ANCC Cardiac-Nursing Certification Exam: Pathophysiologic Processes
Myocardium -
thick and muscular, anchored with a fibrous skeleton
Endocardium -
Inner lining of the chamber
Pericardium -
Surrounds the heart; has two layers, the visceral and pareital; attaches to the structures in the mediastinum
How much pericardial fluid is in between the visceral and parietal pericardium? -
10 to 30 cc
Functions of the Pericardium -
1. Prevents displacement of the heart during acceleration, deceleration, gravitation, pull or movement
2. Provides a physical barrier to protect against friction and inflammation
3. Contains the pain receptors and baroreceptors important in the control of blood pressure
Chambers of the heart -
Right Atrium
Right Ventricle
Left Atrium
Left Ventricle
Right Atrium -
Receives blood from the superior and inferior vena cava. It is a smooth thin-walled, low-pressure chamber collecting venus blood
returning to the heart
Right Ventricle -
Is slightly thicker, triangularly shaped and constitutes most of the lower, anterior surface of the heart. The inflow portion receives blood
from the right atrium and the outflow portion pushes blood into the pulmonary artery with each contraction. The inner surface is trabeculated.
Trabeculated -
It has a strand of tissue projecting into the chamber because of papillary muscle formations
Left Atrium -
Receives blood from two right pulmonary veins and two left pulmonary veins. It is a thin-walled chamber.
Left Ventricle -
Is also triangular in shape; it overlies the right ventricle but composes more of the posterior portion of the heart. It is much thicker with
higher pressures and trabeculated.
Muscular septum -
Divides the right and left sides of the heart
Atrial septum -
Separates the right and left atrium
Ventricular septum -
Separates the right and left ventricle
Valves of the heart -
Provide for unidirectional flow of blood through the heart and vessels.
Atrioventricular valves -
Mitral and tricuspid valves
Semilunar valves -
Aortic and pulmonar valves
Tricuspid valve -
Separates the right atrium and right ventricle. There are three leaflets with thin, fibrous chordae tendinae attached. The valve opens and
closes with the tensing and relaxing of the papillary muscles
Chordae tendinae -
Connect the leaflets to the papillary muscles in the right ventricular wall
Pulmonic valve -
, Separates the right ventricle and pulmonary artery. It is constructed of three cusps. It opens when pressure from the ventricle exceeds the
pressure in the artery during ventricular contraction. Closes when pressure in the right ventricle drops to the same pressure in the artery
during relaxation of the ventricle.
Mitral Valve -
Separates the left atrium and left ventricle. It has two leaflets with chordae tendinae. Opens and closes with the tensing and relaxing of
the papillary muscles.
Aortic valve -
Separates the left ventricle and aorta. It opens when pressure from the ventricle exceeds the pressure in the artery during ventricular
contraction. Closes when pressure in the right ventricle drops to the same pressure in the artery during relaxation of the ventricle.
Cardiac cycle -
Describes the electrical and mechanical events occurring during each heartbeat.
Sinoatrial (SA) node -
Is the pacemaker of the heart. It sends out the impulse in a rhythmic function across the right atrium and left atrium, resulting in atrial
contraction. It is located in the upper anterior portion of the right atrium jut under the superior vena cava.
Atrioventricular (AV) node -
Is located in the lower portion of the right atrium septal wall and receives the impulse from the atrium. Here the impulse is slowed slightly
to allows for atrial contraction.
Bundle of His -
Stretches across the lower right atrium septal wall to the ventricular septum. It brings impulse to the lower portion of the heart.
Bundle branches to the right and left bundles -
Carries the impulse to the right and left ventricle
Purkinje fibers -
Are spread across the endocardial layer of the right ventricle and left ventricle. When the impulse reaches this area, they depolarize the
ventricles, resulting in contraction of the right and left ventricle and the ejection of blood into the arteries.
Automaticity -
Allows for regular firing of the specialized tissue to initiate the action potential. Other sites in the conduction system have the same
property but will initiate the pacing impulse at a slower rate.
Electrical events -
Precede mechanical events in the cardiac cycle
Mechanical events -
1. Systole
2. Diastole
Systole -
Contraction with the ejection of blood
Stroke volume -
The amount of blood ejected from the ventricle with a heart beat
Diastole -
Relaxation with passive filling of the chambers
Hemodynamics -
Refers to the pressure and volume relationships in the heart
Cardiac Output -
The volume of blood ejected from the heart in one minute and is determined by heart rate and stroke volume.
Normal resting cardiac output -
5 to 8 liters per minute based on body size. With extreme exercise in a healthy person it can increase to 20 to 30 liter per minute
Three Factors that determine Stroke Volume -
1. Preload
2. Afterload
3. Contractilty
Preload -
The stretch of the ventricular fibers due to the volume of blood in the right and left ventricle.
Frank-Starling Law -
The greater the stretch, the stronger the contraction and thus the greater the stroke volume. Is a maximum point past which the
contraction is weaker and stroke volume falls.
, Example of Frank-Starling Law -
When a person is greatly dehydrated, the blood volume is decreased, stroke volume is less and heart rate must increase or else cardiac
output falls. But when rehydrated, stroke volume, heart rate and cardiac output return to normal
Afterload -
The amount of resistane that the heart must overcome to eject the blood. This is a reflection of the degree of peripheral vascular
resistance or hypertension that occurs. The more resistance, the harder it is to eject blood
Contractility -
Consists of all other factors that compose the cardiac muscle's ability to contract normally
Right and left sided circulation is synchronized -
So that the right and left atrial systole occurs almost simultaneously and right and left ventricular systole occur nearly simultaneously.
Coronary arteries -
Lie on the epicardial surface of the myocardium. They are the first blood vessels off the aorta just above the aortic valve. The arteries
burrow in the myocardium and the endocardial surface of the last to receive blood flow
Right Coronary Artery (RCA) -
Lies in the grove between the right atrium and right ventricle and wraps around the right lateral wall to the posterior of the heart. It then
runs down the ventricular septum to supply blood to the inferior wall of the left ventricle. It also supplies the right atrium and much of the right
ventricle along with the SA and AV nodes.
Left Main Coronary Artery -
Divides shortly after origin into the left anterior descending and the left circumflex arteries.
Left Anterior Descending Artery (LAD) -
Run in the anterior septal groove and supplies the septum, anterior left ventricle and anterior right ventricle. It also supplies the left and
proximal right bundle branches of the conduction system
Left Circumflex Artery (LCA) -
Supplies the left atrium and the lateral and high posterior walls of the left ventricle.
Left Dominance -
The left circumflex supplies the inferior wall of the left ventricle instead of the right coronary artery
Five Major Components of Cardiac Muscle Cells -
1. Cell membrane and T tubules for conduction
2. Sarcoplasmic reticulum, a calcium reservoir for excitation-contraction coupling
3. Contractile elements
4. Mitochondria
5. Nucleus
Sarcomere -
The contractile unit of cardiac muscle, is an orderly arrangement of actin and myosin together with the regulatory proteins, troponin and
tropomyosin
Intercalated discs -
Permit both mechanical and ionic coupling that promote functional integration of myocytes
Gap Junctions -
Plasma membrane channels, directly link the cytoplasmic components of neighboring cardiac cells.
Cerebral Circulation -
Begins with the carotid and vertebral vessels that arise from brachiocephalic trunk, a branch off the aorta. There is a right and left version
of this circulation
Common Carotid artery -
Branches into the internal and external carotid arteries
External Carotid Artery -
Artery that supplies the face
Internal Carotid Artery -
Artery that supplies the anterior portion of the brain and gives rise to the anterior and middle cerebral arteries.
Vertebral Artery -
Artery that gives rise to the basilar artery and the posterior cerebral artery
Circle of Willis -
Is a special connection of arteries in the brain. The right and left circulations are connected as well ass the anterior and middle cerebral
branches of the internal carotids and the posterior cerebral arteries from the vertebral circulation
Myocardium -
thick and muscular, anchored with a fibrous skeleton
Endocardium -
Inner lining of the chamber
Pericardium -
Surrounds the heart; has two layers, the visceral and pareital; attaches to the structures in the mediastinum
How much pericardial fluid is in between the visceral and parietal pericardium? -
10 to 30 cc
Functions of the Pericardium -
1. Prevents displacement of the heart during acceleration, deceleration, gravitation, pull or movement
2. Provides a physical barrier to protect against friction and inflammation
3. Contains the pain receptors and baroreceptors important in the control of blood pressure
Chambers of the heart -
Right Atrium
Right Ventricle
Left Atrium
Left Ventricle
Right Atrium -
Receives blood from the superior and inferior vena cava. It is a smooth thin-walled, low-pressure chamber collecting venus blood
returning to the heart
Right Ventricle -
Is slightly thicker, triangularly shaped and constitutes most of the lower, anterior surface of the heart. The inflow portion receives blood
from the right atrium and the outflow portion pushes blood into the pulmonary artery with each contraction. The inner surface is trabeculated.
Trabeculated -
It has a strand of tissue projecting into the chamber because of papillary muscle formations
Left Atrium -
Receives blood from two right pulmonary veins and two left pulmonary veins. It is a thin-walled chamber.
Left Ventricle -
Is also triangular in shape; it overlies the right ventricle but composes more of the posterior portion of the heart. It is much thicker with
higher pressures and trabeculated.
Muscular septum -
Divides the right and left sides of the heart
Atrial septum -
Separates the right and left atrium
Ventricular septum -
Separates the right and left ventricle
Valves of the heart -
Provide for unidirectional flow of blood through the heart and vessels.
Atrioventricular valves -
Mitral and tricuspid valves
Semilunar valves -
Aortic and pulmonar valves
Tricuspid valve -
Separates the right atrium and right ventricle. There are three leaflets with thin, fibrous chordae tendinae attached. The valve opens and
closes with the tensing and relaxing of the papillary muscles
Chordae tendinae -
Connect the leaflets to the papillary muscles in the right ventricular wall
Pulmonic valve -
, Separates the right ventricle and pulmonary artery. It is constructed of three cusps. It opens when pressure from the ventricle exceeds the
pressure in the artery during ventricular contraction. Closes when pressure in the right ventricle drops to the same pressure in the artery
during relaxation of the ventricle.
Mitral Valve -
Separates the left atrium and left ventricle. It has two leaflets with chordae tendinae. Opens and closes with the tensing and relaxing of
the papillary muscles.
Aortic valve -
Separates the left ventricle and aorta. It opens when pressure from the ventricle exceeds the pressure in the artery during ventricular
contraction. Closes when pressure in the right ventricle drops to the same pressure in the artery during relaxation of the ventricle.
Cardiac cycle -
Describes the electrical and mechanical events occurring during each heartbeat.
Sinoatrial (SA) node -
Is the pacemaker of the heart. It sends out the impulse in a rhythmic function across the right atrium and left atrium, resulting in atrial
contraction. It is located in the upper anterior portion of the right atrium jut under the superior vena cava.
Atrioventricular (AV) node -
Is located in the lower portion of the right atrium septal wall and receives the impulse from the atrium. Here the impulse is slowed slightly
to allows for atrial contraction.
Bundle of His -
Stretches across the lower right atrium septal wall to the ventricular septum. It brings impulse to the lower portion of the heart.
Bundle branches to the right and left bundles -
Carries the impulse to the right and left ventricle
Purkinje fibers -
Are spread across the endocardial layer of the right ventricle and left ventricle. When the impulse reaches this area, they depolarize the
ventricles, resulting in contraction of the right and left ventricle and the ejection of blood into the arteries.
Automaticity -
Allows for regular firing of the specialized tissue to initiate the action potential. Other sites in the conduction system have the same
property but will initiate the pacing impulse at a slower rate.
Electrical events -
Precede mechanical events in the cardiac cycle
Mechanical events -
1. Systole
2. Diastole
Systole -
Contraction with the ejection of blood
Stroke volume -
The amount of blood ejected from the ventricle with a heart beat
Diastole -
Relaxation with passive filling of the chambers
Hemodynamics -
Refers to the pressure and volume relationships in the heart
Cardiac Output -
The volume of blood ejected from the heart in one minute and is determined by heart rate and stroke volume.
Normal resting cardiac output -
5 to 8 liters per minute based on body size. With extreme exercise in a healthy person it can increase to 20 to 30 liter per minute
Three Factors that determine Stroke Volume -
1. Preload
2. Afterload
3. Contractilty
Preload -
The stretch of the ventricular fibers due to the volume of blood in the right and left ventricle.
Frank-Starling Law -
The greater the stretch, the stronger the contraction and thus the greater the stroke volume. Is a maximum point past which the
contraction is weaker and stroke volume falls.
, Example of Frank-Starling Law -
When a person is greatly dehydrated, the blood volume is decreased, stroke volume is less and heart rate must increase or else cardiac
output falls. But when rehydrated, stroke volume, heart rate and cardiac output return to normal
Afterload -
The amount of resistane that the heart must overcome to eject the blood. This is a reflection of the degree of peripheral vascular
resistance or hypertension that occurs. The more resistance, the harder it is to eject blood
Contractility -
Consists of all other factors that compose the cardiac muscle's ability to contract normally
Right and left sided circulation is synchronized -
So that the right and left atrial systole occurs almost simultaneously and right and left ventricular systole occur nearly simultaneously.
Coronary arteries -
Lie on the epicardial surface of the myocardium. They are the first blood vessels off the aorta just above the aortic valve. The arteries
burrow in the myocardium and the endocardial surface of the last to receive blood flow
Right Coronary Artery (RCA) -
Lies in the grove between the right atrium and right ventricle and wraps around the right lateral wall to the posterior of the heart. It then
runs down the ventricular septum to supply blood to the inferior wall of the left ventricle. It also supplies the right atrium and much of the right
ventricle along with the SA and AV nodes.
Left Main Coronary Artery -
Divides shortly after origin into the left anterior descending and the left circumflex arteries.
Left Anterior Descending Artery (LAD) -
Run in the anterior septal groove and supplies the septum, anterior left ventricle and anterior right ventricle. It also supplies the left and
proximal right bundle branches of the conduction system
Left Circumflex Artery (LCA) -
Supplies the left atrium and the lateral and high posterior walls of the left ventricle.
Left Dominance -
The left circumflex supplies the inferior wall of the left ventricle instead of the right coronary artery
Five Major Components of Cardiac Muscle Cells -
1. Cell membrane and T tubules for conduction
2. Sarcoplasmic reticulum, a calcium reservoir for excitation-contraction coupling
3. Contractile elements
4. Mitochondria
5. Nucleus
Sarcomere -
The contractile unit of cardiac muscle, is an orderly arrangement of actin and myosin together with the regulatory proteins, troponin and
tropomyosin
Intercalated discs -
Permit both mechanical and ionic coupling that promote functional integration of myocytes
Gap Junctions -
Plasma membrane channels, directly link the cytoplasmic components of neighboring cardiac cells.
Cerebral Circulation -
Begins with the carotid and vertebral vessels that arise from brachiocephalic trunk, a branch off the aorta. There is a right and left version
of this circulation
Common Carotid artery -
Branches into the internal and external carotid arteries
External Carotid Artery -
Artery that supplies the face
Internal Carotid Artery -
Artery that supplies the anterior portion of the brain and gives rise to the anterior and middle cerebral arteries.
Vertebral Artery -
Artery that gives rise to the basilar artery and the posterior cerebral artery
Circle of Willis -
Is a special connection of arteries in the brain. The right and left circulations are connected as well ass the anterior and middle cerebral
branches of the internal carotids and the posterior cerebral arteries from the vertebral circulation
