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119 Cards in this Set

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What does the efficiency of the heart depend on?
1. Ability of the heart to pump
2. How patent are the vessels
3. Quality of the blood
4. Quantity of the blood
Where does the myocardium get its O2 supply from?
The coronary arteries,

Right coronary artery
Left main coronary artery
What is the widow maker of the heart?
A block in the Left Main Coronary artery because it cuts off blood to the Left ventricle
When do the coronary arteries fill with blood?
During Diastole
What occurs during diastole?
-The Coronary arteries fill

-The veins empty into the right atrium
What is the innermost layer of the heart called?
The endocardium
What layer of the heart is the thickest and is known to hypertrophy?
The myocardium
The epicardium is which layer of the heart?
The outermost layer
What layer of the heart do the coronary arteries run?
The epicardium
What layer of the heart can be considered a 3rd space for fluid to build?
The epicardium
About how many procedures a year are done on the heart?
1.3 million
What is the average amount of money spend on medical care of the heart each year?
$326.6 billion
WHat is the pacemaker of the heart?
The SA node
What is the intrinsic rate of the SA node?
60-100 bpm
What portion of the heart has an intrinsic rate of 40-60 bpm?
AV node
Which area of the heart has the slowest intrinsic rate? What is the rate?
-The Ventricles

-20 - 40 bpm
WHat determines the pacemaker of the heart?
The area that has the fastest intrinsic rate.
What does the electrical conduction of the heart depend on>
The Na/K pumps
What can an increase in Ca do to the heart?
can cause arrythmias. Messes with the contractility of the heart.
What effect does hypocalcemic levels have on the heart?
No direct effect

-More of an effect on skeletal muscle: causes tetany
What section of the autonomic nervous system usually governs the heart?
The PSNS
THe fibers of the Vagus nerve in the PSNS are considered to be negative _____ and ______?
Chronotrophs and Inotrophs
What is another way of describing an increase in conduction of the heart due to SNS?
positive DROMOTROPIC
What are examples of hormones that can cause an increase in the conduction of the heart>?
Catecholamines:
-Epi
-Norepi
-Dopamine

Thyroid Hormone:
-Increases HR as it's levels increase
what portion of the autonomic nervous system is designed only for short term use?
THe SNS
What are the major/general blood vessels of the ciruculatory system?
-Arteries
-Veins
-Capillaries
-Lymphatics
55% of total blood volume is ____?
plasma
Plasma is composed of?
A. Albumin
B. H2O
C. Fibrinogen
D. All of the above
What % of blood volume is solid particles?
45%
The solid particles of blood is composed of?
WBCs and RBCs
Hematocrit and Hemoglobin describe which group of solid particles?
RBCs
The average female has what % of hematocrit?
40-48%
Which individuals have a hematocrit % of 42-50%?
Males
What are the average ratios of hemoglobin for men and women?
Men: 13-18

Women: 12-16
What is the typical lifespan of WBCs?
A few hours
What is the normal ratio of hemoglobin to hematocrit?
1:3
Which solid particles of blood have a lifespan of about 120 days?
RBCs
What is the normal thrombocyte count in the total blood volume?
100,000-400,000
If a sample of blood is allowed to settle, how will the vial appear?
The solid particles (RBCs and WBCs will take up the bottom: dark red)

The plasma will float to the top: more clear
Where is the base of the heart located anatomically?
At the angle of Louis
The 5th intercostal space at the midclavicular line represents what section of the heart?
The apex or the PMI
Where are the valves of the heart heard best?
A: 2nd intercostal, right
P: 2nd intercostal, left
T: 4th/5th intercostal, right
M: 5th intercostal, midclavicular
What is the equation for cardiac output?
SV x HR
What is SV?
the amount of blood ejected from the heart with each contraction
What is a normal CO?
5-6Liters/min
CO is a reflection of _____ BP?
Systolic
What are the major parameters altering CO?
1. Preload
2. Afterload
3. Heart Rate
What is Preload?
Volume: the amount of blood in the ventricles at the end of ventricular diastole
How would you describe afterload?
The arterial resistance/Force that opposes ventricular systole
What value of BP does afterload correspond with?
Diastolic BP
What does nitroglycerine do to the afterload of the heart?
It drops it because it is a vasodilator
How does epinephrine affect the afterload of the heart?
It increases it because of vasoconstriction
How is the workload of the heart affected with an increase in afterload?
The heart must work harder to pump out the same amount of blood
If you have an increase in HR, does stroke volume also tend to increase? How does this affect the CO of the heart?
No SV usually drops because you have less time to fill the ventricle between beats.

This causes a drop in CO
Pts who are Bradycardic OR tachycardic have what in common?
Decrease in CO
What are the most common determinants used to measure cardiovascular function?
Indirect measurements of CO
What are the indirect measurements of CO? (9)
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
What are the mechanisms to directly measure CO?
1. Swan Ganz catheter
2. Cardiac Cath
What do the baroreceptors respond to?
Change in BP/stretch
a change in acidosis and hypoxia is noticed by what receptors?
Chemoreceptors
How do chemoreceptors respond to an increase in PCO2?
Signal and increase in RR and HR to Increase CO
What are the 6 types of cardiovascular diagnostic tests?
1. EKG
2. Echocardiogram/TEE
3. Stress Test
4. Radionucleotide Imagery
5. Positron Emission Tomography (PET)
6. Chest X-ray
What does an EKG Show?
the electrical activity of the heart
What is the most comprehensive EKG to use?
THe 12 lead

-Gives a look of the heart at 12 different vectors
What is the most common lead used in the hospital?
Lead 2
WHat is the name of the portable EKG that can monitor 24/7?
Holter Monitor
What pts would use a holter monitor?>
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.
What CV diagnostic test is similar to a sonogram?
Echocardiogram
What does an echocardiogram show>
the structural aspects of the heart

-Can see wall motion, valves
What is a TEE?
Trans Esophageal Echocardiogram.

-Pt swallows a transducer to get it in close proximity to the heart.

Works well on the obese
What are the 2 methods of conducting a stress test?
1. Exercise
2. Pharmacological
What is a stress test a good indicator for?
-Coronary artery disease

-the effectiveness of heart meds

-functional capacity of the heart
What protocol is used when conducting a stress test?
The Bruce protocol
What is the bruce protocol?
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
Where does the heart rate need to be during a stress test?
80-90% of the maximum predicted HR
What are the 2 drugs that could be used to induce a stress test?
Persantine: increases coronary artery vasodilation

Adenogard: mimics the effects of exercise
what are the contraindications for a stress test?
1. Severe Aortic Stenosis
2. Acute MI
3. Severe HTN
What are the complications of a stress test?
-MI
-CHF
-Cardiac arrest
-arrhythmias
Normal functioning arteries can increase to what size to meet O2 demands?
4x
What are the nursing interventions for a stress test?
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
When is a stress test considered over?
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
what are the 2 types of radionucleotide imagery?
Thallium 201

Technetium
Why is Technetium preferred over Thallium 201?
Technetium has a shorter half life and can be injected sooner after the test.

The patient doesn't have to wait as long
What can be seen with radionucleotide Imagery?
It can see coronary arteries, perfusion and function of ventricles. It can pick up ischemia or an infarction
What diagnostic test can be used on cancer pts to give more information than radionucleotide imagery?
Positron Emission Tomography (PET) scan
What is a PET scan?
Very specific diagnostic test that can show blood flow and metabolic function of cells
What does a cat scan show?
Cross section of the heart
What can be seen on an Chest Xray?
Size and contour or enlargement
When is the use of isotopes contraindicated?
It the pt is pregnant, thinks she is pregnant or lactating
What must be avoided for several hours before conducting a PET Scan?
Tobacco and caffeine
What enzymes are released from damaged cardiac muscle?
Isoenzymes

1. CK-MB
2. Troponin
3. Myoglobin
4. C Reactive Protein
5. Homocysteine
6. Brain (B type) Naturetic Peptide
What Enzyme is the most cardiac specific?
Troponin
What value of Troponin s positive for an MI?
>2.3
When does CK-MB show up in blood test post damage to the myocardium?
Can vary with patients. Usually 2-8 hours after damage and peaks at 12-24 hours
What is Troponin?
Contractile protein only in cardiac muscle
What is the time frame for Troponin to be seen in the blood following a heart injury?
1-4 hours and stays elevated for 1-3 weeks
How is myoglobin values used to determine a heart injury?
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
Describe C Reactive Protein as an indicator for heart disease
Enzyme produced by the liver in response to inflammatory response. Not specific for cardiac because any chronic injury can increase it as well
What is homocysteine? When is it used?
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
Describe Brain (B type) Natriuertic Peptide.
-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
How useful are electrolyte and BUN values in determining a CV problem?
Not very useful
What is the desired lab value for cholesterol?
<200
What is the highest healthy level triglycerides in the body?
150
On average, a healthy LDL level is _____ and a healthy HDL level is ______?
<100; >40
What are some ways to increase the HDL value?
1. stop smoking
2. Control DM
3. Attain or maintain normal weight
4. Increase physical activity
What must occur to get an accurate lipid profile blood test?
A fast for 8-12 hours prior
An increase in triglycerides is often found as part of the ____ response or a large ____
Stress; fatty meal
What is the action of HDL?
Protective:

Helps remove cholesterol from arterial wall and brings it to the liver to be broken down and excreted in bile
What is the benefit of having an arterial line in place?
Can measure BP from moment to moment and can take repeat ABGs
How does the Swan Ganz/CVP help monitor for CV problems?
GIves a measurement of right heart pressure.

CO is directly monitored.
Why must a pressure cuff be placed around the pressure bag in an arterial line?
The keep blood in the system
What must be done prior to cardiac catheterization?
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
What allergy is associated with contrast dye?
Allergies to shell fish or iodine
What must the health care providers where in the Cath Lab during a procedure?
1. Radiation dose meter
2. Tyroid leg collar
3. Lead shield
4. Full OR suit up
What area of the body is used for the insertion of the cardiac catheter?
THe groin
How long must the patient lay on his or her back after a cardiac catheterization?
2-8 hours
How long must the HCP hold pressure against the insert site following a cardiac catheterization?
20 mins minimum
What are possible complications from cardiac catheterization?
1. Bleeding
2. Lose pulses distal to the entry
3. Clot formation/embolus
4. Chest pain
5. MI
6. Dissection/perforation of the vessel
What actions can be taken if a blockage is found during a cardiac catheterization?
1. Perform an angioplasty (ballon to push blockage and open the vessel
2. Insert a Stent
3. Call for a CABG