Cardiovascular Flashcards
The superior and inferior vena cava drains blood into (chamber of the heart)
A. RIGHT ATRIUM The superior and inferior vena cava drains blood into (chamber of the heart) Right atrium
The (systemic/pulmonary) _____ circulation face greater resistance.
A. SYSTEMIC The SYSTEMIC circulation face greater resistance.
The ____ collects blood from coronary vessels returning from the myocardium
A. CORONARY SINUS The CORONARY SINUS collects blood from coronary vessels returning from the myocardium
The ____ is the muscular middle layer of the heart and forms the bulk of the heart tissue
A. MYOCARDIUM The MYOCARDIUM is the muscular middle layer of the heart and forms the bulk of the heart tissue
The ___ are tendons that attach to the atrioventricular valves and prevent regurgitation of blood back into the atrium
A. CHORDAE TENDINAE The CHORDAE TENDINAE are tendons that attach to the atrioventricular valves and prevent regurgitation of blood back into the atrium
The four ____ carry oxygenated blood from the lungs to the left atrium
A. PULMONARY VEINS The four PULMONARY VEINS carry oxygenated blood from the lungs to the left atrium
The _____ is the innermost layer of the heart and is made of a thin layer of endothelium
A. ENOCARDIUM The ENDOCARDIUM is the innermost layer of the heart and is made of a thin layer of endothelium
The mitral valve has (two/three)___ leaflets
A. TWO The mitral valve has TWO leaflets
The _____ carry deoxygenated blood from the heart to the lungs
A. PULMONARY ARTERIES The PULMONARY ARTERIES carry deoxygenated blood from the heart to the lungs
The _____ layer of the pericardium sticks to the heart itself forming the epicardium
A. VISCERAL The VISCERAL layer of the pericardium sticks to the heart itself forming the epicardium
The heart sound typically heard in pulmonic stenosis is a (diastolic/systolic) ____ ejection murmur
A. SYSTOLIC The heart sound typically heard in pulmonic stenosis is a (diastolic/systolic) SYSTOLIC ejection murmur
The most common symptom of infective endocarditis is ____ which is very nonspecific
A. FEVER The most common symptom of infective endocarditis is FEVER which is very nonspecific
Milroy disease causes (primary/secondary) ____ lymphedema.
A. PRIMARY Milroy disease causes PRIMARY lymphedema.
The mainstay of management of tricuspid insufficiency is _____
A. treatment of the underlying cause. The mainstay of management of tricuspid insufficiency is TREATMENT OF THE UNDERLYING CAUSE
A membrane potential of -85 millivolts means that the (interior/exterior) ____ of the cell is negative.
A. INTERIOR A membrane potential of -85 millivolts means that the (interior) of the cell is negative.
A(n) (early/late) ____ complication of rheumatic fever is mitral valve regurgitation.
A. EARLY A(n) (early/late) ____ complication of eheumatic fever is mitral valve regurgitation.
The greater the amount of elastic tissue within a blood vessel, the (Higher/Lower) ___ the elastance
A.HIGHER The greater the amount of elastic tissue within a blood vessel, the (Higher/Lower) ___ the elastance
Conduction Velocity in the heart is slowest at the _____ node
A. ATRIOVENTRICULAR Conduction Velocity in the heart is slowest at the ATRIOVENTRICULAR node.
____ due to decreased blood supply in the myocardium is characterized by inverted T waves on the electrocardiogram.
A. ISCHEMIA ___ due to decreased blood supply in the myocardium is characterized by inverted T waves on the electrocardiogram.
An ECG usually ST segment (Elevation/Depression) _____ in a transmural myocardial infarction.
A. ELEVATION An ECG usually ST segment (Elevation/Depression) _____ in a transmural myocardial infarction.
The anterior inferior cerebellar artery is a branch of the ____ artery
A. BASILAR The anterior inferior cerebellar artery is a branch of the ____ artery
____ describes the formation of sterile skin pustules after minor trauma and is characteristically found in Behcet disease.
A. PATHERGY describes the formation of sterile skin pustules after minor trauma and is characteristically found in Behcet disease.
____ is the most important risk factor for stroke
A. HYPERTENSION ____ is the most important risk factor for stroke
a holosystolic (pansystolic) murmur at the lower left sternal border is most likely caused by ___ or tricuspid regurgitation.
A. ventricular septal defect
Thrombophlebitis secondary to peritonitis most commonly occurs in the ____
A. portal vein
____ is the most common risk factor for atrial fibrillation.
A. hypertension. is the most common risk factor for atrial fibrillation.
Severe pericardial effusion can lead to the clinical triad of _______ _________ and _____
A. hypotension, distended neck veins, and muffled heart sounds
Renal disease in adults having Henoch-Schonlein purpura is (more/less) severe than that of the children affected by the same disease
A. more severe.
The best initial test to diagnose atherosclerosis of the vessels of the lower limb is the_____
A. ankle-brachial index.
A consequence of increased (preload/afterload) ___ is that less blood is ejected from the ventricle during systole
A. Afterload
Hypoplastic left heart syndrome is the most common cause of death from cardiac defects in the (time period) ___ of life
A. First month.
(endovascular/open surgical) ____ procedures for treating subclavian steal syndrome have fewer complications.
A. endovascular
What is not content of mediastinum: heart, lung thoracic duct oesophagus. primary bronchi
lung
what is lateral relationship of the heart? a phrenic nerve b pleura c pleura and phrenic nerve d. vagus nerve e. pleura and vagus nerve
Pleura and phrenic nerve
heart lies anterior to which vertebrae a. t1-t4 bt2-t5 ct4-t7 et5-t8
t5 - t8 vertabrae recomband (laying down) t5-t8 4 thoracit vertabrae. when standing lung drops slightly. lays behind costal cartilage 4-7 but vertabrae t5 - t8
Anterior suface of heart is formed by a. rv b ra +rv c ra - rv -lv d ra rv la lv e rv la lv
Ra + rv and LV
What is the location of apex of heart a) 5th l intercostal space midaxillary line b) 5th intercostal space parasternal line c) 5th intercostal space midclavicular line d) 4th left intercostal space midclavicular line e) 4th left intercostal space midaxillary line
5th intercostal space, midclavicular line. REMEMBER LEFT.
phrenic nerve supplies a- visceral pericardium b- parietial pericardium fibrous pericardiam fibroud paratiel pericardium partietal and visceral pericardium
fibrous and patietal pericardium
which correct sympathetic innervation a decrease hr b increase rt and force contraction c root value t1 - t6 d innervate parietal layer of the pericardium e relax the heart muscle
increases heart rate and force of contraction
which following correct a) coronary sulcus grow between the right atrium and right ventricle b) circumflex artery branch of right coronary artery c) anterior descending artery is a branch of left coronary artery d) coronary artery arise from coronary sinuses e) posterior descending artery is a branch of the left coronary artery
A. C a- no right and left atrium and ventricle B- no circumflex is branch left coronary artery c) CORRECT d) Not coronary sinuses artery arise, aortic sinuses rise. e) branch of the RIGHT coronary artery.
anterior descending artery supplied which areas of heart ventricle a) ra + rv b rv + lv c) rv +lv + la d) rv + lv + IVS
d) rv + lv + IVS
coronary sinus drains into a) left atrium b) right atrium c) azygos vein d) superior vena cava e) interatrial septa
b) Right atrium
Vacsulogenesis _______ Angiogenesis _________
Vasculogenesis: The NEW formation of a primitive vascular network Angiogenesis: The growth of new vessels from PRE-EXISTING blood vessels.
Which electrolyte maintains the resting potential of ventricular myocytes?
Potassium maintains the resting potential of cardiac myocytes, with depolarization triggered by a rapid influx of sodium ions, and repolarization due to the efflux of potassium. A slow influx of calcium is responsible for the longer duration of a cardiac action potential compared with skeletal muscle.
Hearing a noise after the lub and before the dub can be what?
it is a systolic mumur - can be caused by stenosis of aortic /pulmonary valve or regurgitation through mitral/tricuspid valces
what is the “lub” noise?
mitral and tricuspid valve closing
(aortic/pulmonary valves are open)
what is the “dub” noise?
the aortic and pulmonary valves closing (mitral and tricuspid valves closing)
if you have a murmur after dub (diastole) what is this?
diastolic murmur - could be due to stenosis of mitral/tricuspid valves or regurgitation through aortic/pulmonary valves.
what could cause a continuous murmur?
hole in the septum
left side heart building up to higher pressure than right. pressure L side higher throughout whole cardiac cycle than R. sp hole heart (septal defect) cause a continuous murmur
Regulation of heart rate sympathetic
- nerves release noradrenaline
circulating adrenaline from the adrenal medulla
both act on b1-receptors on sinoatrial node
increases slope of pacemaker potential
increases heart rate = tachycardia.
regulation of heart rate parasympathetic
rest and digest vagus nerve (craniosacral outflow) releases acetylcholine from head to heart
acting on muscarinic cells on the sinoatrial node - hyper polarises decreases slope of pacemaker potential
threshold later interval
decreases HR bradycardia.
regulate stroke volume - preload
preload starling law - energy contraction proportional to the initial length of cardiac muscle fibre.
in vivo what is preload affected by
end-diastolic volume
end-diastolic volume - amount blood left in left ventricle before contraction
Preload or left ventricular end-diastolic pressure (LVEDP),- the initial stretching of the cardiac myocytes prior to contraction/the amount of ventricular stretch at the end of diastole
* so amount of LV stretch before contraction is affected by how much blood is in the LV*
for stroke volume and preload what does an increase in end-diastolic volume cause?
larger the end diastolic volume, the bigger stretch on the cardiac muscle and therefore larger stroke volume.
stroke volume = volume of blood pumped from the left ventricle per beat.
end-diastolic volume - amount blood left in left ventricle before contraction.
Preload or left ventricular end-diastolic pressure (LVEDP),- the initial stretching of the cardiac myocytes prior to contraction/the amount of ventricular stretch at the end of diastole
what is increased venous return
increased end-diastolic volume (vol blood in lv after diastole) and therefore
increased stroke volume (volume blood pumped from the LV per beat)
Decreased venous return =
reduces end-diastolic volume (volume in lv after diastole) therefore
decreased stroke volume - (volume blood pumped from the LV per beat)
what’s the purpose of increased/decreased venous return
to ensure self-regulation. make sure both ventricles pump roughly the same amount of blood
afterload =
Afterload is the pressure that the heart must work against to eject blood during systole. Afterload is proportional to the average arterial pressure
if cardiac muscle is trying to shorten what does it try to do?
push the mitral valve shut
what is stopping it from getting shorter is aortic valve being shut.
what is aortic pressure?
what will it be affected by?
the aortic valve shutting
it will be affected by how easy it is for blood to get out the arterioles = the total peripheral resistance (TPR)
stroke volume with the sympathetic nervous system
bigger stroke volume
sympathetic nerves releasing noradrenaline + circulating adrenaline and adrenal medulla.
both act on b1- receptors on the myocytes.
increases contractility (inotropic effect)
gives stronger but shorter contraction
*more excitation-contraction coupling, more Ca+ more cross-bridges stronger contraction but shorter at Ca+ taken up quicker =more time diastole*
bigger stroke volume
stroke volume with parasympathetic effect
little effect - because the vagus does not innervate the ventricular muscle.
innervates top of heart, atria and sinoatrial node.
if you get increase HR in exercise what happens to cardiac output?
CARDIAC OUTPUT INCREASES :
HR increases - via decreased vagal tone (vagus nerve releasing acetylcholine) increased sympathetic tone
contractility increases - increased sympathetic tone alters inotropic state and shortens systole (act b1 receptors)
venous return increases - via vasoconstriction +skeletal/respiratory pumps maintains preload *constriction returns more blood to heart = increase end-diastolic volume*
total peripheral resistance falls. - due to arteriolar dilation in muscle, skin and heart reduces afterload. (dilate arterioles)
pressure waves are affected by
stroke volume
velocity of ejection
elasticity of arteries
total peripheral resistance
normal blood pressure
120/80
but can range with age etc
pressure flor through arteries and veins
through vasular tree
small drop 95mmHg to 90mmHg as low resistance condiut
pressure flor through arteries and veins
arterioles
large drop 90mmHg-40mmHg as resistance vessels
pressure flor through arteries and veins capillaries
already low and this is good because they are thin-walled (1 cell thick)
pressure flor through arteries and veins leaving back through veins
leaves small pressure difference from 20mmHg to 5mmHg
pressure flor through arteries and veins pulmonary circulation pressure
1.5 of systemic
velocity when relating to cross section
fastest in aorta and vena cava
slowest in capillaries
pressure and flow in veins
end diastolic volume when standing and laying
when standing a smaller end-diastolic volume - smaller preload - reduce stroke volume
co is less and MAP less.
cause distention of blood in legs
when laying - larger end-diastolic volume
if you have a reduced mean arterial pressure
insufficient profusion to body
the brain notices most = faint.
postural hypotension.
raised central venous pressure - neck
dropped venous pressure
The neck vein can collapse = below the clavicle.
venous pressure raises a lot - ven can be visible
arterial baroreflex
sensors in aotric arche and some in carotid sinus
stretch receptors to sense stretch on wall increase fire rate to fire action potential
what is normal MAP
what is ideal
70 and 100 mmHg normal
ideal - 90-95mmHg
when receiving signal from aortic baroreceptor and caroited sinus baroreceptors what happens next
sensory or afferent fibres travel up to brain
aortic arch signal travels up vagus nerve (motor autonomic)
caroited sinus baroreceptor signal travel up in cranial nerve glossopharyngeal nerve.
both go to medullary cardiovascular centre
when the signal travels up the vagus nerve and the glossopharyngeal nerve, where does this arrive?
centre?
both go to medullary cardiovascular centre
the medullary cardiovascular centre can then respond by signals where?
parasympathetic
parasympathetic - down vagus nerve to innervate sinoatrial node (pacemaker of the heart)
-acetylcholine - muscarinic receptor, hyperpolarise pacemaker cell = slower
the medullary cardiovascular centre can then respond by signals where?
sympathetic
down sympathetic nerves
sinoatrial node - noradrenaline - b1 receptors - depolarise faster = increase hr .
innervate muscle ventricle b1 - increase ca+ entering
cross-bridge constrict blood vessels adrenaline (alpha1)
venous ^ stroke vol etc
cardiopulmonary baroreceptors
sense central blood volume (stretch receptors)
fire action potential relay medullary cardiovascular centre
receptors sensing pco2 and po2
central chemoreceptors
increase breathing or decrease trigger bp or decrease
receptors sensing metabolite concentration
chemoreceptor in muscle
receptors sensing joint movement
joint receptors
higher centres
hypothalamus and cerebral cortex
what is the valsalva manoevre
forced expiration against a closed glottis
what is the initial effect of the valsalva menoevre
stops venous return reduced preload on the heart and therefore reduces cardiac output
why would you get someone to perform the Valsalva manoeuvre?
to assess the strength of someone’s baroreflex
Concerning the vascular system: Most vascular beds are arranged in parallel.
Select one:
True
False
True. The significance of this being that all body regions receive fresh oxygenated blood, and that the cardiac output can be redirected between different body regions when require
Concerning the vascular system: Most arterioles are innervated only by parasympathetic nerves.
Select one:
True
False
False. Most blood vessels are innervated only by sympathetic vessels. These release noradrenaline which activates alpha 1 receptors and causes vasoconstriction. Most vessels are not innervated by the parasympathetic system. The genitalia and salivary glands are the exceptions that prove the rule.
Concerning the cardiovascular system: The circular smooth muscle of arterioles controls peripheral resistance under the influence of the sympathetic nervous systems
Select one:
True
False
True. The arterioles are indeed the resistance vessels. The smooth muscle surrounding them is controlled by intrinsic mechanisms, but also by central mechanisms. Notably the sympathetic nerves which innervate the arterioles and release noradrenaline, and adrenaline which is released from the adrenal medulla. Both of these activate alpha 1 receptors on the smooth muscle which causes arteriolar constriction and regulates peripheral resistance.
Concerning the cardiac cycle: At resting heart rate, systole takes approximately twice as long as diastole.
Select one:
True
False
False. At resting heart rate, systole takes about 1/3rd of the cardiac cycle, ie it is half as long as diastole. At higher heart rates, most of the time is taken out of diastole and so systole takes a proportionally greater proportion of the cycle.
Concerning the cardiac cycle: The stroke volume of the right ventricle is approximately one fifth of that of the left ventricle.
Select one:
True
False
False. The right and left sides of the heart lie in series and must have the same cardiac output or blood will accumulate in the systemic or pulmonary circulations. They have the same heart rate because they share the same pacemaker, so the stroke volume must also be the same. If you got it wrong you were probably thinking of the pressure evoked by the left ventricle, which is about one fifth of that of the left.
Concerning the electrical activity of the heart: Cells of the myocardium are electrically connected via gap junctions.
Select one:
True
False
True. Cells of the myocardium are both electrically connected (via gap junctions) and physically connected (via the desmosomes). Hence it acts as functional syncytium which depolarizes as one, and contracts as one.
Concerning the cardiac cycle: The left atrial pressure rises at the start of systole.
Select one:
True
False
True. When the ventricle contacts, the mitral and tricuspid valves close and then bulge into the atria, creating the a wave on the atrial pressure trace, which terminates when the aortic and pulmonary valves open.
Concerning the arterial baroreflex: A fall in baroreceptor firing rate triggers a reflex increase in sympathetic outflow.
Select one:
True
False
True. A fall in baroreceptor firing rate signals a fall in mean arterial pressure which triggers (amongst other things) an increase in sympathetic outflow. This will increase heart rate, increase stroke volume, cause venoconstriction and cause arteriolar constriction, all of which will contribute a pressor response - ie an increase in blood pressure.
Concerning the cardiac cycle: A systolic murmur could be caused by regurgitation of blood through the aortic valve.
Select one:
True
False
False. A murmur is generally caused by turbulence in the blood due to regurgitation through a valve that should be closed, or stenosis (narrowing) of a valve that should be open. During systole the aortic valve is open so a systolic murmur could be due to stenosis of the aortic valve. Regurgitation through the aortic valve would cause a diastolic murmur.
Regarding control of the peripheral circulation: Increasing the radius of an arteriole 2-fold, increases its resistance 16-fold.
Select one:
True
False
False. Close. Varying radius does alter resistance to the power of 4, but increasing radius will reduce resistance, not increase it.
Regarding control of the peripheral circulation: The injury response depends on intact nociceptive nerve function.
Select one:
True
False
True. The injury response depends on action potentials invading the terminals of nociceptive C-fibres and triggering the release of substance P.
Concerning the vascular system: Rhythmic contraction of skeletal muscle promotes venous return.
Select one:
True
False
True. This the action of the skeletal muscle pump. It is one of several mechanism that increase venous pressure and venous return during exercise and therefore offset the reduction in end diastolic volume caused by heart heart rates. The others include the respiratory pump, venomotor tone, and increased systemic filling pressure.
Regarding control of the peripheral circulation: Circulating adrenaline causes arteriolar constriction in all body regions.
Select one:
True
False
False. Whilst adrenaline activates alpha 1 receptors and causes arteriolar constriction in the vast majority of body regions, there are notable exceptions. These are the skeletal muscle and cardiac muscle which also express beta 2 receptors which cause arteriolar dilation and swamp the alpha 1 receptor mediated constriction.
Concerning the arterial baroreflex: Sensory information from the arterial baroreceptors is primarily concerned with regulation of mean arterial pressure in the short, rather than the long, term.
Select one:
True
False
True. Cutting the sensory nerves from the aortic and arch and carotid sinus baroreceptors results in loss of short-term, but not long-term, control of blood pressure. Long term control of blood pressure may rely more on sensory input from the cardiopulmonary baroreceptors.
Concerning the arterial baroreflex: Rising from a sitting to a standing position will cause a reflex increase in heart rate and total peripheral resistance.
Select one:
True
False
True. But do you understand the mechanism? Standing causes pooling of blood in the venules of the feet and legs. This reduces end diastolic volume and therefore preload, stroke volume, cardiac output and mean arterial pressure. This fall in blood pressure is sensed by the arterial baroreceptors which trigger a reflex increase in, amongst other things, heart rate and total peripheral resistance to restore blood pressure.
Concerning the pumping ability of the heart: Stimulation of sympathetic fibres innervating the heart increases contractility.
Select one:
True
False
True. Noradrenaline acting on beta1 receptors increases excitation-contraction coupling and gives a stronger contraction for any given preload.
Concerning the cardiac cycle: The second heart sound is heard at the start of diastole.
Select one:
True
False
True. The first heart sounds is caused by the mitral and tricuscpid valves closing at the start of systole, and the second is caused by the aortic and pulmonary valves closing at the start of diastole
Regarding control of the peripheral circulation: Metabolic autoregulation is a mechanism which matches the metabolic rate of a body region to its energy reserves.
Select one:
True
False
False. Metabolic autoregulation is a mechanism that matches the blood flow of a body region to its metabolic demands.
Concerning the pumping ability of the heart: Cutting the sympathetic and parasympathetic innervation of the sinoatrial node will cause an increase in resting heart rate.
Select one:
True
False
True. The fastest (and therefore the) pacemaker cells of the heart have an inherent rate of about 100 beats per minute. This can be speeded up by the sympathetic system or slowed down by the parasympathetic system. At rest, the parasympathetic system dominates and so the heart is said to be under vagal restraint, giving the resting heart rate of about 70 beats per minute.
Concerning the electrical activity of the heart: The Q-T interval gives a rough indication of the duration of ventricular systole.
Select one:
True
False
True. The Q-T interval indicates the time between ventricular depolarisation and ventricular repolarisation, ie the length of the ventricular action potential. This is approximately the same as the length of the contraction evoked and therefore the duration of systole.
What determines preload
The end diastolic volume - the volume of blood in the heart at the end of diastole
Venous return and filling time
