Exam 3 Flashcards
(150 cards)
1
Q
What is emphysema caused by?
A
The destruction of the alveolar walls and loss of elastin
2
Q
What happens to expiration in emphysema?
A
It becomes an active process
3
Q
Is emphysema obstructive or restrictive?
A
Obstructive
4
Q
Why are pt’s with emphysema called “pink puffers”?
A
Because they hyperventilate
5
Q
Why are emphysema pt’s often very thin?
A
Because it is difficult for them to eat, since eating disrupts their breathing
6
Q
Which type of emphysema has an earlier onset?
A
The genetically determined type (panacinar)
7
Q
What occurs in the genetic type of emphysema (panacinar emphysema)?
A
There is a deficiency of antitrypsin, which normally inhibits proteolytic enzymes. Because these enzymes aren’t inhibited, they digest lung tissue
8
Q
What are three symptoms of emphysema?
A
Tachypnea, very little cough, weight loss
9
Q
What happens to the V/Q ratio in emphysema? Why?
A
It is relatively normal, because capillaries are destroyed along with the alveoli (and therefore Q decreases along with V)
10
Q
What is hypercapnia?
A
Excessive CO2 in bloodstream
11
Q
What is cor pulmonale?
A
Abnormal enlargement of the right side of the heart d/t respiratory disease
12
Q
What does respiratory acidosis result from?
A
Not being able to remove enough CO2
13
Q
What does respiratory alkalosis result from?
A
Low levels of CO2 in blood d/t excessive respiration
14
Q
Which nervous system predominantly controls vasoconstriction and vasodilation?
A
The sympathetic nervous system
15
Q
Which is the only nerve from the parasympathetic system that controls vasoconstriction/dilation?
A
The vagus nerve
16
Q
Which circulation system has higher pressure, systemic or pulmonary?
A
The systemic circulation
17
Q
How much does the heart weigh?
A
Less than a pound
18
Q
Which circulatory system is coronary circulation a part of?
A
Systemic circulation
19
Q
What is the layer of the pericardium closer to the heart called?
A
Visceral pericardium
20
Q
What is the outer layer of the pericardium called?
A
Parietal pericardium
21
Q
What is the endocardium?
A
The internal lining of the heart (lines chambers)
22
Q
Which chambers have thicker walls, the atria or the ventricles? Why?
A
The ventricles, because they pump against pressure
23
Q
What is the “lub” sound associated with?
A
The closure of the atrioventricular valves
24
Q
What is the “dub” sound associated with?
A
The closure of the semilunar valves
25
What occurs during diastole?
The ventricles fill with blood
26
What occurs during systole?
Blood is pumped out of the ventricles and into circulation
27
Which valves are open and which are closed during diastole?
The atrioventricular valves are open and the semilunar valves are closed
28
Which valves are open and which are closed during systole?
The atrioventricular valves are closed and the semilunar valves are open
29
What is the 3rd heart sound due to? (Kentucky)
Decreased ventricular wall compliance
30
What is the 4th heart sound due to? (Tennessee)
Cardiac hypertrophy
31
What is cardiac hypertrophy?
Thickening of the ventricular walls
32
What is happening during the "P" phase in an EKG?
Atrial depolarization
33
What is happening during the "QRS" phase in an EKG?
The ventricles contract
34
What is happening during the "T" phase in an EKG?
Ventricle repolarization (relaxation)
35
What does ST elevation indicate on an EKG?
An MI
36
What does ST depression indicate on an EKG?
Ischemia
37
What is an echocardiogram?
A non-invasive procedure that uses sound waves to view the movement of the heart and valves
38
What is a cardiac stress test?
It involves having the patient run/bike while monitoring their heart
39
What is holter monitoring?
A noninvasive monitor that provides continuous EKG information
40
What is a STEMI code?
It indicates that the patient is having a v. dangerous type of heart attack and will likely die
41
Which coronary artery feeds the left ventricle?
The left coronary artery
42
Blockage of which coronary artery presents a bigger problem, the left or the right? Why?
Blockage of the left, because it feeds the left ventricle which pumps blood throughout the body
43
Which artery feeds the back part of the heart?
The circumflex artery
44
What does Downs syndrome do to the heart?
It produces a fatty heart (and kidneys)
45
The SA node can be affected by a blockage where?
In the right coronary artery
46
What are the two "systems" of the heart?
Electrical and muscular
47
What is collateral circulation?
"Extra" arteries/veins that can protect the heart in case a coronary vessel fails -- they provide an alternate circulatory pathway
48
Where else, besides the heart, can collateral circulation develop?
The brain
49
How many coronary capillaries are there per square millimeter?
3,300
50
How many coronary capillaries are there per muscle cell? When does this present a problem?
One -- this is a problem in ventricular hypertrophy, because the muscle cells enlarge but capillary numbers do not increase
51
What is ventricular hypertrophy?
Thickening of the walls of the ventricles
52
How are cardiac muscle cells joined? What purpose does this serve?
They are joined by intercollated discs, which allows eletrical impulses to travel more quickly
53
What does it mean to say that cardiac muscle cells have 'automaticity'?
That they can depolarize (contract) spontaneously, without input from the nervous system
54
What are three properties of cardiac muscle cells?
They are excitable, conductive, and have automaticity
55
What does it mean to say that cardiac muscle cells are 'excitable'?
That cardiac muscle cells have an ability to respond to an electrical impulse
56
Which neurotransmitters from the sympathetic nervous system speed up the heart?
Epinephrine and norepinephrine
57
Which neurotransmitter from the parasympathetic nervous system slows down the heart?
Acetylycholine
58
What do chronotropic agents do?
Change the heart rate
59
What do inotropic agents do?
Change the force of the heart's contraction
60
What do dromotropic agents do?
Change the rate at which electrical impulses travel thru the heart
61
What effect does the sympathetic nervous system have as a chronotrope, inotrope, and dromotrope?
It is a positive chronotrope, inotrope, and dromotrope
62
What neurotransmitter do muscarinic receptors respond to?
Acetylycholine
63
Which nervous system do beta receptors work in conjunction with?
The sympathetic nervous system
64
How many beats per min does the SA node generate?
70-75
65
How many beats per min does the AV node generate?
50
66
What is a bundle branch block (BBB)?
A disruption in the electrical signal of the heart that may cause a discordination in the ventricle contractions
67
What is atrial fibrillation?
When the atria contract very quickly and irregularly
68
What do you see on an EKG when there is atrial fibrillation?
No P wave
69
What happens to the charge inside of a cell during depolarization?
It becomes less negative
70
What is the membrane potential?
The difference in electrical charge between the inside and the outside of a cell
71
What is the threshold?
The point at which the cell's action potential 'fires'
72
What is hyperpolarization and what does it do to a cell's firing potential?
Hyperpolarization makes the inside of the cell more negative, and makes it harder for it to reach the firing threshold
73
Sodium and potassium are each higher in which areas?
Sodium is higher in the bloodstream and potassium is higher in the cell
74
How many sodium go into the cell for how many potassium out during depolarization?
3 sodium in for every 2 potassium out
75
What happens to potassium during repolarization?
It leaves the cell
76
What happens during the plateau phase of depolarization?
The muscle contraction is sustained
77
Below what heart rate is worrisome for a baby?
Below 100
78
What happens to cardiac output in tachycardia? Why?
It decreases, because the heart has less time to fill up with blood
79
What effect does the sympathetic nervous system have on the peripheral vessels?
It constricts them
80
What effect does the parasympathetic nervous system have on the peripheral vessels?
It dilates them
81
What are the three layers of a blood vessel, from inner to outer?
The tunica intima, tunica media, and tunica adventitia
82
Which layer of a blood vessel responds to the SNS?
The tunica media
83
What are 'resistance vessels' and 'capacitance vessels'?
Resistance vessels are arteries, and capacitance vessels are veins
84
What percent of the blood is held in the arterial system?
25%
85
What percent of the blood is held in the venous system?
75%
86
What are varicose veins do?
Pooling of blood due to malfunctioning veins
87
What is the purpose of diastolic pressure?
It maintains blood pressure in the aorta and so keeps blood flowing forward in the body
88
What is Mean Arterial Blood Pressure a measure of?
The average pressure during systole and diastole
89
What does MAP an indicator of?
How well tissues are being perfused
90
What does a low MAP indicate?
Low tissue perfusion
91
What is cardiac output?
The amount of blood pumped out of the heart in one minute
92
How many liters are pumped thru the heart every min?
About 5
93
What is the stroke volume?
The amount the left ventricle ejects with each beat.
94
What is the formula for cardiac output?
Stroke volume times heart rate
95
What is the formula for blood pressure?
Cardiac output times total peripheral resistance
96
What is end diastolic volume?
The amount of blood in the L ventricle just prior to contraction
97
Why would a weaker heart have a higher end diastolic volume?
Because less blood will have been pumped out of the ventricle with the last contraction, so the volume remaining will be higher
98
What is the ejection fraction?
Percent of the total blood volume that is ejected with each ventricular contraction
99
What is total peripheral resistance a measure of?
Degree of vasoconstriction of the blood vessels and viscosity of the blood
100
What happens to BP if total peripheral resistance is high?
It goes up
101
What is aortic impedence?
Stiffening of the aorta
102
When does aortic impedence occur?
With age
103
What does Starling's law state?
That the force of the heart's contraction is dependent upon the amount of venous return
104
What is preload?
The degree of stretch in the ventricular wall (related to venous return)
105
What is afterload?
The degree of pressure in the aorta
106
What does a high afterload mean for the left ventricle?
It has to pump harder (against more pressure) to circulate blood
107
What happens to ventricular stretch in heart failure?
Ventricular stretch increases because the heart muscle is stretched out, but there will not be a corresponding increase in ventricular contraction
108
What happens to afterload in increased peripheral resistance?
It increases
109
What is end systolic volume?
The amount of blood in the ventricles at the end of contraction
110
What happens to the end systolic volume and the ejection fraction if myocardial contraction increases?
End systolic volume will be lower and ejection fraction higher
111
What is the most important factor in ventricular performance?
Myocardial contractility
112
What happens to myocardial contractility if venous return increases?
It also increases
113
What is hypercapnia?
Elevated blood CO2
114
What effect does hypercapnia have on myocardial contractility?
It depresses it
115
What is a Valsalva maneuver?
A movement that involves bearing down
116
Where are baroreceptors located?
In the carotid
117
What do baroreceptors monitor?
Blood pressure, esp. in the case of a posture change or a Valsalva maneuver
118
What does the vasodepressor center do?
It tries to naturally decrease BP via vasodilation
119
Where are chemoreceptors located?
In the carotid and aortic bodies
120
What is the primary function of chemoreceptors?
To regulate ventilation
121
What effect does angiotensin II have on preload and afterload? Why?
It increases both, because it increases both vasoconstriction and circulating blood volume
122
What effect does ADH have on preload and afterload? Why?
It raises both -- preload because it causes water retention, and afterload because it is also a vasoconstrictor
123
When is BNP released and by what?
It is released by the ventricles when they stretch too much
124
What does BNP do?
It stops the RAAS system from continuing to raise BP
125
Why can BNP be used as a marker for heart failure?
Because it is released in greater quantities by a stretched out heart muscle
126
What is another name for essential hypertension?
Idiopathic hypertension
127
What is the most common cardiovascular disease?
Essential hypertension
128
What must the BP reading be in order to be diagnosed with essential hypertension?
An average of over 140/90 in three readings (only one number must be higher)
129
What are two possible complications of essential hypertension?
Headaches and nocturia
130
In what population does Isolated Systolic Hypertension occur?
In the elderly
131
What is the diastolic pressure in malignant hypertension?
Over 120
132
When does malignant hypertension occur? (Two scenarios)
In pregnancy and under anesthesia
133
What is target organ damage caused by?
Hypertension
134
What is the number one cause of heart disease?
Athesclerosis
135
What are the symptoms of left-sided heart failure?
Pulmonary edema and other lung symptoms
136
What occurs in systolic dysfunction?
The heart is like a "worn out slinky"; the left ventricle is very stretched out
137
What happens to the SV, EDV, and EF in systolic dysfunction?
Stroke volume is low; end diastolic volume is high; and ejection fraction is low
138
What is diastolic dysfunction caused by?
Decreased compliance of the left ventricle
139
How does diastolic dysfunction appear in a chest xray?
Heart's chambers are smaller
140
What happens to SV, EDV, and ESV in diastolic dysfunction?
Stroke volume is low, end diastolic volume is low, and end systolic volume is low
141
What is pheochromocytoma and what is it caused by?
An adrenal gland tumor; can be caused by hypertension
142
Is pregnancy induced hypertension normal?
No
143
What happens to end diastolic volume as heart rate increases?
It decreases
144
What is right sided heart disease often caused by?
Lung disease
145
What is cardiomyopathy?
Damage to the heart muscle
146
What are three intrinsic causes of heart failure?
Cardiomyopathy, congenital heart defects, mitral valve disease
147
What effect does excess CO2 have on the blood pH?
Makes it more acidic
148
What are two causes of left heart failure?
MI, aortic stenosis
149
When does right heart failure occur?
When right ventricle output to the pulmonary arteries drops
150
What is the main cause of right heart failure?
Left heart failure
