Adult 1 unit 3 Cardiac

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Adult 1 unit 3 Cardiac
2012-02-18 23:17:00
Adult unit Cardiac

Adult 1 unit 3 Cardiac
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  1. CO cardiac output
    Cardiac output is the amount of blood pumped by the ventricles into the pulmonary and systemic circulations in 1 minute

    CO = HR x SV (stroke volume)

    Sv = end-diastolic volume (vintricle filling) -minus- end systolic volume (ventricle contraction) -ormal range is 60 to 100 ml/ beat

    CO normal range is 4 to 8 L/ min
  2. ischemic
    tissue is deprived of oxygen
  3. Cardiac Index
    CI is the CO adjusted for the patients body size (expressed as BSA body surface area- mm2)

    CI = CO x BSA

    CI = L/min/mm2
  4. hemostasis
    control of bleeding - series of complez interactions between platelets and clotting mechanisms that maintain a steady state of blood volume
  5. apical impulse
    visible pulsation in apical area (LICS 5MCL) - can been seen on inspection in about half of adult population
  6. Retraction
    pulling in of tissue on the prcordium - abnormal except at apical point
  7. CVD
    Cardiovascular disease - generic term for disorders of the heart and blood vessels
  8. CHD
    • Coronary Heart Disease -also called coronary artery disease
    • -impaired blood flow to the myocardium
    • -usually caused by atherosclerotic plaque in the coronary arteries

    -can lead to angina pectoris, acute coronary syndrome, MI, dysrhythmias, heart failure, and sudden death
  9. collateral channels
    • -connects smaller arteries
    • -if large coronary arteries are occluded, collateral channels enlarge and provide an alternative route for blood flow
  10. Atherosclerosis
    progressive disease characterized by atheroma (plaque) formation in the intimal and medial layers of large and midsize arteries

    -unknown precipitating factor causes lipoproteins and fibrous tissue to accumulate in vessel walls

    -narrows lumen of vessle, inhibits dialation of the vessel, can stimulate thrombosis (blood clot) and emboli (moving blood clot)
  11. Myocardial Ischemia
    myocardial cells become ischemic when oxygen supply is not enough to meet metabolic demand

    • caused by:
    • artherosclerosis
    • platelet aggregation in narrowed vessel (forms thrombus)
    • vessel spasm
    • drop in BP = inadequate flow

    Myocaridal cells have limited ATP - is no oxygen move to anerobic metabolism which has lactic acid byproduct

    Lactic acid buildup damages vessels

    Continued ischemia leads to cell necrosis and death (infarction)
  12. Risk factors for CHD
    Coronary Heart Disease

    • Non-modifiable:
    • Age
    • Men > 45
    • Women >55

    • Gender
    • Heredity

    • Modifiable:
    • Hyperlipidemia
    • Hypertension
    • Diabetes
    • Smoking
    • Obesity
    • Sedentary lifestyle
    • Diet
  13. MI
    Myocardial Infarction - necrosis (death) of myocardial cells

    -most often caused by unstable artherosclerosis where lesion breaks away and platelet aggregation is stimulated - forms thrombus that blocks vessels

    -if perfusion is not restored in 20 minutes permemant damage

    • S & S
    • -sudden pain not associated with activity
    • -pain is crushing or severe - pressure, heavy, squeezing sensation
    • -impending doom
    • -pain begins at center of chest - radiate to shoulders, neck, jaw, or arms
    • -lasts more than 20 minutes and is not relieved by Nitro or rest
  14. Manifiestations of MI
    • -CHEST PAIN -substernal or precordial - may radiate to jaw, neck, shoulder, or left arm
    • -Tachycardia, tachypnea
    • -Dyspnea
    • -Nausea & Vomiting
    • -Anxiety, impending doom
    • - Diaphoresis (excessive sweating)
    • -Cool, mottled skin - dimished peripheral pulses
    • -Hypotenion or hypertension
    • -Palpations, dysrhythmias
    • -Signs of left heart failure
    • -Decreased LOC
  15. Complications of MI
    • Dysrhythmias - most frequent complication
    • - infarction alters electrical conduction - possible v-fib (causes sudden cardiac death)

    • Pump Failure
    • -MI reduces myocardial contractility - cant pump blood
    • -Severity depends on chanbers affected
    • -Anterior infarcts of the left ventricle are most damaging

    • Infarct Extension
    • -10% experience extension or reinfarction during the first 10 to 14 days after MI

    • Structural Defects
    • Nicrotic tissue is replaced by scar tissue which is thinner than the ventricular muscle mass
    • -can cause a ventricular aneurysm (outpouching in ventricular wall) does not contract so SV is deminished and blood pools which may cause clot formation
    • -Damage to valves, papillary muscles or chordae tentinae cause valve insuffiencies

    • Pericarditis
    • inflammation of the pericardium (tissue surrounding heart) within 2 to 3 days after MI - causes chest pain (sharp, aching, stabbing) - pericardial friction rub may be heard
  16. Manifestations of MI in women and older adults
    Women and older adults tend to have atypical manifiestations of MI

    • Women:
    • epigastric pain and nausea (like heartburn)
    • SOB
    • fatigue, weakness of shoulders and arms

    • Older People:
    • difficulty breathing
    • dizziness
    • abdominal pain
    • cough