584 Cardiac pt. 1

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584 Cardiac pt. 1
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584 Cardiac pt. 1
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  1. Which valve separates the right chambers?
    Tricuspid Valve
  2. Which valve separates the left chambers?
    Mitral Valve
  3. Which valve separates the RV and Pulmonary Artery?
    Pulmonary Valve
  4. Which valve separates the LV and Aorta?
    Aortic Valve
  5. What are the 3 layers of the heart?
    • Endocardium
    • Myocardium
    • Pericardium
  6. Pericardium-thin double layer that forms a protective sac around the outside of the heart.
    Contains a small amount of a lubricant fluid- pericardial fluid
    Pericardium
  7. The muscle of the heart gets its oxygen rich blood supply via the ______ ______
    which are located on the outer layer of the myocardium
    coronary arteries
  8. Name the 4 main arteries that supply the heart muscle.
    • 1. Right coronary artery
    • 2. Left main artery
    • 3. Left anterior descending artery
    • 4. Circumflex artery
  9. The Conduction System:
    Impulse being in the _______ _____
    Sinoatrial Node (posterior RA)
  10. The Conduction System:
    Impulse goes to the ___________ _____ which slows the signal before it enters the ventricle to give the atria time to contract before the ventricles
    Atrioventricular Node
  11. Heart's natural pacemaker
    Sinoatrial Node
  12. ECGs
    useful measure of detecting/differentiating between a normal or “sinus rhythm”
    versus an abnormal rhythm which is know as an “__________” 
    arrhythmia
  13. An Arrhythmia that may cause your heart to beat too slowly, less than 60 beats per minute
    Bradycardia
  14. An Arrhythmia that may cause your heart to beat too quickly, more than 100 beats per minute
    Tachycardia
  15. An Arrhythmia that may cause your heart to have uncoordinated contractions
    Fibrillation
  16. Arrhythmia that last < 7 days and start and stop on their own
    Paroxsysmal
  17. Arrhythmia that last < 7 days and typically require treatment to stop them
    Persistent
  18. Arrhythmia that are ongoing and resists most treatment attempts
    Permanent/chronic
  19. What are some causes of A-Fib?
    • Hyperthyroidism
    • Alcohol use ("Holiday Heart")
    • Pulmonary Embolism
    • Other cardiac conditions
  20. The following are symptoms of what?
    Feeling of “pounding or irregular heart beat”
    Shortness of Breath
    Tiredness
    Dizziness or fainting
    A-Fib Symptoms
  21. When patient’s are in rapid a-fib (>____bpm) they are often considered not appropriate for
    therapy
    120
  22. 15% of all strokes are caused by this.
    After age 60, 1/3 of all strokes are caused by this.
    Atrial fibrillation
  23. A-Fib & Stroke
    Atria beat too fast which may lead to decreased “emptying” of atria and pooling leadig to _____
    clots
  24. Fast heart rhythm originating in one of the ventricles

    Potentially life threatening as it could lead to ventricular fibrillation, asystole and sudden death
    Ventricular Tachycardia
  25. Uncoordinated contractions of the ventricles

    Requires immediate BLS interventions

    Life threatening and the most commonly identified arrhythmia causing cardiac arrest
    Ventricular Fibrillation
  26. Generally helps treat a slow heart rhythm

    Permanently implanted under skin

    Monitors rhythm  and generates electrical signals if needed

    nRequires
    lifelong follow up
    Pacemaker
  27. Helps treat dangerous fast rhythms

    Permanently implanted under skin

    Continuously monitors rhythm and if it senses a HR that is too fast it will pace
    the heart

    If needed the ICD can send out one or several shocks to return the heart to normal rhythm

    Requires lifelong follow-up

    Avoid electromagnetic fields
    Implantable Cardioverter Defribrillator (ICD)
  28. What are the 3 Post pacemaker/ICD precautions?
    • •No lifting, pushing, pulling >10 lbs.
    • •No lifting arm above 90 degrees
    • •On side of insertion for ~ 6-8 weeks
  29. True or false?
    Blood pressure measurements are actually VENTRICULAR systole over diastole
    True
  30. Amount of blood ejected with each contraction
    Normal 50-70 ml
    Stroke Volume
  31. Volume in ventricle at the end of diastole/has available to pump (blood volume, compliance of ventricles, diastolic filling time, atrial systole)
    Preload
  32. Pressure the ventricle pumps against to overcome resistance of vascular system-
    (technical name is systemic vascular resistance)- (factors that influence
    afterload- vessel diameter, blood viscosity, anatomical obstruction)
    Afterload
  33. Heart’s contractile force (the force the muscle can create  at the given length)
    Contractility
  34. Amount of blood ejected from the heart in 1 minute

    Key indicator of how well the heart is functioning

    Normal 4.7 L/min
    Cardiac Output (Q)
  35. True or false:
    Cardiomyopathy and heart failure can decrease cardiac output
    True
  36. A cardiodynamic measure based on cardiac output
    Uses the individual’s body surface area
    More sensitive indicator or actual perfusion of cardiac output to the tissues
    Normal is 2.6 to 4.2 L/min/m2
    Cardiac Index
  37. Fraction of blood ejected by the ventricle, relative to end diastolic volume
    End Diastolic Volume (EDV)= volume of blood in the ventricle after filling (~120 ml)

    ____ = Stroke Volume/EDV
    Ejection Fraction (EF)
  38. An ejection fraction less than __% is an indicator of systolic heart failure (pumping
    action of the ♥ is reduced or weakened)
    50%
  39. What is normal EF?
    50-70% 
  40. ef < 35% Patient may be at risk of life-threatening irregular heartbeats-these people may need an ____
    Implantable Cardiac Defibrillator (ICD)
  41. What does low LVEF usually impact?
    Endurance - must be cautioned not to “overdo it”, as fatigue can be cumulative
  42. A restriction in blood supply, generally due to factors in the blood vessels -> damage or dysfunction of the tissue
    Ischemia
  43. Most common cause of cardiac ischemia is ________ _______ in the coronary arteries
    atherosclerotic plaques
  44. Supply the heart muscle with oxygen rich blood
    Have smooth, flexible walls that accommodate changes in blood flow
    Healthy Coronary Arteries
  45. When does Coronary Artery Disease begin?
    Adolescence
  46. Can affect any artery of the body
    Can cause MIs, CVAs, angina, heart failure, sudden cardiac death, renal failure, PVD
    Atherosclerosis
  47. What are the Non-Modifiable Risk Factors? (4)
    • Age (men>45, women>55)
    • Family history (<60)
    • Male gender
    • Race
  48. What are the Modifiable Risk Factors? (6)
    • Hypertension
    • High Cholesterol
    • Diabetes
    • Cigarette smoking
    • Being Overweight
    • Lack of Exercise
  49. It is one of the leading causes of heart disease and it is the leading cause of death
    in NA.
    Hypertension
  50. What are risks of hypertension? (6)
    • Stroke
    • Myocardial Infarction
    • CHF
    • End-stage renal failure
    • Atrial Fibrillation
    • Cognitive changes
  51. What are some non pharmacological treatments for reducing hypertension? (7 ways)
    • Decrease:
    • -Alcohol
    • -Tobacco use
    • -Body weight
    • -Salt intake
    • -Stress
    • -Sleep apnea

    Increase exercise
  52. The term used to describe the range of clinical presentations of Coronary Artery Disease from unstable angina -> acute myocardial infarction
    Acute Coronary Syndrome
  53. Is angina a disease?
    No, it's a symptom of coronary artery disease
  54. It’s a WARNING sign that the heart is unable to balance oxygen demand and oxygen supply and results in  “chest pain” or “discomfort”
    angina
  55. Unlike a heart attack it does not cause lasting damage to the heart
    Angina
  56. How does angina feel?
    • Often described as “chest pain”
    • May have pain, heaviness, tightness, pressure, burning, or aching
    • Symptoms can be located in chest, back, neck, throat, or jaw. Sometimes even felt in
    • arms, elbows, wrists or shoulders
    • Other symptoms can occur at same time: sweating, nausea, fatigue, SOB,
    • lightheadedness, increased or irregular HR
  57. Predictable pattern of occurrence
    Caused by consistent precipitating factors such as exercise or emotional upset
    Controlled by rest and nitrates (nitroglycerine)
    Described by patients as my “usual
    chest pain”
    Will usually find fixed atherosclerotic lesion
    >75% on angiography 
    Stable Angina
  58. Defined as a change in a previously established stable pattern, or a new onset of severe angina
    Occurs without cause (i.e. can occur at rest)
    An attack usually lasts longer than
    is typical with stable angina (15-20 min)
    Does not respond well to nitroglycerine
    Often the result of an unstable plaque that has ruptured
    WARNING sign that a heart attack may
    happen 
    Unstable Angina
  59. Sudden narrowing of a coronary artery (spasm) causing a decrease or stop in blood flow
    Atherosclerosis may or may not be present
    Commonly occurs at rest
    May occur without cause or be triggered by:
    Tobacco
    Alcohol withdrawal
    Emotional stress
    Stimulant drugs (amphetamines, cocaine)
    Medications that cause vasoconstriction
    Variant Angina
  60. The patient is symptom free even though the heart’s oxygen supply is compromised
    Most commonly seen in diabetics. Similar to peripheral neuropathy, consider this
    like a “cardiac neuropathy”
    Silent Angina
  61. What medications are given to relieve or prevent angina attacks and help control risk factors? (3)
    • Nitroglycerine-this
    • dilates the blood vessels and reduces the hearts workload. Fast acting and long
    • acting (tablet patch or ointment)
    • Beta-Blockers - Reduce the HR and
    • force of heart beat and lower blood pressure
    • Calcium Channel Blockers - dilate
    • blood vessel and slow HR
  62. What are 4 interventional procedures for angina?
    • Angioplasty
    • Stenting
    • Artherectomy
    • Bypass Surgery
  63. How to stop an angina attack
    • Nitroglycerine Therapy- Fast Acting “Nitro”
    • Comes in tablet or spray form
  64. What do you do if angina symptoms last for more than a few minutes or that go away and come back?
    Heart attack -get help!
  65. What is the defining factor of myocardial infarction?
    irreversible myocardial necrosis (cell death) has occurred
  66. What are 3 possible causes of myocardial infarction?
    • 1. Acute thrombosis
    • 2. Plaque fissure and hemorrhage
    • 3. Coronary artery spasm
  67. What type of myocardial infarction is this?
    Usually a complete occlusion of a single vessel
    Loss of a large amount of myocardium (full wall thickness injury)
    STEMI
  68. What type of myocardial infarction is this?
    Usually a partial occlusion
    Loss of a small amount of myocardium
    NSTEMI
  69. MI Risk Stratification: Low or high risk?
    ASA, exercise, risk factor modification
    Low
  70. MI Risk Stratification: Low or high risk?
    Beta blockers, coronary angiogram
    Revascularization (PTCA or CABG)
    High
  71. The abrupt cessation of normal circulation of blood due to failure of the heart to contract effectively

    Lack of oxygen to the brain leads to loss of consciousness and abnormal or absent
    breathing

    Clinically diagnosed by absence of a pulse
    Cardiac Arrest
  72. State in which the heart cannot pump a sufficient supply of blood to meet the physiological requirements of the body, or
    requires elevated pressures to do so
    Heart Failure (CHF)
  73. A chronic, progressive condition that is life limiting
    A terminal condition
    There is no "cure"
    It is common and its prevalence is on the rise
    Heart Failure
  74. “Heart muscle disease” , deterioration
    of the function of the myocardium 
    Cardiomyopathy
  75. Disease of myocardium primarily affecting the left ventricle
    Left ventricle becomes enlarged 
    Dilated Cardiomyopathy
  76. Disease of the myocardium in which a portion of the myocardium is abnormally
    hypertrophied (thickened) making it harder for the heart to pump blood
    Often goes undiagnosed because often has few, if any symptoms
    Usually caused by gene mutation
    Often causes arrhythmia’s 
    Hypertrophic Cardiomyopathy
  77. Rarest form of cardiomyopathy
    Abnormal diastolic function due to abnormally rigid ventricular walls
    Restrictive Cardiomyopathy
  78. Blockages are not removed, they are bypassed by creating a new pathway for blood flow with use of a graft
    Coronary Artery Bypass Graft (CABG)
  79. Possible Complications Post _______:
    Infection
    Acute renal failure
    Cerebrovascular complications
    Memory problems of confusion
    Nerve injury or muscle spasms
    Changes in vision, vocal cord function or dsyphagia
    CABG
  80. After CABG, return to week usually...
    • after 3 months 
    • longer if diabetic, or work is physically demanding
  81. What are the sternal precautions?
    • No lifting, pushing or pulling
    • >10 lbs. for 12 weeks
  82. It is a device used to help the heart pump blood throughout the body when the heart is too weak
    Ventricular Assist Device (VAD)
  83. Abnormally high blood pressure in the pulmonary arteries, veins or capillaries leads to increased workload on right heart
    Pulmonary HTN
  84. Blockage of an artery in the lungs by fat, air, tumor tissue or a blood clot
    Pulmonary Embolism
  85. An abnormal accumulation of fluid in the pleural space
    Can impair breathing by limiting expansion of the lungs and cause: Chest Pain, Cough, Fever, SOB, Rapid breathing
    Pleural Effusion

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