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232 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
The heart is a muscular organ about the size of what?
A fist.
How many chambers does the heart have? What kind of pump is it?
Four-chambered double pump.
At rest, the heart of an adult pumps about _____ L/min of blood.
5.0L/min
How long does it take for blood to be circulated to the most distal extremities and back to the heart?
About ONE minute.
What are the four chambers of the heart called? What two categories are they put into and where are they located?
Atria - Two Upper chambers, sometimes called auricles

Ventricles - Two Lower chambers

1. Right/Left Atrium
2. Right/Left Ventricle
The right atrioventricular (AV) valve is also known as the ______ valve.
Tricuspid valve
The left atrioventricular (AV) valve is also known as the ______ valve.
Mitral valve
What are the four heart valves and where are they located?
1. Pulmonary Valve (Right)
2. Right AV Valve (Tricuspid)
3. Aortic Valve (Left)
4. Left AV Valve (Mitral)

Located between the atria and the ventricles.
The pulmonary valve and the aortic valve are also called the __________ valves because they have 3 cusps which resemble half moons.
Semilunar
What happens to the valve when the pressure is greater behind it?
It opens
What happens when the pressure is greater in front of the valve?
It closes.
Heart valves are considered to be ____-way valves.
One
The heart wall is separated into what three layers? Describe the characteristics of each layer.
1. Endocardium - a thin layer of endothelium
2. Myocardium - muscle layer (cardiac muscle)
3. Epicardium - thin external layer
What is the contraction of the heart muscle stimulated by?
Electrical impulses.
When a specialized system of nodal tissue generates and conducts impulses through the heart, what happens?
Rhythmic contractions of the myocardium.
In the cardiac conduction system, there are four structural and functional portions. What are they? (*Hint - Backup pacemakers in order...)
1. Sinoatrial node (SA Node/Pacemaker)
2. Atrioventricular node (AV node)
3. Atrioventricular bundle (AV bundle or bundle of HIS)
4. Purkinje fibers
True or false. When an impulse is created at the top of the heart, it does NOT travel throughout the entire heart.
False.

Impulses DO travel throughout the entire heart.
What are the characteristics of the Sinoatrial node (SA node)? Where is it located and what is the other name for it?
'Pacemaker'

Located within the posterior wall of the right atrium. Near opening of superior vena cava.

Contracts quicker.

Cells here depolarize quicker than any other cell in heart.

Rhythmical impulses originate in the SA node and spread through atria.
What are the characteristics of the Atrioventricular node (AV node)? Where is it located?
Located within the lower right interatrial septum.

Impulse is delayed in the AV node for 1/10 sec to allow atria contraction BEFORE ventricular contraction.
What are the characteristics of the Atrioventricular bundle (AV bundle or bundle of HIS)? Where is it located?
Originates in the AV node and divides into "two bundle branches" which then extend down the two sides of the interventricular septum.
What are the characteristics of the Purkinje fibers. Where are they located?
Originate from the right and left branches, extending to the papillary muscles and lateral walls of the ventricles.
True or False. When atria muscles contract, they contract with an impulse.
True.

Atria muscles DO contract with an impulse.
What is the purpose of Nodal tissue in regards to the conduction system?
Generates and rapidly conducts impulses through the heart.

These impulses initiate the rhythmical atrial and ventricular contractions.
How does an electrocardiogram (EKG) operate?
Monitors impulses that initiate rhythmical and ventricular contractions throughout the heart.
Impulses start in the ________ node and spread over the _______ muscle fibers producing _______ contraction.
1. SA node
2. atrial
3. atrial
After an impulse is started in the ____ node. It reaches the ____ node. The impulse then travels through the ____ _______ and ________ __________. This produces coordinated ___________ contraction.
1. SA node
2. AV node
3. AV bundle
4. Purkinje fibers
5. ventricular
Control of the conduction in the heart is an _________ system.

*(Intrinsic or Extrinsic)
Intrinsic
True or False. An EKG records electrical impulse and spread.
True.

An EKG records electrical impulses and spread, not electrical speed or contractions.
What are some of the many factors which may alter the heartbeat rate?
1. Sympathetic impulses
2. Parasympathetic impulses
3. Hormones
4. Body temperature
5. Exercise
6. Emotion
In the cardiac cycle, there are two main functions (*blood pressure). What are they referred to as, and what are their functions?
1. Systole
Phase of Contraction
Emptying of the atria and
ventricles
2. Diastole
Phase of Relaxation
Filling of the atria and
ventricles.
From the two main functions, the cardiac cycle has a total of four processes. What are they? What is their order?
1. Mid-diastole
2. Atrial systole
3. Ventricular systole
4. Early diastole
During the 'Mid-diastole' process. The _______ and _______ are _______.

The _______ and _______ valves are _____, the ______ and _______ valves are ______.
1. atria
2. ventricles
3. relaxed
4. tricuspid
5. mitral
6. open
7. aortic
8. pulmonary
9. closed
Before the end of the 'Mid-diastole' phase, __to__% of ventricular filling occurs.
65 to 85%
In 'Mid-diastole' the blood flows from the atria to the ventricles, it flows ________?

(*Actively or passively)
Passively.
During the 'Atrial systole' process. The ________ contract and pump the additional __to__% of the blood into the _________. As the _____ contract, the orifices of the ______ ______ and _________ veins narrow; however, there is some regurgitation of blood into the ______.
1. atria
2. 20 to 35%
3. ventricles
4. atria
5. venae cavae
6. pulmonary
7. veins
Which valves are closed during isovolumetric contraction?
All four valves are closed
What is considered to be an average PULSE PRESSURE?
40-50 mm Hg
Name 10 factors that increase heart rate
Excitement
Anger
Painfil stimuli
Hypoxia
Exercise
Epinephrine
Norepinephrine
Thyroid hormones
Fever
Inspiration
What is bradycardia and what are some factors that cause it?
Bradycardia is a decrease in heart rate to less than 60 beats/minute.
It can be caused by expiration, fear (?), and grief
Nerves affect cardiac pumping in two ways: chronotropic and inotropic. What does each of those alter?
Chronotropic- changes the heart rate
Inotropic- changes the strength of contraction
What is the average heart rate in the S.A node?
72-75 beats/minute
What is the heart rate in the A.V node?
50-60 beats/minute
What is the heart rate in the ventricles?
30-40 beats/minute
What is the maximum sympathetic stimulation in the heart?
250 beats/minute
One catecholamine has a significant impact on the permeability of cardiac cells to Na+ and Ca++. Which is it and what is it's influence?
Norepinephrine; increases the permeability
What is the overall impact of sympathetic control on the cardiac system?
It increases the rate and force of contraction
What is the overall impact of parasympathetic control on the cardiac system?
It decreases the rate and force of contraction
Under parasympathetic control, what is the maximum stimulation?
20-30 beats/minute (Bradycardia)
Which catecholomine increases the permeability (when under parasympathetic control) of K+?
Acetylcholine
What does the term inotropic refer to?
The strength or force of contraction
Name four factors that have a positive inotropic effect on the heart?
Frank Starling's Law of the heart
Catecholamines- epinephrine or norephinephrine, isoproterenol
Xanthines- caffeine, theophylline
Digitalis- drug used for cardiac failure
What does the term chronotropic refer to?
The rate of contraction (how fast the heart beats)
What does the term dromotropic refer to?
The rate of conduction of impulse through the specialized conduction system
What is stroke volume?
The amount of blood pumped out of each ventricle per beat (about 60 to 80 ml)
What is the equation that renders cardiac output?
Stroke volume x heart rate = cardiac output
What are five factors that cause an increase in CO (Cardiac Output)?
Anxiety
Eating
Exercise
Increased body temperature
Pregnancy
What is the Fick Principle?
CO (Cardiac Output) = oxygen consumption ml/minute
arterial O2 - venous O2
What are 5 causes of abnormal cardiac rhythms?
Abnormal rhythms in the SA node
Shift of pacemaker activity from SA node
Blockage of impulses
Bradycardium
Tachycadia
What is tachycardia?
An accelerated heart rate of over 100 beats/minute
Why is the QRS a greater event than the P or T wave?
Because the ventricles have more cells than the atria
At rest is the heart more positive or negative? What about when it is firing?
At rest: heart is more +
When firing: heart is more -
What is the normal heart rate?
60-100 beats/minute
What is 'Frank Starling's law of the heart'?
Greater the filling during 'diastole', the greater the force of contraction during 'systole'.
How do Xanthines interact with the heart, and what are two types of drugs in this category?
Positive effect on strength/force of contraction.

1. Caffeine
2. Theophylline
What is dromotropic and how does it effect the heart?
Rate of conduction of impulse.

(+) or (-) effect on heart.
There are two ways that nerve can affect the cardiac pumping. What are they?
1. Heart Rate - Chronotropic
2. Strength of Contraction - Inotropic
Rate and Strength
The cardiac membrane in the heart is a little more permeable to ________.
Sodium (Na)
Under parasympathetic control, acetylcholine does what?
Increases the permeability of the membrane to K+ (Potassium)
Under sympathetic control, norepinephrine does what to cardiac cells?
Increases the permeability of the cardiac cells to Na+ and Ca2+
For an athlete, what is the average heart rate and stroke volume? Cardiac output?
45 bpm
120ml/beat
5.4L/minute
For an asthenic person, what is the average heart rate and stroke volume? Cardiac output?
100 bpm
55ml/beat
5.5L/minute
What are the factors that can cause an increased Cardiac Output (CO)?
Anxiety
Eating
Exercise
Increased Body Temperature
Pregnancy
What is the Fick Principle and how does it work?
Measurement of the Cardiac Output

Amount of substance taken up by an organ/whole body per unit of time = arterial level of substance minus venous level of substance (A-V difference) x blood flow.
On an EKG, the first wave is called the ___ wave and is associated with ___________ in the _____.
1. P wave
2. DE-polarization
3. atria
On an EKG, the second wave is called the ___ wave (complex) and is associated with ___________ of the __________.
1. QRS complex
2. DE-polarization
3. ventricles
On an EKG, the third wave is called the ___ wave and is associated with ___________ of the __________.
1. T wave
2. RE-polorazation
3. ventricles
The repolarization is not monitored in the 'QRS' wave on an EKG. Why?
It is too small of an electrical event to show up.
An impulse moving in the heart from a negative (-) to a positive (+) lead shows up as a __________ spike on an EKG.
POSITIVE
What are the potential differences of the depolarization and repolarization in the heart recorded from?
Myocardium tissue
What is the formation and electrode connectivity in 'Einthoven's Triangle'?
Left Shoulder
Right Shoulder
Left Leg
There are 12 different leads that can be used to record EKG's. What are the different categories?
3 Standard Limb Leads
3 Augmented Limb Leads
6 Chest Leads
In 'Lead I' where are the positive and negative leads located?
NEGATIVE = Right Arm
POSITIVE = Left Arm
In 'Lead II' where are the positive and negative leads located?
NEGATIVE = Right Arm
POSITIVE = Left Leg
In 'Lead III' where are the positive and negative leads located?
NEGATIVE = Left Arm
POSITIVE = Left Leg
In 'Lead I'
'P' wave is ____________.
'QRS' peak is __________.
'T' wave is ____________.
P = POSITIVE
QRS = POSITIVE
T = POSITIVE
In 'Lead II'
'P' wave is ____________.
'QRS' peak is __________.
'T' wave is ____________.
P = POSITIVE
QRS = POSITIVE
T = POSITIVE
In 'Lead III'
'P' wave is ___________.
'QRS' peak is _________.
'T' wave is ___________.
P = POSITIVE (*Not seen well)
QRS = POSITIVE
T = POSITIVE
In 'Lead aVR' where are the positive and negative leads located?
NEGATIVE = Left Arm
NEGATIVE = Left Leg
POSITIVE = Right Arm
In 'Lead aVL' where are the positive and negative leads located?
NEGATIVE = Right Arm
NEGATIVE = Left Leg
POSITIVE = Left Arm
In 'Lead aVF' where are the positive and negative leads located?
NEGATIVE = Right Arm
NEGATIVE = Left Arm
POSITIVE = Left Leg
In 'Lead aVR'
'P' wave is ________.
'QRS' peak is ______.
'T' wave is ________.
P = NEGATIVE
QRS = NEGATIVE
T = NEGATIVE
In 'Lead aVL'
'P' wave is _______.
'QRS' peak is ________.
'T' wave is __________.
P = POSITIVE
QRS = NEGATIVE
T = POSITIVE
In 'Lead aVF'
'P' wave is _______.
'QRS' peak is _____.
'T' wave is _______.
P = POSITIVE
QRS = POSITIVE
T = POSITIVE
Which of the 6 chest leads are mainly negative and which are mainly positive?
V1 - V3 = Mainly Negative

V4 - V6 = Mainly Positive
Deviations from a normal heart rate or from normal electrical activity are referred to as _________.
Cardiac arrhythmia.
Cardiac arrhythmia can results from what three things?
1. Abnormal rhythmicity in the SA node.

2. Ectopic Pacemaker (Ex. shift from SA node to another part of heart)

3. Abnormal pathway or blockage of impulses in conduction system.
What is ischemia defined as?
Lack/Restriction of bloodflow.
What are some of the major factors of ectopic pacemakers? (There are 8 of them)
1. Localized ischemia
2. Localized heart damage
3. Dilation of heart
4. Toxic irritants (nicotine, caffeine, alcohol)
5. Lack of sleep
6. Anxiety
7. Extremes in body temperature
8. Change in body pH
During an 'Atrial Premature Beat', what happens?
1. Premature depolarization of SA node / ectopic pacemaker
2. Some P waves are normal / some are abnormal
3. LITTLE clinical significance.

May precede a flutter or fibrillation
During an 'AV Nodal Premature Beat', what happens?
1. From ectopic discharge of AV node then proceeds down the Bundle of HIS
2. Normal QRS complex

3. Not proceeded by a P wave
During a 'Premature Ventricular Depolarization' (PVD or PVC), what happens?
1. From ectopic pacemaker in the ventricles
2. No P Wave
3. Wide QRS Complex
4. High Voltage
5. T wave is usually inverted
6. Usually a pause post-PVD
7. May become coupled w/ one or more normal beats.
What is the definition of a 'Bigeminy'?
One normal beat and one PVD beat.
What is the definition of a 'Trigeminy'?
Two normal beats and one PVD beat.
Why is the 'QRS' complex bigger in a Premature Ventricular Depolarization (PVD or PVC)?
Because the impulse has to travel through intercalated discs and takes longer.
Throwing a 'Premature Ventricular Depolarization' (PVD or PVC) may be dangerous when one of three things occur. What are the three things?
1. More than 6-7/min
2. Occur in pairs or triplets
3. Occur early in cycle (during the T wave)
During a 'SA Block,' what happens?
1. Pacemaker temporarily stops for at LEAST one complete cycle.
2. P waves before and after block are identical
During a 'First Degree - Incomplete' 'AV Block', what happens?
First Degree - Incomplete

1. Prolonged PR interval (0.2-0.3 sec)
2. Can be caused by digitalis or vagal stimulation
During a 'Second Degree - Incomplete' Mobitz Type 1 'AV Block', what happens? What is another name for this arrhythmia?
1. PR intervals lengthen progressively until a ventricle beat is dropped (6 or 8)
2. Can be caused by digitalis
During a 'Type 2' or 'Mobitz's Type 2 AV Block' arrhythmia, what happens?
1. Present when it takes 2+ atrial impulses to stimulate ventricles
2. Usually 2:1, 3:1 or 4:1
3. May be caused by myocardial infarction or myocarditis
4. May lead to 3rd degree block
During a 'Third Degree' or 'Complete AV Block', what happens?
1. Occurs when NONE of atrial impulses stimulate AV node.
2. Ventricles are paced independently from the atria
3. Ventricular rate is slower than atrial rate of contraction

No impulses from atria make it down.
During an 'Atrial Flutter', what happens?
1. Originates in an atrial pacemaker
2. P waves very rapid/coordinated (Look simliar to each other)
3. 2:1, 3:1, 4:1
4. Treatment = Digitalis
During an 'Atrial Fibrillation', what happens?
1. Caused by many ectopic pacemakers in atria
2. Uncoordinated or irregular P waves
3. Decrease in cardiac output
4. QRS-T usually look normal
True or False:

During an 'Atrial Fibrillation', multiple ectopic pacemakers ARE usually firing at the same time.
FALSE

Multiple ectopic pacemakers are NOT usually firing at the same time.
True or False:

During an 'Atrial Fibrillation', you should be able to count the spikes on the EKG between the QRS complexes.
TRUE

You should be able to count the 'squibble marks'. (Ventricular Fibrillation you won't be able to.)
During a 'Ventricular Flutter', what happens?
1. Caused by a single ectopic pacemaker in ventricles
2. Has smooth sine wave appearance
3. Very Fast = Very Dangerous
4. Abnormal heart filling = Decreased cardiac output
5. Often leads to fibrillation
6. Decreased coronary flow
True or False:

Ventricular Flutter is usually caused by a single ectopic pacemaker.
TRUE

Only a single ectopic pacemaker.
During a 'Ventricular Fibrillation', what happens?
1. Caused by many ventricular ectopic pacemakers
2. Uncoordinated, chaotic twitching, bag of worms
3. Blood pressure drops
4. Unless stopped death will occur in a short time
What is the technical term used for 'Heat Attack'?
Myocardial Infarction
During a 'Myocardial Infarction', what happens?
1. Caused by lack of blood flow to an area of the heart
2. Caused by thrombus formation w/ blockage of vessels
3. May be caused by spasms in coronary arteries w/out total occlusion
4. Narrowing caused by atherosclerosis
5. Area becomes electrically dead
What are the effects of 'Nitroglycerin' on the heart?
1. Causes vasodilation of smooth muscle
2. Blood flow to heart increases
3. Blood pressure decreases
What are the three phases that are also referred to as the 'Classical Triad'?
1. Ischemia
2. Injury
3. Infarction
What is the ischemia phase? What does it show up?
Characterized by a symmetrical inversion of the T wave

Most pronounced in the chest leads

Cause by a delay in the recovery at the epicardial regions

Altered repolarization

(1st PHASE)
What is the injury phase? When does it show up?
ST elevation = infarction is fresh (acute)

Tissue damage starts to occur

(2nd PHASE)
What is the 'infarction' phase? When does it occur?
Significant Q wave - much wider than normal

Q may be 1/3 of the height of the QRS

May last for many years after the infarction

Some drugs can cause effects similar to this significant Q

(3rd PHASE)
If someone has an EKG with a 'Significant Q Wave' that is much wider than normal. What can be assumed?
That the person has had a previous heart attack in their life.
During a myocardial infarction (heart attack), there are 7 things that may occur. What are they?
1. Pain (radiates from neck, jaw, back, shoulder, and left arm)
2. Nausea and vomiting
3. Catecholamines are released
4. Blood sugar usually increases
5. Cardiac troponins (I and T found in the blood)
6. Enzymes (Creatine kinase / lactic dehydrogenase)
7. Troponin/Creatine kinase amounts correlated w/ severity of infarction
During a myocardial infarction (heart attack), there are several options for treatment. What are the 5?
1. Aspirin
2. Heparin
3. Sublingual nitroglycerine
4. Morphine sulfate
5. Oxygen administration
What are the two factors that determine the blood flow through a vessel?
Pressure / Resistance
What is the normal pressure of the heart? Where is it usually measured?
1. 120/80 mm Hg
2. Arteries
Blood flows from an area of ____ pressure to an area of ____ pressure.
1. High
2. Low
The pressure in the right atrium is nearly what?
Zero
Blood flow is driven by pressure, but impeded by ________.
Resistance
Resistance in a blood vessel proportional to two things. What are they?
Length of the blood vessel AND viscosity of the blood
Resistance is INVERSELY proportional to the ____ power of the vessel.
4th (Ln/r^4)
The equation for resistance is (L)(n)/r^4. What two factors usually do not change?
L = Length
n = viscosity
The equation for resistance is Ln/r^4. What factor can change?

How does it change and mainly where are these changes made?
r = radius

Vasoconstriction / Vasodilation (mainly in the arterioles).
With a constant pressure of 100 mm Hg, what would the blood flow be in blood vessels with the following diameter?

1. d=1
2. d=2
3. d=4
1. d=1 (1 ml/min)
2. d=2 (16 ml/min)
3. d=4 (256 ml/min)
What is laminar flow?
The velocity flow is greater at the center of the vessel than along the outer edges.
The diameter of blood vessels is mainly regulated by the ____________ nervous system.
1. Autonomic

*However there are other factors that can also influence vascular diameter.
There are 2 types of NERVES that affect vascular diameter.

What are they and how do they affect vascular diameter?
Sympathetic:
1. Alpha-adrenergic = (Vasoconstriction)

2. Beta-adrenergic = (Vasodilation)

3. Cholinergic = (Vasodilation)

Parasympathetic nerves = (Vasodilation)
There are 3 HORMONES that affect vascular diameter.

What are they and how do they affect vascular diameter?
1. Angiotensin II = (Vasoconstriction)

2. ADH (Vasopressin) = (Vasoconstriction)

3. Histamine = (Vasodilation)
Circulation is divided into two parts.

1. (Not involving lungs)
2. (Involving lungs)

What are they?
1. Systemic (All parts except lungs)

2. Pulmonary (Lungs)
Systemic circulation is responsible for __% of the blood volume?
79% of the blood volume
Pulmonary circulation is responsible for __% of the blood volume?
12% of the blood volume
In systemic circulation, there are three areas in the body that make up 79% of the total blood volume being circulated.

What are the areas and what percentage do they make up?
1. Arteries (15%)
2. Capillaries (5%)
3. Veins (59%)
What percentage of total blood volume is occupied by the heart during diastole?

**Blood volume % depends on cardiac phase
9% = Heart
What is the average pressure of the 'large arteries' when it enters and then when it leaves?
100 - 95 mm Hg
What is the average pressure of the 'small arteries' when it enters and when it leaves?
95 - 85 mm Hg
What is the average pressure of the 'capillaries' when it enters enters and then when it leaves?
30 - 10 mm Hg
What is the average pressure of the 'arterioles' when blood enters and when it leaves?
85 - 30 mm Hg

*This is the most important in regulation of blood pressure
What is the average pressure of the 'veins' when blood enters to when it leaves?
10 - 0 mm Hg
What is the most important blood vessel in regulation of blood pressure? (Constricting / Dilating)
Arterioles
What is the function of precapillary sphincters?
Regulate blood flow to capillaries.

Provide intrinsic, loclized regulation of blood flow in capillary beds.
Precapillary sphincters have mechanisms that help regulate blood flow in relation to the local tissues' need for oxygen.

What is this ability called?
Autoregulation
Water flow across the capillary wall is due to two factors. What are the two factors?
1. Capillary Hydrostatic Pressure (CP)

2. Osmotic Force (OF)
The ability for water to diffuse 'IN' to the vessel is usually caused by what? This ability is also helped by what protein?
Osmotic Force (OF)

Protein = Albumin
The ability for water to diffuse 'OUT' to the vessel is caused by what?
Capillary Hydrostatic Pressure (CP)
What is the smallest protein that also helps in water regulation in blood vessels?
Albumin
True or False:

Osmotic Force (OF) generally changes, but Capillary Pressure (CP) remains the same.
FALSE

Osmotic Force (OF) stays the SAME.

Capillary Pressure (CP) is DIFFERENT.
The 'constant' pressure of Osmotic Force (OF) is usually ____ mm Hg. (*In the Left A/V Valve)
23 mm Hg
What is the equation for determining both the 'Net Filtration Results' (OUTPUT) and the 'Net Absorption Results' (INPUT)?
1. Net Filtration Results = Capillary Pressure (-) Osmotic Force

2. Net Absorption Results = Osmotic Force (-) Capillary Pressure
What is 'Edema'?
The presence of excess interstitial fluid in the tissues.
There are 3 main causes of edema. What are they?
1. Increased capillary hydrostatic pressure

2. Decreased plasma protein (mainly albumin)

3. Increased interstitial fluid protein
One of the causes of 'Edema' is 'increased capillary hydrostatic pressure'.

What is this caused by (3 things)?
1. Venous Obstruction
2. Cardiac Failure
3. Retention of body salt and fluid
One of the causes of 'Edema' is 'decreased plasma proteins (mainly albumin)'.

What causes this to occur (3 things)?
1. Kidney damage resulting in loss of plasma proteins
2. Liver damage - decreased production of plasma proteins
3. Malnutrition - not enough protein in the diet
One of the causes of 'Edema' is 'increased interstitial fluid protein'.

What causes this to occur (2 things)?
1. Increased capillary permeability - inflammation
2. Decreased lymphatic flow
Increased interstitial fluid proteins in the body can cause what to happen?
Edema

More specifically, 'Pneumonia'
What are the 3 factors that can change blood pressure (short term)?
1. Cardiac Output
2. Peripheral Resistance
3. Total Blood Volume
Long term regulation of blood pressure is controlled by what?
Hormones
Alcohol acts as a(n) ___________?

(Diuretic/Antidiuretic)
Diuretic

Alcohol inhibits ADH release
Increases urine production
Increased urine production aids dumping of alcohol from body.
How long does it take the nervous system to regulate blood pressure?
Seconds
What organ(s) monitor blood pressure?
Kidneys
Where is angiotensinogen made?
Liver
The converting enzyme for Angiotensin is stored in what organ?
Lungs
The Renin-Angiontensin System regulates blood pressure in 3 ways. What are the 3 ways?
1. Aldosterone Secretion
2. Increase ADH Release
3. Vasoconstriction of arterioles
What is Primary Aldosteronism (Conn's Syndrome)?
Hypersecretion of aldosterone from the adrenal cortex. Leads to:

Hypertension
Increased extracellular fluid volume
Hypernatremia
Potassium Depletion
What is the major etiologic factor in primary aldosteronism (Conn's Syndrome)? (*Reason why most people have this)
Adrenal adenoma (90% of patients)
What do ACE inhibitors do?
Block the converting enzyme from binding to Angiotensin I so that no Angiotensin II is created.
What are the two major control mechanisms in regulating blood pressure (short term) via the nervous system?
1. Baroreceptors
2. Chemoreceptors
Receptors
In the medulla, there are two centers that help regulate blood pressure (short term) via sympathetic/parasympathetic responses. What are the two centers?
Cardioinhibitory Center (Parasympathetic)
B.P. (Decreases)
H.R. (Decreases)
C.O. (Decreases)
Vasodilation (INCREASES)

Vasomotor Center (Sympathetic)
B.P. (Increases)
H.R. (Increases)
C.O. (Increases)
Vasoconstriction (Increases)
Baroreceptors are found in 5 locations near the heart. What are the 5 locations?
1. Aortic Arch
2. Pulmonary Veins
3. Right/Left Atria
4. Superior/Inferior Vena Cava
5. Carotid Sinus
Where are chemoreceptors found (2 locations) and how are they stimulated?
1. Aortic Bodies
2. Carotid Bodies

Stimulated by DECREASED levels of oxygen and INCREASED levels of CO2 and H+ in blood.
When does circulatory shock occur?
When there is an inadequate bloodflow and/or oxygen delivered to the tissues.
There are 4 types of circulatory shock. What are they?
1. Hypovolemic shock
2. Anaphylactic shock
3. Neurogenic shock
4. Cardiogenic shock
What are the characteristics of 'Hypovolemic shock'?
Reduced blood volume
Caused by hemorrhage/dehydration/ or loss of fluid from burns

Symptoms:

Low B.P.
Rapid Pulse
Cold
Clammy Skin
Little Urine Formation
Increased Respiration Rate
Intense Thirst
What are the characteristics of 'Anaphylactic shock'?
Rapid drop in B.P.
Result from severe allergic reaction
Histamine causes vasodilation and thus a drop in B.P.
What are the characteristics of 'Neurogenic shock'?
Spinal cord damage causes decreased sympathetic activity.
What are the characteristics of 'Cardiogenic shock'?
Inadequate circulation of blood in body tissues due to cardiac failure.
As a result from circulatory shock. The body tries to compensate the 'LOW BLOOD PRESSURE' in 10 different ways. What are they?
1. Vasoconstriction (Minus vessels of brain/heart)
2. Venoconstriction (Extra blood stored in veins)
3. Increased Heart Rate
4. Increased Respiration
5. Increased Thrist
6. Secretion of Epi/Norepi
7. Secretion of ADH
8. Activation of Renin-Angiotensin System
9. Contraction of spleen (Extra RBCs stored here)
10. Increased Hematopoiesis
When the body compensates for 'low blood pressure' after circulatory shock. How long does it usually take for plasma volume to be restored?
Matter of hours
When the body compenstates for 'low blood pressure' after circulatory shock. How long does it usually take for 'plasma proteins' to be restored? Through what synthesis are they restored?
1. Several days
2. Through Hepatic Synthesis
When the body compensates for 'low blood pressure' after circulatory shock. How long does it usually take to restore RBCs (Red Blood Cells)?
3-4 Weeks
When the cardiac output is insufficient to maintain the blood flow required by the body, what happens?
Cardiac Failure
There are generally 3 causes of congestive heart failure. What are they?
1. Myocardial Infarction
2. Congenital Defects
3. Hypertension after infarction
There are 3 common causes of left pump failure. What are they?
1. Myocardial infarction
2. Aortic valve stenosis
3. Incompetence of Aortic/Bicuspid (Mitral Valve)
Failure of the right pump is usually caused by prior failure to the ______ ______.
Left Pump
What happens to the heart when electrolyte concentrations of the blood have high K+ and low Ca++ values? When does this occur?
Cardiac Arrest (Heart Stops)

Diastole
What happens to the heart when electrolyte concentration of the blood have low K+ and high Ca++ values? When does this occur?
Cardiac Arrest (Heart Stops)

Systole
Hypertension occurs in about __% (1 out of every ___ persons)
1. 20%
2. 1 out of every 5 persons
Hypertension causes __% of all deaths.
12%
How does hypertension cause death?
Rupturing vessel in vital organ
Causing Heart/Kidneys to fail
What are the two types of hypertension?
1. Primary (Essential)
2. Secondary
What is the most common type of hypertension?
Primary (Essential)
What systolic/diastolic values are considered to be 'HYPERTENSIVE'?
140/90 mm Hg
What systolic/diastolic values are considered to be 'HYPOTENSIVE'?
100/60 mm Hg
What are some of the characteristics/factors of primary (essential) hypertension? There are 10.
1. No cause
2. 85-90% of all hypertensive patients
3. Rare in persons younger than 20
4. Occurs 25-50 years of age
5. Females more than males
6. Hereditary factors involved
7. High in blacks than whites
8. High salt intake
9. Psycho emotional stress
What are some reasons for essential (primary) hypertension?
Increased sensitivity to epi/norepi

Left ventricular hypertrophy causing enlarged heart and oxygen requirement increases. Heart may outgrow its blood supply.
What is the definition of secondary hypertension?
Results from clearly DEFINABLE causes. (Structural/Phsyiological)
What percentage of the high blood pressure population has secondary hypertension?
10-15%
What mechanisms of secondary hypertension are involved in 'Renal Artery Disease'? What system is involved?
Kidneys

Decreased urine formation
Secretion of vasoactive chemicals
What examples of secondary hypertension are involved with the endocrine system?
1. Conn's Syndrome
2. Adrenal Medulla Tumor
What are the results of having a tumor on the adrenal medulla and blood pressure?
Increased Blood Pressure

Excess Catecholamines created

Increased cardiac output and total peripheral resistance
What are some of the symptoms of essential hypertension? (There are 8 of them)
1. Headache (most common)
2. Dizziness
3. Fatigue
4. Blurring of vision
5. Polyuria (Increased urine output)
6. Polydipsia (Increased fluid intake)
7. Muscle Weakness
8. Hypokalemia (Low K+ in blood)
What are some dangers of hypertension? (There are 4 of them)
1. Future congestive heart failure
2. Cerebral blood vessel damage
3. Stroke
4. Development of atherosclerosis (chronic inflammation of arteries)
There are 6 general treatment methods for hypertension. What are they?
1. Regular physical exercise
2. Weight loss
3. Low refined carbohydrate diet
4. Cessation of smoking
5. Restriction of salt intake
6. Reduce psycho-emotional stress
What causes the first heart sound, "lub"?
The two AV (tricuspid and meitral) valves closing in ventricular systole
What is the diastolic pressure in the pulmonary artery?
10 mm Hg
What is the diastolic pressure in the aorta?
80 mm Hg
After Ventricular Systole, and under normal resting conditions, the pressure reaches ___ mm Hg on the right side and ____ mm Hg on the left side.
1. 24 mm Hg
2. 120 mm Hg
How much blood remains in either ventricle at the end of ventricular systole?
50 ml- the end systolic volume
True or false: The valves make the "lub" "dub" heart sounds.
FALSE! The turbulence of the moving blood makes the noise, not the valves.
When does the second heart sound "dub" take place and what makes the noise?
During early diastole, when the semilunar (pulmonary and aortic) valves close.
What is the correct order of cardiac impulse conduction?
SA node, Atrium AV node, bundle of HIS, purkinje fibers, ventricle
What percent of ventricle filling takes place during MID-DIASTOLE?
65-80%
What causes the 'lub' heart sound?
Closure of the TWO AV valves
What pressure is reached int he right ventricle under normal conditions?
24 mm Hg
Chronotropic refers to what?
RATE of heart contraction
Cardiac output is measured by what TWO factors?
Stroke Volume x Heart Rate
True or False

A shift of the pacemaker function from the SA node to another part of the heart is called an 'ECTOPIC' pacemaker.
TRUE

Ectopic = ABNORMAL
Any pacemaker not started from the SA node is 'ectopic'
Histamine causes what to occur?
VASODILATION
Precapillary sphincters regulate blood flow in relation to what?
Local tissues need for oxygen
Stimulation of the 'VASOMOTOR CENTER' results in what?
DECREASED heart rate