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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
How long does the first heart sound last?
0.14 seconds.
26
What is the second heart sound associated with?
Closure of the aortic valve.
27
How long does the second heart sound last?
0.11 seconds.
28
True or False: The fourth heart sound should be present in healthy individuals.
False.
29
What does the third heart sound indicate?
The third heart sound can indicate heart failure or low compliance in the ventricle.
30
What type of murmur is associated with aortic stenosis?
Systolic murmur.
31
What type of murmur is associated with aortic regurgitation?
Diastolic murmur.
32
What type of murmur is associated with mitral stenosis?
Diastolic murmur or 'Filling Murmur'.
33
What adaptation occurs in the heart due to chronic high blood pressure?
Muscle hypertrophy leading to a thicker ventricular wall.
34
How does pediatric heart compliance differ from adult heart compliance?
Pediatric hearts have less compliant ventricles compared to adult hearts.
35
What compensatory mechanism do pediatric hearts rely on for increased venous return?
Increased heart rate.
36
What characteristic of the ventricular walls affects the ability to accommodate blood volume?
Wall compliance.
37
What happens to the heart sounds when there is dysfunction?
Dysfunction can cause audible problems in heart sounds.
38
What is the relationship between wall thickness and filling pressure?
Thicker walls generally require higher filling pressures.
39
What does low compliance in the ventricle lead to during diastole?
Increased turbulence and a potential third heart sound.
40
What is a diastolic murmur?
A sound produced during diastole, likely loudest at the beginning and tapering off towards the end of diastole.
41
What condition is associated with a diastolic murmur known as a 'filling murmur'?
Mitral stenosis
42
When is the diastolic murmur from mitral stenosis loudest?
At the end of diastole
43
What causes the loudness of the diastolic murmur in mitral stenosis?
Increased atrial contraction pressure due to difficulty filling the ventricle.
44
What is mitral regurgitation?
A condition characterized by the backward flow of blood during systole.
45
When is the systolic murmur from mitral regurgitation loudest?
At the beginning of systole
46
What happens to the loudness of the systolic murmur as systole progresses?
It tails off towards the end of systole.
47
Where should you listen to the aortic valve?
On the patient's right side next to the sternum around the 2nd intercostal space.
48
Where is the pulmonic valve auscultation site located?
On the left side of the chest in the 2nd intercostal space.
49
What is the best location to listen to the tricuspid valve?
The medial left side of the patient in the 5th intercostal space.
50
Where is the mitral valve located for auscultation?
In the same intercostal space as the tricuspid valve but further lateral.
51
What mnemonic can help remember the order of heart valve auscultation?
'All Physicians Take Money' (A, P, T, M)
52
What is 'physiologic splitting' of the 2nd heart sound?
The delayed closure of the pulmonic valve compared to the aortic valve, especially during deep inspiration.
53
What instrument is used to record heart sounds and murmurs?
Phonocardiogram
54
What is the significance of the dichrotic notch in arterial waveforms?
It indicates the closure of the aortic valve and is used to assess blood pressure.
55
What happens to the arterial tracing if there is an air bubble in the art line?
It causes overdamping, making it difficult to see rapid changes.
56
What are artifacts in arterial waveforms?
Extra ridges in the tracing caused by excessive amplification of the signal.
57
What are the divisions of the mediastinum?
Superior mediastinum and inferior mediastinum (anterior, middle, posterior).
58
What structures are found in the middle mediastinum?
* Heart * Pericardium * Ascending aorta * Superior vena cava * Pulmonary arteries and veins * Pericardiacophrenic nerves
59
What is the role of the pericardiacophrenic nerves?
They provide sensory perception in the pericardium and innervation to the diaphragm.
60
What structures are located in the posterior mediastinum?
* Esophagus * Thoracic aorta * Vagus nerves * Azygous vein * Hemiazygos veins * Thoracic duct
61
What is the impact of deep inspiration on the closure of the aortic and pulmonic valves?
The pulmonic valve stays open longer due to reduced afterload on the right side of the heart.
62
What happens if the amplifier for an arterial line is not adjusted properly?
It can lead to overdamping or underdamping of the arterial tracing.
63
What is the effect of turning down the amplifier in a waveform?
Overdamped
64
What are artifacts in the context of an underdamped amplifier?
Extra ridges caused by the amplifier being turned up too high
65
What anatomical variation can occur with the circumflex artery?
It can be an anastomosis between the right and left coronary arteries
66
What is the debate surrounding the circumflex artery anastomosis?
Whether it is physiologic (helpful) or non-physiologic (not significant)
67
What is the significance of anastomosis between coronary arteries?
Provides a pathway for flow if something goes wrong
68
What is the term for blood vessels that can be seen on the surface of the heart?
Epicardial blood vessels
69
What are the deeper blood vessels in the heart wall referred to as?
Endocardial tissues or sub-endocardium
70
During the cardiac cycle, which coronary blood vessels have the lowest surrounding pressure?
Epicardial blood vessels
71
Where is ischemia most likely to occur in the heart?
Sub-endocardial blood vessels in the left ventricle
72
What are the characteristics of aortic stenosis?
High pressure inside the ventricle to pass the bad valve
73
What problem does mitral stenosis cause during the cardiac cycle?
Filling problem leading to increased preload and blood volume
74
What type of murmur is associated with aortic stenosis?
Systolic murmur
75
What type of murmur is associated with mitral stenosis?
Diastolic murmur
76
What happens during diastole in aortic regurgitation?
Backward blood flow occurs through the leaky valve
77
What is the consequence of mitral regurgitation during systole?
Abnormal volume in the atria due to backflow
78
How does pressure build up affect the atria in mitral regurgitation?
It leads to exaggerated atrial pressure and potential arrhythmias
79
How can reducing afterload affect mitral regurgitation?
It may reduce backward blood flow through the leaky valve
80
What is the role of the atrial kick in heart pathologies?
It helps fill the ventricle, especially in conditions like aortic stenosis
81
What is a potential risk of high atrial pressure over time?
Stretching of the atrium and uncoordinated contraction with the ventricle
82
What can happen if heart problems lead to fluid retention?
It can stretch the heart and exacerbate existing issues
83
In the context of heart failure, why might diuretics be administered?
To reduce excess fluid that could stretch the heart
84
What is the primary goal when treating heart failure?
To prevent the heart from harming itself while maintaining adequate volume
85
What is the role of diuretics in heart failure management?
To remove excess volume that could stretch the heart
86
True or False: The body can always return to a normal state after heart failure.
False
87
What happens to wall compliance in chronic heart failure?
It may become terrible over time
88
What can result from pressure backing up in the left atrium?
Congestion in pulmonary veins and increased risk for pulmonary edema
89
Define eccentric hypertrophy.
A condition where the walls of the left ventricle are thin, often due to dilated cardiomyopathy
90
What is congenital dilated cardiomyopathy?
A hereditary condition that often leads to poor outcomes and reduced lifespan
91
What is aortic valve insufficiency?
A condition where the left ventricle fills from two sources instead of one
92
What is a myocardial infarction (MI)?
A condition where the heart patches itself after damage, potentially leading to thinner walls
93
What is systolic dysfunction?
The heart's reduced ability to generate normal stroke volume and blood pressure
94
Define concentric hypertrophy.
A condition where the heart walls become thicker, often due to long-term hypertension
95
What causes diastolic dysfunction?
Filling problems due to thickened heart walls
96
What is ischemia?
A condition where blood flow to a part of the heart is reduced
97
What role does collateral circulation play in ischemia?
It can help deliver nutrients to ischemic areas if nearby blood vessels can dilate
98
What factors can impair blood vessel dilation?
* High cholesterol levels * Smoking * Alcoholism * High blood pressure * Diabetes
99
What happens when the surrounding blood vessels cannot dilate during ischemia?
Increased risk of a larger area of tissue damage
100
What is scar tissue in the context of heart damage?
Fibrous tissue that replaces dead heart muscle
101
What is the problem with excessive scar tissue deposition?
It can lead to dilated cardiomyopathy
102
How do ACE inhibitors help in heart damage recovery?
They slow the deposition of scar tissue and reduce growth factor activity
103
What can occur if a significant portion of the heart wall is nonfunctional?
Systolic stretch leading to lower ejection fraction (EF)

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

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