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DPT 503 > cardiovascular - lecture 2 > Flashcards

cardiovascular - lecture 2 Flashcards

1
Q

cardiac output

A

amount of blood pumped out by each ventricle in 1 minute

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2
Q

cardiac output equals

A

heart rate (HR) times stroke volume (SV)

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3
Q

stroke volume

A

volume of blood pumped out by one ventricle with each beat

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4
Q

stroke volume correlates with the force of _________.

A

contraction

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5
Q

at rest the cardiac output is . . .

A

5.25 L/min

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6
Q

cardiac index =

A

cardiac output x body surface area

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7
Q

normal cardiac index is

A

3 L/min/m2

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8
Q

cardiac output varies directly with _____ and ______.

A

SV and HR

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9
Q

______ increases when the stroke volume __________.

A

cardiac output
increases

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10
Q

_____ increases when the heart beats __________.

A

cardiac output
faster

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11
Q

cardiac reserve

A

the difference between resting and maximal cardiac output

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12
Q

stroke volume =

A

EDV - ESV

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13
Q

EDV is affected by . . .

A

length of ventricular diastole and venous pressure (~120 ml/beat)

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14
Q

ESV is affected by . . .

A

arterial BP and force of ventricular contraction (~50 ml/beat)

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15
Q

normal SV =

A

120 ml - 50 ml = 70 ml/beat

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16
Q

three main factors that affect SV:

A

preload
contractility
afterload

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17
Q

preload

A

degree to which cardiac muscle cells are stretched just before contraction

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18
Q

relationship between preload and SV called

A

Frank-Starling law of the heart

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19
Q

changes in preload causes changes in . . .

A

stroke volume

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20
Q

increased venous return increases the . . .

A

ventricular filling (end-diastolic volume)

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21
Q

myocytes stretching increase the . . .

A

sarcomere length

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22
Q

positive inotropic (contractility)

A
  • epinephrine from adrenal medulla
  • norepinephrine from sympathetic nerve endings
  • promote calcium influx & increased contraction strength
  • digoxin, dopamine, isoproterenol, milrinone
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23
Q

negative inotropic agents

A
  • reduction of sympathetic stimulation — reduced contractility
  • acidosis, increased extracellular K+, calcium channel blockers
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24
Q

afterload

A

the pressure that ventricles must overcome to eject blood

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25
Q

major pressure is . . .

A

back pressure from arterial blood pushing on SL valves

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26
Q

aortic pressure is around . . .

A

80 mmHg

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27
Q

pulmonary trunk pressure is around . . .

A

10 mmHg

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28
Q

___________ increases afterload, resulting in increased ___ and reduced ___

A

hypertension
ESV
SV

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29
Q

afterload is _____________ to the stroke volume

A

inversely proportional

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30
Q

chronotropic effect

A

any mechanism that alters cardiac rate

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31
Q

POSITIVE chronotropic effect ___________ HR

A

increases

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32
Q

NEGATIVE chronotropic effect _________ HR

A

decreases

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33
Q

heart rate can be regulated by:

A

autonomic nervous system
chemicals
other factors

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34
Q

_________ or _____________ can activate the sympathetic nervous system

A

emotional or physical stressors

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35
Q

norepinephrine is released and binds to B1-adrenegric receptors in the heart causing:

A
  • SA node fires more rapidly, increasing HR
  • increased contractility
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36
Q

the parasympathetic nervous system _______ sympathetic effects

A

opposes

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37
Q

acetylcholine ___________ pacemaker cells by opening __________ which slows _____

A

hyperolarizes
K+ channels
HR

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38
Q

heart at rest exhibits a . . .

A

vagal tone

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39
Q

parasympathetic is the . . .

A

dominant influence on heart rate

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40
Q

chemical regulation of heart rate are . . .

A

hormones
ions

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41
Q

other factors that influence heart rate

A

age
gender
exercise
body temperature

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42
Q

best indicator of cardiac function is . . .

A

ejection fraction

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43
Q

ejection fraction is . . .

A

percentage of blood ejected from ventricles relative to the volume in ventricles before contraction

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44
Q

ejection fraction =

A

volume ejected / LV end diastolic volume

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45
Q

normal ejection fraction is

A

60-70%

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46
Q

tachycardia

A

abnormally fast rate (>100 beats/min)

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47
Q

bradycardia

A

heart rate slower than 60 beats/min

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48
Q

congestive heart failure (CHF)

A

progressive condition; cardiac output is so low that blood circulation is inadequate to meet tissue needs

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49
Q

reflects weakened myocardium caused by:

A
  • coronary atherosclerosis
  • persistent high blood pressure
  • multiple myocardial infarcts
  • dilated cardiomyopathy
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50
Q

coronary atherosclerosis

A

clogged arteries caused by fat buildup; impairs oxygen delivery to cardiac cells

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51
Q

persistent high blood pressure

A

aortic pressure >90 mmHg causes myocardium to exert more force

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52
Q

what is the most common cause of heart failure ?

A

persistent high blood pressure

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53
Q

multiple myocardial infarcts

A

the heart becomes weak as contractile cells are replaced scar tissue

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54
Q

dilated cardiomyopathy:

A

ventricles stretch and become flabby, and myocardium deteriorates

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55
Q

left sided heart failure results in . . .

A

pulmonary congestion

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56
Q

right sided heart failure results in . . .

A

peripheral congestion

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57
Q

pulmonary congestion is . . .

A

blood backs up in the lungs

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58
Q

peripheral congestion is . . .

A

blood pools in body organs causing edema

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59
Q

failure of either side ultimately weakens other side which leads to __________.

A

decompensated

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60
Q

elastic arteries:

A

thick-walled with large, low-resistance lumen

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61
Q

aorta and its major branch also called __________ arteries because . . .

A

conducting
they conduct blood from the heart to medium sized vessels

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62
Q

muscular arteries also called ____________ because . . .

A

distributing
they deliver blood to body organs

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63
Q

arterioles are the _______ of all arteries

A

smallest

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64
Q

what do arterioles control?

A

flow into capillary beds via vasodilation and vasoconstriction of smooth muscle

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65
Q

arterioles are also called _________ arteries because . . .

A

resistance
changing diameters change resistance to blood flow

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66
Q

three types of capillaries

A

continuous
fenestrated
sinusoidal

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67
Q

where are continuous capillaries found?

A

abundant in skin, muscles, lungs and CNS

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68
Q

where are fenestrated capillaries found?

A

areas involved in active filtration (kidney), absorption (intestines), or endocrine hormone secretion

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69
Q

where are sinusoidal capillaries found?

A

only in the liver, bone marrow, spleen, and adrenal medulla

** blood flow is sluggish

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70
Q

what do sinusiodal capillaries allow?

A

large molecules and even cells to pass across their walls
** most permeable

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71
Q

capillary bed are made up of what?

A

terminal arteriole
postcapillary venule

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72
Q

capillary bed is

A

an interwoven network of capillaries between the arterioles and venule

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73
Q

terminal arteriole is

A

exchange of gases, nutrients, and wastes from surrounding tissue takes place in capillaries

74
Q

what regulates the amount of blood entering the capillary bed ?

A

local chemical conditions and arteriolar vasomotor nerve fibers

75
Q

arteriole and terminal arteriole dilated when ____________

A

blood needed

76
Q

capillary bes of intestinal mesenteries:

A
  1. vascular shunt
  2. precapillary sphincter
77
Q

vascular shunt

A

channel that directly connects arteriole with venule (bypasses true capillaries)

78
Q

precapillary sphincters

A

acts as valve regulating blood flow into the capillary bed

79
Q

what makes veins a good storage vessel?

A

large lumen and thin walls

80
Q

veins are called ____________ because . . .

A

capacitance vessels
they contain up to 65% of the blood supply

81
Q

venous valves prevent what ?

A

backflow of blood

82
Q

where are venous valves most abundant ?

A

veins of limbs

83
Q

what are venous sinuses?

A

flattened veins with extremely thin walls

84
Q

where are venous sinuses located?

A

coronary sinus of the heart and dural sinuses of the brain

85
Q

varicose veins

A

dilated and painful veins due to incompetent (leaky) valves

86
Q

what can cause varicose veins?

A

elevated venous pressure

  • prolonged standing in one position
  • obesity
  • pregnancy
87
Q

what percentage of adults are affected by varicose veins?

A

15%

88
Q

blood flow

A

volume of blood flowing through a vessel, organ, or entire circulation in a given period

89
Q

blood pressure

A

force per unit area exerted on the wall of blood vessels by blood

90
Q

pressure gradient provides what ?

A

a driving force that keeps blood from moving from higher to lower pressure areas

91
Q

resistance (peripheral resistance):

A

opposition flow
measurement of the amount of friction blood encounters with vessel walls, generally in peripheral (systemic) circulation

92
Q

three important sources of resistance:

A

blood viscosity
total blood vessel length
blood vessel diameter

93
Q

blood viscosity is the . . .

A

thickness or “stickiness” of blood due to formed elements and plasma proteins

94
Q

the greater the viscosity . . .

A

the less easily molecules an slide past each other

95
Q

increased viscosity equals

A

increased resistance

96
Q

total blood vessel length is

A

the longer the vessel, the greater the resistance encountered

97
Q

what has the GREATEST influence on resistance?

A

blood vessel diameter

98
Q

what is laminar flow?

A

fluid close to walls move more slowly than in the middle of the tube

99
Q

if radius increases then . . .

A

resistance decreases (and vice-versa)

100
Q

small-diameter arteriole are major determinants of . . .

A

peripheral resistance

101
Q

laminar flow is disrupted and becomes _____________ which is . . .

A

turbulent flow
an irregular flow that causes increased resistance

102
Q

blood flow is ______________ to a blood pressure gradient

A

directly proportional

103
Q

blood flow is ______________ to peripheral resistance

A

inversely proportional

104
Q

peripheral resistance is more important in influencing local blood flow because . . .

A

it is easily changed by altering blood vessel diameter

105
Q

systemic blood pressure is highest in . . .

A

aorta

106
Q

where does systemic blood pressure have its steepest drop?

A

arterioles

107
Q

arterial blood pressure is determined by two factors:

A
  1. elasticity of arteries close to the heart
  2. volume of blood forced into them at anytime
108
Q

blood pressure near heart is . . .

A

pulsatile

109
Q

systolic pressure

A

pressure exerted in the aorta during ventricular contraction

110
Q

diastolic pressure

A

lowest level of aortic pressure when the heart is at rest

111
Q

pulse pressure

A

difference between systolic and diastolic pressure

112
Q

pulse

A

throbbing of arteries due to differences in pulse pressures

113
Q

mean arterial pressure (MAP)

A

pressure that propels blood to tissues

** heart spends more time in diastole

114
Q

pulse pressure and MAP both decline with . . .

A

increasing distance from heart

115
Q

factors aiding venous return

A
  1. muscular pump
  2. respiratory pump
  3. sympathetic venoconstriction
116
Q

muscle pump

A

contraction of skeletal muscles “milks” blood back toward the heart; valves prevent backflow

117
Q

respiratory pump

A

pressure changes during breathing move blood toward the heart by squeezing abdominal veins as thoracic veins expand

118
Q

sympathetic venoconstriction

A

under sympathetic control, smooth muscles constrict, pushing blood back toward heart

119
Q

capillary blood pressure

A

35 mmHg (beginning) - 17 mmHg (end)

120
Q

venous blood pressure

A

changes little during the cardiac cycle
~ 15 mmHg

121
Q

if a VEIN is cut . . .

A

low pressure of the venous system causes blood to flow out smoothly

122
Q

if the ARTERY is cut . . .

A

blood spurts out because of higher pressure

123
Q

3 main factors regulate BP:

A

cardiac output
peripheral resistance
blood volume

124
Q

blood pressure (MAP) is _____________ to CO and PR

A

directly porportional

125
Q

CO =

A

SV x HR

126
Q

MAP =

A

CO x R

or

SV x HR x R

127
Q

short-term MAP regulation

A

alters BP by changing PR and CO

128
Q

short-term MAP regulation is done through . . .

A

neural controls
hormonal controls

129
Q

Goal of short-term regulation

A

maintain MAP by altering blood vessel diameter AND altering blood distribution in response to various organ demands

130
Q

long-term MAP regulation

A

alters BP by changing blood volume via the kidneys

131
Q

long-term MAP regulation is done through . . .

A

renal controls

132
Q

two main neural mechanisms control peripheral resistance

A
  1. altering blood vessel diameter, which alters resistance
  2. can alter blood distribution to organs in response to specific demands
133
Q

neural controls operate via ___________ that involve . . .

A

reflex arcs

baroreceptors
chemoreceptors / high brain centers

134
Q

baroreceptors

A

pressure-sensitive mechanoreceptors that respond to changes in arterial pressure & stretch

135
Q

baroreceptor reflexes are located in

A

carotid sinuses, aortic arch, and walls of large arteries of neck & thorax

136
Q

if MAP is high:

A
  • inhibits vasomotor and cardioacceleratory centers
  • stimulates cardioinhibitory center
  • results in decreased blood pressure through 2 mechanisms (vasodilation & decreased cardiac output)
137
Q

what are the 2 mechanisms that decrease blood pressure?

A
  1. vasodilation
  2. decreased cardiac output
138
Q

vasodilation

A

decreased output from the vasomotor center causes dilation

139
Q

arteriolar vasodilation

A

reduces peripheral resistance (MAP falls)

140
Q

venodilation

A

shifts blood to venous reservoirs, decreasing venous return and CO

141
Q

decreased cardiac output

A

impulses to cardiac centers inhibit sympathetic activity and stimulate parasympathetic

142
Q

if MAP is low:

A

reflex vasoconstriction is initiated that increases CO and BP

143
Q

carotid sinus reflex

A

baroreceptors that monitor BP to ensure enough blood to the brain

144
Q

aortic reflex

A

maintainsBP in the systemic circuit

145
Q

chemoreceptor reflexes are located in . . . and they detect . . .

A

aortic arch and large arteries of neck
increase in CO2 or drop in pH or O2

146
Q

chemoreceptor reflexes cause increased blood pressure by:

A
  • signaling cardioacceleratory center to increase CO2
  • signaling vasmotor center to increase vasoconstriction
147
Q

influence of higher brain centers

A
  • relfexes that regulate BP are found in medulla
  • hypothalamus & cerebral cortex can modify arterial pressure via relays to medulla
  • hypothalamus increases blood pressure during stress
  • hypothalamus mediates redistribution of blood flow during exercise and changes in body temperature
148
Q

cardiovascular center

A

composed of clusters of sympathetic neurons in the medulla

149
Q

cardiovascular center consists of :

A
  • cardiac center
  • vasomotor center
150
Q

cardiovascular center receives inputs from . . .

A

baroreceptors
chemoreceptors
higher brain centers

151
Q

input to cardiovascular center from higher brain centers:

A

cerebral cortex, limbic system, & hypothalamus

152
Q

input to cardiovascular center from proprioceptors:

A

monitor joint movements

153
Q

input to cardiovascular center from baroreceptors:

A

monitor blood pressure

154
Q

input to cardiovascular center from chemoreceptors:

A

monitor blood acidity

155
Q

output to effectors - heart:

A

decreased rate (from vagus)
increased rate (from cardiac accelerator nerves)

156
Q

output to effectors - blood vessels:

A

vasoconstriction (from vasomotor nerves)

157
Q

hormones regular BP in short term via __________________________ or long term via ___________________________.

A

changes in peripheral resistance
changes in blood volume

158
Q

hormonal controls

A

adrenal medulla hormones
angiotensin II
ADH
atrial natriuretic peptide

159
Q

angiostensin II

A

stimulates vasoconstriction

160
Q

ADH

A

high levels can cause vasoconstriction

161
Q

atrial natriuretic peptide

A

decreases BP by antagonizing aldosterone, causing decreased blood volume

162
Q

kidneys regulate arterial blood pressure by:

A
  1. direct renal mechanism
  2. indirect renal mechanism
163
Q

direct renal mechanism

A

alters blood volume independently of hormones

164
Q

increased BP/blood volume =

A

elimination of more urine, thus reducing BP

165
Q

decreased BP/blood volume =

A

kidneys to conserve water, and BP rises

166
Q

indirect mechanism

A

decreased arterial blood pressure causes the release of renin from the kidneys

167
Q

angiotensin II acts in four ways to stabilize arterial BP and ECF:

A
  • causes ADH release from the posterior pituitary
  • triggers hypothalamic thirst center to drink more water
  • acts as a potent vasoconstrictor, directly increasing blood pressure
168
Q

GOAL of blood pressure regulation is to keep blood pressure high enough to . . . but not so high that . . .

A

provide adequate tissue perfusion
blood vessels are damaged

169
Q

homeostatic imbalances in blood pressure

A

hypertension
primary hypertension
secondary hypertension
hypotension
circulatory shock

170
Q

prolonged hypertension is a major cause of

A

heart failure, vascular disease, renal failure, and stroke

171
Q

primary hypertension is ______ of hypertensive conditions

A

90%

172
Q

primary hypertension risk factors

A

heredity
diet
obesity
age
diabetes mellitus
stress
smoking

173
Q

secondary hypertension is __________ and is due to . . .

A

less common
identifiable disorders including obstructed renal arteries, kidney disease, and endocrine disorders

174
Q

hypotension is low pressure below . . .

A

90/60 mmHg

175
Q

orthostatic hypotension

A

temporary low BP and dizziness when suddenly rising from sitting or reclining position

176
Q

chronic hypotension

A

a hint of poor nutrition and warning sign for Addison’s disease or hypothyroidism

177
Q

acute hypotension

A

an important sign of circulatory shock

178
Q

circulatory shock

A

condition where blood vessels inadequately fill and cannot circulate blood normally

179
Q

hypovolemic shock

A

results from large-scale blood loss

180
Q

vascular shock

A

results from extreme vasodilation and decreased peripheral resistance

181
Q

cardiogenic shock

A

results when an inefficient heart cannot sustain adequate circulation

DPT 503 (14 decks)

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