EXAM 1

layers of the heart from outermost to innermost

epicardium

myocardium

endocardium

myocardium components

thicker in LV

slow twitch fibers

contractile cells

electrical conduction

cardiomyocytes, fibroblasts

endocardium components

lines chamber

endothelial cells

barrier between vessels and blood

anti-inflammatory and anticoagulant

epicardium blends with the 

pericardium 

parietal pericardium

fibrous, dense, irregular connective tissue 

hold heart in place

layers of pericardium from outermost to innermost

parietal pericardium

pericardial space

visceral pericardium/epicardium 

pericardial space

filled with pericardial fluid

provides lubrication and cushion

mesothelial cells 

visceral pericardium

blend with epicardium

thin, loose connective tissue 

fat, mesothelial cells, coronary vessels

provide protection

superior vena cava

blood returning from superior to diaphragm
(head, neck, arms, chest)

formed from R/L brachiocephalic veins

inferior vena cava

blood from inferior to diaphragm 
(LE, abdominal)

formed from R/L common iliac veins

aortic arch

oxygenated blood from LV

what does the aortic arch suppply

brachiocephalic (innominate)

common carotid

subclavian

pulmonary trunk

deoxygenated blood to lungs

what artery is used most in CABG surgery

L internal mammary artery (LIMA)

(internal thoracic artery)

structures in the R/L atria

pectinate muscles

atrial appendages

pectinate muscles

increase surface area to allow for blood in atria

non contractile

RA>LA

atrial appendages

L causes more problems than R

what does a watchman surgery do

blocks the L atrial appendages to not allow blood to pass through and cause clots

R/L ventricle structures

trabeculae carneae

purkinje fibers

intraventricular septum

papillary muscles

trabeculae carneae

non contractile

keeps ventricles from sticking

purkinje fibers

transmit electrical signals

intraventricular septum

separate L/R ventricles

contain conduction fibers

papillary muscles

connect with tendineae carneae and AV valves to prevent prolapse back into atria during systole

deoxygenated pulmonary circuit

SVC/IVC → RA → RV → pulmonary artery → lungs

oxygenated systemic circuit

pulmonary vein → LA → LV → aortic artery → body 

R/L atrioventricular valve (AV valve) made of

tricuspid (RV)

mitral (LV)

R/L semilunar valve made up of

pulmonary valve (RV)

aortic valve (LV)

what prevents back flow during diastole

R/L semilunar valves

S1 “lub”

AV valve closing during systole

S2 “dub”

semilunar valve closing during diastole

SA node

pacemaker

normal: 60-100 BPM

AV node

backup pacemaker

normal: 40-60 BPM

electrical conduction pathway

SA node → AV node → AV bundle (bundle of His)→ purkinje fibers

what is the P wave

atrial systole (depolarization)

what is the QRS complex

ventricular systole (depolarization)

what happens between P wave and QRS complex

end ventricular diastole

depolarization

contract / stimulation

what is the T wave

initiates ventricular diastole (repolarization)

repolarization

rest / reset 

first 2/3 of ventricle filling is

passive

last 1/3 of ventricle filling is

atrial systole / atrial kick

what is atrial kick

contraction of atrium to fill ventricles

R coronary artery (RCA) supply

RV, RA, SA node, AV node

L (main) coronary artery (LCA) supply

LV and LA through branches

branches of L (main) coronary artery (LCA)

L descending artery (LDA)

L circumflex artery (LCX)

coronary sinus receive blood from most __ and delivers to __

coronary veins , R atrium

posterior descending artery (PDA) supply

posterior heart

cholesterol/HDL ratio lab

< 5 calc

non HDL cholesterol lab

< 130 mg/dL

non HDL cholesterol lab for 2+ CHD risks

< 70 mg/dL

artery and vein make up from outermost to innermost

tunica adventitia/externa

tunica media

tunica intima

tunica adventitia/externa contains

collagenous, fibrous tissue with own nerves and blood vessels

tunica media contains

smooth muscle, elastic tissue

larger in arteries

vasoconstriction/dilation by mechanical/chemical/electrical stimulation

tunica intima contains

endothelial cells, smooth muscle, LDL permeable

what happens when LDL adhere to the tunica intima

blockages

cardioversion

use a AED to reset rhythm

cardiac ablation

catheter inserted through groin and freeze/burn part of atria to slow conduction rate

mini maze

damaging part of heart tissue minimally invasive

maze procedure

same as mini but open heart

make one path from SA node to AV node

watchman

alternative for pts who cannot be in anticoagulants (hx of falls)

closes LA appendage

risk of blood pooling

electrocardiogram (ECG or EKG)

monitor HR and rhythm continuously - provide 1 view of heart 

usually 3 lead

12 lead EKG

examine HR and rhythm, conduction delays, and perfusion issues

examine all views of heart at a single moment

 use with pharm and GXT

ECHO

determines wall motion and thickness, valve diameter and integrity, chamber thickness and pressure

dx test for CHF and CM

used to find EF

trans-esophageal ECHO (TEE)

visual of valves, endocarditis, and aortic dissections

closer image of aorta

cardiac MRI compared to ECHO

more precise and you get cross sections of arteries

PHARM stress test

done when GXT is contraindicated

drugs through IV to increase BP and HR

ECG connected

no restrictions after 

GXT

examine cardiovascular efficiency at increasing O2 consumption

determine functional aerobic capacity and detect presence of cardiac ischemia

12 lead ECG, monitoring BP, HR and BORG

sPECT

single photon emission computed tomography 

monitor disease in specific coronary distribution for myocardial perfusion 

catheterization

inserted through femoral vessel into R or L side of hear

dye inserted to highlight coronary flow/blockage and heart chambers

pulmonary pressure high on R side means

R CHF

coronary angiogram

determine blood flow obstructions or lesions

dye is difficult to excrete for pts with compromised renal function 

R sided cath

go through femoral vein and access AA system via SVC to examine R heart and pulmonary AA pressure

dx CH

L sided cath

go through femoral artery and access AA system via aorta to examine coronary AA patency 

PT implications for cardiac cath

pt must lie supine for 4 hours after

check groin for bleeding

monitor vitals and check for chest pain

percutaneous transluminal coronary angiopplasty (PTCA)

opens occluded coronary artery

inflate balloon to compress plaque against arterial wall - balloon is removed

coronary stent

used when artery is too narrow to stay open

maintain intraluminal patency and structure

anticoagulant therapy x 6 weeks

percutaneous transluminal coronary atherectomy

used to break up and remove plaque through shaving

mainly used if PTCA fails

coronary artery bypass graft

use L internal mammary artery (LIMA) or saphenous vein if more than 2 vessels bypassed

CABG on bypass surgery approach 

stop heart to complete graft

machine is circulating blood

results in inflammation to GI and renal 

better revascularization than off pump

off pump CABG surgery approach

graft completed without stopping heart

better post op complications

robotic-assisted CABG surgery approach

small incision to complete graft

PT following CABG

pt seen post op day 1
discharged post op day 4

PT focus - functional mobility and pt ed, sternal precautions, breathing exs, splinted cough

ambulate at least 3x/day - walk right away

balloon valvuloplasty

dialating non calcified stenotic valves

usually aortic

annuloplasty

repair mitral or tricuspid as tx for regurgitation

most common valves to replace

aortic and mitral

transcatheter aortic valve replacement (TAVR)

used with pts who cannot do open heart

usually through femoral artery 

precautions same as cardiac cath

intra-aortic balloon pump (IABP)

used to assist circulation of heart

inserted through femoral artery 

how does IABP work

inflated during diastole to displace blood in thoracic aorta to restore pressure and decrease afterload

deflate during systole 

PT implications post IABP

hip flexion restricted <30 on that side

no out of bed (OOB) if femorally inserted

ther ex allowed otherwisw

L ventricular assist device (LVAD)

LA to aorta bypassing LV

R ventricular assist device (RVAD)

RA to aorta bypassing RV

PT for ventricular assist device

pt can ambulate, exs, go home

CANNOT GET PERIPHERAL PULSE OR BP

BIVAD

bypass both ventricles

RA - machine- pulmonary artery - lungs- LA - machine - aorta

take place of heart itself

total artificial heart (TAH)

bridge to heart transplant

ventricles removed

ECHMO

blood bypass lungs - ECHMO does the oxygenation of blood 

pt can ambulate if careful

central venous pressure of vena cava (CVP) norm

8-12

pulmonary artery pressure (PAP)

11-20

arterial line

measures SBP and DBP and immediate BP changes indicating AND MAP

normal MAP

60-90

<60 mmHg MAP means

compromised systemic perfusion to major organs