Cardiovascular system

  1. Was he ever size of the heart?
    Size of your fist .5" x 3.5"
  2. Was the PMI or point of maximal impulse?
    Pulsation arising at the apex of the heart to put the left ventricle
  3. What are the four chambers of the heart?
    • Right atrium and right ventricle,
    • left a tram left ventricle
  4. What are the four layers of the heart?
    • endocardium: inner lining of the heart, chambers and valves
    • myocardium: actual muscle
    • pericardium: sac surrounds the heart: composed of visceral and parietal layer
    • pericardial space: small amount of fluid in space acts as a lubricant-there's friction caused by movement of the layers with each contraction, contains about 50 mL of serious
  5. How does the Arterial coronary blood flow?
    Coronary arteries branch off just as the aorta leaves the heart.

    • Right coronary artery-supplies blood to the all right anterior surface of the heart and part of
    • the posterior LV. (IWMI, PWMI) 90 % of people AV node.

    LMCA – branches into the left circumflex (supplies the posterior and lateral LA/LV - LWMI), and the LAD (supplies the anterior heart to apex – AWMI).
  6. •What is ischemia?
    • Deficiency of blood due to constriction or obstruction of a blood vessel.
    • Results in tissue hypoxia which reduces the mechanical & electrical activity of the heart
  7. •Is ischemia reversible?
    May be reversible, depending on length of time ischemia occurs and the extent of muscle involved.
  8. •What is an infarction?
    Permanent loss of blood flow to myocardium-results in cell death, overall effect depends on the size of area deprived of O2.---alternate routes are developed in time to nourish the endangered myocardium, collateral blood supply. Causes are emboli, atherosclerotic plaque buildup in the arterial blood supply.
  9. Decsribe the conduction system.
    •Specialized Nerve Tissue
    • Conduction system is composed of specialized nerve tissue responsible for creating and transporting the electrical impulse, or action potential.
    • Cardiac cells have the ability to transmit electrical impulses.
  10. •Depolarization results from ion shifts through what ions?
    • Depolarization - Rapid influx of sodium & calcium ions into the cell & outflux of potassium ions—shift in electrolytes.
    • Causes muscle fibers to shorten and contract.
    • Electrical activity is synchronous with mechanical activity. Cells become positive inside.
  11. •Repolarization return to resting phase how?
    • Repolarization: electrical recovery, resting phase,
    • potassium moves back in,
    • sodium & calcium return to extracellular space.
    • Cell returns to negative state.
  12. •SA node Intrinsic pacemaker
    • SA node - It is the pacemaker of the heart,
    • it creates an electrical impulse, right atria near entrance of superior vena cava.
    • Intrinsic rate of 60-100.
  13. •AV node conducts impulse to Bundle Branches through what?

    •Bundle Branches conduct impulse to Purkinje fibers resulting in ventricular contraction
    • 1.Internodal pathways to reach the left atrium.
    • 2.AV node – rate of 40-60.
    • 5. Impulse terminates in the Purkinje fibers which trigger a uniform ventricular contraction.
  14. Valves prevent the backflow of blood.
    Atrioventricular valves: Tricuspid valve, Mitral valve – First heart sound S1.

    Semilunar valves: Aortic, pulmonic – Second heart sound S2.

    Chordae Tendeneae – attach to the cusps of the mitral and tricuspid valves. They are anchored in the Papillary muscles of the ventricles. Prevent eversion of the valve leaflets during ventricular contraction.

    Tricuspid and mitral (Atrioventricluar) prevent back flow of blood into the atria during contraction;

    • pulmonic and aortic (semilunar) prevent regurgitation into ventricles at end of each ventricular contraction:
    • All keep blood flowing in one direction
  15. Coronary arteries branch off just as the aorta leaves the heart. Fill during diastole.
    Right coronary artery – Supplies blood to the right anterior surface of the heart and part of the posterior LV. (IWMI, PWMI) 90 % of people AV node.

    LMCA – branches into the left circumflex (supplies the posterior and lateral LA/LV - LWMI), and the LAD (supplies the anterior heart to apex – AWMI).
  16. Venous Coronary Blood Flow where do they drain?
    Coronary veins – dump into the coronary sinus which drains directly into the right atrium.
  17. 1.ECG - Electrical activity of the heart detected on one’s body surface ---recorded—and yes ECG and EKG are the same terms.
    • 2.P, QRS, & T waves
    • 3.P wave—depolarization of fibers in atria—lasts .06-.12 seconds
    • 4.PR Interval - .12-.20 sec Conduction through A-V node.
    • 5.The QRS - .04-.10 seconds, ventricular contraction
    • 6.T wave—ventricular repolarization
    • 7.U wave—if seen—not normally seen—delayed ventricular repolarization, may be associated with hypokalemia, Digoxin toxicity.
  18. •What is cardiac output? HR X SV
    Total amount of blood pumped by each ventricle in 1 minute.

    • Normal adult at rest is 4L to 8L.
    • Measured by HR times Stroke Volume
    • (amount of blood ejected from the ventricle with each heartbeat – approx. 70cc).
  19. •Stroke Volume determined by preload, contractility and afterload.

    •What is preload?
    Volume of blood in ventricles at end of diastole before next contraction—it determines the amount of stretch placed on myocardial fibers
  20. •What is contractility?
    Contractility of the heart refers to the ability of the heart to depolarize, the force of contraction.

    It is affected by the autonomic nervous system.
  21. •What is afterload?
    Peripheral resistance which Left ventricle must pump against---affected by size of ventricle, wall tension, and arterial blood pressure.
  22. •What is Starling’s Law?
    Starling’s Law. Up to a point the more myocardial fibers are stretched the greater the force of contraction
  23. How does the Autonomic regulation of the cardiovascular system work?
    Barorecptors in aortic arch and carotids responsive to stretch

    Chemoreceptors in aortic arch and carotids responsive to pH, PO2 and PCo2

    Information conveyed to vasomotor center in brainstem
  24. Sympathetic Stimulation is effected by what?
    Release of Epinephrine and Norepinephrine

    •Epi and NE stimulate β-1 Receptors

    •NE stimulates α-1 receptors

    Increases Heart rate, conduction, contractility, and peripheral vasoconstriction.
  25. •Parasympathetic Stimulation is mediated by what?
    •Mediated by Vagus Nerve

    Slows Heart Rate, Contractility and Conduction.

    No Effect on periphery
  26. •What are the 3 major types of blood vessels?
    • Arteries
    • capillaries
    • veins
  27. What blood vessle carries blood away from heart (O2)?
    • Arteries—carries O2 blood
    • except for pulmonary artery—thick walls & elastic tissue, high pressure--major control of arterial BP
  28. What blood vessle carries blood toward heart (no O2)?
    • Veins—carry no O2 blood
    • except for pulmonary veins—return blood to right atrium—thin walled and large in diameter vessels—low pressure, high volume
  29. Which blood vessle exchanges cellular nutrients & metabolic end products?
    Capillaries—endothelial cells-no elastic or muscle tissue—thin walled vessels
  30. ECG

    Holter Monitor/ Event Monitor
    conduction defects, arrythmias, ischemia

    continually looks at heart rate
  31. HOLTER MONITOR & STRESS TEST, explain the process.
    Patient keeps monitor on for 24-48 hours and must keep a log of activities at all times—information is stored in holter monitor and printed out at a later time

    Stress testing: patient walks on treadmill or stationary bicycle—leads are placed on chest and watch BP, and O2 level—stop test if peak HR, peak exercise tolerance, chest pain, significant ST segment depression (indicates ischemia). Helps diagnose left ventricular function.
  32. What does the cardiac enzymes indicate, it's a marker of what?
    • •Indicate damage to myocardial cells.
    • •Markers of MI

    • •CK-MB
    • –> 5% of total
    • –Rise in 3-12 hours
    • –Peak in 24 hours
    • –Return to baseline in 48-72 hours
    • •Troponin T < 0.1 ng/ml is normal.
    • •Troponin I < 0.4 ng/ml is normal.
    • •Troponins
    • –Elevate within 3 hours
    • –Peak in 24-48 hours
    • –Return to baseline in 5-14 days
  33. Invasive Exam of Heart look at what +/- Coronary Vessels?
    Looks at valve function, ventricular function and presence of CAD
  34. Catheter Threaded through Femoral Artery or Vein?
    Vein for right cath.

    Artery for left cath
  35. Contrast Dye injected and X-rays taken, what is important to assess for?
    • Assess patient for allergy to Iodine, Shellfish or contrast Dyes.
    • Dye injection causes flushing sensation.
    • Patient can be sedated but awake
  36. Potential Complications of a cath, give some examples.
    MI, Embolus, Ventricular Puncture, Bleeding, Hematoma, Allergic Reaction, Arrhythmias, Death.
  37. What are some Cardiac Catheterization Nursing Considerations ?
    • •Informed Consent
    • •NPO 6-12 hours prior.
    • •Assess Allergy History
    • •Post-Procedure must keep leg straight for 6 hours.
    • •Monitor V/S, peripheral pulses, puncture site.
  38. What does Electrophysiology Study(EPS) look for?
    • *Invasive study to diagnose, induce and treat arrhythmias.
    • •Catheter inserted to right side of heart via femoral vein.
    • •Electrodes detect site of arrhythmia.
    • •Can ablate aberrant conduction pathways.
    • •Requires informed consent, NPO 6-8 hours prior.
  39. What are some Cardiovascular Effects of Aging?
    • •High rates of atherosclerosis
    • •Increased incidence of Hypertension.
    • •Increased rates of Valvular Calcification
    • •Decreased Heart Rate response to Exercise.
    • •Decreased Baroreceptor Function

    • 1.Difficult to differentiate normal aging from disease.
    • 2.Decreased CV reserve.
    • 3.Increased risk of orthostatic hypotension
  40. Cardiovascular Risk Factors?
    • •Hypertension
    • •Hyperlipidemia
    • •Diabetes
    • •Smoking
    • •Excessive ETOH
    • •Obesity
    • •Sedentary Lifestyle
  41. Cardiovascular risks
    • •Family History
    • •Age
    • •Race
    • •Sex
  42. Cardiovascular Physical Assessment History looks at what type of histories?
    • •Past Medical History
    • •Past Surgical History
    • •Family History
    • •Social History
    • •Review of Systems
  43. Past Medical History looks at what?
    Any heart disease, MI, Angina, Cardiac testing, Arrhythmias, Valve Disease, Rheumatic Fever, Diabetes, HTN, Meds
  44. •Past Surgical History?
    Any PTCA, CABG, Valve replacement etc.
  45. Family History
    Any relatives with CV disease age at onset, death.
  46. Social History
    Smoking, Alcohol, Drug use, Diet, Exercise
  47. Review of Systems
    Fatigue, Chest Pain, Syncope, Dyspnea, Palpitations, Claudication, Edema, PND, Orthopnea
  48. *Vital Signs
    •Auscultation of Heart
    •Abdominal Vessels
    •Assessment of Periphery
    • 1. BP, Pulse, Resp, O2 sat
    • 2. JVD, Carotids palpation and auscultation for bruits
    • 3.PMI, heaves, lifts, thrills.
    • 4.S1 S2 rate rhythm, murmurs, rubs, gallops
    • 5.AAA or bruits.
    • 6.Peripheral Pulses, Cap refill, Color, temperature, Edema
  49. What is the significance of a prolong PR interval?
    It measures the time it takes to get to the AV node
  50. What is the significance of a prolonded QRS interval?
    it is where depolarization of the ventrical takes place
  51. What are the clinical consequences of SA node dysfunction?
    LAV node takes over
Card Set
Cardiovascular system