how many hollow chambers does the heart have?
A
four
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
15
Q
what separates the left side of the heart from the right?
A
the interventricular septum
16
Q
what valve separates the left atria from the left ventricle?
A
the mitral (or bicuspid) valve
17
Q
what valve separates the right atria from the right ventricle?
A
the tricuspid valve
18
Q
what valve allows blood to exit the right ventricle (and move into the pulmonary artery)?
A
pulmonary valve
19
Q
what valve allows blood to exit the left ventricle (and move into the aortic artery)?
A
aortic valve
20
Q
what types of valves separate the atria from the ventricles?
A
atrioventricular valves (AV valves)
21
Q
what does the closure of the heart valves create?
A
heart sounds
22
Q
what heart valve closure produces S1 (lub)?
A
the AV valves
23
Q
what heart valve closure produces S2 (dub)?
A
the semilunar valves (pulmonary and aortic valves)
24
Q
what types of valves separate the ventricles from the pulmonary artery/aortic artery?
A
semilunar valves
25
which heart sound is produced by the AV (bicuspid/mitral or tricuspid) valves?
the S1 or "lub" sound
26
which heart sound is produced by the semilunar (pulmonary and aortic valves) valves?
the S2 or "dub" sound
27
when do the AV valves close?
when the ventricles have been filled
28
when do the semilunar valves close?
when the ventricles have emptied their blood into the aortic or pulmonic arteries
29
what is the phase of ventricular contraction also referred to as?
systole
30
what is the phase of ventricular relaxation also referred to as?
diastole
31
when does systole begin?
with the closure of the AV valves (S1)
32
when does systole end?
with the closure of the pulmonic and aortic (semilunar) valves (S2)
33
when does diastole begin?
with the closure of the pulmonic and aortic (semilunar) valves (S2)
34
when does diastole end?
with the closure of the AV valves (S1)
35
why does a splitting of S2 occur in some individuals?
results from a slight difference in the time it takes the semilunar valves to close due to intrathoracic pressure during inspiration
36
what is another name for the third heart sound (S3)?
ventricular gallop
37
what causes a ventricular gallop (S3 sound)?
when the av valves open, blood flow into the ventricles may cause vibrations which create the S3 sound during diastole
38
what is another name for the fourth heart sound (S4)?
atrial gallop
39
what causes an atrial gallop (S4)?
caused by atrial contraction and ejection of blood into the ventricles in late diastole (heard before S1)
40
when is an atrial gallop (S4) hears?
before the "lub" (S1) sound
41
which heart sounds may be associated with pathological conditions such as MI or HF?
S3 or S4
42
when does systole occur?
between S1 and S2
43
when does diastole occur?
between S2 and S1
44
what may be auscultated in clients with valvular disease?
clicks and snaps may be heard as the valves open (in a healthy heart, valves opening should be silent)
45
what can result from inflammation of the pericardial sac?
friction rubs
46
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
heart murmurs
47
why would an ejection click be heard in the heart?
due to damage to the aortic or pulmonic valve
48
why would a nonejection click be heard in the heart?
due to prolapse of the mitral valve
49
what kind of "snap" would signify mitral stenosis?
an opening snap
50
where in the heart does pulmonary circulation occur?
the right side of the heart
51
where in the heart does systemic circulation occur?
the left side of the heart
52
what does pulmonary circulation consist of?
- right side of the heart
- pulmonary artery
- pulmonary capillaries
- pulmonary vein
53
what does systemic circulation consist of?
- the left side of the heart
- aorta and its branches
- capillaries that supply the brain and peripheral tissues
- systemic venous system
- vena cava
54
which circulation system(s) is a high pressure system?
systemic circulation
55
which circulation system(s) is a low pressure system?
pulmonary circulation (& coronary circulation ??)
56
pressure within the pulmonary blood vessels that must be overcome in order for blood to flow through the vessel
pulmonary vascular resistance
57
the force or resistance of the blood in the body's blood vessels that helps return blood to the heart
systemic vascular resistance
58
- 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
foramen ovale
59
how does the foramen ovale close?
- 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
the fetal vascular channel between the umbilical vein and the inferior vena cava
ductus venosus
61
the fetal vascular channel between the pulmonary artery and the aorta (sends most fetal blood into circulation rather than to the lungs)
ductus arteriosus
62
what are the three different structures that occur in the fetal heart as compared to the heart after birth?
foramen ovale
ductus arteriousus
ductus venosus
63
the contraction and relaxation of the heart = one heart beat... this is also known as ....
a cardiac cycle
64
- the difference between the end diastolic volume and the end systolic volume
- ranges from 60 to 100mL/beat
stroke volume
65
the amount of blood pumped by the ventricles into the pulmonary and systemic circulations in 1 minute
cardiac output
66
what is the formula to calculate cardiac output?
stroke volume X heart rate = cardiac output
67
represents the fraction or percent of diastolic volume that is ejected from the heart during systole
ejection fraction
68
how do you calculate the ejection fraction?
stroke volume / end diastolic volume = ejection fraction
69
deprived of oxygen
ischemic
70
when do the cardiac arteries primarily fill?
during diastole
71
the inherent capability of the cardiac muscle fibers to shorten
contractility
72
what occurs with poor heart contractility?
- reduces the forward flow of blood from the heart
- increases ventricular pressures from the accumulation of blood volume
- reduces cardiac output
73
what occurs with increased heart contractility?
stresses the heart
74
- 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
preload
75
- the force the ventricles must overcome to eject their blood volume
- the pressure in the arterial system ahead of the ventricles
afterload
76
what is afterload measured as in the right ventricle?
pulmonary vascular resistance
77
what is afterload measured as in the left ventricle?
systemic vascular resistance
78
- 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
cardiac index
79
- 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)
sinoartrial node (SA node)
80
what does the SA node stimulate?
-creates an impulse that travels through the heart, depolarizing the cells and results in myocardial contraction
81
- movement of ions across cell membranes causing an electrical impulse that stimulates muscle activity
- produces waveforms that are represented on an ECG/EKG
action potential
82
- the phase when the heart contracts, resulting from the functions of two types of ion channels
- fast sodium channels and slow calcium channels
depolarization
83
- 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
repolarization
84
in what way do depolarization and repolarization coordinate with a cardiac cycle?
one depolarization and one repolarization occur during each cardiac cycle (heart beat)
85
what are the three main anatomical landmarks for assessing the cardiovascular system?
- sternum
- clavicle
- ribs
86
-a wave of blood created by the left ventricle of the heart
pulse
87
what factors can affect a pulse rate?
- 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
- measurement of the pressure exerted by blood as it flows through the arteries
- because blood moves in waves there are two pressures measures
blood pressure (BP)
89
- pressure of the blood as a result of the contraction of the ventricles
- higher pressure
systolic pressure
90
- pressure of the blood when the ventricles are at rest
- lower pressure
- present at all times in the arteries
diastolic pressure
91
the difference between the diastolic and systolic pressure
pulse pressure
92
what should a normal pulse pressure average?
40mmHg
93
what unit is blood pressure measured in?
mmHg (millimeters of mercury)
94
what factors determine arterial blood pressure?
- pumping action of the heart
- peripheral vascular resistance
- blood volume and viscosity
95
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
arteriosclerosis
96
the proportion of red blood cells to blood plasma
hematocrit
97
what factors can affect blood pressure?
age, exercise, stress, race, obesity, gender, medications, diurnal variations, disease processes
98
when does the heart muscle fully develop?
5 yrs of age
99
when does the systolic BP of a child reach that of an adult?
by puberty
100
why is an infant's heart rate so high?
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
- 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
physiologic anemia of pregnancy
102
why does a pregnant woman's hematocrit go down?
because there is more of an increase in plasma than there is in erythrocytes
103
why is there an increase in iron levels for pregnant women?
because there is an increase in erythrocytes
104
why is there an increased chance of developing venous thrombosis during pregnancy?
- increase in clotting factors (fibrin & fibrinogen - hypercoaguable state)
- venous stasis in late pregnancy
105
what is the issue with a pregnant woman lying supine?
- 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
how much of an increase in blood volume occurs during pregnancy?
50% increase
107
how much does the red blood cell count increase during pregnancy?
30% increase
108
what factors affect how a person ages? (3)
- genetics
- physical factors
- social environment
109
- an increase in the size of muscle cells of the myocardium
| - causes change in the function of the left ventricular wall and ventricular septum
myocardial hypertrophy
110
aging and the heart:
| what happens to the vascular system as we age?
- endothelial layer becomes more irregular, more connective tissue
- lipid deposits and calcification
- decreased elasticity or hardening of arterial walls
111
aging and the heart:
| what pulmonary changes that occur with aging can affect the heart?
- 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
with pediatric patients what is the most common cardiac issue?
congenital defects & anomalies
113
aging and the heart:
| what happens to the myocardium?
decrease in efficiency and contractility
114
aging and the heart:
| what happens to the sinoatrial node?
- increase in thickness of shell surrounding node
| - decrease in number of pacemaker cells
115
aging and the heart:
| what happens in the left ventricle as we age?
- slight hypertrophy
- prolonged isometric contraction phase and relaxation time
- increase in time for diastolic filling and systolic emptying cycle
116
aging and the heart:
| what happens to valves and blood vessels?
- aorta is elongated and dilated
- valves are thicker and more rigid
- resistance to peripheral blood flow increases by 1% each year
117
aging and the heart:
| what effect do the kidneys have on the heart as we age?
- 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
why does blood pressure tend to increase as we age?
- stroke volume may increase to compensate for tachycardia
| - compensation for increase in peripheral vascular resistance and decreased cardiac output
119
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
coronary artery disease (CAD)
120
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
cardiomyopathy
121
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
dysrhythmia
122
```
common cardiovascular illnesses of aging:
-can involve any valve
-involves stenosis or insufficiency
-symptoms depend on severity
-
```
valve disease
123
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
shock
124
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
hypertension (HTN)
125
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.
pregnancy induced hypertension (PIH)
| also known as pre-eclampsia??
126
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!!!)
stroke
127
a palpable vibration over the precordium or an artery
a thrill
128
- when the radial pulse falls behind the apical rate
| - indicates weak, ineffective contractions of the left ventricle
pulse deficit
129
a pattern of gradual increase and decrease in heart rate that is within the normal range and that correlates with inspiration and expiration
sinus arrythmia
130
what can cause an accentuated S1 heart sound to occur?
- tachycardia
- states in which cardiac output is high (fever, anxiety, stress, anemia, hyperthyroidism)
- complete heart block
- mitral stenosis
131
what can cause a diminished S1 heart sound to occur?
- first degree heart block
- mitral regurgitation
- CHF
- CAD
- pulmonary or systemic HTN
- intensity decreases with obesity, emphysema, pericardial effusion
132
when does abnormal splitting of S1 occur? (*in some cases a splitting of S1 can be normal)
- right bundle branch block
| - premature ventricular contractions
133
where is S1 loudest?
at apex of heart
134
where is S2 loudest?
at base of heart
135
what can cause an accentuated S2 heart sound to occur?
- HTN
- exercise
- excitement
- conditions of pulmonary HTN (CHF or cor pulmonale)
136
what can cause a diminished S2 heart sound to occur?
- aortic stenosis
- a fall in systolic BP (shock)
- increased anteroposterior chest diameter
137
what can cause a splitting of S2 to occur?
- 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
when is a midsystolic click heard?
with mitral valve prolapse
139
when are ejection sounds/clicks heard?
opening of deformed semilunar valves
140
what can cause a ventricular gallop (S3) to occur?
- myocardial failure
| - ventricular volume overload (CHF, mitral or tricuspid overload)
141
what can cause an atrial gallop (S4) to occur?
-increased resistance to ventricular filling after atrial contraction (HTN, CAD, aortic stenosis, cardiomyopathy)
