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ESA2 > CVS Flow/Pressure > Flashcards

CVS Flow/Pressure Flashcards

1
Q

Which side has the brachiocephalic trunk that splits into the common carotid and subclavian arteries, and which has the common carotid and subclavian straight off aorta?

A

L side has brachiocephalic trunk

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2
Q

What is pericardicentesis?

A

Aspiration of pericardial fluid e.g. blood or infective exudate that has caused a pericardial effusion

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3
Q

What can CO rise to in exercise?

A

25L/min

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4
Q

What is cardiac tamponade?

A

Fluid in the pericardial sac builds up and leads to compression of the heart - can lead to rocking rather than contraction and lead to cariogenic shock and death.

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5
Q

How much of blood is RBC and how much plasma?

A

2L RBC
3L plasma

5L altogether

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6
Q

Where does most of the blood lie in the cardiovascular system?

A

In the venous system

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7
Q

What are the three layers of artery and vein walls?

A

Tunica intima
Tunica media
Tunica adventitia

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8
Q

What does the tunica media of the aorta contain a lot of?

A

Elastin

Also 40 layers of SMCs

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9
Q

Why are AAAs most likely suprarenal?

A

Less elastin there

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10
Q

What is a capacitance vessel?

A

A vein - stretch passively and accommodate for increased blood (Store) and don’t recoil

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11
Q

Why do we need a CVS?

A

To get O2 nutrients and take waste from cells because diffusion isn’t possible over such large distances - transport system required

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12
Q

What two factors affect diffusion (gas exchange)

A

Area available for diffusion

Conc grad

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13
Q

What is rate of blood flow AKA? and how does this affect diffusion?

A

Perfusion rate

Higher perfusion rate more diffusion

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14
Q

What is the pericardial sac made of? What is the inner layer split into?

A

Outer fibrous layer
Inner serous layer - inner serous layer is made up of visceral layer and parietal (outer) layer with serous pericardial fluid in between

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15
Q

What are the roles of the fibrous layer vs serous layer of pericardial sac?

A

Fibrous layer anchors heart to mediastinum and is continuous with great vessels adventitia layer, prevents overfilling and protects heart against infection

Serous - lubrication to prevent friction during heart contractions

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16
Q

Why are coronary arteries prone to atherosclerosis?

A

Small vessels

Turbulent flow at junctions

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17
Q

Where is the phrenic nerve in relation to the pericardium?

A

Passes down between the lungs and the heart to meet the diaphragm. L phrenic nerve passes over pericardium of LV and pierces diaphragm. R phrenic nerve passes over RA

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18
Q

What is polycythaemia?

A

Rare condition normally defect in JAK2 gene that causes over production of RBCs (polycythaemia vera)

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19
Q

What is serum vs plasma?

A

Serum is plasma minus clotting factors so appears clear

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20
Q

Where are WBCs and platelets contained in a blood sample vial?

A

Buffy coat

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21
Q

What is peripheral resistance?

A

Resistance of the arteries to blood flow

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22
Q

Does a rise or fall in peripheral resistance lead to increased stroke volume?

A

Fall in TPR leads to increased SV

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23
Q

Which 3 characteristics of an artery/blood affect peripheral resistance?

A
  • Change in length
  • Change in diameter
  • Change in blood viscosity
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24
Q

What is CRP? When is it used clinically?

A

It is an acute phase protein released in inflammation so used to measure inflammation

Acute phase proteins increase in concentration in the plasma during inflammation

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25
Give a minor and major cause of increased blood viscosity
Minor - increase in acute phase proteins in inflammation Major - Thrombocythaemia, Polycythaemia, multiple myeloma (plasma cell cancer)
26
What are metarterioles and what do they contain to help their function?
Arterioles that lead to a capillary bed - have SMC at the entrance to capillaries that act as pre capillary sphincters regulating blood flow through the capillary bed
27
Which blood disorder can cause dry gangrene and why?
Multiple myeloma due to increased protein Immunoglobulin that causes dry gangrene
28
Define viscosity
Intrinsic feature of a fluid relating to internal friction of adjacent fluid layers sliding past one another
29
What is the difference between velocity and flow?
Velocity is the distance of blood moved in time | Flow is the volume of blood moved in time
30
How would you work out flow from velocity and area of vessel?
flow = velocity x cross-sectional area of vessel
31
What is laminar flow? What is a flow characteristic of laminar flow?
Velocity of fluid is constant at any given point in the fluid Flows in streamlines so layers of blood remain the same distance from the wall at any given time. Parabolic flow is a characteristic of laminar flow where the fluid in the centra travels faster than that on the edges
32
What is turbulent flow?
Irregular flow in all directions in the vessel - blood continually mixing and changing direction
33
When can turbulent flow occur (5)?
- When blood flow becomes too great - An obstruction - A rough surface - A corner - Increased resistance to flow
34
By definition when does systole end?
When the aortic valve shuts
35
What is the dichrotic notch
Slight back flow in the aorta following aortic valve closure
36
When does blood enter the coronaries - systole or diastole
Diastole
37
How do you find the pulse pressure (equation)
Systolic - diastolic pressure
38
How do you find the MABP?
1/3 pulse pressure + diastolic pressure
39
Below which MABP is organ perfusion impaired?
70mmHg
40
Define the pulse?
Rhythmic shock wave of heart beat arriving slightly before the blood itself
41
What does the strength of the pulse depend on (2)
Force of LV contraction | Pulse pressure
42
What happens to the pulse pressure with a bounding pulse?
It widens
43
Does bradycardia widen or narrow the pulse pressure?
Widens - bounding
44
Does aortic insufficiency (regurgitation) lead to widened or narrowed pulse pressure?
Widened - as increased back flow during diastole reduced diastolic blood pressure so pulse pressure difference is more
45
Does pregnancy, hot baths exercise (low peripheral resistance) widen or narrow pulse pressure?
Widen
46
When taking blood pressure how must the cuff fit? Why?
Must go round at least 80% of arm Too big - underestimates Too small - overestimates
47
Where is blood pressure most accurate and why?
Nearest the heart so left arm as gravity has an effect on BP
48
Why does the heart need resistance and capacitance vessels?
Resistance - restricts blood flow to redirect to harder to perfuse areas of body Capacitance - storage vessels e.g. to engorge and vary amount of blood pumped round body
49
Should L and R heart output over time be equal?
Yes has to be equal
50
Define systole diastole
Systole - contraction and ejection of blood | Diastole - relaxation and filling of blood
51
What is the pressure in the RA, RV, PA, LA, LV, Ao?
``` RA - 0-4 RV 25/4 PA 25/10 LA 8-10 LV 120/10 Ao 120/80 ```
52
How long is a cardiac action potential?
200-400ms normally 280ms
53
How do APs travel from cell to cell in the heart?
Gap junctions
54
What determines whether a valve is open or closed?
Pressure
55
What are the roles of the papillary muscles/cordae tendinae?
Papillary muscles - contract on ventricular systole to prevent inversion (prolapse) of mitral and tricuspid valves Chordae tendonae are tendon like structures that anchor the papillary muscles to the valves
56
Does the cardiac AP originate from the cardiac muscle or nerves?
AP for hear originates in the SAN not from nerves like skeletal muscle
57
Through the myocardial muscle does the AP travel endo-epicardium or epi-endocardium?
Endo - epicardium
58
From the wiggers diagram what is the A, C waves and X descent?
A wave - atrial systole C wave - isovolumetric ventricular contraction increases the pressure in atrium - as mitral valves close X descent - atrial pressure reduces as ventricles contract due to the atrial base being pulled downwards
59
What are the 7 stages of the wiggers diagram? Which are the stages where the heart sounds are heard?
1) Atrial contraction 2) Isovolumetric contraction - S1 3) Rapid ejection 4) Slowed ejection 5) Isovolumetric relaxation - S3 6) Rapid Filling 7) Slowed filling
60
What is the typical EDV (ml)?
120ml
61
How much ventricular filling is from atrial contraction?
10%
62
Which valves are open in stage 1 (atrial contraction)?
Mitral and tricuspid open, pulm and Ao closed
63
During which phase is the QRS complex?
2) Isovolumetric contraction
64
During which phase is the T wave?
Slowed ejection
65
What causes the A wave in the atrial pressure trace?
Atrial systole increases atrial pressure
66
Why does ventricular ejection rate slow (phase 4)?
Due to repolarisation of the ventricle leading to a decline in tension so the rate of ejection begins to fall
67
What is the difference between stenosis/regurg?
Stenosis - valves closed when should be open e.g. calcified Regurg - valves closed when they should be open e.g. cusps not meeting in LV dilation
68
What is a cause of aortic valve stenosis?
1) Calcific - degenerative 2) Bicuspid aortic valve 3) Chronic rheumatic valve - commissural fusion
69
What kind of anaemia can occur from heart valve stenosis and why? What would it look like on microscopy?
Microangiopathy haemolytic anaemia due to shear stress and breaking of RBC when going through the valve Would see schistocytes on histology
70
What is a cause of Ao valve regurgitation?
1) Rheumatic valve 2) Endocarditis 3) LV dilation - stretch - cusps don't meet
71
What is Quinkes sign and head bobbing due to?
Head bobbing - bounding pulse due to aortic regurg - due to increased pulse pressure Quinkes sign - blanching and flushing of the capillary nail bed due to ao regurg
72
What is myxomatous degeneration? What does this lead to in the heart?
It is pathological weakening of connective tissue that leads to mitral valve prolapse - mitral regurg
73
Name some causes of mitral regurg
1) Myxomatous degeneration 2) Damage to papillary muscle post MI 3) LHF - LV dilatation - cusps dont meet 4) Rheumatic fever
74
What is the main cause of mitral stenosis?
99% rheumatic fever
75
What does mitral stenosis lead to?
Dilated LA - AF and thrombus Back pressure in pull veins - pulm hypertension Exercise intolerance due to reduced CO and Pulm congestion LVH LHF
76
What can happen with the oesophagus with mitral stenosis and why?
Compression of the left recurrent laryngeal nerve and compression of the oesophagus can lead to dysphagia and hoarse voice
77
Why is the IJV pressure used to measure RA pressure not EJV?
- It is closer anatomically - It doesn't have valves like the EJV that prevent transmission of pressure - It has a direct course to the RA whereas the EJV doesnt
78
What forms the Left, inferior and right borders of the heart?
L - RV mostly R- RA I - LV
79
How much should the heart occupy of the width of thorax in a chest x ray?
No more than 50%
80
What is the major symptom of an MI? (must describe type of symptom)
Central crushing chest pain
81
Why is an RCA occlusion most likely to cause rhythm disturbances?
RCA supplies SAN in most people | RCA supplies AVN in most people
82
What kind of murmur would a mitral valve regurg cause?
Pansystolic
83
What kind of murmur would a mitral valve stenosis cause?
Mid-diastolic low rumble
84
What kind of flow would occur through a stenotic mitral valve?
Turbulent
85
What would happen to the LA with a chronically stenosed mitral valve?
It would dilate because of the increased volume and pressure as it is harder for blood to flow through a stenosed valve
86
What is the effect of cardiac tamponade?
Compression of heart structures leading to reduced arterial blood pressure (haemodynamic compromise) - reduced cardiac output
87
In cardiac tamponade - why would cardiac output fall?
Because the fibrous layer of the pericardial sac cannot expand, so pressure on heart prevents it filling properly in diastole
88
What effect would a large VSD have on pulmonary circulation if left untreated?
Would cause vascular remodelling (increased SMCs) in pulm circulation leading to increased pulmonary vascular resistance ---- in time would lead to reversal of flow in the VSD (Eisenmenger Syndrome)
89
What is preload?
Amount ventricles are stretched and filled
90
What is after load?
The load that the ventricles have to work against to eject blood - roughly equivalent to aortic pressure
91
What is TPR?
Resistance to blood flow offered by all systemic vasculature
92
What vessels in the body offer the greatest resistance?
Arterioles
93
What is Frank Starlings law? Why?
Increase in SV occurs with increased venous return As increased stretch will cause increased contraction up to a point - until sarcomeres stretched too much to increase force of contraction - then contraction will reduce
94
What effect does dilation at the pre-capillary sphincters have on frank starlings law and on the autonomic NS?
- Would increase venous return so increase SV | - Would activated sympathetic NS so increase HR and contractility in response to increased venous return
95
Why when muscle fibres are stretched you get an increased force of contraction (2) ?
Increased length increases tension - increase force of contraction Fibres are more Ca-sensitive when stretched - larger contraction
96
What effect will increased arterial pressure and increased TPR have on the heart workload and filling? What pathology can this lead to?
Increased work (increased afterload) and decreased filling due to increased TPR - leads to Hypertension
97
What is aortic impedance?
Basically afterload
98
What does ventricular emptying depend on (3)?
Pre load After load Force of contraction - sympathetic drive/circulating adrenaline
99
How does the arterial pressure, venous pressure, TPR change in increased metabolism and why?
Arterial pressure decreases TPR decreases Venous pressure increases To increase blood flow to metabolising tissues
100
If both arterial and venous pressure decrease at the same time (e.g. on standing up) can you use intrinsic (frank starling) mechanisms? What can you use?
No - Need both baroreceptor reflex and increased sympathetic drive to increase HR and increase TPR at the same time.
101
Why do you get postural hypotension?
If the baroreceptor reflex and sympathetic drive to increase TPR fail when you stand up

ESA2 (37 decks)

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