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Midterm Flashcards

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1
Q 
external cardiac anatomy 
right border
left border
inferior border
anterior surface
A

right border = right ventricle
left border = left atrium and left ventricle
inferior border = right atrium and some left ventricle
anterior surface = mostly the right ventricle

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2
Q

blood flow within cardiac chamber

A

blood from lower trunk + limbs enters the heart through inferior vena cava
blood from above enters from superior vena cava

both drain into the right atrium

through tricuspid valve into right ventricle

through pulmonary valve into left lung via pulmonary artery

back into left atrium via left pulmonary veins (left lung)

through mitral valve into left ventricle

through aortic valve into aorta

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3
Q

the great arteries

A

pulmonary artery - anterior to aorta to left shoulder
ascending aorta - posterior to pulmonary artery to right shoulder
the aorta and pulmonary artery are at 60-60 degree angle

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4
Q

coronary arteries

A

right coronary artery and left coronary artery

first branches to come off aorta

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5
Q

right coronary artery

A

arises from right sinus of valsalva

courses between right atrium and right ventricle in atrioventricular groove

gives rise to right atrium branch, acute marginals (feed right ventricle) and most of the time the posterior interventricular artery (PDA)
- right dominant circulation in 70% of people

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6
Q

left main coronary artery

A

arises form the left sinus of valsalva

short segment splits into two: circumflex and the left anterior descending

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7
Q

circumflex

A

courses into left atrioventricular groove

gives rise to obtuse marginal branches that feed lateral left ventricle wall

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8
Q

left anterior descending (LAD)

A

feeds septum and left ventricle free wall

gives rise to diagonals and septal branches

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9
Q

coronary dominance

A

insert picture

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10
Q

venous drainage

A

cardiac veins are paired with arteries

majority of veins drain into coronary sinus (great cardiac vein) in posterior atrioventricular groove

right ventricle venous branches drain directly into right atrium

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11
Q

sequential segments of the internal cardiac anatomy

A

atria
atrioventricular valves
semilunar valves
ventricles

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12
Q

right atrium

A

smooth and trabeculated walls separated by crista terminalis

superior and inferior vena cava drain into smooth walled portion

fossa ovalis (thin wall between right atrium and left atrium, looks like slight depression) is formed from downward migration of septum secundum and upward migration of septum primum

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13
Q

tricuspid valve

A

allows for unidirectional blood flow from right atrium to right ventricle

three leaflets: septal, anterior, posterior

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14
Q

atrioventricular valves

A

mitral valve
tricuspid valve

these valves depend on hinge lines, valve tissue, chordae (like parachute strings), papillary, muscles, and ventricular wall function for proper performance

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15
Q

mitral valve

A

only two leaflet valve: posterior and anterior leaflets

allows unidirectional blood flow from left atrium to left ventricle

leaflets attach to mitral annulus - dense connective tissue of the cardiac skeleton that is the junction between the left atrium and left ventricle

leaflet edges are tethered by chordae tendinae which are attached to the ventricle through papillary muscles

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16
Q

right ventricle

A

inflow portion is below tricuspid valve
has an apex
outflow of infundibulum
has a pulmonary trunk: trabeculates, L shaped, septum is a smooth membranous portion with conduction tissue adjacent

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17
Q

semilunar valves

A

do not depend on ventricular function
there are two of them: aortic and pulmonary
three leaflets - suspended from the pulmonary trunk and aortic root
scalloped (commissures/ hinge lines)
competency is dependent on attachments and elastic/collagenous nature of the leaflet tissue as well as the dimensions of the root and trunk

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18
Q

weight of heart

A
  1. 45% of mens weight: 325gm +/- 75gm

0. 40% of womens weight 275 gm +/- 75gm

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19
Q

cellular composition of heart

A

myocytes - 25% of total cell number but 90% of mass

endothelial cells - 70% of total cell number but negligible contribution to heart weight

fibroblasts

immune cells

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20
Q

pericardium

A

fibrous sac that surrounds the heart - rich in collagen making in distensible
does not have elastic
fibrous component faces away from the heart
serous component faces toward the heart
refections from great vessels and veins
normal = 50cc of straw coloured fluid
sudden increases to 250 cc causes tamponade

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21
Q

fibrous skeleton

A

base of the heart - gives structure and shape
dense collagenous tissue with elastin - this makes up the rings of the atrioventricular valve and aortic annulus - this extends to the pulmonary trunk via conal ligament

separates the atrial and ventricular chambers

separates the left and right ventricles via a membranous septum

the atrioventricular conduction bundle is embedded in it

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22
Q

cardiac skeleton

A

fibrous skeleton = dense connective tissue made of thick collagen + some fibrocartilage

provides point of attachment for valve leaflets and myocardium

provides rigidity to prevent the dilation of valves that might cause leaking

electrically isolates the atria from the ventricles
- AV conducting system is the only electrical connection between the atria and ventricles

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23
Q

heart wall layers

A

epicardium - outer most layer

myocardium - muscle layer

endocardium - inner most layer

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24
Q

epicardium

A

analogue of vascular adventitia

serous pericardium

contains: coronary arteries and veins, fat, nerves, fibroblasts, macrophages

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25
myocardium
analgogue of vascular media bundles of cardiac muscle separated by fibrous bands consists of: myocytes, collagen, blood vessels and elastin
26
5 components of myocytes
1. cell membrane (sacrolemma and T tubules) - responsible for impulse conduction - form gap junctions - intercalated disks - join myocytes mechanically/ionically - functional syncytium 2. sarcoplasmic reticulum - calcium reservoir - action potential causes it to release calcium - tells actin and myosin to contract 3. contractile filaments - actin, myosin, troponin + tropomyosin - contraction = net effect of actin and myosin sliding closer to the sacromere 4. mitchondria - energry generation through aerobic respiration only - 23% of myocyte volume = mitochondria vs regular cell = 2% 5. nucleus - very large compared to most cells
27
myocardial anatomy
intercalated disks provide the transmission of contractile energy from cell to cell long chains of cells are arranged into myofibrils
28
cardiac muscle fibers
ventriciular cardiac muscle | atrial cardiac muscle
29
ventricular cardiac muscle
complex layers of cells wound helically around the ventricular cavity aids in "wringing out the heart" (like a sponge) during contraction of the heart
30
atrial cardiac muscle
muscle cells that are in the outer layer of the myocardium- form a complex helical structure around the atrial chamber
31
atrial cardiac muscle cells compared to ventricular cardiac muscle cells: (list 6 things)
are somewhat smaller have a less extensive T-tubule system have more gap junctions can conduct impulses at a rate 3X higher contract more rhythmically have many granules that contain atrial natiuretic factor (ANF)
32
right atrium
receives blood from superior and inferior vena cava and passes it the to the right ventricle 2mm thick smooth and trabeculated areas coronary sinus empties into it epicardium is rich in ganglia myocytes are smaller than in ventricles auricular appendage - looks like snoopys nose electron dense granules contain atrial natiuretic factor (ANF)
33
left atrium
receives oxygenated blood from pulmonary veins delivers to left ventricle across the mitral valve 3mm thick smooth throughout auricular appendage - shaped like central America
34
right ventricle
anterior most structure 3 subportions: inflow portion, apex, outflow portion C shaped around left ventricle coarsely trabeculated papillary muscles support tricuspid valve myocardium is 5 mm thick membranous septum contains conduction system low pressure ( this is why its thinner than left ventricle)
35
left ventricle
high pressure therefore 15mm thick bullet shaped 3 subportions: inflow, septum, outflow conducts blood from left atrium via mitral valve to aorta via aortic valve
36
ventricular diastole
relaxation semilunar valves are closed AV are open pressure in ventricle goes down bc it is relaxed pressure in atrium is higher the pressure differential is what causes the opening and closing of valves
37
ventricular systole
contraction pushes open valves to pulmonary artery tricuspid and mitral valves close fluid wants to leave therefore semilunar valves will open to allow this
38
aortic valve anatomy
a semilunar valve located in aortic root commisures are high points and cusp nadirs are low points - form a suspension bridge structure - this ring of suspension is called annulus leaflets are named for aortic sinuses (left, right, non)
39
aortic valve histology (three layers)
fibrosa - collagen rich, extends to free edge and coaptin surface - gives strength to the tissue spongiosa - proteoglycan and GAG rich, collagen and fibroblasts (dont really need to know) ventricularis - Left ventricle side - acts as shock absorber - allows leaflets to stretch and coapt under pressure and spring out of the way during ejection
40
pulmonic valve
a semilunar valve in pulmonary trunk anterior and superior to aortic valve same histology as aortic valve (3 layers = fibrosa, spongiosa, ventricularis) but it is thinner bc lower pressure
41
what does the competency of semilunar valves depend on?
their attachment to commissures and hinge lines their strength, pliability, and elasticity dimensions of the aortic root or pulmonary trunk
42
histology of the mitral valve (4 layers)
fibrosa - collagen rich and extends to chordae and tips of papillary muscles spongiosa - atrial side, GAG and proteoglycan rich ventricularis - ventricular side - elastin rich and endothelialized auricularis - EC layer on atrial side
43
what is the mitral valve competency based on?
``` dimension of annular ring structural integrity of leaflets (pliable, elastic, strength) structural integrity of chordae function and dimensions of ventricles ```
44
tricuspid valve histology
compared to mitral valve: lower pressure and thinner chordae, papillary muscles, and leaflets same 4 layers as mitral valve: fibrosa, spongiosa, ventricularis, auricularis
45
epicardial coronary arteries
the myocardium is dependent on only oxygenated blood - therefore the heart extracts oxygen maximally (extracts 60%, leaving the venous saturation at 40% compared to 60% everywhere else in the body) originate from the sinuses of valslava they are 2-4mm in diameter and 5-10cm in length branch into intramural arteries
46
Tunica adventitia
outermost layer of blood vessels primarily loose connective tissue - type 1 collagen and elastin anchor it vessel in veins this is the thickest layer contains vassa vasorum - found in large arteries and veins analogous to epicardium in heart
47
tunica media
middle layer of blood vessel - most variable in size/structure contains smooth muscle collagen fibers, reticular fibers and elastic tissue (more of these in arteries compared to veins) the media layer tends to be large in most arteries analogous to myocardium in heart
48
tunica intima
inner most layer (next to lumen) of blood vessels single layer of endothelial cells and minimal connective tissue in larger vessels it is subdivided into 4: - endothelium - thin basal lamina - subendothelium (connective tissue including collagen) analogous to endocardium in heart
49
properties of the endothelium
can have different functions based on different blood vessel locations cells are bound together by junctional complexes can be activated by cytokines to express cell adhesion molecules which allow WBCs to stick and migrate from the blood vessel into the tissue under normal circumstances: secrete substances that maintain the tone of vascular smooth muscle and prevent blood clotting
50
cellular composition of blood vessels
endothelial cells smooth muscle cells immune cells and fibroblasts are also there but they are not as important for function
51
components of extracellular matrix in blood vessels
collagen elastin glycosaminoglycans
52
endothelial function in blood vessels
EC-EC junction = permeability layer - regulate uptake ``` maintain the delicate balance of pro and anti forces in: clotting fibrinolysis vascular tone inflammation mitogenesis (cell growth) ``` synthesize matrix molecules: collagen and proteoglycans
53
what anticoagulant, antithrombotic and fibrinolytic molecules do endothelial cells make?
prostacyclins thrombomodulin heparans plasminogen activator
54
what pro-thrombotic molecules do endothelial cells make?
von willebrands factor tissue factor plasminogen activator inhibitor
55
how do endothelial cells regulate blood flow?
endothelial cells are responsible for the contraction and relaxation of blood vessels vasoconstriction is caused by endothelin and angiotensin converting enzyme vasodilatation is caused by prostacyclin and nitric oxide
56
how do endothelial cells regulate cell growth?
produce regulator molecules: molecules that stimulate growth: PDGF, FGF, VEG F molecules that inhibit growth: heparin, TGF beta
57
how do endothelial cells regulate inflammation and immunity?
interluekins 1 and 6, chemokines - attract immune cells adhesion factors cause the immune cells to stick and exit blood vessels to go into tissues
58
vascular smooth muscle cells
primary element of vascular media responsible for vasoconstriction and vasorelaxation secrete and synthesize growth factors and cytokines synthesize proteoglycans, collagen, elastin in response to injury they migrate to the intima and proliferate
59
what happens to smooth muscle cells in response to injury?
migrate to intima and proliferate -this is promoted by edothelin, PDGF, FDF, IFN gamma the cells synthesize matrix this can = normal healing or atherosclerosis
60
two types of arteries
elastic and muscular
61
which arteries are elastic arteries?
``` aorta brachiocephalic carotid subclavian iliac pulmonary arteries and larger branches ```
62
physical characteristics of elastic arteries?
vessels are thick - too thick for diffusion of oxygen therefore get their own oxygen via the vasa vasorum tissues and cells organized in lamella intima has endothelial cells and minimal matrix adventitia collagen predominant with vasa vasora - this provides strength elastin dominates in media allowing for expansion in systole - acts as secondary pump (pressure reservoir) -
63
intima, media and adventitia of elastic arteries
intima has endothelial cells and minimal matrix elastin dominates in media - allows for expansion in systole - this acts as a secondary pump/pressure reservoir - VSCM are dominant cell in media adventitia collagen predominant with vasa vasora- this provides strength
64
what does the aorta arise from and where do its branches go
arises from left ventricle root gives rise to coronary arteries arch to head and upper extremity vessels descending to paired intercostal arteries
65
atherosclerotic and hypertensive changes in the elastic arteries
intima thickens and develops plaque fragmentation of collagen and elastin media degenerates causing reduced blood supply results in aortic aneurysm or dissection
66
muscular arteries: layers (intima, media, adventitia)
intima is thinner than elastic arteries internal elastic lamina is well defined media has fewer elastin fibers, lamella are defined but discontinuous in some locations, the VSMC is a major component external elastic lamina is well defined adventitial thickness/ strength variable
67
examples of muscular arteries
coronaries renal arteris femorals + distributive arteries of the lower extremities axillaries and distributive arteries of upper extremity
68
visceral arteries
visceral arteries supply blood to the visceral organs
69
examples of visceral arteries
celiac trunk - splenic artery, distal esophagus, pancreas, hepatic arteries superior mesenteric artery - abdominal extremities inferior mesenteric artery marginal artery (Drummond) anastomoses the SMA and IMA - these are important in atherosclerotic occlusive disease of these vessels - occlusive disease of visceral vessels can result in intestinal angina or hypertensionn
70
marginal artery (drummond)
formed by antastomoses of the terminal branches of the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA) this is critical in atherosclerotic occlusive disease of these vessels occlusive disease of the visceral vessels can result in intestinal angina and hypertension
71
muscular arteries of the upper extremity
subclavian > axillary > brachial> branches into radial and ulnar (closest to body) superficial palmar acrches suply hand and digits INSERT PICTURE
72
axillary artery
begins at lateral border of first rib to teres major multiple branches to chest and shoulder
73
brachial artery
teres major to antecubital fossa branches to elbow and adjacent forearm musculature - into radial and arteries
74
radial and ulnar arteries
supply forearm musculature
75
iliac artery
common iliac: paired arteries at the terminus of the abdominal aorta -4th lumbar vertebra external iliac: common iliac branch that courses along psoas muscle anterior and inferior to the inguinal ligament internal iliac: arises at the sacroiliac joint - courses pestero-inferior to external iliac giving rise to branches that supply the pelvic viscera and medial thigh
76
infra-inguinal arteries: groin
as external iliac crosses he inguinal ligament it becomes the femoral artery this occurs midway between pubic tubercle and anterior superior iliac spine NAVL: lateral to medial = nerve, artery, vein, lymph branches that supply thigh and and sex organs gives rises to profunda femoris artery - this supplies muscles of upper extremity + provides collaterals down to knee gives superficial femoral artery: courses down anteromedial thigh deep to muscles to lower extremities
77
popliteal artery
when superficial femoral artery emerges into posterior knee, from adductor magnus muscle becomes popliteal artery gives 5 geniculate branches to the knee travels in interchondylar fossa divides at popliteal muscle into anterior and posterior tibial aa
78
lower leg arteries
anterior tibial artery - goes into dorsalis pedis in foot posterior tibial artery peroneal artery
79
head and neck arteries
common carotid artery and brachiocephalic trunk gives rise to internal carotid artery and external carotid artery branch point is at the carotid sinus carotid body - sense oxygen content and regulate breathing
80
carotid branches
external carotid: - supplies head and neck external to cranium - multiple branches, most importantly facial arteries and superficial temporal, maxilaryartery internal carotid: supplies brain, eyes, forehead - enters cranium via cranial canal in temporal bone (skull base) - vertebral artery branches of the subclavian artery ascend through postiero neck adn enter cranium through foramen magnum also supplying the brain
81
small arteries
provide distribution form named branches to tissues less than 2 mm in diameter
82
small arterioles
20-100 mm in diameter provide blood flow regulation via medial smooth muscle contraction regulates relative blood flow to capillary beds provide the majority of flow resistance
83
histology of small arteries and arterioles
intima is very thin media = 1 to 6 layers of vascular smooth muscle cells adventitia thickness is similar to media, merges with adjacent tissue connective tissue
84
capillaries
diameter of 8µm (RBC diameter) to 30µm represent a huge cross sectional area in the body endothelial cell lining but no media or elastin pericytes that contain myosin are what provide the support allow rapid exchange of oxygen ad nutrients via diffusion flow is very slow
85
EC lining of capillaries
continuous: complete EC lining fenestrated: EC gaps allowing macromolecular passage discontinuous: larger gaps in EC layer (liver) - larger diameter called sinusoids
86
veins
intima: - narrow and IEL is difficult to ID - sparse elastin with only incomplete elastic lamina media: - vascular smooth muscle cells dominate in media (there are fewer compared to arteries + more disorganized) adventitia: - only largest veins have appreciable connective tissue vein valves: - small and medium veins have valves - made of two bands of lumenal tissue - allow skeletal muscles to assist in blood return against gravity
87
large veins (structure/layers)
no valves (ex=vena cava) Intima: - EC with some connective tissue media: - multiple layers of vascular smooth muscle cells - much thinner than adjacent artery adventitia: - more connective tissue compared to medium veins - blend with adjacent connective tissue
88
medium veins
has vein valves intima: - very thin - EC is complete Media: - few layers of smooth muscle cells (2-5) adventitia: - identifiable and blends into adjacent connective tissue
89
post capillary venules
very thin walled intima is very thin, no elastin, has endothelial cells media = 1 or 2 layers of vascular smooth muscle cells
90
starling law
more venous return to heart = heart pumps more an increase in muscular stretch = increased contraction this operates at the level of the sacromere (actin/myosin) no change in arterial pressure or heart rate can over stretch = flat/descending starling curve
91
cardiac regulation
- autonomic control | - heart has abundant parasympathetic and sympathetic innervation
92
sympathetic drive of cardiac regulation
increase heart rate (chronotropic) increase strength of contraction (inotropic) basasl firing of sympathetic fibres (normal condiiton is baseline sympathetic drive) mediated by beta adreno receptors
93
parasympathetic tone in cardiac regulation
bradycardia (major effect) (to 20-40bpm) decreased force of contraction (minor effect) vagal episode
94
blood flow regulation at the tissue level
metabolic rate is proportional to blood flow kidney is the only exception to this states of low tissue oxygen result in release of vasodilator substances that affect arteriolar tone difference in flow between skeletal muscles at rest and during exercise = 20 fold control lies at level of arteriole
95
blood flow regulation by the endothelium
active role in blood flow control may be a response to sheer stress form increased local flow downstream - vasodilators: nitric oxide , prostaglandins - vasoconstrictors: endothelin, thromboxane affects diameters of pre-arteriolar vessels (even to muscular arteries)
96
humoral regulation of blood flow
norepinephinre/epinephrine: - fight or flight - results in humoral release (adrenals) and increased sympathetic tone - humoral release has same effect as local innervation (constricts vascular smooth muscle and increases heart rate + force of contraction)
97
impact of exercise on blood flow
increased return of blood local vasodilation of skeletal muscle (arteriolar and EC regulated) increased CNS activity results in vasoconstriction center activation
98
baroreceptor reflex
stretch receptors widely distributed in vascular system ``` especially carotid sinus; aortic arch stimulate CNS (medulla) ``` increased pressure results in inhibition fo vasoconstrictor center and excitation of vagal centre (when you stand there is the opposite effect) vasodilation of veins and arterioles decreased heart rate contractility
99
conduction system
conducts the impulse with a delay from atrium to ventricle (AV node) - between Av valve and coronary sinus splits into left bundle and right bundle

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