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Anatomy & Physiology Review I > Chapter 20 - The Cardiovascular System: The Heart > Flashcards

Chapter 20 - The Cardiovascular System: The Heart Flashcards

1
Q

Where is the Heart?

A

The Heart is located in the Mediastinum

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2
Q

What is Pericardium?

A

The heart is enclosed and held in place by the Pericardium

The Pericardium consist of an Outer Fibrous Pericardium and an inner Serous Pericardium

Serous Pericardium has 2 layers:

1- Parietal Layer
2- Visceral Layer

Visceral and Parietal layers are separated by the Serous Cavity, a fluid-filled space

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3
Q

What are the Layers of the Heart?

A

The wall of the heart has 3 layers:

1- Epicardium (the Visceral layer of the Pericardium)
2- Myocardium (cardiac muscle)
3- Endocardium

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4
Q

What are the Chambers of the Heart?

A

The Chambers of the heart include 2 upper Atria and 2 lower Ventricles

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5
Q

What is Right Atrium?

A

Right Atrium:
Receives blood from Superior Vena Cava, Inferior Vena Cava, and the Coronary Sinus
Pumps blood to the Right Ventricle through Tricuspid Valve

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6
Q

What is Right Ventricle?

A

Right Ventricle:
Receives blood from the Right Atrium
Sends blood to the Lungs through the Pulmonary Valve to the Pulmonary Arteries

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7
Q

What is Left Atrium?

A

Left Atrium:
Receives blood from the Lungs through the Pulmonary Veins
Pumps blood to the Left Ventricle through the Bicuspid Valve (Mitral Valve)

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8
Q

What is Left Ventricle?

A

Left Ventricle:
Receives blood from the Left Atrium
Pumps blood through all body through Aortic Valve to Ascending Aorta

Note:
Wall of Left Ventricle is much thicker than wall of Right Ventricle

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9
Q

What is Fibrous Skeleton?

A

Fibrous Skeleton of the Heart:

1- Forms the foundation for which the heart valves attach
2- Serves as a point of insertion for cardiac muscle bundles
3- Prevents overstretching of the heart valves
4- Acts as an electrical insulator

Pulmonary Valve has Pulmonary Fibrous Ring around it
Aortic Valve has Aortic Fibrous Ring around it
Bicuspid Valve (Mitral Valve) has Left Atrioventricular Fibrous Ring around it
Tricuspid Valve has Right Atrioventricular Fibrous Ring around it

Conus Tendon between Pulmonary Valve and Aortic Valve
Left Fibrous Trigone between Aortic Valve and Mitral Valve
Right Fibrous Trigone between Aortic Valve, Mitral Valve, and Tricuspid Valve

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10
Q

What is Heart Valves and Circulation of Blood?

A

The valves of the heart open and close in response to pressure changes as the heart contracts and relaxes

Right and left Atrioventricular Valves:
Tricuspid Valve and Mitral Valve
Prevent backflow from the Ventricles into the Atria

Right and left Semilunar Valves:
Pulmonary Valve and Aortic Valve
Prevent backflow from the Arteries into the Ventricles

When one set of Valves is open, the other is closed
Mitral and Tricuspid is a set
Pulmonary and Aortic is a set

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11
Q

What is Heart Valves Structure?

A

Fibrous Ring around Valve
Cusps (Leaflets)
Chordae Tendineae
Papillary Muscles

When Valve is open:
1- Cusps are open
2- Chordae Tendineae loose
3- Papillary Muscles relaxed

When Valve is closed:
1- Cusps are closed
2- Chordae Tendineae stretched
3- Papillary Muscles contracted

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12
Q

Artery vs Vein?

A

Artery:
Carry oxygen and nutrients in blood away from heart to body tissues

Vein:
Take oxygen-poor blood back from body tissue to heart

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13
Q

What is Systemic and Pulmonary Circulation?

A

Blood circulates in this way:

1- Superior Vena Cava, Inferior Vena Cava, and Coronary Sinus
2- Right Atrium
3- Tricuspid Valve
4- Right Ventricle
5- Pulmonary Valve
6- Pulmonary Trunk and Right and Left Pulmonary Arteries
7- In Pulmonary Capillaries, blood loses CO2 and gains O2
8- Right and Left Pulmonary Veins
9- Left Atrium
10- Mitral Valve
11- Left Ventricle
12- Aortic Valve
13- Aorta, Right and Left Coronary Arteries, and Systemic Arteries
14- In Systemic Capillaries, blood loses O2 and gains CO2
15- Superior Vena Cava, Inferior Vena Cava, and Coronary Sinus

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14
Q

What is Coronary Circulation?

A

1- Blood flow through Coronary Arteries deliver oxygenated blood and nutrients to the Myocardium
Branches arise from the Ascending Aorta

2- Coronary Veins remove CO2 and wastes from the Myocardium
Branches converge at the Coronary Sinus

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15
Q

Where are the Vessels of the Coronary Circulation?

A

1- Left Coronary Artery splits to:
Anterior Interventricular Branch (anteriorly)
Circumflex Branch (from anterior to posterior horizontally)

2- Right Coronary Artery splits into:
Marginal Branch (anteriorly)
Posterior Interventricular Branch (from anterior to posterior

3- Coronary Sinus to which all Coronary Veins converge:
Great Cardiac Vein (anterior left + Tributary to Great Cardiac Vein inferior)
Small Cardiac Vein (anterior right superior)
Anterior Cardiac Vein (anterior right inferior)
Middle Cardiac Vein (posterior)

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16
Q

What is Cardiac Muscle Tissue?

A

1- Nucleus
2- Mitochondria

3- Sarcolemma:
Surrounds cardiac muscle fibers

4- Intercalated Discs:
Connect cardiac muscle cells with Desmosomes
Desmosomes seal the gaps and allow communication

5- Gap Junction
6- Openings of Transverse Tubules

17
Q

What is Arrangement of Cardiac Muscle Fibers?

A

Sarcolemma surrounds cell
Nucleus and mitochondria
Transverse Tubules
Sarcoplasmic Reticulum

Sarcomere:
I Band (at each end, between 2 Myosin filaments)
Z Disc (at center of each I Band)
A Band (between I Bands, length of a Myosin filament)
H Zone (inside A Band, between 2 Actin filaments)
M Line (inside H Zone, center of Sarcomere)

18
Q

What is Conduction System of Heart?

A

Cardiac muscle cells are self-excitable, therefore, Autorhythmic

Cardiac muscle cells repeatedly generate spontaneous action potentials that then trigger heart contractions

These cells form the Conduction System, which is the route for propagating action potentials through the heart muscle

19
Q

What is the Conduction System Route of the Heart?

A

1- Sinoatrial Node (SA Node):
In Right Atrium
Act as pacemaker

2- Atrioventricular Node (AV Node):
In Right Atrium

3- Atrioventricular Bundle (AV Bundle, Bundle of His):
In Interventricular Septum

4- Right and Left Bundle Branches:
In Interventricular Septum

5- Purkinje Fibers:
In Myocardium
Branching all over heart Myocardium
Contract following action potentials

20
Q

What is Sinoatrial Node (SA Node)?

A

The autorhythmic fibers in the SA Node are the natural pacemaker of the heart because they initiate action potential most frequently

Signals from the nervous system and hormones (like Epinephrine) can modify the HR and force of contraction but they do not set the fundamental rhythm

21
Q

What is Action Potential in a Ventricular Fiber?

A

An action potential in a Ventricular Contractile Fiber is characterized by:

1- Rapid Depolarization:
Due to Na+ inflow when voltage-gated fast Na+ channels open

2- Plateau:
Maintained Depolarization
Due to Ca2+ inflow when voltage-gated slow Ca2+ channels open
And K+ outflow when some K+ channels open

3- Repolarization:
Due to a closure of Ca2+ channels
And K+ outflow when additional voltage-gated K+ channels open

22
Q

What is ATP Production in Cardiac Muscle?

A

Cardiac muscle generates ATP via Anaerobic Cellular Respiration and Creatine Phosphate

23
Q

What is Electrocardiogram (EKG or ECG)?

A

An EKG is a recording of the electrical changes that accompany each heart beat

1- P Wave
2- QRS Complex
3- T Wave

P-Q Interval (contains atrial contraction)
S-T Segment
Q-T Interval (contains ventricular contraction)

24
Q

What is Action Potential Propagation Through the Heart?

A

1- Depolarization of Atrial Contractile Fibers produce the P Wave
Action Potential in SA Node

2- Atrial Systole (contraction)

3- Depolarization of Ventricular Contractile Fibers produce the QRS Complex

4- Ventricular Systole (contraction)

5- Repolarization of Ventricular Contractile Fibers produce the T Wave

6- Ventricular Diastole (relaxation)

25
Q

What is the Cardiac Cycle?

A

One Cardiac Cycle consist of the contraction (Systole) and relaxation (Diastole) of both Atria, rapidly followed by the Systole and Diastole of both Ventricles

1- Electrical events
2- Pressure changes
3- Heart sounds
4- Volume changes
5- Mechanical events (Valves open/close)

26
Q

What is Cardiac Cycle Event?

A

1- Atrial Systole:
0.1 Second
PQR
Difference in membrane potential
Left Atrial pressure increases
End-Diastolic Volume at end
Atrial Contraction - Blood go from Atria to Ventricles

Ventricular Systole
0.3 Second
RST
Mitral Valve closes
Left Atrial pressure increases
First heart sound S1
End-Diastolic Volume
Isovolumetric Contraction - Blood pushes on Atrioventricular Valves
Then Aortic Valve opens
Left Atrial pressure decreases
Ventricular Ejection - Blood goes from Ventricles to circulation

Relaxation Period
0.4 Second
T
Aortic Valve closes
Dicrotic Wave in Atrial pressure and goes down
Second heart sound S2
Stroke Volume ejected down to End-Systolic Volume
Isovolumetric Relaxation - Blood filling Atria again
Then Mitral Valve opens
Third heart sound S3
Volume going up
Ventricular Filling - Ventricles getting filled from Atria

27
Q

What is Cardiac Output, Stoke Volume, Heart Rate, and their Relation?

A

Cardiac Output (CO):
Volume of blood ejected from the Left or Right Ventricle into the Aorta or Pulmonary Trunk each minute

Stroke Volume (SV):
Amount of blood pumped out of the Ventricle in one beat

CO = SV x HR
(mL/min) = (mL/beat) x (beats/min)

28
Q

What is Regulation of Stroke Volume?

A

3 Factors regulate SV:

1- Preload
2- Contractility
3- Afterload

29
Q

What is Regulation of Heart Rate?

A

Several factors regulate HR:

1- ANS
2- Hormones
3- Ions
4- Age
5- Gender
6- Physical Fitness
7- Temperature

30
Q

What is Nervous Regulation of Heart?

A

A- Input to CV Center:

1- From Higher Brain Centers:
Cerebral Cortex
Limbic System
Hypothalamus

2- From Sensory Receptors:
Proprioceptors
Chemoreceptors
Baroreceptors

B- Output to Heart:

1- Cardiac Accelerator Nerves (Sympathetic):
Increased rate of spontaneous Depolarization in SA Node (and AV Node) increases HR
Increases contractility of Atria and Ventricles increases SV

2- Vagus Nerve X (10) (Parasympathetic):
Decreased rate of spontaneous Depolarization in SA node (and AV Node) decreases HR

31
Q

What is Factors that Increase CO?

A

A- Factors that increase Stroke Volume (SV):

1- Increased End-Diastolic Volume (EDV) stretches the heart
2-Increased Preload
3- Within limits, cardiac muscle fibers contract more forcefully with stretching (Frank-Starling law of the heart)
4- Positive Inotropic agents such increased sympathetic stimulation, Catecholamines, Glucagon, or Thyroid hormones in blood, increased Ca2+ in ECF
5- Increased Contractility
6- Positive Inotropic agents increase force of contraction at all physiological levels of stretch
7- Decreased Arterial BP during Diastole
8- Decreased Afterload
9- Semilunar Valves open sooner when BP in Aorta and Pulmonary Artery is lower

B- Factors that increase Heart Rate (HR):

1- Nervous system, CV Center in Medulla Oblongata receives input from Cerebral Cortex, Limbic System, Proprioceptors, Baroreceptors, and Chemoreceptors
2- Increased Sympathetic stimulation and decreased Parasympathetic stimulation
3- Catecholamines or Thyroid hormones in blood, moderate increase in ECF Ca2+
4- Other factors, Infants and senior citizens, females, low physical fitness, increased body temperature

C- Factors that increase CO:

Increased SV and HR

32
Q

How does Exercise affect Heart?

A

Regular aerobic exercise can:

1- Increase CO
2- Increase HDL (healthy fats)
3- Decrease Triglycerides
4- Improve Lung function
5- decrease BP
6- Assist in weight control

33
Q

What is IABP?

A

Intra-Aortic Balloon Pump:
Assist heart pump blood to Aorta

34
Q

What is VAD?

A

Ventricular Assist Device:
Mechanical pump that helps weakened Ventricle pump blood
Temporary until transplant (Bridge Therapy)
Alternative to heart transplant (Destination Therapy)

LVAD for left - most common
RVAD for right
BVAD for both

35
Q

What is Cardiomyoplasty?

A

Take part of patient’s own skeletal muscle (Left Latissimus Dorsi)
Wrap around heart
Implant pacemaker that stimulates muscle contractions 10-20 times per minute

36
Q

What is Skeletal Muscle Assist Device?

A

Piece of patient’s own skeletal muscle
Fashion a pouch inserted between heart and Aorta
Functions as booster heart
Pacemaker stimulates muscle to elicit contractions

37
Q

What is Foramen Ovale?

A

Foramen between Atria that closes as adults
Can be closed with surgery
Becomes Fossa Ovalis

38
Q

What is Disorders of the Heart?

A

1- Coronary Artery Disease
2- Atherosclerotic Plaques
3- Congenital Heart Defects
4- Arrhythmia
5- Congestive Heart Failure

Anatomy & Physiology Review I (30 decks)

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