Unit XI Circulation
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Cardiac Output | Amount of blood ejected from the heart each minute (CO = HR x SV)
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Systole | Contraction of the heart. When the heart ejects the blood into pulmonary and systemic circulation.
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Diastole | Relaxation of the heart. When the hearts ventricles fill with blood. This phase is twice as long.
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S1 (lub) | First sound. Beginning of ventricular systole; caused by closure of the atrioventricular valves (loudest at the apex of the heart)
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Atrioventricular valves | Tricuspid and mitral
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S2 (dub) | Second sound. Beginning of ventricular diastole; caused by closure of the semilunar valves (loudest at the base of the heart)
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Semilunar valves | Aortic and pulmonic
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Purpose of heart valves | Keep blood moving forward and prevent regurgitation.
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Arteries | Carry oxygenated blood away from the heart to the tissues.
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Pulmonary arteries | Carry oxygenated blood toward the heart from the lungs.
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Veins | Carry unoxygenated blood toward the heart from the tissues.
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Pulmonary veins | Carry unoxygenated blood away from the heart into the lungs.
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Stroke Volume | Amount of blood ejected from the heart with each beat (SV)
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Heart Rate | Number of beats in each minute (HR)
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Preload | Volume of blood in ventricles at the end of the diastolic period (end diastolic pressure)
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Afterload | Resistance the ventricles must overcome to circulate blood. Ventricles must generate sufficient pressure to overcome vascular resistance.
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Best way to listen for S3 and S4 | Have patient roll partially onto their left side.
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S3 | Occurs early is diastole right after the S2 sound. (S1, S2, S3) Best heard with patient laying on their left side and will usually disappear when they sit up. "lub-dub-ee". May indicate heart failure.
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S4 | "Ventricular gallop". Occurs near the very end of diastole just before the S1 sound (S4, S1, S2) sounds like "dee-lub-dub". Sign of hypertension.
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Heart failure | When the heart cannot pump enough blood to meet the metabolic needs of the body.
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Brain Natriuretic Peptide (BNP) | A hormone produced mainly by the left ventricle of the heart in response to increased ventricular volume pressure.
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Normal BNP | Below 100 pg/mL (100 - 300 pg/mL indicates heart failure)
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Left sided heart failure causes this | Pulmonary vessel congestion
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Right sided heart failure causes this | Systemic vessel problems such as: JVD, hepatosplenomegaly, right upper quadrant pain, edema, weight gain, anorexia, nausea.
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Types of treatments for heart failure | Treat underlying cause, beta blockers, nitrates, Digoxin, Ace Inhibitors, Oxygen, morphine.
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Signs and symptoms of Impaired Tissue Perfusion | 5 P's: Pulse, Pallor, Pain/Parethesia, Paralysis, Polar (cool extremities)
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Fully saturated hemoglobin requires this | All four heme groups are bound to oxygen.
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Sinus Arrhythmia | A normal variation in heart rate. Common in infants and young children, often increasing and decreasing with each breath.
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Atherosclerosis | Build up of fatty plaques within the arteries
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Primary contributor to Cardio Vascular Disease (CVD) and cause of impaired blood flow to organs and tissues? | Atherosclerosis
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Leading cause of death in North America | CVD
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Mean Arterial Pressure (MAP) | Maintains blood flow to the tissues throughout the cardiac cycle. Product of Cardiac Output x Peripheral Vascular Resistance. CO x PVR = MAP
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Peripheral Vascular Resistance (PVR) | Impedes or opposes blood flow to the tissues.
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Nonmodifiable Traditional Risk Factors of CVD | Heredity, Age, Gender
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Modifiable Traditional Risk Factors of CVD | Elevated serum lipid level, Hypertension, Cigarette smoking, Diabetes, Obesity, Sedentary lifestyle
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Myocardial infarction (MI) | Heart attack
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Cause of MI | Atherosclerosis or blood clot in vessels that supply blood to the heart, shutting of blood supply to a portion of the myocardium, resulting in necrotic tissue.
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Signs and symptoms of MI | They vary, but may include: Chest pain (substernal and/or radiating to the left arm, jaw), Nausea, Shortness of breath, Diaphoresis.
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Ischemia | Lack of blood supply due to obstructed circulation.
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Cause of myocardial ischemia | Partial obstruction of coronary arteries
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Complete obstruction of coronary artery causes this. | Results in MI (heart attach)
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Cause of Transient Ischemic Attach (TIA) | Partial obstruction of cerebral vessels
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Cause of a Stroke (Cerebralvascular Accident) | Complete obstruction of cerebral vessels
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Peripheral Vascular Disease leads to what? | Ischemia of distal tissues such as the legs and feet. Gangrene and amputation may result.
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Incompetent valves in veins | Allow blood to pool in veins, causing edema and decreasing venous return to the heart. Increases the risk for thrombi formation and PE
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Pulmonary Embolism (PE) | An embolism that gets trapped in small pulmonary vessels, occludes blood supply to the capillary membrane so no gas exchange occurs.
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Enzymes released in blood during an MI | Creatine kinase (CK) and troponin. Elevated levels of these can help differentiate the source of the pain.
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Risks associated with Venous Stasis | May allow clots to develop in deep vein, often in the thigh or calf (DVT). If the thrombus breaks free, it can become a PE.
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