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Year 3: CardioPulm Rehab > Lecture 1: Introduction > Flashcards

Lecture 1: Introduction Flashcards

1
Q

what is contained in the thoracic cavity

A

ribs
sternum
T/S vertebrae
Heart
lungs
upper abdominal organs

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2
Q

what is contained in the mediastinum

A

all thoracic viscera except lungs

heart
cardiac vasculature
esophagus
trachea
thymus
thoracic duct/lymph structures
phrenic nerve
cardiac neural structures

contents can shift around

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3
Q

location of mediastinum

A

between lung pleurae

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4
Q

basic anatomy/location of heart

A

size of closed fist

apex at 5th intercostal space of midclavicular line

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5
Q

3 tissue layers of heart

A

pericardium = outer layer/ “sac”
myocardium = muscular layer
endocardium = inner layer “lining”

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6
Q

describe the pericardium

A

triple walled sac that contains heart

layers:
- fibrous pericardium = outermost; anchored to diaphragm
- parietal layer = provides lubrication
- visceral layer (epicardium) = contains coronary vessels on heart surface

pericardium has 10-20mL pericardial fluid within pericardial cavity that decreases friction throughout cardiac cycle

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7
Q

describe the myocardium

A

heart muscle

various thickness in different chambers

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8
Q

describe the endocardium

A

inner lining of heart

simple squamous endothelium

valves and chordae tendinae

contains electrical components

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9
Q

function of right atria

A

receives deoxygenated blood from venae cave

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10
Q

function of left atria

A

receives oxygenated blood from pulmonary veins

thicker walls to accommodate for higher pressure of blood coming from pulmonary circulation

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11
Q

describe atria in general

A

separated by interatrial septum

contain auricles to increase available capacity as needed

pectinate muscles contribute to strength of atrial contractions

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12
Q

right ventricle function

A

receives deoxygenated blood from R atria via tricuspid valve

sends blood to lungs via pulmonary valve and arteries

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13
Q

left ventricle function

A

receives oxygenated blood from L atrium via mitral valve

sends blood to body via aortic valve and aorta

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14
Q

general structure of heart valves

A

unidirectional flow

leaflets attached to papillary muscles via chordae tendinae

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15
Q

function of atrioventricular valves

A

prevents back flow during ventricular contraction

AV valves = tricuspid and mitral (bicuspid)

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16
Q

function of semilunar valves

A

prevent back flow during ventricular relaxation

SL valves = pulmonary and aortic

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17
Q

when do coronary arteries receive blood

A

during ventricular relaxation while aortic valve is closed

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18
Q

branches of L coronary artery and where those branches supply blood to

A

L anterior descending = anterior L ventricle, anterior 2/3 IV septum, and small part of R ventricle

Circumflex = L atrium, posterolateral L ventricle, SA node (40%), and Bundle of His

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19
Q

branches of L anterior descending artery (widow maker)

A

diagonal
septal branches
endocardial

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20
Q

branches of cirfumflex artery

A

posterior L ventricular

L obtuse marginal

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21
Q

branches of R coronary artery

A

R marginal artery

R posterior descending

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22
Q

where does R coronary artery supply

A

R atrium
SA node (60%)
AV node

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23
Q

where does the R marginal artery supply blood

A

Lateral R ventricle

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24
Q

where does the R posterior descending artery supply blood

A

inferior L ventricle

posterior 1/3 IV septum

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25
what is coronary dominance
designates the coronary artery system that is responsible for majority of the posterior L ventricular circulation R dominant (most common) = R coronary aa gives off posterior descending aa L dominant = circumflex gives off posterior descending aa
26
superior vs inferior vena cava collect venous blood from
superior = upper body and head inferior = lower body and trunk
27
where do coronary arteries arise from
off aortic sinus of Valsalva
28
aortic arch gives off what
3 arteries that supply BUE and head
29
descending aorta bifurcates into
B iliac arteries descending aorta = highest BP in body
30
list the path of blood flow starting with the venae cavae
venae cava R atrium tricuspid valve R ventricle Pulmonary valve pulmonary artery lungs pulmonary veins L atrium mitral valve L ventricle Aortic valve aorta systemic circulation
31
compare/contrast arteries vs veins
arteries - oxygenated blood away from heart - thicker walls veins - deoxygenated blood to heart - thinner walls - large diameter - valves prevent back flow capillaries = O2/CO2/nutrient exchange
32
describe the layers of blood vessels
tunica intima = inner layer; epithelial cells tunica media = smooth mm tunica adventitia/externa = outer layer; collagen and elastin
33
describe the cell makeup of the myocardium
cardiac myocytes = connected mechanically and electrically sarcomeres have actin and myosin filaments for contractility (force of contraction correlated with Ca++ available for binding) very high # mitochondria (50% myocardial mass); high ATP production
34
describe the physiology behind contractions in the heart
Na-K pump maintains AP and keeps more Na outside cell and more K inside Ca binds to myocardial filaments to induce contraction sarcoplasmic reticulum absorbs Ca and causes relaxation increase in Ca = increase contractility = higher HR myoglobin stores O2 during diastole and releases O2 during systole
35
characteristics of myocardium
automaticity = pacemaker abiltiity conductivity = conducts impulses to one another contractility = shorter or longer irritability = contract on their own and/or send impulses without first being stimulated from another source
36
describe the function of the sympathetic portion of the cardiac plexus
increase HR increase contractility coronary aa vasodilation
37
describe the function of the parasympathetic portion of the cardiac plexus
decrease HR decrease contractility SA node controlled by R vagus AV node controlled by L vagus
38
describe the 3 sympathetic cardiac receptors
Adrenergic (alpha 1) = causes peripheral vasoconstriction (increase SVR); epi and norepi beta 1 = cause increased HR and SV beta 2 = cause pulmonary and peripheral vasodilation (decrease SVR)
39
describe the parasympathetic cardiac receptor
muscarinic = decrease HR acetylcholine
40
purpose/conduction of the SA node
"pacemaker" 60-100 bpm pace in R atrium near superior vena cava
41
action of cardiac receptors
a1 = vasoconstriction = increased systemic vascular resistance b1 = increase HR and SV = increase CO b2 = vasodilation = decreased SVR
42
purpose of AV node
"gate keeper" 40-60 bpm internal pace between intertribal and intraventricular septum
43
describe the path of electrical conduction of the heart
SA node generates AP impulse to R and L atrium and mm contracts impulse to AV node; slows due to Ca++; ventricles fill impulse to Bundle of His in intraventricular septum impulse to R and L bundle branches; depolarizes ventricles and causes ventricular contraction to Purkinje fibers where electrical activity spreads from endocardium to epicardium
44
what is a cardiac cycle
one cycle of atrial and ventricular contraction systole = contract diastole = relax
45
list the phases of systole/diastole and what is happening with each
atrial systole = blood ejected to ventricles atrial diastole = atra relaxed; prepare for next fill cycle early ventricular systole = AV valves close, but not enough pressure to open SL valves late ventricular systole = SL valves open and blood is ejected early ventricular diastole = drop in pressure closes SL valves late ventricular diastole = all chambers closed; passive ventricular filling
46
normal sounds of heart
S1 "lub" = closure of AV valve in early ventricular systole; peak of R wave S2 "dub" = closure of SL valves; termination of ventricular systole and start of ventricular diastole; end of T wave
47
P wave indicates what
atrial contraction
48
PR segment indicates
ventricular filling
49
QRS complex indicates
ventricular contraction
50
ST segment indicates
plateau phase of ventricular relaxation
51
T wave indicates
ventricular relaxation
52
what is stroke volume
volume of blood ejected per contraction
53
what is cardiac output
volume of blood ejected from L ventricle per minute 4-6 L/min
54
equation for cardiac output
CO = HR x SV
55
factors that affect cardiac output
preload = how full is the tank contractility = how good is the squeeze afterload = how loose is the vasculature
56
preload
degree to which heart mm can stretch before contraction correlated to end diastolic volume (EDV) - max amount of blood returning to heart directly proportional to stroke volume; more blood that returns to the heart the greater volume that can leave
57
what is frank starling law
states that greater volume of blood is ejected when a greater volume returns if myocardial fibers are too stretched or shortened, contraction strength is decreased
58
contractility
ability of ventricles to contract to send blood to lungs and periphery increase in HR = increase contractility in HR > 120 there is an increase in Ca++ resulting in stronger contraction reflected by ejection fraction
59
what is ejection fraction
best indicator for cardiac function ratio of volume of blood ejected vs volume received prior to contraction some blood must remain in ventricles to maintain certain degree of stretch
60
what is after load
force that resists contraction pressure within the arterial system during systole expressed as systemic vascular resistance (SVR) or total peripheral resistance (TPR) increase in after load = decrease in stroke volume and decrease in cardiac output
61
what is cardiac index
measure of how well heart is functioning more individualized than cardiac output or ejection fraction correlates blood volume pumped by heart to body surface area normal is 2.5-4.0 L/min/m^2 if CI falls below 2.2 pt is likely in cardiogenic shock
62
describe how venous return works
venous pressure proximal these things allow for gradient of blood flow back to heart during inhalation, increased abdominal pressure creates vacuum in thoracic cavity pulling blood back to heart
63
what does the oxyhemoglobin dissociation curve show
relationship between amount of O2 bound to Hgb ability of RBCs to release O2 to tissues that need it most
64
what is relevant about SpO2 of 90%
90% = PaO2 of 60mmHg this is the minimum O2 concentration needed to prevent ischemia in tissue
65
what does a L shift on the oxyhemoglobin dissociation curve indicate
Hgb holds onto O2 since tissues don't need it more O2 bound to Hgb lower partial pressure O2 lower temp and mm work higher blood pH (less acidic)
66
what does a R shift on the oxyhemoglobin dissociation curve indicate
releases O2 to tissues that need it more less O2 bound to Hgb naturally happens during exercise higher temp and mm work lower blood pH (more acidic)
67

Year 3: CardioPulm Rehab (22 decks)

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