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Patho 1 > 2 - Cardiac > Flashcards

2 - Cardiac Flashcards

1
Q

Why does cardiac output decrease with age?

A

Indicative of decreased basal metabolic rate and decreased muscle mass

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2
Q

When the right atrium is stretched, it triggers which reflex?

A

Bainbridge

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3
Q

According to Ohm’s Law, what is the calculation for Cardiac Output?

A

Arterial Pressure/Total Peripheral Resistance

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4
Q

How does BerBeri effect cardiac output?

A

Massively increased

Interferes with cells’ ability to use nutrients, creating enormous vasodilation to try to get more nutrients to the cells

Decreased peripheral resistance –> increased CO

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5
Q

Would an AV shunt/fistula cause increased or decreased cardiac ouput?

A

Increased

More venous return

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6
Q

How does hyperthyroidims effect cardiac output?

A

Increases 40-80% above normal

Increased metabolic rate

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7
Q

How does anemia influence cardiac output?

A

Increases

Decreased O2 carrying capacity, triggers vasodilation in the periphery

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8
Q

What are 5 peripheral factors that lower cardiac ouput?

A

Decreased Blood volume

Acute venous dilation

Large Vein obstruction

Decreased tissue mass (skeletal esp)

Decreased metabolic rate

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9
Q

What is the mean systemic filling pressure?

A

The pressure at which all systemic flow in the periphery ceases, and both atrial and venous pressures reach equilibrium

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10
Q

Venous return increases as RA pressure decreases, but if RA pressure are less than 0, venous return plateaus even if the RA becomes more and more negative. Why?

A

Because the veins collapse

Negative pressure in the RA sucks the walls of the large veins entering the thorax together

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11
Q

What is the mean circulatory filling pressure?

A

Pressure that would be measured in the entire circulatory system if cardiac pumping stopped completely

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12
Q

A big increase in blood volume (bolus) only increases cardiac output for a couple of minutes. What three compensatory effects cause this?

A
  1. Increased cardiac output increase capillary pressure, creating diffusion out of the capillary
  2. stress-relaxation in veins causes them to distend in response to the increased volume
  3. Autoregulation increases peripheral vascular resistance, which decreases venous return
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13
Q

How does a Fick equation determine cardiac output?

A

Measures the rate of oxygen diffusion by comparing a mixed venous O2 levels with arterial levels

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14
Q

During exercise, why do capillaries dilate?

A
  1. Internal:

decreased o2 and presence of vasodilators (K, ATP, lactic acid, CO2, adenosine)

  1. External:

sympathetic stimulation

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15
Q

During exercise, while the capillaries are dilating, the major vessels are _________

A

contracting

increases flow

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16
Q

Most of the venous flow from the L ventricle returns to the heart via _______

Most of the venous return from the R ventricle returns via __________

A

coronary sinus

anterior cardiac veins

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17
Q

How does the heart get extra nutrients during exercise?

A

Partially through increased coronary flow, but that alone isn’t sufficient. The heart has to be more efficient and utilize energy optimally to make up the difference and provide the needed cardiac output.

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18
Q

Coronary arteries perfuse the heart during _______

A

Diastole

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19
Q

At a normal resting state, what is the % VO2 of cardiac muscle?

A

70%!

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20
Q

Constrictor receptors are called ________

Dilator receptors are called _________

A

Alpha Receptors

Beta Receptors

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21
Q

The epicardial coronary vessels have mostly ______ adrenergic receptors.

The intramuscular arteries have most ______ adrenergic receptors.

A

Alpha

Beta

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22
Q

What is the major driver of vasodilation and vasoconstriction in the coronary arteries?

A

Metabolic control

Very little sympathetic control

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23
Q

In all tissues, more than 95% of the energy liberated ffrom foods is used to ________

A

form ATP in the mitochondria

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24
Q

What is the role of adenosine in capillaries?

A

When ATP is broken down and not resynthesized, adenosine is floating freely in the cell. If it escapes into the vasculature, that’s a sign to the body that the tissue needs more oxygen/nutrient delivery, and the capillary dilates

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25
Q

Why is adenosine loss one of the major causes of cellular death?

A

It’s crucial for ATP formation, and once it escapes into the vasculature it takes hours if not days to be replaced. This makes recovery of the tissue (even when oxygen delivery is restored) extremely unlikely.

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26
Q

Why do infarcted areas turn bluish-brown?

A

The tissue uses all of the remaining oxygen in the blood that lays stagnant at the infarcted site.

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27
Q

Where does infarction occur first: the epicardium or the subendocardium?

A

The subendocardium

Has a higher oxygen consumption and is more easily compressed during systole, much less resilient to decreased O2

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28
Q

What are the four ways an MI leads to death:

A
  1. Decreased CO
  2. Pulmonary edema from blood stuck in the lungs
  3. Fibrillation of the heart
  4. Rupture of the heart
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29
Q

Why do patiens who are recovering nicely from a heart attack develop pulmonary edema two days out?

A

Kidney failure for decreased flow at the time of infarct

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30
Q

When does rupture after an MI usually occur?

A

Not immediately. Several days later.

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31
Q

After an infarct, dead fibers are replaced with ______

A

fibrous scars

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32
Q

Why does the heart often return to normal function after an MI, even though a portion of it is now fibrous?

A

Healthy areas of the heart hypertrophy to compensate

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33
Q

What is a normal cardiac reserve?

What reserve is required to function as long as no strenuous exercise is performed?

A

300-400% capacity

100% capacity

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34
Q

Why do patients who have a heart attack often faint, then regain consciousness?

A

During MI there is a massive decrease in CO and therefore venous return, which initially leads to fainting

Within 30 seconds the sympathetic system is stimulated and makes the healthy heart parts beat harder and causes veins to constrict, increasing blood return to the heart

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35
Q

What happens initially in the kidney following a heart attack?

A

Initially, moderate fluid retention that increases blood volume and helps compensate for decreased pumping

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36
Q

In severe or prolonged cardiac failure, what happens in the kidneys?

A

When blood flow to the kidney drops low enough it can’t excrete urine and sodium, fluid retention is excessive and worsens cardiac failure

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37
Q

How long does it take for the heart to acheive most of its final recovery?

A

5-7 weeks

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38
Q

What drug is digitalis?

How does it increase cardiac function?

A

cardiotonic glycoside

Depresses the sodium-calcium exchange pump, which increases calcium ion concentration in muscle fibers and makes contraction easier

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39
Q

What are 5 known causes of reduced renal output during cardiac failure?

A
  1. Decreased GFR
  2. R-A-A activation
  3. Increased Aldosterone
  4. Increased ADH
  5. SNS activation
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40
Q

In cardiac failure Aldosterone is obviously increased due to R-A-A activation, but what else increases it?

A

Increased potassium d/t renal failure

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41
Q

If ANP is the hormone released by the RA during distention, why do we use BNP instead of ANP when assessing for CHF?

A

The half life of BNP is much longer and much more easily detected in the blood

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42
Q

Where is ANP released?

BNP?

A

Atria

Ventricles

43
Q

What is the best means of diagnosing low cardiac reserve?

A

Exercise Stress Test

44
Q

Heart failure associated with impaired contractility is reffered to as ________ or __________

A

systolic HF

HFrEF

45
Q

What is a normal EF?

A

50-70%

46
Q

When is heart failure associated with normal EF?

A

concentric hypertrophy

decreases filling

Diastolic failure

HFpEF

47
Q

What kind of heart failure is associated with cardiometabolic syndrome?

A

diastolic

48
Q

What are two examples of high output cardiac failure?

A

AV Fistula

BeriBeri

49
Q

A valve opening does/does not normally produce a sound

A

Does not

50
Q

The first heart sound is the closing of the _______

A

A-V valves

Tricuspid

Mitral

51
Q

The second heart sound is the closing of the _______

A

Semilunar Valves

Aortic and Pulmonic

52
Q

What patient position can extra heart sounds be heard best?

A

Apex while laying in L Lat Decub

53
Q

An S3 is caused by ______

A

Volume overload in the ventricle

54
Q

An S4 is caused by ________

A

Pressure Overload

55
Q

Another name for S3

S4

A

Ventricular Gallop

Atrial Gallop

56
Q

Any time the ventricular is hypterophied you get decreased flow to ______

A

the coronary arteries

hypertrophied muscle blocks flow during systole (somewhat normal) but also during diastole d/t increased ventricular mass

57
Q

Once left atrial pressure reaches _______ you get pulmonary edema

A

25-40

58
Q

Disease in which valve is associated with atrial fibrillation? Why?

A

Mitral

L atrial stretch elongates the pathway between the SA node and the atria, and excitatory spots can develop leading to Afib

59
Q

What is the ductus arteriosis?

A

Connects the pulmonary artery and the aorta in the fetus

60
Q

In patent ductus arteriosis, blood passes through ______ multiple times before reaching _______

A

lungs

systemic circulation

61
Q

A PDA causes a ___ to ___ shunt

A

left to right

62
Q

Tetralogy of Fallot causes a ____ to _____ shunt

A

right to left

63
Q

Four abnormalites in Tet of Fallot

A
  1. Aorta comes off the RV instead of the LV
  2. Pulmonary artery is stenosed
  3. The septum is open between the ventricles
  4. Enlarged RV (d/t increased workload)
64
Q

Average cardiac weight

A

200-350 g

65
Q

Functions of the pericardial sac (3)

A
  1. prevents displacement during accel/decel
  2. physical barrier from infection and inflammation
  3. pain and mechanoreceptors that can alter BP and HR
66
Q

How much pericardial fluid is in the sac?

A

20 ml

67
Q

What is the outermost layer of the heart?

A

Epicardium

68
Q

Function of the epicardium

A

provides smooth layer to minimize friction with pericardium

69
Q

What is the thickest layer of the heart wall?

A

Myocardium

70
Q

Myocardium function

A

composed of cardiomyocytes

responsible for contraction

71
Q

Innermost layer of the cardiac muscle wall

A

Endocardium

72
Q

Endocardium function

A

connective tissue and squamous cells

Continuous with the endothelium that lines all the arteries, veins, capillaries that supply the heart

73
Q

What is the normal thickness of the RV?

LV?

A

4-5mm

12-15mm

74
Q

Annuli Fibrosi Cordis

A

Four rings of fibrous tissue that hold the structures of the heart in place

75
Q

The tricuspid has ______ cusps. The mitral has ______.

A

3

2

76
Q

Mitral and tricuspid complex

A

The Tricuspid, mitral, both atria, chordae tendenae, and annuli fibrosi are all interconnected by tissue and function as one unit.

When something happens to one, the others will have altered function

77
Q

Which valves have chordae tendinae?

What do chordae tindinae prevent?

A

The AV valves

Prolapse of the valves into their respective atria

78
Q

Which muscles attach the chordae tendinae to the myocardium?

A

Papillary muscles

79
Q

There are _____ pulmonary arteries and ______ pulmonary veins

A

2

4

80
Q

Which muscle separates the outflow tract from the inflow tract?

A

Crista Supraventricularis

81
Q

Strands of _____ mix blood in the ventricles

A

trabeculae carnae

82
Q

The only bicuspid valve in the heart is the ______

A

mitral

83
Q

What is arteriogenesis?

Angiogenesis?

A

New artery growth/branching from preexisting artery

Growth of new capillaries within a tissue

84
Q

What (3) things stimulate collateral flow growth in the myocardium?

A
  1. Shear stress (increased blood flow through a stenosis, narrowing)
  2. Production of growth factors
85
Q

Why does diabetes impede collateral formation?

A

Increased production of endostatin and angiostatin

86
Q

At rest what is the VO2 of cardiac muscle?

A

70-80%

87
Q

How do capillaries adjust for increased muscle mass in hypertrophy?

A

They don’t.

The capillary network doesn’t expand, so the same number of capillaries have to perfuse a larger area

88
Q

The visceral pericardium is another word for _____

A

Epicardium

89
Q

Resting membrane potentials:

Myocardial

SA Node

AV Node

A
  • 80 to -90
  • 50 to -60
  • 60 to -70
90
Q

What is automaticity?

A

property of generating spontaneous depolarization

91
Q

Rhythmicity

A

regularity of generation of an action potential by the heart’s conduction system

92
Q

Name three vasodilators released when MVO2 is elevated

A

adenosine

nitric oxide

prostaglandins

93
Q

What are the three calcium channel blockers?

A

Nifedipine

Verapamil

Diltiazem

94
Q

How do calcium channel blockers work?

A

Block L-type long lasting calcium channels, leading to decreased contractility

95
Q

How does LaPlace’s law apply to the ventricle?

A

Wall stress = (P x r)/2(wall thickness)

When there is increased pressure, the heart will increase its thickness and decreased its radius to reduce wall tension and prevent rupture

96
Q

What are the three layers of blood vessel walls?

A
  1. Tunica Intima (innermost)
  2. Tunica Media (middle)
  3. Tunica externa/adventitia (external)
97
Q

How are the cells that comprise large vessels nourished?

A

Vasa Vasorum

Located in tunica externa

98
Q

How is vasculogenesis different rom angiogenesis or arteriogenesis?

A

refers to the growth of vessels from progenitor or stemlike cells that originate in the bone marrow and other tissues

99
Q

What are elastic arteries?

A

Very thick tunica media

Have higher proportion elastic fibers to muscle cells

Aorta and major branches

pulmonary trunk

100
Q

What are muscular arteries

A

Medium and small sized arteries

few elastic fibers, more mm fibers

Distribute blood to arterioles

101
Q

When does an artery become an arteriole?

A

lumen less than 0.4mm

102
Q

A given vein is ______than its corresponding artery

A

larger

103
Q

Which are more numerous: veins or arteries?

A

Veins

Patho 1 (17 decks)

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