Test 1💥 Flashcards

Question

What is another term/ shorthand for pulmonary artery pressure?

Answer 1

PAP/MPAP Mean pulmonary artery pressure

Answer 2

25mmHg/ 8mmHg Large variability

Answer 3

Left atrium

Answer 4

16mmHg - 2mmHg= 14mmHg

Answer 5

Systolic - Diastolic

Answer 6

120-80= 40mmHg

Answer 7

Should be stretchy

Answer 8

systole--aorta accommodated lots of blood pumped out of the heart

Answer 9

Blood pumped from aorta is pushed downstream into the system providing blood flow through systemic circuit

Answer 10

Large arteries have widening of pulse pressures

Answer 11

Large arteries (ex: femoral art) are much less stretchy than the aorta When blood is fed into that container the walls are stiff so the pressure goes up

Answer 12

Arterioles

Answer 13

Pulse pressure is reduced as blood is moving through an area of high resistance from energy expended

Answer 14

Increased systolic pressure and decreased diastolic pressure

Answer 15

High pulse pressure Attempting to put blood into a container that have stiff walls and no give

Answer 16

Pressure would be very low

Answer 17

Stiff vessels

Answer 18

Vessels that are stretchy/relaxed walls

Answer 19

Veins would not have a pulse pressure because the walls have a lot of stretch when blood is fed into them compared to arteries which are stiff and dont stretch when blood is fed into them

Answer 20

When everything else is equal: increase SV increases pulse pressure decreased SV decreases pulse pressure

Answer 21

Pulmonary circuit is very stretchy so not expected to see huge spikes during ejection of right ventricle

Answer 22

Lower vascular resistance

Answer 23

Arterioles

Answer 24

Pulmonary arterioles are stretchy so pressure upstream and downstream is less than in systemic circulation

Answer 25

Compliance

Answer 26

Change in volume / Change in pressure

Answer 27

Takes a lot of pressure to put in a little volume --low compliance vessel

Answer 28

Takes little pressure to put a large volume into vessel--high compliance vessel

Answer 29

During Diastole (filling)

Answer 30

Highest pressure will be during systole when pressure needs to be a little higher than aortic pressure to pump blood into aorta

Answer 31

Approximately the same as pulmonary arterial pressure: 25mmHg

Answer 32

Thick walls Narrow openings

Answer 33

Smooth muscle cells--gives high resistance

Answer 34

Yes, but they layer of smooth muscle is much thinner compared to arterioles

Answer 35

Gives veins the ability to adjust wall tension/ keep pressure that is reasonable for body to deal with

Answer 36

no--not enough smooth muscle to do that

Answer 37

Veins have wider internal diameter than arterioles--making veins more stretchy and compliant

Answer 38

Thin walls and thin cells

Answer 39

Lining capillaries Inner most lining of entire CV system--continuous with the chamber of the heart and BVs

Answer 40

Increases pulse pressure

Answer 41

CO= HR x SV

Answer 42

Total cross sectional area of the given section The more area the lower velocity

Answer 43

High--only one aorta to pump 5L/min

Answer 44

2 Vena cava with wide individual opening--velocity is decreased compared to aorta

Answer 45

Relatively slow since there are many more paths for the blood to take

Answer 46

V= Flow/ Area

Answer 47

Increased velocity

Answer 48

increased velocity

Answer 49

Arterial end

Answer 50

venous end

Answer 51

Lots of things: glucose, gases, electrolytes

Answer 52

Blood brain barrier--tighter junctions and more selective to what is allowed through

Answer 53

Either through the cells or in-between individual cells

Answer 54

The fluid is taken up by the lymphatics

Answer 55

13.6mm below pressure source raises pressure by 1mmHg d/t gravity

Answer 56

1mmHg higher pressure than the source of the pressure

Answer 57

Blood/water is heavy--effects of gravity

Answer 58

Isogravimetric point

Answer 59

Middle of the heart at the tricuspid valve No gravity effect because the point is at the center of the pressure source

Answer 60

"U curve" shape of the veins in the arm to the heart create a column of blood that effects the pressure

Answer 61

between 6mmHg - 8mmHg

Answer 62

There is pressure d/t the weight of blood in the small column the veins form when leaving the heart going to the arm

Answer 63

Supine--eliminates the column of blood d/t gravity

Answer 64

Pressures are lower

Answer 65

Stays at 0mmHg

Answer 66

Veins in the neck are wide and thin walled--pressure doesnt go negative because the veins would collapse

Answer 67

Meninges--rigid walls

Answer 68

There is sub-atmospheric pressure in the sinuses

Answer 69

Sub atmospheric pressure in the sinus will suck air in if exposed to the outside environment causing an air embolism

Answer 70

One-way valves

Answer 71

Act as suppose system to prevent back flow so blood can only flow in one direction toward the heart

Answer 72

Limit the effects of gravity by preventing back flow

Answer 73

Movement in lower extremities allows skeletal muscles to push on vein walls and keep blood moving back toward the heart (not pooling in the legs)

Answer 74

Valves are delicate and thinner than the vein wall With age--veins get stretched out but the valves are the same size and they no longer work to prevent pressure increases from gravity

Answer 75

Varicose veins--vein is too wide so the valve cant come together to prevent back flow Pressure builds up in lower extremities

Answer 76

25mmHg in the capillary

Answer 77

gravity will have full effect and pressure in the vein in the foot will be high (95mmHg)

Answer 78

normally pressure would be 5mmHg plus gravity effect which is 90mmHg = 95mmHg

Answer 79

compression from skeletal muscle to push volume out of the legs

Answer 80

Keep moving around so there isnt too much pressure and stasis added

Answer 81

Significantly increases pressure

Answer 82

90mmHg d/t gravity Technically using his math he gave us it would be 110mmHg

Answer 83

Blood pools in the legs and is not being returned to the heart--so the heart is not pumping out enough blood leading to low CO and can cause fainting

Answer 84

Reverse Trendelenberg--blood pooling in legs and not contracting skeletal muscle to return blood to the heart

Answer 85

Increase in volume/ (increase in pressure x original volume)

Answer 86

Low distensibility

Answer 87

Expandability

Answer 88

Decrease distensibility because there isnt much room left to expand

Answer 89

High distensibility

Answer 90

How easy it is to move something from one place to another

Answer 91

Easy to move something from one place to another

Answer 92

Difficult to move something from one place to another

Answer 93

Easy to move something from one place to another

Answer 94

Difficult to move from one place to another

Answer 95

Conductance is the inverse of Resistance

Answer 96

Adjust vascular resistance

Answer 97

Vascular Resistance

Answer 98

Radius/Diameter

Answer 99

Massive reduction in blood flow

Answer 100

Massive increase in blood flow

Answer 101

Flow= Diameter^4

Answer 102

V=iR V= blood pressure i= blood flow R= vascular resistance

Answer 103

Small volume in arterial--pressure goes way up Large volume in venous--pressure hardly increases at all

Answer 104

Arteries are low compliance Veins are high compliance

Answer 105

BP will be much lower in arteries because there isnt any squeeze BP drops in veins but not as much as arteries

Answer 106

Arteries: pressure would be very high Veins: venous pressure goes up to 20mmHg

Answer 107

Based on volume status, need for BP and CO

Answer 108

Reynolds number

Answer 109

Increases risk for clotting Could cause hardened arteries, plaque deposits, calcium deposits, cholesterol deposits

Answer 110

Blood/air is moving in all different directions and massive amount of energy is wasted

Answer 111

Can usually hear when there is turbulent flow present--its loud

Answer 112

Turbulent flow in the lungs when someone has a lung infection

Answer 113

Velocity x Diameter x Density / Viscosity

Answer 114

Increase velocity, diameter, or density

Answer 115

Mass per volume of a substance

Answer 116

Aorta and large arteries close to the heart

Answer 117

Hypothetical calculation that can be used to understand what predisposes things to turbulent flow and how to reduce the likelihood of turbulent flow occurring

Answer 118

Measure flow by looking at the magnetic field that is created as blood is flowing through the sensor Since Hgb has iron the iron moving through a vessel has electromagnetic effect

Answer 119

Implanted and wrapped around a blood vessel

Answer 120

Lasers with embedded sensors that look at height that is being reflected from what we are measuring the higher the flow the different reflection that sensor sees

Answer 121

Hook up needle to BV that is connected to CV system Piece of metal in the middle with smaller version of metal clamp When pressure increases it pushes up on the plate that then pushes on the magnet to show up as a change in pressure recorded on paper

Answer 122

Right and left should have similar volume Right pressures will be much lower than left

Answer 123

1.) Period of filling 2.) Isovolumetric contraction 3.) Period of ejection 4.) Isovolumetric relaxation

Answer 124

50mL Left ventricular end systolic volume (LVESV or ESV)

Answer 125

Filling is passive and dependent on how much preload we have dependent on pressure leading into the heart

Answer 126

Expect heart to fill up quickly with increased preload Slower rate of filling that may not be enough with low preload

Answer 127

Hemorrhage

Answer 128

Aortic valve closed Mitral valve open

Answer 129

Contraction of the atria which is the last portion of filling the heart gets before it starts to contract Small portion where the heart gives a little help to the passive filling

Answer 130

start with 50mL Passively add 60mL 10mL from "atrial kick" total of 70mL added during filling phase

Answer 131

If healthy and resting then the atrial contribution isnt necessary If sick then the 10cc from the atria is important because passive filling may be effected if heart walls are messed up

Answer 132

End Diastolic Filling (EDV/LVEDV) 120mL

Answer 133

Heart starts to contract but volume stays the same Left ventricular pressure increases from contraction creating increase pressure in LV compared to LA so mitral valve closes

Answer 134

Aortic valve is closed Mitral valve is closed

Answer 135

Increase in pressure but no change in volume--created vertical line when the valves are functioning properly

Answer 136

Line will not be vertical Line may be tilted depending on which valve has an issue

Answer 137

Period of ejection Ventricle is contracting when the pressure in the ventricle exceeds pressure in aorta

Answer 138

Phase 3 Aortic valve opens at 80mmHg

Answer 139

Left ventricular volume is decreasing Ventricular pressure must be higher than aortic pressure during the entirety of phase 3

Answer 140

Stroke volume Beginning volume 120mL End volume 50mL SV= 70mL

Answer 141

Isovolumetric relaxation--no change in volume but decrease in pressure

Answer 142

Aortic valve closes when pressure in the ventricle is lower than pressure in the aorta

Answer 143

Aortic valve is closed Mitral valve is still closed when ventricular pressure is higher than atrial pressure

Answer 144

When the left ventricular pressure is lower than the left atrial pressure--so left ventricular pressure would need to be less than 2mmHg At the end of phase 4/ beginning of phase 1

Answer 145

When mitral valve reopens

Answer 146

Contractile state of the heart Stronger strength of contraction pressure volume loop might be higher on the graph

Answer 147

Will generate higher internal and external pressures

Answer 148

Heart does alot of external work by taking blood at low pressure and generating a higher pressure to eject volume into the system

Answer 149

Carl J Wiggers (diagram)

Answer 150

Depolarization of the muscle has to happen first to send signal for muscle to contract delay with calcium and all of the things that have to happen for the muscle to contract after AP is sent

Answer 151

End of phase 3/ beginning of phase 4 and ends at the start of phase 2 Diastole starts when aortic valve closes

Answer 152

Starts at end of phase 1/beginning of phase 2 and ends at ends of phase 3

Answer 153

Phase1 and phase 3

Answer 154

In thirds 1/3-rapid filling 2/3- not much added 3/3-little bit of extra volume from the atria Blood flows into ventricle quickly during first 1/3 because pressure has build up behind the mitral valve

Answer 155

Most of the filling is complete by the first 1/3

Answer 156

Filling may not happen as fasts from left atrium to left ventricle Would be beneficial to allow more time for the ventricle to fill--slow down heart rate If patient went tachycardic would be an issue for filling and cardiac output

Answer 157

Beginning of systole ventricular volume decreases very quickly--sleep slope Later stages of ejection the volume line starts to flatten out because there isnt a lot of volume left to eject (still ejecting just less volume left)

Answer 158

70cc volume filled in phase 1 70cc volume ejected in phase 3 Filing should = want is ejected

Answer 159

Closure of the AV valves

Answer 160

Aortic valves closing

Answer 161

Valve issue

Answer 162

Aortic pressure is the highest at the peak of phase 3

Answer 163

When intraventricular pressure is slightly higher than aortic pressure the aortic valve opens

Answer 164

All valves in the heart are one way valves that either other or close depending on pressures in front or behind it

Answer 165

Atrial pressure in the lower single digits Ventricular pressure gets way higher

Answer 166

Atrial pressure increases when the atria contract Atria dont have a valve behind them only the AV valve in front of them--when atria contract a portion of the blood moves forward and a portion moves backward (both causing an increase in pressure when the atria contract

Answer 167

Atrial contraction (increased pressure from forward or backward movement in the atria)

Answer 168

Atrial pressure rises as blood is returned to the heart and mitral valve is still closed Atrial pressure in increased during systole and continues to increase during phase 4

Answer 169

Rapid drop in atrial pressure when the mitral valve opens because blood is now allowed to move into ventricle

Answer 170

Circulatory system If blood cant get back to the heart we cant have sustained elevated cardiac output

Answer 171

RA: 0mmHg LA; 2mmHg maintains 5L/min CO

Answer 172

Change in pressure (delta P)

Answer 173

Venous return should equal cardiac output What comes into the heart is equal to what is pumped out

Answer 174

Pressure change would be lower and flow would be reduced causes decreased venous return if there are no other compensatory mechanisms

Answer 175

Average CV pressure - Pressure at the end of CV (RA)

Answer 176

Increases delta P which increases flow--causing increased venous return

Answer 177

Shows Venous return increases when right atrial pressure decreases up until venous return maxes out at 6L/min and hits plateau phase

Answer 178

If RA is super negative the large veins (SVC/IVC) can collapse and prevent further augmentation of venous return SVC/IVC dont normally collapse--but if the heart is pumped SUPER hard then it can generate negative RA pressure

Answer 179

Mean systemic filling pressure or Average filling pressure

Answer 180

Sum of all pressures that can be used to fill the heart Total pressure available to return blood to the heart Pressure the heart would stabilize at if the heart was stopped and allowed time for the blood to equilibrate between the veins and the arteries

Answer 181

7mmHg Sum of all pressures that can be used to fill the heart

Answer 182

Blood prefers to hang out in the veins and the veins hold more volume and are more compliant than the arteries

Answer 183

Tightening up arteries or veins--increases systemic filling pressure by elevations in resistance

Answer 184

Contraction of the systemic veins Veins are large and have a lot of volume, a little contraction will increase pressure by a lot

Answer 185

Relies on the central nervous system / SNS

Answer 186

Anesthetics impair CNS so we would have to supplement with synthetic catecholamine since SNS is "offline"

Answer 187

Resistance to venous return (RVR)

Answer 188

Easier for blood to get back to the heart--increases blood return, venous return, and cardiac output Steeper slope on venous return graph

Answer 189

Something is impeding ability to get blood back to the heart decreases blood return, decreases venous return, and decreases cardiac output Lower slope on venous return graph

Answer 190

Delta P would be reduced, blood flow is reduced venous return and cardiac output are decreased

Answer 191

Delta P would be (14-0= 14) doubled so increased flow would increase venous return venous return would be doubled (10L/min) and cardiac output would be 10L/min as long as heart is able to pump out what is being returned to it

Answer 192

Delta P 3.5-0= 3.5 Reduced blood return to the heart by 1/2 decreased venous return and cardiac output by 1/2 (2.5L/min)

Answer 193

1) Blood volume 2) Venous tone

Answer 194

Pressure in the thoracic cavity can change the ease of blood return to the right heart

Answer 195

Causes increased pressures in the thorax without making compensation to the internal pressure of the veins could cause chest veins to collapse under the pressure before blood is delivered to the heart

Answer 196

Positive pressure ventilation

Answer 197

-Give more volume -Give drug to tighten up the veins

Answer 198

Phenylephrine: Synthetic catecholamine that works on alpha receptors

Answer 199

Total pressure of the system is important to look at how clear the path is for blood to return back to the heart

Answer 200

Health of the heart Health of the system

Answer 201

enhanced filling pressures should create for increased cardiac output

Answer 202

RA pressure of +4mmHg Cardiac output tops out at 13L/min

Answer 203

CO is increased as RA pressure lower than normal--maxes out at 23-25L/min in non athlete

Answer 204

CO still increases with increased RA pressure just not as much as normal

Answer 205

1) Frank Starling Mechanism: Optimally aligned cross bridge muscle fibers can better contract 2) Direct Atrial Stretch: Stretching out under stretched walls by increasing filling pressure 3) Bain Bridge Reflex: External reflex to increase HR and accommodate higher filling pressure

Answer 206

Increase atrial stretch produced when filling pressures/CVP increases allows heart rate and contractility to increase Built into electrical system of the heart that if atria stretch increases a little we have increase in HR

Answer 207

Increases HR by 10-15% of normal Built into hearts electrical system to increase rate to accommodate for increased volume returned to the heart--doesnt require any neural input

Answer 208

40-50% of normal

Answer 209

External reflex used to increase heart rate to accommodate for higher filling pressures

Answer 210

Sensed by the heart and carried back to the nervous system--heart is adjusted by nervous system Afferent signal sent to brainstem when atria stretch and brainstem increases heart rate

Answer 211

-Increases sympathetic output of cardiac sympathetic nerves -Decreases parasympathetic output from the vagus nerve

Answer 212

Sensory portion: Vagus nerve Efferent: increases sympathetic outflow and decreases vagal response

Answer 213

23-25L/min

Answer 214

Cardiac output curve shifts to the left Right atrial pressure is lower than in a normally functioning heart because heart is pumping strong and fast pushing RA pressure values lower than normal

Answer 215

Reduce RA pressure and increases cardiac output by generating a vacuum (sub 0 pressure) and increases venous return

Answer 216

RA pressure may be higher than normal because heart is beating slower and pressure is building up in the filling portion of the heart (RA)

Answer 217

Body can increase filling pressures to overcome the heart that is unable to pump on its own--increases CVP and RA pressure to hopefully get to a point where heart can get enough output to sustain life

Answer 218

Cardiac output, Venous return

Answer 219

Small increase in CO--maybe to 6L/min max

Answer 220

Large increase in CO--from 5L/min up to 13L/min increases venous return

Answer 221

Strongly stimulate the heart and Increase filling pressure Need both systems in coordination (contractile state and venous return)

Answer 222

Body changes systemic filling pressure to increase cardiac output--constrict veins

Answer 223

Cardiac output doesnt decrease too much Not very much sympathetic tone at a healthy heart to begin with so not much to take away

Answer 224

Reduced cardiac output

Answer 225

Hypo effective heart= weak pump increases RA pressure Hyper effective heart= strong pump reduces RA pressure

Answer 226

Increase sympathetic stimulation CO increases to 6L/min RA would be -1mmHg

Answer 227

circulating catecholamines--squeeze the system and increase filling pressure to increase return and CO and volume

Answer 228

Increase in RA pressure--trying to pump everything out but its weak decrease CO

Answer 229

RA: 3mmHg CO: low

Answer 230

CVP/RA and PSF

Answer 231

Increases filling pressure by the circulatory system causes increase RA pressure

Answer 232

Catecholamines go away and the action of the catecholamines is replaced by volume retention and blood expansion (kidneys)

Answer 233

Epi and NE increase water retention from the kidney--allows catecholamines to decrease and blood volume to increase

Answer 234

Anesthetics relax blood vessels and reduce systemic filling pressure

Answer 235

Patient is dependent on those pressure to get adequate CO When under anesthesia, sympathetic NS is turned off so BP would drop

Answer 236

slight increase in RA pressure because the veins are constricting to jam more blood back into the heart

Answer 237

Tightening up the circulatory system--good practice to mimic what body normally does

Answer 238

Body surface area

Answer 239

CI= CO/ surface area

Answer 240

3L/min/m^2

Answer 241

Male CI is higher than female unless female is far along in pregnancy

Answer 242

Increased metabolism

Answer 243

Maxes out at 4L/min/m^2 around age 10

Answer 244

Cardiac index increases quickly as you are maturing

Answer 245

with age we lose muscle mass and we dont need as much energy so CI and CO are lower

Answer 246

2.4L/min/m^2

Answer 247

metabolic rate

Answer 248

Increasing cardiac output

Answer 249

Can get away with lower cardiac output because tissue needs are less

Answer 250

Reduced metabolic rate leads to reduces CO due to increase in vascular resistance tissues dont need as much blood so arterial BVs are tighter

Answer 251

Body has less tissue (fewer blood vessels) to take care of so body can deal with lower CO Take options away for blood to go through and vascular resistance increases

Answer 252

CO in reduced

Answer 253

Increases CO Decreases vascular resistance

Answer 254

Increased metabolic rate--tissue need more stuff and arterial vascular resistance will be lower--increases CO

Answer 255

Vitamin B1 deficiency Impacts the way cells use energy and makes cells less efficient on how they consume energy--need more energy delivery to the tissues (increase CO, decrease vascular resistance)

Answer 256

Extra connection/ set of BVs for the blood to move from artery to veins Gives another option for blood to go through and lower vascular resistance and increases CO

Answer 257

Increases CO

Answer 258

Brain: 14% Heart: 4% Splanchnic: 27% Kidneys: 22% Muscle (inactive): 15% Skin: 18%

Answer 259

Increase in O2 consumption is equally matched by increase in cardiac output

Answer 260

Increases metabolic rate of tissues, lower vascular resistance, expect CO to go way up when the nervous system is on board

Answer 261

Unable to increase cardiac output without SNS involvement arteries dilate but veins wont constrict and cant get blood returned to the heart BP crashed because arteries are dilated and veins arent able to be constricted

Answer 262

BP crashes

Answer 263

Venous system

Answer 264

depends on where it is being measured (where is the tip of the catheter

Answer 265

CVP increases the further away from the heart you get

Answer 266

Way higher than RA pressure

Answer 267

Small amount of gravitational pressure When patient is supine on their back, inferior vena cava is at a lower altitude than the heart The further underneath the heart you are, the higher the pressure

Answer 268

VAD, drug to help heart pump out enough volume (vasoconstrictor) Body usually tries to increase filling pressure to help the bad heart pump what it needs

Answer 269

Mean circulatory filling pressure takes into account pulmonary and systemic circuits MSFP is only the systemic circuits

Answer 270

Increase in volume/ sympathetic tone Decrease in volume /sympathetic tone

Answer 271

High pressure in the thorax

Answer 272

Over time blood volume will be increased to make up for that open path from one side of circulation to the other Filling pressures will be normal in this patient but CO high because resistance to venous return is low

Answer 273

Good oxygenated blood in the aorta

Answer 274

Heart will become a weaker pump until it stop working

Answer 275

-4mmHg or -5cmH2O Intrapleural pressure is usually surrounded by negative pressure

Answer 276

Sucking air into the lungs contracts/drops the diaphragm which drops pressure in the thorax Blood is also sucked into the heart on inspiration--CO curve shifts to the left

Answer 277

Blood is sucked into the chest with inspiration If pressure surrounding the heart is more negative--expect to see higher output

Answer 278

Contraction of the abdomen and increased thoracic pressure will see drop in CO if sustained

Answer 279

Long term positive intrapleural pressure shifts CO curve to the right

Answer 280

Mechanical ventilation Opening the chest up to environment (no longer negative pressure--equal to atmospheric pressure)

Answer 281

Increasing filling pressures--tightening the system or add volume to the system to sustain normal cardiac output with abnormally high pressure around the heart

Answer 282

Fluid outside the heart can shift the CO curve to the right and depress the slope of the curve If heart cant fill adequately then there will be poor CO

Answer 283

Get rid of the extra fluid surrounding the heart to give it room to fill

Answer 284

Shifts CO curve to the left and increases the height of the plateau Lower right atrial pressure

Answer 285

CO curve is shifted to the right and higher atrial pressure

Answer 286

Expect RA pressure to be a little higher than normal because circulatory system is returning more blood to the heart than what its use to

Answer 287

Arterioles

Answer 288

Makes it easier to get blood from the left heart to the right heart (reduce RVR) Pressure overall in the system doesnt change

Answer 289

ACE inhibitors--afterload reducers reduce pressure in the arteries increase pressure in the veins

Answer 290

Nitroglycerine--preload reducer

Answer 291

Reduces the amount of blood returning to the heart which will reduce output from the heart to help preserve tissues that are ischemic/infarcting

Answer 292

Patient has to have enough BP/CO to keep everything else healthy wouldnt want to give if BP already low

Answer 293

Doesnt change the slope of the curve because hasnt changed how hard it is to get blood back to the heart Just reduced filling pressure

Answer 294

Reduces resistance to venous return to help get blood back to the heart

Answer 295

Reduced filling pressure outweighs reduced RVR *filling pressure is always more important*

Answer 296

WHen there is a change in RVR

Answer 297

Increase in venous compliance and reduce volume

Answer 298

Increase in volume and reduced venous compliance

Answer 299

Reduced resistance at arteriole--doesnt change PSF just changes RVR

Answer 300

Pressor that clamps down on arteriole--harder to get blood from left to right heart

Answer 301

Vein constriction increases PSF Arterial constriction increases RVR (decrease slope)

Answer 302

1) Veins constrict to increase PSF 2) SVR increases--Clamps off blood supply to areas that arent needed 3) overtime the body increases blood volume by the kidneys so it cane decrease sympathetics

Answer 303

Phenylephrine

Answer 304

NO donors: Sodium Nitroprusside

Answer 305

Reduced the metabolic demands of the heart

Answer 306

Ace inhibitors Hydralazine

Answer 307

MOA is unknown it just somehow relaxes the arteries Takes 10-15 minutes to have effect

Answer 308

CO drops to 1/2 normal RAP is significantly elevated 4mmHg (heart isnt able to pump out everything being returned to it PSF is still normal at this point

Answer 309

Sympathetic nervous system kick in -increases venous tone -higher filling pressures -NE from SNS increases HR--CO back to normal -RAP still increased (reduced pumping capacity and increased filling pressure

Answer 310

SNS dials back as fluid is being retained and blood volume is expanded Over time catecholamines tell kidney to hang onto fluid and electrolytes

Answer 311

PSF increases

Answer 312

By retaining volume and expanded blood volume increases RAP from all the fluid retained

Answer 313

We need sympathetic in reserve to help out when needed day to day--if its maxed out then there isnt any in reserve When getting up out of a chair--without SNS would pass out

Answer 314

Predisposes people to arrhythmias

Answer 315

Catecholamines work at the beta receptors in the heart--phosphorylate calcium channels If calcium channels are too sensitive they can open prematurely causing an arrhythmia

Answer 316

If the cardiac output increased enough to get to the point where O2 requirement is met by the tissues Need 5L/min CO

Answer 317

Preload (mmHg)

Answer 318

Low preload= less volume High preload= more volume

Answer 319

Pressure in the atria at the end of phase 1

Answer 320

More pressure to fill the heart results in more filling EDV increases--stroke volume increases Extra filling allows for more stretch and better cross bridge alignment (increase SV)

Answer 321

Less filling and less volume at the end of diastole Decreased SV and EDV

Answer 322

Afterload Afterload= Diastolic BP

Answer 323

Harder on the heart to pump blood out Takes longer to get the aortic valve open

Answer 324

Easier on the heart to pump blood out Shorter time to get the aortic valve open

Answer 325

measure of diastolic BP

Answer 326

Pressure at the beginning of phase 3/end of phase 2

Answer 327

Higher diastolic BP than normal--higher pressure needed by the ventricle to open aortic valve Takes longer time for contraction to build up the high enough pressure= longer duration of phase 2

Answer 328

Less time in other cardiac phases less time available for ejection (phase 3) Reduced SV

Answer 329

Higher than normal pressure in the aorta could slam aortic valve closed prematurely

Answer 330

Normal EDV Decreased SV--decreases ejection higher ESV

Answer 331

Increase heart rate to make up for low SV Common to have elevated HR in people with high BP

Answer 332

Worried about remodeling of the heart

Answer 333

Increases Decreasing

Answer 334

Giving an ACE inhibitor or hydralazine

Answer 335

Pressure at which the aortic valve opens is lower Pressure at which the aortic valve closes is lower than normal

Answer 336

Reduce afterload causes aortic valve to shut later than normal Greater amount of time in phase 3 (systole) Ejecting blood for longer--increases SV

Answer 337

Aortic valve opens earlier--shorter time in phase 2

Answer 338

Increased ejection= increase SV For normal preload then ESV would be decreased Reduces amount of energy that the heart expends to pump blood

Answer 339

Increase SV can accommodate a lower heart rate Requires less beats per minute to get normal CO

Answer 340

The difference that might exist in SV if we maintain a constant preload and afterload

Answer 341

Line at the top left of the graph Steeper slope= higher contractility Decreased slope= lower contractility

Answer 342

Increases SV--increased squeeze= ejecting more blood -less blood left in the ventricle after ejection (decrease ESV)

Answer 343

Increases CO and BP

Answer 344

Less squeeze= less SV not as much ejected= increase ESV

Answer 345

Decrease CO and BP

Answer 346

Increases HR

Answer 347

Stroke volume ESV Afterload reducers decrease energy requirements of the heart

Answer 348

Higher passive filling pressure Passively jamming more blood in to give the heart a better chance at a normal SV blood volume has been expanded to recover from MI--drives up preload and gives better filling to help with HF

Answer 349

Heart will not pump well Reliant on passive filling to have normal CO

Answer 350

Overtime passive filling will dilate the heart walls out --harmful

Answer 351

Aortic stenosis 50-60

Answer 352

Valve becomes high resistance over time from cholesterol, infection, etc--causes impediment to ejection 3 leaflets dont open entirely making it hard to eject blood

Answer 353

Can treat like high afterload More difficult to get blood out of the higher resistance valve

Answer 354

Pressure inside the ventricles are really high since the valve is really obstructed EX: 200mmHg in the ventricle before the valve opens

Answer 355

Increase preload by the body to try to compensate and pack more blood into the ventricle

Answer 356

Chronically reduced stroke volume--the only way to have a normal CO is through elevated HR

Answer 357

Reduced amount of time we are ejecting blood increased time in phase 2--> less blood ejected during phase 3 less blood ejected= increased ESV

Answer 358

High filling pressure becomes necessary because the walls of the ventricle thicken over time Need higher filling pressure to get decent volume into the ventricle

Answer 359

Increased preload, increased CVP, increased RAP

Answer 360

Blood moving through high resistance point: upstream of resistance is high pressure, downstream of resistance is low pressure High pressure in the ventricle

Answer 361

Low pressure in the aorta (downstream on resistance) pressure in the aorta depends on how stenotic the valve is

Answer 362

Yes, systemic MAP can be normal because high pressure is only building up in the ventricles Bad valve zaps some of the pressure as the blood moves from ventricle to aorta

Answer 363

Pulse pressure is narrowed Diastolic BP is increased and systolic BP is the same= 120 - larger number = narrowed (20mmHg)

Answer 364

Enhanced HR Enhanced PSF

Answer 365

Between left atria and left ventricle

Answer 366

Stenotic mitral valve doesnt open fully Would see problems with filling when the body isnt compensating

Answer 367

EDV would be decreased SV would be decreased since EDV is decreased (not normal filling so decreased volume to pump out)

Answer 368

HR increases to try to make up for low SV and low CO

Answer 369

Increase PSF, increase atrial pressure, increase blood volume

Answer 370

Increased pressures in the circuit in front of the left atrium= increase pressure in the lungs

Answer 371

The increase pressure in the BVs in the lungs will lead to edema Would need to go in and fix the valve at some point otherwise pulmonary BP will be too high--pushing fluid into the lungs causing impaired gas exchange

Answer 372

Insufficiency/ regurgitation

Answer 373

Would expect retrograde blood movement when the valve is closed and when the pressure past the valve is higher than the pressure before the valve

Answer 374

When the aortic valve is "closed" and when the pressure in the aorta is greater than the pressure in the left ventricle

Answer 375

When the pressures in the aorta are very high and when pressures are low in the ventricle

Answer 376

End of phase 4 and beginning of phase 1

Answer 377

The ventricle is filling from the atria and from the leaky aortic valve

Answer 378

Since the ventricle is filling from 2 places (aorta and atria)--EDV would be higher than normal Very leaky aortic valve has EDV much higher than 120cc

Answer 379

The more leaky the valve the more backwards blood flow we have and eventually this stretches out the walls of the ventricle

Answer 380

Heart walls get thin and the valves get stretched out as well--dont work appropriately leads to even worse aortic regurg

Answer 381

Phase 4 is not isovolumetric in aortic regurg Big curve in phase 4 If ventricular volume is increasing when the mitral valve is closed--the blood has to be coming from the aorta

Answer 382

Blood is coming from the aorta Seen in aortic regurg

Answer 383

At the beginning of phase 4--high pressure in the aorta and pressure is still high in the ventricle so not too much backward flow since there isnt a pressure gradient Further into phase 4 the line curves more because pressure is really high in the aorta and coming down in the ventricles--more backwards blood flow End of phase 4 very curved line--lots of filling from the aorta when the ventricles are at low pressure and the mitral valve is still closed

Answer 384

Ventricular pressure is decreasing and the chamber is empty= lots of flow from the leaky aorta

Answer 385

ventricle filling from 2 places (aorta and atria) Rapid filling in the 1st 1/3--beyond that as the ventricle gets more full there is less backward flow

Answer 386

high increase increase

Answer 387

The ventricle gets stretched out and worsens aortic valves and then the mitral valve starts to have issues as well

Answer 388

Technically yes, but it slows down once the ventricle is filled up

Answer 389

Lower pressure than normal--pressure in aorta isnt as high as it normally is from the blood leaking back into the ventricle

Answer 390

Peak systolic pressure is really high--make up for the fact that we have a large SV

Answer 391

Wide pulse pressure: primarily from diastolic pressure being low from the blood leaking in the wrong direction from aortic valve

Answer 392

Blood leaking from ventricle back into the atria

Answer 393

Leak occurs when the pressure is higher in the ventricle than the atria

Answer 394

When the ventricle start to contract phase 2 has a curve to it--blood is moving from the ventricle back to the atria

Answer 395

Ventricular pressure is higher than atria pressure in phases 2, 3, and 4

Answer 396

Decreased volume from the ventricle with mitral regurg in phases 2,3,4

Answer 397

More blood leaking backward early in phase 4 and decreases throughout phase 4 d/t decreased gradient from ventricular relaxation

Answer 398

No longer have isovolumetric lines (curved lines because blood is moving in the wrong direction)

Answer 399

Anterior View A) Left Coronary Artery B) Circumflex C) Great Cardiac Vein D) Left Anterior Descending Artery E) Left ventricle F) Right Ventricle G) Right Coronary Artery

Answer 400

Widespread and covers ventricular muscle

Answer 401

SNS has little basal activity at rest ANS (vagus nerve) more active in a normal resting heart than sympathetic nerves

Answer 402

Serous visceral pericardium Serous parietal pericardium Fibrous pericardium

Answer 403

Serous visceral pericardium

Answer 404

Serous parietal pericardium

Answer 405

Fibrous pericardium

Answer 406

Gap junctions Sodium--calcium can but it doesnt fit in the gap junction as well as sodium

Answer 407

Endocardial fibers--inner muscle layer Epicardial fibers--outer muscle layer angles in criss-cross 90 degree pattern: contract in opposite directions creating an efficient pump in a high pressure system

Answer 408

Cusps or Leaflets

Answer 409

Between atria and ventricle

Answer 410

attached inside of the ventricle

Answer 411

Chordae Tendineae

Answer 412

Papillary muscles contract with the ventricle and reinforce AV valves so they dont get blown back into the atria during ejection function to support the valves in the correct position when pressure is really high

Answer 413

ejected/ starting volume (70/120) is normal (58%)

Answer 414

It can cause a valve problem by not having that muscle to reinforce the valve during systole

Answer 415

2 cusps Bicuspid valve/ Mitral valve

Answer 416

Tricuspid valves 3 cusps

Answer 417

Infection: immune system response High cholesterol: sticks to the valves

Answer 418

3 leaflets

Answer 419

Stuff gets imbedded in the edges where they are suppose to close and fit together

Answer 420

Left and right aortic cusps

Answer 421

Cusps function like a cup after ejection the aortic valve closes and the pressure in the aorta is still high during diastole--likely there will be blood moving in the opposite way toward the valves during filling This movement it directing blood flow into the "cup" that is connected to the coronary artery= allows for coronary artery perfusion

Answer 422

Aorta expands during ejection to accommodate a lot of blood being pumped out Aorta recoils during diastole to push blood forward and backward into the cusps to help with coronary perfusion

Answer 423

Instead of blood being directed into the coronary arteries, the blood gets directed back into the ventricle

Answer 424

Cartilage: layer of insulation between the atria and the ventricle

Answer 425

Cartilage doesnt conduct electricity well so it acts as an insulator to keep electrical activity on the top of the heart separate from electrical activity on the bottom of the heart

Answer 426

Early in development and the size expands as the heart grows "skeleton" for the heart tissue

Answer 427

Bundles of His: opening in the middle of the cartilaginous ring that allows AV node to fire AP to lower portions of the heart

Answer 428

3: one for each leaflet

Answer 429

Commissural cusp

Answer 430

Posterior Descending Artery

Answer 431

Most common to branch from right coronary artery Some people it branches from Circumflex artery of the left coronary artery

Answer 432

Left anterior descending artery (LAD)

Answer 433

Circumflex artery

Answer 434

The great cardiac vein

Answer 435

At the very end of the great cardiac vein--continuous with the right atrium

Answer 436

Coronary sinus is continuous with the right atrium and deoxygenated blood here gets sent through the lungs on the next heartbeat

Answer 437

70mL for each 100g cardiac muscle

Answer 438

Metabolic rate of the heart

Answer 439

When pressures in the walls of the heart are low

Answer 440

Systole Diastole

Answer 441

Blood vessels are imbedded in the wall of the heart-- decrease in perfusion reflects tissue connected to the BVs in the high pressure portions of the heart

Answer 442

Left ventricle Interventricular septum

Answer 443

Low energy required

Answer 444

Areas of the heart that are low pressure all the time

Answer 445

BVs being imbedded in the heart and the walls of the heart having varying degrees of pressure (depending on what part of the cardiac cycle)

Answer 446

Epicardial vessels

Answer 447

Endocardial (subendocardial) vessels

Answer 448

During diastole: lots of blood flow= lots of blood in the epicardial and endocardial blood vessels

Answer 449

Full coronary blood vessels get squeezed as the walls of the heart contract--pushes blood forward and a BIG portion of blood moves backward Negative on a graph: blood moving from walls of heart into left coronary artery and back out into aorta

Answer 450

Retrograde coronary perfusion during that point in time (blood moving from the walls of the heart to the coronary artery and back out into the aorta)

Answer 451

During Systole

Answer 452

Delta P= (aortic pressure) - (wall pressure)

Answer 453

No, coronary perfusion is continuous throughout the cardiac cycle through the right coronary artery

Answer 454

Pressure gradient

Answer 455

Aortic pressure is the pressure available to drive flow High aortic pressure= more perfusion Low aortic pressure= decreased perfusion

Answer 456

Negative coronary blood flow (opposite direction)--not perfusing coronary arteries

Answer 457

Opportunity for coronary blood flow

Answer 458

Problem with coronary perfusion (blood flowing out of coronary artery)

Answer 459

Diastole: time available for perfusion to occur

Answer 460

Increased heart rate

Answer 461

Middle 2/3

Answer 462

Remove part of diastole for a healthy person is fine In someone with CAD/CHF you need that time for the coronary arteries to be perfused

Answer 463

Coronary perfusion--doesnt really change filling

Answer 464

Normal atrial pressures Normal aortic pressures Increase ventricular pressure

Answer 465

Wall pressure is higher than aortic pressure: makes coronary perfusion much more difficult increase pressure= increase metabolic demand= more difficult for the heart to perfuse the tissue

Answer 466

Increased atrial pressure Normal aortic and ventricular pressure

Answer 467

Body is having a hard time filling the ventricle with blood--kidney acts to expand volume (increase PSF) which increases right atrial pressure

Answer 468

Blood leaks back into the ventricles because cusps arent closed tightly aortic pressure is low because blood is leaking from aorta into the ventricle

Answer 469

Pulse pressure is widened

Answer 470

Blood ejects from the left ventricle into the aorta and the atria--causes high pressure in the atria

Answer 471

Atria start empty after atrial contraction and filling--as systole starts pressure builds up because blood is gradually filling up the left atria through the ventricle and the pulmonary vein 2 things filling the atria increases the atrial pressure at the end of systole when the atria is more full

Answer 472

Doesnt create a pumping problem, but wipes out filling pressures and decreases CO that way

Answer 473

small increase in atrial/CVP pressures from atrial contraction backward blood flow when atria contract End of diastole

Answer 474

Function of AV valves bulging backwards as the ventricle is rapidly tightening Early systole

Answer 475

Result of atrial filling while the AV valve is closed During late systole when the AV valves are closed and blood is returning

Answer 476

happens after the C wave--when the valves stop bulging back and the atria is empty pressure in atria is reduced a lot During mid systole

Answer 477

Happens after the V wave--When the AV valve opens and blood is let through from the atria results in lower pressures early diastole

Answer 478

SVR and PVR: correlates to (delta P/ flow)

Answer 479

800-1600mmHg/L/min (cgs) 1PRU

Answer 480

PRU x constant (1333)

Answer 481

40-180 cgs 0.14 PRU (1/7 of SVR)

Answer 482

Peripheral resistance units

Answer 483

cm, g, sec sometimes Dynes x sec/cm^3

Answer 484

Estimates left atrial pressure PAWP is measured further out than the LA, so its always an over estimate

Answer 485

5L/min or 83.3mL/sec round to 100mL/sec

Answer 486

More negative pressure in the heart pulls on the walls of the veins and makes the internal pressures lower CVP drops dramatically with early inspiration

Answer 487

May actually see a drop in CO at the beginning of inspiration because venous pressure is reduced and the blood isnt immediately going into the heart

Answer 488

Some of the blood volume is brought into the thorax from the abdomen some of the blood volume is pulled from the right atrium into the SVC/IVC (decreasing preload)

Answer 489

Preload is decreasing Pulmonary artery and vein pressure dropping reducing afterload (some argue reducing afterload would increase right CO)

Answer 490

pulmonary circulation is compliant and thin walled--when chest pressure drops the pulm artery and vein pressure is reduced Decreases preload for the left heart big decrease in CO since the left heart has to pump into the aorta and the internal aorta pressures arent affected by thoracic pressures

Answer 491

massive Decrease in preload no change in afterload CO in left ventricle is reduced substantially

Answer 492

Right venticle A)Posterior Papillary Muscle B) Anterior papillary muscle C) Chordae Tendineae D) Tricuspid valve, anterior cusp E) Septal Papillary muscle F) Left ventricle G) Right atrium

Answer 493

Left Ventricle A) Mitral Valve B) Posterior papillary muscle C) Chordae Tendineae D) Anterior papillary muscle E) Left atrium

Answer 494

A) Aortic valve left cusp B) Aortic valve right cusp C) Aortic valve posterior cusp D) Aortic valve E) Right coronary artery F) Tricuspid Anterior cusp G) Tricuspid Septal cusp H) Tricuspid Posterior cusp I) Tricuspid Valve J) Coronary sinus K) Mitral anterior cusp L) Mitral posterior cusp M) Mitral Valve N) Left coronary artery O) Pulmonary valve right cusp P) Pulmonary valve anterior cusp Q) pulmonary valve Left cusp R) Pulmonary artery

Answer 495

Aortic valve A) left coronary artery B) Left cusp of aortic valve C) Posterior papillary muscle D) posterior cusp of aortic valve E) right cusp of aortic valve F) right coronary artery

Answer 496

Right ventricle A) Anterior cusp of tricuspid B) Septal cusp of tricuspid C) Septal papillary muscle D) Interventricular septum E) Anterior papillary muscle F) Posterior papillary muscle G) Chordae tendineae H) Posterior cusp of tricuspid I) lateral wall of right ventricle

Answer 497

Left ventricle A) Anterior cusp of mitral B) Commissural cusp C) Left atrium D) Posterior cup of mitral E) Chordae tendineae F) Posterior papillary muscle G) Anterior papillary muscle

Answer 498

Anterior view A) Right coronary artery B) Circumflex artery C) Left coronary artery D) Great cardiac vein E) Left anterior descending artery F) Right ventricle

Answer 499

Posterior view A) Great cardiac vein B) Circumflex artery C) Left atrium D) Right atrium E) coronary sinus F) right coronary artery G) right ventricle H) Posterior descending artery I) left ventricle

Answer 500

Diaphragm contracts and shifts down into abdomen--pressure in the chest is reduced CVP is reduced in early inspiration

Answer 501

Negative pressure pulls on the walls of the veins making the internal pressures lower transient changes in the first beat or 2

Answer 502

Blood being pulled into the thorax doesnt immediately fill up the heart Venous pressure is reduced and blood isnt immediately going into the heart

Answer 503

Abdomen Right atrium

Answer 504

Brief decreased in preload: blood being pulled from RA back into SVC/IVC Decrease in afterload: Pulmonary art/vein pressure dropping Both sides are decreases so "wash" for CO to change

Answer 505

Pulmonary circuit is compliant and thin walled so reduced pressure in the chest reduces pressure in pulm system: Preload for left heart is reduced LV is still pumping out of aorta: no change in pressure in aorta: Afterload is unchanged Big drop in CO

Answer 506

CVP/RA pressure PAP

Answer 507

Respiratory cycle

Answer 508

Increases a little

Answer 509

Between respirations there is time for the chest to fill up with blood PPV with inspiration pushes in a chest full of blood from time between breaths: increases CO and increases preload for both sides of the heart initially Early PPV= increase CO

Answer 510

PPV initial benefit of increased preload go away Preload may be higher but there is nor blood to return to the heart because the lungs are full (impeded venous return from lower parts of the body)

Answer 511

Thorax is more positive→ downstream pressure is insufficient to fill the heart against positive pressure generated from the vent Need higher filling pressures to get around the high pressure in the lungs ↑ volume, tighten up veins

Answer 512

Increases power during each contraction

Answer 513

Left ventricular hypertrophy--thickening of the walls

Answer 514

Compliance is reduced and harder to fill the ventricle with blood (walls arent stretchy)

Answer 515

Increases filling pressures to get adequate volume

Answer 516

Increased slope→ indicating structural changes in the walls of the heart need higher pressure to fill

Answer 517

Takes a lower pressure to fill the ventricle

Answer 518

Low slope→attributed to a ventricle with high compliance

Answer 519

Stretched out→dilated cardiomyopathy

Answer 520

Hypertrophy can be thinning or thickening of the heart wall

Answer 521

Kids ventricles are much less compliant They dont have the ability to stretch out and accommodate increased venous return

Answer 522

Increase HR Kids dont have frank starling stretch Be careful giving large volumes to kids that the heart cant accommodate

Answer 523

Closure of the AV valves

Answer 524

When pressure is higher in the ventricle than the atria

Answer 525

AV valves vibrate as they close

Answer 526

1st heart sound→ 0.14 seconds (low pitch)

Answer 527

At the beginning of systole when the valve closes

Answer 528

Closure of pulmonary and aortic valves occurs after ejection is finished

Answer 529

0.11 seconds (higher pitch than 1st sound)

Answer 530

Physiologic splitting of 2nd heart sound exaggerated on deep inspiration (pulm valve closes second) aferload is on R heart is reduced with early inspiration→pulmonic valve open longer than aortic valve during deep inspiration

Answer 531

Phonocardiogram: ID frequencies when heart murmurs are at a pitch less than 20Hz 20Hz= limit to healthy hearing

Answer 532

Kids Heart failure Both groups have low compliance ventricles

Answer 533

Ventricle thinks its full faster than normal when its not compliant 3rd heart sound from the walls not stretching to accommodate volume in the last part of diastole

Answer 534

The first 1/3 of diastole still fills passively→ if the walls are thick and not allowing a normal stretch we are more likely to hear turbulence as the blood hits the walls of an uncompliant ventricle

Answer 535

Audible when the atria is doing more work

Answer 536

Stenotic Mitral: contraction of the atria occurs when the atria are more full so its more likely to heart 4th heart sound with increased volume

Answer 537

Should only be heard in someone with an unhealthy heart

Answer 538

systolic murmur Like putting thumb over the end of a hose

Answer 539

Turbulence

Answer 540

Diastolic murmur: loudest at the beginning of diastole and tails off at the end of diastole Majority of backward flow should happen early in diastole when pressures are low in the ventricle and the ventricle is empty--reduced flow when the ventricle is more full and when the pressure gradient is less

Answer 541

Diastolic murmur (filling problem)

Answer 542

End of diastole with atrial contraction Loudest when atrial contraction is occurring

Answer 543

Systolic murmur: backwards blood flow during systole

Answer 544

Loud at the beginning of systole and tails off toward the end of systole (when atria are empty and the pressure in the ventricle is going up quickly)

Answer 545

Put on area based on ejection pathway of the valve

Answer 546

Right sternum, 2nd intercostal space by ribs 2 and 3 Can listen a little above because aorta is ejecting blood through the valve in an upward direction

Answer 547

Left sternum 2nd ICS

Answer 548

Left medial side of patient 5 ICS

Answer 549

Left lateral side of patient 5th ICS

Answer 550

Superior mediastinum Inferior mediastinum ◇ Anterior ◇ Middle ◇ Posterior

Answer 551

Everything in front of the heart

Answer 552

Heart Pericardium Ascending aorta SVC Pulmonary arteries Pulmonary trunk Pulmonary veins Pericardiacophrenic veins Phrenic nerves

Answer 553

Sensory perception in the pericardium Supplied innervation to the diaphragm, arteries, and veins associated with it

Answer 554

Run along the outside of the heart

Answer 555

The heart isnt slipping around as its beating within the pericardium→Causes pain because the pericardiacophrenic nerves sense the pericardiac pain

Answer 556

Nerves usually have veins and arteries associated with them

Answer 557

"abdomen" Esophagus Thoracic aorta Vagus Nerves (can be middle or posterior) Azygos vein Hemizygos vein Thoracic ducts

Answer 558

Defined dicrotic notch

Answer 559

Used to calculate HR/EKG from computers→ important to have a clean notch for these calculations to be more accurate

Answer 560

Air bubble Blood clot Gain on amplifier is too low No dicrotic notch

Answer 561

More dicrotic notches so the computer will have a hard time figuring out where the notch is Extra ridges= artifact

Answer 562

Amplifier is turned way up--extra ridges/artifacts

Answer 563

Circumflex doesnt exist in everyone

Answer 564

Epicardial blood vessels

Answer 565

Epicardial BVs sitting on top of ventricle so not exposed to as much pressure during compression

Answer 566

LAD, PDA: they network into deeper layers but sit on top of the tissue

Answer 567

Endocardial and Subendocardial BVs

Answer 568

Deepest BVs are exposed to the highest pressure LV has highest pressure and the blood vessels in the deep wall there are subject to those high pressures

Answer 569

Subendocardial vessels

Answer 570

Cause pressure build up

Answer 571

Coordinated atria and ventricle

Answer 572

Afib/ Aflutter Atria get stretched out when its been exposed to increased volume for long periods and become less coordinated

Answer 573

The atria get stretched out over time--atria and ventricle become uncoordinated resulting in less CO

Answer 574

Diuretics to get rid of extra volume to prevent atria from being over stretched

Answer 575

Walls of the ventricle are thin "Dilated LVH" Adding more sarcomeres side by side

Answer 576

Congenital (not good outcomes) ◇ Dilated cardiomyopathy Aortic valve insufficiency MI

Answer 577

Heart patches itself up but the area that is patched doesnt have as much muscle and is more prone to stretch out

Answer 578

Systolic dysfunction: Wall thickness is reduced making it hard to pump blood out ↓BP, ↓SV

Answer 579

Walls thicken Adding sarcomeres in parallel (on top of each other)

Answer 580

High Afterload ◇ Aortic stenosis ◇ Long term untreated HTN

Answer 581

Walls are thicker and less compliant: less willing to accept blood Filling problem with the left side of the heart

Answer 582

Diastolic dysfunction: filling problem

Answer 583

Ability of the surrounding blood vessels to dilate

Answer 584

If the region cant relax to allow collateral flow

Answer 585

Vessels that have been exposed to pathology for a long period of time ◇ High CHO ◇ Smoking ◇ Alcoholism ◇ DM ◇ HTN

Answer 586

As long as the area isnt too big the body can remodel with fibroblasts laying scar tissue

Answer 587

Heart doesnt know when to stop laying down scar tissue It usually goes over the top when it could stop Sometime scar tissue is put down on good tissue

Answer 588

Helps the heart stretch (dilated cardiomyopathy) Part of the wall with scar tissue wont contract causes systolic outward stretch of the wall during contraction Causes lower EF

Answer 589

Ace inhibitors

Answer 590

(EDV-ESV) / EDV SV/ EDV

Answer 591

Thyroid system

Answer 592

Thyroid hormones are fat soluble and like to hang out on plasma proteins Hard to quantify amount of hormone in circulation

Answer 593

Hyperthyroidism

Answer 594

Next to thyroid cartilage of the larynx

Answer 595

Parathyroid gland

Answer 596

Secrete parathyroid hormone: controller of calcium levels in the blood

Answer 597

Thyroid gland

Answer 598

When the thyroid gland becomes enlarged causing protrusion from the neck

Answer 599

Massive amounts of blood flow helps to carry thyroid hormone into the vascular system at a rapid rate

Answer 600

Bleeding: Lots of blood vessels

Answer 601

Loops around and then comes back up

Answer 602

Right and left recurrent/inferior Laryngeal nerves

Answer 603

Skeletal muscle in each of the larynx muscles Has to receive instruction from motor neurons

Answer 604

R/L recurrent laryngeal nerves

Answer 605

Underneath the arterial trunk on the right side of the patient

Answer 606

Passes under the aortic arch before it turns around and heads toward the voice box

Answer 607

They give us the ability to speak Raspy voice is lose portion of these nerves If lose both we wont be able to speak at all

Answer 608

Tyrosine (amino acid) + Iodides

Answer 609

94% T4 6% T3

Answer 610

Diidodtyrosine + Diiodotyrosine Thyroxine

Answer 611

It can go in, or Enzyme pulls off an iodine to covert to T3

Answer 612

Techincally in the tissue when iodinase pulls off iodide from T4

Answer 613

Monoiodotyrosine + Diiodotyrosine = triiodotyrosine (T3)

Answer 614

Monoiodotyrosine

Answer 615

Diiodotyrosine

Answer 616

Enzyme to link them together

Answer 617

Precursors only have 1 benzene ring Larger compounds have 2 benzene rings

Answer 618

50mg/year Most table salt has iodine in it→main source for most people

Answer 619

Thyroid stimulating hormone (TSH) Produced in anterior pituitary (adenohypothesis)

Answer 620

Increase T3 and T4 in the blood

Answer 621

Hypothalamus

Answer 622

Hypothalamus

Answer 623

Thyrotropin Releasing Hormone (TRH)

Answer 624

Thyrotropin

Answer 625

Temperature If body temp is too cold, hypothalamus released TRH→binds to anterior pituitary→release of TSH→TSH binds to thyroid gland and released T4 and small amount of T3

Answer 626

Thyroxine binding globulin (TBG) Thyroxine binding pre-albumin Albumin

Answer 627

Liver→someone with liver failure will not produce these compounds and that effects thyroid system

Answer 628

Everything in the body is basically a target

Answer 629

T4 Iodinase pulls of a iodine to make T3 T3 and T4 go into the cell

Answer 630

Nucleus Hitch ride on carrier protein in the nucleus too T3 turns on genes

Answer 631

T3 and some extent T4

Answer 632

In the nucleus

Answer 633

Genes are turned on that ramp up cell processes

Answer 634

Synthesis of new proteins Growth in the cells Metabolic rate of cells O2 consumption Glucose absorption/utilization Respiratory depth increases

Answer 635

Metabolic rate of cells increases: Eating carbs to supplement for increased metabolism

Answer 636

Net result is burning more energy→Elevated demands for nutrients

Answer 637

-CO increases, BVs dilate to facilitate more blood flow and nutrient delivery, HR increases

Answer 638

Enhanced CO is a function of decreased SVR Vessels are relaxed so BP doesnt increase (sometimes SBP goes up but compensated by drop in DBP so MAP doesnt increases)

Answer 639

Breathing faster and deeper (respiratory depth increases)

Answer 640

Proper development of the nervous system requires healthy amount of thyroid hormone

Answer 641

Do not develop fully Causes massive issues with CNS: personality, cognition, memory issues

Answer 642

Reduction in amount of cholesterol in the blood  Cholesterol is being used at the cellular level to build things d/t increased metabolism  Decreases blood cholesterol levels because its being utilized more  TG also low

Answer 643

Development problems

Answer 644

Atherosclerosis (CV issue) using less cholesterol and fatty acid so those levels rise in the blood stream and it tightens up BVs, they scar over and cause atherosclerosis

Answer 645

Synthroid: compliance rate is low d/t S/E Hard to get right dose, messes with sleep, relaxation, heart palpitations when dose isnt right

Answer 646

Thyroid hormone doesnt have an immediate effect Large amount of thyroxine from the thyroid gland may take 6-8 hours for changes to manifest

Answer 647

May take up to 10 days for effects to peak: more of a long term thing

Answer 648

Thyroid storm: can happen quickly

Answer 649

Increased TSH Increased thyroid hormone High metabolic rate Decrease TRH

Answer 650

Increase metabolic rate Decrease TRH Decrease TSH

Answer 651

Increase TRH Increase TSH Increase thyroid hormone no feedback since the tumor is on the hypothalamus

Answer 652

Autoimmune disorder where body produces antibodies that interact with TSH receptors to activate them—increases activity at the thyroid gland

Answer 653

Goiter: Increase thyroid hormones Exophthalmos

Answer 654

plasmapheresis to get rid of some of the antibodies attacking the thyroid

Answer 655

Body generates antibodies that attack the thyroid gland to destroy it: antibody binds to thyroid and calls in the immune system to destroy the gland over time Common in asian folks

Answer 656

o Unable to produce thyroid hormone building blocks o Thyroid gland will not be able to produce enough thyroid hormoneExpect hypothalamus to release increase TRH o Pituitary increases TSH release o TSH is stimulating the thyroid gland but there isn’t enough iodine to produce thyroid hormone -Copious amounts of TSH in the blood

Answer 657

From things that inhibit thyroid gland from producing thyroid hormone From stimulating thyroid gland

Answer 658

Yes, common to have goiter but no exophthalmos

Answer 659

Thyroid is only part of the body that uses iodine meaningfully—makes it easy to target with radioactive iodine

Answer 660

I-13 Given in small doses over long periods of time to knock down thyroid production

Answer 661

Interferes with thyroids ability to produce thyroid hormone System gets confused when there is too much iodine (related to REDOX reactions)

Answer 662

High iodine intake

Answer 663

Packaged in solution with a lot of iodine

Answer 664

Problem getting nutrients to the tissues that need it Usually has an issue with the circulatory system

Answer 665

Low blood volume No tone in circulatory system

Answer 666

Replace what is missing

Answer 667

Problems with venous return ◇ Hemorrhage, embolism Issue with pump itself ◇ MI

Answer 668

Volatile anesthetics and high spinal procedures (lose nervous system ability to control CV system) The higher the block in the spine the more SNS eliminated

Answer 669

Reactions from the immune system Latex, peanut allergies: drives histamine released from mast cells

Answer 670

Decreases BV tone Arterial BV not good to dilate, but really more concern with dilation of the veins because will not be able to return blood to the heart if the veins are completely relaxed

Answer 671

Blood borne gram positive bacterial infections Causes BVs to dilate and more difficult for heart

Answer 672

Hypovolemic

Answer 673

Can happen with blood loss or too little volume conservation

Answer 674

ACE Inhibitors

Answer 675

How much SNS we have around

Answer 676

Compromised

Answer 677

Arterial pressure and CO are both relatively normal

Answer 678

Arterial pressures normal Low CO as consequence of the body trying to maintain BP by clamping down on vessels to shunt blood where its needed Reduced SVR

Answer 679

May be losing up to 20% blood volume and have normal BP But CO is decreased

Answer 680

Can hemorrhage down to 50% of normal BP then if bleeding stops--it is survivable

Answer 681

Catecholamine release Kidney conserves volume Fluid shifts

Answer 682

5L: HCT, Plasma, and water

Answer 683

Lots of water between and inside cells This water can shift in CV system if needed and compensate for blood loss resulting in hypotension

Answer 684

Non-progressive shock

Answer 685

Body is unable to compensate, death

Answer 686

initial recovery but ultimately unable to survive

Answer 687

Short initial recovery then rapid decline

Answer 688

Progressive shock

Answer 689

BP has been so low→ coronary arteries aren't perfused → brain, kidneys, other organs under perfused→ ANS doesn't work

Answer 690

Up to 1L (20% of 5L)

Answer 691

without rescue very difficult to survive

Answer 692

spleen Pulmonary circuit (several hundred CCs) GI system: stops digestion and shunts blood

Answer 693

When SNS and fluid compensations cant get CO to normal level (5L/min)

Answer 694

Cardiac glycoside (Digoxin) Phosphodiesterase inhibitors (Milrinone)

Answer 695

Gives the heart enough support to get to normal CO and gives the heart some time to try to repairs itself

Answer 696

If we can get back to the critical CO level then the heart can sometimes patch itself up and fix things (not always possible for heart to fix things)

Answer 697

Kidneys primarily looking at BP When BP is low kidneys retain fluid and electrolytes

Answer 698

Retaining too much fluid that the heart is stretched out past the point that is useful Sometimes we have to step in with chronic conditions to prevent the kidney from retaining tons of fluid tyring to get BP to normal level (BP will not be normal in these pts)

Answer 699

Prevent the kidney from reaching its BP goal CHF we will never get normal BP anyways so no need for the kidney to continue to try to get there if its dilating the heart and making things worse