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CVP - PCC

CVP First lecture exam

QuestionAnswer
What do platelets produce? thromboxane synthatase
Valve closure : 1. Isovolumic contraction 2. Ejection 3. Isovolumic relaxation 4. Rapid inflow 1. MC + AC 2. MC + AO 3. MC + AC 4. MO + AC
If the exchange of protein is inhibited in the cardia cell, what happens to contraction strenght Increases...because calcium accumulates in cardiac cell
The ____ is self-excitatory SA node
When pressure on tissue is releived and reperfused with blood, what forms? Free radicals
3 roles of endothelium: 1. prevents ___ 2. Produces ___ 3. Produces factor ___ 1. Prevent platelet aggregation 2. Produces PGI2 (prostacyclin 3. Produces factor 13 (clotting)
When platelets contact damafes area they do what? (4) 1. Swell 2. Form irregular processes 3. Contractile proteins cause granule release 4. Secretes stuff
What initiates clotting? Phospholipids in platelet cell membrane that contain platelet factor 3
1. Platelet factor 3 AKA what? 2. What does this do? 1. Thromboplastin 2. Initates clotting
1. Responsible for constriction due to pain. 2. Responsible for thromboxane A2 from platelets. 1. SNS 2. Local humoral factor
Responsible for most of vascular constriction Local myogenic spasm
4 mechanisms of hemostasis Vascular spasm, Platelet plug, Blood clot, Fibrous tissue growth
2 things that contribute to hemostasis Platelets form a plug and blood clots
3 things platelets release Seratonin, ADP and Thromboxane A2
1. What does tPA do? 2. What effect will this have? 1. Activates plasmin 2. Dissolves clots
The key step in hemostasis? Fibrinogen goes to fibrin by way of thrombin
Major underlying cause of cardiovascular disease Ischemia
4 things that may cause ischemia 1. Artherosclerosis 2. White thrombus 3. Red thrombus 4. Artery spasm
2 types of ordinary CT? Loose CT and Dense CT
5 types of special CT Adipose tissue, Blood cells, Blood cell forming tissue, cartilage, Bone
Prevention of blood loss Hemostasis
What is associated with vascular constriction? Trauma
___ is proportional to trauma Spasm
PLatelets function as whole cells but cannot ___ Divide
Platelet cell membrane contains glycoproteins that do what? Avoids normal tissue and adheres to damaged area
Stuff that platelets release? ADP, Thromboxane A2, Serotonin
Can platelets still realse their stuffg in the absence of thromboxane A2? Sure... it's just gonna be slower
1. Thromboxanes A2 is a what? 2. What does this do? 1. Vasoconstrictor 2. Increases release of granule contents
1. How long do RBCs stick around? 2. Platelet? 1. 120 days 2. Half life is 8 to 12 days
Platelets are important in __ ruptures Minute
Normal platelet levels 150 000 to 300 000 per micro liter
How many liters of blood in the body %
What does prostacyclin do? (3) 1. Vasodilator 2. Supresses release of granule 3. Limits platelets extension (everything opposite of thromboxane A2)
Chelators such as citrate and oxalate do what? Tye up calcium
What does heparin do? Enhances the action of antithrombin 3
1. Antithrombin 3 inhitbits thrombin right? 2. What does thrombin do? Thrombin allows fibrin to go to fibrinogen which forms the clot
1. What is dicumerol or warfarin? 2. What does it do? 1. Cumadin (rat poison) 2. Inhibits vitamin K proced by liver ... Prevents clotting1.
Asprin and ibuprophen block what? what will this do? 1. Fatty acid cyclooxygenase 2. Limits platelet formation
Asparing and ibuprohen prevent what from turning into what? Arachadonic acid to PGG2-PGH2
Extrinsic mechanism of blood coagulation is initiated by what? Chemical factors release by damaged tissue
Intrinsic mechanism of blood coagulation requires what? Components in blood and trauma to blood or exposure to collagen
What will plasma do to clots? Dissolve them
1. What will increase tPA cause? 2. Why? 1. Hemmorhage 2. Because tPA cause an increase in plasma which dissolves clots
3 endogenous activators 1. Tissue 2. Plasma 3. Urine
2 exogenous activators 1. Streptokinase 2. tPA
1. Aspirine and ibuprophen block what? (2) 2. What do these 2 things do? 1. Thromboxane A2 and Protacyclin 2. T A2 = vasoconstrictor P = vasodilator
1. What will aspirin or ibuprophen block to prevent a heart attack? 2. Why? 1. Thromboxane A2 2. Because it's a vasocontrictor
Most of frank tissue damage associated with infarctions occurs upon what? Reperfusion
Reperfusion injury is associated with what? Formation of ROS - Free radicals
What ios collaterization? The ability to open up alternate routes of blood flow to compensate for a blocked vessel
3 events that occur in collaterization to help increase blood flow 1. Angiogenesis 2. Vasodilation 3. SNS (NPY)
The SNS may impese or augment collaterization...how will it accomplish both? Impede = vasoconstriction Augment = release of NPY
1. Which clotting factors are refered to by name? 2. What are these names? 1. 1 to 4 2. Fibrinogen, Prothrombin, Thromboplastin, Calcium
1. A lack of clotting factors may produce what condition? 2. Where are clotting factors produced? 1. Hemophilia 2. In the liver (5 of them)
5 clotting factors produced in the liver Fibrinogen (1), Prothrombin (2), 7, 9 and 10
Coumadin depresses the liver formation of what clotting factors? (4) How does it do this? 1. 2, 7, 9 and 10 2. By blocking vitamin K
___ are more likely to have hemophilia because it is carried on the __ chromosome 1. Males 2. X
1. 85% of hemophilia cases is a defect in what clotting factor? 2. The other 15%? 1. Factor 8 2. Factor 9
The key step in the conversion of fibrinogen to fibrin require what? Thrombin
1. How many steps in intrinsic pathway? 2. Which steps require calcium? 1. Five 2. All of them except 1 and 2
Without Ca+, how far will you get in the intrinsic pathway? Step 2... activated 12 + kalikrein + kinnogen will activate factor 11
What is the easiest way to stop coagulation? To tye up Ca+ with chelators
What is the 5th step in the intrinsic pathway? In other words, how do you get thrombin? Activates 10 + 5 + Phospholipids + Ca+ converts prothrombin to thrombin
Activated ___ + ____ + phospholipids + Ca+ converts prothrombin to thrombin Factors 10 and 5
When do intrinsic and extrinsic pathways merge? At the 5th step of intrinsic pathway and at the 2nd step of extrinsic pathway
1. Once thrombin does its thing by converting fibrinogen to fibrin it is changed from what to what? What allows this to happen? (factor what? 1. Changed from solluable monomer to insoluble monomer 2. Activated factor 13
What does factor 13 do? Changes fibrin from a soluble monomer to an insoluble monomer
2 things that activate factor 13 Thrombin and Ca++
Clots may be liquified by a proteolytic enzyme called ___ Plasmin
1. Plasmin circulates in the blood as its inactive form called what? 2. 2 things that may activate it? 1. Plaminogen 2. tPA and streptokinase
#1 cause of death Cardiovascular disease
Risk factors in heart disease Age, male, heridity, smoking, cholesterol, BP, Physical inactivty, Fat ass, Diabetes mellitus, Homocystein
What is homocystein? Amino acid in blood that may irritate blood vessel promoting artherosclerosis
Can cause cholesterol to change into oxidized LDL Homocysteine
Can make blood more likely to clot Homocysteine
1. High levels of homocysteine 2. Can be reduces by increased intake of what? (3) 1. More than 12 micro moles per liter 2. Follic acid, B6 and B12
The heart muscle is ___ elongated groups of irregular ___ collums 1. Striated 2. Anastamosing
3 specialized excitator and conducting muscle fibers SA node, AV node, Purkinje fibers
Heart muscle contract ___ and has ___ 1. Weakly 2. Fibrils
Syncytial nature of cardiac muscle...what does syncytium mean? Many acting as one
The syncytial nature of cardiac muscle is due to the presence of what? (3) 1. Intercalated discs 2. Cardiac cells are connected end to end 3. Presence of gap junctions
Duration of APs in cardiac muscle 0.2 to 0.3 seconds
Cardiac muscles has: 1. Fast __ channels 2. Slow ___ channel 3. __ channels 1. Na++ 2. Ca/Na 3. K
What sharply increases at onset of depol? Na+
____ increases during plateau Ca++
What is increased during resting polarized state? K+
Membrane physiology: 1. Na ___ at onset opf depol and ___ during repol 2. Ca ___ at depol and ___ at repol 3. K ___ at depol and ___ at repol 1. Increases, decreases 2. Increases, decreases 3. Decreases, increases
Slow vs fast cardiac cells relate to what? Channels that open during repol
Typical cardiac muscles have what 2 types of channels that open during depol? Fast Na channels and slow Ca/Na channels
1. Specialized excitatory cells like the SA node possess only what kind of channel? 2. What does this allow for? 1. Slow Ca/Na channels 2. increase depol time
What does tetradoxin do? Blocks fast Na channels selectively... turns a fast response into a slow response
3 considerations for passive ino movement across a membrane 1. Concentration gradient (high to low) 2. Electrical gradient (opposite charges attract) 3. Membrane permiability (opened or closed ion channels
If ion channels are open, what will an ion do? Seek its nearst equilibrium potential
What offsets a concentration gradient? Electrical gradient
What allows the heart to act as a syncytium? Intercalated discs
Does Ca increase fast or slow? Slow due to slow Ca/Na channels
T or F: Ca can go through fast channels False
What's longer, a cardiac AP or a nerve AP or a muscle AP Cardiac AP (300 times longer!)
What ion couples the process of AP and muscle contraction Ca++
Do you completly inhibit cadiac contraction if fast Na+ channels are blocked? No, you just slow it down... Na must go through slow channels now
A large enough stimuli can re-excite muscle during the ___ Relative refractory period
What's longer: relative or absolute refractory period? Absolute
____ responses take longer to get out of a relative refractory period. Slower
At resting membrane potential, ___ (efflux) is offset by ____ (influx) 1. Concentration gradient of K 2. Electrical gradient of K
1. More ___ inside the cell 2. more ___ outside the cell 1. K 2. Na
Resting membrane potential -80 mV
During resting membrane potential what channels are open and closed? Fast na and slow Ca/Na are closed and K are open
How is a stable resting membrane potential maintained? K channels are open, therefor K can freely move around to fin its nerst equilibrium potential
1. The Na/K pump is ____ dependant 2. What does it do? And at what ratio does it do it? 1. Energy 2. Pumps Na out and K into cardiac cell at a 3:2 ratio
1. When Na/K pump is active, there is a net loss of what? 2. This helps what? 1. one positive chagre from interior 2. Helps keep a negative environment inside the cell
1. The protein (Na/K) pump uses energy from ___ 2. What can bind to and inhibit this pump? 1. ATP 2. Digitalis
In the cardiac cell membrane is a protein that does what? Exchanges Ca from the interior in return for Na that enters the cell
The function of the exchange protein is related to the ___ Na/K pump
1. What happens to the exchange protein when the Na/K pump is inhibited? 2. What is the result? 1. Function of exchange protein is reduced 2. More Ca is allowed to accumulate in the cardiac cell
If Ca accumulates in the cardiac cell, what happens to contractile strenght? Increases
1. During the absolute refractory period you are unable to do what? 2. When does this occur? 1. Unable to restimulate cardiac cells 2. During plateau
1. The relative refractory period requires what? 2. Occurs when? 1. Supra-Normal stimulus 2. During repol
In a slow response, cardiac cell the ___ is produced and the refractory period ia about ___ % longer `1. Relative refractory period 2. 25
What ion is responsible for obtaining nearst equilibrium? K+
When is nearst equilibrium obtained? When we have a balance of concentration and energy gradient of K
Potassium: 1. Concentration gradient = ? 2. Energy gradient = ? 1. Efflux 2. Influx
T or F Stability of the membrane only occurs when all channels are closed False!!! K needs to be open
What does digitalis do to Ca exchange protein? Inhibits
1. increase K efflux will do what to contraction strenght and heart rate? Increase in Na/Ca? 1. Increase contraction strenght and decrease heart rate 2. Decrease contraction lenght and increase heart rate
If the atria are clipping along at 200 bpm, what keeps the ventricles at about 100 bpm? AV node
1. The SA node lacks a what? 2. Why? 1. Resting polarized state 2. Because its leaking Na and Ca
What needs to happen ion wise to increase HR? Decrease in K efflux and increase in Na/Ca influx
AV node allows atria to do what? Contract ahead of ventricles
In the AV node and bundle the slow response cardiac cell serves to protect the ventricles from what? Supraventrical arythmias
1. Normal pacemaker of the heart? 2. It has a ____ nature 1. Sinu-atrial node 2. Self-excitatory
1. The SA node has a less negative ___. 2. It has leaky membrane to ___ and ____. 1. Resting membrane potential 2. Na and Ca
What are the only operational channels in the SA node? Slow Ca/Na channels
Wall tension = what? (pressure)(radius)\2
Cardiac cycle: 4 things involved in diastole 1. Isovolumic relaxation 2. Rapid inflow 70-75% 3. Diastasis 4. Atrial systole 25-30%
As ventricular pressure rises above atrial pressure, what happens? Tricuspid and mitral valves close
As ventricular pressure rises above pulmonic and aortic artery pressure, what happens? Pulmonic and aortic valves open
Most blood is ejected from ventricles when? First half of phase
1. What contracts first? 2. What allows this to happen? 1. Atrium 2. AV node
During contraction or ___, blood flows is ____ 1. Systole 2. Restricted
P is directly proportional to ___ and ___ Volume and tone of wall
1. As ventricular wall relaxes, ventricular pressure ____ 2. As ventricular pressure falls below aortic and pulmonic pressure, what happens? 1. Falls 2. Aortic and pulmonic valves close (ventricle relaxation)
When ventricular pressure falls below atrial pressure, what occurs? Mitral and tricuspid valves open (rapid inflow of the ventricles)
1. During ventricular relaxation, inflow to ventricle is ____. 2. What is this called? 1. Reduced 2. Diastole
1. Venous return = what? 2. And this should = what? 1. IVC or SVC 2. Cardiac output
What may cause CHF? If venous return is less that cardiac output
1. Total volume ejected by ventricles? 2. Which is ____ minus _____ 1. Stroke volume 2. EDV - ESV
1. How do you find the ejection fraction? 2. What is normal? 1. SV\EDV x 100 2. 50-60%
EDV = 150 and ESV = 75 : 1. What is the ejection fraction? 2. What is the stroke volume? Ejection fraction = 75\150 x 100 = 50% SV = 150-75 = 75
Define preload. It is proportional to what? 1. Strenght on the wall prior to contraction 2. EDV
Define afterload Changing resistance that heart has to pump against as blood is ejected (impedence)
What is impedence? Changing resistance the heart has to pump as blood is ejected
1. Associated with atrial contractions 2. Associated with ventricular contractions (waves) 1. A wave 2. C wave
Bulging of AV waves and tugging on atrial muscle is an example of what wave? C wave
Wave associated with atrial filling V wave
1. Wave associated with AO 2. Wave associated with MO 1. C wave 2. V wave
1. Valves open with a ___ pressure gradient... 2. When LV pressure is bigger that aortic pressure, the ____ valve is open 1. Forward 2. Aortic valve
1. Vavles close with a ___ pressure gradient... 2. When aortic pressure is greater that left ventricular pressure the ____ valve is ____ 1. Backward 2. Aortic valve is closed
1. Valve not opening fully? 2. Valve not closing fully? 1. Stenotic 2. Insufficient\regurgitant\leaky
Heart murmur considerations: Systolic: Aortic and pulmonary ____ Mitral and tricuspid ____ 1. Stenosis 2. Insufficiency
Heart murmur considerations: Diastolic: Aortic and pulmonary ____ Mitral and tricuspid ____ 1. Insufficiency 2. Stenosis
Heart murmur timing in both systolic and diastolic Patent ductus arteriosus combined with vascular defect
Systolic murmur culprits (valvular activity and dysfunction) AO:S PO:S MC:I TC:I
Diastolic murmur culprits AC:I PC:I MO:S TO:S
1. When will aortic stenosis occur? 2. Mitral stenosis? 3. Tricuspid insufficiency 4. Pulmonary stenosis 5. Tricuspid stenosis? 1. S 2. D 3. S 4. S 5. D
With increased wall tension, what is increased? The force of ventricular contraction
What is the law of Laplace? you have 2 ventricles operating at the same pressure but with diffrent radii... the larger chamber will need to generate more wall tension... this will consume more energy and oxygen
1. A larger or smaller diameter ventricle is at a mechanical disadvantage (needs more energy to function) 2. Why? 1. Larger 2. It has greater wall tension
What is the Batista resection? Taking out a chunk of heart muscle making it small in order to reduce the size of the chamber and making it more efficient
The SA node spontaneously depols at a very ___ rate... what is this called? 1. Fast 2. Overdrive suppression
Strenght of SA node contraction? Weake
What is overdrive suppression? Id you drive a self-excitatory cell at a rate faster that its own inherent rate, the cell's own automacity will be suppressed
Overdrive suppression mechanism may be due to what? Increase activity of ___ making a more ____ environment in the cell. Increased activity of Na\K pump creating a more negative resting membrane potential
1. Cells of what two things are under overdrive suppression? 2. What is providing this overdrive suppression? 1. Cells of AV node and purkinje system 2. SA node
1. What does the AV node do? 2. What effect does this have? 1. Delays the wave of depol from entering the ventricle 2. Allows the atria to contract slightly ahead of the ventricles (0.1 second delay)
The AV nide has a ____ conduction velocity due to what? Slow due to small diameter of fibers
In the absence of the SA node, AV node may act as ____ but at a ___ rate 1. Pacemaker 2. Slower
What is the relationship of heart rate and cycle length? As HR increases, CL decreases
At a resting HR, systole = ? and diastole = ? S is less that D
Both the duration of systole and diastole shorten, but ____ shortens to a greater extent... Diastole
At an increased HR, ventricle may not do what? Fill properly
HR of 75 bpm : CL = ? Therefor Systole = ? and Diastole = ? 1. 0,8 sec 2. 0.3 sec 3. 0.5 sec
HR of 150 BPM: CL = ? Therefor Systole = ? and Diastole = ? 1. 0.4 sec 2. 0.2 sec 3. 0.2 sec
During systole perfusion of myocardium, blood vessels where especially are compressed? Left ventricle
Cardiac cycle: 2 things involved in systole Isovolumic contraction and ejection
1. At the onset of ventricular contraction, what valves close? 2. What valves open? 1. Tricuspid and Mitral 2. Pulmonic and Aortic
Ejection is terminated by closure of what valves? Semilunar valves
As HR increases, what shortens more: S or D? Diastole
What would the cycle length be if HR is 150 BPM? 0.4... 60\150
1. Filling happens in ____ 2. What happens to filling if HR increases? 1. Diastole 2. Increase HR = decrease resting phase therefor it won't fill as much
Wave associated with atrial filling V wave
1. Wave associated with AO 2. Wave associated with MO 1. C wave 2. V wave
1. Valves open with a ___ pressure gradient... 2. When LV pressure is bigger that aortic pressure, the ____ valve is open 1. Forward 2. Aortic valve
1. Vavles close with a ___ pressure gradient... 2. When aortic pressure is greater that left ventricular pressure the ____ valve is ____ 1. Backward 2. Aortic valve is closed
1. Valve not opening fully? 2. Valve not closing fully? 1. Stenotic 2. Insufficient\regurgitant\leaky
Heart murmur considerations: Systolic: Aortic and pulmonary ____ Mitral and tricuspid ____ 1. Stenosis 2. Insufficiency
Heart murmur considerations: Diastolic: Aortic and pulmonary ____ Mitral and tricuspid ____ 1. Insufficiency 2. Stenosis
Heart murmur timing in both systolic and diastolic Patent ductus arteriosus combined with vascular defect
Systolic murmur culprits (valvular activity and dysfunction) AO:S PO:S MC:I TC:I
Diastolic murmur culprits AC:I PC:I MO:S TO:S
1. When will aortic stenosis occur? 2. Mitral stenosis? 3. Tricuspid insufficiency 4. Pulmonary stenosis 5. Tricuspid stenosis? 1. S 2. D 3. S 4. S 5. D
With increased wall tension, what is increased? The force of ventricular contraction
What is the law of Laplace? you have 2 ventricles operating at the same pressure but with diffrent radii... the larger chamber will need to generate more wall tension... this will consume more energy and oxygen
1. A larger or smaller diameter ventricle is at a mechanical disadvantage (needs more energy to function) 2. Why? 1. Larger 2. It has greater wall tension
What is the Batista resection? Taking out a chunk of heart muscle making it small in order to reduce the size of the chamber and making it more efficient
The SA node spontaneously depols at a very ___ rate... what is this called? 1. Fast 2. Overdrive suppression
Strenght of SA node contraction? Weake
What is overdrive suppression? Id you drive a self-excitatory cell at a rate faster that its own inherent rate, the cell's own automacity will be suppressed
Overdrive suppression mechanism may be due to what? Increase activity of ___ making a more ____ environment in the cell. Increased activity of Na\K pump creating a more negative resting membrane potential
1. Cells of what two things are under overdrive suppression? 2. What is providing this overdrive suppression? 1. Cells of AV node and purkinje system 2. SA node
1. What does the AV node do? 2. What effect does this have? 1. Delays the wave of depol from entering the ventricle 2. Allows the atria to contract slightly ahead of the ventricles (0.1 second delay)
The AV nide has a ____ conduction velocity due to what? Slow due to small diameter of fibers
In the absence of the SA node, AV node may act as ____ but at a ___ rate 1. Pacemaker 2. Slower
What is the relationship of heart rate and cycle length? As HR increases, CL decreases
At a resting HR, systole = ? and diastole = ? S is less that D
Both the duration of systole and diastole shorten, but ____ shortens to a greater extent... Diastole
At an increased HR, ventricle may not do what? Fill properly
HR of 75 bpm : CL = ? Therefor Systole = ? and Diastole = ? 1. 0,8 sec 2. 0.3 sec 3. 0.5 sec
HR of 150 BPM: CL = ? Therefor Systole = ? and Diastole = ? 1. 0.4 sec 2. 0.2 sec 3. 0.2 sec
During systole perfusion of myocardium, blood vessels where especially are compressed? Left ventricle
Cardiac cycle: 2 things involved in systole Isovolumic contraction and ejection
1. At the onset of ventricular contraction, what valves close? 2. What valves open? 1. Tricuspid and Mitral 2. Pulmonic and Aortic
Ejection is terminated by closure of what valves? Semilunar valves
As HR increases, what shortens more: S or D? Diastole
What would the cycle length be if HR is 150 BPM? 0.4... 60\150
1. Filling happens in ____ 2. What happens to filling if HR increases? 1. Diastole 2. Increase HR = decrease resting phase therefor it won't fill as much
Wave associated with atrial filling V wave
1. Wave associated with AO 2. Wave associated with MO 1. C wave 2. V wave
1. Valves open with a ___ pressure gradient... 2. When LV pressure is bigger that aortic pressure, the ____ valve is open 1. Forward 2. Aortic valve
1. Vavles close with a ___ pressure gradient... 2. When aortic pressure is greater that left ventricular pressure the ____ valve is ____ 1. Backward 2. Aortic valve is closed
1. Valve not opening fully? 2. Valve not closing fully? 1. Stenotic 2. Insufficient\regurgitant\leaky
Heart murmur considerations: Systolic: Aortic and pulmonary ____ Mitral and tricuspid ____ 1. Stenosis 2. Insufficiency
Heart murmur considerations: Diastolic: Aortic and pulmonary ____ Mitral and tricuspid ____ 1. Insufficiency 2. Stenosis
Heart murmur timing in both systolic and diastolic Patent ductus arteriosus combined with vascular defect
Systolic murmur culprits (valvular activity and dysfunction) AO:S PO:S MC:I TC:I
Diastolic murmur culprits AC:I PC:I MO:S TO:S
1. When will aortic stenosis occur? 2. Mitral stenosis? 3. Tricuspid insufficiency 4. Pulmonary stenosis 5. Tricuspid stenosis? 1. S 2. D 3. S 4. S 5. D
With increased wall tension, what is increased? The force of ventricular contraction
What is the law of Laplace? you have 2 ventricles operating at the same pressure but with diffrent radii... the larger chamber will need to generate more wall tension... this will consume more energy and oxygen
1. A larger or smaller diameter ventricle is at a mechanical disadvantage (needs more energy to function) 2. Why? 1. Larger 2. It has greater wall tension
What is the Batista resection? Taking out a chunk of heart muscle making it small in order to reduce the size of the chamber and making it more efficient
The SA node spontaneously depols at a very ___ rate... what is this called? 1. Fast 2. Overdrive suppression
Strenght of SA node contraction? Weake
What is overdrive suppression? Id you drive a self-excitatory cell at a rate faster that its own inherent rate, the cell's own automacity will be suppressed
Overdrive suppression mechanism may be due to what? Increase activity of ___ making a more ____ environment in the cell. Increased activity of Na\K pump creating a more negative resting membrane potential
1. Cells of what two things are under overdrive suppression? 2. What is providing this overdrive suppression? 1. Cells of AV node and purkinje system 2. SA node
1. What does the AV node do? 2. What effect does this have? 1. Delays the wave of depol from entering the ventricle 2. Allows the atria to contract slightly ahead of the ventricles (0.1 second delay)
The AV nide has a ____ conduction velocity due to what? Slow due to small diameter of fibers
In the absence of the SA node, AV node may act as ____ but at a ___ rate 1. Pacemaker 2. Slower
What is the relationship of heart rate and cycle length? As HR increases, CL decreases
At a resting HR, systole = ? and diastole = ? S is less that D
Both the duration of systole and diastole shorten, but ____ shortens to a greater extent... Diastole
At an increased HR, ventricle may not do what? Fill properly
HR of 75 bpm : CL = ? Therefor Systole = ? and Diastole = ? 1. 0,8 sec 2. 0.3 sec 3. 0.5 sec
HR of 150 BPM: CL = ? Therefor Systole = ? and Diastole = ? 1. 0.4 sec 2. 0.2 sec 3. 0.2 sec
During systole perfusion of myocardium, blood vessels where especially are compressed? Left ventricle
Cardiac cycle: 2 things involved in systole Isovolumic contraction and ejection
1. At the onset of ventricular contraction, what valves close? 2. What valves open? 1. Tricuspid and Mitral 2. Pulmonic and Aortic
Ejection is terminated by closure of what valves? Semilunar valves
As HR increases, what shortens more: S or D? Diastole
What would the cycle length be if HR is 150 BPM? 0.4... 60\150
1. Filling happens in ____ 2. What happens to filling if HR increases? 1. Diastole 2. Increase HR = decrease resting phase therefor it won't fill as much
CO = ____ x_____ HR x SV
With regular exercise, maximum CO will increase due to what? Increase stroke volume
With a single bout of exercise, increased cardiac output is mostly due to what? Increase HR
Time line of valves during contraction MC -- AO -- AC -- MO
Valves are never ___ at the same time Open
How many times during cardiac cycle are both valves closed? What is this called? 1. Twice 2. Isovolumic : fixed volume
What marks the last phase of diastole? (ventricular relaxation) When atrial systole actively pumps 25-30% of inflow volume (atrial contraction)
W = ___ x ____ (delta P)(delta V)
Volume of ventricles at the end of filling? Volume of ventricles at the end end of ejection? 1. End diastolic volume (EDV) 2. End systolic volume (ESV)
Changing aortic BP during ejection of blood from left ventricle is an example of what? afterload
Which valves are stronger? Semilunar
In AV valves, ____ act as check lines to prevent prolapse Corda Tendinae
What muscles increase tension on chorda tendinae? Papillary muscles
Valvular dysfunction creates a vibrational noise called a ____ Murmur
T or F All murmurs are due to valve defects? False!!!
As ventricular radius increases, wall tension does what? Increases
How can capillaries withstand such intravascular pressure? Because they have a very small diameter... think of a small bubble as opposed to a large bubble
Control of heart pumping Intrinsic properpies of cardiac muscle cells
What is the frank-strarling law of the heart? Within physiological limits the heart will pump all the blood that returns to it without excessive damming of blood
The frank-starling law of the heart involves: 1. Hetorometric and homometric ____ 2. Direct stretch on ____ 1. Autoregulation 2. SA nodes
Mechanism of frank-starling: Increase venous return causes what? Increase stretch of cardiac muscle fibers (intrinsic affects)
3 characteristics of increase stretch of cardiac muscles due from and increase of venous return 1. Increase cross-bridge formation 2. Ca++ influx 3. Increase stretch on SA node
1. Increased crossbridges and increase Ca+ influx does what? 2. Increase stretch on SA node does what? 1. Increase force of contraction 2. Increase heart rate
1. As cardiac fibers are stretches, force of contraction increases 2. Ability to increase strength of contraction independant of length of change 1. Heterometric autoregulation 2. Homoemetric autoregulation
How does stretch on the SA node increase HR? Increase Ca and\or Decrease Na permiability
Heterometric autoregulation involes what? As cardiac fibers are stretched (within its limit) the force of contraction is increased
2 things involved in heterometric autoregulation 1. Increased cross bridge formation 2. Increase Ca influx
What is homeometric autoregulation? Ability to increase strength of contraction independent of length
3 things involved in homeometric autoregulation: ___ induced ____induced ____induced Flow induced, Pressure induced, Rate induced
Describe: 1. Flow induced 2. Pressure induced 3. Rate induced 1. Icreased SV is maintained as EDV is decreased (as long as ESV is reduced) 2. Increase in aortic BP (afterload) will increase force of contraction 3. Increased HR will increase force of contraction ''treppe''
In flow reduced homeometric autoregulation, SV is maintained as EVD decreases as long as what happens? ESV is reduced
Whaqt form of homeometric autoregulation is associated with treppe? Rate induced
T or F Change in stretch is the only way to increase contraction False! Increases HR, Increases aortic BP in all increased contraction and increases SV
1. What will direct stretch on the SA node do? 2. How? 1. Increases Ca and-or drecreases NA permiability 2. Increases HR
4 extrensic influences on HR 1. ANS 2. Hormones 3. Ionic influences 4. Temperature
1. Sympathetic release ____ 2. Three things sympathetics increase 1. NE 2. Increases HR, Increases strength of contraction, Increases conduction velocity
1. Parasympathetics release ____ 2. Three things parasympathetics decrease 1. AcH 2. Decreases HR, Decreases strenght of contraction, Decreases conduction velocity
If you block both sympathetic and parasympathetic innervation, what does the heart want to beat at? Around 100 BPM
What does both parasympathetic and sympathetic do to the HR that normaly would like to hang out at 100 BPM? 1. Para = slows rate down 2. Sympathetic = increases strength of contraction
Wave of repol travels in what direction? From positive side to negative side
Describe the cardioaccelerator reflex (bain bridge relfex) Stretch on right atrial wall will increase stretch receptors. This sends a signal to open mitral valve and it increases SNS flow to heart
What does the bainbridge reflex prevent? Damming of blood in the heart
1. Neurocardiogenic syncope tests reflexes of what? 2. Reflex effects results in ____ and ___ 1. Baroreceptors in ventricles 2. Hypotension and bradycardia
Baroreceptors reflexes (neurocardiogenic syncope) is stimulated by what? (2) and provide examples on each 1. Occlusion of circumflex artery : inferior wall infarct 2é Increase in LVP and LV volume: aortic stenosis
Thyroid hormones increase 3 things 1. Increase inotropic 2. Increase chronotropic 3. Increases CO
How do thyroid hormones increase CO? By increasing BMR
Define 1. Chronotropic 2. Dronotropic 3. Inotropic 1. Affects HR 2. Affects conduction velocity 3. Affects strength of contraction
1. Normal amount of concentration of K in ECF 2. Effects of elevated concentration of K in ECF 3. What will this do to RMP? 1. 4 meq\L 2. Dilation and flacidity of cardiac muscle 3. Decreases
Effects of increase calcium in ECF? Spastic contraction
For every degree in increase in body temp, HR increases how much? About 10 beats for every degree F
What will increase in body temp do to strength of contraction? Increase temporarily... prolonged fever can decrease strength due to exhaustion of metabolism
Decreased body temp does what to HR and strength? Decrease both
EKG measures ___ across surface of myocardium with respect of time Potential diffrence
EKG: 1. Recording electrodes 2. Line connecting electrodes 3. Perpendicular line to the line conecting electrodes 1. Lead pair 2. Axis of lead 3. Transition line
1. P wave =? 2. QRS complex = ? 3. T wave = ? 4. What is burried in the QRS complex? 1. atrial depol 2. VEntricular depol 3. Ventricular repol 4. Atrial repol
1. EKG paper speed 2. Normal rate (BPS) 1. 25 mm\sec 1mm = 0,04 sec 2. 60-80 bps
On EKG, what determines: 1. Tachycardia 2. Bradycardia 1. more than 100 2. under 50
1. PR interval includes ___ delay? 2. Should be ___ sec 1. AV nodal delay 2. 0,16 sec
1. What denotes first degree AV block? 2. What determines inadequate delay? 1. A PR internval more than 0,20 sec 2. A PR interval less that 0,10 secs
In the pair of recording electrodes: 1. The + is what? 2. the - is what? 1. Active electrode 2. Reference
What determines direction of deflection? Whatever the active electrode (+) sees relative to reference
Routine EKG consists of how many leads? 12... 6 frontal plane leads and 6 chest leads (horizontal)
What direction does the wave of depol travel? From - to + side
If wave of depol is moving towards the + electrode, what direction of deflection will there be? Increase relection or positive deflection
Wave of depol moving toward negative electrode will be what kind of deflection? Down deflection
Wave of repol moving towards + electrode, what's the deflection? Down deflection
1. How many chest leads? 2. How many frontal plane leads 3. No leads in ___ plane 1. 6 2. 6 3. Saggital
What's the deflection if the wave of depol moves along transition line? None: maybe minimal biphasic wave
1. EKG measures voltage where? 2. Measurement of AP voltage across what? 1. Across surface of myocardium 2. Across cell membrane
Frontal plane leads: 1. Lead 1 2. Lead 2 3. Lead 3 1. + LA; -RA 2. +LL; -RA 3. +LL; -LA
What picks up weak spots of: 1. Lead 1 2. Lead 2 3. lead 3 (who are their friends) These are bassically the ____ of their respective leads 1. AvF 2. AvL 3. AvR Transition lines
What leg is your ground? right leg
Changing aortic BP during ejection of blood from L ventricle is an example of what? Afterload
Which valves are stronger? Semilunar valves
In AV valaves, ____ act as check lines to prevent prolapse Chorda tendinae
What muscles increase tension on chorda tendinae? Papillary muscles
Valvular dysfunction creates a vibration noise called a what? Murmur
T or F : all murmurs are due to valve defect. Nope
As ventriculkar radius increases, wall tension does what? increases
How can capillaries withstand such high intravascular pressure? Because of their small diameter
All arrows in igor's triangle point towards what? Positive electrode
Lead 1: buddy ___ Lead 2: buddy ____ Lead 3: buddy ___ 1 = AvF 2 = AvL 3 = AvR
Leads: 1. Views heart in horrizontal plane 2. Views heart in frontal plane 1. Chest Leads 2. Limb leads
Chest lead locations: V1 4th intercostal space right sturnum border
Chest lead locations: V2 4th intercostal space, left sternal border
Chest lead locations: V3 Equidistant space - midclavicular line
Chest lead locations: V4 5th intercoastal space - midclavicular line
Chest lead locations: V5 Equidistant between 4 and 6
Chest lead locations: V6 Left midaxillary line
What is the reference (negative) electrode in the chest leads All limbs electrodes hooked together
EKG provides no information reguarding what? Mechanical performance of the heart .... NO VALVULAR DYSFUNCTION
5 things EKG can measure 1. Rate 2. Rhythm and intervals 3. Axis 4. Hypertrophy 5. Infarction
1. What denotes tachycardia? 2. What denotes bradycardia? 1. HR more than 105 bpm 2. HR less that 60 BPM
300 - 150 - ????? 300 - 150 - 100 - 75 - 60 - 50 - 43
Wave of depol goes from what? Negative to Positive
PR interval: 1. What is the PR interval? 2. Includes AV nodal ___ 1. Time from SA node to entering the ventricle 2. Delay
What denotes a 1st degree AV block A PR interval more than 0.2 secs
PR interval should be about what? 0.16 secs
What interval is HR dependant? QT interval
What has a longer allowable QT interval? Woman
1st degree AV block: 1. What happens? 2. What denotes it? (time and length) 1. Depol wave from atria to ventricle is delayed excessively 2. more than 0.2 secs and more than 5 mm
1. What happens in 2nd degree block? 2. Dropped beat ____ wave with no associated ___ complex 1. Some depol waves pass and others are blocked 2. Dropped beat - P wave with no QRS complex
1. What happens in 3rd degree AV block? 2. No relationship between ___ and ___ 1. All depol waves from atria to ventricle 2. No relationship between P waves and QRS complex
Block in which there is a dropped beat... the P - wave is not associated with QRS complex. 2nd degree AV block
AV blocks 1. Dropped beat 2. No relationship between P waves and QRS complex 3. PR interval greater than 0.2 secs 1. 2nd degree block 2. 1st degree block 3. 3rd degree block
1. Duration of QRS complex normaly 2. Prolonged QRS? 1. 0.6 to 0.8 sec 2. more than 0.12 sec
2 things a prolonged QRS complex is associated with Ventricular hypertrophy and conduction block (of purkinje system)
Relationship between conduction blocks and hypertrophy to axis shift... Whatever side the conduction block or hypertrophy, is the side the axis is shifted to
Axis is always shiftes to the side of the ___ Bundle branch block
Avergae direction of ventricular depol Mean Electrical Axis (MEA)
Ventricles depol from ___ and ____ and from ____ to ____ (ADIO) Base to apex and endocardium to epicardium
What is unreliable to determine an axis shift? MI
Normal axis is between what degrees? -30 to 105
QRS of what 2 frontal plane leads need to be positive for a normal MEA? Lead 1 and AvF
LAD can be due to what? Left ventricle hypertrophy or Left BBB
Hypertrophy of one ventricle relative to the other can be associated with what? Anything that creates an abnormally high work load on that chamber
Hypertrophy will increase volatage of what interval V leads? QRS
Hypertrophy will lease to a prolonged ____ QRS complex (more than 0.12 sec)
The myocardium is supplied by ___ and their branches Coronary arteries
1. At a resting HR, the heart muscle takes the maximum O2 out of the perfusing coronary artery which is what? 2. Any increase in demand must be met by an increase in ____ 1. Max 70% extraction 2. Coronary flow
(in the ventricle) Normally, the first cells to depol are what gang? Last to repol (in ventricle)
Ischemia ___ depolarization and therefor ___ repol 1. Prolongs 2. Delays
1. Normally, whgat is the QRS relationship to repol waves to depol waves ( T waves)? 2. And in ischemia? 1. They are in oposite directions (QRS and T waves point in the same direction though) 2. Same direction (QRS and T waves are in opposite directions)
In frank heart dammage or infarct, damaged cells lose the ability to ____ Repol
Most of frank damage occurs upon ____ and is associated with ___ damage. 1. Reperfusion 2. Free radical
Infarct creates and elevated ___ segment ST segement
Diffrence between segment and interval? Segment is just a flat line between 2 waves and intervals include the waves
1. Wave of repol moving towards negative electrode 2. Wave of depol moving towards negative electrode 1. + deflection 2. - deflection
What kind of deflection: 1. Wave of repolk moving towards + electrode 2. Wave of depol moving towards + electrode 1. Negative deflection 2. Positive deflection
1. Each mm = how many seconds 2. QRS should be below what? 1. 0.04 secs 2. less that 0.12 sec
Created by: LrB
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