Unit 3.1: CV A&P Flashcards
which myocyte property is correct for: Contains actin and myosin myofilaments
A. Similar to neural and skeletal muscle
B. Unique to cardiac muscle
A
which myocyte property is correct for: propagates action potential
A. Similar to neural and skeletal muscle
B. Unique to cardiac muscle
A
which myocyte property is correct for: generates a resting potential
A. Similar to neural and skeletal muscle
B. Unique to cardiac muscle
A
which myocyte property is correct for: has gap junctions
A. Similar to neural and skeletal muscle
B. Unique to cardiac muscle
B
which myocyte property is correct for: Contains t-tubule system
A. Similar to neural and skeletal muscle
B. Unique to cardiac muscle
A
which myocyte property is correct for: oxygen consumption at rest of 8-10 mL O2/100 g/min
A. Similar to neural and skeletal muscle
B. Unique to cardiac muscle
B
the resting membrane potential is established by what 3 mechanisms
- chemical force
- electrostatic counterforce
c. sodium/potassium ATPase
define resting membrane potential
the electrical potential across a cell membrane at rest
define threshold potential
the voltage change that must be achieved to initiate depolarization
Review:
note similarities and differences between neural, skeletal, and cardiac muscle
what is the name of the equation to predict an ions equillibrium pote4ntial
Nernst
Do not need to know how to calculate… just understand concept
Describes the force of myocardial contraction during systole
A. Inotropy
B. Chronotropy
C. Dromotropy
D. Lusitropy
A
describes Heart rate
A. Inotropy
B. Chronotropy
C. Dromotropy
D. Lusitropy
B
Describes conduction velocity through the heart (Velocity = distance/time)
A. Inotropy
B. Chronotropy
C. Dromotropy
D. Lusitropy
C
describes the rate of myocardial relaxation during diastole
D
primary determinant of threshold potential
Serum Calcium
primary determinant of resting membrane potential
serum potassium
2
Review
sort each myocardial event to its primary phase of the myocyte action potential: ST Segment
A. Phase 0
B. Phase 2
C. Phase 3
D. Phase 4
B
sort each myocardial event to its primary phase of the myocyte action potential: Q Wave
A. Phase 0
B. Phase 2
C. Phase 3
D. Phase 4
A
sort each myocardial event to its primary phase of the myocyte action potential: Calcium Influx
A. Phase 0
B. Phase 2
C. Phase 3
D. Phase 4
B
sort each myocardial event to its primary phase of the myocyte action potential: Sodium influx
A. Phase 0
B. Phase 2
C. Phase 3
D. Phase 4
A
sort each myocardial event to its primary phase of the myocyte action potential: isoelectric EKG
A. Phase 0
B. Phase 2
C. Phase 3
D. Phase 4
D
sort each myocardial event to its primary phase of the myocyte action potential: Plateau
A. Phase 0
B. Phase 2
C. Phase 3
D. Phase 4
B
sort each myocardial event to its primary phase of the myocyte action potential: Resting phase
A. Phase 0
B. Phase 2
C. Phase 3
D. Phase 4
D
sort each myocardial event to its primary phase of the myocyte action potential: T Wave
A. Phase 0
B. Phase 2
C. Phase 3
D. Phase 4
C
sort each myocardial event to its primary phase of the myocyte action potential: Potassium Leak
A. Phase 0
B. Phase 2
C. Phase 3
D. Phase 4
D
sort each myocardial event to its primary phase of the myocyte action potential: Final Repolarization
A. Phase 0
B. Phase 2
C. Phase 3
D. Phase 4
C
sort each myocardial event to its primary phase of the myocyte action potential: Potassium Efflux
A. Phase 0
B. Phase 2
C. Phase 3
D. Phase 4
C
sort each myocardial event to its primary phase of the myocyte action potential: Depolarization
A. Phase 0
B. Phase 2
C. Phase 3
D. Phase 4
A
I-f
Review
- what is the order of stimulus through heart
Review SA node Firing
what determines the heart rate…
other name for the SA node
Kieth flack node
Review
the ______ vagus nerve innervates the SA Node and the ______ vagus nerve innervates the AV Node
Right = SA
Left = AV
Cardiac accelerator fibers
T1-T4
REVIEW
what 3 variables can be manipulated to change the sinus node rate
- rate of spontaneous phase 4 depolarization
- threshold potential
- Resting membrane potential
how does SNS stimulation increase the HR
1000 ml/min
oxygen delivery equation
what is the normal
1,000 mL
Review
solution coefficient for dissolved oxygen
0.003
3 things CO is determined by
- preload
- afterload
- contractility
oxygen content equation
what is the normal
20 mL/dL
oxygen extraction ration
oxygen consumption normal amount
venous oxygen content equation
what is the normal
15 mL/dL
match the “parts of the choo choo train” to the components of the oxygen delivery equation
Cargo
A. Hemoglobin
B. SaO2
C. Cardiac Output
B
match the “parts of the choo choo train” to the components of the oxygen delivery equation
Engine
A. Hemoglobin
B. SaO2
C. Cardiac Output
C
match the “parts of the choo choo train” to the components of the oxygen delivery equation
Boxcar
A. Hemoglobin
B. SaO2
C. Cardiac Output
A
what does CaO2 tell you
how many grams of oxygen are contained in a dL of ARTERIAL blood
the amount of oxygen dissolved in blood (PaO2) follows what law
henrys law
hematocrit
equation to calculate MAP
poiseuilles Equation
altering what part of poiseuilles Equation yields the gretest impact on flow
radius
Review
what factors influence CO
SV
HR
ESV
EDV
Filling pressures
compliance
afterload
contractility
how does CO impact the variable that comes after it
directly impacts MAP, tissue blood flow, and oxygen delivery
what are the 5 components of Poiseuilles Law
how much flow occurs when the radius of a tube is quadrupled
256 times
how is viscocity related to temperature
A. Inversely proportional
B. Directly proportional
A
Reynolds # for turbulent flow
> 4,000
Reynolds # for transitional flow
2,000-4,000
Reynolds # for laminar flow
< 2,000
Normal value for:
Cardiac Output
5-6 L/min
Normal value for:
Stroke Volume
50-100 mL/beat
Normal value for:
Ejection fraction
60-70%
Normal value for:
Mean arterial BP
70-105 mmHg
Normal value for:
SVR
Normal value for:
Pulmonary Vascular Resistance
Review
Review
Review
Review
notice that several terms can be used on the x- and y- axes. You should know all of them
atrial kick accounts for ______% of the final LVEVV
20-30%
conditions associated with decreased myocardial compliance…
- myocardial hypertrophy
- heart failure with preserved EF (diastolic failure)
- fibrosis
- aging
On the Starling curve, is this variable on the X- or Y-axes?
LVEDV
X
On the Starling curve, is this variable on the X- or Y-axes?
PAOP
X
On the Starling curve, is this variable on the X- or Y-axes?
CO
Y
On the Starling curve, is this variable on the X- or Y-axes?
SV
Y
On the Starling curve, is this variable on the X- or Y-axes?
LVSW
Y
On the Starling curve, is this variable on the X- or Y-axes?
CVP
X
LVEDP, LAP, and PAOP are all surrogate measures of:
LVEDV
- hypoxia
- hypercapnia
- hyperkalemia
true or false: contractility is independent of preload and afterload
true
What happens to ventricular output when contractility is increased vs decreased
Factors that influence contractility
Remember
C hemicals affect C ontractility - particularly C alcium
Review
Review how Beta-1 stimulation increases contractility
what is the primary substance that determines inotropy
calcium
name 5 factors that increase LV contractility
list 3 ways that B-1 receptor stimulation modulates calcium in the myocyte
Afterload
Review
law of laplace equation
normal SVR in adults
myocardial wall stress is reduced by what 3 factors
- rapid ventricular filling
- diastasis
- atrial systole
REVIEW x 1000
Review
Systole
Review
Diastole
identify the status of the mitral valve ( open vs closed ) during each phase of the cardiac cycle
Ventricular Ejection
mitral valve = closed
identify the status of the mitral valve ( open vs closed ) during each phase of the cardiac cycle
Isometric ventricular relaxation
mitral valve = closed
identify the status of the mitral valve ( open vs closed ) during each phase of the cardiac cycle
Isometric ventricular contraction
mitral valve = closed
identify the status of the mitral valve ( open vs closed ) during each phase of the cardiac cycle
atrial systole
mitral valve = open
identify the status of the mitral valve ( open vs closed ) during each phase of the cardiac cycle
rapid ventricular filling
mitral valve = open
identify the status of the aortic valve ( open vs closed ) during each phase of the cardiac cycle
isometric ventricular contraction
AV= closed
identify the status of the aortic valve ( open vs closed ) during each phase of the cardiac cycle
Ventricular Ejection
AV = open
identify the status of the aortic valve ( open vs closed ) during each phase of the cardiac cycle
rapid ventricular filling
AV = closed
identify the status of the aortic valve ( open vs closed ) during each phase of the cardiac cycle
atrial systole
AV = closed
identify the status of the aortic valve ( open vs closed ) during each phase of the cardiac cycle
isometric ventricular relaxation
AV = closed
stroke volume ___________ between Q wave and end of T wave
A. Does occur
B. Does not occur
A
atrial systole ___________ between Q wave and end of T wave
A. Does occur
B. Does not occur
B
rapid ventricular ejection ___________ between Q wave and end of T wave
A. Does occur
B. Does not occur
A
mitral valve opens ___________ between Q wave and end of T wave
A. Does occur
B. Does not occur
B
atrial valve opens___________ between Q wave and end of T wave
A. Does occur
B. Does not occur
A
left ventricular systole ___________ between Q wave and end of T wave
A. Does occur
B. Does not occur
A
isovolumetric ventricular relaxation ___________ between Q wave and end of T wave
A. Does occur
B. Does not occur
B
what cardiac event occurs at the marked area of the image
A. Mitral Valve closes
B. Mitral Valve Opens
C. Aortic Valve closes
D. Aortic Valve Opens
A
Review
Review
identify each phase of the ventricular cycle as systole or diastole
identify each mechanical event of the ventricular cycle
calculate the stroke volume (in mL)
70 mL
equal to the width of the loop
Review
true or false: the LV volume increases during isovolumetric contraction
False – LV volume does not change
when is DBP measured
where aortic valve opens
When is SBP measured
at the peak of the ejection curve
Review
identify the status of the cardiac valves on the LV pressure volume loop
Ejection Fraction:
- Normal
- mild dysfunction
- moderate dysfunction
- severe dysfunction
- Normal: >/= 50%
- mild dysfunction: 41-49%
- moderate dysfunction: 26-40%
- severe dysfunction: </= 25%
intravenous fluid bolus
Review
increased preload
Review
decreased preload
Review
increased contractility
Review
decreased contractility
Review
increased afterload
Review
decreased afterload
Identify the change that occurs in each LV pressure-volume loop
increased preload
Identify the change that occurs in each LV pressure-volume loop
increased contractility
Identify the change that occurs in each LV pressure-volume loop
increased afterload
Identify the change that occurs in each LV pressure-volume loop
decreased preload
Identify the change that occurs in each LV pressure-volume loop
decreased contractility
Identify the change that occurs in each LV pressure-volume loop
decreased afterload
circumflex
Review
arterial circulation
Review
Review
Review
arterial supply to the conduction system
Review
coronary venous circulation
Review
on TEE/TTE, what is best view for diagnosing LV ischemia
what is 2nd best…
midpapillary muscle level in short axis
…2nd best = apical segment in short axis
Identify each coronary artery
identify the coronary artery responsible for perfusing each segment of the heart
Which part of the myocardium does Lead II monitor
A. Lateral
B. Inferior
C. Anterior
D. Septal
B
Which part of the myocardium does Lead V5 monitor
A. Lateral
B. Inferior
C. Anterior
D. Septal
A
Which part of the myocardium does Lead I monitor
A. Lateral
B. Inferior
C. Anterior
D. Septal
A
Which part of the myocardium does Lead aVF monitor
A. Lateral
B. Inferior
C. Anterior
D. Septal
B
Which part of the myocardium does Lead V1 monitor
A. Lateral
B. Inferior
C. Anterior
D. Septal
D
Which part of the myocardium does Lead V3 monitor
A. Lateral
B. Inferior
C. Anterior
D. Septal
C
Which part of the myocardium does Lead V2 monitor
A. Lateral
B. Inferior
C. Anterior
D. Septal
D
Which part of the myocardium does Lead V6 monitor
A. Lateral
B. Inferior
C. Anterior
D. Septal
A
Which part of the myocardium does Lead III monitor
A. Lateral
B. Inferior
C. Anterior
D. Septal
B
Which part of the myocardium does Lead aVL monitor
A. Lateral
B. Inferior
C. Anterior
D. Septal
A
Which part of the myocardium does Lead V4 monitor
A. Lateral
B. Inferior
C. Anterior
D. Septal
C
MEdiators of coronary vasodilation include (select 2):
A. adenosine
B. Beta 2 stimulation
C. Alpha-1 stimulation
D. hypocapnia
A & B
Review
coronary blood flow and perfusion
coronary blood flow auto regulates between a MAP of
60-140 mmHg
adenosine is a byproduct of ______ metabolism and is a potent coronary vessel___________
ATP
vasodilator
the __________ response refers to a vessels innate ability to maintain a constant vessel diameter
myogenic
Review
causes of coronary artery constriction and dilation
what 2 pressures determine coronary perfusion pressure
CPP = aortic DBP = LVEDP
what 3 responses are responsible for autoregulation of coronary blood flow
Histamine-1 causes:
A. Coronary vasoconstriction
B. Coronary vasodilation
A
Beta-2 causes:
A. Coronary vasoconstriction
B. Coronary vasodilation
B
Hitamine-2 causes:
A. Coronary vasoconstriction
B. Coronary vasodilation
B
muscarinic causes:
A. Coronary vasoconstriction
B. Coronary vasodilation
B
alpha causes:
A. Coronary vasoconstriction
B. Coronary vasodilation
A
blood flow thru which cardiac region corresponds to the waveform in the image
A. RV subendocardium
B. LV subendocardium
C. LV epicardium
D. Aorta
B
describe each waveform
which region of the heart does this pressure waveform represent
Lt coronary artery flow during the cardiac cycle
which myocardial arterial bed is most susceptible to ischemia
endocardial blood vessels of the myocardium
decreased diastolic filling time
Review
what increases and decreases oxygen demand
name 3 circumstances that affect both sides of the myocardial supply-demand equation
- changes in HR
- aortic diastolic pressure changes
- changes to preload
what does tachycardia do to myocardial oxygen supply and demand
what does increased aortic diastolic presure do to myocardial oxygen supply and demand
what does increased preload do to myocardial oxygen supply and demand
mortality rate of a perioperative MI
20%
Review
3 pathways that affect intracellular calcium concentration
PKA affects excitation-contraction coupling by:
Review
Nitric Oxide cGMP pathway
activators of PLC pathway (4)
- phenylephrine
- norepinephrine
- angiotensin 2
- endothelin-1
the nitric oxide cGMP pathway causes:
A. vasodilation
B. Vasoconstriction
A
the Phospholipase C pathway causes:
A. vasodilation
B. Vasoconstriction
B
the G-protein cAMP pathway causes:
A. vasodilation
B. Vasoconstriction
A
What 4 ways does protein kinase A affect excitation-contraction
phenylephrine stimulates what effector to ultimately cause vasoconstriction
phospholipase C
A. I
B. aVL
C. II
D. V6
E. V1
F. V3
A, B, D
trendelenburg
766 mL O2/min
where on the loop does aortic valve open
increasing potassium conductance
adenosine
hyperkalemia increases resting membrane potential
which letter corresponds with diastole (select 2)
B & C
rapid ventricular filling
diastasis
atrial systole
SA Node automaticity
5%
80
neither preload or afterload
