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Bioscience > CV I > Flashcards

CV I Flashcards

1
Q

Heart pumps (BLANK) blood to the lungs and then supplies (BLANK) blood to all parts of the body

A

Heart pumps unoxygenated blood to the lungs and then supplies oxygenated blood to all parts of the body

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2
Q

The CV consist of what?

A

CV system is composed of the heart and the vasculature that carries blood

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3
Q

What controls the normal pumping action of the heart?

A

A complex series of electrical and mechanical events controls the normal pumping action of the heart

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4
Q

what provides Unidirectional flow throughout the heart?

A

Unidirectional flow throughout the heart is provided by four valves

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5
Q

Does the heart function as a highly efficient pump?

A

Yes, the Heart functions as a highly efficient pump.

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6
Q

What spreads electrical activity through the heart?

A

Specialized conduction pathways readily spreads electrical activity

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7
Q

Which node delays conduction and enables atrial contraction to prime the ventricle?

A

Atrioventricular (AV) node delays conduction and enables atrial contraction to prime the ventricle

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8
Q

What can the heart be divided into? (4 things)

A

Cardiac muscle can be divided into atrial, ventricular, and specialized pacemaker and conducting cells

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9
Q

Where is the heart bound to? three things

A

Heart is bound anteriorly by the sternum and the costal cartilages of the 3rd - 5th ribs and inferiorly by the diaphragm

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10
Q

Where is the position of the apex of the heart?

A

Positioned with the apex projecting anteriorly and inferiorly toward the left 5th intercostal space

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11
Q

Where is the point of maximal impulse?

A

The apex, first heart sound and s3

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12
Q

Where is the LV on the cardiac silhouette?

A
  • -LV comprises most of the apex and the lower left lateral border**
  • -LA appendage lies superior to the LV and to one side of the pulmonary artery
  • -Anterior surface almost entirely made up of the RV
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13
Q

what is the pericardium?

A

Fibrous double-walled sac that surrounds the heart and roots of the great vessels

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14
Q

What are is the pericardium made up with? two layers

A
  • -Consists of (two compenents) visceral (think of organ, it is attached directly to the organ) portion and outer parietal portion
  • -Visceral and parietal pericardium separated by pericardial cavity (10-25cc)

Pierced superiorly by the aorta, pulmonary trunk, and SVC

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15
Q

Where is the base of the pericardium fused with?

A

Base fused with central tendon of diaphragm

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16
Q

Which sulcus separates the atria from the ventricles?

A

Coronary sulcus separates the atria from the ventricles

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17
Q

What artery lies inside the coronary sulcus?

A

RCA (Right coronary artery)travels within the sulcus

Circumflex artery arises from the L eft C oronary A and travels in the coronary sulcus

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18
Q

Which sulcus separate the RV and LV?

A

RV and LV are separated by the interventricular sulci which are composed of an anterior interventricular sulcus and posterior interventricular sulcus

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19
Q

what artery lies in the Anterior interventricular sulcus?

A

Anterior interventricular sulcus contains LA antieor D ecending artery, which courses over the interventricular septum and continues in the posterior interventricular sulcus

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20
Q

What are is the cardiac skeleton?

A
  • -Tough fibrous rings surround the AV valves and act as points of attachment
  • -Two additional fibrous annuli develop in relation to the bases of the aorta and the pulmonary trunk
  • -Annulus fibrosis is the fixation point for cardiac musculature and plays an important role in the structure, function, and efficiency of the heart
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21
Q

describe the atria in comparison to the ventricles

A

The atria are smaller and thinner walled than the ventricles (low pressure)

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22
Q

Describe the ventricles in comparison atria

A

Ventricles have a thicker myocardial layer and make up much of the bulk of the heart

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23
Q

Which chambers of the heart are the storage units and conduits for blood that is emptied into the ventricles

A

Atria are storage units and conduits for blood that is emptied into the ventricles

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24
Q

Where do the ventricles propel blood through?

A

Ventricles must propel blood through pulmonary or systemic circulation

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25
Q

Describe the Right atrium?

A
  • RA serves as a reservoir for the RV
  • Muscle wall thickness of ~2 mm***
  • RA receives blood from SVC, IVC, and coronary sinus**
  • RA consists of two parts:
  • -Anterior, thin-walled trabeculated portion
  • -Posterior, smooth-walled portion
  • -Two distinguishing structures
  • > Interatrial septum (separates atrium)
  • > Fossa ovalis cordis
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26
Q

Describe the Right Ventricle?

A
  • -RV ejects blood into the pulmonary arteries for oxygenation and removal of CO2 by the lungs
  • -Tricuspid valve RA to RV
  • -Pulmonary valve RV to Pulm
  • -Muscle wall thickness 4-5 mm***
  • -Papillary muscles have attachments to the ventricular walls and chordae tendineae
  • -Chordae tendineae are attached to the cusps of the tricuspid valve
  • -Chordae tendineae and papillary muscles help to prevent the eversion of the tricuspid valve
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27
Q

Describe the Left Atrium?

A
  • LA acts as a reservoir for oxygenated blood from pulmonary veins and a pump during ventricular diastole
  • Provides a 20 - 30% increase in left ventricular end-diastolic volume (LVEDV), atrial kick***
  • Compromised patients rely on this kick to maintain an adequate CO
  • LA located superiorly and posteriorly to other cardiac chambers
  • Muscle wall thickness ~3 mm
  • Mitral valve connects LA to LV
  • Atrial wall is smooth, may contain a central depression
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28
Q

Describe the Left ventricle?

A
  • LV ejects blood into the aorta
  • LV wall thickness is ~8 to 15 mm (think of the pressure)
  • Ventricular septum separates the RV and LV cavities
  • Upper third of septum smooth endocardium
  • Remaining two thirds of septum and rest of ventricular wall covered with trabeculae carneae
  • Present in the LV are two large papillary muscles
  • Chordae tendineae of each muscle are attached to the cusps of the mitral valve
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29
Q

What are the three distinct layers of the cardiac musculture?

A

Epicardium, Myocardium, Endocardium

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30
Q

Describe the myocardium?

A

–Middle muscular myocardium consists of two layers***
(superficial/deep)
–Layers provide strength during contraction

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31
Q

Describe the endocardium?

A

Inner endocardium consists of endothelium and a layer of connective tissue

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32
Q

Describe the cardiac valves?

A
  • –Cardiac valves ensure a one-way flow of blood through the heart**
  • –Open and close in response to pressure gradients that exist above or below the valves**
  • –AV (Tri/bi) or semilunar (pulm/aortic)
  • –Calculation of valve area accurate way to determine valvular pathology
  • -Echocardiography used in the diagnosis of valvular disease
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33
Q

Describe the tricuspid valve.

A

—Situated within the right AV orifice
–Three leaflets of unequal size:
Anterior
Septal
Posterior
—Leaflets attached to chordae tendineae, which are attached to papillary muscles
–Normal tricuspid valve area is 7 cm2

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34
Q

describe the mitral valve

A
  • –Situated in the left AV orifice
  • –Two major leaflets connected by commissural tissue:
  • Anteromedial
  • Posterolateral
  • —Normal mitral valve area is 4 – 6 cm2 ****
  • —Has papillary muscles and chordae tendineae attached to the leaflets
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35
Q

What are the semilunar valves?

A
  • –Aortic and pulmonary valve configuration is similar
  • –The cusps of the aortic valve are slightly thicker due to being subjected to higher pressures
  • –Semilunar valves situated within the outflow tracts of their corresponding ventricles
  • –Each valve is composed of three cusps
  • –Above the aortic valve is a dilation known as the sinus of Valsalva** (so it wont occlude the coronary arties, aortic valve is closed during diastole which is when the coronary arties fill)
  • –Normal valve area of the aortic valve is 1-3 cm2***
  • –Reduction to a 3rd to a half is associated with increased in symptoms of valvular disease **
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36
Q

In coronary circulation, the heart depends on a constant supply of what to meet its high metabolic demand?

A

Heart depends on a constant supply of OXYGEN to meet its high metabolic demand

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37
Q

The coronary circulation contains an extensive arterial and venous network to ensure that what type of cells are adequately supplied with oxygen

A

Contains an extensive arterial and venous network to ensure that MYOCYTES are adequately supplied with oxygen

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38
Q

In the coronary circulation the Arterial system consists of what two types of vessels

A

Arterial system consists of epicardial and subendocardial vessels

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39
Q

Significant obstruction of about how much can result in myocardial ischemia or infarction ?

A

Significant obstruction (about 50%) can result in myocardial ischemia or infarction

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40
Q

Myocardial blood supply is derived entirely from the right and left coronary arteries,
Blood flows from what kind of blood vessels?

A

Myocardial blood supply is derived entirely from the right and left coronary arteries,
Blood flows from epicardial to endocardial vessels

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41
Q

In the coronary circulation, After perfusing the myocardium blood returns to the right atrium via which sinus and what veins?

A

After perfusing the myocardium blood returns to the right atrium via the coronary sinus and the anterior cardiac veins

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42
Q

In the coronary circulation,A small amount of blood returns directly into the chambers of the heart by way of the which vein?

A

A small amount of blood returns directly into the chambers of the heart by way of the thebesian veins

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43
Q

The right coronary artery normally supplies which cambers of the heart?

A

RCA normally supplies the RA, most of the RV, and a variable portion of the LV (inferior wall)**

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44
Q

In what percentage of individuals, the RCA gives rise to the posterior descending artery (PDA), which supplies the superior-posterior interventricular septum and inferior wall; a right dominant circulation

A

In 50% of individuals, the RCA gives rise to the posterior descending artery (PDA), which supplies the superior-posterior interventricular septum and inferior wall; a right dominant circulation

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45
Q

In what percentage of individuals the PDA is a branch of the LCA; a left dominant circulation

A

In 10-15% of individuals the PDA is a branch of the LCA; a left dominant circulation

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46
Q

In what percentage of individuals of the general population have mixed right and left dominance

A

Remaining 35-40% of the general population have mixed right and left dominance

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47
Q

What parts of the heart does the left coronary artery supply blood to?

A

LCA supplies the LA and most of the interventricular septum and LV (septal, anterior, and lateral walls)

48
Q

Where does the Left Main Coronary Artery bifurcate into?

A

LMCA bifurcates into the left anterior descending artery (LAD), which supplies the septum and anterior wall, and the circumflex artery (CX), which supplies the lateral wall

49
Q

In a left dominant circulation, what wraps around the AV groove and continues down the PDA to supply what part of the heart?

A

In a left dominant circulation, the CX wraps around the AV groove and continues down as the PDA to supply most of the posterior septum and inferior wall**

50
Q

Arterial supply to the SA node may be derived from: what blood vessels in the heart?

A

Arterial supply to the SA node may be derived from:
RCA (60% of individuals)*
LAD (40% of individuals)*

51
Q

Arterial supply to the AV node by what blood vessels?

A

AV node supplied by:
RCA (85-90% of individuals)
CX (10-15% of individuals)

52
Q

Arterial supply to the Bundle of His has a dual blood supply from?

A

Bundle of His has a dual blood supply derived from the PDA and LAD

53
Q

Arterial supply to the Anterior papillary muscle of mitral valve are from what blood vessels?

A

Anterior papillary muscle of mitral valve; LAD and CX

54
Q

Arterial supply to the Posterior papillary muscle of mitral valve is from what blood vessel?

A

Posterior papillary muscle of mitral valve; PDA

55
Q

An extensive venous system exists in the heart what are the three major systems for the heart?

A 
An extensive venous system exists in the heart
The three major systems include:
Coronary sinus
Anterior cardiac veins
Thebesian veins
56
Q

What phase of the cardiac cycle are the LV and RV perfused?

A

LV is perfused almost entirely during diastole**

RV is perfused during both systole and diastole

57
Q

Coronary perfusion pressure is usually determined by difference between which two pressures?

A

Coronary perfusion pressure is usually determined by difference between aortic pressure and ventricular pressure

58
Q

Is Coronary blood flow intermittent or continuous?

A

Coronary blood flow is intermittent rather than continuous

59
Q

Decreases in which pressure or increases in what pressure can reduce coronary perfusion pressure?

A

Decreases in aortic pressure or increases in ventricular end-diastolic pressure can reduce coronary perfusion pressure

60
Q

For determinants of coronary perfusion, Increases in what will decrease coronary perfusion?

A

Increases in heart rate decrease coronary perfusion

61
Q

For determinants of coronary perfusion, Endocardium tends to be most vulnerable to what during decreases in coronary perfusion pressure?

A

Endocardium tends to be most vulnerable to ischemia during decreases in coronary perfusion pressure

62
Q

Coronary blood flow parallels what demand of the heart?

A

Coronary blood flow parallels myocardial metabolic demand

63
Q

Coronary blood flow is about how much at rest?

A

Coronary blood flow is ~250 mL/min at rest (4-5%)

64
Q

Myocardium regulates its own blood flow closely between perfusion pressures of?

A

Myocardium regulates its own blood flow closely between perfusion pressures of 50 mm Hg and 120 mm Hg

Blood flow becomes increasingly pressure dependent beyond this range

65
Q

Changes in blood flow are entirely due to variations in coronary arterial tone in response to what?

A

Changes in blood flow are entirely due to variations in coronary arterial tone in response to metabolic demand

66
Q

For myocardial oxygen balance, Increases in myocardial metabolic demand must be met by an increase what?

A

Increases in myocardial metabolic demand must be met by an increase in coronary blood flow**

67
Q

Myocardium is unable to compensate for reductions in blood flow by extracting more oxygen from what?

A

Myocardium is unable to compensate for reductions in blood flow by extracting more oxygen from hemoglobin

68
Q

In terms of myocardial oxygen balance, Myocardial oxygen demand is normally the most important determinant of what?

A

Myocardial oxygen demand is normally the most important determinant of myocardial blood flow

69
Q

What do most volatile anesthetics do to the coronaries?

A

Most volatile anesthetics are coronary vasodilators

70
Q

Volatile anesthetics effects on coronary blood flow is variable due to what three things?

A

Their effect on coronary blood flow is variable due to:

  • Direct vasodilating properties
  • Reduction of myocardial metabolic requirements
  • Effects on arterial blood pressure
71
Q

Volatile agents appear to exert beneficial effects in what two settings?

A

Volatile agents appear to exert beneficial effects in the setting of myocardial ischemia and infarction

72
Q

Can potentially be beneficial in patients with patient population because preload and afterload is decreased despite a decrease in myocardial contractility?

A

Can potentially be beneficial in patients with heart failure because preload and afterload is decreased despite a decrease in myocardial contractility

73
Q

Normal ventricular cell resting membrane potential is what?

A

Normal ventricular cell resting membrane potential is -80 to -90 mV**

74
Q

Action potential transiently raises myocardial cell membrane potential to what?

A

Action potential transiently raises myocardial cell membrane potential to +20 mV

75
Q

CARDIAC CONDUCTION SYSTEM

Conduction system consists of the what following components?

A 
CARDIAC CONDUCTION SYSTEM
Conduction system consists of the following components:
SA Node
Internodal tracts
AV node
AV bundle purkinje system
76
Q

SA node located along the epicardial surface at the what junction?

A

SA node located along the epicardial surface at the junction of the SVC and the RA

77
Q

SA node consists of what two cell types?

A

Consists of two cell types:
P cells (pacemaker cells) (starts here?)
Intermediate or transitional cells
Transitional cells conduct impulses within and away from the SA node

78
Q

Internodal tracts consist of what type of cells?

A

Contain P cells (spontanous rate of depolerization) and transitional cells

60-80

79
Q

What are the three major internodal tracts?

A

Three major internodal tracts exist:
Anterior- sends fibers to the LA and then travels down through the atrial septum to the AV node
Middle- curves behind the SVC before descending to the AV node
Posterior- continues along the terminal crest to enter the atrial septum and then passes to the AV node

80
Q

AV node causes a delay in the transmission of what?

A

AV node causes a delay in the transmission of the action potential (delay to allow for atrial kick)

81
Q

The AV node delay may be attributed to what three things?

A

Delay may be attributed to:

  • Size of the AV nodal cells
  • Resting membrane potential
  • Paucity of gap junctions
82
Q

There is a greater what? to the transmission of an action potential that exists within the AV node.

A

Greater resistance to the transmission of an action potential exists within the AV node

83
Q

What is the AV bundle?

A 
ATRIOVENTRICULAR BUNDLE 20-40
AV bundle (bundle of His) extends from the lower end of the AV node and enters the posterior part of the ventricle and Purkinje system
84
Q

What are the purkinje system?

A

PURKINJE SYSTEM

Consists of the bundle branch system and its terminal branches

85
Q

What two events define the cardiac cycle?

A

Cardiac cycle can be defined by both electrical and mechanical events

86
Q

Which part of the cardiac cycle is considered contraction and which is considered relaxation?

A

Systole refers to contraction, diastole refers to relaxation

87
Q

Most diastolic ventricular filling occurs how?

A

Most diastolic ventricular filling occurs passively

88
Q

Contraction of the atria contributes what percent of ventricular filling

A

Contraction of the atria contributes 20-30% of ventricular filling

89
Q

Preload and afterload depend on what two systems in the body?

A

Preload and afterload depend on both the heart and vascular system

90
Q

What four factors affect cardiac performance directly?

A

Four factors affect cardiac performance directly:

  • Preload
  • Afterload
  • Heart rate
  • Myocardial contractility
91
Q

What factors affect ventricular preload?

A 
Factors affecting ventricular preload:
Venous return
Blood volume
Distribution of blood volume
Heart rhythm
Heart rate
92
Q

What is preload?

A

Preload:
Ventricular preload is end-diastolic volume
When HR is constant CO is directly proportional to preload

this is a DETERMINANTS OF
VENTRICULAR PERFORMANCE

93
Q

What is afterload

A

Afterload: (SVR)
Commonly equated with either ventricular wall tension during systole or arterial impedance to ejection

this is a DETERMINANTS OF
VENTRICULAR PERFORMANCE

94
Q

What is Heart rate?

A

Heart rate:
-CO is generally directly proportional to HR
-HR is an intrinsic function of the SA node but is modified by autonomic, humoral, and local factors
-Normal intrinsic rate of the SA node in young adults is about 80-100 beats/minute, but decreases with age according to the following formula:
Normal Intrinsic HR = 118 beats/min – 0.57 x age

this is a DETERMINANTS OF
VENTRICULAR PERFORMANCE

95
Q

What is myocardial contractility?

A 
Myocardial contractility:
Stroke volume (volume of blood ejected during systole) depends on myocardial contractility

this is a DETERMINANTS OF
VENTRICULAR PERFORMANCE

96
Q

what are two major factors that influence contractility

A

Two major factors influence contractility:

  • Preload
  • Alterations in sympathetic activation of the ventricles

this is a DETERMINANTS OF
VENTRICULAR PERFORMANCE

97
Q

What is cardiac output?

A

cardiac Output: (4-8L)
Volume of blood pumped from the heart per minute
CO = SV x HR

98
Q

What is cardiac index?

A

Cardiac Index: (2-4)
Compensates for variations in body size
CI = CO/BSA (body surface area)

99
Q

What is ejection fraction?

A

ejection Fraction: (60-70%)

EF = (SV/EndDiastolicVolume) x 100

100
Q

What is SVR?

A

SVR: (800-1200)
Relationship among CO, preload, and afterload
SVR = (MAP - CVP)/CO x 80

101
Q

What is ventricular compliance contraction abnormalities?

A

Contraction abnormalities:

  • Hypokinesis (decrease contraction)
  • Akinesis (failure to contract)
  • Dyskinesis (paradoxyl bulging?)
102
Q

What is ventricular compliance wall motion abnormalities?

A

Wall motion abnormalities:

When the ventricular cavity does not collapse symmetrically or fully, emptying becomes impaired

103
Q

Valvular dysfunction can lead to what?

A

Valvular dysfunction:

Can lead to stenosis, regurgitation, or both

104
Q

What can happen in stenosis in an AV valve or semilunar valve?

A

Stenotic lesions:

  • Stenosis of an AV valve reduces stroke volume primarily by decreasing ventricular preload
  • Stenosis of a semilunar valve reduces stroke volume primarily by increasing ventricular afterload
105
Q

What happens to stroke volume with a regurgitant lesion?

A

Regurgitant lesions:

Effective stroke volume is reduced by the regurgitant volume with every contraction

106
Q

describe arteries

A

Arteries:

  • Transport blood to tissues under high pressure
  • Average diameter 4 mm and wall thickness 1 mm
  • Have a thick layer of elastic tissue, smooth muscle, and fibrous tissue
107
Q

Describe arterioles

A

Arterioles:

  • Last small branches of the arterial system
  • Act as control valves for the release of blood into capillary beds. Structurally similar to arteries
  • Average diameter 30 μm and wall thickness 20 μm
108
Q

describe capillaries

A

capillaries: (one cell thick)
Exchange of fluids, nutrients, electrolytes, hormones, and other substances occurs between the blood and the interstitial fluids in the capillaries
Average diameter 8 μm and wall thickness 1 μm

109
Q

describe venules

A
  • Collect blood from capillaries and gradually and progressively become larger veins
  • Average diameter 20 μm and wall thickness 0.5 mm
  • Contain a thin fibrous layer
110
Q

describe veins

A

Veins:

  • Serve as conduits for the transport of blood back to the heart
  • Act as a large reservoir because they are very distensible*
  • Average diameter 30 mm and wall thickness 1.5 mm
111
Q

How much blood is held in the venous system, arteries, and tissue?

A

The venous system holds about 60% of the blood volume

The arteries contain about 20% of the blood volume

The rest is in the tissue, 20%

112
Q

What are the factors that influence blood flow in the vascular tree?

A

Multiple factors influence blood flow in the vascular tree:

  • Local and metabolic control mechanisms (autoregulation)
  • Endothelium-derived factors
  • Autonomic nervous system (sympathetic, primarily)
  • Circulating hormones (catecholamine)
113
Q

in the systemic circulation, what is arterial blood pressure?

A

Arterial blood pressure:

  • Systemic blood flow is pulsatile in large arteries, when it reaches the systemic capillaries, it is continuous
  • Directly related to SV and inversely proportionate to the compliance of the arterial tree
114
Q

What is the immediate control of arterial blood pressure?

A

CONTROL OF ARTERIAL BLOOD PRESSURE
Immediate control: (min to min)
-Primarily the function of the autonomic nervous system reflexes
-Peripheral baroreceptors (in aortic arch and common carotids)

115
Q

What is the intermediate control of arterial blood pressure?

A

intermediate control:

Activation of the renin-angiotensin-aldosterone system (water follows Na)

116
Q

What is the long term control of arterial blood pressure?

A

Long-term control: (take several hours or days)

Slower renal mechanisms

Bioscience (9 decks)

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