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CTB > CTB5 - Assessing Performance of the Cardiopulmonary System > Flashcards

CTB5 - Assessing Performance of the Cardiopulmonary System Flashcards

1
Q

Why are heart and lung function evaluated?

A

Gives indication of patients in clinical settings or can be used to test athlete performance.

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2
Q

Give brief overview of the intrinsic control of heart function.

A

SA node starts wave of depolarisation. Spreads across the atria causing them to contract - blood pushed into the ventricles. Short delay ensures that atria completely empty and ventricles fill to a maximum. AV node then sends impulse down bundle of his and across ventricles via purkinje fibres.

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3
Q

What nervous system controls heart rate at rest?

A

Parasympathetic nervous system - keeps heart rate at approx 60-80.

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4
Q

What structure in the Brain controls more complex breathing processes?

A

Motor cortex in the pre-frontal gyrus

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5
Q

What types of receptors signal to control breathing rate?

A

Chemoreceptors. Stretch receptors. Pain receptors.

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6
Q

Discuss location of chemoreceptors that control breathing.

A

Central chemoreceptors - located in brain and brainstem.

Peripheral chemoreceptors - located in carotid arteries and aortic arch.

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7
Q

At rest, which nerves control breathing and how (I.e. where is information sent from/to)?

A

Controlled by phrenic nerves. Send impulses from medulla to diaphragm, allowing for its contraction/relaxation

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8
Q

What nerves control heart rate and breathing at rest?

A

Heart rate - vagus nerve.

Breathing - phrenic nerves.

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9
Q

What is the approx. Instrinsic depolarisation rate of the SA node?

A

Approx. 110 bpm

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10
Q

What do chemoreceptors detect to cause changes in breathing ?

A

Detect arterial carbon dioxide concentration, using proton concentration in cerebrospinal fluid.

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11
Q

How does ventilation occur? Discuss muscle contractions and pressure/volume changes.

A

Diaphragm And external intercostal muscles contract. Rib cage pulled up and out. Thoracic cavity volume increased, pressure decreases. Air rushes into lungs as pressure is lower than atmospheric pressure. Diaphragm and external intercostal muscles relax. Rib cage pushed in and down. Thoracic cavity volume decreased, pressure increases. Air forced out of the lungs.

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12
Q

What happens to PNS control of heart rate at rest during inspiration?

A

Activation of inspiratory muscles occurs during inspiration. This inhibit vagus nerve inner spoon of heart rate control

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13
Q

What is the inter beat interval? Discuss it in terms of breathing in vs breathing out.

A

Referred to as the time between heart beats. Longer during breathing out than during breathing in

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14
Q

Define the difference between physical activity and exercise.

A

Physical activity - any movement requiring metabolic energy for the musculoskeletal system.
Exercise - subset of physical activity where increased metabolic energy demand is purposeful.

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15
Q

What are the two types of exercise? Briefly describe each with example.

A

Aerobic - low intensity long duration activity which uses continuous oxygen supply - marathon
Anaerobic - high intensity short duration activating which uses energy stores - sprint.

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16
Q

Discuss ventilation changes during exercise.

A

Sharpe increase in ventilation as exercise starts (the greater the exercise intensity, the sharper the increase). Eventually, steady state is reached when oxygen deficit is overcome. Immediately after exercise stops, sharp decrease in expired volume. Oxygen debt present following exercise cessation,9

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17
Q

What nerves are involved that allow for an increased ventilation during exercise?

A

Mechanoreceptors detect muscle contraction-/relaxation. Activation of neurogenic afferent nerves that send impulses to increase ventilation.

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18
Q

Discuss oxygen levels during the steady state observed during exercise,

A

Steady state indicates that oxygen supply and demand are balanced.

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19
Q

What is the oxygen debt and how is it repaid?

A

Oxygen debt refers to the amount of oxygen that needs to be breathed in to balance any oxygen used during exercise. Repaid following exercise by the continued high breathing rate and depth after exercise stops.

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20
Q

What two changes occur to increasing ventilation during exercise?

A

Breathing depth increases. Ventilation rate increases.

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21
Q

Discuss the changes in ventilation during light-moderate intensity exercise.

A

Breathing rate and depth increases to ensure oxygen supply is sufficient for increased oxygen demand during exercise

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22
Q

Discuss the changes in ventilation during moderate-high intensity exercise.

A

Ventilation rate increases but no further increase to breathing depth. Due to inefficiency of continued breathing depth increases.

23
Q

What are the four parameters that are changed during increased ventilation during exercise? Describe the change in each.

A

Tidal volume - increases until a maximum level is obtained - no further increase beyond this.
Respiratory rate - continues to increase gradually.
Volume expired - exponential growth is observed
Power - gradual slow increase

24
Q

Discuss what happens to cardiac output during exercise

A

Cardiac output increases due to an increase in heart rate and stroke volume. (NOTE - heart rate Can only increase so much)

25
Q

Discuss the process of blood shunting during exercise.

A

Refers to the redistribution of blood flow. Blood shunted towards essential organs (e.g. skeletal muscle) by vasodilation of capillaries at this tissue. Blood shunted away from non essential organs (e.g. digestive system, liver etc) by vasoconstriction of arterioles supplying these tissues.

26
Q

What is ventricular tachycardia?

A

Condition where heart beat is abnormal. Ventricles contract too fast meaning that they are unable to be completely filled.

27
Q

What has a great effect on changes in the cardiovascular system during exercise - blood shunting or the sympathetic nervous system?

A

Sympathetic nervous system has greater effect

28
Q

How do you calculate maximum heart rate?

A

220 - age.

29
Q

Give five chronic adaptations occurring as a result of long term training,

A 
Ventricular remodelling
Increased alveolar vascularisation
Increased myocardium vascularisation
Increased oxidative enzyme density
No change to lung volume
30
Q

Discuss the changes in the cardiovascular system due to long term training (not chronic adaptations).

A

Ventricular hypertrophy - increased muscle around left ventricle in particular allowing for an increased stroke volume.
Increased stroke volume allows for decreased heart rate, which still gives sufficient cardiac output.
Venous return increases - more blood returned to heart so more efficient delivery system overall.
Increased left ventricular end diastolic blood volume - increased amount of blood in ventricles prior to contraction.

31
Q

Discuss the specific changes under the category of ‘ventricular remodelling’ as a result of long term exercise.

A

Ventricular cardio myocytes undergo hypertrophy (increase in size) and hyperplasia (increase in number).

32
Q

Discuss alveolar vascularisation as a chronic adaptation of long term exercise. What is it and why does it occur?

A

Increased capillary network at alveolus aiding more efficient gas exchange. Oxygen demand can be met more readily and reduces oxygen debt during further exercise (minimises risks associated with lactic acid build up).

33
Q

Discuss cardio myocytes vascularisation as a chronic adaptation of long term exercise. What is it and why does it occur?

A

Increased capillary network feeding the cardio myocytes (more coronary arteries). Ensures that heart has plentiful oxygen supply - allows it to efficiently pump blood everywhere.

34
Q

Discuss increased oxidative enzyme density as a chronic adaptation of long term exercise. What is it and why does it occur?

A

Oxygen dependent aerobic energy production involves a variety of enzymes. Increasing the numbers of these enzymes ensures more efficient aerobic energy production for aerobic exercise. Can also contribute to increasing the anaerobic threshold.

35
Q

Discuss why lung volume changes do NOT occur as a chronic adaptation of long term exercise.

A

Generally, lung volume remains relatively constant. Weak evidence for partial increase in swimmers lungs.

36
Q

What two processes can be used to assess heart function? Briefly describe each.

A

Echocardiography - use of ultrasound to take cross sectional areas of the heart. Allows for approximating volumes and analysing valves.
Electrocardiography - measures electrical activity of heart to produce an ECG wave.

37
Q

What two factors can be determined from an ECG?

A

Heart rate. Heart rhythm.

38
Q

What are the three areas in an ECG? Describe what each area indicates.

A

P wave - firing of SA node.
QRS complex - ventricular contraction as a result of wave of excitation spreading from apex, across both ventricles.
T wave - ventricular repolarisation

39
Q

What is the main use of echocardiography?

A

Analyse heart valves. Structure, appearance and function can all be determined. This can then be used to approximate volumes.

40
Q

What are the three processes used to evaluate lung function in clinical environments?

A

Traditional spirometry.
Peak expiratory flow.
Modern spirometry - flow volume loops.

41
Q

What is the difference between vital capacity and forced vital capacity?

A

Vital capacity - during slow regular breathing

Forced vital capacity - during maximum forced breathing out

42
Q

What ratio can be determined from traditional spirometry and can be used as an indicator of various respiratory diseases? Discuss the change in the value,

A

FEV1/FVC ratio. Can be used to determine obstructive vs restrictive respiratory diseases.
Obstructive respiratory diseases - FVC is normal but FEV1 is lower meaning that FEV1/FVC ratio is reduced.
Restrictive respiratory diseases - both FEV1 and FVC are reduced meaning no change to FEV1/FVC ratio.

43
Q

What is a normal healthy FEV1/FVC ratio?

A

Healthy patients will have a ratio above 70%

44
Q

Discuss changes in TLC as a result of obstructive vs restrictive respiratory diseases.

A

Obstructive - same or slightly increased TLC.

Restrictive - reduced TLC

45
Q

Discuss the process of peak expiratory flow measurement.

A

Involves use of Wright peak flow meter. Maximum forceful breath out should be performed using as much of total lung capacity as possible. Peak expiratory flow obtained. Process should be repeated three times with the highest value used for analysis.

46
Q

Discuss the changes of age, height and gender on PEF value.

A

Gender - females have lower PEF than males.
Height - taller individuals have higher PEF than short individuals
Age - peak PEF is at approx 30-40 years of age. Rapid decrease in men following 40 but slower decrease in women.

47
Q

Discuss the changes in PEF with the following respiratory diseases: asthma and COPD.

A

COPD - stable PEF.

Asthma - variable PEF

48
Q

Discuss how to read a volume flow loop.

A

X axis is read from right to left (larger volume on the left).
Y axis indicates flow rate. Negative flow rate is inspiration. Positive flow rate is expiration.

49
Q

Give possible uses of CPET testing.

A

Determining patient fitness levels prior to surgery.
Determining causes of breathlessness.
Monitoring progression and severity of cardirespiratory diseases.

50
Q

what types of demographic information are taken from patients prior to CPET testing?

A

Age. Gender. Current fitness levels. Blood lactate. Baseline heart rate, blood pressure etc. Medical history including drug use.

51
Q

What types of equipment are required as part of cpet testing?

A

Ergo meter. Blood pressure sphygmomanometer. Mask detecting changes in gases. Blood attraction probe. Finger prick test for blood lactate .

52
Q

Give. A brief overview of the process involved in CPET testing.

A

Baseline measurements taken at rest. Patient asked to exercise - starts with no resistance but resistance is slowly applied and increased.

53
Q

What types of parameters can be determined from CPET testing?

A

Anaerobic threshold. Vo2 max. Vco2 max. Maximum work.

54
Q

Give some limitations of CPET testing.

A

Test may not be maximal - requires the patient to work flat out however cannot be ensured.

CTB (9 decks)

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