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119 Cards in this Set
- Front
- Back
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right atrium receives ______ blood via superior and inferior vena cava and heart muscle via
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deoxygenated blood, coronary sinus
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right atrium thru ____ valve to right ventricle
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tricupsid
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right ventricle close tricupsid valve and opens _____ valve to propel blood thru _____ artery into _____
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pulmonic valve, pulmonic artery, into lungs
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reoxygenated blood leaves ____ to go to ____ atrium
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lungs, left
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blood in left atrium goes thru ____ valve to left ventricle
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mitral
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left ventricle is almost filled when left atrium _____ to push the rest of the blood into the ventricle
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contracts - this contraction produces approx 120 mm Hg where the mitral valve closes to open the aortic valve
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___ valve opens and blood is pushed in systemic circulation
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aortic
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systole acts as
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funnel to allow blood flow from atrium to ventricle
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diastole involves
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closure of valves to protect back flow to the atria
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coronary artery provides
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the heart with the metabolic needs required
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coronary blood flow to myocardium occurs during
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primary diastole
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MAP of 60-70 mm Hg is required to maintain
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perfusion to major organs
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BP needs to be at least ___ mm Hg to feel carotid pulse
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60 mm Hg to feel carotid pulse
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___ node is regulator of heart rate. normal rate is
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sa, 60-100 bpm
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sa node is located at junction of ___atrium and super vena cava
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right
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SA node initiates _____ (activation of myocardium cells)
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depolarization
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impulse travels thru atria and __ node
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av
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av node has a rate of ____
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40-60 bpm
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junctional rhythms usually originate from __ node
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av node (40 - 60 bpm)
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bundle of HIS divides into ___ and ___ bundle branches
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right and left
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purkinjie fibers - ______ branches
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terminal branches carry depolarization to ventricle walls, instrinic pacemaker rate of 20-40 bpm
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____ is released in a large amt in order to promote cardiac-muscle contraction
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calcium
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calicum ions are released from ______
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sarciplasmic reticulum
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calicum promotes the interaction of _____ and _____ protein filaments
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actin, myosin - causing a link and overlapping, bridges acts as a force (generator) producing myocardial contraction
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the ____ muscle relaxes when ____ is pumped back in to sarciplasmic reticulum
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cardiac, calicum
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normal serum range calicum
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8.5-10.5
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blood flow from heart into ____ circulation is measured as cardiac output CO
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systemic
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cardiac output is
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amount of blood pumped from left ventricle
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cardiac output = HR x SV stroke volume - normal range is
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4-7 L/min
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stroke volume is
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amt of blood ejected by LV during each systole -
variables can included HR preload, afterload, contractility |
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preload
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pressure stretching the ventricle - after passive filling of ventricle and subsuquent atrial contraction
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preload is determined by
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amt of blood returning to heart from both venous (right) and pulmonary system (left)
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afterload is
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pressure ventricles need to eject blood thru to pass the semilunar valves into peripheral blood vessels
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non modifiable risk CAD
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age, sex, post menopausal,
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CAD modifiable risks
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smoking, inactivity, obesity, stress, chronic diseases
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preload
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degree myocardial fiber stretch at end of diastole
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afterload
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pressure ventricles need to eject blood into systemic circulation
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men present with _____ and women present with ______ during heart attack
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men---substernal chest pain with activity or stress, pale, hx of cp, family hx, n/v
women -- back pain, indigestion, n/v, arm pain, anorexia |
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pt is dyspenic -- heart failure
************what does pt breathing look like? |
accessory muscle use
does it look like htey are working to breath JVD? use oxygen at home, how much smoking |
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fatigue with HF
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tired or weak upon activity, leg fatigue is common with HF
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palpatations with HF
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feeling of flutterign in chest, unpleasant awareness in chest
- after activity could be over exertion non cardiac reasons - anxiety, stress, fatigue, insomnia, hyperthyroidism, caffeine, nicotine, or alcohol |
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weight gain with HF
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sudden increase in weight of 2.2 pounds can be result of excessive fluid in interstital space
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fluid retention is determined by
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weight gain and edema
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church syncope
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older ppl having when standing to leave church,
post-prandial after eating cause include: hypersensivitiy of carotid sinus, pressure applied tosinus when moving their head, shrugging shoulders or bearing down |
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church syncope nursing interventions
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bed rest, orthostatics, blood pressure, ekg
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claudication
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extremity pain caused by ischemia from arthrosclerosis and venous insufficiency of peripheral blood vessels
crammping sensation in legs or buttocks during activty symptoms are relieved when resting or lowering the extremity |
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orthostatic blood pressure
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blood pressure drops more 20mmHg and hr increases 10-20%
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paradoxial blood pressure
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exaggerated decrease in systolic BP more than 10 mmHg during inspiration
normal is 3-10mmHg |
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conditions that induce orthostatic BP
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pericardial tamponade, constrictive periacarditis, pulmonary hypertension
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hypertensions non pharm interventions
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low salt diet, exercise
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cough and dyspnea on exertion -- pt is probably in
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CHF
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4 side effects of lopressor (metoprolol)
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1. bradycardia
2. hypotension 3. HA 4. cough ace inhibitors |
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s1 created by
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closure of mitral and tricupsid valves
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s2 caused by
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closing of aortic and pulmonic valves
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paradoxical splitting
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abnormal splitting of s2, split heard on expiration
severe myocardial depression - causes early closure of pulmonic valve or delay in aortic valve |
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s3 is.... and can indicate
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early sign of HF
rapid passive blood flow ffrom atrium to ventricles normal in kids |
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gallops are
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diastolic filling sounds s3 s4
when there is a non compliant chamber during ventricular filling |
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s4 develops when
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atrial gallop blood enters ventricles during active filling phase at the end of diastole
heard on pt with HTN, anemia, ventricular arhythmias |
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mumurs
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turbulent blood flow thru valves, can be normal or abnormal
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describe mumors...
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where on chest.
when it occurs. characteristics..harsh, whistling..rumbling..squeaking, low or high pitched |
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lead II views which part of heart
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left adn right ventricles
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electrolyte imbalance can be visible on ekg by which part?
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t wave - peaked with high potassium or concurrently with potassium adminstration
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*********P wave indicates
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atrial depolarization or contraction of atrium
normal not longer than 0.11 sec (less 3 squares) |
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p waves provides clues to the ___ impulse and integrity of conduction pathways of heart
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originiating
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p wave covers time taken for impulse to travel from __ node thru atria and av junction thru ____ network
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sa node, thru atria and av junction thru purkinjie network
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SVT will look ___________ and VTACH will look ______
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svt - narrow
vtach - wide |
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pr interval
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av conduction time
duration 0.12 to 0.20 secs |
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QRS complex
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ventricular depolarization or contraction of vent
normally not longer than 0.10 seconds |
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T wave
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ventricular repolarization
not more than 5 mm amplitude in standard leads and 10mm in precordial leads rounded and asymmetrical |
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ST segment
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indicates early ventricular repolarization
normally not depressed more 0.5 mm may be elevated slightly in some leads |
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ST segment depression can indicate
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heart damage
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ST segment elevation can indicate
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injury - concurrent usually with MI
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Q wave can indicate
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past injury
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T wave affected by
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electrolytes and digoxin toxicity
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bradydysrhythmias
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any rate less than 60 bpm
myocard oxygen demand is reducedd to slow heart rate |
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sinus brady occurs
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parasympathetic nervous system
excessive vagal stimulation well conditioned athletes carotid sinus massage - bear down vomiting, suctioning, gagging, ocular pressure, medications (beta blockers) sa - av - normal conduction - just slow |
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dysrhythmias
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occurs in relationship btw electrical conductivity and mechanical response of myocardium
impulse formation - conduction |
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symptoms of dsrhythmias
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chest pain, pressure, discomfort
syncope palpatations sob, hypotension delayed cap refill diaphoresis |
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***sinus dysrhythmias
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sns stimulation or vagal stimulation increase heart rate
??????????? |
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sa node is _____ of heart
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pacemaker
sympathetic nervous system |
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TACHYDYSRHYTHMIAS
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rate greater than 100 bpm
serious hemodynamic issues --decrease diastole time and coronary perfusion --increased CO and blood pressure, decrease in stroke volume --increase in work load of heart, increasing oxygen demand of myocard sa - av - conduction - just faster |
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increased workload --- increased ____ demand
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oxygen
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interventions for tachydysrhythmias
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oxygen, rest, NTG and morphine, diuretics, fluids for hypovolemia, antipyretics and abx (fever & infection)
teaching, sit down, relaxation techniques |
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********if patient septic they need lots of
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FLUID regardless of CHF as well as antiboitics
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premature complexes occur when
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cardiac cell or cell group becomes irriatable and fires impulse before next sinus impulse is produced
extra beats |
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bigeminy
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2 funky rhythms together - repetitive 2 beat pattern with pause in btw
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trigeminy
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3 in row - repeated sequence triplets
heart irritable - doctor aware, oxygen? ekg? electrolytes? |
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quadgeminy
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very irritable, 4 in a row,
doctor aware? oxygen? ekg? eletctrolytes? |
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SVT --
symptoms treatments |
rapid stimulation of atrial tissue at rate of 100-280 bpm
p waves shaped differently than sinus palpatations, sob, weakness, fatigue, hypotension, syncope usually only symptom is WEAKNESS tx - cardizem (always 1st) vagal stimulation, oxygen, adenosine, amiodarone |
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atrial dysrhythmias occur
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impulse from atrial tissue NOT sa node
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atrial dysrhythmia:
p wave looks different due to ________ path most common types? |
conduction
atrial irritablilty caused by: stress, fatigue, anxiety, infection, inflammation, caffeine, nicotine, alcohol PACs, SVT, a flutter, a fib |
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a flutter
cause? |
saw tooth
not every p wave has qrs complex rapid atrial depolarization occuring rate 250-300 times per min av node blocks number of impulses traveling to ventricle cna result in 2:1 block if left untreated since abnormality occurs above av node the QRS complexes are normal in configuration causes: rheumatic fever or ischemic heart disease, CHF, AV valve disease, septal defects, PE, alcholism, pericarditis |
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assessment/interventions with A flutter
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assess: palpatations, weakness, sob, fatigue, anxiety, aginia, heart failure, shock
interv: oxygen, convert amidogarone, cardizem cardioversion if unstable chestpain, hypotension |
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cardioversion
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synchrozied countershock for hemodynamically unstable pt - or electively to pt that are resistent to medical therapies
digoxin must be held 48 hrs prior |
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vent tachycardia
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rapid heart beating starting in ventricles
can interfere with heart's ability to pump enough blood to brain and other vital organs can be converted with electrical shock can lead to almost fatal v- fib |
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vent fibrilation
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lower chambers quiver and heart cannot pump blood
can be converted with electrical shock |
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in a fib the atria
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quiver instead of beating resulting in blood stasis and can lead to thrombus formation and can lead to stroke (blood clot in brain)
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p wave
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records electrical activity of atria
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QRS records
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electrical activity of ventricles
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T wave records
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the hearts return to normal resting state
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Cardiac defibrillation is a way
to return an |
abnormally fast or disorganized
heartbeat to normal with an electric shock |
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shock depolarizes a critical mass of myocardium and is intened
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allow sa node to regain control of heart
adm sedation |
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defibrillation
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anynchronous countershock, depolarizes critical mss of myocardium allowing sa node to regain control of heart
early defib is critical in terminating VT of VF if defib is not available an ACLS nurse may prescribe a precordial thump to pulseless client in VF |
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precordial thump
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if defib equip is not available
striking lower half sternum with closed fist from height 8-12 inches 200 joules, 300 joules, 360 joulels |
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AED
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automatic external defibrillators
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cardioversion/defibrillation
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large amts electricity applied to heart thru chset wall to depolarize heart and allow sa node to regain control of heart
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cardioversions is _____ whereas defibrillation is ______
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cardio is synchronized (afib, svt)
defib is ansynchronized (vf, vt) |
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A fib is
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irregularly irregular
multiple, rapid impulses from many different atrial foci rate can be 300-600 times per min chaotic rhythm NO P WAVE, ATRIUM IS QUIVERING |
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common complications with a fib
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dilation and stagnation of blood cause thrombus and increased risk for CVAs
tx with blood thinners |
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WPW
treatment |
wolfe parkinson white
heart beats too fast due to extra abnormal electrical pathway btw upper and lower heart tx: valsalva maneuver, hospital for iv adenosine or verampril cardioversion may be indicated |
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sick sinus syndrome
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sa node doesnt signal properly, HR slows down, sometimes goes back and forth btw brady and tachy
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a patient in unstable if....
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hypotensive and has arrhythmia
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PEA
OOOH SHIT RHYTHM |
pulseless electrical activity
no pulse no perfusion life threating arrhythmia |
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idioventricular rhythm
OOOH SHIT RHYTHM causes |
20-40 bpm - ventricular nodal cells are pacemaker providing slow rate
no p wave - atrium is doing NOTHING QRS widened causes: hypovolemia, hypoxia, drug OD, tension pneumo, thrombosis, tampanade SHOCK! |
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PVCs
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premature ventricular complexes
increased irritability of ventricle occurs in repetitve rhythms (bigeminy/trigeminy begin to worry) can occur with MIs causes: CHF, chronic hypxemia, chronic airway limitation, anemia, hypokalemia, hypomagnesium, medications (diuretics, diet pills, stimulants) |
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treatment for PVCs
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eliminate cause (caffenie, alcohol, stress etc.) correct elctrolyte imbalance, fix hypoxemia
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ventricular dysrhythmias
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slowest pacemaker
irritiable cells will fire prematurely repolarization changes cause T wave to become larger and in different direction for QRS |
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VT
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wide and bizzare
pulse present, rate 140-180 bpm or higher repetive firing of irritable ectopic focus intermittent or sustained |
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****VT presentation & subsquent treatment
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ischemic heart disease, MI, cardiomyopathy, HYPOKALEMIA, heart failure, hypotension, ventricular aneurysm
occurs with cardiac arrest - VT then VF --- monitor ABCs, LOC aminodaroine, lidocaine or magnesium sulfate will be given pt will need to be cardioverted if stable/defib if unstable with CPR VT with guide wire during central line************** |
