Cardiology

Question 1

Describe the Cardiac Cycle

Answer 1

Diastole (Relaxation of the Heart) is the first phase. This is when ventricular filling begins.

Systole is the 2nd phase first with the Atria contracting which causes the blood in the atria to finish filling the ventricles (atrial kick). The ventricles then contract pushing blood through the pulmonary and aortic valves.

Question 2

What is the Ejection Fraction?

Answer 2

The ratio of the amount of blood pumped out of the ventricles in a contraction. Typically about 2/3rds the total volume.

Question 3

What is stroke volume?

Answer 3

The amount of blood ejected. Normally it is between 60-100ml’s. Avg. is 70ml

Question 4

What does stroke volume depend on?

Answer 4

Preload, Cardiac Contractility and Afterload.

Question 5

Describe Preload

Answer 5

The pressure in the filled ventricle at the end of diastole. It is also called End-Diastolic Volume.

It influences the force and amount of the next contraction.

Question 6

Starling’s law of the Heart states what?

Answer 6

The more the myocardial muscle is stretched the greater its force of contraction will be.

Therefore, the greater the venous return, the greater the preload (filling/stretching of the muscle) and the greater the stroke volume.

Question 7

What landmark denotes the 2nd rib and superior border of the middle mediastinum?

Answer 7

The Sternal Angle

Question 8

Explain the pericardium and its layers.

Answer 8

It is a sac that surrounds the heart. The Fibrous pericardium attaches to the sternum and surrounding structures and protects the heart. It is VERY strong and is why then the pericardial cavity gets fluid in it a Cardiac Tamponade can result.

The Serous layer of the pericardium has a Visceral layer and a Parietal layer. The Visceral layer is the same layer as the epicardium and lies on the hearts outer surface. The Parietal later is the layer ontop of the Visceral Pericardium.

The pericardium contains a pericardial cavity which a lipid based solution resides that allows the heart to beat without friction.

Question 9

Explain the complete flow of blood through the heart.

Answer 9

Blood enters the R. Atrium from the Superior and Inferior Vena Cava as well as the Coronary Sinus. Blood passes through the Tricuspid or Right Atrioventricular valve to the R. Ventricle where it is pumped through the Pulmonary Valve to the Pulmonary Trunk then to the Right and Left lung via the Pulmonary Arteries. The blood flows back to the Left Atrium from the Right and Left Pulmonary Veins. The blood flows through the Mitral or Left Atrioventricular Valve to the Left Ventricle where it is pumped through the Aortic Valve to the Ascending Aorta.

Question 10

Where do the coronary arteries originate? When do they fill?

Answer 10

They originate in the Aorta just after the Aortic Valve. They fill during Diastole.

Question 11

Which nerve controls Parasympathetic Responses in the heart?

Answer 11

The Vagus (10th) Cranial nerve.

Question 12

Trace the normal cardiac conduction system pathways.

Answer 12

SA Node, Internodal Pathways to AV Node, AV Node to the AV Bundle (of His) to the Left and Right Bundle Branches.

Question 13

What are the Inherent Rates for the SA Node, AV Junction and the Purkinje Fibers in the Ventricles?

Answer 13

SA Node 60-100 bpm
AV Junction 40-60 bpm
Ventricle 20-40 bpm

Question 14

What is the “Primary Pacemaker” for the heart? What is it’s rate and how much of it is actual pacemaker cells?

Answer 14

Sinoatrial Node
Rate 60-100
50% Actual Pacemaker Cells

Question 15

Where does the electrical Impluse travel after the SA Node?

Answer 15

Through the Internodal Pathways to the AV Node and AV Junction.

Question 16

What is Bachmann’s Bundle? Why is it important?

Answer 16

Also known as Wenckebach’s bundle and Thorel’s pathway.
A group of interatrial fibers contained in the left atrium
Subdivision of anterior internodal tract.
Conducts electrical activity from the SA node to the left atrium.

Question 17

Describe the AV Node. Why is it important?

Answer 17

Located on floor of right atrium above tricuspid valve.
Electrical activity delayed 0.05 seconds, this pause allows for more complete filling of ventricles.
Only pathway of atrial electrical impulses to ventricles.

Question 18

Where is the “Secondary Pacemaker” Located?

Answer 18

AV junction

Question 19

Describe the Bundle of His

Answer 19

Conduction pathway that leads out of AV node.
Receives blood from left anterior and posterior descending coronary arteries.
Lies at top of interventricular septum.
Referred to as the common bundle.
Ability to self-initiate electrical activity at intrinsic firing rate of 40-60 bpm.
Connection between upper and lower chambers of the heart.
Divides into two main bundle branches

Question 20

What comes after the Bundle of His?

Answer 20

Right bundle branch, Left bundle branch

Conducts electrical activity from bundle of His to Purkinje’s network

Question 21

Describe the Purkinje’s Network

Answer 21

Fibers that spread throughout the ventricles
Carries impulses directly to ventricular muscle cells
Intrinsic firing rate of 20-40 bpm

Question 22

Describe the “P Wave”

Answer 22

Is the first wave produced by electrical impulse from SA Node.
Smooth, rounded upward deflection.
Represents Atrial Depolarization
0.10 seconds in length.

Question 23

Describe the PR Interval

Answer 23

PRI” represents the time the impulse takes to travel from SA Node through the Internodal pathways in the atria towards the ventricles.
The measuring starts from the beginning of the “P” wave to the start of the QRS
Length is 0.12-0.20 seconds

Question 24

Describe the QRS Complex

Answer 24

Consists of the Q, R, and S waves.
Represents the Ventricular Depolarization and Atrial Repolarization
Measures less than 0.12 seconds or 3 small boxes
“Q” Wave is the first downward deflection
“R” wave is the first upward deflection.
Largest deflection seen in Leads I and II
“S” wave is the first downward deflection after the “R” wave.

Question 25

Describe the “T” Wave. Why is it important?

Answer 25

Follows ST Segment
Represents Ventricular Repolarization
Slightly rounded, positive deflection.
Resting phase of cardiac cycle. (Most vulnerable phase of the cycle)

Question 26

What are the 3 ways of determining Heart rates and how does each one work? Which can be used with irregular rhythms? Which is the most accurate?

Answer 26

6 second: Determine a 6 second section (30 large boxes, or use the tick marks on the top of the paper) of the rhythm strip and count the number of “QRS” complexes, multiple by 10. (6 seconds x 10 = 60 seconds)
Can be used to approximate heart rates with irregular rhythms.

R-R: Very quick, but not as accurate for fast rhythms
Rhythm MUST be regular
Count the number of large boxes between R waves, divide by 300. (300 large boxes = 60 seconds)
You can memorize the following:
1 large box = HR of 300
2 large boxes = HR of 150
3 large boxes = HR of 100
4 large boxes = HR of 75
5 large boxes = HR of 60
6 large boxes = HR of 50

1,500: Similar to the 300 method. 1,500 is the most accurate method. Count the number of small boxes between “R” waves and divide 1500 by that number. (1500 small boxes equals 60 seconds)
Works for Regular Rhythms