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Anatomy > Cardiovascular Exam > Flashcards

Cardiovascular Exam Flashcards

1
Q

where in the chest is the heart located?

A

sits posterior to sternum and left of midline between the lungs in the mediastinum

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2
Q

what are the layers of the pericardium

A
  • fibrous pericardium
  • parietal layer of serous pericardium
  • visceral layer of serous pericardium
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3
Q

What is the function of the fibrous pericardium?

A

dense irregular CT that is outermost covering that anchors heart and prevents overfilling

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4
Q

What is the coronary sulcus?

A

external groove extending around circumference of heart that separates atria from ventricles

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5
Q

what superficial feature separates the left from right ventricles?

A

interventricular sulci

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6
Q

what is the wrinkled extension of the atrium called?

A

the auricle

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7
Q

what are the three layers of the heart wall?

A
  • epicardium,
  • myocardium
  • endocardium
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8
Q

what is the thickest layer of the heart wall?

A

myocardium

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9
Q

what is the function of atrioventricular valves?

A

prevent back flow to atria
- close when ventricles contract

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10
Q

what is the function of the semilunar valves?

A

prevent back flow to ventricles
- open when ventricles contract and blood goes to arteries
- close when ventricles relax

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11
Q

how many cusps does each semilunar valve have?

A

3

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12
Q

what do the two sounds of the heart indicate

A

s1: closing of AV valves
s2: closing of semilunar valves

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13
Q

what is a heart murmur?

A

an abnormal heart sound that is the result of turbulence of blood passing through heart

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14
Q

what are the two types of heart murmurs?

A

valvular insufficiency and valvular stenosis

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15
Q

what is occurring in valvular insufficiency?

A

cardiac valves are leaking because cusps are not closing tightly, causing blood to regurgitate back through valve

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16
Q

what is occurring during valvular stenosis?

A

valve cusps are scarred and cannot open completely which causes reduced cardiac chamber output

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17
Q

what are some characteristics of cardiac muscle tissue?

A
  • one or two central nuclei
  • supported by areolar CT (endomysium)
  • myofilaments arranged in sarcomeres
  • cells are connected with intercalated discs
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18
Q

What is the fibrous skeleton of the heart?

A

a network of dense irregular CT that provides support at boundry of atria and ventricles, forms fibrous rings to anchor valves, and acts as electrical insulator preventing ventricles from contracting at the same time as atria

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19
Q

how does the cardiac muscle relate to the fibrous skeleton?

A

cardiac muscle cells are attached to fibrous skeleton and arranged in spiral bundles

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20
Q

how does coronary flow coincide with heart contractions?

A

vessels are patent when heart is relaxed and compressed when heart contracts

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21
Q

what is atherosclerosis?

A

plaques narrow coronary arteries

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22
Q

what is a coronary spasm?

A

sudden narrowing of vessles

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23
Q

what is angina pectoris?

A

chest pain that may also include referred pain in left arm or jaw

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24
Q

what is a myocardial infarction?

A

a sudden and complete occlusion of coronary artery that causes myocardium to be deprived of oxygen

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25
Q

what is the function of the sinoatrial (SA) node?

A

initiates heart beat (pacemaker)

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26
Q

what is another name for the atrioventricular bundle?

A

the bundle of his

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27
Q

where are the purkinje fibers located

A

extend from right and left bundles at apex and course through walls of ventricles

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28
Q

where is the cardiac center located?

A

medulla oblongata

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29
Q

what is the function of the cardiac center?

A
  • receives signals from baroreceptors and chemoreceptors in cardiovascular system
  • sends signals via sympathetic and parasympathetic pathways
  • modifies, but does not initiate, cardiac activity
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30
Q

how does parasympathetic innervation occur?

A
  • starts at cardioinhibitory center in medulla
  • relayed via vagus nerves and heart rate decreases
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31
Q

how does sympathetic innervation occur?

A
  • Starts at cardioacceleratory center
  • relayed via nuerons from T1-T5 segment of spinal cord
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32
Q

what are the two events involved in heart contraction?

A
  • the conduction system initiates and propagates an action potential
  • cardiac muscle cells fire action potentials and contract
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33
Q

what are the cells that initiate heartbeat in the SA Node?

A

nodal cells
- spontaneously depolarize and generate action potential

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34
Q

what kind of voltage gated channels are present in nodal cells?

A
  • slow voltage gated Na + channels
  • fast voltage gated Ca2+ channels
  • voltage gated K+ channels
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35
Q

what are the steps of autorhythmicity?

A
  1. reaching threshold
    - slow V gated Na+ channels open and membrane potential changes from -60 to -40 mV
  2. depolarization
    - fast V gated Ca2+ channels open
    - membrane potential increases to just above 0
  3. repolarization
    - calcium channels close and V gated K+ channels open
    - membrane potential returns to -60
    - voltage gated Na+ channels open at -60 and process repeats
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36
Q

how long of a gap is there between SA node action potentials at rest?

A

0.8 sec after the last

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37
Q

what prevents SA node from firing faster like it wants to?

A

vagal tone keeps resting heart rate slower

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38
Q

How do nodal cells and neurons compare and contrast?

A
  • while both can fire action potentials, neurons require stimulation to fire unlike nodals cells.
  • nodal cells do not have a stable RMP
  • nuerons depolarize from Na+ entry while nodal cells use Ca2+ entry
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39
Q

how does the action potential spread after starting at SA node?

A
  1. AP is distributed through atria and reaches AV node
  2. AP is delayed at AV node
  3. AP travels through AV bundle to bundle branches to purkinje fibers
  4. AP spreads through ventricles
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40
Q

what causes the delay of the AP at the AV node?

A

AV nodal cells are slow due to small diameter and few gap junctions, insulation of fibrous skeleton also means AV node is bottleneck

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41
Q

How do purkinje fibers differ from other cardiac fibers?

A

large in diameter to ensure AP is extremely rapid and ventricles contract at same time

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42
Q

how do papillary muscles aid with ventricular contraction?

A
  • anchor chordae tendinae of AV cusps and starts to pull on cusps just prior to increase in pressure in ventricles
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43
Q

What occurs during depolarization of cardiac muscle cells?

A
  • impulse from conduction system opens fast voltage gated Na+ channels
  • Na+ enters cell changing RMP from -90 to +30
  • voltage gated Na+ channels start to inactivate
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44
Q

what occurs during plateau of cardiac muscle cells?

A
  • depolarization opens V gated K+ channels and slow V gated Ca2+ channels
  • K+ leaves as Ca2+ enters
  • membrane remains depolarized
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45
Q

What occurs during repolarization of cardiac muscle cells?

A
  • voltage gated Ca2+ channels close while K+ channels remain open
  • membrane potential returns to -90 mV
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46
Q

True or false, cardiac muscle cannot exhibit tetany

A

true, unlike skeletal muscle, cardiac cells have a long refractory period and the heart must contract and relax before it can be stimulated again

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47
Q

What are the major waves in an EKG?

A

P wave, QRS complex, T wave

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48
Q

what are the major segments in an EKG?

A

P-Q segment and S-T segment

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49
Q

What does the P wave reflect?

A

shows electrical changes of atrial depolarization

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50
Q

What changes are seen in the QRS complex?

A

shows eletrical changes associated with ventricular depolarization (atrial repolarization is also occurring simultaneously)

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51
Q

What is reflected in the T wave?

A

shows electrical changes that occur with ventricular repolarization

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52
Q

What do segments between waves represent?

A

the plateau phase where there is no electrical change

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53
Q

what occurs during the P-Q segment?

A

atrial cells plateau (atria are contracting)

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54
Q

what occurs during the S-T segment?

A

ventricular plateau (ventricles are contracting)

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55
Q

What happens in a first degree AV block?

A

PR prolongation; slow conduction between atria and ventricles

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56
Q

What happens in a second degree AV block?

A

failure of some atrial action potentials to reach ventricles

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57
Q

What happens in a third degree AV block?

A

complete blockage, failure of all action potentials to reach ventricles

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58
Q

What is atrial fibrillation?

A

chaotic timing of atrial action potentials

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59
Q

What is the cardiac cycle?

A

all events in heart from the start of one heart beat to the start of the next

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60
Q

what is the driving force behind the cardiac cycle?

A

ventricular activity

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61
Q

what occurs during ventricular contraction?

A

ventricular pressure is raised
- AV valves pushed closed
- semilunar valves pushed open and blood ejected to artery

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62
Q

what occurs during ventricular relaxation?

A

ventricular pressure is lowered
- semilunar valves close due to no pressure from below to keep them open
- AV valves open due to no pressure pushing them closed

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63
Q

What is happening during atrial contraction?

A
  • SA node starts atrial excitation
  • atria contract and push blood into ventricles until ventricles reach EDV
  • AV valves open and SL valves closed due to arterial trunk pressure>ventricular pressure
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64
Q

what is happening during ventricular ejection?

A
  • ventricles continue to contract so that ventricular pressure rises above arterial pressure
  • semilunar valves forced open as blood moves from ventricles to arterial trunks
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65
Q

what is stroke volume

A

amount of blood ejected by ventricle

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66
Q

what is end systolic volume

A

amount of blood remaining in ventricle after contraction finishes

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67
Q

what occurs during isovolumetric relaxation

A
  • ventricles relax and start to expand, lowering pressure
  • arterial pressure greater than ventricular pressure
  • SL valves shut and AV valves remain closed
  • when all valves are closed, blood neither enters nor leaves and the time is called isovolumetric
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68
Q

what is ventricular balance?

A

equal amounts of blood are pumped by left and right sides of heart

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69
Q

What is cardiac output?

A

amount of blood pumped by a single ventricle in one minute
- HR x SV

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70
Q

how does heart size affect cardiac output

A

individuals with smaller hearts have smaller stroke volume and faster heart rate and vice versa

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71
Q

what is cardiac reserve?

A

capacity to increase output above rest level, ex: CO increases during exercise

72
Q

what are the two types of edema?

A

systemic edema and pulmonary edema

73
Q

what is occurring in systemic edema?

A

may occur if right ventricle is impaired, results in more blood in systemic circulation and additional fluid entering interstitial space

74
Q

what is occurring in pulmonary edema?

A

ay occur if left ventricle is impaired, results in more blood remaining in pulmonary circulation, swelling and fluid accumulation in lungs, and dyspnea

75
Q

What are chronotropic agents?

A

change heart rate by altering the activity of nodal cells

76
Q

what affect do positive chronotropic agents have?

A
  • sympathetic nerve stimulation that cause NE release on heart
  • cause adrenal gland to release EPI and NE
  • EPI and NE bind to nodal cells and increase their firing rate
77
Q

what are some examples of positive chronotropic agents?

A

thyroid hormone, caffeine, nicotine, and cocaine

78
Q

what affect do negative chronotropic agents have?

A
  • parasympathetic axons release ACh onto nodal cells which open K+ channels and make cell more negative
  • longer time for nodal cel to reach threshold, slower heart rate
79
Q

what affect do beta blockers have?

A

interfere with EPI and NE binding to beta receptors

80
Q

what is the atrial reflex?

A

protects heart from overfilling
- baroreceptors in atrial walls stimulated by increased venous return
- HR increases to move blood through quickly

81
Q

What three factors influence stroke volume

A

venous return, inotropic agents, and afterload

82
Q

how does venous return infleunce stroke volume?

A

determines amount of ventricular blood prior to contract; volume determines preload

83
Q

what is the Frank-Starling law?

A

as EDV increases, the greater stretch of heart wall results in more optimal overlap of thick and thin filaments
- heart contracts more forcefully when filled with more blood so SV increases

84
Q

what are inotropic agents?

A

factors that change stroke volume by altering contractility

85
Q

what affect do positive inotropic agents have?

A
  • EPI and NE work via beta one receptors to increase Ca2+
86
Q

what affect do negative inotropic agents have?

A

decrease available Ca2+ and thus lower contractility

87
Q

what is afterload?

A

resistance in arteries to ejection of blood by ventricles, pressure must be exceeded before blood is ejected

88
Q

what factors contribute to cardiac output?

A
  • chronotropic agents
  • venous return
  • inotropic agents
  • increased afterload
89
Q

define systole and diastole

A

systole: contraction
diastole: relaxation

90
Q

what are some secondary factors that can influence heart rate?

A

age, gender, exercise, body temperature

91
Q

what is the space inside a blood vessel called?

A

lumen

92
Q

what are the layers of the vessel wall called?

A

tunics

93
Q

what are the tunics of vessel walls?

A
  • tunica intima
  • tunica media
  • tunica externa
94
Q

what is the tunica intima composed of?

A
  • endothelium of simple squamous epithelium
  • subendothelium layer of areolar CT
95
Q

What is middle layer of the vessel wall?

A

tunica media

96
Q

what is the function of the tunica media

A

contains circularly arranged layers of smooth muscle cells with elastic fibers that control vasoconstriction/dilation

97
Q

what is the outermost layer of the vessel wall?

A

tunica externa

98
Q

what is the function of the tunica externa?

A

helps anchor vessel to other structures

99
Q

what are vasa vasorum?

A

small arteries found in some tunica externa required to supply very large vessels

100
Q

what are companion vessels?

A

vessels that lie next to each other (arteries and veins serving same body region)

101
Q

what type of blood vessel has the thickest tunica media?

A

arteries

102
Q

how does the composition of arteries aid their function?

A

have more elastic and collagen fibers, which are more resilient and resistant to changes in blood pressure

103
Q

what vessel has the largest lumen?

A

veins

104
Q

what tunics are found in the capillaries?

A

only tunica intima ( no subendothelial layer)

105
Q

as arteries branch how do they change?

A
  • decrease in lumen diameter and elastic fibers
  • increase in relative amount of smooth muscle
106
Q

what are the three types of arteries?

A
  • elastic arteries
  • muscular arteries
  • arterioles
107
Q

what is the largest type of artery?

A

elastic arteries

108
Q

what is the function of elastic arteries

A

conduct blood from heart to muscular arteries
- have large proportion of elastic fibers allowing stretch and recoil and help propel blood through arteries during diastole

109
Q

what is the function of muscular arteries?

A

distribute blood to specific body regions, muscle allows for vasoconstriction/dilation

110
Q

what are the two layers of elastic tissue found in muscular arteries

A
  • internal elastic lamina: between tunica intima and tunica media
  • external elastic lamina: between tunica media and tunica externa
111
Q

what are the smallest type of arteries?

A

arterioles

112
Q

how many tunics do arterioles have?

A

larger ones have 3 and smaller arterioles only have thin endothelium and single layer of smooth muscle

113
Q

what is atherosclerosis

A

progressive disease of elastic arteries which includes the presence of atheroma which can cause the thickening of tunica intima and narrowing of arterial lumen

114
Q

what causes atherosclerosis?

A

may be due to response to injury to endothelium caused by infection, trauma, or hypertension

115
Q

how is atherosclerosis treated

A

stent with balloon angioplasty or coronary bypass surgery

116
Q

how do RBCs pass through capillaries?

A

travel single file (rouleau)

117
Q

what are the three types of capillaries

A

continuous, fenestrated, and sinusoid

118
Q

what features are unique to continuous capillaries?

A
  • endothelial cells form a continuous lining
  • tight junctions connect cells but don’t form a complete seal
119
Q

where are continuous capillaries typically found?

A

muscle, skin, lungs, CNS

120
Q

what features are unique to fenestrated capillaries

A

endothelial cells form a continuous lining but the cells have fenestrations (pores that allow movement of smaller proteins)

121
Q

where are fenestrated capillaries found?

A

found in areas where a lot of fluid transport occurs (intestine, kidneys)

122
Q

what features are unique to sinusoids?

A
  • endothelial cells form an incomplete lining with large gaps
  • basement membrane incomplete/absent
  • openings allow transport of large substances
123
Q

Where are sinusoids found?

A

bone marrow, spleen, some endocrine glands

124
Q

what are capillary beds?

A

groups of capillaries functioning together

125
Q

what feeds into capillary beds?

A

metarterioles

126
Q

what side of a capillary bed contains smooth muscle cells?

A

proximal part

127
Q

what is the precapillary sphincter?

A

smooth muscle ring at true capillary origin that permits entry into capillaries

128
Q

at one time, how many of the bodies capillary beds are open?

A

one quarter

129
Q

what is perfusion?

A

amount of blood entering capillaries per unit time per gram of tissue

130
Q

what are the smallest type of vein?

A

venules

131
Q

what is the function of the valves found in veins

A

prevent blood from pooling in the limbs, ensure flow toward heart

132
Q

What are vein valves made of?

A

tunica intima and elastic and collegen fibers

133
Q

what % of blood is in systemic circulation at rest?

A

70%
- systemic veins: 55%
- systemic arteries: 10%
- systemic capillaries: 5%

134
Q

what is an end artery?

A

one that provides only one path for blood to reach organ/region

135
Q

what is arterial anastomosis?

A

two or more arteries converge to supply same region

136
Q

what is venous anastomosis?

A

two or more veins drain same body region

137
Q

what is arteriovenous anastomosis?

A

transports blood from artery directly to vein

138
Q

what is portal system?

A

two capillary beds in sequence

139
Q

what is the cross sectional area of a vessel?

A

lumen diameter

140
Q

what is total cross sectional area?

A

sum of diameters of all vessels of a certain type

141
Q

what type of vessel has the largest total cross sectional area

A

capillaries

142
Q

how does blood flow velocity relate to total cross sectional area?

A

inversely proportional

143
Q

how do substances enter/leave the blood

A

leave or enter blood based on their concentration gradient
- high to low concentration

144
Q

what is vesicular transport?

A
  • substances are taken in by pinocytosis (form fluid filled vesicles)
  • transport vesicle across cell
  • secrete substance from other side by exocytosis
  • used in both directions
145
Q

what is bulk flow?

A
  • fluids flow doe pressure gradient
  • large amounts of fluids and dissolves substances move in direction that depends on net pressure of opposing forces
146
Q

what are the two types of bulk flow

A
  • filtration (fluid moves out of blood)
  • reabsorption (fluid moves back into blood)
147
Q

what is hydrostatic pressure?

A

force exerted by a fluid

148
Q

what are the types of hydrostatic pressure?

A
  • blood hydrostatic pressure: force exerted per unit are by blood on vessel wall
  • interstitial fluid hydrostatic pressure: force of interstitial fluid on outside of blood vessel
149
Q

what is colloid osmotic pressure?

A

the pull on water due to the presence of protein solutes

150
Q

what are the types of colloid osmotic pressure?

A
  • blood colloid osmotic pressure: draws fluid into blood due to blood proteins, promotes reabsorption
  • interstitial fluid colloid osmotic pressure: draws fluid into interstitial fluid
151
Q

what is net filtration pressure?

A

the difference between net hydrostatic pressure and net colloid osmotic pressure

152
Q

how does net filtration pressure change across a capillary?

A
  • at arterial end: NFP favors filtration
  • at venous end, NFP favors reabsorption
153
Q

what is local blood flow dependent on

A
  • degree of tissue vascularity
  • myogenic response
  • local regulatory factors
  • total blood flow
154
Q

what is blood pressure gradient?

A

change in pressure from one end of vessel to other

155
Q

what is pulse pressure

A

pressure in arteries added by heart contraction

156
Q

what is mean arterial pressure?

A

average arterial blood pressure across entire cardiac cycle
- MAP = diastolic + 1/3(pulse pressure)

157
Q

what is capillary blood pressure?

A

pressure no longer fluctuates between systolic and diastolic

158
Q

what is venous return dependent on?

A

pressure gradient, skeletal muscle pump, and respiratory pump

159
Q

what is the function of the skeletal muscle pump

A

assists venous return from limbs
- as muscle contracts, veins are squeezed moving blood towards heart

160
Q

what is the function of the respiratory pump?

A

assists venous return in the thorax
- in inspiration: diaphragm contracts, abdominal pressure increases and thoracic pressure decreases
- in expiration: diaphragm relaxes, so thoracic pressure increase while abdominal pressure decreases

161
Q

what is resistance?

A

the friction blood encounters due to contact between blood and vessel wall

162
Q

what affects peripheral resistance?

A

viscosity, vessel length, lumen size

163
Q

how does the length of a vessel affect resistance?

A

longer vessels create more resistance

164
Q

what is laminar flow?

A

different flow rate within vessel (faster in center of lumen slower near wall)

165
Q

what is total blood flow?

A

amount of blood moving through the system per unit time

166
Q

what is blood pressure dependent on?

A

cardiac output, resistance, blood volume

167
Q

what regulate bp short term?

A

autonomic reflexes

168
Q

what are the two divisions of the cardiovascular center and their functions?

A
  • cardiac center: influences bp by influencing cardiac output
  • vasomotor center: influences bp by influencing vessel diameter
169
Q

what are the two nuclei housed in the cardiac center?

A
  • cardioacceleratory center: origin of sympathetic pathways
  • cardioinhibitory center: origin of parasympathetic pathways
170
Q

what are baroreceptors?

A

nerve endings that respond to stretch of vessel wall

171
Q

what hormones work w/ the sympathetic nervous system to regulate bp?

A

epinephrine and norepinephrine
- angiotensin II, ADH, aldosterone also have effects

172
Q

how does ADH regulate bp?

A
  • increases water reabsorption in kidneys
  • stimulates thirst center to increase fluid intake
  • in large amounts causes vasoconstriction
173
Q

how does aldosterone regulate bp?

A

increases absorption of sodium ions and water in the kidney

174
Q

what effect does atrial natriuretic peptide have on bp?

A

decreases bp by stimulating vasodilation and increasing urine output

175
Q

how does blood flow distribution change during exercise?

A

total blood flow increases
- heart beats faster/stronger
- blood is removed from venous reservoirs
- blood is redistributed so that more goes to active tissues

Anatomy (10 decks)

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