Physiology of the Heart Flashcards
Stroke Volume is affected by
Contractility
Afterload
Preload
Increased contractility results in an ________________ stroke volume
Increase
Increased pre-load results in an ___________ stroke
Increase
Increased after afterload results in an ____________ in stroke volume
Decrease
A failing heart has decreased systolic function due to
Systolic and/or diastolic dysfunction
Equation for Stroke Volume
Stroke Volume = End Diastolic volume - End Systolic Volume
Contractility (and Stroke volume) increase with
1) Increased intracellular Calcium
2) Decreased extracellular Na+ ( decreased activity of the Na+/Ca2+ exchanger
3) Catecholamine stimulation via stimulation of Beta receptors
Contractility (and Stroke Volume) decrease with
1) Beta 1 blockade (decreased cyclic AMP)
2) Heart failure with systolic dysfunction
3) Acidosis
4) Hypoxia/ Hypercapnia (decreased Po2/ increased Pco2)
What class of drug can decrease the contractility of the heart
Non-dihydropyridine Ca2+ blockers
How does Catecholamine stimulation via B1 receptors increased stroke volume
1) Catecholamines stimulate B1 receptors resulting the Ca2+ channel phosphorylation -> Calcium ions enter channel -> Ca2+ induced Ca2+ release occurs and increases storage in sacroplasmic reticulum
2) Phospholamban phosphorylation -> active Ca2+ ATPase which increases calcium storage in sacroplasmic reticulum
Preload is approximated by
the Ventricular End Diasytolic Volume
Preload depends on
Venous tone and the Volume of circulating blood
What class of medication can decrease the preload
Vasodilators such as (Nitroglycerin)
Afterload is approximated by the
MAP (Mean Arterial Pressure)
Increased Afterload results in an __________ pressure which leads to _________ wall tension according to ___________ Law
Increase, Increase, Laplace Law
What class of medication decreases the Afterload
Arterial Vasodilators ( Hydralazine)
What class of medication decreases both preload and afterload
ACE inhibitors and ARB’s
How does the heart comensate for increased Afterload
LV hypertrophy in oder to decrease wall tension
What is the effect of Chronic Hypertenion on MAP
Increases the MAP which leads to LV hypertrophy
Myocardial Oxygen demand is increased by
1) Increased contractility
2) Increased Afterload (proportional to Arterial pressure)
3) increased Heart Rate
4) Increased diameter of the Ventricle (Increase wall tension)
Wall tension follows which Law
Laplace Law
Equation for wall tension
Wall tension = Pressure x Radius
Equation for Wall Stress
Wall stress = Pressure x Radius / 2 x wall thickness
Equation for Stroke Volume
End Diastolic Volume - End systolic volume
Equation for Ejection Fraction
Stroke Volume / End Diastolic Volume
EF is an index of Ventricular contracility how is EF affected in Systolic vs Diastolic HF
Decreased EF in systolic HF and usually Normal in Diastolic EF
Cardiac Output
Stroke Volume x HR
Fick’s Principle
Cardiac Output = Rate of O2 consumption / ( arterial O2 content - venous O2 content)
How is Cardiac Output affected in Early exercise vs late exercise
Early Exercise CO maintained by increased Heart rate and Stroke Volume
Late exercise CO maintained by Heart rate only as Stroke volume plateaus
Diastole is shortened with increased HR which decreases diastolic filling time which decreases SV which decreased CO
Pulse Pressure equation
Systolic Blood pressure - Diastolic blood pressure
Pulse pressure is directly proportional to ______________ and indirectly proportional to ______________.
Stroke volume, arterial compliance
Pulse pressure is inreased in
1) hyperthyroidism
2) Aortic regurgitation
3) Aortic Stiffening (isolate systolic hypertension in the elderly)
4) Obstuctive Sleep Apnea ( due to increased sympathetic tone)
5) Anaemia
6) Exercise (transient)
Pulse Pressure is decreased in
1) Aortic Stenosis
2) Cardiogenic Shock
3) Cardiac Tamponade
4) Advanced Heart Failure
MAP equation
Cardiac Output x Total peripheral resistance
MAP ( at resting HR) =
2/3 Diastolic BP + 1/3 Systolic BP = 2/3 Diastolic BP + 1/3 PP
Starling curve (pg 283 FA)
Force of contraction is proportional to the End diastolic length of cardiac fibres ( preload)
What factors increase Contractility
Catecholamines and Positive Inotropes (Digoxin)
What factor decrease cardiac contractility
Loss of myocardium ( post MI )
Beta blockers ( acutely)
Non - dihydropyridine Ca2+ channel blockers
Dilated cardiomyopathy
Pressure =
Volumetric flow rate x resistance
Volumetric flow rate ( Q) =
Flow velocity (v) x cross-sectional area (A)
Resistance =
Driving pressure (P) / Volumetric flow rate = 8n (viscosity ) x length / pi r ^4
Total resistance of vessels in series
Rt = R1 + R2 + R3 …
Total resistance of vessel in parallel
Rt = 1/R1 + 1/R2 +1/R3 …
Capillaries have the ___________ cross - sectional are and the __________flow velocity
Highest, Lowest
What types of vessels account for the highest TPR
Arterioles
What provide most of the blood storage capacity
Veins
Viscosity depends mostly on
Hematocrit
Viscosity increases in hyperproteinemic states such as
Multiple myeloma and polycythemia
Viscosity decreases in
anaemia
Compliance =
V/P