APEX Cardiovascular AP Flashcards
What spreads the wave of depolarization?
Gap junctions
How does K affect RMP
Hyper K increases RMP
HypoK decreases RMP
How does CA affect THP
HyperCA increases THP
HypoCA decreases THP
Phases of ventricular AP
0 na in
1 cl in, k out
2 ca in, k out
3 k out
4 k seeps out, nakatpase
What is THP?
Voltage change that is required to achieve depolarization
SA and AV AP phases
4 depolarization, na in(i-f), ca in (t type)
0 depolarization CA in (l type)
3 Repolarization- k out
Cardiac accelerator fibers
T1-T4
CaO2 is what?
Artierial oxygen content
20ml/O2/dL
DO2 is what range
Oxygen delivery
1000ml/min
VO2 is what
Oxygen consumption
250ml.min
cVO2 is what
Venous oxygen content
15ml/dl
CaO2 formula
(1.34 x hgb x SaO2) + (PaO2 x 0.003)
about 20m/dl is goal
Oxygen content
DO2 formula
CO x 10 x [(1.34 x hgb x SaO2) + PaO2 x 0.003)]
Delivery of oxygen- how much o2 is carried andhow fast its being delivered
reference- 1000ml
EO2 reference
reference - 25%
VO2 reference
250ml/min
cVO2 formula range
(1.34 x hgb x sao2) + (PvO2 x .003)
15ml/dl
NOT PaO2!!!
SVR and PVR normal ranges
800-1600
150-250
dynes/sec/cm-5
SVR and PVR formula
(map-cvp/co) x 80
(meanPAP-PCWP/CO) x 80
Frank starling is associated with what two variables?
Ventricular output (SV)
Ventricular volume (PCWP=LVEDV)
Conditions that reduce myocardial compliance
Hypertrophy
Age
Fibrosis
Diastolic HF
Atrial kick %, and when is it most important?
20-30%
In high heart rates bc heart doesnt have enough time to fill passively
Conditions that impair inotropy
Hyper K (acidosis)
Hypercarbia (acidosis)
Hypoxia / ischemia (Lactate= acidosis) /
Propofol, CCB, volatile anesthetics
What increases contractility?
SNS
Catecholamines
Dig
PDE inhibitors
How does B1 stimulate contractility?
ATP to cAMP
cAMP increases PKA
More calcium in and made available via l type ca channel, serca 2 pump is sped up, and ryanodine2 receptor causes CICR
Most important electrolyte for contractility?
Calcium
LV pressure volume loop (square graph chart)
ACAO
MOMC
Right (isovolumetric contraction) and top (contraction) are systole
Left (isovolumetric relaxation) and bottom (ventricular filling) are diastole
Myocardial stress is reduced by what 3 factors
Increased thickness (muscle causes less stress)
Decreased radius (doesnt have to stretch as much)
Decreased Decreased pressure (same as above)
EF formula
(Edv-Esv)/EDV
or
SV/EDV
Mild EF dysfunction
41-49%
When looking at a cross section from above, what parts of the heart are being fed by what arteries?
R side- Circumflex
Middle bottom to half way up septum- LAD
Left side, top side, and half way down septum- inferior RCA
Where does SA node get its blood from? AV?
RCA in 70% of people
AV node in 80% of people
Coronary perfusion pressure formula
DBP-LVEDP
H1 vs H2 to coronary vessels
Vasoconstricts
Vasodilates
Aortic pressure vs LCA flow pressure vs RCA flow pressure
A line tracing
A line with low peak,
unevenly high dicrotic notch/ low systolic pressure,
just a mini a line
Which myocardial bed is most susceptible to MI?
endocardium, its far down
PLC
PLC IP3 CONTRACTION
Constriction
Think Phenyl
PKA
B1 stimulation - cAMP- PKA ativation
activation of Ca channels
Stimulates release of Ca from SR
Facilitation of CA into SR by SERCA2 to speed up the next ca release
How does preload effect Myocardial oxygen?
Decreases supply (heart beating too hard now)
Increases demand
What is wall tension synonymous with?
Preload
DO2 formula
(1.34 x hgb x sao2 + [pao2x.003]) x CO x 10
or
ci x hgb x 1.34 x sao2
NO effect on afterload, NO MOA
Decreases RV afterload by causing a decrease in PVR
Activates guanlyl cyclase, synthesize GTP to cGMP, decreases CA inside cell, causes smooth muscle relaxation
2 mediators of coronary vessel dilation
Adenosine
B2
Severe EF dysfunction
<25%
SERCA2 pump
Sarco Endoplasmic Reticulum Calcium ATPase pump
Resequesters CA, if you speed this up, then you can speed up the following release of more calcium for another contraction
How can we influence(increase) SA node AP?
Increase rate of phase 4 via sns
decrease THP
Increase RMP