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Phase 1 EDF > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are the two phases that make up the blood? Give their proportions also.

A

Cellular phase 45%

Fluid phase 55%

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2
Q

What makes up the majority of the cellular component of the blood?

A

RBCs (44%)

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3
Q

Define heamatorcrit and give its usual value

A

The proportion of the cellular component of the blood, 0.45.

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4
Q

Define serum

A

Fluid component of blood with all the clotting factors removed

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5
Q

What happens to the haematocrit during acute anaemic (bleeding) and why?

A

Stays the same, 0.45. Cellular and fluid components of blood lost in the same proportion

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6
Q

What happens to the haematocrit during chronic anaemia?

A

Decreases (0.2)

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7
Q

Define haematopoesis

A

Production of blood cells

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8
Q

Where are a haemopoetic stem cells in an adult?

A

Bone marrow at axial skeleton

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9
Q

Where are haemopoetic stem cells found in a child?

A

Bone marrow at all bone

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10
Q

Where are haemopoetic stem cells found in utero?

A

Yolk sac, liver and spleen

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11
Q

What growth factor causes haemopoetic stem cells to proliferate into RBCs? And where is the factor secreted?

A

Erythropoetin (EPo)

Kidneys

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12
Q

Where are mature blood cells found?

A

In circulation

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13
Q

What growth factor causes haemopoetic stem cells to proliferate into WBCs?

A

Granulocyte-colony stimulating factor (GCSF)

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14
Q

What growth factor caused haemopoetic stem cells to proliferated into platelets?

A

Thrombopoetin (TPo)

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15
Q

Give the average life span of RBCs

A

120 days

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16
Q

Give the average life span of WBCs

A

6 hours

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17
Q

Give the average life span of platelets

A

7-10 days

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18
Q

Which of the blood cells are anucleate/ have no membrane bound organelles?

A

RBCs and platelets

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19
Q

Erythrocyte is the proper name for which type of blood cell?

A

RBC

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20
Q

Describe the shape of RBCs and state why they are this shape?

A

Biconcave

Increases SA:V for rapid diffusion of O2/CO2

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21
Q

What is a reticulocyte?

A

A young erythrocyte still containing its ribosomes (1% of circulating erythrocytes)

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22
Q

What are the main sites of RBC breakdown?

A

Liver and spleen

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23
Q

What is the major breakdown product of haemoglobin (and therefore RBCs)?

A

Bilirubin

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24
Q

What is the function of RBCs?

A

Contain haemoglobin to allow the transport of gases O2/CO2

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25
Q

Describe the structure of Hb

A

4 polypeptide chains (2 alpha and 2 beta)

4 haem groups each with an Fe 2+ (ferrous group)

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26
Q

How does the presence of CO2 affect the binding of O2 to Hb? What is the name of the shift that results on an oxygen dissociation curve and in which direction does it occur?

A 
Increase in CO2
Decrease in pH
Conformational change of Hb
Decreased affinity for O2 
Increased unloading of O2

Bohr shift
To the right

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27
Q

What is the proper name for WBCs?

A

Leukocytes

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28
Q

What are the two main types of leukocytes

A

Granulocytes

Agranulocytes

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29
Q

Give the normal range of Hb

A

12.5-15.5g/dL

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30
Q

Give the 3 types of granulocyte, give in order of most to least abundant

A

Neutrophil
Eosinophil
Basophil

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31
Q

State the 2 types of agranuolocyte, giving the most abundant type first

A

Lymphocyte

Monocyte

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32
Q

Describe the features and role of a neutrophil

A

Multi-lobar (4) lobes
Phagocytic
Release cytokines in inflammatory response

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33
Q

Describe the features and role of eosinophils

A

2-3 lobes
Pink staining granules
Protect against parasite infection

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34
Q

Describe the structure and function of basophils

A

Blue staining granules
Secrete histamine and anticlotting factors that increase blood flow and therefore attracts infection fighting cells to accumulate at site of infection

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35
Q

Describe the features and role of lymphocytes

A

Small, darkly stained nucleus, & very little cytoplasm
Role in specific/adaptive immunity
T - thymus - cyctotoxic
B - bone marrow - antibodies/immunoglobulins

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36
Q

Describe the features and role of monocytes

A

Kidney shaped nucleus
Phagocytes in blood
Migrate and mature at tissue - macrophages

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37
Q

Define haemostasis

A

The prevention of blood loss

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38
Q

Give the 3 mechanisms of haemostasis when an injury to a blood vessel occurs

A

Vasoconstriction
Platelet plug formation
Coagulation/clotting cascade

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39
Q

Define what is meant by a haematoma

A

Accumulation of blood within tissues (increase interstitial pressure prevents continues blood loss)

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40
Q

Where are the majority of clotting factors synthesised? Which of the clotting factors are synthesised here?

A 
Liver
I
II
V
VII
VII
IX
X
XI
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41
Q

What is clotting factor I?

A

Fibrinogen

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42
Q

What is clotting factor II?

A

Prothrombin

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43
Q

Describe the platelet plug formation

A

Exposure of collagen

von Willerbrand factor bind to collagen

Platelets bind to vWF by GP1b receptor

Binding causes the release of alpha and dense granules

ADP (from dense granules) binds to P2 (purinergic receptors) which activates the cell

Activation

  • change in shape to psuedopodia
  • change in metabolism
  • change in surface membrane
    * activation of GPIIb/IIIa receptor, increased affinity for fibrin
    * thromboxane A2 release, derived from arachidonic acid

Thromboxane A2 and ADP stimulate platelet aggregation

Fibrinogen forms bridges between aggregating platelets

PLATELET PLUG

Surrounding non-damaged cells release prostaglandin and NO that inhibit aggregation and stop the platelet plug spreading any further

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44
Q

Define thrombosis

A

The formation of a clot inside a vessel

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45
Q

What is the proper name for platelets

A

Thrombocytes

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46
Q

Describe the features and role of platelets

A 
Cytoplasmic fragment of megakaryocytes 
Anucleate
Circulate in the inactive form
Alpha and dense granules (also lysosomes and peroxisomes)
Role in heamostatis
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47
Q

What have if the no. of platelets are decreased to less than 20% of their normal amount

A

Spontaneous bleeding

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48
Q

What is the importance of cascade reactions?

A

Bio amplification

Tight regulation/graduated response

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49
Q

What is the penultimate step in the coagulation cascade? And what is this step catalysed by?

A

Prothrombin to thrombin

Prothrombinase (Xa) (Also requires Ca2+)

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50
Q

What is the final step in the coagulation cascade? And what is it catalysed by?

A

Fibrinogen to fibrin

Thrombin (Also requires Ca2+)

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51
Q

What is found in the alpha granules of platelets?

A

Fibrinogen
vWF
V

52
Q

What is found in the dense granules of platelets?

A

ADP
Ca2+
Serotonin

53
Q

Where does thromboxane 2 come from?

A

Derived from arachidonic acid which itself comes from the plasma membrane of platelet

54
Q

Give the functions of thrombin

A

Converts fibrinogen to fibrin
Positive feedback on itself - activates other clotting factors
Activates platelets

55
Q

What is the main component of a blood clot

A

Fibrin (forms insoluble meshwork)

56
Q

Describe the intrinsic pathway of the clotting cascade

A

Slow

Everything it requires w/i blood

57
Q

When is the intrinsic pathway of the clotting cascade activated?

A

When blood comes in to contact with a negatively charged surface e.g. exposed collagen

58
Q

At which clotting factor does the intrinsic pathway of the coagulation cascade start?

A

XII

59
Q

Describe the extrinsic pathway of the coagulation cascade

A

Fast

Requires cellular component - tissue factor

60
Q

When is the extrinsic pathway of the clotting cascade activated

A

When tissue factor is released from damaged cells

61
Q

What is the role of tissue factor in the extrinsic pathway of the coagulation cascade?

A

Tissue factor binds to and therefore activates factor VII

62
Q

Factor VII is involved in the activation of which other clotting factors (this is the point at which the intrinsic and extrinsic pathways merge)

A

IX

X

63
Q

What is vitamin K required for (in terms of haemostasis)?

A

Synthesis of clotting factorsWh

64
Q

What happens to the prothrombin (bleeding) time in someone who develops liver disease? And why?

A

Increased prothrombin time

Due to decrease coagulation as most clotting factors synthesised at the liver

65
Q

Give the 3 types of plasma proteins

A

Albumin
Globulins (immunoglobulins)
Fibrinogens

66
Q

State the roles of albumin

A

Maintain oncotic/osmotic pressure
Transport and binding of substances
Free radical scavenging
Anticoagulant effects

67
Q

Where are immunoglobulins produced?

A

B lymphocytes

68
Q

What causes the plateau of the membrane potential in a cardiac myocyte during contraction

A

Slow influx of Ca2+

69
Q

How long does the absolute refractory period last for in a cardiac myocyte? And why does it exist?

A

0.2 s

Allows the heart to fill with blood

70
Q

What does the P wave on an ECG show?

A

Atrial depolarisation

71
Q

What does the QRS complex show on an ECG?

A

Ventricular depolarisation

72
Q

What does T wave on the ECG show?

A

Ventricular repolarisation

73
Q

What does the PR segment (not the same as PR interval) of an ECG show?

A

Delay at AV node

74
Q

What does the PR interval of an ECG represent? Give the normal time range of a PR interval

A

The time it takes for an electrical impulse to spread from the SAN to the AVN. 0.12-0.2s

75
Q

What does a longer PR interval indicate?

A

Heart block

76
Q

At what speed do electrical impulses travel in atrial/ventricular muscle fibres?

A

0.3-0.5 m/s

77
Q

At what speed to electrical impulses travel in purkinje fibres?

A

4m/s

78
Q

What does the ST segment represent? How long does it last for?

A

State of ventricular contraction

79
Q

When might ST segment become elevated?

A

Myocardial infarction

80
Q

Why might ST segment become depressed?

A

Angina

81
Q

How long does QRS complex normally last?

A

0.6 - 1.0 s

82
Q

Give a reason for QRS complex widening

A

Bundle branch block

83
Q

What does the QT interval represent? How long does it last for?

A

Ventricular depolarisation followed by ventricular repolarisation. 0.4 s

84
Q

Why is the T wave a positive reflexion?

A

Repolarisation in the opposited direction of lead II (double negative)

85
Q

In which direction does septal depolarisation occur? And what is it shown by on an ECG

A

Left to right

Q of QRS

86
Q

What does the R of the QRS complex represent?

A

Depolarisation of the mass of the ventricles

87
Q

What does the S of the QRS complex represent?

A

Depolarisation of the ventricles at the base of the heart

88
Q

Describe the features of cardiac muscle

A 
Striated
Sarcoplasm
T-tubules
Single nucleus
Branched
Intercalated discs w/ gap junctions and desmosomes
89
Q

What is the purpose of gap junctions between cardiac muscle cells and T-tubules within cardiac muscle cells

A

To allow the rapid propagation of action potentials throughout the entire heart allowing simultaneous contraction of cells

90
Q

Where is calcium stored within a cardiac myocyte?

A

Terminal cisternae of the sarcoplasmic reticulum

91
Q

What impact does an increase in cytosolic Ca2+ have on the strength of contraction in skeletal muscle?

A

None, a single action potential releases sufficient Ca2+ to fully saturate troponin sites

92
Q

What impact does an increase in cytosolic Ca2+ have on the strength of contraction in cardiac muscle?

A

Increases

93
Q

Give the 3 subunits of troponin and their roles

A

Troponin C - binds with Ca2+
Troponin I - with tropomyosin inhibits actin/myosin interaction
Troponin T - binds troponin complex to tropomyosin

94
Q

Describe the excitation part of excitation-contraction coupling

A

Pacemaker potential arrives at cardiac myocyte

Action potential at cardiac myocyte w/ slow influx of Ca2+ through L-type channel

Ca2+ binds to ryanoide receptors at sarcoplasmic reticulum, releases Ca2+ into cytoplasm

95
Q

Describe the contraction phase of excitation-contraction coupling

A

Ca2+ released into cytoplasm binds to troponin C which induces a conformational change in troponin I

Tropomyosin moves and exposes action-myosin binding sites

(At rest) ATP bound to myosin head is hydrolysed to ADP + Pi. Myosin head is energised

(Ca2+ present) Energised myosin heads form cross bridges with actin

Binding causes the release of ADP + Pi + ENERGY from myosin head, ratchet/angular movement occurs

ATP binds to myosin head and breaks cross bridge

ATP bound to myosin is hydrolysed to ADP + Pi. Myosin head re-energised.

Cycle repeats for as long as Ca2+ remains bound to troponin (C)

96
Q

Describe the composition of myosin

A

2 heavy chains

4 light chains

97
Q

Define a sarcomere

A

A functional unit of the contractile apparatus

98
Q

What is used for myocardial metabolism during:

a) aerobic respiration
b) anaerobic respiration

A

a) FAs

b) Glucose

99
Q

In a sarcomere what does the A-band show?

A

Myosin and actin (thickest/dArkest)

100
Q

In a sarcomere what does the I-band show?

A

Actin only (thinest/LIghtest)

101
Q

In a sarcomere what does the H zone represent

A

Myosin only

102
Q

Describe the composition of actin

A

Double helix of F(ilament) actin

F actin made up of polymerised globular actin molecules

103
Q

State the equation for Mean Atrial Pressure

A

MAP = Total Peripheral Resistance X CO

104
Q

Which vessels are main determinant of TPR and therefore MAP?

A

Arterioles

105
Q

What law describes resistance in a vessel? State it’s equation

A 
Poiseuille's law
R= 8nl/πr^4
R= resistance
n=viscosity
l=length
r=radius
106
Q

Where are the traberculae carnae located? What are they?

A

RV & LV

Ridges of muscle

107
Q

Where are the musculi pectinati found? What are they?

A

RA

Ridges of muscle

108
Q

What is the cristae terminalis and where is it found?

A

Crest of muscle in the RA dividing the smooth and ridged parts of the atria wall

109
Q

What is the surface marking of the tricuspid valve?

A

Right 4th IC

110
Q

What is the surface marking of the aortic valve?

A

Left 3rd IC

111
Q

What is the surface marking of the pulmonary artery?

A

Left 3rd CC

112
Q

What is the surface marking of the mitral valve

A

Left 4th CC

113
Q

Where would you listen for the mitral valve?

A

Apex

Left 5th IC mid-clavicular line

114
Q

Where would you listen for the tricuspid valve?

A

Right 5th IC

115
Q

Where would you listen for the aortic valve?

A

Right 2nd IC

116
Q

Where would you listen for the valve of the pulmonary artery

A

Left 2nd IC

117
Q

In the fetus, where is the ductus arteriosus found? What does it become?

A

Between the PA ->aorta

Ligamentum arteriousus

118
Q

In the fetus where is the ductus venosus found? What does it become?

A

Between placenta - IVC

Ligamentum venosus

119
Q

Where is the foramen ovale found? What does it become?

A

Between right atrium -> left atrium

Fossa ovalis

120
Q

Where do the coronary arteries arise from?

A

Aortic sinus

121
Q

What branches does the RCA usually give

A
  • nodal
  • posterior interventricular
  • marginal
122
Q

What branches does the LCA usually give?

A
  • left anterior descending (interventricular)

- circumflex

123
Q

In what percentage of the population does the posterior interventricular artery arise from the RCA (only) (RIGHT DOMINANCE)

A

70%

124
Q

In what percentage of the population does the posterior interventricular artery arise from the RCA and LCA (circumflex branch) (CODOMINANCE)

A

20%

125
Q

In what percentage of the population does the posterior interventricular artery arise from the LCA (circumflex branch) (only)

A

10%

126
Q

In what percentage of the population is the SAN supplied by the RCA

A

60%

Phase 1 EDF (12 decks)

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