Cardiovascular System

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Cardiovascular System

• Blood and Blood Vessels

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Formed Elements of Blood
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Whole Blood and the Hematocrit
What is the likely cause of a WBC count of 34K,
in which most of the WBCs are lymphocytes?
Describe the source of each of the plasma
proteins listed.
(1 mm3 1 ?L)
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Hematopoiesis
Where does this take place?
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RBCs and Hemoglobin
How many RBCs in 1 mm3 of blood? How many oxygen
gas molecules may be carried by one RBC? How
many oxygen gas molecules may be carried by 1 mm3
of blood? What are the special structural
characteristics of erythrocytes?
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Homeostatic Mechanism to Maintain Blood Oxygen
Carrying Capacity
What is the term that means low oxygen level in
the tissues? Identify the hormone and target
tissue in this mechanism.
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Types of White Blood Cells
Which of these cells is/are phagocytic? Which of
these cells provide life-long immunity? WBCs
comprise what percentage of whole blood?
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Diapedesis Phagocytosis in WBCs

• WBCs roll along endothelium, stick to it
  squeeze between cells.
• Neutrophils macrophages exhibit positive
  chemotaxis. What does this mean?
• List some examples of materials that these cells
  phagocytize.

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Anatomy of Blood Vessels
Describe the force(s) that move blood in
arteries in veins?
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(No Transcript)
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Capillary Construction
Most capillaries in the body are of the type
known as ____. In most of the brain and spinal
cord, the endothelial cells of continuous
capillaries are welded together by
______. Fenestrated capillaries are found in
close association with transport epithelia. Name
at least one organ in which you would find
fenestrated capillaries. List at least one
location of sinusoids.
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Capillary Exchange
List some examples of plasma proteins.
What is the force that causes water and dissolved
substances to leave the capillary? How is most of
this water returned to the blood?
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Scheme for Lymphatic Circulation
In what way(s) is the lymphatic circulatory
system different than the blood circulatory
system? What is the name for the fluid in
lymphatic vessels? Why is this fluid emptied into
veins and not arteries? which veins?
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The Heart
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Embryonic Development of the Heart
Name the embryonic germ layer from which the
heart develops. When does the myocardium begin
demonstrating intrinsic rhythmicity? Name the
heart structure(s) that enable a separation of
oxygenated and deoxygenated blood.
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Surface Anatomy of the Heart (anterior view)
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Surface Anatomy of the Heart (posterior view)
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Structure of the Heart Wall
Describe the substance normally found in the
pericardial cavity. Describe the movement of the
atria during contraction. the
ventricles. Describe the tissue construction of
each of the three layers of the heart wall. How
are endocardium and endothelium related?
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Cardiac Muscle Tissue (review)
What two types of intercellular junctions are
found at intercalated disks? How is the function
of gap junctions different from the function of
transverse tubules?
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Internal Anatomy of the Heart
Why are structures of the right heart colored
blue in this figure? What is the function of the
coronary sinus? of papillary muscles?
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Skeleton of the Heart and Valve Function
Which side is the anterior surface? What are the
ventricles doing in each figure? What are the
functions of the skeleton of the heart?
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Valve Function (contd)
Name the valve shown in these figures. Justify
your answer. Describe the force that causes the
AV valves to close.
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The Cardiac Cycle
Differentiate between systole and diastole. When
is the systolic pressure created? the diastolic
pressure? What factors determine end-diastolic
volume, and how is this related to cardiac output?
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The Pulmonary Circuit
Describe the pathway of one RBC from the heart,
through the pulmonary circuit, and back to the
heart. Where does gas exchange occur? (Describe
the structures in both the cardiovascular and
respiratory systems.)
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The Systemic Circuit
Describe the structure and function of portal
circulation, including the example shown in this
figure. Do the lungs receive a portion of the
systemic cardiac output? Why or why not?
Why does fetal circulation allow mixing of blood
between the two circuits?
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• Possibly, by focusing so much attention on
  discovering more effective drugs and more
  sophisticated defibrillator technology, we have
  lost sight of the vital importance of more
  mundane therapies, such as timely and proper
  provision of rescue breathing and chest
  compressions.
• Perhaps those who research cardiac arrest are
  guilty of the same oversight made by
  resuscitation team leaders we have all been
  looking at the wrong aspects of the resuscitation
  attempt.
• Stephen Pitts, Arthur L. Kellerman
• (Lancet 2004364314)

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The ResQ Trial
ResQPod
ResQPump
Funding for this study is being provided by the
National Institute of Health (NIH) Grant
2-R44-HL065851-03 to Advanced Circulatory
Systems, Inc. (ACSI), Eden Prairie, MN Keith G.
Lurie, MD, Principal Investigator.
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Why Does CPR Work?
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Cardiac Pump Theory

• Blood flow during CPR is due to the direct
  compression of the heart between the sternum and
  the spine.

May play particularly important mechanistic role
in early phases of CPR (valves lose competence
after prolonged CPR).
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Thoracic Pump Theory

• Ribs sternum act as a bellows.
• During chest compression, increased intrathoracic
  pressure, aided by one-way valves in the heart
  and venous system, cause forward movement of
  blood through the circulatory system.

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Decompression Phase

• Blood returns to the heart during the relaxation
  (decompression) phase of CPR.
• A small, but important, vacuum (negative
  pressure) forms in the chest relative to
  atmospheric pressure and draws blood back into
  the chest and heart.
• The more blood that returns to the heart
  (preload), the more that is circulated forward
  (cardiac output) on the next compression.

Release the pressure on the chest to allow blood
to flow into the chest and heart.
AHA Guidelines 2000 for CPR and ECC
International Consensus on Science, Part 3 Adult
BLS. Circulation. 2000102(suppl I)I-43
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DONT HYPERVENTILATE! Example Vent rate
48/min Chest pressure seldom becomes
negative
Switch
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Porcine Survival

• Seven pigs
• V-fib for 6 min
• Comp 100/min
• Vent 12/min
• CPR for 6 min
• Shock(s) as nec

• Seven pigs
• V-fib for 6 min
• Comp 100/min
• Vent 30/min
• CPR for 6 min
• Shock(s) as nec

Survival 6/7 (86)
Survival 1/7 (14)
Plt0.05
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Study Randomization

• S-CPR week no devices on vehicles
• ACD-CPR ITD week both ResQPumps and ResQPODs
  on vehicles
• S-CPR ITD week only ResQPODs on vehicles

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Anatomy of the Cardiac Conduction System
What is the appropriate stimulus for cardiac
muscle contraction?
What cells make up the cardiac conduction system?
Where does ventricular contraction begin? Why?
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ECG Recording
How many cardiac cycles are represented in this
ECG recording? Describe the electrical events
corresponding to each wave of the ECG. Label the
mechanical events (including when they happen)
related to each wave of the ECG.
dub
lub
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Regulation of Heart Function
Does this figure describe intrinsic or extrinsic
regulation of heart function? Identify and label
the nerve that would supply Parasympathetic
innervation of the heart.

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The Heart as an Effector in Blood Pressure
Regulation
Is this a reflex arc?
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Concept Map Cardiac Output
Where are the receptors for epinephrine that
effect contractility? Differentiate between these
two mechanisms.