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BS - Cardiovascular System > Introduction to Cardiovascular System > Flashcards

Introduction to Cardiovascular System Flashcards

1
Q

What is the general role of the heart and blood?

A

Heart - pump blood around the body

Blood - carry metabolites around the body

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2
Q

What is the general role of the arteries, veins and capillaries?

A

Arteries - distribute oxygenated blood to cells and tissues

Capillaries - metabolite exchange

Veins - return blood to the heart

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3
Q

Where does the heartbeat begin and why?

A

The apex of the heart

This allows blood to be squeezed out of the top of the heart

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4
Q

Where does electrical activity begin in the heart?

A

Sino-atrial node

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5
Q

What is sinus rhythm?

A

The normal rhythm of the heart which is determined by the SA node

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6
Q

How do the valves prevent electrical impulses travelling from the atria to the ventricles?

A

They are insulation as they are made from non-electrically conducting material

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7
Q

How is the electrical activity of the heart stimulated?

How does it reach the AV node?

A
  1. action potential is initiated in SA node

2. it is propagated to the atrioventricular node via internodal tracts in the atria

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8
Q

How does the speed of the action potential vary in the SA node and the AV node?

Why?

A

Cells of the AV node transmit the action potential more slowly and delay the impulse by 100 ms

This gives time for the atria to completely empty into the ventricles before they contract

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9
Q

What happens to the electrical impulse as it leaves the AV node?

A

The impulse spreads down to the ventricles along the bundle of His

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10
Q

What is significant about the bundle of His?

A

It is the only electrical connection between the atria and the ventricles

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11
Q

How does the AV bundle divide?

A

It divides into left and right bundle branches

There are 2 bundles going to the left ventricle

There is 1 bundle going to the right ventricle

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12
Q

What happens to the impulse after it passes down the bundle of His and the bundle branches?

A

It spreads to the contractile cells of the ventricles through an extensive network of Purkinje fibres

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13
Q

What is diastole?

A

The resting period where the heart fills with blood

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14
Q

What is significant about the period between heartbeats?

A

There is a period between heartbeats where there is no electrical activity

This allows the heart to recharge ready for the next contraction

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15
Q

Why can electrical impulses travel so quickly through the heart?

A

Gap junctions in the intercalated discs allow the spread of the action potential throughout the myocardium like a functional syncytium

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16
Q

what is a syncytium?

A

A functional whole

It is one thing even though it is made up from multiple components

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17
Q

What is the main, secondary and backup pacemaker of the heart?

A

Main - SA node

Secondary - AV node

Backup - all the other electrically active myocytes

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18
Q

What is the SA node influenced by?

How do other heart cells respond to these stimuli?

A

Influenced by the blood (e.g. hormones like adrenaline) and parasympathetic and sympathetic nerves

The rest of the heart cannot respond as intelligently to the stimuli

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19
Q

what is an escape pacemaker?

A

an electronic device that will oversee the heartbeat and intervene if something goes wrong

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20
Q

What is the “brake” of the heartbeat?

A

The vagus nerve which slows down the activity of the heart

It releases acetylcholine

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21
Q

How does atropine work?

A

It is a drug that blocks the effect of ACh on the M2 receptors

ACh is released by the vagus nerve, and slows the activity of the heart

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22
Q

What is the “accelerator” of the heartbeat?

A

The “accelerator” speeds up the activity of the heart

Adrenaline is a natural way to speed up and strengthen the heartbeat

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23
Q

Why is adrenaline not often used as a drug?

A

It has more side effects than atropine

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24
Q

What is the resting potential of cells within the SA node?

A

They have no true resting potential

They generate regular, spontaneous action potentials

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25
Q

What is the difference in the depolarising current in non-pacemaker and pacemaker cells?

A

Non-pacemaker action potentials see the depolarising current carried into the cell by fast Na+ currents

In pacemaker cells, the current is carried into the cell via slow Ca2+ currents

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26
Q

Why are ‘slow response’ action potentials produced in SA nodal cells?

A

There are no fast Na+ channels in SA nodal cells

The SA nodal cells take longer to depolarise

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27
Q

What are the 3 phases of pacemaker action potentials, in order?

A
  1. phase 4 (If)
  2. phase 0 (ICa)
  3. Phase 3 (Ik)
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28
Q

what happens at the beginning of phase 4?

A

At the end of repolarisation, the membrane potential is very negative (-60 mV)

“funny” channels open that conduct slow inward Na+ currents

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29
Q

What is the “funny current”?

what does it cause?

A

depolarising slow inward Na+ current

It causes the membrane potential to begin to spontaneously depolarise - the pacemaker potential

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30
Q

What happens during phase 4 as the membrane potential reaches -50 mV?

A

The (transient) T-type Ca2+ channels open

The inwards directed Ca2+ current further depolarises the cell

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31
Q

What happens during phase 4 as the membrane potential reaches -40 mV?

A

The (long-lasting) L-type Ca2+ channels open

These cause more Ca2+ to enter the cell until an action potential is generated

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32
Q

At what magnitude is the action potential generated in the pacemaker cell?

A

The threshold value of -35 mV

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33
Q

What happens during phase 4 relating to K+?

A

Slow decline in the outward movement of K+

Fall in K+ conductance contributes to the depolarising pacemaker potential

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34
Q

What is phase 0 of the pacemaker action potential?

A

The depolarisation phase of the action potential

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35
Q

What is Phase 0 mainly caused by?

A

Increased Ca2+ conductance through L-type calcium channels that begin to open towards the end of phase 4

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36
Q

Why is the rate of depolarisation much slower in pacemaker cells than other cardiac cells?

A

The movement of Ca2+ through the L-type channels is not rapid

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37
Q

What begins to decline during phase 0?

A

funny currents and Ca2+ currents through T-type channels

The respective channels begin to close

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38
Q

What is phase 3 of the pacemaker action potential?

what is the main thing that occurs in this phase?

A

Repolarisation phase

K+ channels are opened which increases the outwards hyperpolarising K+ currents

39
Q

What begins to decline during phase 3?

A

L-type Ca2+ channels close and the inwards flow of Ca2+ declines

This decreases the inwards depolarising Ca2+ currents

40
Q

When is the pacemaker action potential cycle repeated?

A

Once the cell has completely repolarised to around -60 mV, the cycle is spontaneously repeated

41
Q

How are an action potential and an ECG related?

A

An action potential is the electrical activity of one cell. but an ECG shows all the cardiac myocytes acting together

42
Q

What is the minimum number of leads needed for an ECG and what does this produce?

A

A minimum of 2 leads are needed

This provides only the rhythm strip

43
Q

How many wires are used in a 12 lead ECG?

Where are these placed and what views does it provide?

A

It uses 10 wires

4 limb leads and 6 chest leads

It provides 6 different views of the heart

44
Q

Why must the ECG leads be placed some distance apart?

A

So the difference between them can be detected

The entire body is electrically conducting due to saline in the blood

The electrical activity of the heart can be detected from any position

45
Q

On an ECG, what does the P wave represent?

A

Atrial depolarisation

46
Q

On an ECG, what does the QRS complex indicate?

A

Ventricular depolarisation and contraction

47
Q

On an ECG, what does the T wave represent?

A

Repolarisation of the ventricles

48
Q

What does the PR interval represent?

Where does it stretch from?

A

From the start of the P wave to the start of the QRS complex

This is the time between the onset of atrial depolarisation and the onset of ventricular depolarisation

49
Q

What does increasing the length of the PR interval show?

A

There is a problem with the AV node

50
Q

What does the QT interval represent?

Where does it stretch from?

A

From the start of the QRS complex to the end of the T wave

It represents the time of ventricular activity, including depolarisation and repolarisation

51
Q

What does the ST segment represent?

Where does it stretch from?

A

From the end of the QRS complex to the start of the T wave

It represents the interval between ventricular depolarisation and repolarisation

52
Q

Where does the PR segment stretch from?

A

The end of the P wave to the start of the QRS complex

53
Q

What is the mechanism behind complete heart block?

A

A nerve impulse generated in the SA node cannot propagate to the ventricles

54
Q

How can complete heart block be identified on an ECG?

A

There is an increased length of the PR interval

55
Q

How can complete heart block lead to fibrillation?

A

An accessory pacemaker in the lower heart chambers activates the ventricles

The accessory pacemaker acts independently of the SA node

There is no coordination between the frequency of contraction of the atria and ventricles

56
Q

What do positive and negative deflections on an ECG show?

A

Negative deflection shows electrical activity moving away from the electrode

Positive deflection shows electrical activity moving towards the electrode

57
Q

What is the purpose of the cardiac axis?

A

It describes the general direction of depolarisation

58
Q

What is a normal direction of spread of electricity according to the heart axis?

A

The heart axis is usually down and to the left as electricity moves towards the apex

a normal direction of spread is from 11 o’clock to 5 o’clock

(aVR - II)

59
Q

Which leads of the ECG does the spread of electricity head towards?

What does this show?

A

It heads towards leads I, II and III

There is a positive deflection in all these leads, but II has the most positive deflection as it is at 5 o’clock

60
Q

What is the only ECG leads where readings are negative all the time?

A

aVR on the right shoulder

This is at the 11 o’clock position and all electricity is moving away from it

61
Q

What are the approximate positions of the ECG leads in relation to degrees?

A 
aVR  -150 
aVL  -30
I         0
II        60
aVF  90
III       120
62
Q

What is the left ventricular axis?

A

It shows the direction in which the electricity is moving

It goes from V1 to V6

V1 is mostly negative and V6 is mostly positive

63
Q

What is sinus arrhythmia?

A

It is the physiological slowing of the SA node rate during expiration, caused by an increase in vagal activity

64
Q

What condition does sinus arrhythmia lead to during inspiration and why?

A

Tachycardia

Negative pressure in the lungs means that there is slightly more blood returning to the heart

65
Q

What condition does sinus arrhythmia lead to during expiration and why?

A

Bradycardia

Positive pressure in the lungs means that there is slightly less blood returning to the heart

66
Q

Why does an increased heart rate during inspiration help to preserve cardiac output?

A

Left ventricular stroke volume falls

This is due to reduced filling as the pulmonary vascular bed expands during inspiration

67
Q

What is the definition of sinus bradycardia?

When does it occur?

A

It is a sinus rhythm with a resting heart rate of 60 beats per minute or less

it occurs when electrical signals in the heart are slowed down or blocked

68
Q

What are the 3 ways in which sinus bradycardia may be caused?

A
  1. SA node discharges electrical impulses slower than normal
  2. SA node pauses of fails to discharge at a regular rate
  3. SA node discharges an electrical impulse that is blocked before it can cause the atria to contract
69
Q

What is the definition of sinus tachycardia?

What is it caused by?

A

A sinus rhythm with a resting heart rate of 100 beats per minute or more

Caused by SA node sending out electrical impulses more frequently than normal

70
Q

What is ventricular ectopy?

A

An ectopic rhythm is an irregular heart rhythm due to a premature heartbeat

After an early beat of the heart, a brief pause usually follows

71
Q

What condition can ventricular ectopy lead to?

Why does the early heartbeat happen?

A

ventricular tachycardia

due to lack of oxygen reaching the myocyte

72
Q

What is atrial fibrillation?

A

An abnormal heart rhythm characterised by rapid and irregular beating of the atria

73
Q

When does atrial fibrillation occur?

A

When abnormal electrical impulses start firing from myocytes in the atria

This overrides impulses from the SA node

74
Q

How does atrial fibrillation reduce the heart’s efficiency and performance?

A

The atria contract randomly and more rapidly, meaning the heart cannot relax properly between contractions

75
Q

How is atrial fibrillation shown on the ECG trace?

A

There is no clear P wave on the ECG trace

76
Q

How does ventricular fibrillation affect the heart and why does this happen?

A

it causes the heart to quiver, rather than produce a pumping action

This is due to disorganised electrical activity in the ventricles

77
Q

what are the consequences of ventricular fibrillation?

A

Cardiac arrest with loss of consciousness and no pulse

Blood pressure rapidly plummets and cuts off blood supply to the vital organs

78
Q

What is the most common cause of ventricular fibrillation?

A

A problem with the electrical impulses travelling through the heart

This may be due to scar tissue in the heart due to a previous heart attack

79
Q

What happens if ventricular tachycardia lasts for more than 30 seconds?

A

It leads to palpitations, dizziness and fainting

Ventricular tachycardia can lead to ventricular fibrillation

80
Q

How does amiodarone work?

What is it used to treat?

A

Treats ventricular fibrillation

It acts on ion channels and causes a delayed repolarisation by blocking potassium ion channels

81
Q

If someone has collapsed, what is the ABC method that must be followed?

A

A - is the airway clear?

B - are they breathing?

C - circulation

CPR is used to push blood out of the heart towards the brain to extend the 3 minutes it can survive without oxygen

82
Q

What is the pathway that describes the activity of the heart, from energy to metabolism?

A 
Energy
Work
Pressure
Flow
Perfusion
Metabolism
83
Q

What are the 3 problems that encompass cardiovascular problems?

A

Problem with the pump, pipes, electrics or all three

84
Q

What is involved in perfusion?

A

Blood reaching small capillaries to allow metabolic exchange

85
Q

In a healthy individual, how much blood is pumped by the heart per minute?

How does the amount pumped vary in the right and left ventricles?

A

5L per minute

The right and left ventricles pump the same amount of blood

86
Q

In a heart attack, how does the amount of blood pumped per minute change?

A

The amount of blood pumped per minute falls

Blood is diverted to vital organs, such as the brain and heart

Blood flow to skin and digestive system is reduced

87
Q

In a myocardial infarction, what is tissue infarction?

A

Death of tissues due to a lack of oxygenation

88
Q

Why is adrenaline given to myocardial infarction patients?

A

It helps to increase the strength and rapidity of the heart

This helps to increase cardiac output

89
Q

What type of technology is used to observe the heart?

A

Echocardiogram

Usually a transoeosophageal echocardiogram where a probe is swallowed as this allows scanning from the inside without obstruction from the ribs

90
Q

In a myocardial infarction, what problem with the pipes may occur?

A

Blockage in the left coronary artery leads to the left ventricle lacking a sufficient blood supply

91
Q

What is used to observe the coronary arteries?

What is used to open up a blocked artery?

A

An angiogram is used to observe coronary arteries

A black stent device will open up a blocked artery

92
Q

How can platelets lead to a myocardial infarction?

A

They aggregate to form a platelet plug to stop arterial bleeding

This can occur wrongly in the coronary arteries

93
Q

How does aspirin work?

A

It is an anti-platelet drug that inhibits thromboxane

94
Q

What are the actions of Cangrelor and Clopidogrel?

A

They inhibit the platelets to prevent blood clots in (coronary) arteries

BS - Cardiovascular System (20 decks)

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