Heart, lungs and Abdomen Flashcards
What is the common cause of HFpEF?
What is the common cause of HFrEF?
Hypertension - due to the ventricle having to hypertrophy to push out the blood 🩸
CAD - due to the heart ♥️ muscle being to weak to push out the blood due to lack of oxygen
why does breathing out slowly down heart rate and also what else does it do?
Why it slows the heart rate
Vagus nerve activation: Exhaling slowly stimulates the vagus nerve, which is a key part of the parasympathetic nervous system. This system promotes relaxation and helps slow the heart rate.
Baroreceptor reflex: Exhaling increases pressure in the thoracic cavity, which is sensed by baroreceptors (pressure sensors) in blood vessels. These sensors signal the brain to lower the heart rate to stabilize blood pressure.
Reduction in sympathetic activity: Slow exhalation decreases the influence of the sympathetic nervous system (responsible for the “fight or flight” response), helping to reduce the heart rate.
Other effects of slow exhalation
Reduces stress and anxiety: Slow breathing lowers levels of stress hormones like cortisol, promoting a sense of calm.
Improves focus and emotional regulation: Activating the parasympathetic system can improve mental clarity and help manage emotions more effectively.
Enhances oxygen exchange: A slower breath rate improves the efficiency of gas exchange in the lungs, ensuring better oxygenation and removal of carbon dioxide.
Lowers blood pressure: By reducing the stress response, slow breathing can also help decrease blood pressure over time.
Promotes better digestion: Activating the parasympathetic system (“rest and digest”) can enhance digestive processes by increasing blood flow to the gastrointestinal system.
Improves heart rate variability (HRV): Slow exhalation increases HRV, which is associated with better stress resilience and cardiovascular health.
Does inhaling longer cause the opposite, I heard that a man went to mt. everest in short and was doing deep inhales to keep his temperature raised
Sympathetic nervous system activation: Prolonged or deep inhalation tends to activate the sympathetic nervous system (the “fight or flight” system). This increases heart rate and prepares the body for action.
Increased oxygen intake: Deep inhalation provides more oxygen to the blood, which can increase metabolic activity and energy levels.
Thermogenesis (heat production): Techniques like controlled hyperventilation (e.g., the Wim Hof Method) involve deep inhalations and short or controlled exhalations, which can stimulate metabolic processes, generating heat in the body.
The Mount Everest example: Wim Hof Method
The man you mentioned is likely Wim Hof, who is famous for his ability to withstand extreme cold. His breathing techniques involve:
Deep inhalations: To oxygenate the body fully.
Short or controlled exhalations: To retain carbon dioxide and maintain a specific physiological state.
This method is thought to:
Increase metabolic rate: Oxygenation boosts energy production, which can generate heat.
Activate brown fat: Deep breathing and cold exposure activate brown adipose tissue, which burns calories to produce heat.
Regulate blood pH: Controlled breathing shifts blood pH slightly toward alkalinity, which may affect how the body responds to cold.
What are the symptoms of a heart attack?
Symptoms of a Heart Attack
A heart attack (myocardial infarction) occurs when blood flow to the heart muscle is blocked, causing damage to the tissue. Common symptoms include:
Chest pain or discomfort: A feeling of pressure, tightness, or heaviness in the chest.
Pain radiating to other areas: Commonly to the left shoulder, arm, neck, jaw, or back.
Shortness of breath: Due to the heart’s reduced ability to pump blood efficiently.
Nausea and vomiting: Especially common in women, linked to vagus nerve activation.
Sweating (diaphoresis): Caused by the activation of the sympathetic nervous system.
Fatigue: From inadequate oxygen supply to the body.
Dizziness or lightheadedness: Due to reduced blood flow to the brain.
Cold or clammy skin: Caused by reduced blood flow and sympathetic system activation.
Why These Symptoms Happen
Chest Pain (Angina)
The heart muscle is deprived of oxygen due to blocked blood flow, causing ischemia. The pain is a signal of distress from the affected heart tissue.
Shoulder, Arm, and Jaw Pain
Referred pain: The heart and other nearby structures share nerve pathways. Pain signals from the heart can “travel” to areas like the shoulder, arm, neck, or jaw due to overlapping neural pathways in the spinal cord (especially the cervical and thoracic regions).
Shortness of Breath
The heart’s inability to pump blood effectively leads to fluid backup in the lungs (pulmonary congestion), making it harder to breathe.
Nausea and Vomiting
Vagus nerve activation: The vagus nerve, which helps regulate the heart and gastrointestinal system, can become overstimulated during a heart attack, leading to nausea and vomiting.
Reduced blood flow to the digestive system due to prioritization of vital organs also contributes to nausea.
Sweating (Diaphoresis)
The sympathetic nervous system is activated in response to the heart’s distress, triggering sweat glands to produce sweat as part of the “fight or flight” response.
Fatigue
The heart struggles to deliver oxygenated blood to the body, leading to a lack of energy and feelings of extreme tiredness.
Cold or Clammy Skin
The body redirects blood flow to vital organs like the heart and brain, reducing circulation to the skin, causing it to feel cold and clammy.
Dizziness or Lightheadedness
The brain receives less oxygen-rich blood due to the impaired heart function, resulting in dizziness or fainting.
Additional Notes on Variations in Symptoms
Women and older adults: May experience atypical symptoms, such as no chest pain but more fatigue, nausea, or back pain.
Diabetics: Might have “silent” heart attacks with minimal symptoms due to nerve damage.
Understanding the interconnectedness of symptoms helps in recognizing heart attacks early, improving the chance of timely medical intervention.
Why do people who have a heart attack experience pain in the shoulders, neck, jaw and arms?
Referred pain from a heart attack is caused by the overlap of sensory nerve fibers from the heart and other structures, such as the shoulders, neck, jaw, and arms. These structures are all innervated by nerves from the cervical and thoracic regions of the spinal cord, specifically from spinal segments C3-C5 and T1-T4.
Heart pain: The heart receives its sensory input via sympathetic fibers from spinal segments T1-T5, which carry pain signals from the heart to the brain.
Referred pain: These sympathetic fibers from the heart share spinal cord segments with sensory fibers from areas like the shoulder (C3-C5), jaw, and arm, leading to the phenomenon of referred pain.
So, the brain often perceives pain from the heart as coming from these other areas due to the shared neural pathways.
How the Vagus Nerve Regulates the Heart
The vagus nerve (part of the parasympathetic nervous system) helps regulate the heart by releasing the neurotransmitter acetylcholine, which slows the heart rate and reduces its contractility. It works opposite to the sympathetic nervous system (which speeds up the heart rate). The vagus nerve plays a key role in rest and digest responses, bringing the heart rate back to normal after periods of stress or increased activity.
How the Vagus Nerve Can Become Overstimulated During a Heart Attack
During a heart attack, the body experiences a combination of stress, ischemia (lack of oxygen), and changes in intrathoracic pressure. These factors can overstimulate the vagus nerve in a few ways:
Stress Response and Sympathetic Activation:
During a heart attack, there’s typically sympathetic nervous system activation (fight or flight). This leads to the release of stress hormones like adrenaline and norepinephrine, which can influence heart function. The vagus nerve’s counteracting parasympathetic role may be triggered in an attempt to maintain balance, leading to overstimulation or exaggerated parasympathetic responses.
Activation of the Vagus Nerve through Baroreceptors:
The baroreceptors in the blood vessels (e.g., the carotid artery and aortic arch) sense changes in blood pressure. When there’s a drop in blood pressure during a heart attack (due to impaired heart function), the vagus nerve can be activated as part of a reflex to try to bring the heart rate down. In some cases, this response can become exaggerated, leading to bradycardia (slower heart rate) or vasodilation (dilation of blood vessels).
Vagus Nerve Overstimulation Due to Ischemia:
The lack of oxygen (ischemia) in the heart tissue itself during a heart attack can irritate the vagus nerve. This can lead to an abnormal parasympathetic response, where the vagus nerve overreacts, slowing the heart rate excessively. This is why some people with a heart attack can experience bradycardia or hypotension (low blood pressure).
Pain and Stress-Induced Vagal Overstimulation:
Intense pain from a heart attack can trigger an exaggerated vagal response, which may further slow the heart rate or even cause nausea and vomiting. The vagus nerve is involved in both the cardiovascular regulation and gastrointestinal functions, which is why nausea is a common symptom during a heart attack.
How Intrathoracic Pressure Influences the Vagus Nerve
You’re correct that intrathoracic pressure changes can influence vagus nerve activity. For example:
Bearing down (Valsalva maneuver) increases intrathoracic pressure and can stimulate the vagus nerve, leading to bradycardia or a drop in heart rate.
In a heart attack, changes in intrathoracic pressure, along with the other mechanisms above (pain, ischemia, etc.), can also contribute to overstimulation of the vagus nerve, leading to symptoms like slow heart rate, nausea, and even fainting.
Conclusion
The vagus nerve is involved in regulating heart function, and its overstimulation during a heart attack can result from a combination of stress, ischemia, baroreceptor reflexes, and changes in intrathoracic pressure. These mechanisms contribute to symptoms like nausea, vomiting, bradycardia, and dizziness. The interplay between the parasympathetic and sympathetic systems during a heart attack is complex, with the vagus nerve attempting to compensate for the damage, but sometimes leading to further complications.
What is Left-to-Right Shunting:
Left-to-right shunting means that oxygenated blood from the left side of the heart (systemic circulation) moves back into the right side (pulmonary circulation) due to a structural defect like a patent ductus arteriosus (PDA), atrial septal defect (ASD), or ventricular septal defect (VSD). This increases blood volume in the lungs and can lead to pulmonary hypertension over time. The blood does not just go to the right lung; it is directed into the pulmonary arteries, which supply both lungs.
Breakdown of the term Patent Ductus Arteriosus
Patent (Prefix) = Open or unobstructed
Ductus (Root) = Refers to the ductus arteriosus, a fetal blood vessel
Arteriosus (Suffix) = Relating to an artery
So, “patent ductus arteriosus” means an open arterial duct, referring to the failure of the ductus arteriosus to close after birth.
Does blood from both pulmonary veins enter the left atrium?
Yes! Both the right and left pulmonary veins return oxygenated blood from their respective lungs into the left atrium.
How does Cor Pulmonale & Pulmonary Arteries
Cor pulmonale refers to right ventricular hypertrophy and failure due to chronic pulmonary hypertension.
Pulmonary artery hardening (pulmonary hypertension) is usually due to increased resistance in the pulmonary circulation, which can be caused by chronic lung disease, left-sided heart failure, or congenital heart defects.
It is not due to excess blood in the left atrium but rather due to increased pressure in the pulmonary capillary system, often as a consequence of left-sided heart failure.
Which of the following factors increases the risk of spontaneous pneumothorax in neonates?
A) Positive-pressure ventilation
B) Premature birth
C) Maternal diabetes
D) Meconium aspiration syndrome
Correct Answer: A) Positive-pressure ventilation
A) Correct – Positive-pressure ventilation can cause barotrauma, leading to pneumothorax.
B) Incorrect – While preterm infants have many respiratory challenges, pneumothorax is not more common in them than in term infants.
C) Incorrect – Maternal diabetes is associated with macrosomia and neonatal hypoglycemia, not pneumothorax.
D) Incorrect – Meconium aspiration syndrome can cause pneumothorax as a complication but is not a direct risk factor.
Why does positive-pressure ventilation increase the risk of spontaneous pneumothorax?
Positive-pressure ventilation (PPV) increases the risk of pneumothorax because it forces air into the lungs under pressure, which can cause barotrauma. This excessive pressure can lead to alveolar overdistension and rupture, allowing air to escape into the pleural space, resulting in a pneumothorax. Neonates, particularly preterm infants, have immature and more fragile lung structures, making them especially susceptible to this complication.
Why does tachypnea occur in neonatal spontaneous pneumothorax?
Tachypnea (rapid breathing) occurs because a pneumothorax impairs lung expansion, reducing oxygen exchange and leading to hypoxemia. In response, the neonate increases their respiratory rate to compensate for the reduced oxygen levels. Additionally, air trapping in the pleural space can create pressure on the lungs and mediastinum, further stimulating the respiratory centers to increase breathing effort.
What is Air Trapping?
Air trapping occurs when air enters the lungs during inhalation but cannot fully exit during exhalation, leading to hyperinflation of the lungs or specific lung regions. This happens due to partial airway obstruction, which prevents proper airflow out of the alveoli.
Causes of Air Trapping:
Obstructive lung diseases (e.g., asthma, COPD, bronchiolitis)
Meconium aspiration syndrome (thick meconium blocks airways, allowing air in but not out)
Prematurity-related lung issues (immature lung development may lead to inadequate airway clearance)
Pneumothorax (air in the pleural space can cause lung collapse and trapping in the remaining aerated regions)
Imaging Findings:
Hyperexpanded lungs on X-ray (flattened diaphragm, increased lung field radiolucency)
Patchy areas of overinflation (as seen in aspiration syndromes)
Explain the different regions and types of abdominal sections and possible pain i.e. epigastric, hypogastric, etc. or what are the regions of the stomach and what do they mean?
The abdomen is divided into different regions that help localize pain and identify possible underlying conditions. There are two main ways to divide the abdomen:
Four Quadrants:
Right Upper Quadrant (RUQ)
Left Upper Quadrant (LUQ)
Right Lower Quadrant (RLQ)
Left Lower Quadrant (LLQ)
Nine Regions:
Epigastric (upper middle)
Right Hypochondriac (upper right)
Left Hypochondriac (upper left)
Umbilical (middle)
Right Lumbar (middle right)
Left Lumbar (middle left)
Hypogastric (Suprapubic) (lower middle)
Right Iliac (Inguinal) (lower right)
Left Iliac (Inguinal) (lower left)
- Epigastric Region (Upper Middle)
Location: Above the belly button, below the ribcage
Organs: Stomach, liver, pancreas, duodenum, esophagus
Common Causes of Pain:
GERD (Acid Reflux) – Burning pain, worsens after eating
Peptic Ulcers – Gnawing pain, often relieved by eating or antacids
Pancreatitis – Severe pain radiating to the back, nausea
Heart Attack (Referred Pain) – May mimic indigestion - Right Hypochondriac Region (Upper Right)
Location: Beneath the right ribcage
Organs: Liver, gallbladder, right kidney
Common Causes of Pain:
Gallstones (Cholelithiasis) – Sharp pain after fatty meals
Hepatitis – Dull, persistent pain, jaundice
Right Kidney Infection or Stones – Flank pain, nausea - Left Hypochondriac Region (Upper Left)
Location: Beneath the left ribcage
Organs: Spleen, stomach, left kidney, pancreas
Common Causes of Pain:
Gastritis – Burning pain, nausea, bloating
Splenic Injury – Trauma-related sharp pain, possible referred pain to left shoulder
Left Kidney Stones – Flank pain, blood in urine - Umbilical Region (Middle)
Location: Around the belly button
Organs: Small intestine, transverse colon, aorta
Common Causes of Pain:
Small Bowel Obstruction – Cramping, bloating, nausea
Appendicitis (Early Stage) – Starts as dull pain in this area before moving to RLQ
Abdominal Aortic Aneurysm (AAA) – Pulsating mass, severe pain - Right Lumbar Region (Middle Right)
Location: Right side of the belly, between ribs and pelvis
Organs: Ascending colon, right kidney
Common Causes of Pain:
Right Kidney Stones or Infection – Flank pain, fever, nausea
Constipation – Fullness, discomfort
Inflammatory Bowel Disease (IBD) – Crohn’s disease affecting the colon - Left Lumbar Region (Middle Left)
Location: Left side of the belly, between ribs and pelvis
Organs: Descending colon, left kidney
Common Causes of Pain:
Diverticulitis – LLQ pain, fever, constipation or diarrhea
Left Kidney Stones or Infection – Flank pain, nausea - Hypogastric (Suprapubic) Region (Lower Middle)
Location: Below the belly button, above the pubic bone
Organs: Bladder, uterus, prostate, sigmoid colon
Common Causes of Pain:
Urinary Tract Infection (UTI) – Burning urination, urgency
Pelvic Inflammatory Disease (PID) – Lower abdominal pain, fever, discharge
Endometriosis – Chronic pelvic pain, painful periods
Bladder Infection (Cystitis) – Suprapubic pain, frequent urination - Right Iliac (Inguinal) Region (Lower Right)
Location: Lower right side, near the hip bone
Organs: Appendix, cecum, right ovary (in females)
Common Causes of Pain:
Appendicitis – RLQ pain, worsens with movement
Ovarian Cyst (Rupture or Torsion) – Sudden sharp pain, nausea
Hernia – Bulging, pain with lifting - Left Iliac (Inguinal) Region (Lower Left)
Location: Lower left side, near the hip bone
Organs: Sigmoid colon, left ovary (in females)
Common Causes of Pain:
Diverticulitis – LLQ pain, fever, constipation or diarrhea
Ovarian Cyst (Rupture or Torsion) – Sudden sharp pain
Hernia – Bulging, pain with lifting
Conclusion
Upper abdominal pain → Stomach, liver, pancreas, gallbladder issues
Middle abdominal pain → Small intestine, colon, or referred pain from other organs
Lower abdominal pain → Bladder, reproductive organs, or colon issues
