cardio physiology

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rreavis
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cardio physiology
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2010-09-30 07:53:48
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cardio
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  1. pericardial sac
    • envelops heart
    • visceral and parietal layer
    • pericadial cavity - lubricating fluid
    • decrease friction
  2. pericarditis fibrinosis
    • thick layer of fibrin in pericardial cavity b/c of infection
    • (cow eats nail and it punctures heart)
  3. purpose of heart
    TRANSPORT - gas, heat, hormones, cells, water, minerals
  4. when blood leaves organs
    blood pressure is lower even in the lungs
  5. arteries have how much pressure
    HIGH = arteries
  6. veins have how much pressure
    LOW = veins
  7. heart is 1 functional unit
    2 separate pumps
  8. heart skeleton
    base of heart, all vales attached, fibrous, chondric, and osseous (cattle)
  9. semilunar valves
    3 valves
  10. right side of heart
    • 3 valves
    • tricuspid
  11. left side of heart
    • 2 valves
    • bicuspid
    • mitral
  12. role of the atrium is to
    fill ventricles
  13. Systole
    • AV closed
    • ventricles contract
    • semilunar open
    • blood to system
  14. diastole
    • AV open
    • ventricles relaxed
    • semilunar valves closed
  15. contraction
    • shift down for atria filling
    • shift up for ventricle filling
  16. atria filling
    shift down
  17. ventricle filling
    shift up
  18. atria
    • systole and diastole
    • shorter
    • begin and end before ventricle
  19. atrial systole
    • ventricle relaxed
    • atria contraction completes filling of ventricle
  20. ventricular systole
    • increase in blood pressure
    • all valves closed
    • isovolmetric contraction
    • diastole
  21. isovlometric contraction
    ventricular systole
  22. ventricle pressure higher that aortic/pulmonary
    causes ejection
  23. ventricle diastole
    • decrease in blood pressure
    • all valves open
    • isovolmetric relaxation
  24. isovolmetric relaxation
    ventricle diastole
  25. atria high pressure than ventricle
    • AV valves open
    • passive filling
  26. ventricle pressure in diastole
    • lower than atria
    • aortic valve closed
  27. ventricle pressure in systole
    • higher that atria
    • AV valves closed
  28. aortic valves are closed till
    • ventricle pressure is higher than aortic
    • ejection to system
  29. stroke volume
    • difference between end diastolice volume and end systolic volume
    • volume of blood ejected during systole
  30. end systolic volume
    • decrease in ventricle blood volume
    • end of systole
  31. End Diastolic volume
    • max volume of cardiac cycle
    • ventricles fill till end of diastole
  32. catacholamines
    increase heart rate
  33. sympathetic
    whole heart
  34. parasympathetic
    all of heart w/o ventricles
  35. Bathotropic
    • excitibility
    • atria only
  36. chronotropic
    • heart rate
    • ventricles
  37. dromotropic
    • speed of conduction
    • atria only
  38. inotropic
    • force of contraction
    • atria only
  39. norepi
    • steeper diastolic depolarization
    • increase Na
    • decrease K
    • increase heart rate
  40. acetyl
    • flatter diastolic depolarization
    • increase K
    • decrease Ca
    • lower heart rate
    • negative tropic effects on heart
  41. fight or flight
    no parasympthetic
  42. sym and para
    • sym - day
    • para - night
    • equal influence of both SA node intrinsic rate wins
  43. increase in contration
    • exercise
    • increase stroke volume and end diastolic colume
    • digitalis, isoprotenerol, norepi
  44. decrease in contration
    • propanol - Beta antagonist
    • barbituate - anaesthesia
  45. pacemaker cells
    • cant contract
    • generate Action potenital
    • no stable membrane potential
  46. bundle branches
    • 1 on right
    • 2 on left
  47. intrinsci rates of pacemakers
    • SA - 70
    • AV - 40- 50
    • bundle of his, branches and purkinji 25 - 40
  48. SA node fires
    • AP runs through heart and resets all pacemakers
    • self excitation - increase permability to Na and K
  49. pacemaker potenial or prepotential
    • diastole
    • slow depolarization between AP
  50. threshold of funnels
    • -40
    • causes them to close
  51. membrane potential of pacemaker ions
    • -60
    • Na more than K
  52. AV node depolarizing
    • still depolarizing when AP arrives from SA
    • increase deplarization to threshold to generate the AP
  53. Auxilary pacemaker
    nerve complete their pacemaker potential b/c faster pacemeaker dominates
  54. Action potential
    atrium depolarizes, AP reaches AV node before all of atrium depolarizes
  55. AV node delay
    • frequency filter
    • atria then ventricle depolarize
    • atria pump into ventricle
  56. SA AP
    .22 sec to ventricle deplarization to contaction
  57. size of heart
    • relation to body
    • small heart higher heart rate
  58. heart rate
    • more exersize - decreases
    • reptiles - warmer body temp increase heart rate
  59. wave of ECG
    one positive or negative deflection
  60. segment of ECG
    distance/ time between 2 waves
  61. interval of ECG
    consists of one or more waves and segments
  62. ECG
    • AP - wave of depolarization (has direction)
    • number of cells depolarizes increase to max then decrease in number of cells
    • direct corallation between strength of electrical signal and number of depolarized cells
  63. max record potential
    • can't exceed max generated potential
    • can be lower
  64. depolarization direction
    direction of depolarization in realtion to direction of measument
  65. electrical potential
    • ionic differences in Extra cellular fluid = electircal potential
    • occurs during de and repolarization
  66. 0 mV
    • at resting
    • stale depolarization state
    • no difference in ECF
  67. size of item and angle
    view size of an item depends on the view of the angle
  68. record potential
    depends on the location of depolarization and placement of electrodes
  69. vector
    points from depolarized to nonpolarized area
  70. electrode reads
    left to right
  71. Zero
    vector measuring plane are vertical to each other then independently of the actual magnitude of potenital difference
  72. einthoven
    • equilateral triangle
    • 3 different values of same vector
    • only use 2 planes
  73. cardiac vector
    main ptoential difference in heart electrode orientation determines how much of the cardiac vector is measured
  74. III lead
    • use 2 and 3
    • third plane
    • max strenght
    • recorded size of vector is different compared to other leads
  75. animal shape influence on ECG
    • different size and shapes of animals influence ECG
    • don't make equilateral triangle
    • same function (PQRST)
  76. Goldberg
    • 2 connected electrodes
    • stonger signal, better
    • inverted 45 degrees b/c of heart
    • augmented voltage (aV + right, left or foot)
    • aVr, aVl, aVf
    • aVr - 1 electrode on right, 2 connected in series on left
  77. wilsons
    • leads placed on chest close to heart
    • increased detail
  78. P wave
    atria depolarize and AV node
  79. PQ segment
    depolarization of AV node (bundle of his)
  80. PQ interval
    atria depolarization to begining of ventricle depolarization
  81. QRS
    depolarization of ventricle
  82. ST segment
    • ventricle still depolarized
    • no electical change = no signal
  83. T wave
    • ventricle repolarizes
    • only repolarization
    • atria repolarize earlier but to small to see in ECG
  84. R and S wave
    can be missing
  85. no P wave
    • no SV node
    • AV node is the pacemaker
  86. amplified standard
    • 5 or 10 mm per mV
    • slower - better idea of rhythmic events and reveal random events
    • higher - more detail
  87. duration
    • P wave .6
    • PR .13
    • QRS .05
    • QT .19-.23
  88. ECG provides
    • only partial info about mechanical events in heart
    • can be calculated and compared to standard values
  89. ECG also provides
    • only projections to the 3 planes (not actual vector)
    • vector can be reconstructed from projections
    • vector changes value and direction during cycle
    • depolarization of atria and ventricle, reoplarization of ventricle bein and end at zero
  90. vectorcardiogram 3 loops
    • 1. P
    • 2. QRS
    • 3. T
    • QRS largest loop
  91. resting state
    no signal, ECG baseline, cardiogram just a dot
  92. Vectorcardiogram
    • segments are not shown
    • b/c heart is completely depolarized or repolarized
    • dots where circles intersect
    • normal - larger diameter of ellipse almost verticle
  93. Valves
    • not source of heart sounds
    • help generate source of sound from oscillation of blood and vibrations of muscles and valves
  94. murmurs
    • 1. extracardiac events - fibrinous pericaditis - rubbing of heart and pericardium
    • 2. altered valves - stenosis or insuficiencey
    • 3. abnormal openings - ductus arteriosus, foramen ovale, ventricle septum defect
  95. Auscultation
    • PAM (bi) left side
    • tri - right side
  96. 1st heart sound
    • loudest
    • systole
    • AV closed
    • venticle contract
    • QRS
  97. 2nd heart sound
    • diastole
    • semilunar valves close
    • after T wave
  98. 3rd heart sound
    • in rushing blood from atria
    • between T and P
  99. 4th heart sound
    • contaction of atria
    • P wave
  100. stages of murmurs
    • 1. hard to hear
    • 2. soft but definit
    • 3. low to moderate
    • 4. loud
    • 5. very loud (audible all over chest and palpate "thrill")
    • 6. very loud even when stethoscope not in contact w/wall "thrill"
  101. murmurs are from
    • abnormal heart sounds
    • abnormalities of physical heart sounds
    • additional abnormal noises
  102. stenosis
    aquired congenitally undersized valves = developmental
  103. insufficiency
    leakage at closure from disease
  104. Stenosis
    • systole - semilunar valves
    • Diastole - AV valves
  105. insufficiency
    • systole - AV valves
    • diastole - semilunar vlaves
  106. Mitral(bi) insufficiency
    • begining at QRS and ends at T wave (end systole)
    • AV valves closed - leaky systolic murmur
  107. mital stenosis
    diastolic murmur "hic up"
  108. aortic insufificency
    extended diastole murmur
  109. aortic stenosis
    systolic murmur
  110. machinery murmur
    • PDA -patent ductus arterious
    • systolic and diastolic murmur
    • caused by stenosis and insufficency
    • always a sound
  111. Fetus
    • higher pressure on right side of heart (switch when foramen ovale closes)
    • higher resistance through collasped lung - ductus arteriosus
    • lower resistance through placenta - ductus venosus
  112. PDA
    continuous murmur sound
  113. patent foramen ovale
    murmur quiet b/c atrial pressure is low
  114. aortic stenosis
    • long lub
    • first sound in systole
  115. mital reguritation
    • long and low in lub
    • systole
  116. aortic reguritation
    • long diastole
    • 2-4 heart sound
  117. mitral stenosis
    long and low in 3 and 4 heart sounds durign diastole
  118. cardiac electrical abromalities - Excitation
    • nomotropis dysfunction
    • heterotropic dysfunction
  119. nomotropic dysfunctions
    • sinus arrhythmia
    • sinus tachycardia
    • sinus bradycardia
  120. sinus arrhythmia (irregular)
    • abnormalities in cardiac rythum
    • normal in dogs - increase with inspriation and decrease with expiration
  121. sinus tachycardia
    • increase heart rate
    • SA AP rate too high
  122. sinus bradycardia
    • decrease in heart rate
    • SA AP rate too low
  123. heterotropic dysfunction
    • escape rhythm
    • suraventricular extrasystole
    • shifting pacemaker
    • ventricular diastole
    • supraventricular tachycardia
    • atrial flutter
    • artial fibrillation
    • ventricle tachycardia
    • ventricle flutter
    • ventricle fibrillation
  124. escape rhythm
    • extreme brachycardia
    • AV node rate exceeds SA and takes over
  125. Supraventricular Extrasystole
    • premature stimulus by atria
    • SA no effect
    • next systole is normal
    • P wave very close to T wave
    • waves to close together
  126. Shifting pacemaker
    • SA fails
    • ectopic atrial pacemaker takes over
    • b/c increase in vagal tone
    • closer to AV node the shorter the PQ segment
  127. Ventricular tachycardia
    • premature stimulus from heterotropic ventricle
    • next systole back to normal
    • cant see P wave
    • R and L depolarize at same time (from inside out)
  128. supraventricular tachycardia
    • increase in AP from atria
    • P waves differnt shapes b/c several ectopic atrial pacemakers
    • normal intervals
  129. atrial flutter
    • ectopis AP at high rate
    • 220 - 350
    • regular contractions, pulse rate and strenght
    • myocardial infraction
    • atria no pumping
  130. atrial fibrillation
    • ectopic AP at high rate 350-600
    • rapid irregular and uncordinated depolarization
    • pulse irregular
    • no atrial pumping
  131. ventricle tachycardia
    • no P wave
    • R waves from ventricle pacemaker
  132. ventricle flutter
    • multifocal excitation
    • ceases pumping function
    • different paper speeds
  133. ventricle fibrillation
    • mulitfocal excitation
    • ceases pumping function
    • death
    • caused by decrease in blood to myocardium of ventricles
  134. Cardiac electical abnormalities
    conduction disorders
  135. conduction disorders
    • AV blocks
    • firstm second and third degree
  136. AV Block basics
    • conditions and rate of conduction of the impluse through AV node and Bundle of His or block entirly
    • AP to AV node and bundle of His
    • affected by - ishemia (decrease in blood flow)
    • compression (smaller diameter, calcification, scar)
    • inflammation (infection, fever)
    • extreme vagal tone
  137. first degree block
    • AV conduction slow
    • PQ segment very long
  138. second degree block
    • dropped beat, ventricle does not contract
    • SA node work others cant conduct AP
    • no QRST interval
  139. third degree block
    • atrium and ventricle connection broken
    • ventricles (bundle branch) cause AP (slower)
    • need pacemaker
    • atria and ventricles contract at different times
  140. Cardiac structureal abnormalities - morphological
    Hypertorphy
    • of right ventricle
    • change in cardiac vector to side effected
    • increase muscle tissue = stronger signal = increased R waves
    • change in timing of depolarization w/ only one side affected
  141. cardiac structural abnormalities - functional
    myocardial infraction
    • few anastomoses in coranary artery
    • embolus will cause occlusion
    • decrease in blood to cardiac muscle tissue (dies)
    • distorts R wave
    • right after Shifter ST segment
  142. Technical alterations
    • electrical interference
    • trembling patient
  143. electical interference
    • ECG (230 Hz power supply)
    • poor lead connections
    • regular and same reading over and over
  144. trembling patient
    skeletal muscle interfer
  145. Heart Failure
    • not able to adequatly meet body needs b/c of malfunction
    • 1. decrease in cardiac output
    • 2. damming of blood behind left or right heart
    • 3. overload of heart through increased output
  146. low heart failure
    • 1. compensated heart
    • 2. decompensated heart
    • 3. bi/unilateral failure
  147. compensated heart
    • fails but recovers to allow minimum output
    • cardiac reserve reduced
  148. decompensated heart
    • minimum not restored
    • compensatory mechanism continue
    • leads to death
  149. bi/unilateral failure
    whole or part of heart fails
  150. high output failure
    • increase force b/c some bypass of normal circulation
    • continuous overload causes heart failure
  151. high pressure
    increase pressure b/c increased resistance in circulation = heart failure
  152. cardiac output and artial pressure (preload) related
  153. increase tissure demand = increased cardiac output
  154. increase blood = increased atrial pressure and better ventricle filling time
  155. longer muscle fibers
    increased for and pumps more blood
  156. max cardiac output
    max heart rate and stroke volume
  157. min cardiac output
    • determined by tissues
    • blood volume needed for maintenance
    • 5 liters at rest
  158. Cardiac reserve
    • number of times heart increases output from resting level
    • max-min = ___/min = cardiac reserve
  159. heart failure
    • decrease in contractility
    • cardiac output drops below min
    • causes blood to back up in stria and increase atria pressure
    • increase sympathetic stimulation to strengthen heart muscle
    • heart recovers over time (5-7 wks)
  160. Kidney
    • cardiac output min not maintained the kidney retains water and NaCl to increase blood volume and increase atrail pressure
    • begins a few min after and lasts till pressure is normal
  161. pumping ability reduced to 40-50%
    • decrease from normal pumping ability
    • benefits better systemic filling = decrease resistance, increase in preload
    • cardiac output goes back to normal
  162. pumping ability reduced to 25-45%
    • fluid retention is detrimental
    • overstreching of heart leads to increased weakening
    • kidney cant regulate NaCl and water - fluid retention - edema (lung) - death
  163. heart repair
    • immediately
    • new collateral blood supply
    • nercrotic tissue = scar tissue
    • undamaged muscle tissue hypertorpy
    • 5-7 wk
    • muscles at fringe may be functional again
  164. cardiac reserve and different heart compensated heart failure
    • meets needs of tissue at expense of increased atrial pressure
    • little cardiac reserve left (increase preload causes no change in cardiac output (graph more horizontal)
    • heavy exercise usually causes immediate return of symptoms
  165. decompensated heart failure
    • heart to weak to supply kidney (return NaCl and water) excessively
    • causes blood volumes to increase beyond physiological limits - edema - overstreching - diliation of ventricles - death
    • sympathetic strengthening does not work also
  166. cardiac edema and ventricle dialtion cause
    • weaker heart
    • decrease output
    • weaker heart
  167. unilateral heart failure
    • left side more likely then causes right side failure
    • back up into pulmonary veins - increase pressure
    • need 10mmHg for gas exchange and is now to high
    • right pressure increases in pulmonary artery
    • pulmonary edema - elveolar edema
  168. high output edema
    • heart forced to pump more blood to tissues additional volume = heart failure
    • caused by - arterio-venous shunts, decrease reisitance to blood flow
    • 1. PDA
    • 2. ventricle septum defect
    • 3.tetroloy of Fallot
    • 4. low resistance to blood flow
  169. PDA
    • ductus arteriosus to bypass lung
    • blood flow : left ventricle - lung - left ventricle if does not leave after birth
    • heat has to pump increased volume - left ventricle gets larger
    • if large (PDA) peripheral tissue does not receive required blood
  170. ventricle septum defect
    • heart contracts part of left ventricle blood goes through septum into right ventricle
    • increase workload of left ventricle and causes enlargement
    • thickening and dilation of cardiac meuscle
    • rigth dilates muscle walls get thinner
  171. tetrology of fallot
    • 1. aorta connceted to both ventricles
    • 2. ventricle septum defct b/c of aortic valve
    • 3. stenotic pulmonary valve/artery, less space for this to develop b/c aorta in its place
    • 4. hypertorphy of right ventricle - b/c more pressure needed to pump blood to lung (stenosis of pulmonary)
  172. low resistance to blood flow
    • arterioles - regulates blood flow and depends on metabloism of tissue, increased tissue metabolism then arterioles dilate
    • controled by sympathetic of ANS
    • malfunction = dilation - to much blood to tissue
    • BERBERI - decrease Vit B b/c decrease in artery tone, heart has to pump more to maintain pressure
  173. BeriBeri
    • decrease in vit B (thiamine)
    • b/c decrease in arteriole tone
    • edema
    • wobbly and trembling
    • "walking like a sheep"
    • heart pumps volume to maintain pressure
    • low resistance blood flow
  174. high pressure heart failure
    • heart has to continuosly increase blood pressure = hypertorphy of muscle tissue (fibers grow in diameter)
    • pericardium can't expand much to muscle fibers expand into the heart
    • chamber gets smaller - thickness gets bigger
    • increase heart rate and pressure - decrease in blood volume
    • increase rate and increase pressure = increased workload = failure

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