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PBL > CVS > Flashcards

CVS Flashcards

1
Q

Cardiovascular risk assessment

A

QRISK
risk of having a cardiac event in the next 10 years
Used for those up to 84 years old
Shouldn’t be used in those with CVD already or those over 85 or high risk of developing CVD
repeat every 5 years

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2
Q

which details are needed for QRISK assessment?

A 
age
sex
ethnicity
postcode
clinical info - smoking status, medical and family history, systolic BP, height, weight and total cholesterol/ HDL-cholesterol ratio
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3
Q

what are cardiac enzymes?

A

released into the circulation when myocardial necrosis occurs - e.g. MI

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4
Q

what are the cardiac enzymes?

A

myoglobin
troponin
creatine kinase

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5
Q

myoglobin

A

non-specific because come from skeletal muscles

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6
Q

troponin

A

important in the contractile apparatus of cardiac myocytes
released between 3-4 hours after MI
other non-related causes of raised troponin
remains in blood for 10 days

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7
Q

creatine kinase

A

muscle enzyme that exists as isoenzymes
specific to myocardial cells
better for detection of re-infarction as remains in blood for 3-4 days but released 3-4 hours after event

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8
Q

regulation of BP

A

short term and long term

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9
Q

long-term regulation of BP

A

renin-angiotensin-aldosterone
ADH
Natriuretic peptides
prostaglandins

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10
Q

renin

A

peptide hormone released by granular cells in juxtaglomerular apparatus in kidney

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11
Q

what is renin released in response?

A

sympathetic stimulation
reduced sodium-chloride delivery to DCT
decreased blood flow to kidney

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12
Q

what does renin do?

A

converts angiotensinogen to angiotensin I which is converted to angiotensin II using angiotensin-converting enzyme -ACE.

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13
Q

what does angiotensin II do?

A

a potent vasoconstrictor that acts directly on the kidney to increase sodium reabsorption in PCT. Sodium is reabsorbed via a sodium-hydrogen exchanger
promotes the release of aldosterone

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14
Q

what does ACE do?

A

converts angiotensin I to II

breaks down bradykinin which is a potent vasodilator - potentiates constricting effects

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15
Q

what does aldosterone do?

A

promotes salt and water retention by acting at DCT to increase expression of epithelial sodium channels
increases activity of basolateral sodium-potassium ATP-ase, increasing the electrochemical gradient for movement of sodium ions
more sodium collects in kidney tissue and water follows by osmosis cause decreased water excretion and increase blood volume and BP

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16
Q

where is ADH released?

A

organum vasculosum of lamina terminalis

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17
Q

why is ADH released?

A

in response to thirst or increased plasma osmolarity

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18
Q

what does ADH do?

A

increases permeability of collecting duct to water by inserting aquaporin channels into apical membrane
stimulates sodium reabsorption from thick ascending limb of loop of Henley which increases water reabsorption which increases plasma volume and decreases osmolarity

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19
Q

what is another control of BP?

A

natriuretic peptides

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20
Q

Natriuretic peptides

A

atrial natriuretic peptide

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21
Q

Atrial natriuretic peptide

A

synthesised and stored in cardiac myocytes
released when atria are stretched which indicates a high BP
secretion is low when BP is low

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22
Q

what does Atrial natriuretic peptide do?

A

promotes sodium excretion
dilates afferent arteriole of glomerulus increasing blood flow
inhibits sodium reabsorption along nephron

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23
Q

Prostaglandins

A

act as local vasodilators to increase glomerular flow rate and reduce sodium reabsorption
act to prevent excessive vasoconstriction triggered by sympathetic nervous and renin-angiotensin-aldosterone systems

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24
Q

what is the pericardium?

A

fibroserous membrane covering the heart and parts of great vessels

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25
Q

composition of pericardium

A

closed sac

2 layers

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26
Q

what are the layers of the pericardium?

A

fibrous pericardium

serous pericardium

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27
Q

what are the layers of the serous pericardium?

A

parietal

visceral

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28
Q

pericardial sinuses

A

transverse pericardial sinus

oblique pericardial sinus

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29
Q

heart wall layers

A

endocardium
myocardium
epicardium - visceral pericardium

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30
Q

what are the surfaces of the heart?

A

anterior
diaphragmatic
right pulmonary
left pulmonary

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31
Q

what are the borders of the heart?

A

right
inferior
left
superior

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32
Q

what does the right atrium do?

A

receives deoxygenated blood from superior and inferior vena cava and coronary veins
pumps blood through right atrioventricular orifice - tricuspid valve

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33
Q

what is the right auricle?

A

right atrial appendage

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34
Q

what is the coronary sinus?

A

receives blood from coronary veins, opens between the inferior vena cava and right atrioventricular orifice.

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35
Q

What is the interatrial septum?

A

solid muscular wall separates the 2 atria.

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36
Q

what does the left atrium do?

A

receives oxygenated blood from 4 pulmonary veins and pumps through left atrioventricular orifice - mitral valve

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37
Q

anatomy of left atrium

A

left auricle extends from superior aspect of chamber

inferior surface is divided into 2

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38
Q

what are the divisions of the inferior surface of the left atrium?

A

inflow portion

outflow portion

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39
Q

inflow portion of left atrium

A

receives blood from pulmonary veins

internal surface is smooth

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40
Q

outflow portion of left atrium

A

includes left auricle

lined with pectinate muscles

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41
Q

what does the right ventricle do?

A

pumps blood through pulmonary orifice - pulmonary valve into pulmonary artery

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42
Q

structure of right ventricle

A

triangular

can be divided into inflow and outflow portions which are separated by a muscular ridge - supraventricular crest

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43
Q

inflow portion of right ventricle

A

interior part covered by irregular muscular elevations - trabeculae carnae

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44
Q

what are the different types of trabeculae carnae

A

ridges
bridges
pillars

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45
Q

ridges

A

attached along their entire length on one side to form ridges

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46
Q

bridges

A

attached to ventricle at both ends, but free in the middle. Moderator band spans between inter ventricular septum and anterior wall of right ventricle. Have an important conductive function

47
Q

Pillars

A

anchored by their base to ventricles. Apices are attached to fibrous cords which are attached to the 3 tricuspid valve cusps. By contracting the papillary muscles pull on the fibrous cords to prevent prolapse of the valve leaflets during ventricular systole.

48
Q

outflow portion of right ventricle

A 
leads to pulmonary artery
located in superior aspect of ventricle
derived from embryonic bulbs cordis
visible different from rest of right ventricle
smooth walls
no trabeculae carnae
49
Q

Interventricular septum

A

separates the 2 ventricles
made up of superior membranous and inferior muscular parts
muscular part forms most of septum - same thickness of left ventricular wall
membranous part is thine er and part of the fibrous skeleton of heart

50
Q

what does the left ventricle do?

A

pumps blood through aortic orifice - aortic valve into aorta

forms apex of heart

51
Q

structure of left ventricle

A

divided into inflow and outflow portion

52
Q

inflow portion of left ventricle

A

walls lined by trabecular carneae and there are 2 papillary muscles which attach to cusps of mitral valve

53
Q

outflow portion of left ventricle

A

aka aortic vestibule

It is smooth-walled with no trabeculae carneae and comes from bulbs cordis

54
Q

what is the role of the great vessels?

A

carry blood to and from heart

mainly located in middle mediastinum

55
Q

what are the great vessels of the heart?

A

aorta
pulmonary arteries
pulmonary ary veins
superior and inferior vena cava

56
Q

Aorta

A

largest artery
carries oxygenated blood to rest of body
arises from aortic orifice at base of LV
inflow via aortic valve

57
Q

branching of the aorta

A

first segment = ascending aorta within pericardium
coronary arteries branch from aorta
second segment = arch of aorta
major arteries to head, neck and upper limbs come from aortic arch - brachiocephalic trunk, left common carotid and left subclavian
third segment = descending aorta, continues down through diaphragm into abdomen

58
Q

pulmonary arteries

A

receive deoxygenated blood from RV and deliver to lungs for gas exchange
begin at pulmonary trunk
at T5-6 pulmonary trunk splits into R and L pulmonary arteries

59
Q

what is the pulmonary trunk?

A

thick
short vessel
separated from RV by pulmonary valve

60
Q

left pulmonary artery

A

supplies blood to left lung

bifurcates into 2 branches to supply each lobe of the lung

61
Q

right pulmonary artery

A

thicker
longer
supplies blood to right lung, divides into 2 branches

62
Q

pulmonary veins

A

receives oxygenated blood from lungs and delivers to left side of heart

63
Q

how many pulmonary veins are there?

A

4, superior and inferior for each lung

64
Q

pulmonary vein distribution

A

superior Pulmonary veins return blood from upper lobes of lung
inferior pulmonary veins return blood from lower lobes of lung
left inferior pulmonary vein in hilum of lung
right inferior pulmonary vein runs posteriorly to vena cava

65
Q

superior vena cava

A

receives deoxygenated blood from upper body - superior to diaphragm - excluding the lungs and heart
delivers to right atrium
formed by merging of brachiocephalic veins
located in right side of superior mediastinum, then middle mediastinum next to ascending aorta.

66
Q

inferior vena cava

A

receives deoxygenated blood from lower body - inferior to diaphragm delivering it to the heart
formed in pelvis by common iliac veins combining
travels through the abdomen, collects blood from hepatic, lumbar, gonadal, renal and phrenic veins
passes through diaphragm and enters pericardium at T8 level
drains into inferior portion of right atrium

67
Q

what are the layers of the heart wall?

A 
endocardium 
subendocardial layer
myocardium
subepicardial layer
epicardium
68
Q

endocardium

A 
innermost layer
lines cavities and valves of heart
comprised of loose connective tissue and simple squamous epithelial tissue 
regulates contractions
aids cardiac embryological development
69
Q

subendocardial layer

A

between endocardium and myocardium, joining them together
consists of layer of loose fibrous tissue which contains vessels and nerves of conducting system of heart
contains purkinje fibres

70
Q

what can damage to the subendocardial layer cause?

A

arrhythmias

71
Q

myocardium

A

composed of cardiac muscle
involuntary striated muscle
responsible for contractions

72
Q

what happens in an MI?

A

blockage of coronary arteries so myocardium loses its oxygen supply and undergoes ischaemic change

73
Q

subepicardial layer

A

between myocardium and epicardium, joining them together

74
Q

epicardium

A

outermost layer
formed by visceral layer of pericardium
composed of connective tissue and fat
connective tissue secretes a small amount of lubricating fluid into pericardial cavity
outer surface lined by simple squamous epithelial cells

75
Q

what is the role of heart valves?

A

ensure blood flows in only 1 direction
composed of connective tissue and endocardium
there are 4

76
Q

what are the 4 heart valves?

A

atrioventricular valves - tricuspid, mitral

semilunar valves - pulmonary and aortic

77
Q

tricuspid valve

A

between right atrium and right ventricle

3 cusps

78
Q

mitral valve

A

between left atrium and left ventricle

2 cusps

79
Q

pulmonary valve

A

between right ventricle and pulmonary trunk

3 cusps

80
Q

aortic valve

A

between left ventricle and ascending aorta

3 cusps

81
Q

atrioventricular valves

A

close during start of ventricular systole

produces first heart sound

82
Q

what are the cusps of the tricuspid valve?

A

anterior
septal
posterior
base of each cusp anchored to a fibrous ring that surrounds the orifice

83
Q

what are the cusps of the mitral valve?

A

anterior and posterior

base of each cusp is secured to a fibrous ring surrounding the orifice

84
Q

structure of atrioventricular valves

A

supported by attachment of fibrous cords - chordae tendineae to the free edges of the valve cusps
chord tendineae are attached to papillary muscles on anterior surface of ventricles
papillary muscles contract during ventricular systole to prevent prolapse of the valve leaflets into atria

85
Q

papillary muscles

A

5 in total
3 in RV to support tricuspid
2 in LV to support mitral

86
Q

semilunar valves

A

close at beginning of ventricular diastole

produces second heart sound

87
Q

what are the cusps of the pulmonary valve?

A

left
right
anterior

88
Q

What are the cusps of the aortic valve?

A

left
right
posterior

89
Q

how do the semilunar valves work?

A

as blood recoils during ventricular diastole it fills the aortic sinuses and enters the coronary arteries to supply the myocardium
sides of each leaflet are attached to walls of outflow vessel
at beginning of ventricular diastole blood flows back towards the heart and fills sinuses, pushing the valve cusps together causing it to close

90
Q

coronary arteries

A

2 main ones which branch to supply the heart

left and right main coronary artery

91
Q

where do the main coronary arteries arise from?

A

left and right aortic sinuses within aorta

92
Q

what are aortic sinuses?

A

small openings within aorta behind left and right flaps of aortic valve
when heart is relaxed the back flow of blood fills these valve pockets allowing blood to enter the coronaries

93
Q

left coronary artery

A

branches into left anterior descending/ anterior inter ventricular artery
gives off left marginal artery
gives off left circumflex artery

94
Q

right coronary artery

A

branches to form right marginal artery and sometimes posterior inter ventricular artery

95
Q

cardiac veins

A

blood from subendocardium drains into larger veins and empties into coronary sinus

96
Q

what is the coronary sinus?

A

main heart vein on posterior surface in coronary sulcus

drains into right atrium

97
Q

what is the coronary sulcus?

A

runs between left atrium and left ventricle

98
Q

coronary artery disease

A

reduction in blood flow to myocardium

result of narrowing/ blockage of coronaries through reduced blood flow by physical obstruction or changes in vessel wall

99
Q

what causes coronary artery disease?

A 
atherosclerosis
thrombosis
high BP
diabetes
smoking
100
Q

Angina

A

caused by narrowing of coronary arteries
pain on exercise due to lack of oxygen to heart
resolved on rest

101
Q

what happens in an MI?

A

sudden occlusion of an artery results in infarction and necrosis of myocardium
causes section of heart to be unable to beat
ECG leads can be used to locate the artery that has caused the MI

102
Q

what is the SAN?

A

collection of specialised pacemaker cells in upper wall of right atrium where the superior vena cava enters

103
Q

what is the AVN?

A

within atrioventricular septum

near opening of coronary sinus

104
Q

What is the bundle of His?

A

continuation of specialised tissue of AVN and transmits the electrical impulse from AVN to prukinje fibres of ventricles

105
Q

how does the heart contract?

A
  1. pacemaker cells spontaneously generate electrical impulses
  2. wave of excitation spreads via gap junctions across both atria
  3. causing atrial contraction - atrial systole
  4. blood moves from atria to ventricles
  5. after the impulses have spread across atria they converge at AVN
  6. AVN delays the impulses by 120ms to ensure atria have enough time to fully empty blood into ventricles before ventricular systole
  7. wave of excitation passes from AVN into atrioventricular bundle
  8. wave of excitation descends the membranous part of interventricular septum
  9. then divides into 2 main bundles:
106
Q

what are the 2 bundles the electrical impulses pass through?

A
  • right bundle branch = conducts impulse to purkinje fibres of right ventricle
  • left bundle branch = conducts impulse to purkinje fibres of left ventricle
107
Q

purkinje fibres

A

subendocardial plexus of conduction cells
abundant with glycogen
extensive gap junctions
located in subendocardial surface of ventricular walls

108
Q

what do purkinje fibres do?

A

able to rapidly transmit cardiac action potentials from atrioventricular bundles to myocardium of ventricles
allows coordinated ventricular contraction - systole
blood is moved from right and left ventricles to pulmonary artery and aorta

109
Q

how is heart rate regulated?

A

rate at which SAN generates impulses is influenced by ANS

110
Q

what does the sympathetic NS do?

A

increases firing rate of SAN and increases HR
accelerant nerve, postganglionic fibres from sympathetic trunk innervate SAN and AVN
they release noradrenaline which acts on Beta 1 adrenoreceptors to increase pace

111
Q

what does the parasympathetic NS do?

A

decreases firing rate of SAN and decreases HR.

Vagus nerve synapses with postganglionic cells in SAN and AVN which causes acetylcholine to bind to M2 receptors

112
Q

balance of autonomic nervous system

A

at rest parasympathetic input dominates
initial increases in HR occur due to reduced parasympathetic outflow
heart rate over 100bpm is via increase in sympathetic outflow

113
Q

hormonal control of HR

A

adrenaline released from adrenal medulla increases HR

114
Q

how can menopause affect CV health?

A

decline in oestrogen
oestrogen keeps artery wall flexible so they can relax and expand to accommodate blood flow
BP starts to increase
decline in oestrogen increases cholesterol
oestrogen reduces the build-up of fatty plaque
LDL cholesterole tends to increase while HDL declines/ stays the same
triglycerides in blood increase
all these are risk factors for CVD

PBL (2 decks)

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