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Mrs P's flashcards_23 > Chapter 5 Heart and monitoring heart function > Flashcards

Chapter 5 Heart and monitoring heart function Flashcards

1
Q

Outline the benefit of a mass transport system

A
  • moves substances around the body quickly
  • shortens diffusion distance
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2
Q

Explain why a pumping mechanism required for a mass transport system

A

due to a higher demand for nutrients and production of waste (due to higher metabolic rate)

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3
Q

State the function of the atrioventricular valves

A

to prevent backflow of blood into atria from the ventricle during ventricular systole

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4
Q

State the function of the semilunar valves

A

to prevent blackflow of blood into the ventricles from the arteries during ventricular diastole

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5
Q

Describe the events that occur during atrial systole

A
  • atria contract –> increased pressure
  • ventricles in diastole
  • AV valves open/semi-lunar valves close
  • blood flows from A–>V (70% passive)
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6
Q

Describe the events occur during ventricular systole?

A

atrial diastole –> decreased pressure

ventricles in systole

AV valves close/semi-lunar valves open

blood flows from V–>arteries

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7
Q

Describe the events occur during total diastole

A

atrial diastole –> increased pressure

ventricles in diastole

AV valves open/semi-lunar valves close

blood flows passively from vena cave–>A

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8
Q

Explain how is the cardiac cycle controlled

A

the sinoatrial node (SAN) sends a wave of excitation to both atria –> atrial systole

band of fibrous collagen tissue prevents conduction of wave of excitation

atrioventricular node (AVN) delays w.o.e. and then sends out second w.o.e. from top of ventricular septum down the Bundle of His to the apex and then up the walls

causes upward contractions

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9
Q

Explain why monitoring heart function is so important

A

to look for heart/vascular diseases

to look for risk factors that contribute to CHD

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10
Q

Define the term stroke volume

A

the volume of blood pumped out of the left ventricle during the cardiac cycle

60-80cm^3

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11
Q

Define the term cardiac output

A

the volume of blood pumped out of the left ventricle each minute

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12
Q

State how is cardiac output calculated

A

stroke volume x heart rate

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13
Q

Describe the term ‘pulse’

A

the expansion of the artery wall during ventricular systole

during diastole, the elastic recoils

The pulse can be taken at radial, temporal and carotid artery or in the groin (femoral artery)

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14
Q

Explain how age affects the HR

A

decreases with age

children have faster h.r. due to growth

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15
Q

Exlpain how diet can affect the HR

A

cholesterol can block coronary arteries

saturated fats increase risk of strokes and heart disease

fruit/veg/starchy foods decrease h.r.

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16
Q

Explain how exercise can affect the HR

A

during activity + in recovery = exercise increases HR

post activity = exercise increases the strength of cardiac muscle resulting in a decreased HR

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17
Q

Describe how cardiac monitors can be used to analyse heart activity

A

electrodes placed on skin on opposites sides of the heart

result = electocardiogram

corresponds to electrical activity and pressure

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18
Q

State the key stages of an electrocardiogram

A

P = atrial excitation from SAN –> atrial systole

QRS = ventricular systole

T = repolarisation of cardiac muscle during diastole

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19
Q

Describe how an electrocardiogram can indicate heart abnormalities

A

raised ST = heart attack

small P = atrial fibrillation

deep S = ventricular hypertrophy (incr. muscle thickness)

short gaps = tachycardia

long gaps = brachycardia

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20
Q

Define a myocardial infarction?

A

when the blood supply to cardiac muscle is totally/partially cut off, preventing aerobic respiration in muscle cells

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21
Q

State the symptoms of a myocardial infarction

A

faint pulse

chest pain

nausea

ashen skin

irregular or rapid pulse

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22
Q

Define a cardiac arrest

A

When the heart no longer functions usefully as a pump

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23
Q

Describe what is ventricular fibrillation

A

rapid uncontrolled contraction of the muscles in the ventricles –> no effective movement of the blood

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24
Q

Describe an atheroma

A

a build of of WBCs that have taken up LDLs and become deposited in the lining of the artery WALLS

deposits cholesterol, dead fibres and muscle cells

restricts blood flow –> myocardial infarction

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25
Q

Explain how high levels of saturated fats lead to coronary heart disease

A

raises LDL and LDL:HDL ratio

LDLs deposit cholesterol in wall of coronary artery

causing an atheromatous plaque

reduces lumen size which reduces oxygen supply to cardiac muscle

–> coronary thrombosis

–> myocardial infarction

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26
Q

Label the diagram

A
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27
Q

Label the diagram

A
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28
Q

Describe the characteristics of cardiac muscle (6 marks)

A

o Specialised muscle as doesn’t rhythm require nerve stimulation to contract i.e. myogenic
o Muscle contracts in regular rhythm
o Does not fatigue or require rest (unlike skeleatl muscle)
o Specialised striated muscle (fainter striations compared to skeletal muscle)
o Fibres are branched and uninucleated
o Cardiac muscle cells interconnect resulting in simultaneously contraction
o Contraction speed = intermediate [compared to skeletal (rapid) and smooth (slow)]
o Length of contraction = intermediate [compared to skeletal (short) and smooth (long)]
o Cardiomyocytes (cardiac muscle cells) supplied with oxygen & glucose by coronary artery if it becomes blocked -> heart attack

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29
Q

Describe th function of the aorta

A

 Carries oxygenated blood from LV to the body
 At high pressure (as it has to force the blood over a large distance hence overall there is a higher resitance within the blood vessels)
 Largest artery

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30
Q

Describe the function of the atria

A

 Contract to generate a force to move blood at low pressure into the ventricles
 Pressure is low as walls of atria are thin (less cardiac muscle)
 LA: forces oxygenated blood into LV (short distance so low pressure)
 RA forces deoxygenated blood into RV (short distance so low pressure)
 Both atria always contract simultaneously

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31
Q

Describe the function of the ventricles

A

 Contract to generate a force to move blood at high pressure out of the heart
 LV: forces oxygenated blood into aorta at high pressure
 Pressure is high as LV wall is the thickest (of all 4 chambers) i.e. most cardiac muscle
 RV: forces deoxygenated blood into pulmonary artery at lower pressure than LV (if it was the same the pressure would be too high when it reaches the avleoli and would rupture the alveoli)
 Both ventricles always contract simultaneously

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32
Q

State the type of valve and the function of the aortic valve

A

= semi-lunar valve

  • found between the LV and the aorta
  • prevents backflow of blood from aorta to LV during ventricular diastole
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33
Q

State the type of valve and the function of the pulmonary valve

A

= semi-lunar valve
* found between the RV and the pulmonary artery
* prevents backflow of blood from pulmonary to RV during ventricular diastole

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34
Q

Name the 2 atrioventricular valves

A

Bucuspid
Tricuspid

REMEMBER: LAB RAT (LA = bicuspid, RA = tricupsid)

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35
Q

Descirbe the role of the tricuspid valve

A
  • Located between RA and RV
  • Prevents backflow of blood from RV to RA during ventricular systole
  • Close when pressure of RV > pressure of RA
  • Ensures deoxygenated blood flows into pulmonary artery
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36
Q

Describe the role of the bicuspid valve

A
  • Located between LA and LV
  • Prevents backflow of blood from LV to LA during ventricular systole
  • Close when pressure of LV > pressure of LA
  • Ensures oxygenated blood flows into aorta
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37
Q

Describe the role of the septum

A

 Separates RHS from LHS of heart
 Keeps oxygenated blood separated from deoxygeanted blood

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38
Q

Describe the role of the vena cava

A

 Carries deoxygenated blood from the body to the RA
 Superior vena cava delivers deoxygenated blood from head
 Inferior vena cava delivers deoxygenated blood from rest of body
 Largest vein

39
Q

Explain the importance of valves in the heart and associated blood vessels

A

 Only open one way
 Prevent the back flow of blood
 Will open when the pressure behind of it is greater than the pressure in front of it
 Will close when the pressure in front of it is greater than the pressure of blood behind it
 Blood flows down pressure gradient (from high pressure to low pressure)

40
Q

Decsribe the events that occur during atrial systole

A
  • Ventricles relax (ventricular diastole)
  • Atrial walls contract -> decreases volume of blood & increases pressure in atria
  • Atria are emptied -> blood forced into ventricles
  • Through atrioventricular valves (remember LAB RAT)
  • Slight increase in ventricular volume & pressure as ventricles fill with blood
41
Q

Describe the events that occur during ventricular systole

A
  • Atria relax (pressure falls)
  • Ventricle walls contract -> decreases volume of blood
  • Pressure in ventricles rises for ~0.1s
  • Pressure in ventricles -> pressure in atria atrioventricular valves are forced shut
  • High pressure in V opens semi-lunar valves (aortic or pulmonary)
  • Blood is forced into aorta (from LV) or pulmonary artery (from RV)
  • Pressure & volume of blood in V decreases
42
Q

Describe the events during diastole

A
  • Both atria and ventricles relax (muscular walls of both A and V relax)
  • Higher pressure in pulmonary artery & aorta  closes semi-lunar valves (preventing backflow of blood into V)
  • Atria fill with blood (increasing their pressure) due to higher pressure in the vena cava and pulmonary vein
  • Ventricles continue to relax  ventricular pressure <pressure in atria
  • Atrioventricular valves open and blood flows into V passively (i.e. no contraction of A required)
  • Process continues
43
Q

Explain what causs the ‘lub-dub’ sounds of the heart beat

A

Lub = atrioventricular valves closing as V contract
Dub = semi-lunar valves closing from backflow of blood (from aorta and pulmonary artery) as V relax

44
Q

Define the term myogenic

A

no nerve stimulation required to make the cardiac muscles contract

remember: only cardiac muscle is myogenic

45
Q

Describe how the cardiac cycle is controlled

Thois would be a 6 marker, level of response, question so make sure you give details in the correct order and provide sufficient detail

A
  1. Wave of electrical excitation starts in sino-atrial node (specialised patch of muscle found in the wall of the right atrium); SAN = pacemaker
  2. Impulse passes from SAN to atrial muscle
  3. Causes atria to contract together i.e. initiates heartbeat
  4. Layer of non-conducting collagen (fibrous) tissue between atria and ventricles prevents wave of excitation passing directly to ventricles
  5. Electrical activity of SAN is picked up by atrio-ventricular node (AVN) in the septum between the atria
  6. AVN delays electrical activity by 0.1s
  7. Electrical activity is sent from AVN to Bundle of His (specialised conducting muscle fibres made up of Purkyne fibres)
  8. Electrical activity spreads from the Bundle of His down 2 branches of the Purkyne fibres in the septum
  9. Electrical activity arrives at apex of the heart
  10. At apex Purkyne fibres spread out through both ventricle walls
  11. Wave of excitation triggers simultaneous contraction of ventricles starting at the apex (to allow more efficient emptying of ventricles) i.e. ventricular systole occurs from the bottom of the heart upwards
46
Q

Explain why it is importatnt that the V contract after the A

A

If both ventricles contracted at the same time:
o The V would generate a higher pressure than the A
o This would force the A-V valves to shut
o Blood in the A would consequently NOT enter the V
o Blood would be forced back into the veins
o This would place strain on the heart
o And decrease the volume of blood moved through the heart
o Hence less blood would be oxygenated
o Poorer transport system and gas exchange

47
Q

State the 2 nerves that regulate the HR

A

1) accelerator nerve (sympathetic nervous system)

2) vagus nerve (parasympathetic nervous system)

48
Q

Describe the role of the vagus nerve in regulating the HR

A

(vagus nerve)
* is part of the parasympathetic nervous system
* this nerve uses acetylcholine as the neurotransmitter
* it decreases the HR

49
Q

Describe the role of the accelerator nerve in regulating the HR

A

accelerator nerve
* is part of the sympathetic nervous system
* this nerve uses noradrenaline as neurotransmitter
* it increases the HR

50
Q

Name the neurotransmitter involved in the regulation of the HR

A

Adrenaline

51
Q

State the formula used to calculate the cardiac output.
State the most apprropriate units for CO

A

CO = SV x HR
units = cm3 min-1

remember the ‘3’ and ‘-1’ are superscript - It won;t let me do that here :(

52
Q

Suggest why the HR is more accurately determined by counting the PR in 30s and then doubling the value rather than couting the PR for 60s

A

Less likely to get a counting error in shorter time period
Less likely to be affected by fluctations due to envoironmental disturbances
Hence value is more accurate

53
Q

Outline how to accurately measure a patient’s HR

A
  1. If the resting heart rate is to be determined, you must have been resting for at least 10 minutes. The exercise heart rate is obtained while you are exercising
  2. The patient must be in the sitting position
  3. To measure the pulse at the wrist, place the index and middle finger over the underside of the opposite wrist, below the base of the thumb
  4. Press firmly with flat fingers until you feel the pulse. To measure the pulse on the temple, place the index and middle finger just to the side of the head, in the soft, hollow area of the temple (where the temporal artery is positioned). Press firmly until the pulse is located
  5. Once you find the pulse, count the beats for 10 seconds, or for 30 seconds and multiply by 6 or 2 accordingly (to calculate beats per minute)
  6. Repeat 3 times and take a MEAN (increases reliability)

REMEMBER: use the term mean (not average)

54
Q

Explain why the HR increases during (strenuous exercise)

A
  • Skeletal muscles contract at higher rate
  • Hence higher demand for oxygen & glucose
  • Hence volume of blood being circulated needs to **increase **dramatically
  • Hence HR and SV both increase (HR from 72 to 140bpm & SV from 70 to 150cm3 per beat)
  • Heart muscle also contracts more strongly -> greater contraction -> greater force of ejection
  • Skeletal muscles also contract more frequently -> veins compressed more by skeletal muscles -> greater venous return (to remove lactic acid, carbon dioxide, heat from contracting muscles)

Remember: your answer must be comparative. This means you must say highER, greatER, MORE throughout your answer

55
Q

State 3 natural factors which affect a person’s HR

A
  1. Age = children have higher HR than adults (HR decreases with age)
  2. Genetics = tendency for lower/higher HR inherited
  3. Diseases = some affect HR e.g. CF increases HR (and pulmonary blood pressure)
56
Q

State 3 lifesytle (also called environmental) factors which affect a person’s HR

A
  1. Physical activity level = increased PAL -> inc HR for duration of exercise & straight after (but over time leads to decreased HR). Training decreases resting HR (due to increased SV and so same CO is achieved at lower HR)
  2. Smoking = nicotine -> inc HR (as stimulates release of neurotransmitter noradrenaline -> increases electrical activity of SAN)
  3. Diet = diet rich in fruit & veg & CBH -> dec HR; diets rich in saturated lipids -> inc HR
57
Q

Explain the purpose of an ECG

A
  • ECGs measure spread of electrical excitation through heart
  • Process = electrocardiography
  • ECGs don’t directly measure electrical activity of the heart but measures small electrical differences in skin which occur as a result of the electrical activity of the heart
  • Results can be monitored on computer screen or printed out
  • Changes in peaks can be used to detect and diagnose heart conditions
58
Q

Assess the level of risk of giving a patient an ECG

A

Level of risk = very low/none

  • Because this procedure merely monitors the electrical impulses and does not emit electricity
  • Hence no risk of shock
  • During an exercise electrocardiogram, some patients experience arrhythmias or heart distress
59
Q

Label AND annotate this typical ECG

A

Make sure you have both a label AND an annotation for each area of the ECG

60
Q

Explain the significance of the P wave on an ECG

A

wave of excitation passing over atria walls (i.e. depolarisation of atria resulting in atria contraction)

61
Q

Explain the significance of the T wave on an ECG

A

repolarisation (recovery) of ventricles (recovery of the atria is masked by QRS)

62
Q

Explain the significance of the QRS segment in an ECG

A

wave of excitation passing over ventricles walls (i.e. depolarisation of ventricles)

63
Q

Which part of the ECG trace indicates the ventricules are filling. Justify your answer.

A

T to Q
reason: ventricles are relaxed

64
Q

Explain the significance of the difference in height of any waves on an ECG

A

The height of any wave indicates how much electrical charge is passing through the heart: bigger wave = more electrical charge = stronger contraction

65
Q

Which part of the ECG trace indicates the ventricles are contracting?

A

Q to T

66
Q

Identify the medical condition shown in this ECG trace.

Justify your answer.

A

Ventricular fibrillation

reason: there is no regular pattern to ECG

67
Q

Identify the medical condition shown in this ECG trace.

Justify your answer.

A

Atrial fibrillation

Reasons:
There is no distinct P waves
*The P-R interval is not easily identifiable

68
Q

Describe the effects of VF

A
  • Victim has no blood circulation
  • Usually unconscious
  • Almost certainly fatal: causes cardiac arrest
  • The person having VF suddenly collapses or falls unconscious, because the brain and muscles have stopped receiving blood from the heart
69
Q

Describe the treatment for a patient with VF

A
  • Immediate use of defibrillator
  • May need coronary bypass surgery
  • Most common complication of VF is sudden death
  • For survivors of VF, complications include coma, reduced mental acuity, and neurological problems similar to those seen after a stroke
70
Q

Suggest what physiological events may cause a person to go into VF

A
  • Muscle in ventricle walls flutter
  • Possibly due to myocardial infarction
71
Q

Suggest what physiological events may lead to a person going into AF

A
  • Most common cause = abnormalities or damage to the heart’s structure
  • High blood pressure
  • Heart attacks
  • Coronary artery disease
  • Abnormal heart valves
  • Congenital heart defects you’re born with
  • Hyperthyroidism
72
Q

Describe the most appropriate treatment for a person with AF

A
  • Medication to prevent a stroke
  • Medication to control the heart rate or rhythm
  • Cardioversion – where the heart is given a controlled electric shock to restore normal rhythm

NB: AF is not usually life-threatening

73
Q

Describe the effects of AF

A
  • Increased risk of stroke
  • Increased risk of heart failure
  • Chronic fatigue
  • Additional heart rhythm problems
  • Inconsistent blood supply
74
Q

Identify the medical condition shown in this ECG trace.

Justify your answer.

A

Bradycardia

  • Resting HR is very slow
  • Longer gaps between QRS complexes
  • P waves and height of QRS peaks are both similar to a normal trace
  • Defined as resting HR between 40-60 bpm
  • ECG looks normal except delay between waves of more than one second
  • Long gap between T wave and next P wave
75
Q

Describe the effects of bradycardia

A
  • Usually no effect
  • If severe may cause tiredness
  • Due to insufficient blood flow to organs
76
Q

Suggest what physiological events can lead to bradycardia

A
  • Could be the sign of an active/healthy person
  • Could be an inactive SAN
77
Q

State how bradycardia can be treated

A
  • Artificial pacemaker to replace SAN
78
Q

Identify the medical condition shown in this ECG trace.

Justify your answer.

A

Tachycardia

  • Resting HR is very high
  • Shorter gaps between QRS complexes
  • Defined as resting HR above 100bpm
  • ECG shows very small gap between T wave and P wave of next cardiac cycle
79
Q

Suggest what physiological events can lead to tachycardia

A
  • A reaction to certain medications
  • Congenital (present at birth) electrical pathway abnormalities in the heart
  • Congenital abnormalities of the heart
  • Consuming excess alcohol
  • coronary artery disease (atherosclerosis), heart valve disease, heart failure, heart muscle disease (cardiomyopathy), tumours, or infections
  • Hypertension
  • Hyperthyroidism (overactive thyroid gland)
  • Smoking
  • Certain lung diseases
80
Q

Describe the effects of tachycardia

A
  • Rapid HR = less time for the atria and ventricles to fill
  • Hence less blood is pumped to the body with each heartbeat
  • Overtime  drop in blood pressure
  • Also increases the workload of the heart  increasing myocardial (heart muscle) O2 demand
81
Q

Describe the treatment for tachycardia

A
  • Varies depending on what caused the condition, the patient’s age and general health, and other factors
  • Aim = address the cause of the tachycardia
  • May try to slow the rate i.e. prevent subsequent episodes of tachycardia to reduce risk complications
82
Q

Identify the medical condition shown in this ECG trace.

Justify your answer.

A
  • Peaks and troughs of ECG are less distinct and not as regular
  • S-T portion is higher than normal (ST elevation)
83
Q

Describe the effects of a myocardial infarction

A
  • Leads to the formation of a blood clot (coronary thrombosis)
  • Blood supply to part of heart muscle is partly or full blocked
  • Cardiac muscle cells deprived of oxygen
  • Cardiac cells stop contracting
84
Q

Describe the 3 main types of treatment for a myocardial infarction

A
  • Aspirin
  • Thrombolytics
  • Anticoagulants
85
Q

Explain how aspirin is used therapeutically to treat an MI

A
  • Aspirin: stops blood from clotting
  • Nitro-glycerine: dilates blood vessels
  • Pain relieve: relieve pain and is often given intravenously
86
Q

Explain how thrombolytic drugs are used therapeutically to treat an MI

A
  • Thrombolytics: break up clots. Most effective when taken within 2 hours of the heart attack and are not given after 12 hours have elapsed. These drugs may be given with other anticoagulants (blood thinners)
87
Q

Explain how anticoagulants are used therapeutically to treat an MI

A
  • Anticoagulants: make blood less likely to form clots e.g. heparin
88
Q

State the most common cause of an MI

A

An occlusion of coronary artery following the rupture of an atherosclerotic plaque

89
Q

Describe how to use a defibrillator

A

 Apply two electrode pads to chest
 Pads placed in diagonal line across chest with heart position in the middle
 Reading on machine shows if heart is fibrillating
 If it is then AED applies electrical discharge (“electrical shock”)
 This stops the chaotic electrical activity of fibrillation & allows heart to restore regular rhythm determined by SAN

90
Q

What is an AED?

A

 Use an automated external defibrillator (AED)
 AED = safe, portable electrical device
 AED helps to establish a regular heartbeat during a cardiac arrest by monitoring the person’s heartbeat and giving them an electric shock if necessary

91
Q

Describe the events that occur during a cardiac arrest

A

 Supply of blood to region of cardiac muscle is disrupted
 Area of cardiac muscle does not receive sufficient oxygen
 Cardiac muscle in atrial or ventricular walls contract rapidly & irregularly
 Ventricles do not fill fully (as no ventricular diastole to allow filling)
 Blood isn’t pumped out of ventricles
 Patient stops breathing due to lack of oxygen supply

92
Q

Describe how to carry out CPR

A
  • Check airway and for breathing by tilting head back
  • Carry out chest compressions (on adult)
  • Place the heel of your hand on the sternum at the centre of the person’s chest
  • Place your other hand on top of your other hand and interlock your fingers
  • Using your body weight, keep your elbows locked straight & press straight down vertically (using your body weight)
  • Press down firmly & quickly by 4-5cm then relax
  • After each compression release all pressure on the person’s chest without losing contact between the hands and sternum
  • Aim to do the chest compressions at a rate of 100-120 compressions a minute
  • Repeat x30 then give mouth-to-mouth resuscitation (expired air resuscitation) twice
  • Repeat this on 30:2 ratio until an ambulance arrives
93
Q

Describe 3 signs that a person may be having a cardiac arrest

A

o they appear not to be breathing
o they’re not moving
o they don’t respond to any stimulation; such as being touched or spoken to

94
Q

State 5 common signs of a heart attack

A

 chest pain – a sensation of heavy crushing pressure, tightness or squeezing in the centre of the chest
 pain in other parts of the body – it can feel as if the pain is travelling from the chest to the arms (usually the left arm is affected, but it can affect both arms), jaw, neck, back and abdomen
 feeling lightheaded or dizzy
 profuse sweating
 shortness of breath
 cold ashen-looking skin and blue lips
 rapid, weak pulse which may be irregular
 feeling sick (nausea) or being sick (vomiting)
 an overwhelming sense of anxiety (similar to having a panic attack)
 coughing or wheezing
 unexpected collapse

Mrs P's flashcards_23 (35 decks)

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