Dr. Zachow - Last 3 Lectures Flashcards
WHat is responsible for a rise in systolic BP? Diastolic?
Systolic = CO, so like exercise Diastolic = Vasoconstriction so like some sort of blockage
Pulse Pressure
Systolic - Diastolic
If acute venodilation occurs, how will it be compensated for to return to normal RAP?
Increased inotropy
What is the bodies response to an increase in arteriolar dilation?
Initially: There will be an increase in dilation on the venous side to accommodate the all of the blood rushing into the veins. This will cause you to. Move over on the cardiac. Function curve.
Later: After a few seconds, the SNS will be turned on, which will increase inotropy (beta1) as well as arteriolar constriction (alpha1), which will create a new cardiac function curve with a higher CO, increased MAP (closer to basal), and a RAP closer to basal
Much later: Your body will decrease urine output to increase fluid volume, which will increase Pmcf which will increase Pa, and bring things back to normal.
What would be the bodies reaction if you had a significant loss in plasma volume?
SNS would turn on to increase inotropy and vasoconstriction via alpha1 and beta1. Graphically, you would see an increased cardiac function graph and decreased slope on the arteriolar side. This will lead to an increased CO, MAP,
WHat happens during exercise?
Initially there is vasoconstriction and inotropy. This increases CO, MAP, and decreases RAP. Soon though the vasodilatory metabolites kick in. When this happens, we see vasodilation of the arteriolar side, which causes an increase in slope. When this happens, we move over on our starling curve to the right to compensate for these things - so more cardiac function. Because we have vasodilation, we will also have increased venous return, which will cause a dilation on the venous side. Because of all of these things, we will have a decreased MAP closer to Normal…
Compliance =
Change in Volume / Change in Pressure
What will you see in a MI on an EKG?
1) ST elevation
2) inverted T
3) New Q waves
Systolic heart failure
Impaired ejection, causing decreased ejection fraction and CO decreased.
Diastolic Heart Failure
Impaired filling due to a stiff ventricle. Ejection fraction will be maintained.
What would the pressure-volume curve look like for a heart in dystolic heart failure?
The diastolic filling pressure will be higher due to the stiff left ventricle. Additionally, you can’t fill as much so the EDV will be lower. So, the bottom portion of the graph comes up and the right portion of the graph pinches in. Because of this, peak pressure is lower but everything else is the same.
What would the pressure-volume curve look Iike for a heart in systolic failure?
You would. Have a slight increase in diastolic filling, but the heart can Not overcome the afterload so the ESV is higher and the peak pressure is lower. Basically you shift the whole graph over to the right and you shift the top portion down.
What would the cardiovascular function curve look like for a heart in uncompensated heart failure?
You would see a decrease in inotropy, which causes an increase in RAP and a decrease in MAP, which causes low perfusion pressure.
Because of this, blood starts to get shunted away from the splanchnic bed to get blood to the heart, so if someone’s splanchnic organs start to give out you know it is bad.
What happens in a heart in compensated heart failure?
- What does the cardiofunction curve look like?
Because of the heart failure, SNS turns on. Then, blood starts to get shunted away from the splanchnic bed to get blood to the heart. So, on the curve, there would be a move along the lowered inotropic starling curve to increase CO, there would also be arteriolar constriction (both of these things are due to increased SNS). Now MAP returns to roughly normal, but RAP has risen so you will begin to have pleural edema.
what medical intervention would you use for a person in Heart Failure?
Furosemide for the edema and Dijoxin to increase inotropy.
