Hemodynamics and CV Med Classes

Question 1

Hemodyanmics

Answer 1

Movement of blood through circulatory system. Distributes O2 and nutrients, removes CO2, houses immune system

Question 2

Blood Flow

Answer 2

Moves because driving force is greater than resistance
HTN would increase resistance.
Flows from high to low pressure
Dilation and constriction to compensate for changes in flow

Question 3

Cardiac Output

Answer 3

HR x SV
HR controlled mostly by ANS
SV by contractility, preload, and afterload (venous return = primary determinant)
Starling’s Law: Force of contraction is proportional to muscle fiber length

Question 4

RAAS

Answer 4

Supports arterial pressure by constricting veins and arteries via Angiotensin and retention of H2O in kidneys via Aldosterone

Question 5

Aldosterone

Answer 5

Acts on distal tubules to retain Na and excrete K+ and hydrogen.
H2O follows Na = retain water

Question 6

Angiotensin 2

Answer 6

Renin converts angiotensin to angiotensin 1 then
ACE converts it into angiotensin 2
Renin is the rate limiting step in the formation of angiotensin 2

Question 7

Renal water retention

Answer 7

Kidneys retain water if AP is too low for too long.
Decreased Ap = Decreased GFR = activation of RAAS (increases angiotensin 2 = vasoconstriction and aldosterone = water retention and increased blood volume)

Question 8

Vasodilators

Answer 8

Venodilators: Nitrates

Arteriolar dilators: Ca channel blockers and some others

Question 9

Nitrates

Answer 9

Venodilation

Angina and long term CHF

Question 10

Na Nitropusside

Answer 10

Arteriolar and Venous dilation to decrease preload and afterload
HTN emergencies and acute heart failure

Question 11

ACE Inhibitors

Answer 11

Stops conversion of Angio 1 to angio 2, reducing vasoconstriction
Decreases Na and water retention
1st line in CHF, DM, and HTN
-Pril. Lisinopril most common

Question 12

ARBS

Answer 12

Similar to ACEI
2nd line
Less edema and cough compared to ACEI
-sartan

Question 13

Hydralazine

Answer 13

Arterial vasodilator
Acute HTN IV
3/4 line HTN due to 3-4 dose per day
Used in combination with nitrates

Question 14

Minoxidil

Answer 14

Arterial Vasodilator
3/4 line HTN due to dosing 3-4 times/day
Used for hair growth

Question 15

Ca Channel Blockers

Answer 15

Dihydropyridines: Vasodilation only
Non-Dihydropyridines: Vasodilate, slow HR, and decrease contractility via slowing AV node
Angina, 1/2 line HTN and Non-Dihydropyridines are also used in SVT arrhythmias

Question 16

Alpha Adrenergic blockers

Answer 16

Vasodialtes arteries and veins
3/4 line HTN
-zosin

Question 17

Central Alpha Agonists

Answer 17

Reduce vasoconstriction
3/4 line HTN
Clonidine: HTN emergency

Question 18

Digoxin

Answer 18

Increases force of contraction to increase SV and CO. Also decreases HR via AV node slowing
Rate control in A-Fib/flutter

Question 19

Milrinone

Answer 19

Increase force of contraction

Selective phosphodiesterase inhibitor = vasodilation and ionotropic effects