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Patho > Test 2 Cardio > Flashcards

Test 2 Cardio Flashcards

1
Q

Parietal pericardium

A

Outer later
Surface layer of mesothelium over a thin layer of connective tissue

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2
Q

Visceral pericardium (pericardium)

A

Inner layer
Folds back and is continuous with the parietal pericardium to allow large vessels to enter/exit the heart without breaching the layers

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3
Q

Pericardial cavity

A

Fluid containing space between visceral and parietal pericardium

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4
Q

Pericardial fluid

A

Secreted by cells of the mesothelium to lubricate membranes and minimize friction as the heart beats

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5
Q

Phase 1 - isovolumetrics contraction

A

Ventricular volume is constant
Increase in ventricular pressure closes AV valves

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6
Q

Phase 2 of cardiac cycle

A

Increase in ventricular pressure opens semilunar valves and blood is ejected to the circulation
Intraventricular volume and pressure decrease

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7
Q

Phase 3 - isovolumetric relaxation

A

Decrease in ventricular pressure closes semilunar valves
Ventricle continue to relax

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8
Q

Phase 4

A

Decrease in ventricular pressure opens AV valves
Permits ventricular filling from the atria

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9
Q

1st heart sound

A

AV valves shut at beginning of systole due to increasing pressure in the ventricles
Valves shit > surrounding tissue vibrates & blood flow becomes turbulent -> heart sound

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10
Q

2nd heart sound

A

Semilunar valves shut at end of systole due to falling pressure in the ventricles
“Physiologic split” - aortic valve closure by .02-.04 sec during expiration and to .04-.06 sec during inspiration

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11
Q

Third heart sound

A

May be heard if ventricular wall compliance is decreased and structures in ventricular wall vibrate
Can occur in conditions such as congestive heart failure or valvular regurgitation
May be normal finding in individuals younger than 30 yrs of age

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12
Q

4th heart sound

A

May be heard on atrial systole if resistance to ventricular filling is present
NOT a normal finding
Causes include: cardiac hypertrophy, disease, or injury to ventricular wall

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13
Q

Coronary vessels

A

Blood within the chambers does NOT supply oxygen and nutrients to heart cells
Heart cells are nourished by vessels of the systemic circulation
Branch that supplies heart is called the coronary circulation

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14
Q

Right coronary artery

A

Conus - supplies blood to the upper right ventricle
Right marginal branch - transversely right ventricle to apex
Posterior descending - supplies smarter branches to both ventricles

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15
Q

Left coronary artery

A

Left anterior descending artery (LAD) aka anterior interventricular artery - blood to portions of the left and right ventricles and much if the interventricular septum
Circumflex artery - supplies blood to the left atrium and lateral wall of the left ventricle

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16
Q

Collateral arteries

A

Connections or anastomoses between two branches of the same coronary artery or connections of branches of the right coronary artery with branches of the left
Particularly common within the interventricular and interatrial septa, apex, anterior surface of RV, and around the sinus node
More in epicardium than endocardium
Collateral circ protects heart

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17
Q

Coronary capillaries

A

3300 capillaries per square millimeter
One per muscle cell
Where exchange of O2 and nutrients take place

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18
Q

Coronary veins

A

Most venous drainage occurs through veins in the visceral pericardium
Smaller veins feed into the great cardiac vein > empties into RA through the coronary sinus

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19
Q

Coronary lymphatic vessels

A

With cardiac contraction, lymphatic vessels drain fluid to lymph nodes in the anterior mediastinum that eventually employ into the superior vena cava
Important for protecting myocardium against injury

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20
Q

Conduction system

A

Cardiac cycle depends on transmission of electrical impulses
Muscle fibers uniquely joined so that action potentials pass very quickly from cell to cell
Heart contains own conduction system - no stim from NS
Specialized cells are concentrated in areas called nodes
ANS provides regulation via SNS and PSNS nerve fibers that affect heart rate and diameter of the coronary vessels

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21
Q

Cardiac action potentials

A
  • Electrical impulse > fibers shorten > muscular contraction > systole
  • After action potential > fibers relax > return to resting length > diastole
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22
Q

Cardiac conduction

A

Pacemaker rates
- sinus node about 70-170 bpm
- AV node about 50 bpm
- bundle for His
- bundle branches
- purkinje fibers about 15-30 bpm

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23
Q

Propagation of cardiac action potential

A

Depolarization = activation
- inside of cell becomes less negatively charged
Repolarization = deactivation
Membrane potential = electrical difference across the cell membrane
- r/t changes in permeability of cell membranes
Threshold = point at which the cell membranes selective per ability to Na and K is team disrupted -> depolarization

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24
Q

Hyperpolarization

A

Ex: hypokalmeia (low potassium)
Resting membrane potential becomes more negative

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25
Q

Pacemaker cells (cardiac action potential)

A

More permeable to Na and start off more + charged -> reach threshold and fire sooner

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26
Q

Depolarization (cardiac action potentials)

A

Voltage-sensitive Na channels open and allow rapid influx of Na then rapidly close
K channels close then reopens slowly
Voltage-sensitive Ca channels have delayed and slowed opening relative to Na
Normal circumstances < max amt of Ca released which permits modulation of contractile strength

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27
Q

Repolarization (cardiac action potentials)

A

Return to resting membrane potential is delayed
Makes it impossible to fire a second action potential before the first is complete
Prevents summation and tetany

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28
Q

Sympathetic stimulation

A

Releases neurotransmitter norepinephrine -> increased HR, ^ conduction spreed through AV node, ^ atrial and ventricular contractility and peripheral vasoconstriction, stimulation occurs when a decrease in pressure is detected

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29
Q

Parasympathetic stimulation

A

Releases neurotransmitter acetylcholine > decreases HR and lessens atrial and ventricular contractility and conductivity, stimulation occurs when an ^ in pressure is detected

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30
Q

Electrocardiogram (ECG) EKG

A

A common non-invasive diagnostic test that evaluates the heart’s function by recording electrical activity

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31
Q

Implementation of ECG/EKG

A

Determine ability to lie still
Advise lie still, breathe normally and refrain from talking during the tests
Reassure client that an electrical shock will not occur
Document any cardiac medications the client is taking

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32
Q

ECG/EKG tracing

A

P wave: contraction of the atrial muscles
- SA node depolarizing
QRS complex: contraction of the ventricles
- atria repolarizes here but cant see on EKG
T wave: electrical changes during relaxation phase of the ventricles
- ventricles repolarizing

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33
Q

Echocardiogram

A

Noninvasive procedure that uses sound waves (ultrasound)
Evaluates how well the heart is moving, how well the valves are working, the size of the heart and its pumping chambers (ventricles)

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34
Q

Implementation of echocardiogram

A

Determine ability to lie still
Advise lying still, breathe normally and refrain from talking
Gel applied to the chest and a transducer (wand-like apparatus) moved over the chest area to produce an image of the internal structures of the heart
30-90 minutes

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35
Q

Exercise ECG “stress test”

A

Exercise on a treadmill or bike until ischemic ECG changes, angina or dyspnea occurs
Should NOT be performed when significant aortic stenosis, untreated hypertension, CHF, unstable angina
Radionuclide studies may be added

36
Q

Persantine

A

Used in exercise ECG for patients unable to exercise -> produces dilation of coronary arteries

37
Q

Exercise testing (stress)

A

Noninvasive test that studies the heart during activity and detects and evaluates coronary artery disease
Treadmill testing most common
May be used in conjunction with myocardial radionuclide testing, at which point the procedure becomes invasive becomes invasive
Consent form required

38
Q

Exercise testing pre procedure

A

Ensure informed consent
Ensure the client has adequate rest the night before the procedure
Instructions client to eat a light meal 1-2 hours before
Avoid smoking, alcohol and caffeine prior to
Ask dr about taking meds day of
Wear nonconstrictive , comfortable clothing and supportive shoes

39
Q

Holster monitoring

A

Noninvasive test in which the client wears a holster monitors and an ECG tracing is recorded continuously over a period of 24 hours
Identifies dysrhythmias if they occur and evaluates the effectiveness of anti dysrhythmics or pacemaker therapy

40
Q

Implementation of holter monitoring

A

Instruct client the resume normal daily activities and to maintain a diary documenting activities and any symptoms that may develop

41
Q

Coronary angiography

A

GOLD STANDARD = patient w/ symptoms suggesting CVD should be evaluated
Invasive test that requires iodine contrast dye injected into venous circulation via a large bore IV catheter to coincide with cardiac output, timing appropriately

42
Q

Implementation of coronary angiography

A

Must lay flat on CT table
Assessed for allergies
MUST be monitored for post dye injection allergies ‘
HR and BP must be maintained within certain parameters to allow visualization of the coronary arteries when CT contrast dye is injected HR <60 BP<120-110

43
Q

Factors influencing providers decision to perform coronary angiography includes

A

Finding of history and physical
Risk score Calc - variety of cardiovascular risk scoresm not one is optimal
Athlete status, public safety concerns, high risk avocation (scuba diving)

44
Q

Coronary Arteriography

A

GOLD STANDARD = cardiac catheterization
Most precise means to document presence of CAD, also gives measures of left ventral function
- LV end diastolic pressure
- LV end diastolic volume
- ejection fraction
Indicated in patients w/ severe angina, recurrent chest pain of uncertain etiology, survivors of cardiac arrest

45
Q

Tunica Adventitia

A

Outermost later of blood vessels
Connective tissue

46
Q

Tunica media

A

Middle layer of blood vessels
Composed of vascular smooth muscle
Maintains basal tone
-Increased tone - vasoconstriction
-Decreased tone - vasodilation

47
Q

Tunica intima

A

Innermost layer of vessels
Smooth single layer of cells permits laminar blood flow

48
Q

Resistance vessels

A

Arteries
Arterioles
No valves
Think muscular walls
High capacity to change resistance
Ay anytime: 25% of blood volume is in the arterial system

49
Q

Capacitance vessels

A

Veins
Venules
Contains valves
Elastic and distensible
High capacity to “hold” blood
At all times 75% of blood volume is in the venous system

50
Q

Pulse pressure

A

Difference between systolic and diastolic pressures

51
Q

Mean arterial blood pressure (estimate)

A

Add 1/3 pulse pressure to diastolic pressure
Reflects average pressure during contraction and relaxation
Good indicator of tissue perfusion in critically ill

52
Q

Cardiac output

A

Measured in L/min
CO = stroke volume x HR

53
Q

Stroke volume

A

Amount of blood ejected with each ventricular contraction

54
Q

End diastolic volume

A

Total volume of blood in LV at end of filling just prior to contraction

55
Q

Ejection fraction

A

Prevent of volume of blood ejected w/ each ventricular contraction
55-75% of total ventricular volume

56
Q

Total peripheral resistance (TPR)

A

Aka systemic vascular resistance or peripheral vascular resistance
Reflects the tone (degree of vasoconstriction) of resistance vessels (arteries and arterioles) as well as viscosity of the blood

57
Q

Aortic impedance

A

Loss of elasticity of aortic wall
^ w/ aging and functioning of aortic valves
Aortic narrowing > L ventricle must generate higher pressure to get blood through
Can lead to left sides heart failure and hypertension

58
Q

Starling’s law

A

Strength of contraction is directly proportional to initial length of cardiac muscle fiber at onset of contraction
Degree to which heart muscle is stretched corresponds to EDV
Myocardial fiver stretch has an upper optimal limit, when exceeded, contraction strength is decreased
(Slinky) if stretch beyond limit cannot return to normal size

59
Q

Preload

A

Degree of myocardial muscle strength
Determined by blood volume
^ preload ^ stretch ^ force of ventricular contraction
Related to the degree of compliance of the ventricular wall
- ischemic heart muscle > ^ compliance
- hypertrophied heart muscle > decreased compliance
Heart failure > ^ stretch w/out ^ force of ventricular contraction

60
Q

Afterload

A

Determined by:
Resistance offered by aortic and pulmonic valves (aortic impedance)
- aortic stenosis > ^ afterload
Condition and tone of aorta and resistance offered by systemic and pulmonary arterioles (TPR)
- hypertension > ^ afterload
^ afterload > ^ cardiac workload and ^ O2 consumption

61
Q

When myocardial contractility is increased

A

More blood is ejected
Decrease systolic volume
Increase systolic ejection fraction

62
Q

When myocardial contractility is decreased

A

Less blood ejected
Increased end systolic volume
Decreased ejection franction

63
Q

Most important factor in ventricular performance

A

Myocardial contractility

64
Q

Pericardium functions

A

Prevent displacement of heart during gravitational acceleration/deceleration
Physical barrier against infection and inflammation from the lungs and pleural space
Contains pain and mechanoreceptors that elicit reflex changes in blood pressure and heart rate

65
Q

Myocardium function

A

Cardiac muscle
Anchored to hearts fibrous skeleton
Thickness varies and is r/t amount of resistance needed to overcome to pump (left ventricle is thickest)

66
Q

Myocardium function

A

Cardiac muscle
Anchored to hearts fibrous skeleton
Thickness varies and is r/t amount of resistance needed to overcome to pump (left ventricle is thickest)

67
Q

Endocardium

A

Internal lining composed of connective tissue and squamous cells
Continuous with the endothelium the lines arteries, capillaries and veins
Creates a continuous closed circuit

68
Q

Atrioventricular valves

A

Open at the beginning of diastole and allow blood to fill the ventricles
Close at the beginning of ventricular contraction to prevent backflow of blood into the atria

69
Q

Semilunar valves

A

Open at the end of ventricular contraction when the pressure in the ventricles exceed the pressure in the pulmonary artery and aorta
Close at the beginning of ventricular relaxation as the pressure in the chambers drops below the pressure in the pulmonary artery and aorta to prevent back flow into ventricles

70
Q

Right coronary arteries

A

Conus - supplies blood to the upper RV
Right marginal branch - traverses right ventricle to apex
Posterior descending - supplies small branches to both ventricles

71
Q

Why myocardial contractility is important to ventricular performance

A

Dependent on concentration of catecholamines in heart muscle
Epinephrine and norepinephrine directly stimulate beta adrenergic receptors in myocardium to ^ force of contraction

72
Q

Influences of myocardial contractility

A

Preload
After load
SNS stimulation

73
Q

Beta 1 receptors

A

Sympathetic NS for
Affect heart
^ HR + chronotropic
^ force of contraction + inotropic

74
Q

Beta 2 receptors

A

SNS
Lungs
Broncodilation

75
Q

Alpha 1 receptor

A

^ vasoconstriction

76
Q

Adrenergic

A

Released by SNS
^ BP

77
Q

Cholinergic

A

Released by PNS
Decrease BP
Dominant neural control
decreased HR - chronotropic
Slight decrease in force of contraction - inotropic

78
Q

Carotid sinus

A

Baroreceptor that monitors BP to brain

79
Q

Aortic arch

A

Baroreceptor that monitors BP to heart
Makes sure heart has adequate blood flow to get blood to brain

80
Q

Baroreceptors

A

Most important function is to modify BP when there is postural change or valsalva maneuver
- decrease BP : decreased stim of vasodepressor (^ PVR) center and cardio inhibitory center (^ HR) > ^ in CO and BP
- increase BP : stimulate vasodepressor center (decrease PVR) and cardio inhibitory center (decrease HR) > decrease CO and BP

81
Q

Chemoreceptors

A

Primary function is regulation of ventilation
Stimulated when arterial pressure drops below a critical level
Located in carotid bodies

82
Q

Norepinephrine and Epinephrine

A

Adrenal medulla secretes into the blood
Travel to heart
Produce + chronotropic (^HR) and + inotropic (^ contractility) responses
Similar response produced by stress

83
Q

R-A-A

A

Juxtaglomerular cells secrete renin
Renin changes angiotensinogen to angiotensin 1
Angiotensin 1 is converted to angiotensin II in the lungs by ACE

84
Q

Effects of R-R-A

A

Angiotensin II is a potent vasoconstrictor
^ BP and ^ aldosterone secretion from adrenals
^ BP and ^ aldosterone secretion for adrenals
- ^ Na and H2O retention by kidneys
- ^ ECF volume > ^ BP

85
Q

Antidiuretic hormone (ADH)

A

Aka vasopressin
Problem: ^ plasma osmolarity or ^ BP
posterior pituitary secretes ADH
- potent vasoconstrictor
- controls reabsorption of water in collecting ducts of kidneys
^ plasma volume and BP and CO

86
Q

Problems of R-A-A

A

Decreased Pressure in renal arteries
Decreased Na in renal tubules
SNS stimulation

87
Q

Atrial stretch receptors

A

Respond to degree of dissension of L atrial walls during diastole
Problem: ^ venous return

Patho (6 decks)

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