Cardiovascular System (test 8)

How much fluid does the pericardial space contain?

30-50 mL

Right ventricle/atrium function

Receive deoxygenated blood and pump it through the lungs

Left ventricle/atrium function

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

SA Node function

"Pacemaker", initiates electrical impulses in the heart

What is systole?

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

What is diastole?

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

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

5L

Normal ejection fraction

50-70%

• decreases with heart failure
• Ejection fraction = amount of blood ejected from LV in systole

Arteries vs veins

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

Heart sounds during systole

• Mitral/tricuspid valves close (1st heart sound)
• Aortic/pulmonic valves open (2ns heart sound)

Cardiac output equation

Heart rate x stroke volume (amount of blood ejected)

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

Arteriosclerosis vs atherosclerosis

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

Valve stenosis

Narrowing of a valve

Electrocardiography (ECG)

Graphic recording of electrical currents generated by heart muscle

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.)

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)

Venous doppler

Looks for clots

• no smoking for 30 min before

Vascular doppler

Looks at arteries to locate blockages

CT angiography

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

• can also be done via MRI

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

Electrophysiology studies

Much like cardiac catheterization

• mapping of the impulse of the heart to identify abnormals

Post op same as cardiac cath

Auscultating heart sounds acronym

Apple pie tastes mmmm

Aortic
Pulmonary
Tricuspid
Mitral

CRP lab test

C-reactive protein

• looks for inflammation anywhere (very general)

Troponin lab test

Specific to heart muscle damage

• may elevate within 4-6h after MI
• return to normal in 10 days after MI

BNP lab test

Determines degree of HF

Normal HgbA1C

Blow 5.7% is normal

• Above 6.5 = DM

s1 and s2 are?

Systole = s1, diastole =s2

Heart murmurs systolic vs diasolic?

Systolic murmurs = after systolic
Diastolic murmurs = after diastole

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

True

cultural considerations for hypertension

More common in african americans

Complications of hypertension

• CAD
• atherosclerosis
• MI
  -HF
  -Stroke
• Eye damage
• Kidney damage

What to do for hypertension?

• Limit salt, caffeine and alc
• Take potassium and calcium
• Exercise
• quit smoking
• lose weight

Hypertensive crisis vs urgency

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

Peripheral vascular disease

Umbrella term of both

• peripheral arterial disease
• Peripheral venous disease

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)

Peripheral venous disease

• blood gets to leg but cannot come back

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

Heart failure definition

Heart cannot pump enough blood to meet bodies needs

• blood and fluid build up
• 4 stages

Left sided heart failure

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

• Congestion in lungs, fluid backs up
• causes lung related symptoms

Left sided heart failure symptoms

• SOB
• pink, frothy sputum
• cough
• crackles
• wheezing
• fatigue

Right sided heart failure

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

• more fluid in veins

Right sided heart failure s/s

• edema
• weight gain
• ascites
• distended jugular vein

Hypertension is considered as

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

drugs for hypertension

• diuretics
• antihypertensives

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

Assessment for orthostatic hypotension

Symptoms of cardiac dysarrythmias

Low cardiac output

• dizzyness
• palpatations
• low blood pressure
• chest pain
• change in LOC

How is a cardiac dysarrythmia diagnosed?

12 lead ECG

V tach (ventricular tachycardia)

Atria does not have time to contract

• HR 150-200
• can lead to v fib (deadly)

A-fib

disorganized rapid firing of impulses

• increased risk of clots

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

V-fib (ventricular fibrulation)

Start CPR, defibrilate

• 0 cardiac output

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

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

Cardiac tampanade

Increased fluid in heart, restricting pumping

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

What do the coronary arteries supply?

myocardium

Coronary artery disease

Narrowing of arteries that supply the myocardium of the heart

True or false: statins can be toxic to the liver

True

• creatinine kinase drawn regularly

aspirin is what kind of medication

antiplatelet

Myocardial infarction

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

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

How is an MI dx?

ECG, troponin levels, cardiac cath

Acronym for MI treatment

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

Stent

Opens up the artery/stops wall collapse

• balloon angioplasty before to push plaque to the sides

An ejection fraction below _ is a marker of systolic HF

40%

Advanced systolic HF s/s

• s3 and s4 heart sounds
• crackles and wheezing in the lungs

myocardium

heart muscle

Stenosis

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

Regurgitation

Valves do not close completely, causing backwards blood flow

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)

Mitral regurgitation

• mitral valve doesn't close completely
• systolic murmur, possible third heart sound are heard (due to valve trying to close during systole)

Electrical signals through the heart

SA node

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