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Apex Review > Cardiovascular anatomy & physiology 3 > Flashcards

Cardiovascular anatomy & physiology 3 Flashcards

1
Q

Which variables are related by the Frank-Starling mechanism?
a. left ventricular end-diastolic pressure and systemic vascular resistance
b. contractility and cardiac output
c. pulmonary artery occlusion pressure and stroke volume
d. central venous pressure and mean arterial pressure

A

c. pulmonary artery occlusion pressure and stroke volume

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2
Q

The _____________ is the functional unit of the contractile tissue in the heart.

A

Sarcomere

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3
Q

The Frank-Starling law says that the heart

A

will eject a large stroke volume if it’s filled to a higher volume at the end of diastole

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4
Q

Clinical indices of ventricular preload include

A

CVP
PAD
PAOP
LAP
LVEDP
LVEDV
RVEDV

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5
Q

Clinical indices of ventricular output include

A

CO
SV
LV stroke work
RV stroke work

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6
Q

______________- contributes 20-30% of the cardiac output

A

Atrial contraction (atrial kick)

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7
Q

A non-compliant ventricle is stiff, so it is more dependent on a well-timed

A

atrial kick to fill the ventricle and generate a sufficient stroke volume

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8
Q

Conditions associated with reduced myocardial compliance include

A

myocardial hypertrophy
fibrosis
aging
heart failure with preserved ejection fraction (diastolic failure)

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9
Q

Patients with reduced myocardial compliance are more likely to experience _____________- in the setting of atrial fibrillation and junctional rhythm.

A

hypotension

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10
Q

The amount of tension that each sarcomere can generate is directly related to

A

the number of cross-bridges that can be formed before contraction

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11
Q

Preload is the

A

ventricular wall tension at the end of diastole (just before contraction)

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12
Q

What factors influence preload?

A

blood volume
atrial kick
venous tone
intrapericardial pressure
intrathoracic pressure
body position
valvular regurgitation

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13
Q

Atrial kick is lost in the patient with

A

atrial fibrillation

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14
Q

LVEDP, LAP, and PAOP are all surrogate measures of:

A

LVEDV

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15
Q

Which conditions impair inotropy? (select 3)
a. hyperkalemia
b. hypovolemia
c. hypoxia
d. hypercalcemia
e. hypocapnia
f. hypercapnia

A

a. hyperkalemia
c. hypoxia
f. hypercapnia

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16
Q

_______________ is the ability of the myocardial sarcomeres to perform work (shorten and produce force)

A

Contractility (inotropy)

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17
Q

Inotropy is independent of

A

preload and afterload

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18
Q

Things that increase contractility include

A

SNS stimulation
catecholamines
digitalis
PDE inhibitors

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19
Q

Things that decrease contractility (myocardial depression) include

A

myocardial ischemia
severe hypoxia
acidosis
hypercapnia
hyperkalemia
hypocalcemia
volatile anesthetics
propofol
beta blockers
and some calcium channel blockers

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20
Q

Hyperkalemia _________ contractility by locking the voltage-gated sodium channels in their ______________

A

impairs; closed-inactive state

21
Q

____________ affect Contractility particularly _____________

A

Chemicals; Calcium —> think of the three C’s

22
Q

How does beta-1 stimulation increase contractility?

A

activates the enzyme adenylate cyclase which converts ATP to cAMP
cAMP increases activation of protein kinase A (PKA)

23
Q

Activated PKA accomplishes the following three tasks:

A
  1. activation of more L-type Ca2+ channels (more Ca enters the cell)
  2. stimulation of the ryanodine-2 receptor to release more calcium
  3. stimulation of the SERCA2 pump to increase Ca2+ uptake with increased Ca2+ release
24
Q

A reduction of which factor would MOST likely augment stroke volume?
a. preload
b. contractility
c. afterload
d mean arterial blood pressure

A

c. afterload

25
Q

_________ is the force that the ventricle must overcome to eject its stroke volume.

A

Afterload

26
Q

The ________ needs to overcome a much higher afterload than the _____________

A

left ventricle; right ventricle

27
Q

Clinically, we use _______________ as a surrogate for afterload

A

systemic vascular resistance

28
Q

The majority of the afterload is set by the

A

systemic vascular resistance (arteriolar tone)

29
Q

__________, ____________, and __________________- can set the afterload proximal to the systemic circulation

A

aortic stenosis, hypertrophic cardiomyopathy, and coarctation of the aorta

30
Q

We can apply _______________ to help us understand how afterload affects myocardial wall stress

A

the law of Laplace

31
Q

Anything that increases wall stress also increases

A

myocardial oxygen consumption

32
Q

The following reduce afterload:

A

arterial vasodilators (e.g. propofol, clevidipine)
sympathectomy (e.g. regional anesthesia)

33
Q

Wall stress is equal to

A

wall stress= (intraventricular pressure x radius)/ ventricular thickness

34
Q

Wall stress is reduced by

A

decreased intraventricular pressure
decreased radius
increased wall thickness

35
Q

Which phases of the cardiac cycle are associated with an open mitral valve and closed aortic valve? (select 3)
a. isovolumetric contraction
b. rapid ventricular filling
c. ventricular ejection
d. atrial systole
e. diastasis
f. isovolumetric relaxation

A

b. rapid ventricular filling
d. atrial systole
e. diastasis

36
Q

_____________- events always precede _____________ events

A

Electrical events; mechanical events

37
Q

The cardiac cycle is a sequence of

A

electrical and mechanical events that take place from the beginning of one heartbeat to the beginning of the next

38
Q

The cardiac cycle is divided into

A

systole (contraction) and diastole (relaxation)

39
Q

What events occur during systole?

A

isometric ventricular contraction
ventricular ejection

40
Q

What events occur during diastole?

A

isometric ventricular relaxation
rapid ventricular filling
reduced ventricular filling (diastasis)
atrial systole

41
Q

The pressure-volume (PV) loop shows the

A

pressure-volume relationship in the left ventricle during one cardiac cycle- one systole and one diastole

42
Q

The PV loop provides an assessment of

A

systolic and diastolic function as well as the integrity of the cardiac valves

43
Q

The PV loop DOES NOT measure

A

heart rate or linear time

44
Q

The most important elements of the PV loop include:

A

height
width
corners
area of the PV loop

45
Q

The height of the PV loop correlates with

A

ventricular pressure

46
Q

The width of the PV loop correlates with

A

ventricular volume

47
Q

The corners of the PV loop correlates with

A

where valves open and close

48
Q

The area of the PV loop correlates with

A

myocardial workload

49
Q

What are the 6 events of the pressure volume loop?

A

Starting in bottom left corner:
1- rapid filling
2- late filling
3. atrial kick (right corner)
4. isovolumetric contraction (right upstroke)
5. ejection (top of the curve)
6. isovolumetric relaxation

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