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CVP > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is dyslipidemia

A

A abnormal amount of lipids in the blood

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2
Q

True or False, inflammatory mechanisms couple dyslipidemia to atheroma formation

A

True

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3
Q

Leukocyte recruitment and expression of pro-inflammatory cytokines characterize what?

A

Early atherogenesis

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4
Q

What is thrombosis

A

blood clots

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5
Q

What causes most myocardial infarctions and most strokes?

A

thrombosis (blood clots)

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6
Q

What is another name for loose connective tissue?

A

areolar tissue

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7
Q

What are the two kinds of ordinary tissues?

A

Loose connective tissue (areolar tissue)

Dense ordinary connective tissue (Regular vs. Irregular)

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8
Q

Adipose tissue, Blood cells, Blood cell forming tissue (Myeloid or lymphatic tissue), Cartilage and Bone are all examples of what?

A

Special connective tissues

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9
Q

What process prevents blood loss

A

Hemostasis

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10
Q

What are the 4 mechanisms of hemostasis

A

Vascular spasm
Formation of a platelet plug
Blood coagulation
Fibrous tissue growth to seal

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11
Q

True or false, platelets can divide like normal cells?

A

False, they cannot

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12
Q

True or false, platelets contain actin and myosin

A

True

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13
Q

What significant role do glycoproteins play in platelets

A

Avoid normal endothelium but adhere to damaged areas

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14
Q

When platelets come in contact with a damaged area, they swell and what else happens?

A

Contractile proteins (actin and myosin) contract causing granule release

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15
Q

Once the contractile proteins in platelets contract releasing granules, what is secreted?

A

ADP, Thromboxane A2 and Serotonin

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16
Q

Is thromboxane A2 a vasoconstrictor or vasodilator

A

Vasoconstrictor

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17
Q

How long is a platelets half life? How are they eliminated?

A

8-12 days

Primarily by macrophage action

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18
Q

What are typical levels of platelets in the blood?

A

150,000-300,000 per micro liter

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19
Q

What role does PGI2 (prostacyclin) play in blood coagulation

A

vasodilator

stimulates platelet adenyl cyclase which suppresses release of granules

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20
Q

Both Thromboxane A2 and Prostacyclin are derived from what fatty acid?

A

Arachidonic acid

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21
Q

What effect does aspirin and ibuprofen have on thromboxane A2 and prostacyclin

A

They both block production by blocking cyclooxygenase which converts ARA (arachidonic acid) to PGG2 and PGH2 (intermediates)

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22
Q

Citrate and oxylate are both examples of? How do they work?

A

Anti-coagulants

They tie up calcium

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23
Q

Cumadin and Warfarin are both examples of what? How do they work?

A

Synthetic anti-coagulants

inhibiting Vitamin K dependent factors

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24
Q

What substance dissolves blood clots

A

Plasmin

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25
Q

What is the name of inactive plasmin circulating in the blood

A

plasminogen

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26
Q

Where are endogenous activators of plasminogen found in the body

A

Tissues, plasma, and urine

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27
Q

What are 2 examples of exogenous activators of plasminogen

A

streptokinase

tPA (tissue plasminogen activator)

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28
Q

True or false; clots may be liquefied (fibrinolysis) by a proteolytic enzyme called “plasmin”

A

True

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29
Q

True or false; plasminogen is the inactive form of plasmin (which liquifies clots) circulating in the blood

A

True

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30
Q

Most tissue damage from an infarction occurs upon what?

A

Reperfusion

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31
Q

True or false; reperfusion injuries are associated with high levels of reactive oxygen species causing free radicals

A

True

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32
Q

What is collateralization

A

Ability to open up alternative routes of blood flow to compensate for a blocked vessel

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33
Q

What is the extrinsic mechanism of thrombosis (blood coagulation)

A

initiated by chemical factors released by damaged tissues

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34
Q

What is the intrinsic mechanism of thrombosis (blood coagulation)

A

Requires only components in blood and trauma to blood or exposure to collagen

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35
Q

How many clotting factors does your liver make? What are they?

A

5, factors I (fibrinogen), II (prothrombin), VII, IX, X

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36
Q

Coumarin (warfarin or cumadin) are all blood thinners. How do they work?

A

They depress the liver’s ability to form clotting factors II, VII, IX, and X by blocking vitamin K

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37
Q

What is Hemophilia? Is it more common in one sex?

A

It is a sex linked disease causing abnormal thinning of the blood
It affects almost exclusively males

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38
Q

True or false; hemophilia is caused 100% of the time by a defect in clotting factor VIII

A

False, it is caused by clotting factor VIII 85% of cases and factor IX 15%

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39
Q

True or false; calcium plays no role in blood coagulation

A

False, calcium plays a major role

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40
Q

True or false; a key step in blood clotting is the conversion of fibrinogen to fibrin which requires thrombin

A

True

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41
Q

What is Antiphospholipid antibody syndrome? What does it cause?

A

An autoimmune disorder where body makes antibodies against phospholipids in cell membranes

Causes abnormal clot formation

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42
Q

True or false; being a male increases your risk of heart disease?

A

True

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43
Q

What is homocysteine?

A

An amino acid in the blood that may irritate blood vessels promoting atherosclerosis
Can make blood more likely to clot

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44
Q

True or false; SA node, AV node, and purkinje fibers are all specialized excitatory and conductive muscle fibers

A

True

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45
Q

True or false; inflammatory pathways promote thrombosis, which is responsible for myocardial infarction and most strokes

A

True

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46
Q

What is released from the endothelial wall, that promotes vasodilation and limits platelet extension

A

Prostacyclin (PGI2)

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47
Q

What is released from the platelets that promotes vasoconstriction?

A

Thromboxane A2

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48
Q

A traumatized vessel will constrict; most of this constriction is due to what

A

local myogenic spasm

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49
Q

True or false; plasmin dissolves blood clots

A

true

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50
Q

True or false; the conversion of fibrinogen to fibrin is not a crucial step in blood coagulation

A

false, it is

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51
Q

Fibrinogen and prothrombin along with factors VII, IX, and X are produced by what organ?

A

Liver

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52
Q

True or false; Ca++ is vital in blood clotting except for the first two intrinsic steps

A

True

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53
Q

True or false; the SA node lacks a stable resting polarized state

A

true

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54
Q

At a normal resting membrane potential of -85 mV, what ion is closest to its nernst equilibrium potential?

A

K+

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55
Q

A 2-3 times elevation in extracellular fluid of what ion can cause flaccidity and weakness of cardiac muslce in part by decreasing the resign membrane potential

A

K+

56
Q

If end diastolic volume = 160 mL and end systolic volume = 120 mL what is the ejection fraction

A

25% (40/160)

57
Q

What percentage of blood from the atrial to the ventricle is actively pumped?

A

25-30%

58
Q

Norepinephrine binds to which cardiac receptors?

A

Beta

59
Q

Acetylcholine binds to which cardiac receptors?

A

Muscarinic

60
Q

At rest, if you block both divisions of the autonomic nervous system (increase sympathetic) what would expect heart rate to do/

A

HR will increase and strength of contraction with decrease

61
Q

What allows the action potential to spread from one cardiac cell to an adjacent cardiac cell, and therefore allows the heart to behave as a syncytium

A

Intercalated discs

62
Q

Reperfusion injury following infection is primarily associated with what?

A

Free radical production

63
Q

Increased stretch on the ventricular fibers during filling have what effect on calcium influx into the ventricular cells?

A

Increase (promotes more forceful contraction)

64
Q

True or false; thyroxine has a positive inotropic effect on the ventricle

A

true

65
Q

A wave of depolarization moving toward the positive recording electrode would create what type of deflection

A

negative deflection

66
Q

When does myocardial blood flow peak in the left ventricle

A

at the onset of diastole

67
Q

When does myocardial blood flow peak in the right ventricle

A

mid systole

68
Q

True or false; 70% of oxygen is most body can take from blood

A

true

69
Q

If the sympathetic nerves to the heart are cut and then the SNS is stimulated the heart rate will still increase, why?

A

circuating norepinephrine and epinephrine from the adrenal medulla

70
Q

The preferred energy substrate of ventricular cardiac cells is what?

A

fatty acids

71
Q

At a constant operating pressure what happens to the wall tension as the radius of that chamber decreases

A

decreases

72
Q

No consistent relationship of P waves to QRS complexes describes what AV block

A

3rd

73
Q

Prolonged PR interval describes what AV block

A

1st

74
Q

Some waves getting through and others not describes what AV block

A

2nd

75
Q

If you block fast Na+ channels in a typical cardiac muscle cell using “tetradotoxin” what will be observed

A

depolarization is slowed

76
Q

True or false; as heart rate increases, cycle length decreases and diastole shortens more than systole

A

true

77
Q

Most of the energy consumed by the heart for work is utilized for what?

A

Pressurization of blood by the ventricles (key word is energy consumed for WORK) Heat is what energy source is typically absorbed by heart

78
Q

What is syncytium?

A

Means many acting as one

like the intercalated disc in the heart

79
Q

How long is the duration of an action potential in the heart/

A

.2-.3 seconds

80
Q

Are Na+ channels fast or slow in heart? What about Ca+/Na+?

A

Na+ Fast

Ca+/Na+ slow

81
Q

In relation to Na+, Ca+, and K+ how does permeability change in the heart

A

Na+ ^ at onset of depol, decrease during repol

Ca++ ^ at onset of depol, decrease during repol

K+ decreased onset of depol, ^ during repol

82
Q

True or false; membrane permeability is dependent on ion channels

A

true

83
Q

before initial depolarization how many millivolts is the heart resting at

A

-85 millivolts

84
Q

after depolarization during the beat how many millivolts is the heart at

A

+20 millivolts

85
Q

After the initial spike after depolarization how long does the membrane remain depolarized for (plateau)

A

.2 seconds

86
Q

True or false; a ventricular contraction can last as much as 15 times longer than a skeletal muscle contraction

A

true

87
Q

True or false, as the slow Ca++/Na+ channels are open the permeability for K+ decreases causing a prolonged plateau at the end of depolarization

A

true

After the slow Ca++/Na+ channel closes K+ permeability rises again allowing efflux of K+ and a rapid repolarization

88
Q

The Na+/K+ pump in the heart pumps Na+ out and brings K+ in a what ratio? What is the net loss/gain?

A

3:2

Net loss of +1

89
Q

True or false; there is a protein that allows Ca++ from inside the cell to be exchanged for a Na+

A

True

90
Q

If the Na+/K+ pump is inhibited and the Ca++ exchange protein is reduced, Ca++ will accumulate in the cell causing what

A

an increase in contractile strength

91
Q

When is the absolute refractory period

A

during plateau

92
Q

When does the relative refractory period occur

A

during repolarization

93
Q

What is considered the normal pacemaker of the heart

A

SA node

94
Q

True or false; the SA node is considered self excitatory

A

true

95
Q

True or false; in the SA node only the slow Ca++/Na+ channel is operational

A

true

96
Q

Which node spontaneously depolarizes at fastest rate

A

SA node

97
Q

True or false; the AV node speeds the onset of depolarization entering the ventricle

A

False; it delays the wave of depolarization from entering ventricle

This allows the atria to contract slightly ahead of ventricle (.1 sec)

98
Q

True or false; in absence of SA node the AV node can act as a pacemaker

A

true

99
Q

True or false; as heart rate increases cycle length decreases

A

true

100
Q

During systole what is happening?

A

isovolumic contraction

ejection of blood

101
Q

During diastole what is happening

A

isovolumic relaxation
rapid inflow of blood
atrial systole

102
Q

What valves are opened/closed during systole

A

Ventricles are in isovolumic contraction so, Pulmonic and Aortic valves are open, and Mitral and Tricuspid valves are closed

103
Q

What valves are opened/closed during diastole

A

Ventricles are now in Isovolumic relaxation, so pulmonic and aortic valves are closed, blood inflow, mitral and tricuspid valves are open

104
Q

What is End Diastolic Volume (EDV)? What is End Systolic Volume (ESV)? What is Stroke volume (EDV-ESV)

A

EDV= volume of ventricles filling with blood end of diastole

ESV= volume of blood exiting ventricles end of systole

Stroke volume= is calculated EDV-ESV

105
Q

What is the Ejection fraction? What is a normal ejection fraction

A

Stroke volume divided by end diastolic volume multiplied by 100 (SV/EDV x 100)

50-60%

106
Q

Which valves are considered thin and weak, supported by chord tendineae to prevent prolapse and papillary muscles

A

Mitral and tricuspid valves or the atrial valves

107
Q

Which valves are considered the semilunar valves and stronger than the other

A

Aortic and pulmonic valves or ventricular valves

108
Q

What term describes when a valve isn’t opening fully

A

stenotic

109
Q

What term describes when a valve isn’t closing properly

A

insufficient

110
Q

If a valve is stenotic (not opening fully) or insufficient (not closing all the way) what would be the phenotype

A

A heart mummer (they are audible)

111
Q

What could it mean if you heard a heart murmur during systole

A

aortic and pulmonary stenosis
or
mitral and tricuspid insufficiency

112
Q

What could it mean if you heard a heart murmur during diastole

A

aortic and pulmonary insufficiency
or
mitral and tricuspid stenosis

113
Q

What would it mean if you heard a heart murmur during both systole and diastole

A

patient ducutus arteriosis
or
combined valvular defect

114
Q

True or false; as tension on the ventricle wall increases (i.e. the radius is increasing) what would you expect the force of contraction to be

A

increased

115
Q

What does chronotropic mean

A

anything that affects heart rate

116
Q

What does dromotropic mean

A

anything that affects conduction velocity

117
Q

What does inotropic mean

A

anything that affects strength of contraction

118
Q

True or false; caffeine would be an example of a chronotropic agent

A

true

119
Q

True or false; increased stretch on the SA node will increase heart rate

A

true

stretch on SA node will increase Ca++ and/or Na+ permeability which increases heart rate

120
Q

What is the Frank-Starling law?

A

The heart will pump all the blood that is sent to it within physiological limits

121
Q

What does SNS stimulation do to the heart

A

increases heart rate, strength of contraction, and conduction velocity

122
Q

What does parasympathetic stimulation do to the heart

A

decreases heart rate, strength of contraction, and conduction velocity

123
Q

What would stretch on the right atrium do to SNS

A

Cause SNS to release catacholamines try and increase heart rate and contraction to deal with extra inflow of blood

This is called Brainbridge reflex

124
Q

What would thyroid hormones do to heart

A

Act Inotropic (increase strength of contraction) chronotropic (increase in heart rate)

125
Q

How does body temperature effect the heart

A

Increased heat with cause an increase in heart rate and a temporary increase in contractile strength (prolonged fever will cause decrease in strength due to exhaustion of metabolic systems)

Decreased heat will cause a decrease in heart rate and strength of contraction

126
Q

Can the heart use different energy sources outside of fatty acids?

A

yes, the heart just prefers to use fatty acids

127
Q

75% of the energy the heart utilizes is converted to what? What is the remaining 25% utilized for

A

heat

remaining is used for work

128
Q

What is the normal rate of an EKG

A

around 60-80 bps

129
Q

What is a EKG rating of greater than 100 bps mean? What about less than 50?

A

> 100 is considered tachycardia

<50 is considered bradycardia

130
Q

How long should the PR interval be on an EKG

A

about .16 seconds

131
Q

If the PR interval on a EKG is >.20 seconds what is that considered

A

1st AV block

132
Q

Which waves of a electrocardiograph are considered depolarization waves? Which are repolarization

A

P and QRS complex are depolarization

and T wave is the repolarization

133
Q

If troponins are found in blood what does that say about the heart

A

troponins are only released when myocardial necrosis has taken place

134
Q

True or false; after a myocardial infarction damaged cells loose their ability to repolarize

A

true

135
Q

What is characteristic of a 1st degree AV block

A

depolarization from atria to ventricle is delayed

136
Q

What is characteristic of a 2nd degree AV block

A

Some depol waves pass and others do not

137
Q

What is characteristic of a 3rd degree AV block

A

All depol waves from atria to ventricles are blocked

CVP (3 decks)

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