Flashcards in Cardiopulmonary I Deck (167):
What forms the heart Apex?
The base of the heart is the _____ and found _____
2nd Costal cartilage
The anterior of the heart is mostly
What is the depression in the inter-atrial septum called?
(remnants foramen ovale)
What is a failure to form the Fossa Ovalis called?
Patent foramen ovale
Atrial septal defect
Inter-atrial septum forms incorrectly
What are the most common Congenital abnormalities of the heart?
How can a VSD (ventricular septal defect) be acquired?
Myocardial infarction and scar formation by macrophage
Healthy heart ejects _____ of what fills it.
What defines ventricular volume?
End Diastolic Volume
What defines output?
Ejection fraction =
What are the 3 tissue layers of the heart wall?
What is found between the Epicardium and the Parietal Pericardium?
(10 mL fluid)
The Myocardium isn't capable of Hyperplasia, but is capable of...
Nuclei in cardiac cell?
(although many have 2)
What is another name for the Visceral Pericardium?
What important feature of the heart is considered part of the Epicardium?
% total weight?
generally along vasculature
What are 2 functions of the Pericardial Space?
4 Heart valves:
What is backflow called in the heart?
What valve lies between the right atrium and right ventricle?
The tricuspid valve is smaller in diameter and thicker than the mitral valve.
larger diameter, thinner than Mitral
What valve lies between the left atrium and left ventricle?
Mitral (bicuspid) valve
What are the atrial ventricular valves attached to?
From where do they originate?
When do the papillary muscles contract the chordae tendineae?
As Ventrical contracts
(prevents valve from prolapsing and folding in on itself)
The Pulmonic and Aortic are both ______ valves and have ___ cusps.
What is the term for Ventricular filling?
What makes the Lub and Dub sound?
Lub - Tricuspid and Mitral (atrioventricular) valves shutting
Dub - Semilunar (Pulmonic, Aortic) shutting
What 3 structures empty into the Right Atrium?
Superior vena cava
Inferior vena cava
What is the 4th outer layer of the heart?
What are 3 ways acute pericarditis manifests?
Chest pain (can be sharp)
What is the term for exudate between the Visceral and Parietal Pericardium?
*this compresses the heart wall
A clear pericardial effusion associated with SLE, rheumatic fever, and viral infections is called?
A fibrin rich exudate in the pericardial sac caused by uremia, MI, or acute rheumatic fever is called?
What type of pericarditis has a cloudy exudate?
What type of Pericarditis has a bloody exudate?
A swelling of the Pericardial sac can cause what medical emergency?
What is the remedy?
What are the 2 major forms of disorders arising from within the heart tissue (myocardium)?
*excluding cardiovascular disease
What drug can cause myocarditis?
What are 3 types of Primary cardiomyopathies?
Cardiomyopathies often occur without any mitigating pathology
What is the most common form of Primary cardiomyopathy?
What is a Dilated Cardiomyopathy?
What cardiomyopathy could be congenital and is defined by hypertrophy of the ventricles and impaired diastolic filling?
What can Hypertrophic Cardiomyopathy cause?
Outflow Obstruction of Left Ventricle
What is the least common Primary Cardiomyopathy?
What defines Restrictive Cardiomyopathy?
Heart regular shape, but stiffened
What condition affects the endocardial surface?
What 2 factors lead to infective endocarditis?
What organism is involved?
In what other population does it develop?
Portal of entry
S. aureus (50% cases)
IV drug users
What valve is most often associated with Infective Endocarditis?
What is the Penicillin analog?
What are the alternatives if allergic?
Cephalexin, Azithromycin, Clarithromycin
Where are Terminal Cisternae?
Border of T-tubules - begin the Sarcoplasmic Reticulum
3 components of thin filament:
Actin, Tropomyosin, Troponin `
Acetylcholine is is the neurotransmitter in the heart.
Electrical conduction itself propels
Where do the 2 sources of Calcium in a muscle cell come from?
What does Calcium bind to in the muscle cell?
(on actin filament)
What dictates the magnitude of contraction in a cardiac cell (myocyte)?
Amount of Calcium
Sarcoplasmic reticulum is more dense in cardiac muscle (vs skeletal).
Less dense - needs Calcium from two sources
Intercalated Discs and gap junctions allow the myocardium to act as a:
What 3 Proteins make up the cardiac troponin complex?
cTn = Cardiac Troponin
C (cTnC) - Calcium
I (cTnI) - Inhibitory
T (cTnT) - Tropomyosin binding
What causes both Angina and Myocardial Infarction?
Chief difference between them?
No cell death in Angina
(also, MI not remedied by NTG)
What is the preferred blood marker that indicates cardiac injury?
How long do they stay in the blood?
(Troponin I or T)
2 hrs - 8 days (peaking at 12-24 hrs)
Trace cardiac conduction starting at the SA node.
SA > Interatrial Tracts
Internodal Tracts > AV node > AV Bundle > R/L Bundle Branches > Purkinje Fibers
Where do Non-Pacemaker "Fast Response" action potentials take place?
Where do Pacemaker "Slow Response" action potentials take place?
Fast response in the heart involves ___ and ____ in and _____ out.
Na and Calcium
How does Calcium affect the Action Potential in the heart?
Long Lasting (L-type)
Caused by Ca++ channels
Calcium is an absolute requirement in the Cardiac muscle.
Calcium from where does not promote actin-myosin interaction?
What does this trigger?
Sarcolemma Action Potential
*Sarcoplasmic Reticulum Ca++ binds actin
**Calcium induced Calcium release
What receptor releases Calcium from the sarcoplasmic reticulum?
Ryanodine Receptors (RyR2)
What do Beta blockers (and Ach) do to calcium conductance?
What does repolarization of heart cell involve?
L-type Ca++ closes
What happens in the very last phase of cardiac action potential?
(and K+ remain open)
What 3 ways is Ca++ extruded from the heart cell?
Sarcoplasmic Reticulum Ca pumps (SERCA)
Sarcolemmal Ca pumps
3Na/1Ca pump (NCX)
Why is Tetani impossible in the heart?
Electrical and mechanical overlap
No summation or tetanus possible
Effective (absolute) vs. Relative refractory period
Effective: no AP possible
Relative: AP possible only if stumulus big enough
Why does the SA node exhibit automaticity?
How does Phase 0 differ in the SA node compared with Purkinje, etc?
Calcium conductance, not influx Na+, causes
SA node, what causes:
Slow depolarization (phase4)?
Na (current called If)
Where is conduction velocity the fastest?
Where is CV the slowest?
What does this allow?
What do chronotropic effects refer to?
firing SA node
What is a negative chronotropic effect?
Decrease SA node
What type of effect changes velocity of conduction in the heart?
negative - decreases conduction
What type of receptors interact with ACh?
What receptors sympathetically innervate the heart?
Parasympathetic has a _____ chronotropic effect
Decrease If (inward Na current in phase 4 slow depolarization step)
Parasympathetic has a _____ dromotropic effect
decrease Ca in and increase K out
What is the mechanism of positive chronotropic effect?
Increases If conduction in phase 4 depolarization
(more Na in)
What is the mechanism of positive dromotropic effect?
Increase Ca influx current
Lead = Electrode
Lead defines a space over which electrical signal is measured
Lead II is recorded between what?
Right Arm and Left Leg
What are the main components of the Basic Electrocardiogram?
What is happening at the P wave?
SA node fires (and atrial contraction)
What are Latent Pacemakers?
Where does Phase 4 depolarization happen fastest and slowest?
SA node > AV node > purkinje fibers
What is Overdrive Suppression?
Because SA node fastest it supresses the latent pacemakers
What is contraction/emptying of heart?
Amount of blood pumped out?
Heart Rats x Stroke Volume =
What should this equate to
*normally = venous return
Blood in either Ventricle after Diastole?
End Diastolic Volume
Blood in either ventricle after Systole?
End Systolic Volume
What are the 3 phases of ventricular filling?
What produces the 3rd heart sound?
Rapid passive filling
What produces the 4th heart sound?
What produces the 1st heart sound?
Shutting of mitral valve in Atrial Systole
What produces the 2nd heart sound?
Aortic semilunar valve shuts
What does the Dichrotic Notch in the Wigger's Diagram represent?
Backflow and reverb in aorta
*significant for coronary blood flow
Where do the heart sounds come from?
mitral/tricuspid valve closure
semilunar valve closure
Rapid Passive Filling
What 2 types of valve problems can murmurs indicate?
Valve doesn't open
Valve doesn't close
*results in myocardial hypertrophy
What are three risk factors for valvular heart disease?
How long after Strep pyogenes infection can Rheumatic fever hit?
*Group A B-hemolytic
Tiny warty beadlike rubbery vegetations on the valve leaflets:
They result from?
Most often affects?
Rheumatic heart disease
What is the most common heart valve problem?
Mitral Valve Prolapse
*7% population, most often young women
What can Aortic Stenosis lead to?
Three main causes of Aortic Stenosis:
4 causes Aortic insufficiency (backflow)
Birth defect (only 1 or 2 cusps)
Age-related degenerative calcific aortic stenosis
+Infective Endocarditis (aortic insufficiency)
What sympathetically innervates the SA node, atria, AV node, and ventricles?
Thyroid Hormones can decrease heartbeat
T3 and T4 elevate HR
Hyperkalemia and Hypokalemia can both decrease Heart Rate
What are3 factors affecting Stroke Volume?
Inotropism (contractile force)
Afterload (in Aorta)
What Law defines Preload?
Frank-Starling Law of the Heart
What type of Stroke Volume control depends on how much the LT fills?
What effect does stretch in the heart have on the cell?
Enhances troponinC affinity for Calcium
Contractile Force in independent of Preload (Starlings Law).
The Sympathetic system has a negative inotropic effect
increases contractile force
Regulation by Inotropism is called...
What 2 cellular mechanisms does SNS B1 andrenergic affect to increase contraction (Inotropism)?
Increases Calcium current
Increases SERCA pumps
Where does Afterload occur?
Back pressure on Aortic and Pulmonary Semilunar Valves
Increasing the Afterload is analogous to increasing the...
*will decrease stroke volume
What drug decreases Afterload?
Q = P/R
2 Branches off Right Coronary Artery:
Right Marginal (Acute)
Posterior Descending (Inter-ventricular)
2 Branches off Left Coronary Artery:
Left Anterior Descending (Inter-Ventricular Artery)
How does coronary resistance change in response to the Sympathetic response?
What drives blood into the coronary aa.?
Aortic pressure (dichrotic notch)
When the heart's demand for blood/oxygen is Greater than supply, you have...
Ischemic Heart Disease
What is episodic chest pain caused by inadequate oxygenation of the myocardium?
What causes Classic/Exertional Angina?
What type of Angina is caused by spasms of the coronary arteries?
this is related to what?
When can this occur?
mostly related to coronary artery stenosis
Can occur at rest
What does Unstable Angina refer to?
What causes ischemic death of myocardial tissue?
M.I. - Myocardial infarction
What type of MI kills cells through the entire thickness of the ventricular wall?
What MI kills only interior 1/3 of cells?
Artery occlusion that kills the following regions in MI's.
Left Anterior Descending
Posterior Descending Branch
5 complications to MI:
Arrhythmia (most common cause of death)
Papillary muscle rupture
Mural thrombosis (endocardium over infarct)
What is the balloon inflation technique of revascularizing the coronary arteries?
other (relatively) non-invasive technique?
PTCA - percutaneous transluminal coronary angioplasty
Grafting technique to get around occlusion in coronary artery?
CABG - coronary artery bypass grafting
Heart failure refers to:
Failure of pump
What can dyspnea (difficulty breathing) and orthopnea (shortness of breath) indicate?
Heart mechanically overloaded
Rt and Lt ventricles have same pathologies with exception of pulmonary edema(Lt) and systemic edema(Rt)
ECG sign of Sinus Tachycardia
P and T waves running into each other
What are looong breaks between PQRST?
What if the Atria aren't contracting on ECG?
No P wave
QRS spike wide and running into T:
Ventricular Escape Rhythm
(Purkinje fibers running show)
No P because atria not contracting
What will a premature atrial contraction (PAC) look like on ECG?
inverted P wave
What will Atrial Fibrillation look like?
Erratic - but with Ventricular Spikes
Multiple myocytes signalling
ECG with single group of Ventricular myocytes signalling.
PVC - premature ventricular contraction
Irregular looking QRS
What does ventricular fibrillation look like ECG?
Multiple Ventricular Myocytes signaling
Big space between P wave and QRS:
1st degree AV block
*often slowed by scarring
Second degree AV block on ECG:
No QRS - skips beat
Wide QRS with regularly spaced P:
3rd degree AV block