Exam 1 Flashcards
(180 cards)
1
Q
Renal clearance
A
Plasma thats cleared of a substance
volume/time
plasma/ minute
2
Q
Free water clearance
A
How much distilled / pure water is removed from the blood
low osmo-> inc free water clearance -> inc osmo
high osmo ->dec free water clearnace -> dec osmo (water conservation)
3
Q
Free water clearance is governed by?
A
ADH
osmo R next to hypothalmus supraoptic nuclei and the paraventricular nuclei -> adh to posterior pit (neurohypophysis)-> adh release-> V2 R in the late distal collecting duct-> water reabsorption
4
Q
Delta P for systemic circulation
A
100
100-0=100
5
Q
Normal Pulse pressure
A
40mmhg
120-80=40
6
Q
Pulse presure
A
how stiff our arteries are
flexible= low pp
stiff= high pp
7
Q
Why is the aorta strechy?
A
Keeps load down on LV
Acts as a pressure reservoir
Secondary pump (use bounce to push blood forward)
8
Q
compliance
A
how stretchy something is
Delta V/Delta P
low compliance = rigid (low volume/ high pressure)
high compliance = stretchy (high volume/ low pressure)
9
Q
Elastance
A
inverse of compliance
how rigid something is
high compliance = low elastance
low compliance = high elastance
10
Q
Why are veins more compliant
A
higher volume/ lower pressure
thinner wall, less rigid, expandable
11
Q
MPAP
A
mean pulmonary arterial pressure; 16mmhg
Delta P of pulmonary system
12
Q
LAP
A
left atrial pressure; 2mmhg
2-5mmhg
13
Q
PAP
A
pulmonary artery pressure; 25/8
14
Q
why does pulm system have less resistance?
A
closer to the heart/ less distance
pulm bv are compliant not stiff and muscular
not alot of circuits to travel through
15
Q
LVP
A
left ventricle pressure ; 2-120 mmhg
high variability
high pressure because we have ejection to the aorta
16
Q
RAP
A
right atrial pressure; 0-4mmhg
17
Q
RVP
A
right ventricle pressure; 0-25mmhg
also high variability
18
Q
what bv has the highest cross sectional area
A
capillaries; 4500 cm2
19
Q
velocity equation
A
v= f/a
flow/ area
20
Q
byproducts of metabolism
A
H+
co2
A (adenosine)
all these tell the arteriole to relax and inc bf through the tissue
21
Q
Two ways of flow in the cap
A
1) Mechanical high pressure pumping systems (heart) uses a lot of energy to pump blood around cv system,
2) diffusion
22
Q
Pif
A
interstitial fluid Pressure= -3
Favors filtration
+ number w/ edema
23
Q
Aorta cross sectional area
A
2.5 cm2
24
Q
Venae Cavae cros sectional area
A
8 cm2
25
Pc
capillary pressure
arterial end; 30
venous end; 10
delta P; 20
average cap pressure; 17
26
Plasma colloid osmotic pressure
28mmhg
favors reabsorption
Albumin (liver)
Globulins(IS)
Fibrinogen (coag)
Donnan effect; 9
27
ISF colloid osmotic pressure
8 / low number
favors filtration
filaments, collagen, HA
28
Normal lymphatic flow
2L/day
120 ml/hr
can increase by 20 fold
29
ways lymphatic fluid gets to subclavian vein
muscle contraction
one way valves
30
Gravity effect on BP
13.6mm/1.36cm below heart = +1mmhg
31
Natural reference point in heart
isogravimetric point
phlebostatic axis
tricuspid valve
32
Added pressure in upper arm?
+6mmhg
being supine will negate effect of gravity
33
Why do we have negative bp in the sinuses
above the heart
no one way valves
hard walls (wont collapse)
34
Conductance
How much flow we have of something
blood or air
35
Pouseilles law
Flow
if we have a small increase in diameter/ radius= large increase in blood or air flow
36
Distensibility
how expandable something is
Delta V/ (delta P x Starting volume)
large starting volume = small distensibilty
small starting volume = large distensibilty
37
Veins are _____ as distensible as arteries
8 times
38
Flow always occurs_____
down a pressure gradient.
higher the delta P the faster the flow!
39
normal pressure gradient of capillary
Delta P of 20mmhg
30-10
40
Reynolds number
predicts turbulent flow
over 20000 = going to be turbulent blood flow.
If we have large diameter and high velocity = opportunity for turbulent flow - common in the aorta
41
Leaky aortic valve leads to_____
lower diastolic pressure
42
Sympathetic connections originate___
in the sympathetic chain next to the ganglion parallel to the spinal cord (deep spinal anesthesia can loose sympathetic chain)
43
baro receptors in carotid to medulla pathway
baroreceptors in the carotid sinus -> Herrings nerve -> Glossopharyngeal nerve (CN9)-> Nucleus of tractus Solitarius
44
baroreceptors in aorta to medulla pathway
aorta-> vagus nerve (CN10)-> NTS
function 20-30 mmhg higher
45
BP lower than 40, what assumes the role of Bp control?
Blood gas sensors; oxygen and co2 sensors that help us kick in to increase co and bp.
46
What begins phase 1?
Mitral valve opening
pressure in the atria > pressure in the vent
47
What phase is filling?
phase 1
48
ESV
end systolic volume; 50 ml
49
EDV
end diastolic volume; 120ml
50
stroke volume
70ml
51
what ends phase 1?
mitral valve closes
pressure in the atria < pressure in the vent
52
what happens during phase 2
all valves are closed, isovolumetric contraction
pressure in the vent is less than the aorta, but pressure in the vent is increasing
53
What ends phase 2/ begins phase 3
aortic valve opens
pressure in the vent has > than pressure in the aorta
54
Afterload
beginning of phase 3- pressure in the aorta that the vent has to overcome to open valve/ pump blood
55
Phase 3
ejection through all of phase 3.
pressure decreases because blood moves out of the aorta and the vent is not longer contracting
56
what ends phase 3/begins phase 4
aortic valve closes @100mmhg
pressure in the aorta > the pressure in the vent
57
phase 4
isovolumetric relaxation
58
Preload determines_____
how full the heart gets
its a filling pressure; 2-5
preload is a pressure not a volume!
59
normal afterload pressure
80mmhg
60
EW
external work
energy used to do something
heart uses Pressure and volume. increase either of those = increased EW.
61
What phase does atrial systole begin
Phase 1
the last 3rd of filling.
62
Without atrial contraction EDV would be?
110 ml
atrial contraction = 10 ml
63
For a sick heart, atrial contraction contributes to what percentage of SV?
20-25%
If we are healthy and not under stress/ not doing anything difficult, atrial contribution is 5-10%
64
Increased HR causes a decrease in what phase?
Decreased phase 1/ filling time.
65
When is rapid ejection?
first 3rd of phase 3 where we move 70% of the SV
66
When is the end of systole?
Start of phase 4
67
When is the beginning of systole?
Beginning of phase 2
68
When does diastole start?
Beginning of phase 4- majority is spend in filling except for the first part there isn't filling because the mv hasn't opened yet.
69
When is rapid filling
first 3rd of phase 1. - this is where the majority of filling happens.
50ml-> 100ml.
71.4% of SV
41.6% of EDV
70
A wave on CVP
happens at the later portion of filling due to atrial contraction - happens during the 3rd 3rd of filling.
Between the atria and the central veins = no valve, if atria contract it will push blood both ways= inc CVP
71
C wave on CVP
contraction of the vent (phase 2)- when p increases in the vent the av valve is closed but bows backward during ejection
72
What are the muscles that secure the av valves
chordae tendineae papillary muscles anchor the mitral valve into the vent
73
V wave for cvp
is due to volume building up in the atria.
happens during phase 4 when the atria if filled and accumulating fluid.
74
name of tool to heart sounds
phonocardiogram
has mic and amplifier / hear low frequency sounds
75
why is the first heart sound the longest
Av valve less meaty and vibrates for longer period of time vs the aortic valves is more meaty and vibrates for shorter period of time.
76
PSF
7
mostly dependent on veins tone/ volume
Delta P of for the system/ average all the P in all the bv all at the same time/ we pause the system and the blood goes from the high to low pressure systems/ the entire pressure we have in the systemic circuit thats available for us to move from the system back to the heart
77
Transitional zone for venous return
0- -4
max vacuum effect the heart can do by itself
max vr = 6l/min with normal psf.
78
Max CO of the heart on its own.
13L/min
79
Max CO with max sympathetic tone in an untrained person
25-30 L/min
30-40L/min in athlete
80
Max CO with max parasympathetic stimulation
10-11L/min
outside influence that's preventing the heart from working normally= decreased pumping.
81
Resistance to venous return
How easily we can get blood to return to the heart
82
Venous return formula
Venous return = (Psf- RAP)/ RVR
83
Normal intrathoracic pressure
-4mmhg
-5cmh20
84
medication for arterial specific vasodilation
Sodium nitropuriside
NO donor
easier to get blood back to the heart
decr svr/ dec rvr = Inc CO
85
Medication for venous specific vasodilators
nitroglycerine
dec tone of veins = dec psf = dec vr/co
86
compliance change related to veins
increase venous tone = decreased compliance
decrease venous tone = increased compliance
87
Medication for art and venous constriction
phenylephrine
inc svr (arterial) = in bp
inc psf (venous) = inc vr = inc co = inc bp
88
Life time peak CI
age 10= 4.5
89
80 year old CI
entirely healthy = 2.4
normal CI = 3
90
CI units
ml/min/m2
91
CO formula
co = art pressure/ vascular resistance
92
Beriberi
vitamin B1 deficiency
chronically high CO/CI
used as co factor to make 36 atp from one glucose+oxygen
93
Increased preload
increased sv
increased edv
94
decreased preload
dec sv
dec edv
95
increased afterload
dec sv
inc ESV
dec time for ejection
AOV closing sooner
96
decreased afterload
inc sv
dec ESV
AOV open sooner
inc time for ejection
97
inc contractility
inc SV
Dec ESV
98
dec contractility
dec sv
inc esv
99
mitral regurg
blood back to atria when vent P > artia P
2,3, early 4= vent losing volume
late phase 4 = vent gaining volume (before its supposed to)
100
Mitral stenosis
similar to low preload because the inc P in the atria = dec LVP (more resistance to go over)
dec edv and sv
101
aortic regurg
blood from aorta to the vent when aortic p is greater than vent
2 and 4 (late) = vent gaining volume
increased PP
dec diastolic P
102
Aortic stenosis
inc afterload
dec sv
inc ESV
aortic P will be low = low PP
more common the older you are
compensation; Inc cvp and HR (late)
103
why does diastole decrease with aortic regurg
more blood to the LV rather than forward / perfuing
104
LUB
mitral close
105
DUB
aortic close
106
1st heart sound length
0.14 seconds, low pitch
107
2nd heart sound length
0.11
shorter vibration, higher pitch
108
3rd heart sound
Rapid filling of vent
middle of diastole (beginning of phase1)
normally not heard except in children but indicate systolic hf in older adults
109
reason the second heart sound has a higher pitch
Semilunar valves are more taute
elastic coefficient of the arterial walls is more than the vent chambers
110
4th heart sound
atria contraction
heard in sick heart that need atrial kick.
111
Portion of the heart nearest the surface of the chest
Apex of the LV
112
Rheumatic fever causes and effects
Group A hemolytic streptococci toxin release proteins -> antibodies produced-> react w/ bacteria and tissue -> scar tissue (cant close) and regurg
MV affected more and before Aortic valve
113
AO valve stenosis s/s
systolic murmur
exertion related angina
LV hypertrophy (diastolic HF)
114
AO valve regurg murmur
diastolic murmur- loudest at the beginning of diastole
115
loudest murmur
Aortic stenosis - systolic murmur
116
mitral regurg murmur
systolic murmur (difficult to heart on LA)
loudest/ most regurg at the beginning of systole
117
Mitral stenosis murmur
diastolic murmur (weak and low frequency).
louder when atria contract
118
Eccentric hypertrophy
enlargement of the vent chamber
119
Concentric hypertrophy
thickened vent walls and smaller vent chamber
120
Name of the nerve that drives the diaphragm
Phrenic nerve - motor nerves that control the diaphragm
121
Items located in the medial mediastinum
heart w/ 3 layers
ascending aorta
sup and inf VC
pulmonary trunk of PA
Pulm veins
Phrenic nerves
122
Items in the posterior mediastinum
Esophagus
lung artery and veins/ airways
123
R vagus nerve connects to the
SA node (PSNS)
110bpm without
124
L vagus nerve connects to
AV node (PSNS)
125
3 layers of the pericardium
Serous pericardium visceral layer
Serous pericardium Parietal layer
Fibrous Pericardium (most superficial)
126
Tendon that connects the heart to the diaphragm
Central tendon
127
Name of duct that blood flows through as a fetus
Ligamentum arteriosum = open
closed = ducts arteriosus
128
What valve normally has 2 cusps
Mitral valve/ bicuspid
129
How many ppl have a bicuspid aortic valve
1-2% (smaller opening)
99-98% have a tricuspid aortic valve.
130
Name of posterior aortic valve cusp
NCC
non coronary cusp
131
How many ppl have a PDA from the LCA
15% - L coronary dominant
85% off the RCA = R coronary dominant
132
The commissural cusp is on what valve and what cusp
Mitral valve
Posterior cusp
133
Where to listen to the aortic valve
Top of the sternum in the 2nd intercostal space on the pts R side
134
Where to hear the pulmonic valve
2nd intercostal space L sternum
135
Auscultate the tricuspid valve at
5th intercostal space on L sternal border.
136
Auscultate the mitral valve at
lateral to the tricuspid, 5th intercostal space.
137
HZ for human hearing
20 hz - 20 KHZ (20,000 hz)
138
How many ppl with CAD have Mitral regurg
10-20%
139
mild regurg
< 30ml / beat
140
medium/midgrade mitral regurg
30-60 ml / beat
141
Severe/ end stage mitral regurg
> 60 ml/ beat
142
what is codominance?
PDA comes from RCA but there is an anastamosis with the LCA and the RCA
143
Other name for epicardium
serous visceral pericardium layer
144
where does the superior thyroid artery branch from
External carotid artery
145
Where does the inferior thyroid artery branch from
Subclavian artery
146
Where do the recurrent laryngeal nerves sit
Between the thyroid gland and the Larynx (into the voice box).
147
what controls our abillity to speak
branch of the vagus nerve called the recurrent layngeal nerves
148
What kind of control system controls the thyroid?
Hypothalamic pituitary control system
149
what senses and decides on thyroid hormone release
Hypothalamus
150
What does the hypothalamus release for the Thyroid?
TRH
Thyrotropin releasing hormone
151
What does the pit gland release for the thyroid
TSH
Thyroid stimulating hormone
152
What is the Parent compound for Thyroid hormone
Tyrosine (amino acid)
153
Name of one iodide and a tyrosine
monoiodotyrosine
t1
154
two iodine molecule on a tyrosine
Diiodotyrosine
T2
155
T3 name
Triiodothyronine
156
name for T4
Thyroxine
157
What is used to put iodine in a form that it can connect with tyrosine
Peroxidase; using oxidative stress
158
Primary transport proteins for thyroid hormone
1) TBG; Thyroxine binding globulin
2) Thyroxine binding prealbumin
3) albumin
159
Intracellular enzyme that converts T4 to its active form
iodinase
T4-> T3. Strips iodine
160
Percent of T3 thats released from the thyroid gland
15%
161
Term for the production of glucose by turning fats to flucose
Gluconeogenesis
162
What is gylcolysis
Glycolysis is a series of reactions that extract energy from glucose by splitting it into two three-carbon molecules called pyruvates.
163
Graves disease
stimulation of TSH R via autoantibodies
bind and turn on the TSH = inc thyroid hormone release
164
how does thiocyanate work
competitive antagonist for iodine pump
165
how does proplythiouracil work
overwhelm oxidation step/ peroxidate = cant put iodine in form to combine with tyrosine
166
how does inc iodine dec thyroid hormone
overwhelms peroxidase
167
What is hashimotos thyroiditis
body produces antibodies that are reactive to the thyroid gland-> inflammation and destruction of thyroid gland
168
Creatinism
lack of thyroid hormone during early development. irreversible stunted development physically and cognitively
169
Where does thyroid hormone production take place
Thyroglobulin proteins inside the thyroid gland
the place that we have the tyrosines coming in and combining with iodines.
hold 60-70 T3/T4s
Dissolves for release
170
Gold standard of measuring CO
Swan ganz cath
171
V in Vo2 stands for
V = amount of gas absorbed
172
Arterial oxygen content
20ml of O2/ dl
173
Venous blood oxygen content
15 ml of O2 / dL
174
Normal oxygen absoprtion
250 ml of o2/ min
175
Coronary circulation oxygen extraction
extracts ¾ of coronary circulation
176
Normal BP change during inspiration
SBP should drop less than 10 mmhg during inspiration
177
Pulsus Paradoxus
If SBP drops more than 10 mmhg during inspiration = means the system isn't full enough.
Inspire and hypovolemic = sbp will drop by greater extent than normal = hard time ejecting more than what it normally does.
178
Strongest CV reflex in the body
CNS ischemic response
179
Splitting of S2
during inspiration
aortic valve first to close
180
SVR equation
80 x (MAP- CVP ) / CO
