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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

What is responsible for providing low electrical resistance in cardiac muscle?

Intercalcated discs

26

Describe the pathway of blood to and from the heart

```

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

```
27

Where does the blood go after gaining oxygen in the lungs?

The pulmonary veins into the left atrium of the heart

28

Describe blood flow through the heart from the left atrium

1. Left atrium2. Mitral Valve (Bicuspid)3. Left Ventricle4. Aortic Valve5. Aorta6. Circulation

29

Define cardiac cycle

The sequence of events that occur during systole and diastole

30

Define Systole

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

31

Define Diastole

(Ventricle)Muscle relaxes and chambers fillBlood returns to the heart 2nd phase

32

Where is the heart located?

Slightly left and center

33

what do the coronary arteries supply?

Oxygenated blood

34

Where do electrical impulse begin in the heart?

At the Sinus Node

35

What does the conduction system of the heart do?

Keeps your heart pumping in a normal rhythum

36

On the posterior side of the heart what does low oxygenated blood enter?

The coronary sinus

37

How is the heart able to contract without any extrinic stimulation?

Through the intrinsic conduction system

38

Define the hearts intrinsic conduction system

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.

39

Describe the path of the hearts internal conduction system

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

40

What happens at the AV node

1. Impulse is delayed2. The delay allows atria to contract before ventricles

41

Where does the AV bundle take the electrical impulse?

Into the Ventricles

42

Where are the left and right bundle branches located?

Interventricular Septum

43

What is the other name for the sinus node

pacemaker node

44

What is the function of the SA node?

Signals the atria to contract

45

What is the primary function of the AV node?

To cause the ventricles to contract

46

What is the pacemaker potential?

Rhythmic discharge of Sinus Atrial nodal fiber

47

How many discharges are there in a minute at the SA node?

70-80

48

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

Ventricular

49

What does the AV node do to the impulse conduction?

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

50

Why don't the purkinje fibers need to discharge as frequently as the AV node?

They are located very close to the muscle

51

What is depolarization?

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

52

Describe phase zero of ventricular muscle action potential

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

53

Descibe what happens at phase 1 of ventricular muscle action potential

Slight repolarization-apex of the graph-K+ channels open

54

What happens in phase 2 of Ventricular AP?

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

55

What happens in phase 3 of ventricular AP?

Repolarization-more K+ channels open-Membrane potential decreases to about -50

56

What happens in phase 4 of ventricular ap?

Resting membrane potential is acheived-85-95 mV

57

How long does an action potential take in the ventrcle?

about 1.75 second

58

What does calcium flowing into the cell cause?

Coordinated contraction

59

What does a S-T Segment elevation mean?

possible myocardial infarcation

60

What does the P wave of the ECG coorospond to?

Atrial depolarization

61

What does the QRS complex of the ECG corrospond to?

Ventricles depolarizing

62

What segments of the ECG does an R-R interval include?

RSTPQR -a full cycle

63

What is the Q-T interval on the ECG?

QRST

64

How long is a P-R interval

0.16 seconds

65

What does a T wave on an ECG indicate?

When the heart is being primed to relax

66

How does the heart speed up?

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

67

What system is responsible for the heart rate to slow down?

Parasympathetic (Vagus cranial nerve X)

68

What is released to slow the heart rate?

Acetylcholine

69

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

The vagus nerve (X)

70

When Ach is relased at the SA and AV junctional fibers what occurs?

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

71

What do we measure on the Y axis of the cardiac cycle?

Volume and pressure (Ventricular and Atrial volume and pressure)

72

What is the lub sound corrospond to?

Systole

73

What does the Dub sound corrospond to?

Diastole

74

Contraction ______ the pressure within a chamber

Increases

75

Blood Flows from ____ to ______ pressure.

Higher to Lower

76

Semilunar valves open when ______

Ventricular pressures are higher than aortic pressure

77

AV valves _____ when atrial pressures are ______ than ventricular pressure.

Open, higher

78

What is the first heart sound?

S1

79

What is each cardiac cycle initiated in?

The SA Node

80

How do you find the duration of the cardiac cycle?

Take the reciprocal of heart rate

81

What phase is ventricular systole?

Phase 1

82

How long does ventricular systole last?

0.3 seconds

83

What happens during phase 1: Ventricular Systole?

1. Isovolumic contraction2. Ventricular ejection

84

Define ventricular systole

Contraction in the ventricular myocardium

85

What happens during phase 2 of the cardiac cycle?

Diastole

86

What is diastole?

Relaxtion of the ventricular myocardium

87

How long is diastole?

0.4 sec

88

What are the steps in diastole?

3. Isovolumeric relaxation4. Rapid inflow5. Diastasis6. Atrial Systole

89

What is atrial systole?

Contraction of the myocardium (rt. and left atria)

90

How long does atrial systole last?

0.1 sec

91

Why does atrial systole occur during diastole?

Some blood volume is being deposited into the ventricles prior to ventricular systole

92

What happens during isovolumic contraction?

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

93

What do you hear during isovolumeric contraction?

The AV valves snap shut and you hear the lubb sound (S1)

94

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

In response, sympathetic flow to the kidneys is increased

95

An increase in afterload causes stroke volume to

Decrease

96

What does the cardiac cycle refer to?

The sequence of events that occur with every heartbeat

97

What are the two major phases of the cardiac cycle?

Systole and Diastole

98

What does Systole refer to?

Ventricular contraction

99

What does diastole refer to?

Ventricular relaxation

100

Valves open and close according to _______

pressure gradients

101

Contraction ________the pressure

Increases

102

Blood flows from ____ to ______ pressure

Higher to lower

103

Semilunar valves open when Ventricular pressures are _____ than aortic pulmonary pressures

Higher

104

AV valves ______when atrial pressures are ____ than ventricular pressure.

Open, higher

105

How is the cardiac cycle initiated?

When the SA node fires(p wave)

106

What happens to the pressure when contraction begins?

Pressure increases in the atrium and blood flows through the AV valve to the ventricle

107

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

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

108

What causes the AV valves to close?

A decrease in atrial pressure

109

What marks the beginning of systole?

Closing of the AV valves (S1 heart sound)

110

At the beginning of ventricular contraction, are the semilunar valves open?

No they are closed and the ventricle contracts in a closed space

111

What is isovolumetric contraction?

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

112

When does ventricular ejection start?

When ventricular pressures exceed the pressures within the aorta and pulmonary artery

113

what valves open to allow ejection from the ventricles?

pulmonary and aortic

114

What produces the second heart sound?

Closing of the semilunar valves

115

Where is each cardiac cycle initiated?

SA Node

116

What is phase 1 of the cardiac cycle called?

Ventricular Systole

117

What steps occur during ventricular systole?

1. Isovolumic contraction2. Ventricular ejection

118

What is phase 2 of the cardiac cycle called?

Diastole

119

What steps occur during diastole?

3. Isovolumic relaxation4. Rapid inflow5. Diastasis6. Atrial Systole

120

What happens during atrial systole?

More blood is being deposited into the ventricles

121

What happens to ventricular pressure during step 1 of the cardiac cycle isovolumeric contraction?

It rises rapidly without a change in volume

122

Are the valves open or closed during isovolumic contraction?

All 4 are closed

123

Which heart sound is the loudest?

S1 because the pressure is going to be the highest

124

When the bicuspid valve is closed what is the chordae tendiae and papillary muscles doing?

Paillary muscle is contracted and chordae tendinae are taut

125

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

Left ventricular pressure is greater than aortic pressure and the right ventricular pressure is greater than the pulmonary trunk pressure

126

What valves open during step 2 of phase 1 ,Ventricular Ejection?

Semilunar

127

On the ECG What is happening during the T wave?

Ventricular ejection

128

What is end systolic volume (ESV)

The amount of blood remaining in the ventricle after systole (50 ml)

129

How do you calculate stroke volume?

SV = EDV-ESV

130

What is the stroke volume output into the aorta and pulmonary trunk?

70 mL

131

What happens to aortic pressure during ventricular ejection?

It starts increasing during systole after the aortic valve opens

132

When does aortic pressure decrease during ventricular ejection?

Toward the end of the ejection phase

133

What happens to atrial pressure during ventricular ejection?

C wave- there is a slight backflow of blood into the atria

134

What happens to ventricular volume during isovolumic relaxion?

Stays the same

135

What do the valves do during isovolumic relaxation ?

They close (all 4)

136

What sound do you hear when isovolumic relaxation occurs?

S2-the Dupp sound

137

What is happening when you hear the Dupp sound?

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

138

What happens to ventricular volume during the rapid inflow phase of diastole?

Increases

139

What happens to ventricular pressure during the rapid inflow phase of diastole?

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

140

How much blood flows directly through the atria into ventricles before atrial systole?

80%

141

What happens to atrial pressure during the rapid inflow phase of Diastole?

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

142

What is a V wave?

It is the end of ventricular contraction

143

What happens to aortic pressure during the rapid inflow phase of diastole?

Decreases slowly due to elasticity of the aorta and blood flow to the periphery.

144

What will you see on the graph during rapid inflow during diastole?

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

145

What happens during the diastasis stage of diastole?

A small amount of blood passively flows into the ventricles

146

On an ECG what occurs during diastasis?

A P wave

147

What do you see on an ECG during atrial systole?

QRS complex

148

What happens to ventricular volume during atrial s during atrial systole?

Increases by 20% and the end diastolic volume of each ventricle is 120 ml

149

What is the end diastolic volume of each ventricle?

120 ml

150

What happens to ventricular pressure during atrial systole?

It increases slightly

151

What do you see on the atrial pressure graph during atrial systole?

A small wave occurs on the graph due to atrial contraction

152

During atrial systole that occurs during diastole what is happening?

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

153

What do atria function as during atrial systole?

A primer pump or kick that increases ventricular pumping effectiveness by 20%

154

What happens to aortic pressure during atrial systole?

It decreases slightly

155

During the Ventricular Systole in the isovolumic contraction step, What do the valves do?

AV valves close and semilunar valves close

156

During the Ventricular Systole in the isovolumic contraction step, What do you hear?

S1 heart sound (Lubb)Closure of AV valves

157

During the Ventricular Systole in the isovolumic contraction step, What is the ventricular volume?

120ml

158

During the Ventricular Systole in the isovolumic contraction step, What is ventricular pressure?

Rapid increase from 0-90 mmhg

159

During the Ventricular Systole in the isovolumic contraction step, What is the aortic pressure?

80 mmhg

160

During the Ventricular Systole during Ventricular ejection What do the valves do?

AV valves close and semilunar valves open

161

During the Ventricular Systole during Ventricular ejection What do you see on a ECG?

A T wave

162

During the Ventricular Systole during Ventricular ejection, what is the ventricular volume?

ESV=50 mLSV=70 ml

163

During the Ventricular Systole during Ventricular ejection What is the ventricular pressure?

Increases from 90-120 mmhg

164

During the Ventricular Systole during Ventricular ejection What do the valves do?

120 mmhg

165

During Diastole, During isovolumeric relaxation (Phase 3) What do the valves do?

AV valves close and semilunar valves close.

166

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

S2-(Dupp)-semilunar valves closing

167

During Diastole, During isovolumeric relaxation (Phase 3) What is the ventricular volume?

Decreased from previous stage to 50 ml

168

During Diastole, During isovolumeric relaxation (Phase 3) What is the ventricular pressure?

Rapid decrease from 90-0mmhg

169

During Diastole, During isovolumeric relaxation (Phase 3) What is the aortic pressure?

You will see an incisura on the graph and it is 100 mmhg

170

During Diastole, During Rapid inflow (Phase 4) What do the valves do?

AV valves openSemilunar valves close

171

During Diastole, During Rapid inflow (Phase 4) What is the ventricular volume?

50-90 ml

172

During Diastole, During Rapid inflow (Phase 4) What is the aortic pressure?

Decreases from 100-90 mmhg

173

During Diastole, During Diastasis (Phase 5) What do the valves do?

AV Valves open and Semilunar valves close

174

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

A p wave

175

During Diastole, During Diastatis(Phase 5) What is the ventricular volume?

90-96 ml

176

During Diastole, During Diastasis(Phase 5) What is the aortic pressure?

Decreases 90-85 mmhg

177

During Diastole, During Atrial systole(Phase 6) What do the valves do?

AV valves open and semilunar valves close

178

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

QRS complex

179

During Diastole, During Atrial systole(Phase 6) What is the ventricular volume?

Adds 24 ml so EDV = 120 ml

180

During Diastole, During Atrial systole(Phase 6) What is the ventricular pressure?

0 mmhg

181

During Diastole, During Atrial systole(Phase 6) What is the aortic pressure?

Decreases 85 to 80mmhg

182

What is stroke volume?

The amount of blood pumped from each ventricle

183

What is cardiac output?

The amount of blood pumped from each ventricle per minute

184

What is ejection fraction?

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

185

What number does the American heart association use for staging heart failure?

Ejection fraction(Normal is 55-60%)

186

What are three factors that regulate stroke volume?

1. Preload2. Afterload3. Contractility

187

What volume do we want to regulate so there are equal amounts?

Ventricular volume

188

What is the external work of the heart?

The work required for normal stroke volume

189

What is preload?

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

190

What does the frank starling mechanism refer to?

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

191

What is preload measured as?

Measured as End diastolic pressure when ventricle is filled with blood = (EDV)

192

What is the cause of increased pre-load?

Increased stroke volume caused by hypervolemia, Aortic valve stenosis and regurgitation or pulmonary valve stenosis

193

What are some causes of decreased pre-load (decreased sV)?

Atrial FibHemorrhage

194

What is afterload?

The pressure that must be overcome before a semilunar valve can open

195

During Afterload pressure in the ventricle needs to be ______pressure in the aorta

greater

196

What causes increased afterload?

Decreased stroke volume such as atherosclerosis, hypertension, aortic stenosis

197

What causes decreased afterload?

increased stroke volume such as mitral valve regurgitation (endocarditis)

198

What does an increased afterload do to the frank starling curve?

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

199

An increase in afterload ____the velocity of fiber shortening

decreases

200

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

reduces it so that more blood is left within the ventricle at the end of systole

201

What are positive inotropic agents?

Substances that increase contraction by enhancing Ca2+ inflow during cardiac action potential

202

What do positive inotropic agents stimulate?

The sympathetic nervous system (epinephrine and norepinephrine)

203

What does digitalis do?

Enhances Ca2+ inflow during cardiac action potential for dilated cardiomyopathy

204

What are negative inotropic agents?

substances that decrease contraction by blocking Ca2+ inflow during cardiac action potential

205

What do inotropic agents inhibit?

Sympathetic nervous system (anoxia, acidosis, increased K+ in intersticial fluid)

206

What does diltiazem do?

It is an enhanced Ca2+ blocker for hypertrophic cardiomyopathy

207

What is dilated cardiomyopathy?

Heart cannot contract as well

208

What is ventricular myopathy?

Increase in the size and mass of the right or left ventricle

209

Is ventricular myopathy always bad?

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

210

What are causes of pathogenic ventricular hypertrophy?

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

211

What is concentric hypertrophy?

Increase in afterload = chronic pressure overload due to chronic hypertension or aortic valve stenosis

212

Does the ventricular radius always change in concentric hypertrophy?

it may not

213

What happens to the heart wall in the ventricle in concentric hypertrophy?

wall thickness increases and the ventricle is capable of generating greater forces and higher pressures

214

why is ventricle filling compromised in ventricular hypertrophy?

compliance is reduced because ventricle is stiffer

215

what is eccentric hypertrophy?

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

216

What happens to the ventricular chamber in eccentric hypertrophy?

Ventricular chamber radius is increased and wall thickness may increase

217

What is right sided heart failure?

A small amount of blood transfers from the pulmonary circulation to the systemic circulation

218

what increases as a result of right sided heart failure.

small increase in atrial pressure and a small increase in cardiac output.

219

What happens to systemic circulation in right heart failure?

large volume and capitance

220

What are some symptoms of right sided heart failure?

Congested liver leading to ascitesJugular vein distensionperipheral distension (sweilling in feet and ankles)

221

What is pulmonary circulation?

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

222

Why is there jugular distention in right heart failure

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

223

What happens when there is left sided heart failure

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

224

Why is there pulmonary edema in left heart failure?

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

225

How could we evaluate for heart failure?

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

226

What would we see in a echocardiogram in left heart failure?

Encarditis-inflammation of the endocardium(lines the valve)

227

What causes inflammation of the endocardium?

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

228

How are we able to measure the electrical activity in the heart through electrodes?

when heart depolarizes and repolarizes electrical currents spread through the body

229

How many leads in bipolar leads?

3

230

What is an ECG?

A recording of the electrical difference between 2 leads

231

In lead 1 the right arm is

positive

232

How are we able to generate an electrical cardiogram?

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

233

What are the first 3 leads of the 12 lead ecg?

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 +)

234

What are the second type of leads in a 12 lead

1. Augmented unipolar leads (a)

235

What does the aVR lead tell us about the heart?

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

236

What does the aVL lead correspond to?

Left arm and health of lateral wall of the left ventricle

237

What does the aVF lead correspond to?

left leg or foot, inferior wall of the left ventricle

238
what leads detect minor electrical abnormailities in the ventricles?
Chest or precordial leads
239
What are Chest leads (Precordial leads) very sensitive to?
Electrical potential changes underneath the electrode
240
How are the chest leads named?
V1, V2, V3, V4, V5,V6
241
What is on the x axis of an ecg?
Time
242
What is on the Y axis of an ecg?
Voltage
243
What is happening during the p wave?
Atrial Depolarization
244
When does the p wave occur?
Immediatly before the atrial contraction (they need the electrical signal)
245
What is going on in the heart during the QRS complex?
Ventricular depolarization
246
When does the QRS complex occur?
Right before ventricle contracts
247
what does the T wave represent?
Ventricular repolarization and the ventricles remain contracted until a few milliseconds after T wave ends Also the atria remain contracted until repolarized
248
what are the waves with negative voltage
Q and S
249
What type of voltage do repolarization waves produce?
Positive voltage (move away from a positive recording electrode)
250
how long is the P-R interval?
0.16 seconds
251
What is the p-r interval?
Duration of time between the beginning of the p wave and beginning of QRS wave.
252
what does the P-R interval represent?
Time between the beginning of atrial contraction and beginning of ventricular contraction
253
How long is the Q-T interval?
0.35 seconds
254
What is the Q-T interval?
the duration of time from the beginning of the Q wave to the end of the T wave
255
What does the Q-T interval approximate?
Time of ventricular contraction
256
when does the T wave occur?
During systole
257
what are the bipolar leads?
Lead 1, Lead 2, Lead 3
258
Can you get faulty readings if electrodes are in the wrong spot?
yes
259
When does the S-T Segment Begin and End and what does it represent?
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
What is the R-R interval and what does it represent?
R to R heart rate
261
How do you calculate heart Rate?
determined with the reciprocal of tthe time interval between each.
262
What is a normal S-T segment?
0 millivolts
263
What will you see on the ECG with a myocardial infarcation?
ST elevation, myocardial injury due to prolonged ischemia
264
What will you see on the ECG with myocardial ischemia?
ST depression-mild ischemia in the apex of the heart which prevents the apex from repolarizing first and T wave inverts
265
What is ischemia?
Low blood Flow
266
what is realeased when someone is having a heart attack?
troponin
267
What can cause cardiac arrhythemias?
- 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
Describe a normal sinus rhythum on a ecg.
The QRS complexes are normal, evenly spaced and the rate is 60-100
269
What does bracdycardia look like on a ECG and what part of the autonomic nervous system causes this?
QRS complexes are normal and evenly space but beat is under 60 bpm
270
What does Tachycardia look like on an ECG?
Complexes normal,evenly spaced but rate is over 100 bpm (sympathetic)
271
What happens in an AV block?
Impulses through the AV node and Bundle of His are slowed down or blocked
272
What causes a AV block?
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
What is a First Degree AV block?
impulses from the AV node are delayed but not blocked | -no missed beats
274
What does a first degree AV block look like on an ECG?
Prolonged P-R interval
275
What is a Premature Ventricular Contraction?
QRS is prolonged (impulse is conducted through muscle) | QRS voltage is high(one side depolarizes ahead of the other)
276
What is the most frequent cause of a-Fib?
Atrial enlargement
277
what does A-Fib look like on a ECG?
No p wave and no P-R interval
278
What is the treatment for A-Fib?
Beta Blockers (Propranlol), Diltiazem, Blood Thinners (Wayfarin, Pradaxa)
279
How does the circulatory system service the needs of the tissues?
Transporting Nutrients waste products away hormones
280
What are the components of a large vein? ex) superior vena cava
Tunica externa Tunica intima Tunica Media endothelium
281
What makes up the aorta?
Elastic artery Tunica externa tunica media Tunica intima made of enternal elastic membrane and endothelium
282
What is a medium size vein made up of?
Same as a large vein
283
What is a muscular artery made of?
Tunica externa Tunica media Tunica interna Endothelium
284
What is a venule made of?
Tunica externa | Endothelium
285
What is an arteriole made of?
``` Smooth muscle (tunica media) Basement membrane Endothelium ```
286
How is a fenestrated capillary different from a continous capillary?
It has pores
287
which side of the heart is the peripheral circulation?
Right
288
Function of arteries?
transport blood under high pressure to the tissues
289
Describe special features of arteries
strong vascular walls | high velocity flow
290
Arteriole function
Control site for blood flow(resistance site of circulation)
291
Special features of arterioles
strong muscular walls for dilation
292
Capillary Function
Major site of water and solute exchange between blood and tissues
293
Describe a capillary
Thin walls with
294
Where does most of the blood circulate?
Veins, Venous sinuses, venules
295
What do the pulmonary capillaries do?
Site of oxygen and CO2 exchange
296
Veins and Venule function
Return the blood to the heart under low pressure, | Reservoir for blood
297
What type of blood vessel has the greatest crossectional area?
Capillaries need to get more stuff through their walls in the same amount of time
298
Velocity
The speed at which blood flows in the circulation | V=Blood Flow/Crossectional area
299
Velocity of blood flow is the greatest in _____
Aorta
300
Velocity of blood flow is _____to vascular crosssectional area
inversley proportional
301
Equation for velocity of blood flow
v=F/A | velocity = volume of blood flow/crosectional area
302
What vessel has the lowest velocity?
capillaries
303
Define Blood Pressure
Force exerted by blood against any unit area of vessel wall
304
Where do you find high blood pressure?
Arterial Tree
305
What blood vessels have low pressure?
Venous Side
306
Where do you find a very large BP drop?
Across arteriolar capillary junction
307
What is the basic theory of circulatory function?
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
How is blood flow in the tissues controlled?
1. microvessels monitor need 2. act on local BP (dilation or constriction) 3. Also, CNS and hormones help
309
What is Blood Flow?
Q | Quantity of blood that passes a given point in the circulation in a given period of time
310
What do the variables mean in the blood flow equation?
Q = change in pressure/ Resistance of vessel Change in pressure = Pressure difference between 2 ends of the vessel R =
311
What is cardiac output?
Overall flow in the circulation of an adult = 5l/min.
312
What is Laminar flow?
Blood Flows in streamlines with each layer of blood remaining same distance from the wall
313
Where is the velocity the greatest in laminar blood flow?
Center of the vessel Creating a parabolic profile
314
Can you hear laminar flow?
No
315
What is turbulant blood flow?
It does not flow in a streamline and applies greater force to endothelium causing damage/inflammation
316
What causes turbulant Blood Flow?
High velocity Sharp turns rough surfaces rapid narrowing
317
What are bruits?
Murmurs and are important for diagnosing vessel stenosis in the carotid artery, vessel shunts, cardiac valvular lesions
318
Decreased blood vessel radius _____vascular resistance and ______blood flow
increases decreases (poiseuilles)
319
If there is more hemocit then......
Blood viscosity goes up and so does vascular resistance
320
Resisance is_____
an impediment to blood flow
321
A serial arrangement has______resistance and is found among_____,_____,______,____and _______
``` increased Arteries Arterioles capillaries venules veins ```
322
What type of arrangement has decreased resistance?
parallel
323
Where do you find decreased resistance?
Brain Kidney Muscle GI tract
324
What is conductance?
Measure of the ease at which blood flows
325
What happens if you remove a kidney?
You remove a parallel circuit and decrease vascular conductance and blood flow but increases total peripheral resistance
326
What is vascular distensibility?
Fractional increasein volume for each mmHG rise in pressure
327
What is more distensible arteries or veins?
Veins (8 times more)
328
What is Capacitance?
Vascular compliance-total quantity of blood stored in a given portion of circulation for each mmHG
329
Equation for Distensibility
Increase of Volume/(increase in pressure x original volume)
330
What has more compliance (capacitance)?
Veins 24 time
331
In the arterial tree changes in volume results in larger ______in pressure than in veins.
increases
332
What factors affect pulse pressure?
Stroke volume | Arterial compliance
333
when there is an increase in stroke volume there is a _____in pulse pressure
increase
334
______in compliance _____pulse pressure
Decreases, increases
335
What is a patent ductus arteriosus associated with?
Low diastolic pressure and high systolic pressure so an increase in pulse pressure
336
What happens in arteriosclerosis?
Decreases compliance of arterial tree which increases pulse pressure
337
If the BP cuff pressure is greater than 120 mmHG what happens?
no flow and no sound
338
What cuff pressure do you need for free flow and no sound?
80
339
What happens when cuff pressure reaches systolic pressure?
tapping sounds called korotcoff in the antecubital artery
340
When should you record diastolic pressure?
No sound
341
What are three functions of veins?
1. Blood reservoir (60%) 2. Central and peripheral venous pressure affects on right atrial pressure 3. Venous Valves and skeletal muscle pump
342
How is right atrial pressure regulated?
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
What factors increase Right Atrial Pressure?
Decreased cardiac function (increased blood volume and increased venous tone)
344
When there is an increase inright atrial pressure what happens?
Causes blood to back up into the venous system increasing venous pressure and resistance.
345
Why is the venous pressure higher in the feet than the right atrium?
Gravitational weight of blood
346
What maintains low venous pressure in the legs?
Venous valves and skeletal muscle pump
347
What are varicose veins?
increase in venous and capillary pressure causing edema when standing
348
What enhances capillary diffusion?
Concentration differences
349
What can diffuse accross a capillary?
Lipid soluable substances
350
How do lipid insolable substances cross capillary walls?
intercellular clefts
351
What is bulk flow?
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
What is bulk flow most important for?
Regulation of relative volumes of blood and intersticial fluid
353
Define filteration
Bulk flow from arterial end of the capillary into interstitual fluid
354
Define reabsorption
Bulk flow from interstitial fluid to venous end of capillary
355
What is a balance of filteration and reabsorption pressure called?
net filtration pressure
356
Starlings law of capillaries
Volume of fluid and solutes reabsorbed is almost as large as amt. filtered
357
When capillary hydrostatic pressure is greater than blood colloidal osmotic pressure what occurs?
Filteration-fluid exits capillary
358
When Capillary hydrostatic pressure is less than blood colloidal osmotic pressure what happens?
Reabsorption-fluid reenters capillary
359
what is cardiac Output controlled by?
Local Tissue Blood Flow
360
Each tissue Autoregulates its own blood flow in proportion to its ______
Metabolic rate or needs
361
What is arterial pressure controlled by?
Autonomic nervous system, independent of cardiac output or local blood flow control
362
What factors does blood flow increase or decrease and what is this an example of?
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
Blood flow _____ as tissue metabolism increases.
Increases
364
what happens to blood flow when arterial oxygen saturation moves from 100 to 50 %?
It increases gradually
365
What happens to blood flow when arterial saturation is 50 % and below?
It increases from 1.5 to 3 times the normal rate.
366
When there is an increased demand for oxygen and nutrients what happens to local (tissue) blood flow?
It increases | -through local vasodilation and vasoconstriction of arterioles, metarteriole, and pre capillary sphinctors
367
What is a metariole?
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
what is the term used for precapillary and metarteriole sphincters for controlling capillary blood flow?
Vasomotion
369
Does the accumulation of vasodilator metabolites increase or decrease tissue blood flow?
increase
370
What are the vasodilator metabolites?
``` Histamine Adenosine and Adenosine Phosphate compounds CO2 H+ ions K+ ions ```
371
Define Reactive Hyperemia
Occurs after blood supply to a tissue is blocked for a short time
372
What happens during Reactive Hyperemia?
- Blood flow rate increases 4-7X normal after blockage | - Tissue vasodilator metabolites accumulate and hypoxia
373
Define Active Hyperemia-
Exercise
374
What happens to blood flow in active hyperemia?
- Blood flow needs to increase to compensate for increased metabolic demand - Local tissue metabolism causes accumulation of vasodilator substances
375
What is the result of active hyperemia after the blood flow change?
-Local tissue metabolism causes accumulation of vasodilator substances
376
Define Autoregulation
Within < 1 minute tissue blood flow returns to normal if arterial pressure is increased or decreased
377
What are the two theories for how blood flow is regulated during changes in arterial pressure
!. Metabolic Theory of Autoregulation | 2. Myogenic Theory of Autoregulation
378
what happens to arterial pressure in the metabolic theory of autoregulation?
-Arterial pressure increases a lot
379
What happens to local blood flow in the metabolic theory of autoregulation and what is the effect?
-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
In the myogenic theory of autoregulation what does decreased arterial pressure do to local blood flow?
- 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
What is the formula for Wall tension in the Myogenic Mechanism?
Wall Tension (T) = Internal Pressure (P) x Radius (R)
382
How does acute metabolic control of local blood flow work in the kidney?
Tubuloglomerular Feedback
383
How does Tubuloglomerular feedback regulate local blood flow in the kidney?
-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
How does acute metabolic control of local blood flow occur in brain?
When there is an increase of CO2 or H+ - Cerebral Blood Vessels Dilate - blood flow increases
385
How does acute metabolic control of local blood flow occur in the skin?
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
What part of the ANS controls skin blood flow when there is an increase in body temp?
sympathetic
387
What does blood do to retain heat?
Avoid surface of the skin
388
How Does Control of Tissue Blood Flow by Endothelial Derived Relaxing or Constricting Factors work?
- A vasoconstrictor called endothelian is released from a damaged endothelium - A vasodilator called nitric oxide is released from healthy endothelial cells
389
What is long term control of blood flow?
Slow controlled changes (days to weeks to months) in blood flow
390
How is Long-term control of blood flow achieved?
Changes in tissue vascularity
391
How do changes in tissue vascularity control blood flow long term?
1. Increasing the vascularity of tissue- size and number of blood vessels. 2. Angiogenesis = Development of new blood vessels
392
What is Angiogenesis?
Development of new blood vessels
393
when does Angiogenesis occur?
Occurs in response to angiogenic (small peptides) factors called vascular endothelial cell growth factors
394
What are angiogenic factors called and what kind of molecule are they?
Small peptides called Vascular endothelial growth factors
395
Where are angiogenic growth factors released from?
1. Tissues with High Metabolic Rates 2. Ischemic Tissues 3. Rapidly growing tissues or neoplasia
396
what stimulates the regulation of tissue vascularity?
Oxygen
397
Describe Acute Blood Flow in terms of increasing mean arterial pressure
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
What is Humoral Regulation of Blood Flow?
Control of blood flow by substances secreted or absorbed into the body fluids
399
What are the vasoconstrictor players in humoral blood flow?
Norepinephrine and epinephrine Angiotensin II Vasopressin (ADH) Increase Ca2+
400
What are the vasodilators hormones in humoral blood flow?
Bradykinin Histamine Increase H+ vasodilation Increase CO2
401
Describe three functions of nervous system regulation of the circulation
1. Resdistribution of blood flow 2. Pumping Activity of the Heart 3. Rapid Control of arterial pressure
402
Where does the sympathetic system increase blood flow?
1. Lungs-pulmonary circulation | 2. Heart-Coronary system
403
where does the parasympathetic system increase blood flow?
1. Digestive system | 2. Urinary System
404
Does the sympathetic nervous system increase or decrease pumping activity of the heart?
Increase
405
Does the parasympathetic nervous system increase or decrease pumping activity of the heart?
Decrease
406
How does the sympathetic system control arterial blood pressure?
Increases it
407
How does the parasympathetic system control arterial blood pressure?
Decreases
408
what does the sympathetic nervous system do to regulate blood flow, heart pumping and arterial pressure?
It causes vasoconstriction, cardiac output and heart contractability in times of need
409
what does the parasympathetic nervous system do to regulate blood flow, heart pumping and arterial pressure?
Decreases cardiac output and contractability in times of need
410
Where is the vasomotor center located?
Medulla Oblongota and lower 3rd of the pons
411
What are the Vasomotor Center components?
Vasoconstrictor Vasodilator Cardioinhibitor nucleui
412
What does the vasomotor center receive inputs from?
Neural inputs directly from the : baroreceptors hypothalamus higher order neural centers throughout the cerebrum
413
Where does the vasomotor center transmits impulses to?
the spinal cord | sympathetic nervous system to the blood vessels and heart
414
Where is the distribution of vasoconstrictor fibers the greatest?
``` Kidneys Gut Spleen Skin (Distributed throughout all segments of circulation) They are important for autoregulation ```
415
Why is the vasoconstrictor fiber system less potent or dangerous in the coronary circulation and brain?
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
What do the sympathetic nerve fibers NOT innervate?
capillaries, precapillary sphincters, and metarterioles
417
How is vasomotor tone and an increase in vascular resistance acheived?
through Innervation of small arteries, arterioles, and large veins by sympathetic nerves. They saw this when injecting patients with neurotransmitter norepinephrine
418
What is the neurotransmitter for the vasoconstrictor nerves and what does it do?
Norepinephrine-it constricts the blood vessels through alpha adrenergic receptors
419
How can EPI dilate blood vessels?
through a potent Beta2 receptor (decreasing vascular resistance)
420
What is the parasympathetic nervous system important for in terms of regulation of the circulation?
Controls heart rate via the Vagus nerve
421
How does vasovagal syncope occur?
``` 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
How is rapid control of arterial pressure acheived?
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
What is a barorecptor?
Baroreceptors are spray type nerve endings
424
Where are barorecptors located?
1. Carotid sinus- found at carotid bifurcation | 2. Aortic arch
425
What is the significance of the carotid sinus reflex?
maintaining normal blood pressure in the brain
426
Where are the signals transmitted in the carotid sinus reflex?
Signals from the carotid sinus are transmitted by Hering’s nerve to the Glossopharyngeal nerve and then to the VMC
427
Significance of the Aortic Reflex?
maintaining normal general systemic blood pressure
428
Where are the signals transmitted in the aortic reflex?
Signals from the arch of the aorta are transmitted through the vagus to the VMC
429
Arterial Baroreceptor reflex significance
Important in short term regulation of arterial pressure
430
What is the arterial baroreceptor reflex initiated by?
Stretch receptors (baroreceptors)
431
How does the arterial baroreceptor reflex work?
1. Increase in pressure stretches the baroreceptors 2. signals to VMC 3. ANS  4. circulation  5. decrease arterial pressure back to normal
432
What pressure changes do carotid sinus receptors respond to?
changes between 60 and 180 mmHg
433
Baroreceptors reflex is most sensitive at a pressure of ______.
100 mmhg
434
As pressure increases the number of impulses from carotid sinus increases-Why?
1) Inhibition of vasoconstriction | 2) Activation of the vagal center
435
When there is an increase in arterial pressure what will happen?
Opposes either increases or decreases in arterial pressure thereby reducing daily variations in arterial pressure
436
When common carotid arteries are constricted what happens to the baroreceptors at the carotid sinus?
Pressure decreases resulting in an increase in arterial pressure
437
What is a chemoreceptor?
Chemoreceptors are chemosensitive cells sensitive to decreased O2, increased CO2 and H+
438
Where are Chemoreceptors located?
located in carotid bodies near the carotid bifurcation and arch of the aorta
439
How are chemoreceptors activated?
Decreased O2 Increased CO2 Increased H+
440
What is the result of activated chemosensitive receptors?
1. excitation of the vasomotor center 2. Increased sympathetic activity 3. Increased BP
441
Describe the CNS ischemic response
1. Cerebral ischemia occurs 2. Increase in CO2 3. VMC activated 4. increased sympathetic activity 5. Arterial pressure increases
442
What is one of the most powerful activators of the sympathetic vasoconstrictor system?
CNS ischemic response
443
When is the CNS ischemic response activated?
when pressure falls below 60 mmhg | -15-20 mmhg greatest activation
444
What happens when CNS ischemia is prolonged?
a depressant effect on the vasomotor center
445
What do low pressure receptors do?
Low pressure receptors in atria and pulmonary arteries minimize arterial pressure changes in response to changes in blood volume
446
How are low pressure receptors activated?
By Increases in blood volume
447
When low pressure receptors are activated what happens?
arterial pressure drops
448
How does the activation of low pressure receptors enhance water and Na excretion?
Decreasing rate of antidiuretic hormone Increasing glomerular filtration rate Decreasing Na+ reabsorption
449
Describe the atrial and pulmonary artery reflexes
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
What does the Bainbridge reflex prevent?
damming of blood in veins, atria and pulmonary circulation
451
Describe the bainbridge reflex
Stretch of atria sends signals to VMC via vagal afferents to increase heart rate and contractility
452
What does an increase of atrial pressure do to heartrate?
Increases it
453
Define Shock
Decreased Blood Volume and Decreased Blood Pressure = | Hypovolemic Shock
454
What are the causes of hypovolemic shock?
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
What is circlatory shock?
Decreased cardiac function and decreased venous return
456
What cause decreased cardiac function?
1. Myocardial infarction 2. Valvular disease 3. Arrhythmias 4. Metabolic problems 5. Myocarditis
457
What causes decreased venous return?
1. Blood volume | 2. Vascular tone
458
How does the body respond to shock
Disrupts homeostasis: | By decreasing Blood Volume and Pressure
459
What happens to the baroreceptors when Blood Volume decreases along with blood pressure in shock?
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
What happens as a result of more angiotensen II in the blood during shock?
Aldosterone is released from the adrenal cortex and blood vessels constrict
461
What happens when there is ADH in the blood?
Kidneys conserve salt and water and blood vessels constrict
462
What happens when there is increased sympathetic stimulation and hormone release from the adrenal medulla?
Heart rate and contractability increase
463
What does aldosterone release and kidney conservation of salt and water lead to?
Increased Blood Volume
464
What does the constriction of blood vessel lead to during shock?
Increased systemic vascular resistance
465
What does the increase in heart rate and contratability lead to during shock?
increased blood pressure
466
What two things lead to increased blood pressure during shock?
Increased blood volume and increased vascular resistance
467
What needs to happen for the body to return to homeostasis during shock?
When responses bring blood pressure and volume back to normal
468
What does a patient experience during shock?
``` 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
What are the shock characteristics at a cellular level?
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
What are the physical characteristics of blood?
``` 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
What are the three components and approximate percentages of blood when it is spun down in a centrifuge?
55% plasma 45% hematocrit (packed red cell) <1% Buffy Coat
472
Which blood cells are found in the buffy coat
White cells and platelets
473
List the formed elements in blood
Platelets WBCs(Neutrophils,Lymphocytes, Monocytes, Esinophiles, Basophils) RBCs
474
What are the components of plasma?
> 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
Where are plasma proteins made?
Liver
476
Where are plasma proteins Confined to?
Blood Stream
477
What are the functions of the three plasma proteins?
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
what is the definition of hematocrit?
Percentage of total blood occupied by erythrocytes
479
Why do males have higher hematocrits (hct) than females?
Female normal range 38 - 46% (average of 42%) | Male normal range 40 - 54% (average of 46%)
480
What is the definition of anemia?
decreased HCT or decreased Hb or both
481
How is anemia classified?
Classified based on cell size (micro, macro, normocytic) and amount of hb present (hypo, hyper, normochromasia)
482
What is the definition of polycythemia?
``` Increased HCT (>65%) or increased Hb or both Dehydration, tissue hypoxia, blood doping in athletes ```
483
What is the most common cause of polycythemia?
Dehydration, tissue hypoxia, blood doping in athletes
484
Hemoglobin is a globin protein consisting of ___ polypeptide chains with one heme pigment attached to each chain.
Hemoglobin is a globin protein consisting of 4 polypeptide chains with one heme pigment attached to each chain.
485
What does each heme contain?
Each heme contains Fe2+ that can combine reversibly with one oxygen molecule
486
what does this bind to?
oxygen
487
Each hb molecule can carry ___ O2 molecules from lungs to tissue cells.
Hemoglobin also transports 23% of total CO2 waste from tissue cells to lungs for exhalation
488
What is HbA1C used to monitor?
Used to monitor long-term blood glucose control (3 months) in diabetes type I and II Measures amount of glycosylated hemoglobin in blood
489
Why is HbA1C more reliable than analyzing trends in daily or weekly blood glucose measurments?
- 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
How is iron transported in the blood plasma?
Transferrin Transports iron in plasma Two iron binding sites Responsible for pink color of plasma
491
How is iron stored in the tissues?
Ferritin
492
What is hemosiderin?
Water insoluble Yellowish-brown granular intracellular pigment that is formed in some phagocytic cells (as macrophages) by the breakdown of hemoglobin
493
If hemosiderin is not removed from the tissues by the macrophages, what happens?
Liver affected by hemosiderosis-excessive dispositon of iron in the liver in kuppfer cells and hepatocytes causing liver cell death and cirrosis
494
Erythrocytes live for 120 days. Why?
1. Globin can be reused | Heme is used
495
Describe how hemoglobin is recycled.
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
What is the definition of hematopoiesis
Blood Cell Maturation and Production
497
Myeloid progenitor cells give rise to?
1. Mast Cells 2. Reticulocytes 3. Megakaryocytes 4. Myeleblasts
498
What do Reticulocytes mature into?
Erythrocytes
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What do Megakaryocytes mature into?
Thrombocytes
500
What do Myeloblasts mature into?
1. Basophils 2. Esinophils 3. Neutrophils 4. Monocytes
501
Where does hematopoiesis occur in the embryo?
Hematopoietic tissue in bone
502
Where does hematopoiesis occur in the child?
Yellow marrow
503
Where does hematopoiesis occur in the and adult- healthy vs. illness?
Healthy- yellow and red marrow | ill-Liver, spleen, more red and some yellow
504
What happens to the amount of red vs. yellow bone marrow- healthy vs. illness?
more yellow in healthy adult
505
What hormone stimulates erythropoiesis?
Erythropoietin (EPO)
506
Where is EPO produced?
peritubular interstitial cells of the kidney
507
Explain the negative feedback mechanism of erythropoiesis.
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
Which factors will decrease tissue oxygenation and thus stimulate erythropoiesis?
1. Low Blood Volume 2. Anemia 3. Low Hemoglobin 4. Poor Blood Flow 5. Pulmonary Disease
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What is a reticulocyte?
Immature RBC
510
What would a red bone marrow response indicate?
Increased reticulocytes | Indicates recent blood loss or successful iron therapy
511
What would a lack of red bone marrow response indicate?
Decreased reticulocytes Perform bone marrow aspirate (Primary bone marrow problem?) Perform renal function tests (Problem with kidneys (CRF) not producing EPO)
512
What is TPO?
Thrombopoietin (TPO) - Hormone from liver and kidney - Stimulates thrombocyte production
513
What are cytokines?
local hormones of bone marrow-Interleukins stimulate WBC production
514
EPO stimulates production of ____
Reticulocytes
515
TPO stimulates the production of _____
Megakaryocytes
516
GM-CSF stimulates production of
Basophils, esinophils, neutrophils and monocytes from myleoblasts
517
EPO stimulates production of ____in chemotherapy
Reticulocytes
518
TPO stimulates the production of _____in chemotherapy
Megakaryocytes
519
GM-CSF stimulates production of ___in chemotherapy
Basophils, esinophils, neutrophils and monocytes from myleoblasts
520
How is EPO used in medical?
- Available through recombinant DNA technology | - Recombinant erythropoietin (EPO) -Very effective in treating CRF
521
How is EPO, TPO, and GM-CSF used in chemotherapy?
Stimulate cell production

BMS 538 (8 decks)

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