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basics of physiology Flashcards

1
Q

What part of the CVS is in series?

A

Pump to the lungs and pump to the tissues

Gut to the liver

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2
Q

What part of the CVS is in parallel?

A

Most body tissues

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3
Q

Which organs take the largest amount of blood?

A

Abdominal organs, Kidneys and skeletal muscle

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4
Q

Which organs take the smallest amount of blood?

A

Heart, skin

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5
Q

Which organs take the largest amount of oxygen?

A

skeletal muscle, abdominal organs

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6
Q

Which organs take the smallest amount of oxygen?

A

skin, kidney

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7
Q

Equation: Flow in a tube =

A

Change in pressure / Resistance
The pressure difference is the mean atrial pressure – the central venous pressure. The resistance is controlled by the radius.

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8
Q

What is regional distribution of blood controlled by?

A

Arterioles

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9
Q

What is fractional distribution of blood controlled by?

A

venules

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10
Q

What is the excitation - contraction coupling in the heart called?

A

Functional syncytium

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11
Q

What does a functional syncytium involve?

A
  • Gap junctions = Electronic connection

- Desmosomes = Physical connection (intercalated discs)

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12
Q

Where does Ca 2+ come from in the cardiac muscle

A 
Sarcoplasmic reticulum (Doesn't saturate)
Outside cells (Regulation of cardiac contraction)
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13
Q

key features of a cardiac muscle contraction

A
  • Long AP
  • Long refractory period
  • No tetanus
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14
Q

What are pacemaker cells ?

A

Unstable resting membrane potential and will spontaneously depolarise.
AP occurs because of a Ca2+ increase.
Found in SA node

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15
Q

Only non-conducting part of the heart

A

Annulus fibrosis

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16
Q

What is the delay box of the heart?

A

AV node

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17
Q

Path of electrical signal through the heart

A 
SA node
Atrial contraction 
VA node 
Bundle of his 
Purkinje system 
ventral contraction
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18
Q

What are the key elements of a ECG

A

P wave corresponds to atrial depolarisation
QRS complex corresponds to ventricular depolarisation
T wave corresponds to ventricular repolarisation

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19
Q

What is 1st degree block

A

Increase between p and QRS complex

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20
Q

What is 2nd degree block

A

Increasing delay between P and QRS

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21
Q

What is 3rd degree block

A

No p waves

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22
Q

What is atrial flutter

A

Rapid depolarisation. Saw tooth pattern.

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23
Q

What is atrial fibrillation

A

Less crazy looking than atrial flutter

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24
Q

What is ventricular fibrillation

A

Totally uncoordinated

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25
What is standard limb lead I
L arm to R arm
26
What is standard limb lead II
L leg to R arm
27
What is standard limb lead III
L leg to L arm
28
On SLL II what does a depolarisation moving toward the L leg look like ?
Upward spike
29
On SLL II what does a repolarisation moving toward the L leg look like ?
Downward spike
30
On SLL II what does a depolarisation moving away the L leg look like ?
Downward spike
31
On SLL II what does a repolarisation moving away the L leg look like ?
Upward spike
32
What is the PR interval?
normally 0.12 s Time from P to start of QRS
33
What is the QT interval?
normally 0.42 s Time from start of QRS to end of T
34
Why is R bigger than P and T ?
SLL II lead in same direction that the bulk of the ventral depolarisation is in
35
How many ALLs are there
3
36
How many SLLs are there
3
37
How many PCLs are there
6
38
What plane the PCLs look at
Transverse
39
Will V1 be -ve or +ve
negative
40
Rhythm strip settings
25mm/sec | Calibrating pulse should be 0.2s so that it lies over 1 box
41
Difference between STEMI and NSTEMI ?
ST elevation in STEMI
42
What is the normal range for the QRS complex?
2-4 little boxes
43
What heart rate is considered bradycardia and what is considered tachycardia?
Over 100 or under 60
44
Stages of cardiac cycle
``` Late diastole Atrial systole Isovolumetric ventricular contraction ventricular ejection isovolumic ventricular relaxation ```
45
What is the ejection fraction?
SV/EDV
46
What is a phonocardiogram ?
Heart sounds as a result of turbulence
47
When are heart sounds heard?
Closure of mitral and tricuspid valves Closure of aortic and pulmonary valves (Rapid passive filling and active filling phases)
48
What causes systolic murmour
Aortic/pulmonary stenosis | mitral/tricuspid regurgitation
49
What causes a diastolic murmur?
Aortic / pulmonary regurgitation | mitral / tricuspid stenosis
50
What causes a continuous murmur?
Septal defect
51
Regulation of the heart
- Pacemakers - Sympathetic NS noradrenaline B1 in SA depolarise - Adrenal medulla Adrenaline B1 in SA - Parasympathetic (vagus) AcH muscarinic SA hyperpolarise
52
energy of contraction proportional too
initial length of muscle fibres
53
The greater the volume of blood in the heart ...
The longer the muscle fibres and stronger the contraction to a certain length of muscle fibres.
54
What is the afterload?
The load against which the muscles tried to contract i.e. the resistance in the rest of the system
55
what is stroke volume ?
The volume of blood that is pushed out of the heart in each contraction
56
What is preload?
How full the ventricles are before starting contracting
57
Cardiac output =
heart rate x stoke volume
58
What is the systemic filing pressure?
pressure difference which move blood back to the heart
59
Where is blood flow the greatest ?
Largest vessels because they have a smaller total lumen size
60
Things which influence flow in the veins
- Gravity - Skeletal muscle pump - Respiratory pump - Vasomotor tone - Systemic filling pressure
61
What is the skeletal muscle pump?
Contraction of the leg muscles pushes blood back
62
What is the respiratory pump ?
Increased rate and depth of breathing lowers the pressure in the heart pulling blood in.
63
What is the vinometer tone?
Smooth muscle contraction of vessels moves blood
64
Endothelium mechanisms which prevent clot forming in the wrong place
Prevents blood contracting collagen Prostacyclin's and nitric oxide stops platelets binding to each other Tissue factors inhibit thrombin production Thrombomodulin and heparin inactivated thrombin Tissue plasminogen converts plasmin and digests clots
65
Which direction does hydrostatic pressure push blood?
out of capillaries
66
How much blood goes out of the capllarie?
20l
67
How much blood goes into the capillaries ?
17 l
68
How is peripheral circulation regulated?
- Control arteriolar radius
69
Levels of control of smooth muscle
Local (flow to meet the needs of individual tissues) | Central (total peripheral resistance)
70
types of local control
Active hyperaemia - Ions causes endothelium to produce signalling molecules which increased flow Autoregulation - Decrease in perfusion causes decrease in flow Reactive hyperaemia - occlusion causes increased blood flow Injury response - Increased blood flow
71
types of central control
``` Sympathetic nerves decrease flow coronary circulation cerebral circulation pulmonary circulation renal circulation ```
72
How is MAP regulated
Baroreceptors in the aortic (Vagus) arch and carotid sinus (Glossopharyngeal) Chemoreceptors
73
What is the Valsalva manoeuvre
forced expiration when not allowing air out
74
Stages of the Valsalva manoeuvre
- Increase in BP - Reduced filling pressure - Reduced venous return - reduced end diastolic volume - reduced stoke volume - Reduced cardiac output - Reduced mean atrial pressure - Baroreceptors kick in - Manover ends and decreased thoracic pressure passes through the heart causing a further drop in BP - return to normal
75
Long term mediation of BP
Kidneys
76
Kidney process used to regulate BP
Renin-angiotensin-aldosterone system. Reacts to a drop in BP by increasing BP. Antidiuretic factor. reacts to a drop in BP by increasing BP. ANO and BNP react to an increase in BP and lower BP
77
What is an acute coronary syndrome?
New onset collection of symptoms relating to a problem in the coronary artery.
78
What evidence do you need in order to diagnose myocardial infarction?
Evidence of cardiac cell death (Detected on a blood test) i.e. Troponin + symptoms or ECG changes or etc
79
What is dual antiplatelet therapy?
300mg of Aspirin given immediately and then 75-100mg each day thereafter. + the P2Y12 inhibitors
80
Treatment for STEMI
- Thrombolysis - Dual antiplatelet therapy - Get in Cath lab ASAP for reperfusion therapy
81
How do most thrombolytic agents work?
They are serine proteases converting plasminogen to plasmin. Plasmin then breaks down clots.
82
Treatment for NSTEMI and other ACSs
- Aspirin (Dual platelet) - Ticagrelor - Platelet aggregation i.e. P2Y12 inhibitors - Beta blockers - GTN
83
What is the ending of CCBs
-pine
84
What is the ending of ACEis?
-pril
85
What is type I MI ?
Spontaneous MI due to a primary coronary event
86
What is type II MI ?
Due to imbalance of supply and demand of oxygen
87
On an ECG what is used to determine if a patient has a STEMI or NSTEMI ?
ST elevation normally or ST depression
88
Surgical intervention for ACSs
``` Reperfusion therapy (In a cath lab with a balloon and stents) Also called a PCI or angiogram. There are some risks of bleeding. ```
89
What is a stoke?
Neurological deflect which has sudden onset and lasts more than 24 hours and has vascular origin int he brain.
90
Two types of stoke
Haemorrhages (Rupture in the vessel wall) high death rate | Ischemic (blockage)
91
Three types of ischemic stoke
Large artery disease i.e. carotid stenosis where there is thrombus formed at the bifurcations, emboli then occurs. Cardioembolic stoke. I.e. atrial fibrillation causes a clot to from in the LA Small vessel stoke where little vessels in the brain get occluded. Lots of damage because nerves are so close together.
92
Treatment for stoke
- Get patient into a stoke unit - Give them aspirin - Alteplase (A type of thrombolysis) - Clot retrieval
93
Name of Classification system used for stoke
Vaughan-William classification system
94
What are class 1A Antiarrhythmics
Moderate sodium channel blockers i.e. Quinidine
95
What are class 1B Antiarrhythmics
Weak sodium channel blockers i.e. Lidocaine
96
What are class 1C Antiarrhythmics
Strong sodium channel blockers i.e. Flecainide
97
What are class 2 Antiarrhythmics
B- adrenergic receptor antagonist's i.e. Atenolol, and Bisoprolol
98
What are class 3 Antiarrhythmics
Prolong refractory i.e. Aminodarone
99
What are class 4 Antiarrhythmics
Calcium channel blockers i.e. Diltiazem and verapamil
100
other important antiahhyrmias
Digoxin - Inhibits sodium potassium pump
101
Important anticoagulation drugs
- Warfarin - Dabigatran - Rivaroxaban (All end in Ban)
102
What system is used to determine if a patient is at risk of stoke?
CHADSVASC
103
What scoring system is used to determine the risk of giving warfarin ?
HADBLED

Cardiovascular (2 decks)

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