exsc 531 test 1

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1

VO2=___ * _____

MAP= ____ * _____

CO * avo2 diff

CO * TPR

2

The right heart is devoted to ______ circulation and pumps _______ blood to the lungs.

Pulmonary circulation

Venous

3

Left heart is devoted to _______ circulation and pumps _____ blood to the body for continuation of aerobic metabolic function.

systemic,

arterial

4

Name the pathway of blood through the heart

Right Atrium, Intra atrial septum, tricuspid (right A_V valve), right ventricle, pulmonary semilunar valve, left atria, bicuspid, left ventricle, aortic semilunar valve, interventricular septum.

5

Name the path of blood through the coronary artery system.

right coronary artery, right interventricular and the marginal branches, left main coronary artery, left anterior descending coronary arter, left circumflex coronary artery

6

what does the coronary sinus do?

vein that returns blood to heart through right atrium

7

What do the bicuspid and tricuspid valves prevent?

what happens if this fails?

regurgitation (back flow) of blood back into atrium.

Loss of ability to pump blood and loss of contracility

8

What are the three layers of the heart?

endocardial, myocardial, and epicardial

9

whats the function of the epicardial layer of the heart?

serves as a lubricative outer covering

10

whats the function of the myocardial layer of the heart?

filled with contractile proteins to pump blood

11

whats the function of the endocardial layer of the heart?

serves as a protective inner lining of the chambers and valves

12

What does each part of the ECG wave represent?

the P wave represents atrial repolarization

QRS- ventricular depolarization

T wave- rapid repolarizaiton of ventricles

13

How is the heart affected if there is an obstructed artery?

it stops receiving blood & that part of the heart will die (myocardial infarction)

14

What do specialized heart cells in the conduction system do?

move an action potential, regulate heart rate, BP, & CO

15

what are the 3 functions of the atrium?

Hold blood

receive blood

top off ventricle

16

AV node's function

gather action potential and slow them down

17

Bundle of Kent

abnormal pathway that reduces function of AV node

18

Function of arteries and arterioles

conduct arterial blood to the systemic capillary beds

19

How can you tell the difference between an artery, arteriole, and capillary?

the thickness

20

Tunica Adventitia-

tissue layer is thick and protects arteriesq

21

tunica media

smooth muscle with contractile proteins for vasoconstriction and vasodilation

22

Tunica Intima

endotherial layer provides smooth surface for blood to go past

importance- reduces resistance to blood flow so blood pressure is low and nothing clings to the smooth surface.

23

what is the Vaso Vasorum?

Arteries and Veins own blood supply

24

Name the blood pressure at various locations:

left atrium

left ventricle

aorta and large arteries

small arteries

artioles

right atrium

right ventricle

5 mmhg

120/0

120/80

60-90

40-60

2 mmhg

25 mmhg

25

pressures in:

systemic artiole

systemic capillary

systemic venule

30

20

30

26

pulmonary arteriole

pulmonary capillary

pulmonary venule

12

10

8

27

small arteries and arterioles have less ___

elastin and more smooth muscle, making these vessels important resistance vessels

28

function of veins and venules

to conduct venous blood to the heart for delivery to the lungs for re-oxygenation

29

what are veins distensibility characteristics?

can accommodate additional volume without additional transmural (internal) pressure increase.

therefore pressure and volume have no relationship

30

What are the special properties of arteries and veins?

arteries have elastic recoil characteristics. (swell with systole and recoil with diastole)

veins- compliance characteristics (with sympatheric stimulation veins contract and are able to continue to augment venous return)

31

During exercise muscle blood flow ? (increases or decreases)

increases

32

During exercise blood flow to the splanchnic, renal cerebral, and coronary tissues? (Increases or decreases)

decreases

33

During exercise blood flow to the skin? (in or dec)

decreases

34

Sa node serves as

pacemaker of the heart

35

Describe the Sa node role in conduction system

Spontaneous electrical activity in the SA node reaches the depolarization threshold and fires, spreading the depolarization over the atria resulting in atrial contraction.

36

What role does the AV node play on conduction system?

The Av node (at floor of right atrium) connects atrium and ventricle by left and right bundle branches.

37

Why is the delay in the depolarization of the av node important?

it allows atrial contraction to empty atrial blood into the ventricles prior to ventricular depolarization and contraction.

38

what is the path of the conduction system?

SA node-> AV node-> AV bundle->left and right bundle branches-> Purkinje fibers

39

how is central blood pressure regulated (long term)

Renin-angiotensin-aldosterone system

40

briefly describe the Renin-angiotensin-aldosterone system

Kidneys regulate blood pressure by adjusting the volume of blood. Low BP causes the release of renin which converts angiotensinogen to angiotensin 2. Angiotensin 2 constricts blood vessels and stimulates the release of aldosterone by adrenal cortex. Aldosterone increases Na+ and water reabsorption by kidneys. Both of these increase blood volume and arterial pressure.

41

How is BP regulated short term?

Autonomic control in the Medulla through sympathetic and parasympathetic activity.

receptors stimulate a1 receptos everywhere EXCEPT heart for vasoconstriction to augment venous return.

or b2 for vasodilation

42

what do a2 receptors do?

inhibit release of NE; promote blood clotting

43

what do b1 receptors do?

increase heart rate and strength of contraction & stim renin release from kidneys

intrinsic homeometric response

44

reduction of what system causes heart rate to increase to 100

reduction of parasympathetic activity

45

Central BP regulation

Intrinsic Regulation

heterometric homeometric

Frank-Starling Calcium

...

46

what is the Frank Starling Law of the Heart

optimal or increased tension leads to increased contractility and stroke length.

increased initial fiber length increases tension

47

What factors affect stretching of the myocardium?

Atrial contribution to ventricular filling, total blood volume, body position, Intrathoracic pressure, intrapericardial pressure, venous tone, pumping action of skeletal muscle.

48

Central Homeometic Regulation is dependent on

HR and calcium

as hr increases, calcium is associated with the contractile proteins for a greater portion of the cardiac cycle.

greater calcium per minute, greater tension, greater contractile state of heart, greater SV

49

What is the process of sympathetic stimulation of calcium release?

calcium is stored in SR and released from terminal cisterns. It binds to C-receptor on troponin causing shape change. This causes active sit on actin to bind with myosin and form cross bridges.

50

What affect does the shortened time spent in systole have on calcium release?

During exercise you spend less time in systole and more time in each cardiac cycle as a result each minute there is more calcium and SV is increased.

51

4 short term peripheral BP regulation

a1 vasoconstriction (norepi)

b2 vaso dilation (norepi)

active sympathetic cholinergi vasodilation (in sweat glands & blood vessels in skeletal muscles)(ACH)

parasympathetic cholinergic vasodilation (cranial and sacral areas) (ACH)

52

what is the metabolic hypothesis?

local blood flow is governed by the metabolic activity of that tissue.

these factors override any extrinsic factors resulting in dilation and lower TPR in working tissue.

53

Name 5 vasodilation substances

increased:

lactic acid

PCO2

H+

NO

P+

adenosine

prostaglandin

PO2

54

tissue pressure hypothesis-

increased tissue perfusion produces an increase in blood volume of the tissue and net transfer of blood from intravascular to extravascular compartments. The increased pressure compresses the walls in capillaries and reduces blood flow into the tissue.

55

myogenic hypothesis

smooth muscle contracts in response to stretch and is followed by relaxation with an increase blood flow.

56

What is the main way of regulating Long Term BP?

altering blood volume via Renin-Angiotensinogen Aldosterone System and kidneys.

increase in blood volume causes a rise in blood pressure and water retention

decrease in blood volume reduces blood pressure.

57

High Blood pressure damages endothelial cells leading to ... (6)

Atherosclerosis

CAD

Myocardial infarction

heart failure

stoke

renal failure

58

What is the BP range for pre hypertension

SPB (120-139) DBP (80-90)

59

hypertension is...

a persistent elevation of diastolic blood pressure, systolic blood pressure, or both measured on at least two separate occasions at least 2 weeks apart

60

what percent of cases are idiopathic hypertension (primary) and secondary?

p- 90-95%

s- 5-10%

61

1 in ___ adult Americans have hypertension

4

62

what are 3 causes of hypertension?

narrowing due to stenosis at the opening of the arterioles from the aorta increase BP in arteries (most common)

age related elasticity loss in artieries

genetic predisposition

63

what are the nonmodifiable risk factors of hypertension?

family history of CVD

Age >55

Gender (male over 55, female over 55 or after menopause)

Ethnicity (Black Hispanic)

64

What are modifiable risk factors of hypertension?

Salt intake

Obesity

Hypercholesterolemia

Smoking

Emotional Stress

Personality traits (hoplessness & hostility)

Sedentary lifestyle

long-term alcohol abuse

hormonal status (menopause, hysterectomy)

65

Causes of Secondary Hypertension

Stenosis of aorta

Pheochromocytoma (rare catecholamine-secreting tumor)

Pregnancy

Alcohol Abuse

Endocrine disease

renal disease

effect of drugs

acute stress

neurologic disorders

66

what does ACE inhibitors stand for?

Angiotensin Converting Enzyme Inhibitors

67

what factors regulate coronary blood flow

MAP or tissue pressure

local regulation

Sympathetic adrenergic control by b2 receptors

68

what is pressure work?

large increases in MAP (afterload) with small increases in venous return (preload).

myocardial oxygen demand from pressure work is greater then that for volume work

heart disease

69

volume work

small increases in MAP with large increases in venous return

raise MAP but is not associated with heart disease

70

when the heart is doing pressure work there is a _____ oxygen demand

greater

71

Mild Atherosclerosis lesions cover _____% of lumen

30-40%

72

Sever atherosclerosis lesions cover ____% of lumen

80

73

What are the NCEP ATP III Guidelines for desirable levels of blood lipids and lipoproteins

total cholesterol <200 mg.dL

LDL-C <100 mg dl

HDL-C > 40 mg dL

Triglyceride <150 mg.dL

74

Injury in the focal artery impairs (2) ___

permeability and loss of ability to produce nitric oxide

75

What happens without NO?

increase platelet aggregation, increase cell adhesion, increased smooth muscle cell migration and proliferation, loss of avenue for vasodilation

76

What are the Major steps of Pathogenesis of Atherosclerosis

injury, increased permeability, inflammation, proliferation, fatty streak, necrosis, repair, fibrous plaque, complicated lesion

77

Injury is caused by

high shear forces, turbulent blood flow, hypertension, nicotine, oxidized LDL, glycated substances (hyperglycemia)

78

injury leads to endothelial dysfunction and increased permeability which leads to

impaired vasodilation, increased vasospasm potential, increased permeability (lipids), increased platelet aggregation

79

whats the process of inflammation?

1.) platelets release PDGF

2.) PDGF enhances monocyte binding

3.)PDGF increases growth and migration of smooth muscle cells from the media to the intima which becomes an important part of plaque

80

How does PDGF enhance monocyte binding?

monocytes differentiate into macrophages

macrophages are phagocytic and oxidize LDL

Oxidized LDL can more easily enter the endothelium (where injury takes place)

81

How are Fatty Streaks formed?

Smooth muscle and macrophage accumulate oxidized LDL forming "Foam Cells"

foam cells release cholesterol into the cell and surround areas around the cell forming fatty streaks

82

_____ is the earliest detectable subclinical sign of atherosclerosis

Fatty Streaks

83

plaque formation leads to

cell death or repair

84

Necrosis leads to

repair

85

Repair initiates

vascular remodeling

lumen diameter is reduced,

when diameter is reduced by 40% complete compensation is reached and impairment of blood flow occurs

86

Can you have inflammation before Artherosclerosis?

Yes High blood pressure can cause inflammation

87

What are 3 ways of a hospital reducing the affects of atherosclerosis?

Catherization

Stent

ByPass

88

How does a catherization work?

a wire with a balloon attatched opens pushing the plaque against the wall so it reopens the lumen for blood to flow

89

How do stents work?

its put on the end of a catheter like a balloon but it doesn't open the vessel as much as a balloon so a person would need to be put on blood thinners.

90

Whats a bypass?

rerouting veins or arteries

91

what are Emerging risk factors for heart disease

Lipoprotein A

Homocysteine

Prothrombic Factors

Proinflammatory Factors

Subclinical Atherosclerosis

92

Major Signs or Symptoms of CVD and Pumlonary DIsease

Pain, discomfort in chest, neck, jaw, arms due to ischemia

Shortness of breath at rest or mild exertion

Dizziness

Orthopnea

Ankle edema

Palpitations or tachycardia

Intermittent claudication

heart murmur

unusual fatigue

93

whats ischemia?

decreased blood supply and o2 to the tissue (through coronary arteries to heart) resulting in hypoxia- causing chest pain and claudication

94

What are the 4 steps to health screening?

1.) Medical/ Health history questionnaire

2.) CAD risk factor stratification

3.) informed consent

4.) Exercise Testing/ Exercise

95

Whats the order of testing?

Take resting measurements, cardio, muscular fitness, flexibility

96

whats a true-positive test?

true negative test?

true pos- patients has CAD and test is abnormal

true neg- patient does not had CAD and test is normal

97

false positive test?

false neg?

false pos- patient doesnt have CAD but test is abnormal

false neg- patient does have CAD but test is normal

98

whats sensitivity?

percentage of true pos tests in patients with cad. as the rate of false neg tests increases sensitivity decreases

99

how do you calculate sensitivity?

true pos/ (true pos + false neg) x 100

100

what causes false - negative tests?

failure to reach 85% of age predicted max hr

failure to recognize non ECG signs and symptoms

musculoskeletal limitations to eercise preceding cardiac abnormalities

observer error

101

what does SMART stand for in the statement, " Goals should be smart"

specific, measurable, attainable,realistic, timebound

102

the dose response curve represents?

HR and Vo2 changes as you begin an exercise perscription

103

___ had a sharp response when you start exercise

BP

104

____ takes a long time to improve on dose response curve

HDL

105

whats overload principle?

stressing the body beyond the point the body's used to

106

whats FITT

frequency intensity time type

107

intensity is measured in

frequency & duration

108

Relative intensity includes ____ which absolute intensity does not.

body weight

109

What is the Karvonen Method for HR

target hr range= ((220-HR rest) x .5) + hr rest

110

high intensity is above ____ METS

6

111

How much exercise does the ACSM guideline reccommend per week?

per day?

5-7 days a week of 30 minutes or 150 minutes a week minimum

20-60 min of continuous or intermittent exercise a day

112

exercise duration is inversely related to exercise ____

intensity

113

what are the general resistance training guidelines?

  • 1 to 2 sets
  • 10 to 15 repetitions
  • Light to moderate weight (RPE= 11-13)
  • 8-10 exercises involving major muscle groups
  • A minimum of 2 days per week
  • A warm-up of the muscles being worked should be included
114

what are the modalities of training?

  • Isometric- static training. Only strengthens you at that one position. Don’t go through a full range of motion.
  • Dynamic constant external resistance- full range of motion
  • Isokinetic- against resitance
  • Plyometrics- box jumps.
115

whats the 2 for 2 rule?

If the client can complete two more rep then the rep goal in the final set of an exercise for two consecutive training sessions the load in all of the sets for that exercise during subsequent training sessions can be increased.