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A&P II (Spring 2025) > [Exam 1] Lecture 4: Medication Effects on CO/VR Curves, Valve Dysfunction > Flashcards

[Exam 1] Lecture 4: Medication Effects on CO/VR Curves, Valve Dysfunction Flashcards

1
Q

What is a mixed vasodilator?

A

A drug that dilates both veins and arteries in the systemic circulation.

An example is sodium nitroprusside, a nitric oxide donor.

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2
Q

What effect does sodium nitroprusside have on systemic filling pressure?

A

It drops the systemic filling pressure and reduces resistance to venous return.

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3
Q

What is the primary action of nitroglycerin?

A

It primarily relaxes the veins more than the arteries, reducing preload.

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4
Q

True or False: Hydralazine is an arterial vasodilator.

A

True.

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5
Q

What is the mechanism of action for hydralazine?

A

The mechanism of action is completely unknown.

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6
Q

What is phenylephrine classified as?

A

A mixed vasoconstrictor that constricts both veins and arteries.

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7
Q

What happens to right atrial pressure during an MI?

A

It elevates due to the heart struggling to pump out blood.

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8
Q

What compensatory mechanisms occur after an MI?

A

Increased venous tone and increased sympathetic activity.

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9
Q

What does increased venous tone do in the context of heart failure?

A

It shifts venous return profiles to higher filling pressures.

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10
Q

What role do catecholamines play after an MI?

A

They increase heart rate and contractility to improve cardiac output.

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11
Q

What happens to sympathetic activity as fluid is retained post-MI?

A

Sympathetic activity typically decreases as blood volume expands.

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12
Q

What is a potential consequence of high sympathetic activity at the heart?

A

It predisposes patients to arrhythmias.

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13
Q

Fill in the blank: High right atrial pressure is typically a sign of _______.

A

[heart failure or fluid retention].

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14
Q

What does the body do to compensate for cardiac failure?

A

Reduces venous compliance and increases systemic vascular resistance (SVR).

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15
Q

What is the significance of maintaining a higher filling pressure in volume-dependent patients?

A

It is crucial for the heart to pump effectively.

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16
Q

Describe the shape of the cardiac output curve in a failing heart.

A

It is abnormal, indicating compromised heart function.

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17
Q

What happens to the circulatory system when a person stands up?

A

The central nervous system tightens blood vessels to prevent passing out.

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18
Q

What is one reason why catecholamines are reduced over time post-MI?

A

Fluid retention allows for a decrease in catecholamine levels.

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19
Q

What is the primary compensation mechanism for cardiac failure related to venous compliance?

A

Reducing Venous Compliance (¯Cv)

This mechanism involves tightening the veins to shift filling pressure towards higher levels.

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20
Q

How does the body compensate for cardiac failure by affecting systemic vascular resistance?

A

Increasing SVR (­ SVR)

This leads to a reduction in the slope of the venous return curve, making it more difficult to return blood to the heart.

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21
Q

What is the effect of increasing blood volume in the context of cardiac failure?

A

Increase Volume (­Vol)

This volume expansion is part of the body’s compensation mechanisms during cardiac failure.

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22
Q

What happens to right atrial pressure (PRA) during cardiac failure?

A

It increases, potentially around 7 mmHg

This is due to high filling pressures and the heart’s struggle to pump out blood.

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23
Q

What is the minimum cardiac output required to maintain life?

A

Approximately five liters per minute

This is essential for adequate oxygen and nutrient delivery to tissues.

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24
Q

What is the definition of preload?

A

Preload is a pressure

It refers to the pressures available to fill the heart with blood, typically measured in mmHg.

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25
What does an elevated preload indicate?
It should help with filling ## Footnote Higher filling pressure generally allows for more blood to be accommodated in the heart.
26
What is afterload?
Afterload is the pressure that the heart must pump against ## Footnote It is essentially the blood pressure outside the aortic valve.
27
What relationship exists between afterload and heart function?
Higher afterload makes it harder for the heart to pump blood out ## Footnote It increases the time required to open the aortic valve.
28
What is contractility?
A change in stroke volume while preload and afterload are held constant ## Footnote It indicates the heart's ability to contract more forcefully.
29
How does increased preload affect stroke volume?
Increased preload leads to increased stroke volume ## Footnote This is due to enhanced filling and improved cross-bridge alignment.
30
What is the effect of decreased preload on the heart?
It results in less filling and reduced stroke volume ## Footnote This leads to lower end diastolic volume.
31
What happens when afterload is increased?
The heart must generate more pressure to overcome the higher pressure in the aorta ## Footnote This prolongs the contraction phase before the aortic valve opens.
32
Fill in the blank: Preload is the pressure at the end of phase ______.
1 ## Footnote This is when the heart is filled with blood before contraction.
33
True or False: Afterload is defined as the peak systolic pressure.
False ## Footnote Afterload is more accurately described as the diastolic blood pressure.
34
What is the normal diastolic blood pressure, which is considered as afterload?
About 80 mmHg ## Footnote This pressure exists right before the aortic valve opens.
35
What does a higher contractility indicate in terms of stroke volume?
Higher contractility correlates with increased stroke volume ## Footnote This means less blood remains in the ventricle after ejection.
36
How does the pressure volume loop change with increased afterload?
It shifts the pressure volume loop to a higher pressure ## Footnote The heart needs to build more internal pressure to open the aortic valve.
37
What happens to the duration of Phase 2 when afterload is higher than normal?
The duration of Phase 2 is probably longer than normal ## Footnote This occurs because the heart has to build up more pressure to open the valve.
38
What is the relationship between time spent in Phase 2 and Phase 3?
If more time is spent in Phase 2, there will be less time available for Phase 3 ## Footnote This affects the ejection phase of the cardiac cycle.
39
How is stroke volume calculated?
Stroke volume = end diastolic volume - end systolic volume
40
What happens to stroke volume when there is reduced time spent in Phase 3?
Stroke volume is probably going to take a hit
41
What is the normal stroke volume mentioned in the content?
Normal stroke volume is 70 CC's
42
What happens to the aortic valve closure time with high pressure in the aorta?
The aortic valve may close earlier than normal
43
If end diastolic volume is normal but stroke volume is lower, what happens to end systolic volume?
End systolic volume is higher than normal
44
What is the relationship between heart rate and stroke volume when stroke volume is reduced?
Higher heart rate is needed to maintain cardiac output
45
True or False: A lower resting heart rate typically indicates better cardiac health.
True
46
What effect does reducing afterload have on the pressure at which the aortic valve closes?
It lowers the pressure at which the aortic valve closes
47
What is expected to happen to stroke volume when afterload is reduced?
Stroke volume is probably going to go up
48
How does increased contractility affect stroke volume?
Increased contractility leads to an increase in stroke volume
49
What happens to end systolic volume when contractility increases?
End systolic volume decreases
50
What typically happens to blood pressure with changes in contractility?
Increased contractility likely increases blood pressure
51
What is a common consequence of a heart with reduced contractility?
Higher end systolic volume compared to normal
52
What does a depressed contractility curve indicate about the heart's ability to pump?
It indicates the heart is struggling to pump out a normal stroke volume
53
What compensatory mechanism occurs if stroke volume is reduced?
The body compensates with an elevated heart rate
54
What happens to preload in a patient with heart problems?
Preload is significantly increased due to fluid retention
55
What is the most common valve problem by age 50 or 60?
Aortic valve stenosis
56
How does aortic stenosis affect ventricular pressures?
Higher ventricular pressures are required to eject blood
57
Fill in the blank: If the valve is obstructed, it is harder to put blood through that _______.
[stenotic valve]
58
What happens to blood ejection time with a high resistance valve?
It reduces the amount of time spent ejecting blood
59
What is the body's response when the heart struggles to put out a normal volume?
The body compensates by retaining fluid
60
What happens to preload when the heart struggles to put out a normal volume on each heartbeat?
Preload is significantly increased ## Footnote The body compensates by retaining fluid, expanding blood volume, and increasing filling pressure.
61
What is a common observation in heart valve problems?
Increase in preload, CVP, or right atrial pressure ## Footnote This is a typical response to various heart valve issues.
62
In aortic valve stenosis, what happens to pressures upstream and downstream of the resistance?
Upstream pressures are high; downstream pressures are low ## Footnote This pressure difference affects the overall hemodynamics of the heart.
63
How does aortic stenosis affect pulse pressure?
Pulse pressure is narrowed ## Footnote Typically, in a normal individual, pulse pressure is around 40, but in aortic stenosis, it may drop to about 20.
64
What compensatory mechanism occurs in response to reduced stroke volume due to mitral stenosis?
Heart rate increases ## Footnote The body compensates to maintain cardiac output despite lower stroke volume.
65
What is the impact of a stenotic mitral valve on end diastolic volume?
End diastolic volume is lower than normal ## Footnote This is due to impaired filling from the left atrium to the left ventricle.
66
What happens to pulmonary blood pressure in severe mitral valve stenosis?
Pulmonary blood pressure increases ## Footnote High pulmonary pressures can lead to pulmonary edema and impaired gas exchange.
67
What characterizes a regurgitant or insufficient aortic valve?
Blood leaks back into the ventricle ## Footnote This occurs when the valve fails to close tightly, allowing retrograde blood flow.
68
How does a leaking aortic valve affect end diastolic volume?
End diastolic volume becomes higher than normal ## Footnote The ventricle fills from both the atrium and the aorta.
69
What happens to the shape of the pressure-volume loop in aortic regurgitation?
The curve becomes more pronounced in phase four ## Footnote This reflects increased backward blood flow into the ventricle.
70
What occurs during phase one of the cardiac cycle in aortic regurgitation?
The ventricle fills from both the atrium and the leaky aortic valve ## Footnote This dual filling increases end diastolic volume.
71
What is a potential consequence of prolonged high end diastolic volume in the ventricle?
Ventricular walls may thin and stretch ## Footnote This can lead to worsened valve function and increased insufficiency.
72
In the context of mitral stenosis, what does increased filling pressure lead to?
Increased pressure in the lungs ## Footnote Excessive filling pressure can cause pulmonary edema.
73
Fill in the blank: Aortic valve stenosis typically results in a narrowed _______.
pulse pressure
74
True or False: In severe mitral valve stenosis, compensatory mechanisms always improve heart function.
False ## Footnote Eventually, compensatory mechanisms can become detrimental.
75
What should happen in a healthy heart during phase four of the cardiac cycle?
Isovolumetric relaxation occurs ## Footnote In this phase, there should be no change in volume as the ventricle relaxes.
76
What happens to end diastolic volumes when the ventricle fills from two places?
End diastolic volumes become really high ## Footnote This occurs especially if there is a bad valve present.
77
How does a leaky aortic valve affect stroke volume?
It requires a larger stroke volume to compensate for backward blood flow ## Footnote This is due to the need to eject more blood on each beat.
78
What is the consequence of chronic high volumes in the ventricle?
The ventricle gets stretched out, leading to further valve problems ## Footnote This affects both the aortic and mitral valves over time.
79
What does the pressure volume loop indicate about net stroke volume?
It does not provide a clear cut number for net forward stroke volume ## Footnote Estimation is required, especially with a leaky aortic valve.
80
What does an increase in ventricular volume during mitral valve closure indicate?
Blood is likely coming from the aorta ## Footnote This occurs when the mitral valve is closed, and the aortic valve is still closed.
81
At what pressure does the aortic valve typically open in the case of regurgitation?
It opens at a lower pressure than normal ## Footnote This is due to backward blood flow affecting aortic pressure.
82
What occurs to pulse pressure in aortic regurgitation?
Pulse pressure is wide due to low diastolic pressure ## Footnote This is a result of blood leaking in the wrong direction.
83
What is the direction of blood flow in mitral regurgitation?
Blood moves from the ventricle back into the atria ## Footnote This occurs whenever ventricular pressure exceeds atrial pressure.
84
During which phase does pressure in the ventricle begin to ramp up?
During Phase two ## Footnote High ventricular pressure should prevent backward blood flow if the mitral valve is functioning properly.
85
What occurs if the aortic valve is closed while the mitral valve is leaking?
Blood moves from the ventricle back into the atria instead of forward ## Footnote This results in backward movement during ventricular contraction.
86
What happens to the pressure gradient during Phase four of mitral regurgitation?
The pressure gradient decreases as the ventricle relaxes ## Footnote This leads to less backward blood leakage.
87
Describe the shape of the pressure volume loop for mitral regurgitation.
It resembles the shape of an 'M' ## Footnote This indicates the characteristic backward flow issues.
88
How is aortic regurgitation represented in a pressure volume loop?
It appears in the shape of an 'A' on its side ## Footnote This indicates the unique pressure and volume changes associated with this condition.
89
What is a key characteristic of the isovolumetric portion in regurgitant valve issues?
It is no longer truly isovolumetric ## Footnote Backward blood movement alters the expected pressure-volume relationship.
90
What should be monitored in patients with bad valves?
The function of other valves and the overall heart condition ## Footnote This is crucial to prevent further complications from valve dysfunction.
91
What happens if the valves do not fit together properly?
It can lead to difficulty in ejecting blood and backward blood movement ## Footnote Valve fragility and plaque buildup can exacerbate these issues.

A&P II (Spring 2025) (9 decks)

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