A&p Coronary Care Two

Front 1

Review:
Describe the structure and function of the right side of the heart

Back 1

1) Act as a pump for pulmonary circulatio
2) delivers un-oxygenated blood from body to lungs
3)projects vol. against min. resistance(lungs)
4) RV has thinner musculature (4-5 mm thickness)

Front 2

Review:
Describe the structure and function of the Left side of the heart.

Back 2

1) acts as a pump for systemic circulation
2) delivers oxygenated blood from lung to body
3) projects vol. against larger max. resistance(body)
4) LV muscle is 2-3x's thicker than RV

Front 3

Review:
Describe the four specialized properties of myocardial cells.

Back 3

Automaticity- ability to INITIATE impulses

Excitabilty- ability to RESPOND to impluses

Conductivity- ability to PASS impluses to other cells

Contactility- ability to CAUSE SHORTENING of cardiac fibers

Front 4

Review:
Describe the SA node

Back 4

-located in RA wall
-normally the orginal initator of impluses
-normally initiate impluses at 60-100x's per minute
-depolarization of atrial muscles are responsible for P wave (*how does the p wave look)

Front 5

Review:
Describe internodal and intratrial tracts

Back 5

-impluses travel through both atra along these bands of tissue
-travel through RA along internodal pathways
-travel through LA along Bachmans bundle
-preferred route for atrial propagration
-play an important role in intra-atrial conduction, influence conduction time from SA node to AV node

Front 6

Review:
Describe AV node

Back 6

-only normal avenue for an impluses to be transmitted from atria to ventricles
-AV node has low conduction velocity which allows impluses to be slowed before reaching ventricles
-the slowed conduction is responsible to the PR interval

Front 7

Review:
Describe the AV junction

Back 7

1) contains property of automaticty
2) can generate impluses at 40-60x's/min

Front 8

Review:
Describe electrical conduction of the ventricles, Bundle of HIS

Back 8

- impluses travel down to ventricle through the Bundles of HIS
- if needed the Bundle of HIS can generated impluses of 20-40x's/min

Front 9

Review:
Describe R bundle branch

Back 9

Located: lies anteriorly, closer to RV
Supplies:the septum and RV

Front 10

Review:
Describe L bundle branch

Back 10

Divides into 2 fascicles
1)Anterior superior fascicle- supplies: the septum, ant. wall of LV, lateral wall of LV

2) Posterior inferior fascicle- supllies: septum, pos. wall of LV, lateral wall of LV

Front 11

Review:
Describe the electrical impluses through the ventricles and what it represents on an ECG

Back 11

1) After travelling down the BB impluses transmit to the Purkinje Fibers
2) the HIS-Purkinje network has very rapid conduction velocity and provides nearly simultaneous excitation of both ventricles
3) represent QRS complez; look of complex is determined by sequence of ventricular activation

Front 12

Review:
Describe the role of the RCA in terms of supply to tissue and conduction

Back 12

Myocardium supplied:
-RA
-lrg portion of RV
-pos. 1/3 of interventricular(IV)septum
-infer. wall of LV
-part of pos. wall of LV

Conduction system supplied:
- SA node(60% of pop'n)
-AV node(90% of pop'n)
-bundle of HIS
-pos. division of LBB(partially)

Front 13

Review:
Describe possible areas of infarction and arrhythmia you would anticipate with RCA occlusions

Back 13

Possible Infract. Areas:
1) infer. wall of LV(most common)
2)pos. wall of LV
3)RV

Arrhythmias
1) sinus arrhythmias
2) junc. arrhtymias
3)HB

Front 14

Review:
Describe the LCA and location of its divisions

Back 14

LCA branches into LAD and circumflex artery
LAD- lies anterially over IV septum and terminates in the infer. aspect of the cardiac apex
Circumflex - lies in the L ant. AV groove(almost mirror image of RCA) and travels around L side of leart to the hearts pos. side.

Front 15

Review:
Describe the role of the LAD in terms of supply to tissue and conduction

Back 15

LAD
myocardium supplied:
-ant. wall of LV and RV
-ant 2/3 of IV septum

Conduction structures supplied:
-RBB
-Ant. division of LBB
-lrg part of pos. division of the LBB

Front 16

Review:
Describe possible areas of infarction and what arrhythmias to anticipate with LAD occlusion

Back 16

Possible areas of infarct.:
1)Ant. wall of LV(most common)
2) septal wall of LV

Arrhythmias to anticipate:
1)BBB
2) C HB

Front 17

Review:
Describe the role of the Circumflex artery in terms of supply to tissue and conduction

Back 17

Circumflex artery
Myocardium supplied:
-LA
-LV lateral wall and part of the pos. wall of LV

Conduction supplied:
-SA node(40% of pop'n)
-Proximal BB

Front 18

Describe possible areas of infarction and what arrhythmias to anticipate with circumflex artery occlusion

Back 18

Possible areas of infarct:
1)Lat. wall of LV (most common)
2) pos. wall of LV

Arrhythmias to anticipate:
1)sinus arrhythmias
2)BBB

Front 19

Cardiac Muscle Structure

Describe Myofibrils

Back 19

-Tube like structure arranged in bundles of sarcomeres
-Each cardiac cell contains a large amount of myofibrils

Front 20

Cardiac Muscle Structure

Describe Sarcomeres

Back 20

-repeating, contractile sub-units of myofibrils
- each sacromere is divided by a "Z"line
- Z lines, A bands and I namds travel across the myofibrils
-"A-bands" w/in the sacromere contain actin
-"I-bands" w/in the sacromere contain myosin

Front 21

Cardiac Muscle Structure

What are actin and myosin? What role does ATP play?

Back 21

Actin and myosin are muscle proteins that slide together. Their interaction is responsible for muscle contraction and relaxation.
ATP provides energy needed for the interaction of these proteins and muscle contraction.

Front 22

Cardiac Muscle Structure

Describe sacroplasmic reticulum and T tubules

Back 22

Sacroplasmic reticulum is a mesh-like structure that surrounds the myofibrils and is a storage area for Ca++ which is needed for contraction.

T tubules are tubes that carry impluses to the sacroplasmic reticulum.

Front 23

Review: Hemodynamics of the Cardiac Cycle

Describe diastole including blood flow in the heart.

Back 23

-hearts mechanical resting states
Passage of blood:
1) un-oxy. blood from the body enter RA via the sup. and infer. vena cavas
2) oxy. blood from the lungs enters the LA via the pulmonary veins
3)Mitral and tricuspid valves are OPEN
4)blood passively flows through these valves into both ventricles
5)accounts for 80% of hearts total blood volume

Front 24

Review: Hemodynamics of the Cardiac Cycle

Describe Atrial Systole including blood flow in the heart.

Back 24

atrial systole occurs in reponse to electrical activation of the atrial muscle. The atria contract
Passage of Blood:
1)blood is ejected into the partially filled ventricles
2)adds the addition 20% of blood to ventricle blood volume. Referred to as atrial kick.

Front 25

Review: Hemodynamics of the Cardiac Cycle

Describe Ventricular systole including blood flow in the heart.

Back 25

Ventricular systole occurs in response to electrical activation of the ventricular muscle.
Passage of blood:
1) tricuspid and mitral valves CLOSE to prevent backflow into atria
2) this closure causes S1
3) pulmonic and aortic valves OPEN
4) Ventricles contract ejecting unoxy. blood from RV through pulmonic valves into 2 pulmonary arteries and to the lungs. And ejecting oxy. blood through the aortic valve through the aortia and into systemic circulation.
5) When systole is complete, the pulmonic and aortic vavles close to prevent backflow into ventricles and cause S2.