Week 1 Flashcards
(220 cards)
1
Q
3 types of muscle
How many and where are the nuclei?
A
Sk: multinucleated/periferal
C: One/center
Sm: One/center
2
Q
What tissue give risue to all muscles?
What is an exception?
A
Mesoderm
Exception: iris (derives from ectoderm)
3
Q
What contractile all muscles contain?
A
Actin and Myosin
4
Q
Describe the three types of muscles
A
Skeletal muscle is composed of large, elongated, multinucleated fibers.
Cardiac muscle is composed of irregular branched cells bound together longitudinally by intercalated disks.
Smooth muscle is an agglomerate of fusiform cells. The density of the packing between the cells depends on the amount of extracellular connective tissue present.
5
Q
What cells give rise to muscle cells?
What these cells form to produce muscle cells?
A
Mesenchymal cells -> Myoblasts -> Myotubes -> Mature muscle
6
Q
Muscle fiber vs. myofibril
A
Muscle fiber = muscle cell
Myofibril = made up of the myofilaments actin and myosin
7
Q
What is the purpose of the connective tissue in skeletal muscle?
A
Transmits the forces (muscle cells do not extend the length of the musscle)
Transmitting blood vessels
8
Q
How muscle is organized (subcomponents)?
A
9
Q
When is the number of muscle fibers steady?
A
14 years old (~puberty)
10
Q
What might regenerate skeletal muscle cells in an adult?
A
Satellite cells
11
Q
What is the molecule that regulates number of muscle cells (hormone)?
How does it regulate the number muscle fibers?
A
Myostatin
It suppresses skeletal muscle development.
12
Q
What determines the strength of the muscle?
A
Total number of muscle fibers (not length)
13
Q
What is the difference between hypertrophy and hyperplasia?
A
Hypertrophy = Increase in muscle size
Hyperplasia = Increase in number of muscle cells
14
Q
What is the functional unit of muscle cell?
Where does it extrends from?
What multiple sacromeres from?
A
Sacromere
Z to Z
Myofibrils
15
Q
What skeletal muscle bands can we see?
A
Actin (7nm) makes up the thin I band (isotropic to polarized light)
Myosin (15nm) makes up the A band (anisotropic to polarized light)
16
Q
Where are the T-tubules in skeletal muscle cells?
A
A-I band junction
17
Q
What is triad (skeletal muscle) made of?
What is the function of triad?
A
T tubule + 2 SR (terminal cisterna of sarcoplasmic reticulum)
Calcium for uniform contraction
18
Q
What are three bands in skeletal muscle?
A
A band made up of actin and myosin
I band made up of actin
H band made up of myosin
19
Q
How contraction of muscle affects:
A band?
I band?
H band?
Two adjacent Z disks?
A
the A band stays the same length
the I bands and H bands shorten (sliding filament model)
The Z disks are moving closer to one another
20
Q
What covers neuro-muscular junction?
A
Schwann cell
21
Q
What is external lamina?
A
A structure similar to basal lamina that surrounds the sarcolemma of muscle cells. It is secreted by myocytes and consists primarily of Collagen type IV, laminin and perlecan (heparan sulfate proteoglycan). Nerve cells, including perineurial cells and Schwann cells also have an external lamina-like protective coating.
22
Q
What is another name for neuromuscular junctions?
A
Motor end plates
23
Q
What molecule plays crucial role in muscle contraction?
A
Calcium
24
Q
Characteristics of cardiac muscle cells
A
Striations
Intercalated disks
1-2 centrally located nuclei per cell
Bifurcating & anastomosing cells
Highly vascular
Have atrial granules
25
What are atrial granules and where they are found?
The are found in cardiac muscle cells
They contain atrial natriuretic peptide (ANP) that acts on kidney to regulate blood pressure through sodium and water reabsorption.
26
What are the three layers in heart?
Endocardium (homologous to tunica intima)
Myocardium (homologous to tunica medai)
Epicardium (homologous to tunica adventitia)
27
What is a difference between cardiac and skeletal muscle cells in terms of the T-tubules?
Skeletal muscle have and cardiac muscle lack cisternae
Skeletal muscle have T-tubule on A/I band border while cardiac muscle have t-tubule on Z-line
28
What is dyad (cardaiac muscle) made of?
T-tubule + sacroplasmic reticulum
29
What surrounds pericardial cavity?
Pericardium (visceral pericardium)
Parietal pericardium
30
What is an organelle that is excessively present in cardiac muscle?
Mitochondria
31
What are four types of muscle cells in heart?
**Contractile cardicytes** (myocardiocytes) = **contraction**
**Purkinje fibers** (modified myocardiocytes) = found **deep** to **endocardium** lining the **interventricular septum**; **impulse conducting**;
**Myoendocrine cardiocytes** = producing **atrial natriuretic factor**
**Nodal cardiocytes** = control the **rhytmic** contraction; found in **SA** and **AV node**; found **deep to endocardium** of the **interatrial** and **interventricular septa**
32
How Purkinje fibers can be distinguished from other muscle cells?
Location (deep to endocardium)
Size (larger)
Staining (lighter because of glycogen content)
33
Cardiac tamponade
Pericardial sac effusion
34
Unique cardiomyocytes that can be seen on microscope
Purkinje fibers
Myoendocribe cardiocytes
35
How cardiac muscle cells are connected?
Vertical (transverse): **fascia** (longer strip that goes between cells; wider) **adherens** and **desmosomes**
Horizontal (longitudinal): **gap junctions**.
36
What is syncytium?
What allows cardiac muscle to act as syncytium?
**Syncytium** is a **multinucleated** cell that can **result** from **multiple cell fusions** of **uninuclear cells**, in contrast to a coenocyte, which can result from multiple nuclear divisions without accompanying cytokinesis.
Can because of : fascia adherens, desmosomes and gap junctions
37
Cardiac muscle cells exhibit spontaneous rhythmic contraction
What does this contraction depends on?
What regulates it?
Dependent upon gap junctions
autonomic nervous system (ANS) regulation
38
Smooth Muscle characteristics
elongated fusiform cell appearance (relaxed)
one nucleus / centrally located
no striations
Cytoplasmic dense bodies serve as Z lines
Possess caveolae and some SER but not T system
Gap junctions in single-unit smooth muscle
External basal lamina around each cell
Involuntary contraction initiated by several modalities one being the ANS
39
What is the function of caveolae?
Aid in Ca+2 uptake and release.
40
Different types of smooth muscle
**Single unit** (conntected by **gap junction** - syncytium; cannot contract independently of one another; found in the wall of hallow visceras)
**Multi-Unit** (has its **own nerve supply** and can contract independetly of one another; en passant)
**Vascular** (mix of single and muti unit)
41
Examples of single and mulit unit muscle cells
SU: intestine, uterus, ureters
MU: iris
42
En passant ??
| (smooth muscle)
axonal swellings containing synaptic vesciles
43
Heart / Thorax 1
1. Mediastinal part of parietal pleura
2. Axillary vein
3. Horizontal fissure
4. Inferior lobe, right lung
5. Diaphragmatic part of parietal pleura
6. Fibrous pericardium
7. Musculophrenic artery and vein
8. Inferior lob, left lung
9. Left oblique fissure
10. Cardiac notch
11. Costal part of parietal pleura
12. Internal thoracic artery and vein
44
Two potential spaces around lungs
Costomediastinal recess
Costodiaphragmatic recess
45
Mediastinum
An **undelineated group of structures in** the **thorax**, surrounded by loose connective tissue. It is the central compartment of the thoracic cavity. It contains the **heart**, the **great vessels** of the heart, the **esophagus**, the **trachea**, the **phrenic nerve,** the **cardiac nerve**, the** thoracic duct**, the **thymus**, and the lymph nodes of the central chest.
46
Heart / Thorax 2
1. Esophagus
2. T-9 Vertebra
3. Thoracic aorta
4. Mediastinal part of parietal pleura
5. Left phrenic serve, left pericardiacophrenic artery and vein
6. Pericardium
7. Central tendom of diaphragm, middle leaflet covered by pericardium
8. Right costomediastinal recess
9. Inferior vena cava
47
Superior mediastinum components
Roots of great vessels
Esophagus
Trachea
Vagal, phrenic, and cardiac nerves
48
Inferior mediastinum
(anterior portion) **branches** of the **interal thoracic artery** and some **thymus** in children
(middle) **heart** and **ascending aorta** and **SVC**"**everything in** the **pericardial sac**"
(posterior) all other vessels, nerves and visceral structures **anterior** to **vertebrae** and **between** the **parietal pleura** of both lungs
49
Heart / Thorax 3
0. Thymic remanant
1. Internal thoracic artery
2. Rib 1
3. Left phernic nerve, left pericardiacophrenic artery
4. Costal part of parietal pleura
5. Fibrous pericardium
6. Line of fusion of fibrous pericardium to diaphragm
7. Superior epigastric artery
8. Musculophrenic artery
9. Line of fusion for fibrous pericardium with superior vena cava
10. Right axillary artery and vein
11. Right internal thoracic vein
50
Heart / Thorax 4
1. Left Vagus
2. Left subclavian
3. Left axillary artery
4. Left brachiocephalic vein
5. Costal part of parietal pleura
6. Left costocdiaphragmatic recess
7. Fibrous pericardium
8. Right and left phrenic nerves
9. Right costodiaphragmatic recess
10. Mediastinal part of parietal pleura
11. Superior vena cava
12. Arch of aorta
13. Right brachiocephalic vein
14. Right vagus nerve
51
Heart / Thorax 5
1. Left brachiocephalic vein
2. Ligamentum arteriosum and left recurrent laryngeal nerve
3. Left vagus nerve
4. Mediastinal part of parietal pleura
5. Transverse pericardial sinus
6. Fibrous and parietal serous pericardium
7. Left ventricle
8. Auricle of left atrium
9. Right ventricle
10. Right atrium
11. Auricle of right atrium
12. Ascending aorta
13. Pericardial reflections
14. Superior vena cava
15. Right brachiocephalic vein
52
Heart / Thorax 6
1. Ligamentum arteriousm
2. Transverse pericardiac sinus
3. Left superior and inferior pulmonary veins
4. Oblique pericardial sinus
5. Parietal layer of serous pericardium (fused to fibrous)
6. Inferior vena cava
7. Middle cardiac vein
8. Coronary sinus
9. Superior vena cava
53
Heart / Thorax 7
1. Left vagus nerve
2. Pulmonary trunk
3. Transverse pericardial sinus
4. Left phernic nerve and pericardiacophrenic artery and vein
5. Left inferior pulmonary vein
6. Parietal layer of serous pericardium
7. Fibrous pericardium
8. Inferior vena cava
9. Right superior pulmonary vein
10. Superior vena cava
11. Ascending aorta
12. Ligamentum arteriosum
13. Left recurrent laryngeal nerve
54
Heart 1
1. Brachiocephalic artery (trunk)
2. Right atrium
3. Inferior vena cava
4. Coronary sinus
5. Pulmonary veins
6. Auricle of left atrium
7. Right and left pulmonary arteries
8. Left subclavian
9. Left common caroitd
55
Heart 2
1. Left coronary artery
2. Cricumflex artery
3. Left marginal artery (obtuse)
4. Great cardiac vein
5. Anterior interventricular artery (Left anterior descending, LAD)
6. Right marginal artery (acute)
7. Small cardiac vein
8. Right coronary artery
9. Atrial branch of right coronary artery
10. SA artery
56
Heart 3
1. Sinuatrial node artery
2. SA Node
3. Small cardiac vein
4. Right coronary artery
5. Middle cardiac vein
6. Right marginal artery
7. Posterior interventricular artery (posterior descrnding)
8. Left marginal artery
9. Coronary sinus
10. Great cardiac vein
11. Circumflex artery
57
Heart 4
1. Ascending aorta
2. Auricle of right atrium
3. Crista terminalis
4. Pectinate muscles
5. Septal cuscp of tricuspid valve
6. Ostium and valve of coronary sinus
7. Inferior vena cava
8. Fossa ovalis
9. Limbus of fossa ovalis
10. Interatrial septum
11. Superior and inferior right pulmonary veins
12. Right pulmonary artery
13. Superior vena cava
58
Heart 5
1. Pumonary trunk
2. Auricle of left atrium
3. Pulmonary valve
4. Conus arteriosus
5. Supraventricular crest
6. Papillary muscles (septal)
7. Papillary muscles (anterior)
8. Papillary muscles (posterior)
9. Septomarginal trabecula
10. Trabeculae carneae
11. Chordae tendineae
12. Tricuspid valve (posterior cusp)
13. Tricuspid valve (septal cusp)
14. Tricuspid valve (anterior)
15. Ascending aorta
59
Heart 6
1. Ligamentum arteriosum
2. Coronary sinus
3. Inferior vena cava
4. Cordinae tendineae
5. Trabeculae carneae
6. Papillary muscles (anterior/posterior)
7. Epicardium
8. Endocardium
9. Myocardium
10. Bicuspid valve (anterior)
11. Bicuspid valve (posterior)
12. Pulmonary trunk
13. Auricle of left atrium
14. Arhc of aorta
60
Heart 7
1. Aortic valve (left, right, and posterior cusp)
2. Right coronary artery
3. Tricuspid valve (anteior, septal, and posterior cusp)
4. Atrioventricular nodal artery
5. Posterior intraventricular artery
6. Middle cardiac vein
7. Left and right fibrous trigones
8. Bicuspid valve (anterior and posterior cusp)
9. Circumflex artery
10. Left coronary artery
11. Pulmonary valve (left,right, and anterior?)
61
Heart 8 Aortic Valve
1. Ostium of left coronary artery
2. Mitral valve anterior cusp
3. Interventricular septum muscular part
4. Interventricular septum membranous part
5. Nodule
6. Ostium of right coronary artery
7. Sinuses of aortic valve
62
Heart 9 Tricuspid
1. Tricuspid valve (septal, anterior, and posterior)
2. Chordae tendineae
3. Papillary muscle (posteior)
4. Papillary muscle (posteior, septal, and anterior)
5. Interventricular septum membranous part
6. Ostium of coronary sinus
7. Ostium of inferior vena cava
63
Heart 10
1. Left bundle
2. Right bundle
3. Subendocrinal (Purkinje) fibers
4. Atrioventricular bundle (of His)
5. Atrioventricular node
6. Fossa ovalis
7. Crista terminalis
8. Sinu-atrial (SA) node
9. Superior vena cava
64
Heart / Thorax 8
1. Cervical cardiac vagal branches
2. Left vagus nerve
3. Thoracic cardiac vagal branches
4. Left recurrent largyngeal nerve
5. Cardiac plexus
6. Thoracic sympathetic cardiac branches
7. Sympathetic chain ganglion
8. Cervical symapthetic cardiac branches
65
Aortic valve stenosis
What happens during it?
Would be treated immediately?
What this might result in?
Opening of the aortic valve is narrowed
Heart hypertrophy to compensate
No because heart is getting stroned
Heart failure
66
What are the components of innate immunity?
Epithelia (physical barrier)
Phagocytic cells (macrophages and neutrophils)
Natrual killer cells
Blood proteins: complement system
67
What are the components of adaptive immunity?
B cells and plasma cells -- humoral immunity (antibody mediated)
T cells - cell-mediated immunity (cellular immunity)
68
3 types of Lymphocytes and their function
B cells - respond to cell free and plasma membrane bound antigens
T cells - respond to cell-bound antigens
Natural killer cells - non-specific production of perforins and granzymes
69
What is a difference between T cells and NK cells?
NK cells:
lack T cell recepotr (TCR)
lack CD4 and CD8
do not enter thymus to become immunocompetent
70
What are accessory cells of immune system?
Their function?
Macrophages (APC or phagocytic)
Dendritic cells (fibroblast-like cells forming the stroma of lymphatic tissue)
Epithelial reticular cells - found exclusively in the thymus
APCs (express MHCI & MHCII; present antigen; produce cytokines)
\* many APCs belong to mononuclear phagocytic system
71
T cells
Where do they originate?
Where do they become immunocompetent?
Where they can be easily found?
What "test" do they need to pass?
Bone marrow
Thymus
**Paracortical** regions of the **lymph nodes** & **Periarterial** sheaths of the **spleen** (vasculature)
Ability to differentiate between self and antigen
72
What is Naive T cell?
Immunocompetent T cell that must be activated
73
2 types of mature T cells
Memory T cells
Effector T cells
74
Three types of effector T cells
T helper cells (recognition of foreign antigens)
Cytotoxic T Cells (responsible for killing foreign cells, tumor cells, and and virus infected cells)
Suppressor T cells (suppresses the immune response of other T lymphocytes)
75
B cells
General function?
Origin?
In order to become plasma cells what cell they need to interact?
When do B cells proliferate and differentiate?
Are they found in all lymphoid tissue?
Humoral immunity
Bone marrow
T-helper
When they encouter antigen
In all except thymus (very little)
76
B cells
Types?
Function?
Where B memory cells are found?
Plasma cells (clock face): synthesize / secrete Ab; responsible for primaryresponse
B Memory cells: responsible for secondary response
Mante layer of lymph node
77
What is important about IgG and IgA?
IgG is most abundant in serum, fetal aquired immunity
IgA most abundant in glandular secretions (digestive, respiratory, and integument)
78
What is the name of the protein that is attached to IgA and prevents them from degradation in mucosal linings?
J protein
79
Stroma vs. Parenchyma
**Stroma**
**supportive tissue =** connective tissue fiber e.g. reticular fibers in lymph node; could be also dendritic cells; epithelial-reticular cell, but all have tight junctions
**Parenchyma**
**functional unit** = sits in the stroma = T, B, Ma, hepatocyte (liver)
80
Lymphocytes undergo ____ differentiation in the primary lymphatic organs
Lymphocytes undergo \_\_\_\_ activation in the secondary lymphatic organs
antigen-independent
antigen-dependent
81
Lymphatic System
Concentrate and eliminate antigens
Production and maturation of lymphocytes
Addition of antibodies
Provides a means for returning tissue fluid
Absorption of chylomicrons from the small intestine
82
Lymphoid Organs
Primary?
Secondary?
**PRIMARY**
Bone marrow
Fetal liver
Thymus
**SECONDARY**
Diffuse Lymphatic Tissue
Tonsils
Lymph nodes
Spleen
83
What cells/componets (4) are usually found in lymphoid organs?
Reticular fibers
Dendritic cells (APC)
Macrophages (APC/phagocytic)
Lymphatic vessels
84
What captures antigens in intestinal walls?
What are these cells are adjacent to?
What layer are lymphocytes located in?
M cells (mucosa/microfold)
Peyer's patches
Lamina propia
85
What is lymphatic nodule
Examples?
Primary composition?
Is it pernament?
Connective tissue (capsule)?
basic structural unit of diffuse lymphatic tissue
tonsils, lymph nodes, spleen ,GALT (gut associated lymphatic tissue), B (bronchus) ALT and M (mucosa) ALT
B cells, lymphoblasts, plasma cells, memory cells
Not always pernament; can be transitory
86
Types of lymphatic nodules (differentiation stage)
Color?
primary nodule = one that has not seen antigen
secondary = one with a germinal center in response to antigen
(light cells inside that undergo mitosis -- lymphoblasts)
87
Are there germline centers in fetus?
No, there are none because fetus has not seen any antigen.
88
Waldeyer’s Ring
Anatomical term collectively describing the annular arrangement of lymphoid tissue in the pharynx
89
How infections originating in pharynx is separated from the rest of the body?
Tonsils possess an incomplete capsule of connective tissue which acts as a protective barrier against leakage of antigen into pharyngeal CT spaces
90
Tonsils
what is it?
what chracteristic cells do they contain?
Aggregate of nodules grouped around crypts
They contain M cells and APCs
91
How to distinguish different tonsils?
Palatine – stratified squamous
Lingual – stratified squamous
Nasopharyngeal - respiratory
92
Lymph nodes
Where are they found?
Function?
Where T cells are found in lymph nodes?
situated in course of lymph vessels
allows for lymph to pass through before entering blood stream (filters) ; mantain / produce B and T cells
paracortical regions
93
Name of the passage for passage of arterioles, venules and efferent lymphatics in lymph node
Hilum
94
What is the differece between septum and trabeculate?
Septum go from the capsular surface through the organ
Trabeculae end in the organ
95
What is the histological difference between medulla and cortex of the lymph node?
Medulla has no nodules
96
What are two routes of the lymphoctes back to the bloodstream from lymph node?
By high endothelial venule (spread out endothelium that allow passage of lymphocytes)
Efferent lymphatic vessel
97
Subcapsular vs. paratrabecular sinus of lymph node
The subcapsular is just under the capsule while the paratrabecular is perpendicular toward the capsule and goes toward the efferent
98
From which layer are all of the lymphatic organs derived?
Exception?
Mesoderm
Thymus' epithelial reicular cells are derived from endoderm
99
Thymus
Function?
How long does it grow (age)?
Location relative to chest?
Are there germinal centers?
Shape?
T cells maturation
Mid-teens (then undergoes involution with fat accumulation)
Superior mediastinum
No germinal centers ~100% T cells
Bilobular and subdivided into lobules
100
What cells are involved in stroma of thymus?
Parenchyma?
Epithelial reticular cells (not connective tissue) which contain tingible body macrophages
P: T cells and thymocytes
101
Epithelial-reticular cells
Adhesions?
Importance?
What else do they produce?
Types?
Possess desmosomes and tonofilaments
Participate in the blood-thymic barrier (no antigen pass)
Hormones for T cell maturation (no other organ produces hormones)
Type 1-3 in cortex and Type 4-6 in medulla
102
What is one histological hallmark of thymus?
Hassall’s corpuscles in medulla
103
What is the function of medulla and cortex in Thymus?
Cortex = Maturations for T-cell (tangle body macrophages chew up; eliminate intolerant T cells)
Medulla = Thymic corpuscle (possibly worn out reticular epithelial cells)
104
What are the layers of Blood Thymic Barrier?
capillary endothelium
capillary basal lamina
CT sheath of the capillary
epithelial reticular cell basal lamina
epithelial reticular cell
105
Spleen
Size?
Location (old)?
Largest lymphoid organ in the body
106
Functions of spleen
Immunological filter of blood
Blood reservoir
Phagocytossi
Proliferation of B and T cells
Antibody production
107
Where can be T cells found in spleen?
periarteriole sheath (blood vessels that feed the central arterioles)
108
Red pulp vs. White pulp function (spleen)
Both red and white pulp are parenchyma
**Red pulp is the blood filter** _splenic sinusoids_ (capillaries that get blown up) _separated_ out _by splenic cords_ (lymphocytes, APCs, reticular fibers, blood cells WBC, most importantly macrophages. Macrophage is before the sinusoids. This arrangement is to remove old RBCs.
**White pulp is the immunological filter** (lymphatic nodules, has blood vessels associated, _centric arteriors,_ _lymphatic nodules_ with germinal centers including lymphatic nodules, periarterial sheets with T lympocytes, eccentric arteriols.
109
Spleenic sinusoids (Cords of Billroth)
What are they?
Hypothesis?
Location?
Purpose for this arrangement?
consisting of fibrils and connective tissue cells with a large population of monocytes and macrophages
Both open and close are present
Red pulp
This arrangement is to remove old RBCs.
110
Which of the following contains epithelium?
Tonsil / Lymph Node / Thymus / Spleen
Tonsil
111
Which one contains capsule and where is it?
Tonsil / Lymph Node / Thymus / Spleen
Tonsil - uderlying
Lymph node - capsule & trabeculae
Spleen - capsule
Thymus - capsule & septa
112
Main produces of these organs?
Tonsil / Lymph Node / Thymus / Spleen
Tonsil B/T cells
Lymph Node B/T cells
Thymus T cells
Spleen B cells
113
Which one has efferent and afferent lymphatic vessels?
Tonsil / Lymph Node / Thymus / Spleen
All have efferent
Only lymph node has afferent
114
Where are lymph nodules found?
Tonsil / Lymph Node / Thymus / Spleen
All except Thymus
115
What is route taken by antigen?
Tonsil / Lymph Node / Thymus / Spleen
Tonsil - Epithelum
Lymph Node - Afferent
Thymus - No antigen
Spleen - Blood vessels
116
Organized in cortex and medulla?
Tonsil / Lymph Node / Thymus / Spleen
Lymph Node and Thymus YES
Tonisl and Spleen NO
117
Phagocytic capacity of macrophages (strongest to weakest)
Tonsil / Lymph Node / Thymus / Spleen
Tonsil +
Lymph Node ++
Thymus ++++
Spleen ++++
118
Plasma cells
Tonsil / Lymph Node / Thymus / Spleen
Tonsil - Outer layer of Germinal Center
Lymph Node - Outer layer of Germinal Center & medulla
Thymus - None
Spleen - Outer layer of Germinal Center
119
Site of lymphocyte recirculation
Tonsil / Lymph Node / Thymus / Spleen
All have efferent
Lymph node has also high endothelial venule
120
What happens to the blood if there is a left heart failure?
It accumulates in veins then goes to tissue.
121
How is the chest divided?
Chest is divided intop three cavities:
1 pulmonary for each lung
and
mediastinum between
122
How is the diaphgram connected to pericardiac sac?
Central tendom of diaphgram is fued to the fibrous portion pericardium
123
The hole in the left lung where the heart lies
Cardiac notch
124
The "bottom" posterior-inferior part of the heart
What is the importance of it?
Is the bottom of the heart at T9 level?
Diaphragmatic surface of heart
Heart and diaphgram moves together
Only theoretically
125
Where is the pericardiacophrenic artery and phrenic located at the heart level?
Between parietal pleura and fibrous pericardium
126
Why proximity of the escophagus to heart might be clinically important?
Can do ultrasounds of the heart
127
Where is the right costomediastinal recess with respect to the lung pleura?
Relfection of a parietal pleura from its costal surface onto its pericardial surface.
This creates a space
128
What is the top limit for superior mediastinum?
At what level is the mediastinum is divided?
What is the lower limit for inferior mediastinum?
Thoracic outlet / Superior thoracic aperture
T4/T5 level
T9
129
Great vessels
Large vessels that bring blood to and from the heart
130
What is the precurosor of ligamentum arteriosus?
ductus arteriosus
131
Angiogram
an X-ray photograph of blood or lymph vessels
132
Where does the coronary sinus enters the heart?
What is the name of that entrance?
Right atrium
Ostium and valve of coronary sinus
133
Smooth areas vs. Muscular areas of atrium
Names for each?
Reason?
Smooth (interatrial septum) develops along vessels
Muscular (pecinate muscles) remenant of primitive atria
134
What is the name of muscles that pull cusps down?
What are the name of the ropes?
Trabeculae carneae
Chordae tendineae
135
What specific muscular structure carries right bundle branch of the AV?
What is another name?
This septomarginal trabecula is important because it carries part of the right bundle branch of the AV bundle of the conduction system of the heart to the anterior papillary muscle.
Moderator band
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What is the name of the area inferior to pulmonary valve?
Conus arteriosus
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Two parts (types of the wall) in intraventricular septum
Muscular & fibrous (thinner)
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The name of the region in the same plane where all four valves sit
Fibrous skeleton of the heart
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During which phase do coronary arteries fill?
Diastole
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Where do vagus' fibers go to?
Reccurent laryngeal branch
Branch that goes to cardiac plexus
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Where is the referred pain from heart coming from?
Same region where the others synapse C5-T1
Like upper limb
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Pericardial effusion - Why it might be due to? What is the cost?
What is hemopericardium?
What is cardiac tamponade?
What is pericardiocentesis?
**Pericardial effusion** = abnormal accumulation of fluid in the pericardial cavity
Due to penetrating chest wounds and cardiac injuries
Reduces blood volume that is pumped
**Hemopericardium** = blood in pericardium
**Cardiac Tamponade** = compression on the heart
**Pericardiocentesis =** Drainage of fluid from the pericardial cavity = **pericardial tap** (diagnostic and decompressive).
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Difference between aortic and mitrial valve
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Valvular heart disease due to cusps function deterioration
Stages?
Damage to or a defect in one of the four heart valves.
**Rheumatic vegetation** (thickening of the valve)
**Thickening cusps** (blood growth) = insufficiency
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Valvular Heart Disease
General types?
Rheumatic vegetations / Thickening cusps
Mitral Stenosis: Thromboembolic Complications
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Valvular Heart Disease
Mitral Stenosis: Thromboembolic Complications
Susceptibility of the left atrium (due to auricle) to develop thrombi in mitral stenosis
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Atherosclerosis
Coronary artery disease (CAD)
Coronary bypass
Coronary angioplasty
**Atherosclerosis** = characterized by _irregularly distributed lipid deposits_ in the intima of large and medium-sized arteries, causing _narrowing_ of the arterial lumen and eventual _fibrosis_ and _calcifications_. Recanalization of the artery may occur (with some improvement of the symtoms).
**Coronary artery disease** develops when your coronary arteries — the major blood vessels that supply your heart with blood, oxygen and nutrients — become damaged or diseased.
**Coronary angioplasty** (AN-jee-o-plas-tee), also called percutaneous coronary intervention, is a procedure used to open clogged heart arteries. Angioplasty involves temporarily inserting and inflating a tiny balloon where your artery is clogged to help widen the artery.
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Heart Transplantation
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Facial palsy
Facial paralysis
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Lymphedema
Refers to swelling that generally occurs in one of your arms or legs
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Pitting endema
Indicate of heart failure
Skin does not rebound
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Can cardiac muscle form tetanus?
153
Primary and Secondary/Latent Pacemakers
Primary - SA node
Latent - other structures along conduction sytem
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Two types of conduction cells in heart and their subsets
**Conduction cells:** SA node cells, internodal conduction track, AV node, bundle of Hiss, Purkinje cells
**Contraction and relxation cells:** atrial and ventricular
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Where is the SA node located?
Lateral portion of right atrium
Near vena cava
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What is the delay at AV node?
How long is plateau in ventricular cells (no plateau in SA)?
Delay: About 130 ms
Plateau: 100-200 ms
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Why SA nodes fires quicker than Purkinje fiber?
It has higher RMP
Higher permiability to sodium in SA node than in other cells in heart
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Difference of action potential in skeletal muscle vs. cardiac muscle
Fast few miliseconds
300ms with large plateau
Cardaic cells are not permeable to Cl- ions
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What RMP gives the highest maximum upstroke velocity?
about -80mV
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What is the relationship between [K+]o and RMP
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Action potential in ventricular cell.
Treshold?
What happens if some Na+ channels are not inactivated? What does it lead to?
What channels play a role?
Phases?
When Ito activate?
When ICa++ abd IK activate?
Which phase detemines the strength of muscle contraction?
-65 mV
Long QT possibly leads to EAD then to Torsades de Pointes, ventricular tachycardia, and fibrillation
INa, ICa, Ito (transient outward), IK (delayed recitfier), IK1 (inward rectifier)
0. Depolarization/overshoot ; 1. Quick repolarization ; 2. Plaetau ; 3. Final phase of repolarization ; 4. Diastolic
Ito -30 mV ; ICa++ -20mV ; IK -40mV
Pleaeau
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Three types of ion channels classification based on how they are controlled
Channels activated or suppressed by a ligand (e.g. ACh)
Voltage-dependent channels
Background "leak" channels
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Rate of depolarization during phase 0
upstroke velocity
dV/dt max
Vmax
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Why high [K+]o might lead to smaller overshoot and Vmax?
Example?
Which phase / varaible does this change affect?
What is fast-depressed response?
Slow response?
What pathology can result from this?
Na+ channels will become gradually inactivated until membrane potential reaches a level at which they are completely inactivated (~ −50 mV)
Phase 0 (Vmax and overshoot)
Ischemia
**fast-depressed response**: Some sodium channels are inactivated, but there are some open durig the beginning of action potential
**slow response:** only Ca++ channels because all Na+ channels are inactive
abnormal reentrant excitation and ventricular arrhythmias (e.g. heart attack during coronary block)
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By what channels is the fast response and slow response determined?
Na+ channels
Ca+ channels
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Are Ca+ channels conductivity affected by the increasing RMP?
Usually not because they are regulated by the voltage above -50mV
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Why there is an immediate drop of voltage after the action potential in ventricular cells?
Which potassium channel regulates RMP, but it is not involved in during most of action potential?
**Ito** channels.
The permeability of K+ is high due to **IK1 **but drops dramatically to almost 0 during Phase 0 of the action potential when Na+ channels open. It is regulated by Mg2+ and intracellular polyamines spermine it is inactivated during beginning of action potential.
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What ionic currents determine the action potential in SA node?
Which current is not significat?
What is the treshold of SA node?
The activation of two classes of Ca2+ channels, one being activated at slightly more negative potentials than the other.
Voltage-gated Na+ channels DO NOT contribute by any means to Phase 0 or any other phase of the SA nodal action potential.
-40 to -50 mV
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How is the action potential in SA node different?
Ca+ dependent
slow, displaying maximum upstroke velocities of ~ 15-20 Volts/sec.
No phase 1 or 2
Repolarization activates Ifunny or If (activated by hyperpolarization / allow Na+/K+ to flow equally)
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Excitability
The capacity of a cardiac cell to initiate an action potential in response to an external stimulus
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Maximum Diastolic Potential (MDP)
Most negative membrane potential achieved during diastole in cardiac cycle.
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Automaticity
Ability of cardiac cell to spontaneously depolarize and initiate propagated response
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Decremental Conduction
In most cardiac fibers, conduction spreads without decrement (i.e. constant conduction velocity, however in some areas, conduction spreads with decrement (i.e., decrease in conduction velocity).
## Footnote
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Conduction Velocity
The **rate** at which the wave **of excitation spreads** through the functional syncytium of the heart (domino effect by spread of local circuit currents). _Depends_ upon: (i) **fiber diameter**, (ii) **maximum upstroke velocity** of the action potential (dV/dt), and (iii) **overshoot** of the action potential.
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Ion currents in action potential in SA node
IK (rectifier) causes quick repolarization
hypolarization and activateion of If leads to prevention in further repolarization
If leaks mainly sodium leading to another AP
If is inactivated during AP
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Parasympathetic effect on:
SA? Atria? AV? Ventrcle?
Sympathetic effect on:
SA? Atria? AV? Ventrcle?
**Parasympathetic**
**SA:** ↓MDP (ACh → (+) K+ channels) → ↓ SA
Vmax → ↓ SA
**Atria:** similar to SA
**AV:** ↓ in excitbaility
**Ventricle:** antagonizing β-adrenergic stimulation
**Sympathetic**
**SA: **↑ICa++ & ↑ If → ↑ Vmax
No effect on MDP
**Atria: ↑**ICa++
**AV: **↑ Excitability
**Ventricle: **
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Hyperkalemia (high [K+]o) effects on
SA? Atria? AV? Ventrcle?
Hypokalemia (low [K+]o) effects on
SA? Atria? AV? Ventrcle?
**Hyperkalemia**
**SA: **Depresses automaticity
**V, A, and P**: RMP depolarization, reduces maximum rate, reduces conduction velocity, decreases duration
**Hyperkalemia**
**V, A, and P**: Increases potential duration
**SA node:** Enhances automaticity
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Why the Na+/K+ pump is electrogenic?
It Participates in Determining the Resting Potential
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How is the changes in permiability of K+ cardiac muscle different from skeletal muscle during the initial phase of action potential?
It goes down in cardiac muscle and goes up in skeletal muscle
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Causes (external) for Arrhythmia
Causes (mechanism- abnormal impulse formation) for Arrhythmia
Causes (mechanism- impulse conduction) for Arrhythmia
Consequences of Arrhythmias
Classification of Arrhythmias
Occurence of Arrhythmias
**Causes:** Ischemia (pH/electrolyte), fiber strech, autonomic misregulation, chemicals (e.g. digitalis)
**Causes** **(AIF)**: no change of pacemaker location brady/tachycardia, changes in pacemaker site (latent pacemaker, injury current, oscillatory after-depolarization)
**Causes (IC):** slowed without reentry (AV Block), slowed with reentry
**Consequences:** lower mechanical performance, gets worse, formation of thrombi
**Classficiation: **Abnormal implusle formation (Tiggered activity EAD/DAD), Spontaneous automaticity) and Reentrant (Reflection, circus movement, phase 2 reentry)
**Occurence:** MI 80-90%, General Anastesia 20-50%, Digitalis 10-20%
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Factors favoring the development of reentry of signal
Long reentrant pathway
Slow conduction
Short effective refractory
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DAD vs. EAD
Causes for each?
What is EAD associated with on EKG?
**DAD: **Ca2+ release after repolarization
**DAD causes:** ischemia (intracellular Ca2+ overload), cardiac glycosides (digitalis), catecholamines, UP HR, low [K+]o or high [Ca2+]o, caffeine, hypoxia, cardiac hypertrophy
**EAD:** opening Ca2+ occurs during relative refrecatory period
**EAD causes: **most often aquired (drugs/genetic), hypoxia, acidosis, cahnges in the ionic environment, catecholamines, current injections, pharamcological agents, antiarrhtyhmic agents
**EAD & EKG:** Long QT syndrome
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How the height and Rate of Rise of the Upstroke on Conduction Velocity
Faster conduction rate = faster propagation
Faster conduction velocity = faster propagation
184
Modified Goldman-Hodgkin-Katz (GHK) Equation
185
What are the slow responses in Ventricular cells similar to?
action potentials in SA node
186
Long QT (LQT) Syndrome
Causes?
What it might lead to?
**Inherited or congenital (rare):** Genetic mutations affecting the expression and/or function of voltage-gated ion channels determining the cardiac action potential
**Acquired (more common):** Drug-induced but could involve a ill-defined genetic predisposition
**Torrades des pointes:** Torsade de pointes is an uncommon and distinctive form of polymorphic ventricular tachycardia (VT) characterized by a gradual change in the amplitude and twisting of the QRS complexes around the isoelectric line
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Tension vs. [Ca2+]
Tension increases with calcium concentration.
Thre graph has sigmoidal shape.
During diastole pCa = 7 (10 nM)
During normal contraction pCa = 6 to 5.3 (1 to 5 uM)
Maximum force can be evoked by 30 uM.
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What are T-tubules make a close contact with at relatively regular intervals?
SR
189
Does skeletal muscle or cardiac muscle require Ca2+?
Skeletal does not
Cardaic does
190
Ca2+ transient
The surge of calcium going through the its channel
191
Which source of calcium provides main part required for contraction?
Sarcoplasmic Reticulum
Extracellular (only 10%)
192
CICR
Why does it occur?
Ca2+ induced Ca2+ release
The way that calcium is released in muscles
juxtaposition of Ca2+ channels in the T-tubules and ryanodine receptors a Ca2+ channels present in the SR
193
How T-tubules Ca++ channels are activated?
How RyR channels are activated?
Voltage
Calcium
194
What is responsible for relaxation in cardiac muscle?
Ca2+-ATPase activated by Ca++ (main)
Na+/Ca++ exchanger (main for extracellular and needed for balance)
195
What changes in action potential increase ventricular contraction and higer Ca2+ release
Lengthening of the action potential
Elevation of the level of the plateau
This effect is mediated by CICR
196
Cardiac glycosides e.g. digitalis action
Inhibits Na+/Ca2+ exchanger
This leads to buildup in cell
Ca2+-ATP can store more Caclium in SR
More calcium can be released by CICR
197
EC coupling
Exitation Contraction Coupling
198
b1 sympathetic stimulation on heart mechanism
Gs
1. PKA enhace probability of Ca2+ channels opening (phosoporylation) both in plasma membrane and SR (most important)
2. RyR stimulation increases influx and facilitates termination
3. Phospholamban (Ca2+ inhibitor) inactivation by phosphorylation
4. Phosphorylation reduces troponin affinity for Ca++ facilitates relaxation
199
Tropomyosin function
is ultimately responsible nbfor allowing or preventing the interaction of actin and myosin during the cardiac cycle
200
Troponin Complex
Troponin I C T
201
Troponin C
Ca++ binding protein
202
Troponin I
**TnI inhibits** the interaction between **myosin** and **actin** although it is much
weaker than tropomyosin when exposed alone to these two proteins in vitro.
Can be phosphorylated to increase the rate of relaxation.
203
Troponin T
Integrity of the complex
204
The term that describes smooth muscle shape when relaxed.
Fusiform
205
What are myofilaments?
Actin and myosin
206
Term that describes a heart functioning as a one unit.
Syncytium
207
Axonal swellings containing synaptic vesicles
en passant
208
What is a difference in histological composition of large and small arteries?
Small have more smooth muscle and can be regulated
Large have more elastic tissue
209
Where is the most blood in systemic and pulmonary circulartion?
Veins - systemic
Equalliy distributed - pulmonary
210
Which organs are predominantly T cells?
Which organs are predominantly B cells?
Which organs are equal in B & T cells?
T cells: Thymus, Blood
B cells: Lymh nodes, Bone marrow
Equal: Spleen
211
Name the cords that surround splenic sinuses
What do they contain?
Billroth cords
Macrophages
212
Name the macrophages that destroy T cells in thymus
Tingible body macrophages
213
What is the name of the conducting system that connect SA node to left atrium?
Bachmann bundle
214
Three types of leads in EKG
Standard bipolar leads: I, II, and III
Augumented unipolar leads: aVf, aVr, and aVf
Precordial chest leads
215
Normal EKG intervals
P
P-R
QRS
T
Q-T (beggining of Q to end of T)
P 60-110
P-R 120-210
QRS 30-100
T Varies
Q-T (beggining of Q to end of T) 260-490
216
What insulates atrium from ventricle?
What structure only passes
Fibrous skeleton
conducting fibers
217
ERP
Absolute refractory period also refered as effective refractory period
218
Which artery is obtuse?
The left margin artery
219
Where does the SA node lies?
At the top of the sulcus terminalis
220
Sulcus terminalis
Groove in the right atrium of the heart
Separates right atrial pectinate muscle from the sinus venarum
