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Anesthesiology > Cardiac phys > Flashcards

Cardiac phys Flashcards

1
Q

When is the left ventricle perfused?

A

During diastole

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2
Q

When is the right ventricle perfused?

A

During systole and diastole

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3
Q

What percentage of oxygen does the heart extract?

A

60-70%

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4
Q

What are the endogenous regulators of coronary blood flow?

A

Adenosine
Nitric oxide
Adrenergic stimulation

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5
Q

When does CBF become exhaused?

A

when 90% of flow is blocked by stenosis of the coronary artery

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6
Q

What is resistance directly proportional to?

A

The viscosity of blood and length of the vessel

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7
Q

What is resistance inversely proportional to?

A

R4

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8
Q

Where is the site of greatest resistances?

A

arterioles

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9
Q

Where is the largest pressure drop in the systemic circulation?

A

In the arterioles because they are the area of high resistance

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10
Q

When is systolic BP measured?

A

After the heart contracts

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11
Q

When is diastolic BP measured?

A

when the heart is relaxed and blood is returning to the heart

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12
Q

What is pulse pressure?

A

The difference between systolic and diastolic pressure

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13
Q

What is atrial pressure measured with?

A

Swan ganz catheter. = PCWP

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14
Q

What is phase 1 of the cardiac cycle?

A

Atrial systole seen as the P wave and a wave

Contributes 25% of ventricular filling

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15
Q

What is phase 2 of the cardiac cycle?

A

Isovolumetric ventricular contraction:

begins after the onset of the QRS wave

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16
Q

When do the AV valves close?

A

When pressure in the ventricle exceeds that in the atria

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17
Q

What is phase 3 of the cardiac cycle?

A

Rapid ventricular ejection

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18
Q

When does the aortic valve open?

A

Phase 3 when ventricular pressure exceeds aortic

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19
Q

What is happening with the S1 heart sound?

A

The mitral and tricuspid valve close

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20
Q

What is happening with the S2 sounds?

A

The aortic and pulmonic valve close

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21
Q

What wave on the EKG marks the end of phase 3?

A

T wave

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22
Q

What is phase 4 of the cardiac cycle?

A

Reduced ventricular ejection: pressure in the ventricles and aorta decrease as blood flows into the arterioles

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23
Q

What is phase 5 of the cardiac cycle?

A

Isovolumetric ventricular relaxation: end of the T wave
Aortic and pulmonic valves close (S2)
Dicrotic notch is seen after closure of the aortic valve
Ventricular pressure decreases
ALL VALVES ARE CLOSED

24
Q

How is action potential created in cardiac muscle?

A

Due to the option of fast sodium channels and calcium channels

25
Q

When does the mitral valve open?

A

When ventricular pressure becomes less than atrial pressure

26
Q

What is phase 6 of the cardiac cycle?

A

Rapid ventricular filling (S3)

27
Q

What is phase 7 of the cardiac cycle?

A

Reduced ventricular filling:
dependent on HR
longest phase of the cardiac cycle

28
Q

What is a dromotropic effect?

A

Effects on AV conduction

29
Q

What is a ionotropic effect?

A

Effects on contractility

30
Q

What is a lusitropic effect?

A

effects on diastole

31
Q

What is the main NT of the SNS?

A

NE - is chronotropic, inotropic and lusitropic

32
Q

What is the main NT of the PNS?

A

Ach

33
Q

What governs the main resting tone of the heart?

A

PNS

34
Q

What do the baroreceptors in the aortic arch respond to?

A

An increase in BP, but not a decrease

35
Q

What happens in the carotid sinus when there is decreased BP?

A

Decreased stretch, decreased firing of CN IX so decrease PNS by vasomotor center in brain and increase SNS —> Inc. HR, contractility

36
Q

What happens when there is a decrease in renal perfusion?

A

JG cells of afferent arteriole release renin

37
Q

What does renin do?

A

Converts angiotensiogen to angiotensin

38
Q

What converts angiotensin 1 to angiotensin 2?

A

ACE

39
Q

What does angiotensin 2 do?

A

Increase thirst
Vasoconstriction (inc. MAP and TPR
Stimulates aldosterone synthesis and release in adrenal cortex

40
Q

What causes the release of ADH in volume depletion?

A

Atrial receptors sense the decreased volume and cause release of ADH from posterior pituitary

41
Q

What does ADH do?

A

vasoconstriction

water reabsorption in distal tubules and collecting ducts

42
Q

What does ANP do?

A

Causes arteriole dilation
Natriuresis
Inhibits renin secretion

43
Q

What is the carotid sinus reflex?

A

Massage carotid senses stretch –> increased firing of CN IX so sends signal to vasomotor center which decreases SNS and increases PNS tone to slow HR/contractility. Used for SVT

44
Q

What is the Bainbridge reflex?

A

Atrial stretch causes an increase in HR, leading to increased CO

45
Q

What is the abdominal reflex?

A

Decreased HR with stretch of abdominal viscera

46
Q

What is the Cushing reflex?

A

Increased ICP causes cerebral ischemia and an increase in MAP through SNS (due to peripheral constriction to try to preserve blood flow to the brain) with a decrease in HR

47
Q

What is the oculocardiac reflex?

A

A decrease in HR with IOP or stretching of ocular muscles

48
Q

Which inhalation anesthetic increases PVR?

A

Nitric oxide

49
Q

Which inhalation anesthetics have the greatest effect on HR?

A

Isoflurane/Des

50
Q

Which induction agent preserves CO and contractility?

A

etomidate and midazolam

51
Q

What induction agent causes an increase in HR, MAP and CO?

A

Ketamine

52
Q

What is the MOA of Ketamine?

A

Stimulates SNS

Inhibits uptake of NE

53
Q

What happens in cor pulmonale?

A

RV dilation

Decreases stroke volume due to ventricular interdependence (ballooning of right heart into the left heart)

54
Q

What is the equation for MAP?

A

MAP = SVR X CO/80 + CVP

55
Q

What is the equation for coronary perfusion pressure?

A

MAP- LVEDP

Anesthesiology (19 decks)

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