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Body Systems > Cardiovascular strand: Lecture 12 - Coronary Circulation & Tissue Perfusion > Flashcards

Cardiovascular strand: Lecture 12 - Coronary Circulation & Tissue Perfusion Flashcards

1
Q

When does myocardial perfusion occur?

A

During diastole

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2
Q

Where does most of the energy that the heart uses come from?

A

Fat

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3
Q

What is the maximum time a heart can remain active after a person dies?

A

6-12 hours then muscle dies

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4
Q

Where are sites of blockages and where are coronary artery bypasses inserted?

A

saphenous vein is taken from leg (vein graft)

internal mammary artery bypass has been rerouted to the left anterior descending artery (arterial graft)

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5
Q

What is a coronary artery bypass?

A

Giving blood to heart via a different root, passing the blocking

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6
Q

What does the coronary sinus drain into?

A

The right atrium

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7
Q

What is the coronary sinus useful for?

A

resynchronisation pacemaker inserted into left side of heart

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8
Q

Draw two diagrams of an anterior view of coronary arteries and coronary veins

A
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9
Q

Where does athesclerosis occur?

A

In the tunica intima (just inside the endothelium) of an artery

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10
Q

What are muscular arteries involved in?

A

Resistance

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11
Q

How do we calculate pressure?

A

pressure = flow x resistance

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12
Q

How many RBCs can squeeze through a capillary?

A

Only one (even has to deform slightly) - single file flow

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13
Q

What is perfusion?

A

Oxygen, nutrients etc leaving the capillary

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14
Q

Draw and label a diagram of an elastic and musuclar artery

A
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15
Q
  1. How are muscle cells in the heart connected?
  2. What are the structural proteins in the heart that allow the heart to stretch and relax
A
  1. intercalated disks
  2. intercellular collagen network

image is of myocardium capillaries

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16
Q

How does the aorta branch off into smaller arterioles and venules? What is the yellow deposits in the image?

A

yellow deposits - atherosclerosis (hardening of artery)

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17
Q
A

Pressure increases during systole

IM - intramyocardium

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18
Q

Draw a graph showing how flow in the coronary arteries is essentially during diastole

A

A - pressure in aorta

B - flow in LCA

C - flow in RCA

line is less steep i RCA as less blood enters RCA as it is only going to lungs, which requires less than if it were going to heart

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19
Q

Autoregulation: what is the relationship between blood flow and rate of metabolism?

A
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20
Q

What substances relax blood vessels (vasodilation)? How can we demonstrate this?

A

ATP, ADP, AMP, Adenosine, H+, CO2, K+

Place blood pressure cuff on arm - goes red as vessels dilate because theres a build up of waste products causing vasodilation

This is called autoregulation

21
Q

What happens to coronary arteries if BP drops?

A
  1. BP drops
  2. build up of metabolic substances
  3. Coronary artery dilates

does the reverse at high BP

22
Q

What does the green line represent?

A

Ideal bloodflow

Autoregulation occurs if theres devation from this red line

Heart will adjust resistance on its own to fix flow (local)

23
Q

How does mean aortic BP, L.Circ coronary flow, cardiac output change during exercise?

24
Q

Whats your peak heart rate?

25
What are the two mechanisms for myocardial perfusion?
1. Autoregulation 2. Nitric oxide
26
What is nitric oxide made by?
endothelium - when you rub it during exercise when your circulation goes faster (this is why exercise is so important)
27
Why is endothelium so important?
relaxes blood vessels and protects inner space
28
What is angiotensin II made by?
endothelium
29
What are histamne and bradykinin and when are they released?
they're vasodilators and released in response to a burn, infection or anything that induces inflammation
30
Why is there external compression during systole?
To improve flow
31
What different factors determine how blood flows through coronary arteries?
Its a balance between them all Neurohumoral influences aren't very fast
32
Give 5 facts about capillaries
- single layer of endothelial cells - diameter: 5-10 micrometers, length: 0.5-1mm - short distance between each capillary and the cells it serves - junction between capillary cells normally "tight" - stomata squeeze out a little water, nothing bigger like proteins
33
Label this diagram
small holes are stomata
34
What are the 3 types of kidneys and whats the difference? e.g where would you find the different types
1. Continuous - tight capillary. Substances can't leak out. These would be found in brain 2. Fenestrated - substances can leak out. Found where there is a filtering function e.g in the kidney 3. Discontinuous - capillaries with really large holes to let big cells enter and leave the circulation
35
What are 3 typical locations of each type of capillary?
36
What is oncotic pressure?
Oncotic pressure is a form of pressure in the circulatory system which encourages water to cross the barrier of the capillaries and enter the circulatory system. Prevents water leaking and causing oedema
37
What is pitting oedema?
an increase in volume of the interstitial fluid above normal when pushed, still forms pit
38
What is non-pitting oedema caused by?
build up of protein
39
What types of oedema do left and right heart failure cause?
1. right heart failure - systemic oedema 2. left heart failure - pulmonary oedema
40
What changes in blood vessels with age?
endothelial nitric oxide
41
What is angina?
lack of blood tightness around chest goes with rest decrease coronary blood flow increase O2 consumption demand for Oxygen / blood
42
How would angina lead to myocardial ischaemia?
43
What is a catheter?
- in one artery - across one stenosis (narrowing) - measures fractional flow reserve (how much is narrowing impacting on blood flow down that artery) -
44
What is coronary flow reserve?
Coronary flow reserve (CFR) is the maximum increase in blood flowthrough the coronary arteries above the normal resting volume catheter can measure this : placed in one artery cross entire cirulation both used to work out which treatment would be best
45
What is a stent?
Metal device tube that holds artery open
46
Which populations are exposed to angina?
1. Middle aged caucasian males (classic/simple) 2. Young south asian male (complex/diffuse) 3. Elderly patient (complex/severe) 4. Young & active (rare/congenital/ fatal) 5. Middle aged menopausal female (variant/atypical/dynamic/vasospastic) 6. Patients with metabolic syndrome 7. Patient with resistant hypertension
47
What ae the types of interventionand advice for coronary artery disease?
48
What are the 3 biggest causes of CAD?
1. Hypertension 2. Diabetes 3. Hyperlipidaemia (high cholesterol levels) also coborbities, age, gender and ethnicity

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