Cardiovascular Physiology Lecture 4 Flashcards Preview

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Flashcards in Cardiovascular Physiology Lecture 4 Deck (95)
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1
Q

The cardiac cycle can be divided into _______ (ventricular contraction) and _______ (ventricular relaxation)

A

The cardiac cycle can be divided into systole (ventricular contraction) and diastole (ventricular relaxation)

2
Q

What is Systole?

A

Ventricular contraction and blood ejection

3
Q

What is Diastole?

A

Ventricular relaxation and filling

4
Q

_______: period of time from beginning of one heartbeat to the beginning of the next

(each heart beat involves one ventricular systole and one ventricular diastole)

A

Cardiac cycle length: period of time from beginning of one heartbeat to the beginning of the next

(each heart beat involves one ventricular systole and one ventricular diastole)

5
Q

The heart spends most of the time in ______

*important for ventricular filling as the ventricles only fill when relaxed*

A

The heart spends most of the time in diastole

6
Q

What are the two phases of ventricular systole?

A
  1. Isovolumetic ventricular contraction
  2. Ventricular ejection
7
Q

When the ventricle contract, they squeeze the volume of blood in their chambers, generating _______ which creates blood flow

(recall flow = change in pressure / resistance)

A

When the ventricle contract, they squeeze the volume of blood in their chambers, generating pressure which creates blood flow

(recall flow = change in pressure / resistance)

8
Q

_________: same volume (constant/unchanging)

A

Isovolumetric: same volume (constant/unchanging)

“iso” = same

“volumetric” = volume

9
Q

What is isovolumetric ventricular contraction?

A

Phase of ventricular systole:

  • Ventricles contract
  • All heart valves are closed
  • blood volume in ventricles remains constant but pressure rises
  • muscle develops tension but cannot shorten
10
Q

What is the ventricular ejection phase?

A

Phase of ventricular systole:

  • pressure generated by the ventricles during contraction now exceeds the pressure in the artery into which the ventricles eject blood
  • forward pressure gradient:
    • opens semilunar valves
    • ventricular muscle fibres shorten
    • Blood is ejected from ventricles
11
Q

During the ventricular ejection phase of systole, the AV valve is kept from inverting by the _______ and the ______

A

During the ventricular ejection phase of systole, the AV valve is kept from inverting by the chordae tendinae and the papillary muscles

12
Q

What is stroke volume?

A

Volume of blood ejected from each ventricle during systole or during contraction

13
Q

Which ventricle ejects the greater volume of blood?

A

Both left and right ventricle eject the same amount of blood. The only difference is that the left does so with more pressure

14
Q

What are the two phases of Diastole?

A

Two phases of diastole

  1. isovolumetric ventricular relaxation
  2. ventricular filling
15
Q

What has to be relaxed for for the ventricles to fill?

A

Ventricular myocardium (muscle layer of the ventricles)

16
Q

What is happening during isovolumetric ventricular relaxation?

A

Phase of diastole

  • all heart valves closed
  • blood volume remains constant
  • pressures drop as myocardium relaxes
17
Q

What happens during ventricular filling?

A

Phase of Diastole

  • AV valves open, blood flows passively into ventricles from atria (atria are relaxed)
  • Two Phases:
    1. Passive ventricular filling
    2. Atrial contraction
18
Q

What are the two phases of ventricular filling?

A

Ventricular filling:

second phase of Diastole;

Two phases:

  1. Passive ventricular filling
  2. Atrial contraction (or atrial kick)
19
Q

What happens during passive ventricular filling?

A

First phase of the ventricular filling phase of diastole:

  • the ventricles receive approximately 70% of their blood volume via passive ventricular filling
  • blood flows from relaxed atria to relaxed ventricles
20
Q

What happens during atrial contraction?

A

second phase of the ventricular filling phase of diastole

  • Atrial systole begins
  • Atrial contraction forces small amount of blood into relaxed ventricle completing ventricular filling
21
Q

What is the cardiac cycle?

A

the rhythmical contraction and relaxation of the heart’s chambers coordinated by the electrical activity in the heart; represents the events that occur in the chambers of the heart during one single heartbeat

22
Q

What is the pressure-volume curve also called?

A

Wiggers diagram

23
Q

______ is the key to understanding blood flow patterns and the opening and closing of valves

A

Pressure is the key to understanding blood flow patterns and the opening and closing of valves

24
Q

When is pressure generated in the heart?

A
  1. When the muscles of the heart chamber contract
  2. When a chamber fills with blood
25
Q

Valves open and close in response to:

A

Pressure gradient

  • a forward pressure gradient opens a one-way valve while a backward pressure gradient shuts a one-way valve
26
Q

The amount or volume of blood in each ventricle at the end of ventricular diastole (measured in millilitres)

A

End diastolic volume (EDV)

27
Q

The amount or volume of blood in each ventricle at the end of ventricular systole, or at the end of ventricular contraction and ejection

(measured in mL)

A

Ends systolic volume (ESV)

28
Q

The volume of blood pumped out of each ventricle during systole

A

Stroke volume

29
Q

How do you calculate Stroke Volume (SV)?

A

SV = EDV-ESV

EDV = End diastolic volume

ESV = End systolic volume

30
Q

Typical SV values for an adult at rest?

A

stroke volume for an adult at rest ~70-75mL

31
Q
  • What state are the left ventricle and left atrium in at the beginning of the Cardiac cycle (pressure-volume curve).
  • Is the aortic valve open or closed?
  • Is the AV Valve open or closed?
  • What phase is this?
A
  • Left atrium and ventricle are relaxed.
  • Aortic valve is closed
  • AV valve is open (pressure in the atrium is slightly higher than in ventricle)
  • Passive ventricular filling (phase of ventricular phase of Diastole)
    • Blood is passively flowing from relaxed atrium to relaxed ventricle
32
Q

What does the P-wave signify on the pressure-volume curve?

What phase is this?

A

Atrial contraction

  • more blood into ventricle
  • small increase on the left ventricular volume curve (orange line)
  • Phase: Atrial contraction (atrial kick) phase of Ventricular Phase of Diastole
33
Q

What is the volume at the end of diastole called? In the first part of the Pressure volume?

What is its approximate value?

A

EDV

End diastolic volume

~135mL

34
Q

What does the QRS complex signify on the pressure-volume curve (recall this is measured on an ECG)

A

Ventricular depolarization and contraction (systole)

35
Q

The first heart sound (lub) is caused by:

A

Closure of AV valves at the beginning of isovolumetric ventricular contraction (of Systole)

36
Q

What sound signifies the onset of ventricular systole?

What causes this sound?

A

Lub

Caused by closure of AV valves during isovolumetric ventricular contraction

37
Q

What is the second heart sound “Dub” caused by?

What does it signify?

A

Closure of the semilunar valves

  • signifies onset of ventricular diastole
38
Q

The heart sound reflect _______ when the valves passively snap shut as the pressures across them changes

A

The heart sound reflect turbulence when the valves passively snap shut as the pressures across them changes

39
Q

What is a heart murmer?

A

Abnormal sounds produced by the heart.

Can be caused by defects that cause blood flow to be turbulent (normally laminar & makes no sound)

40
Q

What is normal laminar blood flow characterized by?

A

Smooth concentric layers of blood moving in parallel down the length of a blood vessel

41
Q

The flow profile is _____ once laminar flow is fully developed

A

The flow profile is parabolic once laminar flow is fully developed

42
Q

What is stenosis?

A

Blood flows rapidly through a narrowed valve (stenotic valve); leaflets do not open completely

43
Q

What is a stenotic valve and how might it occur?

A

A stenotic valve is a valve in which the leaflets do not open completely;

Can occur when the valve leaflets become stiffer due to calcium deposits or scarring of the valve

44
Q

What is an insufficient valve and how might it occur?

A

Valve does not close completely due to widening of the aorta or scarring of the valve

Blood flows backwards through the leaky valve and produces turbulence which is heard as a murmur

45
Q

The heart is innervated by which division of the autonomic NS?

A

Both

Sympathetic - atria, ventricles, SA node, AV node

Parasympathetic - atria, SA node, AV node

46
Q

Which nerve provides sympathetic innervation to the heart?

A

The thoracic spinal nerves

47
Q

Sympathetic _______ fibres innervate the entire heart, including the atria, ventricles, SA node and AV node

Release the NT: ________

A

Sympathetic Postganglionic fibres innervate the entire heart, including the atria, ventricles, SA node and AV node

Release the NT: norepinephrine

48
Q

Which nerve provides parasympathetic innervation to the heart?

A

Vagus Nerve

49
Q

Parasympathetic postganglionic fibres innervate the _____, _____, and _____

Releases the neurotransmitter: _______

A

Parasympathetic postganglionic fibres innervate the atria, SA node and AV node

Releases the neurotransmitter: acetylcholine

50
Q

Which part of the heart does not receive any parasympathetic innervation?

A

The ventricles

*ventricular myocardium is not affected by parasympathetic activity*

51
Q

How does parasympathetic stimulation affect the heart?

(3)

A
  • Decrease heart rate by decreasing rate of depolarization (or the rate of rise to threshold, of the pacemaker potential)
  • Decrease the conduction of the electrical impulses through the AV node, increasing AV nodal delay (takes longer for stimulus to pass through the AV node into the ventricles)
  • Decrease contractility of the atrial myocardium, decreasing the force of contraction
  • *no effect on contractility of the ventricles (no parasympathetic innervation)
52
Q

What effect does Sympathetic Stimulation have on the heart?

A
  1. Increase heart rate by
    • increasing rate of depolarization (or the rate of rise) of the pacemaker potential to threshold
  2. Increase conduction of the electrical impulses through the AV node
    • ​​Decreases AV nodal delay
    • Less time for stimulus to pass through the AV node to the ventricle
  3. Increase the contractility of the atrial and ventricular myocardium
    • increasing force of contraction
53
Q

What is the effect on the SA Node by:

  • Parasympathetic stimulation
  • Sympathetic stimulation
A

What is the effect on the SA Node by:

  • Parasympathetic stimulation
    • ​​​decrease rate of depolarization to threshold
    • decrease heartrate
  • Sympathetic stimulation
    • increase rate of depolarization to threshold
    • increase heart rate
54
Q

What is the effect on the AV Node by:

  • Parasympathetic stimulation
  • Sympathetic stimulation
A

What is the effect on the AV Node by:

  • Parasympathetic stimulation
    • decrease conduction
    • Increase AV nodal delay
  • Sympathetic stimulation
    • increase conduction
    • decrease AV nodal delay
55
Q

What is the effect on the Atrial muscle by:

  • Parasympathetic stimulation
  • Sympathetic stimulation
A

What is the effect on the Atrial muscle by:

  • Parasympathetic stimulation
    • decrease contractility
  • Sympathetic stimulation
    • increase contractility
56
Q

What is the effect on the Ventricular muscle by:

  • Parasympathetic stimulation
  • Sympathetic stimulation
A

What is the effect on the Ventricular muscle by:

  • Parasympathetic stimulation
    • No significant innervation = no effect
  • Sympathetic stimulation
    • increase contractility
57
Q

the amount of blood pumped by each ventricle in one minute; CO=(HR)(SV)

A

Cardiac output (CO)

58
Q

How is Cardiac output calculated?

A

CO = heartrate multiplied by Stroke volume

Stroke volume: amount of blood pumped out of each ventricle during systole; typical SV ~70-75mL

59
Q

How is cardiac output different than stroke volume?

A

Cardiac output differs from stroke volume in that it is measured per unit time

mL/min (CO)

vs

mL (SV)

60
Q

Altering either the ________ or the _______ will alter the cardiac output

A

Altering either the Heart rate or the stroke volume will alter the cardiac output

CO=SV x HR

61
Q

How is heart rate altered?

A

By modifying the activity of the SA node (heart’s pacemaker)

62
Q

How is stroke volume altered?

A

SV can be altered by varying the strength of the contraction of the ventricular myocardium

  • when the ventricles contract, they do not empty their entire volume of blood
  • altering the strength of contraction of the ventricular myocardium will alter the SV
  • Increased strength of contraction will increase SV (decreased strength of contraction will decrease SV)
63
Q

What does it mean that the heart has a resting autonomic tone?

A

Both the sympathetic and parasympathetic systems are active at a steady background level (called tone)

64
Q

Parasympathetic and sympathetic effects are _______ for heart rate

A

Parasympathetic and sympathetic effects are Antogonistic for heart rate

65
Q

Under resting conditions, which branch of the ANS dominates Heart Rate?

A

Parasympathetic

66
Q

Parasympathetic and sympathetic effects on the heart are _____ (originate outside of the heart)

A

Parasympathetic and sympathetic effects on the heart are extrinsic (originate outside of the heart)

67
Q

How is heart rate increased?

  • increased _______ activity and increased release of ________ from the adrenal _______ will stimulate/increase the activity of the _____ which increases heart rate and cardiac output
  • As the sympathetic and parasympathetic are antagonistic, activity in the _______ system must be decreased
A

How is heart rate increased?

  • increased sympathetic activity and increased release of epinephrine from the adrenal medulla will stimulate/increase the activity of the SA node which increases heart rate and cardiac output
  • As the sympathetic and parasympathetic are antagonistic, activity in the parasympathetic system must be decreased
68
Q

To decrease Heart Rate, must increase activity of the ________ division

  • increased parasympathetic activity will ______ the activity of the ______ thereby decreasing the HR and CO
A

To decrease Heart Rate, must increase activity of the parasympathetic division

  • increased parasympathetic activity will decrease/inhibit the activity of the SA node thereby decreasing the HR and CO
69
Q

What is responsible for initiating the heart rate?

A

conducting myocytes in the heart

  • myocytes of the SA node are the heart’s pacemaker generating the AP’s that are responsible for HR
70
Q

Epinephrine, a hormone secreted by the _______ into the blood, acts similarly to norepinephrine released by the ________

A

Epinephrine, a hormone secreted by the adrenal medulla into the blood, acts similarly to norepinephrine released by the sympathetic nerves

71
Q

To increase HR

  • increased plasma _____, increased release of _______ from _______ nerves, and decreased release of _________ from parasympathetic nerves acts on _____ to increase hr
A

To increase HR

  • increased plasma epinephrine, increased release of norepinephrine from sympathetic nerves, and decreased release of acetylcholine from parasympathetic nerves acts on SA node to increase hr
72
Q

What are three factors that effect Stroke volume?

A
  1. The end-diastolic volume (EDV) also called the preload
  2. Contractility of the ventricular myocardium
  3. afterload
73
Q

What is EDV?

A

End diastolic volume : volume of blood in the ventricles at the end of ventricular diastole (after ventricles have finished filling)

74
Q

The heart has an _______ mechanism to alter stroke volume

A

Intrinsic

75
Q

The relationship between the end-diastolic volume and stroke volume is defined by the ________

A

The relationship between the end-diastolic volume and stroke volume is defined by the Frank-starling mechanism

76
Q

What does it mean that stroke volume is intrinsic?

A

Ventricles will contract more forcefully when they have been stretched prior to contraction

And the stretching of the ventricles is increased by filling the ventricles with more blood

77
Q

How do you fill the ventricles more fully with blood?

A

Increase the venous return

  • fill ventricles more fully
  • increase the EDV
  • Increase SV
  • increase CO
78
Q

What is preload?

A

Tension (or load) on the ventricular myocardium before it begins to contract

(Aka EDV: amount of filling of the ventricles at the end of diastole)

79
Q

How is venous return increased?

A

Sympathetic stimulation of venous smooth mm causing vasoconstriction (extrinsic)

*parasympathetic innervation doesn’t effect venous volume bc most vessels only have sympathetic innervation

80
Q

What is the Frank-Starling Mechanism?

  • Extrinsic or intrinsic
  • stimulation from?
  • describes the relationship between what two factors?
A

What is the Frank-Starling Mechanism?

  • intrinsic
  • Independent of neural or hormonal stimulation
  • describes the relationship between End diastolic volume and stroke volume
    • As you increase EDV you increase SV
81
Q

Why does an increased EDV lead to an increased SV?

  • main determinant for sarcomere length is the degree of _______
  • the initial length of the sarcomere will affect the ______ generated during contraction
  • As the ventricles become more filled with blood, the cardiac fibres on the sarcomeres stretch out, putting more load on the sarcomeres;
    • how does this affect ventricular contraction and SV?
A

Why does an increased EDV lead to an increased SV?

  • main determinant for sarcomere length is the degree of diastolic filling
  • the initial length of the sarcomere will affect the tension generated during contraction
  • As the ventricles become more filled with blood, the cardiac fibres on the sarcomeres stretch out, putting more load on the sarcomeres;
    • ventricles will contract more forcefully when they have been stretched and SV will increase
82
Q

The frank-starling mechanism is a _________-________ curve

A

The frank-starling mechanism is a length-tension curve

83
Q

What does the Frank-Starling mechanism ensure?

A

Matches the outputs of the two ventricles to ensure that the two ventricles pump the same amount/volume of blood and that blood doesn’t accumulate in one circuit compared to the other

84
Q

Under normal conditions the ejection fraction of the ventricles is between:

A

50-75%

85
Q

What is contractility?

A

The strength of contraction at any given EDV

86
Q

A change in the contractality of the ventricles will alter the _________ pumped by the blood during _____ (aka the ___

A

A change in the contractility of the ventricles will alter the volume of blood pumped by the blood during systole (aka the SV)

87
Q

What effect would increased sympathetic stimulation have on contraction of the ventricular myocardium?

A

Increased sympathetic stimulation iwll increase the strength of contraction of the ventricular myocardium increasing SV and CO

88
Q

How would increased parasympathetic activity affect the contractility of the ventricles?

A

Altering parasympathetic activity will not affect contractility of the ventricles and SV as the ventricular myocardium receives little or no parasympathetic innervation

89
Q

Sympathetic stimulation ________ contractility

A

Sympathetic stimulation increases contractility

90
Q

How is the frank-starling mechanism altered under sympathetic stimulation?

A

Frank-starling mechanism still applies under sympathetic stimulation but during sympathetic stimulation, the stroke volume at any give end diastolic volume is GREATER

ie at the same EDV, there is an increase in SV under sympathetic stimulation

91
Q

What effect does increased contractility have on ejection of blood?

A

Increased contractility leads to a more complete ejection of blood = increases ejection fraction

92
Q

Calculate Ejection Fraction:

A

SV/EDV

Stroke volume

End diastolic volume

93
Q

How does sympathetic stimulation give the ventricles more time to fill?

A

Under sympathetic stimulation, the heart contracts and relaxes faster, giving more time for the ventricles to fill despite the increase in heart rate

94
Q

Sympathetic regulation of myocardial contractility acts through a _______ mechanism

A

Sympathetic regulation of myocardial contractility acts through a G-Protein coupled mechanism

95
Q
A