Cardiopulmonary I Flashcards
1
Q
What forms the heart Apex?
A
Left Ventricle
2
Q
The base of the heart is the _____ and found _____
A
Top
2nd Costal cartilage
3
Q
The anterior of the heart is mostly
A
Rt Ventricle
4
Q
Heart dimensions:
A
5 long
3.5 wide
2.5 thick
Fist
5
Q
Right ventricle:
Left ventricle:
A
pulmonary circulation
systemic circulation
6
Q
What is the depression in the inter-atrial septum called?
A
Fossa ovalis
remnants foramen ovale
7
Q
What is a failure to form the Fossa Ovalis called?
A
Patent foramen ovale
8
Q
Define:
Atrial septal defect
A
Inter-atrial septum forms incorrectly
9
Q
Heart:
top?
bottom?
A
Base
Apex
10
Q
What are the most common Congenital abnormalities of the heart?
A
Ventricular septal
11
Q
How can a VSD (ventricular septal defect) be acquired?
A
Myocardial infarction and scar formation by macrophage
12
Q
Healthy heart ejects _____ of what fills it.
A
1/2
13
Q
What defines ventricular volume?
A
End Diastolic Volume
14
Q
What defines output?
A
Stroke volume
15
Q
Ejection fraction =
A
SV/EDV (x100%)
16
Q
What are the 3 tissue layers of the heart wall?
A
Endocardium
Myocardium
Epicardium
17
Q
What is found between the Epicardium and the Parietal Pericardium?
A
Pericardial space
10 mL fluid
18
Q
The Myocardium isn’t capable of Hyperplasia, but is capable of…
A
hypertrophy
19
Q
Nuclei in cardiac cell?
A
Mononucleated
although many have 2
20
Q
What is another name for the Visceral Pericardium?
A
Epicardium
21
Q
What important feature of the heart is considered part of the Epicardium?
A
Epicardial Fat
22
Q
Epicardial Fat:
% surface?
% total weight?
Where found?
A
60-80
20
generally along vasculature
23
Q
What are 2 functions of the Pericardial Space?
A
Heat dissipation
Lubricant
24
Q
4 Heart valves:
A
2 atrioventricular
2 semilunar
25
What is backflow called in the heart?
Regurgitation
26
What valve lies between the right atrium and right ventricle?
Tricuspid Valve
27
T/F
| The tricuspid valve is smaller in diameter and thicker than the mitral valve.
False
| larger diameter, thinner than Mitral
28
What valve lies between the left atrium and left ventricle?
Mitral (bicuspid) valve
29
What are the atrial ventricular valves attached to?
| From where do they originate?
Chordae Tendineae
"heart strings"
Papillary muscles
30
When do the papillary muscles contract the chordae tendineae?
As Ventrical contracts
| prevents valve from prolapsing and folding in on itself
31
The Pulmonic and Aortic are both ______ valves and have ___ cusps.
Semilunar
| 3
32
What is the term for Ventricular filling?
Diastole
33
What makes the Lub and Dub sound?
Lub - Tricuspid and Mitral (atrioventricular) valves shutting
Dub - Semilunar (Pulmonic, Aortic) shutting
34
What 3 structures empty into the Right Atrium?
Superior vena cava
Inferior vena cava
Coronary Sinus
35
What is the 4th outer layer of the heart?
Parietal Pericardium
36
What are 3 ways acute pericarditis manifests?
```
Chest pain (can be sharp)
Friction rub
ECG changes
```
37
What is the term for exudate between the Visceral and Parietal Pericardium?
Pericardial effusion
*this compresses the heart wall
38
A clear pericardial effusion associated with SLE, rheumatic fever, and viral infections is called?
Serous Pericarditis
39
A fibrin rich exudate in the pericardial sac caused by uremia, MI, or acute rheumatic fever is called?
Fibrinous Pericarditis
40
What type of pericarditis has a cloudy exudate?
Purulent
41
What type of Pericarditis has a bloody exudate?
Hemorrhagic pericarditis
42
A swelling of the Pericardial sac can cause what medical emergency?
What is the remedy?
Cardiac Tamponade
Pericardiocentesis
43
What are the 2 major forms of disorders arising from within the heart tissue (myocardium)?
*excluding cardiovascular disease
Myocarditis (inflammation)
| Primary Cardiomyopathies
non-inflammatory, cardiomegaly
44
What drug can cause myocarditis?
cocaine
45
What are 3 types of Primary cardiomyopathies?
Dilated
Hypertrophic
Restrictive
46
T/F
| Cardiomyopathies often occur without any mitigating pathology
True
47
What is the most common form of Primary cardiomyopathy?
Dilated
48
What is a Dilated Cardiomyopathy?
affects?
*common complication?
**caused by?
Ventricular Hypertrophy
pumping
*Mural thrombi
**alcohol
49
What cardiomyopathy could be congenital and is defined by hypertrophy of the ventricles and impaired diastolic filling?
Hypertrophic Cardiomyopathy
50
What can Hypertrophic Cardiomyopathy cause?
Outflow Obstruction of Left Ventricle
51
What is the least common Primary Cardiomyopathy?
Restrictive
52
What defines Restrictive Cardiomyopathy?
Heart regular shape, but stiffened
53
What condition affects the endocardial surface?
Infective Endocarditis
54
What 2 factors lead to infective endocarditis?
What organism is involved?
In what other population does it develop?
Damaged surfaces
Portal of entry
S. aureus (50% cases)
IV drug users
55
What valve is most often associated with Infective Endocarditis?
Mitral
56
What is the Penicillin analog?
| What are the alternatives if allergic?
Amoxicillin
Cephalexin, Azithromycin, Clarithromycin
57
Where are Terminal Cisternae?
Border of T-tubules - begin the Sarcoplasmic Reticulum
58
Thick filament:
| 3 components of thin filament:
Myosin
| Actin, Tropomyosin, Troponin `
59
T/F
| Acetylcholine is is the neurotransmitter in the heart.
False
Electrical conduction itself propels
60
Where do the 2 sources of Calcium in a muscle cell come from?
Sarcolemma/T-tubules
| Sarcoplasmic Reticulum
61
What does Calcium bind to in the muscle cell?
Troponin C
| on actin filament
62
What dictates the magnitude of contraction in a cardiac cell (myocyte)?
Amount of Calcium
63
T/F
| Sarcoplasmic reticulum is more dense in cardiac muscle (vs skeletal).
False
Less dense - needs Calcium from two sources
64
Intercalated Discs and gap junctions allow the myocardium to act as a:
Functional Syncytium
65
What 3 Proteins make up the cardiac troponin complex?
cTn = Cardiac Troponin
C (cTnC) - Calcium
I (cTnI) - Inhibitory
T (cTnT) - Tropomyosin binding
66
What causes both Angina and Myocardial Infarction?
Chief difference between them?
another?
Ischemia
No cell death in Angina
(also, MI not remedied by NTG)
67
What is the preferred blood marker that indicates cardiac injury?
How long do they stay in the blood?
Cardiac Troponins
(Troponin I or T)
2 hrs - 8 days (peaking at 12-24 hrs)
68
Trace cardiac conduction starting at the SA node.
SA > Interatrial Tracts
or
Internodal Tracts > AV node > AV Bundle > R/L Bundle Branches > Purkinje Fibers
69
Where do Non-Pacemaker "Fast Response" action potentials take place?
Atria
Ventricles
Purkinje Fibers
70
Where do Pacemaker "Slow Response" action potentials take place?
SA/AV node
71
Fast response in the heart involves ___ and ____ in and _____ out.
Na and Calcium
| K
72
How does Calcium affect the Action Potential in the heart?
Long Lasting (L-type)
Caused by Ca++ channels
73
T/F
| Calcium is an absolute requirement in the Cardiac muscle.
True
74
Calcium from where does not promote actin-myosin interaction?
What does this trigger?
Sarcolemma Action Potential
*Sarcoplasmic Reticulum Ca++ binds actin
**Calcium induced Calcium release
75
What receptor releases Calcium from the sarcoplasmic reticulum?
Ryanodine Receptors (RyR2)
76
What do Beta blockers (and Ach) do to calcium conductance?
Decrease
77
What does repolarization of heart cell involve?
Efflux K+
| L-type Ca++ closes
78
What happens in the very last phase of cardiac action potential?
Calcium re-uptake
| and K+ remain open
79
What 3 ways is Ca++ extruded from the heart cell?
Sarcoplasmic Reticulum Ca pumps (SERCA)
Sarcolemmal Ca pumps
3Na/1Ca pump (NCX)
80
Why is Tetani impossible in the heart?
Electrical and mechanical overlap
| No summation or tetanus possible
81
Effective (absolute) vs. Relative refractory period
Effective: no AP possible
Relative: AP possible only if stumulus big enough
82
Why does the SA node exhibit automaticity?
Unstable RMP
83
How does Phase 0 differ in the SA node compared with Purkinje, etc?
Calcium conductance, not influx Na+, causes
84
SA node, what causes:
Slow depolarization (phase4)?
Upstroke (Phase0)?
repolarization (Phase3)?
Na (current called If)
Ca
K
85
Where is conduction velocity the fastest?
Purkinje
86
Where is CV the slowest?
| What does this allow?
AV node
| Ventricular filling
87
What do chronotropic effects refer to?
firing SA node
88
What is a negative chronotropic effect?
Decrease SA node
89
What type of effect changes velocity of conduction in the heart?
Dromotropic
negative - decreases conduction
90
What type of receptors interact with ACh?
What type?
Muscarinic
| parasympathetic
91
What receptors sympathetically innervate the heart?
Beta1-receptors
| norepinepherine
92
Parasympathetic has a _____ chronotropic effect
| Mechanism?
```
Negative
Decrease If (inward Na current in phase 4 slow depolarization step)
```
93
Parasympathetic has a _____ dromotropic effect
| Mechanism?
Negative
| decrease Ca in and increase K out
94
What is the mechanism of positive chronotropic effect?
*Sympathetic
Increases If conduction in phase 4 depolarization
| more Na in
95
What is the mechanism of positive dromotropic effect?
Increase Ca influx current
96
T/F
| Lead = Electrode
False
Lead defines a space over which electrical signal is measured
97
Lead II is recorded between what?
Right Arm and Left Leg
98
What are the main components of the Basic Electrocardiogram?
P wave
QRS complex
T wave
99
What is happening at the P wave?
QRS?
T wave?
SA node fires (and atrial contraction)
ventricular depolarization
Ventricular repolarization
100
What are Latent Pacemakers?
AV node
| Purkinje fibers
101
Where does Phase 4 depolarization happen fastest and slowest?
SA node > AV node > purkinje fibers
102
What is Overdrive Suppression?
Because SA node fastest it supresses the latent pacemakers
103
What is contraction/emptying of heart?
Relaxation/filling?
Amount of blood pumped out?
Beats/min.
Systole
Diastole
Stroke Volume
Heart Rate
104
Heart Rats x Stroke Volume =
What should this equate to
Cardiac Output
*normally = venous return
105
Blood in either Ventricle after Diastole?
End Diastolic Volume
106
Blood in either ventricle after Systole?
End Systolic Volume
107
EDV-ESV=
Ejection Fraction
108
What are the 3 phases of ventricular filling?
Rapid passive
Slow passive
Atrial systole
109
What produces the 3rd heart sound?
Rapid passive filling
110
What produces the 4th heart sound?
Atrial systole
111
What produces the 1st heart sound?
Shutting of mitral valve in Atrial Systole
112
What produces the 2nd heart sound?
Aortic semilunar valve shuts
113
What does the Dichrotic Notch in the Wigger's Diagram represent?
Backflow and reverb in aorta
*significant for coronary blood flow
114
```
Where do the heart sounds come from?
S1:
S2:
S3:
S4:
```
mitral/tricuspid valve closure
semilunar valve closure
Rapid Passive Filling
Atrial Contraction
115
What 2 types of valve problems can murmurs indicate?
Incompetent (swishing)
| Stenotic (click)
116
Define:
Valvular Stenosis
Valvular incompetence
Valve doesn't open
Valve doesn't close
*results in myocardial hypertrophy
117
What are three risk factors for valvular heart disease?
Rheumatic fever
Congenital
Prosthesis
118
How long after Strep pyogenes infection can Rheumatic fever hit?
1-4 weeks
*Group A B-hemolytic
119
Tiny warty beadlike rubbery vegetations on the valve leaflets:
They result from?
Most often affects?
Verrucae
Rheumatic heart disease
Mitral valve
120
What is the most common heart valve problem?
Mitral Valve Prolapse
*7% population, most often young women
121
What can Aortic Stenosis lead to?
LV hypertrophy
122
Three main causes of Aortic Stenosis:
4 causes Aortic insufficiency (backflow)
Birth defect (only 1 or 2 cusps)
Rheumatic
Age-related degenerative calcific aortic stenosis
+Infective Endocarditis (aortic insufficiency)
123
Chronotropic:
SA node
124
What sympathetically innervates the SA node, atria, AV node, and ventricles?
T1-T4
125
T/F
| Thyroid Hormones can decrease heartbeat
False
T3 and T4 elevate HR
126
T/F
| Hyperkalemia and Hypokalemia can both decrease Heart Rate
True
*K+
127
What are3 factors affecting Stroke Volume?
Preload (EDV)
Inotropism (contractile force)
Afterload (in Aorta)
128
What Law defines Preload?
Frank-Starling Law of the Heart
129
What type of Stroke Volume control depends on how much the LT fills?
Heterometric regulation
130
What effect does stretch in the heart have on the cell?
Enhances troponinC affinity for Calcium
*more force
131
T/F
| Contractile Force in independent of Preload (Starlings Law).
True
132
T/F
| The Sympathetic system has a negative inotropic effect
False
increases contractile force
133
Regulation by Inotropism is called...
Homometric
134
What 2 cellular mechanisms does SNS B1 andrenergic affect to increase contraction (Inotropism)?
Increases Calcium current
| Increases SERCA pumps
135
Where does Afterload occur?
Back pressure on Aortic and Pulmonary Semilunar Valves
136
Increasing the Afterload is analogous to increasing the...
Blood pressure
*will decrease stroke volume
137
What drug decreases Afterload?
NitroGlycerine
138
Ohm's Law:
Q = P/R
139
2 Branches off Right Coronary Artery:
```
Right Marginal (Acute)
Posterior Descending (Inter-ventricular)
```
140
2 Branches off Left Coronary Artery:
Circumflex
| Left Anterior Descending (Inter-Ventricular Artery)
141
How does coronary resistance change in response to the Sympathetic response?
Dilates vessels
142
What drives blood into the coronary aa.?
Aortic pressure (dichrotic notch)
143
When the heart's demand for blood/oxygen is Greater than supply, you have...
Ischemic Heart Disease
144
What is episodic chest pain caused by inadequate oxygenation of the myocardium?
Angina Pectoris
145
What causes Classic/Exertional Angina?
Coronary obstruction
146
What type of Angina is caused by spasms of the coronary arteries?
this is related to what?
When can this occur?
Variant/Prinzmetal's/vasospastic
mostly related to coronary artery stenosis
Can occur at rest
147
What does Unstable Angina refer to?
Plaque disruption
148
What causes ischemic death of myocardial tissue?
M.I. - Myocardial infarction
149
What type of MI kills cells through the entire thickness of the ventricular wall?
What MI kills only interior 1/3 of cells?
Transmural Infarction
Subendocardial infarction
150
Artery occlusion that kills the following regions in MI's.
Anterior
Lateral
Posterior
Left Anterior Descending
Left Circumflex
Posterior Descending Branch
151
5 complications to MI:
```
Arrhythmia (most common cause of death)
Pump failure
Rupture
Papillary muscle rupture
Mural thrombosis (endocardium over infarct)
```
152
What is the balloon inflation technique of revascularizing the coronary arteries?
other (relatively) non-invasive technique?
PTCA - percutaneous transluminal coronary angioplasty
Stenting
153
Grafting technique to get around occlusion in coronary artery?
CABG - coronary artery bypass grafting
154
Heart failure refers to:
Failure of pump
155
What can dyspnea (difficulty breathing) and orthopnea (shortness of breath) indicate?
Heart mechanically overloaded
Rt and Lt ventricles have same pathologies with exception of pulmonary edema(Lt) and systemic edema(Rt)
156
ECG sign of Sinus Tachycardia
P and T waves running into each other
157
What are looong breaks between PQRST?
Sinus Bradycardia
158
What if the Atria aren't contracting on ECG?
No P wave
159
QRS spike wide and running into T:
Ventricular Escape Rhythm
(Purkinje fibers running show)
No P because atria not contracting
160
What will a premature atrial contraction (PAC) look like on ECG?
inverted P wave
161
What will Atrial Fibrillation look like?
| What causes?
Erratic - but with Ventricular Spikes
| Multiple myocytes signalling
162
ECG with single group of Ventricular myocytes signalling.
PVC - premature ventricular contraction
Irregular looking QRS
163
What does ventricular fibrillation look like ECG?
| Caused by?
sin wave
Multiple Ventricular Myocytes signaling
164
Big space between P wave and QRS:
1st degree AV block
*often slowed by scarring
165
Second degree AV block on ECG:
No QRS - skips beat
166
Wide QRS with regularly spaced P:
Purkinje firing
3rd degree AV block
167
What can correct a 3rd Degree AV block?
Pacemaker
