Perfusion

Question 0

Afterload

Answer 0

The force the ventricles must overcome to eject their blood volume. R Ventricle must generate enough tension to open the pulmonary valve & eject it’s vol. into the low-pressure pulmonary arteries. R Ventricle Afterload is measured as pulmonary vascular resistance. L Ventricular ejects its load by overcoming the pressure behind the aortic valve. L Ventricular Afterload is measured as systemic vascular resistance.

Question 1

Action Potential

Answer 1

Electrical impulse that stimulates muscle contraction, and produces the waveforms represented on electrocardiogram (EEG) strips

Question 2

____________ pressures are much higher than ______________ pressures; thus the _______ ventricle has to work much harder than the _______ ventricle. ~Alterations in vascular tone affect afterload & ventricular work.

Answer 2

Arterial/Pulmonary Left/Right

Question 3

Cardiac output adjusted for the client’s body surface area (BSA), _____________provides beneficial data regarding the heart’s ability to perfuse the tissues. ___________is also an accurate indicator of the effectiveness of the circulation. *same answer for both blanks

Answer 3

Cardiac Index

Question 4

The process that returns the cell to it’s resting, polarized state.

Answer 4

Repolarization

Question 5

Stroke Volume / end-diastolic volume and represents the fraction of percent of the diastolic volume that is ejected from the heart during systole. Normal range: 50%-70%

Answer 5

Ejection Fraction

Question 6

Average adult Cardiac Output range

Answer 6

4-8 L/min

Question 7

HR x SV =

Answer 7

Cardiac Output

Question 8

Central perfusion

Answer 8

*Generated by cardiac output *Propels blood to organs in their tissues *Clinical manifestations are systematic when impaired (meaning the entire body is affected)

Question 9

Tissue perfusion

Answer 9

*volume of blood that flows through the tissues *supplied by blood flow from arteries to capillaries *Poor central perfusion or a problem within the organ itself can cause impaired tissue perfusion

Question 10

What happens with impaired central perfusion?

Answer 10

Hypotension, tachycardia, change in mental status, shortness of breath, change in heart rhythm, peripheral edema, and S1, S2, S3, S4, or murmurs

Question 11

What happens with impaired tissue perfusion?

Answer 11

Lower extremities: pale, cool skin, less hair on legs, diminished dorsalis pedal and posterior Tibial pulses, slowed capillary refill Kidneys: decreased urine output Brain: depends on the extent of ischemia and areas affected

Question 12

First heart sound (S1) the “lub”

Answer 12

Produced by closure of the AV valves, start of systole (phase of ventricular contraction)

Question 13

Closure of the semilunar valves when the ventricles empty their blood into the aorta and pulmonary arteries. Start of diastole (ventricular relaxation)

Answer 13

Second heart sound (S2) the “dub” sound

Question 14

Closure of the Aortic Valve (AV) produces _________ that is characterized by the syllable “lub.”

Auscultation Site _________

Side of stethoscope used during assesment_______

3 answers

Answer 14

• First Heart Sound (S₁ )
• Auscultation site: Apex
• using the disphram of Stethoscope

~ Cardiac Cycle: Start of Systole, high-pitched, patients positioning does not affect sound.

Question 15

Sound produced by the closure of the Semilunar Valves amd characterized by the syllable “dub”__________ with an ausculatating site of __________ using the ___________?

Answer 15

• Second heart sound (S₂ )
• Both in Second Intercostal space (ICS), with the pulmonary component best at left sternal boarder (LSB) and aortic component at right sternal border (RSB)
• Heard best with diaphram

~Cardiac Cycle Timing: End of systole, positioning: sitting or supine, high-pitched

Question 16

Phase of ventricular contraction that begins with the closure of AV Valves.

Answer 16

• Systole

~In Systolic Phase ventricles are filled then contract to expel blood into the aorta & pulmonary arteries.

Question 17

The phase of ventricular relaxation begins with the closure of semilunar valve(S₂ ) and ends at the closure of AV valves (S₁ ).

Answer 17

Diastole

Question 18

Most commonly heard in children & pregnant women in the third trimester.

Answer 18

• Third Heart Sound (S₃ )

~Heard after S₂ using the bell at apex and termed ventricular gallop, When AV valves open the blood flow into vemtricles causes vibrations which produce the S₃ sound during diastole.

Question 19

May be heard in children, well-conditioned athletes, & healthy older adults without cardiac disease.

Answer 19

• Fourth Heart Sound S₄

~caused by atrial contraction & ejection of blood during late diastole and is termed atrial gallop

~Heard best at apex with bell during early diastole right after S₂ Low-pitched

• *

Question 20

Heard in pt. with Valvular disease in early systole

Answer 20

Clicks & Snaps

Question 21

May be heard in mitral stenosis in early systole

Answer 21

Opening Snap

Question 22

Occur in damaged pulmonary & aortic valves (SL Valves)

Answer 22

Ejection Clicks

Question 23

Heard in prolapse of mitral valve

Answer 23

Nonejection Clicks

Question 24

Results from inflamation of the pericadial sac, the surfaces of the parietal & visceral layers of pericadium can’t slide smoothly producing a rubbing or grating sound.

Answer 24

Friction Rubs

Question 25

Harsh blowing sounds, caused by disruptive blood flow into the heart, into the chambers, or from heart to pulmonary or aortic systems.

Answer 25

Heart Murmur

Question 26

Left & Right coronary arteries originate at the base of the __________ and branch out to encircle the ____________.

Answer 26

AORTA & MYOCARDIUM

Question 27

JUST NOTES: Volume of Murmurs are on a scale of 1-6

Answer 27

• Grade 1: Barely audible with stethscope; often considered physiological
• Grade 2: Very soft but distinctly audible
• Grade 3: Moderatly loud; no thrill or thrushing motion is associated
• Grade 4: Distinctly loud, in addition to a palpable thrill.
• Grade 5: Very loud, can hear with diaphram off the chest; palpable thrust & thrill are present.
• Grade 6: Loudest, can hear w/ dialhram off chest; visible thrill & thrust.

Question 28

During diastole, the volume in the ventricles increases to approximatley 120 mL (____________), and at the end of systole the volume in the vemtricles decreases to approximatly 50 mL (_____________).

Answer 28

• End-diastolic Volume
• End-systolic Volume

Question 29

Difference between End-diastolic Volume and End-systolic Volume is the ____________?

Answer 29

Stroke Volume

~Ranges from 60-100 mL/beat with an aversge of 70mL/beat in an adult.

Question 30

The amount of blood pummped by the ventricles into the pulmonary & systemic circulstions in 1 minute.

Answer 30

Cardiac Output

Question 31

Average adult CO?

Answer 31

• Ranges from 4-8 L/min
• CO is and indicator of the hearts ability to function as a pump.
• If the heart can’t pump effectivley, CO & tissue perfussion are decreased leading to ischmic tissues, ultimatly causing necrosis in cells.

Question 32

CO influencing factors

Answer 32

• 4 Most Important Factors of CO

1. Heart rate
2. Preload
3. Afterload
4. Contractility

~with activity level, metabolic rate, physiological & psychological stress responses, age, & body size all influencing CO as well.

Question 33

The hearts ability to respond to an increase of strenuous activity & adjust it’s CO is called_________?

Answer 33

Cardiac Reserve

Question 34

The ability of the arteris to contract & expand is called?

Answer 34

Compliance

Question 35

Factors affecting Pulse

Answer 35

1. Age: As age ⬆ pulse rate gradually ⬇ overall
2. Gender: After puberty, the average males PR is slightly lower than the average female’s.
3. Excercise: The PR normally ⬆ with activity. The rate of increase in a prof. athleteis often less than in the average individual bc of greater cardiac size, strength, & efficiency.