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Med Surg Ch. 21

CV System Function, Assessment and Therapeutic Measures

Where is the heart located? The mediastinum
What surrounds the heart? The pericardium
What are the layers of the pericardium? Fibrous Pericardium, Parietal Pericardium and Viseral Pericardium (Epicardium)
Serous fluid in the pericardium does what? Prevents friction as the heart beats
The chambers in the heart are made of...? Myocardium (Heart muscle)
The chambers are lined with...? Endocardium (Smooth epithelial tissue)
What is the path of the heart? Superior/Inferior Vena Cava--Right Atrium--Tricuspid Valve--Right Ventricle--Pulmonary Semilunar Valve--Pulmonary Artery--Pulmonary Capillaries--Pulmonary Vein--Left Atrium--Bicupid (Mitral) Valve--Left Ventricle--Aortic Semilunar Valve--Aorta
What anchors the AV valves? Chordae Tendinae
Which ventricle works harder? The left ventricle
Where is the SA node located? In the wall of the right atrium
What is "the pacemaker"? SA Node
Where is the AV node located? Bottom of the right atrium
What is the cardiac conduction pathway? SA node, AV node, Bundle of His, Bundle Branches, Purkinje Fibers
The AV node initiates a HR of...? 40-60 beats per minute
What occurs during systole? Contraction of the ventricles
What occurs during diastole? Relaxation of the ventricles
What causes lubb? Closure of AV valves
What causes dupp? Closure of semilunar valves
What is cardiac output? Blood ejected from the left ventricle in one minute
How is cardiac output determined? SV x HR
What is stroke volume? The amount of blood ejected per beat (~60-80mL)
What's the average cardiac output? 5-6L
What is ejection fraction? SV/Total blood in the ventricle (normally ~60%)
What does sympathetic nerve impulses do? Increase rate and force of contraction by releasing norepinephrine
What does parasympathetic nerve impulses do? Decrease HR by releasing acetycholine
Where are baroreceptors and what do they do? In the carotid and aortic bodies. They detect changes in BP
Where are chemoreceptors and what do they do? In the carotid and aortic bodies. They detect changes in oxygen content of the blood
What happens in response to decreased BP or blood oxygen? The heart receives sympathetic impulses and beats faster
What does aldosterone do? Regulates blood levels of Na+ and K+, both needed for the electrical activity of the myocardium
What is ANP and what does it do? Atrial Natriuretic Peptide. It increases excretion of Na+ by the kidneys by inhibiting secretion of aldosterone. It is secreted when an increase in BP or decrease in blood volume stretches the walls of the aorta
What is the inner lining of arteries? Endothelium; simple squamous epithelium which is very smooth to prevent clotting
Where are valves most prevalent and why? In the veins of extremities, especially the legs, where blood must return to the heart against the force of gravity
How thick are capillary walls and why? 1 cell thick to allow exchange of gases, nutrients and waste products between blood and tissue
Normal BP is high enough to _______ but low enough to _______. Permit filtration for nourishment of tissues; prevent rupture
Venous return depends on...? The skeletal muscle pumping to squeeze the deep veins of the legs
What is pulse pressure? The difference between systolic and diastolic
How is renin-angiotensin-aldosterone stimulated? Blood flow through the kidneys decreases, renal filtration decreases and urine output decreases to preserve blood volume. Decreased BP stimulates renin (from kidneys)
What does angiotensin II cause? Arteriole vasoconstriction and stimulates secretion of aldosterone to raise BP
What hormone increases reabsorption of Na+? Aldosterone
The renin-angiotensin-aldosterone mechanism Decreased BP/renal ischemia/increased urine Na+=renin excretion which turns angiotensiongen to angiotensin I--Lungs release angiotensin-converting enzyme to make angiotensin II which causes peripheral vasoconstriction--aldosterone released--BP increases
What is pulmonary arterial pressure? 15-25/8-10 mm Hg
Why is a low lung BP important? To prevent filtration in pulmonary capillaries which keeps tissue fluid from accumulating in the alveoli causing pulmonary edema
Which organ does all blood from the body go? The liver via the hepatic portal vein
When does aging of blood vessels begin? Childhood
What is atherosclerosis? Deposition of lipids in walls of arteries forming rough surfaces that may stimulate clot formation
What is the #1 killer in the U.S.? Cardiovascular Disease
What conditions can lead to heart disease? Rheumatic fever, pulmonary disease, HTN, kidney disease, CVA, transient ischemic attack, renal disease, anemia, strep, congenital heart disease, thrombophlebitis and alcoholism
What is orthostatic hypotension? A drop in systolic BP of more than 15 mm Hg and in response and increase of more than 20 beats per minute
What are the causes of orthostatic hypotension? Fluid volume deficit, diuretics, analgesics, pain and beta blockers
Quality of pulse is described as...? 0 Absent; 1+ Weak, thready; 2+ normal; 3+ Bounding
What is a thirll? The vibration felt when an abnormal vessel with a bulging or narrowed wall is palpated
What is a bruit? Humming heard when auscultating as abnormal vessel caused by turbulent blood flow
What does sputum look like in acute heart failure? Pink and frothy
Lung congestion resulting from heart failure may cause what? Dry cough
What does reddish-brown (rubor) discoloration indicate? Decreased arterial blood flow
What does pallor indicate? Anemia or lack of arterial blood flow
Brown discoloration and cyanosis in extremities indicates...? Venous blood flow problems
What is a sign of reduced arterial blood flow? Decreased hair distribution, thick and brittle nails and shiny, taut, dry skin
What causes clubbing of the nails? Oxygen deficiency
What are the 6 P's that characterize PVD? Pain, Poikilothermia, Pulselessness, Pallor, Paralysis, Paresthesia
What is Homan's sign? Pain in the pts calf or behind the knee when the foot is quickly dorsiflexed with the knee in a slightly flexed position (less than 1/2 pts with VT are negative for this sign)
S3 is heard with what? Left-sided heart failure, fluid volume overload and mitral valve regurgitation
S4 is heard with what? HTN, coronary artery disease and pulmonary stenosis
When is S3 heard? Early in diastole
When is S4 heard? Late in diastole
What causes murmurs? A narrowed valve opening or a valve that does not close tightly
What does pericardial friction rub sound like? A grating sound like sandpaper being rubbed together
A pericardial friction rub may occur after what? MI or chest trauma due to inflammation
In what position should a pt be to better ausculate heart sounds? Leaning forward or lying on their left sides
An ECG is best to diagnose abnormalities related to what? Dysrhythmias, MI or myocardial ischemia
How long/what does a Holter Monitor record? For up to 48 hours it continuously records an ECG as the pt goes about everyday activities
What type of test is an echocardiogram? Sound waves (ultrasound)
What does an echocardiogram record? Valvular abnormalities and vegetation CHF
What is a transesophageal echocardiogram? A transducer on a probe placed in the esophagus. The images are clear.
How long must a pt be NPO before TEE? 6 hours
What can pts not do before an exercise stress test? Smoke, eat or drink for 2 to 3 hours before
What should pts avoid after an exercise stress test? Drinking stimulants such as caffeine and temperature extremes
How is an exercise stress test performed? The pt will walk on a treadmill while ECG and vitals are constantly assessed
What does a plethysmography test measure? Blood volume and changes in blood flow to diagnose DVT, pulmonary embolism and screen pts for PVD
How is a plethysmography test performed? The tested leg is raised 30 degrees with the pt supine. A pressure cuff is inflated to distend veins. Cuff is then rapidly deflated and venous volume changes are measured with electrodes
What occurs during a doppler ultrasound? Sound waves bounce off moving blood cells. Decreased blood flow causes reduced sounds.
What does doppler diagnose? PVD
What do cold spots indicate on thallium imaging? Ischemia or infarction
How is thallium imaging performed? Thallium-201 is injected IV and muscle cells absorb it. After 10-15 minutes the heart is scanned.
What do hot spots indicate on thallium imaging? Healthy myocardial cells with good blood flow
What do hot spots indicate on technetium-99m sestamibi? Myocardial cell damage
What do hot spots indicate on technetium pyrophosphate scans? Areas of ischemia or myocardial cell damage
What occurs during a MUGA scan? Technetium 99m pertechnetate is injected IV and remains in the blood stream. A camera follows the flow of the radioactivity which shows ventricular function and wall motion and the ejection fraction of the heart
What is injected during a PET scan? First nitrogen-13 ammonia then fluoro-18-dexyglucose
What does a PET scan show? Perfusion and metabolic function/viability
What should be avoided before a PET scan? Caffeine, tobacco and sugar (blood glucose should be in the normal range)
How long must a pt fast before a blood lipid test? 12 hours
How long must a pt not drink alcohol before a blood lipid test? 24 hours
High LDLs increase a pts risk for what? Coronary artery disease
HDLs protect against what? Why? Coronary artery disease; They carry cholesterol to the liver to be metabolized
Normal LDL levels Less than 100
Normal HDL levels More than 60
What are cardiac biomarkers? CK-MB, Troponin I & T, Myoglobin
What biomarker elevates first? Myoglobin (rises in 1 hour; peaks at 4-12 hours)
What biomarker elevates second? CK-MB (Rises in 4-6 hours)
What biomarker elevates third? Troponin I & T (rises in 4-6 hours; peaks at 10-24 hours)
Which biomarker is best to diagnose an MI? Troponin I & T
Why is myoglobin not good to diagnose an MI? It is found in all muscles. It is not cardiac specific
Troponin I & T normal levels Varies by lab; very low
Myoglobin normal levels 0-85 ng/mL
CK-MB normal levels 0-7 international units/L
What can a low level of Mg cause? Cardiac dysrhythmias, HTN and tachycardia
Normal Mg level 1.3-2.1
What are angiographs used for? Assess blood clot formation, PVD and test vessels for potential graphing use
What must be done prior to an angiography procedure? Pt assessed for allergies, pt gives informed consent, pt NPO for 4 hours, pt informed the dye will cause a hot, burning sensation when injected
What's assessed in a pt after angiography? Vitals, allergic reaction signs, hemorrhage at injection site and pulses
What is used to guide cardiac cath insertion? Fluoroscopy (real-time imaging x-ray)
What should happen before cardiac cath? Pt gives informed consent, pt assessed for allergies, pt kept NPO, pt instructed they will be awake during the procedure and a warm, flushing sensation will be felt when the dye is injected
How long is a cardiac cath procedure? 2-3 hours
What happens after a cardiac cath procedure? Cath is removed, firm pressure applied in insertion site to prevent hemorrhage and hematoma, vitals assessed, extremity used for insertion is not moved or flexed for several hours after procedure
What are therapeutic measures for the CV system? Exercise, smoking cessation, healthy balanced diet, oxygen, meds and antiembolism devices
Which drugs should be stopped before surgery? Aspirin, coumadin and heparin
Created by: maxxinekj