MIDTERMS (Cardiovascular System) PDF

MIDTERMS (cardiovascular system) I. Anatomy of the Heart Major pumping organ 60-100 bpm (4-5L/ min blood) ○ Conditions that affect heartbeat Autonomic nervous stimulation Sympathetic branch increases HR Parasympathet...

MIDTERMS (cardiovascular system) I. Anatomy of the Heart Major pumping organ 60-100 bpm (4-5L/ min blood) ○ Conditions that affect heartbeat Autonomic nervous stimulation Sympathetic branch increases HR Parasympathetic branch decreases HR Heart will only contract if there is an electricity flows through the muscles of the heart ○ Electrical system SA node (produces 60-100 HR/IFR) (primary pacemaker) AV node (produces 40-60 HR/IFR) (accessory/ secondary pacemaker) Bundle of HIS Divided into left and right branches Purkinje fibers Located ○ Thoracic cavity between the lungs and above diaphragm (MEDIASTINUM) ○ Heart is levorotatory Heart ○ Base (top part heart) ○ Apex (bottom part heart) Also called point of maximal impulse Found in the 5th intercostal space Most important Due to hearing the heartbeat best Blood supply of the heart ○ Coronary artery Right coronary artery Right atrium Right ventricle Left coronary artery Circumflex coronary artery ○ Left atrium ○ Left ventricle posterior Left anterior descending artery ○ Left ventricle anterior Muscle layers ○ Endocardium (inner) Susceptible for infection Patient with metal implants or artificial valve must be given prophylactic medications  ○ Myocardium (middle) Susceptible of infarction Decrease blood flow (necrotic area or no blood flow) ○ Heart attack (Myocardial Infarction) ○ Pericardium (outer) 2 layers Outer fibrous layer ○ Attaches heart to the walls Inner serous layer ○ Produces pericardial fluid Provides lubrication that prevents friction Normal (30cc) Cardiac tamponade (higher than 30 cc) ○ Compress heart that prevents contraction Pericarditis (lower than 30 cc) ○ If you can hear pericardial friction rub Sounds like 2 leather rubbing each other GAB-HS ○ Most common bacterial cause of tonsillitis and pharyngitis Group a-beta hemolytic streptococcus Heart valves ○ Atrioventricular (AV) valves In between atrium and ventricle which prevents backflow from ventricle to atrium Closure produces LUB (1st sound) Open (relaxation) Close (ventricular contraction) 2 AV valves Bicuspid/ mitral valve ○ 2 cusps, in the left Tricuspid valve ○ 3 cusps, in the right ○ Semilunar valves In between large arteries and ventricular chambers which prevents backflow from the arteries to ventricles Closure produces DUB (2nd sound) Open (ventricular contraction) Close (relaxation) 2 Semilunar valves Pulmonary valve ○ Right  Aortic valve ○ Left ○ Valvular insufficiency Swishing sounds (murmurs) Lubhs-dub (problem with AV valve) Lub-dubhs (problem with Semilunar valve) ○ Valvular Landmarks All People Eat Tinolang Manok Aortic area ○ 2nd intercostal right Pulmonic area ○ 2nd intercostal left Erb’s points ○ 3rd intercostal left Tricuspid area/ septal area ○ 5th intercostal left Mitral area ○ 5th intercostal left (midclavicular line) Point of maximal impulse Best heard Heart sounds ○ S1 (av closure) ○ S2 (semilunar closure) ○ S3 (ventricular gallop) Rapid filling of ventricle After s2 ○ S4 (atrial gallop) Resistance to ventricular filling Before s1 II. Rheumatic Fever Affects the connective tissues NO GABHS ○ NO RHEUMATIC FEVER GABHS ○ Is the common bacteria for tonsillitis, pharyngitis, hay fever, etc. The proper treatment Amoxicillin Penicillin The tradition (it is not wrong but it only kills the bacteria surface level) Gargling hot water and salt Strepsils (lozenge) Bactidol  If GABHS are left untreated ○ It may affect: (HKJ) Heart Kidney Joints Diagnosis ○ Step 1: Prior + GABHS Ask if patient has tonsillitis, pharyngitis (2-3 weeks ago) If patient does not know, take ASO (Antistreptolysin o titer) NOTE! If no GABHS do not proceed to step 2 No GABHS = No RHEUMATIC FEVER ○ Step 2: JONES Criteria 2 major or 1 major with 2 minor Major (JONES) Joints/ polyarthritis QRS P > QRS (-) Medication: Atropine sulfate By pass  Premature ventricular contraction (arrhythmias) Reportable (why do we need to report it? Because PVC Non-reportable will turn into VTac and then into VFib) 3 PVCS in a row (-) 6 PVCS in a minute (-) Medication: (-) Lidocaine