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VN201: study test guide revision
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The Heart - ANS About the size of a fist
Located within the mediastinum
Pumps approximately 1000 gallons of blood every day
Divided into four chambers
*Myocardium is a specialized muscle layer that allows the heart to contract*

What are the 4 chambers of the heart? - ANS Right atrium:
Receives deoxygenated blood from the body
Pumps blood to the right ventricle

Right ventricle:
Pumps blood into the pulmonary artery

Left atrium:
Receives oxygenated blood from the pulmonary vein
Pumps blood to the left ventricle

Left ventricle:
Pumps oxygenated blood to the body through the aorta

What are the different valves of the heart? - ANS The tricuspid valve is located between the
right atrium and right ventricle

The pulmonary valve, semilunaris valve, located between the right ventricle and the pulmonary
artery

The mitral valve, bicuspid valve, is located between the left atrium and left ventricle

The aortic valve, semilunar valve, is located between the left ventricle and the aorta

The opening and closing of the AV valves creates the characteristic "lubb," first heart sound

,The opening and closing of the semilunar valves creates the characteristic "dubb," or second
heart sound

Rheumatic fever, a streptococcal infection, is the major cause of cardiac valve disease, most
often affecting the mitral valve

Heart Valves - ANS

The Conduction System of the Heart - ANS Sinoatrial (SA) node—the pacemaker of the heart

Atrioventricular (AV) node slows the impulse to allow the atria to fill the ventricles
- AV node also serves as a secondary pacemaker

The bundle of His

Purkinje fibers

Coronary Blood Flow - ANS Blood enters coronary blood flow through the right and left
coronary arteries
Flows through coronary circulation
Returns to systemic circulation via coronary veins

Dobutamine or Adenosine Stress test - ANS Used in people who are unable to exercise
Heart responds as if the person was exercising

Stress echocardiogram - ANS Graphic outline of the hearts movement
Accurately visualize the motion of the heart's walls and pumping action when the heart is
stressed

Nuclear stress test - ANS Determine which parts of the heart are healthy and function normally
Radioactive substance is injected into the patient
Pictures are done at rest and after exercise
A less than normal amount of thallium will be seen in those area the heart has decreased blood
supply
Ejection Fraction (EF)is the percentage of ventricle volume that is ejected with systole
Normal EF 55%
Mild dysfunction 45-54%
Moderate dysfunction 30-45%
Severe dysfunction <30%

Electrocardiography - ANS ECG or EKG
A graphic study of the electrical activities of the myocardium to determine transmission of
cardiac impulses through the muscles and conduction tissue

, Remote telemetry allows the patient to be on a separate unit, but be monitored in a central
location. The patients can be ambulatory and can sleep with the monitor on. They should not
remove the monitor to shower

Holter Heart Monitor can monitor heart beats 24 hours a day

Event Monitors detect irregularities in heart beats

Transesophageal echocardiogram (TEE) - ANS Used to check for thrombi before cardioversion,
and to visualize vegetation and abscesses on the valves of the heart

Thallium scanning - ANS show adequate perfused areas by the collection of thallium. Dark
spots or "cold spots" indicate tissues that have inadequate perfusion

MUGA Cardiac Scan - ANS Nuclear test designed to evaluate the function of the right & left
ventricles
Provides a more accurate representation of cardiac ejection fraction
Advantage of MUGA scan over ECHO or Angiogram is its accuracy, less invasive and less
expensive

If a patient has had a heart attack, or any other disease that affects the heart muscle (such as
heart failure), the MUGA scan can localize the portion of the heart muscle that has sustained
damage, and can assess the degree of damage. But more importantly, the MUGA scan gives an
accurate and reproducible means of measuring and monitoring the "ejection fraction" of the
cardiac ventricles

MUGA Scan pt teaching - ANS This scan is primarily used to see how much blood leaves your
heart with each contraction, which is known as your ejection fraction

Teaching patient:
Stop taking any medications or using any supplements your doctor instructs you to stop

Don't drink any caffeine or alcohol for a few hours before a resting scan that's done while you're
sitting or lying down

Don't eat or drink anything except water for a few hours before an exercise (stress) scan that's
done while you're doing light activity

Wear loose, comfortable clothing and shoes

Let your doctor know if you're pregnant, as the chemical tracer can harm the fetus

Laboratory tests - ANS CBC
PT/INR

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