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CR2 > Applied Anatomy of the Heart > Flashcards

Applied Anatomy of the Heart Flashcards

1
Q

How does cardiac remodelling occur?

A

Collagen synthesis/increasing myocyte size to allow myocardial hypertrophy
Physiological - pregnancy or athletes can increase their myocardial size
Pathological - worse

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2
Q

What are the 2 types of ventricular hypertrophy and what is the difference between them?

A

Concentric - organ wall thickens (new sarcomeres) but volume is diminished so size doesn’t actually increase
Eccentric - walls and chamber grows so size and volume enlarges

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3
Q

What are the effects of concentric hypertrophy?

A

Increased afterload = hypertension, aortic stenosis
Reduced compliance as thick wall is stiff
Compromised ventricular filling
Can lead to eccentric

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4
Q

What can aortic stenosis lead to?

A

Left ventricular hypertrophy - concentric as increased muscle mass to generate increased force to propel blood past obstruction.

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5
Q

What can be a result of ventricular hypertrophy?

A

Myocyte apoptosis, synthesis of abnormal proteins, increased fibrous tissue, new sarcomeres

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6
Q

What is cardial remodelling?

A

Changing the relationship between preload and stroke by increasing myocardial mass

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7
Q

What is the role of the sympathetic nervous system on the heart?

A

Cardioaccelatory centre - increases heart rate and the force of contraction.
From the medulla, short preganglionic fibres originating in the upper 5/6 segments then post in the symp chain to then go to the SAN and AVN and part of the SM of the heart itself increasing activity

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8
Q

Where is the parasympathetic pathway found?

A

In the reticular formation in the medulla. Long preganglionic fibres inserting on the plexus or on the tissue itself which go to the SAN and AVN (conducting system) to slow everything down

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9
Q

What do the nerves from the cardiac plexus innervate?

A

SAN, AVN, coronary vasculature

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10
Q

What makes up the cardiac plexus?

A

The GVA, paraysympathetic NS (vagus nerve) and the sympathetic NS (symp trunk)

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11
Q

What is the role of the parasympathetic centre on the heart?

A

Cardioinhibitory centre acts to reduce heart rate and reduce the force of contraction

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12
Q

What innervates the heart?

A

Cardiac plexus

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13
Q

How is cardiac pain felt?

A

It is referred pain as the ischemia results in stimulation of sensory nerve endings in the myocardium. These general visceral afferents then conduct impulses to the CNS via the sympathetic trunk.

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14
Q

Where is referred cardiac pain normally felt?

A

In the T1-T4 dermatomes and T5-T9 areas.

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15
Q

What are the different surfaces of the heart?

A

Anterior (costal), right pulmonary, diaphragmatic, apex at the front, left pulmonary, base (posterior)

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16
Q

What are the main coronary arteries on the LHS?

A

Left coronary artery gives off the LAD and the left circumflex (which gives off the left marginal artery).

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17
Q

What coronary arteries makes up the RHS?

A

The right coronary artery gives off the posterior descending and the right marginal artery.

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18
Q

What supplies the interventricular septum?

A

The LAD and the posterior descending coronary arteries

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19
Q

How many ECG leads are there?

A

12 leads: 6 chest precordial (horizontal plane), aVr/aVl/aVf and 3 other in a vertical plane

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20
Q

Where are the precordial ECG leads placed?

A

Right sternal edge 4th ICS, Left sternal edge 4th ICS, 5ICS, one in between, anterior axillary line, mid-axillary line

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21
Q

What is the result of bundle branch block?

A

Impulses have to be conducted via alternative pathways via myocytes which slow the impulse speed prolonging the QRS wave (ventricular depolarisation) so you get a loss of ventricle synchronisation

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22
Q

What is the result of atrial enlargement?

A

AF

23
Q

What does AF cause?

A

Ectopic heartbeat, absent P wave, reduced CO

24
Q

What can cardiac remodelling result in?

A

Hypertension/aortic stenosis, valvular regurg/hypervolaemia, compensatory hypertrophy/reduction in contractility due to scarring

25
Q

What is aortic stenosis?

A

Narrowing of the aortic valve opening

26
Q

What is hypervolemia?

A

Too much fluid in the blood

27
Q

What are the effects of eccentric hypertrophy?

A

aortic and mitral regurg, hypervolemia (volume overload), renal failure, elevates oxygen demand, loss of iontrophy

28
Q

What does lub dub actually mean?

A

Lub is the S1 sound and is the closure of M1 and T1 at the start of systole
Dub is the S2 sound and is the closure of A1 and P1 at the end of systole

29
Q

What is valvular disease?

A

Inflammation of the valves due to bacterial infection/aging/ischemic heart disease/rheumatic disease, fibrosis which can cause stenosis

30
Q

What is mitral regurg caused by? What does it cause?

A

Most common type of valvular disease where mitral valve prolapses so blood goes back into the left atrium.

31
Q

What may LT mitral regurg result in?

A

Left atrial enlargement and left ventricular hypertrophy

32
Q

What is heard with an aortic stenosis?

A

Systolic murmur (turbulence of blood being pushed through stenotic valve) - less severe means systole is earlier whilst more severe means systole is later
hears at right 2nd ICS
diamond shaped sound so gets loudest in middle

33
Q

What kind of sound is heard with aortic regurg?

A

Diastolic murmur - complex and absent sometimes

34
Q

What is dominance of the heart defined by?

A

Where the posterior descending artery comes from. If it stems from the right coronary artery there is right dominance and this happens in 70% of cases. If it stems from the left anterior descending then it is described as left dominance.

35
Q

What does the left marginal artery supply?

A

The left ventricle

36
Q

What anastomoses with the posterior descending artery?

A

LAD

37
Q

What is the septal area supplied by?

A

anterior 2/3 by the LCA

posterior 1/3 by the RCA

38
Q

What does co-dominance mean?

A

There is double supply from both the LAD and RCA

39
Q

Which bundle are there more branches in?

A

The left as the left ventricle is thicker and larger and has more work to do

40
Q

What would happen if there was right bundle block?

A

The conduction of the impulse would have to travel through the left bundle to the right ventricle meaning there would be a slight but unnoticeable delay in its contraction which means the QRS wave is wider (prolonged).

41
Q

What is normal stroke volume?

A

70ml

42
Q

Which stimuli cause cardiac hypertrophy?

A

Pressure overload

Volume overload

43
Q

What stimuli causes concentric hypertrophy?

A

Pressure overload - sarcomeres are added in parallel to thicken the wall

44
Q

What stimuli causes eccentric hypertrophy?

A

Volume overload - sarcomeres added in series to lengthen the wall

45
Q

What are some pathological and physiological causes of concentric and eccentric hypertrophy?

A

Concentric -> Physiological - strength training and pathological - hypertension and aortic constriction
Eccentric -> physiological - endurance training and pathological - valve disease

46
Q

How can pathological ventricular hypertrophy be caused?

A

Pressure overload - hypertension and aortic stenosis
Volume overload - valvular regurgitation, hypervolemia
Cardiac injury - ischaemia/infarct

47
Q

What does remodelling due to ventricular hypertrophy lead to?

A

New sarcomeres
Decreases capillary:myocyte ratio (insufficient angiogenesis)
Increased fibrous tissue (systolic and diastolic dysfunction)
Myocyte apoptosis

48
Q

What is heard with mitral regurg?

A

Systolic murmur
pansystolic (louder in the late part of the murmur)
heard at apex

49
Q

What can aortic stenosis lead to?

A

LVH (concentric)
Concentric hypertrophy
hypertrophied myocardium has reduced compliance
decreased coronary blood flow

50
Q

What does mitral valve stenosis cause?

A

Atrial “kick” needs to be stronger leading to atrial enlargement and increased atrial pressure – pulmonary congestion (oedema)
Ventricular filling reduced – reduced cardiac output

51
Q

What does aortic regurg lead to?

A

Backflow into LV during diastole
The chronic volume overload causes stretching and elongation of myocardial fibers (eccentric hypertrophy).
LV dilatation and congestive heart failure
Decreased cardiac output due to regurgitation
Elevates pre-load

52
Q

What sound is heard with mitral stenosis?

A

Diastolic murmur

53
Q

What sound is heard with aortic regurg?

A

Diastolic murmur

CR2 (35 decks)

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