hemodynamics (physio) Flashcards

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1
Q

What are the cellular elements of blood?

A

Leukocytes, thrombocytes (platelets), erythrocytes.

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2
Q

Centrifuging separates hematocrit from plasma. A hematocrit measurement is routinely performed when a variety of pathologies are suspected (B12 deficiency, long-term blood loss, lung disease, etc). What is a normal hematocrit level?

A

40% in women and 45% in men

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3
Q

RBC count …….. WBC count.

A

>>

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4
Q

……….. is the cellular fraction of blood while………….. is the noncellular fraction.

A

Hematocrit plasma

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5
Q

Plasma mainly contains what?

A

proteins (colloid), lipids, phospholipids, neutral fats, electrolytes.

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6
Q

What are colloids?

A

molecules with MW > 30,000. In blood they are the proteins. They are considered suspended rather than dissolved in solution.

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7
Q

Blood colloids are proteins. ………….are associated with proteins.

A

Fats

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8
Q

The heart is a 2 stroke pump. The left side pumps into the systemic circulation. This is the………… pressure side of the circulatory system. Return is via veins. This is the…………. pressure side. The Right side of the heart pumps into pulmonary circulation.

A

high low

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9
Q

Systole

A

When ventricles contract.

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10
Q

Diastole

A

When ventricles relax.

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11
Q

Systemic circulation consists of…………… distribution to different organs.

A

parallel

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12
Q

When it comes to the histology of arteries and veins, the layers from the lumen side to outside are:

A

endothelium, elastic tissue, smooth muscle, fibrous tissue.

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13
Q

Veins have what relative to arteries?

A
  • a thinner elastic tissue
  • less smooth muscle
  • inner valves to prevent backflow of blood
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14
Q

Why do veins need valves to prevent backflow?

A

Veins return blood to the heart AGAINST gravity.

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15
Q

How do varicose veins form?

A

Incompetent valves result in valves not properly sealing, and blood backflows and results in engorgement of the veins.

A variety of factors causes this. such as obesity or standing on your feet for long periods of time.

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16
Q

Capillaries lack what?

A

elastic, smooth muscle, and fibrous layers.

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17
Q

What are the 3 basic types of capillaries?

A

– Continuous capillaries: where endothelial cells touch each other. MOST COMMON.

– Fenestrated: which have a diaphragm over the fenestration, & are found in exocrine glands, renal corpuscle, and small intestine.

– Sinusoidal: found in the liver.

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18
Q

The sum of the cross sectional areas of all capillaries is substantially greater than all other compartments of the circulatory system! Where is the greatest volume of blood held though?

A

In the veins and venules (due to their compliance).

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19
Q

What are the 2 most widely used imaging modalities to assess the competence of a vascular bed, and what do they rely on?

A

computed tomography angiography & magnetic resonance angiography.

Both rely on IV infusion of contrast agents.

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20
Q

Blood is pumped from the right heart into the………… circulation from which it returns to the left heart.

A

pulmonary

21
Q

* Compartments of the circulatory tree differ in their extent of elastic, smooth muscle, and fibrous tissue. They also differ in their cross-sectional area and blood volume.

A
22
Q

What is the equation for flow? (Poiseilles Law)

A

F=ΔP/R

F= flow (the volume of fluid passing a given cross-section per time) units: ml/min

ΔP= pressure differences between P1 & P2

R= resistance.

Note similarity to electric circuits equation! (I=ΔV/R)

23
Q

In steady state (over period longer than the cardiac cycle) flow in each section of the circulatory system must necessarily be the same. What does this mean?

A

flow in all the arteries combined is the same as that in all the capillaries combined which is the same as the combined flow in the veins.

24
Q

What is the formula for resistance?

A

R= resistance

n= viscosity

L= length

r= radius

25
Q

Alteration in radius is the basis for regulating blood flow. Why?

A

Resistance is inversely related to radius^ 4th power! So if you reduce the radius, you increase the resistance. Since F=ΔP/R, having a larger resistance means a lower flow.

26
Q
A
27
Q

When vessels are in series, the overall resistance is what?

A

The sum of the individual resistances.

28
Q

When vessels are in parallel, is the overall resistance less than or greater than the individual resistances?

A

less than

29
Q

In normal circumstances, flow in vasculature is………….

A

laminar

30
Q

Poiseulle’s law applies to laminar flow. Laminar flow occurs when each cylinder of fluid from that adhering to the vessel wall inward slips past each other. Flow rate……………. as we move from the wall to the center of the vessel.

A

increases

31
Q

How do we tell if flow will be laminar or not?

What are the specific values?

A

We look at Reynold’s Number.

–laminar if NR< 2000

–somewhat turbulent if NR =2000-3000

–turbulent if NR> 3000

32
Q

What is the equation for Reynolds number?

A

N(tiny R)= ρDv/viscosity

Where:

N(tiny R)= Reynold’s number

ρ= density

D = diameter

v = velocity

33
Q

What does it mean when you can hear turbulent flow?

A

A problem! Heart murmurs can be readily heard when flow is turbulent and is indicative of valvular disease.

* Arterial bruts are symptoms of any of a variety of pathologies including stenosis.

34
Q

Velocity is the distance blood flows/time (cm/min). Velocity is inversely proportional to vessel…………….

A

diameter

* The greater the diameter, the slower the velocity

35
Q

Because the total cross-sectional area of capillaries is much greater than any other compartment, velocity of blood here is slower. Why is this important?

A

It allows for greater time to exchange nutrients, O2 and waste between tissue and the capillary bed.

36
Q

* Ultrasound, which is commonly used in diagnosis, provides information on direction, velocity and turbulence of blood in an area under observation.

A
37
Q

What is the formula for compliance?

A

C=V/P

Where:

C = compliance

V = volume (ml)

P = pressure (mm Hg)

38
Q

Veins can support increasing blood volume with…………. pressure change than arteries. This means they have good compliance!

A

Less

39
Q

The veins are the unstressed volume (meaning……………………….) while the arteries are the stressed volume (meaning……………………….).

A

they hold a large volume of blood under low pressure

they hold a small volume of blood under high pressure

40
Q

Because of the high compliance, most of the blood in the circulatory system is in the………………

A

veins

* If we introduce a given amount of volume, the pressure change will be less in the veins than in the arteries (where compliance is low). This is why veins have a greater volume of the blood at any given time than the arteries do!

41
Q

……………………..is the reciprical of compliance.

A

Elastance

42
Q

* Differences in elasticity of tissue is due to the amount of elastic fibers (elastin, elaunin, andoxytalan) in the vessel wall. Note that capillaries and venules don’t have any.

A
43
Q

* The pressure in the aorta is pulsatile (going up during systole and down during diastole). It is dampened due to the high elastance of the arteries, and it is smooth in the……………………

* See diagram.

A

arterioles

44
Q

Mean arterial pressure (MAP) =

A

diastolic pressure + 1/3 pulse pressure.

pulse pressure= P(systoltic) - P(dialstolic)

(Where pulse pressure is the difference between the systolic and diastolic pressures)

45
Q

Why is MAP not simply the average of diastolic and pulse pressure?

A

Because of the longer time of each cardiac cycle spent in diastole.The diastolic (relaxed) phase is about twice as long as systolic!

46
Q

If we were to look at larger arteries, we would see a dramatic difference in systolic vs diastolic pressure (aka pulse pressure).

Then, the drop gets smaller as the arteries get smaller, then no difference in the arterioles.

  • Typical MAP in the aorta is ……………mm Hg. It remains high in arteries because of high elastance.
  • At the end of arterioles, MAP is around………mm Hg.
  • In the vena cava it drops to ………..mm Hg.
  • In the right atrium it’s ……………..mm
A

100

30

4

0-2

47
Q

The notch in the systolic phase is the dicrotic notch (incisura). It is due to a short period of retrograde flow in the aorta just following……………………….

A

closure of the aortic valve.

48
Q

The…………… of arteries prevents a drop in pressure in the arteries.

A

elastance (elastic recoil)

49
Q

When we increase pressure with a blood pressure cuff, we block blood flow through brachial artery completely. Then, we slowly release the pressure. When the pressure inside the vessel equals the pressure of the cuff (well, just above the cuff pressure), this is when we get the measurement for systolic pressure and can start hearing………………. flow (aka Korotkoff sounds). Then, when the sound goes away, there is……………….. flow. This gives us our diastolic pressure reading.

A

turbulent

laminar