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Cardiovascular System

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alkathryn's version from 2016-10-07 03:06

Cardiac Anatomy

Question Answer
Heart locationMediastinum
Pericardium jobsSurround and protect the heart, primary blood supply from coronary arteries
Pericardium partsFibrous, serous
FibrousTouch, inelastic connective tissue
Fibrous functionprotection, prevent overstitching
Serous layersparietal, visceral, pericardial fluid, pericardial cavity
Pericardial fluid functionsecretion of pericardial cells and reduce friction as the heart moves
Heart wall partsepicardium, myocardium, endocardium
Myocardium is responsible forpumping
Endocardium providessmooth lining for inside
Endocardium coversvalves of the heart
Right Atriumdeoxygenated blood from SVC to IVC
Right ventriclesends deoxygenated blood to pulmonary artery
Left Atriumoxygenated blood enters from pulmonary vein
Left ventriclesends oxygenated blood into systemic circulation
Valve purposeprevent back flow
Atrioventricular valvestricuspid, bicuspid
Semilunar valvespulmonary semilunar, aortic semilunar
SA node akaSinoartrial Node
SA node is thepacemaker of the heart
SA node causesboth atria to contract
SA is the junction ofSVC and right atrium
AV node akaAtriventricular Node
AV node is betweenright atria and right ventricle
AV node functiondelay cardiac impulses from SA node
From AV node, the impulses enterthe AV bundle
AV impulses terminate atPurkinjie Fibers
Artery carriesblood away from the heart
All arteries carryoxygenated blood
Only artery doesn't carry oxygenated bloodpulmonary artery
Veins carryblood toward the heart
All veins carrydeoxygenated blood
Only vein doesn't carry deoxygenated bloodpulmonary vein
Capillaries areendpoints of distribution nutrients to cells
Pulse is theimpact of blood striking aortic wall with dilation and contraction
Superior vena cava bringsdeoxygenated blood from most parts of the body superior to heart
Inferior vena cava bringsdeoxygenated blood from all parts of the body inferior to the heart
Heartbeat takes0.8 seconds to complete
Systole is thecontraction
Diastole is thedilation
Heart soundslub and dub
Lub isAV valves closing at end of diastole
Dub isSL valves closing at end of systole
Cardiac output is the amount ofblood ejected from left (or right) ventricle into aorta (or pulmonary trunk) each minute
Normal cardiac output5-6 L/min
Cardiac output equationC.O. = S.V x H.R.
Stroke volume is the volume ofblood pumped by ventricle per contraction
Normal stroke volume80-100 mL
Stroke volume equationS.V. = C.O./H.R.
End-Diastolic Volume ismaximum volume found in ventricles during cardiac cycle
End-Diastolic Volume equationE.D.V. = S.V./E.F.
End-Systolic Volumeminimum volume found in ventricles during cardiac cycle
End-Systolic Volume equationE.S.V. = E.D.S. - S.V.
Ejection fraction isfraction of total volume ejected with ventricular contraction
Ejection fraction equationE.F. = (E.D.V.-E.S.V.)/E.D.V.
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Pathology

Question Answer
Congestive heart failure isfailure of the heart (ventricles) to maintain efficient and adequate output
CHF EtiologyMI, ischemia, arrhythmias
CHF Symptomsdifficulty breathing
CHF treatmentdiuretics, medicine to improve contraction, transplant
Angina Pectoris issevere chest pain caused by inadequate blood flow and oxygen to heart muscle
Angina symptomspain or pressure behind sternum, difficulty breathing, N/V, sweating anxiety
Angina treatmentat home - rest and nitro, at hospital - oxygen, nitro, aspirin
Myocardial Ischemiainadequate supply of blood and oxygen that is required to meet the metabolic demands of the heart muscle
Myocardial infarction is anacute, sudden occlusion of branch of coronary arteries
Myocardial infarction is theleading cause of death in the US
How many people suffer acute MI per year1.5 million
Coronary Artery Disease isnarrowing of coronary arteries
CAD is usually a result ofatherosclerosis
CAD can occur in people whosmoke, have diabetes, HTN
CAD symptomspain or pressure in chest, SOB, N/V, perspiration
CAD treatmentlow fat low cholesterol diet, medication, exercise, quit smoking, invasive procedures
Arteriosclerosis is"hardening of the arteries"
Arteriosclerosis is a diseaseof the arterial vesselsd marker by thickening and hardening of arterial walls
Atherosclerosis is abuild up of fatty deposits in the artery walls
Atherosclerosis etiology risk factorstobacco use, diabetes, HTN, family history
Atherosclerosis symptomsangina
Atherosclerosis treatmentexercise, quit smoking, medication, low fat low cholesterol diet, angioplasty
Cardiomyopathy isany disease that affects the heart muscle diminishing cardiac performance
Cardiomyopathy causesenlarged and/or thickened heart muscle that reducs the ability to pump
Cardiomyopathy usually begins inthe ventricles
Cardiomyopathy symptomsSOB, fatigue, CP, orthopnea
Cardiomyopathy treatmentbeta blockers
Pericarditis isinflammation of the pericardium
Pericarditis etiologyinfection, MI, cancer, renal failure, cardiac surgery, trauma
Pericarditis symptomsCP, fever, dyspnea, palpitation
Pericarditis treatmentdepends on the cause
Endocarditis isinfection or inflammation of endocardium and heart valves
Endocarditis symptomsfever, loss of appetite, muscle aches
Endocarditis diagnosisblood cultures
Endocarditis treatmentantibiotics and surgery to replace damaged valves
Pericardial effusion iscollection of fluid in the pericardium
Pericardial effusion etiologyrenal failure, pericarditis, trauma, rheumatic fever, hypothyroidism
Pericardial effusion symptomsCP, SOB, cough, heart attack, fainting
Pericardial effusion treatmenttreat the underlying condition
Hyperlipidemia isincreased lipids in the blood
Hyperlipidemia is a major risk factor foratherosclerosis
Hypertension isBP >140mmHg systolic or 90mmHg diastolic
Hypertension is a major risk forCAD, CHF, stroke, and kidney failure
4 types of hypertensionprimary, secondary, renovascular, transient
Myxoma isbenign, mucus-filled tumor
Myxoma usually begins inthe atrium
Myxoma symptomsangina, SOB, palpitations
memorize

MUGA

Question Answer
MUGA akaGated Equilibrium Radionuclide Ventriculogram or gated blood pool
MUGA indicationseval of left/right ventricle EF, regional wall motion, pre/post chemo/radiation, CP/SOB, CHF, cardiomyopathy, pre/post transplant, chamber size/morphology
MUGA rphxlabeled RBC
MUGA dose15-20 mCi compartmental
MUGA bio half-life24-30 hours
MUGA viewsANT & 45 LAO
MUGA stress usesbike ergometer
Stress MUGA procedurebaseline image, images at each 3 minute stage (BP/EKG with)
Stress MUGA is done whenpatient can no longer exercise
MUGA processingROI around LV
EF equation(ED-ES)/ED x 100
How to determine regional wall abnormalitiesview images in cine
Regional wall abnormality examplesakinesia, dyskinesia, hypokinesis
ArtifactsArrhythmias, chest ports for inj, bra/metal buttons, pacemakers, EKG in FOV
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First Pass

Question Answer
First Pass akaFirst Pass Radionuclide Angiography
IndicationsRV dysfunction, eval of regional wall motion, pre/post chemo or surgery
RphxDTPA, labeled RBC, sestamibi
Dose20-30 mCi <1mL
Inject whereright antecubital
MOLcompartmental
Pt prep3-lead EKG, NPO 4-12 hours
Study isdynamic
ProcessingROI around RV
Normal EF>55%
Abnormal EF<45%
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Cardiac Slices

Question Answer
Transverse is toHorizontal long axis
VLA top to bottomAAI, anterior apex inferior
HLA top to bottomALS, apex lateral septum
Short axis top to bottomALIS, anterior lateral inferior septum
Sagittal is toVertical long axis
Coronal is toShort axis
Coronal/short is fromapex to base
Sagital/vertical is fromright to left
Transverse/horizontal is fromsuperior to inferior
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Cardiac Adjunct Medications

Question Answer
Persantine akaDipyridamole
Dipyridamole dose0.56 mg/kg
Dipyridamole infusion rateover 4 minutes at 0.142 mg/kg/min
Dipyridamole injection time3-5 minutes post infusion
Coronary vasodilators act toincrease blood flow and heart rate, decrease blood pressure
Dipyridamole monitoring15 minutes
Aminophyiline dose25-50 mg IV
Adenosine dose0.84 mg/kg
Adenosine infusion rate140 ug/kg/min (6 min), 210 ug/kg/min (4 min)
Adenosine contraindictaions2-3rd degree AV block, sinus nose disease
Regadenoson akaLexiscan
Lexiscan is anA2A adenosine receptor agonist
Regadenoson half-life2-4 minutes
Regadenoson dose5 mL (0.4 mg)
Lexiscan is administeredrapidly over ten seconds followed by saline flush
Tracer is administered _________ after Lexiscan10-20 seconds
Dobutamine akaDobutrex
Dobutamine dose250 mg in 50 mL saline
Dobutamine half-life2 mins
Dobutamine infusion rate5 ug/kg/min, 10 minute increases
Dobutamine inject tracer at1 minute after highest dose
___ can be given during dobutamine to increase HRAtropine
Dobutamine contraindicationsrecent MI, tachycardia, aneurysm, chest pain
Dobutamine antagonistEsmolol, propranolol
Aminophylline is a bronchodilator
Aminophylline contraindicationspeptic ulcer, seizure disorder
Atropine Sulfate is used toincrease the heart rate in patients not responding to dobutamine
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MPI

Question Answer
MPI has better ___ than echosensitivity
Echo has better ___ than MPIspecificity
ContraindicationsCP, high BP, medically unstable
Thallium analogpotassium
Thallium dose2-5 mCi
Thallium MOLactive transport
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