Lectures 25-27

Question 1

Cardiac Cycle

Answer 1

alternating, recurring contraction and relaxation of the heart along with associated events, valve openings, ECG

Question 2

Fluids move down

Answer 2

their pressure gradient (high to low pressure)

Question 3

Isometric contraction

Answer 3

force of contraction without change in fiber length

Question 4

Isovolumetric contraction

Answer 4

3-D version of isometric contraction; force of contraction without a change in volume; increase in pressure, no change in volume

Question 5

Isotonic contraction

Answer 5

shortening of fiber length without changing the force; or change in pressure without change in pressure

Question 6

Afterload contractions

Answer 6

always start ISOVOLUMETRIC and then ISOTONIC

Question 7

Systole

Answer 7

period of contraction

Question 8

Diastole

Answer 8

period between contractions (relaxation)

Question 9

Systole Isovolumetric ventricular contraction

Answer 9

All valves close, ventricles contracting, volume the same but pressure increases

Question 10

Systole ventricular ejection

Answer 10

Isotonic: pressure inside greater than outflow pressure, aortic and pulmonic valves open, volume decreases and pressure remains constant

Question 11

Diastole ventricular relaxation isovolumetric relaxation

Answer 11

All valves close, ventricles constant volume pressure gradient reverses Pi<Po, pressure drops below the atrial pressure

Question 12

Rapid ejection vs reduced ejection

Answer 12

Rapid ejection: Huge driving force due to pressure difference in Pi and Po; slows as pressure difference lessens

Question 13

Diastole ventricular filling

Answer 13

Driving force between atria and ventricle causes AV valves to open and isotonic contraction

Question 14

Rapid and reduced filling and atrial systole

Answer 14

Rapid filling: AV valve opens blood rushes from atrium to ventricle more slowly as the pressures equalize (reduced filling), atrial systole - active filling

Question 15

Afterload refers to

Answer 15

the resistance against which the chamber is pumping or contracting

Question 16

Excessively high afterload

Answer 16

afterloaded contraction would become isovolumetric only

Question 17

Afterload of 0

Answer 17

afterloaded contraction would become isotonic only

Question 18

Isovolumetric ventricular contraction of systole

Answer 18

ALL valves are closed, heart is contracting but volume remains the same as pressure rises

Question 19

Ventricular ejection of ventricular contraction of systole

Answer 19

P in LV > P in Aorta, causing Aortic/Pulmonic valves to open. Contraction continues as volume decreases, pressure remains the same

Question 20

Isovolumetric relaxation diastole

Answer 20

P in LV < P in Aorta, causing the aortic valve to slam shut, ALL valves are closed - volume remains constant, pressure drops (reversed)

Question 21

Ventricular filling of diastole isotonic

Answer 21

when P in LV < P in RA, AV valves open and rapid filling occurs as pressure remains the same and volume increases, followed by reduced filling and atrial contraction

Question 22

Atrial contraction

Answer 22

accounts for 20-30% of ventricular filling volume; greater during EXERCISE

Question 23

Similarities between R and L ventricles

Answer 23

Same filling, ejection, same opening/closing of valves

Question 24

Differences between R and L ventricles

Answer 24

R ventricle is a low-pressure system, afterload for the right is lower than for the left; Pulmonic valve opens slightly before and closes slightly after aortic valve due to low pressure system (even though systole begins first in the LV)

Question 25

S1 Heart Sound

Answer 25

Closing of the AV valves, open due to increased atrial pressure, closed when P ventricles > P atria. Closing causes vibration of valves, blood in vessels, etc

Question 26

An exaggerated S1 Heart Sounds may be caused by

Answer 26

Shortened PR interval, mild mitral stenosis

Question 27

A diminished S1 Heart Sound may be caused by

Answer 27

Lengthened PR interval, mitral regurgitation

Question 28

S2 Heart Sound

Answer 28

closure of the aortic and pulmonic valve, close when P in ventricles < Pressure (aorta/pulmonary a)

Question 29

Physiologic split

Answer 29

Aortic valve (A2) closes slightly before pulmonic valve (P2), upon inspiration -> decreased intrathoracic pressure -> increased blood flow to R side of heart -> increased R ventricle EDV and SV -> increases ejection phase and pulmonic closes late

Question 30

Inspiration causes physiologic split to

Answer 30

widen

Question 31

Exhalation causes physiologic split to

Answer 31

narrow or disappear

Question 32

What condition would cause widening of the physiologic split?

Answer 32

pulmonic stenosis

Question 33

What condition would cause a paradoxical split?

Answer 33

LEFT BUNDLE BRANCH BLOCK, severe aortic stenosis (A2 follows P2)

Question 34

Extra Systolic heart sounds

Answer 34

Ejection clicks heard in systole; early in systole or late in systole

Question 35

Ejection click heard early in systole

Answer 35

may be due to aortic or pulmonic valve stenosis or dilation of aorta or pulmonary a

Question 36

Ejection click heard late in systole

Answer 36

may be due to prolapsing of mitral or tricuspid valve

Question 37

Extra Diastolic heart sounds

Answer 37

Opening snap, third heart sounds, fourth heart sound

Question 38

Opening snap in diastole

Answer 38

mitral or tricuspid valves opening can be heard after S2 when they are stenosed

Question 39

3rd Heart sound

Answer 39

occurs in diastole during rapid filling phase; due to excessive oscillation of blood in the ventricle; (normal in children), may indicate heart disease in older adults. Increased diastolic ventricular filling in CHF or severe mitral/tricuspid regurgitation

Question 40

4th heart sound

Answer 40

heard late in diastole, during the atrial contraction into a stiffened ventricle. Hypertrophy or ischemia may cause fibrosis in the ventricle, decreasing compliance

Question 41

Murmur

Answer 41

abnormal sound generated by turbulent blood flow in chambers of the heart and great vessels (valvular lesions or septal defects)

Question 42

Systolic Murmurs

Answer 42

Occur after S1; aortic or pulmonic valve stenosis (high-pitched increased flow velocity); mitral or tricuspid valve insufficiency regurgitation of blood back into atria (low-pitched); interventricular septal defect from left ventricle to right due to patent septum

Question 43

Diastolic murmurs

Answer 43

Occur after S2; mitral stenosis or aortic insufficiency (regurgitation) (Left sided because high pressure system)

Question 44

Continuous murmur occurs during both systole and diastole

Answer 44

Patent ductus arteriosus; flow from aorta to the pulmonary a continuously since the pressure is always greater in the aorta

Question 45

to-and-fro murmurs

Answer 45

outflow valve is stenosed AND insufficient

Question 46

Aortic stenosis wigger diagram

Answer 46

look for a much larger P in the left ventricle than P in the aorta

Question 47

Mitral stenosis wigger diagram

Answer 47

Increased P in atrium

Question 48

Aortic Insufficiency wigger diagram

Answer 48

decreasing pressure in aorta and increasing pressure in LV during diastole

Question 49

Mitral insufficiency wigger diagram

Answer 49

increasing pressure in atria during systole