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Pathophysiology I - Exam 3 (Final) > Cardio Module 1 > Flashcards

Cardio Module 1 Flashcards

1
Q

What are the 3 types of circulation of the heart?

A
  • pulmonary
  • systemic
  • coronary
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2
Q

How do cardiac valves open?

A
  • primarily d/t pressure

- secondarily d/t ATP

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3
Q

When does coronary blood flow occur?

A
  • diastole (relaxation)… After ventricles contract they relax and the backwash of blood goes thru coronary arteries during the relaxed stage.
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4
Q

What is the rate of coronary blood flow?

A
  • 250mL/min
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5
Q

Pulmonary circulation is supplied by which side of the heart

A

Right side

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6
Q

Describe the pathway of pulmonary circulation

A

From the right side of the heart, the Pulmonary trunk divides into the R/L pulmonary arteries to supply the lungs.
The Pulmonary capillaries are within the alveoli.
The Pulmonary veins remove blood from the pulmonary capillaries and send blood to the left side of the heart

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7
Q

What is the function of Pulmonary circulation?

A

To deliver blood to the lungs for gas exchange

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8
Q

Compared to systemic circulation, pulmonary circulation is a ______ pressure system

A

Low

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9
Q

Systemic circulation is supplied by which side of the heart

A

Left side

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10
Q

Which artery is the major blood vessel for the systemic circulatory system

A

The aorta

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11
Q

What is the function of Systemic circulation?

A

To deliver blood to every region of body for gas exchange

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12
Q

The volume of blood pumped per heart beat thru systemic circulation is ______ compared to the pulmonary system

A

the same

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13
Q

Coronary circulation is…

A

Blood supply to the heart itself

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14
Q

Coronary circulation is supplies by which blood vessels

A

the right and left coronary arteries, the coronary capillaries, the coronary veins and coronary sinus

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15
Q

Define arteriogenesis (or collateral growth)

A

In response to artery obstructions and a slow diminishing blood supply, a remodeling occurs in a neighboring artery that allows for new or alternate blood flow pathways to supply the myocardium of the heart. New capillaries grow from nearby sources.

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16
Q

What is happening during the diastolic phase of the heart beat?

A

The heart is relaxing after contraction and the ventricle is filling with blood adding pressure

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17
Q

How much blood is contracted into the aorta of the heart

A

70 mLs of blood

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18
Q

What is happening during the systolic phase of the heart beat?

A

Pressure has built up in the ventricle and it contracts and dumps out 70 mLs of blood to the aorta.

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19
Q

As blood back flows from the aorta to the coronary arteries… what happens to the pressure?

A

It briefly spikes before gradually dipping during the diastolic phase

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20
Q

What is the role of the Right atrium?

A

It receives ‘low oxygenated’ blood from the systemic and coronary circulation (the SVC, IVC and coronary sinus all drain into here)

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21
Q

What does the tricuspid valve (right AV valve) connect?

A

The right atrium and right ventricle… if regulates blood flow between each

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22
Q

What is the role of the Right ventricle?

A

Received ‘low oxygenated’ blood from the right atrium. It’s triangular shape functions like a ‘bellow’ to allow the pumping of a large volume of blood into the low pressure pulmonary circulation system

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23
Q

Where does the right ventricle pump blood to?

A

The pulmonary trunk (and into the pulmonary circulation system)

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24
Q

What valve regulates blood flow btwn the right ventricle and pulmonary trunk?

A

The right semi-lunar valve (pulmonary semilunar valve)

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25
Q

What is the role of the left atrium?

A

It receives oxygenated blood from pulmonary system. (via 4 pulmonary veins… 2 on right and 2 on left)

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26
Q

What connects the left atrium with the left ventricle

A

the Mitral valve (left AV valve)

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27
Q

What is the role of the left ventricle?

A

Receives oxygenated blood from the left atrium. Its bullet shape allows for forceful pumping of blood into the high pressure systemic circulation via the aorta

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28
Q

What is the valve that connects the left ventricle with the systemic circulation system (where does is first go)

A

the Left semilunar valve (aortic semilunar valve). It opens to pump blood into the aorta

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29
Q

Describe the 2 different shapes of the heart’s ventricle and the purpose of those shapes

A

The Right ventricle is ‘heart’ shaped that allows for the pumping of a large volume of blood into a low pressure pulmonary circulation.
The left ventricle is ‘bullet’ shaped that allows for the forceful pumping of blood into a high pressure systemic system.

30
Q

How does the sympathetic side of the autonomic system auto regulate blood flow?

A

Sympathetic system - a1 adrenoceptors (norepinephrine) gives an initial vasoconstriction response (ratcheting up metabolism and strength of contraction) followed by vasodilation from metabolites and local systems to even it out

31
Q

How does the parasympathetic side of the autonomic system auto regulate blood flow?

A

Parasympathetics initially vasodilate then a reduction in local signaling mechanisms which allows for a constriction to even things out

32
Q

An example of sympathetic auto regulation on cardiac muscle cells

A

An increase in HR and contraction from the sympathetic effect on cardiac muscle (B1 adrenoceptors) increase metabolic byproducts that stimulate local vasodialation

33
Q

Examples of local products that override sympathetic/parasympathetic effect on coronary muscle

A

Adenosine, Nitric oxide, CO2, H+, histamine

34
Q

The net effect of the sympathetic system on coronary blood flow is…

A

Vasodilation

35
Q

What are the two primary phases of the cardiac cycle

A

Systole - represents contraction (blood is ejected from the R/L ventricle into the circulation)
Diastole - represents relaxation (blood fills R/L ventricles

36
Q

Two things that happen during the systolic phase

A

1) Isovolumetric contraction

2) Ventricular ejection

37
Q

Three things that happen during the diastolic phase

A

1) Isovolumetric relaxation
2) Ventricular filling
3) Atrial systole

38
Q

When describing the actions of the cardiac cycle, which side of the heart are we talking about

A

BOTH SIDES - ventricular filling, contraction happens at both sides nearly simultaneously

39
Q

What is happening during the Atrial kick phase of the cardiac cycle (and when does it happen)?

A

During Arial systole. The Atria contracts and forces additional blood into the ventricles. The AV vales remain open, the semilunar valves remain closed

40
Q

What is happening during the Isovolumetric ventricular constriction phase of the cardiac cycle (and when does it happen)?

A

During the beginning part of ventricular systole. Ventricular pressure increases, the semilunar valves remain shut and the ventricles are beginning to contract causing the AV valves (mitral and tricuspid) to snap shut (1st heart sound).

41
Q

What is happening during the Ventricular Ejection phase of the cardiac cycle (and when does it happen)?

A

During ventricle systole. Ventricular pressure eventually exceeds vascular pressure forcing semilunar valves to open. Blood ejects from the ventricles while the AV valves remain closed

42
Q

What is happening during the Isovolumetric relaxation phase of the cardiac cycle (and when does it happen)?

A

During early diastole. At the start ventricular pressure falls below atrial pressure. The AV valves remain closed and the pressure forces the semilunar valves (aortic and pulmonary valves) to snap shut (2nd heart sound).
NOTE: back pressure in aorta forces blood to flow into the coronary arteries. At the end of this phase venous blood continues to return to the heart, atrial pressure increases and then forces the AV valves to open

43
Q

What is happening during the Ventricular filling phase of the cardiac cycle (and when does it happen)?

A

During the late diastole phase. Ventricles fill passively with blood. The AV valves remain open and semilunar valves remain closed

44
Q

What phases in the cardiac cycle represents the 2 major heart sounds (what’s happening to make those sounds)

A

1st sound - During the Isovolumetric ventricular contraction or the beginning of ventricular systole (the AV valves snap shut)
2nd sound - During the Isovolumetric relaxation or the transition btwn ventricular systole and early diastole (the Semilunar valves snap shut)

45
Q

The dicrotic notch represents what?

A

When the aortic valve closes and the AV valves open

46
Q

Which phase is the Aortic and Ventricular pressures the lowest? Highest?

A

Lowest - during Early ventricular diastole (Ventricle filling)
Highest - in the middle of ventricular systole (Ventricular ejection)

47
Q

Why is a shortening of the resting phase of a heart beat during exertion dangerous for someone with CAD?

A

If there is a stenosis, blood will have an easier time going through a smaller opening if there is a longer rest phase. If you shorten the rest phase and you get more pressure and chest pain

48
Q

What is the 3rd heart sound

A

It may be heard in adults. May be heard in children. It’s the vibration of the ventricular walls from the rush of blood into the ventricles during rapid filling (late diastole,)

49
Q

At resting heart rate (70 bpm) what is the division of time between the 2 major cardiac phases

A

Considering 70 bpm = 0.8 sec/beat…
Systolic (shorter) - 0.3 sec/beat
Diastolic - 0.5 sec/beat

50
Q

If exercising heart rate is 180 bpm (0.33 sec/beat) what is the division of time btwn the 2 major cardiac phases and how is it different than the resting rate

A 
Systolic = 0.2 sec/beat
Diastolic = 0.13 sec/beat

As HR increases there is a dramatic shortening of the diastolic phase (less of a resting phase) of the cardiac cycle

51
Q

Describe the splitting of the 2nd heart sound

A

There is a very small difference between the aortic and pulmonary semilunar valves to shut (Atrial shuts first). This especially happens during inspiration. It may occur during various pathologies

52
Q

What is the difference between a murmur and a bruit?

A

Both are irregularities in cardiac cycle that can be heard. The difference is in the location. Murmurs happen mostly around the valves of the heart due to a stenosis or regurgitation/insufficiency. A bruit happens more peripherally in the vascular system, outside of the heart.

53
Q

What is considered the normal resting heart rate

A

70 bpm

54
Q

Two ways to estimate Maximum heart rate

A

220 - age or 208 - (0.7 x age)

55
Q

What is the Target Heart Rate

A

The zone or ceiling of a heart rate to use to get benefits of exercise while not taxing the heart too much.

56
Q

Two methods to calculate Target Heart Rate

A

Direct percentage calculation = MHR x chose %

Heart rate reserve (Karvonen method) = {(MHR - RHR)} x chose % + RHR

57
Q

What is Stroke volume

A

The volume of blood pumped out of the ventricles per beat

58
Q

What is the normal SV at rest and what can it be during maximum exercise

A

Rest - Approx 70 ml

Max - 150-200 ml

59
Q

What happens to resting SV and maximum SV after exercise

A

Both will increase

60
Q

Which 3 components regulate SV at rest

A

1) EDV (end-diastolic volume) - how much did I fill the ventricle to begin with (more means you’ll push out more and lower HR)
2) Average aortic blood pressure (MAP) - higher pressure will effect how much you can pump out
3) Strength of ventricular contraction (contractility) - If they ventricular wall is happy and healthy it will stretch more for a stronger contraction (thin will not push out as much)

61
Q

At rest, how much of a cardiac output does your body need to maintain homeostasis. What is the maximum cardiac output that you need during exercise

A

At rest - 5 L/min of cardiac output. Doesn’t matter if you’re fit or not.
During exercise - 20-30 L/min

62
Q

What is the equation for cardiac output

A

CO = SV x HR

63
Q

How does a person who is fit have a more efficient cardiac output

A

They will have a lower heart rate and higher stroke volume to still get that 5L/min needed. So its doing less work because it’s more efficient

64
Q

What happens with resting CO after aerobic training

A

Resting Cardiac Output REMAINS THE SAME!!! (always needs 5L/min at rest for basic functions you need at rest

65
Q

What is the Ejection fraction

A

The percentage of blood that is ejected from the ventricle. The proportion of blood pumped out of left ventricle with each beat. (how strong and efficient is the ventricles)

66
Q

What is the equation to determine the Ejection Fraction

A

EF = SV / EDV (end diastolic volume0

67
Q

What are factors that influence cardiac output

A

Intrinsic - (from normal functional characteristics of heart) - contractility, HR, preload stretch
Extrinsic - Involves neural and hormonal control from the Autonomic nervous system

68
Q

What are the ‘normal’ ventricular ejection fractions of the left and right ventricles

A 
Normal left (LVEF) - at rest = 55-68%
Normal right (RVEF) - slightly les
69
Q

Clinical base guidelines for Ejection fraction

A

Normal = 50-75% (some say 55%)

Below normal = 40-50%

70
Q

If the stroke volume is 70 ml and the EDV is 120 ml what is the EF?

A

EF = SV/EDV —- > 70/120 = 58%

71
Q

How much can EF increase during exercise

A

Approx 5-15% above resting value

72
Q

How much blood does the human heart pump out per day?

A

Approx 1,400 gallons/day at 70 bpm

Pathophysiology I - Exam 3 (Final) (5 decks)

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