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Pathophysiology > Perfusion > Flashcards

Perfusion Flashcards

1
Q

Cardiac Output equation

A

SV x HR = CO

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2
Q

Inotropic Function

A

The FORCE of the contraction of the cardiac muscle

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3
Q

Chronotropic Function

A

Heart RATE

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4
Q

Where does most stroke volume come from?

A

Left ventricle

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5
Q

Heart Rate is measured by

A

beats/min

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6
Q

Stroke volume is measured by

A

mL/beat

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7
Q

CO is measured by

A

mL/min

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8
Q

About how much volume is a healthy CO

A

5 Liters

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9
Q

Baroreceptors

A

Receptors that detect a drop in BP
Activate Sympathetic Nervous System
Increases Inotropic and Chronotropic Functions

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10
Q

Orthostatic Hypotension

A

Drop in BP when changing positions from lying to standing

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11
Q

Orthostatic Hypotension causes what symptom? Why?

A

Dizziness

Decreased perfusion to the brain

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12
Q

Orthostatic Hypotension is common is what population of people?

A

Elderly

Individuals on antihypertensive medication

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13
Q

Decrease BP activates what system?

A

RASS

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14
Q

What 2 things shut down the RASS system?

A

Atrial Natriuretic Peptide (ANP)

B type Natriuretic Peptide (BNP)

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15
Q

Preload

A

Volume of blood the Right Atria pushes into the Right Ventricle

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16
Q

Preload is increased when?

A

Hypervolemia
Regurgitation of cardiac valves
Heart Failure

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17
Q

Afterload

A

Resistance the Left Ventricle must overcome to push blood into the rest of the body.

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18
Q

Increased afterload leads to ___ ___

A

Increased Cardiac Workload

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19
Q

Cardiac Contractibility

A

The ability of the myocardium to stretch and contract in response to the filling of the heart with blood

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20
Q

Stroke Volume

A

The amount of blood within the ventricle that is ejected with each contraction

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21
Q

Atherosclerosis increases what 2 things?

A

Preload and Afterload

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22
Q

Most common free radical in the body

A

Oxygen

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23
Q

Lipids are composed of _____

A

Cholesterol

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24
Q

HDLs

A

Happy=Good cholesterol

Excreted from the body

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25
Q

LDLs

A

Bad Cholesterol!

Deposits on the arterial walls

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26
Q

LDLs deposited on the arterial wall stimulate what process?

A

Inflammatory Process

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27
Q

Athersclerosis occurs due to __ __

A

Endothelial Injury

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28
Q

Foam Cells

A

Macrophages that breakdown LDLs

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29
Q

Why is high glucose level harmful in the bloodstream?

A

Glucose damages the endothelial lining

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30
Q

Glucose reacts with vessel wall proteins and forms ___ ___ ___ ___ (AGEs)

A

Advanced glycosylation end products (AGEs)

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31
Q

What does AGEs cause?

A

Inflammation and plaque build up

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32
Q

Homocysteine is an __ ___

A

Amino Acid

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33
Q

Foods rich in HDLs

A

Salmon, eggs, and avacodo

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34
Q

Hypothyroidism increases HDL/LDL?

A

LDLs

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35
Q

If a patient has a renal Disease what should you screen for?

A

LDL Levels

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36
Q

In a sedentary lifestyle what happens to cholesterol levels?

A

Increases LDLs

Decrease HDLs

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37
Q

What types of dietary foods will increase LDLs?

A

Trans-fats***
Cholesterol
Saturated Fats

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38
Q

What type of medications will increase LDLs?

A

Corticosteroids
Diuretics
Beta-adrenergic blockers

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39
Q

Fats should be less than ___% of total dietary calories

A

30%

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40
Q

What is a type of monounsaturated fat?

A

Olive oil

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41
Q

What is a type of polyunsaturated fats?

A

Vegetable Oil

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42
Q

True/False: Monounsaturated fat and Polyunsaturated fats are part of a Cardioprotective Lifestyle

A

True

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43
Q

How much red wine a day promotes a cardioprotective lifestyle?

A

1 glass a day

Decreases cardiac risk

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44
Q

Endothelial Dysfunction is caused by:

A

Uncontrolled diabetes mellitus
Hypertension
Hypercholesterolemia
Smoking

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45
Q

Endothelial dysfunction increases what 2 things?

A

Afterload

Preload

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46
Q

Atherosclerosis causes ____ blood flow

A

Turbulent

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47
Q

Turbulent blood flow predisposes areas for a _____ formation

A

Thrombus

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48
Q

Bruit

A

Turbulent blood flow the produces a whooshing sound

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49
Q

Xanthoma

A

Yellowish cholesterol deposits under the skin and around the eyes

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50
Q

Arcus Senilis

A

Yellow-white ring around the pupil of the eye consist of cholesterol deposits
Occurs about 60-70 years old

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51
Q

Left-sides heart failure can lead to ___ ____ __ ___

A

Right sided heart failure

52
Q

Heart failure

A

weakened ventricular muscle that is unable to sufficiently pump blood into the arterial circulation to meet the needs fo the tissues

53
Q

What is he most common cause of hospitalization?

A

Heart Failure

54
Q

What is the greatest risk factor for heart failure?

A

Hypertension

55
Q

Why do more women have a greater risk for heart failure following an MI?

A

They are asymptomatic - do not experience normal symptoms of heart failure

56
Q

Why are women diagnosed at an older age for HF?

A

Estrogen is a natural cardioprotective

57
Q

What population is a greater risk for HF?

A

African Americans

58
Q

What are 4 major changes that lead to heart failure?

A

Increased fluid/volume overload
Impaired ventricular filling
Degeneration of ventricular muscle
Decreased ventricular contractile function

59
Q

Heart failure decreases ___ ___

A

Cardiac Output

60
Q

Left Ventricular Ejection Fraction (LVEF)

A

The volume of blood pumped with each ventricular contraction

61
Q

LVEF is responsible for pumping ___% of blood volume out

A

60-70%

62
Q

Right-Sided Heart Failure Symptoms

A 
Jugular Distension
Ascites
Ankle/Sacral edema
Hepatomegaly
Splenomegaly
Increase BNP and ANP
63
Q

RASS improves/declines HF

A

Decline

RASS system stimulation during HF is BAD!

64
Q

A LVEF less than ___% is an indicator of HF

A

40%

65
Q

Major causes of HF

A 
Repeated ischemic episodes of the heart
MI
Chronic Hypertension
COPD
Dysrhythmias
Valvular disorders (Stenosis) (increase after load)
Pulmonary Embolism
66
Q

Risk factors for HF (out of the usual Risk Factors)

A 
Sleep Apnea (Rhythm disturbance)
Congenital heart defects
Kidney conditions
67
Q

Systolic HF refers to

A

Ventricular contraction HF (most common)

68
Q

Diastole HF refers to

A

Ventricular relax HF

69
Q

What does the backward effect of left ventricle HF do?

A

Causes a back up of blood in the lungs (pulmonary edema) > a back up of blood in the right ventricle > Right-sided HF

70
Q

What does the forward effect of the left ventricle HF do?

A

Causes inadequate blood perfusion to brain and kidneys (all body) > activates RASS system, ADH, and Sympathetic Nervous System

71
Q

Pulmonary Edema

A

Extravasation into the pulmonary interstitial spaces

72
Q

Symptoms of Pulmonary edema

A 
Crackles
Pink frothy sputum
Cough
Dyspnea
Orthopnea
S3 heart sound
73
Q

Orthopnea

A

Difficulty breathing while lying flat

74
Q

What question should be asked to a patient experiencing Orthopnea?

A

How many pillows do you sleep with

75
Q

During the forward effects of Left Ventricular HF the SNS stimulates __ receptors

A

Adrenergic receptors

76
Q

Adrenergic receptors

A

Increases heart rate stimulates vasocontriction

77
Q

During the forward effects of Left Ventricular HF the posterior pituitary releases __

A

ADH

78
Q

ADH

A

Increases water reabsorption into the bloodstream > increase blood volume

79
Q

Ventricular Remodeling

A

A complication from HF

Hormones provoke genetic changes and the heart hypertrophy but becomes less effective

80
Q

Ventricular Remodeling increases risks for ___

A

Clotting

81
Q

Anasarca

A

Edema all over the body

82
Q

Severe right ventricular HF manifests as:

A

Massive peripheral edema

83
Q

L/R: Dyspnea upon exertion

A

Both left and right failure

84
Q

L/R: Dyspnea when lying flat for more than a few minutes

A

Left failure

85
Q

L/R: Nocturnal cough

A

Left failure

86
Q

L/R: Confusion

A

Left failure

87
Q

L/R: Difficulty concentrating

A

Left failure

88
Q

L/R: Cold, pale legs and feet

A

Left failure

89
Q

L/R: Swelling in the ankle or fingers

A

Right failure

90
Q

L/R: Tight rings or shoes b/c of fluid retention

A

Right failure

91
Q

L/R: Abdominal swelling

A

Right failure

92
Q

L/R: Gastrointestinal symptoms (Anorexia, feeling full)

A

Both left and right failure

93
Q

L/R: Increases frequency of urination

A

Both right and left failure

94
Q

L/R: Nocturia caused by excess fluid accumulation

A

Both right and left failure

95
Q

L/R: Weight gain of 2 pounds or more per day b/c of fluid retention

A

Both right and left failure

96
Q

S3 Heart sounds is caused by:

A

Fluid build up
Sounds like “kentucky”
Gallop sound

97
Q

S4 heart sound is caused by:

A

Stiffness of the valve (aortic stenosis)

98
Q

When do you hear an S4 heart sound?

A

After remodeling has happened

With high afterload

99
Q

What is the major manifestation of HF?

A

Weight fluctuation of 2 pounds or more a day

100
Q

Basic hemodynamic measurement changes in HF

A

Increase in central venous pressure
Decrease CO
Decrease LVEF (fewer than 40%)
Decrease systematic BP

101
Q

Shock

A

the inability of the heart and lungs to satisfy the metabolic and oxygen requirements of the peripheral tissues

102
Q

Shock categorized by BP falling below __

A

60 mm Hg the patient’s normal BP

103
Q

Three stages of shock

A

Initial
Progressive
Irreversible

104
Q

5 Categories of Shock

A 
Cardiogenic
Hypovolemic
Septic
Anaphylactic
Neurogenic
105
Q

Initial stage of shock effect what organ?

A

Kidneys

106
Q

What happens in the initial stage of shock?

A

Drop in BP > Sympathetic Nervous System, RASS system triggered

107
Q

Progressive stage of shock effect what organs?

A 
Lungs
Kidneys
Gut
Pancreas
Liver
108
Q

What happens in the progressive stage of shock?

A

All blood conserved for brain and heart

Cold and Clammy

109
Q

What organs are effected in the irreversible stage of shock?

A

Heart and brain

110
Q

What happens in the irreversible stage of shock?

A

Myocardial and cerebral ischemia

Widespread cellular hypoxia

111
Q

Lactic acidosis affects ___ ,___, __, ___ functions

A

Cardiac (Arrhythmias)
Respiratory (Tachypnea)
Neurological
Brain

112
Q

What happens to the blood flow to the GI during shock?

A

Blood is shunted away from the GI to the vital organs

113
Q

What hormones are released during shock?

A

Epinephrine and Cortisol

114
Q

What does epinephrine and cortisol want to increase during shock?

A

CO

115
Q

What happens to glycogen during shock?

A

Glycogen is broken down > hyperglycemia

116
Q

What effect does hyperglycemia have on WBC?

A

Decreases WBC function

117
Q

What is Cardiogenic shock caused by?

A

Failure of the heart (MI)

118
Q

What is Hypovolemic shock caused by?

A

Large depletion of body fluids (Diarrhea, vomiting, ascites, burns)

119
Q

What is Anaphylactic shock caused by?

A

Allergic reaction (Histamine response)

120
Q

What is Neurogenic shock caused by?

A

Spinal cord or brain injury

121
Q

What sets Anaphylactic shock and Neurogenic shock away from the others

A

They both cause widespread vasodilation

The other 3 cause widespread vasoconstriction

122
Q

Cardiac Tamponade

A

Fluid buildup around the heart that restricts the heart action

123
Q

What does cardiac tamponade do to the CO?

A

Decreases CO

124
Q

Beck’s Triad (key signs of cardiac tamponade)

A

Distant heart sounds
Low BP (b/c decreased CO)
High jugular venous pressure

125
Q

How much blood volume can a person lose without exhibiting signs or symptoms?

A

20% of blood volume or about 1 Liter

126
Q

What is a compensatory mechanism in Neurogenic shock?

A

Tachycardia

127
Q

What is the initial indicator of shock?

A

Output (Kidney function > GFR)

Pathophysiology (12 decks)

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