Exam I Flashcards

Question

What is pulse pressure?

Answer 1

Difference between systolic and diastolic. (i.e. 120/80 has a pulse pressure of 40mmHg) Ideal pulse pressure is 40mmHg.

Answer 2

Arteries. Arteries are more stiff, so they have more change in pressure when volume is introduced vs. veins stretch out and accommodate extra fluid.

Answer 3

The large arteries have a slightly greater pulse pressure than the aorta. This is because the large arteries are much less stretchy than the aorta. (fluid fed into a stiff container will have a greater pressure variance).

Answer 4

The aorta is pretty stretchy if it's healthy. Systole - walls of the aorta are stretched. Diastole - walls come closer together and act like a second heart pump, which helps pump blood downstream during diastole.

Answer 5

They would have a very wide pulse pressure. Systolic would be very high, and diastolic pressures would be very low. When fluid is put into a container with no give, it takes a lot of pressure which elevates systolic pressure. When fluid is not being put into a stiff container, the pressures are very low.

Answer 6

Not really.. veins are very stretchy and accommodate lots of extra blood/fluid. Veins don't really have a pulse pressure.

Answer 7

Tight walls + High SV = wide pulse pressure. In general, increasing SV increases pulse pressure, vice versa.

Answer 8

Number 1 reason for low pulmonary pressure is that the vascular resistance is low.

Answer 9

Compliance. Can use the term in blood vessels within the heart and lungs, as well as the airway.

Answer 10

Some change in volume over change in pressure. (ΔV/ΔP) = Compliance

Answer 11

High number = more compliant Low number = less compliant

Answer 12

ΔP/F ΔP is the change in pressure F is blood flow example: (100-0mmHg)/(5L/min) = vascular resistance, or SVR if we use a conversion factor

Answer 13

Between 800-1600 (he didn't say units, may or may not need this, it was in passing)

Answer 14

Cardiac output

Answer 15

Venous return Can't pump what isn't there

Answer 16

Left ventricle.

Answer 17

Pressure slightly exceeds aortic pressure. This allows blood to flow into the aorta during systole.

Answer 18

Right ventricle - allows for the same mechanics as the left ventricle/aorta.

Answer 19

Thick walls with small openings. This is due to high resistance from vascular smooth muscle within the arterioles.

Answer 20

Wider internal diameter, stretchy, accommodates lots of volume. There is a small smooth muscle layer, but much thinner than what is seen in arterioles.

Answer 21

Thin endothelial cells that make up capillaries.

Answer 22

Wide opening; thick wall

Answer 23

In a healthy adult, yes. As we age, the aorta becomes less stretchy and more rigid.

Answer 24

5L/min Flows through the entire system.. aorta, capillaries, vena cava, etc. All areas get 5L/min output.

Answer 25

CO = SV x HR

Answer 26

Cross sectional area i.e., we have one aorta, but have two vena cava.. thus a larger cross sectional area in the vena cava, resulting in a slower blood flow/velocity within the vena cava.

Answer 27

V = F/A V = velocity F = flow A = cross sectional area

Answer 28

Increase velocity

Answer 29

Increase velocity

Answer 30

Arterial end

Answer 31

Venous end

Answer 32

Capillaries generally are permeable to electrolytes, glucose, nutrients, gasses etc.

Answer 33

The lymphatic system.

Answer 34

Blood and water are heavy in a column.

Answer 35

It is the point in the body that there is no effect on pressure from gravity. It is located in the middle of the tricuspid valve.

Answer 36

Phlebostatic axis

Answer 37

These vessels are rigid, have meninges/connective tissue supporting them. They are not very compliant. Yes; if exposed to open air, air would be sucked into the CV system and cause an air embolism.

Answer 38

If they were below 0mmHg, they would collapse. They are very wide, and also very thin walled. They are very compliant.

Answer 39

+6-8mmHg in the upper arms both in the veins and arteries while standing. Important because sitting BP in the arm will be slightly higher than true BP.

Answer 40

0mmHg - no gravity effects in a supine patient, no pressure difference

Answer 41

One way valves; act as shelves to limit effect of gravity on pressure. Skeletal muscle contraction also helps move blood to the heart.

Answer 42

They wear down and don't function properly over time. This results in varicose veins, which is mostly aesthetic. However, it can increase the risk of blood clots.

Answer 43

Not very much effect - will see normal pressures. (i.e. foot would not be +90mmHg from isogravimetric point)

Answer 44

Compression, AKA skeletal muscle contraction

Answer 45

There are no valves in arteries, so the pressure of a given artery is the following: Pressure of what is coming from the heart + effects from gravity = significantly elevated BP i.e., in the foot there would be 100mmHg + 90mmHg = 190mmHg pressure.

Answer 46

There is a decrease in cardiac output due to less venous return. Blood pools in the legs.

Answer 47

They would quickly pass out because there is no muscle activity to move the blood around. This is what happens in surgery.

Answer 48

ΔV/ΔP Lungs

Answer 49

Distensibility takes into account the original volume of a container.

Answer 50

Expandable

Answer 51

Descriptor of how difficult it is to move something from one point to another.

Answer 52

Resistance

Answer 53

Tissue metabolism to replenish what is being used by the cells. Resistance is changed, this impacts flow. Resistance is the single most important variable.

Answer 54

F = (πΔPr4)/(8n1) Note: the 4 is supposed to be an exponent but I can't type it. Therefore, resistance and flow are related to diameter to the 4th power.

Answer 55

A huge change

Answer 56

V=IR Voltage = current x resistance

Answer 57

ΔP = F x R Change in pressure = Blood flow x Vascular resistance

Answer 58

It goes way up (less compliant).

Answer 59

It hardly goes up at all (more compliant).

Answer 60

Venous system; highly compliant

Answer 61

Arterial system; lower compliance

Answer 62

Pressure; Volume

Answer 63

Significantly lower; Arterial pressure is highly dependent on SNS tone. Venous pressure also drops with sympathetic inhibition.

Answer 64

Use expanded venous pressure to help return blood to the heart, which then gets pumped by the heart and can help raise pressure.

Answer 65

Hypothetical number (No units) when above 2000 it indicates there is going to be turbulent flow

Answer 66

(V x D x P) / n

Answer 67

V = velocity increased velocity increases the risk for turbulent flow

Answer 68

D = diameter increased diameter increases the risk for turbulent flow

Answer 69

P = density increased density increases the risk for turbulent flow

Answer 70

Aorta & large arteries

Answer 71

Velocity is so slow

Answer 72

Filling phase -- most filling is passive

Answer 73

End Systolic Volume (ESV)

Answer 74

Atrial contraction

Answer 75

25% or greater

Answer 76

The ventricle has difficulty filling and relies on atrial contraction forcing the blood into the ventricle while a healthy heart has no issue filling passively

Answer 77

The heart begins to contract, pressure in the ventricle begins to increase enough to close mitral valve but not enough to over come aortic valve --> both mitral & aortic valve are closed at this point

Answer 78

End diastolic volume (EDV)

Answer 79

Isovolumetric Contraction

Answer 80

Ventricular contraction -- pressure in the ventricle exceeds the pressure in the aorta & ejection occurs

Answer 81

The difference between the ventricular volume at the end of diastole & the end of systole EDV - ESV = SV

Answer 82

120 - 50 = 70mL Normal SV = 70 mL

Answer 83

The aortic valve closing due to pressure in the ventricle being lower than the pressure in the aorta

Answer 84

Isovolumetric Relaxation

Answer 85

The pressure in the ventricle is still too high post systole

Answer 86

The pressure in the ventricle must be lower than the pressure in the atria -- normal left atrial pressure is 2mmHg -- left ventricle must have a pressure lower than 2mmHg

Answer 87

Tricuspid valve. Isogravimetric point.

Answer 88

Relationship between valves, ventricular pressure, atrial pressure, chamber volumes, electrical activity, and sounds of the heart. Be able to draw this for the test.

Answer 89

Venous return

Answer 90

Venous return is reduced (which would then reduce CO without other changes).

Answer 91

Larger ΔP, resulting in increased venous return. No - RA pressure -4 mmHg through 0mm Hg is considered the transitional zone. The lower pressure becomes in this range, the higher venous return. Anything below -4 mmHg results in a plateau of venous return at 6L/min. Large veins can collapse from being in a vacuum as well.

Answer 92

ΔP ΔP = Average pressure in CV system - right atrial pressure (which is the end of the CV system)

Answer 93

Mean Systemic filling pressure (PSF)

Answer 94

Sum/average of all blood vessel pressures within the CV system.

Answer 95

Veins - while they have low pressure, they have significantly more volume than arteries.

Answer 96

Beginning of the CV system - end of CV system OR mean systemic filling pressure (PSF) - RA pressure (CVP) OR 7 mmHg - 0 mmHg = 7mmhg Normal ΔP of a healthy CV system is 7 mmHg

Answer 97

7 mmHg - this is also the mean systemic filling pressure (PSF).

Answer 98

Harder for filling

Answer 99

Tightening up veins/arteries. Contracting systemic veins - hold most of our volume.

Answer 100

Significant increase in pressure due to large volume of veins + arteries are relatively stiff but receive venous volume. This results in a large pressure increase.

Answer 101

Describes how easy it is for the blood to get back to the heart.

Answer 102

SNS is knocked out - this results in lack of venous squeeze, which returns a large portion of blood to the veins. In doing so, pressure drops within the arteries significantly.

Answer 103

Lower resistance to venous return, which increases venous return higher than the max of 6L/min, therefore allowing for an increase in CO.

Answer 104

Higher resistance to venous return, resulting in less venous return. This further results in a decrease of cardiac output. Maybe there is an obstruction.

Answer 105

ΔP increases, resulting in higher venous return. This increases cardiac output.

Answer 106

It is also doubled.

Answer 107

It is also halved.

Answer 108

CVP (central venous pressure) Note: If measured close to the right atrium, they will be more or less the same. If measured far from the right atrium (like in a central line port), the CVP would be significantly higher than the RA pressure.

Answer 109

- Blood volume - Venous tone (remember, veins are a large container.. a change of resistance here can result in a large increase of volume in the arteries, which are a rigid container. This results in a large arterial pressure increase for a small resistance change in the veins).

Answer 110

Intrathoracic pressure is increased. If nothing is changed, this results in decreased venous return due to collapsed veins, which then decreases cardiac output. ^ squeeze veins in increase internal pressure or add volume to the patient to overcome this

Answer 111

Both, left and right

Answer 112

Condition of circulatory system (venous return) The heart (pumping function)

Answer 113

Cardiac output/venous return

Answer 114

Moderate increase in cardiac output. i.e. if RA pressure was 2 mmHg, CO would be 13L/min.

Answer 115

CO would go up a very small amount

Answer 116

Much higher cardiac output

Answer 117

Pumping effectiveness is reduced. While there would be an increase in CO with increased RA pressure, it wouldn't be nearly as high of a cardiac output as with normal sympathetic stimulation due to the lack of cardiac function.

Answer 118

Ventricular walls in a normal heart are a little under stretched. Increasing filling pressure stretches (within reason) and better aligns cross bridges, allowing for better pumping.

Answer 119

1 - Frank starling mechanism 2 - Direct atrial stretch 3 - Bainbridge reflex

Answer 120

Property of the conduction system of the heart that does not require any other input from anywhere else in the body. When atria are stretched, HR increases by 10-15% of normal. Contractility is also increased, but daddy says focus on HR. This allows for accommodation of extra venous return, resulting in increased cardiac output.

Answer 121

When atrial stretch is sensed by the heart, it sends afferent signals to the brainstem, which then increases the sympathetic output of the cardiac SNS nerves and decreases PNS output. This results in an increase in HR by 40-50%. Requires signal to be sent to brainstem unlike direct atrial stretch which works purely from the heart.

Answer 122

Vagus nerve

Answer 123

c3-c5; Diaphragm

Answer 124

Vagus nerve

Answer 125

S2-S4; Urination and defecation, can cause incontinence with prostate surgeries due to accidental snipping

Answer 126

Bainbridge reflex (40-50% increase in HR)

Answer 127

23L-25L/min

Answer 128

Increased SNS outflow Decreased vagal tone (decreased PNS output)

Answer 129

The heart is pumping hard at an increased rate, this decreases RA pressure which increases ΔP (mean systemic filling pressure [PSF]) and helps increase venous return/cardiac output. Reminder: PSF = average CV pressure - RA pressure OR 7 mmHg - 0 mmHg

Answer 130

HR is slower, less pumping action, pressures are higher. This decreases ΔP (mean systemic filling pressure [PSF]) which decreases venous return/cardiac output. Reminder: PSF = average CV pressure - RA pressure OR 7 mmHg - 0 mmHg

Answer 131

15 degree line roughly as drawn in class. A significantly high CVP would be needed to meet 5L/min. This may need to be done artificially (i.e. meds) to maintain life.

Answer 132

It takes time for calcium to bind & the entire process to occur, so we see a delay between electrical changes & physical changes

Answer 133

When the aortic valve closes at the beginning of phase 4 or at the end of phase 3

Answer 134

At the end of phase 1 at the EDV

Answer 135

The contraction of the atria

Answer 136

The first 1/3 of phase is when most of the filling takes place

Answer 137

The blood is built up behind the atria & once the AV valve opens blood floods into the ventricle

Answer 138

Not much filling occurs as most of the blood was filled into the ventricle during the initial part of phase 1

Answer 139

The ventricle gets a little bit of extra filling from atrial contraction

Answer 140

A stenotic mitral valve would lead to slower filling from the atria to the ventricle, if the patient were to become tachycardic cardiac output may drop as there isnt enough time for the ventricle to fill

Answer 141

when the aortic valve first opens

Answer 142

at the peak of phase 3

Answer 143

Metabolic rate

Answer 144

Cardiac index takes into account body surface area

Answer 145

Decrease CO - tissue do no need as much blood flow so arteries will constrict decreasing CO

Answer 146

CI = (SV x HR)/BSA

Answer 147

L/Min/m2 2 = exponent

Answer 148

1.7 meters squared is the normal BSA

Answer 149

Male No - women in late pregnancy have an increased metabolism d/t fetus, which increases Cardiac Index (CI) as a result.

Answer 150

Age 10 4L/min/m2 Daddy says he expected birth to be higher since our metabolism is really high, but turns out from birth to 10y/o our cardiac index increases quickly

Answer 151

Naturally reduces as we get older.

Answer 152

2.4L/min/m2

Answer 153

It will decrease d/t lower metabolic needs

Answer 154

Reduction of metabolic rate --> Reduces CO

Answer 155

Increase of metabolic rate --> Increases CO (by reducing SVR)

Answer 156

CO is reduced

Answer 157

Increases CO by reducing SVR

Answer 158

Less available blood vessels --> Higher SVR since there are less paths of flow for the blood

Answer 159

Vitamin B1 deficiency that impacts the way cells use energy.. makes the cell less efficient, thus increases metabolism. Only really seen in 3rd world countries, not really here.

Answer 160

There are extra paths for blood vessels to take within circulation. This results in a lower SVR. Lower SVR --> Increased CO

Answer 161

Both pressures must be met to have a great CO.

Answer 162

Blood will buildup somewhere; blood will also be absent from filling pressures.. results in lower CO

Answer 163

Low resistance of the pulmonary circuit.

Answer 164

LV does more work because it pumps against a high pressure gradient in the aorta, compared to the RV pumping to a low resistance pulmonary circuit.

Answer 165

CVP will be slightly higher. This is due to the inferior vena cava being slightly inferior in position to the RA in a supine position. Gravity changes CVP in this scenario.

Answer 166

There needs to be a pressure gradient for blood to return to the heart.

Answer 167

LVAD/RVAD/BIVAD, drugs (the good kind) - bridge to keep someone alive until it can heal itself or be repaired.

Answer 168

It will increase vascular resistance & decrease CO - the body will have less tissue to care for --> body doesnt need as much CO --> increase in vascular resistance --> decrease in CO

Answer 169

Decrease vascular resistance & increase CO - increased demand of blood flow by tissues --> decrease in arterial vascular resistance --> increase in CO

Answer 170

Vitamin B1 deficiency -- impacts the way cells use energy by making them less efficient

Answer 171

Decreases vascular resistance & increases CO - cells become less efficient & require more blood flow --> decrease in arterial vascular resistance --> increase in CO

Answer 172

an extra connection between the arterial & venous system

Answer 173

Decreases vascular resistance & increases CO - extra connection or pathway for blood to flow in a parallel system decreases vascular resistance --> increasing CO

Answer 174

They increase metabolic rate

Answer 175

Arterial vascular resistance will decrease as blood flow demand is increased & the veins will constrict which will increase CO

Answer 176

Increased filling pressure - will have increased CVP/RA pressure.

Answer 177

It goes down.

Answer 178

Increase of filling pressure Squeezing veins helps move volume back to the heart --> increases CO/helps forward flow

Answer 179

Normal BP with high CO (d/t low resistance to venous return since there is an additional path for blood to flow)

Answer 180

PEEP (increased intrathoracic pressure)

Answer 181

Heart eventually doesn't receive the nutrients it needs to survive. Heart relies on the aorta (diastolic squeeze) to perfuse the coronary arteries. If this doesn't happen d/t low pressures, the heart doesn't get nutrients and begins to die (MI), then you die without intervention. If we step in in the early stages of bleeding, this can be avoidable.

Answer 182

The arteries will dilate however the veins will not constrict so filling pressure will drop & arterial pressure will crash due to lack of blood return to the heart from the veins --> CO will decrease

Answer 183

Between lungs and chest wall

Answer 184

As the diaphragm moves down, it creates a negative pressure within the lungs. This draws outside air into the lungs.

Answer 185

-4mmHg (-5cmH2O)

Answer 186

CO is increased due to negative pressure within the pleural space

Answer 187

Abdominal contraction

Answer 188

Decreased CO (Need higher RA pressure to achieve the same CO

Answer 189

Trauma/surgery (opening chest to the outside environment) Reduces CO

Answer 190

Increases mean systemic filling pressure (PSF), which increases the slope of the venous return curve --> normal cardiac output. aka, tightens up system or adds volume via kidneys to maintain normal CO

Answer 191

Cardiac tamponade

Answer 192

Reduction in filling --> CO decreases until death

Answer 193

Get rid of the fluid around the heart --> fixed

Answer 194

Lower max CO than normal, but RA pressure of 0mmHg would net you the max (6L/min). CO curve shifted to the left

Answer 195

CO curve shifted to the right - Max CO is higher than normal Need more RA pressure to maintain CO

Answer 196

Decreased - d/t more blood being pumped away.

Answer 197

Increased - d/t blood being left behind and backing up

Answer 198

Cardiac output would increase due to improvement of the circulatory system

Answer 199

- SVR is governed by the arteriole. - Relaxed arterioles --> choke point less choked, resulting in reduction of arterial pressure, and increase of venous pressure --> results in a lower resistance to venous return, and a higher RA pressure which helps drive CO increase

Answer 200

ACE inhibition

Answer 201

Afterload reducer

Answer 202

Nitroglycerin

Answer 203

Large reduction in filling pressure (container is stretchy, fills with blood and removes it from the tight container [arteries]), which reduces ΔP, and thus reduces cardiac output. There is no change to resistance to venous return (slope).

Answer 204

Not really.. Cardiac output must venous return. If the venous return is reduced, the CO will not be improved much with increased SNS stimulation.

Answer 205

Preload - it reduces the amount of blood going back to the heart

Answer 206

Reduces cardiac output --> reduction in metabolism --> preserves heart tissue that may be ischemic/infarcting Caveat: Need enough BP/CO to maintain life, can't dose too high, patient dependent.

Answer 207

No. It is a preload reducer (venular-specific vasodilator) that reduces cardiac demand until the pathology can be corrected.

Answer 208

- Reduced filling pressure d/t venodilation - Reduced resistance to venous return d/t arteriodilation (dilation of arteries reduces resistance to venous return and helps blood get to the other side of the heart)

Answer 209

Reduction in filling pressure + reduction of resistance to venous return gives us a mixed result in effect.

Answer 210

Filling pressure

Answer 211

Reduction of filling pressure - that is why giving a mixed vasodilator reduces cardiac output even though resistance to venous return is lower.

Answer 212

Filling pressure

Answer 213

Changing volume or changing tightness of the venous container

Answer 214

No - the path that blood takes to get back to the right side of the heart is unchanged.

Answer 215

Compliance (venous); measure of stretchiness.

Answer 216

Increases filling pressure; volume is squeezed out of veins to return to the heart.

Answer 217

PSF would be lower; resistance to venous return remains the same.

Answer 218

Change in filling pressure would result in a large cardiac output change

Answer 219

SVR is increased, and mean systemic filling pressure (PSF) remains the same. Resistance to venous return is increased. Ultimately, cardiac output max will drop here due to the drop in venous return. BP remains about the same.. the pressure upstream will be higher, downstream will be lower. Overall, it's a wash.

Answer 220

SVR is decreased, and mean systemic filling pressure (PSF) remains the same. Resistance to venous return is decreased. Ultimately, cardiac output max will increase here due to the increase in venous return.

Answer 221

Increases PSF

Answer 222

Reduces slope of venous return curve.

Answer 223

Arterial constriction.

Answer 224

venous vasoconstriction

Answer 225

Increased filling pressure --> Increased CO

Answer 226

Shunting blood away from where it's not needed.

Answer 227

SVR increases, which decreases the slope of the venous return curve.

Answer 228

Return more blood to the heart.

Answer 229

Instead of constricting veins to get improved venous return, the kidneys do the following - Long term: The kidneys expand blood volume. Short term: High levels of catecholamines. By expanding volume, patients with heart failure don't have to live with high levels of catecholamines.

Answer 230

Hydralazine

Answer 231

The CO would decrease as the heart is not able to pump adequately & the RAP would increase do to the hearts ineffective pumping

Answer 232

The SNS is stimulated & releases catecholamines that increase venous tone which in turn increase filling pressure --> increases CO RAP remains high as the heart is still inadequately pumping

Answer 233

By telling the kidneys to retain volume --> expands blood volume

Answer 234

Both RAP & filling pressure will be elevated and act as the new normal to maintain adequate CO

Answer 235

Arrhythmias - calcium channels can open prematurely due to high SNS

Answer 236

Pts become volume dependent to maintain adequate CO -- excess volume results in higher RAP & filling pressures

Answer 237

Contractility

Answer 238

expect to see increased filling pressure --> increase in EDV --> increased SV --> increased BP

Answer 239

Less filling & less volume in the ventricle at the end of diastole --> leads to reduction in stroke volume d/t reduction in EDV

Answer 240

an increased afterload means the diastolic pressure will be higher & the heart will have to generate a higher pressure to open the aortic valve

Answer 241

- The heart will spend more time in phase 2 trying to generate enough pressure to open the aortic valve that phase 3 will be shortened - a higher afterload will also close the aortic valve sooner which further decreases time spent in phase 3 - this will ultimately decrease SV

Answer 242

The visceral layer - apart of the serous - thin transparent membrane - allows the heart to move without friction

Answer 243

Parietal layer - glued to fibrous layer - helps heart slide

Answer 244

Fibrous pericardium - rigid, tough, thick layer

Answer 245

Gap junctions

Answer 246

Cusps or leaflets

Answer 247

valves are attached to chordae tendinae which is attached to papillary muscle which are a continuation of the ventricular muscle - The papillary muscle prevents the valves from being blown back into the atria & they contract with the ventricle

Answer 248

58% 70/120 = 0.58 x 100 = 58

Answer 249

The cardiac cartilaginous ring

Answer 250

Bundle of his

Answer 251

Mitral - called the commissural cusp -- part of the posterior cusp

Answer 252

The right cusp of the aortic valve

Answer 253

The left cusp of the aortic valve

Answer 254

The left anterior descending & the circumflex arteries

Answer 255

runs down the front & middle of the heart

Answer 256

runs down the side & back of the heart

Answer 257

Posterior descending artery - in some people the PDA is a branch of the LCA

Answer 258

The great cardiac vein

Answer 259

The coronary sinus comes off the great cardiac vein & empties into the RA - it carries deoxygenated blood to be returned to the lungs

Answer 260

during systole --> but pretty much continuous throughout the cardiac cycle

Answer 261

during diastole

Answer 262

Early systole as the coronary arteries & nice & plump from receiving blood during diastole then the pressure in the ventricles increases during systole which causes blood to move back & read as a negative pressure

Answer 263

It reduces time spent during in diastole --> reduces coronary perfusion time & less filling time

Answer 264

High energy expenditure + cardiac remodeling Drop BP to make demand lower

Answer 265

ACE inhibitors, Hydralazine

Answer 266

Diastolic pressure = after load Decreased after load = lower diastolic pressure Aortic valve will open/close at lower pressures Allows for longer phase 3 time, which increases SV

Answer 267

Increased time in phase 1 & 3 Decreased time in phase 2 & 4 Increase of SV in phase 3 Lower ESV d/t higher SV HR will decrease

Answer 268

Decrease HR - reducing after load will increase SV. To maintain the same CO, HR must drop

Answer 269

Measure of heart squeeze, depicted by diagonal line on pressure/volume curve on the top left. The steeper the line, the more contractility.

Answer 270

SV will also increase. More squeeze = more ejected ESV will be lower (Higher SV = Lower ESV) EDV will be normal

Answer 271

Also decreases SV assuming preload/afterload remains the same. Decrease in SV = Increase in ESV

Answer 272

Given that the SV will be lower, if HR is not increased, there will be a reduction of CO

Answer 273

HR will rise to maintain CO

Answer 274

Bloop pressure

Answer 275

Blood moves backwards from the LV to LA. LA will be filled by both LV and the pulmonary system. Occurs when pressure is higher in ventricle than the atria (assuming valve is insufficient). Normally, there is no back flow.

Answer 276

It flows backwards and forwards. The pressure in the atria is less than the ventricles, so back flow occurs.

Answer 277

The beginning of P4. This is due to high ventricular pressures with low atrial pressures. blood follows the gradient until the ventricle is more relaxed in late P4

Answer 278

P2, 3, and 4 Lower ESV, higher EDV

Answer 279

Straight vertical. These are isovolumetric phases (no volume change normally).

Answer 280

There is a valve problem, specifically regurgitation/insufficiency.

Answer 281

The valve doesn't open fully, so there is a problem with ventricular filling. Note: This is a filling problem without compensation that reduces SV d/t reduced filling during diastole. The body compensates, but eventually will be come an issue (later flash cards)

Answer 282

EDV - lower d/t problem filling SV - reduced since there is not enough "gas in the tank" HR - will have to increase to make up the difference to maintain CO

Answer 283

Increase filling pressure Increase atrial pressure Increase blood volume Increase preload ^Helps with filling, but note that this extra pressure will be sitting in the LA/lungs. Note that on a pressure/volume curve that this won't be seen unless it is a atrial graph unlike the ventricular one in our pptt.

Answer 284

Pulmonary HTN/edema with impaired gas exchange d/t high LA/lung pressure from increased filling pressure/volumes.

Answer 285

Blood is moving backwards from the aorta to the LV Expect blood to move backwards when the valve is closed & when aortic BP is higher than LV pressure

Answer 286

The end of P4/beginning of P1 will have the most back flow into the ventricle. The pressure in the ventricle is the lowest at this point, so there is a wider pressure gradient, allowing for greater back flow. Note: There is back flow any point where ventricular pressure is less than aortic pressure.

Answer 287

There is filling from both the aorta AND the atria, leading to a much higher EDV, and a larger SV as well. Eventually, this will lead to dilated ventricular walls, which will cause the valves to function even worse.

Answer 288

Ventricular dilation/stretching. Higher EDV is helpful early on as it helps increase SV to make up for backward flowing blood, but overtime it leads to poor function from dilation.

Answer 289

regurgitant

Answer 290

Higher, to accommodate elevated SV.

Answer 291

High cholesterol; infection on valves

Answer 292

Aortic valve stenosis

Answer 293

Harder to get blood through aortic valve. Reduction in ejection time Reduces SV Increases ESV Very slight increase in EDV Longer P2 d/t increased pressure requirement to get through the aortic valve, resulting in a shorter P3/P1

Answer 294

Like a high after load issue

Answer 295

No - the valve is a place of high resistance. An area after a place of high resistance will have a lower pressure. The MAP may even be normal in the aorta.

Answer 296

Increased HR to maintain CO.

Answer 297

It is increased significantly. If the heart struggles to maintain CO, volume is expanded. This is helpful early on (high filling pressure), but overtime it will lead to wall thickening. This will increase filling pressure requirement.

Answer 298

Narrowed pulse pressure.

Answer 299

It depends on the severity of the stenosis. The pressure in the aorta may be so low that the aortic valve may open prematurely.

Answer 300

Contractility slope is decreased (less contractility) Greater ESV Lower SV Higher HR to allow for normal CO/relatively normal BP

Answer 301

Reduce the oxygen demand/energy requirements by: Treating with an after load reducer results in greater SV, and reduced ESV.

Answer 302

Increases lots to maintain cardiac output. Volume is expanded after healing from an MI. Careful when removing volume from these patients. They are volume dependent.

Answer 303

Dilation of the heart - harmful

Answer 304

Bicuspid AKA mitral (two leaflets; anterior and posterior)

Answer 305

Tricuspid (three leaflets) Anterior, posterior, and septal cusps

Answer 306

The septal cusp

Answer 307

Diastole Coronary blood flow is dependent on resistance, resistance being a function of ventricular pressures. Pressures are lowest in diastole, meaning more blood can flow through the coronary arteries

Answer 308

Stenosis - ventricular pressures are much higher here, leading to increased resistance within the walls of the ventricle. This leads to less blood flow from the coronary arteries.

Answer 309

For ejection to occur, ventricular pressure has to be higher than aortic pressure. This high ventricular pressure "squeezes" the blood out of the coronary arteries and dumps it back into the aorta. ^So yes. Delta P is negative during systole in the coronary arteries

Answer 310

SNS - Knocks out a lot of SNS chains Heart - activity reduced d/t SNS chains being knocked out, but not very much given the SNS doesn't do all too much for us HR wise. Circulation - filling pressure will be lower d/t lower HR/SNS. Overall: If we have normal circulation with a small reduction in pumping effectiveness from spinal anesthesia, CO will only decrease to around 4.8L/min.. not really a big deal. Not a heart problem. It is a circulatory problem (lack of filling pressure).

Answer 311

Contraction of the atria (peak systolic of the waveform usually)

Answer 312

Backward bulging of the AV valves (small notch after the A wave)

Answer 313

Once valves stop bulging backwards, the atria is empty. This reduces atrial pressure, producing a downstroke on the waveform that is X

Answer 314

Blood buildup in the atria early in diastole

Answer 315

Just after the V wave, it is a result of blood going through the open AV valve. AV valve being open = Y descent.

Answer 316

A, C, X, V, Y Daddy said ignore the H wave

Answer 317

Decreases thoracic pressure, which helps CO due to drawing blood into the chest

Answer 318

Increases d/t abdominal muscle contraction. Reduces CO d/t decreased venous return.

Answer 319

The pressure within the veins decreases, as well as the pressure around them which makes the pressure even lower. Because of this, more blood is pulled into the thorax.

Answer 320

The drop in thoracic pressure allows for veins to be filled with blood first, THEN the heart. Note: the initial pressure drop can pull blood from the right atrium as well until the blood can return from the veins.

Answer 321

A beat or two, then CO will increase once blood makes it from the veins to the heart.

Answer 322

Right sided Afterload decreases (lower pulmonary resistance)

Answer 323

Yes, HOWEVER The initial CO drop will be much greater in the left side than the right side. This is due to the LV pumping to the aorta, which is not impacted by inspiration. There is no left side after load change. The only change is a decreased LA preload.

Answer 324

Left side definitely drops Right side probably drops, but maybe increases depending on who you ask

Answer 325

800-1600 dynes x sec/cm5

Answer 326

40-180 dynes x sec/cm5

Answer 327

Centimeters grams seconds; unit of measurement with hemodynamic values

Answer 328

Dynes x sec/cm5

Answer 329

Lower end of normal - lower SVR that way nutrients can make it to the site that it is needed. Lower SVR allows for more blood flow. Higher metabolism reduces SVR to allow for more blood flow.

Answer 330

(Beginning of CV system - end of CV system)/ 5L/min (100mmHg - 0mmHg)/ 5L/min = 83.3mL/sec He then said we'd round this to 100mL/sec to make it easy AKA (100mmHg - 0mmHg)/ 100mL/sec = 1PRU

Answer 331

PRU x 1333 = CGS

Answer 332

The 2nd third of diastole. The majority of filling happens in the first third of diastole, and the last third is atrial kick (~10mL). Not much filling occurs in the second third of diastole. This allows for increased HR.

Answer 333

The coronary arteries are perfused during diastole. Higher HR --> Less time in diastole --> Less coronary artery perfusion time. This can be a concern with a sick heart.

Answer 334

Coronary perfusion. Not so much on filling

Answer 335

No. The bulge is what the C wave it on a CVP waveform.

Answer 336

(16mmHg - 2mmHg)/ 100mL/sec = 0.14 PRU

Answer 337

Pulmonary PRU is about 1/7th of the systemic circulation. Multiplying 0.14 by 7 should give us the vascular resistance of the systemic circulation

Answer 338

When the RCA splits into the PDA - this occurs in about 75% of folks

Answer 339

When the Circumflex artery splits into the PDA - occurs in about 15% of people

Answer 340

The filling pressure will be increased as the ventricular compliance is reduced

Answer 341

The filling pressure is decreased as ventricular compliance is increased

Answer 342

AS & uncontrolled HTN

Answer 343

They do not have the starling component so their ventricles can not accommodate to an increase in venous return & rely on increasing HR

Answer 344

AV valves closing - valves vibrate & bulge back into atria producing sound

Answer 345

1st heart sound 0.14 sec low pitch

Answer 346

Beginning of systole

Answer 347

Closure of the pulmonic & aortic valves

Answer 348

0.11 sec & high pitched

Answer 349

The pulmonic valve staying open longer than the aortic valve on deep inspiration due to the afterload being reduced for the ride side of the heart but not the left side

Answer 350

Atrial contraction - not normally heard in a healthy pt -- exaggerated when the atria has to work harder

Answer 351

a low compliance ventricle --> the ventricle fills after as the walls are thickened & require more pressure to fill to a normal volume

Answer 352

HF or kids

Answer 353

Early diastole

Answer 354

loudest at the end of diastole

Answer 355

Early systole

Answer 356

Medial right sternum - 2nd intercostal space

Answer 357

Medial left sternum - 2nd intercostal space

Answer 358

Medial left sternum - 5thintercostal space

Answer 359

Lateral left sternum - 5th intercostal space

Answer 360

Anastomosis

Answer 361

The sub endocardial coronary arteries in LV

Answer 362

sacromeres stacked in parallel

Answer 363

sacromeres added in series

Answer 364

ACE inhibitors

Answer 365

it is difficult to quantify thyroid hormone it is a fat soluble hormone that hides in plasma proteins

Answer 366

Unexplained high HR at rest with no other comorbidities

Answer 367

T-3 -- has 3 iodides attached to a tyrosine T-4 -- has 4 iodides attached to a tyrosine

Answer 368

T-4 -- 93% T-3 -- 7%

Answer 369

Thyrotropin releasing hormone (TRH) Goes to anterior pituitary which releases Thyroid stimulating hormone (TSH) Which goes to thyroid and thyroid releases T3/4

Answer 370

Thyrotropin

Answer 371

Anterior pituitary gland -- adrenohypophysis

Answer 372

Hypothalamus

Answer 373

Thyrotropin releasing hormone (TRH)

Answer 374

Parathyroid

Answer 375

Calcium levels in blood

Answer 376

Triidothyronine

Answer 377

Vagus nerve

Answer 378

Recurrent laryngeal nerve

Answer 379

Catches a ride on plasma proteins -- TBG (thyroxine binding globulin), thyroxine binding pre-albumin & albumin - all three plasma proteins are produced by the liver

Answer 380

SVR decreases to increase flow to vessels but HR increases as well so BP essentially does not change

Answer 381

Pituitary would increase its release of TSGH --> which would act on Thyroid to release more thyroid hormone

Answer 382

The hypothalamus would stop releasing TRH

Answer 383

Hypothalamus would stop releasing TRH & pituitary would slow the release of TSH

Answer 384

The hypothalamus would release an excess of TRH --> which would act on pituitary to release excess TSH --> TSH TSH would act on thyroid to release more thyroid hormone - there is nothing to combat the hypothalamus

Answer 385

Superior & Inferior

Answer 386

3 Anterior Middle Posterior

Answer 387

Whatever is in front of the heart

Answer 388

This section is the meat and potatoes - it has most of the "stuff" in it. - Heart - Pericardium - Ascending aorta - Superior vena cava - Pulmonary trunk - Pulmonary arteries/veins - Pericardiophrenic nerve

Answer 389

- Abdomen (biggest part of this section) - Esophagus - Thoracic aorta - Vagus nerve (can be here, or in the middle section) - Azygos vein - Hemizygos vein - Thoracic ducts NOTE: Lymph dumps content to venous system - these vessels combine with veins in the posterior mediastinum. Don't need to locate this, just know it.

Answer 390

- Responsible for sensory perception in the pericardium - Supplies enervation to diaphragm

Answer 391

Pericardiophrenic nerve (has blood vessels within middle section of the inferior mediastinum that supply it)

Answer 392

- Thoracic part of the trachea - Thoracic part of the esophagus

Answer 393

Back of chest cavity next to vertebra

Answer 394

Closure of the pulmonary and aortic valves

Answer 395

Based on pressure differential; both have a slightly different pressure differential.

Answer 396

Makes the pressure differential more obvious - left sided afterload will not be impacted as it is aortic, but right side afterload is reduced. Regardless of output of the right side of the heart, this will cause the pulmonic valve to stay open a little longer than the aortic valve on deep inspiration.

Answer 397

The pulmonic valve staying open a little longer than the aortic valve due to change in pressure differentials.

Answer 398

Not really We use a phonocardiogram, which allows us to identify the sounds a bit better. They can be out of our ability to hear naturally.

Answer 399

20Hz - note, some heart murmurs are lower pitched than this, which is why we need a phonocardiogram to hear heart sounds sometimes. We lose this ability (hearing high/low) as we age

Answer 400

It acts as a spring and overdamps the waveform. The bubble compresses when pressure goes up. No dicrotic notch will be seen. Note: Blood clots in art line will do this as well.

Answer 401

Gain on amplifier may not be turned up enough. The bubble will look the same as if the gain was too low - troubleshoot your lines.

Answer 402

Many - they are artifacts due to the gain on the amplifier being turned too high

Answer 403

Physiologic (good, think circle of Wilis, want extra options for blood flow in critical areas) Nonphysiologic - doesn't really matter Doesn't exist in everyone, but maybe more common than we think. Unknown d/t difficulty and expense of testing required to diagnose.

Answer 404

Posterior PDA comes from the right coronary artery

Answer 405

Larger blood vessels outside/on the surface of the heart.

Answer 406

Epicardial vessels Note: Networked with deeper endocardial and subendocardial coronary arteries

Answer 407

Epicardial

Answer 408

Endocardial/subendocardial vessels Deep left ventricular wall

Answer 409

Ventricular pressure

Answer 410

Subendocardial left ventricular vessels

Answer 411

Left ventricle (especially subendocardial)

Answer 412

Diastole (louder in early diastole)

Answer 413

Much higher V wave

Answer 414

Backup - some helpful, some not so much

Answer 415

Bad valves/heart failure

Answer 416

Chambers of the heart are uncoordinated

Answer 417

Diuretics Reliant on forward flow, but also don't want to dilate the heart. Need to find a fine balance.

Answer 418

Dilation; in sequence Tylerism - if you add things together in a line (sequence), they get long or dilated

Answer 419

Thicker walls/hypertrophy; stacked on top of each other. Tylerism - Stacked things are thicker. Concentric = concentrated. Concentrated things are all on top of each other.

Answer 420

Aortic stenosis Long term untreated HTN

Answer 421

Thick walls are less compliant, which causes a filling problem and diastolic dysfunction.

Answer 422

- Congenital cardiomyopathy - Aortic valve insufficiency - MI

Answer 423

ACE inhibitor - either way patients will die in their mid 20s

Answer 424

Heart patches itself up, but areas with patches don't have as much muscle. That means they will be more likely to stretch out over time.

Answer 425

Heart wall is thinner, leading to harder time pumping with as much pressure or against pressure. Systolic dysfunction.

Answer 426

Heart has trouble producing normal SV/BP.

Answer 427

Sure, but not a horrible one as we have collateral circulation that can help provide nutrients. Depends on the ability of nearby vessels to dilate. If unable to dilate (drop SVR to allow more flow), will be much more likely to have a larger area of infarct.

Answer 428

Pathology such as: - HLD - EToH abuse - DM - HTN - "lots of things"

Answer 429

Fibroblasts

Answer 430

It doesn't know when to stop - will lead to too much scar tissue which adds risk of eccentric LVH (dilated cardiomyopathy) Also can lay down scar tissue onto of functioning muscle tissue, further weakening the heart.

Answer 431

Ace inhibitors - inhibits the growth factor needed by fibroblasts.

Answer 432

Area of ventricular wall not working right (i.e. too much scar tissue, damaged tissue, etc) --> leads to systolic stretch. When the rest of the heart contracts, this area does not. This causes an outward stretch of the nonfunctional area. The area bows out during systole, leading to a lower EF***

Answer 433

An autoimmune disease. The body creates antibodies that activates TSH receptors. This increases thyroid gland activity. Key observations: Goiter, exophthalmos (protruding eyes)

Answer 434

Antibodies in graves disease activate TSH receptors in the thyroid, leading to goiter. (Thyroid produces a ton of thyroid hormone)

Answer 435

Protecting the cornea - if protruding enough, they can be injured.

Answer 436

Some sort of treatment that gets rid of the bad antibodies (i.e. plasmapheresis)

Answer 437

- Unable to produce building blocks for thyroid hormone - Thyroid gland doesn't produce enough hormone - Hypothalamus releases lots of TRH to try to get pituitary to release TSH - Anterior pituitary releases lots of TSH - Thyroid gland cannot make T3/4 because it doesn't have the iodine precursor components Results in goiter. Fix? Have some table salt.. has iodine in it

Answer 438

Body produces antibodies that bind/attack the thyroid gland until total destruction. Starts from irritation of thyroid gland, and is more common in asian populations.

Answer 439

Radioactive iodine. No other part of the body takes up iodine. Small doses over a long period of time get the thyroid activity normalized.

Answer 440

- Interferes with thyroid hormone production (too much traffic of iodine) - Cell system in place to attach iodine to tyrosine gets confused - Similar to redox reactions (i.e. too much oxygen leads to bad results)

Answer 441

Amiodarone can cause this. Amiodarone is packaged in solution with high levels of iodine. Giving too much will drop T3/T4 levels.

Answer 442

Yes - with acute hyperthyroid issues (thyroid storm, brain issues). High iodine in a short period slows production of T3/T4.

Answer 443

- Note that the thyroid uses cholesterol and fatty acids to create T3/T4 - Cholesterol and fatty acid levels will increase (increased risk of atherosclerosis) - Will get tougher, thicker blood vessels - Need to treat promptly to prevent the above

Answer 444

People hate the drug. Messes with sleep/relaxation Causes palpations, anxiety, restlessness in higher doses. Healthy patients generally will take it. Old unhealthy patients are typically not compliant.

Answer 445

Problem getting nutrients required to tissues

Answer 446

- Cardiogenic - Hypovolemic - Neurogenic - Anaphylactic - Septic

Answer 447

A pump problem. If you have an MI, or can't meet CO needs, this will result.

Answer 448

Hypovolemic/obstructive

Answer 449

Caused by most anesthetics, especially volatile Takes SNS offline, which nulls the help from the CV system to keep BP up. Need synthetic catecholamines to help overcome this.

Answer 450

Potential loss of CNS below the level of anesthetic, leading to SNS being offline and drop of BP without synthetic catecholamines.

Answer 451

Reaction from immune system (latex allergy? Peanut? Etc) Body panics and releases histamine from mast cells If there is enough histamine, there is no vascular tone. Big issue with the veins (no venous return, drops filling pressure with a huge CO drop)

Answer 452

Shock caused by bacteria, generally gram +. Blood vessels dilate, making it harder to deliver nutrients to the cells.

Answer 453

Hypovolemic shock - can happen with blood loss or too little volume conservation (i.e. drinking only 8oz of fluid a day)

Answer 454

- Catecholamines released - Kidneys conserve volume - Fluid shifts to maintain CO

Answer 455

5L (hct/plasma) Lots of water in the cells and between them

Answer 456

Non-progressive:Body compensations occur, but body can recover. Progressive: Body compensations occur, but body cannot recover without intervention. (MODS, coronary/kidney/brain/brainstem loss of perfusion)

Answer 457

20% (1L blood loss if healthy)

Answer 458

If you are not near a healthcare facility, you may not be able to live.

Answer 459

- Spleen (Hg/RBC) - Pulmonary system (couple 100mLs) - GI system can shunt where needed More systems online? Easier to recover More systems offline? Harder to fix/survive

Answer 460

No. Arterial BP is a good snapshot of the system, but does not tell you CO. i.e. you can have a normal BP with a blood loss of 20%, but have a reduced CO.

Answer 461

The kidney looks at the BP. When it sees that it is low, it retains fluid and electrolytes to increase preload/RAP. The problem? The kidney doesn't know when to stop, and will keep retaining fluid until it reaches its BP goal (which it might never do, the heart may not be capable of it anymore). Filling pressures can be elevated to a point where it is no longer helpful. Treatment: Give diuretics to maximize the patients CO. If the patient can live at a BP of 80 instead of 100, this may be the better choice rather than killing the patient.

Answer 462

Pulse pressure variation

Answer 463

Daddy says no. We can take what we have available and use the information, but look at the full picture. Good to see BP