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Physiology and Pathology Exam 1 > Test 2 Cardiac System > Flashcards

Test 2 Cardiac System Flashcards

1
Q

ventricular contraction

A

systole

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2
Q

ventricular relaxation

A

diastole

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3
Q

explain the 4 stages of the cardiac cycle

A

1: ventricular filling (isotonic-no contraction occurring-no pressure)
2: ventricular contraction (isometric; tension being developed but no change in circumference) – pre-ejection
3: ventricular contraction (isotonic) – ejection; change is occurring
4: ventricular relaxation (isometric)

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4
Q

All cardiac valves are designed to only allow _____ of blood between chambers, dependent on ______

A

one-way flowpressure differential

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5
Q

What are the 4 valves in the heart? what is their purpose?

A

aortic, pulmonic, mitral, and tricuspid

one way blood flow in the heart( 2 way blood flow is a disorder)

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6
Q

When a valve is _____ it only allows one way blood flow, i.e., easy flow in the proper direction

A

“competent”- working the way it should be

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7
Q

Backward flow of blood through a one-way valve is called ______

A

“regurgitation”- can cause a murmur

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8
Q

Resistance to the normal direction of blood flow through a valve is usually caused by valve _______.

A

“stenosis” (means narrowing or constriction of a passage)

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9
Q

What are the semilunar valves of the heart?

A

aortic and pulmonic valves

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10
Q

Name 3 characteristics of the aortic and pulmonic valves.

A
  1. Firm, thick valves between ventricles and pulmonary artery and aorta
  2. Three valve leaflets (tricuspid)
  3. Prevent back flow (“regurgitation”) into ventricles
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11
Q

Name the atrioventricular or AV valves of the heart and how many leaflets each has.

A

Tricuspid-3 leaflets and mitral valves-2 leaflets

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12
Q

What is the lub dub sound?

A

the semilunar valves opening and closing

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13
Q

a think cartilage band that hold valves tightly together to avoid leaking when the heart is pumping

A

the valve annulus

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14
Q

Which valves are thick, flexible valves between atria and ventricles? Floppy like a parachute

A

tricuspid and mitral valves

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15
Q

which valves are stabilized with chordae tendinea attached to papillary muscles (1 muscle and chord bundle for each leaflet)?

A

tricuspid and mitral

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16
Q

dense connective tissue cords connecting valves to papillary muscles

A

Cordae tendinea

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17
Q

_____ contract during ventricular systole and maintain tension throughout systole

A

Papillary muscles

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18
Q

Heart and blood flow competency depends on coordinated what 4 things?

A

function of the annulus, valve leaflets, papillary muscles, and ventricular walls

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19
Q

: when ventricles contract (opens semilunar valves and closes AV valves)

A

Ventricular systole

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20
Q

when the ventricles relax and blood flows into them from the atria (results in closing of the semilunar valves due to artery back pressure)

A

Ventricular diastole

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21
Q

when atria contract (opens the AV valves)

A

Atrial systole

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22
Q

when the atria relax and blood flows into them from the vena cava (R) and the pulmonary vein (L)

A

Atrial diastole:

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23
Q

True or False: there is no electrical connection btw the upper and lower parts of the heart

A

true

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24
Q

Which valve is the only bicuspid valve?

A

mitral valve

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25
Q

narrowed valve opening due to thickening, calcification, or non-separation of leaflets

A

Stenosis

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26
Q

What can result from malfunction?

A

disease

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27
Q

backwards blood flow due to stretching, stenosis, papillary muscle or cordae tendinae disruption

A

Regurgitation

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28
Q

the absence of valve formation in utero/the incomplete formation

A

“atresia”

*Most commonly occurs with the pulmonic valve

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29
Q

Heart (and vascular) sounds are caused by _____

A

vibration

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30
Q

describe the two normal sounds heard from the heart

A

First is a low “lub” (S1) as the AV valves close at the start of ventricular systole
Second is a high-pitched “dup” (S2) as the semilunar valves close after ventricular systole

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31
Q

High rate of blood flow into chambers (e.g., 3rd and 4th heart sounds) could mean what for a patient?

A

heart failure

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32
Q

______ are abnormal sounds heard in various parts of the vascular system

A

Murmurs and bruits

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33
Q

Murmurs are sounds caused by _______, most commonly around valves

A

blood turbulence in the heart

*(late aortic stenosis)

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34
Q

Bruits (pronounced “brew-ee”) are sounds caused by _______

A

blood turbulence in blood vessels

*(carotid bruit)

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35
Q

Know the blood flow throughout the heart

A

veins carry oxygenated blood

arteries carry deoxygenated blood

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36
Q

What are the 3 major epicardial arteries (outside heart)?

A

Left common coronary artery divides into:
-Left anterior descending (LAD) artery: Supplies the apex, left anterior wall, anterior septum
_Left circumflex artery:
Supplies the lateral left

Right coronary artery:
Supplies the right wall, posterior wall, posterior septum

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37
Q

What is the second sound we hear that is associated with pulse?

A

S2-closure of semilunar valves

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38
Q

What is the first sound we hear that is not associated with pulse?

A

S1- closure of av valves

39
Q

Smaller branches extend from the coronary arteries, penetrating into and perfusing the myocardium

A

intramural arteries

40
Q

When the left ventricle contracts, the aortic valve opens. The valve cusps prevent what?

A

filling of the coronary arteries

41
Q

When the left ventricle relaxes, aortic pressure closes the aortic valve, allowing what?

A

the coronary arteries to fill

42
Q

only time the heart is receiving blood flow

A

diastole

43
Q

From most superficial to deep, how is the heart blood vessels arranged?

A

coronary arteries–>intramural arteries–>capillaries

gets smaller and smaller

44
Q

Blood from heart muscle is drained by what into what?, then into what?

A

cardiac veins; coronary sinus; right atrium

45
Q

true or false: coronary veins generally run parallel to coronary arteries

A

true

46
Q

_____ are electrically conductive cells which discharge rhythmically and continuously, starting an electrical impulse which normally travels through conductive pathways (specialized cardiomyocytes)

A

Pacemakers

47
Q

How many pacemakers in the heart?

A

2;Sinoatrial node (SA node; “pacemaker”) and Atrioventricular node (AV node)

48
Q

What is the normal pacemaker of the heart?

A

Sinoatrial node (SA node; “pacemaker”)

49
Q

what is the gate keeper between the atrium and ventricles?

A

Atrioventricular node (AV node)

50
Q

what are present in the atria, ventricles or conductive tissue and can take over when the SA and AV nodes aren’t functioning or conduction is blocked?

A

“Latent pacemakers”

51
Q

what connects the electrical discharge through the atriums?

A

Internodal atrial pathways

52
Q

Where does the bundle of his separate to?

A

RBB and LBB

53
Q

The fastest pacemaker always sets the pace: __ > __ > _____

A

SA (60-100 per min)> AV > inherent ventricular pacemakers

*if something is higher than SA it could be tachycardia

54
Q

purkinje system

A

the smallest fibers of the bundle branches

55
Q

Why do pacemakers never enter resting potential?

A

they’re always preparing for or participating in an AP

56
Q

Explain the 1st stage of pacemaker action potential.

A 
1st phase (4 on figure): 
Slow passive Na+ inward movement (if – red)
At ~ -50 mV, Ca2+ T (transient) channels open, slow inward movement (green)
57
Q

Explain the 2nd phase of pacemaker action potential

A 
2nd phase (0 on figure):
At threshold (~ -40 mV), Ca2+ L (long) channels open, faster inward movement go ions (blue)
58
Q

Explain the 3rd phase of pacemaker action potential

A

At ~ 0 mV the Ca2+ L channels close and K+ channels open (orange), fast K+ outflow to return potential to ~ -60 mV

59
Q

What normally sets the pace in cardiac conduction?

A

SA node

*But fastest pacemaker ultimately controls heart rate

60
Q

What conduct to the AV node in cardiac conduction?

A

Internodal pathways

*Atrial myocytes depolarize following internodal pathway depolarization

61
Q

What delays transmission to the bundle of His in cardiac conduction? (delays conduction from upper to lower part of the heart)

A

AV node

*Facilitates coordination of atrial and ventricular contraction

62
Q

What is the path from the bundle of His in cardiac conduction?

A

Bundle of His to bundle branches to Purkinje fibers to ventricular myocytes – very rapid

63
Q

What is a measure of electrical activity in the heart?

A

The electrocardiogram (ECG, previously called the EKG)

64
Q

What are branched and conduct depolarizations through intercalated disks?

A

Cardiomyocytes

65
Q

What do atrial myocytes secrete?

A

atrial natriuretic peptide (ANP) with atrial distension (stretch)

66
Q

What does ANP cause?

A

vasodilation, diuresis (increased water excretion into urine) and Na+ excretion

67
Q

What do ventricular myocytes produce?

A

produce B-type natriuetic peptide (BNP) with ventricular distention (similar effects to ANP)

68
Q

What is qrs associated with?

A

depolarization of ventricles

69
Q

Why do we measure blood BNP concentration?

A

an indicator of ventricular stretch, e.g., with heart failure

70
Q

What is the average BPM for most people?

A

70 BPM

71
Q

What is the normal sinus rhythm?

A

means HR coming from SA node

72
Q

If you have a slower or junctional rate about 40-59 BPM where is that coming from?

A

AV node

73
Q

If you have a very slow rate under 40 BPM aka ventricular rate, where is that coming from?

A

Purkinje fibers and myocardial cells

74
Q

If there is no P wave on an ECG, what does that mean?

A

something wrong with SA node

75
Q

Myocytes in the heart (cardiomyocytes) release 2 hormones. What are they?

A

ANP and BNP (BNP is primary lab test that tests if someone has heart failure but there is stretch on the heart)

76
Q

What provide strong union between fibers via desmosomes and provides low-resistance bridges for the spread of excitation from one cell to another via gap junction channels?

A

intercalated disks

77
Q

Describe cardiomyocyte action potential.

A
  • -Rapid depolarization (phase 0) due to Na+ influx through rapidly opening Na+ channels (the Na+ current, INa)
  • -Initial rapid repolarization (phase 1) due to inactivation of Na+ channels and activation of repolarization process (phase 3) due to net K+ efflux through K+ channels
  • -Plateau (phase 2) due to Ca2+ influx through more slowly opening Ca2+ L(long or slow channels) channels (the Ca2+ current, ICa)
  • -Rapid repolarization process (phase 3) due to closure of Ca2+ channels with continued K+ efflux through K+ channels
  • -Return to the resting membrane potential (phase 4)
78
Q

What provides all parasympathetic control?

A

vagus nerve

79
Q

What are the stimulation effects of the parasympathetic system on the heart?

A
  • Decrease HR by decreasing SA and AV node pacing rate

- Does not affect myocardial contractility (force)

80
Q

What nerves are responsible for the sympathetic nervous system?

A

spinal T2-T4 segments (thoracic vertebra)

**Pass into the cardiac plexus to the SA node (right) and AV node (left)

81
Q

What are the stimulation effects of the sympathetic nervous system?

A
  • Increase HR via increasing SA and AV node pacing rate

- Increase in myocardial contractility (force, therefore cardiac output)

82
Q

The pressure developed in the ventricle is proportional to the ventricular end-diastolic volume, i.e., increased stretch of myofibrils results in increased contractile force, resulting in increased stroke volume

A

Frank-Starling Law

83
Q

What are three things the heart has in reference to oxygen?

A
  • -An abundant blood supply providing O2 and nutrients
  • -High myoglobin content (muscle O2 “storage” protein)
  • -Many mitochondria (fat metabolism, requires more O2)
84
Q

Myocytes derive most of their energy from aerobic metabolism. Does this require continuous supply of O2?

A

yes

85
Q

What are the sources myocytes receive energy from?

A

Glucose (35%)
Ketones and amino acids (5%)
Fat (60%)

86
Q

Pericardium is a fibrous sack which _____ and _____ it from thoracic viscera

A

encloses the heart; separates

87
Q

What are the two layers of the pericardium?

A
  1. Visceral: thin inner layer, directly attached to the myocardium
  2. Parietal: tough, fibrous out layer
88
Q

Space between the visceral and parietal pericardium (the pericardial sac) contains 5 to 30 mL of clear ______.
Lubricates to minimize what?

A

pericardial fluid;

friction

89
Q

The heart is fully developed by pregnancy week ____.

A

7 or 8

90
Q

In utero function of ductus arteriosis and foramen ovale is to _____.

A

reduce blood flow to lungs

91
Q

Within a few days after birth the ductus arterioles closes off completely and forms what?

A

ligimentum arteriosum

*Sometimes remains open (“patent ductus arteriosis”)

92
Q

_____ (between atria) closes at birth and gradually fuses together over several weeks or months.

A

Foramen ovale

*Sometimes remains open (“patent foramen ovale”)

93
Q

Rate x stroke volume = ____

A

total cardiac output

Physiology and Pathology Exam 1 (4 decks)

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