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Human Organs and Tissues > Cardio > Flashcards

Cardio Flashcards

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1
Q

Major borders and surfaces of the heart

A

Right border = RA
Left border = LA and LV
Inferior border = RV and some LV
RV forms most of the anterior surface of the heart

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2
Q

What do the two appendages look like?

A

Right atrial appendage is like snoopy’s nose, left is longer and skinnier like south america

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3
Q

Relative position of pulmonary artery and aorta

A

Pulmonary artery is anterior to aorta, to left shoulder,
Ascending aorta is posterior to PA, to right shoulder
Angle between the two is 60-90 degrees

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4
Q

Right coronary artery (where does it come from, where does it lie, what does it give rise to)

A

Right coronary artery arises from right sinus of Valsalva (aortic sinus)
Courses between RA and RV in atrioventricular groove
Gives rise to RA branch, acute marginal (feed RV) and usually the posterior interventricular artery

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5
Q

Left coronary artery (where does it come from, and what does it divide into

A

Left coronary artery arises from left sinus of Valsalva

Has a short segment (left main) then divides into circumflex and left anterior descending artery

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6
Q

Circumflex (where, and what does it give rise to)

A

In left atrioventricular groove

Gives rise to obtuse marginal branches that feed lateral LV wall

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7
Q

Left anterior descending artery (what does it do and where does it arise from)

A

Feeds septum and LV free wall

Gives rise to diagonals and septal branches

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8
Q

Where do the majority of the cardiac veins drain to? Where is it?

A

The coronary sinus (great cardiac vein) in posterior AV groove

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9
Q

Right atrium

A

Smooth and trabeculated walls separated by crista terminalis
Superior and inferior vena cava drain into smooth walled portion of RA
Fossa Ovalis is formed from downward migration of septum secundum and upward migration of septum primum
Associated with tricuspid valve
Upper chamber
2 mm thick
Conducts blood from systemic to RV
Coronary sinus empties here
Epicardium rich in ganglia
Myocytes smaller than ventricles
Electron dense granules store atrial naturietic peptide

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10
Q

What two things does the LA not have that the RA does?

A

No crista terminals or pectinate muscles

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11
Q

Right ventricle

A 
L shaped (croissant)
Thin walled
Highly trabeculated
Pumps through pulmonary valve
At apex of heart
Anterior most structure
Inflow portion, apex, outflow portion (infundibulum or conus)
Myocardium 5 mm thick
Membranous septum contains conduction system
Low pressure (25-30mmHg)
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12
Q

Left Ventricle

A 
Cone shaped (donut)
Thick walled
No trabeculations
Pumps through aortic valve
high pressure
Inflow/septal/outflow portions
15 mm thick
Conducts blood from LV to aorta
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13
Q

What 5 things do the AV valves depend on for proper function?

A 
Hinge lines
Valve tissue
Chordae
Papillary muscles
Ventricular wall function
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14
Q

Semilunar valves

A

Aortic and pulmonary
3 leaflets
Suspended from the pulmonary trunk and aortic root
Scalloped (commissures/hinge lines)
Competency dependent on attachments and elastic/collagenous nature of the leaftet tissue as well as the dimensions of the root and trunk
No chordae!

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15
Q

Relative amounts and cell numbers of endothelial cells and cardiomyocytes

A

Myocytes: 25% of total cell number, 90% of cell volume

Endothelial cells: 75% cell number, negligible volume

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16
Q

What is the pericardium? What is it made of?

A 
Fibrous sac surrounding the heart
Reflections from great vessels and veins
Serous component over surface of heart
Fibrous joins serous at reflections.
Collagen rich, inelastic!
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17
Q

Beck’s triad

A

Hypotension, muffled heart sounds, distended jugular veins
Signs associated with acute cardiac tamponade.
50cc of straw coloured fluid is normal, but sudden increase to 250cc causes tamponade

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18
Q

Pericarditis

A

Really thick pericardium, calcifies and restricts the heart even without fluid

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19
Q

Fibrous skeleton

A

Base of the heart, dense collagenous tissue with elastin
Makes up AV valve rings and aortic annulus, extends to pulmonary trunk via conal ligament – point of attachment for valve leaflets and myocardium
Separates the atrial and ventricular chambers, separates the right and left ventricles (membranous septum)
AV conduction bundle embedded
Provides rigidity to prevent dilation of valves

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20
Q

Why is electrical isolation important between atria and ventricles?

A

Electrical isolation is important so that the atria and ventricles keep separated
Muscle cells have gap junctions that can share action potentials but they stop at the fibrous skeleton
So the entire heart doesn’t contract at once
Bundle of His is the only electrical connection between A/V

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21
Q

Epicardium

A

Analogue of vascular adventitia
Serous pericardium
Contains coronary arteries and veins, fat, nerves, fibroblasts and macrophages

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22
Q

Myocardium

A

Analogue of vascular media
Contractile myocytes
Also collagen, blood vessels, and elastin
Bundles of cardiac muscle separated by fibrous bands

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23
Q

Endocardium

A 
Analogue of vascular intima
Endothelial cells and connective tissue
Continuous with intima of vessels
Anticoagulant surface
Has 3 major components
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24
Q

3 major components of the endocardium

A

Endothelium (single layer of squamous endothelial cells held together by tight junctions, also has gap junctions for communication)
Continuous basal lamina
Subendocardium (layer of loose connective tissue – binds the endocardium to myocardium)

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25
5 components of cardiac myocytes
Cell membrane (sarcolemma and T tubules) responsible for impulse conduction – form gap junctions between adjacent cells, intercalated disks join adjacent myocytes both mechanically and ionically, myocardium is a functional syncytium (electrically unified) Sarcoplasmic reticulum: Ca2+ reservoir, release of Ca into cytosol as a result of action potential causes contraction Contractile elements: action, myosin, troponin, and tropomyosin – contraction is the net effect of sliding actin and myosin toward to center of the sarcomere – increased stretch results in longer pull (Starling's) Mitochondria: energy generation through aerobic metabolism, heart muscle almost exclusively aerobic, mitochondria make up 23% of myocyte volume (2% in skeletal) Nucleus: very large
26
Ventricular cardiac muscle
Forms complex layers of cells wound helically around the ventricular cavity
27
Atrial cardiac muscle
``` Muscles in outer myocardium form a helical pattern around the chambers (like ventricles) Atrial cells are smaller Less T tubules More gap junctions Conduct impulses faster Contract more rhythmically Have many granules ```
28
Left atrium
``` Receives blood from pulmonary veins and delivers to LV Smooth throughout Auricular appendage (South America) ```
29
Aortic valve
Located in aortic root Commisures are high points and cusp nadirs the low points Ring of suspension is annulus Left/right/non leaflets
30
3 Layers of aortic valve
Fibrosa (collagen rich, extends to free edge and coapting surface, gives strength to tissue) Spongiosa (proteoglycan and GAG rich, collagen and fibroblasts) Ventricularis (LV side, elastin rich, acts as shock absorber, allows leaflets to stretch and coapt under pressure load and spring out of the way during ejection)
31
Pulmonary valve
Resides in pulmonary trunk, anterior and superior to aortic valve
32
Mitral valve
Regulates flow between LA and LV (only 2 leaflets) Leaflets attach to the mitral annulus (junction of the left atrium and LV made by the cardiac skeleton) Leaflet edges tethered by chordae tendinae attached to papillary muscles Competency based on annular dimension, structural integrity of leaflets (pliable, elastic, strength), structural integrity of chordae, function and dimensions of ventricle
33
4 layers of the mitral valve
Fibrosa (collagen rich, extends to chordae and tips of papillary muscles) Spongiosa (atrial side, GAG and proteoglycan rich) Ventricularis (ventricular side, elastin rich and endothelialized) Auricularis (EC layer on atrial side)
34
Tricuspid valve
Analogous histological structure Lower pressure Thinner leaflets, and chordae and papillary muscles
35
Tunica adventitia
Outermost layer Mainly loose connective tissue with type 1 collagen and elastic fibers that anchor vessel Thickest layer in veins Contains vasa vasorum
36
Tunica media
Middle layer (most variable in size/structure) Contains smooth muscle, collagen fibers, reticular fibers, and elastic tissue (more in arteries, less in veins) Large layer in most arteries
37
Nitric oxide versus endothelin
Nitric oxide dilates coronary arteries, endothelin constricts them
38
Endothelium
Bound together by junctional complexes Can be activated by cytokines to express cell adhesion molecules to allow WBC to stick Secretions to maintain tone and prevent clotting
39
SA node
``` Initiates the heart beat Highest intrinsic heart rate Junction of SVC and RAA Has leakiest phase 4 60-100 bpm ```
40
4 mediators released from endothelial cells that are elaborate anticoagulant, antithrombotic, and fibriolytic molecules
Prostacyclins Thrombomodulin Heparans Plasminogen activator
41
3 pro-thrombotic molecules
Von willebrands factor Tissue factor Plasminogen activator inhibitor
42
Agents each responsible for 1. Vasoconstriction (3) 2. Vasodilation (2)
1. Endothelin, angiotensin converting enzyme, thromboxane | 2. Nitric oxide, prostacylin
43
3 stimulators and 2 inhibitors of cell growth
``` Stimulators: 1. PDGF 2. FGF 3. VEGF Inhibitors: 1. Heparin 2. TGF beta ```
44
Large elastic arteries
Aorta, brachiocephalic, carotid, subclavian, iliac, pulmonary arteries and larger branches Thick vessels, with cells and connective tissue organized in lamella Too thick for oxygen diffusion, so need vasa vasorum Elastin dominates in media, allowing for expansion in systole
45
Muscular arteries
Intima thinner than elastic arteries Internal and external elastic lamina well defined Media has fewer and finer elastin fibers, lamella is defined but occasionally discontinuous, VSMC major component (75% mass) Adventitial thickness/strength is variable Ex: coronaries, renal arteries, femorals and distributive arteries of lower extremities, axillaries and distributive arteries of upper extremity.
46
Aorta as a secondary pump
Elastic artery, so it can expand with systole and become a pressure reservoir
47
Aorta
Arises from LV Root gives rise to coronary arteries Arch to head and upper extremity vessels (variants common), descending to paired intercostal arteries (role in coarctation)
48
Type A dissection
Ascending (40% mortality without surgery, 10% with operation)
49
Type B dissection
Descending (20% mortality, better than with surgery)
50
Axillary artery
Muscular artery in upper limb Begins at lateral border of first rib to teres major Multiple branches to shoulder and chest wall.
51
Brachial artery
Muscular artery in upper limb Teres major to antecubital foss Branches to elbow and adjacent forearm musculature Radial and ulnar arteries supply forearm musculature, deep and superficial palmar arches supply hand and digits
52
Iliac artery (3 parts)
Common iliac: paired arteries arise at the terminus of the abdominal aorta External iliac: common iliac branch that courses along psoas muscle anterior and inferior to the inguinal ligament Internal iliac arteries: arise at sacroiliac joint: courses postero-inferior to external iliac giving rise to branches that supply the pelvic viscera and medial thigh
53
NAVL
Lateral to medial it goes nerve, artery, vein, lymph
54
Relative position of femoral artery
As external iliac crosses the inguinal ligament it becomes femoral artery Midway between pubic tubercule and anterior superior iliac spine
55
Popliteal artery
As superficial femoral artery emerges into posterior knee, from adductor magnus muscle becomes popliteal artery Gives 5 geniculate branches to knee, travels in interchondylar fossa, divides at popliteal muscle into anterior and posterior tibial artery
56
Anterior tibial artery
Popliteal artery as it emerges from popliteus muscle changes name to anterior tibial Courses in anterior compartment of lower leg Gives posterior tibial artery, dorsalis pedis in foot, supplies tibia and adjacent muscles
57
Posterior tibial artery
Arises near origin of anterior tibial artery and courses down behind the tibia in the posterolateral leg Gives peroneal artery Terminates behind the malleolus Supplies tibia and adjacent muscles
58
Structure and function of arterioles
Arterioles (20-100 um diameter): provide blood flow regulation via medial smooth muscle contraction, regulates relative blood flow to capillary beds. Intima is very thin, media is 1-6 layers of smooth muscle, adventitia comparable in thickness to media, merges with adjacent connective tissue Provide majority of flow resistance
59
Capillary structure/function
Diameter of 8-30 um – collectively represent a huge cross sectional area in body Endothelial cell lining but no media or elastin – myosin containing pericytes provide structural support Allow rapid exchange of oxygen and nutrients via diffusion Flow is very slow
60
Veins versus arteries
Veins: intima is narrow and lining is hard to see. Sparse elastin with only incomplete elastic lamina. Media is thinner than in arteries, and smooth muscle cells are less and less organized. Adventitia: only in the largest veins
61
Starling's Law
With more venous return to the heart, the heart pumps more Increased muscular stretch results in increased contraction Operates at the level of the sarcomere No change in arterial pressure or heart rate Can over stretch
62
Autonomic Control
Heart has abundant symp and parasymp innervation Sympathetic drive increases heart rate, strength of contraction, controls basal firing of sympathetic fibers, and is mediated by beta-adrenoreceptors Parasympathetic tone can lead to bradycardia, and decreased force of contraction
63
Baroreceptor reflex
Stretch receptors widely distributed in vascular system (especially carotid sinus, aortic arch) Stimulate CNS Increased pressure results in inhibition of vasoconstrictor center and excitation of vagal center With standing, opposite effect Vasodilation of veins and arterioles Decreased heart rate and contractility Senses increased blood pressure, so it dilates veins and arterioles, as well as decreasing heart rate and contractility
64
What happens in exercise
20-fold flow difference between rest and exercise in skeletal muscle beds (vasodilation – arteriolar and EC regulated) Increased return of blood (frank-starling) Increases CNS activity results in vasoconstrictor center activation
65
Fight or flight response
Norepinephrine/epinephrine: results in humoral release and increased sympathetic tone. Humoral release has same effect as local sympathetic innervation (constricts VSM, increases HR and FVC)
66
3 types of capillaries
Continuous: complete EC lining Fenestrated: EC gaps allowing macromolecular passage (ex: glomerulus) Discontinuous: larger gaps in EC (ex: liver)
67
What sized veins do not have valves?
Large veins
68
What is dominance determined by?
Which artery gives rise to the posterior descending artery If its the right coronary artery, right dominant If its the circumflex, left dominant If both, co dominant
69
7 Endothelial Cell functions
1. Permeability barrier 2. Antioagulant, antithrombotic, fibrinolytic 3. Pro-thrombotic 4. Synthesize matrix molecules 5. Modulate blood flow 6. Regulation of cell growth 7. Regulation of inflammation and immunity

Human Organs and Tissues (11 decks)

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