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Increased SNS activity increases ______, _______, and ______.
Chronotropic, inotropic, and dromotropic activity.
Sympathetic nervous system activation results in mobilization of myocardial -__ _____ and _________ for energy use by the myocardial cells.
Fat-free acids and glycogen
Preganglionic SNS fibers originate from the cells in the __________ columns of the _______ _______ segments of the _______ _____.
Intermediolateral, higher thoracic, spinal cord
SNS fibers synapse at the ____ through the _______ _______ paravertebral ganglia.
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SNS spinal cord segments are known as __________ ________.
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Preganglionic PNS fibers originate in the dorsal motor nucleus of the medulla
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Suppression or blockade of thoracic (1st-5th) portion of the spinal cord by regional anesthesia causes hypotension and bradycardia by inhibition of parasympathetic ganglia.
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Parasympathetic tone decrease _____ _____.
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Maximum vagal nerve stimulation reduces contractile by ____ %
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Maximum stimulation of SNS increases contractility by ____ %
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Physiologic effects of PNS stimulation occur because of increased permeability of cardiac muscle cell membranes to which ion? (Resulting in hyperpolarization)
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Hyperpolarization of the cardiac muscle cell membrane makes SA and AV node more excitable.
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_______ is the neurotransmitter of the PNS.
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Located along the epicardial surface at the junction of the SVC and RA.
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SA node speed of conduction ___ m/sec
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Intrinsic rate of SA node ____ to ____ bpm
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_______ ________ preferential conduction pathways between the SA and the AV node.
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AV node impulse conduction is considerably slower than any other region within the normal cardiac conduction at ____ m/sec.
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___ _______ is the preferential channel for conduction of the action potential from atria to the ventricles.
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Conduction velocity of from the bundle of His into the left and right bundle branches along the intraventricular septum ____ m/sec.
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Purkinje fibers fire at a rate of ___ to ___bpm
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SNS stimulation catecholamines are released from the CNS and the _______ ________.
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When catecholamones interact with Beta-1 receptors, this increases myocardial cell permeability to _______ and ________.
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The force of myocardial contraction is dependent on the quantity of _____ present within the cardiac cell.
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Inhibition of calcium influx into cardiac muscle cells is the proposed mechanism by which _____ anesthetic agents cause depression of myocardial contractility.
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The resting cell membrane is relatively permeable to _______ and relatively impermeable to both _______ and _______.
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During Phase 0, fast sodium channels open between -____ to -____ (threshold potential).
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______ anesthetics such as ______ have an inhibitory effect on Phase 0 by decreasing the influx of sodium.
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Phase 1 (early rapid repolarization) reaches +____mV to +____mV
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Slow calcium channels open at -____mV to -_____mV.
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Inward influx of calcium flux delays and prolongs the ______ refractory period.
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Phase 2 (Plateau phase) maintains a membrane potential near ____ mV.
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Calcium channel blockers exert their pharmacological effect during phase __.
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Phase 3 slow _____ channels become inactivated and is sustained by accelerated ______ efflux.
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Phase 4 (resting potential/diastolic repolarization phase) resting membrane potential is restored ______ ICF to ECF and ____ and ____ ECF to ICF
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______ lenthens the duration of the Phase 4 by decreasing the cardiac cell membrane’s permeability to _____ ion; delaying the onset of the resting membrane potential.
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Period lasts from Phase 0 to the middle of Phase 3.
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The relative refractory period is the time during which
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Period lasts from the middle of Phase 3 to the beginning of Phase 4. (Occurs during the T wave)
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Resting membrane potential of the SA node.
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Phases of diatole (name the 3)
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Atrial systole is the final period of rapid filling and is commonly referred to as atrial kick.
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In patients with mitral stenosis, atrial kick may be responsible for up to ___% of the ventricular filling.
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_______ contraction begins with the closure of the mitral valve and lasts until the opening of the aortic valve.
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The a wave represents the end of ____ systole just before mitral valve closure.
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The ____ wave represents ______ contraction and is produced by bulging of the mitral valve caused by increasing left ventricular pressure.
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The ___ wave represents increased pressure in the LA caused by blood return from the pulmonary veins before mitral valve opening.
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During systole, blood flow ceases to the __________ from compression due to myocardial muscle fiber tendon.
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Flow through the _______ vessels is NOT affected during systole.
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Myocardial oxygen demand is determined by: (4)
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Myocardial oxygen supply is determined by: (5)
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Increased _____ _____ is the most important factor that negatively affects myocardial oxygen consumption.
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80-90% of coronary filling and myocardial perfusion occurs during
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Beta blockers increase _____ and decrease _____, protecting the heart from ischemia.
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Myocardium extracts 65%-70% of the available oxygen from hemoglobin.
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Coronary artery vasodilation can increase coronary blood flow by ____ to _____ times.
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List the vasodilators substances released by the endocardium in response to decreased oxygen delivery or concentration. (7)
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Coronary blood flow is maintained at a constant flow rate through a MAP range of ____ to _____ mmHg.
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Major determinant of coronary perfusion pressure is _____ blood pressure.
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Normal EF:
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Match each definition with the term.
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Chemoreceptor response is elicited from ______, ______, and _______.
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Chemoreceptor reflex stimulates the SNS to
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Threshold potential of the SA node
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Cardioaccelerator fibers originate in the higher thoracic segment of
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Local anesthetics
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Opioids
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Volatile anesthetics
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Study Notes
Sympathetic and Parasympathetic Nervous Systems
- Increased sympathetic nervous system (SNS) activity enhances heart rate, contractility, and conduction velocity.
- SNS activation mobilizes myocardial free fatty acids and glucose for energy use.
- Preganglionic SNS fibers originate from the intermediolateral columns of thoracic spinal cord segments.
- SNS fibers synapse at the sympathetic trunk through paravertebral ganglia.
- SNS spinal cord segments are known as thoracolumbar outflow.
- Preganglionic parasympathetic nervous system (PNS) fibers arise from the dorsal motor nucleus of the medulla.
Effects of Spinal Cord Anesthesia
- Blockade of thoracic spine (T1-T5) by regional anesthesia results in hypotension and bradycardia by inhibiting PNS ganglia.
- Decreased parasympathetic tone can lead to increased heart rate.
- Maximum vagal nerve stimulation can reduce contractility by approximately 25%.
- Maximum SNS stimulation increases contractility by up to 100%.
Cardiac Conduction System
- Increased permeability of cardiac muscle cell membranes to potassium results in hyperpolarization.
- Hyperpolarization makes the SA and AV nodes more excitable; acetylcholine is the chief PNS neurotransmitter.
- SA node conduction speed is approximately 0.8 m/sec.
- The intrinsic firing rate of the SA node is between 60 to 100 beats per minute.
- Specialized conduction pathways exist between the SA and AV nodes for efficient impulse transmission.
- AV node conduction is notably slower at 0.05 m/sec.
- The His-Purkinje system allows rapid conduction from the atria to the ventricles.
Cardiac Muscle Ion Dynamics
- Conduction velocity from the bundle of His into the left and right bundle branches is about 2-4 m/sec.
- Purkinje fibers can fire at a rate of 20 to 40 beats per minute.
- SNS stimulation leads to catecholamine release from the CNS and adrenal medulla, increasing myocardial cell permeability to calcium and sodium.
- Cellular contractility depends heavily on calcium levels; certain anesthetics inhibit calcium influx, diminishing myocardial contractility.
Action Potential Phases
- Resting cell membrane has high permeability to potassium, low permeability to sodium and calcium.
- Phase 0 (depolarization) involves fast sodium channels opening between -70 mV to -50 mV.
- Local anesthetics can inhibit Phase 0 by blocking sodium influx.
- Phase 1 (early rapid repolarization) peaks at +20 to +30 mV.
- Slow calcium channels open at -40 mV to -25 mV, prolonging the refractory period.
- Phase 2 (plateau) maintains a membrane potential near 0 mV.
- Pharmacological effects of calcium channel blockers take effect during Phase 2.
- Phase 3 involves inactivation of slow calcium channels and sustained potassium efflux.
- Phase 4 restores the resting membrane potential, with ion exchange occurring between intracellular fluid (ICF) and extracellular fluid (ECF).
Cardiac Cycle and Function
- Atrial systole is the final rapid filling period, often referred to as the atrial kick, which may account for up to 30% of ventricular filling in mitral stenosis patients.
- Ventricular contraction commences with mitral valve closure and ends with aortic valve opening.
- The "a" wave indicates the end of atrial systole before mitral valve closure.
- The "c" wave is associated with ventricular contraction pressure affecting the mitral valve.
- The "v" wave occurs after blood return from pulmonary veins, indicating increased left atrial pressure before mitral valve opening.
Myocardial Oxygen Dynamics
- Systolic compression of the coronary vessels reduces blood flow, while flow to other vessels remains unaffected.
- Myocardial oxygen demand is influenced by heart rate, contractility, wall tension, and afterload.
- Oxygen supply depends on coronary blood flow, hemoglobin levels, oxygen extraction efficiency, and vascular resistance factors.
- Elevated myocardial oxygen demand is a critical factor negatively impacting consumption.
- 80-90% of coronary blood flow occurs during diastole.
Pharmacological Influences
- Beta blockers can increase oxygen supply while decreasing demand, providing protection from ischemia.
- The myocardium extracts approximately 65-70% of available oxygen.
- Coronary artery vasodilation may boost blood flow by 3 to 5 times in response to stimuli.
- Vasodilators released in response to reduced oxygen delivery include nitric oxide, adenosine, prostaglandins, and others.
Coronary Blood Flow Regulation
- Coronary blood flow is maintained between a mean arterial pressure (MAP) range of 60 to 120 mmHg.
- Coronary perfusion pressure is primarily determined by diastolic blood pressure.
Reflex Responses and Thresholds
- Chemoreceptor responses involve peripheral chemoreceptors, central chemoreceptors, and mechanoreceptors, stimulating the SNS.
- SA node threshold potential is a critical determinant for rhythm initiation.
- Cardioaccelerator fibers originate from higher thoracic segments in spinal cord.
Anesthetic Effects
- Local anesthetics and opioids can influence cardiac conduction and contractility, with volatile anesthetics also providing similar effects.
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