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Medicine II > Cardiac Physiology and Lymphatics > Flashcards

Cardiac Physiology and Lymphatics Flashcards

1
Q

What does the circulatory system deliver?

A

Oxygen, nutrients, hormones, immune cells, other substances

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2
Q

What does the circulatory system remove?

A

Waste products via lungs, kidneys, digestive tract

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3
Q

What circulatory structures are involved in plumbing?

A

heart wall, chambers of the heart, heart valves, great vessels, peripheral vascular

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4
Q

What are the functions of the circulatory structures?

A

control blood flow and maintain intercardiac pressures

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5
Q

What is the epicardium?

A

smooth surface against pericardial sac, lessens friction

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6
Q

What is the myocardium?

A

cardiac muscle/myocytes, varying thickness

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7
Q

What is the endocardium?

A

continuous with the endothelium lining vasculature

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8
Q

What are the 3 layers of the heart enclosed in?

A

pericardium

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9
Q

What is the pericardium?

A

double-walled sac that prevents heart displacement, physical barrier for infection and inflammation, protection

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10
Q

How much pericardial fluid is in the pericardium?

A

20 mL

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11
Q

What does pain and mechanoreceptors cause?

A

changes in blood pressure and heart rate

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12
Q

The right atrium and right ventricle have ____ pressure going to the _____.

A

low, lungs

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13
Q

The left atrium and left ventricle have ____ pressure that is _____.

A

high, systemic

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14
Q

What is the thickest myocardium?

A

left ventricle

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15
Q

The left ventricle pumps against ____ resistance of____ mm Hg.

A

most, 92

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16
Q

The right ventricle is ____, pumping against ___ mm Hg.

A

thinner, 15

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17
Q

______ have thinnest walls with ____ ____ resistance to pump against.

A

Atria, very little

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18
Q

Right heart receives ______ blood from _____ and ______ vena cava.

A

deoxygenated, superior, inferior

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19
Q

Blood leaves the right ventricle through ____ artery (branches from L and R).

A

pulmonary

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20
Q

Oxygenated blood back to left atrium through __________.

A

4 pulmonary veins

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21
Q

Oxygenated blood leaves left ventricle into the aorta.

A

aorta

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22
Q

What are the 4 main valves that ensure one way flow and pressure gradients?

A

2 atrioventricular valves and 2 semilunar valves

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23
Q

Which AV valve has the largest diameter?

A

right (tricuspid) valve

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24
Q

What makes up one cardiac cycle?

A

ventricular contraction (systole) + relaxation (diastole)

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25
Q

What is diastole?

A

relaxation of the heart, allowing the heart chambers to fill

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26
Q

What is systole?

A

propels blood into pulmonary and systemic circulation

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27
Q

Ventricles have _____ pressures in systole than atriums do.

A

higher

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28
Q

What supplies blood to the left atrium and lateral wall of left ventricle?

A

circumflex artery

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29
Q

Coronary arteries are ____ in women.

A

smaller

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30
Q

What are collateral arteries?

A

connections between branches of same coronary artery or connections with left and right CAs

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31
Q

How do new collateral arteries form?

A

in response to shear stress (inc blood flow speed near stenosis) or production of growth factors and cytokines

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32
Q

What do collateral arteries do?

A

arterio/angiogenesis, supplying blood and oxygen to myocardium that has become ischemic following stenosis of 1 or more coronary arteries

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33
Q

Alterations of cardiac muscles affect blood flow in the _____.

A

capillaries

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34
Q

Ventricular hypertrophy causes _____ oxygen delivery.

A

decreased

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35
Q

Veins drain cardiac circulation into visceral pericardium and then into _________ and _______ on posterior heart.

A

great cardiac vein, coronary sinus

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36
Q

What do arterial vessels and veins both have?

A

tunica intima (innermost), tunica media (middle), tunica externa (outermost)

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37
Q

Tell me about arterial vessels.

A

thick-walled, pulsating, carries blood away from heart

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38
Q

What are elastic arteries?

A

They have thick tunica media and are located close to heart. They stretch and recoil to maintain blood pressure.

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39
Q

What are muscular arteries?

A

medium and small arteries further from heart, distribution and blood flow control, vasoconstriction and vasodilation of lumen

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40
Q

Tell me about veins.

A

thin walled, larger diameter, more numerous, do not recoil as much or as rapidly after distension

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41
Q

Valves facilitate _____ flow.

A

one-way

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42
Q

What is the endothelium?

A

blood vessel lining, sometimes considered a separate endocrine organ

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43
Q

What are the functions of the endothelium?

A

substance transport, coagulation, anti-thrombogensis, fibrinolysis, immune function, tissue and vessel growth, wound healing, contraction and relaxation of vessels

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44
Q

When endothelial damage or dysfunction occurs, we see most common and serious cardio disorders such as ________ and _____.

A

hypertension, atherosclerosis

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45
Q

What is the body’s natural pacemaker?

A

sinoatrial (SA) node

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46
Q

What is the process of action potentials?

A

action potentials –> electrical impulses –> intracellular process= muscle shortening/contraction (systole)

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47
Q

Between action potentials, muscles relax known as _____.

A

diastole

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48
Q

Do action potentials move fast or slow?

A

fast, organized and sequential firing (atria first, then ventricles)

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49
Q

The heart has sympathetic and parasympathetic wiring but can function in absence of those known as _____.

A

automaticity

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50
Q

What happens during Phase 0 of action potential?

A

Na+ influx, depolarization

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51
Q

What happens during Phase 1 of action potential?

A

K+ influx, inactive Na+ channels, slight repolarization

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52
Q

What happens during Phase 2 of action potential?

A

plateau, Ca2+ influx, slows repolarization

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53
Q

What happens during Phase 3 of action potential?

A

dec in Ca2+, inc in K+ efflux, repolarization

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54
Q

What happens during Phase 4 of action potential?

A

resting membrane potential

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55
Q

Which branch of autonomic nervous system is fight and flight?

A

sympathetic

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56
Q

Which branch of autonomic nervous system is rest and digest?

A

parasympathetic

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57
Q

Cardiac innervation consists of ____ and _____ nerves.

A

sympathetic, parasympathetic

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58
Q

What are sympathetic nerves?

A

increases electrical conductivity and the strength of myocardial contraction

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59
Q

What are parasympathetic nerves?

A

slows conduction of action potentials through heart and reduces strength of contration

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60
Q

Stimulation/agonism of B1 and B2 adrenergic receptors…

A

increases heart rate (chronotropy) and force of myocardial contraction (inotropy)

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61
Q

Positive chronotropy= _______ heart rate, negative chronotropy= _____ heart rate

A

increased, decreased

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62
Q

Positive inotropy= _______ force of contraction, negative inotropy= _____ force of contraction

A

increased, decreased

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63
Q

What is the function of B3 receptors?

A

dec myocardial contractility (neg inotropic effect), may provide “safety mechanism” to prevent overstimulation of heart by sympathetic nervous system

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64
Q

Norepinephrine binds with a1 receptors in ____ and _______ arteries for smooth muscle contraction and vasoconstriction.

A

systemic, coronary

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65
Q

Norepinephrine binds with a2 receptors in ____ and _______.

A

brain (modulates sympathetic outflow), periphery (controls sympathetic tone)

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66
Q

What factors affect heart rate?

A

autonomic innervation, hormones, fitness levels, age

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67
Q

What factors affect stroke volume?

A

heart size, fitness levels, gender, contractility, duration of contraction, preload (EDV), afterload (resistance)

68
Q

Stroke volume=

A

EDV-ESV

69
Q

Cardiac output=

A

HR x SV

70
Q

What is the average heart rate in healthy adults?

A

60-80 bpm

71
Q

What is stroke volume?

A

volume of blood pumped out of left ventricle per contraction

72
Q

What is end-diastolic volume?

A

during diastole, volume of ventricles inc from 70-120 mL

73
Q

What is end-systolic volume?

A

volume of blood remaining in the ventricle after systole (usually 40-50 mL)

74
Q

What is cardiac output?

A

the volume of blood flowing through either the systemic or pulmonary circuit (L/min)

75
Q

What is normal cardiac output at rest?

A

5 mL/min

76
Q

What is ejection fraction?

A

EF= SV/EDV, %, indicator of ventricular function, normal is 66% for women and 58% for men

77
Q

What is preload?

A

volume inside the ventricle at end of diastole, same as ventricular EDV and ventricular EDP

78
Q

What 2 primary factors determine preload?

A

amount of venous return to ventricle, blood left in ventricle after systole or end-systolic volume

79
Q

When preload exceeds physiologic range, further muscle stretching causes a ______ in ______.

A

decline, cardiac output

80
Q

When is preload increased?

A

hypervolemia, regurgitation of cardiac valves, heart failure

81
Q

What is the Frank-Starling Law of the heart?

A

volume of blood at end of diastole, major way that RV and LV maintain equal minute outputs despite stroke (beat) output variation

82
Q

Myocardial stretch determines the force of _______ __________.

A

myocardial contraction (more stretch= inc force of contraction)

83
Q

What is Laplace’s Law?

A

contractile force within a chamber depends on radius of chamber and thickness of its wall

84
Q

Smaller chambers and thicker chamber walls equals ______ contraction force.

A

increased

85
Q

In ventricular dilation, the force needed to maintain ventricular pressure _______ available contractile force.

A

lessens

86
Q

What is afterload?

A

resistance to ejection during systole

87
Q

______ is a good index of afterload for the left ventricle.

A

aortic systolic pressure

88
Q

Decreased afterload means

A

heart contracts more rapidly

89
Q

Increased afterload means

A

slow contractions and increased workload

90
Q

Volume of blood ejected during systole increases with increase in _________.

A

contractility

91
Q

What determines the force of the contraction?

A

changes in stretching of ventricular myocardium caused by changes in ventricular volume (preload), alterations in nervous system input to ventricles, adequacy of myocardial oxygen supply

92
Q

What are positive inotropic agents?

A

inc force of contraction: norepinephrine, epinephrine

93
Q

What are negative inotropic agents?

A

dec force of contraction: acetylcholine released from vagus nerve

94
Q

Hypoxia ___________ contractility.

A

decreases

95
Q

What is arterial blood pressure?

A

reflects ejection of blood from LV into aorta

96
Q

What is pulse pressure?

A

difference between systolic and diastolic pressure

97
Q

What is mean arterial pressure (MAP)?

A

average arterial pressure throughout one cardiac cycle, systole, and diastole

98
Q

MAP=

A

DP+ 1/3 (SP-DP)

99
Q

What is pressure?

A

force exerted on a liquid per unit area

100
Q

What is resistance?

A

opposition to blood flow, increases with turbulence (think: plaques)

101
Q

_____ and _______ contribute to resistance.

A

diameter, length of blood vessels

102
Q

What is velocity?

A

the distance blood travels in a unit of time

103
Q

Thick fluids move more ______ and cause ________ resistance to flow than thin fluids.

A

slowly, greater

104
Q

High hematocrit _______ flow through blood vessels.

A

reduces

105
Q

What is vascular compliance?

A

increase in volume a vessel can accommodate for given an increase in pressure

106
Q

_____ is the opposite of compliance.

A

stiffness

107
Q

______ are more compliant than arteries.

A

veins

108
Q

What is laminar flow?

A

occurs when concentric layers of molecules move “straight ahead”

109
Q

What is turbulent flow?

A

occurs where flow is obstructed, vessel turns, or blood flows over rough surfaces, producing a murmur

110
Q

What is vasoconstriction?

A

occurs via chemicals or neurotransmitters such as endothelin

111
Q

What is endothelin?

A

powerful vasoconstrictor found in vascular endothelium

112
Q

What is vasodilation?

A

occurs via chemicals or neurotransmitters such as nitric oxide, histamine, kinins

113
Q

What is nitric oxide?

A

secreted by endothelial cells, keeps vessels open

114
Q

Vascular smooth muscle cells produce

A

vasoconstriction or dilation of blood vessels

115
Q

Depolarization depends on

A

extracellular calcium entering through calcium channels

116
Q

Sympathetic nervous system control of smooth muscle occurs by

A

opening or closing of calcium channels

117
Q

Alpha-adrenergic receptors are

A

excitatory

118
Q

When alpha-adrenergic receptors are stimulated, it causes channels to ___ and cause _______ .

A

open, vasoconstriction

119
Q

Beta-adrenergic receptors are

A

inhibitory

120
Q

When beta-adrenergic receptors are stimulated, it causes channels to ___ and cause _______ .

A

close, vasodilation

121
Q

Organs and tissues can regulate their blood flow based on ______ needs.

A

metabolic

122
Q

What is autoregulation?

A

local control mechanism that automatically adjusts tissue blood flow independent of systemic factors

123
Q

Blood flow to kidneys, heart, and brain remains constant over wide range of BP because the organs __________.

A

adjust to BP

124
Q

What is metabolic control of autoregulation?

A

smooth muscle contraction and relaxation occur in response to local tissue factors like lack of oxygen, inc hydrogen, excess CO2, lactic acid

125
Q

When the local tissue factors are released, what happens?

A

immediate vasodilation of arterioles serving metabolically deprived tissues

126
Q

What is a function of endothelial cells?

A

to produce factors that affect the relaxation or contraction of arterial wall

127
Q

What is the most important endothelial cell?

A

nitric oxide

128
Q

Tell me about nitric oxide.

A

released continuously in body, can be released due to stress on endothelium, inhibits platelet aggregation, can be stimulated by endothelial agonists (acetylcholine, bradykinin, histamine, thrombin)

129
Q

What is humoral control of blood flow?

A

involves effect of vasodilator and vasoconstrictor substances in blood

130
Q

What are norepinephrine and epinephrine?

A

vasoconstrictor hormones released from sympathetic nerve endings

131
Q

What is angiotensin II?

A

powerful vasoconstrictor produced in the RAAS, increased PVR/BP

132
Q

What is histamine?

A

powerful vasodilator, acts on arterioles, derived from mast cells in injured tissues

133
Q

What is serotonin?

A

released from aggregating platelets during clotting process, vasoconstriction and plays role in control of bleeding

134
Q

What is bradykinin?

A

released from globulin kininogen, powerful vasodilation of arterioles

135
Q

What are prostaglandins?

A

synthesized from parts of the cell membrane, released in response to tissue injury, produce vasodilation and constriction

136
Q

What are baroreceptors?

A

chemosensitive cells that respond to changes in pCO2 and pO2 and pH levels (hydrogen ion) to regulate BP

137
Q

What is atrial natriuretic peptide (ANP)?

A

hormone secreted by atria of the heart in response to stretch

138
Q

How does ANP lower blood pressure?

A

causes vasodilation and stimulates kidneys to excrete more water and Na+ (lowers BP by reducing blood volume)

139
Q

When is ANP increased significantly?

A

in exacerbations of heart failure since it is trying to get rid of extra fluid with limited success

140
Q

What does the renin-angiotensin-aldosterone system of the kidneys regulate?

A

blood volume

141
Q

In response to decreased blood pressure or fluid volume, the _______ cells in the kidneys secrete ____ into the blood.

A

juxtaglomerular, renin

142
Q

Renin converts the plasma protein angiotensinogen into _____.

A

angiotensin I

143
Q

How is angiotensin I converted to angiotensin II?

A

by enzymes like angiotensin converting enzyme ACE from lungs

144
Q

What does angiotensin II do?

A

constricts blood vessels throughout the body (raising blood pressure by increasing resistance to blood flow)

145
Q

Constricted blood vessels ____ the amount of blood delivered to the kidneys. This ______ kidneys’ potential to excrete water.

A

reduce, decreases

146
Q

BP is raised by ______ blood volume.

A

increasing

147
Q

Angiotensin II also stimulates ______ to secrete aldosterone.

A

adrenal cortex

148
Q

What is aldosterone?

A

a hormone that reduces urine output by increasing retention of H2O and Na+ by the kidneys, raises blood pressure by inc blood volume

149
Q

What is another name for vasopressin?

A

antidiuretic hormone

150
Q

Vasopressin is released from the _______ when BP or volume is down.

A

posterior pituitary gland

151
Q

How does vasopressin raise blood pressure?

A

It stimulates the kidneys to retain H2O (inc blood volume).

152
Q

Vasopressin is secreted when we have increased body fluid _____. It will ____ hepatic vasculature over short-term in another attempt to ____ BP.

A

osmolality, constrict, increase

153
Q

How does nicotine affect blood pressure?

A

It raises BP by stimulating sympathetic neurons to inc vasoconstriction and by stimulating the adrenal medulla to inc secretion of epinephrine and norepinephrine.

154
Q

How does alcohol affect blood pressure?

A

It lowers BP by inhibiting vasomotor center (causing vasodilation) and by inhibiting the release of ADH (inc H2O output, which dec blood volume).

155
Q

Increased blood volume=

A

inc BP (to a point), arterioles and vessels will constrict to protect end organ –> leads to high PVR and BP

156
Q

If BP is rising…

A

baroreceptors stretch> inc central activity (inc impulses to brain)> inc parasympathetic signals > dec sympathetic signals> slows HR > vasodilation occurs > dec BP

157
Q

Tell me about short term (acute) control of blood flow.

A

regulate blood vessel diameter, change HR, change contractility (usually done through neural or hormonal means)

158
Q

Tell me about long term (chronic) control of blood flow.

A

regulate blood volume (usually done via kidney)

159
Q

The ____ system is considered part of the circulatory system.

A

lymphatic

160
Q

____ of fluid filters out of venous capillaries, carried by lymphatic vessels to chest to enter venous circulation.

A

~3L

161
Q

What is the lymph system?

A

pumpless system (valves ensure one-way flow), contains mostly water, some proteins, lymphocytes, and antigen-presenting cells

162
Q

What is the role of the lymphatic system?

A

immune function, fluid balance, transport of lipids, hormones, and cytokines

163
Q

____ and _____ drain into the R and L subclavian veins.

A

R and L lymphatic ducts

164
Q

What is the primary role of lymph nodes?

A

filtration

165
Q

What else are lymph nodes involved in?

A

phagocytosis, delivery of lymphocytes

Medicine II (5 decks)

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