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Multaq Phase One > Module 1 - Anatomy & Physiology of the Heart > Flashcards

Module 1 - Anatomy & Physiology of the Heart Flashcards

1
Q

Heart’s Location

A

The Heart is located in the thorax.

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2
Q

Aorta

A

The main trunk of the systemic arteries, carrying blood from the left side of the heart to the arteries of all limbs and organs except the lungs

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3
Q

Pulmonary Artery

A

Artery that carries venous blood from the right ventricle of the heart to the lungs

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4
Q

Superior Vena Cava

A

Large vein formed by the union of the two brachiocephalic veins and the azy- gos vein and that receives blood from the head, neck, upper limbs, and chest, and empties into the right atrium of the heart

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5
Q

Tap to see image of the Structures of the heart

A
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6
Q

Inferior Vena Cava

A

A large vein formed by the union of the two common iliac veins that receives blood from the lower limbs and the pelvic and abdominal viscera and empties into the right atrium of the heart

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7
Q

How does blood flow through the heart?

A

Blood normally flows through the heart from the right heart to the lungs and then to the left heart.

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8
Q

What is the flow of blood through the Right Heart?

A

The right atrium (RA) receives deoxygenated blood from the superior and inferior vena cavae (1). The RA (2) is a flexible chamber that can easily expand to accommodate larger quantities of blood, if necessary. Blood flows from the RA, across the tricuspid valve and into the right ventricle (RV), across the pulmonic valve, and out through the pulmonary artery (3) to the lungs, where oxygen and carbon dioxide are exchanged.

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9
Q

How doe the blood flow through the left heart?

A

Blood flows from the lungs to the left atrium (LA) (1) via four pulmonary veins, and from the LA across the mitral valve into the left ventricle (LV). The LV is a large muscular chamber that pumps blood across the aortic valve, into the aorta, and into the systemic circulation.1,3

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10
Q

Systemic Circulation

A

The part of the circulation that begins with the aorta and ends with the arterioles, and that carries oxygenated blood to the tissues

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11
Q

Systole

A

the rhythmic contraction of the heart, especially of the ventricles, by which blood is driven through the aorta and pulmonary artery after each dilation or diastole

This is the Squeeze!

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12
Q

The period during the normal beating of the heart in which the chambers of the heart dilate and fill with blood

This is the relax and fill!

A

Diastole

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13
Q

Pulmonic Valve

A

a structure with three cusps that regulates blood flow between the right ventricle and pulmonary artery

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14
Q

Pulmonary veins

A

Pulmonary veins –

vessels through which blood flows from the lungs to the left atrium

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15
Q

Tricuspid valve

A

Tricuspid valve –

a three-leafed structure that regulates blood flow between the right atrium and right ventricle

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16
Q

Mitral valve

A

Mitral valve –

the two-leafed structure that can open and close to regulate blood flow between the left atrium and left ventricle

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17
Q

Order of Blood Throw Through the Heart

A

A red blood cell would flow through the heart in the order represented by the large numbers.

  1. Returning from the superior and inferior vena cavae, the red blood cell would enter the right atrium and flow across the tricuspid valve into the right ventricle
  2. It would then flow out into the pulmonary artery across the pulmonic valve and into the lungs
  3. Returning from the lungs, the red blood cell would flow into the left atrium and then across the mitral valve into the left ventricle
  4. It would be pumped out into the aorta across the aortic valve
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18
Q

Heart Valves

A
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19
Q

Location of the four heart valves

A

The anatomical locations of the four valves are as follows:

  1. The tricuspid valve is between the right atrium and right ventricle
  2. The pulmonary or pulmonic valve is between the right ventricle and the pulmonary artery
  3. The mitral valve is between the left atrium and left ventricle
  4. The aortic valve is between the left ventricle and the aorta
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20
Q

Atrioventricular

A

of, relating to, or involving the atria and the ventricles of the heart

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21
Q

How Heart Valves Prevent Backflow of Blood

A

The aortic and pulmonary valves are able to prevent blood from flow- ing back into the LV and RV in part because their leaflets are mobile and pliable and able to stretch and mold themselves to the opening between the ventricular chamber and the aorta or pulmonary artery.5 The other factor is the differences in pressure that occur during the cardiac cycle that favor either opening of a valve or closing of a valve. For example, during ventricular contraction, when the pressure inside the left ventricle exceeds the pressure in the aorta, the aortic valve opens forcefully. When the blood has emptied sufficiently from the left ventricle to allow the pressure to fall below that in the aorta, the aortic leaflets snap closed.6

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22
Q

Chordae tendineae

A

The delicate tendinous cords that are attached to the edges of the atrioventricular valves of the heart and to the papillary muscles and that serve to prevent the valves from being pushed into the atrium during the ventricular contraction

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23
Q

Papillary muscles

A

group of myocardial bundles that terminate in the tendinous cords that attach to the cusps of the atrioventricular valves

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24
Q

major blood vessel types are:

A
  1. arteries,
  2. arterioles,
  3. capillaries,
  4. venules,
  5. veins.
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25
Q

Arteries

A

Are the largest vessels and have the thickest walls.
Blood flows with the greatest velocity inside the arteries. As it flows down through smaller and smaller vessels, the velocity decreases.

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26
Q

Arterioles

A

Are smaller and structured differently than arteries.
In proportion to the size of their lumen, arterioles have much thicker walls with more smooth muscle and less elastic material than arteries.

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27
Q

Capillaries

A

Are the smallest vessels in the vasculature. They are the exchange vessels of the cardiovascular system because they both pass oxygen and nutrients to the body tissues and pick up carbon dioxide and waste products from the tissues. They have the largest total cross-sectional area, and blood flows with the lowest velocity inside the capillaries, helping to facilitate this exchange.

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28
Q

Venules

A

Are veins with very thin walls in proportion to their diameters. Their walls contain smooth muscle, and the diameters of venous vessels can actively change. This characteristic allows venules — and the venous system in general — to act as a large storage reservoir of blood. When there is a need for a larger amount of blood to be returned to the heart, such as during vigorous exercise, the venous reservoir is able to supply it quickly.

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29
Q

Veins

A

Are larger in diameter and therefore have a greater carrying capacity than venules, but they are structured similarly.

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30
Q

Capacitance Vessels

A

Peripheral venules and veins normally contain more than 50% of the total blood volume. Consequently, they are commonly referred to as the capacitance vessels.

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31
Q

Blood Vessel Functions

A
  1. Regulate Blood Flow
  2. Regulate Blood Pressure
  3. Production of Neccesary chemicals
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32
Q

Action Potential

A

the change in membrane potential occurring in nerve, muscle, or other excitable tissue when excitation occurs

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33
Q

Autonomic

A

functionally independent; not under voluntary control, relating to the autonomic nervous system

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34
Q

Baroreceptors

A

sensory nerve endings that are stimulated by changes in pressure, especially one in the walls of blood vessels such as the carotid sinus

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35
Q

Depolarization

A

partial or complete elimination or counteracting of the polarization of the substance; in the heart, refers to the reduction in the transmem- brane potential

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36
Q

Hemostasis

A

the stoppage of the circulation of blood in a part of the body

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37
Q

Homeostasis

A

the ability or tendency of an organism or cell to maintain internal equilibrium by adjusting its physiological processes

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38
Q

Isovolumetric

A

characterized by unchanging volume; early phase of ventricular systole in which the cardiac muscle exerts increasing pressure on the contents of the ventricle and the ventricular volume remains constant; also refers to the period when the heart relaxes but does not change volume (isovolumetric relaxation)

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39
Q

Myofibrils

A

threadlike fibrils that make up the contractile part of a striated muscle fiber

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40
Q

Papillary muscles

A

group of myocardial bundles that terminate in the tendinous cords that attach to the cusps of the atrioventricular valves

41
Q

Refractoriness

A

the property of a cardiac cell that prevents it from developing a second action potential until it has recovered from a previous action potential

42
Q

Repolarization

A

restoration of a polarized state across a membrane, as in a muscle fiber following contraction

43
Q

Sarcoplasmic reticulum

A

the form of endoplasmic reticulum found in striated muscle fibers that stores Ca2+ for muscle contraction

44
Q

Striated muscle

A

muscle tissue that is marked by transverse dark and light bands, that is made up of elongated fibers, and that includes both skeletal and car- diac muscle in humans and other species

45
Q

Threshold potential

A

voltage level at which an action potential is initiated

46
Q

What is the name of the anatomical structure that transports blood away from the left ventricle?

A

Aorta

47
Q

Which chamber contracts to push blood across the mitral valve?

A

Left atrium

48
Q

Which one of the following is in the correct order for intracardiac blood flow (although not all steps may be included)?

A

Right ventricle

Pulmonary artery

Left atrium

Left ventricle

49
Q

What is the other name given to the mitral and tricuspid valves?

A

Atrioventricular valves

50
Q

Blood flows with the greatest velocity in the ________.

A

Arterioles

51
Q

The term exchange vessels is used to refer to which type of blood vessels in the circulatory system?

A

Capillaries

52
Q

One complete sequence of contraction and relaxation by the cardiac chambers is called _______.

A

A Cardiac Cycle

53
Q

When the aortic valve opens during ventricular contraction, the volume in the left ventricle .

A

Decreases

54
Q

The phase during which the ventricles fill with blood is

called ________.

A

Diastole

55
Q

During isovolumetric contraction of the left ventricle, pressure in the left ventricle __________.

A

Increases

56
Q

The function of the circulation is relatively independent of other organs and organ systems.

A

FALSE

57
Q

The cardiac conduction system comprises ___________.

A

Modified cardiac cells

58
Q

The primary pacemaker in the heart is the _________

A

Sinoatrial node - SA

59
Q

The atrioventricular node is located at the junction of the superior vena cava and the right atrium.

A

False

60
Q

What structure is normally the only conducting pathway between the atria and ventricles?

A

AV node

61
Q

Electrophysiology refers to the electrical impulse that develops inside the individual cardiac cells and that propagates through the heart.

A

TRUE

62
Q

Electrical activity in the heart takes place in _________ .

A

a. Only ordinary heart tissue
b. Only specialized conduction tissue
c. Only in the sinoatrial node and atrioventricular node

**d. All of the above* **

63
Q

What term refers to the capacity of certain cardiac cells to func- tion as pacemakers by spontaneously generating electrical impulses that spread throughout the heart?

A

Automaticity

64
Q

The property of the heart tissue that prevents it from being acti- vated (or depolarized) before it has recovered, at least partially, from a previous activation is called .

A

Refractoriness

65
Q

Under resting conditions, which of the following ions has the highest concentration inside the cardiac cell?

A

K+ (Potassium)

66
Q

Action potentials only occur in pacemaker cells.

A

FALSE

67
Q

Right Heart Blood Flow

A

The right atrium (RA) receives deoxygenated blood from the superior and inferior vena cavae (1). The RA (2) is a flexible chamber that can easily expand to accommodate larger quantities of blood, if necessary. Blood flows from the RA, across the tricuspid valve and into the right ventricle (RV), across the pulmonic valve, and out through the pulmonary artery (3) to the lungs, where oxygen and carbon dioxide are exchanged.

68
Q

Left Heart Blood Flow

A

Blood flows from the lungs to the left atrium (LA) (1) via four pulmonary veins, and from the LA across the mitral valve into the left ventricle (LV). The LV is a large muscular chamber that pumps blood across the aortic valve, into the aorta, and into the systemic circulation.1,3

69
Q

Location of the Heart’s Valves

A
  • The tricuspid valve is between the right atrium and right ventricle
  • The pulmonary or pulmonic valve is between the right ventricle and the pulmonary artery
  • The mitral valve is between the left atrium and left ventricle
  • The aortic valve is between the left ventricle and the aorta
70
Q

Blood vessels constrict and dilate to:

A

(1) regulate arterial blood pressure,
(2) alter blood flow between and within organs,
(3) regulate capillary blood pressure, and
(4) distribute blood volume and flow within the body.

71
Q

Regulation of Blood Pressure and Flow Diagram

A
72
Q

Baroreceptors

A

Arterial blood pressure is maintained via a sophisticated system that involves baroreceptors, which detect the amount of pressure in the arteries (Figure 1-12). Baroreceptors are stretch receptors in the walls of the heart and blood vessels.

Based on whether the detected pressure is too low or too high, baroreceptors may:

  • Increase sympathetic activity if the blood pressure is too low, caus- ing arteriolar blood vessels to constrict and raise the peripheral vas- cular resistance and blood pressure
  • Decrease sympathetic activity if the blood pressure is too high, causing arterioles to dilate, decrease the peripheral vascular resis- tance, and lower the blood pressure
73
Q

Three Phases of Hemostasis

A
  • Vascular constriction - constricts vessels to decrease blood flow
  • Platelet plug formation (primary hemostasis) - adhesion, activation, aggregation
  • Coagulation (clotting, or secondary hemostasis)
74
Q

Cardiac cycle

A

a complete beat of the heart, including systole and diastole and the intervals between, beginning with any event in the heart’s action to the moment when that same event is repeated

75
Q

Seven Phases of the Cardiac Cycle

A
  1. Atrial systole (atria push blood into the ventricles)
  2. Isovolumetric contraction (ventricles contract but do

not eject blood)

  1. Rapid ejection (blood flows rapidly out of the ventricles into the pulmonary artery and the aorta)
  2. Reduced ejection (rate of blood flow decreases)
  3. Isovolumetric relaxation (ventricle relaxes but does not

draw blood into the chamber)

  1. Rapid filling (blood flows quickly from the atria into the ventricles)
  2. Reduced filling (rate of ventricular filling decreases)
76
Q

Cardiac Cycle Wave Forms

77
Q

ECG Waves Explained

78
Q

Isovolumetric video

79
Q

Pulse Pressure

A

The difference between the peak systolic pressure and the diastolic pressure

80
Q

Cardiac Conduction System

A
  • The SA node is located at the junction of the superior vena cava and the right atrium
  • The AV node is located in the right posterior portion of the wall that separates the two atria. It is called the interatrial septum
  • There are four bundles of atrial fibers that connect the SA node to the AV node − three that connect the SA node to the AV node and a fourth, Bachman’s bundle, that goes to the left atrium (Figure 1-17):

– The anterior internodal tract – The middle internodal tract
– The posterior internodal tract – Bachman’s bundle

Conduction also occurs through the atrial myocytes, but conduction is more rapid through the bundles of atrial fibers. The atria and
the ventricles are electrically isolated from each other by the fibrotendinous ring. The AV node is normally the only conducting pathway between the atria and the ventricles

– Moving inferiorly, the AV node becomes the bundle of His, which branches into the left and right bundle branches. The branching occurs at the apex of the interventricular septum

– The left bundle branch divides into smaller components called fascicles8

81
Q

Electrical System Video

82
Q

SA Node

A

“The Pacemaker”

The activity of the pacemaker is regulated by the sympathetic and parasympathetic (vagal) nerves as well as by circulating hormones.

At rest, SA nodal activity is strongly influenced by vagal activity (vagal tone), which significantly reduces the intrinsic SA nodal firing rate to approximately 60 to 80 beats per minute. Pacemaker activity, and therefore heart rate (chronotropy), is increased by sympathetic activa- tion, and it is inhibited by the vagus nerve.1

83
Q

Pacemaker Potential of SA Node:

Explanation of the Na+, K+ and Calcium Channels

84
Q

Atrial Myocardium - Connected?

A

Studies of atrial tissue have shown that interatrial muscular connec- tions are present anteriorly, posteriorly between right pulmonary veins, and inferiorly between the coronary sinus and the right inferior pulmonary vein, suggesting that the electrical activity of the two atria are closely connected.

In patients with atrial fibrillation, these connections may be important in the response to different therapeutic agents.

85
Q

The Atrioventricular Node

A

The AV node, which is normally the only electrical bridge between the atria and the ventricles, decreases the conduction velocity between these chambers. If the SA node does not function, or the impulse generated in the SA node is blocked before it travels down the electrical conduction system, a group of cells further down the heart will become the heart’s pacemaker; this is known as an ectopic pacemaker.

These cells form the atrioventricular node (AV node), which is an area between the atria and ventricles, within the atrial septum. The cells of the AV node normally discharge at about 40-60 beats per minute, and are called the secondary pacemaker.1

86
Q

His-Purkinje System

A

The His-Purkinje system is a group of modified muscle fibers that con- ducts electrical current. The His (pronounced “hiss”) bundle arises in the AV node and continues in the interventricular septum as a single bundle. The His-Purkinje system consists of (1) the His bundle, (2) the right bundle branch, (3) the left bundle branch, and (4) the Purkinje fibers.

87
Q

The Resting Membrane Potential

A

Cardiac cells are characterized by a high intracellular concentration of potassium (K+) ions and a low concentration of sodium (Na+) ions (Figure 1-19; Table 1-1). The relative concentrations of these two ions are just the opposite in the extracellular fluid. An energy-requiring transport process maintains this unequal distribution of sodium and potassium ions by pumping potassium ions into the cell and pumping sodium ions out.

**The difference in the distribution of Na+ and K+ inside and outside the cell creates what is called a resting membrane potential. **

Generally, this is the voltage the cell like to be at when at normal resting state.

88
Q

Sodium, Potassium, and Calcium Channels

A

There are different concentrations of Na+ and K+ inside and outside of the cell; this creates a potential difference, also called voltage. These differences are maintained by pumps, which are actu- ally channels that have specific properties that allow them to trans- port molecules of a specific type in one or both directions and block the transport of other molecules. They generally require energy to function but the amount of energy varies considerably. Ions flow through the membrane channels to the other side and temporarily create a current. This current is called an action potential, which is discussed below. Certain drugs used to treat cardiac arrhythmias are able to block a single ionic channel, whereas others may have the capability to block multiple channels.

89
Q

Action Potentials

A

Normal cardiac excitability results from the delicate balance of ionic currents, which are associated with the movement of ions through specialized channels (Figure 1-20). Each ionic current can be distin- guished by its selectivity for a specific ion and the time course during which the ions flow through the channels.

The movement of ions across these channels is associated with the development of an electrical current.16

90
Q

Action Potentials via Cellular Channels

91
Q

Pacemaker Action Potentials

92
Q

Action Potentials in Different Cardiac Cells

A
93
Q

Excitability

A

Excitability refers to the ability of a heart cell to respond to an electri- cal impulse. The excitability of a cardiac cell depends on many factors, including the rate and duration of the impulse it receives. The primary determinant of excitability depends on the duration of the stimulus:

  • For a stimulus with a short duration, excitability is determined by the difference between the resting membrane potential and the voltage required to create an action potential; this is the threshold potential
  • For a stimulus with a long duration, excitability is determined primar- ily by the resistance of the cell membrane to an electrical stimulus that remains refractory or resistant to stimulation, for a period after a previous excitation19
94
Q

Conductivity

A

Conductivity is the ease with which electrical impulses are conducted within the heart. Conduction is slowest through the AV node and fast- est through the Purkinje fibers. The slower conduction speed through the AV node allows the ventricles time to fill with blood before the sig- nal for ventricular contraction arrives.18

95
Q

Automaticity

A

refers to the capacity of certain cardiac cells to function as pacemakers by spontaneously generating electrical impulses that spread throughout the heart. The sinus node is normally the primary pacemaker of the heart because of its inherent automaticity. Under special conditions, however, other cells outside the sinus node (in the atria, AV junction, or the ventricles) can also act as independent pacemakers.

96
Q

Refractoriness

A

Refractoriness is the property of the heart tissue that prevents it from being activated (or depolarized) before it has recovered, at least par- tially, from a previous activation. There are three types of refractory periods:

  1. Absolute refractory period: the interval during which a stimulus of any kind is unable to create a response
  2. Effective refractory period: the interval during which a conducted action potential cannot be elicited (similar to the absolute refractory period, the difference being the term “conducted”)
  3. Relative refractory period: the interval during which the stimulus required to create an action potential is greater than the resting threshold21
97
Q

Normal Sinus Rythym on ECG Explained

98
Q
A

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