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Key Concepts for CV Part I
Week 5 key concepts
35
Nursing
Undergraduate 1
01/29/2012

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Term
What is Starling's Law? What is the relationship btw Starling's Law and PreLoad?
Definition
The force of ventricular contraction is proportional to muscle fiber length. As a result of this direct relationship, the heart matches its output to the volume of venous return. Preload is the amount of stretch resulting from venous return and determines the force of ventricular contraction.
Term
What is the formula for determining Arterial Pressure?
Definition
AP = PR x CO
Term
What is main outcome of arterial pressure?
Definition
Arterial Pressure is the force that drives blood through the ARTERIAL side of systemic circulation.
Term
What are the 3 main regulators of ARTERIAL PRESSURE?
Definition
Steady state ANS innervation, Baroreceptor Reflexive ANS control, and RAAS control by the kidney.
Term
What arterial pressure conditions can cause Postural Hypotension? What is the body's response?
Definition
Decreases in AP r/t pooling of blood in veins-->decreased venous return-->decreased CO; decreased SBP, increased HR.
Term
What are the determinants of cardiac output?
Definition
CO = SV x HR
Term
What are the determinants of Stroke Volume (SV)?
Definition
Myocardial contractility, cardiac AFTERLOAD and cardiac PRELOAD.
Term
What factor contributes to PRELOAD? What is the relationship to SV?
Definition
Force of venous return, an increase in preload will increase the SV
Term
What factor contributes to AFTERLOAD? What is the relationship to SV?
Definition
Arterial pressure that the Left Ventricle has to overcome to eject blood. As afterload increases SV decreases.
Term
What is myocardial contractility? What is it determined by?
Definition
The force with which the ventricles contract. The degree of cardiac dilation primarily determined by the amount of venous return.
Term
What is the relationship of EJECTION FRACTION to SV?
Definition
Ejection fraction = SV/EDV (EDV is end diastolic volume) and lower EF's are a poor indication.
Term
What are the implications of peripheral resistance and pulmonary resistance on CO and blood flow through the CV system?
Definition
Increases in peripheral and pulmonary resistance will increase afterload, decrease SV and decrease CO. Decreased CO decreases blood perfusion throughout the CV system.
Term
What is the definition of INOTROPIC?
Definition
Changes the strength of the heart muscle's contractions.
Term
What is the definition of CHRONOTROPIC?
Definition
Changing the heart rate.
Term
What classes of drugs can DECREASE PRELOAD?
Definition
DIURETICS and VENOUS DILATORS: ACE IHI, ARB, Aldosterone Blockers
Term
What increases PRELOAD?
Definition
Body products and fluids.
Term
What classes of drugs DECREASE afterload?
Definition
Arterial Dilators (Ca++ blockers, ACE IHI, ARB's, Antihypertensives)
Term
What classes of drugs INCREASE afterload?
Definition
VASOPRESSORS [causing constriction of blood vessels] (eg dopamine, epinephrine, VASOPRESSIN (aka ADH))
Term
What is the relationship between CARDIAC DEMAND for O2 and Supply of O2 r/t cardiac output?
Definition
Imbalance btw cardiac O2 supply and demand leads to MI, ischemia and angina pain.
Term
RAS- what are the main actions of angiotensin II?
Definition
ANGIOTENSIN II is a powerful Vasocontrictor; it also promotes the release of aldosterone from the kidneys.
Term
RAS--what are the effects of ALDOSTERONE release from the kidneys?
Definition
Increases blood volume and therefore blood pressure.
Term
Where in the Renin-Angiotensin System (RAS) do ACE Ihi's work?
Definition
They block ACE which prevents it from forming Angiotensin II and Inactivating bradykinin
Term
Where in RAS do BETA BLOCKERS work?
Definition
Decrease renal blood flow and consequently RENIN release.
Term
Where in RAS do ARB's work?
Definition
They block Angiotensin II receptors in BV, the adrenals and all other tissues.
Term
Where in RAS do Direct Renin IHI work?
Definition
They act on Renin to prevent the conversion of Angiotension I to Angiotensin II.
Term
Where in RAS do SARA's work? (selective aldosterone receptor antagonists)
Definition
Block receptors for aldosterone to prevent HTN and heart failure (ie in the kidney activation of aldosterone receptors promotes K excretion and Na/water retention)
Term
ACE IHI: MOA, Indications, Side Effects, Implications:
Definition
Reduces lvls of angiotensin II, TX HTN, heart failure, diabetic nephropathy and MI, PREVENT adverse cardio events in at risk pts; SIDE EFFECTS cough, angioedema, hyperkalemia, first dose hypotension, renal failure FETAL INJURY (2/3 trimester) Implications: can cause Li to build to toxic lvls
Term
ARB: MOA, Indications, Side Effects:
Definition
Block ANGIOTENSIN II receptors, Reduce BP/HTN, Heart Failure, Diabetic Nephropathy, Stroke prevention. Side Effects: Angioedema, Fetal Injury, Renal failure.
Term
Aldosterone Blockers (non selective): MOA, Indications, Side Effects:
Definition
Blocks receptors for Aldosterone AND other steroid hormones. HTN/Heart failure. Gynecomastia, Hirsuitism, Impotence, Menstrual irreg., deeper voice, etc.
Term
SARA's: MOA, Indications, Side Effects:
Definition
Selective antagonists JUST for aldosterone receptors. HTN/Heart failure. Generally well tolerated.
Term
Effects of combining ACE IHI and Diuretics/AntiHTN and CCB and Beta Blockers?
Definition
They will have additive effects! (more vasodilation/hypotension)(Both reduce force of contraction in the heart, bradycardia, AV block and heart failure!
Term
What class of drugs are PRODRUGS? Where are they converted into active drugs?
Definition
ACE Ihi are prodrugs, activated in the small intestines and the liver.
Term
What are the effects of stimulating alpha 1 receptors on peripheral vasculature?
Definition
VASOCONSTRICTION.
Term
What are the CV effects of Beta 1 stimulation?
Definition
increase heart rate, conduction, contractility; increases renal perfusion
Term
What are the CV effects of Beta 2 stimulation?
Definition
Vasodilation in skeletal muscle, heart and lungs; Bronchiodilation.
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