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Human Organs and Tissues > Midterm > Flashcards

Midterm Flashcards

1
Q 
external cardiac anatomy 
right border
left border
inferior border
anterior surface
A

right border = right ventricle
left border = left atrium and left ventricle
inferior border = right atrium and some left ventricle
anterior surface = mostly the right ventricle

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2
Q

blood flow within cardiac chamber

A

blood from lower trunk + limbs enters the heart through inferior vena cava
blood from above enters from superior vena cava

both drain into the right atrium

through tricuspid valve into right ventricle

through pulmonary valve into left lung via pulmonary artery

back into left atrium via left pulmonary veins (left lung)

through mitral valve into left ventricle

through aortic valve into aorta

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3
Q

the great arteries

A

pulmonary artery - anterior to aorta to left shoulder
ascending aorta - posterior to pulmonary artery to right shoulder
the aorta and pulmonary artery are at 60-60 degree angle

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4
Q

coronary arteries

A

right coronary artery and left coronary artery

first branches to come off aorta

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5
Q

right coronary artery

A

arises from right sinus of valsalva

courses between right atrium and right ventricle in atrioventricular groove

gives rise to right atrium branch, acute marginals (feed right ventricle) and most of the time the posterior interventricular artery (PDA)
- right dominant circulation in 70% of people

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6
Q

left main coronary artery

A

arises form the left sinus of valsalva

short segment splits into two: circumflex and the left anterior descending

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7
Q

circumflex

A

courses into left atrioventricular groove

gives rise to obtuse marginal branches that feed lateral left ventricle wall

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8
Q

left anterior descending (LAD)

A

feeds septum and left ventricle free wall

gives rise to diagonals and septal branches

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9
Q

coronary dominance

A

insert picture

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10
Q

venous drainage

A

cardiac veins are paired with arteries

majority of veins drain into coronary sinus (great cardiac vein) in posterior atrioventricular groove

right ventricle venous branches drain directly into right atrium

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11
Q

sequential segments of the internal cardiac anatomy

A

atria
atrioventricular valves
semilunar valves
ventricles

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12
Q

right atrium

A

smooth and trabeculated walls separated by crista terminalis

superior and inferior vena cava drain into smooth walled portion

fossa ovalis (thin wall between right atrium and left atrium, looks like slight depression) is formed from downward migration of septum secundum and upward migration of septum primum

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13
Q

tricuspid valve

A

allows for unidirectional blood flow from right atrium to right ventricle

three leaflets: septal, anterior, posterior

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14
Q

atrioventricular valves

A

mitral valve
tricuspid valve

these valves depend on hinge lines, valve tissue, chordae (like parachute strings), papillary, muscles, and ventricular wall function for proper performance

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15
Q

mitral valve

A

only two leaflet valve: posterior and anterior leaflets

allows unidirectional blood flow from left atrium to left ventricle

leaflets attach to mitral annulus - dense connective tissue of the cardiac skeleton that is the junction between the left atrium and left ventricle

leaflet edges are tethered by chordae tendinae which are attached to the ventricle through papillary muscles

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16
Q

right ventricle

A

inflow portion is below tricuspid valve
has an apex
outflow of infundibulum
has a pulmonary trunk: trabeculates, L shaped, septum is a smooth membranous portion with conduction tissue adjacent

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17
Q

semilunar valves

A

do not depend on ventricular function
there are two of them: aortic and pulmonary
three leaflets - suspended from the pulmonary trunk and aortic root
scalloped (commissures/ hinge lines)
competency is dependent on attachments and elastic/collagenous nature of the leaflet tissue as well as the dimensions of the root and trunk

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18
Q

weight of heart

A
  1. 45% of mens weight: 325gm +/- 75gm

0. 40% of womens weight 275 gm +/- 75gm

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19
Q

cellular composition of heart

A

myocytes - 25% of total cell number but 90% of mass

endothelial cells - 70% of total cell number but negligible contribution to heart weight

fibroblasts

immune cells

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20
Q

pericardium

A

fibrous sac that surrounds the heart - rich in collagen making in distensible
does not have elastic
fibrous component faces away from the heart
serous component faces toward the heart
refections from great vessels and veins
normal = 50cc of straw coloured fluid
sudden increases to 250 cc causes tamponade

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21
Q

fibrous skeleton

A

base of the heart - gives structure and shape
dense collagenous tissue with elastin - this makes up the rings of the atrioventricular valve and aortic annulus - this extends to the pulmonary trunk via conal ligament

separates the atrial and ventricular chambers

separates the left and right ventricles via a membranous septum

the atrioventricular conduction bundle is embedded in it

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22
Q

cardiac skeleton

A

fibrous skeleton = dense connective tissue made of thick collagen + some fibrocartilage

provides point of attachment for valve leaflets and myocardium

provides rigidity to prevent the dilation of valves that might cause leaking

electrically isolates the atria from the ventricles
- AV conducting system is the only electrical connection between the atria and ventricles

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23
Q

heart wall layers

A

epicardium - outer most layer

myocardium - muscle layer

endocardium - inner most layer

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24
Q

epicardium

A

analogue of vascular adventitia

serous pericardium

contains: coronary arteries and veins, fat, nerves, fibroblasts, macrophages

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25
Q

myocardium

A

analgogue of vascular media

bundles of cardiac muscle separated by fibrous bands

consists of: myocytes, collagen, blood vessels and elastin

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26
Q

5 components of myocytes

A
  1. cell membrane (sacrolemma and T tubules) - responsible for impulse conduction
    - form gap junctions
    - intercalated disks - join myocytes mechanically/ionically
    - functional syncytium
  2. sarcoplasmic reticulum - calcium reservoir
    - action potential causes it to release calcium - tells actin and myosin to contract
  3. contractile filaments
    - actin, myosin, troponin + tropomyosin
    - contraction = net effect of actin and myosin sliding closer to the sacromere
  4. mitchondria - energry generation through aerobic respiration only
    - 23% of myocyte volume = mitochondria vs regular cell = 2%
  5. nucleus - very large compared to most cells
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27
Q

myocardial anatomy

A

intercalated disks provide the transmission of contractile energy from cell to cell

long chains of cells are arranged into myofibrils

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28
Q

cardiac muscle fibers

A

ventriciular cardiac muscle

atrial cardiac muscle

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29
Q

ventricular cardiac muscle

A

complex layers of cells wound helically around the ventricular cavity

aids in “wringing out the heart” (like a sponge) during contraction of the heart

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30
Q

atrial cardiac muscle

A

muscle cells that are in the outer layer of the myocardium- form a complex helical structure around the atrial chamber

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31
Q

atrial cardiac muscle cells compared to ventricular cardiac muscle cells: (list 6 things)

A

are somewhat smaller
have a less extensive T-tubule system
have more gap junctions
can conduct impulses at a rate 3X higher
contract more rhythmically
have many granules that contain atrial natiuretic factor (ANF)

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32
Q

right atrium

A

receives blood from superior and inferior vena cava and passes it the to the right ventricle

2mm thick

smooth and trabeculated areas

coronary sinus empties into it

epicardium is rich in ganglia

myocytes are smaller than in ventricles

auricular appendage - looks like snoopys nose

electron dense granules contain atrial natiuretic factor (ANF)

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33
Q

left atrium

A

receives oxygenated blood from pulmonary veins

delivers to left ventricle across the mitral valve

3mm thick

smooth throughout

auricular appendage - shaped like central America

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34
Q

right ventricle

A

anterior most structure

3 subportions: inflow portion, apex, outflow portion

C shaped around left ventricle

coarsely trabeculated

papillary muscles support tricuspid valve

myocardium is 5 mm thick

membranous septum contains conduction system

low pressure ( this is why its thinner than left ventricle)

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35
Q

left ventricle

A

high pressure therefore 15mm thick

bullet shaped

3 subportions: inflow, septum, outflow

conducts blood from left atrium via mitral valve to aorta via aortic valve

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36
Q

ventricular diastole

A

relaxation
semilunar valves are closed
AV are open
pressure in ventricle goes down bc it is relaxed
pressure in atrium is higher
the pressure differential is what causes the opening and closing of valves

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37
Q

ventricular systole

A

contraction
pushes open valves to pulmonary artery
tricuspid and mitral valves close
fluid wants to leave therefore semilunar valves will open to allow this

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38
Q

aortic valve anatomy

A

a semilunar valve

located in aortic root

commisures are high points and cusp nadirs are low points - form a suspension bridge structure - this ring of suspension is called annulus

leaflets are named for aortic sinuses (left, right, non)

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39
Q

aortic valve histology (three layers)

A

fibrosa

  • collagen rich, extends to free edge and coaptin surface
  • gives strength to the tissue

spongiosa
- proteoglycan and GAG rich, collagen and fibroblasts (dont really need to know)

ventricularis

  • Left ventricle side
  • acts as shock absorber
  • allows leaflets to stretch and coapt under pressure and spring out of the way during ejection
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40
Q

pulmonic valve

A

a semilunar valve
in pulmonary trunk
anterior and superior to aortic valve
same histology as aortic valve (3 layers = fibrosa, spongiosa, ventricularis) but it is thinner bc lower pressure

41
Q

what does the competency of semilunar valves depend on?

A

their attachment to commissures and hinge lines

their strength, pliability, and elasticity

dimensions of the aortic root or pulmonary trunk

42
Q

histology of the mitral valve (4 layers)

A

fibrosa
- collagen rich and extends to chordae and tips of papillary muscles

spongiosa
- atrial side, GAG and proteoglycan rich

ventricularis

  • ventricular side
  • elastin rich and endothelialized

auricularis
- EC layer on atrial side

43
Q

what is the mitral valve competency based on?

A 
dimension of annular ring
structural integrity of leaflets (pliable, elastic, strength)
structural integrity of chordae 
function and dimensions of ventricles
44
Q

tricuspid valve histology

A

compared to mitral valve: lower pressure and thinner chordae, papillary muscles, and leaflets

same 4 layers as mitral valve: fibrosa, spongiosa, ventricularis, auricularis

45
Q

epicardial coronary arteries

A

the myocardium is dependent on only oxygenated blood
- therefore the heart extracts oxygen maximally (extracts 60%, leaving the venous saturation at 40% compared to 60% everywhere else in the body)

originate from the sinuses of valslava

they are 2-4mm in diameter and 5-10cm in length

branch into intramural arteries

46
Q

Tunica adventitia

A

outermost layer of blood vessels

primarily loose connective tissue
- type 1 collagen and elastin anchor it vessel

in veins this is the thickest layer

contains vassa vasorum - found in large arteries and veins

analogous to epicardium in heart

47
Q

tunica media

A

middle layer of blood vessel - most variable in size/structure

contains smooth muscle

collagen fibers, reticular fibers and elastic tissue (more of these in arteries compared to veins)

the media layer tends to be large in most arteries

analogous to myocardium in heart

48
Q

tunica intima

A

inner most layer (next to lumen) of blood vessels

single layer of endothelial cells and minimal connective tissue

in larger vessels it is subdivided into 4:

  • endothelium
  • thin basal lamina
  • subendothelium (connective tissue including collagen)

analogous to endocardium in heart

49
Q

properties of the endothelium

A

can have different functions based on different blood vessel locations

cells are bound together by junctional complexes

can be activated by cytokines to express cell adhesion molecules which allow WBCs to stick and migrate from the blood vessel into the tissue

under normal circumstances: secrete substances that maintain the tone of vascular smooth muscle and prevent blood clotting

50
Q

cellular composition of blood vessels

A

endothelial cells
smooth muscle cells

immune cells and fibroblasts are also there but they are not as important for function

51
Q

components of extracellular matrix in blood vessels

A

collagen
elastin
glycosaminoglycans

52
Q

endothelial function in blood vessels

A

EC-EC junction = permeability layer - regulate uptake

maintain the delicate balance of pro and anti forces in:
clotting
fibrinolysis
vascular tone 
inflammation
mitogenesis (cell growth)

synthesize matrix molecules: collagen and proteoglycans

53
Q

what anticoagulant, antithrombotic and fibrinolytic molecules do endothelial cells make?

A

prostacyclins
thrombomodulin
heparans
plasminogen activator

54
Q

what pro-thrombotic molecules do endothelial cells make?

A

von willebrands factor

tissue factor

plasminogen activator inhibitor

55
Q

how do endothelial cells regulate blood flow?

A

endothelial cells are responsible for the contraction and relaxation of blood vessels

vasoconstriction is caused by endothelin and angiotensin converting enzyme

vasodilatation is caused by prostacyclin and nitric oxide

56
Q

how do endothelial cells regulate cell growth?

A

produce regulator molecules:

molecules that stimulate growth: PDGF, FGF, VEG F

molecules that inhibit growth: heparin, TGF beta

57
Q

how do endothelial cells regulate inflammation and immunity?

A

interluekins 1 and 6, chemokines - attract immune cells

adhesion factors cause the immune cells to stick and exit blood vessels to go into tissues

58
Q

vascular smooth muscle cells

A

primary element of vascular media

responsible for vasoconstriction and vasorelaxation

secrete and synthesize growth factors and cytokines

synthesize proteoglycans, collagen, elastin

in response to injury they migrate to the intima and proliferate

59
Q

what happens to smooth muscle cells in response to injury?

A

migrate to intima and proliferate -this is promoted by edothelin, PDGF, FDF, IFN gamma

the cells synthesize matrix

this can = normal healing or atherosclerosis

60
Q

two types of arteries

A

elastic and muscular

61
Q

which arteries are elastic arteries?

A 
aorta
brachiocephalic
carotid
subclavian iliac
pulmonary arteries and larger branches
62
Q

physical characteristics of elastic arteries?

A

vessels are thick - too thick for diffusion of oxygen therefore get their own oxygen via the vasa vasorum

tissues and cells organized in lamella

intima has endothelial cells and minimal matrix

adventitia collagen predominant with vasa vasora - this provides strength

elastin dominates in media allowing for expansion in systole
- acts as secondary pump (pressure reservoir)
-

63
Q

intima, media and adventitia of elastic arteries

A

intima has endothelial cells and minimal matrix

elastin dominates in media - allows for expansion in systole

  • this acts as a secondary pump/pressure reservoir
  • VSCM are dominant cell in media

adventitia collagen predominant with vasa vasora- this provides strength

64
Q

what does the aorta arise from and where do its branches go

A

arises from left ventricle

root gives rise to coronary arteries

arch to head and upper extremity vessels

descending to paired intercostal arteries

65
Q

atherosclerotic and hypertensive changes in the elastic arteries

A

intima thickens and develops plaque

fragmentation of collagen and elastin

media degenerates causing reduced blood supply

results in aortic aneurysm or dissection

66
Q

muscular arteries: layers (intima, media, adventitia)

A

intima is thinner than elastic arteries

internal elastic lamina is well defined

media has fewer elastin fibers, lamella are defined but discontinuous in some locations, the VSMC is a major component

external elastic lamina is well defined

adventitial thickness/ strength variable

67
Q

examples of muscular arteries

A

coronaries
renal arteris
femorals + distributive arteries of the lower extremities
axillaries and distributive arteries of upper extremity

68
Q

visceral arteries

A

visceral arteries supply blood to the visceral organs

69
Q

examples of visceral arteries

A

celiac trunk - splenic artery, distal esophagus, pancreas, hepatic arteries

superior mesenteric artery - abdominal extremities

inferior mesenteric artery

marginal artery (Drummond) anastomoses the SMA and IMA

  • these are important in atherosclerotic occlusive disease of these vessels
  • occlusive disease of visceral vessels can result in intestinal angina or hypertensionn
70
Q

marginal artery (drummond)

A

formed by antastomoses of the terminal branches of the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA)

this is critical in atherosclerotic occlusive disease of these vessels

occlusive disease of the visceral vessels can result in intestinal angina and hypertension

71
Q

muscular arteries of the upper extremity

A

subclavian > axillary > brachial> branches into radial and ulnar (closest to body)

superficial palmar acrches suply hand and digits

INSERT PICTURE

72
Q

axillary artery

A

begins at lateral border of first rib to teres major

multiple branches to chest and shoulder

73
Q

brachial artery

A

teres major to antecubital fossa

branches to elbow and adjacent forearm musculature - into radial and arteries

74
Q

radial and ulnar arteries

A

supply forearm musculature

75
Q

iliac artery

A

common iliac: paired arteries at the terminus of the abdominal aorta -4th lumbar vertebra

external iliac: common iliac branch that courses along psoas muscle anterior and inferior to the inguinal ligament

internal iliac: arises at the sacroiliac joint - courses pestero-inferior to external iliac giving rise to branches that supply the pelvic viscera and medial thigh

76
Q

infra-inguinal arteries: groin

A

as external iliac crosses he inguinal ligament it becomes the femoral artery

this occurs midway between pubic tubercle and anterior superior iliac spine

NAVL: lateral to medial = nerve, artery, vein, lymph

branches that supply thigh and and sex organs

gives rises to profunda femoris artery - this supplies muscles of upper extremity + provides collaterals down to knee

gives superficial femoral artery: courses down anteromedial thigh deep to muscles to lower extremities

77
Q

popliteal artery

A

when superficial femoral artery emerges into posterior knee, from adductor magnus muscle becomes popliteal artery

gives 5 geniculate branches to the knee
travels in interchondylar fossa
divides at popliteal muscle into anterior and posterior tibial aa

78
Q

lower leg arteries

A

anterior tibial artery - goes into dorsalis pedis in foot

posterior tibial artery

peroneal artery

79
Q

head and neck arteries

A

common carotid artery and brachiocephalic trunk gives rise to internal carotid artery and external carotid artery

branch point is at the carotid sinus

carotid body - sense oxygen content and regulate breathing

80
Q

carotid branches

A

external carotid:

  • supplies head and neck external to cranium
  • multiple branches, most importantly facial arteries and superficial temporal, maxilaryartery

internal carotid:
supplies brain, eyes, forehead
- enters cranium via cranial canal in temporal bone (skull base)
- vertebral artery branches of the subclavian artery ascend through postiero neck adn enter cranium through foramen magnum also supplying the brain

81
Q

small arteries

A

provide distribution form named branches to tissues

less than 2 mm in diameter

82
Q

small arterioles

A

20-100 mm in diameter

provide blood flow regulation via medial smooth muscle contraction

regulates relative blood flow to capillary beds

provide the majority of flow resistance

83
Q

histology of small arteries and arterioles

A

intima is very thin

media = 1 to 6 layers of vascular smooth muscle cells

adventitia thickness is similar to media, merges with adjacent tissue connective tissue

84
Q

capillaries

A

diameter of 8µm (RBC diameter) to 30µm

represent a huge cross sectional area in the body

endothelial cell lining but no media or elastin

pericytes that contain myosin are what provide the support

allow rapid exchange of oxygen ad nutrients via diffusion

flow is very slow

85
Q

EC lining of capillaries

A

continuous: complete EC lining
fenestrated: EC gaps allowing macromolecular passage

discontinuous: larger gaps in EC layer (liver)
- larger diameter called sinusoids

86
Q

veins

A

intima:

  • narrow and IEL is difficult to ID
  • sparse elastin with only incomplete elastic lamina

media:
- vascular smooth muscle cells dominate in media (there are fewer compared to arteries + more disorganized)

adventitia:
- only largest veins have appreciable connective tissue

vein valves:

  • small and medium veins have valves
  • made of two bands of lumenal tissue
  • allow skeletal muscles to assist in blood return against gravity
87
Q

large veins (structure/layers)

A

no valves (ex=vena cava)

Intima:
- EC with some connective tissue

media:
- multiple layers of vascular smooth muscle cells - much thinner than adjacent artery

adventitia:

  • more connective tissue compared to medium veins
  • blend with adjacent connective tissue
88
Q

medium veins

A

has vein valves
intima:
- very thin
- EC is complete

Media:
- few layers of smooth muscle cells (2-5)

adventitia:
- identifiable and blends into adjacent connective tissue

89
Q

post capillary venules

A

very thin walled

intima is very thin, no elastin, has endothelial cells

media = 1 or 2 layers of vascular smooth muscle cells

90
Q

starling law

A

more venous return to heart = heart pumps more

an increase in muscular stretch = increased contraction

this operates at the level of the sacromere (actin/myosin)

no change in arterial pressure or heart rate

can over stretch = flat/descending starling curve

91
Q

cardiac regulation

A
  • autonomic control

- heart has abundant parasympathetic and sympathetic innervation

92
Q

sympathetic drive of cardiac regulation

A

increase heart rate (chronotropic)

increase strength of contraction (inotropic)

basasl firing of sympathetic fibres (normal condiiton is baseline sympathetic drive)

mediated by beta adreno receptors

93
Q

parasympathetic tone in cardiac regulation

A

bradycardia (major effect) (to 20-40bpm)

decreased force of contraction (minor effect) vagal episode

94
Q

blood flow regulation at the tissue level

A

metabolic rate is proportional to blood flow

kidney is the only exception to this

states of low tissue oxygen result in release of vasodilator substances that affect arteriolar tone

difference in flow between skeletal muscles at rest and during exercise = 20 fold

control lies at level of arteriole

95
Q

blood flow regulation by the endothelium

A

active role in blood flow control

may be a response to sheer stress form increased local flow downstream

  • vasodilators: nitric oxide , prostaglandins
  • vasoconstrictors: endothelin, thromboxane

affects diameters of pre-arteriolar vessels (even to muscular arteries)

96
Q

humoral regulation of blood flow

A

norepinephinre/epinephrine:

  • fight or flight
  • results in humoral release (adrenals) and increased sympathetic tone
  • humoral release has same effect as local innervation (constricts vascular smooth muscle and increases heart rate + force of contraction)
97
Q

impact of exercise on blood flow

A

increased return of blood

local vasodilation of skeletal muscle (arteriolar and EC regulated)

increased CNS activity results in vasoconstriction center activation

98
Q

baroreceptor reflex

A

stretch receptors widely distributed in vascular system

especially carotid sinus; aortic arch 
stimulate CNS (medulla)

increased pressure results in inhibition fo vasoconstrictor center and excitation of vagal centre (when you stand there is the opposite effect)

vasodilation of veins and arterioles
decreased heart rate contractility

99
Q

conduction system

A

conducts the impulse with a delay from atrium to ventricle (AV node) - between Av valve and coronary sinus

splits into left bundle and right bundle

Human Organs and Tissues (3 decks)

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