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A&P II (Spring 2025) > [Exam 1] Lecture 6: Myocardial Blood Flow, Pressure Changes Review, Heart Valves and Phonogram, Arterial Line Waveforms > Flashcards

[Exam 1] Lecture 6: Myocardial Blood Flow, Pressure Changes Review, Heart Valves and Phonogram, Arterial Line Waveforms Flashcards

1
Q

What are the oscillations in blood pressure during the respiratory cycle primarily generated by?

A

The respiratory cycle

Other factors may also contribute to these oscillations.

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2
Q

How does positive pressure ventilation differ from negative pressure inspiration?

A

Positive pressure ventilation uses external pressure to inflate the lungs, unlike normal breathing

Negative pressure inspiration relies on the natural expansion of the thoracic cavity.

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3
Q

What is the main branch coming off the right coronary artery at the posterior base of the heart?

A

Posterior descending artery (PDA)

This configuration is present in approximately 75% of individuals.

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4
Q

What is the term for when the PDA is supplied by a branch of the circumflex artery of the left coronary artery?

A

Left coronary dominance

In this case, the circumflex artery extends further around the back of the heart.

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5
Q

What percentage of individuals exhibit left coronary dominance?

A

Approximately 15%

This means the PDA is supplied by the circumflex artery.

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6
Q

What is the relationship between left coronary dominance and coronary perfusion issues?

A

Left coronary dominance is associated with more serious problems due to greater dependency on a single coronary artery for perfusion

This increases mortality risk during angioplasty and CABG procedures.

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7
Q

What happens to pulmonary artery pressure (PAP) and central venous pressure (CVP) during inspiration?

A

Both PAP and CVP are reduced

This occurs because the chest becomes more negative, pulling blood into the heart.

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8
Q

How does inspiration affect preload and afterload on the right side of the heart?

A

Preload is reduced, but afterload is also reduced

This minimizes the impact on the right side of the heart.

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9
Q

What happens to systemic blood pressure during early inspiration?

A

It decreases

This is due to reduced filling pressures for the left side of the heart.

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10
Q

What is the effect of positive pressure ventilation on cardiac output?

A

Cardiac output initially increases but may decrease over time

This is due to the thorax filling with blood and then becoming difficult to refill.

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11
Q

What does the term ‘filling pressure’ refer to in the cardiovascular system?

A

The total of all pressures in the cardiovascular system, averaging out to 7 mmHg

It is crucial for normal heart filling and cardiac output.

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12
Q

What happens to venous return during positive pressure ventilation?

A

Venous return may be reduced

This is due to the compression of the thoracic cavity.

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13
Q

How does the wall thickness of the left side of the heart compare to the right side?

A

The left side of the heart is thicker

This is due to the higher vascular resistance the left heart must pump against.

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14
Q

What physiological change occurs in the heart wall due to severe aortic stenosis?

A

The heart wall becomes significantly thicker due to muscle hypertrophy

This can occur after prolonged periods of pressure overload.

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15
Q

Fill in the blank: The posterior descending artery (PDA) is a branch of the ______ in right coronary dominance.

A

Right coronary artery

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16
Q

True or False: The circumflex artery can sometimes supply the PDA.

A

True

This indicates left coronary dominance.

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17
Q

What effect does aortic stenosis have on the heart wall?

A

Aortic stenosis leads to muscle hypertrophy in the ventricle, causing the heart wall to thicken.

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18
Q

How does a hypertrophied ventricle affect compliance?

A

A hypertrophied ventricle has reduced compliance, making it harder to fill with blood.

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19
Q

What happens to passive filling pressure curves in heart pathology?

A

Passive filling pressure curves shift, requiring increased pressure to fill the heart with the same volume of blood.

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20
Q

What does a higher slope in passive filling pressure curves indicate?

A

A higher slope indicates reduced compliance of the ventricular walls.

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21
Q

What characterizes a ventricle with high compliance?

A

A high compliance ventricle has thin walls and requires relatively low pressures to fill with blood.

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22
Q

What condition can lead to a thicker heart wall?

A

Aortic stenosis can cause a thicker heart wall, making it harder to fill.

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23
Q

What is a common consequence of dilated cardiomyopathy?

A

Dilated cardiomyopathy leads to a highly compliant ventricle that fills easily.

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24
Q

Fill in the blank: The first heart sound is associated with the _______.

A

[A-V (Atrio-Ventricular) Valves Closing]

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25
Q

How long does the first heart sound last?

A

0.14 seconds.

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26
Q

What is the second heart sound associated with?

A

Closure of the aortic valve.

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27
Q

How long does the second heart sound last?

A

0.11 seconds.

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28
Q

True or False: The fourth heart sound should be present in healthy individuals.

A

False.

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29
Q

What does the third heart sound indicate?

A

The third heart sound can indicate heart failure or low compliance in the ventricle.

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30
Q

What type of murmur is associated with aortic stenosis?

A

Systolic murmur.

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31
Q

What type of murmur is associated with aortic regurgitation?

A

Diastolic murmur.

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32
Q

What type of murmur is associated with mitral stenosis?

A

Diastolic murmur or ‘Filling Murmur’.

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33
Q

What adaptation occurs in the heart due to chronic high blood pressure?

A

Muscle hypertrophy leading to a thicker ventricular wall.

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34
Q

How does pediatric heart compliance differ from adult heart compliance?

A

Pediatric hearts have less compliant ventricles compared to adult hearts.

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35
Q

What compensatory mechanism do pediatric hearts rely on for increased venous return?

A

Increased heart rate.

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36
Q

What characteristic of the ventricular walls affects the ability to accommodate blood volume?

A

Wall compliance.

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37
Q

What happens to the heart sounds when there is dysfunction?

A

Dysfunction can cause audible problems in heart sounds.

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38
Q

What is the relationship between wall thickness and filling pressure?

A

Thicker walls generally require higher filling pressures.

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39
Q

What does low compliance in the ventricle lead to during diastole?

A

Increased turbulence and a potential third heart sound.

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40
Q

What is a diastolic murmur?

A

A sound produced during diastole, likely loudest at the beginning and tapering off towards the end of diastole.

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41
Q

What condition is associated with a diastolic murmur known as a ‘filling murmur’?

A

Mitral stenosis

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42
Q

When is the diastolic murmur from mitral stenosis loudest?

A

At the end of diastole

43
Q

What causes the loudness of the diastolic murmur in mitral stenosis?

A

Increased atrial contraction pressure due to difficulty filling the ventricle.

44
Q

What is mitral regurgitation?

A

A condition characterized by the backward flow of blood during systole.

45
Q

When is the systolic murmur from mitral regurgitation loudest?

A

At the beginning of systole

46
Q

What happens to the loudness of the systolic murmur as systole progresses?

A

It tails off towards the end of systole.

47
Q

Where should you listen to the aortic valve?

A

On the patient’s right side next to the sternum around the 2nd intercostal space.

48
Q

Where is the pulmonic valve auscultation site located?

A

On the left side of the chest in the 2nd intercostal space.

49
Q

What is the best location to listen to the tricuspid valve?

A

The medial left side of the patient in the 5th intercostal space.

50
Q

Where is the mitral valve located for auscultation?

A

In the same intercostal space as the tricuspid valve but further lateral.

51
Q

What mnemonic can help remember the order of heart valve auscultation?

A

‘All Physicians Take Money’ (A, P, T, M)

52
Q

What is ‘physiologic splitting’ of the 2nd heart sound?

A

The delayed closure of the pulmonic valve compared to the aortic valve, especially during deep inspiration.

53
Q

What instrument is used to record heart sounds and murmurs?

A

Phonocardiogram

54
Q

What is the significance of the dichrotic notch in arterial waveforms?

A

It indicates the closure of the aortic valve and is used to assess blood pressure.

55
Q

What happens to the arterial tracing if there is an air bubble in the art line?

A

It causes overdamping, making it difficult to see rapid changes.

56
Q

What are artifacts in arterial waveforms?

A

Extra ridges in the tracing caused by excessive amplification of the signal.

57
Q

What are the divisions of the mediastinum?

A

Superior mediastinum and inferior mediastinum (anterior, middle, posterior).

58
Q

What structures are found in the middle mediastinum?

A
  • Heart
  • Pericardium
  • Ascending aorta
  • Superior vena cava
  • Pulmonary arteries and veins
  • Pericardiacophrenic nerves
59
Q

What is the role of the pericardiacophrenic nerves?

A

They provide sensory perception in the pericardium and innervation to the diaphragm.

60
Q

What structures are located in the posterior mediastinum?

A
  • Esophagus
  • Thoracic aorta
  • Vagus nerves
  • Azygous vein
  • Hemiazygos veins
  • Thoracic duct
61
Q

What is the impact of deep inspiration on the closure of the aortic and pulmonic valves?

A

The pulmonic valve stays open longer due to reduced afterload on the right side of the heart.

62
Q

What happens if the amplifier for an arterial line is not adjusted properly?

A

It can lead to overdamping or underdamping of the arterial tracing.

63
Q

What is the effect of turning down the amplifier in a waveform?

A

Overdamped

64
Q

What are artifacts in the context of an underdamped amplifier?

A

Extra ridges caused by the amplifier being turned up too high

65
Q

What anatomical variation can occur with the circumflex artery?

A

It can be an anastomosis between the right and left coronary arteries

66
Q

What is the debate surrounding the circumflex artery anastomosis?

A

Whether it is physiologic (helpful) or non-physiologic (not significant)

67
Q

What is the significance of anastomosis between coronary arteries?

A

Provides a pathway for flow if something goes wrong

68
Q

What is the term for blood vessels that can be seen on the surface of the heart?

A

Epicardial blood vessels

69
Q

What are the deeper blood vessels in the heart wall referred to as?

A

Endocardial tissues or sub-endocardium

70
Q

During the cardiac cycle, which coronary blood vessels have the lowest surrounding pressure?

A

Epicardial blood vessels

71
Q

Where is ischemia most likely to occur in the heart?

A

Sub-endocardial blood vessels in the left ventricle

72
Q

What are the characteristics of aortic stenosis?

A

High pressure inside the ventricle to pass the bad valve

73
Q

What problem does mitral stenosis cause during the cardiac cycle?

A

Filling problem leading to increased preload and blood volume

74
Q

What type of murmur is associated with aortic stenosis?

A

Systolic murmur

75
Q

What type of murmur is associated with mitral stenosis?

A

Diastolic murmur

76
Q

What happens during diastole in aortic regurgitation?

A

Backward blood flow occurs through the leaky valve

77
Q

What is the consequence of mitral regurgitation during systole?

A

Abnormal volume in the atria due to backflow

78
Q

How does pressure build up affect the atria in mitral regurgitation?

A

It leads to exaggerated atrial pressure and potential arrhythmias

79
Q

How can reducing afterload affect mitral regurgitation?

A

It may reduce backward blood flow through the leaky valve

80
Q

What is the role of the atrial kick in heart pathologies?

A

It helps fill the ventricle, especially in conditions like aortic stenosis

81
Q

What is a potential risk of high atrial pressure over time?

A

Stretching of the atrium and uncoordinated contraction with the ventricle

82
Q

What can happen if heart problems lead to fluid retention?

A

It can stretch the heart and exacerbate existing issues

83
Q

In the context of heart failure, why might diuretics be administered?

A

To reduce excess fluid that could stretch the heart

84
Q

What is the primary goal when treating heart failure?

A

To prevent the heart from harming itself while maintaining adequate volume

85
Q

What is the role of diuretics in heart failure management?

A

To remove excess volume that could stretch the heart

86
Q

True or False: The body can always return to a normal state after heart failure.

A

False

87
Q

What happens to wall compliance in chronic heart failure?

A

It may become terrible over time

88
Q

What can result from pressure backing up in the left atrium?

A

Congestion in pulmonary veins and increased risk for pulmonary edema

89
Q

Define eccentric hypertrophy.

A

A condition where the walls of the left ventricle are thin, often due to dilated cardiomyopathy

90
Q

What is congenital dilated cardiomyopathy?

A

A hereditary condition that often leads to poor outcomes and reduced lifespan

91
Q

What is aortic valve insufficiency?

A

A condition where the left ventricle fills from two sources instead of one

92
Q

What is a myocardial infarction (MI)?

A

A condition where the heart patches itself after damage, potentially leading to thinner walls

93
Q

What is systolic dysfunction?

A

The heart’s reduced ability to generate normal stroke volume and blood pressure

94
Q

Define concentric hypertrophy.

A

A condition where the heart walls become thicker, often due to long-term hypertension

95
Q

What causes diastolic dysfunction?

A

Filling problems due to thickened heart walls

96
Q

What is ischemia?

A

A condition where blood flow to a part of the heart is reduced

97
Q

What role does collateral circulation play in ischemia?

A

It can help deliver nutrients to ischemic areas if nearby blood vessels can dilate

98
Q

What factors can impair blood vessel dilation?

A
  • High cholesterol levels
  • Smoking
  • Alcoholism
  • High blood pressure
  • Diabetes
99
Q

What happens when the surrounding blood vessels cannot dilate during ischemia?

A

Increased risk of a larger area of tissue damage

100
Q

What is scar tissue in the context of heart damage?

A

Fibrous tissue that replaces dead heart muscle

101
Q

What is the problem with excessive scar tissue deposition?

A

It can lead to dilated cardiomyopathy

102
Q

How do ACE inhibitors help in heart damage recovery?

A

They slow the deposition of scar tissue and reduce growth factor activity

103
Q

What can occur if a significant portion of the heart wall is nonfunctional?

A

Systolic stretch leading to lower ejection fraction (EF)

A&P II (Spring 2025) (7 decks)

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