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1ST YR CARDIO > BASIC SCIENCE > Flashcards

BASIC SCIENCE Flashcards

1
Q

Which waves on an ECG are negative and WHY?

A

aVR waves are negative

  • vector is depolarising AWAY from the recording (positive) electrode
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2
Q

When does the sound of blood flow stop?

A

when cuff pressure is less than 80mmHg and less than BP throughout cardiac cycle

  • last sounds is heard at minimum diastolic pressure
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3
Q

Purpose and location of the papillary muscles?

A
  • located on the AV valves
  • contract to prevent inversion or prolapse of the valves
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4
Q

how full do ventricles become through passive filling?

A

Around 80% full

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5
Q

what is intersitial fluid osmotic pressure and how does it affect capillary filtration?

A

interstital fluid osmotic pressure

  • pressure exerted by proteins or blood plasma in the interstitial fluid
  • favours filtration
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6
Q

Difference between VENOmotor and VASOmotor tone?

A

VENOmotor

  • shape of vein (size)
  • increase causes increased SV

VASOmotor

  • resistence to blood flow
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7
Q

where do the right and left coronary arteries arise from?

A

base of the aorta

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8
Q

What is cardiac output?

A

Volume of blood pumped by each ventricle of the heart per minute

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9
Q

what is secondary prevention?

A

detecting and being able to treat disease early

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10
Q

what is this? (bottom of aorta)

A

aortic hiatus

  • opening in the diaphragm
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11
Q

Describe Isovolumteric ventricular relaxation

A
  • Starts when aortic/pulmonary valves close
  • ventricles are completely closed again as AV valves are shut
  • tension falls
  • When ventricular pressure falls below atrial pressure, AV valves open again
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12
Q

Name of the thin filaments in microfibrils causing lighter appearance?

A

ACTIN (has less letters - thinner)

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13
Q

What is the extracellular fluid volume?

A

Fluid in which the cells are held in

  • acts as the go between the blood and body cells
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14
Q

How does the ADH increase blood pressure?

A
  1. ADH acts on kidneys to increase water reabsoprtion (conserve water)
  2. This increases extracellular fluid volume and plasma volume
  3. INCREASING cardiac output and blood pressure
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15
Q

What is MEAN ARTERIAL BLOOD PRESSURE?

A

MAP

  • Average arterial blood pressure during a single cardiac cycle(relaxation and contraction)
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16
Q

What is the advice for using fibrates?

A

use with a statin

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17
Q

RENIN role in the renin-angiotensin-aldosterone system?

A

RENIN

  • released from kidneys
  • Stimulates angiotensin I formation from angiotensinogen (in the blood)
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18
Q

what treatment is usually used for carotid sinus syncope?

A

permanent pacing

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19
Q

what is the blood brain barrier impermeable to and why?

A
  • hydrophilic substances
    • ions
    • catecholamines
    • proteins
  • protects the brain neurones from fluctuating levels of ions
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20
Q

why are lipoproteins needed to transport lipids?

A

able to transport hydrophobic lipid molecules in water

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21
Q

define syncope

A

TLOC

  • due to cerebral hypoperfusion
  • characterised by…
    • rapid onset
    • short duration
    • spontaneous complete recovery
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22
Q

where does the recurrent laryngeal nerves supply?

A

supply the pharynx and the larynx

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23
Q

What hapens when sympathetic constrictor tone increases?

A
  • INCREASED systemic vascular resistence (SVR)
  • whihc in turn increases VENOUS ReTURN and so STROKE VOLUME
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24
Q

How long should the QT interval take?

Start of QRS to end of T

A

0.36 - 0.44 sec

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25
Q

When does the jugular venous pulse occur?

A

JVP occurs after right atrial pressure waves

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26
Q

where does the excess fluid go when it is drained via the lymphtics?

A

returned to circulation as lymph

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27
Q

How do fibrates work?

A
  • agonists of nuclear receptor to enhance encoding of LPL (breakup lipoproteins)

decrease TAGs

decrease LDL

increase HDL

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28
Q

What is the absolute refractory period?

A

NO NEW ACTION POTENTIALS can be generated

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29
Q

what vessels does the blood travel from…

  • foetal heart to placenta
  • placenta returning to foetus
A
  • foetal heart to placenta = umbilical arteries
  • fplacenta to foetus = umbilical vein
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30
Q

How do PCSK9 inhibitors work?

A

Inhibit binding of PCSK9 to LDLR

  • therefore increasing number of LDLR available to clear LDL
  • lowers LDL levels
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31
Q

what does increased intrathoracic pressure (pressure in pleural cavity) due to the venous return?

A

decreases it (as theres more resistence)

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32
Q

how many people in the UK does cardiac disease affect?

A

around 7 million

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33
Q

What are the two parts of the septum called?

A

Interarterial and interventricular septums

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34
Q

What are the three types of capillaries?

A
  • continuous
  • fenestrated
  • sinusoidal/discontinuous
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35
Q

What enzymeconverts angiotensin I to angiotensin II?

A
  • Angiotensin converting enzyme (ACE)
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36
Q

examples of fibrates?

A
  • bezafibrate
  • gemfibrozil
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37
Q

What is the cardiac cycle?

A

All events occuring from the start of one heart beat to the start of the next

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38
Q

what does autoregulation do?

A

guards changes in cerebral blood flow if MAP changes within a range

  • direct sympathetic stimulation has v little effect in overall cerebral blood flow
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39
Q

what kind of nerves supply the coronary arterioles?

A

sympathetic vasoconstrictor nerves

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40
Q

Name the four borders of the heart and locate them

A
  • Right (lateral) border
  • Left (lateral) border
  • Inferior border
  • Superior border
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41
Q

where are the purkinje fibres found?

A

subendocardial layer (between endocardium and myocardium)

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42
Q

What causes obstructive shock?

A

Increase in pressure in the intrathoracic cavity

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43
Q

What does the PR interval indicate for the elctrical impulse?

How long should it take?

A

Time for SA node impulse to travel to ventricles

  • 0.12-0.2 sec
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44
Q

what is lipoprotein lipase? (LPL)

A
  • lipolytic enzyme associated with the endothelium of adipose and musce tissue CAPILLARIES
  • key role in BREAK DOWN of fat
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45
Q

what are lipoproteins?

A

spherical particles that carry lipids (fats) in the body

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46
Q

what substance can generally not cross the capillary wall?

A

plasma proteins

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47
Q

What happens to blood pressure in the chronic CVS response to exercise?

A

Blood pressure is reduced

  • mechanism not fully understood
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48
Q

what two veins make up the venous angle?

A
  • subclavian vein
  • internal jugular vein
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49
Q

what may regular exercise due to the heart chronically?

A

increase parasympathetic tone (reducing BP)

  • reduce symp. tone and noradrenaline levels
  • reduce renin levels in plasma
  • improve endothelial function (more vasodilators less vasoconstrictors)
  • arterial stiffening
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50
Q

What are the EXTRINSIC controls on vascular smooth muscles?

A
  • NERVES and HORMONES
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51
Q

how can excess fluid be drained from the interstitial fluid?

A

through lymphatic vessel drainage

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52
Q

whata are the two factors that must be attended to with shock?

A
  • high flow oxygen
  • volume replacement (except cardiogenic)
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53
Q

what is an enterocyte?

A

cell that lines the intestine

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54
Q

what is carotid sinus RELFEX syncope?

A
  • TRIGGER: mechanical manipulation of the neck, shaving, tight collar etc.
  • more common in elderly males
  • may be associated with carotid artery atheroslcerosis
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55
Q

What does the QRS wave represent and how long should it last?

A
  • Represents ventricular depolarisation
  • Duration of 0.1 secs
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56
Q

purpose of the right lymphatic duct?

A

drains lymph into right venous angle

(pink section)

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57
Q

What is STARLING’S law of the heart

A

the greater volume of blood in the ventricle during diastole, the greater the volume of blood ejected will be during the systolic contraction that follows (stroke volume)

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58
Q

How many views in total does the heart have?

A

Six views

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59
Q

How can bood volume AND MAP be controlled?

A

Through controlling the EXTRACELLULAR FLUID VOLUME

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60
Q

what chemicals released from the vascular endothelial are…

  • pro-thrombotic
  • pro-inflammatory
  • pro-oxidants?
A

VASOCONSTRICTORS produced from vascular endothelium

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61
Q

what extrinsic mechanisms can control the coronary blood flow?

A
  • sympathetic stimulation of the heart can result in vasodilation of coronary arterioles (despite usualy vasoconstrictor effect)
  • so circulating adrenaline activates B2 (at low doses) adrenergic receptors causing vasodilation
  • but when in high dose acts on B1 to cause vasoconstriction
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62
Q

Give the interior features of the left atrium?

A
  • interarterial groove
  • left auricle
  • cusps of mitral valve
  • remains of valve of foramen ovale
  • bilateral openings of sup. and inf. pulmonary veins
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63
Q

What is postural hypotension?

A

when baroreceptors fail to respond to gravitational shifts in bloof when moving from lying down to standing up

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64
Q

Length of the QT interval?

A

around 0.44 sec

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65
Q

From which angle does lead II see the heart? (RA to LL)

A

From an inferior direction

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66
Q

cardiac syncope causes…

A
  • arrhythmias
  • acute MI
  • structural cardiac disease (aortic stenosis, hypertrophic cardiomyopathy)
  • other cardio disease (PE, aortic dissection)
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67
Q

what is the main site of systemic vascular resistence?

A

Arterioles

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68
Q

what may affect capillary permeability?

A
  • inflammation
  • histamine increases the leakage of protein out the capillary membrane
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69
Q

What is the Antidiuretic Hormone (ADH)?

A
  • Peptide hormone
  • Made by the hypothalamus
  • stored in posterior pituatry
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70
Q

Give examples of local metabolic changes which may cause vasodilation in smooth muscle?

A

VASODILATION

  • Decreased PO2
  • Increased PCO2
  • Increased [H+] (decreased pH)
  • Increased [K+]
  • increased osmolality of ECF
  • adenosine release
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71
Q

What is the resting membrane potential for the cells in SA node?

A

NO STABLE RESTING MEMBRANE POTENTIAL

  • cells generate regular spontaneous pacemaker potentials
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72
Q

What does the T wave represent?

A

Ventricular repolarisation

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73
Q

what is a venule?

A

a very small vein, collects blood from capillaries

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74
Q

What are actin and myosin arraged into in myofibrils?

A

SARCOMERES

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75
Q

How long should the P-wave last?

(time for depolarisation of the atrial muscle)

A

Around 0.120 sec

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76
Q

What minimum MAP is needed to perfuse the coronary arteries, brain and kidneys?

A

MAP over 60mm Hg is needed to perfuse major organs

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77
Q

What wave in an ECG signals ventricular repolarisation?

A

T-wave

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78
Q

What factors impact stroke volume?

A
  • diastolic stretch of myocardial fibres
  • DETERMINED BY END DIASTOLIC VOLUME
  • this determines the CARDIAC PRELOAD
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79
Q

what is the carina?

A

angle situated below the tracheal bifurcation

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80
Q

pulmonary valve location?

A

between right ventricle and pulmonary trunk

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81
Q

what is the major structure found in the anteior mediastinum?

A

the thymus

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82
Q

which aortic arch gives rise to the right subclavian artery and the aortic arch?

A

fourth aortic arch

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83
Q

what is the fibrous pericardium?

A

sac of connective tissue

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84
Q

What is a positive inotropic effect and what stimulates it?

A

POSITIVE INOTROPIC EFFECT

  • Increased FORCE of contraction
  • Increased by stimulation of sympathetic nerves

AND VICE VERSA (i.e. parasympathetic)

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85
Q

how many subdivisions of the mediastinum are there?

A

4

  • superior inferior
  • anterior
  • middle
  • posterior
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86
Q

where are the vagus nerve located?

A
  • start at the medulla
  • exits cranium via jugular foramen
  • travels down neck with jugualr vein and common carotid artery
  • then the right and left nerves have differing pathways
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87
Q

what is the ductus arteriosus?

A
  • blood vessel connecting pulmonary artery to the aorta
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88
Q

What do fibrates do?

A
  • lower triglyceride levels
  • slightly lower LDL
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89
Q

What is the rate limiting step in the RAAS?

A

Renin secretion

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90
Q

At which korotkoff sound is diastolic pressure measured?

A
  • recorded at the 5th korotkoff sound (point at which sound dissapears)
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91
Q

when does most of the coronary blood flow and myocardial perfusion occur?

A

in diastole

  • subendocardial vessels from left coronary artery are not compressed
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92
Q

what do the recurrent laryngeal nerves supply?

A

branch of vagus nerves supplying intrinsic muscles of the larynx and laryngopharynx

(exception of cricothyroid muscles)

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93
Q

there are no blood vessels in which part of the heart?

A

the valves

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94
Q

what is the JVP?

A

reflects the pressure in the right atrium

(central venous pressure)

  • vertical distance between the top of the blood column and the right atrium
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95
Q

At which 4 points should the heart be auscultated?

A
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96
Q

which way does the bulbus cordis move during looping and folding of the heart tube?

A

inferiorly, ventrally (underside) to the right

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97
Q

where in the neck (artery) is the pulse palpated?

A

bifurcation of the common carotid artery

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98
Q

name the great arteries and veins in the superior mediastinum

A
  • brachiocephalic veins
  • SVC
  • arch of aorta
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99
Q

Where can ventricular contraction be seen on an ECG?

A
  • Contraction of ventricles occurs AFTER QRS
  • QRS signals ventricular depolarisation
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100
Q

When would renin be released from kidneys in the first place?

A

If plasma volume dropped (therefore blood pressure dropped)

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101
Q

what does increased VENOmotor tone increase?

A
  • venous return
  • stroke volume
  • MAP
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102
Q

What is cardiac tamponade?

A

Pericardium fills with blood

  • this prevents the heart from contracting
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103
Q

how does capillary osmotic pressure affect filtration?

A

capillary osmotic pressure

  • ​opposes filtration
  • pulls fluid into capillaries and prevents it from leaving
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104
Q

What makes up the 12 lead ECG?

A

VERTICAL

  • 3 standard limb leads (1, 2 and 3)
  • 3 Augmented voltage leads (aV)
    • aVR (right)
    • aVL (left)
    • aVF (foot)

HORIZONTAL

  • 6 Chest leads (V1-V6)
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105
Q

where is the aorittic valve located?

A

between the left ventricle and the aorta

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106
Q

What causes hypovolaemic shock?

A

Loss of body fluid/blood volume

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107
Q

Why does MAP need to be regulated?

A
  • must be high enough to perfuse organs
  • must not be too high to cause damage to blood vessels or place strain on the heart
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108
Q

what should the drop in BP be from 3 minutes within standing to lying?

A
  • systolic: 20mmHg (with/without symptoms)

OR

  • diastolic: 10mmHg with symptoms
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109
Q

what happens to the venous return to the heart and MAP when somebody stands up from lying down

A
  • Venous return: decreases (due to gravity)
  • MAP : transiently decreases
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110
Q

Where do the V1 to V6 electrodes go on the chest?

A
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111
Q

which gender is more affected by heart disease?

A

males

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112
Q

What is a rhythm strip?

A
  • A prolonged reading of 1 lead
  • Usually lead II (at the bottom)
  • can determine HR and cardiac rhythm
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113
Q

Equation for Cardiac output?

A

CO = SV x HR

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114
Q

what law does movement of gasses and solutes across the capillary wall follow?

A

ficks law of diffusion

  • rate of diffusion is proportionate to surface area and concentration differnce
  • inversely proportional to thickness of membrane
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115
Q

where are apoB-100 apoproteins assembled?

A

liver

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116
Q

where does the left coronary artery lie?

A

mainly between the pulmonary trunk and the left atrium

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117
Q

What effectors regulate the extracellular fluid volume and how do they do it?

A
  • Hormones act as effectors to regulate ECFV
  • They do this through regulating water and salt balance in the body
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118
Q

for how long can the body compensate BP for blood volume loss?

A

until >30% of blood volume is lost

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119
Q

Where is the apex of the heart?

A

Normally to the left side of the heart

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120
Q

How would MAP by regulated long term?

A

Through regulating BLOOD VOLUME through hormones

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121
Q

what is the major resistence vessels for systemic vascular resistence?

A

Arterioles

(vessels stemming from arteries to capillaries)

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122
Q

how does coronary venous blood drain into the right atrium?

A

via the coronary sinus

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123
Q

purpose of the thoracic duct?

A

carries lymph to the left venous angle

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124
Q

Where are the phrenic nerves located?

A

Descending across the lateral borders of the pericardium

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125
Q

what is vasovagal REFLEX syncope?

A
  • most common type of syncope
  • triggered by emotional distree or orthostatic (standing up) distress
  • associated with pallor, sweating, nausea
  • treatment: avoid triggers, education, reassurance, hydration
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126
Q

what blood vessel containsmost blood volume during rest?

A

Veins

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127
Q

How many leaflets do the pulmonary, aortic and tricuspid valves have?

A

Three leaflets

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128
Q

what happens to baroreceptor firing rate when MAP and venous return decreases?

A

Firing rate of broreceptors DECREASES

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129
Q

define the term “oedema”

A

accumulation of fluid in the interstitial space

causes…

  • diffusion distance to increase
  • so gas exchange is comprimised
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130
Q

Length of P wave

A

0.08-0.10 sec

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131
Q

What is the function of the coronary arteries?

A

Supply blood to the heart muscle

(epicardium and myocardium)

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132
Q

Phase 1 of Ventricular muscle action potential?

A
  • Na+ channels close
  • Transient K+ EFFLUX
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133
Q

What are the 2 types of NP’s released by the heart?

A
  • Atrial NP (in response to atrial distension - hypervolaemic states: too much fluid in the blood))
  • Brain-type NP (can be measured in pateints with suspected heart failure)
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134
Q

which arteries arise out of the aorta

A
  • braciocephalic trunk
    • leads to subclavian artery and common carotid artery
  • left common carotid and subclavian artery
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135
Q

What is nitric oxide?

A

Potent vasodilator

  • continuously produced by vascular endothelium
  • stress on vascular endothelium will cause release
  • diffuses into smooth muscle cells to cause relaxation
  • formation may also be stimulated by a chemical trigger
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136
Q

What makes up the extracellular fluid volume?

A

Plasma Volume + Interstitial Fluid Volume

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137
Q

how does glucose cross the blood brain barrier?

A

facillitated diffusion using specific carrier molecules

  • brain has an obligatory need for glucose
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138
Q

what four arteries can be palpated in the lower limb? (proximal to distal)

A
  • femoral
  • popliteal
  • posterior tibial
  • dorsalis pedis
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139
Q

When does the ADH become important?

A

HYPOVOLAEMIC SHOCK

(e.g. haemorrhage)

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140
Q

how would reduced plasma osmotic pressure cause oedema?

A

reduce in oncontic pressure so increased filtration across the capillary

  • caused by…
    • malnutrition
    • protein malabsorption
    • excessive renal excretion
    • hepatic failure
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141
Q

How does arterial pressure not fall to zero during diastole?

A

As there is always a continuous amount of pressure on the arteries to maintain patency

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142
Q

Give 4 examples of humoral agents that cause VASOCONSTRICTION

A
  • serotonin
  • thromboxane A2
  • leukotriene
  • endothelin
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143
Q

What causes the pacemaker potential?

(depolarisation of membrane potential to a threshold)

A
  • DECREASED K+ EFFLUX
  • Na+ INFLUX (N and IN both have N’s)
  • TRANSIENT Ca++ INFLUX
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144
Q

What is pulse pressure?

A

DIFFERENCE between systolic and diastolic pressure

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145
Q

Phase 2 of ventricular muscle action potential?

A
  • Ca++ Influx
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146
Q

list 4 causes of oedema

A
  • raised capillary pressure
  • reduced plasma osmotic pressure
  • lymohatic insufficiency
  • changes in capillary permeability
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147
Q

Name the physical factors that can control vascular smooth muscles?

A
  • Temperature
    • cold = vasoconstriction
    • warmth = vasodilation
  • Myogenic Response
    • to stretch
    • MAP rises = vasoconstriction
    • Map falls = vasodilation to increase flow
  • Sheer Stress
    • dilation of arterioles cause stress to arteries upstream to make them dilate
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148
Q

what is pulmonary circulation?

A
  • entire cardiac output from right ventricle into pulmonary circulation
  • systemic bronchial circulation allows metabolic needs to be met
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149
Q

what levels of LDL and HDL are associated with cardiovascular disease?

A
  • high LDL
  • low HDL
  • OR particles rich in TAGs
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150
Q

So which two hormones INCREASE BP?

A
  • Renin-angiotensin-aldosterone system (RAAS)
  • Antidiuretic Hormone (ADH)
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151
Q

Main influence on Heart Rate?

A

Autonomic Nervous system

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152
Q

What is MAP the product of?

A

MAP = CARDIAC OUTPUT x SYSTEMIC VASCULAR RESISTANCE

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153
Q

what are these?

(arrows coming from right)

A

coronary arteries

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154
Q

Function of the baroreceptor reflex?

A

Short term regulation of MAP

  • using negative feedback
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155
Q

What produces the second heart sound (DUB)?

A
  • Shutting of aortic/pulmonary valves
  • Happens when ventricular pressure falls below arotic/pulmonary pressure
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156
Q

which recurrent laryngeal nerve is affected by mediastinal pathology that results from the assymetry of the nerves?

A

left only

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157
Q

What is the name of the layer that directly covers the heart?

A

Epicardium

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158
Q

What is an ECG LEAD?

A

ECG LEAD

  • IMAGINARY
  • Line between two or more electrodes
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159
Q

What causes the first heart sound (LUB) to be made?

A
  • Shutting of te AV valves
  • When ventricular pressure exceeds atrial pressure
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160
Q

What causes neurogenic shock?

A

loss of sympathetic tone to blood vessels and heart

= vasodilation and decreased heart rate

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161
Q

how is flow produced in the lymph vascular system?

(they have no central pump)

A
  • smooth muscle in walls
  • hydrostatic pressure in tissue
  • compression of vessels by voluntary muscle
  • valves in vessels
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162
Q

What happens to angiotensin II in the renin-angiotensin-aldosterone system?

A

ANGIOTENSIN II

  1. Stimulates aldosterone release
  2. causes systemic vasoconstriction (increasing SVR)
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163
Q

what type of valve is the mitral valve?

A

bicuspid valve (only has two leaflets instead of usually three)

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164
Q

Where does the excitation of the heart to produce a beat originate?

A

In the pacemaker cells located in the sinoatrial node

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165
Q

Pulmonary auscultation location?

A

2nd left intercostal space sternal edge

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166
Q

three areas a patients pulse can be taken?

A
  • neck
  • upper limb
  • lower limb
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167
Q

What lead is normally used as the rhythm strip?

A

Lead II

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168
Q

What are statins used to treat?

A
  • Hypercholesterolaemia
  • diabetes
  • angina/MI
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169
Q

In which segment of the ECG do ventricles contract?

A

ST segment

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170
Q

What are the tnedinous cords and where are they located?

A
  • located in the AV valves
  • keep the AV valves in place while the heart is pumping blood
  • ‘heart strings’
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171
Q

apoproteins associated with HDL particles?

A

apoA-I and apoA-II

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172
Q

What should pulse pressure usually be?

A

Between 30 and 50mmHg

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173
Q

Describe Isovolumetric Ventricular Contraction

A
  • Pressure in ventricles rise
  • AV valves shut when pressure in ventricles is greater than atria
  • No blood can enter or leave ventricle as aortic valve is still shut
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174
Q

name the three layers of the heart from inside to outside?

A
  1. endocardium (inner)
  2. myocardium
  3. epicardium (outer)
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175
Q

Where are the ventricles and atria located on a real image of a heart?

A
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176
Q

what are the special adaptations of coronary circulation?

A
  • high capillary density
  • high basal blood flow
  • high O2 extraction (Po2 of oxygen entering a tissue)
    • this means extra O2 cannot be supplied by increasing O2 extraction only when coronary blood flow is increased
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177
Q

What texture is cardiac muscle and what causes this?

A
  • Cardiac muscle is striated
  • Caused by regular arrangement of contractile protein
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178
Q

Purpose of the refractory period?

A

Prevent the generation of very high rate (tetanic) of contractions in the cardiac muscle

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179
Q

Length of QRS

A

<0.10 sec

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180
Q

what is the ductus arteriosus?

A

connects the pulmonary bifurcation (artery) to the descending aorta

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181
Q

What is the acute response of HR and SV to exercise?

A
  • HR and SV increase
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182
Q

Purpose of desmosomes?

A
  • Provide mechanical adhesion between adjacent cardiac cells
  • Ensure tension developed carries on to each cell
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183
Q

where does the electrical impulse travel to from the AV node after the delay?

A
  1. down interventricular septum via AV bundle
  2. down left and right bundle branches
  3. reach heart apex and turn upwards
  4. makes contact with purkinje fibres beneath the endocardium of the ventricles
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184
Q

what is choronotropic effect?

A

heart rate and rhythm

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185
Q

what vessels supply the brain with blood?

A
  • internal carotids
  • vertebral arteries
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186
Q

Name the three surfaces of the heart and location

A
  • Anterior surface (sternocostal surface)
  • Base (posterior surface)
  • Inferior (diaphrgamatic surface)
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187
Q

which aortic arches sprout branches that form pulmonary arteries, pulmonary trunk and ductus arteriosus?

A

6th aortic arch

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188
Q

what is tertiary prevention of disease?

A

reducing recurrence of chronic incapacity of those with a disease

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189
Q

what anatomical features lie in the posterior mediastinum?

A
  • azygous vein
  • vagus nerve
  • trachea
  • 2 main bronchi
  • thoracic aorta
  • oesophagus
  • vagal trunks
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190
Q

What is the foramen ovale?

A

Hole between left and right atria of every human fetus

  • so blood can bypass the lungs as they dont work until exposed to open air
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191
Q

what happens to the foramen ovale when a baby is born?

A

foramen ovale closes

  • LA pressure exceeds RA pressure as PVR falls and SVR increases
  • flap is pushed closed
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192
Q

what does an increase in Pco2 do to cerebral blood flow?

A

causes cerebral vasodilation

and vice versa

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193
Q

Which direction to augemented limb leads look into the heart?

A

See the heart from different angles, look into the centre of the heart

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194
Q

what is the foramen ovale?

A

opening in atrial spetum

  • connects RA to LA
  • allows blood to bypass the foetal lungs which do not function properly until they are exposed to air
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195
Q

How does heart electrical activity manifest as surface potentials recorded on ECG?

A

Body surface potentials arise from currents flowing when the myocardial tissue membrane potential is changing (e.g. depolarisation or repolarisation)

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196
Q

what is the blood brain barrier?

A

very tight intercellular junctions between cerebral capillaries

  • highly selective semi permeable border of endothelial cells
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197
Q

which route does the right recurrent laryngeal nerve take?

A

hooks under the right subclavian artery

does NOT enter the chest

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198
Q

where are the ascending and aortic arch located?

A
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199
Q

state some causes of transient loss of consciousness other than syncope

A
  • head trauma
  • epileptic seizures
  • TLOC mimics (types of seziures etc)
  • etc. etc.
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200
Q

Which hormone DECREASES blood pressure?

How does it do this?

A

Natriuretic Peptide (NP)

  • Counteract the Renin-angiotensin-aldosterone system
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201
Q

describe the blood pressure in pulmonary circulation

A
  • BP in pulmonary circulation is lower than systemic circulation
  • walls of pulmonary capillaries are thinner than systemuc
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202
Q

When depolarisation moves away from the recording electrode what way will the peak go on ECG?

A

Downwards (so negative)

  • as its moving towards the negative electrode
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203
Q

When repolarisation moves away from the recording electrode, what direction of peak does this show on the ECG?

A

Shows an upward deflection on the ECG

  • Due to the repolarisation being (negative) and it moves towards the negative charge lead so therfore turns POSITIVE
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204
Q

What is aldosterone and its role?

A

ALDOSTERONE

  • steroid hormone
  • acts on kidneys to INCREASE sodium and water retention
  • SO INCREASES PLAMSA VOLUME
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205
Q

Another name for the pulmonary and aortic valves?

A

Semilunar valves

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206
Q

What is cardiac output

A

Volume of blood pumped by each ventricle PER MINUTE

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207
Q

name the nerves in the superior mediastinum laterally to medially

A
  1. phrenic nerves
  2. vagus nerves
  3. recurrent laryngeal nerves
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208
Q

What does vagal stimulation have major influence on and what does it not?

A

VAGAL STIMULATION

  • Major Influence: Heart Rate
  • Minute Influence: Force of contraction (little direct affect on SV)
209
Q

what is the skeletal muscle pump?

A

large veins in limbs lie between skeletal muscle

  • when these msucles contract it helps venous return to move blood towards the heart
  • skeletal muscle pump reduces chance of postural hypotension and fainting
210
Q

where do only parasympathetic nerve fibres remain within the vagus nerve?

A

after the recurrent laryngeal branch is given off

  • in the root of neck on right side and in chest on the left
211
Q

why would a patient with dysphagia and hoarseness have the possibility of having a medistinal mass?

A

as a pulmonary malignancy can spread to the mediastinum through the lymphatic system

212
Q

What receptors does adrenaline have to act on to cause VASOCONSTRICTION?

A

alpha receptors = vasoconstriction

213
Q

what are the two types of distributive shock?

A
  • neurogenic
  • vasoactive
214
Q

What happens to the ionic channels to drop the pacemaker action potential below the threshold again?

(FALLING PHASE - REPOLARISATION)

A
  • Ca++ channels are inactivated
  • K+ channel activated so K+ EFFLUX
215
Q

What happens when firing rate of baroreceptors decreases?

A
  • Vagal tone DECREASES
  • Sympathetic tone INCREASES
  • = Increase in HR and STROKE VOLUME
216
Q

How is the needle for pericardiocentesis inserted into the pericardial cavity?

A
  • Needle inserted via infrasternal angle
  • needle directed superposteriorly
  • aspirating continuously
217
Q

what are cerebral capillaries highly permeable to?

A
  • O2
  • CO2
218
Q

Name the 6 features of the right atrium

A
  • opening of SVC
  • SA node
  • crista terminalis
  • oval fossa
  • opening of the coronary sinus (to drain venous blood from the majority of the heart)
  • opening of IVC
219
Q

Show where the left and right coronary arteries are located

A
220
Q

What is the ‘v’ for in the JVP wave?

A
  • atrial pressure ririsng during atrial filling
  • released when AV valves open
221
Q

how does the heart react to decreased cardiac output?

A
  • Tachycardia (via baroreceptor)
  • small volume pulse (decreased stroke volume)
222
Q

what is pulmonary oedema?

A

accumulation of fluid in the intersitial and intraalveolar lung spaces

  • SOB
  • crepitations at lung bases
  • CXR haziness
223
Q

What is the ‘c’ for in the JVP wave?

A

during ventricular contraction when the tricupsid valve bulges into atrium

224
Q

which germ layer is the heart derived from?

A

the MESODERM

225
Q

what happens to the 1st, 2nd and 5th aortic arch?

A

mostly obliterated

226
Q

How would you calculate MEAN ARTERIAL BLOOD PRESSURE?

A

[(2 x diastolic pressure) + systolic pressure] / 3

OR

DBP + 1/3 Pulse Pressure

227
Q

apoprotein associated with LDL particles?

A

apoB-100

228
Q

WHat is the neurotransmitter and receptor for sympathetic supply of the heart?

A
  • Neurotransmitter: NORADRENALINE
  • Receptor: B1 ADRENOCEPTORS
229
Q

What does the PR interval represent and how long should it take?

A
  • Depolarisation and contraction of atria
  • Largely Av nodal delay
  • SHould take 0.12-0.20 sec
230
Q

how is patency maintained in the ductus arteriosus?

A

circulating prostaglandin E2 produced by placenta

231
Q

how do lipid soluble substances cross the capillary wall?

A

lipid soluble substances go through endothelial cells to cross the capillary wall

232
Q

Describe atrial contraction

A
  • Atria contract
  • End diastolic volume is determind
233
Q

what are the three subtypes of reflex syncope?

A
  • vasovagal syncope (VVS)
  • situational syncope
  • carotid sinus syncope (CSS)
234
Q

What is an electrical vector?

A

The movement of charge

  • Has a magnitude: length of arrow
  • Has a direction: Orientation of arrow
235
Q

what is situational reflex syncope?

A
  • fainting during or just after a certain trigger
  • e.g. cough, peeing, swallowing etc
  • try to treat the cause
  • lie down
  • hydrate
  • may need cardiac permanent pacing
236
Q

What should the approach be for the patient with shock?

A

ABCDE approach

237
Q

what is the thymus?

A

gland that produces T lymphocytes in childhood

238
Q

postural hypotension risk factors?

A
  • age
  • medication
  • certain diseases
  • reduced intravascular volume
  • prolonged bed rest
239
Q

What condition are fibrates used to treat?

A
  1. Hypertriglycerideaemia (high blood level)
  2. Low HDL cholesterol
240
Q

what lies in between the two mesothelial layers of the pericardium?

(visceral and parietal pericardium)

A

pericardial fluid to lubricate heart movement

241
Q

What are the three layers that make up the pericardium?

A
  • Fibrous pericardium
  • Parietal pericardium
  • Visceral Pericardium

(parietal and visceral pericardium make up the serous pericardium)

242
Q

Describe passive filling?

A
  • Almost zero pressure in heart
  • Av valves open
  • venous return flows into ventricles
243
Q

what are these running down the aorta?

A

branches from the thoracic aorta’s anterior surface

  • different arteries going to different parts of the body above the diaphragm
244
Q

what is the purpose of apoproteins?

A

recognised by receptors around the body to allow lipoproteins to bind to cells

245
Q

Name the three types of anti cholesterol drugs

A
  • statins (simva, atorva)
  • fibrates
  • PCSK 9 inhibitors (-umab)
246
Q

What type of cells make up capillaries?

A
  • endothelial cells
  • basal lamina
247
Q

what is a myogenic response?

A

intrisic response of vascular smooth muscle to contract when BP increases and relax as BP decreases

248
Q

how does exercise affect muscle blood flow

A
  • metabolic hyperaemia overcomes sympathetic vasoconstricor activity
  • circulating adrenaline causes vasodilation (B2 adrenergic receptors)
  • increased CARDIAC OUTPUT during exercise so increases skeletal blood flow
249
Q

only part of the aorta that lies in the posterior mediastinum?

A

thoracic aorta

250
Q

Parasympathetic stimulation on Heart rate causes…?

A

Decrease of heart rate

251
Q

what changes take place in the circulatory system when the baby is born?

A

ductus arteriosus and foramen ovale both close

252
Q

Mitral ausculation location?

A

5th left ICS midclavicular line

253
Q

What is the transverse pericardial sinus?

A
  • a space withing the pericardial cavity, posterosuperiorly
  • posterior to ascending aorta and pulmonary trunk
  • used to isolate great vessels for open heart surer
254
Q

Phase 3 of Ventricular Muscle action potential?

A
  • Ca++ channels close
  • K+ EFFLUX
255
Q

Where are the precordial leads placed?

A
  • V1, 2 and 3 on the heart
  • V4 on 5th intercostal spcae
  • V5 and 6 on 6th intercostal space
256
Q

What happens in phase 0 of the ventricular muscle action potential?

A

FAST Na+ INFLUX

257
Q

What stimulates secretion of ADH?

A
  • Low ECFV
  • Increased extracellular fluid osmolality (to keep more fluid inside the body)
  • Increased plasma osmolality
258
Q

which types of nerve fibres does the vagus nerve carry?

A

contains motor and sensory fibres

259
Q

Name the three types of anti hypertensive drugs

A
  • thiazide diuretics
  • beta blockers
  • vasodilators
260
Q

what is inotropic effect?

A

force of heart contraction

261
Q

Cause of cardiogenic shock?

A

Decrease contraction of the heart

262
Q

In which segment of the ECG do ventricles relax?

A

TP segment

263
Q

what is persistent pulmonary hypertension of the newborn?

A
  • pulmonary vascular resistence FAILS to fall
  • shunts remain at formane ovale and ductus arteriosus
  • requires…
    • ventilation
    • oxygenation
    • high systemic blood pressure
    • inhaled nitric oxide
    • ECLS (life support)
264
Q

which way does heart failure shift the frank starling curve?

A

to the right

265
Q

Rule of thumb for ventricular muscle action potential

A
  • Membrane potential increase - Na+ is Influxing
  • Membrane potential Decrease - K+ is effluxing
  • Plateau - Ca++ influx
266
Q

What do stains do to cholesterol?

A
  • Reduce LDL production in the liver
  • Increase LDL clearance in the liver
267
Q

What happens to angiotensin I in the renin-angiotensin-aldosterone system?

A

ANGIOTENSIN

  • angiotensin I converted to angiotesnin II
268
Q

When are NP’s released?

A
  • in response to cardiac distension
  • OR neurohormonal stimuli
269
Q
  • How long is diastole?
  • How long is systole?
A
  • Diastole: Around 0.5 secs
  • Systole: Around 0.3 secs
270
Q

Where is depolarisation at the s wave?

A

At the base of the heart

271
Q

describe the three key components that make up the structure of lipoproteins

A
  • hydrophobic core
    • containing cholesterol and TAGs (triacylglycerols)
  • hydrophilic coat
    • containing phospholipids and cholesterol
  • apoproteins
272
Q

function of the azygouse vein?

A

take blood to SVC from intercostal veins

273
Q

which nerve fibres do the vagus nerves contain?

A
  • somatic sensory nerves
  • somatic motor nerves
  • autonomic parasympathetic nerves
274
Q

what kind of walls do veins have, with what features?

A

thin walls with valves

275
Q

What is a dipole?

A

A dipole is what carries an electrical current

  • represents an electrical vector
276
Q

What third factor does angiotensin II also stimulate?

A
  • Thirst
  • ADH release

(also contribute to increasing plasma volume)

277
Q

How does muscle activity affect venous return?

A

increases venous return to the heart

  • large veins in limbs lie between muscles contraction aids VR
278
Q

where do phrenic nerves originate?

A

C3-C5 spinal nerves

279
Q

How does breathig affect venous return?

A

Increasing rate and depth of breathing increases venous return to the heart

  • on inspiration, intraabdominal pressure increases (intrathoracic pressure decreases)
280
Q

What technique is used so that the heart reaches its position in the thorax?

A
  • Lateral folding
  • cranio-caudal folding (medial fold)
281
Q

what are these?

A
  • bilateral posterior intercostal arteries
  • there is one for each intercostal space
282
Q

3 venous systems found in the embryo?

A
  1. vitelline veins (drain yolk sac)
  2. umbilical veins (oxygenated blood from placenta)
  3. cardinal veins (give systemic venous system)
283
Q

What is the realtionship between resistence and flow of blood?

A
  • Resistence to blood flow
    • directly proportional to viscosity and blood vessel length
    • Inversly proprotional to radius of blood vessel

Mainly controlled by changes in arteriole radius through vascular smooth muscles

284
Q

pathophysiology of reflex syncope?

A

Fall in mean arterial blood pressure

syncope involving…

  • neural reflexes (HEART RATE and VASCULAR TONE)
285
Q

What are the INTRINSIC factors that influence vascular smooth muscle?

A

Chemical and Physical Factors

286
Q

what key role does HDL cholesterol play?

A
  • removes excess cholesterol from cells by transporting it to liver in plasma
287
Q

How do statins work?

A
  • competitive inhibitors of HMG-CoA
    • rate limiting step in cholesterol synthesis in hepatocytes
  • LDL receptors expressed increase
  • increase in LDL clearance

Decrease LDL

Decrease TAGs

Increase HDL

288
Q

which route does the left recurrent laryngeal nerve take?

A

hooks under arch of aorta

  • ENTERS THE CHEST
289
Q

Which vessel of the heart do the coronary arteries arise from?

A

The ascending aorta

290
Q

What is afterload?

A

resistence to the heart pumping

  • If afterload increases, heart cant eject full SV so EDV increases
  • May lead to ventricular hypertrophy if this persists
291
Q

What is the R wave on the precordial chest leads and how does it develop from leads V1 to V6?

A
  • ‘R’ wave is the first positive deflection which is immediately followed by a negative ‘S’ wave deflection
  • From V1 to V6 R wave increases and S wave decreases
292
Q

What are the 5 different stages of the cardiac cycle?

A
  1. Passive filling
  2. Atrial contraction
  3. Isovolumetric ventricular contraction
  4. Ventricular ejection
  5. Isovolumetric ventricular relaxation
293
Q

What is the QT interval?

A
  • Start of the QRS complex to the end of the T wave
  • TIme for ventricular depolarization AND repolarization
  • Should be 0.44-0.46 sec (higher in females)
294
Q

What is the endocardium made up of?

A
  • endothelium
  • basal lamina
  • collagen fibres
  • connective tissue
295
Q

What is the ST segment?

A
  • End of QRS to start of T wave
  • should be ISOELECTRIC
296
Q

What are Natriuretic Peptides (NP’s)?

A
  • Peptide hormones that the heart can synthesise
  • Cause salt and water in kidneys to be excreted
  • So REDUCE blood volume and BP
297
Q

Sympathetic stimulation on heart rate causes…?

A

Increased heart rate

298
Q

What should normal resting diastolic and systolic blood pressures be?

A
  • SYSTOLIC: <140
  • DIASTOLIC (DIE=RESTING): <90
299
Q

Where is depolarisation moving in the Q wave?

A

Starts in ventricular septum

300
Q

what does blood flow in capillaries depend on?

A

contractile state of arterioles

301
Q

Name the features of the inferior ventricles?

A
  • fibrous rings of valves
  • interventricular septum
  • moderator band
302
Q

What is the neurotransmitter and receptors for the parasympathetic nerve supply of the heart?

A

PARASYMPATHETIC

  • Neurotransmitter: ACETYL CHOLINE
  • Receptors: MUSCARINIC (M2)
303
Q

what circulatory changes occur when the baby is born?

A
  • decreased pulmonary vascular resistence
    • lungs expand as breath taken
    • circulating oxygen increases
  • increased systemic vascular resistence
    • umbilical cord clamped
  • increased cardiac output
304
Q

What are the three layers of the heart?

A
  1. Tunica intima (inner)
  2. Tunica media
  3. TUnica adventitia (outer)
305
Q

what are located around the bifurcation of the trachea?

A
  • tracheo-bronchial lymph nodes
306
Q

how does capillary hydrostatic pressure affect filtration of capillary?

A

capillary hydrostatic pressure

  • favours filtration
  • pushes fluid and solutes OUT of capillary
307
Q

what are other beneifts of statins?

A
  • reduced inflammation
  • reversed endothelial dysfunction
  • decreased thrombosis
  • stabilised atherosclerotic plaques
308
Q

what does the diaphragm innervate for sensory functions?

A
  • central diaphragm
  • pericardium
  • mediastinal parietal pleura
309
Q

purpose of the azygous vein?

A

takes blood from intercostal veins to SVC

310
Q

what do capillaries allow movement of?

A

exchange of gases, water and solutes with interstitial fluid

  • delivery of nutrients and O2 to cells
  • removal of metabolites from cells
311
Q

how do varicose veins form?

A

one way venous valves become incompetent in lower limb veins and blood pools in legs

312
Q

what may be some causes of raised venous pressure?

A
  • let ventricular failure
    • pulmonary oedema
  • right ventricular failure
    • peripheral oedema
  • prolonged standing
    • swollen ankles
313
Q

what route does the right vagus nerve take down the thorax?

A

passes anterior to subclavian artery and posterior to sternoclavicular joint

314
Q

Three impacts NP’s have?

A
  1. increase salt and water excretion in kidneys (lower BV and BP)
  2. Decrease release of renin (Decrease BP)
  3. Act as vasodilators (Decrease SVR and BP)

COUNTER ACT RAAS

315
Q

What does the delay in conduction of the AV node allow for in the heart chambers?

A

Enables atria to contract first (systole) then the ventricles (systole)

316
Q

what has the ability to override the sympathetic vasoconstrictor nerves on coronary arterioles?

A

metabolic hyperaemia

  • resulting from increased heart rate and stroke volume
317
Q

name 4 types of vasdilators used to treat hypertension

A
  • calcium antagonists
  • alpha blockers
  • ACE inhibitors (ACEI)
  • Angiotensin Receptor Blockers (ARB)
318
Q

which two veins arise from the superior vena cava?

A
  • right subclavian vein
  • left brachiocephalic vein (BCV)
319
Q

What does vagal stimulation do to the heart?

A
  • Slows heart rate
  • Increase AV nodal delay
320
Q

which direction does the ventricle move in the looping and folding of the heart tube?

A

displaced left

321
Q

which way does heart failure shift the frank starling curve?

A

right

322
Q

Where would you palpate the APEX beat in the heart?

A
  • Left 5th intercostal space in the midclavicular line
323
Q

How is an action potential generated in the SA node?

A
  • Spontaneous pacemaker potential takes membrane potential to a threshold
  • When the threshold is reached an action potential is generated
324
Q

Whatt two related systems make up the circulatory system?

A
  • Cardiovascular system
  • lymphatic system
325
Q

what is cardiac syncope?

A

sudden drop in CARDIAC OUTPUT caused by a cardiac event

326
Q

how does transcapillary fluid cross the capillary wall?

A

passively driven by pressure gradients across the capillary wall

327
Q

What is the coronary sinus?

A

Short venous channel which recieves deoxygenated blood from the cardiac veins and drains into the right atrium

328
Q

number 1 cause of death globally?

A

cardiovascular diseases

329
Q

Function of capillaries?

A

Site of exchange between blood and tissues

  • gas
  • water
  • nutrients
330
Q

6 STEPS TO REMEMBER ANALYSING AN ECG

A
  1. Verify details
  2. check date and time
  3. check calibration
  4. Determne axis
  5. Workout rate and rhythm
  6. Look at individual leads for voltage changes or ST or T wave changes
331
Q

Phase 4 of ventricular muscle action potential?

A
  • Back to resting membrane potential
332
Q

How is muscle tension produced?

A

Through the sliding of actin filaments on myosin

333
Q

Where does the right coronary artery run down to?

A

Posterior interventricular groove

334
Q

what happens during autoregulation of blood flow?

A
  • if MABP rises = constriction of resistence vessels to reduce blood flow
  • if MABP falls = dilation of resistence vessels to maintain blood flow
335
Q

why is the liver important in cholesterol elimination?

A

only the liver has the capacity to eliinate cholesterol from the body

  • cholesterol is secreted into bile
336
Q

where are the phrenic nerves located?

A

lateral to the vagus and recurrent laryngeal nerve

337
Q

What should the highest blood pressures be normally for systolic and diastolic?

A
  • Systolic: <140mmHg
  • Diastolic: <90mmHg
338
Q

What is the only point of electrical contact between atria and ventricles, what happens to conduction at this point?

A
  • Only point of electrical conduction is AV node located at base of right atrium
  • Conduction is delayed at this point
339
Q

What does ADH do to blood vessels?

A

Causes vasoconstriction

  • Increasing SVR and BP
340
Q

What affect does an elevated BP have on the baroreceptors?

A
  • Baroreceptors sense the high BP
  • HR decreases
  • BP decreases
341
Q

What cells mae up the epicardium?

A
  • mesothelium (flattened epihelium)
  • basal lamina
  • connective tissue
  • adipose tissue
342
Q

Which direction does depolarisation move towrads in lead II from the SA node?

A

Direction: inferior and to the left towars the positive (+ve) lead

343
Q

What wave in an ECG signals atrial depolarisation then contraction?

A
  • P-wave signals atrial depolarisation
  • Atria contracts between P and QRS
344
Q

what is the effect of an inotrope?

A

change the force of your heart contractions

345
Q

Why is the T-wave upward?

A

It is an upward (positive) deflection because…

  • repolarisation is spreading AWAY from the recording electrode
  • Like a double negative so positive
346
Q

What does the pericardiocentesis procedure entail?

A

Drainage of fluid from the pericardial cavity using a needle

347
Q

what major feature lies in the middle mediastinum?

A

the heart

348
Q

name the three types of cardiac muscle cells

A
  • contractile cells
  • pacemaker cells
  • conducting cells
349
Q

What is stroke volume

A

Volume of blood pumped by each ventricle of the heart per HEART BEAT

350
Q

function of the moderator band?

A

carries fibres of the right bundle branch to the papillary muscle of the anterior cusp

351
Q

where would a carotid bruit be heard?

A

heard of the carotid artery

  • due to turbulent blood flow through a stenotic area
352
Q

Where is the difference in action potentials in the heart?

A
  • Difference between pacemaker cells (smooth peaks) and the contractile cardiac muscle cells (vertical influx with a plateau phase)
353
Q

what causes orthostatic (postural) hypotension?

A

failure of baroreceptor responses to gravitational shifts in blood

(from horizontal to vertical)

354
Q

how is blood flow to capillary bed regulated?

A
  • by terminal arterioles in most tissues
  • precapillary sphincters in some tissues

Very slow blood flow to allow time for exchange

capillaries unite to fomr venules

355
Q

what do the braciocephalic trunks branch of into?

A
  • common carotid artery
  • subclavian artery
356
Q

What is shock?

A

abnormality of the circulatory system

  • inadequate tissue perfusion and oxygenation
357
Q

The right coronary artery lies in which groove and is located where?

A

Right coronary artery lies in the atrioventricular CORONARY GROOVE in the cardiac septum running between superior vena cava and the right pulmonary vein

358
Q

how does hydrostatic and therfore osmotic pressure change as blood pressure decreases from the arteriole to the venule?

A
  1. at first (arteriole side) higher hydrostatic pressure as the pressure of blood is higher
    • so more fluid going into interstitial space
  2. as hydrostatic pressure of the capillary decreases towards venule, osmotic pressure stays the same so more fluid will actually cross into the capillary
  • only some proteins can leak out the capillary into the interstitial fluid which may affect the forces
359
Q

what does the heart have around it that supports the heart valves and provides attachment for cardiac muscle fibres?

also isolates atria from ventricles with passing electrical impulses

A

fibrous skeleton made of thick connective tissue

360
Q

Hypertension definition

A
  • Clinic BP of 140/90 or higher
  • Daytime average BP of 135/85
361
Q

Which three factors regulate renin secretion?

A
  • hypotension
  • renal sympathetic nerve stimulation
  • decreased Na+ in renal tubular fluid
362
Q

What range should normal MEAN ARTERIAL BLOOD PRESSURE be? (MAP)

A
  • 70-105 mmHg
363
Q

what does the frank starling curve show?

A

describes relationship between END DIASTOLIC VOLUME and STROKE VOLUME

364
Q

orthostatic hypotension symptoms?

A
  • lightheadedness
  • dizziness
  • blurred vision
  • faintness
  • falls
365
Q

What is the serous pericardium?

A
  • layer of simple squamous epithelium (mesothelium) with basal lamina + connective tissue
  • lines inner surface of fibrous pericardium (PARIETAL PERICARDIUM)
  • covers surface of the heart (VISCERAL PERICARDIUM)
366
Q

what causes cool peripheries in haemorrhagic shock?

A
  • decreased cardiac output
  • increased SVR (baroreceptor reflex)
367
Q

Name a competitive inhibitor to acetylcholine (which would speed up the heart)

A

ATROPINE

368
Q

what are SIGNs key reccomendations for interventions to prevent CVD?

A
  • reduce weight
  • exercise
  • smoking cessation
  • antiplatelet therapy (not primary)
  • lipid lowering (statin)
  • hypertension (>140/90 mmHg
    *
369
Q

What is blood pressure?

A

Outward pressure exerted by blood on the blood vessel walls

370
Q

what is intersitial fluid?

A
  • part of EXTRACELLULAR FLUID (75%)
  • bathes the body cells
  • acts as a go between blood and body cells
371
Q

What condition would cause neurogenic shock?

A

Spinal cord injury

372
Q

What is meant by the term sinus rhythm?

A

The heart is controlled by the sino-atrial node

373
Q

Acronym for valve order of auscultation?

A

All Prostitutes Take Money

374
Q

which structures are supplied by the phrenic nerves?

A

somatic sensory to…

  • mediastinal and diaphragmatic parietal pleura
  • fibrous pericardium
  • diaphragmatic partietal peritoneum
375
Q

what is osmotic pressure?

A
  • force on the capillaries to prevent fluid from leaving
376
Q

Give the specific valves closing on S1 and what side of the heart they are located

A
  • Mitral (left)
  • Tricuspid (right)
377
Q

what does the lymph vascular system consist of?

A

lymphatic vessels that drain tissue fluid then returning it to veins in the base of neck

378
Q

What is the aortic sinus and where is it located?

A
  • dilation of the asceding aorta just above the aortic valve
  • between wall of aorta and the three cusps of the aortic valve
  • spaces within the cusps
  • anterior aortic sinus gives rise to the coronary artery
379
Q

what is primary prevention?

A

reducing incidence of a disease in a population

380
Q

What is the ‘a’ for in the JVP wave?

A

Atrial contraction

381
Q

What are the two parts to the pericardium?

A
  • fibrous pericardium
  • serous pericardium
382
Q

What is circle of willis and how does it adapt cerebral circulation?

A

basilar (formed by 2 vertebral arteries) and carotid arteries anastamose to form circle of willis

  • allowing cerebral perfusion to be maintained even if one carotid artery gets obstructed (not taking into account obstruction of smaller branches would cut blood supply to parts of brain)
383
Q

What is the myocardium made up of?

A
  • contractile cardiac muscle
  • lots of capillaries
  • connective tissue
384
Q

which score can be used to asses CVD risk?

A

ASSIGN SCORE

385
Q

apoprotein associated with very low density lipoprotein particles (VLDL) ?

A

apoB-100

386
Q

Which hormone causes vasoconstriction/dilation of vascular smooth msucle?

A

Adrenaline

387
Q

Which hormones other than noradrenaline and adrenaline influence vascular smooth muscle?

A
  • angiotensin II (vasoconstriction)
  • antidiuretic hormone (vasoconstriction)
388
Q

What condition may cause decreased cardiac contractility?

A

Myocardial infarction (heart failure)

389
Q

purpose of left venous angle?

A

recieves lymph from thoracic duct

390
Q

Risk factors of postural hypotension?

A
  • Age
  • Mediction
  • Certain disease
  • Lower intravscular volume
  • prolonged bed rest
391
Q

What does increased VASOmotor tone increase?

A
  • Increase Systemic vascular resistence
  • MAP
392
Q

what is the VASOMOTOR tone?

A

vascular smooth muscle being partially restricted at rest

  • due to them being supplied by SYMPATHETIC nerve fibres and the tonic discharge of these nerves resulting in continuous release of noradrenaline
393
Q

how can a lifestyle be modified to reduce CVD risk?

A
  • weeight loss
  • reduce alcohol intake
  • increase exercise
  • lower salt intake
  • smoking cessation
  • limit fat and cholesterol rich foods
394
Q

What happens to the vasomotor tone in kidneys and gut in acute response to exercise?

A

Vasoconstriction in kidneys and gut

395
Q

whoch part of the blood vessel do straling forces favour filtration or reabsorption?

A
  • favours filtration at arteriolar end
  • favours reabsoprtion at venular end
396
Q

foetal circulation route

A

lungs to heart

  • from heart to placenta, brain and body
397
Q

What are these two side effects commonly associated with?

A
  • myopathy (weak muscles)
  • renal failure
398
Q

What aortic arch gives rise to the common carotid?

A

Third aortic arch

399
Q

Describe ventricular ejection

A
  • Happens when ventricular pressure exceeds AORTA/PULMONARY ARteRY PRESSURE
  • Aortic/pulmonary valves open
  • Stroke volume is ejected
  • leaving behind end systolic volume
  • Aortic pressure rises
  • Aortic /pulmonary valves shut when the ventricular pressure then falls below their pressure
400
Q

what are the three intrinsic mechanisms that control coronary blood flow?

A
  • decreased Po2 = vasodilation of coronary arterioles
  • Metabolic hyperaemia (increased BF when tissue is active) matches flow to demand
  • ADENOSINE (from ATP) is a potent VASODILATOR
401
Q

what happens when babies fail to adapt at birth?

A
  • newborn persistent pulmonary hypertension
    • more likely to occur in sick babies
    • can be due to congential abnormality
402
Q

why is heart disease imporotant in women?

A
  • number 1 cause of death in women
403
Q

how may vasovagal relfex syncope be averted?

A
  • horizontal gravity neutralisation position
  • leg crossing

INCREASE VENOUS RETURN

404
Q

when does cerebral autoregulation fail?

A

if MAPB falls below around 60mmHg or higher than around 160mmHg

(confusion, fainting, brain damage)

405
Q

What happens to ionic channels once the threshold is reached?

(RISING PHASE)

A
  • Long lasting L-type Ca++ channels are activated
  • SO Ca++ INFLUX
406
Q

what blood vessels are particularly important in controlling blood flow in tissue?

A

Arterioles

  • main systemic resistence vessels!!
407
Q

what is the recurrent layngeal nerve?

A

branch of the vagus nerve supplying all instrinsic muscles of the larynx

  • there are a right and a left
408
Q

What four factors influence venous return and therefore stroke volume?

A

Increased Venous Return results from…

  • Increased Venomotor Tone
  • Increased Skeletal Muscle Pump
  • Increased Blood volume
  • Respiratory Pump
409
Q

funcion of the thoracic ducts?

A

drains lymph into the left venous angle

(grey part)

410
Q

what does resistence of skeletal muscle vascular bed have a large impact on?

A

large impact on blood pressure

411
Q

What couples the cardiac muscle cells (myocytes) in cardiac muscle?

A

Gap Junctions

412
Q

what are the two thick branches that come from the arch of the aorta?

A

braciocephalic trunk

413
Q

Where are the baroreceptors located?

A
  • Carotid sinus
  • aorta
414
Q

What determines direction of the electrical vector?

A

Determined by overall activity of the heart

  • varies during cardiac cycle
415
Q

which two arteries can be palpated in the upper limb?

A
  • brachial artery
  • radial artery
416
Q

what type of mechanism controls coronary blood flow?

A

controlled by intrinsic and extrinsic mechanisms

417
Q

How do you determine heart rate from an ECG?

A

HR = 300/ no. of large squares between R-R interval

418
Q

What factors influence systemic vascular resistence (SVR)?

A

Contraction and relaxation of VASCULAR SMOOTH MUSCLE

  • controlled by extrinsic and intrinsic mechanisms
419
Q

What are the three types of diuretics?

A
  • Thiazide diuretics
  • loop diuretics
  • potassium saring diuretics
420
Q

which route does the left vagus nerve take down the thorax?

A

passes inferiorly past left common carotid and left subclavian arteries

  • posterior to sternoclavicular joint into thorax
421
Q

why is LDL cholesterol bad?

A
  1. when LDL is taken from the blood into the artery intima
  2. white blood cells migrate into intima to become macrophages
  3. macrophages take on the now oxidised LDL
  4. LDL converted to fatty streaks with lots of cholesterol
422
Q

What does heart failure do to this curve (inotropic effect)

A

Shifts curve to the right

423
Q

name the three types of syncope

A
  • reflex syncope
  • orthostatic hypotension
  • cardiac syncope
424
Q

risk factors contributing to CVD?

A
  • tobacco use
  • unhealthy diet
  • obesity
  • physical inactivity
  • alcohol abuse
  • poverty
  • pollution
  • family history
  • high BP
  • high cholesterol
425
Q

what is hydrostatic pressure?

A

pressure of the blood on the membrane of the capillary

  • when it increases there will be more fluid leaving the capillary and entering the interstitial fluid
426
Q

Tricuspid auscultation location?

A

4th left ICS lower left sternal edge

427
Q

What route does the pacemaker cell excitation take to reach the ventricular muscle cells?

And how does the current flow cell to cell?

A
  • SA node
  • Atria
  • AV node
  • Bundle of His
  • Left and Right Branches
  • Purkinje Fibres
    *
428
Q

What happens to baroreceptor firing if high blood pressure is sustained (hypertension)

A

Baroreceptor firing will decrease as it will adjust to that new normal

  • Baroreceptors for ACUTE chnges only
429
Q

why is the ductus arteriosus needed?

A
  • only 7% of RV output is needed for the lungs the rest goes into aorta to go elsewhere
430
Q

List what ways each peak in the ECG moves in relation to the recording electrode

A
  • P wave: towards
  • Q wave: away
  • R wave: towards
  • S wave: away
  • T wave: away (but repolarisation so positive)
431
Q

where do the recurrent laryngeal nerves branch from?

A

branches of the vagus nerve

432
Q

Chemical factors that influence vascular smooth muscle?

A
  • Local metabolic changes
  • Local Humoral agents (may be released in response to an injury or inflammation i.e. histamine, bradykinin, nitric oxide)
433
Q

which cells are smaller? pacemaker cells or contractile cardiac myocytes?

A

pacemaker cells are considerably smaller

434
Q

Purpose of protein channels in cardiac muscles?

A
  • Form low resistence electrical communication pathways between neighbouring myocytes
  • make sure each electrical excitation reaches all myocytes
435
Q

where are beta2 receptors predominantly located and why?

A

located in cardiac and skeletal muscle

helps with redistribution of blood in exercise etc.

436
Q

why is resting blood flow low in skeletal muscle circulation?

A

low because of sympathetic vasoconstrictor tone

437
Q

which gender are coronary artery disease outcomes worse in?

A

women

438
Q

where are other lymph nodes located around the bronchi?

A

bronchopulmonary lymph nodes (surrounding main bronchus at lung root)

439
Q

What is autoregulation of blood flow?

A

myogenic repsonse keeps blow flow constant over a wide range of MAP

440
Q

what happens when cuff pressure exceeds 120mm Hg and exceeds blood pressure throughout the cadiac cycle?

A

No blood flows through the vessel

  • so no sound is heard because there is no flow
441
Q
A
442
Q

what does the phrenic nerve innervate for motor functions?

A

the diaphragm

443
Q

what does the anterior mediastinum lie between?

A

between the sternum and the firbous pericardium

444
Q

name the apoprotein associated with chylomicrons

A

apoB-48

445
Q

where do the lymphatics of the lung drain into?

A
  • drain into bronchopulmonary lymph nodes at bifurcations of the larger bronchi
446
Q

What equation makes up the stroke volume?

A

End diastolic volume - End systolic volume

447
Q

what do the sympathetic nerve fibres of the phrenic nerves innervate?

A

supply arterioles (sympathetic tone)

448
Q

What is the relative refractory period?

A

New action potential can be generated under the appropriate circumstances

449
Q

which direction does the atrium move during looping and folding of heart tube?

A
  • dorsal and cranial
450
Q

Give examples of conditions that may cause obstructive shock

A
  • cardiac tamponade
  • tension pneumothorax
  • pulmonary embolisms
  • severe aortic stenosis
451
Q

Name the five regions of the heart tube

A
  • truncus arteriosus
  • bulbus cordis
  • ventricle
  • atrium
  • sinus venosus
452
Q

Which blood vessels empty into the sinus venosus?

A
  • R and L cranial vena cavas
  • caudal vena cava
  • left hepatic vein
453
Q

what enzyme are stains a competitive inhibitor of?

A

HGM-CoA reductase

454
Q

So why the need for 12 leads?

A
  • Determine axis of heart
  • look for ST segment of T wave changes specific to certain region
  • look for voltage changes
455
Q

what is the hydrostatic pressure like in pulmonary capillaries?

A

low hydrostatic pressure (around 8-11mmHg)

456
Q

Three hormones that regulate ECFV?

A
  • Rennin-Angiotensin-Aldosterone System (RAAS)
  • Natriuretic Peptides (NPs)
  • Antidirueti Hormone (arginine vasopressin - ADH)
457
Q

how many aortic arches are there?

A

6 pairs associated with the pharyngeal arches

458
Q

how do pathways for reflex activation cause reflex syncope?

A

when activated pathways cause…

  • cardioinhibition through vagal stimulation
  • vasodepression through depression of sympathetic activity on blood vessels
  • cardioinhibition = decreased HR and CO
  • vasodepression = decreased SVR so vasodilation, venous return, SV, CO
  • decreased CO and SVR = decreased MAP
459
Q

what is the mediastinum?

A

a membrane partition between the lungs

460
Q

What determines the magnitude of the electrical vector?

A

Determined by mass of cardiac muscle involved in generating signal

461
Q

how does raised intracranial pressure affect ceerebral blood flow?

A

decreases cerebral perfusion pressure and cerebral blood flow

  • when intracranial pressure (ICP) is increased may sometimes lead to problems in autoregulation
462
Q

which area of the brain is very sensitive to hypoxia?

A

grey matter

  • loss of consiosuness in few seconds of ischaemia
  • irreversible cell death fast

so special regulation is needed!!

463
Q

treatment for cardiogenic shock?

A

inotropes

464
Q

how do central veins relate to the rigth atrium?

A

large veins close enough to the heart so that pressure within them is said to approx. reflect pressure in right atrium

465
Q

what does adenosine do to blood vessels?

A

vasodilator

466
Q

Should blood pressure be audible through a stehtoscope?

A

NO

  • normally blood should flow in a laminar fashion
467
Q

why can diaphragmatic pathology present as shoulder tip pain?

A
  • irritates the parietal peritoneum which lines interior of diaphrgam supplied by phrenic nerve (C3,4,5)
  • supraclavicular nerves enter spinal chord at the same level as phrenic nerves and supply the dermatomes over the shoulder tip
468
Q

what is the ductus venosus?

A

connects umbilical vein to inferior vena cava

  • allows blood to bypass the liver (from the placenta)
469
Q

What are the two main factors which affect extracellular fluid volume?

A
  • Excess or deficit water level
  • Excess or deficit of Na+
470
Q

what feature does the myocardium have that allows spread of electrical activity?

A

intercalated discs

471
Q

What is the pericardium?

A

Fibrous sac that surrounds the heart

472
Q

Where is aldosterone released from?

A

adrenal cortex

473
Q

Outline the steps of muscle contraction

A
  • Ca++ influx into cell
  • Ca++ bind to troponin on actin filament
  • This displaces the troponin to expose the myosin binding sites
  • Head of each myosin unit is bound to ADP + Pi
  • Myosin heads release the phosphate and bind to the myosin binding sites on actin filaments
  • Myosin units pull the actin filament along whilst releasing ADP
  • ATP molecules bind to myosin head
  • Myosin releases from actin
  • ATP molecules are broken down into ADP + Pi releasing energy
  • Starts again
474
Q

What is the term used to describe how the heart can beat rhythmically WITHOUT an external stimulus?

A

AUTORHYTHMICITY

475
Q

what conditions may cause vasoactive shock? (x2)

A
  • septic shock
  • anaphylactic shock
476
Q

What does osmolality mean?

A

Solute-water balance

  • monitered by osmoreceptors in the brain
477
Q

what happens to the vasomotor tone in skeletal and cardiac muscle in acute response to exercise?

A

Vasodilation

478
Q

where is the haziness located for a CXR with pulmonary oedema?

A

perihilar region

479
Q

how do bile acid binding resins work?

A

cause bile salt excretion

  • meaning more cholesterol is converted to bile salts
  • cause decreased TAG absorption
  • increased LDL receptor expression
480
Q

Where is depolarisation in the R wave?

A

In the main free walls of the ventricles

481
Q

What causes vasoactive shock?

A

vasoactive mediators released

  • = venous and arteria vasodilation
  • = increased capillary permeability
  • = decreased venous return
  • = decreased SVR
482
Q

Where is the epicardium in relation to the pericardium?

A
  • epicardium is the inner layer of the pericardium
  • may also be called the visceral pericardium
483
Q

Where does the release of Ca++ come from?

A

Sarcoplasmic Reticulum

484
Q

What happens if plasma volume falls?

A

Interstitial fluid will be shifted from interstitial compartment to the PLASMA compartment

SO

Plasma, Blood volume and MAP will be controlled if ECFV is controlled

485
Q

What type of electrode is lead 1?

A

The RECORDING electrode

  • when depolarisation moves towards this, an upward deflection is generated
  • when a depolarisation moves away from this, a downward deflection is generated
486
Q

What will increased sympathetic discharge do to the vasomotor tone?

A

Increased sympathetic discharge

= increased vasomotor tone

= vasoconstriction

487
Q

if venous return is changed, what also is changed?

A

Stroke volume (starling)

488
Q

name the three shunts specific to foetal life

A
  • ductus venosus
  • foramen ovale
  • ductus arteriosus
489
Q

What is syncope a specific form of?

A

a transient loss of consciousness (TLOC)

  • loss of consciousness with loss of awareness
  • for a short duration!
490
Q

what receptors does adrenaline act on to cause vasodilation?

A

beta2 receptors = vasodilation

491
Q

Does starlings law match the stroke volume of the RV and LV?

A

Yes

  • Increase in RV EDV = Increased SV into pulmonary artery
  • Increase in LV EDV = Increased SV into aorta
492
Q

how do water soluble substances cross the capillary membrane?

A

water soluble substances go through water filled pores to cross the membrane

493
Q

How does ezetimibe work?

A

inhibits NPC1L1 transport protein in enterocytes of duodenum

  • reduce cholesterol absorption
  • use combines with statins

decrease LDL

little HDL change

494
Q

mitral valve location?

A

between left atrium ad left ventricle

495
Q

What are myofibrils?

A

Contractile units of the muscle

496
Q

What area of the heart do the cardiac sympathetic nerves supply?

A
  • SA node
  • AV node
  • AND myocardium
497
Q

when does peak left coronary blood flow occur?

A

during diastole

498
Q

What do the grooves on the heart surface allow for?

A

Indicate positions of the cardiac septum dividing the heart into the right and left side

499
Q

what state are the lungs in for a foetus?

A

lungs are filled and unexpanded

500
Q

list features that may suggest cardiac syncope

A
  • syncope during excretion of when supine
  • structural cardiac abnormality
  • coronary heart disease
  • family history of sudden death
  • sudden palpitations immediately followed by syncope
  • ECG findings suggesting arrhythmic syncope
501
Q

Where is the tricuspid valve located?

A

between the right atrium and right ventricle

502
Q

what does hypoxia do to pulmonary circulation?

A
  • hypoxia = vasoconstriction of pulmonary arterioles

WHY?? hypoxia normally equals the opposite??

  • it diverts blood away from the poorly vetilated area of lung
503
Q

what is PCSK9 inhibitor drug used to treat?

A

familial hypercholesterolaemia

504
Q

how would raised capillary pressure cause oedema?

A
  • arteriolar diltation and raised venous pressure

causes more liquid in the vessel so more fluid being transferred to interstitial fluid

505
Q

How does cellular failure result from shock?

A
  1. Inadequate tissue perfusion therefore oxygenation
  2. anaerobic metabolism
  3. metabolic wast products accumulate
  4. cells fail
506
Q

how does mature HDL remove excess cholesterol?

A
  1. accepts excess cholesterol from the plasma membrane of cells (macrophages)
  2. HDL delivers cholesterol to liver (reverse cholesterol transport)
  3. cholesterol is transferred into hepatocytes
507
Q

What is stroke volume?

A

Volume of blood ejected from EACH ventricle per heart beat

508
Q

give the lifecycle of apoB-containing lipoproteins

A
  1. assembly
  2. intravascular metabolism (hydrolysis of TAG core)
  3. receptor mediated clearance
509
Q

Summarise what happens when a person stands up from lying down (creating a postural hypotension) to maintain Blood Pressure?

A
  • HR increases (from reduced baroreceptor firing = sympathetic tone increase, vagal tone decrease)
  • SV increases (from same source)
  • SVR increases (from increases sympathetic constrictor tone)
510
Q

what happens to ductus arteriosus and ductus venosus when the baby is born?

A

the ducts constrict

  • decreased flow due to decreases PVR
  • increased pO2
  • decreased PGE2 as lung metabolism increases
511
Q

what events may carotid sinus syncope occur after?

A
  • head/neck surger
  • radiation
512
Q

how is the placenta involved in circulation?

A
  • gas exchange
  • nutrition
  • waste excretion
  • homeostasis
513
Q

What impact does the vagus nerve have on the SA node?

A

Vagus nerve maintains a continuous parasympathetic influence on the SA node (under resting conditions)

  • vagal tone dominates under resting conditions
  • produces a normal heart rate of around 70bpm
514
Q

Name of thick filaments in microfibrils, causing darker appearance?

A

MYOSIN

515
Q

When does blood flow through the vessel become turbulent?

A

When blood pressure exceeds cuff pressure (between 120 and 80mmHg)

516
Q

what is interstitial fluid hydrostatic pressure and how does it affect capillary filtration?

A

interstitial fluid hydrostatic pressure

  • force of fluid pressure outside or within the capillary wall
  • opposes filtration
517
Q

where are apoB-48 apoproteins assembled?

A

intestine

518
Q

what are capillaries?

A

single layer of endothelial cells

519
Q

Location of aortic auscultation?

A

2nd right intercostal space sternal edge

1ST YR CARDIO (6 decks)

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