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A&P 2 > Exam 1 Lecture 3 > Flashcards

Exam 1 Lecture 3 Flashcards

1
Q

What is the example cofactor that Dr. S wanted us to know for ATP production

A

Vitamin B1

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2
Q

Beriberi is a deficiency in what?
How does this impact CO

A

Vitamin B1 Deficiency
Increase CO from increased metabolism

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3
Q

How many ATP can be made from a normal reaction

A

36

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4
Q

How does Hyperthyroid increase CO

A

increase metabolism burns more ATP and burns more O2 causes increase CO

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5
Q

True or false
Pulmonary diseases decrease CO because of a lack of Oxygen delivery to the heart

A

False
Increase CO because decreased Oxygen levels in blood so CO must increase to compensate

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6
Q

How does AV shunts increase CO

A

AV shunts cause pressure problems in heart and the blood flow is different than normal heart so heart has to compensate to provide enough oxygen delivery to the tissues

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7
Q

Does LT Dan from forest Gump have increased or decreased CO

A

Decreased because Heart doesn’t need to provide blood to his non existent extremities

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8
Q

What is the name of the old weight loss drug that we discussed in class?
What is a major side effect of it

A

Dinitrophenol- weight loss drug, burns glucose inefficient, increase our body temp from increase metabolism

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9
Q

What does PRA stand for
What is this the EXACT same as?

A

PRA= pressure at right atria
PRA=RAP

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10
Q

What is the normal Intrathoracic pressure
What about the normal value in the pulmonary system

A

-4mmHg
5cmH2O

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11
Q

How does inspiration impact our intrathoracic pressures

A

Inspiration makes it more negative

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12
Q

True or false
A more positive pleural pressure will draw blood from the peripheral to the inside of the thoracic cavity

A

False
A more negative pleural pressure does this

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13
Q

What machine operates on creating a more negative pleural space

A

Iron lung

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14
Q

A normal lung is under which of the following pressures?
Supratmospheric
Atmospheric
Subatmospheric

A

Normally under Subatmospheric

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15
Q

How does positive pressure ventilation impact thoracic pressure

A

Increases pressure

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16
Q

What is a example of an arterial specific vasodilator

A

Sodium Nitroprusside
(Keep out of light)

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17
Q

How does an arterial Specific vasodilator impact CO

A

Increases CO
Reduces RVR and SVR
Increase blood return back to heart

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18
Q

What happens to CO when we give a Vein specific vasodilator
What is an example of drug

A

When we dilate the veins decreases CVP and decrease systemic filling pressure, decrease venous return back to heart and decreased CO
Drug: Nitric Oxide

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19
Q

What happens to CO when we give a mixed vasodilator

A

Decreased systemic filling pressure from veins dilation
Decreased RVR from arteries dilating so yes easier to get blood back but Psf low

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20
Q

What is happening to the veins if we have decreased compliance

A

Decreased compliance= constriction

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21
Q

How does a really high SVR impact CO

A

High SVR usually will decrease CO

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22
Q

Which is more important for Psf arteries or veins

A

Veins

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23
Q

What does the body do in the acute phase of HF to increase CO

A

Activates Sympathetic

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24
Q

What do we have to be careful doing to our chronic heart failure patients

A

Diuresis

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25
Q

Why does the body want to tone down high Sympathetic activity in HF patients

A

In HF body wants to tone done high sympathetic activity because you need some sympathetic reserve for daily activity like walking stairs

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26
Q

What does the body do to compensate for high Sympathetic activity in HF

A

Body will retain fluid to increase filling pressure to help the heart

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27
Q

What point is no compensation occurring

A

Point B

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28
Q

The heart beats best when it is ______ stretched

A

A little Over stretched

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29
Q

Increased preload does what to
EDV
SV
CVP

A

Increases them all

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30
Q

Does increased preload increase contractility

A

No according to Dr. S
by definition contractility doesn’t take into account preload and afterload

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31
Q

How does decreased preload impact
EDV
SV

A

Decreases them both

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32
Q

How does increased afterload impact
ESV
Aortic Valve timing
SV

A

SV decreased because we spend less time in ejection
Elevated pressure in aorta will shut aortic valve earlier soon and cuts off ejection
Increased ESV- more left over

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33
Q

How does decreased afterload impact
SV
ESV
Aortic valve timing

A

Open aortic valve sooner and longer
Spend more time in ejection
Increase SV
Decreased ESV

34
Q

How does decreased afterload impact
SV
ESV
Aortic valve timing

A

Open aortic valve sooner and longer
Spend more time in ejection
Increase SV
Decreased ESV

35
Q

How does increased contractility impact
SV
ESV

A

Increased SV
Decreased ESV- squeezes harder

36
Q

How does decreased contractility impact
SV
ESV

A

Decreased SV
Increased ESV

37
Q

In mitral valve regurgitation what phases do we have backwards blood movement

A

Phase 2,3,4

38
Q

What will the heart do to compensate with a bad mitral valve regurgitation

A

Increase CVP
Increase EDV

39
Q

How does mitral stenosis impact
Preload
SV
EDV
Psf

A

Decreased Preload
Less filling
Decreased SV
Decreased EDV
Increase in Psf long term

40
Q

In what phase of the cardiac cycle is aortic valve regurgitation very apparent and it can’t be issues with any other valves

A

Blood leaks back in phase 4, mitral valve would be closed here so only place blood can leak from is aortic

41
Q

How does aortic valve stenosis impact
Afterload
LV pressure
Pulse pressure
CVP
HR

A

Increased afterload
Increased LV pressure
Decreased pulse pressure
increased CVP
Increased HR chronic

42
Q

How does an afterload reducer increase SV

A

Increases ejection time
Less resistance

43
Q

How does inspiration effect our Right side of the heart

A

Inspiration makes chest more negative
increases filling-right side
Decreases afterload- right side
Increase in CO-right side

44
Q

What happens to systemic MAP during inspiration

A

Systemic MAP drops early during inspiration because poor filling to left side heart

45
Q

What is interesting about PPV and thoracic pressure

A

Positive pressure ventilation increase thoracic pressure and temporarily pushes blood into the heart and increase right and left heart CO
overtime it will impair venous return and reduce CO long term

46
Q

Is normal breathing positive or negative pressure breathing

A

Negative pressure

47
Q

How does Inspiration impact CVP and PAP in the beginning

A

Decreases CVP and PAP

48
Q

what two variables effect venous return

A

Volume and pressure

49
Q

True or false, increases in SVR will translate to an increase in RVR

A

TRUE

50
Q

For this class thus far what are the 2 numbers we need to remember for intrathroacic pressure?

A

-4 mmHg
5cmH2O

51
Q

Will changes in intrathoracic pressure shift this graph left or right or up and down?

A

left and right, the height should not increase or decrease.

52
Q

True or False, positive pressure ventilation will increase venous return to the heart?

A

False!

53
Q

What are 3 ways to increase venous return?

A

1- increase filling pressure
2- decrease right atrial pressure
3- lower RVR

54
Q

What is the formula for venous return?

A

Venous return= (systemic filling pressure- Right atrial pressure) / RVR

55
Q

What does SNP stand for

A

Sodium nitroprusside apparently….. even though im not convinced this is even a real thing and that he is just making up abbreviations as we go alone

56
Q

What will cause a shift from A –> B

A

For this class a shift from A to B can be accomplished with the administration of a Arterial specific Vasodilator (SNP, even though according to Schmiddy its not REALLY arterial specific) this will increase venous return to the heart as well as decrease after load allowing for an increase in cardiac output.

57
Q

What would cause a shift in this graph from A – > B

A

a venous specific vasodilator such a Nitro would probably be a good answer for this class.

note here that the drop in CVP will also cause a shift in the PSF

58
Q

In the chronic phases of heart failure what is the hearts primary compensatory mechanism?

A

Fluid retention

59
Q

Why would sympathetic stimulation not be an appropriate compensatory mechanism for chronic heart failure

A

if you live in a state of constant sympathetic stimulation you might drop dead just walking up a flight of stairs or something because your heart wouldn’t be able to handle even that little increase in workload.

60
Q

How does Cardiac index compare to cardiac output

A

Cardiac index takes into account the patients body surface area

CI = CO/ Body surface area (m^2)

61
Q

What is the normal cardiac index for a middle aged male?

A

3

62
Q

What is the cardiac index for lets say an 80 year old

A

for this class a good answer would probably be 2.4

63
Q

what is the Cardiac index dependent on? (2 variables)W

A

TPR, and SVR both of these are controlled by the metabolic rate, so it is fair to say that Cardiac index is also controlled by metabolism.

64
Q

Why does Beri Beri have constantly high CO and CI?

A

Because they can’t make enough ATP due to the B1 deficiency, so they increase blood flow to the capillaries to get more o2 and glucose to the cells in an attempt to make more ATP.

65
Q

would hyperthyroidism have increased or decreased cardiac output?

Hypothyroidism?

A

Hyper = increased

Hypo = decreased

66
Q

Explain in crayon what happens with an AV shunt.

A

Blood moves from high to low pressures in the heart and by doing so bypass the normal circulatory pathway and do not get oxygenated. This decrease in the availability of oxygenated blood will cause an increase in CO and CI to try and get more oxygen to the tissues.

67
Q

How does dinitorphenol work

A

“uncouples normal metabolism”

68
Q

How would an increase in preload change the volume pressure loop?

A

it would cause an increase in filling which would cause in increase in EDV and eventually in increase in SV

69
Q

How would a decrease in preload change the volume pressure loop?

A

it would cause a decrease in filling with would cause in decrease in EDV and eventually a decrease in SV

70
Q

How does an increase in afterload change the volume pressure loop?

A

an increase in after load will cause the heart to have to work harder to eject blood this will cause the loop to become taller.

overall this will reduce Stroke volume due to more Time being spent in isovolumetric contraction and relaxation and less time able to be spent in filling and ejection.

71
Q

How does a decrease in after load change the volume pressure loop?

A

a decrease in after load will allow the heart to work less to eject blood. Overall the loop will get shorter.
This will allow less time to be spent in isovolumetric contraction and relaxation and more time filling and ejecting.

72
Q

How does increased contractility change the volume pressure loop

A

The SV will increase and ESV will decrease due to the heart providing a stronger more efficient squeeze.

73
Q

How does decreased contractility change the volume pressure loop

A

The SV will decrease and the ESV will increase due to the heart not pumping efficiently.

74
Q

How does mitral regurgitation change the volume pressure loop

A

I have no good words to describe this other than the shape is. “blown out”

essentially we lose ventricular volume into the atria during ventricular contraction when that contraction is supposed to be isovolumetric.

We are also loosing volume in the beginnings of phase 4 because the ventricular pressure is still higher than the atrial pressure, even though we have started the diastolic phase.

75
Q

What 3 phases do we loose ventricle volume into the atria with Mitra regurgitation?

A

II, III, IV

76
Q

How does the body compensate for mitral regurgitation?

A

we increase our blood volume this will in turn increase the CVP. This will maintain our filling pressures and allow us to keep a CO that is consistent with living.

77
Q

How does mitral stenosis change the volume pressure loop?

How to we compensate?

A

Lower stroke volume and decreased EDV due to stenosis

Compensation: increase systemic filling pressures.

78
Q

How does Aortic Valve insufficiency change the volume pressure loop?

A

Blood leaks back into the ventricles from the Aorta, this is most likely to occur in the last portion of Phase 4 during isovolumetric relaxation when the ventricle pressure is at its lowest.

Per Schmiddy, this is probably still occurring during phases 1 and 2, but we can’t see it on this graph and he really isnt 100% sure even after 13 years….

79
Q

How do we compensate for aortic valve insufficiency?

A

fill the heart with more blood, this will cause ventricular pressure to stay higher and restrict the amount of blood flow that can back flow from the aorta.

Not swell long term hypertrophy of the L Ventricle will occur and you will NOT be most happy.

80
Q

How does Aortic Valve stenosis change the volume pressure loop?

A

Aortic stenosis will cause an increase in after load. The shape of the volume pressure curve, will get taller, and shift up.

81
Q

How do we compensate for Aortic Valve stenosis?

A

Increase filling pressure.
Increase Heart rate (late compensation)

Increase in left ventricular pressure in required in order to eject the required amount of blood to keep living.

82
Q

If you have idiopathic tachycardia, what is the most likely cause?

A

“Its probably a heart problem, usually the aortic valve”

A&P 2 (7 decks)

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