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MAP2
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Graduate
02/20/2010

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Term
DO2
Definition
Oxygen Delivery
DO2= Arterial O2 x CO
Term
VO2
Definition
Oxygen Consumption
VO2= (Arterial O2- Venous O2) x CO
Term
OER
Definition
Oxygen Extraction Ratio
OER= (Consumption/Delivery)= (VO2/DO2)
Term
Step 1
Definition
Inspired oxygen + Quality of air
Atmospheric air
Air Quality
Humidity
Term
Step 2
Definition
Airways
UPPER RESPIRATORY TRACT:
nasal cavity
pharynx
larynx
LOWER RESPIRATORY TRACT:
trachea
1* bronchi
lungs
Term
Step 3
Definition
Lungs + chest wall
RELAXED:
lung elastic force
chest wall elastic force
INHALE:
active
chest wall elastic force
active muscle contraction
lung elastic force
Term
Chest wall mechanics
Definition
INSPIRATION- ^ vol. of pleural cavities
external intercostals: elevate ribs
diaphragm: depresses inf. wall of thoracic cavity

EXPIRATION: - dec. vol. of pleural cav.
Int. intercostals- compress + lower ribs
Abdominals- compress ab. cavity
- elevate ab. organs
- passively elevate diaphragm
Term
Step 4
Definition
DIFFUSION
1: surface area of alveolar capillary membrane
2: diffusing capacity of alveolar capillary membrane
3: pulmonary capillary blood volume
4: transit time of blood at the capillary membrane
5: transit time of blood in alveolar capillary membrane

amount of O2 diffusion varies directly with size and inversely with thickness

Ventilation
Term
Diffusion
Definition
transfer of O2 from alveolar sacs to pulmonary arterial circulation
Term
Step 5
Definition
PERFUSION
Apical: low perfusion
Lung base: perfusion ^ due to gravity

Apical: alveoli expand fully
lung base: enlarged vessels compress alveoli
Term
Step 6
Definition
MYOCARDIAL FUNCTION
synchronization of:
electrical excitation
CO -preload
-contractility
- afterload
measurement of Impairement
- HR
- Ejection fraction
Term
Step 7
Definition
PERIPHERAL CIRCULATION
Large vessels:
elastic
ct
Med- Small Vessels:
smooth muscle
Term
Arterioles regulate:
Definition
BLOOD FLOW
-from vascular beds
Term
Arterioles regulated by:
Definition
Hydrostatic + Oncotic pressure
Term
Step 8
Definition
TISSUE EXTRACTION + UTILIZATION OF O2
*O2 diffusion occurs quickly
-from high to low
*Intracellular PO2 avg 23 mmHg
*3mmHg needed for cell metabolism
*OER @ rest is 23%
*Rate of O2 extraction is regulated by O2 demand
Term
Rate of O2 extraction is regulated by:
Definition
O2 demand
Term
mmHg needed for cell metabolism
Definition
3 mmHg
Term
OER @ rest
Definition
23%
Term
Step 9
Definition
RETURN OF PARTIALLY SATURATED BLOOD + CO2 TO LUNGS
partially desaturated blood + CO2 are removed from cells to venous circulation
Term
Disease factors that perturb O2 transport
Definition
bedrest
fever
disease itself
inflammation process
medication
Term
Normal Factors that perturb O2 transport
Definition
activity
position
emotional stress
Term
Greatest influences on O2 transport
Definition
Gravity
Exercise
CO
Tissue Utilization
Term
Gravitation stress
Definition
1: normally gravity keeps fluid body/legs
2: loss of gravity allows fluid to shift to thorax/head
3: body responds by eliminating fluid
4: return to gravity, unable to adjust, fluid in legs
Term
Body responds to loss of gravity by:
Definition
eliminating fluids
Term
Normally, gravity keeps fluid in:
Definition
body/legs
Term
Loss of gravity allows fluid to shift:
Definition
thorax/head
Term
3 CP Principles
Definition
1: Optimal CP fxn when
-upright
-moving
2: CP impairments + FXN limitations
3: Normal Physiology + Pathology
Term
Elements of Patient/Client Management
Definition
Screening
Examination
Evaluation
Diagnosis
Prognosis
Intervention
Outcomes
Term
Screening for CP disease
Definition
Gen. Health
Skin
Respiratory system
CV system
Peripheral Vascular System
Neuro System
Hematologic System
Endocrine System
Term
Gen. Health assessment
Definition
weight gain/loss
fatigue/malaise/weakness
fever chills
sweats/night sweats
Term
Skin assessment
Definition
Excessive dryness/moisture
Itching (puritis)
Excessive bruising
Lesion or rash
Term
Respiratory System assessment
Definition
History of Lung Diseases
Chest pain with breathing
Wheezing or Noisy breathing
SOB
cough
Sputum
Meds
Term
Cardiovascular system assessment
Definition
Heart or retrosternal pain
palpitations
cyanosis
dyspnea on exertion
orthopnia
edema
history of heart murmur, HTN, CAD, or anemia
Meds
Term
Peripheral vascular system assessment
Definition
coldness, numbness, tingling of legs
swelling of legs
discoloration hands/feet
varicose veins
intermittent claudications
thrombophlebitis
ulcers
meds
Term
Hematologic system assessment
Definition
Bleeding in skin or mucus membranes
excessive bruising
lymphnode swelling
blood transfusion + RXNs
meds
Term
Endocrine system assessment
Definition
History of diabetes
history of thyroid disease
thyroid disease symptoms:
-change in skin texture
-excessive sweating
-relationship b/t appetite + weight
-nervousness
-tremors
Term
External signs of O2 transport dysfunction
Definition
Skin: pale, cyanotic, cold
Speech: SOB
diaphoresis
Term
Internal signs of O2 transport dysfunction
Definition
vitals
Respiratory patterns
Hypoxia (low pulse Ox)
Poor peripheral circulation
Decrease capillary refill (>3 seconds)
Term
Cardiopulmonary Impairment Categories
Definition
*Impaired Aerobic Capacity- VO2 peak
*Gas Exchange abnormality- ABG or SaO2
*Ventilatory pimp abnormality- rib cage/ pleural space
*Airway clearance abnormality- ^ secretion or can't manage
*Cardiac pump abnormality - Decrease Ejection Fraction, CO
*Cardiovascular Abnormality- HR, BP response
Term
PT Prevention
Definition
Address Physical Activity
Address CV risk factors
Term
PT 2* prevention
Definition
^ Aerobic Capacity/ Endurance
^ Breathing pattern/ Ventilation
Term
PT treatment
Definition
airway clearance
exercise: strength mobility, ADL
Term
Membrane coverings of the heart
Definition
Parietal pericardium
-serous
-fibrous
Visceral pericardium
Pericardial Caviity
Term
Heart Wall layers
Definition
Epicardium
Myocardium
Endocardium
Term
Left Coronary artery branches:
Definition
Circumflex
LAD
-post Interventricular Artery
Term
Right Coronary artery brances:
Definition
Marginal arteries
Post Interventricular Artery
Term
Circumflex artery supplies:
Definition
Left Atrium and Post walls of Left ventricle
Term
LAD supplies:
Definition
blood to interventricular septum
Term
Posterior Interventricular ARtery supplies:
Definition
Posterior ventricular walls
Term
Together the RCA + Interventricular Artery supplies:
Definition
Right Atrium and All Right Ventricle
Term
Internal Anatomy
Definition
Chambers- atria/ventricles
Structure- AV valves-bicuspid/tricuspid- semilunar
Term
Specialized excitatory and conductive muscle fiber cells:
Definition
muscle cells
intercalated discs
gap jxns
Term
Similarities b/t Cardiac and Skeletal mechanism of contraction
Definition
Striated
- Actin/myosin mechanism

T-Tubule mechanism
-acting on sarcoplasmic reticulum
Term
Differences b/t Cardiac and Skeletal mechanism of contraction
Definition
T--tubule mechanism
- direct diffusion of Ca++

Action Potential
-cardiac muscle plateau

Strength of Contraction
Term
Intrinsic conduction system of heart
Definition
SA node
Internodal pathways
AV node
Budnle of His
Purkinje fibers
Term
SA Node
Definition
pacemaker
smaller diameter muscle fibers
almost no contractile muscle fibers
connect directly w/ atrial muscle fibers
Cell mem is naturally leak to Na+ + CA++
-less negative resting mem potential tat other cardiac muscle cells
Fast Na+ channels
-less negative potential, inactivated
self excitation
Term
P wave
Definition
Atrial depolarization
Atrial pressure
Term
QRS Complex
Definition
Ventricular depolarization
ventricular pressure
Term
T wave
Definition
ventricular repolarization
ventricular relaxation
Term
Cardiac Cycle
Definition
EVENTS THAT OCCUR FROM THE BEG. OF ONE HB TO THE BEG OF THE NEXT
Chamber + vessel blood vol. changes
Chamber + vessel blood pressure changes
Electrical Activity noted
Heart Sounds occur
Valves open + close
Term
Diastole
Definition
Period of relaxation
heart filling with blood
Term
Systole
Definition
contraction period
heart ejects blood
Term
Majority of returning venous blood flows directly from:
Definition
Atrium to Ventricle
Term
Atrial Contraction usually causes an addition _ of ventricle filling
Definition
20%
Term
Ventricle filling:
After systole:
Definition
AV valves open due to build of pressure in atria
Term
Ventricular filling:
During systole:
Definition
Period of rapid filling of ventricles followed by 2 phases
Term
Preload
Definition
end-diastolic pressure when the ventricle is filled
Term
Afterload
Definition
Pressure in artery leading from the ventricle
the load against which the muscle exerts its contractile force
Term
Compared to skeletal muscle, cardiac muscle has a great dependency on _ for _
Definition
O2
oxidative metabolism
Term
energy derived primarily from oxidative metabolism is from:
Definition
Fatty acids
Term
Heart pumps ____ liters of blood/minute
Definition
4 to 6 liters
Term
Intrinsic regulation of Cardiac pump
Definition
frank starling mechanism
Term
extrinsic regulation of cardiac pump
Definition
SNS
PNS
Term
Function of circulation
Definition
Transport
- nutrients + O2
- waste + CO2 away from tissue
- hormones from one area of body to another
- heat throughout the body
Term
Arteries
characteristics
Definition
transport blood under high pressure
strong vascular walls
blood flow is rapid
Term
Arterioles
characteristics
Definition
final small branches of arterial system
act as control conduits
-blood released into capillaries
strong muscular walls that vasoconstrict/dilate
innervated by SNS only
Term
Capillaries
characteristics
Definition
walls-very thin
contain small capillary pores
permeable to small molecular substance
exchange site for
nutrients
wastes
electrolytes
fluid
Term
Venules
characteristics
Definition
Collects blood from capillaries
gradually merge into larger veins
Term
Veins
characteristics
Definition
Transport blood from tissue to hear
serves as a blood reservoir
low pressure
thin walled
contain muscle- can constrict/dilate
Term
Most blood volume is in what system?
Definition
systemic
veins 64%
Term
Blood flow
Definition
the volume of blood flowing through a vessel, an organ, or the entire circulation in a given period
Term
Blood pressure
Definition
the force per unit area exerted on a vessel wall by the contained blood
Term
Resistance
Definition
opposition to flow
the amount of friction blood meets when passes through the vessels
Term
Blood flow affected by 2 factors
Definition
Pressure gradient
vascular resistance
Term
OHM's Law
Definition
Blood flow = change in pressure divided by change in resistance
Term
2 descriptions of blood flow
Definition
laminar
turbulent
Term
Laminar Blood flow
Definition
normal blood flow
Term
Laminar Blood Flow
Definition
Normal blood flow
highest velocity in center of vessel
Term
Turbulent Blood flow
Definition
blood that does not flow linearly and smoothly
chotic
happens at:
branch points
diseased arteries
across stenotic heart valves
Increase energy required to drive blood flow
Term
Conductance
Definition
measure blood flow through a vessel for a given pressure difference
reciprocal of resistance
Term
Poisseuille's Law
Definition
Related to laminar flow
Term
Diameter plays the greatest in determining___________
Definition
rate of blood flow
Term
In systemic circulation 2/3s of resistance to flow is_______
Definition
arteriole resistance
Term
Hematocrit
Definition
% of blood that consists of cells
Term
viscosity has a(n) __________ relationship to blood flow
Definition
inverse
Term
CO is primarily controlled by sum of _________
Definition
all local tissue flows
Term
arterial pressure is controlled independently ____________
Definition
of local blood flow or CO
Term
MAP
Definition
mean arterial pressure
pressure that propels blood to tissues
Term
PP
Definition
pulse pressure
affected by SV and compliance of arterial tree
Term
MAP and PP decreases with ___________
Definition
increasing distance from heart
Term
Pressure effect on force on blood flow?
Definition
increases force on blood flow through vessels

distends vessels
Term
Compliance
Definition
capacitance
total quanitity of blood that can be stored in a given portion of the circulation for each mmHg pressure rise

distensability x volume
Term
Venous pressure influences_____
Definition
Right Atrium pressure
Term
Increasing decrease in Right Atrial pressure is a possible_____
Definition
pathology
Term
2 phases of local blood control
Definition
Acute
Long-term
Term
Increased blood flow ___________ o2 saturation
Definition
decreases
Term
EDRF
Definition
endothoelium derived relaxing factor
made primarily of nitric Oxide
reduces the resistance to BF in upstream arteries
Term
Reactive Hyperemia
Definition
transient increase in organ Blood flow following a brief period of ischemia
Term
Active hyperemia
Definition
Increase in organ blood flow associated with an increase in metabolic activity of an organ or tissue

muscle contraction
Term
Metabolic autoregulation
Definition
an Increase in tissue metabolism leads to an increase in blood flow

related to active hyperemia
Term
Myogenic autoregulation
Definition
if pressure within a vessel suddenly increased, vessels respond by constricting

related to Reactive Hyperemia
Term
Vasoconstriction
factors
Definition
Nore/Epinepherine
Angiotensin II
Vasopressin
Endothelin
Term
Vasidukatir factors
Definition
Bradykinin
Histamine
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