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119 Cards in this Set
- Front
- Back
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What does the efficiency of the heart depend on?
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1. Ability of the heart to pump
2. How patent are the vessels 3. Quality of the blood 4. Quantity of the blood |
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Where does the myocardium get its O2 supply from?
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The coronary arteries,
Right coronary artery Left main coronary artery |
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What is the widow maker of the heart?
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A block in the Left Main Coronary artery because it cuts off blood to the Left ventricle
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When do the coronary arteries fill with blood?
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During Diastole
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What occurs during diastole?
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-The Coronary arteries fill
-The veins empty into the right atrium |
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What is the innermost layer of the heart called?
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The endocardium
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What layer of the heart is the thickest and is known to hypertrophy?
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The myocardium
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The epicardium is which layer of the heart?
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The outermost layer
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What layer of the heart do the coronary arteries run?
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The epicardium
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What layer of the heart can be considered a 3rd space for fluid to build?
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The epicardium
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About how many procedures a year are done on the heart?
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1.3 million
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What is the average amount of money spend on medical care of the heart each year?
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$326.6 billion
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WHat is the pacemaker of the heart?
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The SA node
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What is the intrinsic rate of the SA node?
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60-100 bpm
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What portion of the heart has an intrinsic rate of 40-60 bpm?
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AV node
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Which area of the heart has the slowest intrinsic rate? What is the rate?
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-The Ventricles
-20 - 40 bpm |
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WHat determines the pacemaker of the heart?
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The area that has the fastest intrinsic rate.
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What does the electrical conduction of the heart depend on>
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The Na/K pumps
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What can an increase in Ca do to the heart?
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can cause arrythmias. Messes with the contractility of the heart.
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What effect does hypocalcemic levels have on the heart?
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No direct effect
-More of an effect on skeletal muscle: causes tetany |
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What section of the autonomic nervous system usually governs the heart?
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The PSNS
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THe fibers of the Vagus nerve in the PSNS are considered to be negative _____ and ______?
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Chronotrophs and Inotrophs
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What is another way of describing an increase in conduction of the heart due to SNS?
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positive DROMOTROPIC
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What are examples of hormones that can cause an increase in the conduction of the heart>?
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Catecholamines:
-Epi -Norepi -Dopamine Thyroid Hormone: -Increases HR as it's levels increase |
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what portion of the autonomic nervous system is designed only for short term use?
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THe SNS
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What are the major/general blood vessels of the ciruculatory system?
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-Arteries
-Veins -Capillaries -Lymphatics |
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55% of total blood volume is ____?
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plasma
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Plasma is composed of?
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A. Albumin
B. H2O C. Fibrinogen D. All of the above |
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What % of blood volume is solid particles?
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45%
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The solid particles of blood is composed of?
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WBCs and RBCs
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Hematocrit and Hemoglobin describe which group of solid particles?
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RBCs
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The average female has what % of hematocrit?
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40-48%
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Which individuals have a hematocrit % of 42-50%?
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Males
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What are the average ratios of hemoglobin for men and women?
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Men: 13-18
Women: 12-16 |
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What is the typical lifespan of WBCs?
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A few hours
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What is the normal ratio of hemoglobin to hematocrit?
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1:3
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Which solid particles of blood have a lifespan of about 120 days?
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RBCs
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What is the normal thrombocyte count in the total blood volume?
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100,000-400,000
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If a sample of blood is allowed to settle, how will the vial appear?
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The solid particles (RBCs and WBCs will take up the bottom: dark red)
The plasma will float to the top: more clear |
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Where is the base of the heart located anatomically?
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At the angle of Louis
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The 5th intercostal space at the midclavicular line represents what section of the heart?
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The apex or the PMI
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Where are the valves of the heart heard best?
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A: 2nd intercostal, right
P: 2nd intercostal, left T: 4th/5th intercostal, right M: 5th intercostal, midclavicular |
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What is the equation for cardiac output?
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SV x HR
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What is SV?
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the amount of blood ejected from the heart with each contraction
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What is a normal CO?
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5-6Liters/min
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CO is a reflection of _____ BP?
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Systolic
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What are the major parameters altering CO?
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1. Preload
2. Afterload 3. Heart Rate |
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What is Preload?
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Volume: the amount of blood in the ventricles at the end of ventricular diastole
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How would you describe afterload?
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The arterial resistance/Force that opposes ventricular systole
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What value of BP does afterload correspond with?
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Diastolic BP
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What does nitroglycerine do to the afterload of the heart?
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It drops it because it is a vasodilator
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How does epinephrine affect the afterload of the heart?
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It increases it because of vasoconstriction
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How is the workload of the heart affected with an increase in afterload?
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The heart must work harder to pump out the same amount of blood
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If you have an increase in HR, does stroke volume also tend to increase? How does this affect the CO of the heart?
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No SV usually drops because you have less time to fill the ventricle between beats.
This causes a drop in CO |
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Pts who are Bradycardic OR tachycardic have what in common?
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Decrease in CO
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What are the most common determinants used to measure cardiovascular function?
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Indirect measurements of CO
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What are the indirect measurements of CO? (9)
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1. 2+ pulses
2. Skin warm and dry 3. Good cap refill 4. BP WINL 5. Good UA output 6. Clear sensorium 7. HR WNL 8. RR WNL 9. Clear breath sounds |
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What are the mechanisms to directly measure CO?
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1. Swan Ganz catheter
2. Cardiac Cath |
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What do the baroreceptors respond to?
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Change in BP/stretch
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a change in acidosis and hypoxia is noticed by what receptors?
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Chemoreceptors
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How do chemoreceptors respond to an increase in PCO2?
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Signal and increase in RR and HR to Increase CO
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What are the 6 types of cardiovascular diagnostic tests?
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1. EKG
2. Echocardiogram/TEE 3. Stress Test 4. Radionucleotide Imagery 5. Positron Emission Tomography (PET) 6. Chest X-ray |
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What does an EKG Show?
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the electrical activity of the heart
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What is the most comprehensive EKG to use?
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THe 12 lead
-Gives a look of the heart at 12 different vectors |
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What is the most common lead used in the hospital?
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Lead 2
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WHat is the name of the portable EKG that can monitor 24/7?
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Holter Monitor
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What pts would use a holter monitor?>
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Ones thought to have arrhythmias.
It allows a 24 hour reading to be watched. Or pt can press to monitor when they feel an arrhythmia happening. |
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What CV diagnostic test is similar to a sonogram?
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Echocardiogram
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What does an echocardiogram show>
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the structural aspects of the heart
-Can see wall motion, valves |
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What is a TEE?
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Trans Esophageal Echocardiogram.
-Pt swallows a transducer to get it in close proximity to the heart. Works well on the obese |
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What are the 2 methods of conducting a stress test?
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1. Exercise
2. Pharmacological |
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What is a stress test a good indicator for?
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-Coronary artery disease
-the effectiveness of heart meds -functional capacity of the heart |
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What protocol is used when conducting a stress test?
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The Bruce protocol
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What is the bruce protocol?
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Every 3 mins the speed and elevation is increased
Mins: 1-3: 1.7mph and 10 degree incline 4-6: 2.5mph and 12 degree incline 7-10: 3.1mph and 14 degree incline >10: 4.2 @16 degree incline |
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Where does the heart rate need to be during a stress test?
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80-90% of the maximum predicted HR
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What are the 2 drugs that could be used to induce a stress test?
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Persantine: increases coronary artery vasodilation
Adenogard: mimics the effects of exercise |
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what are the contraindications for a stress test?
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1. Severe Aortic Stenosis
2. Acute MI 3. Severe HTN |
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What are the complications of a stress test?
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-MI
-CHF -Cardiac arrest -arrhythmias |
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Normal functioning arteries can increase to what size to meet O2 demands?
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4x
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What are the nursing interventions for a stress test?
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1. NPO 12 hours prior, no caffeine 12-24 hours prior.
2. Meds withheld: no beta blockers 3. Wear comfortable clothes and shoes 4. 1-2 mins before the test is over inject the pt with a radio isotope, take images of the heart, then allow the pt to relax, then take more images |
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When is a stress test considered over?
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1. If the pt is symptomatic or reached the target HR (even in stage 2)
2. + stress test if any symptoms. - test if reach target HR with no symptoms |
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what are the 2 types of radionucleotide imagery?
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Thallium 201
Technetium |
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Why is Technetium preferred over Thallium 201?
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Technetium has a shorter half life and can be injected sooner after the test.
The patient doesn't have to wait as long |
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What can be seen with radionucleotide Imagery?
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It can see coronary arteries, perfusion and function of ventricles. It can pick up ischemia or an infarction
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What diagnostic test can be used on cancer pts to give more information than radionucleotide imagery?
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Positron Emission Tomography (PET) scan
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What is a PET scan?
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Very specific diagnostic test that can show blood flow and metabolic function of cells
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What does a cat scan show?
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Cross section of the heart
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What can be seen on an Chest Xray?
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Size and contour or enlargement
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When is the use of isotopes contraindicated?
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It the pt is pregnant, thinks she is pregnant or lactating
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What must be avoided for several hours before conducting a PET Scan?
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Tobacco and caffeine
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What enzymes are released from damaged cardiac muscle?
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Isoenzymes
1. CK-MB 2. Troponin 3. Myoglobin 4. C Reactive Protein 5. Homocysteine 6. Brain (B type) Naturetic Peptide |
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What Enzyme is the most cardiac specific?
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Troponin
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What value of Troponin s positive for an MI?
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>2.3
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When does CK-MB show up in blood test post damage to the myocardium?
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Can vary with patients. Usually 2-8 hours after damage and peaks at 12-24 hours
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What is Troponin?
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Contractile protein only in cardiac muscle
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What is the time frame for Troponin to be seen in the blood following a heart injury?
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1-4 hours and stays elevated for 1-3 weeks
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How is myoglobin values used to determine a heart injury?
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Increased values are not specific for cardiac disease, BUT negative test is good way to RULE OUT heart damage
-elevates 1-3 hours and peaks 4-12 hours |
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Describe C Reactive Protein as an indicator for heart disease
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Enzyme produced by the liver in response to inflammatory response. Not specific for cardiac because any chronic injury can increase it as well
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What is homocysteine? When is it used?
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Type of amino acid used in overall testing and not really in emergency situations.
high levels correlated with CAD and linked to coronary arteriosclerosis. For low levels you treat with Vit B6 or B12 |
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Describe Brain (B type) Natriuertic Peptide.
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-Secreted from the left ventricle when preload or afterload increases
-Neuro hormone for BP and fluid volume. -Helps determine CV or lung problem -If its a CV problem then the value will be > 400 -Lung problem will show no rise |
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How useful are electrolyte and BUN values in determining a CV problem?
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Not very useful
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What is the desired lab value for cholesterol?
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<200
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What is the highest healthy level triglycerides in the body?
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150
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On average, a healthy LDL level is _____ and a healthy HDL level is ______?
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<100; >40
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What are some ways to increase the HDL value?
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1. stop smoking
2. Control DM 3. Attain or maintain normal weight 4. Increase physical activity |
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What must occur to get an accurate lipid profile blood test?
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A fast for 8-12 hours prior
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An increase in triglycerides is often found as part of the ____ response or a large ____
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Stress; fatty meal
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What is the action of HDL?
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Protective:
Helps remove cholesterol from arterial wall and brings it to the liver to be broken down and excreted in bile |
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What is the benefit of having an arterial line in place?
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Can measure BP from moment to moment and can take repeat ABGs
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How does the Swan Ganz/CVP help monitor for CV problems?
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GIves a measurement of right heart pressure.
CO is directly monitored. |
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Why must a pressure cuff be placed around the pressure bag in an arterial line?
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The keep blood in the system
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What must be done prior to cardiac catheterization?
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1. Signed informed consent
2. Check for allergies to contrast dye 3. Usually NPO 4. Check distal pulses 5. Check legs for possible DVT 6. Give sedation: versaid, benzos and benedryl |
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What allergy is associated with contrast dye?
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Allergies to shell fish or iodine
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What must the health care providers where in the Cath Lab during a procedure?
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1. Radiation dose meter
2. Tyroid leg collar 3. Lead shield 4. Full OR suit up |
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What area of the body is used for the insertion of the cardiac catheter?
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THe groin
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How long must the patient lay on his or her back after a cardiac catheterization?
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2-8 hours
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How long must the HCP hold pressure against the insert site following a cardiac catheterization?
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20 mins minimum
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What are possible complications from cardiac catheterization?
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1. Bleeding
2. Lose pulses distal to the entry 3. Clot formation/embolus 4. Chest pain 5. MI 6. Dissection/perforation of the vessel |
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What actions can be taken if a blockage is found during a cardiac catheterization?
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1. Perform an angioplasty (ballon to push blockage and open the vessel
2. Insert a Stent 3. Call for a CABG |
