Chapter 19- Heart Flashcards
Pulmonary circuit
sends deoxygenated blood to the lungs
Systemic circuit
sends oxygenated blood to the body
The heart is located between the lungs, within a space called the _________. ____ of the heart is on the ____ side of the thorax between the ___ rib and ___ ______ ___.
The heart is located between the lungs, within a space called the MEDIASTINUM. 2/3 of the heart is on the LEFT side of the thorax between the 2ND rib and 5TH INTERCOSTAL SPACE.
The heart is angled obliquely with the apex pointing towards the ____ ____ resting on the _____. It’s also enclosed in a _________ ___ which has 2 layers, the ______ ______ and the _____ _____.
The heart is angled obliquely with the apex pointing towards the LEFT HIP resting on the DIAPHRAGM. It’s also enclosed in a PERICARDIAL SAC which has 2 layers, the FIBROUS PERICARDIUM, and the SEROUS PERICARDIUM.
Fibrous pericardium
the outer tough fibrous CT sac that surrounds the heart, preventing overfilling
Serous pericardium
This _______ ____ is filled with a few milliliters of _____ _____
the thinner, more delicate membrane that is composed of 2 layers (parietal and visceral) with a small space in between.
This PERICARDIAL SPACE is filled with a few milliliters of PERICARDIAL FLUID.
Inflammation of the serous pericardium
Inflammation of the epicardium
Pericarditis
Epicarditis
Epicardium
Myocardium
Endocardium
Definition and which is the largest layer?
Epicardium- thin, external layer of the heart
Myocardium- cardiac muscle layer, in the middle, intercalated discs, striated, involuntary
Endocardium- thin, lines the inside of the heart
Myocardium is the largest layer
List the order of the pericardial sac from the outside-in
The ____ is the same layer as the ____
- Fibrous pericardium
- Serous pericardium
- Parietal
- Visceral
The visceral is the same layer as the epicardium
The heart flows from
right to left
&
top to bottom
Internally, the atria are separated by the ______ _____, while the ventricles are separated by the ________ _____.
Interatrial septum
Interventricular septum
Externally, the _____ ___ divides the atria from the ventricles
Coronary sulcus
What are the auricles?
Extensions of the atria
3 openings into the right atria
SVC
IVC
Coronary sulcus
Valves function to
prevent backflow of the blood
The __ ______________ ______ between the atria and ventricles are flaps connected to _______ _______ in the walls of the ventricles by ______ ______. The AV valve on the right side is the _______ valve and the AV valve on the left is the ________ valve.
The __ _______ _____ are within the pulmonary trunk and the aorta, 2 of the vessels that are attached to the heart: ________ ____ and _____ ____
The 2 ATRIOVENTRICULAR VALVES between the atria and ventricles are flaps connected to PAPILLARY MUSCLES in the walls of the ventricles by CHORDAE TENDINEAE. The AV valve on the right side is the TRICUSPID valve and the AV valve on the left is the BICUSPID VALVE.
The 2 SEMILUNAR VALVES are within the pulmonary trunk and the aorta, 2 of the vessels that are attached to the heart: PULMONARY VALVE and AORTIC VALVE
The papillary muscles and chordae tendinae help with the
valves closing
How the heart beats
Top (atria) 1st beats together
Bottom (ventricles) beat together
List the blood flow THROUGH the heart and whether it’s deoxy. or oxygenated blood
SVC, IVC, or CS –> right atrium –> tricuspid valve –> right ventricle –> pulmonary valve –> pulmonary artery –> LUNGS –> pulmonary vein –> left atrium –> bicuspid valve –> left ventricle –> aortic valve –> aorta –> BODY
everything before the lungs (right side of the heart) is deoxygenated blood, and everything after (left side of the heart), is oxygenated
Determine the starting point (SVC, IVC, CS) and why:
RBC that flows from the toe to the toe
IVC- the toe is BELOW the heart
Determine the starting point (SVC, IVC, CS):
RBC that flows from ear to ear
SVC- the ear is ABOVE the heart
Determine the starting point (SVC, IVC, CS):
RBC that flows from arm to arm
SVC- the arm is ABOVE the heart
Determine the starting point (SVC, IVC, CS):
RBC that flows from heart to heart
Coronary sinus- only option for heart
Pulmonary artery carries
deoxygenated blood
Pulmonary vein carries
oxygenated blood
From the aorta, the heart will get the first supply of newly oxygenated blood through the _____ and _____ _______ _____.
The deoxygenated blood goes through the veins in the myocardium and will be drained back into the heart/returned by the ________ _____, a large vein.
From the aorta, the heart will get the first supply of newly oxygenated blood through the RIGHT and LEFT CORONARY ARTERIES
The deoxygenated blood goes through the veins in the myocardium and will be drained back into the heart/returned by the CORONARY SULCUS, a large vein.
The ______ ______ _____ is smaller than the left one and extends from the aorta around to the posterior part of the heart. Two branches are the _____ ______ ______, bringing oxygenated blood to the lateral wall of the right atrium, and the _______ ________ _____, supplying oxygenated blood to both ventricles posterior. Branches of each of these supply the right atrium.
The RIGHT CORONARY ARTERY is smaller than the left one and extends from the aorta around to the posterior part of the heart. Two branches are the RIGHT MARGINAL BRANCH, bringing oxygenated blood to the lateral wall of the right atrium, and the POSTERIOR INTERVENTRICULAR BRANCH, supplying oxygenated blood to both ventricles posterior. Branches of each of these supply the right atrium.
The _____ ______ ____ branches off into the ____ ______ __________ _______, supplying oxygenated blood to both anterior ventricles.
Other branches include the ________ _____, supplying blood to the lateral and posterior left atrium
The LEFT CORONARY ARTERY branches off into the LEFT ANTERIOR INTERVENTRICULAR BRANCH, supplying oxygenated blood to both anterior ventricles.
Other branches include the CIRCUMFLEX BRANCH, supplying blood to the lateral and
posterior left atrium.
It’s not uncommon to have variation in the blood supply to the heart. Examples:
15% of people have both IV branches off left
4% have a single coronary artery
Most cardiac health problems result from faulty coronary circulation due to blood clots, fatty atherosclerotic plaque, or spasms of the smooth muscle within the coronary artery wall. When there is a reduced flow to the heart muscle, it is termed _______. This may result in _____ ______ = severe pain in the heart that results from reduced blood flow.
__________ pills can be placed under the tongue and dissolve – this is a vasodilating drug that will result in an increase in blood flow to areas of the heart wall.
Most cardiac health problems result from faulty coronary circulation due to blood clots, fatty atherosclerotic plaque, or spasms of the smooth muscle within the coronary artery wall. When there is a reduced flow to the heart muscle, it is termed ISCHEMIA. This may result in ANGINA PECTORIS = severe pain in the heart that results from reduced blood flow.
NITROGLYCERIN pills can be placed under the tongue and dissolve – this is a vasodilating drug that will result in an increase in blood flow to areas of the heart wall.
Myocardial Infarction
-definition and cause
A heart attack, in which there is death of an area of the myocardium due to interruption of the blood supply. When this occurs, the normal contractile muscle dies and is replaced by fibrous connective tissue (scar tissue) that does not contract.
Cause: thrombus formation in the coronary artery.
Cardiac muscle has large demand for oxygen and the need to produce ATP at all times.
As a result there are a _______________ within the cells.
These take up space, limiting the amount of space for other organelles such as the __________ _______.
As you recall, the sarcoplasmic reticulum is a storage area for ______ which is necessary for ______________________
Cardiac muscle has large demand for oxygen and the need to produce ATP at all times.
As a result there are a large number of mitochondria within the cells.
These take up space, limiting the amount of space for other organelles such as the SARCOPLASMIC RECTICULUM.
As you recall, the sarcoplasmic reticulum is a storage area for calcium which is necessary for the muscle to contract.
Cardiac muscle cells need to contract uniformly. This is accomplished with the presence of _______ and ___ junctions allowing the cardiac muscle cells the ability to ______ and ______ __ __ _____
Cardiac muscle cells need to contract uniformly. This is accomplished with the presence of desmosomes and gap junctions allowing the cardiac muscle cells the ability to communicate and function as a unit.
Conduction system through the heart:
1. Under normal conditions, cardiac excitation begins the ___ _____ located in the wall of the ____ ____. Each impulse (action potential) from the SA node travels through both atria and cause them to contract.
- The impulse moves down to the ___ _____, located in the superior portion of the _________ ____. It is then stimulated and sends the action potential to….
- the _____ ___ ___ then to the……
- _____ and _____ _____ _____ within the interventricular septum.
- Finally, the impulse is passed to the _______ _____, taking the impulse to the myocardium of the ventricles and causing a contraction of the ventricles.
- Under normal conditions, cardiac excitation begins the SINOATRIAL NODE (SA node), located in the wall of the RIGHT ATRIUM. Each impulse (action potential) from the SA node travels through both atria and cause them to contract.
- The impulse moves down to the ATRIOVENTRICULAR NODE (AV node), located in the superior portion of the INTERVENTRICULAR SEPTUM. It is then stimulated and sends the action potential to….
- the BUNDLE OF HIS then to the……
- RIGHT and LEFT BRANCH BUNDLES within the interventricular septum.
- Finally, the impulse is passed to the PURKINJE FIBERS, taking the impulse to the myocardium of the ventricles and causing a contraction of the ventricles.
SA node originates the _____ and is called the _____ of the heart
impulse
pacemaker
Sometimes, a site other than the SA node becomes the pacemaker and sets up the impulse. This is known as an ______ ______ or an _____ ______ (foci). This may result in ____ ____ ____of the heart and be brought on by caffeine, nicotine, toxic reactions, heart damage. An ______ _____ may be used to restore cardiac rhythm if SA node is___ _____
Sometimes, a site other than the SA node becomes the pacemaker and sets up the impulse. This is known as an ECTOPIC PACEMAKER or an ECTOPIC FOCUS (foci). This may result in EXTRA IRREGULAR BEATS of the heart and be brought on by caffeine, nicotine, toxic reactions, heart damage. An ARTIFICIAL PACEMAKER may be used to restore cardiac rhythm if SA node is NOT FUNCTIONING
The heart is ________, meaning it stimulates ____ to _____
autorhythmic
itself to contract
1st sound occurs
during the QRS and is due to the closing of the AV valves
2nd sound occurs
during the T wave and is due to the closing of the SLV valves
P wave
atrial depolarization
AV open, SLV closed
QRS complex
ventricular depolarization and atrial repolarization
AV closing, SLV open (1st sound)
depolarization=
repolarization=
contraction
relaxation
T wave
ventricular repolarization
SLV closing (2nd sound)
AV closed
P-Q (PR) interval
conduction time from the beginning of atrial excitation to the beginning of ventricular excitation
Q-T interval
conduction time from the beginning of the QRS complex to the end of the T wave
4 things to evaluate for abnormal EKGs
- Intervals
- Consistency
- Height of each wave
- Number of beats
An EKG can detect problems that have occurred in the past, even some that a person may not have been aware of, like a
silent heart attack
1 heartbeat is considered to be
1 cardiac cycle
Normally, the
2 atria contract while the 2 ventricles relax and the 2 ventricles contract while the 2 atria relax
Systole
phase of contraction
(high pressures)
Diastole
phase of relaxation
(low pressures)
The blood will flow from an area of
higher pressure to an area of lesser pressure
What does a cardiac cycle consist of?
A systole and diastole of both atria plus a systole and diastole of both ventricles
An average heart rate of ___ will have each cardiac cycle last ___
75 bpm
0.8 seconds
Blood flow is controlled by _____ ____
Blood flow goes through ____ _______
pressure changes
avaliable openings
During the cardiac cycle, ____ _______ can be heard through a _______. The first heart sound is ___, and is created by the blood turbulence associated with the closing of the ___ ______. The second heart sound is ___, which is caused by the blood turbulence around the _______ _____closing near the end of ventricular systole.
During the cardiac cycle, HEART SOUNDS can be heard through a STETHOSCOPE. The first heart sound is LUB, and is created by the blood turbulence associated with the closing of the AV VALVES. The second heart sound is DUP, which is caused by the blood turbulence around the SEMILUNAR VALVES closing near the end of ventricular systole.
EKG detects _____ ____, while the stethoscope detects ______________
electrical activity
movement of blood
HEART MURMUR: abnormal sound heard _______________, or that may mask these normal heart sounds. Generally, it is due to a valve not ______ completely or abnormal valve ______.
____ ______occurs around valve and it is heard as a murmur. Not necessarily a pathology as these are often heard in young children due to thin cardiac walls leading to vibrations.
HEART MURMUR: abnormal sound heard BEFORE OR AFTER THE LUB-DUP, or that may mask these normal heart sounds. Generally, it is due to a valve not CLOSING completely or abnormal valve ANATOMY.
BLOOD TURBULENCE occurs around valve and it is heard as a murmur. Not necessarily a pathology as these are often heard in young children due to thin cardiac walls leading to vibrations.
Cardiac Output is the
amount of blood ejected by each ventricle per minutes
Cardiac Output equation
CO = Stroke Volume X Heart Rate
What causes the heart sounds heard with a stethoscope?
Closure of the valves
CO=
SV=
HR=
CO= amount / minute
SV= amount of left ventricle / beat
HR= beats / min
Stroke volume is the
amount of blood ejected from the left ventricle per beat
about 60% of the volume is ejected per beat, so keep in mind that it doesn’t squeeze out 100% of the volume
What is the normal cardiac output of a healthy heart?
5L per minute
Intrinsic regulation
changes with the stroke volume
Extrinsic regulation
changes with the heart rate
Intrinsic regulation:
The amount of blood that is able to fill the ventricles prior to depolarization and the resulting stretching to the ventricular walls is termed the _______. An increased preload due to exercise for example leads to an increase in _____ ____ by causing an increase in stroke volume. This relationship is referred to ______________of the Heart.
Intrinsic regulation:
The amount of blood that is able to fill the ventricles prior to depolarization and the resulting stretching to the ventricular walls is termed the PRELOAD. An increased preload due to exercise for example leads to an increase in CARDIAC OUTPUT by causing an increase in stroke volume. This relationship is referred to FRANK-STARLINGS LAW of the Heart.
Intrinsic regulation:
If venous return to the heart can be increased (either due to exercise or by increasing filling time) then the ______________________________
chambers are able to fill more prior to contraction.
Intrinsic regulation:
Contractility and Afterload
strength of contraction
resistance in blood vessels that the heart has to work against
Extrinsic regulation:
Several factors will regulate heart rate. If left on its own, the SA node would establish a HR of ____ beats per minute. This rate will be modified by other mechanisms of the body, according to input from the _________ ______ ______ and _________
Extrinsic regulation:
Several factors will regulate heart rate. If left on its own, the SA node would establish a HR of 100 beats per minute. This rate will be modified by other mechanisms of the body, according to input from the AUTONOMIC NERVOUS SYSTEM and CHEMICALS.
AUTONOMIC NERVOUS SYSTEM: Portion of nervous system that controls ______ functions, including ___ ____. There is a ______________ _____ in the medulla oblongata of the brain and this region receives input from many receptors in the body and regulate the HR accordingly.
AUTONOMIC NERVOUS SYSTEM: Portion of nervous system that controls INVOLUNTARY functions, including heart rate. There is a CARDIOVASCULAR CENTER in the medulla oblongata of the brain and this region receives input from many receptors in the body and regulate the HR accordingly.
The types of receptors in the body that provide the brain with information are:
proprioceptors, chemoreceptors, and baroreceptors
Proprioceptors
receptors sensitive to muscle activity
Chemoreceptors
detect chemical changes in blood
Baroreceptors
detect changes in pressure in blood vessels.
A ______ in pH is detected by _________ which
decrease
chemoreceptors which speeds up the HR in response
An ______ in ____ is detected by _________ which
increase in CO2
detected by chemoreceptors which speeds up the HR in response
Sympathetic branch of the ANS
- fight or flight
- ## releases Norepinephrine which causes an increase in HR and BP
Beta ____ on the heart bind to norepinephrine which increases the HR. _____ _____ can be given to ________________
receptors
Beta blockers can be given to decrease the heart rate
Parasympathetic Branch of the ANS:
Parasympathetic impulses reach the heart via the ____ _____ from the cardiovascular center of the medulla oblongata. These fibers innervate the SA node, AV node and a small number of muscle fibers of the myocardium by releasing ________. The result is a ______ ____ of heart rate after the sympathetic branch had increased it, and the ________ of the heart rate under normal conditions.
Parasympathetic impulses reach the heart via the VAGUS NERVE from the cardiovascular center of the medulla oblongata. These fibers innervate the SA node, AV node and a small number of muscle fibers of the myocardium by releasing ACEYTLCHOLINE. The result is a SLOWING DOWN of heart rate after the sympathetic branch had increased it, and the MAINTENANCE of the heart rate under normal conditions.
Chemical regulations include
Hormones (epinephrine and norepinephrine speeds up HR)
Thyroxine- high levels speed up HR
Ions- particularly calcium and potassium
Calcium Channel Blockers:
Medication such as _______ block Ca++ channels leading to a ______ in the the ______ ___ and ____ ____
Calcium Channel Blockers:
Medication such as VERAPAMIL block Ca++ channels leading to a DECREASE in the CONTRACTION FORCE and HEART RATE
Genetic valve disorder that affects young women and is related to abnormal chordae tendineae or malfunction of papillary muscles
Diagnosed by shortness of breath upon exertion
They also have a heart murmur on the ____ heart sound
Mitral valve prolapse
1st
In Mitral Valve Prolapse, one or more valve flaps billows into the left atrium during ventricular systole, allowing for ______ ________back into atrium and ultimately resulting in a ______ _______ _____
In Mitral Valve Prolapse, one or more valve flaps billows into the left atrium during ventricular systole, allowing for BLOOD REGURGITATION back into atrium and ultimately resulting in a DECREASED CARDIAC OUTPUT
Endocarditis
Normal EKG,
slurring noise on both 1st and 2nd sound (all valves impacted)
Can be prevented by brushing teeth
Cardiomyopathy
Issue can be found w an EKG
Abnormality of heart muscle which leads to a large heart
Heart failure
Leads to an edema
left side: lungs swells
right side: body swells
7 risk factors in heart disease:
high cholesterol level
high blood pressure
cigarette smoking
obesity
lack of exercise
genetics
male gender
