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Front Back
50% of blood is in systemic venous compartment
20% in pulmonary venous compartment
P-cells
Few sarcomeres Undifferentiated cell junctions
His-Purkinje system
Specialized muscle cells with fewer sarcomeres and mitochondria, gap junctions
Myocytes Densely
Packed sarcomeres and mitochondria; attached by intercalated disks
Intercalated discs
Fascia adherens Desmosomes
LAD
Anterior LV and anterior septum
LCF
Lateral wall of LV, posterior His-Purkinje
RCA
Inferior LV, RV, posterior septum, SA node
PNS from Heart
Glossopharyngeal from carotid body Vagal nerve from stretch receptors
Vagal Efferents to heart
Sinus and AV nodes
Sympathetic Efferents to heart
Cardiac and vasomotor stimulation
Pumping function
Preload, Inotropy, VSR
Diastolic performance
Lusitropy, LA (filling) pressure, LV compliance, Heart Rate, Atrial kick
Pulmonary wedge pressure
Pulmonary venous or LV pressure
Left Ventricular function
Pressure of contraction, Ejection Fraction
Stroke Volume
EDV-ESV
Ejection fraction
SV/EDV
Normal Ejection fraction
55-80%
Cardiac Output
SV X HR
Cardiac Oxygen Consumption
Afterload, size, contractility, HR
Law of LaPlace
Tension = SBP x LV radius
Circulatory regulation
Venoconstriction (preload) and Vasoconstriction (afterload)
Sympathetic baroreflex
Tachycardia, increased inotropy and lusitropy, arteriolar constriction, venous constriction
Common Underloading Stresses
Mitral stenosis, Hypovolemia, Pericardial restriction Valsalva maneuver, Hemmorhage, Erect posture
Primary Myocardial Failure
Dilated cardiomyopathy Hypertrophic cardiomyopathy Ischemic cardiomyopathy
Common Volume Load Stresses
Digestion, Hot temperature, Isotonic exercise, regurgitation, shunting
Common Pressure Load Stresses
Aortic stenosis, HTN, cor pulmonale, pulmonic stenosis Cold temperature, Isometric exercise
EDRF
NO causes increase in adenylyl cyclase, increase in cGMP, and vasodilation
Shock definition
Inadequate tissue profusion due to underfilling arterial system
Types of shock
Hypovolemic, Distributive, Cardiogenic
Neurohumeral response Elements
Functional signaling, Proliferative signaling, Inflammatory signaling
Neurohumoral response mediators
NE, AII, aldosterone, ADH, endothelin
Backward heart failure
Increased venous pressure
Forward heart failure
Reduced cardiac output
Neurohumoral response to heart failure
Vasoconstriction, fluid retention, cardiac stimulation, proliferative signaling
Systolic heart failure
Heart cannot empty Reduced ejection fraction Common in Men after MI Beta-agonists, endothelin, AII activate GPCR and Ca ERK 1,2 pathway
Diastolic heart failure
Heart cannot empty Normal ejection fraction Common in older women with hypertension Cytokines activate gp130 ERK-5 pathway
Heart Failure
Energy starvation Depressed contractility Abnormal ion channel function Ca overload
Heart Failure drug classes
Inotropes- increase contractility Diuretics- reduce afterload Vasodilators- improve symptoms Beta-blockers- reduce contractility
Drugs that inhibit heart remodeling
Beta Blockers ARB’s ACE inhibitors
Dilated cardiomyopathy
Eccentric hypertrophy and Systolic Heart Failure Direct- infection, ischemic, toxic; Indirect- ischemic, valvular Orthopnea, S3 gallop, Dyspnea, Low EF Positive inotropes, diuretics, Beta blockers, vasodilators, anticoagulants
Hypertrophic cardiomyopathy
Diastolic heart failure Direct- inherited; Indirect- HTN, aortic stenosis Angina, dyspnea, S4 gallop, murmur louder with increased heart size or contractility Beta blockers, surgery, danger with NTG or dig
Restrictive cardiomyopathy
Diastolic heart failure Direct
Pericardial diseases
Acute pericarditis Pericardial tamponade Chronic constrictive pericarditis
Acute pericarditis
E
Pericardial tamponade
Pp- fluid accumulation, compression, cardiogenic shock C- Beck’s Triad Tx- emergency pericardiocentesis
Chronic constrictive pericarditis
E- after episode of acute pericarditis Pp- Fibrotic pericardium C- Paradoxical pulse, Kussmaul Sign, Pericardial Knock Tx- pericardectomy
Beck’s Triad
Paradoxical pulse- decreased arterial pressure JVC with inspiration Quiet precordium
Kussmaul sign
Increased systemic venous pressure
Cardiomyopathy
Heart failure Sudden Death AFIB Stroke
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