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Cardiac phys

QuestionAnswer
The heart is bounded anteriorly by the _____________ and the costal cartilages of the third, fourth, fifth ribs and inferiorly by the ___________. sternum, diaphragm
What is located anteriorly and inferiorly toward the left 5th intercostal space? the apex
This is known as the point of maximal impulse. S1 and S3 can also be auscultated here. apex
What are the 3 layers of heart muscle? epicardium, myocardium, endocardium
What is the sac around the heart called? pericardium
What are the two layers of the pericardium? parietal and visceral
What separates the atria and ventricles? coronary sulcus aka AV sulcus
The RV and LV are separated by the _______________ __________, which descends from the coronary sulcus to the apex. interventricular sulcus
What is the interventricular sulcus composed of? anterior interventricular sulcus and posterior interventricular sulcus
The anterior IVS contains the ____, which course over the IV septum and continues posterior. LAD
The atria and ventricular septa meet where in the heart? the crux
The crux is important in determining what? coronary artery dominance
One of 2 main veins that carry deoxygenated blood from the body to the right atria. superior vena cava
one of 2 main veins that carry deoxygenated blood from the lower extremities to the right atria. inferior vena cava
The largest single blood vessel in the body that carries oxygen rich blood from the left ventricle to the rest of the body. Aorta
Transporter of de-oxygenated blood from the right ventricle to the lungs. pulmonary artery
Transporter of oxygenated blood from the lungs to the left atrium. pulmonary vein
Receives de-oxygenated blood from the body through the superior vena cava and inferior vena cava; has a muscle wall thickness of about 2um, Right atrium
This valve separates the right atrium and right ventricle, and opens to allow de-oxygenated blood to enter the right ventricle. tricuspid
Receives de-oxygenated blood from the right atrium. right ventricle
Receives oxygenated blood from the lungs through the pulmonary veins. left atrium
Blood passes through which valve from the left atrium to the left ventricle? mitral valve
Receives oxygenated blood from the left atrium. left ventricle
These muscles attach the lower portion of the inferior wall of the ventricles. They attach the cordae tendonae, which is attached to the mitral and tricuspid valves. papillary muscles
What is the normal valve area of the tricuspid? 7cm squared
Symptoms of tricuspid insufficiency occur with a valve area less than : 1.5cm squared
What is normal area for the mitral valve? 4-6cm squared
What area is considered mild mitral stenosis? 1.5-2cm squared
What area is considered moderated mitral stenosis? 1-1.5cm squared
What area is considered severe mitral stenosis? <1cm squared
When do clinical symptoms start to occur in the mitral valve? when the valve area is cut in half
The ____________ valves are situated within the outflow tracts of their corresponding ventricle. semilunar
What valve separates the left ventricle from the pulmonary artery? pulmonary valve
What valve separates the left ventricle from the aorta? aortic valve
Above the aortic valve is a dilation known as the sinus of ___________, which allows the valve to open efficiently without occluding the ostia or openings that communicate with the coronary arteries. valsalva
What is the normal valve area of the aorta? 3-4 cm squared
Reduction in aortic valve area by how much is associated with increased symptoms. 1/3 - 1/2
What valve area produces severe AS? <0.8 cm squared
What supplies blood to all tissues except the lungs? systemic aka peripheral aka greater circulation
What circulation carries deoxygenated blood away from the heart, then returns oxygenated blood back to the heart? pulmonary circulation
What transports blood under high pressure to body tissues, consists of strong vascular walls, and blood flows rapidly through them? arteries
What are the last small branches of the arterial system that contain control valves in which blood is released into capillaries? arterioles
What has a strong muscular wall capable of completely closing or dilating that has a greater effect on altering blood flow to the capillaries? arterioles
What functions in the exchange of fluid, nutrients, hormones, and other substances between blood and interstitial fluid? capillaries
Capillary walls are very thin and permeable. T/F T
What are the collectors of blood from the capillaries and delivers it to the veins? venules
What functions as a conduit of blood away from the tissues and back to the heart? veins
Walls of the venous system are very thin and distensible, which makes it easier for the vessels to carry a large amount of blood. T/F T
Blood pressure is controlled _______________ of local blood flow or cardiac output. independent
Arterioles will constrict based on nerve reflexes in response to decreases in the mean arterial pressure below what? 100 mmHg
What intrinsic reflexes are found on the walls of the carotid sinus and respond to changes in the wall stress? baroreceptors
What reflexes are located in low pressure areas? cardiopulmonary reflexes
Which reflex responds to increases in atrial pressure and volume, including tachycardia? bainbridge reflex
What are located in the aortic arch and carotid sinus that respond to hypoxia, hypocapnia, and acidosis? chemoreceptors
Chemoreceptors will stimulate breathing, but also _________ areas of the brain and arterial system when pressure is too low to stimulate the baroreceptors? vasoconstricts
What response is stimulated by brain stem hypoxia. It occurs with severe hypotension and causes a powerful vasoconstriction to maintain cerebral perfusion? CNS ischemic response
The CNS ischemic response is also known as what? cushings reflex
What are a couple examples of extrinsic reflexes? cold, pain
What are the 3 layers of the aorta made up of? intima, media, and adventicia
What occurs when there is a tear in the intima leading to separation of the tunica media and formation of a false lumen? aortic dissection
_____________ fibers within the aorta allow it to stretch under pressure. connective
Connective fibers are especially dense in the wall of the _______________ aorta, which experiences the greatest force with each heart beat. ascending
When the diameter is 1.5 times the size of the aorta, this is what? an aneurysm
What is the beginning of the aorta? the root
The aortic root gives rise to 2 _______ arteries and ends at the beginning of the ascending aorta (sinotubular junction). coronary
The 2 coronary arteries are responsible for carrying oxygen rich blood to the heart muscle. T/F T
What part of the aorta leaves the left ventricle and has little support from surrounding tissues and is the most vulnerable part of the aorta? ascending aorta
What arteries that come from the arch of the aorta supply blood to the head and upper body? inominate, left common carotid, and left subclavian
Where does the descending aorta end? the diaphragm
What arteries that feed the spinal cord are contained in the descending aorta? intercostal arteries
The beginning portion of the descending aorta is most vulnerable to injury. T/F T
What portion of the aorta begins at the diaphragm and ends at the visceral vessels? thoracic abdominal aorta
What part of the aorta begins below the renal arteries, which supply blood to the kidneys? abdominal aorta
The aorta ends where it divides into the two ________ arteries. iliac
Oxygen rich arteries that supply the myocardium are? coronary arteries
Deoxygenated vessels involved in coronary circulation are? coronary veins
What arteries run on the surface of the heart? epicardial coronary arteries
What arteries run deep within the heart muscle? subendocardial coronaries (blockage to these arteries is critical)
What artery originates from the aorta, distal to the aortic valve and appears on the surface of the heart between the pulmonary trunk and the auricle of the right atrium? RCA
What are the branches of the RCA? marginal, posterior interventricular, and AV nodal branch
Where does the RCA distribute to? R atrium and R ventricle and variable portions of the L atrium and ventricle
Where does the left coronary artery arise from? the base or ascending aorta
What are the major branches of the LCA? anterior interventricular branch and circumflex
Where does the LCA distribute to? both ventricles, IV septum, and left atrium
What opens directly into the heart chambers and returns blood back to the right atrium? coronary sinus
Failure of the coronary circulation causes what? ischemic heart disease
What are the branches of the left main? LAD, LCX, and possibly the diagonal margin
Where does the LAD provide collateral circulation to? the anterior wall of the RV
What arises from the left main and is directed posteriorly as it travels around the left side of the heart within the left AV sulcus? left circumflex
_____________ is determined by the coronary artery that crosses the crux and provides blood flow to the posterior descending artery. Dominance
What is the dominant artery in 60% of the population? RCA
What percent of the population has left coronary dominance? 25%
What are the 3 main venous systems in the heart? coronary sinus, anterior cardiac veins, and thesbian veins
What are the 3 types of cardiac muscle? atrial, ventricular, and excitatory and conduction muscle fibers
The cardiac muscle is striated similar to _____________ muscle. skeletal
Cardiac muscle contains myofibrils that contain _________ and __________. actin and myosin
What are the cell membranes that separate individual cardiac muscle cells from one another? intercalated discs
Cardiac muscle is a mass of many heart muscle cells. T/F T
Action potentials can be conducted between the atrial synctium and the ventricles by a special conduction system called the____ ________________. AV bundles
What is cardiac RMP? -85 --- -95
Phase 0 is: depolarization
Phase 1 is: initial repolarization
Phase 2 is : the plateau phase
The CA influx delays repolarization and prolongs the ______________ ______________ period. absolute refractory
Phase 3 is: terminal repolarization and returns the resting membrane potential near 0
Phase 4 is: diastole
The ____________ conduction system is a group of specialized cardiac cells that pass an electrical signal throughout the heart. intrinsic
What is the intrinsic conduction system composed of? SA node, AV node, bundle of His, right and left bundle branches, and the Purkinje fibers
What is the velocity of conduction of the excitatory action potential along the atrial and ventricular muscle fibers? 0.3 - 0.5ms
What is the primary pacemaker of the heart? SA node
What is the time interval during which a normal cardiac impulse cannot be reexcited? Absolute refractory period
What is the period during which the muscle is more difficult to excite, but can be excited? Relative refractory period
The refractory period and the rhythmic rate of contraction in the _____ is faster than the _____________. atria, ventricles
Where does cardiac innervation originate? the ANS and T4-T5
What is autonomic outflow divided into? SNS and PSNS
Rate is: dromotropic
strength of myocardial contraction is : inotropic
What is the SA node also known as? keith flack node
What 2 cell types are contained in the SA node? P-cells and intermediate/transitional cells
What inhalational anesthetics decrease SA node automaticity? halothane, iso, and ethrane
Internodal tracts are found where? in the atrium
What are the 3 major internodal tracts? anterior, posterior, middle
What tract sends fibers to the LA and through the septum to the AV node? anterior or bachman's bundle
What tract continues along the terminal crest to enter the atrial septum and then the AV node? posterior
What tract curves behind the superior vena cava before descending to the AV node? middle or wenckebach's tract
What causes a delay in the cardiac action potential? AV node
Why is there a greater resistance to the action potential at the AV node? cell size is small
What extends to the lower end of the AV node and enters the posterior part of the ventricle and purkinji system? bundle of His
What is the preferred channel for the conduction of the action potential? AV bundle
What does the purckinji system consist of? bundle branches
What is the period from one ventricular contraction to the next? cardiac cycle
What is the first phase of diastole? isovolumetric relaxation
During isovolumetric relaxation, which valves are closed? mitral and aortic valves
What is the 2nd phase of diastole? true filling phase
What happens in the first period of filling? mitral valve opens
What is the second period of filling? diastasis
What is the 3rd period of filling also known as? atrial kick (rapid filling)
What is the first phase of systole? isovolumetric contraction
During the first phase of systole, there is an increase in ________, but no increase in ___________. pressure, volume
What is the second phase of systole? true systole
During true systole, what valve opens and what valve closes? aortic valve opens; mitral valve closes
During the first 1/3rd of true systole what happens? rapid ejection
What represents ventricular depolarization? QRS complex
What is the first negative deflection on the EKG? Q wave
What on the EKG is representative of the time from the end of ventricular depolarization to the beginning of repolarization? ST segment
In the ST segment, what is considered abnormal elevation in the standard lead and precordial leads? 1mm-standard 2mm- percordial
What is representative of ventricular repolarization? T wave
The T wave is normally upright in what leads? I, II, V3-V6
The T wave is usually inverted in what lead? AVr
The T wave should not exceed what height in the standard or precordial leads? 5mm or 10mm
What is the small upright deflection after the T wave that is usually non-detectable? V wave
What wave is thought to represent repolarization of the papillary muscles and purkinji fibers? Q wave
What is normal coronary blood flow? 4-7% of cardiac output or 225-250cc/min
What is the ability of the heart to maintain coronary blood flow through a range of MAP of 50-120mmHg? autoregulation
When arterial blood exceeds or falls below these levels, the autoregulation becomes ____________ dependent. pressure
During hypotension, when the coronary vesicles are maximally dialted, coronary blood flow is determined by what? MAP - RAP (or CVP 2-8mmhg)
How is CPP determined? DBP - LVEDP
What phenomenon is of concern with the administration of vasodilating agents in anesthesia? coronary steal phenomenon
In the coronary steal phenomenon the area with normal _____________ is the only area that has the ability to dilate and increase coronary flow. autoregulation
What anesthetic agent has myocardial protective properties during periods of ischemia? isoflurane
How does isoflurane protect the heart? decreases oxygen free radicals, preserves myocardial ATP stores, and inhibits increased intracellular CA
The volume of blood pumped by the heart each minute is? cardiac output
How is CO calculated? CO= HR x SV
What is normal CO? 5-6L/min
What are the determinants of SV? preload, afterload, contractility, and ventricular compliance
What is CO corrected by? CI
How is CI calculated? CI= CO/BSA
What is normal CI? 2.5- 3.5 L/min
End diastolic volume is also known as: preload
The relationship between EDV and CO is shown by what principle? Frank Starling Principle
In healthy hearts, the EDV for the right side is approximately equal to the left. T/F T
How is EDV measured? PCWP and RAP
What are the determinants of preload? blood volume, ventricular compliance, myocardial contractility, and venous tone
Increase in intrathoracic pressure during inspiration will decrease ________ ___________. blood volume
Increased activity causes an increase in tone, which increases ___________. volume
_________ _________ is determined by the volume of blood in the heart at the beginning of systole (EDV), and the amount of blood remaining in the ventricle at closure of the aortic valve at the end of systole (ESV) stroke volume
The equation for SV is: SV= EDV-ESV
Normal SV = 55-100ml
The degree of stretch of the left ventricle fibers, influenced by the amount of blood in the ventricle, determines the amount of work the ventricles can do. EF
What is normal EF? 60-70%
How is EF calculated? EF = EDV- ESV/ EDV
Severe impairment occurs with an EF less than what? 40%
Wall stress or tension faced during ventricular contraction is: afterload
What is afterload dependent on? shape, radius, size, wall thickness, aortic impedence, arterial wall stiffness, blood viscosity
SVR is usually used to measure afterload, however this only measures what? peripheral arterial tension
What states that the larger the radius, the greater the wall tension required to develop CO? Law of Laplace
What is determined by the automaticity of the sinus node? HR
What is the SA node rate? 60-80
What is the AV node rate? 40-50
Increased HR = Increased ? even if SV is constant CO
Increased HR shortens the filling time between beats, decreasing diastolic filling at rates of > ? 160
What is the inotropic state of the heart independent of preload, afterload, and HR? contractility
Systole- contractility is determined by the length of the sarcomere, which is dependent on what electrolyte? calcium
Diastole- myocardial relaxation occurs as a result of reuptake or binding of Ca ions by what? the sarcoplasmic reticulum
What effect says that increasing afterload, increases contractility? Anrep effect
What is the forced frequency or staircase phenomenon? Treppe phenomenon
As ventricles fill with blood, the pressure and volume that results are determined by what? compliance
When is compliance decreased? dilated cardiomyopathy, tamponade, htn
Heart pump and adjustment of the pump to extreme changes occurs by way of what 2 mechanisms? intrinsic regulation and ANS
What mechanism describes that the greater the heart muscle is stretched during filling, the greater the force of the contraction and a greater quantity of blood is ejected? Frank starling
graphic analysis of ventricular pumping is illustrated via what? pressure- volume loops
The area within the loop which is the product of the SV and afterload is what? stroke work
The max amount of pressure that can be developed at any given volume is what point on the loop? ESPVR
The filling curve of the ventricle and the passive properties of the myocardium is what point on the loop? EDPVR
The EDPVR curve is reciprocal of ventricular compliance. T/F T
When would you see an increased afterload loop? htn, aortic stenosis
Ventricles become dilated w/o thickening of the wall, which results in an increase in ESV and EDV. Pressure remains constant and the curve is shifted to the right. dilated cardiomyopathy
An increase in thickness and mass of the myocardium, which results in decreased chamber compliance. LV pressures are elevated. ESV is increased and EDV is decreased. Left ventricular hypertrophy
What impairs LV filling so that there is a decrease in preload. This also leads to a decrease in SV by the Frank-starling mechanism and a fall in CO and aortic pressure. Mitral stenosis
This is a condition in which the aortic valve fails to close completely at the end of systolic ejection, causing leakage of blood back through the valve during LV diastole. Aortic insufficiency
When the LV begins to contract and pressure is increased, blood will flow back into the left ventricle. This is called what? aortic regurg
What is it called when blood flows back into the left atria during ventricular systole? mitral regurg
In mitral regurg, there is no true period of isovolumetric relaxation. T/F T
The heat pump can be increased by almost 100% by the ____, and decreased to zero by the _____. SNS, PSNS
In an individual, the SNS can increase HR to ? 180-200
Strong ______ stimulation to the heart can stop the heart for a few seconds, but the heart usually escapes and will beat at a rate of 20-40. This stimulation can also decrease heart strength by 30%. vagal
What is the most important determinant of CO, as long as afterload and contractility are not affected? Preload
What is forced expiration against a closed glottis? valsalva maneuver
What are located at the bifurcation of internal and external carotids and aortic arch? baroreceptors
What goes through Herrings nerve and either the glossopharyngeal or vagus nerve? afferent pathways
When there is inhibition of the vasomotor center of the medulla what happens? decrease SNS, increase PSNS, and decrease HR, contractility, and vasodilation
What reflex is caused by traction on the extraocular muscles, conjunctiva, or orbital structures? oculocardiac reflex
Disturbing the oculocardiac reflex produces what responses? hypotension, decreased HR, and arrhythmias
The oculocardiac reflex can be seen with what? retrobulbar blocks, trauma, and post enucleation
Stimulation of the oculocardiac reflex can be blunted by what? removing the noxious stimuli, or by administering an anticholinergic
What reflex is seen in patients undergoing abdominal surgery when there is traction on the mesentery or gall bladder? celiac reflex
Stimulation of the celiac reflex results in : bradycardia, hypotension, and apnea
The atria and aorta contain receptors that respond to pressure changes. These receptors will increase or decrease HR in response to high or low BP. T/F T
What reflex responds in a shock state, failing heart, or overtransfused heart that will increase HR and BP. Bainbridge reflex
Increased ICP causing cerebral ischemia. The response to this reflex is htn, bradycardia, and resp variability. Cushings
What reflex responds to a decrease in O2 sat and an increase in CO2. The response is increase in resp drive and increase in BP. chemoreceptor reflex
Brain % CO? 15
Heart % CO? 3.3
kidneys % CO? 23
liver % CO? 29
Lungs % CO? 3.5
Muscle % CO? 19
Rest % CO 9.7
What are the 2 specialized excitatory and conductive systems that control cardiac contractions? SA node and internodal pathways
Where is the SA node located? superior lateral wall of the right atria
The SA node has the ability of self____________, which is why it ordinarily controls the rate of the entire heart. excitation
What is the action potential of the SA node? -55 to -60
The sinus node exhibits only activation of the slow _______ channels. Action potential is much slower than the ventricle. Ca
Conduction through the atria occurs at what speed? 0.3m/sec
Atria conduction will occur through several tracts and bundles, which spread to the L atria and eventually to the ___ node. AV
The ___ node delays the impulse to allow time for the atriam to empty into the ventricle. AV
The _______ fibers lead the AV node through the AV bundles. purkinji
The AV bundles are a one way system, which prevents re-entry of cardiac impulses back to the atriam. T/F T
Total time for the transmission of cardiac impulses is about how long? 0.06 seconds
Created by: Jmw015