What is the mediastinum?
Space between two lungs two parts:
Superior: - Aorta, pulmonary artery, trachea, esophagus
Inferior: Heart in center in reclining position towards left, Atria behind & ventricles in front
What are the blood vessels incoming into the Right Atrium? What type of blood are they carrying?
* Superior & Inferior Vena Cava, & Coronary Sinus -
* Deoxygenated blood -
**Coronary Sinus collects from sulcus/fissure of the heart - major VEIN of the heart aka DU channel of the Heart,
What is the blood vessel that brings deoxygenated blood to the lungs?
What are two pairs of blood vessels that bring oxygenated blood to the Left Atrium?
What are other blood vessels that penetrate the heart & supply with oxygen?
The branches of coronary arteries
What is the major blood vessel that brings oxygenated blood to the Systemic Circulation from the Left Ventricle?
What are the valves of the heart?
Tricuspid - (Right Atrium/Right Ventricle)
Bicuspid/Mitral Valve - (Left Atrium/Left Ventricle)
Pulmonary Valve (From R. Ventricle ==> Pulmonary arteries ==> Lungs ==> L. Atrium)
Aortic Valve (from L. Ventricle ==> Aorta ==> systemic circulation)
What is the pace maker of the heart? What are corresponding sounds?
SA node in Right Atrium under epicardium (2nd intercostal space);
Bicuspid & Tricuspid valves closing produce s1 sound lub, semi-lunar are s2 sound dub
(s3 and s4 generated by turbulence of the flow of heart or exertion of left ventricle muscle)
How does a heart beat? Sino-Atrial node begins pacemaker then goes to ____ node, and then to Bundle of His which is divided into Right & Left branches, and then Perkinje Fibers send radiation. Where is conduction the slowest? Fastest?
SA node (under epicardium) ==> AV node (in septum - division btwn R/L) ==> Bundle of His (2 branches) ==> Perkinje fibers.
*Slowest - when impulse is being conducted from SIA node to AV node
*Fastest - Perkinje Fibers
The force of cardiac conduction of the muscle depends on what? On what two constituents does this conduction depend?
*Factor 1 = Preload - Frank Starling Law - The more the preload; the more force of cardiac conduction. Include Diastole & elasticity of cardiac muscle
*Factor 2 = Calcium available in smooth endoplasmic reticulum of the sarcomeres. The more calcium; the more contractility.
**When heart is overexerting - people are given calcium channel blockers.
What does Sino signify in SA node?
Alternating systole & diastole of Atria versus Ventricles
When Atria in Systole - Ventricles are in Diastole & vice versa
What rate does SA node generate? What is normal rate?
60-100 - SA node
40-60 - AV node
*diminished cardiac output is aka - Bradychardia; increased is aka Tachycardia
What is Systolic pressure? Diastolic pressure? What is pulse pressure?
* Systolic pressure = in systemic circulation on the peak of the systole
* Diastolic pressure = pressure in systemic circulation when heart ventricles are in diastole
* Pulse pressure = difference between Systolic and Diastolic ESV-EDV = PP (45-55 ideally)
if lower PP then double jeopardy - heart over exerted & blood vessels are stiff - congestive heart failure;
if too high PP - then might be in septic shock, anaphalactic shock
What is preload? Ejection Fraction? Afterload?
* Preload is EDV (end diastolic volume) of blood, amount of blood in heart ventricles filling at end of ventricular diastole - 75/80% should return to peripheral circulation;
* Ejection Fraction: 75/80% preload # (qi-gong & meditation can increase this % in weaker patients by 25-35%) Stroke Volume will be this same # but will be MEASURED in ML
* Afterload: maximum exertion at peak of Systole - to get semi-lunar valves working in left ventricle - almost equal to systolic BP
How is cardiac ouput calculated? How much is pumping into peripheral circulation every minute?
Stroke Volume x Heart Rate = Cardiac Output; about 5 liters
SV x HR = CO
(in severe Tachycardia, CO will diminish because SV will diminish because of less preload)
Blood flow depends on what two major constituents?
1. Diameter of blood vessels aka RESISTANCE --- larger diameter/LESS resistance; smaller diameter/MORE resistance
2. Viscosity - stew vs. liquid - more viscous leads to less blood flow
Qi & Blood stasis - becomes more viscous bc of dehydration, absolute polycythemia, inflammation - more proteins from LV increasing viscosity aka alcapoco analogy
Resistence to blood flow is normal in capillaries - where exchange occurs for Oxygen with Tissues
What hormones are involved in regulation of cardiovascular activity? What part of the brainstem is involved?
* Andrenaline - Sympathetic system reactions,
* Natriuretic Peptide produced by Atria - diminishes redistribution of sodium-potassium pumps in blood
* brainstem function located in medulla oblongata - commanded by Hyopthalamus - autonomic regulation of the heart
2nd intercostal space - Right sternal border?
2nd intercostal space - Left sternal border?
3rd/4th/5th intercostal space - Left sternal border?
Mid-Clavicular line - 5th/6th intercostal space?
* 2nd intercostal space - Right sternal border = Aortic semi-lunar valve
* 2nd intercostal space - Left sternal border = Pulmonary Valve
* 3rd/4th/5th intercostal space - Left sternal border = tricuspid valve
* Mid-Clavicular line - 5th/6th intercostal space = bicuspid valve
What is the #1 cause of death in industrialized countries?
Ischemic Heart Disease
What is a major Sign & Sympton of Angina Pectoris?
A Squeezing Heart Pain
Extremely insufficient or deficient circulation will lead to ____
Shock - loss of consciousness - blood flow not going to the brain, severely hypoxic
Also known as "Smokers disease"?
Will most likely find in Hep B or Hep C patients?
Pulmonary Embolisms have a pathogenesis of what condition?
Deep Vein Thrombosis
T/F: The large pulmonary vessels are unique in that the pulmonary artery is the only artery that carries venous blood & the pulmonary veins, the only veins that carry arterial blood.
True, the pulmonary veins are the only veins in the body that carry oxygenated blood to the heart - all other veins carry deoxygenated blood back to the Heart.
T/F: The systemic circulation consists of the left heart, the aorta & its branches, the capillaries that supply the brain & peripheral tissues, & the systemic venous system & the vena cava
The pulmonary circulation consists of the right heart, the pulmonary artery, the pulmonary capillaries, & the pulmonary veins.
Superior & Inferior vena cava empty into the _____ Heart.
The exchange of gases, nutrients, & wastes takes place in the _____________
Basic background knowledge: The heart is situated within:
the mediastinum, in the space between the two lungs.
Basic background knowledge: The heart sound S1 is generated by the following activity of the heart:
Generated by the Tricuspid & Bicuspid Valves closing
Basic background knowledge: Pulse pressure should be calculated as the following:
ESV-EDV = PP – aka End Systolic Volume (-) End Diastolic Volume (=) Pulse Pressure. An ideal PP will be in the 45-55 range.
Basic background knowledge: The normal heart rate is within the following limits ________, and is generated by ______.
60-100 BPM; SA node
In unstable angina pectoris, the typical character and onset of pain is...
Squeezing or heavy character, with possible onset with exertion or at rest
In hypertrophic cardiomyopathy, the preload of the left ventricle along with the cardiac output will be most likely of the following characteristic:
In dilated cardiomyopathy, the preload of the heart will be most likely of the following characteristic:
The most common cause of left CHF is the following
In distributive shock (septic or anaphylactic), peripheral microcirculation is in a state of:
The most typical patient, affected by hypertrophic cardiomyopathy is the following:
a young athlete
Which of the following clinical features are most likely in a shock patient, regardless of the cause of shock?
- Deficient arterial circulation.
- Hypotension with systemic BP below 90;
- Tachycardia; Altered mental state;
- Decreased urinary output to below 30-55 mL/Hr;
- Cool & clammy skin.
*This can be categorized as Yang Collapse in TCM
Reactive (Dressler’s) pericarditis is due to the following cause:
Myocardial Infarction. It’s an immune system response following damage to heart tissue or the pericardium; post heart attack, surgery or traumatic injury (S&S appear weeks to months after)
Basic background knowledge: Left atrium receives blood via the following blood vessels:
Via the Pulmonary Veins carrying Oxygenated blood
List three blood vessels, which are emptying into the right atrium:
- Superior Vena Cava; 2.) Inferior Vena Cava & 3.) Coronary Sinus
Describe the phenomenon of Portal Hypertension:
Can be due to either
- high blood pressure in venous system due to Right Heart Failure or
- stagnation in the Liver and it’s functions.
Systemic arterial hypertension is a diagnosis, established when minimal blood pressure measurements on two random occasions are at or above the following
140/90 mm Hg
The most common cause of secondary systemic arterial hypertension is:
The most common type of systemic arterial hypertension is the following:
Essential/Primary or Idiopathic Hypertension is the most common
What is the major risk factor for pulmonary embolism?
Sudden blockage in the lung due to Deep Vein Thrombosis. Can cause permanent damage to lung, low oxygen levels in blood, damage to other organs due to Hypoxia or in worst cases Death.
What type of cardiomyopathy is the most common and what are its associated risk factors?
Dilated Cardiomyopathy is the most common (where the L. Ventricle dilates and weakens). 40% of cases are genetic & the rest usually occurs in Alcoholics or pregnant women. It can also be caused by Diabetes, Viral/Bacterial/Parasitic Infections, cancer medications & exposure to toxins like lead & mercury.
What are the cardiac enzymes, which are to be measured for the diagnostic procedure of myocardial infarction? What their increased levels do signify?
Markers or Biomarkers will measure whether the heart is damaged & the extent of its damage. Creatine Phosphokinase (CPK), Creatine Kinase (CK-MB), Myoglobin & Troponin.
What is the term for accumulation of the inflammatory fluid within the pericardial cavity?
What is the procedure for removal of the blood or any other type of fluid from the pericardial cavity?
Describe the chain of bio-chemical reactions, generated by the kidneys, as a result of their ischemia, and contributing to systemic arterial hypertension (as we discussed in class):
With systemic vasoconstriction kidney will receive less blood supply/ blood flow per unit of time and activate secretion of hormone renin setting off a
Renin ==> Angiotensin I ==> Angiotensin II ==> Aldosterone ==> ADH ==> Increased osmolarity, Increased blood & Increased vascular resistance reaction.
What is orthostatic hypotension?
A form of low blood pressure that drops happens when you stand up from sitting or laying down.
Describe three types of Angina pectoris:
1. Stable Angina pectoris – heavy crashing chest pain that happens with over exertion of a predictable amount for not more than 15- 20 minutes;
2.) Unstable Angina Pectoris – feeling of heavy crashing feeling of chest pain but with unpredictability of time and can happen during exertion or at rest.
3.) Prinzmetal Angina – sort of a migraine of the Heart where the vessels spasm, also unpredictable but usually happens at night due to Paroxysmal or Episodic vasospasm
Will Dyspnea (subjective SOB) be present in cardiovascular diseases? And Orthopnea (inability to breath when in supine position)?
Yes; Yes, both are usually present in Left congestive heart failure because a lot of fluid situated within heart compartment so lungs will have partial edema (congestive heart failure pillow test)
________ pain - is usually anginal pain aka heavy, squeezing or crushing like elephant on chest
_________ pain - stabbing, sharp aka blood bi pain, aggravated by supine position - rubbing against pericardium is painful - like salt on wound
ischemic VS. pericardial
(Venous Distention) Distended __________ veins will be present when a patient presents with Cardiac Tamponade.
Skin Discolorations for Heart Failure:
- Right Congestive Heart Failure = __________ - if LV is affected & blood will be stagnant in _________; will be dark with grey scales on them
- Left Congestive Heart Failure = blood will be stagnant in ______; will see edema and skin discolorations, patechia, redness, etc.
- Jaundice if LV involved; blood stagnant in veins if Right failure
- Left failure blood will be stagnant in arteries
Finger clubbing is a marker for auto-immune atrophy due to chronic ________
What is normal BP?
115-120/60-75 normal; anything more is pre-hypertension & less is shock
140/90 on two occasions is Hypertension
age, smoking, hypercholesterolemia (high cholesterol levels), diabetes, hypertension and family history and being a male are all pathogenisis for ________
IHD - Ischemic Heart Diseases/ Myocardial Ischemia - usually due to coronary artery disease