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what is the cause of the S1 heart sound?S2
mitral valve closing
S2 aortic and pulmonary valves closing
S3 sound indiates?
(galloping in mid diastole)possbile CHF
wehre are hrt murmurs heard best in mitral stenosis? mitral regurgitation
stenosis: over the cardiac apex
regurg: cardiac apex
describe best place to hear murmurs in aortic stenosis? aortic regurgitation?
aortic stenosis: second right intercostal space ( over hte arotic arch); during systole
regurgitaion: left sternal border (during diastole)
hiw is arotic regurgitation graded?
grades by level 1-4 based on severity (seen with contrast injection)
what does it mean if neborn has a systolic and diastolic murmur
patent ductus arteriosus
what dysrrhythmia is most commonly observed in the pt with mitral valve lesion either stenosis or regurgitant?
afib
what is the formula for calculating SI
what is normla value for SV in average 70 kg person
SI = SV/BSAn (nl 40-60)
SV = 60-90
What is EF? nl range for EF?
EF = ratio of SV to end-diastolic volume
EF = SV/EDV
nl is 60-80%
name the organs in the vessel rich group and give % of CO that goes to each
heart 5%
brain15%
liver 25%
kidneys 20%
lungs 100%
What does Nitroglycerin do to the heart and how does this affect the P-V loop?
it decreases preload
the volume and pressures decreased, but ESV says the same**
What heart disorder cause the P-V loop to get taller, but not change the volumes?
Chronic Aortic stenosis
the volumes don't change bc of concentric hypertrophy
HOw is IHHS unique with its P-V loop?
it is the only loop that has smaller volumes and larger pressures (loop gets taller and skinny and shifts to the left)
Mitral stenosis: is the problem increased afterload or decreased preload
how does this change the P-V loop?
Decreased preload
looks like a loop with decreased preload (filling is decreased but empties to about normal)
How can you tell the p-v loop is showing aortic regurgitation?
the relacation phase (D to A) of the curves is not isovolumetric
instead of being straight up and down, it is slanted (looks like the side of the letter A)
How can you tell the p-v loop curve is showing mitral regurgitation?
the early systolic phase (B to C) is not isovolumetric
instead of being straight up and down it is curved
SVR=?
normal value:
SVR = (80)(MAP-CVP)/CO
900-1500 dynes sec cm-5
PVR=?
normal value
PVR = (80)(PAP-PCWP)/CO
50-150 dynes sec cm -5
If pt has low BP and increased PCWP, what does this suggest and what do you do?
Heart Failure
give Neo to increased SVR and coronary perfusion
Give nitroglycerin to decrease venous return
Give an inotrope to increase contractility
What nerve carries Afferent action potential from the aortic arch baroreceptors to the brainstem?
VAGUS Nerve
What happens when there is increase stretch or the barorecptors in the carotid sinus and aortic arch due to increased BP?
Vagus nerve carries signals for the Arotic arch to the brainstem
nad herings nerve (branch of the glossopharyngeal) carries sginals to the brainstem from the carotid
Efferent signals to the Vagus nerve in SA node and Sympathetic nerves in the ventricles and vasculature casue decrease in HR, CO, and SVR
What Nerve carries signals from the baroreceptors in the carotid sinus to the brainstem (in resonse to changes in BP)
Hering's Nerve - a branch of the glossopharyngeal nerve
Arginine is an amino acid used to form what subastance in the body?
Nitric Oxide
What does nitric oxide synthase (NOS) do?
it converts L-Arginine to Nitric Oxide inrespoonse to a stimulus (Ca, Ach, bradykinins)
HOw do Nitroglycerin and nitroprusside work to produce vasodilation?
they both donate NO molecuels to the vascular wall to promote vasodilation
(NO activates sGC, which converts GTP to cGMP wiich causes smooth musle relaxation)
When NO causes smooth muscle relaxation, is cGMP the first or second messanger?
Second messanger
Nitroprusside works on veins and arteries, but Nitroglycerin only works on viens, why?
only the venous endothelium enzymes can generate NO from nitoglycerin b.c the process is more complex than it is for nitroprusside
The area under the arterial pressure curve divided by time yields?
mean arterial blood pressure
Verapmil, diltiazem, and Nifedipine are all ____
Calcium channel blockers
arterial dilators
first 2 decrease HR and Nifedipine causes a reflex increase in HR
Captopril and Enalapril are _____
ACE Inhibitors (angiotensin converting enzyme Inhibitors)
Arterial dilators
Milrinone and Inamrinone (Inocor) are ______ and how do they work?
Phosphodiesterase (PDE) Inhibitors =Positive Inotropes
they prevent the breakdown of cAMP, causeing increased contractility and decreased SVR
What type of Cardiac drug is  Adenosine?
what is its half time and what special condition can it be used for
Antidysrhythmic -- slow the conduction of impulses through the AV node
half time is less than 10 seconds
can be used to treat paroxysmal SVT ass. with Wolff-Parkinson-White syndrome
List 4 direct acting vasodilator drugs
Hydralazine
Diazoxide (Hyperstat)
Nitroglycerin
Nitroprusside
what % of the right heart's cardiac output traverses the pulmonary circulation?  Bronchial curculation?
100% to pulmonaryand 0% traverse bronchial
in words describe where isovolemic contraction occurs on ht eleft ventricular pressure-volume loop
form the mitral vavle closure to aortic vavle opening
normal pressures in the chambers of hte heart?
right atrium: 1-8
right ventricle:15-30/0-8
left atrium: 2-12
left ventricle: 100-140/0-12
what is normal value for mean pumonary artery pressure?
16 mmHg
normal range value for PCWP (pulmonary capillary wedge pressure)
0-12
if BP is 150/90, what is MAP
MAP = (SBP + 2xDBP)/3
MAP = (150 + 180)/3 = 330/3 = 110
what causes a change in BP when changing a pt's position?
alteration in preload (altered venous return is most responsible)
what are the 2 determinant so farterial blood pressure?  waht law applies?
SVR and CO
Ohm's law
normal range of values fo rSVR?
1200-1500 dynes•sec•cm-5
calculate SVR if CVP = 8, CO = 9, and MAP =80
SVR = 80 (MAP -CVP)/CO
SVR = 80 (80-8)/9 = 5760/9 = 640dynes•sec•cm-5
in what segment of hte systemic circulation is resistance greatest?  the greatest decrease in BP in the arterial tree occurs where?
resistance to blood flow is greatest in the arterioles

greatest decrease in BP occurs in the arterioles
what maintains systemic arterial BP during diastole?
elastic recoil of arterial blood vessels
what is pulse pressure?
what are 2 determinants of pulse pressure
the difference b/t the SBP and the DBP
determinants are SV and arterial compliance; pulse presure decreases when SV decreases or arterial compliance increases
where are venous baroreceptors located, how do they work and what is the reflex called
located in right atrium and great veins
cause ain increase HR wehn they are stretched by increased volume
Bainbridge reflex
what happens to the HR during inspiration? during expiration
HR increases with inspiration
HR decreases during expiration
both due to the bainbridge reflex
**what nerves carry afferent and efferent signaling of the bainbridge reflex?  what does it help prevent?
afferent signals via Vagus nerve
efferent signals via sympathetic nerves (increase HR and contracitlity)
prevent damming up of blood in ht eveins atria, and plulmonary circulation
How does a normal dorsalis pedis arterial waveform differ from the waveforme found in the aorta in the supine or prone pt?
systolic pressure is greater and diastolic pressure is lower, so the pulse pressure is greater in the dorsalis pedis than in the aorta
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