Cardiovascular Part I Flashcards
Heart Located in ___________
Base - ____________
Apex - ___________
- mediastinum, between lungs
-broad superior portion of heart - inferior end, tilts to
the left, tapers to point
Small space between aortic arch and the pulmonary trunk. ________ it contains the ___ ______ and ______ _____ nerve. May occur on its own or with ________.
Aorto-pulmonary window
Ligamentum Arteriosum
Recurrent Laryngeal Nerve
heart defects.
Special anesthetics consideration s with mediastinal masses
Hemodynamics
Respiratory compromise
Four Ts
Hemodynamic compromises Neuro problems (Increased ICP) Resp comprose Four Ts : thymoma, teratoma, Thyroid Carcinoma and Terrible lymphoma
CARDIOPHRENIC ANGLE MASS: 2 most common and 4 less common
Pericardial Fat pad
Pericardial cyst
less common
Morgagni herniation
Lymphadenopathy
Malignant NEOPLASM
Pericardium role:
Surrounds, protects and hold heart in place.
allows heart to beat without friction
room to expand
2 types of Pericardium
serous pericardium
fibrous pericardium
Ligaments
Central tendon ligament
Sternalpericardial ligament
Vertebrol pericardial ligaments
Heart attachments/Ligaments
Central tendon ligament
Sternalpericardial ligament
Vertebropericardial ligaments
Chambers of the heart
2 atria
2 ventricles
2 auricles
Right atrium received _____blood from 3 veins : ___ _____ _____
Deoxygenated
Superior Vena Cava
Inferior Vena Cava
Coronary sinus
Left atrium received _______blood from the ______through _______ veins? How many?
Oxygenated; lungs; 4 Pulmonary
Puch like structure on surface of both atria
Auricles
Ventricles are
2 blood pumping chambers
Right Ventricle
Pumps blood out to the pulmonary trunk
___ ____- pumps blood out to the pulmonary trunk. The PT Divides into _____ and __________
• ______distance, _____resistance, ______pressure required
Right Ventricle
right and left pulmonary arteries (to lungs)
Short; less; lower
_____ _______- pumps blood out to the Aorta (then systemically)
• ______distance, ______ resistance, requires higher pressure
• It is the thickest chamber - works harder to maintain ____________
Left Ventricle
Longer; more; higher
maintain same rate of blood flow as right side
Atrioventricular (AV) valves: prevent __________
pressure in atrium ____ valve; Ventricles contract = pressure in ventricle _____ valve
backflow into the 2 atria; open; close
- Tricuspid valve (3 cusps) - location ?
between right atrium & right ventricle
- Bicuspid (mitral) valve -location_________
between left atrium & left ventricle
2 Semilunar (SL) valves: prevent_________ _______closes
prevent back flow into ventricle
LOCATIONS
- Pulmonary semilunar valve - _________
- Aortic semilunar valve - ___________
between right ventricle and pulmonary trunk
between left ventricle and aorta
Valve Disorders:
Prolapse occurs when ______________
AV valve cusp is pushed up into atrium
________ is a narrowing of a heart valve which restricts blood flow.
• repaired by ______ _______, surgical repair, or valve replacement.
Stenosis; balloon valvuloplasty
AORTIC location
2ND-3RD R IC SPACE
PULMONIC location
2ND-3RD L IC SPACE
TRICUSPID location
LLSB
MITRAL location
APEX
Aortic Valve Stenosis can produce:
3 results of AV stenosis
Decreased C.O.
Increased Pulmonary vascular resistance
Ventricular hypertrophy –> R sided HF
*****AV valves are anchored inside heart by what? and what are they ?
Chordae tendinea cords between valve cusps and papillary muscles
Papillary muscles: cone shaped raised bundles of cardiac muscle ?
valve flaps from moving backward into atria (Mitral valve prolapse)
SL valves are not anchored why ? vs _______ pressure in the ventricles.
because they are subject to
in the aorta and pulmonary trunk lower pressure (20-80 mmHg) ; 120mmHg.
Fossa ovalis
Remnant of the foramen ovale. - opening through the atrial septum.
Higher pressure is in the
Lower pressure is in the
left side of the heart.
right side of the heart
Meaty rideges
Bundles of cardiac muscle within chambers
***Firbrous skeleton of the Heart
Dense Connective Tissue
Form ring structure of the valves
COARCTATION Of the Aorta
Ducturs arteriosus extends to the aorta.
The path of Blood Flow (PULMONARY CIRCULATION)
Right side of heart pumps to the lungs and back Right Atrium(1) receives de-oxygenated blood from vena cava & coronary sinus Through Tricuspid valve(2) and into Right Ventricle(3) Pumps through pulmonary semilunar valve(4) to pulmonary trunk(5); then into pulmonary arteries/arterioles(6) Within Lungs gas exchange occurs at pulmonary capillaries(7) Oxygenated blood now into pulmonary venules/veins(8) to left atrium(9)
The Path of Blood flow (Systemic circulation)
Left side of heart pumps to organs of the body
Left atrium through Bicuspid(10) valve and into Left Ventricle(11)
Left ventricle pumps through aortic semilunar valve(12) to aorta(13)
Aorta branches to many systemic arteries(14) that branch into arterioles(15)
then to systemic capillaries(16) found in all organs of the body (Exchange occurs)
De-oxygenated blood returns via systemic venules(17), veins(18), vena cava(19),
into Right atrium(1)
Aorta Coronary arteries coronary capillaries coronary veins coronary sinus Right atrium
Aorta –> Coronary arteries –> coronary capillaries (exchange)–>coronary veins –> coronary sinus –>Right atrium
The 3 major Coronary Veins that deliver to the Coronary Sinus:
Great Cardiac Vein (within the anterior interventricular sulcus)
Middle Cardiac Vein (within the posterior interventricular sulcus)
Small Cardiac Vein (within the coronary sulcus – posterior right side)
Distinguishes R sided CHF from L sided CHF
Peripheral Edema.
Right sided HF shows
Tx
Peripheral Edema.
Diuretics
Unstable angina– _____________
prolonged pain at rest
Agina Pectoris (3 types) and their symptoms Pt present with \_\_\_\_\_ and\_\_\_\_\_\_
SOB and chest pain:
a) Exertional – pain with activity, relieved with rest
b) Variant: pain at rest
c) unstable: Prolonged pain at rest.
Glycosilated hemoglobin
Endothelial cells sticks to hgb
Glycosilated hemoglobin
Endothelial cells sticks to glucose
Turbulent blood flow in the carotids, what does it do to some cells?
From plaques built up, irritates endothelial cells.
also the _______ ________ term can be used to describe a fistula between aorta and pulmonary trunk
AortoPulmonary window
Hemodynamic compromise with Mediastinal tumors.
pulmonary artery & cardiac compression
Neurologic problems with Mediastinal masses : _____ ____ ______ from __________ in the upper thorax (___ syndrome)
↑ ICP, HA, altered mental status) from obstructed venous drainage in
the upper thorax (ex. superior vena cava syndrome
What is the serous pericardium?
Thin, delicate membrane; forms a double layer parietal & visceral (epicardium)
What does the fibrous pericardium do?
Prevents overstretching, provides protection,
anchors heart
Pericardial cavity filled with pericardial fluid ______ml
5-30ml.
Serous pericardium has 2 layers
Which layer is the epicardium?
parietal and visceral layer (epicardium)
______pouch-like structure on surface of both _____
atria , Auricles
What is the function of the auricles?
Increases Capacity
Pressure in atrium ______valve; Ventricles contract = pressure in ventricle ____valve
opens valve; closes valve
For the semilunar valves the pressure in ventricle______ valve; pressure outside _____ valve
opens valve; closes
What is stenosis ? How is it repaired (3)
Stenosis is a narrowing of a heart valve which restricts blood flow.
• repaired by balloon valvuloplasty, surgical repair, or valve replacement.
What is insufficiency or incompetence for valve?
Insufficiency or incompetence is a failure of a valve to close completely.
What is a prolapse of a valve?
Prolapse occurs when AV valve cusp is pushed up into atrium
What is the papillary muscle role?
Prevent valve flaps from moving backward into atria
Explain the pathophysiology of how blood flow through the SL valves during contraction and relaxation?
As the ventricles contract, the intra-ventricular pressure rises, and blood is pushed up against the SL valve forcing it to open..
As the ventricle relax, the intra-ventricular pressure falls, blood flows back
What are the 3 factors that regulates stroke volume
Preload
Contractility
Afterload
Preload is proportional to ______ and supports the ______law, which states the ______ , the ________. Ex is a ________
EDV; Frank-Starling Law
The greater the stretch, the greater the contraction.
rubberband
Contractility
Positive Inotropic Agents _______ contractility ex: ________
Negative Inotropic Agents _______ contractility
ex: ___________
increase; Epi, Norepi
Ca++ channel blockers
Decrease: Ca++ channel blockers
Afterload = the pressure that must be overcome before SL valves open
_____ mmHg pressure in Aorta
____ mmHg pressure in Pulmonary Trunk
the pressure that must be overcome before SL valves open; 80; 20
LV ejects about _____ml in the Aorta. This is the _____RV ejects ______
70; EF; same
Cardiac output (CO) =
HR x SV
When ventricular pressure ____ _____ atrial pressure, AV valves open and passive ventricular filling begins again.
drops below
At the end of the relaxation period, the ventricles are about
three-quarters full (~ 105 ml)
Explain the procedure of Heart Transplant
2 Indications and procedures.
End-stage heart failure or severe coronary artery disease
Heart-lung bypass machine oxygenates & circulates patient’s blood during procedure
Donor heart sutured into position
Reinitiate blood flow
Immunosuppressant drugs
CABG
“grafted” blood vessel between the aorta and unblocked portion of the coronary artery
Balloon catheter is inserted into an artery of an arm or leg and guided into a coronary artery
Coronary angioplasty.
Myocardial infarction is a loss of ________ as a result of __________.
Loss of living heart muscle as a result of prolonged or severe ischemia
Tissue dies and is replaced by scar tissue
Reperfusion is
Restoration of blood flow.
Collateral arteries;
Function ?
Formed by (2) :
- Are connections, or anastomoses, between the branches of the coronary circulation.
- Protects the heart from ischemia.
- Are formed by arteriogenesis or -angiogenesis.
Heart size
Weight?
3.5 in. wide at base, 5 in. from base to apex and 2.5 in. anterior to posterior; weighs 10 oz
Fibrous skeleton of the heart: made up of__________
Function?
Forms what?
Dense connective tissue
Forms ring structure of the valves (prevents over-stretching of valves)
Coarctation of the AORTA? How it’s detected? what is it?
Can be detercted by checking BP in arms and legs.
Is a narrowing of the aorta.
Patent Ductus Arteriosus (PDA)
Ductus arteriosus remains open
Atrial Septal Defect (ASD)
Foramen Ovale fails to close
Ventricular Septal Defect (VSD)
Opening in the Interventricular septum
Tetralogy of Fallot (4 defects)
Ventricular septal defect (VSD)
Pulmonary valve stenosis
Misplaced aorta
Right ventricular hypertrophy
Left sided HF shows
Tx
Pulmonary Edema.
How are venules formed?
Merged capillaries.
Veins are under_____pressure’ and the blood contained in the veins is called _____volume; they have _______ receptors
Low ; unstressed; ALPHA 1
Arteries are under_____pressure’ and the blood contained in the arteries is called _____volume; they have _____, which is found in skin, splanchnic and renal circulation. and have _______ which is found is skeletal muscles
HIGH ; stressed; Alpha 1; beta 2
Capillaries are made up of
single layer of endothelial cells surrounded by basal lamina.
Largest total cross sectional and surface area.
From capillaries to vena cava
Capillaries merge to form venules
Venules to veins
Veins merge to form larger vein
Largest vein –> Vena Cava
The marginal branch and the posterior interventricular are branches of the
RCA
What are 2 branches of the RCA?
Marginal branch
Posterior interventricular branch
Heart beats approximately_______per day
100
The circumflex branch and the Anterior Interventricular artery are branches of the
LCA
LCA branches
Circumflex
anterior interventricular
The AV valve permit blood flow in
one direction only
The cusps of the AV valves attach directly to the
Chordae tendinae.
Contraction of the papillary muscles
Prevent AV valves from reversing into the atria.
Earlike extension of the atria
Auricles
How many pulmonary veins
4
In a procedure known as ________, an inflatable balloon at the end of a catheter is used to press plaque back against the vessel wall.
balloon angioplasty
A procedure in which a length of the patient’s vein or artery is used to create a detour around an obstruction in a coronary artery is called
CABG
A fine tubular wire mesh called a ________ may be inserted into a coronary vessel, holding it open.
stent
The coronary sinus drains the ________ into the ________.
cardiac veins; right atrium
The ________ is a remnant of an important fetal blood vessel that once linked the pulmonary and systemic circuits.
ligamentum arteriosum
The efficiency of the right ventricle is increased by the left ventricle because _______
the wall of the left ventricle pushes into the right ventricle.
The endocardium consists of this type of tissue.
simple squamous tissue
The principle that increasing the end-diastolic volume results in a corresponding increase in the stroke volume is known as
Frank Starling
Which factor directly influences preload?
PRELOAD
Which ion’s entry causes rapid depolarization? Which ion’s entry causes the plateau? Which ion’s exit causes repolarization?
Sodium; Calcium; Potassium
Normal resting CO
5-7.5L
A prolonged PR indicates
Slow AV conduction possible due to decrease blood flow (ischemia)
What forms the ring structures of the valves in the heart
Fibrous Skeleton of the heart
