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Cardiovascular system Flashcards

1
Q

What factors affect diffusion

A

Concentration gradient, area available for exchange and diffusion resistance

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2
Q

What factors are included in ‘diffusion resistance?’

A

Nature of molecule, nature of barrier, diffusion path length.

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3
Q

What determines the area that’s available for exchange at capillaries?

A

Capillary density (how many capillaries there are per unit volume) highest in most metabolically active tissues

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4
Q

Which factor affecting exchange at capillaries is the most limiting?

A

Concentration gradient

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5
Q

Which organs have an absolute requirement for blood flow that doesn’t vary?

A

Brain of 0.75 l/minKidneys of 1.2 l/min

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6
Q

What is the minimum and maximum blood flow to heart, gut, muscle and skin?

A

Heart 0.3-1.2 l/minGut 1.4 - 2.4 l/minmuscle 1-16 l/minskin 0.2 - 2.5 l/min

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7
Q

What is the distribution of blood volume at rest?

A

11% in arteries and arterioles17% in lungs and heart67% in veins5% in capillaries

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8
Q

Describe the position of the heart

A

Sits in the pericardium which is within the middle mediastinum, between ribs 2-5

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9
Q

What’s the main nerve supply to the heart?

A

Phrenic nierve C3-C5 and vagus nerve

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10
Q

What are the main histological characteristics of large, elastic arteries?

A

fenestrated elastic membrane with smooth muscles cells and collagen in between. vasovasorum in adventitia

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11
Q

What are the main histological characteristics of muscular arteries?

A

Many layers of smooth muscle cells, connected by gap junctions. Slight vaso vasorum.

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12
Q

What are the main histological characteristics of arterioles

A

Few smooth muscle cels. Scant adventitia

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13
Q

What are the 3 types of capillaries and where are they found?

A

Continuous - in most locations eg muscles, nervous tissue, connective tissue, exocrine glands and lungs.Fenestrated - in parts of the gut, endocrine glands and renal glomerulusSinusoidal - in bone marrow, liver and spleen

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14
Q

What are the main histological features of venules?

A

Very thin layer of smooth muscle cells. Contain valves

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15
Q

What are the main histological features of veins?

A

Less elastic and muscle fibres than accompanying arteries but more connective tissue.

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16
Q

What are venae commitantes?

A

2 veins either side of a small artery, all wrapped in one sheath. Pulsing of artery promotes venous return

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17
Q

What is the most common congenital heart syndrome associated with Down Syndrome?

A

Atrioventricular septal defect

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18
Q

What do the different parts of the primitive heart tube develop into in an adult?

A

Truncus arteriosus - Roots of aorta and pulmonary trunk
Bulbus cordis - Right ventricle, Ventricular outflow
Ventricle - Left ventricle
Atrium - Auricles of atria
Sinus venosus - Right atrium

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19
Q

Where does the cardiogenic field form?

A

At cephalic end of splanchnic mesoderm

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20
Q

How do valves attach to the heart wall?

A

Attached to chordae tendinae which attach to papillary muscles which make up part of the heart wall near the valve

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21
Q

What muscle forms the rough surface of the ventricles?

A

Trabeculae carnae

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22
Q

What is pectinate muscle?

A

Forms rough walls of atria, more prevalent in right atrium which has greater input from primordial atrium

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23
Q

Where can you listen for the 2 atrioventricular valves?

A

Mitral (left AV) listen at 5th intercostal space, mid clavicular line
Tricuspid (right AV) listen at 4th intercostal space, left sternal edge

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24
Q

Where can you listen for the 2 semilunar valves?

A

Aortic valve listen at 2nd intercostal space, right sternal edge
Pulmonary valve, listen at 2nd intercostal space, left sternal edge

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25
What control does the parasympathetic nervous system exert over the CVS?
Vagus nerve releases ACh which acts on M2 receptors in the AV node to reduce heart rate
26
What control does the sympathetic nervous system exert over the CVS?
Noradrenaline release at Beta1 receptors in AV and SA nodes and in myocardium to increase force and rate of contraction. Circulating adrenaline also acts on Beta2 receptors to cause vasodilation although pharmacologically active noradrenaline causes vasoconstriction by acting on alpha1
27
What determines the flow through a vessel, with a given pressure gradient?
Resistance which is determined by the nature of the fluid and the vessel
28
Define flow and velocity
Flow - Volume of fluid passing a given point per unit time | Velocity - rate of movement of fluid particles along a tube
29
At a given flow, how does velocity relate to diameter of a vessel?
At a given flow, velocity is inversely proportional to cross-sectional area
30
At a constant pressure, what determines flow?
Mean velocity, which depends on viscosity and radius. | Viscosity is inversely propotional to velocity
31
Define viscosity
The extent to which fluid layers resist sliding over each other
32
At a given pressure, how does velocity relate to diameter?
At a given pressure, velocity is proportional to cross sectional area
33
What does poiseulle's law state?
That pressure is equal to flow x resistance | Change in pressure = flow x 8 x viscosity x length/ PiR^4
34
How is effective resistance calculated for vessels in series and vessels in parallel?
In series - add all different resistances together | In parallel - and all resistances together and divide by 2
35
Where do pressure drops occur in the circulation?
Large pressure drop between Arteries and arterioles (high resistance) Small pressure drop over capillaries
36
How does TPR affect diastolic pressure?
A higher TPR means it's harder for blood to leave arteries so diastolic pressure is higher
37
What is the pulse pressure?
Difference between systolic and diastolic pressures - measure of how hard the heart pumps
38
How is the average pressure calculated?
Diastolic pressure + (pulse pressure/3)
39
What is reactive hyperaemia?
The massive increase in blood flow after circulation to an area is cut off momentarily. Vessels are dilated due to build of vasodilatory metabolites
40
How does TPR affect central venous pressure?
Decreased TPR increases venous pressure
41
What is stroke volume?
Difference between volumes at the end of systole and the end of diastole. Increased filling leads to increased contraction so increased stroke volume
42
What is contractility?
Intrinsic ability of cardiac muscle to contract and generate tension. Related to performance of the heart.
43
What is force of contraction determined by?
End diastolic volume and contractility
44
What is the response of the CVS to a long term increase in blood flow?
There's increased venous pressure and cardiac output so arterial pressure increases. The increased blood flow decreases concentration of metabolites so there's vasoconstriction, increasing TPR and further increasing arterial pressure. Eventually, arterioles develop more smooth muscle to maintain high TPR and there's maintained high arterial pressure so there's hypertension
45
What's the response of the CVS to standing up?
Blood pools in superficial veins of the legs so central venous pressure falls transiently and there's a fall in cardiac output and arterial pressure. Heart rate increases, as does TPR as response by sympathetic nervous system so arterial pressure increases again
46
What's the response of the CVS to haemorrhage?
Massive decrease in blood volume causes a fall in venous and arterial pressure. Body increases TPR but also increases heart rate so venous pressure is massively reduced. There's venoconstriction and autotransfusion to increase venous pressure
47
How do cardiac glycosides work?
Block Na/K/ATPase which normally provides gradient for Na/Ca exchanger so Ca2+ accumulates in the cell and there's positive inotropy of heart
48
How do organic nitrates work?
Produce NO2- which forms NO which is a vasodilator by activating cGMP which decreases intracellular Ca2+
49
What cardiac uses are there for beta blockers?
After MI to prevent ventricular arrhythmias and decrease workload of heart In heart failure for their negative inotropic and chronotropic effect Angina to decrease workload Hypertension
50
How are warfarin and heparin used differently?
Heparin is used more acutely and given intravenously or fractionated heparin can be given subcutaneously Warfarin is used more in long term and is given orally
51
How do warfarin and heparin exert their antithrombotic effects?
Heparin inhibits thrombin production and warfarin inhibits vitamin k which is needed for clotting factor synthesis
52
What makes the pulmonary circulation low resistance?
Short wide vessels Lots of capillaries in parallel Relatively little smooth muscle in capillaries
53
How do diameter of vessels in lungs differ due to gravity?
When upright (orthostasis) there's an increase in hydrostatic pressure in lower lung vessels so vessels are distended and vesels towards the apex collapse in diastole due to low pressure
54
How does pulmonary circulation react to exercise?
There's an increased cardiac output so increase in pulmonary arterial pressure so apical vessels open and there's increased oxygen uptake throughout lungs
55
How is cerebral circulations adapted to meet high oxygen demand?
Anastamoses between basilar and internal carotid arteries to form the Circle of Willis so if one route is blocked, brain will still get blood supply brainstem regulates blood flow to other parts of the body to ensure its own needs are met Myogenic autoregulation maintains blood supply in hypotension Metabolic factors control blood flow through constriction and dilation There's also a high capillar density and high basal flow rate
56
What is involved in cerebral myogenic autoregulation?
If blood pressure increases there's vasoconstriction and if blood pressure decreases there's vasodilation. This means blood flow is well maintained within limits of roughly 180-60mmg but outside of these limits, blood flow quickly changes
57
How does cerebral circulation react to CO2?
Very sensitive. As it's a metabolite, hypercapnia causes vasodilation and hypocapnia causes vasoconstriction so in ventilation there's vasoconstriction, dizziness and fainting
58
What is cushing's reflex?
Maintains cerebral blood flow in increased intracranial pressure by increased sympathetic activity to increase arterial blood pressure
59
How is coronary circulation adapted to meet its demand for oxygen?
High capillary density Continuous production of NO by coronary endothelium which is a vasodilator Blood flow increases to meet demand through vasodilation
60
Why can there be angina flare ups in the cold?
Cold temperatures causes sympathetic induced coronary vasoconstriction
61
How is skeletal muscle circulation adapted to meet demand?
Resistance vessels are richly innervated by sympathetic fibres so are very responsive Different muscle types have different capillary densities depending on needs eg postural muscles have high capillary density High vascular tone which allows high degree of vasodilatation so blood flow can rapidly increase when needed At rest, only abot 50% of capillaries are being used at any one time so there can be increased recruitment of remaining capillaries if needed
62
How do arteriovenous anastamoses help regulate body temperature?
Found in apical skin so if there's an increase in core body temperature, there's decreased sympathetic output and passive vasodilation of AVAs and a low resistance shunt to venous plexus closer to surface so blood flows closer to the skin and there's heat dissipation. Opposite happens if core body temperature falls
63
How does non apical skin react to cool temperatures?
Increased sympathetic output so noradrenaline acts on venules and arterioles to cause vasoconstriction
64
What are some signs and symptoms of left side heart failure?
``` Fatigue Breathlessness on exertion or lying flat Tachycardia Dyspnoea on walking on the flat Displaced apex beat indicating cardiomegaly Gallop rhythm Basal pulmonary crackles Mitral regurgitation ```
65
What are some causes of right side heart failure?
``` Secondary to left side heart failure Chronic lung disease Pulmonary embolism Pulmonary hypertension Left to right shunt Pulmonary/tricuspid valve disease Isolated right ventricular cardiomyopathy ```
66
What drugs can be given to treat heart failure?
``` Beta blockers diuretics ACE inhibitors Calcium channel blockers organic nitrates cardiac glycosides ```
67
What are some signs of right side heart failure?
``` Peripheral oedema Fatigue Dyspnoea Anorexia Nausea Raised JVP Ascites Pleural effusion Hepatic enlargement ```
68
What are some causes of left side heart failure?
``` Mainly ischaemic heart disease Hypertension Dilated cardimyopathy Restrictive cardiomyopathy Hypertrophic cardiomyopathy Valvular heart disease Arrhythmia Pericardial disease ```
69
How do you calculate heart rate from an ECG?
If regular 300/number of big squares between QRS complexes | If irregular - number of qrs complexes in 30 big squares, x 10
70
What counts as a pathological Q wave?
More than 2 small squares deep
71
On average, how long is the QRS complex?
Roughly 3 small squares
72
How long should the PR interval on an ECG be?
3-5 small squares
73
What is classed as a prolonged QT interval?
More than 2.5 big squares
74
What is the ECG sign for right axis deviation?
Increased peak in lead 3 instead of lead 2 with lead 1 pointing downwards
75
What are the different types of second degree heart block?
Mobitz type 2 - occasional dropped beat with waves being otherwise normal Wenckebach phenomenon - progressive lengthening of PR interval until a beat is missed 2:1 / 3:1 - alternate conducted and non conducted beats. 2/3 p waves to every QRS complex
76
What is the ECG sign for atrial flutter and atrial firillation?
Atrial flutter there is no flat baseline between P waves | Atrial fibrillation there are no p waves and QRS complexes occur at irregular intervals
77
What is the progression of ECG changes in a STEMI?
ST elevevation Pathological Q waves (both of these disappear in time) Inverted T wave (permanent)
78
What area of the heart is the most vulnerable to ischaemia?
Subendocardial area as myocardium is perfused from outside in and is closest to left ventricle which is under the most strain
79
How do you differentiate between an NSTEMI and unstable angina?
By using biochemical markers such as troponin and creatine kinase MB. If these are present, it's a NSTEMI
80
What history indicated acute coronary syndrome?
Recurrent chest pain on minimal exertion or at rest. | Episodes last longer than 15 minutes
81
How do atheromas cause angina?
Atheromas can either be stable, with a small necrotic core, or vulnerable with a fibrous cap. This fibrous cap can erode or fissure so blood is exposed to its thrombogenic necrotic center. Platelets from within the core emerge and react with fibrin to form a fibrin thrombus which traps RBCs to cause an occlusion
82
How is angina treated?
If necessary, can carry out reperfusion through percutaneaous coronary intervention where a catheter's inserted through groin and a stent is inflated or by coronary bypass graft. Pharmacologically, can use beta blockers, ACE inhibitors, nitrates, calcium channel blockers, aspirin, statins
83
What vessels can be used for a coronary bypass graft?
Internal thoracic artery Saphenous vein Radial artery
84
How are STEMIs treated?
Reperfusion by PCI or fibrinolytic therapy Revascularisation ACEi Antiplatelet drugs eg aspirin Antiischaemia drugs eg nitrates/ beta blockers Statins
85
How are NSTEMIs treated?
``` Pain control Antithrombolytic therapy eg aspirin/heparin Statins ACEi Reperfusion ```
86
What ECG leads will show abnormal readings if there's an MI at the distal Left Anterior Descending coronary artery?
V3 and V4
87
When does troponin peak as a biochemical marker for MI?
Peaks around 18 hours after event. | Levels begin to rise 3-4 hours after and slowly decline until 10-14 days after event
88
What types of shock occur due a decrease in TPR?
Toxic shock | Anaphylactic shock
89
What leads to development of mechanical shock?
Two different mechanisms Eg in cardiac tamponade, there's reduced filling of ventricles so cardiac output falls or eg in massive pulmonary embolism, right ventricle can't empty due to massive increase in pressure of pulmonary arteries so there's reduced filling of left heart and cardiac output is reduced.

ESA 2 (4 decks)

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