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ESA 2: Cardiovascular > Cardiovascular: Session 2 > Flashcards

Cardiovascular: Session 2 Flashcards

1
Q

Describe the basic structure of the heart?

chambers, valves, main vessels, differences between left and right

A
  • Right atria and ventricle. They have a tricuspid valve between them.
  • Left atria and ventricle. There is a mitral valve between them.
  • Inferior and superior vena cava bring blood to right atrium.
  • Right ventricle contract to eject blood through pulmonary artery. Pulmonary valve is present
  • Left atrium receive oxygenated blood from pulmonary vein
  • Left ventricle contracts to eject blood though the aorta. Aortic valve Is present
  • Left side of the heart has a thicker muscular wall
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2
Q

What attaches the valves to papillary muscle and why?

A
  • Chordae tendinae.

- Stop inversion of the valve during systole

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3
Q

What does a stenosis mean in heart valves?

A

Valve doesn’t open enough and there is obstruction to blood flow.

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4
Q

What is systole?

A

It is the period involving the contraction of the left ventricle myocardium and opening of the aortic valve

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5
Q

What is diastole?

A

It is a period of relaxation between contractions. Ventricular filling occurs (Aortic valve closes and Aorta recoils).

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6
Q

What is distinctive about Cardiac muscle compared to other types of muscle?

A
  • Relatively Long Action potential (280ms)
  • Action potential causes rise in intracellular calcium
  • Branching
  • Gap junctions enable electrical interconnection
  • Discrete cells but interconnected electrically
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7
Q

What is regurgitation of heart valve?

A

Valve doesn’t close all the way so there is back leakage when valve should be closed

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8
Q

What are the causes of aortic valve stenosis?

A
  • Degenerative (senile calcification/ fibrosis)
  • Congenital (bicuspid form of the valve)
  • Chronic rheumatic fever
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9
Q

What are the results of aortic valve stenosis?

A

Less blood can get through the valve.

  • Left ventricular pressure increase which can result in LV hypertrophy.
  • Left sided heart failure can also occur which leads to syncope or angina.
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10
Q

What are the causes of Aortic valve regurgitation?

A

Caused by

  • Valvular damage
  • Aortic root dilation
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11
Q

What are causes of mitral valve regurgitation?

A
  • Myxomatous degeneration can weaken tissue leading prolapse. Inhibits function of the chordae tendineae and papillary muscle.
  • Damage to papillary muscle after heart attack.
  • Left sided heart failure leads to LV dilation which can stretch the valve
  • Rheumatic fever can lead to leaflet fibrosis which disrupts seal formation
  • Also blood leakage into LA increases preload as more blood enter LV in subsequent cycles so LV hypertrophy.
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12
Q

What is the main cause(99.9%) of Mitral valve stenosis?

A

Rheumatic fever. Commissural fusion of valve leaflets makes it harder for blood to flow from LA to LV.

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13
Q

What produces the 1st heart sound(S1)?

A

Closure of the tricuspid and mitral valve.

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14
Q

What produces the 2nd heart sound(S2)?

A

Closure of the aortic and pulmonary valve.

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15
Q

What is cardiac output?

A

Stroke volume X heart rate. Volume of blood pumped out per min

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16
Q

What is preload?

A

Amount the ventricles are stretched in diastole. Related to end diastolic volume.

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17
Q

What is afterload?

A

The load the heart must eject blood against. Roughly equivalent to aortic pressure.

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18
Q

What is contractility?

A

The force of contraction given the fibre length

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19
Q

Explain the Frank-Starling law of the heart?

A

The more the heart fills with blood, the greater the stretch in the heart fibres and the harder the contraction of the heart so greater stroke volume from the heart.

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20
Q

What can cause the heart to fill with more Blood?

A

Increase in the Venous pressure.

21
Q

What is the peripheral resistance?

A

Resistance to blood flow offered by all the systemic vasculature.

22
Q

How does contraction of arteriole affect the blood pressure when cardiac output is the same?(converse is true)

A
  • Resistance increases
  • Pressure on the arterial side increases.
  • Pressure in the venule side and capillaries decreases.
23
Q

What is compliance and when does it change?

A
  • Compliance. is used to describe how a chamber of the heart or lumen of a blood vessel expands when it is filled with blood.
  • Changes to compliance occur in diseased states.
24
Q

What happens when the left ventricle fills up with too much blood and why?

A

Left ventricular distension. This is because the sarcomere is too stretched so the myosin head cannot attach well to the actin filaments for the ratchet mechanism to occur.

25
Q

Which ion has increased sensitivity when muscle fibres are stretched ?

A

Calcium ions

26
Q

What extrinsic factors can increase contractility?

A

Increasing sympathetic stimulation and circulating adrenaline.

27
Q

What factors affect cardiac output?

A
  • How hard the heart contracts

- How hard it is to eject blood

28
Q

How does the cardiovascular system respond to higher metabolism?(Example)

A
  1. Total peripheral resistance decreases to supply more blood
  2. Arterial pressure decreases (less pressure required to overcome the peripheral resistance)
  3. Venous pressure increases (increase In blood volume)
  4. Body senses this and responds by increasing the stroke volume and heart rate.
  5. Increases in cardiac output as a result
  6. Arterial pressure increases and Venous pressure decreases
29
Q

Concept question: how do arterial pressure, venous pressure and total peripheral resistance link(when cardiac output doesn’t change)

A
  • Increased arterial pressure links to increased peripheral resistance. Venous pressure decrease linked.
  • Decreased arterial pressure links to Decreased peripheral resistance. Venous pressure increase linked.
30
Q

Concept question: how does Cardiac output changes affect Venous pressure and arterial pressure

A

-Increase in Cardiac output linked to increased Arterial pressure. decrease in venous pressure linked.

31
Q

When does time for systole change?

A

Never

32
Q

What happens in phase 7 named the reduced filling stage?

A
  • The rate of filling slows down as ventricle reaches its inherent relaxed volume.
  • At rest the ventricles are 90% full by the end of phase 7
33
Q

What forms the right border, left border, and inferior border of the heart in the diaphragmatic surface of the heart?

A

Right border - Right Atrium
Left border - Left Ventricle
Inferior - Right Ventricle

34
Q

What is the typical stroke volume pumped by each ventricle at rest?

A

About 70 ml per beat

35
Q

What is the conduction mechanism of the heart?

A
  • Pacemake cells in sinoatrial node generate an action potential
  • Activity spread over atria
  • Reaches the atrioventricular node and is delayed for about 120ms
  • From the AV node, excitation spreads down the septum between the ventricle.
  • Electrical activity spread through the myocardium from inner to the outer surface of the heart
  • Goes down the bundle of his and the right and left bundle branches to the apex and spreads through the purkinje fibres.
  • Ventricle contract upwards from the apex forcing blood through the outflow valves
36
Q

What happens in phase 1 during atrial contraction?

A
  • Atrial pressure rises due to atrial systole. Called the A wave
  • P wave on the ECG signifies onset of atrial depolarisation
  • Atrial contraction account for the final 10% of ventricular filling. This value varies with age and exercise
  • At the end of phase 1, end diastolic volume is produced.
37
Q

What happens in phase 2 named isovolumetric contraction?

A
  • Mitral valve close as the intraventricular pressure exceed the atrial pressure
  • Rapid rise in ventricular pressure as ventricles contract
  • Closing of mitral valve causes the ‘C wave’ in atrial pressure curve
  • Isovolumetric since there is no change in ventricular volume
  • QRS complex in ECG signifies onset of ventricular depolarisation
  • Closure of mitral and tricuspid valves results in the first heart sound
38
Q

What happens in phase 3 named Rapid ejection?

A
  • Ejection begins when the intraventricular pressure exceeds the pressure within the aorta. they causes the aortic valve to open
  • Atrial pressure initially decreases as the atrial base is pulled downward as ventricle contract. This is called X descent
  • Rapid decrease in ventricular volume as blood is ejected into aorta
39
Q

What happens in phase 4 named reduced ejection?

A
  • Repolarisation of ventricles leads to a decline in tension and the rate of ejection begins to fall
  • Atrial pressure gradually rises due to continued venous return from the lung. This is called the V wave
  • Ventricular repolarisation is depicted by the T wave of ECG
40
Q

What happens in phase 5 named Isovolumetric relaxation?

A
  • When the itnraventricular pressure falls below aortic pressure, there is a brief back flow of blood which causes the aortic valve to close
  • Dicrotic notch in aortic pressure curve caused by valve closure
  • Volume remains contant due to the valves being closed.
  • Closure of the aortic valve produces the second heart sound
41
Q

What happens in phase 6 named rapid filling?

A
  • Fall in atrial pressure that occurs after opening of the mitral valve. Named the Y descent
  • When the intraventricular pressure falls below the atrial pressure, the mitral valve opens and rapid ventricular filling begins
  • Sometimes a third heart sound is present.
42
Q

Which group of people are third heart sounds normal in?

A

-Children

43
Q

What is the heart sound for aortic valve stenosis?

A

Crescendo-decrescendo. S2 murmur.

44
Q

What is heart sound for aortic valve regurgitation?

A

Early decrescendo diastolic murmur. S2 murmur

45
Q

What is heart sound for mitral valve regurgitation?

A

Holosystolic murmur due to back flow . S1 murmur.

46
Q

What is heart sound for mitral valve stenosis?

A
  • Snap as valve opens

- Diastolic rumble. S1 murmur .

47
Q

What happens with increased venous pressure?

A

The heart fills more.

48
Q

Why doesn’t the ventricle go on filling at the same rate throughout diastole?

A

There are pressure changes in the ventricle.

49
Q

What can occur from different volumes on either side of the heart?

A

Pulmonary oedema

ESA 2: Cardiovascular (11 decks)

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