cvp exam 2 Flashcards
what has a main function of delivering adequate oxygen, nutrients to the systemic tissues and remove carbon dioxide and other waste products of the system tissues
systemic circulation
what serves as the conduit for transport of hormones, and other substances and allows these substances to potentially act at a distant site from their production
systemic circulation
what is designed to carry blood under high pressure out to the tissue beds
systemic arteries
what acts as control valves to regulate local flow
arterioles and pre capillary sphincters
what allows the exchange between tissue(cells) and blood
capillaries
how thick are capillaries
one cell layer
what collects blood from capillaries
venules
what returns blood to the heart/dynamic storage
systemic veins
what is blood flow proportional to
metabolic demand
what is cardiac output controlled by
local tissue flow
what is arterial pressure control independent of
local flow or cardiac output
what are the 4 components of vessles
endothelium, elastic tissue, smooth muscle, and fibrous tissue
one layer of what exists in all vessels
endothelium
what vessel has a high amount of elastic tissue a moderate amount of fibrous tissue and low amount of smooth muscle
aorta
what type of vessel has a high amount of smooth muscle a moderate amount of elastic tissue and a low amount of fibrous tissue
a typical artery
what type of vessel has equal parts elastic tissue, smooth muscle and fibrous tissue
a vein
what is a capillary composed of
only endothelium
what does the equation V = IR represent
ohm’s law
what is analogous to ohm’s law (V=IR)
⌂P = QR
flow(Q) is directly proportional to
⌂P
flow(Q) is inversely proportional to
Resistance (R)
what is the volume of blood that passes a certain point per unit time referred to as
flow (Q)
what is the equation used to determine flow
Q=⌂P/R
at a given Q the greater the drop in P in a segment or compartment the greater the
resistance to flow
what is the driving force of blood which is also proportional to flow
pressure gradient
what is the difference in pressure between two points
pressure gradient
independence of local flow control, minimizing total peripheral resitance, and oxygen rich blood supply to every tissue are all advantages of what
a parallel circuit
what is internal friction of a fluid associated with the intermolecular attraction
viscosity
what is the viscosity of blood
3
where does most of blood viscosity come from
RBC’s
what is the viscosity of plasma
1.5
what is the viscosity of water
1
in terms of viscosity when blood is going slow it is ____ and when it is going fast it is _____
thicker, thinner
if velocity decreases what will happen to the viscosity of blood
the viscosity will increase
when cells get stuck at constriction points momentarily what does it do to viscosity
increases apparent viscosity
where do cells line up to decrease the viscosity to offset the cells from getting stuck at constriction points
in small vessels with a diameter less that .3mm
which type of flow is streamline,silent,most efficient, and normal
laminar flow
what type of flow is cross mixing, vibrational noise, least efficient, and frequently associated with vessel disease (bruit)
Turbulent flow
the greater the R# the greater the probability for
turbulance
if R# is <2000 flow is usually what
laminar
if R# is >3000 is usually what
turbulant
when using Doppler ultrasonic flow-meter a broad band is associated with
turbulent flow
when using Doppler ultrasonic flow-meter a narrow band is associated with
laminar flow
Fick principal and indicator dilution are used to determine what
cardiac output
venous occlusion plesthymography, doppler ultrasonic flowmeter and vascular flow cuffs are used to determine what
vessel flow
what is a small cuff that fits around a vessel. and is an electromagnetic measuring device
Vascular flow cuff
what is represented by the following equations Flow = amount of substance per min / AV difference
fick principal
what is the ability of a vessel to stretch known as
distensibility
what is the ability of a vessel to stretch and hold volume known as
compliance
which vessel is thick has low distensibility, low compliance and contains ~15% of blood volume
Artery
which vessel is thin has high distensibility, high compliance, and holds ~65% of blood volume
Vein
what does the following equation represent ⌂ vol / ⌂ pressure X initial volume
Distensibilty
what does the following equation represent ⌂ Vol /⌂ pressure
compliance
what does distensibility X initial vol. determine
compliance
where is a small change in volume associated witha large change in pressure
systemic arteries
where is a large change in volume associated with a small change in pressure
systemic veins
viens are about __ times more distensible and __ times more compliant than systemic arteries
8X, 24X
local blood flow is regulated in proportion to
metabolic demand
what type of control involves vasodilation and vasoconstriction of precapillary resistance vessels
short term control of blood flow
what type of control involves changes in tissue vascularity
long term control of blood flow
the formation or dissolution of vessels as well as vascular endothelial growth factor and angiogenin are associated with what
long term control of blood flow
in regards to blood flow: what acts as an integrator of multiple inputs, are richly innervated by SNS vasoconstrictor fibers and have alpha receptors, and may be effected by local factors
arterioles
Adenosine, CArbon Dioxide, adenosine phosphate compounds, histamine, potassium ions, hydrogen ions, PGE & PGI series prostoglandins, NO, CO are all what
local vasodilators
what is the ability to keep blood flow constant in the face of a changing arterial blood pressure known as
autoregulation
in the kidney both renal flow and the glomerular filtration rate are what
autoregulated
what is the production of new microvessels referred to as
angiogenesis
the shear stress caused by enhanced blood flow velocity associated with partial occlusion is referred to as
arteriogenesis
small peptides that stimulate growth of new vessels such as VEGF are referred to as
angiogenic factors
what is it called when mesenchymal cells differentiate into endothelial cells
vasculogenesis
what is the formation of new blood vessels by sprouting from pre existing small vessels ( usually lacking developed tunica media) called
angiogenesis
what is the rapid proliferation of pre-existing collateral vessels with fully developed tunica media
arteriogenesis
what are the mechanical tirggers of angiogenesis
hemodynamic and shear stress
what is the broad term from producing new vessels (vasculogenesis, angiogenesis, arteriogenesis)
Neovascularization
what are the chemical triggers of angiogenesis
hypoxia and NO
decreased glucose, increased VEGF, inflammation, and angiogenic growth factors are all example of what kind of angiogenic triggers
molecular
fibroblast growth factor, VEGF, placenta growth factor, and angiopoietin are all what type of growth factor
angiogenic growth factors
protein therapy, Gene therapy, and cellular therapy are all example of what type of angiogenesis
therapeutic angiogenesis
what method of therapeutic angiogenesis utilizes growth factor proteins
protein therapy
what method of therapeutic angiogenesis utilizes manipulation of gene expression for angiogenic peptides
Gene therapy
what method of therapeutic angiogenesis utilizes cells that produce angiogenic factors are introduced into ischemic tissue
cellular therapy
inhibition of platelet aggregation, and relaxation of vascular smooth muscle (dilating) is a result of the release of what
prostacyclin (PGI2)
Release of NO in healthy endothelium results in
vasodilation
release of endothelin to damaged endothelium causes what to happen to vascular smooth muscle
constricts vascular smooth muscle
what is the functional unit of circulation
capillary
where does the bulk of exchange take place
capillary
diffusion,ultrafiltration, and vesicular transport are all example of what
mechanisms of exchange
if flow doubles and we don’t uptake any more oxygen what happens
non-functional flow increase
if flow doubles and we have and increase in uptake of oxygen what will happen
metabolic demand increase
what are non nutritive flow increases associated with
shunting of blood
what is the average capillary hydrostatic pressure gradient
17mmHg
what is the average interstitial hydrostatic Pressure gradient
-3 mmHg
what does high hydrostatic pressure favor
filtration
what does low colloid osmotic pressure favor
reabsorption
what is the average colloid osmotic pressure of a capillary
28mmHg
what is the average interstitial colloid osmotic pressure
9mmHg
what proteins can exert osmotic pressure
only those that cannot cros the capillary wall
what may have walls that can range from tight junctions(blood brain barrier) to discontinuous(liver)
capillaries
what capillaries have filtration slits (fenestrations)
glomerular capillaries in the kidneys
if all colloid proteins freely cross the capillary wall none are reflected(no colloid effect) what is the reflection coefficeint and what tissue may this be in
RC=0 in the liver
if all colloid protiens are reflected and none cross the capillary wall (full colloid effect) what is the reflection coefficient and what tissue may this be found in
RC=1 in the blood brain barrier
superficial portions of the skin, the CNS, endomysium of muscle and bones all lack what type of vessels
lymphatic vessels
____ duct drains the lower body and left side of head,left arm, and part of the chest
thoracic duct
_____ duct drains the right side of the head, neck and right arm and part of the chest
right lymph duct
what acts as the lymphatic system in the CNS
perivascular spaces
what spaces contain CSF and communicate with subarachnoid space functioning as the “lymphatic system” of the CNS
perivascular spaces
any factor that increases filtration and/or decreases reabsorption will do what to lymph formation
increase
how much lymph flows through the thoracic duct
100ml/hr
how much lymph flows through the right lymph duct
20ml/hr
what is the total lymph flow
120ml/hr or 2.9L /day
return of lost protein to the vascular system, draining of excess plasma filtrate from the ISF space, carrying absorbed substances/nutrients from the GI tract are all function of what system
lymphatics system
a meshwork of sinuses lined with tissue macrophages is a description of what
a lymph node
the volume of blood interacting with the wall is refered to as
arterial blood pressure
when the left ventricular output is greater than peripheral runoff the heart is in
systole
during what phase does total blood volume rise causing arterial blood pressure to increase to a peak
systole
during systole the arteries are _____
distended
during what phase of the heart is the the left ventircle is filling, the arteries are recoiling, serving to maintain perfusion to the tissue beds
diastole
when total blood volume in the arterial tree is decreasing causing arterial blood pressure to fall to a munium value what is this phase of the heart called
diastole
what represents the maximum pressure in the systemic arteries
systolic blood pressure
pressure peaks as blood is ejected from the left bentricle into the aorta during what phase
systole
the minimum pressure in the systemic arteries
diastolic blood pressure
increased cycle length will do what to diastolic blood pressure
decrease
increased total peripheral resistance (TPR) will do what to diastolic blood pressure
increase
what two factors does how low the diastolic blood pressure will fall depend on
cycle length (CL) and total peripheral resistance (TPR)
when may diastolic blood pressure not change much due to decrease in cycle length being offset by decreased total peripheral resistance
during excersise
1/3 pulse pressure + diastolic blood pressure roughly yields what
Mean Arterial Blood Pressure (MAP)
critical luminal pressure is required to keep arterioles from doing what
closing completly
vascular tone is proportional to what
critical closing pressure
as arterial pressure falls, ther is a critical pressure below which, flow ceases due to …
closure of arterioles
if cardiac output is stopped, arterial pressure will fall and venous pressure will do what
rise
the equilibration pressure where arterial blood pressure is equal to venous blood pressure is know as
mean circulatory filling pressure (MCFP)
equilibration pressure may be prevented by what
the closure of arterioles (critical closing pressure)
what is responsible for pressure gradient driving peripheral venous return
Mean Circulatory filling pressure
at a given mean circulatory filling pressure as central venous pressure increases venous return will do what
decrease
if MCPF = CVP venous return will equal what
0
as central venous pressure increases, cardiac output increases due to what effects
intrinsic and extrinsic
the pressure in the central veins at the entry into the fight atrium are referred to as the
central venous pressure
central venous pressure is equal to
right atrial pressure
the pressor center, depressor center, sensory area, and cardioinhibitory area are the four major regions of what
Vasomotor center
the pressor center of the vasomotor center functions to
increase blood pressure
the depressor center of the vasomotor center functions to
decrease blood pressure
the sensory area of the vasomotor center functions to
mediate baroreceptor reflex
the cardioinhibitory area of the vasomotor center functions to
stimulate CN X
what center of the vasomotor center causes vasoconstiction, stimulates cardiac activity, and is tonically active exiting SNS outflow and is located in the anterolateral portion of the upper medulla
the pressor center of the vasomotor center
what center of the vasomotor center has fibers that project into and inhibit the pressor center, causes decreased cardiac activity, and vasodilation, and is located in the anterolateral lower part of the M.O.
the depressor center of the vasomotor center
what area of the vasomotor center receives input primarily from CN IX and X, has outputs to both pressor and depressor centers, mediates baroreceptor reflex and is located in the posterolateral portions of the pons and medulla in the nucleus tractus solitarius
Sensory Area
what area of the vasomotor center transmits impulses into DMNV inhibiting heart activity and is located medially next to dorsal motor nucleus of vagas
cardioinhibitory area
what maintains normal arterial blood pressure and is due to pressor center input
sympathetic vasoconstrictor tone
rapid short term control of blood pressure involves the nervous system effect on what
vascular smooth muscle
long term control of blood pressure is dominated by what organ
kidneys
control of blood pressure is accomplished by affecting what two things
vascular tone or blood volume
where are baroreceptors especially abundant in
carotid sinus and the arch of the aorta
baroreceptors are stimulated when stretched and inhibit was vasomotor center
pressor center
what receptors are located in atrial walls and pulmonary arteries and minimize arterial pressure changes in response to blood volume changes
low pressure baroreceptors
which reflex senses low pressure
baroreceptor reflex
which reflex senses increased heart rate
Bainbridge reflex
increased total peripheral resistance will not create a long term elevation of blood pressure if what does not change
fluid intake and renal function
what is the normal glomerular filtration rate
~100ml/min
what is normal renal blood flow
~1.25L/min
in the kidney constriction of afferent arterioles will have what effect on renal flow and GFR
decrease both
in the kidney constriction of efferent arterioles will have what effect on renal flow and GFR
decrease renal flow but increase GFR (by creating back pressure)
with rising arterial blood pressure constriction of what arterioles alone can autoregulate flow and GFR
afferent arterioles
what happens to arterial pressure when extracellular fluid levels rise
they rise as well
SNS stimulation, the renin-angiotensin system, aldosterone and ADH all have what effect on chronic blood pressure
raise it
what effect does ANP have one chronic blood pressure
decrease it
is the heart an endocrine organ
yes
norepinephrine, epinephrine and angiotesin II have what effect on renal blood flow
decrease
what hormone increases renal blood flow
Prostaglandins (E and I)
what monitors the Nacl in the macula densa of the distal tubule
tubuloglomerular feedback
where does tubuloglomerular feedback take place
between the afferent and efferent arteriole
renin is released from the juxtaglomerular cells causeing an increase in angiotensin II levels, causing and increase in efferent arteriole resistance in turn causing an overall increase in total blood pressure. what causes this cascade of events
a decrease in NaCl in the Macula densa
decrease in NaCl in the macula densa causes dilation of what arteriole
afferent
where is the synthesis, storage, and release of renin from
smooth muscle cells in afferent arterioles
decreased perfusion pressure, SNS stimmulation, decreased NaCl delivery to the macula densa as well as thyroid and growth hormone all stimulate the release of what enzyme from smooth muscle cells in afferent arterioles
Renin
what enzyme catalyses the formation of angiotensin 1 from angiotensinogen,
Renin
angiotensin I changes into angiotensin II via angiotensin converting enzyme in what tissue
primarily the pulmonary endothelium of the lungs
what hormone stimulates the adrenal cortex to secrete aldosterone, stimulates the release of ADH/vasopressin, and stimulates the kidneys
angiotensin II
the decrease of Na and H2O excretion from angiotensin II has what effect on blood pressure
increases blood pressure
increasing what will reduce the number of free radicals allowing nitric oxide (a dilator) to have a longer lasting effect in lowering blood pressure
antioxidants
what inactivates nitric oxide
superoxide
glutathione, melatonin, superoxide dismutase, beta-carotene, lutein, lycopene, selenium, Vit A, Vit C, Vit E, are all examples of what
antioxidants
what humoral substance may act at the CNS to inhibit relex SNS activation
Serotonin
what humoral substance may act centrally to inhibit sympathetic nerve activity
Nitric Oxide
what humoral substances my promote bradycardia and hypotension
Serotonin, Nitric Oxide
the umbilical arteries are branches off the anterior lilac arteries supplies blood to what
the placenta
blood returns to the fetus from the placenta via what vessel
umbilical vein
what fetal shunt fits the following path SVC –> RA –>RV –> pulmonary trunk –> ______–>aorta
Ductus arteriosis (DA)
what fetal shunt fits the following path IVC –> RA–>______ –>LA –> LV –> aorta
foramen ovale (FO)
what fetal shunt fits the following path umbilical vein –>_____–>IVC
Ductus Venosus (DV)
what fetal shunt fits the following path portal vein –____–>IVC
Ductus Venosus (DV)
what fetal shunts allow blood to bypass the lungs
ductus arteriosus and foramen ovale
what fetal shunt allows the umbilical and portal blood to bypass the liver
ductus venosus
how does oxygen saturation in the fetal blood compare to that of an adult
it is lower compared to an adult
upon birth pulmonary vascular resistance decreases causing an increase of blood flow through which organs
lungs and liver
how does the loss of blood flow through th placenta effect the systemic vascular reistance
it doubles the systemic vascular resistance
the reversal of pressure gradient between the RA and LA causes what to close
foramen ovale
reversal of flow from the aorta to the pulmonary artery, and increased oxygen levels causes constriction of smooth muscles causing the closure of what
ductus arteriosis
the closure of what allows portal blood to perfuse liver sinuses
Ductus venosus
patent ductus arteriosus,ventricular septal defect, transposition of great vessels and tetrology of follot are all examples of what
congenital deftects
what congenital defect is associated with right ventricular hypertophy, large ventricular septal defect, right ventricular outflow obstruction and overrides the aorta
tetrology of fallot
what are symptoms of tetrology of fallot
cyanosis, dyspnea
increased heart rate and decreased blood flow to organs are associated with what activity
excersise
during exercise cardiac output is increased how much
5-6 fold
vasoconstriction of arterioles to decrease flow to non active tissues, and vasoconstriction of veins to increase MCFP which increases venous return are both SNS effects activated by what
excersise
during excersise an increased O2 uptake will decrease VO2 causing what to happen to AVO2 difference
increase in AVO2 difference
increased heart rate and stroke volume induces what at the heart
local metabolic vasodilation
during exercise: reflex signals from active joint prorioceptors and muscle spindles, as well as local chemoreceptor signals originating in the active muscle stimulate what
SNS
SNS stimulation of pre-capillary resistance vessels during excersise (organs and inactive skeletal muscle) has what effect on blood flow
decreases blood flow
SNS stimulation of veins during excersise causes constriction which mobilizes blood out of veins doing what to venous return
increases by the redistribution of blood volume
SNS stimulation of vascular smooth muscle in walls of arteries helps maintain slightly ______ blood pressure during excersise
increased
will skeletal muscle activation trump SNS stimulation during excersise
yes
does metabolism trump constrictor effects during excersise
yes
increase in systolic blood pressure during exercise is due to what
increase in cardiac output
increased blood flow to the active muscles during exercise is not mediated by SNS but by the local release of _____________
tissue metabolites
tissue metabolites are released in response to the increase in what
metabolism local vasodilators
adenosine,CO2,K+ histamine and lactic acids are examples of
local vasodilatiors
coronary, and active muscle blood flow both _______ with excersise
increase
what % of blood flow is redirected to active muscle during excersise
90%
what is the cardiovascular endpoint that decreases with excersise
total peripheral resistance will decrease, and stroke volume will increase then decrease
the maximum volume of oxygen that one can take up from the lungs and deliver to the tissues/minute is known as
VO2 Max
what is the VO2 max in a cadiac patient
1.5L/min
what is the VO2 max in a sedentary man
3.0L/min
what is the VO2 max in a endurance athlete
6.0L/min
the VO2 max is proportional to what as training occurs
stroke volume
the function of cardiac output and AVO2 difference is
VO2 max
if energy demands of excercise cannot be met by oxidative phosphorylation what occurs
O2 debt
how does O2 debt get repayed
by respiration remaining elevated after excercise
restoring metabolite levels and metabolizing lactate generated by glycolysis is resolved by
extra O2
energy consumed during exercise - the energy supplied by oxidative metabolism yields what
O2 debt
