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Advanced A&P II > Exam 1 - Ventricular compliance, Waveforms, Heart sounds > Flashcards

Exam 1 - Ventricular compliance, Waveforms, Heart sounds Flashcards

1
Q

What is left and right coronary dominance?

A

Right coronary dominance: PDA is branched from RCA (most people)
Left coronary dominance: PDA is branched from circumflex artery

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2
Q

Why can left coronary dominance be a bad thing?

A

More cardiac tissue is being supplied by the LCA and will increase mortality if damaged

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3
Q

What initial effects would PPV have on the heart?

A

After exhalation, the chest is full of blood. When positive pressure is started, it increases pressure in the chest which increases preload on the left side of the heart - increasing CO.
On the right side of the heart both afterload and preload are increased, so the effects may be negligable.

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4
Q

What effects are seen after the inital phase of PPV?

A

After the positive pressure has increased preload and pushed blood into the heart, the positive pressure is always pushing on the heart and vessels preventing adequate venous return into the RV ,and from the RV to the LA, leading to a reduced CO

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5
Q

Describe PPV effects on venous return?
Treatments?

A

PPV opposes Psf, preventing filling of the heart.
In order to overcome the increased intrathoracic pressure we need to increase Psf by increasing venous volume or tone.

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6
Q

How does compliance related to LV wall thickness?

A

A thick or hypertrophied LV is more stiff and unable to passively fill well = decreased compliance
A thin or dilated LV is less stiff and more stretchy, and passively fills easier = increased compliance

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7
Q

What is occuring in the top line of this curve regarding the LV?

A

The slope has increased = decreased LV compliace
The graph is showing that pressure required to fill the LV has increased in order to fill it with adequate volume. This is due a hypertorphied LV.

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8
Q

What conditions would cause LV hypertrophy?

A

Aortic stenosis and chronic HTN

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9
Q

What conditions would cause LV dilation?

A

Aortic and mitral regurgitation

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10
Q

Explain what is occuring in phase 1 of this diagram/
What causes it?

A
  • The slope of phase 1 is steeper = decreased ventricular compliance
  • Increased pressure is required to fill the stiff, non-compliant ventricle
  • Caused by aortic stenosis
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11
Q

How are children’s heart compliance different than adults?
How do they compensate for this?

A
  • They have decreased compliance - they don’t have the Frank-Starling forces available yet
  • Because the heart wall can’t accommodate volume well, they have to increase their heart rate to adapt to an increased volume
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12
Q

Describe the longest heart sound?
When does it occur?

A
  • 1st heart sound
  • Lasts 0.14 secs
  • Low pitch
  • Occurs during systole from AV valves closing
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13
Q

Describe the 2nd heart sound?

A
  • Occurs during diastole from aortic valve closing
  • Higher pitch than 1st heart sound
  • Lasts 0.11 sec
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14
Q

What causes the 4th heart sound?
When would you hear it?
What disease is this heard in?

A
  • Atrial contraction in an unhealthy heart - caused by overly full atria, requiring a greater contraction to eject the blood
  • Would be heard in late diastole
  • Mitral stenosis
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15
Q

What causes the 3rd heart sound?
When would you hear it?

A
  • Turbulence during mid-diastole from an incompliant ventricle
  • Stiff ventricles and kids
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16
Q

What murmur is heard with aortic stenosis?

A
  • Loud systolic murmur caused by turbulence through stiff aortic valve
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17
Q

What murmur is heard with aortic regurgitation?

A
  • Diastolic murmur from retrograde flow from aorta to ventricle
  • Loudest at beginning of diastole when ventricles are empty and then gets softer
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18
Q

What murmur is heard with mitral stenosis?

A
  • Late diastolic murmur heard when atria are contracting blood through stenotic valve (loudest at the end of diastole)
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19
Q

What murmur is heard with mitral regurgitation?

A
  • Systolic murmur caused by blood moving backwards into atria, loudest at beginning of systole when atria are most empty
20
Q

Where can the aortic valve be auscultated?

A

Right sternum, 2nd intercoastal space, up into right side of neck

21
Q

Where can the pulmonic valve be auscultated?

A

2nd ICS, left sternal border

22
Q

Where can the tricuspid valve be auscultated?

A

5th ICS, Left sternal border

23
Q

Where can the mitral valve be auscultated?

A

5th ICS, midclavicular line

24
Q

Where can you hear a split heart sound?
Why?

A
  • 2nd heart sound, heard on deep inspiration
  • Due to pulmonic valve closing after aortic valve from decreased RV afterload
25
Q

What device can be used to hear heart sounds below our level of hearing?

A

Phonocardiogram

26
Q

Label each of the numbers below:

A
  1. Superior mediastinum
  2. Sternum
  3. Anterior mediastinum
  4. Middle mediastinum
  5. Inferior mediastinum
  6. Posterior mediastinum
27
Q

What compromises the inferior mediastinum?

A
  • Anterior, Middle, and Posterior mediastinum
28
Q

What anatomy is included in the middle mediastinum?

A
  • Heart
  • Pericardium
  • Ascending aorta
  • Superior vena cava
  • Pulmonary trunk
  • Pulmonary veins
  • Pericardiacophrenic arteries, veins, and nerves
29
Q

What is the function of the pericardiophrenic nerves?

A
  • Sensory perception in pericardium
  • Innervates part of the diaphragm
30
Q

What is included in the posterior mediastinum?

A
  • Esophagus
  • Thoracic aorta
  • Vagus nerves (can be in middle mediastinum also)
  • Azygos vein
  • Hemiazygos vein
  • Thoracic ducts
31
Q

What is an ideal waveform for an ART line?
Why?

A
  • Clear dicrotic notch
  • Computer uses the dicrotic notch to calculate pressures and vital signs
32
Q

What is the ART wavefrom called?
What could cause it?

A
  • Overdamped
  • Air bubble, blood clots, gain too low
33
Q

What is the ART line wavefrom called?
What can cause it?

A
  • Underdamped
  • Gain is too high, showing artifacts
34
Q

What is happening in the left tracing below?

A

Aortic stenosis
LV pressure has to be very high to overcome the high afterload
This results in a loud systolic murmur as blood is spraying through the stiff aortic valve

35
Q

What is happening in the right tracing below?

A

Mitral stenosis
Left atrial pressure is increased from a high preload due to decreased ventricular filling
There is a diastolic murmur loudest at the end of diastole when atrial contraction pushes blood through the stiff valve

36
Q

What is occuring in the left tracing?

A

Aortic regurgitation
Diastolic aortic pressure is much lower from loss of volume during diastole
Creates a diastolic murmur loudest at the beginning of diastole when aortic blood rushes back into an empty ventricle

37
Q

What is the valve dysfunction in the right tracing?
Explain the atrial pressure tracing?

A

Mitral regurgitation
The atrial pressure increases throughout systole much more than normal because of filling from pulmonary veins + extra blood entering the atrira from the ventricle
This is an enlarged v-wave

38
Q

What is a treatment that can decreased mitral regurgitation?

A

Decreasing afterload
A decreased afterload reduces ventricular pressure during systole which decreases the amount of retrograde blood into the atria

39
Q

Why is atrial kick so important with valvular diseases?

A

In most of the valve diseases, ventricular filling is altered and atria are over-filled. Therefore, the atrial contraction is responsible for a greater amount of ventricular volume.

40
Q

What adverse effects can occur from chronic increased atrial pressure?

A

Atria can stretch overtime causing dyscoordination between atria and ventricle and lead to arrythmias

41
Q

List the causes of dilated cardiomyopathy?
What is another name for this?
Is this systolic or diastolic dysfunction?

A
  • Genetics (poor outcomes)
  • Aortic/mitral regurgitation
  • MI
  • Eccentric LVH
  • Systolic, not enough muscle to produce a normal SV or BP
42
Q

List the causes of left ventricular hypertrophy?
What is another name for this?
Is this systolic or diastolic dysfunction?

A
  • Aortic valve stenosis
  • Chronic HTN
  • Concentric LVH
  • Diastolic, increased heart muscle decreases space available for filling
43
Q

What makes myocardial ischemia worsen in a lot of people?

A

The arteries that would normally provide collateral flow are unable to dilate well due to comorbidites including: diabetes, high cholesterol, smoking, alcoholism

44
Q

How does the heart repair cardiac tissue damage short term?
What is the problem with this?
How can this be treated?

A
  • Fibroblasts lay scar tissue down over the injured muscle cells
  • They usually go beyond just the injuried area and lay down scar tissue over potentially salvagable cells
  • ACEi slow growth factors to prevent over activity of fibroblasts
45
Q

What sort of wall movement occurs due to an MI?
What does this cause?

A
  • Paradoxical wall movement - ventricle bulges out during systole due to non-functional heart muscle
  • Results in a reduced EF

Advanced A&P II (4 decks)

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