36 cardio system


True or False

Men are more likely to have lung cancer over
women
True False


true


Hemorrhage of the nares or nostrils


epistaxis


Where is the heart located?


In the lower anterior area of the mediastinum


____ carry oxygenated blood away from the left side of the heart to the body tissues.


arteries


____ carry deoxygenated blood back to the right side of the heart


veins


What is the function of the cardiovascular system?


To provide oxygen, nutrients, and hormones to cells and remove carbon dioxide and waste products from the body cells


The protective sac that encapsulates the heart is called ___


pericardium


What are the three layers of the pericardium?


1. endocardium 2. myocardium 3. epicardium


The layer that lines the inside of the heart that is made up of epithelium cells


endocardium


Layer that is made up of striated muscles and varies in thickness depending on the hearts chamber


myocardium


The thickest chamber of the heart that pumps blood to the body is ___


left ventricle


Layer that surrounds the outside of the heart


epicardium


The layer that is also called the epicardium that surrounds the heart and lines the great vessels


Visceral layer


The emptying of blood with each contraction


depolarization


The cardiac recovery phase


repolarization


The upper chambers of the heart are called ___


atria


The lower chambers of the heart are called


ventricles


Left ventricle pumps blood into the ____


Aorta and out to the body


Right ventricle pumps blood into the ____


Pulmonary arteries and on to the lungs


What are the 4 heart valves


1. tricuspid 2. bicuspid 3. pulmonic 4. aortic


Fibrous cords attached to the cusps of the tricuspid and mitral valves is called __


Chordae tendineae


___ keeps the valves from inverting when the ventricles contract thus preventing blood from flowing back into the atrium


Chordae tendineae


____ and ____ valves prevent blood from flowing back into the ventricles from the pulmonary artery and aorta during repolarization


Pulmonic and aortic


The volume of blood ejected from the left ventricle with each contraction or systole is known as ____?


stroke volume


The amount of blood ejected in 1 minute


Cardiac output


____ Supply nutrients and oxygen to the heart


Coronary arteries


The conduction system that controls the heartbeat consists of


1. sinotria node (SA node) 2. atrioventricular node (AV node) 3. bundle of His 4. bundle branches 5. purkinje fibers


Called the pacemaker of the heart that initiates electrical impulses and is Located in the right atrium


SA node


Located in the lower right atrium


AV node


Group of specialized conduction fibers located in the interventricular septum


Bundle of His


Fibersthat separate into right and left bundle branches and divides into smaller branches


Purkinje fibers


_____ is completed when an impulse has completely gone through the conduction system of the heart and the ventricles have contracted


Cardiac cycle


Factors that influence stroke volume


Preload, afterload, contractility and HR


Amount of pressure within the ventricle


preload


The force that resists ejection of blood from the ventricles


afterload


The strength of cardiac contraction


contractility


Sound of the mitral and tricuspid valves closing simultaneously


Lubb (s1)


Sound heard on the right intercostal space. Simultaneous closing of the pulmonic and aortic valves.


Dubb (s2)


Low pitched sound that sounds like a gallop


S3


Three layers of arteries


Tunica intima Tunica media Tunica adventitia


Single layer of smooth endothelial cells


Tunica intima


Middle layer composed of smooth muscle cells


Tunica media


Outer layer that consists of connective tissue sheaths and collagen fibers that hold the vessel in place


Tunica adventitia


Thin vessels that connect the smallest arterioles with the smallest venules


capillaries


Excess fluid in the abdomen


ascites


Capillary refill should be less than ____ in fingers and toes


3 seconds


The leg will be ____if there is an arterial circulatory problem


cool


The leg will be ____ if there is a venous circulatory problem


warm


Inflammation of the skin caused by decreased circulation


Stasis dermatitis


A positive ____ is present in some cases of DVT and if there is pain in the calf or behind the knee it may indicate a venous clot.


Homan's sign


The firing of the SA node and the electrical impulse spreading across the atria yields a ___ wave in the ECG


P wave


Purkinje fibers transmit an electrical impulse to the _____ cells resulting in depolarization or contraction of ventricles


myocardial


Waves that represent repolarization of the ventricles and are repeated after each heart beat


T wave


The wave that is not always present on an ECG strip


Q wave


complex that represents the electrical impulse from beginning to end


QRS complex


The pause after qrs complex that represents the period between contraction and repolarization or recovery


ST segment


Irregularity in the rate, rhythm or conduction of the electrical system of the heart


dysrythmia


Irregular beats


ectopic beats


Most common causes of dysrythmias


1. myocardial infarction 2. coronary artery disease 3. CHF 4. electrolyte imbalance 5. drug toxicity


Administration of atropine is a treatment for ____?


bradycardia


Device that senses the dysrhythmia and automatically sends an electrical shock directly to the heart to defibrillate it.


Implanted cardiovascular defibrillator (ICD)


Occurs when the valves do not open and close properly


Valvular heart disease


When the valve does not close and leaks blood back into the chamber which it came from is called


regurgitation


True or False

The aortic valve is not repaired only replaced
True False


True


Narrowing and hardening of arteries


arteriosclerosis


Fatty deposits on the inner lining of vessel walls also known as plaque


atherosclerosis


Chest pain that is a tempoarary inadequate blood and oxygen supply to the myocardial tissues is also called


Angina pectoris


Ischemic attacks that do not experience angina


Silent Myocardial infarction


Final stage of heart conditions


heart failure


HF usually begins on which side


left


_____ failure is caused by left ventricular myocardial infarction, aortic valve stenosis, prolapsed valve complications and hypertension


Left sided heart failure


when blood becomes congested in the inferior vena cava, causing edema first in the extremeties and then in the trunk of the body this is a liklyhood of ______.


right sided heart failure


enlargement of the liver


hepatomegaly


edema, hepatomegaly, and neck vein distention are all signs and symptoms of ________.


right sided heart failure


a localized dilation occuring in a weakened section of an artery's medial layer is called a(n):


aneurysm


an example of congenital congestion would be:


Marfan's syndrome


known as high blood pressure


hypertension


a BP of 140/90 indicates


hypertension


african american race, male gender, aging, post menopausal women, and family history are all_______ risk factors


unalterable


smoking, lack of exercise, obesity, stress, low socioeconomic status, diet high in fat and sodium, alcohol intake, and oral contraceptives are all examples of ______ risk factors


modifiable


cause of hypertension is unknown is called:


primary hypertension


when the cause of hypertension is another condition in the body such as renal artery stenosis, chronic renal disease, sleep apnea etc is also known as:


secondary hypertension


which step in the stepped care approach involves adding a diuretic or beta blocker to the clients care regimen


second step


this step in the stepped care approach is to increase the drugs, try another drug, or add a secondary hypertensive


third step


this step in the stepped care approach invilves encouraging the client to try some lifestyle changes such as diet adn exercise.


first step


inflammation in the wall of a vein without clot formation


phlebitis


formation of a clot in a vessel


thrombosis


clot that remains in the site where it formed


thrombus


a clot (thromubus) that moves becomes an


embolus


pooling of blood, vessel trauma, and coagulation problems are all known as:


virchow's triad


true or false

is there are clinical signs of a thrombus homan's sign should not be assessed because the clot may be dislodged adn become an embolus
True False


true


when a clot is surgically removed is called:


thrombectomy


value at a particular time taht serves as a reference point for future value levels


baseline level


destruction of red blood cells


hemolysis


involves injecting a chemicalinto the vein causing the vein to become hardened so blood no longer flows through it


sclerotherapy


involves introducing a wire into a vein is called:


vein stripping


visibly prominant, dilated, and twisted veins usually in the lower extremeties


varicose veins


varicose veins in the esophagus is also known as


esophageal varices


varicose veins in the anus is also known as:


hemorrhoids


tieing off an involved section of the vein with a suture is called


vein ligation


an intermitten spasm of the digital arteries and arterioles resulting in decreased circulation in the fingers and toes is called


raynaud's disease


dysrhythmia that occurs from electrical conduction disturbances in the atria. Not usually life threatening.

common causes: MI, CHF, electrolyte imbalance, stress, medication


atrial dysrhythmia


dysrythmia that is more life threatening and originates from the ventricles


ventriclar dysrhythmia


dysrhtymia when client has no BP, pulse or respiration


V-Fib


dysrythmia when client is unconscious, no pulse or resps


V-asystole


electrical conduction interrupted to some degree between atria and ventricles at AV node


AV block


inflammation or infection of inside lining of heart


infective endocarditis


what does the cardio system consist of


the heart and its vasculature and the peripheral vascular system


in a lifetime how much blood will the heart pump


80 million gallons


peripheral vascular system consists of:


arteriesarteriolescapillariesvenulesveins


how much blood volume do veins and venules contain


60-70%


3 goals when obtaining health history


1. identify present and potential health problems

2. identify possible familial and lifestyle risk factors

3. involve client in planning long term health care


major risk factors associated with cardiovascular diseases


stressagegenderhereditysmokingdyslipidemiahigh BPphysical inactivityobesityDM


unalterable risk factors


agemale genderdiabetesheredityfamily Hx of chest painMI


3 objectives in assisting client toward healthier lifestyle


1. educate about risk factors

2. determine risk factors client wants to modify


typical concers expressed by a client with cardiac disorder


chest paindyspneaedemafaintingpalpitationsdisphoresisfatigue


a woman with cardiac disorder is most likely to experience:


SOBback or jaw painindigestionnauseavomiting


why do caridac cleints faint


bc of decreased CO causing decrease blood flow to brain


how to alleviate fatigue in cardiac clients


frequent rest periods


distended internal and external neck veins with HOB at 45 degrees can indicate:


right sided HF


if a heartbeat is heard but not felt through radial pulse this can mean?


Decreased CO to extremeties


Bradycardia:

�Heart rate of:

�Treatment?


Heart rate of 60 beats per minute or less

Treatment: Atropine or pacemaker


Tachycardia

�Heart rate of:

�Treatment:


Heart rate of 100 to 150 beats per minute

Treatment depends on cause


dysrythmia Symptoms vary from:


none to cardiacarrest:Fainting, seizures, fatigue,decreased energy level, exertional dyspnea, chest pain, andpalpitations


most important thing a nurse should consider if tachycardic is


what was pt doing


Occur from electrical conduction
disturbances in atria resulting in

Premature atrial contractions
Atrial tachycardia
Atrial flutter
Atrial fibrillation


Atrial Dysrhythmias


paroxysmal supraventricular tachycardia occurs suddenly, what could the MD perform to help stop this dysrythmia


vagal stimulation/valsalva maneuver


rapid contraction ofthe atria yielding a HR of 250-350 bpm, sawtooth pattern requiring immediate intervention


atrial flutter


erratic electrical activity of the atria of 350-600 bpm. atria quivers bc of mitral valve disease, HF, CAD, MI, hyperthyroidism, hypertensive HD.


a-fib


lifethreatning dysrythmia bc of the blood supply to lungs and body


ventricular dysrythmia


if PVC occurs without any other cardiac contractions what Tx should be done


remove cause such as stress or caffeine


dysrhythmia that can lead to pulmonary congestion and can result in low BP, weak body, and unconsciousness. rate may go as high as 140-240 bpm


ventricular tachycardia


cardioversion is delivered on ___ wave. why?


R

bc if given during ventricular depolarization it may cause ventricles to fibrillate


types of ventricular dysrythmia Treatment:


Oxygen, amiodarone (Cordarone), magnesium sulfate, lidocaine, cardioversion or defibrillation, CPR, andadvanced cardiac life support (ACLS) protocol


delivery of a synchorized electrical shock to change rythm circulate blood and oxygenate tissues


cardioversion


delivery of an unsynchornized, high energy electrical shock given in emergency situation. everyone stands clear of bed to prevent shock.


defibrillation


most common cause of ventricular fibrillation is _____


CAD


disorganized, chaotic, jagged unidentifiable waves with client having no BP, pulse, or respiratrion.


ventricular fibrillation


during ventricular fibrillation measures are to


initiate CPR and defibrillate immediately


electrical conduction is interrupted to some degree between atria and ventricles at the AV node


atrioventricular blcok


AV block degree with impulse that reaches ventricles but is delayed. requires no Tx bc it has no s/s


first degree


Tx for 2nd and 3rd degree AV block


pacemaker


nursing mgt for dysrythmia


monitor vitals = apicalprovide rest


Tx for atria dysythmia


amiodaronecardizemdigoxin


Tx for ventricular dysrythmia


amiodaronelidocainemag


what do crackles indicate


lung is filling with fluid


A Complication of rheumatic fever with s/s such as polyarthritis, chorea, rash, carditis

Linked to group A streptococcus following
upper respiratory infection

occurs 2-3 weeks after inadequetly treated pharyngitis


rheumatic fever


main goal for rheumatic fever


�Treat inflammation, prevent cardiac complications, and prevent recurrence


what should be done for people with rheumatic heart disease before surgery or dental work


put on prophylactic antibiotic


rheumatic heart disease can be treated with


antibioticantiinflammatorycorticoseroidsbed rest


Inflammation or infection of inside
lining of heart Including valves

Clients may develop murmurs, dyspnea,
peripheral edema, or pulmonary congestion

�Acute symptoms: Tachycardia, pallor, diaphoresis,
and symptoms of infection


infective endocarditis


infective carditis is caused by


bacteriafungivirus


Tx for infective endocarditis


Surgery and antibiotics (penicillin, vancomcin, garamycin)


�Inflammation of myocardium

�Symptoms: Flu-like symptoms of fever,
pharyngitis, myalgias, GI complications, chest pain, and pericardial friction rub

Treatment: Digoxin, antibiotics, anti-inflammatories, oxygen, and bed rest to prevent congestive heart failure

can lead to CHF

usually caused by virus

prevelant in aids Pt


myocarditis


activity to prevent myocarditis


bed rest


�Inflammation of membranous sac surrounding heart

�Symptoms: Severe chest pain and pericardial
friction rub

�Complication: Cardiac tamponade


pericarditis


�Caused by myocardial ischemia

�Squeezing pain under sternum radiating to left or right shoulder, jaw, or ear

�Pain may be mild or immobilizing

�Treat to increase blood supply to affected area via medication or surgical procedures E.g., percutaneous transluminal coronary angioplasty (PTCA), stent, coronary artery bypass graft (CABG)


angina pectoris


vasodilator tx for angina


nitro then morphine


mona for angina


morphineoxygennitroasprin


�Obstruction in coronary artery resulting
in necrosis to tissues supplied by artery

�Symptoms: Chest heaviness, lower sternal pain, dyspnea, diaphoresis, nausea, anxiety, vomiting, change in pulse and blood pressure, pallor, and cyanosis

�Women may have different symptoms

atherosclerosis common cause

left ventricle most affected


MI


MI s/s for men


chest heaviness tightness griping pain in sternal area

pain in arm, neck, back, epigastric area


�Treat to reduce oxygen demands, increase oxygen supply, relieve pain, improve tissue perfusion, and prevent complications and further tissue damage

�Treatment: Medications, surgery, diet, and bed rest


MI


�Develops when heart no longer capable of
meeting body�s oxygen needs

�Causes: Untreated left ventricular failure, right ventricular myocardial infarction, chronic obstructive coronary disease, cor pulmonale, and pulmonic valve stenosis


right side hf


Treatment of Heart Failure


�Treat to improve circulation to coronaryarteries and decrease workload of left ventricle
�Treatment: Medication, diet changes, fluid restriction, oxygen, and surgery E.g., ventricular assist device (VAD), intra-aortic balloon pump


�Heart affected because of lung condition
that interferes with exchange of carbon dioxide and oxygen in alveoli

�Symptoms and medical and nursing care
same as right-sided heart failure


cor pulmonale


�Done for cardiomyopathy, end-stage coronary artery disease, and valvular disease

�Recipient must remain on immunosuppressant medication for remainder of life


Cardiac Transplantation


�Localized dilation occurring in weakened
section of artery

�Symptoms depend on location:Hypotension, tachycardia, pallor, cool and clammy skin, and abdominal or back pain

�Treatment: Medications, surgery, and periodic
monitoring

abdominal aorta common


aneurysm


�Inflammatory disease of small and medium
arteries and veins leading to vascular obstruction

�Symptoms: Numbness, burning, pain at rest,
and decreased sensation in hands and feet


Buerger�s Disease (Thromboangiitis Obliterans)


�Intermittent spasm of digital arteries and arterioles

�Results in decreased circulation to fingers and toes

�Symptoms: Fingers pale, cyanotic, red as
circulation returns, and with tingling or throbbing pain


Raynaud�s Disease/Phenomenon