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NBS1 > Physiology > Flashcards

Physiology Flashcards

1
Q

Depolarization of free walls of ventricles

A

Endocardium to epicardium

Purkinjie fibers are located in the endocardial layer (Subendocardium)

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2
Q

Depolarization direction of IV septum

A

Left to right due to the shortness of Anterior LBB vs RBB

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3
Q

Depolarization of ventricles direction

A

Right ventricle completely depolarizes before the left because the outer wall is much thinner (fewer myocytes to take over cell to cell conduction after Purkinjie fibers)

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4
Q

Repolarization of ventricles

A

Epicardial cells
Duration of Epicardial cells is shorter than duration of action potentials for endocardial cells
Epicardium to endocardium.
Endocardial contracts sooner and lasts longer, epicardial contracts later and relaxes sooner

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5
Q

Split second heart sound during inspiration and expiration

A

Delayed right ventricular contraction,
RBBB
Prolonged right ventricular ejection

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6
Q

Paradoxical split

A

Split second heart sound heard during expiration but not inspiration
Delayed left ventricular contraction
LBBB
Or prolonged left ventricular ejection

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7
Q

Systolic murmurs

A

Stenosis of semilunar valves
Insufficiency of atrioventricular valve–holosystolic
Severe mitral–early systolic

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8
Q

Three general regions so AV node and cells they contain

A

AN-atrial muscle cells and nodal type cells
N-only nodal cells with slow changing pre potential (phase 4), slow rate of Phase 0, and low amplitude AP
NH zone–nodal cells and fibers of the bundle of His
—faster than N only zone because His fibers have a rapid rate of depolarization and large amplitude depolarization during phase 0

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9
Q

Systolic murmurs vs holosystolic murmurs

A

Systolic–mitral/tricuspid insufficiency and aortic/pulmonary stenosis
Holosystolic–mitral/tricuspid insufficiency

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10
Q

Reduced ejection (left vent pressure vs aorta)

A

Left vent.aortic

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11
Q

PR interval

A

Conduction time between atrial and ventricles

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12
Q

Completely depolarized ventricles, which segment

A

ST segment

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13
Q

RAD, LAD, Circumflex leads

A

RAD–II, III, aVF
LAD– V1, V2 (septal)(lad for the V’s)
Circumflex–I, aVL (I-alphabetically first, and L-fLEX)

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14
Q

P wave

A

Atrial depolarization and contraction

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15
Q

PR interval

A

Beginning of P wave to beginning of Q wave–initial depolarization of the ventricle
Varies with conduction velocity through the AV node–heart block (AV conduction decreases, PR increases)
Decreased by stimulation of SNS
Increased by PNS

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16
Q

Pathway of baroreceptor inhibition of SNS in brain

A

Caudal ventral lateral medulla in SNS vasodepressor center to rostral ventral lateral medulla in vasopressorlcenter… Inhibition using GABA.
CVLM (depressor—CD)
RVLM(pressor–PR)

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17
Q

First degree AV block

A

More than 1 large square for PR interval (greater than .2)
Consistent in every cycle
P-QRS-T order normal for every cycle
Conduction delay in AV node

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18
Q

Wenekebach/Type 1

A

One less QRS than P waves, (3:2, 4:3)
PR gradually increases
Final P fails to conduct QRS
Parasympathetic excess, so vagal makes it go from 3:2-4:3
QRS is normal (less than .2) because the block is the AV node

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19
Q

Mobitz/Type II

A 
Located in purkenji/bundle of His
1 normal P-QRS-T, followed by just a P
2:1 or 3:1
QRS widened
P-P normal. 
Vagal maneuver eliminates
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20
Q

Third degreee junctional

A

Atrial depolarization not conducted to ventricles
Upper AV blocked, junctional complex takes over
Normal/narrow QRS with a rate (RR) of 40-60 bpm (slower rate than PP)

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21
Q

Third degree AV block, ventricular focus

A

Slower than junctional (RR is approximately 20-40 bpm)
Cerebral blood flow compromised, syncope
Large, wide PVC-like complexes
Completely obliterated AV node or right below the AV node)

22
Q

RBBB

A

Right axis deviation (+120-+180)
Widened QRS >0.12 (or 3 small squares)
Chester leads–V1, V2
R is left ventricle, r’ is right ventricle

23
Q

LBBB

A 
Left axis deviation (-30 to -90)
QRS > .12 (3 small squares)
Chest leads V5 and V6
R would be right ventricle
R' is left ventricle
24
Q

Depolarization of the heart proceeds in what direction

A

Endocardium to epicardium

25
Q

CVP average

A

5 mmHG

26
Q

MAP average

A

100 mmHG

27
Q

Aorta pressures

A

90-140 systolic

60-90 diastolic

28
Q

LV pressures

A

90-140 systolic

4-12 diastolic

29
Q

PWP

A

4-12

30
Q

Left Atrium pressure

A

4-12

31
Q

Right ventricle pressure

A

Systole–15-30

Diastole 0-5

32
Q

Pulmonary artery

A

Systole–15-30

Diastole 5-15

33
Q

What channels do both Purkinje and myocardium use to conduction of depolarization

A

Fast Na+

34
Q

Ventricle contraction and ECG

A

Ventricle contraction spans QRS to the end of T wave
ST segment is corresponds to phase 2 (plateau of repolarization)
T is the fast repolarization (phase 3)
All of this is due to K+ efflux
called the QT interval (ventricular systole)

35
Q

Actions of Ca, K, and Na in the action potential for myocytes

A

Ca–myocytes contract
K+ outflow causes repolarization
Na produces cell to cell conduction of depolarization in the heart (except at AV node)

36
Q

Simple definition of depolarization

A

Positive deflection on EKG, advancing wave of positive chasers within the cardiac myocytes (think Na advancing through gap junction, Na is positively charged)

37
Q

Beta adrenergic vs alpha adrenergic

A

Beta–beat.. Heart beat…myocytes

Alpha, Greek alpha, pull around arteries to constrict them, a for alpha a for arteries

38
Q

BPM for different rhythms

A

Atria– 60-80
AV junction –40-60
Ventricles 20-40c

39
Q

Sinus arrhythmia

A

Normal, but extremely minimal, increase in heart rate during inspiration and and extremely minimal decrease in heart rate during expiration

40
Q

Depolarization occurs in what direction (sides of the heart)

A

Left to right due to the terminal filaments in the left bundle branch

41
Q

Atrial fibrillation

A

Continuous rapid-firing of multiple atrial automaticity foci
No single impulse depolarized the atria completely
Only occasionally atrial depolarization reaches the AV node to be conducted—irregular QRS
Para systolic–insensitive to overdrive suppression

42
Q

PVCs

A

Wide and bizarre
They are usually opposite the polarity of the normal QRS
Hypoxia
Premature ventricular contraction
Irritable ventricular automaticity focus fires an impulse and that region depolarized before the rest of the ventricle. Enormously wide QRS
Unopposed deflections with mixed amplitudes

43
Q

Paraxysmal tachycardia

A

150-250 beats per minute
Sudden
The next beat will fall before the 150
Atrial–effects P waves (excess digitalis)
Junctional–suddenly initiate… Could be inverted P
Ventricular–SA still paces atria, but large dramatic ventricular complexes hide individual P wave

44
Q

Flutterq

A

250-350 beats per minute

45
Q

Fibrillation

A

350-450 beats per minute

46
Q

Ventricular tachycardia

A

Looks like a run of PVCs

47
Q

WPW

A

Delta waves
Rapid conduction–supraventricular tachycardia
Re entry

48
Q

Pulmonary artery normal pressure

A

25/10

49
Q

Cardiac glycosides

A

Inhibits Na-K pump (raising Na) slowing down Na/K exchange, ymaintaining higher Ca in cell… Stays around longer

50
Q

SV, increase decrease, normal value

A

80mL, increased by increased contractility, decreased after load, increased preload

51
Q

Ejection Fraction (normal)

A

Greater than 55%

SV/EDV

52
Q

average MPAP

A

25/15

NBS1 (9 decks)

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