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Pathophysiology > Exam 2 Cardiac > Flashcards

Exam 2 Cardiac Flashcards

1
Q

Describe the cardiac cycle.

A

The pumping action of the heart

  • Repeated contraction (systole)
  • Relaxation (diastole)

of the walls of the atria and ventricles

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2
Q

What is excitation contraction coupling?

A

Process by which an action potential in the plasma membrane of the muscle fiber triggers the cycle, leading to cross-bridge activity and contraction

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3
Q
A

a) Pulmonary valve
b) Tricuspid valve
c) Aortic valve
d) Mitral valve(bicuspid valve )

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4
Q

Critical role of the endothelium

All tissues depend on a blood supply and the blood supply depends on a)________, which form the blood vessel.

a)________ can adjust their number and arrangement to accommodate local requirements.

Vascular endothelial cells produce a number of essential chemicals including b)_______, c)________, d)________, and e)_______.

A

a) endothelial cells
b) vasodilators
c) vasoconstrictors
d) anticoagulants
e) growth factors

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5
Q

Cardiac cycle

What is the 5 phase?

A
  1. Atrial Systole
  2. Early Ventricular Systole
  3. Ventricular Systole
  4. Early Ventricular Diastole
  5. Late Ventricular Diastole

Systole=contraction
Diastole=relax

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6
Q

What stage is Isovolumetric Ventricular Contraction?

A

The 2nd Phase:
Early Ventricular Systole

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7
Q

What stage is Isovolumetric Ventricular Relaxation?

A

The 4th Phase:
Early Ventricular Diastole

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8
Q

What phase is the “rapid ejection period”?

A

The 3rd Phase:
Ventricular Systole

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9
Q

When does “ventricular filling” occur?

A

The 5th Phase:
Late Ventricular Diastole

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10
Q

Valves movement #1

A

Open tricuspid and mitral valves
valves are relax

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11
Q

Valves movement #2

A
  • *Closed tricuspid and mitral valves**
  • *Both ventricles are contracted**

When the right ventricle is full, the tricuspid valve closes and keeps blood from flowing backward into the right atrium when the ventricle contracts

When the left ventricle is full, the mitral valve closes and keeps blood from flowing backward into the left atrium when the ventricle contracts.

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12
Q

Valves movement #3

A

Open pulmonic and aortic valve

As the right ventricle begins to contract, the pulmonic valve is forced open.
Blood is pumped out of the right ventricle through the pulmonic valve into the pulmonary artery to the lungs.

As the left ventricle begins to contract, the aortic valve is forced open.
Blood is pumped out of the left ventricle through the aortic valve into the aorta. The aorta branches into many arteries and provides blood to the body.

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13
Q

Valves movement #4

A
  • *Closed pulmonic and aortic valves**
  • *ventricle finishes contracting and starts to relax**

When the right ventricle finishes contracting and starts to relax, the pulmonic valve snaps shut. This keeps blood from flowing back into the right ventricle.
When the left ventricle finishes contracting and begins to relax, the aortic valve snaps shut. This keeps blood from flowing back into the left ventricle.

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14
Q

What is the perfusion means?

A

Perfusion”=Think “ BLOOD Flow

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15
Q

What is the Systole and Diastole means?

A

Systole-constriction phase
Diastole-relaxation phase

The left ventricle connects nearly all organ systems
To pump oxygenated blood to the body
Thicker and more muscular

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16
Q

What is the Coronary circulation?

A

Blood supply to the heart, via coronary arteries

  • Right coronary artery; arises from right/anterior aortic sinus
  • Left coronary artery; arises from left aortic sinus
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17
Q

What three major vessels return blood to the heart?

A
  1. Superior Vena Cava
  2. Inferior Vena Cava
  3. Coronary Sinus
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18
Q

What is the difference between AV valves and semilunar valves?

A

AV valves

  • Between the atria and ventricles
  • Require chordae tendinea to prevent them from opening in the wrong direction

Semilunar valves

  • Stronger and are half moon shaped
  • Between the ventricles and the arteries leaving the heart
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19
Q

Systolic and diastolic blood pressure

A

Systolic blood pressure (the first and higher number) measures pressure inside your arteries when the heart beats

Diastolic blood pressure (the second and lower number) measures the pressure inside the artery when the heart rests between beats

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20
Q

Which term is determined by stroke volume, speed of ejection, and arterial distensibility?

Arterial pulse pressure
Mean arterial pressure
Diastolic pressure
Pulse pressure

A

Pulse pressure

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21
Q

Mean Arterial Pressure

It’s all about a)________
MAP—Normal range b)________
Minimum MAP to maintain tissue perfusion c)________

How do we calculate? d)________

A

a) TISSUE PERFUSION
b) 70-110 mmHg

c) >/= 65
d) MAP= 1 Systolic + 2 Diastolic *3

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22
Q

What is the Left Heart Failure?

A

Congestive Heart Failure

Left ventricle failure(systolic failure)
Fluid backs into the lung
Reduce injection fraction

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23
Q

What is the Congestive Heart Failure?

A

The heart doesn’t pump blood as efficiently as it should
Causes by coronary artery disease(high cholesterol, high BP)

Develops over years
Chronic end-stage heart disease
Can lead to circulatory inadequacies

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24
Q

Symptoms of left side of heat failure

A
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25
What is the right Heart Failure?
Ventricle is too weak to pump enough blood to the lungs Backs up in the systemic system Chronic lung disease Lung Infections
26
Symptoms of right side of heat failure
27
28
What is the coronary artery bypass graft? **CABG**
Taking a blood vessel from another part of the body (usually the chest, leg or arm) and attaching it to the coronary artery above and below the narrowed area or blockage
29
What is the cause of DVT? 3
Venous Stasis Venous Endothelial Damage Hypercoagulable States
30
**Thrombus Formation--Arterial** What cause is this?
Inflammation Traumatic injury Infection
31
What is the primary HTN?
Increased afterload **Overactivity of the RAAS** Insulin resistance Increased vascular resistance
32
What is the secondary HTN?
**Renal Disease** Adrenocortical tumors Fix other problem BP go away Medication
33
What is the 2 types of main reason of heart failure?
Systolic Loss of Contractility Ventricles can’t pump enough blood during systole Diastolic Loss of Relaxation Ventricles can’t fill with enough blood during diastole
34
What is the factors of left heart failure?
Myocardial Infarction (MI) Myocarditis Cardiomyopathies Increased ischemia Increased workload (CO formula…?) (Hypertension--High afterload)
35
What is the common causes of Congestive heart failure/CHF?
Pump failure Impaired contractility Increased workload Arrhythmias: myocardial infarction, cardiomyopathies
36
Increased workload over a period of time
Causes ventricle to pump harder HTN because heart must work harder volume overload Sodium content (kidney failure)
37
Why CHF is secondary disease?
Because it is the end result of another underlying and persisting condition. - often called end stage cardiovascular disease - slowly develops
38
What is the Preload?
**the amount of blood returning to the heart** Initial stretching of the cardiac myocytes (muscle cells) prior to contraction Volume of blood that enters the right atrium from the venous system -Volume of blood in ventricles at the end of diastole
39
What is the Afterload?
* *The resistance against the heart has to pump** - The resistance exerted by the pressure within the aorta against the left ventricle - The amount of resistance that the ventricle must overcome in order to pump blood out of the heart
40
What is the Cardiac Output?
Amount of blood that the heart pumps out of the left ventricle each minute
41
What is the Stroke Volume?
Amount of blood within the ventricle that is ejected with each contraction This can also be referred to as left ventricular ejection fraction
42
The higher the ___________ the more the heart has to work and the weaker it gets afterload
afterload
43
How Does Chronic HTN Lead to HF?
- High aortic pressure against the left ventricle - Left ventricular hypertrophy occurs - Coronary artery blood flow becomes insufficient to supply the enlarged left ventricle - Ischemia of left ventricle--\>MI--\>HF
44
Why does heart failure result in hypokalemia?
- In heart failure, blood volume increases because of excess water within the bloodstream - The repeated stimulation of the RAAS increases the risk of hypokalemia
45
Left ventricular hypertrophy (LVH) is an adaptation to a persistently high: b. cardiac preload c. cardiac ischemia d. cardiac depression
**a.** cardiac afterload
46
Which of the following factors will cause cardiac O2 demands to increase? a. Increased End Diastolic Volume b. Decreased Heart Rate c. Increased End Systolic Volume d. Decreased End Diastolic Volume
**a. Increased End Diastolic Volume**
47
Which coronary artery branch is responsible for perfusing the ventricular conduction system? a. The Left Anterior Descending b. The Left Circumflex c. The Right Coronary Artery d. The Left Anterior Descending
a. The Left Anterior Descending
48
Anginal cardiac ischemic pain is a form of a. referred pain b. psychosomatic pain c. somatosensory pain d. phantom pain
referred pain
49
GI distress, weight loss, and impaired liver function are signs of which kind of heart failure? **a.** Right-sided heart failure **b.** Left-sided heart failure
**a.** Right-sided heart failure
50
The physiologic compensatory responses to decreased cardiac function seen with chronic heart failure have what kind of effects: a. Increased cardiac afterload b. Increased cardiac preload c. Increased heart rate and O2 demands d. All of these
**a.** Right-sided heart failure
51
Inflammation of the heart tissue is also known as?
carditis
52
An unstable plaque in the coronary arteries can result in which of the following complications? a. abnormal vasodilation b. stable angina c. myocardial infarction d. hypertension e. myocardial ischemia
C
53
In the development of primary hypertension, increased sympathetic nervous system (SNS) activity causes: (select all) a. decreased heart rate b. increased renal excretion c. peripheral vasoconstriction d. decreased insulin resistance e. increased peripheral resistance
C, E
54
Dysfuntion in the normal secretion of natriuretic hormones affects renal absorption of: a. water only b. calcium c. sodium d. aldosterone
C
55
How is insulin resistance related to the development of primary hypertension?
Insulin resistance activates the sympathetic nervous system, contributes to the development of diabetes, dyslipidemia, and eventually atherosclerosis, and promotes thrombus formation Insulin resistance contributes to increases in SNS activity, peripheral resistance, endothelial injury and thrombus formation.
56
What is the Atherosclerosis?
The build-up of fats, cholesterol, and other substances in and on the artery walls
57
A risk factor that is associated with atherosclerosis and primary hypertension is: a. high sodium diet b. advanced age c. hyperhomocystenemia d. a low potassium diet
B
58
Over time, sustained hypertension can result in which of the following problems?
Vascular remodeling Over time, prolonged vasoconstriction can result in permanent remodeling of blood vessel walls.
59
Complications of sustained hypertension include which of the following? a. retinal damage b. stroke c. renal disease d. all of the above
D
60
Sustained uncontrolled hypertension can result in which of the following life-threatening complications? A. CVA(stroke) B. encephalopathy C. cardiac failure D. all of the above
D
61
Secondary hypertension is caused by?
Altered hemodynamics associated with a primary disease such as atherosclerosis or renal failure.
62
An individual with secondary hypertension has an abnormal blood pressure caused by: a. prolonged primary b. high sodium intake c. genetics d. a systemic disease
D
63
The pathophysiology of deep venous thrombosis (DVT) can be described through three processes, known as Virchow's triad. Which of the following is not a component of Virchow's Triad? a. venous stasis b. LDL accumulation c. hypercoagulable state d. endothelial injury
B
64
Clinical manifestations of a deep vein thrombosis (DVT) in the lower leg include: a. pain and edema in the affected limb b. muscle paralysis c. reduced pulse in foot d. skin pallor in the area of thrombosis
A
65
The most common cause of coronary artery disease is: a. myocarditis b. hypoglycemia c. atherosclerosis d. vasospasm
C
66
Atherosclerosis results in decreased blood flow to the
Myocardium The muscular layer of the heart
67
The most important component in the development of acute coronary syndromes is a decrease in supply or an increase in demand for: a. potassium and sodium b. glucose c. myoglobin d. oxygen D
D
68
Unstable angina is considered a precursor to?
Myocardial infarction The concern with unstable angina is that a clot may form in the diseased coronary artery and cause occlusion of the vessel and a myocardial infarction.
69
Which of the following conditions is caused by the collection of fluid in the pericardial sac, resulting in tamponade? a. pericardial rub b. pericardial effusion c. cardiomyopathy d. constrictive pericarditis
B
70
In left ventricular failure, decreased perfusion to the kidneys stimulates the renin-angiotensin-aldosterone system, which may ultimately result in: a. decrease in preload b. decrease blood pressure c increased blood volume d. vasodilation
C
71
Congestive heart failure (CHF) results in which of the following intraventricular hemodynamic changes? a. increases left ventricular preload, LVEDP b. increased ejection fraction c. decreased right ventricular preload d. decreased right ventricular end-diastolic pressure
A
72
A patient is diagnosed with chronic pulmonary disease and elevated pulmonary vascular resistance. Which fo the following heart failures generally results from this condition? a. left heart failure, CHF b. right heart failure, Cor Pulmonale
B
73
Of the following diseases, which is the most common cause of right heart failure? a. primary HTN b. infective endocarditis c. left heart failure d. pericarditis
C
74
Manifestations of increased left atrial and pulmonary venous pressures in left (congestive) heart failure include: a. syncope b. weak pulses and decreased skin temperature c. oliguria d. dyspnea and cough
D
75
Increased atrial pressure and pulmonary venous pressure from back flow (CHF) result in
Pulmonary edema; --\> hypoxemia which causes dyspnea and the accumulation of fluid in lung tissue stimulates cough
76
Blood pressure that is sustained systolic greater that 140mmHg and diastolic that is below 90 is associated with CV and cerebrovascular events, and is referred to as which of the following terms?
Isolated systolic hypertension
77
Blood Pressure that is rapidly progressive with diastolic above 140 mmHg can cause cerebral edema/loss of function, which of the following terms best describes this type of BP
Malignant hypertension
78
What's conditions refers to the imbalance between coronary blood supply and myocardial demand?
myocardial ischemia
79
What's conditions refers to the imbalance between coronary blood supply and myocardial demand? myocardial ischemia
myocardial ischemia
80
What is the most commonly involved coronary artery in myocardial infarction (MI)? a) Right coronary artery (RCA) b) Left anterior descending artery (LAD) c) Left circumflex artery (LCA) d) Posterior descending artery (PDA)
b
81
What is the key complication in the first 24 hours of an MI? A) Fibrinous pericarditis B) Cornry artery aneurysm C) Arrhythmia D) Mitral insufficiency
C
82
What are the characteristics of stable angina? A) Chest pain that occurs with exertion and/or emotional stress B) Severe and crushing chest pain (\>20 mins) C) Chest pain that occurs at rest D) Bradycardia
A
83
Stable angina is type of a)\_\_\_\_\_\_\_\_? What is a)\_\_\_\_\_\_\_\_ characteristic?
a) Ischemic heart disease b) Narrowed heart arteries Buildup of plaque Limiting blood flow
84
What is the most common cause of right-sided heart failure? a) Left-sided heart failure b) Chronic lung disease (Cor Pulmonale) c) Hypothyroidism
a
85
Pulmonary artery?
great vessel from right ventricle; enters pulmonary circulation divide into right and left PA transport deoxygenated blood
86
Pulmonary veins?
great vessel carry oxygenated blood from lungs to left atrium
87
Aorta?
88
right heart blood flow
superior vena cava right atriu triscupid valve right ventricle pulmonary valve pulmonary artery lungs
89
left heart blood flow lungs pulmonary veins left atrium mitral valve left ventricle aortic valve aorta entire body
lungs pulmonary veins left atrium mitral valve left ventricle aortic valve aorta entire body lungs
90
diastole?
relaxation occurs when AV valves open blood fills ventricles capillary perfusion
91
systole?
contractoin ventricles contract propels blood of pulmonary artery and aorta AV valves close
92
coronary vessels
support metabolic needs of the heart go across myocardium right: extends around right heart to posterior left: circumflex artery - provides blood to left atrium
93
a) Collateral arteries function? b) coronary capillaries function?
a) supply blood/O2 to myocardium b) exchange O2 and nutrients
94
Conduction system special cells enable myocardium to transmit action potentions SA node, AV node, Bundle of His, R/L Bundle Branches, Purkinje Fibers
a) supply blood/O2 to myocardium b) exchange O2 and nutrients
95
a) sinoatrial node b) atrioventricular node
a) "primary pacemaker"a) "primary pacemaker" b) conduction between atria and ventricles
96
frank-starling law of heart
direct relation between volume of blood in heart and force of contraction
97
systemic circulation
left heart; to entire body: arteries arterioles capillaries venules veins
98
Deep venous thrombosis
**disease of veins** thrombus obstruction of venous flow leading to increased venous pressure factors: Triad Virchow (venous stasis, venous endothelial damage, hypercoaguble states)
99
Thromboembolis
100
superior vena cava syndrome
progression occlusion of SVC that leads to venous distention of upper extremities and head oncologic emergency
101
primary hypertension
= consistent elevation of blood pressure essential or idiopathic; genetic and environmental factors 92%-95% of individuals
102
secondary hypertension
BP elevation caused by a systemic disease process that raises peripheral vascular resistance or cardiac output
103
isolated systolic hypertension
elevations of systolic pressure are caused by increase in cardiac output, total peripheral vascular resistance or both
104
aneurysm?
disease of arteries/veins local dilation or outpouching of a vessel wall or cardiac chamber
105
thrombus formation
blood clot that remains attached to vessel wall thromboembolus thrombophlebitis arterial venous
106
embolism
bolus of matter that circulates in the bloodstream \*dislodged thrombus, air bubble, amniotic fluid, aggregate of fluid, bacteria, cancer cells, or foreign substance
107
coronary artery disease any vascular disorder that narrows/occludes the coronary arteries most common cause: artherosclerosis risk factors: dyslipidemia (increased lipid/fat level); hypertension; smoking; diabetes; obesity/sedentary lifestyle
any vascular disorder that narrows/occludes the coronary arteries most common cause: artherosclerosis risk factors: dyslipidemia (increased lipid/fat level); hypertension; smoking; diabetes; obesity/sedentary lifestyle
108
myocardial ischemia
any vascular disorder that narrows/occludes the coronary arteries most common cause: artherosclerosis risk factors: dyslipidemia (increased lipid/fat level); hypertension; smoking; diabetes; obesity/sedentary lifestyle
109
stable angina current chest pain; can be reversible
current chest pain; can be reversible
110
unstable angine
acute coronary syndrome impending myocardial ischemia (heart attack
111
Rate of impulse (HR) What cause sympathetic and parasympathetic?
Sympathetic (SNS) Increases rate/strength contraction (epinephrine); Dilate coronary arteries Parasympathetic (PNS): Decreases rate/strength contraction (Acetylcholine)
112
BP is maintained by?
Contraction of Left ventricle Peripheral (systemic) vascular resistance (diameter) Elasticity of arterial walls Viscosity and volume of blood
113
CO= a)\_\_\_\_\_\_\_\_ x b\_\_\_\_\_\_\_\_
CO = Cardiac Output a) Haert rate b) stroke volume
114
115
116
a) Fill the tank? b) Squeeze the tank? c) Open the gate? d) Repeat as necessary?(not too fast, not too slow) Result: Enough blood pumped out (CO)good MAP --\>Good tissue perfusion (O2 & nutrients)
a) Preload b) contractility c) afterload d) heart rate
117
RAAS--Renin-Angiotensin-Aldosterone System Vaso\_\_\_\_\_\_\_\_ and ________ retention ADH—Anti-Diuretic Hormone Controls __________ retention ANH/BNP—
Vaso**constriction** and **sodium** retention Controls **water** retention
118
Myocardial infection Pathophysiology
coronary artery completely obstructed leads to prolonged ischemia and cell death 3 ways: **1. thrombus buildup** **2. vasospasm occur** in presence of a partial occlusion by artheroma **3. part of thrombus break away;** embolus lodges in smaller branch
119
The most immediate of the compensatory mechanisms are the __________ and _________ systems, which are designed to maintain ____________ and \_\_\_\_\_\_\_\_\_\_\_\_
sympathetic and renin cardiac output and blood pressure.
120
The intense vasoconstriction causes a decrease in ____________ and insufficient supply of \_\_\_\_\_\_\_\_\_\_
tissue perfusion oxygen.
121
\_\_\_\_\_\_\_\_\_\_\_\_\_ occurs when the heart fails to pump blood sufficiently to meet the body's demands.
Cardiogenic Shock
122
Decreased cardiac output Hypotension Hypoperfusion Tissue hypoxia These define \_\_\_\_\_\_\_\_\_\_\_
Cardiogenic shock
123
Which of the following could lead to cardiogenic shock? "Select ALL that apply"
MI Inadequate coronary blood flow Sustained arrythmia Cardiomyopathies All of the above
124
Mechanisms of cardiogenic shock:
Impaired myocardial contractility Abnormalities of cardiac rhythm Cardiac structural disorder
125
People with cardiogenic shock have A decrease in _______ and \_\_\_\_\_\_ Increased ________ and \_\_\_\_\_\_\_\_
stroke volume and cardiac output afterload and preload
126
Why is there a decrease in stroke volume and cardiac output in cardiogenic shock?
Decreased myocardial contractility Increased afterload Excessive preload
127
Why is there increased afterload in cardiogenic shock? SNS and RAAS activation
SNS and RAAS activation
128
Why is there increased preload in cardiogenic shock?
RAAS activation results in an aldosterone-mediated increase in fluid retention Blood returning to the heart is added to blood that previously was not pumped forward, resulting in an increased LVED (left ventricle end diastole)
129
As hypovolemic shock progresses, ________________ of the blood vessels that supply the skin, skeletal muscles, kidneys, and abdominal organs becomes more severe, with a further _________ in blood flow and conversion to anaerobic metabolism resulting in \_\_\_\_\_\_\_\_\_\_.
vasoconstriction, decrease, cellular injury
130
Pathophysiology of hypovolemic shock (5)
decreased blood volume → decreased venous return → decreased SV → decreased CO → decreased tissue perfusion
131
What is the difference between a thrombus and an embolus?
A thrombus is a blood clot An embolus is a sudden blocking of an artery.
132
Which term describes an occlusion in a blood vessel caused by a bolus of circulating matter in the bloodstream? A. Thrombus B. Embolus C. Thrombophlebitis D. Foam cell
B. Embolus An embolus is a **bolus of matter** that is circulating in the blood. A thrombus is a blood clot that remains attached to the vessel wall. Thrombophlebitis is the inflammation caused by a thrombus. Foam cells are lipid-laden cells that contribute to fatty streaks. bolus　小さくて丸く柔らかい塊
133
Cholesterol travels in the bloodstream in predominantly which lipoprotein form? a. HDLs b. Chylomicrons c. LDLs d. IDLs
c. LDLs ## Footnote **"bad" cholesterol**
134
An embolus that originates in the deep veins of the lower legs will travel and cause... a. a heart attack b. an embolic stroke c. All of these d. a pulmonary embolus
d. a pulmonary embolus
135
Define dysrhythmia
Improper beating of the heart, whether irregular, too fast, or too slow.
136
Cardiac output
- Volume of blood ejected by each ventricle each minute
137
What is cardiac output determined by?
- Heart rate and stroke volume - CO= HR X SV
138
Stroke volume
- blood pumped per beat - measured in ml/beat
139
Types of shock (5)
- hypovolemic - cardiogenic - circulatory/distributive - neurogenic - anaphylactic
140
Cardiogenic shock
heart's ability to contract and pump blood is impaired
141
Circulatory/distributive shock (2)
intravascular volume pools in peripheral blood vessels includes septic shock
142
Neurogenic shock
loss of balance between PNS and SNS stimulation causes vasodilation
143
Someone with an MI is more likely to develop what kind of shock?
Cardiogenic
144
Cardiogenic Shock
Results from impaired cardiac output. This shock state primarily involves failure of the left ventricle.
145
Ischemia
Reduces the heart muscle's ability to pump blood

Pathophysiology (11 decks)

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