B2 Physiology of Cardiac Muscle Flashcards
1
Q
What are the functional parts of the cardiac muscle?
A
Myocyte
Sarcomere
Actin & Myosin
Troponin & Tropomyosin
2
Q
What is a myocyte?
A
Bundles of spirally arranged myofibrils
3
Q
How many myosin molecules are in a myofilament?
A
300
4
Q
What are myocytes made from?
A
Myofilaments
5
Q
What is a sarcomere?
A
Basic individual contractile unit
The distance between two Z lines on a myofibril?
6
Q
What are myofilaments made from?
A
Myofibrils
7
Q
How do sarcomeres relate to muscle contraction?
A
Shortening of lots of sarcomeres - muscle contraction
8
Q
What is actin?
A
Thin filament contributing to structure of sarcomere
9
Q
What is myosin?
A
Thick filament contributing to structure of sarcomere; has two heads
10
Q
What does myosin contain that is necessary for muscle contraction?
A
ATPase
11
Q
What is regulatory protein complex?
A
Thin filaments which are made up of actin and a chain of globular protein.
12
Q
What are the three types of troponin?
A
T
C
I
13
Q
What is the role of Troponin T?
A
Tropomyosin attachment
14
Q
What is the role of Troponin C?
A
Ca2+ binding (when it’s released from sarcoplasmic reticulum)
15
Q
What is the role of Troponin I?
A
Inhibits actin and myosin binding (Until troponin C has bound Ca2+)
16
Q
When are troponin and tropomyosin present in the blood?
A
After myocyte damage (e.g. heart attack)
17
Q
What is the first step of excitation - contraction coupling (ECC)?
A
Receptors activated at neuromuscular synapse
18
Q
What happens after receptor activation in the ECC process?
A
Release of Ca2+ from sarcoplasmic reticulum
19
Q
What happens after Ca2+ is released from the sarcoplasmic reticulum?
A
Troponin- I is released from the troponin molecule
20
Q
What happens to the actin to allow cross linking of actin and myosin?
A
Myosin binding sites are exposed
21
Q
What happens after cross linking of the two filaments?
A
ATP attaches to the myosin head
22
Q
What effect does the ATP attachment have on the filaments?
A
Cross bridges detach
23
Q
What does the term ‘power stroke’ mean?
A
Myosin filaments rotate towards the centre of the sarcomere
24
Q
What happens after the cross bridges detach?
A
Myosin hydrolyses the ATP
25
What does the myosin head do with the energy from hydrolysed ATP?
Reorientates itself
26
How does contraction occur on the level of the sarcomere?
The myosin stays in the same place but binds to different segments of actin, resulting in actin sliding towards the M line
27
What is the M line?
The vertical mid line of the sarcomere
28
What type of nerve terminal is involved in cardiac muscle contraction?
Sympathetic
29
Where are the nerve terminals in cardiac muscle contraction?
SA and AV nodes
30
What is released at the sympathetic nerve terminals?
Noradrenaline
31
What does noradrenaline bind to on the post-synaptic membrane?
B1 receptors
32
What is the result of noradrenaline binding to B1 receptors in the process of cardiac muscle contraction?
G protein gets activated
33
What is the role of G protein in cardiac muscle contraction?
It converts ATP to cAMP
34
What is the role of cAMP in cardiac muscle contraction?
It activates B-adrenoreceptor kinase
35
What is B-adrenoreceptor kinase?
A protein kinase
36
What is the role of B- adrenoreceptor kinase in cardiac muscle contraction?
Ca2+ in the sarcolemma gets phosphorylated
37
What effect does Ca2+ phosphorylation have on cardiac muscle contraction
Increased Ca2+ means increased speed and force of contraction
38
What is transmembrane potential?
The voltage difference across a cell membrane
39
What causes transmembrane potential?
The accumulation of negative ions within the cell
40
How is a transmembrane potential set up?
Stimulation of the cell
41
What does a transmembrane potential result in?
Ion transfer across the membrane
| Voltage change
42
How is an action potential triggered in heart muscle?
Cell to cell depolarisation in cardiac myocytes
| Spontaneous in cardiac pacemaker cells
43
What is the difference between action potentials triggered betwene cardiac myocytes and in pacemaker cells
In myocytes there is a fast response
| In cardiac pacemaker cells there is a slow response
44
Why are action potentials prolonged in cardiac muscle?
To allow for complete atrial systole before ventricular systole starts.
45
What happens during repolarisation?
K, Na and Ca returns the cell membrane to resting potential
Myocyte in refractory period- will not respond to a further stimulus.
46
What are the cardiac pathways through the heart?
SAN -> AVN -> Bundle of His -> Bundle branches -> Purkinje Fibres
47
How long does the cardiac cycle usually last (how long is a single heart beat)
0.8s
48
What is the average person's heart rate?
72 beats/min
49
What are the two basic components of the cardiac cycle?
Systole and diastole
50
How do you calculate heart rate?
time divided by speed
51
How is the direction of blood flow controlled?
Valves
52
How many phases are in the cardiac cycle?
5
53
What is the first phase of the cardiac cycle?
Atrial systole
54
What does the P wave represent on the ECG?
Atrial systole
55
How much more blood the ventricles from atrial systole?
30%
56
Which valves are open during atrial systole?
Mitral and tricuspid
57
What is the benefit of atrial systole over passive filling of the ventricles?
More blood enters the ventricles
| Ventricles are stretched improving the strength of contraction
58
What is Starling's law?
The ability of the heart to change its force of contraction and therefore stroke volume in response to changes in venous return.
59
What is the second phase of the cardiac cycle?
Isometric ventricular contraction
60
What happens to the ventricles in the second phase of the cardiac cycle?
The ventricles change in shape but not volume and the valves are still closed.
Atrial diastole
61
Where is phase 2 of the cardiac cycle on the ECG?
The peak of the QRS complex
62
What causes the first heart sound (S1/'Lub')
The Mitral and Tricuspid valves closing
63
What causes the C wave?
Blood bulging back into the atria and against the valves causing a small pressure increase.
64
What is the third phase of the cardiac cycle?
Ejection phase
65
What happens during the ejection phase of the cardiac cycle?
50%-70% of the ventricular contents is ejected until the pulmonary/aortic valves close
66
What part of the ECG represents the ejection phase?
ST segment
67
When do the aortic and pulmonary valves close?
When the aortic/ pulmonary trunk pressure is higher than the ventricles
68
What causes the second heart sound (S2/'Dub')?
The Aortic and Pulmonary valves closing
69
What is the fourth phase of the cardiac cycle?
Isometric ventricular relaxation
70
What happens during isometric ventricular relaxation?
```
Cardiac myocytes repolarise
All valves closed
Both chambers are in diastole
Ventricuar pressure falls
Atria fill from veins so the atrial pressure starts to rise
```
71
What part of the ECG represents isometric ventricular relaxation?
T wave
72
What is the fifth phase of the cardiac cycle?
Slow filling
73
What happens during slow filling?
Mitral/ Tricuspid open
Blood from veins filling atria
Pressure in atria eventually rises to above ventricular pressure
74
What part of the atrial trace represents slow filling?
V wave
75
How much of the venous blood actually enters the ventricles?
70%
76
What factors influence cardiac output?
Stroke volume
| Heart rate
77
What is the another name for Starling's law
Frank-Starling Effect
78
Why does a higher diastolic volume mean higher contractility mean a higher stroke volume?
Increasing fibre length results in increased velocity of contraction
Increasing diastolic volume increases the length of the cardiac muscle fibres in the ventricles
79
What does the P-R interval show?
The period of time from onset of P wave to start of QRS complex (normally 0.12-0.2s)
80
What does the Q wave represent?
Excitation of intraventricular septum
81
What does the R wave represent?
Excitation of apex and free walls
82
What does the S wave represent?
Excitation of regions near the base of the heart
83
How long does the QRS complex last?
0.06-0.1s
84
What kind of shape does a normal T wave have?
Assymetrical
85
True or false? The T wave may be followed by a small U wave repolarisation of papillary muscle
True
86
What does the ST segment show?
The period between the end o ventricular depolarisation and the beginning of ventricular repolarisation
87
What does the QT interval show?
Total time taken for depolarisation and repolarisation of the ventricles
88
Why is it that the after a myocardial infarction, the ST segment can appear raised or lowered?
Baseline changes
89
How long is the QT interval on average?
0.35-0.45s
90
True or false? QT interval varies with heart rate?
True
91
What is sinus rhythm?
Heart rhythm is determined by the SA node
92
What cells are responsible for generating the spontaneously unstable membrane potential?
Pacemaker cells
93
What is the normal sinus rate range?
60-100 beats/min
94
What is bradycardia?
Slow heart beat (
95
What is tachycardia?
Fast heart beat (>100 beats/min)
96
What is the commonest form of arrhythmia?
Atrial Fibrillation
97
What increases the prevalence of atrial fibrillation?
Age
98
How is atrial fibrillation caused?
Multiple re-entrant circuits sweeping around atrial myocardium which may hit the SA node causing irregular ventricular contraction
99
How would atrial fibrillation present on an ECG?
P-Waves absent
| Wavy irregular baseline of fibrillation waves - 300-600 beats/min
100
What is inotropy?
Force of contraction
101
What is chronotropy?
Timing of impulse firing/ heart rate
102
What is the effect of digoxin on the heart?
Cardiac glycoside
Increases force of contraction
Decreases conduction in AV node
103
What is the effect of adrenaline on the heart?
Increases heart rate, inotropy and automaticity
104
Between digoxin and adrenaline, which drug doesn't have an effect on automaticity?
Digoxin
105
What are adrenaline's pharmalogical mechanisms of action?
Acts on B1-adrenoreceptors via cAMP on SAN, atrial muscle, AVN and ventricular muscle
106
What types of cells does the cardiac muscle have?
Myocardial cells
| Conduction cells
107
What are myocardial cells?
Cells responsible for generating pumping pressure to pump blood around body; cells- connected
108
What are conduction cells?
Cells responsible for rapidly spreading electrical signals to myocardial cells
109
How are myocardial cells connected?
Via intercalated discs with gap junctions.
110
Why do conduction cells spread electrical signals to myocardial cells?
To coordinate pumping.
111
Give an example of conduction pathway cells?
Bundle of His
| Purkinje fibres
112
What are the three layers in the walls of blood vessels known as?
Tunics
113
What is the innermost layer of a blood vessel, histologically?
Tunica Interna (Intima)
114
What is the middle layer of a blood vessel, histologically?
Tunica Media
115
What are the properties of the tunica interna/intima?
Continuous with endocardial lining of heart
Smooth surface so blood flows through smoothly
Simple squamous epithelium
116
What are the qualities of the simple squamous epithelium in the tunica interna?
Short diffusion path
Site where chemical signals are sent/received
Site for synthesis of various agents
117
What are the qualities of the basement membrane in the tunica interna?
Provides physical support base for epithelial layer.
Framework of collagen fibres
Anchors epithelium to underlying connective tissue
Regulates molecular movement
118
What are the qualities of the internal elastic lamina in the tunica interna?
Thin sheet of elastic fibres
| Variable number of window-like openings (facilitate diffusion from tunica interna to tunica media)
119
What allows for the diffusion of materials from the tunica interna to the tunica media?
Window like openings in internal elastic lamina of tunica interna
120
What is the tunica media?
Muscular and connective tissue layer
121
What layer varies the most among different vessel types?
Tunica media
122
What is the primary role of muscle cells?
To regulate the diameter of the lumen
123
What does the tunica media mainly consist of?
Smooth muscle cells
| Elastic fibres
124
When does vasoconstriction occur?
Sympathetic stimulation
| Vascular spasm to limit blood loss after damage
125
What separates the tunica media from the tunica externa?
External elastic lamina
126
Between the tunica media and the tunica externa, which layer does the external elastic lamina belong to?
Tunica media
127
What is another name for the tunica externa?
Tunica Adventitia
128
What is the tunica externa?
Outer covering of blood vessel
129
What is the tunica externa made from?
Elastic and collagen fibres
130
What type of nerve does the tunica externa contain?
Autonomic
131
What is the term used to describe tiny blood vessels that supply the tissues of the vessel walls?
Vasa vasorum
132
What does vasa vasorum mean?
Vessels to the vessels
133
Where can you see vasa vasorum?
The aorta
134
What are the roles of the vasa vasorum
Supplying vessel wall with nerves and self-vessels
| Helps anchor vessels to surrounding tissues
135
What are the roles of the aorta/large arteries?
Contain blood at high pressure
| Distributing blood to smaller vessels
136
What are larger arteries known as?
Elastic arteries
137
Why are vasa vasorum frequent on larger arteries
Poor oxygen diffusion across thicker surfaces (i.e. larger arteries)
138
What are smaller arteries known as?
Muscular arteries
139
What is the role of smaller arteries/ arterioles?
Site of flow control since there is a significant pressure drop across arterioles
140
Why are larger arteries more elastic?
They have a greater proportion of tunica media which contains the elastic fibres
141
What are the vessels with the smallest diameter called?
Capillaries
142
What are the qualities of capillaries?
```
Diameter comparable with blood cells
Extensive network
Total cross sectional area large
Thin walled
Tunica media almost absent
Occasional pericytes
```
143
What are the three types of capillary?
Continuous
Fenestrated
Discontinuous
144
What is the most common type of capillary?
Continuous
145
What are fenestrated capillaries?
Capillaries found in tissues with high exchange function - endothelium appears to have pores for exchange- these are known as fenestrations
146
What is the structure of fenestrated capillaries?
Regular, contain diaphragm material
147
What organs would have a high exchange function?
Small Intestine
Kidney
Endocrine Glands
148
Where are discontinuous tissues found?
In tissues where there is cell as well as molecule exchange.
149
What organs would have cell as well as molecule exchange?
Liver
| Spleen
150
What are the qualities of discontinuous capillaries?
Gaps between endothelial cells
Irregular fenestrations
Large sub-endothelial space
Sub-endothelial space occupied by specialised cells
151
What is the primary purpose of venules and veins?
To be a low pressure collecting system
152
What are the structures of venules and veins?
No internal elastic lamina underlying endothelium
| Relatively thin tunica media for lumen size
153
True or false? Venules and veins have the abilility to change their capacity
True - some capacity
154
How do the venules and veins move blood back to the heart?
Valves and 'muscle pump'.
155
What is the cardiac muscle made of?
Cardiac myocytes
156
What junctions are between intercalated disks?
Gap
| Adherens
157
How are signals transmitted between intercalated disks?
Electro-chemical coupling
| Mechanical link
158
How is it that the heart can function aerobically?
Metabolic substrates
159
What does blood pressure depend on?
Cardiac output and peripheral resistance
160
What factors affect peripheral resistance?
Blood viscosity
Dimensions of vessel
Blood volume
161
What are the properties of lymphatic vessels?
```
Lined by endothelium
Extremely low pressure
Thin walled (Normally endothelium only)
Valves
Non-continuous circulation
```
162
Why is lymphatic circulation non-continuous?
It drains fluid from tissues and ultimately drains it into the venous system, it's doesn't find its way back to tissues
163
What does lymph filter through?
Lymph nodes
164
What is the structure of smooth muscle?
Individual long thin cells (spindle shaped)
Actin-myosin contractile system not in sarcomeres
Central oval shaped nuclei
165
In comparison to striated muscle, does smooth muscle have more or less contractility?
More
166
What is the speed of smooth muscle contraction in comparison to striated?
It is slower
167
How is smooth muscle able to maintain tension?
Low ATP consumption
168
Where is smooth muscle typically found?
Walls of vessels and tissues
169
Is smooth muscle somatic or autonomic in terms of nerve control?
Autonomic
170
What kind of pressure do individual tissues generally start off with?
High
171
Why do different tissues have different pressures?
They can choose what blood pressure they want
172
Other than heart rate and peripheral resistance, what else determined cardiac output?
Tissue demand
173
How is tissue flow locally determined?
Tissue demand; acts by changing resistance
174
What formula is used to calculate blood flow?
Change in pressure gradient / Resistance
175
What is the average cardiac output in humans?
5L/min
176
What happens to cardiac output if there is an increase in venous return?
Cardiac output increases
177
True or false? Blood pressure and cardiac output are independent of each other
True
178
How can you relate blood flow to the radius of the vessel?
Flow is proportional to the 4th power of the radius of the vessel.
179
How is blood flow mechanically controlled?
Muscle sphincters in pre-capillary arterioles constrict/open the vessels (changing vessel radius)
180
Is flow within a vessel linear?
No
181
What is the effect of pressure on vessels?
Pressure distends vessels decreasing peripheral resistance
182
What is the effect of blood pressure on blood flow?
Blood pressure increases blood flow
183
What is peripheral resistance?
The friction-like force decreasing blood flow along a vessel
184
How is peripheral resistance/flow measured
Pressure drop/ flow
185
How is blood flow increased during exercise?
Increase in blood pressure from profound decrease in resistance
186
Can an increase in blood pressure result from a decrease in peripheral resistance?
Yes. If there is an increase in venous return from the reduced peripheral resistance it can increase cardiac output and therefore blood pressure
187
What happens chemically during exercise?
Metabolic waste products cause local vasodilation
Hypoxia
Increased CO2
Sheer stress (NO)
188
How is blood pressure neurologically controlled?
ANS-Keeps systemic BP high
| Sympathetic control
189
What are the centres in the brain responsible for controlling BP?
Vasomotor centre in medulla
Vasoconstrictor
Vasodilator
Cardioinhibtory
190
How do sympathetic nervous fibres work to control blood pressure?
```
Release noradrenaline (NA)
NA binds to a-receptors -> Vasoconstriction-> Increased peripheral resistance = Increased BP
```
191
How do sympathetic fibres (SNS) affect heart rate?
Increasing heart rate
Inotropic
Lusitropic
192
What does continuous constriction mean?
At rest there is underlying SNS though it can be turned off with anaesthesia
193
Where are arterial baroreceptors located?
Aortic arch
Carotid sinuses
Baroreflexes
194
How are carotid sinus baroreceptors stimulated?
Stretch - Signals transmitted to brain stem via afferent limbs of cranial nerve
Very sensitive
195
How do baroreflexes work to control blood pressure?
Cause increased/decreased sympathetic outflow -> constriction/ relaxation of pre-capillary sphincters
196
What happens to our blood flow when we stand up?
Fall in blood pressure
Vasoconstriction by SNS
Arteries increase in BP
Veins increase in venous return
197
Where can other arterial baroreceptors be found?
Low pressure receptors
Atrial stretch
Chemoreceptors
CNS Ischemia
198
Where would low pressure receptors be found?
In lower pressure part of circulation
199
What do atrial stretch receptors do?
Cause renal arteriolar dilation
| Cause a decrease in ADH
200
How do chemoreceptors detect a decrease in blood pressure?
A decrease in PaO2
201
What is pressure diuresis?
Increased BP causes increased blood flow to kidneys -> increased urination and decreased BP
202
What happens to blood pressure when there is an increased salt and water uptake?
BP increases
203
How does kidney disease relate to BP?
A higher BP is required to remove the same amount of salt and water
204
What does RAAS stand for?
Renin Angiotensin Aldosterone System
205
What do the kidneys rely on to function that the heart produces?
High blood pressure
206
What happens in the kidneys if blood pressure decreases?
The juxtaglomerular apparatus releases renin
207
Is the RAAS system long term or short term? Why?
Long-term
| Use of hormones
208
What does renin do after being released?
Converts angiotensinogen to angiotensin I (both are inactive)
209
What happens to angiotensin I after being produced?
It is converted to the active form - angiotensin II by ACE
210
What are the roles of angiotensin II?
Causes vasoconstriction, vascular hypertrophy and release of aldosterone
211
What receptors does angiotensin act on?
AT1 and AT2
212
What is the role of aldosterone?
Induces salt and water retention
213
How does increasing salt and water retention increase blood pressure?
Salt itself draws water towards it via osmosis.
| Increasing water retention increased blood volume and therefore blood pressure.
214
Are there any other hormonal mechanisms for blood pressure control?
Natriuretic peptides
| Arginine vasopressin
215
How do Natriuretic peptides control blood pressure?
Decrease in BP
They respond to stretch
Salt loss
Vasodilation
216
How does arginine vasopressin (ADH) control blood pressure?
Increase in BP
Vasoconstriction
Water retention
217
What do ACE inhibitor drugs usually end in?
-pril
218
What do angiotensin recepto blockers (ARBs) usually end in?
-sartan
219
What do antimineralcorticoids do?
Diuretic- Interfere with aldosterone by stopping it from retaining Na+ and water -> causes urination
220
What do alpha blockers generally do?
Block alpha receptors so noradrenaline can't bind
Decrease peripheral resistance and BP
Decrease heart rate
221
What do beta blockers generally do?
Bind to beta receptors so adrenaline and noradrenaline from SNS can't
222
What do calcium antagonists do?
Inhibit Ca2+ from entering smooth muscle cells.
| This results in vasodilation because the smooth muscles in sphincters don't contract.
223
What do calcium antagonist drugs usually end in?
-ipine
