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Physiology Exam 2 (Lauren) > Cardiac Cycle > Flashcards

Cardiac Cycle Flashcards

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1
Q

What happens when the intraventricular pressures exceed the pressures in the aorta and pulmonary artery?

A

The semilunar valves open and blood is RAPIDLY ejected

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2
Q

Which ventricle enters systole first?

A

LV

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3
Q

What can cause systolic murmurs?

A

Aortic (or pulmonaryvalve) stenosis -flow though a narrowed opening

Mitral (or tricuspid) regurgitation- closure of valve not complete, blood is forced into the atrium under pressure

(Note that regurgitant valves may be called “incompetent” valves)

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4
Q

Which kind of systolic murmur will cause a mid-systolic/ crescendo-decrescendo murmur?

A

Aortic or pulmonary valve stenosis

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5
Q

As ventricles continue to fill with blood and expand do they become more or less compliant?

A

Less complaint

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6
Q

How is systole determined?

A

From S1 to S2

Closure of mitral valve to closure of aortic valve

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7
Q

What is the cardiac index and how is calculated?

A

The cardiac output normalized for body surface area

CI= CO/SA

(Larger people are going to have a larger cardiac output, so we can do this to correct for body size)

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8
Q

What are diastolic murmurs associated with?

A

Ventricular relaxation and filling

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9
Q

What causes the a-wave?

A

A-wave is a VENOUS wave in the jugular pulse that is caused by atrial systole

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10
Q

If increased heart rate decreases the amount of time for ventricular filling, what will happen to stroke volume and therefore cardiac output?

A

Stroke volume will decrease and therefore cardiac output will decrease
(Note: this does not happen in real life due to the effects of the SNS protecting stroke volume)

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11
Q

During which phase is the maximal outflow velocity of blood?

A

Rapid ejection phase

Most of the stroke volume is ejected, and there is a dramatic decrease in ventricular volume

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12
Q

What effect does expiration have on the A2 P2 split?

A

Decreases it

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13
Q

What will happen to the contractility of the heart muscle if you increase the preload

A

It will increase (Frank-starling relationship/?)

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14
Q

What effect does inspiration have on the A2 P2 split?

A

Increases it

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15
Q

What valves are open and closed during the reduced ejection phase?

A

SL valves open

AV valves closed

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16
Q

What sorts of things can widen the S2 split/physiological split/A2-P2 split?

A

Anything that delays RV emptying:

Pulmonic stenosis (narrowing of pulmonary valve)

RV failure (increases preload)

Right bundle branch block (delays depolarization)

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17
Q

Systole or diastole:

Period of relaxation fo the heart

Filling of the chambers

Perfusion of the coronary arteries

A

Diastole

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18
Q

What is the stroke volume?

A

EDV-ESV

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19
Q

What valves are open and closed duting reduced ventricular filling?

A

AV valves open

SL valves closed

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20
Q

What is End-diastolic volume?

A

When the ventricular blood volumes are at their maximum

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21
Q

During which part of the heart cycle are the coronary arteries perfused?

A

Diastole

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22
Q

When do diastolic murmurs occur?

A

After S2

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23
Q

Is it normal to hear a sound when the AV valves are open and the ventricles are filling?

A

No

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24
Q

What is meant by isovolumic ventricular contraction?

A

The ventricles have started to contract, but the aortic and pulmonary valves are still closed, so no blood has been ejected yet

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25
When would be times you would hear an S3? (Tensing of chordea tendineae and AV valve ring)
- normal to hear it in children - associated with rapid ventricular filling - caused by ventricular dilation
26
What would a decreased ejection fraction indicate?
Decreased contractility (heart failure)
27
What causes S4?
Vibration of the ventricular wall during atrial systole Noted only when ventricular compliance is reduced as in LV hypertrophy
28
What causes S1 and when does it happen?
Closure of AV valves during isovolumeteric contraction’
29
What kinds of conditions can cause diastolic murmurs?
Aortic valve regurgitation Pulmonary valve regurgitation Mitral or tricuspid valve stenosis
30
what causes S1?
Mitral and Tricuspid valves closing
31
When does the ventricular volume begin to approach the minimum
Reduced ejection phase
32
Is stroke volume constant?
No, it decreases with exercise, although the SNS does have an effect on trying to keep it up
33
What does isovolumic mean?
Same volume
34
Increases in heart rate (increase/decrease) the time available for the reduced ventricular filling phase
Decrease
35
What is the longest phase of the cardiac cycle?
Reduced ventricular filling
36
WHat must be true for something in the heart to be isovolumic?
All valves must be closed
37
What type of systolic murmur will cause a holosystolic/pansystolic murmur
AV valve regurgitation
38
What does the p-wave represent?
The initiation of contraction of the atria
39
Systole or diastole: Generation of pressure by the heart Contraction of a chamber Ejection of blood from a chamber
Systole
40
What side of the heart is associated with venous waves?
Right side
41
During isovolumic contraction of the ventricles, what is happening in the atria?
They are filling with blood from venous return, AND the AV valves are bulging into the atria (increasing atrial pressures too)
42
What causes S2 and when does it happen?
Closure of SL valves during isvolumetric relaxation | Remember that S2 has two components: A2 and P2 and that inspiration causes splitting of the 2 sounds
43
What is another name for the A2 P2 split?
Physiological split
44
Why does exhalation decrease the A2 P2 split?
Exhalation increases intrathroacic pressure Decreases venous return to theRV Decreases preload and stroke volume decreases RV ejection time Pulmonary valve closes sooner =decreased physiological split
45
Why does inspiration increase the A2 P2 split (delays closure of the pulmonary valve)?
Inspiration decreased intrathoracic pressure Increases venous return to the RV increases preload and stroke volume of RV Prolongs RV ejection time Delays closure of the pulmonary valve =increases the physiologiocal split
46
Does atrial contraction account for a large volume of blood being squeezed into the ventricles?
No only about 10-25%. Most of the filling is passive. | With high heart rates, atrial systole may account for up to 40% of filling though
47
What kind of pathology than cause the S2 split to narrow?
Left bundle branch block (A2 comes later and P2 stays the same)
48
What can cause a paradoxical S2 split (P2 is heard before A2)?
Severe aortic stenosis | Pressure in LV stays high for a much longer period of time which delays closure of the aortic valve
49
What drives the ejection of blood during rapid ejection vs during reduced ejection?
Rapid ejection: pressure differentials Reduced ejection: inertial energy of blood
50
Which ventricle gneerates higher peak systolic pressure?
Left ventricle, BY FAR
51
What is the only organ system that receives 100% of the cardiac output?
Lungs
52
What initiates isovolumic ventricular contraction?
QRS complex- the depolarization leads to a rapid increase in pressure in the ventricles (This increase in pressure causes the AV valves to close giving you S1)
53
What is happening the the blood when you see the T-wave
Reduced ejection phase (ventricles are starting to repolarize but blood is still flowing out due to inertia)
54
How are murmurs different than heart sounds?
Heart sounds represent closures of the valves during cardiac cycles
55
Which AV valve closes first?
Mitral closes first (due to systole starting in LV first)
56
What is the end systolic volume?
The lowest volume of blood in the ventricles at the very end of systole
57
What valves are open and closed during rapid ejection phase?
SL valves open, AV valves closed
58
Which closes first: Aortic valve or pulmonary valve?
Aortic | Remember A2 P2 split?
59
What is S3?
The sound of the chordae tendineae tensing as well as the AV ring while the ventricles are filling
60
During which phase is the systolic pressure highest in the aorta and pulmonary artery?
Rapid ejection
61
What causes S3and when is it heard?
Caused by tension of chordae tendineae and AV valve ring during rapid ventricular filling. Normal in children, not normal in adults
62
What period of the heart cycle is diminished the most during exercise?
Passive Ventricular filling. | So it is helpful that the atrial systole accounts for more of the filling during these times
63
In what population is it normal to hear an S3
Children
64
What valves are open and closed during rapid ventricular filling?
AV valves open | SL valves closed
65
What does end-diastolic volume correspond to?
It is the exact same as the ventriucular preload
66
What is the v-wave?
“Fake” wave in venous pressure not caused by any contraction of the heart It’s caused by the tricuspid valve opening and causing a sudden drop in the pressure of the veins (remember up until the time the valve opened, the RA was filling up and building pressure)
67
WEhat is the ejection fraction and how is it calculated?
If it the effectiveness of the ventricles in ejection. It is what percentage of the EDV actually got ejected. (An indicator of Contractility**) EF= SV/EDV x100% (Normally 50-75%)
68
What causes the SL valves to close during isovolumic relaxation?
The ventricular pressure falling below vessel pressure
69
What is stroke volume and how is it calculated?
Volume of blood ejected on one ventricular contraction SV=EDV-ESV Difference between the volume of blood in the ventricle at the end of atrial systole (EDV) and the amount following reduced ejection (ESV)
70
What causes S2?
Aortic and pulmonary valves closing
71
When does atrial filling begin?
During rapid ejection phase | This blood will be ejected in the next cycle
72
Which valves are open and closed during isovolumic relaxation?
All valves are closed
73
What is the c-wave?
It is a wave noted in the jugular pulse caused by the bulging of the tricuspid valve back into the right atrium during isovolumic ventricular contraction
74
WHen is ventricular volume at its lowest
Isovolumic relaxation
75
What causes S4 and when is it heard?
S4 is caused by vibration of the ventricular walls (?i think...) during atrial systole Caused when ventricular compliance is decreased as in ventricular hypertrophy
76
What causes the pulmonary aortic pressures to fall during reduced ejection phase?
The blood “running off” into the arterial trees
77
When do systolic murmurs happen?
Occur during ventricular systole after S1
78
As the ventricles fill, the intraventricular pressure increases, reducing the pressure gradient across the AV valves. What will happen to the rate of filling as this pressure gradient falls?
Rate of filling will decrease
79
What causes the S2 split?
The aortic valve and pulmonary valve closing separately (A2 and P2). (A2 normally occurs first)
80
What are murmurs?
Abnormal movement of blood across valves and between cardiac chambers causing turbulence which produces vibrations that we can hear
81
What is cardiac output and how is it calculateD?
Total volume of blood ejected per unit of time CO= HR x SV (mL/min or L/min)
82
What is the dicrotic notch?
When the aortic valve closes, there’s a bit of a rebound of the aortic wall that causes a dip in the pressure of the aorta. That dip in pressure is called the dicrotic notch

Physiology Exam 2 (Lauren) (5 decks)

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