| Flap 1 | Flap 2 |
| Sac encasing heart | Pericardium |
| 2 layers of pericardium | Visceral pericardium & Parietal pericardium |
| Visceral vs. Parietal pericardiums | V:attaches to heart's epicardium, P:supports heart mediastinum |
| 3 physiologic characteristics that provide heart's synchronization | Automaticity, Excitability, Conductivity |
| Automaticity vs. Excitability vs. Conductivity | A:initiate electrical impulse, E:respond to electrical impulse, C:transmit electrical impulse to another cell |
| SA node location | Junction of superior vena cava & Right atrium |
| AV node location | Right atrial wall near tricuspid valve |
| Reason for AV node delay | Allow atria to contract and complete ventricular filling |
| Purkinje fibers stimulate | Myocardial cells causing ventricular contraction |
| Ions that stimulate cardiac cells | Na, K, Ca |
| Na & K r/t Location during Polarized/resting state | Na is extracellular ion, K is intracellular ion |
| Cardia action potential d/t | Repeated depolarization and repolarization |
| Phase 0 | Rapid Depolarization, Positive Na ions move into cells |
| Phase 1 | Rapid Repolarization, K exits cells |
| Phase 2 | Plateau phase, Repolarization slows, Ca enters cells |
| Phase 3 | Final repolarization |
| Phase 4 | Resting phase b/f next depolarization |
| Speed r/t Ca & Na | Na uses fast channels, Ca uses slow channels |
| Cells are incapable of stimulation during | Refractory period |
| Responsiveness r/t Effective refractory period | Unresponsive to any electrical stimulus |
| Phases r/t Effective refractory period | Phase 0-mid Phase 3 |
| Phases r/t Relative refractory period | End of Phase 3 |
| Stronger than normal electrical impulse during Relative refractory period causes | Premature depolarization |
| Causes closing of AV valves | Increase in ventricular pressure |
| Causes semilunar valves to open | Increased ventricular pressure |
| Causes closure of semilunar valves | Decreased pressure in pulmonary and aortic arteries |
| Atrial systole synonym | Atrial kick |
| Hemodynamic monitoring measures | Chamber pressures |
| Stroke volume | Amount of blood ejected per heartbeat |
| Cardiac output vs. Stroke volume r/t Resting adult | CO:5 L/min, SV:70 mL |
| Sympathetic impulses vs. Parasympathetic implusles r/t HR | S:Increase HR, P:Decrease HR |
| Catecholamines & Thyroid hormone r/t HR | Increase HR |
| Location of baroreceptors | Aortic arch, Both internal carotid arteries |
| 3 Factors that determine Stroke volume | Preload, Afterload, Contractility |
| Diuresis, Venodilating agents & Low blood volume r/t Preload | Decrease preload |
| Example of Venodilating agent | Nitrates |
| Systemic vascular resistance | Resistance of systemic BP to left ventricular systole |
| Pulmonary vascular resistance | Resistance of pulmonary BP to right ventricular systole |
| Relationship b/w Afterload & Stroke volume | Inverse |
| Increase in stroke volume r/t Preload, Contractility & Afterload | Preload & Contractility increase, Afterload decreases |
| Complications r/t Acute Coronary Syndrome (ACS) | Dysrhythmias, HF |
| ACS is due to | Thrombus in diseased coronary artery |
| Signs and symptoms of CVD are r/t | Dysrhythmias, Conduction problems, CAD, HF, Cardiogenic shock |
| Elderly w/Diabetes may not experience which symptom r/t ACS | Angina d/t neuropathy |
| Symptoms r/t ACS in Elderly w/Diabetes to look for | SOB, Fatigue |
| More at risk for CAD r/t Gender | Men |
| Common elimation symptom r/t HF | Nocturia |
| Indicator r/t Dysfunction of heart | Reduced pulse pressure, Cardiac enlargement, Abnormal heart sounds |
| Central cyanosis is observed | Tongue, Buccal mucosa |
| Normal pulse pressure range | 30-40 mm Hg |
| Factors r/t Increased Pulse pressure | Elevated stroke volume, Reduced systemic vascular resistance, Reduced artery distensibility |
| Factors r/t Decreased Pulse pressure | Reduced stroke volume, Obstruction to blood flow during systole |
| 3 most common causes r/t Orthostatic hypotension | Reduced blood volume, Vasoconstrictor mechanism insufficiencies, Insufficient autonomic vasoconstricition |
| Time elapse b/w postural changes r/t Orthostatic hypotension measurement | 1-3 minutes |
| Vasoconstrictor mechanism insufficiencies vs. Autonomic insufficiencies | HR does not change w/autonomic insufficiencies |
| Sinus arrhythmia r/t Inspiration | Pulse increases w/inhalation, Decreases w/exhalation |
| Sinus arrhythmis is common in | Children, Young adults |
| Palpability r/t Apical pulse in 2 adjacent intercostal spaces | Left ventricle hypertrophy |
| S1 & S2 r/t Area most audible | S1:Apex, S2:Base |
| Gallops are d/t | Vibrations during diastole |
| Gallops during ventricular filling vs. Gallops during atrial contraction | Vent filling:S3, Atrial contraction:S4 |
| Inadequate renal perfusion r/t Urine output | Decreases urine output |
| First enzyme level to increase d/t MI | Creatine kinase |
| Peaks 2-3 days after CK increases | Lactic dehydrogenase |
| Myoglobin vs. Troponin | M:Can rule out early diasnosis of MI, T:Very early or late MI diagnosis |
| Necessary before Lipid profile and Homocysteine level may be drawn | 12-hour fast |
| Normal cholesterol level | Less than 200 mg/dL |
| LDL vs. HDL r/t function | LDL:transports cholesterol and triglycerides into cell, HDL:transports away from tissues/cells to liver for excretion |
| Triglyceride levels r/t LDL & HDL levels | LDL and triglycerides increase, HDL decreases |
| Brain natriuretic peptide(BNP) excellent in diagnosing | Heart Failure |
| End products of protein metabolism | BUN and creatinine |
| Prothrombin time(PT) and International Normalized Ratio(INR) measure | Level of coagulation and effectiveness of warfarin(Coumadin) |
| Graphic recording of heart's electrical activity | Electrocardiography(ECG) |
| Lead II vs. Lead VI r/t Monitoring effectiveness | II:atrial depolarization(P wave), VI:Ventricular dysrhythmias |
| Electrode changing r/t Telemetry | Every 1-2 days, Use different locations |
| 3 tests r/t Cardiac stress test | Excersise stress test, Pharmacologic stress test, Mental stress test |
| Nursing interventions r/t Exercise stress testing & Pharmacologic stress testing | 4-hour fast b/f test, Avoid stimulants |
| Ultrasound of heart | Echocardiography |
| 2 IV drugs used to vasodilate r/t Pharmacologic stress testing | adenosine(Adenocard), dipyridamole(Persantine) |
| Block effects of dipyridamole & adenosine | Theophylline & xanthines |
| Thallium uptake r/t Myocardial perfusion imaging | No uptake:infarcted tissue, Delayed uptake:ischemic myocardium |
| Computed tomography(CT) scans provide | Cross-section images of chest |
| Cardiac catheterization measures | Pressure & O2 sat in all heart chambers |
| Electrophysiology provides | Dysrhythmia diagnosis & management |
| Phlebostatic axis vs. Phlebostatic level r/t Hemodynamic monitoring | A:4th intercostal space at sternum, L:horizontal line in even w/phlebostatic axis in which stopcock must be level for accurate readings |
| Must be confirmed b/f Intra-arterial catheters are inserted | Collateral circulation |
| Cardioversion vs. Defibrillation | C:synchronized w/Pt's conduction, D:unsynchronized |
| 2 Safety measures r/t Paddles | Good contact b/w paddles and skin, No one in contact w/Pt when defibrillator is discharged |
| Medium necessary b/w Paddles and skin | Conductive medium |
| Called 3x b/f pressing Discharge button | CLEAR |
| CPR cycles b/w shocks | 5 |
| Cardioversion discharge that is not synchronized can cause | Ventricular fibrillation |
| Defibrillation is not used on these Pt's | Conscious, Have a pulse |
| Inhibited vs. Triggered r/t Pacemaker function | I:pacemaker functions when heart does not beat, T:pacemaker functions d/t intrinsic activity |
| Capture vs. Spike r/t Pacemakers | S:ECG interpretation when pacing begins, C:appropriate rhythm after spiking |
| Most common complication r/t Pacemakers | Dislodgement of pacing electrode |
| Magnet-containing objects | Earpiece of phone, Large stereo speakers |
| Airport searching r/t Pacemakers | Request hand search instead of wand |
| Implantable Cardioverter Defibrillators(ICD) function | Detect/terminate life-threatening tachycardia/fibrillation |
| Microwaves r/t ICD's | No concerns |
