CV

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Author:
trucle
ID:
85751
Filename:
CV
Updated:
2011-05-14 14:13:11
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CV system
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anatomy, labs, disorders
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  1. pericardium
    outermost, 2 layers (b/w is a serous fluid that allows friction –free movemtn as heart contracts & relaxes)
  2. myocardium
    form bulk of heart wall, thickest and strongest, composed of cardiac muscle tissue which is responsible for pumping blood
  3. Endocardium
  4. innermost, thin connective, lines interior, valve & larger vessels.
  5. Rt atrium
    receive deoxygenated blood fr entire body. SCV return blood fr head/neck/arms. ICV fr lower body. Coronary vein returns blood fr heart muscle to coronary sinus.
  6. Rt ventricle
    lower Rt = receive deoxygenated blood fr Rt atrium => pump blood to thru Pulmonary artery to Lung to release Co2 & receive O2.
  7. Left atrium
    upper left = receive oxygenated blood from lung via Pulmonary veins.
  8. Left ventricle
    receives oxygenrated blood fr left atrium. It is the thickest, most muscular section of heart and pumps oxygenated blood out thru aorta to all parts of body.
  9. Right side pump
    receives deoxygenated blood & pumps to Lungs
  10. Left side pump
    receives oxygenated blood from lungs & pumps it throughout body.
  11. 2 atrioventricular (AV) valves
    • located b/w atrium & ventricles.
    • Small cord-like structures = chrodae tendinease = connect AV valves to walls of heart & work with papillary muscles located in walls of ventrlcles to make a tight seal to prevent backflow when ventricle contract
  12. Rt AV valve
    b/w Rt atrium & Rt ventricle = tricuspid valve = 3 flaps/cusps.
  13. Left Av valve
    2 cusps =bicuspid = mitral valve = b/w left atrium and left ventricle.
  14. 2 semilunar valves
    • (3 cusps resembling a half moon) located at points where blood exits ventricles.
    • 1) pulmonary semilunar valve = b/w Rt ventricle & pulmonary artery.
    • 2) Aortic semilunar valve
  15. Automaticity
    Heart muscle tissue contains an ability to contract in a rhythmic pattern.
  16. irritability.
    Muscle cell = can beat, respond to stimulus in same way that nerve cells do
  17. characteristics that affect function of conduction system; also affect conduction of message around heart, initiation of heartbeat, coordination of beating patterns b/w atria & ventricles.
    • automaticity & irritability
    • Hormones, ion concentration, changes in body temp
  18. Sinoatrial (SA)
    initiates heartbeat = pace maker = regulate heartbeat = in upper part of Rt atrium, just beneath opening of SVC.
  19. AV node
    base of Rt atrium = slow down impulse to allow atrium to complete contraction & allow ventricle to refill.
  20. Bundle of His
    group of conduction fibers => divide into Rt & Lt branches of AV bundle to travel to smaller branches = Purkinje fibers which surround ventricles. The message travel thru ventricles & cause contractions which empty ventricles.
  21. electricity pathway explanation
  22. ð Specialized cardiac muscle cells in wall of heart rapidly initiate or conduct an electrical impulse throughout myocardium. The signal is initiated by SA node & spread to rest of Rt atrial myocardium directly, to the Left atrial myocardium by way of bundle of interatrial conducting fibers, AND to AV node by way of 3 internodal bundles. AV node then initiates a signal that is conducted thru conduction fibers = bundle of His & break into Lt and Rt branches to travel to smaller branches = Purkinje fibers, which surround the ventricles.
  23. electricity pathway summary
    SAVE HIS P


    SA node => AV node => bundle of His => Rt & Lt bundle branches of AV bundle => Purkinje fibers
  24. Cardiac cycle
    complete heartbeat = average of 0.8 second. 2 atria contract while 2 ventricles relax. When ventricle contracts, 2 atria relax
  25. Phase of contraction
    systole
  26. phase of relaxation
    diastole = period b/w contraction of atria or ventricles during which blood enters relaxed chambers fr systemic circulation & lungs.
  27. Lub
    1st sound = long & low pitch = heard when AV valves close
  28. Dubb
    2nd sound = short, sharp = heard when semilunar valves close.
  29. 3 main types of vessels.
    1) capillaries = joining arterioles & venules = connect arteries (large vessels carrying blood away from heart) to the veins ((vessels that convey blood from capillaries & return it to heart). Heart delivers blood to arteries, which branch into tiny vessels = arterioles (blood vessels of smallest branch of arterial circulation0 which deliver blood to tissues. w/in tissues, capillaries (microscopic vessels) form a network that exchange of products/by products b/w tissue & blood. Capillaries then join with tiny veins (venules), that link with larger veins & return to heart
  30. Blood vessel pathway
    Artery => arteriole => capillary => venule => vein.
  31. coronary circulation
    delivery of O2 & nutrient-rich arterial blood to cardiac muscle tissue & return of oxygen-poor blood fr this tissue to venous system. Blood flow into heart muscle by way of 2 small vessels = Rt & Lt coronary arteries which form a crown around myocardium. Openings into these vessels lie behind flaps of aortic semilunar valves . Coronary arteries bring O2/nutrient to myocardium. Once circulation is completed and CO2 /waste products have been collected, blood flow into a large coronary vein & finally into coronary sinus, which empties into Rt atrium.
  32. Systemic circulation
    When oxygenated blood leaves left ventricle, it enters largest artery of body = aorta = main trunk, 4 parts = ascending, arch, thoracic of descending and abdominal portion of descending. Blood continues to flow into capillaries. Capillaries surround cell & exchange O2/nutrients/CO2/waste. Blood proceeds to tiny venules => larger veins => rt atrium via largest vein (vena cava). Blood is now deoxygenated & need to be replenished with O2.
  33. depolarization
    When heart contracts => electrical activity
  34. pulmonary circulation
    Deoxygenated blood now passes thru pulmonary circulation to pick up needed O2. Blood is pumped fr Rt atrium to Rt ventricle where it leaves heart to travel via pulmonary artery to lungs. Once blood reaches lungs, it travels through arterioles to capillaries. Microscopic capillaries surround alveoli (air sacs) where O2 diffuses into bloodstream. Capillaries then connect w venules & finally with 4 pulmonary veins, which return oxygenated blood to Left atrium. It is then pumped to Left ventricle & to aorta & systemic circulation is then repeated.
  35. blood flow
    S/IVC -=> RA => Tri => RV => PS => Pul artery => lung => Pul veins => LA => Bi => LV => AS => A
  36. repolarization
    Relaxation phase
  37. P wave
    depolarization of atria.
  38. QRS complex
    depolarization of ventricle.
  39. Atrial repolarization
    not represented but does occur, it is covered by large QRS complex & cannot be seen on ECG tracing
  40. Reasons need telemetry
    hx of cardiac dis, angina pectoris, suspected dysrhythmias, a change in meds, electrolyte abnormality, unexplained syncope.
  41. ECHOCARDIOGRAPHY
    Use high-frequency ultrasound directed at heart. Echo, or reflected sound = graphically recorded, outlining size/shape/position of cardiac structures. => to detect pericardial effusion (collection of blood or other fluid in pericardial sac), ventricular function, cardiac chamber size & contents, ventricular muscle & septal motion & thickness, cardiac output (ejection fraction = EF), cardiac tumors, valvular function, congenital heart disorder. EF of ventricle demonstrated by echocardiogram is as follows Normal > 60%; moderate HF 40-60%, moderate to severe HF 20-40%, severe HF (candidate for heart transplant) < 20%
  42. POSITRON EMISSION TOMOGRAPHY (PET)
  43. Computerized radiographic technique that uses radioactive substances to examine the metabolic activity of various body structures. Pt either inhale or injected w a biochemical radioactive substance. Specific color-coded images reveal organs metabolic function. Used to study dementia, stroke, epilepsy & tumor, cardiac. Distinguish b/w viable & nonviable myocardial tissue allow identify the most appropriate candidate for bypass surgery or angioplasty. Accurately detect coronary artery dis (CAD), noninvasively, in an asymptomatic pt, prompting early intervention that can salvage potentially ischemic myocardium.
  44. Blood culture
    detect growth of bac in blood = infective endocarditis
  45. Erythocyte sedimentation rate (ESR)
    monitor and rule out inflammatory infective conditions. ESR is elevated with MI & infective endocarditis and decreases when healing begins. Also indicates extent of inflammation & infection in rheumatic fever.
  46. Serum electrolyte tests
    body’s balance of Na, k, Ca, Mg, which necessary for myocardial muscle function. Na help maintain fluid balance, K = required for relaxation of cardiac muscle, Ca = required for contraction of cardiac muscle, Mg = maintain correct level of electric excitability in nerve & muscle, including myocardium & cardiac conduction system.
  47. B-type natriuretic peptide (BNP)
    neurohormone secreted by heart in response to ventricular expansion. An elevated BNP >100 pg/mL indicate HF. BNP is present in ventricle of heart & correlate to left ventricular pressure. The greater BNP level, the more severe HF.
  48. Systole
    The moment after End Diastole ¤ The AV valves slam shut ¨ LUB ¤ Pressure builds; contraction starts ¤ The Semilunar valves open ¨ Pulmonic – between (R) atrium & ventricle ¨ Aortic – between (L) atrium & ventricle ¤ Ejection of blood ¤ The Semilunar valves slam shut ¨ DUB
  49. "power house"
    left ventricle
  50. Semilunar Valves
     Located between a ventricle and a great vessel Pulmonic Valve = Right ventricle & pulmonary artery Aortic Valve = Left ventricle & aorta Both have 3 cusps = Looks like a half moon when closed
  51. Diastole
    Ventricles are filling with blood What valves are open?• Tricuspid – between (R) atria & ventricle• Mitral – between (L) atria & ventricle• End Diastole = The moment of the last drop of blood enters the ventricle
  52. ¨ Artery
    ¤
    Large vessels carrying blood away (*A “AWAY”) from heart ¤ Always oxygenated blood except for: n Pulmonary artery! ¤ Branch off into Arterioles
  53. Veins
    Vessels carrying blood to the heart ¤ Always de-oxygenated blood except for: Pulmonary vein!
  54. Capillary
    Tiny blood vessels that join arteries & veins
  55. CIRCULATION – AORTA
    Blood leaves left ventricle via the Aorta ¨ Largest Vessel in the Body** also largest responsibility (if problem => death) ¨ Highest pressure vessel & the heart has to pump against this pressure ¨ 2.5 cm in diameter ¨ Aorta has 4 sections = Ascending Aorta; Aortic Arch; Thoracic (Descending) Aorta; Abdominal (Descending) Aorta
  56. ¨ Ascending Aorta
    ¤ From Ventricle/Aortic Valve to the beginning of archCoronary Arteries branch
  57. ¨ Aortic Arch
    ¤ Brachiocephalic artery AKA Innominate artery ¨ (Right Carotid artery and right subclavian artery branch from here) ¤ Left Carotid Artery ¤ Subclavian Artery
  58. ¨ Thoracic (Descending) Aorta
    ¤ Visceral branches = Lungs, pericardium, esophagus, lymph nodes ¤ Parietal branches = Chest muscles, diaphragm, spinal cord
  59. ¨ Abdominal (Descending) Aorta
    ¤ Celiac Artery = Gastric, Liver, spleen ¤ Mesenteric Arteries = Intestines, renal, ovaries, testicular
  60. CIRCULATION – CORONARY CIRCULATION
    ¨ Myocardium requires lots of oxygen ¨ Coronary arteries branch off Ascending Aorta ¤ Right Coronary Artery = Most often supplies the SA node!! ¤ Left Coronary Artery n Several branches n LAD – Left Anterior Descending n Supplies the LEFT VENTRICLE!!!! ¨ Fill during Diastole ¨ Coronary veins dump into Coronary Sinus (Right Atrium) ¨ Blockage = Heart Attack
  61. ¨ SA node (Sino-atrial node)
    ¤ Our internal pacemaker ¤ Located in upper Right Atrium (= can survive if have problem = atrial) n Beneath the opening of the SVC
  62. ¨ AV node (Atrio-ventricular node)
    ¤ Receives impulse from SA node ¤ Located at the base of Right Atrium ¤ Slows the impulse to allow time for atria to contract & ventricles to contract ¤ If SA node is damage, AV node can generate a pulse (**40-60, still can work, just slower
  63. P wave
  64. ¨ When impulse travels from SA to AV node it passes through the Atria
    • ¨ Atria Contract
    • ¤ Depolarize (*=contracting)
  65. QRS
  66. ¨ When Impulse travels from AV node to the Purkinje fibers it passes through the ventricles
    • ¨ Ventricles Contract (** QRS = big b/c ventricle needs to pump hard, this complex is spike and bigger than p wave)
    • ¤ Depolarize
  67. T wave
  68. ¨ After the ventricles contract they need time to recoup
    • ¨ Ventricles relaxing (((*** we don’t see atrial – 20% of blood relaxing b/c ventricle is big and main house)
    • ¤ Repolarization
  69. ¨ Which valve(s) see the highest pressure?
    AV, or aorta valve ** aortic b/c blood inside heart has to be higher to open up aortic valve. Mitral = keep fr back flow to left atrium
  70. ¨ 4 leads:
    one lead on each limb = Right & Left Arm and Right & Left Leg ¨
  71. 6 leads:
    placed on specific sites on chest ¨ V1 and V2 on each side of sternal border 4th ICS ¨ V3 – halfway between V2 & V4 ¨ V4 on 5th ICS space, left mid-clavicular line ¨ V5 – halfway between V4 & V6 ¨ V6 on 5th ICS space, mid-axillary line (level with V4)
  72. ¨ White Blood Count – WBC
    ¤ 4-11 x 103/µL ¤ High value = Infection; Inflammatory response; Leukemia ¤ Low Value = Aplastic Anemia; Side effect of chemo & radiation
  73. ¨ Hemoglobin – Hgb
    (*carry O2, if high = over blood transfusion, if low = anemia, blood loss ¤ Female 12-16 g/dl; Male 13.5 – 18 g/dl ¤ Can be altitude dependent ¤ High value = COPD; Polycythemia ¤ Low Value = Hemorrhage; Anemia
  74. ¨ Hematocrit – HCT or “Crit”
    (*same as Hgb ¤ Female 38-47% = Male 40-54% ¤ Also Altitude dependant ¤ High value = Dehydration; Polycythemia ¤ Low value= Hemorrhage; Anemia; Overhydrated (*B/c pt normally on IV => overfluid = dilute blood
  75. ¨ Platelet Count – plts
    ((** sticky. Being on aspirin and plavix => same amt of platelet but just cut “arms” of plately make it less sticky, but heparin may make platete go down => see below ¤ 150 – 450 x 103/ µL ¤ High Value = Acute infections; Chronic pancreatitis, cirrhosis; Postsplenectomy ¤ Low Values n Acute Leukemia n HIT – Heparin Induced Thrombocytopenia ¨ Baseline platelets prior to starting heparin
  76. ESR
    ¨ Erythrocyte sedimentation rate
    ¤ Monitor inflammatory conditions of the heart ¤ Will decrease once patient starts healing ¤ Male < 20mm/hr; Female <30mm/hr ¨ Moderate increase = Acute hepatitis; Myocardial infarction; Rheumatoid arthritis ¨ Marked increase = acute and severe bacterial infections; malignancies; pelvic inflammatory disease
  77. ¨ Total Cholesterol
    = Desirable level: less than 200; Borderline: 200-239; High: 240 or greater
  78. HDL
  79. ¨ Contains more protein than fat
    • ¨ Removes cholesterol from tissues & transports to the liver
    • ¤ Used to make bile
    • ¤ Bile is essential to break down lipids
    • ¨ Low levels, less than 40 mg/dL (believed) to increase risk for Cardiac Disease
    • ¨ Greater than 60 mg/dL are believed to be protective
  80. LDL
  81. ¨ Equal amount of protein & fat (cholesterol)
    • ¨ It is used to build plasma membranes
    • ¨ Sticky, can adhere to sides of vessel walls
    • ¨ Less than 130 mg/dL
    • ¤ <100 mg/dL Optimal
    • ¤ 100-129 mg/dL Near Optimal
    • ¤ 130-159 mg/dL borderline high
    • ¤ 160-189 mg/dL high
    • ¤ >190 mg/dL Whoa!
  82. serum cardiac marker
  83. ¨ CK & CKMB start to rise within 2-3 hours after beginning of MI
    • ¤ Levels peak in 24 hours
    • ¤ Levels return to normal within 24-48 hours
  84. creatine phosphokinase (CK-MB)
  85. CREATINE PHOSPHOKINASE (CK-MB)
    • ¨ Was the Golden standard for detection of MI
    • ¨ CKMB is also found in the skeletal muscle
    • ¨ CKMB can be elevated:
    • ¤ During surgery
    • ¤ Muscle trauma (skeletal muscle)
    • ¤ Muscular diseases
    • ¤ Renal disease/failure

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