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Mine ESA 2 > Cardiovascular system > Flashcards

Cardiovascular system Flashcards

0
Q

What are the components of the cardiovascular system?

A

Pump, heart
Distribution system, blood vessels & blood
Exchange mechanism, capillaries
Flow control, Arterioles & pre capillary sphincters
Capacitance, veins

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1
Q

What three factors affect diffusion?

A
  1. Area available for exchange, determined by capillary density
  2. Diffusion resistance, nature of molecule/natural of barrier/path length
  3. Concentration gradient, greater concentration gradient = greater the rate of diffusion
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2
Q

Distribution of blood in the cvs system

A

Heart and lungs = 17%
Arteries and Arterioles = 11%
Capillaries = 5%
Veins = 67%

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3
Q

What are pericytes?

A

They are cells that form a branching network on the outer surface of the endothelium and are cells that are capable of dividing into muscle cells or fibroblasts during angiogenesis, tumour growth and wound healing

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4
Q

Describe elastic arteries

A

Tunica Intima: endothelial cells, narrow sub endothelium CT with discontinuous internal elastic lamina
Tunica Media: 40 to 70 fence started elastic membranes with smooth muscle and collagen between lamellae, thin external elastic lamina may be present
Tunica adventitia: thin layer of fibroelastic CT, contains vaso vasorum, lymphatic vessels and nerve fibres

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5
Q

Describe muscular arteries

A

Tunica Intima: endothelium, sub endothelium layer, thick internal elastic lamina
Tunica media: 40 layers SM, prominent external elastic lamina, thin layers of fibroelastic CT

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6
Q

Describe Arterioles

A

Tunica Intima: endothelial cells, thin elastic lamina in larger ones
Tunica media: 1-3 layers of smooth muscle cells, no external elastic lamina
Tunica adventitia: is scant

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7
Q

Describe metarterioles (are arteries that supply blood to the capillary beds)

A

Tunica intima: endothelial cells, thin external elastic lamina in larger ones
Tunica media: 1-3 layers of SM but this is not continuous
Tunica adventitia: scant

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8
Q

What are the three types of capillaries?

A

Continuous
Fenestrated
Sinusoid/discontinuous

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9
Q

Describe continuous capillaries

A

Continuos endothelial layer
Cells joined by tight or concluding junctions
Most common in nervous, muscle, CT, exocrine glands, lungs

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10
Q

Describe fenestrated capillaries

A

Have little windows which exist across thin parts of endothelium and are bridged by a thin diaphragm except in the renal glomerulus
Elf. Parts of gut, endocrine glands and renal glomerulus

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11
Q

Describe sinusoid/discontinuous capillaries

A

Large diameter 30-40um
Have an incomplete basal lamina
Gaps exist in walls allowing whole cells to move between blood and tissue

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12
Q

Describe post capillary venules

A

Wall= endothelial lining with pericytes
Diameter = 10-30um
More permeable than capillaries and pressure is lower than that of capillaries or surrounding tissue so fluid drains into them except where there is an inflammatory response
Preferred site of emigration of leukocytes from blood

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13
Q

Describe venules

A

Diameters of merging venules increase to more than 50um and up to 1mm
Endothelium associated with pericytes or smooth muscle cells so has tunica media appearing
Has valves consisting of thin intima extensions and by pressing these together it restricts the transport of blood

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14
Q

Describe small and medium sized veins

A

Tunica Intima: thin endothelial lining
Tunica media: 2/3 layers of SM
Tunica Adventitia: well developed

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15
Q

Describe large veins

A

Tunica Intima: thicker endothelial lining
Tunica media: not prominent except in superficial veins of legs when have to defy gravity
Tunica adventitia: well developed

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16
Q

How does the organisation of the muscles in the ventricular Ella facilitate the pumping of blood?

A
  • figure of 8 bands
    These squeeze the ventricular chamber forcefully in a way most effective for ejection through the outflow valves
    The apex of the heart contracts first and relaxes last to prevent back flow
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17
Q

What is the order of pressure changes in the internal jugular vein?

A

a: pre systole/right atria contracting
c: bulging of tricuspid valve into right atrium during ventricular systole
x: atrial diastole and downward movement of tricuspid valve, ventricular systole
v: late systole increased blood flow in right atrium following venous return
y: tricuspid valve opens and blood flows into right ventricle

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18
Q

How is the heart supported in the mediastinum?

A

The fibrous part of the pericardium is continuous with the central tendon of the diaphragm which anchors the heart in the mediastinum in the centre of the thorax

The heart is supported within the pericardium which has two components:

  1. Fibrous pericardium
  2. Serous pericardium
    • > visceral layer
    • > parietal layer

Or double layer of serous pericardium with pericardial cavity.

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19
Q

Name the branches of the right coronary artery which a rises from the aortic sinus?

A

Right marginal branch

Posterior inter ventricular branch

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20
Q

What does the right marginal branch supply

A

Right ventricle, apex of heart

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21
Q

What does the posterior interventricular branch supply?

A

Right and left ventricles

And posterior 1/3 of IVS

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22
Q

What does the right coronary artery supply?

A

Right atrium, SAN, AVN, posterior part of IVS

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23
Q

What does the left coronary artery supply?

A

Most of LA and LV, IVS, AV bundles, AV node

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24
Q

What does the circumflex branch supply?

A

LA and LV

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25
Q

What does the left anterior descending/anterior interventricular branch supply?

A

RV and LV and anterior 2/3 of IVS

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26
Q

What is the inferior border of the heart?

A

Right ventricle

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27
Q

What forms the apex of the heart?

A

Left ventricle

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28
Q

What forms the right border of the heart?

A

Right atrium

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29
Q

Where does the coronary sinus lie?

A

In the posterior atria ventricular groove

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30
Q

What forms the left border of the heart?

A

Left ventricle

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31
Q

What does the aortic roots go on to become?

A

Proximal apart of the aorta

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32
Q

What does the truncus arteriosus go on to become?

A

Proximal part of aorta and pulmonary trunk

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33
Q

What does the bulbus cordis go on to become

A

The proximal 1/3 of RV where trabeculated

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34
Q

What dels the ventricle become?

A

Left ventricle

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35
Q

What does the atrium become?

A

Atria auricles

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36
Q

What does the sinus venousus become?

A

Right atrium except left horn

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37
Q

Describe looping of the primitive heart tube

A

Cephalic portion = ventrally and caudally to right

Caudal portion = dorsally, cranially, to left

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38
Q

Hat does looping of the primitive heart tube achieve?

A

Creates a transverse pericardial sinus
Atrium now copomminuctae with ventricles via atrioventricular canal
Primordial of RV and LV closets to outflow tract

Atrium dorsal to bulbus cordis I.e. Inflow is dorsal to outflow

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39
Q

How does the oblique sinus develop?

A

lA expands and absorbs the pulmonary veins

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40
Q

Development of sinus venosus?

A
  1. Initially inflow of primitive heart is through sinus horns which are equal in size then become remodelled with venous drainage of the yolk sac so less important and venous return shifts to right side and eft sides receded, then right side horn is absorbed by enlarging right atrium
41
Q

Where to the endocardial cushions develop?

A

Atrioventricular region

So form to separate developing heart into left and right

42
Q

What does the ductus arteriosus become?

A

The ligamentum arteriosum

Previously caused shunt from pulmonary trunk to aorta

43
Q

What does the ductus venous become?

A

Ligamentum venosum

Previously allows oxygen blood from placenta/umbilical vein to bypass liver

44
Q

What does the umbilical vein become?

A

Ligamentum teres

45
Q

What is tetralogy of fallot?

A

VSD, overriding aorta (positioned directly over VSD), pulmonary stenosis, right ventricular hypertrophy

46
Q

What is tricuspid atresia?

A

Lack of development of tricuspid valve therefore no inlet into right ventricle, need right to left shunt and then to allow blood flow to lungs need another left to right shunt

47
Q

What is transposition of great arteries.

A

Right ventricles is connected to aorta and left ventricle to pulmonary trunk.

48
Q

What is a hypo plastic left heart?

A

Left ventricle and ascending aorta fail to develop properly

49
Q

What is pulmonary atrisia?

A

Lack of development of orifice of pulmonary valves, need right ASD and then PDA

50
Q

What is Patent ductus arteriosus?

A

Is the failure of the ductus arteriosus to close. Useful as allow so survival of other Cyanotic disease.

51
Q

What is coarctation of the aorta?

A

Is the narrowing of rhymes aortic lumen in the region of the ligament arteriosum. So increased overload on the LV leading to left ventricular hypertrophy. Blood supply to heart and upper limbs is not compromised but rest of body is. Femoral pulse is weak and delayed and has upper body hypertension.

52
Q

What is the term used to describe the failure to close of the foramen ovale?

A

Patent foramen ovale

53
Q

What does the parasympathetic nervous system do to the heart?

A

Increases K+ conductance, makes ap more negative
Decrease cAMP
Decreases slope of pacemaker potential
Therefore decreases heart rate

54
Q

Define flow

A

The volume of fluid passing a given point per unit time.

Is proportional to the pressure difference between vessels

55
Q

Define velocity

A

The rate of movement of fluid particles along a tube

56
Q

Describe laminar flow

A

Is a gradient of velocity from the middle to the edge of the vessel

57
Q

Turbulent flow occurs when…

A

If mean velocity increase will reach a point where the velocity gradient breaks down so flush tumbles over

58
Q

Define viscosity

A

The extent to which fluid layers resist sliding over one another.
Mean velocity is inversely proportional to viscocity

59
Q

What does pressure equal?

A

Flow x resistance

60
Q

What is the relationship between velocity and cross section area?

A

Velocity is inversely proportional to cross sectional area

61
Q

What does resistance decrease with the radius?

A

Resistance decreases to the 4th power of the radius

62
Q

What happens if pressure falls too much in distensible vessels?

A

The walls collapse and blood flow ceases

63
Q

How does resistance change with viscosity?

A

The resistance increases as the viscosity increases

64
Q

What is the name of the law we follow in flow?

A

Poiseulles law

65
Q

What is pulse pressure?

A

The difference between systole and diastole pressure

66
Q

How does the elastic nature of arteries act to reduce arterial fibrillation between systole and diastole?

A

Arteries stretch during systole and more blood flows in than out so pressure does not rise much then arterioles recoil in diastole and flow is conitnous throughout Arterioles

67
Q

Define vasomotor tone

A

The conitnous tonic contraction of smooth muscles

68
Q

What is the pulse wave?

A

When the ventricles contract is generates a pulse wave which propagates along the arteries faster than blood.

69
Q

What is total peripheral resistance proportional to?

A

The bodies need for blood flow so it is auto regulating it self

70
Q

What is central venous pressure?

A

the pressure in the great veins supply then heart

71
Q

What does CVP depend on?

A

Return of blood from badly, pumping if heart, gravity and muscle pumping

72
Q

Define contractility

A

Is the force of contraction which is produced for a given fibre length. An increase in contractility causes an increase in the force of contraction for a given fibre length. An increase in contractility causes a steepening of the slope of the Starling curve.

73
Q

What is the name given to the mechanism where rises in venous pressure is detected in the right atrium?

A

Bainbridge reflex

This causes a decreases in parasympathetic activity and increases the heart rate.

74
Q

Define pre load on the ventricular myocardium?

A

Is the diastolic stretch of the ventricles caused by the filling of the ventricles in diastole to the volume of which is determined by the venous pressure.

75
Q

What is the after load on the myocardium?

A

Is what determines the effect of a given force of contraction during systole, it is the force necessary to expel blood from the arteries.

76
Q

What depends the amplitude of the signal on in ECGs?

A

How much muscle is depolarising

How directly towards the electrode the excitation is

77
Q

What is the optimal ratio for ventilation and perfusion

A

0.8

78
Q

How does the cerebral circulation meet its demands for oxygen?

A

Higher capillary density
Higher basal flow rate
High oxygen extraction

79
Q

How is a secure blood supply ensured in the cerebral circulation?

A

Structurally: anastomoses between basicalar and internal carotid arteries
Functionally: bran sites regulates other circulation, metabolic factors control blood flow, Myogenic auto regulation maintains perfusion during hypotension

80
Q

What are the effects of exercise on pulmonary blood flow?

A

An increase in cardiac output, small increases in arterial pressure, increased oxygen uptake by the lungs, rate of blood flow increase capillary transit time.

81
Q

What is the name given to the specialised structures that under increased core temperature are opened and are found in apical skin?

A

Arteriovenous anastomoses.

Are under vasoconstrictor fibres and are Leo resistance shunts to the skin plexus

82
Q

Why do we faint when we hyperventilate?

A

This is because we below off lots of carbon dioxide which causes a decrease in the partial pressure of carbon dioxide so vasoconstriction occurs in the vessels to the brain and you faint. Where as high carbon dioxide causes vasodilation.

83
Q

What is Cushing’s reflex?

A

A rigid cranium protects the brain, increase in intracranial pressure impair cerebral blood flow e.g. Cerebral tumour or haemorrhage so get impaired blood floe to vasomotor control region in the brain stem so see a increase in sympathetic vasomotor activity, causing an increase in arterial BP, which slows the HR and we get irregular breathing. Brain is trying to maintain the cerebral blood flow.

84
Q

Causes of heart failure

A 
IHD 
Hypertension 
Dilated cardiomyopathy, bigs, drugs, alcohol, poisoning, pregnancy, idiopathic 
Valvular heart disease  
Restrictive cardiomyopathy 
Pericardial disease 
Arrhythmias   
MI
85
Q

What is systolic dysfunction?

A

Increased LV capacity but reduced LV cardiac output:

Thinning of myocardial wall, mitral valve incompetence, neuro hormonal activation, cardiac arrythmias

86
Q

What structural changes do we see in systolic dysfunction?

A

Uncoordinated, myocardial contraction
Changes in ECM, collagen and slippage of myocardial orientation
Changes in cell structure and function:
Myocytes hypertrophy
Chanegs in calcium avail it and receptor regulation
Myocytosis and vacoualtion of cells

87
Q

What is diastolic dysfunction?

A

Reduced LV compliance so have impaired myocardial relaxation, so have impaired diastolic filling and unable to compensate by increase in left diastolic pressure so have low CO

  • elderly and female
  • history of hypertension and diabetes
88
Q

Causes of right heart failure

A

Chronic lung disease, PE, pulmonary/tricuspid valvular disease, left to right shunts, secondary to LF, isolated RV cardiomyopathy

89
Q

Signs and symptoms of right heart failure

A 
Fluid accumulation in areas drained by systemic veins.
Fatigue,
JVP 
Pleural effusion 
Dyspnea 
Tender smooth hepatic enlargement 
Pitting oedema
90
Q

What are the signs and symptoms of left heart failure?

A

Fatigue, exterional dysnpnoea, at night too,

Progresses to tachycardia, cardiomegaly, 3rd/4th heart sound, functional rumour of regurtation, peripheral oedema,

91
Q

Principles involved in the management of HF

A
  • correct underlying cause
  • non pharmacological measures e.g. diet (salt and alcohol), lifestyle, exercise
  • treat complications or associated conditions
  • implant dfib and pacemakers
92
Q

What are the drugs used in heart failure?

A 
Ones to reduce work load: 
Ace, diuretics, beta blockers
Positive inotropes: 
B adrenoceptor agonist 
Cardiac glycosides
93
Q

Define shock

A

An acute condition of inadequate blood flow throughout the body, causing a catastrophic fall in arterial blood pressure leading to circulatory shock. Either a fall in cardiac output or a fall in peripheral resistance.

94
Q

Define cardiogenic shock

A

Acute failure of the heart to maintain cardiac output, following MI or heart failure

95
Q

Define hypovalemic shock

A

Reduced blood volume.

96
Q

Describe the mechanism of hypovalemic shock

A

Venous pressure falls, so co falls then arterial pressure fal, detected by baroreceptor causes an increases sympathetic response, rachycarida dn increased force of contraction and veno constriction. Then also see an increase in peri preheat resistance reducing the capillary hydrostatic pressure and net movements of fluid into the capillaries then get tissue dames due to hypoxia resulting in the release of Vasodilators and TPR fails so arterial bp falls dramatically and vital organs no longer perfumed and get multi system organ failure

97
Q

What is distributive shock?

A

Is low resistance shock when there is profound peripheral vasodilation. So either septicaemia where bacteria release endotoxins which are profound Vasodilators or anaphylactic shock were histamines from mast cells has as powerful vasodilator effect try to comes sate by increasing CO but too powerful.

98
Q

What causes the two types of mechanical shock?

A

Cardiac tamponade, effects both left and right sites have high CVo and low arterial BP
Pulmonary embolism,
Pulmoanry artery pressure is high so RV cannot empty, CVP is high and get reduced return of blood to left heart, limits filling of left heart limits SV, chest pain and dysnpnoea

99
Q

Where is the SAN located?

A

Located in the wall of the right atrium at the point where the superior vena cava enters the right atrium

100
Q

Where is the AV node located?

A

Is located in the posterior inferior region of the inter atrial septum near the opening of the coronary sinus into the right atrium

Mine ESA 2 (3 decks)

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