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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
Q

Give a minor and major cause of increased blood viscosity

A

Minor - increase in acute phase proteins in inflammation

Major - Thrombocythaemia, Polycythaemia, multiple myeloma (plasma cell cancer)

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26
Q

What are metarterioles and what do they contain to help their function?

A

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

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27
Q

Which blood disorder can cause dry gangrene and why?

A

Multiple myeloma due to increased protein Immunoglobulin that causes dry gangrene

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28
Q

Define viscosity

A

Intrinsic feature of a fluid relating to internal friction of adjacent fluid layers sliding past one another

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29
Q

What is the difference between velocity and flow?

A

Velocity is the distance of blood moved in time

Flow is the volume of blood moved in time

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30
Q

How would you work out flow from velocity and area of vessel?

A

flow = velocity x cross-sectional area of vessel

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31
Q

What is laminar flow? What is a flow characteristic of laminar flow?

A

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

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32
Q

What is turbulent flow?

A

Irregular flow in all directions in the vessel - blood continually mixing and changing direction

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33
Q

When can turbulent flow occur (5)?

A
  • When blood flow becomes too great
  • An obstruction
  • A rough surface
  • A corner
  • Increased resistance to flow
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34
Q

By definition when does systole end?

A

When the aortic valve shuts

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35
Q

What is the dichrotic notch

A

Slight back flow in the aorta following aortic valve closure

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36
Q

When does blood enter the coronaries - systole or diastole

A

Diastole

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37
Q

How do you find the pulse pressure (equation)

A

Systolic - diastolic pressure

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38
Q

How do you find the MABP?

A

1/3 pulse pressure + diastolic pressure

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39
Q

Below which MABP is organ perfusion impaired?

A

70mmHg

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40
Q

Define the pulse?

A

Rhythmic shock wave of heart beat arriving slightly before the blood itself

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41
Q

What does the strength of the pulse depend on (2)

A

Force of LV contraction

Pulse pressure

42
Q

What happens to the pulse pressure with a bounding pulse?

A

It widens

43
Q

Does bradycardia widen or narrow the pulse pressure?

A

Widens - bounding

44
Q

Does aortic insufficiency (regurgitation) lead to widened or narrowed pulse pressure?

A

Widened - as increased back flow during diastole reduced diastolic blood pressure so pulse pressure difference is more

45
Q

Does pregnancy, hot baths exercise (low peripheral resistance) widen or narrow pulse pressure?

A

Widen

46
Q

When taking blood pressure how must the cuff fit? Why?

A

Must go round at least 80% of arm

Too big - underestimates
Too small - overestimates

47
Q

Where is blood pressure most accurate and why?

A

Nearest the heart so left arm as gravity has an effect on BP

48
Q

Why does the heart need resistance and capacitance vessels?

A

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
Q

Should L and R heart output over time be equal?

A

Yes has to be equal

50
Q

Define systole diastole

A

Systole - contraction and ejection of blood

Diastole - relaxation and filling of blood

51
Q

What is the pressure in the RA, RV, PA, LA, LV, Ao?

A 
RA - 0-4
RV 25/4
PA 25/10
LA 8-10
LV 120/10
Ao 120/80
52
Q

How long is a cardiac action potential?

A

200-400ms normally 280ms

53
Q

How do APs travel from cell to cell in the heart?

A

Gap junctions

54
Q

What determines whether a valve is open or closed?

A

Pressure

55
Q

What are the roles of the papillary muscles/cordae tendinae?

A

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
Q

Does the cardiac AP originate from the cardiac muscle or nerves?

A

AP for hear originates in the SAN not from nerves like skeletal muscle

57
Q

Through the myocardial muscle does the AP travel endo-epicardium or epi-endocardium?

A

Endo - epicardium

58
Q

From the wiggers diagram what is the A, C waves and X descent?

A

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
Q

What are the 7 stages of the wiggers diagram? Which are the stages where the heart sounds are heard?

A

1) Atrial contraction
2) Isovolumetric contraction - S1
3) Rapid ejection
4) Slowed ejection
5) Isovolumetric relaxation - S3
6) Rapid Filling
7) Slowed filling

60
Q

What is the typical EDV (ml)?

A

120ml

61
Q

How much ventricular filling is from atrial contraction?

A

10%

62
Q

Which valves are open in stage 1 (atrial contraction)?

A

Mitral and tricuspid open, pulm and Ao closed

63
Q

During which phase is the QRS complex?

A

2) Isovolumetric contraction

64
Q

During which phase is the T wave?

A

Slowed ejection

65
Q

What causes the A wave in the atrial pressure trace?

A

Atrial systole increases atrial pressure

66
Q

Why does ventricular ejection rate slow (phase 4)?

A

Due to repolarisation of the ventricle leading to a decline in tension so the rate of ejection begins to fall

67
Q

What is the difference between stenosis/regurg?

A

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
Q

What is a cause of aortic valve stenosis?

A

1) Calcific - degenerative
2) Bicuspid aortic valve
3) Chronic rheumatic valve - commissural fusion

69
Q

What kind of anaemia can occur from heart valve stenosis and why? What would it look like on microscopy?

A

Microangiopathy haemolytic anaemia due to shear stress and breaking of RBC when going through the valve
Would see schistocytes on histology

70
Q

What is a cause of Ao valve regurgitation?

A

1) Rheumatic valve
2) Endocarditis
3) LV dilation - stretch - cusps don’t meet

71
Q

What is Quinkes sign and head bobbing due to?

A

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
Q

What is myxomatous degeneration? What does this lead to in the heart?

A

It is pathological weakening of connective tissue that leads to mitral valve prolapse - mitral regurg

73
Q

Name some causes of mitral regurg

A

1) Myxomatous degeneration
2) Damage to papillary muscle post MI
3) LHF - LV dilatation - cusps dont meet
4) Rheumatic fever

74
Q

What is the main cause of mitral stenosis?

A

99% rheumatic fever

75
Q

What does mitral stenosis lead to?

A

Dilated LA - AF and thrombus
Back pressure in pull veins - pulm hypertension
Exercise intolerance due to reduced CO and Pulm congestion
LVH
LHF

76
Q

What can happen with the oesophagus with mitral stenosis and why?

A

Compression of the left recurrent laryngeal nerve and compression of the oesophagus can lead to dysphagia and hoarse voice

77
Q

Why is the IJV pressure used to measure RA pressure not EJV?

A
  • 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
Q

What forms the Left, inferior and right borders of the heart?

A

L - RV mostly
R- RA
I - LV

79
Q

How much should the heart occupy of the width of thorax in a chest x ray?

A

No more than 50%

80
Q

What is the major symptom of an MI? (must describe type of symptom)

A

Central crushing chest pain

81
Q

Why is an RCA occlusion most likely to cause rhythm disturbances?

A

RCA supplies SAN in most people

RCA supplies AVN in most people

82
Q

What kind of murmur would a mitral valve regurg cause?

A

Pansystolic

83
Q

What kind of murmur would a mitral valve stenosis cause?

A

Mid-diastolic low rumble

84
Q

What kind of flow would occur through a stenotic mitral valve?

A

Turbulent

85
Q

What would happen to the LA with a chronically stenosed mitral valve?

A

It would dilate because of the increased volume and pressure as it is harder for blood to flow through a stenosed valve

86
Q

What is the effect of cardiac tamponade?

A

Compression of heart structures leading to reduced arterial blood pressure (haemodynamic compromise) - reduced cardiac output

87
Q

In cardiac tamponade - why would cardiac output fall?

A

Because the fibrous layer of the pericardial sac cannot expand, so pressure on heart prevents it filling properly in diastole

88
Q

What effect would a large VSD have on pulmonary circulation if left untreated?

A

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
Q

What is preload?

A

Amount ventricles are stretched and filled

90
Q

What is after load?

A

The load that the ventricles have to work against to eject blood - roughly equivalent to aortic pressure

91
Q

What is TPR?

A

Resistance to blood flow offered by all systemic vasculature

92
Q

What vessels in the body offer the greatest resistance?

A

Arterioles

93
Q

What is Frank Starlings law? Why?

A

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
Q

What effect does dilation at the pre-capillary sphincters have on frank starlings law and on the autonomic NS?

A
  • Would increase venous return so increase SV

- Would activated sympathetic NS so increase HR and contractility in response to increased venous return

95
Q

Why when muscle fibres are stretched you get an increased force of contraction (2) ?

A

Increased length increases tension - increase force of contraction

Fibres are more Ca-sensitive when stretched - larger contraction

96
Q

What effect will increased arterial pressure and increased TPR have on the heart workload and filling? What pathology can this lead to?

A

Increased work (increased afterload) and decreased filling due to increased TPR - leads to Hypertension

97
Q

What is aortic impedance?

A

Basically afterload

98
Q

What does ventricular emptying depend on (3)?

A

Pre load
After load
Force of contraction - sympathetic drive/circulating adrenaline

99
Q

How does the arterial pressure, venous pressure, TPR change in increased metabolism and why?

A

Arterial pressure decreases
TPR decreases
Venous pressure increases

To increase blood flow to metabolising tissues

100
Q

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?

A

No -

Need both baroreceptor reflex and increased sympathetic drive to increase HR and increase TPR at the same time.

101
Q

Why do you get postural hypotension?

A

If the baroreceptor reflex and sympathetic drive to increase TPR fail when you stand up

ESA2 (37 decks)

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