Lilly's Chapter 1 PP&WB Flashcards by Linsay AugustinCRNA

Right-sided structures lie mostly to

their left-sided counterparts

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Both atrial chambers located mostly to the____of their corresponding ventricles

right

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Pericardium function 2

Allow heart to beat without friction

Allow room to expand

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Pericardial cavity

Filled with pericardial fluid 5-30ml

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3 attachments

Central tendon of diaphragm
•Sternopericardial ligaments
•Vertebropericardial ligaments

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*****Endocardium is the ___________and is comprised of

FENP-B

Single layer of endothelial cells
Fibroblasts
Elastic and collagenous fibers
Nerves
Purkinje fibers
Blood vessels

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Right heart receives _______blood from the body (IVC, SVC)and from the _______(________)

deoxygenated; Heart, coronary sinus

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**RV pumps blood to __________via_________ which is the only artery with _______blood

the lungs; pulmonary artery; deoxygenated blood

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**RV characteristicsIOM 3

Inner wall covered by trabeculae carneae
Outflow tract (conus arteriosus) is smooth for laminar flow
Moderator band : Large trabeculae, Crosses vent. Cavity – Carries component of RBB of the conducting system to the ventricular muscle

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RV has ______ papillary muscles and contains the Tricuspid valve

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**Left heart : LA receives _______blood from the _____via the _________Veins, which is the only veins carrying ________blood

oxygenated; lungs; pulmonary veins;

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**LV pumps blood through the ________circulation via _____

Systemic ; aorta

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LV characteristics***TA 2

wall? size

Thicker wall 9 – 11 mm ~3x thicker than R. vent.

Aortic Vestibule smooth for laminar flow

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LV has ______papillary muscles, contains the _____valve and is the origins of _______and ________ just above

• 2 large papillary muscles
– Mitral Valve
• Origins of RCA & LCA just above Aortic valve cusps

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Cardiac Conduction System

SA node–>AVnode–> Bundle of his–>R+ L bundle branches–> Purkinje fibers(subendocardial fibers)

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Conduction systemSubendocardial plexus of Purkinje fibers allow_______________before________, this prevents valve_______

papillary muscles to contract before vent. wall

– Prevents valve regurgitation

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****Cardiac Innervation(sympathetic )

• Sympathetic fibers from T1-T6 innervate cardiac nerves that terminate in heart and great vessels

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***Effect of sympathetic stimulation

HR, Contractility, AVN, PR

Increase HR and Contractility
Decrease AVN Effective Refractory Period
Decrease PR

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**Effect of parasympathetic stimulation

HR, Contractility, AVN, PR

Decrease HR and Contractility
Increase AVN effective Refractory Period
Increase PR

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**Parasympathetic fibers from_____ innervate

CN X; SA Node, AV Node and Purkinje fibers

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Vagal innervation ______and______whereas Sympathetic innervation

Supraventricular and purkinje ; all over

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Cardiac Vessels LCA division (AIVCI)

LAD (AIV) (anterior interventricular artery)

Circumflex

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Cardiac Vessels RCA division (PM)

PDA (posterior descending) PIV (posterior interventricular artery)
– Marginal

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Th blood supply to the SA node is most often derived from the ______in ____% of the population and derived from Circumflex artery in___% of the population. Other 5% from both

RCA;70%; 25%

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Posterior Descending and AV nodal arteries arise from the RCA in______of the population. The coronary circulation is termed __________. __% the PDA arises from the Circumflex , resulting in coronary circulation termed. The remaining population PDA is supplied by both the RCA and circumflex, coronary circulation is thermed____

85% of the population; Right dominant; 8% ;Left dominant; 7% Co-dominant

*****Muscle fibers beneath endocardium, particularly _______And________supplied by coronary a. terminal branches or veins.

papillary muscles and left vent. wall | Thebesian

*****A myocyte is an

Individual cardiac muscle cell

******Myofibril is a

Group of sarcomeres

*****Sarcomere

Individual contractile unit of the cell | Line up in cell

The sarcolemma is the

Cell membrane

****A distinct characteristic of cardiac muscle tissue

intercalated disks

Intercalated disks are : | Function

Gap junction complexes | They establish structural and electrical continuity between the myocardial cells

*****The sarcoplasmic reticulum is a

- intracellular membrane network - Most of the intracellular calcium stored there - responsible for Ca release and excitation-contraction coupling

*****Action potential

Reversal of electrical potential across a semipermeable membrane cause by conformation changes in selective ion channels.

3 ways

Rhythmic Conducted appropriately Coupled to myocardial contraction

*****3 major electrically excitable cell types

1. Pacemaker cells found in SA node and AV node 2. Specialized conducting cells (purkinje fibers) 3. Cardiac myocytes (myocardial syncytium)

Pacemaker cells have _____but no

Automaticity; NMJ

****Pacemaker cells have resting potential of

-60mV

*****Compare to resting potential of vent. Myocytes at

-90mV

*****Unique physiology of Pacemaker cells | SUF

- Slow voltage gated Na+ channels unable to recover so they remain inactivated - Unique ion channel "pacemaker channel" which allow continuous flow of Na+ until threshold is reached

Depolarization depends on ion transport, gov.d by:

Concentration Gradients | Transmembrane potential

***** Cardiac myocytes have

Fast Na+ ion channels

“Fast Na+ Channels”

* When activated remain open for only a few thousandths of a second, then close * Inactivated state persists until membrane is repolarized, providing refractory period

Are Fast Na+ channels active on SA/AV nodes?

• Not active on pacemaker cells (SA/AV nodes)

******K+ ion channels

***Inward rectifer channels - open in resting state allow some K+ to flow out of cell, but overall negative interior charge slows K+ outflow • At equilibrium, these forces are balanced and there is zero net movement of K+

The electrical potential point at which there is zero net movement of K+ across the membrane is known as as "_________" What is the K+ equilibrium potential is ____mV Calculated by _______

The potassium equilibrium potential -91mV Nernst Equation

****Action potential of cardiac muscles : Phase 4

Na+, Ca2+, Channels closed. Open K+ RECTIFIER CHANNELs keep TMP stable at -90mV

*****Action potential of cardiac muscles : Phase 0

Rapid Na+ influx through open FAST Na+ Channels

*****Action potential of cardiac muscles : Phase 1

Transient K+ channels open and K+ efflux return TMP to 0mV

******Action potential of cardiac muscles : Phase 2 aka ___phase

Plateau phase ; Influx of Ca2+ through L-TYPE Ca2+ channels is electrically balanced by K+ efflux through DELAYED RECTIFIER K+ Channels Ryanodine receptors: release Ca++ from S.R

*****Action potential of cardiac muscles : Phase 3

Ca2+ channels close but DELAYED RECTIFIER K+ channels remain open and return TMP to -90mV

****Cardiac Depolarization: “Fibrous Skeleton” of the heart

– Fibrous connective tissue that surrounds the AV valves – Serves as electrical INSULATOR isolates Atria and Ventricles - AV NOTE IS THE ONLY ELECTRICAL CONDUCTOR TO THE VENTRICLES

Delay at AV node (0.1sec) allows

• atria time to contract before ventricles

_____ node is the only electrical conductor to the Ventricle

AV node

****AV node

serves as electrical “gatekeeper” to limit ventricular stim. during abnormal rapid atrial rhythms

***Electrical AP leads to

Physical contraction

****Myosin

Arranged in thick filaments, globular heads contain MYOSIN ATPASE

*****Actin

Thin filament , a-helix

Tethers myosin to Z-line

Titin (connectin)

***Tropomyosin

Double helix lies between actin filaments and blocks actin&myosin interaction

*****Troponin

Regularly spaced on acting, 3 SUBUNITS

****CALCIUM INDUCED CALCIUM RELEASE | Initial ____________ signal is amplified by ______During what phase

L-type Ca2+ current signal; Calcium induced calcium Release (CICR) Phase 2 of action potential

*****Ca2+ enters cell via

T-Tubule system

*****Ca2+ triggers _______Receptors on ______ then this membrane dumps_________

Ryanodine receptors; Sarcoplasmic Recticulum ; it stores of Ca2+

Calcium channel Blockers | Bind to which channels

Bind to the L-type calcium channels

****Three Classifications:

Non-Dihydropyridines benzothiazepines phenylalkylamines Dihydropyridiness

****Benzothiazepines Ex (BD) • dihydropyridines – nicardipine , amlodipine, nifedipine , nisoldipine, et

– diltiazem

*****Phenylalkylamines (PV)

– verapamil

**** dihydropyridines (NNA) | –NNNA

nicardipine , nifedipine , nisoldipine, amlodipine,

Lilly's Chapter 1 PP&WB Flashcards

(69 cards)