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CRNA Adv. A&P > Cardiovascular # 1 > Flashcards

Cardiovascular # 1 Flashcards

1
Q

Aortopulmonary Window

A
  • Small space between the aortic arch and the pulmonary trunk
  • Contains ligament arteriosum and recurrent laryngeal nerve
  • Also refers to a fistula between the aorta and pulmonary trunk (may occur on its own or with other heart defects0
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2
Q

Mediastinal Tumors Effects

A
  • Pulmonary artery and cardiac compression
  • ↑ ICP, HA, AMS
  • Airway obstruction and loss of lung volumes
  • Most common = 4 T’s (Thyoma, teratoma, Thyroid carcinoma, and terrible lipoma)
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3
Q

Superior Vena Cava Syndrome (SVCS)

A

The Superior Vena Cava is a major blood vessel that brings blood from the head, neck, upper chest, and arms to the heart. SVCS happens when the SVC becomes partially blocked my a mass, usually mediastinal tumors.

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4
Q

Causes of Cardiophrenic Angle Mass

A
  • Common (Pericardial fat and pericardial cyst)

- Less Common - (Morgagni herniation, lymphadenopathy, malignant neoplasm

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5
Q

Symptoms of Cardiophrenic Angle Mass

A
  • Mild dyspnea upon exertion
  • Intermittent cough
  • Lobular opacity in left cardiophrenic angle
  • Diminished breath sounds in the left infra scapular region with occasional crepitus
  • No prior cardiac hx
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6
Q

Pericardium

A
  • Membrane that surrounds, protects and holds the heart in place
  • 2 layers: fibrous and serous pericardium (together are know as parietal pericardium)
  • Allows heart to beat without friction
  • Allows heart room to expand
  • Filled with fluid ~ 5 to 30mL
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7
Q

Fibrous Pericardium

A
  • Prevents overstretching
  • Anchors the heart
  • Provides protection
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8
Q

Serous Pericardium (Parietal Layer)

A
  • Forms a double layer (parietal and visceral)

- Thin and delicate

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9
Q

3 layers of the heart was from outside to inside?

A

Epicardium (aka serous pericardium visceral layer), myocardium, endocardium

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10
Q

3 attachments of the Pericardium

A
  • Central tendon of diaphragm
  • Sternopericardial ligaments
  • Verteobropercardial ligaments
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11
Q

Pericardium Arterial blood supply

A
  • Branches of internal thoracic arteries

- Bronchial, esophageal, and superior phrenic arteries

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12
Q

Venous drainage of Pericardium

A
  • Azygos system

- Percadirophrenic veins

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13
Q

What is Cardiac Tamponade?

A
  • Tamponade is when the pericardium fills with blood or serosanguinous fluid
  • This compresses the heart and ↓ CO
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14
Q

Acute Tamponade vs. Chronic Tamponade

A
  • Acute (Rapid volume increase)

- Chronic (Pericardium stretches over time to compensate)

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15
Q

Effect of Cardiac tamponade on the heart during inspiration and expiration

A
  • Expiration allows more blood than during inspiration but still less than normal
  • Inspiration further compresses the heart which makes less blood enter ventricle and further decreases CO
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16
Q

2 Interwoven layers of Myocardium

A
  • Interdigiting deep and superficial (spinospiral)

- Superficial bulbospiral

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17
Q

Effect of Myocardium fiber orientation?

A
  • LV chamber shortening along heart’s longitudinal axis

- Torsional twisting motion during contraction ↑ LV EJ fraction

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18
Q

Result of Heart Failure patients losing the “Twisting” motion due to spiral myocardium muscle fibers

A

↓ EF

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19
Q

Biomechanics of heart muscle contraction

A
  • At rest, tropomyosin covers troponin binding sites
  • Ca2+ released fro SR binds to troponin causing tropomyosin to move
  • Actin binding sites exposed
  • Myosin head binds and flexes
  • Filaments slide past each other
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20
Q

Troponin I
Troponin C
Troponin T

A

Troponin I - Inhibits actin/myosin interaction
Troponin C - Binds Ca2+ and exposes binding sites
Troponin T - Ties or anchors the other troponin molecules and influences Ca2+ sensitivity

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21
Q

Effects of inhaled anesthetics on cardiac myocites

A

Inhibit Ca2+ influx into cardiac myocites which results in depression of contractility

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22
Q

4 Biomarkers of an MI

A
  • Troponin I
  • Troponin T
  • Myocardial fraction of CK
  • Myoglobin
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23
Q

Right Atrium receives deoxygenated blood from which 3 veins

A
  • Superior Vena Cava
  • Inferior Vena Cava
  • Coronary Sinus
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24
Q

Left Atrium receives oxygenated blood from ____?

A

The 4 pulmonary veins:

1) Right superior PV
2) Right inferior PV
3) Left Superior PV
4) Left inferior PV

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25
Q

Auricles

A

Pouch like structures on the surface of each atria that increases capacity

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26
Q

Right Ventricle pumps blood_______?

A
  • Pumps blood out to Pulmonary Trunk which divides into R and L pulmonary arteries
  • Pumps blood a short distance, against less resistance, and against lower pressure
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27
Q

Left Ventricle pumps blood ______?

A
  • Pumps blood out to aorta
  • Pumps blood a Longer distance, against more resistance, and requires higher pressure
  • Thickest chamber (works to maintain same rate of blood flow as right side
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28
Q

Valves of the Right Atrium

A
  • Eustachian Valve (a rudimentary valve that protect the entrance of the IVC into the RA)
  • Thebesian Valve - (valve that protects the entrance from CS into the RA)
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29
Q

Right Atrium wall thickness

A

2mm

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30
Q

Fossa Ovalis

A

A depression in the wall of the right atrium, that used to be the hole (foramen ovale) that connected RA and LA during fetal development

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31
Q

Right Ventricle Wall thickness

A

4 to 5mm

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32
Q

Conus Arteriosus

A

Conical pouch in the superior left side of the right ventricle from which the pulmonary artery arises

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33
Q

Right Ventricle characteristics

A
  • SV ~ same as LV each cycle
  • Contains Conus Arteriosus
  • Decompensates easily with ↑ in afterload
  • Easily accommodates ↑ in preload compared to LV
  • Produce < 20% stroke work compared to LV
  • Thin RV wall with more compliance
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34
Q

Left atrium Wall Thickness

A

3mm

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35
Q

Atrial Kick

A
  • Left Atria receives 20 to 30% increase in LVEDV which increases CO
  • Compromised PTs rely on Atrial Kick to achieve adequate CO
  • Normal PTs do not
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36
Q

Left Ventricle Wall Thickness

A

8 to 15mm

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37
Q

Why is the LV so thick

A
  • Necessary to overcome SVR, afterload and maintain SV
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38
Q

2 Large Papillary Muscles of the LV

A
  • Anterior papillary muscle from ant. LV wall

- Posteriror papillary muscle from post. aspect of inferior wall

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39
Q

4 Areas for stethoscope placement

A
  • Aortic area (2nd -3rd right interspace)
  • Pulmonic area (2nd to 3rd left interspace)
  • Tricuspid area (left lower sternal area)
  • Mitral area (apex)
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40
Q

2 Atrioventricular Valves

A
  • Prevent back flow into the atria
  • Pressure in atria opens valve
  • Pressure in ventricles closes valve
  • Tricuspid valve (btw RA and RV)
  • Bicuspid (mitral) Valve (btw LA and LV)
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41
Q

2 Semilunar Valves

A
  • Prevent back flow into ventricles
  • Pressure in ventricles opens valve
  • Pressure outside ventricles closes valve
  • Pulmonary Semilunar Valve (btw RV and Pulmonary trunk)
  • Aortic Semilunar Valve (btw LV and aorta)
42
Q

3 Valve Disorders

A
  • Stenosis (narrowing that restricts blood flow)
  • Insufficiency or Incompetency (failure of valve to close completely)
  • Prolapse (when AV valve cusp is pushed up into atrium)
43
Q

How is stenosis of the valve repaired?

A
  • Balloon valvuloplasty
  • Surgical repair
  • Valve replacement
44
Q

AV valves are anchored inside the heart by ___?

A
  • Chordae Tendonae (cords btw valve cusps and papillary muscle)
  • Papillary Muscles (cone-shaped bundles of papillary muscle)
45
Q

Function of Chordae Tendonae and Papillary Muscles

A

Prevents mitral valve prolapse

46
Q

Triscuspid Valve

A
  • Normal area = 7cm²
  • Thinner and more translucent than mitral valve
  • 3 leaflets (ant., post., and septal)
  • Symptoms assoc’d. w/stenosis when area < 1.5cm²
47
Q

Mitral (Bicuspid) Valve

A
  • Normal valve area 4-6cm²
  • Symptoms appear when area decreased by half or more
  • 2 leaflets (ant. - oval shape, post. - crescent shape)
48
Q

Mitral Apparatus

A

The functional unit of the 4 anatomies that aid in unidirectional flow throw the mitral valve. 4 anatomies include: leaflets, chordae tendonae, papillary muscles, and mitral annulus.

49
Q

Changes in anatomy from Mitral valve replacement

A
  • Chordal attachments severed

- Reduced EF

50
Q

Pulmonic valve leaflet names

A

Based on anatomic locations

  • right
  • left
  • anterior
51
Q

Aortic valve leaflet names

A

Based on Coronary artery osmium

  • right coronary
  • left coronary
  • non coronary
52
Q

Aortic Valve

A
  • Aortic cusps thicker than pulmonary secondary to LV ejection pressures
  • Normal valve area = 2.5-3.5cm²
  • Area reduction by 1/3-1/2 results in symptoms
53
Q

Aortic Valve Stenosis can produce _____?

A
  • ↓ CO
  • ↑ PVR
  • Ventricular hypertrophy
54
Q

Why aren’t Semilunar Valves anchored like AV valves?

A

because they are subjected to lower back pressures (20 – 80 mmHg) in the aorta and pulmonary trunk vs. 120 mmHg pressure in the ventricles.

55
Q

Fossa Ovalis

A
  • Remnant of the foramen ovale

- Opening through the atrial septum

56
Q

Ligamentum Arteriosum

A
  • Remnant of the ductus arteriosus

- Temporary blood vessel that shunts blood from pulmonary to aorta

57
Q

Tribeculae Carnae

A
  • “Meaty Ridges”
  • Bundles of cardiac muscle within chambers
  • Similar to papillary muscles but not attached to valves
58
Q

Fibrous Skeleton of the Heart

A
  • Dense connective tissue
  • Forms ring structure of the valves
  • Prevents overstretching of valves
  • Electrically insulates Atria from Ventricles
59
Q

What are the 4 interconnected annuli structures of the heart that forms the fibrous skeleton?

A
  • Fibrous ring of pulmonary valve
  • Fibrous ring of aortic valve
  • Right atrioventricular ring
  • Left atrioventricular ring
60
Q

Tendon of Conus

A

Connects the fibrous ring of the pulmonary valve with the fibrous ring of the aortic valve

61
Q

Left Fibrous Trigone

A

Connects fibrous ring of aortic valve with left atrioventricular ring

62
Q

Right Fibrous Trigone

A

Connects left atrioventricular ring with right atrioventricular ring

63
Q

Trace blood flow from Vena Cava and Coronary Sinus all the way to the Left Atrium (Pulmonary Circulation)

A

Coronary Sinus and Vena Cava&raquo_space;> Right Atrium&raquo_space;> Tricuspid Valve&raquo_space;> Right Ventricle&raquo_space;> Pulmonary Semilunar Valve&raquo_space;> Pulmonary Trunk&raquo_space;> Pulmonary Arteries/Arterioles&raquo_space;> Pulmonary capillaries (where gas is exchanged)&raquo_space;> Pulmonary Venules/Veins&raquo_space;> Left Atrium

64
Q

Trace blood flow from Left Atrium all the way back to the Right Atrium (Systemic Circulation)

A

Left Atrium&raquo_space;> Bicuspid Valve&raquo_space;> Left Ventricle&raquo_space;>Aortic Semilunar Valve&raquo_space;> Aorta&raquo_space;> Systemic Arteries/Arterioles&raquo_space;> Systemic Capillaries (gas exchange occurs)&raquo_space;> Systemic Venules/Veins&raquo_space;> Vena Cava&raquo_space;> Right Atrium

65
Q

Right Sided CHF vs. Left Sided CHF

A
  • Right (Peripheral edema)

- Left (Pulmonary edema)

66
Q

Sinus of Valsalva and Coronary Artery Ostia

A

Sinus of Valsalva is the enlargement of the area above the aortic valve that functions to permit aortic valve opening during systole without the occlusion of coronary artery ostia.

67
Q

Theorized by Leonardo DiVinci?

A

Flow vortices behind the leaflets of aortic valve in the sinus of Valsalva allowed valves to open without occluding the coronary artery Ostia

68
Q

Function of the Coronary Circulation?

A
  • Deliver oxygen and nutrients to myocardium

- Remove CO2 and waste

69
Q

Coronary Circulation Flow of Blood

A

Aorta&raquo_space;> Coronary arteries&raquo_space;> coronary capillaries&raquo_space;> coronary veins&raquo_space;> coronary sinus&raquo_space;> Right atrium

70
Q

Coronary Circulation Scheme of Distribution

A
  • Ascending Aorta&raquo_space;> R and L Coronary Artery
  • R Coronary Artery&raquo_space;> Posterior Interventricular Branch and Marginal Branch
  • Posterior Interventricular Branch&raquo_space;>Both Ventricles
  • Marginal Branch&raquo_space;> Right Ventricle
  • L Coronary Artery&raquo_space;> Anterior Interventricular Branch and Circumflex Branch
  • Anterior Interventricular Branch&raquo_space;> Both Ventricles
  • Circumflex Branch&raquo_space;> Left Ventricle and Left Atrium
71
Q

Collateral Arteries

A
  • Are connections, or anastomoses, between the branches of the coronary circulation
  • Protects the heart from ischemia
  • Formed by arteriogenesis or angiogenesis
  • Distribution of capillaries is uniform throughout atria & ventricles, except in AV node & interventricular septum = more vulnerable to ischemia
72
Q

Coronary Veins

A
  • Brings deoxygenated blood from myocardium

- Drains via the coronary sinus into right atrium

73
Q

Flow of blood through coronary veins

A

Aorta&raquo_space;> Coronary arteries&raquo_space;> coronary capillaries&raquo_space;> coronary veins&raquo_space;> coronary sinus&raquo_space;> Right atrium

74
Q

3 Major Coronary Veins that deliver blood to the Coronary Sinus

A
  • Great Cardiac Vein (within the anterior interventricular sulcus)
  • Middle Cardiac Vein (within the posterior interventricular sulcus)
  • Small Cardiac Vein (within the coronary sulcus – posterior right side)
75
Q

Causes of Myocardial Ischemia

A
  • Blood clot
  • Atherosclerosis
  • Other rare causes
76
Q

3 Types of Angina Pectoris

A
  • Exertional (pain with activity, relieved with rest)
  • Variant (pain at rest)
  • Unstable (prolonged pain at rest)
77
Q

Methods of Myocardial Reperfusion

A
  • Thrombolytic agents (“clot busters” )
  • Balloon angioplasty
  • Coronary artery bypass grafts
78
Q

Myocardial Infarcation

A
  • “Heart Attack”
  • Loss of living heart muscle as a result of prolonged or severe ischemia
  • Tissue dies and is replaced by scar tissue
79
Q

Coronary Angioplasty

A

Balloon catheter is inserted into an artery of an arm or leg and guided into a coronary artery

80
Q

CABG

A
  • Coronary Artery Bypass Grafting

- Grafted blood vessel between aorta and unblocked portion of coronary artery

81
Q

What happens during the 5 Phases of and Action Potential of a Cardiac Cell

A
  • Phase 0: Fast Na+ channels open and Rapid Na+ influx
  • Phase 1: K+ moves out to ECF and returns TMP to 0mV
  • Phase 2: L-type Ca2+ channels open and Ca2+ moves to the ICF to balance K+ efflux (plateau), also ryanodine receptors release Ca2+ from SR.
  • Phase 3: Ca2+ channels close, but K+ channels remain open and return TMP to -90mV
  • Phase 4: Na+ and Ca2+ channels closed. K+ open to keep TMP stable at -90mV
82
Q

Refractory Period

A

Refractory period allows ventricles to empty before next contraction

83
Q

4 Types of Refractory Periods

A
  • ARP (absolute) = does not allow any depolarizations.
  • ERP (effective) = may allow non-propagated depolarizations.
  • RRP (relative) = allows stronger than normal stimulus to trigger depolarization.
  • Supranormal = hyperexcitable period – even weak stimulus can cause an action potential
84
Q

Action Potential of Cardiac Nodal Cells

A
  • Nodal cells exhibit only Phases 4, 0 & 3
  • Rapid depolarization is absent
  • Plateau does not occur
85
Q

Pressure Requirements for each Ventricle

A
  • Left Ventricular pressure needs to surpass 80 mmHg in Aorta for valve to open
  • Right Ventricular pressure needs to surpass 20 mmHg in Pulmonary Trunk for valve to open
86
Q

Volume Changes

A

Atrial systole contributes a final 25 ml to the already 105 ml in the resting/filling ventricle, for a total EDV of 130 ml

87
Q

Ejection Fraction

A
  • Left Ventricle ejects about 70 ml (of the 130 ml) into the Aorta
  • EF = SV/EDVx100
88
Q

Cardiac Output

A

HR x SV

89
Q

What happens when ventricular pressure drops below atrial pressure

A
  • AV valves open and passive ventricular filling begins again.
  • At the end of the relaxation period, the ventricles are about three-quarters full (~ 105 ml)
90
Q

3 Factors that regulate Stroke Volume

A
  • Preload
  • Contractility
  • Afterload
91
Q

Preload

A
  • The greater the stretch, the greater the contraction (ex: a rubberband)
  • Frank-Starling Law (Preload is proportional to EDV)
92
Q

Afterload

A
  • The pressure that must be overcome before SL valves open
  • 80 mmHg pressure in Aorta
  • 20 mmHg pressure in Pulmonary Trunk
93
Q

Efferent Sympathetic Nerve Fibers

A
  • Originate in Thoracic S.C.
  • Branch into Super, Middle & Inferior Cardiac Nerves
  • Join at Cardiac Plexus (neural jct. @ root of Aorta)
  • Release Norepinephrine
  • Increase HR & strength of contraction.
94
Q

Efferent Parasympathetic Nerve Fibers

A
  • Originate in M.O.
  • Travel via C.N. X to join Cardiac Plexus
  • Release ACh
  • Decrease HR & strength of contraction.
95
Q

Epinephrine Effects

A
  • β1 in conduction system (excitatory) = HR & contraction
  • β2 in coronary vessels (inhibitory) = coronary vasodilation
  • β3 throughout heart, opposes effects of β1 & β2 = prevents overstimulation by sympathetic nervous system
96
Q

Norepinephrine Effect

A
  • α1 in systemic & coronary arteries (excitatory) = vasoconstriction
  • α2a on sympathetic ganglia & nerve terminals (inhibitory) = vasodilation
97
Q

Automaticity

A
  • Property of generating spontaneous depolarization to threshold
  • Automatic cells: All heart cells capable of spontaneous depolarization
98
Q

Rhythmicity

A
  • Regular generation of an action potential by the heart’s conduction system
  • SA node depolarizes spontaneously 60-100 times per minute
  • AV node 40-60
  • Ventricles 20-40
99
Q

Interpret the following elements of an ECG:

  • Pwave
  • PR Interval
  • QRS Complex
  • ST Interval
  • QT Interval
  • TWave
A
  • Pwave: Atrial depolarization
  • PR Interval: Time from onset of atrial depolarization to the onset of ventricular depolarization
  • QRS Complex: Sum of all ventricular depolarizations
  • ST Interval: Ventricular myocardium depolarized
  • QT Interval: Electrical systole of the ventricles
  • Twave: Ventricular repolarization
100
Q

How large can the Pericardium increase before the patient experience any symptoms?

A

10x

101
Q

Basic Wave Abnormalities:

1) P wave enlarged
2) Q wave enlarged
3) R wave enlarged
4) T wave flatter
5) T wave elevated

A

1) P wave enlarged - Enlarged Atrium
2) Q wave enlarged - MI
3) R wave enlarged - Enlarged Ventricles
4) T wave flatter - Insufficient O2
5) T wave elevated - Hyperkalemia

102
Q

Basic Segment Abnormalities:

1) PQ Lengthened
2) ST Elevated
3) ST Depressed
4) QT Lengthened

A

1) PQ Lengthened - SA node pathology or Detour around scar tissue from previous MI, CAD, or rheumatic fever
2) ST Elevated - Acute MI
3) ST Depressed - Insufficient O2
4) QT Lengthened - Myocardial damage, ischemia, conduction abnormalities

CRNA Adv. A&P (8 decks)

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