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82 Cards in this Set

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  • Back
  • 3rd side (hint)
What is the number 1 killer in the US?
Cardiovascular disease (CVD) since 1990.
27.6
Risk factors for coronary artery disease (CAD)
-age
-family history
-HTN
-Elevated cholesterol level
-smoking
-carbohydrate intolerance
-women are at higher risk than men
-poor diet/sedentary lifestyle
-obesity
-oral contraceptive use
27.6
Goals/ways to decrease risk of cardiovascular disease
-Quit smoking
-Lower and control BP
-Lower total cholesterol level
-Lower LDH cholesterol level
-Increase HDL cholesterol level
-Lower weight, if overweight
-Increase aerobic exercies
27.6
The heart moves ____________________ of blood around the body every day [in the average adult].
7,000 to 9,000 L
27.7
Pericardium
Tough, fibrous sac surround the heart.
27.7
Notes on the pericardium
Contains about 30 mL of serous fluid serving as a lubricant enabling the heart to contract and relax within the pericardium.
27.7
What are the three layers of the heart?
Epicardium-outermost surface layer, as a thin serous membrane.

Endocardium-Innermost smooth layer of connective tissue.

Myocardium-The muscular layer of the cardiac wall found between the epicardium and endocardium.
27.7
What are the two main coronary artereies?
left and right
27.7
What does the left coronary artery subdivide into?
Left anterior decending and circumflex coronary arteries, both of which supply the left ventricle along with the interventricular septum and part of right ventricle.
27.7
What does the RCA supply?
Right atrium and ventricle and part of the left ventricle.
27.7
collateral circulation
The mesh of arteries and capillaries that furnish blood to segment of tissues whose original arterial supply has been obstructed.
27.88
Define coronary sulcus
The groove along the exterior surface of the heart that separates the atria from the ventricles.
27.89
Define coronary sinus
A large vessel in the posterior part of the coronary sulcus into which the coronary veins empty.
27.89
The upper and lower chambers of the heart are separated by ___________________, preventing back flow during ventricular contraction.
atrioventricular valves
27.7
What valve separates the left atrium from the left ventricle?
Bicuspid valve or mitral valve
(Mighty next to the mighty left ventricle)
27.7
What valve separates the right atrium from the right ventricle?
Tricuspid (try it before you buy it)
27.7
chordae tendineae
Fibrous strandsshaped like umbrella that stays attach to the free edges of the leftlets, or cusps, of the atrioventricular valves to the papillary muscles.
papillary muscles
Protrusionsof the myocardium into the ventricularcavities to which the chordaetendineae are attached.
27.89
What are the valves between the ventricles and pulmonary circulation?
Semilunar valves because of their half -moon shape. The pulmonary and aortic semilunar valves.
27.8
Heart sounds
Normal sounds ar lub-dub, S1 and S2. The two abnormal sounds are S3 and S4.
27.8
Heart sounds S1
"Lub"
Normal heart sound near the beginning of the ventricular contraction (systole) when the tricuspid and mitral valves are closed, which should close simultaneously.
27.8
Heart sounds S2
"Dub"
Normal heart sound occurs near the end of ventricular contraction (systole), when the pulmonary and aortic valves close. Valves may close simultaneously or slightly delay under normal physiologic circumstances.
27.8
Heart sounds S2
"Dub"
Normal heart sound occurs near the end of ventricular contraction (systole), when the pulmonary and aortic valves close. Valves may close simultaneously or slightly delay under normal physiologic circumstances.
27.8
Heart sounds S3
"da"
Abnormal heart sound especially in adults often signifying heart failure. Occurs in about 120 to 170 milliseconds after S2.
27.8
Heart sounds S4
"bla"
Abnormal heart tone indicating a weak ventricle.
27.8
Cardiac cycle
One complete phase of atrial and ventricular relaxation (diastole), followed by one atrial and ventricular contraction (systole).
27.9
Why is relaxation period so important?
Normally only 0.52 seconds, however if it is to short it can dramatically effect cardiac output because ~80% of ventricular filling occurs during relaxation because the tricuspid and mitral valve are open.
27.9
atrial kick
The amount of blood "kicked" into the ventricle by the atrium.
27.9
Distention of external jugular veins signals
That there is considerable back pressure from the right side of the heart throughout the systemic circulation.
27.9
Characteristics s/s of pulmonary edema:
Dyspnea, bubbling crackles, and frothy sputum.
27.10
The layers of blood vessels
Tunica adventitia-Tough outer fibrous layer.
Tunica media-A middle layer of elastic fiber and muscle.
Tunica intima-A innermost layer.
Lumen-Opening within the blood vessels.
27.10-11
Blood pressure
The pressure exerted by the blood against the arterial wall.
27.11
What influences BP?
Cardiac output (HR x SV) and the volume of blood present in the system. Also by the nervous system constriction or dilation of arteries.
27.11
Cardiac output
The amount of blood that is pumped out by either ventricle. Ventricles are relatively the same size. HR x SV
27.13
What is the average CO for adult?
5 to 6 L/min
27.13
Stroke volume
The amount of blood (express in mL) pumped out by either ventricle in a single contraction.
27.13
What is normal stroke volume?
60 to 100mL
27.13
Frank Staling mechanism
A characteristic of cardiac muscle, that when it is stretched it contracts with greater force.
27.13
inotropic
Heart contractility.
27.13
chronotropic
Heart rate.
27.13
automaticity
A unique property of the cardiac muscle in its ability to generate its own electrical impulses without stimulation from nerves.
27.13
What cell can act as the heart's pacemaker?
Any cell within the heart's electrical conduction system can act as a pacemaker.
27.14
What is the dominant pacemaker a normal heart? List some properties.
Sinoaterial (SA) node
-Located in the right atrium, near the inlet of the superior vena cava.
-Receives blood from the RCA.
-Normal firing rate 60 to 100 bpm.
27.14
Explain the electrical conduction of the heart from start to end
SA node sends an electrical impulses to the internodal pathways causing atrial tissue to depolarize as it passes. From there the impulse moves to the atrioventricular (AV) node in the region of the AV junction. The AV node serves as a "gate keeper" to the ventricles causing a delay in conduction of about 0.12 seconds so that the atria can empty into the ventricles from there it goes to the bundle of His moving rapidly to the right and left branches. Next it spreads into the Purkinje fibers, thousands of fibrils in the ventricular muscles.
27.14
dromotropic effect
Velocity of conduction, or amount of conduction.
27.14
Depolarization
The process by which muscle fibers are stimulated to contract.
27.14
Electrolytes of the heart during depolarization
Like a cells in the body, myocardial cells are bathed in electrolyte solutions. When the myocardial cell receives a stimulation from the conduction system, the permeability of the cell wall changes opening channels so that sodium (Na+) rushes into the cell, causing the inside of the cell to become more positive.
Calcium ions (Ca++) also enter the cell (more slowly through different channels) to help maintain the depolarized state of the cell membrane and supplying calcium ions for use in conduction of cardiac muscle tissues.
27.14
Electrolytes of the heart during repolarization
Starts with the closing of the sodium and calcium channels, which stops the rapid inflow of those ions. Next special potassium channels (K+) ions from the cell, restoring the cell to its negative charge. The negative charge than causes the electrolyte distribution to reestablish itself and pump sodium ions out and potassium back in.
27.14
Sodium and potassium uses _________ transport to move in and out.
active
27.15
Refractory period
A special perod of myocardial cells when the cell must depolarize by repolarizing. Consist of two phases; absolute refractory period and relative refractory period. Absolute in when the power has been drained and recharge is a must.
Relative refractory period-The heart is partially drained and not strong enough to create a full contraction.
27.15-16
AV junction intrinsic firing rate
40 to 60 bpm
27.16
Purkinje intrinsic firing rate
20 to 40 bpm
27.16
P wave represents
Depolarization of the atria.
27.16
QRS represents
Depolarization of ventricles.
27.16
T wave represents
Repolarization of the atria and ventricles, mainly just ventricles.
27.16
PRI represents
P-R intervals is the distance from the beginning of the P to the beginning of the QRS. Normally 0.12 to 0.20 seconds.
27.16
ST segment represents
The from the end of the QRS complex to the beginning of the T wave. Should be at the isometric line.
27.16
Isometric line
Basline set be PRI.
27.16
R-R interval
The time between two successive QRS complexes.
27.16
Autonomic Nervous System
Part of Nervous system that controls automatic or involuntary actions. Has two parts parasympathetic (vegetative) and sympathetic nervous system (fight and fight).
27.16
Actions of the sympathetic system
Speeds up the heart, dilates bronchi and pupils. Strengthens the force of the cardiac muscle contractions.
27.17
What is the primary nerve of the parasympathetic system?
Vagus
27.18
What are ways to stimulate the vagus nerve, and what will it cause?
The vagus nerve causes parasympathetic response slowing the heart rate and can be stimulated by carotid sinus, straining against closed glottis, and distension of hollow organs.
27.17
What is the main hormone of the parasympathetic system?
Acetylcholine (AcH)
27.18
Atropine acts by blocking...
parasympathetic system allowing body's natural sympathetic system to increase the heart rate. Anticholinergic with vagolytic properties.
27.18
What is the main hormone of the sympathetic nervous system?
Norepinephrine
27.18
Stimulation of the Beta receptors causes
The heart only has one ignition switch/receptor site, beta, which causes increase force, and automaticity of the heart.
27.19
Receptors of the blood vessels
Stimulation of the alpha receptors causes vasocontriction.
Beta stimulation causes vasodilation.
27.19
Receptors of the lungs
Stimulation of the alpha receptors has very little effect, causing minor bronchoconstriction.
Beta stimulation triggers significant bronchodilation.
27.19
How does Atropine interact with the autonomic nervous system?
Parasympathetic blocker, opposing the vagus nerve. It is used to spped the heart when excessive vagal firing has caused bradycardia.
27.21
How does Norepinephrine interact with the autonomic nervous system?
Sympathetic agent (primarily alpha), causing vasoconstriction. It is used to increase blood pressure when hypotension is caused by vasodilation, as in neurogenic shock.
27.21
How does Isoproterenol interact with the autonomic nervous system?
Sympathetic agent (almost pure beta), causing a strong increase in HR and dilation of bronchi. It is used in extreme cases to increase CO and to dilate bronchi in asthma.
27.21
How does Epinephrine interact with the autonomic nervous system?
Sympathetic agent (predominantly beta), with actions similar to those of isoproterenol, but having an additional, primarily peripheral vasoconstrictor effect. Indications for epinephrine are similar to those for isoproterenol, but also include asystole, pulseless electrical activity (PEA), and ventricular fibrillation (to increase the automaticity of the hear and vasoconstriction); and anaphylactic shock (for all of its effects, bronchodilation, vasoconstriction, increased CO).
27.21-22
How does Dopamine interact with the autonomic nervous system?
Sympathetic agent, used as low (beta) doses to increase the force of cardiac contractions in cardiogenic shock. Its dilation (beta) effects on renal and mesenteric arteries mean that dopamine may help maintain urine flow and good perfusion to abdominal organs.
27.22
How does Albuterol, isoetharine, terbutaline interact with the autonomic nervous system?
Sympathetic beta-2 agents that act on the lungs. These agents are used to induce bronchodilation in asthma, chronic obstructive pulmonary disease, and other bronchospastic conditions.
27.22
How does Propranolol interact with the autonomic nervous system?
Sympathetic beta blocker, opposing the actions of beta-stimuation agents. It is used clinically to slow the HR in certain tachyarrhythmias, to decrease to pair of chronic angina (by decreasing the tendency of the heart to fire automatically). Its use is contraindicated in asthma.
27.22
BP consist of...
CO x Peripheral resistance so if CO fails because of a hemmorage, BP can be maintain by peripheral resistance.
27.22
Afterload
The resistance against which the ventricles must contract. The greater the afterload, the harder the ventricles must work to pump the blood.
27.22
Paroxysmal nocturnal dyspnea (PND)
Episode of SOA that awakens the pt from sleep feeling suffocated. Classic sign of left sided heart failure.
27.23
Pulse pressure
The difference between the systolic and diastolic pressure, gives a rough indicator of the elasticity of the aterial walls and the stroke volume.
27.25
pulsus paradoxus
A weakening or loss of a palpable pulse during inhalation, characteristic and severe asthma.
27.90
The cold, sweaty skin of many patients with MI reflects...
massive peripheral vasoconstriction.
27.26