Cardiopulm Quiz 1

Front 1

bucket handle movement of ribs

Back 1

lower ribs (6-9) - ribs move out laterally as they expand

Front 2

pump handle movement of ribs

Back 2

upper ribs (1-4) - move sternum anteriorly as they rotate

Front 3

main muscle of inspiration at rest

Back 3

diaphragm

Front 4

intercostals

Back 4

1. peristernals - primary movers of the ribcage (internal - stabilize ribs/anterior thorax)
2. perivertebral intercostals
3. lateral intercostals: primarily laterally bend

intercostals will help with inspiration or expiration depending on location

Front 5

scalenes

Back 5

attach to clavicle, and 1st and 2nd ribs; prime movers of inspiration, just don't initiate it

Front 6

inspiratory muscles during exercise or disease

Back 6

SCM, upper traps, pec major (inspir if hum above clav; expir when hum below clav), pec minor, subclav, levatores costarum, spinal extensors

Front 7

phonation (talking, singing, control of expiration)

Back 7

diaphragm works eccentrically

Front 8

prime movers of expiration

Back 8

there are none (no expiratory muscles active at rest)

Front 9

expiratory muscles during exercise or disease

Back 9

transverse abdominis, internal obliques, external obliques, rectus abdominis, spinal flexors, lats

Front 10

upper airway (order of anatomy)

Back 10

nose --> mouth --> pharynx --> larynx --> trachea

Front 11

breathing through nose vs mouth

Back 11

nose filters, humidifies, and warms the air...but can't take in as much volume

Front 12

air exchange begins at the

Back 12

respiratory bronchiole, alveoli, etc.

Front 13

ventilation

Back 13

movement of air

Front 14

respiration

Back 14

gas exchange

Front 15

mechanics of breathing

Back 15

1. elastic recoil force
2. thoracic spring force
3. respiratory muscle force

during the pause in the breathing cycle, the erf and tsf oppose each other and are usually in equilibrium...the rmf messes up the equilibrium

Front 16

elastic recoil force

Back 16

lungs are always stretched (even on exhale), so the lung tissue always wants to recoil and pull in..trying to make lungs smaller

Front 17

thoracic spring force

Back 17

trying to make thorax bowed out and bigger (esp in the A-P direction, not really in the lateral direction)

Front 18

respiratory muscle force

Back 18

stretches thorax, which makes elastic recoil force increase...thorax will then recoil more than it wants to

Front 19

respiratory end expiratory pressure (REEP)

Back 19

difference btwn elastic recoil force and thoracic spring force (pause after expiration...this is at rest!)

Front 20

tidal volume (TV)

Back 20

normal range at rest that you breathe in and out (do you have enough air to manage?)

Front 21

inspiratory reserve volume (IRV)

Back 21

extra amount that you can inhale, beyond TV (use IRV in exercise, yawn, cough, sneeze, etc)

Front 22

inspiratory capacity (IC)

Back 22

TOTAL amount you can inhale...tidal volume + inspiratory reserve volume

Front 23

expiratory reserve volume (ERV)

Back 23

amount you can exhale, lower than TV (during exercise, your abs become expiratory muscles almost immediately)

Front 24

vital capacity (VC)

Back 24

ERV + TV + IRV

Front 25

total lung capacity (TLC)

Back 25

IC (IRV and TV) + ERV + RV

(looking at this can tell you about a pathology)

Front 26

residual volume (RV)

Back 26

amount left in your lungs that you cannot expire

Front 27

functional residual capacity (FRC)

Back 27

amount of air left in your lungs after you breathe out your tidal volume...ERV + RV

Front 28

V/Q changes with positioning

Back 28

air will go where there is open space, but blood is gravity dependent (V/Q changes with disease)

Front 29

central controllers of breathing

Back 29

pons, medulla, other parts of the brain (send output signal to effectors)

when you're not thinking about you're breathing, you breathe with your pons and medulla...cortical control comes in during other types of VOLUNTARY control of breathing

Front 30

effectors of breathing

Back 30

the respiratory muscles

Front 31

sensors of breathing

Back 31

chemoreceptors, lung, and others (send input to brain/central controllers)

Front 32

mitral valve/bicuspid valve

Back 32

left A-V valve

Front 33

tricuspid valve

Back 33

right A-V valve

Front 34

blood flow through heart

Back 34

RA --> RV --> pulm artery --> lungs --> LA --> LV --> aorta

tricuspid valve btwn RA and RV
pulm valve before pulm artery
pulm vein from lungs to LA
mitral valve btwn LA and LV
aortic valve before aorta

Front 35

valves open/close during systole/diastole

Back 35

A-V valves open during diastole and close during systole; valves to veins close during diastole and open during systole

Front 36

layers of cardiac muscle

Back 36

endocardium --> myocardium --> epicardium (inside to out)

endocardium = innermost layer, tephlon lining, one-cell thick, epithelial cells
myocardium = muscle layer
epicardium = outermost layer; thin fibrous layer of protection, hard to penetrate

Front 37

cardiac muscle characteristics

Back 37

cardiac muscle: contractile and autorhythmic

syncytium (once muscle starts to fire, the whole thing fires..what happens in the left happens in the right..no other muscle in the body is a syncytium...for example, you can recruit just a few muscle fibers in elbow flexion instead of ALL of them at once)

only ONE pathway for signal to go from atria to ventricle

Front 38

normal HR

Back 38

60-100 bpm (normal sinus rhythm)

Front 39

cardiac automaticity (will continue to beat without brain...ability of heart to beat itself)

Back 39

the muscles in the heart need a certain voltage to fire:
-->SA node (in post right atrium 60-100bpm)
-->AV node (higher voltage, lower threshold...this is the first backup system) (40-60bpm...will never fire first)
-->ventricular muscle fibers (second backup system) (20-40bpm)

(ventr muscles not in conduction system of heart, muscle can be anywhere within muscle fibers)

Front 40

order of depolarization

Back 40

SA node --> AV node --> Bundle of His --> right and left bundle branches --> Purkinje fibers

Front 41

cardiac overtones

Back 41

vagal: the overtone your heart has at all times
parasympathetic: at rest
sympathetic: fight or flight

person with heart transplant, can't hook autonomic nervous system back up, so they lose their vagal overtone)

Front 42

alignment of atrial and ventricular fibers and how it affects their contraction

Back 42

atria: bellows/accordion (from outside in)
ventricle: fist (starts at apex and squishes up toward great vessel valves)

Front 43

conductivity of heart (specialized cells heart, impulse conduction speed, synctium)

Back 43

still muscle cells but act as nerve cells

conduction speed is very fast

Front 44

excitability (action potential, resting membrane potential, refractory period)

Back 44

resting membrane potential: SA node reaches threshold to fire sooner than AV node or ventricular muscle fibers (SA node threshold lower than the others)

refractory period: SA node has smaller refractory period than AV node

Front 45

P-wave of EKG

Back 45

atrial depolarization (doesn't mean it contracts, just electrical activity)

Front 46

QRS of EKG

Back 46

ventricular depolarization

Front 47

tiny pause btwn P and Q

Back 47

time it takes for impulse to go through fibrous band from one syncytium to the next

Front 48

obstructive disease

Back 48

have hard time getting air out of lungs --> lungs filled with air, can't get rid of it...breathe really high in their IRV...can't get air in bc their lungs are already so full

REEP moves up in obstructive disease; FRC will increase; VC decreases

Front 49

restrictive disease

Back 49

breathing near bottom of FRV...inability to expand lungs

REEP moves down in restrictive disease

Front 50

pneumectomy

Back 50

removal of air - in one area, not homogeneous. often done for people with severe obstructive disease

Front 51

FEV1

Back 51

amount of air you blow out in one second (forced expiratory volume in one sec)

varies with height so you must use percentages to ssee if they're healthy

(FEV1 / FVC) --> above 70% = non-obstructive
-->under 70% = obstructive disease

Front 52

dead space

Back 52

more air than perfusion; doesn't participate in perfusion (anatomical dead space is diff, we all have some sead space in our airways. this is physiological dead space)

Front 53

shunt

Back 53

blood goes by capillary but no air in alveoli

Front 54

breathing zones

Back 54

zone 1: ventilation is greater than perfusion in upper zone (least mobile)

zone 2: middle zone

zone 3: less ventilation and more perfusion in lower zone (most mobile/dynamic abililty)

(goes zone 1-2-3 VERTICALLY, no matter what position you're in...lungs work best when upright)

Front 55

cardiac or pulmonary system more likely to limit?

Back 55

so much extra air in lungs that they rarely limit the system...heart has more potential to limit

Front 56

which side of the heart is oxygenated and which is deoxygenated?

Back 56

right heart = deoxygenated

left heart = oxygenated

Front 57

which side of the heart works harder?

Back 57

left side has to work hard to get blood into the aorta, while right heart barely has to work against any pressure because the lungs are very accepting

Front 58

what happens in the arteries reflects what happens in the...

Back 58

VENTRICLES

(right atrium systole = 0-8mmHg and no diastole. right ventricle systole = about 30mmHg. left atrium is just a little higher than R atrium. L ventricle has very high pressure!)

Front 59

can heart atrophy?

Back 59

yes, the heart is a muscle. will atrophy without use and will hypertrophy with more use (exercise, disease)

lots of elite athletes have dies from cardiomyopathy - died from hypertrophied heart - at some point, it becomes TOO hypertrophied

Front 60

protection of heart

Back 60

fat deposits around heart (protection and warmth/insulation), lungs cushion it, and the bony thorax is the "armor" of the heart

Front 61

coronary arteries

Back 61

first dibs on CO...the coronary arteries are the first branch off the heart. (the last branch is the toes and skin...you can tell how important something is by when it gets its blood)

Front 62

which side of heart/coronary arteries usually have more problems?

Back 62

right heart usually doesn't have that many problems bc it doesn't have to work as hard, so right coronary artery doesn't cause as many problems (although it does supply the SA node). LEFT coronary artery disease is much more common - if you get disease in the "left main," you'll get disease in the whole left side of the heart.

(coronary artery disease - could require bypass surgery)

*left main is the worst, then LAD (left ascending?) ...number and location of problems in arteries will tell you the severity of the disease

Front 63

coronary arteries on left side of heart

Back 63

left anterior descending: supplies anterior wall of heart (very common to get heart disease here)

left circumflex: supplies backside of heart

left posterior descending: posterior and inferior wall

Front 64

flow of O2 and CO2

Back 64

inhale oxygen-rich air --> oxygen-rich blood from lungs to body --> exercising muscle uses oxygen....CO2 enriched/O2 deplete blood returns to the heart --> oxygen-poor air to lungs --> exhale CO2...inhale oxygen-rich air

Front 65

minute ventilation (VE)

Back 65

volume of air taken into lungs in one minute (can measure on inspiration or expiration..should be the same)

VE = respiratory rate x tidal volume

RR in breaths per minute
TV in ml/breath
VE in ml/min or L/min

Front 66

cardio output (Q)

Back 66

Q = HR x stroke volume

HR in bpm
SV in ml/beat
Q in volume/time

Front 67

oxygen consumption (VO2)

Back 67

VO2 is the volume of oxygen that the body can consume during aerobic exercise (to produce work)

oxygen consumption is linearly related to energy expenditure..indirectly shows an individual's capacity to work aerobically (more O2 in = more work you can perform)

given in mL O2/min or L O2/min

we can measure VO2 much better with the ventilatory system than the cardiac system

Front 68

a-v O2 difference

Back 68

arterial-venous difference: difference between O2 out and amount of O2 coming back unused

VO2 = a-v O2 diff x Q
VO2 = % change in O2 diff x VE

Front 69

relative oxygen consumption

Back 69

include body weight in the equation

usually applied to tasks that involve moving body through space (walking, biking, etc)

relatively speaking, you and someone much larger or smaller could be doing the same amount of work

in ml O2/kg-min

Front 70

absolute oxygen consumption

Back 70

how much oxygen is used to do a task...has nothing to do with body weight (usually talking about work where the body isn't part of the work, for example moving bricks)

a larger person does more work than a smaller person..uses more O2/min

L O2/min

Front 71

MET

Back 71

metabolic equivalence

1 MET = 3.5 ml O2/kg-min

1 MET = just lying down, doesn't require much energy

Front 72

RPP

Back 72

indicator of oxygen requirements of the heart..inferring how much O2 the HEART is bringing in to do work (whereas VO2 is how much the BODY is bringing in to do work)

rate pressure product = HR x systolic BP

-HR in bpm
-systolic BP is max pressure exerted on vessel walls by blood..the resistance that left ventricle is working against

Front 73

angina

Back 73

occurs when at a certain work load, the heart isn't getting enough O2 to do the required amount of work

Front 74

___ helps us predict when someone is going to have angina

Back 74

RPP

Front 75

premise for exercise

Back 75

lungs extract oxygen, heart pumps O2 around body (oxygen via blood delivery), then muscles use O2 to DO work

Front 76

relative distribution of blood flow at rest and during exercise

Back 76

brain - lots of O2 at rest, less during exercise

heart - same amount during rest and exercise, Q goes way up but % is the same

skin gets a lot of O2 during exercise bc of temperature control

Front 77

definitions of resting, submax, max, and peak

Back 77

resting: sitting/lying down

submax: self-selected work load that is held constant

max: can't predict it ahead of time = max amt of work body can do...HR plateaus through increased load

peak: most exercise you did at that session (can be same as max, but doesn't have to be)

Front 78

changes from rest to exercise (HR, SV, Q, coronary perfusion...RR, TV, VE, VO2)

Back 78

HR increases with increased work (linearly)

SV (how much blood is squished out with each beat) increases with work to a point, then starts to level off

Q increases with work (linearly)

coronary perfusion (extraction of O2 at coronary artery capillary system) increases with exercise. at rest, extraction is 70-75% (very efficient). but during exercise coronary dilation increases to up to 4x the resting size to bring more blood; flow increases; and pressure increases.

RR increases with exercise (tends to start increasing even when you think you're going to exercise). Could it go higher than RR at max? -->yes.

tidal volume (the amt of air brought in with each breath) increases with exercise (pushes into both IRV and ERV). could it be bigger? --> yes.

minute ventilation increases with exercise (heart maxes out before your lungs do..heart is the limiting factor. unless you have diseased lungs, then lungs MAY be the limiting factor.) can get up to ~118 L/min with heavy exercise.

VO2 increases with exercise linearly to a point, then plateaus. not using more O2 to do more work.

Front 79

changes associated with training (HR, SV, Q...RR, TV, VE, VO2)

Back 79

resting HR down, resting SV up, resting Q stays the same

submax HR down, submax SV up, submax Q stays the same

max HR stays the same (can do more work within same max HR). also, recovery post-exercise is faster after training.

SV increases with training.

Q may increase slightly after training bc of increased SV, but is relatively the same. (HR decreases and SV increases so it pretty much evens out.)

RR, TV, and VE: all pretty much stay the same during rest and submax because you don't work your ventilatory system hard enough to train it. HOWEVER, when you train, you can do more work within the given parameters, so these will all increase during max.

VO2 increases after training, and is even higher with endurance training. (should NOT see a change in VO2 relative bc you're testing at the submax level...but VO2 max WOULD have changed --> will be able to do more work)