What are the four chambers?Right Atrium, Right Ventricle, Left Ventricle, Left Atrium
What are the heart valves?Pulmonary Semilunar Valve, Aortic Valve, Left AV(Mitral) valve, Right AV(Tricuspid) Valve
Where is the Pulmonary semilunar Valve?Allows bl flow from the R ventricle to the pulmonary artery sending bl to the lungs
What are the pulse sites?Temporal, Facial, Carotid, Brachial, Radial, Femoral, Popliteal, Posterior Tibial, Dorsal Pedal
Cardiac OutputThe total amount of bl discharged from the ventricles per minute ( 3 decimal places to the right)
Formula for Cardiac OutputSV X HR Normal range: 4-8L/Min
Formula for Cardiac IndexCO/ BSA
Normal Range for Cardiac Index2.5-4.2 L/min
Formula for Stroke VolumeCO/HR
Normal Range for Stroke Volume40-80 ml
Normal Range for Central Venous Pressure (CVP)0-8 mmHg
Normal Range for Right Atrial Pressure (RAP)0-8 mmHg
Normal Range for Mean Pulmonary Artery Pressure (PA)9-18 mmHg
Pulmonary Capillary Wedge Pressure (PCWP)4-12 mmHg
Define Stroke VolumeThe amount of blood ejected from the ventricle during each contraction
What is hematocrit?The percentage of RBCs in relation to the total volume of blood
Normal Hematocrit for Males45%
Normal Hematocrit for Females42%
Normal Hemoglobin for Males14-18 gm/100 ml of blood
Normal Hemoglobin for Females12-16 gm/100 ml of blood
Blood cells are what % of total bl volume?45%
Plasma makes up what % of total bl volume?55%
What is trabeculae carneae?A cord tissue that serves as a supporting structure by forming a septum that extends into an organ from its wall or capsule.
Mean Arterial Pressure (MAP)FormulaSystolic pressure + (Diastolic X 2)/ 3
What is mean arterial pressure?Average of Pressure pushing through systemic circulation
MAP <60 mmHg…circulation to vital organs compromised
Map >100 mmHg after vascular surgery or aneurysms…may need antihypertensive agents and vasodilators
What is pulse pressure?Difference between the diastolic and systolic pressure
Decreased pulse pressure leads to…decrease in diastolic pressure in patients developing hypovolemic shock
Pulse pressure is first sign for what?blood volume loss
Normal range for Arterial Blood Pressure120/80 mmHg
What do arteries do?Carry blood away from the heart; “Resistance vessels”
What do veins do?Hold large amt of bl with very little pressure change; “Capacitance vessels”
InotropismHow strong the heart beats
Positive InotropismIncrease in myocardial contractility
Negative InotropismDecrease in myocardial contractility
What would an Inotropic drug do?Increase the strength of contraction
ChronotropismRate of myocardial contraction
Positive ChronotropismIncrease in the rate of myocardial contraction
Negative ChronotropismDecrease in the rate of myocardial contraction
What would a Chronotropism drug do?Increase the rate of contraction
Starling LawAbility of the heart to stretch and pump out more blood
Limit of Starlings LawIf the heart is pushed beyond its ability to accommodate the inccreased blood supply and subsequent myocardial stretch the heart will go into failure; pulmonary edema decreases CO
Normal range of MAP80-100 mmHg
What is the Apex of the heart and where does it lie?tip of the LV, 5th ICS at the left mid clavicular line just above diaphragm
5 structures that compose the vascular systemHeart, arteries, capillaries, veins and blood
Veins act as a reservoir and accommodate __% of circulating blood volume70%
Aorta to right atrium, high resistance, high pressure= _________ circulationsystemic
Pulmonary artery to LA, low resistance, low pressure= ________ circulationpulmonary
The body’s smallest blood vessels are___ and the measure __-__ micrometers in diametercapillaries; 5-10
Purpose of capillariesconnect arterioles and venules for gas and nutrient exchange bw blood and surrounding tissue
3 layers of the heartpericardium, myocardium, endocardium
What is the pericardium?outermost layer that encases the heart and attached to the great vessels
2 layers of the pericardium and their locationparietal-outside layer and visceral-adheres to myocardium
How much pericardial fluid separates the 2 layers of the pericardium?20-30ml
This layer of the pericardium is fused to and inseparable from the fibrous pericardiumparietal
this layer of the pericardium is part of the epicardiumvisceral
The myocardium consists of involuntary striated muscle fibers called ____myofibrils
2 types of filaments that make up myofibrils and link together to cause muscle tension and shortening areMyosin and Actin
_____= thick protein filament responsible for skeletal movementmyosin
___= thin protein filament responsible for aiding in contractionactin
Where is the endocardium and what does it do?innermost layer lining the chambers of the heart; regulates contractility and electrophysiology of the heart
In which layer of the heart do blood clots attach?endocardium
RAP=(diastolic only) 0-8 mmHg
RVP=15-25 mmHg Systolic; 0-8 mmHg Diastolic
Pulmonary artery Pressure15-25 mmHg Systolic; 8-15 mmHg Diastolic
LAP=(Diastolic only)4-12 mmHg
LVP=110-130 mmHg Systolic; 4-12 mmHg Diastolic
Aorta pressure=110-130mmHg Systolic; 70-80 mmHg Diastolic
Which valves are open during diastole and closed during systole?AV valves (bicuspid and tricuspid)
Bicuspid valve is AKAmitral valve
What are Chordae Tendoneaefibrous cords that connect the edges of the leaflets to the papillary muscles
What are the papillary muscles?muscular projections of the inner surface of the ventricles that tether the valves to prevent backflow to atria during systole
These valves are open during systole and closed during diastolesemilunar valves
Incompetence of the valve that results in back flow during systole is calledprolapse
2 things that can cause valve prolapseRheumatic fever and infectious endocarditis
Progressive narrowing of the valve orifice creating obstruction of blood flow isstenosis
4 causes of stenosiscongenital disorders, fibrosis, calcium build-up, Rheumatic fever
RVEDP=___, ___, ____, ___CVP, RAP, RVEDV, Preload of RV
LVEDP= ___, ___, ___ = ____LAP, LVEDV, Preload of LV, Pulmonary capillary wedge pressure
Describe right heart systoleA-V equilibration, tricuspid closes, ventricles tense, RVSP>PAP, pulmonic valve opens
At end systole RVSP= ___ and pulmonic valve closesPASP
Describe Left heart systoleA-V equilibration, Bicuspid closes, ventricles tense, LVSP> Aortic Pressure, Aortic valve opens
At end systole LVSP=___ and aortic valve closesaortic systolic pressure
What is preload and what affects it?amount of end-diastolic stretch on myofibrils affected by fluid volume, valvular disease
HIgh PCWP indicates what type of disease?lung disease
What is afterload?force against which the muscle fibers of the ventricles must pump against
Right ventricular afterload= ___ ___ ___, PADPpulmonary vascular resistance
Left ventricular afterload =SVR, ___
What does the Right Coronary Artery perfuse?SA Node, AVN, Bundle of His, posterior 1/3 of ventricular septum
What supplies blood to the greatest portion of the myocardiumThe left main coronary artery
2 branches of the LCA areLeft anterior descending and circumflex
LAD supplies __-__% of the left ventricle45-55%
Circumflex is located ___ and ____ and supplies __-__% of left ventriclelateral and posterior; 15-25%
Coronary circulation (heart) extracts approx. __% of oxygen from arterial blood supply at rest70%
SvO2 of CS blood= __%, PvO2 __mmHg30%; 20mmHg
Systemic circulation extracts approx __% of oxygen from arterial blood supply25%
SvO2 of systemic blood= __%, PvO2 __ mmHg75%; 40mmHg
Coronary artery dilation can increase perfusion volume __ times normal5
What can cause coronary artery dilation?increase HR, stress, inotropic drugs, increase in wall tension(hypertrophy, afterload)
What is teh major determinant of left ventricular blood flow?aortic diastolic pressure
Approx __% vessel occlusion is required to significantly decrease blood flow70%
3 things that decrease vessel diameterspasm, plaque, thrombus
3 factors that determine blood flowvessel diameter, viscosity of blood and pressure gradients
Hct > __% is critical increase in WOH55%
What is Starling Law?the force of contraction is related to the amount of blood in the ventricles at end diastole (more volume = more stretch= more contraction)
Starlings law is lost in what disease statescardiomegaly/hypertrophy (overstretched muscles= less contraction)
The force of contraction is partly related to _____ in the __cellular fluidcalcium; extracellular
Calcium channel blockers are given to patients with ___’s to slow contractionSVT’s
Muscle contraction occurs when calcium goes into the cell and goes into ___troponin
What is troponin?protein located on teh actin filament that initiates contraction
Path of the electrical conduction systemSA node-Bachmans bundle(intraatrial)-AV node- Bundle of His- bundle branches- Perkinje fibers- Myocardium
Sympathetic: Vaso___, ___HR, conduction velocity and contractility, and broncho____constriction; increases; dilation
Parasympathetic: ___ HR, conduction and promotes Vaso___slows; vasodilation
extravascular=lung tissue, alveoli, interstitial space
Normally intravascular should be ____ extravascular volumeequal to
Capillary diffusion is dependent upon what 2 things?capillary permeability and opposing forces of hydrostatic and oncotic forces
Capillaries are highly permeable to ___ and relatively impermeable to _____electrolytes; plasma proteins (ex: albumin)
Pressure exerted by a volume of fluid within a given spacehydrostatic pressure
this protein keeps fluid in the capillariesalbumin
Capillaries have > fluid pressure than alveoli, therefor forces fluid from what to whatvascular space(capillaries) to interstitial space (lung tissue) AKA pulmonary capillary hydrostatic pressure
When insterstital hydrostatic pressure is low but alveolar and capillary pressures are normal, what occursfluid leaks from capillary into lung tissue
What is the force generated by the attraction of protein molecules for H2oOncotic pressure
What is Plasma oncotic pressureholds proteins together to keep blood from leaking out of capillary
In normal lungs how much fluid leaks into lung tissue and interstital space and is cleared by lymphatics20-30 ml/hr
What is the abnormal accumulation of fluid outside of the vascular spaces of the lungpulmonary edema
Fluid balance is controlled by what 2 thingsAC membrane permeability and Oncotic and hydrostatic forces
Lymphatic system can compensate for an increase up to __ times to maintain dry state10
hypoalbuminemia causes a decrease in whatplasma oncotic pressure
Causes of cardiogenic pulmonary edemarenal failure, CHF, hypervolemia, Left ventricular failure (MI, valvular disorders, htn; arrythmia)
Assessment: Cardiogenic pulmonary edemavisible CHF pattern, crackles
Ways to treat cardiogenic pulmonary edemaO2, Positive pressure, decrease fluid intake, diuretics, inotropes
what are the 3 phases of cardiogenic pulmonary edemaCompensated, Interstitial, and alveolar
Non-cardiogenic pulmonary edema usually results from whatARDS
Clinical findings assoc with Non cardiogenic pulmonary edemaacute onset resp distress 24-48 hrs after cause, diffuse bilat interstitial infiltrates on CXR, severe refractory hypoxemia
Causes of ARDSSepsis (>30% of cases), trauma, severe lung infection, aspiration, near drowning, DKA
3 phases of ARDSexudative, proliferative, resolution
Stage of ARDS characterized by accumulation of excessive fluids, protein and inflammatory cells in the alveoliExudative
The exudative stage usually unfolds over the first __-___ days after onset of lung injury2-4
During this stage of ARDS alveolar thickening continues, the lung tissue resembles liver tissue, danger of pneumonia, sepsisProliferative (fibrotic)
Lung function may continue to improve for as long as __-__ months6-12