Mixed Physiology Flashcards by Alex Hamidi

what causes the 1st heart sound

closure of AV valves

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when does the aortic valve open?

during what phase of cardiac cycle?

Ventricular P > aortic P

rapid ventricular ejection

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what does the onset of the T wave mark?

end of both ventricular contraction and rapid ventricular ejection

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what wave on the venous curve corresponds with rapid ventricular ejection?

c wave

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what is the 2nd heart sound?

closure of aortic and pulmonic valves

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what special event occurs after closure of aortic valve during isovolumetric ventricular relaxation?

dicrotic notch/incisura

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where is ventricular volume at its lowest point?

during isvolumetric ventricular relaxation

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what causes the 3rd heart sound?

rapid blood flow from the atria into the ventricles

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what is the longest phase of the cardiac cycle?

diastasis (reduced ventricular filling)

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which baroreceptors respond to inc. and dec. in arterial pressure?

carotid sinus

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which baroreceptors responds only to INCREASES in arterial pressure?

aortic arch

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dec. arterial pressure leads to dec. stretch of the walls of the carotid sinus. what does this do?

dec. firing rate of carotid sinus nerve (CN 9)

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what are the responses to dec. in arterial pressure?

INC HR, contractility, vasoconstriction of arterioles and veins

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a decrease in renal perfusion pressure triggers what?

JG cells of afferent arteriole to secrete renin

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what are the 4 effects of angiotensin II?

secretion of aldosterone from adrenal cortex
INC. Na-H exchange in PCT to INC Na reabsorption
INC. thirst
vasoconstriction of the arterioles –> INC TPR and arterial Pressure

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what is a response to cerebral ischemia?

Cushing reaction

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when is ADH (Vasopressin) released?

during hemorrhage

when atrial receptors respond to DEC in blood volume (or BP)

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what are ADH’s affects?

inc BP towards normal via V1 and V2

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what is the ADH V1 response

vasoconstriction that INC TPR on arterioles

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what is the ADH V2 response?

INC water reabsorption by collecting ducts

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when is ANP released?

response to INC in blood volume and atrial pressure

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what does ANP cause?

relaxation of vascular smooth m., dilation, dec TPR
inhibits renin secretion
INC excretion of Na and water to DEC arterial pressure

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release of histamine causes large increases in what and can eventually lead to what local effect?

edema

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what organs exhibit autoregulation?

brain, kidney, heart

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what are some vasodilator metabolites?

CO2, H+, K+, lactate, adenosine

what hormone causes vasoconstriction, common in migraines?

serotonin

what is the only compensatory mechanism to hemorrhage that DECREASES? what does this lead to?

Pc INC fluid reabsorption and blood volume

what causes the 4th heart sound?

filling of the ventricle by atrial systole

what do platelets contain?

``` actin and myosin mitochondria and ER COX1 PDGF serotonin fibrin stabilizing factor ```

what do platelets bind to in the formation of a platelet plug? what links this binding?

collagen VW factor

when a platelet is activated what happens next?

platelet swells, extends its podocytes and contracts granules leave platelets stick to vessel walls and each other

what does PDGF do?

stimulate fibroblasts to grow into the area

where is plasminogen made? what does it become upon activation?

liver tissue plasminogen activator tPA

how is tPA normally inactive?

inhibited by tPA inhibitor

what inactivates the tPA inhibitor ?

activated Protein C

once tPA inhibitor is inactivated what happens next?

tPA acts on plasminogen to make plasmin plasmin will remove the clot

how are clots prevented in blood vessels?

smooth surface stops them from rupturing glyocalyx repels platelets thrombomodulin

what chemicals limit clotting?

Fibrin PGI2 vasodilates Antithrombin III Heparin

what does Protein C do when activated?

inactivates F 5 and 8 to inhibit further fibrin creation

what happens to the stroke volume curve when preload is increased?

INC SV, shifts right

what happens to stroke volume curve when afterload is increased?

dec SV and INC ESV, shifts up and shrinks

what happens to stroke volume curve when contractility is increased?

INC SV, dec ESV curve shifts up and left

what is inotropy

contractility

what is a chronotropic effect? if it is negative what happens?

changes in HR dec. HR by dec. firing rate of SA Node

what is a dromotropic effect? Positive example

changes in conduction velocity, mainly in AV node inc. velocity, speeding contraction of APs, Dec. PR interval

M2 receptor is what G subtype?

M4 receptor is what G subtype?

alpha-1 receptor is what G?

alpha-2 receptor is what G?

Beta1-3 receptor is what G?

M3 receptor is what G?

what are the inferior leads? what associated artery?

2,3, aVF right coronary artery

septal leads?

V1, V2

Anterior leads? what associated artery?

V2, V3, V4 LAD

lateral leads? what artery?

1, aVL, V4, V5, V6 Left circumflex

what does increased afterload result from?

hypertension, higher aortic pressure

where is the P wave upright?

1, 2, V4-V6, aVF inverted aVR

what is QRS normal in?

1, aVL, aVF, V5, V6

what leads is T wave upright in?

1, 2, V3-V6, inverted aVR

what is characteristic of a PAC?

premature atrial contractiona no heart disease common w/stress, coffee, alcohol, tobacco, COPD

what are the characteristics of PVCs?

early wide QRS direction of QRS goes 1 way, ST segment opposite followed by a PAUSE

What is 3 PVCs in a row?

non-substained VT

What is characteristic of VTs?

wide, fat QRS w/inverted ST segment P wave often lost think of ghosts if there are more than 6

6 or more PVCs lasting 30 seconds or longer is what?

pathological VT

what is characteristic of AFib?

quivering baseline, NO P waves, irregular rhythm and QRS

what is characteristic of SVT? what drug to treat?

narrow QRS w/out well defined P waves generally benign common to see in ER adenosine

what is characteristic of 1st degree AV block?

prolonged PR interval (>.20 seconds or 1 BIG square) | low QRS voltage normally COPD, bad lung disease, hypothyroid

what is characteristic of a sinus arrhythmia?

not regular rhythm | SA node forms impulses irregularly based on your breathing

what is characteristic of MAT?

3 morphologically different P waves people with COPD/pneumonia atrial rate > 100

what is characteristic of atrial flutter?

Saw tooth appearance | best seen in leads 2,3,aVF, V1

VFib characteristics?

disorganized depolarization not effective pump AMI

hypokalemia characteristics?

Flat or inverted T waves u waves INC QT interval bc of diuretics or metabolic alkalosis

hyperkalemia characteristics?

peaked T wave Wide QRS wave INC PR interval loss of P wave looks like ventricular AP w/plateau

ischemia characteristics?

inverted T wave

inverted QRS waves indicate what?

necrosis

what is a cardiac biomarker of necrosis in heart?

CK-MB | troponin-I