Cardiovascular System

Front 1

What are the layers of the heart wall?

Back 1

Epicardiuum (visceral pericardium)
Myocardium
Endocardium

Front 2

What are the valves of the heart?

Back 2

Tricuspid (AV)
Mitral (AV)
Pulmonic (Semilunar)
Aortic (Semilunar)

Front 3

Myocardial Blood Supply
Left Coronary Artery LCA

Back 3

Branches into Left Anterior Descending LAD artery and circumflex artery.
LAD supplies blood to anterior wall of left ventricle, anterior ventricular septum and bundle branches.
Circumflex Artery provides blood to lateral and posterior portions of the left ventricle.

Front 4

Myocardial Blood Supply
Right Coronary Artery RCA

Back 4

RCA fills groove between atria / ventricles, gives rise to acute marginal artery, ends as posterior descending artery.
Sends blood to sinus and AV nodes and to right atrium.
PDA supplies posterior and inferior wall of the Left ventricle and posterior portion of R ventricle

Front 5

Heart Circulation

Back 5

Inf / sup vena cava to R atrium
Thru tricuspid valve to R ventricle
Thru pulmonic valve to pulm. artery
To Lungs
Thru pulmonary veins to L atrium
Thru mitral valve to L ventricle
Thru aortic valve to aorta
To systemic circulation

Front 6

Normal Cardiac Conduction

Back 6

SA Node
Intra-atrial ducts
AV junction
Bundle of HIS
R and L Bundle Branches
Purkinje Fibers

Front 7

When do coronary arteries primarily receive blood?

Back 7

During diastole, or ventricular relaxation

Front 8

When is blood pumped out to systemic circulation?

Back 8

During systole, or ventricular contraction

Front 9

Key facts about electrical conduction

Back 9

Heart's muscle fibers generate/conduct electric impulses
Impulses follow right to left, top to bottom path
Initiated at SA node
Impulse moves thorough conduction system to ventricles.

Front 10

What is CO?

Back 10

Cardiac output or the total amount of blood ejected per minute.

Front 11

What is SV?

Back 11

Stroke volume, or the amount of blood ejected with each beat.

Front 12

What is Cardiac Output?

Back 12

CO = SV x HR

Front 13

What is ejection fraction?

Back 13

The percentof left ventricular end-diastolic volume ejected during systole (normally 60-70%)

Front 14

What are arteries?

Back 14

Three layered vessels which carry 02 blood from heart to tissues.

Front 15

What are veins?

Back 15

Large capacity, low pressure vessels which return CO2 blood to heart.

Front 16

Key signs and symptoms of cardiovascular disorders

Back 16

Dyspnea
chdest pain
syncope
pulse/BP changes
Edema
Arrhythmias

Front 17

Patterns of cardiac pain
Pericarditis

Back 17

Sudeen onset of mild ache to severe pain
deep or superficial
stabbling
continuous pain lasting for several days
residual soreness

Front 18

Patterns of cardiac pain
Angina

Back 18

Gradual or sudden onset of mild to moderate pressure; deep sensation; varied pattern of attacks; tightness, squeezing, crushing, pressure;
pain usually lasts less than 15 minutes and not more than 30 minutes. Average three minutes.

Front 19

Patterns of cardiac Pain
Myocardial Infarction MI

Back 19

Sudden onset of persistent, severe pressure; deep sensation; crushing squeezing. heavy. oppressive. Pain lasts 30 min to 2 hours, waxes and wanes. Residual soreness 1-3 days.

Front 20

Key facts about
Electrocardiography

Back 20

noninvasive
graphical representation of heart's electrical activity
Intervention - interpret ECG for changes (i.e. life threatening arrhythmias).

Front 21

Key facts about
cardiac catheterization

Back 21

invasive fluoroscopic procedure
examines intracardiac structures, pressures, O2, and CO
Intervention - note allergies to shellfish/dyes before; monitor insertion site and pulses and bleeding after. keep leg straight. pressure dressing and bedrest 4-8 hours. Increase fluid intake unless contraindicated. Monitor for signs of MI.

Front 22

Key facts about
coronary arteriography

Back 22

invasive, fluoroscopic procedure
examines coronary artery
note allergies, monitor vitals
Afterwards monitor site and pulses

Front 23

Key facts about
Digital Subtraction Angiography

Back 23

Invasive, fluoroscopic procedure
Complete visual of arterial blood supply to specific area (carotid, cerebral arteries)
Intervention: perform baseline neuro exam before. After, instruct patient to drink 1 L water, monitor insertion site after and assess for delayed allergic reaction to dye.

Front 24

Key facts about
Echocardiography

Back 24

Noninvasive
soundwaves to visualize intracardiac structures and direction of bloodflow
Intervention - determine pt ability to lie still

Front 25

Key facts about
Stress Test / Exercise Test

Back 25

Noninvasive
Study heart's electric activity and ischemic events during prescribed levels of exercise.
Withhold food/fluids, especially caffiene, 1 hr before test.

Front 26

Key facts about
Nuclear cardiology

Back 26

noninvasive
allows for visual exam of heart with radioisotopes (via IV injection)
imaging of perfusion/contractility
Determine patient's ability to lie still

Front 27

Key facts about
Hemodynamic monitoring (single procedure or continuous)

Back 27

invasive, catheter in pulmonary artery
exam of intracardiac pressures and CO
Obtain consent, monitor pressure tracings / record readings; after, check site for signs of infection

Front 28

Key facts about
Chest X Ray

Back 28

Noninvasive
provides radiographic picture of heart/lungs
make sure pt removes jewelry

Front 29

Normal Values in Hemodynamic Monitoring
RAP or CVP

Back 29

1 to 6 mm Hg
(1.34 to 8 cm H2O)

Front 30

Normal Values in Hemodynamic Monitoring
RVP

Back 30

15 to 25 mm Hg
Diastolic 0 to 8 mm Hg

Front 31

Normal Values in Hemodynamic Monitoring
PAP

Back 31

Systolic - 15 to 25 mm Hg
Diastolic 8 to 15 mm Hg
Mean 10 to 20 mm Hg

Front 32

Normal Values in Hemodynamic Monitoring
PAWP

Back 32

Mean pressure - 6 to 12 mm Hg

Front 33

Normal Values in Hemodynamic Monitoring
LAP

Back 33

6 to 12 mm Hg

Front 34

Normal Values in Hemodynamic Monitoring
CO

Back 34

4 to 8 L

Front 35

What does Hemodynamic monitoring measure?

Back 35

RAP (Right Atrial Pressure) or CVP (Central Venous Pressure
RVP (Right Ventricular Pressure)
PAP (Pulmonary Artery Pressure)
PAWP (Pulmonary Artery Wedge Pressure)
LAP (Left Atrial Pressure)
CO (Cardiac Output)

Front 36

What does an elevated RAP indicate?

Back 36

Right Heart Failure, Volume Overload
tricuspid stenosis or insufficiency
constrictive pericarditis
pulmonary hypertension
cardiac tamponade
right ventricular infarction

Front 37

What does low RAP indicate?

Back 37

reduced circulating blood volume

Front 38

What is RVP?

Back 38

RV systolic pressure normally equals pulmonary artery systolic pressure. RV end-diastolic pressure,which equals RAP reflects RV function.

Front 39

What does elevated RVP indicate?

Back 39

mitral stenosis or insufficiency
pulmonary disease
hypoxemia
constrictive pericarditis
chronic HF
atrial and ventricular septal defects
patent ductus arteriosus

Front 40

What is PAP?

Back 40

Pulmonary artery systolic pressure reflects right ventricular function and pulmonary circulation pressures. pulmonary artery diastolic pressure reflects left vetricular presssures, specificially left ventricular end diastolic pressure.

Front 41

What does an elevated PAP indicate?

Back 41

Left side HF
increased pulmonary blood flow (L or R shunting as in atrial or VSD)
any condition causing increased pulmonary arteriolar resistance.

Front 42

What is PAWP?

Back 42

PAWP reflects left atrial and left ventricular pressures unless patient has mitral stenosis.

Front 43

What do changes in PAWP reflect?

Back 43

changes in left ventricular filling pressure. Heart momentarily relaxes during diastole as it fills with blood from pulmonary veins. This permits pulmonary vasculatore left atrium, and left ventricle to act as a single chamber.

Front 44

What is the value of LAP?

Back 44

It reflects left ventricular end-diastolic pressure in patients without mitral valve disease.

Front 45

What is cardiac index?

Back 45

Adustment of CO to patient's size.