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Blood pumped into the pulmonary artery is still _______ blood.
Bicusped or mitral valve is located where?
between the left atrium and laft ventricle
The tricusped valve is located where?
between the right atrium and right ventricle
Sinoatrial Node (S-A node) is located where?
posterior wall of the right atrium
Note: The S-A node initiates the heartbeat without outside stimulation.
The impulse passes along fibers to A-V Node
Atrioventricular Node (A-V Node) is located where?
Floor of the right atrium
Note: A-V Node impulse passes into group of fibers called bundle of His
- bundle of His conducts impulses from atria to ventricle
- terminates in Purkinje fibers
Vegas nerve _____ the heart during rest and sleep and also transmits ________ which causes __________.
- slows the heart
- acetycholine, slowdown
The vegas nerve is known as a cardio-_______.
Nerves of the _________ portion of the autonomic nervous system are cardiac-_________>
The sympathetic autonomic nervous system releases ______ which is a cardio-accelerator.
What type of line measures pressure of blood in the right atrium that is inserted via the jugular or subclavian to distal SVC?
Central venous pressure (CVP) line
What type of catheter permits monitoring of CVP (placed in right atrium or SVC) that has a proximal lumen port that is used for administration of drugs and fluid?
Type of catheter? Soft flow directed catheter with balloon at the tip for measuring: pulmonary arteriole pressure, arterial pressure, right atrial pressures (CVP), left atrial pressures, reflected left ventricular end diastolic pressure?
Note: Swans-Ganz catheter is introduced into the basilic or subclavian vein, to the SVC, to the right atrium, to the right ventricle, to the right pulmonary artery.
Can also be placed into the femoral vein to IVC if they cannot go another route
The _____ ventricle is not well visualized in a PA chest projection.
The heart is in the right side of the chest with the apex pointing to the right. *Just the heart*
Define situs inversus
- Transposition of organs to the opposite side of the body.
- Will notice the fundus of the stomach on the right side of the body.
For a normal adult heart size, the transverse diameter of the heart shadow should be _____________________ of the transverse diameter of thorax inside the rib cage.
- less than 1/2.
- If it is more than 1/2, it is cardiomegaly
Heart size can not be accurately estimated on AP supine CXR because?
- diaphragm moves up
- heart is further away from film-magnified
- less than 72" SID (40-48)
What is introduced directly into one of the chambers of the heart or pulmonary artery that records hemodynamic and physiologic information?
Note: Left cardiac cath- arteriole access. Use pigtail catheter (non-tramic shape) for left ventricle. Pushes through aortic semilunar valve and into left ventricle (dysrhythmia common)
- Contrast is injected, films taken, pressure measurements taken across aortic valve and left ventricle (should be same).
- If aortic pressure is low-stenosis of valve.
Cardiac catheterization (arteriole access) is used to diagnosis _______, _________, ______ of the _____heart.
- occlusions of vessels on the left side of the heart
- congenital abnormalities
Right cardiac catheterization (venous access). Line into ________ (_____-alternate) to the IVC, to right atrium, to right ventricle, to _______.
- femoral vein, alternate basilic
- pulmonary artery
Right Cardiac Catherterization path? (normal)
Femoral vein-IVC-right atrium-right ventricle-pulmonary artery
Type of catheter preferred for right cardiac catheterization?
Information obtained with a right cardiac cath?
- chamber pressure
- condition of heart wall
- O2 levels
- cardiac volume
- overall function
Pathway of coronary angiography?
femoral artery to root of aorta where coronary arteries connect
Power inject or manually inject contrast in coronary angiography? Why?
manual, less dysrhythmias
PTCA- percutaneous transluminal coronary angioplasty. What is it?
A catheter is placed into the coronary vessel, a ballon is inflated to open stenotic vessels. (Pushes the buildup against the vessel wall)
DCA- directional coronary atherectomy. What is it?
Catheter is placed into stenotic coronary vessel, a cutting device is attached to the ballon that is inflated.
PTCRA-percutaneous transluminal coronary rotational ablation. What is it?
Rotoblade removes plaque
Cutting device shaves plaque and vacuum extracts the debris
Note: Echo stress test: Pt walks on treadmill or rides bike, or may be given drug that stresses the heart.
Heart readings are taken using echo transducer that produce image.
Fetal Circulation: Umbilical vein carries blood with oxygen adn nutrients from placenta to fetus, opens into ductus venosis.
Ductus venosis conducts about 1/2 the blood from umbilical vein to IVC bypassing the fetal liver.
Foramen ovale? Purpose?
- opeing between right and left artium of the heart in the fetus.
- Allows blood to bypass the lungs
Ductus arteriosus? Purpose?
- Vessel in the fetus that connects the pulmonary artery with aorta.
- bypass nonfunctioning lungs
Umbilical arteries, how many and what is their function?
paired arteries, carry blood (CO2, waste) from internal iliac arteries to placenta for reoxygenation
Umbilical vein becomes completely closed by ________-____ day after birth and degenerates into the ___________ of the liver.
Ductus venosis closes by the ____-____ day after birth and degenerates into the _______ of the liver.
Foramen ovale closes by about the _____ day after birth. If it fails to close it causes "late" _______.
Ductus arteriosis completely closes by the ____-____ day after birth, degenerates into the ______________. If it fails to close it will cause ________.
- ligimentum arteriosum
Congenital heart anomalies occur in ____-____ babbies per 1000 live births in the US.
ASD- Atrial septal defect. What happens?
Foramen ovale in atrial septum fails to close, left to right shunting.
Any right to left atrial shunting causes?
ASD may have the radiographic appearance of?
increased pulmonary artery size
VSD-ventricular septal defect. What causes it?
Hole between the ventricles. Left to right shunting.
Radiographic appearance of VSD?
Increased left artial and ventricular size as well as increased pulmonary size.
What are teh four defects of Tetralogy of Fallot?
- Pulmonary stenosis
- Hypertrophy of right ventricle
- Displacement of Aorta (blood enters aorta from both ventricles)
What is the radiographic appearance of tetralogy of Fallot?
A boot shaped heart due to hypertrophy of right ventricle.
PDA-patent ductus arteriosus?
Failure of ductus arteriosus to close. Blood flows from aorta to pulmonary artery
Coarctation of Aorta?
narrowing or stricture of aorta usually distal to subclavian with dilation of aortic arch proximal to coarctation.
What pathology caused increased pulse in arms and decreased pulse in legs?
Coarctation of the aorta
CAD- coronary artery disease?
narrowing of coronary arteries around the heart
Predesposing factors of CAD?
- high cholesterol
- lack of exercise
acute chest pain
dilation of coronary arteries
Acute ischemic necrosis of an area of myocardium is defined as?
Most common site of the heart for an MI?
Left ventricle- works the hardest
Visualization techniques for MI?
- radionuclide thalium perfussion scanning
- coronary angiography
What is the definitive study to determine CAD?
coronary angiography (it is an invasive study)
CABG- coronary artery bypass graft is a repair of a coronary artery with a graft from the ________ in the leg.
PTCA- Percutaneous transluminal coronary angioplasty uses a __________ to _______ narrowed areas.
- uses a balloon to dialte narrowed areas
- Balloon is infalted to push bloackage up against arteriole wall
PTCRA-percutaneous transluminal coronary rotational ablation ________ plaque.
pulverizes (high speed rotoblade covered with diamond crystals), which disperses it into the circulation
DCA- Directional coronary atherectomy.
Cuts plaque, keeps in catheter then it can be removed
Inflammation in the blood stream is a newly recongnized cause of MI's which is linked to _______ and __________.
- long standing gum disease
- chronic urinary tract infections
CHF? What is it?
- Congestive heart failure
- inability of the heart to propell blood at an efficient rate and volume. Results in congestion of circulatory system
Major cause of CHF?
CHF-Left ventricular failure?
- left ventricle cannot pump enough blood equal to the venous return in the right ventricle. (Most common)
- pulmonary vein backs up
- can lead to pulmonary edema
CHF-Right ventricular failure?
- Right ventricle cannot pump as much blood as it receives from the right atrium
- leads to engorgement of SVC and IVC and edema of the lower extremities
Left vs Right ventricular failure:radiographic appearance?
- Left- increased vascular markings
- Right- right ventricle and atrium enlarged
Pulmonary edema is the most common sign of?
CHF-left ventricular failure
What is the most common cause of pleural effusions?
Hypertension results from persistant ________ resistance.
- type of arteriosclerosis
- artery wall thickens as the result of a build-up of fatty materials (plaque)
hardening or thickening (sclerosis) of the arterial walls
Prolonged HBP forces teh heart to overwork causes ______ to enlarge and eventually fail.
Hypertensive heart disease: An enlarged left ventricle wall has _____ blood flow due to _______ chamber size which leads to _______ cardiac output.
CVA? What is it?
Cerebral vascular accident: occlusion of cerebral or carotid arteries leads to ischemia of brain tissue
Most common cause of CVAs?
Causes of CVAs?
- atherosclerosis (thrombus)
- embolus (broken from thrombus)
- rupture of vessel (cerebral hemmorage)
Types of aneurysms?
- Sac involves one side of the vessel
- Most often in brain
- main cause of CVA (due to hypertension)
- Affect cerebral arteries of circle of willis
- main cause of subarachnoid bleeds
- Medial layer of vessel splits allowing blood to accumulate between layers
- often effects thoracic aorta
- Buldge includes entire circumference of vessel wall
- Commonly occurs in the abdominal aorta
Position for conventional visualization of an aneurysm?
- lateral abdomin/l-spine
- vessel is usually calcified
Palpation of abdomen detects abdominal aneurysms... why?
It's an artery and therefore it will pulse
Thrombosis is more common in ______.
veins. Blood flow is slower and platelets fall out easier
Thrombus formation is usually composed of primarily ___________.
- This happens as the blood flow slows, the platelets fall out of the blood stream
Rheumatic fever is an immune response to ______.
Mitral stenosis and mitral insufficiency is a complication of?
What is phlebitis?
inflammation of a vein
Notes: Angiography PT care: Informed consent, preliminary blood tests (renal function, potassium level, anticoagulation state), allergy hx, NPO 6-8hrs prior.
PT meds- sedative, steriods, antihistimines and all the other stuff ECG, pulse oximeter automatic BP....
Angiography catheterization arterial access?
- femoral artery (most common)
- axillary artery
- brachial artery (least common)
Angiography venous access?
- femoral vein (it's medial to the artery)
- cubital vein
- internal jugular vein
Post procedural care for angiography?
- pressure applied to site: 10min if venous, 15min for artery.
- Dress puncture site with band-aid
- PT supine for 6hrs (cannot bend at site) watch for hematoma.
Digital subtraction angiography
In cardiac catheterization, the catheter is introduced directly into one of the _________ or the __________.
chambers of the heart, or the pulmonary artery
In cardiac catheterization, right cardiac catheterization requires ________ access.
In cardiac catheterization, left cardiac catheterization requires ______ access.
TEC- transluminal extraction?
Cutting device shaves plaque and vaccum packs debris
Cerebral angiography: Catheter most often introduced into ______ and advanced to level of interest.
Abdominal angiography uses the _______ catheter in abdominal aorta.