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Cardiovascular Flashcards

1
Q

Where is the heart located?

A

Mediastinum of thoracic cavity
Top at 3rd costal cartilage
Apex between 4th and 5th rib

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2
Q

What is the outer layer of the heart?

A

Epicardium (visceral layer of serous pericardium)
Contains nerves, vessels and fat for protection

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3
Q

What is the middle layer of the heart?

A

Myocardium
Thickest layer
Specialised interconnected muscle cells perform contraction

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4
Q

What is the inner layer of the heart?

A

Endocardium
Lines the chambers
Smooth surface for blood flow

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5
Q

What is the pericardium?

A

Protective sac around heart
Together with pericardial cavity (gap between pericardium and epicardium) allows it to beat without friction or injury

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6
Q

What are the layers of the pericardium?

A

Fibrous pericardium: dense connective tissue to protect, support and anchor to sternum and diaphragm

Serous pericardium: has two layers - parietal (lines fibrous layer) and visceral (continual with epicardium)

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7
Q

What is automaticity?

A

Heart cells ability to generate an impulse without stimulation

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8
Q

What are cardiac fibroblasts?

A

Cells that support structure and aide in transmitting impulses

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9
Q

What are cardiac myocytes?

A

Specialised interconnected cells which create heart contraction and relaxation

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10
Q

What are cardiac endothelial cells?

A

Form endocardium to line chambers and regulate substance exchange

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11
Q

What are cardiac conducting cells?

A

Specialised cells generate impulses

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12
Q

What valves separate atria from ventricles?

A

Atrioventricular valves
Tricuspid on the right
Mitral (bicuspid) on the left

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13
Q

What valves separate ventricles from large vessels?

A

Semilunar
Pulmonary valve and aortic valve

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14
Q

What is the pulmonary circulatory system?

A

DeO2 blood enters vena cavas, RA, through tricuspid valve, RV, pulmonary valve, PA, lungs, PV
Blood is now O2

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15
Q

What is the systemic circulatory system?

A

O2 blood enters LA, through mitral valve, LV, aortic valve, aorta to whole body

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16
Q

What is the function of heart valves?

A

Prevent back flow of blood during systole
Chordae tendinae and papillary muscles help reinforce valves

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17
Q

Define cardiac output

A

Amount of blood pumped by heart per minute

CO = SV x HR

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18
Q

What is SV?

A

Stroke volume
Amount of blood pumped by the LV per beat (ml)

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19
Q

What 3 factors influence SV?

A

Preload - amount of blood returned to the heart influences stretch/recoil ability
Contractile force - strength of contraction influenced by calcium
After load - amount of resistance LV has to overcome to eject blood out

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20
Q

What is blood pressure?

A

The force exerted on the walls of vessels

BP = CO x total vascular resistance

Also influenced by blood volume, vessel elasticity and vessel diameter

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21
Q

How do you manually measure BP?

A

Sphygmomanometer and stethoscope over brachial artery
Inflate cuff until all sounds gone then start letting down slowly
First sound to return called korotkoff sounds and is systolic
When sound disappears again that is diastolic

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22
Q

What are the 3 stages of hypertension?

A

1: >140
2: >160
3: >180

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23
Q

What is the pathway of electrical impulse through the heart?

A

SA node depolarises causing atrial contraction
AV node delays signal to allow atrium to empty
Signal reaches Bundle of His, L and R branches and purkinje fibres causing ventricles to contract

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24
Q

What happens at each part of the ecg?

A

P: atrial depolarisation/contract
QRS: ventricular depolarisation/contract
T: ventricular repolarisation/relax

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25
What intrinsic factors affect cardiac cycle?
Automaticity of cardiac cells (fail safe if no impulse received) Highest intrinsic rate at SA and decreases at each point thereafter
26
What extrinsic factors affect cardiac cycle?
ANS Baroreceptors Endocrine hormones Atrial natriuretic peptide (released from atrial cells to reduce CO if blood volume or stretch too high)
27
Describe arteries
Carry oxygenated blood away from heart Muscular and elastic Branch into arterioles and capillaries
28
Describe veins
Carry deoxygenated blood back to the heart Contain valves to prevent back flow Connect to capillaries via venules
29
Describe capillaries
Site of gas exchange Single endothelial cell layer wall for maximum exchange Basement membrane surrounds for structural support Pericytes are contractile cells to contract and relax
30
What are the layers of vessels?
Tunica intima: smooth internal layer for flow Tunica media: muscular middle layer to change diameter and give strength/support Tunica adventitia: fibrous outer layer for protection
31
What are the four sections of the aorta?
Ascending Arch Thoracic Abdominal (bifurcates into L/R femoral arteries)
32
What 3 factors aide in blood flow through veins?
Valves Skeletal muscle pump action Thoracic pump action via breathing creating pressure changes in the chest
33
What is an abdominal aortic aneurysm?
Bulge in the wall of the abdominal aorta SX: back/abdo pain, pulsating feeling in abdomen, unequal BP on each side
34
What is a DVT?
Thrombus in a deep vein caused by disruption of flow, injury or increased clotting May lead to PE and post thrombotic syndrome SX: swell, pain, red, warm
35
How much blood do adults have?
70ml/kg
36
What is the ratio of cells comprising blood?
55% plasma 45% RBC <1% WBC and platelet
37
What are erythrocytes?
RBC Contain haemoglobin to transport O2
38
What are leukocytes?
WBC Identify and destroy invaders; produce antibodies
39
What are thrombocytes?
Platelets Small fragments derived from megakaryocytes produce plug to stop bleeding
40
How do RBC transport O2?
Haemoglobin molecule has 4 subunits (Heme group) each with an Fe molecule where oxygen binds Disk shape and no nucleus improves surface area for better gas exchange
41
What is carbaminohaemoglobin?
Product of CO2 bound to haemoglobin
42
What controls production and maintenance of RBC?
Process called erythropoiesis regulated by kidney hormone erythropoietin Occurs in marrow RBC lasts 120 days then recycled by liver/spleen
43
What is anaemia?
Low number of RBC or haemoglobin Caused by blood loss, RBC destruction (autoimmune, infection) or reduced production (low iron, disease) SX: fatigue, dizzy, palpitation, SOB
44
What are the 6 functions of blood?
Oxygen and nutrient transport CO2 and waste removal Immune defence Clotting Regulation of temperature Transport hormones etc
45
How do blood groups work?
Determined by what antigens are present on surface of RBC: A, B, AB or none (O) Antibodies opposite to antigens are present in the plasma Rh antigen is either present + or not -
46
How does paediatric CVS differ?
Higher BSA leads to greater blood loss Reduced contract-ability means they can’t change SV so increase HR instead High metabolic rate = heart works heart and more O2 needed Higher blood volume (newborn 90ml/kg) Can compensate well but then deteriorate quickly
47
How does geriatric CVS differ?
Reduced vessel elasticity (arteriosis) so higher BP SA node tired so lower intrinsic HR Capillary walls thicken = less exchange Reduced RBC production = minor anaemia Reduced heart valve function
48
What is artherosclerosis?
Chronic disease of hardened and narrowed arteries from the build up of plaque on artery walls
49
What is the disease process of artherosclerosis?
Damage to endothelium Lipids penetrate and accumulate at injury site LDL oxidises and triggers inflammatory response attracting WBC to area These become macrophages and engulf LDL forming foam cells Foam cells and smooth muscle cells form fatty streaks which progress into plaque over time
50
What issues can artherosclerosis cause?
Plaque can break off and cause clots resulting in angina, MI, TIA, stroke etc
51
What is angina pectoris?
The temporary reduction of blood flow to heart muscle often due to coronary artery artherosclerosis
52
What is the disease process of angina?
Reduced blood flow causes a lack of oxygen resulting in ischemic tissue Ischemic tissue does not receive energy to function and waste products build up including adenosine, bradykinin and lactic acid These stimulate cardiac nociceptors signalling pain to the brain
53
What are the symptoms of angina and MI
Pain - squeeze, pressure, tight chest which may refer to left jaw/shoulder/arm SOB or high RR High BP and HR Fatigue Sweaty/clammy Nausea Dizzy (MI has sudden onset, not improved with rest and ECG changes)
54
What is stable and unstable angina?
Stable occurs predictably under physical or emotional stress. Improves with rest Unstable occurs unpredictably, even at rest
55
What are the risk factors of angina and MI?
Age >45 Male more common Family hx Smoking, hypertension, obesity, poor diet, low exercise, smoking, stress, DM, high cholesterol
56
What medicines are used by EMT to treat angina?
Nitrates for vessel dilation Morphine for pain Aspirin to reduce clot
57
What is a myocardial infarction?
Blocked flow to part of cardiac muscle resulting in tissue damage (Usually from thrombus from artherosclerosis)
58
What is a STEMI and NSTEMI MI?
STEMI is when coronary artery is completely blocked and has raised ST segments on ECG NSTEMI is when coronary artery is partially/temporarily blocked and ST segment may be depressed, inverted or not change at all
59
What is the difference between angina and an MI?
Angina is a temporary reduction in blood flow usually from narrowed arteries, which is short lasting and improves with rest. MI is a disruption to blood flow usually from a blocked artery that results in tissue damage.
60
What is a cardiac arrest?
Heart stops beating effectively and therefore the body is starved of blood/O2 Asystole, VF and VT
61
What is acute cardiogenic pulmonary oedema?
Fluid in the lungs caused by heart dysfunction LV cannot pump effectively so blood remains after contraction causing a back pressure in pulmonary circulation causing fluid to be forced into lung tissue. Fluid in lungs reduces surface area for gas exchange
62
What are the symptoms of ACPO?
Crackles/rales on auscultation SOB - fast and shallow with strained accessory muscles Wheeze/cough Pink sputum Anxious Cold/clammy Cyanosis High HR
63
What causes rales on auscultation?
Surfactant that lines alveoli to keep them open during exhalation gets washed out by fluid. This causes the alveoli to ‘pop’ open and closed during breathing.
64
What else can cause fluid in the lungs?
Toxic inhalation ARDS Kidney issues causing circulatory overload High altitude PE
65
What are other causes of fluid in the lungs?
ARDS Toxic inhalation Kidney disease causing circulatory overload High altitude PE
66
How does cardiovascular system differ in pregnancy?
Higher blood volume Anaemia Higher HR Reduced ability to compensate Higher metabolic demand

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