Term
| what are the three layers of the blood vessel |
|
Definition
1. tunica intima
2. tunica media
3. tunica adventitia |
|
|
Term
| which layer of the vascular anatomy is composed of smooth muscle |
|
Definition
|
|
Term
| describe the pathological progression of atherosclerosis |
|
Definition
1. fatty streak
2. fibrous plaque
3. complicated lesion |
|
|
Term
| prehypertension is a bp of? |
|
Definition
|
|
Term
| what is the name for HTN with unknown etiology? What % of people have this |
|
Definition
| 90-95% of people have unk etiology of their htn which is categorized as primary (essential) hypertension. |
|
|
Term
| what are two physiological components of HTN |
|
Definition
1. increase in SVR
and / or
2. increase in CO |
|
|
Term
| what systems in the body can cause an increase in SVR? |
|
Definition
| 1. SNS 2. RAAS 3. Natriueretic peptides |
|
|
Term
| What can cause an increase to intravascular volume (results in higher BPs) |
|
Definition
|
|
Term
| patients with uncontrolled HTN are at most risk for large changes in what normal body regulatory processes |
|
Definition
1. vasoconstriction
2. autoregulation
3. vasodilating |
|
|
Term
| What are the two classes of aortic aneurysms |
|
Definition
1. degenerative aneursyms
2. Dissecting aneurysms |
|
|
Term
| the most common type of aneurysm is? Describe it... |
|
Definition
| Degenerative aneurysm which is a result of a breakdown of the connective tissue and muscular layer. |
|
|
Term
| if an aneurysm is ___ or greater you should electively repair the aneurysm |
|
Definition
|
|
Term
| which diseases can predispose patients to aneurysms |
|
Definition
1. HTN
2. Arteriosclerosis
3. syphilis
4. marfan syndrome
5. post MI
6. Traumatic |
|
|
Term
| what three things can cause a DVT |
|
Definition
1. venous thromosis
2. hypercoagulation
3. venous endothelial damage |
|
|
Term
| does ACS include stable angina? |
|
Definition
NOOOOOOOO
ACS only include NSTEMI, STEMI and unstable angina |
|
|
Term
| what are two changes in blood vessels during coronary artery stenosis |
|
Definition
1. structural changes (at endothelium)
2. functional changes of coronary vessels |
|
|
Term
| endothelium dysfunction from CAD results in what changes to the endothelium |
|
Definition
1. coronary vasospasm
2. impaired relaxation
3. blood clots formation on it |
|
|
Term
| chronic stable angina is caused by |
|
Definition
| narrowing of coronary arteries from atherosclerosis |
|
|
Term
| can angina that is stable and chronic be mitigated? With what? |
|
Definition
| it will go away with nitrate administration or rest |
|
|
Term
| what is prinzmetal's angina |
|
Definition
| a type of angina caused by coronary artery vasospasm. May not be associated with atherosclerosis like chornic and acute angina is. |
|
|
Term
| how many times a day does the heart beat |
|
Definition
|
|
Term
| the pericardium is made up of how many layers |
|
Definition
| 3x layers. From outer to inner they are: 1. Fibrous layer --> 2. parietal layer --> 3. Visceral layer. |
|
|
Term
| The pericardial cavity is located where |
|
Definition
| between the parietal and visceral pericardium layers |
|
|
Term
| which layer of the heart protects and anchors it |
|
Definition
|
|
Term
| which layer of the heart prevents it from over filling |
|
Definition
|
|
Term
| The right coronary artery branches into |
|
Definition
1. posterior descending artery
2. right marginal |
|
|
Term
| the left main branches into? |
|
Definition
1. left anterior descending
2. left circumflex |
|
|
Term
| the left circumflex branches further into |
|
Definition
1. left obtuse marginal
2. posterolateral branch |
|
|
Term
| collateral arteries in the heart are formed from a process called |
|
Definition
|
|
Term
| what physical properties in the vessels causes the stimulation of arteriogenesis? |
|
Definition
| sheear stress from increase blood velocity related to occlusions |
|
|
Term
| The degree of collateral circulation is decided by what factors |
|
Definition
1. degree of stenotic coronaries
2. degree of myocardial ischemia |
|
|
Term
| Which vein for myocytes returns 85% to the heart |
|
Definition
|
|
Term
| the coronary sinus vein releases its blood into? |
|
Definition
|
|
Term
| which veins of the heart empty their blood directly into the hearts chambers |
|
Definition
|
|
Term
| Name the three venous systems of the heart |
|
Definition
1. coronary sinus
2. anterior cardiac veins
3. Thebesian veins |
|
|
Term
| name the veins that dump deoxygenated blood into the coronary sinus |
|
Definition
1. great cardiac vein
2. oblique cardiac vein
3. small cardiac vein
4. middle cardiac veins |
|
|
Term
| AV node beats at what rate |
|
Definition
|
|
Term
| purkinjee fibers beat at what intrinsic rate |
|
Definition
|
|
Term
| The extrinsic conduction system is comprised of? 2x |
|
Definition
|
|
Term
| do the intrinsic cells for conduction contract |
|
Definition
| NONE CONTRACT, they only conduct |
|
|
Term
| The SA node has ___ phases during its AP while the rest of the cardiac conduction system has ___ phases |
|
Definition
SA node: 3 phases
AV, purkinjee, myocytes: 5 phases |
|
|
Term
| what is the difference between the SNS and PNS as far as how they contribute to the extrinsic influence on conduction of the heart |
|
Definition
| the SNS innervates SA, AV and myocytes resulting in increase conduction, faster HR and Stronger contraction, while the PNS only innervates the SA and AV node and can only decrase HR and conduction. |
|
|
Term
| Baroreceptors are located where? What nerve innervates them? Where in the brain is involved |
|
Definition
| There are two baroreceptors. There is the aortic baroreceptor on the arch of the aorta and there is the carotid baroreceptor located at the carotid sinus. The aortic baroreceptor transmits via vagus nerve to the medulla. The carotid barorecpeptors transmit via the carotid sinus nerve to the glossopharyngeal nerve to medulla. |
|
|
Term
| An increase in pulse frequency from a baroreceptors results in? Due to? |
|
Definition
| Increase pulse frequency from a baroreceptor indicates increase stretch due to increase pressure. It triggers the medulla which then sends inhibitor signals via PNS to slow down heart rate and vessel resistance. |
|
|
Term
| the general location of the carotid baroreceptors is |
|
Definition
| at the bifurcation of the internal and external carotid arteries. |
|
|
Term
| what type of nerve endings are baroreceptors |
|
Definition
| they are a spray nerve ending which acts as a mechanoreceptor which senses alterations in PRESSURE. |
|
|
Term
| peripheral chemoreceptors can sense changes in what chemicals? Results in what effect |
|
Definition
1. O2
2. pH
3. CO
Medulla changes respiration in response to chemoreceptors |
|
|
Term
| bainbridge reflex also known as the __ reflex |
|
Definition
|
|
Term
| stroke volume is dependent on 4 factors |
|
Definition
1. preload
2. afterload
3. contractility
4. rhythm or muuscular synchrony |
|
|
Term
| Between two Z lines lies what? |
|
Definition
|
|
Term
| a myosin contains how many heads |
|
Definition
|
|
Term
| The thin filament of a muscle cell is composed of three different types of protein, they are |
|
Definition
1. actin
2. tropomyosin
3. troponin |
|
|
Term
| which type of protein in the thin filament is a globular protein chain of repeating units |
|
Definition
|
|
Term
| the two major components of frank starling law are |
|
Definition
1. preload
2. contractility |
|
|
Term
|
Definition
| SVR = [(MAP-CVP) / CO] x 80 |
|
|
Term
| what is the primary factor determining myocardial oxygen consumption |
|
Definition
| Myocyte contraction! More myocytes contracting the more O2 needed |
|
|
Term
| Wall tension is inversely related to |
|
Definition
|
|
Term
|
Definition
T = (IVPxIVR)/wall thickness
Pressure creates tension and the larger the radius the more tension. Then thickness is increased to trying and compensate for this. If more thickness then less degree of tension. |
|
|
Term
| what is difference in the arrangement of concentric and eccentric hypertrophy |
|
Definition
1. concentric hypertrophy: is from AS, sarcomeres added in width fashion (parallel) Need more myocytes in strength
2. Eccentric: usually from Aortic regurgitation. Sarcomeres added in series. |
|
|
Term
| increase wall tension causes what to o2 needs |
|
Definition
|
|
Term
| The higher the afterload, then what happens to tension (higher or lower?) |
|
Definition
|
|
Term
| Increase wall tension to increase HTN results in remodeling of the heart to increase its thickness. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is poiseuille's formula |
|
Definition
|
|
Term
| The myocyte is composed of bundles of |
|
Definition
|
|
Term
| what is the difference between concentric and eccentric hypertrophy |
|
Definition
Eccentric = EXTEND there are sarcomeres added in length.
Concentric is sarcomeres added in combination |
|
|
Term
| increase aneurysm size will result in ___ wall tension |
|
Definition
|
|
Term
| during isovolumetric contraction or relaxation what is happening in both |
|
Definition
| During either there is a change in pressure but NO CHANGE IN VOLUME since the valves are all closed during this period. |
|
|
Term
| The most major vasodilator of the coronaries is |
|
Definition
|
|
Term
| Coronary perfusion pressure equals___ pressure minus _______ |
|
Definition
| coronary perfusion pressure equals aortic diastolic pressure - LVEDP |
|
|
Term
| where are the two layers of the coronaries located |
|
Definition
1. sub-endocardium vessels
2. epicardial vessels |
|
|
Term
| during systole blood flow through the coronaries is diminished most at what layer of coronary blood flow |
|
Definition
| sub-endocardium coronary vessels suffer the most |
|
|
Term
| coronary pressure mirrors what pressure |
|
Definition
| aortic diastolic pressure |
|
|
Term
| wall tension decided by what two factos |
|
Definition
|
|
Term
| is it common to have a posterior MI only |
|
Definition
| NO.. usually accompanies lateral or inferior MI |
|
|
Term
| every big box on the ecg is __ mm. Every little box is ____ mm |
|
Definition
Big box 5 mm
little box 1 mm |
|
|
Term
| The posterior wall of the heart is supplied by what arteries. Which one is the major |
|
Definition
Posterior:
1. Left Circumflex 15%
2. Right coronary 85%**** |
|
|
Term
| lateral wall supplied by what artery |
|
Definition
|
|
Term
|
Definition
1. diagonal arteries
2. septal arteries
Lawyers(LAD)-> defend (Diagonal) suspects (septal) |
|
|
Term
| name the branches off the RCA |
|
Definition
1. marginal artery
2. posterior descending artery
Rain (RCA) -> Makes (Marginal) Puddles (posterior descending) |
|
|
Term
| in 60% of people the SA Nodal artery is a branch off of what artery? in the other 40% it is off the? |
|
Definition
| 60% of people SA nodal is off the RCA while the other 40% its off the circumflex. |
|
|
Term
| arteriogenesis is a direct results of what |
|
Definition
| shear stress on blood vessel walls from increase velocity due to narrowing vessels from atherosclerosis |
|
|
Term
| 85% of the venous blood is drained via the? A nd empties into? |
|
Definition
Coronary sinus. Which gets inputs from the
1. small cardiac vein
2. middle cardiac vein
3. great cardiac vein
Great coronary sinus empties into the right atrium |
|
|
Term
| what ion channel brings the resting membrane of nodal tissue to threshold? What then is triggered at threshold which results on nodal AP |
|
Definition
| Funny Na channels bring resting membrane potential to threshold (This process is depolarization), at threshold the voltage that is needed to open Ca channels has been met and Ca channels open causing the AP. |
|
|
Term
| what does chronic HTN do to baroreceptors and why is this important during anesthesia |
|
Definition
| chronic HTN causes changes in the tolerance of baroreceptors to the increase pressures. AS a result it resets the scale and allows for higher pressures to be present without stimulation of the vagal center in the medulla. |
|
|
Term
| ANP release can happen following what reflex? What does ANP do in the body |
|
Definition
| Following brainbridge reflex (Atrial stretch reflex) following increase blood return will result in ANP release. ANP tells kidneys to excrete more Na and H20 b/c it senses higher than normal preload. ANP will also in the short term vasodilate vessels to try and immediately decrease preload. While the reflex increases HR to try and promote faster forward movement of excess blood to keep blood from being backed up. |
|
|
Term
| Atrial reflex receptors are located where on the heart |
|
Definition
| at the junction of the SVC of the right atrium and 4x pulmonary vein junction with the left atrium. |
|
|
Term
| A respiratory related sinus arrythmia may occur with what population of people? Why |
|
Definition
| Very healthy cardio adults, kids and infants may have variations in heart rate through inspiration and expiration as a result of the brainbridge reflex. |
|
|
Term
| a frank sterling curve down and to the right means what |
|
Definition
| decrease SV and CO = seen in CHF |
|
|
Term
| frank starling is directly related to what two components of CO |
|
Definition
| Preload and contractility |
|
|
Term
| does afterload affect preload? Does preload affect afterload? |
|
Definition
| Afterload is slightly influenced by preload but preload is not altered by afterload |
|
|
Term
| increase afterload does what to frank starling curve |
|
Definition
| shifts it down and to the right. |
|
|
Term
| afterload is related to what in la Places law |
|
Definition
| related to intraventricular pressure. So higher the afterload the higher the tension due to a build up of pressure to overcome the afterload (SVR) |
|
|
Term
|
Definition
|
|
Term
| according to Poiseuille's formula Resistance is = |
|
Definition
|
|
Term
| coronary arteries are also called ___ Arteries |
|
Definition
| epicardial arteries since they are located on the surface of the heart and are least effected by the systolic contraction of the myocardium. |
|
|
Term
| Coronary perfusion pressure = |
|
Definition
| Aortic diastolic pressure minus Left ventricle end diastolic pressure |
|
|
Term
| what leads are unipolar and which are bipolar |
|
Definition
I,II, III = Bipolar
AvF, AvL, AvR, V1-V6 = unipolar |
|
|
Term
| V7, V8, V9 are aligned on what landmark |
|
Definition
|
|
Term
| one cardiac cycle is how long |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
1. acidemia
2. hypercapnia
3. hypoxemia |
|
|
Term
| diastolic heart failure caused by |
|
Definition
1. decreased compliance of LV during diastole
2. abnormal relaxation of LV during diastole |
|
|
Term
|
Definition
|
|
Term
| pain with ambulation is called |
|
Definition
|
|
Term
| a common sx of acute pericarditis |
|
Definition
1. pain that worsens with inspiration
2. diffuse ST segment elevation
3. friction rub |
|
|
Term
| ___ type of hypertrophy is related to volume overload while the other is related to pressure overload |
|
Definition
| volume overload results in dilation of the ventricles and sarcomeres being added in length to accomodate this. This type of hypertrophy is called eccentric Hypertrophy (extending more sarcomeres together). The other type is concentric hypertrophy related to high pressure demands the heart beefs up its left ventricle by enhancing its size. |
|
|
Term
| which type of hypetrophy is autosomal dominant |
|
Definition
| asymmetric septal hypertrophy which is a concentric type of hypertrophy |
|
|
