CV System Function, Assessment and Therapeutic Measures
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| Where is the heart located? | The mediastinum
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| What surrounds the heart? | The pericardium
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| What are the layers of the pericardium? | Fibrous Pericardium, Parietal Pericardium and Viseral Pericardium (Epicardium)
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| Serous fluid in the pericardium does what? | Prevents friction as the heart beats
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| The chambers in the heart are made of...? | Myocardium (Heart muscle)
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| The chambers are lined with...? | Endocardium (Smooth epithelial tissue)
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| 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
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| What anchors the AV valves? | Chordae Tendinae
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| Which ventricle works harder? | The left ventricle
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| Where is the SA node located? | In the wall of the right atrium
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| What is "the pacemaker"? | SA Node
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| Where is the AV node located? | Bottom of the right atrium
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| What is the cardiac conduction pathway? | SA node, AV node, Bundle of His, Bundle Branches, Purkinje Fibers
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| The AV node initiates a HR of...? | 40-60 beats per minute
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| What occurs during systole? | Contraction of the ventricles
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| What occurs during diastole? | Relaxation of the ventricles
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| What causes lubb? | Closure of AV valves
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| What causes dupp? | Closure of semilunar valves
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| What is cardiac output? | Blood ejected from the left ventricle in one minute
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| How is cardiac output determined? | SV x HR
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| What is stroke volume? | The amount of blood ejected per beat (~60-80mL)
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| What's the average cardiac output? | 5-6L
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| What is ejection fraction? | SV/Total blood in the ventricle (normally ~60%)
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| What does sympathetic nerve impulses do? | Increase rate and force of contraction by releasing norepinephrine
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| What does parasympathetic nerve impulses do? | Decrease HR by releasing acetycholine
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| Where are baroreceptors and what do they do? | In the carotid and aortic bodies. They detect changes in BP
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| Where are chemoreceptors and what do they do? | In the carotid and aortic bodies. They detect changes in oxygen content of the blood
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| What happens in response to decreased BP or blood oxygen? | The heart receives sympathetic impulses and beats faster
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| What does aldosterone do? | Regulates blood levels of Na+ and K+, both needed for the electrical activity of the myocardium
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| 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
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| What is the inner lining of arteries? | Endothelium; simple squamous epithelium which is very smooth to prevent clotting
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| 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
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| How thick are capillary walls and why? | 1 cell thick to allow exchange of gases, nutrients and waste products between blood and tissue
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| Normal BP is high enough to _______ but low enough to _______. | Permit filtration for nourishment of tissues; prevent rupture
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| Venous return depends on...? | The skeletal muscle pumping to squeeze the deep veins of the legs
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| What is pulse pressure? | The difference between systolic and diastolic
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| 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)
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| What does angiotensin II cause? | Arteriole vasoconstriction and stimulates secretion of aldosterone to raise BP
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| What hormone increases reabsorption of Na+? | Aldosterone
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| 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
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| What is pulmonary arterial pressure? | 15-25/8-10 mm Hg
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| 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
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| Which organ does all blood from the body go? | The liver via the hepatic portal vein
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| When does aging of blood vessels begin? | Childhood
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| What is atherosclerosis? | Deposition of lipids in walls of arteries forming rough surfaces that may stimulate clot formation
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| What is the #1 killer in the U.S.? | Cardiovascular Disease
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| 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
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| 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
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| What are the causes of orthostatic hypotension? | Fluid volume deficit, diuretics, analgesics, pain and beta blockers
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| Quality of pulse is described as...? | 0 Absent; 1+ Weak, thready; 2+ normal; 3+ Bounding
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| What is a thirll? | The vibration felt when an abnormal vessel with a bulging or narrowed wall is palpated
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| What is a bruit? | Humming heard when auscultating as abnormal vessel caused by turbulent blood flow
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| What does sputum look like in acute heart failure? | Pink and frothy
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| Lung congestion resulting from heart failure may cause what? | Dry cough
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| What does reddish-brown (rubor) discoloration indicate? | Decreased arterial blood flow
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| What does pallor indicate? | Anemia or lack of arterial blood flow
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| Brown discoloration and cyanosis in extremities indicates...? | Venous blood flow problems
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| What is a sign of reduced arterial blood flow? | Decreased hair distribution, thick and brittle nails and shiny, taut, dry skin
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| What causes clubbing of the nails? | Oxygen deficiency
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| What are the 6 P's that characterize PVD? | Pain, Poikilothermia, Pulselessness, Pallor, Paralysis, Paresthesia
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| 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)
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| S3 is heard with what? | Left-sided heart failure, fluid volume overload and mitral valve regurgitation
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| S4 is heard with what? | HTN, coronary artery disease and pulmonary stenosis
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| When is S3 heard? | Early in diastole
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| When is S4 heard? | Late in diastole
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| What causes murmurs? | A narrowed valve opening or a valve that does not close tightly
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| What does pericardial friction rub sound like? | A grating sound like sandpaper being rubbed together
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| A pericardial friction rub may occur after what? | MI or chest trauma due to inflammation
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| In what position should a pt be to better ausculate heart sounds? | Leaning forward or lying on their left sides
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| An ECG is best to diagnose abnormalities related to what? | Dysrhythmias, MI or myocardial ischemia
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| 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
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| What type of test is an echocardiogram? | Sound waves (ultrasound)
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| What does an echocardiogram record? | Valvular abnormalities and vegetation CHF
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| What is a transesophageal echocardiogram? | A transducer on a probe placed in the esophagus. The images are clear.
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| How long must a pt be NPO before TEE? | 6 hours
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| What can pts not do before an exercise stress test? | Smoke, eat or drink for 2 to 3 hours before
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| What should pts avoid after an exercise stress test? | Drinking stimulants such as caffeine and temperature extremes
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| How is an exercise stress test performed? | The pt will walk on a treadmill while ECG and vitals are constantly assessed
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| What does a plethysmography test measure? | Blood volume and changes in blood flow to diagnose DVT, pulmonary embolism and screen pts for PVD
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| 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
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| What occurs during a doppler ultrasound? | Sound waves bounce off moving blood cells. Decreased blood flow causes reduced sounds.
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| What does doppler diagnose? | PVD
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| What do cold spots indicate on thallium imaging? | Ischemia or infarction
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| How is thallium imaging performed? | Thallium-201 is injected IV and muscle cells absorb it. After 10-15 minutes the heart is scanned.
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| What do hot spots indicate on thallium imaging? | Healthy myocardial cells with good blood flow
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| What do hot spots indicate on technetium-99m sestamibi? | Myocardial cell damage
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| What do hot spots indicate on technetium pyrophosphate scans? | Areas of ischemia or myocardial cell damage
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| 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
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| What is injected during a PET scan? | First nitrogen-13 ammonia then fluoro-18-dexyglucose
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| What does a PET scan show? | Perfusion and metabolic function/viability
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| What should be avoided before a PET scan? | Caffeine, tobacco and sugar (blood glucose should be in the normal range)
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| How long must a pt fast before a blood lipid test? | 12 hours
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| How long must a pt not drink alcohol before a blood lipid test? | 24 hours
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| High LDLs increase a pts risk for what? | Coronary artery disease
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| HDLs protect against what? Why? | Coronary artery disease; They carry cholesterol to the liver to be metabolized
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| Normal LDL levels | Less than 100
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| Normal HDL levels | More than 60
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| What are cardiac biomarkers? | CK-MB, Troponin I & T, Myoglobin
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| What biomarker elevates first? | Myoglobin (rises in 1 hour; peaks at 4-12 hours)
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| What biomarker elevates second? | CK-MB (Rises in 4-6 hours)
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| What biomarker elevates third? | Troponin I & T (rises in 4-6 hours; peaks at 10-24 hours)
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| Which biomarker is best to diagnose an MI? | Troponin I & T
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| Why is myoglobin not good to diagnose an MI? | It is found in all muscles. It is not cardiac specific
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| Troponin I & T normal levels | Varies by lab; very low
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| Myoglobin normal levels | 0-85 ng/mL
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| CK-MB normal levels | 0-7 international units/L
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| What can a low level of Mg cause? | Cardiac dysrhythmias, HTN and tachycardia
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| Normal Mg level | 1.3-2.1
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| What are angiographs used for? | Assess blood clot formation, PVD and test vessels for potential graphing use
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| 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
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| What's assessed in a pt after angiography? | Vitals, allergic reaction signs, hemorrhage at injection site and pulses
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| What is used to guide cardiac cath insertion? | Fluoroscopy (real-time imaging x-ray)
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| 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
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| How long is a cardiac cath procedure? | 2-3 hours
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| 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
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| What are therapeutic measures for the CV system? | Exercise, smoking cessation, healthy balanced diet, oxygen, meds and antiembolism devices
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| Which drugs should be stopped before surgery? | Aspirin, coumadin and heparin
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