NURS 5315/ NURS5315 Exam 3 – Advanced Pathophysiology
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Question:
How does blood flow through the heart chambers/valves?
Answer
Superior vena cava to inferior vena cave. Blood then enters the right atrium and passes through the tricuspid valve to
the right ventricle. The right ventricle pumps the blood to the lungs through the pulmonary valve to the pulmonary
arteries where it becomes oxygenated. The oxygenated blood is brought back to the heart by the pulmonary veins
which enter the left atrium. From the left atrium blood flows through the bicuspid (mitral) valve into the left ventricle.
Question:
Which coronary arteries provide blood to which part of the heart?
Answer
a. ) Left coronary artery
i.) Left anterior descending artery:widow maker
LV and RV, intraventricular septum
ii. ) Circumflex: LA and left lateral wall of LV.
b. ) Right coronary artery
RV, intraventricular sulcus and small vessels of the RV and LV
Question:
What factors contribute to blood flow in a vessel?
Answer
Pressure difference between two ends of a vessel
Resistance: r/t diameter of a vessel
Viscosity (n) of the blood
Length (l) of the vessel
Question:
What does QP: QS mean and what factors alter a normal ratio?
Answer
Q=blood flow
QP= blood flow to the lungs (pulmonary) : QS= blood flow to the body (systemic)
i ) Vascular resistance =measures in woods units
ii) Pulmonary vascular resistance (PVR)
1. ) 8 weeks of age: 1-3 woods units/m2
iii) Systemic vascular resistance
1. ) Infant 10-15 woods units/m2
2.) 1-2 years old: 15-20 woods units/m2
3.) Child to adult: 15-30 woods units/m2
a) Factors affecting resistance
i.) Compliance-ease that blood travels through the arteries
1. Constriction and relaxation of smooth muscle of arteries and arterioles
a. ) Sympathetic nervous system
b.) Local tissue metabolism
c.) Hormone responses
d.) Changes in chemical environment
Explain the process of cardiac contraction and relaxation.
Question:
What are the roles of actin, myosin, and troponin in this process?
Answer
At rest, active sites on actin are blocked by troponin and tropomyosin complexes. During action potential, troponin C
binds with calcium and moves the complexes off the actin active site. Actin and myosin interact (contract).
Question:
"Walk-along" theory:
Answer
Head of myosin cross-bridge attached to the actin filament at the active site.
Intra molecular forces cause the myosin head to tilt forward on a flexible hinge and drag the actin filament with it
(power stroke)
Myosin head breaks away and interacts with the next actin active site.
Z disc pulls filaments together at the sarcomeres= muscle contraction.
Question:
What is the effect of Epinephrine on the cardiovascular system?
Answer
Stronger Alpha 1 than Alpha 2. Works on both, equally strong on Beta 1 (renin release), and Beta 2. Positive inotrope.
Increases heart rate, smooth muscle contraction, myocardial contractility, coronary flow, increase systolic blood
pressure, mild increase in diastolic blood pressure.
Question:
What is the effect of Norepinephrine on the cardiovascular system?
Answer
Slightly stronger Alpha 2 than Alpha 1. Some effect on Beta 1, none on Beta 2. Strong vasoconstriction (smooth muscle
contraction). Increase coronary flow, increase systolic and some diastolic BP.
Question:
What is the effect of Dopamine on the cardiovascular system?
Answer
Positive inotrope. Increases HR, increases BP (vasoconstriction) Alpha 1, 2, beta 1 and dopamine receptors)
Question:
What is the process of generating a cardiac action potential?
Answer
What electrolytes are involved?
0-Depolarization
1-Early repolarization
Rapid sodium entering the cell
2. Plateau (repolarization)
Slow sodium and calcium enters the cell
3. Potassium moves out of the cells
4. Return to resting potential
Sodium, Calcium, Potassium
Question:
What is the conduction pathway?
Answer
SA Node, AV Node, Bundle of His, Right & Left Bundle Branches, Perkinje Fibers
Question:
How does conduction correlate with the EKG and activity in the heart?
Answer
P-wave: spread of depolarization through the atria followed by atrial contraction.
P-R interval: pause in conduction at the A-V node
QRS complex: Depolarization of the ventricle, followed by ventricular contraction
T wave: depolarization of the ventricles, happens just before the end of ventricular contraction
Question:
Define preload.
Answer
Volume of blood returning to the heart from systemic circulations. RA pressure or CVP
Question:
Define afterload.
Answer
Systemic pressure=the pressure the heart must pump against to circulate blood=MAP
Question:
Define stroke volume.
Answer
Amount of blood ejected with each contraction of the heart
Question:
Define end-diastolic volume.
Answer
Amount of blood in the heart after filling, before systole (end of diastole)
Question:
Define end-systolic volume.
Answer
Amount of blood that remains in the heart after systole
Question:
Define ejection faction.
Answer
Percentage of blood in the chamber that is ejected with each systole
Question:
Define cardiac output.
Answer
Amount of blood pumped into the aorta each minute
Question:
What are the causes, risk factors, pathophysiology and manifestations of atrial fibrillation?
Answer
Risk factors/causes: Heart failure, ischemic heart disease, HTN, obesity, obstructive sleep apnea, rheumatic heart
disease, thyroid disease
Patho: Remodeling of the myocytes of the myocardium-atria does not fully contract to empty contents. Estimated 25%
loss of blood from the artia to ventricle.
Manifestations: Fatigue, dizziness, dyspnea, irregular pulse, palpitations.
Untreated: at risk for thrombus formation and stroke
Question:
What are the causes, risk factors, pathophysiology and manifestations of premature ventricular contractions (PVCs)?
Answer
Risk factors/causes: Abnormal electrolytes (hypokalemia, hypercalcemia), hypoxia, aging, induction of anesthesia,
central line placement, cardiac cath, caffeine intake, drug use, exercise.
Patho: Decreased cardiac output from lack of atrial contribution to ventricular preload
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