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Uncategorized > Fall- Final Exam > Flashcards

Fall- Final Exam Flashcards

1
Q

2 sources provide gas flow to the blender (Air and Oxygen source).
–What color is the air line and what does it consist of? –What color is the oxygen line and what does it consist of?

A
  • -Air line is yellow. Consists of 79% Nitrogen and 21% Oxygen
  • -Oxygen line is green. Consists of 100% Oxygen
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2
Q

Name 5 characteristics of arteries

A
  • More elastic fibers
  • More muscle fibers
  • Thicker wall
  • No valves
  • Small lumen
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3
Q

Name 5 characteristics of veins

A
  • Less elastic fibers
  • Less muscle fibers
  • Thinner wall
  • Has valves
  • Large lumen
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4
Q

The apex of the heart is near what rib

A

Left 6th rib

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5
Q

When opening the rib cage, what sections of the heart are visible?

A

Right Atrium and Right Ventricle

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6
Q

How do roller pumps move blood forward?

A

Positive displacement

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7
Q

How do centrifugal pumps move blood forward?

A

Kinetic assist

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8
Q

What is the difference between the surface area of the human lung and an oxygenator?

A

Human lung surface area= 70-100 sq. meters

Oxygenator surface area= 2-2.5 sq. meters

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9
Q

Equation: Convert pounds to kilograms

A

Pounds / 2.2

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10
Q

Equation: Convert inches to centimeters

A

Inches * 2.54

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11
Q

Equation: BSA

A

Sq Root of [Height (cm) * Weight (kg)] / 3600

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12
Q

Equation: Target BF

A

Target Cardiac Index * BSA

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13
Q

Equation: Post-dilutional Hct

A

RBCV + ((Hct of added RBC* Vol of added RBC)) / TCBV+Prime+Anes Vol+Vol of added RBC-UOP

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14
Q

Equation: Heparin loading dose

A

350 units * Weight (kg)

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15
Q

Equation: Heparin dose-response curve

A

(Post ACT- Baseline) / 350

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16
Q

Equation: Protamine dose

A

Heparin dose in units * 1.3

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17
Q

Equation: Mean Arterial Pressure

A

[(systolic-diastolic) / 3] + diastolic

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18
Q

Equation: Oxygen Consumption (transfer)

A

[1.34 * grams Hgb * (Art Sat-Ven Sat)] * ml of blood

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19
Q

Equation: Oxygen Delivery

A

1.34 * grams Hgb * Art Sat * ml of blood

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20
Q

Equation: Oxygen Content

  • -dissolved in plasma
  • -carried by hemoglobin
  • -arterial content
  • -venous content
A
  • -dissolved by plasma= PO2 * 0.003
  • -carried by hemoglobin= 1.34 * grams of Hgb * Sat of Hgb
  • -arterial content= 1.34 * grams Hgb * Art Sat
  • -venous content= 1.34 * grams Hgb * Ven Sat
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21
Q

Equation: Peripheral Vascular Resistance

A

[(MAP-LAP) / CO] * 80

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22
Q

Equation: Systemic Vascular Resistance

A

[(MAP-CVP / CO] * 80

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23
Q

Equation: Hct

A

RBCV / TCBV

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24
Q

Equation: RBCV

A

Hct * TCBV

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25
Q

Equation: TCBV

A

Female: 70ml/kg * Weight (kg)
Male: 75 ml/kg * Weight (kg)

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26
Q

define asepsis

A

absence of infectious agent

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27
Q

How many air exchanges (per hour) occur in the OR

A

15-20

Goal is to introduce fresh air supply to the OR to control temp/humidity/carry away contaminants

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28
Q

define nosocomial infection

A

hospital acquired infection

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29
Q

Who is the Father of Circulation

A

William Harvey (1628)

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30
Q

Who developed the leak-proof technique for anastomosing blood vessels without constricting the vessels or causing thrombosis?

A

Dr. Alexis Carrel (1904)

–laid the foundation for CABGs and Heart transplants

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31
Q

Who discovered heparin use for reducing blood clotting?

A

McLean (1916)

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32
Q

Who did the first cardiac catherization?

A

Forossmann (1929)

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33
Q

Who discovered penicillin?

A

Fleming (1928)

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34
Q

Who did and developed the first shunt procedure to for cyanosis relief?

A

Dr. Blalock and Dr. Taussig (1945)

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35
Q

Who did the first successful operation within a human heart under direct vision?

A

Dr. Lewis (1952)

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36
Q

Who created the first heart/lung machine? What procedure was it first used for?

A

Dr. Gibbon (1953)

VSD closure

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37
Q

Who used cross-circulation to close a VSD?

A

Dr. Lillehei (1954)

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38
Q

Who first used potassium based cardioplegia to arrest the heart?

A

Dr. Melrose (1955)

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39
Q

Where was the first cardiopulmonary bypass procedure performed?

A

Rochester Methodist Hospital

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40
Q

Who performed the first heart transplant?

A

Dr. Bernard (1967)

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41
Q

Who was the first to implant a totally artificial heart (the Liotta Heart)

A

Dr. Cooley (1969)

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42
Q

Who was the first to successfully use a intra-aortic balloon pump?

A

Dr. Kantrowitz (1968)

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43
Q

NY Heart Association Functional Classification:

  • Functional Class 1=
  • Functional Class 2=
  • Functional Class 3=
  • Functional Class 4=
A
  • Functional Class 1= No limitation of physical activity
  • Functional Class 2= Slight limitation of physical activity
  • Functional Class 3=Marked limitation of physical activity
  • Functional Class 4= Inability to carry out any physical activity w/o discomfort- symptoms present at rest.
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44
Q

define neoplasms

A

new growth (both cancerous and non-cancerous)

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45
Q

define exercise tolerance test (ETT)

A

Records the patients electrical activity (rate/rhythm). Used to diagnose CAD

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46
Q

define Radionuclide Stress Test

A

Patient is injected with a radioactive isotope (usually thallium or cardiolyte)- a nulclear picture is taken of the heart pre and post exercise- the cold areas that dont absorb the isotope indicates areas of poor perfusion

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47
Q

Define Positron Emission Tomography (PET)

A

Glucose is tagged with a radioactive marker that emits positrons. It identifies poor perfusion areas (like damaged myocardium) and excessive perfusion areas (like tumors)

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48
Q

define Magnetic Resonance Imaging (MRI)

A

uses a strong magnet to align protons in tissues to produce a weak signal that can be analyzed by radio waves. Provides a granular 3D imaging

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49
Q

define Computerized Axial Tomography (CAT or CT)

A

Multiple 2D radiographs are combined to make a 3D image. Useful for cardiac lesions and coronary structures

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50
Q

What procedure is considered to gold standard of cardiac pathology diagnostics before open heart surgery

A

Cardiac Catheterization

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51
Q

What information do we get from a cardiac catheterization

A 
chamber pressures
Cardiac output
Art+Ven sats
Coronary anatomy
Ventricular function
Valvular regurg 
Ejection fraction
SVR+PVR
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52
Q

what is the Maze procedure used for

A

Atrial fibrillation

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53
Q

define myxoma

A

benign tumor/ usually originates in the LA/ more common in women

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54
Q

define angiosarcoma

A

malignant tumor/ usually originates in RA or pericardium/ common in men

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55
Q

what is the typical max flow rate and pressure that a pump can withstand

A

7 LPM

500 mmHg

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56
Q

define pump creep

A

roller heard continues to turn even when the knob is turned off- bad because it generates pressure

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57
Q

what is the standard tubing type used

A 
Polyvinyl Chloride (PVC)
-blended with organic oils (plasticizers) and organo-metal soaps (stabalizers)
(2 other types are silicone and latex- don't use either)
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58
Q

define durometer

A

measure of the hardness of the tubing (higher number=harder tubing)
-durometer of ECC tubing is 65-72

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59
Q

define spallation

A

release of micro particles from inner wall of tubing due to compression of tubing by rollers against raceway. Majority of release occurs during first 2-4 hours. Pre-bypass filters decrease amount of spallation

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60
Q

how do you determine if you set the occlusion properly

A

hold fluid filled tube 30 inches above pump- you should see the fluid drop 1cm per minute

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61
Q

roller pumps are afterload and preload ________

A

independent

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62
Q

centrifugal pumps are afterload and preload ______

A

dependent

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63
Q

Equation: Flow Generation

A

(Inlet pressure- Outlet pressure) / resistance

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64
Q

Equation: Centrifugal Force Generation

A

(Mass in kg * velocity squared) / radius

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65
Q

What is the max negative inlet pressure and max positive outlet pressure for a centrifugal pumps

A 
max neg inlet pressure= -500 mmHg
max pos outlet pressure= 900 mmHg
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66
Q

define screen filter

A

made of mesh material (Nylon or Dacron). filtration depends on pore size.

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67
Q

define depth filter

A

composed of packed material (polyurethane foam, dacron or glass wool). No pore size- filtration depends on absorption of emboli

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68
Q

Gas line filters pore size

A

0.2 microns

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69
Q

Pre-Bypass filter pore size

A

0.2 microns

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70
Q

Arterial line filter pore size

A

40 microns

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71
Q

Systemic Leukocyte depleting filter pore size

A

40 microns

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72
Q

Cardioplegia filter pore size (blood and crystalloid)

A

Blood- 40 microns

Crystalloid- 0.2 microns

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73
Q

Blood transfusion filter pore size

A

10-200 microns

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74
Q

what is the average amount of aggregates in 1 cubic millimeter of bank blood

A

100 aggregetes per cubic millimeter

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75
Q

the amount of drainage from the patient depends on what 3 things

A
  1. patients CVP
  2. distance from patient to blood level in VR
  3. resistance created by cannula, connectors, tubing
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76
Q

what is the normal siphon gradient pressure

A

30-40 mmHg

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77
Q

Equation: Poiseuills Law

A

(LengthViscosity8) / pie*radius^4

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78
Q

How do you convert French size into millimeters

A

divide French size by 3

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79
Q

what is the max pressure drop for venous cannulas

A

30-40 mmHg

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80
Q

describe single cannulation

A

goes in to RA. used for congenital procedures

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81
Q

describe bicaval cannulation

A

goes into SVC and IVC. used for some congenital procedures and adult procedures such as MVR.
cannot collect coronary sinus return (LV vent will be used)

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82
Q

describe dual stage cannulation

A

goes into RA and IVC. most common. used for adult acquired procedures such as CABGs and AVR

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83
Q

describe femoral cannulation

A

used for redo’s and minimally invasive procedures

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84
Q

when would right thoracotomy be used

A
  • previous sternotomy
  • MVR
  • ASD
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85
Q

when would a left thoracotomy be used

A
  • descending thoracic aorta surgery
  • redo CABG
  • left atrial-to-femoral artery bypass
  • left ventricular apical-aortic conduit
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86
Q

where is the origin of the axillary artery

A

lateral margin of the first rib (before that it is the subclavian artery)

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87
Q

what is the narrowest part of the ECC

A

arterial cannulae

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88
Q

the pressure gradient for arterial cannulaes should be below what?

A

below 100 mmHg

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89
Q

Equation: Reynolds Number

A

(velocitydensitydiameter) / viscosity

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90
Q

when reynolds number is above _____, flow is likely to be turbulent

A

2500

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91
Q

what is the difference between viscosity and density

A
  • -viscosity= a liquids resistance to flow (Increase in viscosity will decrease reynolds number)
  • -density= mass per unit vol (gm/ml) (Increase in density will increase reynolds number)
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92
Q

Jetting increases with smaller cannulas. Jetting velocities can be how much more greater than normal systolic flow velocities?

A

5-10 times

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93
Q

what is the coanda effect

A

a jet stream (through the arterial cannula) adheres to the boundary wall which produces low pressure along the opposite wall. Creates potential for under-perfusion of the head vessels

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94
Q

with femoral arterial cannulation, it is important that the patient has a competent _______

A

aortic valve

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95
Q

describe axillary cannulation

A

attached via 8mm graft
right axillary is favored
possible brachial plexus injury

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96
Q

bronchial circulation accounts for what % of cardiac output? where do bronchial veins empty into?

A

1-3% of CO

empty into pulmonary veins

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97
Q

where do the left and right coronarys drain

A

right coronary drains into RA via small cardiac veins

left coronary drains into coronary sinus and then the RA

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98
Q

with retrograde cardioplegia, where does it empty and what does that mean for the heart?

A

most empties into the aortic root and LV via the left coronary ostia. This means that retrograde cardioplegia does a poor job of perfusing the right heart

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99
Q

why can you never perfectly vent the LV?

A

micro air bubbles can hide behind the traburcule

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100
Q

why is hypothermia used

A

lower temps decrease the basal metabolic rate and provides cerebral and myocardial protection

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101
Q

define conduction

A

thermal energy is passed from molecule to neighboring molecule in the conductor

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102
Q

define convetion

A

transfer of heart from one point to another by mass motion of a gas or liquid medium

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103
Q

define radiation

A

heat transfer by way of electromagnetic waves

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104
Q

equation: change is heat

A

CMchange in temperature
C= specific heat (calories/gm Celsius)
M= mass (grams)
T= temp in celsius

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105
Q

what is stainless steels thermal conductivity

A

311 (lower compared to aluminum which is 5374)

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106
Q

Equation: Coefficient of heat exchange

A

(Temp of blood out of the HE- Temp of blood going into the HE) / (Temp of water going into the HE-Temp of blood going into the HE)

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107
Q

what are chevrons

A

little bumps that are used to disrupt laminar flow and promote mixing and a larger surface area to increase heat flow

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108
Q

define chugging

A

excessive drainage causing compliant vein walls to collapse around the ends of the venous cannula

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109
Q

how can you fix chugging

A

partially clamping/occluding the venous line which may paradoxically increase venous drainage

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110
Q

what is pascals law

A

principle of transmission of fluid pressure:

1 mmHg per 1.36cm height

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111
Q

when applying negative pressure (vacuum) to the VR- where should you monitor the pressure and what should the pressure never exceed?

A
  • monitor pressure 10cm before pump inlet OR within the hard shell VR
  • never exceed -60 to -100 mmHg
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112
Q

When do you never apply vacuum?

A

never apply vacuum when there is no forward flow

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113
Q

What is the pos and neg pressure relief valve for a hard shell reservoir?

A

pos pressure relief at 15mmHg

neg pressure relief at -150mmHg

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114
Q

define colloid and give an example

A

a substance that is microscopically dispersed evenly throughout another substance. contains larger/insoluble molecules, such as albumin or gelatin. BLOOD is a colloid

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115
Q

define crystalloid and give an example

A

aqueous solutions of mineral salts or water soluble molecules. they mimic normal plasma electrolyte concentrations. NORMAL SALINE is a crystalloid

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116
Q

define osmolaLity

A

measure of osmoles per kg of solvent

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117
Q

define osmolaRity

A

measure of osmoles per liter of solution

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118
Q

define colloid osmotic pressure (oncotic pressure)

A

osmotic pressure exerted by proteins in plasma that pulls water into the circulatory system. this reduces tissue edema

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119
Q

define tonicity

A

state of being hypertonic, isotonic or hypotonic. related to how much osmotic pressure is exerted on a membrane by fluid

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120
Q

define osmotic pressure

A

pressure which needs to be applied to a solution to prevent the inward flow of water across a semipermeable membrane

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121
Q

What is the difference between plasamLyte and Lactated Ringers?

A

Lacated Ringers is essentailly the same electrolyte solution- except with lactate added. The lactate is converted into bicarbonate by a functioning liver

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122
Q

define hypertonic

A

solution with an osmolarity over 350 mOsm/L

Hypertonic solutions increase serum osmolarity- which pulls fluid from cells- and pulls it into the intravascular space.

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123
Q

define isotonic

A

a solution with a osmolarity between 285-295 mOsm/L

Isotonic solutions freely move in/out of intravascular space

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124
Q

define hypotonic

A

solution with an osmolarity below 250 mOsm/L

Hypotonic solutions cause fluid to move out of the intravascular space and into interstitial space- causes edema

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125
Q

define hydrostatic pressure

A

pressure of intravascular fluid against the wall of the vein

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126
Q

how much does 1 liter of water at 4C weigh?

A

1 kg or 2.2 pounds

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127
Q

name 5 advantages of hemodiltion

A
  1. Improved regional BF
  2. Improved BF at lower perfusion pressures (lower shear stress)
  3. Improved O2 delivery
  4. Decreased blood viscosity
  5. Decreased exposure to homologous blood products
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128
Q

What is added to the prime for infants under 5kg? Why?

A

100 ml PRBC to avoid prolonged period of asanguineous perfusion

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129
Q

what are 2 benefits adding albumin to the prime

A
  1. increase colloid oncotic pressure
  2. help prevent the platelet lowering effects of CPB
    (dont use on Jehovah Witnesses)
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130
Q

What is the antibiotic dose for Cefazolin (Ansef, Kefzol)

A

25mg/kg. Max= 1g

Added to circuit before CPB

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131
Q

What is the antibiotic dose for Ampicillin

A

50mg/kg. Max= 1g

Added to circuit before CPB

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132
Q

What is the antibiotic dose for Gentamicin

A

2mg/kg. Max= 80mg

Added to circuit before CPB

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133
Q

What is the antibiotic dose for Nafcillin

A

25mg/kg. Max=1g

Added to circuit before CPB

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134
Q

What is the antibiotic dose for Vancomycin

A

10-15mg/kg. Max=1g

Titrated during CPB

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135
Q

What is the antibiotic dose for Solumedrol (Methylprednisolone)

A

30mg/kg. Max=500mg
Added to circuit before CPB
–Ped transplant patients may receive another dose when XC is released

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136
Q

Equation: Amount of bicarb that should be added to crystalloid primed circuit

A

Amount of bicarb= 0.025*ml of prime solution

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137
Q

Equation: Amount of bicarb that should be added to a primed circuit with blood added

A

Amount of bicarb= 0.3weight in kgBE

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138
Q

What is the dose for the amount of mannitol added to prime? How much can be given when the AoXC is released?

A

prime dose= 0.25g/kg

AoXC release= additional 0.25g/kg

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139
Q

What are 3 benefits of using mannitol?

A
  1. Osmotic diuretic
  2. Increased osmolarity rapidly
  3. Oxygen radical scavenger
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140
Q

after initiation of CPB- if CaCl levels fall too low- what value should you try to correct it to?

A

try to keep CaCl levels at 0.7 mM/L minimum during CPB

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141
Q

define p-value

A

measure used to weigh the strength of the evidence/data collected.
p-value below 0.05= strong evidence
p-value above 0.05= weak evidence

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142
Q

define a newtonian fluid

A

a uniform fluid with a constant viscosity

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143
Q

define a non-newtonian fluid

A

a fluid with varying viscosity (BLOOD is non-newtonian)

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144
Q

how does temperature effect viscosity

A

viscosity increases 5% per 1C drop in temp

inverse relationship

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145
Q

define shear stress

A

force applied to an area of liquid confined between 2 plates- sufficient enough to set liquid in motion

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146
Q

define shear rate

A

rate at which a progressive shearing deformation is applied

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147
Q

Equation: Viscosity in relation to shear stress and shear rate

A

Viscosity= Stress / Rate

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148
Q

Equation: Diffusion of gas transfer

A

[(Change is P)(Area)(Solubility)] /

[(Distance)*(sq. rt of Molecular Weight)]

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149
Q

What 4 things happen when you increase the Gas to BF ratio?

A
  1. O2 transfer increases
  2. CO2 transfer increases
  3. Arterial pO2 increases
  4. Arterial pCO2 decreases
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150
Q

what do you do if your O2 is to low

A

increase FiO2

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151
Q

what so you do if your CO2 is to low

A

decrease Gas to BF ratio

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152
Q

what do you do if you SvO2 is to low

A

increase BF

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153
Q

when can suckers be turned on

A

when ACT is over 300 or 2x above baseline

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154
Q

what do you do if the ACT does not reach 480 after the loading dose

A
  1. Give more heparin and re-test
  2. Consider AT3 deficiency
  3. Give FFP or recomniant AT3 (Atryn)
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155
Q

what is cold agglutinin disease

A

at low temperatures the anitbodies cause RBCs to clump together. The clumps can get stuck in line filters and increase the pressure drop

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156
Q

what is the ideal urine output during CPB

A

0.5-1 cc/kg/hr

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157
Q

what are 3 benefits of using diuretics such as mannitol or lasix during CPB

A

helps treat hyperkalemia, hemoglobinuria and excessive hemodiltion

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158
Q

What is the ideal MAP during CPB? What are the consequences if MAP is too high or low?

A

ideal= 80-85 mmHg (better neurological outcomes)
Too High= over 100 mmHg (increased intracranial pressures, fluid shifts/edema, increased SVR)
Too Low= 50-60 mmHg (cerebral injury, reduced kidney function)

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159
Q

how do newborn oxygen requirements compare to adults

A

newborns require 2 times more oxygen- this peaks around 2 months old

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160
Q

what is the mild hypothermia range

A

32-35C

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161
Q

what is the moderate hypothermia range

A

28-32C

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162
Q

what is the severe hypothermia range

A

20-28C

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163
Q

what is the profound hypothermia range

A

below 20C

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164
Q

list all the units of the metric system

King Henry Died By Drinking Chocolate Milk

A 
Giga +9
Mega +6
Kilo +3
Hecto +2
Deca +1
Base [liter/gram/meter] 0
Deci -3
Centi -3
Milli -3
Micro -6
Nano -9
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165
Q

what are the 5 steps of the pressure wave signal path? (steps to get pressure reading from patient to pump?

A
  1. pressure wave from patient
  2. transducer
  3. strain gauge
  4. wheatstone bridge
  5. monitor signal
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166
Q

define artifact

A

false signals superimposed on true signal

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167
Q

define catheter whip

A

movement of catheter tip within blood vessel in response to pulsatile flow

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168
Q

define damping

A

loss of energy and vibrations within monitoring system

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169
Q

What is the Fourier Analysis?

A

used to break down complex pressure wave forms into a series of sine and cosine waves- then reassembles them for us to view on the monitor

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170
Q

What is the first component waveform of the Fourier Analysis called

A

Fundamental Frequency / First Harmonic

-this wave forms frequency is the same as the complex wave

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171
Q

What is the second component waveform of the Fourier Analysis called

A

Second Harmonic

- this wave forms frequency is 2x that of the first

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172
Q

what is the ideal frequency response and how can you achieve it?

A

40-50 Hz (20 Hz minimum)

Use a short, stiff, wide-bore catheter (7Fr or 18gauge) connected directly to the transducer with no air in the system

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173
Q

define dynamic response testing (snap test)

A

testing the ability of the system to faithfully reproduce the patients pressure on the monitor (flush test). a normal system will return to baseline waveform after 1-2 oscillations

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174
Q

name 2 effects of Overdamped wave forms

A

underestimates SBP
overestimates DBP
- caused by air, kinks, compliant tubing

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175
Q

name 2 effects of Underdamped wave forms

A

Overestimates SBP
Underestimates DBP
-caused by long tubing or increased SVR

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176
Q

If the transducer is zeroed too low below the patient, what will happen

A

it will read a higher pressure

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177
Q

If the transducer is zeroed too high above the patient, what will happen

A

it will read a lower pressure

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178
Q

what is Coulombs Law

A

describes the electricostatic interaction between electrically charged particles separated by a distance [force].

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179
Q

define a Joule

A

passing of electric current of 1 ampere (A) through a resistance of 1 ohm for 1 second

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180
Q

define a Watt

A

energy rate of transfer. measured as Joules/Second

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181
Q

define voltage

A

work per unit charge against a static electrical field. measures the potential difference. Voltage drop occurs as the initial voltage supply is reduced after moving through passive elements

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182
Q

define conductor, insulator and semiconductor

A 
conductor= carries electrical current (metal)
insulator= blocks electrical current (rubber)
semiconductor= can carry some electrical current (carbon)
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183
Q

define Direct Current (DC) Voltage

A

Flow of charge in one direction and the fixed polarity of the applied voltage. Can be steady or vary in magnitude

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184
Q

define Alternating Current (AC) Voltage

A

Polarity periodically reverses/alternates and the flow of charge reverses as the polarity changes. Varies in magnitude btwn reversals in polarity. Can power devices up to 240V

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185
Q

what is a common electrical interference value in the operating room

A

60 cycle

186
Q

what is the common voltage and hertz in a house (AC Current)

A

120 V and 60 Hz

187
Q

what are the equations to calculate voltage, current and resistance in a series circuit

A 
voltage= V1+V2+V3... [sum of components]
Current= I1= I2= I3... [constant]
resistance= R1+R2+R3... [sum of components]
188
Q

what are the equations to calculate voltage, current and resistance in a parallel circuit

A

Voltage= V1=V2=V3… [constant]
Current=I1+ I2+ I3… [sum of components]
resistance= 1/ (1/R1 + 1/R2)… [sum of inverse]

189
Q

which one (series or parallel circuit) has the larger pressure drop

A

series

[parallel circuits have a constant pressure drop for each branch of the circuit]

190
Q

what is the best way to hook up 2 oxygenators for a single patient on bypass

A

hook them up in parallel

191
Q

whats the difference between an electrode and a transducer

A 
Electrode= device that captures biopotential and sends the electronic signal to signal-conditioning equipment (monitor)
Transducer= converts a non-electrical physical force (pressure/temp) to an analogous electrical signal. Uses a strain guage and a wheatstone bridge to determine the pressure applied to the diaphragm
192
Q

Electrodes have a high impedance (resistance) to human skin. What is the resistance (ohms) when damp vs dry?

A

Damp skin= 10K ohms

Dry skin= 500K ohms

193
Q

what are the most common electrodes used and how do they work?

A

Silver-silver electrodes are most common. They create a potential difference of voltage.

194
Q

What are 2 types of transducers?

A
  1. Fiber Optic (Not dependent on fluid)

2. Fluid Filled (Fluid dependent)- most common

195
Q

convert 1 atmosphere (ATM) to mmHg

A

755 mmHg

196
Q

how should a fluid filled transducer ideally be leveled

A

at the phlebostatic axis (4th ICS)

197
Q

what is the difference bwtn a unipolar and bipolar electrode tip on a pacemaker lead

A 
Unipolar= sends signal back to case
Bipolar= sends signal back to lead
198
Q

what is the difference btwn signal, dual and triple chamber pacemakers

A

Single chamber= One lead place in RA or RV
Dual chamber= Two leads placed in RA and RV (this type more closely mimics a natural HR)
Triple chamber= Two leads placed in RA and RV/LV (second lead stimulates both ventricles)

199
Q

what is the difference btwn demand, fixed rate and rate responsive pacemakers

A

Demand= sends electrical pulse when HR is too slow or misses a beat to get back to a normal rhythm
Fixed Rate= discharge steadily regardless of natural activity
Rate Responsive= raise or lower HR to meet needs

200
Q

what is an Implantable Cardiac Defibrollator (ICD)

A

prevents cardiac arrest due to tachycardia. monitors rhythm but remains inactive. sends an electrical shock (depolarizes the heart) to get out of V-tach. can also be programmed to raise or lower HR

201
Q

what is synchronized cardioversion

A

a therapeutic dose of electrical current is used (timed to the R wave) to convert a fast HR to normal pace. Used for A-Fib, A-Flutter, A-Tach, SVT)

202
Q

What happens during Phase 1 (Inotropic Component) of the arterial pressure wave

A

Aortic Valve opens

Pressure wave rises

203
Q

What happens during Phase 2 (Volume Displacement) of the arterial pressure wave

A

Blood moves into aorta
May see Anacrotic notch (marks the change from iontropic component to volume displacement)
Peak of the curve

204
Q

What happens during Phase 3 (Late systole and diastole) of the arterial pressure wave

A

Aortic Valve closes at dicrotic notch (start of diastole)
Blood moves from aortic root to peripheral vessels
Slope declines

205
Q

what is the most common artifact for arterial BP monitoring seen in clinical practice and what is it due to?

A

Overshoot of systolic pressure. Due to underdamping or inadequate frequency response

206
Q

Since pulse pressure increases as it goes down the arterial tree… does this sound like over or under damping?

A

under damping (think of it as waves added to the original waveform)

207
Q

what is Einthovens Triangle

A

used for placing EKG leads. its a equilateral triangle whose vertices lie at the Left and Right shoulders and pubic region. the center corresponds to the vector sum of all electric activity in the heart.

208
Q

describe sinus bradycardia

Rhythm/Rate/Characteristics

A

Normal rhythm

less than 60 bpm

209
Q

describe sinus tachycardia

Rhythm/Rate/Characteristics

A

Normal rhythm
more than 100 bpm
originates in SA node

210
Q

describe premature atrial contraction (PAC)

A

ectopic electrical cells in the atria begin to fire an electrical signal telling the muscle in the atria to contract before its supposed to

211
Q

describe sinus arrhythmia

Rhythm/Rate/Characteristics

A
  • rhythm increases with inspiration and decreases with expiration
  • atrial and ventricular rates are normal
  • the difference btwn the shortest and longest P-P interval will exceed 0.12 seconds
212
Q

describe atrial fibrillation

Rhythm/Rate/Characteristics

A

rhythm is irregularly irregular
rate is 100-160 bpm
Normal QRS, PR and P wave are undistinguisable
Many cells in the atria are firing to generate own electrical impulse

213
Q

describe atrial flutter

Rhythm/Rate/Characteristics

A

rhythm is normal
rate is 110 bpm
P wave is replaced with flutter waves at 300 bpm
saw toothed pattern

214
Q

what are the 7 rhythms that occur outside the SA node

A

junctional, SVT, PVC, BBB, 1st/2nd/Complete Heart Block

215
Q

describe supraventricular tachycardia (SVT)

Rhythm/Rate/Characteristics

A

rhythm is regular
rate is 140-220 bpm
impulse generated from AV node

216
Q

describe junctional rhythms

Rhythm/Rate/Characteristics

A

rhythm is regular
rate is 40-60bpm
has inverted or non-visible P wave

217
Q

describe premature ventricular contractions (PVC)

Rhythm/Rate/Characteristics

A

rhythm is regular
rate is normal
ventricles depolarize prematurely in response to a signal within the ventricles
Unifocal= single PVCs that look alike
Multifocal= single PVCs that look different
Bigeminy or Trigeminy= per 2 or 3 beats
Couplets= multiple in a row- leads to v-fib

218
Q

describe bundle branch blocks

A

abnormal conduction through bundle branches- causes depolarization delay through ventricular muscle- causes widening of the QRS complex- can be right heart or left heart bundle branch block

219
Q

describe differences btwn left and right bundle branch blocks

A 
LEFT= never occurs normally- CAD, AS, or HTN heart disease
RIGHT= looks like rabbit ears- CAD, MI, Pulmonary embolism
220
Q

describe a 1st degree AV block

A

conduction delay through AV node but electrical signal still reaches ventricles
-prolonged PR interval

221
Q

describe 2nd degree AV block Type 1 (Wenkebach)

A

conduction block of some (not all) atrial beats- progressive lengthening of the PR interval then dropped QRS complex

222
Q

describe 2nd degree AV block Type 2

A

electrical excitation sometimes fails to pass through the AV node or bundle if HIS- normal PR interval with QRS occasionally dropping

223
Q

describe 3rd degree heart block (complete heart block)

A

atrial contractions are normal but no electrical conduction reaches the ventricles- the ventricles generate their own rhythm that is slow- has a prolonged QRS and variation in PR interval

224
Q

describe V-Tach

A

180+ bpm, prolonged QRS, no P wave- caused by ventricles generating own rapid/irregular rhythm. causes poor CO and cardiac arrest

225
Q

describe V-Fib

A

300+ bpm, ventricles quiver, no CO

226
Q

what does a depressed ST segment/ inverted T wave indicate

A

myocardial ischemia- causes: not enough blood, atheroscelerosis, vasospasm, thrombosis, embolism

227
Q

what does an elevated ST segment indicate

A

Myocardial Injury- caused by no BF

228
Q

what does a deep Q wave (pathologic Q wave) indicate

A

Myocardial infarct with troponin released

229
Q

what are the 5 phases of the cardiac cycle? describe each

A
  1. Isovolumetric ventricular contraction= QRS complex, AV and PV open at the end- MV and TV are closed
  2. Ventricular ejection- AV and PV open, blood pumped systemically
  3. Isovolumetric relaxation- all valves are closed- atrial diastole occurs and blood fills the atria
  4. Ventricular filling- MV and TV open, blood passively fills ventricles
  5. Atrial systole- atria contract and fill ventricles with remaining blood- coincides with ventricular diastole
230
Q

define preload

A

passive stretching of muscle fibers in the ventricle- determined by pressure and blood remaining in the ventricle

231
Q

define afterload

A

pressure that the LV must work againt to contract

232
Q

define contractility

A

ability of the muscle cells to contract after depolarization- ability depends on how much the fibers stretched at the end of diastole

233
Q

define depolarization and repolarization

A 
depolarization= change in a cells membrane potential- making it more positive
repolarization= change in a cells membrane potential- making it more negative
234
Q

what are the phases of the action potential curve

A 
phase 0= rapid depolarization
phase 1= early depolarization
phase 2= plateau
phase 3= rapid repolarization
phase 4= resting phase
235
Q

describe automaticity, excitability and conductivity

A 
automaticity= a cells ability to spontaneously initiate an impulse
excitability= how well a cell responds to an electrical stimuli
conductivity= the ability of a cell to transmit an electrical impulse to another cell
236
Q

what is the conduction pathway of the heart

A 
Sinoatrial Node
Bachmanns Bundle (in LA)
Internodal Tracts
Atrioventricular Node
Bundle of HIS (right and left split)
Perkinje Fibers
**(the nodes and cells have sympathetic AND parasympathetic innervation and each has its own inherent rate)**
237
Q

what are the inherent rates of the SA node, AV node and purkinje fibers

A

SA node= 100 bpm
AV node= 40-60 bpm
PF= 20-40 bpm
- these rates only apply when electrical impulse is not received by the preceding portion of the pathway

238
Q

what does the P wave represent

A

atrial depolarization

239
Q

what does the T wave represent

A

ventricular repolarization (recovery)

240
Q

what does the U wave represent

A

purkinje fiber repolarization (recover)

- a prominant U wave can indicate hypercalcemia, hypokalemia or digoxin toxicity

241
Q

what does the PR interval represent

A

atrial impulse from SA node/AV node/Bundle of His

normal= 0.12-0.20 seconds

242
Q

what does the QRS complex represent

A

intra-ventricular conduction time

normal= 0.08-0.12 seconds

243
Q

what does the ST segment represent

A

the end of ventricular depolarization and the beginning of repolarization

244
Q

describe swan-ganz catheterization

A

small catheter is threaded through a vein until it passes through to the right side of the heart and into the PA and a small balloon is inflated to get PCWP

245
Q

what does a swan-ganz measure

A 
CVP (RV Preload)
PAWP (LV Preload)
Afterload
SVR and PVR
Cardiac Output and Index
Venous Saturation
-Can also be used as a pacemaker
246
Q

what is pulmonary capillary wedge pressure (PCWP) the gold standard for determining/diagnosing?

A

acute pulonary edema (>20mmHg)

- can also be used to determine the severity of LV failure, MS, or ARDS

247
Q

what is the Fick Method

A

measure CO with simultaneous measurement of arterial O2 content, mixed venous O2 content and O2 uptake by the lungs. More accurate with lower cardiac outputs

248
Q

what is doppler ultrasonography

A

doppler effect asses whether blood is moving towards or away the probe and its relative velocity and flow

249
Q

on the CVP waveform, what does the A wave represent and what does it correlate with on an EKG

A

due to the increased atrial pressure during RA contraction- correlates with P wave on an EKG

250
Q

on the CVP waveform, what does the C wave represent and what does it correlate with on an EKG

A

caused by a slight elevation of the tricuspid valve into the RA during early ventricular contraction- correlates with the end of the QRS complex on an EKG

251
Q

on the CVP waveform, what does the X wave represent and what does it correlate with on an EKG

A

due to the downward movement of the ventricles during systolic contraction- occurs before the T wave on an EKG

252
Q

on the CVP waveform, what does the V wave represent and what does it correlate with on an EKG

A

due to the pressure produced when the blood filling the RA comes up against the closed tricuspid valve- occurs as the T wave is ending on an EKG

253
Q

on the CVP waveform, what does the Y wave represent and what does it correlate with on an EKG

A

due to the tricuspid valve opening in diastole with blood flowing into the RV- occurs before the P wave on an EKG

254
Q

what portions of the CVP waveform are systolic events and which are diastolic events

A

Waves C/X/V are systolic

Waves A/Y are diastolic

255
Q

the anterior intercostal artery arises from what artery?

A

interthoracic artery

256
Q

what is the visceral pericardium also known as?

A

epicardium

257
Q

where is the apex of the heart located

A

to the left at the 5th ICS on the midclavicular line

258
Q

where is the atrioventricular sulcus located and what does it contain

A

btwn atria and ventricles

contains right and left coronary arteries, circumflex artery and coronary sinus

259
Q

where is the anterior interventricular sulcus located and what does it contain

A

btwn LV and RV on anterior surface

contains left anterior descending artery and great cardiac vein

260
Q

where is the posterior interventricular sulcus located and what does it contain

A

btwn LV and RV on posterior side

contains posterior interventricular artery and middle cardiac vein

261
Q

where do the coronary arteries arise from

A

the ascending aorta at the aortic valve
Right= Right cusp of AV (Sinus of Valsalva)
Left= Left cusp of AV

262
Q

when does blood fill the coronary arteries

A

when the AV is CLOSED- during diastole

263
Q

what does the right coronary artery supply

A 
RA
Most of RV
Diaphragmatic part of LV
SA node (60%)
AV node (80%)
Posterior septum 1/3
264
Q

what does the left coronary artery supply

A 
LA
Most of LV
Part of RV
SA node (40%)
Anterior spetum 2/3
265
Q

how does coronary blood return to the heart

A

cardiac veins that run parallel to the arteries- empty into the coronary sinus which empties into RA (EXCEPT for the anterior cardiac vein which empties directly into the RA)- also thebesian veins (begin in myocardium) empty into atria/ventricles)

266
Q

Name and describe the 3 layers of the heart wall

A
  1. Epicardium: outer surface, provides slippery texture, composed of mesothelium, has 2 layers
  2. Myocardium: 95% of heart wall, responsible for pumping action, made of cardiac muscle fibers organized in bundles that swirl diagonally
  3. Endocardium: thin layer of endothelium that lines the chambers and valves and is continuous with the endothelial lining of blood vessels
267
Q

describe chordea tendinae and papillary muscles

A

chordea tendinae= thin chords that are attached to the TV and MV to help prevent valve proplapse
papillary muscles= anchor the chordea tendinae to the heart wall (TV has 3 and MV has 2)

268
Q

what is special about the moderator band

A

it is a papillary muscle in the RV that carries the right bundle branch of the conduction system

269
Q

where is the foramen ovale, whats its purpose and what does it turn into after birth

A

located in interatrial septum
used to shunt blood from RA to LA (to bypass lungs) during fetal circulation
turns into Fossa Ovalis after birth

270
Q

describe the tricuspid valve

A

3 leaflets
cusps are triangular
papillary muscles attach to septum

271
Q

describe the mitral valve

A

2 leaflets

papillary muscles do NOT attach to septum

272
Q

describe the pulmonary artery valve

A

semi lunar

3 cusps

273
Q

describe the aortic valve

A

semi lunar
3 cusps
coronary arteries arise from right and left cusps in the sinus of valsalva (posterior cusp does NOT have a coronary artery)

274
Q

the proximal anastomosis site for a CABG is on what vessel

A

Aorta

275
Q

what plane divides the body into anterior and posterior planes

A

frontal plane

276
Q

what lines the superior surface of the diaphragm

A

parietal pleura

277
Q

what is ectopia cordis

A

congenital defect of the sternum where the heart is exposed externally

278
Q

what is pectus excavatum

A

inward funneling of the sternum

279
Q

what is a flail chest

A

trauma resulting in multiple rib fractures- the chest wall moves freely and paradoxically with respiration

280
Q

what are autorhythmic fibers

A

self excitable fibers that generate action potentials to trigger heart contractions- acts as hearts pacemaker. 1% of cardiac fibers become autorhythmic during embryonic development. will continue to stimulate beats even after being removed from the body (transplants)

281
Q

where is the SA node located

A

superior end of the Crista Terminalis (in the RA wall where the RA meets the SVC)
*SA node is the pacemaker of the heart

282
Q

where is the AV node located

A

interatrial septum (superior to the opening of the coronary sinus/in the triangle of Koch)

283
Q

what 3 things form the triangle of Koch

A
  1. Tendon of Todaro
  2. Septal leaflet of the TV
  3. Orifice of the Coronary Sinus
    * *AV node is located inside the triangle
284
Q

After the Bundle of His receives the action potential from the AV node, it travels down the bundle but does not cause a contraction until it reaches the apex. Why does this occur?

A

this ensures that blood is pushed up and out of the ventricles.
** also dont forget that in the RV, the moderator band contains the right bundle branch

285
Q

where does conduction begin and end with the purkinje fibers

A

begins at the beginning of the apex pf the heart upwards to the remainder of the ventricle myocardium and it ends near the AV and PV. Also passes into papillary muscles

286
Q

what regulates (mainly) heart rate and contractility

A

the medulla. recieves information from temp, emotions, stress, cortex, chemoreceptors and baroreceptors

287
Q

what do chemoreceptors and baroreceptors monitor

A 
chemo= chemical changes in blood
baro= pressure changes sensed from the stretching of major vessels (ex: Aortic Arch)
288
Q

describe cardiac, smooth and skeletal muscle

A
  • Cardiac= branching/striated cells that are fused at plasma membrane
  • Smooth= long/spindle with a single nucleus
  • Skeletal= long/striated with multiple nuclei
289
Q

cardiac muscle fibers are composed of smaller units called MYOFIBERS- and those are made of even smaller units called MYOFILAMENTS- these made of thick and thin threads called what?

A

thick protein= Myosin

thin protien= Actin

290
Q

describe sacrolemma

A

this is the plasma membrane enclosing a cardiac fiber- it contains sacroplasm (cytoplasm) and a lot of mitochondria

291
Q

describe intercalated discs

A

holds myofibers together and aids in the conduction of impulse from one cell to the next

292
Q

describe sarcoplasmic reticulum

A

network of tubes/sacs that contain large amounts of Ca++, surrounds each myofibril. (similar to smooth endoplastic reticulum in other cells)

293
Q

describe transverse tubules

A

located at Z disc, crosses the sarcoplasmic reticulum at a right angle. They communicate with the outside of the cell- brings composition of external environment to the interior- allows for easy movement of the action potential from the outside to the inside

294
Q

describe a sarcomere

A

the fundamental unit of muscle contraction- extends from the Z line to Z line- alternating myosin and actin filaments. Contains the A band, I Band, Z line, M line and H zone

295
Q

describe the A band, I Band, Z line, M line and H zone of a sarcomere

A

A Band= middle portion of alternating myosin and actin
I Band= the actin strands that surround the Z Line
Z Line= Zig zag line that cuts across the I Band
M Line= connects adjacent myosin strands w/in H Zone
H Zone= w/in A Band but only contains myosin strands

296
Q

describe the anatomy of actin (thin strands)

A

contains the actin protein, tropomysin and troponin complex. these are twisted together into strands

297
Q

describe the anatomy of myosin (thick strands)

A

myosin proteins with oval heads and long tails

298
Q

which lung is bigger? how many lobes in each?

A

Right is bigger with 3 lobes- left has 2 lobes

299
Q

how many alveoli do the lungs contain? what their surface area?

A

300 million alveoli

surface area is 70 m2

300
Q

why do alveoli secrete surfactant? What is surfact made of? What secretes it?

A

to lower the surface tension, reduce tendency for alveoli collapse, maintain patency. Made of phospholipids and lipoproteins. Secreted by type 2 alveolar epithelial cells

301
Q

how do the lungs react in response to local hypoxia?

A

pulonary vessles constrict (while all other vessels dilate to increase BF) to divert BF to better ventilated areas of the lung where gas exchange it better

302
Q

describe the ligamentum arteriosum

A

a fibrous connective tissue cord that connects the aortic arch bifurcation to the pulmonary trunk. it is remnants of the ductus arteriosus from fetal circulation

303
Q

where does the aortic arch become the thoracic aorta? where does the thoracic aorta become the descending aorta

A

the arch becomes the thoracic aorta at T4 verterbral level and becomes the descending aorta below the diaphragm

304
Q

what are the branches of the aortic arch

A
  1. Brachiocephalic (further branches into Right Subclavian and Right Common Carotid)
  2. Left Common Carotid
  3. Left Subclavian
    * Remember BCS
305
Q

what does the brachiocephalic artery (subclavian and carotid) supply

A
  • right subclavian= right upper extremity, some brain and branch to heart
  • right common carotid= right side of head/neck/brain
306
Q

what does the left common carotid and subclavian supply

A
  • left subclavian= left upper extremity, some brain and branch to heart
  • left common carotid= left side of head/neck/brain
307
Q

what do the subclavian arteries become

A

going up= vertebral arteries of the head

going down= turns into the axillary arteries at the 1st rib

308
Q

where is the phrenic nerve located? what happens if it gets injured

A

arises from C3-C5 nerves and supplies the diaphragm. If injured you will get paralysis of the diaphragm of that side (so it will effect breathing)

309
Q

what is the purpose of the circle of willis

A

allows for potential collateral cerebral blood flow if a blockage were to occur in one area of the brain- helps prevents ischemia

310
Q

what are the 3 layers of a blood vessel

A
  1. Tunica Interna (Intima)= inner epithelial lining
  2. Tunica Media= middle smooth muscle and elastic CT
  3. Tunica Externa (Adventitia)= outer CT covering
311
Q

what layer of the blood vessel controls BF rate and will vasospasm if injured

A

Tunica Media

312
Q

what is the largest gland and 2nd largest organ of the body? how much does it weigh

A

Liver
weighs 1.4 kg or 3 lbs
*2nd most common transplant performed

313
Q

how many lobes does the liver have

A

4 (right/left/caudate/quadrate)

*the falciform ligament divides the right and left lobes

314
Q

what is the liver covered by

A

Glissons capsule (connective tissue)

315
Q

what is the portal triad

A

portal vein
hepatic artery
common bile duct

316
Q

what are 4 functions of the liver

A
  1. produce bile (emulsify fat)
  2. detoxify chemicals/drugs
  3. store glycogen
  4. blood pigment breakdown
317
Q

Name 7 diseases that lead to liver tranplantation

A
  1. hepatitis with cirrhosis
  2. biliary cirrhosis
  3. biliary atresia
  4. hepatocellulat carcinoma
  5. hemochromatosis
  6. wilsons disease
  7. alcoholism
318
Q

what are the 5 anastamosis sites for a liver transplant

A 
Suprahepatic Vena Cava
Hepatic Artery
Portal Vein
Bile Duct
Infrahepatic Vena Cava
319
Q

describe the flow path for V-V bypass for a liver transplant

A

Drain from Portal AND Femoral vein
Flow to centrifigal pump w/ flow probe + heat exchanger
Return blood to Axillary vein

320
Q

what is the difference btwn innate and adaptive immunity

A 
innate= present at birth, non-specific (acts the same against everything)
adaptive= specific recognition and response to pathogens (T and B cells are responsible for this)
321
Q

what are 3 functions of the lymphatic system

A
  1. drain excess interstitial fluid (has 1 way structure for interstitial fluid to flow Out and not In)
  2. transport dietary lipids and lipid soluble vitamins absorbed by GI tract
  3. Immune response
322
Q

what do lymph nodes contain

A

masses of T and B cells

323
Q

what 4 areas in the body do NOT have lymphatic tissue

A
  1. avascular tissue (cartilage/epidermis/cornea)
  2. central nervous system
  3. portions of the spleen
  4. red bone marrow
324
Q

Immature T Cells migrate to the thymus to begin to mature? Only 2% survive to maturity. Where do the surviving T Cells go

A

Medulla

325
Q

how does blood flow through a lymph node

A

enters through afferent lymphatic vessel- then it enters sinuses (trabecular and medullary)- drains into efferent lymphatic vessels

326
Q

what is the largest single mass of lymphatic tissue

A

the spleen
white pulp= lymphatic tissue
red pulp= blood filled venous sinuses

327
Q

what are the 8 functions of the kidney

A
  1. regulate blood chemistry composition
  2. regulate blood pH
  3. regulate blood volume
  4. regulate blood pressure
  5. regulate blood osmolarity
  6. produce hormones (erythropoietin and calcitrol)
  7. excrete wastes (ammonia, urea,bilirubin, creatinine)
328
Q

what is the functional unit of the kidney

A

nephron

1 million per kidney

329
Q

how does blood flow through the kidney

A

renal artery- afferent arterioles- glomerular capillaries- efferent arterioles- peritubular capillaries- renal vein

330
Q

body water account for 60% body weight. Of that 60%, how much is intracellular and how much is extracellular

A

2/3 intracellular [volume in cells]

1/3 extracellular [interstital/plasma/ect]

331
Q

what is the % cardiac output that goes to the

  1. Brain
  2. Heart
  3. Bronchi
  4. Kidneys
  5. Liver
A
  1. Brain 14%
  2. Heart 3%
  3. Bronchi 2%
  4. Kidneys 22%
  5. Liver 27% (21% portal and 6% arterial)
332
Q

what is the purpose of endoplasmic reticulum in cells

A

synthesize new protein molecules

-Smooth ER produces lipids and enzymes that control glycogen breakdown and detoxify substances

333
Q

what is the purpose of the golgi apparatus in cells

A

it is prominent in secretory cells and lysosomes- creates vesicles that contain proteins from the ER

334
Q

what is the purpose of lysosomes in cells

A

breaks off from the golgi apparatus- function as intracellular digestive system (digests food particles, damaged cell structures, bacteria ect). Digests things with hydrolase enzymes

335
Q

what is the purpose of peroxisomes in cells

A

formed by self replication or by breaking off the smooth ER. Contains oxidases including catalase. They are similar to lysosomes b/c they break down substances

336
Q

what is the purpose of mitochondria in cells

A

“power house”- contain oxidative enzymes and other enzymes needed to extract energy from nutrients. they are self replicating. They heart has the most per cell b/c it consumes so much oxygen

337
Q

describe the structure of adenosine triphosphate (ATP)

A

its a nucleotide made of a nitrogenous base (adenine), pentsose sugar (ribose) and 3 phosphate radicals
** the last 2 phosphates are connected by a high energy bond which hold 12K calories per gram mole of ATP

338
Q

how do carbs, fatty acids and proteins produce ATP

A

Carbs= 1. Aerobic (citric acid/krebs cycle) 2. Anaerobic (glycolysis)
Fatty Acids= Beta Oxidation
Proteins= Hydrolysis to amino acids

339
Q

define brownian motion

A

random motion in all directions- speed is affected by temperature- bigger molecules move slower

340
Q

name 4 lipid soluble substances that can move directly through a cell membrane

A

oxygen/ carbon dioxide/ nitrogen/ alcohol

341
Q

how do lipid insoluble substances cross a cell membrane

A

via a protein channel (can be gates to control entry and can be specific to certain substance)

342
Q

what are protein channels that are specific for water called? what is the diffusion rate of water across a cell membrane?

A 
Aquaporins
Rapid diffuison (100x the cell volumes moves in or out of an RBC each second)
** Only water can pass through- hydrated ions cannot pass
343
Q

describe the Na-K pump of the cell

A

pump moves 3 Na out and 2 K in. this sets up an electrical (-4mV) and osmotic gradient. they also regulate the amount of water in the cell- w/o the pump, cells would accumulate water

344
Q

what is the Nernst Equation (used to calculate membrane potential if you know the concentration of an ion on both sides of the membrane

A

(+/-61.5/valence) * (Log [ion inside/ion outside])
use +61.5 for NEGATIVE ions and -61.5 for POSITIVE ions
final units in mili volts

345
Q

most cells in the body have a _____ resting membrane potential

A

negative

346
Q

SODIUM: what is the ion concentration inside and outside of a cell membrane and what is the resulting membrane potential?

A

Inside: 10
Outside: 142
Membrane Potential: 71 mV

347
Q

POTASSIUM: what is the ion concentration inside and outside of a cell membrane and what is the resulting membrane potential?

A

Inside: 140
Outside: 4
Membrane Potential: -95 mV

348
Q

CALCIUM: what is the ion concentration inside and outside of a cell membrane and what is the resulting membrane potential?

A

Inside: 0.0001
Outside: 2.4
Membrane Potential: 134 mV

349
Q

CHLORIDE: what is the ion concentration inside and outside of a cell membrane and what is the resulting membrane potential?

A

Inside: 4
Outside: 103
Membrane Potential: -87 mV

350
Q

what is the normal resting membrane potential for cardiac cells

A

-90 mV

351
Q

what happens if you increase or decrease K+ permeability

A

Increase K+ permeability= more pos charges leave cell making it more negative and hyperpolarized
Decrease K+ permeability= less pos charges leave cell making it less negative and depolarized

352
Q

what happens if you increase or decrease Na+ permeability

A

Increase Na+ permeability= more pos charges enter cell making it less negative and depolarized
Decrease Na+ permeability= less pos charges enter cell making it more negative and hyperpolarized

353
Q

during phase 0 of the action potential, we see depolarization with a big increase in Na+ permeability. what does the membrane potential become

A

will go as high as +35 mV

354
Q

during phase 1 of the action potential,, how do Na+, Ca++ and K+ react

A

Na+ permeability starts to decrease
Ca++ permeability increases
K+ permeability starts to increase

355
Q

during phase 2 of the action potential, why do we see a plateau? how are Na+ and K+ reacting

A

plateau is due to increased Ca++ movement into cells
Na+ permeability is back to normal
K+ permeability continues to increase

356
Q

during phase 3 of the action potential, why does repolarization occur? how is Ca++ reacting

A

repolarization is due to a big increase in K+ permeability
Ca++ permeability is back to normal
–membrane potential is now at resting level (-90 mV)

357
Q

during phase 4 of the action potential, cells of the atria and ventricles are at a stable resting potential- but the SA and AV nodes potential is unstable….why?

A

Na+ permeability slowly increases- allowing Na+ ions to enter the cell and slowly depolarize it to restart the cycle at phase 0

358
Q

what % of blood is plasma, RBCs and WBCs/Platelets

A 
Plasma= 54%
RBCs= 45%
WBCs/Platelets= 1%
359
Q

what does plasma consist of

A

90% water
10% solute= proteins, electrolytes, non-electrolytes (Phospholipids, cholesterol, glucose, urea, lactic acid, creatinine, bilirubin, bile salts

360
Q

what 3 electrolytes are responsible for normal impulse conduction in nerves and muscle fibers

A

Na+
K+
Ca++

361
Q

what 2 electrolytes are responsible for maintaining fluid balance btwn blood and body tissues

A

Na+

Cl-

362
Q

what electrolyte is responsible for coagulation and muscle contraction

A

Ca++

363
Q

what electrolyte is responsible for maintaining cardiac rhythm

A

K+

364
Q

what electrolyte is responsible for replacing bicarb ions taken up by RBCs

A

Cl- (chloride shift)

365
Q

what electrolyte is responsible for promoting normal neuromuscular function

A

Mg++

366
Q

what are the 3 plasma proteins? and their concentrations and percentage

A 
Albumin= 4.5 g/dl - 62% total plasma protein
Globulins= 2.5 g/dl - 34% total plasma protein
Fibrinogen= 300 mg/dl - 4% total plasma protein
367
Q

what is the molecular weight of albumin?
what organ produces it? how much daily?
what is albumins purpose?

A

Molecular weight= 66,000
Produced by liver, 15 g produced daily
Purpose= main protein responsible for colloid osmotic pressure, transports free fatty acids and bilirubin, binds competitively with drugs

368
Q

what are the 4 types of globulins and what are their functions?

A
  1. Alpha-1=
  2. Alpha-2=
  3. Beta=
  4. Gamma/Immunoglobulins=
369
Q

what are the 4 plasma proteolytic protein systems

A
  1. Complement
  2. Coagulation
  3. Kinin= formation of bradykinina dn kallikreins
  4. Fibrinolytic= produces plasmin to breakdown fibrin
370
Q

what is hypoproteinemia? what can cause it? what does it effect? how can you fix it on CPB?

A

Protein deficiency caused by decreased protein intake/absorption/production (liver problems) or hemodiltion on CPB. It affects pH, clotting and fluid balance. You can fix it by giving albumin, diuretics or hemoconcentrating

371
Q

what is hyperproteinemia? what causes it? what does it affect?

A

Increased plasma proteins cause by multiple myeloma or abnormal production of paraproteins (abnormal immunoglobulin produced by malignancies of the spleen, liver or bone marrow. Affects hyperviscosity which can cause microvascular clot formation

372
Q 
What are the dimensions of a RBC
Shape=
Diameter=
Greatest and least thickness=
Area=
Volume=
A 
Shape= biconcave discoid
Diameter= 8.1 microns
Greatest and least thickness= 2.7 - 1.0 microns
Area= 138 microns2
Volume= 95 microns3
373
Q

what is the life cycle of a RBC?
what is RBC production affected by?
how are old/damaged RBCs removed from the body?

A
  • life cycle is 120 days
  • production is affected by arterial pO2
  • old/damaged RBCs are removed by macrophages in the liver and spleen
374
Q

what are immature RBCs called?

what are remnants of ruptured RBCs called?

A

immature RBCs= reticulocytes

remnanats= ghosts or red cell stroma

375
Q

what are the contents inside a RBC

A

70% water
25% hemoglobin
5% other constituents (Na+, K+, Cl-, Bicarb, proteins)
**NO NUCLEUS OR OTHER ORGANELLES

376
Q

how many molecules of hemoglobin are in each RBC

A

300 million

-once released to circulation, the RBC cannot produce anymore hemoglobin

377
Q

describe the structure of hemoglobin

A

4 polypeptide chains of amino acids (2 alpha and 2 beta chains). A heme molecule is attached to each chain and each heme molecule can bind with one molecule of oxygen

378
Q

what does it mean if hemoglobin has a high or low affinity for oxygen?

A

high affinity= easy to bind with O2 and hard to release

low affinity= hard to bind with O2 and easy to release

379
Q

what is the oxyhemoglobin dissociation curve? what is the P50 concept?

A

curve shows us arterial pO2 vs hemoglobin saturation. this gives us an idea of the affinity for oxygen. the P50 shows us what arterial pO2 will give us 50% saturation

380
Q

what is bohr affect? How does a decreased or increased affinity affect the curve?

A

shows how CO2 and pH affect the affinity for oxygen to bind to hemoglobin (on the oxyhemoglobin dissociation curve)

  • decreased affinity= curve shifts to the right (CO2 increases, pH decreases)
  • increased affinity= curve shifts to the left (CO2 decreases, pH increases)
381
Q

what % of oxygen in the body is dissolved in plasma and how much is reversibly bound to hemoglobin in the RBC

A

2% dissolved in plasma

98% bound to hemoglobin

382
Q

what % of CO2 is dissolved, bound to protein and chemically modified to bicarb

A

dissolved= 5%
bound to protein= 3%
modified to bicarb= 95%

383
Q

what is methemoglobin and methemoglobin reductase

A

the normal state of iron (Fe2+) on heme becomes oxidized to Fe3+ to form methemoglobin which does not bind to O2- this is caused oxidation by nitrites or sulfates and congenital deficiencies of methemoglobin reductase. [blood looks bluish brown]
- methemoglobin reductase is the enzyme in the RBC that keeps iron in its reduced state

384
Q 
Fetal hemoglobin (Hgb F):
When does production start?
Where is it produced?
Is its affinity for O2 high or low?
How is it different from Adult hemoglobin (Hgb A)?
When is Hgb F replaced by Hgb A?
A
  • production starts in the 4th month
  • produced by immature RBCs in bone marrow
  • high affinity for O2
  • the polypeptide chains are different from Hgb A
  • Hbg A replaces Hbg F btwn 3-6 months after birth
385
Q

describe Sickle cell anemia (Hgb S)

A

its a congenital disease with the production of a defective gene that codes Hgb. The Beta chain substitutes valine for glutamic acid at position 6
Homozygous= 100% Hgb S production
Heterozygous= 40% Hgb S and 60% Hgb A

386
Q

The structural change of Hgb S is triggered by low O2 content (change can be reversible or permanent). The sickled cells will easily hemolyze and become trapped it microvasculature. What can this result in?

A

ulcerations of low extremities
organ infarction
retinal degeneration

387
Q

when RBCs are lysed, hemoglobin is released as plasma-free hemoglobin. What can this cause?

A

the remnants of the cell can activate the clotting cascade

388
Q

what are the 3 types of WBCs and their sub-types?

A
  1. Granulocytes (Neutrophils/Eosinophils/Basophils)
  2. Monocytes (become macrophages)
  3. Lymphocytes (T cells/ B cells)
389
Q

what progenitor cell lineage do granulocytes arise from?

A

myeloid lineage

390
Q 
Neutrophils: 
what is the primary function?
how do they respond to inflammation/infection?
what are they sensitive too?
what do they eventually form?
how are they removed?
what is their life span?
A
  • primary phagocytic defense against bacteria
  • respond quickly and in large #s to sites of inflammation
  • sensitive to chemotactic molecules
  • cause pus formation
  • removed by macrophages
  • 10-12 hours in blood then 5-6 days in tissue
391
Q 
Eosinophils:
what is the primary function?
what do they release and what does that do?
are they weak or strong phagocytes?
where do they mature?
what is their life span?
A
  • function in allergic reactions
  • release a chemical called Major Basic Protein (MBP) which binds to the antigen and lyses its membrane. TOXIC to all antigens
  • weak phagocytes
  • matures in bone marrow, circulate for 1 day then enters tissure
  • life span is 12- 24 hours
392
Q

Basophils:
what is the primary function?
what do they exhibit?
what are they called when found in tissues?

A
  • release histamine and heparin into area of antigen invasion
  • exhibit chemotaxis with little phagocytosis
  • called Mast cells when in tissue space
393
Q

what are the % concentration of the 3 types of granulocytes?

A 
Neutrophils= 60%
Eosinophils= 2%
Basophils= 1%
394
Q 
Monocytes:
what releases them into circulation?
how long do they circulate?
what are they called when they enter tissue space?
are they small or big?
A
  • released from bone marrow at immature stage
  • circulates for 1-2 days
  • mature into Macrophages when they enter tissue space
  • very BIG
395
Q

Lymphocytes:
what progenitor lineage do they arise from?
what is the main function?

A
  • arise from lymphoid lineage of progenitor cells
  • most complex WBC- they direct the immune response- they can recognize, respond to and retain memory for specific antigens
396
Q

Platelets:
what progenitor lineage do they arise from?
what is the main function?
where are they produced?

A
  • arise from myeloid lineage of progenitor cells
  • major role in coagulation
  • produced in bone marrow by fragmentation of megakaryocytes
397
Q

what is hematopoiesis? where does it occur? what controls it?

A
  • production of mature blood cells from primitive stem cells (pluripotential cells)- 1 trillion cells made daily
  • occurs in red bone marrow
  • controlled by protein hormones (hematopoietic growth factors which are glycoprotein molecules called cytokines)
398
Q

what are the 4 hematopoietic growth factors requires for the growth and development of new cells

A
  1. Interlukens 1-13
  2. Colony stimulating factors (G-CSF and GM-CSF)
  3. Thrombopoietins (all molecules responsible for the development of platelets and megakaryocytes)
  4. Erythropoitin (renal hormone)
399
Q

what is erythropoiesis

A

renal peritubular cells sense low O2 levels and stimulate the release of erythropoietin which then activates stem cells in the hematopoietic marrow to produce RBCs

400
Q

whats the difference between antigens and antibodies

A

Antigens are substances that provoke an immune response.
Antibodies are proteins that are secreted as a result of the antigen provoked immune response.
In short, antigens cause the disease and antibodies cure it

401
Q

what are the 6 varieties of antigens that the RBC membrane can express

A

ABO / Rh / Kidd / Kell / Duffy / Lewis

402
Q 
What antigens and antibodies does each blood type present?
Type A
Type B
Type AB
Type O
A

Type A= A antigen / B antibody
Type B= B antigen / A antibody
Type AB= A and B antigen / NO antibodies
Type O= NO antigens / A and B antibodies

403
Q

what blood type is the universal acceptor and donor

A 
AB= acceptor
O= donor
404
Q

what happens when blood types mix

A

the recipients antibodies attach to the anitgen on the RBC which stimulates complement activation and then agglutination and lysis occur

405
Q

what is newborn Rh hemolytic disease

A

the first child is D+ while the mother is D-. The mother develops the D antibody. Then when pregnant with the second child- it is exposed to the D antigen via the placenta. have to treat with blood transfusions every 2 weeks and the mother gets immunizations to decrease the formation of the D antibody

406
Q

how much blood can an adult donate and how often?

A

450 ml every 8 weeks

407
Q

what 4 things do citrate anticoagulants contain and what is the purpose of each

A
  1. Citrate= binds with Ca++
  2. Phosphate= control pH and keep high levels of ATP
  3. Dextrose= energy source to maintain viability
  4. Adenine= helps maintain high levels of ATP
408
Q

Whole Blood / PRBC Storage:
Temp:
Shelf Life:

A
  • refrigerated at 1-6 C

- refrigerated shelf life is 21 days with CPD or CP2D and 35 days with CPDA-1

409
Q

Platelets Storage:
Temp:
Shelf Life:
Special requirement:

A
  • temp is 20-24C
  • shelf life is 5 day
  • must be slowly rocked
410
Q

Plasma Storage:
Temp:
Shelf Life:

A
  • temp= frozen at -18C

- shelf life is 1 year

411
Q

Lungs are very elastic and their natural tendency is to __________ when no force is applied to keep the lungs inflated

A

collapse ( force air out of lungs)

412
Q

what creates the natural expansion of the lungs

A

the surface tension of pleural fluid and drainage of the pleural cavity by lymphatic channels creates negative pressure (suction) btwn the visceral and parietal pleura that holds the visceral surface of the lungs close to the chest wall

413
Q

what is transpulmonary pressure

A

the difference btwn alveolar pressure and pleural pressure- measures the elastic forces in the lungs that tend to collapse the lungs- an increase in transpulmonary pressure indicates that forces trying to collapse the lungs have increased

414
Q

what is lung compliance? what is the normal value?

A

it is how much the lungs will expand for each unit increase in transpulmonary pressure
Normal= 200 mls of air per 1 cmH2O increase in transpulmonary pressure

415
Q

when does surfactant starts to form (babies)?

describe the differences btwn newborn and adult alveoli?

A

starts to form during 6-8th month of GESTATION
-newborn alveolus diameter is less than 1/4 of an adult and the tendency for them to collapse can be 6-8x that of an adult (condition is called respiratory distress syndrome of the newborn)

416
Q

what is lung tidal volume and its normal value?

A

volume normally inspired/expired

500 ml

417
Q

what is lung vital capacity and its normal value?

A

Max amount of air that can be expired after max inspiration: 4600 ml

418
Q

what is total lung capacity and its normal value?

A

Max volume the lungs can hold

5800 ml

419
Q

what is minute respiratory volume and the equation

A

total amount of new air moved into the respiratory passages each minute
Tidal Volume*Respiratory Rate

420
Q

what is alveolar ventilation and the equation

A

total amount of new air that is brought into the alveoli each minute
(Tidal Volume-Dead Space)*(Respiratory Rate)

421
Q

describe bronchial circulation

A

High pressure/Low flow, supplies arterial blood to the respiratory system, branches off thoracic aorta and returns blood to the pulmonary veins, 1% of cardiac output

422
Q

describe pulmonary circulation

A

Low pressure/High flow, large compliance, supplies venous blood to lungs for gas exchange and returns blood to left atrium

423
Q

what % and volume (ml) of blood is held in the lungs

A 
9% of total blood volume
450 ml (70ml of that is in pulmonary capillaries)
424
Q

what is the normal alveolar surface area

A

750-1050 ft2

425
Q

how does left heart failure or mitral valve problems effect changes in blood volume in the lungs

A

can change from 1/2 normal to 2x normal bc of increased resistance to flow leaving the pulmonary capillaries

426
Q

describe blood flow through zone 1, 2, and 3 of the lungs

A

Zone 1: No BF at any time (Alveolar pressure is always greater than pulmonary capillary pressure)
Zone 2:Intermittent BF (Flow during systole and little flow during diastole)
Zone 3: Continuous BF (Pulmonary capillary pressure is always higher than alveolar pressure)

427
Q

how does increased cardiac output affect the lungs

A
  1. Increased # of open capillaries
  2. Distend open capillaries to decrease resistance and increase flow
  3. Increase pulmonary arterial pressure
428
Q

how does left heart failure affect pulmonary circulation

A
  • LA press of 6 mmHg= dilation of pulomary veins
  • LA press >7 mmHg= increase in pulmonary pressure back to the RA (increased work load of right heart)
  • LA press >30 mmHg= pulmonary edema
429
Q

how do the lungs compensate if pulmonary capillary pressure remains elevated for more than 2 weeks and they have pulmonary edema?

A

there is a large expansion in lymphatic blood vessels (can carry 10x normal volume)- this allows patients with LA pressure >40 mmHg to live w/o developing lethal pulmonary edema

430
Q

describe how the sarcomere of the myofibril contracts

7 steps

A
  1. Ca++ enters the cell/interacts with troponin
  2. Conformational shift in tropomyosin exposes binding sites and cross bridges form
  3. Myosin head lacking a bound nucleotide locks onto a actin filament (rigor configuration)
  4. ATP binds to the back of the head and actin moves away from myosin
  5. Cleft closes around ATP and hydrolysis of ATP occurs while ADP and phosphate remains on myosin
  6. Myosin now releases the phosphate which triggers the power stroke then the ADP is released
  7. Myosin head regains original position
431
Q

what is the ideal gas law equation

A 
P= nRT/V
P (partial pressure)
n (amount of gas)
R (Gas constant= 0.082)
T (Temp in Kelvin) [zero K= -273C)
V (volume in liters)
432
Q

what is boyles law

[remember T pG/vG]

A

at a constant temp, pressure of gas is INVERSLEY proportional to the volume of gas

433
Q

what is charles law

[remember P vG=tG]

A

at a constant pressure, volume of gas is DIRECTLY proportional to the temp of gas

434
Q

what is gay-lussacs law

[remember V pG=tG

A

at a constant volume, pressure of gas is DIRECTLY proportional to the temp of gas

435
Q

what is the % and partial pressure of Nitrogen

A

79%

600 mmHg

436
Q

what is the % and partial pressure of Oxygen

A

21%

160 mmHg

437
Q

what is the % and partial pressure of Carbon Dioxide

A
  1. 04%

0. 30 mmHg

438
Q

what is henrys law equation and the 2 possible solubility coefficients

A

[gas]= partial pressure of gas * solubility coefficient
Solubility coefficient is either:
0.024 ml O2/ ml solution/ atm
0.003 ml O2/ 100 ml solution/ mmHg

439
Q 
what is the solubility of:
Oxygen
Carbon Dioxide
Nitrogen
Helium
A

Oxygen= 1
Carbon Dioxide= 24
Nitrogen= 0.5
Helium= 0.33

440
Q

how many more times is CO2 more soluble than:
Oxygen
Nitrogen
Helium

A 
Oxygen= 24
Nitrogen= 57
Helium= 71
441
Q

what is the diffusion equation

A

[(change in P)*(Solubility)] / [(Sqrt of MW)]

442
Q 
what is the diffusability of:
Oxygen
Carbon Dioxide
Nitrogen
Helium
A

Oxygen= 1
Carbon Dioxide= 20
Nitrogen= 0.53
Helium= 0.95

443
Q

how many more time is CO@ more diffusable that O2? Why is this?

A

20x more diffusable bc of the difference in molecular weight. So for every 1 molecule of O2 removed, 2 molecules of CO2 is removed

444
Q

what happens to O2 solubility when temp goes up

A

solubility increases

445
Q

what is the difference btwn the Bohr and Haldane effect

A 
Bohr= shows how changes in CO2 affects Hgb affinity for O2 (Increased CO2 decreases O2 affinity)
Haldane= shows how changes in O2 affects Hgb affinity for CO2 (Increased O2 decreases CO2 affinity)
446
Q

what is the limiting factor of O2 utilization at the tissue level?

A

the amount of ADP determines the amount of O2 utilization UNTIL the pCO2 goes over 1 mmHg

447
Q 
what is the non lethal range for:
O2
CO2
Na+
K+
Ca++
Bicarb
Glucose
Body Temp
pH
A 
O2= 10-1000 mmHg
CO2= 5-80 mmHg
Na+= 115-175 mmol/L
K+= 1.5-9.0 mmol/L
Ca++= 0.5=2.0 mmol/L
Bicarb= 8-45 mmol/L
Glucose= 20-1500 mg/dL
Body Temp= 18.3-43.3C
pH= 6.9-8.0
448
Q

what is the difference btwn pressure work and strok work of the heart

A
  • -pressure work= work needed to move blood from low pressure veins to higher pressure arteries (99% of total work)
  • -stroke work= work needed to accelerate blood to its ejection velocity [kinetic energy] (1% of total work)
449
Q

what is the work load of the right side of the heart compared to the left side?

A

1/6th

450
Q

what is normal end diastolic filling volume of the LV?

what is the normal end systolic volume of the LV?

A

diastolic filling= 120 ml
end systolic= 50 ml
(difference of 70 ml is stroke volume)

451
Q

what are the factors that change heart rate?

what are the factors that change stroke volume?

A

Heart rate= sympathetic and/or parasympathetic tone

Stroke volume= Preload/Afterload/Contractility

452
Q

with normal myocardial function, how (what type) is energy produced by the heart

A

75% from oxidative metabolism of fatty acids

25% from lactate and glucose

453
Q

how do fetal myocardial cells derive most of their ATP

A

from lactate and glucose

-changes to fatty acid oxidation several weeks after birth

454
Q

what is venous saturation of the heart?

what is the only way to increase O2 supply to the heart?

A

venous saturation is 25% (most of the O2 is used)

have to increase coronary BF to increase O2 supply

455
Q

what is the basal metabolism and muscle contraction % O2 use of the heart?

A

basal metabolism uses 25% of the O2

muscle contraction uses the other 75%

456
Q

how many more time are veins more dispensable than arteries

A

8x

So the same increase in pressure would result in 8x the increase in volume in a vein than an artery of the same size

457
Q

what is the volume/pressure compliance for an artery and a vein

A 
artery= 2ml / mmHg
vein= 100ml / mmHg
458
Q

approximately how much lymphatic flow is returned to the circulatory system each day?

A

2.5 liters

459
Q 
what is the blood volume disbursement as a % among:
Systemic Circulation:
Pulmonary Circulation:
Heart:
Arteries:
Arterioles/Capillaries:
Veins/Venules:
A 
Systemic Circulation: 84%
Pulmonary Circulation: 9%
Heart: 7%
Arteries: 13%
Arterioles/Capillaries: 7%
Veins/Venules: 64%
460
Q

under normal conditions, is MAP closer to systolic or diastolic pressure?

A

diastolic….but as HR increases the MAP gets closer to systolic pressures

Uncategorized (4 decks)

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