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Medicine Phase 1 HH > CVS > Flashcards

CVS Flashcards

1
Q

What is the equation for cardiac output (CO)?

A

CO = Heart rate (HR) x Stroke volume (SV)

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2
Q

What is the equation for pulse pressure (PP)?

A

PP = Systolic pressure - diastolic pressure

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3
Q

What is the equation for mean arterial pressure (MAP)?

A

MAP = Diastolic pressure + 1/3 pulse pressure

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4
Q

What is the equation for blood pressure (BP)?

A

BP = CO (cardiac output) x total peripheral resistance (TPR)

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5
Q

What is the composition of blood?

A

45% haematocrit - % of blood volume that erythrocytes (RBC) make up, 55% plasma,

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6
Q

What are the functions of erythrocytes, leukocytes and platelets respectively?

A

Erythrocytes (more than 99% of all blood cells) - carry O2, leukocytes protect against infection and cancer, platelets function in blood clotting

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7
Q

What is the definition of preload?

A

The degree of ventricular myocyte stretch at the end of diastole. It is determined by the end diastolic volume (EDV).

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8
Q

What is the definition of afterload?

A

The work the heart does while ejecting blood; a function of the arterial blood pressure, as well as the diameter and thickness of the ventricles

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9
Q

What is the definition of contractility?

A

The force of heart contraction that is independent of sarcomere length

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10
Q

What is the definition of elasticity?

A

The ability of a vessel or hollow organ to recoil to its original dimensions once the distending or compressing force is removed.

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11
Q

What is the definition of compliance?

A

The ability of a vessel or hollow organ to distend and increase volume (stretchability).

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12
Q

What is the definition of resistance?

A

Resistance vessels act to control local blood flow. Increasing resistance decreases blood flow.

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13
Q

What happens at the P wave on an ECG?

A

Near the end of diastole, the sino-atrial node discharges and the atria depolarize.

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14
Q

What happens at the QRS complex on an ECG?

A

From the atrio-ventricular node, the wave of depolarization passes into and throughout the ventricular tissue. This triggers ventricular contraction.

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15
Q

What happens at the QRS complex on an ECG?

A

From the atrio-ventricular node, the wave of depolarization passes into and throughout the ventricular tissue. This triggers ventricular contraction.

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16
Q

How long (approx.) does the cardiac cycle last? How long do normal systole and diastole last?

A

Cardiac cycle: 0.8 secs. Systole = 0.3 secs and diastole = 0.5 secs.

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17
Q

What happens in mid to late diastole in terms of pressure and volume changes?

A

LA & LV both relaxed but Ap (Atrial pressure) > Vp (ventricle pressure) because atria filling with blood. AV valves are open, aortic and pulmonary valves closed, Aop (aortic pressure) > than Vp at this point. SA node discharges, causing atria to contract, thus filling ventricles with blood.

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18
Q

What happens in mid to late diastole in terms of pressure and volume changes?

A

LA & LV both relaxed but Ap (Atrial pressure) > Vp (ventricle pressure) because atria filling with blood. AV valves are open, aortic and pulmonary valves closed, Aop (aortic pressure) > than Vp at this point. SA node discharges (P wave of ECG), causing atria to contract, thus filling ventricles with blood.

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19
Q

What is the end-diastolic volume (EDV)?

A

The amount of blood in the ventricles at the end of ventricular diastole.

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20
Q

What happens in systole in terms of pressure and volume changes?

A

From AV node, wave of depolarisation passes through ventricular tissue (QRS complex of ECG) - triggers ventricular contraction. Vp increases rapidly, then Vp > Ap, so AV valves close. Vp then becomes > then Aop, so aortic valve opens, this is called ventricular ejection. Aop increases along with Vp. Peak Vp and Aop reached before the end of ventricular ejection.

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21
Q

What happens at the T wave on an ECG?

A

Ventricular repolarisation

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22
Q

What happens in early diastole in terms of pressure and volume changes?

A

Ventricular repolarisation. Ventricles relax, so Vp

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23
Q

What is Starling’s Law of the Heart?

A

Stroke volume of the heart increases in response to an increase in volume of blood filling the heart (end-diastolic volume) when all other factors remain constant.

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24
Q

What are the four components of circulation?

A

Heart, arterial system, capillaries, venous system.

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25
Q

What makes up the arterial system?

A

Elastic arteries - increase efficiency eg. aorta, brachiocephalic, carotids, subclavian, pulmonary. Muscular arteries - Main distributing branches. Arterioles - terminal branches.

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26
Q

What happens in the capillaries?

A

Functional part of circulation. Blood flow regulated by precapillary sphincters. Between 3 - 40 microns in diameter. 3 types of capillary: continuous (most common), fenestrated (kidney, small intestine, endocrine glands), discontinuous (liver sinusoids).

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27
Q

What happens in the venous system?

A

Blood is returned to the heart. The system of valves allows ‘muscular pumping’. Some peristaltic movement.

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28
Q

What are the two types of circulation in the body?

A

Systemic and pulmonary circulation.

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29
Q

Where is the auscultatory site for the aortic valve located?

A

2nd intercostal space, left of the sternum.

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30
Q

Where is the auscultatory site for the pulmonary valve located?

A

2nd intercostal space to the right of the sternum.

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31
Q

Where is the auscultatory site for the tricuspid valve located?

A

4th intercostal space to the left of the sternum.

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32
Q

Where is the auscultatory site for the mitral valve located?

A

5th intercostal space in the mid-clavicular line.

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33
Q

What makes up the posterior border of the heart?

A

Left atrium mainly, and pulmonary veins.

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34
Q

What makes up the anterior border of the heart?

A

Mainly right ventricle.

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35
Q

What makes up the left border of the heart?

A

Left ventricle and left auricle.

36
Q

What makes up the right border of the heart?

A

Right atrium, superior vena cava.

37
Q

What makes up the inferior border of the heart?

A

Right ventricle (tiny bit of left ventricle near the apex).

38
Q

What makes up the superior border of the heart?

A

Where the great vessels enter and leave the heart. Formed by both atria.

39
Q

What supplies the SAN and AV node with blood?

A

Right coronary artery.

40
Q

What does the left coronary artery bifurcate into (and what do these branches in turn bifurcate into)?

A

Left coronary artery bifurcates into the left anterior descending artery (LAD) and the circumflex artery. The LAD has a branch coming off it called the diagonal branch. The circumflex artery has a branch coming off it called the left marginal branch.

41
Q

What are the branches of the right coronary artery?

A

The RCA has a branch coming off it called the marginal branch, then further on the posterior interventricular branch comes off it.

42
Q

What does the LAD supply and where is it located?

A

The LAD runs in the anterior interventricular groove. It supplies the left ventricle and the septum.

43
Q

What does the circumflex artery supply and where is it located?

A

Runs in the left atrioventricular groove. Supplies the left atrium and some of the left ventricle.

44
Q

What does the right coronary artery supply and where is it located?

A

Runs in the right atrioventricular groove. Supplies right atrium, right ventricle, inferior left ventricle and the back of the septum. Also usually supplies the SAN and AV node.

45
Q

When do the coronary arteries fill?`

A

During diastole.

46
Q

What is contained within the mediastinum?

A

All the structures in the chest except the lungs.

47
Q

Where is the division between the superior and inferior mediastinum?

A

At T4/T5.

48
Q

What are the two layers that make up the pericardium?

A

Fibrous and serous. The serous layer can be divided up into parietal and visceral layers.

49
Q

What is the function of the pericardial fluid in the pericardial cavity?

A

Prevents friction as the heart beats, protects from shock/motion.

50
Q

What are the first three branches of the aorta after the coronary arteries (from the patient’s right to left)?

A

Brachiocephalic artery (divides into right subclavian and right common carotid), left common carotid, left subclavian.

51
Q

What makes up the sternocostal heart surface?

A

Mainly right ventricle.

52
Q

What makes up the diaphragmatic heart surface?

A

Mainly the left ventricle and part of the right ventricle.

53
Q

What makes up the basal surface of the heart?

A

Mainly left atrium (posterior).

54
Q

Dominance: What supplies the posterior descending artery?

A

70% RCA, 10% Cx (left) and 20% co-dominant.

55
Q

What does Troponin C do?

A

Binds to calcium to cause a conformational change in Troponin I.

56
Q

What does Troponin T do?

A

Binds to tropomyosin, forming a troponin-tropomyosin complex.

57
Q

What does Troponin I do?

A

Binds to actin to hold tropomyosin-troponin complexes in place.

58
Q

What is a T tubule?

A

Deep invagination of the sarcolemma (plasma membrane of skeletal and cardiac muscle cells). These invaginations allow the depolarisation of the membrane to quickly penetrate to the interior of the cell.

59
Q

Where are the preipheral chemoreceptors located?

A

Carotid and aortic bodies.

60
Q

Where are the central chemoreceptors located?

A

Medulla.

61
Q

Where are arterial baroreceptors located?

A

Carotid sinus and aortic arch.

62
Q

How do baroreceptors work?

A

Respond to stretch of the vessel wall. Increased BP -> Increased stretch -> increased firing of bararecptors - > increased parasymp. drive and decreased symp drive -> decreased HR and therefore decreased BP. Afferents: CN IX and efferents - sympathetic and CN X.

63
Q

FA Qu’s: What is the bloody supply to the heart?

A

Left and right coronary arteries.

64
Q

FA Qu’s: When does blood flow to the heart occur?

A

Mostly during diastole.

65
Q

FA Qu’s: What does the left circumflex artery divide into?

A

LAD and circumflex arteries.

66
Q

FA Qu’s: Why is the O2 saturation in coronary venous blood very low (often only 35%) compared with other veins?

A

O2 extraction by the heart is very high.

67
Q

FA Qu’s: What does the right coronary artery supply?

A

Inferior surface (underside) of the heart.

68
Q

FA Qu’s: What is responsible for synthesising coagulation factors and fibrinogen?

A

The liver.

69
Q

FA Qu’s: What is the precursor for the enzyme that lyses clots?

A

Plasminogen.

70
Q

FA Qu’s: What constitutes the coagulation cascade?

A

A series of proteolytic enzymes that circulate in plasma in an inactive form and generate thrombin when activated.

71
Q

FA Qu’s: What cleaves fibrinogen to create fibrin?

A

Thrombin

72
Q

FA Qu’s: What are released upon cell activation and contain a high concentration of a molecule that acts as an agonist at the platelet P2Y12 receptor?

A

Platelet dense granules.

73
Q

FA Qu’s: What is responsible for the apex beat normally palpated in the the left 5th intercostal space and midclavicular line?

A

Left ventricle.

74
Q

FA Qu’s: What prevents backflow of blood into the left atrium during ventricular systole?

A

Mitral valve.

75
Q

FA Qu’s: What carries oxygenated blood from the lungs to left side of the heart?

A

Pulmonary vein.

76
Q

FA Qu’s: What maintains the systemic diastolic blood pressure by preventing backflow of blood into the heart during diastole?

A

Aortic valve.

77
Q

FA Qu’s: What prevents high pressures developing in the jugular veins during ventricular systole?

A

Tricuspid valve.

78
Q

FA Qu’s: What carries deoxygenated blood back to the right atrium?

A

Inf vena cava.

79
Q

FA Qu’s: What part of the ECG represents ventricular repolarisation?

A

T wave.

80
Q

FA Qu’s: What part of the ECG has a normal duration of 120 to 200ms (0.12-0.2s)?

A

PR interval.

81
Q

FA Qu’s: What in the ECG assess the electrical activity within the lateral myocardial territory?

A

Leads I, aVL, V5 and V6.

82
Q

FA Qu’s: What yields complexes that are normally inverted compared to the anterior and inferior leads?

A

Lead aVR.

83
Q

FA Qu’s: What may be abnormally elevated during an acute injury/infarction of a substantial myocardial territory?

A

ST segment.

84
Q

FA Qu’s: What represents atrial depolarisation?

A

P wave.

85
Q

FA Qu’s: What represents ventricular repoarisation and should be less than 120 ms in duration?

A

QRS complex.

Medicine Phase 1 HH (7 decks)

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