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MD3001 > The Coronary Circulation > Flashcards

The Coronary Circulation Flashcards

1
Q

GO OVER WITH NOTES

A

GO OVER WITH NOTES

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2
Q

What is the blood supply of the heart?

A
  • Right and left coronary arteries (RCA) and (LCA)
  • these are the only branches of the ascending aorta
  • the endocardium receives blood from the chambers of heart
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3
Q

describe cardiac muscle?

A
  • striated but voluntary
  • bibles branch and join with each other with intercalated discs
  • works as a single functional organ or syncytium
  • synchronised contraction
  • does not tetanize.
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4
Q

When do the coronary arteries fill up?

A

They fill up when the aortic sinuses fill up in diastole.
In systole the aortic valve cusps close the opening of the arteries

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5
Q

describe the the blood supply to the heart?

A
  • supplied by coronary arteries and their branches
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6
Q

where do the coronary arteries energy from?

A

aortic sinuses
- right coronary
- left coronary
with an anastomoses between them.

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7
Q

where does the endocardium get blood from?

A

it receives oxygen and nutrients directly from the chamber of the heart.

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8
Q

Name the branches of the right coronary artery

A
  • SA node branch
  • AV nodal brunch
  • the right (acute) marginal branch
  • posterior interventricular branch.
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9
Q

What two arteries form the anastamosis at the apex

A
  • The posterior interventricular branch (posterior descending artery)
  • the left coronary artery.
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10
Q

What are the terminal branches of the left coronary artery?

A

Circumflex branches and anterior interventricular artery (left anterior descending artery LAD).

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11
Q

what are the 4 branches of the right coronary artery?

A
  • SA nodal branch
  • Right marginal branch
  • Posterior inter ventricular branch
  • AV nodal branch
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12
Q

What does the anterior interventricular branch supply?

A

The sternocostal surface

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13
Q

where does the coronary artery start?

A

right aortic sinus

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14
Q

Name the branch of the circumflex artery and what artery it forms an anastamosis with.

A

Left (obtuse) marginal branch. Anastamosis with RCA

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15
Q

What does the right coronary artery and its branches supply?

A
  • walls of right atrium and right ventricle
  • SA node and AV node
  • posterior part of the inter ventricular septum
  • small areas of the walls of left atrium and left ventricle
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16
Q

What does the left coronary artery and its branches supply?

A
  • walls of the left atrium and left ventricle
  • most of the inter ventricular septum, including the distal parts of the AV node.
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17
Q

where does the left coronary artery arise from?

A
  • the left aortic sinus between the left auricle and the pulmonary trunk.
  • enters into the coronary sulcus
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18
Q

what does the left coronary artery divide into?

A
  • circumflex
  • anterior inter ventricular branches
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19
Q

What is coronary dominance?

A

This is the artery that gives off the posterior interventricular (posterior descending) artery determines the coronary dominance. In 80% of people the RCA is dominant.

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20
Q

left coronary artery branches?

A
  • anterior inter ventricular
  • circumflex artery
  • left marginal branch
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21
Q

What is coronary co-domincance?

A

Where both RCA and LCA supply the posterior interventricular artery.

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22
Q
A
23
Q

What is the order of frequency of occlusion of arteries that cause MIs

A
  • Left anterior descending artery(40-50%)
  • right coronary artery (30-40%),
  • the circumflex artery (15-20%)
24
Q

what may be damaged in the conducting system by a coronary occlusion?

A
  • LAD septal branches (supplies the AV branches)
    -RCA supplies both the SA and AV node.
  • heart block (bradycardia)
25
Q

What can you do if the artery becomes narrowed or blocked?

A

Coronary Artery Bypass Grafting (CABG) or Percutaneous Transluminal Coronary Angioplasty

26
Q

What is a CABG?

A

This is where you can use another artery (often the internal thoracic artery) to bypass the portion of occluded vessel

27
Q

what does a CABG do?

A
  • vessels are grafted to bypass blockages
  • autograft from internal thoracic, great saphenous
28
Q

What is Percutaneous transluminal coronary angioplasty?

A

A catherter is passed through the femoral artery till it reaches the blocked artery, it is then opened by a ballon. A stent may be left and teh stent may be drug eluting.

29
Q

Name the four coronary veins and where they drain too

A
  • great cardiac vein (anterior interventricular) vein joins the coronary sinus
  • small cardiac vein, accompanies the right marginal branch
  • middle cardiac (posterior intervetricular) vein drains into the coronary sinus
  • anterior cardiac veins drain independently into the RA
30
Q

Where is the position of the coronary sinus?

A

It lies between the left atrium and the left ventricle and is surrounded by the muscle fibres of the left atrium.

31
Q

Name the 2 networks the cardiac muscle forms and what separates them

A

The atrial and ventricular networks which are separated by the fibrous skeleton.

32
Q

describe the venous drainage percentage of the coronary sinus?

A

drains 60% of the venous blood of the heart into the RA
- 40% is drained by the smallest cardiac veins and anterior cardiac veins.

33
Q

What is the role of the ANS

A

Shortens or prolings the duration of a cardiac cycle, it however, does not start the heart as it acts independently.

34
Q

what are the 4 cardiac veins and where do they join??

A
  • great cardiac vein joins the coronary sinus
  • small cardiac vein accompanies the right marginal branch
  • middle cardiac vein drains into coronary sinus
  • anterior cardiac veins drain independently into the RA
35
Q

What are the compounents of the cardiac conduction system?

A
  • Sino-atrial node,
  • Atrioventricular node
  • Atrioventricular bundle (Bundle of His) which splits into a left bundle branch and a right bundle branch)
  • purkinjie fibres.
36
Q

what is the difference in position between the SA and AV node?

A

SA node= anterior to the opening of the SVC, upper end of the crust terminals
AV node= posters-inferior part of the IA septum, close to the opening of the coronary sinus.

37
Q

Where is the location of the SA node

A

Anterior to the opening of the SVC at the upper end of crista terminalis.

38
Q

Where is the rough location of the AV node

A

At the posto-inferior part of the IA septum close to opening of coronary sinus.

39
Q

Where is the rough location of the AV bundle?

A

It runs along the membranous part of the IV septum.

40
Q

Where is the rough location of the AV bundle branches?

A

Along the IV septum with the right bundle branch in the septomarginal trabecula. Both bundles split into purkinjie fibres

41
Q

Describe the nerve supply of the heart

A

-Supplied by cardioaccelartory and cardioinhibitory centres found in the medulla and the cardiac plexus.
- it supplies the conduction system, coronary blood vessels and myocardium.

42
Q

What is the effect of the presynaptic sympathetic fibres? and what spinal nerves do they travel in?

A

They travel in T1-5 spinal nerves and they increase the heart beat, force of contraction and dilate the coronary arteries.

43
Q

What is the parasympathetic effect and what nerves do they travel in?

A

Travel in vagus nerve (10th cranial nerve) and it decreases the heart beat and constricts coronary arteries

44
Q

Where is the referred pain caused by ischaemia and damage to cardiac muscle felt?

A

Areas of the skin supplied by T1-5 (anterior chest and medial aspect of left arm)

45
Q

obstruction of the right coronary artery can lead to what?

A
  • anterior infarct
  • mild cases will cause ischaemia.
46
Q

1- obstruction of the left anterior descending causes what?
2- obstruction of the circumflex artery causes what?
3- what kind of infarct causes loss of Left ventricle function and ventricular fibrillation

A

1 - an anterior or lateral infarct
2- posterior infarct
3- septal infarcts

47
Q

where do the cells lie that can generate electrical impulses without external stimuli? (group of specialised cells)

A

they lie immediately below the endocardium

48
Q

what causes the heart to contract

A

cardiac muscle cells distribute electrical impulses through the myocardium

49
Q

what part of the ns shortens or prolongs the duration of the cardiac cycle?

A

autonomic ns

50
Q

what are the components of the conduction system?

A
  • SA node
  • AV node
  • atrioventricular bundle (bundle of HIS) = there is a left and right bundle branch
  • Purkinje fibres
51
Q

describe bundle of HIS?

A
  • runs along the membranous part of the IV septum
  • only conductive route through the fibrous skeleton
52
Q

describe the right bundle of his branch?

A
  • depends on the right side of the membranous part of the IV septum
  • enters the septomarginal trabecular to reach the base of the anterior papillary muscle
  • splits into Purkinje fibres which spread out into the ventricular walls
53
Q

describe the left bundle of His branch?

A
  • depends on the left side of the membranous part of the IV septum
  • splits into purkinje fibre

MD3001 (56 decks)

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