11 heart valves
aortic stenosis. healthy valve: [ ] diseased valve with stenosis: [ ]
aortic stenosis. healthy valve: -opens and closes properly diseased valve with stenosis: -fails to open fully -reduces blood flow
define patent ductus arteriosus. patent ductus arteriosus = [ ]
define patent ductus arteriosus. patent ductus arteriosus = when there is still a connection between the pulmonary artery and aorta
define total peripheral vascular resistance. R = P/Q total peripheral resistance = [ ]
define total peripheral vascular resistance. R = P/Q total peripheral resistance = (MEAN ARTERIAL PRESSURE - MEAN VENOUS PRESSURE)/CARDIAC OUTPUT
describe the importance of the vessel diameter of "FOURTH POWER LAW" in determining arteriole resistance increasing the diameter of a vessel from 2 to [ ] will decrease resistance from 16 to [ ]
describe the importance of the vessel diameter of "FOURTH POWER LAW" in determining arteriole resistance increasing the diameter of a vessel from 2 to 4 will decrease resistance from 16 to 256 (16^2).
diagnosis for endocarditis MAJOR DIAGNOSTIC CRITERIA: [ ]: -typical endocarditis organisms (strep viridins or bovis, HACEK gram negative -staph aureus without another primary site -enterococcus -from 2 separate blood cultures or 2 positive cultures from samples drawn >12 hours apart or 3 or a majority of 4 separate cultures of blood [ ]: -path of regurgitant jets or on implanted material in the absence of an alternative anatomic explanation or abscess or new partial dehiscence or prosthetic valve or new valvular regurgitation MINOR DIAGNOSTIC CRITERIA: -[ ] -intravenous drug use -temp >80 C -[ ]: arterial emboli, pulmonary infarcts, mycotic aneurysms, intracranial bleed, conjunctival hemorrhages, Janeway lesions -[ ]: glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor -[ ]: positive blood culture but does not meet a major criteria as noted above or serological evidence of active infection with organism consistent with endocarditis (excluding coag neg staph and other common contaminants) -[ ]: consistent with endocarditis but do not meet a major criterion as noted above
diagnosis for endocarditis MAJOR DIAGNOSTIC CRITERIA: POSITIVE BLOOD CULTURE: -typical endocarditis organisms (strep viridins or bovis, HACEK gram negative -staph aureus without another primary site -enterococcus -from 2 separate blood cultures or 2 positive cultures from samples drawn >12 hours apart or 3 or a majority of 4 separate cultures of blood ECHOCARDIOGRAM WITH OSCILLATING INTRACARDIAC MASS ON VALVE: -path of regurgitant jets or on implanted material in the absence of an alternative anatomic explanation or abscess or new partial dehiscence or prosthetic valve or new valvular regurgitation MINOR DIAGNOSTIC CRITERIA: -PREDISPOSING HEART CONDITION -intravenous drug use -temp >80 C -VASCULAR PHENOMENA: arterial emboli, pulmonary infarcts, mycotic aneurysms, intracranial bleed, conjunctival hemorrhages, Janeway lesions -IMMUNOLOGIC PHENOMENA: glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor -MICROBIOLOGICAL EVIDENCE: positive blood culture but does not meet a major criteria as noted above or serological evidence of active infection with organism consistent with endocarditis (excluding coag neg staph and other common contaminants) -ECHOCARDIOGRAPHIC FINDINGS: consistent with endocarditis but do not meet a major criterion as noted above
diagnosis for endocarditis. [ ] major criteria [ ] minor criteria [ ] major criteria [ ] minor criteria [ ] major criteria [ ] minor criteria
diagnosis for endocarditis. 2 major criteria 0 minor criteria 1 major criteria 3 minor criteria 0 major criteria 5 minor criteria
etiology for endocarditis. [ ] of bacteria and fungi cause episodes of endocarditis. only A FEW BACTERIAL SPECIES CAUSE THE [ ] because of their different portals of entry, the pathogens involved vary somewhat with the clinical types of endocarditis. often from [ ] such as nursing homes and hospitals catheter insertion, colon polyps and tumors and other GI disorders are common causes
etiology for endocarditis. MANY SPECIES of bacteria and fungi cause episodes of endocarditis. only A FEW BACTERIAL SPECIES CAUSE THE MAJORITY OF CASES because of their different portals of entry, the pathogens involved vary somewhat with the clinical types of endocarditis. often from HEALTH-CARE SETTINGS such as nursing homes and hospitals catheter insertion, colon polyps and tumors and other GI disorders are common causes
factors affecting heart sound intensity: [ ]
factors affecting heart sound intensity: -rate of rise of ventricular pressure -physical characteristics of the ventricles and valves -volume of the heart -transmission characteristics of the chest wall
heart valves. abnormal first sound split. normal (if split [ ] msec apart) abnormal (if [ ] msec) [ ]: -myxoma = left atrial [ ]: -right bundle branch block (BBB) -myxoma = right atrial [ ]: -epsteins anomaly -atrial septal defect (ASD) [ ]: -atrial septal defect (ASD)
heart valves. abnormal first sound split. normal (if split <30 msec apart) abnormal (if >60 msec) DELAYED M1: -myxoma = left atrial DELAYED T1: -right bundle branch block (BBB) -myxoma = right atrial LOUD T1: -epsteins anomaly -atrial septal defect (ASD) S1 WITH PULMONARY EJECTION SOUND: -atrial septal defect (ASD)
heart valves. abnormal second sound split. normal = split occurs during [ ] [ ] = SPLIT APPEARS WITH EXPIRATION 1.CAUSED BY [ ]: -left bundle branch block (BBB) -right ventricular pacemaker 2. CAUSED BY [ ]: -aortic stenosis: valvular, sub & supra-valvular -hypertrophic cardiomyopathy [ ] = SPLIT THROUGHOUT RESPIRATION 1. CAUSED BY [ ]: -right bundle branch block (BBB) 2. CAUSED BY [ ]: -atrial septal defect (ASD) -pulmonic stenosis -pulmonary embolism (Acute elevation of PA pressure) 3. CAUSED BY [ ]: -mitral regurgitation -ventricular septal defect (VSD)
heart valves. abnormal second sound split. normal = split occurs during INSPIRATION PARADOXICAL SPLITTING = SPLIT APPEARS WITH EXPIRATION 1.CAUSED BY DELAYED ONSET OF LV SYSTOLE: -left bundle branch block (BBB) -right ventricular pacemaker 2. CAUSED BY PROLONGATION OF LV SYSTOLE: -aortic stenosis: valvular, sub & supra-valvular -hypertrophic cardiomyopathy PERSISTENT SPLITTING = SPLIT THROUGHOUT RESPIRATION 1. CAUSED BY DELAYED ONSET OF RV SYSTOLE: -right bundle branch block (BBB) 2. CAUSED BY PROLONGATION OF RV SYSTOLE -atrial septal defect (ASD) -pulmonic stenosis -pulmonary embolism (Acute elevation of PA pressure) 3. CAUSED BY SHORTENED DURATION OF LV SYSTOLE: -mitral regurgitation -ventricular septal defect (VSD)
heart valves. fourth heart sounds. sound associated with [ ] (usually heart when ventricle is abnormally stiff)
heart valves. fourth heart sounds. sound associated with peak atrial contraction immediately before S1 (usually heart when ventricle is abnormally stiff)
heart valves. normal first sound split. split S1 results from [ ] [ ] is usually the earlier component with [ ] NORMALLY occurring 20-30 ms after [ ]
heart valves. normal first sound split. split S1 results from asynchronous closure of mitral (M1) and tricuspid (T1) valves. M1 is usually the earlier component with T1 NORMALLY occurring 20-30 ms after M1
heart valves. normal second sound split. split S2 results from [ ]. NORMALLY, the separation of [ ] is 40msec during inspiration
heart valves. normal second sound split. split S2 results from asynchronous closure of AORTIC (A2) and PULMONIC (P2) valves. NORMALLY, the separation of A2 and P2 is 40msec during inspiration
heart valves. third heart sound. usually can't hear it with stethoscope
heart valves. third heart sound. usually can't hear it with stethoscope
identify factors that might result in converting laminar flow into turbulent flow. REYNOLDS NUMBER (RE) IS THE [ ] V is the mean [ ] of blood flow (in cm/second) D is the [ ](cm) p is [ ] n is the [ ] (poise) -normally about 1/30 poise when reynolds number rises above 200-400, turbulent flow will occur at [ ] however, when reynolds numbers rises above approximately 2000, turbulence will [ ]
identify factors that might result in converting laminar flow into turbulent flow. REYNOLDS NUMBER (RE) IS THE MEASURE OF THE TENDENCY FOR TURBULENCE TO OCCUR V is the mean VELOCITY of blood flow (in cm/second) D is the VESSEL DIAMETER (cm) p is DENSITY n is the VISCOCITY (poise) -normally about 1/30 poise when reynolds number rises above 200-400, turbulent flow will occur at some branches of vessels but will die out along the smooth portions of the vessels however, when reynolds numbers rises above approximately 2000, turbulence will usually occur even in a straight smooth vessel
identify the characteristics of laminar flow and turbulent flow laminar flow is when the [ ] turbulent flow is when the [ ]
identify the characteristics of laminar flow and turbulent flow laminar flow is when the blood moves faster through the center and has resistance on the walls turbulent flow is when the blood moves backwards
identify the correct definition of VASCULAR CONDUCTANCE conductance is a measure of the [ ] conductance of a vessel increases in proportion to the [ ]
identify the correct definition of VASCULAR CONDUCTANCE. conductance is a measure of the blood flow through a vessel for a given pressure difference conductance of a vessel increases in proportion to the 4th power of the radius
identify the effect on total resistance to blood flow for: -number of vascular resistances in series -number of vascular resistances in parallel BLOOD VESSELS IN [ ] = increase in resistance in one vessel DECREASES THE FLOW through all vessels BLOOD VESSLS IN [ ] = increase in resistance in one vessel INCREASES THE FLOW through the other vessels
identify the effect on total resistance to blood flow for: -number of vascular resistances in series -number of vascular resistances in parallel BLOOD VESSELS IN SERIES = increase in resistance in one vessel DECREASES THE FLOW through all vessels BLOOD VESSLS IN PARALLEL = increase in resistance in one vessel INCREASES THE FLOW through the other vessels
identify the effects of hematocrit, vessel diameter and rate of blood flow on apparent viscosity of whole blood. the [ ] the viscosity the [ ] the flow in a vessel if all other factors are constant. the viscosity of normal blood is about [ ] as great as the viscosity of water. blood is viscous because of [ ] hematocrit = [ ] [ ] in hematocrit will cause an [ ] in blood viscosity order of most to least viscosity = [ ]
identify the effects of hematocrit, vessel diameter and rate of blood flow on apparent viscosity of whole blood. the greater the viscosity the less the flow in a vessel if all other factors are constant. the viscosity of normal blood is about 3x as great as the viscosity of water. blood is viscous because of RBCs friction against adjacent cells and other RBCs hematocrit = portion of blood that is RBC increase in hematocrit will cause an increase in blood viscosity order of most to least viscosity = blood, plasma, water
identify the etiology, signs and symptoms, and diagnosis of infective endocarditis -the prototypic lesion of infective endocarditis is the [ ] -it is a mass of [ ] -infection most commonly involves [ ] but may also occur on the low-pressure side of a ventricular septal defect on the [ ]
identify the etiology, signs and symptoms, and diagnosis of infective endocarditis -the prototypic lesion of infective endocarditis is the VEGETATION -it is a mass of platelets, fibrin, colonies of microorganisms, and inflammatory cells -infection most commonly involves heart valves (either native or prosthetic) but may also occur on the low-pressure side of a ventricular septal defect on the mural endocardium
identify the relationships of driving pressure, flow, and resistance (POISEUELLES EQUATION) Q = pie delta pressure radius ^4/8nL Q = [ ] n (eta) = [ ] L = [ ] r = [ ] P = [ ] these factors contribute to [ ]
identify the relationships of driving pressure, flow, and resistance (POISEUELLES EQUATION) Q = pie delta pressure radius ^4/8nL Q = flow n (eta) = viscocity L = length r = radius P = pressure these factors contribute to resistance to blood flow
mitral regurgitation. mitral regurgitation = [ ] -mitral valve leaks when the [ ] and some blood flows backward into the left atrium
mitral regurgitation. mitral regurgitation = INCOMPETENT VALVE -mitral valve leaks when the left ventricle contracts (during systole) and some blood flows backward into the left atrium
mitral stenosis. -mitral valve opening is [ ] -blood flow from[ ] during [ ] is reduced
mitral stenosis. -mitral valve opening is narrowed -blood flow from left atrium into left ventricle during diastole is reduced
phonocardiogram can see: [ ]
phonocardiogram can see: -normal -aortic stenosis -mitral regurgitation -aortic regurgitation -mitral stenosis -patent ductus arteriosus
recall key features of infective endocarditis pathogenesis and outline treatment options. [ ]
recall key features of infective endocarditis pathogenesis and outline treatment options. ANTIMICROBIAL THERAPY OR SURGICAL INTERVENTION
recall reasons why the linear velocity of blood flow [ ] progressively from the aorta to the capillaries. because the same volume of blood flow (Q) must pass through each segment of the circulation each minute, the [ ] V=[ ] aorta cross sectional area = [ ] capillaries cross sectional area = [ ]
recall reasons why the linear velocity of blood flow DECREASES progressively from the aorta to the capillaries. because the same volume of blood flow (Q) must pass through each segment of the circulation each minute, the VELOCITY OF BLOOD FLOW (V) IS INVERSELY PROPORTIONAL TO VASCULAR CROSS-SECTIONAL AREA (A): V=Q/A aorta cross sectional area = 2. 5 capillaries cross sectional area = 2500
recognize the initial hemodynamic consequence of mitral stenosis, mitral regurgitation, aortic stenosis, and aortic insufficiency (regurgitation) mitral stenosis = [ ] mitral regurgitation = [ ] aortic stenosis = [ ] aortic insufficiency/regurgitation = [ ]
recognize the initial hemodynamic consequence of mitral stenosis, mitral regurgitation, aortic stenosis, and aortic insufficiency (regurgitation) mitral stenosis = narrowing of opened mitral valve mitral regurgitation = mitral valve fails to close completely during ventricle systole which causes blood to flow back into LA aortic stenosis = LV pressure is much greater than aortic pressure during LV ejection aortic insufficiency/regurgitation = aortic valve fails to close completely and blood flows back from aorta into the LV
recognize why the linear velocity of blood flow will INCREASE and the lateral pressure will decrease within a stenosis of a blood vessel BERNOULLI'S PRINCIPLE: -as a fluid's velocity goes up, its fluid pressure must [ ] and as its velocity goes down its fluid pressure must [ ] -this is what happens in a [ ] -in essence, this is a form of [ ] -the increase in kinetic energy of the fluid going from the large part of the tube to the small part of the tube occurs at the expense of a drop in fluid pressure
recognize why the linear velocity of blood flow will INCREASE and the lateral pressure will decrease within a stenosis of a blood vessel BERNOULLI'S PRINCIPLE: -as a fluid's velocity goes up, its fluid pressure must go down and as its velocity goes down its fluid pressure must go up -this is what happens in a stenotic blood vessel -in essence, this is a form of conservation of energy -the increase in kinetic energy of the fluid going from the large part of the tube to the small part of the tube occurs at the expense of a drop in fluid pressure
review normal heart sounds and correlate murmurs to respective cardiac lesions. first heart sound = [ ] -closing of [ ] second heart sound = [ ] -closing of [ ] murmur = [ ] -related to turbulence occurring in the heart
review normal heart sounds and correlate murmurs to respective cardiac lesions. first heart sound = lub -closing of mitral valve and tricuspid valve -as systole begins (ventricles start to contract) the rise in pressure within ventricles causes valves to close second heart sound = dub -closing of pulmonary and aortic semilunar valves -during systole, blood is forced out of aorta and pulmonary artery then semilunar valves close murmur = abnormal heart sound -related to turbulence occurring in the heart
