Med-Surg 2 Exam 1

What is the epicardium?

The outer protective layer.

What is the myocardium?

The muscular middle layer of the heart.

What layer of the heart do contractions occur in?

The myocardium.

What is the endocardium?

The thin inner layer of the heart.

What holds the layers of the heart wall?

The pericardial sac.

What does the pericardial sac allow for?

Expansion during systole and provides lubrication to the heart.

What type of blood do the right atrium and right ventricle provide to the body?

Deoxygenated blood which then goes to the lungs.

What is the responsibility of the left atrium and left ventricle?

Provide oxygenated blood to the body.

What valve separates the left atrium and left ventricle?

The mitral valve.

Why are ventricles larger than atria?

They pump more blood.

What are the atrioventricular valves of the heart?

The mitral and tricuspid valve.

Where is the tricuspid valve located?

In between the right atrium and the right ventricle.

Are atrioventricular valves opened or closed during diastole?

Opened.

Why are atrioventricular valves opened during diastole?

They allow blood to move into the ventricles when relaxed.

What are the two semilunar valves of the heart?

The aortic and pulmonic valve.

Where is the aortic valve?

In between the left ventricle and aorta.

Where is the pulmonic valve?

In between the right ventricle and pulmonary artery.

Are semilunar valves opened or closed during diastole? Why?

They are closed in order to prevent reflux from happening.

What electrical conduction leads to the right atrium beginning work?

Firing of the SA node.

Where does the AV node go to?

The bundle of HIS.

Where does the bundle of his go?

To the left and right bundle branches and then purkinje fibers.

When the electrical conduction reaches the end of the purkinje fibers, what does the heart do?

Contract.

Where does the aorta receive blood from?

The left ventricle.

Where does the aorta move blood to?

The brain, vital organs, and the peripheral system.

What does the right coronary artery supply blood to?

The right side of the heart.

What do the left anterior descending and left circumflex artery do?

Supply blood to the left side of the heart.

What coronary arteries are most common for issues?

Left main, Left AD.

What is cardiac output?

The amount of blood ejected from a ventricle in liters per minute per contraction.

What is a normal cardiac output?

4 - 6 L/min.

What is stroke volume?

The overall amount of blood ejected from the ventricle per contraction.

What is a normal stroke volume?

60 - 130 mL

What is preload?

Initial stretch of cardiac muscle at the end of diastole before systole.

What is afterload?

The pressure against which the heart must pump to eject blood during diastole (Systole).

What is contractility?

The overall strength of the cardiac contraction during systole. It’s usually measured around the left ventricle.

What is the largest chamber of the heart?

The left ventricle.

What is ejection fraction?

The overall percentage of blood ejected from the ventricle during each contraction.

What is an average ejection fraction?

Around 60%.

What do S1 and S2 indicate?

The lub-dub of the heart. These are normal heart sounds.

What does S1 indicate?

Closure of the atrioventricular valves (mitral and tricuspid valves).

What does S2 indicate?

Closure of the semilunar valves (pulmonic and aortic valves).

What does S3 indicate?

A ventricular gallop, usually associated with systolic heart failure.

What does S4 indicate?

An atrial gallop, usually associated with diastolic heart failure but can be seen in aortic stenosis and cardiac ischemia.

What do snaps/clicks of the heart refer to?

Usually refers to a mitral valve issue (stenosis or prolapse).

What does friction rub result from?

Pericarditis

How are murmurs graded?

1 being the most quiet, 6 being the loudest.

What causes cardiac enzymes to be released?

Chest trauma, myocardial infarctions.

What are the cardiac enzymes?

• Creatine Kinase (CK)

• CK Izoenzymes (CK-MB)

• Troponin T

• Troponin I

What electrolytes are important to monitor for cardiac function?

• Sodium

• Potassium

• Magnesium

• Calcium

What are PTT, PT/INR, and fibrinogen important for measuring?

Coagulability of blood.

What causes BNP to be produced?

The ventricles release this in response to increased preload.

What causes CRP to be released?

The liver releases it in response to inflammatory process.

What is an EKG/ECG?

A machine that gives healthcare provider the ability to view the entire conductional cycle of the heart. Usually a 12-lead.

What is an echocardiogram?

An ultrasound of the heart.

What are TEC’s good for?

Viewing the back of the heart.

What are cardiac catheterizations done for?

To determine coronary artery blood flow.

What is a Holter Monitor?

A 24/7 telemetry monitoring system that monitors a patient heart.

What are loop recorders?

An implanted holter monitor.

When is hemodynamic monitoring indicated?

Critically ill patients.

What are some common types of hemodynamic monitoring?

• Central Venous Pressure (CVP) Monitoring → Measures pressure in the right atrium.

• Pulmonary Artery Pressure Monitoring → Done via a Swan Ganz Catheter

• Intra-Arterial BP Monitoring → A continuous assessment of blood pressure.

What are some complications of hemodynamic monitoring?

• Infections → Central Line Access Blood Infections

• Pneumothorax

• Air embolism

What are pressure bags used for?

To measure intra arterial BP.

What does CVP Monitoring measure?

Pressure in the vena cava and right atrium and ventricle.

What does elevated CVP indicate?

Increased right ventricular preload, often secondary to hypervolemia.

What does decreased CVP indicate?

Reduced right ventricular preload, often secondary to hypovolemia.

What is an average CVP?

5 - 10.

What makes measurement possible for CVP?

A central venous catheter. It is inserted into the jugular or subclavian vein and is threaded right outside the SA node to give an accurate pressure around the right side of the heart.

What does Pulmonary Artery Pressure Monitoring Measure?

Right ventricular pressure.

What is a normal systolic pulmonary artery pressure?

18 - 25 mmHg

What is a normal diastolic pulmonary artery pressure?

Near 10 mmHg.

What does elevated PAP indicate?

Pulmonary hypertension, or sometimes a pulmonary embolism.

What type of catheter is used for Pulmonary Artery Pressure Monitoring?

A Swan Ganz catheter.

Where does the tip of a Swan Ganz catheter rest?

Just outside of the pulmonary valve.

What is intra-arterial pressure monitoring used for?

Continuously measuring BP in critically ill patients.

Where is the catheter for Intra-arterial pressure monitoring usually placed?

In the radial artery with an Allen’s Test performed prior to insertion.

What artery is avoided in Intra-arterial pressure monitoring?

Femoral artery.

Which node is more powerful, the SA node or AV node?

AV node.

When the electrical signal reaches the right bundle branch, what happens?

The right ventricle contracts.

When the electrical signal reaches the left bundle branches, what happens?

The left ventricle contracts.

Atrial depolarization is initiated by the firing of what node?

The SA node.

The P wave on an EKG corresponds with what muscular action?

Atrial depolarization.

After atrial depolarization is complete, there is a delay. This leads to what segment on an EKG?

PQ.

The QRS segment on an EKG represents what?

Ventricular depolarization, atrial repolarization.

If a QRS segment is shrunk or widened, what is true of the myocardium?

It is not contracting appropriately.

What does the T wave indicate on an EKG?

Ventricular repolarization.

When does systole occur on an EKG strip?

P wave until right before the start of the T wave.

When does diastole begin on an EKG strip?

After the end of the T wave.

Why are electrodes important for cardiac monitoring?

They are adhesive and reduce the skin’s ability to block electricity.

What is an artifact?

A distorted, false waveform that doesn’t indicate a dysrhythmia. Usually a complication of movement, poor adhesion, etc.

What types of patients use implantable loop recorders?

Patients with a history of dysrhythmias.

What does an implantable loop recorder do?

Records the rhythms of the heart.

When can patient’s show dysrythmias?

Stress, exercise, sleep

In sleep apnea, what is common of heart rates?

They get low.

What is an external defibrillator (Life vest)?

A vest worn on the outside of HF patients that doesn’t have to be implanted. It recognizes lethal rythms and gives impulses to fix them.

What telemetry lead placement goes over the patients right upper part of their body?

The white lead.

What telemetry lead goes over the patients right lower part of their upper body?

The green lead.

What telemetry lead goes over the patients left upper part of their upper body?

The black lead.

What telemetry lead goes over the patients left lower part of their upper body?

The red lead.

What telemetry lead goes over the patient’s chest?

The brown lead.

Why are 12-leads needed to view ST-segment elevation?

They don’t always occur in all leads. You need a 12-lead or 16-lead to determine where in the body the ST segment elevation is occuring.

Which EKG leads are lateral?

I, aVL, V5-V6.