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cardiovascular Flashcards

(61 cards)

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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
where would you auscultate to hear the tricuspid valve
left sternal edge,4th ICS
26
what cells release renin when a low blood pressure is detected
juxtaglomerular
27
when doing a cardiac exam you hear a pan systolic murmur that radiates to the axilla . what does this show
mitral regurgitation
28
superior mediastinum
located above the trans thoracic plane behind the manubrium and in front of the T1-T4 vertebrae - aortic arch - thymus gland - oesophagus - trachea
29
inferior mediastinum
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
anterior mediastinum
no major structures - loose connective tissue - in children the thymus can extend into the anterior mediastinum
31
posterior mediastinum
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
pericardium
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
pericardium -fibrous layer
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
pericardium-parietal and visceral layers
produce serous fluid which is secreted into the pericardial. sac to promote friction free movement of the heart
35
pericardium-visceral layer
epicardium is the outermost layer of the heart wall it is formed of epithelial cells, connective tissue and fat
36
myocardium
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
endocardium
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
cells of the heart
``` contractile cells (majority of atrial and ventricular tissue) conducting cells (SA node etc) ```
39
cardiac excitation/contraction coupling
- 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
cardiac conduction system
``` 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
Sympathetic heart innervation
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
parasympathetic heart innervation
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
cardiac output
HRxSV
44
preload
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
what are drugs called that increase contractility
ionotropes eg digoxin
46
what are drugs called that decrease contractility
negative ionotropes eg beta blockers of Ca2+ channel blockers
47
contractility
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
after load
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
ejection fraction
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
heart rate
increased by the sympathetic activity(adrenaline/noradrenaline) binds to B1 receptors decreased by parasympathetic activity releasing Ach onto M2 receptors
51
P wave
atrial depolarisation
52
PR interval
time between initial depolarisation of atria to initial depolarisation of ventricles
53
QRS complex
ventricular depolarisation
54
T wave
ventricular depolarisation
55
QT interval
first ventricular depolarisation to last ventricular depolarisation
56
NSTEMI
partial blockage of coronary artery and ischemic damage to myocardium is only of partial thickness
57
STEMI
coronary artery is completely occluded , there is ischemic damage to the full thickness of the myocardium
58
by which landmarks is the mediastinum divided into its superior and inferior portion
thoracic plane between the angle of Louis and the T4/T5 vertebral disc
59
effusion/bleeding into the pericardium can result in which clinical condition that is considered a reversible cause of cardiac arrest
cardiac tamponade
60
which mechanism is the main factor by which Ca2+ is released from the SR in cardiac muscle during EC-coupling
Ca2+ induced Ca2+ release
61
a calcified aorta is likely to alter which factor that influences stroke volume
after load

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