Exam 1: 4 Feb 25 CV A&P Key Concepts to Know Flashcards
What is the typical coronary artery setup in most individuals?
The right coronary artery supplies the posterior descending artery (PDA)
This setup is present in about 75% of people.
What does left coronary dominance indicate?
The circumflex artery supplies the posterior descending artery (PDA)
This occurs in approximately 15% of individuals.
What are the implications of having left coronary dominance?
Increased risk of coronary perfusion issues and higher mortality rates during procedures
This is due to more heart tissue depending on a single coronary artery.
How does positive pressure ventilation initially affect cardiac output?
It initially increases cardiac output due to increased preload
However, long-term effects can lead to preload issues.
What happens to pulmonary artery pressure during inspiration?
Pulmonary artery pressure decreases
This is due to the thoracic pressure becoming more negative.
What is the effect of positive pressure ventilation on preload and afterload?
Preload may be reduced; afterload is also affected differently for the right and left sides of the heart
The right side experiences a reduction in both preload and afterload, while the left side does not see a reduction in afterload.
What is ventricular wall compliance?
The ability of the ventricular walls to stretch and accommodate blood volume
Thicker walls (hypertrophy) reduce compliance, while thinner walls (dilated cardiomyopathy) increase it.
What are the normal heart sounds?
First, second, third, and fourth heart sounds
Each sound has clinical significance in diagnosing heart conditions.
What is aortic stenosis?
A narrowing of the aortic valve opening
This condition can lead to significant heart complications.
What is the role of atrial contraction in the heart?
It assists in filling the ventricles with blood
Atrial contraction is crucial for optimal cardiac output.
True or False: The left side of the heart benefits from decreased afterload during inspiration.
False
The left side does not experience a reduction in afterload due to thoracic pressure changes.
What is collateral circulation in the context of coronary arteries?
Alternative pathways for blood flow that develop when primary routes are obstructed
This can mitigate damage in cases of coronary artery blockage.
Fill in the blank: The posterior descending artery (PDA) is typically a branch of the _______.
right coronary artery
What is the significance of understanding coronary artery variations?
It is crucial for accurate diagnosis and treatment of coronary perfusion issues
Variations can impact surgical outcomes and patient management.
What is the primary method for getting air into a patient’s lungs when positive pressure ventilation is used?
Pushing air into the lungs
Positive pressure ventilation is used when normal breathing is insufficient or impossible.
What happens to cardiac output during the initial phase of positive pressure ventilation?
Cardiac output is expected to increase
This is due to increased preload as the chest fills with blood.
What effect does prolonged positive pressure ventilation have on venous return?
It impedes venous return
High intrathoracic pressure reduces the ability of blood to return to the heart.
How does positive pressure ventilation influence the left and right sides of the heart differently?
Left side output may increase; right side may decrease
Increased preload benefits the left side, while increased afterload affects the right side.
What is the relationship between thoracic pressure and filling pressure during positive pressure ventilation?
Increased thoracic pressure leads to higher filling pressures
This can create an obstruction to blood flow into the heart.
What structural change occurs in the ventricular wall due to severe aortic stenosis?
Hypertrophy of the ventricular wall
This adaptation helps generate more force but reduces compliance.
What is the effect of reduced compliance of the ventricular wall on filling pressure?
Increased filling pressure is required
Thicker walls resist expansion, necessitating higher pressures to fill the ventricle.
In terms of compliance, how does a highly compliant ventricle behave?
Requires low filling pressures
Thin-walled ventricles can easily stretch to accommodate blood.
What happens to the pressure-volume relationship in a ventricle with reduced compliance?
The slope of the passive filling curve increases
This indicates that more pressure is needed to achieve the same volume.
What is the characteristic of a pediatric heart compared to an adult heart in terms of compliance?
Pediatric hearts have less compliant ventricles
This makes them less able to accommodate increased venous return.
What is a potential risk when administering fluids to young children?
Their hearts may not accommodate large volumes
Pediatric hearts rely more on increasing heart rate than stroke volume to manage fluid return.
True or False: Aortic regurgitation leads to increased ventricular wall compliance.
True
This condition can stretch the ventricular walls, making them easier to fill.
What type of hypertrophy can occur in the heart?
Both thickening and thinning of the heart wall
Hypertrophy can be adaptive but may also lead to filling difficulties.
Fill in the blank: The __________ of the ventricular wall affects the heart’s ability to fill with blood.
compliance
Compliance refers to how easily the ventricular walls can stretch and accommodate blood.
What physiological change occurs in the thorax during positive pressure ventilation?
Increased thoracic pressure
This can hinder blood flow into the heart.
What can result from using high levels of positive end-expiratory pressure (PEEP)?
Reduced cardiac output
Sustained high pressure can impede venous return to the heart.
What should be considered when giving volume to pediatric patients?
Kidneys aren’t fully developed, and the volume returning to the heart must be carefully monitored due to their immature systems.
How do pediatric heart ventricular walls compare to adults?
Pediatric heart ventricular walls are probably less compliant than adults.
What is the first heart sound a result of?
The closure of the AV valves when the ventricle starts to build pressure.
What is the duration and pitch of the first heart sound?
Approximately 0.14 seconds and low pitch.
When does the second heart sound occur?
After ejection is finished.
What is the duration and pitch of the second heart sound?
Approximately 0.11 seconds and higher pitch than the first heart sound.
True or False: The fourth heart sound should be audible in healthy individuals.
False.
What can cause the atrial heart sound to be audible?
Mitral valve stenosis or if the atria contracts when it is fuller than normal.
What condition is the third heart sound associated with?
Heart failure or low compliance ventricles.
What happens to the third heart sound in a low compliance ventricle?
Turbulence or blood rattling occurs as it hits the walls.
What is aortic stenosis characterized by?
An abnormal murmur during systole when blood shoots through a stenotic valve.
What type of murmur is associated with a regurgitant aortic valve?
A diastolic murmur.
When is the loudest point of the murmur for mitral stenosis?
At the end of diastole.
What characterizes mitral regurgitation?
Backwards flow of blood during systole.
Where is the best place to auscultate the aortic valve?
On the right side of the sternum around the second intercostal space.
Where can the pulmonic valve be auscultated?
On the left side of the chest near the second intercostal space.
Where is the tricuspid valve best auscultated?
Medial left side of the patient in the fifth intercostal space.
Where is the mitral valve located for auscultation?
In the fifth intercostal space, further lateral from the tricuspid valve.
What is the mnemonic used to remember auscultation sites?
All Patients Take Meds.
What physiological phenomenon can cause splitting of the second heart sound?
Deep inspiration.
What is a phono cardiogram used for?
To record heart sounds and identify frequencies of heart murmurs.
What are the divisions of the mediastinum?
Superior and inferior mediastinum.
What are the three parts of the inferior mediastinum?
Anterior, middle, and posterior.
What are the two designations of the mediastinum?
Superior and inferior
What are the three parts of the inferior mediastinum?
Anterior, middle, and posterior
What structures are found in the middle mediastinum?
- Heart
- Pericardium
- Ascending aorta
- Superior vena cava
- Pulmonary arteries
- Pulmonary veins
- Pericardiacorenic nerves
What is the function of the pericardiacorenic nerves?
Responsible for sensory perception in the pericardium and innervation to the diaphragm
What structures are located in the posterior mediastinum?
- Esophagus
- Thoracic aorta
- Thoracic duct
- Vagus nerves
- Azygous vein
- Hemiazygous veins
True or False: The thoracic aorta runs down the front of the chest cavity.
False
What happens if there is an air bubble in the arterial line?
It dampens changes in the cardiovascular system
What is the significance of the dichrotic notch in arterial pressure tracings?
It is used to calculate heart rate and EKG data
What can cause an over-damped arterial tracing?
- Air bubbles in the line
- Blood clots in the line
- Gain on the amplifier turned down
What is the consequence of under-damping in an arterial tracing?
Excessive artifacts in the tracing
What is an epicardial blood vessel?
A blood vessel that can be seen on the surface of the heart
What is the term for deeper blood vessels within the heart wall?
Endocardial or subendocardial blood vessels
Where is ischemia most likely to occur in the heart?
In the subendocardial blood vessels
What is the effect of severe aortic stenosis on ventricular pressure?
Pressure inside the ventricle must be much higher than normal
What type of murmur is associated with aortic stenosis?
Systolic murmur
What type of murmur occurs during diastole?
Murmur associated with mitral stenosis
Fill in the blank: The circumflex artery can sometimes be an anastomosis between the _______ and the _______.
Right coronary artery, left coronary artery
True or False: The circumflex artery anatomy is consistent across all patients.
False
What happens to blood flow during diastole in the presence of a leaky valve?
Backward blood flow occurs
What is the typical consequence of a filling problem in the ventricle?
Increased preload and blood volume
What is the effect of a leaky mitral valve on pulse pressure?
It leads to a pretty wide pulse pressure due to backward blood flow during diastole
Blood is not all ejected forward into the system; some returns through the leaky valve.
During which phase does backward blood flow occur with mitral regurgitation?
Diastole
Backward flow can’t happen during systole because the mitral valve is closed.
What happens to the atria during systole in the case of mitral regurgitation?
The atria may fill with abnormal volume due to backward blood flow
The mitral valve should be closed during systole, leading to relatively empty atria.
What is the consequence of increased atrial filling in mitral regurgitation?
Higher atrial pressure and potentially much higher V wave
Atria is filled from multiple sources, causing extra volume and pressure.
What can reduce backward blood flow through a leaky mitral valve?
Reducing the afterload the left side of the heart has to work against
Lower pressure in the ventricle during systole results in less backward flow.
True or False: Atrial kick is not important in heart pathologies.
False
Atrial contraction becomes crucial for filling in many heart conditions.
What is the difference between systolic dysfunction and diastolic dysfunction?
Systolic dysfunction involves difficulty in generating stroke volume; diastolic dysfunction involves filling problems
Systolic dysfunction is marked by thin, less compliant walls; diastolic dysfunction by thick, less compliant walls.
What is eccentric hypertrophy?
A condition where the left ventricular walls are thin
This can result from congenital issues or conditions like aortic valve insufficiency.
What causes concentric hypertrophy?
Thickening of the heart walls due to factors like untreated hypertension or aortic stenosis
This leads to diastolic dysfunction due to less compliant walls.
What is the role of collateral circulation during ischemia?
It helps deliver nutrients to areas affected by ischemia
However, the ability of surrounding blood vessels to dilate is crucial for its effectiveness.
What can happen if the body lays down too much scar tissue after a heart injury?
It can lead to dilated cardiomyopathy
Excessive scar tissue may impair heart function and lead to further complications.
Fill in the blank: The backward blood flow through the mitral valve occurs during _______.
Diastole
What happens to the atria over time with high atrial pressure?
They become stretched and less coordinated
This increases the risk of atrial arrhythmias.
What factors can impair blood vessels’ ability to dilate in the heart?
High cholesterol, smoking, high blood pressure, diabetes
These factors lead to reduced blood flow and increase the risk of heart attacks.
What is the effect of aortic stenosis on left ventricular walls?
They become thickened due to increased pressure
This can lead to diastolic dysfunction.
True or False: Atrial flutter is beneficial for heart function.
False
Atrial flutter disrupts coordinated contraction between the atria and ventricles.
What can excessive volume retention in heart failure lead to?
Stretching of the heart and potential for further dysfunction
This necessitates careful management, sometimes requiring diuretics.
What is the role of fibroblasts in scar tissue formation?
Fibroblasts lay down scar tissue, which can lead to dilated cardiomyopathy if excessive
Excessive scar tissue can impair heart function by affecting muscle cells that are not severely damaged.
What condition can result from excessive scar tissue deposition in the heart?
Dilated cardiomyopathy
This condition occurs when the heart muscle becomes weakened and enlarged, affecting its ability to pump blood effectively.
How do ACE inhibitors help in the context of scar tissue deposition?
They slow the deposition of scar tissue by reducing the activity of fibroblast growth factors
This helps prevent excessive scar formation in the heart.
What is a potential consequence of having non-functional areas in the heart wall?
Decreased ejection fraction (EF)
Non-functional areas can lead to inefficient blood flow during systole.
True or False: All areas of the heart wall should contract uniformly during systole.
True
Any bulging or non-functional areas can disrupt normal contraction and blood flow.
What is the significance of thyroid function in relation to cardiac output?
Thyroid function is important for regulating metabolic demand and cardiac output
Thyroid hormones influence heart rate and myocardial contractility.
Fill in the blank: Excessive scar tissue can lead to _______ in the heart.
dilated cardiomyopathy
What are the potential topics to be discussed in the upcoming lecture?
Thyroid function, congenital differences between young and adult hearts, and shock
The lecture aims to explore how the body handles shock and the differences in heart development.
What happens during systole if part of the heart wall is non-functional?
There may be outward stretches instead of efficient blood flow into the aorta
This can lead to complications such as low ejection fraction.
