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BMSC 207 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Action potentials of smooth muscle can be initiated by____, ____, or _____ simulation

A

neural, hormonal, mechanical

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2
Q

Why is the upstroke slower in smooth muscle action potentials?

A

Because Ca2+ channels propagate the AP instead of Na+

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3
Q

Why is the repolarization slower in smooth muscle action potentials?

A

Because Ca2+ channels inactivate slowly and there is a delayed activation of voltage gated K+ and in some cases Ca2+ - activated K+ channels

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4
Q

Membrane potentials vary in smooth muscle: ____- ____ potentials fire action potentials when they reach threshold, while ____ potentials always depolarize to threshold

A

slow-wave, pacemaker

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5
Q

Smooth muscle cells produce a ___ range of membrane potentials (Vm), and in some smooth muscle Vm oscillations can lead to ?

A

wide, tonic contractions in the absence of action potentials

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6
Q

Action potentials usually do not occur in ______ smooth muscle

A

multiunit

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7
Q

Autonomic neurons create a local depolarization that spreads _______ (graded fashion) throughout the muscle fibre triggering ____ entry

A

electrotonically, Ca2+

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8
Q

Autonomic AP initiation (spikes or plateaus) and spontaneous AP (slow-wave or pacemaker) is considered ? whereas graded potentials are considered ?

A

single unit, multiunit

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9
Q

Contraction due to electrical signaling is known as ?

A

electromechanical coupling

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10
Q

Both _____ entry and _____ release of Ca2+ activate contraction and cytosolic [Ca2+]i is increased by __ different mechanisms

A

extracellular, intracellular, 3

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11
Q

Both extracellular entry and intracellular release of Ca2+ activate contraction and cytosolic [Ca2+]i is increased by three different mechanisms:
1. Ca2+ entry through ___ gated channels or ____ gated ion channels
2. Ca2+ release from the __
3. Ca2+ entry through voltage-______ channels

A
  1. voltage, ligand
  2. SR
  3. independent
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12
Q

? respond to graded stimulation or action potentials, both of which produce an influx of Ca2+ through voltage-gated L-type Ca2+ channels

A

Smooth muscle cells

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13
Q

____ SR in smooth muscle than in skeletal and cardiac muscle

A

Less

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14
Q

Ca2+ release from SR occurs via ___ -induced Ca2+ release and ___ pathway.

A

Ca2+, IP3

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15
Q

IP3 pathway can cause contraction with minimal ______ and negligible extracellular Ca2+ ___

A

depolarization, influx

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16
Q

What are the proper steps in GPCR-phospholipase C signal transduction:
1. PLC converts membrane phospholipids into diacylglycerol, which remains in the membrane, and IP3, which diffuses into the cytoplasm
2. Signal molecule activates receptor and associated G protein
3. DAG activates protein kinase C, which phosphorylates proteins
4. IP3 causes release of Ca2+ from organelles, creating a CA2+ signal
5. G protein activates phospholipase C, an amplifier enzyme

A

2, 5, 1, 3, 4

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17
Q

Depletion of Ca2+ in the SR causes _____of store-operated channels which cause a ____ influx across the cell membrane. Allows [Ca2+]i to remain elevated and _____ SR.

A

activation, Ca2+, replenishes

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18
Q

There is ____ on SR, while ____ proteins make up Ca2+ channel on cell membrane.

A

STIM1, Orai-1

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19
Q

? occurs when chemical signals change muscle tension through signal transduction pathways with little or no change in membrane potential

A

Pharmacomechanical coupling

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20
Q

Ca2+ release from SR via IP3 pathway and entry of Ca2+ via store operated channels are voltage independent and is known as ?

A

pharmacomechanical coupling

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21
Q

____, _______ _______ and _____ can induce smooth muscle contraction independent of AP generation.

A

Drugs, excitatory neurotransmitters, hormones

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22
Q

There are stretch activated ion channels in the cell membrane of some smooth muscle that when activated lead to ?

A

depolarization (Ca2+, Cl-, TRPV4, TRPC1, TRPC6)

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23
Q

Stretch of smooth muscle causes an internal release of Ca2+ from the SR through the ?

A

ryanodine receptor

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24
Q

Stretch has been shown to cause _______ of the myosin light chain leading to contraction

A

phosphorylation

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25
Q

In smooth muscle _____ ATPase must be activated

A

myosin

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26
Q

The Ca2+ _______ complex then activates an enzyme known as myosin light chain kinase (MLCK)

A

calmodulin

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27
Q

MLCK phosphorylates the regulatory light chain near the myosin head which ? of the myosin head, ______ its ATPase activity and allows it to interact with actin (conformation change).

A

alters the conformation, increasing

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28
Q

In skeletal and cardiac muscle ATPase activity of myosin head is always ___

A

high

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29
Q

Increased Ca2+ entering-> ______ MLCK activated->___ myosin heads activated-> _______ force generated

A

increased, more, increased

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30
Q

Order these statements in accordance with cross bridge cycling:
1. Ca2+ calmodulin activated myosin light chain kinase (MLCK)
2. Active myosin crossbridges slide along actin and create muscle tension
3. Intracellular Ca2+concentrations increase when Ca2+ enters cell and is released from sarcoplasmic reticulum
4. Intracellular Ca2+ binds to calmodulin (CaM)
5. MLCK phosphorylates light chains in myosin heads and increases myosin ATPase activity

A

3, 4, 1, 5, 2

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31
Q

Cross-bridge cycling is similar but occurs more ____

A

slowly

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32
Q

Order these statements in the context of cross-cycling:
1. Power stroke begins when Pi is released
2. Myosin releases ADP at the end of the power stroke
3. Myosin hydrolyzes ATP. Energy from ATP rotates the myosin head to the cocked position. Myosin binds weakly to actin
4. ATP binds to myosin. Myosin released actin.

A

4, 3, 1, 2

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33
Q

In relaxation in smooth muscle Ca2+ is moved back to the SR and extracellular space Ca2+ removal does not _____ lead to relaxation. The regulatory light chain must be ________ by myosin light chain phosphatase

A

immediately, dephosphorylated

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34
Q

Even after _________ of regulatory light chain some smooth muscle can maintain force for an extended period of time with ____ ATP use known as latch state (unknown process)

A

dephosphorylation, little

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35
Q

_______, ______ and ______ molecules can alter smooth muscle Ca2+ sensitivity by modulating myosin light chain phosphatase (MLCP)

A

Neurotransmitters, hormones, paracrine

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36
Q

Increasing Ca2+ entry and Ca2+ sensitivity to increase ?

A

contractile force

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37
Q

Contractile force in smooth muscle largely depends on the ?

A

balance of MLC phosphorylation and dephosphorylation

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38
Q

MLC phosphorylation is regulated by the Ca2+-CaM complex, which in turn depends on levels of ?

A

intracellular Ca2+

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39
Q

Smooth muscle can regulate Ca2+ over a _____ range than in skeletal or cardiac muscle

A

wider

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40
Q

Inhibiting MLCP or activating MLCK leading to greater contraction at ____ [Ca2+]i

A

lower

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41
Q

The requirement for a circulatory system is a consequence of ? and ?

A

increasing size, complexity of multicellular organisms

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42
Q

The cardiovascular system provides a ? from the blood to cells for nutrients and in the opposite direction for waste.

A

concentration gradient

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43
Q

What is the primary role of the circulatory system?

A

The distribution of dissolved gases and other molecules for nutrition, growth and repair, while simultaneously removing cellular wastes.

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44
Q

What are the three basic functional parts of the circulatory system?

A

Heart, blood, vessels

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45
Q

What are the 3 secondary role of the circulatory system?

A
  1. Chemical signaling to cells by means of circulating hormones or neurohormones
  2. Dissipation of heat by delivering heat from the core to the surface of the body
  3. Mediation of inflammatory and host defense responses against invading microorganisms
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46
Q

What was a very old belief about the body and blood?

A

Tissues were thought to consume all blood delivered to them and that the liver constantly made new blood

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47
Q

What was Dr. William Harvey able to prove?

A

In one hour the heart pumped more than your entire body weight of blood and that there was no way the liver could constantly produce that much blood

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48
Q

Transport in the circulatory system can be divided into 3 types: ?

A
  1. Materials entering the body
  2. Materials moved from cell to cell
  3. Materials leaving the body
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49
Q

What is the heart?

A

A dual pump driving blood in 2 serial circuits

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50
Q

What are the 2 circuits of the heart?

A

Pulmonary and systemic

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51
Q

Carrying blood away from the heart are _____; carrying blood back to the heart are ____

A

arteries, veins

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52
Q

Smallest vessels where transport (transfer) takes place are the ______

A

capillaries

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53
Q

As blood moves through the circulation, a system of valves in the heart and veins ensures that blood flows in ?

A

one direction

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54
Q

What are the 3 most notable circulations within systemic circuit?

A

-Coronary circuit
-Digestive tract/liver portal system
-Kidney portal system

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55
Q

The ____ ____ receives blood from the venae cavae and sends blood to the right ventricle

A

right atrium

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56
Q

The ____ ____ receives blood from the right atrium and sends blood to the lungs

A

right ventricle

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57
Q

The ____ ____ receives blood from the pulmonary veins and sends blood to the left ventricle

A

left atrium

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58
Q

The ____ ____ receives blood from the left atrium and sends blood to the body except for the lungs

A

left ventricle

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59
Q

The ____ ____ receives blood from the systemic veins and sends blood to the right atrium

A

venae cavae

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60
Q

The ____ ____ receives blood from the right ventricle and sends blood to the lungs

A

pulmonary trunk (artery)

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61
Q

The ____ ____ receives blood from the veins of the lungs and sends blood to the left atrium

A

pulmonary vein

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62
Q

The ____ receives blood from the left ventricle and sends blood to the systemic arteries

A

aorta

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63
Q

How does blood flow though the cardiovascular system?

A

Liquids and gases commonly flow down pressure gradients (ΔP) from regions of high pressure to regions of lower pressure

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64
Q

The initial region of high pressure in the cardiovascular system is created by ?

A

contraction of the heart

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65
Q

Blood then flows out of this high pressure region into ?

A

the lower pressure vessels

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66
Q

As blood flows through the vessels pressure is lost due to friction created between ?

A

the blood and vessel walls

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67
Q

The mean blood pressure of the systemic circulation ranges from a high of 93mmHg in the ___ to a low of a few mmHg in the ____ ____

A

aorta, venae cavae

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68
Q

What is the driving presure?

A

The high pressure created in the ventricles

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69
Q

When the heart muscles relax and expand the pressure exerted by the blood within the ventricles ?

A

decreases

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70
Q

Aside from pressure changes within the ventricles many vessels have the ability to constrict or dilate also affecting ?

A

blood pressure

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71
Q

Blood flows from ____ pressure to ____ pressure regions

A

higher, lower

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72
Q

Blood flow in the cardiovascular system needs a pressure gradient, this is created through ?

A

contraction of the ventricles

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73
Q

Flow ∝ ?

A

ΔP

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74
Q

ΔP = ?

A

P1 - P2

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75
Q

The flow of blood in a tube is directly proportional to the pressure gradient at each end of the tube, not the ?

A

absolute pressure

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76
Q

Fluid flows only if there is a ____ pressure gradient

A

positive

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77
Q

Resistance opposes ___

A

flow

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78
Q

While a fluid flows through a tube, the fluid encounters friction from ? and from ?, which opposes flow

A

the walls of the tube, cells in the blood colliding

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79
Q

Flow ∝ 1/?

A

R

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80
Q

Flow (F or Q) = ?/?

A

ΔP/R

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81
Q

Flow is inversely proportional to ?

A

resistance

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82
Q

In a well defined system it is possible to predict the resistance to flow from the geometry of the vessel and the properties of the fluid using what law?

A

Poiseuille’s

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83
Q

What is Poiseuille’s law?

A

F =ΔP × (πr^4)/(8ηl)

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84
Q

What are the parameters that determine resistance in Poiseuille’s equation?

A

r = radius of the tube
l = length of the tube
η = viscosity of the fluid

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85
Q

Larger radius = ___ resistance

A

less

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86
Q

Flow is inversely proportional to both the ? and ?

A

length of the vessel, viscosity of the liquid

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87
Q

Resistance is directly proportional to ? and ?

A

viscosity of liquid, length of tube

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88
Q

In Poiseuille’s equation, what remains relatively constant in the CV system?

A

l and η

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89
Q

A shorter length tube will have ___ resistance and more flow

A

less

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90
Q

Velocity depends on the ? and ?

A

flow rate, cross-sectional area

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91
Q

What is velocity of flow?

A

How fast blood flows past a certain point

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92
Q

Velocity (v) = ?/?

A

Q (flow rate)/A (cross-sectional area)

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93
Q

With an equal flow rate, the velocity of blood is more ____ in narrow sections of vessel

A

rapid

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94
Q

The heart is a muscle that _____ contracts, resting only for milliseconds between beats

A

continuously

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95
Q

The heart lies in the center of the ?

A

thoracic cavity

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96
Q

The heart is about the size of a ?

A

fist

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97
Q

The apex angles ? of the body

A

slightly downward to the left

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98
Q

The heart is on the ____ side of the thoracic cavity?

A

ventral

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99
Q

The heart is encased in a tough membranous sac known as the ?

A

pericardium

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100
Q

The pericardium is a _____ walled sac filled with a thin layer of clear pericardial _____

A

double, fluid

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101
Q

The pericardium ____ the external surface of the heart as it beats within the sac

A

lubricates

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102
Q

The _____ occupy the bulk of the heart

A

ventricles

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103
Q

The ____ and _____ attach to the base of the heart

A

arteries, veins

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104
Q

The heart itself is mostly composed of ______ covered by thin inner and outer layers of _____ and _____ tissue

A

myocardium (cardiac muscle), epithelium, connective

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105
Q

________ _____ - allow flow from the atria into the ventricles

A

atrioventricular valves (AV)

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106
Q

Where do you find the tricuspid valve?

A

Right atrium to the right ventricle. It has 3 flaps.

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107
Q

Where do you find the mitral valve?

A

Left atrium to the left ventricle, and is bicuspid

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108
Q

The ___ valves are attached to a papillary muscle in each ventricle by chordae tendineae (tendon. These muscles only supply stability to the valves and are not able to ?

A

AV, open them

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109
Q

One-way flow through the heart is ensured by ?

A

two sets of valves

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110
Q

______ _____ are one way valves that exist between the ventricle and outflow artery

A

Semilunar valves

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111
Q

Semilunar valves have __ cup-like leaflets

A

3

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112
Q

Where is the aortic valve?

A

From the left ventricle to the aorta

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113
Q

Where is the pulmonary valve?

A

From the right ventricle to the pulmonary artery

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114
Q

______ ____ do not need connective tendons due to their shape

A

Semilunar valves

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115
Q

During _____ contraction, the AV valves remain closed to prevent blood flow backward into the atria

A

ventricular

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116
Q

The semilunar valves prevent blood that has entered the arteries from flowing back into the ventricles during ventricular _____

A

relaxation

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117
Q

What are the atrioventricular rings?

A

Encircle the orifices of the tricuspid and mitral valves

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118
Q

Cardiac action potential originates in a ? and spreads through a network of ?

A

group of cells in the SA node (pacemaker), autorhythmic cells

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119
Q

The ? and ? have slower pacemaker activity overridden by that of the SA node.

A

AV node, purkinje fibres

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120
Q

What are the 6 elements of the conduction system of the heart?

A

SA node, internodal pathways, AV node, AV bundle, bundle branches, purkinje fibers

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121
Q

The group of autorhythmic cells with the most rapid ? set the heart rate.

A

pacemaker activity

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122
Q

The atrial muscle has __ special conducting bundles

A

4

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123
Q

What is Backman’s bundle?

A

Conducts action potentials from the SA pacemaker into the left atrium causing contraction

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124
Q

What is the purpose of the anterior, middle, and posterior internodal pathways?

A

Conduct the action potential from the SA node to the AV node, depolarizing the right atrial muscle along the way

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125
Q

Atrial conduction is relatively ____

A

slow

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126
Q

There is a layer of connective tissue prevents ____ directly from atria to ventricle

A

conduction

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127
Q

Conduction slows down through the ? to allow blood from atria to empty into ventricles

A

AV node

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128
Q

In ventricular conduction, ? proceeds through the septum to the apex, then spreads up the walls of the ventricles from apex to base

A

depolarization

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129
Q

Ventricular muscles have a ____ arrangement that ensures blood is squeezed _____ from the apex of the heart

A

spiral, upward

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130
Q

Intercalated disks contain _____ that transfer force from cell to cell, and gap junctions that allow _____ signals to pass rapidly from cell to cell

A

desmosomes, electrical

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131
Q

What happens if electrical activity cannot be transferred from the atria to ventricles?

A

There is a complete conduction block caused by damage in conduction pathway

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132
Q

When electrical activity cannot be transferred from the atria to the ventricles, the ? continues to be pacemaker for the atria, but electrical activity does not make it to the ventricles so the ? take over as the pacemaker for the ventricles. This requires an ?

A

SA node, purkinje fibers, artifical pacemaker

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133
Q

These recordings are known as ? and show the summed electrical activity generated by all the cells of the heart

A

electrocardiograms (ECG’s or EKG’s)

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134
Q

Why/how can we record the electrical activity of the heart from the surface of the skin?

A

Because salt-solutions like our NaCl-based extracellular fluid are good conductors of electricity

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135
Q

What was Walter Einthoven’s contribution?

A

Einthoven’s triangle, a hypothetical triangle created around the heart when electrodes are placed on both arms and the left leg

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136
Q

The sides of Einthoven’s triangle are numbered corresponding to the three ? they create. The ECG is recorded one lead at a time, where one electrode acts as a ? electrode and one acts as a ?electrode.

A

“leads” (pairs of electrodes), positive, negative

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137
Q

If the electrical activity of the heart is moving towards the positive electrode of the lead then an _____ deflection is recorded; if it is moving away from a positive electrode is recorded as a ______ deflection; moving perpendicular to the axis of the electrodes causes ?

A

upward, downward, no deflection

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138
Q

ECG’s are a combination of _____ and _____

A

waves, segments

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139
Q

In the ECG:
_____ appear as deflections above or below the baseline
______ are the sections of baseline between two waves
_______ are the combination of waves and segments.

A

Waves, Segments, Intervals

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140
Q

An ECG is divided into waves (?), the segments between the waves (?), and intervals consisting of a combination of waves and segments (?)

A

P, Q, R, S, T
P-R, S-T
PR, QT

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141
Q

What is a P wave?

A

Atrial depolarization

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142
Q

What is a P-R segments?

A

Conduction through AV node and AV bundle

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143
Q

What is the QRS complex?

A

Ventricular depolarization

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144
Q

What is a T wave?

A

Ventricular repolarization

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145
Q

ECGs provide information on ? and ?, ? and even ?

A

heart rate, rhythm, conduction velocity, condition of tissues in the heart

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146
Q

What is the heart rate in an ECG?

A

P wave to P wave or R-R (tachycardia, bradycardia)

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147
Q

In an ECG, is the rhythm of that heart beat (intervals) regular?

A

Arrhythmia (abnormal rhythm) can be the result of many issues

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148
Q

In an ECG, are all normal waves present?

A

Is each wave P, Q, R, S,T present?

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149
Q

Is there one QRS complex for every P wave and is the PR segment constant?

A

Elongated segments are indicative of damage

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150
Q

______ can appear as elongated segments or intervals, altered, missing or additional waves

A

Arrhythmias

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151
Q

What are arrhythmias?

A

Electrical problems during the generation or conduction of AP’s through the heart

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152
Q

What are premature ventricular contractions and how are they perceived?

A

Purkinje fibres randomly kick in as pacemaker. Perceived as skipped beat or palpitation

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153
Q

What can cause premature ventricular contractions?

A

Due to insufficient oxygen to myocardium, excessive Ca2+, hypokalemia, medications, exercise, high levels of adrenaline

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154
Q

What is Long QT syndrome?

A

Inherited channelopathy, delayed repolarization of the ventricles. Palpitations, fainting, and sudden death due to ventricular fibrillation, can be drug induced

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155
Q

What is a cardiac cycle?

A

One complete contraction and relaxation

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156
Q

What are the 2 primary phases of a cardiac cycle?

A

Diastole and Systole

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157
Q

What is diastole?

A

The time during which cardiac muscle relaxes

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158
Q

What is Systole?

A

The time during which cardiac muscle contracts

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159
Q

Because the atria and ventricles do not contract and relax at the same time the events are discussed _______

A

separately

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160
Q

A single cardiac cycle is divided into __ phases

A

5

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161
Q

What are the 5 phases of a single cardiac cycle?

A
  1. Atrial and ventricular diastole, late diastole
  2. Atrial systole
  3. Isovolumetric ventricular contraction
  4. Ventricular ejection
  5. Isovolumetric relaxation, early diastole
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162
Q

What is atrial and ventricular diastole, late diastole?

A

Cycle starts with atria relaxed and filling with blood from veins. The ventricles begin to relax, when the ventricles are sufficiently relaxed and pressure in atria exceeds ventricles, AV valve opens and ventricles passively fill with blood from atria.

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163
Q

What is atrial systole?

A

Most blood enters ventricles passively but under normal resting conditions the last ~ “20%” enters when the atria contract

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164
Q

What is isovolumetric ventricular contraction?

A

The ventricles begin to contract, this builds up pressure in the ventricles and causes the AV valves to snap shut (first heart sound s1 “lub”)
Both valves are now closed and then the ventricle continues to contract building up pressure.

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165
Q

What is ventricular ejection?

A

As the ventricles contract pressure in the ventricle exceeds pressure in the outflow arteries (aorta or pulmonary arteries) causing the semi lunar valves to open and blood to flow out

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166
Q

What is isovolumetric ventricular relaxation, early diastole?

A

The ventricles then begin to relax, pressure in the outflow arteries begins to exceed the ventricles causing blood to attempt to flow backward into the ventricles causing the semi lunar valves to snap shut (second heart sound s2 “dub”)

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167
Q

What is the A-A’ segment in the pressure volume loop of cardiac cycle?

A

Late diastole

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168
Q

What is the A’-B segment in the pressure volume loop of cardiac cycle?

A

Atrial systole

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169
Q

What is the B-C segment in the pressure volume loop of cardiac cycle?

A

Isovolumetric contraction

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170
Q

What is the C-D segment in the pressure volume loop of cardiac cycle?

A

Ventricular ejection

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171
Q

What is the D-A segment in the pressure volume loop of cardiac cycle?

A

Isovolumetric relaxation

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172
Q

The ? : starts at ESV (end systolic volume; not all blood is pumped out during a ventricle contraction, the volume of blood left over after contraction is ESV). Pressure in ventricle is lower than atria and the AV valve opens causing the ventricle to passively fill with blood (majority is passive)

A

A-A’ segment

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173
Q

The ? : atria contracts forcing more blood into the ventricle slightly increasing volume and pressure. At the end, the maximal amount of blood is in the ventricles, this occurs at the end of ventricular diastole and is termed the end diastolic volume

A

A’-B segment

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174
Q

The ? : the ventricle begins contracting closing AV valve, continued contraction causes a large increase in pressure within the ventricle

A

B-C segment

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175
Q

The ? : Once pressure in ventricle rises above ~80mm Hg, it exceeds the aorta and the aortic valve opens causing a rapid ejection of blood. Pressure still rises as the ventricle continues to contract. Part way through this segment the ventricle begins to relax and pressure begins to drop but blood still flows due to the inertia

A

C-D segment

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176
Q

The ? : pressure in aorta begins to exceed ventricle causing semi-lunar valve to close, ventricle continues to relax

A

D-A segment

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177
Q

What is the Wiggers Diagram?

A

Follows left heart and aortic pressures, left ventricular volume, and the ECG through one cardiac cycle

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178
Q

What is signified by ‘D’ in a wiggers diagram?

A

Ventricle relaxes, pressure in atria begins to exceed ventricle. AV valve opens and you get the passive filling of the ventricle. Atria then contracts increasing the volume and pressure slightly

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179
Q

What is signified by ‘C’ in a wiggers diagram?

A

Ventricle beings to contract, increasing pressure within ventricle causing the AV valves to snap shut (S1)

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180
Q

What is signified by ‘E’ in a wiggers diagram?

A

Represents maximal ventricle volume (EDV)

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181
Q

In the wiggers diagram, the ventricle continues to contract until it exceeds pressure in aorta at point __

A

A

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182
Q

In the wiggers diagram, the aortic valve opens and you get a rapid ejection of blood from point __ to __

A

E to F

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183
Q

In the wiggers diagram, the ventricle begin to relax, and at point __ pressure in aorta starts to exceed ventricle causing the semi-lunar valve to snap shut (S2). Ventricle continues to relax until it is lower than the atrium and passive filling of the ventricle occurs once again

A

B

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184
Q

What is end diastolic volume (EDV)?

A

The maximal volume in the ventricle, after ventricular filling, 70kg man at rest ~135ml

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185
Q

What is end-systolic volume (ESV)?

A

the minimal amount of blood in the ventricles, blood left after ventricular contraction, ~65ml

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186
Q

What is stroke volume (SV)?

A

amount of blood ejected during a single ventricular contraction, ~70ml

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187
Q

Why is stroke volume ~70ml?

A

Because SV = EDV-ESV, so 135-65 = 70ml

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188
Q

The ESV provides a ?

A

safety margin

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189
Q

A more forceful contraction of the heart will cause a _____ stroke volume resulting in a ______ in the ESV.

A

larger, decrease

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190
Q

Stroke volume can increase to as high as 100ml and is modulated by the ?, ? and by certain ?

A

autonomic nervous system, venous return, drugs

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191
Q

What is the ejection fraction (EF)?

A

The percentage of EDV that is ejected from the heart (SV)

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192
Q

How to calculate the ejection fraction?

A

SV/EDV = 70/135 - 52%

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193
Q

How do you calculate total blood flow (cardiac output)?

A

Heart rate x stroke volume

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194
Q

What is cardiac output (CO)?

A

Flow of blood delivered from one ventricle in a given time period (usually 1 minute)

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195
Q

Cardiac output is a measure of cardiac ______?

A

performance

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196
Q

The output from a single heartbeat, from either the left or right ventricle is the ?

A

Stroke volume (SV) L/beat or mL/beat

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197
Q

What is heart rate (HR) measured in?

A

beats per minute (bpm)

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198
Q

What is the average heart rate?

A

72bpm

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199
Q

What is the average stroke volume?

A

70mL/beat

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200
Q

What is the average cardiac output of a 70kg male?

A

~5L/min

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201
Q

CO’s of the pulmonary and systemic circuit are usually ______

A

identical

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202
Q

If offset, blood tends to pool in the circuit feeding the _____ side of the heart

A

weaker

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203
Q

CO can raise to__-__L/min during exercise

A

30-35

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204
Q

Steve has an end diastolic volume of 150ml, an end systolic volume of 30 ml and a heart rate of 90 bpm. Calculate Steve’s cardiac output

A

CO= SV x HR
CO=(EDV-ESV) x HR
CO=(150 ml/b-30 ml/b) x 90 b/m
CO=10800 ml/min or 10.8L/min

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205
Q

Cardiac output can be modified by adjusting ?

A

heart rate

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206
Q

Cardiac output can be adjusted by modulating ?

A

stroke volume

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207
Q

Stroke volume is directly related to the force generated by the ?.

A

cardiac muscle during contraction

208
Q

Normally as force of contraction increases, ? increases

A

stroke volume

209
Q

Two factors determine the amount of force generated by cardiac muscle: ?

A
  1. Contractility of the heart
  2. The length of the muscle fibers at the beginning of contraction
210
Q

The length of the muscle fibres at the beginning of contraction is determined by the ?

A

volume of blood in the ventricle at the beginning of contraction (end-diastolic volume)

211
Q

Contractility is controlled by the ?

A

nervous and endocrine systems

212
Q

Any chemical that affects contractility is called an ? and its influence is referred to as an ?

A

inotropic agent, inotropic effect

213
Q

Chemicals increasing contractility have a ____ inotropic effect and ones decreasing contractility a _____ inotropic effect.

A

positive, negative

214
Q

What are two common catecholamines?

A

Norepinephrine and epinephrine

215
Q

? released from the sympathetic neurons or adrenal medulla cause a positive inotropic effect regardless of EDV

A

Catecholamine’s (Norepinephrine and epinephrine)

216
Q

Contractility increases as the amount of Ca2+ available for contraction _____

A

increases

217
Q

Order these statements in order for sympathetic modulation of contraction (stroke volume):
1. Phosphorylation of ryanodine receptors enhances sensitivity to Ca2+, increasing release of Ca2+ from the sarcoplasmic reticulum
2. Increases rate of myosin
3. Phosphorylation of Ca2+ channels increases calcium conductance during action potentials
4. Phosphorylation of SERCA (PLN) increases the speed of Ca2+ re-uptake which increases Ca2+ storage

A

3, 1, 2, 4

218
Q

Increasing sarcomere length increases ?

A

force of contraction (stroke volume)

219
Q

Skeletal length tension relationship explained by degree of overlap between ?

A

thick and thin filaments.

220
Q

Raising sarcomere length ____ the Ca2+ sensitivity of the myofilaments. A stretched sarcomere has a ______ diameter which may reduce the distance that Ca2+ needs to diffuse _____ probability of cross-bridge cycling

A

increases, decreased, increasing

221
Q

Raising sarcomere length puts additional tension on stretch-activated Ca2+ channels, _______ Ca2+ entry from extracellular space and ______ Ca2+ induced Ca2+ release _______ tension

A

increasing, increasing, increasing

222
Q

What is Frank-starling’s law of the heart?

A

The amount of force developed by the cardiac muscle of a ventricle, depends on the initial stretch of the ventricle walls

223
Q

The degree of myocardial stretch prior to contraction is known as the ?

A

preload on the heart

224
Q

According to frank-starling law, stroke volume increases with increasing ?

A

end-diastolic volume

225
Q

What is a Starling curve?

A

Length-force relationships in the intact heart

226
Q

What is venous return?

A

The rate of blood flow back to the heart

227
Q

___ is normally determined by venous return

A

EDV

228
Q

Increased venous return ______ venous pressure resulting in _____ atrial filling leading to ______ ventricle filling

A

increases, increased, increased

229
Q

What are the 3 factors that affect venous return?

A
  1. Skeletal muscle pump
  2. Respiratory pump
  3. Sympathetic constriction of veins
230
Q

How does the skeletal muscle pump affect venous return?

A

Skeletal muscle activity compresses veins in the extremities pushing blood back to the heart. Increased muscle activity of the extremities can increase venous return

231
Q

How does the respiratory pump affect venous return?

A

During inspiration the chest expands and diaphragm moves down creating a subatmospheric pressure in the thoracic cavity, this draws blood into the vena cava that exist within this cavity, and veins in the abdomen are compressed also forcing blood back to the heart

232
Q

How does sympathetic constriction of the veins affect venous return?

A

Decreasing their volume squeezing blood back towards the heart

233
Q

What is afterload?

A

The is the end load against which the heart contracts to eject blood

234
Q

Afterload is primarily determined by the combination of the ___ and the ?

A

EDV, pressure in the outflow artery prior to contraction (aorta or pulmonary artery).

235
Q

Afterload can be increased in _____ situations (eg. increased arterial blood pressure, decreased aortic compliance)

A

pathological

236
Q

The functional model of the cardiovascular system shows the heart and blood vessel as a ?

A

single closed loop

237
Q

Each side of the heart functions as an ______ pump

A

independent

238
Q

Systemic veins serve as an _____ volume reservoir

A

expandable

239
Q

Exchange between the blood and cells takes place only at the ?

A

capullaries

240
Q

The arterioles are the site of _____ resistance

A

variable

241
Q

The elastic system arteries are a _______ reservoir that maintains blood flow during ventricular relaxation

A

pressure

242
Q

What is the progressive branching of vessels?

A

Aorta > Arteries > Arterioles > Capillaries > Venules > Veins > Vena Cava

243
Q

All vessels contain inner layer of ? and can be wrapped in a combination of _____ tissue, ____ muscle or _____ tissue

A

thin endothelial cells, elastic, smooth, fibrous

244
Q

In vessels, the endothelial cells were thought to only be a ?

A

passive barrier

245
Q

______ are important in secreting paracrines (substances that signal changes in near by cells) regulation of blood pressure, blood vessel growth, as well as absorption of materials.

A

vessels

246
Q

The amount of smooth muscle in each vessel type ____

A

varies

247
Q

In most vascular smooth muscle there is always a state of ?

A

partial contraction (tone)

248
Q

Vascular smooth muscle can be influenced by a variety of substances including _______, ______, ______. These substances bind receptors ultimately resulting in an increase in ?

A

neurotransmitters, hormones, paracrines, cytosolic Ca2+ causing contraction

249
Q

Arteriole diameter is controlled by ?

A

tonic release of norepinephrine

250
Q

Moderate signal rate results in a blood vessel of _______ diameter

A

intermediate

251
Q

As the signal rate increases, the blood vessel ____

A

constricts

252
Q

As the signal rate decreases, the blood vessel _____

A

dilates

253
Q

Arteriole wall is _____ muscle

A

smooth

254
Q

Metarterioles can act as ?

A

bypass channels

255
Q

Precapillary sphincters can close off capillaries in response to ?

A

local signals

256
Q

Systemic circuit begins with a single aorta that branches off to ?

A

major arteries

257
Q

Arteries have walls that are both ____ and _____. Thick _____ muscle layer and large amount of ?

A

stiff, springy, smooth, elastic and fibrous connective tissue

258
Q

Arteries branch into smaller ______

A

arterioles

259
Q

Arterioles, capillaries and venules make up the _______

A

microcirculation

260
Q

Across the microcirculation you have _______ which act as a capillary bypass vessels, and also for WBC’s

A

metarterioles

261
Q

______ are the smallest vessels in the cardiovascular system, where the majority of exchange between the blood and interstitial space occur.

A

capillaries

262
Q

______ have a single thin endothelial layer surrounded by a basal lamina (extracellular matrix)

A

capillaries

263
Q

____ can normally passively diffuse across the endothelial cells

A

gases

264
Q

Capillaries are linked by ? that also aid in the transport of small solutes and water

A

interendothelial junctions

265
Q

Some cells contain fenestrations, which are ?

A

Membrane lined conduits running through them to allow the transport

266
Q

Capillaries are often surrounded by ?

A

pericytes (BBB)

267
Q

What are the 3 kinds of capillaries?

A
  1. Continuous
  2. Fenestrated
  3. Discontinuous (sinusoidal)
268
Q

____ capillary: most common, thicker endothelial cells that do not contain fenestrations. Only allow passage of water and small ions through intercellular junctions

A

Continuous

269
Q

______ capillary: thin endothelial cells that are perforated with fenestrations. The fenestrations often have a thin diaphragm. Small molecule passage

A

Fenestrated

270
Q

_______ capillary: lack a basal membrane, have large open fenestrations as well as gaps between the endothelial cells. (liver and spleen)

A

Discontinuous (sinusoidal)

271
Q

What are the 3 methods of transport in capillaries?

A

Transcellular, paracellular, transcytosis

272
Q

Veins are more numerous and have a larger volume, thinner walls and less muscle tissue in comparison to _____ making the venous circulation the _____ reservoir of the circulatory system

A

arteries, volume

273
Q

What is Angiogenesis?

A

The formation of new blood vessels

274
Q

Adult microcirculation is considered _____, but what are some exceptions?

A

constant, would healing, endurance training, inflammation, tumor growth, endometrium during menstrual cycle

275
Q

? (mitogens-pro mitotic) activate receptors on endothelial cells

A

Angiogenic growth factors

276
Q

Activated endothelial cells produce _____ that degrade the basal lamina so it can move away from the parent vessel

A

proteases

277
Q

Endothelial cells proliferate into the surrounding matrix and form ____ towards the angiogenic stimulus in tandem. They then form loops to become a full-fledged ? as cells migrate to the site of angiogenesis

A

sprouts, vessel lumen

278
Q

Angiogenesis is a necessary part of the process in the progression of _____ from small, localized neoplasms to larger, growing, and potentially metastatic tumors

A

cancer

279
Q

What is Coronary Heart Disease?

A

Type of heart disease where the arteries of the heart cannot deliver enough oxygen-rich blood to the heart

280
Q

Ventricular contraction creates the force necessary to ?

A

propel blood through the cardiovascular system

281
Q

?: contraction of the ventricles pushes blood into the elastic arteries, causing them to stretch

A

Ventricular contraction

282
Q

?: elastic recoil in the arteries maintains driving pressure during ventricular diastole

A

Ventricular relaxation

283
Q

Aorta and large arteries sustain driving pressure during ?

A

ventricular diastole

284
Q

Order these statements in terms of ventricular contraction:
1. Aorta and arteries expand and store pressure in elastic walls
2. Semilunar valve opens. Blood ejected from ventricles flows into the arteries
3. Ventricle contracts

A

3, 2, 1

285
Q

Order these statements in terms of ventricular relaxation:
1.Semilunar valve shuts, preventing flow back into ventricle
2. Isovolumic ventricular relaxation
3. Elastic recoil of arteries sends blood forward into rest of circulatory system

A

2, 1, 3

286
Q

Blood pressure is highest in the ____ and decreases throughout circuit

A

aorta

287
Q

Aortic pressure highest during ?: systolic pressure (120 mm Hg) and lowest during ?: diastolic pressure (80 mm Hg).

A

ventricular contraction (systole), ventricular relaxation (diastole)

288
Q

What is pulse pressure?

A

The difference between the systolic and diastolic pressure

289
Q

How do you calculate pulse pressure?

A

Systolic pressure - diastolic pressure

290
Q

What is the pulse pressure in the aorta?

A

120mmHg - 80mmHg = 40mmHg

291
Q

Pulse pressure normally only exists on the ? side of circuit

A

arterial/arteriole

292
Q

Mean arterial blood pressure reflects the driving pressure for ?

A

blood flow

293
Q

Mean arterial blood pressure is commonly measured in a major artery (brachial) as reflection of ?

A

ventricle (driving) pressure

294
Q

The mean arterial blood pressure is not simply the average of the systolic and diastolic pressures (100 mm Hg) because ?

A

equal amounts of time are not spent in systole and diastole

295
Q

How would you calculate mean arterial pressure?

A

Diastolic pressure + 1/3 (pressure pressure)

296
Q

_______ represents when the blood pressure falls too low (<90/60). This can cause the driving force for blood flow to be inadequate to overcome the opposition by _______

A

Hypotension, gravity

297
Q

________ represents when the blood pressure is chronically elevated (>140/90)

A

Hypertension

298
Q

High pressure on the vessel walls can cause them to become ? and leak. If this occurs in the brain it is called a ? and may cause a loss of neurological function, commonly referred to as a ____.

A

weakened or even rupture, cerebral hemorrhage, stroke

299
Q

What is a sphygmomanometer?

A

A blood pressure monitor, or blood pressure gauge, is a device used to measure blood pressure

300
Q

What is the normal range for systolic and diastolic blood pressure?

A

Systolic: >120
Diastolic: >80

301
Q

Mean arterial blood pressure is the balance between ?

A

blood flow into the arteries and blood flow out of the arteries

302
Q

Increased volume in arteries = ______ arterial blood pressure

A

increased

303
Q

Most cases of hypertension believed to be due to ?

A

increased peripheral resistance without changes in cardiac output

304
Q

What are the 2 factors that influence arterial blood pressure?

A
  1. Blood volume
  2. Relative distribution of blood between arterial and venous blood vessels
305
Q

Blood volume is determined by ?

A

Fluid intake
Fluid loss, which may be passive or regulated at kidneys

306
Q

Relative distribution of blood between arterial and venous blood vessels is determined by ?

A

diameter of the veins

307
Q

Arteries are low-volume vessels that contain ~___% of the total blood volume at any one time. Veins are high volume vessels and hold ~__% of the circulating blood volume at any one time

A

11, 60

308
Q

Changes in blood volume affect blood ?

A

pressure

309
Q

Small changes in blood volume occur from ingestion of food and liquids, primarily resolved by _____

A

kidneys

310
Q

Decreases in blood volume require an ?, ? and ?

A

integrated response from the kidneys, the cardiovascular system (increase sympathetic output), ingestion of fluid

311
Q

Resistance is highest within the ______

A

arterioles

312
Q

Area along the curve with the greatest drop in pressure should coincide with the ?

A

largest increase in resistance.

313
Q

Vessels with the smallest radius theoretically should have the ? Is this the case?

A

highest resistance (capillaries), no

314
Q

Aggregate (total) resistance not only depends on the ? but also on how ?

A

radius of each vessel, vessels are arranged (series vs parallel)

315
Q

What is the difference in calculation between vessels arranged in a series vs. arranged in parallel?

A

Series: Req = R1 + R2 + R3
Parallel: Req = 1/R1 + 1/R2 + 1/R3

316
Q

Resistance in the arterioles contributes >__% of total resistance to flow in cardiovascular system

A

60

317
Q

Arteriolar resistance is influenced by both ? control mechanisms that alter the vascular smooth muscle changing the radius of vessels greatly influencing ?

A

local and systemic, resistance

318
Q

How is resistance mathematically related to radius?

A

R ∝ 1/r^4

319
Q

Local control of arteriolar resistance matches tissue blood flow to the ?: in the heart and skeletal muscle, these local controls often take precedence over ?

A

metabolic needs of the tissue, reflex control by the CNS

320
Q

Sympathetic reflexes mediated by the CNS maintain ? and govern ? for certain homeostatic needs such as temperature regulation

A

mean arterial pressure, blood distribution

321
Q

Hormones-particularly those that ?, influence blood pressure by acting directly on the arterioles and by altering autonomic reflex control

A

regulate salt and water excretion by the kidneys

322
Q

The myogenic theory of autoregulation states that ?

A

Some vascular smooth muscle has the ability to regulate its own state of contraction

323
Q

An increase in blood pressure causes the vascular smooth muscle in the wall of the arteriole to stretch, which then causes the ?

A

vascular smooth muscle to contract, leading to vasoconstriction

324
Q

Arterioles contain a variety of ? TRP channels, particularly TRPV2, TRPC6, and TRPM4 that are thought to be responsible for the mechano-depolarization leading to ?

A

stretch activated, a myogenic response

325
Q

______ alter vascular smooth muscle

A

Paracrines

326
Q

Local control of blood flow is important in allowing ? (arteriole or precapillary sphincters)

A

individual tissues to regulate their own blood supplies

327
Q

Active hyperemia matches blood flow to ?

A

increased metabolism

328
Q

What are some paracrines that alter vascular smooth muscle?

A

Metabolism related: low oxygen, high carbon dioxide, NO, H+, lactate, adenosine
Non-metabolism related: kinins and histamine (inflammation), serotonin

329
Q

The main determinant of resistance in the majority of arterioles is the _____ nervous system

A

sympathetic

330
Q

primarily sympathetic neurons innervate arterioles and tonically control arteriolar diameter through activation or deactivation of ?

A

α1 adrenergic receptors

331
Q

Epinephrine has a low ____ for alpha receptors that cause vasoconstriction and a ____ affinity for B2 adrenergic receptors which lead to vasodilation

A

affinity, high

332
Q

Parasympathetic = bradycardia/tachycardia; sympathetic = bradycardia/tachycardia

A

bradycardia, tachycardia

333
Q

What is bradycardia?

A

A slower than normal heart rate

334
Q

What is tachycardia?

A

A heart rate over 100 beats a minute

335
Q

At rest regional amount of blood flow depends on the number and size of ?

A

arteries feeding the organ

336
Q

Regional variations can occur because arterioles are arranged in ? (in addition to series branching) meaning they all receive blood at the same time

A

parallel

337
Q

Total blood flow through all the arterioles equals the ?

A

CO

338
Q

Flow for each arteriole depends on the _____, if an arteriole constricts resistance _______ and blood flow through that arteriole ________

A

resistance, increases, decreases

339
Q

Blood is diverted away from high resistance arterioles towards ? and thus takes the path of least resistance

A

low resistance arterioles

340
Q

Main integrating center: ?. Primary function: ensures adequate blood flow to the brain and heart by maintaining ?

A

medullary cardiovascular control center (CVCC), sufficient mean arterial pressure

341
Q

The primary reflex pathway for homeostatic control of mean arterial blood pressure is the ?

A

baroreceptor reflex

342
Q

Baroreceptors are ______ active stretch sensitive mechanoreceptors that are situated on the ____ and on the ?

A

tonically, aorta, carotid artery

343
Q

When there is an increase in blood pressure the baroreceptors sense the stretch in the artery walls and ______ their firing rate

A

increase

344
Q

Decrease blood pressure > _____ firing rate

A

decrease

345
Q

Baroreceptor reflex is _______ active

A

constantly

346
Q

Orthostatic hypotension triggers ?

A

baroreceptor reflex

347
Q

Every morning when you stand up out of bed your baroreceptor reflex is ?

A

highly engaged

348
Q

Peripheral chemoreceptors located on the ? and ?

A

aortic arch, carotid artery

349
Q

Peripheral chemoreceptors sense alterations in ? as well as changes in ?

A

blood-gas concentrations ([O2], [CO2]), blood pH

350
Q

Peripheral chemoreceptors send information back to the ? which then results in a change in autonomic output to return blood gas levels to ?

A

cardiovascular control center, normal values

351
Q

Peripheral chemoreceptor activation changes ventilation within the ?

A

respiratory system

352
Q

The _______ is capable of altering cardiovascular function in response to emotional stress

A

hypothalamus

353
Q

What is the Vasovagal syncope?

A

Faint in response to sudden emotional distress, sight of blood, phlebotomy (needle insertion), acute pain

354
Q

The combination of decreased CO and decreased peripheral resistance cause a large fall in mean arterial pressure, primarily ?

A

parasympathetic decrease in HR

355
Q

Capillary density in any tissue is related to its ?

A

metabolic activity

356
Q

What is bulk flow?

A

The mass movement of fluid as the result of hydrostatic or osmotic pressure gradients

357
Q

If bulk flow is resulting in fluid moving into the capillaries, _________is taking place

A

absorption

358
Q

If bulk flow is resulting in the movement of fluid out of the capillaries this is ______

A

filtration

359
Q

What is hydrostatic pressure (Ph)?

A

The pressure in the blood vessels drives fluid out of the capillaries through pores and cell junctions (filtration)

360
Q

What is colloid osmotic pressure/oncotic pressure (π)?

A

The pressure that draws fluid into the capillaries is the pressure created by plasma proteins in the blood

361
Q

π is _____ in the capillary and _____ the interstitial space π (zero)

A

steady, exceeds

362
Q

Ph in vessels ______ as blood travels through the capillaries due to the ? and ?

A

decreases, resistance encountered, exceeds interstitial Ph (zero)

363
Q

At the _____ end PH exceeds π causing net filtration; at the _____ end π exceeds PH and there is absorption

A

arterial, venous

364
Q

Overall, there is a net filtration from the entire capillary network resulting in a loss of ? of fluid/day from the blood

A

3L

365
Q

High hydrostatic pressure forces fluid ____ of the capillary

A

out

366
Q

Low colloid osmotic pressure of proteins within the capillary pulls fluid ____ the capillary

A

into

367
Q

What is the equation for Net Pressure?

A

Hydrostatic pressure - colloid osmotic pressure

368
Q

Positive net pressure indicates _______; negative net pressure indicates _______

A

filtration, absorption

369
Q

Lymph fluid empties into the _____ circulation

A

venous

370
Q

Lymphatic vessels assist the cardiovascular system with returning fluid and proteins lost through ?

A

the capillaries

371
Q

? vessels have single endothelial cell layer

A

Lymphatic

372
Q

Lymphatic vessels contain large ________ junctions that act like one-way valves

A

interendothelial

373
Q

In the initital lymphatic segment, the interstitial hydrostatic pressure is _____ than inside the lymphatic causing the microvalves to open and fluid to ?

A

higher, flow in

374
Q

As it fills up with fluid the lymphatic hydrostatic pressure _____ interstitial, the microvalves close and the ?

A

exceeds, secondary valves open

375
Q

Collecting lymphatics contain ? that actively contract to propel fluid and one way valves to prevent backflow, skeletal muscle assists as well

A

smooth muscle

376
Q

What is an edema?

A

An abnormal accumulation of fluid in the interstitial space

377
Q

What are the 2 causes of an edema?

A
  1. Inadequate lymph drainage
  2. A disruption in normal balance between capillary filtration and absorption
378
Q

What are the 3 causes of the disruption between capillary filtration and absorption?

A

i. Increased capillary hydrostatic pressure (heart failure)
ii. decrease in plasma protein concentration (malnutrition, liver failure)
iii. increase in interstitial proteins (excessive leakage of proteins out of capillaries):injury, inflammation

379
Q

With each branching of a vessel, the two new branches always have a _____ total cross-sectional area than the parent vessel

A

higher

380
Q

The rate at which blood flows through the capillaries plays a role in the efficiency of exchange between the blood and ______

A

the interstitial fluid

381
Q

How would you calculate velocity of blood?

A

Flow rate/ c.s. area

382
Q

Single capillaries have a very ____ cross-sectional area BUT all the capillaries together have a very ____ cross-sectional area

A

small, large

383
Q

The ____ velocity ensures adequate gas and nutrient exchange at the capillaries

A

slow

384
Q

Velocity of blood flow depends on the ?

A

total cross-sectional area

385
Q

Risk factors for cardiovascular disease include: ?

A

Uncontrolled, controlled, and a combination of both

386
Q

What are some uncontrolled risk factors in cardiovascular diseases?

A

age, sex, family history of early CVD, genetics

387
Q

What are some controlled risk factors in cardiovascular diseases?

A

cigarette smoking, obesity, sedentary lifestyle and untreated hypertension

388
Q

What are some combination risk factors in cardiovascular diseases?

A

diabetes, hyperlipidemia

389
Q

What is atherosclerosis?

A

Inflammatory process leading to hardening or narrowing of arteries

390
Q

Clinicians concerned with two types of lipoproteins: ?

A
  1. High-density lipoprotein-cholesterol complexes (HDL-C)
  2. Low-density lipoprotein-cholesterol complexes (LDL-C)
391
Q

High levels of ? associated with lower risk of heart attack; while elevated levels of ? is associated with coronary heart disease

A

HDL-C, LDL-C

392
Q

Necessary for cholesterol transport into cells, ? proteins are digested to amino acids and the freed cholesterol is used to make cell membranes and steroid hormones

A

LDL-C’s

393
Q

The development of atherosclerotic plaques is a process that develops over ?

A

years

394
Q

Order these statements for the development of atherosclerotic plaques:
1. Smooth muscle cells, attracted by macrophage cytokines, begin to divide and take up cholesterol
2. Fibrous scar tissues forms to wall off the lipid core
3. Macrophages may release enzymes that dissolve collagen and convert stable plaques to unstable plaques
4. Macrophages ingest cholesterol and become foam cells
5. Calcifications are deposited within the plaque
6. A lipid core accumulates beneath the endothelium
7. LDL-cholesterol accumulates between the endothelium and connective tissue and is oxidized
8. Platelets that are exposed to collagen activate and initiate a blood clot
9. Smooth muscle cells divide and contribute to thickening of the intima

A

7, 4, 1, 6, 2, 9, 5, 3, 8

395
Q

If a clot blocks blood flow to the heart muscle, a ? ensues

A

myocardial infarction (heart attack)

396
Q

In a myocardial infarction, the ____ of O2 leads to ATP supply declining, the contractile cells become unable to _____ Ca2+ from cytosol. ___ intracellular [Ca2+] closes gap junctions in the damaged cells, electrically _____ them.

A

lack, remove, High, isolating

397
Q

If the damaged region of myocardium is large, disruption can cause an ? potentially leading to cardiac arrest or death

A

irregular heart beat (arrhythmia)

398
Q

? in brain vasculature account for 50% of strokes

A

Atherosclerosis

399
Q

Hypertension is a failure of _______

A

homeostasis

400
Q

Doubles the risk for cardiovascular disease for each ? mmHg increase in blood pressure above the baseline value of ?

A

20/10, 115/75

401
Q

Approx 90% of hypertensive patients have essential (primary) hypertension with no definitive cause besides ? These patients have normal cardiac output, but elevated ?

A

genetics, peripheral resistance

402
Q

What are the 2 biggest effects of hypertension?

A

Adaption of the baroreceptors to higher pressure with a down regulation of their activity
Risk factor for atherosclerosis, the increased pressure exerted on arterial walls damages the endothelial cell lining and promotes plaque formation

403
Q

Hypertension increases _________

A

afterload

404
Q

In hypertension, over time the heart must overcome the increased force causing myocardial contractile cells to undergo _____. Eventually the heart cannot meet workload and begins to ?

A

hypertrophy, fail

405
Q

What is hypertrophic cardiomyopathy?

A

The walls of the left ventricle become thick and stiff. Over time, the heart can’t take in or pump out enough blood during each heartbeat to supply the body’s needs.

406
Q

What are the 4 main hypertension treatments?

A
  1. Ca2+ channel blockers
  2. Diuretics
  3. Beta blockers
  4. ACE inhibitors and angiotensin receptor blockers
407
Q

? to relax the vascular smooth muscle and/or decrease CO (HR and force of contraction)

A

Ca2+ channel blockers (L-type)

408
Q

_______ increase urination removing excess fluid to decrease blood volume

A

Diuretics

409
Q

Beta blockers block ?

A

B1 adrenergic receptors decreasing CO

410
Q

ACE inhibitors and angiotensin receptor blockers prevent _______ from renin-angiotensin aldosterone axis

A

vasoconstriction

411
Q

_____ is a connective tissue composed of cellular elements suspended in an extensive fluid matrix that circulates in the CV system

A

blood

412
Q

~5L of blood is composed of ____ plasma, which is ____ water and ___ proteins (globulins)

A

~3L, 92%, 7%

413
Q

Interstitial fluid has ____ concentration of proteins, whereas the plasma has a ____ concentration of proteins. Interstitial fluid has ____ dissolved oxygen, whereas the plasma has a ____ amount of dissolved oxygen

A

less, high, less, high

414
Q

What is the source and function of albumins?

A

Source: liver
Function: major contributors to colloid osmotic pressure of plasma; carriers for various substances

415
Q

What is the source and function of globulins?

A

Source: liver and lymphoid tissue
Function: clotting factors, enzymes, antibodies, carriers for various substances

416
Q

What is the source and function of fibrinogen?

A

Source: liver
Function: forms fibrin threads essential to blood clotting

417
Q

What is the source and function of transferrin?

A

Source: liver and other tissues
Function: iron transport

418
Q

Total blood volume: ~__-__% of total body weight: ___/1 kg body weight in an adult female and ~____/kg body weight in an adult male

A

7-8, 70mL, 80mL

419
Q

What is the hematocrit?

A

The fraction of the total column occupied by RBC’s (40-45%)

420
Q

What is the Buffy coat?

A

WBC’s and platelets (1%<)

421
Q

What is Plasma?

A

Pale white solution of electrolytes, plasma proteins, carbohydrates and lipids (55-60%)

422
Q

What is Hematopoiesis?

A

Production of blood cells

423
Q

In an adult, where does hematopoiesis occur?

A

Pelvis, spine, ribs, cranium, and proximal ends of long bones

424
Q

___% of cells produced are WBC’s (short lifespan), ___% RBC’s (4 months)

A

75, 25

425
Q

Bone marrow consists of blood cells in different stages of development and supporting tissue known as the _____?

A

stroma

426
Q

Stroma is composed of?

A

Fibroblast-like reticular cells, collagenous fibers, and extracellular matrix

427
Q

_________: lineage development guided by cytokines (cell signaling molecules)

A

Hematopoiesis

428
Q

In the bone marrow, all cells start as a ?

A

pluripotent hematopoietic stem cell

429
Q

Cells like lymphocyte stem cells, uncommitted stem cells, megakaryocyte, erythoblast, and reticulocytes are found in ?

A

bone marrow

430
Q

What are cytokines?

A

Proteins or peptides released from one cell that affect growth or activity in another cell

431
Q

What is the site of production of erythropoietin (EPO), and what does it influence in terms of growth/differentiation of?

A

Site of production: kidney cells primarily
Influences Growth/differentiation of: red blood cells, stimulated by low O2

432
Q

What is the site of production of thrombopoietin (TPO), and what does it influence in terms of growth/differentiation of?

A

Site of production: liver primarily
Influences Growth/differentiation of: megakaryocytes (platelets)

433
Q

What is the site of production of colony-stimulating factors, interleukins, stem cell factors, and what does it influence in terms of growth/differentiation of?

A

Site of production: endothelium and fibroblasts of bone marrow, leukocytes
Influences Growth/differentiation of: all types of blood cells; mobilizes hematopoietic stem cells

434
Q

What is Erythropoiesis?

A

RBC production (EPO)

435
Q

What is Leukopoiesis?

A

Leukocyte (WBC) production (CSF’s)

436
Q

What is Thrombopoiesis?

A

Thrombocyte (platelet) production (TPO)

437
Q

What are red blood cells (RBC)s also known as?

A

erythrocytes

438
Q

______ are the most abundant cell type in the blood (5 million/ul) (~4 month lifespan)

A

RBCs (erythrocytes)

439
Q

_____ are non-nucleated biconcave cells with diameter ~7.5um

A

RBCs (erythrocytes)

440
Q

What is the significance of the shape of RBCs (erythrocytes)?

A

Their distinctive shape increases surface to volume ratio, decreases diffusion distance

441
Q

RBC’s have three major tasks: ?

A
  1. Carrying O2 from the lungs to the systemic tissue
  2. Carrying CO2 from the tissues to the lungs
  3. Assisting in the buffering of acids and bases.
442
Q

How do you get an erythrocyte?

A

Erythroblast → Exocytosis of nucleus / loss of mitochondria and ribosomes → reticulocyte → erythrocyte

443
Q

What kind of micrograph shows the biconcave disk shape of RBCs?

A

Scanning electron (SEM)

444
Q

The ______ is what creates the unique shape of RBCs

A

cytoskeleton

445
Q

The biconcave disk shape of RBCs allow them to ?, respond to ?, and provide ?

A

squeeze through capillaries, osmotic changes, evidence of disease

446
Q

Erythrocytes placed in a _____ medium shrink, but the rigid cytoskeleton remains intact, creating a ____ surface. These cells are said to be ?

A

hypertonic, spiky, crenated (notched)

447
Q

Erythrocytes placed in a _____ medium swell and lose their biconcave disk shape

A

hypotonic

448
Q

Abnormal ______ in sickle cell disease can cause RBCs to change shape

A

hemoglobin

449
Q

RBC’s mainly consist of _______

A

hemoglobin

450
Q

What is hemoglobin?

A

The O2 transport protein ~96% of dry weight

451
Q

A hemoglobin molecule is composed of __ protein globin chains, each centered around a ____ group. In most adult hemoglobin, there are ___ alpha chains and ___ beta chains

A

4, heme, two, two

452
Q

What are the 4 kinds of globulin proteins?

A

Alpha, beta, gamma, delta

453
Q

Each heme group consists of a _____ ring with an iron atom in the center

A

porphyrin

454
Q

__% of iron in the body found in heme groups of hemoglobin, each heme group can bind ?

A

70, one oxygen (O2) molecule

455
Q

Hemoglobin synthesis requires ____

A

iron

456
Q

Order these statements in accordance to hemoglobin synthesis:
1. Transferrin protein transports Fe in plasma
2. RBCs live about 120 days in the blood
3. Bilirubin and metabolites are excreted in urine and feces
4. Iron (Fe) ingested from the diet
5. Bone marrow uses Fe to make hemoglobin (Hb) as part of RBC synthesis
6. Liver metaboizzes bilirubin and excretes it in bile
7. Fe absorbed by active transport
8. Spleen destroys old RBCs and converts Hb to bilirubin
9. Liver stores excess Fe as ferritin

A

4, 7, 1, 5, 2, 8, 3, 6, 9

457
Q

What are white blood cells also known as?

A

Leukocytes

458
Q

What is the main purpose of WBCs (leukocytes)?

A

defending against infection

459
Q

What are the 2 major groups of WBCs?

A
  1. Granulocytes
  2. Non-granule containing lymphocytes and monocytes
460
Q

_______: contain cytoplasmic granules visualized under microscope. Brief lifespan in the blood < 12hours, but if activated can migrate into tissues for longer time.

A

Granulocytes

461
Q

What are the 3 granulocytes?

A

Neutrophil, eosinophil, basophil

462
Q

What is a neutrophil?

A

Most abundant leukocyte, contain granules with lysosomal enzymes capable of digesting foreign material (phagocytosis)

463
Q

What is an eosinophil?

A

Granules contain Major Basic Protein (MBP) which is toxic to parasites and other enzymes. Important in response to virus’ and in allergic reactions

464
Q

What is a basophil?

A

Least common granulocyte, granules contain histamine, heparin and peroxidase and play a role in allergic reactions

465
Q

What are the two categories of Non-granule containing lymphocytes and monocytes?

A
  1. Lymphocytes
  2. Monocytes
466
Q

What are lymphocytes?

A

For adaptive immunity

467
Q

What are the two types of lymphotcytes?

A

T-lymphocytes (T-Cell)
B lymphocytes (B-cell)

468
Q

What are T-cells?

A

70-80% of all lymphocytes and responsible for cell mediated immunity, does not involve antibodies

469
Q

What are B-cells?

A

Responsible for humoral immunity, make antibodies to antigens

470
Q

What are monocytes?

A

spend life in peripheral tissues developing into macrophages

471
Q

What are the two purposes of monocytes?

A
  1. Phagocytosis of pathogens or cellular debris
  2. Present antigens to lymphocytes
472
Q

________ are nucleus-free fragments, 2-3um in diameter in their inactive state

A

Platelets (thrombocytes)

473
Q

A single ________ can produce thousands of platelets ~10 day life span

A

megakaryocyte

474
Q

150-400 000 platelets per 1__ of blood.

A

ul

475
Q

Platelets contain two special types of granules: ?

A
  1. Dense core granules
  2. α-granules
476
Q

Platelets are essential for ?

A

hemostasis

477
Q

Megakaryocytes are giant cells with multiple copies of DNA in the ____

A

nucleus

478
Q

The edges of the megakaryocyte break off the form cell fragments called ?

A

platelets

479
Q

What is Hemostasis?

A

The prevention of hemorrhage (bleeding) from a damaged vessel

480
Q

Hemostasis is achieved through a 3-step process: ?

A
  1. Vasoconstriction
  2. Platelets aggregate into loose platelet plug
  3. Clot: reinforced platelet plug (coagulation)
481
Q

________ contributes to hemostasis by closing the vessel and preventing blood flow to the damaged region

A

Vasoconstriction

482
Q

Vasoconstriction in hemostasis can be triggered by direct _____ to vascular smooth muscle, the release of _______ signals from damaged endothelial cells (endothelin) or _______ (serotonin, thromboxane A2)

A

injury, paracrine, platelets

483
Q

Vasoconstriction brings down the _____ within the vessel so a secure mechanical seal can be applied in the form of a ?

A

pressure, clot

484
Q

Exposed _____ binds and activates platelets

A

collagen

485
Q

Inactivated platelets do not adhere to themselves or to the intact ? that line the vessel, but they contain cell surface receptors called ?

A

endothelium cells, integrins

486
Q

A breach of the endothelium exposes the integrins of _______ to ______, fibronectin and laminin, which are all part of the _______ layer causing them to bind

A

platelets, collagen, subendothelial

487
Q

Intact endothelial cells release substances to prevent activated platelets from binding, which includes _____ and ?

A

prostacyclin, nitric oxide (NO)

488
Q

In platelet plug formation, the binding of integrins causes the activation of an ? in platelets causing them to release the contents of their _______

A

intracellular signaling pathway, granules

489
Q

What are the granule contents in platelets?

A

serotonin (vasoconstrictor)
ADP
platelet-activating factor

490
Q

PAF signals platelets to release ?, and activates more _____

A

thromboxane A2 (vasoconstrictor), platelets

491
Q

Platelet extends many finger-like _____

A

filopodia

492
Q

When ADP, serotonin and thromboxane A2 are released, they all activate additional platelets causing them to ?

A

recruit to the site and aggregate

493
Q

The von Willebrand factor causes ?

A

platelets to form molecular bridges between one another

494
Q

Order these statements according to platelet plug formation:
1. Platelets aggregate into platelet plug
2. Factors attract more platelets
3. Exposed collagen binds and activate platelets
4. Release of platelet factors

A

3, 4, 2, 1

495
Q

Coagulation is an _______ pathway

A

extrinsic

496
Q

What is an extrinsic pathway?

A

Another cascade of protease reactions occurring outside the vascular system

497
Q

In coagulation, subendothelial cells express a membrane protein known as ?, which is a receptor for a plasma protein: ?When it leaves the vessel through _____ region and comes into contact with tissue factor its converted (non-proteolytically) to factor ____

A

tissue factor, factor VII, damaged, VIIa

498
Q

Factor VIIa and Ca2+ form a complex that proteolytically ____ factor X to produce factor ___, which is produced from either the ______ or ______ pathway is important for the ?

A

cleaves, Xa, intrinsic, extrinsic, common pathway

499
Q

Factor Xa produced from the intrinsic and extrinsic pathway join together with factor Va and Ca2+ to create ?

A

prothrombinase

500
Q

Prothrombinase converts prothrombin to ______, which is a central protease of the ?

A

thrombin, coagulation cascade

501
Q

Fibrinogen is then cleaved by _____ to fibrin monomers, which spontaneously polymerize to form a ? that weaves through plug and traps ?

A

thrombin, gel of fibrin polymers, blood cells

502
Q

Thrombin also activates factor _____ to _____ which assists in forming the fibrin polymers into a ?

A

XIII to XIIIa, stable fibrin mesh

503
Q

The intrinsic pathway is by ______ ______, whereas the extrinsic pathway is by ____ _____

A

contact activation, cell injury

504
Q

? : factor XII is activated when contacting exposed collagen, activated platelets.
Final product is factor Xa

A

Intrinsic pathway (surface contact pathway)

505
Q

? : factor VII leaves vessel and binds to tissue factor receptor and become activated Factor VIIa.
Final product is factor Xa

A

Extrinsic pathway (cell injury pathway)

506
Q

? : factor Xa from intrinsic and extrinsic is used to create thrombin which ultimately converts fibrinogen to a stable fibrin clot

A

Common pathway

507
Q

_______ is a name given to several diseases in which one of the factors in the coagulation cascade is defective or lacking

A

hemophilia

508
Q

What are the common symptoms of hemophilia?

A

Bruise easily, spontaneous bleeding, bleeding in the joints and muscles can be painful and disabling and if bleeding occurs in the brain it can be fatal

509
Q

What is hemophilia A?

A

A factor VIII deficiency
Most common ~80% of cases

510
Q

What is hemophilia B?

A

Factor IX deficiency

511
Q

Both hemophilia A and B are ?

A

X-linked recessive

512
Q

What is hemophilia treated with?

A

with synthetic factors

513
Q

Endothelial cells also produce a variety of anticoagulant factors that interfere with the ?

A

clotting cascade

514
Q

What is a TFPI? And what are 4 examples?

A

Tissue Factor Pathway Inhibitor
Antithrombin III, thrombomodulin, protein S and C

515
Q

What is fibrinolysis?

A

Breakdown of blood clots

516
Q

Fibrinolysis begins with the conversion of _______ (produced in liver) to ____ through proteolysis. Endothelial cells produce tissue _____ activator (t-PA) that causes this conversion. Plasmin is capable of breaking down both ? as well as ______

A

plasminogen, plasmin, plasminogen, stable fibrin, fibrinogen

BMSC 207 (3 decks)

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