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Cardiac - Vascular > Cardiac review > Flashcards

Cardiac review Flashcards

1
Q

Anatomy of the heart

atriums, ventricles, valves, coronaries

A

R and L atrium and ventricles

Tricuspid valve, pulmonic valve, mitral valve, aortic valve

Right coronary artery: Posterior descending artery and Right marginal artery (80%)

Left coronary artery: LAD, L circumflex

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2
Q

Right atrium anatomy:

where is blood coming from: systemic veins

what are the two protective valves

A

right atrium

systemic veins: superior vena cava and inferior vena cava

protective valves: Eustachian valve: protects the IVC and Thesibian valve: protects the coronary sinus

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3
Q

Right ventricle

what valve protect the pulmonary artery

A

Right ventricle

infundibulum (Conus arteriosus)

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4
Q

Left Atrium Anatomy

what type of reservior is it

size and position compared to R.A.

where does it receive blood from

A

left atrium

reservior of oxygenated blood

Size: larger than R.A.

sits superior and posterior to other chambers

receives blood from pulmonary veins

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5
Q

left ventricle

where does it receive blood from

compesition of LV

A

left ventricle

receives blood from LA

upper 1/3 is smooth muscle

lower 2/3 is muscular

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6
Q

discuss the sizing of the AV valves and when they become sympomatic

A

tricuspid: 7cm | < 1.5cm

Pulmonic: 4cm | <1/3 size

Mitral: 4 - 6cm | <1/3 size

Aortic: 1 - 3cm | <1/3 size

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7
Q

how many leaflets does the aortic and pulmonic valve have

what is the sinus of valsalva

A

aoritc and pulmonic have 3 leaflets

sinus of valsalva: area of enlargement for leaflets of aorta to not occlude coronary sinus

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8
Q

where does coronary sinus flow start

A

at the sinus of valsalva

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9
Q

which leads look at the left coronary artery

which leads look at the right coronary artery

A

left coronary artery: V-V5

right coronoary artery II, III, aVf

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10
Q

what is the percentage of coronary dominance in people

A

50% are right coronary dominant

20% are left coronary dominant

30% are mixed between right and left

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11
Q

Coronary physiology

how much blood flow to the coronaries per min

how is flow determined

when does flow go to the LCA, RCA

when is myocardial oxygen consuption the highest

A

5% or 250ml/min

flow is determined by diastolic pressure - LVEDP

LCA is fed during diastole. RCA is fed during systole

myocardial oxygenation is highest when mixed venous sat is lowest at 30%

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12
Q

tell me about coronary autogulation

changes are dependent on what

greatest dilation occurs where

LCA vs RCA

A

autoregulation occurs between 50-120mmhg

changes are dependent on pressure

greatest dialtion occurs at the small vessels

LCA>RCA in autoregulation

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13
Q

what is the pathway of the conduction system

A

SA node, internodal tracts, AV node, bundle of his, purkinje fibers

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14
Q

SA node

what type of cells are located here (2)

A

SA node

P cells- pacemaker cells

transitional or intermediate cells - conduct impuleses within and away from the node

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15
Q

what are the pathways of internodal tracts (3)

A

anterior = buckmanns bundle

middle = Wenkebach

posterior = Thorels tract

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16
Q

how does the AV node compare to the SA node

A

smaller cells

resting membrane is lower at -60 vs -50

Rate is 50 bpm

fewer Gap junctions

more resistant to action potentials

17
Q

where does the purkinje system spread?

A
  1. spreads under the endocardium 2. throughout the papillary muscles
18
Q

Action potential of the heart

At rest, what is the action potential dependent and permiable to ?

A

at rest, heart is most dependent and permeable to potassium

19
Q

Discuss the 5 phases of the actional potential to the heart

A

phase 0- depolarization, fast Na channels

phase 1 : repolarization - Na channels close and permiable to Cl-

phase 2: plateau phase: slow Ca channels open

phase 3: termination of repolarization: efflux of K

phase 4: diastolic phase: Na+ and K+ channels

20
Q

ventricle fires at what mV conductance

A

-90 mv

21
Q

when is absolute and relative refactory periods

A

absolute: phase 0 - middle phase III
relative: middle phase III to phase IV

22
Q

discuss the sympathetic pathway of the cardiac conduction system

what occurs at the synaptic nerves

A
  1. cervical caudal fibers and stellate ganglion
  2. right dorsal median and lateral cardaic nerves
  3. merge in LCA
  4. branch into LAD and LCx

Ach released and interacts with postsynaptic nicotinic receptors which stimulate B1 receptors

23
Q

parasympathetic fibers of the heart

what is the pathway

what happens the receptor

A
  1. arises from medulla at (dorsal vagal nucleus) and (nucleus ambiguious)
  2. RLN to TVN
  3. R and L cardiac nerves and left lateral cardiac nerves

postsynaptic interaction stimulate nictonic receptors and then muscarnic receptors

24
Q

where are vagal receptors and sympathetic receptors in the heart

A

vagal receptors: all over. in R and L atrium. R and L ventricles. but most present in the RA

sympathetic fibers: all throughout the heart. RA contains 75% of B1 and Ventricles contain 85% of B1

25
Q

when does the cardiac cycle start

A

starts with the filling of the R and L atria

26
Q

discuss diastole

isovolumetric relaxation

ventricular filling

A

isovolumetric relaxation: blood is filling the atriums. aortic valve is closed. ventricular pressure for .04 seconds is higher than atrium

ventricular filling: AV valves open and bloood starts to fill the ventricles and pressure in the ventricles begins to rise

27
Q

discuss systole

isovolumetric contraction

ventriuclar action

A

isovolumetric contraction: AV valves close signalling the end of diastole. pressure rising within the ventricles before semilunar vlaves open

ventricular action: atrial pressure decreases, ejection of blood through aorta and pulmonary artery

28
Q

discuss the cardiac cycle

A

B: (mitral valve open) graph going to the right, volume increase

C: (mitral valve closed) graph now going up, pressure increase

D: aortic valve closes, graph going to left, ejection and emptying of blood

A: aortic valve closes, pressure decreases

29
Q

what influences stroke volume

A

preload

afterload

contractility

HR

ventricular compliance

30
Q

discuss the Frank Starling curve

A
31
Q

law of laplace

A

wall tension = radius X pressure/ 2x wall thickness

32
Q

discuss CAD and the goals for

preload, afterload, HR, contractility, rhythm

A

CAD is a supply/demand issue

supply: get more blood to the coronaries. increase diastolic time, decrease HR, mantain CPP (DP - LVEDP), maintain tone

Demand: decrease HR, decrease volume overload(myocardial stretching), decrease contractility,

preload: keep full, not too much that it increases wall tension
afterload: mantain high afterload for CPP, specifically for DP

HR: low to allow for filling and decrease demand

contractility: minimal to decrease demand
ryhtm: sinus

33
Q

discuss aortic stenosis and goals

what type of murmer

preload, afterload, HR, contractility, rhythm

what are the two key points

flow loop picture

A

narrowing of aortic opening. normal is 1-3 cm. evident at .8cm or <1/3 size.

leads to concentric hypertrophy, increased wall tension, and decreased ventricular compliance. systolic murmer

SAD: syncopy, angina, dyspnea

preload: full and maintain
afterload: maintain and high for CPP
contractility: maintain

HR: maintain, not too slow to decrease CO, but too fast blood will begin to back up

key points: diastolic time, and perfusion pressure

skinny and stright up to overcome the pressure

34
Q

pts with aortic stenosis are sensitive to what

A

volume depletion, they depend on the “atrial kick” for adequate filling pressures

PCWP underestimates the LVEDP

35
Q

Aortic Insufficiency

discuss patho

goals: preload, afterload, contractility, HR, rhythm

whats important

what does the flow loop look like

A

dilation of arotic root, backload leading to overload, increase wall stress, Eccentric hypertrophy, diastolic murmur

preload: maintain, full
afterload: decrease. want blood moving forward
contractility: adequate, HR: increased, mild tachycardia, rhythm: sinus

increase preload and decreased afterload

to the right and shorter

36
Q

Mitral stenosis

discuss patho

preload, afterload, contractility, HR, rhythm

GOALS

A

LV not affected. LA enlargement leading to Afib and DOE, fluid backing up leads to CHF and pulm edema.

diastolic murmur

preload: low normal afterload: decreased, contractility: increased and needed for the LA and RV, rate: decreaesd needing time for filling, rhythm: may be in Afib

slower HR

37
Q

mitral regurgitation

discuss patho, murmur

preload, afterload, contractility, HR, rhthym

whats the KEY

A

systolic murmur, backflow of blood during diastole, back flow into lung and RV

preload: normal afterload: decreased. Contractility: we want increased. Rate: faster normal rhyrthm: nomral

key is reduced afterload. keep blood moving forward

38
Q
A

Cardiac - Vascular (3 decks)

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