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y2s1 cardio. > Coronary Circulation & Conduction System > Flashcards

Coronary Circulation & Conduction System Flashcards

1
Q

what are the 5 key physiological features of the heart

A 
chronotropy 
dromotropy (conduction)
bathmotropy (excitability)
ionotropy (contractility) 
Lusitropy (relaxation)
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2
Q

blood supply to the heart tissue

A

supplied by coronary arteries and their branches

Right coronary artery (RCA)

Left coronary artery (LCA)

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3
Q

where does the endocardium receive oxygen and nutrients from

A

the chambers of the heart

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4
Q

what and where are the coronary arteries

A

the only branches of the ascending aorta and they emerge in the aortic sinuses

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5
Q

what happens to the aortic sinus during systole

A

they fill up which means that coronary arteries also fill up

during systole they are blocked off as the valves are pushed open

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6
Q

RCA

A

arises from the right aortic sinus

  • has a SA nodal branch, supplies the node of the conduction system
  • its atrial branches supply the right atrium
  • the right (acute) marginal branch
  • usually gives off posterior inter ventricular branch (aka posterior descending artery)
  • anastomoses with branches of left coronary artery in the artery sulcus at the apex
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7
Q

LCA

A

arises from the left aortic sinus between the left auricle and the pulmonary trunk

  • shorter but thicker than the RCA
  • enters the coronary sulcus and divides into the circumflex and the anterior interventricular branches (LAD)
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8
Q

LAD - left anterior inter ventricular descending artery (2nd branch of the LCA)

A
  • supplies the sternocostal surface
  • anasomoses with posterior inter ventricular branch of the RCA at the apex
  • artery of sudden death, as when it gets blocked it causes instant death
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9
Q

circumflex branch of the LCA

A

branches to the left (obtuse) marginal branch which anastomoses with the branches of the RCA

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10
Q

RCA and its branches supply

A
  • the walls of the RA and RV
  • SA and AV nodes
  • Posterior part of the inter ventricular septum (the proximal portion of the bundle of His)
  • Small areas of the walls of LA and LV
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11
Q

LCA and its branches supply

A
  • Walls of LA and LV

- most of the atrioventricular septum including part of the AV bundle

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12
Q

CORONARY DOMINANCE

A

✓ The artery that gives off the posterior interventricular/posterior descending artery determines the coronary dominance
✓ In ~80% of the people RCA is dominant

If both are involves it is called coronary co-dominance

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13
Q

Where and what is the likelihood of a myocardial infarction happening in what artier

A

LAD - 40-50%
RCA - 30-40%
Circumflex 15-20%

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14
Q

what damage could of myocardial infarction do to the conducting system

A

if its in the LAD = it supplies the AV bundles
RCA supplies both the SA and AV nodes

Heart block can cause bradycardia

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15
Q

Coronary Artery Bypass Grafting (CABG)

A

this bypasses the occluded portion of the vessel using the internal thoracic artery

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16
Q

CORONARY ANGIOPLASTY

A

Percutaneous Transluminal Coronary Angioplasty
✓ With or without stent (drug-eluting v bare-metal stents)
✓ Anticoagulation medication

17
Q

where is the catheter of the coronary angioplasty

A

femoral artery

18
Q

cardiac veins

A

✓ Most of the venous blood drains into RA via coronary sinus

19
Q

great cardiac vein

A

anterior inter ventricular vein joins the coronary sinus

20
Q

small cardiac vein

A

accompanies the right marginal branch

21
Q

middle cardiac vein

A

posterior ventricular vein drains into the coronary sinus

22
Q

anterior cardiac veins

A

drain independently into the RA

23
Q

what is the coronary sinus

A

✓ Lies between the LA and LV ✓ Surrounded by muscle fibers
from LA
✓ Drains 60% of the venous blood of the heart into the RA
✓ 40% is drained by smallest cardiac veins (thebesian veins) and anterior cardiac veins

24
Q

the cardiac conduction system

A

form 2 networks separated by fibrous skeleton: Atrial and ventricular networks

25
Q

electrical impulses through the heart

A

There is a group of specialized, modified cardiac muscle cells that
− lie immediately beneath the endocardium
− can generate electrical impulses without external stimuli
✓ Cardiac muscle cells distribute electrical impulses through the myocardium,
– causing the heart to contract in the proper sequence

26
Q

what is the role of the autonomic nervous system in conduction

A

✓ Autonomic nervous system shortens or prolongs the duration of a cardiac cycle

27
Q

what are the components of the cardiac conduction system

A 
− Sinu-atrial node (SA node)
− Atrioventricular node (AV node)
− Atrioventricular bundle (bundle of His)
• Left bundle branch
• Right bundle branch − Purkinje fibers.
✓ None of them are macroscopic
28
Q

SINU-ATRIAL (SA) NODE

A

✓ Keith-Flack node
✓ Pace-maker
✓ The basic depolarization rate of the SA node is 70 to 80 beats per minute
✓ Located anterior to the opening of the SVC, upper end of crista terminalis
✓ Usually supplied by branches of the right coronary artery

29
Q

ATRIOVENTRICULAR (AV) NODE

A

✓ Aschoff-Tawara node
✓ Located at the postero- inferior part of IA septum, close to the opening of the coronary sinus
✓ Usually supplied by AV nodal branch of the right coronary artery

30
Q

ATRIOVENTRICULAR (AV) BUNDLE

A

✓ Bundle of His
− Continuation of the AV node
− Runs along the membranous part of the IV septum.
− Splits into right and left bundle branches

31
Q

✓ Right Bundle branch

A

− Descends on the right side of the
membranous part of the IV septum.
− Enters the septomarginal trabecula to reach the base of the anterior papillary muscle
− Splits into Purkinje fibres which spread out into the ventricular walls

32
Q

✓ Left Bundle branch

A

− Descends on the left side of the
membranous part of the IV septum.
− Splits into Purkinje fibres

33
Q

The AV bundle of His role

A

✓ The AV bundle of His is (and should be) the only conductive route through the fibrous skeleton
✓ This system ensures synchronous contraction, in the correct sequence, toward the outflow of each chamber

34
Q

NERVE SUPPLY OF THE HEART - workbook

A

✓ Cardioacceleratory and Cardioinhibitory centers in the Medullary reticular formation
✓ Superficial and deep cardiac plexus
− Lie inferior to the aortic arch, adjacent to the bifurcation of both the
pulmonary trunk and the trachea
− Supply conduction system, coronary blood vessels, and myocardium
1. Presynaptic sympathetic fibres travel in T1-5(6) spinal nerves
− Increase the heart beat and force of contraction
− Dilate coronary arteries
2. Parasympathetic fibres reach in vagus
− Decrease the heart beat (and force of contraction)
− Constrict coronary arteries
3. General visceral afferents

35
Q

Cardiac referred pain

A

pain caused by ischaeia and damage to the cardiac muscle

  • the visceral sensory nerve ending are activated
  • the GVA sympathies fibres carrying sense travel with the sympathecis in the T1-5 spinal nerves
  • pain fibres from organ and skin travel in the spina cord together
  • pain is not felt in heart but is referred to somatic areas supplied by the T1-5 (which is the anterior chest wall and possilby the medical aspect of the left arm

y2s1 cardio. (47 decks)

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