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Phase 1 flashcards > Quick Cardio physiology > Flashcards

Quick Cardio physiology Flashcards

1
Q

superior mediastinum

A

aortic arch

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2
Q

anterior mediastinum

A

thymus
lymph nodes
internal thoracic vessels
thyroid tissue

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3
Q

middle mediastinum

A

heart and pericardial sac
ascending aorta
SVC
IVC
pulmonary vessels
trachea and main bronchi
phrenic
vagus
LRLN
all the good stuff

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4
Q

posterior mediastinum

A

descending aorta
oesophagus
azygos (right) and hemiazygos (left)

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5
Q

layers of heart

A

epicardium, myocardium, endocardium
epicardium - adipose tissue, vessels and nerves
myocardium - muscle
endocardium - inner endothelial cells

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6
Q

ventricle muscle ridges

A

trabeculae carneae

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7
Q

where are pectinate muscles?

A

atria

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8
Q

first branch from aorta

A

coronary arteries
left and right

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9
Q

borders of the heart

A

right - right atrium
inferior - left and right ventricles
left - left ventricle and some left atrium
superior - L and R atria and great vessels

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10
Q

what does the RCA supply

A

right atrium
right ventricle

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11
Q

what does the RMA supply?

A

right ventricle
apex

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12
Q

what does the PIV supply?

A

AVN
posterior third of IV septum

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13
Q

AVN blood supply

A

PIV always

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14
Q

what does the LAD supply?

A

anterior 2/3 IV septum
R and L ventricle

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15
Q

what does the LMA supply?

A

left ventricle

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16
Q

what does the Cx supply?

A

left atrium
left ventricle

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17
Q

heart dominance

A

PIV from RCA only - 70%
PIV from LCA only - 10%
PIV from both - 20%

be careful to see how it is worded!

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18
Q

SAN blood supply

A

60% RCA
40% LCA

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19
Q

apex beat

A

left 5th intercostal space midclavicular line

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20
Q

auscultation points for:
aortic valve
pulmonary
mitral
tricuspid

A

right 2nd IC sternal border
left 2nd IC sternal border
left 5th IC MCL
right 5th IC sternal border
only the mitral valve is mid clavicular line
you would think aortic valve would be on left since left ventricle is on left but it pumps to the other side

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21
Q

right phrenic nerve

A

travels along pericardium of right atrium
descends anterior to lung root

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22
Q

where does RIGHT phrenic pierce diaphragm?

A

T8 with IVC

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23
Q

left phrenic nerve

A

descends anterior to lung root
travels along pericardium of left ventricle
does not pass diaphragm at T8

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24
Q

vagus nerve relative to lung root

A

posterior

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25
Q

where does vagus pass through diaphragm?

A

T10 with oesophagus

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26
Q

where do the left and right RLN loop back up?

A

left - under arch of aorta
right - under right subclavian

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27
Q

which chemoreceptor does vagus innervate?

A

carotid sinus

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28
Q

truncus arteriosus

A

aorta
pulmonary trunk

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29
Q

bulbus cordis

A

smooth part of ventricles (outflow parts)

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30
Q

primitive ventricle

A

trabeculated parts of ventricles (majority)

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31
Q

primitive atrium

A

trabeculated parts of atria (auricular appendages)
entire left atrium
anterior right atrium

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32
Q

sinus venosus

A

smooth part of right atrium (posterior)
coronary sinus
oblique vein of left atrium
vena cavae

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33
Q

smooth part of right atrium

A

sinus venarum

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34
Q

which layer does the heart develop from

A

mesoderm

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35
Q

cardiac embryology stages

A

formation of primitive heart tube
cardiac looping
cardiac septation

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36
Q

layers of primitive heart tube, superior to inferior

A

truncus arteriosus
bulbus cordis
primitive ventricle
primitive atrium
sinus venosus

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37
Q

formation of primitive heart tube

A

mesoderm
cells from cardiogenic region form endocardial tubes
endocardial tubes fuse to form primitive heart tube
20-21 days

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38
Q

cardiac looping

A

bulbus cordis moves inferiorly and anteriorly
primitive ventricle moves superiorly and posteriorly
primitive atrium and sinus venosus move superiorly and posteriorly
only bulbus cordis moves differently

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39
Q

cardiac septation

A

forming the septum
at this point, there is one atrium and one ventricle connected by atrioventricular canal
endocardial cushions grow from sides of AV canal
cushions fuse to form left and right atrioventricular canal

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40
Q

first aortic arch

A

maxillary artery

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41
Q

second aortic arch

A

stapedial artery

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42
Q

third aortic arch

A

proximal internal carotid artery
common carotid artery

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43
Q

fourth aortic arch

A

right side - right subclavian artery
left side - aortic arch

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44
Q

5th aortic arch

A

regresses

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45
Q

sixth aortic arch

A

right - pulmonary trunk
left - left pulmonary artery and ductus arteriosus

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46
Q

layers of arteries, out to in

A

tunica adventitia
external elastic lamina
tunica media
internal elastic lamina
tunica intima
basement membrane
lumen

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47
Q

what are blood vessels inside blood vessels, and in which layer are they?

A

vaso vasorum
tunica adventitia

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48
Q

muscular artery examples

A

coronary arteries
femoral artery
radial artery
usually peripheral

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49
Q

difference between elastic and muscular arteries

A

elastic
- media larger than adventitia
muscular
- media = adventitia

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50
Q

types of capillary

A

continuous, fenestrated, discontinuous

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51
Q

how many muscle layers do arterioles have?

A

3 or fewer

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52
Q

end diastolic volume

A

100ml

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53
Q

stroke volume

A

70ml

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54
Q

end systolic volume

A

30ml

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55
Q

equation for ejection fraction

A

stroke volume/ end diastolic volume x 100
percentage of blood pumped out of the left ventricle during systole

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56
Q

normal value for ejection fraction

A

70%

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57
Q

duration of cardiac cycle

A

0.8s

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58
Q

duration of diastole

A

0.5s

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59
Q

duration of systole

A

0.3s

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60
Q

parts of systole

A

isovolumic contraction
ejection

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61
Q

parts of diastole

A

isovolumic relaxation
rapid filling
passive blood flow
atrial booster

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62
Q

isovolumic contraction

A

AV valve closes when ventricular pressure exceeds atrial pressure
but pressure is not high enough to open aortic valve
therfore isovolumic contraction increases pressure but does not affect the volume
this increase in pressure causes the aortic valve to open leading to ejection

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63
Q

ejection

A

aortic valve opens
only 70% blood is pumped out

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64
Q

passive blood filling

A

rapid filling at first
then diastasis reached

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65
Q

atrial booster

A

atrial walls contract to fill ventricles

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66
Q

the closure of which valve = dub

A

semilunar valves

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67
Q

window maker

A

LAD

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68
Q

are the heart sounds made by the valves opening or closing?

A

closing

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69
Q

what do pulmonary arteris divide into?

A

lobar arteries

70
Q

how many pulmonary veins?

A

4

71
Q

what do subclavians supply?

A

arms

72
Q

what do carotids supply?

A

face and neck

73
Q

mean arterial pressure

A

diastolic volume + 1/3 (pulse pressure)
average arterial pressure during one cardiac cycle

74
Q

pulse pressure

A

systolic - diastolic

75
Q

blood pressure

A

cardiac output x TPR
TPR is exerted by vascular walls

76
Q

myogenic autoregulation

A

increased stretch of vessels during blood flow can stimulate contraction

77
Q

local vasoconstrictors

A

endothelin-1 produced by endothelial cells

78
Q

local vasodilators

A

hypoxia
adenosine and bradykinin
NO from endothelial cells
increase in K, CO2 and H

79
Q

release of NO and endothelin-1

A

NO is a vasodilator produced continuously
endothelin-1 is released in response to stimuli

80
Q

what are baroreceptors and where are they located?

A

peripheral pressure sensing receptors
arterially in
- carotid sinus
- aortic arch
venously in
- veins
- myocardium
- pulmonary vessels

81
Q

what must we do in exam questions?

A

give units
be specific .g not CO2 level, say PaCO2 for arterial carbon dioxide partial pressure
differentiate between bundle of his, left and right bundle branches and purkinje fibres

82
Q

what must we do when talking about blood transport in the pulmonary system?

A

talk about how pulmonary artery splits into left and right

83
Q

what do central and peripheral chemoreceptors respond to?

A

central
increase in PaCO2

peripheral
increase in PaCO2
fall in PaO2

84
Q

cardiac preload vs afterload

A

preload
stretching of cardiac muscles before contraction
i.e caused by EDV

afterload
force myocytes coontract against

preload is a volume
afterload is a force

85
Q

effect of increase in EDV

A

increased stretch of myocardium
increase in sarcomere length
increased length of overlapping filaments
increased force of contraction
increased stroke volume

86
Q

what is a sarcomere?

A

basic contractile unit of a myocyte (muscle fibre)
a sarcomere is composed of two main protein filaments (thin actin and thick myosin filaments)

87
Q

sarcomere physiology

A

increased stretch opens stretch sensitive calcium channels
stretch enhances affinity of troponin C for Calcium
increased force of contraction as a result

88
Q

when maximum stretch reached

A

little overlap between actin and myosin
lots of unbound myosin heads
decreased stroke volume

89
Q

factors affecting preload

A

ventricular compliance
heart rate
venous return
ventricular compliance
valvular resistance
atrial contractility

90
Q

myocyte action potential - look at graph!

A

phase 0 - fast depolarisation and overshoot
- AP of adjacent cell induced due to movement of ions between gap junctions
- voltage gated sodium channels open
- rapid depolarisation
- channels close immediately afterwards

phase 1 - notch
- opening of transient K+ channels
- efflux of potassium
- small repolarisation
- +10mV to 0mv

phase 2 - plateau
- L-type Ca2+ channels open
- influx of calcium balanced by K+ efflux
- less duration in atria than ventricles as ventricles need greater contraction

phase 3 - repolarisation
- closure of calcium channels
- opening of more potassium channels for K+ efflux

phase 4 - baseline
- resting membrane potential achieved by action of Na/ K+ ATPase pump
- also achieved by membrane being more permeable to K+

remember it starts on 4, then 0, then 1…

91
Q

how long is the delay at the AVN?

A

0.1s
to allow ventricles to fill fully

92
Q

where is the Bachmann’s bundle?

A

left atrium

93
Q

how many libres of blood?

A

5

94
Q

blood serum

A

blood plasma without clotting factors

95
Q

haematocrit

A

proportion of erythrocytes
0.45

96
Q

where is haematopoeisis in
adults
embryo

A

adults
- bone marrow
embryo
- other sites e.g spleen

97
Q

platelet life span

A

6h

98
Q

blood cell growth factors

A

erythropoietin - rbc
granulocyte colony stimulating factor - wbc
thrombopoietin - platelet

99
Q

wbc life span

A

days to weeks to years

100
Q

rbc precursor cells located where?
adults
children
in utero

A

adults
- axial skeleton
- skull, ribs, spine
children
- all bones
utero
- yolk sac
then liver, then spleen

101
Q

how to remember which factors push o2 dissociation curve right

A

CADET face right
increase in these causes right shift
- co2
- acidity (decrease in pH)
- DPG
- exercise
- temperature
decrease in affinity
Bohr effect

102
Q

haldane effect

A

oxygen displaces carbon dioxide from Hb

103
Q

haem

A

protoporphyrin IX and iron

104
Q

what is anaemia?

A

hb deficiency
NOT RBC deficiency necessarily

105
Q

types of anaemia

A

impaired production
increased haemolysis

106
Q

iron deficiency anaemia

A

low iron diet
low mcv - mean cell volume
microcytic

107
Q

vitamin b12/ folate deficiency anaemia

A

pernicious anaemia
causes
- autoimmune attack on gastric mucosa
slow onset as LIVER stores B12 for 3-5 years
- lack of folic acid in diet
- lack of b12
both needed for rbc dna maturation and to condense
high MCV - macrocytic
high mcv because dna not condensed

108
Q

haemorrrhagic anaemia

A

blood loss
peptic ulcer
gunshot wound
normal mcv of course!

109
Q

aplastic anaemia

A

affects all blood cells
caused by destruction of bone marrow e.g chemotherapy
common myeloid progenitor destroyed
causes pancytopenia
- anaemia
- leukopenia
- thrombocytopenia

110
Q

where are beta 2 receptors

A

lung

111
Q

where are beta 1 receptrs

A

heeart

112
Q

what is the a band of a sarcomere?

A

mostly myosin
dark band

113
Q

thalasseaemia

A

congenital
alpha or beta depending on which subunit of haemoglobin is reduced/ absent

114
Q

haemolytic anaemia

A

hereditary
- G6PD deficiency
acquired
- autoimmune haemolytic anaemia
- infection e.g malaria

115
Q

agranulocytes

A

monocytes
lymphocytes

116
Q

granunocytes

A

basophils
eosinophils
neutrophils

117
Q

which cells differentiate into macrophages?

A

monocytes

118
Q

macrophage examples

A

liver Kupffer cells
microglial cells of CNS
tissue macrophages

119
Q

lymphocytes

A

B cells
- antibodies
T cells
- bone marrow then thymus
natural killer cells
- kill virus infected cells

120
Q

platelet structure

A

anucleat
discoid then
become spiculated with pseudopodia once activated
haemostasis

121
Q

where is tpo produced?

A

liver and kidneys

122
Q

largest white blood cell

A

monocyte

123
Q

primary haemostasis

A

platelet plug formation

vessel injury
- endothelial wall exposed
- smooth muscle contracts to limit blood loss
- mechanisms of contraction are nervous stimulation and endothelin release

adhesion
- subendothelial collagen exposed
- platelets bind to collagen via vWF using their receptor GP1B

activation and granule release
- once bound, platelets change shape
- alpha and electron dense granules released from platelets to escalate haemostasis

aggregation
- more platelets join and they bind to each other using GP2b/3a receptors and fibrinogen

124
Q

secondary haemostasis

A

coagulation cascade
fibrin clot formation

125
Q

contents of alpha dense granules

A

vWF
fibrinogen
fibrin stabilising factor

126
Q

contents of electron dense granules

A

ADP
Ca2+
serotonin

127
Q

coagulation cascade

A

intrinsic
12-11-9-8
extrinsic
3-7
both
10-5-2-1
(5x2x1=10)

128
Q

what triggers intrinsic pathway?
extrinsic pathway?

A

internal damage to vessel wall
external damage

129
Q

factor 2

A

thrombin

130
Q

factor 1

A

fibrinogen

131
Q

factor 1a

A

fibrin

132
Q

factor XIIIa

A

fibrin stabilising factor

133
Q

factor 4

A

Ca2+

134
Q

vitamin K dependent factors

A

1972

10, 9, 7, 2

135
Q

types of blood transfusion

A

homologous
- emergency transfusion
autologous
- self-transfusion

136
Q

cross matching

A

mix recipient serum with donor blood

137
Q

what factors influence haematocrit?

A

erythropoiesis and haemolysis

138
Q

site of haemolysis

A

spleen
bone marrow
lymph nodes

139
Q

causes of high haematocrit

A

dehydration
polycythemia

140
Q

fibrinolysis

A

by plasmin
intrinsic action by factor 7a and extrinsic action of tissue plasminogen activator converts plasminogen to plasmin
plasmin causes degredation of fibrin

factor 7a is part of thee extrinsic pathway in the coagulation cascade and part of the intrinsic pathway in the fibrinolytic system

141
Q

heart embryology

A

week 3/4
- visceral mesoderm –> 2x heart tubes
heart tubes fuse (lateral folding) –> craniocaudal folding –> heart tube has divisions now
primitive heart tube has 5 section
- truncus arteriosus
- bulbus cordis
- primitive ventricle
- primitive atrium
- sinus venosus
septation
cardiac looping
aortic arches

142
Q

when does heartbeat start

A

day 23

143
Q

when does heart appear

A

week 3

144
Q

when does the ductus arteriosus close?

A

10-15h after birth

145
Q

obstetrical climbing

A

constriction of umbilical vein to form ligamentum teres

146
Q

embryological remnants

A

ductus arteriosus to ligamentum arteriosum
umbilical vein to ligamentum teres
umbilical arteries to medial umbilical ligament
foramen ovale to fossa ovale
ductus venosus to ligamentum venosum
urachus/ median umbilical ligament - remnant of allantois - foetal bladder drains here - urinary bladder to umbilicus

147
Q

why does the foramen ovale close?

A

increased left atrial pressure
decreased right atrial pressure
due to first breath

148
Q

cardiac myocyte membrane potential

A

-90mV

149
Q

is the action potential of the heart longer than skeletal muscle?
is the absolute refractory period longer?

A

yes
yes

150
Q

pacemaker potential

A

3 phases
phase 4
- leaky F type Na channels (permeable to K+) open
- ‘funny’ as open when most negative
- positive Na+ influx causes gradual -60mV to -40mV

phase 0
- T-type Ca2+ channels open
- depolarisation from -40mV to +10mV

phase 3
- +10mV to -60mV
- closure of T type Ca2+ channels and opening of K+ channels

responsible for automaticity of the heart

151
Q

primary pacemaker
latent (potential) pacemakers

A

primary - SAN - highest rate of discharge
latent
- AVN
- bundle of his
- purkinje fibres

152
Q

control of pacemaker potential
sympathetic and parasympathetic

A

NAd is sympathetic
- increases Ca2+ channel opening
- faster depolarisation
- stepher phase 0
- increases heart rate and force of contraction

ACh is parasympathetic
- decreases heart rate
- activates K+ channels
- hyperpolarises membrane
- longer to reach threshold potential
- decreases calcium influx
- decreases slope of pacemaker potential

153
Q

excitation-contraction coupling

A

waves of depolarisation spread into myocytes via T-tubules
L-type Ca2+ channels open
Ca2+ enters muscle cell
Ca2+ binds to ryanodine receptor
release of more calcium from sarcoplasmic reticulum
(calcium induced calcium release)
calcium binds to troponin to uncover active site on tropomyosin
cross bridge cycling = muscle contraction
force of contraction is directly proportional to levels of cytosolic Ca2+

154
Q

what determins force of cardiac contraction?

A

cytosolic Ca2+
so drugs that increase myocardial contractility increase cytosolic calcium levels
e.g adrenalin

155
Q

difference between segment and interval

A

segment
- period of isoelectric neutrality
interval
- a region including magnitude

156
Q

PR segment

A

delay in AVN
because it is between end of P wave (atrial contraction) and start of QRS complex (vent. contraction)

157
Q

ST segment

A

plateau phase of ventricular repolarisation

158
Q

PR interval

A

atrioventricular conduction time

159
Q

QT interval

A

total ventricular contraction during systole

160
Q

how many leads? how many of each type?

A

12 leads
6 limb leads
- 3 bipolar
- unipolar
6 chest leads
- all unipolar

161
Q

one small square and one large square

A

small - 0.05s
large 0.2s

162
Q

limb leads

A

3 bipolar - I, II, III
3 unipolar (augmented) - aVR, aVL, aVF

163
Q

lead electrode placements

A

lead V1
- 4th intercostal space right sternal border

V2
- 4th ICS left sternal border

V3
- midway between V2 and V4

V4
- 5th ICS midclavicular line

V5
- anterior axillary line at the same level as V4

V6
- midaxillary line at same level as V4 and V5

164
Q

Frank Starling Curve

A

find picture
2 ways stroke volume increases
1. increased stretch opens stretch sensitive calcium channels
increased cytosolic calcium
increased force of contraction

  1. stretch enhances affinity of troponin C for calcium
    increased force of attraction

after maximum stretch reached
- little overlap between actin and myosin
- lots of unbound myosin heads
- decreased force of contraction
- decreased stroke volume

165
Q

positive ionotrophy

A

increased contractility
agents
- adrenaline, thyroxine
- drugs e.g digitoxin
- sympathetic nervous system

166
Q

negative ionotrophic agents

A

beta blockers
parasympathetic nervous system

167
Q

poiselles law

A

.

168
Q

what controls blood volume?

A

RAAS

169
Q

intrinsic blood pressure control

A

myogenic autoregulation
- arterioles regulate its own blood pressure based on how much it is stretched
- constrict if pressure increases

local mediators
vasoconstrictors
- endothelin 1
vasodilators
- prostacyclin
- hypoxia in systemic circulation
- tissue factor
- NO
- bradykinin
- protons, potassium, calcium

170
Q

extrinsic blood pressure control

A

circulating hormonal factors
vasoconstrictors
- adrenaline - alpha adrenergic receptors
- angiotensin II
- vasopressin
dilators
- ANP
- adrenaline - beta 2 adrenergic receptors
baroreceptors
- pressure
- carotid sinus and aortic arch
- afferent neurons are CN 9 and 10
- efferent are SNS or PNS to heart and vessels
neural control

171
Q

how is blood controlled long and short term

A

long - RAAS and blood volume
short - baroreceptors

Phase 1 flashcards (27 decks)

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