DSA 11 Electrophysiology PDF

DSA11 : electrophysiology · Set by Nalk+ pump that creates the chemical RMP : + gradient that drives passive K · During diastole , N...

DSA11 : electrophysiology · Set by Nalk+ pump that creates the chemical RMP : + gradient that drives passive K · During diastole , Nat moves down its chemdelectrical gradient most calcium released from SR 0 K+ * Na/kt runs Z& 4: diffusing out Nat in constantly K+ ↓ due to electrochemical gradient + Caz ↑K + ↓ : + 3 : Ca SlowlyI K+ Slowly I less negative resting membrane potential leads to slowed conduction velocity · calcium Influx determines contractility Al · + * K ↓ Ca ↑ + + contribute to Ica depolarization 65 - If * parasump > - hyperpolarization & slowed conduction DSA 12 : ECG * PAC : Carly heartbeat normal QRS - 90 , A PVC : wide QRS * v tach : Wide QRS , no p AVR * SUT : normal QRS , nop arL I C.. IR.. t 188 o P 98 III 11 aUF DSA 13 : Cardiac cycle : Ventricle : could V - refer mm : CTrIC * splitting of hearts due to delayed pulmonic closure ↑ preload : TEDV : ↑ SV , ↑Vent. pressures ↑ afterload : ↑ ESU = ↓SV ↓ ejection time ↑ peak systolic pressure ↑ Contractility : ↓ ESU = 4SV , 4 systolic pa ejection time aortic stenosis : ↑LV pressure , systolic , to compliance due to hypertrophy mitral stenosis : ↑ Atrial pressure , afterload , hupertrophy , diastolic, * large wave A mitral requraitation : systolic , atual pressure DSA 14 : cardiac mechanics SV : EDV-ESV EF : CEDU-ESU)/EDU X100 CO : HRXSV Co : OcCompl(A-V) · E A : ESU , mitral opens · F P · D C: EDU Mitral Closes , SV - D: aortic opens F : aortic closes ESPUR -B C. E V · * 4A L.. ESPUR · F ↓ SV P · D4 ESV ↑ · E *I preload X4PN ↑ Su 4 EDV · F ↓ contractility D P · No -B C. > * 4 External work - V -B sytosolic dys. diastolic dys. Is t Orion! V ↑ atrial contractivity ↓ HR ↓ ↑ ventricular compliance ↓ ↓ * Preload > - Cup TBV & Ow comp a ↓ venous comp.  external work : urg to propel blood SW.. PXSV (4m4P L) =. DW : na needed to Stretch/lengthen 14 In 4 A L.. CP = SWXHR Wall Stress = (PXr) It DSA IS : hemodynamics sustemic circulation a venous return v Q/A APXXr4] + r will t flow but I velocity = Q = Ap QR= nL Ap (HRXSV)XSUR = most Sump Vascular Innervation is e arterioles. PP systolic-diastolic : impacted by SV & art compliance -. 4 SV = 4 PPI compliance = ↓ PP MCFP : driving force for venous return · venoconstriction , ↓ Venous comp , BV = ↑ MCFP - ↑ venous return & · venodilation , ↑ venous Comp., BV = ↓ MCFP RAP 4 WhenI COST Pulm UR ↑ MCFP -↑ CUPCRAP). ** When blood backs up ,TRAP will ↓ venous return BUT When Venous return ↑ bC ↑MCFP-4RAP 4 venous return VR = MCFP-CVP Q = (APT r4)/(8nL) DSA 16 : Control of cu function Q APIR = or CO (MAP-RAP)/SUR = myogenic regulation autoregulation/constant : flow for Ap , limit 130mmHg metabolic control - > active huperemia : ↑ metabolism , ↓02 4COH+ ↳ reactive hyperemia : ↓ in of be occlusion , washout overshoot , ↑ BF leads to sheer stress-a Vasodilators Vasodilators : NO PG12 , EDFH , vasoconstrictors : ET , EDCF TBP : I barorece por firing ↑ Vagal Stim (HR) Stretch (TBP) ↓ SUmp STIM (tHRESURI ! ↓ FAND * peripheral : 10 z renal dilation ↓ ADH * during inspiration , pressures ↓ to ↳ urine & ↑ VR& CO mechano III y SWA : constriction , , IV Metabolic : HRECO  mild pain : sumpli para > - ↑ HR CO , SUR ,MAP , opposite for severe pain - > ADH Brain ↓ Vasopressin X ↓ parat & ↑ ACC f symp/aldo-adrenal vascular Vz (Kidney Vi Kidney-renin - Al All - - ↓ ↑ SVR ↑ BV ↓ angiotensinogin ↳ Imap * ↑ BUGCO -4APY ↓ SUR AND EBNP-Vasodilate to ↓ BP & BV DSA 17 : Coronary circulation * LV Coronam flowI during diastole * ↑ autoregulation XRV Coronary flowI systole * subendocardium is last to get blood flow prope to Ischema - A primary regulator of Coronary BF is +issue metabolism myocardial Ischemia : O demands supply , myocardial infarction : Irreversible necrosis due to Ischemia & , 20-25 min of occir. maximal coronam dilation occurs C 60mmitg v ↓ ST depression : Transmural Ischemia ↓ Supply a : norm ST depression : subendocardial a D : HFrEF Ischemia , supply # demand ⑧ E C : ↑ EDU D (pulm O ⑧ edema Heart fallure bC HF) systolic dusfunction : HFrEF ↓ Contractility - , - diastolic dysfunction : HFPEF , stiff Muscle can't relax Left HF : Pulmonary edema right HF : systemic edema DSA 18 : Special circulations Circle of Willis Collateral allows continued perfusion a oxygenation : BBB : Light junctions allow passive lipid soluble CPP MAP-ICP = CPP CBFXCVR Cushings : HTN WITICP = ↑ COO vasodilation 7-hypotension mitigates Sensitivity to CO2 : ↓ CO2 & 402 : vasoconstriction * Neurovascular coupling : reactive hyperemia suncope cerebral hupoperfusion : GIOC : 1G2 78 100 X V = 4G2 = - = 100 = 100 - X = X  phasic contractions permit blood flow while tonic does not functional Sympatholysis : ↑ local vasodilation dispite + sumpathetic tone #nepatic V C > -.. Sup cella mes. * Sump : Strong vasoconstriction portaiv para : Secretions metabolites - dilate I. small.- Inf. colon mes apical Skin : ears , nose , hands , feet : active constriction a passive dilation , alomus body : anastamoses non-apical Skin : Vasoconstriction (NE) a Vasodilation (Ach) DSA 19 : exercise ,Valsalvad temp Co , VR , a VO2 all Plateau ↑ ur via muscle pump , vasod.,venoc , a resp. Dump Ventilatory threhold : after resp alkalosis Valsava Mus -. conduction : direct convection : flow of air or water BP radiation ⑪ evaporation : can only I heat HR - 11 44 + VR , SV , COGBP. ↑ HR IV ↑ VR , SV , COEBP , HR. * mitral regura. L In 11 dysautonomia : No HR response - abnorma by * Stenosis ↑ IV DSA 20 : Dhaum ↓ BP ↓ baroreceptors to : a sump Drugs Phenulpherine : agonist vasoconstrict nasal decongestant L , , clonidine : < , agonist release NE to - SNA , BPGHR vasoconstriction , , ↳ (c) Pheocromocytoma epinephrine : Bagonist , vasoconstrict , HR , dilate Sk bu ↳ B2X norepinephrine : , so X , B, B , dilates constrict agonist , vasoconstrict , HR C low closes Isoproterenol : B.. < agonist , HR hBP albuterol : Be agonist , also used for x of hyperkalemia BE Turamine : can cause hypertensive crisis in pts on MAO's atropine : muscarinic antagonist adverse , > - tachy I pratropium : muscarinic antagonist C blocker , Prazosin :. phentolamine : nonselective a ant., ↓VR , hupot, reflex tachy Slower acting - Phenoxybenzamine : nonselective x ant.  ~ metaprolol : B , antagonist atenolol : B, antagonist propanolol : nonselective B antagonist vasoconstrict epi + phentolamine : HR A BP 1TPR DSA 21 : Orthostas Is standing : LEDV① 1st to BP leading > - ② Is Comp : HR then contractivity ,then Sure So , Initial : MAP = [(LEDV-ESVXHR] XSUR Comp : MAP =