Week 1 Quiz 1 Flashcards
Name the parts of the heart
Ejection fraction?
The percentage of blood flowing out of the left ventricle with each contraction as compared to total left ventricular blood volume. A normal ejection fraction is around 60%, so with each squeeze of the left ventricle, 60% of the blood is pumped into the aorta and 40% remains in the left ventricle.
Cardiac output?
If a heart ejects 70 ml of blood per stroke and the HR is 70, what is the cardiac output?
CO = SV x HR
Cardiac output is the amount of blood pumped each minute. In this case it is 4900 ml/min (4.9L/min).
What is the typical volume of blood in a non-pregnant person?
4.5-5.5L. The healthy heart pumps the entire blood volume each minute!
What is the underlying cause of cardiovascular disease? How does this pathology lead to myocardial infarction?
Atherosclerosis! A cholesterol plaque builds in the wall of the arterioles. When this plaque ruptures through the lining of the artery and becomes exposed to the blood, it causes a chain of events that makes a blood clot on the ruptured plaque and an arteriolar spasm. This decreases the blood flow downstream, depriving whatever is downstream of oxygen. If the event happens in a cardiac artery (usually the LAD) and is severe, then heart tissue can become hypoxic and die.
Smoking makes this much worse. Diabetes makes the arterioles unhealthy so atherosclerotic rupture can happen easier.
Remember, this is arterial disease.
What is hyperventilation? Is it the same as fast respiratory rate?
Ventilation is the exchange of air in the lungs to specifically eliminate CO2 (and exchange for O2). Remember that “ventilation” is about CO2.
Hyperventilation is the elimination of more CO2 from the blood than is produced by the body or, in other words, lowering the pCO2. The hormone progesterone, which is the predominant hormone in pregnancy, causes a maternal drive to lower pCO2 because she is eliminating CO2 for two!
One way to increase ventilation is to increase respiratory rate, but there are other ways also – like increasing the volume of air or volume of blood participating in exchange.
What does hyperventilation do to the blood pH?
What is it called?
Increases the pH
Respiratory alkalosis
(think of CO2 like an acid. Low CO2 from hyperventilation causes alkalosis.)
What is the compensatory mechanism to alkalosis employed by the kidneys?
Metabolic acidosis
(by eliminating HCO3-)
Name parts?
How does GFR relate to serum creatinine?
Glomerular filtration rate is inversely proportional to serum creatinine. Lower serum creatinine reflects good kidney function.
What does aldosterone do?
Aldosterone leads to reabsorption of sodium in the renal tubules. Because water follows sodium, this causes a net retention of fluid.
Too much total body H2O?
Hyponatremia
(low serum sodium)
Too little total body H2O
Hypernatremia
(high serum sodium)
Too much total body sodium (or salt)
Edema
Too little total body sodium (or salt)
Volume depletion
(hypotension, elevated HR)
White blood cells including the 2 most abundant types?
Neutrophils (defend against bacteria) and Lymphocytes (defend against viruses). There are also Eosinophils, Basophils, and Monocytes.
What is the risk of being in a “hypercoagulable state”? What bad things can happen? What are ways to decrease this risk nonpharmacologically and pharmacologically?
Hypercoagulable states put people at risk for DVT (Deep Vein Thrombosis) and life-threatening PE (Pulmonary Embolism), or collectively called Venous Thromboembolism (VTE) events.
Hypercoagulable states are a problem in the veins, not the arteries. But note that some risk factors are common to both hypercoagulable states and arterial disease.
Some Risk Factors of Thromboembolism?
Previous thromboembolic event!
Surgery – especially ortho or pelvic
Prosthetic heart valves
Immobilization (such as casts)
Cancers
Tobacco use
Obesity
Pregnancy
Hormone medications
Prolonged travel, esp. by air
Trauma
Inherited prothrombotic conditions
Certain chronic diseases including CHF, liver disease, severe renal disease, collagen vascular diseases, blood disorders
Certain medications
Family history
Advancing age
Methods to decrease VTE risk
Decrease modifiable risk factors!
Increase mobility
Graduated compression stockings and mechanical compression devices
Pharmacological Anticoagulants (these are coupled specifically to the risk factor and not completely interchangeable)
Warfarin (Coumadin)
Heparin and LMW heparin
DOACs (Direct Oral Anticoagulants)
Note: Antiplatelet medications like aspirin and clopidogrel are used for people with increased arterial risk (such as stroke or cardiac ischemia). Occasionally people with VTE are on these meds also.
atrial fibrillation?
People with a-fib are not hypercoagulable in that they do not have an increased risk for VTE. But the clot in their left atrium can embolize to their brain and cause a severe stroke or death. Even though this disease is on the arterial side of the body, all the studies show that treating it like a venous problem is more effective (that is, using anticoagulants). However, because many people with a-fib also have cardiac arterial disease, many of them are also on antiplatelet medications.
4 M’s of Geriatrics
Geriatric Syndromes
Conditions from impairments from multiple organ systems
Delirium
Dementia
Falls
Incontinence
Polypharmacy
Frailty
Multimorbidity
Mini-Cog?
List and repeat 3 unrelated items e.g. Banana – Sunrise - Chair
Draw a clock with the hands to show 10 past 11
Recall the three items
