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Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the pericardium?

A

Membrane that surrounds and protects the heart

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2
Q

What are the two parts (layers) of the pericardium?

A

Fibrous pericardium

Serous pericardium

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3
Q

What is the inner visceral layer of the serous pericardium also called?

A

Epicardium

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4
Q

Normally how much pericardial fluid is in the pericardial cavity?

A

15-50ml

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5
Q

What is the function of the pericardial fluid?

A

Reduces friction between the two layers of serous pericardium as the heart moves

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6
Q

What are the three layers of the heart wall?

A

Epicardium
Myocardium
Endocardium

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7
Q

What is the myocardium?

A

A thick, helical middle layer of the heart wall composed of cardiac muscle

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8
Q

What is the endocardium?

A

The thin internal layer of the heart wall made of endothelium and sub endothelial connective tissue, or a lining membrane that covers the valves

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9
Q

What is the auricle of the heart?

A

A wrinkled pouch like structure on the anterior surface of the atria

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10
Q

What is the purpose of the auricles of the heart?

A

Each one slightly increases the capacity of its atrium so it can hold a larger volume of blood

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11
Q

What are sulci and what do they contain?

A

They are grooves on the surface of the heart that contain coronary blood vessels and a variable amount of fat

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12
Q

What does each sulcus mark?

A

The external boundary between two chambers of the heart

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13
Q

What does the deep coronary sulcus mark?

A

It encircles the heart and marks the external boundary between the superior atria and inferior ventricles

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14
Q

What marks the external boundary of the ventricles on the heart?

A

Anteriorly - the anterior interventricular sulcus

Posteriorly - the posterior interventricular sulcus

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15
Q

From what 3 blood vessels does the right atrium receive blood?

A

Superior vena cava
Inferior vena cava
Coronary sinus

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16
Q

What is a prominent feature in the interatrial septum, and what is it a remnant of?

A

Fossa ovalis - remnant of foramen oval

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17
Q

Where is the sinoatrial node located?

A

Right atrium, where the SVC joins the atrial tissue mass

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18
Q

What causes activation of the pacemaker of the heart without external activation?

A

The SA node has an unstable resting potential and is repeatedly depolarising to the threshold spontaneously

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19
Q

What structures conduct the impulse generated by the SA node across the left and right atrium?

A

Internodal tracts and Bachmanns bundle

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20
Q

What are the three internal tracts that transmit impulses across the atria?

A

Anterior
Wenkebach
Thorel’s

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21
Q

The heart is supplied by autonomic fibres from where?

A

The cardiac plexus

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22
Q

Where is the deep cardiac plexus located?

A

On the anterior surface of the bifurcation of the trachea

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23
Q

Where does the superficial cardiac plexus lie?

A

On the arch of the aorta

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24
Q

Is the cardiac plexus sympathetic or para-sympathetic?

A

Both

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25
Q

What fibres make up the parasympathetic nervous supply of the heart?

A

Presynaptic fibres of the vagus nerve

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26
Q

Name three effects of sympathetic stimulation to the heart.

A

Increased heart rate
Increased impulse conduction
Increased force of contraction

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27
Q

Name three effects of parasympathetic stimulation to the heart.

A

Slowed heart rate
Reduced force of contraction
Constrict coronary arteries

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28
Q

What do postsynaptic parasympathetic fibres release and what does it bind to?

A

Acetylcholine - muscarinic receptors

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29
Q

When fluid is pumped through a closed system, what two factors determine its flow?

A

Pressure and resistance

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30
Q

According to Darcy’s Law, what is mean arterial blood pressure equal to?

A

Cardiac output multiplied by total peripheral resistance

MABP = CO x TPR

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31
Q

What is laminar flow?

A

Also known as streamline flow, occurs when a fluid flows in parallel layers, with no disruption between layers

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32
Q

What are the primary areas in the cardiovascular system responsible for resistance to blood flow?

A

Mainly arterioles

To a lesser extent, capillaries and venules too

33
Q

Where is the steepest fall in blood pressure?

A

Arterioles

34
Q

What is elastance?

A

Quality of recoiling or returning to an original form after removal of pressure.
Way to describe the elastic properties of a blood vessel

35
Q

What is compliance? (in relation to vessels)

A

Ability of a vessel to distend and increase volume with increasing transmural pressure

36
Q

Which part of the cardiovascular system has the highest compliance?

A

veins and venules

37
Q

What percentage of total blood volume is normally in the veins and venules?

A

70%

38
Q

What is the difference in compliance between arteries and veins?

A

Veins are about 20 times more compliant than arteries

39
Q

In blood vessels, what is the transmural pressure equal to?

A

Pressure inside the vessel minus the interstitial pressure

40
Q

What does the Law of Laplace state about vessels?

A

The total circumferential wall tension at equilibrium is counterbalanced by the total pressure in the lumen.
i.e. the tension in the wall of a blood vessel depends on the radius, thickness of the wall and the transmural pressure

41
Q

What does the elastic recoil of the aorta do to the blood flow?

A

It converts what would be intermittent flow into a continuous, albeit pulsatile, flow through the arterial system

42
Q

What are Windkessel vessels?

A

Aorta and large elastic vessels

43
Q

What is pulse pressure?

A

The difference between systolic and diastolic pressure

44
Q

What is the mean arterial blood pressure?

A

Pressure averaged over the whole cardiac cycle

45
Q

In terms of percentage, how much time does the heart spend in diastole?

A

60%

46
Q

What is the mean arterial blood pressure roughly equal to?

A

Diastolic pressure, plus one third of the pulse pressure

47
Q

What are Korotkoff sounds?

A

Varying sounds heard with a stethoscope she measuring blood pressure

48
Q

What measures mean arterial blood pressure and where are they located?

A

Arterial baroreceptors

Located in the wall of the aortic arch and in the carotid sinus

49
Q

What is the carotid sinus?

A

An enlarged part of the internal carotid artery just after it rises from the common carotid artery

50
Q

What do atrial stretch receptors measure?

A

Atrial blood volume

51
Q

A rise in levels of which ion causes contraction of the heart muscle?

A

Calcium

52
Q

What category of factors alter the contractility of cardiac muscle?
And name one.

A

Inotropic factors

Noradrenaline

53
Q

What type of agents affect atrioventricular conduction?

A

Dromotropic agents

54
Q

How do chronotropic agents affect heart rate?

A

By affecting nerves controlling the heart or changing the rhythm produced by the SA node

55
Q

In a heart beat, what is the absolute refractory period?

A

A period immediately following the firing of a nerve fibre when it cannot be stimulated no matter how great a stimulus applied

56
Q

What is the relative refractory period?

A

The period shortly after the firing of a nerve fibre when partial depolarisation has occurred and a greater than normal stimulus can stimulate a second response

57
Q

What is first-degree (incomplete) heart block?

A

Abnormally slow conduction in the AV node, where delay is greater than normal

58
Q

How does first-degree heart block appear on an ECG?

A

An extended PR interval

59
Q

What happens to the impulses in second-degree heart block?

A

A fraction of the impulses from the atria are conducted to the ventricles

60
Q

How is second-degree heart block Mobitz type II seen on an ECG?

A

Ventricular contraction is only initiated every second (2:1) or third (3:1) atrial contraction

61
Q

What is seen on an ECG in Wenkebach block (second-degree heart block Mobitz I)?

A

The PR interval progressively lengthens until there is no transmission from atria to ventricles and a QRS complex is missed. The cycle then begins again

62
Q

What happens in third-degree heart block?

A

Conduction between atria and ventricles is abolished

63
Q

What can cause third-degree heart block?

A

Ischaemic damage to nodal tissue or the bundle of His

64
Q

What does third-degree heart block: AVN escape look like on ECG?

A

Complete dissociation between P wave and QRS complex. Narrow QRS (<0.12s), about 40bpm

65
Q

What does third-degree heart block: ventricular escape look like on ECG?

A

Complete dissociation between P wave and QRS complex. Wide QRS (>0.12s). Heart rate usually down to less than 20bpm

66
Q

What does bundle branch block look like on ECG?

A

Wide QRS complex, usually with a bit of a M or W shape, showing that activation is delayed from one side to the other

67
Q

What does the Frank-Starling law of the heart state?

A

That stroke volume of the heart increases in response to an increase in the volume of blood filling the heart, when all other factors remain constant

68
Q

What is an important consequence of Starlings law of the heart, in regards to stroke volume?

A

That stroke volume between the left and right ventricles are matched

69
Q

Which law is Darcy’s law analogous to?

A

Ohm’s law

70
Q

Which vessels are capacitance vessels and why?

A

Veins, because they can serve as blood volume reservoirs

71
Q

What binds to beta1-receptors?

A

The catecholamines - noradrenaline and adrenaline

72
Q

What does activation of cardiac beta1-receptors result in?

A

Positive inotropic effect = increases contractility

Positive chronotropic effect = increases heart rate

73
Q

What can cause aortic stenosis?

A

Calcified valves
Congenital bicuspid valve
Rheumatic fever

74
Q

What is the typical history of aortic stenosis?

A

Syncope
Angina
Dyspnoea

75
Q

What is the character of the pulse like in aortic stenosis?

A

Slow rising, narrow pulse pressure

76
Q

What is the management for aortic stenosis?

A

Aortic valve replacement
Balloon Valvuloplasty
Medical flow up - for mild-moderate

77
Q

What is a TAVI?

A

Transcutaneous Aortic Valve Implantation

78
Q

What is infective endocarditis?

A

Infection of endocardium or vascular endothelium

79
Q

What are some signs of infective endocarditis?

A

Sepsis
May have valve regurgitation
New heart murmur
Janeway lesions

Medicine (19 decks)

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