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GNURS627 > CV Final > Flashcards

CV Final Flashcards

1
Q

Arterioles have the greatest what?

A

resistance to bloodflow

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2
Q

Vein function?

A

Capacitance function (blood volume)

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3
Q

Distension of the aorta and its branches during?

A

Systole

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4
Q

• Elastic recoil of the large arteries with forward propulsion of blood during ventricular relaxation during?

A

Diastole

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5
Q

Velocity of blood flow is __________ related to the cross-sectional area of the vascular system

A

Inversely.

Blood flow velocity is very slow in the capillaries

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6
Q

The cardiac output is controlled mainly by the sum of?

A

all the local tissue flows

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7
Q

Cardiac accelerators

Sympathetic

A

T1-T4

Stellate ganglia (cervicothoracic ganglia) and middle cervical ganglia

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8
Q

Parasympathetic

A

– Much innervation to SA and AV nodes

– Little innervation to ventricles

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9
Q

Pericardium Layers

A

– Fibrous
– Serous
• Parietal layer
• Visceral layer

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10
Q

Potassium is the major determinant of the _________ ________ _______

A

Resting Membrane Potential

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11
Q

As K+ leaves cell, ________ increases on the inside of the cell membrane and __________ attracts K+

A

negativity, electrostatically

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12
Q

Na+, K+ - ATPase Pump Ratio

A

Pumps in 3:2 ratio (3 Na+ out: 2 K+ in)

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13
Q

PHASES OF THE FAST RESPONSE ACTION POTENTIAL

A
  • Phase 0 = Depolarization
  • Phase 1 = Partial Repolarization
  • Phase 2 = Plateau
  • Phase 3 = Repolarization
  • Phase 4 = Resting Membrane Potential
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14
Q

ERP & RRP

A

ERP = Effective Refractory Period (cannot regenerate another action potential)

RRP = Relative Refractory Period (can begin to generate another action potential)

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15
Q

Phase 0

A

• The characteristics of the upstroke of the action potential depend almost entirely on inward movement of Na+

There is a small inward Ca++ current (important for contraction)

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16
Q

PHASE 1 – Partial Repolarization

A

Inactivation of Na+ channels ends

Transient outward K+ current

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17
Q

PHASE 2 - Plateau

What produces the plateau?

A

Slow inward Ca++ currents (L-type calcium channels)

Counterbalanced by:
Outward K+ currents

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18
Q

PHASE 3 - Repolarization

What outward movement is mainly responsible for repolarization?

A

K+

Na+ channel recovery begins during Relative Refractory Period

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19
Q

PHASE 4 – Resting Membrane Potential

A
  • Restoration of ionic concentrations
  • Na+,K+-ATPase
  • Na+-Ca++ Exchanger (driven by gradients not electrical)
  • ATP-driven Ca++ Pump
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20
Q

• The ability of a focal area of the heart to generate pace making stimuli is known as?

A

Automaticity

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21
Q

Calcium-Induced Calcium Release (CICR)

A

Because the T-tubules are continuous with the extracellular fluid, extracellular concentration of calcium becomes important for adequate heart contraction.

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22
Q

8 ECG Waves Intervals & Segments

A

Page 8

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23
Q

Ventricular Systole Phases

A

– Phase 2
Isovolumic contraction

– Phase 3 Rapid ejection (70% of ventricular volume is ejected)

– Phase 4
Reduced ejection

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24
Q

• Ventricular Diastole Phases

A

– Phase 5 Isovolumic relaxation

– Phase 6
Rapid filling

– Phase 7
Diastasis

– Phase 1
Atrial systole

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25
Q

Determinants of CO

A

Heart Rate

Contractility

Preload

Afterload

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26
Q

• Changes in heart rate alone inversely affect?

A

Stroke Volume

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27
Q

Effects of Heart Rate on Cardiac Output

Bowditch (Treppe) Effect

A
  • An increase in heart rate will also cause positive inotropy (Bowditch effect, Treppe or “staircase” phenomenon).
  • This is due to an increase in intracellular Ca++ with a higher heart rate
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28
Q

• Preload can be defined as?

A

the initial stretching of the cardiac myocytes prior to contraction. It is related to the sarcomere length at the end of diastole.

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29
Q

indirect indices of preload?

A

– LVEDV (left ventricular end-diastolic volume)

– LVEDP (left ventricular end-diastolic pressure)

– PCWP (pulmonary capillary wedge pressure)

– CVP (central venous pressure)

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30
Q

What is the Frank Starling Mechanism

A

The heart pumps the blood that is returned to it

Increasing venous return and ventricular preload leads to an increase in stroke volume.

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31
Q

What is afterload?

A

the “load” that the heart must eject blood against.

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32
Q

Afterload increased by?

A

Increased aortic pressure
Increased systemic vascular resistance

Aortic valve stenosis

Ventricular dilation

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33
Q

La Place and Afterload

A

– LaPlace’s Law: Wall stress = Pr/h

P = ventricular pressure

R = ventricular radius

h = wall thickness

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34
Q

What affects the FSC the most?

A

Changes in afterload and inotropy

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35
Q

Spontaneous respiration and venous return

A

– Decreased intra-thoracic pressure results in a decreased right atrial pressure which enhances venous return

36
Q

Mechanical ventilation and venous return

A

– Increased intra-thoracic pressure during positive-pressure lung inflation causes increased right atrial pressure which decreases venous return

37
Q

Valsalva Maneuver and venous return

A

– Causes a large increase in intra-thoracic pressure which impedes venous return to the right atrium

38
Q

As the PRA starts to fall below zero what happens to CO

A

the CO begins to level off because the vena cava collapses, thus limiting venous return to the heart.

39
Q

Experimentally, if cardiac output is stopped, aortic pressure falls and PRA increases to a common value of about ___ mmHg

A

8 (Mean Circulatory Filling Pressure)

Pmc

40
Q

Venous return curves

A

pg.15

41
Q

EF =

A

SV/EDV

SV=EDV-ESV

42
Q

the width of a pressure volume loop represents the difference between _______ and ________

A

EDV and ESV, which is by definition the stroke volume (SV). The area within the loop is the ventricular stroke work.

43
Q

Pressure Volume loop Phases

A

Slide 17

44
Q

ability of the heart to change its force of contraction and therefore stroke volume in response to changes in venous return is called?

A

the Frank-Starling mechanism (or Starling’s Law of the heart).

45
Q

. Myocyte stretching increases the ______ _______, which causes an increase in force generation

A

sarcomere length

46
Q

Velocity is _______ _______ to cross-sectional area

A

inversely related

47
Q

• Flow, which is ______ ______ _____, must be distinguished from velocity, which is distance per unit time.

A

volume per unit time

Flow = velocity x cross sectional area of the vessel

pg. 19 diagram

48
Q

Blood pressure is

A

the force exerted by the blood against any unit area of the vessel wall

49
Q

What is perfusion pressure?

A

perfusion pressure (i.e., pressure gradient) that is normally represented by the difference between the arterial and venous pressures across the organ.

50
Q

Cerebral Perfusion Pressure

A

– Mean arterial pressure – CVP or ICP (whichever is higher)

51
Q

Coronary Perfusion Pressure

A

– Diastolic pressure - LVEDP

52
Q

Poiseuille’s Law

A

• Flow is directly proportional to the pressure gradient
• Flow varies directly as the fourth power of the radius
o Doubling the radius of a tube causes a 16-fold increase in flow
• Flow is inversely proportional to the viscosity of the fluid
• Flow is inversely proportional to the length of the tube

53
Q

What is resistance?

A

Resistance = the impediment to blood flow in a vessel and cannot be measured by any direct means

54
Q

SVR formula

A

MAP-CVP/CO *80

Normal SVR = 700-1600

55
Q

Resistance in series

Resistance in parallel

A

Resistance in Series is Additive

Resistance in Parallel has a decreased resistance by increasing the overall radius

56
Q

the best transducer placement for standard clinical monitoring is at a vertical height approximately

A

5 cm below the left sternal border at the fourth intercostal space.

57
Q

Thermodilution Pac: Cardiac output is _______ _______ to the area under the curve (AUC)

A

inversely proportional

58
Q

MAP equation

A

SBP + DBP(2)/3

59
Q

% of the blood volume may be stored in the veins

A

70

60
Q

Arterioles are the ________ of the circulation

A

“Stopcocks”

61
Q

True capillaries are devoid of smooth muscle and are_____of active constriction

A

incapable

62
Q

Diffusion through Capillary Membrane

A

pg. 23

63
Q

Iv Fluid and TBW

A

pg 24

64
Q

– Capillary hydrostatic pressure, Interstitial fluid hydrostatic pressure, & interstitial fluid osmotic pressure ALL MOVE FLUIDS?

A

OUTWARD FROM THE CAPILLARY

65
Q

– Plasma colloid osmotic pressure is the only major factor that moves fluid?

A

INTO THE CAPILLARY

66
Q

Tissue Metabolic Activity Is the Main Factor in Acute Control of what?

A

of Local Blood Flow

67
Q

What is the metabolic Mechanism?

A

Any intervention that results in an inadequate oxygen (nutrient) supply for the metabolic requirements of the tissues results in the formation of vasodilator substances which increase blood flow to the tissues.

68
Q

What is Reactive Hyperemia

A

= when blood supply is blocked to a tissue for a few seconds to as long as an hour or more and then is unblocked, blood flow through the tissue usually increases immediately to 4-7 times normal for a few seconds to many hours

69
Q

What is auto regulation?

A

Intrinsic ability of an organ to maintain a constant blood flow despite changes in perfusion pressure

70
Q

Autonomic Nervous system control: Two sources and their neurotransmitters are?

A

Sympathetic Nerves
– Norepinephrine released

Adrenal Gland (longer lasting effect)
– Releases mostly epinephrine (80%)
– Lesser amount of norepinephrine released (20%)

71
Q

A1

A

Vasoconstriction

72
Q

Beta 1

A

Increased heart rate & Contractility

73
Q

Beta 2

A 
–	Vasodilation
–	Bronchodilatation
–	Uterine relaxation
–	Glycogenolysis
–	Drive Potassium into the cells (repeated albuterol treatments)
74
Q

Baroreceptor Reflex is Responsible for?

A

Rapid Adjustments of Blood Pressure

Carotid Sinus and Aortic Arch Baroreceptors

Senses and buffers changes in blood pressure

– Works in both directions

75
Q

Diving Reflex =

A

water on the face causes vasoconstriction and slowing of the HR

76
Q

CNS Ischemic Response

A

Cushing Response = hypertension with bradycardia

77
Q

Bezold-Jarisch Reflex

A

This reflex plays a role in blood pressure regulation

Hypotension with Bradycardia / parasympathetic response
– (Ventricular Receptor Reflex)

Empty Ventricle

78
Q

Bainbridge Reflex

A

increase in volume causes sympathetic response- inc. HR

Low pressure receptors that respond to stretch

Sense cardiovascular system volume

79
Q

The heart extracts _______to a ______ ______ than any other organ

A

oxygen, greater extent

80
Q

Abrupt pressure rise (80-90% of LV flow occurs when?

A

early diastole

81
Q

The __________ is more susceptible to ischemia than the midmyocardium or subepicardium

A

subendocardium

82
Q

Epicardial coronary stenoses are associated with reductions in the?

A

subendocardial to subepicardial flow ratio

83
Q

The ultimate cause of Myocyte death in myocardial ischemia

A

Intracellular Ca+ overload leads to impaired contraction and cell death.

Decrease Na/Ca exchange

84
Q

what is ischemic preconditioning

A

brief periods of ischemia appear to “precondition” myocardium against reversible or irreversible tissue injury, including stunning, infarction, and the development of malignant ventricular arrhythmias

85
Q

The valve area in regurgitant lesions can respond to?

A

changes in loading conditions (respond to changes in preload, afterload)

86
Q

AS Presenting symptoms and life span

A

– Angina = 5 years

– Syncope = 3 years

– CHF = 2 years

87
Q

Valve Pathology

A

pg. 39-42

GNURS627 (5 decks)

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