Pressures in the cardiovascular system

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Pressures in the cardiovascular system

cardio

cardio

Introduction to the cardiovascular system
Introduction to the lymphatic system
Cardiovascular system anatomy and physiology
Coronary circulation
Lymphatic system anatomy and physiology
Abnormal heart sounds
Normal heart sounds
Baroreceptors
Chemoreceptors
Renin-angiotensin-aldosterone system
Cardiac cycle
Cardiac work
Changes in pressure-volume loops
Pressure-volume loops
Cardiac and vascular function curves
Altering cardiac and vascular function curves
Cardiac afterload
Cardiac contractility
Cardiac preload
Frank-Starling relationship
Law of Laplace
Measuring cardiac output (Fick principle)
Stroke volume, ejection fraction, and cardiac output
Physiological changes during exercise
Cardiovascular changes during hemorrhage
Cardiovascular changes during postural change
Cardiac conduction velocity
Cardiac conduction system
ECG basics
ECG normal sinus rhythm
ECG intervals
ECG QRS transition
ECG axis
ECG rate and rhythm
ECG cardiac infarction and ischemia
ECG cardiac hypertrophy and enlargement
Control of blood flow circulation
Microcirculation and Starling forces
Blood pressure, blood flow, and resistance
Compliance of blood vessels
Laminar flow and Reynolds number
Pressures in the cardiovascular system
Resistance to blood flow
Action potentials in myocytes
Action potentials in pacemaker cells
Cardiac excitation-contraction coupling
Excitability and refractory periods
Adrenergic antagonists: Beta blockers
Calcium channel blockers
cGMP mediated smooth muscle vasodilators
Class I antiarrhythmics: Sodium channel blockers
Class II antiarrhythmics: Beta blockers
Class III antiarrhythmics: Potassium channel blockers
Class IV antiarrhythmics: Calcium channel blockers and others
ACE inhibitors, ARBs and direct renin inhibitors
Thiazide and thiazide-like diuretics
Lipid-lowering medications: Fibrates
Lipid-lowering medications: Statins
Miscellaneous lipid-lowering medications
Positive inotropic medications
Atrioventricular block
Bundle branch block
Pulseless electrical activity
Atrial fibrillation
Atrial flutter
Atrioventricular nodal reentrant tachycardia (AVNRT)
Premature atrial contraction
Wolff-Parkinson-White syndrome
Brugada syndrome
Long QT syndrome and Torsade de pointes
Premature ventricular contraction
Ventricular fibrillation
Ventricular tachycardia
Endocarditis
Myocarditis
Rheumatic heart disease
Cardiac tumors
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Atrial septal defect
Coarctation of the aorta
Patent ductus arteriosus
Ventricular septal defect
Hypoplastic left heart syndrome
Tetralogy of Fallot
Total anomalous pulmonary venous return
Transposition of the great vessels
Persistent truncus arteriosus
Cor pulmonale
Heart failure
Cardiac tamponade
Dressler syndrome
Pericarditis and pericardial effusion
Shock
Arterial disease
Aneurysms
Aortic dissection
Angina pectoris
Coronary steal syndrome
Myocardial infarction
Prinzmetal angina
Stable angina
Unstable angina
Abetalipoproteinemia
Familial hypercholesterolemia
Hyperlipidemia
Hypertriglyceridemia
Conn syndrome
Cushing syndrome
Hypertension
Hypertensive emergency
Pheochromocytoma
Polycystic kidney disease
Renal artery stenosis
Hypotension
Orthostatic hypotension
Lymphangioma
Lymphedema
Peripheral artery disease
Subclavian steal syndrome
Nutcracker syndrome
Superior mesenteric artery syndrome
Angiosarcomas
Human herpesvirus 8 (Kaposi sarcoma)
Vascular tumors
Behcet's disease
Kawasaki disease
Vasculitis
Chronic venous insufficiency
Deep vein thrombosis
Thrombophlebitis
Acyanotic congenital heart defects: Pathology review
Aortic dissections and aneurysms: Pathology review
Atherosclerosis and arteriosclerosis: Pathology review
Cardiac and vascular tumors: Pathology review
Cardiomyopathies: Pathology review
Coronary artery disease: Pathology review
Cyanotic congenital heart defects: Pathology review
Dyslipidemias: Pathology review
Endocarditis: Pathology review
Heart blocks: Pathology review
Heart failure: Pathology review
Hypertension: Pathology review
Pericardial disease: Pathology review
Peripheral artery disease: Pathology review
Shock: Pathology review
Supraventricular arrhythmias: Pathology review
Valvular heart disease: Pathology review
Vasculitis: Pathology review
Ventricular arrhythmias: Pathology review
Arteriole, venule and capillary histology
Artery and vein histology
Cardiac muscle histology
Development of the cardiovascular system
Fetal circulation
Anatomy of the coronary circulation
Anatomy of the heart
Anatomy of the inferior mediastinum
Anatomy of the superior mediastinum
Anatomy clinical correlates: Heart
Anatomy clinical correlates: Mediastinum
Introduction to pharmacology
Chest X-ray interpretation: Clinical sciences
Electrolyte disturbances: Pathology review
Anatomy clinical correlates: Breast
Anticoagulants: Heparin
Thrombolytics
Congestive heart failure: Clinical sciences
Approach to ascites: Clinical sciences
Approach to dyspnea: Clinical sciences
Approach to lower limb edema: Clinical sciences
Coronary artery disease: Clinical sciences
Chronic obstructive pulmonary disease: Clinical sciences
Tobacco use: Clinical sciences
Approach to chest pain: Clinical sciences
Approach to hypertension: Clinical sciences
Acute coronary syndrome: Clinical sciences
Carotid artery stenosis screening: Clinical sciences
Diabetes mellitus (Type 1): Clinical sciences
Diabetes mellitus (Type 2): Clinical sciences
Dyslipidemia: Clinical sciences
Essential hypertension: Clinical sciences
Peripheral arterial disease and ulcers: Clinical sciences
Abdominal aortic aneurysm: Clinical sciences
Aortic dissection: Clinical sciences
Approach to bradycardia: Clinical sciences
Approach to postoperative hypotension: Clinical sciences
Approach to tachycardia: Clinical sciences
Atrioventricular block: Clinical sciences
Cardiac tamponade: Clinical sciences
Central line-associated bloodstream infection: Clinical sciences
Hypovolemic shock: Clinical sciences
Infectious endocarditis: Clinical sciences
Pericarditis: Clinical sciences
Ventricular tachycardia: Clinical sciences

Flashcards

Pressures in the cardiovascular system

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Questions

USMLE® Step 1 style questions USMLE

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A 67-year-old man presents to the cardiologist for a routine visit. During this visit, the patient is diagnosed with arteriosclerosis. Which of the following best describes the systolic blood pressure, diastolic blood pressure, pulse pressure, and arterial compliance of this patient when compared to those of a healthy individual?  

Transcript

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When we talk about pressures in the cardiovascular system, we’re talking about blood pressure. Pressures in different parts of the cardiovascular system aren’t equal and these differences in pressures keep the blood moving from high pressure areas leaving the heart like the arteries to low pressure areas like the veins.

Actually, the pressure curve looks a little more like this, and fluctuates in the arteries depending on part of the cardiac cycle it’s in, with these peaks being systole, and these low points being diastole -That being said, this original line is the average of these fluctuations, or the mean arterial pressure. Now, since systole takes up about a third of a single cardiac cycle, and diastole takes up the remaining 2/3 of the cycle, we can calculate the mean arterial pressure at any time by the equation:

                            MAP = (⅓) SBP + (⅔) DBP

Which after distributing we get:

                            MAP = DBP + (⅓) PP

Now, looking at these fluctuations on the arterial side, there’s a couple important things to notice. First of all, on the downswing of the curve, there’s a sharp sharp pressure drop followed by a rise again forming what’s called the dicrotic notch or incisura. As blood is ejected out into the aorta, pressure rises quickly, and then as a tiny amount of blood flows back into the ventricle, and causes the valve to snap shut and the pressure to fall. That snapping shut of the valve causes it to recoil back, which causes a brief increase in pressure of aorta, and then finally the pressure falls as the aorta settles and the heart relaxes.

A second interesting thing to notice is that the pulse pressure in the large arteries downstream of the aorta is larger than those in the aorta themselves!That’s because the pressure from blood travels a bit faster than blood itself. To understand that idea - think of the molecules and cells in the blood like Newton’s cradle, and while they move together, they bump into each other and transmit that pressure wave faster than the group can move as a whole, meaning that the pressure wave actually increases the pressure downstream. Also, the pressure waves bounce off the branch points in the arteries, which causes them to reflect back and increase the pressure in the arteries even more.

Key Takeaways

In the human body, the heart is the pump, the arteries are pressure reservoirs and conduits, the arterioles are resistance vessels that control distribution, the capillaries are exchange sites, and the veins are conduits and blood reservoirs. Due to the varying degrees of compliance and resistance, blood pressures are not equal throughout the cardiovascular system. The mean arterial pressure falls as blood moves away from the heart to the periphery. This is because as blood flows downstream through many blood vessels, each of those vessels offers a bit of resistance, which adds up and reduces the blood pressure.

Sources

  1. "Medical Physiology" Elsevier (2016)
  2. "Physiology" Elsevier (2017)
  3. "Human Anatomy & Physiology" Pearson (2018)
  4. "Principles of Anatomy and Physiology" Wiley (2014)