Professional Documents
Culture Documents
<Cardiology>
Diastole
= relaxation of the muscle
→ chambers fill w/ blood
•Output = 5 L / min
7. Blood Pressure
- Pulse pressure = SBP –DBP [Normal = 40-50 mmHg]
→ narrow = low SV, as in CHF, shock or aortic valve stenosis (constriction or narrowing of a passage)
→ wide = stiffness of the major arteries
- MAP (Mean arterial pressure) = (SBP+2DBP)/3 -- avg pressure in arteries throughout cardiac cycle
[Good perfusion if b/w 50 – 150 mmHg]
9. Frank-Starling Law
- ↑ Elasticity (the bigger the stretch) = ↑ Contraction (the stronger the contraction)
- ↑ Venous Return = ↑ CO
- Stretch of the myocardium is increased by increased filling.
*increase or decrease in the volume of blood = an increase or decrease in the force of contraction (like a rubber
band flying)
*this can max out...your actin and myosin can disengage and your force of contraction will drop to zero (like a
rubber band breaking)
2. Physical assessment
- Skin - Jugular vein pussations
- BP - Heart inspection, palpation, percussion, and auscltation
- Pulse - Lung & Abd assessment
3. Hemodynamic Monitoring
Intra-artrial BP monitoring (IABP)
- Measures direct and continuous BP
- Useful for freq ABG and blood sample
- MAP = good indicator of perfusion
4. Cardiac auscultation
5. Heart Sounds
- S1 = closure of mitral & tricuspid valves
- S2 = closure of aortic & pulmonic valves
- S3 gallop Low-pitched "plop"
: After S2, during rapid ventricular filling right after “dub”.
: Ventricles fail to eject all blood during systole (vol overload) Sounds like Ken(S1)-
: Best heard at apex, lying on L side tuc(S2)-ky(S3)
: eg) CHF, MI, normal for children
- S4 gallop
: Before S1, during atrial contraction
: r/t enlarged/hypertrophy of ventricles, resistant to filling
: Best heard at apex in a supine position while holding breath
: eg) HTN, MI
- Murmur
: High- or low-pitched sounds, lasting longer than normal HS
: Caused by blood flowing through a damaged or overworked heart valve
: eg) Ischemia, Infection, Drug toxicity
- Pericardial friction rub
: Leather rubbing sounds
: eg) Pericardititis
6. Laboratory tests
Cardiac markers
: Enzymes are released from injured cells when the cell membranes rupture
: Enzymes leak into the interstitial spaces of the myocardium
→ Carried into the coronary and lymph circulation ↑ serum enzymw concentrations.
Lipid profile
: Measured to evaluate a person’s risk of developing atherosclerotic dis.
: Blood specimen should be obtained after a 12-hour fast
- Cholesterol [normal = <200 mg/dL]
- LDLs [normal = <160 mg/dL]
- HDLs [normal = 35 – 70 (♂) or 85 (♀) mg/dL / > 70 mg/dL]
- Triglycerides [normal = 100 – 200 mg/dL]
Blood chemistries
- Na+
- K+: hypo- may cause V tach or V fib / hyper- may cause heart block, asystole and vent. dysrhythmia
- Ca2+: hypo- impairs myocardial contractility / hyper- causes ↑ myocardial contractility & ↑ risk of ♥ block.
- Mg2+
- BUN/Creatinine: ↑ when ↓ renal perfusion from ↓CO or intravascular fluid vol deficit
- Glucose: ↑ in stressful situations
Coagulation studies
- PT [10 – 13 sec] /INR [ 1.0 – 2.0 / 2.0 – 3.0 w/ coagulation therapy / 2.5 – 3.5 w/ mechanical heart valve ]
- PTT [25 – 39 sec]
7. Diagnostic tests
- Chest radiography and fluosroscopy (X-ray w/ motion)
- ECG
- Cardiac stress testing: NPO 4 hrs, withhold some cardiac drugs and caffeine
- Echocardiogram: Non-invasive ultrasound. Examine the size, shape, and motion of cardiac structures. Can
determine the EF.
- Transesophageal echocardiography (TEE): NPO 6hrs pre & 2 hrs post. IV line for mild sedation.
- Radionuclide imaging
: Use of radioisotopes to evaluate coronary artery perfusion noninvasively,
to detect MI
to assess L vent fxn
: SPECT = 3Ds. Pt is @ supine with arms over head for 30 min.
: No need for post radiation precaution because dye is small amount.
: ERNA/MUGA
: CT scan
: MRI = Ask whether pt has a pacemaker, metal plates, or prosthetic joints. Remove nitro patch.
- Cardiac catheterization
: Invasive procedure used to measure cardiac chamber pressures and assess patency of the coronary arteries
: Insert catheter via femoral or radial vein
Cardiology 5
: Requires ECG and hemodynamic monitoring. Resuscitation equipment must be ready for when the
myocardium becomes ischemic.
: To prevent renal failure in pt w/ DB or HF, administer IV fluids and the antioxidant acetylcysteine
(Mucomyst)
: IV line for sedatives, fluids, heparin and other meds.
: Usually performed with angiography
: Before catheterization…
√Assess for allergy to iodine-containing agents (seafood etc)
√Blood work to check BUN and creatinine, PT/INR, Hct, Hbt, Plat, and e-lyte levels
√NPO 8-12 hrs before
√Mild sedatives or moderate sedation will be given IV
√Inform pt may feel occasional pounding sensation in the chest (d/t extra systole)
: After catheterization…
√Observe the cath access site for bleeding or hematoma formation
√Assess circulation in the affected ext. q 15 min for 1 hour
√2 – 6 hrs of bed rest w/ the affected leg straight and HOB 30 degrees
√Encourage fluid intake to increase UO in order to prevent renal failure from contrast agent
√Next 24 hrs = do not bend at the waist (to lift anything), strain, or lift heavy objects.
√Avoid tub baths, but shower as desired
√Monitor for bleeding, swelling, new bruising or pain from the puncture site, and temp >38.6°C
(101.5°F)
Cardiac Cells
Pacemaker cells
- SA node: Discharge at 60 – 100/min
- AV junction: Possible at 40 – 60/min
- Purkinjie fibers: Possible at 20 – 40/min
Electrical conducting cells
- Excitability, conductivity
- Conduction pathway
Mechanical muscle cells
- Myocardial cells
Cardiac Cycles
At resting stage = inside of cells are negatively charged ← maintained by membrane pumps [K, Na, Cl, Ca]
ECG
Measures and shows the electrical current (conductivity) of the heart
Deflections
Positive when depolarization wave move toward a positive electrode = upward slope
Negative when depolarization wave move away a positive electrode = downward slope
Positive when repolarization wave move away a positive electrode = upward slope
Negative when repolarization wave move toward a positive electrode = downward slope
-
12-Lead ECG
Cardiology 6
o 10 electrodes
- Precordial leads
V1: 4th ICS, R sternal border
V2: 4th ICS, L sternal border
V3: b/w V2 & V4
V4: 5th ICS, L MCL
V5: 5th ICS, L AAL (Anterior axillary line)
V6: 5th ICS, L MAL (Mid-axillary line)
- Limb leads
RA, LA, RL, LL
Avoid bony, oily and hairy place
ECG Paper
Duration = fractions of sec.
Amplitude = generated voltage ← depolarization is higher voltage than repolarization = taller wave
Configuration = shape (round), peak
Horizontal axis = time
- small box (1 mm) = 0.04 sec
- large box (5 small sq) = 0.2 sec
Vertical axis = voltage
- small box (1 mm) = 0.1 mV
- one big box = 0.5 mV
ECG Basics
3 methods to calculate HR
1. HR regular: count # of large boxes b/w 2 R-R interval
→ 300 / # of boxes (1 min strip has 300 sec mall boxes) More accurate!
2. HR regular: count # of small boxes b/w 2 R-R interval
→ 1500 / # of small boxes
3. HR irregular: count # of R-R intervals in 6 sec
Less accurate
→ # of R-R intervals x 10 (3 sec = 15 large boxes)