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LCRS and LSS > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are the approximate dimensions of one ventricular cell

A

100um x 15um

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2
Q

What is a T-tubule?

A

A finger-like invagination of a cell

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3
Q

Is calcium higher naturally intracellularly or extracellularly?

A

Extracellularly

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4
Q

How is calcium removed from the cell?

A
  1. Calcium induced calcium release from the SR.

2. Exported by Na+/Ca2+ pump

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5
Q

Does the Na+/Ca2+ exchanger require energy?

A

No; uses Na+ gradient to drive sodium in and calcium out of the cell.

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6
Q

Which is more compliant to stretching - cardiac or skeletal muscle?

A

Skeletal muscle. Cardiac muscle is more resistant to stretching (less compliant); extracellular properties of the cytoskeleton.

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7
Q

What is isometric contraction?

A

No shortening of the muscle fibre but pressure increases in ventricles.

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8
Q

What is isotonic contraction?

A

Shortening of the muscle fibre and blood is ejected from the ventricles.

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9
Q

Which type of contraction is associated with increased filling and increased pressure within the ventricles?

A

Isometric contraction.

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10
Q

Are semi-lunar valves open or closed during isometric contraction?

A

Closed; ventricles are filling.

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11
Q

Define Preload

A

The initial stretch of the myofibre during diastolic filling.

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12
Q

Define Afterload

A

The pressure that the left ventricle must overcome to eject blood through the aorta to the systemic circulation.

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13
Q

What does increased afterload result in?

A

A decrease in isotonic shortening and volume of blood ejected from the heart.

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14
Q

Name one measure of afterload and one of preload.

A 
Afterload = DBP
Preload = RAP, EDV, EDP
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15
Q

Preload relates mostly to….

A

Ventricular filling

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16
Q

Afterload relates mostly to….

A

Pressure within the aorta

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17
Q

Describe Frank-Starling’s law

A

Increased diastolic fibre length increases ventricular contraction. (know word for word!)

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18
Q

What are the two explanations for greater contraction at a greater myofibre length?

A
  1. Greater myofibre length = more actin-myosin interactions.
  2. Greater myofibre length = increased affinity of troponin for calcium.
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19
Q

What is stroke work?

A

Work performed by the heart to eject blood under pressure into the pulmonary artery and aorta.

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20
Q

Define LaPlace’s law

A

When the pressure within a cylinder is kept constant, the tension on its walls increases when its radius does.

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21
Q

Where does the heart spend more time in?Systole or diastole?

A

Diastole by 2/3. Diastole has 4 phases whereas systole has 3.

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22
Q

How many cardiac cycle phases are there?What are they?

A
  2. Atrial systole
  3. Isovolumetric contraction
  4. Rapid ejection
  5. Reduced ejection
  6. Isovolumetric relaxation
  7. Rapid passive filling
  8. Reduced passive filling
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23
Q

What is a formula for ejection fraction?

A

SV/EDV

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24
Q

Define tetanus

A

Prolonged contraction of a muscle due to a rapidly repeated stimuli.

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25
Q

Which segment of the pressure volume loop is the longest in duration?

A

D to A; Filling

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26
Q

What is a formula for Stroke volume?

A

EDV-ESV

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27
Q

When is the 4th heart sound heard?

A

Congestive heart failure or pulmonary embolism. 4th heart sound = abnormal.

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28
Q

What does the 1st heart sound ‘lub’ indicate?

A

Closure of the atrioventricular valves

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29
Q

During which phase of the cardiac cycle is the first heart sound seen?

A

Isovolumetric contraction

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30
Q

What does the 2nd heart sound ‘dub’ indicate?

A

Isovolumetric relaxation; closure of semi-lunar valves.

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31
Q

What does the dichrotic notch indicate?

A

Closure of the aortic valve.

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32
Q

What does the 3rd heart sound indicate?

A

Turbulent flow and may be abnormal. Can signify mitral incompetence

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33
Q

When may be the 3rd heart sound be seen?

A

During rapid passive filling.

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34
Q

The right ventricle pumps the same volume of blood to the pulmonary circulation as the left ventricles does to the systemic circulation. True or false.

A

True. Same volume just at lower pressures.

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35
Q

Which has a larger volume - ESV or EDV?

A

EDV.

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36
Q

An increase in afterload has what affect on stroke volume?

A

Afterload decreases stroke volume.

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37
Q

Stroke volume is affected by which 3 things?

A

Preload
Afterload
Contractility

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38
Q

Which is the capacitance vessel?

A

The vein

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39
Q

What is Darcy’s law?

A

Pressure Gradient = Blood flow x Resistance.

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40
Q

Which vessels have the most resistance?

A

Small arteries and small arterioles.

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41
Q

What is the biggest determinant of blood flow?

A

Resistance.

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42
Q

What is the shear rate?

A

The gradient of velocity at any point

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43
Q

What is shear stress?

A

Shear rate x viscosity. Shear stress is a good indicator of endothelial function. High shear stress indicates good endothelial survival.

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44
Q

Where is low shear stress seen?

A

Platelet aggregation, coagulation and vasoconstriction.

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45
Q

How do you calculate pulse pressure?

A

Systolic blood pressure - diastolic blood pressure.

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46
Q

How do you calculate mean arterial blood pressure?

A

(2/3 x DBP) + (1/3 x SBP).

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47
Q

Which are the more compliant blood vessel - arteries or veins?

A

Veins.

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48
Q

Varicose veins are often caused by what?

A

Incompetent valves causing dilatation of superficial veins.

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49
Q

What is central venous pressure?

A

The pressure in the vena cavae and indicates the mean pressure within the right atrium.

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50
Q

What is ANP?

A

Atrial Natriuretic peptide secreted from the atria in response to stretch which has vasodilatory effects.

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51
Q

Where does the parasympathetic system arise from in comparison with the sympathetic system?

A

Parasympathetic system arises from the cranial and sacral spinal cord.
Sympathetic system arises from the thoracic and lumbar spinal cord.

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52
Q

Which is the pre-synaptic neurotransmitter for the sympathetic and parasympathetic system? What is the post- synaptic neurotransmitter?

A 
Pre-synapse = ACh for both symp. and parasymp.
Post-synapse = NA for symp, ACh for parasymp.
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53
Q

What does increased tonic activity cause?

A

Vasoconstriction.

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54
Q

Noradrenaline binds to which receptors in the heart?

A

B1 receptors

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55
Q

What stage of events occurs when Noradrenaline binds to the b1 receptor?

A

Calcium influx into the myocardial cell increases

Calcium uptake into the ST increases; increases Ca2+ induced Ca2+ release from SR.

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56
Q

Does a low or high intrathoracic pressure increase the EDV?

A

A decrease in intrathoracic pressure.

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57
Q

When is the baroreceptor reflex most sensitive? How would this show on a graph

A

When arterial pressures are between 90-100mmHg.

Graph shows a gradual upward curve until 90-100mmHg when it becomes very steep.

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58
Q

How does the basoreceptor reflex decrease blood pressure?

A

Stimulates parasympathetic activity to the heart and inhibits sympathetic activity to the heart, arteries, veins and venules and tonic activity.

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59
Q

Which are the Parasympathetic nervous system’s afferent and efferent nerves?

A

Afferent: Vagus nerve and Glossopharyngeal nerve.
Efferent: Vagus nerve.

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60
Q

How do baroreceptors detect a increase/decrease in blood pressure?

A

Through the stretch of the aortic arch/carotid arteries.

61
Q

How is venous returned controlled?

A

Through venous return which is determined by 1. Skeletal muscle pump and 2. Sympathetic activation of veins.

62
Q

When blood pressure decreases e.g. during haemorrhage, what mechanisms take place by baroreceptor reflex?

A
  1. Increased vaso+venoconstriction
  2. Increased sympathetic stimulation(discharge) to veins
  3. Increased venous pressure
63
Q

What is the myogenic theory?

A

When there is an increase in blood pressure, smooth muscles fibres in the vessel contract.

64
Q

What is the metabolic theory?

A

When blood flow decreases, metabolites accumulate and cause vasodilatation.

65
Q

Where is the vasomotor centre?

A

The Medulla Oblongata

66
Q

What is the purpose of capillaries?

A

To deliver metabolic substances to the cell

67
Q

Why is capillary density important?

A

Capillary density maximises the surface area and minimises diffusion distance = enhances diffusion.

68
Q

Where are fenestrated capillaries found?

A

Kidney

69
Q

Where are discontinuous capillaries found?

A

Bone marrow, liver

70
Q

What are the x3 types of capillary structure?

A

Continuous, discontinuous and fenestrated.

71
Q

Give an example of where a continuous capillary is found.

A

The blood brain barrier.

72
Q

Describe Oncotic pressure.

A

Oncotic pressure is a ‘pulling force’; it pulls proteins from the interstitial fluid back into the vessel.

73
Q

Describe Hydrostatic pressure.

A

A pushing force i.e. from blood vessel out to interstitial fluid.

74
Q

Apart from direction of flow what is a difference between hydrostatic and oncotic pressures?

A

Hydrostatic pressure is greater at the beginning of the capillary whereas oncotic pressure stays the same throughout the capillary.

75
Q

Which is more effective - ultrafiltration or reabsorption?

A

Ultrafiltration; hydrostatic forces. Reabsorption is controlled by oncotic forces.

76
Q

What is another name for oncotic pressures?

A

Colloid osmotic pressure.

77
Q

Capillary density is proportional to metabolic activity. True or false?

A

True.

78
Q

What are the three components of the ECG?

A

Electrodes, cables/ wires and leads

79
Q

What is a vector?

A

A quantity that has both magnitude and direction.

80
Q

What does the isoelectric line represent?

A

No net change in voltage

81
Q

Are upward cardiac vectors towards the anode or cathode?

A

Towards the cathode(+)

82
Q

Which part of the cardiac anatomy has the slowest conduction velocity?

A

The bundle of his; 2-5 m/s

83
Q

Which are the bipolar leads in the ECG?

A

Leads I, II and III.

84
Q

What is the normal R-R interval?

A

0.6s-1.2s

85
Q

What is the normal voltage and paper speed?

A

25mm/s, 10mm/mV

86
Q

Which is the shockable rhythm?

A

Ventricular tachycardia and ventricular fibrillation

87
Q

What is Ventricular fibrillation?

A

An irregular rhythm where the heart is unable to generate an output.

88
Q

What is Ventricular fibrillation?

A

An irregular rhythm at a rate of above 250bpm, where the heart is unable to generate an output.

89
Q

What is ST depression caused by?

A

Myocardial ischaemia

90
Q

Would you defibrillate on asystole?

A

No; it is not a shockable rhythm.

91
Q

Which is the most isoelectric lead?

A

aVL.

92
Q

Name 2 effects of thromboxane.

A

Causes platelet aggregation and vasoconstriction.

93
Q

Name 4 effects of Angiotensin II.

A

Arteriolar vasoconstriction, sympathoexcitation, ADH secretion, Aldosterone secretion and Tubular sodium reabsorption.

94
Q

What are the approximate values of intracellular vs extracellular calcium?

A 
Intracellular = 100nmol/L
Extracellular = 2mmol/L (REMEMBER THE nm Vs mm). Intracellular = less.
95
Q

Is calcium higher intracellularly or extracellularly?

A

Extracellularly

96
Q

In the Na+/Ca2+ exchanger, what is the direction of each of the ions?

A

Calcium flows into the cell as it is lower intracellularly. Sodium flows out of the cell; Na+ has been pumped in from Na+/K+ pump.

97
Q

Is the inhibition of COX enzymes by aspirin reversible or irreversible?

A

Irreversible.

98
Q

What treatment should you use if you want reversible inhibition of the COX enzymes?

A

NSAIDS.

99
Q

What is the difference between the platelet and the endothelial cell?

A

The platelet does not have a nucleus.

100
Q

What are the 3 phases of atherosclerosis?

A
  1. Endothelial damage and dysfunction.
  2. Fatty streak formation (foam cells)
  3. Well-developed atheromatous lesion (macrophages and necrotic area formed).
101
Q

Define senescence

A

Deterioration with age. Cell stops growing, dividing.

102
Q

Name one physiological mechanism that may predispose an individual to atherosclerosis.

A

Type of blood flow - turbulent or laminar?

103
Q

What is angiogenesis?

A

The formation of new blood vessels from the endothelial lining of existing blood vessels.

104
Q

Give x3 circumstances where the body require angiogenesis.

A
  1. Embryonic growth
  2. Menstrual cycle
  3. Wound healing
105
Q

Are senescent cells good for the body?

A

Yes; they stop the growth of damaged cells and prevent that damage being passed onto the daughter cell.
No; they are pro-inflammatory and can be found in atherosclerotic lesions.

106
Q

What is the name of the substance in red wine that is thought to decrease cardiovascular risk? How does it work?

A

Resveratrol. Resveratrol promotoes endothelial protective pathways e.g. production of eNOS. Also reduces cell senescence.

107
Q

What is the intrinsic rate of the heart?

A

100-110bpm.

108
Q

Are venous pressures higher at the top or the bottom of the body?

A

At the bottom of the body.

109
Q

What affect does hydrostatic pressure have on capillary fluid from the supine to standing position?

A

Increased hydrostatic pressure pushes fluid out of the capillary which leads to CAPILLARY FLUID LOSS.

110
Q

Name one key effect of capillary fluid loss during standing? (Why is there capillary fluid loss?)

A

Decreased venous return. (; Increased hydrostatic pressure forces fluid out of the capillary).

111
Q

In one day, more fluid exits the capillary through filtration than enters through reabsorption. True or false?

A

True.

112
Q

The pupil is always mildly….

A

constricted; vascular tone so vessel can further dilate when needed.

113
Q

What is the mechanism of action of Pilocarpine? When may it be used?

A

Causes constriction of the pupil. This is useful when there is high pressure inside the eye e.g. glaucoma, as constriction causes decreased fluid inside the eye.

114
Q

What is the mechanism of action of Tropicamide?

A

Causes dilatation of the pupil.

115
Q

What group of drugs does Pilocarpine belong to?

A

Cholinergic agonist

116
Q

What group of drugs does Tropicamide belong to?

A

Muscarinic antagonists

117
Q

How is respiratory function regulated?

A

Pontine respiratory centre = controls rate and pattern of breathing.
Medullary respiratory centre = controls diaphragm and rhythm

118
Q

Which nerves innervate the diaphragm?

A

C3, C4, C5.

119
Q

Which nerves innervate the accessory muscles?

A

C1, C2, C3.

120
Q

Which nerves innervate the intercostal muscles?

A

T1-T11

121
Q

Which nerves innervate the abdominal muscles?

A

T6-L1

122
Q

Activation of the parasympathetic system in the bladder has what effect?

A

Contraction of the detrusor muscle = inhibition of the internal sphincter = micturition.

123
Q

Which part of the bladder is under voluntary control?

A

The external sphincter; made up of skeletal muscle.

124
Q

NTS sends signals to where?

A

Nucleus Tractus Solitarius sends signals to the hypothalamus which sends signals to the DMNX (Dorsal motor nucleus of the vagus nerve).

125
Q

What are the two divisions of the parasympathetic receptors?

A

Nicotinic and muscarinic.

126
Q

What are the two divisions of the sympathetic receptors?

A

alpha (a1, a2) and beta (b1, b2)

127
Q

Which are the receptors which determine neurotransmitter release?

A

Pre-synaptic receptors

128
Q

Which receptor type innervate the sweat glands?

A

Muscarinic receptors

129
Q

Which group are nicotinic and muscarinic receptors a part of?

A

Cholinergic receptors

130
Q

What is atropine?

A

Competitive muscarinic receptor antagonist

131
Q

What is common side effect of atropine?

A

Dry mout

132
Q

What is the effect of atropine on the heart?

A

Atropine will increase the heart rate

133
Q

What is the effect of atropine on the sweat gland?

A

Decrease sweat gland production

134
Q

What is tubocucarine?

A

A nicotinic receptor antagonist

135
Q

What is the effect of tubocurarine on the heart rate?

A

Removes all autonomic control from the heart as there are nicotinic receptors at both the sympathetic and parasympathetic systems.

136
Q

All adrenergic receptors are….

A

GPCRs

137
Q

What is Medetomidine?

A

An alpha 2 receptor agonist.

138
Q

What is the effect of alpha 2 receptor agonists on noradrenaline release?

A

Inhibition of noradrenaline release.

139
Q

An alpha 1 receptor antagonist will have what effect on smooth muscle?

A

Smooth muscle dilatation.

140
Q

To which class of drugs does salbutamol belong?

A

Beta 2 receptor agonists.

141
Q

To which class of drugs does atenolol belong?

A

Beta 1 receptor antagonists.

142
Q

Which factor is Thrombin?

A

FIIa.

143
Q

What does the ‘a’ stand for in e.g. FIIa

A

Activated coagulation factor.

144
Q

Which is the main trigger of coagulation?

A

Tissue factor and Factor VIIa.

145
Q

Which is the main trigger of forming the primary haemostatic plug?

A

Platelets binding to vWF and Collagen.

146
Q

What is the name for FII

A

Pro-thrombin; no activation.

147
Q

Factor VIIIa is a protease. True or false.

A

False.

148
Q

Thrombin generates which two main coagulation factors?

A

FVa and FVIIIa.

149
Q

Where does activated coagulation occur?

A

On the platelet surface.

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