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Flashcards in Pathophys Deck (52)
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Function of the pericardium

- superficial fibrous outer layer: it protects, anchors, and prevents overfilling
- deep 2 layered serous pericardium: parietal and visceral (epicardium) layers that are separated by fluid that decreases friction


Layers of the heart wall?

- epicardium:visceral layer of serous pericardium
- myocardium: spiral bundles of cardiac muscle cells, and fibrous skeleton of the heart that anchors muscle fibers and supports vessels and valves, limits spread of action potentials to specific paths
- endocardium: continuous with endothelial lining of blood vessels


Vessels entering the right atrium?

- SVC and IVC
- coronary sinus


Vessels entering left atrium?

- right and left pulmonary veins


Difference in pressures: systemic and pulmonary circuit

- equal volumes of blood are pumped to the pulmonary and systemic circuits
- pulm circuit is short, low pressure circulation
- systemic circuit blood encounters much resistance in long pathways, high pressure


What is the shortest circulation circuit in the body?

- coronary circulation


What are the important coronary arteries?

- right and left coronary, marginal, circumflex and LAD


What are the branches off of the right coronary artery? Left?

- R: right marginal and posterior interventricular artery
- L: anterior descending and circumflex


During what period of the cardiac cycle do the coronary arteries receive perfusion?

- diastole


What is angina pectoris?

- thoracic pain caused by a fleeting deficiency in blood delivery to the myocardium so cells become weakened


What is an MI?

- prolonged coronary blockage
- areas of cell death are repaired with noncontractile scar tissue


Different heart valves? function?

- ensure unidirectional blood flow through the heart
- AV valves::
prevent backflow into atria when ventricles contract, tricuspid and mitral
- chordae tendineae anchor AV valve cusps to papillary muscle
- semilunar valves: prevent backflow into the ventricles when ventricles relax, aortic and pulmonary semilunar valves


Why are there no valves going into R and L atria?

- no valves guarding Vena cavas and pulm veins because pressure is so low


Circulation of blood through the heart?

1. blood returning to heart fills atria putting pressure against AV valves which are then forced open
2. as ventricles fill, AV valves flaps hang limply into ventricles
3. atria contract, forcing additional blood into ventricles
4. ventricles contract forcing blood against atrioventricular valves cusps and the valves close, the papillary muscles contract and chordae tendineae tighten, preventing valve flaps from everting into atria
5. As ventricles contract and intraventricular pressure rises, blood is pushed up against semilunar valves forcing them open
6. as ventricles relax and intraventricular pressure falls, blood flows back from arteries filling the cusps of the valves and forcing them to close


Why is there a fibrous insulator between the atrium and ventricle?

- keeps everything in order through specific pathways, keep ventricles from depolarizing at the same time


Describe cardiac muscle and contraction.

- has actin and myosin filaments
- has low resistance intercalated disks
- depolarization of the heart is rhythmic and spontaneous
- about 1% of cardiac cells have automaticity (self-excitable)
- gap junctions ensure the heart contracts as a unit
- long absolute refractory period (250 ms)


similarities b/t cardiac and skeletal muscle?

- both are triggered by action potentials that sweep across cell membranes
- 1% of cardiac fibers are auto rhythmic
- bulf of heart msucle however are composed of contractile muscle fibers responsible for heart's pumping action
- in these cells, the sequence of event leading to contraction is similar to that in skeletal muscle fibers


Describe systole and diastole?

- systole: ventricular muscle stimulated by action potential and contracting
- diastole: ventricular muscle reestablishing Na/K/Ca gradient and relaxing


What is the intrinsic cardiac conduction system?

- a network of noncontractile (autorhythmic) cells that initiate and distribute impulses to coordinate the depolarization and contraction of the heart


Describe the electrical pathway of the heartbeat?

begins at SA node (pacemaker of heart) - goes down internodal pathway to AV node and impulse is delayed here to allow atria to contract before ventricles and AV bundle then takes impulse into ventricles through bundle of his and then down the left and right bundles of purkinje fibers that take impulses to rest of ventricles


Describe the autorhythmic cells?

- have unstable resting potentials (pacemaker potentials or prepotentials) due to open slow Na+ channels and closing of K+ channels
- at threshold Ca2+ channels open and explosive Ca2+ influx produces the rising phase of the action potential and depolarization occurs
- repolarization results from the inactivation of Ca2+ channels and opening of voltage gated K+ channels, this allows K+ efflux which brings the membrane potential back to its most negative voltage


Describe the sinus node and it's action potential?

- specialized cardiac muscle connected to the atrial muscle
- acts as a pacemaker because membrane leaks Na+ and membrane potential is -55 to -60 mV and when the membrane potential reaches -40 mV slow Ca2+ channels open causing action potential
- after 100-150 sec Ca++ channels close an K+ channels open more thus returning membrane potential to -55 mV


Electrical pathway?

1. SA node (pacemaker): generates impulses about 75 times/minute (sinus rhythm), depolarizes faster than any other part of myocardium
2. AV node: smaller diameter fibers, fewer gap junctions, delays impulses approx 0.1 sec
depolarizes 50 times/min in absence of SA node input, delays impulse from atria into ventricles
3. AV bundle (bundle of his): only electrical connection between the atria and ventricles
4. Right and left bundle branches: 2 pathways in the interventricular septum that carry the impulses toward the apex of the heart
5. purkinje fibers: complete the pathway into the apex and ventricular walls, av bundle (bundle of his) and purkinje fibers depolarize only 30x per minute in absence of AV node input


What are the homeostatic imbalances that may result in if there are defects in the intrinsic conduction system?

- arrhythmias: irregular heart rhythms
- uncoordinated atrial and ventricular contractions
- fibrillation: rapid, irregular contractions, useless for pumping blood


What may a defective SA node result in?

- ectopic focus: abnormal pacemaker takes over
- if AV node takes over, there will be a junctional rhythm (40-60 bpm)


What may a defective AV node result in?

- partial or total heart block
- few or no impulses from SA node will reach the ventricles


Describe the extrinsic innervation of the heart?

- heartbeat is modified by the ANS
- cardiac centers are located in the medulla oblongata:
cardioacceleratory center innervates the SA and AV nodes, heart muscle and coronary arteries through sympathetic neurons
cardioinhibitory center inhibits SA and AV nodes through parasympathetic fibers in the vagus nerve (can control rate but not contractility)


Describe what the waves on an EKG mean?

- atrial depolarization which is initiated by the SA node, causes the P wave
- with atrial depolarization complete, the impulse is delayed at the AV node, ventricular depolarization begins at the apex, causing the QRS complex, and atrial repolarization occurs
- next ventricular depolarization is complete and repolarization begins at the apex causing the T wave, and ventricular repolarization is complete


What produces the first and second heart sounds?

- lubb: first heart sound (S1), this occurs during ventricular systole, due to AV vlaves closing - this signifies the beginning of systole
- dupp: second heart sound (S2), occurs during ventricular diastole when the pulmonary and semilunar valves are closing- beginning of ventricular diastole
- heart murmurs are often indicative of valve problems


Where on the chest are the valves heard opening and closing?

aortic valve: in 2nd intercostal space at right sternal margin
pulmonary valve: 2nd intercostal space at left sternal margin
tricuspid: right sternal margin of 5th intercostal space
mitral: over heart apex in 5th intercostal space (in line with clavicle)