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COM - Cardiopulmonary > Mixed Physiology > Flashcards

Mixed Physiology Flashcards

1
Q

what causes the 1st heart sound

A

closure of AV valves

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2
Q

when does the aortic valve open?

during what phase of cardiac cycle?

A

Ventricular P > aortic P

rapid ventricular ejection

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3
Q

what does the onset of the T wave mark?

A

end of both ventricular contraction and rapid ventricular ejection

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4
Q

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

A

c wave

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5
Q

what is the 2nd heart sound?

A

closure of aortic and pulmonic valves

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6
Q

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

A

dicrotic notch/incisura

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7
Q

where is ventricular volume at its lowest point?

A

during isvolumetric ventricular relaxation

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8
Q

what causes the 3rd heart sound?

A

rapid blood flow from the atria into the ventricles

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9
Q

what is the longest phase of the cardiac cycle?

A

diastasis (reduced ventricular filling)

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10
Q

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

A

carotid sinus

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11
Q

which baroreceptors responds only to INCREASES in arterial pressure?

A

aortic arch

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12
Q

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

A

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

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13
Q

what are the responses to dec. in arterial pressure?

A

INC HR, contractility, vasoconstriction of arterioles and veins

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14
Q

a decrease in renal perfusion pressure triggers what?

A

JG cells of afferent arteriole to secrete renin

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15
Q

what are the 4 effects of angiotensin II?

A

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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16
Q

what is a response to cerebral ischemia?

A

Cushing reaction

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17
Q

when is ADH (Vasopressin) released?

A

during hemorrhage

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

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18
Q

what are ADH’s affects?

A

inc BP towards normal via V1 and V2

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19
Q

what is the ADH V1 response

A

vasoconstriction that INC TPR on arterioles

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20
Q

what is the ADH V2 response?

A

INC water reabsorption by collecting ducts

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21
Q

when is ANP released?

A

response to INC in blood volume and atrial pressure

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22
Q

what does ANP cause?

A

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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23
Q

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

A

Pc

edema

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24
Q

what organs exhibit autoregulation?

A

brain, kidney, heart

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25
Q

what are some vasodilator metabolites?

A

CO2, H+, K+, lactate, adenosine

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26
Q

what hormone causes vasoconstriction, common in migraines?

A

serotonin

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27
Q

what is the only compensatory mechanism to hemorrhage that DECREASES?

what does this lead to?

A

Pc

INC fluid reabsorption and blood volume

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28
Q

what causes the 4th heart sound?

A

filling of the ventricle by atrial systole

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29
Q

what do platelets contain?

A 
actin and myosin
mitochondria and ER
COX1
PDGF
serotonin 
fibrin stabilizing factor
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30
Q

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

what links this binding?

A

collagen

VW factor

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31
Q

when a platelet is activated what happens next?

A

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

32
Q

what does PDGF do?

A

stimulate fibroblasts to grow into the area

33
Q

where is plasminogen made?

what does it become upon activation?

A

liver

tissue plasminogen activator tPA

34
Q

how is tPA normally inactive?

A

inhibited by tPA inhibitor

35
Q

what inactivates the tPA inhibitor ?

A

activated Protein C

36
Q

once tPA inhibitor is inactivated what happens next?

A

tPA acts on plasminogen to make plasmin

plasmin will remove the clot

37
Q

how are clots prevented in blood vessels?

A

smooth surface stops them from rupturing
glyocalyx repels platelets
thrombomodulin

38
Q

what chemicals limit clotting?

A

Fibrin
PGI2 vasodilates
Antithrombin III
Heparin

39
Q

what does Protein C do when activated?

A

inactivates F 5 and 8 to inhibit further fibrin creation

40
Q

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

A

INC SV, shifts right

41
Q

what happens to stroke volume curve when afterload is increased?

A

dec SV and INC ESV, shifts up and shrinks

42
Q

what happens to stroke volume curve when contractility is increased?

A

INC SV, dec ESV curve shifts up and left

43
Q

what is inotropy

A

contractility

44
Q

what is a chronotropic effect?

if it is negative what happens?

A

changes in HR

dec. HR by dec. firing rate of SA Node

45
Q

what is a dromotropic effect?

Positive example

A

changes in conduction velocity, mainly in AV node

inc. velocity, speeding contraction of APs, Dec. PR interval

46
Q

M2 receptor is what G subtype?

A

Gi

47
Q

M4 receptor is what G subtype?

A

Gi

48
Q

alpha-1 receptor is what G?

A

Gq

49
Q

alpha-2 receptor is what G?

A

Gi

50
Q

Beta1-3 receptor is what G?

A

Gs

51
Q

M3 receptor is what G?

A

Gq

52
Q

what are the inferior leads?

what associated artery?

A

2,3, aVF

right coronary artery

53
Q

septal leads?

A

V1, V2

54
Q

Anterior leads?

what associated artery?

A

V2, V3, V4

LAD

55
Q

lateral leads?

what artery?

A

1, aVL, V4, V5, V6

Left circumflex

56
Q

what does increased afterload result from?

A

hypertension, higher aortic pressure

57
Q

where is the P wave upright?

A

1, 2, V4-V6, aVF

inverted aVR

58
Q

what is QRS normal in?

A

1, aVL, aVF, V5, V6

59
Q

what leads is T wave upright in?

A

1, 2, V3-V6,

inverted aVR

60
Q

what is characteristic of a PAC?

A

premature atrial contractiona

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

61
Q

what are the characteristics of PVCs?

A

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

62
Q

What is 3 PVCs in a row?

A

non-substained VT

63
Q

What is characteristic of VTs?

A

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

64
Q

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

A

pathological VT

65
Q

what is characteristic of AFib?

A

quivering baseline, NO P waves, irregular rhythm and QRS

66
Q

what is characteristic of SVT?

what drug to treat?

A

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

adenosine

67
Q

what is characteristic of 1st degree AV block?

A

prolonged PR interval (>.20 seconds or 1 BIG square)

low QRS voltage normally COPD, bad lung disease, hypothyroid

68
Q

what is characteristic of a sinus arrhythmia?

A

not regular rhythm

SA node forms impulses irregularly based on your breathing

69
Q

what is characteristic of MAT?

A

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

70
Q

what is characteristic of atrial flutter?

A

Saw tooth appearance

best seen in leads 2,3,aVF, V1

71
Q

VFib characteristics?

A

disorganized depolarization
not effective pump
AMI

72
Q

hypokalemia characteristics?

A

Flat or inverted T waves
u waves
INC QT interval

bc of diuretics or metabolic alkalosis

73
Q

hyperkalemia characteristics?

A

peaked T wave
Wide QRS wave
INC PR interval
loss of P wave

looks like ventricular AP w/plateau

74
Q

ischemia characteristics?

A

inverted T wave

75
Q

inverted QRS waves indicate what?

A

necrosis

76
Q

what is a cardiac biomarker of necrosis in heart?

A

CK-MB

troponin-I

COM - Cardiopulmonary (12 decks)

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