Cardiovascular 17, 18, 19 Flashcards

Question 1

Q

components of whole blood

Answer

A

plasma
55% of whole blood
least dense component
buffy coat
leukocytes and platelets
<1% of whole blood
erythrocytes
45% of whole blood (hematocrit)
most dense component

Question 2

Q

formed elements

Answer

A

buffy coat and erythrocytes

Question 3

Q

water

Answer

A

90% of plasma volume; dissolving and suspending medium for solutes of blood; absorbs heat

Question 4

Q

electrolytes

Answer

A

most abundant solutes by number; cations include sodium, potassium, calcium, magnesium; anions include chloride, phosphate, sulfate, and bicarbonate; help to maintain plasma osmotic pressure and normal blood pH

Question 5

Q

plasma proteins

Answer

A

8% (by weight) of plasma; all contribute to osmotic pressure and maintain water balance in blood and tissues; all have other functions (transport, enzymatic, etc.) as well

Question 6

Q

albumin

Answer

A

60% of plasma proteins; produced by liver; main contributor to osmotic pressure

Question 7

Q

globulins

Answer

A

36% of plasma proteins

Question 8

Q

alpha, beta

Answer

A

produced by liver; most are transport proteins that bind to lipids, metal ions, and fat-soluble vitamins

Question 9

Q

gamma

Answer

A

antibodies released by plasma cells during immune response

Question 10

Q

fibrinogen

Answer

A

4% of plasma proteins; produced by liver; forms fibrin threads of blood clot

Question 11

Q

nonprotein nitrogenous substances

Answer

A

by-products of cellular metabolism, such as urea, uric acid, creatinine, and ammonium salts

Question 12

Q

nutrients (organic)

Answer

A

material absorbed from digestive tract and transported for use throughout body; include glucose and other simple carbohydrates, amino acids (protein digestion products), fatty acids, glycerol and triglycerides (fat digestion products), cholesterol, and vitamins

Question 13

Q

respiratory gases

Answer

A

oxygen and carbon dioxide; oxygen mostly bound to hemoglobin inside RBCs; carbon dioxide transported dissolved as bicarbonate ion or CO2, or bound to hemoglobin in RBCs

Question 14

Q

hormones

Answer

A

steroid and thyroid hormones carries by plasma proteins

Question 15

Q

erythropoietin mechanism for regulating erythropoiesis

Answer

A

stimulus: hypoxia (inadequate O2 delivery) due to
- decreased RBC count
- decreased amount of hemoglobin
- decreased availability of O2
kidney (and liver to a smaller extent) releases erythropoietin
erythropoietin stimulates red bone marrow
enhanced erythropoiesis increases RBC count
O2 - carrying ability of blood rises

Question 16

Q

life cycle of red blood cells

Answer

A

low O2 levels in blood stimulate kidneys to produce erythropoietin
erythropoietin levels rise in blood
erythropoietin and necessary raw materials in blood promote erythropoiesis in red bone marrow
new erythrocytes enter bloodstream; function about 120 days
aged and damaged red blood cells are engulfed by macrophages of spleen, liver, and bone marrow; the hemoglobin is broken down
raw materials are made available in blood for erythrocyte synthesis

Question 17

Q

sickle-cell anemia

Answer

A

Normal erythrocyte has normal
hemoglobin amino acid sequence
in the beta chain.

Sickled erythrocyte results from
a single amino acid change in
the beta chain of hemoglobin

Question 18

Q

granulocytes

Answer

A

neutrophils (50-70%)
eosinophils (2-4%)
basophils (0.5-1%)

Question 19

Q

agranulocytes

Answer

A

lymphocytes (25-45%)
monocytes (3-8%)

Question 20

Q

Neutrophil:

Answer

A

Multilobed
nucleus, pale
red and blue
cytoplasmic
granules

Question 21

Q

Eosinophil:

Answer

A

Bilobed
nucleus, red
cytoplasmic
granules

Question 22

Q

Basophil:

Answer

A

Bilobed
nucleus,
purplish-black
cytoplasmic
granules

Question 23

Q

Lymphocyte
(small):

Answer

A

Large
spherical
nucleus, thin
rim of pale
blue cytoplasm

Question 24

Q

Monocyte:

Answer

A

Kidney-shaped
nucleus,
abundant pale
blue cytoplasm

Question 25

Q

events of hemostasis

Answer

A

vascular spasm- smooth muscle contracts, causing vasoconstriction
platelet plug formation- injury to lining of vessel exposes collagen fibers; platelets adhere
platelets release chemicals that make nearby platelets sticky; platelet plug forms
coagulation- fibrin forms a mesh that traps red blood cells and platelets, forming the clot

Question 26

Q

CHAPTER 18 ——————————————————————————————————————————————————————————————————————-

Question 27

Q

function of the atrioventricular (AV) valves
- AV valves open; atrial pressure greater than ventricular pressure

Answer

A

blood returning to the heart fills atria, pressing against the AV valves. the increased pressure forces AV valves open
as ventricle fills, AV valve flaps hang limply into ventricles
atria contract, forcing additional blood into ventricles

Question 28

Q

function of the atrioventricular (AV) valves
- AV valves closed; atrial pressure less than ventricular pressure

Answer

A

ventricles contract, forcing blood against AV valve cusps
AV valves close
papillary muscles contract and chordae tendineae tighten, preventing valve flaps from everting into atria

Question 29

Q

semilunar valves open

Answer

A

as ventricles contract and intraventricular pressure rises, blood is pushed up against semilunar valves, forcing them open

Question 30

Q

semilunar valve closed

Answer

A

as ventricles relax and intraventricular pressure falls, blood flows back from arteries, filling the cusps of semilunar valves and forcing them to close

Question 31

Q

pacemaker potential

Answer

A

This slow
depolarization is due to both opening of Na+
channels and closing of K+ channels. Notice
that the membrane potential is never a flat line

Question 32

Q

depolarization

Answer

A

The action potential
begins when the pacemaker potential reaches
threshold. Depolarization is due to Ca2+ influx
through Ca2+ channels.

Question 33

Q

repolarization

Answer

A

is due to Ca2+ channels
inactivating and K+ channels opening. This
allows K+ efflux, which brings the membrane
potential back to its most negative voltage.

Question 34

Q

Intrinsic cardiac conduction system and action potential succession during one heartbeat

Answer

A

The sinoatrial
(SA) node (pacemaker)
generates impulses
The impulses
pause (0.1 s) at the
atrioventricular
(AV) node.
The
atrioventricular
(AV) bundle
connects the atria
to the ventricles
The bundle branches
conduct the impulses
through the
interventricular septum
The subendocardial
conducting network
depolarizes the contractile
cells of both ventricles

Question 35

Q

The sequence of depolarization and repolarization of the heart related to the deflection waves of an ECG tracing

Answer

A

Atrial depolarization, initiated by the SA node, causes the P wave
With atrial depolarization complete, the impulse is delayed at the AV node
Ventricular depolarization begins at apex, causing the QRS complex. Atrial repolarization occurs
Ventricular depolarization is complete
Ventricular repolarization begins at apex, causing the T wave
Ventricular repolarization is
complete.

Question 36

Q

Aortic valve

Answer

A

sounds heard in 2nd intercostal
space at right sternal margin

Question 37

Q

Pulmonary valve

Answer

A

sounds heard in 2nd intercostal space at left sternal margin

Question 38

Q

Mitral valve

Answer

A

sounds heard over heart apex
(in 5th intercostal space)
in line with middle of
clavicle

Question 39

Q

Tricuspid valve

Answer

A

sounds typically heard in right sternal margin of 5th intercostal space

Question 40

Q

CHAPTER 19 ——————————————————————————————————————————————————————————————————————-

Question 41

Q

Tunica intima

Answer

A

Endothelium
Internal elastic membrane
Subendothelial layer

Question 42

Q

Tunica media
(smooth muscle and
elastic fibers)

Answer

A

External elastic membrane

Question 43

Q

Tunica externa
(collagen fibers)

Answer

A

Vasa vasorum

Question 44

Q

Continuous capillary

Answer

A

Continuous capillaries are the least permeable and most common.
* Abundant in skin, muscles, lungs, and CNS.
* Often have associated pericytes.
* Pinocytotic vesicles ferry fluid across the endothelial cell.
* Brain capillary endothelial cells lack intercellular clefts and have
tight junctions around their entire perimeter. (This is the
structural basis of the blood brain barrier described in
Chapter 12.

Question 45

Q

Fenestrated capillary

Answer

A

Fenestrated capillaries have large fenestrations (pores)
that increase permeability.
* Occur in areas of active filtration (e.g., kidney) or absorption
(e.g., small intestine), and areas of endocrine hormone secretion.
* Fenestrations are Swiss cheese–like holes that tunnel through
endothelial cells.
* Fenestrations are usually covered by a very thin diaphragm made
of extracellular glycoproteins. This diaphragm has little effect on
solute and fluid movement.
* In some digestive tract organs, the number of fenestrations in
capillaries increases during active absorption of nutrients.

Question 46

Q

Sinusoid capillary

Answer

A

Sinusoid capillaries are the most permeable and
occur in limited locations.
* Occur in liver, bone marrow, spleen, and adrenal medulla.
* Have large intercellular clefts as well as fenestrations;
few tight junctions.
* Have incomplete basement membranes.
* Are irregularly shaped and have larger lumens than other capillaries.
* Allow large molecules and even cells to pass across their walls.
* Blood flows slowly through their tortuous channels.
* Macrophages may extend processes through the clefts to catch
“prey” or, in liver, form part of the sinusoid wall.

Question 47

Q

Relative proportion of blood volume throughout the cardiovascular system

Answer

A

systemic veins and venules 60%
systemic arteries and arterioles 15%
pulmonary blood vessels 12%
heart 8%
capillaries 5%

Question 48

Q

Baroreceptor reflexes that help maintain blood pressure homeostasis

Answer

A

Stimulus:
Blood pressure (arterial blood
pressure rises above normal
range).
Baroreceptors in carotid sinuses and aortic arch are stimulated.
Increase Impulses from baroreceptors
stimulate cardioinhibitory center (and inhibit cardioacceleratory
center) and inhibit vasomotor center

LOOK AT POWER POINT pg 25 ch.19

Question 49

Q

Capillary transport mechanisms

Answer

A

Diffusion through membrane (lipid-soluble substances)
Movement through intercellular clefts (water-soluble substances)
Movement through fenestrations (water-soluble substances)
Transport via vesicles or caveolae (large substances)

Question 50

Q

PODCAST ———————————————————————————————————————————————————————————————————————–

Question 51

Q

pulmonary circulation

Answer

A

input = pulmonary artery coming off of right heart
output = pulmonary veins (there are 4) going into the left heart

Question 52

Q

chambers of the heart

Answer

A

right heart chamber is low pressure deoxygenated blood coming from systemic circulation
left heart chamber is high pressure oxygenated blood coming from pulmonary circulation

Question 53

Q

Answer

A

going to be the output for the pulmonary circulation and it is going to be delivered to the systemic circulation from the heart itself
going from the right low-pressure heart delivering deoxygenated blood through the pulmonary artery to the pulmonary circulation
going up the pulmonary artery bifurcating delivering a pulmonary trunk to the right and left lung
enter the lung through the hilum
eventually break down into smaller vessels until it becomes capillaries
those capillaries are going to be very intimately associated with the squamous epithelium of the alveoli
the blood will be delivered there and there will be a left shift in the hemoglobin dissociation curve where there is an increased affinity for oxygen hemoglobin allows for oxygenation
for tissue metabolites like carbon dioxide, lactic acid, decrease in pH, acidic environment, low concentration of oxygen, these are factors that are going to right shift the oxygen dissociation curve of hemoglobin allow for a decreased affinity at hemoglobin for oxygen
tissues will have a relative increase affinity for oxygen where they need it

Question 54

Q

Answer

A

at the hemoglobin level at the pulmonary circulation you can see how in the lungs in an environment that is very rich in oxygen we have a left shift and an increased affinity for oxygen because we are trying to oxygenate hemoglobin
when we get to the tissue metabolics are going to affect the tertiary structures and the configuration of hemoglobin itself in such a way that oxygen will dissociate from hemoglobin and go to the tissues because we will right shift the dissociation curve and we will favor oxygen leaving hemoglobin and going to the tissues and we call that a decreased affinity of hemoglobin for oxygen

Question 55

Q

Answer

A

binding of oxygen itself will allosterically modify the hemoglobin
- that means that whenever an oxygen molecule binds one of the sites on hemoglobin (there are four oxygen binding sites) the other three become allosterically modified to increase their affinity for oxygen
- so when one oxygen binds the next oxygen site will actually increase its affinity and will be more likely to bind another oxygen molecule
- and when a second oxygen molecule binds there the third hemoglobin will be modified in such a way allosterically that allows it have an increased affinity and more chance of binding an oxygen
- the last one will have the absolute easiest chance of binding to hemoglobin

Question 56

Q

carbon monoxide poisoning

Answer

A

carbon monoxide has sixteen hundred times the affinity for hemoglobin that oxygen has
hemoglobin will prefer to bind to carbon monoxide relative to oxygen because carbon monoxide has such a high affinity for oxygen that will outcompete it whenever it is present in the alveoli and thats because we are breathing it in
the same allosteric modification is happening
one carbon monoxide molecule binds and it will increase hemoglobin affinity for binding “oxygen” but in reality it is actually binding more carbon monoxide that is present in the alveoli because that carbon monoxide is outcompeting the oxygen
what is basically happening is that you are consuming all of your hemoglobin stores by binding them to carbon monoxide that has increased affinity for hemoglobin and it is also increasing its affinity more every time it binds
telltale sign of carbon monoxide poisoning is cherry bright red coloration of the skin, color of the hemoglobin itself in the circulatory system and all occupied by carbon monoxide giving off the color because it is very well bound a lot of binding
intervene medically by introducing the patient to hyperbaric oxygen chamber in order to favor oxygen binding to hemoglobin and kick carbon monoxide out

Question 57

Q

Answer

A

pulmonary artery coming off the right heart and supplying the lungs capillary beds with deoxygenated blood
so we have pulmonary artery coming from the right heart, deoxygenated blood to the pulmonary capillaries that are intimate with the alveoli
oxygenate the blood at the lung
those capillaries become the output, which is going to be the pulmonary veins
pulmonary veins will eventually condense into four pulmonary veins and become bound to the left atrium of the heart
left atrium will be the left heart chamber

Question 58

Q

entire circulation

Answer

A

start with pulmonary veins
oxygenated blood coming from the lungs into four pulmonary veins
pulmonary veins are going to feed into the left atrium
left atrium is going to hold oxygenated blood, opening there with the mitral valve
mitral valve is going to separate the left atrium from the left ventricle
so then oxygenated blood will pass from the atrium to the left ventricle through the mitral valve
on the other side of the heart we have the tricuspid valve
those are both going to be the atrioventricular valves, the AV valves
they are going to seperate the respective chambers, the respective atria from the respective ventricles
and so on the left heart, we pass from left atrium to the left ventricle through the AV valve, that is the mitral valve on the left
when the mitral valve closes, that is going to be S1 (first heart sound)
that is the first heart sound in the lub-dub sounds of the heart, closure of the valves that give the heart sounds, not the opening
so the first, lub in the lub-dub is going to be the closures of the AV valves, the atrioventricular valves, which are tricuspid and mitral
on the left we have the mitral valve
isovolumetric contraction at the heart
then systole, open the aortic valve
pump blood into the aorta
going to go to the systemic circulation, thats systole
then go up the aorta
aortic valve close right before diastole, when the aortic and pulmonic valve close
those are semilunar valves (three cusps while AV=two)
second heart sound (S2) is going to be the closure of the semi-lunar valves (aortic and pulmonic)
through the aortic valve, from the left ventricle, through the aortic valve into the aorta and out to the systemic circulation
aorta is going to break off into elastic arteries and muscular arteries, arterioles
down to capillaries, it’s going to oxygenate at the capillaries various organs
venules to valve veins to larger veins
upper extremity, upper appendicular areas, feed into subclavians, then merge into the superior vena cava, coming up from lower extremity there are femoral veins etc
end up becoming the inferior vena cava and feeding up to the heart
deoxygenated blood is going to travel in the systemic veins
systemic veins feed deoxygenated blood through the inferior vena cava for the lower extremity and the superior vena cava from the upper extremity
those are both going to feed in both vena cavae going to feed into the right atrium
which is going to be in the right heart chamber, the low pressure deoxygenated chamber
the right atrium will accept blood from superior and inferior vena cavae and pool into the right atrium
right atrium accepts the oxygenated blood
blood is going to pass through the tricuspid into the right atrium
tricuspid valve closes again, S1 (mitral and tricuspid valve close at the same time)
pass through the tricuspid and to the right ventricle, low pressure ventricle
then during systole, we are going to have isovolumetric contraction and during systole pulmonic valve open
pump blood through the pulmonic valve, which is the semi-lunar valve, into the pulmonary artery
going to do that through the pulmonic valve and then the pulmonary artery and the aorta are both going to close
its going to be S2, closure of those of the semi-lunar valves, which is the dub in the lub-dub cycle
lub closing of the atrioventricular valves and those are the AV valves
they close thats lun and the semi-lunar valves close after systole ends and thats going to be the dub and they are S1 and S2 respectively
aorta is delivering oxygenated blood to the systemic circulation and the pulmonic artery, which is the site of the pulmonic valve, is going to deliver deoxygenated blood to the lungs to be oxygenated and returned to the heart through the pulmonary veins at the left atrium to repeat the cycle

Question 59

Q

right atrium

Answer

A

site where atrial-natriuretic peptide is going to be synthesized by the myocytes, those are detecting stretch in the heart
so as the heart is filling through the two vena cavae, the inferior and superior, as it fills the heart, they are going to detect stretch and synthesize that
site where we have the SA node, sinoatrial node (natural pacemaker of the heart)
nearby is the AV node, atrial ventricular node
the site that regulates the impulse from the SA node, natural pacemaker of the heart
tachycardia, bradycardia, vagus nerve relevant in this region

Question 60

Q

ventricles

Answer

A

right ventricle, low pressure ventricle, faces thoracic wall (sternum),
note a penetrating injury to the chest is going to go through the right ventricle, which is a low pressure chamber; we would rather stab through that than a high pressure chamber like the left ventricle
left atrium faces the esophagus

Question 61

Q

heart faces more left

Answer

A

heart is turned on its side and faces to the left
left heart chambers face inward into the inferior mediastinum toward the left side
left atrium is going to point towards the esophagus
left ventricle is going to be kinda hidden inward, pointed to the left
facing the outside, facing the sternum, is the right ventricle and the right atrium
heart is kind of twisted off to the left and turned so that the left side of the heart is facing deeper
right ventricle and the right side of the heart is more superficial

Question 62

Q

pulse

Answer

A

we feel apical pulse at the left fifth intercostal at the midclavicular line
and that’s where we hear the mitral valve is because the heart tends to face its left
better access to the left ventricle because of that twist

Question 63

Q

pulmonary differences

Answer

A

pulmonary artery carries deoxygenated blood
pulmonary veins carry oxygenated blood

Question 64

Q

bronchial differences

Answer

A

bronchial arteries that supply the lung carry oxygenated blood to the lungs
bronchial veins carry deoxygenated blood from the lungs

Answer 62

A

bronchial arteries and veins have the traditional systemic sort of pattern of carrying certain types of blood

Answer 63

A

heart is superior to the diaphragm and turned left
apex will be the pointed end of the heart, more superficial and to the left
base of the heart will be basically where the vessels are attached, the pulmonary artery and the aorta
apex beat can be measured or palpated at the fifth intercostal at the midclavicular line

Answer 64

A

fibrous pericardium (most superficial/surface), parietal layer of the serous pericardium, the pericardial cavity (a potential space), true heart layers - epicardium (the visceral layer of the serous pericardium), myocardium, endocardium, then inside of the heart chamber
fibrous pericardium, the pericardial cavity, and the parietal layer of the serous pericardium all sort of mimic the tunica adventitia in the blood vessels
epicardium mimics the tunica externa
myocardium is like the tunica media of the heart
endocardium is like the tunica intima for the blood vessels
heart does have an abundance of elastic fibers

Answer 65

A

pulmonary trunk leaves the right ventricle and twists left
aorta leaves the left ventricle and twist right and then go superior to the pulmonary trunk and then dive downward and become the descending aorta
right ventricle is giving off the pulmonary artery carrying deoxygenated blood and the left ventricle is giving off the aorta
the second right intercostal that we actually hear the aortic valve best at when we auscultate it
we can auscultate the pulmonic valve best at the second left intercostal
auscultate the pulmonary artery at the left second intercostal
auscultate the aorta at the right second intercostal

Answer 66

A

right ventricle gives off the pulmonary artery and the pulmonary artery twists to the left
left ventricle gives off the aorta which twists to the right becomes the ascending aorta
its going to give off three branches there and then its going to become the descending aorta and then dive down to supply the rest of the body
its going to be up to those three branches that it gives off, the brachiocephalic trunk, the left common carotid artery, and the left subclavian artery to supply the upper extremity while the descending aorta supplies the lower extremity

Answer 67

A

first branches off the aorta are the left and right coronary arteries, specially at the coronary ostia, which are basically the vestibules or the entry points into the coronary arteries
so what are the first branches off the aorta? ans: they are the coronary arteries and then the third, fourth, and fifth branches off the aorta are the brachiocephalic trunk, the left common carotid artery and the left subclavian artery
brachiocephalic trunk will become the right subclavian artery and the right common carotid
left common carotid artery is coming exactly right off the aorta as the fourth branch
left subclavian artery is coming right off the aorta as the fifth branch
remaining aorta will be descending aorta, which twists, which return back to the left, then becomes descending aorta

Answer 68

A

emerges from the left ventricle , then it goes and twists to the right, goes superior to the pulmonary artery, where at the bifurcation point of the pulmonary artery goes superior to that, gives off three branches and then goes to the left and descends and becomes the descending aorta
ascending aorta is oriented to the right
descending aorta is oriented to the left
branches of the aorta, two coronary arteries, the main stem coronary arteries, so they start as the left and right main stem coronary arteries
then become the ascending aorta on the right side
go superior to the pulmonary artery at the pulmonary arteries bifurcation point
give off the brachiocephalic trunk and that will become the right subclavian artery and the right common carotid and the right common carotid and then the left common carotid and the left subclavian come directly off the aorta
left common carotid and the left subclavian are coming directly off the ascending aorta
on the right side, we have to go through thus intermediate step where we start off as the brachiocephalic trunk and then bifurcates into the right subclavian and the right common carotid

Answer 69

A

ligamentum arteriosum connects the aorta to the pulmonary artery
that was originally the ductus arteriosus in fetal circulation
ductus arteriosus is a vessel, providing communication between the aorta and the pulmonary artery because in fetal circulation it is irrelevant to oxygenate the blood in the lungs
the mother actually oxygenates the blood for the fetus
fetal hemoglobin steals oxygen away from the mother’s hemoglobin A, adult hemoglobin
so the fetal hemoglobin has an increased affinity for oxygen, an affinity that can outcompete the mother’s hemoglobin’s affinity for oxygen
it has a higher affinity, stealing the oxygen from the mother’s hemoglobin F

Answer 70

A

hydroxyurea and sickle cell disease basically allows adults to resynthesize the hemoglobin F from their heterochromatin
so it reactivates the heterochromatin for the hemoglobin F and it makes it U-chromatin and allow them to resytheize hemoglobin F
which in a way is a way of keeping sickle cell disease at bay by synthesizing a new hemoglobin that has a high affinity for oxygen and is not prone to sickling the way hemoglobin S, the sickle cell anemia will, sickle cell anemia hemoglobin will

Answer 71

A

fetuses have hemoglobin F and they have a patent or an open ductus arteriosus, which is the connection between the aorta and the pulmonary artery
in fetal circulation, that connection is basically allowing the aorta to shunt blood away from the pulmonary artery because its senseless to supply the lungs with any blood at all
because the lungs are not, the fetal lungs are not going to be responsible for oxygenating it
the fetus is not breathing inside the uterus or mother’s womb
it is relying on the umbilical cord and the umbilical vessels ti supply the maternal blood that is oxygenated from the mother to the fetus in order for the fetus to survive

Answer 72

A

basically shunting blood in the fetal circulation away from the pulmonary artery and favoring the aorta in that situation
we don’t wanna to waste the blood in fetal circulation on the pulmonary artery because it going to the lungs that are not being used
so while we have the fetus and while we have the neonate as soon as its born, that ligamentum arteriosum is actually a ductus arteriosum (patent or open ductus arteriosum)
once baby born, patent arteriosus becomes ligamentum arteriosum
the pressure inside aorta and the pressures inside the pulmonary artery are going to overwhelm it and going to involute and degrade and eventually become a collagen connection between the aorta and the pulmonary artery
its basically a ligament of collagen there thats a remnant of the ductus arteriosus

Answer 73

A

transportation of the great vessels in which you give prostaglandins to keep the patent ductus arteriosus open
prostaglandins for PDA and that’s for transportation of the great vessels
a pathology un which diabetic mothers are prone to their diabetic state, hindering the heart’s ability to rotate its vessels on a proper axis and that malrotation of the heart vasculature at the base of the heart will lead to transportation of the great vessels
it has the ductus arteriosus left over from its time as a fetus
if we give prostaglandins we are able to encourage the patency of the ductus arteriosus and that will allow the shunting of blood to continue so that we can overcome the fact that you are not oxygenating the body

Answer 74

A

they are the first branches off the aorta so it is relevant to note that there is a left and right common main stem coronary
right main stem coronary gives off several branches
theres an oracle for the left atrium and an oracle for the right atrium and how the way that they guard those coronaries from trauma
right coronary going down and give off the right marginal artery, supply the lateral wall of the right ventricle
thats the right coronary artery and then its giving off the right marginal artery and then going to the backside of the heart
its going to supply the heart posteriorly and supply part of the septum of the heart and most importantly the AV node, the atrium ventricular node
majority of population is right coronary circulation dominant
left main stem coronary is hidden by oracle but coming off the aorta
its goin basically between the pulmonary artery and the oracle and then its emerging

Answer 75

A

first branch off the left main stem coronary is going to the left anterior descending artery which is the widowmaker
it supplies the largest surface area of the heart, two thirds of the surface area of the anterior that is very relevant
it also supplies the interventricular septum, this houses the purkinje fiber network that is going to be conducting the electrical activity of the heart from the SA and AV nodes respectively
that purkinje system is very relevant to the heart depolarizing in a synchronous fashion and we know that the interventricular septum separates the high pressure left ventricle from the low pressure right ventricle
having those myocytes disrupted and weakened and replaced by scar tissue and a myocardial infarction there is very common at the left anterior descending artery
part of the septum is supplied by the right coronary artery

Answer 76

A

at the left coronary twists and it becomes traveling in this left coronary sulcus of course near the oracle, it twists and becomes the circumflex artery
it supplies the lateral wall of the left ventricle so it can be considered when it infarcts there to be a lateral wall infarction
left coronary does twist after giving off the LAD branch, it twist into circumflex and dives and goes posterior supplying the posterior heart
see anastomose and form this compensatory or alternate circulation where there isn’t an anastomosis with the right coronary artery
depending on whether theres a blockage in one or the other, we can salvage as much myocardium as possible and save as much of it from ischemia as possible through the anastomosis

Answer 77

A

right coronary artery is giving off a branch on the posterior heart called the posterior interventricular artery
that is the artery that supplies one third of the interventricular septum
the anterior two thirds of the interventricular septum were supplied by the left LAD, left anterior descending artery
posterior interventricular artery coming off the right coronary artery on the posterior heart supplying the posterior on third
included in the one third will be the atrioventricular node, the AV node

Answer 78

A

left coronary artery, after it became the circumflex, continued on its way and eventually it will anastomose
the coronary sinus and the middle cardiac veins and the great cardiac vein
the great cardiac vein becomes the coronary sinus and the middle cardiac vein feeds into that coronary sinus

Answer 79

A

inferior and superior vena cava and the way that the four pulmonary veins are feeding into the left atrium and that the vena cava are feeding into the right atrium
how intimate those vessels are at the base of the heart
bifurcation point superior to the pulmonary veins as they insert into the left atrium
we can see the bifurcation point of the pulmonary artery and superior to that the ascending aorta itself, which is now beginning to become the descending aorta after giving off its third, fourth, and fifth branches
its becoming the descending aorta and twisting back to the left again before it descends into the abdominal cavity
the third branch off of it is the brachiocephalic trunk which bifurcates
left common carotid is the fourth and the fifth is left subclavian artery

Answer 80

A

right main stem coronary giving off the right marginal artery, twisting, going posterior to the heart
giving off the posterior interventricular artery, which will supply the one third of the interventricular septum and the AV node
left coronary artery, which is the left main stem
its giving off the left anterior descending artery, the LAD, the widowmaker
then its becoming the left circumflex artery supplying that left lateral wall of the left ventricle, which is a more relevant lateral wall because the left ventricle is a high pressure chamber
after becoming a circumflex artery, its twisting, going posterior and anastomosis with the right coronary artery after the right coronary artery has been extended
that has given off the posterior interventricular artery branch

Answer 81

A

left pulmonary veins feeding into right atrium
mitral valve = bicuspid valve
mitral/bicuspid is one of the AV valves
enter that the left atrium through the pulmonary veins, four of them
cross the mitral valve into the left ventricle
chordae tendineae are tethered to papillary muscles that are maintaining that mitral valve
then exit the left atrium through the aorta, through the aortic valve into the aorta
aortic valve is a semilunar valve

Answer 82

A

aorta and the pulmonic valves are semi lunar valves
enter the aorta through them
right atrium with the superior and inferior vena cava entering there
right atrium fill up with deoxygenated blood, which will follow into the right ventricle through the tricuspid valve, which is also maintained by the chordae tendineae that are tethered to papillary muscles
exit the right ventricle through the pulmonic valve, the other semilunar valve into the pulmonary and bifurcate to each lung

Answer 83

A

lub dub cycle that corresponds to S1 and S2
S1 is the closer of the AV valves, the atrioventricular valves, the bicuspid and the tricuspid or the mitral and the tricuspid
S2 or dub sound is going to be the closure of the semilunar valves, the aortic and pulmonic
all sets close at the same time, which is what we hear

Answer 84

A

situation of afterload in the heart and that is felt at the aorta, the collective resistance that the heart must overcome in order to pump blood to the systemic circulation
afterload is the collective peripheral resistance, the amount of pressure required
hypertension will contribute to the afterload and that extra pressure that the heart must pump against that will lead to malignant transformation of the heart through a positive feedback mechanism of hypertrophy that will end up causing compromise of the heart’s ability to fill, which will be diastolic failure
it will not compromise the heart’s ejection fraction, it will not compromise the heart’s ability to pump until there ischemia
it will compromise the heart’s ability to fill and that will be diastolic failure and eventually the heart will hypertrophy to a point where it may become ischemic because the coronary arteries are unable to diffuse enough blood through the thickened hypertrophic myocardium to supply that much muscle that is hypertrophy and lead to ischemia and myocardial infarction
myocardial infarction compromise the heart’s systolic function
first have the diastolic dysfunction because the hypertrophy, the first thing it will hinder is the heart’s ability to fill

Answer 85

A

problem is the preload
heart must overcome afterload in order to pump so if the afterload gets too high the heart can hypertrophy and overcome the afterload and the other parameter is preload
preload is how much blood volume the heart is filling during diastole
if we increase venous return to the heart, we increase the preload
if we decrease the amount of venous return to the heart (decrease the amount of blood that the veins give back to heart), we effectively decrease preload
exercise increase preload by mobilizing all muscles and squeezing on veins more because the muscles are contracting and relaxing, that’s pumping more venous blood, increasing venous return to heart though inferior and superior vena cava
decrease venous return to the heart by giving nitrates, those are vasodilators that dilate the veins which are the capacitance vessels allow the veins to retain more venous return and decrease preload
decrease the amount of work that the heart has to do because that’s less blood volume that the heart has to pump out
ischemia blood flow (oxygen) is restricted

Answer 86

A

diastole allows the heart to fill and distend,
as the heart distends sarcomeres of the heart, allow all Z-discs to align properly
Z-discs are held by desmosomes at the heart so it is zig-zaggy
its zig-zaggy because the heart doesn’t want to begin its maximum contraction until its filled during diastole with enough blood volume
adding preload (adding blood volume) during diastole when the heart is filling, it distends sarcomeres gradually going from wavy to straight
at the end of diastole, all sarcomeres will be aligned
then we are going to get the isovolumetric contraction which the traditional way that muscles contract (myosin, actin, calcium)
isometric contraction build up wall tension then get systole
heart pumps, going to blow that stroke volume out through the aorta and blow the amount of blood volume and preload that it loaded into the right ventricle at a lower pressure rate into the pulmonary artery or the pulmonary trunk
pressures in aorta are 120 millimeters of mercury while pressure in pulmonary artery are 8-20 millimeters of mercury
pulmonary artery deliver deoxygenated blood only to the lungs, small relative to the body, small surface area of the pulmonary circulation
aorta supply the entire systemic circulation with blood in a large surface area of blood vessels so much greater pressure gradient
if hypertrophy in left chamber hypertension happens
if pressure in the pulmonary artery rises above 20 millimeters or mercury pulmonary hypertension happens
pulmonary hypertension builds up and transfers into the pulmonary artery
once raising the pulmonary artery pressures above 30 mm, pressure will arrive downstream at the right ventricle
increased pressure in the pulmonary artery leads to heart failure and right heart hypertrophy of the right ventricle is called core pulmonol

Answer 87

A

coronary arteries supply the myocardium with its required oxygen demand
the heart has a very high oxygen demand, only muscle that never rests, has the highest concentration of mitochondria per unit of volume
left anterior descending the circumflex and the anastomosis at the back
right main stem coronary giving off the right marginal artery then going to the back giving off the posterior interventricular artery
then anastomosing with the left coronary artery and the posterior heart
heart filling with the left atrium of the heart filling with the four pulmonary veins carrying oxygenated blood from the lung
the left atrium fills the blood goes from the left atrium through the mitral valve into the left ventricle
the mitral valve closes there is isovolumetric contraction then we blow stroke volume through the aortic valve, the semi lunar valve, the aortic valve into the aorta at 120 mm of mercury
the aorta’s elastic fibers allow the aorta to balloon out and adapt to this rapid increase in pressure gradient and the pulse pressure propagates forward
aortic valve close, with cusps like leaflets so what left the blood volume from the stroke volume that has been resisted by the afterload washes into the ascending aorta
volume that has been resisted by the afterload back washes into the aorta down the ascending aorta and fills that area
aortic valve has cusps, these cusps make semilunar valve, those cusps allow blood to pool in around the aortic valve and retain it there
gentle lake will slowly fill into coronary ostia, the vestibules of the coronary arteries, their openings all occurring during diastole

Answer 88

A

blood is leaving the left atrium through the mitral valve and slowly filling into the left ventricle
left ventricle is filling with oxygenated blood from the mitral valve
right ventricle is also filling with deoxygenated blood through the tricuspid valve from the right atrium
both sides fill and also filling the coronary arteries at the aorta

Answer 89

A

inferior and superior vena cava
the vena cava those are filling into the right atrium and going from the right atrium through the tricuspid valve the other AV valve and fill into right ventricle
theres going to be isovolumetric contraction
then during systole, blow stroke volume (output through the pulmonic valve) into the pulmonary artery or the pulmonary trunk

Answer 90

A

right atrium is filling with deoxygenated blood from the superior and inferior vena cava
at the same time the left atrium is filling with oxygenated blood from the four pulmonary veins, so both atria are filling
atria contract the AV valves, open the tricuspid and the bicuspid mitral valve both open
during diastole they contract
on right side, the deoxygenated blood is going to leave the right atrium and enter the right ventricle
on left side oxygenated blood is going to leave the left atrium and enter the left ventricle
during diastole, both ventricles are filling, the heart is filling with preload
that heart is descending and all of the sarcomeres as the heart descends are becoming aligned
sarcomeres are fully aligned and the heart has filled with the maximum preload
at that point the AV valves are going to close
there’s going to be isovolumetric contraction that going to push and begin to build wall tension and begin to build pressure in those chambers
once the pressures inside the right ventricle become greater than the pressures of the pulmonary artery and once the pressures of the left ventricle become greater than the pressures inside the aorta or afterload
systole and that massive contraction of the heart and the entire cardiac output that will be pushed out of the heart and on the left side, its a high pressure chamber that is where we get stroke volume that is deliver during systole out through the aortic valve
then through the pulmonic valve push at a lower pressure relative to the left, push out output that going to lungs to be oxygenated and returned
returned to the heart through the pulmonary veins as oxygenated blood

Answer 91

A

diastole is filling the right atrium with the superior and inferior vena cava
we fill the left atrium with the pulmonary veins
also fill the coronary arteries with backwash of blood returned to the ascending aorta by the afterload
filling those because during systole aortic valve opens up and closes over the coronary osteos and protects them from high pressure
then once it closes back up the backwash of blood returns during diastole and both the right and left atrium are filling up with their vessels respectively
coronary arteries fill with blood from the backwash in the aorta
its ideal for the coronary arteries of the heart to be filled with oxygenated blood during diastole because during diastole the heart is relaxing, the myocardium is relaxing, and the sarcomeres are being aligned
whole consumption of ATP and work that the myocardium undergo only occurs during isovolumetric contraction and during systole
so during diastole, myocardium is descending and the sarcomeres are aligning and myocardium is relaxed; which is perfect time to load up the myocardium with nutrients like oxygen and glucose
during diastole the heart is beginning to gather up resources and when it has them isovolumetric contraction begins
systole begins, we pump the stroke volume out through vessels and myocardium relaxes the aortic valve closes again
afterload delivers backwash of blood down through the aorta and begins to fill the coronary arteries
during diastole, heart is beginning to fill at a low pressure because they are small vessels that only fill during diastole from the backwash not systole

Answer 92

A

there are gap junctions
cardiac myocytes must communicate very rapidly with each other, especially in purkinje fiber system which must conduct electrical discharges and action potential very rapidly through the ventricle in order to polarize the ventricular system
function as a syncytium so it functions basically synchronously, gap junctions allow for that so it can function as an entire unit
differences in the sarcoplasmic reticulum: source for calcium for contraction comes only from the sarcoplasmic reticulum in skeletal muscle but it comes from the sarcoplasmic reticulum and extracellular fluid in cardiac muscle
because cardiac muscle had automaticity; cardiac muscle always ready to depolarize voltage gated channel and always allowing an influx of calcium
always approaching action potential resting gradient, positive 30, because myocytes are more permeable to calcium and the extracellular fluid
automaticity is the heart is constantly permeable to ions and always ready to depolarize
heart has a natural pacemaker, sinoatrial node, SA node, constantly depolarizing for the heart to beat
SA node and AV node slows conduction down for the purkinje system
skeletal muscle rely on neurons from the brain to depolarize
tetanus is possible in skeletal but not in cardiac
cardiac is resistant to tetanus and cannot be tetanized
tetanus = fatigue
in skeletal we had to depolarize skeletal muscle to open voltage gated sodium channels however in voltage channels in heart are constantly permeable or leaky

Answer 93

A

phase 0, phase 3, phase 4
during phase 4 there is a constant permeability to sodium through the voltage gated channels; constantly permeable or leaky allowing sodium to leak in; myocytes allow sodium to leak in through channels
that is allowing the heart muscle to have the automaticity, the heart muscle is always slowly beginning to depolarize and always approaching
slope of phase 4 is approaching the positive membrane charge for depolarization, its always in a state of gradual depolarization and thats its automaticity
then phase 0 begins, that discharge from the sinoatrial node and then its conducted to the AV node and then the AV node brings it down to the purkinje fiber system
then conducts through the ventricles down the septum and then up through the ventricles through the lateral walls of the ventricles
SA node and the right atrium, down to the AV node and then down to the purkinje fibers which go down the interventricular septum and then up through both ventricles, the right and left ventricles through their lateral walls
when that discharge from the sinoatrial node occurs, that initiates phase 0, so voltage gated calcium channels open up calcium influxes into the cell and not a lot is needed because there is a bunch of sodium influx into the cell during phase 4 and now phase 0 begin
giant massive influx of calcium on top of that, sodium (NA+) and calcium (CA2+) so we have more positive ion piling in and a quick depolarization during phase 0 and then just in the muscle
phase 3 is the depolarization step with potassium
myocytes is with potassium relevant for lethal injection, hypo/hyper kalemia

Answer 94

A

automaticity during phase 4 is because of leaky voltage gated sodium channels, the heart is constantly approaching depolarization through its automaticity, through its voltage gated sodium channels, then we get that discharge from the sinoatrial node, we have the opening of voltage gated calcium channels during phase 0, we get the depolarization of the myocytes which is the isovolumetric contraction and then the stroke volume, the heart beats, thats where the beat happens, is the influx of calcium during phase 0, we depolarize and then we have to get the heart to repolarize, then we have the permeability to the potassium channels during phase 3
phase 4, automaticity, leaky sodium channels, sinoatrial node depolarizes, we get that discharge from SA node, phase 0 begins, the voltage gated calcium channels open up, calcium influxes, we get action potential, heart beat, depolarize with potassium
phase 4, phase 0, phase 3
sodium, calcium, potassium, automaticity, sodium, depolarization, calcium, repolarization, potassium

Answer 95

A

P wave = atrial depolarization
QRS = heart beat, ventricular depolarization, phase 0 in heart, which is the calcium channels opening up and the depolarization
T wave = ventricular repolarization, which is when the potassium channels are open, phase 3
phase 4 cant be seen on EKG but its the automaticity of the heart, sodium channels, allowing the heart to approach depolarization but not actually depolarization
P wave atrial depolarization, QRS ventricular depolarization, phase 0 calcium voltage gated calcium channels, T wave ventricular repolarization voltage gated potassium

Answer 96

A

overwhelm the heart with potassium, repolarize the heart, making the T wave so big that it becomes a sine wave, entire EKG becomes a sine wave
when we flood with potassium remember they shoot intravenously so it goes right to the heart and hyper repolarizes the heart
it repolarizes it to the point that the heart cannot depolarize; its flooded with positive ions
it goes into cardiac arrest, EKG looks like a sine wave, patient dead
hypokalemia on an EKG will have flattened T waves
T wave is related to potassium
so if you are hypokalemic, you have low potassium, you are going to flatten the T wave
flat T wave = hypokalemia
peaked T wave = hyperkalemia

Answer 97

A

first degree heart block = extended PR interval
second degree heart block MOBITZ type one = progressive lengthening of the PR interval until a QRS is dropped
QRS = a beat
one of the P waves is not going to be followed by a QRS complex
second degree heart block MOBITZ type two = dropped beats that are not preceded by a change in the length of the PR interval, there is no pattern when we drop a QRS or a beat, just chaotic
third degree or complete heart block = absolute worst, atria and ventricles beat independently of each other, P waves are not neatly associated with QRS complexes, can occur before or after QRS complexes
treat third degree heart block with a pacemaker
atrial fibrillation = atria are depolarizing and beating chaotically (rapid, ineffective, inefficient), has risk factor for stroke and thrombus formation, ventricular fibrillation (shock them)
congenital long QT syndrome = if interval lengthened they are at a higher susceptibility to developing torsades de pointes, increased QT interval (interval between QRS and T wave)
drugs can prolong QT
it predisposes them to torsades de pointes which may progress to ventricular fibrillation
antidote to torsades de pointes is magnesium; prevent them from going into ventricular fibrillation and can be precipitated by certain agents and those with congenital long QT syndrome
Wolf Parkinson white syndrome = ventricular pre excitation syndrome, they have an abnormal fast accessory conduction pathway through the bundle of Kent (acts as its own aberrant circuit)
it basically conducts it leads to a supraventricular tachycardia because it leads to a reentry circuit
Wolf Parkinson white syndrome = bundle of kent, reentry circuit, supraventricular tachycardia delta wave on EKG

Answer 98

A

auscultate the aortic valve in the right second intercostal space
auscultate the pulmonic valve in the left second intercostal space
aorta is the right second intercostal space
pulmonic valve is left second intercostal space
tricuspid is going to be the left fifth parasternal intercostal space
mitral valve, apical beat, apex beat are going to be in the left fifth intercostal space midclavicular
third intercostal parasternal (under pulmonic valve area) called herbs point, best place to hear aortic regurgitation
aortic stenosis = right second intercostal
pulmonic stenosis = left second intercostal
tricuspid endocarditis = flow murmurs, ventricular septal defect

Answer 99

A

aortic stenosis = narrow, systole
mitral stenosis = diastole, opening snap
aortic regurgitation = backwash, diastole, rumble
mitral regurgitation = systole, pan or holo

Answer 100

A

anterior septum = V1-V4, brickyard left anterior descending
lateral = aVL, left circumflex
inferior = aVF, posterior interventricular artery

Answer 101

A

atrial fibrillation = irregularly regular
atrial flutter = sawtooth
stable angina = action, emotion at rest ST
prinzmetal angina = coronary artery spasms

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