Xx - Cv Physiology Ii

Front 1

What is the contractile unit of a cardiac myocyte called?

Back 1

Sarcomere

Front 2

What are the borders of the Sarcomere?

Back 2

Z-line to Z-line

Front 3

Sarcomeres contain what Thick filament(s)?

Sarcomeres contain what Thin filament(s)?

Back 3

Myosin

Actin
Troponin
Tropomyosin

Front 4

Intercalated discs are found where?

Back 4

at the ends of sarcomeres

Front 5

Intercalated discs have what function?

Back 5

cell to cell Cohesion

Front 6

Intercalated discs house what important structure?

Back 6

Gap junctions

Front 7

What unique property of Gap Junctions allow for rapid AP spread?

Back 7

Path of lowest resistance

Front 8

Gap junctions account for what cardiac electrical activity?

Back 8

Electrical Syncytium

Front 9

T-tubules are continuous with?

T-tubules invaginate cells at?

Back 9

Cardiocyte membrane

Z-lines

Front 10

T-tubules have what important function?

Back 10

Carries AP into cells

Front 11

T-tubules are well developed where?

T-tubules are poorly developed where?

Back 11

Ventricles

Atria

Front 12

What structures form a DYAD?

Back 12

(STD)

SR + T-tubule = Dyad

Front 13

What organelle is the site of Calcium storage and release?

Back 13

Sarcoplasmic Reticulum

Front 14

What important mechanism is allowed due to the SR's ability to store and release calcium?

Back 14

Excitation Coupling

Front 15

Describe the steps in Excitation-Coupling

Back 15

(TPS Slide)
1.) T-tubule carries AP into cell
2.) Plateau phase 2 occurs with inward Ica
3.) SR is triggered to release Ca2+
(Calcium-induced Calcium release)
4.) Sliding filament model takes place

Front 16

Describe the Sliding Filament model in the heart

Back 16

1.) Calcium binds Troponin C
2.) This allows inhibitory Tropomyosin to move out of the way
3.) Actin & Myosin can now bind each other
4.) Thus Thin filaments slide along the Thick filament via cross-bridging

Front 17

Magnitude of the cardiac muscle's TENSION is PROPORTIONAL to what?

Back 17

Intracellular Calcium concentration

Front 18

Relaxation of the cardiac muscle occurs how?

Back 18

Calcium reabsorption by active Calcium-ATPase on the SR

Front 19

Contractility is also known as?

Back 19

Ionotropism

Front 20

Ionotropism is directly related to what cell property?

Back 20

Intracellular Ca2+ concentration

Front 21

Ionotropism (contractility) is estimated by what variable?

Back 21

Ejection Fraction (EF)

Front 22

EF equation

Back 22

EF = SV / EDV

Front 23

EF is normally at what value?

Back 23

0.55 (or 55%)

Front 24

What are the factors that increase Ionotropy (contractility)?

Back 24

(HSC)
1.) HR increase (pos. chronotropy)
2.) Sympathetic stimulation
3.) Cardiac Glycosides

Front 25

What are the factors that decrease Ionotropy (contractility)?

Back 25

Parasympathetic stimulation
via ACh on Muscarinic Receptors
on
ATRIA only!

Front 26

Calcium enters cardiomyocytes when?

Back 26

Phase 2 plateau phase

Front 27

Give 2 examples of how positive chronotropy effects increased ionotropy

(describe a bit on each example)

Back 27

1.) Positive Staircase
(Bowditch effect - increased HR increases ionotropy in a stepwise manner as Ca2+ accumulates intracellularly)

2.) Post-extrasystolic Potentiation
(beat after extrasystolic beat is increased in contractility b/c "extra Ca2+" enters cells during extrasystole)

Front 28

Sympathetic stimulation increases Ionotropy (contractlity) via what 2 MOA's?

Back 28

1.) Increase inward Ica during plateau phase 2

2.) Increase activity of Ca2+ Pump of SR
(thus SR accumulates more Ca2+ for later release)

Front 29

What has to occur to increase the activity of the Calcium Pump of the SR?

Back 29

Phosphorylation of PHOSPHOLAMBAN

Front 30

Give 2 examples of Cardiac Glycosides

Back 30

Digitalis & Oubain

Front 31

Describe the MOA of how Cardiac Glycosides increase ionotropy.

Back 31

1.) Cardiac Glycosides inhibits Na+/K+ ATPase

2.) Na+ buildup intracellularly
(fucks up Na+ gradient)

3.) Na+/Ca2+ Exchanger is now inhibited
(calcium can not be exchanged out)

4.) Calcium is trapped intracellularly

Front 32

Increased Preload is equivalent to?

Back 32

Increased EDV or RAP

Front 33

Increased Venous Return (increased Preload) will cause increase in?

Thus, causing what?
(based on Frank-Starling)

Back 33

EDV (or RAP)

increased Stretch/Lengthening of Ventricular Muscle

Front 34

Afterload is equivalent to what for the LV?

Back 34

Aortic Pressure

Front 35

Afterload is equivalent to what for the RV?

Back 35

Pulmonary Artery Pressure

Front 36

RAP is equivalent to?

LAP is equivalent to?

Back 36

EDV (preload)

Pulmonary Wedge Pressure

Front 37

What determines the MAX Tension (or Max force of contraction) in ventricular muscles?

Back 37

Sarcomere length

Front 38

Velocity of Contraction @ Fixed Length is at a Maximum when?

Back 38

Afterload is Zero

Front 39

Velocity of Contraction @ Fixed Length is Decreased with?

Back 39

Increased Afterload

Front 40

Frank-Starling relationship describes ____ & ____ in response to _________.

Back 40

CO & SV

Increased VR
(or EDV or RAP)

Front 41

Frank-Starling Relationship MOA?

Back 41

(FELT)
Frank-Starling relationship:
(in response to increased VR)
EDV increase causes increase in
LENGTH of Ventricular muscle
thus producing increase in TENSION

Front 42

Frank-Starling relationship matches what to what?

Back 42

CO to VR

(thus greater the VR, greater the CO)

Front 43

Based on Frank-Starling, the main point is that Positive Ionotropy (increased Contractility) causes what property change, under that conditions?

Back 43

Increased CO (or SV)

(for any level of EDV or RAP)

Front 44

Based Frank-Starling, the main point is that Negative Ionotropy (decreased Contractility) causes what property change, under that conditions?

Back 44

Decreased CO (or SV)

(for any level of EDV or RAP)

Front 45

Preload increases ventricular muscle length, thus affecting what muscle property and how?

Back 45

Increasing TENSION of contraction

(Ventricular Length-Tension relationship)

Front 46

Afterload (increased Aortic Pressure or Pulmonary Artery Pressure) affects what ventricular muscle property and how?

Back 46

Decreases VELOCITY of contraction

Front 47

List the steps of ventricular Pressure-Volume Loop

Back 47

(1 -> 2) Isovolumetric Contraction
(2 -> 3) Systolic Ejection
(3 -> 4) Isovolumetric Relaxation
(4 -> 1) Ventricular Filling

Front 48

PRESSURE-VOLUME LOOP

- describe the valve activities at each point of the PV Loop

Back 48

1 - Mitral Valve Closes
2 - Aortic Valve Opens
3 - Aortic Valve Closes
4 - Mitral Valve Opens

Front 49

PRESSURE-VOLUME LOOP

- Mitral Valve closes under what pressure conditions

Back 49

LVP > LAP

Front 50

PRESSURE-VOLUME LOOP

- Aortic Valve opens under what pressure conditions

Back 50

LVP > Aortic Pressure

Front 51

PRESSURE-VOLUME LOOP

- Aortic Valve closes under what pressure conditions

Back 51

LVP < Aortic Pressure

Front 52

PRESSURE-VOLUME LOOP

- Mitral Valve opens under what pressure conditions

Back 52

LVP < LAP

Front 53

PRESSURE-VOLUME LOOP

- at what stage of the PV Loop would S3 and S4 occur

Back 53

(4 -> 1) Ventricular Refilling

Front 54

PRESSURE-VOLUME LOOP

- S3 occurs when in terms PV Loop stage & Valve activity

Back 54

During Rapid Filling (of 4 -> 1)

- immediately AFTER Mitral Valve Opens (@ 4)

Front 55

PRESSURE-VOLUME LOOP

- S4 occurs when in terms PV Loop stage & Valve activity

Back 55

During Reduced Filling (of 4 -> 1)

- immediately BEFORE Mitral Valve Closes (@ 1)

Front 56

PRESSURE-VOLUME LOOP

- during (2 -> 3) Systolic Ejection, the ejected blood is what?

- the remainder of the blood is what?

Back 56

Stroke Volume (SV)

End-Systolic Volume (ESV)

Front 57

PRESSURE-VOLUME LOOP

- at which stage would you have a period of Highest O2 Consumption?

Back 57

(1 -> 2) Isovolumetric Contraction

Front 58

PRESSURE-VOLUME LOOP

- the amount of volume at point #1 is?

(specify the amount in mL)

Back 58

End-Diastolic Volume

(roughly 140 mL)

Front 59

PRESSURE-VOLUME LOOP

- equation for SV

Back 59

SV = EDV - ESV

Front 60

PRESSURE-VOLUME LOOP

- Increased Preload refers to what?

Back 60

Increased EDV

Front 61

PRESSURE-VOLUME LOOP

- Increased Preload affects cardiac property how?

- affects PV Loop how?

Back 61

Increases SV

Increases Width (to the Right)

Front 62

PRESSURE-VOLUME LOOP

- Increased Afterload refers to what?

Back 62

- Increased Aortic Pressure

Front 63

PRESSURE-VOLUME LOOP

- Increased Afterload affects cardiac property how?

- affects PV Loop how?

Back 63

- Decreases SV
- Increases End-Systolic Volume (ESV)

- Decreases Width
- Increases Height

Front 64

PRESSURE-VOLUME LOOP

- Increased Contractility refers to what?

Back 64

- Increased Tension of ventricles

Front 65

PRESSURE-VOLUME LOOP

- Increased Contractility affects cardiac property how?

- affects PV Loop how?

Back 65

- Increases SV
- Decreases ESV

- Increases Width (to the Left)
- Increases Height

Front 66

PRESSURE-VOLUME LOOP

- Increased SV occurs under what cardiac property conditions?

Back 66

Increased Preload

Decreased Afterload

Increased Contractility

Front 67

PRESSURE-VOLUME LOOP

- Increased ESV occurs under what cardiac conditions?

- Decreased ESV occurs under what cardiac conditions?

Back 67

Increased Afterload

Increased Contractility

Front 68

Afterload increases what property?

Afterload decreases what property?

Back 68

Increases ESV

Decreases Velocity of Contraction

Front 69

CARDIAC & VASCULAR F(X) CURVE

- y axis is?

- x axis is?

Back 69

CO (or VR)

EDV (or RAP)

Front 70

CARDIAC & VASCULAR F(X) CURVE

- Mean Systemic Pressure (MSP) involves which curve?

Back 70

Vascular Function curve

(aka - VR curve)

Front 71

CARDIAC & VASCULAR F(X) CURVE

- MSP is determined graphically when?

Back 71

VR curve intersects X-axis

Front 72

CARDIAC & VASCULAR F(X) CURVE

- when MSP intersects X-axis, then the MSP = ?

Back 72

RAP

Front 73

CARDIAC & VASCULAR F(X) CURVE

- when MSP increases, what change is seen on the Vascular function curve?

Back 73

Right shift (along CO curve)

Front 74

CARDIAC & VASCULAR F(X) CURVE

- when MSP decreases, what change is seen on the Vascular function curve?

Back 74

Left shift (along CO curve)

Front 75

CARDIAC & VASCULAR F(X) CURVE

- Increased MSP (or Right shift) can occur under what conditions?

Back 75

Increased Blood Volume
or
Decreased Venous Compliance

Front 76

CARDIAC & VASCULAR F(X) CURVE

- Decreased MSP (or Left shift) can occur under what conditions?

Back 76

Decreased Blood Volume
or
Increased Venous Compliance

Front 77

CARDIAC & VASCULAR F(X) CURVE

- what does Increased Venous compliance mean?

Back 77

- shifting of blood to the VENOUS side

Front 78

CARDIAC & VASCULAR F(X) CURVE

- what does Decreased Venous compliance mean?

Back 78

- shifting of blood to the ARTERIAL side

Front 79

CARDIAC & VASCULAR F(X) CURVE

- CCW rotation (decreasing slope) of the Vascular F(x) curve, pivoting at the MSP, occurs under what condition?

Back 79

Increased TPR

Front 80

CARDIAC & VASCULAR F(X) CURVE

- CW rotation (increasing slope) of the Vascular F(x) curve, pivoting at the MSP, occurs under what condition?

Back 80

Decreased TPR

Front 81

CARDIAC & VASCULAR F(X) CURVE

- Slope of the Vascular F(x) curve is determined by ?

Back 81

- Arteriolar resistance

Front 82

CARDIAC & VASCULAR F(X) CURVE

- for the VR curve, an Increase in TPR will affect slope how?

- how does increased TPR affect VR

Back 82

CCW rotation (pivoting from MSP), so decreases the slope

VR is decreased
(since slope of VR curve decreased)
(thus decreased EDV & CO)

Front 83

CARDIAC & VASCULAR F(X) CURVE

- for the VR curve, a Decrease in TPR will affect slope how?

- how does decreased TPR affect VR

Back 83

CW rotation (pivoting at MSP), so Slope is increased

VR is increased
(b/c VR curve slope increased)
(thus increased EDV & CO)

Front 84

CARDIAC & VASCULAR F(X) CURVE

- give an example of a vascular condition causing Increased TPR

Back 84

VasoConstriction of ArteriOles

Front 85

CARDIAC & VASCULAR F(X) CURVE

- give an example of a vascular condition causing Decreased TPR

Back 85

VasoDilation of ArteriOles

Front 86

CARDIAC & VASCULAR F(X) CURVE

- what Factors only involve VR curve?

Back 86

Blood Volume

Venous compliance

Front 87

CARDIAC & VASCULAR F(X) CURVE

- what Factors only involve CO curve?

Back 87

Ionotropic agents (i.e. - Digitalis)

Front 88

CARDIAC & VASCULAR F(X) CURVE

- what Factors involve Both curves?

Back 88

TPR

Front 89

CARDIAC & VASCULAR F(X) CURVE

- Increased Blood Volume OR Decreased Venous compliance will have what effects on cardiac property?

Back 89

Increases BOTH the CO & RAP

(with Right shift / Increased MSP)

Front 90

CARDIAC & VASCULAR F(X) CURVE

- Decreased Blood Volume OR Increased Venous compliance will have what effects on cardiac property?

Back 90

Decreases BOTH the CO & RAP

(with Left shift / Decreased MSP)

Front 91

CARDIAC & VASCULAR F(X) CURVE

- Positive Ionotropic agents affects cardiac properties how?

Back 91

Increased CO

Decreased RAP
(b/c more blood leaves heart, so less volume)

Front 92

CARDIAC & VASCULAR F(X) CURVE

- Negative Ionotropic agents affect Cardiac function curve how?

Back 92

Decreased CO

Increased RAP

Front 93

CARDIAC & VASCULAR F(X) CURVE

- Increased TPR affects on VR curve?

- Increased TPR affects on CO curve?

Back 93

CCW rotation (thus decreased VR)

Down shift (thus decreased CO)

Front 94

CARDIAC & VASCULAR F(X) CURVE

- Decreased TPR affects on VR curve?

- Decreased TPR affects on CO curve?

Back 94

CW rotation (thus increased VR)

Up shift (thus increased CO)

Front 95

CARDIAC & VASCULAR F(X) CURVE

- Increased TPR effects on cardiac properties

Back 95

Decreases Both CO & VR

Front 96

CARDIAC & VASCULAR F(X) CURVE

- Decreased TPR effects on cardiac properties

Back 96

Increases Both CO & VR

Front 97

CARDIAC & VASCULAR F(X) CURVE

- thus CO is increased under what conditions?

Back 97

Increased Blood Volume
or
Decreased Venous compliance
or
Positive Ionotropic agents
or
Decreased TPR

Front 98

CARDIAC & VASCULAR F(X) CURVE

- RAP is increased under what conditions?

Back 98

Increased Blood Volume
or
Decreased Venous Compliance
or
Negative Ionotropic agents

Front 99

CARDIAC & VASCULAR F(X) CURVE

- CC: in Hemorrhages, how is the Cardiac & Vascular F(x) curves affected?

Back 99

(Hemorrhage = Decreased Blood volume)

Left shift, so decreased MSP
- decreased CO
- decreased RAP

Front 100

Equation for Stroke Work

Back 100

Stroke WORK = Aortic Pressure x SV

Front 101

Primary source of energy for Stroke work comes from?

Back 101

Fatty acids

Front 102

Cardiac O2 Consumption is directly related to what muscle property?

Back 102

Ventricular TENSION

Front 103

Cardiac O2 Consumption Increases with what conditions?

Back 103

(CASH)

Contractility increase
Afterload increase
Size of Heart increase
HR increase

Front 104

CARDIAC & VASCULAR F(X) CURVE

- why does increased heart size also increase cardiac O2 consumption?

Back 104

Laplace law :
Tension is proportional to radius

Front 105

Fick's Equation for CO

Back 105

(O2 consumption)

divided by

([O2] of Pulm. vein) - ([O2] of Pulm. artery)

Front 106

To solve for Fick's CO equation, what is the 1st step?

Back 106

Measure O2 consumption for whole body

Front 107

To solve for Fick's CO equation, the [O2] of Pulmonary Vein is measured where?

Back 107

Peripheral artery

Front 108

To solve for Fick's CO equation, [O2] of Pulmonary Artery is measured where?

Back 108

Systemic Mixed Venous Blood

Front 109

CO is normally of what value?

Back 109

5.0 L/min

Front 110

CO is normally of what value?

Back 110

5.0 L/min