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Exam 3 Flashcards

Cardiovascular Respiratory

1
Q

Cardiac: Widowmaker

A

left anterior descending artery

– supplies left ventricle

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2
Q

Spontaneous depolarization of Heart

A

purkinje < bundle HIS < AV < SA

**SA to purkinje

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3
Q

Location of the Heart

A

Thoracic cavity: Mediastinum between lungs

  • medial to lungs
  • posterior to sternum
  • anterior to ventral column
  • superior to diaphragm
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4
Q

Location of the apex of the heart (distal end)

A
  • distal end (apex) points to left (5th intercostal)

* hear heartbeat

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5
Q

Layers of the Heart wall

A
  1. Endocardium (inner)
  2. Myocardium: Muscle, middle tissue – hardest working muscle in the body
  3. Epicardium: Adipose
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6
Q

The pericardial cavity is located between what layers of the heart?

A

Parietal layer of serous peicardium) and cisceral layer of serous pericardium (Epicardium)

Pericardial effusion: fluids in heart muscle, heart wall = occurs in pericardial cavity

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7
Q

The Epicardium is also known as the _______ layer of the serous pericardium

A

visceral layer of the serous pericardium

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8
Q

The Pericardium (pericardial sac) is composed of two layers: fibrous and serous

What are the faetures?

A
  1. fibrous: sac w/tough CT
  2. serous: double layer
    - parietal peri
    - visceral peri (epicardium covers heart)

-serous fluid fills pericardial cavity

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9
Q

3 layers of the wall of the heart

A
  1. Epicardium (outside layer of CT)
  2. Myocardium (cardiac muscle)
  3. Endocardium (inner epithelial and CT lining heart and valves)
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10
Q

Chambers of the Heart

A
  1. Atria
    - receive blood
    * auricle (ext. chamber)
  2. Ventricle
    - expel blood
    - separated by septum
    * interatrial
    * interventricular
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11
Q

Chambers of the Heart

A
  1. Atria
    - receive blood
    * auricle (ext. chamber)
  2. Ventricle
    - expel blood
    - separated by septum
    * interatrial
    * interventricular
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12
Q

True/False: The heart valves are flaps that allow blood to flow in only one direction

A

True

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13
Q

Describe the Atrioventricular (AV) valves of the heart

A
  • between atrium and ventricle
  • blood from atrium to ventricle
  • bicuspid (mitral; left))
  • tricuspid (right side)
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14
Q

The semilunar valves of the heart separate the ventricles from the major heart arteries, allowing blood flow out of each ventricle.

List the semilunar valves

A
  1. pulmonary (RV and R pulmonary trunk)

2. aortic valve (LV and aorta)

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15
Q

The valve cusps are held in place by “heart strings” known as ______ which originate from papillary muscles (inside ventrical wall)

A

chordae tendinae

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16
Q

True/False: When a chamber wall contracts, blood is pumped through a valve. Backflow increases pressure on the cusps and closes the valves.

A

True

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17
Q

AV valves close during _____ contraction.

A

Ventricular contraction

To prevent backflow, papillary muscles contract (chordae tendinae) – keep valve cusps from prolapse

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18
Q

Blood returns to heart via

A

superior and inferior vena cava into right atrium

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19
Q

End diastolic area describes

A

final contraction of the atria to pump last bit of blood into ventricle

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20
Q

Oxygen exchange between blood and tissues occurs at the

A

capillaries

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21
Q

Describe cardiac circulation (coronary, pulmonary)

A

Vena cava – RA – RV – pulmonary artery – pulmonary vein – LA –LV – aorta – systemic

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22
Q

When does the heart feed itself?

A

Diastole

-coronary artery flaps are open

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23
Q

The right coronary artery gives rise to

A

right marginal artery and posterior descending artery

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24
Q

the left coronary artery gives rise to the

A

left circumflex and left anterior descending artery

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25
Q

The ______ vessels provide oxygenated blood to the heart

A

Coronary vessels

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26
Q

The left circuflex artery supplies blood to

A

lateral and posterior walls of the left ventricle

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27
Q

The PDA branches off of the left circuflex artery 10% of the time. These patients are considered to have ____-dominant circulation

A

Left

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28
Q

The left anterior descending artery supplies blood to

A

ant. wall of LV and anterior 2/5 of interventricular septum

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29
Q

The ______ gives rise to the posterior descending artery (PDA) in patients with right dominant circulation

A

right coronary artery (RCA)

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30
Q

The right marginal artery supplies the

A

RV

  • papillary muscles
  • posterior wall of heart
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31
Q

Pulmonary arteries carry ______

Pulmoanry veins carry

A

Arteries: deox blood to lungs

Veins: ox blood to LV of heart

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32
Q

______ refers to the series of contractions and relaxations of the heart to produce a complete heartbeat

A

Cardiac cycle

systole: vent. contraction
Diastole: vent. relax

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33
Q

During diastole, the atria and ventricles fill with blood. The atria contract to complete ventricular filling. During this time the ventricles are

A

relaxed

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34
Q

During systole the ventricles ______ forcing blood up and out of the heart arteries. The AV valves shut

A

Ventricles contract

  • Av valves shut “lup”
  • Semilunar valves shut”dup”
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35
Q

Conduction system of the heart

A
  1. SA “pacemaker” - wall of atrium
  2. AV node - septum at junction of RA and LA
  3. AV bundle of HIS - interventricular septum
  4. bundle branches (R and L)
  5. Purkinje fibers - myocardium wall
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36
Q

Spontaneous depolarization:

A

SA –AV–HIS–purkinje

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37
Q

Conduction velocity

A

time required for an electrical signal to spread through cardiac tissue

Speed: Purkinje fibers > SA > AV

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38
Q

Describe the Pacemaker action potential

A

Pacemaker: No phases 1 and 2

Phase 4: HCN “Funny current”

  • -T-type Calcium channels
  • -Inc. Na2+ influx
  • -Dec. K+

Phase 0 (slope): L-type Ca2+ channels

Phase 3: Voltage-gated K+ channels

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39
Q

Describe depolarization of Heart

A

Phase 0 (upstroke): Na2+ influx

Phase 1: K+ efflux (out)

Phase 2: Plateau

  • -Influx of Ca2+
  • -L-type channels

Phase 3 (down-slope; rapid repolarization):

  • Ca2+ channels close
  • K+ channels (out)

Phase 4: Na, Ca2+ closed
–K+ open

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40
Q

EKG

A
  1. P wave: depol of atria
  2. QRS interval: depol of ventricles
  3. T wave: ventricular repol.

PR interval: Delay of AV
–ventricles fill

ST segment: ventricle repol starts

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41
Q

Describe the conducting zone of the lungs

A
  1. Conducting (airways)
    - air in and out
    - mucociliary escalatory
    - SM lining
    - Parasympathetic: Ach: Gq - bronchoconstriction
    - Sympathetic: NE - bronchodilation
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42
Q

Describe the respiratory zone of the lungs

A

gas exchange

  • alveoli
  • elastic fibers and epithelial cells (type I, II)
  • alveolar macrophages
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43
Q

Type I epithelial (pneumocytes)

A

squamous cells

  • 95% of alveolar surface
  • gas exvhange
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44
Q

Type II pneumocytes

A
  • granular, cuboidal
  • 5%
  • surfactant (inc. compliance)
  • replace type I
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45
Q

Conducting zone volume vs. Respiratory zone volume

A

Conducting: 150mL
Respiratory: 350mL

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46
Q

Emphysema is a desease of the

A

alveoli

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47
Q

Gas exchange begins at

A

respiratory bronchioles

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48
Q

Rhonci (low pitched wheezing) is an obstruction or secretion of the

A

largeer airways

*COPD, bronhiectasis, pneumonia, cystic fibrosis

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49
Q

Rales (crackles) are caused by the opening of the

A

small airways and alveoli (fluid)

*pulmonary edema, heart failure, pulmonary fibrosis or Resp. distress syndrome

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50
Q

Conducting zone are composed of

A
  • cartilage (stops at trachea)
  • goblet cells
  • cilia (to resp. bronchioles)
  • SM (to bronchioles)

*vocalization

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51
Q

Terminal bronchioles to alveoli are composed of

A

elastic fibers

no cartilage

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52
Q

Describe the epithelium in the conducting zone vs. respiratory zones

A

Conducting:

  1. pseudostratified ciliated columnar
  2. simple ciliated columnar

Respiratory:
3. respiratory epithelium (ciliated simple cuboidal)???

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53
Q

Dead Space is air that you breathe in, but does not participate in gas exchange. What are the two divisions?

A
  1. anatomic: nose to bronchioles
    - no gas exchange
    - “last air in, first air out”
  2. Physiologic
    - anatomic + functional
    - air in resp. zone
    - no gas exchange
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54
Q

Physiologic Dead Space

A

Taco Paco Peco Paco

Vd = VT PaCO2 - PeCO2/PaCO2

*If PeCO2 = 0 then no gas exchange

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55
Q

Preload is determined by

A

EDV

  • EDV is proportional to right atrial pressure
  • inc. RAP = inc. preload
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56
Q

Afterload is determined by what the ventricle is working against when ejecting blood. For the left ventricle, afterload is determined by

A

Aortic pressure

  • higher aortic pressure = higher afterload
  • RV = pulmonary artery
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57
Q

Stroke Volume is the volume of blood pumped out (LV) with every contraction (heartbeat)

*What are the factors affecting stroke volume?

A

Contractility
Preload

  • inc. preload: inc. SV
  • inc. contract: inc. SV
  • dec. afterload: inc. SV
58
Q

Calculate SV

A

SV = EDV - ESV

59
Q

Cardiac output is the volume of blood pumped by the heart every minute.

Calculate CO

A

CO = SV x HR

CO = rate of O2 consump/arterial O2 - venous O2

60
Q

Ejection fraction is a comparison of the volume of blood pumped out of the LV to the colume of the blood that remains in the LV after contraction

Calculate EF

A

EF = EDV -ESV/EDV

61
Q

Stroke work is the work the heart performs on a single beat

Calculate stroke work

A

Stroke work = aortic pressure x stroke volume

62
Q

Resistance is affected by

A

viscosity, length of blood vessel = direct proportion

radius = indirect proportion

*small radius: high resistance

63
Q

Mean arterial pressure is a function of the hydrostatic forces exerted by the volume of blood in the circulation and the resistance within the vessel.

Calculate mean arterial pressure in the heart

A

MAP = CO x TPR

-

64
Q

Pulse pressure

A

Systolic - diastolic

normal: 30-50

65
Q

Blood flow describes the movement of blood over a given period of time

Calculate blood flow

A

Q = ΔP / R

Velocity:
V = Q/A

66
Q

Compliance (of the heart) indicates the ability of the tissue to expand as the pressure rises

Calculate compliance

67
Q

Elastance (of the heart) is the ability to recoil

Calculate elastance

68
Q

Minute Ventilation is the amount of air breathed in per minute

A

VT x breaths/min

  • 500
  • Normal Respiratory rate: 12-20 bpm

ex: 500 x 12

69
Q

Alveolar ventilation is the rate of air movement into and out of the lungs/minute

*corrects for dead space

A

(VT - VD) x breaths/min

ex; 500 -150 x 12 = 4200ml/min

70
Q

What can be used to measure Residual volume?

A

Helium or Nitrogen

*can’t use spirometry

71
Q

_______ is the volume inspired or expired with each normal breath. (at rest)

A

Tidal volume

500mL

72
Q

______ is the volume that can be inspired over and above the tidal volume. Used during exercise.

A

Inspiratory reserve volume

*3000mL

73
Q

_____ is the volume that can be expired after the expiration of a tidal volume.

A

Expiratory reserve volume

*1000mL

74
Q

_______ is the volume that remains in the lungs after a maximal expiration. (cannot be measured by spirometry)

A

Residual volume

*1200mL

75
Q

_____ the sum of tidal volume and IRV.

A

Inspiratory capacity

ICV: VT + IRV

76
Q

_____ is the sum of ERV and RV. The volume remaining in the lungs after a tidal volume is expired. Includes the RV, so it cannot be measured by spirometry.

A

Functional residual capacity

FCR: ERV + RV

77
Q

_____ is the max volume of air that can be expired after inspiration. It is the sum of tidal volume, IRV, and ERV.

A

Vital capacity

VC = VT + IRV + ERV

78
Q

_____ is the sum of all four lung volumes. The volume in the lungs after a maximal inspiration.

*(includes RV, so it cannot be measured by spirometry).

A

Total Lung capacity

TLC = VT + ERV + IRV + RV

79
Q

Obstructive vs. restrictive lung disease

A

Obstructive diseases: move flow volume loop to the left

  • can’t fully exhale
  • inc. RV
  • inc. TLC
  • dec. VT

ex: asthma, bronchitis, emphysema

Restrictive:

  • move to right
  • can’t fully inhale
  • dec. TLC
  • dec. RV
    ex: fibrosis
80
Q

FEV1/FVC ratio is acquired by performing the Forced expiration test: inhale as much as possible and rapidly exhale. What are the values for obstructive and restrictive lung diseases compared to normal?

A

FEV is forced expiratory volume in 1 sec.

Normal: 4/5 = 0.7 - 0.8
Restrictive: 3/3
Obstructive: 1/3

Obstruction (barrel chest): <70%

Restrictive: >70% or normal

81
Q

Boyle’s law

A

volume of gase is inversely proportional to pressure

82
Q

True/False: Pulmonary pressures are expressed relative to atmospheric pressure

83
Q

Atmospheric pressure is the pressure of outside air. What is the normal atm?

84
Q

At rest, the lung volume is equal to

85
Q

Intralveolar pressure is within alveoli. At rest, the intralveolar pressure is equal to

A

atmospheric pressure

0

86
Q

During inspiration

  • diaphragm and external intercostals _____
  • Alv p. ____ atm P.
  • Lung vol = _____
A
  • diaphragm and EIC’s contract
  • Alv. pressure < atm. P.
  • Lung volume = FRC + 1TV
87
Q

Intrapleural pressure inside the pleural space is always ____ than intraalveolar pressure

A

Less than

*always negative during breathing

88
Q

During expiration:

  • diaphragm and external intercostals _____
  • Alv p. ____ atm P.
  • Lung vol = _____
A
  • Diaphragm and EIC’s relax
  • Thoracic space dec.
  • Intrpleural pressure returns to normal
  • Alv. P. > atm P
  • lung vol. return to FRC
89
Q

True/False: large sized alveoli have a less tendency to collapse

A

True

*surfactant dec. pressure and thus dec. tendency to collapse in small alveoli

90
Q

Compliance (lungs) is a measure of distensibility. How is it calculated?

91
Q

Compliance vs. Elastance

A

Distensibility vs. recoil

  1. Inc. elastance (dec. compliance)
    - restrictive lung diseases (fibrosis)
    - dec. surfactant
  2. inc. compliance (dec. elastance)
    - aging
    - asthma
    - obstructive (emphysema)
92
Q

Hypoventilation vs. Hyperventilation

A

Hypoventilate:

  • -retain CO2
  • -dec. O2 (< 100mmHg)

Hyperventilate:

  • -dec. CO2 (>40mmHg)
  • -inc. O2 (>100mmHg)
93
Q

Hb affinity for O2 is affected by:

  1. CO2
  2. Acidity (pH)
  3. DPG
  4. Exercise
  5. Temperature
A

Shift right: CADET (inc.)

Shift left: dec. all

94
Q

The majority of CO2 is not bound to Hb, rather it is converted to HCO3 in RBC’s. Describe this process

A
  • converted to H2CO3 via carbonic anhydrase
  • H2CO3 breaks into H+ and HCO3-
  • HCO3- exchange w/chloride shift into plasma
95
Q

Chemoreceptors in the respiratory respond to chemical changes causing inc. breathing rate. List the types of receptors and the chemicals they respond to

A

Central:

  • medulla
  • dec. pH
  • inc. CO2

Peripheral:

  • carotid and aortic bodies
  • dec.PO2
  • inc. PCO2
  • dec. pH
96
Q

Resistance to blood flow equation

A

F = deltaP/R

  • P = pressure
  • Resistance
97
Q

Which of the following provides oxygenated blood supply to the lungs?

  1. pulmonary arteries
  2. bronchial arteries
A

Bronchial arteries:

-supply bronchi and pleura

98
Q

True/False: the pulmonary circulation has the capacity to accomodate two-fold to three-fold inc. in CO with little change in the pulmonary artery pressure

A

TRue

*ex: exercise

99
Q

Fetal shunts: (R to L)

  • Foramen ovale
  • Ductus arteriosus
A

FO: R atrium to L atrijm
DA: shunt from pulmonary artery to aorta

*High pulm. pressure

100
Q

True/False: In a standing position, gravity causes blood to naturally flow downward towards Zone 3

A

True

Zone 3: alveolar pressure less than venous pressure
high gas exchange

101
Q

Sight of highest airway resistance in lungs

*turbulent flow

A

Conducting zone: Medium sized Bronchi

102
Q

Normal V/Q ratio

A

Normal: 0.8

-exercise = 1

103
Q

What happens when V/Q is infinite?

A

–Ventilation, no perfusion

*pulmonary embolism - obstructed pulmonary artery

**dead space problem

104
Q

What happens when V/Q is zero?

A

–Perfusion, no ventilation

  • shunt problem
  • complete airway obstruction, ARDS
105
Q

What happens when V/Q is low?

A

wasted perfusion

  • low compliance
  • fibrosis, bronchitis, asthma
106
Q

What happens when V/Q is high?

A

some wasted ventilation

e.g. emphysema

107
Q

Hypoxia is decreased O2 in the _____

Hypoxemia is decreased O2 to the

A

Hypoxia: tissues
-dec. organ perfusion

Hypoxemia: arteries
< 60mmHg
<90%

108
Q

The following are potential causes of what disease?

  • Ischemia
  • Hypoxemia
  • Decreased O2-carrying capacity of blood
A

Hypoxia

Ischemia:

  • A clot
  • V clot
  • shock

Dec.O2

  • anemia
  • CO poisoning
  • cyanide (ox phos)
  • Methhemoglobineia
109
Q

Why is hypoxia bad?

A

Decr. ATP

  • reversible cell. injury and swelling (Na2+)
  • irreversible injury and death (membrane damage; Ca2+)
  • acidosis
110
Q

Hypoxemia caused by

A

dec. PIO2
- hypoventilation
- high altitude
- diffusion
- V/Q defects
- R to L shunt

111
Q

At a high altitude, what would you expect the A-a gradient to be?

112
Q

When you have low oxygen levels in the lungs, Hypoxic vasoconstriction occurs in the lungs. What does this cause?

A

Inc. resistance

  • redirect blood flow from poorly ventilated alveoli, to good alveoli
  • more perfusion to good areas
113
Q

Aa gradient:

PAO2 - PaO2

What is the normal range?

A

PAO2 = partial pressure of O2 in the alveoli

PaO2 = partial pressure in arteries

5-15mmHg

114
Q

Dec. PaO2 + Normal Aa gradient is caused by

A

extrapulmonary (hypoxemia)

hypoventilation - benzos, opiates or high altitude

115
Q

Dec. PaO2 + Inc. Aa gradient is caused by

A

V/Q mismatch
R to L shunt
Diffusion impairments

116
Q

Effect of 100% O2 on the A-a gradient on:

  1. High altitude
  2. Hypoventilation
  3. R to L shunt
A
  1. Altitude: normal
  2. Hypo: normal
  3. R to L: Inc; no improvement
117
Q
  1. CO2, N2O and O2 (normal conditions) are all ____ limited gases
  2. CO and O2 (during exercise) are ____ limited gases
A
  1. perfusion

2. diffusion

118
Q

Describe adaptations to dec. O2 availability at high altitude

A

Short term:
1. inc. respiration rate (hyperventilation)

*resp. alkalosis

  1. Inc. heart rate
    - relieve perfusion limitation

Long term:

  1. HCO3- excretion
    - -dec. pH
  2. inc. EPO (RBC #)
    - inc. carrying capacity
  3. Inc. DPG
119
Q

Response to smoking (lungs)

A
  1. squaous metaplasia
  2. goblet cell hypertophy, mucous hypersecretion
  3. chemotaxis (protease-anti-protease imbalance); inc. free radicals
  4. inactivate AAT and anti-oxidants
  5. inc. laryngeal cancer
120
Q

Acidosis is characterized by too much acid in the body.

A

“not blowing off enough in lungs”

not excreting enough acid or inc. H+ ion formation

121
Q

Alkalosis is characterized by less acidity

A

-lungs blow off too much

-excrete too much
diuresis, diarrhea

122
Q

Metabolic acidosis

A
  • high H+
  • low HCO3-
  • lungs: hyperventilate
  • kidneys: excrete acids
123
Q

Normal ranges

A

pH: 7.35-7.45
PCO2: 35-45
PO2: 95-100
HCO3-: 22-26

124
Q

Metabolic alkalosis

*metabolic: H+ and HCO3- are opposite

A
  • low H+
  • high HCO3-

Lungs: hypO
kidneys: excrete HCO3-

125
Q

Respiratory acidosis:

A
  • high CO2
  • High H+
  • high HCO3-

–inc. renal HCO3- reabsorption

126
Q

Respiratory alkalosis

A

-low CO2
-low H+
=low HCO3-

-dec. renal HCO3- reabsorption

127
Q

Which of the following vessels would have the highest velocity?

a. aorta
b. arteries
c. capillaries

A

V = Q/A

  • highest: aorta
  • lowest: capillaries (exchange)
128
Q

Ohm’s law describes that blood flow is determined by the pressure difference of a vessel and resistance.

Which of the following vessels has the higest resistance?

A. aorta
B. arteries
C. arterioles
D. capillaries

A

Q = P/R

Highest: Arterioles

129
Q

Poiseulle’s law describes resistance to blood flow as being dependent on the arrangement of the blood vessesl (series vs. parallel)

What other factors affect flow?

A

R = 8nl/pi r2

n=viscosity
l=length
r=radius

Increase viscosity = inc. resistance
Increase length = increase resistance
Increase radius = dec. resistance

130
Q

Reynold’s number describes flow of blood (laminar vs. turbulent). It is determined by the following equation:

N = pdv/n

p = density of blood
d= diamter of vessel
v = velocity of flow
n = viscosity

If N < 2000 what kind of flow would we expect?

A

Laminar flow

> 2000 would be turbulent

NOTE: max velocity at center of vessel

131
Q

Vascular compliance (capacitance) is determined by the equation: C = V/P

C= compliance
V= volume
P= pressure

Which vessels have the highest compliance? The lowest?

A

HIghest: veins
Lowest: aging arteries

132
Q

How do you determine pulse pressure?

A

Systolic - Diastolic

*highest in large arteries

133
Q

If a patient presents with arteriosclerosis, what happens to PP and systolic pressure?

A

inc. PP, inc. SyS, inc. MAP

134
Q

If a patient presnts with aortic stenosis, the aorta cannot easily pump blood to the system. What happens to pulse pressure (PP), MAP, and systolic pressure?

A

all decrease

135
Q

True/False: greater fraction of time is spend in diastole than in systole

136
Q

How do you calculate mean arterial pressure?

MAP

A

Diastolic + 1/3 Pulse pressure

137
Q

The dichrotic notch on a curve represents

A

aortic valve closing

138
Q

Which phase of the SA node action potential sets the heart rate?

139
Q

When the SA node is dysfunctional, a latent pacemaker can assume the job. What is the term for this?

A

ectopic pacemaker (AV, HIS, Purkinje)

140
Q

Contraction of the SM of vessels requires which adrenergic receptor?

141
Q

Heart function is under the control of which adrenergic recptor?

A

B1

rate, conduction velocity, contractility

(M2)

142
Q

SK muscle vessels are under the control of which adrenergic receptor?

A

a1 - constrict
B2 - dilate

(M3)

Bridge Physiology (4 decks)

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