control of heart function Flashcards

1
Q

what cells can contract and relax in response to electrical stimuli

A
muscle cells (cardiac myocytes)
essential for pumping blood around the body
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2
Q

what do specialised electrical cells do

A

they are cells that create spontaneous currents and those that transmit currents exist within the heart - essential for regulation contraction of cardiac myocytes

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3
Q

what are the vessels responsible for

A

the major blood vessels are responsible for transporting the blood in and out of the heart
while the coronary blood vessels are responsible for supplying blood to the heart

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4
Q

what cells are the most prominent in controlling heart function

A

electrical cells

although cardiac myocytes and vessels of the heart are able to modulate function

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5
Q

what are the 2 nodes of the heart

A

SAN

AVN

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6
Q

what is the SAN and where is it found

A

pacemaker of the heart - 60-100 bpm

at the junction of crista terminalis - upper wall of right atrium and opening of superior vena cava

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7
Q

what is the AVN and where is it found

A

has pacemaker activity : slow calcium mediated action potential
traingle of Koch at the base of right atrium

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8
Q

what is the bundle of His and bundle branches

A

internodal tracts - specialised myocytes
connect the SAN to AVN
bundle of His that goes from the atria down through interventricular septum

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9
Q

what are purkinje fibres

A

specialised conducting fibres along ventricles of the heart

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10
Q

how many phases does nodal action potential have

A

3 phases (0, 3 and 4)
in the order 4 0 3
(pre potential, upstroke and then repolarisation)

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11
Q

what is upstroke and what is it due to

A

depolarisation due to Ca2+ influx

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12
Q

what is repolarisation due to (in terms of ions)

A

K+ efflux

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13
Q

do nodal cells have a resting membrane potential

A

no

only a pre potential due to Na+ influx through a “funny” channel

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14
Q

why do different parts of the heart have different action potential shapes

A

caused by different ion currents flowing and different ion channel expression in cell membrane

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15
Q

which AP is longer - cardiac or nerve

A

cardiac AP

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16
Q

what does the duration of AP control the duration of

A

contraction of the heart

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17
Q

what kind of contraction is required to produce an effective pump

A

long slow contraction

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18
Q

how many phases does AP have

A

5 phases labelled 0-4

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19
Q

describe phase 0

A

upstroke

start off with resting membrane potential around -80/90 mV then upstroke takes it up to 20/30 mV

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20
Q

describe phase 1

A

early repolarisation

brings the membrane potential back down to a slightly more negative value

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21
Q

describe phase 2

A

plateau

maintains the cell at a level of depolarisation

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22
Q

describe phase 3

A

repolarisation

repolarisation at around 270 ms

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23
Q

describe phase 4

A

resting membrane potential

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24
Q

what is the absolute refractory period (ARP)

A

time during which no AP can be initiated regardless of stimulus intensity
(phases 0, 1 and 2)

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25
Q

what is the relative refractory period (RRP)

A

period after ARP where an AP can be elicited but only with larger stimulus strength
(phases 3 and 4)

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26
Q

what are 3 major organ systems that have the ability to modulate the activity of the heart

A

the brain/CNS
the kidneys
the blood vessels

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27
Q

how can the brain/CNS modulate heart activity

A

can effect immediate changes through nerve activity or slower changes through hormonal activity
the CNS also impacts other systems > subsequently affecting the heart

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28
Q

how can the kidneys modulate heart activity

A

the heart and kidneys share a bidirectional regulatory relationship usually through indirect mechanisms

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29
Q

how can the blood vessels modulate heart activity

A

by regulating the amount of blood that goes to and from the heart, the blood vessels are able to influence cardiac activity

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30
Q

how is the autonomic nervous system involved in CNS control of the heart

A

cairo-regulatory centre and vasomotor centres in medulla

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31
Q

how is the parasympathetic nervous system involved in CNS control of the heart

A

rest and digest
PS nerves leave from medulla and goes via vagus nerve to heart
PS nerve is activated > causes a decrease in HR
decreases slope of phase 4 reducing HR by affecting SAN
affects pre-potential of AP within nodal cell

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32
Q

how is the sympathetic nervous system involved in CNS control of the heart

A

fight or flight
increase in HR (positive chronotrophy) - increases the slope of phase 4 (sympathetic nerves decreases time taken to get back to depolarisation phase)
increase force of contraction (inotropy) - increases Ca2+ dynamics

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33
Q

what does an increase in volume and pressure activate

A

baroreceptors

reduce SNS activity and HR

34
Q

design of the ANS

A

split into PNS and SNS

35
Q

describe the parasympathetic nervous system

A

parasympathetic nerves arising from cranial part of spinal cord and sacral part of spinal cord
rest and digest
preganglionic fibres (long) use ACh as NT
PNS post ganglionic NT = ACh
PNS is important for controlling the HR

36
Q

describe the sympathetic nervous system

A

arises from thoracic vertebrae and lumbar vertebrae
fight or flight
preganglionic fibres (short) use ACh as their NT
SNS post ganglionic NT = NA (noradrenaline)
SNS is important for controlling the circulation

37
Q

where is the vasomotor complex located

A

located bilaterally in reticular substance of medulla and lower third of pons

38
Q

what is the vasomotor cortex composed of

A

vasoconstrictor (pressor) area
vasodilator (depressor) area
cardioregulatory inhibitory area

39
Q

where are impulses transmitted through

A

distally through spinal cord to almost all blood vessels

40
Q

what can exert powerful excitatory or inhibitory effects on the vasomotor complex/centre

A

many higher centres of the brain such as the hypothalamus

41
Q

what do lateral portions of Vasomotor complex/centre control

A

heart activity by influencing heart rate and contractility

42
Q

what do medial portions of the vasomotor complex/centre transmit

A

signals via the vagus nerve to the heart that tend to decrease heart rate

43
Q

what does the PS release to inhibit the SAN

A

releases ACh
acts on M2 muscarinic receptors on cell membrane of SAN cell and by a G protein known as Gi protein > inhibition of adenylyl cyclase > prevents conversion of ATP to protein kinases

44
Q

what does the sympathetic system release to activate/stimulate the SAN

A

releases noradrenaline > acts on beta 1 receptors > stimulates adenylyl cyclase and cause increase in level of protein kinase A

45
Q

what is shown if you cut sympathetic nerves

A

the heart rate goes down suggesting that there was already some level of S activity occurring all the time

46
Q

describe how sympathetic nerves in the renal system regulate blood volume and can therefore affect BP

A

sympathetic nerves innervate the kidneys

they reduce glomerular filtration (less filtered) > decreases Na+ excretion > increasing blood volume (aldosterone)

47
Q

what is blood volume detected by

A

venous volume receptors

48
Q

sympathetic nerves can also increase activity

how do the kidneys regulate blood volume and pressure with increased renin secretion?

A

increased renin secretion > releases angiotensin 2 (causes release of aldosterone - impacts blood volume/increased production of aldosterone leads to vasoconstriction and increases blood pressure)

49
Q

what cells is blood pressure detected by

A

arterial baroreceptors

decreases SNS activity and decreases HR

50
Q

what nerve fibres innervate afferent and efferent arterioles of the glomerulus and nephron tubule cells

A

sympathetic nerve fibres

51
Q

where is the primary site of sympathetic activity

A

afferent arterioles

52
Q

STEPS for what happens at afferent arterioles upon release of NA

A

release of NA

1) activation of alpha 1 adrenoreceptor
2) reduced chronotropy and increased intropy for heart
3) activation of receptors causes vasoconstriction (reduces GFR and increases blood volume)
4) reduction in GFR = reduction in Na+ filtered
5) sympathetic nerves act on juxtaglomerular cells (site of synthesis, storage and release of renin)
6) stimulation of beta 1 adrenoreceptor leads to renin secretion
7) renin increases blood volume by sympathetic nerves at the kidney

53
Q

what do volume sensors do

A

also atria and right ventricle

send signals through glossopharyngeal and vagus nerves

54
Q

what does a decrease in filling (less blood returning to the heart) lead to

A

reduction in baroreceptor firing > increased SNS activity

increased HR

55
Q

what does distension (heart is full - more blood returning to the heart) lead to

A

increased baroreceptor firing

decreased SNS activity

56
Q

what regulates how much blood coming back to the heart

A

kidneys and blood vessels

57
Q

what is involved in the arterial circuit

A

aortic arch
carotid sinus
afferent arterioles of the kidneys

58
Q

what do pressure receptors do

A

send signals through glossopharyngeal and vagus nerves

59
Q

what does a decrease in pressure lead to

A

reduction in baroreceptor firing

increases SNS activity

60
Q

what does an increase in pressure lead to

A

increased baroreceptor firing

decreased SNS activity

61
Q

what is the relationship between baroreceptor firing and SNS activity

A

they are reciprocals

62
Q

how many circulations are there and what are their names

A

2 circulations
pulmonary and systemic
right heart > lungs > left heart > body

63
Q

what is venous volume and what is venous volume distribution affected by

A

venous volume = amount of volume in veins

affected by peripheral venous tone, gravity, skeletal muscle pump and breathing

64
Q

what is central venous pressure and what does it determine

A

mean pressure in right atrium
determines the amount of blood flowing back to the heart
determines filling pressure and distension of the heart

65
Q

what determines stroke volume

A

the amount of blood flowing back to the heart (Starling’s Law of the heart)

66
Q

in veins, what does constriction do

A

constriction reduces compliance and increases venous return - greater pressure (bigger effect than decreased volume due to constriction)

67
Q

in arterioles (less blood but higher pressure) constriction determines? (3)

A

blood flow to downstream organs
mean arterial blood pressure
the pattern of blood flow to organs

68
Q

what are local mechanisms for regulating blood flow (characteristics not actual things)

A

intrinsic to smooth muscle (or closely associated)

important for reflex local blood flow regulation within an organ

69
Q

what are some endothelium derived vasodilators

A

Nitric oxide

prostacyclin

70
Q

what are some endothelium derived vasoconstrictors

A

thromboxane A2

endothelins

71
Q

what does NO do

A

potent vasodilator

diffuses into vascular smooth muscle cells

72
Q

what does prostacyclin do

A

vasodilator

has antiplatelet and anticoagulant effects

73
Q

what does thromboxane A2 do

A

aka TXA2

vasoconstrictor that is also heavily synthesised in platelets

74
Q

what do endothelins do

A

ET

vasoconstrictors generated from nucleus of endothelial cells

75
Q

what are characteristics of systemic mechanisms

A

extrinsic to smooth muscle

these include the autonomic nervous system and circulating hormones

76
Q

what are some non endothelium derived vasodilators

A

kinins

atrial natriuretic peptide (ANP)

77
Q

what are some non endothelium derived vasoconstrictors

A

vasopressin
noradrenaline/adrenaline
angiotensin 2

78
Q

what do kinins do

A

vasodilator

binds to receptors on endothelial cells and stimulates NO synthesis

79
Q

what does atrial natriuretic peptide (ANP)

A

vasodilator

secreted from the atria in response to stretch to reduce BP

80
Q

what does vasopressin do (ADH)

A

vasoconstriction
secreted from the pituitary gland
binds to V1 receptors on smooth muscles to cause vasoconstriction

81
Q

what does noradrenaline/adrenaline do

A

vasoconstriction

secreted from the adrenal glands (and SNS) causing vasoconstriction

82
Q

what does angiotensin 2 do

A

potent vasoconstrictor from the renin-angiotensin-aldosterone axis
also stimulates ADH secretion