Cardiovascular system

-msucle with different thickness first layer myocardium, myocardium

and epicardium ( visceral)
-muscle is thinner in the atriam b/c the valve here is at the bottom
when the bottom flows down into the ventricle not too much
contraction needed
-protected sac inner layer is epicardium outer layer is pericardium
-dont have to memeorized the conary arteries
-memorized electrical impulses
- the imaginary line is on the ecg is isometric line , one or two box
above is elevated st segment is an acute mi total occulasion of the
three cells, , st depression is partial occulusio nof coronary artery,
cardiac muscle is ischemic will have cell death and the t wave would
be inverted, when it looks like qrs of the t wave it means hyperkalemia
-three phase of contraction: polarization is the heart at rest the cardiac
cell is negative charged, depolarized the potassium leaving the cell
sodium enters the cells wen na enters it becomes positively charged
the electrical activity will happen , repolarization is when all the k is
leaving ca enters the cell when the cell gets full of calcium contraction
occurs the sodium leaves potatsium leaves and then the potassium
returns when its full of potatssium its polarization
-caridiac ouput is sv+ HR
-SV preload: the amount of blood that enters the atrium , contractility
amount of force that it has to contract, afterload has to do with
pressure with opening up the value
-the blood that is going against the value is systolic
-frank starling law:
-preload: if preload goes up the co goes up
-fluid in the lung , edema, the heart is not working order diuretic you
urinate out the extra fluid, the preload goes down the co goes down bp
goes down
-bp=co x svr
-memorized puluse pressure formula , mean atrial pressure ( average
arterial pressure that is require to sustain to the vital organs you need
60)
-incrase of collagen makes the values goes hard
-decrease of b-adrenageric site the beta blocker needs to be switched
to another medication because not a lot of b-adrenergic site
-asseessment of cardio: needs a good PMH really good to asked them if
they are sob, do you get tired a lot , are you forgetful, have you have a
value replacement, are you tire lately
-troponin , CKMB, BNP( routine test they do if they suspect ventricular
failure), the cardiac marker , homocysteine is a very delicate test
-chem panel is order and it focused on hypokalemia muscle becomes
weak its not going to contracting or functiniong very well,

hyperkalemia the ventrical are going to start febriliating its going to

get tired eventually slow down and then enters brady cardia
hypocalcemia: not enough ca the heart is not going to contract its
going to slow down the heart rate , hypercalcemia the heart is going to
contract and contract its going to tire out and its going to code
-magnesium: they are opposite of potassium , same as hyperkalemia ,
hypermagnesium is like hypokalemia
-chest xray is only done to determine how big is the heart where is it
-holter monoitor is good for diabetic because they have neuropathy
and they dont always feel chest pain they could experience chest pain
without knowing about it , bowel movement is important for heart pt
beause there is a lot of strining involved
-no lotion or slippery thing when you have the treadmill test , before
the test , during the test and after the test vital is going to be taken
and so is the ecg
-ejection fraction is the amount of blood that is ejected
-someone who is obsed they have to do a tee pt has to be npo at least
8 hours need an concsent after test is done you cant fed them
immediately bc no gag reflects give them water and then give them
some clear liquid and advances it
-dobutamine echocardiogram dont smoke it increase the hr npo for at
least 4 hrs you need an consent . warning that their bp and ecg will be
monitored is meant for ppl who cant use the treadmill as it increase
the doubtamine it increase the HR to mimc the exercise
-nuclear cardiology be injected with radio ispotope warn that they
might feel uncomfortable
-cardiac catherterization need to be npo usually npo the night before if
its stat needs to be npo for at least 4 hours check their pedial pulse
every hours times 4 until they are ready to go home , they keep on
bedrest for 6 hours , check for the pedi pulse when he goes in and
mark it
hypertension
-short term first one to kick in is sympathetic nervous system
norepinephrine
second short term mechanism baroreceptor , third vascular
endothelium
et1 is a strong vasoconstrictor
-when bp is too low brain tells the barorecpot to release renin
when ecf goes up your preload goes up
-isolated systolic htn ( pain, running systolic will rise while nothing
happens to the disostlic)
-false high really harden artiers will give you a false high
-baroreceptor gets less reactive once you get older
-women have more estrogen they will have softer vessles
-know the dash diet is high fiber

stage 2 htn
-dont need to know about the the risk factors
-nitapino if you squeeze it and put it for sublingual it will lower it
withint 2 mins for cocacin use
do not lower the bp no more thatn 25 systolic pressure per hour
-run other test to make sure that they dont have other conditions ,
liver function to seeif you have portal hypertension to see if is
contributing to it
stage 1 : take 1 pill
stage2 take 2 type of drug
essential is iv
if you want it work fast give it iv push
after giving a diuretic you listen to lung bp and hr
hypotension can occur with coreg(carvedilol) orthrostatic hypotension
when taking nifedipine dont take it with grape juice