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wvc cardiac lecture
| Question | Answer |
|---|---|
| Blood Pressure | force of blood exerted against walls of the vascular system; SBP amount of pressure exerted by the left ventricle of the heart during contraction (systole); DBP is the amount of pressure in the arteries during the relaxation phase of the heart-diastolie |
| Bp regulation Baroreceptors | – carotid sinus, aorta and left ventricle |
| Bp regulation Chemoreceptors | – sensitive to rise in CO2 during hypoxia |
| Bp regulation Autonomic Nervous System- | balance of parasympathetic & sympathetic in response to changes |
| Bp regulation Renal System- | retention or excretion of water & sodium, renin-angiotensin system |
| Sympathetic nervous system | system that is responding to stress |
| BP Regulation | Autonomic nervous system; Arterial Baroreceptors; Body Fluid Volume Renin-Angiotensin-Aldosterone; Vascular Autoregulation |
| The Silent Killer | May be few symptoms; Comes on gradually; Damages vessels in heart, brain, kidneys and peripheral vasculature |
| Hypertension | Blood pressure of >140 systolic and >90 diastolic; Three Stages: Stage I - BP 140/90 to 159/99 Stage II - BP 160/100 to 179/109Stage III - BP > 180/110 |
| Types of Hypertension | Malignant Hypertension; Essential Hypertension; Secondary Hypertension; Essential Hypertension |
| Primary type | Accounts for 85% to 90% of all hypertension; Risk factors: Similar to risk factors for coronary artery disease. Many risk factors can be controlled with lifestyle changes |
| Secondary Hypertension | Caused by other disease processes or medications Most commonly associated with renal disease; Can also be a problem with endocrine function, brain tumors or encephalitis, estrogen, corticosteroids. Sympa…., |
| Malignant Hypertension | Severe HTN: SBP >200, DBP >150 Progresses rapidly; Sx: blurred vision, headache, dyspnea, uremia; Unless interventions are begun quickly, patient may have CVA, heart failure or renal failure; This is a medical emergency |
| Hypertension Intervention | Decrease risk factors: diet, exercise; Low sodium diet |
| BP Medications Loop diuretics- | furosemide (lasix) PO or IV, ethacrynic acid (edecrin) |
| BP Medications Thiazides- | HCTZ (Diuril, Hydrodiuril) PO |
| BP Medications Potassium sparing Diuretics - | Spironolactone (aldactone) , Triamterone (dyrenium) |
| BP Medications Vasodilators | relaxes smooth muscle and reduced to peripheral resistancde; nitroglycerin, minoxidil, doxanzosin, , terazosin, nitroprusside |
| BP Medications Beta-Blockers | Block adrenergic impulses (blocks sympathetic system) in the heart and peripheral vessels; Lower heart rate and contractility: Propranolol, Atenolol, Nadolol & Metoprolol. (bradycardia, hypotension) |
| BP Medications Calcium Channel Blockers | Interfere with the movement of calcium ions; Results in reduced vasoconstriction; Nifedipine, Verapamil, Diltiazem (side effects bradycardia, hypotension) |
| BP Medications ACE- Inhibitors | Inhibits the action of the angiotensin-converting enzyme; ACE is a strong vasoconstrictor; Postural hypotension is common; Captopril, Enalapril and Lisinopril |
| BP Medications Central Alpha Agonists | Prevent reuptake of norepinephrine in the central nervous system; Lower peripheral vascular resistance: Clonidine, Methyldopa |
| Angiotension II receptor blockers | inhibit vasoconstriction by inhibiting the binding of angiotension II; it will protect against renal failure in patients with DM II; does not cause cough; examples: losartan (cozaar), olmesartan (Benicar), & candesartan (Atacand) |
| Sympathetic Nervous system | Stress response; flight or fight; Adrenergic |
| Parasympathetic | homeostatsis, rest and digest, Cholinergic |
| Assessment of hypertensive crisis | severe headache; extremely high BP; dizziness, blurred vision; disoriented; -----Intervention- semi fowlers; O2; IV nitroprusside or other antihypertensive, monitor BP q 5min. Monitor for symptoms of CVA, seizures, dysrhythmias or chest pain. |
| Coronary Artery Disease (Leading cause of death in the USA) | Narrowing or occlusion of the vessels feeding the heart muscle; Ischemia occurs when insufficient oxygen is available, symptom angina; Infarction occurs when heart muscle begins to die from anoxia, 30% sometimes first symptom is lethal arrhythmia |
| Risk Factors for CAD | Age; Heredity; Gender; Smoking; Obesity; Sedentary; Stress; Dietary habits; Diabetes; Hypertension; Hyperlipidemia; Acute Coronary Syndromes; Stable Angina; Unstable Angina; Non-Q wave MI; Q-wave MI; |
| Diagnostics & Interventions | Chest Pain (OPQRST); 12-lead EKG; Cardiac markers - CK, CK-MB, ;troponin, isoenzymes; Cardiac Catheterization; Physical assessment; Intervention- MONA (morphine, oxygen, nitroglycerine, aspirin) |
| OPQRST | Onset; Provokes, Quality, Radiate, severity, time started (how long) |
| Diagnostics for Cardiac Function | EKG; Chest x-ray; Electrolytes, CBC, UA, ABG, BNP; Echocardiogram; Thalium or T-phos scans; MUGA - gives ejection fraction; Pulmonary Wedge Pressure |
| Stable Angina Pectoris | Temporary lack of oxygen; Causes pain with exertion; Usually associated with stable atherosclerotic plaque |
| Diagnostics for Cardiac Function | EKG; Chest x-ray, Electrolytes, CBC, UA, ABG, BNP, Echocardiogram, Thalium or T-phos scans (areas of damage); MUGA - gives ejection fraction; Pulmonary Wedge Pressure |
| Stable Angina Pectoris | Temporary lack of oxygen; Causes pain with exertion; Usually associated with stable atherosclerotic plaque |
| Unstable Angina | One of the Acute Coronary Syndromes; Occurs with rest or minimal exertion; Increase in intensity, duration and frequency. Plaque rupture, thrombus formation |
| Myocardial Infarction | Myocardial tissue is deprived of oxygen (reprefuse heart); Occlusion of blood ; flow to area of the heart; Process of infarction occurs; Time is muscle |
| Blockage of the Left Anterior Descending | Perfuses the anterior wall and most of the septal wall of the left ventricle; 25% of all MIs and highest mortality rate; Left ventricular heart failure, ventricular arrhythmias; Highest incidence of lethal arrhythmias and sudden death |
| Blockage of the Circumflex | Supplies blood to the lateral wall of the left ventricle and portions of the posterior wall; Posterior wall MI 2%; Lateral wall MI 3%; Sinus arrhythmias. |
| Obstruction of the Right Coronary Artery | Perfuses the SA and AV nodes, the inferior and diaphragmatic portion of the left ventricle. Inferior MI 17% of all MIs, 10% mortality rate; Bradydysrhythmias, heart block, right ventricular failure, nausea |
| Symptoms of Angina | Substernal chest discomfort, Can radiate to the left arm; Precipitated by exertion or stress, Relieved by NTG or rest, Lasting < 15 minutes (stable angina), Few associated symptoms |
| Diagnostics for Angina | 12-lead EKG; Cardiac Stress Test, Echocardiogram, Transesophageal Echocardiogram (TEE), Tissue damage releases some intracellular enzymes. |
| Cardiac Catheterization | Done to determine where the obstruction is in emergent situations; Done to look at the coronary arteries to determine need for bypass |
| Stents | Placed during heart cath, Mesh that opens the vessel |
| Balloon Angioplasty | Balloon is placed in the area of narrowing during cardiac cath. Inflated and pushes the plaque against the vessel wall; Opens the vessel |
| Risks of Cardiac Catheterization | Acute myocardial infarction; Stroke; Arterial bleeding; Thromboembolus; Lethal dysrhythmias; Death |
| Manifestations of Successful Reperfusion of Heart Muscle | Cessation of chest pain, Onset of ventricular arrhythmias, Resolution of ST depression, A peak of 12 hours for cardiac markers. |
| Normal Cardiac Cycle | All the components that make up one heartbeat; When working correctly, the heart rhythm is regular and beats 60-100 times per minute |
| Approach to EKG Interpretation | How is the patient? Is it regular? Is it fast or slow? Are there P-waves? Is there a P-wave for every QRS? Measure the PR interval; Measure the QRS; Measure the QT interval |
| Bradycardia | A pulse rate of less than 60 bpm; How is the patient tolerating the rhythm? Are there medications causing the rhythm? Is there an underlying medical condition causing the rhythm? |
| Sinus Bradycardia | Heart rate less than 60 beats per minute; May or may not be symptomatic; Treat for symptoms and treat only if symptomatic; Treat underlying cause; are they on meds that would cause this. Better tolerated than tachycardia. |
| Hemodynamics of Bradycardia | Myocardial oxygen demand is reduced; Coronary perfusion time is adequate because of prolonged diastole; If the rate is too slow, cardiac output and blood pressure may drop and this will decrease coronary perfusion causing symptoms |
| Causes of Bradycardia | Athlete’s normal rate; Excessive vagal stimulation; Hypoxia; Inferior MI; Beta-adrenergic blockers; Calcium channel blockers; Digitalis. |
| Sinus family | you must have a P wave to be in the sinus rhythm family |
| Big square hear rate calculation method | count the number of big squares between r waves and divide number of squares by 300. (300 big squares per min) |
| Little square heart rate calculation method | count the little squares between r waves and divide the number of little square by 1500. (1500 little squares per min) |
| PR Interval | 0.12-0.20 corresponds with |
| QRS interval | 0.06-0.12 corresponds with |
| Symptoms of bradycardia | Dizziness, syncope, Weakness, Confusion, hypotension, Dyspnea, Ventricular ectopy (irritable heart with extra beats), angina, |
| Digoxion | slows heart contraction and increases strength of contraction |
| Interventions for bradycardia | Treat only if symptomatic; Atropine 0.5 mg – 1.0 mg IV push (anti cholergernic), end point is 0.04mg/kg, Treat hypotension with fluid replacement or vasopressors, Withhold medications that cause bradycardia; Pacemaker. |
| Tachycardia | Heart rate of >100, Dominant sympathetic stimulation, Normal response to increased oxygen, demand, Compensatory response to decreased cardiac output |
| Sinus Tachycardia | Rate > 100 bpm, Regular rhythm, P-wave for every QRS, QRS complex is narrow and upright in Lead II |
| Hemodynamics of Tachycardia | Increased oxygen demand by the heart muscle; Decreased filling time with shorter diastole; Blood is moved through the lungs more rapidly to get oxygen out to the body quickly in stress situations; Can trigger angina pain in CAD |
| Interventions for Narrow Complex Tachycardias | Assess ABCs, Oxygen, Monitor, IV Access, Vagal maneuvers, Adenosine, 12-lead EKG, Cardioversion |
| Atrial Fibrillation/Flutter | Rapid firing of SA node in flutter; Disorganized firing of many atrial foci in fibrillation, Flutter is more difficult to convert, Fibrillation has more hemodynamic consequences, Treatment for both is aimed at controlling rate & re-establishing NSR |
| Atrial Flutter | SA rate is too rapid, Blocked by AV node, Sx related to ventricular rate, Synchronized cardioversion is the treatment of choice, Drugs: Digoxin, Ca Channel Blockers, Ibutalide, Characteristic saw-tooth pattern, atria blocks extra R waves from firing. |
| Atrial fibrillation | Disorganized impulses from multiple atrial foci, No atrial contractions, atrial kick is lost (30% of blood is lost), Irregular ventricular response, Favors formation of thrombi, |
| Symptoms of Atrial Fibrillation | Usually dependent on ventricular rate, irregular pulse, Monitor shows an irregular-irregularity, No discernible P-waves, QRS complexes are narrow, |
| Cause of Atria Fibrillation | (Co-morbidities with AF) AMI, Mitral stenosis, Atrial-septal defect, CHF, Cardiomyopathy, Post-surgery CABG, Hyperthyroidism, Pulmonary emboli, WPW syndrome, Congenital heart disease, Chronic obstructive pericarditis |
| Atrial Fibrillation drugs | Drugs: Heparin or Enoxaprin, Dofetilide, Ca Channel blockers, Digoxin, Quinidine, Cardioversion, Ablation |
| Atrial Fibrillation/Flutter | Rapid firing of SA node in flutter; Disorganized firing of many atrial foci in fibrillation, Flutter is more difficult to convert, Fibrillation has more hemodynamic consequences, Treatment for both is aimed at controlling rate & re-establishing NSR |
| Atrial Flutter | SA rate is too rapid, Blocked by AV node, Sx related to ventricular rate, Synchronized cardioversion is the treatment of choice, Drugs: Digoxin, Ca Channel Blockers, Ibutalide, Characteristic saw-tooth pattern, atria blocks extra R waves from firing. |
| Atrial fibrillation | Disorganized impulses from multiple atrial foci, No atrial contractions, atrial kick is lost (30% of blood is lost), Irregular ventricular response, Favors formation of thrombi, |
| Symptoms of Atrial Fibrillation | Usually dependent on ventricular rate, irregular pulse, Monitor shows an irregular-irregularity, No discernible P-waves, QRS complexes are narrow, |
| Cause of Atria Fibrillation | (Co-morbidities with AF) AMI, Mitral stenosis, Atrial-septal defect, CHF, Cardiomyopathy, Post-surgery CABG, Hyperthyroidism, Pulmonary emboli, WPW syndrome, Congenital heart disease, Chronic obstructive pericarditis |
| Atrial Fibrillation drugs | Drugs: Heparin or Enoxaprin, Dofetilide, Ca Channel blockers, Digoxin, Quinidine, Cardioversion, Ablation |
| Heart Failure | Failure to pump blood through the body (pump failure); insufficient perfusion of body tissues & organs; 75% caused HTN; Healthcare costs $24.3 billion |
| Left Heart Failure | Most heart failure starts as left HF; Also called left-sided heart vent. failure or congestive heart failure (acute or chronic); May be d/t systolic or diastolic failure |
| Left-sided Systolic Failure | unable to contract to eject adequate blood; Preload increases w/ decreased contractility; afterload increases w/ increased peripheral resistance; ejection fraction decreases, tissue perfusion is decreased; blood accumulates in pulmonary vessels. |
| Ejection fraction | normally 60-80% in HF reduced to 40% |
| LT sided HF described as: | Big boggy heart |
| LVH | left ventricular hypertrophy |
| Ejection fraction and CO related to left diastolic HF | in heart failure ejection fraction remains the nearly same, but the volume has been decreased. This is a result of hypertrophy. |
| Left-sided Diastolic Heart Failure | Stiffening or hypertrophy of the Lt. vent.; Less compliance, unable to fill adequately; CO decreased but ejection fraction may be near normal. |
| symptoms of Left Heart Failure | Decreased CO & Pulmonary Congestion; Fatigue, Oliguria during day, Confused, Dizziness, Tachycardia, Weak peripheral pulses, Pallor; Cool extremities; Angina; cough worse at night; Dyspnea; Crackles, wheezes; Frothy pink-tinged sputum; Tachypnea; S3, S4 |
| Cor pulmonary | hypertension in the pulmonary system causes a back up and can result in RT side HF. |
| Right Heart Failure | Can be caused by Lt HF, RT vent. MI or pulmonary HTN(cor pulmonale); RT. side is unable to empty adequately; Increased vol. & pressure develop systemically; Systemic venous congestion with peripheral edema |
| Symptoms of Right Sided Heart Failure | JVD; Enlarged liver & spleen; Anorexia, nausea Dependent edema; Distended abdomen; Polyuria at night; Weight gain; Increased bp from excess volume; OR decreased bp from HF. Systemic congestion |
| Signs & Symptoms of Right Heart Failure | Systemic congestion; Retention of fluid; JVD, Increased abdominal girth; Edema is an unreliable sign of heart failure & Weight is the best indicator, Anorexia & nausea |
| Compensatory Mechanisms in HF consume more | Oxygen |
| Compensatory Mechanisms of heart failure: Sympathetic nervous system | - increases heart rate, vasoconstriction |
| Compensatory Mechanisms of heart failure: Renin-angiotensin system | - reduced blood flow to the kidneys activates the RAS. Increases preload & afterload |
| Compensatory Mechanisms of heart failure: Neurohumoral responses | - immune inflammatory response, BNP, ADH & endothelin |
| Compensatory Mechanisms of heart failure: Myocardial hypertrophy | - thickening of the walls of the heart to provide more muscle mass. The final compensatory mechanism |
| The body compensates for heart failure by: | Tachycardia: to increase output; Enlarging: to pump more blood; Developing more muscle mass (hypertrophy): to pump more strongly |
| Heart failure Diagnostics | Chest x-ray; Electrolytes, CBC, UA, ABG, BNP; Echocardiogram; Thalium or T-phos scans; MUGA - gives ejection fraction; Pulmonary Wedge Pressure |
| Low ejection fraction= | low cardiac output/ |
| CHF Meds and interventions | ACE-Inhibitors; Diuretics; Nitrates; Cardiac Glycosides; Beta Blockers; Low sodium diet; Fluid restriction, energy conservation |
| Surgical Interventions in Heart Failure | Ventricular assist devices; Reshaping the heart; Heart reduction; Acorn cardiac support device; Myosplint |
| Ventricular Assist Device | Surgically implanted device Does the work of the Lt. vent.; Used in cardiogenic shock, cardiomyopathy & for patients waiting for heart transplant |
| Intra-aortic Balloon Pump | Balloon inserted via the femoral artery into the descending aorta; Inflates during diastole to increase coronary artery perfusion pressure; Deflates before systole to reduce cardiac workload |
| Indications of worsening condition: | Rapid weight gain, over 2 lbs overnight; Decreased exercise tolerance; Cough lasting more than 3 to 5 days; Excessive waking at night to urinate;Dyspnea or angina at rest; Swelling of feet, ankles or hands |
| Patient Education for CHF | Medications: name, dose & schedule; Low salt diet; indications of worsening condition; Advanced directives |
| Staging of Heart Failure | Stage A: at risk/ no structural changes/ symptoms; Stage B: structural changes/ no symptoms; Stage C: structural changes & current or history of HF; Stage D: end stage disease, ongoing chronic support & treatment |
| Killip Classification of Heart Failure | I – Absent crackles & S3; II – Crackles in lower half of lung fields & possible S3; III – Crackles more than halfway up the lung fields & frequent pulmonary edema; IV – Cardiogenic shock |
| Valvular Heart Disease | Heart valves do not fully open or close; Usually valves of the left heart; Tricuspid valve damage usually following endocarditis; Rarely pulmonic valve; Mitral (Bicuspid) - Stenosis, Regurgitation, Prolapse; Aortic - Stenosis, Regurgitation |
| Mitral Stenosis | Rheumatic fever most common cause; Valves thicken, become fibrotic, calcified; Pulmonary congestion and right heart failure |
| Symptoms of Mitral Stenosis | Fatigue; Dyspnea on exertion; Paroxysmal nocturnal; dyspena; Hemoptysis; Hepatomegaly; Jugular vein distention; Pitting edema; Atrial fibrillation; Rumbling, apical diastolic murmur |
| Mitral Regurgitation | Changes in the leaflets cause incomplete closure of the valve.; Backflow from the left ventricle into atrium; Symptoms begin when left ventricle fails. both atrium & vent. hypertrophy |
| Symptoms of Mitral Insufficiency | Fatigue; Dyspnea on exertion; Orthopnea; Palpitations; A- fib; JVD; Pitting edema; High-pitched holosystolic murmur |
| Mitral Prolapse | leaflets enlarge & prolapse into the Lt. atrium during systole; May be asymptomatic; May progress to mitral regurgitation |
| Symptoms of Mitral Valve Prolapse | Atypical chest pain; Dizziness, syncope; Palpitations; Atrial tachycardia; Ventricular tachycardia; Systolic click, systolic murmur. |
| Aortic Stenosis | Valve orifice narrows; Obstructs Lt. ventricular outflow during systole; Increased resistance or afterload; Hypertrophy of Lt. ventricle. won't respond to increased demand. systolic murmur |
| Symptoms of Aortic Stenosis | Dyspnea on exertion; Angina; Syncope on exertion; Fatigue; Orthopnea; Paroxysmal nocturnal dyspena; Harsh, systolic crescendo-decrescendo murmur |
| Aortic Regurgitation | Leaflets do not close properly during diastole; The valve ring may be dilated; Left ventricular failure. Hypertrophy will result |
| Symptoms of Aortic Insufficiency | Palpitations; Dyspnea; Orthopnea; Paroxysmal; nocturnal dyspena; Fatigue; Angina; Sinus tachycardia; Blowing decrescendo diastolic murmur |
| Medications and Interventions | Reduce preload or afterload with medications; Coumadin for a-fib; Rest, energy conservation; Surgical replacement or dilation Education for medications, disease process, prophylactic antibiotics |
| Reparative procedures | Balloon valvuloplasty; Commissurotomy; Annuloplasty |
| valve Replacement procedures | Xenograft; Synthetic; Pulmonary autograft |
| orthopnea | difficulty breathing while lying down. |
| pulse pressure | difference between systolic and diastolic. A narrow pulse pressure can be an indicator of CHF due to increased congestion and pressure in the heart |
| aortic valve problems | congenital,men are more at risk than women, marfan's syndrome, |
| Pericarditis | Inflammation of the pericardium; Acute pericarditis may be fibrous, serous, hemorrhagic, purulent or neoplastic; Postpericardiotomy syndrome (after surgery) |
| Symptoms of Pericarditis | Substernal, precordial pain radiating to the left neck, shoulder or back; Pericardial friction rub; Elevated WBCs; FEVER; Changes in T wave; A-fib |
| Interventions for Pericarditis | Non-steroidal anti-inflammatory drugs; Corticosteroids; hospitalization (acute); Bacterial pericarditis will need antibiotics and pericardial drainage; Complications include a-fib, cardiac tamponade, HF |
| Pericardial Tamponade | Complication of pericarditis; Pericardial space fills with fluid and restricts diastolic ventricular filling; Pericardiocentesis |
| Symptoms of Tamponade | JVD; Pulsus paradoxus – systolic BP> 10 mm Hg points higher on expiration than inspiration; decreased cardiac output; Muffled heart sounds; Circulatory collapse (heart stops) |
| Pulsus paradoxus | systolic BP> 10 mm Hg points higher on expiration than inspirationInfective Endocarditis |
| Symptoms of Infective Endocarditis | Fever w/ chills, night sweats, malaise & fatigue, new murmur, HF, systemic embolization, Petechiae, Splinter hemorrhages under finger nails, Osler’s nodes, Janeway’s lesions, Positive blood cultures |
| Treatment of ineffective endocarditis | Rest, activity followed by rest; Antibiotics IV for 6 weeks; May need surgical removal of infected valve and replacement |
| Rheumatic Endocarditis | after Rheumatic fever, URI w/ Group A beta-hemolytic streptococcus; Inflammation layers of heart; Forms small nodules on myocardium that turn to scar tissue; Hemorrhagic & fibrous lesions form on the leaflets of the valves, primarily the mitral & aortic |
| Symptoms of Rheumatic Endocarditis | Tachycardia; Cardiomegaly; New heart murmur or change in existing murmur; Pericardial friction rub; EKG changes; Heart failure; Evidence of existing streptococcal infection |
| Cardiomyopathy | Subacute or chronic enlargement of the heart muscle; Dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy; Treatment is usually palliative, death within 5 years |
| Dilated Cardiomyopathy | Most common type (87%); Damage to muscle fibers; Normal ventricle thickness but dilation of atria and ventricles; Impaired systolic function |
| Hypertrophic Cardiomyopathy | Asymmetrical vent. hypertrophy of Lt. vent.; Obstruction of the left ventricular outflow; Diastolic filling abnormalities; Congenital or hereditary genetic trait. Rigid ventricular walls. |
| Restrictive Cardiomyopathy | Rare form of cardiomyopathy; Endocardial and/or myocardial disease; Similar symptoms to restrictive pericarditis |
| Diagnostics and Interventions for cardiomyopathy | Echocardiogram; Radionuclide imaging (thalium scan); Cardiac cath; Meds; ICD (Implanted Cardiac Defibrillator);Surgical: Excision of hypertrophied septum, cardiomyoplasty, heart transplant |
| Medications for cardiomyopathy | Diuretics; Vasodilators; Cardiac glycosides; Beta adrenergic blockers; Calcium antagonists (Diltiazem) |
| Surgical Procedures for cardiomyopathy | Excision of hypertrophied septum; Cardiomyoplasty; Heart Transplant |
| Excision of Septum | For obstructive hypertrophied cardiomyopathy; Remove a portion of the septum to create a widened outflow tract |
| Diuretics treat | preload |
| Cardiomyoplasty | For dilated cardiomyopathy; Use back muscle, the latissimus dorsi; Helps the ventricles pump; Enhanced cardiac output |
| Heart Transplant Criteria: | Life expectancy less than 1 year; Under 65 years of age; Normal or slightly increased pulmonary vascular resistance; Absence of active infection; Stable psychosocial status; No evidence of drug/ alcohol abuse |
| the heart is located... | anterior to and between the lungs and mediastinum. |
| The apex is above... | the diaphragm tilted slightly left of midline |
| Pericardial membranes... | *fibrous *parietal *visceral pericardium fibrous pericardium outer layer |
| Parietal pericadium | serous lining the fibrous pericardium |
| Visceral pericardium | aka epicaridium, on surface of heart muscle. |
| walls of the heart is made up of... | myocardium |
| starlings law-- | the more the cells stretch, the harder they contract. |
| CHAMBERS of the heart are lined with... | endocardium |
| How many chambers in the heart? | 4--> Lt and Rt Atrium and Lt and Rt ventricles |
| Right Atrium and Ventricle... | Both Superior and Inferior Vena Cava empty into the Rt Atrium. |
| Left Atrium and Ventricle... | Oxygenated blood returns back from the lungs by the 4 pulmonary veins and dump into left atrium---> mitral valve--->left ventricle--> aortic valve---> aorta---> out to body |
| Coronary Vessels | *supply oxygen to myocardium itself *Rt and Lt come off the ASENDING AORTA. *Blockage of coronary artery causes ischemia or infarction. |
| Cardiac Cycles | *sequence of events in one heartbeat ---> the simultaneous contraction of atria, followed a fraction of a fraction of second later by the simultaneous contraction of the ventricles. |
| The mitral and tricuspid valves are anchored with... | chorde tendinae and papillary muscles---> if weak, creates mitral/tricuspid prolapse. |
| Blood flows passively from the superior/inf. vena cava into... | the atria |
| First Heart Sound S1 | *Loudest *Ventricular Systole closing tricuspid and mitral valves. |
| Second Heart Sound S2 | *Closing of Aortic and Pulmonary semilunar valves. |
| Valves not closing properly causes... | heart murmurs |
| Mechanical function of the heart is regulated by... | electrical activity. |
| The natural pacemaker is the... | sinoatrial Node (SA)node---> located in wall of Rt. Atrium |
| Impulses from the SA node travel to... | Atrioventricular Node (NA) node---> down the Bundle of His----> Purkinje Fibers the bundle of his can also act as a... pacemaker |
| Non invasive Cardiac Assessment... | *Pulses *BP in both arms *Edema in LE *Pain *EKG*Heart Sounds *Breath Sounds. |
| Cardiac Cycle | the beginning of one heartbeat to the beginning of the next. |
| At the beginning of systole, the ventricles... | contract forces AV valves to close(S1 sound) and the semilunar valves to open. |
| At the end of systole/beginning of distole, the semilunar valves... | close(S2 sound), and the AV valves (tricuspid and mitral valves) open. |
| Volume of blood ejected from the heart each minute... | 4-7 L stroke volume |
| the amount of blood ejected from the left ventricle during each systole--- | this is influenced by HR, contractility, preload & afterload. |
| Cardiac Output= | stroke volume x HR |
| Contractility | the inherent ability of the myocardium to stretch and contract normally. |
| The more stretch during diastole (rest), the... | greater systolic contraction (Starling's Law)----->the more volume in the ventricles, the greater the stretch. |
| Preload | the degree of myocardial muscle fiber stretch at End of Diastole. |
| Preload is determined by... | the left ventricular end-diastolic volume. |
| Excessive filling of the ventricles results in... | excessive LVED (left ventricular end diastole) and decreased cardiac output. |
| Afterload | the pressure the left ventricle must overcome to get blood out of the heart---> created by high BP, athrosclerosis, ect. |
| The higher the pressure in the aorta, the.... | more force the ventricles must use to eject the blood. Afterload |
| Resistance is... | the pressure the heart must work against to get the blood out. |
| How to reduce Arterial Resistance... | Angiotensin ACE Inhibitors---->works on the kidneys---->common Side Affects: *hypotension *dry cough |
| When gathering Cardiac Hx from a pt, you must include... | *Health Hx *Risk Factors *Hereditary Factors *Medications |
| APTM ( All Puppies Tear Meat)= | Aortic Pulmonary Tricuspid Mitral |
| Murmer | when the valve either does not close or resists opening.--->causes turbulance--->this shows mitral regurgitation on top and aortic stenosis on the bottom.---> occurs with every heartbeat. |
| Gallop Ventricular (S3) *sloshing in... | *decreased compliance *sign of early heart failure or ventral septal defect |
| Gallop Atrial (S4) “a stiff wall” | *can get this normally as you get older *short sounding *HTN,Anemia, ventricular hypertrophy, MI, aortic or pulmonic stenosis, pulmonary emboli or loss of compliance with age. |
| Diagnostics to assess a Cardiac Situation.. | *12-lead EKG *Serum Markers, other blood tests like clotting times or electrolytes *Stress Test(treadmill or drugs) *Chest X Ray(tells size of Hrt) *Angiography *Cardiac Catherization |
| Electrical Conduction... | The myocardium responds to electrical impulses of special cells---> electrodes pick up these electrical impulses on an EKG aka electrocardiogram. |
| The sinoatrial node (SA) is the... | *primary pacemaker of the heart *located near opening of vena cava in Rt Atrium *Initiates atrial depolarization *Rate is 60-100 bpm. |
| The atrioventricular node (AV) is... | *located on floor of Rt Atrium *delays conduction .05 seconds to allow ventricular filling *takes over as primary pacemaker if SA fails *Rate 40-60 bpm |
| The bundle of his... | *aka superventricular *Right and Lt branches to Rt and Lt ventricles *intrinsic rate 40-60 bpm *can take over is SA fails. |
| Purkinje Fibers... | *Web of fibers going deep into myocardium *cause ventricular depolarization *can beat at 20-40 bpm if all else fails. *is symptomatic |
| P wave | *represents atrial depolarization * *.12-.20 mil sec is norm *smooth, rounded, upright in leads I, II, |
| PR interval... | *is atrial depolarization and atrial repolarization |
| QRS Complex... | *Ventricular Depolarization (closing of AV valves--> S1 sounds)---> the impulse down the Bundle of His to the Purkinje System |
| T wave... | *Ventricular Repolarization (S2 sounds) *Follows same deflection as P wave |
| Abnormal T wave... | *Peaked in Hyperkalemia, with a prolonged QRS and PR interval *Low and rounded in hypokalemia with ST depression and U wave |
| ST segment... | *EARLY ventricular repolarization *from J point to beginning of T wave *length changes with HR |
| Abnormal ST segments | *cardiac ischemia pattern. *myocardial infarction pattern |
| A normal cardiac cycle is... | all the components that make up one heartbeat---> when working correctly, the heart rhythm is regular and beats 60-100 bpm. |
| Risk factors that cannot be altered for cardiac issues... | *Age *Heredity * Gender |
| Risk Factors that can be controlled... | *Smoking *Obesity *Sedentary *Stress *Dietary habits *Diabetes (uncontrolled) *Hypertension (uncontrolled) *Hyperlipidemia (uncontrolled) |
| Smoking is a major risk factor in... | *CAD *PVD----> d/t tar, nicotine and carbon monoxide |
| How to calculate pack usage... | 4 cigarettes/day= 2X the risk 20 cigarettes/day= 4X the risk |
| Obesity contributes to... | *diabetes *hyperlipidemia *hypertension----> it is linked to sedentary lifestyle and poor diet. |
| 30 minutes a day of regular excercise is recommended to promote... | caridovascular fitness |
| Dietary Habits... | *too much of a good thing *Hi Fat *Hi Na+ *Big Proteins *Low Fiber |
| Poor disease control can lead to cardiac issues in these... | *Diabetes *Hypertension *Hyperlipidemia |
| Hypertension | poorly controlled hypertension causes increased strain on heart and blood vessels |
| Hyperlipidemia | promotes the formation of plaque on the vessels and leads to atherosclerosis |
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wvc
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