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92 Cards in this Set
- Front
- Back
What kind of bicarbonate level do you have for a pt. with longstanding COPD?
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High
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What are the normal values for pH?
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7.35 to 7.45 (absolute is 7.4)
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What are the normal values for PaCO2?
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35-45
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What are the normal values for PaO2?
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80-100
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What are the normal values for HCO3?
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22-26
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What values will you see in Acute Ventilatory Failure?
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low pH, high CO2 & normal Bicarb
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What causes Metabolic alkalosis?
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common in acutely ill patients-acid/base imbalance that is iatrogenic in origin (resulting from the use of diuretics,low salt diet & gastric drainage)
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What causes Metabolic Acidosis?
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decreased tissue oxygenation/diffusion, increased sugar(DKA), renal failure, loss of bicarb(diahreah-hyperchloremic)
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PaO2 mild
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70-61
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PaO2 moderate
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60-56
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PaO2 severe
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55 or less
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What are the primary causes low O2 levels(hypoxemia)?
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V/Q mismatch, shunt, alveolar hypoventilation, diffusion impairment, perfusion/diffusion impairment, decreased inspired O2 & venous admixture
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Hypoxemia mild
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60-79
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Hypoxemia moderate
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40-59
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Hypoxemia severe
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40 or lower
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Tissue Layers of the Heart
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epicardium myocardium endocardium
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What chamber has the most muscle mass?
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the left ventrical
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Where is the mitral valve located & what does it do?
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(bicuspid) Lft side of the heart to prevent backflow into the left atria
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Where is the pulmonary valve located & what does it do?
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the pulomary semilunar valve is on the rt side of the heart stop backflow into the right atria
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Where is the bicuspid valve located & what does it do?
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mitral valve is the bicuspid valve it is located on the lft side of the heart and prevents backflow
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Describe briefly Frank Starling's law
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the inherent ability of the heart to increase its force of contraction as increasing amounts of blood flow into it ( rubber band) (this is how the heart changes stroke volume)
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Path of the blood cell back to the heart (beachy chapter 6 pg109-110)
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the rt venterical receives mixed venous blood through the tricuspid valve from the rt atrim and pumps it though the pulmonic valve deoxygenated blood flows through the pulmonary arteries and arterioles to an immense alverolar capillary bed were it is re-oxygenated. then through the pulmonary veines into the left atrium to the mitral valve (bicuspid) to the left venterical to the systemic arties to the arterioles and cappillary beds supplying o2
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Difference between high pressure & low pressure systems (think venous & artery) chpter 6 beachy pg 110
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pulomonary circulation is low pressure low resistance it is about one tenth compared to the systemic. the systemic system is much higher pressure
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Figuring Cardiac Output: P1V1=P2V2
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?use an example from lecture
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What is normal Cardiac Output?
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5 L/min (range of 4-8) HR x SV= cardiac output
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What does ejection fraction refer to?
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70 l/m stroke volume/120 ml or 65% (egan's pg 206 says 75 for stroke volume)
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1st heart sound
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closure of the AV valves (tricuspid and mitral)(lub)
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2nd heart sound
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closure of the similunar valves (dub)
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Define ischemia
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tissue hypoxia from decrease in blood flow (starving for O2)
(ischemia = angina pectoris) |
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Define angina
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pain felt from hypoxia(decreased oxygen in tissue)
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When does the most coronary perfusion occur?
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during ventricular relaxation (diastole) pg 282 Beachy
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Describe ventricular filling(preload)
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ventricles relax, pressure accumulated in atria during ventricle contraction pushes av valves open and blood rushes in filling 80% RAPIDILY(passive) + during the last .1 sec the atria contract(KICK) filling the remaining 20%
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Describe the atrial kick
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slow filling phase that happens during the 0.1 sec of vetricular filling where atria contract and force the additional 20% into the ventricles(when this happens the atria pressure had decreased dramatically and is only slighty higher than ventricular pressure)
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Describe the anatomy of the heart
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think we should break this one up into all the parts
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Conduction pathway through the heart
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SA node->Av node->AV bundle(bundle of His)->bundle branches (left & right)-> Purkinje fibers
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word problem on Tachycardia & V tach
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heart rate of 100 beets a min or more otherwise normal
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Bradycardia
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heart rate of 60 beats a min. or less other wise normal
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1st degree block
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the pr interval is longer than .2 sec.will see a p and a qrs r-r is normal
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2nd degree block type I. or wenckebock
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pr get longer and than looses a qrs
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2nd degree block type II.
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multiple p`s for every QRS
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3nd degree block.
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A and V are paced independantly no relationship between the QRS
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A Fib.
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results when the aterial muscle quivera in an erratic pattern
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A Flutter.
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looks like saw tooth 250-350 beats a min. many p`s |
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V fib.
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run of 3 or more PVC rate usally 100-250
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Ventriculer asystole
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flat line with out
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Define Automaticity
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the ability of the cells in the heart to depolarize without stimulations the cells of electerical excitation: pacemaker, SA node AV node purkinje fibers
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Define contractility
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ability to shorten muscle fibers(contract)
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Define rhythmicity
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the ability to depolarize spontaneously in a repetitive manner
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what dose each type of tissue of the heart consist of?
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epicardium= visceral pericardium
myocardium is the bulk of the heart muscle that raps around to creat greater force endocardium lines the inner serviceof the harts chambers resembling smooth endotheilum lining of the blood vessels |
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What does the P wave represent?
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Atrial depolarization
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What does the PR segment represent?
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tfrom the start of aterial contraction to the start of venticular replolarization (normal 0.20 seconds or less)
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What does the QRS segment represent?
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venterical depoliration max of .12 sec for normal (3 boxes)
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What does the T wave represent
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ventricucluar repolrization (refilling) (normally upright rounded)
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What can be detected by EKG's?
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assess posible MI`s heath screanning tool can detect hart blocks or abnormal inpussive of the heart
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What can't be detected by EKG's?
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\cannot perdict future MI`s or detected structural defects
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What causes Tachycardia?
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acute illness pain anxiety fevor hypovolemia hypoxemia(#1 cause)
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What causes Bradycardia?
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vasovagal response hypotension and syncope
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What are the lethal arrythmias?
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ventricular fibillation, ventricular tachycardia
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Define the blocks
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interference with normal conduction of the heart
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PMI placement
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(point of maximal impulse) the apical beat that is createdby the beating heart`s repeated impact on the inner chest wall can be felt or seen at the 5th intercostal space and midclavicular line
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Definition of afterload
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load against which an activated muscle must try to shorten; greater afterloads results in lower velocites
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Define Preload
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pressure stretching the ventricular walls at the onset of ventricular contraction
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What is the most dangerous cause of Hyperkalemia?
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Chronic Renal Disease, hemorrhage, tissue necrosis, nonsteroidal antiinflammatory drugs
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What is the most dangerous cause of Hypokalemia?
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Diuretics, steroid therapy, renal tubular disease, vomiting
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What is the rate of the SV node?
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70-80bpm
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What is the rate of the AV node?
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40-60bpm
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Are there any other pacer rates we need to know?
?Purkinje rate |
Perkinjie fibers 15-39bpm 15-40bpm |
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prolapse
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protudes pokes out
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dichotic notch
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vascular recoil helps push blood forward in the arteries during venticular diastole creating it
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stroke volume
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70ml of blood contraction ejects leaving behind 40-50ml (the end of systolic volume)
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the ejection fraction (normally)
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aproximately 60%
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Ventricular filling
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is preload
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Alveolar Hyperventilation Superimposed on Compensated Respiratory Acidosis
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A pt with COPD and compensated resp acidosis (can be mistaken for compensated metabolic alkalosis)
* Hypoxia = increased alveolar ventilation |
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Define excitability
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the inclination to depolarize spontaneously
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4 key properties of cardiac tissue
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1. automaticity
2 .rhythmicity 3. excitability 4. contractility |
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Parasympathetic stimulus
(Vagal Response) |
releases acetycholine which
-decreases SA node firing -decreases AV node excitability: AV block -increasing outward diffusiom of K+ |
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Sympathetic stimulus
(flight or fight) |
releases norepinephrine
-increasing SA node firing -increasing permeability to Na+ and Ca+ |
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Define conductivity
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ability of myocardial tissue to propagate electrical impulses (textbook def)
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Define contractility
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Property of muscle tissue to shorten in response to a stimulus, usually electrical (textbook def)
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Define automaticity
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term denoting the heart's ability to generate its own intrinsic electrical rhythm (textbook def)
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Heart wall
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1. epicardium-visceral pericardium
2. myocardium-heart muscle forming the bulk of the heart wall 3. endocardium- line the inner surfaces of the hear |
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Right Atria chamber
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recieves deoxygentated blood from superior vena cava, inferior vena cava, and coronary sinus
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Left Atria chamber
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recieves oxygenated blood from pulmonary veins
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Right Ventricle Chamber
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pumps blood into the pulmonary circulation to the left atria
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Left Ventricle chamber
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pumps blood into the systemic circulation to the right atria
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atrioventricular valves
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one-way valves in which both atria channel their blood through into the ventricles
1. tricuspid=right AV-valve & 2. mitral (bicuspid)= left AV-valve *prevent backflow during ventricular contraction |
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interatrial septum
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-seperates the two atria
-prevents mixing of oxygentated and deoxygentated blood *small depression in this septum marks former location of the foramen ovale |
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pulmonary semiluminar valve
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right ventricle pumps blood through this valve into the pulmonary trunk
*prevent backflow into the ventricle during ventricular relaxation |
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aortic semiluminar valve
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left ventricle pumps blood through this valve into the aorta
*prevents backflow into the ventricle during ventricular relaxation |
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interventricular septum
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seperates the right and left ventricles, preventing mxiing of oxygentated and deoxygentated blood.
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fibrous annuli
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a tough set of connected trings forming a semi-rigid framework to which the heart valves and cardiac muscle are attached nforming the skeleton of the heart
-directs blood from apex to base -responsible for heart valve function during cardiac cycle |
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Of all the electrolytes involved in heart contractility, which is the one we are most concerned with imbalances?
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Potassium (K+)
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