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CVR Week 1 > The Heart > Flashcards

The Heart Flashcards

1
Q

what is an echocardiogram?

A

an ultrasound of the heart

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2
Q

what is the right AV valve called?

A

tricuspid

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3
Q

what is the left AV valve called?

A

mitral valve

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4
Q

what are the stages of the cardiac cycle?

A

atrial systole
atrial diastole
ventricular systole - first phase
ventricular systole - second phase
ventricular diastole - early
ventricular diastole - late

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5
Q

what happens during atrial systole

A

atria are full of blood
atrial contraction forces blood into ventricles

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6
Q

what happens during ventricular systole?

A

muscle of ventricle starts to contract, shuts AV valves, pressure still building in the ventricle. when contraction is advanced enough to high pressure then the valves will open and ventricles eject blood

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7
Q

what happens during ventricular diastole?

A

ventricular cells stop contracting and relax, pressure in ventricles decrease and blood starts to flow back which catches in SL valves and forces them closed. blood flows into relaxed atria

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8
Q

what happens during the late phase of ventricular diastole?

A

all chambers are relaxed. ventricles fill passively. return to atrial systole and filling of atrium.

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9
Q

what is inotropy?

A

contractile capability of the heart muscle itself, conditions can affect it

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10
Q

how can blood pressure be calculated?

A

cardiac output x peripheral vascular resistance

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11
Q

what is peripheral vascular resistance?

A

how distesible arterial circulation is

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11
Q

what are cardiac muscle cells like?

A

large long thin cells, act with striations and packed with contractile units and lots of mitochondria, joined by intercalated discs

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12
Q

what are the powerhouse of the cardiac muscle cells?

A

contractile filaments
myosin and actin

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13
Q

how are the myocardial cells arranged within the heart?

A

fibres of myocytes are lined up in one direction, sheets then wrapped around the heart so that when it contracts there is an efficient movement

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14
Q

what is the action potential?

A

the dynamic signal that is sent between cardiac myocyte cells to signal for contraction

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15
Q

what is membrane potential?

A

determined by ion conc inside vs outside the cell
generally about -80mV

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16
Q

what is it called when positive molecules make their way inside the cell?

A

depolarisation

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17
Q

what is it called when positive molecules travel back outside of the cell?

A

repolarization

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18
Q

where are potassium ion conc higher?

A

intracellularly

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19
Q

where are Ca ions higher?

A

extracellularly

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20
Q

where are Na conc higher?

A

extracellularly

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21
Q

what are potassium currents?

A

repolarizing

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22
Q

what are sodium and Ca currents?

A

depolarising

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23
Q

what happens during an action potential?

A

sequential activation and inactivation of inward (Na+ and Ca2+) and outwards (K+) currents

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24
Q

what are the phases of a cardiac action potential?

A

upstroke
notch
plateau
repolairsation
resting

25
Q

what happens during upstroke?

A

1st stage, opening of voltage gated Na+ channels allows inwards flow

26
Q

what happens during notch phase ?

A

rapid voltage dependent inactivation of sodium current, activation of depolarising outwards K current

27
Q

what happens during the plate phase?

A

activation of further K currents
inwards Ca current
plateau of action potential

28
Q

what happens during depolarisation stage?

A

calcium current switches off as Ca conc inside cell rise
outward K currents predominate and cell returns to resting potential

29
Q

where in the heart is there never a resting potential?

A

SA node, constant cycle of depolarisation and depolarisation
sometimes AV node which is constantly active

30
Q

what is the hierarchy of pacemakers?

A

SAN - 70bpm
AVN - 50 bpm
purkinje cell - 30bpm

30
Q

what is the activity of the myofilaments deoendent on?

A

Ca concentrations intracellularly

31
Q

what happens during excitation contraction coupling?

A

membrane depolarisation
activation of L type Ca channels
inwards movement of Ca
Ca induced Ca release
Ca binds to myofilaments initiating contraction
relaxation
return to resting Ca levels

32
Q

what are the grooves within the membrane of the cell called?

A

T tubules,

33
Q

what are inside the T tubules?

A

packed with L type calcium channels

34
Q

what is the sarcoplasmic reticulum?

A

intracellular store of Ca
packed full of calcium
release is mediated by reanidane receptor
opens and pours calcium inside the cell

35
Q

what happens during calcium induced calcium release?

A

calcium released into the cell from the L type current which is picked up by ranodeine receptor, opens up and pours calcium into the cell.
calcium entry into the cell from L type calcium channels produces a massive amount of calcium release form intracellular stores.

36
Q

what happens during relaxation stage of excitation-contraction coupling?

A

after depolarisation of action potential
pump of sarcoplasmic reticulum pumps Ca back into the stores
extrusion of Ca on pump and exchanger so that calcium that entered cell from the L channel leaves

37
Q

what does the route of the left coronary artery look like?

A

splits into two main branches
anterior descending comes down the front of the heart and wraps over round the apex of the left ventricle
circumflex artery circles around the base of the heart at the AV margin and travels round that margin and wraps round the back of the heart to share supply of the posterior surface with the right coronary artery territory

37
Q

where do the coronary arteries arise from?

A

the base of the aorta, just above the SL valve cusps
main origins are form the right and the left

38
Q

what does the route of the right coronary artery look like?

A

comes down towards inferior surface if heart and supplies branches around the inferior posterior surface

39
Q

how do the coronary veins generally run?

A

with the coronary arteries

40
Q

where do all the coronary veins drain into?

A

coronary sinus

41
Q

where does the coronary sinus drain into?

A

right atrium

42
Q

when is the window for coronary arterial flow?

A

during the diastolic phase
allows perfusion of the ventricular muscle

43
Q

when could coronary flow to the heart be limited?

A

when diastolic pressure is low
ventricular end diastolic pressure is high

44
Q

where does the right side of the heart lie?

A

underneath the sternum

45
Q

what is the inferior border of the heart largely made up of?

A

the right ventricle

46
Q

where do we listen for the aortic valve?

A

right sternal edge
2nd - 3rd left interspace

47
Q

where do we listen to the pulmonary valve?

A

similar level on the sternal edge
2nd - 3rd level

48
Q

where do we listen to the tricuspid valve?

A

left sternal border down towards apical level of heart
4th - 5th interspace

49
Q

where do we listen to the mitral valve?

A

apical impulse of the heart
in the midclavicular line

50
Q

what does blood pressure measure?

A

difference in systolic and diastolic pressure in the aorta and arterial circulation

51
Q

what is the JVP?

A

what atrial pressure is

52
Q

what does cardio myopathy?

A

disease of the heart muscle

53
Q

which pair of ribs are the false ribs?

A

8-10

54
Q

what causes the initial depolarisation of the Sino-atrial node?

A

calcium entry into the cells via voltage gated calcium channels

55
Q

In which phase of the cardiac cycle do the aortic and pulmonary valves open?

A

ventricular ejection

56
Q

in which part of the cardiac cycle are all of the heart valves closed?

A

early ventricular systole

57
Q

What type of cell junction allows the electrical signal to pass between cells in cardiac muscle?

A

gap junctions

58
Q

What is the physiological reason for splitting of the 2nd heart sound?

A

During inspiration the pulmonary valve closes later and the aortic valve closes earlier

59
Q

Which vein can act as an alternative route for blood to the heart if either superior vena cava or inferior vena cava are occluded?

A

azygous

CVR Week 1 (8 decks)

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