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SF3 > Cardiac Cycle > Flashcards

Cardiac Cycle Flashcards

1
Q

What are the anatomical structures involved in cardiac pump function?

A

Ventricular walls

Heart valves

Chordae Tendinea

Papillary muscles

Pericardium

Sarcomeres

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2
Q

Where will you find the lowest pressure in teh body?

A

Right atrium

(also known as central venous pressure)

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3
Q

The atria have how many layers of muscle?

A

2 layers

each are perpendicular to one another

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4
Q

The ventricles have how many layers?

A

3 layers

( 2 perpendicular, one diagonal)

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5
Q

How does right ventricular ejection occur?

A
  1. Shortening of the free wall
  2. compression of the chamber (Bellows Action)
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6
Q

How does left ventricular ejection occur?

A
  1. Constriction of chamber
  2. Shortening of Chamber
  3. Traction on Right ventricular wall
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7
Q

What occurs when you have ventricular pressure?

A

The AV valves close

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8
Q

What occurs when you have high atrial pressure?

A

The AV valves open

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9
Q

Since the valves are made of connective tissue, what type of opening do they do?

A

The valves passivly open when there is a pressure difference

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10
Q

What the requirements for effective cardiac pumping (effective efficient ventricular pumping action)?

A
  1. The contractions of individual cardiac muscle cells must occur at regular intervals and be synchronized.
  2. The valves must open fully
  3. The valves must not leak
  4. The muscle contractions must be forceful
  5. The ventricles must fill adequately during diastole
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11
Q

what is the cardiac cycle?

A

The period of time from the beginning of one ventricular contraction to the beginning of the next

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12
Q

What are the two phases that are part of the cardiac cycle?

A
  1. Systole: contraction of the ventricle
    • closure of the A-V valves -> closure of the Semilunar valves
    • 1/3rd of the cycle
  2. Diastole: the period of ventricular relaxation
    • closure of the semilunar valve -> closure of the A-V valve
    • 2/3rd of the cycle
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13
Q

There are two phases of systole, what are they?

A

Isovolumic contraction

Ejection period

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14
Q

There are two stages in diastole, what are they?

A

Isovolumic relaxation

Filling period

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15
Q

What occurs during Isovolumic Contraction Period?

A
  1. ventricles generate pressure (by slow contraction) without expulsion of blood volume (increase in pressure causes AV valves to close)
  2. Bothe A-V valve and semilunar valves are closed (closed chamber)

This is also known as Ventricular Systole

Atria are relaxed

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16
Q

What occurs during the ejection period?

A
  1. the A-V valves are closed and semilunar valves have opened up (this is because the pressure in the ventricle is now higher than the pressure in the aorta/pulmonary trunk)
  2. Rapid ejection: 70% of total ejection volume is expelled during the 1st 1/3 of the ejection period
  3. Reduced Ejection: the remaining 30% of the ejected volume occurs during the last 2/3 of the ejection period.
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17
Q

What occurs during Isovolumic relaxation?

A
  1. The ventricular chamber volume remains constant but the chamber pressure drops
  2. Both A-V and Semilunar Valves are closed

Ventricles are relaxed

Dicrotic Notch occurs during this phase

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18
Q

What occurs during the filling period?

A
  1. A-V valves are open and the semilunar valves are closed (rapid filling occurs and fills 2/3 of the ventricle)
  2. Diastasis: (slow filling) the 2nd 1/3 of diastole contributes minimally to ventricular filling
  3. Arterial Systole: (SA node excites and causes contraction of the atria = top off) the last 1/3 of diastole contribute about 15% to ventricular filing

This is also know as mid-to-late diastole

Heart Blood pressure is low as the blood enters atria and flows into ventricles

19
Q

After the atria contract and top off the ventricle what occurs?

A

Atria contract due to the SA node firing -> ventricles are topped off -> ventricles strecth but contraction does not occur because the AV node hold exicitation -> eventually the excitation is released -> ventricles begin to contract -> pressure increases -> AV valve closes -> now in ventricular systole

20
Q

What causes the semilunar valves to close?

A

When the arterials are filled with blood they stretch. When they recoil to propel the blood forward some of the blood goes back which causes the Semilunar valves to close

21
Q

What is the Dicrotic notch?

A

Brief rise in aorta pressure caused by backflow of blood rebounding off semilunar valves

22
Q

What are the normal audible sounds?

A

S1

S2

23
Q

What is S1?

A

1st heart sound that is heard during Isovolumic contraction. This is when the A-V valves close

Low Pitch, Loud and Long

24
Q

What is S2?

A

2nd heart sound. This is heard during Isovolumic Relaxation when the semilunar valves close

High Pitch, loud and short

25
Q

What is the sound that the regularly non-audible heart sound make?

A

A gallop sound

26
Q

What is the significance of hearing S3 and/or S4 in adults?

A

In adults they are associated with myocardial disease

27
Q

What are non-audible heart sounds?

A

S3 and S4

28
Q

What is S3?

A

The third heart sound. This is heard when there is a transition from rapid diastolic filling to diastasis.

Low pitch and faint

29
Q

What is S4?

A

This is the 4th heart sound. This is heard during Atrial Systole.

Low pitch and faint

30
Q

On a normal, there is a thing know as the S2 splitting. How can this be heard during clinical exam? What exactly is the S2 splitting?

A

S2 occurs from the closing of the aortic and pulmonic valves. There are times where there is a delay in the valve closure. This is normal.

To hear during exam:

Ask patient to inspire -> increases thoracic cage volume and flattens the diaphragm

The decrease in thoracic pressure = increase in venous return (increase R. ventricle stoke volume) -> this causes the pulmonic valve to close later (since more blood needs to get through)

More blood remaining stagnant in the lungs (due to increase capacity of the capillary bed when inspiring) = reduce blood return to the Left side of the heart (decrease in left stoke volume) -> aortic valve closes faster

31
Q

What causes heart Murmurs?

A

Turbulence

32
Q

The intensity (loudness) and frequency (pitch) of a heart murmur depends on what?

A

Depend on the velocity which is determined by pressure gradient across area of murmur production

33
Q

What are the three catagories of heart murmurs?

A

Systolic

Diastolic

Continous

34
Q

What are the two type of Systolic Murmurs?

A

Ejection (Mid-Systolic) Murmor

Regurgitant Murmur

35
Q

Ejection (Mid-Systolic) Murmor

A
  • Etiology: Forward FLow across stenotic semilunar valve(s)
  • Timing: starts after Isovolumiv contraction (delay from S1) with semilunar valve closure
  • Occurence: Aortic and pulmonary valvular stenosis
  • Quality: crescendo-decrescendo systolic
36
Q

Regurgitant Murmurs (Systolic)

A
  • Etiology: Retrograde Flow from high to low pressure chamber
  • Timing: starts with S1 until end of Isovolumic Relaxation
  • Occurence: AV valvular incompetence or Ventricular Septal Defect
  • Quality: pansystolic or holosystolic murmur
37
Q

What are the two types of Diastolic Murmurs?

A

Diastolic Fillinf Murmurs (Rumbles)

Regurgitant Murmurs

38
Q

Regurgitant Murmurs (Diastolic)

A
  • Etiology: Retrograde flow across incompetent semilunar valve
  • Timing: Isovolumic relaxation at SL valves closure (S2) until S1
  • Occurence: Aortic or pulmonary Incompetence
  • Quality: High Pitch, high frequency, blowing decrescendo
39
Q

Diastolic Filling Murmurs (Rumbles)

A
  • Etiology: Forward flow across stenotic AV valve)s)
  • Timing: Starts after Isovolumic relaxation (delay from S2) with AV valve opening and end with AV valve vlosure
  • Occurence: Mitral and tricupsid AV valvar stenosis
  • Quality: Prominent during rapid diatolic filling and atrial systole. Low frequency rumbling
40
Q

What are the two type of Continous Murmurs?

A

Rapid Blood Flow through the heart

High-to-low pressure shunts

41
Q

Rapid Blood FLow through the heart

(Continous Murmurs)

A
  • Occurence
    • Mammary Souffle
      • Mid-late pregnancy to end of lactation
    • High cardiac output such as in anemia
  • High Speed flow, volume of blood increases up to 50%
42
Q

High to low pressure shunts

(Continous Murmurs)

A

Occurence:

Congenital Cardiovascular Defect - shunt systemic circulation (aorta) to arterial pulmonary circulation

Patent ductus arteriosus

It has a waxing and wanning intensity

43
Q

What are the mechanical events of the cardiac cycle?

A
  1. Late Diastole: both sets of chanmbers are relaxed and ventricles fill passively
  2. Atrial sytole: atrial contraction forces a small amount of blood into ventricles
  3. Isovolumic ventricular contraction: first phase of ventricular contraction pushes AV valves closed but does not create enough pressure to open semilunar valves
  4. Ventricular ejection: pressure rises and exceed pressure in the arteries, the semilunar valves open and blood is ejected
  5. Isovolumic ventricular relaxation: as ventricles relax, pressure in ventricles falls, blood flows back into cusps of semilunar valves and snaps them closed

SF3 (15 decks)

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