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ANAP 520 > CV SYSTEM > Flashcards

CV SYSTEM Flashcards

1
Q

CV system delivers sufficient _______ to the tissues to meet metabolic demand.

A

Oxygen

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2
Q

CV transports metabolic waste products (carbon dioxide) from the _________ and delivery to the ________ for elimination

A

From the tissues

Delivery to lungs

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3
Q

CV system transports metabolic waste products to the kidneys for elimination. TRUE/FALSE.

A

TRUE

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4
Q

CV system supplies nutrients by absorption from ________ and delivers to the body

A

GI tract

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5
Q

How does the CVS regulate body temperature?

A

Vasodilation

Vasoconstriction

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6
Q

How does the CVS help to regulate cellular function?

A

Transport of hormones and other substances (NT, drugs etc)

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7
Q

The heart is an endocrine organ; what hormone does the heart secrete?

A

Natriuretic peptide

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8
Q

Sits directly posterior to the sternum, inbetween the lungs and anterior to the vertebral column; heart located here.

A

Mediastinum

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9
Q

From an anterior perspective, which side of the heart can be seen better?

A

RIGHT side

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10
Q

_______ side of the heart seen much better from a posterior perspective

A

Left

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11
Q

Great vessels are located also in the ________

A

Mediastinum

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12
Q

Brings venous deoxygenated blood from the upper part of the body to the right atrium

A

Superior vena cava

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13
Q

Brings deoxygenated venous blood from lower body to RA

A

IVC

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14
Q

Descending thoracic aorta runs along posterior aspect of heart and pierces the __________, then becomes the abdominal aorta.

A

Diaphragm

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15
Q

Esophagus and trachea also pass through the mediastinum. TRUE/FALSE

A

TRUE

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16
Q

The heart is surrounded by pericardial __________

A

Membranes

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17
Q

Most inner pericardial membrane

A

Visceral pericardium

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18
Q

Outer pericardial membrane

A

Parietal pericardium

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19
Q

Most inner pleural membrane; directly attached to the lungs

A

Visceral pleura

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20
Q

Outer most pleural membrane

A

Parietal pleura

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21
Q

Small band of tissue that separates the most outer pericardial and pleural membranes

A

Fibrous pericardium

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22
Q

Can have CV implications when we do this to pts, bc the layer between the heart/lungs is so thin

A

PPV

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23
Q

Branches right off aorta as emerges from LV, runs down coronary sulcus between RA and RV.

A

RCA

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24
Q

Left Main coronary artery Branches off of the aorta and quickly divides into what two coronary arteries?

A

Left anterior descending (LAD)

Left circumflex

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25
Q

Where is the LAD located on the heart?

A

In sulcus between LV and RV on anterior surface of heart

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26
Q

Pulmonary carries what type of blood?

A

Venous deoxygenated blood

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27
Q

Arteries carry blood to the heart. TRUE/FALSE.

A

FALSE

Arteries carry blood away from the heart

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28
Q

Veins carry blood to the heart. TRUE/FALSE

A

TRUE

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29
Q

Freshly oxygenated blood is returned to the heart after pulmonary circulation via ___________

A

Pulmonary veins

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30
Q

In most people the _______ becomes the posterior descending artery (PDA)

A

RCA

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31
Q

PDA descends posteriorly between what two structures of the heart?

A

RV and LV

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32
Q

In about _____% of people the PDA is a branch of the RCA

A

80%

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33
Q

In about 20% if people the PDA is a branch of what artery

A

Left circumflex

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34
Q

All coronary veins join together to form what vein?

A

Great Cardiac Vein

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35
Q

The great cardiac vein empties into the _______ that empties into the RA

A

Coronary Sinus

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36
Q

Tiny, microscopic veins that permeate walls of the heart and empty deoxygenated blood into all 4 chambers of the heart

A

Thebesian veins

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37
Q

Two reasons why PaO2 is less in the Left side of the heart than the blood at the pulmonary capillaries after gas exchange occurs.

A

Thebesian veins

Bronchial circulation (need blood but do not participate in gas exchange)

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38
Q

Two types of circulations in the lungs

A

Pulmonary (fresh blood back to LA)

Bronchial (tracheobronchial tree)

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39
Q

Outer most layer of the heart; directly attached and cannot be separated from the heart.

A

Visceral pericardium (epicardium)

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40
Q

Visceral pericardium composed of what?

A

Squamous epithelial cells

Loose connective tissue/fat

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41
Q

Thickest layer of the heart; muscle fibers.

A

Myocardium

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42
Q

What determines the thickness of the myocardium of the different chambers?

A

Workload on the heart

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43
Q

Order of chambers from largest myocardium to the least

A

LV
RV
LA
RA

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44
Q

Inner most layer of the heart, faces chambers in folds.

A

Trabeculae corneae

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45
Q

2 functions of the folds of the trabeculae corneae

A

Provides structure so when undergo contraction, do not collapse

Creates turbulence of blood flow; prevents blood clots

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46
Q

The visceral pericardium completely surrounds the heart, when it gets to the _________ it turns out on itself and becomes the parietal pericardium.

A

Great vessels

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47
Q

Space between visceral and parietal pericardium

A

Pericardial space (potential space)

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48
Q

Parietal and visceral pericardium combines are the ___________ pericardium; secretes fluid into pericardial space.

A

Serous pericardium

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49
Q

Under normal conditions there is ~______mL of fluid in the pericardial cavity

A

20mL

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50
Q

Purpose of pericardial fluid

A

Allows visceral/parietal pericardium to glide over smoothly during systole/diastole

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51
Q

Right outside the parietal pericardium and heaps anchor the heart in place and to adjacent structures

A

Fibrous pericardium

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52
Q

When pericardial membranes become inflamed; can be from infection, virus, etc.

A

Pericarditis

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53
Q

Classic auscultated sign of pericarditis

A

Friction rub

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54
Q

Pericarditis can be caused from something infectious or non-infectious. TRUE/FALSE

A

TRUE

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55
Q

Example of non-infectious cause of pericarditis

A

Nephrogenic toxins

Trauma to chest

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56
Q

Where is a friction rub best heard?

A

Apex of heart; 5th intercostal space midclavicular line

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57
Q

Increased capillary permeability in the pericardial membranes, allowing excess pericardial fluid to accumulate

A

Pericardial effusion

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58
Q

Pericardial effusion can lead to _________

A

Cardiac tamponade

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59
Q

Difference in pericardial effusion and cardiac tamponade

A

With cardiac tamponade, you will have CV manifestations

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60
Q

What usually is the determinant factor in whether a pericardial effusion/tamponade causes manifestations?

A

Length of time fluid is accumulated

The more quickly fluid accumulates, the more quickly can decompensate

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61
Q

How do we manage anesthesia with cardiac tamponade?

A

FULL, FAST, FORWARD

Keep them full, HR up, and blood moving forward

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62
Q

Pts with CT have a fixed _________ and cannot adjust their contractility; so CO is dependent on________ primarily. So you should avoid __________.

A

Fixed SV

CO dependent on HR

Avoid bradycardia

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63
Q

With CT, you want to avoid ________, because you take a risk of decreasing venous return and preload

A

Vasodilators

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64
Q

With CT, we need to optimize __________ to maximize LV filling

A

Volume status

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65
Q

With CT, maintain _________ tone, but do not overly constrict them.

A

Sympathetic

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66
Q

Why should we maintain spontaneous ventilation with CT?

A

PPV can result in CV collapse bc of decreased venous return

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67
Q

There are no valves between the IVC/SVC and the RA. TRUE/FALSE

A

TRUE

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68
Q

There should be constant flow of blood into RA, with a pressure gradient. What should the pressure gradient be between CVP and RA to allow this to happen?

A

CVP should be a little higher than pressure in the RA to allow blood to flow forward.

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69
Q

When RA pressure is greater than RV pressure, _________ opens and blood flows passively from RA to RV

A

Tricuspid leaflets

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70
Q

At some point the RA goes into systole and injects more blood into RV. TRUE/FALSE.

A

TRUE

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71
Q

When do the tricuspid leaflets close?

A

When RV pressure is > RA

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72
Q

RV goes into systole and chamber gets smaller, increasing RV pressure; when RV pressure is > pulmonary artery pressure, the ________ valve opens and blood ejected into pulm art circuit to lungs.

A

Pulmonary valve

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73
Q

“Heart strings”

A

Chordae tendineae

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74
Q

Chordae tendineae are attached to __________ muscles that are continuous with the myocardium

A

Papillary

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75
Q

During systole chordae tendineae are pulled tight and hold _______ in place. Preventing _________ bloodflow and favoring forward flow of blood into pulm circuit.

A

Tricuspid leaflets

Retrograde

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76
Q

Just like the vena cava, there are no _______ between the pulmonary veins and the LA.

A

Valves

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77
Q

When LA pressure is > LV pressure, then ________ leaflets open and there is initial passive blood flow into LV.

A

Mitral

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78
Q

When does mitral valve close

A

When LV pressure is > LA

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79
Q

LV goes into systole, and when LV pressure exceeds aortic pressure, then _________ valve opens to eject blood into aorta

A

Aortic

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80
Q

When does aortic valve close

A

When aortic pressure is > LV pressure

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81
Q

What opens and closes valve leaflets

A

Pressure Gradients

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82
Q

Which valves are associated with chordae tendineae and papillary muscles?

A

Atrioventricular valves

Tricuspid and mitral

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83
Q

Passive flow of blood from atrium to ventricle accounts for about ____% of ventricular preload.

A

~75%

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84
Q

When atria goes into systole, ~___% of blood is ejected into ventricle = atrial kick.

A

25%

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85
Q

What type of arrhythmia would cause atria to contract against closed atrioventricular valve, losing atrial kick.

A

Afib

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86
Q

What causes a transient increase in atrial pressure during ventricular systole?

A

Valve leaflets ballooning into the atrium

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87
Q

What causes heart sounds

A

Turbulence of bloodflow with opening and closing of valves

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88
Q

Location of pulmonic auscultatory area

A

2nd intercostal space, Left sternal border

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89
Q

How do you find the 2nd intercostal space?

A

Start at sternal notch, below notch is manubrium, bump where the manubrium meets the sternum is the angle of Louis; directly over should be 2nd intercostal space

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90
Q

Location of aortic auscultatory area

A

2nd intercostal space, Right sternal border

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91
Q

Location of tricuspid auscultatory area

A

5th intercostal space, Left sternal border

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92
Q

Location of mitral auscultatory area

A

5th intercostal space, L Midclavicular line

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93
Q

Why do we not auscultate to diagnose murmurs anymore?

A

Echocardiography/TEE

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94
Q

During ventricular diastole, what valves should be open?

A

Tricuspid

Mitral

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95
Q

If you hear a murmur during diastole at the tricuspid area, it would indicate what type of murmur?

A

Tricuspid stenosis

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96
Q

If you hear a murmur during diastole at the mitral area, it would indicate what type of murmur?

A

Mitral stenosis

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97
Q

If you hear a murmur during diastole at the aortic area, it would indicate what type of murmur?

A

Aortic regurgitation

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98
Q

If you hear a murmur during diastole at the pulmonic auscultatory area, it would indicate what type of murmur?

A

Pulmonic valve regurgitation

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99
Q

During systole, what valves should be open?

A

Aortic

Pulmonic

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100
Q

If you hear a murmur during systole at the aortic auscultatory area, it would indicate what type of murmur?

A

Aortic stenosis

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101
Q

If you hear a murmur during systole at the pulmonic auscultatory area, it would indicate what type of murmur?

A

Pulmonic stenosis

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102
Q

If you hear a murmur during systole at the tricuspid auscultatory area, it would indicate what type of murmur?

A

Tricuspid regurgitation

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103
Q

If you hear a murmur during systole at the mitral auscultatory area, it would indicate what type of murmur?

A

Mitral regurgitation

104
Q

You can have combined diastolic systolic murmurs. How?

A

May be very stenotic when blood flowing through and valves may not shut completely either.

105
Q

Why is it common for pts to have murmurs after an MI?

A

Bc papillary muscles or muscles attached to them can be infarcted and not function correctly anymore in keeping tricuspid/mitral valves shut during systole

106
Q

The first organ to be perfused by the heart is the______

A

Heart

107
Q

During the resting state, about ___% of CO circulates through the coronary arteries.

A

~3%

108
Q

Driving force against blood flowing through the coronary arteries is what?

A

Pressure created by the LV during systole/contraction

109
Q

Most perfusion of the heart occurs during ventricular systole. TRUE/FALSE

A

FALSE

Most perfusion occurs DIASTOLE

110
Q

Why is perfusion of the heart hindered during systole?

A

Small arteries, arterioles, and capillaries are compressed during systole

111
Q

Which chamber is it most important to have adequate diastole for perfusion?

A

LV

112
Q

Sympathetic stimulation with epi/NE at alpha-1 receptors causes coronary artery ________

A

Constriction

113
Q

Sympathetic stimulation with epi/NE at beta-2 receptors causes coronary artery ________

A

Dilation

114
Q

During sympathetic stimulation, which receptor effect normally dominates?

A

Beta-2

115
Q

Possible parasympathetic/vagal stimulation that affect coronary artery blood flow, via _______ receptors, usually minimal effect and mild _________.

A

Acetylcholine/muscarinic

Mild dilation

116
Q

During the resting state, about _____% of O2 is extracted from coronary blood flow

A

~75%

117
Q

Under normal conditions, in other areas of the body besides the heart, ~____% of O2 is extracted from the blood flow

A

~30%

118
Q

The heart is very _______ hungry

A

Oxygen

119
Q

Coronary arter blood flow and myocardial perfusion are controlled primarily by what?

A

Rate of myocardial O2 consumption

120
Q

Any condition that increases myocardial O2 consumption causes reflex ________ of coronary arteries.

A

Dilation

121
Q

If _______ on the heart increases, then O2 consumption increases.

A

Workload

122
Q

For O2 supply to meet O2 demand, coronary arteries must __________ to increase blood flow and O2.

A

Dilate

123
Q

What are some things that increase myocardial workload?

A

Increased strength of contraction
Increased afterload
Increased preload
Increased HR

124
Q

What increases myocardial oxygen consumption and workload on the heart more than any other factor?

A

INCREASED HR

125
Q

What would be of most benefit to a pt you were worried about perfusion of their CA?

A

Betablocker; decreased HR

126
Q

What are some metabolic vasodilators; providing more bloodflow, more O2 delivery to tissues?

A 
Increased CO2
Increased H+ ions
Decreased pH
Lactate
Adenosine
127
Q

What does it mean to be right coronary artery dominant?

A

PDA is a branch of the RCA

128
Q

How is it determined whether you are right/left CA dominant?

A

By which CA your PDA branches off of

129
Q

Regardless of dominance, the ___________ artery supplies the majority of blood flow to the heart in EVERYONE.

A

LEFT MAIN CA

130
Q

Right atrium is perfused by what major artery?

A

RCA

131
Q

Left atrium is perfused by what major artery?

A

Left circumflex

132
Q

Right ventricle anterior is perfused by what major artery?

A

RCA

133
Q

Right ventricle posteriorly is perfused by what major artery?

A

RCA (PDA)

134
Q

LV (diaphragmatic/inferior) is perfused by what major artery?

A

Left circumflex and RCA(PDA)

135
Q

LV anteriorly is perfused by what major artery?

A

LAD

Left circ

136
Q

LV laterally is perfused by what major artery?

A

Left circ

137
Q

Apex is perfused by what major artery?

A

LAD

138
Q

Interventricular septum anteriorly is perfused by what major artery?

A

LAD

139
Q

Interventricular septum posteriorly is perfused by what major artery?

A

RCA (PDA)

140
Q

LV papillary muscles anteriorly is perfused by what major artery?

A

LAD

L circ

141
Q

LV papillary muscles posteriorly is perfused by what major artery?

A

L circ and RCA (PDA)

142
Q

SA node is perfused by what major artery?

A

RCA

143
Q

Atrial internodal pathways are perfused by what major artery?

A

RCA

144
Q

AV node is perfused by what major artery?

A

RCA

145
Q

Bundle of HIS is perfused by what major artery?

A

RCA

146
Q

Right bundle branch is perfused by what major artery?

A

LAD

147
Q

Left bundle branch anteriorly and posteriorly is perfused by what major artery?

A

LAD

148
Q

Leads V1-V4 are indicative of changes in what area of the heart?

A

Anterior surface

149
Q

Leads V5-V6 are the best leads to see changes effecting what area of the heart?

A

Lateral surface of the heart

150
Q

If you saw prominent Q waves in leads V1-V4, what coronary artery is most likely infarcted?

A

LAD

151
Q

If ST elevation was present in V5-V6, what coronary artery is most likely infarcted?

A

Left circumflex

152
Q

Two types of muscle

A

Striated and smooth

153
Q

Two types of striated muscle

A

Skeletal

Cardiac

154
Q

Muscle fibers in the atria and ventricles that bring about muscle contraction

A

Mechanical contractile fibers

155
Q

Form electrical conduction system throughout the heart

A

Electrical fibers

156
Q

Electrical fibers initiate and conduct __________ throughout the heart and to mechanical contractile fibers.

A

Action potentials

157
Q

AP’s transferred to contractile fibers and are __________ with mechanical contraction

A

Coupled

158
Q

This MUST precede mechanical contraction of the heart

A

Electrical impulses (AP)

159
Q

Clinical scenario where we know there is not electrical/mechanical coupling.

A

PEA

160
Q

Cardiac muscle is smooth muscle. TRUE/FALSE

A

FALSE

It is striated muscle

161
Q

Actin:myosin ratio for cardiac muscle

A

2:1

162
Q

Cardiac muscle includes tropmyosin and troponin (I,T, and C) similar to skeletal muscle fibers. TRUE/FALSE

A

TRUE

163
Q

In cardiac muscle, actin is attached to _______ and forms sarcomeres.

A

Z-discs

164
Q

What is actin attached to in smooth muscle

A

Dense bodies

165
Q

Cardiac muscle contains intercalated discs and __________ between adjacent sarcolemma for spread of AP directly from muscle fiber to muscle fiber

A

Gap jxns

166
Q

This allows for free flow of ions in cardiac muscle, and contraction as a unit.

A

Gap junctions

167
Q

What are the 2 functional syncytium of the cardiac muscle?

A

Right and left Atria

Right and Left Ventricles

168
Q

What’s the purpose of the functional syncytium?

A

When one muscle fiber becomes excited in either the right/left atria/ventricle, all of the fibers in the fxnal syncytium become excited and contract at the same time

169
Q

The atria and ventricles are separated by fibrous tissue with openings for _________ and pathway for _________ fibers so impulse can be conducted, one way, from atria to ventricles

A

Valves

Electrical fibers

170
Q

Heart requires flow of Ca+ into sarcoplasm from from what two sources?

A

Sarcoplasmic reticulum

EC fluid

171
Q

The 2 sources of Ca+ allow for sustained contraction of cardiac muscles to enhance _______ and ______.

A

Stroke volume

Cardiac output

172
Q

If you gave calcium to a pt having contraction issues, it would enhance their contraction bc the heart is affected by extracellular Ca+ concentrations. TRUE/FALSE.

A

TRUE

173
Q

The inward movement of Ca+ from EC fluid and SR occurs during the cardiac ______

A

AP

174
Q

Where one cardiac muscle fiber adjoins to the next one; forms gap jxn

A

Intercalated disks

175
Q

Cardiac muscle fibers require a lot of this organelle because of a lot of consumption of O2 needed in the heart

A

Mitochondria

176
Q

Cell membrane of cardiac muscle fiber

A

Sarcolemma

177
Q

T tubule along with terminal cisterna on either side of it makes up what?

A

Triad

178
Q

AP travels along sarcolemma and down the T tubule; opens up _________ channel where calcium enters from __________.

A

v-g Ca+ channel

EC fluid

179
Q

Ca+ enters sarcoplasm and AP is transferred from T tubule to _________ , membrane is depolarizes, and v-g _____ channels are opened

A

Sarcoplasmic reticulum (on either side of t tubule)

V-g Ca channels

180
Q

Both the Ca+ from the SR and EC fluid increases Ca+ sarcoplasmic conc, this pulls troponin ___ towards the Ca+, along with troponin ___ and ______.

A

troponin C towards Ca+

Troponin T and tropomyosin

181
Q

When tropomyosin is pulled away, this uncovers the binding sites on ______ and allows for ________ to crossbridge and powerstroke

A

Uncovers binding sites on ACTIN

Allows for MYOSIN HEADS to CB and PS

182
Q

Muscle fibers are arranged _______ around the ventricles to allow for a more effective SV and CO.

A

Obliquely

183
Q

Vasopressors are frequently utilized for intraoperative hypotension in a radical neck dissection with free flap. TRUE/FALSE.

A

FALSE

You CANNOT use vasopressors for intraoperative hypotension in these cases

184
Q

This can be used to verify adequate fluid volume status intraoperatively.

A

Pulse Pressure Variation

185
Q

What would the benefits be of calcium administration for your patient with intraoperative hypotension?

A

Increased myocardial contractility

Calcium dependent exocytosis of NT (NE)

186
Q

Sympathetic postganglionic neurons are depending on this for release of NE.

A

CALCIUM dependent exocytosis

187
Q

3 properties of electrical fibers

A

Automaticity
Excitability
Conductivity

188
Q

Property: Ability to automatically generate AP

A

Automaticity

189
Q

Property: Becomes excited in response to AP’s

A

Excitability

190
Q

Property: rapidly conducts AP’s

A

Conductivity

191
Q

All electrical fibers have all 3 properties, BUT some fibers have more of one than the other properties. TRUE/FALSE.

A

TRUE

192
Q

Located in the roof of the RA where the SVC joins with the RA.

A

SA node

193
Q

SA node

A

<1cm

194
Q

SA node primarily composed of ______ cells

A

Pacemaker cells (P cells)

195
Q

Primary property of P cells.

A

Automaticity

196
Q

Rate P cells generate AP

A

~60-100

197
Q

AP generated by the SA node are transmitted through the superior, middle and inferior ____________ pathways

A

Atrial internodal pathways

198
Q

Provides input to the LA from the SA node.

A

Interatrial branch of the atrial internodal pathway

199
Q

Atrial internodal pathways and interatrial branch are composed of ______ cells.

A

Purkinje fibers

200
Q

Primary property of purkinje cells is _______

A

Conductivity

201
Q

We hope purkinje cells are lying adjacent to atrial muscle fibers to allow what?

A

Electrical mechanical coupling

202
Q

2 atrial internodal pathways join back together to form the ________.

A

Atrioventricular node (AV node)

203
Q

Where is the AV node located?

A

Bottom of the RA, right above the tricuspid valve

204
Q

What type of cells compose the AV node

A 
P cells
T cells (transitional cells)
205
Q

What are the 2 functions of the T cells in the AV node?

A

Slow the AP slightly so atria contract before the ventricles

Regulates # of AP’s that can get through

206
Q

At what rate does the AV node generate AP in the absence of the SA node?

A

~40-60

207
Q

Where the AV node enters and becomes the Bundle of HIS.

A

Superior part of interventricular septum

208
Q

Bundle of HIS divides into what 3 bundle branches?

A

Right bundle branch

Anterior branch of Left bundle

Posterior branch of left bundle

209
Q

Bundle branches terminate at ____________ that are hopefully adjacent to muscle fibers.

A

Purkinje fibers

210
Q

Which two bundle branches descend into the interventricular septum towards the apex?

A

Right bundle branch

Anterior branch of Left bundle

211
Q

Posterior branch of Left bundle innervates the _______ aspect of the LV.

A

Posterior

212
Q

Bundle branch that innervates the purkinje fibers on the anterior and lateral LV

A

Anterior branch of Left bundle

213
Q

Why does the left side of the heart have 2 bundle branches, and the right side have only one branch?

A

More muscle mass to depolarize on the L side.

214
Q

Which ventricle contracts first?

A

RV

Less muscle mass to depolarize

215
Q

AP from a large axon or skeletal muscle fiber has a RMP of ~ _____mV and a TP of ~ ____mV.

A

RMP ~ -85mV

TP ~ 60mV

216
Q

In an AP of a large axon or skeletal muscle fiber, the depolarization/repolarization phase is SLOW/RAPID?

A

RAPID

217
Q

Repolarization in cardiac AP is __________

A

Slow, prolonged

218
Q

Why does the heart need slow, prolonged repolarization?

A

Allows for sustained AP and sustained contraction (CO and SV)

219
Q

Cardiac AP takes about ________ msec.

A

~500msec

220
Q

RMP for cardiac AP

A

~ -85mV

221
Q

what are the 4 contributors to RMP at this time?

A

Potassium leak channels
Sodium leak channels
Na-K pump
(-) charged proteins that line cell membrane

222
Q

If stimulus applied to cell membrane, causes initial influx of _____ ions and moves RMP upward in less negative fashion.

A

Sodium

223
Q

At TP (~ ____ mV), there is opening of ___________ Channels and more influx of + charges into the cardiac cell

A

~ -60mV

V-g Na channels

224
Q

Early Phase 0 of depolarization begins at -____mV and continues to about -____mV.

A

-90mV to ~ -40mV

225
Q

What initiates early phase 0 of depolarization?

A

Initial stimulus causing initial Na influx

226
Q

During early phase 0, cell membrane becomes impermeable to _______

A

Potassium

227
Q

Early phase 0, -40mV, opening of v-g ________ channels.

A

Voltage gated Ca-Na channels

228
Q

LATE phase 0 of depolarization begins at -___mV and continues to about +_______ mV.

A

-40mV - +20-30mV

229
Q

Peak amplitude of depolarization in cardiac fiber is ~____mV

A

~ +20mV

230
Q

At peak amplitude of depolarization, +20mV, the v-g ______ channels snap shut; ending __________ and beginning ____________.

At the same time, v-g _____ channels start to open up; initiating phase 1 of repolarization.

A

V-g Na channels shut

Ends depolarization

Begins repolarization

V-g K channels open

231
Q

Phase 1 of repolarization begins at +_____mV and continues to _____ mV.

A

+20-30mV - 0mV

232
Q

Longest phase of repolarization of cardiac muscle fiber.

A

Phase 2

233
Q

Phase 2 of repolarization, the MP remains at about ______mV

A

0mV

234
Q

Why does the MP remain at ~0mV during all of phase 2 of repolarization?

A

Equal influx/efflux of cations

Inward movement of Ca+ through slow Ca-Na channels; K channels are open = outward K+.

235
Q

V-g Ca/Na channels shut at the end of phase ____ of repolarization; no more influx of + charges; beginning phase ____.

A

Phase 2

Begin phase 3

236
Q

During phase 3, the only channels open for ion movement are?

A

K channels

237
Q

During phase 3, K channels are fully open and MP SLOWLY/RAPIDLY returns to RMP.

A

Rapidly

238
Q

The phase in between AP’s is phase ______; RMP.

A

Phase 4

239
Q

Cell cannot depolarization again regardless of stimulus during this period

A

Absolute RP

240
Q

ARP starts and ends at what phases of repolarization?

A

Starts Early phase 0, late phase 0, phase 1, 2 and most of 3.

Lasts until reaches TP in phase 3 (~60mV)

241
Q

If an extra strong stimulus is applied, depolarization might occur in this period.

A

Relative refractory period RRP

242
Q

RRP lasts from ~____mV down to ~_____mV.

A

-60mV down to ~ -85mV

243
Q

Is depolarization happens during RRP, what abnormality might you see on the EKG?

A

QRS sitting right on top of the T wave

244
Q

Only a mild stimulus applied can cause depolarization during this period

A

Supranormal refractory period. SNP.

245
Q

SNP is form __mV to __mV.

A

~-85mV down to -90mV, RMP.

246
Q

If depolarization occurs during SNP, what EKG change would you see?

A

QRS on downslope of T wave

247
Q

In pacemaker cell AP’s, these channels are inactivated.

A

V-g Na channels

248
Q

RMP in pacemaker cell starts at ~-_____mV

A

~ -55mV

249
Q

When MP of P cell gets to -40mV, there is opening of v-g ________ channels (depolarization)

A

Ca-Na channels

250
Q

Pacemaker cells are VERY leaky to _____ ions; we don’t have to have a stimulus applied to generate AP bc of this!

A

Sodium

251
Q

In P cells, after opening of v-g Ca-Na channels, MP gets to peak amplitude, _____mV, _____ channels close, and ______ channels open (repolarization); MP moves back down to RMP

A

~+20mV

V-g Ca-Na channels close

K channels open

252
Q

Rate of AP generation: 60-100/min

Overrides lower, slower potential pacemakers

A

SA node (normal pm)

253
Q

Inherent rate 40-60/min

A

AV node/jxn

254
Q

Inherent rate 15-40/min

A

Ventricular purkinje fibers

255
Q

_________ pacemakers can occur anywhere in the conduction system.

A

Ectopic

ANAP 520 (6 decks)

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