Cardiology Exam 2

Apnea

a cessation of breathing especially during sleep. it can be prolonged or intermittent

Eupnea

normal breathing

Biots Breathing

deep rapid breathing followed by a period of apnea. is commonly seen with meningitis.

Hyperpnea

increased depth of respiration with a normal to increased rate and regular rhythm

Hyperventilation

increased rate and/or increased depth

Hypoventilation

decreased rate and/or decreased depth

Tachypnea

rapid respiratory rate with shallow breaths

Cheyne-Stokes breathing

gradually increased tidal volume then decreasing tidal volume followed by apnea. common with CHF and cerebral disorders

Kussmauls breathing

high rate and depth of breathing commonly seen with diabetic ketoacidosis

Orthopnea

trouble breathing when lying down. all patients with lung or cardiac disease have this.

Dyspnea

difficulty breathing, seen in all of patients with lung or cardiac disease

Ventilation occurs in response to

pressure gradients or differences

Gas flows from an area of

high pressure to an area of low pressure (flowing down the airway)

The trans-airway pressure gradient is the pressure difference between the

nose and mouth and the lungs and alveoli

The major muscles of ventilation include the

diaphragm and external intercostals

The muscles are used during what phase of ventilation

inspiration

When these muscles contract they increase the size of the thorax. This causes a _______________________ in intrathoracic, intraplueral, and intrapulmonary pressures.

decrease

The _____________________ increases the vertical diameter of the thorax (chest wall) and the ____________________ increases the transverse and AP diameter of the thorax (chest wall)

diaphragm and external intercostals

During inspiration a ____________________ pressure gradient develops and gas flows from the nose/mouth (P1) to the alveoli/lungs (P2) and alveolar/lung volume increases.

transrespiratory

What phase of ventilation is normally passive i.e. no muscular involvement

exhalation

During exhalation, the muscles relax and the thorax decreases in size. This causes a ______________ in intrathoracic, intrapleural and intrapulmonary pressures and alveolar/lung volume ____________________

increase and decrease

During exhalation a ________________________ gradient develops and gas flows the alveoli/lungs (P1) to the nose/mouth (P2) and lung volume______________________

transrespiratory pressure and decrease

What muscles are used for forced exhalaiton

abdominal

During inhalation the pressure at the nose/mouth is _________________ (the same as Atmospheric) and the pressure in the lungs/alveoli is __________________ Atmospheric; Gas flows toward the ______________________

higher

lower

lungs

During exhalation the pressure at the nose/mouth is _______________ and thepressure in the lungs/alveoli (intrapulmonary) is _______________________gas flows toward the _________________

lower

higher

nose and mouth

Inspiration is

active not passive

Expiration is

passive (no energy or muscles involved simply just a recoil)

Pressure goes _________ during exhalation because everything is decreased in size

up

During inhalation pressures within the thorax, pleura and lungs/alveoli,_________________. This causes a pressure gradient to develop between themouth/nose and ________________. The pressure gradient generates gas flow.

decrease

alveoli or lungs

The gas flows into the lungs/alveoli and lung volume ______________________This follows ______________ Law

increases

Boyles

During exhalation, intrathoracic, intrapleural and intra alveolar pressure______________________ creating a pressure gradient in the opposite direction.

increases

Gas flows out of the lungs/alveoli (towards the nose/mouth) and lung volume_________________

decreases

Define Elastic Resistance

The natural ability of matter to change shape or stretch when an external force is applied and then, to return to its original resting shape/size or recoil after the external force no longer exists.

Elastic Resistance includes

Structural elastic properties of the lungs and chest wall Surface tension of the liquid film lining the alveoli

Issues with the structural elastic properties of the lungs and chest wall is found in what diseases?

pneumonia and pulmonary fibrosis

Issues with the surface tension of the liquid film lining the alveoli is found in what diseases?

IRDS and ARDS

Define Nonelastic Resistance

Frictional resistance to gas flow caused by the airways and the organs impinging on the lungs.Measurements are taken during periods of gas flow

Nonelastic Resistance includes

airway resistance and tissue inertia

Airway resistance occurs in what diseases?

COPD and asthma

There are a total of _____ resistances to inspiration (2 elastic & 2 non-elastic).

4

The Law of Laplace states that the higher the surface-tension of a substance the______________ its surface tension pressure. The smaller the radius of a bubble or alveolus, the ____________ the surface tension pressure

higher

higher

Surface tension pressure is the pressure exerted when liquid molecules at the surface of a liquid-air interface pull together and get smaller. This causes alveoli and bubbles to __________________. The higher the surface tension pressure is the faster this phenomenon occurs.

collapse

Tissue inertia occurs in what disease?

Heart failure and cirrhosis

What substance in the alveoli reduces surface tension? _______________

surfactant

What are the functions of surfactant?

decreases surface tension

increases CL

it helps to keep the alveoli dry

alveolar stability is promoted

What is surfactant made of?

composed of DPPC (dipalmitoyl phosphatidyl choline)

Where is surfactant made?

it is synthesized in the lungs (Type II pneumocytes)

What is surfactant like?

it is a soap like compound causing H20 molecules to repeal each other. surfactant is hydrophillic at one end and hydrophobic at the other

Airway resistance (Raw) is a ____________________________ resistance. Most of it is attributed to the ________________ airway while about ______ is attributed to the __________ airway.

nonelastic

upper

1/3

lower

Identify the five factors that affect Raw.

gas flow pattern, diameter of bronchus, lung volume, gas density and viscosity, and length of bronchus

Whose number determines the gas the gas flow pattern?

Reynolds

The gas flow pattern will be _____________ if the number is >2000. Where is this pattern found in the airway?

turbulent

larger airways

If the number is < 2 the gas flow pattern will be ____________________. Where in the airway is this gas flow pattern found?

laminar

small airways

If the number is between 2 & 2000 the gas flow pattern is_____________. Where in the airways is this pattern found?

transitional

medium sized airways

Gas Density affects ____________________ gas flow patterns and is animportant factor if a patient has an upper airway obstruction such as atumor. What gas mixture is less dense and therefore easier to breath pastan upper airway obstruction?

turbulent

heliox

Whose law is used to determine the amount of Raw in laminar or transitional gas flow patterns?

Poiseuilles

This law states that is the radius of an airway decreases by ½, (i.e. 4 mm to2 mm) Raw will ____________________.

increase 16 times

The major sites of Raw in the lower airway are the ________________and _______________________ bronchi.

segmental and subsegmental

Regarding Raw; an increase in driving pressure or a decrease in gas flow indicates a _____________________ in Raw.

increase

Calculate Raw if the Δ P is 20 cm H2O P and the gas flow is 4 L/sec___________

5

The Raw in the last question is ______________

increased

Identify a clinical condition that would increase Raw?

COPD or Asthma

Give one example of a cause of active exhalation

coughing, exercising, and breathing fast

The ________________________ airways close first. This occurs at low lung volumes in normal healthy individuals and the amount of gas trapped after a normal exhalation is ________________

smaller

functional residual capacity (RV + ERV)

Dynamic compression of the airways occurs after a _____________________exhalation and the amount of gas trapped is normally _______________

forced exhalation

RV (always stays)

In a patient with COPD, airway closure occurs sooner in exhalation especially with a forced maneuver. The result is __________________ gas trapped at the end of exhalation

more

Work in the lungs is defined as ____________ X____________

pressure x volume

Energy or __________ is needed to do the work of breathing.

ATP

____________________ and ______________________ produce the mostenergy/ATP to do the work of breathing

oxygen and glucose

The ______________ ______________ provide the power to do the work ofbreathing.

respiratory muscles

O2 is consumed by the mitochondria to produce energy. This is called_____________________ metabolism. The end products of this type ofmetabolism are _______________, __________________ & ______________

aerobic

ATP, CO2, and H2O

Two of the end products are waste products. They are ____________ &_______________

CO2 and H2O

Identify the five factors that contribute to the work of breathing.

1.Elastic recoil of the lung and chest wall (inspiration)

2.Surface tension (inspiration)

These are Elastic Resistances

3.Airway Resistance - 80 - 85% (inspiration and expiration)

4.Tissue Resistance/Inertia - 15 - 20% (inspiration)

These are Nonelastic Resistances

5.Active or forced exhalation

Identify the breathing pattern that a patient with decreased compliance would have.

These patients can't take a deep breath resulting in a decreased VT. The patient tries to maintain a constant minute ventilation by increasing their frequency (f). Rapid shallow breathing (tachypnea).

Identify the breathing pattern that a patient with increased Raw would have.

These patient's have trouble moving air into and out of their airways especially during exhalation, so they breath less times per minute(decreased f). They are able to expand their lungs and may have an increased tidal volume. Expiratory time is longer than normal. (normal 1: 2)

Gas distribution is equal throughout the lungs/alveoli in normal individuals.

false

At end exhalation (FRC) most of the gas left in the lung in a patient who is sittingor standing is at the _____________ of the lungs

top

During inspiration most of the gas taken in occurs at the _____________ of the lungs.

bottom

Uneven distribution of ventilation in diseased lungs occurs because of varying___________________ __________________________

time constants

"The amount of time necessary to inflate a particular lung region to 60% of itsfilling capacity" is the definition for a ______________ __________________

time constants

Ventilation is efficient when ___________________________

it consumes little energy

Ventilation is effective when it meets the demands for_______________________________and ____________________________

oxygen uptake and CO2 removal

Identify the all of methods of determining efficiency and effectiveness of ventilation.

Determine Minute Ventilation

Determine Alveolar Ventilation

Determine Alveolar Ventilation in 1 minute

Determine the Deadspace to the Tidal Volume Ratio (VD/VT)for one breath.

Determine the Deadspace Ventilation in one minute (VDE) tothe Minute Volume (VE) Ratio (VDE/VE)

Determine minute ventilation

VE = VT x f

Normal Value 5 - 10 L/min

VE minute ventilation/volume

VT tidal volume 3 - 4 mL/lb or 6 - 7 mL/kilo (Ideal Body Weight)

f breaths per minute 12- 20/min

Determine Alveolar Ventilation

VA = Vt - VD

VA Alveolar Ventilaion

VT Tidal Volume

VD Dead-Space Volume/Ventilation (Deadspace ventilation isAKA Wasted Ventilation)

Determine Alveolar Ventilation in 1 minute

VAE = VA x f

VA alveolar ventilation/volume

f breaths per minute

Determine the Deadspace to the Tidal Volume Ratio (VD/VT)for one breath.

Normal range 0.2 to 0.4 or 20 - 40% (33% is perfect)

Increased value indicates ineffective or "wasted ventilation"

Determine the Deadspace Ventilation in one minute (VDE) tothe Minute Volume (VE) Ratio (VDE/VE)

Normal range 0.2 to 0.4 or 20 - 40% (33% is perfect)

Increased value indicates ineffective or "wasted ventilation"

Calculate the minute ventilation if the f is 35/min and the Vt. is 320 ml.__________. This minute ventilation is ________________

11 and inefficient

Calculate the minute ventilation if the f. is 10/min and the Vt. is 400 ml.________________. This minute ventilation is ________________

4 and ineffective

Calculate the Alveolar Ventilation (one breathe) if the Vt. 400ml and the personweighs 150 lbs. Is this patient's alveolar ventilation normal?

250

Anatomical + Alveolar dead space is the _______________________ dead space.

physiological

What is the normal amount of alveolar dead space? _________________

0, none

Another name for dead space is ________________ _______________________.

wasted ventilation

Anatomical dead space is equal to _________ per _________.

1mL per pound (ideal body weight)

Normally, the dead space to tidal volume ratio/percentage is _______________

20-40% (33% is best)

As dead space increases, ventilation becomes _________________________. The work of breathing ___________________because the patient will breathe faster.

ineffective and increases

The ________________ equation measures Physiologic dead space. Itdemonstrates that _______ is the major factor affecting alveolar ventilation.

Bohr

PaCO2

Assuming CO2 production (VCO2) is constant, if alveolar ventilation decreases the PCO2 ________________. If Alveolar ventilation is cut in half the PCO2________________

increases

double

According to the formula, if CO2 production (VCO2) is constant, if alveolar ventilation doubles, the PCO2 will _____________

decreases by half