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Advanced Pathophysiology 2 > Cardiovascular Physiology - Exam 1 > Flashcards

Cardiovascular Physiology - Exam 1 Flashcards

1
Q

Atrial and ventricular syncytium can be attributed to each side having _ _

A

gap junctions

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2
Q

Which side of the heart has lower pressures?

A

right
-hence PE, clots, etc

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3
Q

What anatomical structure allows the atria to fully contract before the ventricles?

A

fibrous insulator

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4
Q

What helps keep the blood flow in the heart unidirectional?

A

valves

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5
Q

Cardiac muscle is comprised of _ and _ filaments

A

myosin and actin

-much lower resistance to conduction than cell membranes

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6
Q

RMP of cardiac muscle is _-_mV, and the action potential is _ mV

A

-85 to -95mV
105mV

-plateau lasts longer than skeletal musc ~0.2-0.3sec

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7
Q

Action potential of cardiac muscle results in _

A

depolarization

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8
Q

Ventricular Muscle Action Potential
-phases

A

0-Fast Na+ channels open, slow Ca++ channels open too
1-K+ channels open
2-Ca ++ channels open more
3- K+ channels open more
4-resting membrane potential

-K+ channels opening is pretty transient bc Ca++ channels open wider and offsets K+ leaving cell

-the latter K+ is vent repolarization occurring

-biggest diff from skeletal musc is in phase 2 with Ca++ channels opening wider

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9
Q

T/F Vent conduction AP is the same process as pacemaker cells

A

false

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10
Q

The _ refractory period does not allow the ventricle’s cardiac muscle to be re-excited again

A

absolute

-an AP is currently occurring

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11
Q

The _ refractory period can allow the ventricle’s cardiac muscle to be re-excited again

A

relative

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12
Q

The absolute refractory period of ventricular AP is - sec and _ sec in atria

A

0.25-0.3sec
0.15sec

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13
Q

On an EKG, the P wave represents conduction prior to _ _

A

atria contracting

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14
Q

On an EKG, the QRS complex represents conduction prior to _ _

A

ventricular depolarization
-this is SYSTOLE!
-this also is masking the atria repolarizing

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15
Q

On an EKG, the T wave represents electrical conduction of _ _

A

ventricular repolarization
-vent diastole
-vents stay contracted a few milliseconds after T wave

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16
Q

S1 heart sound is heard when the _ valves close

A

AV
-@ START of vent systole

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17
Q

During atrial systole, which valves are open?

A

Tricuspid and Mitral

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18
Q

During ventricular systole, which valves are open?

A

Pulmonic and Aortic

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19
Q

In the vent pressure/volume curve, isovolumetric relaxation occurs:

A

AFTER T wave

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20
Q

S1 heart sound is heard when the _ valves close

A

AV (tricuspid and mitral)
-@ START of vent systole

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20
Q

In the vent pressure/volume curve, isovolumetric contraction occurs:

A

DURING QRS complex

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21
Q

S2 heart sound is heard when the _ and _ valves close

A

aortic and pulmonic
-@ END of vent systole

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22
Q

On a vent pressure/volume curve, an “a” wave represents:

A

atrial cx

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23
Q

On a vent pressure/volume curve, a “c” wave represents:

A

vent cx (AV valves bulge)

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24
Q

On a vent pressure/volume curve, a “v” wave represents:

A

blood flowing back into atria

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25
Q

What does a dicrotic notch(incisura) represent?

A

sudden stop of back flow toward L vent

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26
Q

Aortic pressure must overcome _ pressure to allow blood forward

A

systemic (SVR)

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27
Q

_ _ accounts for 25% of filling in the ventricle during diastole

A

atrial systole
-“atrial kick”

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28
Q

Normal Values
End diastolic volume (EDV)

A

120mL

-max volume at end-diastole
-directly proportional to SV and CVP

-higher CVP increases EDV which increases SV ; (good; more volume on the receiving end, so SV is more forceful and more blood is readily replenishing chambers)

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29
Q

Normal Values
End systolic volume (ESV)

A

50mL
-directly proportional to afterload (SVR) and INversely proportional to SV

-increased SVR increases ESV which decreases SV ; (heart is pushing against too strong of a force and it’s leaving volume behind and making the stroke weaker)

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30
Q

Normal values
Ejection volume (SV)

A

SV= EDV - ESV
~70mL

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31
Q

Normal values
Ejection fraction

A

EF= SV / EDV

normally ~60%

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32
Q

EDV-ESV =

A

SV

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33
Q

_ is the total volume of blood going thru the heart in 1 min

A

CO

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34
Q

If HR increases, SV will _

A

decrease
-helps maintain CO, compensatory

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35
Q

Normal values
CO

A

~5L/min

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36
Q

Chordae tendinae are attached to which valves?

A

AV

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37
Q

Resting cardiac muscle stretch is _ than skeletal muscle

A

less

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38
Q

T/F Afterload should be > LV pressure

A

false

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39
Q

_, or venous return, is important to the Frank-Starling curve because it causes the optimal stretch for maximum contraction.

A

preload/CVP

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40
Q

Preload is synonymous with _ and _ _ _

A

CVP and end diastolic pressure (EDP)

41
Q

T/F High afterload is from HTN coming from the heart

A

false,
this is systemic~SVR

42
Q

CO will only increase when HR is elevated if _ also increases

A

SV

43
Q

Sympathetic activity would _ CO

A

increase
-increased HR and contractility

44
Q

Vagal fibers mainly go to the _

A

atria

45
Q

PNS stimulation would cause CO to _

A

decrease
-slows HR and slightly decreases SV

46
Q

During a normal cardiac cycle, the impulse is delayed in the _ _

A

AV bundle

-lets atria fully contract

47
Q

Which structure brings the cardiac impulse into the ventricular area?

A

AV bundle

48
Q

Which structure brings the cardiac impulse to each part of the ventricles?

A

R and L Purkinje bundles

49
Q

Normal rate of discharge
-sinus node

A

70-80bpm

50
Q

Normal rate of discharge
-AV node

A

40-60bpm

51
Q

Normal rate of discharge
-purkinje fibers

A

15-40bpm
-think about a heart block pt and how low their rates can be. Their conduction doesn’t work thru the SA and AV node so Purkinje takes over and old man Purkinje is slow

52
Q

Valve areas
-aortic

A

2.5-3.5cm^2 -same as mitral!
crit=0.7cm^2

53
Q

Valve areas
-pulmonic

A

4-6cm^2

54
Q

Valve areas
-mitral

A

2.5-3.5cm^2-same as aortic
crit=<1cm^2

55
Q

Valve areas
-tricuspid

A

8-10cm^2

56
Q

Normal chamber pressures
-RA

A

0-6mmHg

very similar to CVP…

57
Q

Normal chamber pressures
-RV

A

15-30 Systole
0-6mmHg Diastole

“Quarter over a nickel”

58
Q

Normal chamber pressures
-LA

A

6-12mmHg

59
Q

Normal chamber pressures
-LV

A

100-140mmHg Systole
6-12mmHg Diastole

LV works hard and doesn’t like to relax

60
Q

Normal chamber pressures
aorta

A

100-140 mmHg Systole
60-80mmHg Diastole

kinda like a normal BP….

61
Q

Normal chamber pressures
PA

A

15-30 mmHg Systole
6-12mmHg Diastole

“A quarter over a dime”

62
Q

Normal PR interval

A

0.16sec

63
Q

Normal QT interval

A

0.4sec

64
Q

If alterations in the _ _ pump occur, could change EKG

A

Na/K+ ATPase pump

-I’m looking at you, Digoxin (rate control, inc contractility)

65
Q

T/F No potential is recorded when vent muscle is either depolarized or repolarized

A

true

66
Q

T/F QRS complex has positive deflections only

A

false, has both
-deflection depends on which lead you are looking at

67
Q

Lead II and _ have opposite QRS deflections

A

V2

68
Q

HR counting methods
-high

A

if 2 R-R waves are seperated by one box =300bpm

if 2 boxes = 150bpm, etc.

69
Q

HR counting methods
-low

A

count R waves in 6 sec, x by 10

70
Q

HR counting methods
-irregular/high

A

if strip is 10 sec, count R waves and x 6

if strip is not 10sec, count how many R waves in 6 sec and x10

71
Q

T/F Repolarization of atria occurs rapidly follows depolarization and occurs during PT segment

A

true

72
Q

T/F Depolarization of vents = QRS and repolarization is T wave

A

true

73
Q

When a depolarization wave spreads towards the electrode, the deflection will be _ and when if depolarizes away from the electrode it will be _

A

positive
negative

-when current flows obliquely towards the lead it will deflect up a little less (occurs with bipolar impulses)

74
Q

The cardiac cycle is coordination of 5 things:

A

-electrical changes
-ions
-pressure changes in LA, LV, and aorta
-ventricular volume changes
-cardiac valves

75
Q

Which lead is best to look at for ischemia?

A

II

76
Q

12 lead ekg
-3 bipolar limb leads

A

I, II, and III

77
Q

12 lead
-3 augmented voltage leads

A

aVR, aVL, aVF

78
Q

12 lead
-precordial leads

A

V1-V6

79
Q

Frank Starling mechanism

A

-heart will pump blood that comes to it without damming veins TO A CERTAIN POINT…

-extra stretch on cardiac myocytes makes actin and myosin interdigitate to more optimal degree of force generation
(actin and myosin adjust to accommodate stretch to allow for forceful contraction)

-think about yourself (volume) jumping on a trampoline (contractility). If your trampoline is a perfect size and is working well, you can get a good bounce off it. Your older brother joins and you can bounce higher on it bc he’s bigger (adding more volume to same system).

Systolic issue: At a certain point, too many people (too much volume) on the trampoline will break it and you wear it out and you all can’t bounce as high.

Diastolic issue: Similarly, if you have a small trampoline or if it’s too stiff (less contractility) you won’t bounce as well either

80
Q

ABV
-premies

A

95mL/kg

81
Q

ABV
-full term neonate

A

85mL/kg

82
Q

ABV
-infants

A

80mL/kg

83
Q

ABV
-men

A

75mL/kg

84
Q

ABV
-women

A

65mL/kg

85
Q

Pulse pressure is _ - _ and normal value is _mmHg

A

SBP - DBP
40mmHg

86
Q

Factors affecting pulse pressure
-SV

A

Direct relationship

increased SV = increased PP
decreased SV = decreased PP

87
Q

Factors affecting pulse pressure
-arterial compliance

A

inverse relationship

higher compliance = lower PP
lower compliance = higher PP

88
Q

Factors affecting pulse pressure
-arteriosclerosis

A

decreases compliance = increases PP

89
Q

Factors affecting pulse pressure
-PDA

A

-low diastolic and high systolic pressures = net INCREASE in PP

90
Q

Factors affecting pulse pressure
-aortic regurg

A

backflow causes low diastolic and high systolic pressures = INCREASE in PP

91
Q

Factors affecting pulse pressure
-aortic stenosis

A

low BF thru aortic valve causing low systolic pressure = decreased PP

92
Q

RAP correlates with which hemodynamic measurement?

A

CVP

93
Q

Normal value
CVP

A

0mmHg
-can be as high as 20-30mmHg

94
Q

Factors that increase RAP/CVP

A

-increased blood volume
-increased venous tone
-dilation of arterioles
-decreased cardiac function

95
Q

Increased SNS activity would _ CVP

A

increase

96
Q

Increased CVP can be useful to increase _ but detrimental if too high and cause _ edema

A

SV
peripheral

97
Q

Local blood flow in the heart is controlled via _

A

autoregulation
-via catecholamines and hyperemia from increased tissue demand

98
Q

Resistance equation

A

R= change in P (pressure difference in 2 points in vessel) mmHg / Q (mL/min-flow)

99
Q
A

Advanced Pathophysiology 2 (4 decks)

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