Physio Flashcards
Explain the pacemaker potential
Phase 4: resting membrane potential. membrane is -60 mv opening of slow Na channels that give inward current which causes depolarization
Opening of T-type Ca channels with Ca inflow, reaches -40 mV
Phase 0: firing level. closure of slow Na and T Ca channels. Opening of L-type Ca channel giving slow AP response and opening of delayed rectifying K+ channels
Phase 3: repolarization
Opening of delayed rectifying K+ channels, closure of LCa channels and in activation of delayed rectifying K+ channels and activation of slow Na channels restarting a new phase 4
Factors affecting rate of discharge of SA node?
Body temp: for every degree 10 heart beats
Autonomic activity:
Sympathetic: tachycardia
Parasympathetic: bradycardia
Catecholamines: adrenal medulla releases adrenaline and noreadrenaline which increases HR
Extracellular K level: hypokalemia is tachycardia and hyper is bradycardia
Ca channel blockers: in activation causes bradychardia
What are the factors affecting inotropic state of cardiac myocytes
Positive inotropic:
increasing sympathetic or catecholamines which increases Ca in cells
Glucagon: increases c-AMP in myocytes
Increase ECF Ca which makes more inter the cell
Drugs: digitalis and caffine
Negative inotropic:
Ischemia: hypoxia to cardiac muscle
Increase parasympathetic: release acetylcholine which decreases c-AMP
Adenosine: — c-AMP
Drugs: Ca channel blockers and anesthetic drugs
Explain myocyte action potential
Phase 4: RMP
K+ slowly moves out (Ik1) through inward rectifying potassium channels IRK to reach RMP (-90 mV)
Phase 0: Depolarization goes to +20 mv
fast Na channel op and Na influx
IRK close
Fast Na channels close
Phase 1: rapid small initial repolarization
Fast Na are inactivated
transient outward channels op
Phase 2: plateau
L Ca open, inward Ca current
Na and Ca exchanger active
Op of delayed rectifying K
Phase 3: rapid repolarization
Long lasting Ca channels closed
K outward current and then closer of DRK
op of IRK
Describe the excitation contraction coupling
Membrane depolarization–> op of L type Ca–> Ca enters below sarcolemma which open ‘ryanodine Ca channel” which cause SR to release Ca
❶ Ca++ binds to Troponin-C → removes blocking action of tropomyosin. Myosin binding sites become exposed allowing myosin to bind to actin.
❷ Ca++ release decreases when AP ends.
❸ Relaxation: Ca++ is removed from the cytoplasm by:
a. Ca++ pump into SR
b. Ca++ is transported into ECF by:
• Na+ -Ca++ exchanger
• Ca++ pump
Effect of changing afterload on cardiac muscle performance
Effect of changes in afterload on muscle shortening:
+++ afterload → —- degree of shortening
Effect of changes in afterload on velocity of shortening:
• +++ afterload → —- velocity of shortening
velocity can be zero if load greater than max tension
Effect of changing preload on cardiac muscle performance
Effect of changes in preload on muscle shortening:
+++ preload →+++ degree of shortening
b. Effect of changes in preload on velocity of shortening:
• +++ preload → +++ velocity of shortening
Describe the effect of changes in heart rate on cardiac output
+++ HR alone from 70-140 beat/min → no change in CO (because of —– ventricular filling → —–SV → thus no change in CO)
+++ HR alone above 150/min → —- CO (marked —- in SV can’t be compensated by the +++ in HR)
—- HR alone below 60/min → —- CO (marked —- in HR can’t be compensated by the +++ in SV)
During muscular exercise, +++ HR (doubled) → +++ CO (more than double) because of the associated +++ in SV (+++sympathetic)
Describe the effect of changes in afterload on stroke volume
At constant preload, +++ afterload → —- SV
At constant preload & afterload, +++ inotropy → +++ SV
Describe the effect of changes in preload on stroke volume
+++ preload → +++ SV
Several factors can affect ventricular preload:
- +++ venous pressure & VR → +++ ventricular filling → +++ preload
- Strong atrial contraction → +++ preload.
- +++ HR (with constant VR) → —- preload (no enough time for ventricular filling)
- —- ventricular compliance (hypertrophy or myocardial infarction) → —- preload
Describe the venous return curve and describe the factors affecting it
Effect of changes in right atrial pressure on venous return curve: +++ RAP → —- VR —–RAP→+++ VR
Effect of changes in MSFP on venous return curve:
+++ MSFP→ shift of VR curve up & right
—–MSFP→ shift of VR curve down & left
What are the mechanisms that help venous return against gravity?
Muscle pump
Venous valves
Thoracic pump: During inspiration it sucks up VR
Heartbeat effect: atrial suction and ventricular suction
Define Edema, mention its causes
Abnormal large accumulation of ISF in lower limb
Causes:
Inadequate lymph flow, like elephantiasis
Decrease osmotic pressure gradient: decrease plasma protein level.
-accumulation of osmotically active substance in the interstitial space
Increased filtration pressure: high venous pressure
Increase capillary permeability, histamine
What is meant by autoregulation? Explain it’s types
Intrinsic capacity of vascular beds to compensate for moderate changes in perfusion pressure by
changing vascular resistance so that blood flow remains constant
Myogenic autoregulation:
Aim: maintain constant blood flow to an organ in spite of increase in its perfusion pressure
Mechanism: +++ perfusion pressure–> increase in blood flow and makes blood vessels distended which causes Ca to enter and cause VC increasing the resistance.
Metabolic auto-regulation: maintain constant blood flow to organ despite decrease of perfusion pressure
—- perfusion pressure → initial —- in blood flow
→ +++ VD metabolites → relaxation of arterioles & pre-
capillary sphincters → — resistance →+++ blood flow
Give an account of the diff vasoactive substances secreted by endothelium.
NO: stimulated by acetylcholine and its action is VD of coronary, cerebral and pulmonary vessels
Endothelin-1: Stimulated by Hypoxia, catecholamines, stress. Inhibited by NO, prostacyclin
VC of veins, renal VC, pulmonary VC and coronary VC, positive chronotropic and inotropic effect
Prostacyclin: Action: VD, decrease platelet aggregation and facilitates NO release.