7. Cardiac Physiology - Beth Phillips Flashcards
Right side of the heart
- What kind of blood comes in?
- Through what?
- What valve is between the atrium and ventricle?
- What vessel does the blood come out from? Through which valve?
- Deoxygenated blood
- Superior and inferior vena cava
- Tricuspid valve
- Through the pulmonary valve into the pulmonary artery
Left side of the heart
- What kind of blood comes in?
- What valve is between the atrium and ventricle?
- What vessel does the blood come out from? Through which valve?
- Oxygenated blood
- Mitral valve AKA bicuspid valve
- Aortic valve into aorta
Coronary circulation
- What does the coronary circulation supply?
- Explain the 2 things the right coronary artery branches into
- Explain the 2 things the left coronary artery branches into
- Heart
- Marginal branch and posterior inter-ventricular branch
- Circumflex branch and anterior inter-ventricular branch
Explain the 5 steps of heart muscle conduction
SA node AV node AV bundle (bundle of His) Right and left bundle branches Purkinje fibres
Cardiac muscle
- What type of muscle is it?
- What is contraction dependent on?
- What is a sarcomere?
- What is a myofibril?
- Explain a H zone, an I band and an A band
- What are thick filaments mainly made of? What are thin filaments mainly made of?
- Striated
- Calcium and ATP
- Smallest functional unit of any striated muscle
- Sarcomeres end to end
- H zone = part in middle (only thick band)
I band = thin filaments connecting on adjoins sarcomeres (no thick)
A band = whole thick and the thin that it overlaps with - Thick = myosin
Thin = actin
Cardiac myocytes
- Explain cardiac myocytes in 3 ways. Explain the syncytium aspect.
- Define intercalated discs
- Define gap junctions
- Define connexons
- Small cell, single nucleus, mitochondria take up 30-40% of cell
Work as functional syncytium but are not a structural syncytium - Electrical boundaries between cells with leaky gap junctions
- Electrical pores made of proteins
- Charged aqueous pores
Action potentials
- What is the rating membrane potential of all cells?
- Membrane permeability to which ions causes depolarisation?
- Membrane permeability to which ions causes repolarisation?
- What is the part of an action potential called where the line is going from polarised to reaching the threshold?
- Electronegative
- Sodium and calcium
- Potassium
- Pacemaker potential
Autonomic control
- Higher brain centres and sensory receptors send input to where?
- From there, the output to the heart goes via the SNS or the PNS. What does the SNS release and on which receptor? What does this lead to an increase in?
- What does the PNS release and on which receptor? What does this lead to a decrease in?
- Cardiovascular centre
- Nor-adrenaline on beta1-adrenoreceptors
Leading to an increase in HR, spontaneous depolarisation in SA and AV node, contractility and stroke volume - Acetylcholine on muscarinic receptors
Leading to a decrease in HR and spontaneous depolarisation in SA and AV node
What do the following do to the slope of the pacemaker potential:
- Sympathetic tone
- Parasympathetic tone
- Increases slope
2. Decreases slope
- Define ECG
- What kind of recordings are these?
- What is a galvanometer?
- What is a dipole?
- Recording of electrical activity of the heart which represents mechanical activity
- Extracellular recordings
- Detects, measures and determines direction of small electrical currents
- Difference in charge between one bit of the membrane and another
What kind of deflection would happen in the following cases?
- Depolarisation moving towards unipolar electrode (or towards + pole of bipolar lead)?
- Depolarisation moving away from unipolar electrode (or away from + pole of bipolar lead)?
- What is the case for repolarisation?
- Positive upward deflection
- Negative downward deflection
- Opposite for repolarisation
Explain the places where the 10 electrodes are placed, naming each electrode (point out which one is the neutral electrode)
R wrist / L wrist R ankle (neutral) / L ankle V1 = 4ICS R sternum V2 = 4ICS L sternum V3 = between V2 and V4 V4 = 5ICS L mid-clavicle V5 = 5ICS L axilla start V6 = 5ICS L mid-axilla
Which leads are bipolar? Which leads are unipolar?
Bipolar leads = leads 1, 2 and 3
Unipolar leads = leads aVR, aVL, aVF
Einthoven’s triangle - limb electrodes
- What is each corner?
- What is lead 1? What is lead 2? What is lead 3?
- What are the labels inside the triangle? How do they work?
- Where are the other 6 leads from? What are they called?
- Right arm / left arm / left leg
- Lead 1 = LA to RA
Lead 2= LL to RA
Lead 3 = LL to LA - aVR (right arm) / aVL (left arm) / aVF (left foot)
They compare their own spot with the average of the other 2
Eg. aVF compares LL to average of LA and RA - 6 chest leads (V1-V6)
ECG and heart regions Describe what part of the heart each of these sections represents: V5, V6 aVL 1 aVF 2 3 V2, V3, V4 V1
V5, V6 = left side of the heart - lateral leads aVL = upper left side of heart 1 = second high lateral lead aVF = inferior wall of heart 2 = second inferior lead 3 = third inferior lead V2, V3, V4 = anterior face of heart V1 = septal leads (with V2)
ECG recording
- What 2 things do you need to be careful of when placing electrodes?
- What 3 things should the patient be doing?
- What else do you need to keep in mind when using an ECG machine?
- Accurate placing (no crossed cables)
Contact with skin (may require shaving) - Patient relaxed (pain free), not moving and not talking
- Electrical interference
P wave
- What does it show?
- Which atrial activation starts first?
- Size of muscle? Amplitude?
- Atrial depolarisation
- Right
- Small hence small
PR interval
- What does it show?
- It is measured from the start of the P wave up until when?
- Normal duration?
- Conduction through AV node, Bundle of His and Purkinje fibres
- First deflection of QRS complex
- 0.12-0.20 secs
QRS complex
- What does it show?
- Large muscle mass of what? Results in what?
- Normal duration?
- Ventricular depolarisation
- Left ventricle
QRS predominantly representing LV - Less than 120 ms
Q wave
- What is it?
- Normal depth? Normal duration?
- Any initial negative deflection
- Less than 2mm
Less than 40 ms
ST segment
- What does it show?
- What is the muscles status at this point?
- Usual depth?
- End of ventricular depolarisation to beginning of repolarisation
- Muscle is depolarised and contracting
- Level or +- 1mm from baseline
QT interval
1. What does this show?
- Total time for depolarisation and repolarisation of the ventricles
T and U wave
- What does the T wave show?
- Rarely exceeds what depth?
- What is the U wave? Do many ECGs have a discernible U wave?
- Ventricular repolarisation
- 10mm
- Small deflection after T wave
No
What 2 types of cells does the heart contain and which one is 99% of them? What does each one do?
Contractile cells (99%) Mechanical work
Autorhythmic cells
Initiate and conduct action potentials for contractile cells
- Where is the SA node?
- Where is the AV node?
- Explain the travel of the Bundle of His (AV bundle)
- Where are the Purkinje fibres?
- Which valves are open during ventricular diastole?
- Which valves are open during ventricular systole?
- Right atrial wall near opening of superior vena cava
- Base of right atrium, near septum
- AV node to IV septum-divides into right and left bundle branches- curve around ventricle walls back towards atria
- Bundle of His and spread throughout ventricular myocardium
- Bicuspid and tricuspid
- Pulmonary and aortic
Wall of ventricle
- What are the 2 sections either side of the mid-wall called? Which direction do the fibres run in and towards what?
- Which cells are activated slightly quicker?
- Subendocardial section
Fibres run away from mid-wall towards subendocardial surface
Subepicardial section
Fibres run away from mid-wall towards epicardium surface
- Endo cells
3 distinct layers of heart: epicardium, myocardium and endocardium
- Describe the epicardium
- What is the myocardium composed of?
- Describe the endocardium. What type of tissue is it made of?
- Thin external membrane that covers the heart
- Cardiac muscle
- Thin inner layer made of endothelium