Cardiac med surg unit Part 1

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Questions and Answers

What prevents friction between the layers of the heart as it beats?

Serous fluid (correct)

Fibrous pericardium

Endocardium

Epicardium

Where does the right atrium receive deoxygenated blood from?

Pulmonary veins

Aortic arch

Left ventricle

Coronary sinus (correct)

Which layer of the heart is directly responsible for preventing abnormal clotting?

Myocardium

Parietal pericardium

Endocardium (correct)

Visceral pericardium

What is the primary function of the coronary circulation?

To provide oxygenated blood to the myocardium (A) Signup and view all the answers

Which septum separates the right and left atria?

Interatrial septum (D) Signup and view all the answers

Which heart valve prevents backflow into the right atrium during ventricular contraction?

Tricuspid valve (B) Signup and view all the answers

From which structure does the coronary circulation originate?

Ascending aorta (B) Signup and view all the answers

Which layer of the heart is also known as the epicardium?

Visceral pericardium (A) Signup and view all the answers

What is the role of having the patient sit and lean forward when listening for a pericardial friction rub?

It allows the rub to be heard more clearly. (D) Signup and view all the answers

Which part of the stethoscope is best used to hear a pericardial friction rub?

Diaphragm (B) Signup and view all the answers

What condition is suggested by Mrs. Cheung's symptoms of shortness of breath, ankle edema, and visible jugular veins?

Heart failure with acute MI (C) Signup and view all the answers

Why might Mrs. Cheung not experience chest pain despite having an acute MI?

Elderly patients often do not feel pain the same way. (B) Signup and view all the answers

What is the reason for documenting ankle edema data carefully?

To monitor fluid accumulation and heart failure progression. (C) Signup and view all the answers

What is the significance of a cardiac troponin test?

To detect cardiac cell damage. (B) Signup and view all the answers

Which healthcare team member is likely to collaborate in caring for Mrs. Cheung with acute MI and heart failure?

Cardiologist (D) Signup and view all the answers

How do you convert Mrs. Cheung's weight from pounds to kilograms?

Divide the weight in pounds by 2.205 (D) Signup and view all the answers

What is a common cause of dyspnea during exertion?

Angina pectoris (A) Signup and view all the answers

Which condition can cause numbness and tingling in the extremities?

Paresthesia (B) Signup and view all the answers

What might cause a dry cough in patients with heart conditions?

ACE inhibitor medication (D) Signup and view all the answers

What symptom is commonly associated with orthostatic hypotension?

Dizziness (C) Signup and view all the answers

Which symptom is commonly associated with right-sided heart failure?

Jugular vein distention (B) Signup and view all the answers

Which childhood disease is linked to the development of heart disease later in life?

Rheumatic fever (A) Signup and view all the answers

For accurate blood pressure measurement, how long should the patient sit quietly before the measurement?

5 minutes (C) Signup and view all the answers

What is the primary consequence of a pulmonary embolus concerning breathing?

Shortness of breath (A) Signup and view all the answers

What abnormal heart sound is commonly associated with left-sided heart failure?

S4 (D) Signup and view all the answers

Which factor is NOT modifiable in the context of cardiovascular risk?

Family history (D) Signup and view all the answers

Which sign indicates insufficient arterial blood flow?

Cool temperature (A) Signup and view all the answers

What is a typical skin color change in tissue hypoxia?

Pallor (B) Signup and view all the answers

Which of the following is a common outcome of electrolyte imbalance affecting the heart?

Palpitations (D) Signup and view all the answers

Which test or observation is crucial for diagnosing right-sided heart failure?

Jugular vein distention (D) Signup and view all the answers

What is an average systolic blood pressure difference between the arm and ankle?

17 mm Hg (D) Signup and view all the answers

Where does systemic circulation begin?

Left ventricle (B) Signup and view all the answers

Which condition can be a result of low pressure in the pulmonary capillaries?

Prevention of alveoli fluid accumulation (C) Signup and view all the answers

What is the role of the hepatic portal circulation?

To regulate blood levels of nutrients and remove toxins (B) Signup and view all the answers

What consequence does atherosclerosis have on arterial blood flow?

It narrows arteries and may decrease blood flow (C) Signup and view all the answers

What is the most common form of cardiovascular disease among U.S. adults?

Hypertension (A) Signup and view all the answers

What symptom might older adults uniquely exhibit during a myocardial infarction?

Dyspnea (C) Signup and view all the answers

What factor is NOT typically a risk for cardiovascular disease?

Consistent physical activity (C) Signup and view all the answers

In terms of cardiovascular health, what does the initiative Go Red for Women aim to address?

Reducing risk factors specifically in women (D) Signup and view all the answers

Which characteristic is most relevant in assessing a patient's subjective complaints about cardiovascular pain?

Radiation and nature of pain (D) Signup and view all the answers

What factor can lead to edema as per the cardiovascular examination?

Right-sided heart failure (D) Signup and view all the answers

What is a typical manifestation of left-sided heart failure?

Crackles (B) Signup and view all the answers

What aspect of the cardiovascular system does the term 'atherosclerosis' describe?

Hardening and narrowing of the arteries (A) Signup and view all the answers

What role do the pulmonary veins play in the circulatory system?

Carry oxygenated blood to the left atrium (A) Signup and view all the answers

Which symptom is crucial to identify when assessing older adults for potential cardiovascular issues?

Dyspnea (D) Signup and view all the answers

What is the normal response of the pulse when a patient experiences a drop in systolic blood pressure while standing?

Increase by 15 to 20 beats per minute (C) Signup and view all the answers

Which of the following conditions could indicate orthostatic hypotension?

Heart rate increased by 25 beats per minute (D) Signup and view all the answers

Which of the following should be avoided before measuring BP to detect orthostatic hypotension?

Eating a meal (A) Signup and view all the answers

What should be done if a patient experiences dizziness during position changes due to orthostatic hypotension?

Assist the patient in lying down (D) Signup and view all the answers

Which group is at increased risk of orthostatic hypotension leading to falls?

Older adults with chronic illness (C) Signup and view all the answers

What measurement scale is used to describe pulse quality?

Four-point scale (A) Signup and view all the answers

What is a 'thrill' in the context of pulse palpation?

A vibration felt in an abnormal vessel (C) Signup and view all the answers

Which symptom might a patient report due to orthostatic hypotension?

Lightheadedness or syncope (D) Signup and view all the answers

What is the correct procedure if an abnormal pulse deficit is detected?

Report to the HCP (B) Signup and view all the answers

How is a 'bounding' pulse identified during palpation?

Pulse remains strong under slight pressure (A) Signup and view all the answers

What is indicated by pink, frothy sputum?

Acute heart failure (B) Signup and view all the answers

What action should be taken if a resident becomes unsteady and holds their head in the hallway?

Ensure their safety from falling (C) Signup and view all the answers

How long should a patient lie flat before BP measurements to identify orthostatic hypotension?

5 minutes (B) Signup and view all the answers

What should be ensured when taking BP and heart rate measurements for orthostatic hypotension detection?

Patient remains quiet during measurements (B) Signup and view all the answers

What should be documented along with BP and heart rate measurements?

Extremities used and patient position (D) Signup and view all the answers

What does dependent rubor in the lower extremities signify?

Decreased arterial blood flow (D) Signup and view all the answers

What condition does clubbing of the nailbeds most commonly indicate?

Oxygen deficiency over time (D) Signup and view all the answers

What does a capillary refill time longer than 3 seconds suggest?

Anemia or decreased arterial blood flow (B) Signup and view all the answers

Which heart sound is characterized by a low-pitched gallop heard early in diastole?

S3 (D) Signup and view all the answers

What finding might indicate a problem with venous blood return?

Varicose veins (B) Signup and view all the answers

What does an increase in jugular vein distention typically indicate?

Right-sided heart failure (B) Signup and view all the answers

What characterizes the S2 heart sound?

Closure of the semilunar valves (A) Signup and view all the answers

What does poikilothermy indicate in a patient?

Temperature variation reflecting environmental temperature (C) Signup and view all the answers

Which of the following is a typical symptom of peripheral vascular disease?

Paresthesia (D) Signup and view all the answers

How is pallor in a patient's extremities most commonly interpreted?

Anemia or lack of arterial blood flow (A) Signup and view all the answers

What is the expected finding when palpating the point of maximum impulse (PMI)?

A thrust during ventricular contraction (D) Signup and view all the answers

Which area is the best for hearing the second heart sound (S2)?

Erb's point (A) Signup and view all the answers

What condition might cause the PMI to shift to the left of the midclavicular line?

Enlarged heart (A) Signup and view all the answers

What does edema in the lower extremities typically signify?

Right-sided heart failure or venous return problems (C) Signup and view all the answers

Which heart sound may occur in adults with hypertension?

S4 (B) Signup and view all the answers

Oxygen-rich blood enters the heart through which vessel?

Pulmonary veins (A) Signup and view all the answers

Which valve prevents blood from flowing back into the left atrium during ventricular contraction?

Mitral valve (D) Signup and view all the answers

What is the role of the chordae tendineae and papillary muscles?

To prevent the AV valves from inverting during ventricular systole (A) Signup and view all the answers

Why is the wall of the left ventricle thicker than the right ventricle?

It pumps blood to the entire body, requiring more force (A) Signup and view all the answers

What is the role of the smooth muscle in arteries?

To alter where the greatest volume of blood is directed (B) Signup and view all the answers

What is the primary pacemaker of the heart?

Sinoatrial (SA) node (A) Signup and view all the answers

If the SA node fails, what structure takes over as the pacemaker?

AV node (C) Signup and view all the answers

What feature of veins prevents backflow of blood?

Presence of valves (B) Signup and view all the answers

What is a cardiac cycle?

The complete sequence of events related to blood flow into and out of the heart during one heartbeat (B) Signup and view all the answers

Why are capillary walls one-cell thick?

To permit exchange of gases, nutrients, and waste products (C) Signup and view all the answers

What causes the "lub" sound of the heartbeat?

Closing of the AV valves (D) Signup and view all the answers

What happens when precapillary sphincters dilate in active tissues?

Blood flow increases to the active tissue (B) Signup and view all the answers

What is the primary driving force for filtration at the capillaries?

Pressure differential across capillary walls (D) Signup and view all the answers

What is cardiac output?

The amount of blood ejected by the left ventricle per minute (C) Signup and view all the answers

What is stroke volume?

The amount of blood pumped by a ventricle in one contraction (A) Signup and view all the answers

What mechanistic role does renin play in blood pressure regulation?

Initiates the renin-angiotensin-aldosterone mechanism (A) Signup and view all the answers

What is Starling's law of the heart?

Increased venous return leads to increased stroke volume (B) Signup and view all the answers

How does the body's skeletal muscle pump contribute to venous return?

By squeezing the peripheral veins during muscle contraction (A) Signup and view all the answers

Which part of the brain primarily regulates heart rate?

Medulla oblongata (D) Signup and view all the answers

How does the heart’s rate and force influence blood pressure?

An increase raises blood pressure within limits (B) Signup and view all the answers

Which hormone directly increases water reabsorption by the kidneys?

Antidiuretic hormone (A) Signup and view all the answers

What effect does epinephrine have on the heart?

Increases heart rate and contractile force (B) Signup and view all the answers

What condition results from excessive tissue fluid formation that exceeds lymphatic collection?

Edema (A) Signup and view all the answers

What is the role of aldosterone in cardiac function?

It regulates blood levels of sodium and potassium (A) Signup and view all the answers

What is the function of atrial natriuretic peptide?

Decreases blood volume and pressure (B) Signup and view all the answers

What effect does a decrease in venous return have on the heart?

It results in weaker heart contractions (D) Signup and view all the answers

What is the primary function of endothelial lining in blood vessels?

To prevent abnormal clotting (A) Signup and view all the answers

Which vessels have walls that are one-cell thick?

Capillaries (D) Signup and view all the answers

What happens to systemic arterial pressure as blood progresses into the veins?

It decreases significantly (C) Signup and view all the answers

What is the result of increased sympathetic stimulation on veins?

Extensive constriction (A) Signup and view all the answers

Study Notes

Cardiovascular System

The cardiovascular system comprises the heart, blood, and blood vessels (arteries, capillaries, and veins). Its function is to circulate blood throughout the body, delivering oxygen and nutrients to tissues and removing waste products.

Heart Structure and Function

Location: Located within the mediastinum of the thoracic cavity, enclosed by three membranes: the fibrous pericardium (outermost), parietal pericardium (middle), and visceral pericardium/epicardium (innermost). Serous fluid between these layers reduces friction during heartbeat.
Chambers: Four chambers: two atria (thin-walled, receiving chambers) and two ventricles (thick-walled, pumping chambers). Separated by septa (interatrial and interventricular). Cardiac muscle (myocardium) forms the walls, lined with endocardium (smooth epithelium preventing clotting) continued as endothelium in vessels.
Coronary Circulation: Coronary arteries, branches of the ascending aorta, supply oxygenated blood to the myocardium. Deoxygenated blood returns via the coronary sinus to the right atrium.
Blood Flow Through the Heart:
- Deoxygenated blood enters the right atrium from the superior vena cava (upper body), inferior vena cava (lower body), and coronary sinus.
- Passes through the tricuspid valve into the right ventricle.
- Pumped through the pulmonary semilunar valve to the lungs via the pulmonary trunk and arteries.
- Oxygenated blood returns to the left atrium via the pulmonary veins.
- Enters the left ventricle through the mitral (bicuspid) valve.
- Pumped through the aortic semilunar valve into the aorta for systemic circulation.
Valves: AV valves (tricuspid and mitral) prevent backflow into the atria during ventricular contraction (systole). Semilunar valves (pulmonary and aortic) prevent backflow into the ventricles during ventricular relaxation (diastole). Each valve has flaps (cusps) of connective tissue covered by endocardium, anchored by chordae tendineae and papillary muscles. The left ventricle is thicker than the right, generating higher pressure for systemic circulation.

Cardiac Conduction Pathway and Cycle

Conduction Pathway:
- Initiated by the sinoatrial (SA) node (pacemaker) in the right atrium (depolarizes ~75 bpm at rest).
- Impulses travel to the atrioventricular (AV) node, then to the bundle of His, bundle branches, and Purkinje fibers to the ventricles.
Cardiac Cycle:
- Atria contract simultaneously, followed by simultaneous ventricular contraction (systole).
- Relaxation (filling) or diastole follows each contraction phase.
- Heart sounds ("lub-dub") result from valve closure. The "lub" is AV valve closure, and the "dub" is semilunar valve closure during ventricular systole and diastole, respectively.

Cardiac Output

Cardiac output: Volume of blood ejected from the left ventricle per minute, calculated by stroke volume (volume per beat) multiplied by heart rate.
Average: ~5-6 liters/minute at rest, determined by average HR (75 bpm) and stroke volume (60-80 ml/beat).
Ejection fraction: Measure of ventricular efficiency (55-70% of the end-diastolic volume).
Regulation:
- Starling's Law: Increased venous return stretches ventricles, resulting in stronger contractions and increased stroke volume.
- Increased heart rate also increases cardiac output during exercise, allowing for a higher blood circulation to accommodate the increased energy need.

Regulation of Heart Rate

Nervous System: Medulla oblongata alters heart rate according to sensory input. Sympathetic fibers increase rate and force; parasympathetic fibers decrease rate.
Hormones:
- Epinephrine: Increases heart rate and force of contraction, dilates coronary vessels, increasing cardiac output and blood pressure.
- Aldosterone: Regulates sodium and potassium levels essential for myocardial electrical activity.
- Atrial Natriuretic Peptide (ANP): Increases sodium excretion by the kidneys and reduces blood volume and blood pressure in response to increased blood pressure or volume.

Blood Vessels

Arteries/Arterioles: Carry blood away from the heart. Thick walls with smooth muscle to regulate blood pressure and direct blood flow. Endothelium prevents clotting.
Veins/Venules: Carry blood toward the heart. Thin walls with valves to prevent backflow, especially in extremities.
Capillaries: Fine networks connecting arterioles and venules. One-cell thick walls for efficient gas, nutrient, and waste exchange. Blood flow regulated by precapillary sphincters.

Blood Pressure

Definition: Force of blood against vessel walls measured in mmHg (systolic/diastolic).
Normal: 120/80 mmHg (systemic arterial pressure).
Regulation:
- Arteriolar constriction/dilation maintains peripheral resistance. The vasomotor center in the medulla regulates constriction and dilation in direct correlation with the state of the sympathetic nervous system. Sensory input also plays a role.
- Cardiac output affects blood pressure. High heart rate and contraction strength increase blood pressure, however, excessive heart rate decreases ventricular filling time and thus decreases cardiac output, which lowers blood pressure.
- Venous return: Factors like vein constriction, skeletal muscle pump, and respiratory movements affect venous return, influencing blood pressure.
- Elasticity of large arteries helps maintain pressure during ventricular relaxation.
Orthostatic Hypotension: Significant drop in blood pressure when changing positions, indicative of a potential underlying problem. Factors contributing to this include decreased fluid volume, diuretics, analgesics, or pain.

Renin-Angiotensin-Aldosterone Mechanism (RAAS)

Decrease in blood flow to the kidneys activates RAAS. Kidneys secrete renin, triggering a series of reactions that raise blood pressure by promoting water reabsorption and vasoconstriction.

Circulation Circuits

Pulmonary: Right ventricle pumps deoxygenated blood to lungs, oxygenates blood to return to the left atrium. Lower pressure prevents filtration, reducing the risk of pulmonary edema
Systemic: Left ventricle pumps oxygenated blood to body tissues. The hepatic portal vein allows blood from digestive organs to first pass to the liver for nutrient regulation before returning to the heart.

Aging and Cardiovascular System

Arterial aging (atherosclerosis) begins early in life, impacting blood flow.
Heart muscle efficiency decreases with age, affecting cardiac output and heart rate, although resting functions may be sufficient for healthy aging.
Valve thickening from fibrosis, leading to heart murmur, can occur.

Cardiovascular Disease

Prevalence of CVD is high, impacting American adults and significantly affecting women.
Lifestyle factors (diet, exercise, smoking) and access to quality health care play crucial roles in CVD risk.

Cardiovascular Data Collection

Comprehensive data collection includes patient health history and physical examination. Consideration of geriatric patients with possible atypical symptoms, physical examination, and documenting subjective and objective data.

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Description

Test your knowledge on the anatomy and functions of the heart. This quiz covers key concepts such as the layers of the heart, blood flow, and heart valves. Perfect for students studying human biology or cardiovascular systems.