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Life Support #1
Cardiac anatomy and Physiology
| Question | Answer |
|---|---|
| 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 |
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Dabi2
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