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Z. CV FINAL > Cardiac Cycle & Control of Cardiac Output - Quiz 3 > Flashcards

Cardiac Cycle & Control of Cardiac Output - Quiz 3 Flashcards

1
Q

Ventricular Systole

A

Phase 2: Isovolumic Contraction

Phase 3: Rapid Ejection

Phase 4: Reduced Ejection

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2
Q

Ventricular Diastole

A

Phase 5: Isovolumic Relaxation

Phase 6: Rapid Filling

Phase 7: Diastasis

Phase 1: Atrial Systole

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3
Q

Atrial contraction is ____ essentatial for ventricular filling.

A

NOT Essential

More important for faster heart rates

Accounts for 10% of LV filling

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4
Q

When does most of ventricular filling occur?

A

Phase 6: Rapid Ventricular Filling

  • AV valves open, Aortic and Pulmonic Vavles Close
  • Passive filling
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5
Q

Opening of AV Valve produces what sound?

A
  • No heart sounds opening of any normal valves
  • S3 may be present and normal in children during rapid filling d/t tensing of chordae tendinae and AV ring.
  • Not normal in adults = Ventricular Dilation
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6
Q

Closure of Aortic and Pulmonic Valve produces what sound?

A

Produce S2

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7
Q

Closure of AV Valves produce what sound?

A

Produce S1

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8
Q

What does the incisura or dicrotic notch of aortic pressure tracings mark the beginning of ?

A

Diastole

Aortic and Pulmonic Valve Closure

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9
Q

During what cardiac phase does the Mitral and Aortic valve both close?

A

Phase 2: Isovolumic Contraction

All valves are close

QRS = ventricular depolarization

Phase 5: Isovolumic Relaxation

  • All valves closed
  • Ventricular volumes constant
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10
Q

Various Waves of CVP

A

a: atrial contraction
c: ventricle contraction
v: slow atrial filling, AV valves close

x descent: base of the atria are pulled downward decreasing initial atrial pressures/

y descent: opening of the AV valve that causes a massive fall in pressure

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11
Q

What signifies the first heart sound?

A

Closure of the AV Valves

(Triscuspid and Mitral)

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12
Q

What signifies the second heart sounds?

A

Closure of Aortic and Pulmonic Valves

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13
Q

When does the majority of blood ejection from the LV happen?

A

Phase 3: Rapid Ejection

  • Aortic and Pulmonic valves open, AV valves stay closed
  • About 70% ejected
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14
Q

How much does Atrial Kick contribute to Ventricular Filling?

A

About 10%

  • At Higher HR, atrial kick up to 40%
  • In A-Fib, atrial kick is 0%
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15
Q

4 Major Determinants of Cardiac Output

A

Heart Rate, Contractility, Preload, and Afterload

CO = HR x SV

SV = EDV - ESV

EF = SV
EDV

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16
Q

How can Stroke Volume normally be increased?

A

Increase End Diastolic Volume (EDV)

OR

Decrease End Systolic Volume (ESV)

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17
Q

What is the Bowditch Effect?

A

Autoregulation - Increase in heart rate will cause Positive Intropy

AKA: Treppe Effect/Staircase Phenomenon

Due to Na/K ATP pump unable to keep up with influx of NA at higher rates –> more intracellular calcium.

18
Q

Why do extremely high heart rates result in decreased Cardiac Output?

A

Decreased Stroke Volume due to decrease filling time –> decreases End Diastolic Volume

19
Q

The name of the phenomenon where Preload increases and Cardiac Output increases

A

Frank-Starling Mechanism - Upward curve shift

20
Q

As PRELOAD decreases, CARDIAC OUTPUT decreases. This is called?

A

Frank-Starling Mechanism - Downward curve shift

21
Q

What keeps the CARDIAC OUTPUT of the ventricle matched with venous return?

A

Frank-Starling Relationship - Stretching of the ventricle results in increased force of contraction

22
Q

What keeps the CARDIAC OUTPUT of the right and left ventricles matched?

A

Frank-Starling Mechanism

23
Q

Factors that Affect Ventricular Preload (7)

A
  • Venous BP
  • Venous Volume
  • Filling Time (HR)
  • Ventricular Compliance
  • Atrial Contraction
  • Inflow/Outlfow Resistance
  • Ventricular Systolic Failure
24
Q

What is the Frank-Starling Relationship?

A

Increases venous return, ventricular filling, and preload leads to increased stroke volume

25
Q

What is the Y-Axis of the Starling Curve?

A

Stroke Volume

26
Q

What is the X-Axis on the Starling Curve

A

Left Ventricule End Diastolic Pressure (LVEDP)

27
Q

Factors that Cause Increased Afterload

A

Aortic Pressure

Increased SVR

Aortic Stenosis

Ventricular Dilation

28
Q

How does After Load effect Cardiac Output

A

Increase in Afterload decreases Cardiac Output

29
Q

Does ventricular wall hypertrophy have more of less wall stress?

A

⇣wall stress/afterload on individual fibers because there are more parallel fibers to share the stress.

Think of it as an adaptive mechanism, by which the ventricle is able to offset the ⇡ in wall stress that is associated with ⇡ ventricular systolic pressures or ventricular dilation.

30
Q

Wall stress can be used to help understand what determinant of Cardiac Output

A

Afterload > a more exact definition is wall stress during LV ejection

Bigger left ventricle the greater its radius, the more wall stress

At any given radius (LV size) the greater the pressure developed by the left ventricle, the greater the wall stress

31
Q

What is Contractility?

A

Capacity of myocardium to contract independently of changes in afterload or preload

32
Q

What is another name for Contractility?

A

Inotropy

33
Q

What is the Anrep Effect?

A

Modest increase in inotropy after an abrupt increase in afterload

34
Q

When are S4 heart sounds produced?

A

Sometimes heard during atrial contraction - vibration of ventricular wall with reduced compliance

35
Q

Phase 2: Isovolumic Contraction

A

All Valves Closed

QRS - Ventricular Depolarization

Rise in Ventricular pressure, but volumes stays the same

36
Q

Phase 4: Reduced Ejection

A

T Wave - Ventricular Repolarization

37
Q

When would an S3 sound be produced?

A

Not normal. May happen during Rapid refilling - tensing of chordae, tendinae and AV ring.

also known as the “ventricular gallop,” occurs just after S2 when the mitral valve opens, allowing passive filling of the left ventricle. The sound is actually produced by the large amount of blood striking a very compliant left ventricle.

38
Q

Phase 7: Diastasis

A

Reducing Ventricular Filling

39
Q

What is the most important mechanism regulating inotropy?

A

Autonomic Nerves

  • Sympathetic nerves have big role in intropic regulation.
  • Parasympathetic have big negative inotropic effects in atria, but little in ventricles.
40
Q

What valve closes at the dicrotic notch?

A

Aortic Valve

Z. CV FINAL (11 decks)

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