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BMS 538 > Cardio > Flashcards

Cardio Flashcards

1
Q

<p>T/F Oxygenated blood from the upper body is returned to the heart via the superior vena cava</p>

A

<p>F-oxygen poor blood is returned</p>

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2
Q

<p>What vessel is blood returned to the heart from the upper body?</p>

A

<p>The superior vena cava</p>

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3
Q

<p>What is the normal resting heart rate for a human?</p>

A

<p>70 bpm</p>

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4
Q

<p>What is the normal arterial pressure for a human?</p>

A

<p>120/80 mmHg</p>

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5
Q

<p>What are the normal hemocrit values for a human male and female?</p>

A 
<p>F = 38-46%
M = 40-54%</p>
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6
Q

<p>What is the top number in BP readings?</p>

A

<p>Systolic</p>

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7
Q

<p>What is the bottom number in BP readings?</p>

A

<p>Diastolic</p>

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8
Q

<p>What is hemacrit?</p>

A

<p>The total number of blood cells in the total blood volume</p>

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9
Q

<p>A normal heart shape and size = what?</p>

A

<p>A normal cardiac cycle</p>

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10
Q

<p>What does dialated cardiomyopathy cause?</p>

A

<p>Congestive heart failure (backflow of blood)</p>

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11
Q

<p>What are the three CV system components?</p>

A

<p>1. Heart2. Blood Vessels3. Blood</p>

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12
Q

<p>What does persistant high blood pressure cause?</p>

A

<p>High blood pressure damages the endothelium in the artery causing inflammation. The inflammation causes a plaque formation in the artery. The plaque causes a turbulant blood flow</p>

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13
Q

<p>What is atheroscleric plaque consist of?</p>

A

<p>Lipids, Calcium, Cellular Debris</p>

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14
Q

<p>What is a myocardial infarcation caused by?</p>

A

<p>The fibrous cap in the artery when there is plaque formation breaks and blood flow is hindered causing a heart attack.</p>

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15
Q

<p>What does the plasma contain?</p>

A

<p>WBCs and Platelets</p>

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16
Q

<p>What does coagulation of the blood lead to?</p>

A

<p>Thrombus formation leading to myocardial ischemia or infarcation (zero blood flow)</p>

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17
Q

<p>What is ischemia?</p>

A

<p>Decrease in Blood Flow</p>

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18
Q

<p>Define Hemorrhage</p>

A

<p>You lose the entire RBC including its membrane from the body</p>

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19
Q

<p>Hemolysis</p>

A

<p>RBC membrane ruptures</p>

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20
Q

<p>What can cause Hemorrhage or hemolysis?</p>

A

<p>Trauma, Major Surgery, Hemolytic Anemia or Hemophilia</p>

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21
Q

<p>How is cardiac muscle different than skeletal muscle in a histological sample?</p>

A

<p>Branching of fibers and intercalcated discs (At the tissue level)</p>

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22
Q

<p>What does it mean when we say cardiac muscle is a syncytium?</p>

A

<p>Many cells joined together allowing for fast conduction of action potentials from cell to cell</p>

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23
Q

<p>What does the distinct features of cardiac muscle allow for?</p>

A

<p>Resist fatigue and contract in a corrdinated fashion</p>

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24
Q

<p>What feature of cardiac muscle is important for pumping blood throughout the entire CV system?</p>

A

<p>Rapid, involuntary contraction and relaxion</p>

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25
Q

<p>What is responsible for providing low electrical resistance in cardiac muscle?</p>

A

<p>Intercalcated discs</p>

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26
Q

<p>Describe the pathway of blood to and from the heart</p>

A 
<p>1.Low oxygenated blood -superior vena cava  from upper limbs -inferior vena cava from lower limbs into the right atrium
2. right atrium 
3. tricuspid valve 
4. right ventricle.
5. pulmonary valve
6. pulmonary artery
7. Lungs 
Blood Picks up Oxygen</p>
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27
Q

<p>Where does the blood go after gaining oxygen in the lungs?</p>

A

<p>The pulmonary veins into the left atrium of the heart</p>

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28
Q

<p>Describe blood flow through the heart from the left atrium</p>

A

<p>1. Left atrium2. Mitral Valve (Bicuspid)3. Left Ventricle4. Aortic Valve5. Aorta6. Circulation</p>

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29
Q

<p>Define cardiac cycle</p>

A

<p>The sequence of events that occur during systole and diastole</p>

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30
Q

<p>Define Systole</p>

A

<p>Cardiac muscle contracts and pumps blood from the ventricles into the arteries (Blood leaves the heart)1st phase</p>

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31
Q

<p>Define Diastole</p>

A

<p>(Ventricle)Muscle relaxes and chambers fillBlood returns to the heart
2nd phase</p>

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32
Q

<p>Where is the heart located?</p>

A

<p>Slightly left and center</p>

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33
Q

<p>what do the coronary arteries supply?</p>

A

<p>Oxygenated blood</p>

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34
Q

<p>Where do electrical impulse begin in the heart?</p>

A

<p>At the Sinus Node</p>

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35
Q

<p>What does the conduction system of the heart do?</p>

A

<p>Keeps your heart pumping in a normal rhythum</p>

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36
Q

<p>On the posterior side of the heart what does low oxygenated blood enter?</p>

A

<p>The coronary sinus</p>

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37
Q

<p>How is the heart able to contract without any extrinic stimulation?</p>

A

<p>Through the intrinsic conduction system</p>

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38
Q

<p>Define the hearts intrinsic conduction system</p>

A

<p>It can be described as a group of specialized cardiac muscle cells in the walls of the heart that sends signals to the heart muscle causing it to contract.</p>

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39
Q

<p>Describe the path of the hearts internal conduction system</p>

A

<p>1. SA node2. Internodal pathways3. AV node4. AV bundle 5. Left and Right bundle branches6. Purkinje fibers to ventricle</p>

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40
Q

<p>What happens at the AV node</p>

A

<p>1. Impulse is delayed2. The delay allows atria to contract before ventricles</p>

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41
Q

<p>Where does the AV bundle take the electrical impulse?</p>

A

<p>Into the Ventricles</p>

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42
Q

<p>Where are the left and right bundle branches located?</p>

A

<p>Interventricular Septum</p>

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43
Q

<p>What is the other name for the sinus node</p>

A

<p>pacemaker node</p>

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44
Q

<p>What is the function of the SA node?</p>

A

<p>Signals the atria to contract</p>

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45
Q

<p>What is the primary function of the AV node?</p>

A

<p>To cause the ventricles to contract</p>

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46
Q

<p>What is the pacemaker potential?</p>

A

<p>Rhythmic discharge of Sinus Atrial nodal fiber</p>

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47
Q

<p>How many discharges are there in a minute at the SA node?</p>

A

<p>70-80</p>

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48
Q

<p>Which has a higher action potential in millivolts, the Sinus nodal fiber or ventricular muscle fiber?</p>

A

<p>Ventricular</p>

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49
Q

<p>What does the AV node do to the impulse conduction?</p>

A

<p>Slows it considerably to allow sufficient time for the atrial depolarization and contraction (systole) before the ventricle</p>

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50
Q

<p>Why don't the purkinje fibers need to discharge as frequently as the AV node?</p>

A

<p>They are located very close to the muscle</p>

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51
Q

<p>What is depolarization?</p>

A

<p>Membrane potential increases Phase 0 -->Fast Na+ channels open, then slow Ca++ open</p>

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52
Q

<p>Describe phase zero of ventricular muscle action potential</p>

A

<p>It is the phase where depolarization occurs and the fast sodium ion channels open and then the slow Calcium ion channels open. There is a sharp increase in membrane potential from negative to positive</p>

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53
Q

<p>Descibe what happens at phase 1 of ventricular muscle action potential</p>

A

<p>Slight repolarization-apex of the graph-K+ channels open</p>

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54
Q

<p>What happens in phase 2 of Ventricular AP?</p>

A

<p>There is a plateau-slower Ca++ channels open, -decreased permeability to K+-Membrane potential decreases but it is still postive</p>

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55
Q

<p>What happens in phase 3 of ventricular AP?</p>

A

<p>Repolarization-more K+ channels open-Membrane potential decreases to about -50</p>

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56
Q

<p>What happens in phase 4 of ventricular ap?</p>

A

<p>Resting membrane potential is acheived-85-95 mV</p>

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57
Q

<p>How long does an action potential take in the ventrcle?</p>

A

<p>about 1.75 second</p>

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58
Q

<p>What does calcium flowing into the cell cause?</p>

A

<p>Coordinated contraction</p>

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59
Q

<p>What does a S-T Segment elevation mean?</p>

A

<p>possible myocardial infarcation</p>

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60
Q

<p>What does the P wave of the ECG coorospond to?</p>

A

<p>Atrial depolarization</p>

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61
Q

<p>What does the QRS complex of the ECG corrospond to?</p>

A

<p>Ventricles depolarizing</p>

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62
Q

<p>What segments of the ECG does an R-R interval include?</p>

A

<p>RSTPQR -a full cycle</p>

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63
Q

<p>What is the Q-T interval on the ECG?</p>

A

<p>QRST</p>

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64
Q

<p>How long is a P-R interval</p>

A

<p>0.16 seconds</p>

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65
Q

<p>What does a T wave on an ECG indicate?</p>

A

<p>When the heart is being primed to relax</p>

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66
Q

<p>How does the heart speed up?</p>

A

<p>The sympathetic nervous system....1. Norepinephrine is released at the synapse2. Sinus node discharge increases3. Impulse conduction rate increases4. Force of contraction into atria and ventricles increases</p>

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67
Q

<p>What system is responsible for the heart rate to slow down?</p>

A

<p>Parasympathetic (Vagus cranial nerve X)</p>

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68
Q

<p>What is released to slow the heart rate?</p>

A

<p>Acetylcholine</p>

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69
Q

<p>What is the SA node and AV junctional fibers innervated by to slow the heart rate?</p>

A

<p>The vagus nerve (X)</p>

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70
Q

<p>When Ach is relased at the SA and AV junctional fibers what occurs?</p>

A

<p>Increased permeability of K+ causing hyperpolarization-rate of conduction impulse decreases-Decrease in force of contraction in atria and ventricles</p>

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71
Q

<p>What do we measure on the Y axis of the cardiac cycle?</p>

A

<p>Volume and pressure (Ventricular and Atrial volume and pressure)</p>

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72
Q

<p>What is the lub sound corrospond to?</p>

A

<p>Systole</p>

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73
Q

<p>What does the Dub sound corrospond to?</p>

A

<p>Diastole</p>

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74
Q

<p>Contraction \_\_\_\_\_\_ the pressure within a chamber</p>

A

<p>Increases</p>

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75
Q

<p>Blood Flows from \_\_\_\_ to \_\_\_\_\_\_ pressure.</p>

A

<p>Higher to Lower</p>

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76
Q

<p>Semilunar valves open when \_\_\_\_\_\_</p>

A

<p>Ventricular pressures are higher than aortic pressure</p>

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77
Q

<p>AV valves \_\_\_\_\_ when atrial pressures are \_\_\_\_\_\_ than ventricular pressure.</p>

A

<p>Open, higher</p>

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78
Q

<p>What is the first heart sound?</p>

A

<p>S1</p>

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79
Q

<p>What is each cardiac cycle initiated in?</p>

A

<p>The SA Node</p>

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80
Q

<p>How do you find the duration of the cardiac cycle?</p>

A

<p>Take the reciprocal of heart rate</p>

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81
Q

<p>What phase is ventricular systole?</p>

A

<p>Phase 1</p>

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82
Q

<p>How long does ventricular systole last?</p>

A

<p>0.3 seconds</p>

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83
Q

<p>What happens during phase 1: Ventricular Systole?</p>

A

<p>1. Isovolumic contraction2. Ventricular ejection</p>

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84
Q

<p>Define ventricular systole</p>

A

<p>Contraction in the ventricular myocardium</p>

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85
Q

<p>What happens during phase 2 of the cardiac cycle?</p>

A

<p>Diastole</p>

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86
Q

<p>What is diastole?</p>

A

<p>Relaxtion of the ventricular myocardium</p>

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87
Q

<p>How long is diastole?</p>

A

<p>0.4 sec</p>

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88
Q

<p>What are the steps in diastole?</p>

A

<p>3. Isovolumeric relaxation4. Rapid inflow5. Diastasis6. Atrial Systole</p>

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89
Q

<p>What is atrial systole?</p>

A

<p>Contraction of the myocardium (rt. and left atria)</p>

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90
Q

<p>How long does atrial systole last?</p>

A

<p>0.1 sec</p>

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91
Q

<p>Why does atrial systole occur during diastole?</p>

A

<p>Some blood volume is being deposited into the ventricles prior to ventricular systole</p>

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92
Q

<p>What happens during isovolumic contraction?</p>

A

<p>First step of Sytole- 1.The ventricular pressure rises rapidly without a change in volume2. All valves are closed</p>

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93
Q

<p>What do you hear during isovolumeric contraction?</p>

A

<p>The AV valves snap shut and you hear the lubb sound (S1)</p>

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94
Q

<p>Which statement about hypovolemia is accurate?AIt is defined as high ECF volumeBIt is caused by low ECF Na+ concentrationCIn response, sympathetic flow to the kidneys is increasedDTo correct it, the Renin-Angiotensin system will be inhibitedSubmit</p>

A

<p>In response, sympathetic flow to the kidneys is increased</p>

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95
Q

<p>An increase in afterload causes stroke volume to</p>

A

<p>Decrease</p>

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96
Q

<p>What does the cardiac cycle refer to?</p>

A

<p>The sequence of events that occur with every heartbeat</p>

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97
Q

<p>What are the two major phases of the cardiac cycle?</p>

A

<p>Systole and Diastole</p>

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98
Q

<p>What does Systole refer to?</p>

A

<p>Ventricular contraction</p>

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99
Q

<p>What does diastole refer to?</p>

A

<p>Ventricular relaxation</p>

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100
Q

<p>Valves open and close according to \_\_\_\_\_\_\_</p>

A

<p>pressure gradients</p>

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101
Q

<p>Contraction \_\_\_\_\_\_\_\_the pressure</p>

A

<p>Increases</p>

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102
Q

<p>Blood flows from \_\_\_\_ to \_\_\_\_\_\_ pressure</p>

A

<p>Higher to lower</p>

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103
Q

<p>Semilunar valves open when Ventricular pressures are \_\_\_\_\_ than aortic pulmonary pressures</p>

A

<p>Higher</p>

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104
Q

<p>AV valves \_\_\_\_\_\_when atrial pressures are \_\_\_\_ than ventricular pressure.</p>

A

<p>Open, higher</p>

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105
Q

<p>How is the cardiac cycle initiated?</p>

A

<p>When the SA node fires(p wave)</p>

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106
Q

<p>What happens to the pressure when contraction begins?</p>

A

<p>Pressure increases in the atrium and blood flows through the AV valve to the ventricle</p>

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107
Q

<p>T/F atrial contraction is responsible for filling the entire ventricle</p>

A

<p>False-it only accounts for a fraction of the filling as the ventricles already have some blood in them.</p>

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108
Q

<p>What causes the AV valves to close?</p>

A

<p>A decrease in atrial pressure</p>

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109
Q

<p>What marks the beginning of systole?</p>

A

<p>Closing of the AV valves (S1 heart sound)</p>

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110
Q

<p>At the beginning of ventricular contraction, are the semilunar valves open?</p>

A

<p>No they are closed and the ventricle contracts in a closed space</p>

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111
Q

<p>What is isovolumetric contraction?</p>

A

<p>Semilunar valves are closed while ventricle contracts, no blood is ejected and pressure in the ventricle is unchanged</p>

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112
Q

<p>When does ventricular ejection start?</p>

A

<p>When ventricular pressures exceed the pressures within the aorta and pulmonary artery</p>

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113
Q

<p>what valves open to allow ejection from the ventricles?</p>

A

<p>pulmonary and aortic</p>

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114
Q

<p>What produces the second heart sound?</p>

A

<p>Closing of the semilunar valves</p>

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115
Q

<p>Where is each cardiac cycle initiated?</p>

A

<p>SA Node</p>

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116
Q

<p>What is phase 1 of the cardiac cycle called?</p>

A

<p>Ventricular Systole</p>

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117
Q

<p>What steps occur during ventricular systole?</p>

A

<p>1. Isovolumic contraction2. Ventricular ejection</p>

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118
Q

<p>What is phase 2 of the cardiac cycle called?</p>

A

<p>Diastole</p>

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119
Q

<p>What steps occur during diastole?</p>

A

<p>3. Isovolumic relaxation4. Rapid inflow5. Diastasis6. Atrial Systole</p>

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120
Q

<p>What happens during atrial systole?</p>

A

<p>More blood is being deposited into the ventricles</p>

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121
Q

<p>What happens to ventricular pressure during step 1 of the cardiac cycle isovolumeric contraction?</p>

A

<p>It rises rapidly without a change in volume</p>

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122
Q

<p>Are the valves open or closed during isovolumic contraction?</p>

A

<p>All 4 are closed</p>

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123
Q

<p>Which heart sound is the loudest?</p>

A

<p>S1 because the pressure is going to be the highest</p>

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124
Q

<p>When the bicuspid valve is closed what is the chordae tendiae and papillary muscles doing?</p>

A

<p>Paillary muscle is contracted and chordae tendinae are taut</p>

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125
Q

<p>What happens to ventricular pressure in step 2 of phase 1 (Ventricular Ejection)?</p>

A

<p>Left ventricular pressure is greater than aortic pressure and the right ventricular pressure is greater than the pulmonary trunk pressure</p>

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126
Q

<p>What valves open during step 2 of phase 1 ,Ventricular Ejection?</p>

A

<p>Semilunar</p>

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127
Q

<p>On the ECG What is happening during the T wave?</p>

A

<p>Ventricular ejection</p>

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128
Q

<p>What is end systolic volume (ESV)</p>

A

<p>The amount of blood remaining in the ventricle after systole (50 ml)</p>

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129
Q

<p>How do you calculate stroke volume?</p>

A

<p>SV = EDV-ESV</p>

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130
Q

<p>What is the stroke volume output into the aorta and pulmonary trunk?</p>

A

<p>70 mL</p>

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131
Q

<p>What happens to aortic pressure during ventricular ejection?</p>

A

<p>It starts increasing during systole after the aortic valve opens</p>

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132
Q

<p>When does aortic pressure decrease during ventricular ejection?</p>

A

<p>Toward the end of the ejection phase</p>

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133
Q

<p>What happens to atrial pressure during ventricular ejection?</p>

A

<p>C wave- there is a slight backflow of blood into the atria</p>

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134
Q

<p>What happens to ventricular volume during isovolumic relaxion?</p>

A

<p>Stays the same</p>

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135
Q

<p>What do the valves do during isovolumic relaxation ?</p>

A

<p>They close (all 4)</p>

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136
Q

<p>What sound do you hear when isovolumic relaxation occurs?</p>

A

<p>S2-the Dupp sound</p>

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137
Q

<p>What is happening when you hear the Dupp sound?</p>

A

<p>Semilunar valves are closing (pressure in the ventricle decreases and blood flows back to the ventricles which closes the semilunar valves</p>

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138
Q

<p>What happens to ventricular volume during the rapid inflow phase of diastole?</p>

A

<p>Increases</p>

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139
Q

<p>What happens to ventricular pressure during the rapid inflow phase of diastole?</p>

A

<p>it is low due to the AV valves being open and rapid ventricular filling and blood flowing continually from the great veins in the atria</p>

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140
Q

<p>How much blood flows directly through the atria into ventricles before atrial systole?</p>

A

<p>80%</p>

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141
Q

<p>What happens to atrial pressure during the rapid inflow phase of Diastole?</p>

A

<p>There is a slow venous return of blood into atria from veins while AV valves are closed</p>

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142
Q

<p>What is a V wave?</p>

A

<p>It is the end of ventricular contraction</p>

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143
Q

<p>What happens to aortic pressure during the rapid inflow phase of diastole?</p>

A

<p>Decreases slowly due to elasticity of the aorta and blood flow to the periphery.</p>

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144
Q

<p>What will you see on the graph during rapid inflow during diastole?</p>

A

<p>An incisura on the aortic pressure due to the sudden cessation of back flow toward the left ventricle</p>

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145
Q

<p>What happens during the diastasis stage of diastole?</p>

A

<p>A small amount of blood passively flows into the ventricles</p>

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146
Q

<p>On an ECG what occurs during diastasis?</p>

A

<p>A P wave</p>

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147
Q

<p>What do you see on an ECG during atrial systole?</p>

A

<p>QRS complex</p>

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148
Q

<p>What happens to ventricular volume during atrial s during atrial systole?</p>

A

<p>Increases by 20% and the end diastolic volume of each ventricle is 120 ml</p>

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149
Q

<p>What is the end diastolic volume of each ventricle?</p>

A

<p>120 ml</p>

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150
Q

<p>What happens to ventricular pressure during atrial systole?</p>

A

<p>It increases slightly</p>

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151
Q

<p>What do you see on the atrial pressure graph during atrial systole?</p>

A

<p>A small wave occurs on the graph due to atrial contraction</p>

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152
Q

<p>During atrial systole that occurs during diastole what is happening?</p>

A

<p>Atria contract and this accounts for 20% of ventricle filling during the cardiac cycle.</p>

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153
Q

<p>What do atria function as during atrial systole?</p>

A

<p>A primer pump or kick that increases ventricular pumping effectiveness by 20%</p>

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154
Q

<p>What happens to aortic pressure during atrial systole?</p>

A

<p>It decreases slightly</p>

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155
Q

<p>During the Ventricular Systole in the isovolumic contraction step, What do the valves do?</p>

A

<p>AV valves close and semilunar valves close</p>

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156
Q

<p>During the Ventricular Systole in the isovolumic contraction step, What do you hear?</p>

A

<p>S1 heart sound (Lubb)Closure of AV valves</p>

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157
Q

<p>During the Ventricular Systole in the isovolumic contraction step, What is the ventricular volume?</p>

A

<p>120ml</p>

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158
Q

<p>During the Ventricular Systole in the isovolumic contraction step, What is ventricular pressure?</p>

A

<p>Rapid increase from 0-90 mmhg</p>

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159
Q

<p>During the Ventricular Systole in the isovolumic contraction step, What is the aortic pressure?</p>

A

<p>80 mmhg</p>

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160
Q

<p>During the Ventricular Systole during Ventricular ejection What do the valves do?</p>

A

<p>AV valves close and semilunar valves open</p>

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161
Q

<p>During the Ventricular Systole during Ventricular ejection What do you see on a ECG?</p>

A

<p>A T wave</p>

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162
Q

<p>During the Ventricular Systole during Ventricular ejection, what is the ventricular volume?</p>

A

<p>ESV=50 mLSV=70 ml</p>

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163
Q

<p>During the Ventricular Systole during Ventricular ejection What is the ventricular pressure?</p>

A

<p>Increases from 90-120 mmhg</p>

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164
Q

<p>During the Ventricular Systole during Ventricular ejection What do the valves do?</p>

A

<p>120 mmhg</p>

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165
Q

<p>During Diastole, During isovolumeric relaxation (Phase 3) What do the valves do?</p>

A

<p>AV valves close and semilunar valves close.</p>

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166
Q

<p>During Diastole, During isovolumeric relaxation (Phase 3) What heart sound do you hear?</p>

A

<p>S2-(Dupp)-semilunar valves closing</p>

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167
Q

<p>During Diastole, During isovolumeric relaxation (Phase 3) What is the ventricular volume?</p>

A

<p>Decreased from previous stage to 50 ml</p>

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168
Q

<p>During Diastole, During isovolumeric relaxation (Phase 3) What is the ventricular pressure?</p>

A

<p>Rapid decrease from 90-0mmhg</p>

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169
Q

<p>During Diastole, During isovolumeric relaxation (Phase 3) What is the aortic pressure?</p>

A

<p>You will see an incisura on the graph and it is 100 mmhg</p>

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170
Q

<p>During Diastole, During Rapid inflow (Phase 4) What do the valves do?</p>

A

<p>AV valves openSemilunar valves close</p>

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171
Q

<p>During Diastole, During Rapid inflow (Phase 4) What is the ventricular volume?</p>

A

<p>50-90 ml</p>

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172
Q

<p>During Diastole, During Rapid inflow (Phase 4) What is the aortic pressure?</p>

A

<p>Decreases from 100-90 mmhg</p>

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173
Q

<p>During Diastole, During Diastasis (Phase 5) What do the valves do?</p>

A

<p>AV Valves open and Semilunar valves close</p>

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174
Q

<p>During Diastole, During Diastasis (Phase 5) What do you see on a ECG?</p>

A

<p>A p wave</p>

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175
Q

<p>During Diastole, During Diastatis(Phase 5) What is the ventricular volume?</p>

A

<p>90-96 ml</p>

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176
Q

<p>During Diastole, During Diastasis(Phase 5) What is the aortic pressure?</p>

A

<p>Decreases 90-85 mmhg</p>

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177
Q

<p>During Diastole, During Atrial systole(Phase 6) What do the valves do?</p>

A

<p>AV valves open and semilunar valves close</p>

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178
Q

<p>During Diastole, During Atrial systole (Phase 6) What do you see on an ECG?</p>

A

<p>QRS complex</p>

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179
Q

<p>During Diastole, During Atrial systole(Phase 6) What is the ventricular volume?</p>

A

<p>Adds 24 ml so EDV = 120 ml</p>

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180
Q

<p>During Diastole, During Atrial systole(Phase 6) What is the ventricular pressure?</p>

A

<p>0 mmhg</p>

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181
Q

<p>During Diastole, During Atrial systole(Phase 6) What is the aortic pressure?</p>

A

<p>Decreases 85 to 80mmhg</p>

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182
Q

<p>What is stroke volume?</p>

A

<p>The amount of blood pumped from each ventricle</p>

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183
Q

<p>What is cardiac output?</p>

A

<p>The amount of blood pumped from each ventricle per minute</p>

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184
Q

<p>What is ejection fraction?</p>

A

<p>How well the heart is pumping, what is the percentage of blood ejected by the ventricles each contraction.</p>

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185
Q

<p>What number does the American heart association use for staging heart failure?</p>

A

<p>Ejection fraction(Normal is 55-60%)</p>

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186
Q

<p>What are three factors that regulate stroke volume?</p>

A

<p>1. Preload2. Afterload3. Contractility</p>

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187
Q

<p>What volume do we want to regulate so there are equal amounts?</p>

A

<p>Ventricular volume</p>

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188
Q

<p>What is the external work of the heart?</p>

A

<p>The work required for normal stroke volume</p>

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189
Q

<p>What is preload?</p>

A

<p>the degree of tension (amt. of stretch) on the myocardium when it begins to contract</p>

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190
Q

<p>What does the frank starling mechanism refer to?</p>

A

<p>Greater stretch on cardiac muscle fibers prior to contraction increases force of contraction (stretching and releasing a rubber band)</p>

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191
Q

<p>What is preload measured as?</p>

A

<p>Measured as End diastolic pressure when ventricle is filled with blood = (EDV)</p>

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192
Q

<p>What is the cause of increased pre-load?</p>

A

<p>Increased stroke volume caused by hypervolemia, Aortic valve stenosis and regurgitation or pulmonary valve stenosis</p>

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193
Q

<p>What are some causes of decreased pre-load (decreased sV)?</p>

A

<p>Atrial FibHemorrhage</p>

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194
Q

<p>What is afterload?</p>

A

<p>The pressure that must be overcome before a semilunar valve can open</p>

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195
Q

<p>During Afterload pressure in the ventricle needs to be \_\_\_\_\_\_pressure in the aorta</p>

A

<p>greater</p>

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196
Q

<p>What causes increased afterload?</p>

A

<p>Decreased stroke volume such as atherosclerosis, hypertension, aortic stenosis</p>

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197
Q

<p>What causes decreased afterload?</p>

A

<p>increased stroke volume such as mitral valve regurgitation (endocarditis)</p>

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198
Q

<p>What does an increased afterload do to the frank starling curve?</p>

A

<p>shifts it down and to the right, which decreases SV (y axis) but increases left ventricular end diastolic pressure (x axis) (LVEDP)</p>

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199
Q

<p>An increase in afterload \_\_\_\_the velocity of fiber shortening</p>

A

<p>decreases</p>

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200
Q

<p>What does the decrease in fiber velocity shortening do to the rate of volume ejection in the ventricle?</p>

A

<p>reduces it so that more blood is left within the ventricle at the end of systole</p>

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201
Q

<p>What are positive inotropic agents?</p>

A

<p>Substances that increase contraction by enhancing Ca2+ inflow during cardiac action potential</p>

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202
Q

<p>What do positive inotropic agents stimulate?</p>

A

<p>The sympathetic nervous system (epinephrine and norepinephrine)</p>

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203
Q

<p>What does digitalis do?</p>

A

<p>Enhances Ca2+ inflow during cardiac action potential for dilated cardiomyopathy</p>

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204
Q

<p>What are negative inotropic agents?</p>

A

<p>substances that decrease contraction by blocking Ca2+ inflow during cardiac action potential</p>

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205
Q

<p>What do inotropic agents inhibit?</p>

A

<p>Sympathetic nervous system (anoxia, acidosis, increased K+ in intersticial fluid)</p>

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206
Q

<p>What does diltiazem do?</p>

A

<p>It is an enhanced Ca2+ blocker for hypertrophic cardiomyopathy</p>

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207
Q

<p>What is dilated cardiomyopathy?</p>

A

<p>Heart cannot contract as well</p>

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208
Q

<p>What is ventricular myopathy?</p>

A

<p>Increase in the size and mass of the right or left ventricle</p>

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209
Q

<p>Is ventricular myopathy always bad?</p>

A

<p>No, in athletes it enables the heart to pump more effectively. It is physiological and not abnormal. It is reversible</p>

210
Q

<p>What are causes of pathogenic ventricular hypertrophy?</p>

A

<p>Ventricle adapting to increased stress either increased volume load (preload) or increased pressure load (afterload)-valve disease-cardiomyopathies-genetic abnormalitiescoronary heart disease</p>

211
Q

<p>What is concentric hypertrophy?</p>

A

<p>Increase in afterload = chronic pressure overload due to chronic hypertension or aortic valve stenosis</p>

212
Q

<p>Does the ventricular radius always change in concentric hypertrophy?</p>

A

<p>it may not</p>

213
Q

<p>What happens to the heart wall in the ventricle in concentric hypertrophy?</p>

A

<p>wall thickness increases and the ventricle is capable of generating greater forces and higher pressures</p>

214
Q

<p>why is ventricle filling compromised in ventricular hypertrophy?</p>

A

<p>compliance is reduced because ventricle is stiffer</p>

215
Q

<p>what is eccentric hypertrophy?</p>

A

<p>there is an increase in preload (a volume increase) and afterload (increase in pressure) which leads to a volume and pressure overload</p>

216
Q

<p>What happens to the ventricular chamber in eccentric hypertrophy?</p>

A

<p>Ventricular chamber radius is increased and wall thickness may increase</p>

217
Q

<p>What is right sided heart failure?</p>

A

<p>A small amount of blood transfers from the pulmonary circulation to the systemic circulation</p>

218
Q

<p>what increases as a result of right sided heart failure.</p>

A

<p>small increase in atrial pressure and a small increase in cardiac output.</p>

219
Q

<p>What happens to systemic circulation in right heart failure?</p>

A

<p>large volume and capitance</p>

220
Q

<p>What are some symptoms of right sided heart failure?</p>

A

<p>Congested liver leading to ascitesJugular vein distensionperipheral distension (sweilling in feet and ankles)</p>

221
Q

<p>What is pulmonary circulation?</p>

A

<p>Only in the lungs-it cannot store a lot of blood. it only has small volume and capitance</p>

222
Q

<p>Why is there jugular distention in right heart failure</p>

A

<p>Blood backs up in the superior and inferior vena cava due to the increased volume and pressure but due to gravity it will be mostly towards the inferior vena cava</p>

223
Q

<p>What happens when there is left sided heart failure</p>

A

<p>A large amount of blood transfers from the systemic circulation into the pulmonary circulation and causes a big increase in left atrial pressure</p>

224
Q

<p>Why is there pulmonary edema in left heart failure?</p>

A

<p>due to the pressure increase in the left atria there will be a backup of blood into the bicuspid valve and then into lungs</p>

225
Q

<p>How could we evaluate for heart failure?</p>

A

<p>Could hear it in the lungs, more shallowradiographyincrease in radioopacity will see fluid (cloudy)</p>

226
Q

<p>What would we see in a echocardiogram in left heart failure?</p>

A

<p>Encarditis-inflammation of the endocardium(lines the valve)</p>

227
Q

<p>What causes inflammation of the endocardium?</p>

A

<p>Bacteria enter the bloodstream during dental procedures, sx, iv drug useBacteria attach to heart valve and there are growths holes and scarringvalves get leakyleaky valves can become fibrotic and calcified causing stiffnessif they are stiff papillary muscles can stretch or tear</p>

228
Q

<p>How are we able to measure the electrical activity in the heart through electrodes?</p>

A

<p>when heart depolarizes and repolarizes electrical currents spread through the body</p>

229
Q

<p>How many leads in bipolar leads?</p>

A

<p>3</p>

230
Q

<p>What is an ECG?</p>

A

<p>A recording of the electrical difference between 2 leads</p>

231
Q

<p>In lead 1 the right arm is</p>

A

<p>positive</p>

232
Q

<p>How are we able to generate an electrical cardiogram?</p>

A

<p>As the heart undergoes depolarization and repolarization the electrical currents that are generated spread both within the heart but also throughout the body.</p>

233
Q

<p>What are the first 3 leads of the 12 lead ecg?</p>

A

<p>1. 1st 3 leads are called the bipolar leads

| 2. The ecg is recording the difference between these 2 leads (rt arm - and left arm +)</p>

234
Q

<p>What are the second type of leads in a 12 lead</p>

A

<p>1. Augmented unipolar leads (a)</p>

235
Q

<p>What does the aVR lead tell us about the heart?</p>

A

<p>hooked up to the right arm and corresponds to the right upper side of the heart. It provides information about the right ventricle outflow tract and basal part of the septum</p>

236
Q

<p>What does the aVL lead correspond to?</p>

A

<p>Left arm and health of lateral wall of the left ventricle</p>

237
Q

<p>What does the aVF lead correspond to?</p>

A

<p>left leg or foot, inferior wall of the left ventricle</p>

238
Q

what leads detect minor electrical abnormailities in the ventricles?

A

Chest or precordial leads

239
Q

What are Chest leads (Precordial leads) very sensitive to?

A

Electrical potential changes underneath the electrode

240
Q

How are the chest leads named?

A

V1, V2, V3, V4, V5,V6

241
Q

What is on the x axis of an ecg?

A

Time

242
Q

What is on the Y axis of an ecg?

A

Voltage

243
Q

What is happening during the p wave?

A

Atrial Depolarization

244
Q

When does the p wave occur?

A

Immediatly before the atrial contraction (they need the electrical signal)

245
Q

What is going on in the heart during the QRS complex?

A

Ventricular depolarization

246
Q

When does the QRS complex occur?

A

Right before ventricle contracts

247
Q

what does the T wave represent?

A

Ventricular repolarization and the ventricles remain contracted until a few milliseconds after T wave ends
Also the atria remain contracted until repolarized

248
Q

what are the waves with negative voltage

A

Q and S

249
Q

What type of voltage do repolarization waves produce?

A

Positive voltage (move away from a positive recording electrode)

250
Q

how long is the P-R interval?

A

0.16 seconds

251
Q

What is the p-r interval?

A

Duration of time between the beginning of the p wave and beginning of QRS wave.

252
Q

what does the P-R interval represent?

A

Time between the beginning of atrial contraction and beginning of ventricular contraction

253
Q

How long is the Q-T interval?

A

0.35 seconds

254
Q

What is the Q-T interval?

A

the duration of time from the beginning of the Q wave to the end of the T wave

255
Q

What does the Q-T interval approximate?

A

Time of ventricular contraction

256
Q

when does the T wave occur?

A

During systole

257
Q

what are the bipolar leads?

A

Lead 1, Lead 2, Lead 3

258
Q

Can you get faulty readings if electrodes are in the wrong spot?

A

yes

259
Q

When does the S-T Segment Begin and End and what does it represent?

A

End of the S wave to the beginning of the T wave
Represents the time when the ventriclar contractile fibers are depolarized during the plateau phase of the action potential

260
Q

What is the R-R interval and what does it represent?

A

R to R heart rate

261
Q

How do you calculate heart Rate?

A

determined with the reciprocal of tthe time interval between each.

262
Q

What is a normal S-T segment?

A

0 millivolts

263
Q

What will you see on the ECG with a myocardial infarcation?

A

ST elevation, myocardial injury due to prolonged ischemia

264
Q

What will you see on the ECG with myocardial ischemia?

A

ST depression-mild ischemia in the apex of the heart which prevents the apex from repolarizing first and T wave inverts

265
Q

What is ischemia?

A

Low blood Flow

266
Q

what is realeased when someone is having a heart attack?

A

troponin

267
Q

What can cause cardiac arrhythemias?

A
  • Abnormal rhythumicity of the pacemaker
  • Shift of pacemaker from the sinus node
  • Blocks at different points in the transmission of the cardiac impulse (Fibrotic tissue)
  • Abnormal pathways of transmission in the heart
  • spontaneous generation of abnormal pulses from any part of the heart
268
Q

Describe a normal sinus rhythum on a ecg.

A

The QRS complexes are normal, evenly spaced and the rate is 60-100

269
Q

What does bracdycardia look like on a ECG and what part of the autonomic nervous system causes this?

A

QRS complexes are normal and evenly space but beat is under 60 bpm

270
Q

What does Tachycardia look like on an ECG?

A

Complexes normal,evenly spaced but rate is over 100 bpm (sympathetic)

271
Q

What happens in an AV block?

A

Impulses through the AV node and Bundle of His are slowed down or blocked

272
Q

What causes a AV block?

A
  1. Ischemia of AV nodal or AV bundle fibers(coronary ischemia)
  2. Compression of AV bundle (scar of calcified tissue)
  3. AV nodal or AV bundle inflammation
  4. excessive vagal stimulation
273
Q

What is a First Degree AV block?

A

impulses from the AV node are delayed but not blocked

-no missed beats

274
Q

What does a first degree AV block look like on an ECG?

A

Prolonged P-R interval

275
Q

What is a Premature Ventricular Contraction?

A

QRS is prolonged (impulse is conducted through muscle)

QRS voltage is high(one side depolarizes ahead of the other)

276
Q

What is the most frequent cause of a-Fib?

A

Atrial enlargement

277
Q

what does A-Fib look like on a ECG?

A

No p wave and no P-R interval

278
Q

What is the treatment for A-Fib?

A

Beta Blockers (Propranlol), Diltiazem, Blood Thinners (Wayfarin, Pradaxa)

279
Q

How does the circulatory system service the needs of the tissues?

A

Transporting
Nutrients
waste products away
hormones

280
Q

What are the components of a large vein? ex) superior vena cava

A

Tunica externa
Tunica intima
Tunica Media
endothelium

281
Q

What makes up the aorta?

A

Elastic artery
Tunica externa
tunica media
Tunica intima made of enternal elastic membrane and endothelium

282
Q

What is a medium size vein made up of?

A

Same as a large vein

283
Q

What is a muscular artery made of?

A

Tunica externa
Tunica media
Tunica interna
Endothelium

284
Q

What is a venule made of?

A

Tunica externa

Endothelium

285
Q

What is an arteriole made of?

A 
Smooth muscle (tunica media)
Basement membrane 
Endothelium
286
Q

How is a fenestrated capillary different from a continous capillary?

A

It has pores

287
Q

which side of the heart is the peripheral circulation?

A

Right

288
Q

Function of arteries?

A

transport blood under high pressure to the tissues

289
Q

Describe special features of arteries

A

strong vascular walls

high velocity flow

290
Q

Arteriole function

A

Control site for blood flow(resistance site of circulation)

291
Q

Special features of arterioles

A

strong muscular walls for dilation

292
Q

Capillary Function

A

Major site of water and solute exchange between blood and tissues

293
Q

Describe a capillary

A

Thin walls with

294
Q

Where does most of the blood circulate?

A

Veins, Venous sinuses, venules

295
Q

What do the pulmonary capillaries do?

A

Site of oxygen and CO2 exchange

296
Q

Veins and Venule function

A

Return the blood to the heart under low pressure,

Reservoir for blood

297
Q

What type of blood vessel has the greatest crossectional area?

A

Capillaries need to get more stuff through their walls in the same amount of time

298
Q

Velocity

A

The speed at which blood flows in the circulation

V=Blood Flow/Crossectional area

299
Q

Velocity of blood flow is the greatest in _____

A

Aorta

300
Q

Velocity of blood flow is _____to vascular crosssectional area

A

inversley proportional

301
Q

Equation for velocity of blood flow

A

v=F/A

velocity = volume of blood flow/crosectional area

302
Q

What vessel has the lowest velocity?

A

capillaries

303
Q

Define Blood Pressure

A

Force exerted by blood against any unit area of vessel wall

304
Q

Where do you find high blood pressure?

A

Arterial Tree

305
Q

What blood vessels have low pressure?

A

Venous Side

306
Q

Where do you find a very large BP drop?

A

Across arteriolar capillary junction

307
Q

What is the basic theory of circulatory function?

A
  1. Blood flow to tissues is controlled in relation to tissue needs
  2. Cardiac Output is controlled by local tissue blood flow
  3. Arterial pressure is controlled independly
308
Q

How is blood flow in the tissues controlled?

A
  1. microvessels monitor need
  2. act on local BP (dilation or constriction)
  3. Also, CNS and hormones help
309
Q

What is Blood Flow?

A

Q

Quantity of blood that passes a given point in the circulation in a given period of time

310
Q

What do the variables mean in the blood flow equation?

A

Q = change in pressure/ Resistance of vessel
Change in pressure = Pressure difference between 2 ends of the vessel
R =

311
Q

What is cardiac output?

A

Overall flow in the circulation of an adult = 5l/min.

312
Q

What is Laminar flow?

A

Blood Flows in streamlines with each layer of blood remaining same distance from the wall

313
Q

Where is the velocity the greatest in laminar blood flow?

A

Center of the vessel Creating a parabolic profile

314
Q

Can you hear laminar flow?

A

No

315
Q

What is turbulant blood flow?

A

It does not flow in a streamline and applies greater force to endothelium causing damage/inflammation

316
Q

What causes turbulant Blood Flow?

A

High velocity
Sharp turns
rough surfaces
rapid narrowing

317
Q

What are bruits?

A

Murmurs and are important for diagnosing vessel stenosis in the carotid artery, vessel shunts, cardiac valvular lesions

318
Q

Decreased blood vessel radius _____vascular resistance and ______blood flow

A

increases
decreases
(poiseuilles)

319
Q

If there is more hemocit then……

A

Blood viscosity goes up and so does vascular resistance

320
Q

Resisance is_____

A

an impediment to blood flow

321
Q

A serial arrangement has______resistance and is found among_____,_____,______,____and _______

A 
increased
Arteries
Arterioles
capillaries
venules
veins
322
Q

What type of arrangement has decreased resistance?

A

parallel

323
Q

Where do you find decreased resistance?

A

Brain
Kidney
Muscle
GI tract

324
Q

What is conductance?

A

Measure of the ease at which blood flows

325
Q

What happens if you remove a kidney?

A

You remove a parallel circuit and decrease vascular conductance and blood flow but increases total peripheral resistance

326
Q

What is vascular distensibility?

A

Fractional increasein volume for each mmHG rise in pressure

327
Q

What is more distensible arteries or veins?

A

Veins (8 times more)

328
Q

What is Capacitance?

A

Vascular compliance-total quantity of blood stored in a given portion of circulation for each mmHG

329
Q

Equation for Distensibility

A

Increase of Volume/(increase in pressure x original volume)

330
Q

What has more compliance (capacitance)?

A

Veins 24 time

331
Q

In the arterial tree changes in volume results in larger ______in pressure than in veins.

A

increases

332
Q

What factors affect pulse pressure?

A

Stroke volume

Arterial compliance

333
Q

when there is an increase in stroke volume there is a _____in pulse pressure

A

increase

334
Q

______in compliance _____pulse pressure

A

Decreases, increases

335
Q

What is a patent ductus arteriosus associated with?

A

Low diastolic pressure and high systolic pressure so an increase in pulse pressure

336
Q

What happens in arteriosclerosis?

A

Decreases compliance of arterial tree which increases pulse pressure

337
Q

If the BP cuff pressure is greater than 120 mmHG what happens?

A

no flow and no sound

338
Q

What cuff pressure do you need for free flow and no sound?

A

80

339
Q

What happens when cuff pressure reaches systolic pressure?

A

tapping sounds called korotcoff in the antecubital artery

340
Q

When should you record diastolic pressure?

A

No sound

341
Q

What are three functions of veins?

A
  1. Blood reservoir (60%)
  2. Central and peripheral venous pressure affects on right atrial pressure
  3. Venous Valves and skeletal muscle pump
342
Q

How is right atrial pressure regulated?

A

a balance between the ability of the heart to pump blood out of the atrium and the rate of blood flowing into the atrium from peripheral veins

343
Q

What factors increase Right Atrial Pressure?

A

Decreased cardiac function (increased blood volume and increased venous tone)

344
Q

When there is an increase inright atrial pressure what happens?

A

Causes blood to back up into the venous system increasing venous pressure and resistance.

345
Q

Why is the venous pressure higher in the feet than the right atrium?

A

Gravitational weight of blood

346
Q

What maintains low venous pressure in the legs?

A

Venous valves and skeletal muscle pump

347
Q

What are varicose veins?

A

increase in venous and capillary pressure causing edema when standing

348
Q

What enhances capillary diffusion?

A

Concentration differences

349
Q

What can diffuse accross a capillary?

A

Lipid soluable substances

350
Q

How do lipid insolable substances cross capillary walls?

A

intercellular clefts

351
Q

What is bulk flow?

A

Move a large amt. of water containing small lipid insolable solutes in the same direction based on net filktration pressure.
Faster than diffusion or osmosis

352
Q

What is bulk flow most important for?

A

Regulation of relative volumes of blood and intersticial fluid

353
Q

Define filteration

A

Bulk flow from arterial end of the capillary into interstitual fluid

354
Q

Define reabsorption

A

Bulk flow from interstitial fluid to venous end of capillary

355
Q

What is a balance of filteration and reabsorption pressure called?

A

net filtration pressure

356
Q

Starlings law of capillaries

A

Volume of fluid and solutes reabsorbed is almost as large as amt. filtered

357
Q

When capillary hydrostatic pressure is greater than blood colloidal osmotic pressure what occurs?

A

Filteration-fluid exits capillary

358
Q

When Capillary hydrostatic pressure is less than blood colloidal osmotic pressure what happens?

A

Reabsorption-fluid reenters capillary

359
Q

what is cardiac Output controlled by?

A

Local Tissue Blood Flow

360
Q

Each tissue Autoregulates its own blood flow in proportion to its ______

A

Metabolic rate or needs

361
Q

What is arterial pressure controlled by?

A

Autonomic nervous system, independent of cardiac output or local blood flow control

362
Q

What factors does blood flow increase or decrease and what is this an example of?

A

Acute control of tissue blood flow

  1. Tissue Metabolic rate
  2. Arterial O2 saturation
  3. Amt. of oxygen and Nutrients present
  4. Accumulation of vasodilator metabolites (Co2, H+, lactic acid)
  5. LAck of other nutrients (glucose, amino acids or fatty acids)
363
Q

Blood flow _____ as tissue metabolism increases.

A

Increases

364
Q

what happens to blood flow when arterial oxygen saturation moves from 100 to 50 %?

A

It increases gradually

365
Q

What happens to blood flow when arterial saturation is 50 % and below?

A

It increases from 1.5 to 3 times the normal rate.

366
Q

When there is an increased demand for oxygen and nutrients what happens to local (tissue) blood flow?

A

It increases

-through local vasodilation and vasoconstriction of arterioles, metarteriole, and pre capillary sphinctors

367
Q

What is a metariole?

A

A metarteriole is a short microvessel in the microcirculation that links arterioles and capillaries. Instead of a continuous tunica media, they have individual smooth muscle cells placed a short distance apart, each forming a precapillary sphincter that encircles the entrance to that capillary bed.

368
Q

what is the term used for precapillary and metarteriole sphincters for controlling capillary blood flow?

A

Vasomotion

369
Q

Does the accumulation of vasodilator metabolites increase or decrease tissue blood flow?

A

increase

370
Q

What are the vasodilator metabolites?

A 
Histamine
Adenosine and Adenosine Phosphate compounds
CO2
H+ ions
K+ ions
371
Q

Define Reactive Hyperemia

A

Occurs after blood supply to a tissue is blocked for a short time

372
Q

What happens during Reactive Hyperemia?

A
  • Blood flow rate increases 4-7X normal after blockage

- Tissue vasodilator metabolites accumulate and hypoxia

373
Q

Define Active Hyperemia-

A

Exercise

374
Q

What happens to blood flow in active hyperemia?

A
  • Blood flow needs to increase to compensate for increased metabolic demand
  • Local tissue metabolism causes accumulation of vasodilator substances
375
Q

What is the result of active hyperemia after the blood flow change?

A

-Local tissue metabolism causes accumulation of vasodilator substances

376
Q

Define Autoregulation

A

Within < 1 minute tissue blood flow returns to normal if arterial pressure is increased or decreased

377
Q

What are the two theories for how blood flow is regulated during changes in arterial pressure

A

!. Metabolic Theory of Autoregulation

2. Myogenic Theory of Autoregulation

378
Q

what happens to arterial pressure in the metabolic theory of autoregulation?

A

-Arterial pressure increases a lot

379
Q

What happens to local blood flow in the metabolic theory of autoregulation and what is the effect?

A

-Blood Flow increases too much as a result of increased arterial pressure
-As a result there is too much O2 and nutrients
This washes out the vasodialtors metalbolites
-Washing out metalbolites causes vasoconstriction and allows normal blood flow despite increased arterial pressure

380
Q

In the myogenic theory of autoregulation what does decreased arterial pressure do to local blood flow?

A
  • They dilate in response to decreased wall tension
  • decreased wall tension decreases vascular resistance
  • this allows blood flow to be maintained at a constant rate
381
Q

What is the formula for Wall tension in the Myogenic Mechanism?

A

Wall Tension (T) = Internal Pressure (P) x Radius (R)

382
Q

How does acute metabolic control of local blood flow work in the kidney?

A

Tubuloglomerular Feedback

383
Q

How does Tubuloglomerular feedback regulate local blood flow in the kidney?

A

-The macula densa detects the composition of fluid in the distal convoluted tubule
-This tells it that GFR has increased as a result of increased blood flow
Since the GFR is increased the macula densa cause the contraction of the afferent arteriole and less blood enters the glomerulas, Pc decreases, and the GFR decreases

384
Q

How does acute metabolic control of local blood flow occur in brain?

A

When there is an increase of CO2 or H+

  • Cerebral Blood Vessels Dilate
  • blood flow increases
385
Q

How does acute metabolic control of local blood flow occur in the skin?

A

When there is an Increase in body temperature
- blood flow increases to 7 to 8 L/min
Body senses this and decreases body temperature

386
Q

What part of the ANS controls skin blood flow when there is an increase in body temp?

A

sympathetic

387
Q

What does blood do to retain heat?

A

Avoid surface of the skin

388
Q

How Does Control of Tissue Blood Flow by Endothelial Derived Relaxing or Constricting Factors work?

A
  • A vasoconstrictor called endothelian is released from a damaged endothelium
  • A vasodilator called nitric oxide is released from healthy endothelial cells
389
Q

What is long term control of blood flow?

A

Slow controlled changes (days to weeks to months) in blood flow

390
Q

How is Long-term control of blood flow achieved?

A

Changes in tissue vascularity

391
Q

How do changes in tissue vascularity control blood flow long term?

A
  1. Increasing the vascularity of tissue- size and number of blood vessels.
  2. Angiogenesis = Development of new blood vessels
392
Q

What is Angiogenesis?

A

Development of new blood vessels

393
Q

when does Angiogenesis occur?

A

Occurs in response to angiogenic (small peptides) factors called vascular endothelial cell growth factors

394
Q

What are angiogenic factors called and what kind of molecule are they?

A

Small peptides called Vascular endothelial growth factors

395
Q

Where are angiogenic growth factors released from?

A
  1. Tissues with High Metabolic Rates
  2. Ischemic Tissues
  3. Rapidly growing tissues or neoplasia
396
Q

what stimulates the regulation of tissue vascularity?

A

Oxygen

397
Q

Describe Acute Blood Flow in terms of increasing mean arterial pressure

A

When mean arterial blood pressure changes from 10 to 50, acute blood flow into the tissues rises from 0 blood flow to 1 x normal, then it rises slowly at mean arterial pressure increases to 200 mmhg. At 200 mmhg, mean arterial pressure blood flow is 1 times the normal flow but when arterial pressure increases from 200 to 250 mmhg, blood flow increases rapidly to 2.5 times normal.

398
Q

What is Humoral Regulation of Blood Flow?

A

Control of blood flow by substances secreted or absorbed into the body fluids

399
Q

What are the vasoconstrictor players in humoral blood flow?

A

Norepinephrine and epinephrine
Angiotensin II
Vasopressin (ADH)
Increase Ca2+

400
Q

What are the vasodilators hormones in humoral blood flow?

A

Bradykinin
Histamine
Increase H+ vasodilation
Increase CO2

401
Q

Describe three functions of nervous system regulation of the circulation

A
  1. Resdistribution of blood flow
  2. Pumping Activity of the Heart
  3. Rapid Control of arterial pressure
402
Q

Where does the sympathetic system increase blood flow?

A
  1. Lungs-pulmonary circulation

2. Heart-Coronary system

403
Q

where does the parasympathetic system increase blood flow?

A
  1. Digestive system

2. Urinary System

404
Q

Does the sympathetic nervous system increase or decrease pumping activity of the heart?

A

Increase

405
Q

Does the parasympathetic nervous system increase or decrease pumping activity of the heart?

A

Decrease

406
Q

How does the sympathetic system control arterial blood pressure?

A

Increases it

407
Q

How does the parasympathetic system control arterial blood pressure?

A

Decreases

408
Q

what does the sympathetic nervous system do to regulate blood flow, heart pumping and arterial pressure?

A

It causes vasoconstriction, cardiac output and heart contractability in times of need

409
Q

what does the parasympathetic nervous system do to regulate blood flow, heart pumping and arterial pressure?

A

Decreases cardiac output and contractability in times of need

410
Q

Where is the vasomotor center located?

A

Medulla Oblongota and lower 3rd of the pons

411
Q

What are the Vasomotor Center components?

A

Vasoconstrictor
Vasodilator
Cardioinhibitor nucleui

412
Q

What does the vasomotor center receive inputs from?

A

Neural inputs directly from the :
baroreceptors
hypothalamus
higher order neural centers throughout the cerebrum

413
Q

Where does the vasomotor center transmits impulses to?

A

the spinal cord

sympathetic nervous system to the blood vessels and heart

414
Q

Where is the distribution of vasoconstrictor fibers the greatest?

A 
Kidneys
Gut
Spleen
Skin
(Distributed throughout all segments of circulation) They are important for autoregulation
415
Q

Why is the vasoconstrictor fiber system less potent or dangerous in the coronary circulation and brain?

A

Heart and Brain are suceptible to not receiving enough blood flow because when the fibers are activated you are going to have ischemia or decreased blood flow and you wouldn’t want this in the brain

416
Q

What do the sympathetic nerve fibers NOT innervate?

A

capillaries, precapillary sphincters, and metarterioles

417
Q

How is vasomotor tone and an increase in vascular resistance acheived?

A

through Innervation of small arteries, arterioles, and large veins by sympathetic nerves. They saw this when injecting patients with neurotransmitter norepinephrine

418
Q

What is the neurotransmitter for the vasoconstrictor nerves and what does it do?

A

Norepinephrine-it constricts the blood vessels through alpha adrenergic receptors

419
Q

How can EPI dilate blood vessels?

A

through a potent Beta2 receptor (decreasing vascular resistance)

420
Q

What is the parasympathetic nervous system important for in terms of regulation of the circulation?

A

Controls heart rate via the Vagus nerve

421
Q

How does vasovagal syncope occur?

A 
Syncope = faint
1. Emotional Stress interpretated by cerebral cortex
2. signal sent to medulla
3. sympathetic output is decreased and vagal output is increased.
     -Decrease of 
     sympathetic output 
     leads to a 
     decrease in total 
     peripheral 
     resistance
  - Increased vagal 
    output leads to a 
    decrease in venous 
    return and 
    decrease in cardiac 
    output 
4.  Decrease in arterial pressure
5. Decrease in cerebral blood flow
6. loss of consciousness
422
Q

How is rapid control of arterial pressure acheived?

A

Through the vasomotor control system:

  1. Constricting large vessels of the circulation thereby increasing venous return and cardiac output
  2. Directly increasing CO by increasing heart rate, stroke volume and contractility
  3. Constricting almost all arterioles of the body increasing total peripheral resistance (TPR)
423
Q

What is a barorecptor?

A

Baroreceptors are spray type nerve endings

424
Q

Where are barorecptors located?

A
  1. Carotid sinus- found at carotid bifurcation

2. Aortic arch

425
Q

What is the significance of the carotid sinus reflex?

A

maintaining normal blood pressure in the brain

426
Q

Where are the signals transmitted in the carotid sinus reflex?

A

Signals from the carotid sinus are transmitted by Hering’s nerve to the Glossopharyngeal nerve and then to the VMC

427
Q

Significance of the Aortic Reflex?

A

maintaining normal general systemic blood pressure

428
Q

Where are the signals transmitted in the aortic reflex?

A

Signals from the arch of the aorta are transmitted through the vagus to the VMC

429
Q

Arterial Baroreceptor reflex significance

A

Important in short term regulation of arterial pressure

430
Q

What is the arterial baroreceptor reflex initiated by?

A

Stretch receptors (baroreceptors)

431
Q

How does the arterial baroreceptor reflex work?

A
  1. Increase in pressure stretches the baroreceptors
  2. signals to VMC
  3. ANS 
  4. circulation  5. decrease arterial pressure back to normal
432
Q

What pressure changes do carotid sinus receptors respond to?

A

changes between 60 and 180 mmHg

433
Q

Baroreceptors reflex is most sensitive at a pressure of ______.

A

100 mmhg

434
Q

As pressure increases the number of impulses from carotid sinus increases-Why?

A

1) Inhibition of vasoconstriction

2) Activation of the vagal center

435
Q

When there is an increase in arterial pressure what will happen?

A

Opposes either increases or decreases in arterial pressure thereby reducing daily variations in arterial pressure

436
Q

When common carotid arteries are constricted what happens to the baroreceptors at the carotid sinus?

A

Pressure decreases resulting in an increase in arterial pressure

437
Q

What is a chemoreceptor?

A

Chemoreceptors are chemosensitive cells sensitive to decreased O2, increased CO2 and H+

438
Q

Where are Chemoreceptors located?

A

located in carotid bodies near the carotid bifurcation and arch of the aorta

439
Q

How are chemoreceptors activated?

A

Decreased O2
Increased CO2
Increased H+

440
Q

What is the result of activated chemosensitive receptors?

A
  1. excitation of the vasomotor center
  2. Increased sympathetic activity
  3. Increased BP
441
Q

Describe the CNS ischemic response

A
  1. Cerebral ischemia occurs
  2. Increase in CO2
  3. VMC activated
  4. increased sympathetic activity
  5. Arterial pressure increases
442
Q

What is one of the most powerful activators of the sympathetic vasoconstrictor system?

A

CNS ischemic response

443
Q

When is the CNS ischemic response activated?

A

when pressure falls below 60 mmhg

-15-20 mmhg greatest activation

444
Q

What happens when CNS ischemia is prolonged?

A

a depressant effect on the vasomotor center

445
Q

What do low pressure receptors do?

A

Low pressure receptors in atria and pulmonary arteries minimize arterial pressure changes in response to changes in blood volume

446
Q

How are low pressure receptors activated?

A

By Increases in blood volume

447
Q

When low pressure receptors are activated what happens?

A

arterial pressure drops

448
Q

How does the activation of low pressure receptors enhance water and Na excretion?

A

Decreasing rate of antidiuretic hormone
Increasing glomerular filtration rate
Decreasing Na+ reabsorption

449
Q

Describe the atrial and pulmonary artery reflexes

A
  1. Blood Volume Increases
  2. Atrial Stretch increases
  3. Renal sympathetic activity drops and atrial natruuretic peptide increases
  4. Sodium and Water excretion increases
  5. Increase in blood volume
450
Q

What does the Bainbridge reflex prevent?

A

damming of blood in veins, atria and pulmonary circulation

451
Q

Describe the bainbridge reflex

A

Stretch of atria sends signals to VMC via vagal afferents to increase heart rate and contractility

452
Q

What does an increase of atrial pressure do to heartrate?

A

Increases it

453
Q

Define Shock

A

Decreased Blood Volume and Decreased Blood Pressure =

Hypovolemic Shock

454
Q

What are the causes of hypovolemic shock?

A
  1. Hemorrhage
  2. GI
    a. Vomiting
    b. Diarrhea
  3. Renal fluid loss
    a. Diabetes mellitus
    b. Diabetes insipidus
    c. Excessive use of diuretics
  4. Cutaneous fluid loss
    a. Burns- direct plasma loss
    b. Perspiration
  5. Intestinal obstruction
455
Q

What is circlatory shock?

A

Decreased cardiac function and decreased venous return

456
Q

What cause decreased cardiac function?

A
  1. Myocardial infarction
  2. Valvular disease
  3. Arrhythmias
  4. Metabolic problems
  5. Myocarditis
457
Q

What causes decreased venous return?

A
  1. Blood volume

2. Vascular tone

458
Q

How does the body respond to shock

A

Disrupts homeostasis:

By decreasing Blood Volume and Pressure

459
Q

What happens to the baroreceptors when Blood Volume decreases along with blood pressure in shock?

A

the baroreceptors in the kidney (juxtaglomerular cells) secrete renin resulting cleaving of angotensenogen to angiotensin II in the blood
2.The baroreceptor in the carotid sinus and aortic arch decrease the rate of nerve impulses causing the hypothalamus and posterior pituitary to release ADH into the blood and cardiovascular center in medulla signals to increase sympathetic stimulation and hormones from the adrenal medulla

460
Q

What happens as a result of more angiotensen II in the blood during shock?

A

Aldosterone is released from the adrenal cortex and blood vessels constrict

461
Q

What happens when there is ADH in the blood?

A

Kidneys conserve salt and water and blood vessels constrict

462
Q

What happens when there is increased sympathetic stimulation and hormone release from the adrenal medulla?

A

Heart rate and contractability increase

463
Q

What does aldosterone release and kidney conservation of salt and water lead to?

A

Increased Blood Volume

464
Q

What does the constriction of blood vessel lead to during shock?

A

Increased systemic vascular resistance

465
Q

What does the increase in heart rate and contratability lead to during shock?

A

increased blood pressure

466
Q

What two things lead to increased blood pressure during shock?

A

Increased blood volume and increased vascular resistance

467
Q

What needs to happen for the body to return to homeostasis during shock?

A

When responses bring blood pressure and volume back to normal

468
Q

What does a patient experience during shock?

A 
Clammy, cool, pale skin (drop in BP)
Tachycardia (Increased sympathetic stim and hormones from adrenal medulla)
Weak and rapid pulse
Sweating
Hypotension
Systolic pressure < 90 mm hg
Altered mental status
Decreased urinary output
Thirst
Metabolic acidosis- Acidosis in shock prevents glycolysis
469
Q

What are the shock characteristics at a cellular level?

A

Cellular membrane dysfunction
Cellular metabolism is abnormal
Cellular death may eventually occur without proper treatment.
Inadequate perfusion
Cells forced to switch to anaerobic respiration  lactic acid increases

470
Q

What are the physical characteristics of blood?

A 
Increased viscosity (thicker) when compared with water
Slower flow rate for blood
pH 7.4 (7.35-7.45)
8 % of total body weight
Blood volume
5 to 6 liters in average male
4 to 5 liters in average female
471
Q

What are the three components and approximate percentages of blood when it is spun down in a centrifuge?

A

55% plasma
45% hematocrit (packed red cell)
<1% Buffy Coat

472
Q

Which blood cells are found in the buffy coat

A

White cells and platelets

473
Q

List the formed elements in blood

A

Platelets
WBCs(Neutrophils,Lymphocytes, Monocytes, Esinophiles, Basophils)
RBCs

474
Q

What are the components of plasma?

A

> 90% Water
7% Plasma Proteins- Produced in the liver, confined to bloodstream
1. Albumin- Maintains blood oncotic pressure
Oncotic pressure, or colloid osmotic pressure, is a form of osmotic pressure exerted by proteins in a blood vessel’s plasma that pulls water into the circulatory system.
2. Globulins (immunoglobulins)- Form antigen-antibody complexes
3. Fibrinogen (soluble)- During the coagulation cascade, there is eventual conversion to insoluble fibrin via thrombin to stabilize the platelet plug.
2% other substances
Electrolytes, nutrients, hormones, gases, waste products

475
Q

Where are plasma proteins made?

A

Liver

476
Q

Where are plasma proteins Confined to?

A

Blood Stream

477
Q

What are the functions of the three plasma proteins?

A
  1. Albumin- Maintains blood oncotic pressure
    Oncotic pressure, or colloid osmotic pressure, is a form of osmotic pressure exerted by proteins in a blood vessel’s plasma that pulls water into the circulatory system.
  2. Globulins (immunoglobulins)- Form antigen-antibody complexes
  3. Fibrinogen (soluble)- During the coagulation cascade, there is eventual conversion to insoluble fibrin via thrombin to stabilize the platelet plug.
478
Q

what is the definition of hematocrit?

A

Percentage of total blood occupied by erythrocytes

479
Q

Why do males have higher hematocrits (hct) than females?

A

Female normal range 38 - 46% (average of 42%)

Male normal range 40 - 54% (average of 46%)

480
Q

What is the definition of anemia?

A

decreased HCT or decreased Hb or both

481
Q

How is anemia classified?

A

Classified based on cell size (micro, macro, normocytic) and amount of hb present (hypo, hyper, normochromasia)

482
Q

What is the definition of polycythemia?

A 
Increased HCT (>65%) or increased Hb or both
Dehydration, tissue hypoxia, blood doping in athletes
483
Q

What is the most common cause of polycythemia?

A

Dehydration, tissue hypoxia, blood doping in athletes

484
Q

Hemoglobin is a globin protein consisting of ___ polypeptide chains with one heme pigment attached to each chain.

A

Hemoglobin is a globin protein consisting of 4 polypeptide chains with one heme pigment attached to each chain.

485
Q

What does each heme contain?

A

Each heme contains Fe2+ that can combine reversibly with one oxygen molecule

486
Q

what does this bind to?

A

oxygen

487
Q

Each hb molecule can carry ___ O2 molecules from lungs to tissue cells.

A

Hemoglobin also transports 23% of total CO2 waste from tissue cells to lungs for exhalation

488
Q

What is HbA1C used to monitor?

A

Used to monitor long-term blood glucose control (3 months) in diabetes type I and II
Measures amount of glycosylated hemoglobin in blood

489
Q

Why is HbA1C more reliable than analyzing trends in daily or weekly blood glucose measurments?

A
  • Measures amount of glycosylated hemoglobin in blood
  • Hemoglobin, like all proteins, link up with sugars- glucose  excess glucose enters the erythrocyte  binds to Hb  Glycosylated hemoglobin. *Excess glucose in the blood = increased glycosylation of hemoglobin
490
Q

How is iron transported in the blood plasma?

A

Transferrin
Transports iron in plasma
Two iron binding sites
Responsible for pink color of plasma

491
Q

How is iron stored in the tissues?

A

Ferritin

492
Q

What is hemosiderin?

A

Water insoluble
Yellowish-brown granular intracellular pigment that is formed in some phagocytic cells (as macrophages) by the breakdown of hemoglobin

493
Q

If hemosiderin is not removed from the tissues by the macrophages, what happens?

A

Liver affected by hemosiderosis-excessive dispositon of iron in the liver in kuppfer cells and hepatocytes causing liver cell death and cirrosis

494
Q

Erythrocytes live for 120 days. Why?

A
  1. Globin can be reused

Heme is used

495
Q

Describe how hemoglobin is recycled.

A
  1. RBC dies and phagocytosis occurs
  2. Globin is broken into amino acids reused for protein synthesis
  3. Iron is released from Heme
  4. Iron binds to transferrin and goes to the liver and bind to ferritin. Ferretin releases iron from the liver and it binds again to a transferretin to go to bone marrow. Iron with globin, vitamin B12 and Erythropoiden undergoes erythropoiesis in bone marrow
  5. Heme relesaes
496
Q

What is the definition of hematopoiesis

A

Blood Cell Maturation and Production

497
Q

Myeloid progenitor cells give rise to?

A
  1. Mast Cells
  2. Reticulocytes
  3. Megakaryocytes
  4. Myeleblasts
498
Q

What do Reticulocytes mature into?

A

Erythrocytes

499
Q

What do Megakaryocytes mature into?

A

Thrombocytes

500
Q

What do Myeloblasts mature into?

A
  1. Basophils
  2. Esinophils
  3. Neutrophils
  4. Monocytes
501
Q

Where does hematopoiesis occur in the embryo?

A

Hematopoietic tissue in bone

502
Q

Where does hematopoiesis occur in the child?

A

Yellow marrow

503
Q

Where does hematopoiesis occur in the and adult- healthy vs. illness?

A

Healthy- yellow and red marrow

ill-Liver, spleen, more red and some yellow

504
Q

What happens to the amount of red vs. yellow bone marrow- healthy vs. illness?

A

more yellow in healthy adult

505
Q

What hormone stimulates erythropoiesis?

A

Erythropoietin (EPO)

506
Q

Where is EPO produced?

A

peritubular interstitial cells of the kidney

507
Q

Explain the negative feedback mechanism of erythropoiesis.

A

There is an increase in the production of RBCs when tissue oxygenation increases

  1. Tissue oxygen decreases
  2. EPO is produced
  3. Hematopoietic stem cells are produced giving rise to proerythroblasts and RBCs
  4. Oxygen is broght to tissues
508
Q

Which factors will decrease tissue oxygenation and thus stimulate erythropoiesis?

A
  1. Low Blood Volume
  2. Anemia
  3. Low Hemoglobin
  4. Poor Blood Flow
  5. Pulmonary Disease
509
Q

What is a reticulocyte?

A

Immature RBC

510
Q

What would a red bone marrow response indicate?

A

Increased reticulocytes

Indicates recent blood loss or successful iron therapy

511
Q

What would a lack of red bone marrow response indicate?

A

Decreased reticulocytes
Perform bone marrow aspirate (Primary bone marrow problem?)
Perform renal function tests (Problem with kidneys (CRF) not producing EPO)

512
Q

What is TPO?

A

Thrombopoietin (TPO)

  • Hormone from liver and kidney
  • Stimulates thrombocyte production
513
Q

What are cytokines?

A

local hormones of bone marrow-Interleukins stimulate WBC production

514
Q

EPO stimulates production of ____

A

Reticulocytes

515
Q

TPO stimulates the production of _____

A

Megakaryocytes

516
Q

GM-CSF stimulates production of

A

Basophils, esinophils, neutrophils and monocytes from myleoblasts

517
Q

EPO stimulates production of ____in chemotherapy

A

Reticulocytes

518
Q

TPO stimulates the production of _____in chemotherapy

A

Megakaryocytes

519
Q

GM-CSF stimulates production of ___in chemotherapy

A

Basophils, esinophils, neutrophils and monocytes from myleoblasts

520
Q

How is EPO used in medical?

A
  • Available through recombinant DNA technology

- Recombinant erythropoietin (EPO) -Very effective in treating CRF

521
Q

How is EPO, TPO, and GM-CSF used in chemotherapy?

A

Stimulate cell production

BMS 538 (8 decks)

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