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CR 2 > Applied anatomy of the heart > Flashcards

Applied anatomy of the heart Flashcards

1
Q

What 3 types of fibres make up the cardiac plexus?

A

1) General visceral afferent
2) Parasympathetic via vagus
3) Sympathetic via sympathetic trunk

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2
Q

Effect of parasympathetic nervous system on the heart

A

Reduces heart rate and reduces force of contractability

Stimulates cardioinhibitory centre

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3
Q

Effect of sympathetic nervous system on the heart

A

Increases heart rate and increases force of contractibility

Stimulates cardioaccelaratory centre

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4
Q

Where does cardioinhibitory centre send axons to?

A

SAN and AVN

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5
Q

Where do you find pre and post ganglionic axons from cardioaccelaratory centre

A 
Pre= thoracic spinal cord
Post= Neurons to AVN and SAN
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6
Q

Where do you find cardioinhibitory and cardioacceleratory centres

A

In the reticular formation of the medulla

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7
Q

Describe the anatomical position of the cardiac plexus

A

Anterior to bifurcation of the trachea

Posterior to arch of the aorta

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8
Q

What causes cardiac pain

A

Ischaemia which stimulates sensory nerve endings in myocardium

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9
Q

Where is cardiac pain usually referred to

A

T1-T4

Somtimes T5-T9

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10
Q

Why is cardiac pain referred?

A

Somatic afferents from skins ascend in the same spinal segment as visceral sensory fibres- brain confuses the signals

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11
Q

From where is coronary circulation derived?

A

Ascending aorta

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12
Q

What does the left coronary artery divide into

A

Left marginal
Left anterior descending/ anterior interventricular
Circumflex

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13
Q

What does the right coronary artery divide into

A

Right marginal

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14
Q

Which vessel supplies the SAN

A

right coronary artery

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15
Q

Which vessel ‘decides’ the dominance of the heart- how

A

Posterior interventricular
If it comes mainly from right coronary artery= right dominance
If it comes mainly from circumflex= left dominance

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16
Q

Where are conducting fibres of the heart found

A

Interventricular septum

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17
Q

Describe distribution of blood supply to interventricular septum

A

LAD provides anterior 2/3

PDA provides posterior 1/3

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18
Q

What is bundle branch block

A

Ischaemic bundle branch ceases to properly conduct so uses altered pathways for depolorisation eg through myocytes

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19
Q

Effect of bundle branch block

A

Depolarisation is slower
Prolonged QRS
Loss of ventricular synchrony

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20
Q

Define atrial remodelling

A

Any persistent change in atrium structure

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21
Q

Define cardiac remodelling

A

Structural changes associated with cardiac dynsfunction (increased myocyte mass)

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22
Q

Define cardiac dysfunction

A

Altered relationship between preload and stroke volume

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23
Q

3 main causes of pathological remodelling

A

Pressure overload, volume overload and cardiac injury

24
Q

What can causes pressure overload

A

hypertension and aortic stenosis

25
Q

What can cause volume overload

A

Caused by valvular regurgitation or hypervolaemia

26
Q

Define valvular regurgitation

A

Backward flow so increased volume in the first chamber

27
Q

Define hypervolaemia

A

Increased fluid levels in the blood

28
Q

5 molecular changes that occur during ventricular hypertrophy

A
  • Increased sarcomeres
  • Synthesis of abnormal proteins
  • Decreased capillary: myocyte
  • Apoptosis of myocytes
  • Increased fibrous tissue
29
Q

What is concentric hypertrophy

A

Thickening of the ventricular wall due to the paralell addition of sarcomeres

30
Q

What is eccentrial hypertrophy

A

Dilation of the ventricular wall due to the addition of sarcomeres in sequence

31
Q

Main causes of each type of ventricular hypertrophy

A 
Concentric= aortic stenosis, chronic hypertention
Eccentric= aortic and mitral regurgitation, systolic dysfunction, hypervolaemia
32
Q

Effect of concentric hypertrophy

A

Increased afterload, less compliant, compromised ventricular filling

33
Q

Effect of eccentric hypetrophy

A

Increased oxygen demands, decreased mechanial effects

34
Q

What happens to cusps and cordae tendonies during rheumatic disease

A

Cusps fibrose

Cordae tendinae soften

35
Q

What is mitral regurgitation and its two most common causes

A

Abnormal regurgitation in left atrium

MItral valve prolapse, rheumatic heart disease

36
Q

Effect of mitral regurgitation

A

Reduced CO, pulmonary oedema

37
Q

Describe murmur heard for mitral regurgitation

A

Mitral closed throughout
Pansystolic (louder at late systole)
Heard at apex

38
Q

Why does aortic stenosis lead to concentric ventricular hypertrophy

A

Left ventricle has to generate increased pressure in order to overcome increased afterload. INcreased muscle mass allows ventricle to generate increased force necessary to propel blood past obstruction

39
Q

Describe murmur heard with aortic stenosis

A

Turbulence as blood pushing through stenotic aortic valve
Mid systolic typically
Heard at tight intercostal space

40
Q

Is aortic stenosis murmur more or less severe if heard early or late

A

Late- time taken to generate pressure to pass through stenotic valve

41
Q

Effect of mitral valve stenosis (4)

A
  • L atrium needs higher pressure to overcome stenosis
  • Atrial kick larger leading to atrial enlargement and increased pressure leading to oedema
  • Reduced ventricular filling, reduced CO
  • Can lead to AF
42
Q

Describe murmur of mitral stenosis

A

Diastolic murmur

Soft and rumbling

43
Q

Effect of aortic regurgitation

A

Blood goes back into the LV during diastole
Chronic volume overload–> stretching and elongation of myocardial fibres
LV dilation
Decreased CO
Increased preload

44
Q

Describe murmur of aortic regurgitation

A

Rheumatic

Complex and absent

45
Q

Where does the cardiac plexus of nerves flie

A

Anterior to bifurcation of the trachea

Posterior to arch of the aorta

46
Q

What makes up the anterior and posterior/ base surface of heart

A 
Anterior= mainly right ventricle
Posterior= Left atrium (some right atrium)
47
Q

What makes up the diaphgramatic surface of heart

A

RV/LV

Mainly LV

48
Q

Which coronary artery is most commonly occluded

A

LAD

49
Q

Which ECG leads give information about LAD

A

V1, V2, V3, V4`

50
Q

What ECGS leads give information about the diagonal branch of LAD

A

1, avL, V5, V6

51
Q

What ECG leads give info about RCA

A

2,3 avF

52
Q

Name 4 leads that give lateral view of the heart

A

1, aVL

v5, v6

53
Q

Name 3 leads that give inferior view of the heart

A

2, 3, aVF

54
Q

Name 2 leads that give view of the septum

A

V1. V2

55
Q

Name 2 leads that give anterior view of the heart

A

V3, V4

CR 2 (33 decks)

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