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@MY Anesthesia!! > Cardiology > Flashcards

Cardiology Flashcards

1
Q

what three areas does RCA supply?

A

-RA -RV -LV (inferior wall)

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2
Q

85% of the time, which artery gives rise to PDA (posterior descending artery)

A

RCA

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3
Q

what does PDA (posterior descending artery) supply?

A

-superior interventricular septum -inferior wall

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4
Q

what EKG leads correspond to PDA ischemia?

A

-ii, iii, AVF (inferior leads) ST-Elevate -reciprocal changes lateral leads (i, AVL, V5/V6); ST depression

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5
Q

LMCA supplies what parts of heart?

A

-LA -LV (septal, anterior, lateral) walls -most interventricular septum

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6
Q

what parts of left ventricle NOT supplied by Left

A

-SUPERIOR interventricular septum -inferior wall of LV

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7
Q

SA node supplied 60% by which artery?

A

RCA

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8
Q

SA node supplied 40% by which artery?

A

LAD

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9
Q

AV node supplied by which two arteries?

A

-RCA -circumflex

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10
Q

RCA provides what percent to AV node

A

85-90%

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11
Q

which artery supplies only 10-15% of AV node?

A

circumflex

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12
Q

Bundle of His supplied by WHICH two arteries

A

PDA LAD

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13
Q

blood flow rate to heart is ____ mL/min?

A

250 mL/min

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14
Q

what is flow to heart per min per 100grams?

A

80mL/100g/min

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15
Q

what percent of CO does coronary flow take up?

A

5%

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16
Q

myocardium what percentage extraction of oxygen from blood?

A

65% (this is maximum extraction)

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17
Q

WHICH EKG LEAD MOST SENSITIVE FOR ISCHEMIA?

A

lead V - 75% lead II + V - 80%

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18
Q

lateral EKG leads

A

I, AvL, V5, V6

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19
Q

inferior EKG leads

A

II, III, AVF

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20
Q

septum leads

A

V1, V2

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21
Q

anterior leads

A

V3-V4

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22
Q

AVR lead?

A

???? supplied by?

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23
Q

what TEE view is most effective for diagnosing ischemia?

A

transgastric short axis view

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24
Q

which valve is bicuspid USUALLY

A

mitral

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25
Q

normal Aortic valve area?

A

2.5-4.5cm^2

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26
Q

chordae tendinae on which valve?

A

tethers MV to papillary muscles; if rupture muscles, can have acute failure

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27
Q

normal area of MV?

A

4-6cm^2

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28
Q

sympathetic input to heart from WHAT ganglia of brainstem?

A

stellate ganglion (to both SA/AV nodes & ventricular mm)

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29
Q

cardioaccelerators at what thoracic level?

A

T1-4

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30
Q

Vagal input to conduction system of heart from WHICH nucleus in medulla?

A

nucleus ambiguous

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31
Q

transplanted heart lacks ability to do WHAT things?

A

-NO BARO-RECEPTOR FUNCTION (norepi has beta and alpha agonist function, increases BP and HR initially, but baroreceptor reflex to decrease HR doesn’t work)

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32
Q

transplanted heart has NO what?

A

-no Vagal tone -no cardiac accelerators -no baroreceptor reflexes

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33
Q

changes in CARDIAC OUTPUT in transplanted heart happen by WHAT mechanism??

A

increase in STROKE volume

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34
Q

which sympathomimetic agents work on transplanted heart?

A

-amines 1) isoproterenol 2) epi 3) dopamine 4) dobutamine

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35
Q

cardiac cells attached together how?

A

attached by desmosomes

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36
Q

what makes striations in cardiac cells?

A

from linearly organized sarcomeres

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37
Q

What transmits depolarization in cardiac cells?

A

T-tubules - transmit depolarization

38
Q

specialized Calcium reservoir in cardiac cells?

A

sarcoplasmic reticulum

39
Q

what cell junction helps heart function as syncytium?

A

gap junctions

40
Q

Cardiac MYOCYTE AP maintains plateau phase how?

A

inward Ca current (against concurrent K efflux); prolongs refractory period to allow mechanical contraction

41
Q

Phase 0 of Cardiac MYOCYTE Action potential is known as WHAT phase?

A

-depolarization

42
Q

Phase 0 of Cardiac MYOCYTE Action potential membrane potential change

A

-90 to above 0

43
Q

Phase 0 of Cardiac MYOCYTE Action potential from WHAT ion movement?

A

-Na entrance thru fast VOLT-gated channels

44
Q

Phase 1 of Cardiac MYOCYTE Action potential; what happens at BEGINNING?

A

-Sodium channels close -POTASSIUM CHANNELS [delayed rectifier channels] open to efflux

45
Q

Phase 2 of Cardiac MYOCYTE Action potential also known as?

A

plateau phase

46
Q

Phase 2 of Cardiac MYOCYTE Action potential; PLATEAU phase from WHAT type of channels?

A

L-type Ca channels

47
Q

how much TIME between phase 0 and phase 4?

A

200ms

48
Q

Phase 3 Cardiac MYOCYTE Action potential; WHAT CHANNELS CLOSE/OPEN?

A

-CLOSE: Ca -OPEN: K+ delayed rectifier

49
Q

what helps trigger AP of phase 0 in myocyte?

A

inward Ca from phase 2/plateau phase

50
Q

PACEMAKER cells (conducting cells) resting state at what mV?

A

-60mV

51
Q

Phase 0 in PACEMAKER cells (conducting cells) is caused by WHAT ion?

A

Ca

52
Q

what TYPE of CHANNELS (of ion) causes phase 0 in PACEMAKER cells (conducting cells); WHICH is primary?

A

-T-type Ca -L-type Ca** **PRIMARY, open after T-type (t-type causes slow gradual upslope of phase 4)

53
Q

what ion creates automaticity of PACEMAKER cells (conducting cells)

A

Na

54
Q

via WHAT CHANNELs does __(ion)__ provide automaticity

A

-LEAKY (i-funny) -Na channels

55
Q

what phase(s) does PACEMAKER cells (conducting cells) NOT HAVE?

A

NO phase 1 NO phase 2

56
Q

in PACEMAKER cells (conducting cells); what ion/channel provides phase 0 to phase 3 change?

A

iK (potassium channels)

57
Q

nodal action potentials spread via WHAT means?

A

gap junctions in myocytes

58
Q

when electrical vector of depol in direction of lead, get WHAT?

A

Positive deflection

59
Q

P-R interval represents?

A

AV nodal delay (if any)

60
Q

normal PR interval?

A

.12-.20 sec

61
Q

normal QT?

A

.36-.44 sec

62
Q

thick filament?

A

myosin (head groups that bind ATP)

63
Q

thin filament

A

actin (monomers together)

64
Q

regulatory proteins of myocyte sarcomere?

A

troponin and tropomyosin?

65
Q

LONG filament that sits over actin binding sites

A

(LONG name, LONG filament) tropomyosin

66
Q

what pulls tropomyosin out of the way? and how?

A

-troponin -CALCIUM binds it to allow initiation of contractile cycle

67
Q

when powerstroke, what released?

A

ADP released

68
Q

entrance of Calcium into myocytes triggers opening of WHAT other receptors?

A

RYANODINE receptors

69
Q

where are Rya receptors?

A

on surface of sarcoplasmic reticulum

70
Q

what to the Rya receptors do?

A

lflood out ca into cytoplasm (Ca-triggered-ca-release)….Ca then binds troponin

71
Q

in order to STOP contraction cycle, how does cell get rid of Ca from cytoplasm? (2 mechanisms)

A

**SERCA pump reaccumulates Ca in Sarco retic *Na/Ca exchanger pumps Ca out of cell (3Na in, 1Ca out)

72
Q

what is phospholamban (PLN)?

A

tonic inhibitor of SERCA pump; when phosphorylated, SERCA can work

73
Q

WHAT is lusitropy? HOW is lusitropy related to Phospholamban and SERCA?

A

LUSITROPY = ability to relax –>phosphorylation of phospholamban allows SERCA to work, which HELPS relaxation more rapidly

74
Q

which part of brain maintains tight BP control?

A

-MEDULLA

75
Q

where does medulla receive input from?

A

-higher cortical centers -peripheral afferents from chemo and baroreceptors

76
Q

types of receptors ON the heart? -what neurotrans for each?

A

Beta1 (NE) Beta2 (NE) ——— M2 (Ach)

77
Q

chronotropy?

A

HR

78
Q

inotropy

A

force of contraction

79
Q

dromotropy

A

velocity of conduction of A.P.

80
Q

beta receptors are WHAT kind of receptors?

A

G-protein coupled

81
Q

G-prot receptor mediation from Sympathetic nerve input changes

A

aden cyclase–>cAMP–>protein kinases PK’s, increases the funny channels and T-type polarization

82
Q

how much increase in ventricular filling from Atrial kick?

A

20-30% increase

83
Q

usual process of Ventricular filling is done how? based on what pressure?

A

PASSIVELY; based on pressure decrease from ventricle relaxing goes BELOW atrial pressure

84
Q

describe what’s happening at each wave part

A
85
Q

what happens during “a” part of atrial pressure wave?

A

a - the end of Atrial contraction

86
Q

what happens during “c” part of atrial pressure wave?

A

c - RV Contraction, triCuspid bulge

87
Q

what happens during “x” part of atrial pressure wave?

A

x - atrial relaXation

88
Q

what happens during “v” part of atrial pressure wave?

A

v - Venous filling

89
Q

what happens during “y” part of atrial pressure wave?

A

y - rapid emptYing of the atrium

90
Q
A
91
Q
A

@MY Anesthesia!! (14 decks)

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