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Week 4-7 Cardiovascular > Week 5 > Flashcards

Week 5 Flashcards

1
Q

The most important baroreceptors are found in the ___ sinus and ___ arch.

A 
Carotid sinus (thin walled and highly compliant)
Aortic arch
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2
Q

How are changes in blood pressure transduced by baroreceptors and where do they send signals to?

A

Stretch causes Na+ channels to open resulting in firing to the brainstem cardiovascular centre in medulla
Firing is integrated in pressor and depressor centres and sympathetic or parasympathetic nerves are efferents to effector organs

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3
Q

The firing rate threshold for the baroreflex can reset within ___ to ___ days.

A

1 to 2

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4
Q

If BP is less than ___, then firing is silenced! Therefore, ___ are used as backup regulators of BP.

A

60 mmHg

Chemoreceptors

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5
Q

Chemoreceptors respond to very low ___ - this occurs at very low ___ ___ ___ because flow is low.

A

Very low O2

Occurs at very low mean arterial pressure -> flow is low so O2 is low, CO2 is high and pH is low

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6
Q

Chemoreceptors are found in the carotid ___

A

Bodies

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7
Q

What is the population paradox?

A

In a population, more deaths occur in a large number of people at moderate risk, than in small number of people at highest risk

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8
Q

The highest incidence of carcinomas occur in the ___, ___ quadrant of the breast because there is a superolateral extension of glandular tissue to the axilla (therefore, more glandular tissue in this quadrant).

A

Upper, outer

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9
Q

Glandular tissue of the breast is separated from muscles and overlying fascia by a ___ or ___ space of loose areolar tissue - for movement of breasts.

A

Retromammary or submammary

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10
Q

The medial 2/3 of the base of the breast overly ___ ___ and the lateral 1/3 of the base of the breast overlies ___ ___.

A

Medial 2/3 - over pectoralis major

Lateral 1/3 - over serratus anterior

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11
Q

Arterial/venous system of lateral breast is the same as for the ___ ___, and of the medial breast is the same as for the ___ ___. Lymphatics follow the same pattern.

A

Lateral breast - same supply/drainage as upper limb (axillary artery/vein), lymph via axillary LNs
Medial breast - same supply/drainage as thoracic cage (internal thoracic artery/vein), lymph via intercostal and parasternal LNs (inside thoracic cavity)

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12
Q

How many ribs are there?

A

12

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13
Q

Ribs ___-___ articulate with sternal complex directly, ___/___/___ articulate with costal cartilage above to form the costal margin, and ___/___ form a cap on the rib with NO anterior articulation (called ___ ribs).

A

1-7 articulate with sternal complex directly
8/9/10 articulate with costal cartilage above to form costal margin
11/12 form cap on rib, called floating ribs

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14
Q

The internal aspect of the inferior edge of the ribs are grooved for the ___ ___.

A

Neurovascular bundle

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15
Q

Middle ribs are typical, but superior and inferior are atypical. The ___ and ___ ribs have short costal cartilages that do not articulate anteriorly. The ___ rib is short and broad with grooves for subclavian vessels, and ONLY articulates with __ so it only has a single facet on its head unlike typical vertebrae (2 facets).

A

11th and 12th - floating ribs

1st rib - ONLY articulates with T1

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16
Q

How can you tell that a vertebra is from the thoracic spine? (3 features?)

A

1 - costal facets (demifacets) on body
2 - facets on transverse processes (not on ANY other series of vertebrae in the spine)
3 - long, almost vertically orientated spinous process

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17
Q

What are the sites of articulation for a rib to the vertebral column?

A

Costovertebral joints: articulation of head of rib with demifacets on body of vertebra above and below AND IVD in between (except for 1st rib - articulates with T1 only)
Costotransverse joints: articulation with facet on transverse process

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18
Q

The ___ ligament of the head of the rib reinforces the costovertebral joint. The costotransverse ligament is a ___ part ligament that is very strong - NEVER dislocates, the rib would fracture first.

A

Radiate ligament from head to vertebrae above and below and IVD in between
Costotransverse ligament - 3 parts

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19
Q

In trauma to the chest, there is often a ___ line of fractures to the ribs that results in a ___ chest segment that functions independently during respiration.

A

Vertical line

Flail chest

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20
Q

What is the origin of the diaphragm, from anterior to posterior?

A

Xiphoid process -> costal margin -> tip of 11th and 12th rib -> lateral arcuate ligament -> medial arcuate ligament -> lumbar vertebrae (by crura)

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21
Q

The arcuate ligaments are thickenings in fascia overlying muscles of the posterior abdominal wall. The medial arcuate ligament overlies ____ and the lateral arcuate ligament overlies ___ ___.

A

Medial arcuate - over psoas major

Lateral arcuate - over quadratus lumborum

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22
Q

The left crus extends from L___ to L___ only.

The right crus extends from L___ to L____ to L___.

A

Left crus - L1 to L2
Right crus - L1 to L2 to L3
Remember - right dome of diaphragm is higher (over liver), so it attaches to more lumbar vertebrae for stronger attachment

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23
Q

There are three main hiatuses in the diaphragm: the ___ ___ ___ through central tendon at T___ (right of midline), the ___ through muscular part of diaphragm at T___ (left of midline), and the ___ behind the diaphragm and between the crura at T___ (midline).

A

Inferior vena cava - through central tendon at T8
Oesophagus - through muscular part of diaphragm at T10
Aorta - behind diaphragm at T12

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24
Q

Each dome of the diaphragm (left or right) is supplied by a left or right ___ nerve. Paralysis of a phrenic nerve and of a hemidiaphragm results in paradoxical movements of the diaphragm. Why?

A

Left or right phrenic nerve
In inspiration, the functional dome descend -> pushes down abdominal contents -> abdominal contents push up the non-functional dome (paradoxical movement)

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25
Q

What is the order of structures of the neurovascular bundle in the costal groove? Where should you insert a needle to access the thorax?

A 
From superior to inferior:
Intercostal vein
Intercostal artery
Intercostal nerve
Needle should bounce over the top of the rib below to avoid major vessels, even though this may affect collateral branches
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26
Q

The intercostal nerves are the ___ rami of ___ spinal nerves.

A

Ventral rami of thoracic spinal nerves

Dorsal rami go back to supply extensor musculature and overlying skin

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27
Q

The neurovascular plane for the neurovascular bundle is between the ___ ___ muscles and ___ ___ muscles.

A

Internal intercostals

Innermost intercostals

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28
Q

Muscles in the neck and abdomen can act as ____ muscles of respiration.

A

Accessory

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29
Q

The heart and roots of great vessels are enclosed in the ___ sac which is adherent to the central tendon of the diaphragm.

A

Pericardial

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30
Q

The line dividing superior and inferior mediastinum is from the ___ junction anteriorly back to the IVD between T___ and T___.

A

Manubriosternal junction

T4/5

31
Q

The pericardium is a 2 layer structure of outer ___ pericardium and inner ___ pericardium. The inner ___ pericardium has 2 layers - a ___ layer that lines the internal aspect of outer ___ pericardium and a ___ layer that lines the external surface of the heart.

A

Outer fibrous pericaridum

Inner serous pericardium - with outer parietal layer and inner visceral layer

32
Q

The right border of the heart is formed by the ___ ___ and the left border of the heart and apex is formed by the ___ ___,

A

Right border - right atrium

Left border and apex - left ventricle

33
Q

Where is the apex beat normally palpable?

A

5th intercostal space in midclavicular line

34
Q

The ___ sulcus or ___ sulcus (ant and post) is a groove between the atria and ventricles, and the ___ sulcus (ant and post) is a groove between the ventricles.

A

Atrioventricular or coronary sulcus - between atria and ventricles
Interventricular sulcus - between ventricles

35
Q

The internal aspect of the anterior wall of the right atrium is lined by muscular ridges called ___ ___.

A

Musculi pectinati

36
Q

The posterior wall of the RA is smooth - called the ___ ___.

A

Sinus venarum

37
Q

The musculi pectinati in the RA end at the right side at a distinct line called ___ ___.

A

Crista terminalis

38
Q

The SVC has an unvalved opening into the heart, but the IVC has a rudimentary valved opening that directs blood to the ___ ___.

A

Fossa ovalis - imprint on smooth posterior wall of RA

In the fetus - blood goes from IVC through foramen ovale to left heart to bypass lungs

39
Q

In the right ventricle, the muscular ridges are called ___ ___. They cover most of the surface of the RV EXCEPT for the terminal end of outflow tract before pulmonary valve (smooth here) - this area is called the ___ ___ or ___.

A

Trabeculae carnae

Conus arteriosus or infundibulum - area before pulmonary valve that is smooth, not ridged

40
Q

From the apex of 3 ___ muscles are a series of ___ ___ that connect the apex of ___ muscles and the cusps of the tricuspid valve in the right ventricle.

A

3 papillary muscles
Series of chordae tendineae
Connect apex of papillary muscles with cusps of valve

41
Q

What is the valve between the LA and LV? How many papillary muscles are in the LV for the valve?

A

Bicuspid or mitral valve

2 papillary muscles in LV for the 2 cusps of the bicuspid valve

42
Q

The ventricular muscle mass attaches to the fibrous skeleton of the heart separately to the atrial muscle mass resulting in ____ isolation. Therefore, impulses from the atria cannot spread to the ventricles without some type of conduction system.

A

Electrical

43
Q

During atrial systole, opening and closing of the valves is ___ i.e. not actively due to papillary muscles or chordae tendineae.

A

Passive

44
Q

When ventricular muscle contracts, the papillary muscles contract and pull on the ___ ___ which hold the cusps closed to prevent back flow into atria.

A

Chordae tendineae

45
Q

The ___ node is in the RA at the top of the crista terminalis, and comes across in front of the SVC. The ___ node is in the RA between the opening of the coronary sinus and the tricuspid valve. The ___ ___ ___ bridges the fibrous skeleton between atria and ventricles and splits into right and left bundle branches (either side of interventricular septum).

A

Sinoatrial node
Atrioventricular node
Bundle of His

46
Q

The cardiac plexus is located at the base of the heart and receives branches from the ___ and the ___ ___.

A

Vagus

Sympathetic trunks

47
Q

The right and left ___ arteries are the first branches of the ___ ___. They emerge onto the anterior surface of the heart on either side of the pulmonary trunk. The right ___ artery descends in the anterior ___ sulcus or ___ sulcus and sends branches to the RA and RV.

A

Coronary arteries
Ascending aorta
Right coronary artery descends in the anterior atrioventricular/coronary sulcus

48
Q

If you block all of the effects of the ANS using atropine and propranolol, heart rate levels at around ___ bpm - this is due to spontaneous activity of the ___ ___.

A

100 bpm

Sinoatrial node

49
Q

Side effects of class 2 beta-adrenoceptor antagonists include: ___cardia, ___ exercise capacity, ___tension, AV ___ block, broncho___ (and therefore, contraindicated in asthmatics) and ___glycaemia.

A 
Bradycardia
Reduced exercise capacity
Hypotension
AV conduction block
Bronchoconstriction
Hypoglycaemia
50
Q

Adverse effects of ACE inhibitors include ___-___ hypotension, dry ___, ___kalaemia (therefore, often prescribed with a ___ ___), acute ___ failure, itching/rash/angioedema and fetal malformations.

A 
First-dose hypotension
Dry cough
Hyperkalaemia
Thiazide diuretic
Acute renal failure
51
Q

ACE inhibitors and anteiotensin receptor antagonists are contraindicated in: ___, bilateral ___ stenosis, and ___ oedema.

A

Pregnancy
Bilateral renal stenosis
Angioneurotic oedema

52
Q

Adverse effects of beta-adrenoceptor antagonists for hypertension include ___ extremities, fatigue (therefore, contraindicated in ___ as it masks awareness of hypoglycaemia), dreams, insomnia, and broncho___ (therefore, contraindicated in ___).

A

Cold extremities - due to reflex A1 constriction, and blockade of dilatory B2s
Fatigue - B1 blockade leads to reduced cardiac response, and B2 blockade leads to constriction of skeletal muscle arteries
Contraindicated in diabetes
Bronchoconstriction
Contraindicated in asthma

53
Q

The two main types of bias are ___ bias and ___ (or measurement) bias. What does each type mean?

A

Selection and information
Selection bias - a systematic difference in characteristics of people selected for the study, and those not selected
Information bias - systematic difference in the way information is collected between/among groups being compared

54
Q

The three layers of the heart are the ___, ___ and ___.

A

Epicardium, myocardium and endocardium

55
Q

The three layers of a blood vessel are the internal ___ ___, middle ___ ___ and external ___ ___.

A

Internal tunica intima
Middle tunica media
External tunica adventitia

56
Q

Large blood vessels have their own blood supply in the tunica adventitia called ___ ___.

A

Vasa vasorum

57
Q

Microscopic features of atherosclerosis include a ___ cap, a ___ core, a ___ inflammatory infiltrate, ___ (purple in histology), neovascularisation, a narrowed ___, thickened ___ and a thinned ___.

A 
Fibrous cap
Necrotic core
Mononuclear inflammatory infiltrate
Calcification (dystrophic) - purple in histology
Narrowed lumen
Thickened intima
Thinned media
58
Q

What are the two types of calcification?

A

Dystrophic - in areas of cell degeneration e.g. TB, breast lesions, atherosclerosis
Metastatic - serum calcium and phosphate is too high, reaches precipitation threshold

59
Q

What are some non-modifiable and modifiable risk factors for atherosclerosis?

A

Non-modifiable - age, gender, family Hx, genetics, existing atherosclerosis
Modifiable - hypertension, smoking, diabetes, cholesterol, sedentary lifestyle

60
Q

Hypertrophy is an increase in left ___ mass relative to body size.

A

Left ventricular

61
Q

Hypertension and aortic stenosis are causes of ___ hypertrophy.

A

Concentric

62
Q

___ and ___ valve regurgitation and ___ septal defect are causes of ___ hypertrophy.

A

Mitral and aortic valve regurgitation

Ventricular septal defect

63
Q

Thick muscle is less ___ resulting in diastolic dysfunction i.e. increased LVEDP (because increased afterload) to achieve the same LVEDV (preload).

A

Compliant

64
Q

Cardiac output is determined by: ___, ___ ___, ___ and ___.

A

Preload
Heart rate
Contractility
Afterload

65
Q

Cardiac output equals venous return because of the ___-___ mechanism/relationship.

A

Frank-Starling

66
Q

At the end of diastole, atrial pressure is the same as ___ pressure.

A

Ventricular

I.e. at end of diastole, RA pressure = RVEDP

67
Q

___ ___ ___ is an indicator of RA pressure. LA pressure can be measured by ___ ___ ___ pressure.

A

Jugular venous pressure for RA (and therefore RVEDP)

Pulmonary artery wedge pressure - measures pulmonary venous pressure (LA) (and therefore LVEDP)

68
Q

Fluid usually leaks out of the ___ end of the capillary, and leaks in at the ___ end of the capillary. An increase in ___ pressure causes fluid to leak out of vessels.

A

Out at arterial end
In at venous end
Increase in venous pressure causes fluid to leak out of vessels -> oedema

69
Q

If LVEDP increases above 20-30 mmHg, ___ congestion may occur.

A

Pulmonary

70
Q

Cardiac failure occurs when ___ ___ is less than the needs of the body.

A

Cardiac output

71
Q

In cardiac failure, the body may be able to maintain normal cardiac output by fluid ___, but this may result in ___ in legs and lungs.

A

Fluid retention to maintain cardiac output

Oedema in legs and lungs

72
Q

Symptoms of left heart failure include ___ of breath, fatigue, ___cardia, and lung ___. Symptoms of right heart failure include ___.

A

LH failure - shortness of breath, fatigue, tachycardia and lung crepitations
RH failure - oedema

73
Q

Fluid retention occurs because decreased cardiac output leads to ___ renal blood flow and activation of the ___-___ system leading to ___ and ___ retention, K+ loss and vaso___.

A

Decreased renal blood flow
Activation of renin-angiotensin system
Na+ and water retention, K+ loss and vasoconstriction

74
Q

Treatment of cardiac failure involves reducing ___ by removing fluid and by reducing ___ by vasodilation (e.g. diuretics, aldosterone antagonists, ACE/AT-1 inhibitors).

A

Reducing preload

Reducing afterload

Week 4-7 Cardiovascular (4 decks)

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