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Life Support #1

Cardiac anatomy and Physiology

What is the Apex of the heart and where does it lie? tip of the LV, 5th ICS at the left mid clavicular line just above diaphragm
5 structures that compose the vascular system Heart, arteries, capillaries, veins and blood
Veins act as a reservoir and accommodate __% of circulating blood volume 70%
Aorta to right atrium, high resistance, high pressure= _________ circulation systemic
Pulmonary artery to LA, low resistance, low pressure= ________ circulation pulmonary
The body's smallest blood vessels are___ and the measure __-__ micrometers in diameter capillaries; 5-10
Purpose of capillaries connect arterioles and venules for gas and nutrient exchange bw blood and surrounding tissue
3 layers of the heart pericardium, myocardium, endocardium
What is the pericardium? outermost layer that encases the heart and attached to the great vessels
2 layers of the pericardium and their location parietal-outside layer and visceral-adheres to myocardium
How much pericardial fluid separates the 2 layers of the pericardium? 20-30ml
This layer of the pericardium is fused to and inseparable from the fibrous pericardium parietal
this layer of the pericardium is part of the epicardium visceral
The myocardium consists of involuntary striated muscle fibers called ____ myofibrils
2 types of filaments that make up myofibrils and link together to cause muscle tension and shortening are Myosin and Actin
_____= thick protein filament responsible for skeletal movement myosin
___= thin protein filament responsible for aiding in contraction actin
Where is the endocardium and what does it do? innermost layer lining the chambers of the heart; regulates contractility and electrophysiology of the heart
In which layer of the heart do blood clots attach? endocardium
RAP= (diastolic only) 0-8 mmHg
RVP= 15-25 mmHg Systolic; 0-8 mmHg Diastolic
Pulmonary artery Pressure 15-25 mmHg Systolic; 8-15 mmHg Diastolic
LAP= (Diastolic only)4-12 mmHg
LVP= 110-130 mmHg Systolic; 4-12 mmHg Diastolic
Aorta pressure =110-130mmHg Systolic; 70-80 mmHg Diastolic
Which valves are open during diastole and closed during systole? AV valves (bicuspid and tricuspid)
Bicuspid valve is AKA mitral valve
What are Chordae Tendoneae fibrous cords that connect the edges of the leaflets to the papillary muscles
What are the papillary muscles? muscular projections of the inner surface of the ventricles that tether the valves to prevent backflow to atria during systole
These valves are open during systole and closed during diastole semilunar valves
Incompetence of the valve that results in back flow during systole is called prolapse
2 things that can cause valve prolapse Rheumatic fever and infectious endocarditis
Progressive narrowing of the valve orifice creating obstruction of blood flow is stenosis
4 causes of stenosis congenital disorders, fibrosis, calcium build-up, Rheumatic fever
RVEDP=___, ___, ____, ___ CVP, RAP, RVEDV, Preload of RV
LVEDP= ___, ___, ___ = ____ LAP, LVEDV, Preload of LV, Pulmonary capillary wedge pressure
Describe right heart systole A-V equilibration, tricuspid closes, ventricles tense, RVSP>PAP, pulmonic valve opens
At end systole RVSP= ___ and pulmonic valve closes PASP
Describe Left heart systole A-V equilibration, Bicuspid closes, ventricles tense, LVSP> Aortic Pressure, Aortic valve opens
At end systole LVSP=___ and aortic valve closes aortic systolic pressure
What is preload and what affects it? amount of end-diastolic stretch on myofibrils affected by fluid volume, valvular disease
HIgh PCWP indicates what type of disease? lung disease
What is afterload? force against which the muscle fibers of the ventricles must pump against
Right ventricular afterload= ___ ___ ___, PADP pulmonary vascular resistance
Left ventricular afterload = SVR, ___
What does the Right Coronary Artery perfuse? SA Node, AVN, Bundle of His, posterior 1/3 of ventricular septum
What supplies blood to the greatest portion of the myocardium The left main coronary artery
2 branches of the LCA are Left anterior descending and circumflex
LAD supplies __-__% of the left ventricle 45-55%
Circumflex is located ___ and ____ and supplies __-__% of left ventricle lateral and posterior; 15-25%
Coronary circulation (heart) extracts approx. __% of oxygen from arterial blood supply at rest 70%
SvO2 of CS blood= __%, PvO2 __mmHg 30%; 20mmHg
Systemic circulation extracts approx __% of oxygen from arterial blood supply 25%
SvO2 of systemic blood= __%, PvO2 __ mmHg 75%; 40mmHg
Coronary artery dilation can increase perfusion volume __ times normal 5
What can cause coronary artery dilation? increase HR, stress, inotropic drugs, increase in wall tension(hypertrophy, afterload)
What is teh major determinant of left ventricular blood flow? aortic diastolic pressure
Approx __% vessel occlusion is required to significantly decrease blood flow 70%
3 things that decrease vessel diameter spasm, plaque, thrombus
3 factors that determine blood flow vessel diameter, viscosity of blood and pressure gradients
Hct > __% is critical increase in WOH 55%
What is Starling Law? the force of contraction is related to the amount of blood in the ventricles at end diastole (more volume = more stretch= more contraction)
Starlings law is lost in what disease states cardiomegaly/hypertrophy (overstretched muscles= less contraction)
The force of contraction is partly related to _____ in the __cellular fluid calcium; extracellular
Calcium channel blockers are given to patients with ___'s to slow contraction SVT's
Muscle contraction occurs when calcium goes into the cell and goes into ___ troponin
What is troponin? protein located on teh actin filament that initiates contraction
Path of the electrical conduction system SA node-Bachmans bundle(intraatrial)-AV node- Bundle of His- bundle branches- Perkinje fibers- Myocardium
Sympathetic: Vaso___, ___HR, conduction velocity and contractility, and broncho____ constriction; increases; dilation
Parasympathetic: ___ HR, conduction and promotes Vaso___ slows; vasodilation
Intravascular= capillary
extravascular= lung tissue, alveoli, interstitial space
Normally intravascular should be ____ extravascular volume equal to
Capillary diffusion is dependent upon what 2 things? capillary permeability and opposing forces of hydrostatic and oncotic forces
Capillaries are highly permeable to ___ and relatively impermeable to _____ electrolytes; plasma proteins (ex: albumin)
Pressure exerted by a volume of fluid within a given space hydrostatic pressure
this protein keeps fluid in the capillaries albumin
Capillaries have > fluid pressure than alveoli, therefor forces fluid from what to what vascular space(capillaries) to interstitial space (lung tissue) AKA pulmonary capillary hydrostatic pressure
When insterstital hydrostatic pressure is low but alveolar and capillary pressures are normal, what occurs fluid leaks from capillary into lung tissue
What is the force generated by the attraction of protein molecules for H2o Oncotic pressure
What is Plasma oncotic pressure holds proteins together to keep blood from leaking out of capillary
In normal lungs how much fluid leaks into lung tissue and interstital space and is cleared by lymphatics 20-30 ml/hr
What is the abnormal accumulation of fluid outside of the vascular spaces of the lung pulmonary edema
Fluid balance is controlled by what 2 things AC membrane permeability and Oncotic and hydrostatic forces
Lymphatic system can compensate for an increase up to __ times to maintain dry state 10
hypoalbuminemia causes a decrease in what plasma oncotic pressure
Causes of cardiogenic pulmonary edema renal failure, CHF, hypervolemia, Left ventricular failure (MI, valvular disorders, htn; arrythmia)
Assessment: Cardiogenic pulmonary edema visible CHF pattern, crackles
Ways to treat cardiogenic pulmonary edema O2, Positive pressure, decrease fluid intake, diuretics, inotropes
what are the 3 phases of cardiogenic pulmonary edema Compensated, Interstitial, and alveolar
Non-cardiogenic pulmonary edema usually results from what ARDS
Clinical findings assoc with Non cardiogenic pulmonary edema acute onset resp distress 24-48 hrs after cause, diffuse bilat interstitial infiltrates on CXR, severe refractory hypoxemia
Causes of ARDS Sepsis (>30% of cases), trauma, severe lung infection, aspiration, near drowning, DKA
3 phases of ARDS exudative, proliferative, resolution
Stage of ARDS characterized by accumulation of excessive fluids, protein and inflammatory cells in the alveoli Exudative
The exudative stage usually unfolds over the first __-___ days after onset of lung injury 2-4
During this stage of ARDS alveolar thickening continues, the lung tissue resembles liver tissue, danger of pneumonia, sepsis Proliferative (fibrotic)
Lung function may continue to improve for as long as __-__ months 6-12
Created by: Dabi2