Perfusion Flashcards
1
Q
Cardiac Output equation
A
SV x HR = CO
2
Q
Inotropic Function
A
The FORCE of the contraction of the cardiac muscle
3
Q
Chronotropic Function
A
Heart RATE
4
Q
Where does most stroke volume come from?
A
Left ventricle
5
Q
Heart Rate is measured by
A
beats/min
6
Q
Stroke volume is measured by
A
mL/beat
7
Q
CO is measured by
A
mL/min
8
Q
About how much volume is a healthy CO
A
5 Liters
9
Q
Baroreceptors
A
Receptors that detect a drop in BP
Activate Sympathetic Nervous System
Increases Inotropic and Chronotropic Functions
10
Q
Orthostatic Hypotension
A
Drop in BP when changing positions from lying to standing
11
Q
Orthostatic Hypotension causes what symptom? Why?
A
Dizziness
Decreased perfusion to the brain
12
Q
Orthostatic Hypotension is common is what population of people?
A
Elderly
Individuals on antihypertensive medication
13
Q
Decrease BP activates what system?
A
RASS
14
Q
What 2 things shut down the RASS system?
A
Atrial Natriuretic Peptide (ANP)
B type Natriuretic Peptide (BNP)
15
Q
Preload
A
Volume of blood the Right Atria pushes into the Right Ventricle
16
Q
Preload is increased when?
A
Hypervolemia
Regurgitation of cardiac valves
Heart Failure
17
Q
Afterload
A
Resistance the Left Ventricle must overcome to push blood into the rest of the body.
18
Q
Increased afterload leads to ___ ___
A
Increased Cardiac Workload
19
Q
Cardiac Contractibility
A
The ability of the myocardium to stretch and contract in response to the filling of the heart with blood
20
Q
Stroke Volume
A
The amount of blood within the ventricle that is ejected with each contraction
21
Q
Atherosclerosis increases what 2 things?
A
Preload and Afterload
22
Q
Most common free radical in the body
A
Oxygen
23
Q
Lipids are composed of _____
A
Cholesterol
24
Q
HDLs
A
Happy=Good cholesterol
Excreted from the body
25
LDLs
Bad Cholesterol!
| Deposits on the arterial walls
26
LDLs deposited on the arterial wall stimulate what process?
Inflammatory Process
27
Athersclerosis occurs due to __ __
Endothelial Injury
28
Foam Cells
Macrophages that breakdown LDLs
29
Why is high glucose level harmful in the bloodstream?
Glucose damages the endothelial lining
30
Glucose reacts with vessel wall proteins and forms ___ ___ ___ ___ (AGEs)
Advanced glycosylation end products (AGEs)
31
What does AGEs cause?
Inflammation and plaque build up
32
Homocysteine is an __ ___
Amino Acid
33
Foods rich in HDLs
Salmon, eggs, and avacodo
34
Hypothyroidism increases HDL/LDL?
LDLs
35
If a patient has a renal Disease what should you screen for?
LDL Levels
36
In a sedentary lifestyle what happens to cholesterol levels?
Increases LDLs
| Decrease HDLs
37
What types of dietary foods will increase LDLs?
Trans-fats***
Cholesterol
Saturated Fats
38
What type of medications will increase LDLs?
Corticosteroids
Diuretics
Beta-adrenergic blockers
39
Fats should be less than ___% of total dietary calories
30%
40
What is a type of monounsaturated fat?
Olive oil
41
What is a type of polyunsaturated fats?
Vegetable Oil
42
True/False: Monounsaturated fat and Polyunsaturated fats are part of a Cardioprotective Lifestyle
True
43
How much red wine a day promotes a cardioprotective lifestyle?
1 glass a day
| Decreases cardiac risk
44
Endothelial Dysfunction is caused by:
Uncontrolled diabetes mellitus
Hypertension
Hypercholesterolemia
Smoking
45
Endothelial dysfunction increases what 2 things?
Afterload
| Preload
46
Atherosclerosis causes ____ blood flow
Turbulent
47
Turbulent blood flow predisposes areas for a _____ formation
Thrombus
48
Bruit
Turbulent blood flow the produces a whooshing sound
49
Xanthoma
Yellowish cholesterol deposits under the skin and around the eyes
50
Arcus Senilis
Yellow-white ring around the pupil of the eye consist of cholesterol deposits
Occurs about 60-70 years old
51
Left-sides heart failure can lead to ___ ____ __ ___
Right sided heart failure
52
Heart failure
weakened ventricular muscle that is unable to sufficiently pump blood into the arterial circulation to meet the needs fo the tissues
53
What is he most common cause of hospitalization?
Heart Failure
54
What is the greatest risk factor for heart failure?
Hypertension
55
Why do more women have a greater risk for heart failure following an MI?
They are asymptomatic - do not experience normal symptoms of heart failure
56
Why are women diagnosed at an older age for HF?
Estrogen is a natural cardioprotective
57
What population is a greater risk for HF?
African Americans
58
What are 4 major changes that lead to heart failure?
Increased fluid/volume overload
Impaired ventricular filling
Degeneration of ventricular muscle
Decreased ventricular contractile function
59
Heart failure decreases ___ ___
Cardiac Output
60
Left Ventricular Ejection Fraction (LVEF)
The volume of blood pumped with each ventricular contraction
61
LVEF is responsible for pumping ___% of blood volume out
60-70%
62
Right-Sided Heart Failure Symptoms
```
Jugular Distension
Ascites
Ankle/Sacral edema
Hepatomegaly
Splenomegaly
Increase BNP and ANP
```
63
RASS improves/declines HF
Decline
| RASS system stimulation during HF is BAD!
64
A LVEF less than ___% is an indicator of HF
40%
65
Major causes of HF
```
Repeated ischemic episodes of the heart
MI
Chronic Hypertension
COPD
Dysrhythmias
Valvular disorders (Stenosis) (increase after load)
Pulmonary Embolism
```
66
Risk factors for HF (out of the usual Risk Factors)
```
Sleep Apnea (Rhythm disturbance)
Congenital heart defects
Kidney conditions
```
67
Systolic HF refers to
Ventricular contraction HF (most common)
68
Diastole HF refers to
Ventricular relax HF
69
What does the backward effect of left ventricle HF do?
Causes a back up of blood in the lungs (pulmonary edema) > a back up of blood in the right ventricle > Right-sided HF
70
What does the forward effect of the left ventricle HF do?
Causes inadequate blood perfusion to brain and kidneys (all body) > activates RASS system, ADH, and Sympathetic Nervous System
71
Pulmonary Edema
Extravasation into the pulmonary interstitial spaces
72
Symptoms of Pulmonary edema
```
Crackles
Pink frothy sputum
Cough
Dyspnea
Orthopnea
S3 heart sound
```
73
Orthopnea
Difficulty breathing while lying flat
74
What question should be asked to a patient experiencing Orthopnea?
How many pillows do you sleep with
75
During the forward effects of Left Ventricular HF the SNS stimulates __ receptors
Adrenergic receptors
76
Adrenergic receptors
Increases heart rate stimulates vasocontriction
77
During the forward effects of Left Ventricular HF the posterior pituitary releases __
ADH
78
ADH
Increases water reabsorption into the bloodstream > increase blood volume
79
Ventricular Remodeling
A complication from HF
| Hormones provoke genetic changes and the heart hypertrophy but becomes less effective
80
Ventricular Remodeling increases risks for ___
Clotting
81
Anasarca
Edema all over the body
82
Severe right ventricular HF manifests as:
Massive peripheral edema
83
L/R: Dyspnea upon exertion
Both left and right failure
84
L/R: Dyspnea when lying flat for more than a few minutes
Left failure
85
L/R: Nocturnal cough
Left failure
86
L/R: Confusion
Left failure
87
L/R: Difficulty concentrating
Left failure
88
L/R: Cold, pale legs and feet
Left failure
89
L/R: Swelling in the ankle or fingers
Right failure
90
L/R: Tight rings or shoes b/c of fluid retention
Right failure
91
L/R: Abdominal swelling
Right failure
92
L/R: Gastrointestinal symptoms (Anorexia, feeling full)
Both left and right failure
93
L/R: Increases frequency of urination
Both right and left failure
94
L/R: Nocturia caused by excess fluid accumulation
Both right and left failure
95
L/R: Weight gain of 2 pounds or more per day b/c of fluid retention
Both right and left failure
96
S3 Heart sounds is caused by:
Fluid build up
Sounds like "kentucky"
Gallop sound
97
S4 heart sound is caused by:
Stiffness of the valve (aortic stenosis)
98
When do you hear an S4 heart sound?
After remodeling has happened
| With high afterload
99
What is the major manifestation of HF?
Weight fluctuation of 2 pounds or more a day
100
Basic hemodynamic measurement changes in HF
Increase in central venous pressure
Decrease CO
Decrease LVEF (fewer than 40%)
Decrease systematic BP
101
Shock
the inability of the heart and lungs to satisfy the metabolic and oxygen requirements of the peripheral tissues
102
Shock categorized by BP falling below __
60 mm Hg the patient's normal BP
103
Three stages of shock
Initial
Progressive
Irreversible
104
5 Categories of Shock
```
Cardiogenic
Hypovolemic
Septic
Anaphylactic
Neurogenic
```
105
Initial stage of shock effect what organ?
Kidneys
106
What happens in the initial stage of shock?
Drop in BP > Sympathetic Nervous System, RASS system triggered
107
Progressive stage of shock effect what organs?
```
Lungs
Kidneys
Gut
Pancreas
Liver
```
108
What happens in the progressive stage of shock?
All blood conserved for brain and heart
| Cold and Clammy
109
What organs are effected in the irreversible stage of shock?
Heart and brain
110
What happens in the irreversible stage of shock?
Myocardial and cerebral ischemia
| Widespread cellular hypoxia
111
Lactic acidosis affects ___ ,___, __, ___ functions
Cardiac (Arrhythmias)
Respiratory (Tachypnea)
Neurological
Brain
112
What happens to the blood flow to the GI during shock?
Blood is shunted away from the GI to the vital organs
113
What hormones are released during shock?
Epinephrine and Cortisol
114
What does epinephrine and cortisol want to increase during shock?
CO
115
What happens to glycogen during shock?
Glycogen is broken down > hyperglycemia
116
What effect does hyperglycemia have on WBC?
Decreases WBC function
117
What is Cardiogenic shock caused by?
Failure of the heart (MI)
118
What is Hypovolemic shock caused by?
Large depletion of body fluids (Diarrhea, vomiting, ascites, burns)
119
What is Anaphylactic shock caused by?
Allergic reaction (Histamine response)
120
What is Neurogenic shock caused by?
Spinal cord or brain injury
121
What sets Anaphylactic shock and Neurogenic shock away from the others
They both cause widespread vasodilation
| The other 3 cause widespread vasoconstriction
122
Cardiac Tamponade
Fluid buildup around the heart that restricts the heart action
123
What does cardiac tamponade do to the CO?
Decreases CO
124
Beck's Triad (key signs of cardiac tamponade)
Distant heart sounds
Low BP (b/c decreased CO)
High jugular venous pressure
125
How much blood volume can a person lose without exhibiting signs or symptoms?
20% of blood volume or about 1 Liter
126
What is a compensatory mechanism in Neurogenic shock?
Tachycardia
127
What is the initial indicator of shock?
Output (Kidney function > GFR)
