general cardiovascular

Question 1

Where is the heart situated?

Answer 1

2/3 left sided restrosternal in the mediastinum, tip pointing to the bottom left

behind: osophagus, holzknechtian space
front: sternum, erbs point
below: diaphragm

Question 2

Constitution of the heart muscle?

Answer 2

from the inside to the surface:

endocard, myocard, epicard, liquid, pericard

Question 3

Course of the coronary arteries?

Answer 3

right: ramus interventricularus posterior, sidebranch ramus marginalis
left: ramus circumflexus, ramus marginalis; ramus interventricularis anterior, sidebranch ramus diagonalis

Question 4

What is between the left and right ventricle?

Answer 4

ventricle septum

Question 5

When are the coronary arteries perfused?

Answer 5

during diastole due to backflow of windkessel function, cusps of the aortic valve close the coronary osteses during systole

Question 6

What is preload/afterload?

Answer 6

pre: passive expansion of the ventricular muscle during the diastolic filling phase of the heart
after: due to the active contraction of the ventricle during the systolic ejection phase

Question 7

Dependency of cardiac output?

Answer 7

co = hr * sv

Question 8

Significance of the arterial/venous system?

Answer 8

art: carry mostly oxygen rich blood, lead away from the heart
ven: lead to the heart, carry mostly non oxygenated blood and have cusps to reduce backflow

Question 9

Describe the physiological reflux of the blood in the veins?

Answer 9

muscle vein pump, due to muscle movement and parallel moving arteries the blood will be pushed to the heart, venous cusps prevent a backflow

Question 10

What is hemoglobin?

Answer 10

oxygen transporting quaternary protein inside of an erytrocyte, oxygen is bound to the iron complex of the heme. hemoglobin is responsible for the bound oxygen transport

Question 11

What binds the iron?

Answer 11

O2, CO, ions

Question 12

What is the hematocrit?

Answer 12

gives information about the amount of solid compounds inside the blood

Question 13

What are normal/surgery values for Hb and HKT

Answer 13

HB:

men: 13,5-17,5 g/dl
women: 12-16 g/dl
hlm: lower

HKT:

men: 42-50%
women: 37-45%
hlm: 20-30%

Question 14

What is the ACT?

Answer 14

activated clotting time, measuring the coagulation activity of blood.

norm: 80-100s
hlm: 400-600s

Question 15

Which coagulation reducing drugs are being used and how do they work?

Answer 15

heparin and low molecular heparin, increases the effect of AT3, inhibition of the formation of thrombin from prothrombin and fibrin from fibrinogen -> reduced aggregation of thrombocytes

Question 16

mean time and doses of heparin?

Answer 16

T0.5: 90min
initial dose: 200-400 IE/kg
additional: 100-200 IE/kg

Question 17

What is the counter part of heparin?

Answer 17

protamin/protamin sulfate, used when patient disconnected from hlm, 1ml eliminates 1000 IE

Question 18

What are the known coagulation cascades?

Answer 18

primary hemolysis: stops bleeding, depending on thrombocytes and fibrin

secondary (plasma):
two paths that cross at factor Xa:
extrinsic: due to phosphate contact and tissue damage
intrinsic: inside the blood vessel system

Question 19

Explain the Starling mechanism.

Answer 19

given that all other values are constant, the law states that an increase in preload results in an increased cardiac output.

Question 20

What kind of artificial heart valves exist?

Answer 20

mech:
tilting disk
ball type
bi/tri leaflet

bio:
stented type
unstented type

Question 21

(dis)advantages of said heart valves?

Answer 21

mech:
lifelong support
anticoagulation required

bio:
10-15 years
no anticoag.
non human tissue

Question 22

Where is the centre for respiration and which parameters are most important?

Answer 22

partial pressure of carbon dioxide controls the rate of respiration inside the medulla oblongata

Question 23

Describe the Seldinger technique.

Answer 23

used to safely access blood vessels:

1: punctured
2: guidewire advanced
3: trocar is withdrawn
4: sheath passed over wire to vessel
5: guidewire withdrawn
6: catheter can be placed on sheath

Question 24

Name some of the bigger blood vessels.

Answer 24

aorta, branchio-cephalic arteries r/l, vcs/i, femoral veins r/l

Question 25

What is a myocardial infarct?

Answer 25

due to coronary stenosis there is not enough blood supply for the myocard -> ischemia -> muscle cells die and replaced by scar tissue -> no action potential -> not enough contraction

Question 26

What is angina pectoris?

Answer 26

A continuous chest pain (some times moves to the left shoulder and arm), it is caused by insufficient blood supply to the heart. Coronary artery disease is a common cause for angina pectoris

Question 27

Which types of heart valve vitia do you know?

Answer 27

stenosis: not fully opening -> no good blood flow
insuff: no complete closing -> blood flows back

Question 28

What are alcalosis and acidosis?

Answer 28

alc: abnormal increase of body blood pH
aci: abnormal decrease of body blood pH

Question 29

Meaning of (para) sympathicus?

Answer 29

two counter parts of the nervous system that balance the control the involuntary movements like heart beat

Question 30

What kind of heart/vessel deseases are known?

Answer 30

heart:
insufficiency
coronary desease
valve vitium

vessel:
stenosis
arterosclerosis
arteriosclerosis
thrombosis
aneurysma