Cardiovascular Flashcards
the pulmonary valve is
between right ventricle and pulmonary artery
the aortic valve is
between left ventricle and the aorta
right atrium receives deoxygenated blood from
IVC/SVC/coronary sinus
left atrium receives oxygenated blood from
right and left pulmonary veins
anterior/sternocostal surface of heart
mostly R ventricle
inferior/diaphragmatic surface of heart
mostly L ventricle
posterior surface/base of heart
L atrium + pulmonary veins
apex of heart
L ventricle
right border of heart consists of
right atrium
inferior border of heart consists of
L ventricle + R ventricle
left border of heart consists of
L ventricle (some of L atrium)
superior border of heart consists of
R/L atria and great vessels
surface marking for apex of heart
mid-clavicular line
5th intercostal space
auscultation of mitral valve
apex
auscultation for tricuspid valve
left lower sternal border 5th intercostal space
auscultation for pulmonary valve
left of sternum 2nd intercostal space
auscultation for aortic valve
right of sternum 2nd intercostal space
the first heart sound (S1) is
the closing of tricuspid/mitral valves at beginning of systole
the second heart sound (S2) is
the closing of aortic/pulmonary valves at beginning of diastole
superior mediastinum contains (5)
arch of aorta - 3 branches superior vena cava - 4 tributaries vagus nerve phrenic nerve thymus/trachea/oesophagus etc
middle mediastinum contains (6)
heart pericardium bifurcation of trachea origins of great vessels cardiac plexus phrenic nerves
what is the floor of the inferior mediastinum
the diaphragm
posterior mediastinum contains (5)
oesophagus descending aorta - branches azygous veins sympathetic nerve trunks thoracic splanchnic nerves
where does the right coronary artery arise from
anterior aortic sinus and runs in coronary sulcus
what does the right coronary artery supply
SAN
AVN
R atrium/R ventricle
where does the left coronary artery arise from
left posterior aortic sinus and divides in the atrioventricular groove
dominance refers to
70% people RCA supplies PDA
20% co-dominant from RCA and Cx
10% Cx supplies PDA
right marginal artery supplies
right ventricle and apex
left anterior descending supplies
R ventricle L ventricle and interventricular septum
left marginal artery supplies
left ventricle
left circumflex artery supplies
left atrium left ventricle
why are LV walls x3 thicker than RV
increased resistance of systemic circulation compared to pulmonary circulation
brachiocephalic trunk landmark
second right costal cartilage
the pericardium consists of
fibrous layer
serous layer= parietal and visceral
what is the pericardial cavity
space between parietal and visceral layers
mneumonic for pericardium
fart police smell villains
where is the oblique sinus
pericardial space behind the left atrium
what is the blood supply of the pericardium
pericardiacophrenic arteries
internal thoracic arteries
what innervates the pericardium
phrenic nerve
what supplies parasympathetic innervation of the heart
the vagus nerve
what supplies sympathetic innervation of the heart
sympathetic trunk via cardiac nerves
what provides motor innervation to the diaphragm
phrenic nerve
why do we get referred pain from heart damage
pain felt in cutaneous regions because dermatomes responsible for cutaneous pain are supplied by same spinal cord levels as visceral afferents from the heart
where is pain felt during myocardial infarction
right shoulder region
what are the nerve roots of the phrenic nerves
anterior rami of C3 C4 C5
what structures are supplied by the vagus nerve (6)
pharynx larynx heart lungs foregut midgut
left common carotid artery supplies
most of cerebral hemisphere + L face and neck
left subclavian artery supplies
vertebral
thyrocervical
axillary arteries
what supplies the SAN
60 % people RCA
40% people LCA
what supplies the AVN
posterior descending artery
what is haemocrit
the percentage of RBCs in the cellular component of blood
components of blood proportions are
45% cellular
55% fluid
45% haemocrit
where are erythrocytes formed in adults
bone marrow in axial skeleton
where are erythrocytes formed in children and foetuses
bone marrow in bones in children
liver/yolk sac/bone marrow in foetus
what is the erythrocyte regulatory hormone
erythropoietin
5 types of leukocytes
eosinophil neutrophil basophil monocyte lymphocyte
eosinophil characteristics
bilobed nucleus
upregulated in parasitic infection
decrease histamine
bright pink/orange granules
neutrophil characteristics
most abundant
multilobed nucleus - increase with age
granular cytoplasm
acute inflammation/phagocytic function
basophil characteristics
bilobed nucleus
dark blue granules fill cell
precursor to mast cells
contain histamine = allergic response
monocyte characteristics
kidney shaped nucleus
pale blue cytoplasm
differentiate into dendritic cells/macrophages
adaptive immunity
lymphocyte characterists
fried egg appearance
B or T cells
immature = bigger than RBC
B lymphocytes become
plasma and produce antibodies
what do T cells do
mediate inflammation
platelet features
anucleate and discoid
stain blue
4 types of granules
where are platelets formed
from megakaryocytes in the bone marrow
platelet life span
5-10 days
platelet regulatory hormone
thrombopoietin
name 4 soluble plasma proteins
albumin
carrier proteins
coagulation factors
immunoglobulins
what is haemostasis
maintenance of balance of blood flow so it is liquid in vessels but clot outside
what allows blood to stay liquid
coagulation factors and platelets are INACTIVE
what activates platelets
tissue factor found on all cells except endothelial cells
what happens when you cut yourself
vessel damage leads to vessel constriction
slow of blood flow to area and endothelial surfaces press together
bleeding is stopped by platelet plug and coagulation cascade
formation of platelet plug 5 steps
- endothelium disrupted = expose collagen fibres
- platelets adhere to VWF which is bound to collagen
- binding causes release of dense granules and thrombin form platelet
- platelet is activated = spiculated shape
- fibrinogen binds to platelets to allow more platelets to aggregate
what does the release of platelet dense granules do
causes platelet amplification
what does the release of thrombin do
platelet activation and further thrombin release via positive feedback
how does the platelet plug stay where its wanted
prostaglandins produced by undamaged endothelium = inhibit aggregation
nitric oxide from undamaged endothelium = vasodilation and inhibit aggregation
why do we have a coagulation cascade
occurs around platelet plug to support and reinforce
what enzyme converts prothrombin to thrombin
clotting factor Xa
what is the role of thrombin enzyme
convert soluble fibrinogen to insoluble fibrin
fibrinolytic pathway
plasminogen converted to plasmin to break down fibrin
what level is the arch of the aorta
T4
type A have
A antigen on surface of RBC and anti-B antibodies in plasma = co-dominant
type B have
B antigens on surface of RBC and anti-A antibodies in plasma = co-dominant
type AB have
A and B antigens on surface of RBC but no anti-A or anti-B in plasma = universal recipient
type O have
no A or B on surface of RBC but BOTH anti-A and antiB antibodies in plasma = universal donor
what is rhesus
C, D, E antigens
what is rhesus postivie
D antigen present
what is rhesus negative
D antigen NOT present
what is rhesus sensitisation in pregnancy
mother has RhD negative baby has positive
mothers blood recognises as foreign = makes antibodies against
takes time so 1st baby unaffected but mother = sensitised to RhD positive blood
what is rhesus disease
mother has antibodies against RhD positive baby
attacks baby RBC
causes anaemia and jaundice
4 features of a cardiac myocyte
intercalated discs
centrally nucleated
striated
branching
what is systole
isovolumetric ventricular contraction and ventriucular emptying (not completely)
0.3 secs
what is diastole
isovolumetric ventricular relaxation and ventricular filling
0.5 secs
isovolumetric definition
change in pressure but not in volume
what is responsible for 80% ventricular filling
rapid ventricle filling - rest is slow filling due to equalising pressures
what is diastis
little to no net movement of blood
what is atrial booster
sudden pressure increase due to atrial contraction (SAN) allowing ventricles to be actively filled
what is the length of a cardiac cycle
0.8 secs
what is starling’s law
the larger the volume of the heart the greater the energy of its contraction and amount of chemical change at each contraction
larger end diastolic volume = larger stroke volume