Exam 2 Flashcards
1
Q
_____, this valve disease will decrease left ventricular volume
A
Mitral Stenosis
2
Q
____, this valve disease, causes ventricular enlargement.
A
Aortic Stenosis
3
Q
More plasma potassium leads to more potassium going into the cell, leading to (depolarization or hyperpolarization), less excitable cells and bradycardia
A
hyperpolarization
4
Q
3rd Heart Sound most likely occur …
A
during the rapid filling phase
5
Q
4th heart sound most likely occur…
A
during atrial contraction
6
Q
2nd heart sound most likely occur…
A
by the closure of aortic and pulmonic valves
7
Q
1st heart sound most likely occur…
A
by the closure of the mitral and tricuspid valve
8
Q
____ causes systolic murmur.
A
Mitral regurgitation
9
Q
____ causes diastolic function disorder
A
Mitral stenosis, Aortic Regurgitation, Restrictive Cardiomyopathy
10
Q
Afterload is related to ______ (BP=COxTPR)
A
arterial pressure
11
Q
Preload is related to …
A
volume and venous return
12
Q
Increase afterload occurs with (increase, decrease) arteriolar resistance, and increased preload occurs with (less, more) venous compliance
A
increase; less
13
Q
Tension is greatest in ….
A
big vessels with large diameters (aorta)
14
Q
Tension is smallest in…
A
small vessels with low pressure (capillaries)
15
Q
Vasculitis disease includes…
A
Raynaud
Buerger
Wegner
16
Q
Coronary blood flow is controlled mainly by autoregulation, and coronary blood flow is (highest, lowest) at a high heart rate.
A
lowest
17
Q
Coronary autoregulation is primarily through ____ activation and ___ generation
A
eNOS; NO
18
Q
Patient with 75% occlusion: What do we expect?
A
Symptoms with exercise
19
Q
Patient with 95% occlusion: What do we expect?
A
Symptoms at rest and with exercise
20
Q
Cardiac demand for O2 is increased by …
A
high systolic pressure
increased ventricular volume
increased heart rate of stroke volume
21
Q
Infarction is…
A
necrosis resulting from irreversible cellular hypoxia.
22
Q
(1/3 or 2/3) of total CV volume is intracellular volume.
A
2/3
23
Q
1/3 of total CV volume is extracellular volume and of that, ___% is plasma volume and ___% is interstitial volume
A
20;80
24
Q
Fluid Flux: Starlings Law – flux occurs (up/down) pressure gradient
A
down (high to low)
25
Fluid Flux: Normal flux is out on the end of (arterial or venous)
arterial
26
When baroreceptors detect low pressure ....
SV increases, TPR increases, Vasoconstriction increases, and CO increases
27
The baroreflex is great for controlling blood pressure for (long-term or short term)
short term
28
____ + ___ are great for controlling blood pressure long term
AVP;RAAS
29
AVP: High levels of ___ in the body activate aquaporins to increase volume
sodium
30
____ increases sodium retention in the kidney to pull water back in and increase volume
RAAS
31
Match type of Shock
Hemorrhaging due to major car accident
```
Cardiogenic
Hypovolemic
Neurogenic
Septic
Anaphylactic
```
Hypovolemic
32
Match type of Shock
Allergic reaction to lisinopril
```
Cardiogenic
Hypovolemic
Neurogenic
Septic
Anaphylactic
```
anaphylactic
33
Match type of Shock
Bacterial endotoxin
```
Cardiogenic
Hypovolemic
Neurogenic
Septic
Anaphylactic
```
Septic
34
Match type of Shock
Anesthesia
```
Cardiogenic
Hypovolemic
Neurogenic
Septic
Anaphylactic
```
Neurogenic
35
Match type of Shock
Myocardial Infarction
```
Cardiogenic
Hypovolemic
Neurogenic
Septic
Anaphylactic
```
Cardiogenic
36
Normal CK level for a man?
38-200 IU/L
37
Normal CK level for a woman?
26-150 IU/L
38
Troponin is the cardiac specific troponin biomarker with a normal value of ...
< 1.5 ng/mL
39
Troponin, Creatinine Kinase, and lactate dehydrogenase are all cardiac markers and markers of ____ damage
muscle
40
Normal ratio of LDH1:LDH2 is (greater or less) than 1
less
41
Increase radius + Decrease resistance= ___ flow
increase/more
42
Arterioles: Decrease radius + increase resistance would decrease flow which means there are more pressure in the upstream (artery) or downstream (capillaries)
Less Flow= Less pressure downstream but more pressure upstream
43
___ valve disease, pressure overload in L. Atrium
Mitral Stenosis
44
____ valve disease, Pressure overload in L. Ventricle
Aortic Stenosis
45
____ valve disease, loud S1, Diastolic sound
Mitral Stenosis
46
____ valve disease, Late (S4) systolic sound
Aortic Stenosis
47
____ valve disease, long S1 sound, Systolic (all)
Mitral Regurgitation
48
_____ valve disease, Volume overload of Atrium, enlargement of atrium and ventricle (S3)
Mitral regurgitation
49
____ valve disease, volume overload of ventricle
Aortic regurgitation
50
_____ valve disease, early diastolic murmur, floppy valve leaflets
Aortic regurgitation
51
Low resistance would (increase or decrease) flow
increase
52
low pressure would (increase or decrease) flow
decrease
53
Increased resistance would increase pressure and flow (upstream or downstream)
upstream
54
Decreased resistance would increase pressure (upstream or downstream)
downstream
55
Sympathetic would (increase or decrease) compliance which results in more pressure (stiffen walls)
decrease
56
Less compliance would result in (more or less) volume and result in increased venous return
less
57
Increase in Sympathetic Tone will (decrease or increase) cardiac output
increase
58
T or F: Parasympathetic NS has little effect on venous tone
T
59
T or F:
Parasympathetic only affects arteriolar resistance in small subset of arterioles and this would not directly alter Cardiac output
T
60
Mitral Stenosis increases left atrial pressure work and would (decrease or increase) L. Ventricle Stroke volume
decrease
61
Aortic Stenosis increases ____ pressure
left ventricle
62
___ heart sound is during atrial contraction, occur with LV enlargement secondary to aortic stenosis
4th
63
___ heart sound is during rapid filling phase
3rd
64
Mitral stenosis causes (ventricular or atrial) enlargement
atrial
65
In a third degree AV block the origin of ventricular wave of depolarization is in:
- SA
- AV
- Purkinje Fibers
- Cardiomyocytes
Purkinje Fibers
66
In Ventricular tachycardia, the origin of the ventricular wave of depolarization is:
- SA
- AV
- Purkinje Fibers
- Cardiomyocytes
Ventricular tachycardia- origin is in ventricle and QRS is different (wide and fast)
Answer: Cardiomyocytes
67
Which causes a disorder of diastolic function?
- Aortic stenosis
- Mitral regurgitation
- Dilated cardiomyopathy
- Restrictive cardiomyopathy
Restrictive Cardiomyopathy
| affects the heart's ability to relax and fill
68
(Restrictive or Dilated) myopathy mainly affect contractility and pumping ability
dilated
69
Administration of α1 agonist drug would (increase or decrease) blood pressure, followed by a reflex (increase or decrease) in heart rate
increase; decrease
70
Increase parasympathetic nerve activity to the heart would (increase or decrease) blood flow to kidney
decrease,
increase PNS to heart will decrease heart rate, decreasing cardiac output and decrease flow to kidney
71
Increased sympathetic nerve activity to the (kidney or heart) would increase blood flow to the kidney
heart,
Increase SNS to heart will increase HR, increasing Cardiac output and aortic blood pressure resulting in increased driving pressure to kidney
Increase SNS to kidney would cause renal vasoconstriction= reduce flow to kidney
72
T or F:
| Increase parasympathetic nerve activity to the kidney would increase blood flow to the kidney
False;
| No direct effect of PNS on kidney
73
Adenosine is a (dilator or constrictor)
dilator
74
____, ____, ____ act as vasodilators or constrictors that would be affected by endothelial damage.
Adenosine, Bradykinin,
| Acetylcholine
75
____ acts as vasodilators or constrictors that acts directly on the vascular smooth muscle
Ang II, AVP, ANP, Prostaglandins
76
Order of progression of atherosclerosis:
Lipid deposition to complicated injury
Monocytes invade intimal layer (through endothelial barrier) then smooth muscle cells migrate into intimal layer and in complicated lesion (not early stage) hemorrhages/ infection occurs
77
Atherosclerosis of coronary arteries would increase your risk of myocardial ischemia because it would reduce ___ supply
O2
| `
78
Hypertension would increase your risk of myocardial ischemia by (increasing or decreasing) work of heart
increasing,
| increase work of heart increase workload (O2 demand)
79
Aortic valve insufficiency increases your risk of myocardial ischemia by ...
increasing work of heart (workload increase Oxygen demand)
80
Would lymphatic disease increase your risk of myocardial ischemia?
No, lymphatic disease would cause peripheral edema, would not affect the work of heart
81
Patient with coronary arterial atherosclerosis with 80% occlusion, what would most likely occur?
- Elevated serum troponin I
- Elevated ST segments with exercise
- Angina at rest
- A fourth heart sound
Elevated ST segments with exercise
With exercise, insufficient flow to match higher oxygen demand will result in ischemia and altered ST segment
82
Elevated serum Troponin 1 occur after > ___% occlusion (after cardiac necrosis)
90
83
Angina at rest occur (only common) with > __% occlusion
90
84
Lymphatic flow is decreased with (increase or decrease) venous pressure
increase,
increase venous pressure reduces the gradient of flow from interstitium back to the veins
85
Thromboxane production causes...
platelet to aggregate and cause thrombi to form
86
Diseases associated with thrombi includes...
Atherosclerosis, Aneurysms, Injection/Inflammation, Cardiac valve disease with calcification or infection (endocarditis)
87
Deep red to blue-purple skin most likely associated with ...
- Arterial thrombosis
- Venous thrombosis
- aneurysm
- endocarditis
venous thrombosis
88
Pale skin is associated with (venous or arterial ) thrombosis
arterial
89
Complications of thrombosis includes ____ with edema (venous thrombosis) due to higher pressure the swelling press on nerve and cause nerve pain
neuralgia
90
Vasculitis disease, ____, cause vasospasm in hand (red, white, blue)
Raynaud's disease
91
Vasculitis disease, _____, occurs in the kidneys and lungs
Wegner's
92
Vasculitis disease, _____, affect blood vessels in the brain (temporal arteritis)
giant cell arteritis
93
Vasculitis disease, ____, induce inflammation from smoking, history of smoking alter vascular response cause inflammation of blood vessels long term
Buerger's
94
Vasculitis disease, _____, induce inflammation from cold/stress, induced vasospasm induced by cold exposure or stress
Raynaud's phenomenon
95
Increase in ____ reflects inflammation made by smooth muscle cells, endothelial cells, macrophages, lymphocytes, hepatocytes + adipocytes)
C-reactive protein (CRP)
96
Complication of atherosclerosis includes the increase in blood pressure due to (more or less) venous compliance which leads to stiffer vessels and further results in increased pulse pressure (systolic>diastolic)
less
97
Problem with peripheral artery atherosclerosis: severe condition includes arteriosclerosis obliterans which is...
cannot feel pulse below site
98
_____ affects perfusion and responsiveness.
Vasculitis
99
To increase flow- increase pressure in artery and/or increase (resistance or radius) of arteriole
radius
100
Ventricles contraction begins to occur when Mitral valves (open or close).
close
| stop filling to contract
101
Isovolumetric (contraction or relaxation) is when aortic valve is closed then we close mitral valve and volume of blood in chamber is held constant
contraction
102
___ heart sound is in early diastole; can be in normal, large heart
S3
103
(stenosis or insufficiency) valve does not completely close which results in backflow
insufficiency
104
____ pathway is the SA to AV and to reach from SA to left atrium is the bachmann bundle.
internodal
105
Internodal pathway is the SA to AV and to reach from SA to left atrium is the ____bundle.
bachmann
106
Sympathetic nerves via ___ activation of HCN increase SA and AV activity
beta-1
107
Parasympathetic (Vagus) nerves via ____ inhibition of HCN decreases SA and AV activity
M2
108
R-R intervals and P-R intervals are shortened by (SNS or PNS)
SNS
shorter --> decrease
109
P-R interval reflects _____
AV node delay
110
R-R interval reflects ___
heart rate
111
QRS complex reflects the (atrial or ventricular) depolarization
ventricular
112
Automaticity of other cells are over-ridden by rate set by ____ because it is faster.
SA
113
____ degree nodal block results in more excitation of atria (P wave) than ventricle (QRS)
second
114
____ degree nodal block results in longer AV delay, increase P-R interval
First
115
____ degree nodal block results in irregular P-QRS interval due to dissociation of atrial and ventricular depolarization (no impulse gets thru AV node)
Third
116
Ventricular ectopic focus would produce ___ shaped QRS, with regular p waves
abnormal
117
T or F: ischemia can cause reentry and ectopic foci.
T
118
Increase plasma (outside) potassium will result in (more or less) negative resting membrane potential
less
119
Torsades des pointes have long ___ intervals
QT
slow time to repolarize
120
Early triggered beats _____ produces tachycardia which excites cells earlier than we should
afterdepolarization
| are early action potentials
121
Tachycardia occurs if there is (decrease or increase) plasma K+ which results in a more negative RMP, Na If channels available to open, more excitable, and repolarization period is faster.
decrease
122
Tachycardia is (more or less) negative RMP
more
123
Contractility increases force of contraction which leads to (more or less) cardiac output
more
124
Beta- adrenergic stimulation increases ____ release to cause stronger contraction
Ca++ (calcium)
125
_____ cardiomyopathy is thickening of ventricular walls, abnormal diastolic relaxation.
Hypertropic
126
In hypertropic cardiomyopathy, Contractility normal (or increase) -- (increase or decrease) relaxation-- increase diastolic filling pressure-- more muscle mass (more oxygen demand)
decrease
127
_____ cardiomyopathy is ventricular dilation, Impaired systolic function, impair contractility -- reduced stroke volume
Dilated
128
_____ cardiomyopathy is the rigidity of ventricular wall, impaired diastolic relaxation
Restrictive (constrictive)
129
In restrictive cardiomyopathy, decrease relaxation results in increase diastolic filling pressure and (increase or decrease) venous pressure
increase
130
Which cardiomyopathy affects systolic pumping ability?
- Constrictive
- Hypertrophic
- Dilated
Dilated
131
____= resistance, regulated by SNS, hormones, and local facors acting on vascular smooth muscle and regulate intracellular calcium
Tone
132
Constrictors increase calcium release from SR and they include...
```
Norepinephrine via alpha 1
Angiotensin
Vasopressin
Prostaglandin PGF2alpha
oxygen
```
133
Dilators increase calcium storage in SR and/or increase K+ efflux and includes...
```
Adenosine
Bradykinin
Lactic Acid
CO2
NO (nitric oxide)
Prostacyclin
Epinephrine (low dose) via beta 2
ACh
```
134
Need ___ release to activate eNOS to produce NO from L-arginine, release of NO goes through soluble guanylate cyclase which activates sGMP and results in vasodilation and increases flow.
Calcium
135
Baroreceptors (____ sensors) are stretch receptors in the aortic arch (after heart) and carotid arteries (going toward brain).
pressure
136
Increased blood pressure will stretch vessel wall and (increase or decrease) baroreceptors firing rate.
increase
137
Efferent neural mechanisms for sympathetic nervous system are...
```
HR
Contractility
Arteriolar Resistance
Venous Compliance
Renin secretion
```
138
Baroreceptors are good for (long or short) term adaptation
short
139
In the long term the baroreflex adapts to shift slope ; (decreasing or increasing) slope of blood pressure called desensitized reflex: it requires a higher blood pressure for SNS to fire.
decreasing
140
Efferent hormonal mechanisms play backup and are important for long term control, they include...
RAAS (Renin-Angiotensin-Aldosterone system)
AVP (Vasopressin)
ANP (atrial natriuretic peptide)
141
____ results in vasoconstriction by being released once receptors sense high sodium concentration or dehydration. Released from pituitary gland and low conc. of it acts on kidney which increases water channels (aquaporin) AQP which increases and help us retain or conserve water. High conc. of it will lead to constriction.
AVP;
Low conc. --> Increase AQP channels (conserve water)
High conc. --> vasoconstriction
142
```
RAAS: Angiotensinogen is converted to Angiotensin 1 (inactive) by renin which is then converted into angiotensin II by ACE1. Renin is produced by kidney.
Angiotensin II (active) will do these three things...
```
stimulate THIRST
VASOCONSTRICTION
Stimulate Adrenal to release Aldosterone (sodium retention)
143
Renin is secreted if Pressure and sodium is (high or low) and SNS is stimulated via beta 1.
low
144
ANP is released when filling pressure of heart (decrease or increase).
increase
145
Increase flow release (dilators or constrictors)
constrictors; to increase resistance (Q=P/R)
146
Normal control of coronary blood flow is by ____ -- vessels dilate to meet increased oxygen demands
autoregulation
147
Coronary autoregulation is primarily through adenosine-induced eNOS activation and ___ generation--> cause soluble GMP mechanism (dilation)
NO
148
Demand for Oxygen is increased by...
Increase ventricular volume
high systolic pressure
increase wall thickness (hypertrophy)
increased heart rate or stroke volume
149
Supply for Oxygen is limited by...
increase coronary resistance
reduced flow
reduced oxygen availability
150
Microcirculation...
arterioles get smaller in size as they branch further into tissue... at point of capillary, a precapillary sphincter controls whether the capillary is open or not
151
Fluid flux occurs between ...
capillary lumen and interstitium
proportional to net filtration pressure= Hydrostatic pressure (water) - Oncotic pressure (protein)
152
In fluid flux, ____ do not move across capillary (from interstitial to lumen, or from lumen to interstitial)
protein (oncotic pressure)
153
(higher or lower) protein concentration in the plasma
higher
154
Hydrostatic pressure will flow outside (interstitial) to inside (lumen) if the oncotic pressure is (high or low)
HIGH
unbound protein pull water across membrane (net fluid reabsorption)
155
At the arterial end of capillary-- Net (outward or inward) flux
outward, inc. hydrostatic pressure
156
At the venous end of capillary-- Net (inward or outward) flux
inward, inc. oncotic pressure
157
Net flux overall in the body tend to be slightly (positive or negative)
positive (push out fluid) (hydrostatic pressure tend to be more than oncotic pressure)
158
Inc hydrostatic pressure, more fluid flow out of capillaries, and interstitial fluid pressure increases which (increase or decrease) lymphatic flow.
Lymphatic flow is determined by pressure gradients, there is no pumping action.
increase
Pressure would go up (systolic) - pulsation of arteries pushes on lymphatic and cause them to go up to vena cava.
159
______ determines flux of fluids (which could contain the solutes)
Fc or filtration coefficient
160
Constriction of arterioles will (increase or decrease) capillary pressure
decrease
| constrictions of arterioles, or venous obstructions will decrease capillary pressure
161
Edema -- fluid lost out of capillaries; caused by increased venous pressure, lymphatic failure, (increase or decrease) oncotic pressure
decreased
