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Cardiovascular and Pulmonary > Cardiovascular Systems Physiology and Pathophysiology V > Flashcards

Cardiovascular Systems Physiology and Pathophysiology V Flashcards

1
Q

When the pathologic release of AII and aldosterone occurs, and BP remains abnormally elevated, the high pressure baroreceptors can become

A

Desensitized

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2
Q

Does not increase in response to chronically elevated bP

A

Urinary output

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3
Q

Abnormal levels of (or increased sensitivity to) An-II appear to be central in some forms of essential hypertension, what can be used to combat this?

A
  1. ) ACE inhibitors
  2. ) Renin inhibitors
  3. ) AT1 antagonists (angiotensin receptor blockers, ARB)
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4
Q

What is an example of an ACE inhibitor?

A

Enalapril

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5
Q

What is an example of a renin inhibitor?

A

Aliskiren

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6
Q

What is an example of an angiotensin receptor blocker (ARB)?

A

Losartan

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7
Q

Can be given to reduce the stimulatory actions of

catecholaminergic neurotransmitters within the heart and lower BP

A

Beta blockers (B1 adrenoreceptor antagonists)

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8
Q

Lower BP by impairing inward Ca2+ currents in vascular smooth muscle and/or cardiac muscle

A

Ca2+ channel blockers

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9
Q

Can be administered to lower blood volume by blocking the effects of aldosterone and/or alterating renal Na+ absorption

A

Diuretics

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10
Q

The phenomenon of left ventricular hypertrophy (LVH) is commonly observed in patients with

A

Long-standing hypertension, valve disease, an MI, or a mutation

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11
Q

In the heart, pathologic increases in systolic wall stress and/or diastolic wall stress will over time induce

A

LVH

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12
Q

In response to pathologic systolic wall (pressure overload) stress the formation of sarcomeres occurs in parallel, and the LV thus forms thick walls and a relatively small cavity; this is called

A

Concentric LVH

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13
Q

By comparison, chronic diastolic wall stress (i.e. volume overload) stimulates the formation of new sarcomeres in series; this is called

A

Eccentric LVH

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14
Q

Results in a relatively dilated LV with thin walls

A

Eccentric LVH

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15
Q

Not selective for simply myocyte hypertrophy and the formation of new sarcomeres, but includes increased apoptosis, interstitial fibrosis, and endothelial cell dysfunction

A

Pathologic LVH

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16
Q

The molecular mechanisms for pathologic LVH, which make it markedly different than that resulting from exercise include the induction of cell signalling cascades and changes in

A

Gene transcription

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17
Q

Over time, patholigic LVH can lead to decompensation, resulting in

A

LV dilation and heart failure

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18
Q

Isotonic exercise (e.g., running) is correlated with increased venous return, causing a condition of intracardial volume overload, and leading to

A

Eccentric LVH

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19
Q

Isometric exercise (e.g., strength training) causes cardiac pressure overload and

A

Concentric LVH

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20
Q

Exercise-induced LVH is phenotypically different from pathologic remodeling in that physiologic LVH does not induce

A

Cardiac interstitial fibrosis

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21
Q

Which is reversible, physiologic (exercise induced) or pathologic LVH?

A

Physiologic LVH

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22
Q

Unlike pathologic LVH, is NOT associated with heart failure and increased mortality

A

Physiologic LVH

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23
Q

In Hyoptension, Epi/norepi instigate an increase in

arteriolar TPR that causes a drop in

A

Capillary pressure

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24
Q

Reduced capillary pressure establishes a gradient that favors reabsorption of H2O from the

-aids in venous return

A

ECF

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25
Q

Enables increased cardiac output and will therefore increase arterial BP

A

Increased venous return

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26
Q

The average blood volume is approximately

A

5-6 L

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27
Q

The displacement of blood per second determines the

A

Velocity of the blood (v = m/s)

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28
Q

The volume of blood moved per second

A

Flow (Q)

  • Q = volume/s
  • Q = mL/s
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29
Q

What term is interchanged with blood flow?

A

Conductance

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30
Q

The peripheral vasculature is comprised of vessels of varying diameter (cross-sectional area, A), and diameter affects the rate of flow such that

A

v = Q/A

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31
Q

Which laws describe hemodynamics?

A

The conservation of mass laws

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32
Q

Must be constant through a given vessel at a specific point in time

A

Blood flow (Q)

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33
Q

At a given flow, velocity (v) is inversely proportional to

A

Area (A)

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34
Q

The resistance (R) offered by a vessel must be accounted for because it will of course alter flow. This is accounted for in

A

Ohms Law

Q = ΔP/R

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35
Q

The difference between arterial pressure and venous

pressure (Pa – Pv) as it relates to flow through the entire systemic vascular network

A

Total peripheral resistance (TPR)

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36
Q

The parallel nature of the arteriole tree results in less total resistance to systemic flow than would occur in a

A

Single vessel

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37
Q

The resistance through a single capillary is much greater than through an arteriole, why then is there a much lower pressure drop across the capillary system as compared to a high pressure drop across the arteriole system?

A

The number of capillaries vastly exceeds the number of arterioles

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38
Q

Changes in arteriole circulation account for the vast majority of

A

TPR

39
Q

The diameter of the arteriole network can change by approximately 4x, thus very dramatically

A

Increasing (via constriction) or decreasing (via dilation) TPR

40
Q

In general, blood flows equals

A

% L/min

41
Q

What are the two types of blood flow that occur?

A
  1. ) Laminar flow

2. ) Turbulent flow

42
Q

A very streamlined movement of blood, and is predominant in the vasculature under normal circumstances

A

Laminar Flow

43
Q

The type of blood flow where a blood cell moving through the center of a vessel would tend to stay in the center stream of flow

A

Laminar blood flow

44
Q

What is greater during laminar flow, the velocity of blood in the center or towards the periphery?

A

The center

45
Q

More random in nature and is characterized by very

complex flow dynamics consisting of eddies, cross-currents, back-flow, etc

A

Turbulent flow

46
Q

Can result from extreme increases in pressure, obstructions, the movement of blood over irregular surfaces such as atherosclerotic plaques, and/or increased blood viscosity

A

Turbulent flow

47
Q

Increase friction, turbulence, and therefore cause a higher resistance to blood flow

A

Elevations in blood viscosity

48
Q

Determined mainly by the percent volume of blood cells (RBCs and WBCs) in whole blood

A

Blood viscosity

49
Q

Blood viscosity can be measured by performin a

A

Hematocrit analysis

50
Q

Veins are known as

A

Compliance vessels

51
Q

The capacitance “side” and is responsible for blood storage and return to the heart

A

Venous network

52
Q

What are the two key properties possessed by veins, which react to alterations in arterial BP?

A

Compliance and distensibility

53
Q

Distend in response to increased BP

A

Veins

54
Q

Aids in lowering resistance in response to elevated arterial BP

A

Venous distension

55
Q

Allows continuous laminar flow though the capillary network to be maintained as arterial BP rises

A

Venous distension

56
Q

Another venous phenomenon, which can be thought of as the amount of blood that can be stored (accommodated) when arterial BP increases

A

Compliance

57
Q

Not very distensible and have low compliance

A

Arteries

58
Q

Accommodate approximately 60% of circulating blood

A

The great veins

59
Q

Veins have low BP but a high

A

Flow velocity

60
Q

What is used as a guide for measuring the central venous pressure (CAP)?

A

Right atrial pressure (RAP)

RAP = CVP

61
Q

Determined by balances between RA emptying and venous return to the heart

A

RAP

62
Q

Central venous pressure approximates around

A

2mmHg

63
Q

Fights venous return to the heart by increasing venous pressures, especially in the upper and lower limbs

A

Hydrostatic pressure from gravity

64
Q

What do veins within skeletal muscle have to help them fight the hydrostatic pressure of gravity?

A

Valves

65
Q

Anything that disrupts cardiac output (CO) can lead to elevations in

A

RAP

66
Q

When we say “left heart failure” we are talking about

A

Impaired left ventricular emptying

67
Q

Since the right atrium is open to the vena cava, a significant rise in RAP can lead to increased venous pressures within the

A

Jugular and Hepatic Portal Circulations

68
Q

The rhythmic pattern of systolic and diastolic BP in the arteries is known as the

A

Pulse Pressure

69
Q

Determined by SV (EDV – ESV), total compliance of the arterial tree, and the least significant factor being force of blood ejection from the LV

A

Pulse Pressure

70
Q

Must increase as SV increases in order to maintain normal pulse pressure

A

Arterial compliance

71
Q

If arteries become less compliant, we will see an elevation in

-Causes a greater workload on the LV

A

Systolic arterial BP

72
Q

Cardiac output and total peripheral resistance determine

A

Mean arterial pressure (MAP)

-a dependent variable

73
Q

The myocardium requires high levels of O2. As local O2 concentration diminish, what processes are impaired?

A

Oxidative phosphorylation and generation of ATP

74
Q

The impairment of ATP generation leads to the formation of

A

ADP, AMP, and ultimately adenosie

75
Q

Blocks Ca2+ entry into vascular smooth muscle and thus induces vasodilation

A

Adenosine

76
Q

The three major determinants of myocardial O2 requirements in order of demand are

A
  1. ) Ventricular wall stress
  2. ) HR
  3. ) Contractility (inotropic state)
77
Q

The myocardium is supplied with O2 via the

A

Coronary arteries

78
Q

Occlusion of the coronary arteries can lead to ischemia and is a common cause of

A

Coronary heart disease (CHD)

79
Q

If severe enough, coronary artery occlusion can lead to

A

Angina pectoris and MI

80
Q

Peak blood flow within the coronary arteries occurs during

A

Diastole

81
Q

Blood flow is greatly reduced due to the compression of the vessels by the surrounding myocardium during

A

Systole

82
Q

Flow (Q) is

  1. ) Directly proportional to
  2. ) Inversely proportional to
A
  1. ) Pressure

2. ) Resistance

83
Q

Maintanence of perfusion pressure (MAP) is critical for

A

O2 delivery and CO2 removal

84
Q

The majority of myocardial O2 uptake occurs during

A

Diastole

85
Q

Approximately 70% of the exchange of O2 for CO2 is accomplished within the myocardium during

A

Diastole

86
Q

What are some important vasodilators?

A

NO, CO2, H+, Lactate, Adenosine, and rostacyclins

87
Q
  1. ) Which type of adrenoreceptors does the coronary vascular smooth uscle express?
  2. ) Which one is more predominant?
A
  1. ) a1 and a2 adrenoreceptors

2. ) a2 is more predominant

88
Q

Mediate vasoconstriction in coronary artery vascular smooth muscle

A

a1 and a2 adrenoreceptors

89
Q

Occurs if endothelial function is disrupted such that vasodilator production is compromised

-impedes normal blood flow

A

a2-mediated vasoconstriction

90
Q

A localized anemia due to a reduction in blood supply

A

Ischemia

91
Q

Results from an imbalance between O2 supple and myocardial demand

-produces a localized hypoxia concomitant with the accumulation of waste metabolites

A

Ischemic heart disease

92
Q

If severe enough, ischemia will lead to MI; less drastic reductions in delivery can manifest as one or more forms of

A

Angina

93
Q

Two general mechanisms underlie the pathophysiology of cardiac ischemia and these are

A
  1. ) Fixed vessel narrowing (atherosclerotic plaques)

2. ) Abnormal vascular tone

94
Q

Very metabolically active tissues which produce a number of factors that mediate vascular smooth muscle
tone and local antithrombotic processes

A

Vascular endothelium and Vascular smooth muscle

Cardiovascular and Pulmonary (25 decks)

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