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Marcus' A&P S24 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Label the following.

A

See picture

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2
Q

What is Free H2O clearance, what is it regulated by & what does a high number mean?

A

How much pure H2) is removed from the blood. Regulated by ADH & high # means getting rid of a lot of water.

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3
Q

What is the systemic pulse pressure?

A

100mmHg

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4
Q

What is the CVP in a healthy person & where is it measured?

A

It should be 0 & is measured outside the RA.

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5
Q

Where are low & high compliance found?

A

Low compliance is on arterial side & veins have a high compliance.

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6
Q

What is the meaning of pulse pressure?

A

It relates to how stiff vessels are. Low PP means more flexible. High PP means stiffer (arteries).

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7
Q

Where is turbulent flow found & what is another function of it?

A

In the Aorta & acts as a volume reservoir.

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8
Q

What is another word for compliance?

A

Elasticity. Higher elasticity means higher compliance= more stretch.

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9
Q

What does elastance mean?

A

How rigid something is. It is the inverse of compliance. High elastance = low compliance.

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10
Q

What kind of compliance is found in the pulmonary system?

A

High compliance due to low resistance.

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11
Q

What do vasopressors not innervate?

A

Capillaries & cranial sinuses.

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12
Q

Which has a higher velocity, aorta or vena cavae?

A

Aorta

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13
Q

MAP Formula

A

Diastolic + 1/3 (Systolic – Diastolic)

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14
Q

What tells arterioles to relax & increase flow?

A

Waste products

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15
Q

What are the colloid pressures of Albumin, Globulins, & Fibrinogen?

A

21.8, 6, & 0.2 (mmHg)

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16
Q

What is normal lymphatic flow & what is max?

A

2L/day & max is 40L/day

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17
Q

Where does the lymphatic system drain into & what controls the flow?

A

The subclavian vein. Controlled by skeletal muscles.

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18
Q

Do the lungs have a lymphatic system?

A

Yes, but it does not work as well as the systemic one.

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19
Q

Where would one encounter negative venous pressures?

A

In the cranial sinuses

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20
Q

BP at Thigh has how much extra pressure?

A

40mmHg

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21
Q

BP at the femoral artery bifurcation would be?

A

142/102 mmHg; + 22mmHg

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22
Q

If a BP is measured on a healthy person’s wrist & it reads 150/110 mmHg, how much arm distance is below the heart?

A

40.8cm (1.36cm for each 1 mmHg increase.

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23
Q

What is the formula for Vascular compliance?

A

Compliance= Delta volume / Delta pressure

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24
Q

High volume and low pressure result in ____ compliance?

A

High

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25
Q

What are normal pulmonary pressure:
Systolic
Diastolic
Mean

A

25/8 mmHg (16 mmHg)

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26
Q

What is the pulmonary Delta P?

A

14 mmHg (MPAP= 16 mmHg & LA pressure = 2 mmHg)

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27
Q

What is the normal pressure range for the RA?

A

0-4 mmHg

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28
Q

What is the normal pressure range for the RV?

A

0-25 mmHg

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29
Q

What are the normal pressure ranges for LA & LV?

A

LA= 2-5 mmHg & LV= 2-120 mmHg

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30
Q

When CO is 5L/min, CVP is?
What is CO when CVP is 4?

A

CVP = 2
CO= 2.5

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31
Q

What is the formula for vessel velocity?

A
  • Velocity= Flow (5L/min) x cross sectional area of vessel
  • Cross section: Radius squared x 3.14
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32
Q

What are the beginning pressure, end pressure & Delta P of capillaries?

A

Beginning= 30 mmHg, end= 10mmHg,
Delta P= 20mmH

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33
Q

What is the capillary colloid pressure?

A

28mmHg

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34
Q

What is the interstitial fluid pressure?

A

-3mmHg

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35
Q

What is the average pressure inside a capillary?

A

17mmHg

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36
Q

What are the πp & g/dL of Albumin, Globulins & fibrinogen?

A
  • Albumin: 21.8 mm Hg & 4.5 g/dL
  • Globulins: 6 mm Hg & 2.5 g/dL
  • Fibrinogen: 0.2 mm Hg & 0.3 g/dL
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37
Q

Sympathetic vasoconstriction releases _____?

A

Norepinephrine

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38
Q

What is normal intrathoracic pressure?

A

-4mmHg or -5cm H2O

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39
Q

What structural pressure is not affected by gravity?

A

Jugular veins

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40
Q

Veins are ___ times more/less _____ than arteries.

A

8, more & distensible

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41
Q

What is the formula for vascular distensibility?

A

Vd= Increase in Volume / (Increase in Pressure x Original volume)

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42
Q

What is the formula for Delta P?

A

Delta P= F x R (Flow times Resistance)

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43
Q

What is the formula for Flow?

A
  • F= π △Pr4 / 8 η l
  • [ (π times Delta P times radius to 4th power) / 8 times viscosity times length) ]
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44
Q

Conductance is proportional to?

A

Diameter to the 4th power

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45
Q

Small volume to large volume means?

A

High distensibility

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46
Q

What is the formula for predicting turbulent flow?

A

Re= [ (v x d x p) / η ]. (velocity x diameter x density / viscosity)

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47
Q

____ pressure & ____ velocity= low compliance.

A

High & low

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48
Q

Vascular Resistance unit PRU is also equivalent to what?

A

mmHg/mL/sec

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49
Q

Vascular resistance unit CGS is also equivalent to which two units?

A

mmHg/L/min = Centimeter Gram Second unit = Dynes x sec / cm⁵

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50
Q

How to convert CGS units to PRU?

A

1333 x PRU (mmHg/ml/sec)

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51
Q

What kind of sensors are carotid baroreceptors?

A

Stretch sensors

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52
Q

Aortic baroreceptors are controlled by the ____ thru the ____?

A

Medulla NTS (nucleus tractus solitarus & Vagus nerve

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53
Q

The carotid & aortic baroreceptors function at the same pressures?

A

False the aortic receptors function at a BP 20-30mmHg higher.

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54
Q

The carotid baroreceptors receive their signal from the ___, which then sends it thru the ___ & then thru the___?

A

Hering’s nerve & Glossopharyngeal nerve & Medulla (NTS) vasomotor center.

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55
Q

If someone was to have no baroreceptors, it would result in?
Denervated Neurons lead to increase in _____ of BP.

A

Higher BP fluctuation.
Increase in variability

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56
Q

If both carotid arteries were to be clamped for short period of time, what happens to the arterial pressure?

What mechanism limits the BP rise when carotids sense low BP

A

Is will increase 50-60mmHg

Aortic Baroreceptors will sense high BP and limit pressure increase

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57
Q

What is normal ESV?

A

50cc

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58
Q

What all happens in phase 1?

A

Filling, ESV=50cc, AV valves open, high atrial pressure, low intraventricular pressure

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59
Q

What is the normal EDV?

A

120cc

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60
Q

What all happens in phase 2?

A

Isovolumetric contraction, AV valves close, all 4 valves are closed at the beginning

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61
Q

What all happens in phase 3?

A

Ejection, peak pressures at 120mmHg, aortic valve closes @100mmHg

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62
Q

What all happens in phase 4?

A

Isometric relaxation, all 4 valves are closed, ESV= 50cc

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63
Q

What happens during the 1st part of Phase 3?

A
  • 70% (49cc) of SV is ejected,
  • LV pressure higher than aortic pressure,
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64
Q

What happens during the 2nd part of Phase 3?

A
  • 30% (21cc) of SV is ejected
  • at end aortic pressure > LV pressure
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65
Q

What is the 1st heart sound?

A

A-V valves (bicuspid and tricuspid) closing
Low pitch

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66
Q

What is the 2nd heart sound?

A

Semilunar Valves Close (Aortic & Pulmonic)
High Pitch

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67
Q

Why does the 1st heart sound vibrate more than the 2nd?

A

The aortic valve is meatier & doesn’t vibrate as much

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68
Q

Compare atrial kick in a healthy vs sick heart?

A
  • In a healthy heart it contribute 5-10% &
  • In a sick heart it contributes 20-25%
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69
Q

Normal Afterload for LV

A

80mmHg

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70
Q

A RA pressure of -4 mmHg will results in?

A

6L venous return

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71
Q

A RA pressure of 7 results in what?

A

0 CO & VR (Venous return)

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72
Q

System Psf
Another acronym for Psf?

A

+7 mm Hg
Ppv = Psf

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73
Q

Psf (systemic filling pressure) depends on 2 things

A

Tone & volume of the system

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74
Q

A Psf of 14 mmHg results in how much venous return?

A

12L/min

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75
Q

A Psf of 3.5 mmHg results in how much venous return?

A

4L/min

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76
Q

Effects on CO Curve:
Changing Psf
Changing Resistance

A

Psf changes size and position of curve.
Resistance changes shape (slope) of graph

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77
Q

Increases Psf:
Effect on RVR

A

Decreases RVR

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78
Q

Normal Arterial Volume

A

700cc

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79
Q

What does Pcv stand for?

A

Thoracic pressure

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80
Q

Maximum CO for Normal Sympathetic Activation

A

13L/min

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81
Q

Maximum CO for Max Sympathetic Stimulation

A

25L/min

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82
Q

A left shift of the cardiac output curve results in what?

A

Increased CO & contractility

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83
Q

What are causes of a right shift of the cardiac output curve? (2)

A

Parasympathetic stimulation, bad heart

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84
Q

Direct Atrial Stretch Reflex

How is stretch sensed?

MOA

A

body responds to increased stretch in right atrium by 10-15% increase in HR & SV

Sensor/Mechanism: Already built into the heart

MOA: increase permeability to Na and Ca

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85
Q

Describe Bainbridge Reflex
How is stretch sensed?
Result?

A

Stretch in Atria sensed by Vagus Nerve transmits to brainstem’s cardioinhibitor.
Brainstem increases SNS activity
Inc HR & SV by 50-60%

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86
Q

What is a normal cardiac index & what is it for an 80y old?

A

Normal is 3.5 & 80y old is 2.4

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87
Q

Arterial Specific Vasodilator

A

Hydralazine

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88
Q

What is TPR
Another name for it?

A

Total peripheral resistance & SVR

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89
Q

Spinal Anesthesia effect on Psf, VR, CO?

A

Minimal effect on Psf, VR, and CO.
Slightly decreases

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90
Q

What are causes for increased CO & decreased TPR? (6)

A

AV shunts, Anemia,
Beriberi, Hyperthyroidism,
Pulmonary disease, Paget’s disease

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91
Q

What are causes for decreased CO & increased TPR? (2)

A

Remove both arms and legs
Hypothyroidism

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92
Q

Hypothyroidism effect on CO and SVR?

A

Increased SVR
Decreased CO

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93
Q

What is Beriberi?
-involved in cofactor for what?
S/s (3)

A
  • Vitamin B-1 (thiamine) deficiency (a co-factor for ATP production)
  • S/S: High CO, lactic acidosis, right heart failure
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94
Q

Increased O2 consumption & metabolism leads to what?

A

Increased CO

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95
Q

Explain SVR relationship to VR

A
  • Increasing SVR –> increased resistance to venous return –> decreased venous return (L/min).
  • Decreasing SVR –> decreased RVR –> increased venous return (L/min)
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96
Q

Halving & doubling RVR results in how much venous return?

A

Halving= 12L/min & Doubling= 4L/min

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97
Q

A right shift in the Cardiac Output/ Thoracic Pressure curve is caused by (2)

What is needed to compensate?

A
  • PEEP, tamponade &
  • Increasing BP to push blood into chest
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98
Q

Arterial Specific Vasodilator effects:
SVR
RVR

A

Reduces SVR and RVR

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99
Q

Mixed vasodilator effects:
Psf
RVR
CO
RA pressure?

A

Psf decreases (venodilation)
RVR decreases (arteriodilation)
CO Slightly decreases
RA moderately decreases

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100
Q

Reduce Compliance or add volume
Effect on Psf and VR

A

stiff walls –> inc Psf –> inc VR

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101
Q

Constriction effect on Psf and RVR

A

Increase Psf and RVR

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102
Q

Venular specific vasodilator
Effects on CVP, Psf, VR, CO
Drug Class Example

A

drop in CVP –> reduce Psf –> reduce VR –> reduce CO
NO Donor

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103
Q

Short-term/acute: constriction of the veins mediated via (2)

A
  1. circulating catecholamines
  2. neural reflex
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104
Q

Phenylephrine Important Effect

A

Increase Psf & SVR

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105
Q

Long term compensations of cardiac injury is (3)

A

fluid retention → volume expansion –> Psf increase

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106
Q

Administering 2u of blood effect on
Psf
Vessel size
RVR

A

Psf inc
Increased volume widens vessel walls
Which decreases RVR

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107
Q

sky high sympathetic tone makes you more prone to ? (2)

A

Electrical arrhythmias
Myocardial Infarction

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108
Q

Volatile & Spinal Anesthetics considerations for SNS?
What is the safest and why?

A

Volatile - high doses inhibit the Autonomic NS.
Spinal Anesthetics drifts up the cord.
Epidural is safest because outside the dural sac.

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109
Q

AV Fistula effect on Psf and RVR

A

AV Fistula - creates easier flow so
NO Psf change
RVR decreases

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110
Q

Label the following

A

See picture

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111
Q

What does the picture describe?

A

Increased Preload

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112
Q

Increased Preload results in?
EDV/SV/EF

A
  • Increased EDV & SV.
  • Slight EF increase.
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113
Q

Decreased preload will result in?
EDV/SV/EF

A
  • Decreased EDV & SV.
  • Slight EF decrease
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114
Q

Increased Afterload will result in?
ESV/SV/EF/ Aortic Pressure

A
  • Increased aortic pressure.
  • SV & EF decrease.
  • ESV increases
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115
Q

Decreased Afterload will result in?
ESV/SV/EF

A
  • Decreased aortic pressure.
  • SV & EF increase.
  • ESV decreases.
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116
Q

Increased contractility will result in?
ESV/SV/EF

A
  • SV & EF increase.
  • ESV decreases.
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117
Q

Decreased contractility will result in?

A
  • Decreased SV & EF.
  • Increased ESV.
118
Q

Mitral stenosis leads to what & what is the compensation?

A
  • Reduced preload –> lower SV, EDV & EF.
  • Compensate via increased preload.
119
Q

Causes of Mitral Stenosis (3)

A

Rheumatic Fever (autoimmune reaction)
Strep
Staph infection

120
Q

What 3 things stick to the cusps of valves?

A

Calcium, Cholesterol, Scar Tissue

121
Q

With what kind of valve issue will there be a decreased pulse pressure?

A

Aortic Valve stenosis

122
Q

Everyone has aortic stenosis after the age of

A

60.

123
Q

With heart failure, expect substantially lower:

To improve SV for CHF patients use:

A

contractility

use afterload reducer to improve SV

124
Q

What is DOC afterload reducer for CHF patients?
2 Benefits

A

ACE Inhibitor
Growth factor inhibitor so less scarring and slower remodeling.

125
Q

What is normal coronary blood flow?

A
  • 70mL/min/100grams of muscle
  • 250mL/min
126
Q

RCA blood flow during diastole vs systole

A

Increases with systole
Ok during diastole

127
Q

LCA blood flow during diastole vs systole

A

Systole: retrograde at early systole, low
Diastole: Highest!

128
Q

Oxygen Extraction Ratio for:
Heart
Regular Tissues
Brain

A

Heart: 75%, removes 15ml O2
Tissues: 25%, removes 5ml of O2
Brain: 75%, removes 15ml of O2

129
Q

1dL in ml?
1dL of arterial blood = ? Oxygen Content
O2 in Cardiac Venous Blood?

A

1dL of arterial blood = 20 mL of O2
Venous Cardiac O2: 5ml

130
Q

Left Vagus nerve on heart location

A

Goes over the top of the LA and ends at the AV node

131
Q

Name the Heart Rates at:
Nodal HR
No Sympathetic Stimulation
No Parasympathetic stimulation

A

Nodal: 72
No Sym: 60
No Para: 110

132
Q

What are the 3 pericardial layers?

A

Serous/visceral= thin & slippery not much connection to other 2
Parietal layer= attached to fibrous layer
Fibrous= doesn’t stretch much

133
Q

Name the Cusps of the Valves:
Tricuspid
Bicuspid
Aortic
Pulmonic

A

T: Anterior, Posterior, Septal
B: Anterior, Posterior
A: Left, Right, Posterior
P: Left, Right, Anterior

134
Q

Commissural Cusp

A

small, undeveloped on mitral valve but not large enough to count as an independent cusp

135
Q

Aortic Left Cusp has an opening to the

Aortic Right Cusp has an opening to the

Coronary Perfusion best with open or closed aortic valves?

A

Left Cusp –> LCA
Right Cusp –> RCA
Coronary Perfusion best with closed valves

136
Q

Length of 1st heart sound
Length of 2nd heart sound

A

1st: 0.14s
2nd: 0.11s

137
Q

3rd Heart sound heard?
Normal in which population?

A

Beginning of the 2nd/3rd of Diastole OR
-1/3 into diastole

Normal in Kids

138
Q

What is the 3rd heart sound suggest (4)

A

-Suggests low LV compliance heart
Mitral regurgitation = restrictive diastolic filling

139
Q

4th Heart Sound:
Cause
When is sound loudest

A

Cause: excessive atrial contraction “Atrial Kick” in the beginning of last ⅓ of filling

140
Q

Human hearing
Hz unit is a sound wave that ?

A

20 Hz - 20K Hz

Sound wave that oscillates a number of times per second

141
Q

3 Phases of Diastole

A

Rapid Inflow - 1/3 of filling
Diastasis - little filling
Atrial Systole - atrial kick

142
Q

Sympathetic ganglia that affect the heart originate

A

C-spine to T1

143
Q

Right Coronary Flow during Systole vs Diastole

A

Sys: flow increases
Dia: flow is decent

144
Q

Nutrient levels are low in heart after ejection

A

Oxygen, fatty acid, glucose concentration

145
Q

CVP in mechanically ventilated patient will be

A

high to counteract the PEEP

146
Q

Loudest of all heart murmurs

A

Aortic Stenosis

147
Q

List the murmurs:
Systolic Murmurs (2)
Diastolic Murmurs (2)

A

Sys: Aortic Stenosis, Mitral Regurgitation
Dia: Mitral Stenosis, Atrial Regurgitation

148
Q

What shift will be seen on the pressure-volume loop with Mitral stenosis?

A

Left shift

149
Q

What EKG changes will be seen with mitral stenosis?

A
  • Prolonged P wave
  • right axis deviation.
150
Q

What results from mitral stenosis?
RV
LA
Arrythmias
Overtime…

A
  • Increased RV afterload
  • Dilated LA
    Arrhy: A FIb, A Flutter
    Overtime failure of the right heart.
151
Q

Aortic Valves Pressures
Opens at __
Closes at __

A

Opens: 80
Closes: 100

152
Q

Inspiration will shift the cardiac output curve to the___?

A

Left, due to blood being pulled into chest & increasing negative pressure.

153
Q

What conditions could be deadly for someone with Mitral Stenosis?

A

A-fib & tachycardia due to decreased filling time.

154
Q

How is Mitral Regurgitation treated? (2)

A
  • Decrease afterload
  • Tachycardia
155
Q

What shift on the pressure-volume loop would AR cause?

A

Right shift due to increased intraventricular volume.

156
Q

When does most aortic regurgitation happen?

A

At end of phase 4 as LV pressures are low.

157
Q

What valve issue is the worst for someone with CAD?

A

Aortic stenosis due to increased wall pressures –> decreased coronary perfusion.

158
Q

What pulse pressure will be seen with Aortic Stenosis?
Effects of CVP, Psf, and HR

A

Narrowed pulse pressure.

CVP, Psf, and HR increas

159
Q

What will ultimately result from MR?

A

Eccentric hypertrophy –> A-Fib

160
Q

With a congenital bicuspid aortic valve

A

75% L and R cusps are tied together.

161
Q

Pulse pressure is related to___. Higher PP= higher___?

A

Contractility & contraction

162
Q

In hemorrhagic shock when do CO & BP start dropping?

A
  • CO @ 15% blood loss
  • BP @ 20% blood loss
163
Q

How much cardiac output is seen with 35% of blood volume loss?

A

50%

164
Q

Normal Thoracic Pressure
Thoracic Pressure During Inspiration

A

Normal -4
Inspiration -6

165
Q

Inspiration/more Negative Thoracic Pressure effect on CO for:
Left Heart
Right Heart

A

Left Heart: Decreases CO b/c decreased pulmonary pressures. Pulm pressures like preload for LV

Right Heart: Negative pressure pulls on vena cava walls, reduces afterload–> inc CO –> PAP decrease

166
Q

In the beginning of respiration, what is the max Systemic BP decrease

If BP drops more than that, pt might be ?

A

10mmHg

Hypovolemic

167
Q

What are 3 causes of decreased venous return?

A
  • Low volume
  • Low tone
  • Obstruction
168
Q

What does the A wave signify? (2)
Occurs during which phase of cardiac cycle?

A
  • Atrial contraction
  • Short increase in CVP

During Atrial Systole of Diastole

169
Q

What does the C wave signify? (2)

A

-Isovolumetric Ventricular Contraction
-AV Valves bow backwards into atria

170
Q

What does the V wave signify?

A

-End of systole
-Volume builds in atria during all of systole

171
Q

What is the X descent? (2)

A
  • Atria relaxing
  • Filling back up during mid systole
172
Q

What is the Y descent? (3)

A
  • A-V valves opening
    -Dec in atrial pressure during
  • Early ventricular filling
173
Q

What is the H wave/plateau?

A

Diastasis; Middle third of diastole

174
Q

What affect will A-fib have on the CVP waveform?

A
  • Prominent C wave,
  • Loss of A wave
175
Q

Label the CVP waveform descents & waves in order.

A

A-wave, C-wave, X-descent, V-wave, Y-descent, H-wave/plateau

176
Q

What affect will an AV block have on the CVP waveform?

A

Cannon A wave

177
Q

What affect will TR have on the CVP waveform?

A
  • Tall systolic C-V wave
  • Loss of X descent
178
Q

What affect will TS have on the CVP waveform?

A
  • Tall A wave
  • Attenuation of Y descent
179
Q

What effect will RV ischemia have on the CVP waveform?

A
  • Tall A & V waves
  • Steep X & Y descents
  • M or W configuration
180
Q

What affect will pericardial constriction have on the CVP waveform?

A
  • Tall A & V waves
  • Steep X & Y descents
  • M or W configuration
181
Q

What affect will tamponade have on the CVP waveform?

A
  • Dominant X descent,
  • Attenuated Y descent
182
Q

What is the most common shock?

A

Hypovolemic

183
Q

During normal breathing, the systemic MAP drops on ____ & LV output drops during___?

A

On early inspiration for both

184
Q

What will prolonged positive pressure ventilation lead to?

A

Decreased venous return & decreased CO

185
Q

How is SVR calculated?

A

[ (MAP – CVP) / (CO) ] x80

186
Q

How is PVR calculated?

A

[ (MPAP – PAWP) / (CO) ] x80

187
Q

PAWP normal value
PAWP is an estimate of

A

10mmHg
- pulmonary capillary pressure.

188
Q

Miller’s Hemodynamic Values:
SVR Normal / Range
PVR Normal / Range
Oxygen Consumption

A

SVR: 1200; 800-1600 CGS
PVR: 80; 40-180
O2: 250ml/min

189
Q

Air in an A-line will lead to an____ waveform?

High Gain on Art Line Amplifier causes

A

-Over dampened
-Causes artifact

190
Q

(PDA) Posterior Descending Artery originates from:
RCA in __% of people
LCA in __% of people

A

RCA - 85%
LCA - 15%

191
Q

Circumflex Artery anastomosis with which artery?

A

RCA
Not a lot of blood moves there.

192
Q

The Great Cardiac Veins turns into _____ & empties into _______

A

Cardiac Sinus and empties into the Right Atrium

193
Q

APTM for Valve Auscultation
Aortic Valve
Pulmonic Valve
Tricuspid
Mitral

A

A: Right 2nd ICS
P: Left 2nd ICS
T: Left 5th ICS
M: Left Lateral to T measurement area (nipple)

194
Q

Aortic Baroreceptors Setpoint

A

130-150 mmHg

195
Q

Kidney reaction to high Right Atrial pressures (4)

What is this called?

A

Dec SNS –> Relax Afferent Arteriole –> Inc Renal Perfusion –> urine

Atrial stretch Direct Neural Pathway

196
Q

Why is ANF/ANP produced

An effective diuretic for how long?

A

High stretch in Right Atrium produces Atrial Natriuretic Factor/Peptide.

2 weeks

197
Q

ANF/ANP effect on kidney (4)

Which hormone has a similar effect?

A

increases prostaglandins production →
increased RBF → increases GFR
→ increases UO

Brain Natriuretic Peptide (BNP)

198
Q

BNP is produced from

A

Overloaded ventricles

199
Q

Increased atrial stretch effect on 3 hormones?

A

Reduces
ADH
ALDO
ANGII

200
Q

What does the inferior part of the heart rest on?

A

The central tendon of diaphragm

201
Q

What all anchors the heart valve cusps?

A

Chordae tendineae & papillary muscles

202
Q

What anchors papillary muscles?

A

Trabecula

203
Q

What are the parts of heart valves called that touch each other when closed?

A

Lunule

204
Q

What connects the pulmonic valve fibrous ring to the rest of the cartilaginous ring?

A

The tendon of conus

205
Q

What is another name for the PDA?

A

Posterior interventricular descending artery

206
Q

When is a PDA murmur the loudest?

A

During 2nd part of systole

207
Q

What does a S3 sound like & when is it?

A

Rattles during/near end of ventricle filling

208
Q

When is a S4 heard & what is it?

A
  • In a sick heart
  • It’s atrial kick into a full ventricle (end of diastole)
209
Q

What sound pitch is better heard with a phonocardiogram?

A

Low pitch

210
Q

How is coronary perfusion calculated?

A

Delta P of aortic pressure minus ventricular pressure

211
Q

Using coronary blood flow, how much does a healthy heart weight?

A

321 grams (225ml / 70mL= 3.21  x100grams= 321 grams

212
Q

What drives the low Vascular Resistance of Subendocardial layer during diastole?

A

High metabolic requirements drive low resistance to promote blood flow

213
Q

During the normal cardiac cycle, when do forces favor retrograde perfusion?

A

Early in systole; Hardly any ∆P between LV & Aorta

214
Q

Aortic stenosis would be heard when, if relating to a specific EKG tracing part?

A

ST segment & ST interval

215
Q

MS murmurs will be heard when on an EKG tracing?

A

TP & PR intervals

216
Q

In AS the pulse pressure will be___ & in AR pulse pressure will be____?

A

Narrower & wider

217
Q

Pulse pressure is related to___ & increased SV___ pulse pressure?

A

Contractility & increases

218
Q

MR can be heard when on an EKG tracing?

A

QRS, ST segment & ST interval

219
Q

Hearing S2 splitting would be when & due to what?

A

During inspiration due to increasing negative pressure, reducing pulmonic valve afterload, keeping valve open a bit longer.

220
Q

Which area of the heart is hardest to perfuse & why?

A
  • Subendocardial arterial plexi.
  • Subject to high wall pressures & sustained pressure due to inner cells depolarizing first & repolarizing last.
221
Q

Thyroid Gland blood flow per minute is ___ its mass.

A

5x its mass

222
Q

Concentric LVH is___ heart failure caused by___ &
Eccentric LVH is___ heart failure caused by__.

A
  • Diastolic & AS
  • Systolic & AR
223
Q

What is the BP pressure difference at the phlebostatic axis?

A

+ 6 mm Hg

224
Q

At what Reynolds’ number is flow turbulent?

A

> 2,000

225
Q

_____ velocity & _____ diameter lead to turbulent flow.

A

High & large

226
Q

How does conductance & resistance relate?

A

Conductance= ( 1 / resistance )

227
Q

What is another name for dicrotic notch?

A

Incisura (Lecture 1 slide 31)

228
Q

Max sympathetic stimulation for CO is also called ____ & will shift the curve ____?

A

Hypereffect & left

229
Q

Type of shock generated during anesthesia

A

Form of neurogenic shock
Loss of Psf

230
Q

When is S-4 heard?

A

Shortly before S1. Means increased ventricular diastolic stiffness

231
Q

When is stroke work is increased?

A

With increased SV & increased afterload

232
Q

What will cause shifts in the end-systolic pressure-volume relationship

A

Only contractility alterations will cause shifts in end-systolic pressure-volume relationship

233
Q

How does AR affect BP, PP, EDV & LV pressures?

A

Aortic regurgitation: Aortic pressures fall faster & further than normal during diastole –> a low diastolic pressure & large pulse pressure. EDV & pressure are higher. Often it is stenotic & insufficient.

234
Q

Decreased arterial compliance leads to ___ pulse pressure & ___systolic pressure?

A

Increased & increased

235
Q

Increased SV leads to___ pulse pressure & ___systolic pressure?

A

Increased & increased

236
Q

Aortic regurgitation has ___ SV & ___ diastolic pressure?

A

Increased & decreased

237
Q

Aortic stenosis leads to ___SV, ___ pulse pressure & ___systolic pressure?

A

Decreased, decreased & increased

238
Q

A decreased diastolic pressure means Resistance is ___ & conductance is ___?

A

High & low

239
Q

Increased plasma osmotic pressure means filtration is ____?

A

decreased

240
Q

What happens to the SNS, PSNS, HR, BP, & TPR in cushing’s reaction?

A
  • SNS increases
  • PSNS decreases
  • HR increases
  • BP increases
  • TPR increases
241
Q

At beginning of exercise the CVP ____ & RVR ____?

A

Both increase. At max output the CVP > RVR

242
Q

Examples that cause a right shift on the cardiac curve?

A
  • open chest Sx
  • tamponade
  • blowing(trumpet)
  • positive pressure ventilation
243
Q

Examples causing a left shift on the cardiac curve?

A
  • breathing against negative pressure
  • taking someone off the ventilator
  • decreasing intrathoracic pressure
244
Q

Decreased venous compliance leads to ____ CVP?

A

increased

245
Q

Anemia leads to ___ RVR & arteriolar ____, which leads to ___venous return?

A
  • Decreased
  • vasodilation
  • increased
246
Q

Examples of what increases RVR

A
  • Increased venous return
  • increased arterial resistance
  • increased SNS activity
  • obstructions
247
Q

Beriberi is a deficiency in ____ leading to ____ & ____ cardiac output?

A
  • thiamine
  • vasodilation
  • increased
248
Q

How does adenosine affect the heart?

A

Increases coronary blood flow

249
Q

In compensated heart failure, alodisterone & angiotensin 2 are?

A

Increased

250
Q

A blowing sounding murmur means?

A

Insufficiency

251
Q

If your patient’s mean systemic arterial pressure changes, it must be because of changes in?

A

Cardiac output and/or TPR

252
Q

Getting up after days in bed results in hypotension & dizziness, why?

A

Lying down results in increased CVP & baroreceptor firing –> increased renal activity –> fluid loss. When standing up there is decreased cerebral blood flow & the respiratory & skeletal pumps cannot compensate enough.

253
Q

Why can BP rise very high during static exercises?

A

Muscles compression –> decreased blood flow

254
Q

How does giving someone phenylephrine affect BP, SNS activity, contractility, TPR, HR?

A
  • BP, TPR would increase.
  • HR would decrease.
  • Phenylephrine stimulates alpha-adrenergic –> increased BP –> increased baroreceptor firing –> decreased SNS activity & increased PSNS activity.
255
Q

What would decreased renal & splanchnic blood flow despite an increase in MAP mean?

A

Increased sympathetic activity

256
Q

Acute increases in arterial pulse pressure usually result from increases in stroke volume. True or false?

A
  • True.
  • Pp= SV/Ca (Pulse pressure= stroke volume / arterial compliance
257
Q

An increase in TPR increases diastolic pressure more than systolic pressure. True or false?

A

False

258
Q

At rest the patient has a pulse rate of 70 beats/min and an arterial blood pressure of 119/80 mm Hg. During exercise on a treadmill, pulse rate is 140 beats/min and blood pressure is 135/90 mm Hg. Use this information to estimate the exercise¬ related changes in the following variables: SV, CO & TPR?

A
  • SV=Pp -> SV rest= 39cc. SV exercise= 45cc –> 6cc difference=15% increase.
  • CO: CO rest= 70 x 39cc= 2.73L/min. CO exercise= 140 x 45cc= 6.3L/min. CO increased 2.3 times.
  • TPR: MAP rest= 93, MAP exercise= 105. TPR= Pa/CO TPR rest= 93/2.73= 34mmHg. TPR exercise= 105/6.3= 16.7mmHg. TPR= 16.7mmHg / 34mmHg= 0.49= 49% decrease during exercise.
259
Q

What is indicated by a normal MAP but very high arterial pulse pressure?

A

Increased arterial stiffness.

260
Q

How would a stenotic aortic valve influence coronary blood flow?

A
  • Increased LV pressures –> increased O2 use –> increased coronary flow. But high LV intraventricular pressures decrease flow.
  • Resting O2 may be enough but cardiac reserve for exercise is not adequate
261
Q

Which of the following will decrease the mean circulatory filling pressure?
- Increased circulating blood volume.
- Decreased arteriolar tone.
- Increased venous tone.

A

None

262
Q

Severe dehydration would cause what kind of shift in the venous function curve?

A

Left shift

263
Q

Which of the following would directly decrease CVP?
A) increased SNS activity
B) increased PSNS activity
C) Increased blood volume
D) Decreased TPR

A

Increased SNS activity

264
Q

Consider the various components of the arterial baroreceptor reflex and predict whether the following variables will increase or decrease in response to a rise in arterial pressure?
– baroreceptor firing
– PSNS activity on the heart
– SNS activity on the heart
– Arteriolar tone
– Venous tone
– Peripheral venous tone
– TPR
– Cardiac output?

A
  • Increase= baroreceptor firing rate, PSNS activity.
  • Decrease= the rest.
265
Q

Carotid massage in PSVT would do what?

A

Increased baroreceptor firing –> increased PSNS –> decreased HR &/or establishing normal rhythm

266
Q
  • Describe the immediate direct and reflex cardiovascular consequences of giving a healthy person a drug that blocks a,-adrenergic receptors.
  • Describe the possible changes in mean arterial pressure, sympathetic nerve activity, cardiac output, total peripheral resistance, and shifts in the cardiac function and venous return curves?
A
  • CO increases.
  • TPR decreases.
  • MAP decreases
  • SNS activity increases(HR)
  • Cardiac curve goes up
  • Venous curve has no shift.
267
Q

Whenever cardiac output is increased, mean arterial pressure must also be increased. True or false?

A

False. Increased CO usually decreased TPR but MAP could be same, lower or higher

268
Q

Chronic elevation of arterial pressure requires that either cardiac output or TPR (or both) be chronically elevated. True or false?

A

True. Pa= CO x TPR

269
Q

If resistance through an organ decreases what happens to TPR?

A

TPR decreases

270
Q

Calculate TPR. MAP= 100mmHg, CVP= 0mmHg, CO= 6L/min?

A

1) R= △P/Q => TPR= (Pa – Pcv) / CO
2) TPR= (100-0) / 6L/min= 16.7mmHg x L/min

271
Q

Determine Flow. Cap pressure= 28mmHg, Plasma oncotic= 24mmHg, tissue hydrostatic= -4mmHg, tissue oncotic= 0mmHg?

A

F= [28 – (-4) – 24 + 0]= +8mmHg

272
Q

Increased Pulse pressure is related to which valve disease?

A

Aortic insufficiency

273
Q

Calculate resistance to flow across this stenotic valve.
BP= 150/100mmHg,
LV pressures= 150/2mmHg,
LA pressures= 50/32mmHg,
HR= 60bpm,
SV= 50cc?

A

1) CO= 60bpm x 50cc= 3L/min.
2) R= △P/Q R= 30mmHg/3l/min= 10mmHg x L/min

274
Q

What alteration in jugular venous pulsations might accompany third-degree heart block?

A

Irregular giant a-waves also called cannon waves

275
Q

When is tricuspid regurgitation heard on an ECG tracing?

A

Right after S-1 –> close to S-2

276
Q

Does 3rd degree HB cause an increased or decreased SV?

A

Increased SV due to lower HR= longer filling time

277
Q

Pulmonic stenosis will cause what kind of axis shift?

A

Right axis shift

278
Q

What is the definition of ejection fraction?

A

Ration of SV to EDV

279
Q

P-wave in normal aVR lead will have what deflection?

A

Downward deflection

280
Q

Decreased AV node conduction velocity will?
- Decreased HR,
- increase P-wave
- Increase PR interval
- widen QRS

A

Increase PR interval

281
Q

Calculate CO.
- Male 70kg,
- SAO2= 200cc/L
- PAO2= 140cc/L
- VO2= 600cc/L

A

1) CO= 10L/min. Q= [ VO2 / (SAO2 – PAO2) ]

282
Q

With all other factors equal, myocardial oxygen demands will be increased to the greatest extent by which of the following?
- increases in the heart rate
- increases in coronary flow
- increases in end-diastolic volume
- decreases in arterial pressure
- decreases in cardiac contractility

A
  • Isovolumetric contraction uses most energy.
  • Increased EDV will also increase O2 use but less than increased HR.
283
Q

Four of these conditions exist during the same phase of the cardiac cycle and one does not. Which one is the odd one?
- The mitral valve is open.
- The ST segment of the ECG is occurring.
- The “v” wave of thejugular venous pulse hasjust occurred.
- Ventricular volume is increasing.
- Aortic pressure is falling.

A

ST segment occurs during systole

284
Q

Increases in sympathetic neural activity to the heart will result in an increase in stroke volume by causing a decrease in end-systolic volume for any given end¬ diastolic volume. True or false?

A

True. Increased SNS activity –> increased contractility & EF

285
Q

In which direction will cardiac output change if central venous pressure is lowered while cardiac sympathetic tone is increased?

A
  • Need more info to properly answer question.
  • Decreased preload decreases SV.
  • Increased SNS will increase SV & HR.
286
Q

Which of the following interventions will increase cardiac stroke volume?
- Increased ventricular filling pressure.
- decreased arterial pressure.
- Increased activity of cardiac sympathetic nerves.
- Increased circulating catecholamine levels?

A

All are correct.

287
Q

How does a stenotic valve affect EDV, ESV, CO, flow?

A
  • Flow is low due to high resistance.
  • EDV is reduced.
    -ESV is increased due to decreased CO.
288
Q

A common Side effect of beta-blocker therapy is decreased exercise tolerance. Why is this not surprising?

A

Block the ability to increase HR & CO

289
Q

Individuals with high arterial blood pressure (hypertension) are often treated with drugs that block beta-adrenergic receptors. What is a rationale for such treatment?

A
  • Reduce HR & contractility –> decrease CO.
  • Less flow through a constant = smaller pressure difference.
290
Q

What direct cardiovascular consequences would you expect from an intravenous injection of norepinephrine?

A

Increased HR, contraction, arteriolar & venous constriction

291
Q

How would a 10% diameter increase affect resistance?

A
  • Resistance decreases by 32%.
  • (R=1/r4th) R= 1/1.1 to the 4th –> 1/1.46 = 0.68%

Marcus' A&P S24 (9 decks)

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