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à Node
Bundle of His
Àurkinje Fibers
V mà node located at the junction of the right
atrium and the superior vena cava, functions as
the pacemaker of the m ocardium, initiate
electric impulses at a rate of 60- 100 per
minute
V Ã node located in the septal wall of the right
atrium, receives impulses from mà node and
rela s them to the ventricles
V Bundle of his a bundle of specialized muscle
fibers into the m ocardial septum. donducts
impulses from the à node and is divided into
right BB and left BB
V Àurkinje fibers the terminal, propagate
electrical impulses into the endocardium and to
the m ocardium
V The coronar arteries suppl the capillaries of
the m ocardium with blood
V The first heart sound is heard as the
atrioventricular valves close
V The second heart sound is heard when the
semilunar valves close
V The faster the heart rate, the less time for the
heart has for filling, and the cardiac output
decreases.
V Ãn increase in heart rate increases ox gen
consumption
V The normal HR is 60-100 bpm
V BÀ d x TÀR
V dardiac output defined as the volume of blood
ejected b each ventricle in 1 minute
V d m x HR
a. mtroke volume is the amount of blood ejected
b the left ventricle with each heart beat
a. Àreload- filling volume of the ventricle
b. Ãfterload- resistance to ventricular ejection
b. Heart rate is the number of heart beats per
minute. Normal is 60-100 bpm
dardiac c cle consists of 2 phases
a. s stole contraction phase. Triggered b
depolarization of cardiac cells
b. diastole relaxation (Filling) phase.
Immediatel after depolarization. Ã return to
the resting state
V dardiac enz mes
{ d-B (creatinine kinase, m ocardial
muscle)
Ãn elevation in value indicates m ocardial
damage
9levation occurs within 4-6 hrs and peaks
18- 24 hrs following an acute ischemic
attack
Normal value is 25- 175 units/L
{ Lactatedeh drogenase (LDH)
ccurs 24 hrs following m ocardial
infarction and peak in 48- 72 hrs
N 140-280 iu/L
{ The troponin I and troponin T
{ It rises within 3 hrs and persists for up to 7
da s
{ N with troponin T normall ranging from 0-
0.2 ng/ml and troponin I being less than 0.6
ng/ml
{ Ãn rise can indicate m ocardial cell damage
{ Isan ox gen binding protein found in cardiac
and skeletal muscle
{ level rises within 1 hour after cell death,
peaks in 4- 6 hours, and returns to normal
within 24- 36 hrs
{ Red blood cell count increases in conditions
characterized b inadequate tissue
ox genation
{ The white blood cell count increases in
infectious and inflammator diseases of the
heart and after m ocardial infarction
{ Decreases in hematocrit and hemoglobin
can indicate anemia
V an increase in coagulation factors can occur
during and after I, which places the client at
greater risk of thrombophlebitis and extension
of clots in the coronar arteries
{ Itmeasures the cholesterol, trigl cerides
{ The lipid profile is used to assess the risk of
developing coronar arter disease
{ The desirable range for serum cholesterol is
less than 200 mg/dL, LDL of less than 130
mg/dL, and HDL of higher than 70 mg/dL
{ Àotassium- causes d srh thmias and
increased risk of digitalis toxicit
{ modium - it decreases with the use of
diuretics, it decreases in heart failure,
indicating water excess
{ dalcium - can cause ventricular
d srh thmias
{ Is done to determine the size, silhouette, and
position of the heart
{ Interventions: prepare the client, explain the
procedure and remove jewelr
{Ã common noninvasive diagnostic test that
evaluates function of the heart b recording
electrical activit
{Ã client wears a holter monitor and an
electrocardiogram tracing is recorded
continuousl over a period of 24 hours or more
{ It identifies d srh thmias if the occur and
evaluates effectiveness of medications or
pacemaker therap
{ Instruct to resume normal activities and to
maintain a diar documenting activities and an
s mptom that ma develop
{ Is a noninvasive procedure based on the
principles of ultrasound
{ It evaluates structural and functional
changes in the heart
{ Involves insertion of a catheter into the heart
and surrounding vessels
{ btains information about the structure and
performance of the heart valves and
circulator s stem
V Àreprocedure
{ btain informed consent
{ 9levated
{ a occur at rest
V Àain
{ dan develop slowl or quickl
V mweating
V Tach cardia
V H pertension
V Ãssess pain
V Àrovide bed rest, stop an activit
V Ãdminister ox gen as prescribed
V Ãdminister nitrogl cerin
V btain a 12 lead 9d
V Àrovide continuous cardiac monitoring
V Àrovide diet instructions and must be
maintained for life
V ccurs when m ocardial tissue is abruptl and
severel deprived of ox gen
V Ischemia can lead to necrosis if blood flow is
not restored
V bvious ph sical changes do not occur in the
heart until 6 hours after the infarction, when
the infarcted area appears blue and c anotic
V Ãfter 48 hours, the infarct turns gra with
ellow streaks as neutrophils invade the tissue
V B 8-10 da s after infarction, granulation tissue
forms
V ver 2-3 months, the necrotic area develops
into a scar, scar tissue permanentl changes
the size and shape of the entire left ventricle
V Ãtherosclerosis
V doronar arter disease
V mmoking
V H pertension
V besit
V Àh sical inactivit
V mtress
V d- B
V Troponin level
V oglobin
V LDH level
V WBd count
V Àain
{ a experience as crushing, substernal pain
V Àulmonar edema
V dardiogenic shock
V Thrombophlebitis
V Àericarditis
V btain a description of chest discomfort
V Ãssess vital signs
V aintain cardiac monitoring
V Àlace in semi fowlers position
V Ãdminister ox gen as prescribed
V 9stablish I access
V Ãdminister morphine sulfate as prescribed
V btain 12 lead 9d
V onitor for complications
V Is the inabilit of the heart to maintain
adequate circulation to meet the metabolic
needs of the bod because of an impaired
pumping capabilit
V dardiac output is diminished and peripheral
tissue is not perfused adequatel
V dongestion of the lungs and peripher ma
occur
V Right dHF
{ 9vident in the s stemic circulation
{ Àitting edema in the feet, legs, sacrum, back,
and buttocks
{ Ãscites from portal h pertension
{ rganomegal
{ Distended neck veins
{ Bloating abdomen
{ Fatigue
{ Weight gain
{ Nocturnal diuresis
V Left dHF
{ 9vident in the pulmonar s stem
{ D9
{ rthopnea
{ drackles on auscultation
{ Tach cardia
{ Fatigue
{ Àallor
{d anosis
V Àlace the client in high fowlers position, with
legs elevated
V Ãdminister ox gen to improve gas exchange