Cardiopulmonary II Flashcards
Name the 5 sections of the Aorta:
Ascending Aortic Arch Descending Thoracic Abdominal
What effect dampens pulsatile flow from heart?
Windkessel Effect
*due to elastic tissue
What are the 3 layers of arteries/veins?
Tunica Intima - endothelium
Tunica Media - Elastic/Smooth m.
Tunica Adventitia - CT
What is the site of the greatest resistance and largest pressure drop in the circulation?
Arterioles
Vasoconstriction leads to:
Vasodilation leads to:
Decreases Blood flow
Increases
Name 2 hormones that affect radius of arteries/arterioles.
Angiotensin II
Vasopressin
What makes up capillaries structurally?
Endothelium - single cell layer
Basal Lamina
What % of blood is in the veins at any given time?
60%
What layer is thinner in veins?
Tunica Media
*so not as much smooth muscle
What is the largest vein in the body?
What forms it?
Inferior Vena Cava
Common Iliac Veins
What forms the Superior Vena Cava?
Right and Left Brachiocephalic veins
What are the 1st three branches off the aortic arch?
excluding coronaries
Brachiocephalic trunk
Left common carotid
Left subclavian
What does the Brachiocephalic trunk split into?
Right common carotid
Right Subclavian
The internal carotid arteries are _____ to the externals.
Lateral to
Five divisions of arteries leading down the arm:
Subclavian Axillary Brachial Radial Ulnar
What are the 3 branches off the Celiac trunk?
Common Hepatic
Splenic
Left gastric
(look at figures)
What artery supplies small and large intestine?
Large intestine and rectum?
Superior mesenteric
Inferior mesenteric
(look at figures)
What supplies the kidney?
Left and Right Renal aa. and vv.
What does the Inferior vena cava split into as it descends?
L/R Common Iliac
L/R Internal Iliac
L/R External Iliac
L/R Femoral
*all aa. and vv.
What drains the liver?
Portal hepatic vein
The internal jugular vein is ____ to the external.
Medial
At rest % blood flow to the following areas: Renal: GI: Skeletal: Cerebral: Skin: Coronary:
25% 25% 25% 15% 5% 5%
Ohm’s Law:
Q = P/R
Pulmonary pressure originates:
Systemic pressure originates:
Right ventricle
Left ventricle
Systolic Pressure represents:
Diastolic Pressure represents:
Peak ejection pressure
Minimum pressure
What is meant by “diastolic runoff”?
The pressure exerted by the aorta that propels blood
What is the pressure storing effect of the aorta called?
Wind Kessel effect
What blood pressure measurement was invented by Korotkoff?
Auscultatoric
What blood pressure measurement uses electronic pressure sensor algorithm?
Oscillometric
MAP =
2/3 DP + 1/3 SP
DP + 1/3 PP
*PP = pule pressure (systolic - diastolic)
What is the sum of all resistance in the vasculature?
Total Peripheral Resistance (TPR)
or
Systemic Vascular Resistance (SVR)
What are the 3 sources of resistance in vasculature?
Viscosity
Length
Diameter
R=8 (viscosity) (length) / pi r to the 4th
What law?
What does this suggest?
Poiseuille’s Law
Radius is very important to resistance
Normal viscosity of blood is 4x thicker than…
Water
Anemia:
viscosity?
vascular resistance?
blood flow?
decrease
decrease
increase
Polycythemia:
viscosity?
vascular resistance?
blood flow?
increase
increase
decrease
Increasing vessels radius x2 increases flow…
Increasing vessel radius x4 increases flow…
16
256
Poiselle’s formula
How does vasoconstriction affect blood flow in arteries?
Why?
decreases blood flow
because elastic, pressure doesn’t build enough to increase flow
How does vasoconstriction affect blood flow in veins?
Increases flow
- pressure increases because lack of elastic structure
- *veins VERY sensitive to vasoconstriction/dilation
Q = P/R, analogous to:
CO = MAP / TPR
Short term regulation of Mean Arterial Pressure occurs via…
neural pathways
Long term regulation of Mean Arterial Pressure occurs via ____ and targets _____.
endocrine
kidneys and blood vessels
Where are the 2 primary baroreceptors that are involved in short-term regulation of the heart?
Carotid sinus
Aortic arch
What cranial nerves innervate the baroreceptors?
What is the destination in the brain?
Glossopharyngeal (IX) and Vagus (X)
Medullary cardiovascular (cardioregulatory) center of brainstem
What is the function of the Medullary Cardiovascular Center of brainstem?
Uses SNS or ParaNS in response to hyper/hypotension
Increasing constriction of veins will _____ venous return and ____ Mean systemic pressure.
Increase
Increase
T/F
Chronic hypertension can alter baroreceptor acuity
True
*allows hypertension to proceed unchecked
What do kidneys secrete in response to low BP?
Renin
What is the function of Renin?
Angiotensinogen > Angiotensin I
What secretes Angiotensinogen?
Liver
What enzyme converts Angiotensin I to Angiotensin II?
Where?
Angiotensin Converting Enzyme (ACE)
Lungs
What are the 4 primary effects of Angiotensin II?
Increases Aldosterone
Increases Na+ and H+ exchange
Increases Thirst
Vasoconstricts and Increases TPR
How does RAA pathway react to hemorrhage?
Renin > Angiotensinogen > Angiotensin I > Lung > Angiotensin II > 4 things
ADH, aka…
Vasopressin
What is the most important factor leading to secretion of ADH?
What else stimulates ADH secretion?
Increased Plasma Osmolarity
Hypovolemia
*ADH retains water, balancing (decreasing) osmolarity and increasing volume
What are the 2 primary effects of ADH?
What receptors are involved?
Increase water reabsorption in kidneys
(V2 receptors)
Vasoconstricts
(V1 receptors)
Where are V1 receptors?
Arterioles
What are two hormonal effects of atrial detection of too much blood volume?
Increased ANP (Atrial Naturetic Peptide)
Decreased ADH
Where is Atrial Naturetic Peptide secreted from?
Atria
What are ANP’s effects at the level of the vasculature?
At the level of the kidney?
Relaxes smooth muscle (Vasodilation)
Increased Na+ and water excretion
decreases volume Blood, ECF
TPR =
Total Peripheral Resistance
What two factors primarily affect Mean Arterial Pressure?
Cardiac Output
Total Peripheral Resistance
Why isn’t one data point good enough to diagnose hypertension?
Hypertension is chronic increase of MAP (mean arterial pressure)
What does hypertension do at the level of the vessel?
2 things
Decreases elasticity Damages Capillaries (eyes and kidneys)
What does hypertension do to the aorta?
Increases Afterload
- greatly increases workload of LV - hypertrophy
- *Bowling ball heart
T/F
Hypertension is a major risk factor for chronic kidney disease.
True
What are the ranges for BP: Normal Prehypertension Stage 1 hypertension Stage 2 hypertension
Below 120
120-139
140-159
160 and above
What is meant by secondary hypertension?
Secondary to a Primary disease
like hyperthyroidism, renal failure, etc
What is the difference between Atherosclerosis and Arteriosclerosis?
Atherosclerosis - Plaque build-up
Arteriosclerosis - Thickening and stiffening of walls
What layers does Arteriosclerosis preferentially thicken?
Tunica Intima and Media
*This increases rigidity and decreases elasticity
T/F
Arteriosclerosis can cause ischemia
True
*narrows lumen
What can weakening of vessel walls cause?
Aneurysm
What type of aneurysm, common in the abdominal aorta, constitutes the entire wall “outpouching”?
Circumferential or Fusiform
If only one portion of the arterial wall outpouches, it is called?
Where does this often occur?
Saccular (or Berry)
Circle of Willis
What type of aneurysm is common in the aortic arch?
What occurs?
Dissecting
Tunics separate and blood flows in
Where does the bulk of lymph come from?
Extra-cellular fluid
What are the 2 rare types of capillaries and where are they found?
Sinusoidal - Liver
Continuous - Brain
- sinusoidal very porous for exchange
- *brain continuous to maintain blood brain barrier
What is the most common type of capillary?
Fenestrated
T/F
Pinocytosis is a common way to exchange materials at the level of the capillaries.
False
at least in humans
What are the 4 Starling Forces?
Pc - capillary hydrostatic pressure
Pi - interstitial hydrostatic pressure
Pi-c - capillary oncotic
Pi-i - interstitial oncotic
*Pc and Pi-c are most important
What creates Oncotic Pressure?
Protein in the blood (while none in the interstitial fluid) creates a gradient IN to the capillary
What are the 4 things that don’t fit through capillary fenestrations?
Big proteins
RBC’s
WBC’s
platelets
Where does the Pc (capillary hydrostatic pressure) dominate?
Where does the Pi-c (capillary oncotic pressure) dominate?
Beginning of capillary bed
End of capillary bed
When all the pressures (oncotic/hydrostatic and capillary/interstitial) added up, what is the net?
Small amount of fluid is pushed into the interstitium
*this creates Lymph
What happens if Pc is too high?
Pi-c too low?
Both lead to Edema
Other than Pc being high or Pi-c being low, what other 2 conditions can cause edema?
Trauma
Lymphatic blockage
What collects lymph on the right and left side?
Which collects more lymph?
Right: rt lymphatic duct
Left: Thoracic duct
Thoracic duct collects most lymph in body
Where does the Right Lymphatic Duct drain?
Thoracic duct?
Right subclavian
Left subclavian
What region of the body is drained by the Right Lymphatic Duct?
Right head, neck, arm and chest
T/F
There are no cells in lymphatic fluid
True
with the exception of cancer
What are the 2 types of edema?
What are they caused by?
Which is more common?
Pitting and non-pitting
Non-pitting caused by excess protein and debris as well as fluid
Pitting more common
What are 4 causes of Edema?
increase Pc
decrease Pi-c
increase capillary permeability
blocked lymphatics
What are the muscles of inspiration?
Diaphragm
External Inercostals
What are the muscles of expiration?
Internal intercostals
Abdominal muscles
What spinal nerves are required for diaphragm function?
C3-C5
*Phrenic nerve
How do the external intercostals move the ribs?
Elevate superolaterally
Move sternum anteriorly
Inhalation is innervated by the _____ nerve and exhalation is generally a ______.
Phrenic
Passive process
Why do emphysema pts have to force air out?
Diaphragm has lost elasticity
Lower respiratory structures starting with the trachea:
Trachea Bronchi Bronchioles Alveolar Ducts and sacs Alveoli
At what branching does the conduction zone turn into the respiratory zone in the lung?
Around 16-17
Where does most airway resistance occur in breathing?
Bronchi and Bronchioles
*lots of smooth muscle
What receptors induce bronchodilation?
What receptors induce bronchoconstriction?
Beta-2 (symphathetic)
Muscarinic (parashympathetic)
T/F
The alveoli have cilia
False
no smooth muscle either
What is the structure of respiratory epithelium?
Pseudostratified ciliated columnar epithelium
4 paranasal sinuses:
Frontal
Maxillary
Sphenoidal
Ethmoidal
3 Tonsils:
Pharyngeal
Palatine
Lingual
What are the triangular structures in the posterior Larynx?
What is on top of them?
Arytenoid
Corniculate
3 types of Bronchi, 3 types of alveolar structures, what’s in between?
Primary, Secondary, Tertiary bronchi
Bronchioles
Alveolar ducts, sacs, Alveoli
Lobes Left lung and Right lung?
Left - 2
Right - 3
What are the 2 Pleura that line the lung?
What is in between?
Visceral Pleura
Parietal Pleura
Pleural Cavity - filled with fluid
What is the presence of air in the intrapleural space called?
What does it lead to?
Pneumothorax
Collapse
What type of tissue lines the alveolus?
What secretion lines it?
Simple squamous (type I alveolar cell) Surfactant
What type of cell secretes surfactant in the alveolus?
Type II alveolar cell (pneumocyte)
What constitutes 90% alveolar surface area?
Type I alveolar cell (pneumocyte)
*simple squamous
What often contains granules of exogenous material in the alveolus?
Dust cell macrophage
What can diagnostic spirometry tell us?
Disease Type and Severity
What treatment is often used to reduce the risk of Atelectasis?
Incentive Spirometry
What is in/out volume of quiet breathing?
What is the volume?
Tidal Volume
500mL
What is the air that does not participate in gas exchange called?
Anatomical Dead Space
Alveolar Volume =
(Tidal Volume - Anatomical Dead Space) x Respiratory Rate
*this is a one minute calculation
What is the amount of air you can inspire above the normal tidal volume?
Inspiratory reserve
What is the amount of air you can expire below normal tidal volume?
Expiratory reserve
After forced expiration, what is the amount of air left over?
Residual volume
What is the Functional Residual Capacity?
Residual Volume + Expiratory Reserve volume
Where does IC (Inspiratory Capacity) begin and end?
Bottom tidal volume to top inspiration
T/F
The Vital Capacity does not include the Residual Volume
True
Orthostatic/Postural hypotension (standing up too quickly) can be caused by?
Delay in baroreceptors
Anti-hypertensive drugs can often be…
Diuretics
Non-selective Beta blockers act where?
Beta-1 Heart
Beta2 Lungs
A selective Beta blocker acts where?
Beta1 Heart
Why might cessation of Beta1 blockers lead to sudden death?
Sometimes Beta1 receptors have been increased and sympathetic overcompensates
What type of drug prevents Angiotensin I from being converted to Angiotensin II in the lungs?
ACE inhibitor
What type of drug prevents the binding of Angiotensin II?
ARB - Angiotensin Receptor blocker
What type of drug stops Angiotensin at its source?
DRI - Direct Renin Inhibitor
What type of drug decreases force of contraction of the heart as well as decreasing the SA node firing rate?
CCB - Calcium Channel blockers
- this also affects smooth muscle so constipation is a side effect
- *generally dilates BV’s, causes headaches
What type of drug only effects Calcium channels in Smooth Muscle?
CCB - Calcium Channel blocker (selective)
