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8361 Exam I > Mod2: Review of Cardiac Anatomy > Flashcards

Mod2: Review of Cardiac Anatomy Flashcards

1
Q

LOCATION

Where does the heart sits?

A

in the MEDIASTINUM

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2
Q

LOCATION

The heart sits in the mediastinum. Which structures is it boarded laterally by?

A

the lungs

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3
Q

LOCATION
Which structures sits anterior to the heart?

A

The Sternum

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4
Q

LOCATION

Which structures sit porterior to the heart?

A

Descending aorta

Esophagus

Major Bronchi

T5-8 vertebra

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5
Q

LOCATION

What’s the overall shape of the heart?

A

Blunt shaped cone

with 2/3 of its mass left of the midline

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6
Q

VALVES:AREA AUSCULTATED

Where is the Aortic valve auscultated? Why that location?

A

Aortic valve is auscultated at the second ICS right sternal border because the LV ejects towards the right

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7
Q

VALVES:AREA AUSCULTATED

Where is the Pulmonic valve auscultated? Why that location?

A

RV ejects towards the left, so the Pulmonic valve will be heart 2 ICS left sternal border

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8
Q

VALVES:AREA AUSCULTATED

Where is the Tricuspid valve auscultated? Why that location?

A

The tricupsid valve is ausculatated at the L (or R) lower sternum

Tricuspid is 5th ICS just to either the right or the left of the sternal line.

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9
Q

VALVES:AREA AUSCULTATED

Where is the Mitral valve auscultated? Why that location?

A

Apex

The mitral valve is located in the middle between the left atrium and ventricle at the apex of the heart. 5th ICS mid clavicular

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10
Q

HEART SOUNDS

S1 heart sound - What sound does it make? Where is auscultated? What events does is correspond to?

A

Makes “lupp” sound

Auscultated at the Apex

Corresponds to blood is being ejected form the LV

d/t closure of the AV valves

Marks the begining of Systole

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11
Q

HEART SOUNDS

S1 - EKG

A

Correlates with QRS

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12
Q

HEART SOUNDS

S2

A

S2 “dub”

Heard at the 2nd ICS

S2 is dub, so listen by the aortic valve because that’s where the blood is exiting the aortic valve

d/t closure of semilunar valves

Systole ends

Correlates with downstroke of T

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13
Q

HEART SOUNDS

S3

A

S3 (apex)

S3 listen for at the apex and its due to when the mitral valve opens

Beginning to mid third of diastole

d/t rush of blood from atria to ventricles

Correlates with isoelectric line

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14
Q

HEART SOUNDS

S4

A

S4 (apex)

Mid to end of diastole

d/t atrial contraction

Correlates with P wave

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15
Q

HEART SOUNDS

All heart sounds are heard at the apex except:

A

S2

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16
Q

BLOOD FLOW THROUGH HEART

Describe how blood flows through the heart

A

See picture

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17
Q

BLOOD FLOW THROUGH HEART

List structures through which blood flows through the heart

A

See picture

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18
Q

LAYERS OF THE HEART AND PERICARDIUM

Which two layers make up the pericardium?

A

Fibrous Pericardium

Serous Pericardium

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19
Q

LAYERS OF THE HEART AND PERICARDIUM

The skeleton that surrounds heart valves and separates atria and ventricular muscle masses is known as:

A

Fibrous pericardium

It’s also a protective tissue that prevents overdistension and anchors the heart to the mediastinum

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20
Q

LAYERS OF THE HEART AND PERICARDIUM

Serous Pericardium is double layered. What are the two layers called?

A
  1. Parietal layer
  2. Visceral layer (epicardium)
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21
Q

LAYERS OF THE HEART AND PERICARDIUM

Where is the Parietal layer of the Serous pericardium located?

A

Lies just under the fibrous pericardium

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22
Q

LAYERS OF THE HEART AND PERICARDIUM

Where is the Visceral layer of the Serous pericardium located? What’s its other name?

A

Visceral layer, which is the outermost layer of the wall of the heart also known as the epicardium

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23
Q

LAYERS OF THE HEART AND PERICARDIUM

What’s found between the parietal and visceral layers of the Serous pericardium?

A

Pericardial cavity

Contains about 10-60 mL of fluid that allows the heart to move freely within the sac and prevents friction between the two layers

This is also where you would get Pericarditis and Cardiac Tamponade

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24
Q

HEART WALL

The outermost layer of the wall of the heart also known as:

A

The Epicardium

It is visceral layer of the Serous pericardium

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25
Q

HEART WALL

The three cardiac muscle which form the main muscle mass of the heart constitute which structure?

A

The Myocardium

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26
Q

HEART WALL

There are three muscle masses of the heart:

A

Atria

Ventricle

Conduction system

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27
Q

HEART WALL

Muscle of the atria and ventricle are completely separated by:

A

The fibrous skeleton of the heart

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28
Q

HEART WALL

What’s the only muscular connection between the atria and the ventricle?

A

The conduction system of the heart

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29
Q

HEART WALL

The muscle of the atria is relatively thin and the myocardium of the LV is how many times thicker than the RV?

A

Three times thicker

This is the case because the LV must eject to systemic circulation against afterload

Whereas the RV ejects into the pulmonary circulation

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30
Q

HEART WALL

Which structure lines internal surfaces of the heart and is continuous with tunica intimae of blood vessels?

A

Endocardium

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31
Q

HEART WALL

Which layer of the heart is in direct contact with blood?

A

Endocardium

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32
Q

HEART WALL

The endocardium is in direct contact with the blood in the heart and is divided into which layers?

A

Endothelial, and

Subendothelial layers

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33
Q

HEART WALL

Which layer of the heart wall is most susceptible to ischemia? and why?

A

Endocardium

Because the arteries are smaller and the pressure is higher

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34
Q

HEART WALL

T/F: Coronary arteries start off thick and then become thinner as the get deeper into heart muscle

A

True

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35
Q

DIVIDING THE CHAMBERS OF THE HEART

What surrounds the heart valves?

A

Fibrous Skeleton

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36
Q

DIVIDING THE CHAMBERS OF THE HEART

Where does the Fibrous Skeleton originate?

A

From connective tissue that separate the two heart muscle masses

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37
Q

DIVIDING THE CHAMBERS OF THE HEART

There are two sulci called?

A

Coronary Sulcus

Interventricular Sulcus

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38
Q

DIVIDING THE CHAMBERS OF THE HEART

Which sulcus separates the atria from the ventricles and encircles the heart, houses the coronary sinus and RCA anteriorly and the circumflex of the LCA posteriorly?

A

Coronary sulcus

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39
Q

DIVIDING THE CHAMBERS OF THE HEART

Which sulci separate the two ventricles anteriorly and posteriorly?

A

Anterior and posterior interventricular sulci

Contain the LAD and PDA

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40
Q

DIVIDING THE CHAMBERS OF THE HEART

The area where the coronary sulcus and the posterior interventricular sulcus meet on the back side of the heart is called?

A

The Crux of the heart

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41
Q

DIVIDING THE CHAMBERS OF THE HEART

Why is the Crux of the heart important?

A

Because coronary artery that passes this point and descends as the PDA is the “dominant” coronary of the heart

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42
Q

RIGHT ATRIUM

Which cavities are found in the RA?

A

Auricle (right atrial appendage)

Main cavity

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43
Q

RIGHT ATRIUM

What’s the site of venous cannulation in the RA during bypass?

A

Auricle (right atrial appendage)

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44
Q

RIGHT ATRIUM

The RA Main cavity has several openings. What are they?

A

Superior Vena Cava (has no valve; blood flows freely from the SVC to the RA)

SA node at junction of SVC and RA

IVC, which is covered by the Eustachian valve

Coronary sinus (sits b/t IVC and TV); Coronary sinus which is the venous drainage of much of the heart; Drains venous blood from the heart back into the RA; also the area where retrograde cardioplegia cannula placed for CPB

Tricuspid Valve

Fossa ovalis which is located in the septal wall between both atria and is the corresponding site of the foramen ovale in the fetal heart; “probe-patent” in 10-20% of population; this is important because a “probe-patent” Fossa ovalis is a potential direct route for venous air to enter arterial circulation that goes back to the patient; must be assessed by cardiologist or surgeon prior to surgery to make sure it isn’t wide open

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45
Q

RIGHT ATRIUM

T/F: Superior Vena Cava has no valve

A

True

Blood flows freely from the SVC to the RA

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46
Q

RIGHT ATRIUM

Where is the SA node located?

A

At the junction of SVC and RA

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47
Q

RIGHT ATRIUM

Which valve covers the IVC?

A

The Eustachian valve

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48
Q

RIGHT ATRIUM

What’s the function of the Coronary sinus?

A

It is the venous drainage of much of the heart

Drains venous blood from the heart back into the RA

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49
Q

RIGHT ATRIUM

Where is Coronary sinus located?

A

It sits between the IVC and the TV

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50
Q

RIGHT ATRIUM

Where is retrograde cardioplegia cannula placed for CPB

A

Coronary sinus

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51
Q

RIGHT ATRIUM

Which opening in the main cavity of the RA correspond to the site of foramen ovale?

A

Fossa ovalis

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52
Q

RIGHT ATRIUM

What percentage of the population has a “probe-patent” Fossa ovalis?

A

10-20%

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53
Q

RIGHT ATRIUM

Why is it important to assess the patency of the Fossa ovalis prior to bypass surgery?

A

Because Fossa ovalis is a potential direct route for venous air to enter arterial circulation that goes back to the patient

Must be assessed by cardiologist or surgeon prior to surgery to make sure it isn’t wide open

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54
Q

LEFT ATRIUM

Similar to the right atrium, the left atrium is comprised of an auricle or appendage. What’s the significance of the left auricle or Left atrial appendage?

A

Site where clots form during a-fib

Site of atrial appendage ligation to reduce the chance of clot formation

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55
Q

LEFT ATRIUM

What are Openings to the LA?

A

Four pulmonary veins: 2 from each lung in the posterior wall

A-V orifice which is protected by the mitral valve

And the possible Foramen Ovale/Fossa Ovalis

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56
Q

RIGHT VENTRICLE

What is the structural appearance of the RV?

A

Crescent shaped, wrapped around 1/3 of the LV

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57
Q

RIGHT VENTRICLE

What are openings to the RV?

A

A-V opening which is protected by the tricuspid valve

Pulmonary orifice protected by the pulmonic valve

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58
Q

LEFT VENTRICLE

Why is the muscle of the left ventricle three times thicker than the muscle in the RV?

A

because it must generate 4-5 times the pressure of the RV to eject blood into systemic circulation

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59
Q

LEFT VENTRICLE

How does the LV eject blood into systemic circulation?

A

The outer layer pulls the apex toward the base, while

The inner layer constricts the inner lumen to eject blood

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60
Q

LEFT VENTRICLE

T/F: Equal volume ejected by each ventricle

A

True

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61
Q

LEFT VENTRICLE

T/F: blood ejected by both ventricles at the same pressure

A

False

LV ejects at a pressure 4-5x > RV

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62
Q

LEFT VENTRICLE

What are openings to the LV?

A

Atrioventricular orifice, protected by the mitral valve, and

Aortic orifice protected by the aortic valve

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63
Q

ATRIOVENTRICULAR VALVES

TRICUSPID valve: location

A

Lies b/t RA & RV

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64
Q

ATRIOVENTRICULAR VALVES - TRICUSPID

How many cups?

A

3 cusps: anterior, septal (medial), and posterior (inferior)

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65
Q

ATRIOVENTRICULAR VALVES - TRICUSPID

has a valve area of:

A

7-10 cm

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66
Q

ATRIOVENTRICULAR VALVES - TRICUSPID

T/F: Tricupsid valvular disease is much less common unless congenital

A

True

67
Q

ATRIOVENTRICULAR VALVES - MITRAL/BISCUSPID

Location:

A

Lies b/t LA & LV

68
Q

ATRIOVENTRICULAR VALVES - MITRAL/BISCUSPID

How many cups does it have?

A

2 large cusps: anterior and posterior

2 small cusps: come together to form the two main cusps of the valve

Forms anteromedial (always by aortic valve; becomes important during systolic anterior motion of the Mitral valve) and posterolateral cusps

69
Q

ATRIOVENTRICULAR VALVES - MITRAL/BISCUSPID

Has an area of:

A

4-6 cm

70
Q

ATRIOVENTRICULAR VALVES TV & MV

What’s the commonality between TV and MV in terms when they open or close?

A

They open when pressure in the atria is higher than that of the ventricle (ventricular diastole) and

They close when pressure in the ventricle is higher than that of the atria (ventricular systole)

71
Q

SEMILUNAR VALVES - PULMONARY

Pulmonic valve sits

A

Between RV and pulmonary artery trunk

72
Q

SEMILUNAR VALVES - PULMONARY VALVE

of cups

A

3 cusps: right, left, anterior

73
Q

SEMILUNAR VALVES - PULMONARY VALVE

Area is

A

4 cm

74
Q

SEMILUNAR VALVES - AORTIC VALVE

The aortic sits

A

Between LV and aorta

75
Q

SEMILUNAR VALVES - AORTIC VALVE

of cups:

A

3 cusps

right (coronary)

left (coronary) and

posterior (non-coronary)

76
Q

SEMILUNAR VALVES - AORTIC VALVE

Area

A

2-4 cm

77
Q

SEMILUNAR VALVES

When in the cardiac cycle do semilunar valves (pulmonary and aortic) close? When do they open?

A

Close during ventricular diastole and

Open during ventricular systole

This is a commonality between these valves

78
Q

CORONARY CIRCULATION

What’s another name for the opening to the coronary arteries?

A

Coronary ostium

79
Q

CORONARY CIRCULATION

What’s another name for the dilated pocket just outside of the aortic valve?

A

Sinus of Valsalva or Aortic sinus

80
Q

CORONARY CIRCULATION

What’s another name for the posterior interventricular branch?

A

Posterior Descending Branch, or

Posterior Descending Artery (PDA)

81
Q

CORONARY CIRCULATION

What’s another name for the Anterior interventricular branch?

A

Left anterior descending branch, or

Left Anterior Descending artery (LAD)

82
Q

RIGHT CORONARY ARTERY

The right coronary artery arises from

A

Right aortic sinus just outside of the aortic valve, and

Runs through the coronary sulcus

83
Q

RIGHT CORONARY ARTERY

The right coronary artery has three branches:

A

Anterior branch

Acute marginal, and

Posterior descending branch (PDA)

84
Q

RIGHT CORONARY ARTERY

Which branch of the right coronary artery supplies blood to the RA?

A

Anterior branch

85
Q

RIGHT CORONARY ARTERY

Which branch of the right coronary artery supplies blood to the RV?

A

Acute marginal branch

86
Q

RIGHT CORONARY ARTERY

Which branch of the right coronary artery supplies blood to the inferior left ventricle?

A

Posterior descending branch (PDA)

This is true in 85% of the population

PDA connects with LAD in posterior interventricular sulcus

87
Q

RIGHT CORONARY ARTERY

Which branch of the right coronary artery supplies blood to AV node in 85%?

A

PDA

88
Q

RIGHT CORONARY ARTERY

Which coronary artery supplies blood to the SA node (55% of population)?

A

RCA

How about the other 45%?

89
Q

RIGHT CORONARY ARTERY

Which branch of the right coronary artery supplies blood to the Posterior Fascicle LBB?

A

PDA

90
Q

LEFT CORONARY ARTERY

The left coronary artery arises from

A

The Left Aortic sinus

91
Q

LEFT CORONARY ARTERY

As the the Left Coronary artery enters the coronary sinus, it divides into

A

The Circumflex branch, and

The anterior interventricular branch (LAD)

92
Q

LEFT CORONARY ARTERY

Important branches of the LAD include

A

Diagonal arteries: supply the anterolateral aspect of the heart

Septal branches: supply the interventricular septum, bundle branches (RBB and Anterior fascicle of LBB), and purkinje system

93
Q

LEFT CORONARY ARTERY

The LAD goes down the apex of the hart in the anterior intraventricular sulcus and passes the apex to anastomose with

A

the PDA on the posterior side of the heart

94
Q

LEFT CORONARY ARTERY

The Left circumflex courses along the atrioventricular groove and gives rise to

A

one of three obtuse marginal that supply the lateral wall of the left ventricle

95
Q

LEFT CORONARY ARTERY

While the RCA supplies blood to the SA node in 55% of the population, where do blood supply to the SA node comes from in the other 45%?

A

From the Left circumflex

96
Q

LEFT CORONARY ARTERY

In 15% of patients, the left circumflex gives rise to the PDA, which supplies the posterior inferior aspect of the left ventricle. What are these patients categorized in terms of LV coronary blood supply?

A

“left-dominant”

97
Q

RIGHT VS. LEFT DOMINANT

What does it mean to be Right vs. Left Dominant (Coronary Artery Dominance)?

A

Defined as the vessel which gives rise to the posterior descending artery (PDA), also known as the posterior interventricular branch

This is the vessel that ultimately supplies the posterior inferior aspect of the left ventricle

98
Q

RIGHT VS. LEFT DOMINANT

According to Miller, what percentage of the population is “Right dominant”? Explain coronary supply in “Right dominance”.

A

85% of patients are right dominant

In “Right dominance”, the RCA gives rise to the PDA (right dominant)

PDA supplies posterior inferior aspect of the LV

99
Q

RIGHT VS. LEFT DOMINANT

According to Miller, what percentage of the population is “Left dominant”? Explain coronary supply in “Left dominance”.

A

15% of patients are left dominant

In “Left dominance”, the PDA comes off of the left circumflex artery, thus the LCA (left dominant)

PDA supplies posterior inferior aspect of the LV

100
Q

RIGHT VS. LEFT DOMINANT

T/F: The AV node blood supply will come from which ever artery is dominant

A

True

101
Q

RIGHT VS. LEFT DOMINANT

In the majority of the population, which vessel supplies blood to the AV node?

A

RCA

102
Q

CORONARY VENOUS DRAINAGE

Where do most of the venous blood from the heart wall drains?

A

From the Coronary sinus into the RA

103
Q

CORONARY VENOUS DRAINAGE​

Where is the coronary sinus located? Where does it originate?

A

lies on the posterior side of the heart in the atrioventricular groove or coronary sulcus

is a continuation of the great cardiac and middle cardiac veins that both drain into the coronary sinus and back into the right atrium

104
Q

CORONARY VENOUS DRAINAGE​

Where are retrograde cardioplegia cannula placed during bypass?

A

In the coronary sinus

105
Q

CORONARY VENOUS DRAINAGE​

Small veins that drain directly into any chamber of the heart are also known as:

A

Thebesian veins

106
Q

CORONARY VENOUS DRAINAGE​

What’s created when Thebesian veins drain into the left side of the heart?

A

Small arteriovenous** **shunts

107
Q

CORONARY VENOUS DRAINAGE​

What percentage of arteriovenous shunts is normally present?

A

1-3%

108
Q

CORONARY VENOUS DRAINAGE​

Which coronary vein drains the anterior cardiac wall, and empties into the coronary sinus?

A

Great cardiac vein (anterior)

109
Q

CORONARY VENOUS DRAINAGE​

Which coronary vein drains posterior wall, empties into coronary sinus?

A

Middle cardiac vein (posterior)

110
Q

CORONARY VENOUS DRAINAGE​

Which coronary vein drains RA and RV, empties into RA?

A

Small cardiac vein (inferior)

111
Q

CORONARY BLOOD FLOW

What’s the range of Coronary blood flow?

A

225-250 ml/min

which is 4-7% of cardiac output

112
Q

CORONARY BLOOD FLOW

Normally coronary blood flow is autoregulated to which MAP range? What happens above or below the limits of this range?

A

Between 50-120 mmHg

This is why its important to maintain MAP in these patients because their autoregulation is dependent on MAP

Above or below the MAP limits, coronary blood flow is pressure dependent

113
Q

CORONARY BLOOD FLOW

Why is it important to maintain MAP in cardiac surgery patients?

A

Because autoregulation is dependent on MAP

114
Q

CORONARY BLOOD FLOW

What happens to autoregulation when there is an obstruction? How does it affect coronary blood flow or coronary perfusion pressure (CPP)?

A

you lose the ability to autoregulate and coronary blood flow becomes pressure dependent

so THEN coronary blood flow or coronary perfusion pressure (CPP) = diastolic blood pressure (DBP) - LVEDP

so, anything that decreases your DBP or increases your LVEDP will decrease your coronary blood flow (CPP)

115
Q

CORONARY BLOOD FLOW

T/F: Coronary blood flow directly proportional to CPP and inversely proportional to coronary vascular resistance

A

True

116
Q

CORONARY BLOOD FLOW

Why does someone who is in heart failure has a decraesed coronary blood flow?

A

Because their LVEDP is elevated

This is also why we do adequate chest compression during cardiac arrest to increase coronary blood flow

117
Q

CORONARY BLOOD FLOW

Which heart chamber receives most of the coronary blood flow?

A

80% to the left ventricle

118
Q

CORONARY BLOOD FLOW

When, in the cardiac cycle do most LV coronary perfusion occur?

A

80-90% of LV coronary perfusion occurs during diastole

119
Q

CORONARY BLOOD FLOW

What makes the RV more difficult to protect during CPB?

A

The right coronary receives blood flow during both systole and diastole

120
Q

CORONARY BLOOD FLOW

What’s the value of myocardial O2 consumption?

A

8-10 mL O2/100 g per min

121
Q

CORONARY BLOOD FLOW

What’s the value of myocardial O2 extraction?

A

65-70%

122
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

How does Coronary artery disease affect autoregulation?

A

Coronary artery disease causes a loss in autoregulation

Flow beyond the obstruction becomes pressure dependent

123
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

So when coronary perfusion pressure is inadequate, which part of the heart the first to become ischemic? Why?

A

The Subendocardial layer

When coronary perfusion pressure is inadequate, the inner ¼-1/3 of the left ventricular wall is the first to become ischemic

Because as the vessels descend into that layers of the heart, they become smaller

Blood flow is much more dependent on higher pressure in that layer

You can see why it’s important to keep MAP up

124
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

SNS stimulation causes:

A. Vasoconstriction

B. Vasodilation

A

A. Vasoconstriction

B. Vasodilation

125
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

PSNS stimulation causes:

A. Vasoconstriction

B. Vasodilation

A

A. Vasoconstriction

B. Vasodilation

126
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

How do Ischemic tissue cause the coronaries to vasodilate?

A

Ischemic tissue causes the release of local metabolic byproducts, which cause the coronaries to vasodilate

127
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

Why would a person who is chronically ischemic have their coronaries maximally dilated all the time?

A

Because the stenotic lesions decrease perfusion distal to the obstruction

So the vasculature will maximally dilate to maintain adequate blood supply

128
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

What would happen if a vasodilator like Nipride was added to a patient with chronic coronary ischemia?

A

It would cause normal coronaries to vasodilate

With blood going preferentially down the path with no obstruction, this could cause more ischemia

This is called Coronary steal

129
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

Although it has never been shown to be clinically significant, which phenomenom causes some providers to still believe atemently that the use of Nipride in CAD pts will cause ischemia?

A

Coronary steal

130
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

Which inhalation agent was suspected to cause Coronary steal?

A

Isoflurane

But now we know that inhalation anesthetics are cardioprotective

131
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

What’s responsible for the cardioprotective effect of inhalation agents?

A

Preconditionning

132
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

Once the lesion has been repaired with bypass surgery and the flow has been restored, what causes left ventricular function to be impaired after bypass surgery?

A

Reactive hyperemia, also known as

Reperfusion injury or a

Stunned myocardium, can occur

133
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

How would Reactive hyperemia, also known as Reperfusion injury or Stunned myocardium be interpreted on TEE?

A

as “Regional wall abnormality”

134
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

Explain the phenomenom of Reactive hyperemia, also known as Reperfusion injury or Stunned myocardium

A

Once flow is restored following a period of ischemia, coronary blood flow increases by 5-6x through the coronaries

This causes edema of the tissue

135
Q

FACTORS INFLUENCING CORONARY BLOOD FLOW

What is a treatment option for Reactive hyperemia, also known as Reperfusion injury or Stunned myocardium?

A

Epinephrine infusion for 24 hrs

136
Q

MYOCARDIAL ISCHEMIA= SUPPLY< DEMAND

Myocardial O2 determinants are:

A

Maintained diastolic BP

Reduced LVEDP

Increased coronary blood flow

Increasedd arterial O2 content

137
Q

MYOCARDIAL ISCHEMIA= SUPPLY< DEMAND

What determines arterial O2 content

A

Amount of hemoglobin-bound O2

Supplemental O2

138
Q

MYOCARDIAL ISCHEMIA= SUPPLY< DEMAND

Why is it more important to reduce the demand on the heart rather than trying to increase supply?

A

Eventhough a high hemoglubin level will give the blood a higher O2 carrying abilities, the minimum levels of O2 supply needed to reduce incidence of ischemia are known

It becomes important to reduce the O2 demand on the heart

139
Q

MYOCARDIAL ISCHEMIA= SUPPLY< DEMAND

Controlling for which variables reduce the O2 demand on the heart?

A

Heart rate

Contractility

Myocardial wall tension

These are the determinants of Myocardial O2 demand (MVO2)

140
Q

MYOCARDIAL ISCHEMIA= SUPPLY< DEMAND

When does perfusion of the LV occur?

A

during diastole

141
Q

MYOCARDIAL ISCHEMIA= SUPPLY< DEMAND

When does perfusion of the RV occur?

A

primarily during systole

142
Q

MYOCARDIAL ISCHEMIA= SUPPLY< DEMAND

T/F: the duration of diastole becomes extremely important when considering blood flow, especially to the LV

A

True

Because perfusion of the LV occurs during diastole

143
Q

MYOCARDIAL ISCHEMIA= SUPPLY< DEMAND

How does tachycardia decrease myocardial delivery?

A

Perfusion of the LV occurs during diastole

Time for diastole decreases with increased tachycardia

Tachycardia decreases myocardial delivery by increasing demand especially during low O2 states

144
Q

MYOCARDIAL ISCHEMIA= SUPPLY< DEMAND

Why are beta-blockers good to use in patients with myocardial ischemia?

A

Increased contractility can also impair LV function

Beta-blockers decrease contractility

145
Q

MYOCARDIAL ISCHEMIA= SUPPLY< DEMAND

Which law states that “wall stress is directly proportional to pressure 1x the radius, and inversly proportional to 2x the wall thickness”

A

LaPlace’s Law

146
Q

MYOCARDIAL ISCHEMIA= SUPPLY< DEMAND

Why is it important to reduce preload and afterload in patients with myocardial ischemia?

A

Because based on LaPlace’s Law,

any increase in chamber size (preload), or any pressure increase in the ventricle during contraction (afterload) could lead to increase wall stress

147
Q

THE CONDUCTION SYSTEM

Why are cells the atria and ventricles considered “working myocardial muscle cells” which are cells normally found in muscle mass of atria and ventricles?

A

Because they contain the property of “contractility”, or the ability to shorten and return to original length during depolarization

148
Q

THE CONDUCTION SYSTEM

What’s required in order for atria and ventricles to contract?

A

They must be electrically stimulated, or depolarized

This is a capability they do not carry themselves

149
Q

THE CONDUCTION SYSTEM

Where are pacemaker cells that have the property of “automaticity” because they can spontaneously depolarize found? What’s their main role?

A

In the SA, AV, Bundle of His, and Purkinje System

They are the electrical system of the heart

They are responsible for the formation of the electrical current that spreads to the working myocardial muscle cells, causing them to depolarize.

150
Q

CARDIAC CONDUCTION SYSTEM

What is the pacemaker of the heart? and why is it so considered?

A

The SA node is the pacemaker for the heart

It is so considered because it has the fastest automaticity, or spontaneous depolarization at a rate of 60-100 bpm

151
Q

CARDIAC CONDUCTION SYSTEM

Where is the SA node located?

A

It sits in the right atrium just at the junction of the SVC

152
Q

CARDIAC CONDUCTION SYSTEM

Down which three pathways does the SA node send its depolarization?

A

one to the left atrium via Bachman’s bundle

the other two to the AV node

153
Q

CARDIAC CONDUCTION SYSTEM

Where is the AV node lacated?

A

Just outside the fibrous skeleton of the heart

anterior to the coronary sinus

This is the floor of RA

154
Q

CARDIAC CONDUCTION SYSTEM

T/F: While the AV node receives its depolarization from the SA node (depolarizes after SA node), it also has the ability to spontaneously depolarize

A

True

But at a slower rate of 40-60bpm

155
Q

CARDIAC CONDUCTION SYSTEM

Why is conduction (not to be confused with depolarization or automaticity), why is conduction through the AV node is slow?

A

To allow for both atria to completely empty into the ventricles

This process is known as Atrial kick

156
Q

CARDIAC CONDUCTION SYSTEM

What’s another name for the process that allows for both atria to completely empty into the ventricles before ventricular contraction?

A

Atrial kick

157
Q

CARDIAC CONDUCTION SYSTEM

What percentage of Cardiac Output comes from Atrial kick?

A

20%

158
Q

CARDIAC CONDUCTION SYSTEM

In Aortic stenosis, what percentage of cardiac output could come from atrial kick?

A

40%

159
Q

CARDIAC CONDUCTION SYSTEM

What is the only connection between atria and ventricle?

A

The Bundle of His/AV bundle

Splits into left and right bundle branches

160
Q

CARDIAC CONDUCTION SYSTEM

What is the conduction pathways for the ventricles?

A

The purkinje fibers

161
Q

CARDIAC CONDUCTION SYSTEM

Where are the Purkinje fibers located?

A

They sit just below the endocardium

162
Q

CARDIAC CONDUCTION SYSTEM

The Purkinje fibers have the slowest depolarization. At what rate do they depolarize?

A

at a rate of 20-40 bpm

163
Q

CARDIAC CONDUCTION SYSTEM

Why do the the purkinjes fibers have the fastest speed of conduction?

A

Because the impulse must travel to both ventricles and contract them at the same time

164
Q

CARDIAC CONDUCTION SYSTEM

What’s the difference between “Automaticity” and “Conduction”?

A

“Automaticity” = spontaneous depolarization

“Conduction” = transmission of electrical impulse

8361 Exam I (18 decks)

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