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504 CARDIOLOGY > MODULE 1 LECTURE VIDEO QUESTIONS > Flashcards

MODULE 1 LECTURE VIDEO QUESTIONS Flashcards

1
Q

Which of the following is/are benefit(s) of a closed circulatory system with two pumps? Choose all that apply.

(A) Permits control of blood flow towards systemic tissues

(B)Avoids high concentrations of waste in systemic tissues

(C) Allows O2 to diffuse directly into all cells from the surrounding environment

(D) Allows delivery of O2 to tissues distant from the heart & lungs

A

A, B, D,

(A) Permits control of blood flow towards systemic tissues

(B)Avoids high concentrations of waste in systemic tissues

(D) Allows delivery of O2 to tissues distant from the heart & lungs

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2
Q

BLOOD FLOW

The pulmonary arteries have oxygen- (rich/poor) blood, whereas the systemic arteries have oxygen- (rich/poor) blood.

A

PULMONARY ARTERIES HAVE POOR BLOOD

SYSTEMIC ARTERIES HAVE RICH BLOOD

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3
Q

TRUE/FALSE: All veins bring deoxygenated blood to the heart, and all arteries take oxygenated blood away from the heart?

A

FALSE: This is true for systemic circulation but not for pulmonary circulation.

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4
Q

Which valve controls the flow of recently re-oxygenated blood into systemic circulation?

(A) mitral valve
(B) aortic valve
(C) tricuspid valve
(D) pulmonic valve
(E) none of these

A

(B) aortic valve

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5
Q

Which valve controls blood flow into the left atrium?

(A) mitral valve
(B) aortic valve
(C) tricuspid valve
(D) pulmonic valve
(E) none of these

A

(E) none of these
There are no valves at the venous-atrial junction; blood enters the atria directly as it flows in from venous circulation.

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6
Q

The cardiac cycle consists of a period during which the ventricle fills with blood called:

(A) systole
(B) diastole
(C) isovolumetric relaxation
(D) isovolumetric contraction

A

(B) diastole

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7
Q

At the end of which phase is there sufficient pressure in the ventricles to push the semilunar valves open against the afterload?

(A) systole
(B) diastole
(C) isovolumetric relaxation
(D) isovolumetric contraction

A

(D) isovolumetric contraction

Once the pressure in the ventricular chamber has surpassed the afterload, the semilunar valve will open, and the isovolumetric contraction phase ends as ejection of blood into arterial circulation begins.

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8
Q

Isovolumetric contraction begins when: Select all that apply

(A) The ventricles depolarize.
(B) The atria depolarize.
(C) The AV valves close.
(D) The semilunar valves open.

A

A &C

(A) The ventricles depolarize.
(C) The AV valves close.

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9
Q

Rank the atria and ventricles from highest to lowest systolic pressure.
(L=Left, R=Right, A=Atrium, V=Ventricle)

(A) LV > RV > LA > RA

(B) RV > LV > RA > LA

(C) RA > LA > RV > LV

(D) RV > RA > LV > LA

A

(A) LV > RV > LA > RA

The LV has the highest peak systolic pressure (~120 mmHg), followed by the RV (~30 mmHg). The RV which only needs to overcome the pulmonary artery afterload, which is significantly lower than the high pressures in the aorta. For the atria, the LA has a mean pressure of 8 mmHg, followed by the RA mean pressure of 2 mmHg.

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10
Q

Which heart sound is most associated with the QRS wave complex?

S1

S2

S3

S4

OS

A

S1

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11
Q

The __________can be calculated by subtracting the end-systolic volume from the end-diastolic volume. The area of the PV loop represents the ___________.

A

STROKE VOLUME
STROKE WORK

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12
Q

Which segment on the PV loop represents inflow during diastole?

ABC

CD

DEF

DEFABC

A

ABC

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13
Q

Which segment of the PV diagram would most likely represent atrial contraction?

ABC

AB

FA

right before C

A

right before C

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14
Q

Systole

A

refers to cardiac muscle contraction
ventricular muscle stimulated by AP and contracting

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15
Q

Diastole

A

Refers to the relaxation of cardiac muscle
Ventricular muscle reestablishing Na+/K+/Ca2+ gradient and is relaxing

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16
Q

Main components of the ECG

A

P:Atrial wave (observed when the atria have become depolarized/ meaning the normal membrane voltage of these muscles has reached threshold to trigger muscle contraction. (depolarization is closely followed by the A-wave which depicts atrial contraction).

QRS: ventricular wave (observed when ventricular muscles have depolarized, followed by ventricular contraction which causes the pressure inside the ventricular chambers to increase.

T: ventricular repolarization (represents repolarization of ventricular muscle, which is when the membrane voltage returns to its resting potential, and the cardiac muscle cells relax).

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17
Q

Isovolumic/Isovolumetric Contraction

A

Ventricular pressure rises

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18
Q

Ejection Phase

A

Ventricular pressure gets to high and surpasses aortic pressure, the aortic valve opens . (Aortic and ventricular pressure rises during this phase as the force of contraction presses in on blood in the chamber, pushing it out through the aortic valve).

2 parts
- Rapid Ejection: Ventricular volume drops significantly because the mitral valve is closed and the aortic valve is open, which means that blood is leaving the chamber and there’s no blood entering the chamber.

Reduced Ejection: the ECG shows the T wave, which corresponds to ventricular repolarization and relaxation of the ventricle. Ventricular pressure begins to drop and the rate of volume decreases and the ventricle is less steep.

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19
Q

Isovolumic/Isovolumetric Relaxation

A

Mitral and Aortic valves are closed
no change in volume but has a constant volume
(ventricle does not deliver all of the blood from the chamber, typically only half is delivered).

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20
Q

Convection

A
  • refers to the transfer of energy (usually as heat from the bulk movement of fluid molecules within a system
  • Movement of solutes between internal and external environments by means of convection.
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21
Q

3 MAIN FUNCTIONAL PARTS OF CIRCULATORY SYSTEM

A

3 MAIN FUNCTIONAL PARTS OF CIRCULATORY SYSTEM
1. PUMP: operates off of two pumps
2. A LIQUID: refers to the blood
3. SERIES OF CONTAINERS: refers to blood vessels that carry blood to and from different parts of the body

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22
Q

Primary role of the circulatory system

A
  • is to distribute dissolved gases and molecules for nutrition, growth and repair.
  • Circulatory system also provides means for moving chemical signs like hormones and also immune system mediators throughout the body.
  • Circulatory system also dissipate body heat by delivering heat from the core to the surface of the body.
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23
Q

The two pump dual circulatory system

A

The two pump dual circulatory system creates an efficient setup for delivering nutrients and oxygen to all systems of the body and then sending the waste products to the contact points with the external environment.

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24
Q

A single pump

A

A single pump can do the job rapidly circulating fluid between the external environment and the internal cells through a fast convection system. ** however the further away you get away from the pump the fewer available resources there are for those cells to extract from the blood.

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25
Q

Diastasis

A

period of reduced ventricular filling. (a passive process)

(by the end of rapid inflow and diastasis about 70% of the blood flow that will enter the ventricle from the atrium has done so)

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26
Q

Atrial systole

A

The P-wave of the ECG occurs, which the p-wave represents depolarization of the atria, which triggers atrial muscle contraction.

-volume and pressure within the ventricle will rise.

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27
Q

3 Atrial Pressure Waves

A

A-Wave: occurs during atrial systole.is the increase in atrial pressure due to atrial contraction

C-Wave: occurs during the beginning of ventricular contraction (ventric. contraction occurs after AV valve closes bc both AV and semilunar valves are closed).
- at this point ventricular muscle contraction builds up pressure on blood in the ventricle, but no blood is being pumped out. this causes blood to push on the AV valves and cause them to bulge into the atria.

V-Wave: slower rise in atrial pressure due to the flow of blood entering the atria from venous circulation.

  • there is no valve b/w the veins and the atria, which means that blood enters the atria steadily as it returns to the heart via the veins.
  • this atrial filling causes the steady increase in atrial pressure indicated by the V-wave.
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27
Q

S1

A

First heart sound (like lub) Closure of mitral and tricuspid valves

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28
Q

S2

A

Second heart sound (sounds like dub)
Closure of aortic and pulmonary valves

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29
Q

OS

A

Opening snap

Opening of stenotic mitral valve

-stenosis of the heart which means stiffness happens when the valve becomes stiff and thickness causes opening become narrow

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30
Q

S3

A

3rd heart sound

Diastolic filing gallop or ventricular or protodiastolic gallop

31
Q

S4

A

4th heart sound

atrial sound that creates an atrial or presystolic gallop

32
Q

PV Loop

A

the cardiac cycle diagram with the pressure y axis and volume the x axis graphed on separate axes.

33
Q

EDV: (in relation to the PV loop for left ventricle)

A

End Diastolic Volume

-the volume of the blood that is present in the left ventricle at the end of diastole immediately before isovolumetric contraction begins.

34
Q

EDPVR

A

End Diastolic Pressure Volume Relationship

-encompasses the ventricular passive filling phase of the cardiac cycle.

  • the slope of the EDPVR is the reciprocal of ventricular compliance.
    -a decrease in compliance would cause the EDPVR slope to increase. The result is that blood in the ventricle will be under a higher pressure during the filling for any given ventricular volume.
35
Q

Ventricular Hypertrophy

A

a condition in which the ventricle wall is thickened. This stiffens the ventricle and makes it less compliant.

36
Q

ESPVR

A

END SYSTOLIC PRESSURE VOLUME RELATIONSHIP

-defined as the maximal pressure that can be developed by the ventricle at any given ventricular volume.
- It represents inotropic state of the ventricle. (hearts ability to generate force).

  • defines the maximal pressure that can be generated under a given inotropic state, the PV loop cannot cross over the ESPVR.
37
Q

Stroke volume

A

the volume of blood that the ventricle pumps in a single heartbeat

  • used to determine the stroke work done by the ventricle to eject a volume of blood
    (ventricular stroke work is estimated to be the product of stroke volume and means systolic pressure during ejection.
38
Q

PRELOAD

A

refers to the force that stretches the relaxed muscle fibers,

39
Q

AFTERLOAD

A

refers to the force against which the contracting muscle must act

40
Q

INOTROPY

A

contractility of the heart

  • ESPVR depicts the inotropy of the left ventricle. That line tells the maximum force that the heart can generate when filled with a given volume of blood because the strength of contraction is what generates the pressure within the ventricle.
41
Q

EJECTION FRACTION

EF=SV/EDV

A

refers to the percentage of diastolic volume that is ejected from the ventricle during systole .

calculated by divided the stroke volume by the end diastolic volume

42
Q

CARDIOMYOCYTE

A
  • a cardiac muscle cell
    -interior is highly organized and has a striated appearance like skeletal muscle.
    -within this muscle cell are bundles of myofibrils that contain myofilaments

-** is essential for the hearts ability to contract in unison is the presence of GAP JUNCTIONDS.

  • RICH IN MITOCHONDRIA(which produce large quantities of ATP that’s necessary to sustain myocardial function.

-cardiomyocytes are shorter, branched, and interconnected from end to end by the intercalated disc.

43
Q

MYOFILAMENTS

A

muscle proteins that are classified as 2 main types

  1. thin filaments (made out of ACTIN )
  2. thick filaments (made out of MYOSIN)
44
Q

TRUE/FALSE
Cardiac Muscle is under involuntary control and is innervated by sympathetic and parasympathetic neurons of the autonomic nervous system?

A

TRUE

45
Q

INTERCALATED DISCS

A

contain gap junctions which electrically link neighboring cells

46
Q

DESMOSOMES

A

like adjacent cells mechanically which means that they provide structural support by connecting neighboring cardiomyocytes.

47
Q

Cardiac Muscle acts as…?

A

a mechanical and electrical syncytium of coupled cells.

(syncytium definition: A large cell-like structure formed by the joining together of two or more cells)

48
Q

Which regulatory protein binds calcium which allows cross-bridge cycling in cardiomyocytes?

  • phospholamban
  • troponin C
  • ryanodine receptors
  • protein kinase A
A

troponin C

49
Q

TRUE/FALSE
Cardiac muscle contains neuromuscular junctions?

A

FALSE

50
Q

Which of the following is/are true about gap junctions?

(A) Current easily passes through gap junctions.

(B) Gap junctions allow for rapid diffusion of ions, permitting functional communication between cardiomyocytes.

(C) Gap junctions are highly selective for a specific ion, similar to the voltage-gated sodium channels.

(D) Gap junctions mechanically connect neighboring cardiomyocytes.

A

A &B

(A) Current easily passes through gap junctions.

(B) Gap junctions allow for rapid diffusion of ions, permitting functional communication between cardiomyocytes.

51
Q

Which of the following are properties of cardiomyocytes?

striated muscle

voluntary control

stimulated by the sympathetic nervous system

relies on both intracellular and extracellular sources of calcium for contraction

A

striated muscle

stimulated by the sympathetic nervous system

relies on both intracellular and extracellular sources of calcium for contraction

52
Q

Ventricular muscle contraction occurs…….

A

occurs immediately after action potential

53
Q

typical resting membrane potential for cardiac muscle ranges from ?

A

-85 to 95mV

means that at rest the intracellular environment is negative in voltage compared with the extracellular environment.

54
Q

Ventricular Muscle Action Potential

PHASE 0

A

Fast Na+ channels open then slow Ca2+ channels

  • the result of the influx of sodium through voltage activated sodium channels
  • these channels are activated very fast and only allow sodium current to flow for a brief time before becoming inactivated
55
Q

Ventricular Muscle Action Potential

Phase 1

A

k+channels open
- brief depolarization due to the transient efflux of potassium

  • the depolarization of the membrane opens voltage-gated potassium channels; but open more slowly than the voltage-gated sodium channels
  • cells interior is positively charges and potassium moves down its gradient to leave the cell
56
Q

Ventricular Muscle Action Potential

Phase 2

A

Ca2+ channels open more

  • also called the plateau phase, due to the balance of cations entering and leaving the cells. (typically last around 200-300 msec in ventricular muscle)
  • like sodium and potassium the membrane voltage change triggers calcium influx through voltage gated calcium channels
  • these are the long lasting L-TYPE calcium channels, which are the predominant type in the heart . Once open they inactivate slowly.
  • VARIOUS CHEMICALS CAN MODIFY THE CONDUCTANCE OF CALCIUM ACROSS THE MEMBRANE SUCH VERAPAMIL (which acts as a calcium channel antagonist to block these channels from conduction calcium.
  • CATECHOLAMINES: can enhance conductance into the cell and is the principal mechanism by which cardiac muscle contractility is enhanced .
57
Q

Ventricular Muscle Action Potential

Phase 3

A

K+ channels open more

-the potassium efflux begins to exceed the calcium influx, resulting in repolarization of the membrane voltage toward the resting potential.

  • Vm becomes increasing negative, the conductance of the channels that carry potassium current progressively increase and accelerates repolarization.
58
Q

Ventricular Muscle Action Potential

Phase 4

A

Resting membrane Potential

-there is a steady leakage of ions across the plasma membrane

-the maintenance of the stable resting potential is due to the balance of these leaky ion currents with the active pumping of sodium out of the cell and potassium into the cell by sodium-potassium ATPase as well as pumping of calcium out of cell.

59
Q

Tetrodotoxin

A

The voltage0gated sodium channel responsible for phase 0 can be blocked by pufferfish toxin tetrodotoxin.

60
Q

ARP

A

Refers to the absoulte refractory period

  • is the part of action potential in which the cardiac myocyte cannot be excited to generate action potential again no matter how strong the stimulus.

-Occurs from Phase 0 though about 1/2 of Phase 3, until the membrane potential reaches around -50mV during repolarization.

61
Q

RRP

A
  • refers to the relative period and immediately follows the absolute refractory period.

-serve as a safety feature for cardiac tissue b/c they prevent cardiac muscle from generating the type of tetanus thats seen in skeletal muscles.

  • The cardiomyocyte remains RRP until Phase 4, which means the minimal excitation occurs during this period.
  • a larger magnitude or longer duration of stimulus can generate an action potential during RRP .
62
Q

Sort the phases of an action potential in ventricular muscle starting at threshold.

-K+ efflux > opposing influx

-Transient K+ efflux

-Na+ & K+ gradients reestablished

-Na+ influx

  • Efflux of K+ = influx of Ca2+
A
  1. Na+ influx
  2. Transient K+ efflux
  3. Efflux of K+ = influx of Ca2+
  4. K+ efflux > opposing influx
  5. Na+ & K+ gradients
63
Q

Which of the following ions causes Ca2+ release from the sarcoplasmic reticulum?

A

Ca2+

Cardiomyocytes employ calcium-induced calcium release to initiate muscle contraction.

64
Q

Calcium transport out of the cytosol occurs via 3 mechanisms?

A
  1. Calcium ATPase in the sarcoplasmic reticulum membrane called SERCA to sequester intracellular calcium and the two methods for extruding calcium from the cell entirely.
  2. the sarcolemmal calcium ATPase
  3. the sarcolemmal exchange of sodium for calcium
65
Q

TRUE/FALSE
The activity of the sodium-potassium pump always plays a role in calcium removal.

A

True

66
Q

A class of drugs called cardiac glycosides which include digoxin does what?

A

takes advantage of this role for treatment of heart failure by increasing the strength of cardiac contractions.

-it inhibts the sodium potassium pump in cardiomyocytes

67
Q

TRUE/FALSE :Blocking the sodium-potassium pump, the sodium calcium exchanger slows down and calcium stays inside the cell to strengthen contraction?

A

TRUE

-this is a pharmacological mechanism for increasing the strength of cardiac muscle contraction

68
Q

TRUE/FALSE
Another way to incease the strength of cardiac contraction is through Catecholamines?

A

-TRUE
-ex.epienephrine noepinephrine,
- Catecholamines activate beta-adreneric receptors to increase heart rate and contractile force.

69
Q

Catecholamines activate ___________ to increase heart rate and contractile force.

A

beta- adrenergic receptors

  • this process occurs through the G-protein mediated increase in cyclic AMP and enhanced activity of a cAMP dependent protein kinase

-catecholamines bind to a receptor that increase the activity of kinases inside the cell, which then go on to phosphorylate target proteins.

70
Q

PHOSPHOLAMBAN

A

-a protein that inhibits the SERCA pump
-slowing down the activity of phospholamban, effectively eases up to allow SERCA to sequester calcium quickly.

  • a key regulator in cardiac contractility
  • modulates the sequestration of calcium in the sarcoplasmic reticulum b/c of inhibition of SERCA when its in dephosphorylated state.
71
Q

Which of the following are example of primary active transport?

(A) PMCA (Plasma Membrane Calcium ATPase)

(B) SERCA (Sarcoplasmic and Endoplasmic Reticulum Calcium ATPase)

(C) Na/K pump

(D) NCX (Na/Ca eXchanger)

A

(A) PMCA (Plasma Membrane Calcium ATPase)

(B) SERCA (Sarcoplasmic and Endoplasmic Reticulum Calcium ATPase)

(C) Na/K pump

-Primary active transport uses the energy from ATP hydrolysis to move its substrate against its concentration gradient. The NCX is electrogenic, reversible, and does not use ATP hydrolysis to fuel the Na+ & Ca2+ antiport mechanism.

72
Q

Stimulation of the sympathetic nervous system enhances the contractile force of the cardiac muscle through which mechanisms?

(A) Increasing calcium entry

(B) Phosphorylating the regulatory protein phospholamban

(C) Decreasing inhibition of SERCA

(D) Phosphorylating cardiac TnI (tropinin I), which changes the protein conformation and its interaction with other troponins

A

(A) Increasing calcium entry

(B) Phosphorylating the regulatory protein phospholamban

(C) Decreasing inhibition of SERCA

(D) Phosphorylating cardiac TnI (tropinin I), which changes the protein conformation and its interaction with other troponins

-All 4 of these mechanisms occur following beta-adrenergic stimulation through catecholamines.

73
Q

INa

A

net flow is 0 due to the rapid sodium influx. Phase0 curve
dashed line

74
Q

ICa

A

Calcium curve which immediately shuts off b/c channels inactivate very quickly

-anything below the dashed line denotes the net ion flowing into the cell.

2 types of calcium channels
1. T-type
2. L-type: slower to open and closed conduct inward calcium current

75
Q

IK

A

Potassium curve
-a line above the net ion denotes current flowing out of cell

504 CARDIOLOGY (2 decks)

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