All Cards Together

Apex

the lowest part of the heart formed by the infero-lateral part of the left ventricle.

Projects anteriorly and to the left at the level of the 5th intercostal space and the left mid-clavicular line

Base

The upper border of the hear involving the left atrium, part of the right atrium and the proximal portions of the great vessels.

Lies approximately below the second rib at the level of the second intercostal space

Endocardium

endothelial tissue that lines the interior of the heart chambers and valves

Epicardium

serous layer of the pericardium.

contains the epicardial coronary arteries and veins, autonomic nerves and lymphatics

Myocardium

thick contractile middle layer of muscle cells that forms the bulk of the heart wall

Pericardium

double-walled connective tissue sac that surrounds the outside of the heart and great vessels

Aorta

body’s largest artery and the central conduit of blood form the heart to the body

beings at the upper part of the left ventricle, after ascending for a short distance arches backward and the the left (arch of aorta). descends within the thorax (thoracic aorta) and passes into the abdominals cavity (abdominal aorta)

Inferior Vena Cava

vein that returns venous blood from the lower body and viscera to the right atrium

Pulmonary arteries

arteries that carry deoxygenated blood from the right ventricle to the left and right lungs

Pulmonary veins

veins that carry oxygenated blood from the right and left lungs to the left atrium

Superior Vena Cava

vein that returns venous blood from the head, neck, and arms to the right atrium

Coronary arteries are network of

progressively smaller vessels that carry oxygenated blood to the myocardium

Right/Left coronary arteries arise from the _____ _____ just beyond where the aorta leaves the _____ ______

ascending aorta

left ventricle

Coronary veins

includes the coronary sinus, cardiac veins, and thebesian veins.

The great cardiac vein, small and middle cardiac vein drain into the _____ _____, emptying into the _____ _____

coronary sinus

right atrium

Thebesian vein arise in the ____ and drain into all chambers of the heart, but primarily the right _____ and _____

myocardium

atrium and ventricle

SA node is the

normal pacemaker of the heart

_____ _____ ______ conduct the cardiac impulse between the SA node and AV node and to the atrial musculature

Specialized conduction tracts

the vagus and sympathetic cardiac nerves converge to form the ____ ____ at the base of the heart

cardiac plexus

Sympathetic influence

is achieved by release of epinephrine and norephinphrine

Sympahtetic nerves stimulate the chambers to ____ ____ and with ____ ___ of contraction

beat faster (chronotropic effect)

greater force (inotropic effect)

parasympathetic influence

is achieved via acetylcholine release from the vagus nerve

parasympathetic nerves slow the ____ ____ primarily through their influence on the ___ ____

heart rate (chronotropic effect)

SA node

Baroreceptors

mechanoreceptors that detect changes in pressure.

Baroreflex

reflexes by which BP is maintained, includes arterial baroreceptors and cardiopulmonary receptors

arterial baroreceptors

high pressure receptors located in the carotid sinus, aortic arch and origin of the right subclavian artery

cardiopulmonary receptors are

low pressure receptors

Atrial Systole

contraction of the right/left atria pushing blood into the ventricles

Atrial Diastole

period between atrial contractions when the atria are repolarizing

Ventricular systole

contraction of the right/left ventricles pushing blood into the pulmonary arteries and aorta

Ventricular diastole

period between ventricular contractions when the ventricle are repolarizing

Preload

tension in the ventricular wall at the end of diastole.

reflects the venous filling pressure that fills the left ventricle during diastole

Afterload

forces that impede the flow of blood out of the heart, primarily the pressure in the peripheral vasculature, the compliance of the aorta and the mass and viscosity of blood

Stroke volume

volume of blood ejected by each contraction of the left ventricle.

60-80 ml depending on age, sex, activity

Cardiac output

amount of blood pumped from the left or right ventricle per. minute.

Stroke volume X HR

4.5-5.0 L/min and increases up to 25 L/min during exercise

Venous return

amount of blood that returns to the right atrium each minute

Cardiovascular system is a ____ ____, so venous return must equal CO when averaged over time

closed loop

____ and ___ _____ are considered the prinicple muscles of inspiration

diaphragm

external intercostals

Contraction of the diaphragm causes the chest to ____ _____ and the lower ribs ____ to allow innspiration

expand longitudinally

elevate

Upward movement of the upper ribs increase the ____ _____ diameter of the chest; elevation of the lower ribs increases the ____ ____

anterior-posterior (A-P)

transverse diameter

Other muscles that assist in inspiration

SCM, scalenes, pec. major/minor, serratus anterior

Other muscles that assist in expiration

rectus abdominis, external/internal oblique, transverse abdominis

upper respiratory tracts include

nasal cavity, pharynx, larynx

upper respiratory tracts function

humidify, cool or warm inspired air, filter foreign matter

Lower respiratory tract extends from

the larynx to the alveoli in the lungs

anatomic dead space volume (VD)

volume of air that occupies the non-respiratory conducting airways

Expiratory reserve volume (ERV)

maximal volume of air that can be exhaled after a normal tidal exhalation.

15% of total lung volume

Forced expiratory volume (FEV)

maximal volume of air exhaled in a specified period of time

Forced vital capacity (FVC)

volume of air expired during a forced maximal expiration after a forced maximal inspiration

Functional residual capacity (FRC)

volume of air in the lungs after normal exhalation

40% of total lung volume

Inspiratory capacity (IC)

maximal volume of air that can be inspired after a normal tidal exhalation

60% of total lung volume

Inspiratory reserve volume (IRV)

maximal volume of air that can be inspired after normal tidal volume inspiration

50% of total lung volume

Minute volume ventilation (VE)

volume of air expired in one minute

Peak expiratory flow (PEF)

maximum flow of air during the beginning of a forced expiratory maneuver

Tidal volume (TV)

total volume inspired and expired with each breath during quiet breathing

10% of total lung volume

Total lung capacity (TLC)

volume of air in the lungs after maximal inspiration

Vital capacity (VC)

volume change that occurs between maximal inspiration and maximal expiration

Pulmonary circulation

carries deoxygenated blood form the heart to the lungs via the pulmonary arterial trunk, right/left pulmonary arteries, lobar arteries, arterioles and capillaries

Pulmonary circulation returns

oxygenated blood from the lungs to the left atrium via the pulmonary veins

Bronchial circulation

supplies oxygenated blood to the bronchi and connective tissue of the lungs via the bronchial arteries

bronchial arteries drain directly into the

bronchial veins

oxygen is physically dissolved in the ___ ____ and chemically combined with ____ in the RBC

blood plasma

hemoglobin

Carbon dioxide is physical dissolved in the ___, chemically combined with the ___ ___ of hemoglobin as ____ ______ and as _____ ______

blood

amino acids

carbamino compounds

bicarbonate ions

Aneurysm

abnormal dilation of blood vessel

Etiology: congenital defect; weakness in the wall of the vessel often due to chronic hypertension; connective tissue disease; trauma; infection

Signs and symptoms: variable based on the site. Aortic aneurysms- asymptomatic, generalized abdominal or low back pain. Abdominal aortic aneurysm may cause pulsations near the naval. Cerebral aneurysm can cause sudden and sever headache, N/V, stiff neck. loss of consciousness and double vision

Treatment: antihypertensive meds, surgery- repair large aortic aneurysms- synthetic fabric graft

Angina Petoris

transient precordial sensation of pressure or discomfort resulting form myocardial ischemia

Etiology: inadequate blood flow and oxygenation of the heart muscles mostly due to coronary artery disease

S/S: pressure, heaviness, fullness, squeezing, burning or aching behind the sternum, neck, back, jaw, shoulder, or arms. SOB, N/V, sweating, anxiety or fear. Triggered by exertion or strong emotion and subsides with rest

Treatment: acute angina: supplement oxygen, nitroglycerin, and rest. Chronic: long-acting nitrates, beta-blockers, calcium channel blockers. Angioplasty with stenting of the coronary arteries or bypass surgery- whens meds are not effective

Stable angina

occurs at a predictable level of exertion, exercise or stress and responds to rest or nitroglycerin

unstable angina

usually is more intense, lasts longer, is precipitated by less exertion, occurs spontaneously at rest, progressive

Prinzmetal (variant) angina

coronary artery spasms, most often associated with coronary artery disease

Atherosclerosis

a slow progressive accumulation of fatty plaques on the inner walls of arteries. restrict blood flow, causing a blood clot

Etiology: damage or injury to the inner wall of the artery from HTN, high cholesterol, smoking, DM.

S/S: angina, numbness, weakness, difficult speaking, slurred speech, drooping face, intermittent claudication

Treatment: lifestyle changes, meds, surgery

Chronic Venous Insufficiency

veins and valves in the LE are damaged and cannot keep blood flowing towards the heart. veins remain filled with blood

Etiology: weak or damaged valves inside the veins. Risk factors: age, female, obesity, pregnancy, prolonged sitting or standing

S/S: leg swelling, varicose veins, aching, heaviness, cramping, itching, redness, skin ulcers of the legs and ankles

Treatment: compression stockings, elevation of legs, varicose stripping

Cor Pulmonale

narrowing or blockage of the coronary arteries due to atheromatous plaques resulting in diminished blood flow

Etiology: pulmonary HTN from chronically inc resistance in the pulmonary circulation

S/S: SOB, fatigue, palpitations, atypical chest pain, swelling of LE, dizziness, syncope

Treatment: supplemental oxygen sufficient to maintain SaO2> 90% and/or PaO2> 60 mm Hg. diuretics and anticoagulation

Coronary Artery Disease

narrowing or blockage of the coronary arteries due to atheromatous plaques resulting in diminished blood flow

Etiology: damage or injury to the inner layer of artery. fatty plaques accumulate, ruptures and platelets clump at site leading to blockage

S/S: angina, SOB, heart attack

Treatment: modifications: smoking cessation, weight loss, diet, exercise. drug therapy

Deep vein thrombosis

condition in which blood clot forms in one or more of the deep veins, usually LE

Etiology: any condition that impairs normal circulation of normal blood clotting. prolonged sitting, bed rest, inherited blood clotting disorders, surgery, pregnancy, cancer, birth control or hormone replacement therapy, overweight, obesity, smoking

S/S: asymptomatic, swelling, pain, redness, warmth in affected leg

Treatment: prevent clot from getting bigger and prevent it from getting loose. Meds, filters

Heart failure

CHF, progressive condition in which the heart cannot maintain a normal cardiac output to meet the body’s demand for blood and oxygen

Etiology: coronary heart disease, HTN, DM, myocardial infraction, abnormal heart valves, cardiomyopathy

S/S: SOB, fatigue, weakness, swelling in the legs, feet and abdomen; rapid, irregular heartbeat with S3 or S4 heart sounds. persistent cough or wheezing and weight gain

Treatment: meds, lifestyle changes

Hypertension

normal BP is systolic BP less than 120 and diastolic BP less than 80. stages are elevated, stage 1, stage 2

Etiology: primary or essential HTN has no known cause. Secondary has a identified cause

S/S: often asymptomatic until its developed into the organs. S4 heart sound is an early sign

Treatment: lifestyle modifications, meds.

Myocardial infraction

“heart attack”, blood flow through one or more of the coronary arteries is severely reduced or cut off completely. irreversible necrosis to the position of myocardium supplied by the blocked artery

Etiology: ruptured atherosclerotic plaque or blood clot blocks the flow of blood. spasm of the coronary artery

S/S: chest discomfort with pressure, squeezing, or pain. SOB, discomfort in the UE, N/V dizziness, sweating and palpitations

Treatment: meds, surgery

Peripheral arterial disease (PAD)

stenotic, occlusive, and aneurysmal diseases of the aorta and peripheral arteries

Etiology: primarily by atherosclerosis and thromboembolic processes that alter the structure and function of the aorta and its branches

S/S: fatigue, aching, numbness or pain in buttocks, thigh, calf or foot at rest or walking. poor healing wounds of LE, distal hair loss, trophic skin changes, hypertrophic nails

Treatment: smoking cessation, lipid lowering meds, control DM and hypertension.

Valvular heart disease

damage to one or more of the hearts valves results in regurgitation or stenosis of blood flow.

Etiology: congenital defects, calcific degeneration, infective endocarditis, coronary artery disease, myocardial infraction, rheumatic fever

S/S: palpitations, SOB, chest pain, coughing, ankle swelling, fatigue

Treatment: meds to reduce workload, regualte rhythm, prevent clotting

Asthma

chronic inflammation of airways caused by an inc airway hypersensitivity to various stimuli

Etiology: allergens, mold, dander, feathers, dust, food, cockroaches, cold air, sudden temp changes. smoke, excitement/stress, exercise

S/S: mild: dyspnea, flaring nostrils, diminished wheezing, anxiety, cyanosis, inability to sleep. severe: respiratory failure

Treatment: reduce exposures. meds, education, airway clearance, breathing exercises, relaxation, endurance/strength training

Bronchitis

inflammation of the bronchi characterized by hypertrophy of the mucus secreting glands. inc mucus secretions, insufficient oxygenation due to mucus blockage. productive cough for 3 months over the course of two consecutive years

Etiology: acute: cold viruses and exposure to smoke and other air pollutants. Cigarette smoking is primary cause of chronic, as well as pollutants, dust, toxins in workplace or environment

S/S: persistent cough with production of. thick sputum, inc use of accessory mm, wheezing, dyspnea, cyanosis, inc pulmonary artery pressure. Chronic: cough that is worse in the morning, in damp weather, frequent respiratory infections

Treatment: relieving symptoms, improving breathing. rest, fluids, breathing warm/moist air, cough suppressants, acetaminophen or aspirin. Chronic: antibiotics, anti-inflammatory, bronchodilators. lifestyle changes: stop smoking, air humidifier, cold-air face mask, pulmonary rehab

Chronic Obstructive Pulmonary Disease

group of lung diseases that block airflow due to narrowing of the bronchial tree. alveolar destruction and air trapping. inc total lung capacity, inc in residual volume

Etiology: long-term smoking or exposure. air pollution, certain occupations

S/S: excessive mucus production, chronic productive cough, wheezing, SOB, fatigue, reduced exercise capacity

Treatment:medications, bronchodilators, inhaled steroids, supplemental oxygen, antibiotics. surgery. lifestyle modifications. stop smoking, flu shot, good nutrition, pulmonary rehab

Cystic Fibrosis

autosomal recessive genetic disease of the exocrine glands that primarily affects the lungs, pancreas, liver, intestines, sinuses, and sex organs.

Etiology: causative factor- mutation of the cystic fibrosis transmembrane conductance regulator on chromosome 7. produce unusually thick, sticky mucus that leads to life-threatening lung infections, obstructs the pancreas, inhibits normal digestion and absorption of food

S/S: salty tasting skin, persistent and productive coughing, frequent lung infections, wheezing, SOB, poor growth/weight gain, frequent greasy, bulky stools

Treatment: meds, antibiotics, nutritional supplements, pancreatic enzyme replacement. mucolytics, bronchodilators. airway clearance, breathing techniques, assisted cough, ventilatory muscle training. strength and endurance

Emphysema

alveolar walls are gradually destroyed and the alveoli are turned into large, irregular pockets with gaping holes in the walls. elastic fibers are destroyed, collapse during exhalation. Alveoli are permanently overinflated and dead space inc with the lungs

Etiology: smoking, genetic disorder (low levels of protein alpha-1 antitrypsin)

S/S: SOB, wheezing, chronic coughing, orthopnea, barrel chest, inc uses of accessory mm, inc RR, fatigue and reduced exercise capacity

Treatment: meds, bronchodilators, inhaled steroids, supplemental oxygen, antibiotics. Surgery. stop smoking, flu shot, good nutrition, pulmonary rehab

Pneumonia

inflammation of the lungs

Etiology: bacterial, viral, fungal, parasitic infection

S/S: fever, cough, SOB, sweating, shaking chills, chest pain that fluctuates with breathing, headache, muscle pain, fatigue

Treatment: antibiotics, antiviral, anti-fungal, rest and drinking fluids.

Pulmonary edema

fluids collect in the alveoli within the lungs, making it difficult to breathe. medical emergency

Etiology: left ventricle is unable to pump blood adequately. pressure inc inside the left atrium and then in the pulmonary veins and capillaries, causing fluid to be pushed through the capillary walls into the alveoli.

non-cardiac pulmonary edema: fluid leaks from the capillary within the alveoli. from pneumonia, toxins, meds, smoke, respiratory distress syndrome, high elevations

S/S: SOB, difficulty breathing, suffocating, drowning, wheezing, gasping for breath, anxiety, restlessness, coughing, frothy, blood-tinged sputum, chest pain, rapid/irregular pulse

Treatment: supplemental oxygen and meds

Pulmonary embolism

condition where one or more arteries in the lungs become blocked. life-threatening, anti-clotting meds can reduce the risk

Etiology: caused by blood clots from the lower extremities

S/S: SOB, chest pain that becomes worse with deep breathing, coughing, eating or bending; coughing up blood or blood streaked sputum. Wheezing, LE swelling, excessive sweating, rapid or irregular pulse, lightheadedness, fainting

Treatment: anticoagulants, thrombolytic agents. surgery. Compression stockings, pneumatic compression. physical activity, drinking fluids.

Restrictive lung dysfunction

abnormal reduction in lung expansion and pulmonary ventilation

Etiology: abnormal lung parenchyma, abnormal pleura, disorders affecting ventilatory pump function

S/S: dyspnea on exertion, persistent non-productive cough, inc RR, hypoxemia, dec vital capacity, abnormal breath sounds, reduced exercises tolerance

Treatment: antibiotics, treatment for edema, mechanical ventilation, supplemental oxygen, nutrition support, pulmonary rehab

ABG

arterial blood gas

pH

7.4 (7.35-7.45)

PaCO2- ventilation

40 mm Hg (35-45)

PaO2- oxygenation of arterial blood

97 mm Hg (80-100)

HCO3- -bicarbonate

24mEq/L (22-26)

SaO2- oxygen saturation of hemoglobin

95-98%

Acidemia

elevated acicity of blood (pH<7.35)

Alkalemia

dec acidity of blood (pH>7.45)

Eucapnia

normal level of CO2 in arterial blood (PaCO2 35-45 mm Hg)

Hypercapnia

elevated level of Co2 in arterial blood (PaCO2 >45 mm Hg)

Hypocapnia

low level of CO2 in arterial blood (PaCO2 < 35 mm Hg)

hypoxia

low level of O2 in the tissue despite adequate perfusion of the tissue

Alpha Adrenergic Antagonist Agents

Actions: reduce peripheral vascular tone by blocking alpha-1-adrenergic receptors. causes dilation of arterioles and veins and dec blood pressure

Indications: HTN, benign prostatic hyperplasia

Side Effects: HTN, palpitations, orthostatic hypotension, drowsiness

Implications for PT: use caution when rising from a sitting or lying position. closely monitor patient during exericses

Examples: Cardura, Minipress