W3 Cardiovascular assessment

Question 1

Superior and Inferior Vena Cava receives:

Answer 1

Returns deoxygenated blood from the systemic circulation

Question 2

Right Coronary Artery supplies:

Answer 2

Supplies blood to the right atrium (SA node and AV node), right ventricle, the bottom portion of left ventricle and back of septum

Question 3

Branch of Right Coronary Artery supplies:

Answer 3

Posterior descending artery and right marginal artery

Question 4

Aorta supplies:

Answer 4

Takes oxygenated blood from the heart into the systemic circulation.

Question 5

Pulmonary Artery supplies:

Answer 5

Takes deoxygenated blood from the heart to the lungs

Question 6

Left Coronary Artery breaks off into:

Answer 6

Divides into branches: circumflex artery and left anterior descending artery

Question 7

Circumflex Artery supplies:

Answer 7

Supplies blood to the left atrium and the side and back of the left ventricle

Question 8

Left Anterior Descending Artery supplies:

Answer 8

Supplies blood to the front and bottom of left ventricle and the front of the septum

Question 9

what is included in the assessment and monitoring of heart function?

Answer 9

1) Preload, 2) Contractility, 3) Afterload, 4) Stroke Volume, 5) Central Venous Pressure, 6) Cardiac Output 7) Mean Arterial Pressue

Question 10

Define Preload:

Answer 10

o Pressure exerted on walls of the ventricle by the volume of blood filling ventricles at the end of diastole.
o Used as an indication of circulatory volume status

Question 11

Define Contractility:

Answer 11

o The ability of the muscle to shorten and contract when stimulated
o Force of myocardial contraction

Question 12

Define Afterload

Answer 12

o The pressure the ventricles have to overcome to eject blood
o The resistance to ventricular contraction

Question 13

Define Stroke Volume

Answer 13

o The volume of blood pumped with each contraction

Question 14

Define Central Venous Pressure

Answer 14

Pressure measured in the central veins close to the heart and measures preload of the right ventricle

Question 15

Define Cardiac Output and what is the formula?

Answer 15

o The amount of blood pumped by the heart each minute.

o (stroke volume X heart rate)

Question 16

Define Mean Arterial Pressure (MAP) and what is the formula?

Answer 16

Average pressure in the patient’s arteries during one cardiac cycle
(Diastolic X 2) + Systolic / 3

Question 17

What regulates/impacts stroke volume?

Answer 17

Preload
Afterload
Contractility

Question 18

what regulates cardiac output?

Answer 18

stroke volume and heart rate

Question 19

what increases preload?

Answer 19

o Alterations in afterload:
increased afterload, high blood pressure or faulty heart valves increases preload because more blood stays in the heart after it pumps
o Decreased Heart Rhythm
slower the heart, the more time the heart has to fill

Question 20

what decreases preload?

Answer 20

1) Low blood volume (hypovolaemia)
2) Increased intrathoracic pressure
3) Increased intracardiac pressure (temponade- Drain)
4) Decreased venous blood pressure/return
5) Atrial arrhythmia (AF)

Question 21

what increases afterload?

Answer 21

1) increased vascular resistance
2) Hypertension:
* because left ventricle has to work harder to pump blood out of the aorta. The aortic valve won’t open until the left ventricle pressure is higher than the systemic blood pressure.
3) Aortic stenosis and regurgitation
4) Hypothermia (vasoconstriction)

Question 22

What decreases afterload?

Answer 22

1) Hypovolaemia
2) Mitral valve regurgitation
3) Hyperthermia (vasodilation)

Question 23

What decreased heart contractility?

Answer 23

 Hypoxia/hypoxaemia
 Ischaemia
 Drugs: calcium channel blockers, thiopentone

Question 24

Does Oxygen “Increase” or “Decrease” contractility?

Answer 24

Increases contractility

This increases oxygen demand and work load on heart

Question 25

Sympathetic stimulation ________ HR by Stimulating ___ and ___ node and cardiac muscles during ________ and _________ stress

Answer 25

Sympathetic stimulation Increases HR by Stimulating SA and AV node and cardiac muscles during emotional or physical stress

Question 26

what does parasympathetic stimulation do to heart rate?

Answer 26

Decreases heart rate

Via vagus nerve

Question 27

How is Cardiac output assessed?

Answer 27

• Heart rate and rhythm monitoring with continuous
  cardiac monitoring
• Feel pulses,
• Auscultate heart sounds for S1 & S2.
• Haemodynamic monitoring (invasive and/or non-
  invasive)
  o TPR, BP SPo2 and UO (>0.5ml/kg/hr)
  o Invasive intra-arterial pressure (continuous BP
  monitoring)
  o Central venous pressure
  o Pulmonary artery pressure
  o Thermodilation cardiac output (measure the time it takes for ventricle to change dimension when a cool substance is ejected into the heart blood- this provides a measurement of stroke volume)

Question 28

What is Haemodynamic monitoring?

Answer 28

Measures the blood pressure from inside the veins, heart and arteries, it also measures flood flow and how much oxygen is in the blood

Question 29

what are the two types of haemodynamic monitoring?

Answer 29

Invasive (catheter) and
Non invasive (BP cuff, obs, urine output, inspection)

Question 30

list the different haemodynamic monitoring measurements:

Answer 30

• Arterial pressure
• Mean arterial pressure
• Cardiac monitoring
• Central venous pressure (preload of R ventricle)
• Left and right ventricular pressure
• pulmonary artery wedge
• Left Atrial Pressure
• Aortic pressure (aneurysm)

Question 31

How is preload measured?

Answer 31

• Central Venous Pressure
• Pulmonary artery pressure
• Pulmonary capillary wedge pressure (catheter with an inflated balloon is wedged into the small pulmonary arterial branch. Provides a measurement of the end diastolic pressure in the left ventricle).

Question 32

Non-invasive assessment of cardiac output includes:

Look, Listen, Feel- IPPA

Answer 32

• Inspect:
  o Skin colour, temperature, cap refill, mucous membranes, GCS
• Check pulses:
  o (Invasive and Non-invasive) Rate, Rhythm, strength and equality. Difference between central and peripheral pulses
• Urine output:
  o > 0.5ml/kg/hour