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Medicine - Year 1 > Block 2 - Cardiac Systems (3-4) > Flashcards

Block 2 - Cardiac Systems (3-4) Flashcards

1
Q

Where is the right border of the heart?

What is its shape?

A

Between the 3rd and 6th costal cartilage
Parasternal line
Straight border

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2
Q

Where is the left border of the heart?

What is its shape?

A

Between the 2nd and 5th costal cartilage
Midclavicular line
Oblique border

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3
Q

What vertebral level does the heart run from and to?

A

T5-T8

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4
Q

What are the layers of the heart?

A

Fibrous pericardium - Parietal pericardium - Visceral pericardium (Epicardium) - Myocardium - Endocardium

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5
Q

What type of epithelium is the epicardium and endocardium?

A

Simple squamous

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6
Q

Is the pericardial cavity a potential or real space?

A

Potential

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7
Q

What are the two sinuses of the heart?
Where are they?
Which one has a blind-ending space?

A

Oblique pericardium sinus: Between pulmonary veins (blind ending)

Transverse pericardial sinus: Between aorta, pulmonary trunk and area of venous drainage

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8
Q

What is the aortic knuckle?

A

The aortic arch as seen on an xray

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9
Q

What are the 3 surfaces of the heart?

A

Sternocostal: Against sternum and ribs
Diaphragmatic: Contact with the diaphragm
Posterior: Against the vertebrae

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10
Q

What are the 4 borders of the heart?

A

Right, left, superior and inferior

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11
Q

How fast do the atria and ventricles beat?

A

Atria: 60bpm
Ventricles: 40bpm

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12
Q

What is the smooth wall called in the atria?

A

Sinus venarum

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13
Q

What is the rough wall called in the atria?

A

Musculi pectinati

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14
Q

What does the crestiterminalis contain?

What is it seen from the outside of the heart as?

A

Contains SAN

Seen as a groove called the sulcus terminalis

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15
Q

How many pulmonary veins are there?

A

4

Left and right: superior and inferior

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16
Q

What is the rough area of the ventricle called?

What is its role?

A

Trabeculae carnae

Stops the heart walls from sticking together

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17
Q

What is the smooth area of the ventricle called?

A

Infundibulum/ Consus anteriosus

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18
Q

What is the moderator band in the right ventricle called?

Where is it found?

A

Septomarginal trabeculae

In the IV groove with the Bundle of His

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19
Q

What is the path of blood in the ventricle?

A

Atria - Rough area - Smooth area - Valve

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20
Q

What is the same about the size of the R and L ventricle?

A

The size of the lumen

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21
Q

What are the 3 aortic sinuses?
Where are they positioned?
Which ones have a coronary artery?

A

Right aortic sinus (anterior): Right artery
Left aortic sinus (left posterior): Left artery
Posterior aortic sinus (right posterior)

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22
Q

Where does the right coronary artery run?

What are its branches?

A

Runs down AV groove
MARGINAL artery branches along the inferior border to the apex
On the diaphragmatic surface this branches into the POSTERIOR DESCENDING artery which passes the IV groove in 85% of people

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23
Q

What does the right coronary artery supply?

A

Right atria and ventricle
Posterior 1/3 of IV septum
SAN (60%)
AVN (80%)

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24
Q

Where does the left coronary artery run?

What are its branches?

A

Bifurcates early into the:
LEFT ANTERIOR DESCENDING (widow maker) which runs down the IV septum
LEFT CIRCUMFLEX

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25
Q

What does the left coronary artery supply?

A

Left atria and ventricle

Anterior 2/3 of IV septum

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26
Q

Why is coronary circulation variable?

A

Many vessels enatamose

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27
Q

What are the 4 main veins in the heart?
What artery do they accompany?
Where do they run?

A

Great cardiac vein: Left anterior descending (anterior IV septum)
Middle cardiac vein: Posterior descending (posterior IV groove)
Small cardiac vein: Marginal artery (inferior border)
Oblique cardiac vein: Descends from the left atrium

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28
Q

Which two veins do not drain into the coronary sinus?

A

Anterior cardiac vein: Drains blood into the right atrium from the right ventricle

Smallest (thesbian) cardiac vein: Return blood directly the heart chambers through the myocardium

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29
Q

Two ways in which cardiac muscle is similar to skeletal muscle

A

Striated

Myofibrils made from actin and myosin

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30
Q

5 differences between cardiac muscle and skeletal muscle

A 
Branching of myofibrils increased
Intercalated discs made from gap junctions
Mitochondria increased
Mononucleated
Shorter myofibrils
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31
Q

What are the gap junctions in cardiac muscle made from?

A

Connexon proteins

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32
Q

What type of chain is myosin

What are the two chains made from?

A

Alpha helix chain
Heavy chain: Tail region and hinge protein
Light chain: Contains the head which is made from alkali and an ATPase

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33
Q

How many actin molecules surround one myosin?

A

6

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34
Q

What type of protein is actin?

What type of protein does it also contain?

A

Globular protein with a tropomyosin protein which lies between 2 helical strands

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35
Q

What is troponin?

A

A regulatory complex that attaches to tropomyosin

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36
Q

What are the 3 parts of troponin?

A

TnT: Binds troponin to tropomyosin
TnC: Where calcium ions bind
TnI: Inhibits actin and myosin binding

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37
Q

Explain the sliding filament mechanism

A

Myosin bound
ATP binds –> detachment
Hydrolysing –> pivoting to cocked position
Myosin binds –> new cross bridge
Pi released –> power stroke
ADP released –> muscle ready for next time

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38
Q

What is excitation-contraction coupling?

A

An action potential triggered by the SAN spreads over the muscle –> contraction

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39
Q

What are the calcium channels found on the sarcolemma surface called?

A

L-type voltage gated calcium channels

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40
Q

How is cardiac muscle diad?

A

One sarcoplasmic reticulum for every T tubule

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41
Q

Define lusitrophy

A

Muscle relaxation

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42
Q

What is phospholambin?

A

Regulatory protein which is phosphorylated to allow the SERCA pump to increase uptake

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43
Q

Why are high levels of Calcium an issue?

A

It is toxic

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44
Q

Explain what happens during sympathetic control of the heart?

A

Noradrenaline and adrenaline to beta 1 adrenoreceptors on the SAN, AVN and muscle

Activate G-simulator –> cascade and phosphorylation of calcium channels to increase calcium release

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45
Q

Explain what happens during parasympathetic control of the heart?

A

Acetylchoine released from the vagus nerve and binds to M2 receptors on the SAN and AVN

Activate G-inhibitor –> inhibits calcium channels and phosphorylates K channels –> hyperpolarisation

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46
Q

Define Chronotropic

Is it increased or decreased by increased calcium in the sympathetic system?

A

Heart rate

Increased

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47
Q

Define Dronotrophic

Is it increased or decreased by increased calcium in the sympathetic system?

A

Impulses

Increased

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48
Q

Define Inotropic

Is it increased or decreased by increased calcium in the sympathetic system?

A

Force and rate of contraction

Increased

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49
Q

What is the transmission like in the nodes compared to the muscles and fibres?

A

Nodes: Fast transmission

Muscles and fibres: Slower transmission

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50
Q

What is the difference in potentials between the nodes, muscles and fibres

A

Nodes: Pacemaker potential

Muscles and fibres: Resting membrane potential

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51
Q

Explain how depolarisation occurs in the SAN and AVN

A
  • Steady and unstable membrane potential gradually depolarises to reach the threshold
  • Slow depolarisation (Na and Ca) = the ‘funny current’
  • Threshold –> rapid depolarisation
  • K channels re-polarise and overshoot
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52
Q

Explain how depolarisation occurs in the muscle and Purkinje fibres

A
  • Rapid depolarisation by fast Na channels
  • Slight depolarisation when K channels open
  • Plateau when Ca enters
  • Re-polarisation when K leaves
  • Pumps restore the ion gradients
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53
Q

What does the time from re-polarisation - depolarisation in the muscles and Purkinje fibres match with on the ECG?

A

The R-T interval

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54
Q

What is the purpose of the refractory period in muscles?

A

Stops random firing and arrhythmias

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55
Q

How long does atrial systole, ventricular systole and diastole last?

A

Atrial systole: 0.1 seconds
Ventricular systole: 0.3 seconds
Diastole: 0.4 seconds

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56
Q

What is the average EDV?

A

135ml

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57
Q

What are the two stages of ventricular systole?

A

Isovolumic ventricular contraction: Contract to close the AV valves but not enough to open the semi-lunar
Ventricular ejection: Pressure rises and semi-lunar valves open

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58
Q

What is he average ESV?

A

65ml

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59
Q

What is another term for ventricular diastole?

A

Isovolumic ventricular relaxation

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60
Q

How do you calculate cardiac output?

What is the average value?

A

Cardiac output = Heart rate x Stroke volume

5 L/min

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61
Q

How do you calculate stroke volume?

What is the average value?

A

Stroke volume = EDV - ESV

70ml

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62
Q

Define stroke volume

A

The volume of blood ejected from the ventricles per heart beat

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63
Q

Define the ejection fraction

What is it a measure of?

A

Fraction of the EDV which is ejected with each beat

A measure of ventricular performance

64
Q

How do you calculate the ejection fraction?

What is the average value?

A

(Stroke volume/EDV) x 100%

>55%

65
Q

What makes the 1st and 2nd heart sound?

A

1st heart sound: AV valves close

2nd heart sound: SL valves close

66
Q

What three things did Starling discover?

A
  • Increasing EDV increased stroke volume
  • Increased venous return increased heart contractility and increased cardiac output
  • Increased calcium causes increased muscle tension
67
Q

What 3 things influence stroke volume?

How do they affect the EDV/ESV?

A

Increased preload = Increased SV = Increased EDV
Increased afterload = Decreased SV = Increased ESV
Increased intropy = Increased SV = Decreased ESV

68
Q

How does sympathetic stimulation increase stroke volume?

A

Increases the volume of blood coming back to the heart and increases the force generated by the heart

69
Q

What cells are the SAN and AVN made from?

A

Pacemaker cells

70
Q

What is the intrinsic rate of firing for the SAN, AVN and Purkinje fibres?

A

SAN: 70bpm
AVN: 50bpm
Purkinje fibres: 30-40bpm

71
Q

What is the difference between the sympathetic and parasympathetic control of the heart in regards to membrane potentials?

A

Normal: Resting potential is -60mv and the threshold is -40mv

Parasympathetic: Resting potential increases to -70mv so it takes longer to reach the threshold of -40mv and heart rate decreases

Sympathetic: Resting potential decreases to -50mv so it lates less time to reach the threshol dof -40mv and heart rate increases

72
Q

What 4 parts of the heart does adrenaline act on and what does it do?

A

SAN: Increases rate of contraction
Atrial muscle: Increases force of contraction
AVN: Increases the automatic response
Ventricular muscle: Increases the automatic response and increases contraction force

73
Q

Explain how a current is generated in an ECG

A

Rest: Muscle polarised (+ outside and - inside) - charge of zero
Depolarisation: (- inside and + outside) dipole forms and charge moves to the electrode forming a peak
Full depolarised: No charge difference (S-T line)
Re-polarisation: Charge moves back in the opposite direction (T wave)

74
Q

Define isoelectric

A

Charge of zero

75
Q

What does the P-R interval on an ECG represent?

A

The time take from SAN-AVN

76
Q

What do Q, R and S represent separately?

A

Q: Depolarisation of the IV septum
R: Depolarisation of the apex and walls
S: Depolarisation of the base

77
Q

What does the S-T segment on an ECG represent?

When is it elevated?

A

Between the end of ventricular depolarisation and re-polarisation
Elevated during a MI

78
Q

What 2 things may the U wave represent?

A

Re-polarisation of the papillary muscles

Pathology

79
Q

What may an increased R-R interval mean?

A

Increased risk of Arrhythmia due to increased Q-T interval

80
Q

What is the role of the Hexaxial Reference System of the ECG?

A

Diagnoses conditions by looking at axis deviation (direction of the hearts depolarisation)

81
Q

What 4 things do you examine the ECG for?

A

Cardiac axis, rate, rhythm and waveforms

82
Q

What is atrial fibrillation?

A

Abnormal electrical activity causes rapid firing of the atria

83
Q

What 3 things can atrial fibrillation cause?

A

Arrhythmia (irregular heartbeat)
Heart failure
Stroke

84
Q

What is the ECG like for someone with atrial fibrillation?

A

Irregular R waves
No P waves
F waves
Irregular irregularity in R-R intervals

85
Q

Give 3 causes of atrial fibrillation?

A

Alcohol, Heart disease, Hypertension

86
Q

What are the 5 types of atrial fibrillation?

A 
1st diagnosed (feeling faint)
Paroxysmal (less than 7 days)
Persistent (more than 7 days)
Long-standing permanent (trying to restore)
Permanent (cannot restore)
87
Q

What do the treatments of atrial fibrillation aim to do?

A

Control the ventricular rate to prevent thrombo-embolism

88
Q

4 classes of drugs which can be used for atrial fibrillation treatment
Which one is only used now in the elderly?

A

Anticoagulants
Beta blockers
Digoxin (now only in the elderly)
Non-dihydropyran calcium channel antagonists

89
Q

What is cardioversion?

What is it used to treat?

A

Coordinates the heart beat through electricity or drugs

Atrial fibrillation

90
Q

What are 4 other names for ventricular ectopic beats?

A

Ventricular extrasystoles
Ventricular premature complexes
Ventricular premature beats
Ventricular contractions

91
Q

What 3 things happen during ventricular ectopic beats?

A

Beats occur earlier
There is a compensatory (longer) pause between beats
Impulse is not conducted well down the purkinje fibres causing slower depolarisation

92
Q

What is the ECG like for ventricular ectopic beats?

A

Wide QRS complex
No P wave
An inverted T wave

93
Q

How can you increase the removal of toxins from the body?

A

Increase the blood pressure

94
Q

What does a decrease in peripheral resistance cause?

A

The blood runs away faster

The pulse collapses faster

95
Q

What is the equation for flow?

A

Flow = pressure gradient / resistance

96
Q

What is resistance provided by?

A

Capillaries

97
Q

What happens to pressure and flow when resistance increases?

A

Pressure and flow decrease

98
Q

What is the difference between systemic and pulmonary vascular difference?

A

Systemic vascular difference is greater than pulmonary vascular difference

99
Q

Why does the brain need a constant pressure?

A

So that the tissues can draw whatever blood they need

100
Q

Explain how tissues get more blood during exercise

A

Cardiac output increases

Resistance decreases and pressure remains constant so flow increases

101
Q

What happens to the heart if the blood pressure gets to high?

A

It continues to pump

102
Q

What controls blood flow at rest?

What will altering blood pressure during this time do?

A

Tissues control blood flow at rest by adjusting peripheral resistance
Altering blood pressure does little to control flow

103
Q

Explain how small levels of vasodilation increases blood flow

A

Tissue flow is proportional to the radius^4

Dilate the tube from 1-2 = dilate the flow from 1-16

104
Q

Where are precapillary sphincters found?

What are they made from?

A

At the site of arterial bifurcation

Smooth muscle

105
Q

What causes relaxation of the precapillary sphincter?

A

Metabolic products

e.g. CO2, H+, Hypoxia, NO

106
Q

What are the 4 short term controls of blood pressure?

How long is short term?

A

Arterial stretch, autonomic nervous system, baroreceptors, chemoreceptors
Seconds - hours

107
Q

Where do sympathetic fibres run to?

A

The vasomotor centre in the medulla

All blood vessel

108
Q

How is blood pressure slightly increased at rest?

A

Increased sympathetic outflow

109
Q

Where do nor-adrenergic fibres run to?
What receptor do they work on?
How do they cause vasoconstriction/dilation?

A

Smooth muscle alpha receptors
Agonise noradrenaine –> vasoconstriction
Block noradrenaline –> vasodilation

110
Q

What happens to the muscles, tissues and heart if you stimulate the CNS?

A

Muscles vasodilate
Tissues vasoconstrict due to an increase in peripheral resistance, blood pressure, venous return and CO
Increased contractility, rate and relaxation of the heart

111
Q

How do baroreceptors transmit impulses to the brain?

A

Cranial nerves 9 and 10

112
Q

What do baroreceptors do when the pressure increases and decreases?

A

Increased pressure: Increased impulses to medulla so a decrease in sympathetic tone
Decreased pressure: Decreased impulses to the medulla so an increase in sympathetic tone

113
Q

Why are baroreceptors important when you stand up?

A

Standing up changes gravity and thus circulation

Resting vasomotor tone causes a decrease in blood pressure and vasoconstriction so arteries increase increase blood pressure and increase venous return

114
Q

What happens if there are no baroreceptors?

A

The mean blood pressure stays the same but it is all over the place

115
Q

Which baroreceptors are the most important?

A

The ones in high pressure circulation

Low pressure ones are still needed

116
Q

When is long term control of blood pressure needed?

A

When blood pressure is persistently high

117
Q

What are the four methods of long term blood pressure control?

A

ADH, Natriuretic peptides, Pressure diureses, RAAS

118
Q

What happens in pressure diureses if you have a high salt diet or kidney disease?

A

High salt: Increased blood pressure needed to get rid of the salt
Kidney disease: Increased blood pressure is needed to get rid of the same amount of salt and water (causes hypertension)

119
Q

What are Natriuretic Peptides?

What do they do?

A

Hormones
Increased fluid stretches the cardiac muscle causing production of Natriuretic Peptides which increases salt and water removal by the kidney

120
Q

What is renin?

A

An enzyme released from the kindey’s juxtaglomerular apparatus

121
Q

What is the RAAS system’s pathway?

A

Angiotensin –> ANG 1 (Renin)

ANG 1 –> ANG 2 (ACE)

122
Q

4 roles of ANG 2

A

Aldosterone release
Increases vasopressin from the posterior pituritary
Vascular hypertrophy
Vasoconstriction

123
Q

What does aldosterone do?

Where is it released?

A

Sodium and water retention

Adrenal cortex

124
Q

What is contraction of the aorta?

Why is it a problem?

A

A congenital defect where the aorta is occluded
Descending aorta has a LOW blood pressure –> RAAS activation
Ascending aorta is fine –> too high bp in the brain

125
Q

Explain, in detail, how the RAAS system works if salt intake is high

A

Increased volume - Increased blood pressure - Decrease RAAS - Decrease salt and water retention - Decreased volume - Decreased blood pressure

126
Q

What is hypertrophy?

A

An enlarged heart

127
Q

What is the difference between Angina Pectoris and Myocardial Infarction?

A

Angina Pectoris: Marginally blocked coronary artery causing a weaker muscle and chest pain
Myocardial Infarction: Completely blocked coronary artery causing the death of a muscle

128
Q

What does the tunica externa include?

A

Collagen for protection

129
Q

What does the tunica media include?

A

Layers of smooth muscle supported by connective tissue

130
Q

What is the epithelium in the tunica intima?

What else does it contain?

A

Simple squamous

Layers of connective tissue

131
Q

What are the three types of capillary?

A

Continuous: Least permeable; small space between the capillary and cell
Fenestrated: Increased pores
Einusoid: Super increased pores

132
Q

When does the heart tube begin to form?
Where?
What form?

A

21 days
The pericardial cavity
From cardiogenic mesoderm

133
Q

What three things happen at 23 days?

A

Blood vessel formation
Heart begins to beat
Folding of the heart tube

134
Q

What is the heart tube?

What is is made from?

A

A pair of blood vessels folded together to produce a kink

This kink is formed from 2 sheets of endoderm and makes up the foregut

135
Q

What is the left common cardial vein formed by?

A

Formed by the fusion of two blood vessels and nerves either side of the lungs
Form the pleural and pericardial cavities

136
Q

What does the 1st pharyngeal arch form?

A

Maxillary artery

137
Q

What does the 2nd pharyngeal arch form?

A

Corticotympatic artery

138
Q

What does the 3rd pharyngeal arch form?

A

Common and internal carotid

139
Q

What does the 4th pharyngeal arch form?

A

Left part of the aortic arch

Right part of the right subclavian

140
Q

What does the 6th pharyngeal arch form?

A

Left part of the left pulmonary

Right part of the right pulmonary

141
Q

When are the pharyngeal arches symmetrical?

A

29 days

142
Q

What is it called when the heart loops to the left instead of the right?

A

Dextrocardia

143
Q

Explain how the heart tube develops

A

2 tubes filled with cardiac jelly stick together forming a single chamber with 2 vessels exiting out of the top and bottom.
The heart then loops to the right

144
Q

What are the 3 chambers of the heart during early development?

A

Right and left ventricle

TRUNCUS ARTERIOSUS

145
Q

What is the first wall to partition the atria?

A

Septum primum wall grows from the top and bottom of the endocardial cushion and form a hole known as the foramen ovale

146
Q

What is the second wall to partition the atria?

A

Septum secundum grows adjacent to the first wall and covers the foramen ovale forming a flap

147
Q

What are the 4 defects in tetrology of farrot?

A

Enlarged aorta
Enlarged ventricle
Pulmonary valve constricted
Ventricular septum incomplete

148
Q

How does the truncus arteriosus form 2 tubes from 1?

A

Walls grow from the outside of the tube and fuse in the midline
The walls grow in different orientations forming a spiralling tube
The tubes then separate

149
Q

What two vessels does the truncus arteriosus create?

A

Aorta and pulmonary artery

150
Q

Explain how blood enters the foetus?

A

Umbilical artery –> Ductus venosus –> Inferior vena cava –> Liver –> Heart

151
Q

What are the 2 bypasses in a foetus which prevent blood going to the lungs?

A

Foramen oval in atria

Ductus arteriosis from the pulmonary trunk to the aorta

152
Q

What does the ductus arteriosus form in the adult?

A

Ligamentum arteriosusm

153
Q

What does the foramen oval form in the adult?

A

Fossa ovalis

154
Q

What does the ductus venosus form in the adult?

A

Ligamentum venosum

155
Q

What does the umbilical vein form in the adult?

A

Round ligament of the liver

156
Q

What does the umbilical arteries form in the adult?

A

Medial umbilical ligament

Medicine - Year 1 (20 decks)

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