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Chapter 19 Flashcards

1
Q

wWhat is cardiology?

A

The study of the heart and treatment of its disorders

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2
Q

Divisions of the cardiovascular system?

A

Pulmonary circuit and systemic circuit

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3
Q

What is the pulmonary circuit?

A

Brings blood to the lungs

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4
Q

What is the systemic circuit?

A

Brings blood to every organ of the body

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5
Q

What does the left half of the heart do?

A

Supplies the systemic circuit, deals with oxygenated blood

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6
Q

What does the right half of the brain do?

A

Supplies the pulmonary circuit, deals with deoxygenated blood

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7
Q

Where do veins carry blood?

A

To the heart

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8
Q

Where do arteries carry blood?

A

Away from the heart

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9
Q

Flow of deoxygenated blood?

A

Through vena cavae into right atrium -> tricuspid valve -> right ventricle -> pulmonary valve -> pulmonary trunk -> right and left pulmonary arteries -> lungs (drops off CO2, picks up O2)

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10
Q

Flow of oxygenated blood?

A

Right and left pulmonary veins to left atrium -> bicuspid (mitral) valve -> left ventricle -> aortic valve -> ascending aorta, aortic arch, descending aorta -> out to body via systemic circuit

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11
Q

Where is the heart?

A

In the mediastinum, between the 2 lungs

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12
Q

What is the base of the heart?

A

The wide upper part where great vessels are attached

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13
Q

What is the apex of the heart?

A

The inferior pointed part tilting left

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14
Q

How much does the heart weigh?

A

About 300g in adults

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15
Q

What encloses the heart?

A

Pericardium

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16
Q

Layers of the parietal pericardium / pericardial sac?

A

(Superficial) fibrous layer and (deep) serous layer

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17
Q

What lies between the parietal and visceral membranes?

A

The pericardial cavity

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18
Q

What is in the pericardial cavity?

A

5-30 mL of pericardial fluid

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19
Q

What does pericardial fluid do?

A

Lubricate the heart so there’s no friction

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20
Q

What is pericarditis?

A

Inflammation of the pericardium

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21
Q

Simple function of the right atrium?

A

Receive blood from systemic circuit

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22
Q

Simple function of the right ventricle?

A

Pump blood into pulmonary circuit

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23
Q

Simple function of the left atrium?

A

Receive blood from the pulmonary circuit

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24
Q

Simple function of left ventricle?

A

Pump blood into systemic circuit

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24
Q

What do atria do?

A

Receive blood

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25
Q

What do ventricles do?

A

Pump blood

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26
Q

What are the layers surrounding the heart?

A

From outermost to innermost, pericardial sac, parietal pericardium, pericardial cavity, epicardium, myocardium, endocardium

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27
Q

Layers of heart wall, from outermost to innermost?

A

Epicardium, myocardium, endocardium

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28
Q

What are the atrioventricular valves?

A

Tricuspid and mitral (bicuspid) valves

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29
Q

What are the semilunar valves?

A

Pulmonary and aortic valves

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30
Q

What do the atrioventricular valves do?

A

Permit blood flow in one direction

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31
Q

What do the semilunar valves do?

A

Prevent backflow of blood into ventricles

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32
Q

Divisions of valves?

A

Atrioventricular and semilunar

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33
Q

What is auscultation?

A

Listening to the sounds the body makes

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34
Q

What is the first heart sound?

A

S1, the “lubb” or louder and longer-lasting sound. Signifies closing of AV valves

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35
Q

What happens during the S1 sound?

A

Atrioventricular valves close

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36
Q

What is the second heart sound?

A

S2, or “dupp”, the softer and sharper sound that signifies the closure of the semilunar valves

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37
Q

What happens during the S2 sound?

A

Semilunar valves close

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38
Q

What is valvular insufficiency?

A

Incompetence, or failure of the valve to prevent backward flow of blood (reflux)

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39
Q

Types of valvular insufficiency?

A

Valvular stenosis and mitral valve prolapse

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40
Q

What is valvular stenosis?

A

When the cusps are stiffened and the opening is constricted due to scar tissue. Increases afterload and heart overworks

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41
Q

Causes of valvular stenosis?

A

Rheumatic fever, calcification, or autoimmune attack on mitral and aortic valves

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42
Q

What is mitral valve prolapse?

A

A form of valvular insufficiency, in which one or both mitral valves bulge into the atria during ventricular contraction. May cause chest pain and shortness of breath

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43
Q

What is a heart murmur?

A

An abnormal sound due to blood rushing backwards during contraction

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44
Q

What are cardiac sulci?

A

Superficial groups which mark the boundaries of the 4 chambers. They follow where the sinuses are internally, externally

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45
Q

What is the coronary sulcus?

A

A sulcus separating the atria from the ventricles

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46
Q

What are the cardiac sulci?

A

Coronary sulcus, anterior interventricular sulcus, and posterior interventricular sulcus

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47
Q

What does the right coronary artery supply?

A

The right atrium and the sinoatrial node (pacemaker)

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48
Q

What are the branches of the right coronary artery?

A

The right marginal branch and the posterior interventricular branch

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49
Q

What does the right marginal branch of the RCA supply?

A

The lateral aspect of the right atrium and ventricle

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50
Q

What does the posterior interventricular branch of the RCA supply?

A

Posterior walls of both ventricles

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51
Q

What branches off of the left coronary artery?

A

The anterior interventricular branch and the circumflex branch

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52
Q

What does the anterior interventricular branch of the LCA supply?

A

Both ventricles and the anterior 2/3rds of the interventricular septum

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53
Q

What does the circumflex branch of the LCA supply?

A

The left atrium and posterior wall of the left ventricle

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54
Q

What is the coronary circulation?

A

When 5% of blood being pumped is routed throughout the heart, in order to supply it with nutrients and oxygen for its workload

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55
Q

What method does cardiac muscle use to make ATP?

A

Aerobic respiration

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56
Q

Benefits and downsides of cardiac muscle using aerobic respiration?

A

It doesn’t fatigue over a whole lifetime (unless something is wrong), but lack of oxygen means heart attack

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56
Q

What is coronary artery disease?

A

A constriction of the coronary arteries in which lipids degrade the arterial wall and form obstructions

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57
Q

What is angina pectoris?

A

Chest pain caused by partial obstruction of coronary blood flow

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58
Q

What causes coronary artery disease?

A

An endothelium gets damaged by hypertension, diabetes, or other causes

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59
Q

Avoidable risk factors of coronary artery disease?

A

Obesity, smoking, lack of exercise, anxious personality, stress, and diet

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60
Q

Unavoidable risk factors for coronary artery disease?

A

Genetics, aging, and being male

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60
Q

What is the coronary sinus?

A

A coronary vein which collects blood and empties into the right atrium

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61
Q

What is the great cardiac vein?

A

A coronary vein which collects blood from the anterior portion of the heart and empties into the coronary sinus

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62
Q

What is the middle cardiac vein?

A

A coronary vein which collects blood from the posterior portion of the heart and empties into the coronary sinus

63
Q

What is the left marginal vein?

A

A coronary vein which empties into the coronary sinus

64
Q

What is cardiac muscle tissue made of?

A

Cardiomyocytes

65
Q

Structure of cardiomyocytes?

A

Striated, short, and thick. Branched, and joined at the ends by intercalated discs

66
Q

Purpose of intercalated discs?

A

Allows the entire myocardium of either atria or ventricles to act like a single unified cell

67
Q

How do cardiomyocytes join?

A

By mechanical junctions (desmosomes) and electrical junctions (gap junctions)

68
Q

Purpose of mechanical junctions (desmosomes)?

A

Prevents contracting cardiomyocytes from being pulled apart from each other

69
Q

Purpose of electrical junctions (gap junctions)?

A

Allows ions to flow between cells, so cells can stimulate their neighbors

70
Q

In systemic circuit, blood leaves which chamber?

A

Left ventricle

71
Q

In systemic circuit, blood enters which chamber?

A

Right atrium

72
Q

In pulmonary circuit, blood exits which chamber?

A

Right ventricle

73
Q

In pulmonary circuit, blood enters which chamber?

A

Left atrium

74
Q

In systemic circuit, what artery leaves heart and is it oxygenated?

A

Aorta, oxygenated

75
Q

In pulmonary circuit, what artery leaves heart and is it oxygenated?

A

Pulmonary arteries (left and right), deoxygenated

76
Q

In systemic circuit, what vein leads to heart and is it oxygenated?

A

Inferior and superior vena cavae, deoxygenated

77
Q

In pulmonary circuit, what vein leads to heart and is it oxygenated?

A

Pulmonary veins, oxygenated

78
Q

What does autorhythmic mean?

A

The heart doesn’t depend on the nervous system for its rhythm. It has its own built-in pacemaker and electrical system

79
Q

What are cardiomyocytes?

A

The muscle cells of the heart, which are branched, allowing cardiomyocytes to contact others around it

80
Q

Distinctive features of intercalated discs?

A

Interdigitating folds, mechanical junctions, electrical junctions

81
Q

What are interdigitating folds?

A

When folds of adjoining cells interlock with each other to increase the surface area of intercellular contact

82
Q

What are mechanical junctions?

A

Fascia adherens and desmosomes. Desmosomes prevent contracting cardiomyocytes from pulling apart from each other

83
Q

What are electrical junctions?

A

Gap junctions that allow ions to flow from the cytoplasm of one cardiomyocyte to the next. Enabling each cardiomyocyte to electrically stimulate its neighbors and act as one

84
Q

Can cardiac muscle replace itself?

A

No, it repairs by fibrosis and scar tissue

85
Q

How does cardiac muscle make ATP?

A

Aerobic respiration

86
Q

Benefits and drawbacks of the heart using aerobic respiration?

A

It’s highly resistant to fatigue, but lack of oxygen has detrimental effects

87
Q

What makes up the cardiac conduction system?

A

Internal pacemaker cells and nervelike conduction pathways

88
Q

Steps of conduction system?

A

SA node fires, excitation spreads through atrial myocardium, AV node fires, excitation spreads down AV bundle, Purkinje fibers distribute excitation through ventricular myocardium

89
Q

Does the nervous system have any effect on the cardiovascular system?

A

Yes, it can influence the heart rate and force of contraction. And there are fibers for cardiovascular reflexes and transmission of pain signals to the heart

90
Q

What contracts first in a heartbeat?

A

Atria, then ventricles

91
Q

2 types of cardiac muscle cells?

A

Autorhythmic and contractile cells

92
Q

What do autorhythmic cells do?

A

Control and coordinate the heartbeat

93
Q

What do contractile cells do?

A

Produce contractions that propel blood

94
Q

What is the conducting system?

A

Specialized cardiomyocytes that initiate and distribute electrical impulses to stimulate contraction

95
Q

Components of the conducting system?

A

Pacemaker cells and conducting cells

96
Q

Where are pacemaker cells?

A

In the SA node and the Av node

97
Q

Where are conducting cells?

A

In internodal pathways of atria and AV bundle, bundle branches, and Purkinje fibers of ventricles

98
Q

Steps of impulse conduction through the heart?

A

SA node and atrial activation -> stimulus spreads across atria and reaches AV node -> impulse is slightly delayed, atrial contraction starts ->impulse travels in Av bundle and reaches Purkinje fibers -> they distribute impulse to ventricular myocardium, ending atrial contraction and starting ventricular contraction

99
Q

What is bradycardia?

A

Abnormally slow heart rate

100
Q

What is tachycardia?

A

Abnormally fast heart rate

101
Q

What is an ECG?

A

A recording of electrical events in the heart that can diagnose damage

102
Q

What are cardiac contractile cells?

A

They form the bulk of atrial and ventricular walls, and receive stimulus from Purkinje fibers

103
Q

What are intercalated discs?

A

They interconnect cardiac contractile cells, holding cells together by desmosomes and linked by gap junctions. They transfer force of contraction from cell to cell and propagate action potentials

104
Q

Steps of action potential in cardiac contractile cells?

A

Rapid depolarization, plateau, and repolarization

105
Q

What happens during rapid depolarization?

A

Massive influx of sodium ions from fast sodium channels. Raise RMP to positive

106
Q

What happens during plateau?

A

Extracellular calcium ions enter cytosol through slow calcium channels

107
Q

What happens during repolarization?

A

Potassium ions rush out of the cell through slow potassium channels, RMP returns to -90mV

108
Q

How long does an action potential in ventricular contractile cells take?

A

250-300 milliseconds, 30x longer than in skeletal muscle fibers

109
Q

What is the cardiac cycle?

A

The start of one heartbeat to the start of the next. Includes alternating periods of contraction and relaxation. One complete systole and diastole of all 4 chambers

110
Q

What is systole?

A

Contraction

111
Q

What is diastole

A

Relaxation

112
Q

Formula for cardiac output?

A

CO = heart rate x stroke volume

113
Q

What is cardiac reserve?

A

The difference between resting and maximum cardiac outputs

114
Q

What is the atrioventricular node?

A

The electrical gateway to the ventricles. Has the fibrous skeleton, an insulator that stops currents from getting to ventricles by any other route

115
Q

What is the atrioventricular bundle / bundle of His?

A

It forks into the right and left bundle branches, which pass through the septum toward the apex

116
Q

What are Purkinje fibers?

A

They spread signal upward throughout ventricular myocardium and distribute electrical excitation to the cardiomyocytes of the ventricles

117
Q

What happens after Purkinje fibers deliver the signals?

A

The cardiomyocytes perpetuate it by passing ions from cell to cell via gap junctions

118
Q

Conduction system pathway?

A

SA node -> AV node -> AV bundle -> right and left bundle branches -> Purkinje fibers -> cardiomyocytes of the ventricles

119
Q

What is the P wave?

A

SA node fires, atria depolarization and contraction. Systole begins 100ms after SA signal

120
Q

What is the QRS complex?

A

Ventricular depolarization

121
Q

What is the ST segment?

A

Ventricular repolarization, which corresponds to the plateau in myocardial action potential

122
Q

What is the T wave?

A

Ventricular repolarization and relaxation

123
Q

Ways of cardiac rhythm

A

Sinus rhythm and ectopic focus

124
Q

What is sinus rhythm?

A

A normal heartbeat triggered by the SA node, typically 70-80 bpm in adults at rest

125
Q

What is ectopic focus?

A

A region of spontaneous firing other than the SA node. Can govern heart rhythm if SA node is damaged

126
Q

What is nodal rhythm?

A

Heart rate of 40-50 bpm when SA node is damaged. Set by AV node

127
Q

What is an arrythmia?

A

Any deviation from the regular sinus rhythm

128
Q

What can deviations of ECG indicate?

A

Myocardial infarction, abnormalities in conduction pathways, heart enlargement, and electrolyte and hormone imbalances

129
Q

What is ventricular fibrillation?

A

A serious arrhythmia caused by electrical signals traveling randomly

130
Q

What is defibrillation?

A

A strong electrical shock, with the intent to depolarize the myocardium and reset the heart to sinus rhythm

131
Q

What variables govern fluid movement?

A

Pressure causes flow, resistance opposes it. Fluid flows following a pressure gradient

132
Q

What is Wigger’s diagram?

A

A diagram measuring cardiac cycles. it shows that pressure and volume are inversely related

133
Q

What happens when the ventricles relax?

A

Pressure drops in the ventricles, semilunar valves close, AV valves open, and blood flows from atria to ventricles

134
Q

What happens when ventricles contract?

A

AV valves close, pressure rises in ventricles, semilunar valves open and blood flows into great vessels

135
Q

Phases of cardiac cycle?

A

Ventricular filing (diastole), isovolumetric contraction (systole), ventricular ejection (systole), isovolumetric relaxation (diastole)

136
Q

What is ventricular filling?

A

Atria contract, 130mL of blood in each ventricle

137
Q

What is ventricular ejection?

A

Blood is ejected, leaving 60mL in each ventricle

138
Q

What variables govern stroke volume?

A

Preload, contractility, and afterload

139
Q

What is pulse?

A

The surge of pressure produced by heart beat that can be felt by palpating a superficial artery. 120bpm in infants and 60-100bpm in adults

140
Q

What are positive and negative chronotropic agents?

A

Positive are factors that raise heart rate, negative are factors that lower heart rate

141
Q

What does the ANS do?

A

Modulate rhythm and force of the heartbeat. Cardiac centers in the medulla oblongata initiate the autonomic output to the heart

142
Q

What is the cardiostimulatory effect?

A

Some neurons of cardiac center transmit signals to heart via sympathetic pathways. Symp fibers release norepinephrine, binds to fibers in the heart to speed it up and increase force of contractions

143
Q

What is the cardioinhibitory effect?

A

Some neurons of cardiac center transmit parasympathetic signals via vagus nerve. Slows down heart

144
Q

What happens to heart rate if symp and parasymp stimulation is blocked, or cardiac nerves are severed?

A

Heart beats at about 100bpm which is the intrinsic rate of the SA node

145
Q

What happens if the innervation of the heart is intact?

A

it beats at 70-80 bpm by vagal tone, background firing rate of vagus nerves

146
Q

What is blood pressure’s formula?

A

Cardiac output x systemic vascular resistance

147
Q

What is preload?

A

The amount of tension in ventricular myocardium right before it begins to contract. Increased preload = increased force of contraction

148
Q

What is contractility?

A

How hard the myocardium contracts for a given preload

149
Q

What are positive inotropic agents?

A

They increase the heart’s contractility and include calcium, catecholamines, glucagon, and digitalis

150
Q

What are negative inotropic agents?

A

They decrease the heart’s contractility and include hypocalcelmia and hyperkalemia

151
Q

What is afterload?

A

The sum of all forces opposing ejection of blood from ventricles

152
Q

What is cor pulmonale?

A

Right ventricular failure due to pulmonary vasoconstriction

153
Q

What can restrict pulmonary circulation?

A

Lung diseases like COPD

154
Q

How are volume and pressure in the chambers connected?

A

Inversely, when volume increases, pressure decreases and vice versa

155
Q

Stages of diastole?

A

Rapid filling, diastasis, atrial systole, isovolumetric relaxation

156
Q

Stages of systole?

A

Isovolumetric contraction, ventricular ejection

157
Q

What does myogenic mean?

A

The impulse for contraction originates in the heart itself

158
Q

What increases stroke volume?

A

Higher preload and contractility

159
Q

What lowers stroke volume?

A

Higher afterload

‱ (40 decks)

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