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PHTH 536 - Body Systems > Cardiopulmonary - Anatomy and Physiology > Flashcards

Cardiopulmonary - Anatomy and Physiology Flashcards

Lecture #1

1
Q

What areas are supplied by the circumflex arteries?

A
  • Inferior wall of left ventricle (when it’s not supplied by the right coronary artery)
  • Left atrium
  • Sinoatrial node (around 40% of humans)
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2
Q

What areas are supplied by right coronary artery?

A
  • Right atrium
  • Right ventricle
  • Inferior wall of left ventricle (in most humans)
  • Atrioventricular (AV) node
  • Bundle of His
  • Sinoatrial (SA) node (around 60% of humans)
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3
Q

What areas are supplied by the left anterior descending artery?

A
  • Left ventricle
  • Interventricular septum
  • Right ventricle
  • Inferior areas of the apex
  • Inferior areas of both ventricles
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4
Q

What percentage of humans does the circumflex artery supply the SA node?

A

around 40% of humans

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5
Q

What percentage of humans does the right coronary artery supply the SA node?

A

around 60% of humans

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6
Q

In order from the outside, what are the tissue layers of the heart?

A

Fibrous pericardium
Parietal pericardium
- with pericardial cavity in between
Visceral pericardium (also known as epicardium)
Myocardium
Endocardium

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7
Q

What is identified as the heart muscle?

A

the myocardium

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8
Q

How is the myocardium different from skeletal muscles?

A

Due to automaticity
- there are pacemaker cells that keep the heart moving without conscious voluntary control

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9
Q

What influences the myocardium?

A

Both sympathetic and parasympathetic pathways of the autonomic nervous system

External factors also play a role (stress, exercise, caffeine, elicit and Rx drugs)

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10
Q

What bundle influences the parasympathetic nervous system and what does it do?

A

Vagus nerve bundle

Some voluntary control over the HR to help it slow down

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11
Q

What other elements are associated with the myocardium?

A

Conductive and contractile elements

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12
Q

How is the blood supply of the myocardium?

A

Heavily reliant and demanding of O2

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13
Q

What are the structures that are lined by the endocardium?

A

myocardium, valves and atria

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14
Q

What is the structure of the endocardium?

A

Thin, smooth layer of cells which has some connective tissue and some elastic fibers and muscle tissue

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15
Q

What is the function of the endocardium?

A
  • has a smooth surface to allow blood and platelets to flow freely and not adhere to heart walls
  • strengthens the valves and support other heart tissue
  • supports the subendocardial layers
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16
Q

What structures are found in the subendocardial layer?

A

Purkinje fibers

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17
Q

What valves are within the atrioventricular valves?

A

Tricuspid and mitral

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18
Q

Where is the tricuspid valve located?

A

From the right atrium to the right ventricle

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19
Q

Where is the mitral valve located?

A

From the left atrium and left ventricle

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20
Q

What valves are within the semilunar valves?

A

Aortic and pulmonary

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21
Q

Where is the pulmonary valve located?

A

From the right ventricle and pulmonary artery (to lungs)

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22
Q

Where is the pulmonary valve located?

A

From the left ventricle and aorta

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23
Q

What is the pathway for deoxygenated blood from the body?

A

Vena cava
Right atrium
Tricuspid
Right ventricle
Pulmonary valve
Pulmonary artery
Lungs

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24
Q

What is the pathway for oxygenated blood?

A

Through the pulmonary veins
Left atrium
Mitral valve
Left ventricle
Aortic valve
Aorta
Body

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25
Q

What is the equation for cardiac output?

A

CO = HR x SV

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26
Q

What is cardiac output?

A

Amount of blood ejected out of the left ventricle into the systemic vasculature per minute

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27
Q

How many liters of blood is ejected at rest?

A

4-5 L/minute

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28
Q

How long does it take for blood to travel through the pulmonary and system circuits?

A

About 1 minute

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29
Q

What happens when one of the cardiac output is compromised?

A

Compensation occurs which will need outside intervention to compensate

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30
Q

What is stroke volume?

A

Amount of blood ejected out of the left ventricle/beat

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31
Q

How much blood is ejected per beat?

A

55-100 mL/beat

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32
Q

What is stroke volume affected by?

A

left ventricular end diastolic volume and end systolic volume

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33
Q

What is left ventricular end diastolic volume?

A

Amount of blood left in ventricle at the end of diastole

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34
Q

What is end systolic volume?

A

Volume returning to the heart

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35
Q

What is preload?

A

The amount of stretch experienced by cardiac sarcomeres pre-contraction

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36
Q

What is Starling’s law?

A

The greater the LVEDV - the greater the stretch and volume pumped

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37
Q

What is DIRECTLY proportional to stroke volume?

A

Preload

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38
Q

What affects preload?

A

Affected by venous return and volume of returning blood

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39
Q

What is afterload?

A

the force the left ventricle must generate to overcome aortic pressure to open aortic valve

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40
Q

What is INVERSELY related to stroke volume?

A

Afterload

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41
Q

What is contractility?

A

The squeezing pressure of the left ventricle

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42
Q

What is ejection fraction?

A

The percentage of blood emptied from the ventricle during sytole

clinically useful way to understand left ventricle function

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43
Q

What is the equation of ejection fraction?

A

SV/LVEDV

The volume of blood ejected (SV) in relation to the amount of blood received before contraction (LVEDV)

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44
Q

What are the normal averages of ejection fraction?

A

> 55% (60-70%)

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45
Q

What does a lower ejection fraction percentage mean?

A

more impaired the ventricles

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46
Q

What does a low EF indicate?

A

indicator of cardiomyopathy or heart failure

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47
Q

What produces a rate pressure product?

A

HR x SBP

Which increases with activity and with HR and/or BP

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48
Q

What does the sympathetic system stimulate?

Also called the adregenic

A
  • Increase HR and force of myocardiaal contraction = increase in myocardial in myocardial O2 demand
  • coronary artery vasodilation
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49
Q

What controls the adrenergic stimulation?

or sympathetic stimulation

A

The medulla via T1-T4

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50
Q

What is an example of a sympathetic blockers?

A

Antihypertensives

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51
Q

What nodes do the adrenergic innervate?

A
  • SA node
  • AV node
  • Conduction pathways
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52
Q

What controls the parasympathetic stimulation?

or the cholinergic

A

The medulla via vagus nerve (X) and the cardiac plexus

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53
Q

What does the cholinergic innervate?

A

SA and AV nodes

54
Q

What are the effects of the parasympathetic stimulation?

A
  • Slows rate and force of myocardial contraction = decrease in myocardial demand
  • coronary artery vasoconstriction
55
Q

Where are baroreceptors located?

or pressoreceptors

A

Walls of aortic arch and carotid sinus

56
Q

What reflex responds to BP changes?

A

circulatory reflex

57
Q

What does an increase in BP result in?

A
  • Parasympathetic stimulation
  • decrease rate
  • force of contraction
  • sympathetic inhibition results in decreased peripheral resistance
58
Q

What does a decrease in BP result in?

A
  • sympathetic stimulation
  • increased HR
  • increased BP
  • vasoconstriction
59
Q

Where are chemoreceptors located?

A

In the carotid body
- near the bifurcation of the carotid artery

60
Q

What are chemoreceptors sensitive to?

A

Changes in O2, CO2 and lactic acid (pH) and will affect HR and RR

61
Q

What does increased CO2 or decreased O2 or pH result in?

A

Increase in HR and RR

62
Q

What is the result of increased O2?

A

Decreased HR

63
Q

What is hyperkalemia and its outcomes?

A

Increased concentraction of potassium ions

  • decreased HR
  • decreased contractile force
  • arrhythmias
  • EKG changes (wide PR intervals and QRS, tall T-waves)
64
Q

What is hypokalemia and its outcomes?

A

decreased concentration of potassium ions

  • EKG changes (flat T waves, prolonged PR intervals)
65
Q

What is hypercalcemia and its outcomes?

A

Increased calcium concentration
- increased HR
- Increase inotrophic effectrs
- kidney affected, confusion or coma

66
Q

What is hypocalcemia and its outcomes?

A

Decreased calcium concentration
- can cause arrhythmias

67
Q

What is hypermagnesmia and it’s outcomes?

A

Increased magnesium concentration and calcium blocker
- calcium blocker
- arrhythmias or cardiac arrest
- hypotension
- Confuction
- lethargy

68
Q

What is hypomagnesmia and its outcomes?

A

decreased magnesium concentration
- ventricular arrhythmias
- coronary artery vasospam

69
Q

Where does action potential start?

A

At the SA node which depolarizes the atria which then spread to the AV node

70
Q

Why is there a .1 second delay during depolarization?

A

Allowing for the atria to contract and ventricles to fill

71
Q

What is systole?

A

The period of contraction that the heart undergoes while it pumps into circulation

72
Q

What is diastole?

A

The period of relaxation that occurs as the chambers fill with blood

73
Q

What happens to the coronary arteries during diastole?

A

It perfuse the myocardium duyring diastole through the capillaties

As the aortic valve snaps shut leftover blood and is shunted to the coronary arteries

74
Q

What areas involved in gas exchange?

A

Only the respiratory zone and not the conducting zone

75
Q

Describe the pleurae of the lungs

A

A double layered membrane that folds back on itself
- visceral: innermost
- parietal: outermost

76
Q

What is present in the pleural cavity?

Analgous to the pericardial cavity

A

Pleural fluid

77
Q

What is the purpose of the pleural fluid?

A

Creating surface tension to keep the lungs in place of the thorax which lets the lungs to expand when the thorax expands

Cushions and lubricates the lungs during expansion and retraction

78
Q

What happens when tension in the pleura is lost?

A

the lungs collapses

pneumothorax

79
Q

What innervates the parietal pleura?

A

Phrenic and intercostal nerves

allows for pain, temperature and touch

80
Q

What is the **accessory ** muscles of the inspiration?

A
  • SCM = elevates sternum
  • scalenes group = elevate upper ribs
  • pectoralis minor
81
Q

What is the **principal ** muscles of the inspiration?

A
  • external intercostals (interchondral part of internal intercostals) = elevates the ribs
  • diaphragm = dome descends and increasing vertical dimension of thoracic cavity. elevates lower ribs
82
Q

Muscles of quiet breathing of expiration

A

Expiration results from passive, elastic recoil of the lungs, dib cage and diaphragm

83
Q

Muscles of the quiet breathing of active breathing

A
  • internal intercostal except interchondral part = pulls ribs down
  • abdominals = pulls ribs down, compress abdominal contents thus pushing diaphragm up
  • QL = pulls ribs down
84
Q

What is atmospheric pressure?

A

Pressure exerted on the lungs by the outside atmosphere

85
Q

What is intra-alveolar pressure?

A

Pressure exerted within the alveoli

86
Q

What is intrapleural pressure?

A

Pressure within the two layers of the pleurae

87
Q

What creates an inward pull?

A

Elasticity of the lungs and the surface tension of the alveoli

Surfactant prevents the alveoli from collapsing during experiation

88
Q

What creates an outward pulls?

A

Surface tension within the pleural cavity

Parietal pleura attached to thoracic wall

89
Q

What is pulmonary ventilation?

A

Air moving in and out of the lungs

90
Q

What is the muscular process of inspiration?

A
  • Diaphragm contracts = thorax expands inferiorly
  • External intercostals contract = pulls ribs up and out = expands thorax anteriorly
  • this creates a pressure gradient which drives air into the lungs
91
Q

Is normal expiration active or passive?

A

Largely passive

92
Q

What is the muscular process of expiration?

A
  • Diaphragm and external intercostals relax
  • The natural elastic recoil of the lungs puts the thorax back to normal = decreases volume of the thorax
  • creating a pressure gradient and drives air out the lungs
93
Q

What is the physical properties of the lungs to help with breathing?

A
  • lung compliance = distensibility (extend) of lung tissue (balloon)
  • tendency of the lungs to recoil (collapse)
  • elastic recoil or elasticity
  • surface tension at air-liquid interface on the alveolar surface to collapse alveoli
  • resistance to airflow at the level of the airway
94
Q

What is transmural pressure?

A

The difference between the intrapulmonary pressure and intrapleural pressure
- this needs to be maintained through a distending (expanding) force

95
Q

How is distending force provided?

A

Provided by inspiratory muscles and complaince and elastic properties of the lungs

96
Q

What surrounds the alveolar network?

A

Elastin and collagen which surrounds the surrounding capillaries and bronchi

97
Q

What counters the surface tension on the alveolar surface?

A

Surfactant

98
Q

Clinical application of scoliosis for breathing

A

impairs the ability of the ribcage to expand which impairs the ability of the lungs to expand

99
Q

Clinical application of pulmonary fibrosis for breathing

A

impairs compliane of lungs

100
Q

Clinical application of COPD for breathing

A

over inflates the lungs by trapping air so it affects the elasticity of the lungs

101
Q

Clinical application of asthma for breathing

A

increasing resistance to airflow due to brochoconstriction

102
Q

Clinical application of premature babies (< 7 months) for breathing

A

reduces surfactant = alveolar collapse

103
Q

Clinical application of TBI for breathing

A

Neural control of breathing

104
Q

Where in the brain controls breathing?

A

Medulla and pons

105
Q

What does breathing require?

A

Repetitive stimulation from the brain and nerve stimulation to muscles

106
Q

What is respiration driven by and what does it stimulate once a certain level is reached?

A

Driven by CO2 and pH levels
- this stimulates the central chemoreceptors in the medulla

107
Q

What occurs once CO2 increases?

A

pH decreases which stimulates the respiratory centers in the medulla
- this contracts the diaphragm and external intercostals = increases the rate and depth of respiration

108
Q

Where are peripheral chemoreceptors located?

A

In the carotid artery and aortic arch

109
Q

What occurs as CO2 decreases?

A

pH increases = respiratory centers to lower rate and depth of respiration

110
Q

How does peripheral chemoreceptors influence respiratory centers?

A
  • Driven by the chemoreceptors for CO2 vs O2
  • Increasing ventilation because of increases levels of CO2
  • Increased ventilation because of lower levels of CO2
111
Q

What is hypercapnia?

A

Increase ventilation because of increased CO2 levels

112
Q

What is hypoxia?

A

Increased ventilation because of decreased CO2 levels

113
Q

What occurs with chronic COPD patients regarding breathing?

A

They trap CO2 and start to rely more on O2 receptors = hypoxic drive to breath

114
Q

How is supplemental O2 administered for chronic COPD patients?

A

cautiously administered because the increased O2 saturation will suppress the hypoxic drive to breath

115
Q

What other systems influence breathing?

A

Hypothalamus and limbic
- i.e anxiety or stress can increase rate. fear can cause holding breath

116
Q

What is gas exchange?

A

Respiration

117
Q

What is the primary role of the pulmomary system?

A

get O2 in and CO2 out

118
Q

Where does gas exchange occur?

A

Occurs in the respiratory zone of the lungs closer to the bottom because of its smaller but has more alveoli at the base
- gas diffuses across membranes down a concentration gradient
- driven by gases in the air and blood pH

119
Q

How does effective has exchange occur?

A

Alveoli must be both:
- ventilated = flowing in and out
- perfused = blood flowing into alveoli capillaries

120
Q

What is the goal for ventilation?

A

V to be matched by perfusion > Q (V/Q match)
- V/Q mismatch - pathological state

121
Q

What can impact ventilation and perfusion?

A

Positioning

122
Q

How does non-uniform ventilation affect gas exchange?

A
  • Areas of the lungs with greater perfusion act as shunts
  • Areas with greater ventilation considered dead space
123
Q

How is O2 and CO2 transported?

A

Veins carry CO2 to the lungs
Arteries carry O2 from lungs to peripheral tissues

124
Q

What does hemoglobin HgB made of?

A

4 iron molecues -hemes
4 protein molecules -globins

Exists in different forms

125
Q

What is oxyhemoglobin?

A

Hgb carrying O2

126
Q

What is doxyhemoglobin?

A

Hgb that has released O2 to peripheral tissues

127
Q

What is carboxyhemoglobin?

A

Hgb bound to CO instead of O2 = which is abnormal

128
Q

Hgb tranports how much O2 and to where?

A

Transports 98% of O2 to the periphery with 2% in plasma

129
Q

What is SaO2?

A

Oxyhemoglobin/total hemoglobin (blood gas analysis)

called SpO2 when measured with pulse oximeter

130
Q

What is the O2 carrying capacity of the body?

A

Determined by concentration of Hgb
- Women = 12-16 g/dL
- Men = 13-16 g/dL

131
Q

What is anemia?

A

Lower than normal concentration of Hgb which impairs the body’s ability to circulate O2

PHTH 536 - Body Systems (5 decks)

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