USMLE Step 1 Web Prep Heart Muscle Mechanics: Part 4

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Venous Pulse

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VALVULAR PROBLEMS
Aortic Stenosis Aortic valve acts as a major resistance in series. Ventricular systolic pressure increased (increased a terload! A pressure "radient #et$een t%e le t ventricle and aorta durin" ejection &ystolic murmur

'oncentric %ypertrop%y
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Aortic Insufficiency

Aortic valve does not close properly )ncreased ventricular end diastolic pressure (increased preload! )ncreased ventricular and aortic systolic pressures *ecreased aortic diastolic pressure )ncreased aortic pulse pressure *iastolic murmur +ccentric %ypertrop%y
SLIDE 4 of 10

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Mitr l Stenosis

,arro$ mitral valve creates a pressure "radient -ressure and volume elevated in le t atrium *iastolic murmurs present

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Mitr l Insufficiency

.lood re"ur"itates rom t%e /V to t%e /A Atrial volumes and pressures increased Ventricular volumes and pressures increased &ystolic murmur

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PRESSURE#VOLUME LOOPS

Aortic insu iciency 1eart ailure (decreased contractility! +ssential %ypertension (aortic stenosis! )ncreased contractility +2ercise
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BASI% AL&ERA&IO'S DURI'( E)ER%ISE

Pul*on ry %ircuit .lood lo$ (cardiac output! 3 lar"e increase -ulmonary arterial pressure 3 sli"%t increase -ulmonary vascular resistance 3 lar"e decrease -ulmonary #lood volume 3 increase ,um#er o per used capillaries 3 increase 'apillary sur ace area 3 increase
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Syste*ic %ircuit
Arteri l syste* 3 no si"ni icant c%an"e 3no si"ni icant c%an"e p1 3 no c%an"e or a decrease 4ean arterial pressure 3 sli"%t increase .lood lo$ 3 lar"e increase Vascular resistance (5-6! 3 lar"e decrease Venous syste* 3 decrease 3 increase
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Re-ion l %ircul tions

1. +2ercisin" s7eletal muscle .lood lo$ 3 increase Vascular resistance 3 decrease 'apillary pressure 3 increase

'apillary iltration 3 increase /ymp% lo$ 3 increase Venous 3 decrease +2traction o o2y"en 3 increase 2. 'utaneous #lood lo$ 3decrease t%en increase 3. 'oronary #lood lo$ 3 increase 4. 'ere#ral #lood lo$ 3 no si"ni icant c%an"e 5. 6enal and 8) #lood lo$ 3 any c%an"e $ould #e a decrease
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.e rt
)ncrease in volume $or7 mainly #y an increase in %eart rate /i"%t and moderate e2ercise no increase in preload -reload increase in %eavy e2ercise

P/ysic l %on0itionin6e"ular e2ercise $ill raise ma2 #y:3 )ncreasin" t%e a#ility to deliver o2y"en to t%e active muscles ('9! )ncreasin" t%e a#ility o muscles to utili:e o2y"en