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Tim's Cards > Cardiopulmonary I > Flashcards

Cardiopulmonary I Flashcards

1
Q

What forms the heart Apex?

A

Left Ventricle

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2
Q

The base of the heart is the _____ and found _____

A

Top

2nd Costal cartilage

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3
Q

The anterior of the heart is mostly

A

Rt Ventricle

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4
Q

Heart dimensions:

A

5 long
3.5 wide
2.5 thick
Fist

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5
Q

Right ventricle:

Left ventricle:

A

pulmonary circulation

systemic circulation

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6
Q

What is the depression in the inter-atrial septum called?

A

Fossa ovalis

remnants foramen ovale

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7
Q

What is a failure to form the Fossa Ovalis called?

A

Patent foramen ovale

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8
Q

Define:

Atrial septal defect

A

Inter-atrial septum forms incorrectly

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9
Q

Heart:
top?
bottom?

A

Base

Apex

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10
Q

What are the most common Congenital abnormalities of the heart?

A

Ventricular septal

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11
Q

How can a VSD (ventricular septal defect) be acquired?

A

Myocardial infarction and scar formation by macrophage

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12
Q

Healthy heart ejects _____ of what fills it.

A

1/2

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13
Q

What defines ventricular volume?

A

End Diastolic Volume

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14
Q

What defines output?

A

Stroke volume

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15
Q

Ejection fraction =

A

SV/EDV (x100%)

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16
Q

What are the 3 tissue layers of the heart wall?

A

Endocardium
Myocardium
Epicardium

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17
Q

What is found between the Epicardium and the Parietal Pericardium?

A

Pericardial space

10 mL fluid

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18
Q

The Myocardium isn’t capable of Hyperplasia, but is capable of…

A

hypertrophy

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19
Q

Nuclei in cardiac cell?

A

Mononucleated

although many have 2

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20
Q

What is another name for the Visceral Pericardium?

A

Epicardium

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21
Q

What important feature of the heart is considered part of the Epicardium?

A

Epicardial Fat

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22
Q

Epicardial Fat:
% surface?
% total weight?
Where found?

A

60-80
20
generally along vasculature

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23
Q

What are 2 functions of the Pericardial Space?

A

Heat dissipation

Lubricant

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24
Q

4 Heart valves:

A

2 atrioventricular

2 semilunar

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25
Q

What is backflow called in the heart?

A

Regurgitation

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26
Q

What valve lies between the right atrium and right ventricle?

A

Tricuspid Valve

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27
Q

T/F

The tricuspid valve is smaller in diameter and thicker than the mitral valve.

A

False

larger diameter, thinner than Mitral

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28
Q

What valve lies between the left atrium and left ventricle?

A

Mitral (bicuspid) valve

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29
Q

What are the atrial ventricular valves attached to?

From where do they originate?

A

Chordae Tendineae
“heart strings”

Papillary muscles

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30
Q

When do the papillary muscles contract the chordae tendineae?

A

As Ventrical contracts

prevents valve from prolapsing and folding in on itself

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31
Q

The Pulmonic and Aortic are both ______ valves and have ___ cusps.

A

Semilunar

3

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32
Q

What is the term for Ventricular filling?

A

Diastole

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33
Q

What makes the Lub and Dub sound?

A

Lub - Tricuspid and Mitral (atrioventricular) valves shutting

Dub - Semilunar (Pulmonic, Aortic) shutting

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34
Q

What 3 structures empty into the Right Atrium?

A

Superior vena cava
Inferior vena cava
Coronary Sinus

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35
Q

What is the 4th outer layer of the heart?

A

Parietal Pericardium

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36
Q

What are 3 ways acute pericarditis manifests?

A 
Chest pain (can be sharp)
Friction rub
ECG changes
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37
Q

What is the term for exudate between the Visceral and Parietal Pericardium?

A

Pericardial effusion

*this compresses the heart wall

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38
Q

A clear pericardial effusion associated with SLE, rheumatic fever, and viral infections is called?

A

Serous Pericarditis

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39
Q

A fibrin rich exudate in the pericardial sac caused by uremia, MI, or acute rheumatic fever is called?

A

Fibrinous Pericarditis

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40
Q

What type of pericarditis has a cloudy exudate?

A

Purulent

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41
Q

What type of Pericarditis has a bloody exudate?

A

Hemorrhagic pericarditis

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42
Q

A swelling of the Pericardial sac can cause what medical emergency?
What is the remedy?

A

Cardiac Tamponade

Pericardiocentesis

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43
Q

What are the 2 major forms of disorders arising from within the heart tissue (myocardium)?

*excluding cardiovascular disease

A

Myocarditis (inflammation)

Primary Cardiomyopathies
non-inflammatory, cardiomegaly

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44
Q

What drug can cause myocarditis?

A

cocaine

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45
Q

What are 3 types of Primary cardiomyopathies?

A

Dilated
Hypertrophic
Restrictive

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46
Q

T/F

Cardiomyopathies often occur without any mitigating pathology

A

True

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47
Q

What is the most common form of Primary cardiomyopathy?

A

Dilated

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48
Q

What is a Dilated Cardiomyopathy?
affects?
*common complication?
**caused by?

A

Ventricular Hypertrophy
pumping
*Mural thrombi
**alcohol

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49
Q

What cardiomyopathy could be congenital and is defined by hypertrophy of the ventricles and impaired diastolic filling?

A

Hypertrophic Cardiomyopathy

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50
Q

What can Hypertrophic Cardiomyopathy cause?

A

Outflow Obstruction of Left Ventricle

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51
Q

What is the least common Primary Cardiomyopathy?

A

Restrictive

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52
Q

What defines Restrictive Cardiomyopathy?

A

Heart regular shape, but stiffened

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53
Q

What condition affects the endocardial surface?

A

Infective Endocarditis

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54
Q

What 2 factors lead to infective endocarditis?
What organism is involved?
In what other population does it develop?

A

Damaged surfaces
Portal of entry

S. aureus (50% cases)

IV drug users

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55
Q

What valve is most often associated with Infective Endocarditis?

A

Mitral

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56
Q

What is the Penicillin analog?

What are the alternatives if allergic?

A

Amoxicillin

Cephalexin, Azithromycin, Clarithromycin

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57
Q

Where are Terminal Cisternae?

A

Border of T-tubules - begin the Sarcoplasmic Reticulum

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58
Q

Thick filament:

3 components of thin filament:

A

Myosin

Actin, Tropomyosin, Troponin `

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59
Q

T/F

Acetylcholine is is the neurotransmitter in the heart.

A

False

Electrical conduction itself propels

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60
Q

Where do the 2 sources of Calcium in a muscle cell come from?

A

Sarcolemma/T-tubules

Sarcoplasmic Reticulum

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61
Q

What does Calcium bind to in the muscle cell?

A

Troponin C

on actin filament

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62
Q

What dictates the magnitude of contraction in a cardiac cell (myocyte)?

A

Amount of Calcium

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63
Q

T/F

Sarcoplasmic reticulum is more dense in cardiac muscle (vs skeletal).

A

False

Less dense - needs Calcium from two sources

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64
Q

Intercalated Discs and gap junctions allow the myocardium to act as a:

A

Functional Syncytium

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65
Q

What 3 Proteins make up the cardiac troponin complex?

cTn = Cardiac Troponin

A

C (cTnC) - Calcium
I (cTnI) - Inhibitory
T (cTnT) - Tropomyosin binding

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66
Q

What causes both Angina and Myocardial Infarction?
Chief difference between them?

another?

A

Ischemia
No cell death in Angina

(also, MI not remedied by NTG)

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67
Q

What is the preferred blood marker that indicates cardiac injury?
How long do they stay in the blood?

A

Cardiac Troponins
(Troponin I or T)

2 hrs - 8 days (peaking at 12-24 hrs)

68
Q

Trace cardiac conduction starting at the SA node.

A

SA > Interatrial Tracts
or
Internodal Tracts > AV node > AV Bundle > R/L Bundle Branches > Purkinje Fibers

69
Q

Where do Non-Pacemaker “Fast Response” action potentials take place?

A

Atria
Ventricles
Purkinje Fibers

70
Q

Where do Pacemaker “Slow Response” action potentials take place?

A

SA/AV node

71
Q

Fast response in the heart involves ___ and ____ in and _____ out.

A

Na and Calcium

K

72
Q

How does Calcium affect the Action Potential in the heart?

A

Long Lasting (L-type)

Caused by Ca++ channels

73
Q

T/F

Calcium is an absolute requirement in the Cardiac muscle.

A

True

74
Q

Calcium from where does not promote actin-myosin interaction?
What does this trigger?

A

Sarcolemma Action Potential

*Sarcoplasmic Reticulum Ca++ binds actin

**Calcium induced Calcium release

75
Q

What receptor releases Calcium from the sarcoplasmic reticulum?

A

Ryanodine Receptors (RyR2)

76
Q

What do Beta blockers (and Ach) do to calcium conductance?

A

Decrease

77
Q

What does repolarization of heart cell involve?

A

Efflux K+

L-type Ca++ closes

78
Q

What happens in the very last phase of cardiac action potential?

A

Calcium re-uptake

and K+ remain open

79
Q

What 3 ways is Ca++ extruded from the heart cell?

A

Sarcoplasmic Reticulum Ca pumps (SERCA)
Sarcolemmal Ca pumps
3Na/1Ca pump (NCX)

80
Q

Why is Tetani impossible in the heart?

A

Electrical and mechanical overlap

No summation or tetanus possible

81
Q

Effective (absolute) vs. Relative refractory period

A

Effective: no AP possible
Relative: AP possible only if stumulus big enough

82
Q

Why does the SA node exhibit automaticity?

A

Unstable RMP

83
Q

How does Phase 0 differ in the SA node compared with Purkinje, etc?

A

Calcium conductance, not influx Na+, causes

84
Q

SA node, what causes:
Slow depolarization (phase4)?
Upstroke (Phase0)?
repolarization (Phase3)?

A

Na (current called If)
Ca
K

85
Q

Where is conduction velocity the fastest?

A

Purkinje

86
Q

Where is CV the slowest?

What does this allow?

A

AV node

Ventricular filling

87
Q

What do chronotropic effects refer to?

A

firing SA node

88
Q

What is a negative chronotropic effect?

A

Decrease SA node

89
Q

What type of effect changes velocity of conduction in the heart?

A

Dromotropic

negative - decreases conduction

90
Q

What type of receptors interact with ACh?

What type?

A

Muscarinic

parasympathetic

91
Q

What receptors sympathetically innervate the heart?

A

Beta1-receptors

norepinepherine

92
Q

Parasympathetic has a _____ chronotropic effect

Mechanism?

A 
Negative
Decrease If (inward Na current in phase 4 slow depolarization step)
93
Q

Parasympathetic has a _____ dromotropic effect

Mechanism?

A

Negative

decrease Ca in and increase K out

94
Q

What is the mechanism of positive chronotropic effect?

*Sympathetic

A

Increases If conduction in phase 4 depolarization

more Na in

95
Q

What is the mechanism of positive dromotropic effect?

A

Increase Ca influx current

96
Q

T/F

Lead = Electrode

A

False

Lead defines a space over which electrical signal is measured

97
Q

Lead II is recorded between what?

A

Right Arm and Left Leg

98
Q

What are the main components of the Basic Electrocardiogram?

A

P wave
QRS complex
T wave

99
Q

What is happening at the P wave?
QRS?
T wave?

A

SA node fires (and atrial contraction)
ventricular depolarization
Ventricular repolarization

100
Q

What are Latent Pacemakers?

A

AV node

Purkinje fibers

101
Q

Where does Phase 4 depolarization happen fastest and slowest?

A

SA node > AV node > purkinje fibers

102
Q

What is Overdrive Suppression?

A

Because SA node fastest it supresses the latent pacemakers

103
Q

What is contraction/emptying of heart?
Relaxation/filling?
Amount of blood pumped out?
Beats/min.

A

Systole
Diastole
Stroke Volume
Heart Rate

104
Q

Heart Rats x Stroke Volume =

What should this equate to

A

Cardiac Output

*normally = venous return

105
Q

Blood in either Ventricle after Diastole?

A

End Diastolic Volume

106
Q

Blood in either ventricle after Systole?

A

End Systolic Volume

107
Q

EDV-ESV=

A

Ejection Fraction

108
Q

What are the 3 phases of ventricular filling?

A

Rapid passive
Slow passive
Atrial systole

109
Q

What produces the 3rd heart sound?

A

Rapid passive filling

110
Q

What produces the 4th heart sound?

A

Atrial systole

111
Q

What produces the 1st heart sound?

A

Shutting of mitral valve in Atrial Systole

112
Q

What produces the 2nd heart sound?

A

Aortic semilunar valve shuts

113
Q

What does the Dichrotic Notch in the Wigger’s Diagram represent?

A

Backflow and reverb in aorta

*significant for coronary blood flow

114
Q 
Where do the heart sounds come from?
S1:
S2:
S3:
S4:
A

mitral/tricuspid valve closure
semilunar valve closure
Rapid Passive Filling
Atrial Contraction

115
Q

What 2 types of valve problems can murmurs indicate?

A

Incompetent (swishing)

Stenotic (click)

116
Q

Define:
Valvular Stenosis
Valvular incompetence

A

Valve doesn’t open
Valve doesn’t close

*results in myocardial hypertrophy

117
Q

What are three risk factors for valvular heart disease?

A

Rheumatic fever
Congenital
Prosthesis

118
Q

How long after Strep pyogenes infection can Rheumatic fever hit?

A

1-4 weeks

*Group A B-hemolytic

119
Q

Tiny warty beadlike rubbery vegetations on the valve leaflets:

They result from?

Most often affects?

A

Verrucae

Rheumatic heart disease

Mitral valve

120
Q

What is the most common heart valve problem?

A

Mitral Valve Prolapse

*7% population, most often young women

121
Q

What can Aortic Stenosis lead to?

A

LV hypertrophy

122
Q

Three main causes of Aortic Stenosis:

4 causes Aortic insufficiency (backflow)

A

Birth defect (only 1 or 2 cusps)
Rheumatic
Age-related degenerative calcific aortic stenosis

+Infective Endocarditis (aortic insufficiency)

123
Q

Chronotropic:

A

SA node

124
Q

What sympathetically innervates the SA node, atria, AV node, and ventricles?

A

T1-T4

125
Q

T/F

Thyroid Hormones can decrease heartbeat

A

False

T3 and T4 elevate HR

126
Q

T/F

Hyperkalemia and Hypokalemia can both decrease Heart Rate

A

True

*K+

127
Q

What are3 factors affecting Stroke Volume?

A

Preload (EDV)
Inotropism (contractile force)
Afterload (in Aorta)

128
Q

What Law defines Preload?

A

Frank-Starling Law of the Heart

129
Q

What type of Stroke Volume control depends on how much the LT fills?

A

Heterometric regulation

130
Q

What effect does stretch in the heart have on the cell?

A

Enhances troponinC affinity for Calcium

*more force

131
Q

T/F

Contractile Force in independent of Preload (Starlings Law).

A

True

132
Q

T/F

The Sympathetic system has a negative inotropic effect

A

False

increases contractile force

133
Q

Regulation by Inotropism is called…

A

Homometric

134
Q

What 2 cellular mechanisms does SNS B1 andrenergic affect to increase contraction (Inotropism)?

A

Increases Calcium current

Increases SERCA pumps

135
Q

Where does Afterload occur?

A

Back pressure on Aortic and Pulmonary Semilunar Valves

136
Q

Increasing the Afterload is analogous to increasing the…

A

Blood pressure

*will decrease stroke volume

137
Q

What drug decreases Afterload?

A

NitroGlycerine

138
Q

Ohm’s Law:

A

Q = P/R

139
Q

2 Branches off Right Coronary Artery:

A 
Right Marginal (Acute)
Posterior Descending (Inter-ventricular)
140
Q

2 Branches off Left Coronary Artery:

A

Circumflex

Left Anterior Descending (Inter-Ventricular Artery)

141
Q

How does coronary resistance change in response to the Sympathetic response?

A

Dilates vessels

142
Q

What drives blood into the coronary aa.?

A

Aortic pressure (dichrotic notch)

143
Q

When the heart’s demand for blood/oxygen is Greater than supply, you have…

A

Ischemic Heart Disease

144
Q

What is episodic chest pain caused by inadequate oxygenation of the myocardium?

A

Angina Pectoris

145
Q

What causes Classic/Exertional Angina?

A

Coronary obstruction

146
Q

What type of Angina is caused by spasms of the coronary arteries?

this is related to what?

When can this occur?

A

Variant/Prinzmetal’s/vasospastic

mostly related to coronary artery stenosis

Can occur at rest

147
Q

What does Unstable Angina refer to?

A

Plaque disruption

148
Q

What causes ischemic death of myocardial tissue?

A

M.I. - Myocardial infarction

149
Q

What type of MI kills cells through the entire thickness of the ventricular wall?
What MI kills only interior 1/3 of cells?

A

Transmural Infarction

Subendocardial infarction

150
Q

Artery occlusion that kills the following regions in MI’s.
Anterior
Lateral
Posterior

A

Left Anterior Descending
Left Circumflex
Posterior Descending Branch

151
Q

5 complications to MI:

A 
Arrhythmia (most common cause of death) 
Pump failure
Rupture
Papillary muscle rupture
Mural thrombosis  (endocardium over infarct)
152
Q

What is the balloon inflation technique of revascularizing the coronary arteries?

other (relatively) non-invasive technique?

A

PTCA - percutaneous transluminal coronary angioplasty

Stenting

153
Q

Grafting technique to get around occlusion in coronary artery?

A

CABG - coronary artery bypass grafting

154
Q

Heart failure refers to:

A

Failure of pump

155
Q

What can dyspnea (difficulty breathing) and orthopnea (shortness of breath) indicate?

A

Heart mechanically overloaded

Rt and Lt ventricles have same pathologies with exception of pulmonary edema(Lt) and systemic edema(Rt)

156
Q

ECG sign of Sinus Tachycardia

A

P and T waves running into each other

157
Q

What are looong breaks between PQRST?

A

Sinus Bradycardia

158
Q

What if the Atria aren’t contracting on ECG?

A

No P wave

159
Q

QRS spike wide and running into T:

A

Ventricular Escape Rhythm
(Purkinje fibers running show)
No P because atria not contracting

160
Q

What will a premature atrial contraction (PAC) look like on ECG?

A

inverted P wave

161
Q

What will Atrial Fibrillation look like?

What causes?

A

Erratic - but with Ventricular Spikes

Multiple myocytes signalling

162
Q

ECG with single group of Ventricular myocytes signalling.

A

PVC - premature ventricular contraction

Irregular looking QRS

163
Q

What does ventricular fibrillation look like ECG?

Caused by?

A

sin wave

Multiple Ventricular Myocytes signaling

164
Q

Big space between P wave and QRS:

A

1st degree AV block

*often slowed by scarring

165
Q

Second degree AV block on ECG:

A

No QRS - skips beat

166
Q

Wide QRS with regularly spaced P:

A

Purkinje firing

3rd degree AV block

167
Q

What can correct a 3rd Degree AV block?

A

Pacemaker

Tim's Cards (140 decks)

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