Test 1 Flashcards
Aortic annulus is attracted to pulmonic annulus by
Tendon of conus
Aortic annulus also connected to AV valves by
Ventral fibrous body
What constitutes the fibrous cardiac skeleton
Four valve annuli
4 components of skeletal base of heart
Valve annuli
Aortic and pulmonary roots
Central fibrous body
Fibrous trigones
Location of coronary sinus
Between AV orifice and valve of IVC
Compare thickness of RV and LV
RV 4-5mm
LV 8-15mm
Compare upper 1/3 of septum to lower 2/3
Upper 1/3 is smooth endocardium
Lower 2/3 is trabeculae
Myocardium is ____ layers. Middle is _____
3
Middle is muscular which runs in spiral fashion
Normal size of aortic, tricuspid, and mitral valve
Aortic. 2.5-3.5 cm2
Mitral. 4-6 cm2
Tricuspid. 7 cm2
Coronary artery which typically provides flow to bundle branches
LAD
Provides flow to anterior 2/3 of IVS, bundle branches, papillary muscles of MV, anterior-lateral and apical LV
LAD
Provides flor to LA and posterior-lateral LV
Circumflex
Provides flow to SA/AV nodes
RCA
Provides flow to SA/AV nodes, RA, RV, posterior 1/3 of IVS
RCA
Dominance is determined by
Whether the circumflex of RCA provides flow to PDA
Effect of CAD of coronary vascular smooth muscle tone and anitcoagluation
Thickening of endothelium resulting in clot- vasospasm
Adversely effects autoregulatory fx of vascular endothelial cells expressing anticoagulant substances and myocardial blood flow
Define coronary perfusion pressure and its component/formula
CPP = DBP - LVEDP
Compare LV and RV perfusion in systole and diastole
RV fills throughout cycle
LV fills during diastole
Area of myocardium most affected by extravascular compression and higher LVEDP
Subendocardium
Lower heart rate minimizes compression
Key responses to CAD in coronary circulation
Collateral flow and remodeling
4 determinants of coronary blood flow
Perfusion pressure
Myocardial extravascular compression
Myocardial Metabolism
Neurohumoral control
Determinants of myocardial oxygen supply
Heart rate ** PCWP/LVEDP** DBP O2 sat Hct CAD
Components of myocardial oxygen demand
Heart rate **
PCWP/LVEDP **
SBP
CO
2 determinants of myocardial oxygen balance that both decrease supply and increase demand
Increased HR and PCWP/LVEDP
Increased SNS from what segments increase chronotropy and inotrope
T1-T4
Effect of increased PNS activation on chronotropy
SNS competes with PNS in medulla
PNS has only modest effect on inotropy 30%
Role of accessory pathways in dysrhythmia
Abnormal accessory pathways bw atria and ventricles may bypass the AV node and cause re-entrant dysrhythmias
Basic contractile unit of monocytes
Sarcomere
Effect of actin-myosin configuration on contractility based on frank starling law
If hypovolemia don’t have same wall tension and suboptimal interaction
Wall stress is typically greatest where
Subendocardium
Blood supply lowest and demand highest
normal size of aortic valve
> 2cm
2.5-3.5cm2
Normal mitral valve area
> 2cm
role of accessory pathways in dysrhythmias
Bypass AV node causing re-entrant dysrhythmias
LaPlace’s law. ______ and ______ vary directly with _________. Inversely with _____
Wall stress and MVO2 diaries directly with internal pressure.
Inversely with wall thickness
Wall stress is typically greatest in ______
Why
Subendocardium
Blood supply lowest due to LVEDP
Demand highest
Myocardial sarcomere are relatively permeable to _______ and impermeable to_____
Permeable to K+
Impermeable to Na and Ca
Phase 0 ion movment
Fast Na channels open
Then slow Ca channels
Phase 1 ion movement
K+ channels open
Phase 2 ion movement
Ca channels more open
Phase 3 ion movment
K+ channels open more
Phase 4 ion movement
RMP
SA node AP has no phase _____
1 and 2
Pint 1 on pressure volume loop
MV closes
Point 2 on pressure volume loop
AV valve opens
Point 3 on pressure volume loop
AV closes
Point 4 on pressure volume loop
MV opens
Increased preload effect on pressure volume loop
Shifts to right
Increased SV
EDPVR is directly related to
LV compliance
Effect of increased afterload on pressure volume loop
Narrow and taller
Lower SV and higher pressures
Higher EDV
ESPVR reduced
ESPVR related to
Myocardial contractility
ESPVR is heart rate sensitive index of
Contractility
Heart failure shifts LV volume loop
To right
Compensates for decreased contractility
Aortic stenosis effect on PV loop
Higher pressure for given volume
Taller