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OCHT Term II > CARDIOLOGY - Anatomy & Mechanical Physiology (Week 1) > Flashcards

CARDIOLOGY - Anatomy & Mechanical Physiology (Week 1) Flashcards

1
Q

Main organs of cardiopulmonary system

A

heart and lungs

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2
Q

Blood supplies body with ___________ and _________, and carries away ________ and _________.

A

oxygen, nutrients

carbon dioxide, waste products

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3
Q

Heart

A

A hollow muscular organ producing a pumping action causing pressure changes that circulate blood throughout body

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4
Q

Base vs apex of heart

A

Base: more flat, broad

Apex: more conical, blunt

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5
Q

Heart acts as a double sided pump. What does this mean?

A

Means that pumping occurs on L and R side, which happens when muscular walls of each heart chamber contract (squuze) causing blood to be forced out of the chambers

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6
Q

Heart has ___ chambers. They are:

A

4

Right atrium

Left atrium

Right ventricle

Left ventricle

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7
Q

In individuals of average height and weight, what is the size/weight/shape of the heart?

A

Weight: ~453g (1 lb)

Size: ~an adult’s fist (12cm long x 9 cm wide x 6 cm deep)

Shape: blunt cone

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8
Q

Shape of heart in taller, thinner individuals?

Shape of heart in shorter, stalkier people?

A

taller, thinner ppl: elongated hearts

short people: heart is of greater width

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9
Q

Location of the heart

A
  • lies obliquely (slanted) in the mediastinum
  • anterior to the esophagus and vertebra
  • posterior to the sternum
  • approx 2/3 of heart’s mass is L of midline (sternum)
  • approx 1/3 of heart’s mass is R of midline
  • base is directed poserior and slightly superior; lies just below 2nd rib (2nd intercostal space)
  • apex is directed anterio and slightly inferior; lies just below the 5th rib (5th intercostal space) ⇒ pointed downwards towards the left
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10
Q

Mediastinum

A

place between the lungs in thoracic cavity & extends from vertebral column to sternum

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11
Q

How many layers make up the heart wall? list from outer layer to inner layer

A

1) epicardium
2) myocardium
3) endocardium

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12
Q

Pericardium/pericardial sac

A
  • Loose-fitting inextensible membrane sac which encases the heart
  • sac made of white firbous tissue, but lined with a smooth membrane (which has parietal and visceral layer)
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13
Q

Pericardium contains 2 parts. What are they?

A

1) Fibrous pericardium - tough, loose-fitting and inelastic sac

2) Serous pericardium (space) - thinner and has 2 layers

  • Parietal layer - lining inside of fibrous pericardium
  • Visceral layer - aka the EPICARDIUM - adheres to outside of the heart
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14
Q

Between the parietal and visceral layer of the pericardial sac contains what?

A

small amount of pericardial/serous fluid (10-30mL)

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15
Q

Function of pericardial fluid

A

to act as a lubricant, reducing change of friction and allowing the heart to move within the pericardial save as it beats

there is no danger of irritation as long as serous membrane remains undamaged and produces serous fluid

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16
Q

Epicardium

A
  • translates to “above heart”
  • outer layer of the heart
  • also the same as the visceral layer of the serous pericardium
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17
Q

Myocardium

A
  • literally translates to “muscle heart”
  • thick middle layer of the heart
  • consists of contractile cells (non-autorhythmic) and pacemaker cells (autorhythmic)
  • has striated involuntary cardiac muscle cells (myocytes) joined into a continuous mass by end-to-end gap junctions (basically creating tunnels) called intercalated discs
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18
Q

Function of myocardium

A

contracts rhythmically and continuously thus providing pumping action in order for blood to circulate systemically throughout the body

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19
Q

What is the unique feature about intercalated discs?

A

These end-to-end gap junctions form discs that are electrically coupled into a single functional unit called syncytium (meaning if one feels it, they all feel it)

syncytium allows action potential (electrical impulse) to pass from cell to cell along the entire heart wall thus stimulating heart contractions

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20
Q

Endocardium

A
  • translates to “within heart”
  • inner layer of the heart
  • made of delicate lining, endothelial tissue
  • also covers the inside of the myocardium
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21
Q

Label all the chambers and blood vessels

A
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22
Q

Upper chambers/receiving chambers are also known as

A

atria

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23
Q

Atria are separated by

A

interatrial septum

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24
Q

Myocardial walls of each atrium are not that thick. Why is this?

A

Because thick walls are not required as the blood is travelling a very short distance to the ventricles

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25
Q

Function of atria

A
  • acts as reservoirs for blood
  • when contracted, pushes blood into ventricles (atria contract and relax at the same time)
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26
Q

Atria receives blood from (veins/arteries). Specify the blood vessels that supply the RA and LA.

A

veins

RA: receives blood from superior and inferior vena cava, and coronary sinus (deoxygenated blood)

LA: receives blood from pulmonary veins (oxygenated blood)

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27
Q

Lower chambers/primary pumping chambers also known as

A

ventricles

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28
Q

Myocardial walls of each ventricle compared to atria

A

much thicker (and LV myocardial wall is thicker than RV because LV has to pump further )

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29
Q

Ventricles are separated by

A

interventricular septum

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30
Q

Function of LV

A

acts as a pump for blood (both contract and relax at the same time)

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31
Q

Ventricles receive blood from

A

atria

LV receives oxygenated blood

RV receives deoxygenated blood

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32
Q

Left ventricle is considered a (high/low) pressure pump. What is its function?

A

high pressure pump

function: pumps blood through aorta which ultimately travels to all cells in the body

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33
Q

RV is considered a (high/low) pressure pump. What is its function?

A

low pressure pump

pushes blood through pulmonary trunk then pulmonary arteries which enter capillaries of lungs where gas exchange takes place

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34
Q

Identify all the valves in the heart

A
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35
Q

Arterioventricular valves (AV vales) include

A

tricuspid valve

bicuspid (mitral) valve

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36
Q

Function of AV valves

A
  • allows blood to flow from atria to ventricles
  • permits flow of blood in a forward direction and prevent backflow into atria
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37
Q

semilunar valves include

A

pulmonic valve: between RV and pulmonary trunk

aortic vale: between LV and aortic arch

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38
Q

Function of semilunar/SL valves

A
  • Pulmonic valve: allows blood flow from RV to pulmonary trunk
  • Aortic valve: allows blood flow from LV to aortic arch
  • SL valves permit blood flow in a forward diretion, prevents backflow down the ventricles from aorta and pulmonary arteries
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39
Q

Label the valves

A
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40
Q

The “heart sounds” heard through the stethoscope indicate what action in the heart?

A

heart valves closing

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41
Q

Heart murmur

A

an abnormal heart sound made as blood flows through a heart valve working incorrectly (i.e. improper closing, stenosis, etc.)

murmurs are typically due to malfunctioning mitral valve

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42
Q

Coronary arteries originate from what structure. Briefly describe the structure of the coronary arteries.

A

the aorta

just above aortic valve where the aorta exits the heart, runs along epicardial surface. Divides into small vessels as they penetrate myocardium and endocardial surface

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43
Q

Function of coronary arteries and how much blood does it deliver?

A

sole supplies of arterial blood to the heart

delivers approximately 200-250mL of blood to myocardium each minute

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44
Q

Left Coronary Artery (LCA) supply what % of blood to the heart?

Right Coronary Artery (RCA) supply what % of blood to the heart?

A

LCA: supplies 85%

RCA: supplies 15%

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45
Q

How do coronary arteries fill?

A

When aortic valve is open, blood flows through to body (as per usual).

When aortic valve is closed (during ventricular relaxation) - bacflow of blood closes the valve and fills coronary arteries

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46
Q

Label the coronary arteries in the diagram below.

A
47
Q

RCA supplies blood to:

A
  • RA
  • RV
  • inferior and posterior surface of LV in ~85% of ppl
  • SA in 60% of people
  • AV node in 85-90% of people
48
Q

LAD supplies blood to:

A
  • anterior of LV
  • part of lateral surface of LV
  • most of interventricular septum
49
Q

Circumflex artery supplies blood to:

A
  • LA
  • part of lateral surface of LV
  • inferior and posterior surface of LV in 15% of ppl
  • SA node in 40% of ppl
  • AV node in 10-15% of ppl
50
Q

Label the cardiac veins in the following diagram

A
51
Q

Describe the pathway in which blood that supplies the heart returns back to circulation

A

coronary arteries ⇒ cardiac veins ⇒ common venous channel (coronary sinus) ⇒ right atrium

52
Q

Anastomosis

A

connection of one or more branches that exist ebtween arterioles to provide backup (collateral) circulation (so that in the event of a blockage, blood can still get to the heart through other channels)

53
Q

Function of coronary capillaries

A
  • allow for exchange of nutrients and metabolic waste
  • merge to form coronary veins which empties into coronary sinus
54
Q

Provider an overview of the circulatory system -how deoxygenated blood becomes oxygenated (i.e. what structures it goes into/out of).

A

Deoxygenated blood

  1. blood enters into RA from superior and inferior VC and coronary sinus
  2. RA empties most of its blood into RV and then when 70% is emptied into RV, atrial kick occurs to empty the remaining 30%
  3. high pressure of RV pushes tricuspid valve close, and pulmonary valve opens to allow blood towards pulmonary arteries & lungs

Oxygenated blood

  1. back from the lungs and into the LA from pulmonary veins
  2. LA ⇒ LV via bicuspid/mitral valve (again 70% blood enters before a mitral kick occurs to empty remaining 30%)
  3. high pressure of LV pushes bicuspid valve close, and opens aortic valve to allow blood to systemically move to all cells except gas exchange tissue
55
Q

Cardiac cycle

A

refers to mechanical events that occur to pump blood

56
Q

What are the two phases of the cardiac cycle?

A

Systole (ventricles contract and expel blood)

Diastole (ventricles relax and fill)

57
Q

1st phase of diastole - what is this phase called and what is happening?

A

Rapid refilling - atria dumping blood into ventricles

  • atria are full of blood, therefore have high pressure
  • ventricles are empty (just expelled blood) therefore low pressure
  • the difference in pressure causes AV valve to open and fill the ventricles
58
Q

2nd phase of diastole - what is it called and what is happening during this phase?

A

Diastasis - slowing blood flow

  • pressure in the atria and ventricles start to equalize
  • ventricles fill and atria empty, so blood flows slow
  • there is where 70% of blood is in ventricles, 30% is still in atria
59
Q

3rd phase of diastole - what is it called and what is happening during this phase?

A

Atrial Kick - Atria contracting to squeeze remainder of blood into ventricles

  • atria are essentially empty but still has a little bit remaining that needs to be delivered to ventricles (30%)
  • atria therefore contract, squeezing on themselves ⇒ causes the remainder of blood into the ventricles
  • atrial kick provides 15-30% (use 30% for testing purposes) of ventricular filling
60
Q

1st phase of systole - what is it called and what is happening during this phase?

A

Isovolumetric contraction - ventricles squeezing (on itself to build pressure) but not pumping

  • ventricles are full but the pressure in them is not high enough to open SL valves
  • ventricles squeeze down on themselves to force muscular walls inwards, thereby putting pressure on the blood inside and causing ventricular pressure to rise
  • NO blood flow occurs during this phase
61
Q

2nd phase of systole - what is it called and what is happening during this phase?

A

Ventricular Ejection - pumping vigourously

  • ventricles are under high pressure causing SL valves to open
  • blood flows out and into pulmonary trunk and aorta
62
Q

3rd phase of systole - what is this called and what is happening during this phase?

A

Protodiastole - pumping less

  • ventricular contraction continues but blood flow slows as the ventricualr pressure falls (as it empties)
  • aortic and pulmonary arteries pressure rise (as they fill)
63
Q

4th phase of systole - what is it called and what is happening during this phase?

A

Isovolumetric relaxation - relaxing, valves are closing to end systole

  • ventricular presure is low as blood has been pumped out
  • ventricles relax
  • aorta and pulmonary arteries now have high pressure
  • no longer foward pressure from the ventricles
  • some of the blood starts to flow backwards towards the valves closing them shut
64
Q

Cardiac output

A

the amoutn of blood pumped by the left ventricle in 1 minute

65
Q

Normal cardiac output range is ________.

What factors does cardiac output depend on?

A

4000-8000mL

depends on gender, body, age, and size

66
Q

Formula for calculating cardiac output

A

CO = SV x HR

67
Q

Stroke Volume

Avg amount?

A

the amount of blood ejected from the heart with each ventricular contraction

~70mL

68
Q

Stroke volume is dependent on what 3 factors?

A

1) Preload
2) Afterload
3) Myocardial contractility (performance of the cardiac muscle)

69
Q

Heart rate

A

number of times the left ventricle contracts in 1 minute; normal is 60-100

70
Q

Preload

A

volume of blood returning to the heart (the amount of stretch on ventricles at the end of diastole)

71
Q

During diastole (relaxation), blood flows from the _______ into the ______.

A

atria; ventricle

72
Q

During preload, the volume of blood entering each ventricle is known as __________. The volume of blood is approximately __________.

A

end diastolic; around 120-130mL

73
Q

When ventricles pump during systole (contraction), they don’t exactly empty entirely. The remaining volume is approximately ______, and this remaining volume of blood left in each ventricle after systole is known as _________.

A

50-60mL

end systolic

74
Q

Ejection fraction

A

% of blood volume ejected in each cardiac cycle - a representation of LV performance

normal is 55-65%

calculated by EF = SV/EDV x 100

75
Q

Afterload

A

the resistance against the heart muscle during its pump (aka peripheral vascular resistance)

i.e. the pressure that the heart must work against to eject blood during systole/contraction

76
Q

An increase in resistance causes a ________ in stroke volume. Examples of resistance include:

A

decrease

Ex: HTN, aortic stenosis, hypothermia

77
Q

A decrease in resistance causes an __________ in stroke volume. Examples that would cause a decrease in resistance include:

A

increase

ex. septic shock, anaphylactic shock, use of vasodilators, etc.
remember: less resistance = more can come out (like a garden hose)

78
Q

The heart’s behaviours are controlled by what nervous system?

A

autonomic nervous system

79
Q

ANS influences chronotropy, inotropy, and dromotropy. Define these terms.

A

Chronotropy: influences HR

Inotropy: influences contractility (blood volume)

Dromotropy: influences conductivity

80
Q

ANS inntervates what in the heart?

A

atria and ventricles

81
Q

Atria is controlled by what parts of the autonomic nervous system?

A

Controlled by a large number of sympathethic and parasympathetic nerve fibers

82
Q

Ventricles are controlled by what parts of the ANS?

A

Controlled MAINLY by sympathetic nerve fibers

83
Q

True or False. Autonomic nerve fibers help maintain cardiac output according to the metabolic needs of the body

A

True

84
Q

Sympathetic control (Fight or flight response) influences the heart how?

A

increase HR and contractility

85
Q

Parasympathetic control influences the heart how?

A

primarily by decrease HR and to a lesser extent, contractility

controlled through vagus nerve

86
Q

What are the three parts of an autonomic pathway?

A
  1. preganglionic neuron (stemming from CNS)
  2. preganglion neuron synapsing (releasing NT) with postganglioninc neuron at the autonomic ganglion
  3. Postganglionic neuron release NT to target tissue
87
Q

In sympathetic control, where do the neurons originate from and what chemical mediates this response?

A

Originates from: thoracolumbar region (CNS)

Mediated by: norepinephrine (secreted by adrenal gland)

88
Q

Describe the sympathetic control pathway.

A

Preganglionic neuron originates from thoracolumbar region and is cholinergic (so secretes ACh)

⇒

synapses at autonomic ganglion (cholinergic nicotinic receptors) where preganglion neuron releases ACh into axon terminal

⇒

postganglionic neuron is adrenergic and acts on target tissue via alpha and beta receptors by releasing norepinephrine

89
Q

Acetylcholine is considered:

a) +ve chronotropic
b) -ve chronotropic
c) +ve ionotropic
d) -ve ionotropic
e) A and C

A

b) -ve chronotropic

decreases HR

90
Q

Norepinephrine is considered:

a) +ve chronotropic
b) -ve chronotropic
c) +ve ionotropic
d) -ve ionotropic
e) A and C

A

e) A and C

increases both HR and contractility

91
Q

Parasympathetic response is controlled by what nerve?

A

vagus nerve

92
Q

Describe the parasympathetic control pathway.

A

Preganglionic neurons (cholinergic) from craniosacral region of CNS synapse with cholinergic nicotonic receptors

⇒

Preganglionic neurons release ACh at autonomic ganglion (axon terminal)

⇒

Postganglionic neurons (cholinergic) are stimluated and conduct impulse to target tissue, acting on cholinergic muscarinic receptors via ACh

93
Q

Parasympathetic control is mediated by what chemical?

A

Acetylcholine (ACh)

94
Q

The act of closing the glottis (flap over trachea) or stimulation of the vagus nerve causes release of what chemical?

A

Acetylcholine

95
Q

Lungs

A

large spongy organs located in the chest cavity, slightly behind and on either side of the heart

encased in protective pleural sac

96
Q

Main function of lungs

A

remove CO2 from blood and replace it with oxygen

97
Q

Trachea

A

hollow tube extending ~4.5 inch down and divides into 2 slightly smaller tubes (bronchi)

98
Q

Bronchi enter the lungs (one on each side) and further divides into smaller tubes known as

A

bronchioles

99
Q

alveoli

A

tiny sacs of tissue arranged in grape-like clusters and surrounded by capillaries; where gas exchange occurs

100
Q

Hollow tubes of smooth muscle with primary function of transportation

A

Blood vessels

101
Q

Perfusion

A

movement of blood through an organ or part of the body

102
Q

Identify the function of:

arteries

veins

capillaries

A

Arteries: carry blood away from the heart

Veins: carry blood to the heart

Capillaries: where exchange of nutrients and waste products for body cells take place (one cell thick)

103
Q

Peripheral veins

A

veins in arms/legs (contain tiny valves to prevent backflow of blood)

104
Q

largest veins in the body

A

superior and inferior VC (these do not have valves)

105
Q

ischemia

A

decreased supply of oxygen to tissue

106
Q

Angina

A

caused by increased demand of oxygen in heart muscle

107
Q

Classic Sx of angina

A
  • vague dull ache
  • indigestion (heart burn) not relieved with antacids
  • pressure in chest
  • crushing, squeezing chest tightness (“elephant” or “tight belt” around/on chest)
  • can be localized or spread ot L shoulder, either arm, jaw, upper back
108
Q

Atypical Sx of angina

A
  • fatigue
  • lack of Sx/pain
  • pain in jaw/upper back
109
Q

Angina is more likely to occur when (i.e. what factors exacerbate it)?

A
  • after physical exercise
  • after a large meal
  • stressful situations
  • extreme temps
110
Q

Stable vs unstable angina

A

Stable: usually starts with physical exertion and is relieved with rest (treatment is nitro to relieve pain)

  • can become unstable angina if episodes increase in frequency or severity

Unstable: not relieved by rest, more painful than usual, can cause N/V, difficulty breathing, sweating

  • can indicate increased myocardial ischemia or decreased ability to tolerate ischemia
111
Q

When cardiac output is abnormal, what will the heart try to do initially?

A

compensate (balance it out by changing SV or HR)

112
Q

Signs and symptoms of poor cardiac output

A
  • ashen, pale, cool clammy skin
  • N/V
  • dizziness, weakness, faintness
  • tachycardia
  • diaphoresis
  • mild to severe chest pain
  • unresponsiveness/altered LOC
  • SOB
  • hypotension
  • dyspnea
  • confusion/disorientation
  • cyanosis (skin, lips, nail beds)
  • decreased urinary output
113
Q

What are the 3 phases of diastole?

A

1) Rapid refilling
2) Diastasis
3) Atrial Kick

114
Q

What are the 4 phases of systole?

A

1) isovolumetric contraction
2) ventricular ejection
3) protodiastole
4) isovolumetric relaxation

OCHT Term II (31 decks)

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