Which valve separates the RV and Pulmonary Artery?
Pulmonary Valve
Which valve separates the LV and Aorta?
Aortic Valve
What are the 3 layers of the heart?
Endocardium
Myocardium
Pericardium
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
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
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
The Conduction System:
Impulse being in the _______ _____
Sinoatrial Node (posterior RA)
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
Heart's natural pacemaker
Sinoatrial Node
ECGs
useful measure of detecting/differentiating between a normal or “sinus rhythm”
versus an abnormal rhythm which is know as an “__________”
arrhythmia
An Arrhythmia that may cause your heart to beat too slowly, less than 60 beats per minute
Bradycardia
An Arrhythmia that may cause your heart to beat too quickly, more than 100 beats per minute
Tachycardia
An Arrhythmia that may cause your heart to have uncoordinated contractions
Fibrillation
Arrhythmia that last < 7 days and start and stop on their own
Paroxsysmal
Arrhythmia that last < 7 days and typically require treatment to stop them
Persistent
Arrhythmia that are ongoing and resists most treatment attempts
Permanent/chronic
What are some causes of A-Fib?
Hyperthyroidism
Alcohol use ("Holiday Heart")
Pulmonary Embolism
Other cardiac conditions
The following are symptoms of what?
Feeling of “pounding or irregular heart beat”
Shortness of Breath
Tiredness
Dizziness or fainting
A-Fib Symptoms
When patient’s are in rapid a-fib (>____bpm) they are often considered not appropriate for
therapy
120
15% of all strokes are caused by this.
After age 60, 1/3 of all strokes are caused by this.
Atrial fibrillation
A-Fib & Stroke
Atria beat too fast which may lead to decreased “emptying” of atria and pooling leadig to _____
clots
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
Uncoordinated contractions of the ventricles
Requires immediate BLS interventions
Life threatening and the most commonly identified arrhythmia causing cardiac arrest
Ventricular Fibrillation
Generally helps treat a slow heart rhythm
Permanently implanted under skin
Monitors rhythm and generates electrical signals if needed
nRequires
lifelong follow up
Pacemaker
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)
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
True or false?
Blood pressure measurements are actually VENTRICULAR systole over diastole
True
Amount of blood ejected with each contraction
Normal 50-70 ml
Stroke Volume
Volume in ventricle at the end of diastole/has available to pump (blood volume, compliance of ventricles, diastolic filling time, atrial systole)
Preload
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
Heart’s contractile force (the force the muscle can create at the given length)
Contractility
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)
True or false:
Cardiomyopathy and heart failure can decrease cardiac output
True
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
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)
An ejection fraction less than __% is an indicator of systolic heart failure (pumping
action of the ♥ is reduced or weakened)
50%
What is normal EF?
50-70%
ef < 35% Patient may be at risk of life-threatening irregular heartbeats-these people may need an ____
Implantable Cardiac Defibrillator (ICD)
What does low LVEF usually impact?
Endurance - must be cautioned not to “overdo it”, as fatigue can be cumulative
A restriction in blood supply, generally due to factors in the blood vessels -> damage or dysfunction of the tissue
Ischemia
Most common cause of cardiac ischemia is ________ _______ in the coronary arteries
atherosclerotic plaques
Supply the heart muscle with oxygen rich blood
Have smooth, flexible walls that accommodate changes in blood flow
Healthy Coronary Arteries
When does Coronary Artery Disease begin?
Adolescence
Can affect any artery of the body
Can cause MIs, CVAs, angina, heart failure, sudden cardiac death, renal failure, PVD
Atherosclerosis
What are the Non-Modifiable Risk Factors? (4)
Age (men>45, women>55)
Family history (<60)
Male gender
Race
What are the Modifiable Risk Factors? (6)
Hypertension
High Cholesterol
Diabetes
Cigarette smoking
Being Overweight
Lack of Exercise
It is one of the leading causes of heart disease and it is the leading cause of death
in NA.
Hypertension
What are risks of hypertension? (6)
Stroke
Myocardial Infarction
CHF
End-stage renal failure
Atrial Fibrillation
Cognitive changes
What are some non pharmacological treatments for reducing hypertension? (7 ways)
Decrease:
-Alcohol
-Tobacco use
-Body weight
-Salt intake
-Stress
-Sleep apnea
Increase exercise
The term used to describe the range of clinical presentations of Coronary Artery Disease from unstable angina -> acute myocardial infarction
Acute Coronary Syndrome
Is angina a disease?
No, it's a symptom of coronary artery 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”
angina
Unlike a heart attack it does not cause lasting damage to the heart
Angina
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
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
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
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
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
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
What are 4 interventional procedures for angina?
Angioplasty
Stenting
Artherectomy
Bypass Surgery
How to stop an angina attack
Nitroglycerine Therapy- Fast Acting “Nitro”
Comes in tablet or spray form
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!
What is the defining factor of myocardial infarction?
irreversible myocardial necrosis (cell death) has occurred
What are 3 possible causes of myocardial infarction?
1. Acute thrombosis
2. Plaque fissure and hemorrhage
3. Coronary artery spasm
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
What type of myocardial infarction is this?
Usually a partial occlusion
Loss of a small amount of myocardium
NSTEMI
MI Risk Stratification: Low or high risk?
ASA, exercise, risk factor modification
Low
MI Risk Stratification: Low or high risk?
Beta blockers, coronary angiogram
Revascularization (PTCA or CABG)
High
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
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)
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
“Heart muscle disease” , deterioration
of the function of the myocardium
Cardiomyopathy
Disease of myocardium primarily affecting the left ventricle
Left ventricle becomes enlarged
Dilated Cardiomyopathy
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
Rarest form of cardiomyopathy
Abnormal diastolic function due to abnormally rigid ventricular walls
Restrictive Cardiomyopathy
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)
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
After CABG, return to week usually...
after 3 months
longer if diabetic, or work is physically demanding
What are the sternal precautions?
No lifting, pushing or pulling
>10 lbs. for 12 weeks
It is a device used to help the heart pump blood throughout the body when the heart is too weak
Ventricular Assist Device (VAD)
Abnormally high blood pressure in the pulmonary arteries, veins or capillaries leads to increased workload on right heart
Pulmonary HTN
Blockage of an artery in the lungs by fat, air, tumor tissue or a blood clot
Pulmonary Embolism
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