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APEX-CV & Respiratory > CV Anatomy modules 10-18 > Flashcards

CV Anatomy modules 10-18 Flashcards

(101 cards)

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1
Q

When is the mitral valve open and aortic valve closed

A

During:
Rapid ventricular filling
Diastasis
Atrial systole

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2
Q

What valve is open when LA pressure is greater than LV pressure

A

Mitral valve

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3
Q

What valve is open when LV pressure is greater than aortic pressure

A

Aortic valve

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4
Q

What happens to the aortic valve when aortic pressure exceeds LV pressure

A

It closes (producing the second heart sound), then causes retrograde flow from aorta toward aortic valve (Dicrotic notch)

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5
Q

What happens to the mitral valve when LV pressure exceeds LA pressure

A

It closes producing the 1st heart sound

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6
Q 
Identify the status of the mitral valve during each phase of the cardiac cycle:
Atrial systole
Ventricular ejection
Isovolumetric ventricular relaxation
Isovolumetric ventricular contraction
Rapid ventricular filling
A

Atrial systole-MV open
Ventricular ejection-MV closed
Isovolumetric ventricular relaxation-MV closed
Isovolumetric ventricular contraction-MV closed
Rapid ventricular filling-MV open

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7
Q 
Identify the status of the aortic valve during each phase of the cardiac cycle
Atrial systole
Ventricular ejection
Isovolumetric ventricular relaxation
Isovolumetric ventricular contraction
Rapid ventricular filling
A

Atrial systole-AV closed
Ventricular ejection-AV open
Isovolumetric ventricular relaxation-AV closed
Isovolumetric ventricular contraction-AV closed
Rapid ventricular filling-AV closed

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8
Q 
What does each element represent in the cardiac PV loop
Height
Width
Corners
Area of PV loop
A

Height = ventricular pressure
Width = ventricular volume
Corners = where valves open and close
Area of PV loop = myocardial workload

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9
Q

What happens to myocardial external workload if the volume axis widens or the pressure axis increases heaight

A

Each will increase workload

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10
Q 
Determine the severity of cardiac dysfunction based on EF
>50%
41-49%
26-40%
<25%
A 
>50% = normal
41-49% = mild dysfunction
26-40% = moderate dysfunction
<25% = severe dysfunction
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11
Q

What alterations affect the morphology of the cardiac PV loop

A

Preload
Contractility
Afterload

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12
Q

How does preload change the cardiac PV loop

A 
Increased = wider PV loop
Decreased = narrower loop
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13
Q

How does a change in contractility affect the cardiac PV loop

A 
Increased = PV loop is wider, taller, and shifts LEFT
Decreased = PV loop is narrower, shorter, and shifts RIGHT
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14
Q

How do changes to afterload affect the PV loop

A 
Increased = PV loop is narrower, taller, and shifts ESV to right
Decreased = PV loop is wider, shorter, and shifts ESV left
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15
Q

What arteries arise from the LCA

A

Left anterior descending

circumflex arteries

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16
Q

What does the left anterior descending artery perfuse

A

Anterolateral and apical wall of LV

Anterior 2/3 of interventricular septum

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17
Q

Perfusion changes caused by the left anterior descending will be seen in which lead

A

EKG V1-V4

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18
Q

What does the circumflex artery supply?

A

Left atrium

Lateral and posterior walls of ventricle

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19
Q

Perfusion changes caused by the circumflex artery will be seen in which leads

A

Leads I, aVL, V5 - 6

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20
Q

What does the right coronary artery perfuse

A

Right atrium
Right ventricle
Interatrial septum
Posterior third of interventricular septum

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21
Q

Perfusion changes caused by the right coronary artery are seen in which leads

A

Leads II, III, aVF

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22
Q

What does the posterior descending artery perfuse

A

Inferior wall

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23
Q

Where is the coronary sinus

A

The heart’s posterior surface

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24
Q

Where does the coronary sinus return blood

A

To the right atrium

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25
How is the coronary sinus used during bypass
It can be cannulated to administer retrograde cardioplegia solution
26
Describe the unique properties of the Thebesian circulation
It returns deoxygenated blood to the left side of the heart Contributes to small amount of anatomic shunt
27
When using TEE/TTE, what is the best view for diagnosing myocardial ischemia
Midpapillary muscle level in short-axis
28
Where do the left and right coronary arteries originate
The aortic root
29
How is PDA coronary dominance defined
Defined by origin: right dominance = RCA gives rise to PDA Left dominance = circumflex Codominance = RCA and circumflex
30
What coronary supplies the SA node
RCA
31
The RCA supplies which cardiac node
SA node | AV node in 80% pts
32
What coronary artery supplies the AV node
RCA in ~80% of patients
33
What coronary supplies the Bundle of His
LCA in 75% of pts
34
What nodes does the LCA supply
Bundle of His | Left and right bundle branches
35
What coronary supplies the left and right bundle branches
LCA
36
What are the 3 main coronary veins
Great cardiac vein Middle cardiac vein Anterior cardiac vein
37
What blood drains into the coronary sinus
Most of the blood returning from the LV
38
Which veins carry most of the blood returning from the right ventricle
Anterior cardiac vein
39
What type of coronary vessels are the RCA, LAD, and CxA
Epicardial vessels
40
Describe the function of collateral vasculature in the heart
They provide redundancy of blood flow to poorly perfused areas They develop from different branches of the same coronary artery or between 2 different coronary arteries Single fed vessels are at risk if occlusion develops proximal to collateral branch
41
Lateral leads
I, aVL, V5, V6
42
Inferior leads
II, III, aVF
43
Septal leads
V1 - V4
44
What is coronary blood flow at rest? What percent of CO?
225-250 mL/min 4-7% of CO
45
What are the variables in the equation for coronary blood flow?
Coronary BF = (Coronary perfusion pressure)/(Coronary vascular resistance)
46
What range is coronary BF MAP autoregulated?
MAP between 60-140 mmHg
47
What is the most important determinant of coronary vessel diameter
Local metabolism
48
How does cardiac metabolism impact coronary vessels
It affects the coronary vessel diameter
49
What percent of O2 is consumed by myocardium in coronary blood flow
70%
50
Definition = To ensure constant amount of blood flow over a wide range of perfusion pressures
Autoregulation
51
What is coronary BF autoregulation?
The constant amount of blood flow over a wide range of perfusion pressures MAP 60-140 mmHg Allows for constant coronary BF over a wide range of BPs
52
How is coronary BF affected when out of autoregulation range
BF is dependent on CPP
53
What is coronary reserve
The difference between coronary BF at rest and maximal dilation Coronary reserve = resting coronary BF - Maximal dilation BF
54
What is the difference between resting coronary BF and coronary BF at maximal dilation
Coronary reserve
55
What does coronary reserve allow for during stress
Allows CBF to increase in times of hemodynamic stress or exercise
56
Describe coronary reserve in the patient with atherosclerosis
When O2 demand increases, atherosclerotic vessels are maximally dilated at rest and can't dilate further Patient has DECREASED coronary reserve
57
What is autoregulation of coronary BF affected by
Local metabolism Myogenic response Autonomic nervous system
58
What metabolic byproducts cause coronary vasodilation
Adenosine, a byproduct of ATP metabolism
59
What are some mediators of coronary vasodilation
``` Nitric oxide PGs Hydrogen (decreased pH, increased CO2) Potassium CO2 ```
60
What are the effects of vasodilation on coronary blood flow (3)
1. Decreases vascular resistance 2. Increases coronary perfusion 3. Flushes out products of metabolism
61
How does hypocarbia affect coronary blood flow
It causes vasoconstriction, decreasing CBF
62
What muscarinic mediators cause coronary artery vasodilation
Nitric oxide
63
Which receptors lead to coronary artery vasodilation
Beta-2 Histamine-2 Muscarinic
64
What receptors lead to coronary artery vasoconstriction
Alpha | Histamine-1
65
What 2 pressures determine coronary perfusion pressure
CPP = Aortic DBP - LVEDP
66
What 3 responses are responsible for autoregulation of coronary BF
1. Local metabolism 2. Myogenic response 3. Autonomic nervous system
67
Why does LCA endocardial vessel flow decrease dramatically during systole
LV contraction compresses the endocardial vessels during systole due to the large mass of the LV
68
Describe the coronary flow via the RCA during the cardiac cycle
Flow remains relatively constant throughout the cardiac cycle
69
Why is the RV coronary flow more constant versus the LV coronary flow
RV has a thinner wall that doesn't generate high enough pressures to occlude blood supply during systole
70
How does P50 affect myocardial O2 consumption
Left shift means less O2 is released to myocardium | Decreases supply
71
How does end-diastolic volume affect myocardial O2 consumption
Decreased EDV reduces wall stress | Decreased demand
72
How does heart rate affect myocardial O2 consumption
Reduces supply and increases demand Increased heart rate decreases DIASTOLIC filling time
73
How does aortic diastolic BP affect myocardial O2 consumption
Decreased DBP means decreased supply and reduced CPP
74
What 2 components maintain myocardial O2 balance
Supply and demand
75
What are 3 determinants of O2 delivery (supply)
Coronary BF CaO2 O2 extraction
76
What are 4 determinants of O2 demand
Preload Afterload Contractility Wall stress
77
How is tachycardia detrimental to the ischemic heart?
It decreases O2 SUPPLY and increases O2 DEMAND
78
How does afterload affect coronary perfusion pressure
it INCREASES CPP
79
When do most perioperative myocardial infarctions occur
within 24-48 hours of surgery
80
What is normal coronary sinus O2 saturation?
~30%
81
What does the amount of myocardial O2 extraction mean for myocardial O2 delivery/demand
The heart cannot meaningfully increase O2 extraction ratio when O2 demand increases
82
What 2 factors must increase to meet myocardial O2 demand
Coronary BF or CaO2
83
List factors that increase myocardial O2 demand (7)
``` Tachycardia HTN SNS stimulation INC wall tension INC LV EDV INC afterload INC contractility ```
84
List factors that decrease myocardial O2 delivery
Decreased coronary flow - Tachycardia - DEC aortic pressure - DEC vessel diameter (hypocapnia, spasm) - INC LV EDV Decreased CaO2 - Hypoxemia - Anemia Decreased O2 extraction - DEC P50 (left shift) - DEC capillary density
85
How does tachycardia affect myocardial O2
It can decrease supply by -decreasing diastolic filling time Increase demand -increasing cardiac contraction and cycles requires more energy/ATP and O2 utilization
86
How does increased aortic diastolic pressure affect myocardial O2
Increased supply - It increases coronary artery perfusion - INC aortic DBP - LVEDP = INC CPP Increased demand - Increased wall tension to overcome afterload - Myocardium requires higher pressures to overcome AV
87
How does increased preload affect myocardial O2
Decreased supply -Increased EDV decreases CPP Increased demand -higher preload increases wall stress (pressure)
88
Describe the relationship between nitric oxide and hgb
NO is inactivated by hgb, which is why it has a short half-life (5 seconds) It is inactivated before entering systemic circulation
89
What 4 responses regulate vascular smooth muscle tone
Autonomic nervous system Renin-angiotensin-aldosterone system Local metabolism Myogenic response
90
How does Ca++ affect vessel diameter
INCREASED CA++ = vasoconstriction | DECREASED Ca++ = vasodilation
91
List the second messenger systems that modulate vascular tone by altering Ca++ concentrations
``` G-protein cAMP -Increased cAMP = vasodilation Nitric oxide cGMP -Increased cGMP = vasodilation Phospholipase C -Increased IP3 and DAG = vasoconstriction ```
92
Describe the process of the G-protein cAMP pathway to vasodilation
Norepi => beta-2 receptor => G-protein => adenyl cyclase => cAMP increase => PKA => decreased Ca++ => vasodilation
93
How does PKA affect excitation-contraction coupling
Leads to vasodilation via - Inhibition of voltage-gated Ca++ channels in sarcolemma - Inhibition of SR release of Ca++ release - Myofilament reduced Ca++ sensitivity - Ca++ reuptake into SR via SERCA2 pumps facilitated DECREASES available Ca++ in sarcolemma, from SR, sequesters Ca in SR and decreases myofilament Ca sensitivity
94
What mediators increase nitric oxide production (8)
``` ACh Substance P Bradykinin Serotonin Vasoactive intestinal peptide Thrombin Shear stress ```
95
What is the role of NOS in the nitric oxide pathway
NOS is an enzyme that catalyzes conversion of L-arginine to NO
96
How does NO travel into smooth muscle
diffusion
97
What activates guanylate cyclase? | Role of activated guanylate cyclase?
nitric oxide converts guanosine triphosphate to cyclic guanosine monophosphate (cGMP)
98
How does phosphodiesterase (PDE) contribute to vessel diameter
It deactivates cGMP to guanosine monophosphate (Ca++ availability increases?)
99
What mediators activated the PLC pathway? The result?
Mediators = phenylephrine, norepinephrine, angiotensin 2, endothelin-1 Result = vasoconstriction
100
Describe the PLC pathway to vasoconstriction
Angiotensin 2 etc => ATII receptor => Gq G-protein => PLC => IP3, DAG => Increased Ca++ => vasoconstriction
101
What 2 second messengers are activated by PLC
IP3 | DAG

APEX-CV & Respiratory (8 decks)

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