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Flashcards in Cardiopulmonary I Deck (167):
1

What forms the heart Apex?

Left Ventricle

2

The base of the heart is the _____ and found _____

Top
2nd Costal cartilage

3

The anterior of the heart is mostly

Rt Ventricle

4

Heart dimensions:

5 long
3.5 wide
2.5 thick
Fist

5

Right ventricle:
Left ventricle:

pulmonary circulation
systemic circulation

6

What is the depression in the inter-atrial septum called?

Fossa ovalis

(remnants foramen ovale)

7

What is a failure to form the Fossa Ovalis called?

Patent foramen ovale

8

Define:
Atrial septal defect

Inter-atrial septum forms incorrectly

9

Heart:
top?
bottom?

Base
Apex

10

What are the most common Congenital abnormalities of the heart?

Ventricular septal

11

How can a VSD (ventricular septal defect) be acquired?

Myocardial infarction and scar formation by macrophage

12

Healthy heart ejects _____ of what fills it.

1/2

13

What defines ventricular volume?

End Diastolic Volume

14

What defines output?

Stroke volume

15

Ejection fraction =

SV/EDV (x100%)

16

What are the 3 tissue layers of the heart wall?

Endocardium
Myocardium
Epicardium

17

What is found between the Epicardium and the Parietal Pericardium?

Pericardial space
(10 mL fluid)

18

The Myocardium isn't capable of Hyperplasia, but is capable of...

hypertrophy

19

Nuclei in cardiac cell?

Mononucleated
(although many have 2)

20

What is another name for the Visceral Pericardium?

Epicardium

21

What important feature of the heart is considered part of the Epicardium?

Epicardial Fat

22

Epicardial Fat:
% surface?
% total weight?
Where found?

60-80
20
generally along vasculature

23

What are 2 functions of the Pericardial Space?

Heat dissipation
Lubricant

24

4 Heart valves:

2 atrioventricular
2 semilunar

25

What is backflow called in the heart?

Regurgitation

26

What valve lies between the right atrium and right ventricle?

Tricuspid Valve

27

T/F
The tricuspid valve is smaller in diameter and thicker than the mitral valve.

False
larger diameter, thinner than Mitral

28

What valve lies between the left atrium and left ventricle?

Mitral (bicuspid) valve

29

What are the atrial ventricular valves attached to?
From where do they originate?

Chordae Tendineae
"heart strings"

Papillary muscles

30

When do the papillary muscles contract the chordae tendineae?

As Ventrical contracts

(prevents valve from prolapsing and folding in on itself)

31

The Pulmonic and Aortic are both ______ valves and have ___ cusps.

Semilunar
3

32

What is the term for Ventricular filling?

Diastole

33

What makes the Lub and Dub sound?

Lub - Tricuspid and Mitral (atrioventricular) valves shutting

Dub - Semilunar (Pulmonic, Aortic) shutting

34

What 3 structures empty into the Right Atrium?

Superior vena cava
Inferior vena cava
Coronary Sinus

35

What is the 4th outer layer of the heart?

Parietal Pericardium

36

What are 3 ways acute pericarditis manifests?

Chest pain (can be sharp)
Friction rub
ECG changes

37

What is the term for exudate between the Visceral and Parietal Pericardium?

Pericardial effusion

*this compresses the heart wall

38

A clear pericardial effusion associated with SLE, rheumatic fever, and viral infections is called?

Serous Pericarditis

39

A fibrin rich exudate in the pericardial sac caused by uremia, MI, or acute rheumatic fever is called?

Fibrinous Pericarditis

40

What type of pericarditis has a cloudy exudate?

Purulent

41

What type of Pericarditis has a bloody exudate?

Hemorrhagic pericarditis

42

A swelling of the Pericardial sac can cause what medical emergency?
What is the remedy?

Cardiac Tamponade

Pericardiocentesis

43

What are the 2 major forms of disorders arising from within the heart tissue (myocardium)?

*excluding cardiovascular disease

Myocarditis (inflammation)

Primary Cardiomyopathies
(non-inflammatory, cardiomegaly)

44

What drug can cause myocarditis?

cocaine

45

What are 3 types of Primary cardiomyopathies?

Dilated
Hypertrophic
Restrictive

46

T/F
Cardiomyopathies often occur without any mitigating pathology

True

47

What is the most common form of Primary cardiomyopathy?

Dilated

48

What is a Dilated Cardiomyopathy?
affects?
*common complication?
**caused by?

Ventricular Hypertrophy
pumping
*Mural thrombi
**alcohol

49

What cardiomyopathy could be congenital and is defined by hypertrophy of the ventricles and impaired diastolic filling?

Hypertrophic Cardiomyopathy

50

What can Hypertrophic Cardiomyopathy cause?

Outflow Obstruction of Left Ventricle

51

What is the least common Primary Cardiomyopathy?

Restrictive

52

What defines Restrictive Cardiomyopathy?

Heart regular shape, but stiffened

53

What condition affects the endocardial surface?

Infective Endocarditis

54

What 2 factors lead to infective endocarditis?
What organism is involved?
In what other population does it develop?

Damaged surfaces
Portal of entry

S. aureus (50% cases)

IV drug users

55

What valve is most often associated with Infective Endocarditis?

Mitral

56

What is the Penicillin analog?
What are the alternatives if allergic?

Amoxicillin

Cephalexin, Azithromycin, Clarithromycin

57

Where are Terminal Cisternae?

Border of T-tubules - begin the Sarcoplasmic Reticulum

58

Thick filament:
3 components of thin filament:

Myosin
Actin, Tropomyosin, Troponin `

59

T/F
Acetylcholine is is the neurotransmitter in the heart.

False

Electrical conduction itself propels

60

Where do the 2 sources of Calcium in a muscle cell come from?

Sarcolemma/T-tubules
Sarcoplasmic Reticulum

61

What does Calcium bind to in the muscle cell?

Troponin C
(on actin filament)

62

What dictates the magnitude of contraction in a cardiac cell (myocyte)?

Amount of Calcium

63

T/F
Sarcoplasmic reticulum is more dense in cardiac muscle (vs skeletal).

False

Less dense - needs Calcium from two sources

64

Intercalated Discs and gap junctions allow the myocardium to act as a:

Functional Syncytium

65

What 3 Proteins make up the cardiac troponin complex?

cTn = Cardiac Troponin

C (cTnC) - Calcium
I (cTnI) - Inhibitory
T (cTnT) - Tropomyosin binding

66

What causes both Angina and Myocardial Infarction?
Chief difference between them?

another?

Ischemia
No cell death in Angina

(also, MI not remedied by NTG)

67

What is the preferred blood marker that indicates cardiac injury?
How long do they stay in the blood?

Cardiac Troponins
(Troponin I or T)

2 hrs - 8 days (peaking at 12-24 hrs)

68

Trace cardiac conduction starting at the SA node.

SA > Interatrial Tracts
or
Internodal Tracts > AV node > AV Bundle > R/L Bundle Branches > Purkinje Fibers

69

Where do Non-Pacemaker "Fast Response" action potentials take place?

Atria
Ventricles
Purkinje Fibers

70

Where do Pacemaker "Slow Response" action potentials take place?

SA/AV node

71

Fast response in the heart involves ___ and ____ in and _____ out.

Na and Calcium
K

72

How does Calcium affect the Action Potential in the heart?

Long Lasting (L-type)

Caused by Ca++ channels

73

T/F
Calcium is an absolute requirement in the Cardiac muscle.

True

74

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

75

What receptor releases Calcium from the sarcoplasmic reticulum?

Ryanodine Receptors (RyR2)

76

What do Beta blockers (and Ach) do to calcium conductance?

Decrease

77

What does repolarization of heart cell involve?

Efflux K+
L-type Ca++ closes

78

What happens in the very last phase of cardiac action potential?

Calcium re-uptake
(and K+ remain open)

79

What 3 ways is Ca++ extruded from the heart cell?

Sarcoplasmic Reticulum Ca pumps (SERCA)
Sarcolemmal Ca pumps
3Na/1Ca pump (NCX)

80

Why is Tetani impossible in the heart?

Electrical and mechanical overlap
No summation or tetanus possible

81

Effective (absolute) vs. Relative refractory period

Effective: no AP possible
Relative: AP possible only if stumulus big enough

82

Why does the SA node exhibit automaticity?

Unstable RMP

83

How does Phase 0 differ in the SA node compared with Purkinje, etc?

Calcium conductance, not influx Na+, causes

84

SA node, what causes:
Slow depolarization (phase4)?
Upstroke (Phase0)?
repolarization (Phase3)?

Na (current called If)
Ca
K

85

Where is conduction velocity the fastest?

Purkinje

86

Where is CV the slowest?
What does this allow?

AV node
Ventricular filling

87

What do chronotropic effects refer to?

firing SA node

88

What is a negative chronotropic effect?

Decrease SA node

89

What type of effect changes velocity of conduction in the heart?

Dromotropic

negative - decreases conduction

90

What type of receptors interact with ACh?

What type?

Muscarinic

(parasympathetic)

91

What receptors sympathetically innervate the heart?

Beta1-receptors

(norepinepherine)

92

Parasympathetic has a _____ chronotropic effect
Mechanism?

Negative
Decrease If (inward Na current in phase 4 slow depolarization step)

93

Parasympathetic has a _____ dromotropic effect
Mechanism?

Negative
decrease Ca in and increase K out

94

What is the mechanism of positive chronotropic effect?

*Sympathetic

Increases If conduction in phase 4 depolarization
(more Na in)

95

What is the mechanism of positive dromotropic effect?

Increase Ca influx current

96

T/F
Lead = Electrode

False

Lead defines a space over which electrical signal is measured

97

Lead II is recorded between what?

Right Arm and Left Leg

98

What are the main components of the Basic Electrocardiogram?

P wave
QRS complex
T wave

99

What is happening at the P wave?
QRS?
T wave?

SA node fires (and atrial contraction)
ventricular depolarization
Ventricular repolarization

100

What are Latent Pacemakers?

AV node
Purkinje fibers

101

Where does Phase 4 depolarization happen fastest and slowest?

SA node > AV node > purkinje fibers

102

What is Overdrive Suppression?

Because SA node fastest it supresses the latent pacemakers

103

What is contraction/emptying of heart?
Relaxation/filling?
Amount of blood pumped out?
Beats/min.

Systole
Diastole
Stroke Volume
Heart Rate

104

Heart Rats x Stroke Volume =

What should this equate to

Cardiac Output

*normally = venous return

105

Blood in either Ventricle after Diastole?

End Diastolic Volume

106

Blood in either ventricle after Systole?

End Systolic Volume

107

EDV-ESV=

Ejection Fraction

108

What are the 3 phases of ventricular filling?

Rapid passive
Slow passive
Atrial systole

109

What produces the 3rd heart sound?

Rapid passive filling

110

What produces the 4th heart sound?

Atrial systole

111

What produces the 1st heart sound?

Shutting of mitral valve in Atrial Systole

112

What produces the 2nd heart sound?

Aortic semilunar valve shuts

113

What does the Dichrotic Notch in the Wigger's Diagram represent?

Backflow and reverb in aorta

*significant for coronary blood flow

114

Where do the heart sounds come from?
S1:
S2:
S3:
S4:

mitral/tricuspid valve closure
semilunar valve closure
Rapid Passive Filling
Atrial Contraction

115

What 2 types of valve problems can murmurs indicate?

Incompetent (swishing)
Stenotic (click)

116

Define:
Valvular Stenosis
Valvular incompetence

Valve doesn't open
Valve doesn't close

*results in myocardial hypertrophy

117

What are three risk factors for valvular heart disease?

Rheumatic fever
Congenital
Prosthesis

118

How long after Strep pyogenes infection can Rheumatic fever hit?

1-4 weeks

*Group A B-hemolytic

119

Tiny warty beadlike rubbery vegetations on the valve leaflets:

They result from?

Most often affects?

Verrucae

Rheumatic heart disease

Mitral valve

120

What is the most common heart valve problem?

Mitral Valve Prolapse

*7% population, most often young women

121

What can Aortic Stenosis lead to?

LV hypertrophy

122

Three main causes of Aortic Stenosis:

4 causes Aortic insufficiency (backflow)

Birth defect (only 1 or 2 cusps)
Rheumatic
Age-related degenerative calcific aortic stenosis

+Infective Endocarditis (aortic insufficiency)

123

Chronotropic:

SA node

124

What sympathetically innervates the SA node, atria, AV node, and ventricles?

T1-T4

125

T/F
Thyroid Hormones can decrease heartbeat

False

T3 and T4 elevate HR

126

T/F
Hyperkalemia and Hypokalemia can both decrease Heart Rate

True

*K+

127

What are3 factors affecting Stroke Volume?

Preload (EDV)
Inotropism (contractile force)
Afterload (in Aorta)

128

What Law defines Preload?

Frank-Starling Law of the Heart

129

What type of Stroke Volume control depends on how much the LT fills?

Heterometric regulation

130

What effect does stretch in the heart have on the cell?

Enhances troponinC affinity for Calcium

*more force

131

T/F
Contractile Force in independent of Preload (Starlings Law).

True

132

T/F
The Sympathetic system has a negative inotropic effect

False

increases contractile force

133

Regulation by Inotropism is called...

Homometric

134

What 2 cellular mechanisms does SNS B1 andrenergic affect to increase contraction (Inotropism)?

Increases Calcium current
Increases SERCA pumps

135

Where does Afterload occur?

Back pressure on Aortic and Pulmonary Semilunar Valves

136

Increasing the Afterload is analogous to increasing the...

Blood pressure

*will decrease stroke volume

137

What drug decreases Afterload?

NitroGlycerine

138

Ohm's Law:

Q = P/R

139

2 Branches off Right Coronary Artery:

Right Marginal (Acute)
Posterior Descending (Inter-ventricular)

140

2 Branches off Left Coronary Artery:

Circumflex
Left Anterior Descending (Inter-Ventricular Artery)

141

How does coronary resistance change in response to the Sympathetic response?

Dilates vessels

142

What drives blood into the coronary aa.?

Aortic pressure (dichrotic notch)

143

When the heart's demand for blood/oxygen is Greater than supply, you have...

Ischemic Heart Disease

144

What is episodic chest pain caused by inadequate oxygenation of the myocardium?

Angina Pectoris

145

What causes Classic/Exertional Angina?

Coronary obstruction

146

What type of Angina is caused by spasms of the coronary arteries?

this is related to what?

When can this occur?

Variant/Prinzmetal's/vasospastic

mostly related to coronary artery stenosis

Can occur at rest

147

What does Unstable Angina refer to?

Plaque disruption

148

What causes ischemic death of myocardial tissue?

M.I. - Myocardial infarction

149

What type of MI kills cells through the entire thickness of the ventricular wall?
What MI kills only interior 1/3 of cells?

Transmural Infarction

Subendocardial infarction

150

Artery occlusion that kills the following regions in MI's.
Anterior
Lateral
Posterior

Left Anterior Descending
Left Circumflex
Posterior Descending Branch

151

5 complications to MI:

Arrhythmia (most common cause of death)
Pump failure
Rupture
Papillary muscle rupture
Mural thrombosis (endocardium over infarct)

152

What is the balloon inflation technique of revascularizing the coronary arteries?

other (relatively) non-invasive technique?

PTCA - percutaneous transluminal coronary angioplasty

Stenting

153

Grafting technique to get around occlusion in coronary artery?

CABG - coronary artery bypass grafting

154

Heart failure refers to:

Failure of pump

155

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)

156

ECG sign of Sinus Tachycardia

P and T waves running into each other

157

What are looong breaks between PQRST?

Sinus Bradycardia

158

What if the Atria aren't contracting on ECG?

No P wave

159

QRS spike wide and running into T:

Ventricular Escape Rhythm
(Purkinje fibers running show)
No P because atria not contracting

160

What will a premature atrial contraction (PAC) look like on ECG?

inverted P wave

161

What will Atrial Fibrillation look like?
What causes?

Erratic - but with Ventricular Spikes
Multiple myocytes signalling

162

ECG with single group of Ventricular myocytes signalling.

PVC - premature ventricular contraction

Irregular looking QRS

163

What does ventricular fibrillation look like ECG?
Caused by?

sin wave

Multiple Ventricular Myocytes signaling

164

Big space between P wave and QRS:

1st degree AV block

*often slowed by scarring

165

Second degree AV block on ECG:

No QRS - skips beat

166

Wide QRS with regularly spaced P:

Purkinje firing

3rd degree AV block

167

What can correct a 3rd Degree AV block?

Pacemaker

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