584 Cardiac pt. 1

Which valve separates the right chambers?

Which valve separates the left chambers?

Which valve separates the RV and Pulmonary Artery?

Which valve separates the LV and Aorta?

What are the 3 layers of the heart?

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

The muscle of the heart gets its oxygen rich blood supply via the ______ ______
which are located on the outer layer of the myocardium

Name the 4 main arteries that supply the heart muscle.

The Conduction System:
Impulse being in the _______ _____

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

Heart's natural pacemaker

ECGs
useful measure of detecting/differentiating between a normal or “sinus rhythm”
versus an abnormal rhythm which is know as an “__________” 

An Arrhythmia that may cause your heart to beat too slowly, less than 60 beats per minute

An Arrhythmia that may cause your heart to beat too quickly, more than 100 beats per minute

An Arrhythmia that may cause your heart to have uncoordinated contractions

Arrhythmia that last < 7 days and start and stop on their own

Arrhythmia that last < 7 days and typically require treatment to stop them

Arrhythmia that are ongoing and resists most treatment attempts

What are some causes of A-Fib?

The following are symptoms of what?
Feeling of “pounding or irregular heart beat”
Shortness of Breath
Tiredness
Dizziness or fainting

When patient’s are in rapid a-fib (>____bpm) they are often considered not appropriate for
therapy

15% of all strokes are caused by this.
After age 60, 1/3 of all strokes are caused by this.

A-Fib & Stroke
Atria beat too fast which may lead to decreased “emptying” of atria and pooling leadig to _____

Fast heart rhythm originating in one of the ventricles

Potentially life threatening as it could lead to ventricular fibrillation, asystole and sudden death

Uncoordinated contractions of the ventricles

Requires immediate BLS interventions

Life threatening and the most commonly identified arrhythmia causing cardiac arrest

Generally helps treat a slow heart rhythm

Permanently implanted under skin

Monitors rhythm  and generates electrical signals if needed

nRequires
lifelong follow up

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

What are the 3 Post pacemaker/ICD precautions?

True or false?
Blood pressure measurements are actually VENTRICULAR systole over diastole

Amount of blood ejected with each contraction
Normal 50-70 ml

Volume in ventricle at the end of diastole/has available to pump (blood volume, compliance of ventricles, diastolic filling time, atrial systole)

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)

Heart’s contractile force (the force the muscle can create  at the given length)

Amount of blood ejected from the heart in 1 minute

Key indicator of how well the heart is functioning

Normal 4.7 L/min

True or false:
Cardiomyopathy and heart failure can decrease cardiac output

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

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

An ejection fraction less than __% is an indicator of systolic heart failure (pumping
action of the ♥ is reduced or weakened)

What is normal EF?

ef < 35% Patient may be at risk of life-threatening irregular heartbeats-these people may need an ____

What does low LVEF usually impact?

A restriction in blood supply, generally due to factors in the blood vessels -> damage or dysfunction of the tissue

Most common cause of cardiac ischemia is ________ _______ in the coronary arteries

Supply the heart muscle with oxygen rich blood
Have smooth, flexible walls that accommodate changes in blood flow

When does Coronary Artery Disease begin?

Can affect any artery of the body
Can cause MIs, CVAs, angina, heart failure, sudden cardiac death, renal failure, PVD

What are the Non-Modifiable Risk Factors? (4)

What are the Modifiable Risk Factors? (6)

It is one of the leading causes of heart disease and it is the leading cause of death
in NA.

What are risks of hypertension? (6)

What are some non pharmacological treatments for reducing hypertension? (7 ways)

The term used to describe the range of clinical presentations of Coronary Artery Disease from unstable angina -> acute myocardial infarction

Is angina a disease?

It’s a WARNING sign that the heart is unable to balance oxygen demand and oxygen supply and results in  “chest pain” or “discomfort”

Unlike a heart attack it does not cause lasting damage to the heart

How does angina feel?

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 

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 

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

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”

What medications are given to relieve or prevent angina attacks and help control risk factors? (3)

What are 4 interventional procedures for angina?

How to stop an angina attack

What do you do if angina symptoms last for more than a few minutes or that go away and come back?

What is the defining factor of myocardial infarction?

What are 3 possible causes of myocardial infarction?

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)

What type of myocardial infarction is this?
Usually a partial occlusion
Loss of a small amount of myocardium

MI Risk Stratification: Low or high risk?
ASA, exercise, risk factor modification

MI Risk Stratification: Low or high risk?
Beta blockers, coronary angiogram
Revascularization (PTCA or CABG)

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

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

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 muscle disease” , deterioration
of the function of the myocardium 

Disease of myocardium primarily affecting the left ventricle
Left ventricle becomes enlarged 

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 

Rarest form of cardiomyopathy
Abnormal diastolic function due to abnormally rigid ventricular walls

Blockages are not removed, they are bypassed by creating a new pathway for blood flow with use of a graft

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

After CABG, return to week usually...

What are the sternal precautions?

It is a device used to help the heart pump blood throughout the body when the heart is too weak

Abnormally high blood pressure in the pulmonary arteries, veins or capillaries leads to increased workload on right heart

Blockage of an artery in the lungs by fat, air, tumor tissue or a blood clot

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