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BBS1002 > CASE 2 > Flashcards

CASE 2 Flashcards

1
Q

pulmonary circuit

A

right side receives oxygen-poor blood –> pumps into lungs to pick up O2 and dispel CO2
- blood vessels that carry blood to and from the lungs form the pulmonary circuit

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2
Q

Systemic circuit

A

left side of the heart receives oxygenated blood from lungs –> pumps this blood throughout body
- blood vessels that carry blood to and from all body tissue form the systemic circuit

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3
Q

mediastinum

A

medial cavity of the thorax

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4
Q

coverings of the heart

A
  • pericardium, double walled sac
  • fibrous pericardium: loosely fitting superficial part of this sac
    1. protect the heart
    2. anchor it to surrounding structures
    3. prevent overfilling of the heart with blood
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5
Q

serous pericardium

A
  • thin, slippery, two-layer membrane that forms a closed sac around the heart.
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6
Q

parietal layer

A
  • lines the internal surface of fibrous pericardium
  • at the superior side, parietal layer attaches to the large arteries exiting the heart and then turn inferiorly and continues over the external heart surface as the visceral layer (epicardium)
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7
Q

pericardial cavity

A
  • between parietal and visceral layer
  • contains a thin layer of serous fluid
  • the serous membranes, lubcricated by the fluid, glide smoothly past each other
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8
Q

heart wall

A

has three layers

  1. epicardium
  2. myocardium
  3. endocardium
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9
Q

epicardium

A
  • superficial

- visceral (deep) layer of the serous pericardium

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10
Q

myocardium

A
  • composed of cardiac muscle,
  • this layer contracts
  • connective tissue fibers form the cardiac skeleton, which strenghtens the myocardium internally.
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11
Q

endocardium

A
  • glistening white sheet of squamous endothelium resting on a thin connective tissue layer
  • lines heart chambers and covers the valves
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12
Q

chambers and associated great vessels

A
  • two superior atria
  • two inferior ventricles
  • interatrial septum, seperates atria
  • interventricular septum, separates ventricles
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13
Q

Coronary sulcus (atrioventricular groove)

A

encircles the junction of atria and ventricles like a crown

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14
Q

anterior interventricular sulcus

A

cradling the anterior interventricular artery, marks the anterior position of the septum separating the right and left ventricles –> continues as the posterior interventricular sulcus –> provides a similar landmark on the heart’s posteroinferior surface

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15
Q

right atrium

A
  1. a smooth-walled posterior part
  2. an anterior portion in which bundles of muscle tissue are. These are called pectinate muscles because they look like the teeth of a comb.
    - posterior and anterior are separated by C-shaped ridge, crista terminalis
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16
Q

left atrium

A
  • mostly smooth
  • pectinate muscle are only found in the auricle.
  • Fossa ovalis, interatrial septum has a little weakness, marks the spot where the foramen ovale existed
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17
Q

atria

A
  • receiving chambers for blood returning to the heart from the circulation.
  • thin walled chambers
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18
Q

Blood entering in atria

A

Right atrium:

  1. superior vena cava
  2. inferior vena cava
  3. coronary sinus: collects blood from myocardium

Left atrium:
- four pulmonary veins, transport blood from lungs back to the heart

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19
Q

Ventricles

A
  • Trabeculae carneae mark the internal walls of ventricular chambers
  • papillary muscles, play a role in valve function, project into the ventricular cavity
  • discharging chambers
  • bigger walls than atria
  • right ventricle pumps into the pulmonary trunk
  • left ventricle pumps into the aorta
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20
Q

heart valves

A
  • ensure one-way traffic of blood inside the heart

- four types

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21
Q

Atrioventricular valves (AV)

A

prevent backflow into the atria when the ventricles contract.

  1. right AV valve, tricuspid valve
  2. left AV valve, mitral valve
    - chordae tendinae, tiny collagen cords which anchor the cusps to the papillary muscles
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22
Q

Semilunar valves (SL)

A
  1. right SL valve, pulmonary valve
  2. left SL valve, aortic valve
    - open and close in response to differences in pressure
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23
Q

Coronary circulation

A

functional blood supply of the heart

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24
Q

coronary arteries

A
  • arise from the base of the aorta and encircle the heart
  • left coronary artery runs towards the left side of the heart and divides into two major branches:
    1. anterior interventricular artery
    2. circumflex artery
  • right coronary artery runs towards the right side of the heart and divides into two major branches:
    1. right marginal artery
    2. posterior interventricular artery
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25
Q

coronary veins

A
  • cardiac veins: after passing through the capillary beds of the myocardium, blood is collected here.
  • veins join to form an enlarged vessel, called the coronary sinus, which empties the blood into the right atrium. has three tributaries:
    1. great cardiac vein
    2. middle cardiac vein
    3. small cardiac vein
26
Q

the heart is myogenic

A

functions in ordered rhytmic fashion because of the inherent properties of cardiac muscle rather than specific neural stimuli

27
Q

cardiac muscle cells are self-excitable

A

they can initiate their own depolarization and that of the rest of the heart –> automaticity

28
Q

Action potentials

A

cardiac muscle contraction is triggered by action potentials.

29
Q

Intrinsic conduction system

A
  • ## made up of cardiac pacemaker cells –> have an unstable resting potential that continuously depolarizes –> pacemaker potentials –> trigger heart to its rhythmic contractions
30
Q

sequence of excitation

A 
cardiac pacemaker cells are found in the:
1. sinoatrial node
2. atrioventricular node
3. atrioventricular bundle
4. right and left bundle branches 
5. subendocardial conducting network
impulses pass from 1-5
31
Q

SA node

A
  • right atrial wall
  • sets pace for the heart
  • the hearts pacemaker –> no other region has a faster depolarization rate
  • sinus rhythm determines heart rate
32
Q

AV node

A
  • wave spreads via gap junctions throughout the atria and via the internodal pathway to the AV node
  • located immediately above the tricuspid valve
  • impulse is delayed for 0.1 s allowing atria to respond and complete contraction
33
Q

AV bundle

A
  • also called bundle of His

- superior part of interventricular septum

34
Q

Right and left bundle branches

A
  • AV bundle splits into two pathways :
    1. right bundle branch
    2. left bundle branch
  • go towards the heart apex
35
Q

Subendocardial conducting network

A
  • also called Purkinje fibers are long strands of barrel-shaped cells with few myofibrils.
  • penetrate into heart apex and then turn superiorly into the ventricular walls
36
Q

Total time of impulse is

A
  • from SA node to last of ventricular muscle cells is 0.22 s (220 ms)
37
Q

Cardioinhibitory center

A
  • sends impulses to the parasympathetic dorsal vagus nucleus in the medulla –> sends inhibitory impulses to heart via vagus nerves
38
Q

Cardiac cycle

A
  • systole, period of contraction
  • diastole, period of relaxation
  • includes all events associated with the blood flow through the heart during one complete heartbeat
39
Q

Ventricular filling, mid to late diastole

A
  • pressure in heart is low
  • blood flows through atria and open AV valves into ventricles, aortic and pulmonary valves are closed.
  • atria contract, compressing blood in their chambers –> rise in arterial pressure –> propels residual blood out of the atria into the ventricles
40
Q

Ventricular systole, atria in diastole

A
  • atria relax –> ventricles begin contracting

- ventricular pressure rises rapidly, closing AV valves.

41
Q

Isovolumetric contraction phase

A

split-second period when the ventricles are completely closed and blood volume in chambers remains constant as the ventricles contract

42
Q

Isovolumetric relaxation, early diastole

A
  • ventricles relax
  • ventricular pressure drops because the blood remaining in their chambers, end systolic volume (ESV) is no longer compressed.
43
Q

heart sound

A

phonocardiogram

  • first sound is tricuspid and mitral valves closing
  • second sound is pulmonary and aortic valve closing
44
Q

Pressure volume diagram

A
  • zie plaatje pagina 29
  • D-A phase is diastole
  • B-C phase is systole
    1. mitral valve opens
    2. mitral valve closes
    3. aortic valve opens
    4. aortic valve closes
45
Q

Stroke volume

A
  • volume of blood pumped out of our heart per beat

- EDV (end diastolic volume) - ESV (end systolic volume)

46
Q

isovolumic

A

volume stays the same

47
Q

stroke volume depends on 3 factors

A
  • contractility, inotropy
  • preload, left ventricular wall stress at end diastole
  • afterload, pressure required to open aortic valve
48
Q

Contractility, inotropy

A
  • ability of heart muscle to contract
  • increasing influx calcium –> increasing contractility
  • increases the slope and shifts the end-systolic pressure- volume relationship (ESPVR) to the left –> ventricle generates more pressure at a given left ventricular volume.
  • increases pressure development and ejection velocity –> increases stroke volume and ejection fraction and decreases ESV
  • decreasing inotropy increases ESV and decreases stroke volume and ejection fraction
49
Q

Preload

A
  • left ventricular wall stress at end diastole.
  • increase in preload –> increase in stroke volume –> increase in cardiac output and arterial pressure –> afterload on ventricle increases.
  • decrease in preload –> reduces stroke volume –> ESV decreases slightly
50
Q

Afterload

A
  • pressure required to open aortic valve.
  • increased –> stroke volume is reduced –> end-systolic volume increased
  • decreased –> stroke volume increases –> end systolic decreases
51
Q

Blood volume

A
  • determined by amount of water and sodium ingested + excreted by kidneys + lost through the GI-tract, lungs and skin.
  • mainly regulated by kidneys
52
Q

Changes in bloodvolume

A
  • affect arterial pressure by changing cardiac output.
  • increase blood volume –> increase central venous pressure –> increases right arterial pressure, right ventricular end-diastolic pressure and volume.
  • increase in ventricular preload increases ventricular stroke volume by the Frank-Starling mechanism.
  • increase in right ventricular stroke volume –> increases pulmonary venous blood flow to left ventricular –> increasing left ventricular preload and strok volume –> increase cardiac output and arterial blood pressure.
53
Q

Frank-Starling mechanism

A
  • by increasing blood volume the heart will contract harder
54
Q

effects of autonomic nervous system (ANS)

A
  • leer pagina 34
55
Q

Nicotinic acetylcholine receptors (parasympathetic)

A
  • respond to neurotransmitter acetylcholine
  • also respond to nicotine
  • they are primary receptor in muscle for motor nerve-muscle communication that controls muscle contraction
  • activation of these receptors –> depolarization of plasma membrane
56
Q

Muscarinic acetylcholine receptor (parasympathetic)

A
  • acetylcholine receptors which work with G-proteins
  • act as main end-receptor stimulated by acetylcholine released from postganglionic fibers in the parasympathetic nervous system
  • activation of these –> inhibition of postsynaptic neurons
57
Q

Adrenergic receptors or adrenoceptors

A
  • alfa and beta receptors
  • targets of noradrenaline and adrenaline
  • stimulate SNS, responsible for fight-or-flight response
58
Q

Alfa receptors

A
  • vasoconstriction

- decreased motility of smooth muscle in GI-tract

59
Q

Beta 1- receptors

A
  • increase cardiac output by increasing heart rate, conduction velocity, stroke volume and rate of relaxation of myocardium by increasing calcium ion concentration
60
Q

Dobutamine effect on heart

A

direct stimulation of B1-adrenergic receptors of SNS, causing threshold to be reached more quickly –> SA node fires more rapidly –> heart starts beating faster –> increase in cardiac output and heart rate

BBS1002 (10 decks)

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