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A&P II (Spring 2025) > [Exam 1] Lecture 5: More Heart Valves, Cardiac Anatomy, CVP waveforms, > Flashcards

[Exam 1] Lecture 5: More Heart Valves, Cardiac Anatomy, CVP waveforms, Flashcards

1
Q

What is the role of the right vagus nerve in heart innervation?

A

Handles the SA node

The SA node is responsible for initiating the heartbeat.

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2
Q

What does the left vagus nerve primarily innervate?

A

Handles the AV node

The AV node coordinates the electrical signals between the atria and ventricles.

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3
Q

True or False: Sympathetic innervation covers less of the heart muscle than the vagus nerve.

A

False

Sympathetic innervation is widespread and covers more of the ventricular muscle.

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4
Q

What happens to heart rate if vagus nerve input is removed?

A

Heart rate goes up significantly

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5
Q

What is the typical activity level of the vagus nerves in a healthy resting heart compared to sympathetic nerves?

A

Vagus nerves are more active than sympathetic nerves

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6
Q

What is the innermost layer surrounding the heart called?

A

Serous pericardium

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7
Q

What is the function of the visceral layer of the serous pericardium?

A

Covers the outside of the heart and reduces friction

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8
Q

What is the fibrous pericardium?

A

The outer, tougher layer of the pericardium

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9
Q

What connects the cusps of the AV valves to the ventricular muscle?

A

Chordae tendinae

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10
Q

What are papillary muscles?

A

Muscles that help reinforce AV valves during ventricular contraction

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11
Q

Fill in the blank: The normal ejection fraction is approximately _______.

A

58%

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12
Q

What are the two types of AV valves in the heart?

A
  • Bicuspid valve (mitral valve)
  • Tricuspid valve
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13
Q

What happens to the heart valves if papillary muscles are damaged?

A

Can lead to valve problems

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14
Q

What is the typical structure of the pulmonary and aortic valves?

A

Each has three cusps

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15
Q

What occurs when heart valves do not fit together properly?

A

Can lead to backflow and heart stretching

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16
Q

How do healthy heart valves appear when closed?

A

They fit together tightly without allowing leakage

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17
Q

What can cause heart valves to become calcified?

A

Cholesterol buildup or infections

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18
Q

What is the primary ion for conducting action potentials in the heart?

A

Sodium

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19
Q

What is the function of gap junctions in cardiac muscle?

A

Allow electrical signals to flow between cells

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20
Q

What is the criss-crossing pattern of muscle fibers in the ventricles compared to?

A

Ringing out a wet towel

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21
Q

What is the ejection fraction formula based on a starting volume of 120 CCs and an ejection of 70 mLs?

A

70/120 = 58%

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22
Q

What are the two cusps of the bicuspid valve called?

A
  • Anterior cusp
  • Posterior cusp
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23
Q

What is the role of the septal cusp in the tricuspid valve?

A

Fastened into the wall of the interventricular septum

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24
Q

True or False: The aortic valve has two cusps.

A

False

The aortic valve has three cusps.

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25
Q

What are the three cusps of the aortic valve named?

A
  • Left cusp
  • Right cusp
  • Posterior cusp
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26
Q

What is stenosis in relation to heart valves?

A

Narrowing that prevents full opening of the valves

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27
Q

What are the locations where the coronary arteries attach to the aorta?

A

The openings for the left and right coronary arteries are located at the left and right cusps of the aortic valve respectively.

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28
Q

What happens to the aortic valve after blood ejection?

A

The aortic valve closes, and the pressure in the aorta is high.

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29
Q

During which phase does blood flow retrograde towards the coronary arteries?

A

During diastole, when the heart is filling.

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30
Q

True or False: The shape of the aortic valve cusps can affect coronary perfusion.

A

True.

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31
Q

What condition can lead to difficulties in coronary perfusion due to high resistance?

A

Aortic stenosis.

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32
Q

What are the three cusps of the pulmonary artery?

A
  • Left cusp * Right cusp * Anterior cusp
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33
Q

What anatomical feature separates the electrical activity of the atria from the ventricles?

A

A layer of insulation made of cartilage.

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34
Q

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

A

It acts as an insulator to keep electrical activity in the atria separate from that in the ventricles.

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35
Q

How does the heart maintain communication between the atria and the ventricles?

A

Through a small opening in the cartilaginous ring that allows the AV node to send action potentials.

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36
Q

What are the cusps of the left AV valve?

A
  • Anterior cusp * Posterior cusp * Commissural cusp
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37
Q

What are the two main branches of the left coronary artery?

A
  • Left anterior descending artery (LAD) * Circumflex artery
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38
Q

What is the PDA and how is it typically formed?

A

The Posterior Descending Artery (PDA) is commonly a branch of the right coronary artery.

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39
Q

What is the name of the large vein situated on the posterior inferior part of the heart?

A

Great cardiac vein.

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40
Q

What is the coronary sinus and where does it lead?

A

The coronary sinus is continuous with the right atrium and collects deoxygenated blood from the coronary veins.

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41
Q

How much coronary blood flow is typically needed per minute for heart muscle?

A

70 mL of coronary blood flow per 100g of heart muscle.

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42
Q

Fill in the blank: The anterior cusp of the pulmonary artery is located on the _______ side of the heart.

A

anterior

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43
Q

What happens to coronary perfusion when the aortic valve is dysfunctional?

A

Blood may not be directed into the coronary arteries effectively.

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44
Q

What can happen if there’s a continuous pathway between the atria and ventricles?

A

It may lead to potential electrical problems that could require ablation.

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45
Q

What is the typical coronary blood flow per 100 grams of heart muscle?

A

70 mL

This amount is necessary to meet the metabolic requirements of heart tissue.

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46
Q

What is the average coronary blood flow needed per minute for the heart?

A

225 mL

This is the amount required to satisfy the heart’s metabolic needs.

47
Q

Coronary blood flow is dependent on what factor?

A

Metabolic demand

Increased heart rate or stronger contractions require more blood flow.

48
Q

When does the majority of coronary blood flow occur?

A

When pressures in the wall of the heart are low.

49
Q

What happens to coronary blood flow during systole?

A

It decreases due to high resistance.

50
Q

During which phase is coronary blood flow typically higher: systole or diastole?

A

Diastole

Both sides of the heart have more blood flow during diastole than systole.

51
Q

What is the relationship between ventricular filling and coronary blood flow?

A

Coronary blood flow increases when ventricles are filling.

52
Q

What type of blood vessels are embedded in the walls of the heart?

A

Endocardial and sub-endocardial blood vessels.

53
Q

What does a drop in coronary perfusion during systole indicate?

A

High pressure in heart walls.

54
Q

Which coronary artery typically supplies blood to high-pressure areas of the heart?

A

Left coronary artery.

55
Q

Which coronary artery provides blood flow to lower pressure areas of the heart?

A

Right coronary artery.

56
Q

How does coronary blood flow behave in a healthy patient during the cardiac cycle?

A

Right coronary artery perfusion is continuous throughout the cardiac cycle.

57
Q

What unusual phenomenon can occur with left coronary blood flow during systole?

A

Negative coronary blood flow

Occurs when blood is pushed backward due to high ventricular pressure.

58
Q

What drives coronary blood flow?

A

Delta P (pressure gradient).

59
Q

What is the first pressure considered when calculating delta P for coronary blood flow?

A

Aortic pressure.

60
Q

What happens when wall pressure exceeds aortic pressure?

A

Reverse coronary blood flow can occur.

61
Q

Why is time an important factor in coronary perfusion?

A

It determines how long perfusion can occur, especially during diastole.

62
Q

What happens to coronary perfusion when heart rate increases?

A

Available time for coronary perfusion decreases.

63
Q

What is the significance of the area under the curve in relation to coronary perfusion?

A

It represents the relationship between pressure and time available for perfusion.

64
Q

During diastole, when does the majority of ventricular filling occur?

A

At the very beginning of diastole.

65
Q

What occurs in the middle of diastole regarding ventricular filling?

A

There is not much filling; most occurs early and late in diastole.

66
Q

What happens during the middle third of diastole in a healthy heart?

A

Not much filling occurs during the middle third of diastole

Most ventricular filling happens at the beginning and end of diastole.

67
Q

What is the effect of increasing heart rate on coronary perfusion?

A

Increases heart rate reduces time for coronary perfusion, which is problematic in patients with coronary artery disease

Healthy hearts can tolerate reduced filling time, but diseased hearts cannot.

68
Q

What is the primary issue with aortic stenosis?

A

Obstruction of blood flow from the left ventricle requires higher interventricular pressures to eject blood

This increases the workload on the heart and can complicate coronary perfusion.

69
Q

What happens to left ventricular pressure during aortic stenosis?

A

Left ventricular pressure must exceed aortic pressure significantly to eject blood

This pressure increase complicates perfusion of the left ventricle.

70
Q

How does mitral stenosis affect atrial pressure?

A

Atrial pressures are elevated due to difficulties in filling the ventricle

This can lead to reduced cardiac output and compensatory mechanisms by the kidneys.

71
Q

What occurs during aortic regurgitation?

A

Blood leaks back into the ventricle after being pumped into the aorta

This results in low diastolic blood pressure and widened pulse pressure.

72
Q

What is the consequence of mitral insufficiency?

A

Blood is ejected into both the aorta and the atria, leading to high atrial pressure

Atria fill from both pulmonary veins and the ventricle.

73
Q

What does the A wave in the CVP waveform represent?

A

A small increase in atrial and CVP pressures due to atrial contraction

This occurs because blood is pushed forward and backward during atrial contraction.

74
Q

What causes the C wave in the CVP waveform?

A

Backwards bulging of the AV valves at the beginning of systole

This occurs as the ventricles contract rapidly.

75
Q

What is the V wave in the CVP waveform indicative of?

A

Atrial filling while the AV valves are closed

This happens as blood returns from circulation during systole.

76
Q

What does the X descent in the CVP waveform signify?

A

A reduction in atrial pressure after the C wave

This occurs when the atria are empty and the AV valves are no longer bulging backwards.

77
Q

What is the Y descent in the CVP waveform?

A

A decrease in atrial pressure following the V wave

This occurs after the AV valves open and blood rapidly fills the ventricle.

78
Q

What is the effect of deep spinal anesthesia on cardiac output?

A

Reduces filling pressure, leading to low cardiac output

This is primarily a circulatory problem, not a heart pumping problem.

79
Q

What is diastole?

A

The phase of the cardiac cycle when the heart relaxes and fills with blood

Diastole is essential for understanding cardiac function and pressure dynamics.

80
Q

What does the Y descent represent in the CVP waveform?

A

The lower pressure in the atria after the V wave when the valves open

It is an important feature in understanding venous pressure dynamics.

81
Q

What occurs during the X descent in the CVP waveform?

A

It occurs after the C wave due to the valves no longer being pushed backwards

This reflects changes in atrial pressure during the cardiac cycle.

82
Q

What is the average cardiac output as per Miller and Guyton?

A

Approximately five liters per minute

This is a key value in cardiovascular physiology.

83
Q

How does systemic vascular resistance (SVR) compare to pulmonary vascular resistance (PVR)?

A

SVR is several times higher than PVR

This difference is crucial for understanding the pressure dynamics in systemic vs pulmonary circulation.

84
Q

What is the normal clinical range for systemic vascular resistance (SVR)?

A

800 to 1600

These values are important for assessing cardiovascular health.

85
Q

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

A

MAP - CVP divided by cardiac output

MAP stands for mean arterial pressure, and CVP stands for central venous pressure.

86
Q

What are the units for systemic vascular resistance (SVR)?

A

Millimeters of mercury divided by liters per minute

Alternatively referred to as CGS units.

87
Q

What is the typical mean pulmonary arterial pressure in a healthy individual?

A

16

This value is used in calculations for pulmonary vascular resistance.

88
Q

What is the purpose of using pulmonary arterial wedge pressure?

A

To estimate the pressure in the left atrium

This measurement is often used in critical care settings.

89
Q

What is the normal left atrial pressure approximation?

A

8

This value is used in calculating pulmonary vascular resistance.

90
Q

What is a Peripheral Resistance Unit (PRU)?

A

It is defined as delta P divided by flow

This unit simplifies the concept of vascular resistance.

91
Q

What does a normal peripheral vascular resistance (SVR) equal in PRU?

A

1 peripheral resistance unit

This is an easier way to express vascular resistance.

92
Q

What happens to cardiac output during a normal breathing cycle?

A

It can move left or right depending on pleural pressure

Changes in thoracic pressure influence venous return and cardiac output.

93
Q

What effect does inspiration have on central venous pressure (CVP)?

A

CVP drops significantly

This drop in CVP aids in drawing blood into the thorax.

94
Q

How does increased pleural pressure affect blood return to the heart?

A

It makes it harder to return blood

Increased chest pressure can reduce venous return.

95
Q

What is the consequence of a negative pressure in the thorax during inspiration?

A

It pulls blood into the thorax, reducing preload initially

This can lead to a temporary decrease in cardiac output.

96
Q

What happens to venous pressure during deep inspiration?

A

Venous pressure decreases, pulling blood into the chest

This effect is due to the compliance of the veins.

97
Q

What is the relationship between right atrial pressure and venous pressure during inspiration?

A

Right atrial pressure may decrease as venous pressure drops

This can lead to a brief drop in cardiac output.

98
Q

What happens to pressure in the chest during inspiration?

A

It drops pressure in the veins

This drop in pressure affects the thin-walled veins, making them more susceptible to being pulled apart.

99
Q

How does the pressure drop in the chest affect the right atrium?

A

The right atrium may experience a slight pull of blood into the large veins in the chest due to the pressure drop.

100
Q

What happens to cardiac output initially during inspiration?

A

Cardiac output may briefly drop for both the right and left heart.

101
Q

How does the pulmonary circulation respond to a drop in chest pressure?

A

The pressures inside the pulmonary arteries and veins are reduced, decreasing preload for the left side of the heart.

102
Q

What is the effect of inspiration on the preload of the left side of the heart?

A

Preload for the left side of the heart drops significantly during early inspiration.

103
Q

True or False: The left heart experiences a reduction in afterload during inspiration.

A

False

The left heart does not experience a reduction in afterload due to its thick-walled aorta.

104
Q

What happens to cardiac output from the left ventricle during inspiration?

A

It is likely reduced due to decreased preload and normal afterload.

105
Q

What changes occur in pulmonary arterial pressures during inspiration?

A

Pulmonary arterial pressures drop as a result of the negative thoracic pressure.

106
Q

Fill in the blank: The _______ pressure is affected by the drop in thoracic pressure during inspiration.

A

pulmonary venous

107
Q

What is the general overview of cardiac output changes during the respiratory cycle?

A

Cardiac output may initially drop during inspiration, but eventually increases as the chest fills with blood.

108
Q

How does the right heart’s afterload change during inspiration?

A

Afterload for the right heart is probably reduced.

109
Q

What happens to the right heart’s cardiac output during inspiration?

A

It probably drops a little, but there is debate about whether it might slightly increase.

110
Q

How does the left side of the heart respond to changes in preload and afterload during inspiration?

A

The left side experiences a drop in preload but normal afterload, leading to reduced cardiac output.

111
Q

What is noted about the relationship between pulmonary arterial and venous pressures during inspiration?

A

If pulmonary arterial pressure drops, pulmonary venous pressure is also likely to drop.

112
Q

What occurs within the first heartbeat or two of inspiration?

A

Transient changes in cardiac output and preload are noted.

113
Q

What is the conclusion regarding cardiac output changes during early inspiration?

A

Cardiac output is likely reduced initially but may increase later as blood fills the chest.

A&P II (Spring 2025) (7 decks)

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