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217 Cards in this Set

  • Front
  • Back
what is heart failure?
inability of the heart to maintain a cardiac output appropriate to systemic metabolic requirements
what is a low output state?
forward pump function of the heart is impaired and cannot meet metabolic needs
what is a high output state?
pump function of the heart is normal but systemic metabolic needs are excessive
give two causes of low output failure
cardiomyopathy, myocardial infarction
give two causes of high output failure
thyrotoxicosis, beri-beri
name two compensatory adaptations of the heart occurring in chronic heart failure
ventricualar dilatation, eccentric myocardial hypertrophy
what is the major compensatory mechanism in acute heart failure?
increase in heart rate
list some causes of heart failure
impaired blood supply due to coronary artery disease (with or without MI), increased haemodynamic load on the heart due to valve disease (such as aortic stenosis, aortic/mitral regurgitation), intrinsic dysfunction of the systolic contractile function of the myocardium (cardiomyopathy) resulting in dilatation of the cardiac chambers
list some causes of dilated cardiomyopathy
alcohol abuse, previous myocarditis, hereditary defects in myocardial metabolism, metabolic abnormalities such as hyper/hypothyroidism, haemochromatosis, occasionally drugs (e.g. adriamycin) or heavy metal poisoning
what occurs in restrictive cardiomyopathy?
thickened and stiff ventricular myocardium due to fibrous infiltration or deposition of abnormal glycoproteins
what is the most common cause of restrictive cardiomyopathy in Australia?
amyloidosis (mostly in older women)
which criteria is used to grade the severity of symptoms in heart failure?
New York Heart Association
Name 4 symptoms of heart failure.
dyspnoea, orthopnoea, fatigue, low exercise tolerance
Name some signs of heart failure.
peripheral oedema, elevation of JVP, dispacement of apex beat, atrial or ventricular gallop sounds, murmurs of aortic or mitral regurgitation
give an equation for ejection fraction.
EF=stroke volume/end-diastolic volume
what is the normal ejection fraction for an adult?
50-70%
at what level is the superior border of the heart?
T4/5
does the heart lie closer to the sternum or the vertebral column?
sternum
what is contained in the superior mediastinum?
thymus, brachiocephalic vein and SVC, arch of aorta and its 3 branches, trachea, oesophagus, thoracic duct, phrenic nerve and vagus nerve
where does the phrenic nerve travel in relation to the root of the lung?
anterior
how does the vagus nerve travel past the root of the lung?
behind it
what is in the anterior mediastinum?
ligaments attaching pericardium to sternum and loose connective tissue
what is in the middle mediastinum?
heart, pericardium, roots of great vessels (8), phrenic nerve
what is in the posterior mediastinum?
descending thoracic aorta, oesophagus, azygos vein, thoracic duct
where is the apex of heart?
5th intercostal space, midclavicular line
t/f... the arch of the aorta lies posterior to the body of the sternum
false, it lies posterior to the manubrium, the heart is posterior to the body of sternum
where is the coronary groove?
between atria and ventricles on outer surface or heart
which groove separates the ventricles?
interventricular groove
how many pulmonary veins are there?
4
how many pulmonary arteries are there?
2
what forms the right border of the heart?
right atrium
which ventricle is mainly anterior?
right ventricle
which ventricle is more inferior?
left ventricle
which coronary artery runs in the atrioventricular groove?
RCA
which chambers have auricles?
atria
what is the first branch of the aorta (after the coronary arteries)?
brachiocephalic trunk
what does the brachiocephalic trunk branch into?
right common carotid and right subclavian artery
what veins drain into the superior vena cava?
left and right brachiocephalic veins
t/f... the right pulmonary artery passes in front of the aorta and inferior vena cava
false, it passes behind those structures
where are the pectinate muscles?
atria
what is the name of the ridge formed by the pectinate muscles in the right atrium?
crista terminalis
which veins open into the right atrium?
SVC, IVC, coronary sinus
where is the fossa ovalis?
between the atria
what are the muscles on the inner surface of ventricles?
trabeculae carneae
which heart valve only has two cusps?
mitral
which are the semilunar valves?
pulmonary and aortic
what are the branches of the left coronary artery?
anterior interventricular artery (left anterior descending) and circumflex artery
what are the branches of the right coronary artery?
posterior interventricular artery and marginal artery
when in the cardiac cycle does blood flow to the heart occur?
diastole
which region is most prone to infarct?
subendocardial region
what is the blood supply to the endocardium?
blood within the chambers
what part of the heart does the right coronary artery supply?
right atrium, most of right ventricle, diaphragmatic surface of left ventricle, posterior 1/3 of interventricular septum, SA node (in 60% of people), AV node (in 40% of people)
what part of the heart does the left coronary artery supply?
left atrium, most of left ventricle, part of right ventricle, anterior 2/3 of IV septum including AV bundle, SA node (in 40% of people)
what does the great cardiac vein travel with?
LAD
what does the middle cardiac vein travel with?
posterior interventricular artery
what does the lesser cardiac vein travel with?
right coronary artery
where is the coronary sinus?
posterior coronary groove
where does the cardiac action potential originate?
SA node
where is the SA node?
sulcus terminalis (junction of SVC and RA)
what is the depolarisation rate of the SA node?
70-100
what is the bridge in conduction between atria and ventricles?
AV node
where is the AV node?
at the opening of th ecoronary sinus
what is the spontaneous depolarisation rate of the AV node?
50
what is the spontaneous deploarisation rate of the bundle of his?
30
what is the parasympathetic innervation of the heart?
vagus
which spinal segments contribute to the heart's sympathetic supply?
T1-4/5
which fibres do the pain fibres of the heart travel with?
sympathetic
which fibres accompany the vagus nerve?
reflexes
what in the heart is innervated by the phrenic nerve?
parietal layer of serous pericardium and fibrous pericardium
which part of the conduction system of the heart has the highest conduction velocity?
bundle of his
where is conduction slowest in the heart?
AV node
what is the advantage of a long ventricular AP?
helps to prevent re-entrant arrhythmias
which leads in a standard ECG are detecting the horizontal plane?
V1-6
what angles do leads I, II and III represent?
0, +60, +120
what angles do aVR, aVL and aVF represent?
-150, -30, 90
what does a positive QRS in leads I, II and III tell you about axis?
normal
what would you expect to see in an ECG with right axis deviation?
negative QRS in I, positive QRS in II and III
what would you expect to see in an ECG with left axis deviation?
positive QRS in I, negative in II and III
what is the duration of a ventricular action potential?
300 ms
what is the duration of a skeletal muscle AP?
2 ms
what current is responsible for the rapid depolarisation of cardiac AP?
I(Na) - fast inward current
which current maintains the long plateau of cardiac AP?
I(Ca) - slow inward current
what is the repolarising current of the cardiac AP?
I(K)
what causes contraction of cardiac muscle?
large calcium release from sarcoplasmic reticulum
which two processes cause relaxation of cardiac muscle?
1) reuptake of calcium into the SR
2) removal of calcium from the cell by the Na/Ca exchanger
which two pathways resupply ATP?
1) aerobic oxidative phosphorylation (in the mitochondria)
2) anaerobic glycolysis (in myoplasm)
which receptors are responsible for the increase in heart rate and contractility with sympathetic activation?
beta1 receptors
which type of blood vessel does not receive sympathetic innervation?
capillaries
which adrenoceptor activates phospholipase C?
alpha1
which adrenoceptor activates adenylate cyclase?
beta
what are the effects of activation of beta1 receptors in cardiac muscle on intracellular calcium?
increase intracellular calcium concentration
which beta receptor reduces intracellular calcium?
beta2
what type of ventricular hypertrophy occurs with pressure overload?
concentric hypertrophy (wall thickening)
what type of ventricular hypertrophy occurs with volume overload?
eccentric hypertrophy (chamber enlargement)
where is A-type natriuretic peptide released from?
atria
what releases B-type natriuretic peptide?
ventricles
what releases C-type natriuretic peptide?
vascular endothelium
what effect do natriuretic peptides have on blood vessels?
vasodilation
what are natriuretic peptides released in response to?
increased filling pressure and volume of shear stress
what is the interval between pharyngeal infection with group A streptococci and rheumatic fever?
1-5 weeks
at the commencement of an attack of rheumatic fever, are cultures for GAS positive or negative?
negative
what percentage of people with GAS throat infection develop RF?
3%
which organs are affected by RF?
heart - pancarditis
joints - migratory polyarthritis
brain - sydenham's chorea
skin - erythema marginatum
at what age does the first attack of RF occur most frequently?
5-15
what percentage of children with RF may develop carditis?
50-75%
what criteria are used for the diagnosis of RF?
Jones criteria
what is responsible for fibrinous pericarditis?
esudation of fibrin into pericardial cavity which stimulates fibrous adhesions between parietal and visceral pericardium
where do Aschoff nodules develop in myocarditis?
close to blood vessels
which white cells are present in an Aschoff nodule?
lymphocytes (mainly T cells) and macrophages
what type of macrophages are present in an Aschoff nodule?
Anitschkow cells, Aschoff multi-nucleated giant cells
which valves are most commonly affected in RF?
mitral and aortic
where do vegetations develop in RF?
cusps of valves
what do the vegetations in RF consist of?
fibrin and platelets but no microorganisms
what effect do vegetations have on the vascularity of heart valve cusps?
vascularity increases
what is responsible for aortic stenosis in RF?
fibrous adhesions between the cusps
what are the effects of vegetations on the chordae tendinae?
adhesion and fusion of chordae, shortening of chordae
t/f... tricuspid involvement is common in RF
false, tricuspid involvement in unusual
why would a lung with chronic venous congestion appear brown in colour?
chronic deposition of haemosiderin laden macrophages
what type of overload does aortic stenosis cause?
pressure overload
what is the cause of dyspnoea in aortic stenosis?
high left ventricular end diastolic pressure
will BP be high, low or normal in aortic stenosis?
low
what type of murmur is heard in aortic stenosis?
harsh, loud systolic, crescendo-decrescendo murmur in aortic area
what does a harsh, loud systolic, crescendo-decrescendo murmur in aortic area indicate?
aortic stenosis
what type of overload is caused by aortic regurgitation?
volume overload
what is the murmur of aortic regurgitation?
decrescendo diastolic murmur
what is a bounding pulse suggestive of?
aortic regurgitation
which arrhythmia is associated with mitral stenosis?
atrial fibrillation
what does a diastolic-presystolic rumbling murmur indicate?
mitral stenosis
what does a soft, blowing pansystolic murmur at the apex suggest?
mitral regurgitation
what is the percentage mortality associated with aortic valve replacement? with CABG?
4%, 6%
what is the percentage mortality associated with mitral valve replacement? with CABG?
8%, 10%
where are the M proteins?
bacterial cell wall
where is the hyaluronate?
capsule
what do the M protein antibodies cross react with in the myocardium?
myosin
what do the hyaluronate antibodies cross react with?
hyaline lining of heart valves (and cartilage in joints)
what separates the atria from ventricles?
coronary groove
what separates the ventricles?
interventricular groove
what forms the right border of the heart?
right atrium
what is contained in the superior mediastinum?
thymus
brachiocephalic vein
SVC
arch of aorta
trachea
oesophagus
thoracic duct
phrenic nerve
vagus nerve
what is contained in the anterior mediastinum?
ligaments attaching pericardium to sternum
loose connective tissue
what is contained in the middle mediastinum?
heart
pericardium
roots of great vessels
phrenic nerve
what is contained in the posterior mediastinum?
descending thoracic aorta
oesophagus
azygos vein
thoracic duct
which ventricle is mainly anterior?
right ventricle
which atrium is mainly posterior?
left atrium
which chamber of the heart is mainly inferior?
left ventricle
where does the right coronary artery lie?
atrioventricular sulcus
which artery does the great cardiac vein travel with?
anterior interventricular artery
which artery lies in the anterior interventricular sulcus?
anterior interventricular artery
which muscles line the right atrium?
pectinate muscles
where is the crista terminalis?
right atrium
which veins open into the right atrium?
SVC
IVC
coronary sinus
which muscles line the right ventricle?
trabeculae carnae
t/f... the right ventricle is thin-walled
true
what attaches the cusps of the atrioventricular valves to the papillary muscles?
chordae tendinae
which ventricle is thick walled?
left ventricle
which valve has two cusps?
mitral valve
which pericardium is attached to the diaphragm and great vessels?
fibrous pericardium
what are the branches of the left coronary artery?
anterior interventricular artery (left anterior descending artery)
circumflex artery
what are the branches of the right coronary artery?
posterior interventricular artery
marginal artery
what is the blood supply to the endocardium?
direct by blood within chambers
which region of the heart is most prone to infarct?
subendocardial region
what does the right coronary artery supply?
RA
most of RV
diaphragmatic surface of LV
posterior 1/3 of IV septum
SA node (in 60% people)
AV node (in 40% people)
what does the LCA supply?
left atrium
most of left ventricle
part of right ventricle
anterior 2/3 of IV septum including AV bundle
SA node (in 40% of people)
what does the middle cardiac vein travel with?
posterior interventricular artery
what does the lesser cardiac vein travel with?
right coronary artery
what do the cardiac veins drain into?
coronary sinus
where is the coronary sinus?
below the left atrium
where is the SA node?
junction of SVC and RA at sulcus terminalis
where does the cardiac action potential originate?
SA node
what is the depolarisation rate of the SA node?
70-100/min
where is the AV node?
opening of coronary sinus (posteroinferior region of interatrial septa)
what is the depolarisation rate of the AV node?
50/min
what is the depolarisation of the bundle of His and L and R bundle branches?
30/min
what is the motor innervation of the heart?
parasymp - vagus
symp - sympathetic trunk
what is the sensory innervation of the heart?
reflexes travel with vagus
pain - travel with symp
what is the innervation of the parietal layer of serous pericardium and the fibrous pericardium?
phrenic nerve (C3-5)
describe the foetal circulation?
oxygenated blood returns to RA from placenta
shunted across the foramen ovale to LA
blood enters RV and then pumonary trunk - shunted across ductus arteriosus
where is the ligamentum arteriosum?
between aorta and pulmonary trunk
when does blood supply to the heart occur?
diastole
what is the sympathetic supply to the heart?
T1-4
where does the most rapid conduction of cardiac AP occur?
bundle of His (conduction velocity 2-4 ms)
what is the conduction velocity of the atria?
1 m/s
what is the conduction velocity at the AV node?
0.1 m/s
where does the delay in cardiac AP occur?
AV node
what is the conduction velocity at the ventricles?
0.3 m/s
what indicates a normal axis?
leads I, II and II all positive
what indicates right axis deviation?
lead I negative
leads II and III positive
what indicates left axis deviation?
lead I positive
leads II and III negative
t/f... ventricular cells contain numerous mitochondria
true
what connects ventricular cells?
connexin 43`
what type of junctions connect ventricular cells?
gap junctions
what is the duration of a cardiac action potential?
300 ms
what is the duration of a skeletal muscle AP?
2 ms
which current causes rapid depolarisation?
fast inward sodium current
which current maintains the long plateau of cardiac AP?
calcium current (slow inward current)
what is the repolarising current of cardiac AP?
potassium current
what causes contraction in the cardiac AP?
large calcium release form SR (induced by calcium binding to SR ca release channel)
what causes relaxation in the cardiac AP?
reuptake of Ca into SR by SR Ca pump
removal of Ca from the cell by Na/Ca exchanger
how is contractility of cardiac muscle modulated?
varying Ca release from SR
Which receptors are responsible for sympathetic regulation of the heart rate and contractility?
beta1 receptors
which receptors are responsible for reduction in heart rate and slight reduction in cardiac contractility?
muscarinic receptors
what causes arteriolar vasoconstriction?
increased myogenic activity
increased O2
decreased CO2
increased sympathetic stimulation
vasopressin, ATII
cold
what causes arteriolar vasodilation?
decreased myogenic activity
decreased O2
increased CO2
reduced symp stim
histamine
heat
which blood vessels do not receive sympathetic innervation?
capillaries
what is the usual neurotransmitter causing vasoconstriction?
noradrenaline
how does alpha1 receptor activation result in smooth muscle contraction?
G protein -> activation of phospholipase C -> increased level intracellular second messengers inositol triphosphate and diacylglycerol -> increase in intracellular calcium -> SM contraction
how does beta receptor activation induce a cellular response?
activation of adenylate cyclase -> increased cAMP -> activation of protein kinases -> cellular response
which receptors induce vasodilation in vascular smooth muscle?
beta2 receptors
which receptors increase cardiac contractility?
beta1 receptors
what is heart failure?
mechanical failure of the heart to maintain systemic perfusion commensurate with the requirements of metabolising tissues
what are the causes of diastolic heart failure?
acute ischaemia
age
hypertension
aortic stenosis
hypertrophic cardiomyopathy
infiltrative myocardial disease
pericardial disease
what releases B-type natriuretic peptide?
ventricles
what releases C-type natriuretic peptide?
vascular endothelium
what are the actions of natriuretic peptides?
natriuresis and vasodilation
suppress RAAS and endothelin
t/f... there is no major survival difference for patients with heart failure post discharge despite differences in systolic function
true
what are the modes of death in heart failure?
progressive heart failure
sudden death (VT/VF)
stroke
what are the risk factors for chronic heart failure?
hypertension
atherosclerotic disease
diabetes mellitus
obesity or metabolic syndrome
exposure to cardiotoxins
family history of cardiomyopathy