Npte - Cardiovascular/pulmonary Systems

Front 1

Neutrophils

Back 1

Help protect the body against infections by ingesting bacteria and debris
Normal count - 40-70%

Front 2

Lymphocytes

Back 2

3 types
T lymphocytes & natural killer cells - help protect against viral infections and can detect and destroy some cancer cells
B lymphocytes - develop into cells that produce antibodies
Normal count - 20-50%

Front 3

Monocytes

Back 3

Ingest dead or damaged cells and help defend against infectious organisms
Normal count - 4-8%

Front 4

Eosinophils

Back 4

Kill parasites, destroy cancer cells, and are involved in allergic responses
Normal count - 0-6%

Front 5

Basophils

Back 5

Participate in allergic responses
Normal count - 0-2%

Front 6

TLC

Back 6

Total lung capacity = RV + VC
or TLC = FRC + IC

Front 7

FRC

Back 7

Functional residual capacity
Volume of air in lungs after normal exhalation
= ERV + RV
40%

Front 8

IRV

Back 8

Inspiratory Reserve Volume
Maximal volume of air that can be inspired after normal tidal volume inhalation.
50%

Front 9

ERV

Back 9

Expiratory Reserve Volume
Air that can be exhaled after normal tidal exhalation
15%

Front 10

VC

Back 10

Vital capacity = ERV + TV + IRV
75%

Front 11

Blood pressure values for adults

Back 11

Normal - <120/80
Pre - 120-139/80-89
Stage I HTN - 140-159/90-99
Stage II HTN - >160/100

Front 12

pH

Back 12

7.4 (7.35-7.45)
Acidemia - <7.35
Alkalemia - >7.45

Front 13

PaCO2

Back 13

40 mmHg at sea level breathing ambient air
(35-45)
Eucapnia - normal CO2
Hypercapnia - >45
Hypocapnia - <45

Front 14

PaO2

Back 14

97 mmHG at sea level breathing ambient air
(80-100)
Mild hypoxemia - 60-79
Moderate hypoxemia - 40-59
Severe hypoxemia - <40

Front 15

HCO3-

Back 15

24 mEq/L
(22-26)

Front 16

SaO2

Back 16

95-98%

Front 17

ABG

Back 17

Arterial Blood Gas
Commonly written:
pH/PaCO2/PaO2/HCO3

Front 18

Hypoxia

Back 18

Low O2 in tissues despite adequate perfusion of the tissue

Front 19

Systematic Analysis of Arterial Blood Gas

Back 19

STEP 1 - Examine pH to assess acid-base balance
STEP 2 - Examine PaCO2 as an indicator of ventilatory status
STEP 3 - Interpret PaCO2 in relation to pH
STEP 4 - Interpret HCO3- in relation to pH
STEP 5 - Interpret PaO2 and SaO2

Front 20

Erythrocyte Count

Back 20

Males - 4.3-5.6 x 10^6/ml
Females - 4.0 - 5.2 x 10^6/ml

Front 21

Leukocyte Count

Back 21

3.45-9.06 x 10^3/mm^3

Front 22

Platelet Count

Back 22

165-415x10^3/mm^3

Front 23

Partial Thromboplastin Time (PTT)

Back 23

26.3-39.4 sec

Front 24

Hematocrit

Back 24

Males - 38.8-46.4%
Females - 35.4-44.4%

Front 25

Hemoglobin

Back 25

Males - 133-162 gm/dL
Females - 120-158 gm/dL

Front 26

Total Serum Cholesterol

Back 26

<200 mg/dL - Desirable
200-239 - Borderline
>240 - High

Front 27

LDL Cholesterol Levels

Back 27

<100 mg/dL - Optimal
100-129 - Near optimal
130 - 159 - Borderline
160 - 189 - High
'3E190 - Very High

Front 28

HDL cholesterol

Back 28

<40 - Low
>60 - High

Front 29

Triglyceride levels

Back 29

<150 mg/dL - Desirable
150-199 - Borderline
200 - 499 - High
>500 - Very high

Front 30

BMI

Back 30

Body Mass Index = weight (kg) / height (m ^ 2)
OR BMI = weight (lb) / height (in ^ 2) x 703
<18.5 = Underweight
18.5-24.9 - Normal
25.0 - 29.9 - Overweight
30.0 - 34.9 - Obesity (Class I)
35.0 - 39.9 - Obesity (Class II)
>40.0 - Extreme obesity (Class III)

Front 31

Borg Dyspnea Scale

Back 31

0 - No breathlessness
0.5 - Very, very slight
1 - Very slight
2 - Slight breathlessness
3 - Moderate
4 - Somewhat severe
5 - Severe breathlessness
6
7 - Very severe breathlessness
8
9 - Very, very severe breathlessness
10 - Maximal

Front 32

Prinzmetal (variant) angina

Back 32

occurs due to coronary artery spasm most often associated with coronary artery disease

Front 33

Angina pain pattern

Back 33

Usually described as pressure, heaviness, fullness, squeezing, burning, or aching behind the sternum
May also be felt in neck and back, jaw, shoulders, and arms.
May involve difficulty breathing, nausea, vomiting, sweating, anxiety or fear
Pain may not be felt until 70% of the lumen is occluded.

Front 34

Intermittent claudication

Back 34

a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue) classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest

Front 35

Cardiomyopathy

Back 35

Many causes including CAD, valvular heart disease
s/s - may be absent in early stages. Later -> breathlessness with exertion or even at rest, swelling of LE ankles or feet, abdominal distention, fatigue, irregular heartbeat, dizziness
3 Types:
- Dilated
- Hypertrophic
- Restrictive

Front 36

Chronic Venous Insufficiency (CVI)

Back 36

A condition in which the veins and valves in the lower extremity are damaged and cannot keep blood flowing toward the heart. This causes veins to remain filled with blood.
s/s - leg swelling, varicose veins, heaviness or cramping, itching, redness, skin ulcers
Tx - compression stockings and elevation of legs

Front 37

Atrial Septal Defect (ASD)

Back 37

Hole in the wall separating the R and L atria. Failure of foramen ovale to close.
May be asymptomatic up to 30 years old. Surgical closure recommended if hole is large, heart is swollen, or symptoms occur.

Front 38

Coarcation of the aorta

Back 38

Congenital heart defect in which the aorta is narrowed near the ductus arteriosus.
Ranges from mild to severe and may not be detected until adulthood.
s/s include SOB during exercise, intermittent claudication weakness, headache. High blood pressure in the arms, but low blood pressure in the legs.
Tx usually consists of surgical repair or balloon angioplasty.

Front 39

Ductus arteriosus

Back 39

A blood vessel connecting the pulmonary artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fetus's fluid-filled non-functioning lungs. Upon closure at birth, it becomes the ligamentum arteriosum.

Front 40

Patent ductus arteriosus (PDA)

Back 40

Ductus arteriosus does not close after birth.
s/s - small could be asymptomatic; large - tacycardia, respiratory distress, poor eating, weight loss, CHF
Non surgical tx for small hole include diuretics and idomethacin. Large may require surgical repair

Front 41

Ventricular septal defect (VSD)

Back 41

Hole in R/L ventricles. If too large, extra blood will be pumped to the lungs, leading to heart failure.
Small defect - hole may eventually close
Large - may cause cyanosis of skin, lips, fingernails, poor eating/failure to thrive, fast breathing or breathlessness, fatigue, swelling of legs, feet, or abdomen, rapid heart rate
Tx - surgery

Front 42

Tetralogy of Fallot

Back 42

1) VSD
2) pulmonary stenosis
3) right ventricular hypertrophy
4) aorta overriding the ventricular septal defect
Death or disability common by early adulthood. Tx - surgery to patch VSD and widen the pulmonary valve and arteries

Front 43

Cor Pulmonale

Back 43

Also known as pulmonary heart disease
Hypertrophy of R ventricle caused by altered structure or function of the lungs.
s/s - progressive SOB especially with exertion. Also fatigue, palpitations, atypical chest pain, swelling of LE, dizziness, syncope
Tx - supplemental oxygen to maintain SaO2 >90% and or PaO2 >60mmHg. Diuretics and anticoagulation

Front 44

Endocarditis

Back 44

Inflammation of endothelium that lines that heart and cardiac valves.
Can damage or destroy valves and become life-threatening.
Caused by bacteria from catheters, needles, dental procedures, gum disease, STD, or inflammatory bowel disease.
Tx - antibiotics and potential surgery to repair damaged heart valve

Front 45

Myocarditis

Back 45

Inflammation and weakness of the myocardium. It can become thick and swollen, which can lead to symptoms of heart failure.
Usually caused by viral or bacterial infection.

Front 46

Pericarditis

Back 46

Inflammation of the pericardium
Often, fluid builds up between the inner and outer layers, resulting in pericardial effusion.
Often, cases will clear up with rest and simple tx. More severe cases can lead to cardiac tamponadeq

Front 47

Exercise tx for peripheral artery disease

Back 47

minimum of 30-45 minutes, at least 3x per week for minimum of 12 weeks

Front 48

Rheumatic Fever

Back 48

Inflammatory disease that can develop as a complication of untreated or poorly treated strep throat. Can damage the heart valves and cause heart failure.

Front 49

ARDS

Back 49

Acute Respiratory Distress Syndrome
Sudden respiratory failure due to fluid in the alveoli. Typically occurs in people who are already critically ill or who have significant injuries.
Fatal in 25-50%
Inflammation disrupts the integrity of alveolar wall causing fluid leakage
First goal of tx is to get O2 to lungs and tissues

Front 50

Atelectasis

Back 50

lung collapse in one or more areas
Caused by conditions that prevent deep breathing and coughing, such as post-op pain, pleural effusion, tumor, ARDS, asthma, COPD, and cystic fibrosis

Front 51

Bronchiectasis

Back 51

Progressive obstructive lung disease that produces abnormal dilation of a bronchus. This is an irreversible condition usually associated with chronic infections, aspiration, cystic fibrosis, or immune system impairment. Th bronchial walls waken over time due to infection and allow for permanent dilation of bronchi and bronchioles.

Front 52

Bronchitis

Back 52

Ain't nobody got time for that

Front 53

Bronchitis

Back 53

Inflammation of the bronchi, with hypertrophy of mucus secreting glands, increased mucous production, and insufficient oxygenation due to mucus blockage
Acute or chronic

Front 54

COPD

Back 54

Chronic Obstructive Pulmonary Disease
Emphysema + Chronic Bronchitis
Impaired air flow and narrowing of bronchial tree
Alveolar destruction and air trapping
Increased TLC and RV

Front 55

Cystic Fibrosis

Back 55

Autosomal recessive disease of the exocrine glands that primarily affects the lungs, pancreas, liver, intestines, sinuses, and sex organs.
Must inherit one faulty genes from each parent.
Body produces thick, sticky mucous that leads to life-threatening lung infections, obstructs the pancreas, and inhibits normal digestion and absorption of food.

Front 56

Emphysema

Back 56

Destruction of alveolar walls
Elastic fibers that hold bronchioles open are destroyed, so that they collapse during exhalation, not letting air escape from the lungs.
Increased dead space
Primarily caused by smoking

Front 57

Pleural Effusion

Back 57

Buildup of fluid in pleural space between lungs and chest cavity.
Can push against lungs making inhalation difficult, and in severe cases can cause atelectasis.
If fluid gets infected it's called empyema.

Front 58

Pneumonia

Back 58

Inflammation of lungs, typically caused by bacterial, viral, fungal, or parasitic infection.

Front 59

Pulmonary edema

Back 59

LIFE THREATENING MEDICAL EMERGENCY
When fluid collects in alveoli making it different to breathe.
Often occurs when left ventricle is unable to pump properly.
May also occur from pneumonia, toxin inhalation, ARDS
s/s include
- extreme SOB
- a bubbly, wheezing or gasping sound during breathing
- a cough that produces frothy sputum that may be tinged with blood
- cyanotic skin color
- rapid, irregular pulse
- severe drop in BP

Front 60

s/s of pulmonary edema

Back 60

- extreme SOB
- a bubbly, wheezing or gasping sound during breathing
- a cough that produces frothy sputum that may be tinged with blood
- cyanotic skin color
- rapid, irregular pulse
- severe drop in BP

Front 61

s/s of pulmonary embolism

Back 61

sudden onset SOB,
chest pain that becomes worse with deep breathing, coughing, eating, or bending;
coughing up bloody sputum,
wheezing,
LE swelling,
excess sweating,
rapid or irregular pulse,
lightheadedness or fainting

Front 62

Prevention of pulmonary embolism

Back 62

Compression stockings, pneumatic compression, physical activity, and drinking fluids

Front 63

Pulmonary fibrosis

Back 63

Microscopic damage to alveoli causes irreversible scarring of the interstitial tissue. This decreases lung elasticity, making breathing more difficult.
Most cases are idiopathic. However, can be caused by chronic exposure to irritants (silica dust, asbestos, grain dust, sugar cane, animal droppings)
Lung scarring is irreversible

Front 64

Restrictive Lung Disease

Back 64

An abnormal reduction in lung expansion and pulmonary ventilation.
Causes:
- abnormal parenchyma (atelectasis, pneumonia, PF, pulmonary edema, ARDS),
- abnormal pleura (pleural effusion, pleural fibrosis, pneumothorax, hemothorax)
- disorders affecting ventilatory pump function (decreased respiratory drive, neurologic and neuromuscular diseases, muscle disease or weakness, thoracic deformity or trauma, connective tissue disorders affecting thoracic joints, pregnancy, obesity, ascites)

Front 65

Artery that supplies the right atrium

Back 65

Sinus node artery

Front 66

Artery that supplies the right ventricle

Back 66

Right marginal artery

Front 67

Supply the inferior walls of both ventricles
and inferior portion of the interventricular septum

Back 67

Posterior descending artery

Front 68

Supplies left atrium, posterior and lateral walls of left ventricle, and anterior/inferior walls of left ventricle

Back 68

Circumflex artery

Front 69

Supply anterior portion of interventricular septum

Back 69

Left anterior descending artery

Front 70

Muscles of inhalation

Back 70

Diaphragm (primary)
Internal/external intercostals - elevates the ribs, increases AP chest diameter, and elevation of lower ribs increases transverse diameter
Also SCM, scalenes, pec major (sternocostal portion), pec minor, and serratus during high levels of ventilation

Front 71

Muscles of exhalation

Back 71

Tidal breathing - exhalation results from passive recoil of lungs and rib cage.
Forceful breathing - rectus, internal/external oblique, and TrA depress lower ribs and compress abdominal contents, pushing diaphragm up

Front 72

Upper respiratory tract

Back 72

Larynx and superior

Front 73

Lower respiratory tract

Back 73

Larynx and inferior
Airways divide ~23 times

Front 74

Baroreceptor Reflex

Back 74

Maintains blood pressure
Low pressure (cardiopulmonary receptors) -> Sympathetic activation -> increased cardiac contractility, incrased HR, venoconstriction, arterial vasoconstriction, to increase cardiac output and peripheral resistance -> increased BP
High blood pressure (arterial baroreceptors) -> parasympathetic activation -> decreased HR, small dec in contractility -> dec BP

The Bainbridge reflex and the baroreceptor reflex act antagonistically to control heart rate. The baroreceptor reflex acts to decrease heart rate when blood pressure rises. When blood volume is increased, the Bainbridge reflex is dominant; when blood volume is decreased, the baroreceptor reflex is dominant.

Front 75

Bainbridge reflex

Back 75

Increased venous return -> stretches receptors in R atrium -> afferent vagal signals -> medulla inhibits parasympathetic activity -> increased heart rate

The Bainbridge reflex and the baroreceptor reflex act antagonistically to control heart rate. The baroreceptor reflex acts to decrease heart rate when blood pressure rises. When blood volume is increased, the Bainbridge reflex is dominant; when blood volume is decreased, the baroreceptor reflex is dominant.

Front 76

Chemoreceptor reflex

Back 76

Decreased pH (acidosis) or dec partial oxygen pressure leads to increased rate and depth of ventilation

Front 77

Valsalva maneuver

Back 77

Increases intrathoracic pressure, decreasing venous return. This decreases CO and BP
This is sensed by baroreceptors, which respond by increasing HR and contractility via sympathetic stimulation

Front 78

Cardiac conduction

Back 78

Front 79

Pacemaker Codes

Back 79

I - Chamber Paced
V = ventricle; A = atrium; D = dual; O=none

II - Chamber Sensed
same

III - Response sensed
T = Triggered; I=Inhibited; D=dual, O = none

IV - Rate modulation
R - Rate modulation; O=none

V - Multisite pacing
V = ventricle; A=atrium; D=dual; O=none

Front 80

Artherectomy

Back 80

similar to angioplasty but instead the catheter removes plaque with a rotating shaver

Front 81

Cardiac Ablation

Back 81

surgical procedure that uses radiofrequencies or chemicals to destroy areas of the myocardium that have been identified to be causing cardiac arrhythmia

Front 82

Enhanced Extracorporeal Graft Surgery

Back 82

Inflation of pressure cuffs on LEs compresses veins and assists w venous return to heart

Front 83

Ventricular Assist Devices

Back 83

miniature pump that is implanted in the chest to provide mechanical support to the ventricle

Front 84

Angina Pain Scale

Back 84

1 - Mild, barely noticable
2 - Moderate, bothersome
3 - Moderately severe, very uncomfortable
4 - Most severe or intense pain ever experienced

Front 85

Ankle Brachial Index (ABI)

Back 85

Compares systolic BP at ankle and arm to check for peripheral artery disease
Divide higher of two systolic LE BP measurements by higher of arm BP
> 1.30 - rigid arteries and need for an ultrasound to check for PAD
1-1.3 normal, no blockage
.8-.99 - mild, beginnings of PAD
.4-0.79 - moderate block; may be associated with intermittent claudication during exercise
<0.4 - severe blockage suggesting severe PAD; may have claudication pain at rest