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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
Rate of blood flow from aorta
aorta 4m/s big art - 8m/s small - 16m/s
26
Dicrotic notch
on aortic pressure wave - aortic valve closes
27
Jugular wave
a - atrial systole c - ventricular systole v - atrial filling against tricuspid x - atrial filling y - ventricular filling
28
murmur in VSD
systolic
29
Methods measure cardiac output
doppler ficks - O2 consumption/A-V indicator dilution method
30
Cardiac index
CO/BSA = 5/1.6 = 3.2
31
Causes incresae CO
700% exercise 30% eating anxiety 100% decreased on standing from sitting
32
Frank startlin
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
33
Reynold value
likelihood turbulence <2000 unlikely >3000 likely Calculate: Densityxflowxlineardimension / VISCOSITY
34
Velocity of blood
high in aorta, low in capillaries due to increased area velocity=flow/area
35
poiselle hagen
small increase radius, huge increase flow
36
viscocity
decreases turbulence, increases resistance, blood in small vessels less viscous as RBC goes to centre\ high haematocrit -> increased resistance -> increased BP
37
Compliance vs resistance vessels
resistance - small arteries, arterioles and pre capillary sphincters compliance most - veins v compliant (50% circulating volume in veins)
38
Pulse pressure
increases with age and excercise, decreases with hypovolaemia
39
Medullary control BP
Low BP -> RVLM -> IML column -> symp activation and renin High BP -> IX +X -> nucleus tractus solitaris -> glutanate to CVLM -> GABA to RVLM
40
Bainbridge reflex
atrial stretch leads to vasodilation but increased HR atrial receptors - A - systole, B - diastole
41
Prostacyclin and thromboxane A2 aspirin effect
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
Endothelin
vasoconstrictor from endothelial layer ET I & II Upregulated by gene transcription upregulated by ATII, catecholamines, hypoxia down by NO, ANP, PGE2, prostacyclin
43
Kinins
vasodilatory peptides - kallidin and bradykinin Plasma derived
44
CO and O2 consumption by organ
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
CSF
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
Energy source brain
glucose via glut 1 transporter (90% energy requirement)
47
Blood to heart impeded during systole
Subendocardial LV
48
O2 to coronaries
80% extracted at rest Perfusion limited increased 200-300% by asphyxia, hypoxia and cyanide inc by adenosine, k, lactate etc
49
Fetal circulation
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
Volume liver blood supply
1300 from portal 500 from hepatic
51
Causes capillary outflow
Increased hydrostatic pressure in cap reduced cap colloid osmotic pressure
52
Serum
Plasma without fibrinogen
53
Heart energy source
60% fat, 35% carbs, 5% ketones and AA inc glucose the uses more lactate and pyruvate starvation uses more fat + FFA
54
Increased ANP renal sequalae
inc GFR, dec Na resorption, dec renin
55
Cardiac refractory period
absolute (stops tetany) during plateau (2) relative (shorter) during repolarisation (3)
56
Location carotid sinus baroreceptor
adventitia
57
Myocardial O2 consymption
2ml/100g/m not beating, 9 beating 90 going fast
58
Stroke work LV vs RV
x7
59
U wave
repolarisation purkinje and papillary muscles
60
Mobitz I vs II
I extends then drops II random drop
61
Location blood in circulation
54% venous system 18% pulmonary 12% heart 11% arterial 5% capillaries
62
EDV and SV
EDV 130 SV70-90
63
Capillary pressure mmHg
MAP arterial 32 venous 15 Pulse pressure 5 and 0
64
Decrease in BP per cm above heart
x0.77
65
CVP value
8-12mmHg
66
Heart rate / vagal/ symp
resting 70 vagal>symp unopposed symp 150-180 denervated 100
67
Baroreceptor range
50-200 more sensitive to pulse pressure
68
Poiselle equation
(8*length*viscocity)/(pie*r^4)
69
Blood volume
8% of body weight 55% plasma goes through circulation x1 / minte
70
Refractory period and systole/diastole HR 75 vs 200
absolute 0.2 0.13 relative 0.05 0.02 systole 0.27 0.16 diastole 0.53 0.14
71
Blood type determined by
red cell agglutinogens
72
Cells with longest action potential in heart
ventricular
73
O2 carrying capacity of blood inc by hb
X70
74
%blood per vessel type
54% veins 18 pulmonary 12 heart 8 arteries 2 aorta 5 capillaries
75
%blood per vessel type
54% veins 18 pulmonary 12 heart 8 arteries 2 aorta 5 capillaries
76
%blood per vessel type
54% veins 18 pulmonary 12 heart 8 arteries 2 aorta 5 capillaries
77
% body weight interstitial fluid
15%
78
Most rapid conduction fibres in heart
Purkinje (4m/s) Bundle his, atria, vents only 1m/s SA and AV nodes 0.05
79
Diastolic pressure left ventricle
4-12
80
Right atrial pressure
2-6 (Similar to right vent end diastolic pressure)
81
Amount of blood filtered /d through capillaries
24L
82
Interstitial fluid% total body weight
15
83
Thebesian veins
Smallest cardiac veins Blood from myocardium to LV
84
Pressure to open pulmonary valve
8-10
85
Left ventricular pressure to open aortic valve
80
86
Time from sa to av node
0.1 s
87
Inspiration causes cardiac changes
Decreased systemic art pressure Negative intrathoracic pressure Inc LV preload and CO Inc HR

Part 1 Physiology (10 decks)

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