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Block C - Circulation > Physiology Lecture 1 -- The Heart as a Pump > Flashcards

Physiology Lecture 1 -- The Heart as a Pump Flashcards

1
Q

When does first heart sound (S1) occur?

A

Mitral valve closes

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2
Q

When does S2 occur?

A

Aortic valve closes

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3
Q

When can S3 occur in terms of Wigger’s diagram?

A

After early rapid/brisk filling via the LA-LV P gradient

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4
Q

What is the most common reason for S3 being abnormal?

A

Congestive heart failure causing increased ventricular pressure (a poor prognostic factor)

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5
Q

Define systole in terms of heart events

A

Mitral valve closes –> aortic valve closes

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6
Q

Define diastole in terms of heart events

A

Aortic valve closes –> mitral valve closes

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7
Q

Explain the purpose of isovolumetric contraction

A

Both valves are closed, so no blood flow occurs as pressure builds in the ventricle to overcome the pressure of the aorta = establish P gradient

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8
Q

Pressure gradient during ejection

A

Left ventricle > Aorta

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9
Q

Explain the purpose of isovolumetric relaxation

A

Both valves are closed, so no blood flow as the left ventricle is given time to relax until its pressure is lower than the atrium

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10
Q

Pressure gradient during diastole (post isovolumetric relaxation)

A

Left atrium > Left ventricle

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11
Q

What physical event causes the mitral valve to close?

A

When P left atrium was higher than P left ventricle and then their P become equal

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12
Q

What physical event causes the aortic valve to close?

A

When P left ventricle was higher than P aorta and then their P become equal

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13
Q

What physical event causes the aortic valve to open?

A

When P aorta was higher than P ventricle and then their P become equal

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14
Q

What physical event causes the mitral valve to open?

A

When P ventricle was higher than P atrium and then their P become equal

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15
Q

When can a fourth heart sound be heard?

A

During the atrial kick

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16
Q

How much of the blood is passively emptied from the left atrium to the left ventricle during diastole?

A

70%

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17
Q

What is the purpose of the atrial kick?

A

Contraction of the atrium to force the remaining 30% of the blood to enter the left ventricle

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18
Q

What wave in the wigger’s diagram indicates the atrial kick?

A

a wave

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19
Q

What event does the x descent of the Wigger’s diagram represent?

A

Atrial relaxation (early systole)

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20
Q

What event does the v wave of the Wigger’s diagram represent?

A

Atrial filling

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21
Q

What event does the y descent of the Wigger’s diagram represent?

A

Atrial emptying (early diastole)

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22
Q

What might cause an opening heart sound?

A

Bicuspid aortic valve (an ejection sound)

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23
Q

Define this event

A

Aortic valve closes

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24
Q

Define this event

A

Aortic valve opens

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25
Q

Define this event and associated wave

A

A Wave = Atrial Kick

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26
Q

Define this time interval

A

Atrial systole

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27
Q

Define this time interval

A

Diastalsis

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28
Q

Define this interval

A

Diastole

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29
Q

Define this interval

A

Ejection

30
Q

Define this interval

A

Isovolumetric contraction

31
Q

Define this interval

A

Isovolumetric relaxation

32
Q

Define this event

A

Mitral valve close

33
Q

Define this event

A

Mitral valve open

34
Q

Define this interval

A

Rapid inflow

35
Q

Define this interval

A

Systole

36
Q

Define this wave

A

v wave = atrial filling

37
Q

Define this wave

A

x descent = atrial relaxation

38
Q

Define this wave

A

y descent = atrial emptying

39
Q

Define ESV

A

Ventricular volume at the end of systole (when aortic valve closes

40
Q

Define EDV

A

Ventricular volume at the end of diastole (mitral valve closes)

41
Q

Defien inotropy

A

Contractility, reflected by the relationship between ESV and afterload

42
Q

Define preload

A

The ventricular volume of blood prior to systole (same as EDV)

43
Q

Define afterload

A

The pressure (of aorta) that the left ventricle must overcome during systole to eject blood

44
Q

Describe the significance of the relatively shallow slope of the ventricular fillling line of the PV loop

A

Low slope = low P for changes in V = good compliance

45
Q

Define diastology

A

PV relationship during diastole (V filling property; compliance)

46
Q

An example of a heart with decreased compliance

A

Hypertension (thickened ventricular wall)

47
Q

An example of a heart with increased compliance

A

Cardiomyopathy

48
Q

What happens if left ventricular pressure cannot overcome aortic P

A

No ejection = keep contracting isovolumetrically

49
Q

Define SV

A

Stroke Volume = EDV - ESV

Amount of blood ejected to the aorta

50
Q

Define ejection fraction

A

EF = SV/EDV

Proportion of blood ejected to aorta that was in the ventricle

51
Q

3 factors that affect ventricular performance

A

Contractility

Afterload

Preload

52
Q

Effect of increased preload on isovolumetric pressure

A

Increase

53
Q

Define systology

A

End systolic pressure volume relationship (contracility)

54
Q

Effect of inotropy with constant afterload and preload

A

Positive inotropic agent = increase contractility = increase SV (blue)

Negative inotropic agent = decrease contractility = decrease SV (red)

55
Q

Predict effect of preload based on Starling’s Laws

A

If V is increased, a NORMAL heart will has more vigorous contractions and produce higher pressures

56
Q

Define premature ventricular contraction

A

Compensatory pause, which signifies filling of the ventricle = bigger ventricle = very forceful contraction

57
Q

Effect of preload with constant inotropy and afterload

A

Increased preload = increased SV

58
Q

Normal ejection fraction

A

60%

59
Q

Effect of afterload (aortic P) with constant preload and inotropy

A

Increased afterload = decreased SV = lowered EF (since higher ESV)

60
Q

How to treat patients with too much afterload

A

Decrease afterload with vasodilator (ACE inhibitor), which “unloads” the heart

61
Q

Effect of heart failure on PV loops

A

Decrease contraciltiy and increased EPV –> decreased SV

62
Q
A

Afterload

63
Q

Define this event

A

Aortic valve opens

64
Q

What does this space represent?

A

Diastole

65
Q

What does this corner represent?

A

Mitral valve closes

EDV = preload

66
Q

What does this corner represent?

A

ESV

Aortic valve close

67
Q

What does this slope represent?

A

Inotropy

68
Q

What does this edge represent?

A

Isovolumetric contraction

69
Q

What does this edge represent?

A

Isovolumetric relaxation

70
Q

What does this space represent?

A

Systole

71
Q

What does this corner represent?

A

Mitral valve opens

72
Q

What does this width represent?

A

SV

Block C - Circulation (26 decks)

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