Exam2:Cardiac

high pressure in pulmonary system would result in?

pulmonary HTN

pulmonary side of heart?

right

systemic circulation

left

pulmonary arteries carry?

deoxygenated blood

cardiac system needs to be _______ to work properly

euvolemic

consequences of not euvolemia (dehydration)

HR up, BP down, orthostatics

consequences of too much volume

edema, pulm edema, HTN, HR high (trying to move fluid)

Pericardium

loose fitting sac enclosing the heart

pericardial cavity

Between the visceral and parietal layer

Myocardium

Myocardium-muscular portion of the heart forms the walls of the atria and ventricles

Endocardium

thin three layered membrane that lines the heart and covers the valves

flow is equal to

pressure and resistance

as peripheral vascular resistance increased, your BP will _____

increase

higher the viscousity, the ______ the heart has to work

harder

Fibrous skeleton

consists of 4 interconnecting valve rings and surrounding connective tissue

left AV

mitral

aortic valve attached to the…and does?

left ventricle and aorta

-flow of blood to the systemic

“lub” sound / S1

AV closing (what sound)

“dub” sound / s2

semi-lunar valves closing

systole =

contraction

diastole =

relaxation and filling

atrial systole / contraction, the ventriles _____, the AV are _____, semi-lunar are _____c

1.relax

2. open

   1. closed

during ventricular systole, the atria _____, the AV _____, and the Semi-lunar are _____

1. relax

2. closed

3. open

ventricular diastole, Atria _____, ventricles _____, AV_____, Semi-lunar ____

1. 
   

   1. 
      

1. relax

2. relax

3. open

4. closed

 Cardiac output-

the amount of blood the heart pumps each minute. SV X HR. 

 Stroke volume is the

amount of blood that the heart ejects with each beat

 Cardiac reserve-

the maximum percentage of increase in cardiac output that can be achieved above the normal resting level

 Preload-

degree of stretch blood puts on walls of heart when full with blood prior to systole

Afterload

-pressure or tension work of the heart.  It is the pressure that the heart must generate to move blood into the aorta.  It is the work presented to the heart after the contraction has ended

-narrow pipe, higher afterload. wide pipe, less afterload.

what node initiates signal for atrial contraction?

SA

pacemaker of the heart?

SA node

“gatekeeper” of the heart

AV node

AV node’s job?

delay impulses—this allows atria to completely emptye

electrical conduction in heart?

SA-AV-bundle of his-bundle branch-purkinje’s fibers

frank starling mechanism

compensatory

when preload goes up (stretching of the heart), the heart muscles then squeeze/contract extra hard to get the blood out

what electrolyte impacts contraction?

Calcium

vasoconstrictor or vasodilate?
norepi

constrictor

vasoconstrictor or vasodilate?

epi

less of a constrictor

vasoconstrictor or vasodilate?

angiotension II

constrictor vasoconstrictor or vasodilate?

vasoconstrictor or vasodilate?

histamine

dilate

vasoconstrictor or vasodilate?

serotonin

constrict

vasoconstrictor or vasodilate?

bradykinin

dilate

vasoconstrictor or vasodilate?

prostaglandins

dilate

blood flow increases (exercise?), endothelium releases _______ to help vaso ______

nitrous oxide, dilate.

what cholesterol do we want low?

LDL

what cholesterol do we want high?

HDL

what cholesterol do statins target?

LDL

organs that secrete HDL

liver and intestines

HDL carries cholesterol from ______ to the _____

peripheral system to liver

lipids are insoluble or soluble in plasma

insoluble

apoproteins

activate enzymes for normal lipid metabolism

2 sites for lipoprotein synthesis

small intestines and liver

chylomicrons

small intestines

main carrier of cholesterol?

LDL

Hypercholesterolemia

high LDL

LDL levels

<100= optimal

total cholesterol level

<200

HDL level

40-60

Atherosclerosis

•fibro-fatty lesions in the intimal lining of the large and medium sized arteries

leading cause of stroke, CAD, PAD

•Homocysteine

inhibits anticoagulation

three levels of atherosclerosis

1. fatty streak

2. fibrous atheromatous plaque

3. complicated legion

fatty streak

1. Thin, flat yellow smear on arteries

   1. “Butter on toast”

2. Will get bigger

3. Slightly elevated

   1. Macrophages and smooth muscle cells

1. Fibrous atheromatous plaque (FAP)

1. Basic lesion, accumulation of intra and extra cell lipid

2. Decreased blood flow

3. Seen on cardiac cath

vasculitis

1. Inflammation of blood vessels resulting in injury and necrosis

2. Scar tissue on blood vessels

peripheral artery disease biggest risk factor (2)

DM and smoking

big s/s of PAD

intermittent claudification

what is intermittent claudification?

Big s/s of PAD

walking hurts—cramping in legs. pain stops when they rest. best tx is to walk—build collateral circulation

raynaud’s

•intense vasospasm of the arteries and arterioles in the fingers and less often the toesp

primary vs secondary raynaud’s

primary is idiopathic but secondary is b/c of another disease (like autoimmune)

what type of aortic aneurysms have more symptoms?

thoracic r/t less room

fight or flight?

sympathetic NS

“rest and digest”

parasympathetic NS

how does neural regulation effect BP?

PSNS produces slower HR, SNS produces higher HR

chemoreceptors located?

carotids

chemoreceptor job?

respond to pH changesba

baroreceptor job?

detect stretch

RAAS is what type of system?

humoral

RAAS. explain.

renin converts angiotensinogen to angiotensin I, then Angiotensin I converted to Angiotensin II. then Angiotensin II functions in both the short and long term regulation of BP

•Strong vasoconstrictor

•Vasopressin (ADH)-is released in response to decreases in blood volume and blood pressure-direct vasoconstrictor

renin is a vaso_____

constrictor

kidney release _____

renin

kidney thinks they are not getting perfused (low BP). so they release renin to vasoconstrict. BP goes up. problem?

pt has plaque in RENAL arteries—false alarm but kidney still releases more and more renin.

aldosterone job?

hold onto Na and water

primary HTN

no known cause—

Na intake, sedentary, age, gender, race

secondary HTN

cause—kidneys, adrenal, coarctation of aorta, oral birth control

causes of renal HTN?

glomerulonephritis, stones, pyleo, polycystic kidney disease

estrogen birth control contraindications?

hx blood clot, HTN, smoking >35yr.

orthostatic hypotension point drop?

20 SBP, 10 DBP within 3min

causes of orthostatic hypotension

dehydration, GI (vomit, diarrhea), fever / sweating, HTN meds. diuretics. parkinson’s meds. autonomic problem (head injury). immobility / deconditioning.

chronic insufficiency

valves are supposed to open and close one way. here, they don’t close all the way / properly. blood backs up.

virchow’s triad

factors towards DVT

1. stasis of blood (crossing legs, sitting, immobility/sedentary)

2. increased blood coag (cancer, obese, pregnancy)

3. vessel wall injury (surgery)

dyslipidemia

unhealthy imbalance in cholesterol in blood

Preeclampsia–eclampsia

-elevated blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg)

-proteinuria (300 or greater in 24 hours)

-after 20 weeks of gestation.

Xanthomas

elevated LDL levels, not HDL levels.

Homocysteine associated w/

endothelial damage

berry aneurysm usually found

circle of Willissm

smoking is bad because…

-increases serum lipid levels and decreases HDL

-promotes vasoconstriction

-Endothelial damage

pericarditis

inflammation in sac around heart

what causes pericarditis

viral usually.

Increase cap permeability, plasma protein enter

s/s of pericarditis

chest pain, potentially friction rub

tx for pericarditis?

NSAIDs