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PHYSICAL THERAPY > Cardiovascular Physiology > Flashcards

Cardiovascular Physiology Flashcards

1
Q

CO

A

(Cardiac Output), L/min [CO = HR x SV]
Volume of blood pumped from each ventricle per minute

Avg at rest: 5L/min

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2
Q

SA Node

A

(Sinoatrial), 1st step in Impulse Conduction System

  • Primary Pacemaker
  • Intrinsic Rate: 60-100bpm
  • Sends AP to AV Node via Bachman’s and Internodal Bundles
    (0. 4sec)
  • P wave on EKG

*Cardiac Cycle electrical event: slow channel with AV Node

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3
Q

Impulse Conduction System

A 
SA Node*
AV Node*
Bundle of His
Bundle Branches
Purkinje Fibers*

*All muscle cells have potential to conduct an impulse

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4
Q

AV Node

A

(Atrioventricular), 2nd step in Impulse Conduction System
-Secondary Pacemaker
-Intrinsic Rate: 40-60bpm
-Sends AP to Bundle of His (0.11sec - slower for
ventricular filling)
-Delay following P wave on EKG

*Cardiac Cycle electrical event: Slow channel with SA Node

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5
Q

Bundle of His

A

3rd step in Impulse Conduction System

-Sends AP to Bundle Branches via interventricular septum

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6
Q

HR

A

(Heart Rate), bpm
Number of cardiac cycles/beats per minute

Avg at rest: 72bpm

  • Stronger myocardium & sympathetic drive
    • -> lower resting HR
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7
Q

SV

A

(Stroke Volume), mL/beat [EDV - ESV = SV]
Volume of blood ejected by each ventricle per cycle/beat

Avg at rest: 70mL/beat

3 Physiologic Controls:
Preload
Contractility
Afterload

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8
Q

EF

A

(Ejection Fraction), % [EF = (SV / EDV) x 100]
Percentage of blood ejected by each ventricle per cycle/beat
-indicator of pump efficiency
-% decline: ^HR and VO2 = heart works harder to deliver same amt of O2

Avg at rest: 55-65%
Critical point: <20%

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9
Q

CI

A

(Cardiac Index) [CO / Body SA]
Indicator of pump function in clinical units

Avg at rest: 2.8 - 4.2

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10
Q

Cardiac Innervation

A

Modulation of HR and contractility

  1. Sensors
  2. Afferent pathways (Vagus & Glossopharyngeal N)
  3. Integration center (Medulla/pons)
  4. Efferent pathways (Symp vs Parasymp)
  5. Receptors (Myocardium)
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11
Q

Cardiac Innervation:

Efferent Pathways

A

Sympathetic Parasympathetic
-Cardiac N -Vagus N
-Ventricular myocardium -Atrial myocardium
-Adrenergic (Epi/Norepi) -Cholin / Musc (AcH)
-AMPING: -DAMPENING
Inc HR / AV conduxn / Dec HR / AV conduxn /
Force contraxn Force contraxn

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12
Q

Sensors of Cardiac Innervation

A
  1. Baroreceptors - pressure
  2. Chemoreceptors - Dec O2 / Inc CO2 or H+
  3. Stretch receptors - venous return
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13
Q

Baroreceptors

A

Pressure sensors in aortic arch + carotid sinus

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14
Q

Chemoreceptors

A

Sensors in aortic arch and carotid body that detect decrease in [O2] and increase in [CO2 and H+]

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15
Q

Stretch Receptors

A

Sensors that detect venous return in junction of great veins and atria

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16
Q

Bundle Branches

A

4th step of Impulse Conduction System
=Send AP down interventricular septum to Purkinje Fibers in
subendocardium

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17
Q

Purkinje Fibers

A

5th step of Impulse Conduction System

  • Tertiary Pacemaker
  • FAST cell to cell AP transmission
  • Intrinsic Rate: 20-40bmp
  • Synchronous contraction + wringing action

*Cardiac Cycle electrical event: Fast channel

18
Q

Adrenergic Receptors

A

Cardiac N
Myocardial receptors of the Sympathetic Pathway
-mediated by epi/norepinephrine

Examples: Beta-1 & 2, Alpha-1

19
Q

Cholinergic Receptors

A

(Muscarinic) - Vagal N
Myocardial receptors of the Parasympathetic Pathway
-mediated by ACH

20
Q

Chronotropic

A

HR

21
Q

Dromotropic

A

AV Conduction Speed

22
Q

Inotropic

A

Atrial Contraction

23
Q

Cardiac Cycle

A

(Heart Beat)

sequence of simultaneous electrical (depol / repol) and mechanical (systole / diastole) events

24
Q

Electrical Events of Cardiac Cycle

A

Depolarization = Inc permeability of pacing cells –> AP
Excitation

Repolarization = Restoration / Recovery / Refractory
periods of cell

25
Q

Mechanical Events of Cardiac Cycle

A

Systole

Diastole

26
Q

Characteristics Common to All Muscle Cells

A 
(CRAE)
Conductivity
Rhythmicity 
Automaticity 
Excitability
27
Q

Depolarization

A

Electrical event of Cardiac Cycle:
-Increased membrane permeability of pacing cells (Na, K,
Ca)
–>AP Excitation

Slow Channels: SA/AV Nodes
Fast Channels: Purkinje Fibers + myocytes

28
Q

Repolarization

A

Electrical event of Cardiac Cycle:

  • Cell restored to negative via Na/K Pump
    • -> Recovery

*Refractory periods (ERP / RRP)

29
Q

Cardiac Electrical Cycle Fast Response

A

Fast channels: Purkinje + myocytes

Phase 0: Rapid Depol (Na+ IN)
Phase 1: Partial Repol (Cl- IN)
Phase 2: Plateau (No net change) *Not in SA/AV Nodes
Phase 3: Rapid Repol (Na/K Pump restores)
Phase 4: Rest (K+ OUT)

30
Q

Cardiac Mechanical Cycle

A

Vent Late Diastole (+ Atrial Sys) = Fast vent filling
Vent Early Diastole (+ Atrial Dia) = Isovolumetric Contraxn
Vent Late Diastole = Vent Ejection
Vent Early Diastole = Isovolumetric Relaxation
Vent Mid Diastole = Slow vent filling

31
Q

EDV

A

(End Diastolic Volume)
Volume of blood when ventricles completely filled

Norm: 120-130mL
[EDV - ESV = SV]

32
Q

Isovolumetric Contraction

A

Contraction with no blood movement bc Vent Pressure > Atrial Pressure and AV valves close while SL valves do not open immediately

*Ventricular Early Systole

33
Q

ESV

A

(End Systolic Volume)
Volume of blood left in ventricles post ejection

Normal: 50-60mL
[EDV - ESV = SV]

34
Q

Isovolumetric Relaxation

A

Relaxation with no blood movement bc vent pressures < atrial pressures so SL valves close, and AV valves remain closed until vent pressure < atrial pressure

*Ventricular Early Diastole

35
Q

Preload

A

Physiological control of SV
=Degree of stretch prior to contraxn
-dependent on venous return (increase = INC SV)

Drugs that decrease preload:

  • Diuretics
  • Venous dilators
  • Sympathomimetics
36
Q

Contractility

A

Phys control of SV
=Force of contraction based on interactions at
crossbridges of myofilaments (Inc = INC SV)
-dependent on Ca avail & increased SNS input

Drugs that affect contractility:

  • Adrenergics (INC)
  • Beta blockers and Ca Blockers (DEC)
37
Q

Afterload

A

Phys control of SV
=amt of aortic/pulmonary pressure the ventricles must
overcome to open SL valves and eject blood
(Inc Arterial Pressure = Inc afterload = DEC SV)
-dependent on pressure, radius and wall
thickness

Drugs that increase afterload:

- Vasodilators 
- ACE Inhibitors
- ACE Receptor blockers
- Sympatholytics
38
Q

Hemodynamics

A

Relationship b/w blood flow and pump (pressure source)
[R SV = L SV] and [CO = VR]

3 Variables:

  1. CO
  2. Perfusion Pressure
  3. Peripheral Vascular Resistance
39
Q

Hemodynamic Disorders

A
  1. Thrombosis
  2. Embolism
  3. MI
  4. Edema
  5. Shock
40
Q

Shock

A

microcirculation failure and inadequate perfusion of blood to vital organs
–> Peripheral vasodilation: Hypotension
= bad O2 delivery, cap beds close and shunt
blood to major organs, others shut down

Types:

  1. Cardiogenic
  2. Hypovolemic
  3. Neurogenic
  4. Septic
41
Q

Albumin

A

Plasma protein that acts as oncotic pressure that pulls fluid into cells

PHYSICAL THERAPY (13 decks)

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