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Anatomy & Physiology: Cardiovascular

What determines stroke volume (3)? 1. preload 2. afterload 3. contractility
What is the order of the valve closer that corresponds to S1 and S2? mitral - tricuspid - aortic - pulmonary
1. What is S2 splitting? 2. What is fixed splitting? 1. aortic valve closes before pulmonic 2. splitting that does not differ upon inspiration/expiration
1. What is S3? 2. What is S4? 1. sound of rapid ventricular filling 2. ventricular filling during atrial kick
Which nerve innervates: 1. aortic arch baroreceptor 2. carotid sinus baroreceptors 1. vagus 2. glossopharyngeal
What are the waves of the atrial pressure curve and what do they correspond to? 1.a wave - atrial contraction 2. c wave - ventricular contraction 3. x wave - atrial relaxation 4. v wave - atrial filling 5. y wave - tricuspid open and ventricular filling
What do the following portions of the EKG correspond to? 1. P 2. QRS 3. T 4. PR segment 1. atrial depolarization 2. ventricular depolarization 3. ventricular repolarization 4. how long it takes impulse to travel from SA node to ventricles
How do you find heart rate on an EKG? 300/number of boxes between R waves
How many seconds is a large box on an EKG? 0.2 s
What on the EKG is indicative of atrial enlargement? P wave bigger than the QRS
What rate in normal sinus rhythm? 60-100 bpm
Which chamber of the heart normally has the highest pressure? Left ventricle
What does Qp/Qs signify? Flow ratio of pulmonary blood to systemic blood flow
Increased blood pressure leads to increased baroreceptor firing. What does this lead to? 1. decrease in sympathetic tone 2. increase in parasympathetic tone 3. vasodilation 4. decreased HR
What must happen for systemic vasoconstriction to occur without a change in systemic blood pressure decrease in cardiac output
1. What is afterload? 2. How is afterload measured? 3. How does increased arterial pressure effect afterload? 1. measure of the pressure used by a chamber of the heart to eject blood. 2. aortic pressure 3. increases afterload because less blood is able to flow out of the ventricles
1. How is EDV related to contractility? 2. How is EDV related to cardiac output? 1. EDV directly increases the force of contraction 2. EDV directly increases cardiac output
What is mean systemic pressure? pressure in systemic circulation when flow is zero
What is blood pressure equal to? cardiac output x peripheral vascular resistance
How is venous return related to right atrial pressure? inversely proportional lower atrial pressure allows for a greater return
1. Ejection Fraction equation 2. Can the ejection fraction of the two ventricles be different? 1. EF = SV/EDV x 100% 2. Yes
1. What is cardiac output using the Fick Principle? 2. How is O2 consumption calculated? 3. How is O2 content calculated? 1. CO = (O2 consumption/minute)/(Arterial O2 content - venous O2 content) 2. spirometry 3. [Hb] x 1.34 x O2 sat.
How does increased Afterload affect the preload? ↑afterload →↓ stroke volume →↑ preload
What is the best way to clinically measure contractility of the heart? ejection fraction
How do positive inotropic agents effect ejection fraction? ↑stroke volume and ↓ end diastolic volume so ↑ ejection fraction
1. What do the positive inotropic agents have in common? 2. What do negative inotropic agents have in common? 1. ↑ intracellular calcium 2. ↓ intracellular calcium
What is the formula for pulse pressure? PP = systolic pressure - diastolic pressure
What is the greatest influence on blood viscosity? hematocrit
Which receptors in the systemic vasculature cause vasodilation? Constriction? 1. B2 → Gαs→ vasodilation 2. α1→ Gαq→ vasoconstriction
S4 occurs in what physiological states... decreased ventricular compliance or increased ventricular stiffness
What two ways does Atrial Natriuretic Peptide act to decrease BP? 1. decrease aldosterone and renin (decreased Na reabsorption) 2. vasodilation of renal arterioles
What 2 ways does AVP act to increase blood pressure? 1. vasoconstricts renal arterioles 2. increases water reabsorption from collecting duct and distal convoluted tubule
1. Vasodilation in coronary vasculature is mediated by what? 2. When is this substance released? 1. increased adenosine 2. ↑ metabolic activity of heart, ↓ blood flow to heart, ↓ myocardial PO2
1. Cardiac cells are permeable to which ion during resting phase (phase 4)? 2. Which channel do these ions flow through? 1. K+ 2. inwardly rectifying current
What pumps and exchangers are active during resting phase? 1. Na/K ATPase - 3 Na out, 2 K in 2. Calcium/Na exchanger - 1Ca out, 2 Na in 3. Calcium ATPase - 2Ca out
Which direction do the concentration and electrical membrane forces influence K flow? 1. concentration influences K flow out of cell 2. electrical potential favors flow into cell
How does an increased permeability to K affect the resting membrane potential? more K exits the cell creating a more negative RMP
How does acetylcholine affect RMP? - increases membrane permability to K so more exits cell - cells become hyperpolarized
Acetylcholine acts mainly where in the heart? parasympathetic NS acts mainly on nodal cells and small amount on atrial myocytes
In slow fibers: T-type calcium channels are open during phase__. L-type calcium channels are open during phase __. phase 4 phase 0
What happens at each stage in fast fibers 0. 1. 2. 3. 4. 0. Na channel open and enter cell 1. transient outward K+ open and exit cell 2. L-type Ca2+ open - enter to balance K+ exit 3. Delayed K+ channels open net K+ influx 4. inward rectifier K+ open - K+ in
1. What is effective refractory period? 2. What is the relative refractory period? 1. when an action potential cannot be elicited 2. when an AP can be elicited if there is a greater than normal stimulus
How do the areas that are sympathetically and parasympathetically stimulated differ in the heart 1. sympathetic - effects both atrial and ventricles 2. para - effects atrial only
What are the relative conduction speeds for: atria, AV node, purkinje fibers and ventricles? purkinje fibers > atria > ventricles > Av node
Stroke volume is affected by: 1. Contractility 2. Afterload 3. Preload
Myocardial O2 demand is increased by anything that ↑ tension or rate 1. ↑ afterload (↑ EDV) 2. ↑ heart rate 3. ↑ heart size (↑ wall tension)
1. How do venodilators affect preload? 2. How do vasodilators affect afterload? 1. ↓ preload 2. ↓ afterload
Which phase of the cardiac cycle is the period of highest O2 consumption? isovolumetric contraction
What is the bowditch staircase and why is it seen? increase heart rate leads to increased force of contraction in a stepwise fashion by slowing increasing levels of intracellular calcium
What are the positive inotropic agents? 1. increased HR 2. sympathetic stimulation 3. cardiac glycosides
How do cardiac glycosides affect inotropy? 1. inhibit the Na/K ATPase so more Na accumulates in cell 2. high intracellular Na prevents the Na/Ca exchanger from removing Ca from the cell 3. leads to increased intracellular Ca
1. What is the law of la place in relation to the heart? 2. How does increased end diastolic volume affect wall tension? 3. How does the heart compensate for this 1. T = (P x r)/wall thickness 2. ventricular dilation increases radius of ventricle so increases Tension 3. hypertrophies and increases wall thickness
1. How do positive inotropic agents affect preload? 2. How does an increase venous resistance affect preload? 1. decrease preload 2. increases preload
Normal: CO = 4 L/min, O2 consumption = 0.25 L/min, pulmonary ventilation = 5 L/min During Exercise: CO = 20 L/min, O2 consumption = 3 L/min, pulmonary ventilation = ? L/min Pventilation during exercise/Pventilation at rest = O2 consum. during exercise/O2 consum. at rest Pventilation during exercise = 60 L/min
How does in increase in contractility change the end systolic volume? decreases the end systolic volume
What are the 3 cellular causes for the Starling Mechanism (increased contracility from increase EDV)? 1. altered sensitivity of tropnin-C for calcium 2. optimum association between actin and myosin 3. more calcium "channels" or stretch calcium channels
Strength of cardiac muscle contraction is a function of: number of actin-myosin crossbridge formed amount of Ca2+ entering muscle fibers from extracellular fluid activity of the Na+/K+ ATPase pump
Which part of the cardiac myosin contains ATPase activity? head
Describe the steps of the cross-bridge cycle in the sarcomere: 1. ATP bound to myosin is hydrolyzed to ADP and Pi 2. ADP spontanteously released and active comple shifts the thin filament 3. ATP binds myosin again and the complex dissociates
What is the resting compliance and resting length tension of the heart compared to skeletal muscle? cardiac muscle has low compliance and higher testing length tension
How does contractility differ from Frank-Starling Mechanism? contractility changes cardiac performance independent of fiber length (preload) or afterload
During stage 2 of the cardiac cycle Ca2+ enters the cell through __-type Ca2+ channels, also known as ____. L-type dihydropyridine
Do cardiac glycosides affect preload or afterload? How? decrease preload because they prolong the plateau phase of cardiac depolarization thus slowing ventricular contraction
1. most likely cause of a systolic ejection murmur in children? 2. in adults? 1. pulmonary stenosis 2. aortic stenosis
Which ventricle performs more work? Why? Left Ventricle; performs at a higher Pressure and W = PV
1. What is the external work of the heart? 2. What is the internal work of the heart? 1. that which expels blood from the LV 2. the strength and lengthening of myocardial elements
How do positive inotropic agents affect EDV? decrease EDV of subsequent beats by leaving less in the ventricle after contraction (less ESV)
How does increased filling pressure affect cardiac output? lowers
1. What is the major energy source for cardiac myocytes? 2. Parasympathetic NS innervates which area of the heart? 1. fatty acids 2. SA/AV nodes and atrial myocytes
1. What is the metabolism pattern (with respect to glucose and fatty acid metabolism) in normal heart? 2. How is metabolism in heart affected under ischemic condition? 1. normally 10-40% of acetyl-CoA comes from glucose and lactate, 60-90% of acetyl-CoA comes from beta-oxidation of fatty acids. 2. during fatty acid beta-oxidation ↓ and there is an ↑ in use of glucose and lactate.
Which coronary artery supplies the SA and AV nodes? Right coronary artery
Which heart chamber: 1. most posterior and can compress the esophagus 2. most anterior 1. left atrium 2. right ventricle
How is the total resistance calculated for blood vessels within an organ? connected in series: R1 + R2 + R3...
How is total resistance calculated for blood vessels within the systemic circulation? connected in parallel: 1/R1 + 1R2 + 1/R3...
What accounds for most of the total peripheral resistance in the circulation? arterioles
If the radius of an arteriole doubles, how does resistance change? Resistance is inversely proportional to the inverse of radius to the 4th power. Doubling radius will decrease resistance by a factor of 16.
How does S2 splitting change with inspiration? splitting should increase during inspiration because increased venous return to right heart → longer pulmonary valve closure
Which heart defect presents with fixed splitting (does not change with inspiration)? atrial septal defect
Which heart defects present with paradoxical splitting (Pulmonic valve closes before aortic)? 1. aortic stenosis 2. left bundle branch block
How does squatting or hand grip exercise change mitral or trispid regurgitation? ↑ TPR enhances mitral regurgitation, not tricuspid
Which ion channels does the autonomic nervous system act upon to change: 1. heart rate 2. conduction velocity 1. If channels 2. inward Ca2+ current
Ventricles are not innervated by which ANS component? parasympathetic nervous system
In which part of the cardiac conduction circuit is the velocity the slowest? AV node - allows time for ventricular filling
What effect does atrial natriuretic peptide have on the kidney's to reduce blood volume? cases constriction of the efferent renal arteriole and dilation of the afferent arteriole promoting diuresis
Chemoreceptors respond to PO2, PCO2, and pH. 1. Which do peripheral chemoreceptors respond to? 2. Which do central receptors respond to? 1. all of the above 2. only PCO2, and pH
What is the Cushing reaction? 1. ↑ intracranial pressure compresses arterioles → ischemia 2. sympathetic discharge → ↑ HR, hypertension 3. baroreceptors sense ↑BP and ↑ parasympathetic outflow → bradycardia
How are lung arterioles affected by hypoxia differently than systemic arterioles? 1. lung arterioles constrict 2. systemic arterioles dilate
Why does systolic blood pressure decrease during cardiac tamponade? 1. RV cannot adequately contract bc of ↑ volume in pericardiac sac 2. instead, it pushes against the intraventricular septum reducing the blood volume that can enter the LV
How do the following murmurs change with squatting: 1. Hypertrophic cardiomyopathy 2. VSD 3. aortic stenosis 1. decrease 2. increase 3. increase
A person's EKG has no P wave, but has normal QRS complexes and normal T waves. where is the pacemaker located? AV node
Two causes of turbulent blood flow leading to bruits 1. decreased blood viscosity 2. increased blood velocity
How does the valsalva maneuver effect cardiac output? decreases venous return to the heart and decreases CO
Which murmurs increase with the valsalva? hypertrophic cardiomyopathy, mitral valve prolapse
1. What is the max pressure in the atria 2. What is the max pressure of the right ventricle? 1. 10mmHg 2. 25mmHg
Which arrhythmia presents with absent P waves on EKG and a fast HR? Atrial fibrillation
1. Which nerve innervates the aortic body 2. Which nerve innervates the carotic body 1. vagus 2. glossopharyngeal
What effect does hypertension have on baroreceptor firing? increase in blood pressure will increase baroreceptor firing
Role of Ryanodiine receptor calcium stimulates ryanodine receptor, which allows release of larger pool of calcium from within the sarcomplasmic reticulum
Renin levels during congestive heart failure? increased because of poor perfusion of kidneys; leads to edema
Which ion is the ventricular myocyte most permeable to during phase 4 potassium (funny channels in pacemaker cells)
At which site is systolic BP the highest: 1. aorta 2. central vein 3. pulmonary artery 4. renal artery 5. renal vein renal artery
Which coronary artery supplies the diaphragmatic surface of the heart? posterior descending artery, a branch of the right coronary artery
Created by: amichael87



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