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Physiology > Cardiac Lecture #3 > Flashcards

Cardiac Lecture #3 Flashcards

1
Q

major side effect from all valvular abnormalities on the left side

A

pulmonary edema

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2
Q

normal pressure of the left atrium

A

5

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3
Q

normal left ventricular diastolic pressure

A

5

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4
Q

what happens during mitral stenosis

A
  • narrowing of the mitral valve

- cannot get blood from atria to ventricle

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5
Q

in mitral stenosis, the aortic pressure is increased or decreased

A

decreased

-no blood to pump out

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6
Q

in mitral stenosis, the left atrial pressure is increased or decreased

A

increased

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7
Q

in mitral stenosis, is pre-load increased or decreased

A

decreased pre-load

-less stretch in left ventricle

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8
Q

in mitral stenosis, is cardiac output/ stroke volume increased or decreased

A

decreased

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9
Q

valve disease where blood backs left atrium from the left ventricle

A

mitral valve regurgitation

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10
Q

what happens during mitral valve regurgitation

A
  • valve is prolapsed
  • blood goes back into left atrium
  • left atrium expands
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11
Q

in mitral valve regurgitation, is left ventricular systolic pressure increased or decreased

A

decreased

-blood has 2 places to go

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12
Q

in mitral valve regurgitation, is there an increase/decrease in preload/ afterload

A

increase in pre-load

-more blood backs up into left atrium, more blood for diastolic filling

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13
Q

in mitral valve regurgitation, is the diastolic pressure increased or decreased

A

increased

-more blood in diastole increases pressure

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14
Q

in mitral valve regurgitation, will aortic pressure increase or decrease

A

decrease

  • less blood being pumped out through aorta
  • decreased CO
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15
Q

what happens during aortic stenosis

A

narrowing of the aorta

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16
Q

in aortic stenosis there is an increase/ decrease in afterload/ preload

A

increase in afterload

-increased pressure the left ventricle has to pump against

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17
Q

in aortic stenosis, cardiac output is increased/ decreases

A

decreased

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18
Q

severe side effect of aortic stenosis

A

hypertrophy

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19
Q

in aortic stenosis is BP increased or decreased

A

decreased

-low CO and stroke volume because blood cannot get through

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20
Q

in aortic stenosis is the left ventricular pressure increased or decreased

A

increased due to increased afterload

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21
Q

in aortic stenosis is left ventricular diastolic pressure increased or decreased

A

increased because more blood left in ventricle during diastole

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22
Q

what happens in aortic regurgitation

A

blood flows back from the aorta into the left ventricle

-chamber dilation

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23
Q

in aortic regurgitation, is there an increase/ decrease in afterload/preload

A

increase in pre-load

-increased stretching of the left ventricle due to increase in back flow of blood

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24
Q

in aortic regurgitation, is SV increased or decreased

A

increased

-more preload = bigger ST= bigger contraction

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25
Q

in aortic regurgitation, will systolic pressure in the aorta and ventricle be increased or decreased

A

increased

-pre-load increases pulse pressure

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26
Q

in aortic regurgitation will aortic diastolic pressure be increased or decreased

A

decreased

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27
Q

in aortic regurgitation, is ventricular diastolic pressure increased or decreased

A

increased

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28
Q

when is mitral valve regurgitation heard

A

ventricular systole

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29
Q

when is mitral valve stenosis heard

A

ventricular diastole- end

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30
Q

when is aortic stenosis heard

A

ventricular systole

31
Q

when is aortic regurgitation heard

A

ventricular diastole

32
Q

heart condition that results in a dilated ventricle and weak thin walls

A

dilated cardiomyopathy

33
Q

3 problems with dilated cardiomyopathy

A
  1. weakened enlarged portion of the heart
  2. Low ejection fraction
  3. increased systolic and diastolic volumes
    - increase in ANP and BNP
34
Q

heart condition that results in increase in size of heart muscle

A

pathological cardiac hypertrophy

35
Q

another name for pathological cardiac hypertrophy

A

heart failure with preserved ejection fraction (diastolic HF)
-stroke volume is low but chamber volume is also low

36
Q

what is the cause of pathological cardiac hypertrophy

A

increased afterload; aortic stenosis

37
Q

5 problems with pathological cardiac hypertrophy

A
  1. small chamber size due to inward growth of muscle
  2. concentric hypertrophy
  3. release of ANP and BNP released due to increased stretch of ventricle and want to decrease BP
  4. decreased SV
  5. arrythmias from slow relaxation
38
Q

after an MI, what content does the damaged cardiac myocyte release into the blood FIRST

39
Q

after an MI, what content does the damaged cardiac myocyte leak into the blood LAST

40
Q

conduction where blood gets trapped between the endothelium and the blood vessel

A

coronary artery dissection

41
Q
  1. problems with coronary artery dissection
A
  1. blood trapping
  2. hematoma can get so big that it occludes blood flow
  3. clotting
42
Q

systolic heart failure is also known as

A

Heart failure with reduced ejection fraction

-SV is low but chamber volume is high

43
Q

2 changes in cardiac myocytes in heart failure

A
  1. release of ANP and BNP due to chamber stretching

2. lower contractility (cardiac myocytes become weaker)

44
Q

what is the primary cause arrythmias in heart failure

A

change in shape of the ventricle

45
Q

2 things the body does to compensate for MILD heart failure

A

because CO decreases

  1. increase sympathetics to increase HR by baroreceptor
  2. increase RAAS system to increase blood pressure
46
Q

what is the optimal blood pressure in those with hypertension

47
Q

why is blood pressure high in someone with HF?

A
  1. hypertension caused the problem in the first place
  2. decreased CO
  3. activates the sympathetic NS and RAAS system to increase HR and BP
48
Q

what is the main goal of treatment for heart failure

A

decrease sympathetics
decrease the RAAS system
decrease afterload and decrease BP

49
Q

medications used in patients with HFpEF

A
  1. control systolic and diastolic BP
  2. diuretics
  3. beta blockers
  4. ACE inhibitors
  5. ARBS
  6. aldosterone receptor antagonist
50
Q

treatments for HFrEF

A

same as HFpEJ

  1. ARNI
  2. use diuretics as needed with congestive heart failure
51
Q

what is the last effort in HF to prevent shock

A

inotropic agents

52
Q

mechanism of digitalis/ digoxin

A

inotropic agent
inhibits Na+/K+ pump, Increases Ca++ concentration
-slows conduction in the AVnode
-too high can lead to arrhythmias

53
Q

mechanism of dobutamine

A
  • mainly used for LEFT side heart failure
  • can induce vasodilation
  • incraese heart rate and arrythmias
54
Q

mechanism of milrinone

A

-mainly used for RIGHT side heart failure
-phosphodiesterase inhibitor- Increases cAMP
-vasodilation- increases K+ in smooth muscle
increases HR and arrythmias

55
Q

mechanism of levosimendan

A
  • increases suceptibility of Ca++ to Troponin C
  • opens K+ channels- vasodilation
  • does NOT increase HR
56
Q

what are 2 types of hypovolemic shock?

A
  1. hemorrage

2. vomiting/ diahrrea

57
Q

what is a type of cariogenic shock

A

decrease in cardiac pumping ability

58
Q

what 2 types of vasogenic shock

A
  1. septic shock from toxins

2. anaphylactic shock- massive immune response

59
Q

what is a type of sympathetic shock

A

decreased sympathetic motor activity

60
Q

3 reasons for cardiogenic shock

A
  1. MI
  2. arryhthmias
  3. cardiomyopathy
61
Q

side effects of cardiogenic shock

A
  1. reduced CO
  2. weak heart
  3. pulmonary edema
62
Q

3 reasons for hypovolemic shock

A
  1. low blood volume
  2. decreased venous return
  3. decreased cardiac output
63
Q

what are some compensatory mechanisms of hypovolemic shock

A
  1. increase in sympathetic nervous system
  2. baroreceptor reflex
  3. vasoconstriction
  4. induce RAAS system
64
Q

causes of septic shock

A
  1. rupture of GI system
  2. UTI
  3. skin or staph infections
  4. pulmonary infections
65
Q

3 big problems with septic shock

A
  1. system wide blood clots-release of clotting factors
  2. massive systemic vasodilation-release of nitric oxide by monocytes
  3. increase capillary permeability leading to edema
66
Q

treatment for septic shock

A

Angiotension II to treat hypotension

antibiotics

67
Q

problems of anaphylactic shock

A
  1. MABP decreases
  2. antigen-antibody reaction
  3. release of histamines by mast cells
  4. vasodilation
  5. increased capillary permeability= edema
68
Q

treatment for anaphylactic shock

A

norepinephrine will induce vasoconstriction and bronchodilation

69
Q

problems with neurogenic shock

A
  1. loss of vasomotor tone; vasodilation
  2. lose pressure; reduced venous return to the heart
  3. sympathetics are blocked; reduced NE
70
Q

causes of neurogenic shock

A
  1. deep general anesthesia depresses the vasomotor center
  2. spinal anesthesia- block sympathetic outflow
  3. spinal cord damage
  4. brain damage from concussion
71
Q

treatment of neurogenic shock

A

maintain sympathetic nervous system

72
Q

which types of shock reduce cardiac output

A
  1. cardiogenic shock

2. hypovolemic shock

73
Q

which types of shock cause vasodilation

A
  1. anaphylactic shock
  2. neurogenic shock
  3. septic shock

Physiology (6 decks)

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