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A & P > EXAM 1: Lecture 5 > Flashcards

EXAM 1: Lecture 5 Flashcards

1
Q

What are cardiac muscle cells similar to in their setup?

A

Smooth muscle cells

Cardiac muscle cells connect and communicate with neighbors, contracting as a unit.

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2
Q

What structures connect cardiac muscle cells?

A

Gap junctions

These junctions allow ionic/electrical current to pass from one cell to another.

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3
Q

What are connexons made up of?

A

6 connexin proteins

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4
Q

What primary ion moves through gap junctions between cardiac cells?

A

Sodium

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5
Q

What is the function of intercalated discs in cardiac muscle cells?

A

Increase surface area for gap junctions

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6
Q

How many nuclei do cardiac muscle cells typically have?

A

1 nucleus

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7
Q

What is the role of fibroblasts in the heart?

A

Lay down scar tissue

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8
Q

What is an ACE inhibitor used for in relation to the heart?

A

Prevent unnecessary scar tissue formation

It blocks the RAAS system, which controls fibroblast activity.

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9
Q

What is the term for the arrangement of heart muscle layers in the ventricles?

A

Syncytial connection

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10
Q

What is the deepest layer of the heart called?

A

Endocardium

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11
Q

What is the largest layer of the heart muscle wall?

A

Myocardium

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12
Q

What is the outermost layer of the pericardium called?

A

Fibrous pericardium

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13
Q

True or False: The pericardial space is filled with a large amount of fluid.

A

False

The pericardial space typically contains a small amount of fluid.

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14
Q

What does the serous pericardium visceral layer do?

A

Covers the outside of the heart

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15
Q

What is the purpose of the fibrous pericardium?

A

Provide a stiff outer layer to the heart

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16
Q

Which nerve innervates the SA node?

A

Right vagus nerve

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17
Q

What is the pathway of electrical conduction in the heart starting from the SA node?

A

SA node > internodal pathways > AV node > bundle of HIS > right and left bundle branches > purkinje fibers

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18
Q

What are the components of valve anatomy?

A
  • Valves
  • Chordae tendineae
  • Papillary muscles
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19
Q

What is the function of chordae tendineae?

A

Connect cusps of the valve to the ventricles

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20
Q

What happens if the papillary muscles are damaged during an MI?

A

Can lead to valve problems

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21
Q

What do closed AV valves look like during systole?

A

They are closed and prevent backflow

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22
Q

What happens to the aortic valve during diastole?

A

Closes and provides a reservoir for coronary blood flow

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23
Q

What is the role of the cartilaginous ring in the heart?

A

Acts as an insulator between atria and ventricle

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24
Q

Fill in the blank: The myocardium is _______ to the endocardium.

A

superficial

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25
Q

What is the function of the cartilaginous ring in the heart?

A

Acts as an insulator between the atria and ventricle

Cartilage does not conduct electricity well, facilitating proper heart function.

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26
Q

What happens in the case of a genetic anomaly affecting the atria and ventricle?

A

A continuous pathway is formed that may need to be ablated

This can cause significant cardiac problems.

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27
Q

What is the role of the bundle of HIS in heart anatomy?

A

Allows conduction communication between the atria and ventricle

It is the only opening for this communication in a normal heart.

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28
Q

How does the wall thickness of the right ventricle compare to the left ventricle?

A

The right ventricle has a much thinner wall than the left ventricle.

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29
Q

What are the key structures to identify in the right ventricle anatomy?

A
  • Tricuspid valve
  • Chordae tendineae
  • Anterior papillary muscle
  • Posterior papillary muscle
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30
Q

What is the ejection fraction and how is it calculated?

A

Ejection fraction = (70mL ejected / 120mL end diastolic volume) x 100 = 58%

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31
Q

What anatomical feature is described as a small part of the posterior cusp of the mitral valve?

A

Commissural cusp

32
Q

What is the primary artery branching off the left coronary artery that supplies blood to the heart?

A

Left anterior descending artery (LAD)

The LAD supplies a significant amount of blood to heart tissue.

33
Q

What is the difference between epicardial vessels and endocardial vessels?

A

Epicardial vessels are superficial, while endocardial vessels are embedded in the wall of the heart.

34
Q

What is right coronary dominance?

A

The right coronary artery supplies the posterior descending artery (PDA) in most individuals.

35
Q

What is left coronary dominance and its prevalence?

A

Occurs in about 15% of people and is associated with increased mortality and risk during procedures.

36
Q

Where does deoxygenated coronary blood return to the heart?

A

Coronary sinus

The coronary sinus is continuous with the right atrium.

37
Q

How is coronary blood flow quantified?

A

As oxygenated blood per minute per 100 grams of muscle tissue.

38
Q

When does the majority of coronary blood flow occur?

A

During diastole, when wall pressure is low.

39
Q

What happens to coronary perfusion during systole?

A

Coronary perfusion is reduced due to high wall pressure.

40
Q

What is the delta pressure formula for coronary blood flow?

A

Delta pressure = aortic pressure – wall pressure.

41
Q

What effect does increased heart rate have on diastolic time?

A

Reduces the time available for coronary perfusion.

42
Q

What is aortic stenosis characterized by?

A

Obstruction to outflow from the left ventricle, requiring higher ventricular pressures.

43
Q

What is the typical pulse pressure in aortic stenosis?

A

Narrowed pulse pressure of about 20mmHg.

44
Q

What type of murmur is associated with aortic stenosis?

A

Systolic murmur.

45
Q

What occurs during mitral stenosis?

A

Elevated atrial pressures due to difficulty filling the ventricle.

46
Q

What is the pulse pressure like in mitral stenosis?

A

Widened pulse pressure of about 50mmHg.

47
Q

What is aortic regurgitation characterized by?

A

Backward flow of blood into the ventricle due to leaky aortic valve cusps.

48
Q

What type of murmur is associated with aortic regurgitation?

A

Diastolic murmur.

49
Q

What is the effect of mitral regurgitation on atrial pressure?

A

High buildup of pressure in the atria due to backward flow.

50
Q

What type of murmur is associated with mitral regurgitation?

A

Systolic murmur.

51
Q

How does deep anesthesia affect cardiac output?

A

Reduces heart activity similar to parasympathetic stimulation.

52
Q

What is a systolic murmur indicative of?

A

Backward blood flow due to a leaky mitral valve

The mitral valve should be closed, but blood leaks back through the valve.

53
Q

What happens to cardiac output during deep spinal anesthesia?

A

It decreases to about 2.5L/min

Deep spinal anesthesia causes a circulation problem, not a heart pumping problem.

54
Q

What is the average cardiac output?

55
Q

What is the average systemic vascular resistance (SVR)?

A

1200 with a range of 800-1600

56
Q

What is the average pulmonary vascular resistance (PVR)?

A

80 with a range of 40-180

57
Q

Define the A wave in a CVP waveform.

A

Small increase in atrial and CVP pressures at the end of diastole

Represents the atrial kick/contraction.

58
Q

What does the C wave in a CVP waveform represent?

A

Bulging of AV valves at the beginning of systole

59
Q

What occurs during the X descent in a CVP waveform?

A

Reduction in atrial pressure after the C wave

Happens during mid systole.

60
Q

What causes the V wave in a CVP waveform?

A

Atrial filling during late systole while AV valves are closed

61
Q

What happens during the Y descent in a CVP waveform?

A

Rapid filling of the ventricle in early diastole

Results in lower atrial pressure.

62
Q

What is the formula for calculating systemic vascular resistance (SVR)?

A

(MAP - CVP) / Cardiac Output x 80

63
Q

What is the formula for calculating pulmonary vascular resistance (PVR)?

A

(MPAP - PAWP) / Cardiac Output x 80

64
Q

What happens to cardiac output during a normal breathing cycle?

A

It moves left and right depending on intrapleural pressure changes

65
Q

What is the effect of inspiration on CVP and PAP?

A

Both CVP and PAP reduce during inspiration

66
Q

What happens to preload for the right heart during inspiration?

A

It decreases

This causes a brief drop in cardiac output.

67
Q

What happens to preload for the left heart during inspiration?

A

It decreases significantly

68
Q

True or False: Positive pressure ventilation increases cardiac output for both sides of the heart.

A

False

Cardiac output for the right side remains the same due to increased afterload.

69
Q

What is PRU in relation to vascular resistance?

A

Peripheral resistance unit correlating delta pressure divided by flow

70
Q

What happens to filling pressures when positive pressure ventilation is applied?

A

Filling pressures need to be higher to overcome obstruction in the thorax

71
Q

What is the effect of deep spinal anesthesia on systemic filling pressures?

A

Decreases from 7mmHg to 4mmHg

72
Q

What does the X descent in the CVP waveform indicate?

A

A reduction in atrial pressure after AV valves stop bulging

73
Q

What is the primary consequence of reduced thoracic pressure during inspiration?

A

Increased venous return to the heart

74
Q

Fill in the blank: Average pulmonary vascular resistance is ______.

A

80 with a range of 40-180

75
Q

What happens to venous return during expiration?

A

It decreases due to increased pleural pressure

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