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Part 1 Physiology > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Order of valves closing

A

Mitral then tricuspid
Atrial then pulm (alphabetical)
MTAP

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2
Q

NO

A

From arginine
Calcium activates NOS
3 isoforms
Increases cGMP causing smooth muscle relaxation
Inactivated by Hb

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3
Q

La place

A

Vessel diameter increases, wall tension increases exponentially
For spheres and cylinders
IV pressure directly proportional to wall tension
Dilated heart more tension needed
Small blood vessels less likely to rupture
pressure=tension/radius

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4
Q

Baro receptors

A

Carotid - via IX
Aortic - via X to medulla
No firing <60
in adventitia

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5
Q

Platelets

A

half life 4/7
60-75% in blood, rest in spleen
binds collagen via vWF
Synthesizes thromboxane
Releases calcium and ADP

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6
Q

Granunlocytes

A

neutrophils - half life 6h, phagocytose bacteria
eosinophils - phagocytose parasites, in lung, GIT and urine, IL3/5 late stage hypersensitivity
basophils - allergy, contain heparin, histamine, only present in blood

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7
Q

Mast cells

A

allergy
contain heparin, histamine, adenosine, proteases
IgE receptor -> degranulation
Release TNFalpha

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8
Q

Monocyte

A

circulate and then become macrophages
antigen presentation and phagocytosis
Activates by lymphokines form T lymphocytes
Bacteriocidal

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9
Q

Lymphocytes

A

60-70% Tcells - CD4 MHCII memory, CD8 MHCI cytotoxic
10-20% B cells - secrete IGs, recognise antigens via IgM
10-20% NK cells - recognise cels MHCI, lyse cells without sensitisation

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10
Q

Lymph

A

lower protein than plasma
gets most of its protein from the liver
contains fat, protein, clotting factors, hormones and fluid
2-4L/day
initial vessels no valves, collecting with

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11
Q

Plasma

A

5% body weight 3.5L
contains albumin, globulin, fibrinogen, clotting factors
osmotic force 25mmHg

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12
Q

Vessel wall injury pathway

A
  1. damage -> plt activation -> serotionin release and vasoconstriction
  2. platelet aggregation -> temp haemostatic plug from vWF and collagen
  3. fibrin clot formation
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13
Q

Clotting cascade

A

intrinsic: collagen, 12,(kallikrein) 11, 9
Extrinsic: tissue thromboplastin, 7
Common: 10, (Va, Ca, phospholipid), pro->thrombin, fibrinogen->fibrin, 8 helps

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14
Q

Anticlotting

A

antithrombin III - inhib 9-12 with heparin
thrombin-thrombomodulin complex -> protein C+S plus inibs tPA inhibitors
plasmin - lyses fibrin and fibrinogenV

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15
Q

Vitamin K
Calcium and clotting

A

synth 2 7 9 10 protein C&S

Ca - from plt, thrombin and 8 activation

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16
Q

Heart cell depolarisation

A

0 - rapid depolarisation na influx
1 - rapid depolarisatin k efflux
2 - plateaux calcium influx
3 - final repolarisation K efflux (slow)
4 - RMP NaK ATPase, calcium sodium exchanger, calcium pump (out)

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17
Q

Pacemaker cell depolarisation

A

4 - (-60) slow Na and Ca influx
0 - (-40) fast Ca influx
3 - K efflux

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18
Q

Symp and para effect on pacemaker potential

A

Symp -> beta 1 -> inc cAMP -> increase calcium channels and faster depolarisation
Para -> muscarinic -> increased K channels, rapid repolarisation -> hyperpolarisation and decreased rate firing

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19
Q

Normal QRS axis

A

-30 -> +110

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20
Q

Phase 0 depolarisation on ECG

A

R wave

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21
Q

MI cellular abnormalities causing ECG changes

A
  1. seconds - rapid repolarisation of infracted cells due to accelerated K+ opening
  2. minutes - decreased RMP due to less intracellular K+
  3. 30m - delayed depolarisation
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22
Q

Cause arrhythmia risk post MI

A

30m - reentrant circuit
12h - increased automaticity
32-7d - reentrant circuit

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23
Q

ECG changes K and Ca

A

HyperK - peaked T, no P, increased QRS duration, sine waves
Hypo K - inc pr, t inversion, u waves
Hypo Ca - prolonged QT

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24
Q

Cardiac cycle

A
  1. atrial systole
  2. Isovolumetric contraction - closure AV
  3. Ventricular systole - open pulm then aortic
  4. Isovolumetric relaxation - AP close
  5. Late diastole - AV open, 70% LV filling
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25
Q

Rate of blood flow from aorta

A

aorta 4m/s
big art - 8m/s
small - 16m/s

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26
Q

Dicrotic notch

A

on aortic pressure wave - aortic valve closes

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27
Q

Jugular wave

A

a - atrial systole
c - ventricular systole
v - atrial filling against tricuspid

x - atrial filling
y - ventricular filling

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28
Q

murmur in VSD

A

systolic

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29
Q

Methods measure cardiac output

A

doppler
ficks - O2 consumption/A-V
indicator dilution method

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30
Q

Cardiac index

A

CO/BSA = 5/1.6 = 3.2

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31
Q

Causes incresae CO

A

700% exercise
30% eating
anxiety 100%

decreased on standing from sitting

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32
Q

Frank startlin

A

contractile force proportional to initial length fibre
CVP index resting fibre length
stroke volume index contractility

curve right - HF, acidosis, hypothermia
left - healthy, catecholamines, exercise, decreased afterload

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33
Q

Reynold value

A

likelihood turbulence
<2000 unlikely
>3000 likely

Calculate:
Densityxflowxlineardimension / VISCOSITY

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34
Q

Velocity of blood

A

high in aorta, low in capillaries due to increased area
velocity=flow/area

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35
Q

poiselle hagen

A

small increase radius, huge increase flow

36
Q

viscocity

A

decreases turbulence, increases resistance, blood in small vessels less viscous as RBC goes to centre\
high haematocrit -> increased resistance -> increased BP

37
Q

Compliance vs resistance vessels

A

resistance - small arteries, arterioles and pre capillary sphincters
compliance most - veins v compliant (50% circulating volume in veins)

38
Q

Pulse pressure

A

increases with age and excercise, decreases with hypovolaemia

39
Q

Medullary control BP

A

Low BP -> RVLM -> IML column -> symp activation and renin
High BP -> IX +X -> nucleus tractus solitaris -> glutanate to CVLM -> GABA to RVLM

40
Q

Bainbridge reflex

A

atrial stretch leads to vasodilation but increased HR
atrial receptors - A - systole, B - diastole

41
Q

Prostacyclin and thromboxane A2
aspirin effect

A

both from arachidonic acid made via cox pathway
Prostacyclin from endothelium - vasodilation and inhibs plt aggregation
Thromboxane from plt - aggregation and vasoconstriction
aspirin - inhibits cox, longer lasting plt effect as half life plt 4 days

42
Q

Endothelin

A

vasoconstrictor from endothelial layer
ET I & II
Upregulated by gene transcription
upregulated by ATII, catecholamines, hypoxia
down by NO, ANP, PGE2, prostacyclin

43
Q

Kinins

A

vasodilatory peptides - kallidin and bradykinin
Plasma derived

44
Q

CO and O2 consumption by organ

A

CO - 30 liver, 23 kidney (most per 100g), 15 brain and skeletal, 5 heart
O2 consumption - 20 skeletal brain and liver, 10 heart, 7 kidney

45
Q

CSF

A

500ml/d, 150ml at 1 time
50-70 made choroid, rest vessels
compared to plasma - less K, 2/3 glucose, way less protein, more CO2

46
Q

Energy source brain

A

glucose via glut 1 transporter (90% energy requirement)

47
Q

Blood to heart impeded during systole

A

Subendocardial LV

48
Q

O2 to coronaries

A

80% extracted at rest
Perfusion limited
increased 200-300% by asphyxia, hypoxia and cyanide
inc by adenosine, k, lactate etc

49
Q

Fetal circulation

A

umbilical vein -> ductus venosus bypass liver –> RA then throgh foramen ovale –> to aorta
Some from RA goes to pulm art then ductus arterosum to aorta

Ovale closes at birth pressure, arteriosum functionally 2-3h, properly 2-3d

umbilical vein becomes ligamentum teres

50
Q

Volume liver blood supply

A

1300 from portal 500 from hepatic

51
Q

Causes capillary outflow

A

Increased hydrostatic pressure in cap
reduced cap colloid osmotic pressure

52
Q

Serum

A

Plasma without fibrinogen

53
Q

Heart energy source

A

60% fat, 35% carbs, 5% ketones and AA
inc glucose the uses more lactate and pyruvate
starvation uses more fat + FFA

54
Q

Increased ANP renal sequalae

A

inc GFR, dec Na resorption, dec renin

55
Q

Cardiac refractory period

A

absolute (stops tetany) during plateau (2)
relative (shorter) during repolarisation (3)

56
Q

Location carotid sinus baroreceptor

A

adventitia

57
Q

Myocardial O2 consymption

A

2ml/100g/m not beating, 9 beating
90 going fast

58
Q

Stroke work LV vs RV

A

x7

59
Q

U wave

A

repolarisation purkinje and papillary muscles

60
Q

Mobitz I vs II

A

I extends then drops
II random drop

61
Q

Location blood in circulation

A

54% venous system
18% pulmonary
12% heart
11% arterial
5% capillaries

62
Q

EDV and SV

A

EDV 130
SV70-90

63
Q

Capillary pressure mmHg

A

MAP
arterial 32
venous 15
Pulse pressure 5 and 0

64
Q

Decrease in BP per cm above heart

A

x0.77

65
Q

CVP value

A

8-12mmHg

66
Q

Heart rate / vagal/ symp

A

resting 70 vagal>symp
unopposed symp 150-180
denervated 100

67
Q

Baroreceptor range

A

50-200
more sensitive to pulse pressure

68
Q

Poiselle equation

A

(8lengthviscocity)/(pie*r^4)

69
Q

Blood volume

A

8% of body weight
55% plasma
goes through circulation x1 / minte

70
Q

Refractory period and systole/diastole HR 75 vs 200

A

absolute 0.2 0.13
relative 0.05 0.02
systole 0.27 0.16
diastole 0.53 0.14

71
Q

Blood type determined by

A

red cell agglutinogens

72
Q

Cells with longest action potential in heart

A

ventricular

73
Q

O2 carrying capacity of blood inc by hb

A

X70

74
Q

%blood per vessel type

A

54% veins
18 pulmonary
12 heart
8 arteries
2 aorta
5 capillaries

75
Q

%blood per vessel type

A

54% veins
18 pulmonary
12 heart
8 arteries
2 aorta
5 capillaries

76
Q

%blood per vessel type

A

54% veins
18 pulmonary
12 heart
8 arteries
2 aorta
5 capillaries

77
Q

% body weight interstitial fluid

A

15%

78
Q

Most rapid conduction fibres in heart

A

Purkinje (4m/s)

Bundle his, atria, vents only 1m/s
SA and AV nodes 0.05

79
Q

Diastolic pressure left ventricle

A

4-12

80
Q

Right atrial pressure

A

2-6
(Similar to right vent end diastolic pressure)

81
Q

Amount of blood filtered /d through capillaries

A

24L

82
Q

Interstitial fluid% total body weight

A

15

83
Q

Thebesian veins

A

Smallest cardiac veins
Blood from myocardium to LV

84
Q

Pressure to open pulmonary valve

A

8-10

85
Q

Left ventricular pressure to open aortic valve

A

80

86
Q

Time from sa to av node

A

0.1 s

87
Q

Inspiration causes cardiac changes

A

Decreased systemic art pressure
Negative intrathoracic pressure
Inc LV preload and CO
Inc HR

Part 1 Physiology (10 decks)

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