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CVS > Session 2- heart anatomy and CO > Flashcards

Session 2- heart anatomy and CO Flashcards

1
Q

Which system needs the most blood at rest?

A

Gastrointestinal system

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2
Q

Cardiac muscle functions as a _____. The cardiac myocytes communicate through ___ _____?

A

Syncytium

gap junctions

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3
Q

What can the jugular vein pulse tell you?

A

Approximate right heart function

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4
Q

On a Wiggers diagram, why does the pressure in the ventricles fall more steeply (quicker) than the aortic pressure?

A

The aorta (and pulmonary artery) is elastic

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5
Q

Length of systole and diastole?

A

systole 0.35s

diastole 0.55s

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6
Q

What holds the atrioventricular valves closed?

What does this stop?

A

chordae tendinae and papillary muscles in the ventricles

Atrial regurgitation during ventricular contraction

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7
Q

Pressure in the atrium and ventricles?

A

Right heart
A- 0-4 mmHg
V- 25* / 4’ mmHg

Left heart
A 8-10mmHg
V 120 / 10 mmHg

*systole ‘diastole

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8
Q

Pressure in the arteries leaving the heart?

A

Pulmonary artery
25*/ 10’ mmHg

Aorta
120/ 80 mmHg

*systole ‘diastole

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9
Q

How long is the cardiac action potential?

How long is the AVN delay?

A

280 ms

120ms

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10
Q

The pacemaker cells are muscular/ neuronal in origin?

Conduction through the ventricles spreads in what direction?

A

muscular- specialised cardiac myocytes

endocardial to epicardial face
inner to outer surface

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11
Q

Describe an atrial pressure curve

Hint; there are 3 waves and 2 descents

A

A wave- Atrial contraction/ kick
C wave- mitral valve closes so atrial volume reduces and pressure transiently increases
X descent- base of atria is pulled downwards in ventricular contraction so volume increases and pressure falls
V wave - venous return
Y descent - mitral valve opens

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12
Q

When does the mitral valve open?

When does the aortic valve close?

A

When ventricular pressure falls below atrial

When ventricular pressure falls below aortic

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13
Q

What is the atrial kick?

How does the majority of ventricular filling occur?

A

Atrial contraction which forces the final 10% of blood volume into the ventricles

90% full due to passive filling

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14
Q

What are the 7 stages of the cardiac cycle?

A

SYSTOLE

1) Atrial contraction
2) Isovolumetric contraction
3) Rapid ejection

DIASTOLE

4) reduced ejection
5) isovolumetric relaxation
6) rapid filling
7) reduced filling

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15
Q

Why does the rate of ventricular emptying reduce?

Why does the rate of ventricular filling reduce?
What is this stage called?

A

Ejection rate reduces because repolarisation (T wave) reduces tension in the ventricles

Filling rate reduces because it approaches its inherent relaxed volume (90% full); passive filling has ceased
- diastasis

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16
Q

What is the dichrotic notch on a Wigger’s diagram?

A

Brief increase in aortic pressure due to closure of the aortic valve
(as ventricular pressure falls below pressure in the aorta)
The aortic volume reduces so pressure rises transiently

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17
Q

Normal EDV and ESV values?

A

EDV - 120ml
ESV- 50ml

(SV 70ml)

18
Q

When are the two heart sounds heard in the cardiac cycle?

When would you hear S3 in the cycle and what does it signal?

Who is more likely to have an S3 sound?

A

S1 - isovolumetric contraction
S2- isovolumetric relaxation

S3- phase 6/ rapid filling
It signals turbulent flow during filling

Common in children
pathological in adults

19
Q

The S2 sound is 2 sounds very close together. Explain.

A

Closure of the aortic valve minutely precedes that of the pulmonary valve due to higher pressure gradients on the Left side

20
Q

How long does a cardiac cycle last?

How do you label the axes of a wiggers diagram?

A

0.9 s

X axis- time/ seconds
Y- Pressure/ mmHg
Volume/ ml

21
Q

What is the jugular venous pulse used for?

Where is it measured?

What does the JVP waveform look like?

A

Indicates right atrial pressure
(because there’s a direct column of blood from the atria to the internal jugular vein)

Right internal jugular vein

Biphasic pulse (2 peaks per cardiac cycle); exactly the same as the atrial pressure curve

22
Q

How do you measure the jugular venous pressure?

A

Two methods;

  • measure height of the pulse behind the sternocleidomastoid muscle (normal; 5-8 cm H20)
  • Insert a central line into the internal jugular vein to see the waveform
23
Q

What’s the normal height of the jugular venous pulse?

Where is it seen?

A

5-8cm H20

Behind the sternocleidomastoid muscle

24
Q

What could increase the JVP?

A
  • Impaired filling
  • Impaired ejection of R side
  • Volume overload with IV infusion
25
Q

What does aortic valve stenosis sound like?

A

crescendo- decrescendo

1 sound

26
Q

What can aortic stenosis cause?

What causes aortic stenosis?

A
  • left ventricle hypertrophy
  • left sided heart failure, leading to syncope or angina
  • microangiopathic haemolytic anaemia
  • old age (senile calcification)
  • Rheumatic fever
  • congenital defect; bicuspid aortic valve
27
Q

Aortic stenosis causes which type of anaemia?

How?

A

microangiopathic haemolytic anaemia

RBC’s lyse/ are damaged through narrowed valve and are cleared by the spleen; the bone marrow cannot replenish RBC numbers quicker than they are removed

28
Q

Which is the only heart valve to have 2 cusps?

A

The mitral/ bicuspid valve between the left atrium and ventricle

29
Q

Which bacterium causes rheumatic fever?

How does rheumatic fever damage heart valves?

A

Streptococcus Pyogenes

Streptococcal antibodies bind epitomes on the heart leading to inflammation and commissure fusion (where the leaflets join).

30
Q

What is aortic valve regurgitation?

What can cause it?

A

Blood flows back into the ventricle during diastole (doesn’t close properly)

  • Aortic root dilation (leaflets pulled apart)
  • Damaged valves; Rheumatic fever/ endocarditis
31
Q

Symptoms of aortic regurgitation?

Sound of aortic regurgitation?

A
  • Bounding pulse (heart is beating extra hard)
  • Head bobbing in time with heart
  • Quinke’s sign (nail beds flush and pale in time with heart)

2 sounds
II IIIIiiiiiiii
Early diastolic decrescendo

32
Q

Why does aortic regurgitation increase the stroke volume?

Why does it cause bounding pulse?

A

Blood flows backwards into the left ventricle during diastole- stretching the myocardium and increasing contractility according to the starling mechanism

Large pressure difference between systole and diastole

  • diastolic pressure falls as blood returns to ventricle
  • systolic pressure rises bc pump more out
33
Q

Mitral valve reguritation increases the ____ which causes LV ______.

What does it sound like?

A

preload
hypertrophy

Holosystolic murmer
(one sound)

34
Q

What is the preload?

A

The end diastolic stretch generated by the volume of the ventricles before systole

35
Q

What causes mitral valve regurgitation?

A
  • Damage to the papillary muscles after heart attack
  • Fibrosis (scarrring) after rheumatic fever
  • Stretched valve due to LV dilation in left sided heart failure
36
Q

Why does mitral valve stenosis cause pulmonary oedema?

It causes hypertrophy of which ventricle?

A

Less blood entering the L ventricle (leaving the L atrium) and pumped into systemic circulation; thus there’s a backlog of blood in the pulmonary circulation.

Right ventricle hypertrophy because the R side pumps blood into the pulmonary circulation and the backlog of blood creates a greater resistance

37
Q

In mitral valve stenosis, the left atrium becomes ____ which increases the risk of ___ ______ and ____ of the oesophagus which leads to difficulty _____ing?

A

dilated (stretched and weakned)

atrial fibrillation (more likely for a thrombus to form)

compression of the oesophagus

difficulty swallowing (dysphagia)

38
Q

Describe the 2nd heart sound

When can turbulent flow occur in health individuals?

A

lup-dup (heart sounds)

dup- higher frequency, shorter duration, lower intensity (quieter)

during exercise

39
Q

How does venous pressure influence EDV?

A

The ventricles will fill until ventricular pressure equals venous pressure- thus the venous pressure determines the preload

40
Q

How does a fall in TPR increases the SV?

How does the pressure within the ventricles change?

A

If the TPR reduces so does the afterload and it’s easier for the heart to push blood into the circulation. Thus more blood leaves with one contraction- the stroke volume increases

It is lower because they’re pushing against a smaller force

41
Q

Neurotransmitters which increase contractility?

What effect does this have on the SV?

A

Adrenaline, Noradrenaline

Increases SV at a given preload and afterload

CVS (7 decks)

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