Exam 1 - Lecture 6

Question 1

what % of people have the “normal” vasculature structure in the heart?

Answer 1

75%

Question 2

Left coronary artery splits into

Answer 2

circumflex and LAD

Question 3

If the circumflex artery is attached to the _____, it’s considered ______

Answer 3

PDA; left coronary dominance

Question 4

Typically, the PDA is attached to the

Answer 4

right coronary artery

Question 5

in a small portion of people (10%), the PDA is part of

Answer 5

both circumflex and right coronary artery

Question 6

Which coronary artery blockage has more serious problems?

Answer 6

Left coronary artery

Question 7

On PPV, even with low settings, the increased pressure will initially

Answer 7

push the blood out thats in the heart, which increases preload initially, but then the positive pressure decreases venous return to the heart, so then preload decreases

Question 8

For the initial PPV breath, whats the effects of cardiac output for each side of the heart?

Answer 8

Increases cardiac output for the left side due to increased preload and no changes to afterload..

Right side is a wash because preload and afterload are both increased.

Question 9

How is cardiac output more effected by PPV?

Answer 9

Long inspiration and higher peep will prolong the time of impedence on venous return, decreasing overall cardiac output

Question 10

during PPV, most filling for the heart will be

Answer 10

in between inspirations

Question 11

If we had severe aortic stenosis for 5 years, what happens to the heart? (2 things)

Answer 11

Thicker ventricular walls to get past the bad valve (pathologic hypertrophy)

Leads to less space for filling as well, due to not being as compliant and thicker.

Question 12

What happens to the graph on filling volume/pressures with pathologic hypertrophy?

Answer 12

The curve is steeper. (Higher pressure and less volume)

Question 13

If the heart walls are very compliant/stretchy, what happens to the graph on filling volume/pressures?

Answer 13

Much flatter curve… low pressure and higher volume.

Question 14

What causes dilated cardiomyopathy?

Answer 14

Aortic regurgitation, from the ventricle filling from places at the same time.

Question 15

For aortic stenosis, what happens to LV pressure during filling?

Answer 15

Less compliance from the left ventricle fighting against the stenotic valve, so that means increased pressure for filling.

Question 16

For aortic regurgitation, what happens to LV pressure during filling?

Answer 16

More compliance from it being stretched out, so there is less pressure for filling.

Question 17

Hypertrophy could be related to both

Answer 17

stretched out walls and thickened walls.

Question 18

Kids have more or less compliant ventricles?

Answer 18

less.

Question 19

How do kids adapt to venous return?

Answer 19

The heart cant expand its chambers to compensate for venous return, so they arent really volume responsive. They compensate by increasing heart rate.

Question 20

What is the first heart sound? what kind of pitch?

Answer 20

AV valve closing/ the backwards bulge of the valves closing and the vibration it causes.

Low pitch

Question 21

What is the second heart sound? pitch?

Answer 21

Aortic valve/pulmonic valve; higher pitch than 1st heart sound

Question 22

what is the longest heart sound?

Answer 22

1st

Question 23

Is the atrial heart sound audible?

Answer 23

Not in healthy people. Its audible when atria is doing extra work and more full than normal (mitral stenosis).

Question 24

what is the 3rd heart sound?

Answer 24

Heard with heart failure or kids since they have low compliance ventricle.

Walls dont stretch to accomodate volume at the end of filling

Question 25

Heart sounds during aortic stenosis

Answer 25

Systolic murmur, like putting your thumb at the end of a hose. loudest in the middle

Question 26

Heart sounds during aortic regurgitation

Answer 26

Diastolic murmur, the backwards flow happens during diastole. loudest at the beginning, sound trails off towards end of diastole as VENTRICLE GETS FULL/less blood in aorta to backflow.

Question 27

Heart sounds during mitral stenosis

Answer 27

Disatolic murmur, loudest towards the end due to atrial kick fighting more blood against a stenotic valve.

Question 28

Heart sounds during mitral regurgitation

Answer 28

Systolic murmur, loudest at the beginning of systole, as the most blood gets pushed back into the atria and atria were empty (less pressure resistance)

Question 29

The aortic valve can be auscultated where?

Answer 29

2nd ICS, right sternal border, and you can hear it up to the right neck (ejection pathway)

Question 30

The pulmonic valve can be auscultated where?

Answer 30

2nd ICS, left sternal border and you can hear it up to the left clavicle

Question 31

The tricuspid valve can be auscultated where?

Answer 31

5th ICS, left sternal border

Question 32

The mitral valve can be auscultated where?

Answer 32

5th ICS, mid clavicular line

Question 33

Pnuemonic for auscultation spots for the valves

Answer 33

All Physicians Take Money (in a Z-pattern)

Question 35

What’s something special that can happen with the 2nd heart sound, and why?

Answer 35

Can have a splitting sound, because the aortic valve and pulmonic valve dont close at the same time. It’s during deep inspiration, and the aorta isn’t affected by it but the pulmonic valve is, so the pulmonic valve closes LATER.

Question 36

What is the recording instrument that detects frequencies and listens to heart murmurs?

Answer 36

Phonocardiogram

Question 37

What is the lower frequency limit to healthy hearing?

Answer 37

20Hz

Question 38

Mediastinum is divided into how many divisions? Where is the divider?

Answer 38

2; superior and inferior; you’ve got the superior mediastinum and then everything below it is the other division

Question 39

In the inferior mediastinum, how many parts? What are they called?

Answer 39

3, anterior middle and posterior

Question 40

Anterior mediastinum is

Answer 40

Anything sitting in front of the heart

Question 41

Middle mediastinum

Answer 41

Heart and most stuff attached directly to it, such as: heart, pericardium, ascending aorta, superior vena cava, pulmonary trunk, pulmonary veins, pericardiacophrenic nerves, phrenic nerves

Question 42

Whats in the Posterior mediastinum

Answer 42

Abdomen: esophagus, thoracic aorta, thoracic ducts, vagus nerves, azygos vein, hemizygos vein.

Question 43

What are the pericardiacophrenic nerves?

Answer 43

Responsible for sensory perception in the pericardium as well as supplying innervation to the diaphragm

Question 44

What does an overdamped art line look like?

Answer 44

No notch

Question 45

What does an underdamped art line look like?

Answer 45

Too many notches

Question 46

How does the computer calculate pressure and heart rate for the a line?

Answer 46

By measuring the dichrotic notch

Question 47

What causes an overdamped art line?

Answer 47

Clot, spring, air, etc. in the art line. OR the amplifier is too low.

Question 48

What causes an underdamped arterial line?

Answer 48

Amplifier is too high! Cant figure out the dichrotic notch. Causes artifacts.

Question 49

Sometimes, the circumflex is a what between what arteries?

Answer 49

Anastomosis between left and right cardiac arteries

Question 50

Which blood vessels are OUTside the heart?

Answer 50

Epicardial coronary arteries (Only if they can be seen) and those are networked/connected into the deeper vessels.

Question 51

What are the deeper vessels?

Answer 51

Deep: endocardial Deepest: subendocardial

Question 52

Which coronary vessels experience the lowest surrounding pressure?

Answer 52

Epicardial coronary arterials

Question 53

What coronary vessels experience the most pressure?

Answer 53

Left ventricle subendocardial arterial vessels

Question 54

Where would ischemia most likely to be in coronary vessels?

Answer 54

Subendocardial left ventricle vessels

Question 55

Aortic stenosis has which major change in the pressures/volume?

Answer 55

Left ventricle pressure

Question 56

Mitral stenosis has which major change to pressure/volume?

Answer 56

Increased left atrial pressure due to more pressure required to fill ventricle past bad valve

Question 57

Whats the major change with aortic regurgitation?

Answer 57

Widened pulse pressure since blood goes back into ventricle.

Question 58

Whats the major change with mitral regurgitation?

Answer 58

Increased left atrial pressure as systole progresses due to more blood coming back in.

Question 59

How can you somewhat fix mitral regurgitation?

Answer 59

Reducing afterload, which would decrease pressure in the left ventricle, which prevents some blood from pushing back into atria.

Question 60

What pathologies is the atrial kick more important?

Answer 60

Aortic stenosis (less compliant ventricle walls = more pressure) Mitral stenosis (less passive filling)

Question 61

If the atria pressure increases, what are you at greater risk for?

Answer 61

Can mess up the coordination between ventricles and atria, and can cause atria arrhythmias

Question 62

What is Eccentric LVH? Causes? Characteristics?

Answer 62

Dilated left ventricle -dilated cardiomyopathy -genetic -Ventricular septal defect -Systolic dysfunction -aortic/mitral valve regurgitation -MI

Question 63

What is concentric LVH? Causes?

Answer 63

-Thicker walls -Caused by stenotic aortic valve, long term HTN -Thicker walls means less compliance, less filling, less stroke volume. -DIASTOLIC dysfunction because it’s a FILLING problem. It ejects what it has without issue, so it’s NOT a systolic dysfunction.

Question 64

If we have ischemia in the heart, how can that area adapt? What can reduce likeliness of this adaptation?

Answer 64

Collateral perfusion of the vessels, vessels need to dilate to help bring blood to ischemic area. Smoking, diabetes, chronic htn, pretty much anything that hurts blood flow…

Question 65

Whats the issue with fibroblasts?

Answer 65

They dont know when to stop laying down heart tissue, and it lays down too much, even over the good cells. Can slow it down by giving ACE-I. Can cause the heart to stretch out (cardiac myopathy)

Question 66

What happens if you have nonfunctional heart muscle in the wall?

Answer 66

Bows out and causes systolic stretch, looks like a little bubble. Lowers EF.