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medsoc teaches > cardiovascular > Flashcards

cardiovascular Flashcards

1
Q

right side=receives deoxygenated blood from body, ejects to lungs

A

receives vena cava and coronary sinus
ejects to pulmonary arteries
tricuspid valve

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2
Q

left side= receives oxygenated blood from lungs, ejects to body

A

receives pulmonary veins
ejects to aorta
bicuspid valve

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3
Q

tunica intima

A

endothelial cells
basement membrane
connective tissue

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4
Q

tunica media

A

smooth muscle cells

elastin and collagen

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5
Q

tunica externa

A

connective tissue
nerves, blood vessels
elastin and collagen

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6
Q

aorta

A 
1st segment=ascending aorta
-lies within pericardium
-from it branches coronary arteries
2nd segment=arch of the aorta
-from it branches major arteries 
3rd segment=descending aorta
-continues down to diaphragm(goes through aortic hiatus T12,VC=T8)
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7
Q

heart

A

T2-T5

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8
Q

atherosclerosis

A 
LDL accumulation and oxidation 
macrophages(foam cells)/T cells recruited 
smooth muscle proliferation 
narrowing of arteries
collagen deposition
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9
Q

fibrous cap

A

structural support for atherosclerotic plaque, organised layer of smooth muscle and connective tissue

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10
Q

ruptures

A

exposed sub endothelium=activates coagulation cascade

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11
Q

RAAS system

A

1-renin released from juxtaglomerular cells
2-renin=converts angiotensin to angiotensin 1
3-ACE released from lungs=convert angiotensin 1 to 2=vasoconstriction and increases vascular resistance
4-angiotensin 2=aldosterone secretion=increase Na+ (and H20) reabsorption in DCR and collecting duct

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12
Q

drugs-ACEi

A

-inhibit ACE enzyme
-pril
-block conversion angiotensin 1 to 2
-reduces circulating angiotensin 2=arterial dilation
-lower ACE also=increased bradykinin=increases vasodilation
SE=dry cough

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13
Q

drugs-ARB

A

angiotensin 2 receptor blocker

  • artan
  • prevent angiotensin 2 binding=no effects of angiotensin 2(vasoconstriction and aldosterone release)
  • often alternative to ACEi
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14
Q

calcium channel blocker

A

acts on L-type channels, prevent calcium entry
-reduce muscle contraction
dilate coronary arteries
some types slow heart rate and decrease contractility
SE=ankle swelling
beware of using in heart failure

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15
Q

thiazide type diuretics

A

block NaCl co-transporter
reduced Na=absorption of DCT
results higher osmolarity of urine and decreased water reabsorption
self limiting-lower blood volume activates RAAS
commonly used in heart failure as help with treating oedema

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16
Q

aortic stenosis

A

systolic
ejection systolic
2nd ICS right sternal edge
radiates to carotids

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17
Q

pulmonary stenosis

A

systolic
ejection systolic
2nd ICS left sternal edge
left shoulder/infraclavicular

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18
Q

mitral regurgitation

A

systolic
pan systolic
apex
radiates to axilla

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19
Q

aortic regurgitation

A

early diastolic

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20
Q

pulmonary regurgitation

A

early diastolic

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21
Q

embryology

A

lateral plate mesoderm and primitive heart tube elongates and loops to form shape of heart
8th week pregnancy=4 clear chambers
foramen ovale=RA-LA SHUNT
Ductus arteriosus=pulmonary artery-descending aorta
Ductus venosus=umbilical vein-IVC (bypass liver)

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22
Q

IVC

A

=oxygenated blood from umbilical vein
flows mainly through foramen ovale
to brain

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23
Q

SVC

A

deoxygenated blood
-ductus arteriosus
lower body

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24
Q

at what level does the vena cava enter the abdomen

A

T8

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25
Q

where would you auscultate to hear the tricuspid valve

A

left sternal edge,4th ICS

26
Q

what cells release renin when a low blood pressure is detected

A

juxtaglomerular

27
Q

when doing a cardiac exam you hear a pan systolic murmur that radiates to the axilla . what does this show

A

mitral regurgitation

28
Q

superior mediastinum

A

located above the trans thoracic plane behind the manubrium and in front of the T1-T4 vertebrae

  • aortic arch
  • thymus gland
  • oesophagus
  • trachea
29
Q

inferior mediastinum

A

located below the trans thoracic plane
in 3 parts
-anterior mediastinum=anterior to heart/pericardium
-middle mediastinum=pericardium and heart
-posterior mediastinum=behind heart and in front of T5-T12

30
Q

anterior mediastinum

A

no major structures

  • loose connective tissue
  • in children the thymus can extend into the anterior mediastinum
31
Q

posterior mediastinum

A

located posterior to the heart and anterior to the bodies of the T5-T12 vertebrae

  • oesophagus
  • thoracic aorta
  • sympathetic trunks
  • thoracic duct and lymphatics
32
Q

pericardium

A

has 2 main layers
an outer fibrous layer
an inner layer which is itself composed of the parietal pericardium and visceral pericardium
effusion/bleeding into the pericardium will constrict the hear resulting in a cardiac tamponade

33
Q

pericardium -fibrous layer

A

the fibrous layer prevents over expansion of the heart
the parietal and visceral layers of the serous pericardium helps produce serous fluid which is secreted into the pericardial sac to promote friction free movement of the heart

34
Q

pericardium-parietal and visceral layers

A

produce serous fluid which is secreted into the pericardial. sac to promote friction free movement of the heart

35
Q

pericardium-visceral layer

A

epicardium is the outermost layer of the heart wall it is formed of epithelial cells, connective tissue and fat

36
Q

myocardium

A

layer of striated cardiac muscle
myocardial infarction results from blockage of a coronary artery which causes ischemia to the affected areas
angina results from temporary myocardial ischemia
myocarditis =inflammation of heart muscle often due to viral infection

37
Q

endocardium

A

inner layer of the heart wall, composed of connective tissue and epithelial tissue
a subendocardial layer connects the endocardium with the myocardium
the subendocardial layer also includes the conducting system of the heart including the Purkinje fibres

38
Q

cells of the heart

A 
contractile cells (majority of atrial and ventricular tissue)
conducting cells (SA node etc)
39
Q

cardiac excitation/contraction coupling

A
  • cardiac action potential travels along the sarcolemma
  • voltage change causes Ca2+entry into the intracellular fluid via voltage sensitive L-type Ca2+ channels
  • Ca2+ entry causes more Ca2+ release via opening of cardiac ryanodine receptors on the sarcoplasmic reticulum
  • Ca2+ ions bind to Troponin C causing tropomyosin to move out of the myosin binding site
  • cross bridge cycling now occurs as myosin binding site on actin filament no longer blocked
  • sarcomeres shorten ->cardiac muscle contraction
40
Q

cardiac conduction system

A 
SA node=generates action potentials
atrial internal tracts 
AV node(slower conduction to allow ventricular filling 
Bundle of His (branches to L and R bundle branches )
Purkinje System (v fast conduction through His-Purkinje system),distributes AP throughout ventricles, then AP spread through cardiomyocytes
41
Q

Sympathetic heart innervation

A

arise from T1-T4/5 before entering the sympathetic trunk
postganglionic fibres then travel to the cardiac plexus
the cardiac plexus is a group of nerves which regulate the sympathetic/parasympathetic activity to the heart
sympathetic fibres:
-increase HR
-increase contraction force
-slightly vasoconstrictor coronary vessels

42
Q

parasympathetic heart innervation

A

arise from the vagus nerve and synapse onto postganglionic neurons in the cardiac plexus or within the heart wall

  • decreases HR
  • decreases force of contraction
  • vasodilates coronary resistance vessels
43
Q

cardiac output

A

HRxSV

44
Q

preload

A

amount of blood delivered to the heart before it contracts
starlings law of the heart states that : the volume of blood ejected by the ventricle depends on the volume present in the ventricle at the end of diastole

45
Q

what are drugs called that increase contractility

A

ionotropes eg digoxin

46
Q

what are drugs called that decrease contractility

A

negative ionotropes eg beta blockers of Ca2+ channel blockers

47
Q

contractility

A

describes how well the heart is able to contract with a given preload and after load

  • intrinsic property of the myocardium
  • difficult to measure clinically
  • sympathetic stimulation increases contractility
48
Q

after load

A

force the heart has to work against to pump blood out
related to LV size,thickness and stiffness of ventricular wall,elastance of aorta,diastolic BP of the aorta, aortic valve pathology
healthy elastic aorta vs aortic calcification and amount of LV work

49
Q

ejection fraction

A

measures that ability of the ventricles to eject blood it is the proportion of blood filling the heart that is subsequently ejected
=SV/EDV
-indicator of contractility

50
Q

heart rate

A

increased by the sympathetic activity(adrenaline/noradrenaline) binds to B1 receptors
decreased by parasympathetic activity releasing Ach onto M2 receptors

51
Q

P wave

A

atrial depolarisation

52
Q

PR interval

A

time between initial depolarisation of atria to initial depolarisation of ventricles

53
Q

QRS complex

A

ventricular depolarisation

54
Q

T wave

A

ventricular depolarisation

55
Q

QT interval

A

first ventricular depolarisation to last ventricular depolarisation

56
Q

NSTEMI

A

partial blockage of coronary artery and ischemic damage to myocardium is only of partial thickness

57
Q

STEMI

A

coronary artery is completely occluded , there is ischemic damage to the full thickness of the myocardium

58
Q

by which landmarks is the mediastinum divided into its superior and inferior portion

A

thoracic plane between the angle of Louis and the T4/T5 vertebral disc

59
Q

effusion/bleeding into the pericardium can result in which clinical condition that is considered a reversible cause of cardiac arrest

A

cardiac tamponade

60
Q

which mechanism is the main factor by which Ca2+ is released from the SR in cardiac muscle during EC-coupling

A

Ca2+ induced Ca2+ release

61
Q

a calcified aorta is likely to alter which factor that influences stroke volume

A

after load

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