Ap 2 Exam 1

Front 1

Lecture 1

Back 1

1/13/2016 - Wednesday

Front 2

What changes does Vitamin D have to go through before it is activated?

Back 2

An -OH(hydroxyl) group is added by the liver and another one is added by the kidney.

Front 3

What's another name for inactive vitamin D?

Back 3

Cholecalciferol

Front 4

What does activated vitamin D do?

Back 4

Helps reabsorb Ca++ in the GI tract

Helps to hang on to more Ca++ in the kidney

Involved in building bone

Front 5

What is bone made out of?

Back 5

Ca++ and Phospate

Front 6

So, if your kidney was failing, what would you expect to see in your blood for the Ca++ concentration?

Back 6

Decrease in vitamin D activation

so... there will be a?

Decrease in the concentration of Ca++ in the blood

Front 7

So what happens when we have a Ca++ deficit in our blood?

Back 7

There is an increase in bone breakdown.

This releases Ca++ and Phosphate

So, you'd have hypocalcemia and hyperphosphatemia

Front 8

What's the name for activated vitamin D?

Back 8

Dihydroxycholecalciferol

Front 9

What drives filtration in the kidneys?

Back 9

glomerular hydrostatic pressure in the capillary

Front 10

What helps with the pressure in the glomerular capillaries?

Back 10

Podocytes

Front 11

What is renal clearance?

Back 11

It's all about how fast the kidney can clear the body.

Front 12

What's equal to GFR?

Back 12

The maximum amount of plasma or blood that you can clear

Front 13

Filtration fraction

Back 13

How much of the plasma is skimmed off

It's about 1/5

Front 14

What happens upstream and downstream where we pinch?

Back 14

Upstream: increase in pressure

Downstream: drop in pressure

Front 15

What happens to most of the stuff that we filter?

Back 15

We reabsorb it

Front 16

What does the SNS do to the kidney?

Back 16

It works at the afferent arteriole causing a squeeze to happen.

This allows our bodies to hang onto more fluid.

Front 17

What other system promotes fluid retention?

Back 17

Renin

Ang I

Ang II

Front 18

Where do we get our circulating catacholamines?

Back 18

We get it from the adrenal medulla

Front 19

What makes vasopressin different?

Back 19

Reabsorbs water w/o reabsorbing salt

Front 20

What's the 1st thing we think about when it comes there is low blood osmolarity?

Back 20

ICP

Fluid could be moving into the brain

Front 21

Diabetes insipidous

Back 21

There are 2 types

Central: Brain is not producing ADH

Nephrogenic: Receptors are not able to receive ADH. The problem is the kidney.

Front 22

What are some of the causes of central DI?

Back 22

Stroke or trauma

Front 23

What is a cause of nephrogenic DI?

Back 23

Acute kidney failure. Can be temporary.

Front 24

Who is most likely to get SIADH?

Back 24

Lung cancer pts because it produces all kinds of crazy stuff.

Front 25

How do you treat SIADH?

Back 25

Give salt and diuretic to balance osmolarity

Front 26

What does ADH control?

Back 26

Osmolarity

Front 27

What does aldosterone control?

Back 27

K+

Front 28

Recall what happens to our body after drinking 1 L of distilled water.

Back 28

After 15-20 min the body is already decreasing ADH release after the influx of water.

Blood osmolarity only drips a little.

Urine output(increase) and osmolarity (drop) change alot

Slight increase in the amount of solutes in urine

Front 29

What type of HTN do white folks have?

What causes it?

Back 29

Essential HTM

Unknown

Front 30

What HTN do asian and black folks have?

What causes it?

Back 30

Salt sensitive HTN

Salt and water

Front 31

What age do we lose half our nephrons?

What disease can kill out kidneys?

Back 31

80

DM

Front 32

How does chronic kidney failure work?

Back 32

As nephrons died out the remainder of work goes to the remaining functioning nephrons, which break them down faster because they are exposed to more toxins

Front 33

What is end stage renal disease defined as?

Back 33

<5% normal GFR

Front 34

What problems may occur with a kidney when it is failing?

Back 34

Hypernatermia

Hypervolemia

Hyperkalemia

HTN

Hypocalcemia

Uremia(Azotemia) Nitrogenous compounds

Acidosis

Anemia

Hyperphosphatemia

Front 35

What do you need to give a pt with renal failure?

Back 35

EPO and 1, 25 -OH synthetic vitamin D

Front 36

What do NSAIDS do to pt with renal failure?

Back 36

Prostaglandins keep AA open, but with NSAID the prostaglandins go away, so AA closes a little bit, so there is less blood flow.

Front 37

What's the heart of the kidney?

Back 37

Medullary blood flow

Front 38

What are the 2 different circuits and which has a higher pressure?

Which 2 pumps is bigger?

Back 38

A- Systemic circuits (Higher)

B- Pulmonary circuit

The left side is bigger because it has to pump against circuit with higher pressure.

Front 39

What do AV valves do?

Back 39

Separate atria from the ventricle

Front 40

What are your aortic valves and all their other names?

Back 40

Pulmonic/Pulmonary artery Valves

Aortic/Systemic aortic valve

Front 41

What are the characteristic Muscle types of each of the chambers?

Back 41

They will vary a little depending on the side of the heart that you are on, and if you are in the atria or ventricle.

Front 42

Which has thinner walls?

What separates the left and right side of the heart?

Which ventricle is thicker?

Back 42

Atria walls are thinner than ventricle walls

The intraventricular septum

The left

Front 43

The pressures in the circuit reflect what about the heart?

So the RA will be like what?

What does elevated CVP do for the heart?

Back 43

What the pressures are going to be in the heart

What will be like the vena cava, which will be a low pressure

It helps the heart pump, so it is an adaptation

Front 44

What is this?

Back 44

Cardiac cycle - Carl Wiggers diagram

Look at how thing are happening in relation to each other

Front 45

What is phonocardiogram?

Back 45

Heart sounds

Front 46

What is the P wave in the electrocardiogram?

Back 46

Where the atria is depolarizing?

Front 47

What causes the delay in mechanical contraction from electrical depolarization?

Back 47

The Ca++ still has to come in and bind, so mechanical force is possible.

Electrical event occurs before mechanical event

Front 48

What causes the increases in pressure in the ventricle?

Back 48

The contraction of the ventricle

Front 49

What is the a wave?

Back 49

It is the blip on the CVP detected by the central line from the contraction of the atria

Front 50

Where can you see the result of the contraction of the ventricle?

Back 50

Arterial pressure, but we don't see the effects until the valve opens

Front 51

What opens a valve?

Back 51

It's the change in pressure, so that the ejection side is higher than the receiving side.

Front 52

What closes the valve?

Back 52

Change in pressure where the receiving side is higher than the ejection side.

Front 53

Which line represents the pressure inside of the ventricle?

Back 53

The red line

Pressure increases after the contraction starts

Front 54

Do we spend more time is systole or diastole?

Back 54

Diastole

Front 55

What is isovolumetric contraction?

Back 55

Both valves are closed, contraction is occurring with no change in volume.

Front 56

So, why does volume move from one location to another?

Back 56

There is a difference in pressure

Moves from high pressure to low pressure

Front 57

What do we consider systole?

Back 57

The time between 1st and 2nd heart sounds

Front 58

Isovolumetric relaxation

Back 58

When both valves are closed and the mechanical event has ceased.

Front 59

What produces the heart sounds?

Back 59

The vibration of closure

Front 60

Which valve is more "meaty"?

Back 60

Aortic is more meaty than the tricuspid valve, so it vibrates for a shorter amount of time.

This is why there is a difference in the duration of heart sounds. 2nd is shorter that 1st heart sound.

Front 61

How much does the pressure change in the atrium?

Back 61

It's only by a few mm Hg

Front 62

How are the skeletal muscle stretched before they are in use?

Back 62

They are optimally stretched before they are put into use

Front 63

How is cardiac muscle stretched?

Back 63

it's slightly sub-optimum, so that the more volume is in the ventricle, the better it can contract because it stretches it to an optimal lvl.

Front 64

William Howell

Back 64

1st to find the relationship between the stretch and the force of contraction.

1884

Front 65

When did Otto Frank come into play?

E.H. Starling?

Back 65

1894

1918

Front 66

What is the frank-starling law?

Back 66

The more you stretch the heart, the better it pumps, to a certain point.

Front 67

Lecture 2

Back 67

1/20/2016 - Wednesday

Front 68

What accounts for the lag between the electrical event in the heart and the mechanical events?

Back 68

It is the excitation-contraction coupling

it takes very little time

Front 69

What is optimally stretched at rest?

What is not?

Back 69

Skeletal muscle

Cardiac muscle

Front 70

What helps to optimally stretch the cardiac muscle?

What does optimal stretch mean for the heart?

Back 70

Filling with volume and atrial force

It means that the heart can pump better

Front 71

What does the atrial force determine?

Where does the force come from?

Do these forces come from the ventricle?

Back 71

What's going on with cardiac filling?

Static filling and contraction of the atria

Nope, it's a passive party

Front 72

What does this represent?

How can you get a good picture of this?

Back 72

Pressure volume loop

It looks at the function of the heart and how much it is putting out and what pressures we are seeing.

You see it best by putting instrumentation on the left side of the heart. (not safe or easy)

Front 73

What should be the same between the left and right side of the heart?

Back 73

SV

Front 74

How can you find SV?

So how would you find CO?

Back 74

EDV - ESV

SV x HR

Front 75

What is normal EDV?

ESV?

So, what would be SV in this situation?

And... CO?

Back 75

120

50

70

70 x 72 = approximately 5L/min

Front 76

What kind of change in pressure occurs during the period of filling?

Back 76

Pressure should correspond to somewhat of what CVP is and become a U shape.

Front 77

Preload

What happens if we increase preload and nothing else?

Decrease preload and nothing else?

Back 77

Pressure/force that assists in filling the heart

Increase EDV, which increases SV, increasing CO and increase BP

Decrease ED , decreasing SV, decreasing CO, and decreasing BP

Front 78

Afterload

What happens if we only increase afterload?

Decrease Afterload?

Back 78

Pressure immediately outside the LV

Take longer for the LV to overcome the pressure on the aorta to open the aortic valve and less time for it to be open. Increase ESV, which decreases SV

Decreased ESV, so increased SV

Front 79

What are the two ways we look at afterload?

Back 79

Pressure that exists when the aortic valve opens 80 mm Hg

Peak systole 120 mm Hg

Front 80

Contractility

Increase Contractility

Decrease Contractility

Back 80

Ability of the heart to increase or decrease SV, independent from preload and afterload.

Increase SV by pumping harder, increase the peak systolic pressure

Decrease SV by not pumping as hard

Front 81

What can affect contractility?

Back 81

Beta agonist

-increase pumping performance of the heart

Beta antagonists

-Decrease the pump performance of the heart

Front 82

How do beta agonists increase the performance of the heart?

Back 82

Increases the amount of Ca++ that comes in through the heart, increases the speed at which Ca++ is removed (PKA inhibiting phosphoamban), increase cross bridge cycling rate.

Front 83

In the explanation of contractility, how do we hold afterload constant?

So, what can we say in references to slope and contractility?

Back 83

By taking it as the diastolic pressure of 80 mm Hg

The steeper the slope, the higher the contractility

The lower the slope, lower the contractility

Front 84

What are the 4 phases of the pressure volume loop?

Back 84

1- Filling

2- Isovolumetric contraction

3- Ejection

4- Isovolumetic relaxation

Front 85

The 1st heart sound is the closing of what valves?

2nd heart sound?

Back 85

Mitral/tricuspid

-louder, lower pitch

Aortic/pulmonic

Front 86

What causes the 3rd heart sound?

Back 86

"Sloshing" of blood against an uncompliant walls of the heart. mostly peds because the younger the heart, the less compliant it is. This can cause DPS to the walls.

Typically can't be heard.

Front 87

How do peds make up for an uncompliant heart, if they need more output?

What if you take that mechanism away?

Back 87

HR

DPS the heart, if they can't get rid of an increase in return

Front 88

What the purpose of the increase pressure the further it is from the heart?

Back 88

So, it can return blood to the heart

Front 89

What is Right Atrial Pressure(RAP)?

LAP?

Back 89

0 mmHg

2 mmHg

-the walls are thicker and have less give, so more pressure

Front 90

a wave

c wave

v wave/peak

Note: this is a low pressure waveform

Back 90

Atrial contraction

AV valves being pushed backwards towards atria in isovolumetric contraction

Blood being pushed into the AV valves(closed) as filling of atria occurs, right before the AV valves open.

Front 91

How much leaves the ventricle in the 1st 1/3 of ejection? What is it called?

What about the rest?

Back 91

70% of SV (Rapid ejection/outflow)

30% of SV (Reduced Ejection/outflow)

Front 92

How much enters the ventricle in the 1st 1/3 of ventricular filling?

2nd 1/3 of ventricular filling?

last 1/3 of ventricular filling?

Back 92

Rapid inflow 70-75%

Diastasis, where hardly anything moves

Atrial systole 10-15% (Called atrial kick) Can be up to 25%

Front 93

Where is atrial kick important?

Back 93

in very sick pts

Front 94

What part of diastole has no filling occuring at all?

Back 94

Isovolumetric relaxation

Front 95

What opens and closes valves?

Back 95

Pressure

Front 96

What is pulse pressure?

Does it change?

Back 96

OR SBP-DBP

Typically 40 mm Hg

Yes, throughout the system

Front 97

What is the most important variable that determines pulse pressure?

Back 97

Compliance

Front 98

What is vascular compliance?

Back 98

This is for the cardiovascular system

Front 99

What happens when we change the contractility of our heart?

Back 99

It also changes pressure

Front 100

Looking back at PP, if SV increases?

If compliance increases?

Back 100

PP increases, for those with hard arteries, the pulse pressure increases.

PP decreases, the compliance allows for the extra volume without much increase in pressure.

Front 101

What is the difference in compliance with healthy pple and sick pple?

Back 101

Healthy pple have more compliance than sick pple.