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Cardiovascular And Respiratory Medicine Flashcards

(104 cards)

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1
Q

which arteries supply blood the the cardiac muscle

A

Aorta spilts into right and left coronary arteries

Left coronary artery branches into (left) circumflex artery first and left anterior descending further down

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2
Q

What the 2 semi lunar valves called

A

Pulmonary valve - on right side, pulmonary artery comes out of it
Aortic valve - on left side, aorta comes out of it

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3
Q

How much is stroke volume

A

Around 70 ml

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4
Q

What is ejection fraction

A

(100 x stroke volume) / end-diastolic volume

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5
Q

Normal range of ejection fraction

A

52-72 percent

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6
Q

What are pennate muscles

A

Fibres spread out from tendon at angles
Unipennate - all muscle fibres go in same direction from tendon
Bipennate - muscles fibres spread out from tendon in 2 directions along its length
Multipennate - multiple tendons

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7
Q

What factors affect resistance - also give the equation

A 
Vessel length (L)
Vessel radius (r)
Blood viscosity (n)

R = 8 x L x n / pie x r^4

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8
Q

What is vascular tone

A

Partial contraction of arterioles

This allows them to contract further or dilate further - room for accomodation

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9
Q

What is MAP

A

Mean arterial pressure

93 mmHg

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10
Q

What is the usual/average pressure in the venules/capillaries

A

37 mmHg

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11
Q

What 2 fucntions of radii are arterioles adjusted independently to accomplish and what regulates each function

A

1) adjusting blood flow to meet the metabolic demands of specific tissues. Is regulated by intrinsic controls, independent of nervous and endocrine system
-chemically driven
or
-physically driven
(Vasodilation = active hyperaemia, vasoconstriction = myogenic autoregulation/vasoconstriction)

2) regulating systemic arterial blood pressure. Is regulated by extrinsic controls
-neural control
or
-hormonal control

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12
Q

What is total peripheral resistance

A

Sum of resistance of all the arterioles in the systemic circulation

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13
Q

How to calculate cardiac output

A

Use Q = delta P / R
Q = cardiac output
delta P = MAP (as venule pressure is negligible so total pressure difffernce across whole system is basically mean arterial pressure)
R = total peripheral resistance

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14
Q

Explain how the brain is involved in helping regulate arterial blood pressure

A

Cardiovascular control centre in the medulla oblongata

Causes vasocontrcition which decreases blood flow and increases blood pressure

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15
Q

Which 3 hormones can lead to vasoconstriction of arterioles in order to help regulate arterial blood pressure

A

ADH/vasopressin
Angiotensin II
adrenaline/noradrenaline

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16
Q

What is ficks law

A

The rate of diffusion across a surface is proportional to the concentration gradient

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17
Q

3 types of capillary structure

A

1) continuous - small h2o filled water channels that only electrlytes can pass through
2) fenestrated - fenestrae, slightly larger gaps that some larger molecules can pass through eg glucose
3) discontinuous - larger gaps in capillary wall. Found where WBCs need to get into blood eg in liver/spleen/bone marrow

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18
Q

Where does the thoracic duct of the lymphatic system drain into

A

Junction of the left subclavian and internal jugular veins

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19
Q

What causes elephantiasis

A

Rate of release of fluid into interstitial space exceeds rate of drainage
Caused by blocking of lymph nodes by parasites
Leading to oedema

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20
Q

What does a ventricular require for contraction

A

Excitation of the cell

Ca2+

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21
Q

Outline the basic process leading up to a contraction of a ventricular cell

A 
Electrical event (AP)
Calcium transient - calcium in sarcoplasm increases for a short period of time 
Contractile event
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22
Q

Does skeletal muscle need external calcium for contraction

A

No

Only myocardial muscle

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23
Q

Outline the dimensions of a ventricular cell and T tubules

A

Ventricular cell: 100 um length, 15 um diameter
T tubule: 200 nm length, finger linke invaginations of the cell surface membrane which are 2 um apart, lie alongside each Z line of every myofibril

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24
Q

What is the relationship between force production (y) and intracellular signalling (x)

A

Sigmoidal

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25
What are active and passive forces
Active: due to shortening of sarcomere - forces act in direction of point of muscular attachment towards centre Passive: ressitance to stretch of a muscle
26
What is preload dependent on and measured by
Dependent on venous return | Measured by end diastolic volume, end diastolic pressure, and right atrial pressure
27
What measures does afterload involve
Diastolic blood pressure - pressure exerted by heart on arterial walls between contractions
28
Which 3 primary factors affect stroke work
Pre load Contractility Afterload
29
Stroke work
Stroke work = stroke volume x pressure at which blood is ejected
30
Law of la place
``` Tension = pressure x radius Or = pressure x radius / wall thickness ```
31
What happens to the structure of a failing heart
(Law of la place) Becomes dilated Increased radius So tension/wall stress increases
32
What is the difference between type 1 amd 2 cells that civer the alveoli
Type 1: very thin - short diffusion distance for gas exchange, cover 95% of the alveolar surface Type 2: chunkier than type 1, secrete surfactant to reduce surface tension, secrete proteases, carry out xenobiotic metabolism (metabolise harmful/noxious chemicals that might harm body), there are more type 2 cells than type 1 but type 2 cells only cover 5% of the alveolar surface
33
Whihc bronchioles are non cartilaginous
Terminal bronchioles
34
Describe airway branching in one word
Dichotomous
35
What is the purpose of nasal conchae
Highly vascular Contribute to warming and humidifacation of inhlaed air Nasal hairs filter out large particles
36
What do the conchae, meatuses and paranasal glands do
Secrete mucus to trap debris
37
What does cintraction of the smooth muscle in the trachea lead to and why
The inferior portion of the submucosal glands in embedded in the smooth muscle So contraction of the smooth muscle leads to secretion of mucus into the lumen
38
What are the categories of airway cell types
``` Immune cells Neuroendocrine cells Lining cells Contractile cells Vascular cells Secretory cells Connective tissue cells ``` IN LC V SC
39
What are the two types of airway submucosal glands
Mucous acini: secrete mucous Serous acini: secrete antibacterial enzymes (more watery secretion so it can wash out the viscous secretion of mucous acini into the collecting ducts)
40
Describe the arrangemnt of serous and mucous acini
Serous acini are more distal to mucous acini
41
What are the main functions of the airway epithelium
1) Production of mucins, water and electrolytes 2) movement of mucous 3) physical barrier 4) production of inflammatory mediators - chmeikines - cytokines - proteases - arachidonic acid metabolites - carbon monoxide - nitric oxide
42
How do the cilia beat
In a metachronal rhythm | Backwards cilia sequnetially move through alternating forward and backwards movements
43
What is the arrangement of ciliary structures
9 + 2 microtubule arrangement
44
Describe teh structure of a single cilia
Apical hooks on top Main body containing microtubles is called the axoneme Anchoring hooks below the cell membrane surface
45
What does brown staining on a histological section of a human airway indicate
Nitric oxide synthase
46
3 functions of airway epithelium
1) tone - contraction/relaxation 2) structure - hypertrophy/proliferation 3) secretion - chemokines, cytokines, mediators
47
What is the name of airway vasculature
Tracheo-bronchial airway vasculature
48
How does blood return from tracheal or bronchial circulation
Blood returns from tracheal circulation via sympathetic veins Blood returns from bronchial circulation via bronchial and pulmonary veins, to both sides of the heart
49
What are the main functions of the tracheo bronhcial system
Humidifies air Cleans air from inflammatory mediators Cleans air from inhaled drugs Warms up air Goood gas exchange Supplies tissues and lumen with inflammatory mediators Supplies tissue and lumen with proteinaceous plasma
50
Describe the sympathetic and parasympathetic control of the airway smooth muscle
Constriction: parasympathetic - sensory nerve via nodose ganglion to brainstem. Vagus nerve returns (is parasympathetic amd releases Ach) and causes smooth muscle to contract and therefore airway constricts Dilation: sympathetic- sensory nerve via dorsal root ganglion to spinal cord. Sympathetic motor nerve then releases Nitric oxide whihc causes smooth muscle to relax and vessel to dilate Adrenal galnd also releases adrenaline which causes the airway to dilate
51
Describe the effects of inflammation on airway smooth muscle
Inflammation (cytokines/bacteria) cause airway smooth muscle to produce Nitric oxide synthase NOS which causes production of NO and causes smooth muscle to produce Cylco oxygenase COX which causes prodcution of prostaglandins In response to inflammation, Airway smooth muscle also stimulates production of cytokines, chemokines and adhension molecules - all of which cause immune cell recruitmemt
52
What is the average minute ventilation of a 70kg healthy male
0.5 L x 120 breaths per minute = 6 L/min
53
How can body size affect lung capacity
greater height = greater lung capacity | Weight does not affect it
54
How does gender affect lung capacity
Males generally have greater lung capacity than females
55
Define hypoventilation and hyperventilation
``` Hypoventilation = deficient ventilation of the lungs, unable to meet metabolic demand (increased PCO2 - acidosis) Hyperventilation = excessive ventilation of the lungs, atop of metabolic demand (decreased PCO2 - alkalosis) ```
56
What are the two main types of dead space found in the lungs
``` Conducting zone (anatomical dead space) Non perfused parynchema (alveolar dead space) ```
57
What zones are the brinchioles split into
Conducting zone: 16 generations, no gas exchange, equivalent to anatomical dead space Respiratory zone: 7 generations, gas exchange, equivalent to alveolar ventilation
58
Tyoical volume of conducting zone
150 ml
59
How do you increase or decrease the amount of dead space
Increase: intubation Decrease: tracheostomy
60
Which way do the chest and lung naturally recoil
Lung naturally recoils inwards | Chest naturally recoils outwards
61
What happens to the hcest and lung forces at functional residual capacity
Lung recoil = chest recoil
62
What happens when chest recoil exceeds lung recoil
Inspiration
63
Describe the membranes surrounding the lungs
Visceral pleura lines the lungs Intrapleural space Parietal pleura lines the inner chest wall
64
What is a heamothorax
Bleeding into the intrapleural space
65
What is a pneumothorax and why can it happen
Fluid building up in the intrapleural space - due to perforated chest wall or a punctured lung
66
What is the difference between positive and negative pressure breathing
Negative pressure breathing: alveolar pressure is below atmospheric pressure so air is drawn into lungs (normal breathing) Positive pressure breathing: atmospheric pressure is increased above alveolar pressure so air is pushed into the lungs (eg CPR, mechnaical ventilation etc)
67
How do you calculate transrespiratory system pressure
P (alveolar) - P (atmospheric)
68
What is Daltons law
The pressure of a gas mixture is the sum of the partial pressures of all the gases in the mixture
69
What is Ficks law
The rate of diffusion of a gas down its concentration gradient is proportional to the steepness of the conc gradient, the exchange SA and the diffusion capacity of the gas And is inversly proportional to the thickness of the exchange surface
70
What is henrys law
At a constant temp, the amount of gas that dissolves in a liquid of given volume and type is directly proportional to the partial pressure of that gas in equilibrium with that liquid
71
What is Boyles law
At a constant temp, the volume of a gas is inversely proportional to the pressure of the gas
72
What is charles law
At a constant pressure, the volume of a gas is proportional to the temp of the gas
73
How does the compostion of air breathed in chnage a)in a fire b) at high altitudes
a) O2 decreases CO2 and CO increase b) composition doesnt change the volume decreases so you breathe in less of all gases
74
What 4 things happen to air as it passes down into respiratory tract
Warmed Slowed Humidified Mixed
75
What makes up HbA, HbA2 and HbF
``` HbA = 2 alpha, 2 beta HbA2 = 2 alpha, 2 delta HbF = 2 alpha, 2 gamma ```
76
What does 2,3 DPG do to Hb
Binds to it allosterically and facilitates the unloading of O2 from the Hb
77
Can you calculate O2 levels in the blood from just bpm (beats per minute) and SPO2% (%saturation of Hb)
No, you also need the amount of Hb Because spo2 could be v high if you have a v low Hb - all Hbs will be fully saturated - so its not an accurate representation of the actual oxygen levels
78
What causes right shift on o2 diss. Curve
Increased temp Acidosis Hypercapnia Increased 2,3 DPG BOHR EFFECT
79
what causes left shift on o2 diss curve
Decreased temp Alkalosis Hypocapnia Decreased 2,3 DPG
80
What causes upward and downward shifts on O2 diss curve
``` Upward = polycythaemia (more RBCs) Downward = anaemia ```
81
How does CO affect o2 diss curve
``` Down and to the left When it binds to Hb, it increases the affinity of Hb for o2 But it also takes up binding sites - decrased capacity -inceased affinity ```
82
Which has higher o2 affinity, foetal Hb or myoglobin
Myoglobin, it extracts o2 from circulating blood and stores it
83
How would uncontrolled type 1 diabetes affect the o2 disscociation curve
Would lead to ketones being used for fuel —> get diabetic ketoacidosis whihc reduces pH Get acidosis so have a right shift (bohr effect)
84
3 ways Co2 is tranported in blood
Dissolved as a gas Transported as HCO3- Transported as carboaminohaemoglobin
85
When is the ventral group inactive
During quiet breathing
86
Where is the dorsal respiratory group located
In the dorsomedial medulla, in the ventrolateral nucleus of the solitary tract
87
Where is the ventral respiratory group relative to the dorsal resp group
Dorsal to it
88
Where are the apneustic and pneumotaxic centres located
Apneustic centre = lower part of the pons | Pneumotaxic centre = upper part of the pons
89
Do action potentials at a low frequency stimulate the apneustic centre or the pneumotaxic centre
Apneustic centre
90
What effect does PC (pneumotaxic centre) have on action potentials and what is this effect followed by
PC causes cessation of action potentials | Followed by a period of latency before the AC then stimulates the DRG again to increase Action potential frequency
91
Describe the motor and sensory innervations of the phrenic nerve
Motor innervation: diaphragm | Sesnory innervation: provodes sensation to central tendon aspect of diaphragm
92
What happens when you reach the CO2 threshold for breathing
Accumulation of H+ beyond the blood brain barrier activates the DRG - “the struggke phase”
93
What is the role of irritant receptors
Afferent fibres which detect foreign matter causing irritation and lead to cough reflex: forceful expiration/ high velocity expulsion of air against a closed glottis, leading to sudden opening of the glottis
94
Where are pulmonary stretch receptors found
Past the second bronchi
95
How are strectch receptors activated and what do they do once theyre activated
Excessive inflation of lungs activates the stretch receptors Stretch receptors send afferent signals to turn off dorsal respiratory group and apneustic centre and switch on pneumotaxic ventral resp group Leads to expiration
96
Where are J receptors found
Alveolar walls in close proximity to capillaries
97
Role of J receptors
Respond to oedema or pulmonary capillary engorgement | Leads to increase in breathing rate
98
Formula for pH
-log 10 [H+]
99
What is alkalaemia and how is it different to alkalosis
``` Alkalaemia = higher than normal pH of blood Alkalosis = describes the circumstances that cause a decrease in [H+] and increase in blood pH ```
100
What is the difference between acidaemia and acidosis
``` Acidaemia = lower than normal blood pH Acidosis = describes the circumstances that cause an increase in [H+] and a decrease in pH of blood ```
101
Where are peripheral chemoreceptors found
Near carotid baroreceptors Carotid bodies in aortic arch Aortic bodies in aortic arch
102
What is the role of peripheral chemoreceptors
Stimulate breathing in response to hypoxia
103
How is breathing affected by exercise
Nerve fibres between primary motor cortex and skeletal muscle innervate medulla, stimulatimg the respiratory groups
104
Why does cardiac tissue produce a greater passive force
Because it’s less compliant and more resistant to stretch due to properties of the extra cellular matrix and cytoskeleton

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