Question Answer
acute coronary syndrome refers to rupture of an atheromatous plaque in a diseased coronary artery, which rapidly form an obstructive thrombus
afterload the amount of resistance to ejection of blood from the ventricles
apical impulse impulse normally palpated at the 5th intercostal space, left midclavicular line: caused by the contraction of the left ventricle: also know as the point of maximal impulse
atrioventricular node AV secondary pacemaker of the heart, located in the right atrial wall near the tricuspid valve
baroreceptors nerve fibers located in the aortic arch and carotid arteries that are responsible for control of the blood pressure
cardiac catheterization an invasive procedure used to measure cardiac chamber pressures and assess patency of the coronary arteries
cardiac conduction system specialized heart cells strategically located throughout the heart that are responsible for methodically generating and coordinating the transmission of electrical impulses to the myocardial cells
cardiac output amount of blood pumped by each ventricle in liters per minute. In a resting adult it is 4-6 L/min but varies greatly depending on the metabolic needs of the body
cardiac stress test a test used to evaluate the functioning of the heart during a period of increased O2 demand
contractility ability of the cardiac muscle to shorten in response to an electrical impulse. contractility is enhanced by circulating catecholamines, sympathetic neuronal activity, & certain meds like digoxin, dopamine, dobutamine. contractility is depressed by hypoxem
depolarization electrical activation of a cell caused by the influx of Na+ into the cell while K+ exits the cell CONTRATION HAPPENS HERE
diastole period of ventricular relaxation resulting in ventricular filling. during diastole all four heart chambers are relaxed, as a result the AV valves are open and the semilunar valves are closed.
ejection fraction % of the end-diastolic blood volume ejected from the ventricle with each heartbeat, usually on the left ventricle is measured and runs 55%-65%. ejection fraction of <40% indicates that the pt has decreased L/ventricular function and likely requires treatm
hemodynamic monitoring the use of pressure monitoring devices to directly measure cardiovascular function
HTN BP that is persistently >140/90
Hypotension BP <100/60 that compromises systemic perfusion
murmurs sounds created by abnormal, turbulent flow of blood in the heart
myocardial ischemia condition in which heart muscle cells receive less O2 than needed
myocardium the middle layer is made up of muscle fibers (muscle layer of the heart) responsible for the pumping action of the heart
normal heart sounds sounds produces when the valves close; normal heart sounds are S1 (atrioventricular valves) S2 (semilunar valves)
opening snaps abnormal diastolic sound generated during opening of a rigid atrioventricular valve leaflet
postural hypotension (orthostatic) a significant drop in BP (20 mm Hg systolic or more) after an upright posture is assumed
preload degree of stretch of the cardiac muscle fibers at the end of diastole. the volume of blood within the ventricle at the end of diastole determines preload. Therefore, preload is commonly referred to as "L/ventricular end-diastolic pressure". Anything that
pulmonary vascular resistance resistance to blood flow out of the right ventricle created by the pulmonary circulatory system
pulse deficit the difference between the apical and radial pulse rates
radioisotopes unstable atoms that give off small amounts of energy in the form of gamma rays as they decay; used in cardiac nuclear medicine studies
repolarization return of the cell to resting state caused by reentry of K+ into the cell while Na+ exits the cell
S1 the 1st heart sound produced by the closure of the atrioventricular (mitral & tricuspic) valves
S2 the 2nd heart sound produced by the closure of the semilunar (aortic & pulmonic) valves
S3 an abnormal heart sound detected early in diastole as resistance is met to blood entering either ventricle; most often due to volume overload associated with heart failure
S4 an abnormal sound detected late in diastole as resistance is met to blood entering either ventricle during atrial contraction; most often caused by hypertropy of the ventricle
sinoatrial node SA primary pacemaker of the heart located in the right atrium
stroke volume amount of blood ejected from ONE of the ventricles per heartbeat. the average resting stoke volume is about 60-130mL
summation gallop abnormal sounds created by the presence of an S3 & S4 during periods of tachycardia
systemic vascular resistance resistance to blood flow out of the left ventricle created by the systemic circulatory system
systole period of ventricular contraction resulting in ejection of blood from the ventricles into the pulmonary artery and aorta
systolic click abnormal systolic sound created by the opening of a calcified aortic or pulmonic valve during ventricular contraction
telemetry the process of continuous electrocardiographic monitoring by the transmission of radio waves from a battery-operated transmitter worn by the pt
endocardium the inner layer of the heart; consist of endothelial tissue and lines the inside of the heart and the valves
epicardium the exterior layer of the heart
pericardium a thin fibrous sac the heart is encased in, which is composed of 2 layers adhering to the epicardium is the visceral pericardium. enveloping the visceral pericardium is the parietal pericardium a tough fibrous tissue that attaches to the great vessels,
phase 0 cellular depolarization is initiated as positive ions influx into the cell. during this phase, the atrial and ventricular myocytes rapidly depolarize as Na+ moves into the cells though Na+ fast channels
phase 0 the myocytes have a fast response action potential. in contrast the cells of the SA & NA nodes depolarize when Na+ enters these cells through Na+ slow channels. these cells have a slow response action potential
phase 1 early cellular repolarization begins during this phase as K+ exits the intracellular space
phase 2 this phase is called the plateau phase because the rate of repolarization slows. Ca ions enter the intracellular space
phase 3 this phase marks the completion of repolarization and return of the cell to its resting state
phase 4 this phase is considered the resting phase before the next depolarization
nodal and Purkinje (electrical cells generate and transmit impulses across he heart, stimulating the cardiac myocytes to contract. If both nodals fail Purkinje cells in the ventricle will fire its inherent brady-cardic rate of 30-40 impulses per minute
cardiac action potential has 5 phases
refractory period myocardial cells must completely repolarize before they can depolarize again. this has 2 phases effective and the relative
effective refractory period the cell is completely unresponsive to any electrical stimulus, it is incapable of initiating an early depolarization. this period corresponds with the time in phase 0 to the middle of phase 3 of the action potential
!!RELATIVE REFRACTORY PERIOD (CAN BE LIFE THREATENING) this period corresponds with the short time at the end of phase 3.
!!RELATIVE REFRACTORY PERIOD (CAN BE LIFE THREATENING) if an electrical stimulus is stronger than normal, the cell may depolarize prematurely,. early depolarization cause premature contractions that cause dysrythmias of either the atrium/venticle. Ventricular dysrthymias can be life threatening
cardiac cycle refers to the events that occur in the heart from the beginning of 1 heartbeat to the next. the number completed in 1 min depends on the HR. each cycle has 3 major sequential events: diastole, atrial systole, & ventricular systole
atrial kick atrial systole augments ventricular blood volume by 15%-25% (adds to what is already there)
ventricular systole the pressure inside the ventricles rapidly increase forcing the AV valves to close. as a result blood cease to flow from the atria into the ventricle & regurgitation (backflow) of blood into the atria is prevented. the <pressure forces the pulmonic/aort
hypertrophy thickening of the heart walls which reduces the volume the chamber can hold
CAD women usually develop this 10 later than men r/t estrogen. by 65yo women and men have the same risk ratio
estrogen three major effects are 1 an increase in HDL that transports cholesterol out of arteries. 2 a reduction in LDL that deposits cholesterol in the artery.
orthopnea need to sit upright or stand to avoid SOB
nocturia awaking at night to urinate is common in pt with HF
valsalva maneuver momentarily increases pressure on the baroreceptors. this triggers a vagal response causing the HR to slow and resulting in syncope in some pts
Angina Pectoris, S/S uncomfortable pressure, squeezing, or fullness in substernal chest area. Can radiate across chest to the medial aspect of 1 or both arms & hands, jaw, shoulders, upper back, or epigastrium. radiation to arms & hands described as numbness, tingling, aching
Angina Pectoris, duration, precipitating events, alleviating factors Duration: 5-15 min. Causes: physical exertion, emotional upset, eating large meal, or exposure to extremes in temperature. Alleviating Factors: rest, nitroglycerin, oxygen
ACS (unstable angina, MI) S/S same as angina pectoris pain or discomfort ranges from mild to severe associated with SOB, diaphoresis, palpitations, unusal fatigue & N/or V
ACS (unstable angina, MI) duration, precipitating events, alleviating factors Duration: >15 min. Causes: emotional upset or unusual physical exertion occurring within 24/h of symptom onset. can occur at rest or while asleep. AF: morphine, reperfusion of coronary artery with thrombolytic agent or percutaneous coronary intervention
pericarditis S/S sharp, severe substernal or epigaastric pain. Can radiate to neck, arms, & back. associated symptoms include fever, malaise, dysnea, cough, nausea, dizziness, & palpitations
pericarditis duration, precipitating events, alleviating factors Duration: intermittent. Causes: sudden onset pain increases with inspiration, swallowing, coughing, & rotation of trunk. AF: high-fowlers, analgesia, anti-inflammatory meds.
Esophageal Disorders (hiatal hernia, reflux esophagitis, or spasm) S/S substernal pain described as sharp, burning, or heavy. Often mimics angina. can radiate to neck, arm, or shoulders. Duration 5-60 min. Causes: Recumbency, cold liquids, exercise. AF: food, antacid, or nitroglycerin
Anxiety/Panic disorders S/S pain described as stabbing to dull ache. Associated with sweating, palpitations, SOB, tingling in hands/mouth, feeling of unreality or fear of losing control
Anxiety/Panic disorders duration, precipitating events, alleviating factors Duration: peaks in 10 min. Causes: can occur at any time even during sleep, can be associated with trigger AF: removal of stimulus, relaxation, medication to treat anxiety or underlying disorder
Musculoskeletal Disorders (costochondritis) S/S sharp or stabbing pain localized in anterior chest. Most often unilateral. Can radiate across chest to epigastrium, or back
Musculoskeletal Disorders (costochondritis) duration, precipitating events, alleviating factors Duration: hours to Days. Causes: most often follows respiratory tract infection with significant coughing, vigorous exercise, or posttrauma. Some cases are idiopathic. Exacerbated by deep inspiration, coughing, sneezing, and movement of U/Torso or arms
!!! Postural Hypotension Assessment 1 position pt supine for 10 min. then take the initial BP & HR. 2 reposition pt to sitting with legs dangling, wait 2 min. retake BP & HR. 3 if pt is s/s free or has no significant decreases in systolic/diastolic BP, assisit pt into a standing po
pulse pressure the difference in systolic & diastolic pressures. normal is 30-40 mmHg. <30 mmHg signifies a serious reduction in cardiac output and requires farther assessment
aortic area second intercostal space on the right of the sternum
pulmonic area second intercostal space to the left of the sternum
Erb's point third intercostal space to the left of the sternum
tricuspid area 4th & 5th intercostal space to the left of the sternum
mitral area (apex) left 5th intercostal space at the midclavicular line
epigastric area below the xiphoid process
Heart Heart chapter 25

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