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Pathophysiology I - Exam 3 (Final) > Cardio Module 4 > Flashcards

Cardio Module 4 Flashcards

1
Q

What are the 2 portal circulation pathways

A

1) GI/hepatic portal system - GI/spleen capillary beds sends blood to liver before blood empties into iVC
2) Renal system - has 2 capillary beds within kidney to allow reabsorption

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2
Q

What is the breakdown of blood volume in the body?

A 
70% in the systemic circulation
    - 16% in arteries (stressed volume)
    - 54% in veins (unstressed volume)
18% in pulmonary circulation
12% in coronary circulation
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3
Q

Circulation is _______ driven

A

Pressure

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4
Q

Pressure gradients in the systemic circulation stars at _____ mmHg and gradually decrease to _______ mmHg

A

100+

0-4

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5
Q

What is the circulation pressure in the left atria

A

4-12 mmHg

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6
Q

What is the circulation pressure in the right atria

A

0-8 mmHg

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7
Q

What is the circulation pressure in the left ventricle (Systolic and end-diastolic)

A

Systolic - 90-140 mmHg

Diastolic -4-12 mmHg

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8
Q

What is the circulation pressure in the right ventricle (Systolic and end-diastolic)

A

Systolic - 15-28 mmHg

Diastolic -0-8 mmHg

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9
Q

What is the circulation pressure in the 1) aorta, 2) capillaries and 3) venous return to Vena cava

A

1) 80-140 mmHg
2) 20-40 mmHg
3) 4 mmHg

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10
Q

Where would you find the largest functional change in arterial pressure

A

In the arterioles

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11
Q

As for pulmonary circulation, what is the circulation pressure in 1) Pulmonary trunk, 2) Pulmonary capillaries and 3) Pulmonary veins

A

1) 3-30 mmHg
2) 10 mmHg
3) 4-12 mmHg

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12
Q

Pressure gradients in the heart chambers start out at _______ and gradually increase to.______

A

0-4 mmHg

100+ mmHg

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13
Q

Pressure gradients thru the systemic circulation start out at _______ and gradually increase to.______

A

100+ mmHg

0-4 mmHg

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14
Q

What are the 3 layers of a blood vessel

A

1) Tunica intima - smooth frictionless inner layer
2) Tunica media - smooth muscle and elastic fibers
3) Tunica externa (adventitia) - Thin layer of connective tissue

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15
Q

What are the ‘elastic arteries’ and what are their function

A

Pulmonary trunk, aorta and major branches
- Elastin > smooth muscle
Function - To stretch to absorb systolic volume of blood and recoil to return to original diameter

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16
Q

What are the blood flow characteristics of elastic arteries

A

High pressure, High velocity, small tonal cross section area

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17
Q

What are the ‘muscular arteries’ and what are their function

A

Medium to small size arteries.
Have a thinner tunica media - transition to less elastin and more smooth muscle
Function: muscular control distributing blood flow to arterioles throughout body

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18
Q

What is the major role of arterioles?

A

They act as a controller to direct blood to the capillary bends at slow/low pressure flow. They slow the velocity, pressure and volume travelling into the capillaries.

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19
Q

What is change of pressure in the arterioles

A

The largest drop in arterial pressures happen here.
Enter arterioles - 90-100 mmHg
Leave arterioles - 25-35 mmHg

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20
Q

What’s the size and make up of arterioles

A

0.5 mm

Mostly smooth muscle and minimal elastin

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21
Q

what are the blood flow characteristics of the arterioles

A

1) Decrease pressure
2) Decrease velocity
3) Increase total cross section area

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22
Q

What controls the functions of arterioles

A

Intrinsic - Metabolic demands and conditions

Extrinsic - Autonomic nervous system

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23
Q

What is the physical make up of capillaries

A

A Single endothelial layer with a basement membrane without tunica media and externa

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24
Q

What are the blood flow characteristics of capillaries

A

LOW pressure
SLOW velocity (1.5 sec for RBC to pass thru capilaries0
HUGE total cross section area (1000 x larger than aorta)
Individual cross section very narrow (one cell at a time)

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25
Q

What is the cross section of capillaries

A

Individual cross section very narrow

Total cross section huge

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26
Q

What is the functional role of capillaries?

A

Its the site of respiration (gas exchange) as well as nutrient and H2O exchange

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27
Q

How much of the circulating blood is generally found in the capillaries?

A

About 5%

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28
Q

At any given moment, most capillaries are _____

A

closed

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29
Q

What are some differences between arteries and veins

A

1) Veins have thinner and more fibrous walls
2) Veins have less elastin than arteries
3) Veins have larger diameter
4) Greater compliance of venous system allows for larger blood volume fluctuations w/o dramatic BP variations

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30
Q

When it comes to blood vessels which are more related to ‘elastance”

A

Arteries - More force is required to stretch and accommodate volume increase

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31
Q

When it comes to blood vessels which are more related to ‘compliance”

A

Veins - They expand easily to accommodate volume increase

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32
Q

What assists veins to direct blood flow back to the heart

A

One way valves (formed by in-folds of tunica intima)

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33
Q

By the time that blood reaches the heart from the veins it has increased in velocity (for its original velocity by)

A

60%

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34
Q

Since the veins have lower pressure. What are two pumps that assist in bringing blood back to the heart?

A

Respiratory pump - Thru inspiration

Muscular pump - Lower extremity muscles contract pushing blood to the heart as valves behind it close

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35
Q

After surgery or during a long flight one should be instructed to do ________, This will help avoid_____?

A

Ankle pumps

DVT - Deep vein thrombosis

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36
Q

What are some factors that affect blood flow?

A

1) Velocity
2) Pressure of fluid
3) Laminar vs. Turbulent flow
4) Resistance

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37
Q

How does resistance affect blood flow?

A

Resistance is inversely related to blood flow (increase resistance = decrease flow and volume per unit of time)

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38
Q

Describe Laminar flow

A

Perfect blood flow no resistance, RBC can ‘shoot’ thru system.

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39
Q

Describe turbulent flow

A

“Funny flow” something is getting in the way of the RBC making its way as fast as it can thru the system

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40
Q

Most resistance in blood flow is due to…(what else can?)

A

Length and diameter of blood vessels ( due to buildup or vasoconstriction and dilation)
Viscosity of blood - More ‘sludgy’ tougher time getting thru vessels

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41
Q

What is the most important determinant of blood viscosity

A

Hematocrit

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42
Q

What is the relation between hematocrit and blood viscosity.

A

As hematocrit increases, there is a DISPROPORTIONATE increase in viscosity.
Hematocrit increases from 40% to 60% viscosity doubles
Hematocrit = 40%, Relative viscosity = 4
Hematocrit = 60%, Relative viscosity = 8

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43
Q

What is Total Peripheral Resistance

A

Aka Systemic vascular resistance its the resistance to all systemic vasculature excluding pulmonary vasculature

44
Q

What is the vessels play a major role in regulating TPR (total peripheral resistance)

A

Arterioles - The narrowed channel of arterioles provide the most resistance

45
Q

What is the relationship between TPR (total peripheral resistance) and blood flow

A

Inverse: If you decrease resistance you are allowing for a larger diameter for blood to flow easier… It allows more arterial blood to reach the tissues and an increased blood flow to the venous system

46
Q

What are things contribute to the Neural control of TPR?

A

1) Autonomic nervous system
- Sympathetic and Parasympathetic
2) Baroreceptors
3) Chemoreceptors

47
Q

What are the sympathetic NS’s influence on TPR

A

1) Alpha and Beta receptors on BV
2) Epinephrine and norepinephrine
3) Nodal tissue and myocradium on the atria
4) Myocardium on ventricles

48
Q

What are receptors on blood vessels that allow sympathetic influence on TPR

A 
Alpha receptors (a1 and a2) - they CONSTRICT smooth muscles of BV
   - a1 - major constrictor
   - a2 - more inhibit relaxation (weaker constrictor)
Beta receptors (B2) - they DIALATE (or inhibit contraction) of smooth muscle of BV
49
Q

How does norepinephrine provide a sympathetic influence on TPR

A

NE has a strong affinity for alpha (both 1 and 2 but mostly a1) receptors that give a vasoconstriction response and they weakly bind to beta (B2) receptors which can help for vasodilation but it’s generally ‘overpowered’ by alpha receptor vasoconstriction

50
Q

How does epinephrine provide a sympathetic influence on TPR

A

Epi has a strong affinity for beta (B2) receptors = vasodilation response in some organs
Epi’s response is ‘concentration dependent’ - High epi concentration will bind to alpha receptors and overpower beta and will vasoconstrict

51
Q

What is the sympathetic NS role in the actual heart for TPR

A

In Atria - It acts on nodal tissue to increase HR and on the myocardium to increase the contractility of the atria
In Ventricles - It acts on the myocardium to increase contractility (strength) of the ventricles

52
Q

What is the sympathetic NS role in the kidneys for TPR

A

It forces the kidneys to retain more fluid and up Blood volume

53
Q

What is the parasympathetic NS influence on TPR

A

PS muscarinic (M3) receptors ‘indirectly’ promote vasodilation via a coupling reaction in BV wall. Acetylcholine binds to M3 recptors in BV that signals Nitric Oxide production. NO stimiulates vasodilation (counteracts a contraction that would have happened w/o NO.

54
Q

How do conditions like HTN and Reynaud’s affect parasympathetic NS influence on TPR

A

They block NO and when Ach binds to M3 receptors they vasoconstrict and increase blood flow resistance

55
Q

What is the parasympathetic NS role in the actual heart for TPR

A

Parasymp fibers innervate ATRIA ONLY.
Atria - Influence nodal tissue and decrease HR
Ventricles - NO INFLUENCE

56
Q

Where are baroreceptors (stretch receptors) localted?

A

Located in the aorta and carotid sinus

57
Q

How do baroreceptors (stretch receptors) affect HR

A

Pressure changes in the carotid flow will signal CV centers in the medulla to increase/decrease BV resistance and CO
If increase stretch (Simulated) (BP up) - Parasymp output up, Symp output down… CO/HR an contractility down. Systemic BV dilation up
If decrease stretch (BP down) - Parasymp output down and symp output up.

58
Q

Where are Arterial chemoreceptors located

A

In aorta and carotid arteries. Central receptors located in the brainstem (medulla)

59
Q

What is the major role of Arterial chemoreceptors

A

Respiratory rate but also has a smaller influence on resistance by vasodilating and constricting BV

60
Q

What is compliance?

A

The ability for a BV to stretch per given increase in BP (veins more than arteries)

61
Q

What is Elastance?

A

Ability for BV to return (Recoil) to original diameter. (arteries more than veins

62
Q

Arteries will not accommodate______?

A

A large blood volume change (unless accompanied by a large pressure increase)

63
Q

What is systolic pressure?

A

The highest atrial pressure during the cardiac cycle - It’s measured after the ventricular ejection

64
Q

What is diastolic pressure?

A

The Lowest atrial pressure during the cardiac cycle. It’s measured during ventricular (passive) filling

65
Q

What is pulse pressure

A

The difference btwen systolic and diastolic pressures (systolic - diastolic = PP).

66
Q

Pulse pressure is determined by….

A

Stroke volume

67
Q

What are pathological effects of pulse pressure

A

Any pathology that reduces contraction or filling of ventricle will reduce PP.

68
Q

What is Mean arteriole pressure (MAP) (how is it determined)

A

The average pressure of the arterial system. Measured by Diastolic pressure + 1/3 Pulse pressure

69
Q

What are normal MAP values

A

70-110 mmHg

70
Q

What are the Minimal and Maximal MAP values

A

Minimal - 50-60 mmHg (threshold to sustain visceral organ health
Maximal - > 160 mmHg (may elevate CSF and intracranial pressure.

71
Q

All changes in MAP are due to

A

A change in CO or TPR

72
Q

Why does a higher HR make MAP come closer to actual average btwn systolic and diastolic pressure (rather than diastolic + 1/3 PR

A

Because you’re eliminating or reducing the rest time in between heart beats when HR increases

73
Q

What is CVP

A

Central venous pressure - the assessment of the right ventricular function and systematic fluid status

74
Q

How is CVP measured

A

by a CVP catheter on the right side of the heart (on the SVC, IVC side to the right atria)

75
Q

What are normal CVP values?

A

Btwn 2-6 mmHg (values of the blood returning to right atria)

76
Q

What are factors that increase CVP?

A

1) Over hydration
2) CHF
3) Pulmonary trunk stenosis
4) Positive pressure breathing (like a ventilator or bag mask) or physiological straining

77
Q

What are factors that decrease CVP?

A

1) Under hydration
2) Transient orthostatic (stand up)
3) Negative pressure breathing (Iron lung)

78
Q

The mean CVP is determined by…

A

The High points and low points of the A wave

79
Q

What is the A wave of an EKG

A

It represents atrial contraction (high point = right ventricular-end diastolic pressure). Atria is contracted and tricuspid valve is open so atrial and ventricle pressures are equal

80
Q

What is the c wave of an EKG

A

Occurs at the closure of the tricuspid valve. Its peak occurs from the tricuspid valve bulging back into the atrium

81
Q

What is the x decent of an EKG

A

Represents atrial relaxation

82
Q

What is the V wave of an EKG

A

Represents the rise in atrial pressure before the tricuspid valve opens

83
Q

What is the y decent of an EKG

A

Represents atrial emptying as blood fills the ventricle

84
Q

What may tricuspid regurgitation show on an EKG

A

An enlarged V wave

85
Q

What is the z-point in an EKG

A

It occurs just before the tricuspid valve closes (mid to end QRS)

86
Q

What is Pulmonary Capillary wedge pressure (PCWP)?

A

Opposite of CVP it measures the back pressure of the left side of the heart

87
Q

What is PCWP measured

A

A balloon tipped catheter (Swan-Ganz catheter) is passed into a peripheral vein and goes thru the right atrium, ventricle and into the pulmonary artery (and branch). When balloon is inflated it indirectly measures the pressures within the pulmonary veins and left atrium

88
Q

What are the normal values of PCWP (or LAP Left Atrial PRessure)

A

8-10 mmHg

89
Q

What will an abnormal elevation in PCWP cause

A

Congestion (back up) into the pulmonary system

90
Q

What is the PCWP or LAP threshold (what happens then)

A

> 20mmHg, pulmonary edema may occur

91
Q

Why is PCWP measured?

A

1) Evaluate severity of any pathology causing elevated LAP.
2) Left ventricular failure
3) Mitral or Aortic valve stenosis or regurgitation
4) Evaluated pulmonary HTN
5) Monitor blood volume during hypotensive shock
6) Monitor and titrate diuretic meds

92
Q

What are some influences on MAP

A

1) CO
2) TPR
3) Hormonal control (endocrine system)
4) Venous compliance

93
Q

What are the hormonal influences on MAP

A

1) ADH
2) Renin-angiotensin system
3) Natriuretic peptides (ANP)
4) Adenomedullin
5) Insulin

94
Q

What is ADH’s influence on MAP

A

It stimulates the retention of water

95
Q

What is the Renin-angiotensin’s influence on MAP

A

It stimulates the retention of sodium and constricts BV

96
Q

What is Natriuretic peptides (ANP)’s influence on MAP

A

It stimulated excretion of sodium and water

97
Q

What is Adenomedullin’s influence on MAP

A

From the endothelium and smooth muscle of BV. They have a vasodilation effect on BV and thus decreasing MAP

98
Q

What is Insulin’s influence on MAP

A

Stimulates NO from endothelium to dilate BV

99
Q

What is the net result of the renin-angiotensin-aldosterone system

A

1) Blood pressure down
2) Fluid volume down
3) B2 sympathetics up

100
Q

What’s another role for Angiotensin II

A

It can be a direct vasoconstrictor

101
Q

What is Natriuretic peptides (ANP)’s influence on MAP

A

It stimulated excretion of sodium and water. Opposite effect of Renin angiotensin and ADH.

102
Q

What is Adenomedullin’s influence on MAP

A

From the endothelium and smooth muscle of BV. They have a vasodilation effect on BV and thus decreasing MAP

103
Q

What is Insulin’s influence on MAP

A

Stimulates NO from endothelium to dilate BV

104
Q

What is the net result of the renin-angiotensin-aldosterone system

A

1) Blood pressure down
2) Fluid volume down
3) B2 sympathetics up

105
Q

What’s another role for Angiotensin II

A

It can be a direct vasoconstrictor

106
Q

What is the venous return influence on MAP

A

Increase venous return increases preload SV/CO and indirectly increases afterload

107
Q

How much blood volume can the venous system accommodate?

A

Up to 60% and still maintain a 10 mmHg pressure

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

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