Test one Flashcards
How much fluid does the pericardium hold?
10-15ml
What is end diastolic volume?
End systolic volume?
Stroke volume? measured as what?
Amount of blood in the ventricle right before contraction
Amount of blood in ventricle after contraction
Amount of blood in mL ejected from the ventricle with one heartbeat ml/beats
What is systemic vascular resistance?
the force opposing the movement of blood
What are the two factors that influence BP?
what is the equation?
CO and SVR
BP+ COx SVR
How to calculate MAP
what do we need in order to perfuse organs?
SBP+2DBP/3
Above 60
What is pulse pressure?
What is normal?
What would an increased pulse pressure indicate?
Decresed?
difference between SBP and DBP
one third difference
exercise, atherosclerosis, of larger arts
heart failure or hypovolemia
What is cardiac output.\?
How is it measured?
How do we calculate it?
What is normal?
The amount of blood pumped by each ventricle in one min
measured in L/min
CO+SVx HR
4 to 8 L/min
What is stroke volume?
measured?
Amount of blood pumped by the vent in one beat (ml/beat)
What is cardiac index?
calculate?
Normal?
It adjust the CO to the body size
CO divided by body surface area
2.8-4.2L/min/meter squared L/min/m2
How high can a hr be for a short period of time?
180
What is preload?
the volume of blood in the vents at the end of diastole it determines the amount of stretch placed on myocardial fibers
What can increase preload?
myo infarct, aortic stenosis, hypervolemia
What is after load?
What affects after load?
what happens to the heart if their is high bp
peripheral resistance against which the left vent must pump
size of ventricle, wall tension, arterial bp
Ventricular hypertrophy with no increase in CO or size of chambers so just the mm
What is postprandial hypotension?
Decrease in BP of at least 20mmHg within 75min after eating
What about BP and HR with laying and standing
Should not decrease/increase more than 20
What is a bruit
A buzzing or humming sound over a vessel that is from a narrowed or bulging wall
What is the angle of louis?
Manubrim and sternum it is where the second rib is located
What are the points to listen to the heart and where are they? and what should you hear?
Ape to Man Aortic r 2nd Pulmonic l 2nd Erbs- r3rf s1 and s2 equally Tri- l 5th Matrial-5 midclavicular
what is the best part of the stethoscope to listen to s1 and s2?
The diaphragm because they are high pitched noises
What is s3?
low intensity vibration of vent walls associated with decreased compliance of the vents during filling
What is s4
Low frequency vibration caused by atrial contractions.
4 things about troponin
detectable within 4-6 hours of myocardial injury
peak at 10-24 and can be detected for 10-14 days
It is the biomarker of choice in diagnosis of MI
Creatine kinase (CK)- MB levels and where are they found
Rises in 3-6 hours, peaks in 12-24 hours, returns to baseline within 12-48 hours
Sk mm, Brain, heart
what are the Cardiac Natriuretic Peptide Markers
atrial natriuretic peptide (ANP) from the atrium
b-type natriuretic peptide (BNP) from the ventricles
c-type natriuretic peptide from endothelial and renal epithelial cells.
how do you distinguish between cardiac or respiratory dyspnea?
BNP
Name one thing that would suggest heart fail
N-terminal pro-brain natriuretic peptide (NT-pro-BNP)
When diastolic blood pressure increases (e.g., heart failure),
BNP and NT-pro-BNP are released and increase natriuresis (excretion of sodium in the urine).
2 things about CRP
produced by the liver during acute inflammation and elevated is independent risk for CAD
What is Homocysteine
Hcy an amino acid that is produced during protein catabolism from hereditarynor dietary b deficiencies that increases risk of CAD, PVD, and stroke
HDL and cholesterol ratio
how to do it. what is good?
Set up proportion with HDL and Cholesterol and make HDL equal to one and solve.
<3.5-1
What is ejection fraction?
percentage of end diastolic blood volume that is ejected from left vent during systole
What drug do they give with a stress echo? 2
Dobutamine or dipyridamole
What is TEE what aare some considerations?
Transesophageal echocar
endoscope with a probe
they need to be sedated and no one with radiation therapy to the chest wall
What is one thing you would expect to find in an older patient
a systolic murmur
What are heaves?
sustained lifts of the chest wall in the precordial area. Usually indicative of hypertrophy in the left vent
What is Point of maximal impulse?
Apical pulse mid clavicular line 4th or 5th space if below it may be enlarged patient needs to be supine
thrills
Abnormal vibration possibly do to a valve disorder
What side of the stethoscope is best for s1 and s2? and why? s3 and s4?
The diaphragm because they are high pitched the bell because they are low pitched
What are the best patient positions for auscultating aortic and pulmonic areas and mitral
aortic and pulmonic lean forward while sitting
mitral left side laying
What are the points for palpating arteries?
carotid, brachial, radial, ulnar, femoral, popliteal, post tib, dorsalis pedis
What are the two heart dysrhythmias we need to call a code on
Ventricular tachy w/o pulse and ventricular fib
Name two more biomarkers and why
c reactive prot- made by liver during inflamation may indicate early MI
and homocysteine- Amino acid made during protein catabolism vit b deficiency higher risk for CAD, peripheral disease, stroke. Testing is recommended for predisposition to CAD
What is CXR and what will it show?
Chest XR
Heart enlargement, displacement, contour, fluid, pulm congetsion
Nuclear studies show
Stress perfusion imaging
What will a ct show and one thing about it
heart anatomy, coronary circulation and great blood vessels calcium scoring
may need contrast
Two things about exercise stress test
Good for people with pacemaker for diagnostic reasons and measure BP and ECG
s3 and s4 states
3 kentucky 4 tenesse
The vagus nerve
Slows heart rate
Timeline on MI
20min cell death, 4 hours full mm 12 if partial block
What are the complications of MI
DysR, cardiogenic shock- severe L vent fail, Papillary mm dysfunction, Ventricular aneurism, Acute pericarditis, dresslers
After MI heart healing
10-14 days scar tissue still weak and person is more active it takes 6 weeks to be considered healed
What is Sudden cardiac death?
What are the dysR that cause it 2
Unexpected death from a cardiac issue where there is sudden disruption in the cardiac output causing loss of CO and cerebral blood flow
vent tachy and vend fib
What two groups do people fall in with SCD? because of CAD
NO acute MI no symptoms and yes acute MI symptoms -Death within one hour
What lab values are indicative of MI and one for heart fail
Troponin, c reactive protein, lipoptrotein, phosoholipase A2-M!, CK-MB
BNP
3 signs of sinus bradycardia
Confusion, disorientation, SOB
One thing to do with PVC
apical radial pulses should be checked
What do we need to do with 3rd degree block?
Pacemaker
What do we do with vent tachy vs vent fib?
Vent tachy- unstable no pulse cpr defib
Vent fib -CPR and defib
What do we like to defib
VFib and V tachy
2 Thinks about defib
Within 2 mins
and start CPR right away
When do we use Sync? and one thing not to do
VT with a pulse or supraventricular tachy aka a fib with rapid vent response
Use on t wave
What to remove before sync 5
Metallic objects, dentures, trans derm patch, hair
PR interval
time of spread of electrical impulse right before vent contraction
ST segment
Time from vent depolarization to repolarization
t wave
ventricular repolarization
What is a premature atrial contraction mean and one thing that shows up
Location other than SA node distorted p wave
Atrial flutter 2 things
saw tooth and cant measure PR interval
A fib
Disorganized electrical activity from multiple ectopicfoci
Chaotic waves replace p waves so no p wave
AV block
no atrial pulses to vents p wave and qrs have no relationship
cant measure pr
PVC
early QRS that are wide and bizzare no p wave with pvc
Vent tachy
3 or more PVC in a row
vent fib
Cant measure anything
What is ACS 2 and three groups
Ischemia that is prolonged and not immediately reversed. It is a coronary art that is part or all the way occluded with thrombus.
UA, STEMI and NSTEMI
One thing about chest pain with NSTEMI
20 mins or longer
s/s of NSTEMI
maybe s3 s4 heart fail issues valve dysfunction issues
order of management for ACD and what is gold star for diagnostic test
12 lead, semi fowler, 02, Nitro asa, morphine, troponin
Angiography
Treatment for STEMI or NSTEMI
PCI STENT - reperfuses the myocardium,
PCI in cath lab
CABG- PCI fail or 3 or more injured vessels
thrombolytics- 1 hr to 8 hr given IV w/o clab
