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Cardiovascular Overview
Heart
38
Pharmacology
Graduate
08/19/2013

Additional Pharmacology Flashcards

 


 

Cards

Term
Pumonary Circulation
Definition

Pumps blood throught the lungs

 

Right ventricle ---> pulmonary artery (no oxygen) ---> lungs ---> pulmonary vein (oxygen) ---> left ventricle

Term
Systemic Circulation
Definition

Pumps blood to organs and tissues

 

Left ventricle --> aorto to organs/tissues --> right atrium (via superior or inferior vena cava)

Term
Diastole
Definition

Time where the heart refills with blood after systole

 

Tricuspid valve and Mitral valve are open and the Pulmonary valve and Aortic Valve are closed

Term
Systole
Definition

Contraction of the heart

 

Tricuspid and mitral valves are closed and the pulmonary and aortic valves are open

Term
Non-Renin Creation of Angiotensin II
Definition

T-P Factor

Cathepsin P

Tonin

Term
Non-ACE Synthesis of Angiotensin II
Definition

Chymase

CAGE

Cathepsin P

Term

Consequences of Angiotensin II on AT I Receptor

 

Vascular Smooth Muscle Growth

Definition

(Generally negative consequence)

 

Increase arteriolar constriction

Term

Consequences of Angiotensin II on AT I Receptor

 

CNS

Definition

(Generally Negative Consequences)

 

Stimulate to increase cardiac output

Term

Consequences of Angiotensin II on AT I Receptor

 

Adrenal Cortex

Definition

(Generally negative consequences)

 

Aldosterone stimulation

Increase renal sodium reabsorption

Term

Consequences of Angiotensin II on AT I Receptor

 

Kidney

Definition

Generally negative consequences

 

Increase filtration fraction

Increase GFR

 

(Over a chronic fashion, it can damage the kidneys)

Term

Consequences of Angiotensin II on AT I Receptor

 

Brain

Definition

Generally negative consequences

 

Increase ADH (antidiuretic hormone) and thirst

Increase free water intake

Term
Consequences of Angiotensin II on AT II Receptor
Definition

Generally positive consequences

 

Vasodilation

Anti-proliferation

Cell differentiation

Tissue repair

Term

Consequences of Aldosterone

 

Heart

Definition

Myocardial fibrosis

Ventricular arrhythmias

Left ventricular hypertrophy (LVH) (enlargening of the heart to decrease the burden on the heart)

Term

Consequences of Aldosterone

 

Kidney

Definition

Sodium retention

Magnesium and potassium loss (hyperkalemia)-Specifically with aldosterone blockers

Term

Consequences of Aldosterone

 

Vasculature

Definition

Hypertension

Endothelial dysfunction

Inhibits nitric oxide synthesis

Prothrombotic

Term

Consequences of Aldosterone

 

CNS

Definition

Sympathetic activation

Parasympathetic inhibition

Term
Preload
Definition

May lead to cardiac remodelling, it can lead to blood backing up into lungs, etc. if preload is high

 

Pressure stretching the ventricle of the heart after atrial contraction and subsequent filling of the ventricle

 

End diastolic volume (clinically)

Term
Afterload
Definition

Tension or pressure used by the chamber of the heart in order to contract and eject blood out of the chamber

 

End systolic volume (clinically)

Term

Stroke Volume

(SV)

Definition

SV = End diastolic volume - End systolic volume

 

What actually got pumped out of the heart

Term

Cardiac Output

(CO)

Definition

Amount of blood pumped per unit of time

 

L/min

 

CO = Heart rate x SV

Term

Cardiac Index

(CI)

Definition

CO adjusted for BSA

 

L/min/m2

 

CI = CO / BSA

Term

Ejection Fraction

(EF)

Definition

Fraction of blood ejected by the left ventricle (LV) during contraction or ejection phase of cardiac cycle

 

EF = SV/EDV (End-Diastolic Volume) x 100%

 

55-75% is normal

Term

Mean Arterial Pressure

(MAP)

Definition

Average blood pressure in an individual

 

MAP = (CO x Systemic vascular resistance [SVR])+Central venous pressure (CVP))

 

MAP=[(2 x Diastolic pressure)+systolic pressure]/3

Term

Pulmonary Capillary Wedge Pressure

(PCWP)

Definition

Under most circumstances provides an accurate estimate of the diastolic filling (preload) of the left heart

 

During diastole when mitral valve is open, the PCWP reflects LVEDP. LVEDP is an index of left ventricular end-diastolic volume (preload)

Term

Clinical Assessment of Hemodynamic Parameters

 

Preload

Definition

Hepatomegaly (enlarge liver, measure LFTs, palpatate their liver)

Jugular venous distention (JVD)

Peripheral edema

Pulmonary crackles

S3 heart sound (seen w/ extreme heart failure and increased preload)

Mucous membrane and skin turgor

Daily weight

Term

Clinical Assessment of Hemodynamic Parameters

 

Afterload

Definition

Vascular diastolic pressure (decrease) systolic pressure may increase or stay the same

 

Pulse pressure

 

Pulses

Term

Clinical Assessment of Hemodynamic Parameters

 

Role of the Swan Ganz Catheter

Definition

Used to measure pulmonary artery pressure, especially in the acute decompensated heart failure patient

 

Diagrams showing placement of catheter

 

(Measures pressure)

Term
Arteriosclerosis
Definition
Hardening of the arteries
Term
Atherosclerosis
Definition

Subset of arteriosclerosis

 

Formation of atheroma (fibrous fatty intimal plaques) in arterial walls

Term

Ischemic Heart Disease

(IHD)

 

aka

Coronary Heart Disease (CHD), Coronary Artery Disease (CAD), Atherosclerotic Vascular Disease (AVD)

Definition

Ischemia is a lack of oxygen tension at the cellular level and results in loss of high enery phosphates due to disruption of aerobic metabolism

Cardiovascular dysfunction occurs at the cellular level due to imbalance between myocardial oxygen supply and myocardial demand, may be transient or permanent (cell death), cellular dysfunction translates into organ dysfunction

Etiology: Atherosclerosis

Term
4 Main Steps in the Development of Atherosclerosis
Definition

1. Endothelial dysfunction

 

2. Fatty streak formation

 

3. Fibrous plaque

 

4. Thrombus formation

Term
Main Roles of the Endothelium
Definition

1. Maintenance of permeability barrier

2. Maintain nonthrombogenic blood-tissue interface (regulate thrombosis, thrombolysis, and platelet adherence)

3. Modulate vascular tone and blood flow

4. Regulate immune and inflammatory reactions (control leukocyte interactions within the vessel wall)

5. Modify lipoproteins in the artery wall

6. Regulate the growth of other cell types, particularly smooth muscle cells

Term
Definition of Endothelial Dysfunction
Definition
Diminished ability of the endothelium to regulate vascular tone, clotting, and inflammation
Term
Causes of Endothelial Dysfunction
Definition

Age (Not modifiable)

Sex (Male>Female)

Smoking

Family history of CHD (Not modifiable)

Dyslipidemia (Increase total cholesterol or LDL, decrease HDL-C)

Obesity

Diabetes

Hypertension

Increase homocysteine

Term
Results of Endothelial Dysfunction
Definition

Vasoconstriction, pro-thrombotic, and pro-inflammatory

 

Angiotensin II and endothelin produced as a result of the dysfunctional endothelium resulting in vasoconstriction

Term
Fatty Streak Formation Process
Definition

Inside the artery wall monocytes differentiate into macrophages

Macrophages engulf lipoproteins (LDL) and then form foam cells

Both macrophages and foam cells secrete growth factors and cytokindes resulting in cell proliferation, inflammation, matrix degradation

Term
Formation of Fibrous Plaque Process
Definition

Foam cells accumulate and expand in the lining of the artery wall

Smooth muscle cells from the middle layer of the artery (media) move into the layer of endothelial cells (intima)

Plaque grows and protrudes into the lumen of the blood vessel

Fibrous cap of connective tissue overlays the fibrous plaque (prevents vessel from bursting)

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