Exam 1 Flashcards
What key components of CVP management of known?
- normal physiology
- cardiac
- pulmonary
- vacular
What key components of CVP management of applied?
- pathology
- disease progression
- pharmacology
What key components of CVP management of managed?
- primary and secondary prevention
- inpatient and outpatient
What is primary prevention?
directly addressing the disease
What is secondary prevention?
preventing further complications
threat to oxgyen transport =
threat to life
what are three steps of oxygen transport?
- oxgyen delivery
- oxygen consumption
- oxygen extraction ratio
oxygen delivery DO2 =
arterial O2 x cardiac output
VO2 =
(arterial O2 - venous O2) x cardiac outpu
oxygen extraction ratio (OER) =
consumption / delivery
what is the utilization coefficient?
~23% at rest
What may cause VO2 to fall short of demant?
if severe cardiopulmonary dysfunction exists
what kind of biological work requires continuous oxygen supply?
aerobic metabolism
What is DO2 normally based on?
demands of tissues
At rest, DO2 is ______ greater than actual demand
3-4x
What does the 3-4x greater DO2 allow for?
creation of reserve
98% O2 transported in combination with _______________.
hemoglobin
What are determinants of hemoglobin’s affinity for O2?
temperature and oxygen
What 3 structures are involved in oxgyen delivery / gas exchanges?
- lungs
- arteries
- tissue cells
Balance b/n intravascular and _________________ fluid volume is important.
extravascular
If imbalance occurs, what happens?
electrolytes are impacted wich can impact oragn function
What can cause imbalances in the mechanism for delivery?
too much H20
not enougth H2O
too much Na+
not enougth Na+
What impacts delivery of oxygen from outside air to tissues?
- atmospheric air
- air quality
- humidity
How does air quality interfere with repiratory tract filtering?
poor air quality leads to inflammation of alveolar capillary
In dry ENs:
loss of mucus covering, erosion and infection
In alveoli, inspired air saturated w/
water vapor
What are the first 3 steps of oxygens transport?
- inpired oxygen and quality of air
- airways
- lungs & chest wall
What are steps 4-6 of oxygen transport?
- diffusion
- perfusion
- myocardial function
What are steps 7-9 of oxygen transport?
- peripheral circulation
- tisue extraction & utilization of oxygen
- return of partially (de)saturated blood & CO2 to lungs
what are the critical structures included in the airways?
upper respiratory: nasal cavity, pharynx, larynx
lower respiratory: trachea, primary bronchi, lungs
with a relaxed diaphragm: lungs=
chest wall
lungs= elastic force relaxed
chest wall= elastic force relaxed
with inhalation, the diaphragm ______________________________ and the lungs & chest wall __________________.
active muscle contraction
actively expand
* increase in negative pressure, similar to vacuum
during inspiration the external intercostals:
elevate and therefore increase the volume of the pleural cavities
during inspiration the diaphragm:
depresses the inferior wall of the thoracic cavity and, therefore, increase the volume of the cavities
during expiration the internal intercostals:
compress and lower the ribs and therefore decrease the volume of the pleural cavities
during expiration the abdominals:
compress the abdominal cavity which elevates the abdominal organs and passively elevates the diaphragm and, therefore, decreases the volume of the pleural cavities.
diffusion=
transfer of oxygen from alveolar sacs to pulmonary circulation
what 5 principles is diffusion based on:
- surface area of alveolar capillary membrane
- diffusing capacity of alveolar-capillary membrane
- pulmonary capillary blood volume
- ventilation / blood volume
- transit time of blood in alveolar capillary membrane
what does the amount of oxygen that diffuses across alveolar-capillary membrane vary with?
varies directly with size (surface area) and inversely with thickness.
decrease the surface area and increase in thickness –>
decrease in amount of O2 in blood
vent (v) / perf (Q) =
0.8
apical low perfusion =
lung base perfusion increased due to gravity
apical alveoli expand fully =
lung base enlarged vessels compress alveoli
what does optimal function of the heart depend on?
synchronized coupling of electrical conduction and mechanical contraction
cardiac output =
- preload
- force (inotropic effect) & rate of contraction (chronological effect)
- afterload
what are two measures of myocardial impairment?
heart rate
ejection fraction
large vessels =
elastic & connective tissue
medium to small vessels =
more smooth muscle
what do arteriolar regulate blood flow through?
regional vascular beds
hydrostatic = out , oncotic = in
O2 diffusion (__________ content to ____________ content) occurs quickly
high to
low
intravenous at PO2 averages ____mm Hg
23mmHg
Only _____mmHg pressure needed for cell metabolism
3mmHg
OER: amount of O2 extracted at _______ = 23%
rest
rate of O2 extraction regulated by oxygen ___________ (not oxygen availability)
demand
partially desaturated blood and CO2 are removed from:
cells to venous circulation
what are factors that “shake up” O2 transport
normal: activity, position, emotional stress
disease: bed rest, fever, disease itself, inflammation process, medication, fluid imbalance
what is the greatest influence on O2 transport?
Gravity
humans are designed to function:
upright (1G)
60% of body weight is fluid so…:
small shifts in Gravity –> big fluid shifts
restricted activity:
- impacts CO and VO2 with exercise (decrease)
- impacts OER (decrease
- multiple other systems are affected
bed rest also adds the reduction in gravitational forces with physiological impact including:
- change in fluid distribution
- reduced muscle activity
- change in body weight distribution
- aerobic deconditioning and all that impacts with oxygen transport/exchange
Gravity normally keeps fluid in:
body/legs
loss of Gravity allows fluid to shift to:
thorax and head
response to fluid shift –>
reduction in volume
What are examples of general health abnormalities that could be identified during the system assessment?
- weight gain or loss
- fatigue, weakness, malaise
- fever, chills
- sweats, night sweats
What are examples of skin abnormalities that could be identified during the system assessment?
- excessive dryness
- itching (pruritis)
- excessive bruising
- lesion or rash
What are examples of respiratory system abnormalities that could be identified during the system assessment?
- history of lung diseases
- chest pain with breathing
- wheezing or noisy breathing
- shortness of breath (how much activity)
- cough
- sputum (color, amount)
- hemoptysis (bloody sputum)
- medications
What are examples of cardiovascular system abnormalities that could be identified during the system assessment?
- heart or retro sterna pain
- palpations
- cyanosis (blue/purple) –> not enough exertion
- dyspraxia on exertion (amount of exertion)
- Orthoptera (shortness of breath laying down)
- edema
- history of heart murmur, HTN, CAD or anemia
- medications for cardiac disease
What are examples of peripheral vascular system abnormalities that could be identified during the system assessment?
- coldness, ,numbness, tingling of legs
- swelling of legs (time of day and activity)
- discoloration hands or feet
- varicose veins (causes poor venous return)
- intermittent claudication (arteries not pushing blood dismally properly)
- thrombophlebitis (inflammation of veins)
- ulcers
medications
What are examples of hematologic system abnormalities that could be identified during the system assessment?
- bleeding in skin or mucus membranes
- excessive bruising
- lymph node swelling
- blood transfusion and reactions
- medications
What are examples of endocrine system abnormalities that could be identified during the system assessment?
- history of diabetes (medications)
- history of thyroid disease or symptoms (change in skin texture / excessive sweating / extreme thirst / relationship between appetite and weight / nervousness / tremors)
Pale, cyanosis or cold skin are what?
external signs of oxygen transport dysfunction
What is short breath a sign of?
external sign of oxygen transport dysfunction
What is diaphoresis (excessive sweating) a sign of ?
An external sign of oxygen transport dysfunction
What are 4 internal signs of oxygen transport dysfunction?
1) vital signs
2) respiratory patterns
3) hypoxia/ low pulse oximetry
4) poor peripheral circulation
- decreased capillary refill (>3 sec)
pt history –> systems review –> hypothesis –> diagnostic exams and tests –> evaluation –> PT diagnosis –> PT prognosis –> working problem list –> plan of care
pt history –> systems review –> hypothesis –> diagnostic exams and tests –> evaluation –> PT diagnosis –> PT prognosis –> working problem list –> plan of care
List 3 levels of PT interventions:
1) prevention
2) secondary prevention
3) treatment
What is considered prevention?
- addresses PA
- addresses CV risk factors
What is considered secondary prevention?
- increase aerobic capacity/ endurance
- improve breathing pattern / ventilation
What is considered treatment?
- airway clearance
- exercise: strength mobility, ADL
Which circulation is the shortest in the body?
Coronary circulation
What structures of body are considered the functional anatomy of the heart?
- sternum
- lungs
- diaphragm
- liver
- colon
- stomach
- heart (left & right ventricles)
What are two membrane coverings of the heart?
- fibrous
- serous (2 layers)
==> pericardial cavity
The heart wall has (___ layers)
3
the __________ pericardium directly touches the heart (myocardium). External to that is the _______________________, which is covered by the ___________________ (which surrounds the _________________________________).
visceral pericardium
pericardial cavity
parietal pericardium fibrous
parietal pericardium serous
the internal anatomy includes the:
chambers and structures
what are two of the primary coronary arteries on the anterior surface of the heart?
- right coronary artery
- circumflex artery
What is a pathological change of the coronary artery?
percutaneous translational coronary angioplasty (PTCA)
Oxygen poor blood come from the _______________ and enters through the inferior and superior ___________________ traveling to the right ______________ then tho the right ___________________ and out to the _______________________. Blood is oxygenated in the capillary beds of the lungs where gas exchange occurs. From there it travels through the ___________________________ to the left __________ to the left ______________________________ out to the body through the _________________________ then the capillary beds of all body tissues where gas exchange occurs.
Oxygen poor blood come from the BODY and enters through the inferior and superior VENAE CAVAE traveling to the right ATRIUM then tho the right VENTRICLE and out to the PULMONARY ARTERIES. Blood is oxygenated in the capillary beds of the lungs where gas exchange occurs. From there it travels through the PULMONARY VEINS to the left ATRIUM to the left VENTRICLES out to the body through the AORTA & BRANCHES then to the capillary beds of all body tissues where gas exchange occurs.
List 3 cardiac muscles:
1) atrial muscle
2) ventricular muscle
3) specialized excitatory and conductive muscle
List 3 structures of micro anatomy of the heart:
1) muscle cells
2) intercalated discs
3) gap junctions (communication pathways)
What are 2 similarities between cardiac and skeletal mechanisms of contraction?
1) striated - myosin/actin mechanism
2) T-tubule mechanism - acting on sacroplasmic reticulum
What are 3 differences between cardiac and skeletal mechanisms of contraction?
1) T-tumble mechanism - direct diffusion of Ca++ (tubules store larger amounts of Ca++)
2) action potential (cardiac muscle “plateau” / plateau results in much longer time of contraction than skeletal mm)
3) strength of contraction (dependent on extracellular Ca++)
The ability of cardiac mm to depolarize and contract is intrinsic and known as:
conduction
What are the components of intrinsic conduction system:
1) sinus node = sinistral/ SA node
2) intermodal pathways
3) AV node
4) AV bundle (bundle branches)
5) Left and right bundle branches of Purkinje fibers
- Smaller diameter muscle fibers
- Almost no contractile muscle fibers
- Connect directly with atrial muscle (mm) fibers
- Cell membranes naturally “leaky” to Na++ and Ca++ ions (therefore, less negative resting membrane potential than other cardiac mm cells)
- Self excitation
All are features of what?
SA node
@ -40mV the __________ are already open.
fast Na++
List the following events in order from first occur in got last:
- K+ permeability accompanied by slow Na+ entry decreases
- Slow depolarization: pacemaker potential
- Fast Ca2+ channels open
- Ca2+ permeability increased
- K+ permeability increase
- Ca2+ permeability decreased
- K+ permeability accompanied by slow Na+ entry decreases
- Ca2+ permeability increased
- Fast Ca2+ channels open
- Ca2+ permeability decreased
- K+ permeability increase
- Slow depolarization: pacemaker potential
during the very early P (PQRST wave) what occurs?
SA node generates impulse: atrial excitation begins
During the p -wave what happens?
impulse delayed at AV node
during the q-way what happens?
impulse passes to heart apex; ventricular excitation begins at the bundle branches
during the QRS segment what is occuring?
ventricular excitation is complete.
Electrical impulses passing through the heart also spread into _____________ and some to the _____________________.
adjacent tissues
surface of the body
the p-wave =
atrial depolarization
QRS complex =
ventricular depolarization
T-wave =
ventricular depolarization
List 5 events that occur from the beginning of one heartbeat to the beginning of the next:
1) chambers and vessel blood volume changes
2) chamber and vessel blood pressures changes
3) electrical activity notes
4) heart sounds occur
5) valves open and close
The cardiac cycle consists of:
- diastole period of relaxation; heart fill in with blood
- systole: contract ration period, heart ejects blood
What is end-diastolic volume (EDV)?
.
What is the definition of end-systolic volume (ESV)?
.
What is the ejection fraction?
fraction of EDV ejected
atrioventricular valves are __________ and aortic and pulmonary valves are ____________ during phase 1. During this phase _____________ filling and _____________ contraction occurs. This happens during mid-to-late ______________.
atrioventricular valves are OPEN and aortic and pulmonary valves are CLOSED during phase 1. During this phase VENTRICULAR filling and ATRIAL contraction occurs. This happens during mid-to-late DIASTOLE.
atrioventricular valves are __________ and aortic and pulmonary valves are ____________ during phase 2b. During this phase ___________________________ occurs. This happens during __________________________ (atria in diastole).
atrioventricular valves are CLOSED and aortic and pulmonary valves are OPEN during phase 2b. During this phase VENTRICULAR EJECTION occurs.This happens during VENTRICULAR SYSTOLE (atria in diastole).
Phase 2a is _________________________. also ventricular systole (atria in diastole)
isovolumetric contraction
During phase 3 _________________________ occurs in early ___________.
Isovolumetric relaxation
early diastole
P wave =
spread of depolarization through atrial tissue followed by contraction
p wave =
increase in atrial pressure
QRS complex : spread of depolarization through ventricular tissue followed by contraction =
ventricular increase pressure
T-wave =
repolarization of the ventricles which represents ventricular relaxation.
The majority of returning venous blood flows directly from _____________ to _______________.
atrium to ventricle
Atrial contraction usually causes an additional ________ ventricle filling, “primer pump”
20%
Atrial function “unnecessary” except during:
vigorous exercise
Atrial pressure changes:
a wave -
c wave -
v wave -
a wave - during atrial contraction
c wave - onset of ventricular con traction
v wave - end of ventricular contraction
Ventricular filling: after systole, A-V valves open due to build up of pressure in ___________________________________________________________________________.
atrial during systole: period of rapid filling of ventricles followed by 2 additional phases
Ventricle as pump = period of __________________, ___________________ and ____________________.
Isovolumetric contraction, ejection, and isovolumetric relaxation.
preload is defined as:
end-diastolic pressure when the ventricle is filled; amount of tension on the muscle when it begins to contract.
Afterload is defined as:
pressure in the artery leading from the ventricle; load against which the muscle exerts its contractile force
Heart and/ or circulation pathology can severely alter:
preload and/or afterload
Chemical energy requirements for cardiac contraction: great dependency / almost exclusive reliance on O2 for energy metabolism (oxidative) compared to ______________________________________________________________________.
skeletal muscle which can utilize anaerobic metabolic sources as well.
Chemical energy requirements for cardiac contraction: energy derived primarily from oxidative metabolism of fatty acids (_________________ of energy source), some lactate, glucose (___________).
70-90%
10-30%
Chemical energy requirements for cardiac contraction: cardiac muscle can also use lactic acid generated by what?
skeletal muscle activity
How is the volume of blood pumped by the heart regulated?
Heart pumps ___________ liters of blood/ minute
4-6 liters
How is the volume of blood pumped by the heart regulated?
Heart may be required to pump ___________ this amount (4-6 liters of blood/ minute) with heavy EX.
4-7 x
How is the volume of blood pumped by the heart regulated?
Blood volume pump is regulated by:
1) intrinsic cardiac regulation of pumping in response to changes in volume of blood flowing into the heart.
2) (extrinsic) control of heart rate and strength of heart pumping by the autonomic nervous system
Intrinsic regulation of heart pumping: Frank-starling mechanism
Heart automatically pumps incoming blood, I.e., amount of blood pumped determine primarily by______________________________. As cardiac muscle is stretched with returning blood volume,
by rate of blood flow into heart
approach optima length of actin and myosin fibers for contraction.
Extrinsic regulation of cardiac pump =
- sympathetic nervous system (SNS)
- Norepinephrine released by sympathetic nerve fibers in response to stressors such as fright, anxiety, or exercise; threshold reached more quickly
Norepinephrine released by sympathetic nerve fibers in response to stressors such as fright, anxiety, or exercise; threshold reached more quickly:
- increase cardiac output (CO)
- -> pacemaker fires more rapidly
- -> enhanced mm contractile try
- effects of inhibiting SNS
What are 3 more components of extrinsic regulation of the cardiac pump?
1) parasympathetic nervous system
2) reduces HR when stressors removed
3) Acetylcholine hyper polarizes membranes of cells –> opens K+ channels
- –> PNS fibers in vagus nerves to heart can decrease CO
- —–> primarily affects HR rather than contractile try
parasympathetic NS =
feed, bread, and rest
(constricts pupil, stimulates flow of saliva, slows heartbeat, constricts bronchi, stimulates peristalsis and secretion, stimulates release of bile and contracts bladder).
Sympathetic NS =
fight or flight (dilates pupil, inhibits flow of saliva, accelerates heartbeat, dilates bronchi, inhibits peristalsis and secretion, conversion of glycogen to glucose, secretion of adrenaline and noradrenaline, inhibits bladder contraction)
During the autonomic innervation of the heart the vagus nerve:
sympathetic chain ganglion:
vagus nerve: stimulates SA node and AV nose via parasympathetic fibers
sympathetic chain ganglion: stimulate SA node and AV node via sympathetic fibers
resting conditions include:
- SA node receives impulses from both ________________________________.
- Dominant influence is inhibitory - heart said to exhibit “____________________.”
- “Disconnect” vagaries nerves = HR increases ~____ bpm almost immediately.
- automatic divisions continuously
- “vagal tone”
- 25
normal sinus rhythm =
In a normal sinus rhythm, the electrical impulse originates within the SA node and travels through the AV node. After a brief delay, the impulse travels down the bundle branches.
sick sinus=
resultant in bradycardia (slow heart, often due to problems with SA node)
atrial flutter =
(tachycardia) Upper chambers (atria) of heart beat too fast, making them out of sync with ventricles.
atrial fibrillation =
Atria fibrillate (quiver or twitch quickly). Impulses begin in atria and fight to get through the AV node. (Disorganized electrical pulses causing fast an irregular pattern)
Wolff-Parkinson-white
When there is an extra electrical pathway b/n heart’s atria and ventricle causing tachycardia. (present at birth)
ventricular tachycardia
(cause sudden death) any rhythm faster than 100 (or 120 beats/min), with 3 or more irregular beats in a row, arising distal to bundle of His.
pacemaker =
small device that’s placed in chest or abdomen to help control abnormal heart rhythms. (traditionally inserted into a vein to heart). regulate hearts rate. “new” SA node
Heart pumps ~ 1,9000 gallons of blood through _______________________________ miles of blood vessels each day.
60,000 - 100, 000
there are ____ billion capillaries in the body.
40 billion
the functions of circulation include:
transport of:
- nutrients and O2 to tissues
- waste and CO2 away from tissues
- hormones from one area of body to another
- heat throughout the body
Circulation is primarily influenced by tissue needs by:
dilation or constriction
cardiac output is a response to:
vascular inflow
Arterial pressure generally controlled independently of local tissue flow or ________
cardiac output
circulation is influence by :
- basic physical characteristics of blood
- physical principles affecting the flow of liquids through vessels (fluid dynamics)
key factors of circulation include:
- blood flow
- pressure
- resistance
- control mechanisms mediating these characteristics
What are the 2 circulatory systems?
- pulmonary
2. systemic
List 3 characteristics of arteries:
- transport blood under high pressure
- strong vascular walls
- blood flow is rapid
list 4 characteristics of arterioles:
- final small branches of arterial system
- act as control conduits - blood real ease into capillaries
- strong muscular walls that vasoconstrict/ dilate
- innervates by SNS only
Name 4 characteristics of capillaries:
- exchange site for nutrients, wastes, electro yes, fluid, etc
- walls - VERY thing (unicellular layer of endothelial cells)
- contain small capillary pores
- permeable to small molecular substance, H2O
Name 2 characteristics of venules:
- collects blood from capillaries
2. gradually merge into larger veins
List 5 characteristics of veins:
- transport blood from tissues to heart
- major function: serve as blood reservoir (64% of total blood volume)
- low pressure, thin walled
- contain muscle- can constrict/ dilate
- act as controllable reservoir for extra blood depending on body needs
The distribution of blood volume within the systemic system is:
veins =
arteries =
capillaries =
veins = 64% arteries = 15% capillaries = 5%
The distribution of blood volume within in the pulmonary system is:
total pulmonary =
= 9%
The distribution of blood volume for the total heart =
7%
blow flow is defined as:
the volume of blood flowing through a vessel, an organ, or the entire circulation in a given period (ml/min)
blood pressure is defined as:
the force per unit area exerted on a vessel wall by the contained blood (mmHg)
resistance is defined as:
opposition to flow; amount of friction blood meets when passes through the vessels
In the interrelationship between flow, pressure, and resistance, blood flow is affected by 2 factors:
- pressure gradient
2. vascular resistance (can be caused by PAD)
Ohm’s Law =
calculation of low through a vessel
more resistance -plaque- lower blood flow
Ohm’s law:
F = change in P/ _____
R
F =
blood flow
change in P =
change in pressure b/n 2 ends of vessel
R =
resistance
Normal adult overall blood flow =
~5,000 ml/min = cardiac output
What are the 2 descriptions of blood flow?
- Laminar (smooth, layered-together)
2. Turbulent
Which has less resistance? (laminar or turbulent)
laminar
conductance (ml/sec/mmHg) =
-measure of blood flow through a vessel for a given pressure difference
What is the reciprocal of resistance?
conductance
A small change in vessel diameter causes enormous change in:
conductance
Conductance of a vessel increases in proportion to the _________________________________.
4th power of the diameter
What is Poiseuille’s law?
F = pie (change) P r^4/ 8nl
Poiseuille’s law is related to :
laminar flow
In Poiseuille’s law, diameter plays the greatest role in determining rate of
blood flow
In systemic circulation: 2/3 of resistance to flow is ___________________ resistance
arteriole
Strong mm walls of arteriole so can change ____________________________. Which can increase blood flow up to __________-fold
diameter up to fourfold
256-fold
Viscosity has an inverse relationship to ____________________.
blood flow.
Hematocrit =
% of blood that consists of cells
hematocrit = 40
polycythemia =
many cells in the blood
Who has more hematocrit, males or females??
males
The theory of circulatory function addresses the needs of tissues that tightly controls blood flow; small-tissue specific vessel dilate or constrict locally to control:
flow in addition to change in cardiac output
Cardiac output primarily controlled by:
some of all local tissue flows
In general, arterial pressure is controlled independently of:
local blood flow or cardiac output
MAP =
DBP + (pp/3)
PP (partial pressure) =
SBP - DBP
Mean arterial pressure (MAP) =
pressure that propels blood to tissues
Pulse pressure (pp) =
affected by SV and compliance of “arterial tree”
(arteriosclerosis affects????)
Difference between SBP and DBP. Normally about 1/3 of SBP.
MAP and PP decrease with:
increasing distance from heart
Mean pressure ~0mmHg at:
venae CAVAE
mean pressure at capillaries =
~17mmHg
mean pressure of pulmonary circulation =
~16mmHg
What is the difference b/n MAP and Mean pressure?
???
What are 3 effects of pressure on blood flow?
- increases force on blood flowing through vessels
- distends vessel
- what are the effects of vessel distension
Distension linty: veins ____ arteries
veins > arteries
Compliance = capacitance =
total quantity of blood that can be stored in a given portion of the circulation for each mmHg pressure rise
compliance = distensibility X :
volume
Central venous pressure =
right atrial pressure ~0mmHg
venous pressure influences on ____________________
R atrial pressure
venous pressure increase or decrease in _______________
R atrial pressure (potential pathology)
What is the gravitational effect of venous pressure:
- quiet stance
- movement “venous pump”
Where are blood reservoirs located?
veins spleen liver heart lungs (>60% blood usually in veins)
Different tissues have different _____________ needs over time.
metabolic
blood flow/ 100 g of tissue
Regulated to provide the necessary level of blood flow to provide needs –>
no “extra”
What are the 2 phases of local blood control?
1) acute
2) long-term
Describe the acute phase of local blood control:
fast adjustment of arteriole so, metarterioles, and pulmonary sphincter a (i.e. small vessels)
Describe the long-term phase of local blood control:
adjustment over days/ weeks/ months to control blood blow to tissue
Increase blood flow leads to _________________ O2 saturation.
decreased arterial O2 saturation
What is the vasodilator theory?
-Vasodilator substance released from local tissue
List examples of vasodilator theory:
adenosine CO2 Adenosine phosphate compounds histamine potassium ions H+
Describe the oxygen lack theory (aka nutrient lack theory)
- pre capillary sphincter a
- metarteriole sphincter
- other ‘lack of substances’ may facilitate vasodilation
Dilating “upstream” arteries, larger arteries “upstream” from local tissue control respond to effects of ________________________
“downstream regulation”
Drag on “upstream” endothelium of vessel walls by rapid increased flow allows release substance that can _______________________ the “upstream” vessels
vasodilate
Endothelium- derived relaxing factor (EDRF) made primarily of________________. Reduces the resistance to _______ in upstream arteries
nitric oxide (NO) BF
What are 2 other mechanisms affecting local blood flow:
- reactive hypermedia
2. active hyperemia
What is auto regulation of BF?
concept that after increase in BF to a tissue due to increase in arterial pressure, BF returns to near normal levels
- tissues have varying abilities to autoregulate
What are the 2 theories of autoregulate on?
- metabolic
2. myogenic
Long-term mechanisms:
provide _______________________
affects _____________________
Deficiency of nutrients/O2 release of ____________________
vascularization “built” for ______________________.
- provides more complete regulation
- affects tissue vascularization
- deficiency of nutrients / O2 - resistance of angiogenic factors
- vascularization “built” for maximum need
What are 2 factors of humoral control?
- vasoconstriction
2. vasodilators
Name 4 vasoconstrictors:
- norepinephrine/ epinephrine
- angiotensin II
- vasopressin
- endothelium
Name 2 vasodilators:
- Bradykinin
2. histamine
What are the 3 primary atherosclerotic diseases?
- coronary disease
2 cerebrovascular disease - peripheral arterial disease
What demographic has the highest reported % of deaths due to heart disease?
Whites (% of deaths = 25.1%) African Americans (24.5%) Asians or Pacific Islanders (23.2%) Hispanics (20.8%) American Indians or Alaska Natives (18%)
About 2,150 Americans die each day from cardiovascular diseases, one every _________ seconds
40
Cardiovascular diseases claim more lives than:
all forms of cancer combined
Heart disease is the ______ cause of death in the world and the leading cause of death in the US, killing over 375,000 Americans a year.
no. 1
List 6 cardiovascular risk factors:
- cigarette smoking
- abnormal lipids (apo B)
- hypertension
- diabetes
- abdominal obesity
- psychosocial stress
What are 3 cardio protective factors?
- fruit/veggies
- Ex
- moderate alcohol
What factors contribute most to CV risk?
abnormal lipids (Apo A & B ratio) AND smoking
What is the least life-threatening acute coronary syndrome?
unstable angina
non-St elevation MI =
NSTEMI
- fatty material is deposited in vessel wall
ST-elevation MI =
STEMI = full occlusion ; no blood is getting through
What is atherosclerosis?
- one type of ARTERIOsclerosis
- A progressive process affecting large and middle sized arteries
What are the consequences associated with atherosclerosis?
- narrow size (smaller diameter) of artery
- blockage
- stiffness (less reactivity)
- TURBULENT flow
What are the 3 layers of the arterial wall?
- tunica intima
- tunica adventitia
- tunica media
