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Critical Care Test 1

The top of the heart base
The bottom of the heart apex
The outermost layer of the heart. The coronary arteries run along this layer. epicardium
The middle and thickest layer. Made of pure muscle and does the work of contracting. Part that is damaged with a MI Myocardium
The thin innermost layer that lines the heart's chambers and folds back onto itself to for the heart valves. Watertight to prevent leakage of blood into the other layers. The cardiac conduction system is found in this layer. endocardium
A receiving chamber for deoxygenated blood returning to the heart from the body. O2 saturation of only 60%-75%, blood is a dark maroon color, and CO2 concentration is high. Delivers blood to the right ventricle. right atrium
pumps the blood to the lungs for a fresh supply of O2. O2 saturation of 6-%-75%, blood is dark maroon, and CO2 concentration is high. right ventricle
Receiving chamber for the blood returning to the heart from the lungs. O2 saturation is 100%, bright red in color, CO2 concentration is extremely low. Delivers blood to left ventricle. left atrium
Job is to pump blood out to the entire body. Major pumping chamber of the heart. O2 is 100%, bright red color, and CO2 is low. left ventricle
The heart is divided into left and right sides by septum
The septum separating the atria is interarterial septum
The septum separating the ventricles is interventricular septum
The hearts two valves that prevent backflow of blood semilunar valves and AV valves
separate a ventricle from an artery and have three half-moon-shaped cups. Semilunar valves
This valve is located between the right ventricle and the pulmonary artery pulmonic valve
located between the left ventricle and the aorta aortic valve
Valves that are located between the atrium and ventricles AV (atrioventricular) valves
located between the right atrium and ventricle, has three cusps tricuspid valve
located between the left atrium and ventricle, it has two cusps mitral or bicuspid valve
Between s1 and s2, the heart beats and expels blood. systole
Between s2 and the nest s1, the hear rests and fills with blood diastole
large vein that returns deoxygenated blood to the right atrium from the head, neck, upper chest, and arms Superior vena cava (SVC)
large vein that returns deoxygenated blood to the right atrium from the lower chest, abdomen, and legs inferior vena cava (IVC)
Large artery that takes deoxygenated blood from the right ventricle to the lungs to load up on oxygen and unload carbon dioxide pulmonary artery
large veins that return oxygenated blood from the lungs to the left atrium pulmonary veins
largest artery in the body. takes oxygenated blood from the left ventricle to the systemic circulation to feel all the organs in the body. aorta
Blood flow through the heart Blood enters the heart in the superior or inferior vena cava, right atrium, tricuspid valve, right ventricle, pulmonic valve, pulmonary artery, lungs, pulmonary veins, left atrium, mitral valve, left ventricle, aortic valve, aorta, into the body.
refers to the mechanical events that occur to pump the blood cardiac cycle
the two phases of the cardiac cycle diastole and systole
three phases of diastole rapid-filling, diastasis, and atrial kick
first phase of diastole. Atria is full of blood, ventricles empty. Pressure differential causes AV valves to pop open and blood rapidly fills ventricles rapid filling phase
Second phase of diastole. Pressure equalize between atria and ventricles, flow in ventricles slows. diastasis
last phase of diastole. Atria contract to squeeze remainder of blood into the ventricles atrial kick
four phases of systole isovolumetric contraction, ventricular ejection, prodiastole, isovolumetric relaxation
first phase of systole. Ventricles contracting, no blood flow occurring because of the aortic and pulmonic valves are still close. Huge expenditure of myocardial o2 consumption. isovolumetric contraction
second phase of systole. Valves open, blood pours out of ventricles into pulmonary artery and aorta ventricular ejection
third phase of systole. Pressure equalize between ventricles and pulmonary artery and aorta, blood flow slows prodiastole
last phase of systole. Ventricles relax and pulmonic and aorta valves closed isovolumetric relaxation
Blood flow through the systemic circulation leaves aorta and enters arteries, then arterioles, into each organs capillary bed, now deoxygenated blood enters venules, widen into veins, and back to the vena cava.
arise from the base of the aorta and course along the epicardial surface of the heart and then dice into myocardium to provide its blood supply coronary arteries
a branch off of the left main coronary artery and supplies blood to the anterior wall of the left ventricle left anterior descending coronary artery
a branch off of the left main coronary artery and feeds the lateral wall of the left ventricle circumflex coronary artery
feeds the right ventricle and the inferior wall of the left ventricle right coronary artery
The heart has two kinds of cells contractile and conduction system cells
cause the heart muscle to contract, resulting in a heartbeat contractile cells
create and conduct electrical signals to tell the heart when to beat. Without these electrical signals the contractile cells would never contract conduction system cells
The hearts main function pump enough blood to meet the bodys metabolic needs
a state of readiness, the cardiac cell if ready for electrical action polarized state
cardiac cell is stimulated by an electrical impulse, a large amount of sodium rushed into the cell and a small amount of potassium leaks out, cause a discharge of electricity and becomes positively charged. Result in muscle contraction depolarization
during cell recovery, sodium and potassium ions are shifted back to their original places by way of the sodium-potassium pump, and active transport system that returns the cell back to its negative charge. Result in muscle relaxation repolarization
these are the myocardium's electrical stimuli depolarization and repolarization
These are the myocadium's mechanical responses Contraction and relaxation
There can be no heartbeat (mechanical response) without first having had depolarization (the electrical stimulus)
Can the heart have an electrical stimulus without having an mechanical response? Yes, but the heart will not pump
What happens to the cardiac cell when stimulated by electrical charge. 4 phases action potential
Cardiac at rest. Corresponds with isoelectric line of EKG phase 4
depolarization. Cell becomes positively charged. Corresponds with QRS complex on EKG phase 0
Early repolarization. Calcium is released. Muscle contraction begins. Corresponds with ST segment on EKG phase 1 and 2
rapid repolarization. Cell is returning to electrically negative state. Corresponds with T wave on EKG phase 3
Cardiac cells resists responding to/ depolarizing from an impluse refractory periods
Cardiac cell cannot respond to another impulse, no matter how strong, will not result in another depolarization absolute refractory period
cell can respond only to very strong impulse and will result in depolarization Relative refractory period
Cardiac cell is hyper, and will respond to very weak stimulus will cause depolarization Supernormal period
on the EKG equals one heartbeat P-QRS-T
atrial depolarization, small, rounded, upright on most leads P wave
usually not seen, occurs same time as QRS, but atrial repolarization, Ta wave
ventriclular depolarization, spiked upward and/or downward deflections QRS
ventricular repolarization, broad, rounded, upright if the QRS is upright T wave
represents late ventricular repolarization, not normally seen, shallow, broad, and rounded U wave
The flat lines between the P wave and QRS, no electrical current PR segment
the flat line between the QRS and T wave, no electrical current ST segment
The flat line between T wave of one beat and the P wave of the next beat baseline or isoelectric line
Atrial contraction occurs during the P wave and PR segment
Ventricular contraction occurs during the QRS and ST segment
When atria depolarizes a P wave is written on EKG
A negative deflection that occurs before a positive deflection Q wave
any positive deflection R wave
there can be more than one R wave, a second on is called R prime written R'
a negative deflection that follows an R wave S wave
A negative deflection with no positive deflection at all QS wave
A pathway of specialized cells whose job is to create and conduct the electrical impulses that tell the heart when to pump conduction system
the area of the conduction system that initiates the impulses pacemaker
conduction pathway of the heart originates in the sinus node, through interarterial tracts, carry impulses to the atrial tissue, through the intranodal tracts, AV node, Bundle of His, to left and right bundle branches, purkinje fibers, and arrives at ventricles
Cardiac cells have several characteristics automaticity, conductivity, excitability, and contractility
The ability to create an impulse without outside stimluation, electrical automaticity
the ability to pass this impluse along to neighboring cells,electrical conductivity
the ability to respond to this stimulus by depolarizing, electrical excitability
the ability to contract to do work, mechanical contractility
Three types of pacemakers sinus node, AV junction, ventricle
pacemaker that's 60-100 beats per minute sinus node
pacemaker that's 40-60 beats per minute AV junction
pacemaker that's 20-40 beats per minute ventricle
has the fastest inherent rate of all the potential pacemaker cells. the sinus node
true or false: the fastest pacemaker at any given moment is the one in control true
predominant pacemaker slows down; lower pacemaker takes over at its slower inherent rate and results in a slower heart rate than before escape
beat that comes in after a pause longer than normal R-R interval. life saver escape beat
series of escape beats escape rhythm
lower pace maker becomes hyper; fires in at an accelerated rate, stealing control away from slower predominant pacemaker and results in a faster hear rate than before usurpation
pattern of successive heart beats heart rhythm
abnormal heart rhythm arrhythmia
a printout of the heart's electrical activity viewed from 12 different angles as seen in 12 different leads 12-lead-EKG
an electrocardiographic picture of the heart's electrical activity lead
a printout of one or two leads at a time and is done to assess the patent's heart rhythm rhythm strip
on EKG each small block is 0.04
on EKG each big block is 0.20
counting horizontally measures intervals in secs
counting vertically measures amplitudes in mm
enable a determination of the heart's efficiency at transmitting its impulses down the pathway interval measurements
time traveling from atrium to ventricle. 0.12-0.20. measuring from beginning of P wave to the beginning of the QRS PR interval
measures the time it takes to depolarize the ventricles. <.012 usually 0.06-0.10. beginning of QRS to the end of the QRS QRS interval
measures depolarization and repolarization time of the ventricles. less than or equal to half of R-R interval. beginning of the QRS to the end of the T wave QT interval
three methods for calculating the heart rate the 6-second strip method, the memory method, and the little block method
the least accurate of all the methods. count the number of QRS complexes and multiply by 10 which will tell the mean rate the 6-second strip method
Since the 6-second strip method can be misleading, it makes more sense to provide a range of the heart rates
this is the fastest method. count the number of big blocks between consecutive QRS complexes and divide that number into 300 the memory method
count the number of little blocks between QRS complexes and divide into 1500. the little block method
is concerned with the spacing of the QRS complexes rhythm regularity
count the number of little blocks between QRS complexes to compare R-R intervals
three types of regularity regular, regular but interrupted, irregular
rhythm is which the R-R intervals vary by only one or two little blocks. the QRS complexes usually look alike regular rhythm
regular rhythm that is interrupted by either a premature beat or pause. the beats that interrupt this otherwise regular rhythm may look the same as the surrounding regular beats or may look quit different. regular but interrupted rhythm
beats that arrive early, before the next normal beat is due premature beats
rhythm in which the R-R intervals vary, not just because of premature beats or pauses, but because the rhythm is intrinsically chaotic. irregular rhythm
Calculate the heart rate by choosing any two successive QRS complexes and using the little block or memory method. calculating one heart rate Calculating for regular rhythms
Calculate the mean rate by using 6-sec strip method, and then calculate the heart rate range using the little block or memory method. calculating the range slowest to fastest, plus mean rate calculating for irregular rhythms
ignore premature beats and calculate the heart rate, using little block or memory method, on an uninterrupted part of the strip. calculating one heart rate calculating for regular rhythms but interrupted by premature beats
calculate the heart rate range slowest to fastest, along with the mean rate calculating regular rhythms but interrupted by pauses
five steps to rhythm interpretation QRS complexes? are they the same shape? regularity? heart rate? P waves? are they the same shape? in the same place or relative to the QRS? are any P waves not followed by a QRS? what are the PR and QRS intervals?
The normal sinus rhythm originating from the sinus node if sinus rhythm
normal sinus rhythm consists of narrow QRS, uniform shape, regular, HR 60-100, upright P waves and married to QRS, PR interval 0.12-0.20, QRS interval <0.12
arrhythmias consists of QRS absent or abnormally shaped, absent P waves or multiple numbers or abnormal shape, abnormal PR and QRS intervals, HR abnormally slow or fast, irregular rhythm or rhythm with interruptions
inherent rate of the sinus node is 60-100 but this rate can go higher or lower if the sinus node is acted on by the SNS or the PNS
heart rates that are too fast or too slow can cause symptoms of decreased cardiac output (inadequate blood flow to the body)
criteria that must be met for the rhythm to be sinus in origin upright matching P waves in Lead II followed by a QRS, PR intervals constant, and HR < or = 160 at rest
in lead II are considered sinus P waves until proven otherwise all matching upright P waves
in sinus rhythm QRS is normally narrow and <0.12 sec
if conduction through the bundle branches is altered QRS can be wide and >0.12 secs
impulse is born in the sinus nose and heads down the conduction pathway to the ventricle. every P wave is married to a QRS complex, HR is the normal 60-100. regular rhythm P waves upright, PR= 0.12-0.20sec QRS= <0.12 secs Sinus Rhythm
slower than normal rhythm from the sinus node, impluse originated in the sinus nose and travels the conduction system normally. HR <60 regular P wave upright, shaped the same, and married to QRS, PR= 0.12-0.20 secs QRS= <0.12 secs Sinus Bradycardia
Causes of Sinus brady vagal stimulation, MI, hypoxia, dig toxcity, athlete, other meds (beta blocker, opiods)
a slow heart rate can cause signs of decreased cardiac output
treatment for brady none unless pt symptomatic, atropine, O2, pacemaker, epi and dopamine (if in shock),
the sinus node fires at a heart rate faster than normal, impulse originates in the sinus node and travels down the conduction pathway normally. HR 101-160, regular, P wave upright, same shaped, and married to QRS, PR= 0.12-0.20 secs QRS= <0.12 secs Sinus tachycardia
causes of sinus tach atropine or bronchodilators, emotional upset, pulmonary embolus, MI, CHF, fever, inhibition of vagus nerve, hypoxia, thryotoxicosis
sinus tach can cause increased cardiac workload and decreased cardiac output
treatment for sinus tach meds for fever, sedation for anxiety, beta blockers for MI, O2
only irregular rhythm from sinus node, pattern that is cyclic and usually corresponds with breathing pattern, rate varies with resp., irregular or repetitive, R-R interval exceeds the shortest by >or=0.16secs Sinus arrhythmia
P wave upright and same shape, married to QRS, P-P interval is irregular, PR= 0.12-0.20 secs QRS= <0.12 secs Sinus arrhythmia
causes of sinus arrhythmia breathing pattern, but can be caused by heart disease
Treatment for sinus arrhythima usually none required
a pause that occurs when the regularly firing sinus node suddenly stops firing for a brief period, one or more P-QRS-T sequences will be missing, escape beat from lower pacemaker may take over for one or more beats sinus arrest
the sinus node may resume after missing or the lower pacemaker may continue as pacemaker, creating a new escape rhythm, not multiple of previos R-R intervals sinus arrest
can occur at any HR, regular but interrupted (pause), normal sinus P waves and normal or different P waves ending the pause. P-P is regular before pause and vary after. sinus arrest
PR= 0.12-0.20 secs before and shorter or absent after pause, QRS= <0.12 secs but on escape beat may be narrow <0.12secs or wide >0.12secs depends on which pacemaker resumes after pause sinus arrest
causes of sinus arrest sinus node ischemia, hypoxia, dig toxicity, excessive vagal tone, med side effects
treatment for sinus arrest may not cause a problem (no ill effects), meds to be stopped that's causing arrest, atropine and/or pacemaker, O2
very long sinus arrest can cause decreased cardiac output
pause that occurs when the sinus node fires its impulse on time, but the impulse's exit from the sinus node to the atrial tissue is blocked. results in one or more P-QRS-T sequences being missing, creating a pause, the length depends on how many missed Sinus block
when conduction of the regularly firing sinus impulses resumes, the sinus beats return on time at the end of the pause. the pause will be a multiple of R-R intervals (2 or more R-R cycles) Sinus block
can occur at any rate, regular but interrupted (pause), normal sinus P waves before and after and same shape, PR= 0.12-0.20secs QRS= <0.12secs Sinus block
causes of sinus block med side effects, hypoxia, strong vagal stimulation
frequent or very long sinus blocks can cause decreased cardiac output
treatment for sinus block may not cause a problem (no ill effects), stop med causing block, atropine and/or pacemaker, O2
Created by: 605946556
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