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General Health and Disease (GHD) > The Cardiovascular System and Physiology > Flashcards

The Cardiovascular System and Physiology Flashcards

1
Q

Location of the heart?

A

Middle mediastinum

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2
Q

Basic anatomy of the heart - layers?

A

4 chambers: left and right atria and ventricles

3 layers: peri, myo and endocardium

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3
Q

Basic function of the heart?

A

The right side receives deoxygenated blood from the body and the left side receives oxygenated blood from the lungs

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4
Q

Pericardium? Characteristics?

A

Fibrous outer layer and serous visceral and parietal layer

Pericardial cavity: space between visceral and parietal later

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5
Q

Orientation of the heart?

A

Left 5th intercostal space

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6
Q

Right atrium? Characteristics?

A
  • Opening of the superior vena cava, inferior vena cava and the coronary sinus
  • Interartrial spetum
  • Right atrioventricular orifice
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7
Q

Right ventricles? Characteristics?

A
  • Trabeculae carneae
  • Irregular muscular elevations
  • Right AV (tricuspid) orifice
  • Interventricular (IV) septum
  • Pulmonary valve
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8
Q

Left atrium? Characteristics?

A
  • Forms most of base of the heart
  • 4 pulmonary veins
  • Left AV orifice
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9
Q

Left ventricle?

A
  • Forms apex of the heart
  • Mitral valve
  • Aortic orifice and Aortic valve
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10
Q

Heart valves?

A
  • Tricuspid and bicuspid
  • Aortic and pulmonary valve
    (Semilunar valves)
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11
Q

Heart valve? Anatomy?

A
  • The cusp of the valve is connected to the tendinous cords which are connected to the papillary muscles
  • Muscles contract to close the valve
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12
Q

Right coronary artery? Supply?

A
  • RA
  • Most of the RV
  • Part of the LV
  • SAN (60%)
  • AVN (80%)
  • Part of the AV septim (post 1/3rd)
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13
Q

Left coronary artery? supply?

A
  • Left atrium
  • Most of the left ventricle
  • Part of the right ventricle
  • Most of the IV septum
  • SA node (40%)
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14
Q

Important coronary arteries?

A
  • Ascending aorta
  • R/L coronary artery
  • Atrial artery
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15
Q

Venous drainage?

A
  • Superior and inferior vena cava
  • Great cardiac vein
  • Small cardiac vein
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16
Q

Innervation of the heart? Characteristics?

A

Sympathetic: superficial and deep plexus

  • stim produces dilation of coronary arteries
  • allows more o2 and nutrients to reach the myocardium when needed

Parasympathetic: vagus nerve (CN10)

  • stim slow HR
  • reduces FoC and constrict coronary arteries
  • saves energy
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17
Q

Conduction system of the heart? Characteristics?

A

SAN: specialised cardiac muscle fibres, at the junction of SVC and the RA and is the pacemaker of the heart

AVN: near the opening of the coronary sinus

Bundle of His and purkinje fibres

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18
Q

Circulation around the body? Ascending and Arch of the Aorta? Characteristics?

A

Brachiocephalic trunk: divides into right subclavian and right common carotid artery

left common carotid and subclavian artery

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19
Q

Circulation around the body? Thoracic and abdominal aorta? Characteristics?

A

Source: descending aorta
Branches: bronchial, oesophageal, posterior intercostal, abdominal aorta, superior phrenic and pericardial arteries

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20
Q

Circulation around the body? Upper and lower limbs? Characteristics?

A
  • Subclavian
  • Axillary
  • Brachial
  • Radial
  • Ulnar
  • Femoral
  • Popliteal
  • Tibial
  • Dorsal artery
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21
Q

Pulse points?

A
  • Radial artery (distal)
  • Brachial (cubittal fossa)
  • Femoral (midinguinal point)
  • Popliteal (popliteal fossa)
  • Tibial (between achilles and heel)
  • Dorsal (dorsum of foot)
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22
Q

Circulation around the body? Head, Neck and Brain? Characteristics?

A
  • Carotid (superior thyroid, lingual, facial, ascending pharyngeal, occipital and posterior auricular)
  • Maxillary
  • Basilar
  • Superficial temporal
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23
Q

Venous circulation? Characteristics?

A

Superior vena cava: returns blood from above the diaphragm except lungs and heart

Inferior vena cava: returns non-oxygenated blood from lower body

Portal venous system: collects blood of reduced o2 but rich in nutrients from the GI tract to the liver

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24
Q

Portal system circulation? Composition?

A
  • Portal vein
  • Superior mesenteric vein
  • Splenic vein
  • Inferior mesenteric vein
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25
Q

Role of the lymphatic system?

A

Transports:

  • Interstitial fluid back to the blood
  • Absorbed fat from the SI to the blood

Immunological defences
Spread infection and cancer

26
Q

Lymphatic drainage?

A

Right lymphatic duct:
- drains right upper quad of the body
Thoracic duct:
- remainder of the body

27
Q

Structure of the CVS? Characteristics?

A
  • Pumps are in series
  • Most vascular beds are in parallel (all tissues get oxygenated blood, allowing regional redirection)
  • Specialised vascular beds exist in series (portal system)
28
Q

How is blood flow produced?

A
  • Pa in the vein is 0 mmHg

- Pa in the arteries is 100 mmHg

29
Q

Regulation of blood flow? Equation?

A
  • Mean Art Pa - Central ven Pa = Difference in Pa
  • Flow = Difference in Pa/Resistance
  • Resistance is controlled by vessel radius
30
Q

Aorta? Composition?

A

Elastic artery: inside - out

  • tunica intima (elastic layer with endothelium)
  • tunica media
  • tunica externa
  • wide lumen and role to dampen pressure variations
31
Q

Arteries? Composition?

A

Muscular arteries: out - in
- externa, media, endo and intima

  • wide lumen
  • strong non-elastic wall
  • low resistance
32
Q

Arterioles? Composition?

A

Resistance vessels:
- Media, endo and base mem

  • narrow lumen, thick contractile wall
  • control resistance and flow
33
Q

Capillaries? Composition?

A

Exchange vessels:

  • narrow lumen and thin walled
  • endo and base mem
34
Q

Venules/Veins? Composition?

A

Capacitance vessels:

  • wide lumen, distensible wall
  • low resistance and resevoir
  • allows fractional distribution of blood
  • externa and endo (venule)
  • externa, media, endo and intima (veins)
35
Q

Gross structure of the heart? Valves?

A
  • Right AV valve - tricuspid valve
  • Left AV valve - bicuspid valve
  • Cusps of fibrous tissue connected round AV space
  • connected to chordae tendinae anchored to papillary muscles (no contract)
  • During heart contraction the cusps inflate

Semilunar valves:

  • aortic and pulmonary
  • outward facing pocket (closing valve)
36
Q

Conduction of the heart? Process?

A
  • Pacemaker cells in the SAN, caused the atria to contract (signal does not pass to ventricles due to annulus fibrosis)
  • Signal passed to the AVN, with a delay to allow the ventricles to fill, when the signal is initiated it travels down the left and right bundle of His to the purkinje fibres that cause the ventricles to contract (apex contraction)
37
Q

Excitation-contraction coupling? Process? Muscle?

A
  • Cardiac cells contain desmosomes, intercalated discs and gap junctions with all allow the passage of signal between the cardiac cells, allowing continuous depolarisation.
  • Depolarisation occurs causing the release of Ca that travels down the t-tubules and activating the sarcoplasmic reticulum to release further Ca that causes the contraction of the myosin-actin complex

(Ca induced Ca release)

38
Q

Mechanical events of the cardiac cycle?

A
  • Chambres relaxed, passive vent filling
  • atrial systole (atria push blood to vent)
  • Isovol vent contract (AV valves closed but no great enough to open SLV)
  • Vent eject (open SLV, and ejected)
  • Isovol vent relax (SLV close)
39
Q

Reg of the HR? Parasympathetic?

A

Vagus nerve:

  • release ACh
  • acts on muscarinic ACh recep on SAN
  • slows pacemaker cells
  • reduced HR (bradycardia)
40
Q

Reg of the HR? Sympathetic?

A

Sympathetic nerves:

  • Release NAD
  • act B1- recep on SAN
  • increases slope of pacemaker potential (threshold achieved quicker)
  • speed up pacemaker
  • increases HR +ve chonotropic (tachy)
41
Q

Preload and Afterload? Definition?

A

Preload:
- volume of blood in the ventricles at the end of diastole
(increased during hypervolemia, regurgitation and heart failure)

Afterload:
- resistance the left ventricle must overcome to circulate blood
(increased during hyperten and vasoconst)
(increased afterload increases cardaic load)

42
Q

Stroke volume and cardiac output? Factors affecting each?

A

CO = SV*HR
HR: affected by sympth and parasympth tone
SV: affected by pre/afterload and contractility

43
Q

Regulation of stroke volume? Preload? Characteristics?

A

Frank-Starling’s law of the heart:

  • the energy of contraction is proportional to the initial length of the cardiac muscle fibre
  • relation between EDV (end diastolic volume), contraction strength and stroke volume
  • intrinsic property of heart muscles

Increased contractility caused by sympth nerve stim causes increased stroke volume than ventricular end-diastolic volume

44
Q

Preload and EDV relationship? Explanation?

A

Preload is affected by EDV:

  • increased venous return, increased EDV and therefore increased stroke volume and vice versa
  • ensures self-reg (match SV of left and right ventricles)
45
Q

Regulation of stroke volume? Afterload? Characteristics?

A

Afterload is set by the arterial Pa against which the blood is expelled

If total peripheral resistance increases, stroke volume will reduce

46
Q

Preload and afterload affect on stroke volume?

A

Capacitance vessels affect preload and increase SV

Resistance vessels affect afterload which decreases SV

47
Q

Neural regulation of stroke volume? Sympth NS?

A

Sympth:

  • release NAD (also from adrenal medulla)
  • act on B1 receptor on myocyte
  • increases contractility (+ve inotrope), stronger but shorter
  • Increased SV and EDV
48
Q

Pressure and blood flow from arteries to veins? Characteristics?

A

Pressure falls throughout the vascular tree
- driving force = MAP-CVP

Small drop through arteries (from ~ 95 to 90 mmHg)
- low resistance conduit

Large drop through arterioles (from ~ 90 to 40 mmHg)
- the resistance vessels

Leaves a small pressure difference pushing blood back through the veins (from ~ 20 to 5 mmHg)
- the systemic filling pressure

49
Q

Skeletal muscle pump? Effect on Pa and flow? Veins?

A

Muscle compresses veins:

  • squeeze blood back
  • increases return, EDV and SV
  • CO responds to activity
  • valves prevent backflow
50
Q

Respiratory pump? Effect on Pa and flow?

A

Pressure gradient favours increase in venous return:

  • increased rate or TV increases venous return and therefore preload
  • CO responds rapidly
51
Q

Venomotor tone? EFfect on Pa and flow?

A

Contraction of SM in the walls of veins mobilises spare capacitance, increasing venous return and preload

52
Q

Microcirculation? Composition and Characteristics?

A

Specailised for exchange:

  • thin walled small diffusion barrier
  • large SA:V

Local control by metarterioles and precap sphinctors

53
Q

Types of capillaries? Structure and location?

A

Continious:

  • Base mem and tunica intima (with intracellular cleft)
  • skeletal muscle, adipose, lung and CNS

Fenestarted:

  • fenestartions
  • kidneys, intest and endocrine

Sinusoid:

  • incomplete base
  • intracellular gap
  • liver, spleen and bone marrow
54
Q

Extrinsic control of blood flow? Parasymph and symph?

A

Parasympth:
- limit effect to digest, external genitalia and salivary glands

Sympth: tonic discharge

  • releases NAD, binds a-receptor on arteries (causing constriction)
  • reduces blood flow and increases TPR
55
Q

Extrinsic control of blood flow? Hormonal?

A

Tissues: liver, skeletal and cardiac
- adrenaline activates B2 causing arteriolar dilation, therefore increasing flow and reducing TPR

Peripheral vasoconstrict diverts blood and combined vasodil promotes BF to important organs

e.g. liver, skeletal/cardiac muscle (all rich in b2)

56
Q

Local control? Active hyperaemia? Autoreg?

A

Active hyperaemia:

  • increase of CO2, H and K promotes vasodilation
  • increased meta increases metabolites, that increase flow by needing to wash out metabolites
  • match blood flow to metabolic need

Autoreg:
- reduced MAP reduces flow
- metaboloites accumulate stim arteriole dilation
(maintains blood supply despite MAP change)

57
Q

Fundamental equation of CVP?

A

MAP = CO*TPR
MAP driving force behind circulation:
- too low (faint)
- too high (HT)

58
Q

Arterial baroreflex? Nerves to anatomy?***

A

Internal carotid arteries to brain (carotid sinus baroreceptor)
aortic arch baroreceptor to brain

59
Q

Regulation of BP long term?

A
  • Cardio-pulmonary baroreceptors
  • tends to be hormonal
  • act on BVs and kidenys (blood volume)
60
Q

Posture? Scenario?

A

Lying to standing:
- gravity increases Pa in veins below heart
- veins distended and accommodate pooling
- venous return drops
(reduced EDV, preload, SV, CO and MAP and so less baroreceptor firing)

Reflex response: 
- Reduced vagal tone increasing HR and CO
Sympth tone:
- increased contractility and SV
- venoconstrict, EDV, SV and TPR

(good diagram in CVP lecture 3)

61
Q

Exercise? Scenario?

A

HR increases due to

  • decreased vagal tone
  • increased sympathetic tone

Contractility increases due to

  • increased sympathetic tone
  • circulating epinephrine

EDV (preload) is “maintained”:

  • shortened systolic phase
  • sympathetic venoconstriction
  • skeletal muscle pump
  • respiratory pump

General Health and Disease (GHD) (31 decks)

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