process of systole
1. electrical impulse from SA to AV node
2. impulse movement from AV to bundle of His and Purkinje fibers
3. contraction of ventricles
process of diastole
1. contraction of ventricles (systole)
2. closure of mitral and tricuspid valves
3. forces the aortic and pulmonic valves to open = ejection of blood into the aorta (LV) and pulmonary arteries (RV)
4. as blood is ejected the ventricular pressure decreases causing aortic/pulmonic valves to close
5. ventricles relax to fill with blood
EKG pathway
P = stimulation of SA and AV node; atrial contraction
QRS = stimulation of bundle of His and Perkinje fibers; ventricles contraction and atrial relaxation
T = ventricles relaxation
infarction
tissue death (necrosis) due to inadequate blood supply to the affected area (ischemia)
2 types of perfusion
central and local/tissue perfusion
generation of central perfusion
generated by cardiac output mainly through coronary arteries
cardiac output
- amount of blood heart pumps out in 1 min.
- movement of blood through the heart into the peripheral vascular system
Frank-Starlings Law
direct relationship between stroke volume of the heart and end diastolic volume = ejection fractions
normal ejection fraction
50-70%
As EF decreases, tissue perfusion decreases
Less than 40% = heart failure
central perfusion impairment
#NAME?
coronary arteries
supplies oxygenated blood to entire heart muscle
shock
inability of central perfusion to supply blood to peripheral tissues > ischemia cascade
2 primary causes of shock
impaired O2 and glucose use
5 types of shock
1. cardiogenic
2. hypovolemic/hemorrhagic
3. anaphylactic
4. septic
5. neurogenic
Shock is a complex pathophysiologic process involving all of the following except:
A. decreased blood perfusion to kidneys.
B. acidosis.
C. rapid heart rate.
D. Hypertension
D. Hypertension
S&S (vital signs) of impaired central perfusion
low BP, tachycardia compensation for low BP, low O2 saturation
S&S (cardiac assessment) of impaired central perfusion
tachycardia, extra heart sound or murmur
S&S (neurological assessment) of impaired central perfusion
dizziness, light-headedness, fainting
S&S of impaired central/local perfusion in infants and young children
#NAME?
local/tissue perfusion
#NAME?
tissue/local perfusion impairment
#NAME?
occlusion
atherosclerosis/thrombi
atherosclerosis
narrowing of the artery because of plaque build-up
arteriosclerosis
stiffening or hardening of the artery walls
metabolic syndrome
name for cluster of risk factors occurring together to increase the risk for heart disease and other health problems
3 diseases related to risk factors of metabolic syndrome
1. coronary artery disease
2. stroke
3. diabetes mellitus 2
2 important metabolic syndrome risk factors
central obesity and insulin resistance
5 risks for metabolic syndrome
- BP ? 130/85 mmHg ("apple" obesity)
- Fasting BG ? 100 mg/dL
- Waist circumference
> Men ? 40 inches
> Women ? 35 inches
- Low HDL cholesterol:
> Men < 40 mg/dL
> Women < 50 mg/dL
- Triglycerides ? 150 mg/dL (also causes HDL to ?)
aneurysms
out-pouching or dilation of an artery common in the aorta due to high workload demand
risk factors of hypertension
#NAME?
2 important causes of hypertension
1. increased peripheral resistance
2. increased blood volume
treatment for hypertension
ACE inhibitors, ARB's, and calcium channel blockers
G.P., a 50-year-old man, was referred for evaluation of blood pressure. If he has a high diastolic blood pressure, which of the following is G.P.'s reading?
a. 140/82 mm Hg
b. 160/72 mm Hg
c. 130/95 mm Hg
d. 95/68mm Hg
e. 140/72 mm Hg
c. 130/95 mm Hg
hyperlipidemia/dyslipidemia
increase in LDL and decrease in HDL
ideal labs for lipids
LDL = <100 mg/dL
HDL = >40mg/dL
cholesterol = <200 mg/dL
triglycerides = <150mg/dL
peripheral arterial disease
damage to the intimal layer of arteries
effects of peripheral arterial disease
#NAME?
2 types of results from coronary artery disease
1. stable angina
2. acute coronary syndrome (ACS)
acute coronary syndrome (ACS)
any condition brought on by a sudden reduction or blockage of blood flow to the heart
2 important aspects of ACS
#NAME?
condition resulting less than 20min of myocardial O2 deficit
ischemic attack
condition resulting greater than 20min of myocardial O2 deficit
myocardial infarction
S&S of coronary artery disease (CAD)
no S&S until they start to have ischemia
S&S of myocardial ischemia
angina at rest
EKG changes during acute coronary syndrome
ischemia = T wave can become flipped and have ST depression, which means part of the muscle cell wall in the heart isn't getting enough O2
injury = ST elevation = we have had some infarction so that entire muscle in the wall is ischemic and part of it has infarcted
infarction/necrosis = deep Q waves mean permanent infarction of the heart
2 types of myocardial infarctions
STEMI and NON-STEMI
STEMI
#NAME?
NON-STEMI
#VALUE!
3 interrelated concepts related to myocardial infarction
#NAME?
2 requirements for proper cardiac output
1. heart rate
2. stroke volume
- these refer to the ability of heart muscles to contract and get blood out into the system
CO = HR x SV
stroke volume
volume of blood pumped from the left ventricle per beat
stroke volume is impacted by (3)
1. contractility
2. preload
3. afterload
contractility
force of heart's contractions
preload
amount of blood in heart prior to contraction
afterload
amount of pressure heart exerts to move blood
heart failure
heart is unable to generate adequate cardiac output
3 results of heart failure
1. inadequate perfusion of tissues
2. increased diastolic filling pressure of the left ventricles
3. increased pulmonary capillary pressures
1st major organ to sense heart failure
kidneys because they are the farthest away from the heart
important lab indicating heart failure
increased BNP (brain natriuretic peptide - peptide released by heart when stressed)
most common cause of right-sided heart failure
left-sided heart failure because fluid backs up into lungs and overtime, it back up into the right-side of the heart
Individuals with only left heart failure would exhibit which of the following? (More than one answer may be correct.)
a. hepatomegaly
b. dyspnea
c. ankle swelling
d. pulmonary edema
e. peripheral edema
b. dyspnea
d. pulmonary edema
cardiomyopathy
dysfunction of myocardial cells
3 types of cardiomyopathy
1. dilated
2. restrictive
3. hypertrophy
dilated cardiopmyopathy
#NAME?
restrictive cardiomyopathy
#NAME?
hypertrophic cardiomyopathy
#NAME?
3 inflammatory conditions of the heart
1. rheumatic heart disease
2. endocarditis
3. pericarditis
rheumatic heart disease
autoimmune disease that causes valvular defects due to an exaggerated response after strep infection
2 effects of rheumatic heart disease
leaky valves and regurgitation
endocarditis
infection that attacks valves but not related to a strep infection
pericarditis
#NAME?
A nurse is caring for a client with pericarditis. Which of the following findings should the nurse anticipate?
A. Petechiae
B. Murmur
C. Abdominal Pain
D. Friction Rub
D. Friction Rub
2 effects of valvular heart disease
stenosis and regurgitation
stenosis
narrowing of valvular open that can lead to increase pressure/workload in the heart and can cause hypertrophy of the chamber preceding the stenosis
regurgitation
valve isn't fully closing and blood is leaking backward
impact of valvular dysfunctions on stroke volume
#NAME?
congenital heart defects
defects in how blood circulates in the heart
2 major classes of congenital heart defects
1. acyanotic
2. cyanotic
acyanotic defects
#NAME?
cyanotic defects
#NAME?
4 defects with increased pulmonary blood flow (acyanotic defects)
1. ASD
2. VSD
3. AV (atrioventricular) canal
4. PDA
ASD
atrial septal defect
- hole between atrias
VSD
ventricular septal defect
- hole between ventricles
PDA
patent ductus arteriosis
- failure of PDA (artery connecting aorta and pulmonary artery) to close within 1st weeks of life
3 defects with obstructive lesions (acyanotic defects)
1. coarctation of the aorta
2. aortic valve stenosis
3. pulmonic valve stenosis
coarctation of the aorta
narrowing of aorta = increased BP in upper extremities, decreased BP in lower extremities
aortic valve stenosis
narrowing of aortic valve
pulmonic valve stenosis
narrowing of pulmonic valve
2 defects with decreased pulmonary blood flow (cyanotic defects)
1. tetralogy of fallot (TOF)
2. tricuspid atresia
4 features of tetralogy of fallot
1. pulmonary stenosis
2. right ventricular hypertrophy
3. ventricular septal defect (VSD)
4. overriding aorta
tricuspid atresia
missing tricuspid valve
4 defects with mixed blood flow
1. transposition of great vessels
2. total anomalous venous return
3. truncus arteriosis
4. hypoplastic left ventricle
transposition of great vessels
aorta leaves RV and pulmonary artery leaves LV
total anomalous venous return
pulmonary venous return connects to right heart not left
truncus arteriosis
aorta and pulmonary vessels are 1 major vessel not 2
hypoplastic left ventricle
underdeveloped left side of heart along with ASD and PDA