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Unit 3 Flashcards

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1
Q

Cardiac output it determined mainly by ___________

A

Venous return

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2
Q

What are the factors that influence Venous return?

A

Body metabolism (local flow and autoregulation)

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3
Q

______ is a slow process of plaque formation where large quantities of cholesterol become deposited beneath the endothelium, scar tissue forms (fibrosis) and then calcifies (plaque)

A

Atherosclerosis

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4
Q

Partial or total blockage of coronary arteries leads to _______

A

Ischemia (lack of blood flow)

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5
Q

________ is a sudden process which occurs due to a thrombus or an embolus

A

Acute coronary occlusion

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6
Q

______ is a penetrating atherosclerotic plaque can cause a blood clot to form which quickly occludes an artery

A

Thrombus

** when this breaks away, it is then called an embolus

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7
Q

_______ is a thrombus that has broken loose for th site of origin and flows to another site where it lodges

A

Embolus

***leads to acute coronary occlusion

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8
Q

_________ is an attempt by the body to restore blood supply to ischemic tissue

A

Collateral circulation

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9
Q

During plaque formation, _______ may occur during plaque development

A

Angiogenesis

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10
Q

After _______ angiogenesis is too slow to restore blood flow acutely, however _______ of collateral vessels may resent some cardiac muscle death

A

After acute occlusion; vasodilation

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11
Q

Ischemic heart disease includes what 4 forms?

A

Angina pectoris
Coronary artery disease
Myocardial infarction
Sudden cardiac death

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12
Q

What does angina pectoris mean?

A

Chest pain

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13
Q

What are the types of angina pectoris?

A

Chronic stable angina

Unstable angina

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14
Q

______ is often a prelude to MI if not treated

A

Angina

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15
Q

_________ angina is where pain comes along during activity and is released at rest

A

Chronic stable angina

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16
Q

______ angina where chest pain comes and goes and doesnt seem to be related to anything

A

Unstable angina

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17
Q

Myocardial infarction results from an _________

A

Acute coronary occlusion

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18
Q

The muscle has ________ blood flow and the area affected ceases to function and may die during myocardial infarction SP’s

A

Little or no blood flow

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19
Q

Myocardial infarction most commonly affects the __________

A

Left ventricle

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20
Q

What are the causes of death due to MI

A
  • decreased cardiac output
  • pulmonary edema and kidney failure
  • fibrillation
  • cardiac rupture (rare)
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21
Q

Decreased CO can cause death due to MI when more than ______ of the left ventricle is infarcted (no blood flow) OR when _________ exacerbates the decrease in CO

A

40% of the left ventricle is infarcted

Systolic stretch exacerbates the decrease in CO

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22
Q

Pulmonary edema and kidney failure results from_____________ and can clean to death from an MI?

A

Result from the backlog of blood in the body’s venous system

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23
Q

______ is a chaotic pattern of contraction in the ventricles

A

Fibrillation

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24
Q

Fibrillation may result from:

  • leakage of ______ from infarcted area
  • formation of an _______
  • _______ reflexes
  • bulging weka muscle sets up __________
A

K+; injury current; sympathetic reflexes; circus movement

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25
The anatomy of an infarcted is made up of a _____ area and a ____ area
Central area and peripheral area
26
Central area made up of _______ Peripheral area made up of ______ **anatomy of an infarct
Dead cardiac myocytes Non-functional but living myocytes
27
Recovery from MI: Dead fibers are replaced by _______ Nonfunctional fibers either ____ or ______ depending on if the color is dissolved or collateral circulation is adequate Normal tissue ______ overtime to compensate for tissue loss
Scar tissue; die or recover; hypertrophies
28
What are some life style modifications for treatment for ischemic heart diseases?
Lose weight eat a diet low in Saturated fat and cholesterol Exercise
29
What are other treatments for ischemic heart diseases?
``` Nitroglycerin Beta blockers TPA (tissue plasminogen activator) Bypass surgery Angioplasty ```
30
What is the definition of congestive heart failure?
Failure of the heart to pump enough blood to satisfy the needs of the body
31
Heart failure is characterized by ________ and ______
Reduced cardiac output and damming up of the venous circulation
32
Heart failure is due to either ______ dysfunction or a _______ dysfunction
Systolic; diastolic
33
Which dysfunction is more common in congestive heart failure, systolic or diastolic?
Systolic dysfunction
34
________ is progressive loss of contractile funciton of the heart muscle
Systolic dysfunction
35
_________ is the inability of heart to expand to fil the ventricles properly
Diastolic dysfunction
36
Heart failure can also be classified as R or L sided. What are the 4 causes of left heart failure?
Ischemic heart disease Hypertension Valve diseases Myocardial diseases ** these diseases cause left ventricle to hypertrophy and/ or dilate
37
What does left sided CHF lead to?
Pulmonary congestion and edema | Decreased renal perfusion leading to water and salt retention
38
What are the symptoms of a left sided CHF?
Dyspnea, orthopnea and cough
39
What are the causes of R heart failure?
``` Left sided heart failure Cor pulmonale (heart problem likely secondary to a lung problem, ex: cystic fibrosis) ```
40
Pure R sided heart failure leads to what 4 things?
Systemic and portal vein congestion Hepatomegaly and splenomegaly Peripheral edema Kidney congestion leading to alter and salt retention
41
If the heart is not too damaged, the exces fluid retention actually helps CO by __________ (________ heart failure)
Increasing venous return Compensated heart failure
42
If the heart is severely damaged, the excess fluid retention can overwhelm the heart and lead to __________
Severe edema and death ***decompensated heart
43
What are the characteristics of compensated heart failure?
CO will be normal RA pressure is elevated No further Na and H2O retention occurs Over the ensuing weeks and months, Heath may recover
44
What are characteristics of decompensated Heart failure?
Excessive fluid retention Overstretching of the heart (weakens it further) Pulmoary edema Renal failure
45
Renal contribution to progressive decompensated heart failure due to what 3 things?
The kidney need a minimum CO of 5 L/min for normal fluid balance Decreased glomerular flatiron ANH (atrial natiruretic hormone
46
________ hormone may slow the progression of heart failure
Atrial natriuretic hormone (ANH)
47
First heart sound of S! Is due to _______. Duration of _____ and more of a ___pitch
Closure of AV valves Duration fo .14 sec Lower pitch
48
2nd heart sound of S2 is due to closer of the ________ for a duration of _______ and _____ pitch
Closure of semilunar valves 1.1 seconds Higher pitch
49
Third heart sound is during _______ and caused by _______. ______ frequency
During middle third of diastole Caused by inrushing of bloo into ventricles Low (may be audible
50
Fourth heart sound is during _______ and caused by ______. _______ frequency
During atrial systole Caused by inrushing of blood Very flow frequency
51
Aortic area - ______ intercostal space Pulmonic area -_______ intercostal space Erbs point -________ intercostal space Tricuspid area - ______ intercostal space Mitral area - _____ intercostal space at mid clavicular line
``` Aortic area- 2nd right Pulmonic area -2nd left Erbs point- 3rd left Tricuspid area- 5th left Mitral area- 5th intercostal space at mid clavicular line ```
52
What heart murmurs are heard during systole? (2)
Aortic stenosis | Mitral regurgitation
53
What heart murmurs are heard during diastole
Aortic regurgitation | Mitral stenosis
54
What heart murmur is heard throughout (continuous) diastole and systole?
Patent ductus arteriosus
55
________ is generalized inadequacy of blood flow throughout the body to the extent that the body tissues are damaged
Circulatory shock
56
What are the two cardinal features of circulatory shock?
Decrease in cardiac output | Decreased blood pressure
57
______ is self-perpetuating
Circulatory shock
58
What are the factors that affect Venous return?
Diminished blood volume Decreased vascular tone Venous obstruction
59
What causes lead to cardiogenic shock?
MI Toxicity Valve dysfunction Arrhythmias
60
What are the three stages of shock?
Non-progressive stage (compensated stage) Progressve stage Irreversible stage
61
__________ stage of circulatory shock, the body’s own compensatory mechanisms will lead to recovery without outside help
Non-progressive (compensated stage)
62
________ stage of circulatory shock where shock becomes self-perpetuating until death; is reversible with treatment
Progressive stage
63
_______ stage of circulatory shock that is severe shock that is refractory to treatment
Irreversible stage
64
_________ shock is characterize by decreased systemic filling pressure and decreased venous return. CO ad BP then also decrease
Hypovolumic/hemorrhagic shock
65
Non-progressive/compensated stage - within 30 seconds: _________ - within 20min to 1 hr: ____, ____, _____ - within 1-48 hours: ______, _____
Within 30 sec: baraoreceptor reflex (SNS response) Within 10 min to 1 hr: reverse stress-relaxation response, Renin-angiotensin system activation, ADH Within 1-48 hrs: absorption of water from interstitial tissues, increased thirst
66
What is hallmark of progressive stage of circulatory shock?
Hallmarked by progressive deterioration of the cardiovascular system (positive feedback loops)
67
What are the features of the progressive stage of hypovolumic/ hemorrhagic shock?
``` Cardiac depression Vasomotor failure (CNS depression) Blockage of small vessels “slugged blood” Increased capillary permeability (late) Release of toxins Cellular deterioration Acidosis (carbonic and lactic acid) ```
68
Describe the irreversible stage of hypovolumic/ hemorrhagic shock
Too much tissue damage Too many destructive enzymes and toxins have been released Too much acidosis Depletion of high-energy phosphates in the body (creatine phosphate, ATP)
69
What are other forms of hypovolumic shock OTHER than hemorrhagic shock?
Intestinal obstruction Severe burns Dehydration (sweating, diarrhea, vomiting, nephrotic kidney disease)
70
What is the hallmark of neurogenic shock?
Hallmaked by an increased vascular capacity ( loss of vasomotor tone)
71
What are the causes of neurogenic shock?
Deep general anesthesia Spinal anesthesia Brain damage
72
_______ shock is an allergic response to an Ag in the circulation (Due to a severe type 1 hypersensitivity reaction)
Anaphylactic
73
In ______ shock, basophils and mast cells release histamine which causes ______, _____ and _____
Anaphylactic Venous dilation, arteriole dilation, increased capillary permeability
74
______ shock AKA blood poisoning that is causes by BLOOD BORNE bacterial infection in which the bacteria has been disseminated throughout the body
Septic shock
75
Damage during ______ shock is due to infection itself or due to bacterial ENDOTOXINS release
Septic shock
76
_______ shock has nothing to do with IgE, while ______ shock does
Septic shock; anaphylactic shock
77
______ shock features high fever, vasodilation, sludging of blood, disseminated intravascular coagulation
Septic
78
What are the treatments of shock? (5)
``` Blood or plasma transfusion Dextran Sympathomimetic drugs (epipen) Oxygen therapy Glucocorticoids ```
79
What are general characteristics of RBCs?
Lack nucleus, ER and mitochondria Biconcave discs Contains Hb Contains carbonic anhydrase
80
Regulation of RBC is controlled by
Erythropoietin
81
Where is erythropoietin secreted from?
Kidneys
82
The kidneys secreted ________ in response to low oxygen levels in the blood
Erythropoietin
83
What are the factors that decrease oxygenation?
Low blood volume Low Hb Anemia Poor blood flow pulmonary disease
84
______ carries oxygen and some CO2 in the blood
Hb
85
What is Hb composed of?
Heme and globin Heme: iron containing protoporphyrin ring structure Globin: polypeptide (alpha, beta or gamma delta
86
What are the most common type of Hb?
HbA-adult Hb- alpha2/Beta2 HbF- fetal Hb- alpha2/gamma2
87
Iron is absorbed from ______
GI tract
88
Iron binds to _______ to form transferrin
Aportrasnferrin
89
What is the function f transferin?
Carries iron in the blood
90
Iron is released to tissue which then bind to _____ to form ferritin
Apoferrin
91
______ is the storage form of iron in cells
Ferritin
92
When ferritin stores are maximized, a insoluble form of iron storage is ______
Hemosiderin
93
Iron is incorporated into ______
Heme
94
Iron loss occurs in what 3 things?
In feces Bleeding Menstrual loss
95
What is the average life span of RBCs?
120 days
96
``` Metabolism of RNC weakens so that: Cell membrane becomes _______ Membrane transport of ions ____ Heme iron goes into the______ form ______ of proteins ```
Cell memabnr becomes less pliable Membrane transport of ion decreases Heme iron goes into the ferric form Oxidation of proteins
97
RBCs rupture in the ______ or _______
Peripheral circulation | Especially in the spleen
98
Hb is broken down into _____ and ______ which then break down into _____ and ______
Heme and globin | Bilirubin and amino acids
99
What is the definition of anemia?
Deficiency of Hb
100
Classification based on RBC size. What are the different sizes?
Microcytic (MCV 80) Macrocytic (MCV >100) Normocytic (MCV 80-100)
101
Classifications based on Hb content: ______ and _____
Normochromic | Hypochromic
102
Low ______, _____ and _______ all indicate anemia
Red blood cell count Hematocrit Hemoglobin
103
________ indicates average cell size (microcytic, normocytic, macrocytic)
Mean corpuscular volume
104
______ and _______ indicates Hb content per cell (hypochromic, normochromic)
Mean corpuscular hemoglobin | mean corpuscular hemoglobin concentration
105
The completel blood count is useful but it cannot do what?
Detect abnormalities in shape of cells
106
What are the characteristics of cells in hemorrhagic anemia?
Normocytic | Normochromic
107
What are the characteristics in aplastic anemia
Generally normocytic | Normochromic
108
What are the characteristics of megaloblastic anemia’s?
Macrocytic, normochromic
109
What anemia is anemia of folate deficiency?
Megaloblastic anemia
110
What anemia is characteristic of anemia of B12 deficiency?
Megaloblastic anemia
111
What is characteristic of pernicious anemia?
Megaloblastic anemia
112
What are the characteristics of hemolytic anemia’s?
Normochromic, normocytic Hereditary sperocytosis Sickle cell anemia Eyrthroblastosis
113
What are the characteristics of anemia of iron defiency?
Microcytic, hypochromic
114
What are symptoms common to anemia in general?
Fatigue Weakness Dizziness Paleness of skin
115
In severe anemia what are the symptoms?
Fainting Angina Chest pain Heart attack
116
_________ is high RBC count
Polycythemia
117
What is relative polycythemia?
Loss of fluid concentrates blood cells (intravascular volume depletion)
118
What is an absolute polycythemia?
Actual increase in RBC production
119
What is absolute primary polycythemia?
Defect involving bone marrow results in increase in red cell production (Genetic) Polycythemia Vera, primary congenital and familial polycythemia
120
What is secondary absolute polycythemia?
Consequence of hypoxia or other problem which leads to an actual increase in RBC production
121
______= prevention of blood loss
Hemostasis
122
What are the steps of hemostasis?
Vascular spasm Platelet plug formation Fibrin clot (coagulation) Retraction
123
________ - constriction of blood vessels reduces the rate of blood loss
Vascular spasm
124
_______ is due to pain, vascular wall damage or thromboxane A2
Spasm
125
_________- activated platelets form a weak plug
Platelet plug formation
126
__________ - a series of clotting factors are involved in forming the clot
Fibrin clot formation (coagulation)
127
________- shrinking of the clot material to approximate edges of clot together
Retraction
128
Where are platelets formed and from what?
Formed in bone marrow | From megakaryocytes
129
Platelets contain _____ and ______ and store _____
Contain actin and myosin | Store calcium
130
What do platelets synthesize?
``` ATP, ADP Prostaglandins Fibrin stabilizing factor Thromboxane A2 Growth factors ```
131
Platelets have surface _____ that stick to exposed collagen
Glycoproteins
132
Primary hemostasis - ____________
Platelet plug formation
133
What are the events that occur when platelets encounter damaged blood vessel wall?
- Platelets swell and send out pseudopods that stick out to the vessel wall - Contractile proteins contract to cause release of factors including ADP and thromboxane A2 - Newly activated platelets stick to the growing plug
134
______ and _______ activate other platelets and promote vascular spasm
ADP and thromboxane A2
135
Secondary hemostasis (_____, _____) platelet plugs are strengthened by the _________
Coagulation, clot formation | Clotting process
136
``` Clotting factors: I: _______ II:______ III:_________ IV:________ VIII:_______ XIII:______ ```
``` I: fibrinogen II: prothrombin III: tissue factor IV: calcium VIII: antihemophilia factor XIII: Fibrin stabilizing factor ```
137
The intrinsic and extrinsic pathways of the clotting cascade both end with ______
Prothrombin (factor 1) common pathway
138
What starts the extrinsic clotting cascade?
Tissue trauma leads to tissue factor production
139
How does the intrinsic clotting cascade begin?
Blood trauma or contact with collagen
140
The lower the concentration of clotting factors such as _______ the longer it takes for the blood to clot
Prothrombin
141
___________ is a test used to help detect and diagnose a bleeding disorder
Prothrombin time test
142
_________ can be used to monitor how well an anticoagulant medication is working to prevent blood clots
Prothrombin time test
143
___________- contraction of platelets tighten the clot and pull the edges of the wound together
Clot retraction
144
What are the preventions of unwanted clotting?
Intact blood vessel wall Glycocalyx- repels platelet s and clotting factors Thombomodulin
145
_______ inhibits thrombin and activates anticoagulant protein C which inturn inactivates factors ____ and ____
Thrombomodulin; V and VIII
146
________ purpose is to limit the size of the clot
Anticoagulant
147
What are examples of anticoagulants
Heparin | Antithrombin
148
______ binds with _______ which binds to thrombin
Heparin; antithrombin
149
__________ is released by damaged tissues over time as they heal
Plasminogen activator (tissue plasminogen activator, TPA)
150
________ converts plasminogen to plasmin when the concentraiton of the activator is great enough
TPA (plasminogen activator
151
_________ digests away the fibrin clot
Plasmin
152
_________ can be used o digest thrombi (abnormal clots)
Plasminogen activator
153
What clotting factors are affected by vitamin K deficiency?
Factors II, VII, IX and X *** require within K for their synthesis by the liver
154
_______ is the source of many clotting factors
Liver
155
___________ is caused by inheritance of a faulty factor 8 gene. It is an ___ -linked trait
Hemophilia; X-linked trait
156
________ is a lack of platelets (______ rash= red sports visible on the skin)
Thrombocytopenia Petechial rash
157
What are the 4 bleeding disorders?
Vitamin K deficiency Liver damage/ disease Hemophilia Thrombocytopenia
158
_______ are abnormal clots that form on roughed endothelial surfaces (arteriosclerosis, infection, trauma)
Thrombi
159
_______ are thrombi that have broken loose from their attachment and may age lodge elsewhere in circulation
Embolus
160
Unwanted clots may be dissolved clinically by administering _________
Plasminogen activator
161
What are the factors affecting heart rate?
Autonomic innervation Hormones Fitness levels Age
162
What are the factors affecting stroke volume?
``` Heart size Gender Contractility Duration of contraction Preload (EDV) Afterload (resistance) ```
163
CO will match VR via what 3 mechanisms?
``` Frank starling’s mechanism (effects force of contraction) Brainbridge reflex (effects rate of contraction) SA node stretch (effects rate of contraction) ```
164
The heart has a limit to the maximum CO it can achieve. Normal (at rest) ________ Maximum _________
5 L/min 13 L/min
165
_______ demonstrates the effectiveness of cardiac function at different levels of RA pressure (which reflects _____)
Caridac output curve VR
166
What causes a hypereffective heart?
Sympathetic sitmulation | Hypertrophy
167
What causes a hypo-effective heart?
Hypertension Sympathetic inhibition Any heart pathology
168
Pathologically LOW cardiac output can be due to ______ or _______ factors
Cardiac | Peripheral
169
What are the 4 cardiac factors that can lead to pathologically low caridac output?
Myocardial infarction Severe valve disease Myocarditis Cardiac tamponade
170
What are the 4 peripheral factors that can lead to pathologically low CO?
Decreased blood volume (hypovolemia) Acute venous dilation (SNS suppression) Large vein obstruction Decreased metabolic rate of tissues (hypothyroidism)
171
When cardiac output falls too low, it is called _________
Circulatory shock
172
In the venous return curve, that is the plateau due to?
Low atrial pressures leading to vein collapse
173
___________- the venous return becomes zero when the RA pressure rises to __________
Mean systemic filling pressure (both answers)
174
The steady ______ with changes in amount of sympathetic activity
RA pressure
175
_________ can be used to calculate CO
Flicks principle
176
Applying _______ by measuring oxygen uptake from the lungs and blood gas measurements
Ficks principle
177
In circulation during exercise, it is regulated locally via _______
Autoregulation
178
In circulation during exercise, regulation via the NS is controlled by ______ and ______
Sympathetic (norepinephrine) and adrenal (epinephrine)
179
Norepinephrine works via ______ receptors Epinephrine works via ___ receptors
Alpha | Beta
180
Exercise results in mass __________
Sympathetic discharge
181
Mass sympathetic discharge during exercise results in what 3 things?
Increases HR and cardiac contractility Arterioles are contracted all over the body (except coronary blood vessels and cerebral vessels) Capacitance vessels and reservoirs contract to increase mean systemic filling pressure
182
Increase in arterial pressure during exercise is a result of what?
Mass sympathetic discharge
183
What are the 3 results of mass sympathetic discharge?
Increases HR and cardiac contractility Arterioles are contracted all over the body except muscles that are working, coronary blood vessels and cerebral blood vessels Capacitance vessels and reservoirs contract to increase mean systemic filling pressure
184
Who is more likely to have higher blood pressure, a stress induced individual or one in whole body exercise?
Stress induced individual would end up with higher blood pressure than whole body exercise because whole body exercise would result in vasodilation and stress induced will not compensate with vasodilation
185
What is the effect of rhythmic muscle contraction on blood flow?
When muscles are contracted you have less flow and when they are released you have more flow
186
Left coronary artery and branches- supplies the ______ and ________ portions of the left ventricle
Anterior and left lateral
187
Right coronary artery and branches- supplies most of the ___________ and _________ of the left ventricle
RV and posterior part of the left ventricle
188
Local autoregulation as determined by local muscle cells metabolism; most likely by _________ secretion in presence of low O2
Adenosine
189
Sympathetic coronary arteries contain mostly ________ receptors; therefore general tendency is ________
Beta androgenic | Vasodilation
190
Some pericardial arteries also contain _______ receptors, it is a thought that this helps to prevent backflow during heart exercise in the epicardial arteries
a1 (vasoconstrictor) receptors
191
What helps to prevent backflow during heavy exercise in the epicardial arteries?
Some epicardial arteries also contain a1 (vasoconstrictor) receptors
192
________- very little DIRECT innervation to coronary vessels
Parasympathetic
193
________ slows heart rate and contractility, autoregulation leads to ____________
Ach | Decreased blood flow
194
What is the structure of blood brain barrier?
Continuous capillaries Astrocytes foot processes Pericytes
195
__________ - endothelial cells have tight junctions and lack fenestrae, low amount of vesicular transport
Continuous capillaries
196
What is the function of blood brain barrier
Low permeability to most water soluble substances Need special carrier systems to transport glucose, amino acids, etc.
197
_______ of the hearts energy is derived from fatty acids at rest
70%
198
Under anaerobic or ischemic conditions, the heart must rely more on _______.
Glucose/ glycolysis
199
ATP degrades to ADP-> AMP-> adenosine. ________ diffuses out of the caridac muscle cell and is a potent vasodilator
Adenosine
200
Excessive loss of adenosine can lead to _______
Cardiac muscle death
201
About ______ of the hearts adenosine can be lost in 30 min of ischemia
1/2

CVP (3 decks)

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