Applied Anatomy Of The Heart

Front 1

Describe the locations of the different surfaces of the heart.

Back 1

v

Front 2

Describe the coronary artery supply of blood the the heart:

Back 2

LCA gives off the left main stem, the circumflex, the left marginal and LAD.

RCA gives off the right marginal and RPDA.

Front 3

What is the blood supply to the IV septum?

Back 3

Anterior and posterior descending arteries.

Front 4

What is left and right dominance?

Back 4

v

Front 5

Where are the 6 chest leads placed?

Back 5

v

Front 6

What parts of the heart does the ECG image?

Lateral

Anterior

Septal

Inferior

Back 6

v

Front 7

Describe the heart conducting system

Back 7

v

Front 8

What is atrial enlargement?

Back 8

TheAnhat W

Front 9

What is the commonest heart arrythmia and what does it result in?

Back 9

v

Front 10

How is AF diagnosed?

Back 10

v

Front 11

What is bundle branch block?

Back 11

Ischaemia and ceasing of conduction of impulses.

Altered pathways for depolarisation

Impulse travels through the myocytes slows impulse speed: prolonged QRS.

Loss of ventricular syncrony.

Front 12

What is cardiac remodelling?

Back 12

Strucutral changes with associated cardiac dysfunciton. Increase in myocyte size.

Front 13

What are the consequences of cardiac remodelling?

Back 13

Increased myocyte size

Increased collagen synthesis.

Altered relationship between preload and SV. Structural changes.

Front 14

When might physiloigcal cardiac remodelling occur?

Back 14

Pregnancy plus in athletes due to strenuous regular excercise.

Front 15

When would pathological cardiac remodelling occur?

Back 15

pressure overload: aortic stenosis. HT.

volume overload: valv regurg. hypervol.

cardiac injury (ischaemia/infarct)

Front 16

Describe the features of remodelling/Ventricular hypertrophy:

Back 16

new sarcomeres

decreased capillary: myocyte ratio

increases fibrous tissue

synthesis of abnormal proteins.

loss of myocytes: apoptosis.

Front 17

What is and what causes CONCENTRIC hypertrophy.

Back 17

Increased afterload

- aortic stenosis/chronic HT

Wall thickness increases - new sarcomere:

compliance reduced (stiff), ventricular filling compormised (diastrolic dysfunction)

can lead to eccentric hypertrophy.

Front 18

Concentric hypertrophy can lead to eccentric hypertrophy. What is eccentric hypertrophy

Back 18

Volume/preload overload. or both.

Chamber dilation: aortic and mitral regurgitation. Systolic dysfunction (loss of cardiac inotrophy) Vol overload dueto hyervolaemia due to ventricular or renal failure. Alcohol or cocaine. elevated oxygen demand. lowered mecahnic efficacy.

Front 19

What are two consequences of eccentric hypertrophy?

Back 19

Elevated oxygen demand

Lower mechanical efficacy

Front 20

Which valves are open/shut in diastole and systole?

Back 20

Diastole A and P shut

Systole AV shut

Front 21

Describe the structure of the heart valves AV: tricuspid and bicuspid and Aortic and Pulmonary

Back 21

chorda tendinae slack and papillary muscles relaxed when valve open.

Chorda tendinae taut and papillary muscles are contracted when the valve is closed.

Front 22

Describe the features of valvular disease

- What are the causes of inflammation?

- What is the result?

Back 22

Inflammation of the valve (infection, bacterial, endocarditis, rheumatic disease).

Ageing

Caridomyopathy

IHD

Fibrosis and calcification

Valvular incompetence -> regurgitation

Rheumatic disease - not only do the cusps fibrose but the chordea tendinae soften.

Front 23

What is the most common form of valvular disease?

What are the consequences?

Back 23

Mitral regurgitation

Abnormal regurgitation of blood back into the L.A.

Acute volume overload on the left ventricle with an increase in end diastolic volume.

Long standing regurg may show evidence of left atrial enlargement and left ventricular hypertrophy (dilation)

Pulmonary oedema

Reduced CO

Front 24

Describe Aortic regurgitation.

Back 24

Chronic vol overload: stretching and elongation of the myocardial fibres = eccentric hypertrophy

LV dilation and congestive heart failure.

Decreased CO due to regurgitation

Elevated pre-load.

Front 25

Describe Aortic stenosis

Back 25

Left ventricle has to overcome increased pressure in order to overcome the increased afterload caused by the stenotic aortic valve.

LVH (concentric)

Concentric hypertrophy develops in response.

Front 26

What is cardiac pain

Back 26

Pain from Ischaemia.

stimulates sensory nerve endings in the myocardium

afferent nerve fibres ascend to the CNS through cardiac branches of the sympathetic trunk.

pain not felt in the heart -- it is referred to the skin supplied by T1 to T4. Medial upper arm and neck/jaw.

for inferior wall infarct it is referred to the epigastrium T5 to T9

Front 27

Mitral stenosis:

Back 27

Mitral valve stenosis=> increased atrial kick. atrial enlargement and increased atrial pressure. pulmonary congestion (oedema)

Ventricular filling is reduced => reduced CO.

AF can result

Embolic events in 1/3rd of those with mitral stenosis.