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Urban RRD #7

Terms in this set (63)

Arterial vessels carry _______ blood, venous vessels carry _______ blood.
oxygenated, deoxygenated
The only venous vessles that carry oxygenated blood are the _____________ and ______________.
pulmonary venules and veins.
Trace blood flow "forward" through the heart.
SVC / IVC --> RA -->RV --> PA -->lungs --> PV
--> LA --> LV --> aorta --> systemic circulation
Trace blood flow "backward" through the heart.
LV --> LA --> PV --> lungs (edema)
lungs -->PA -->RV --> RA --> SVC/IVC --> (edema)
What is systole?
The part of the heart beat where the RV and LV are contracting and ejecting blood from their chambers.
What is the sinoatrial (SA) node?
It is a structure in the right atrium that tells the heart to "beat" or squeeze by sending out an electrical signal.
What is the stroke volume?
The amount of blood ejected per contraction (or squeeze, or with each beat of the heart). The average amount is around 70ml/beat.
What is an electrocardiogram?
The electrical signal that is created by the heart, starting with the SA node, can be recorded on paper by using specialized patches on the skin and recoding equipment.
Each depolarization, contraction, and repolarization of the chambers of the heart can be recorded on paper and analyzed by nurses and other healthcare providers.
What is a normal heart rate and rhythm?
A normal heart rate is 60 - 100 beats/minute.
A normal heart rhythm (the pattern that the electrical impulses travel through the heart) is called: "normal sinus rhythm (NSR)" or "sinus rhythm (SR)".
What is cardiac output (CO)?
The amount of blood ejected by the LV per minute. Normal CO is 4 - 6 liters of blood per minute.
What is the calculation for cardiac output?
CO = stroke volume * heart rate
What three conditions influence or impact stroke volume?
contractility of the cardiac muscles (how well does the pump squeeze)
preload (venous return to the heart)
afterload (arterial resistance to forward flow of blood out of the heart)
What is contractility?
How well the cardiomyocytes respond to electrical signals contract, squeeze, or pump out blood. How efficiently are the cells working together to eject blood. How toned the heart muscle is.
What is a positive inotropic effect?
something that enhances contractility of the heart
What is a negative inotropic effect?
something that decreases the contractility of the heart
What is preload?
The volume of blood that is returned to the right side of the heart / the amount of blood in the ventricles before contraction.

Good preload = good stretch of ventricular fibers = good contraction (Frank-Starling law).
What is afterload?
Any form of resistance to the forward flow of blood or ejection of blood from the RV or LV. A certain amount of afterload or resistance is considered to be normal.
What heart rate changes can affect cardiac output?
tachycardia (a heart rate greater than 100)
bradycardia (a heart rate less than 60)

If you have no heart rate at all, could that affect cardiac output? Totally!
Why would someone experience tachycardia?
SNS secreting epinephrine which stimulates Beta 1 receptors of heart (increasing HR)
Certain electrolyte changes (Ex. hyperkalemia)
Glitches in SA or AV node function
irregular heart rhythms (ex. atrial fibrillation, ventricular fibrillation)
What is atrial fibrillation (a-fib)?
an arrhythmia in which a chaotic series of electrical impulses in the atria cause them to quiver ineffectively rather than contract smoothly.
What are two possible sequelae of a-fib?
a small but sometimes significant decrease in cardiac output because of a loss of atrial kick

pooling of blood in the atria
Arterial thrombi form in which atria and if they get loose they can go where?
left atria; brain / systemic circulation
Venous thrombi form in which atria and if they get loose they can go where?
right atria / to the lungs
What is ventricular fibrillation?
a ventricular arrhythmia in which a chaotic series of electrical impulses causes them to quiver ineffectively rather than contract smoothly.
What is a significant sequela of ventricular fibrillation?
V-fib has no cardiac output at all.

S/sx of no cardiac output: no blood flow, no pulse, no perfusion, unconsciousness, and death.
Identify three pathological changes that can affect contractility (and cardiac output.)
ischemia from a blockage in a coronary artery
neurohormonal changes - SNS release of epineohrine
electrolyte imbalances
Identify two pathological changes to preload that can affect cardiac output.
Increased preload (increased blood volume / fluid volume overload)

Decreased preload (decreased blood volume / fluid volume deficit)
Identify three pathological changes to afterload that can affect cardiac output.
RV = increased pulmonary vascular resistance (increased afterload)
LV = increased systemic vascular resistance (increased afterload) and decreased afterload (Ex. septic shock, anaphlyaxis)
What is homocysteine?
An amino acid that can contribute to atherosclerosis via oxidative damage.
How are CRP levels related to coronary artery disease?
CRP is linked to the inflammatory process of plaque formation in the coronary arteries. If you have coronaty atherosclerosis, your CRP will be likely to be elevated.
Ischemia to cardiac cells causes a ______ inotropic influence to the cells.
negative inotropic influence
Tissue necrosis (death) in the heart is known as a ________________.
myocardial infarction (which is considered to be irreversible).
The most common symptom of CAD is __________.
Angina pectoris. Angina is a painful constriction or tightness. Patients will also describe it as burning, indigestion, or heaviness in their chest. It is rated on a 1 - 10 scale.
Why does angina occur?
Due to ischemia, lactic acid buildup and abnormal stretching of the ischemic myocardium occurs. This causes irritation to the myocardial nerve fibers and the afferent sensory nerve fibers in the area transmit these pain impulses to the spinal tract for detection.
Describe the pain pattern in stable angina.
The pain pattern is predictable and well-controlled by lifestyle changes, meds, etc.
What is collateral circulation?
The development of new, smaller branches of coronary arteries that grow in response to a vessel that has slowly become occluded or nearly occluded over time.
What kinds of treatments are used for stable angina?
nitroglycerine (NTG) and aspirin
What is an acute coronary syndrome?
This is when one of several possible coronary-artery-flow-blocking situations occurs:
1.) sudden clot development
2.) an arterial embolus flows into a narrowed coronary artery
3.) an existing plaque ruptures and it's contents fill up the lumen
What are the two sub-categories of ACS?
unstable angina
acute myocardial infarction
What makes unstable angina different from stable angina?
Unstable angina occurs when someone with stable angina experiences a change for the worse in their s/sx of chest pain. Examples:
angina does not get better with treatment
EKG (a tracing of the electrical activity of the heart) shows acute ischemic changes (changes from normal)
What are the s/sx of a myocardial infarction?
severe, unrelenting pain
specific s/sx related to the coronary artery that is blocked.
EKG changes that reflect ischemia and /or necrosis
serum lab tests that show an elevation in CK and troponin
What are the treatments for unstable angina or a myocardial infarction?
intravenous nitroglycerine, intravenous morphine
aspirin, oxygen
intravenous heparin or other medications to thin your blood (platelet inhibitors)
angioplasty and / or stent placement in the cath lab, coronary artery bypass graft (CABG) surgery, or clot-busting drugs.
What additional s / sx are present in an acute MI?
nausea, vomiting, sweating, diaphoresis
variations in heart rate and rhythm
chest pain
fatigue / weakness
mental status change
hypotension, prolonged cap refill times
dyspnea, low urine output
What is valvular stenosis?
A narrowed, stiffened heart valve. Blood cannot flow forward easily through it. It can affect cardiac output and may cause the patient to have a murmur.
What is valvular incompetence?
A floppy valve that doesn't close properly. it is also known as a valve prolapse or insufficiency. It can affect cardiac output and may cause the patient to have a murmur.
What is the definition of heart failure (HF)?
Heart failure is a general term used to describe several types of cardiac dysfunction secondary to the failure of the heart to eject / propel blood forward effectively. AKA: congestive heart failure.
Why does heart failure occur?
1.) there is a pump problem (weakened heart contractility)
2.) there is an afterload problem (increased resistance to forward flow)
3.) there is a preload problem (fluid volume overload)
What are the sequelae of heart failure?
diminished cardiac output
eventual problems related to the back-up of fluid and fluid volume overload
the RAAS works continually and inappropriately
When the RAAS is activated by the kidneys, what is the role of renin?
It facilitates the creation of angiotension I
With the help of __________ angiotension I is converted to angiotension II.
angiotension converting enzyme (ACE)
What is the role of angiotension II?
1.) it is a powerful vasoconstrictor (which will increase SVR)
2.) it triggers increased aldosterone secretion by the adrenal gland (which will increase Na and water retention).
What are s/sx of decreased CO?
fatigue / weakness
mental status change, deterioration of responsiveness
hypotension, prolonged cap refill times
dyspnea, low urine output
What are s/sx of left heart failure?
general s/sx of decreased CO and s/sx of fluid back-up into the lungs (lung congestion, pulmonary edema)
What are s/sx of pulmonary edema?
crackles on auscultation of the lungs
cough with blood-tinged sputum
orthopnea
increased respiratory rate
decreased oxygen saturation
What are s/sx of right heart failure?
general s/sx of decreased CO and s/sx of fluid back-up into the periphery (peripheral edema or peripheral venous congestion)
What are s/sx of peripheral edema / peripheral venous congestion?
jugular venous distention (JVD)
liver congestion
ascities (extra fluid in the abdominal cavity)
edema in the legs and feet
What are some causes of right heart failure?
ischemia and MI
anything that causes pathologically increased PVR (especially chronic pulmonary diseases).
What is cor pulmonale?
A type of right heart failure caused specifically by pathologicaly increased pulmonary vascular resistance.
How do we treat heart failure?
1. improve the pump (positive inotropic drugs, possibly slow down the heart rate to reduce heart workload).
2. decrease afterload (SVR and PVR): use NTG and ACE inhibitors
3. decrease preload: give diuretics
The _________ system is triggered when we have fluid volume deficit, and the _________ system is triggered when we have fluid volume overload.
RAAS, natriuretic
An abnormally elevated serum BNP level indicated that _____________ is occurring.
heart failure. This hormone (BNP) is secreted by the left ventricle when the myocardial fibers are stretched by increased volume. It circulates around to the kidneys to tell them to diurese some of the volume.
What is a general definition of "shock"?
Inadequate perfusion of tissues, usually due to hypotension (BP< 90/60) with resultant impaired cellular metabolism.
What are some general s/sx of shock?
generally decreased perfusion (decreased level of consciousness, dyspnea, low urine output, pale, cool skin, delayed cap refill)
and increased HR (a compensatory response).

Specific s/sx for shock will depend on its cause (ex. cardiogenic shock is shock caused by a heart problem)
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