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MUSC Physiology > EXAM 2 Cardiac System > Flashcards

EXAM 2 Cardiac System Flashcards

1
Q

You expect that your patients aortic valve is calcified, therefore non compliant. what sign might you expect to find when you auscultate the heart?

A

Murmer

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2
Q

in which phase of the cardiac contraction is the cardiac muscle perfused

A

diastole

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3
Q

5 stages of cardiac cycle

A
  1. atrial systole (ventricular diastole)
  2. isometric ventricular contraction
  3. ventricular ejection (isotonic)
  4. isometric ventricular relaxation
  5. atrial systole (ventricular diastole
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4
Q

systole

A

contract/ejecting blood

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5
Q

diastole

A

relaxed/receiving blood

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6
Q

what phase of the cardiac cycle is the pulse we feel?

A

ventricular ejection

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7
Q

phase of cardiac cycle when blood leaves atria and enters into ventricles, ventricles contract

A

isometric ventricular contraction

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8
Q

semilunar valves

A

aortic and pulmonic valves

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9
Q

Firm, thick valves between ventricles and pulmonary artery and aorta

A

Aortic and pulmonic valves (semilunar valves)

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10
Q

valves that are tricuspid

A

Aortic and pulmonic valves (semilunar valves)

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11
Q

what is competence?

A

Prevention of back flow into ventricles

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12
Q

Thin, flexible valves between atria and ventricles

A

Tricuspid and mitral valves (atrioventricular or AV valves)

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13
Q

mitral has how many leaflets?

A

2

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14
Q

chordae tendinea are attached to_____.

A

papillary muscles

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15
Q

dense connective tissue cords from valves to papillary muscles

A

chordae tendinea

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16
Q

these Prevent AV valve leaflets from bulging excessively into atria during ventricular contraction

A

chordae tendinea

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17
Q

these muscles contract during ventricular

systole and maintain tension throughout systole

A

Papillary muscles

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18
Q

what does competency depend on?

A

coordinated function of the annulus, valve leaflets,

papillary muscles, and ventricular walls

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19
Q

narrowed valve due to thickening, calcification, non-separation of leaflets

A

Stenosis

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20
Q

what is stenosis?

A

narrowed valve due to thickening, calcification, non-separation of leaflets

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21
Q

leaky valve due to stretching, stenosis, papillary muscle or cordae tendinae disruption

A

Regurgitation

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22
Q

what is Regurgitation

A

leaky valve due to stretching, stenosis, papillary muscle or cordae tendinae disruption

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23
Q

what is Valvular “atresia”?

A

the absence of valve formation (no connection between chambers)

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24
Q

stretching of annulus effects?

A

competency

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25
Q

disorder where leaflets gets pushed up into atria and allows back flow, pt will feel this and think it palpitations

A

mitral valve prolapse

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26
Q

sound that is low “lub” as the AV valves close at the start of ventricular systole

A

S1

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27
Q

sound that is a high-pitched “dup” as the semilunar valves close after ventricular systole

A

S2

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28
Q

pulse we see in jugular vein correlates with what sound?

A

s1

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29
Q

pulse we feel correlates with what sound?

A

S2

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30
Q

sound when 2 av valves close at same time

A

S1

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31
Q

sound when ventricular valves close

A

S2

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32
Q

Sometimes the interval between aortic and pulmonary valve closure during inspiration is not simultaneous, causing two sounds to be heard, what is that sound?

A

split s2

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33
Q

sound that happens if 2 semilunar valves close at different times

A

split S2

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34
Q

sound that may be heard one third of the way through diastole in many normal young individuals (rapid ventricular) (“Ken-tuc ky”), or indicate disease (e.g., heart failure or volume overload)

A

third sound (S3)

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35
Q

sound may be heard immediately before S1 when atrial pressure is high or the ventricle is stiff (ventricular filling) (“Ten nes-see”) (e.g., LV hypertrophy or heart failure)

A

fourth sound (S4)

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36
Q

sound that occurs after diastole, can be normal or associated with disease (heart failure )

A

S3

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37
Q

Sound caused by blood as it enters from atrium crashing into ventricular wall

A

S3

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38
Q

Sound heard before S1

A

S4

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39
Q

sound that is blood turbulence around valves

A

murmer

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40
Q

sound that is blood turbulence around blood vessels

A

bruits

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41
Q

sounds caused by blood turbulence in the heart, most commonly around valves (late aortic stenosis)

A

Murmurs

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42
Q

sounds caused by blood turbulence in blood vessels (carotid bruit)

A

Bruits

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43
Q

what encloses the heart and separates it from thoracic viscera

A

Pericardium

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44
Q

Two layers of Pericardium

A

Visceral: thin inner layer, directly attached to the myocardium
Parietal: tough, fibrous out layer

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45
Q

Space between the visceral and parietal pericardium (the pericardial sac) contains 5 to 30 mL of clear______.

A

pericardial fluid

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46
Q

purpose of pericardial fluid

A

Lubricates to minimize friction

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47
Q

thin inner layer of pericardium, directly attached to the myocardium

A

Visceral

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48
Q

tough, fibrous out layer of pericardium

A

parietal

49
Q

what is cardiac tamponade caused by?

A

too much pericardial fluid, can be caused by stabbing,HIV, etc.

50
Q

when pericardial fluid is low and can hear during heart sound in coordination with breathing

A

friction rub

51
Q

Three major epicardial arteries (outside heart)

A

Right coronary artery

left coronary artery divides into:
Left circumflex artery
Left anterior descending (LAD) artery

52
Q

artery that Supplies the apex, left anterior wall, anterior septum

A

Left anterior descending (LAD) artery

53
Q

artery that Supplies the lateral left

A

Left circumflex artery

54
Q

artery that Supplies the right wall, posterior wall, posterior septum

A

Right coronary artery

55
Q

Smaller branches that extend from the coronary arteries, penetrating into and perfusing the myocardium

A

intramural arteries

56
Q

one blocked coronary artery can lead to__.

A

hypoxia of the heart,

this can cause angina

57
Q

When the left ventricle contracts, what valve opens?

A

aortic

58
Q

what prevents filling of the coronary arteries.

A

The valve cusps

59
Q

When this happens, the aortic pressure closes the aortic valve, allowing the coronary arteries to fill.

A

left ventricle relaxes

60
Q

artery associated with widow maker

A

left common coronary artery

61
Q

what Side of heart provides most perfusion?

A

left

62
Q

hypoxia to heart will cause the pt to have ____.

A

pain

63
Q

Blood from heart muscle is drained by the cardiac veins into the ________,

A

coronary sinus

64
Q

Blood from heart muscle is drained by the cardiac veins into the coronary sinus, then into the ____.

A

right atrium

65
Q

relationship of coronary veins and coronary arteries?

A

Coronary veins tend to parallel coronary arteries

66
Q

The heart is fully developed by pregnancy week___.

A

7 – 8

67
Q

In utero function of ductus arteriosis and foramen ovale is to ______.

A

reduce blood flow to lungs

68
Q

when does the ductus arteriosis closes off completely

A

Within a few days after birth

69
Q

when the ductus arteriosis closes off completely, it forms the ___.

A

ligimentum arteriosum

70
Q

if the ductus arteriosis DOES NOT close off completely, what is this called?

A

patent ductus arteriosis

71
Q

Foramen ovale is located between?

A

atria

72
Q

when does Foramen ovale (between atria) close?

A

at birth

73
Q

Foramen ovale (between atria) closes at birth and gradually fuses together over _____.

A

several weeks or months

74
Q

electrically conductive cells which discharge rhythmically, starting an electrical impulse which travels through conductive pathways from myocyte to myocyte

A

pacemakers

75
Q

Sinoatrial node (SA node; “pacemaker”) beats how many per minute?

A

60-100 beats/minute

76
Q

Atrioventricular node (AV node) beats how many per minute?

A

40-60 beats/minute

77
Q

where is SA node located?

A

upper lateral portion of right atrium

78
Q

where is av node located?

A

between atria and ventricles

79
Q

role of av node

A

let electrical signals pass through but regulates speed

80
Q

Internodal atrial pathways is sending signals along ___.

A

cardiac muscle cells to cardiac muscle cells, myocyte to myocyte conduction is slow, you see this in bundle branch block.

81
Q

these are present in the atria or ventricles
and can take over when the SA and AV nodes aren’t
functioning or conduction from them is blocked

A

“Latent pacemakers”

82
Q

Action Potential in the SA and AV nodes are due to what movements across plasma membranes?

A

Na+, Ca++, and K+

83
Q

Parasympathetic (acetylcholine) stimulation causes what to action potential?

A

hyperpolarizes and decreases rate of firing

84
Q

this stimulation causes hyperpolarization and decreases rate of firing to action potential

A

Parasympathetic (acetylcholine) stimulation

85
Q

Sympathetic (epinephrine) stimulation causes what to action potential?

A

speeds depolarization and increases discharge rate

86
Q

this stimulation speeds depolarization and increases discharge rate to action potential

A

Sympathetic (epinephrine) stimulation

87
Q

Pacemaker firing rate is

influenced by _______.

A

temperature

88
Q

higher temperature will do what to firing rate?

A

increase it

89
Q

node that sets pace

A

SA

90
Q

Internodal pathways conduct to what node

A

AV

91
Q

AV node delays transmission to _____.

A

bundle of His

92
Q

cardiac conduction

Bundle of His to bundle branches to Purkinje fibers to ____.

A

myocytes

93
Q

depolarization of atrial muscle is ____.

A

atrial systole

94
Q

a measure of electrical activity in the heart.

A

electrocardiogram

95
Q

account for 90% myocardial volume

A

Cardiac muscle cells (myocytes)

96
Q

what secretes atrial natriuretic peptide (ANP) with atrial distension (stretch)

A

Atrial myocytes

97
Q

ANP causes _____.

A

vasodilation, diuresis (loss of water through urine) and Na+ excretion

98
Q

what produce B-type natriuetic peptide (BNP) with ventricular distention (similar effects to ANP)

A

Ventricular myocytes

99
Q

atrial stretch causes secretion in ____.

A

ANP

100
Q

ventricular distention causes secretion in ____.

A

BNP

101
Q

Provide strong union between cardiomyocyte fibers maintaining cell-to-cell cohesion

A

Intercalated disks

102
Q

Provides low-resistance bridges for the spread of excitation from one cell to another

A

Intercalated disks

103
Q

The heart has 3 things associated with cardiac metabolism

A

An abundant blood supply providing O2 and nutrients
High myoglobin content (muscle O2 “storage” protein)
Many mitochondria (fat metabolism, requires more O2)

104
Q

Myocytes derive most of their energy from ____.

A

aerobic metabolism- requires continuous supply of O2

105
Q

Energy sources for heart

A

Glucose (35%)
Ketones and amino acids (5%)
Fat (60%)

106
Q

preferred substrate for heart

A

fat

107
Q

Frank-Starling Law

A

The pressure developed in the ventricle is proportional to the ventricular end-diastolic volume

108
Q

according to the Frank-Starling Law increased stretch results in ______.

A

increased contractile force, resulting in increased stroke volume

109
Q

cardiac rate x stroke volume =

A

cardiac output

110
Q

nerve that provides all parasympathetic control for heart

A

vagus nerve

111
Q

effects of vagus nerve on heart

A

Decreases HR by decreasing SA and AV node pacing

112
Q

vagus nerve does not affect ____.

A

myocardial contractility

113
Q

Sympathetic nervous system effects to cardiac control

A

Increase HR via increasing SA and AV node pacing

Increase in myocardial contractility and stroke volume

114
Q

for cardiac control, the Sympathetic nervous system Nerves arise from spinal what segments? (thoracic vertebra)

A

T2-T4

115
Q

the spinal nerves for sympathetic control, Pass into the cardiac plexus to the_______.

A

SA node (right) and AV node (left)

116
Q

what slows down repolarization in cardiomyocyte conduction?

A

calcium

117
Q

At rest, the inside of the cardiomyocyte is_______ compared to outside the cell (+20 mV).

A

negatively charged (-90 mM)

118
Q

cardiomyocyte conduction steps

A
  1. Rapid depolarization (phase 0) due to Na+ influx
  2. Initial rapid repolarization (phase 1) due to inactivation of Na+ channels and activation of repolarization process (phase 3) due to net K+ efflux through K+ channels
  3. Plateau (phase 2) due to Ca2+ influx through more slowly opening Ca2+ channels (the Ca2+ current, ICa)
  4. Rapid repolarization process (phase 3) due to closure of Ca2+ channels with continued K+ efflux through K+ channels
  5. Return to the resting membrane potential (phase 4)

MUSC Physiology (12 decks)

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