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Flashcards in Test 1 Deck (120):
1

Arterial supply of AV node

RCA

2

Net effect of decreased PCOP

Interstitial edema

Decreased vascular volume

3

Arterial supply of lateral LV

Circ

4

Arterial supply of atrial internodal pathways

RCA

5

Driving force of coronary circulation?

Occurs when?

Driving force- Pressure created by LV contraction (systole)

Most perfusion occurs during ventricular diastole

6

Auscultation area for mitral valve

5th ICS Left MCL

7

Causes of increased CHP (capillary hydrostatic pressure)

Increased BP
Increased vascular volume
Heart failure/increased CVP

8

A wave on LA waveform represents

Atrial kick (contraction)

9

If depolarization during RRP what will see on EKG

QRS right on T wave

10

Phase 1 of repolarization

mV

Ion movement

+20-30mV to 0mV

Fast voltage gated Na channels close. K+ channels begin to reopen. Influx of Ca through slow Ca-Na continues

11

Blood vessels have PNS/SNS/both innervation

Only SNS innervation

Dilation due to lack of SNS not PNS domination

12

Phase 4 of repolarization

Resting phase between action potentials

Mvmt of ions same as during RMP

13

How many functional syncytium are there?

What to they entail

2

1- right and left atria

2- right and left ventricle

14

Auscultation area for tricuspid valve

5th ICS L sternal border

15

SNS effect on AV node

Increased rate of transmission (increased dromotropic effect)

16

Early phase 0 of depolarization

mV

Ion movement

-90mV to -40mV

-90 to -60 inflow of Na through leak channels, K channels very impermeable

-60 fast voltage gated Na channels open

17

Arterial supply of posterior IVS

PDA (RCA)

18

What increases workload on heart and increases myocardial oxygen demand/consumption more than any other factor

Increased heart rate

19

V wave on LA waveform represents

LA filling

20

SNS effect on ventricular contractile fibers

Increased strength of contraction (positive inotropic effect)

21

Anesthetic management of cardiac tamponade

Full, fast, forward

- avoid vasodilators, bradycardia
- optimize LV filling
- maintain sympathetic tone
- avoid PPV- have breathe spontaneously

22

End result of increased CHP

Interstitial edema

Decreased vascular volume

23

Effect of ventricle going into systole on AV valves

AV valve leaflets balloon into atria causing a transient increase in pressure

24

Arterial supply of anterior LV

LAD and circ

25

Arterial supply of anterior and posterior RV

RCA

Posterior by PDA (most commonly from RCA)

26

Where is a pericardial friction rub best heard?

Apex of heart- 5th ICS L MCL

27

Atrial contraction contributes how much of RV preload?

25%

28

((SBP-DBP)/3) + DBP

MAP

29

Portion of pericardium that anchors heart in place to adjacent structures

Fibrous pericardium

30

((MPAP-PCWP)/CO) X 80

PVR

31

Supranormal refractory period mV

-85mV to -90mV

32

Arterial supply of SA node

RCA

33

Point 4 on LV pressure-volume loop

Mitral valve opens

34

((MAP-RAP)/CI) X 80

SVRI

35

LVSV/LVEDV

LV Ejection Fraction

36

Pacemaker action potential ion mvmt

RMP -55mV

Fast Voltage gated Na channels inactivated

Very leaky to Na

At -40mV voltage gated Ca-Na channels open (depolarization)

At +20mV Ca-Na channels close and K channels open

37

Which artery perfuses the largest part of myocardium?

Left main coronary artery

38

Arterial supply of diaphragmatic (inferior) LV

Circ and PDA

39

Pressures that favor filtration

CHP- capillary hydrostatic pressure

-IFP- negative interstitial fluid pressure

IFCOP- interstitial fluid colloid osmotic pressure

40

Between point 4 and 1 on LV pressure-volume loop represents

LV filling

41

2nd heart sound caused by

Closure of pulmonic and aortic valves

42

Effects of increased afterload on LV pressure-volume loop

Increased distance bw point 1 and 2 as well as 3 and 4

Also less distance bw 2 and 3

43

((MAP-RAP) / CO ) X 80

SVR

44

CO/BSA

CI

45

Arterial supply of RA

RCA

46

Point 1 on LV pressure-volume loop

Mitral valve closes

47

If cardiac electrical primary property is excitability what does that mean

Easily excited in response to action potential

48

Phase 2 of repolarization

mV

Ion movement

Stays 0 mV

Inward mvmt of Ca continues through slow Ca-Na channels. K+ channels fully open

Inward and outward movement of ions equal so MP remained 0mV

49

Arterial supply of anterior IVS

LAD

50

SBP-DBP

Pulse pressure

51

Causes of decreased PCOP (plasma colloid oncotic pressure)

Hypoalbuminemia

52

Point 3 on LV pressure-volume loop

Aortic valve closes

53

Dicrotic notch is caused by

Aortic pressure greater than LV pressure and AV closes causing transient increase in aortic pressure

54

4 metabolic vasodilators

Increased CO2
Decreased pH (increased H+)
Lactate
Adenosine

55

Arterial supply of LA

Circumflex

56

Auscultation area for aortic valve

2nd ICS Right sternal border

57

During systole which valves should be open?

Closed?

Open- aortic and pulmonic

Closed- tricuspid and mitral

58

Point 2 on LV pressure-volume loop

Aortic valve opens

59

Arterial supply of bundle of His

RCA

60

Beta 2 receptors in the heart have what effect on coronary arteries?

Coronary artery dilation

61

Effects of increased strength on contraction on LV pressure-volume loop

Increased distance bw 2 and 3 as well as 3 and 4

Increases SV

62

Auscultation area for pulmonic valve

2nd ICS Left sternal border

63

HR X LVSV

Cardiac output CO

64

Effect of thebesian veins

Why blood on L side of heart has lower PaO2 than pulmonary veins

65

Between point 1 and 2 on LV pressure volume loop represents

Isovolumetric contraction

66

Net effect of decreased CHP

More volume stays in systemic circulation

67

Passive blood flow from RA to RV accounts for how much of RV preload?

75%

68

If cardiac fiber primary property is automaticity it means

It generates action potentials best

69

CO X AFTERLOAD

Systemic BP

70

Which valves are associated with chordae tendineae

tricuspid and mitral

71

In cardiac muscle does each fiber need to be innervated?

Why?

No. Intercalated disks and gap junctions spread AP

Functional syncytium

72

About ____% of CO circulates through coronary arteries

3%

73

Arterial supply of posterior LV papillary muscles

Circ and PDA (RCA)

74

Relative Refractory Period mv

-60mV to -85mV

75

What accounts for the difference in net arterial filtration pressure and net venous reabsorption pressure

Terminal lymphatic vessels

76

RVO X PVR

PAP

77

Increase preload effect on LV pressure-volume loop

Increased distance between point 4 and 1 as well as between point 2 and 3

Longer filling and ejection

78

Late phase 0 of depolarization

mV

Ion movement

-40mV to +20-30mV

-40 opening slow voltage gated Ca-Na channels. K channels impermeable

79

1st heart sound caused by

Closure of mitral and tricuspid valves

80

Coronary artery blood flow and myocardial perfusion controlled primarily by what

Rate of myocardial O2 consumption

81

1/3PP +DBP

MAP

82

Impact of afib on preload?

Lose atrial kick so lose 25% of preload

83

((SPAP-DPAP)/3) + DPAP

MPAP

84

LVEDV-LVSV

LV end systolic volume

LVESV

85

Absolute refractory period mV

-60mV to -60mV

86

Between point 2 and 3 on LV pressure-volume loop represents

Ejection- stroke volume

87

Strong SNS stimulation can increase cardiac output by how much

Up to 100%

88

During diastole which valves should be open?


Which closed?

Open- tricuspid and mitral

Closed- aortic and pulmonic

89

Which dominates in heart in relation to coronary arteries- alpha 1 or beta 2?

Resulting effect

Beta 2 predominates so coronary artery dilation predominates

90

Intrinsic regulation of CO

CO depends on venous return

91

Causes of decreased CHP (capillary hydrostatic pressure)

Decreased BP
Decreased vascular volume

92

Anesthesia implications of hypocalcemia?

If not enough Ca will not have effective release of NE into synapse

Ca administration results in increased myocardial contractility and Ca dependent exocytosis of NE

93

Between point 3 and 4 on LV pressure-volume loop represents

Isovolumetric relaxation

94

C wave on LA waveform represents

Ventricles in systole causing valve leaflets to bulge into LA (transient increase in pressure)

95

In cardiac electrical fibers if primary property is conductivity it means

Primary property is that it rapidly conduction action potentials

96

Phase 3 of repolarization

- mV

- ion mvmt

0mV- -90mV

Slow Ca-Na channels close. K+ channels fully open

97

Arterial supply of LV apex

LAD

98

Any condition hat increases myocardial O2 consumption causes

Dilation of coronary arteries to increase O2 supply to meet increased demand

99

Signals beginning of repolarization (ion mvmt)

K+ channels begin to reopen

100

Regulation of blood flow from metarterioles into capillaries determined by

O2 demand of tissue supplied by capillary network

101

At RMP contributes to maintenance of RMP in cardiac fiber

K+ leak channels
Na+ leak channels
Na-K pumps
(-) charged proteins lining inner membrane

102

Overall effect of PNS on heart

Decreased cardiac output

103

CO/HR

LVSV (stroke volume)

104

Difference between pericardial effusion and cardiac tamponade

Tamponade has CV manifestations- impairs cardiac function

105

Signals end of depolarization (ion mvmt)

Fast voltage gated Na channels close

106

Arterial supply of anterior LV papillary muscles

LAD and circ

107

((MPAP-PCWP)/CI) X 80

PVRI

108

Small microscopic veins that permeate through walls of the heart and empty venous blood into all 4 chambers of the heart

Thebesian veins

109

primary PNS effect on heart

Muscarinic receptors in SA node= increased permeability to K+. Negative chronotropic effect (decreased HR)

110

What is the longest phase of repoalrization

Phase 2 of repoalrization

111

Most rapid phase of repolarization

Phase 3 of repolarization

112

If depolarization occurs during SNP what will you see on EKG

QRD on downslope of T wave

113

Layer of pericardium that completely surrounds the heart that is inseparable from the heart

Visceral pericardium

114

Net effect of increased IFCOP

Interstitial edema
Decreased vascular volume

115

Causes of increased IFCOP (interstitial fluid colloid osmotic pressure)

Leaky capillaries and loss of albumin into interstitial fluid

116

Cardiac action potential in non- pacemaker cells in comparison to skeletal muscle action potential

Longer action potential

Slow prolonged repolarization

117

Alpha 1 receptors in the heart cause what effect to coronary arteries

Coronary artery constriction

118

Pressures that favor reabsorption

PCOP- plasma colloid osmotic pressure

119

Arterial supply of R and L bundle branches

LAD

120

SNS stimulation on SA node causes

Increased permeability to Na+

Increased Heart rate (positive chronotropic effect)