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Flashcards in Heart Deck (226):
1

heart block causes heart beat to be (2)

slow and irregular

2

heart block is a type of

arrhythmia

3

chest trauma can initiate arrhythmias =

heart contusion

4

right bundle branch block often shows which symptoms?

no symptoms

5

in right bundle branch block ,activation of which chamber of the heart is delayed?

right ventricle

6

right bundle branch block has what affect on QRS complex

prolongs QRS complex

7

left bundle branch block is often due to

problems with heart (e.g. high BP)

8

interventricular septum is normally activated by

left bundle branch

9

if conduction in left bundle branch is slowed, interventricular septum is activated by

right bundle branch

10

in right bundle branch block, what shape is seen in V1?

M

11

in right bundle branch block, what shape is seen in V6?

W

12

In left bundle branch block, what shape is seen in V1?

W

13

In left bundle branch block, what shape is seen in V6?

M

14

Mnemonic that can be used to remember ECG appearances of left and right bundle branch blocks?

WiLLiaM MaRRoW

15

referred pain: heart dermatomes =

body wall and upper limb (T1-T5)

16

....... men die of CHD

1/5

17

...... women die of CHD

1/7

18

CHD is ........... cause of death and premature death in UK

most common

19

CHD causes ........... deaths in UK per year

94 000

20

myocardial infarction defintion

damage to heart muscle due to interruption in regional coronary circulation

21

myocardial infarction often caused by

clot/ fatty deposit

22

non-function area of heart after MI =

infarct

23

ischaemia definition

reduced blood delivery to organ, sufficient to compromise function

24

infarction definition

reduced blood delivery to organ, sufficient to lead to its death

25

types of MI

STEMI, NSTEMI

26

STEMI =

coronary artery completely blocked. large amount of muscle damage

27

NSTEMI =

tests positive for troponin I/T (unlike angina). Partial/ temporary blockage

28

coronary artery spasm =

artery tightens, comes and goes, no plaque

29

demand ischaemia =

heart requires more oxygen than available e.g. infarction, anaemia

30

symptoms of MI (8)

chest pain (tightness), pain travelling from chest to other parts of body, shortness of breath, feeling/being sick, anxiety, coughing, wheezing, light headedness

31

Mi can be missed in ........ as mistakes for symptoms of .....

diabetics; neuropathy

32

diagnosis of MI using (2)

ECG, blood tests

33

treatment of MI (10)

antiplatelets, heparin, pain relief, clot busting meds, beta blocker, insulin, oxygen, ACE inhibitor, statin, coronary artery bypass

34

angina pectoris =

pain from heart usually caused by coronary artery narrowing and reduced blood blow

35

stable angina =

symptoms stereotypic. lower risk of infarct, improves with meds

36

unstable angina =

pain at rest, increased attack severity, high risk of infarct, pain over 15 mins

37

classic/ exertional angina pectoris =

provoked by physical exertion. pain fades quickly with rest

38

nocturnal angina =

at night, may wake patient. provoked by vivid dreams. vasospasm, critical coronary artery disease

39

decubitis angina =

lying down. impaired left ventricle function as result of severe coronary artery disease

40

variant (Prinzmetal's) angina =

without provocation, at rest. result of coronary artery spasm. more common in women. ST elevation. Arrhythmias during ischaemic episode

41

cardiac syndrome X =

history angina, positive exercise test and angiogram normal. coronary arteries seem normal. most common in women. highly symptomatic. difficult to treat.

42

unstable angina =

recent onset, worsening. at rest

43

symptoms of angina (4)

pain in arm, jaw, neck, stomach; pain eases with rest; breathlessness on exertion; pain, ache, discomfort, tightness across front of chest on exertion

44

exacerbating factors of angina (4)

physical exercise, high emotion, cold temperatures, eating large meal

45

risk factors of angina (8)

smoking, high BP, overweight, high cholesterol, inactivity, diet, salt, alcohol

46

medication for angina (8)

glyceryl trinitrate, statin, aspirin, beta blocker, ACE inhibitor, calcium-channel blocker, nitrate medicines, potassium channel activators

47

2 types of cardiac centres in medulla oblongata

cardioacceleratory and cardioinhibitory centres

48

vasomotor centres in medulla oblongata have which 2 populations of neurons

large group = widespread vasoconstriction; small group = skeletal muscle and brain vasodilation

49

vasomotor centre controls activity of ...... motor neurons

sympathetic

50

vasoconstriction neurons of vasomotor centre have what type of neurotransmitter?

noradrenaline and adrenaline (adrenergic neurons)

51

vasodilation neurons of vasomotor centre have what type of neurotransmitter?

nitrogen oxide

52

most common vasodilator synapses are ..... and trigger the endothelial release of .... which causes local vasodilation

cholinergic, NO

53

other vasodilator synapses have .... as neurotransmitter which has intermediate and direct effect on vascular .... .... cells

NO; smooth muscle

54

3 locations of baroreceptors

walls of carotid sinuses, aortic sinuses, walls of right atrium

55

baroreceptors in aortic sinuses are in walls of ..... aorta and trigger the ..... reflex

ascending; aortic

56

baroreceptors in walls of right atrium trigger .... reflex

atrial

57

baroreceptors in aortic sinuses monitor BP at beginning of .....

systemic circuit

58

baroreceptors in walls of right atrium monitor BP at end of .....

systemic circuit

59

effects on heart result from release of .... from sympathetic neurons innervating ..., .... and .....

noradrenaline; SAN, AVN and myocardium

60

smoking causes immediate and long term ...... in BP

increase

61

smoking causes immediate and long term .... in HR due to ...... which causes increase in adrenaline and HbCO2

increase; nicotine

62

smoking causes .... in cardiac output and coronary blood flow

decrease

63

smoking reduces the amount of oxygen delivered to tissues due to binding of .... to Hb

CO

64

smoking ..... blood clotting process

stimulates

65

increased blood cholesterol in smoking is due to ...... which interferes with the transport of HDLs by modifying site in ......

acrolein; apoA-1

66

current smokers have .... fibrinogen levels

high

67

smoking causes increase in levels of proinflammatory ..... and leukocytes as well as an increase in cell adhesion molecules and platelet .......

cytokines; dysfunction

68

two types of natriuretic peptide

ANP (atrial natriuretic peptide) BNP (brain natriuretic peptide)

69

ANP produced by

myocytes of right atrium

70

BNP produced by

myocytes of ventricles

71

ANP produced in response to

excessive stretching in diastole

72

BNP produced in response to

stress

73

Natriuretic peptides reduce blood volume and BP by which 5 methods:

reduce thirst; increase kidney sodium ion excretion; stimulate peripheral vasodilation; promote water loss and increase urine production; block release of ADH, aldosterone, adrenaline and noradrenaline

74

....... and ...... from adrenal medullae stimulate cardiac output and .....

adrenaline and noradrenaline; peripheral vasoconstriction

75

ADH is release from the ......... pituitary in response to decreased blood volume, increase in osmotic conc. or secondary to circulating angiotensin II

posterior

76

ADH stimulates conservation of water in

kidneys (collecting duct)

77

erythropoietin is released by ..... when BP falls or .... is low

kidneys; oxygen

78

erythropoietin stimulates ..... and stimulates production and maturation of erythrocytes

vasoconstriction

79

............... cells release renin in response to fall in renal BP

juxtaglomerular

80

renin converts ............ to .............

angiotensinogen to angiotensin I

81

ACE converts .......... to .......

angiotensin I to angiotensin II

82

4 functions of angiotensin II

stimulates thirst; stimulates cardiac output and constriction of arterioles; stimulates ADH secretion; stimulates renal aldosterone production and therefore sodium ion retention and potassium ion loss

83

chemoreceptors respond to changes in ...., .... and .... in blood and ....

carbon dioxide, oxygen and pH; cerebrospinal fluid

84

chemoreceptors have sensory neurons in (2)

carotid and aortic bodies

85

sympathetic activation stimulates .... and ..... centres

cardioacceleratory and vasomotor centres

86

parasympathetic activation stimulates .... centre

cardioinhibitory centre

87

chemoreceptors for CBS fluid prioritise blood flow to brain to ensure .... delivery there

oxygen

88

endocardium =

thin, internal layer - covers valves. squamous epithelium over thin areolar tissue. no adipose

89

myocardium =

thick, helical middle layer. cardiac muscle

90

epicardium =

mesothelium formed by visceral layer of serous pericardium. simple squamous epithelium overlying thin areolar tissue. some areas have thick layers of adipose

91

systole =

ventricular contraction

92

diastole =

ventricular filling

93

5 properties of cardiac muscle

striates, short, thick, branches, 1 centrally placed nucleus surrounded by glycogen

94

sarcoplasmic reticulum of cardiac muscle is .... developed than skeletal as it lacks .... although it's T tubules are .... than in skeletal muscle

less; terminal cisternae; larger

95

cardiac myocytes have large ....

mitochondria

96

cardiocytes joined by

intercalated discs

97

2 types of mechanical junctions

fascia adherens, desmosomes

98

interdigitating folds =

plasma membrane at end of cell (folded and interlock)

99

fascia adherens = most extensive. broad bands of .... and .... form transmembrane proteins interrupted by ....

actin, myosin, desmosomes

100

desmosomes =

weld-like junctions between cells

101

desmosomes prevent cardiocytes from

pulling apart during contraction

102

electrical junctions =

intercalated discs contain gap junctions which form channels to allow ion flow from different cell cytoplasms > stimulate neighbours

103

order of heart conductive system (5)

SAN > signals spread through atria > AVN > bundle of His > Purkinje fibres

104

Parasympathetic stimulation > occupation of ... ..... .... ..... > negatively coupled with ..... .... > reduce cAMP formation > inhibit and slow calcium ion current

M2 muscarinic acetylcholine receptors; adenylate cyclase

105

parasympathetic stimulation also opens ..... channels creating a ...... current

potassium ion; hyperpolarising current

106

sympathetic stimulation > ... .... stimulation > enhanced ... flux in myocyte > strengthened force of contraction

beta1 adrenergic; calcium ion

107

binding of ..... to myocyte ... .... receptor stimulates membrane bound ... .... > enhances production of cAMP > activates intracellular protein kinases > ....... cellular proteins

catecholamines; beta1 adrenergic receptor; adenylate kinases; phosphorylate

108

return of calcium ion from cytosol to sarcoplasmic reticulum regulated by

phospholamban

109

beta1 adrenergic activation of protein kinase phosphorylates phospholamban > greater uptake of calcium ions by ......... > myocyte ..........

sarcoplasmic reticulum; relaxation

110

increased cAMP activity > phosphorylation of .......... > inhibits actin-myosin interaction

troponin I

111

sinus rhythm =

normal heart beat triggered by SAN

112

ectopic focus =

any region of spontaneous firing other than SAN.

113

nodal rhythm =

slower HR produced by AVN if SAN not working properly

114

4 phases of cardiac cycle

ventricular filling, isovolumetric contraction, ventricular ejection, isovolumetric relaxation

115

3 phases of ventricular filling

rapid ventricular filling, diastasis (slower filling), atrial systole

116

P wave of ECG =

end of diastasis

117

isovolumetric contraction =

atria repolarise and remain in diastole for rest of cycle. ventricles depolarise,

118

QRS complex of ECG =

ventricles depolarise and begin to contract

119

S1 can be heard as beginning of

isovolumetric contraction

120

ventricular ejection =

ventricular pressure exceeds atrial pressure and valves forced open. rapid ejection followed by reduced ejection

121

T wave of ECG =

late in ventricular ejection stage

122

in ventricular ejection, not all blood ejected. (~54% is) what is left is

end systolic volume

123

isovolumetric relaxation =

early ventricular diastole. T wave ends - ventricles begin to expand

124

S2 can be heard as

blood rebounds from closed semi lunar valves (end of isovolumetric relaxation)

125

SAN cells do not have stable resting potential - starts at -60mV and drifts upwards > gradual depolarisation = .... .... from slow influx of ... and outflow ...

pacemaker potential; sodium ions; potassium ions

126

SAN - when pacemaker potential reaches threshold potential of ...... > volatage-gated fast .............. open > influx .... ..... > 0mV > outflow .... > repolarisation

+40mV; calcium-sodium channels; sodium ions, calcium ions; potassium ions

127

SAN firing excites atrial cardiocytes > atria contract > AVN .......... contraction which allows ventricular filling before .....

slows down; contraction

128

Signals travel through AV bundle and Purkinje fibres > depolarisation of ...... ..... in near unison > signals reach .... ..... first > take up slack in .... ... > opens valves (mitral and tricuspid) before blood surges against them

ventricular myocardium; papillary muscle; chordae tendinae

129

cardiocytes have stable resting potential of

-90mV

130

cardiocytes normally only depolarise when stimulated > voltage gated .... channels open > influx of sodium ions > depolarisation to ......... ...... > additional .... gates open > ....... feedback loop > +30mV > sodium ion channels close

sodium ion; threshold potential; sodium ion; positive

131

as action potential spreads throughout heart, .... influx into cells > bind to ......... > calcium ions from sarcoplasmic reticulum to cytosol > second wave of calcium ions bind to ..... > contraction

calcium ion; sarcoplasmic reticulum; troponin

132

depolarisation of heart is prolonged causing ....... of action potential (more prolonged in ......) > at end of plateau ..... channels close, .... channels open > potassium ions .... cell and calcium ions are transported back into .....

plateau; ventricles; calcium; potassium; leave; sarcoplasmic reticulum

133

propioceptors =

muscles and joints - change in physical activity

134

3 hormones that increase heart rate

adrenaline, noradrenaline, thyroid hormone

135

end diastolic volume

blood volume of ventricles at end of diastole

136

end diastolic volume is affected by

filling time and venous return - Starling's law

137

venous return directly affects

nodal cells

138

venous return has indirect effect on HR via

atrial reflex

139

Increased venous return > stretching ... cells > more rapid depolarisation > Increased HR

SAN

140

end systolic volume

ventricular blood volume at the end of systole

141

factors affects end systolic volume =

preload, overload, contractility of ventricle

142

preload =

degree of ventricular stretching in diastole

143

preload affects ability of myocytes to produce

tension

144

as sarcomere length increases past resting length forced produced during systole

increases

145

as sarcomeres approach optimal lengths > more ..... and .... contraction

efficient and forceful

146

contractility =

amount of force produced during contraction at given preload

147

positive inotropic action

factors that increase contractility

148

negative inotropic action

factors that decrease contractility

149

positive inotropic factors stimulate ..... entry into cell

calcium ion

150

negative inotropic factors block calcium ion movement/ depress cardiac muscle ....

contraction

151

parasympathetic stimulation (vagus) > negative inotropic effect > release of .... > hyperpolarisation and inhibition

acetylcholine

152

sympathetic stimulation > positive inotropic effect > release of ....... by postganglionic fibres of cardiac nerves and secretion of ...... and ..... from adrenal medulla > stimulate alpha and beta receptors in cardiac muscle plasma membranes

noradrenaline; adrenaline and noradrenaline

153

4 things that have positive inotropic effects

adrenaline, noradrenaline, glucagon, thyroid hormones

154

how do stretch receptors work

stretch detected > greater number of actin-myosin cross links > increased calcium ion uptake > increased rate of contraction

155

afterload =

amount of tension contracting ventricle must produce to open atrioventricular valve

156

as afterload increases, stroke volume ....

increases

157

any factor restricting blood flow through atrial system ...... afterload

increases

158

frank starling law

greater the stretch of heart muscle during filling, the greater the force of contraction and the greater the quantity of blood pumped into the aorta

159

basal crepetations/ lower lung crackles

explosive opening of small airways

160

basal crepetations are more common during

inspiration

161

if basal crepetations don't clear after cough, could be sign of (2)

pulmonary oedema / fluid in alveoli

162

basal crepetations heard over which lobe of lung

inferior

163

echocardiogram =

ultrasound scan of heart

164

echocardiogram helps define .... of heart failure

aetiology

165

echocardiogram provides information of ejection fraction of left ventricle. what is normal value

~60%

166

heart failure patients with preserved left ventricle function have ejection fraction of..

more than 45%

167

heart failure patients with left ventricular systolic dysfunction have ejection fraction of...

less than 45%

168

7 causes of mitral valve regurgitation

degenerative, rheumatic heart disease, mitral valve prolapse, hypertrophic cardiomyopathy, MI, congenital heart problems, endocarditis

169

most common cause of mitral valve regurgitation

degenerative (tissues connecting valve to wall become weak and stretched over time)

170

rheumatic heart disease sometimes follows

infection with streptococcus > antibodies attack body, particularly mitral valve. developing countries

171

3 features of atrial fibrillation

HR fast, irregular (arrhythmia), irregular force of heart beat

172

in atrial fibrillation SAN overridden by other signals from

atrial cardiac muscle

173

Fibrillate =

rapid partial contraction > only some impulses to ventricles

174

Atrial fibrillation process: high BP > stretch receptors > increased ..... uptake > increased rate of contraction > fibrillation

calcium ion

175

3 types of atrial fibrillation

paroxysmal, persistent, permanent

176

paroxysmal atrial fibrillation

recurring and sudden episodes. stops without treatment within 7 days

177

persistent atrial fibrillation

longer than 7 days. needs treatment

178

permanent atrial fibrillation

long term. heart beat not normal. treated. heart rate still irregular. most common.

179

lone atrial fibrillation

no apparent cause

180

Electrocardiogram (ECG) records ...

electrical activity of heart

181

In ECG electrodes are attached to (3)

arms, legs, chest

182

Exercise ECG used to detect

narrowing of coronary arteries > angina

183

Ambulatory ECG used to detect

heart rhythms

184

P-R interval is time taken for excitation to spread through ..... (usually 0.12-0.2s)

ventricles

185

Lead to right ankle is

neutral (completes circuit)

186

Right arm lead known as

aVr

187

Left arm lead known as

AVl

188

Left leg lead known as

aVf

189

Lead I = info between

aVr and aVl

190

Lead II = info between

aVr and aVf

191

Lead III = info between

aVl and aVf

192

aVl looks at ..... side of heart

left

193

aVf looks at .... of heart

inferior

194

V2, V3, V4 are .... leads which look at .... of heart

anterior; front

195

V5, V6 are .... leads that look at .... side of heart

lateral; left

196

P wave =

atrial depolarisation

197

flat line between P wave an Q wave is when impulse spreads through

bundle of His

198

Q wave =

depolarisation in septum (from left > right)

199

R wave is when impulse spreads through

main portion of ventricular walls

200

R wave is large because there is more muscle > more cells > more .... required

voltage

201

S wave =

depolarisation of Purkinje fibres

202

ST segment =

flat line

203

If ST segment is not flat, it is an indicator of

myocardial ischaemia/ necrosis

204

T wave =

ventricular repolarisation

205

Heart failure as defined by NICE (2003)

complex syndrome resulting from structural/ functional cardiac disorder impairing pump function of heart

206

Heart failure accounts for 900 000 - ......... deaths in UK per year

1 000 000

207

Mortality rate of heart failure at 1 year`

20-30%

208

Heart failure accounts for ......% hospital admissions

5-10%

209

5 physiological changes that lead to heart failure

failure of pump, obstruction to flow, regurgitation of flow, disorders of cardiac conduction, disruption of continuity of circulatory system

210

Heart failure is when adaptive mechanisms to overcome physiological changes ....

fail

211

2 symptoms of heart failure

breathlessness, loss of energy

212

7 signs of heart failure

pulmonary oedema, pleural effusion, S3 'gallop', raised JVP, pitting oedema, ascites, tachycardia

213

10 causes of heart failure

ischaemic, heart failure, infective, dilated cardiomyopathy, diabetes, valvular, genetic, tachycardia induced, toxins/drugs, endocrine

214

5 treatments for heart failure with impaired systolic function

diuretics, ACE inhibitors, beta blockers, aldosterone receptor agonists, CRT/ICD devices

215

2 treatments for heart failure with preserved left ventricular function

diuretics, treating comorbidities

216

left sides heart failure =

failure of left ventricle

217

right sides heart failure =

failure of right ventricle

218

8 signs of left sided heart failure

exercise intolerance, dizziness/confusion, wheezing, heart murmurs, gallop rhythm, cyanosis > hypoxemia, pulmonary oedema > crackles at lung base, increased breathing rate& work of breathing

219

8 signs of right sided heart failure

ascites, pitted peripheral oedema, hepatomegaly, parasternal heave, nocturia, excess fluid accumulation in body, jaundice, impaired liver function

220

3 signs of biventricular heart failure

reduced breath sounds, pleural effusion (particularly of left side), dullness of lung fields to finger percussion

221

TROPONIN T TEST: 3 forms

C, T, I

222

TROPONIN T TEST: cardiac troponin has which 2 forms

I and T

223

TROPONIN T TEST: cardiac troponin levels are usually

so low cannot be meaured

224

TROPONIN T TEST: troponin is found with ..... on thin ..... filamin

tropomyosin; actin

225

TROPONIN T TEST: troponin .... attached to ....., troponin C binds calcium and troponin I ...... myosin binding site on ....

T; tropomyosin; inhibits; actin

226

TROPONIN T TEST: monoclonal antibody tests to cardiac specific troponin > identifies myocyte ....

necrosis