1- Anatomy and Physiology Flashcards
1
Q
__ side: heart extends from 2nd costal cartilage to 5th intercostal space
A
right
2
Q
___ side: heart extends from the 3rd to 6th costal cartilage about 10-15 mm from sternum
A
left
3
Q
___ of heart is the largest portion: lies to the left of the mid sternal line
A
apex
4
Q
4 layers of heart?
A
outer to inner:
1. parietal pericardium
2. visceral pericardium
3. myocardium
4. endocardium
5
Q
___: encloses the heart, contains two layers
A
pericardium
6
Q
___ pericardium: a fibrous relatively unyielding outer layer that forms a sac, contains terminal branches of several blood vessels
A
parietal
7
Q
___ pericardium: inner layer forms pericardial fluid to moisten the heart to prevent friction and maintains the heart in position
A
visceral
8
Q
another word for visceral pericardium?
A
epicardium
9
Q
___: cardiac muscle fibers provide the work in distributing blood to the heart
A
myocardium
10
Q
____: innermost layer that lines the heart contains smooth muscle
A
endocardium
11
Q
Left atrium: receives oxygen rich blood from the ___ ___ and sends it to the left ventricle through the ____ (____) valve
A
pulmonary vein, mitral, bicuspid
12
Q
Right atrium: receives blood from the superior and inferior vena cava and sends it to the right ventricle through the ____ valve
A
tricupsid
13
Q
left ventricle: ejects blood through the ___ valve into the aorta
A
aortic
14
Q
right ventricle: ejects oxygen deficient blood through the _____ valve into the ___ ___ which becomes the left and right pulmonary artery
A
pulmonic, pulmonary trunk
15
Q
___: carry oxygen rich blood to peripheral tissues via pressure exerted by the heart and the elastic and contractile properties of the vessels
A
arteries
16
Q
___: carry oxygen deficient and CO2 rich blood back to the heart via pressure exerted by contractions by the skeletal mm (large veins) and smooth mm (venules)
A
veins
17
Q
large veins are made of ___ muscle
A
skeletal
18
Q
venules are made of ____ muscle
A
smooth
19
Q
larger muscle mass - arteries or veins?
A
arteries
20
Q
has valves - arteries or veins?
A
veins
21
Q
if blood is backflowing into the lungs, which side of the heart is most likely impaired?
A
left
22
Q
if blood is backflowing into the body, which side of the heart is most likely impaired?
A
right
23
Q
What two myofilaments does myocardial tissue contain, similar to skeletal muscle?
A
actin and myosin
24
Q
Myocardium undergoes ___-___ phenomena similar to skeletal muscle?
A
excitation-coupling
25
3 properties of myocardial cells?
1. automaticity
2. rhythmicity
3. conductivity
26
___: able to contract without external stimuli
automaticity
27
___: able to contract in a rhythmic manner
rhythmicity
28
___: nerve impulses can be transmitted from one myocardial ell to another due to intercalated disks that form a syncytium
conductivity
29
intercalated disks contain what two junctions?
1. desmosomes
2. connexins
30
Intercalated disks contains two junctions:
1. ___: attach one cell to another
desmosomes
31
intercalated disks contains two junctions:
2. ____: allow electrical impulses to spread from one cell to another
connexins
32
___ arteries supply the myocardium
coronary
33
___ coronary artery: supplies most of the right ventricle, AV node (55% of people) and SA node
right
34
parts of right coronary artery?
right posterior descending, right marginal
35
parts of left coronary artery?
left anterior descending, left circumflex arteries, left marginal
36
___ coronary artery: supplies left ventricle, left atrium, ventricular septum and SA node (45% of people)
left
37
___ ___: functions as "pacemaker" of the heart; must set a pace of depolarization faster than any other myocardial cell
sinoatrial node
38
sinoatrial node paces the heart to beat >___ bpm without any other input
100
39
____ nervous system: neurotransmitter (norepinephrine) increases heart rate and myocardial contractility
sympathetic
40
____ nervous system (via vagus nerve): neurotransmitter (acetylcholine): decreases heart rate and myocardial contractility to 60-90 bpm
parasympathetic
41
Cardiac conduction:
1. SA node transmits impulses to the ___ to cause them to contract first
2. excitation impulses are then sent to the ___ ___ (located at the floor of the right atrium) to cause the ventricles to contract; about ___ seconds later
atria
AV node
0.04
42
AV node can spontaneously discharge without external stimuli at a rate of ___ bpm
40-60
43
AV node impulses are transmitted to the ventricular myocardium through ___ ___ ____
bundle of His
44
Bundle of His:
- divides into a left and right bundle branch at the ___ ____ to innervate each respective ventricle
- bundle branches further divide into smaller nerve fibers called ___ ___ to cause the ventricles to contract
intermuscular septum
pukinje fibers
45
Why is the SA node susceptible to disease?
1. proximity to the epicardium (pericarditis)
2. coronary artery occlusion
46
Why is the AV node susceptible to disease?
right coronary artery occlusion
47
possible manifestations of hypokalemia?
arrhythmias, mm cramps especially if taking a diuretic
48
possible manifestations of hyperkalemia?
nausea and vomiting
49
normal potassium levels?
3.5-5.0 mEq/L
50
possible manifestations of hypercalcemia?
erratic cardiac contraction
51
possible manifestations of hypocalcemia?
decreased myocardial contractility
52
normal calcium levels?
9-11 mg/dl
53
one cardiac cycle lasts about ___ second for a HR of 75 bpm
0.8
54
cardiac cycle contains two primary phases based on ventricular activity:
systole and diastole
55
equation for cardiac output?
CO= HR x SV
56
___ L of blood at rest?
5-6
57
blood volume may increase by ___x the resting level with exercise
4-7x
58
equation for BP?
BP = HR x SV x total peripheral resistance
59
Cardiac output affects ___ BP
systolic
60
TPR affects ___ BP
diastolic
61
MAP equation?
MAP = DBP + 1/3(SBP-DBP)
62
normal MAP assuming a BP of 120/80?
about 93
63
MAP is an important measure to assess for patients with ___?
hypotension
64
at what MAP would you question whether to get patients up?
< 60 mmHg
65
4 factors that mean arterial blood pressure (MAP) is determined by?
1. blood volume
2. effectiveness of the heart as a pump (cardiac output)
3. resistance of the system to blood flow
4. relative distribution of blood between arterial and venous blood vessels
66
what would have a higher BP? standing or laying supine
laying supine
67
term for the difference between systolic and diastolic pressure?
pulse pressure
68
term for end diastolic volume?
preload
69
cardiac ____: amount of left ventricular blood volume prior to contraction
preload
70
4 factors cardiac preload is dependent on?
1. venous return
2. total blood volume
3. left atrial contraction
4. frank starling law
71
cardiac __: amount of resistance (pressure) encountered by the left ventricle (aortic pressure)
afterload
72
___ ___: neural and hormonal influences to the myocardium that affects strength of contraction
myocardial contractility
73
During exercise, SV increases up to about ____% of VO2 max then levels off
40-60%
74
if preload increases, does SV increase or decrease?
increase
75
if afterload increases, does SV increase or decrease?
decrease
76
if inotropy increases, does SV increase or decrease?
increase
77
___: strength of contraction
inotropic
78
___ ___: amount of ventricular blood volume pumped per heart beat
ejection fraction
79
ejection fraction equation?
EJ = SV / EDV
80
normal ejection fraction values at the left ventricle?
55-70%
81
systolic heart failure: results in ____ ejection fraction
low
82
diastolic heart failure: results in ___ ejection fraction
normal (in some cases elevated)
83
if stroke volume decreases, does EJ increase or decrease?
decrease
84
AV valves are attached to respective ventricular surfaces via fibrous and muscular structures:
fibrous structure: ___ ___
muscular structure: __ __
chordae tendinae
papillary muscles
85
Most (64%) of the blood volume is located where?
systemic veins and venules
86
blood makes up ___% of an individuals body weight
7-8
87
____: % of red blood cells in blood
hematocrit
88
Blood functions:
- ___ oxygen and nutrients to the lungs and tissues
- forms blood ___ to prevent excess blood loss
- carries cells and antibodies that fight ___
- brings ___ products to the kidneys and liver, which filter and clean the blood
- regulates body ____
transports
clots
infection
waste
temperature
89
4 main components of blood?
1. plasma
2. red blood cells
3. white blood cells
4. platelets
90
What component of blood?
- transports red blood cells
- deliver nutrients to tissues
- act as a conduit to remove waste products
- carries antibodies, clotting proteins and hormones to select areas of the body
- maintain the body's fluid balance
plasma
91
___: not a blood cell, involved in the production of platelets to promote the clotting process
thrombocytes
92
production of red blood cells is called ___. this takes place in ___ bone.
hematopoiesis, cancellous (spongy) aka bone marrow
93
Bound O2: no increased SaO2 if PaO2 >/- ____ mmHg
>/- 50 mmHg
94
blood oxygen concentration shift to the right = ___ release of O2
increased
95
blood oxygen concentration shift to the left = ___ release of O2
decreased
96
blood oxygen concentration shift depends on location:
- working muscles shift to the ___
- lungs shift towards the ___
right, left
97
PERIPHERAL GAS EXCHANGE: autonomic nervous system
- under control of the ___
- receives input from the baroreceptors from carotid sinus and aortic arch on changes in BP
- ___ post ganglionic fibers innervate arterioles - very little input from parasympathetic nervous system
- increased activation causes ___
- reduced activation causes ____
hypothalamus, sympathetic, vasoconstriction, vasodilation
98
4 factors that affect the movement of fluid in the microcirculation?
1. capillary hydrostatic pressure
2. capillary oncotic pressure
3. interstitial hydrostatic pressure
4. interstitial oncotic pressure
99
PERIPHERAL GAS EXCHANGE:
___ ____ pressure:
- tends to move blood across the capillary membrane into the interstitium
- pressure originates from the blood pressure in the arterial system
capillary hydrostatic pressure
100
PERIPHERAL GAS EXCHANGE:
____ ____ pressure:
- plasma proteins albumin increase osmolarity within the capillary vessels as compared to the interstitial fluid
- results in flow of interstitial fluid into the capillary circulation
capillary oncotic pressure
101
PERIPHERAL GAS EXCHANGE:
___ ____ pressure:
- move fluid back into the microcirculation (capillaries)
interstitial hydrostatic pressure
102
PERIPHERAL GAS EXCHANGE:
____ ____ pressure:
- draws fluid out of the microcirculation into the interstitium
interstitial oncotic pressure
103
Fick equation to determine VO2?
VO2 = HR x SV x (a-VO2 difference)
104
NET fluid exchange = ___ mmHg OUTWARDS from capillary
2
105
PERIPHERAL CIRCULATION:
At rest:
- muscles receive about ___% of cardiac output
- mesenteric, splenic and portal tissues receive ___% of cardiac output
- brain and myocardium receive about ___ of cardiac output
10-15%, 20-30%, 5%
106
PERIPHERAL CIRCULATION:
with vigorous exercise, muscles receive about ____% of cardiac output
- exercising muscle will require increased blood flow while tissue beds of other organs (gut) are reduced
- increased blood flow directed to the skin to promote cooling
80-85%
107
oxygen delivery (DO2) ___ as tissue metabolism increases
increases
108
oxygen consumption (VO2) ____ as tissue metabolism increases
increases
109
at rest, ____ of oxygen is extracted from peripheral circulation
23%
110
OXYGEN EXTRACTION RATIO:
normally, if DO2 decreases, VO2 does not:
- the tissues will utilize the same ___ amount of O2 that is present in the blood
- tissue metabolism will decrease to survive on a lesser ____ amount of O2
relative, absolute
111
