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Sem 2 > Heart > Flashcards

Heart Flashcards

1
Q

heart block causes heart beat to be (2)

A

slow and irregular

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2
Q

heart block is a type of

A

arrhythmia

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3
Q

chest trauma can initiate arrhythmias =

A

heart contusion

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4
Q

right bundle branch block often shows which symptoms?

A

no symptoms

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5
Q

in right bundle branch block ,activation of which chamber of the heart is delayed?

A

right ventricle

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6
Q

right bundle branch block has what affect on QRS complex

A

prolongs QRS complex

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7
Q

left bundle branch block is often due to

A

problems with heart (e.g. high BP)

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8
Q

interventricular septum is normally activated by

A

left bundle branch

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9
Q

if conduction in left bundle branch is slowed, interventricular septum is activated by

A

right bundle branch

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10
Q

in right bundle branch block, what shape is seen in V1?

A

M

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11
Q

in right bundle branch block, what shape is seen in V6?

A

W

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12
Q

In left bundle branch block, what shape is seen in V1?

A

W

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13
Q

In left bundle branch block, what shape is seen in V6?

A

M

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14
Q

Mnemonic that can be used to remember ECG appearances of left and right bundle branch blocks?

A

WiLLiaM MaRRoW

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15
Q

referred pain: heart dermatomes =

A

body wall and upper limb (T1-T5)

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16
Q

……. men die of CHD

A

1/5

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17
Q

…… women die of CHD

A

1/7

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18
Q

CHD is ……….. cause of death and premature death in UK

A

most common

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19
Q

CHD causes ……….. deaths in UK per year

A

94 000

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20
Q

myocardial infarction defintion

A

damage to heart muscle due to interruption in regional coronary circulation

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21
Q

myocardial infarction often caused by

A

clot/ fatty deposit

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22
Q

non-function area of heart after MI =

A

infarct

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23
Q

ischaemia definition

A

reduced blood delivery to organ, sufficient to compromise function

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24
Q

infarction definition

A

reduced blood delivery to organ, sufficient to lead to its death

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25
Q

types of MI

A

STEMI, NSTEMI

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26
Q

STEMI =

A

coronary artery completely blocked. large amount of muscle damage

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27
Q

NSTEMI =

A

tests positive for troponin I/T (unlike angina). Partial/ temporary blockage

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28
Q

coronary artery spasm =

A

artery tightens, comes and goes, no plaque

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29
Q

demand ischaemia =

A

heart requires more oxygen than available e.g. infarction, anaemia

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30
Q

symptoms of MI (8)

A

chest pain (tightness), pain travelling from chest to other parts of body, shortness of breath, feeling/being sick, anxiety, coughing, wheezing, light headedness

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31
Q

Mi can be missed in …….. as mistakes for symptoms of …..

A

diabetics; neuropathy

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32
Q

diagnosis of MI using (2)

A

ECG, blood tests

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33
Q

treatment of MI (10)

A

antiplatelets, heparin, pain relief, clot busting meds, beta blocker, insulin, oxygen, ACE inhibitor, statin, coronary artery bypass

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34
Q

angina pectoris =

A

pain from heart usually caused by coronary artery narrowing and reduced blood blow

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35
Q

stable angina =

A

symptoms stereotypic. lower risk of infarct, improves with meds

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36
Q

unstable angina =

A

pain at rest, increased attack severity, high risk of infarct, pain over 15 mins

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37
Q

classic/ exertional angina pectoris =

A

provoked by physical exertion. pain fades quickly with rest

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38
Q

nocturnal angina =

A

at night, may wake patient. provoked by vivid dreams. vasospasm, critical coronary artery disease

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39
Q

decubitis angina =

A

lying down. impaired left ventricle function as result of severe coronary artery disease

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40
Q

variant (Prinzmetal’s) angina =

A

without provocation, at rest. result of coronary artery spasm. more common in women. ST elevation. Arrhythmias during ischaemic episode

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41
Q

cardiac syndrome X =

A

history angina, positive exercise test and angiogram normal. coronary arteries seem normal. most common in women. highly symptomatic. difficult to treat.

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42
Q

unstable angina =

A

recent onset, worsening. at rest

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43
Q

symptoms of angina (4)

A

pain in arm, jaw, neck, stomach; pain eases with rest; breathlessness on exertion; pain, ache, discomfort, tightness across front of chest on exertion

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44
Q

exacerbating factors of angina (4)

A

physical exercise, high emotion, cold temperatures, eating large meal

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45
Q

risk factors of angina (8)

A

smoking, high BP, overweight, high cholesterol, inactivity, diet, salt, alcohol

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46
Q

medication for angina (8)

A

glyceryl trinitrate, statin, aspirin, beta blocker, ACE inhibitor, calcium-channel blocker, nitrate medicines, potassium channel activators

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47
Q

2 types of cardiac centres in medulla oblongata

A

cardioacceleratory and cardioinhibitory centres

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48
Q

vasomotor centres in medulla oblongata have which 2 populations of neurons

A

large group = widespread vasoconstriction; small group = skeletal muscle and brain vasodilation

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49
Q

vasomotor centre controls activity of …… motor neurons

A

sympathetic

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50
Q

vasoconstriction neurons of vasomotor centre have what type of neurotransmitter?

A

noradrenaline and adrenaline (adrenergic neurons)

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51
Q

vasodilation neurons of vasomotor centre have what type of neurotransmitter?

A

nitrogen oxide

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52
Q

most common vasodilator synapses are ….. and trigger the endothelial release of …. which causes local vasodilation

A

cholinergic, NO

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53
Q

other vasodilator synapses have …. as neurotransmitter which has intermediate and direct effect on vascular …. …. cells

A

NO; smooth muscle

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54
Q

3 locations of baroreceptors

A

walls of carotid sinuses, aortic sinuses, walls of right atrium

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55
Q

baroreceptors in aortic sinuses are in walls of ….. aorta and trigger the ….. reflex

A

ascending; aortic

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56
Q

baroreceptors in walls of right atrium trigger …. reflex

A

atrial

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57
Q

baroreceptors in aortic sinuses monitor BP at beginning of …..

A

systemic circuit

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58
Q

baroreceptors in walls of right atrium monitor BP at end of …..

A

systemic circuit

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59
Q

effects on heart result from release of …. from sympathetic neurons innervating …, …. and …..

A

noradrenaline; SAN, AVN and myocardium

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60
Q

smoking causes immediate and long term …… in BP

A

increase

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61
Q

smoking causes immediate and long term …. in HR due to …… which causes increase in adrenaline and HbCO2

A

increase; nicotine

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62
Q

smoking causes …. in cardiac output and coronary blood flow

A

decrease

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63
Q

smoking reduces the amount of oxygen delivered to tissues due to binding of …. to Hb

A

CO

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64
Q

smoking ….. blood clotting process

A

stimulates

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65
Q

increased blood cholesterol in smoking is due to …… which interferes with the transport of HDLs by modifying site in ……

A

acrolein; apoA-1

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66
Q

current smokers have …. fibrinogen levels

A

high

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67
Q

smoking causes increase in levels of proinflammatory ….. and leukocytes as well as an increase in cell adhesion molecules and platelet …….

A

cytokines; dysfunction

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68
Q

two types of natriuretic peptide

A

ANP (atrial natriuretic peptide) BNP (brain natriuretic peptide)

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69
Q

ANP produced by

A

myocytes of right atrium

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70
Q

BNP produced by

A

myocytes of ventricles

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71
Q

ANP produced in response to

A

excessive stretching in diastole

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72
Q

BNP produced in response to

A

stress

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73
Q

Natriuretic peptides reduce blood volume and BP by which 5 methods:

A

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

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74
Q

……. and …… from adrenal medullae stimulate cardiac output and …..

A

adrenaline and noradrenaline; peripheral vasoconstriction

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75
Q

ADH is release from the ……… pituitary in response to decreased blood volume, increase in osmotic conc. or secondary to circulating angiotensin II

A

posterior

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76
Q

ADH stimulates conservation of water in

A

kidneys (collecting duct)

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77
Q

erythropoietin is released by ….. when BP falls or …. is low

A

kidneys; oxygen

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78
Q

erythropoietin stimulates ….. and stimulates production and maturation of erythrocytes

A

vasoconstriction

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79
Q

…………… cells release renin in response to fall in renal BP

A

juxtaglomerular

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80
Q

renin converts ………… to ………….

A

angiotensinogen to angiotensin I

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81
Q

ACE converts ………. to …….

A

angiotensin I to angiotensin II

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82
Q

4 functions of angiotensin II

A

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

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83
Q

chemoreceptors respond to changes in …., …. and …. in blood and ….

A

carbon dioxide, oxygen and pH; cerebrospinal fluid

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84
Q

chemoreceptors have sensory neurons in (2)

A

carotid and aortic bodies

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85
Q

sympathetic activation stimulates …. and ….. centres

A

cardioacceleratory and vasomotor centres

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86
Q

parasympathetic activation stimulates …. centre

A

cardioinhibitory centre

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87
Q

chemoreceptors for CBS fluid prioritise blood flow to brain to ensure …. delivery there

A

oxygen

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88
Q

endocardium =

A

thin, internal layer - covers valves. squamous epithelium over thin areolar tissue. no adipose

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89
Q

myocardium =

A

thick, helical middle layer. cardiac muscle

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90
Q

epicardium =

A

mesothelium formed by visceral layer of serous pericardium. simple squamous epithelium overlying thin areolar tissue. some areas have thick layers of adipose

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91
Q

systole =

A

ventricular contraction

92
Q

diastole =

A

ventricular filling

93
Q

5 properties of cardiac muscle

A

striates, short, thick, branches, 1 centrally placed nucleus surrounded by glycogen

94
Q

sarcoplasmic reticulum of cardiac muscle is …. developed than skeletal as it lacks …. although it’s T tubules are …. than in skeletal muscle

A

less; terminal cisternae; larger

95
Q

cardiac myocytes have large ….

A

mitochondria

96
Q

cardiocytes joined by

A

intercalated discs

97
Q

2 types of mechanical junctions

A

fascia adherens, desmosomes

98
Q

interdigitating folds =

A

plasma membrane at end of cell (folded and interlock)

99
Q

fascia adherens = most extensive. broad bands of …. and …. form transmembrane proteins interrupted by ….

A

actin, myosin, desmosomes

100
Q

desmosomes =

A

weld-like junctions between cells

101
Q

desmosomes prevent cardiocytes from

A

pulling apart during contraction

102
Q

electrical junctions =

A

intercalated discs contain gap junctions which form channels to allow ion flow from different cell cytoplasms > stimulate neighbours

103
Q

order of heart conductive system (5)

A

SAN > signals spread through atria > AVN > bundle of His > Purkinje fibres

104
Q

Parasympathetic stimulation > occupation of … ….. …. ….. > negatively coupled with ….. …. > reduce cAMP formation > inhibit and slow calcium ion current

A

M2 muscarinic acetylcholine receptors; adenylate cyclase

105
Q

parasympathetic stimulation also opens ….. channels creating a …… current

A

potassium ion; hyperpolarising current

106
Q

sympathetic stimulation > … …. stimulation > enhanced … flux in myocyte > strengthened force of contraction

A

beta1 adrenergic; calcium ion

107
Q

binding of ….. to myocyte … …. receptor stimulates membrane bound … …. > enhances production of cAMP > activates intracellular protein kinases > ……. cellular proteins

A

catecholamines; beta1 adrenergic receptor; adenylate kinases; phosphorylate

108
Q

return of calcium ion from cytosol to sarcoplasmic reticulum regulated by

A

phospholamban

109
Q

beta1 adrenergic activation of protein kinase phosphorylates phospholamban > greater uptake of calcium ions by ……… > myocyte ……….

A

sarcoplasmic reticulum; relaxation

110
Q

increased cAMP activity > phosphorylation of ………. > inhibits actin-myosin interaction

A

troponin I

111
Q

sinus rhythm =

A

normal heart beat triggered by SAN

112
Q

ectopic focus =

A

any region of spontaneous firing other than SAN.

113
Q

nodal rhythm =

A

slower HR produced by AVN if SAN not working properly

114
Q

4 phases of cardiac cycle

A

ventricular filling, isovolumetric contraction, ventricular ejection, isovolumetric relaxation

115
Q

3 phases of ventricular filling

A

rapid ventricular filling, diastasis (slower filling), atrial systole

116
Q

P wave of ECG =

A

end of diastasis

117
Q

isovolumetric contraction =

A

atria repolarise and remain in diastole for rest of cycle. ventricles depolarise,

118
Q

QRS complex of ECG =

A

ventricles depolarise and begin to contract

119
Q

S1 can be heard as beginning of

A

isovolumetric contraction

120
Q

ventricular ejection =

A

ventricular pressure exceeds atrial pressure and valves forced open. rapid ejection followed by reduced ejection

121
Q

T wave of ECG =

A

late in ventricular ejection stage

122
Q

in ventricular ejection, not all blood ejected. (~54% is) what is left is

A

end systolic volume

123
Q

isovolumetric relaxation =

A

early ventricular diastole. T wave ends - ventricles begin to expand

124
Q

S2 can be heard as

A

blood rebounds from closed semi lunar valves (end of isovolumetric relaxation)

125
Q

SAN cells do not have stable resting potential - starts at -60mV and drifts upwards > gradual depolarisation = …. …. from slow influx of … and outflow …

A

pacemaker potential; sodium ions; potassium ions

126
Q

SAN - when pacemaker potential reaches threshold potential of …… > volatage-gated fast ………….. open > influx …. ….. > 0mV > outflow …. > repolarisation

A

+40mV; calcium-sodium channels; sodium ions, calcium ions; potassium ions

127
Q

SAN firing excites atrial cardiocytes > atria contract > AVN ………. contraction which allows ventricular filling before …..

A

slows down; contraction

128
Q

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

A

ventricular myocardium; papillary muscle; chordae tendinae

129
Q

cardiocytes have stable resting potential of

A

-90mV

130
Q

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

A

sodium ion; threshold potential; sodium ion; positive

131
Q

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

A

calcium ion; sarcoplasmic reticulum; troponin

132
Q

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 …..

A

plateau; ventricles; calcium; potassium; leave; sarcoplasmic reticulum

133
Q

propioceptors =

A

muscles and joints - change in physical activity

134
Q

3 hormones that increase heart rate

A

adrenaline, noradrenaline, thyroid hormone

135
Q

end diastolic volume

A

blood volume of ventricles at end of diastole

136
Q

end diastolic volume is affected by

A

filling time and venous return - Starling’s law

137
Q

venous return directly affects

A

nodal cells

138
Q

venous return has indirect effect on HR via

A

atrial reflex

139
Q

Increased venous return > stretching … cells > more rapid depolarisation > Increased HR

A

SAN

140
Q

end systolic volume

A

ventricular blood volume at the end of systole

141
Q

factors affects end systolic volume =

A

preload, overload, contractility of ventricle

142
Q

preload =

A

degree of ventricular stretching in diastole

143
Q

preload affects ability of myocytes to produce

A

tension

144
Q

as sarcomere length increases past resting length forced produced during systole

A

increases

145
Q

as sarcomeres approach optimal lengths > more ….. and …. contraction

A

efficient and forceful

146
Q

contractility =

A

amount of force produced during contraction at given preload

147
Q

positive inotropic action

A

factors that increase contractility

148
Q

negative inotropic action

A

factors that decrease contractility

149
Q

positive inotropic factors stimulate ….. entry into cell

A

calcium ion

150
Q

negative inotropic factors block calcium ion movement/ depress cardiac muscle ….

A

contraction

151
Q

parasympathetic stimulation (vagus) > negative inotropic effect > release of …. > hyperpolarisation and inhibition

A

acetylcholine

152
Q

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

A

noradrenaline; adrenaline and noradrenaline

153
Q

4 things that have positive inotropic effects

A

adrenaline, noradrenaline, glucagon, thyroid hormones

154
Q

how do stretch receptors work

A

stretch detected > greater number of actin-myosin cross links > increased calcium ion uptake > increased rate of contraction

155
Q

afterload =

A

amount of tension contracting ventricle must produce to open atrioventricular valve

156
Q

as afterload increases, stroke volume ….

A

increases

157
Q

any factor restricting blood flow through atrial system …… afterload

A

increases

158
Q

frank starling law

A

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
Q

basal crepetations/ lower lung crackles

A

explosive opening of small airways

160
Q

basal crepetations are more common during

A

inspiration

161
Q

if basal crepetations don’t clear after cough, could be sign of (2)

A

pulmonary oedema / fluid in alveoli

162
Q

basal crepetations heard over which lobe of lung

A

inferior

163
Q

echocardiogram =

A

ultrasound scan of heart

164
Q

echocardiogram helps define …. of heart failure

A

aetiology

165
Q

echocardiogram provides information of ejection fraction of left ventricle. what is normal value

A

~60%

166
Q

heart failure patients with preserved left ventricle function have ejection fraction of..

A

more than 45%

167
Q

heart failure patients with left ventricular systolic dysfunction have ejection fraction of…

A

less than 45%

168
Q

7 causes of mitral valve regurgitation

A

degenerative, rheumatic heart disease, mitral valve prolapse, hypertrophic cardiomyopathy, MI, congenital heart problems, endocarditis

169
Q

most common cause of mitral valve regurgitation

A

degenerative (tissues connecting valve to wall become weak and stretched over time)

170
Q

rheumatic heart disease sometimes follows

A

infection with streptococcus > antibodies attack body, particularly mitral valve. developing countries

171
Q

3 features of atrial fibrillation

A

HR fast, irregular (arrhythmia), irregular force of heart beat

172
Q

in atrial fibrillation SAN overridden by other signals from

A

atrial cardiac muscle

173
Q

Fibrillate =

A

rapid partial contraction > only some impulses to ventricles

174
Q

Atrial fibrillation process: high BP > stretch receptors > increased ….. uptake > increased rate of contraction > fibrillation

A

calcium ion

175
Q

3 types of atrial fibrillation

A

paroxysmal, persistent, permanent

176
Q

paroxysmal atrial fibrillation

A

recurring and sudden episodes. stops without treatment within 7 days

177
Q

persistent atrial fibrillation

A

longer than 7 days. needs treatment

178
Q

permanent atrial fibrillation

A

long term. heart beat not normal. treated. heart rate still irregular. most common.

179
Q

lone atrial fibrillation

A

no apparent cause

180
Q

Electrocardiogram (ECG) records …

A

electrical activity of heart

181
Q

In ECG electrodes are attached to (3)

A

arms, legs, chest

182
Q

Exercise ECG used to detect

A

narrowing of coronary arteries > angina

183
Q

Ambulatory ECG used to detect

A

heart rhythms

184
Q

P-R interval is time taken for excitation to spread through ….. (usually 0.12-0.2s)

A

ventricles

185
Q

Lead to right ankle is

A

neutral (completes circuit)

186
Q

Right arm lead known as

A

aVr

187
Q

Left arm lead known as

A

AVl

188
Q

Left leg lead known as

A

aVf

189
Q

Lead I = info between

A

aVr and aVl

190
Q

Lead II = info between

A

aVr and aVf

191
Q

Lead III = info between

A

aVl and aVf

192
Q

aVl looks at ….. side of heart

A

left

193
Q

aVf looks at …. of heart

A

inferior

194
Q

V2, V3, V4 are …. leads which look at …. of heart

A

anterior; front

195
Q

V5, V6 are …. leads that look at …. side of heart

A

lateral; left

196
Q

P wave =

A

atrial depolarisation

197
Q

flat line between P wave an Q wave is when impulse spreads through

A

bundle of His

198
Q

Q wave =

A

depolarisation in septum (from left > right)

199
Q

R wave is when impulse spreads through

A

main portion of ventricular walls

200
Q

R wave is large because there is more muscle > more cells > more …. required

A

voltage

201
Q

S wave =

A

depolarisation of Purkinje fibres

202
Q

ST segment =

A

flat line

203
Q

If ST segment is not flat, it is an indicator of

A

myocardial ischaemia/ necrosis

204
Q

T wave =

A

ventricular repolarisation

205
Q

Heart failure as defined by NICE (2003)

A

complex syndrome resulting from structural/ functional cardiac disorder impairing pump function of heart

206
Q

Heart failure accounts for 900 000 - ……… deaths in UK per year

A

1 000 000

207
Q

Mortality rate of heart failure at 1 year`

A

20-30%

208
Q

Heart failure accounts for ……% hospital admissions

A

5-10%

209
Q

5 physiological changes that lead to heart failure

A

failure of pump, obstruction to flow, regurgitation of flow, disorders of cardiac conduction, disruption of continuity of circulatory system

210
Q

Heart failure is when adaptive mechanisms to overcome physiological changes ….

A

fail

211
Q

2 symptoms of heart failure

A

breathlessness, loss of energy

212
Q

7 signs of heart failure

A

pulmonary oedema, pleural effusion, S3 ‘gallop’, raised JVP, pitting oedema, ascites, tachycardia

213
Q

10 causes of heart failure

A

ischaemic, heart failure, infective, dilated cardiomyopathy, diabetes, valvular, genetic, tachycardia induced, toxins/drugs, endocrine

214
Q

5 treatments for heart failure with impaired systolic function

A

diuretics, ACE inhibitors, beta blockers, aldosterone receptor agonists, CRT/ICD devices

215
Q

2 treatments for heart failure with preserved left ventricular function

A

diuretics, treating comorbidities

216
Q

left sides heart failure =

A

failure of left ventricle

217
Q

right sides heart failure =

A

failure of right ventricle

218
Q

8 signs of left sided heart failure

A

exercise intolerance, dizziness/confusion, wheezing, heart murmurs, gallop rhythm, cyanosis > hypoxemia, pulmonary oedema > crackles at lung base, increased breathing rate& work of breathing

219
Q

8 signs of right sided heart failure

A

ascites, pitted peripheral oedema, hepatomegaly, parasternal heave, nocturia, excess fluid accumulation in body, jaundice, impaired liver function

220
Q

3 signs of biventricular heart failure

A

reduced breath sounds, pleural effusion (particularly of left side), dullness of lung fields to finger percussion

221
Q

TROPONIN T TEST: 3 forms

A

C, T, I

222
Q

TROPONIN T TEST: cardiac troponin has which 2 forms

A

I and T

223
Q

TROPONIN T TEST: cardiac troponin levels are usually

A

so low cannot be meaured

224
Q

TROPONIN T TEST: troponin is found with ….. on thin ….. filamin

A

tropomyosin; actin

225
Q

TROPONIN T TEST: troponin …. attached to ….., troponin C binds calcium and troponin I …… myosin binding site on ….

A

T; tropomyosin; inhibits; actin

226
Q

TROPONIN T TEST: monoclonal antibody tests to cardiac specific troponin > identifies myocyte ….

A

necrosis

Sem 2 (11 decks)

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