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73 Cards in this Set
- Front
- Back
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What are the 2 types of nodes in the heart and what do they do?
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-> SA node (Sinoatrial)
primary pacemaker of the heart, intrinsic firing rate of 60-100 beats per minute, internodal pathways in atria conduct pulses -> AV nodes (Atrioventricular) back up pacemaker for SA nodes, intrinsic firing rate of 40-60 beats per minute, pathway for conducting impulses to ventricles, delays impulses to allow for emptying of atria-atrial kick |
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What are the electrophysiologic properties of cardiac cells that causes them to contract?
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-electrical impulse initiated
- Na moves into the cell and K moves out -negatively charged charged cell now positively charged or depolarized -Ca moves in causing myofibrils to contract -Cell returns to resting electrical state or repolarizes |
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What are the 2 phases of the heart?
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-systole
contraction of the myocardium -diastole relaxation of the myocardium |
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What is cardiac output?
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-the volume of blood ejected per minute
-CO= stroke volume X heart rate -averages between 4-8 L per minute |
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Stroke volume is determined by what 3 factors?
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-preload
-afterload -contractility |
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What is preload?
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-degree of stretch of myocardial fibers
-determined by the volume of blood in the LV (left ventricle) at thte end of diastole -compliance of cardiac cells also affects preload |
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What are the factors that will increase preload?
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- IV fluid
-blood -vasoconstriction |
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What are the factors that will decrease preload?
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-diuretics
-dehydration -hemorrhage -vasodilation |
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Does increased volume increase or decrease preload?
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Increases preload which increases cardiac output
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Does decreased volume increase or decrease preload?
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Decreases preload which decreases cardiac output
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What is afterload?
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-resistance or pressure the ventricles must overcome to pump blood out
-Left ventricle affeted by Systematic vascular resistance (SVR) -Right ventricle affectged by pulmonary vascular resistance (PVR) -related to arterial pressure or diameter of arteries |
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T or F
As pressure increases, resistance increases, afterload increases. |
True
Just as pressure decreases, resistance decreases, afterload decreases |
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What is contractility?
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-Force generated by the myocardium when it contracts
-inotropic property |
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What is the ejection fraction?
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-percentage of LV end diastolic volume that is ejected with each contraction
-normally approximately 50-55% |
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How does the autonomic nervous system regulate the cardiovascular system?
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-heart rate
-contractility -conduction velocity at AV node -Afterload->vascular resistance->arterial vasoconstriction and dilation -Preload->venous constriction and dilation |
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Where does the heart lie in the chest?
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Middle left of your chest
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What arteries supply blood to the heart?
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Right Coronary Artery
(RCA) |
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What causes true angina?
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Not enough oxygen to the heart muscle
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What is the cycle blood goes through when being pumped by the heart? Start with deoxygenated blood
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-Superior & Inferior vena cava
-Right atrium -Tricuspid valve -Right ventricle -pulmonic valve -pulmonary artery -lungs -Left atrium -Mitral valve -Left ventricle -Aortic valve -Aorta -Sytematic circulation |
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What is the average beats per minute of the heart and how does it usually move blood?
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- 60-100 bpm
-ventricular force |
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T or F
Proper fluid and electrolyte balance has no effect on your heart. |
False
It's very important because if its off it affects contraction |
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What are the 3 layers of the heart?
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-epicardium
-myocardium -endocardium |
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If the patients heart rate is around 40 which node has kicked in?
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AV node
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What are the components of the cardiac conduction system?
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-SA node
-Intra-artrial tracts -AV junction -Bundle of his -R & L Bundle branches - Purkinje fibers *normal electrical impulse intiated in SA node which is the hearts intrinsic pacemaker |
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How do you measure systole and diastole?
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Taking a blood pressure
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When asking questions about the subjective data concerning cardiac assessment what are important key points?
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-past health history
-past and current medications -surgery and other treatments |
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What is a four chambered hollow muscular organ normal the size of a fist?
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Heart
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Where is the heart located?
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It lies within the thorax in the mediastinal space that seperates the L & R pleural cavities
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How many valves does the heart have?
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Four
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T or F The Heart has its on supply of blood.
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True, it's called coronary circulation
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What are the cues you are looking for in cardiac assessment when using subjective data?
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A careful health history should be obtained, and the signs or complaints a patient might include are: fatigue, fluid retention, irregular heartbeat, dyspnea, pain, tenderness in calf or leg, syncope or near syncope, altered neurological function, leg pain
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What are the cues you are looking for in cardiac assessment when using objective data?
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Obtain vital signs, and look for: distended neck veins, central or peripheral cyanosis, splinter hemorrhages, clubbing, color changes in extremities with postural changes, ulcers, varicose veins, palpation of pulse (bounding, thready, irregular or absent), unusually war or cold extremities, regular or pitting edema, positive Holman's sign, abnormal cap. refill, pulse deficit, arterial bruit, S3 and S4 sound, cardiac murmurs, pericardial friction rub
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What are the common signs and symptoms of Cardiovascular Disease?
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Chest discomfort or pain, palpitations, syncope, fatigue, dyspnea, cough resulting in hemopytosis, weight gain, edema, nocturia
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What is the PMI?
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It is the point of maximal impulse or the apical pulse
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Why is chest discomfort or pain important as a sign or symptom?
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One of the most important manifestations of cardiac ischemia, it's assumed to be related ischemia unless proven wrong if there is a history of CAD or risk factors, little correlation between severity of pain and gravity of situation
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When assessing and using palpations what are the causes of dysrhythmias or arrhythmias?
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Causes: stress, caffeine, drugs, myocardial ischemia, mitral valve disorder, electrolyte imbalances, ventricular aneurysm **make sure to ask about dizziness or fainting, and skipped beats, irregular, fluttering, or racing heart beats
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What are the common causes of syncope or changes in mentation?
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Stroke, hypovolemia, orthostatic hypertension, seizures, dysrhythmias, hypoglycemia
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What are the different causes of dyspnea and the different forms?
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Causes: associated with myocardial ischemia, primary symptom of of pulmonary congestion from liver failure, fever, anemia, pulmonary disorders, obesity Forms: extertional dyspnea (DOE), orthopnea, paroxysmal nocturnal dyspnea (PND)
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What are the causes of cough and hemopytosis?
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Heart failure, pulmonary edema, ACE inhibitors **make sure to ask about, frequency, quality and whether or not if streaks of blood, pink tinged or frank blood are present
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What are the causes of weight gain, dependent edema, and nocturia?
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as heart fails, fluid accumulates, with nocturia the kidneys inadequately perfused by weak heart and receive increased blood flow during the night which increases output **increase of 3 lbs. or more in 24 hrs or 5 lbs. in one week **inquire about weight gain, fitting of shoes, or tightening of clothes around waistband
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During the health history assessment what are some important things you should acquire about?
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inquire about diabetes, kidney disease, stroke, heart disease, hypertension, and also inquire about health of parents and siblings
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When assessing the clients general appearance what should you look at and consider?
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-Does the client lie quietly or is he restless,
-Can the client lie flat or must be upright -Do facial expressions reflect pain or distress -Are there signs of cyanosis or pallor and not level of consciousness (LOC) |
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What are the optimal, normal, and high ranges for blood pressure?
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Optimal - systolic <120 diastolic < 80
Normal- systolic <130 diastolic <85 High- systolic >140 diastolic >90 |
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When assessing the periperal vascular system what changes that should be noted?
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-skin color
-hair distribution -venous pattern -neck veins -distal pulses (posterior tibial and dorsalis pedis), -palpate arterial pulses -evaluate for edema |
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What are the common sites for palpating arteries?
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Carotid, brachial, radial, ulnar, femoral, popliteal, posterior tibial, dorsalis pedis
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When ausculating the heart how should you do it aand what are you looking for?
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When listening start at the base of the heart and use a Z pattern.
-Take note of: -rate and rhythm -identify S1 and S2 -then assess them seperately -listen for extra heart sounds -listen for murmurs |
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What are the gallop sounds and when are they heard?
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S3-Ventricular gallop heard in early diastole right after S2, normal in children and young adults, characteristic of liver failure
S4- Atrial gallop heard in late diastole right before S1, heard during atrial contraction as atria force blood into resistant ventricles, characterisc of HTN, heart failure, and pulmonary disease |
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How do you ausculate Aortic heart sounds?
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Listen with the diaphragm at the right 2nd intercostal space near the sternum
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How do you ausculate Pulmonic heart sounds?
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Listen with the diaphragm at the left 2nd intercostal space near the sternum
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How do you ausculate Tricuspid area sounds?
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Listen with the diaphragm at the 5th intercostal space neat the sternum
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How do you ausculate Mitral Area sounds?
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Listen with the diapragm at the apex PMI in mitral area
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How do you ausculate the apex of the heart?
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Listen with the bell at the apex
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What are two important positions to use when ausculating heart sounds?
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1. Leaning forward accentuates aortic and pulmonic sounds
2. Left lateral decubitus position accentuates sounds produced in the mitral area |
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What causes murmurs and how are they classified?
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Caused by turbent blood flow related to:
-narrowed or stenosed valve -incompetent or regurgitant valve -atrial or ventrical septic defect -increased metabolic states Classification- based on the timing cardiac whether its systolic or diastolic and the quality of murmur |
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What is a pericardial friction rub and where and when is it heard?
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Cause:
-produced by inflammation of pericardial sac heard during systole and diastole -best heard with diaphragm with client sitting up and leaning forward |
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What are the gerontolgical considerations with cardiac assessment?
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-poor chest wall expansion due to kyphosis
-myocardial hypertrophy due to decreased elasticity -aging also causes blood vessles to stiffen |
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What happens to the elderly regarding the blood pressure when blood vessels stiffen?
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Blood pressure increases due to the stiffening of the blood vessles and the left ventricular wall thickens
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What are some changes that occur with the elderly affecting the cardiac and circulatory systems?
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-chest wall->kyphosis
-heart->decreased elasticity which leads to myocardial hypertrophy -blood vessels stiffening causing BP to rise -decreased circulation -arrythmias more common -tachycardia -syncope |
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What are the noninvasive diagnostic studies of the cardiovascular system?
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-electrocardiogram
-echocardiogram -nuclear cardiology -magnetic resonance imaging -computed tomography |
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What are the noninvasive diagnostic studies of the cardiovascular system?
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-electrocardiogram
-echocardiogram -nuclear cardiology -magnetic resonance imaging -computed tomography |
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What are the invasive diagnostic studies of the cardiovascular system?
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-intracoronary ultrasound
-electrophysiology study |
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What are the invasive diagnostic studies of the cardiovascular system?
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-intracoronary ultrasound
-electrophysiology study |
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What is and electrocardiogram?
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-ECG or EKG
-records electrical activity of the heart -determines if heart attack has occured -monitors changes in heart rhythm |
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What is and electrocardiogram?
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-ECG or EKG
-records electrical activity of the heart -determines if heart attack has occured -monitors changes in heart rhythm |
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What is cardiac catheterization?
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-uses special x rays to examine the inside of your hearts vessels
-most accurate |
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What is cardiac catheterization?
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-uses special x rays to examine the inside of your hearts vessels
-most accurate |
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What are the cues to cardiovascular problems?
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-fatigue-> mot common
-irregular heart beat -dyspnea -leg pain or cramps -edema -tenderness in calf or leg -dizzy or light-headed -cyanosis or pallor |
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What are the cues to cardiovascular problems?
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-fatigue-> mot common
-irregular heart beat -dyspnea -leg pain or cramps -edema -tenderness in calf or leg -dizzy or light-headed -cyanosis or pallor |
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What are the noninvasive diagnostic studies of the cardiovascular system?
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-electrocardiogram
-echocardiogram -nuclear cardiology -magnetic resonance imaging -computed tomography |
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What are the invasive diagnostic studies of the cardiovascular system?
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-intracoronary ultrasound
-electrophysiology study |
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What is and electrocardiogram?
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-ECG or EKG
-records electrical activity of the heart -determines if heart attack has occured -monitors changes in heart rhythm |
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What is cardiac catheterization?
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-uses special x rays to examine the inside of your hearts vessels
-most accurate |
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What are the cues to cardiovascular problems?
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-fatigue-> mot common
-irregular heart beat -dyspnea -leg pain or cramps -edema -tenderness in calf or leg -dizzy or light-headed -cyanosis or pallor |
