Cardiovascular System (test 8)

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How much fluid does the pericardial space contain?

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How much fluid does the pericardial space contain?

30-50 mL

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Right ventricle/atrium function

Receive deoxygenated blood and pump it through the lungs

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Left ventricle/atrium function

Receive oxygenated blood from lungs and pump it through the systemic circulation

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SA Node function

"Pacemaker", initiates electrical impulses in the heart

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What is systole?

Contraction of the heart muscle (force of the blood against aorta) (Top number on B/P)

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What is diastole?

Relaxation of the heart muscle (bottom number on B/P)

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How many L of blood does the heart pump out each min?

5L

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Normal ejection fraction

50-70%

  • decreases with heart failure

  • Ejection fraction = amount of blood ejected from LV in systole

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Arteries vs veins

Arteries: carry oxygenated blood AWAY from the heart Veins: Carry low oxygen blood back to the heart for reoxygenation

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Heart sounds during systole

  • Mitral/tricuspid valves close (1st heart sound)

  • Aortic/pulmonic valves open (2ns heart sound)

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Cardiac output equation

Heart rate x stroke volume (amount of blood ejected)

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Effects of aging on the CV system

  • Stiff heart muscles (lower stroke volume)

  • Valves thicken (especially on L side which works harder/subjected to higher pressure)

  • CAD to some degree in everyone

  • SA node loses cells, increasing risk of dysrhythmias

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Arteriosclerosis vs atherosclerosis

Arteriosclerosis = Thickening/hardening of BV due to loss of elasticity Atherosclerosis = Thickening/hardening of BV due to buildup of plaque

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Valve stenosis

Narrowing of a valve

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Electrocardiography (ECG)

Graphic recording of electrical currents generated by heart muscle

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Stress testing (chemical/treadmill)

Goal is to evaluate heart function during exercise while getting ECG

  • NPO 2-3 h before

Chemical stress test given to pt's who cannot tolerate treadmill (med given to increase HR and BP.)

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Echocardiogram

An ultrasound done to evaluate the size of heart, valves, wall motions

  • can be done via probe in esophagus (especially in obese pt's)

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Venous doppler

Looks for clots

  • no smoking for 30 min before

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Vascular doppler

Looks at arteries to locate blockages

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CT angiography

Injection of iodine contrast combined with CT scan to examine arteries that supply blood to heart

  • can also be done via MRI

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Cardiac catheterization

Catheter enters femoral or radial artery into the R or L side of the heart

  • Evaluates presence of coronary artery blockage

  • Uses dye (assess for shellfish/iodine allergy)

MARK WHERE PEDAL PULSES ARE BEFORE TEST

  • after pt must lay flat with leg extended (if femoral site was used)

  • encourage fluids to flush contrast

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Electrophysiology studies

Much like cardiac catheterization

  • mapping of the impulse of the heart to identify abnormals

Post op same as cardiac cath

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Auscultating heart sounds acronym

Apple pie tastes mmmm

Aortic Pulmonary Tricuspid Mitral

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CRP lab test

C-reactive protein

  • looks for inflammation anywhere (very general)

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Troponin lab test

Specific to heart muscle damage

  • may elevate within 4-6h after MI

  • return to normal in 10 days after MI

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BNP lab test

Determines degree of HF

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Normal HgbA1C

Blow 5.7% is normal

  • Above 6.5 = DM

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s1 and s2 are?

Systole = s1, diastole =s2

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Heart murmurs systolic vs diasolic?

Systolic murmurs = after systolic Diastolic murmurs = after diastole

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True or false? Women have more "irregular" symptoms of MI such as neck and arm pain

True

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cultural considerations for hypertension

More common in african americans

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Complications of hypertension

  • CAD

  • atherosclerosis

  • MI -HF -Stroke

  • Eye damage

  • Kidney damage

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What to do for hypertension?

  • Limit salt, caffeine and alc

  • Take potassium and calcium

  • Exercise

  • quit smoking

  • lose weight

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Hypertensive crisis vs urgency

180/120 = crisis 180/110 = urgency (without s/s of organ damage)

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Peripheral vascular disease

Umbrella term of both

  • peripheral arterial disease

  • Peripheral venous disease

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Peripheral arterial disease

  • Blood does not get to legs (arterial insufficiency)

  • pain when walking that subsides with rest

  • Ulcers

  • Dependant rubor (pale when leg is elevated, red when leg is down)

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Peripheral venous disease

  • blood gets to leg but cannot come back

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Chronic venous insufficiency

  • from damage to valves in the veins

  • RBC leak into tissue S/S

  • chronic edema, itchy scaly skin, ulcers

Nursing treatment: Ted hose, elevation

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Heart failure definition

Heart cannot pump enough blood to meet bodies needs

  • blood and fluid build up

  • 4 stages

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Left sided heart failure

-Left ventricle cannot contract correctly, not pumping enough blood out

  • Congestion in lungs, fluid backs up

  • causes lung related symptoms

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Left sided heart failure symptoms

  • SOB

  • pink, frothy sputum

  • cough

  • crackles

  • wheezing

  • fatigue

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Right sided heart failure

Right ventricle works harder but is unable to push blood + fluid back up

  • more fluid in veins

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Right sided heart failure s/s

  • edema

  • weight gain

  • ascites

  • distended jugular vein

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Hypertension is considered as

B/P >140/90 when taken at least twice on two different occasions, two weeks apart

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drugs for hypertension

  • diuretics

  • antihypertensives

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What should be done for a patient who started a new B/P medication?

Assessment for orthostatic hypotension

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Symptoms of cardiac dysarrythmias

Low cardiac output

  • dizzyness

  • palpatations

  • low blood pressure

  • chest pain

  • change in LOC

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How is a cardiac dysarrythmia diagnosed?

12 lead ECG

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V tach (ventricular tachycardia)

Atria does not have time to contract

  • HR 150-200

  • can lead to v fib (deadly)

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A-fib

disorganized rapid firing of impulses

  • increased risk of clots

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Premature ventricular contration (PVC)

Ventricular contraction early in the cycle, no P wave

  • can turn into v fib (deadly)

  • flip flop sensation in chest

  • pallor, sweating

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V-fib (ventricular fibrulation)

Start CPR, defibrilate

  • 0 cardiac output

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Endocarditis

Inflammation of the inner layer of the heart

  • inflamed tissue traps bacteria and organisms

  • can cause clots

  • common causes are virus, fungi, strep

  • may develop murmur

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Periacarditis

Inflammation of the pericardium (sac around the heart)

  • either dry (no fluid causing dry rubbing) or wet (too much fluid, leaking into space)

  • may hear friction rub

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Cardiac tampanade

Increased fluid in heart, restricting pumping

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Order of blood traveling through the heart

-right atrium tricuspid valve

  • right vetricle pulmonary valve

  • pulmonary artery

  • left atrium mitral valve

  • left ventricle aortic valve

  • aorta

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What do the coronary arteries supply?

myocardium

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Coronary artery disease

Narrowing of arteries that supply the myocardium of the heart

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True or false: statins can be toxic to the liver

True

  • creatinine kinase drawn regularly

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aspirin is what kind of medication

antiplatelet

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Myocardial infarction

100% occlusion of coronary artery, no blood getting to myocardium

  • tissue becomes necrotic and dies due to lack of blood flow

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How is an MI dx?

ECG, troponin levels, cardiac cath

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Acronym for MI treatment

M- morphine O- oxygen N- nitrates A- aspirin (chew)

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Stent

Opens up the artery/stops wall collapse

  • balloon angioplasty before to push plaque to the sides

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An ejection fraction below _ is a marker of systolic HF

40%

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Advanced systolic HF s/s

  • s3 and s4 heart sounds

  • crackles and wheezing in the lungs

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myocardium

heart muscle

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Stenosis

stiffening of heart valves (tricuspid, mitral) and difficulty opening

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Regurgitation

Valves do not close completely, causing backwards blood flow

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Mitral stenosis

  • difficulty opening mitral valve

  • backs up pressure in lungs

  • most commonly caused by strep and rheumatic fever

  • pulmonary s/s

  • diastolic murmur (due to mitral valve trying to open during diastole)

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Mitral regurgitation

  • mitral valve doesn't close completely

  • systolic murmur, possible third heart sound are heard (due to valve trying to close during systole)

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Electrical signals through the heart

SA node

  • av node

  • relays via bundle of his and purkinje fibers to ventricles to contract

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