3. Chest pain

Question 1

F. Which sentence best describes the relationship of BP and SVR with the parasympathetic nervous system?
Parasympathetic nerves …. peripheral blood vessel diameter … systemic vascular resistance and … blood pressure

Answer 1

e) Parasympathetic nerves do not have a major influence on peripheral blood vessel diameter and have little/no effect on systemic vascular resistance and blood pressure

Question 2

F Which sentence best describes the relationships of CO and BP with the sympathetic nervous system?
c) Sympathetic nerves … peripheral blood vessel diameter … systemic vascular resistance and … blood pressure

Answer 2

c) Sympathetic nerves decrease peripheral blood vessel diameter thereby increasing systemic vascular resistance and increasing blood pressure

Question 3

F Match the following questions to the most appropriate vessel:
Occlusion is most likely to result in a fatal heart attack

Answer 3

a) Left main coronary artery

Question 4

F Which nerve innervates the pericardium?

Answer 4

a) Vagus nerve

Question 5

F If the end diastolic volume (EDV) in a healthy person’s left ventricle is 120mls, what would you expect the end systolic volume (ESV) to be?

a) 0mls
b) 10mls
c) 50mls
d) 70mls
e) 100mls

Answer 5

c) 50mls

Question 6

F Which of these following statements is correct?

a) Atrial systole corresponds to closure of the tricuspid valve
b) Atrial contraction occurs before the P-wave on ECG
c) Ventricular systole corresponds to closure of the pulmonary valve
d) Ventricular volume increases during ventricular systole
e) For part of the cardiac cycle, both atrial and ventricular diastole occur together

Answer 6

e) For part of the cardiac cycle, both atrial and ventricular diastole occur together

Question 7

F Consider the pressure changes within the heart and decide which pressure is most affected in the following situation:
Increase in this signifies left heart failure
a) Left atrial end-diastolic pressure
b) Left atrial end-systolic pressure
c) Left ventricular end-diastolic pressure
d) Left ventricular end-systolic pressure
e) Mean aortic pressure

Answer 7

c) Left ventricular end-diastolic pressure

Question 8

F Consider the pressure changes within the heart and decide which pressure is most affected in the following situation:
Increase in this indicated mitral valve stenosis
a) Left atrial end-diastolic pressure
b) Left atrial end-systolic pressure
c) Left ventricular end-diastolic pressure
d) Left ventricular end-systolic pressure
e) Mean aortic pressure

Answer 8

b) Left atrial end-systolic

Question 9

F What is the purpose of the Ductus Arteriosus in the foetal cardiovascular system?

a) Allows blood to bypass the foetal lungs by shunting it from the right atrium to the left atrium
b) Allows blood to bypass the foetal lungs by shunting it from the Pulmonary Artery to the Aorta
c) Allows blood to bypass the foetal systemic circulation by shunting it from the left atrium to the right atrium
d) Allows blood to bypass the foetal systemic circulation by shunting it from the aorta to the pulmonary artery
e) Allows blood to bypass the foetal liver by shunting maternal blood to the inferior vena cava

Answer 9

b) Allows blood to bypass the foetal lungs by shunting it from the Pulmonary Artery to the Aorta

Question 10

F Cardiac output is…

a) Mean blood pressure x systemic resistance
b) Mean blood pressure x stroke volume
c) Heart rate x mean blood pressure
d) Heart rate x stroke volume

Answer 10

d) Heart rate x stroke volume

Question 11

F Pulmonary oedema in the presence of a normal central venous pressure is a sign of…

a) Right heart failure
b) Left heart failure
c) Biventricular failure
d) Bilateral failure
e) Respiratory failure

Answer 11

c) Biventricular failure

Question 12

F Severe pulmonary hypertension is a cause of…

a) Right heart failure
b) Left heart failure
c) Biventricular failure
d) Bilateral failure
e) Isolated septal hypertrophy

Answer 12

a) Right heart failure

Question 13

F Shortness of breath, severe peripheral oedema and ascites (oedema in peritoneal cavity) after heart attack indicates…

a) Right heart failure
b) Left heart failure
c) Biventricular failure
d) Bilateral failure
e) Isolated septal hypertrophy

Answer 13

c) Biventricular failure

Question 14

F Define the normal pathway of conduction through the heart
A SAN
B Bundle of his
C Contractive of the atria
D Purkinje fibres
E AVN
F Contraction of the ventricles 
a)	E, C, A, B, D, F
b)	A, E, C, B, D, F
c)	A, C, E, B, D, F
d)	E, C, A, D, B, F
e)	A, C, E, D, B, F

Answer 14

c) A, C, E, B, D, F

Question 15

F Which artery most frequently supplies the AVN?

a) Left coronary artery
b) Right coronary artery
c) Left circumflex artery
d) Posterior descending artery
e) Left anterior descending artery

Answer 15

d) Posterior descending artery (This is the more correct of the 2 answers)
also b)

Question 16

Q Describe the coronary circulation

Answer 16

Right and left coronary arteries coming out of the aortic sinus – left and right cusps
Right coronary artery supplies SAN, right atrium and right ventricle (in most cases supplies posterior descending artery and right marginal artery – goes down the border)
Left coronary artery supplies – bundle of His, some of the right ventricle, left ventricle, left atrium
Left ventricle – supplied by LAD and part of left circumflex
Left atrium – supplied by left circumflex
In 70% of people – PDA comes from right coronary artery
In 20% it comes from the left circumflex branch
In 10% it comes from both
Anterior MI – LAD is occluded, causes ischaemia to the left ventricle, usually fatal
Venous drainage: all drain into coronary sinus – which drains into the RIGHT ATRIUM
5 tributaries into coronary sinus
Great cardiac vein Originates at apex, runs with the LAD (up the interventricular groove),
Drains the left ventricle and bundle of His
Small cardiac vein Anterior surface of the heart, passes around the right side of the heart
(accompanies right marginal), drains the right atrium and right ventricle

Middle cardiac vein On the back of the heart, follows the posterior interventricular artery,
drains part of both ventricles
Left marginal vein Running along the left side on the posterior surface
Left posterior ventricular vein
In the centre at the back
Left oblique vein Runs obliquely round the back of the left atrium, drains the left
atrium

Question 17

Right coronary artery:
comes out of
supplies

Answer 17

the aortic sinus – right cusp
SAN, right atrium and right ventricle (in most cases supplies posterior descending artery and right marginal artery – goes down the border)

Question 18

Left coronary artery
comes out of
supplies

Answer 18

the aortic sinus – left cusp

– bundle of His, some of the right ventricle, left ventricle, left atrium

Question 19

Left:
ventricle – supplied by
atrium …

Answer 19

LAD and part of left circumflex

left circumflex

Question 20

Ratio of …. variation of …

Answer 20

70% – PDA comes from R coron. art only!
20% from L circumflex branch only!
10% it comes from both

so 80:30!

Question 21

Anterior MI

Answer 21

– LAD is occluded, causes ischaemia to the left ventricle, usually fatal

Question 22

Venous drainage:

Answer 22

all drain into coronary sinus – which drains into the RIGHT ATRIUM

Question 23

how many tributaries into coronary sinus

Answer 23

5:
-Great cardiac vein: Originates at apex, runs with the LAD (up the interventricular groove),
Drains the left ventricle and bundle of His
-Small cardiac vein: Anterior surface of the heart, passes around the right side of the heart
(accompanies right marginal), drains the right atrium and right ventricle
-Middle cardiac vein: On the back of the heart, follows the posterior interventricular artery, drains part of both ventricles
-Left marginal vein Running along the left side on the posterior surface
-Left posterior ventricular vein
In the centre at the back
-Left oblique vein Runs obliquely round the back of the left atrium, drains the left
atrium

Question 24

Q . Define Starling’s law of the heart ***

Answer 24

Frank startling mechanism states that for a larger end diastolic volume, the STROKE VOLUME will be greater (due to stretch and elastic recoil of the sarcomeres –)
*** Frank starling = larger preload = stretches the sarcomeres = causes a greater elastic recoil = greater force of contraction to cope with the increased preload

Question 25

2 ways to increase stroke volume:

Answer 25

1. Increase the preload (by increasing venous return)
2. Increase the contractility via sympathetic stimulation (positively inotropic, independent of
   preload)

Question 26

Contractility
Chronotropic
Inotropic

Answer 26

– the ability of the heart’s contractile strength to change, independent of the venous return/end diastolic volume
Chronotropic = alters heart rate
Inotropic = alters contractility

Question 27

Heart failure def. ***

+ explanat.

Answer 27

***– when ventricular contraction doesn’t meet the systemic demand for blood
Initially – cardiac myocytes undergo hypertrophy to compensate and maintain the original CO
Eventually – the size of the heart muscle itself demands a greater amount of blood supply than the cardiac reserve (the blood that the heart uses to supply its own tissues) can supply, so it becomes ischaemic

Question 28

Q Starling’s law of the heart, its significance of heart failure

Answer 28

?????

Question 29

Q Define cardiac output, its components and how it’s measured

Answer 29

HR x SV
Cardiac output measured by the heart rate and urine output
Flow is measured by Doppler shifts, resistance to flow can be indirectly measured by calculating flow (flow = change in length/resistance)
Blood pressure = cardiac output x total peripheral resistance

Question 30

SV def

Answer 30

The amount of blood pumped by the left ventricle of the heart in one contraction

Question 31

BP def and equation

Answer 31

pressure that is exerted by the blood upon the walls of the blood vessels
CO x tot peripheral resistance

Question 32

Q Describe the mechanism of blood pressure control

Answer 32

Extrinsic controls
Sympathetic innervation – causes vasoconstriction in the periphery
Parasympathetic innervation – causes vasodilation in the periphery
RAAS – due to control of volume
Hormones – vasopressin/adh (vasoconstriction and increase blood vol), angiotensin 2 (vasoconstriction and increases blood vol)
Intrinsic controls
Nitric oxide – vasodilator released by endothelial cells
Endothelin 1 – vasoconstrictor released by endothelial cells
**Prostacyclins (derivatives of prostaglandins) – powerful vasodilator released by healthy cells near damaged tissue to increase bl flow to the damaged area
Myogenic response (also intrinsic control):
Increased bl vol/flow to area stretches the myoepithelial cells – in response to this stretch they become more leaky to calcium ions. Ca2+ ions then enter and cause the smooth muscle to contract. To constrict the blood flow to an area.
**Active hyperaemia (means the action of causing increased perfusion):
In respiring tissue, the increase in metabolic waste products causes local vasodilators to be released. This increases blood flow to the area to remove these waste products.
Reactive hyperaemia (what the body does in case you have blocked blood vessels)
When there is a blockage in a blood vessel, ischaemia occurs. This causes vasodilators to be released proximal to the area of the blockage, causing a large increase in blood flow to this area. This means as soon as the blockage is cleared, blood flow will be restored to the area to quickly nourish as much tissue as possible.
Extrinsic and intrinsic controls is talking about controlling peripheral resistance
But blood pressure can also be controlled by cardiac output (central control)
CO can be increased by increasing sympathetic stimulation as this increases HR and contractility (Chronotropic and inotropic).
Venous return can also be increased by increasing the skeletal muscle pump

Question 33

intrinsic blood pressure control

Answer 33

Nitric oxide – vasodilator released by endothelial cells
Endothelin 1 – vasoconstrictor released by endothelial cells
Prostacyclins (derivatives of prostaglandins)
Myogenic response:
Active hyperaemia
Reactive hyperaemia

Question 34

extrinsic blood pressure controls

Answer 34

Sympathetic innervation – causes vasoconstriction in the periphery
Parasympathetic innervation – causes vasodilation in the periphery
RAAS – due to control of volume
Hormones – vasopressin (vasoconstriction and increase blood vol), angiotensin 2 (vasoconstriction and increases blood vol)

Question 35

*** Active hyperaemia

Answer 35

intrinsic controls ( the action of causing increased perfusion):
In respiring tissue, the increase in metabolic waste products causes local vasodilators to be released. This increases blood flow to the area to remove these waste products.

Question 36

• Reactive hyperaemia

Answer 36

(what the body does in case you have blocked blood vessels)
intrinsic c.
When there is a blockage in a blood vessel, ischaemia occurs. This causes vasodilators to be released proximal to the area of the blockage, causing a large increase in blood flow to this area. This means as soon as the blockage is cleared, blood flow will be restored to the area to quickly nourish as much tissue as possible.

Question 37

• Myogenic response

Answer 37

Increased blood volume/flow intrinsic c
to an area stretches the myoepithelial cells – in response to this stretch they become more leaky to calcium ions. Calcium ions then enter and cause the smooth muscle to contract. To constrict the blood flow to an area.

Question 38

*** Prostacyclins

Answer 38

(derivatives of prostaglandins) – powerful vasodilator released by healthy cells near damaged tissue to increase blood flow to the damaged area

Question 39

Q. Describe the signs and symptoms of left ventricular failure

Answer 39

Pulmonary oedema - because there is backflow from the left ventricle and atrium in to the
pulmonary vein and then into the lungs. Causes an increased venous pressure in the lungs.
This means the venule end of the capillary will have a very high hydrostatic pressure, meaning
there is no pressure gradient to pull fluid back into the venous end of the capillary from the
surrounding tissue, which means the fluid will remain in the interstitium.

Question 40

Q Describe the signs and symptoms of right ventricular failure

Answer 40

Systemic oedema (in the legs etc.). Blood is back flowing through to the SVC to cause palpable 
liver (portal hypertension), high venous pressure causing low venous return of blood against the 
pressure gradient, and oedema as fluid cannot return to the venule end of the capillary.