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A & P II > EXAM 1 CV > Flashcards

EXAM 1 CV Flashcards

1
Q

Aorta internal diameter

A

2.5 cm

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2
Q

Venae cavae internal diameter

A

3 cm

1.5 cm diameter each

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3
Q

Aorta total cross-sectional area

A

4.5 cm^2

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4
Q

Venae cavae total cross-sectional area

A

Combined is 18 cm^2 for inferior and superior

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5
Q

2 names for anatomical landmark behind tricuspid valve

A

Phlebostatic axis or isogravimetric point

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6
Q

Vascular compliance formula

A

(change in volume)/(change in pressure)

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7
Q

Vascular distendibility formula

A

(change in volume)/(change in pressure X original volume)

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8
Q

Normal arterial volume and pressure

A

700 mL and 100 mm Hg

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9
Q

Normal venous volume and pressure

A

3200 mL and 7 mm Hg

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10
Q

What is capacitance as it relates to CV?

A

The amount of volume a vessel can hold

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11
Q

Conductance is inversely proportional to?

A

Resistance

conductance = 1/resistance

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12
Q

Poisveille’s law explains what?

A

Flow is determined by several factors:

F = (pi X delta P X r^4)/(8 X viscosity X length)

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13
Q

A high hematocrit will do what to flow?

A

Will decrease flow due to increased viscosity

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14
Q

How does gravity affect BP?

A

for every 13.6 mm below the heart we will see 1 mm Hg increase of BP

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15
Q

Why is CVP of a CVC in fem artery higher in obese patient?

A

1st: catheter is further away from the isogravimetric point
2nd: adipose tissue compresses the catheter
3rd: hairpin turns catheter must make in groin

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16
Q

What is delta P from veins to left atrium?

A

10 mm Hg because pressure in venules is 10 and at inferior vena cavae its 0 so the difference is 10. But actually this is the Psf of around 7

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17
Q

Our patient has a blood volume of?

A

5L

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18
Q

Percent of systemic blood circulation as well as values within it?

A

84% total = 4.2 L
veins = 64% = 3.2L
arteries = 13% = 0.65L
arterioles/capillaries = 7% = 0.35L

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19
Q

How much blood does heart hold?

A

7% = 0.35L
LVEDV = 0.12L
RVEDV= 0.12L
Atria combined = 0.11L

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20
Q

How much blood in the pulmonary circulation?

A

9% = 0.45L

divided evenly among pulm arterial, capillary, and veins

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21
Q

Pulmonary circulation holds a little extra why?

A

In case we need to shunt to other areas of body, its a nice little resivoir

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22
Q

How is autonomic tone controlled?

A

Sympathetic ganglion

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23
Q

Why is the carotid artery set point lower than the baroreceptor set point of the aortic arch?

A

Because when we stand the carotid should see less BP and this set value is 100 mm Hg

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24
Q

What is the normal end-systolic volume?

A

50 mL

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25
Q

What is the normal end-diastolic volume?

A

120 mL

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26
Q

What is the difference between end-diastolic volume and end-systolic volume?

A

Stroke volume or how much leaves the ventricle

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27
Q

How to calculate ejection fraction

A

Stroke volume/LVEDV

basically how much leaves the heart vs how much the left ventricle was filled before it left

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28
Q

What is represented by the a, c, and v wave in a CVP waveform?

A

a: increase in pressure back towards systemic circulation due to atrial contraction
c: bulging backwards of mitral valve (a-v) from full ventricular contraction
v: blood from systemic begins to come back towards the closed mitral valve pressure slowly increases and then when valve opens to fill the ventricles we see a sharp drop off in CVP

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29
Q

What is Mean systemic filling pressure?

A

If the heart were stopped and all the blood left the low compliant arteries and filled the veins this is the pressure exerted by the veins to push blood back towards the heart. This value is 7 mm Hg

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30
Q

Where is the phlebostatic axis

A

On the posterior side of the tricuspid valve

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31
Q

How much does the average person’s BP when they are standing, increase at the foot?

A

+90 mm HG

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32
Q

Why is there negative pressure @ sagittal sinus?

A

Held open with connective tissue

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33
Q

What could happen if sagittal sinus gets knicked during surgery?

A

Air embolism cause air would move in

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34
Q

What is the BP +/- at the carotid?

A

0 mm Hg

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35
Q

What is the pressure +/- at the arm/shoulder at the level of the heart?

A

+6 mm Hg because of the shape of the artery as it rises above the heart first then comes down creating a syphoning type situation

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36
Q

What will turbulent flow do to a vein?

A

Increase chance of clotting

increase scarring of endothelium

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37
Q

How to calculate reynolds #

A

(velocity x diameter x density)/viscosity

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38
Q

SVR calculation and normal values

A

[(Map - RAP)/CO] X 80

800 - 1600 centimeteres/gs or Dynes sec/cm^5

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39
Q

PVR calculation and normal values

A

[(MPAP - PAWP)/CO] X 80

40-180 centimeteres/gs or Dynes sec/cm^5

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40
Q

What is a PRU?

A

Peripheral resistance unit which is equal to

1 mm Hg)/(mL/s

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41
Q

How many PRU for SVR?

A

roughly 1

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42
Q

How many PRU for PVR

A

0.14

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43
Q

Conversion for PRU to CGS

A

multiply PRU x 1333 [mm Hg/(ml/s)]

44
Q

What does the h (flat) wave in CVP waveform represent?

A

diastolic plateu mid to late distole

45
Q

What does the x wave (descent) in CVP waveform represent?

A

atrial relaxation

46
Q

What does the y wave (descent) in CVP waveform represent?

A

ventricular filling

47
Q

How does a transducer work?

A

When the metal in the transducer bends it causes electrode to send impulse to screen for amplification

48
Q

What does a overdamped a-line signal look like and what can cause it?

A

it looks smooth, no notch; basically a triangle

Blood clot
Air bubbles
compliant tubing
catheter kinks
no fluid or low flush bag pressure
49
Q

What does a underdamped a-line signal look like and what can cause it?

A

lots of ridge artifacty looking stuffs

Long stiff tubing
increased vascular resistance

50
Q

Pulsus Paradoxus is seen when?

A

When there is greater than 10 mm Hg systolic drop during early inspiration which probably means we are hypovolemic

51
Q

What is a physiologic sign that we may be experiencing pulsus paradoxus?

A

Decreased heart sounds during inspiration to almost none heard through stethoscope

52
Q

What is the delta P seen in coronary blood flow?

A

Aortic pressure - Ventricular wall pressure

53
Q

How much perfusion per 100 gms of heart muscle do the coronary arteries see?

A

70 mL/min/100 gm

54
Q

Why do we see increased opportuinity for turbulent flow in the aorta?

A

Because of its large diameter and velocity of blood flow

55
Q

How fast does blood move in aorta?

A

33 cm/sec or 1 ft/sec

56
Q

What could be a possible reason for aortic aneurysm?

A

damage to blood vessels from the speed and turbulent flow of blood

57
Q

For the normal heart what are the high and low pressures you might see?

A

100 down to 2

58
Q

What are the 2 reasons why we see decreased coronary perfusion with a person with aortic stenosis?

A 
#1 we will see HR increase to compensate for les SV, so 
     less time for coronary perfusion during diastole
#2 the pressure on the other side of the valve is low,
      therefore the delta P is low so less driving force 
      for coronary perfusion
59
Q

Can we have retrograde coronary perfusion?

A

Yes, if during aortic stenosis our ventricular pressure exceeds aortic pressure during diastole

60
Q

What percentage of CO is coronary blood flow?

A

4-5%

61
Q

What is the normal coronary blood flow rate?

A

225 mL/min

62
Q

O2 extraction in coronaries and peripheral tissue?

A

Coronaries 75% extraction

Peripheral 25% extraction

63
Q

Given a normal H & H how much oxygen content is in arterial circulation?

dL to mL conversion

A

20 mL/dL of blood

1 dL = 100 mL

64
Q

What should be the SVO2 @ CVP?

A

15 mL/dL or 75%

65
Q

What all is in the superior mediastinum?

A 
Thymus (adult)
Superior vena cava 
aortic arch : left subclavian artery
                     left common carotid artery
                     brachiocephalic trunk (shoulder to arm)
trachea
esophagus
thoracic duct
Phrenic nerves
Vagus nerves
Recurrent laryngeal nerve
66
Q

What all is in the inferior anterior mediastinum

A

Thymus in children

67
Q

What all is in the inferior middle mediastinum

A

Vagus nerve
phrenic nerve
Heart
Pericardium
roots of great vessels : ascending aorta
superior vena cava
pulmonary trunk

68
Q

RLN has sensosory and motor nerves for?

A

larynx (speech) and trachea (stridor if not)

69
Q

What all is in the inferior posterior mediastinum?

A 
Ascending aorta
Thoracic duct
Esophagus 
azygous venous
hemizygous venous
thoracic aorta
vagus nerves
70
Q

What do the azygous and hemizygous veins do?

A

Pick up accessory venous drainage from

  • ribcage
  • trachea
  • some GI

and drop off in superior vena cava which runs along spine along posterior portion of inferior mediastinum

71
Q

What is the Fibrous pericardium set up?

A

Inflexible and rigid and attaches to the serous pericardium

72
Q

What is the serous pericardium like?

A

2 layers:

Parietal layer attaches to fibrous pericardium but is slippery

Visceral layer is smooth also and touches heart

73
Q

What could a stretched out atria cause?

A

a-fib or flutter. Basically conduction issues since the atria themselves are conduction tissue

74
Q

What could cause stretched out atria?

A

Poor stenotic a-v valves or regurg or heart failure

75
Q

How many cusps in aortic valve?

A

3

Left
right
posterior

76
Q

How many cusps in pulmonic valve?

A

3

Left
right
anterior

77
Q

How many cusps in tricuspid valve (right atrioventricular valve)

A

3

anterior
septal
posterior

78
Q

How many cusps in bicuspid valve (left atrioventricular valve)

A

2

anterior
posterior and comissural lumped together

79
Q

Describe the function of 2 of the cusps in the aortic valve

A

Left opens into left coronary artery

Right opens into right coronary artery

80
Q

What percentage of the population has a bicuspid aortic valve and what does this predispose them to?

A

2% can have aortic stenosis easier

81
Q

What do the cardiac cartilaginous rings do?

A

Separate superior and inferior heart and are conduction tissue insulators

82
Q

Explain the S3 sound heard in children and some adults

A

The cartilaginous rings increases vibration and since child heart or noncompliant hypertrophied adult heart is less compliant we hear it.

83
Q

What could messed up or stretched out chordea tendineae cause?

A

a-v valve regurg

84
Q

Total cross sectional area of capillaries

A

4500 cm^2

85
Q

What situation would cause splitting of S2

A

Aortic closing before Pulmonic due to increased afterload

Also, pulm pressures are lower as is the delta p so ejecction time might be longer so S2 split usually heard during early inspiration

86
Q

What is the cause of most abnormal heart sounds?

A

Aortic stenosis

87
Q

When Left ventricle wall thickens what does the body rely on to help with CO?

A 
atrial kick
sinus rhythm
no arrythmias or conduction issues
no bradycardia
no SVR reduction
no vasodilation
88
Q

How to calculate filtration rate

A

K(f) X net pressure

net pressure = cap hydrostatic pressure - plasma colloid osmotic pressure - interstitial colloid osmotic pressure - interstitial hydrostatic pressure

the hydrostatic is negative but remember just use its absolute value when subtracting it from the above equation

89
Q

Important mean systemic filling pressure vs RVR

A

Psf more important and rely on that

90
Q

What are the proteins and pressures associated with venular end of capillary?

A

Pressures pushing out/pulling fluid into interstitium

  • 17.3 mean capillary pressure
  • 8 intersitial oncotic pressure
  • (-)3 interstitial free fluid pressure

Pressure keeping fluid in
- 28 Plasma oncotic pressure

Total of 0.3 favoring push into interstitial which gives lymph its pressure to do its thing

91
Q

What are the proteins and pressures associated with arteriole end of capillary?

A

Pressures pushing out/pulling fluid into interstitium

  • 30 mean capillary pressure
  • 8 intersitial oncotic pressure
  • (-)3 interstitial free fluid pressure

Pressure keeping fluid in
- 28 Plasma oncotic pressure

For a difference of 13 to help perfuse tissues

92
Q

How much can we increase lymphatic flow with exercise

A

Up to 20 fold

93
Q

T/F Veins are more compliant so we can add much more volume to them without increasing pressure too much as compared to arteries?

A

True

94
Q

Which ventricle holds more volume?

A

Neither, they should be the same, even though LV is concentric

95
Q

Normal ventricular pressure

A

6-7 mm Hg from filling then we get atrial empty that might bring it to 10 mm Hg

96
Q

What things cause BP drop as we move down the circulation from arteries to veins and such?

A

Resistance

Biforcations

97
Q

If we double Psf what happens to CO?

A

Double

98
Q

What is the value of the plateau value for RAP when heart is super effective we don’t see an increase in CO?

A

At -4 RAP or more we still have a CO of 6 l/min

So from 0 to -4 we see an increase from 5 l/min to 6 l/min

99
Q

Venous return formula

A

(Psf - RAP)/vascular resistance = blood flow

100
Q

2 ways to increase venous return

A

Increase blood volume

Decrease compliance of vessels

101
Q

LAP and RAP #s

A 
RAP = 0
LAP = +2
102
Q

With no sympathetic work what is our max CO?

A

13

103
Q

With extreme sympathetic work what is our max CO?

A

25 and this is at maximum contractility

104
Q

Definition of contractility

A

Ability of heart to increase CO independent of preload or afterload

105
Q

What does the “EW” represent in the pressure volume loop?

A

External work done by the ventricle such as

106
Q

Is Peripheral vascular resistance the same as systemic vascular resistance?

A

No, the calculation for PVR ends before we multiply by 80

A & P II (1 decks)

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