Heart Flashcards
1
Q
heart block causes heart beat to be (2)
A
slow and irregular
2
Q
heart block is a type of
A
arrhythmia
3
Q
chest trauma can initiate arrhythmias =
A
heart contusion
4
Q
right bundle branch block often shows which symptoms?
A
no symptoms
5
Q
in right bundle branch block ,activation of which chamber of the heart is delayed?
A
right ventricle
6
Q
right bundle branch block has what affect on QRS complex
A
prolongs QRS complex
7
Q
left bundle branch block is often due to
A
problems with heart (e.g. high BP)
8
Q
interventricular septum is normally activated by
A
left bundle branch
9
Q
if conduction in left bundle branch is slowed, interventricular septum is activated by
A
right bundle branch
10
Q
in right bundle branch block, what shape is seen in V1?
A
M
11
Q
in right bundle branch block, what shape is seen in V6?
A
W
12
Q
In left bundle branch block, what shape is seen in V1?
A
W
13
Q
In left bundle branch block, what shape is seen in V6?
A
M
14
Q
Mnemonic that can be used to remember ECG appearances of left and right bundle branch blocks?
A
WiLLiaM MaRRoW
15
Q
referred pain: heart dermatomes =
A
body wall and upper limb (T1-T5)
16
Q
……. men die of CHD
A
1/5
17
Q
…… women die of CHD
A
1/7
18
Q
CHD is ……….. cause of death and premature death in UK
A
most common
19
Q
CHD causes ……….. deaths in UK per year
A
94 000
20
Q
myocardial infarction defintion
A
damage to heart muscle due to interruption in regional coronary circulation
21
Q
myocardial infarction often caused by
A
clot/ fatty deposit
22
Q
non-function area of heart after MI =
A
infarct
23
Q
ischaemia definition
A
reduced blood delivery to organ, sufficient to compromise function
24
Q
infarction definition
A
reduced blood delivery to organ, sufficient to lead to its death
25
types of MI
STEMI, NSTEMI
26
STEMI =
coronary artery completely blocked. large amount of muscle damage
27
NSTEMI =
tests positive for troponin I/T (unlike angina). Partial/ temporary blockage
28
coronary artery spasm =
artery tightens, comes and goes, no plaque
29
demand ischaemia =
heart requires more oxygen than available e.g. infarction, anaemia
30
symptoms of MI (8)
chest pain (tightness), pain travelling from chest to other parts of body, shortness of breath, feeling/being sick, anxiety, coughing, wheezing, light headedness
31
Mi can be missed in ........ as mistakes for symptoms of .....
diabetics; neuropathy
32
diagnosis of MI using (2)
ECG, blood tests
33
treatment of MI (10)
antiplatelets, heparin, pain relief, clot busting meds, beta blocker, insulin, oxygen, ACE inhibitor, statin, coronary artery bypass
34
angina pectoris =
pain from heart usually caused by coronary artery narrowing and reduced blood blow
35
stable angina =
symptoms stereotypic. lower risk of infarct, improves with meds
36
unstable angina =
pain at rest, increased attack severity, high risk of infarct, pain over 15 mins
37
classic/ exertional angina pectoris =
provoked by physical exertion. pain fades quickly with rest
38
nocturnal angina =
at night, may wake patient. provoked by vivid dreams. vasospasm, critical coronary artery disease
39
decubitis angina =
lying down. impaired left ventricle function as result of severe coronary artery disease
40
variant (Prinzmetal's) angina =
without provocation, at rest. result of coronary artery spasm. more common in women. ST elevation. Arrhythmias during ischaemic episode
41
cardiac syndrome X =
history angina, positive exercise test and angiogram normal. coronary arteries seem normal. most common in women. highly symptomatic. difficult to treat.
42
unstable angina =
recent onset, worsening. at rest
43
symptoms of angina (4)
pain in arm, jaw, neck, stomach; pain eases with rest; breathlessness on exertion; pain, ache, discomfort, tightness across front of chest on exertion
44
exacerbating factors of angina (4)
physical exercise, high emotion, cold temperatures, eating large meal
45
risk factors of angina (8)
smoking, high BP, overweight, high cholesterol, inactivity, diet, salt, alcohol
46
medication for angina (8)
glyceryl trinitrate, statin, aspirin, beta blocker, ACE inhibitor, calcium-channel blocker, nitrate medicines, potassium channel activators
47
2 types of cardiac centres in medulla oblongata
cardioacceleratory and cardioinhibitory centres
48
vasomotor centres in medulla oblongata have which 2 populations of neurons
large group = widespread vasoconstriction; small group = skeletal muscle and brain vasodilation
49
vasomotor centre controls activity of ...... motor neurons
sympathetic
50
vasoconstriction neurons of vasomotor centre have what type of neurotransmitter?
noradrenaline and adrenaline (adrenergic neurons)
51
vasodilation neurons of vasomotor centre have what type of neurotransmitter?
nitrogen oxide
52
most common vasodilator synapses are ..... and trigger the endothelial release of .... which causes local vasodilation
cholinergic, NO
53
other vasodilator synapses have .... as neurotransmitter which has intermediate and direct effect on vascular .... .... cells
NO; smooth muscle
54
3 locations of baroreceptors
walls of carotid sinuses, aortic sinuses, walls of right atrium
55
baroreceptors in aortic sinuses are in walls of ..... aorta and trigger the ..... reflex
ascending; aortic
56
baroreceptors in walls of right atrium trigger .... reflex
atrial
57
baroreceptors in aortic sinuses monitor BP at beginning of .....
systemic circuit
58
baroreceptors in walls of right atrium monitor BP at end of .....
systemic circuit
59
effects on heart result from release of .... from sympathetic neurons innervating ..., .... and .....
noradrenaline; SAN, AVN and myocardium
60
smoking causes immediate and long term ...... in BP
increase
61
smoking causes immediate and long term .... in HR due to ...... which causes increase in adrenaline and HbCO2
increase; nicotine
62
smoking causes .... in cardiac output and coronary blood flow
decrease
63
smoking reduces the amount of oxygen delivered to tissues due to binding of .... to Hb
CO
64
smoking ..... blood clotting process
stimulates
65
increased blood cholesterol in smoking is due to ...... which interferes with the transport of HDLs by modifying site in ......
acrolein; apoA-1
66
current smokers have .... fibrinogen levels
high
67
smoking causes increase in levels of proinflammatory ..... and leukocytes as well as an increase in cell adhesion molecules and platelet .......
cytokines; dysfunction
68
two types of natriuretic peptide
ANP (atrial natriuretic peptide) BNP (brain natriuretic peptide)
69
ANP produced by
myocytes of right atrium
70
BNP produced by
myocytes of ventricles
71
ANP produced in response to
excessive stretching in diastole
72
BNP produced in response to
stress
73
Natriuretic peptides reduce blood volume and BP by which 5 methods:
reduce thirst; increase kidney sodium ion excretion; stimulate peripheral vasodilation; promote water loss and increase urine production; block release of ADH, aldosterone, adrenaline and noradrenaline
74
....... and ...... from adrenal medullae stimulate cardiac output and .....
adrenaline and noradrenaline; peripheral vasoconstriction
75
ADH is release from the ......... pituitary in response to decreased blood volume, increase in osmotic conc. or secondary to circulating angiotensin II
posterior
76
ADH stimulates conservation of water in
kidneys (collecting duct)
77
erythropoietin is released by ..... when BP falls or .... is low
kidneys; oxygen
78
erythropoietin stimulates ..... and stimulates production and maturation of erythrocytes
vasoconstriction
79
............... cells release renin in response to fall in renal BP
juxtaglomerular
80
renin converts ............ to .............
angiotensinogen to angiotensin I
81
ACE converts .......... to .......
angiotensin I to angiotensin II
82
4 functions of angiotensin II
stimulates thirst; stimulates cardiac output and constriction of arterioles; stimulates ADH secretion; stimulates renal aldosterone production and therefore sodium ion retention and potassium ion loss
83
chemoreceptors respond to changes in ...., .... and .... in blood and ....
carbon dioxide, oxygen and pH; cerebrospinal fluid
84
chemoreceptors have sensory neurons in (2)
carotid and aortic bodies
85
sympathetic activation stimulates .... and ..... centres
cardioacceleratory and vasomotor centres
86
parasympathetic activation stimulates .... centre
cardioinhibitory centre
87
chemoreceptors for CBS fluid prioritise blood flow to brain to ensure .... delivery there
oxygen
88
endocardium =
thin, internal layer - covers valves. squamous epithelium over thin areolar tissue. no adipose
89
myocardium =
thick, helical middle layer. cardiac muscle
90
epicardium =
mesothelium formed by visceral layer of serous pericardium. simple squamous epithelium overlying thin areolar tissue. some areas have thick layers of adipose
91
systole =
ventricular contraction
92
diastole =
ventricular filling
93
5 properties of cardiac muscle
striates, short, thick, branches, 1 centrally placed nucleus surrounded by glycogen
94
sarcoplasmic reticulum of cardiac muscle is .... developed than skeletal as it lacks .... although it's T tubules are .... than in skeletal muscle
less; terminal cisternae; larger
95
cardiac myocytes have large ....
mitochondria
96
cardiocytes joined by
intercalated discs
97
2 types of mechanical junctions
fascia adherens, desmosomes
98
interdigitating folds =
plasma membrane at end of cell (folded and interlock)
99
fascia adherens = most extensive. broad bands of .... and .... form transmembrane proteins interrupted by ....
actin, myosin, desmosomes
100
desmosomes =
weld-like junctions between cells
101
desmosomes prevent cardiocytes from
pulling apart during contraction
102
electrical junctions =
intercalated discs contain gap junctions which form channels to allow ion flow from different cell cytoplasms > stimulate neighbours
103
order of heart conductive system (5)
SAN > signals spread through atria > AVN > bundle of His > Purkinje fibres
104
Parasympathetic stimulation > occupation of ... ..... .... ..... > negatively coupled with ..... .... > reduce cAMP formation > inhibit and slow calcium ion current
M2 muscarinic acetylcholine receptors; adenylate cyclase
105
parasympathetic stimulation also opens ..... channels creating a ...... current
potassium ion; hyperpolarising current
106
sympathetic stimulation > ... .... stimulation > enhanced ... flux in myocyte > strengthened force of contraction
beta1 adrenergic; calcium ion
107
binding of ..... to myocyte ... .... receptor stimulates membrane bound ... .... > enhances production of cAMP > activates intracellular protein kinases > ....... cellular proteins
catecholamines; beta1 adrenergic receptor; adenylate kinases; phosphorylate
108
return of calcium ion from cytosol to sarcoplasmic reticulum regulated by
phospholamban
109
beta1 adrenergic activation of protein kinase phosphorylates phospholamban > greater uptake of calcium ions by ......... > myocyte ..........
sarcoplasmic reticulum; relaxation
110
increased cAMP activity > phosphorylation of .......... > inhibits actin-myosin interaction
troponin I
111
sinus rhythm =
normal heart beat triggered by SAN
112
ectopic focus =
any region of spontaneous firing other than SAN.
113
nodal rhythm =
slower HR produced by AVN if SAN not working properly
114
4 phases of cardiac cycle
ventricular filling, isovolumetric contraction, ventricular ejection, isovolumetric relaxation
115
3 phases of ventricular filling
rapid ventricular filling, diastasis (slower filling), atrial systole
116
P wave of ECG =
end of diastasis
117
isovolumetric contraction =
atria repolarise and remain in diastole for rest of cycle. ventricles depolarise,
118
QRS complex of ECG =
ventricles depolarise and begin to contract
119
S1 can be heard as beginning of
isovolumetric contraction
120
ventricular ejection =
ventricular pressure exceeds atrial pressure and valves forced open. rapid ejection followed by reduced ejection
121
T wave of ECG =
late in ventricular ejection stage
122
in ventricular ejection, not all blood ejected. (~54% is) what is left is
end systolic volume
123
isovolumetric relaxation =
early ventricular diastole. T wave ends - ventricles begin to expand
124
S2 can be heard as
blood rebounds from closed semi lunar valves (end of isovolumetric relaxation)
125
SAN cells do not have stable resting potential - starts at -60mV and drifts upwards > gradual depolarisation = .... .... from slow influx of ... and outflow ...
pacemaker potential; sodium ions; potassium ions
126
SAN - when pacemaker potential reaches threshold potential of ...... > volatage-gated fast .............. open > influx .... ..... > 0mV > outflow .... > repolarisation
+40mV; calcium-sodium channels; sodium ions, calcium ions; potassium ions
127
SAN firing excites atrial cardiocytes > atria contract > AVN .......... contraction which allows ventricular filling before .....
slows down; contraction
128
Signals travel through AV bundle and Purkinje fibres > depolarisation of ...... ..... in near unison > signals reach .... ..... first > take up slack in .... ... > opens valves (mitral and tricuspid) before blood surges against them
ventricular myocardium; papillary muscle; chordae tendinae
129
cardiocytes have stable resting potential of
-90mV
130
cardiocytes normally only depolarise when stimulated > voltage gated .... channels open > influx of sodium ions > depolarisation to ......... ...... > additional .... gates open > ....... feedback loop > +30mV > sodium ion channels close
sodium ion; threshold potential; sodium ion; positive
131
as action potential spreads throughout heart, .... influx into cells > bind to ......... > calcium ions from sarcoplasmic reticulum to cytosol > second wave of calcium ions bind to ..... > contraction
calcium ion; sarcoplasmic reticulum; troponin
132
depolarisation of heart is prolonged causing ....... of action potential (more prolonged in ......) > at end of plateau ..... channels close, .... channels open > potassium ions .... cell and calcium ions are transported back into .....
plateau; ventricles; calcium; potassium; leave; sarcoplasmic reticulum
133
propioceptors =
muscles and joints - change in physical activity
134
3 hormones that increase heart rate
adrenaline, noradrenaline, thyroid hormone
135
end diastolic volume
blood volume of ventricles at end of diastole
136
end diastolic volume is affected by
filling time and venous return - Starling's law
137
venous return directly affects
nodal cells
138
venous return has indirect effect on HR via
atrial reflex
139
Increased venous return > stretching ... cells > more rapid depolarisation > Increased HR
SAN
140
end systolic volume
ventricular blood volume at the end of systole
141
factors affects end systolic volume =
preload, overload, contractility of ventricle
142
preload =
degree of ventricular stretching in diastole
143
preload affects ability of myocytes to produce
tension
144
as sarcomere length increases past resting length forced produced during systole
increases
145
as sarcomeres approach optimal lengths > more ..... and .... contraction
efficient and forceful
146
contractility =
amount of force produced during contraction at given preload
147
positive inotropic action
factors that increase contractility
148
negative inotropic action
factors that decrease contractility
149
positive inotropic factors stimulate ..... entry into cell
calcium ion
150
negative inotropic factors block calcium ion movement/ depress cardiac muscle ....
contraction
151
parasympathetic stimulation (vagus) > negative inotropic effect > release of .... > hyperpolarisation and inhibition
acetylcholine
152
sympathetic stimulation > positive inotropic effect > release of ....... by postganglionic fibres of cardiac nerves and secretion of ...... and ..... from adrenal medulla > stimulate alpha and beta receptors in cardiac muscle plasma membranes
noradrenaline; adrenaline and noradrenaline
153
4 things that have positive inotropic effects
adrenaline, noradrenaline, glucagon, thyroid hormones
154
how do stretch receptors work
stretch detected > greater number of actin-myosin cross links > increased calcium ion uptake > increased rate of contraction
155
afterload =
amount of tension contracting ventricle must produce to open atrioventricular valve
156
as afterload increases, stroke volume ....
increases
157
any factor restricting blood flow through atrial system ...... afterload
increases
158
frank starling law
greater the stretch of heart muscle during filling, the greater the force of contraction and the greater the quantity of blood pumped into the aorta
159
basal crepetations/ lower lung crackles
explosive opening of small airways
160
basal crepetations are more common during
inspiration
161
if basal crepetations don't clear after cough, could be sign of (2)
pulmonary oedema / fluid in alveoli
162
basal crepetations heard over which lobe of lung
inferior
163
echocardiogram =
ultrasound scan of heart
164
echocardiogram helps define .... of heart failure
aetiology
165
echocardiogram provides information of ejection fraction of left ventricle. what is normal value
~60%
166
heart failure patients with preserved left ventricle function have ejection fraction of..
more than 45%
167
heart failure patients with left ventricular systolic dysfunction have ejection fraction of...
less than 45%
168
7 causes of mitral valve regurgitation
degenerative, rheumatic heart disease, mitral valve prolapse, hypertrophic cardiomyopathy, MI, congenital heart problems, endocarditis
169
most common cause of mitral valve regurgitation
degenerative (tissues connecting valve to wall become weak and stretched over time)
170
rheumatic heart disease sometimes follows
infection with streptococcus > antibodies attack body, particularly mitral valve. developing countries
171
3 features of atrial fibrillation
HR fast, irregular (arrhythmia), irregular force of heart beat
172
in atrial fibrillation SAN overridden by other signals from
atrial cardiac muscle
173
Fibrillate =
rapid partial contraction > only some impulses to ventricles
174
Atrial fibrillation process: high BP > stretch receptors > increased ..... uptake > increased rate of contraction > fibrillation
calcium ion
175
3 types of atrial fibrillation
paroxysmal, persistent, permanent
176
paroxysmal atrial fibrillation
recurring and sudden episodes. stops without treatment within 7 days
177
persistent atrial fibrillation
longer than 7 days. needs treatment
178
permanent atrial fibrillation
long term. heart beat not normal. treated. heart rate still irregular. most common.
179
lone atrial fibrillation
no apparent cause
180
Electrocardiogram (ECG) records ...
electrical activity of heart
181
In ECG electrodes are attached to (3)
arms, legs, chest
182
Exercise ECG used to detect
narrowing of coronary arteries > angina
183
Ambulatory ECG used to detect
heart rhythms
184
P-R interval is time taken for excitation to spread through ..... (usually 0.12-0.2s)
ventricles
185
Lead to right ankle is
neutral (completes circuit)
186
Right arm lead known as
aVr
187
Left arm lead known as
AVl
188
Left leg lead known as
aVf
189
Lead I = info between
aVr and aVl
190
Lead II = info between
aVr and aVf
191
Lead III = info between
aVl and aVf
192
aVl looks at ..... side of heart
left
193
aVf looks at .... of heart
inferior
194
V2, V3, V4 are .... leads which look at .... of heart
anterior; front
195
V5, V6 are .... leads that look at .... side of heart
lateral; left
196
P wave =
atrial depolarisation
197
flat line between P wave an Q wave is when impulse spreads through
bundle of His
198
Q wave =
depolarisation in septum (from left > right)
199
R wave is when impulse spreads through
main portion of ventricular walls
200
R wave is large because there is more muscle > more cells > more .... required
voltage
201
S wave =
depolarisation of Purkinje fibres
202
ST segment =
flat line
203
If ST segment is not flat, it is an indicator of
myocardial ischaemia/ necrosis
204
T wave =
ventricular repolarisation
205
Heart failure as defined by NICE (2003)
complex syndrome resulting from structural/ functional cardiac disorder impairing pump function of heart
206
Heart failure accounts for 900 000 - ......... deaths in UK per year
1 000 000
207
Mortality rate of heart failure at 1 year`
20-30%
208
Heart failure accounts for ......% hospital admissions
5-10%
209
5 physiological changes that lead to heart failure
failure of pump, obstruction to flow, regurgitation of flow, disorders of cardiac conduction, disruption of continuity of circulatory system
210
Heart failure is when adaptive mechanisms to overcome physiological changes ....
fail
211
2 symptoms of heart failure
breathlessness, loss of energy
212
7 signs of heart failure
pulmonary oedema, pleural effusion, S3 'gallop', raised JVP, pitting oedema, ascites, tachycardia
213
10 causes of heart failure
ischaemic, heart failure, infective, dilated cardiomyopathy, diabetes, valvular, genetic, tachycardia induced, toxins/drugs, endocrine
214
5 treatments for heart failure with impaired systolic function
diuretics, ACE inhibitors, beta blockers, aldosterone receptor agonists, CRT/ICD devices
215
2 treatments for heart failure with preserved left ventricular function
diuretics, treating comorbidities
216
left sides heart failure =
failure of left ventricle
217
right sides heart failure =
failure of right ventricle
218
8 signs of left sided heart failure
exercise intolerance, dizziness/confusion, wheezing, heart murmurs, gallop rhythm, cyanosis > hypoxemia, pulmonary oedema > crackles at lung base, increased breathing rate& work of breathing
219
8 signs of right sided heart failure
ascites, pitted peripheral oedema, hepatomegaly, parasternal heave, nocturia, excess fluid accumulation in body, jaundice, impaired liver function
220
3 signs of biventricular heart failure
reduced breath sounds, pleural effusion (particularly of left side), dullness of lung fields to finger percussion
221
TROPONIN T TEST: 3 forms
C, T, I
222
TROPONIN T TEST: cardiac troponin has which 2 forms
I and T
223
TROPONIN T TEST: cardiac troponin levels are usually
so low cannot be meaured
224
TROPONIN T TEST: troponin is found with ..... on thin ..... filamin
tropomyosin; actin
225
TROPONIN T TEST: troponin .... attached to ....., troponin C binds calcium and troponin I ...... myosin binding site on ....
T; tropomyosin; inhibits; actin
226
TROPONIN T TEST: monoclonal antibody tests to cardiac specific troponin > identifies myocyte ....
necrosis
