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CBL Year 1 > CVS > Flashcards

CVS Flashcards

1
Q

What is systole

A

The contraction phase

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2
Q

What is diastole

A

the relaxation phase

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3
Q

What is the systemic circuit

A

Peripheral (all around the body)

left ventricle to right atrium

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4
Q

What is the pulmonary circuit

A

lung circuit

right ventricle to left atrium

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5
Q

Differences in cardiac muscle compared to skeletal muscle

A

Cardiac muscle has:
Intercalated discs and gap junctions
All electrically coupled cells

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6
Q

What is the foramen ovale what does it turn into

A

Hole between right and left ventricles in a foetus

turns into fossa ovalis

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7
Q

What causes the foramen ovale to close

A

Increase in pressure in the left atrium

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8
Q

Layers of the heart from outermost to innermost

A 
Fibrous pericardium
Parietal pericardium
Pericardial fluid
visceral pericardium (aka epicardium)
cardiac muscle (myocardium)
connective tissue and endothelium (endocardium)
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9
Q

What does the fibrous pericardium do

A

anchors the heart in the mediastinum and protects heart from trauma

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10
Q

What is the main pathology that affects the pericardium

A

Pericarditis

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11
Q

What is pericarditis? What does it present as? How to treat it

A

is: inflammation of pericardium
Present as: sharp, pleuritic (stabbing pain when inhaling/exhaling), usually made worse by lying flat
Treat: non-steroidal anti-inflammatory drugs

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12
Q

What is a common complication with pericarditis

A

effusion of the pericardial cavity

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13
Q

Where is the mitral valve located

A

Between the left atrium and left ventricle

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14
Q

What are the atrioventricular valves

A

Mitral and tricuspid valve between the atrium and ventricles

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15
Q

What are the chordae tendinae

A

chord like connective tissue and elastin tendons

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16
Q

What are the semilunar valves

A

Pulmonary and aortic valves (tricuspid valves)

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17
Q

What is S1 and what is it generated by

A

First heart sound

generated by the closure of atrioventricular valves

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18
Q

What is S2 and what is it generated by

A

Second heart beat

Generated by the closure of semilunar valves

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19
Q

What is the sinus venosus

A

Comes before primitive atrium
part of it forms the coronary sinus
also forms the sinoatrial node

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20
Q

What is the coronary sinus

A

vein that contains deoxygenated blood from the myocardium before draining into the right atrium

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21
Q

What is the primitive ventricle

A

separated from the primitive atrium by the atrioventricular canal
Gives rise to part of the left ventricle

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22
Q

When are chambers of the heart formed

A

during the fourth/fifth week after conception

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23
Q

What are intercalated discs

A

adhering structures that hold individual cardiomyocytes to form functional syncytium

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24
Q

What is a syncytium

A

single cell containing multiple nuclei

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25
Q

What are t-tubules

A

inside out bits of sarcolemma which allow depolarisation of the membrane

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26
Q

In a normal heart where does the electrical activity arise from

A

the sinoatrial node

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27
Q

What is the sinoatrial node known as

A

the physiological pacemaker

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28
Q

What are the atria and ventricles insulated by

A

the annulus fibrosus

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29
Q

What does the atrioventricular node act as ? Why?

A

“a relay station”; has a slow conduction velocity to allow atria to contract

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30
Q

What does the Bundle of His divide into

A

The right and left bundle branches

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31
Q

What do the bundle branches divide into

A

the purkinje fibres

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32
Q

what is a moving dipole

A

a pair of equal and opposite electrical charges separated in space

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33
Q

How to measure heart rate with the RR interval

A

HR(bpm)=60/RR(s)

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34
Q

How to get the RR value from intervals

A

RR=TQ + QT

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35
Q

What is the Valsalva manoeuvre

A

forced expiration against a closed glottis (straining)

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36
Q

What happens to a person doing the Valsalva manoeuvre

A

face may become red, jugular veins may become exposed, can experience dizziness

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37
Q

Describe where lead I electrodes go

A

negative electrode: right arm
positive electrode: left arm
earth electrode: right leg

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38
Q

Describe where lead II electrodes go

A

negative electrode: right arm
positive electrode: left leg
earth electrode: right leg

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39
Q

Describe where lead III electrodes go

A

negative electrode: left arm
positive electrode: left leg
earth electrode: right leg

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40
Q

What does the TQ interval mean

A

measure of ventricular diastole

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41
Q

What does the QT interval mean

A

measure of ventricular systole

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42
Q

What does the P wave represent

A

atrial depolarisation

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43
Q

What does the QRS complex represent

A

ventricular depolarisation

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44
Q

What does the T wave represent

A

ventricular repolarisation

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45
Q

When is your blood pressure lowest? highest?

A

lowest when you’re asleep

highest when you get up after just waking up

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46
Q

what is dynamic exercise? what happens to BP when doing it

A

Alternating between contraction and relaxation
systolic pressure increases (cardiac output)
diastolic pressure may decrease (fall in total peripheral resistance)

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47
Q

What is static exercise? What happens to BP when doing it

A

sustained hand grip

both systolic and diastolic increase

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48
Q

What is autorhythmicity? what has it? what is another name for it

A

how cardiomyocytes are able to fire action potentials without nervous input
sinoatrial node has it (as the pacemaker)
another name: myogenic

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49
Q

What does sinus rhythm mean

A

normal heart rhythm

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50
Q

Where is the sinoatrial node located

A

in the posterior wall of the right atrium

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51
Q

How are the cells specialised in the SAN

A

less polarised than other cells

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52
Q

What are chronotropic factors

A

factors that effect heart rate

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53
Q

What do positive chronotropes do

A

increase heart rate (treat bradycardia)

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54
Q

What is sinus tachycardia

A

sinus rhythm of more than 100bpm

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55
Q

what can sinus tachycardia be a normal response to

A

response to exercise, anxiety and pain

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56
Q

what can sinus tachycardia be a sign of

A

shock, infection or acute respiratory failure

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57
Q

What is sinus bradycardia

A

sinus rhythm of less than 60bpm

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58
Q

When is sinus bradycardia normal

A

with trained athletes or during sleep

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59
Q

What is starlings law of the heart

A

the energy of contraction of a cardiac muscle fibre is proportional to the initial fibre length at rest

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60
Q

How does the sympathetic nervous system control the heart

A

it accelerates heart rate, speed of conduction and strengthens contractions
postganglionic neurotransmitter is noradrenaline
works via β-adrenoreceptors

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61
Q

How does the parasympathetic nervous system control the heart

A

Slows the heart rate, and conduction time
postganglionic neurotransmitter acetylcholine
work via muscarinic receptors

62
Q

What does contractility mean

A

energy of contraction independent of fibre length at rest

63
Q

What does positive inotropy mean/give some examples

A

increased contractility

noradrenaline, adrenaline, digoxin

64
Q

What does negative inotropy mean/give some examples

A

decreased contractility

β-blockers, Ca2+ channel blockers

65
Q

What does positive luisotropy mean

A

increased rate of relaxation

66
Q

How do you measure cardiac output (Q) in an equation

A

(mean arterial pressure (MAP)-central venous pressure (CVP))/total peripheral resistance (TPR)

67
Q

What is the rate of blood flow directly related to

A

the pressure difference

68
Q

What is the rate of blood flow inversely related to

A

resistance in the system

69
Q

What is the resistance of a vessel inversely related to

A

its radius (small radius=large resistance)

70
Q

When does turbulent blood flow occur

A

when flow is disrupted

71
Q

What is a bruit

A

a vascular sound resembling heart murmurs

72
Q

Where are common signs for bruits

A

over the femoral arteries, carotid arteries and renal arteries

73
Q

What is bolus flow

A

in capillaries when red blood cells travel with a little bit of plasma (bolus) between them

74
Q

What are vascular myocytes

A

vascular smooth muscle cells

75
Q

Describe vascular myocytes

A 
spindle shaped
non-striated
involuntary muscle cells
joined by gap functions
contain a single nucleus
76
Q

What are caveolae

A

invaginations (inside out bits) of cell membrane which increase surface area and facilitate movement of calcium from extracellular fluid for contraction

77
Q

What is vascular smooth muscle contraction reliant upon

A

rise in intracellular calcium concentration

78
Q

What is vascular smooth muscle contraction caused by

A

phosphorylation of myosin

79
Q

What are the four most important hormones in regulating vascular tone

A

adrenaline (epinephrine)
Vasopressin (an ADH)
Angiotensin II
ANP

80
Q

Name a few vasoconstrictors

A 
Noradrenaline/adrenaline
Endothelin
Angiotensin
Vasopressin
Thromboxane A2
81
Q

Name a few vasodilators

A 
Adrenaline/noradrenaline
Adenosine
Bradykinin
Prostacylcin
Nitric oxide
82
Q

What is microcirculation

A

delivery of oxygen and other nutrients to the tissues and removal of CO2 and other waste products

83
Q

What are three local factors that affect blood flow at capillary level

A

autoregulation
metabolic byproduct vasodilators
local vasoactive hormones

84
Q

What is a haemorrhage

A

loss of blood from the cardiovascular system

85
Q

what is hypovolaemia

A

reduction in blood volume

86
Q

What does hypovolaemia produce

A

a decrease in mean arterial pressure

87
Q

Where are baroreceptors located

A

in the carotid sinus and aortic arch

88
Q

Where do baroreceptors relay information

A

to the vasomotor (central processor) in the medulla

89
Q

Give two equations for mean arterial pressure

A

Mean arterial pressure (mmHg)= cardiac output (l/min) x total peripheral resistance (mmHg/l/min)

Mean arterial pressure (mmHg) = diastolic pressure (mmHg) + 1/3 pulse pressure (mmHg)

90
Q

Equation for pulse pressure

A

Pulse pressure (mmHg) = systolic pressure (mmHg)-diastolic pressure (mmHg)

91
Q

Equation for cardiac output

A

cardiac output (l/min)= heart rate (bpm) x stroke volume (l)

92
Q

What does HR stand for

A

heart rate

93
Q

What does ABP stand for and how is it recorded

A

arterial blood pressure

recorded from a catheter inserted into a peripheral artery

94
Q

What does PAP stand for and how is it recorded

A

pulmonary arterial pressure

recorded by a catheter inserted via venous system through the right side of the heart and into the pulmonary artery

95
Q

What is CVP and how is it recorded

A

central venous pressure
recorded from a catheter inserted into the venous system until its tip is situated at the junction of the right atrium and superior vena cava

96
Q

What is CO and how is it recorded

A

cardiac output

recorded by a rapid injection of a known amount of cold saline into the right atrium

97
Q

What are spaces in the body that can hold enough blood to cause death

A

pleural space
abdominal cavity
mediastinum
retroperitoneum

98
Q

What are the signs of stage 4 shock

A 
extremities cold to the touch
"thready" pulse
may be cyanotic due to hypoxemia
sweating results in moist, clammy feel
digits will have severely slow capillary refill time
decrease in urinary output
99
Q

What is the average life span of a red blood cell

A

120 days

100
Q

what’s the other name for a red blood cell

A

erythrocyte

101
Q

What is erythropoiesis

A

production of red blood cells

102
Q

Where is the site for erythropoiesis in a foetus

A

the liver

103
Q

Where are the sites for erythropoiesis in children

A

all bones with red bone marrow

liver and spleen

104
Q

Where are the sites for erythropoiesis in adults

A 
ends of long bones
skull
vertebrae
ribs
sternum
pelvis
liver and spleen
105
Q

what stem cells do red blood cells come from

A

haemopoietic stem cells

106
Q

How would you listen to the aortic valve

A

put stethoscope over second right intercostal space to the right hand side of the sternum

107
Q

How would you listen to the pulmonary valve

A

put stethoscope over the second left intercostal space to the left hand side of the sternum

108
Q

How would you listen to the right tricuspid valve

A

place stethoscope over the left fifth intercostal space just to the left hand side of the sternum

109
Q

How would you listen to the mitral valve

A

place stethoscope over the left fifth intercostal space on the mid-clavicular line

110
Q

How would you palpate the carotid pulse

A

in the neck between the anterior border of the sternoclastoid muscle lateral to the thyroid cartilage

111
Q

How would you palpate the brachial pulse

A

at the elbow medial to biceps brachii aponeurosis

112
Q

How would you palpate the radial pulse

A

at wrist lateral to the flexor carpi radials tendon (in the supinated position)

113
Q

How would you palpate the ulnar pulse

A

at wrist lateral to flexor carpi ulnaris tendon (medial aspect of the arm)

114
Q

How would you palpate the femoral pulse

A

located at the mid-inguinal point

115
Q

How would you palpate the popliteal pulse

A

can be difficult to palpate
located deep in the fossa
best felt with knee passively flexed

116
Q

How would you palpate the posterior tibial pulse

A

at ankle posterior and slightly inferior to the medial malleolus

117
Q

How would you palpate the dorsals pedis pulse

A

felt on the dorsum of the foot lateral to extensor hallucis longus tendon distal to navicular bone

118
Q

What us JVP and what is it used to measure

A

jugular venous pressure

allows us to measure pressure within the right atrium

119
Q

When taking a pulse measure what four things should you be looking for

A

rate
rhythm
volume
character

120
Q

What is meant by rate when measuring a pulse

A

number of pulses occurring per minute

121
Q

What is meant by rhythm when measuring a pulse

A

pattern or regularity of pulses

122
Q

what is meant by volume when measuring a pulse

A

perceived degree of pulsation

123
Q

What is meant by character when measuring a pulse

A

an impression of the pulse waveform or shape

124
Q

What artery should you use to measure rate and rhythm when measuring a pulse

A

radial artery

125
Q

What arteries should you use to measure volume and character when measuring a pulse

A

brachial
carotid
femoral

126
Q

What is the third heart sound caused by

A

rapid ventricular filling

127
Q

When does third heart sound occur

A

0.1 seconds after the first heart sound

128
Q

When is the fourth heart sound heard

A

just before the first heart sound

129
Q

What is the fourth heart sound caused by

A

caused by stiff ventricles

130
Q

When listening for murmurs, what side of the stethoscope should you use to listen for high pitched sounds? low pitched?

A

high pitched: diaphragm

low pitched: bell side

131
Q

What should you do to help you hear a patient with mitral stenosis

A

turn them on their left hand side

132
Q

What should you do to help you hear a patient with aortic regurgitation

A

sit patient up
ask them to lean forward
breathe out and hold their breath

133
Q

What are the features of a murmur (SCRIPT)

A 
Site where murmur is loudest
Character (soft?crescendo?)
Radiation (to carotids?)
Intensity (grade of murmur)
Pitch (high?low?)
Timing (systolic? diastolic?)
134
Q

Describe the grades of murmurs 1-6

A

1: difficult to hear
2: quiet
3: easy to hear
4: easy to hear with palpable thrill
5: hear murmur with stethoscope barely touching their chest
6: hear murmur with stethoscope off chest

135
Q

What is hypertrophy

A

Where heart muscle thickens into the chambers and outside the heart

136
Q

What is dilatation

A

Where heart muscle gets thinner and expands

137
Q

what is mitral stenosis

A

Where the mitral valve becomes narrowed

138
Q

What does mitral stenosis result in

A

Atrial hypertrophy

139
Q

What is mitral stenosis caused by

A

rheumatic heart disease

infective endocarditis

140
Q

What does mitral stenosis sound like

A

mid-diastolic low pitched rumbling murmur
get a loud S1 because of thick valves
(Sounds like LUB DUB DRRR)

141
Q

What is mitral stenosis associated with

A

with malar flush (flushed cheeks)

and atrial fibrillation

142
Q

What is mitral regurgitation

A

incompetent mitral valve allows blood to flow back through during systole

143
Q

What does mitral regurgitation sound like

A

high pitched whistling murmur
(Because of high velocity of blood flow through leaky valve)
sounds like BRRRRRRRRR

144
Q

What are some causes of mitral regurgitation

A 
idiopathic weakening with age
ischaemic heart disease
infective endocarditis
rheumatic heart disease
connective tissue disorders
145
Q

What is aortic stenosis

A

narrowing of aortic valve

146
Q

What does aortic stenosis cause

A

ventricular hypertrophy
slow rising pulse
narrow pulse pressure
exertion syncope (light headed/fainting with exercise)

147
Q

What are some causes of aortic stenosis

A

idiopathic age related calcification

rheumatic heart disease

148
Q

What is aortic regurgitation

A

where the aortic valve becomes incompetent

149
Q

What does aortic regurgitation sound like

A

diastolic soft murmur

LUB TARR

150
Q

What causes aortic regurgitation

A

idiopathic age related weakness

connective tissue disorder

CBL Year 1 (7 decks)

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