MS 1

what is perfusion

the flow of blood thru arteries and capillaries, delivering nutrients and o2 to cells and removing cellular waste

how do we assess for adequate perfusion

BP - MAP greater than 65

pulses

cap refill

auscultation of heart tones

assessing 4 jugular vein distention

LOC

BS

UO- greater than 30 cc/hr

I and O

daily weights

pain - cardiac heart os oxygenated peripheral - pain in the limbs

assess skin - color - palpate -temperature

lung sounds - moist

o2 stat

what will we see on assessment for someone with impaired perfusion

confused and light headed

peripheral sensation decreased

decreased o2 fx

pain from ischemia

cell and tissue necrosis

what labs will be assessed for perfusion

H and H

RBC count

protein albumin

BUN and Cr

Cardiac enzymes

BNP - tells of HF

liver enzymes

what is central perfusion

a coordinated effect of electrical and mechanical factors move thru the heart

where does central perfusion come from

the ehart

where does the blood go in central perfusion

blood is propelled thru the heart and out to the peripheral system

what is peripheral perfusion

the volume of blood that flows thru target tissues

what is cardiac output

the amount of blood pumped out of the ehart each minute

how is CO determined

stroke volume times HR

what is the normal CO

4-8 L per minute

what is stroke volume

the amount of blood ejected with each beat

*usually abt 70 ccs when the heart fills its abt 120 ccs

what is the ejection fraction of the heart

a little over 50 percent

normal ejection fraction is 55-75 percent

what is cardiac index

the cardiac output in relation to body size

how is CI determined

CO divided by body surface area

what is the normal cardiac index

2.5-5.2 L

what is cardiac reserve

looks at if the heart can increase its CO in relation to what is going on in body

what do we see in hf pts

poor cardiac reserve and limited activity

what kind of effect to tachycardia and bradycardia have on CO

initially tachycardia increases CO but then the heart has less time to fill

initially bradycardia decreases CO but the heart senses that and fills

overall there is no long term effect on CO due to tachy or bradycardia

what does cardiac output look like with HYPERtension

normal

what does cardiac output look with with hypotension

the CO is decreased

what does exercise do to CO

increases

what does stress do to CO

increases

what does calcium do to CO

calcium makes the heart contract stronger and increases CO

what does epinephrine do to CO

speeds up the heart therefore increasing CO

what does ventricular hypertrophy do to CO

its a muscle that stretched out and doesn't contract well which decreases CO

what is cardiac preload

the amount of cardiac muscle stretch at the end of diastole

the degree of myocardial fiber stretch at the end of diastole -PRIOR to contraction

what is preload determined by

left ventricular end diastolic fluid volume

what is starlings law

the more the heart is filed during diastole the more forcefully it contracts

what does excessive filling of the heart mean

excessive left ventricular end diastolic volume and pressure which decreases CO

what is afterload

the amount of pressure the heart has to pump against to eject blood into the peripheral BV

what is the resistance in afterload related to

the arterial BP and the diameter of the BV (impedance)

what is impedance

the pressure the heart must overcome to open the aortic valve

the amount depends on aoritc compliance and total systemic vascular resistance

what increases afterload

how big the arteries r

how elastic the arteries r

what the BV is

blood viscosity

age

weight

fit

stress

who has the greatest risk for impaired perfusion

middle aged and older adults

men

african americans

what r non modifiable risk factors for cardiac conditions

age

gender

genetics

ethnicity

homocysteine levels- damage of the heart vessel walls

what r modifiable risk factors for cardiac conditions

HTN

HLD

smoking

sedentary lifestyle

weight

diabetes

stress

homocysteine levels- damage of the heart vessel walls

metabolic syndrome

LDL and HDL which is bad and which is good

LDL bad and HDL good we want more

what is metabolic syndrome

group of risk factors that raises the risk for heart dx, diabetes, strokes

what does metabolic syndrome look like in a male and females waist line

M 102 cm or greater 40 in

F 88 cm or 34 in greater

what is the criteria for metabolic syndrome in regard to BP

greater than 130/85 or ur on meds to treat it

what is the criteria for metabolic syndrome in regard to triglycerides

150 mg or greater or on meds to tx it

what is the criteria for metabolic syndrome in regard to FBS

greater than 110 or on meds to tx it

what is the criteria for metabolic syndrome in regard to HDL levels

if less than 50 or on meds to tx it

how many risk factors do u have to qualify for to confirm metabolic syndrome

3 of the 5 risk factors

when does cardiac perfusion occu

during diastole when the heart muscle is at rest

what are the two main vessels of the heart

the right coronary artery and the left coronary artery

what does the left coronary artery branch into

left anterior descending

cricumflex

phrase to remember coronary perfusion

There was a gal names sali. She was dating two lads. She had sex with them both. That is not right.

S- septal LAD

A- Anterior LAD

L- Lateral Cx

I-inferior right

what is the conduction system in the heart made up of

specialized nerve cells which can create and transport electoral impulse

*this impulse triggers ventricular contraction

what nervous system controls the SA node

autonomic nervous system

what r the two brances of the autonomic nervous system

parasympathetic and sympathetic

what is the parasympathetic nervous system known as

rest and digest

what nerve is the primary component of the parasympathetic nervous system

vagal nerve

what does vagal nerve stimulation due in regard of the heart

it decreases the HR

decreases the rate of the SA node sinoatrial node

slows impulse conduction of the av node atrioventricular

what is the sympathetic nervous system known as

fight or flight

what does the fight or flight response do in regard to the heart

increases the HR

increases the rate of the SA node

increases impulse conduction of the AV node

increases cardiac contractility

how is cardio vascular regulated

with baroreceptors and chemoreceptors

where are baroreceptors located

carotid sinus and aortic arch

what do baroreceptors do

react to volume status such as HTN

they cause the individual to produce more urine for example

Where are chemoreceptors located?

aortic arch

What do chemoreceptors do?

react to chemical changes (co2 and pH)

detect the level of co2 in the blood

cause the pt to hyperventilate or hypoventilate

when performing a cardio assessment what is considered the subjective data of the ass

hx

risk factors

meds

acitvity

cognitive perceptual

exercise pattern

sleep rest patterns

when performing a cardio assessment what is considered to be objective ass

vs

peripheral pulses

edema

cap refill

auscultation

JVD

what history should be taken into consideration during a cardiac exam

pmh

family hx

psycho social hx

what is important to ask in regard to symptoms for a cardiac pt

what r the precipitating factors

what relieves the symptoms

pain rating and number of occurences

what r some cardiac causes of chest pain

angina

MI

pericarditis

what is angina

ischemia

what is MI

death of the heart muscle

what is pericarditis

inflammation of the heart muscle

what r non cardiac problems of chest pain

pulmonary embolism

pleurisy

dissecting aorta

esophagitis

hiatal hernia

peptic ulcer

cholecystitis

where may locations or chest pain radiate to

upper chest

neck and jaw

epigastric

intrascapular

beneath sternum

radiating

left arm

what r palpatations

feeling your heart beat

cardiac dysrhtymias (tachycardia)

what is dyspnea

difficulty breathing

what is dyspnea on exertion

SOB with activity

what is orthopnea

severe dyspnea when laying down

what is paroxysmal nocturnal dyspnea

dyspnea occurring at night and is a symptom of fluid overload

the individual goes to sleep and awakens and feels as tho they r drowning

what is nocturia

voiding during the night

how is nocturia a cardiac symptom

reflects hypervolemia

the heart doesn't perfuse the kidneys as well

what is the best indicator of fluid balance

weight

2.2 lbs is equal to how many kg

1

1 kg is equal to how many liters of fluid

1

what does dizziness and syncope indicate

decreased cerebral blood flow; can be related to cardiac dysrhythmias

what is claudication

a symptom of peripheral profusion

muscle pain due to the muscles not getting enough oxygen

how does claudication present

cramping pain in legs/buttocks when walking

how is claudication relieved

rest until severe

what is rest pain with caludication

wakes them up at night with leg cramps

why is fatigue often a cardiac symptom

bc of decreased perfusion

seen with dehydration or hypokalemic

when do we see pallor

with decreased blood flow

when do we see cyanosis

with decreased oxygenation in blood

*important to know where it occurs

what vital signs are important to assess

apical and radial pulse bilaterally

BP bilaterally - choose the higher BP

peripheral pulses

what r symptoms of infectious endocarditis

olsers nodes- tender erythemous lesions on fingers

janeway spots-non tender hemorrhagic lesions on palms/soles

what are 5 assessments for central and peripheral perfusion

P pulses

U urine output

M moist lung sounds

P pain

S skin color

diagnostic tests for a cardiac event

blood studies - cardiac biomarkers - troponin + creatine kinase

c reactive protein

cardiac natriuretic peptide markers BNP

serum lipids - triglycerides and cholesterol

what is the major cardiac biomarker used today

troponin

what r troponin t and i

proteins released from irreversibly damaged tissue cells

what is troponin 1 specific too

cardiac specific

what is important to know abt troponin

once elevated it wont elevate more if the individual re-infarcts

what cardiac enzymes are looked at following a cardiac event

creatine kinase

ck-mb is specific to what

cardiac specific

elevated af cardiac trauma