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Pharmacology: CV
Cardiovascular Lecture - 10-23-09
108
Nursing
Graduate
10/28/2009

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Cards

Term
Explain pulmonary and systemic circulation.
Definition

Pulmonary: Blood enters right atrium from vena cava > tricuspid valve > right ventricle > pulmonary artery > lungs > pulmonary vein

Systemic: Pulmonary vein > Left atrium > Mytrial Valve > Left ventricle > Aortic valve > Aorta > Arteries > Capillarys > Veins

Term
Describe differences in pulmonary and systemic circulation.
Definition

Pulmonary: Low pressure (12 mm Hg) - Good for gas exchange

Systemic: High Pressure (90-100 mm Hg) - Good for transporting and traveling distances against gravity

Term
What are the 2 pump series?
Definition

1. Semilunar (Aortic and Pulmonary)

2. AV Valves (Tricuspid and Mytrial)

Term
What is the pressure of the blood through the circulatory system?
Definition

Aorta/Systemic - 100-120 mm Hg

Capillaries - 30 mm Hg

Veins - 12 mm Hg

Vena Cava - 0 mm Hg

Term
What are the 4 factors that govern the function of the cardiovascular system?
Definition
Volume, Pressure, Flow, Resistance
Term
The heart has what type of pump?
Definition
Intermittent
Term
Blood Pressure =
Definition
Cardiac Output  X  Peripheral Vascular Resistance
Term
Cardia Output =
Definition
Stroke Volume  X  Heart Rate
Term
What determines Peripheral Vascular Resistance?
Definition
Diameter of the vessels
Term
Describe the Volume & Pressure distribution throughout the systemic circulation.
Definition

Volume

64% Veins

16% Arteries

4% Capillaries

4% Left ventricle

4% Right ventricle

 

Pressure

Greatest at Aorta (90-100 mm Hg)

No pressure in vena cava (0 mm Hg)

Term
What are the 3 layers of the blood vessel and their function?
Definition

1. Intima - Elastic layor - able to bend and move flexibly

2. Media - Consists mostly of smooth muscle that constricts or dilates the vessels based on the ANS and the release of Alpha receptors

3. Externa - Fibrous and connective tissue - Tough to protect the arteries

Term
How is the capillary structure different from an artery or vein structure?
Definition
Capillaries have no smooth muscle.
Term
How do resistance Atrioles maintain blood pressure?
Definition

The diameter of an atriole is determined by the degree of contraction of the smooth muscle, which is mediated by the ANS (alpha-1 receptors)

 

 

* The diameter of the artery/arteriole is determined by the degree of contraction of the smooth muscle, which is mediated by the SNS (alpha receptors).

Term
Alpha 1 & 2 Receptors
Definition

Constrict blood vessels

Increase Blood Pressure

Term
Beta 1 Receptors
Definition

Increase Heart Rate

Increase Conductability

Release Renin

Term
Beta 2 Recetors
Definition
Dilate arteries and veins
Term
In a healthy individual, blood vessels constrict or relax to meet the demands of _______________.
Definition
Tissues and organs
Term
What organs require the largest amount of blood flow?
Definition
Liver, Heart, Kidneys, Brain
Term
What are the major resistant vessels in the circulatory system?
Definition
Arteries
Term
What role do the arteries play in the circulatory system?
Definition
Arteries determine the systemic vascular resistance
Term
What causes the arteries to constrict or relax?
Definition

SNS - Sympathetic fibers innervate (send signals) to arteries, causing them to constrict or relax, to maintain blood pressure.

Alpha 1 receptors are in charge of constricting or relaxing the arteries.

Term
What are the 2 primary functions of veins?
Definition

1. Carry blood back to the heart

2. Store blood

Term
Venous constriction can increase the ______________ to the heart by conducting stored blood into the vena cava.
Definition
Preload
Term
What do veins have that arteries don't?
Definition
Valves to prevent backflow of blood
Term

What is the pressure of the venules?

The Vena Cava?

Definition

Venules: 10 mm Hg

Vena Cava: 0 mm Hg

Term
How does the endothelial cell structure change in veins/arteries and capillaries?
Definition

In veins and arteries, the endothelial cell layer is compact; the cells are close together so blood does not escape the systemic circulation in unwanted places.

In capillaries, the endothelial cells are loosely connected, allow nutrients, particles, gas and other particles into the blood stream. The capillaries do not allow large protein molecules in.

Term
Capillaries are composed of ________________ surrounded by __________.
Definition

1. Endotelium cells

2. Basement membrane

Term
What structure do capillaries contain that allow the passage of small molecules?
Definition
Fenestrations
Term
Explain how the SNS constricts vessels.
Definition

Norepinephrine is released from the ANS, which activate the Alpha-1 Receptors. Alpha-1 Receptors cause calcium channels to open, which produces vasoconstriction

 

Calcium Causes Contraction

Term
Explain how the SNS dilates vessels.
Definition
SNS activate Beta 2 receptors to close the calcium channels - which prevent the vessel from consticting - therefore the vessel dilates.
Term
How does your body know how much blood to send to the organs?
Definition
Minute-to-Minute basis
Term
What are 2 mechanisms that control the amount of blood being sent to the tissues/organs?
Definition

Neural Mechanism (Regulate CO and BP to control how much of blood is sent to the tissues or organs)

Local Control Mechanisms (Local vasoconstriction or dilation mediated by the CNS OR by organ intrinsic mechanisms)

Term
What factors are released from tissues or organs that constrict or dilate local blood vessels?
Definition

Histamine: Dilates blood vessels - Increase blood flow to local vessels

Seratonin: Constricts blood vessels - Decrease blood flow to local vessels

Term
How does the endothelium control vascular smooth muscle vasodilation and vasoconstiction?
Definition

Vasodilation: Nitric Oxide

Vasoconstriction: Prostaglandins, Angiotensin II and Endothelins

Term
Explain the Ananomical Structures of the Heart.
Definition

Endocardium - inner layer

Myocardium - Thick muscle surrounding the heart

Viscerial Pericardium - Outside of the heart - Start of the pericardium cavity

Parietal pericardium - Outermost layer - surrounds the pericardial cavity

Term
What is pericardial effusion?
Definition
Fluid or blood fills the pericardial cavity around the heart.
Term
What type of cancer are you likely to see pleural effusion with?
Definition

Leukemia and cancers of the blood

Cancers of the blood do not produce tumors - instead they inflame organs by filling pleural spaces around the lungs

Term
What is the MAJOR function of heart valves?
Definition
To control the one way flow of blood
Term
What are the heart valves?
Definition
Pulmonary Valve, Aortic Valve, Tricuspid Valve, Mytrial Valve
Term
What is the cardiac conduction system?
Definition

Electrical impulses that set the pace of the heart

Stimulates the myocardium (heart muscle) to contract and pump blood

Term
What are the 2 conduction systems?
Definition

Atrial Conduction

Ventricular Conduction

Term
What conduction is known as the "Pacemaker"? How many beats per minute?
Definition

SA Node

60-100 BPM

Term
How is the heart rate determined in cardiac conduction?
Definition

Beta 1 receptors from the SNS stimulate an increased heart rate

Muscarinic receptors decrease heart rate

Term
What is the 2nd/back-up pacemaker of the heart? How much does it beat per minute?
Definition

AV Node

40-60 bpm

Term
What is the function of the Purkinje Fibers?
Definition

Function: Ventricular Contraction

BPM: 15-40 BPM

Term

ECG:

What does the P stand for?

Definition
Atrial Depolarization
Term

ECG:

What does the QRS Stand for?

Definition
Depolarization of the ventricle
Term

ECG:

What does the T stand for?

Definition
Repolarization of the Ventricle
Term

ECG:

When does the atrial repolarize?

Definition
It is hidden in the QRS phase
Term
What is the cardiac cycle?
Definition
Rhythmatic pumping of the heart
Term
What are the 2 parts of the Cardiac Cycle?
Definition

Systole: Contacting

Diastole: Relaxing

Term
Explain Venticular Systole
Definition
Tricuspid and Mitrial Valves shut (S1) > All valves are closed for a brief second > Ventricular pressure is greater then Aortic or Pulmonary Artories > Ventricule contract > Pushing the blood out of the heart > When the aorta or pulmonary artery pressure is greater then the ventricle, small amount of blood triggeres back to close the semilunar valves (S2)
Term
2 Phases of Systole
Definition

1. Isovolumetric Contraction

2. Ejection

Term
Explain Ventricular Diastole.
Definition
Semilunar valves close. The pressure in the atrium is higher then the pressure in the ventricle; AV valves open; Ventricles rapidly fill (S3); Atrium Contracts (Atrial Kick) to squeeze out the last 25% of blood into the ventricle (Atrial Kick is S4)
Term
What are the 2 phases of systole?
Definition

Isovolumetric relaxation

Rapid Filling

Term
Atrial contraction is important during ________________ or other _______________ disease that impairs ventricular filling.
Definition

Tachycardia

Heart

Term
What is Cardia Output?
Definition
The amount of blood the heart pumps per minute.
Term
What is stroke volume?
Definition
The amount of blood the heart pumps per each beat (about 70mL/beat)
Term
How do you calculate Cardiac Output?
Definition
CO = SV  X  HR
Term
Cardiac Output varies with _________________________ and ______________________ and/or _________________.
Definition

1. Body Activities

2. Stroke Volume

3. Heart Rate

Term
What is heart rate?
Definition
The frequency the blood is ejected from the heart.
Term
Do heart rate and cardio ouput have an inverse or direct relationship?
Definition

Direct

Heart rate increases : Cardiac Output increases

Term
How does heart rate increase or decrease?
Definition

Activation of Beta-1 Receptors: HR Increases

Activation of Muscarinic Receptors: HR Decreases

Term
Is Diastolic Filling directly or inversly related to Heart Rate?
Definition

Inverse

Heart Rate Increases : Diastolic Filling Decreases

Term
A decrease in diastolic time results in ___________ in stroke volume and __________ in cardiac output.
Definition

1. Decrease

2. Decrease

Term
Why is Tachycardia dangerous?
Definition
Heart does not have time to fill adequately, which results in decreased Cardiac Output
Term
What are the components of Stroke Volume?
Definition
PreLoad, AfterLoad, Contractility
Term
What is preload?
Definition
Ventricle filling with blood; volume of blood the heart must pump with each beat
Term
Preload is determined by __________ and ___________.
Definition

1. Venous Return

2. Stretch of the muscle fibers

Term
64% of blood volume is in the veins. Preload is determined by Venous Return. Venous constriction is mediated by ___________ Receptors
Definition
Alpha - 1
Term
Alpha Receptors vs. Beta Receptors for Cardiovascular
Definition

Alpha = After > Alpha receptors constrict vessels after the eart

Beta = Before > Beta receptors control heart rate before the blood goes out to the periphery

Term
Explain Frank-Sterlings Law of the Heart
Definition

The normal heart will pump what is given. The more venous return, the more force the ventricle will develop, the more blood it will pump.

 

At High volumes, the heart muscles become over stretched and contractility decreases.

Term
Overstretched heart muscles occur in people with ....
Definition
Chronic Stress or Heart Failure
Term
Increased Contractility is an ________________ property of the heart; NOT part of the SNS
Definition
Intrinsic
Term
What is Afterload?
Definition
The pressure the heart must develop during the period of isovolumetric contraction to open the aortic and pulmonary valves.
Term
Major source or resistance is ... ?
Definition

Arterial Pressure

(Right (Pulmonary) and Left (Systemic) Ventricle)

Term
Diseased semilunar valves cause ___________ Resistance.
Definition
Increased Resistance
Term
What are some examples of diseased semilunar valves?
Definition

Stenosis/Narrowing of the artery (The heart has to develop increased pressure to open the diseased valve)

Diastolic Hypertension (Increases pressure to open aortic valve)

Term

What is important in people with normal hearts?

A. Afterload

B. Preload

C. Contractility

Definition
Preload - Determines Cardiac Output for people with normal functioning hearts
Term
What is an important determinant of Cardiac Output in people with heart disease?
Definition
Afterload
Term
What is contractility?
Definition
Ability of the heart to change its force of contraction
Term
What influences Contractibility?
Definition

1. Determined by Biochemical and Biophysical properties that govern actin and myosin interactions in myocardial cells.

2. Activation of Beta-1 Receptors in the ventricles by norepinephrine increases the availability of calcium ions and increases contractibility.

Term
Arterial Pressure must remain ________________ as blood flow shifts from one area of the body to another area.
Definition
Constant Constriction
Term
What would happen if the arterial pressure remained dilated?
Definition
The blood flow would fall down to the feet.
Term
What system is responsible for Long Term Blood Pressure Regulation? Short Term Regulation?
Definition

Long Term: 

* RAAS

* Kidneys control blood volume as well as RAAS (long term mechanism of BP control)

 

Short Term

* Autonomic Nervous System (ANS)

Term
Explain the baroreceptors reflex (cardiac).
Definition

Sensory:  Baroreceptors in the aortic arch and carotid artery

 CNS: Autonomic centers in the brainstem

 

Motor:  Cardiac muscle, cardiac conduction system, and vascular smooth muscle.

Term
What are the components of the Baroreceptor Reflex?
Definition
[image]
Term
What are the receptors in the ANS regulation of Blood Pressure (Baroreceptor Reflex)
Definition
[image]
Term
Kidneys control long-term regulation of blood pressure through ___________ and __________balance.
Definition
Sodium and Water Balance
Term
Neural mechanisms act _____________ on BP, but _________ maintain their effectiveness over time.
Definition

1. Rapidly

2. Cannot

Term
What is the humoral mechanism of Blood Pressure? (Long term response of BP from the kidneys)
Definition
RAAS (Renin Angiotensin-Aldosterone System)
Term
How does Vasopressin contribute to Blood Pressure?
Definition

1. Reabsorbs water by the kidneys

2. Increased Extracellular Water Volume

 

*Note: Hypothalamus stimulates thrist so the person is ingesting more fluids.

Term
What is Orthostatic Hypotension?
Definition
Abnormal drop of blood pressure (> 20 mm Hg in Systolic; > 10 mm Hg in Diastolic) when moving to standing position
Term
What happens, during Orthostatic Hypotension, when there is an absence of normal circulatory reflexes or if blood volume decreases?
Definition

1. Blood pulls in lower part of the body when the standing position is assumed >

2. Causing a decreased venous return, Decreased Cardiac Output and blood flow to the brain is inadequate®

 3. Causing dizziness, syncope (fainting), or both

Term
Causes of Orthostatic Hypotension
Definition

1. Reduced blood volume, reduced preload (dehydration)

2. Drug-induced

3. Aging - sluggish reflexes, including baroreceptors

4. Bed Rest

5. Disorders of the ANS

Term
How do drugs induce Orthostatic Hypotension?
Definition

1. Diuretics: Reduce preload by dehydrating the patient

2. Beta and Alpha-1 Blockers: Impair the baroreceptor reflex

3. Calcium Channel Blockers: Impairs venous return; reduced preload

Term
What is the most common cause of Orthostatic Hypotension among young people?
Definition
Reduced Blood Volume, Dehydration
Term
Treatment for Orthostatic Hypotension
Definition

1. Alleviate Cause (Rehydrate, Meds)

2. Help cope with the disorder, prevent falls and injuries,

Gradual ambulation (sit on edge of bed, move legs)
Avoid venodilation (drinking ETOH; exercise in warm environment)
Maintain hydration
Term
Hypertension is a leading risk factor for ___________________ disease. List some examples.
Definition

1. Cardiovascular Disorders

 

Examples

1. Myocardial Infarction

2. Heart Failure

3. Stroke

4. Vascular Disease

Term
People who have ___________, have a greater risk for developing hypertension.
Definition
Diabetes
Term
Characteristics of population prone to developing Hypertension.
Definition
Men more then women, Blacks more then whites, Older/Increased age, Low SES (Socioeconomic Status) 
Term
What is primary Hypertension?
Definition

Essential Hypertension

* Chronic rise in blood pressure that occurs with out evidence of other diseases.

(90-95%)

Term
What is Secondary Hypertension?
Definition

Elevation of Blood Pressure comes from some other disorder

(Ex: Kidney Disease, Chronic Renal Failure, Disorders of Adrenocorticoid hormones - pheochromocytoma)

Term
Pheochromocytoma
Definition
A neuroendocrine tumore of the medulla of the adrenal glands that secretes excessive amounts of catecholamines, usually adrenaline and nonadrenaline.
Term

Hypertension Definitions

JNC-VII

Definition

 

JNC-VII* (June 2003)
Prehypertension” (120-139/80-89)
Stage I (140-159/90-99)
Stage II (160-179/100-109)
Stage III (>180/>110)
Term
Innate risk factors for Hypertension.
Definition

Family history

Age related changes

Insulin resistance, metabolic syndrome, diabetes (especially type II)

Race

African Americans more prevalent, early onset, more severe; greater renal, CV damage
Term
Lifestyle Risk Factors for Hypertension
Definition

 

Diet high in Na+ & saturated fats
Obesity & Diabetes
Physical inactivity
Excessive alcohol consumption
Oral contraceptives in predisposed women
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