Exam 1: The Heart and Vessels Flashcards
(551 cards)
1
Q
What is the cavity between the lungs that contains the heart?
A
Mediastinum
2
Q
What are the subdivisions of the pericardium?
A
Parietal pericardium
Visceral pericardium
3
Q
What is the sac that surrounds the heart (externally)?
A
Parietal pericardium
4
Q
What is adhered to the heart muscle?
A
Visceral pericardium
5
Q
What is another name for the epicardium?
A
Visceral pericardium
6
Q
What are the layers of the parietal pericardium?
A
Serous layer
Fibrous layer
7
Q
What is the inner layer of the parietal pericardium that produces fluid?
A
Serous layer
8
Q
What is the outer layer of the parietal pericardium that is made of connective tissues?
A
Fibrous layer
9
Q
What is the outermost layer of the heart?
A
Epicardium
10
Q
How thick is the epicardium?
A
Very thin
11
Q
What is the middle layer of the heart?
A
Myocardium
12
Q
What is the innermost lining of the heart?
A
Endocardium
13
Q
How thick is the endocardium?
A
Very thin
14
Q
What layer of the heart is known as the heart muscle?
A
Myocardium
15
Q
What type of cells is the endocardium made of?
A
Simple squamous epithelium
16
Q
List the layers of the heart from most external to most internal:
A
Fibrous parietal pericardium
Serous parietal pericardium
[Pericardial cavity]
Visceral pericardium
Myocardium
Endocardium
17
Q
What chamber of the heart receives blood flow returning from the entire body (excluding lungs)?
A
Right atrium
18
Q
What structure returns blood to the heart from structures above the heart?
A
Superior vena cava
19
Q
What structure returns blood to the heart from structures below the heart?
A
Inferior vena cava
20
Q
What appendage-like chamber adds volume to the right atrium?
A
Right auricle
21
Q
What does the fossa ovalis mark?
A
The location of the fetal pulmonary bypass
22
Q
What is the fetal pulmonary bypass?
A
Foramen ovale
23
Q
Where is the fossa ovalis/foramen ovale located?
A
In the interatrial septum
24
Q
What are bundles of muscles only seen in the right atrium? (exist in left, can’t see them)
A
Pectinate muscles
25
What is the wall between the two atria?
Interatrial septum
26
Where does blood return from the heart itself?
The opening of the coronary sinus
27
What is the valve between the right atrium and ventricle?
Tricuspid valve
28
What are the string-like cords that connect the cusps of the atrioventricular valves to specific muscles of the heart?
Chordae tendineae
29
What is the purpose of chordae tendineae?
They prevent the valve from pushing up into the atrium
30
What is another term for an anatomical part that is displaced?
Prolapse
31
What is the pathology when:
The chordae tendineae break?
Ruptured chordae
32
What is the pathology when:
A valve is forced up into the atrium during ventricular contraction, thus causing blood to go in the wrong direction?
Mitral/bicuspid valve prolapse or tricuspid valve prolapse
33
What is the pathology when:
Some blood goes back up into the atrium (the wrong way)
Atrioventricular regurgitation
34
Where should blood go out through in the heart?
The semilunar valves
35
What do ruptured chordae cause?
Mitral/bicuspid valve prolapse or tricuspid valve prolapse
36
Which chamber of the heart pumps blood to the lungs?
Right ventricle
37
What are specialized muscles of the heart that hold tension on the chordae tendineae?
Papillary muscles
38
What muscles keep tension on the chordae tendineae to keep the atrioventricular valves closed during ventricular contraction?
Papillary muscles
39
What are the internal heart muscles that create "nooks and crannies" in the ventricles?
Trabeculae carneae
40
Which heart muscles are like "struts"?
Trabeculae carneae
41
What is the valve between the right ventricle and the pulmonary trunk?
Pulmonary semilunar valve
42
What is the pulmonary semilunar valve also known as?
The pulmonary valve
43
What is the large artery that leads from the right ventricle to the pulmonary arteries?
Pulmonary trunk
44
What takes deoxygenated blood to the lungs where the blood can become oxygenated?
[Right and left] pulmonary arteries
45
What, in birthed humans, used to be a fetal pulmonary bypass between the pulmonary artery and aortic arch?
Ligamentum arteriosum
46
What, in fetal humans, is a pulmonary bypass between the pulmonary artery and aortic arch?
Ductus arteriosus
47
Where do the pulmonary veins obtain oxygenated blood from?
The lungs
48
Where do pulmonary veins take oxygenated blood from the lungs to?
The left atrium
49
What adds volume to the left atrium?
Left auricle
50
What is an atrioventricular valve between the left atrium and left ventricle?
Mitral or bicuspid valve
51
Are there chordae tendineae supporting both atrioventricular valves?
Yes, they are on both valves
52
What is the chamber that pumps blood to the entire body [except for the lungs]?
Left ventricle
53
Are there papillary muscles and trabeculae carneae in both ventricles?
Yes
54
What is the valve between the left ventricle and ascending aorta?
The aortic semilunar valve
55
What is another name for the aortic semilunar valve?
Aortic valve
56
What is the first part of the aorta that leaves the heart?
Ascending aorta
57
What is the part of the aorta that gives off the first 3 major arteries?
Aortic arch
58
What part of the aorta has blood flowing inferiorly?
Descending aorta
59
What region of the descending aorta is above the diaphragm?
Descending thoracic aorta
60
What region of the descending aorta is below the diaphragm?
Descending abdominal aorta
61
What is the wall between the two ventricles?
Interventricular septum
62
What is the wall between the two atria?
Interatrial septum
63
Is cardiac muscle striated or smooth?
Striated
64
Is cardiac muscle voluntary or involuntary?
Involuntary
65
Are there branches in cardiac muscle?
Yes
66
Is cardiac muscle mono or multinucleated?
Mononucleated
67
What mineral does cardiac muscle require extracellularly?
Cardiac muscle requires extracellular calcium
68
Why can calcium channel blockers be used to treat certain pathologies?
Cardiac muscle relies upon extracellular calcium to function normally. For example, if calcium is limited to the heart by CCBs, this may lower blood pressure (treating hypertension)
69
What are intercalated discs?
Structures in the heart that connect cardiac muscle cells together and allow communication
70
What are gap junctions?
Channels that connect the cytoplasms of neighboring cells, allowing the passage of ions and the spread of cardiac APs
71
What is the main function of intercalated discs and gap junctions?
Allow AP to pass from cell to cell throughout the heart with little resistance
72
What does it mean for the heart to be a functional or physiological syncytium?
While the heart muscle cells are mononucleated, they still behave as if they were all one giant multinucleated cell (or one unit)
73
What allows for the heart to behave as a functional or physiological syncitium?
Gap junctions in the intercalated discs
74
Where is a true anatomical syncytium seen?
Multinucleated cells in skeletal muscle
75
What fibers conduct AP throughout the heart?
Conductive fibers
76
Where does the AP begin in the heart?
The primary pacemaker, the sinoatrial node
77
Are nodes nerves?
NO! They are modified muscle cells
78
Where is the SA node located?
The roof of the right atrium between the superior vena cava and right auricle
79
What pace does the primary pacemaker set in bpm?
100 bpm
80
What slows the hearts rhythm from the SA's pace (100bpm)?
The vagus nerve
81
What does the vagus nerve slow the heart down to?
75bpm
82
What nervous system controls the vagus nerve and makes the heart slow?
Parasympathetic
83
What is normal sinus rhythm in bpm?
75bpm
84
Can the SA node create an AP by itself?
Yes, as seen in hearts still beating after being taken out of a body... Just not for terribly long
85
What is the "normal" rate of the heart called?
Sinus rhythm
86
What is normal sinus rhythm in adults?
75bpm
87
What is normal sinus rhythm in neonates?
120-160bpm
88
What can overstimulation of the vagus nerve cause?
A vasovagal episode
89
What are symptoms of a vasovagal episode?
Dizziness and concomitant syncope (fainting)
90
Why do you faint in a vasovagal episode?
Increased vasodilation and reduction of blood pressure
91
What does concomitant mean?
Along with
92
What is the secondary pacemaker of the heart?
Atrioventricular node
93
What takes over if the SA node stops?
AV Node
94
Where is the Atrioventricular node located?
Interatrial septum
95
Which node is located just behind the opening for the coronary sinus?
AV node
96
What is the purpose of the AV node delay? Is it a pathology?
AV node delay is seen in healthy normal hearts. The AP speed is slowed down by the AV node to allow for optimal filling of the ventricles
97
Which node is faster? AV or SA?
SA node is faster. If the AV node has to take over, it will be much slower
98
What does nodal or junctional rhythm indicate?
Pathology! It suggests the SA node is not working and the AV node took over
99
What is the bpm of nodal or junctional rhythm?
40-50bpm
100
What is another name for the atrioventricular bundle?
Bundle of His
101
Where does the AV bundle leave the AV node?
Interventricular septum
102
How long is the bundle of His before it splits in two?
About 1cm long
103
What are the two divisions of the AV bundle called?
Right and left bundle branches
104
Where do the right and left bundle branches go down?
The thick portion of the interventricular septum to the heart's apex
105
What conductive fibers begin at the heart's apex and move up the sides of the heart into the papillary muscles?
Purkinje fibers
106
What takes over if both the SA and AV nodes stop working?
Purkinje fibers
107
How fast are Purkinje fibers?
Very slow- 30bpm
108
Are Purkinje fibers an acceptable pacemaker?
No, the bpm of 30 is so slow it may result in brain damage. If the SA and AV nodes are both broken you will need an artificial pacemaker
109
What is electrical potential?
The difference in charges on the inside and outside of the cell
110
What is the natural resting electrical potential of a cell?
Negative inside, positive outside
111
What is chemical potential?
Difference in chemical ions inside and outside the cell
112
What is the natural resting chemical potential of a cell?
K+ inside
Cl-, Na+, Ca+ outside
113
What is an influx or efflux of ions called?
Current
114
Where does action potential travel from? (from neuron to neuron)
Axon hillock to the terminal of a typical neuron
115
What is threshold?
The point of no return where AP will be generated
116
What enters the cell to bring it to threshold?
Positive Na+ ions
117
When does a cell reach threshold? What kind of potential?
A local potential/stimulus is strong enough to bring lots of Na+ ions into the cell
118
Is a resting cell polar or nonpolar?
Polar (neg inside)
119
What is the cell's state when Na+ enters?
Cell becomes depolarized
120
What effluxes outside the cell for it to become repolarized?
Potassium
121
What is the impact of K+ efflux?
Cell becomes negative (polar) again, but now the chemical gradient is messed up. This leads to hyperpolarization (too negative)
122
What fixes hyperpolarization?
Sodium potassium pump
123
What is the Na-K pump ratio?
3 Na+ OUT
2 K+ IN
124
What does the Na-K pump regulate?
Cell volume and secondary active transport
125
What is the plateau in heart cell AP?
Influx of Ca++ stops the cell from becoming too negative and creates a plateau
126
What is the benefit of the heart cell's Ca++ plateau?
This optimizes ejection/emptying of ventricles
127
How does repolarization complete in the heart?
Ca++ influx stops and K+ efflux continues
128
Does the Na-K pump function differently in the heart?
It still pumps 3 Na+ OUT and 2 K+ IN to restore the gradient.
The only difference is the Ca++ plateau due to Ca++ influx
129
What does the Ca++ plateau represent?
A prolonged contraction to maximize emptying of the heart's chambers (pumping blood OUT)
130
What slows the heart by using the mechanism described by the Na-K pump?
Calcium channel blockers. These prevent the influx of Ca++, which in turn prevents the optimization of the heart's contractions
131
What stage of the AP cycle is different in the heart than the neuron?
There is no hyperpolarization in the heart's cycle, there's a Ca++ plateau
132
Which has a longer refractory period: nerves or the heart?
The heart
133
Why does the heart have a longer refractory period?
To prevent the myocardium from entering tetanus or fatigue
134
Does the heart's Ca++ plateau occur at the peak?
No, there is a decline/slight repolarization first
135
How does digitalis poison the Na-K pump?
Digitalis prevents Na+ from exiting the cell. This means there is less of a Na+ gradient and Ca++ accumulates inside the heart cell
136
What does > Ca++ inside the heart muscle do for the strength of contraction?
Increases strength of contraction
137
What kicks Ca out of the heart normally? (I.e., when digitalis is not interfering)
The sodium/calcium counter transport
138
What does an ECG/EKG represent?
All of the electrical events in the heart muscles combined
139
What wave occurs just prior to contraction?
P wave
140
What wave represents atrial depolarization?
P wave
141
What wave represents atrial repolarization?
It is hidden by the QRS complex
142
What wave represents ventricular depolarization?
QRS complex
143
What wave represents ventricular repolarization?
T wave
144
Which wave is of an unknown origin and is not always seen on EKGs?
U wave
145
What can enhance the U wave?
Hypokalemia (low potassium)
146
Where is the AV node delay on an EKG?
Right after the p wave, there is a flat line prior to the Q dip. This is the delay.
147
What does this EKG pathology mean?
Enlarged P wave
Atrial hypertrophy (enlargement)
148
What does this EKG pathology mean?
Missing p wave
SA node damage
149
How do you know that the AV node has taken over as pacemaker?
There's a missing P wave, and the bpm has slowed to 40-50
150
What does this EKG pathology mean?
Extra QRS complex, sometimes inverted
Premature ventricular contractions (PVC), where the ventricles beat twice for the beat of one atria
151
What is another name for Premature ventricular contractions (PVC)?
Extra systole
152
What does this EKG pathology mean?
Enlarged Q, S-T elevation, and/or inverted T
Myocardial infarction (MI)
153
What is a myocardial infarction (MI)?
Ischemic necrosis of the myocardium
154
What does this EKG pathology mean?
Enlarged R
Ventricular hypertrophy (enlargement)
155
What does this EKG pathology mean?
Flattened T
Cardiac ischemia or hypoxia
156
What does this EKG pathology mean?
Prolonged P-Q
Damage in the atria blocking APs
157
What does this EKG pathology mean?
Bifid R wave (2 peaks)
An R wave with 2 peaks indicates left bundle branch block
158
What is an ectopic focus?
An AP that originates anywhere except the SA node
159
What is a premature contraction of the heart that results in an early beat? (You get two beats together followed by an asystolic period)?
Extra systole
160
What is an asystolic period?
Period without systole or contraction
161
Is the recovery beat after an extra systole strong or weak?
Recovery beat is very strong and is felt as a thud or flutter
162
Where is the cardioacceleratory center?
In the medulla oblongata
163
What NS increases heart rate and SOC from the cardioacceleratory center?
Sympathetic NS
164
What sympathetic NS receptors can impact the heart?
Adrenergic receptors
165
What are the neurotransmitters that bind to adrenergic receptors?
Norepinephrine and epinephrine
166
What's another name for the NTs that bind to adrenergic receptors?
Receptor ligands
167
What does the adrenergic receptor Alpha 1 do to the heart?
Causes vasoconstriction increasing BP
168
What does the adrenergic receptor Beta 1 do to the heart?
Increases HR, SOC, BP when bound to norepi
169
What does the adrenergic receptor Beta 2 do to the heart?
Causes relaxation of smooth muscle around blood vessels (vasodilation) which reduces BP around bronchi and bronchioles (bronchodilation)
170
Which adrenergic receptor is associated with bronchodilation?
Beta 2
171
What does "chronotropic factors" mean? Positive vs negative?
Things that effect heart rate
Positive increases HR, negative decreases HR
172
Does this increase or decrease HR?
Beta 1 receptors
Increase HR
173
Does this increase or decrease HR?
Cardioacceleratory center
Increase HR
174
Does this increase or decrease HR?
Sympathetic NS
Increase HR
175
Does this increase or decrease HR?
Epinephrine/adrenalin
Increase HR
176
Does this increase or decrease HR?
Caffeine and nicotine
Increase HR
177
When is epinephrine released? What does this do to HR and BP?
Epi is released due to anxiety and increases HR and BP... This makes anxiety even worse.
178
What does long-term epi from anxiety do to the body?
Cortisol is released from the adrenal glands
179
Does this increase or decrease HR?
Parasympathetic NS
Decrease HR
180
Does this increase or decrease HR?
Vagus nerve
Decrease HR
181
What is the NT for the vagus nerve?
Achtylcholine
182
What does inotropic factors mean?
Things that effect the heart's SOC
183
Does this increase or decrease SOC?
Parasympathetic NS
Decrease SOC
184
Does this increase or decrease SOC?
Vagus nerve-Ach
Decrease SOC
185
Where is the cardioinhibitory center located?
Also the medulla oblongata
186
What is in the cardioinhibitory center?
Parasympathetic nerves from the vagus nerve
187
What are proteins/receptors involved in the Parasympathetic NS?
Muscarinic receptors
188
What is another name for muscarinic receptors?
Cholinergic receptors
189
What cranial nerve # is the vagus nerve?
10
190
Is the vagus nerve large or small?
Large
191
What does the vagal NT Ach do to K+ channels?
Acetylcholine opens K+ channels, allowing K+ to flood OUT. This hyperpolarizes muscle cells
192
What is continuous vagal stimulation that keeps the HR down?
Vagal tone
193
What happens to the HR if you cut the vagus nerves?
HR increases to 100bpm (the actual pacing of the SA node naturally)
194
What makes the first sound of the heart?
Closure of the atrioventricular valves (especially the mitral valve)
195
What makes the second sound of the heart?
Closure of the semilunar valves, especially the aortic valve
196
What makes the third sound of the heart?
Too much volume in the atrium causes a gallop that sounds like "Kentucky"
197
Is a third heart sound normal?
In children and young adults, it is normal. For those over 40 it can indicate heart failure
198
How many heart sounds might you hear if you have mitral valve regurgitation?
3
199
When does the third heart sound happen?
Immediately following S2 in early diastole
200
What makes the fourth sound of the heart?
Stiff walls (noncompliant or non-elastic) vibrate when blood hits them and it makes a gallop sound like "Tennessee"
201
What does 4 heart sounds indicate?
Myocardial damage
202
When does the fourth heart sound take place?
Occurs immediately before S1
203
What is diastole?
The heart relaxing and filling with blood
204
What is systole?
The heart contracting and ejecting blood
205
What is the normal pressure for diastole?
Low pressure or 75mmHg for periphery
206
What is normal pressure for systole?
High pressure or 120mmHg for periphery
207
How do you calculate pulse pressure?
Diastole - Systole
208
What is the pulse pressure for the average healthy person?
Diastole - Systole
75mmHg - 120mmHg = 45mmHg
209
What is the first step in the cardiac cycle?
Ventricular filling
210
What brings blood into the heart, and where?
Veins return deoxygenated blood to the heart through the atria
211
Does pressure increase or decrease in ventricular filling?
Atrial pressure increases as blood begins to fill
Ventricular pressure decreases, as systole (ejection) just finished
212
What happens when the pressure in the atrium is greater than the pressure in the ventricle?
The AV valve pops open
213
What happens when the AV valve opens?
Blood floods the ventricles
214
What percent of ventricular filling is powered by low pressure venous return?
80%
215
What powers 20% of ventricular filling?
Atrial contraction
216
What is the end diastolic volume (EDV)?
Volume in the chamber at the end of diastole, or its max volume
217
What is the max volume, or EDV in ml?
120ml
218
What happens after ventricular filling?
Isovolumetric (isovolumic) contraction (IVC)
219
What happens to the AV valves when ventricles contract?
The valves snap shut (all 4 of them)
220
What does the word isovolumic mean and how does it relate to the cardiac cycle?
Same volume, meaning the volume remains the same despite pressure rising sharply
221
When does the aortic and pulmonary semilunar valves open?
When pressure in the ventricles get higher than the pressure in the aorta or pulmonary artery
222
What phase follows IVC?
Ventricular ejection
223
Where does blood get ejected out of in the heart?
The two semilunar valves
224
What is the BP in the right ventricle?
12-25/0 mmHg
225
What is the BP in the left ventricle?
120/0 mmHg
226
What is the end systolic volume (ESV)?
Blood left in the ventricle at the end of systole/ejection
227
What is the minimum ESV?
50 ml
228
What is the stroke volume?
Actual amount of blood pumped out with each beat
229
How do you calculate stroke volume?
EDV - ESV
230
What is the typical stroke volume?
EDV - ESV
120 ml - 50 ml = 70 ml
231
What is the total blood volume of a woman?
4000-5000ml
232
What is the total blood volume of a man?
5000-6000ml
233
What is the normal heart rate or sinus rhythm for an adult?
75bpm
234
What is normal sinus rhythm for neonatal?
120-160bpm
235
What is the cardiac output?
Amount of blood pumped out each minute
236
How do you calculate cardiac output?
Stroke volume (SV) x Sinus rhythm
237
What is normal cardiac output?
SV x rate
70 ml x 75 bpm = 5250 ml
238
How often do you pump your entire blood volume?
Every minute of your life
239
What does the ejection fraction mean?
Percent of blood (EDV) pumped out each beat
240
How do you calculate ejection fraction?
(Stroke volume/EDV) x 100
241
What is a normal ejection fraction?
(SV/EDV) x 100
(70 ml / 120 ml) x 100 = 58.33%
242
How high can ejection fraction get during exercise?
90%
243
What lowers ejection fraction?
Heart disease
244
How does increasing HR impact the ejection fraction?
There is reduced time for diastole, not systole, so there is less filling time
245
What does an ejection fraction below 40% indicate?
Heart damage and possible heart failure
246
At what point (in bpm) is there not enough filling time so there's a reduction in the ejection fraction/loss of heart efficiency?
200 bpm
247
What is the maximum HR?
220-age
248
What happens in isovolumetric (isovolumic) Relaxation (IVR)?
The heart begins to relax, but all four valves are still closed. This means there is the same volume, but pressure decreases steeply
249
How does preload affect stroke volume?
The tension/stretch/volume on the heart's chamber before contraction impacts the amount of venous return. More stretch = more contraction = more stroke volume
250
What is Frank-Starling's Law?
The heart pumps more efficiently with increasing volumes (preload stretch).
Increased venous return causes increased SV and increased ejection fraction
251
How does contractility affect SV?
As SOC increases, stroke volume increases
252
What is afterload
The pressure the heart must exert to pump blood out of the ventricles during contraction
253
What is peripheral resistance?
The resistance or pressure the heart must pump against
254
How does afterload relate to SV?
As afterload increases, SV decreases
255
How does BP in the arterioles affect afterload?
When arterioles constrict, they increase resistance and therefore increase afterload, leading to higher blood pressure
256
Does increased afterload make it easier or harder for the heart?
Increased afterload makes the heart work harder
257
Does this increase or decrease afterload?
Atherosclerosis
Increase afterload
258
What is atherosclerosis?
Clogging/hardening of the arteries
259
Does this increase or decrease afterload?
Loss of arteries due to tissue damage, scarring, amputation
Increase afterload
260
Does this increase or decrease afterload?
Hypertension
Increase afterload
261
Does this increase or decrease afterload?
Cor Pulmonale
Increase afterload
262
Why does Cor Pulmonale cause right heart failure?
Pulmonary diseases increase afterload in the right ventricle, making it work harder. This causes an enlargement of the cells (hypertrophy), thickening of the wall, which decreases volume availability, leading to right heart failure
263
What NS receptor can impact afterload?
Stimulation of the sympathetic NS's Alpha 1 Receptor causes vasoconstriction, which increases afterload
264
Pressure of the: right atrium
5/0
265
Pressure of the: right ventricle
12-25/0
266
Pressure of the: pulmonary arteries
12-25/8
267
What keeps the diastole of pulmonary artery pressure from 0?
The pulmonary valve and sympathetic tone of arterial walls
268
Pressure of the: left atrium
8/0
269
What causes the foramen ovale to close at birth [normally]?
Left atrial pressure 8/0 being slightly higher than right atrial pressure 5/0 closes the foramen ovale
270
Pressure of the: left ventricle
120/0
271
Pressure of the: aortic arch
120/80
272
What keeps the aortic arch diastole from 0?
Aortic valve and sympathetic tone of arterial walls
273
What is the mean arterial pressure (MAP)?
96 mmHg
274
What is an abnormal rate/rhythm of the heart- either too fast or too slow?
Arrhythmia
275
What is an abnormal rate/rhythm of the heart- irregular, but within normal range?
Dysrhythmia
276
What is the normal rhythm from the SA node and vagus nerve called?
Sinus rhythm
277
What happens when the heart beats at <60bpm? Is this ever normal?
Bradycardia...Normal in some top athletes
278
What happens when the heart beats between 100-150bpm?
Tachycardia
279
What happens when the APs fire at 250-300 AP/min?
Flutter (Ventricular/Atrial)
Very inefficient pumping
280
What happens when the APs fire at >300 AP/min?
Fibrillation (Ventricular/Atrial)
No pumping, no flow, no beating at all
281
How fast can you lose consciousness (LOC) with fibrillation?
3-5 seconds
282
What are the cardiovascular pathology ("trilogy") from most treatable to irreversible?
Coronary Artery Disease
Myocardial Ischemia
Myocardial Infarction
283
What causes coronary artery disease?
Arteriosclerosis
Atherosclerosis
284
What is arteriosclerosis?
Loss of elasticity or hardening due to clogging/scarring
285
What is atherosclerosis?
Clogging of arteries (a type of arteriosclerosis)
286
What causes 50% of all deaths, 1/3 of those between 35-50 years old?
Atherosclerosis
287
What causes atherosclerosis?
Obesity, sedentary lifestyles, hyperlipidemia, hormones, alcohol, age, hypertension, smoking, diabetes
288
Is coronary artery disease permenant?
No, it is reversible
289
What is myocardial ischemia?
Reduced blood flow due to vascular occlusion or atherosclerosis
290
Is myocardial ischemia fixable?
Yes, it is reversible
291
What is a symptom of myocardial ischemia?
Angina pectoris
292
What is angina pectoris?
Chest and left neck/arm pain due to build up of lactic acid in the heart
293
What is myocardial infarction caused by?
Tissue death (ischemic necrosis)
294
What is a symptom of myocardial infarction?
Crushing chest pain, a "heart attack"
295
What does a heart attack look like on an EKG?
Prolonged Q wave, elevated ST, inverse T wave
296
Is a myocardial infarction fixable?
It is non-reversible
297
What pulmonary diseases can cause right heart failure/cor pulmonale?
Emphysema, chronic bronchitis, black lung
298
Why do pulmonary diseases effect the right heart?
Destruction of the pulmonary vasculature increases pulmonary afterload. This backup causes pulmonary hypertension
299
What happens to the heart when it works too hard?
It hypertrophies and may later atrophy (dilation)
300
What is the difference between hypertrophy and hyperplasia?
-trophy = enlargement with same # of cells getting bigger
-plasia = enlargement due to increase in cell #
301
What can right heart failure cause?
Peripheral edema (especially in lower extremities) and hepatic congestion
302
What is another name for left heart failure?
Congestive heart failure (CHF)
303
What happens in CHF?
The left heart is unable to pump blood out due to hypertension (etc.) and this increases afterload. The right heart tries to pick up the slack, and forces a back-up in the lungs.
304
How does CHF impact pulmonary BP?
CHF increases pulmonary BP causing a pulmonary edema, which is where the name gets "congestive" from
305
How can enzymes help identify pathologies?
When cells die, enzymes are released into the blood. We can test for these enzymes and see what cells died and why
306
What is an example of an enzyme that transfers a phosphate group to another molecule, thereby activating or inhibiting the recipient molecule?
Creatine Kinase
307
What does creatine kinase do with creatinine phosphate?
Creatine kinase adds a phosphate group from creatinine phosphate to ADP, making ATP
308
What enzyme converts lactic acid to pyruvic acid?
Lactic dehydrogenase (LDH)
309
What does Serum Glutamic-Oxaloacetic Transaminase (SGOT) do in the body and where?
Helps metabolize amino acids in Kreb's cycle. Seen in the liver, heart, skeletal muscles, kidneys, pancreas, RBCs
310
Is SGOT specific?
No. When you test for SGOT, you learn cells are dying somewhere, but you do not know which specific organ
311
What protein indicates heart damage when found in the blood?
Troponin
312
What is a pericardial or cardiac tamponade?
Fluid accumulation in the pericardial cavity. As pressure builds, it becomes more and more difficult to fill the heart chambers
313
What happens in patent foramen ovale?
The foramen ovale fails to close. This causes pulmonary bypass and hypoxia
314
Is patent foramen ovale life threatening?
No, many are asymptomatic and require no treatment
315
What is patent ductus arteriosus?
A type of fetal pulmonary bypass. When it is closed, it causes hypoxia
316
What is it called when there is a fetal hepatic bypass causing buildup of metabolic toxins?
Patent ductus venosus
317
What is coarctation of the aorta?
Aortic stenosis (narrowing) and insufficient perfusion of tissues
318
What is an example of a ventricular septal defect?
A hole in the interventricular septum
319
What is difficulty breathing called?
Dyspnea
320
What is dyspnea when lying down called?
Orthopnea
321
What does paroxysmal mean?
Sudden extreme attack on your breathing
322
What does paroxysmal nocturnal dyspnea mean?
Sudden extreme suffocation at night causing difficulty breathing
323
How does digitalis treat cardiovascular disease? What does it treat?
Buildup of Ca++ from the poisoning of Na-K pump and reduction of the Na-Ca counter transport increases the SOC. This treats CHF and arrhythmias
324
Does digitalis increase or decrease HR?
Digitalis decreases HR, and can be used to treat hypertension
325
How can nitrates treat cardiovascular disease?
They vasodilate allowing more blood flow to the heart, increasing HR
326
What nitrate is used to treat heart problems?
Nitroglycerine
327
What cardiovascular treatment causes vasodilation and reduces water retention?
ACE Inhibitors
328
Do ACE inhibitors increase or decrease BP?
Decrease BP, treats hypertension
329
What do beta blockers do for the heart?
Inhibit Beta 1 receptors. This slows HR down, reduces SOC, and reduces BP
330
What do calcium channel blockers do for the heart?
If there is less Ca+ in the heart, the HR, SOC, and BP will all DECREASE
331
What reduces blood volume by increasing urine output?
Diuretics
332
How do diuretics impact BP?
Lowers BP
333
What does lidocaine do for the heart?
Lidocaine resets heart muscles to re-establish sinus rhythm by forcing Na+ channels open
334
What does lidocaine treat?
Temporary arrythmias/dysrhythmias
335
What is the innermost layer/inner lining of a blood vessel?
Endothelium
336
What is the endothelium made of?
Simple squamous epithelium
337
What is the subendothelial layer/space made of?
Connective tissue
338
What are the three components of the tunica intima?
Endothelium
Subendothelial space
Internal elastic lamina
339
Which layer of blood vessels contain smooth muscle?
Tunica media
340
Does the tunica media have an elastic lamina?
Yes, the external elastic lamina
341
What part of the blood vessel is involved in vasoconstriction/dilation?
Smooth muscle in the tunica media
342
Does vasoconstriction make the diameter bigger or smaller?
Smaller
343
Does vasodilation make the vessel diameter bigger or smaller?
Bigger
344
What is the outer layer of the blood vessel made of?
Connective tissue
345
What are the three layers of the blood vessel?
Tunica intima
Tunica media
Tunica externa
346
What is lumen?
The inside cavity of the vessel/organ
347
What is the BP of: Aorta, a type of elastic artery
120/80 mmHg
348
What is the BP of: Muscular arteries
96 (Mean Arterial Pressure)
349
How much of peripheral resistance do arterioles control?
2/3
350
What is the total area of the body's capillaries in m2?
6300m2
351
What is the BP of: Capillaries
14-17 mmHg
352
What % volume of blood are capillaries?
5%
353
Where does gas exchange occur?
Capillaries
354
Is there pulse or pulse pressure in capillaries?
No
355
What % of blood volume is in the venules?
10%
356
What is the BP of: Veins
0-5 mmHg
357
What % blood volume is the veins?
54%
358
What % blood volume is in the heart?
12%
359
Where is most of the blood in the body and how much?
Veins (54%)
360
What are the elastic arteries?
Major branches near the heart, like the aorta
361
How big are elastic arteries?
Very large, near the heart, thick walled
362
Do elastic arteries contribute to vasoconstriction?
Very little
363
What are examples of muscular arteries?
Inferior phrenic, brachial
364
What type of arteries are most of the named ones?
Muscular arteries
365
Which have a thicker tunica media: muscular or elastic arteries?
Muscular arteries have thicker tunica media
366
What is the MAP of muscular arteries?
96 mmHg
367
What proportionately has the greatest amount of smooth muscle?
Arterioles
368
What proportion do arterioles regulate peripheral resistance/afterload/BP?
2/3
369
What are the major regulators of blood pressure through vasoconstriction/dilation?
Arterioles
370
What is peripheral resistance?
Similar to afterload (pressure against which the heart pumps) and correlated with blood pressure
371
How big are capillaries? What do they consist of?
Very small, basically only the tunica intima
372
Where do exchanges of gases, hormones, nutrients, wastes occur?
Capillaries
373
Are venules thick or thin?
Thin
374
Which have valves, veins or arteries?
Veins
375
What % of blood is held in venules and veins?
64%
376
Do veins and venules have a large tunica media and smooth muscle?
No, relatively little
377
Where is the vasomotor center?
Medulla oblongata
378
Where is the sympathetic NS control regulated?
Vasomotor center in medulla oblongata
379
How does increasing sympathetic NS effect: Vasoconstriction and BP
Increase vasoconstriction, increase BP
380
How does increasing sympathetic NS effect: HR and BP
Increase HR, increase BP
381
Does reducing sympathetic NS stimulation decrease BP, SOC, HR?
Yes
381
How does increasing sympathetic NS effect: SOC and BP?
Increase SOC, increase BP
382
Does the parasympathetic NS act opposite to the sympathetic NS in regards to BP, HR, etc.?
Yes. Increase of Parasympathetic NS stimulation decreases HR, SOC, BP
383
Can you exercise arterial muscles?
Yes! Continuous stimulation of arteries, called vasomotor tone, improves the vasomotor (BP) system. This is exercised alongside skeletal muscles
384
Local vs systemic BP?
Local: POV of a single organ
Systemic: All the arterioles of a body as a whole
385
How does vasoconstriction of a renal artery affect the kidney's BP?
Decrease kidney BP
386
How does vasodilation of renal artery affect kidney BP?
Increase kidney BP
387
If you vasoconstrict systemically, how does this impact BP?
BP rises
388
If you vasodilate systemically, how does this impact BP?
BP drops
389
Should we assume local or systemic in a question?
Systemic
390
If you reduce a vessel's diameter by 1/2, how does this impact blood flow volume?
Blood flow volume DROPS to 1/16...That's a BIG drop
391
How does systemic BP going up impact local BP for a kidney?
Systemic increase in BP causes local vasoconstriction of the renal artery to reduce internal kidney BP (or keep it from rising with the rest of the system).
392
Do organs want to stay the same BP?
Yes. They will trigger mechanisms to keep their internal pressure the same, even if the systemic pressure changes
393
Does this affect BP/vasomotor control in the short term or long term? Baroreceptors
Short
394
Does this affect BP/vasomotor control in the short term or long term? Chemoreceptors
Short
395
Does this affect BP/vasomotor control in the short term or long term? Higher centers of the brain
Short
396
Does this affect BP/vasomotor control in the short term or long term? Adrenal medulla
short
397
Does this affect BP/vasomotor control in the short term or long term? Antidiuretic hormone
Short
398
Does this affect BP/vasomotor control in the short term or long term? Atrial natriuretic peptide
Short
399
Does this affect BP/vasomotor control in the short term or long term? Endothelin
Short
400
Does this affect BP/vasomotor control in the short term or long term? Nitric oxide
Short
401
What are baroreceptors?
Stretch receptors or mechanoreceptors
402
Where are baroreceptors found?
Everywhere in the body, but large concentrations are found in carotid sinus (glossopharyngeal nerve) and aortic arch (vegus nerve)
403
How does an increase in BP affect baroreceptors?
Increase in BP, increase in arterial stretch, increased stretch of baroreceptors
404
What happens when baroreceptors are stretched?
AP is sent to the vasomotor control center to reduce sympathetic NS stimulation and/or increase parasympathetic NS stimulation to REDUCE BP
405
Where are chemoreceptors found?
Everywhere in the body, but large concentrations are found in carotid sinus (glossopharyngeal nerve) and aortic arch (vegus nerve)
406
What triggers chemoreceptors to send AP to increase HR and SOC?
Decrease of O2 or increase of CO2 and H+
407
Why do chemoreceptors increase HR and SOC?
To increase perfusion and wash away waste products (like CO2 and H+)
408
Where in the body do you see vasodilation due to chemoreceptors?
The brain
409
How do chemoreceptors affect the lungs?
Increase lung ventilation rate
410
Where in the "higher centers of the brain" causes stimulation of sympathetic NS?
Hypothalamus, cerebrum
411
What happens in your body when you are angry/afraid and where?
Higher centers of the brain stimulate SNS with norepi and epi. This increases BP
412
What produces most of the body's norepi/epi/adrenalin?
Adrenal medulla
413
What works closely with the higher brain centers and the sympathetic fight/flight?
Adrenal medulla
414
What is the name of the antidiuretic hormone (ADH)?
Vasopressin
415
Where is vasopressin made and stored?
Vasopressin is made in the hypothalamus, then stored and released from the posterior pituitary gland
416
What is ADH responsible for?
Primary hormone for tonicity homeostasis and BP control
417
What kind of states trigger ADH release?
Hyperosmolar (hypertonic) states trigger ADH release to initiate water retention to bring the body closer to isotonic
418
What common conditions result in elevated osmolarity and subsequent increased ADH secretion?
High salt diets and hypertension
419
What hormone promotes water reabsorption in the kidneys?
Vasopressin
420
Does ADH vasodilate or constrict?
Causes vasoconstriction
421
How does water retention and vasoconstriction impact BP and volume?
Increase arterial blood volume and increase BP to maintain tissue perfusion
422
What does ADH turn on when the blood becomes hypertonic/hyperosmotic?
Protein synthesis in the kidneys
423
What does ADH activating protein synthesis in the kidneys do?
Increase the number of water channels (proteins) in the renal tubules, allowing more water to be returned to the circulatory system
424
How does more water in the circulatory system affect BP?
Prevent reduction of BP
425
What is one of the most powerful vasoconstrictors in the body that help increase BP?
Antidiuretic hormone (ADH) vasopressin
426
Where does ADH get released from?
Posterior pituitary gland, angiotensin 2, pain, nausea, hypoglycemia, nicotine, opiates, certain medications, estrogen
427
What can be released due to increased estrogen at types of the menstrual cycle?
ADH! This causes edema (bloating) and BP rise
428
What inhibits ADH?
Ethanol
Alpha-adrenergic agonists
Atrial natriuretic peptide
429
How does being intoxicated affect water retention?
Increased ethanol due to drinking alcohol, which inhibits ADH, causes diuresis (excessive urination) in drunk people
430
What makes atrial natriuretic peptide (ANP)?
Heart's atria
431
When is ANP released?
When BP rises, the atria stretch and released ANP to turn on Na-K pump
432
Where does Na+ go when ANP is released?
Pumped out of the blood into urine
433
Does water follow or go away from Na?
Water always follows Na
434
Does the body releasing 3 Na+ into the urine due to ANP increase or decrease urination? How is BP affected?
More Na+ in urine causes more water in urine, causing more urination. This decreases blood volume and BP
435
Where does 2 K+ go when ANP is released?
Into the blood
436
What hormone pumps Na+ and K+ into opposite directions?
Aldosterone
437
What releases endothelin?
Endothelium in tissues
438
What does endothelin do locally?
Local vasoconstriction to decrease local BP
439
What does endothelin do systemically?
Increases BP systemically
440
Is endothelin important in systemic or local control?
Local control
441
What releases nitric oxide?
Endothelium in tissues
442
What does nitric oxide do locally?
Local vasodilation to increase local BP
443
What does nitric oxide do systemically?
Decrease in BP as a system
444
Is nitric oxide important in systemic or local control?
Local control
445
What is the basic filtering unit of the kidneys?
Nephron
446
How many nephrons are in the kidney's cortex?
2 million
447
Where does urea from unfiltered blood diffuse in a nephron?
Urea diffuses OUT into the tubules, along with a lot of water
448
How much water does the body need back (that is diffused out with urea)?
99.3%
449
How does the body get water back IN that was filtered out with urea?
2 hormones: aldosterone and ADH
450
What are the 3 hormones involved in urine filtration?
Aldosterone
ADH
ANP
451
Which hormone diffuses substances OUT of the body, through urination?
ANP
452
What % of water remains in urine?
0.7%
453
How does Na+ and urea affect the deep medulla?
Makes it hypertonic
454
Where are the 3 filtration hormones found?
Late distal convoluted tubules (DCT) and the collecting ducts
455
What is the normal urine isotonic range in the cortex?
280-296 mOSM (roughly 300 mOsm)
456
How does a concentration of 1200 mOsm in the deep medulla compare to the renal cortex?
Very hypertonic
457
What makes the deep medulla hypertonic?
Na+ and urea
458
Does the renin-angiotensin system work for short or long term BP control?
Long term
459
Where in the kidneys is renin released from?
Juxtaglomerular aparatus
460
What are the tubules in the kidney that indirectly monitor BP through urine flow?
Macula densa
461
Where in the juxtaglomerular aparatus is renin released?
Granular cells in the afferent arteriole
462
Where does renin turn angiotensinogen into angiotensin 1?
The liver
463
What enzyme turns angiotensinogen into angiotensin 1?
Renin
464
What turns angiotensin 1 into angiotensin 2?
Angiotensin converting enzyme (ACE)
465
Where does ACE convert angiotensin from 1 to 2?
Lungs
466
What does angiotensin 2 do?
Causes intense vasoconstriction, which increases BP
Releases aldosterone
467
Where is aldosterone released from when activated by angiotensin 2?
Adrenal cortex
468
What is aldosterone?
A steroid hormone
469
Where does aldosterone go when released by the adrenal cortex?
To the kidney
470
What turns on the Na-K pump in the kidney?
Aldosterone
471
What do ACE inhibitors do to BP?
These block ACE, which lowers BP. Used to treat hypertension
472
What is it called when you listen to heart sounds?
Auscultation
473
What is a blood pressure cuff called?
Sphygmomanometer
474
How do you hear korotkoff's sounds?
Pump blood in the cuff until cut cuts off blood flow in the brachial artery. Slowly release the pressure and listen
475
What are the "puffing" sounds you hear from a blood pressure cuff?
The blood flowing into the artery vibrating the walls
476
What kind of pressure is measured during contraction (the first phase of blood pressure cuff)
Systole (ex. 120 mmHg)
477
What kind of pressure is noted when the artery is opened enough that there is no more korotkoff sounds?
Diastolic pressure (ex. 75 mmHg)
478
Why did they use mercury to measure BP?
It is less dense, and if you used water the sphygmomanometer would have to be over 6 feet tall
479
What is perfusion?
Blood flow to tissues relative to the tissue's mass
480
Do organs regulate their own local BP?
Yes! It is called autoregulation
481
What is metabolic control?
When perfusion is reduced and there is a reduction of O2, and an increase of wastes/CO2, the tissues vasodilate to increase perfusion again
482
What is myogenic control?
Muscle contraction to stabilize BP
483
How would muscles react in myogenic control when BP is raised?
When BP is increased and the vessels dilate stretching the walls, the muscle will react with a reflex vasoconstriction to prevent wall damage
484
Do muscles dilate or contract when stretched?
Muscles contract when stretched
485
How many capillaries in skeletal muscles are open at rest?
25% (75% are closed)
486
Why does the metabolic control system cause vasodilation with exercise?
To respond to the increased waste products (ex. CO2)
487
How much can blood flow increase with exercise?
Up to a 10 fold increase in blood flow
488
How do arteries in the brain respond to waste products?
Vasodilation
489
How does the skin respond to high body temperatures (fever, exercise, etc.)?
Arterial dilation
490
Does cold temperature vasodilate or vasoconstrict the skin?
Vasoconstrict
491
Are the lung's autoregulatory mechanisms the same as other regions?
No! The lungs always have to be difficult/different/special/opposite
492
What do the lungs do when O2 levels are HIGH?
Vessels DILATE to pick up even MORE O2
493
What do the lungs do when O2 levels are low?
Vessels CONSTRICT...There's no point in perfusing the lung if there isn't any O2 to pick up
494
What happens to the lungs with emphysema?
Lung tissue is destroyed, as chronic low O2 levels make the body abandon those tissues
495
When does hypoxic pulmonary vasoconstriction occur?
If ventilation is low and there is low O2
496
Where does fluid leak out of the capillary into and when?
When blood approaches the capillary, fluid leaks into the extracellular matrix (ECF)
497
What happens to the capillary as blood courses through it and there has been fluid loss?
The capillary is concentrated and hypertonic
498
What kind of pressure is built from a capillary that is concentrated and hypertonic?
Colloid pressure (PULLING force)
499
What does colloid pressure do as it increases in the capillary?
Pulls fluid back in from the ECF thanks to the pulling force
500
How much ECF is drained by the lymphatic vessels?
10%
501
What is continuously washed by fluid?
The interstitium
502
What happens if the lymphatics are blocked by tiny worms, tumors, etc.?
Massive swelling as seen in elephantiasis
503
What is the pushing pressure?
Hydrostatic pressure
504
What is the pulling pressure?
Colloid or osmotic pressure
505
Capillary/plasma hydrostatic pressure ____ blood ___ a capillary
pushes fluid OUT of
506
Capillary/plasma colloid/osmotic pressure ____ blood ___ a capillary
pulls fluid IN
507
Interstitial hydrostatic pressure ____ blood ___ the interstitium
pushes fluid OUT
508
Interstitial colloid/osmotic pressure ____ blood ___ the interstitium
pulls fluid IN
509
Will low plasma colloid pressure push fluid in or out the capillary?
Push fluid out
510
Will high plasma hydrostatic pressure push fluid in or out the capillary?
Push fluid out
511
Will high interstitial hydrostatic pressure push fluid in or out the capillary?
Push fluid in
512
What is the net result of ECF pushing/pulling within the capillary?
Fluid leaves the vessel at the arterial end of the capillary
513
As blood courses through the capillary and fluid is lost, the blood becomes...
More concentrated or hypotonic
514
How does prednisone affect Na+ and water retention?
Prednisone increases Na+ reabsorption, which increases water retention. This can result in increased fat in face and neck
515
What can kidney/heart/and liver failure cause in the interstitium?
An edema
516
What kind of disease/process is plaque formation?
Inflammatory
517
What size vessels are inflammatory?
vessels > 1 mm
518
What does smoking, hypertension, and hyperlipidemia do to the endothelium?
Damages endothelium and causes plaque
519
What is endothelial dysfunction?
The barrier is compromised allowing LDL P (small LDL particles) to move in the sub-endothelial space and produce free radicals
520
What is an example of a free radical?
Superoxide radical
521
What do free radicals like superoxide radical attract?
Monocytes
522
What do macrophages produce?
Macrophages phagocytize and oxidize LDL P, making "foam cells"
523
Where is the fatty streak found and why?
The subendothelial space, where macrophages that were full of lipids die (and their contents spill out when they die)
524
What cells are activated to amplify the inflammatory reaction?
T Cells
525
Where do smooth muscle cells migrate in plaque formation?
Into tunica intima from the tunica media
526
What do smooth muscle cells make out of collagen and elastin proteins?
Fibrous cap
527
What does the fibrous cap do in the subendothelium?
Bulges into the blood vessel narrowing its diameter (atherosclerosis)
528
What can smooth muscle cells release that cause stiffening of the arterial walls?
Calcium, they cause calcification
529
What does it mean for an arterial wall to have reduced compliance?
Less flexible, can't stretch
530
How does decreased compliance affect BP?
Less stretch increases BP
531
What is an aneurysm?
Ballooning artery with an increased chance of fatal rupture
532
What are varicose veins?
Overstretched veins with compromised valves, as seen in tissue edema and pregnancy
533
What is orthostatic hypotension?
Reduction in BP upon standing
534
What percent of hypertension is primary or essential?
90%
535
What causes primary or essential hypertension?
Unknown for sure. Suspected smoking, genetics, stress, obesity, age, race
536
What percentage of hypertension is secondary?
10%
537
What causes secondary hypertension?
Atherosclerosis, too much renin
538
What is the BP of malignant hypertension?
Diastolic BP > 140 mmHg
539
What can malignant hypertension cause?
Encephalopathy, cerebral edema, intracerebral hemorrhage
540
What is shock?
Poor tissue perfusion (blood flow) which starves organs
541
What causes cardiogenic shock?
Heart failure, usually myocardial infarction
542
Is cardiogenic shock treatable?
Poor response to treatment
543
What kind of shock is "bleeding out"?
Hypovolemic
544
What type of shock is from an imbalance of PSNS and SNS?
Neurogenic
545
What happens in neurogenic shock?
Massive vasodilation and peripheral pooling of blood
546
What causes anaphylactic shock?
Hypersensitive reaction to allergy
547
What causes septic shock?
Bacterial or fungal infection in the blood
548
What does agonist mean?
A helper, works WITH
549
What does antagonist mean?
Works AGAINST
550
What would a medicine with Acetylcholine do for BP?
Lower BP, treat hypertension
