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wvc cardiac lecture

QuestionAnswer
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
Created by: wvc