Karteikarten
A and P Test Four - Coronary Circulation and IHD Flashcards
Karten in diesem Stapel (45)
- 1What is the most common cause of death in the United States?Ischemic heart disease. It is the cause of death in 35 percent of the population.
- 2What percentage of patients who undergo surgery in the US have IHD?30 percent
- 3Name modifiable risk factors for IHD.1. Cigarette smoking
2. Obesity - reduce triglycerides, cholesterol intake; Help for those with Diabetes
3. Sedentary lifestyle - can lead to low HDL levels
4. Hypertension - 4Name three IHD risk factors that aren't modifiable1. Genetic predisposition/family history
2. Increasing age
3. Male gender - 5How does C-reactive protein correlate to heart disease risk?C-reactive protein -- or CRP -- appears to be correlated to heart disease risk. Inflammation (swelling) of the arteries has been linked to an increased risk of heart disease, heart attack, stroke, and peripheral arterial disease.
- 6The myocardial blood supply is derived entirely from what?The right and left coronary arteries
- 7In a right-dominant person, name the major coronary blood supplies:1. Right atrium
2. Most of right ventricle
3. Left ventricle inferior wall (varies)
PLUS
1. Posterior descending artery (PDA)
2. Posterior left ventricle - 8What percentage of people are right-dominant?70 to 80 percent
- 9What percentage of people are left-dominant?10 to 15 percent
- 10If a person is left-dominant, how is blood supply different from if the person was right-dominant?If a person is left-dominant, the circumflex supplies the PDA.
- 11If a person is co-dominant, how does this affect the coronary arteries?In co-dominant, both the circumflex and the RCA supply the posterior descending artery
- 12What percentage of people are co-dominant?15 to 20 percent
- 13Name the aspects of the left coronary artery blood supply.Left atrium. Most of
1. Intraventricular (IV) septum
2. Left ventricle
3. Septum
4. Anterior wall
5. Lateral wall
The LCA bifurcates to the LAD and circumflex. - 14What comes after the bifurcation of the left coronary artery?The left anterior descending artery (LAD) and the circumflex artery
- 15How would you sum up the LAD and circumflex's coronary blood supply?The LAD supplies the septum and anterior wall
The Circumflex supplies the lateral wall.
In left-dominant circulation, the Circ wraps around the AV groove and supplies most of the posterior septum and inferior wall - 16What are the two options for blood supply of the SA node?In 60 percent of people, the RCA supplies blood flow to the SA node. In 40 percent of people, the LAD supplies blood flow.
- 17What coronary arteries supply the Bundle of His?A dual blood supply - the LAD and PDA
- 18What are the two options for coronary blood supply of the AV node?85 to 90 percent of people have an AV node that's supplied by the RCA. 10 to 15 percent have one that's supplied by the circumflex.
- 19What are the anterior papillary muscle of the mitral valve blood supply fed by?1. Diagonal branches of the LAD
2. Marginal branches of the circumflex. - 20What are the posterior papillary muscles supplied by?The PDA alone.
- 21Which is more prone to ischemic dysfunction: the anterior or posterior papillary muscles? Why?The posterior papillary muscle; Because it only has one blood supply source.
- 22What is the normal resting coronary blood flow?225 to 250 ml/minute
- 23What are the two sources of blood flow to the muscles of the heart?Inner 0.1 mm of endocardial surface is supplied by the blood in the heart chamber's.
The largest portion is supplied by epicardial vessels, which are outer surface vessels that supply most of the muscle. - 24What are the subendocardial arteries?They are plexus of vessels located immediately beneath the endocardium.
- 25What makes coronary perfusion unique when compared with other organs?`Coronary perfusion is intermittent. In other organs, it is continuous.
- 26What happens to the left ventricle during contraction in regards to intramyocardial pressures?The left ventricle's pressure approaches systemic arterial pressure.
- 27What do you know about changes in flow during the cardiac cycle?The coronary perfusion pressure is usually determined by the difference between aortic pressure and ventricular pressure, and the LV is perfused almost entirely during diastole
- 28When is the Left ventricle mostly perfused? What about the right ventricle?The left ventricle is perfused almost entirely during diastole. The right ventricle is perfused during both systole and diastole
- 29Coronary blood flow is what percent of total cardiac output?5 percent
- 30How do decreases in diastolic time affect flow?Heart rate increases result in decreased coronary perfusion due to
disproportionate reduction in diastolic time (% of cardiac cycle) as heart rate increases
AKA: The faster the heart rate, the less diastolic (filling) time. - 31How is coronary perfusion determined?Coronary perfusion is determined by the difference between aortic pressure and ventricular pressure.
- 32In terms of myocardial blood flow, which is more important, aortic diastolic pressure or mean arterial pressure?Aortic Diastolic Pressure (ADP)
- 33What is the formula for calculating coronary perfusion pressure?ADP - LVEDP = CPP.
Decreases in Aortic Pressure or increases in ventricular end-diastolic pressure can reduce CPP. - 34Name the factors that control the demand of coronary blood flow.1. Basal requirements
2. Heart rate
3. Wall tension (A. Preload and B. Afterload)
4. Contractility - 35What is the most important determinant of myocardial blood flow?Myocardial 02 demand (basal requirements) These includes basal requirements, electrical activity, volume work, and pressure work
- 36What percentage of oxygen does the myocardium extract? How does this compare to other tissues?The myocardium extracts 70 percent of oxygen. Usually, it is 25 percent in most tissues.
- 37What is the coronary sinus oxygen saturation?30 percent
- 38What happens when there is an increase in myocardial metabolic demand?The myocardium can't extract more 02 from hemoglobin. Therefore increases in myocardial metabolic demand must be met by an increase in coronary blood flow.
- 39Name the vasodilator substances that are released to increase coronary blood flow to the heart.1. Adenosine (because of ATP degradation)
2. Potassium ions
3. Hydrogen ions
4. Carbon dioxide
5. Bradykinin
6. Prostaglandins
7. Nitric oxide - 40How does the nervous system contribute to coronary blood flow?The nervous system causes direct effects of acetylcholine from vagus nerves & sympathetic nerves secrete EPI and NE
Indirect (most important): Offsetting the deleterious responses caused by Epi, NE, and acetylcholine (they cause increased metabolic requirements, to stimulate regulatory mechanisms) - 41What is the effect of aCh on coronary blood flow?aCh release from the parasympathetic nerves produces coronary artery dilation. However, the parasympathetic nervous system effect is minimal (because there are few parasympathetic nerves in the autonomic system)
- 42What do you know about the sympathetic innervation of the heart?A1receptors: located in the epicardial vessels. Excess stimulation can produce vasospastic myocardial ischemia and angina.
B1 receptors cause cardioacceleration & positive inotropy
B2 Receptors are dilators and located mainly in smaller intramuscular & Subendocarial vessels - 43Tell me about the energy supply of the heart.Fat metabolism is 70 percent of the heart's energy supply (body tissues are usually carbs)
Glycolysis: Under ischemic conditions, cardiac metabolism will convert to anaerobic glycolysis - 44Tell me about the venous drainage of the heart1. Coronary sinus: Most of the venous blood flow returns from left ventricle to r. atrium by way of coronary sinus
2. - 45What does SAD stand for? What does it refer to?Syncope, Angina, and Dyspnea. These are the most common symptoms of aortic stenosis.
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- Karteikarten am A and P Test Four - Coronary Circulation and IHD Flashcards, erstellt von Rachel Nall am 08/07/2016.
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