Take or Leave Chapter 21 Flashcards
Path of Blood Flow to the Heart (Coronary Circulation)
340
- Deoxygenated blood flows through superior and inferior vena cavas to the right atrium.
- Blood then flows through the tricuspid or (AV) valve to the right ventricle.
- The right ventricle pumps blood through the pulmonary semi-lunar valve into the lungs.
- The newly oxygenated blood is sent from the lungs by the 4 pulmonary veins, back to the heart.
- This blood fills the left atrium and then travels through the bicuspid or (mitral) valve into the left ventricle.
- The left ventricle sends blood through the aortic semi-lunar valve into the aorta, which sends the blood through the body.
Patho of Cardiac Conduction
340-341
- SA node (pacemaker of the heart) initiates each heartbeat by depolarizing 100 times per minute, at rest due to parasympathetic fibers at 75 bpm.
- If SA node is dysfunctional AV node takes over at 40-60 bpm
- If the AV node fails The Bundle of His generates ventricles at 20-35 bpm
What is Cardiac Output?
341
The amount of blood ejected from the left ventricle in 1 minute. Average cardiac output 5-6 L
What is Stroke Volume?
341
Amount of blood ejected by a ventricle in one contraction 60-80 ml/bpm. Its average resting rate is 75 bpm.
What is Ejection Fraction?
341
The measure of Ventricle Efficiency is 55%-70% of total blood ejected inside the left ventricle with every beat.
What are the Heart Hormones?
341
Epinephrine
Aldosterone
Atrial Natriuretic Peptide
What is the function of epinephrine/ what does it do?
341
Secreted by the adrenal medulla during stressful situations, increases heart rate, a force of contraction, and dilates blood vessels. This increases cardiac output & blood volume
What is the Function of Aldosterone/ what does it do?
341-342
Produced by the Adrenal cortex, regulates blood sodium & potassium, both needed for the heart’s electrical activity.
Atrial Natriuretic Peptide
342
Secreted by atria, it increases sodium excretion by kidneys and inhibits aldosterone secretion. By removing this sodium the BP and blood volume are lowered due to all the water being lost with the sodium.
Arteries vs Viens
342
Arteries (Away) carry blood away from the heart and to capillaries.
Viens (The van to the Heart) carry blood from capillaries to the heart.
Blood Pressure
343
Force of blood against blood vessels. Average BP 120/80.
What is Pulse Pressure?
344
Difference between systolic, and diastolic BP. Average ration 3:2:1.
Renin-Angiotensin-Aldosterone Mechanism
345
- Low BP due to insufficient fluids, renal ischemia, and elevated urine sodium initiates the release of renin.
- The renin splits angiotensins produced by the liver into angiotensin 1.
- Angiotensin-converting enzyme from lungs, converts angiotensin 1 into angiotensin 2.
- Angiotensin 2, then causes vasoconstriction, and releases aldosterone which causes sodium reabsorption, which increases blood volume, and finally BP!
Starlings Law
341
When exercise causes the venous return to stretch the myocardium making it contract more forcibly, resulting in increased stroke volume. This increases cardiac output by more than 4 times its resting level (even more so in athletes).
Aging of Cardiovascular System
345 (Box Gerontological Issues)
- Atherosclerosis (lipids collecting within arteries over a period of years).
- Clotts due to the Atherosclerosis
- Less efficient heart muscle (decrease in maximum cardiac output).
- Thickened valves causing heart murmurs
- Orthostatic Hypotension due to immobility, chronic illness, or meds.
Cardiovascular Disease Risk Factors
346 (Box Cultural Consids)
- Lifestyle
- Sedentary lifestyle
- Excess calories
- Smoking
- Being a United States Adult, particularly of Asian, African, or Mexican Ethnicity.
Data Collection of BP
Reading in both done for comparison, the difference reported to HCP. The higher reading arm was used from then on. A larger BP cuff may be used on the leg, however, this will be 10 mm Hg higher than BP on arm.
Data Collection Hx
347 (Box 21.1)
- Allergies (Med/diagnostic dyes?)
- Smoking history (a possible risk factor for cardiovascular disease)
- Medications (possibly causing toxicity, or influencing symptoms)
- Pain, location, radiation, description (possible sign of angina, myocardial infarction, thrombus, embolism)
- Dyspnea (possible sign of Left HF, pulmonary edema, embolism)
- Fatigue (Decreased cardiac output)
- Palpitations (arrthymias)
- Dizziness (arrhythmias)
- Weight gain (Right-sided HF)
Physical Exam Data
347 (Box 21.1)
- Vitals (assess for Bradycardia, Tachycardia, Hypotension, Hypertension, Tachypenia, Apnea, Shock)
- Heart Rhythm (Assess for Arrthymias)
- Edema (Right-sided HF)
- Jugular Distented Viens (Right-sided HF)
- Breath Sounds (Assess for crackles/wheezes may indicate left-sided HF)
- Cough Sputum (Assess for acute HF, DRY COUGH!, and PINK FROTHY SPUTUM).
Subjective Data
347-348 (21.2)
- Pain
- Dyspnea
- Palpitations
- Fatigue
- Edema
- Paraesthesia
- Childhood Disease
- Risk Factors
- Family History
Pulses
348
Auscultate for 1 min should be around 60-100 bpm
Why do athletic people have slower heart rates?
348
The athlete’s well-conditioned heart pumps more efficiently causing a slower heart rate of around 50 bpm
What does pink frothy sputum indicate?
349
Acute HF
What does a dry cough indicate?
349
Lung congestion from HF
