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Clin Med Cardio Exam 1 > Cardiophysiology > Flashcards

Cardiophysiology Flashcards

1
Q

When is cardiac pressure the highest in the ventricles?

A

When blood is being ejected into the aorta (ventricular contraction)

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2
Q

What happens at the beginning and the end of a pressure loop in the ventricles?

A

Blood fills left atrium and mitral valve closes (passive ventricular filling)

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3
Q

When does isovolumetric contraction happen? What is another name for it?

A

The time in between the mitral valve closing and the aortic valve opening

AKA systole

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4
Q

When does isovolumetric relaxation happen? What is another name for it?

A

Between when the aortic valve closes and the mitral valve opens

AKA diastole

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5
Q

What happens with pressure in relation to volume of blood flow through the ventricles in the heart?

A

As pressure rises, volume decreases

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6
Q

What is the dicrotic notch?

A

When the aortic pressure is greater than the ventricular pressure

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7
Q

In normal heart sounds, the “lub” is also called ? What does it represent?

A

S1 - represents the closing of the atrioventricular valves (i.e. tricuspid and mitral valve closing while pulmonic and aortic valve open)

ONSET OF VENTRICULAR CONTRACTION

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8
Q

In normal heart sounds, the “dub” is also called? What does it represent?

A

S2 - represents the closing of the semilunar valves (i.e. pulmonic and aortic valve snap shut while mitral and tricuspid open)

ONSET OF VENTRICULAR RELAXATION

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9
Q

What would you call an atrial gallop?

A

S4

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10
Q

What would you call a ventricular gallop?

A

S3

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11
Q

Due to a forceful atrial contraction in a stiff or hypertrophic ventricle

A

S4

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12
Q

Can be associated with heart failure

A

S3 (ventricular gallop)

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13
Q

How is coronary blood flow influenced if an individual has aortic regurgitation?

A

It is decreased

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14
Q

How do you determine cardiac output?

A

Heart rate X stroke volume

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15
Q

What is the max exertion of cardiac output?

A

20-25L/min

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16
Q

How do you get a 4-5 fold increase in cardiac output?

A

Exercise

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17
Q

How do you determine the appropriate maximum heart rate for a patient?

A

220-age

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18
Q

How do you determine the maximum stroke volume if you are only given the age of an athlete?

A

Take the maximum cardiac output exertion (2500mL/min) and divide it by the maximum heart rate for that patient

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19
Q

What are the physiological variables responsible for increasing cardiac output?

A

Increased heart rate and stroke volume

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20
Q

What causes an increase in heart rate?

A 
Decreased parasympathetic/increased sympathetic tone
Bainbridge reflex (atrial reflex)
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21
Q

What causes an increase in stroke volume?

A

Increased sympathetic tone
Increased pre-load (VR) leads to an increase in contractility
Decreased arterial resistance (after load)

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22
Q

What is after load?

A

Amount of pressure the heart has to overcome to get blood back to the rest of the body or to the lungs (resistance faced when letting go of slingshot)

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23
Q

How is venous return increased? (Bainbridge reflex)

A

Skeletal muscle pump
Respiratory and abdominal pump
Venoconstriction from sympathetic tone

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24
Q

The frank starling mechanism and bainbridge reflex mechanism are all what type of stroke volume control?

A

Intrinsic

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25
Q

An increase in heart rate due to an increase in central venous pressure from increased venous return

A

Bainbridge reflex

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26
Q

What is stroke volume?

A

Volume of blood ejected from the heart/heartbeat

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27
Q

Increased venous return causes ???

A

Increased heart rate (bainbridge reflex)

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28
Q

Increased end-diastolic volume causes ???

A

Increased contractility (frank-starling mechanism)

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29
Q

What is extrinsic control of stroke volume

A

Increased sympathetic activity (and epinephrine) cases an increase in venous return and increased strength of cardiac contraction, leads to an increase in stroke volume or vice versa

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30
Q

Does sympathetic stimulation affect the frank-starling curve?

A

Yes. A frank-starling curve on sympathetic stimulation will have an increased stroke volume when compared to a normal frank-starling curve at the same end-diastolic volume

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31
Q

The percent of blood that is being ejected from the ventricle per beat

A

Ejection fraction

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32
Q

How do you determine ejection fraction?

A

Need to measure EDV and ESV

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33
Q

How do you assess ejection fraction?

A

Nuclear imaging, MRI, Echo, CT, Cardiac catheterization

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34
Q

What is the equation for ejection fraction?

A

EF = (EDV-ESV/EDV) x 100

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35
Q

How do you measure the extent of a patient’s MI?

A

Ejection fraction

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36
Q

What is a normal ejection fraction?

A

55-70%

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37
Q

What is an ejection fraction that is below normal?

A

40-55%

38
Q

What ejection fraction may confirm a diagnosis of heart failure?

A

Less than 40%

39
Q

Fight or flight uses what system

A

Sympathetic - increases rate and force of contraction!

40
Q

Rest and digest uses what system

A

Parasympathetic - decreases rate and force of contraction

41
Q

What is essential for coronary blood flow?

A

Has to meet oxygen demand

Oxygen supply = oxygen demand

42
Q

Oxygen extraction is near _____ at rest

A

Maximal

43
Q

What happens when the body needs more oxygen for metabolic activity?

A

Available O2 decreases, adenosine increases, and Co2 increases

44
Q

What happens when available O2 decreases, adenosine increases, and Co2 increases

A

Vasodilation of coronary vessels due to endothelial derived releasing factor

Increased vasodilation due to increased nitrous oxide (shear stress) and decreased O2

45
Q

What happens when the coronary vessels vasodilate

A

Increased blood flow to cardiac muscle cels, increased oxygen available to meet oxygen needs!

46
Q

Atherosclerosis ____ blood flow

A

Compromises

47
Q

Large MI’s can lead to ??

A

Chronic heart failure

48
Q

What causes problems during heart failure?

A

Depressed contractility that leads to decreased end diastolic volume and stroke volume

49
Q

How does the body compensate for a decreased cardiac output in a patient with heart failure?

A

Increased sympathetic activity: Increased venous return (increased end diastolic volume) and increased strength of cardiac contraction increases stroke volume and CO!

50
Q

What happens if one’s resting CO cannot be attained?

A

Fluid imbalance because you cannot reach the critical cardiac output level for normal fluid balance

51
Q

What are some common medications to treat CHF?

A 
Diuretics
ACE/ARBs
Vasodilators
Beta Blockers
Cardiac Glycosides
52
Q

Stage 1 heart failure

A

Mild weakness doesn’t affect daily tasks

53
Q

Stage 2 heart failure

A

More than usual tiredness after performing daily exercise

54
Q

Stage 3 heart failure

A

Excessive fatigue after performing daily tasks

55
Q

Stage 4 heart failure

A

Any physical activity causes discomfort

56
Q

What is normal right atrial pressure?

A

2-6mmHg

57
Q

What continues to drive blood toward arterioles during diastole?

A

Elastic recoil

58
Q

How do you determine pulse pressure?

A

SBP - DBP

59
Q

How do you determine mean arterial pressure?

A

Diastolic pressure + 1/3 pulse pressure

OR Diastolic pressure + 1/3 (SBP-DBP)

60
Q

Parabolic, highest velocity in center (least resistance); lowest adjacent to vessel walls

Will be quiet when listening with a stethoscope

A

Laminar blood flow

61
Q

Disoriented and non-parabolic; energy is wasted, thus more pressure required to drive blood flow

Will be detectable and NOISY with a stethoscope

A

Turbulent blood flow

62
Q

Sounds associated with measuring blood pressure

A

Korotokoff sounds

63
Q

Korotkoff sound that is a loud or sharp tapping

A

Phase 1

64
Q

Korotkoff sound that sounds like a “swooshing tap”

A

Phase 2

65
Q

Korotkoff sound that sounds like loud knocking or crisp tapping

A

Phase 3

66
Q

Korotkoff sound that sounds muffled or like a dull thudding

A

Phase 4

67
Q

Korotkoff sound that is silent as cuff drops below diastolic pressure

A

Phase 5

68
Q

What influences arterial pulse pressure?

A

elasticity
rigidity
resistance

69
Q

What is an abnormal sound or a murmer? What causes it?

A

A bruit

Caused by some kind of an obstruction like an atherosclerotic plaque that causes reduced blood flow

70
Q

If you have increased resistance, you are going to have ____ pulse pressures

A

Decreased

71
Q

Increased contraction of the circular smooth muscle in the arteriolar wall, which leads to increased resistance and decreased flow through the vessel

A

Vasoconstriction

72
Q

Decreased contraction of circular smooth muscle in the arteriolar wall, which leads to decreased resistance and increased flow through the vessels

A

Vasodilation

73
Q

Sympathetic tone usually causes ____? (vasoconstriction/vasodilation)

A

Vasoconstriction

74
Q

Parasympathetic tone usually causes ___? (Vasoconstriction/vasodilation)

A

Vasodilation

75
Q

Caused by increased myogenic activity, increased O2, decreased CO2, increased sympathetic stimulation

Vasopressin, angiotensin II, COLD

A

Vasoconstriction

76
Q

Caused by decreased myogenic activity, decreased O2, increased CO2, and decreased sympathetic stimulation

Histamine release, HEAT

A

Vasodilation

77
Q

It is important that blood flow matches ?

A

Metabolic need of tissue

78
Q

What causes vasodilation within local control?

A

Sympathetic cholinergic reflex

79
Q

Lack of nitric oxide release is reflective of ____?

A

Endothelial dysfunction (inhibited flow mediated dilation)

80
Q

What could cause a resistance of blood flow?

A

Viscosity, length of the blood vessel, diameter of the blood vessel (4th power)

81
Q

Veins have high _____

A

Capacitance (compliance)

82
Q

What increases venous return?

A

Sympathetic venoconstriction
Skeletal muscle pump
Respiratory pump
Increased blood volume

83
Q

What decreases venous return?

A

Hydrostatic pressure due to gravity
Incompetent venous valves
Decreased pressure gradient

84
Q

Venous return affects cardiac ____

A

Preload

85
Q

Why is the velocity of blood flow through capillaries slow?

A

TO allow exchange due to a large cross-sectional area

86
Q

The total blood flow throughout your body is ____

A

Constant

87
Q

The velocity of your blood depends on the ??

A

Cross-sectional area

Faster in river (aorta) than lake (capillaries)!

88
Q

How do you increase its metabolic activity?

A

Decrease O2, increase CO2 and other metabolites

This will increase blood flow

89
Q

What forces favor filtration

A

Capillary hydrostatic pressure

Interstitial/tissue oncotic pressure

90
Q

What forces favor reabsorption?

A

Plasma oncotic pressure

Interstitial/tissue hydrostatic pressure

Clin Med Cardio Exam 1 (3 decks)

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