Exam 2 Cardiovascular

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Exam 2 Cardiovascular
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2013-10-18 15:22:53
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  1. Heart
     is a four-chambered muscular pump*
  2. Epicardium
    • (visceral layer), heart wall
    • location: inner layer of the serous pericardium 
    • consists: mesothelium and connective tissue
  3. Shock
    • Shock is an inadequate cardiac
    • output that results in failure of the cardiovascular system to deliver adequate
    • amounts of oxygen and nutrients to meet the metabolic needs of body cells.

    • Signs and symptoms clammy, cool, pale skin; tachycardia; weak, rapid
    • pulse; sweating; hypotension (systemic pressure < 90 mm Hg); altered mental
    • status; decreased urinary output; thirst; and acidosis.
    • Hypovolemic shock refers to decreased blood volume resulting from loss of blood or plasma due to acute hemorrhage or excessive fluid loss (as in excess vomiting, diarrhea, sweating,dehydration, urine production, and burns).

    • 3 stages of Shock:
    • Stage I is compensated (nonprogressive)
    • shock, in which negative feedback systems restore homeostasis
    • 1. If the initiating cause does not get any worse, a full recovery follows.
      2. Compensatory adjustments include activation of the sympathetic division of the ANS, the renin-angiotensin pathway, release
    • of antidiuretic hormone (ADH), and release of vasodilator factors in response to hypoxia
    • Stage II is decompensated (progressive) shock, in which positive feedback cycles intensify the shock and immediate medical intervention
    • 1. It occurs when there has been a reduction in blood volume of 15-25%
    • 2. Among the positive feedback cycles that contribute to decreased cardiac output and blood pressure are depression of cardiac activity, depression of vasoconstriction, increased permeability of capillaries, intravascular clotting, cellular destruction, and acidosis
    • Stage III is irreversible shock, in which there is rapid deterioration of the cardiovascular system than cannot be helped by compensatory mechanisms or medical intervention
  4. Endocatditis
    • Inflammation of the endocardium usually confined to the endocardium of the heart valves. Results from infection by bacteria that have entered the bloodstream but may result from fungal infection or an autoimmune response.
    • endocardium: endothelium and connective tissue
  5. Epicardium
    • (visceral layer), heart wall
    • location: inner layer of the serous pericardium
    • consists: mesothelium and connective tissue
  6. Terms: endocardium, myocardium, trabeculae carneae, pectinate muscles, chordae tendineae
    • endocardium- white, third layer of the heart wall, consists of endothelium and connective tissue, lines the heart chambers, blood vessels leaving & entering the heart and covers the fibrous skeleton of the valves
    • myocardium- cardiac muscle tissue, bulk of the heart, contracts, cardiac muscle bundles
    • trabeculae carneae- crisscross and projection from the inner walls of the heart ventricles
    • pectinate muscles- muscular ridges internally in the atria
    • chordae tendineae- white collagen cords attached to each AV valve flap  which anchor the cusps to the papillary muscles into a closed position valves pointing in the direction of the blood flow and stop blood from backing into the atria
  7. endocardium-
    3rd layer of the heart wall, white layer, endothelium (squamous epithelium) and connective tissue, continuous with linings of blood vessels leaving and entering the heart
  8. Cardiac Temponade
    bleeding into the pericardial cavital compresses the heart and is potentially lethal large amounts of inflammatory fluid seep into the pericardial cavity. This excess fluid compresses the heart and limits its ability to pump blood, a condition called cardiac tamponade heart plug. Insert a syringe into the pericardial cavity and draining off the excess fluid
  9. Myocardium
    • cardiac muscle
    • forms the bulk of the heart
    • contracts, cardiac muscle bundles
  10. Function of the Pericdardial fluid
    reduce friction between the pericardial membranes
  11. CV center
    • Cardiovascular (CV) center is a group of neurons in the medulla that regulates heart rate, contractility, and blood vessel diameter.
    • Requires input from higher brain regions and sensory receptors (baroreceptors and chemoreceptors)
    • Output from the CV center flows along the sympathetic and parasympathetic fibers
    • 1. Sympathetic impulses along vagus (X) nerves decrease heart rate
  12. Blood flow
    • Blood flow is determined by:
    • 1. Blood Pressure
    • 2. Cardiac Output
    • 3. Resistance
  13. Chemoreceptors
    • receptors sensitive to chemicals monitor blood levels of oxygen, CO2, and pH
    • O↓/CO2↑--(turns into solid)-->↑carbonic acid (chemical) -->↓pH (acidic) 
  14. Calcium & Muscle Contraction
    • sarcoplasmic reticulum stores calcium
    • The depolarization of the T tubule membrane causes nearby voltage-gated calcium ion channels on the sarcoplasmic reticulum to open, resulting in an increase in the permeability of the sarcoplasmic reticulum to calcium ions (Ca2+).
    • 2. Calcium ions then diffuese from the sarcoplasmic reticulum into the sarcoplasm.
    • 3.Long filmentous tropomyosin proteins lie on two sides of the actin myofilament, covering up the sites where myosin can bind to the actin myofilaments. Globular troponin proteins are attached to the tropomyosin.
    • 4. When calcium ions bind to troponin, this causes troponin to change conformation and move the tropomyosin
    • 5. When the tropomyosin moves, this uncovers the myosin binding sites on the actin, allowing myosin heads to bind and form cross-bridges. The cross-bridges play a role in muscle contraction
  15. Pulmonary circulation
    • blood in the pulmonary veins returns to the left atrium
    • right side of the heart acts as the pump for pulmonary circulation
  16. How the heart responds to changes in blood pressure
    (add more ***)
    if BP falls, the baroreceptor reflexes accelerate Heart Rate. increase force of contraction, and promote vasoconstriction
  17. Which of the following will increase the heart rate?
    *CO2
  18. Mediastinum
  19. Angioplasty (what is it?)
    • procedure used to open narrow or blocked coronary (heart) arteries. The procedure restores blood flow to the heart muscle.Plaque buildup in any artery can harden or rupture which reduces blood flow a blood clot forms and completely blocks blood flow.
    • A thin, flexible catheter (tube) with a balloon at its tip is threaded through a blood vessel to the affected artery. Once in place, the balloon is inflated to compress the plaque against the artery wall. This restores blood flow through the artery.
  20. Angina Pectoris (cause)
    • describes chest caused by myocardial ischemia - a condition in which the amount of oxygen getting to the heart muscle is insufficient
    • cause: coronary artery spasm, and atherosclerotic plaque buildup
  21. AV valves (location)
    • separate atria from ventricles
    • Right: tricuspid valve
    • Left: mitral (bicuspid) valve
    • Valves, composed of dense connective tissue
    • covered by endothelium, prevent backflow of blood in the heart
    • attached to small papillary muscles by tough tendons called cordae tendineae. Papillary muscles contract in synchrony with the ventricles, thus maintaining constant tension on the valve leaflets.
  22. Pulmonary semilunar valve (location)
    Semilunar valves prevent blood from flowing back into the heart as it leaves the heart for the lungs (pulmonary semilunar valve
  23. Baroreceptor reflexes
    • Carotid
    • Aortic
    • Right Atria
    • Baroreceptors (pressure-receptors)- important pressure sensitive sensory neurons that monitor stretching of the walls of the blood vessels and the atria.
    • 1. Caratoid Sinus Reflex-maintaining normal NP in the brain and is initiated by baroreceptors in the wall of the carotid sinus
    • 2. Aortic Reflex- general systemic BP and is initiated by baroreceptors in the arch of the aorta or attached to the arch
    • 3. if BP falls, the baroreceptor reflexes accelerate Heart Rate. increase force of contraction, and promote vasoconstriction
    • 4. Right heart (atrial) reflex responds to increases in venous BP and is initiated by baroreceptors in the right atrium and venae cava
  24. Chordae tendineae (heart strings)
    chordae tendineae- white collagen cords attached to each AV valve flap  which anchor the cusps to the papillary muscles into a closed position valves pointing in the direction of the blood flow and stop blood from backing into the atria
  25. Baroreceptor reflex
  26. ECG (parts, represents)
    • P wave: atrial depolarization (spread of impulse from SA node over atria)
    • QRS: ventricular depolarization (spread of impulse through ventricles)
    • T wave: ventricular repolarization
    • Depolarize- Na+ rushes in
    •                  K+ rushes out
  27. ECG (P,Q,R,S,T, Conduction system)
    each cardiac cycle
  28. Systole
    A cardiac cycle consists of the systole (contraction) and diastole (relaxation) of both atria, rapidly followed by the systole and diastole of both ventricles
  29. Cardiac cycle (def.)
     A cardiac cycle (heart beat) consists of the systole (contraction) and diastole (relaxation) of both atria, rapidly followed by the systole and diastole of both ventricles
  30. Stroke Volume (def.)
    • Stroke volume (SV) is the amount of blood ejected by the ventricles during each systole. Stroke volume depends on three factors:
    • 1. Preload or (End Diastolic Volume) this is the “stretch” that is put on the ventricles as they fill with blood. The more blood that enters the ventricles the more they are stretched and this causes them to contract with more force.  The more stretch the greater the force of contraction will be.
    • 2. Contractility is the strength or force of contraction
    • 3. Afterload is the amount of pressure that is needed to push open the semilunar valves of the heart (aortic and pulmonary).  An increase in afterload pressure will cause stroke volume to decrease ex.arthrosclerosis.
    • According to the Frank-Starling law of the heart, a greater preload (stretch) on cardiac muscle fibers just before they contract increases their force of contraction during systole.
  31. Cardiact Output (Co=HRxSV)
    Cardiac Output= Heart Rete x Stroke Volume
  32. Preload (stretch, more blood into ventricles the greater the next contraction will be)
    Preload or (End Diastolic Volume) this is the “stretch” that is put on the ventricles as they fill with blood. The more blood that enters the ventricles the more they are stretched and this causes them to contract with more force.  The more stretch the greater the force of contraction will be.
  33. Afterload
    • 3. Afterload is the amount of pressure that is needed to push open the semilunar valves of the heart (aortic and pulmonary). An increase in afterload pressure will cause stroke volume to decrease  ex.arthrosclerosis.
    • According to the Frank-Starling law of the heart, a greater preload (stretch) on cardiac muscle fibers just before they contract increases their force of contraction during systole.
  34. Stimulation of the heart via the sympathetic nerves would
    ↑HR (heart rate), ↑Co (cardiac output)
  35. Increased vagal stimulation would cause
  36. Conduction system of the heart (function of the SA node)
  37. Conduction system of the heart (components in correct order SA node-->
  38. Semilunar valves cardiovascular peripheral circulation and regulation ( blood vessels and hemodynamic)
  39. Systemic blood vessels transport blood
    from the left ventricle through the body to the right atrium
  40. What is the order of the blood vessels that a red blood cell would pass through as the blood leaves the heart, travels to a tissue, and then returns to the heart?
    artery, arteriole, capillary, venule, vein
  41. Which of the following enhances the exchange between capillary walls and the interstitial spaces?
    the thinness of the capillary wall
  42. Capillaries (function)
    • materials exchanged between blood and tissue cells by diffusion
    • usually connect arterioles and venules
    • composed: endothelium and basement membrane
  43. Continuous Capillries
    have a wall where the endothelial cells fit very tightly together
  44. Fenestrated capillaries (location)
    KIDNEYS
  45. Precapillary sphincters (location)
    • location:
    • control the blood flow into capillary beds.
  46. Compare arteries to veins
  47. Blood is moved through the vascular system by
    Heart pumps
  48. Tunics of blood vessels
  49. Compare arteries to veins
  50. Veins (def)
    • Veins consist of the same three tunics as
    • arteries but have a thinner tunics interna and media and a thicker tunica externa; they have less elastic tissue and smooth muscle and are therefore thinner-walled
    • than arteries.
    • 1. They contain valves to prevent backflow of blood.
    • 2. Weak valves can lead to varicose veins.
    • 3. Vascular (venous) sinuses are veins with very thin walls with no smooth muscle to alter their diameters.
    • Examples are the brain’s superior sagittal sinus and the coronary sinus of the heart
  51. Velocity of blood flow (hemodynamics)
    The velocity of blood flow is inversely related to the cross-sectional area of blood vessels; blood flows most slowly where cross-sectional area is greatest.
  52. Laminar blood flow (def)
    • def:
    • The outermost layer of blood experiences the greatest resistance to flow
    • Laminar flow is the normal way that blood flows through our blood vessels.  It is characterized by concentric layers of blood moving in parallel down the length of a blood vessel. The highest  velocity is found in the center of the vessel. The lowest velocity is found along the vessel wall.
  53. Blood Pressure (def)
    measure of force blood exerts against blood vessel walls
  54. Blood Pressure (reading measurements
  55. Resistance
    a decrease in the radius of the vessel-(will increase resistance to blood flow)
  56. Resistance (viscosity)
    tends to increase if blood viscosity increases-resistance in the cardiovascular system
  57. Viscosity
    As viscosity of the blood increases,the pressure required to force it to flow increases
  58. Which of the following acts as a storage area for blood?
    Veins
  59. Aorta
    • Divisions of the aorta are the ascending aorta, arch of the aorta, thoracic aorta, and abdominal aorta.
    • important baroreceptors are located in the arch of the aorta and carotid arteries
    • Blood flow decreases from the aorta to arteries to capillaries and increases as it returns to the heart
    • The aortic reflex is concerned with general systemic blood pressure and is initiated by baroreceptors in the wall of the arch of the aorta or attached to the arch.

  60. Pulse pressure (calculate pulse pressure)
    • Pulse pressure (PP) is the difference between systolic and diastolic pressure. It normally is about 40 mm Hg and provides information about the condition of the
    • arteries.
    • Pulse is the alternate expansion and elastic recoil of an artery wall with each heartbeat.
    • Normal resting pulse (heart) rate is between 70 and 80 beats per minute.
    • Tachycardia means a rapid resting heart or pulse rate (> 100beats/mm).
    • Bradycardia indicates a slow resting heart or pulse rate (<60beats/mm).
    • Measurementof Blood Pressure (BP)
    • Blood pressure is the pressure exerted by blood on the wall of an artery when the
    • left ventricle undergoes systole and then diastole. It is measured by the use of a sphygmomanometer, usually in one of the brachial arteries.
    • 1. Systolic blood pressure (SBP) is the force of blood recorded during ventricular contraction
    • Diastolic blood pressure (DBP) is the force of blood recorded during ventricular
    • relaxation.
    • Normal BP of a young adult male is 120-180 mm Hg (8-10 mm Hg less in a young adult female). The range of average values varies with many factors.

     
  61. Shock (symptoms and signs)
  62. Filtration
    Fluid movement out of the capillaries
  63. Blood colloid osmotic pressure (re-absorption)
    • fluid into the capillaries
    • measurement of pressure exerted within the cardiovascular system by proteins found in blood plasma. The special nature of these protein cells helps ensure that fluids pass in and out of the capillaries at the proper rate.
  64. Edema (causes)
    • 1. Increased hydrostatic pressure in capillaries due to an increase in venous pressure
    • 2. Decreased concentration of plasma proteins that lower blood colloid osmotic pressure
    • 3. Increased permeability of capillaries, allowing greater amounts of plasma proteins to leave the blood an enter tissue fluid
    • 4. Increased extracellular fluid volume as a result of fluid retention
    • 5. Blockage of lymphatic vessels postoperatively or due to filarial worm infection
  65. Resistance (
    arterialsclerosis (scaring) thickening of the tunica intima and loss of elasticity in the tunica media.
  66. Baroreceptors
  67. Hormones (Epinephrine)
    causes vasodilation of coronary blood vessels.
  68. Baroreceptors
  69. Chemoreceptors
    are located in the aortic and carotid bodies
  70. Chemoreceptors
    maintain homeostasis when CO2 levels increase
  71. Blood pressure
  72. Angiotensin II
    causes vasoconstriction*
  73. Renin (function of RAA pathway)
    an increase in blood volume*-(Which of the following would occur as a result of increased renin release by the kidneys?)
  74. Atrial natriuretic peptide
    (cause blood pressure to decrease)
  75. Shock (body response) low BP, CO
    the renin-angiotensin mechanism is activated.
  76. Atrial natriuretic factor
    is released in response to elevated atrial pressure.
    • A. aortic semilunar valve
    • B. pulmonary semilunar valve
    • C. right atrium
    • D. left atrium
    • E. bicuspid (mitral) valve
    • A. right atria
    • B. right ventricle
    • C. left atria
    • D. left ventricle
  77. Name and describe the layers that make up the heart wall
    • 1. Epicardium-squamous epithelium (endothelium)
    • 2. Myocardium- cardiac muscle
    • 3. Endocardium- squamous epithelium
  78. Give the location and function of the components of the conduction system of the heart (correct order)
    • 1. SA node- location: right atrium function- pacemaker
    • 2. AV node- location: near the interventricular septum in the lower portion of the right atrium function:temporarily slow down nervous impulses 
    • 3. Bundles of His- location: interventricular septum, near the atria function: regulates the heartbeat from the right atrium to the ventricle
    • 4. Right/Left bundle branches- location: interventricular septum function:
    • 5. Purkinje fibers- location: branch into the ventricular myocardium function: contraction of the ventricles
  79. Describe the 3 types of sensory receptors that provide information to the CV center of the brain
    • 1. Baroreceptors- monitors pressure
    • 2. Chemoreceptors- monitors chemicals
    • 3. Proprialreceptors- monitors body position
  80. Describe the RAA system. Be sure to include the pathway as well as the function of angiotensin II/aldosterone
  81. 9Give the signs and symptoms of shock
    • Signs and symptoms clammy, cool, pale skin; tachycardia; weak, rapid
    • pulse; sweating; hypotension (systemic pressure < 90 mm Hg); altered mental
    • status; decreased urinary output; thirst; and acidosis.

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