Term
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Definition
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Term
| Cardiac muscle requires energy for __ and __. |
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Definition
| contraction and relaxation |
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Term
| What organs have the best ability to auto-regulate? |
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Definition
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Term
| Circulatory system is made of what two circuits? |
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Definition
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Term
| Coronary circulation occurs during ___. |
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Definition
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Term
| Name the AV valves and the semilunar valves: |
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Definition
- AV valves: Mitral bicuspid valve, Tricuspid valve
- Semilunar valves: Aortic valve, Pulmonic valve |
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Term
| Cardiac muscle likes to have calcium comng from the ___, whereas skeletal muscle has most of the calcium in it. |
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Definition
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Term
| Triponin inhibits the interaction of actin and myosin. Measure tryponin during an MI. Trypnonin comes out when cells are damaged like with a MI. |
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Definition
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Term
| Conductivity is talking about the __ effect, which is how fast or slow the __ __ are ___. __ have a positive __ effect, while ___ have a negative ___ effect. |
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Definition
- dromotropic effect
- action potentials are conducted
- Sympathetics have a positive dromotropic effet
- Parasympathetics have a negative dromotropic effect |
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Term
| The chronotropic effect is talking about __ __. |
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Definition
| heart rate (tachycardia, bradycardia) |
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Term
normal stroke volume:
normal CO: |
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Definition
SV normal: 60-80 ml
CO normal: 4.6-6.4 L/minute |
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Term
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Definition
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Term
| Pre-load is how much fluid the heart is filled with right before __ starts. Or you could say it is the amount of volume/pressure on the ventricle at the end of ___. |
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Definition
- before contraction
- end of diastole |
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Term
| The Frank-Starling law of the heart is related to ___. The more you fill it, the better it will squeeze, up to a certain point. |
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Definition
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Term
| Ejection fraction formula: |
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Definition
ejection fraction= (SV/EDV) x 100
- a normal ejection fraction is 50-75% or about 2/3 |
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Term
| ejection fraction indicative of heart failure: |
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Definition
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Term
| ejection fraction indicative of heart failure: |
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Definition
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Term
| Afterload can be considered as __ __, or the ____ to blood being pumped out of the ventricle. Increased systemic vascular resitance results in ___ afterload. ___ pressure can be considered a rough estimate of afterload. |
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Definition
- arterial pressure
- resistance
- increased
- Diastolic |
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Term
| PAWP: pulmonary capillary wedge pressure: measure where you take a tube and run it into the venous system through right atrium and ventricle and into the pulmonary artery and it opens to the left atria, it measures the left atrial pressure |
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Definition
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Term
| A fib. patients lack an __ __. |
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Definition
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Term
| The first heart sound is the closure of the __ valve which occurs just after the ___ __ on the EKG. |
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Definition
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Term
| The second heart sound is the __ valve closing. |
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Definition
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Term
| You would hear a __ __ during the first half of diastole when the blood from the lungs is rushing into the left ventricle. |
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Definition
| S3 gallop (if something was wrong and the pt had an S3 gallop, this is where you would hear it) |
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Term
| During isovolumetric contraction, both the mitral and aortic valves are ___ and pressure is increasing in the ____. Once pressure in the left ventricle is __ than the __ or aortic pressure, the __ valve ___. |
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Definition
- closed
- left ventricle
- greater than the afterload
- aortic valve opens |
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Term
| If you increase the afterload/aortic pressure, the aortic valve will open __ and stroke volume would ___. |
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Definition
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Term
| If you give someone a vasodilator, you reduce their ___, thereby allowing the aortic valve to open ___. This would increase __ __. |
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Definition
- reduce their afterload
- sooner
- increase stroke volume |
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Term
| At the end of systole, the aortic valve __ b/c the aortic pressure has become __ than the left ventricular pressure. This period is called __ __ and both the aortic and mitral valves are ___. |
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Definition
- closes
- greater
- isovolumetric relaxation
- closed |
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Term
| Left atrial pressure is going up during diastole b/c its filling from the pulmonary system, we have passive filling. The little brown inflection is where the atria contracts and p wave occurs so atria pressure increases during the contraction, atrial kick. So left ventricular volume is going up and then goes up more in conjuction with atrial kikc. Kick usually puts in an extra 5-10%. (A fib patients do not have an atrial kick!! KNOW THIS). Nothing yet for heart sounds. Left ventricular pressure is going up and mitral valve is open so flowing from left atria to left ventricle. Mitral valve is open during part of diastole. QRS and ventricles start to contract and the mitral valve closes. During this time the ventriclular volume is not going up, but the pressure is going up (no more volume b/c mitral valve is closed)= isovolumetric phase of contraction-both aortic and mitral valves are closed. The first heart sound is the closure of the mitral valve (sound delivered more slowly than the electrical impulse so slight delay). So during isovolumetric contraction we are developing pressure in the left ventricle> suddenly the left ventricular end diastolic volume drops a lot b/c the aortic valve is open. The aortic vlalve opens when the intraventricular pressure is just greater than the aortic pressure or afterload. So when left ventricular pressure is just greater than the afterload> aortic valve opens. If increase afterload or arterial pressure, the aortic vavle will open later. If reduce pressure it opens sooner (vasodilator). As long as left vent pressure is greater than arterial pressure, aortic vavle is open. But then at end of contraction> aortic valve closes b/c the aoritc pressure is greater than the left ventricular pressure. Now we are in isovolumetric relaxation- no changes occuring in ventricular volume- both valves are closed during this period. The second heard sound (dub) is the aortic valve closing. Now we restart filling, filling occurs during the first half of diastole. Then aortic pressure comes down in aortic pressure and ventricular volume increases. Volume ventricular increase is caused by the lungs b/c when mitral vavle opens, it just comes rushing in. This is the phase you would hear a gallop. Then get atrial kick and see p wave. And that’s the cardiac cycle. |
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Definition
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Term
increased afterload= aortic valve opens later= decreased stroke volume
decreased afterload= aortic valve opens sooner= increased stroke volume |
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Definition
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Term
| S4 gallops are closely associated with __. |
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Definition
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Term
| S3 gallops are closely associated with __. |
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Definition
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Term
| Left atrial pressure and left ventricular volume and pressure are __ during diastole. The __ __ then creates the P wave on the EKG. |
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Definition
- increasing
- atrial kick |
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Term
So the aortic valve closes when the aortic pressure is greater than the left ventricular pressure.
So when does the mitral valve close? |
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Definition
| when the left ventricular pressure is greater than the left atrial pressure |
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Term
So the aortic valve opens when the left ventricular pressure is greater than the aortic pressure.
So when does the mitral valve open? |
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Definition
| when the left atrial pressure is greater than the left ventricular pressure |
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Term
| The atrial kick increases left ventricular volume by 5-10%. During this time the mitral valve is __ and the left ventricle is filling. Then the ventricles start to contract and slap the mitral __ since the left ventricular pressure is __ than the left atrial pressure. This begins the period of ___ __ in which the pressure in the left ventricular greatly ___. |
|
Definition
- open
- closed
- greater
- isovolumetric contraction
- increases |
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Term
| When the ventricles start to contract the __ valve closes and __ __ beings. |
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Definition
mitral valve closes
isovolumetric contraction begins |
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Term
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Definition
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Term
| At the end of isovolumetric contraction, the pressure in the __ __ is greater than the pressure in the __, causing the __ __ to open. |
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Definition
- left ventricle
- aorta
- aortic valve |
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Term
| During the ejection phase of systole, the left ventricular volume greatly ___. |
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Definition
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Term
| During the ejection phase, aortic pressure is ___. |
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Definition
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Term
| The beginning of isovulmetric relaxation/diastole is marked by the aortic pressure ___ left ventricular pressure and causing the aortic valve to close making the __ heart sound. |
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Definition
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Term
| At the end of ejection phase and during __ __ we see the __ __ on the EKG signifying repolarization of the ventricles. |
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Definition
- isovolumetric relaxation
- T wave |
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Term
| what is systole signified by on the EKG? |
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Definition
| QRS through the end of the T wave |
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Term
| During the isovolumetric relaxation period, the left atria is ___ but the pressure in the left atria is NOT greater than that in the left ventricle yet, thus the __ valve remains ___. |
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Definition
- filling
- mitral
- closed |
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Term
| During isovolumetric relaxation and contraction both the __ and __ valves are __. |
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Definition
| - aortic and mitral valves are closed |
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Term
| At the end of isovolumetric relaxation, the left atrial pressure exceeds the left ventricle pressure, so the __ valve ___. It is now the __ ___ phase of ___. |
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Definition
- mitral valve opens
- rapid filling phase of diastole |
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|
Term
systole = isovulmetric contraction + ejection phase
diastole = isovolumetric relaxation + rapid filling phase |
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Definition
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|
Term
| The volume of blood pumped by the heart per minute is the __ __. |
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Definition
- cardiac output
CO= HR (beats/min) x SV (ml/beat or L/beat)
units can be ml/min or L/min |
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Term
| How many ml or liters your heart ejects each beat is the __ __. |
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Definition
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Term
| Stroke volume can be altered by 2 mechanisms, via changing ___ or via Frank Starlings law of the heart by altering __ aka __ __ __. |
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Definition
- contractility
- pre-load aka end diastolic volume |
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Term
2 ways of changing SV.
Starling Law of the Heart: if you increase the filling you get more output
Contracitlity changes: makes the heart muscle more vigorous (harder and faster contractions |
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Definition
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Term
| Under physiological conditions if the ventricle is loaded with more blood before contraction (i.e. increased preload or increased EDV), then the ventricle responds with a more forceful contraction, as shown on the following "ventricular function" curve. |
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Definition
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Term
End-diastolic fiber length (shown at bottom) is determined by EDV. At point A there is essentially no stretch (negligible) on the left ventricular muscle and actin fibers abut each other and impead contraction - there is little contraction and hence little SV.In contrast at point B, EDV is large enough to optimally stretch the myocardial crossbridges, so there is an optimal LV contraction and optimal SV.Cardiac muscle can also be overstretched as shown at point C.
What physiological or pathological condition could cause this? |
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Definition
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|
Term
| A change in contractility is a change in __ of contraction that is NOT due to a change in ___. |
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Definition
- change force
- NOT due to a change in length |
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Term
| What is the primary way of changing contractility? |
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Definition
| sympathetic nervous system |
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Term
| __ from sympathetic neurons act on _ __ receptors on the heart to increase contractility. What drugs could you use to block this? |
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Definition
- Norepinephrine
- beta-1 recptors
Drugs to block this:
- Propanolol
- Natenolol
- Metropolol
(beta blockers) |
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Term
| With increased contractility, the __ of contraction and the __ __ are both increased. |
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Definition
- rate of contraction
- max force |
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Term
| The ___ __ __ has NO effect on contractility. |
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Definition
| - parasympathetic nervous system |
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Term
| __ __ can be changed by changing contractility or by Frank Starling law (preload). |
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Definition
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Term
| Describe how stroke volume increases with exercise. |
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Definition
- Initially when you start exercising, you are increasing the blood flow back to the heart> increase preload (Frank Starling)> increased stroke volume
- But also as you exercise, the SNS increases contractility to increase SV. |
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Term
| Pressure-volume loops describe the relation of left ventricular __ to left ventricular ___ during ___ cardiac cycle. There is NO __ component. |
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Definition
- pressure
- volume
- one
- NO time component |
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Term
| See drawn notes and slides starting at slide 62 for pressure-volume loop examples. |
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Definition
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Term
| On a pressure-volume loop, changing pre-load changes the ___ or point __. |
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Definition
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Term
|
Definition
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Term
| An increase in contractility means you are pushing more out of the heart with each beat. This means an increase in contractility would increase SV, thereby __ ESV. Thus point __ on a pressure-volume loop changes with a changes in contractility. |
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Definition
- decreasing ESV
- point D |
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Term
| If afterload aka aortic/arterial pressure increases, it takes more __ __ __ to open the ___ valve for ejection to occur, and vice versa. Thus with changes in afterload, point __ changes on a pressure volume loop. But changing point B, means changing time spent in __ __, meaning __ is also effected. Thus point __ also changes. |
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Definition
- left ventricular pressure to open the aortic valve
- point B
- isovolumetric contraction
- ejection
- point D |
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Term
| Both the __ and __ effect heart rate, but on the __ effects contractility. |
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Definition
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Term
| If end-diastolic volume is 150 ml, and end-systolic volume is 100 ml, then the ejection fraction is |
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Definition
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Term
|
Definition
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Term
| With the fight or flight response, both __ and __ increase. |
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Definition
| - contractility and afterload |
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Term
| Afterload aka diastolic pressure aka arterial pressure (diastolic is better term though b/c more time is spent in diastole and thus is more related to afterload). |
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Definition
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Term
| Preload aka stretch aka filling aka left ventricular diastolic volume aka left atrial pressure |
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Definition
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Term
| Contractility aka positive inotropic effect (increased contractility). Decreased contractility (negative inotropic effect). Digoxin would increase contractility. Beta blocker (1) would decrease contractility. |
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Definition
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Term
| In the situation of acute volume loss, like hemorrhage, the ___ decreases and the ___ decreases, thus __ decreases. __ does NOT change |
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Definition
- preload
- afterload
- SV
- contractility does not change |
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Term
| HE WILL NOT GO INTO REFLEX CHANGES, IT WILL GET WAY TOO COMPLICATED, SO DON’T THINK ABOUT WHAT WOULD HAPPEN DO DUE TO THE HEMORRHAGE, JUST THINK ABOUT THE HEMORRHAGE. |
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Definition
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Term
| Consider 1. preload, 2. afterload, 3. contractility. Think of them in this order. |
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Definition
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Term
| see slides 87-90 to quiz self |
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Definition
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Term
| Adrenal glands make 85% ___. The ratio of __ to __ made by the adrenals is 4:1. Thus most ___ comes from neurons. |
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Definition
- epinephrine
- epinephrine to norephinephrine
- norepinephrine |
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Term
| The blood supply to the anterior brain are the __ __. Blood supply to the posterior brain are the __ and __ ___. These all connect to form the __ __ __. |
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Definition
- carotid arteries
- vertebral and basal arteries
- circle of willis |
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Term
| Larger veins have one way valves/conduits so that as blood is going up and not down, if these are destroyed> edema |
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Definition
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Term
| Autoregulation is ___ to tissues, meaning no __ are needed. |
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Definition
- INTRINSIC
- no nerves are needed |
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Term
| Autoregulation is the intrinsic ability of an organ to maintain __ __ __ despite changes in __ __. The __ and __ mechansims help achieve this. |
|
Definition
- constant blood flow
- perfusion pressure
- myogenic and metabolic mechanisms |
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Term
| For any given tissue, between mean pressure of __ and __, flow to the organ is constant. |
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Definition
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Term
| Heart uses 4% of circulation all the time. So increase in CO, the percentage of blood flow stays 4% but will have increased since CO increased. |
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Definition
|
|
Term
|
Definition
Q= (Pa-Pv)/R
figure this out |
|
|
Term
Blood pressure = CO x total peripheral resistance
Blood pressure = flow x resistance |
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Definition
|
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Term
| Increased pressure> increased flow. Without autoregulation flow would just stay up. With autoregulation, pressure increases> flow increases> tissue responds to reduce flow via increasing resistance (2 ways it does this: 1)myogenic: muscle stretches and responds by contracting. 2)metabolic: you increase pressure and flow you wash out vasodilators > resistance goes up to bring down flow. |
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Definition
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Term
| In a healthy normal heart, the left ventricle is ___during systole than it is during diastole. |
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Definition
|
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Term
| With CHF, you get __ __ meaning the left ventricle has __ out and have less ability to generate pressure and pump. This can also occur after a heart attack. |
|
Definition
- dilated cardiomyopathy
- thinned |
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Term
| With pericarditis or sarcoidosis, ___ cardiomyopathy occurs so the heart cannot __ and __ well. |
|
Definition
- restrictive cardiomyopathy
- cannot expand and fill well |
|
|
Term
| Hypertrophic cardiomyopathy may be due to __ __ __ , which is like __ __. With this condition, the __ and __ __ are too __. This is a genetic condition a lot of people have. This can lead to sudden cardiac death due to ___ problems. |
|
Definition
- hypertrophic obstructive cardiomyopathy (HOCA)
- subaortic stenosis
- septum and left ventricle are too big
- electrical problems |
|
|
Term
| Chronic HTN will result in __ __ _. |
|
Definition
| left ventricular hypertrophy |
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Term
| When a valve is described as stenotic, what does that mean? |
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Definition
| it does not open up well enough |
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Term
| When you hear regurgitation, what does that mean about the valve? |
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Definition
| doesn't close well enough |
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Term
| With rheumatic heart disease, the bacteria love the valves and grow on the valves and create little hard things> valve does not open as fluidly as you would like> have to create more pressure in ventricles to open up the valve. |
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Definition
| rheumatic heart disease> stenotic valves |
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|
Term
| Aortic insufficiency is failure of the aortic valve to __ __, thus ___ of the blood occurs into the __ __. |
|
Definition
- close tightly
- backflow
- left ventricle |
|
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Term
| With Mitral Stenosis, fluid movement from the __ into the __ __ is impaired. Thus, the patient gets __ __ __ into the __. |
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Definition
- from the lungs into the left ventricle
- fluid back up into the lungs |
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Term
| ___ murmurs are more common than __ murmurs. |
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Definition
|
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Term
| If you hear a murmur in the left axillary region, it is __ __. TEST, KNOW THIS. |
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Definition
|
|
Term
| With mitral regurgitation, you have backflow of blood into the __ __ during ___. |
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Definition
|
|
Term
| 2 most common murmurs in adults: |
|
Definition
- Mitral Regurgitation
- Aortic Stenosis |
|
|
Term
| murmurs involving valves of the left side of the heart are __ murmurs. |
|
Definition
systolic
mitral regurg= systolic
aortic stenosis= systolic |
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|
Term
| If you hear a murmur in the carotids, it is __ ___. KNOW THIS, TEST. |
|
Definition
|
|
Term
| Mitral Valve Prolapse means ___ the valve clicks back some and there is a little leakage. This is NOT a full insufficiency problem. |
|
Definition
|
|
Term
| Tricupsid valve disease on a physical exam would present with a __ __ __ in __. |
|
Definition
| giant jugular wave in neck |
|
|
Term
| Plaque ruptures> platelets and thrombus forms |
|
Definition
|
|
Term
|
Definition
| When this happens you get changes in the blood pressure b/c aorta expands and has to squeeze back to maintain pressure, but if aorta can’t squeeze back b/c of calcifications so diastolic will fall a lot more, so blood pressure variations will be greater. |
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|
Term
| CT is typically how you look at aneurysms. |
|
Definition
|
|
Term
| Describe the 4 starling forces and capillary filtration: |
|
Definition
- Pc: arterial hydrostatic pressure, pushes fluid out
- Pi: interstitial hydrostatic pressure, pushes fluid in
- (Pi)c: vessel osmotic pressure, pulles fluid in
- (Pi)i: interstitla osmotic pressure, pulls fluid out
These are balanced failry well, to where we lose about 4 L a day that get picked up by lymphatics |
|
|
Term
| Equation for starling forces for capillarty filtration: |
|
Definition
Qf= k[(Pc-Pi)-(Op-Oi)]
Qf= fluid movement (to be solved for)
Pc= capillary hydrostatic pressure
Pi= interstitial fluid hydrostatic pressure
Op (Pip): capillary oncotic pressure
Oi (Pii): interstitial oncotic pressure
k= filtration constant for capillary membrane, relates how effective will be the net driving prssure for transcapillary fluid flux
FIGURE OUT WHAT IT MEANS IF THESE NUMBERS ARE POSITIVE OR NEGATIVE |
|
|
Term
| How do you assess for venous thrombosis? |
|
Definition
- D-dimer
- ultrasound or doppler |
|
|
Term
BLOOD PRESSURE = CO X TPR.
CO= SV X HR
SV= EDV-ESV |
|
Definition
|
|
