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KLowe Anesthesia Physiology 1: Cardiovascular Larmon > Final Exam Review > Flashcards

Final Exam Review Flashcards

1
Q

What are the 2 pumps of the heart?

A

RV & LV

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2
Q

Right ventricle = ___ circulation

A

Pulmonary circulation

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3
Q

Left ventricle = ___ circulation

A

Systemic circulation

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4
Q

___ causes unidirectional flow in the heart

A

Valves

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5
Q

What part of the systemic circulation has the greatest resistance to blood flow?

A

Arterioles

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6
Q

What is the primary function of the veins?

A

Capacitance function (has the greatest percentage of blood volume)

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7
Q

___ of the aorta and its branches during systole

A

Distention

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8
Q

___ of the large arteries with ___ of blood during ventricular relaxation during diastole

A

Elastic recoil of the large arteries; forward propulsion of blood

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9
Q

Blood flow is essentially ___ at the capillary level

A

Non-pulsatile

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10
Q

Velocity of blood flow is ___ related to the cross-sectional area of the vascular system

A

Inversely

I.e.: blood flow velocity is very slow in the capillaries (large cross-sectional area), which makes conditions ideal for exchange of diffusible substances

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11
Q

The blood flow to each tissue of the body is almost always precisely controlled in relation to ___

A

Tissue needs

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12
Q

Cardiac output is controlled mainly by the sum of ___

A

All the local tissue flows

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13
Q

Sympathetic innervation of the heart

A

T1-T4 “cardiac accelerators”

Distributed throughout the heart

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14
Q

Parasympathetic innervation of the heart originates in the ___

A

Medulla oblongata, vagus nerves

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15
Q

Parasympathetic provides much innervation to ___ and little innervation to ___

A

Much innervation to SA/AV nodes; little innervation to ventricles

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16
Q

What is the conduction system of the heart?

A

SA node —> AV node —> Bundle of His —> Bundle Branches (right and left)

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17
Q

Interatrial conduction pathways

A

SA to LA

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18
Q

Internodal conduction pathways

A

SA to AV

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19
Q

Where is the AV node located?

A

On the RIGHT side of the interatrial septum, near the ostium of the coronary sinus

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20
Q

Where does venous drainage of the heart occur?

A

Coronary sinus

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21
Q

What are the coronary arteries (identify 2 main ones and their branches)?

A
  • Right coronary

- Left coronary—branches = left anterior descending (LAD); left circumflex; Ramos intermedius

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22
Q

What is right coronary dominance?

A

In 85% of individuals, the RCA supplies the posterior descending artery

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23
Q

Branch of LAD

A

Diagonal

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24
Q

Branch of left circumflex

A

Obtuse marginal

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25
Q

What is Ramus intermedius?

A

A tri-furcation of the left coronary artery; found in 37% of people

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26
Q

What is the normal resting membrane potential?

A

-90 mV

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27
Q

Which electrolyte is high INSIDE a cardiac cell?

A

K+

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28
Q

Which electrolyte is high OUTSIDE a cardiac cell?

A

Na+

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29
Q

What is the chemical driving force?

A

K+ moving down it’s concentration gradient (from inside of the cell to outside of the cell)

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30
Q

What is the electrical driving force?

A

As K+ leaves the cell, negativity increases on the inside of the cell membrane and electrostatically attracts K+; this electrostatic force prevents K+ from leaving cell

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31
Q

What is the major determinant of the resting membrane potential?

A

Potassium

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32
Q

What is the Nernst equation? Balance of ___ + ___ = ___

A

Balance of chemical driving force + electrical driving force = no further net movement of K+

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33
Q

Na+, K+ - ATPase pump pumps Na+/K+ in what ratio?

A

3 Na+ out : 2 K+ in

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34
Q

The Na+, K+ - ATPase pump is partially inhibited by ___

A

Digitalis (digoxin)

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35
Q

What 3 things result in the resting membrane potential?

A
  • Potassium diffusion
  • Sodium diffusion
  • Na+, K+ - ATPase
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36
Q

What type of cells (3) have the FAST RESPONSE action potential?

A

Myocardial muscle cells—atrial, ventricular, and purkinje myocardial fibers

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37
Q

What are the (5) phases of the fast response action potential?

A
  • Phase 0
  • Phase 1
  • Phase 2
  • Phase 3
  • Phase 4
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38
Q

Phase 0 fast response action potential

A

Depolarization—Na+ into cell

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39
Q

Phase 1 fast response action potential

A

Partial repolarization—small amount of K+ out

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40
Q

Phase 2 fast response action potential

A

Plateau—slow influx of Ca+ through L-type calcium channels; stimulates the C-ICR (explained on separate flash card); some K+ moves out of the cell to counterbalance the large influx of calcium into the cell

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41
Q

Phase 3 fast response action potential

A

Repolarization—K+ moves out of the cell

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42
Q

Phase 4 fast response action potential

A

Resting membrane potential—ionic concentrations restored

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43
Q

What does C-ICR stand for/what does it involve/what phase does it occur during?

A

Calcium-induced calcium release

The slow influx of Ca++ into the cell (during phase 2 of the fast response action potential) stimulates a large amount of calcium to be released from the sarcoplasmic reticulum

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44
Q

ERP =

A

Effective refractory period—cannot regenerate another action potential

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45
Q

RRP =

A

Relative refractory period—can begin to generate another action potential

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46
Q

During what phases does ERP occur in the fast response action potential?

A

Between phases 1-2

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47
Q

During what phase(s) does RRP occur in the fast response action potential?

A

Phase 3

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48
Q

The characteristics of the upstroke of the action potential (depolarization, phase 0) depend almost entirely on inward movement of ___

A

Na+

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49
Q

There is a small inward ___ current during phase 0 depolarization (important for contraction)

A

Ca++

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50
Q

What produces the plateau phase (phase 2)?

A

Slow inward movement of Ca++ through L-type calcium channels; counterbalanced by outward K+ currents

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51
Q

Ventricular contraction persists throughout the action potential, so the ___ produces a long action potential to ensure forceful contraction of substantial duration

A

Long plateau = long action potential

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52
Q

___ is mainly responsible for repolarization (phase 3)

A

Outward K+ current

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53
Q

What 3 pumps are involved in the restoration of ionic concentrations (resting membrane potential, phase 4)?

A
  • Na+,K+-ATPase
  • Na+-Ca++ exchanger—driven by gradients, not electrical
  • ATP-driven Ca++ pump
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54
Q

What type of cells have SLOW response action potentials?

A

Pacemaker cells—SA node, AV node

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55
Q

What are the 4 phases of the SLOW response action potential?

A
  • Phase 0
  • Phase 2
  • Phase 3
  • Phase 4
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56
Q

What phase is absent in the SLOW response action potential?

A

Phase 1

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57
Q

Phase 0–slow response action potential

A

Depolarization—caused by Ca++ influx

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58
Q

Phase 2–slow response action potential

A

Very brief

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59
Q

Phase 3–slow response action potential

A
  • Not separated clearly from phase 2

- K+ efflux causes repolarization

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60
Q

Phase 4–slow response action potential

A

Resting membrane potential

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61
Q

What does diastolic depolarization involve? — Inward ___ and ___; outward ___

A

Inward Na+ (not via typical Na+ channels) / Ca++

Outward K+ (opposes effects of other ions)

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62
Q

What phase of the slow response action potential does diastolic depolarization occur?

A

Phase 4

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63
Q

Slow depolarization of cell in phase ___ until activated in phase 0

A

4

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64
Q

Shorter diastolic depolarization = ___ pacer

A

FASTER

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65
Q

Longer diastolic depolarization = ___ pacer

A

SLOWER

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66
Q

What is the heart’s dominant pacemaker?

A

SA node

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67
Q

The ability of a focal area of the heart to generate pacemaking stimuli is known as ___

A

Automaticity

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68
Q

What term best describes this?—the SA node rate of firing is faster than any other node, so it will suppress other nodes from firing.

A

Overdrive suppression

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69
Q

At higher heart rates, more Na+ is extruded than K+ enters the cell. This tends to ___ the cells.

A

Hyperpolarize

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70
Q

Slow diastolic depolarization requires more time to reach ___

A

Threshold

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71
Q

What is the process by which an electrical stimulus triggers the release of calcium by the SR, initiating the mechanism of muscle contraction by sarcomere shortening?

A

Excitation-contraction coupling

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72
Q

What structure within the L-type calcium channels allows for communication between extra/intracellular?

A

T-tubules

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73
Q

What structure is responsible for calcium storage in the cell?

A

Sarcoplasmic reticulum

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74
Q

Cardiac action potentials are transmitted rapidly from cell-to-cell via ___

A

Gap junctions

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75
Q

The influx of Ca++ from the interstitial fluid during the action potential triggers the release of ___ from the ___; the free cytosolic ___ level increases; this is known as ___

A

Ca++ from the sarcoplasmic reticulum; the free cytosolic Ca++ level increases; this is known as calcium-induced calcium release (C-ICR)

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76
Q

Because the T-tubules are continuous with the extracellular fluid, ___ concentration of calcium becomes important for adequate heart contraction

A

Extracellular concentration of calcium

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77
Q

During muscle contraction—calcium binds to ___, which causes a conformational change in the ___ system

A

Calcium binds to troponin; causes a conformational change in the troponin-tropomyosin system

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78
Q

After calcium binds to troponin, this releases inhibition on ___, and the muscle ___ by the ___ mechanism

A

Releases inhibition on the actin and myosin interaction; the muscle shortens by the sliding filament mechanism

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79
Q

Sliding filament mechanism = ___ bind to ___, leading to ___ movement and reduction in ___, which causes muscle contraction

A

Myosin heads bind to actin, leading to cross-bridge movement and reduction in sarcomere length, which causes muscle contraction

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80
Q

Muscle contraction requires ___

A

ATP

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81
Q

ATP is required for muscle contraction to ___

A

Unbind myosin from actin—this allows the sarcomere to return to its original, relaxed length so another muscle contraction can occur

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82
Q

Normal PR interval

A

0.12-0.20 sec

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83
Q

Normal QRS

A

0.06-0.10 sec

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84
Q

AV node is situated on the ___ side of the interatrial septum, near the ostium of the ___

A

Right side of the interatrial septum; near ostium of the coronary sinus

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85
Q

How many phases are in the cardiac cycle?

A

Phases 1-7

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86
Q

What phases are in ventricular systole?

A

Phase 2
Phase 3
Phase 4

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87
Q

What phases are in ventricular diastole?

A

Phase 5
Phase 6
Phase 7
Phase 1

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88
Q

Phase 1

A

Atrial systole

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89
Q

Phase 2

A

Isovolumic contraction (all valves closed)

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90
Q

Phase 3

A

Rapid ejection (70% of ventricular volume is ejected)

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91
Q

Phase 4

A

Reduced ejection

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92
Q

Phase 5

A

Isovolumic relaxation (all valves closed)

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93
Q

Phase 6

A

Rapid ventricular filling—most LV filling occurs here

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94
Q

Phase 7

A

Diastasis (reduced ventricular filling)

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95
Q

Closure of what 2 valves generates the first audible heart sounds (S1)? What phase is this sound heard?

A

Tricuspid and mitral valves, close during phase 2–isovolumic contraction

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96
Q

___% of blood volume is ejected during phase 3, rapid ejection

A

70%

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97
Q

Closure of what valve generates the second audible heart sound (S2)? What phase is this sound heard?

A

Closure of the aortic valve, phase 5–isovolumic relaxation

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98
Q

All valves are closed during what 2 phases of the cardiac cycle?

A

Phase 2: isovolumic contraction

Phase 5: isovolumic relaxation

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99
Q

S1 =

A

Closure of tricuspid/mitral valves

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100
Q

S2 =

A

Closure of aortic valve

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101
Q

Normal healthy heart valves are only audible when ___

A

Closing

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102
Q

An S3 heart sound is ___ and is associated with ___

A

Abnormal, associated with heart failure

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103
Q

S4 may be heard during what phase? What does it sound like?

A

Phase 1–atrial systole, sounds like a gallop

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104
Q

Very common to hear all 4 heart sounds in a person with ___

A

Heart failure

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105
Q

Phase 1 (atrial systole) contributes to ___ filling but is not essential

A

Ventricular filling

Contributes more to ventricular filling in a stiff heart

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106
Q

Dicrotic notch = ___ closure, marks end of ___

A

Aortic valve closure, marks end of ventricular systole

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107
Q

Atrial kick—at normal HR, contributes to ___% of ventricular filling

A

10% — insignificant

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108
Q

Atrial kick—at higher heart rates (i.e.: during exercise), can contribute up to ___% of ventricular filling

A

40%

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109
Q

There can be a loss of atrial kick in patients with ___

A

Atrial fibrillation

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110
Q

What are the 5 CVP waves?

A 
A wave
C wave
V wave
X descent
Y descent
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111
Q

A wave =

A

Right atrial contraction; right after P wave/atrial depolarization

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112
Q

C wave =

A

Right ventricular contraction; just after QRS complex/ventricular depolarization

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113
Q

V wave =

A

Passive filling of right atrium; just after T wave begins/ventricular repolarization

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114
Q

Normal CO = ___ L/min

A

6 L/min

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115
Q

Strenuous exercise can kick CO up to ___ x normal

A

4-7 x normal

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116
Q

Cardiac output is the ___

A

Quantity of blood pumped into the aorta each minute

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117
Q

How do you calculate cardiac output?

A

CO = HR x SV

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118
Q

How do you calculate SV?

A

SV = EDV - ESV

EDV = how much is in the ventricle when you start to squeeze

ESV = how much is left after the squeeze

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119
Q

Venous return is the quantity of blood flowing from ___ into the ___ each minute

A

Veins into the right atrium each minute

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120
Q

Cardiac output and venous return should match—T/F

A

True

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121
Q

What are the 4 major determinants of cardiac output?

A
  • Preload
  • Afterload
  • Contractility
  • Heart rate
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122
Q

What has more of an effect on cardiac output—change in heart rate or change in stroke volume?

A

Change in heart rate

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123
Q

If HR increases, you have (more/less) time to fill, so you will have (increased/decreased) SV/CO

A

If HR increases, you have less time to fill, so you will have decreased SV/CO

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124
Q

Bowditch (Treppe) Effect—an increase in heart rate will also cause ___ inotropy d/t an increase in intracellular ___ with a higher heart rate

A

Positive inotropy d/t an increase in intracellular calcium

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125
Q

The Bowditch (Treppe) Effect is also known as…

A

“Staircase” phenomenon

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126
Q

The increase in intracellular calcium causes more ___ per minute

A

Depolarizations

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127
Q

Why is there more calcium lingering in the cell—the ___ pump doesn’t function as well (Bowditch/Treppe Effect)?

A

The Na+/Ca++ exchange pump doesn’t function as well because the Na+/K+-ATPase pump can’t keep up with the influx of Na+

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128
Q

Increased stroke volume = ___ end diastolic volume, ___ end systolic volume

A

Increased end diastolic volume, decreased end systolic volume

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129
Q

___ preload = increased end diastolic volume (and vice versa)

A

Increased preload = increased end diastolic volume

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130
Q

___ contractility = decreased end systolic volume (and vice versa)

A

Increased contractility = decreased end systolic volume

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131
Q

___ afterload = decreased end systolic volume (and vice versa)

A

Decreased afterload = decreased end systolic volume

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132
Q

___ is the initial stretching of the cardiac myocytes prior to contraction

A

Preload

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133
Q

Preload is related to the ___ length at the end of diastole

A

Sarcomere

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134
Q

Can we measure sarcomere length (aka preload) directly?

A

No—so we must use indirect indices of preload

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135
Q

What are 4 indirect indices of preload?

A
  • LVEDV
  • LVEDP
  • PCWP
  • CVP
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136
Q

Determinants of preload—how do venous return/total blood volume affect preload?

A

Increase in venous return/total blood volume = increase in preload

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137
Q

Determinants of preload—how does respiration (i.e.: mechanical ventilation) affect preload?

A

Mechanical ventilation = positive pressure ventilation, which will decrease venous return d/t increased intrathoracic pressures, which in turn will decrease preload

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138
Q

Determinants of preload—how does filling time (heart rate) affect preload?

A

Higher heart rate = less time for ventricular filling, decreased preload

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139
Q

Determinants of preload—how does ventricular compliance affect preload?

A

Increased compliance = increased preload

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140
Q

Determinants of preload—how does inflow/outflow resistance affect preload?

A

Less resistance = increased preload

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141
Q

“The heart pumps the blood that is returned to it” refers to what?

A

Frank-Starling Mechanism

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142
Q

The Frank-Starling Mechanism plays an important role in balancing ___

A

The output of the 2 ventricles

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143
Q

Frank-Starling—increasing ___ and ___ leads to an increase in stroke volume

A

Increasing venous return and ventricular preload

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144
Q

What is afterload?

A

The “load” that the heart must eject blood against

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145
Q

Afterload is closely related to the ___ pressure

A

Aortic

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146
Q

LaPlace’s Law refers to ___

A

Wall stress

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147
Q

Increased ventricular pressure = ___ wall stress

A

Increased wall stress

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148
Q

Increased ventricular radius = ___ wall stress

A

Increased wall stress

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149
Q

Increased wall thickness = ___ wall stress

A

DECREASED wall stress

Thick, hypertrophied ventricle = less wall stress

Thinner wall = increased wall stress

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150
Q

Frank-Starling looks at changes in ___

A

Volume

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151
Q

___ (increased/decreased) aortic pressure increases afterload

A

Increased

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152
Q

___ (increased/decreased) systemic vascular resistance increases afterload

A

Increased

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153
Q

Aortic valve ___ increases afterload

A

Stenosis—can’t get blood out of stenotic or stiff aorticle valve

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154
Q

Ventricular dilation ___ afterload

A

Increases—ventricle itself increases in size, but the surrounding wall is thin

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155
Q

What is the inherent capacity of the myocardium to contract independently of changes in afterload or preload?

A

Contractility

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156
Q

What is an alternate name for contractility?

A

Inotropy

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157
Q

Increased inotropy = ___ stroke volume, ___ end-diastolic volume

A

Increased stroke volume, decreased end-diastolic volume

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158
Q

Decreased inotropy = ___ stroke volume, ___ end-diastolic volume

A

Decreased stroke volume, increased end-diastolic volume

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159
Q

Sympathetic activation/catecholamines ___ inotropy

A

Increase

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160
Q

Heart rate ___ inotropy

A

Increases

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161
Q

Afterload ___ inotropy

A

Increases

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162
Q

Systolic failure and parasympathetic activation ___ inotropy

A

DECREASE

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163
Q

Venous pooling may significantly ___ cardiac output

A

Reduce

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164
Q

Spontaneous respiration—___ (increased/decreased) intrathoracic pressure results in a ___ (increased/decreased) right atrial pressure, which ___ venous return

A

Decreased intrathoracic pressure results in a decreased right atrial pressure, which enhances venous return

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165
Q

Mechanical ventilation— ___ (increased/decreased) intrathoracic pressure during positive-pressure lung inflation causes ___ (increased/decreased) right atrial pressure, which ___ (increases/decreases) venous return

A

Increased intrathoracic pressure during positive-pressure lung inflation causes increased right atrial pressure, which decreases venous return

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166
Q

Valsalva maneuver causes a large ___ (increase/decrease) in intrathoracic pressure, which ___ venous return to the right atrium (to the point of passing out)

A

Large increase; impedes venous return

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167
Q

Heart rate has a ___ (positive/negative) effect on end-diastolic volume—the faster the heart is going, the ___ (more/less) filling time you have, so the ___ (more/less) volume you have

A

Heart rate has a negative effect; the less filling time; less volume

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168
Q

Increased afterload = ___ end-systolic volume

A

Increased (less is squeezed out)

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169
Q

Cardiac function curve = ____ curve

A

Frank-Starling curve

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170
Q

Increase in right atrial pressure = ___ in cardiac output

A

Increase

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171
Q

___ afterload = increased cardiac output

A

Decreased

172
Q

___ inotropy = increased cardiac output

A

Increased

173
Q

Mean circulatory filling pressure = pressure at ___

A

Zero flow (~ 7 mm Hg)

174
Q

Changes in ___ and ___ change the hinge point (mean circulatory filling pressure)—shift it left or right

A

Blood volume and venous compliance

175
Q

Changes in ___ = same mean circulatory filling pressure, but will shift curve up or down

A

Systemic vascular resistance

176
Q

X-axis of venous return curve =

A

Right atrial pressure

177
Q

Y-axis of venous return curve =

A

Cardiac output

178
Q

Why is there a plateau in the venous return curve?

A

As the right atrial pressure starts to fall below 0, CO begins to level off because the vena cava collapses, thus limiting venous return to the heart

179
Q

Increase in blood volume shifts venous return curve/mean circulatory filling pressure ___

A

Up and to the right

180
Q

Increase in venous compliance shifts venous return curve/mean circulatory filling pressure ___

A

Down and to the left

181
Q

Decrease in blood volume shifts venous return curve/mean circulatory filling pressure ___

A

Down and to the left

182
Q

Decrease in venous compliance shifts venous return curve/mean circulatory filling pressure ___

A

Up and to the right

183
Q

Increased systemic vascular resistance shifts the venous return curve ___; how does it affect mean circulatory filling pressure?

A

Down and to the left; same mean circulatory filling pressure

184
Q

Decreased systemic vascular resistance shifts the venous return curve ___; how does it affect mean circulatory filling pressure?

A

Up and to the right; same mean circulatory filling pressure

185
Q

Mean circulatory pressure is the pressure in the circulatory system when there is ___ flow, CO = ___

A

NO flow; CO = 0

186
Q

Mean circulatory pressure reflects ___ and ___

A
  • Total blood volume

- Compliance of the entire system

187
Q

Cardiac output must equal venous return—T/F?

A

True!

188
Q

The width of the pressure-volume loop represents ___

A

Stroke volume—the difference between EDV and ESV

189
Q

How does afterload affect the pressure-volume loop? A change in afterload = a change in ___

A

Change in position on line of same slope

Increased afterload = lower point on line of same slope
Decreased afterload = higher point on line of same slope

190
Q

How does contractility/inotropic state affect the pressure-volume loop? A change in contractility = a change in ___

A

Change in the slope of the line

Increased contractility = line with steeper slope
Decreased contractility = line with less slope

191
Q

Change in slope of the ESPVR (end-systolic pressure volume relationship) = ___ issue

A

Contractility issue

192
Q

Change in slope of the EDPVR (end-diastolic pressure volume relationship) = ___ issue

A

Compliance issue

193
Q

X-axis of pressure volume loop =

A

LV volume (ml)

194
Q

Y-axis of pressure volume loop =

A

LV pressure (mm Hg)

195
Q

What is not a factor in pressure-volume loops?

A

Time

196
Q

A pressure volume loop represents one ___

A

Cardiac cycle

197
Q

Pressure volume loop moves in what direction?

A

Counterclockwise

198
Q

If pressure volume loop gets wider, that means there is an increase in ___

A

Stroke volume/preload

199
Q

Velocity is ___ related to cross-sectional area

A

INVERSELY

I.e.: capillaries

200
Q

What is flow?

A

Volume per unit time

201
Q

What is velocity?

A

Distance per unit time

202
Q

What is the force exerted by the blood against any unit area of the vessel wall?

A

Blood pressure

203
Q

One mm Hg of pressure = ___ cm of H2O pressure

A

1.36

204
Q

Blood flow is driven by a ___ pressure

A

Perfusion pressure aka pressure gradient—normally represented by the difference between the arterial and venous pressures across the organ

205
Q

Cerebral perfusion pressure (formula) =

A

CPP = MAP - CVP or ICP (whichever is higher)

206
Q

Coronary perfusion pressure (formula) =

A

Coronary perfusion pressure = diastolic pressure - LVEDP

207
Q

Poiseuille’s Law—flow is directly proportional to the ___

A

Pressure gradient

208
Q

Poiseuille’s Law—flow varies directly as the ___ power of the radius

A

Fourth power

209
Q

What is the most important factor for flow, according to Poiseuille’s Law?

A

RADIUS!

210
Q

Poiseuille’s Law—doubling the radius of a tube causes a ___ increase in flow

A

16-fold (2^4)

211
Q

Flow is inversely proportional to the ___ of the fluid

A

Viscosity

I.e.: polycythemia—blood is more viscous, results in less flow

212
Q

Flow is inversely proportional to the ___ of the tube

A

Length

Longer tube = less flow

213
Q

What is the impediment to blood flow in a vessel that cannot be measured by any direct means?

A

Resistance

214
Q

What are the greatest resistance vessels in the circulation?

A

Arterioles

215
Q

SVR formula

A

SVR = ( (MAP-CVP) / CO ) x 80

Because CVP is normally near 0 mm Hg, the calculation is sometimes simplified to:

SVR = MAP / CO

216
Q

Normal SVR = ___ - ___

A

700-1600

217
Q

Resistance in series is ___

A

Additive

RT = R1+ R2 + R3

218
Q

Resistance in parallel has a ___ (increased/decreased) resistance by ___ (increasing/decreasing) the overall radius

A

Decreased resistance by increasing the overall radius

219
Q

What is the measure of the tendency for turbulence to occur?

A

Reynold’s number

220
Q

If R > 2,000…

A

Turbulence is likely to occur, even in a straight, smooth vessel!

221
Q

Reynold’s number is directly proportional to what 3 things?

A
  • Velocity (how fast it’s flowing)
  • Density
  • Diameter
222
Q

Reynold’s number is INVERSELY proportional to ___

A

Viscosity

223
Q

Viscosity is related to ___ flow

A

Laminar

224
Q

Density is related to ___ flow

A

Turbulent

225
Q

Relationship of hematocrit to blood viscosity—increased hematocrit = ___ (increased/decreased) viscosity, so ___ (more/less) flow

A

Increased hematocrit = increased viscosity, so less flow

226
Q

Dicrotic notch = closure of ___

A

Aortic valve

227
Q

Normal RA pressure

A

2-3 mm Hg

228
Q

Normal RV pressure

A

25 mm Hg

229
Q

Normal PA pressure

A

20-30 [systolic] / 8-12 [diastolic] (mean 25 mm Hg)

230
Q

Normal PCWP

A

4-12 mm Hg

231
Q

The best transducer placement is at a vertical height approximately 5 cm BELOW the left sternal border at the fourth intercostal space—T/F

A

True

232
Q

Normal SV =

A

70 ml/min

233
Q

Normal EF =

A

> 55%

234
Q

Calculating cardiac output with thermodilution technique—cardiac output is ___ proportional to the area under the curve (AUC)

A

INVERSELY proportional

235
Q

CO thermodilution technique—greater area under the curve, ___ (higher/lower) cardiac output

A

LOWER

236
Q

Function of the ___ system is to distribute blood to the capillary systems in the body

A

Arterial system

237
Q

The ___ regulate the distribution of flow of blood to the various capillary beds

A

Arterioles

238
Q

Arterioles are AKA the “___” of the vascular system

A

Stopcocks

239
Q

The ___ are the greatest resistance vessels

A

Arterioles

240
Q

Pulse pressure =

A

Systolic BP - diastolic BP

241
Q

How do you calculate MAP?

A

([2 * diastolic] + systolic ) / 3

242
Q

Does MAP increase or decrease as blood is pumped out of LV and goes through the arteries&raquo_space; arterioles&raquo_space; capillaries&raquo_space; venules?

A

MAP decreases

243
Q

Where does pulse pressure disappear?

A

In the capillaries

244
Q

Does the venous system contain a pulse pressure?

A

No

245
Q

Pressures are very ___ (high/low) in the veins just before reentry into the heart

A

Low

246
Q

The arterial system converts pulsatile blood flow to ___ blood flow

A

Continuous

247
Q

Arterioles are the “___” of the circulation

A

“Stopcocks”

248
Q

Veins are the ___ for the CV system

A

Reservoir

249
Q

___% of blood volume may be stored in the veins

A

70%

250
Q

Venous pump helps propel blood ___

A

Forward—enhances venous return

251
Q

___ (increased/decreased) cardiac output increases CVP

A

Decreased CO (less blood leaving the heart)

252
Q

___ (increase/decrease) in total blood volume increases CVP

A

Increase in total blood volume (increases preload)

253
Q

Venous ___ (dilation/constriction) increases CVP

A

Venous constriction (more blood returns to the heart)

254
Q

If you go from standing to supine position, does CVP increase or decrease?

A

CVP increases—blood pooled in legs returns to the heart

255
Q

Arterial ___ (dilation/constriction) increases CVP

A

Dilation

256
Q

How does respiratory activity increase CVP?

A

Increased respiratory rate promotes venous return (normal breathing is negative-pressure respiration…decreased intrathoracic pressure = more venous return)

257
Q

Does exercise increase or decrease CVP?

A

Increases—promotes venous return to the heart

258
Q

Arterioles contain ___ (thick/thin) smooth muscle

A

Thick smooth muscle

259
Q

Arterioles give rise to ___, then to capillaries

A

Metarterioles

260
Q

Metarterioles contain ___, which regulate flow into the capillaries

A

Precapillary sphincters

261
Q

What regulates the opening/closing of the precapillary sphincters?

A

Local conditions in the tissues

262
Q

Capillaries are ___-walled (thick/thin)

A

Thin-walled

263
Q

Capillaries are the ___ vessels in the circulation

A

Smallest

264
Q

Capillaries have the greatest ___ because they are so numerous

A

Cross-sectional area

265
Q

Capillaries have the greatest ___ for exchange

A

Surface area

266
Q

True capillaries are devoid of ___ and are incapable of ___

A

Devoid of smooth muscle and are incapable of active constriction

267
Q

Capillary distribution varies from tissue to tissue—T/F

A

True

268
Q

Why can capillaries withstand high intravascular pressures?

A

Because small capillaries have less wall stress—LaPlace’s law

269
Q

What is the difference in pressure in cylindrical vessels vs. spherical vessels?

A

Cylindrical vessels have > pressure than spherical vessels—spherical vessel you divide by 2

270
Q

How do O2, CO2, and lipid-soluble substances move through the capillary membrane?

A

Diffusion

271
Q

How do H2O, electrolytes, and small molecules move through the capillary membrane?

A

Bulk flow

272
Q

How do macromolecules move through the capillary membrane?

A

Via vesicles

273
Q

How do ions and small molecules move through the capillary membrane?

A

Active transport

274
Q

The permeability of the capillary endothelial membrane is the same in all body tissues—T/F

A

FALSE—permeability of the capillary endothelial membrane is NOT the same in all body tissues!!!

275
Q

Body fluid compartments—ICF = ___%

A

40%

276
Q

ECF = ___%

A

20%

277
Q

ICF = ___ L

A

28 L

278
Q

ECF = ___ L

A

14 L

279
Q

ECF—interstitial fluid = ___ L

A

11 L

280
Q

ECF—plasma = ___ L

A

3 L

281
Q

Colloid goes into what body fluid compartment(s)?

A

Intravascular space (plasma)

282
Q

0.9% NS/LR go into what body fluid compartment(s)?

A

ECF—both plasma and interstitial fluid compartments

283
Q

0.9% NS and LR are ___ fluids

A

Isotonic

284
Q

5% dextrose goes into what body fluid compartment(s)?

A

ICF and ECF—goes into ALL compartments

285
Q

5% dextrose is what kind of fluid?

A

Isotonic until entering body; once it enters the body, the glucose gets metabolized and it becomes hypotonic

286
Q

Capillary hydrostatic pressure, interstitial fluid hydrostatic pressure, and interstitial fluid osmotic pressure all move fluids ___

A

OUTWARD from the capillary

287
Q

Plasma colloid osmotic pressure moves fluid ___

A

INTO the capillary

288
Q

Lymphatics are lacking in ___ junctions

A

Tight junctions

289
Q

Pumping by the lymphatic system is the basic cause of ___ pressure in the interstitial fluid space

A

Negative pressure

290
Q

Plasma filtrate from the lymphatics is returned to the circulation by what 4 things?

A
  • Tissue pressure
  • Intermittent skeletal muscle activity
  • Lymphatic vessel contraction
  • System of one-way valves
291
Q

Lymphatics return what 4 things to the circulation?

A
  • Protein (albumin)
  • Bacteria
  • Fat
  • Excess fluid
292
Q

What are 4 things that cause edema?

A
  • Lymphatic obstruction (can’t filter excess fluid out)
  • Change in capillary permeability
  • Reduction in plasma protein (reduced albumin)
  • Increased capillary hydrostatic pressure (increased outflow on arterial end)
293
Q

What are two ways peripheral blood flow is regulated?

A
  • Extrinsic control

- Intrinsic control

294
Q

Extrinsic control =

A
  • Nervous system

- Humoral control

295
Q

Intrinsic control =

A

Locally in the tissues

296
Q

What is the main factor in acute control of local blood flow?

A

Tissue metabolic activity

297
Q

Each tissue in the body is able to control its own local blood flow in proportion to ___

A

Its metabolic needs

298
Q

What is this describing?—any intervention that results in an inadequate oxygen (nutrient) supply for the metabolic requirements of the tissues results in the formation of vasodilator substances which increase blood flow to the tissues

A

Metabolic mechanism

299
Q

What specific condition contributes to metabolic mechanisms?

A

Hypoxia

300
Q

What are 4 tissue metabolites/ions that contribute to metabolic mechanisms?

A
  • K+
  • CO2
  • H+
  • Lactic acid
301
Q

Two types of hyperemia:

A
  • Active hyperemia

- Reactive hyperemia

302
Q

Which type of hyperemia is this?—when any tissue becomes highly active, the rate of blood flow through the tissue increases. The increase in local metabolism causes the cells to devour tissue fluid and nutrients extremely rapidly and also increases large amounts of vasodilator substances (i.e.: exercise).

A

Active hyperemia

303
Q

Which type of hyperemia is this?—when blood supply is blocked to a tissue for a few seconds to as long as an hour or more and then is unblocked, blood flow through the tissue usually increases immediately 4-7 times normal for a few seconds to many hours (i.e.: tourniquet).

A

Reactive hyperemia

304
Q

Within limits, the peak blood flow and the duration of the reactive hyperemia are proportional to the duration of the ___

A

Duration of the occlusion

305
Q

Autoregulation is the intrinsic ability of an organ to maintain a constant ___ despite changes in ___

A

Constant blood flow despite changes in perfusion pressure

306
Q

The myogenic mechanism proposes that the stretch of vascular smooth muscle causes activation of ___ channels

A

Calcium channels

307
Q

Myogenic mechanism—higher pressure ___ (increases/decreases) flow but also increases ___; vessel contracts back down to maintain increased pressure and returns to original flow

A

Higher pressure increases flow but also increases vessel diameter

308
Q

Myogenic mechanism—when the lumen of a blood vessel is suddenly expanded, the smooth muscles respond by ___ in order to restore the vessel diameter and resistance; the converse is also true

A

Contracting

309
Q

What are 4 vasoactive substances released from the endothelium?

A
  • Nitric oxide (NO)
  • Prostacyclin
  • Endothelin
  • Endothelial-derived hyperpolarizing factor (EDHF)
310
Q

Nitric oxide =

A

Vasodilator; endothelium-derived relaxing factor

311
Q

Prostacyclin =

A

Vasodilator

312
Q

Endothelin =

A

Vasoconstrictor

313
Q

What is the primary site in the brain for regulating sympathetic and parasympathetic (vagal) outflow to the heart and blood vessels?

A

The medulla

314
Q

Chronotropy =

A

Heart rate

315
Q

Inotropy =

A

Contractility

316
Q

Dromotropy =

A

Conduction velocity

317
Q

Lusitropy =

A

Relaxation

318
Q

Sympathetic stimulation comes from ___ nerves and ___ gland

A

Sympathetic nerves and adrenal gland

319
Q

Sympathetic nerves release ___

A

Norepinephrine

320
Q

Adrenal gland releases mostly ___ and lesser amount of ___

A

Mostly epinephrine (80%); lesser amount of norepinephrine (20%)

321
Q

Which has a longer lasting sympathetic effect, sympathetic nerves or the adrenal gland?

A

Adrenal gland

322
Q

Adrenergic receptors (3)

A
  • Alpha
  • Beta 1
  • Beta 2
323
Q

Alpha receptor =

A

Vasoconstriction

324
Q

Beta 1 =

A

Increased heart rate and contractility

325
Q

Beta 2 =

A

Vasodilation

Bronchodilation

326
Q

What reflex is this?—increased arterial pressure causes parasympathetic response

A

Baroreceptor reflex

327
Q

What reflex is this?—increase in volume causes sympathetic response; AKA atrial stretch receptor reflex

A

Bainbridge reflex

328
Q

What reflex is this?—hypotension with bradycardia/parasympathetic response; also known as ventricular receptor reflex

A

Bezold-Jarisch reflex

329
Q

What reflex is this?—high PCO2, low PO2, and high H+ can cause sympathetic response

A

Chemoreceptor reflex

330
Q

What reflex is this?—hypertension with bradycardia

A

CNS ischemic response/Cushing response

331
Q

What reflex is this?—water on the face causes vasoconstriction and slowing of HR

A

Diving reflex

332
Q

Baroreceptor reflex is responsible for rapid adjustments of ___

A

Blood pressure—helps with postural changes in BP

333
Q

Where are the baroreceptors located?

A

Carotid sinus and aortic arch

334
Q

Bainbridge reflex—the atrial stretch receptors are ___ pressure receptors that respond to stretch; sense CV system ___

A

Low pressure; sense CV system volume

335
Q

Where are the atrial stretch receptors located?

A

Vena cava—right atrial junction

Pulmonary vein—left atrial junction

336
Q

Bainbridge reflex—infusion of volume causes an ___ in heart rate d/t activation of atrial stretch receptors, which causes medullary center activation of sympathetic output to the SA node

A

Increase in HR—a small portion of HR increase is d/t stretch of the SA node (not mediated by atrial stretch receptors)

337
Q

Bainbridge reflex—degree and direction of heart rate change depends on the prevailing heart rate; slow baseline heart rate = ___ HR with infusion; high baseline heart rate = ___ HR with infusion

A

Slow baseline = increased HR with infusion

High baseline = decreased HR with infusion

D/t baroreceptor reflex

338
Q

How does the Bainbridge reflex affect urine output and BP? (remember, these are not technically part of the Bainbridge reflex…these are just additional effects)

A
  • Increased urine output

- Decreased BP

339
Q

What elicits the Bezold-Jarisch reflex?

A

Strong contraction of an under filled ventricle

340
Q

Bezold-Jarisch reflex plays a role in ___ regulation

A

Blood pressure regulation

341
Q

Bezold-Jarisch reflex is possibly involved in what 2 things?

A
  • Cardiac arrest during spinal anesthesia

- Vasovagal syncope

342
Q

Where are the peripheral chemoreceptors located?

A

Aortic and carotid bodies

Remember—the baroreceptors are located in the carotid sinus and aortic arch (NOT the same thing)

343
Q

The peripheral chemoreceptors in the aortic and carotid bodies are primarily concerned with regulation of ___

A

Respiration

344
Q

___ (increased/decreased) arterial blood oxygen tension, ___ (increased/decreased) CO2, and/or ___ (increased/decreased) hydrogen ion concentration results in excitation of the vasomotor center

A

Decreased arterial blood oxygen tension, increased CO2, and increased H+ concentration results in excitation of the vasomotor center

345
Q

The peripheral chemoreceptor reflex, aside from its role in the regulation of respiration, helps to return the blood pressure back to a normal level; it is usually not stimulated strongly until the arterial pressure falls below ___ mm Hg

A

Below 80 mm Hg

346
Q

CNS ischemic response is the result of decreased blood flow to the vasomotor center in the ___

A

Medulla

347
Q

CNS ischemic response—increased local concentration of ___ results in sympathetic stimulation in the medulla; results in ___ (increased/decreased) BP; very powerful activator of the sympathetic nervous system

A

Increased local concentration of CO2; results in increased BP

348
Q

Cushing response is a special type of ___

A

CNS ischemic response

349
Q

Cushing response is the result of increased ___

A

Intracranial pressure

350
Q

Cushing response—increased ___ results in increased ___, until blood flows once again in the vessels of the brain

A

Increased ICP results in increased BP

351
Q

What is Cushing’s triad?

A
  • Increased ICP
  • Increased BP (hypertension)
  • Bradycardia
352
Q

Diving reflex—cold water to face = ___

A

Reduced heart rate (which results in reduced O2 consumption)

353
Q

Sinus arrhythmia—heart rate ___ with inspiration, ___ with expiration

A

Increases with inspiration (increased sympathetic activity with inspiration), slows with expiration (increased parasympathetic activity with expiration)

354
Q

Renin-angiotensin-aldosterone system—renin is released from the ___

A

Kidney

355
Q

Renin converts ___ to ___

A

Angiotensinogen to angiotensin I

356
Q

Angiotensin converting enzyme (ACE) converts ___ to ___

A

Angiotensin I to angiotensin II

357
Q

Angiotensin II causes release of aldosterone from the ___

A

Adrenal cortex

358
Q

Aldosterone results in ___ and ___ retention; systemic ___ = ___ BP

A

Sodium and water retention; systemic vasoconstriction = increased BP

359
Q

Vasopressin is AKA ___

A

Antidiuretic hormone

360
Q

Vasopressin is released from the ___

A

Posterior pituitary

361
Q

Vasopressin causes ___ and ___ BP

A

Vasoconstriction and increases BP

362
Q

Vasopressin causes ___ of fluid at the kidney level and ___ blood volume

A

Reabsorption of fluid at the kidney level and increases blood volume

363
Q

Atrial Natriuretic Peptide is released as a result of ___ distention; ___ stimulation; angiotensin ___; and ___

A

Atrial distention; sympathetic stimulation; angiotensin II; and endothelin

364
Q

ANP ___ SVR; ___ BP; causes an ___ in urine output and sodium loss, leading to a ___ in blood volume

A

Decreases SVR; decreases BP; causes an increase in urine output and sodium loss, leading to a decrease in blood volume

365
Q

What are the indirect effects of hypoxia (lesser degree)?

A

Sympathetic nervous system stimulation—increase HR, contractility, SVR

366
Q

What are the direct effects of hypoxia? (if hypoxemia is very profound)

A

Decreased contractility, HR

367
Q

What are indirect effects of hypercarbia?

A

SNS activation—increase HR, contractility, SVR

368
Q

What are direct effects of hypercarbia?

A

Decreased contractility

369
Q

Do the major epicardial arteries contribute to coronary vascular resistance?

A

NO—epicardial conductance vessels do NOT contribute significantly to coronary vascular resistance—only a small % of a resistance normally

370
Q

What vessels contribute most to total coronary vascular resistance?

A

Intramyocardial vessels (Arterioles)

371
Q

Is capillary density increased or decreased in the myocardium?

A

Increased!

372
Q

What are the 3 major determinants of myocardial oxygen demand?

A

Heart rate
Contractility
Systolic wall tension

373
Q

What are the 3 major determinants of myocardial oxygen supply?

A

Vascular resistance
Coronary blood flow
Oxygen-carrying capacity

374
Q

Resting oxygen consumption of the heart is higher or lower relative to other organs in the body?

A

Higher

375
Q

What is the pressure gradient that drives blood through the coronary circulation?

A

Coronary perfusion pressure

376
Q

Formula for coronary perfusion pressure =

A

Diastolic BP - LVEDP (or PCWP)

377
Q

What organ extracts oxygen to the greatest extent?

A

The heart

378
Q

Why is the coronary sinus PO2 value so low (normally in range of 20-22 mm Hg; % sat = 32-38%)?

A

It is low because the heart extracts so much oxygen

379
Q

Can the heart increase O2 extraction significantly?

A

No—can only minimally increase O2 extraction

380
Q

Increases in O2 demand must be met by ___

A

Increased coronary blood flow

381
Q

When does the majority of coronary blood flow occur? During systole or diastole?

A

During diastole in the left ventricle because ventricular myocytes collapse the coronary arterial supply vessels as they contract (extravascular compression); during diastole, the compressive forces are removed, and blood surges through the coronary musculature at peak rates

382
Q

The idea that ventricular myocytes collapse the coronary arterial supply vessels as they contract is known as ___

A

Extravascular compression

383
Q

Extravascular compressive forces are greater in the ___ layer and least near the ___ layer

A

Greater in the subendocardium (inner) layer; least near the subepicardial (outer) layer

384
Q

Which layer of the heart is most susceptible to ischemia?

A

Subendocardium > midmyocardium > subepicardium

385
Q

Changes in ___ affect myocardial oxygen consumption LESS than do changes in other factors

A

Preload (less effect than increased heart rate, inotropy, or afterload)

386
Q

Coronary vessels have to be at least ___% occluded before interventional measures are taken (i.e.: balloon angioplasty, stent placement, arterial bypass surgery)

A

75%

387
Q

What is the final intracellular ion disturbance that leads to impaired myocardial contraction and cell death?

A

Increased intracellular calcium

388
Q

What best describes the following?—single or multiple brief periods of ischemia can be protective against a subsequent prolonged ischemic insult. The brief periods of ischemia appear to “precondition” myocardium against reversible or irreversible tissue injury, including stunning, infarction, and the development of malignant ventricular arrhythmias.

A

Ischemic preconditioning (IPC)

389
Q

What agents have effects that mimic IPC?

A

Inhaled anesthetic agents—SEVO!

390
Q

What channels play an important role in IPC?

A

K+ ATP channels

391
Q

What are 3 major factors that affect flow across any valvular lesion?

A
  • Valve area (more area = better flow; less area = less flow)
  • Square root of the hydrostatic pressure gradient across the valve (higher pressure gradient = more flow and vice versa)
  • The time duration of transvalvular flow (less time = less flow and vice versa)

Increasing any of these major factors increases transvalvular flow; conversely, decreasing any of these major factors decreases transvalvular flow

392
Q

It is desirable to INCREASE transvalvular flow with ___ lesions

A

Stenotic lesions

393
Q

It is undesirable to increase flow with ___ lesions

A

Regurgitant

394
Q

Goal for regurgitant lesions is to ___ flow

A

Reduce flow

395
Q

How can you reduce flow in regurgitant lesions?

A

Increase HR—there will be less time for regurgitant flow to occur across a valve

396
Q

Goal for stenotic lesions is to ___ flow

A

Maximize flow

397
Q

How can you maximize flow for stenotic lesions?

A

Slow HR down—you will have a longer period of time for flow to occur across that stenotic valve

398
Q

The valve area in regurgitant or stenotic lesions can respond to changes in loading conditions (preload, afterload)?

A

Regurgitant lesions—the valve area will respond to changes in preload, afterload

399
Q

The valve area in stenotic lesions is generally ___

A

Fixed—so they are NOT affected by changes in preload or afterload

400
Q

What kind of murmur (systolic/diastolic) is heard with aortic stenosis?

A

Systolic murmur

401
Q

What kind of murmur (systolic/diastolic) is heard with aortic regurgitation?

A

Diastolic murmur

402
Q

What kind of murmur (systolic/diastolic) is heard with mitral stenosis?

A

Diastolic murmur

403
Q

What kind of murmur (systolic/diastolic) is heard with mitral regurgitation?

A

Systolic murmur

404
Q

Aortic stenosis usually has a long ___ period

A

Asymptomatic

405
Q

Aortic stenosis presenting with angina (with no planned surgical intervention) typically has life span of ___

A

5 years

406
Q

Aortic stenosis presenting with syncope (with no planned surgical intervention) typically has life span of ___

A

3 years

407
Q

Aortic stenosis presenting with CHF (with no planned surgical intervention) typically has life span of ___

A

2 years

408
Q

Aortic stenosis is considered an independent risk factor for perioperative ___

A

Perioperative morbidity

409
Q

Aortic stenosis—want ___ preload

A

Increased preload—to fill non compliant LV

410
Q

Aortic stenosis—HR goals

A

Want to avoid extremes of HR, maintain sinus rhythm

411
Q

Aortic stenosis—SVR goals

A

Increased; AVOID hypotension

412
Q

Aortic regurgitation is AKA ___

A

Aortic insufficiency

413
Q

Aortic regurgitation has a long ___ period, during which the LV undergoes progressive ___ hypertrophy

A

Asymptomatic period; eccentric hypertrophy

414
Q

What is eccentric hypertrophy?

A

LV chamber size is normal, but the LV wall is very thick—occurs with pressure overloading

415
Q

Two main symptoms of aortic regurgitation:

A
  • CHF (fatigue, exercise intolerance, ankle swelling)

- Angina

416
Q

Patients with aortic regurgitation develop pressure or volume overloading?

A

VOLUME overloading

417
Q

___ (increased/decreased) coronary perfusion pressure with aortic regurgitation because you have ___ (increased/decreased) diastolic pressure in the LV, ___ (increased/decreased) diastolic pressure in the aorta

A

Decreased coronary perfusion pressure

Increased diastolic pressure in the LV

Decreased diastolic pressure in the aorta

418
Q

Aortic regurgitation—want ___ preload

A

Increased preload to maintain forward flow (avoid hypovolemia)

419
Q

Aortic regurgitation—___ heart rate

A

Increased HR—reduces diastolic time and reduces regurgitant fraction

420
Q

Aortic regurgitation—___ SVR

A

Decreased SVR—afterload reduction is helpful in improving forward flow

421
Q

Mitral stenosis—maintain ___ heart rate

A

Decreased—slow to allow time for ventricular filling

422
Q

Mitral stenosis—maintain ___ PVR because these patients have elevated ___ pressures

A

Decreased PVR d/t elevated PA pressures

423
Q

Mitral stenosis—avoid what 3 things so we don’t further elevate PA pressures?

A

Avoid acidosis, hypercarbia, and hypoxemia

424
Q

Mitral regurgitation—___ HR; leads to a ___ in LV volume, ___ forward flow, and ___ regurgitant fraction

A

Increased HR; leads to a decrease in LV volume, increased forward flow, and decreased regurgitant fraction

425
Q

Mitral regurgitation—___ contractility tends to ___ forward flow and ___ regurgitant fraction by constricting mitral annulus

A

Increase contractility tends to increase forward flow and reduce regurgitant fraction

426
Q

Mitral regurgitation—___ SVR

A

Decreased SVR—afterload reduction is helpful in improving forward flow

427
Q

Hypertrophic cardiomyopathy goals—___ preload; ___ SVR; ___ HR; ___ inotropy

A

Increase preload (reduces gradient across LVOT); increase SVR (reduces gradient across LVOT); decrease HR (reduces oxygen demand of thickened myocardium); decrease inotropy (reduces gradient across LVOT)

KLowe Anesthesia Physiology 1: Cardiovascular Larmon (7 decks)

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