Cardiology Review (Exam 2) Flashcards
Describe the path of blood from the vena cava to the aorta
vena cava –> right atrium –> right ventricle –> lungs –> left atrium –> left ventricle –> aorta –> body
name the four chambers of the heart
left ventricle
left atrium
right ventricle
right atrium
where does the right side of the heart pump to? the left?
right - pulmonary circulation
left - systemic circulation
what are the physical differences between arteries and veins
arteries - thicker tunica media, smooth musculature due to high pressure, low volume
veins - more narrow, low pressure, high volume
describe the hierarchy of vasculature from the largest vessels down to the smallest
arteries/veins
arterioles/venules
capillaries
the definition of hypertension
any blood pressure >130/>80
what causes hypertension
genetics, sodium retention, diet, exercise amount, etc.
increase in peripheral resistance
what is the difference between systolic and diastolic blood pressure
systolic - heart contraction
diastolic - heart relaxation
what are the symptoms of hypertension
asymptomatic!!!
what are the consequences of untreated hypertension
organ failure - occurs after 20 years
which receptors are responsible for vasoconstriction
alpha1
beta 1 in heart and kidneys
which receptors are responsible for vasodilation
beta 2 - skeletal and smooth muscle
what two factors have a direct effect on blood pressure?
peripheral resistance and cardiac output
describe the RAAS system. how does it work to regulate blood pressure?
activates renin when pressure is low
activation of RAAS increases blood volume, which increases blood pressure
what other endogenous compounds can affect blood pressure?
prostacyclins (inflammatory mediators)
nitric oxide
naturetic peptides
What is ADH/Vasopressin and how does it affect blood pressure
anti diuretic hormone (part of RAAS)
inc water reabsorption –> increase in blood volume –> inc blood pressure
what are some factors that may contribute toward the Patho of hypertension?
sodium retention
over activation of RAAS
overactivation of SNS
vascular endothelial dysfunction
describe the actions of beta1, beta2, alpha1, and alpha2 receptors and where they are located
beta1 - vasoconstrictor, heart (inc contractility)
beta 2 - vasodilator, lungs
alpha 1 - vasoconstrictor, attires/veins
alpha2 - presynaptic neuron, stops flow of ACh
describe how lipids are processed and transported in the body
packaged into cholymicrons –> intestines to liver –> breakdown with lipoprotein lipase, makes VLDL –> VLDL leaves liver into blood stream –> drops nutrients in the body –> converts to IDL then LDL, LDL back to liver via LDL receptors
why are lipoproteins needed?
water is waterbased
Which lipoproteins contain Apo-B? Apo-A?
Apo-B: chylomicrons, VLDL, IDL, LDL
Apo-A: HDL
purpose of HDL
picks up excess cholesterol in the blood and brings it back to the liver
what is dyslipidemia
abnormal blood lipid levels caused by inflammation
what are the symptoms of dyslipidemia
asymptomatic
what are the consequences of artherosclerosis
compromising blood flow
nutrient exchange impaired
plaque development –> rupture of plaque
what is the largest driver in the development if dyslipidemia subsequent atherosclerosis
inflammation
how are LDL particles cleared from the blood?
HDL picks up and brings excess to the liver
LDL returned to the liver through LDL receptors
describe the steps in the development of atherosclerosis
inflammation event –> LDL attracted to site –> immune system triggers VLDL out of liver –> LDL and WBCs converge –> WBC killed and becomes foam cell –> generates plaque
what is hypertriglyceridemia and what causes it?
type of severe dyslipidemia
excessive triglycerides leads to CV damage
can be from diabetes
what are the consequences go hypertriglyceridemia
extreme elevations lead to acute pancreatitis
nausea, vomiting, persistent epigastric abdominal pain, fever, low bp, high levels of pancreatic enzymes, etc.
what is peripheral artery disease? intermittent claudication?
plaques in the peripheral arteries (limbs)
pain in the extremities due to reduced oxygen supply; pain due to exercise at rest is fine
what is ischemic heart disease? what are the symptoms?
plaques in the coronary arteries; can lead to MI
angina
what is acute coronary syndrome? what are the three types?
sudden obstruction or rupture of plaques lead to thrombus formation in coronary arteries
types: unstable angina, NSTEMI, STEMI
what are the symptoms of ACS
angina, sweating, dizziness, loss of consciousness, abnormal breathing
what happens after ACS? What is cardiac remodeling
congestive heart failure/arrhythmia
scar tissue forms and heart can’t contract or relax like normal tissue
what is heart failure?
reduction in cardiac output
what causes heart failure?
some acute ischemic event to the heart
long standing HTN
what are symptoms of heart failure?
tachycardia, peripheral edema, pulmonary edema, trouble breathing, cough, fatigue, etc.
what is the difference between reduced ejection fraction and preserved ejection fraction heart failure
reduced - dilated ventricles, cardiac output decreased, thinner walls
preserved - stiffened myocardium, thicker walls, muscles can’t relax
what are the compensatory mechanisms involved in HF
activation of RAAS
activation of SNS
increase cardiac output
what objective measure can be clinically followed to determine the status of a patients heart failure
weight
what two factors have a direct effect on cardiac output
stroke volume and heart rate
how does preload and after load affect stroke volume?
preload - increase preload, increase stroke volume
afterload - increase after load, decrease stoke volume
how does fluid volume and vessel diameter affect preload?
fluid volume - inc volume, inc preload
diameter - larger, dec preload
what is after load? how does vessel diameter effect it?
afterload - resistance the left ventricle overcomes to pump blood to the aorta
larger diameter, lowers pressure, dec afterload
how does contractility affect stoke volume?
increase contractility, increase stroke volume
what affect does activation of beta1 receptors have on contractility? M2 receptors?
beta1 - inc contractility
M2 - dec contractility
how does preload affect contractility?
volume goes up, pressure should go up
increase preload, increase contractility
how does cardiac remodeling affect heart failure?
scarring makes heart worse –> inc failure
what is acute decompensated heart failure?
sudden worsening of heart failure
how are ADHF patients categorized based on perfusion and volume?
perfusion - warm (stable) and cold (hypo perfusion)
volume - dry (stable, no fluid) and wet (fluid overload)
what is an arrhythymia
irregular heart rhythm or rate
what causes arrhythmias
energy drinks, drugs, damage to cardiac tissue, imbalance in electrolytes, etc.
what are the symptoms of arrhythmia?
palpitations, chest discomfort, light headedness
depends on the type of arrhytmia
what are the three most common ways to classify arrhythmias?
location, how they effect the heart and the type of conduction abnormality
what are pacemaker cells? what is automaticity?
pacemaker cells - generate action potential
automaticity - don’t need input from the nervous system to create an action potential
what are the two sets of pacemaker cells in the heart?
SA node
AV node
How does the sympathetic and parasympathetic nervous system affect heart rate? what receptors are involved?
sympathetic - increases heart rate
parasympathetic - decreases heart rate
beta1 receptors
depolarization at phase 0 occurs due to influx of
sodium
phase 1 notch is due to efflux of
potassium
phase 2 plateau is due to influx of ____ and eflux of ____
calcium
potassium
phase 3 depolarization is due to
potassium efflux
what does the P wave in the EKG represent? QRS wave? T wave?
P wave - atrial depolarization
QRS wave - ventricular depolarization
T wave - ventricular repolarization
describe what heart block arrhythmia is
block does not allow full action potential
failure of normal propagation of action potentials from atrium to ventricle
which arrhythmia are more common?
tachyarrythmia
describe the normal pathway of action potential starting from SA node
SA node –> AV node –> down bundle branches
what is an ectopic pacemaker?
cardiac cells gain automaticity and begins to spontaneously depolarize
what is atrial fibrillation? what causes A fib?
atrium cannot effectively contract, can form thrombus
causes - ischemia, HTN, damage to myocardium
what are the consequences of A fib?
stroke and heart failure
what is ventricular fibrillation? what causes V fib
ectopic centers in ventricular area, can’t pump properly, most dangerous
causes - ectopic pacemakers
what are the consequences of vfib
death
what is shock
lack of blood flow leading to organ failure, impairment of cellular metabolism
name and describe 3 types of shock
hypovolemic shock - low fluid volume from bleeding
cardiogenic shock - damage/dysfunction of the heart from MI
distributive shock - leaky blood vessels and excessive vasodilation (ex: septic shock)
