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113 Cards in this Set
- Front
- Back
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Pericardium
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encloses the heart and root of the great vessels
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2 layers of pericardium
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-fibrous pericardium (outer tough fibrous tissue)
-serous pericardium (inner smooth layer) |
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serous pericardium composed of a parietal and visceral layer, space between two layers contains what?
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A thin layer of lubricating fluid called pericardial fluid
-about 30cc |
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True or False: the Apex is formed by the tip of the left ventricle of the heart.
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True
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Four boarders of the Heart
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~Right border: right atrium and in line with the superior and inferior vena cavae
~Inferior border is almost horizontal and formed by the Rt Ventricle, small part of Lt Ventricle at Apex. ~Lt border , Lt Ventricle and part Lt Atrium ~Superior border made of both Atria. |
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Three layers of heart
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Endocardium, Myocardium, Epicardium
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Flow of Blood through heart
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Two main arteries that supply the heart
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~Left Main Coronary Artery- LCA
~Right Coronary Artery- RCA |
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LCA gives rise to...
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Left Anterior Descending- LAD and Left Circumflex-LCX
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RCA gives rise to...
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Posterior Descending Artery PDA
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Variances in coronary artery anatomy
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85% are RCA dominant
8% Circumflex is dominant 7% both RCA and Circumflex give rise to posterior descending branches. |
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what makes skeletal muscle cells different then cardiac muscle cells
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Cardiac cells only have one or two nuclei, skeletal cells have many nuclei.
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what does the myocardial cell membrane contain that establishes electrical continuity within the myocardium
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Intercalated disk
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The Basic unit of electrical stimulation
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Action Potential, ion fluxes through specific ion channels create depolarization, the trigger for muscular contraction.
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Myocardium contains 3 types of electrophysiologic types:
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pacemaker cells: SA and AV nodal cells
Specialized rapidly conducting tissues: Purkinje fibers Cardiac muscle cells themselves |
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The Heart is innervated (the distribution or supply of nerve fibers or nerve impulses to a body part) by both...
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Sympathetic and Parasympathetic nervous system
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Systole is...
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Ventricular contraction, when the ventricles push blood out into the pulmonary and systemic circulation
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Diastole is...
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Ventricular relaxation, when the ventricles are filling up with blood again.
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First heart sound, S1, caused by...
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nearly simultaneous closure of the tricuspid and mitral valves, preventing backflow of blood into the atria.
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second Heart sound S2.
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After blood has ejected, the aortic and pulmonic valves close.
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Period from S1-S2
Period from S2 to the next S1 |
Systole
Diastole |
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Cardiac Auscultation
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Listening to the sounds of the heart
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Electrocardiogram-ECG
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Diagnostic method to record the heart's electrical activity. Surface representation of myocardial depolarization and re-polarization.
12 lead ECG is standard, placed at different angles |
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disorders ECG can identify
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-conduction abnormalities
-cardiac dysrhythmias -cardiac hypertrophy -pericarditis -electrolyte imbalances -myocardial ischemia -myocardial infarction (MI) and extent of recovery from MI |
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Most Common Heart Disease
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Ischemic Heart Disease
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Insufficient myocardial perfusion (blood flow) that causes 600,000 deaths per year.
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Ischemic Heart Disease!
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Patients with Ischemic Heart Disease present with...
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Angina ( cardiac chest pain)
Myocardial infarction Congestive heart failure Sudden death |
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Decreased blood flow to tissue resulting in decreased tissue oxygen and increased build-up of tissue metabolites that are harmful
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Ischemia
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Infarction
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decreased blood flow to a tissue to such and extent that tissue death occurs
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Slowly progressive disease that affects the arteries, in which fatty deposits and fibrous tissue occlude the lumen, and cause of angina pectoris.
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Atherosclerosis
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Thrombosis
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Clotted blood and involves platelets, and fibrin produced from the blood coagulation system.
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Embolus
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Any substance that circulates in the bloodstream and becomes lodged with in a vessel lumen resulting in occlusion
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Two most common lesions of atherosclerosis
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Fatty streak and fibrous plaque
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Fatty lesions
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-most have them by age 20
-yellow discoloration on the inner surface of the artery -precursor lesion that develops into fibrous plaque |
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Fibrous Lesion
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Fibrous Plaques are the pathologic lesions that caus the morbidity and mortality of atherosclerosis.
-most common in the aorta, then coronary arteries, popliteal, descending thoracic aorta, internal carotid, and cerebral vascular arteries |
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Risks for developing atherosclerosis
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modifiable risk:
Hyperlipidemia, hypertension, cigarettes, and diabetes non-modifiable risk: Men, age, and family history of coronary disease minor risk: obesity, sedentary lifestyle, and stressful behavior |
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Angina Pectoris (cardiac chest pain) results from...
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Imbalance between myocardial oxygen supply and demand
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most common cause of angina pectoris
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inability of atherosclerotic coronary arteries to supply heart with oxygen-rich blood, in conditions of demand.
can also occur with valvular disease, hypertension, and coronary artery vasospam. |
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Pain of angina described as...
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Pressure, heaviness, or squeezing sensation
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Pain location in substernal area, percorium, or epigastrium with pain radiating to what areas?
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Left arm, jaw, and neck.
usually only lasting a few minutes |
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Angina may be provoked by
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Exterion, emotion, cold weather, and eating or smoking.
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Relive angina by
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resting, remove provoking factors, or the drug nitroglycerin.
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Acute Myocardial Infarction (AMI)
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result of prolonged ischemia that has led to irreversible necrosis of the myocardial tissue.
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85% of AMI cases is associated with
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occluded coronary artery, mainly atherosclerosis
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how many people in US suffer from MI each year, and what is the hospital mortality rate?
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over 1.5 million people and around 15%
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which area of the heart is most commonly affected by MI?
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the left ventricle
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Clinical presentation for MI
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-Pale
-Diaphoretic(sweaty) -Anxious maybe increased heart rate, respiration, and blood pressure. |
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what are the 2 main diagnostic test used for diagnosing MI
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ECG: serial ECG tracings to show evolution of myocardial damage. "Q-waves" develop with infarction and necrosis. can locate area of damage
Cardiac serum protein markers: proteins presented in blood for a defined period of time after injury and during injury. |
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a protein and enzyme that show up in blood after a few hours of injury
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Myoglobin: muscle protein, dissipates within a day
Creatine Kinase: enzyme last for 3 days in blood |
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Troponin
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Early and late marker: Cardiac muscle enzyme released 6 hours after injury, stays elevated for about a week
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Stable Angina
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occurs with exertion, rest can help heal
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Unstable Angina
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Pain at rest and/or at night, more dangerous, bad prognosis, and usually 3 months.
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If blood flow to heart does not get better in 6 hours...
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Necrosis of heart tissue that can not be reversed
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complications of AMI
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-Arrhythmias
-Rupture of the Lt Ventricle wall -Aneurysm |
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Arrthyhmia
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-occur due to interruption of the blood supply to the pacemaker cells
-extremely common and major cause of mortality. |
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Rupture of Lt Ventricular wall
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-result from the necrotic heart tissue tearing
-hemorrhage occurs in the pericardial space -deadly and often occurs within the first 2 weeks after a MI. -survival rate low |
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Aneurysm
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-Late complication of Mi, 2 weeks to months after MI
-develops as the ventricular wall is weakend from clean up of tissue by phagocytic cells - localized outward bulge |
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Treatments
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-aspirin, to decrease clot formation
-beta-blockers, to reduce the work the heart has to do, decreasing demand for oxygen -nitroglycerin, to improve oxygen -morphine, calm the patient |
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Thrombolytic therapy
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reoxygenate the heart, break down throbus lodged in the artery by intravenous enzymes, TPA and Streptokinase. Given within the first 6 hours
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Primary coronary angioplasty
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-improves coronary blood flow by enlarging the disease artery's lumen
-pressurized balloon is inflated in the vessel to open obstruction |
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Define Stenosis
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narrowing of the valvular opening, usually due to valvular tissue thickening that prevents it from opening properly
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insufficiency and regurgitation mean the same thing.
T or F? |
True: valvular incompetence that prevents complete valve closure, allowing blood to flow back up into previous chamber
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Valvular Heart Disease affects how many valves?
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one or all the valves
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consequences of valvular heart disease are
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- arrhythmias
- heart failure - pulmonary congestion - dyspnea (trouble breathing) - synocpe (fanting) |
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Heart Failure
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When heart is unable to pump blood forward at a rate to meet the body's metabolic demands or when the heart can only meet the demands if the filling pressure are abnormally high, or both.
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Cardiac auscultation can reveal...
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abnormal murmurs and or particular sounds indicative of valvular disease.
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Mitral valve prolapse
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when the leaflet is floppy and enlarged and protrudes into the left atrium.
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what is the major diagnostic tool for valvular heart disease
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Echocardiography
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Chest radiograph
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in which cardiac enlargement, valvular calcification and interstitial edema in the lungs can appear
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treatment for valvular heart disease is
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usually valve replacement
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Acute Rheumatic Fever - ARF
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-Inflammatory condition that involves the skin, heart, and connective tissues.
-significant cause of valvular lesions, in mostly developing countries, due to lack of antibiotics. -usually in childhood |
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what is the bacteria that causes ARF?
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Group A Streptococci, causing streptococcus pharyngitis (strep throat)
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why is it important to get on antibiotics if you have strep throat?
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Because 3% of people with strep will develop ARF 2-3 weeks after
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what parts of the heart does ARF affect?
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can affect all 3 layers of heart
valves become inflamed, and one or more valve can be permanently distorted and thickened. |
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when do symptoms of valvular dysfunction from ARF occur?
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may not be until 10-30 years after ARF
-40% develop mitral stenosis -25% develop aortic regurgitation or stenosis |
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Mitral valve stenosis- MVS
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Fibrous thickening of the valve leaflets, fusion of the commissures and leaflets calcification due to inflamation.
Photograph of a short-axis section from the base of the heart of a 44-year-old woman with rheumatic mitral stenosis shows diffuse fibrous leaflet thickening (arrow) and commissural fusion (arrowhead) that cause the valve to resemble a fish mouth. A large anteroseptal myocardial infarction with associated mural attenuation also is depicted. (Courtesy of William D. Edwards, MD, Department of Pathology, Mayo Clinic, Rochester, Minn.) |
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What is MVS almost always caused by?
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Acute Rheumatic Fever
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when mitral valve becomes stiff and hard to push through Lt atrium and the pressure decreases. T or F ?
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False: Increases pressure to push through the stenotic valve.
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The increase pressure from MVS is transferred back to the lungs causing what?
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Pulmonary congestion, and after time Pulmonary Arteriolar Hypertension
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Which side of the heart becomes hypertrophied (enlarged) due to MVS and pulmonary congestion?
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Right side, because of lungs congestion, there is greater pressure to push against and right side then has to work harder.
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MVS leads then to right- heart failure T or F ?
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True, eventually right side gives up
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Due to Right heart failure, what other conditions with the patient have?
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-Liver congested and enlarged
-Ascites and edema in lower extremities -trouble breathing -reduced exercise capacity |
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Mitral Regurgitation
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Leaflets of mitral valve do not close properly, back flow of blood into the left atrium.
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Proper closure of mitral valve depends on what 3 structures?
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chordae tendineae, papillary muscles, and a tight mitral annulus (ring)
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what causes the components of mitral valve to malfunction?
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Acute myocardial infarct could damage papillary mucsle or ARF could calcify the annulus
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because of blood regurgitation into the left atrium and the pressure due to extra volume, what happens to the left side of the heart?
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Both the atrium and ventricle can become dilated to compensate for the greater stroke volume... eventually resulting to left ventricular failure.
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Mitral Valve Prolapse - MVP
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mitral valves flop into the left atrium during left ventricular systole (contraction)
mid-systolic click can be heard during auscultation Flippy floppy |
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MVP affects what % of normal population?
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About 7% and slightly more common in women
common and usually asymptomatic |
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definitive diagnosis of MVP made with?
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Echocardiography :)
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MVP puts patients at more risk for?
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infective endocarditis(one reason why people take prophylactic antibiotics), arrhythmias, and mitaral insufficiency
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Aortic Stenosis
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Calcified and harden aortic valve
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What are the 3 pathways to aortic stenosis?
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1.Rheumatic heart disease
2.Congenitally deformed valve (bicuspid): leads to abnormal blood flow, calcium deposits, and hardens valve. 3. Senile: wear and tear with old age |
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most common cause of aortic stenosis?
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Senile
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what happens to the Lt ventricle when it struggles against the stiff AO valve?
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Hypertrophy of Lt ventricle, which leads to Lt ventricle becoming stiff as well
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with AO valve stenosis the Lt ventricle works harder and then doesn't fill as easy because it is becoming stiff, what happens to the Lt Atrium?
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Also becomes hypertrophied
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Aortic Insufficiency (AI)
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Occurs from abnormalities of the valve leaflets or dilation of the aortic root which stretches leaflets and prevents form closing tightly, creating backflow to Lt ventricle during diastole
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Acute AI
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left ventricle can't handle increasing volume and high pressure goes to left artrium and pulmonary tree.
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Acute AI results in...
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Severe Dyspnea (difficultly breathing) , and usually is a surgical emergency
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Chronic AI
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Left ventricle compensates by dilation and hypertrophy
can last many years with out problems, but eventually will need intervention to prevent heart failure. |
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Infectious Ednocarditis (IE)
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-One of the most serious infections
-acute and chronic types -colonization and invasion of heart valves by bacteria |
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what does IE look like?
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Vegetation of bacteria on heart valves
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What is the best way to diagnose IE
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Ultrasound and Blood work
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IE is life threatening and results in death up to 60%. T or F?
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True
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Why is IE so deadly?
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The bacteria grow and erode valve surface, exposing underlying collagen. Platelets bind to the damage and envelop the organisms into a vegetation. Which then protects the organisms from antibodies and antibiotics.
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Acute IE
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-organisms with high virulence ( high ability to cause disease) enter the blood stream and circulate the heart valves.(such as Staphylococcus aureus)
-Causing scaring, valve proforation, perivalvular abcesses -life threatening and aggressive medical treatment needed. |
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major risk factor for Acute IE?
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IV drug abusers
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Acute IE vegetations occur mostly where?
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Tricuspid and pulmonic valves
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Chronic IE
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-Low virulence organisms get into blood stream
-require previously damaged valve to attach -rheumatic heart disease -MVP -prosthetic heart valves |
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what should patients with increase of IE take ?
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Prophylactic Antibiotics
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Chronic IE is a slower progressing disease and more likely to kill the patient. T or F ?
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False: least likely to kill them
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Both chronic and acute IE are dangerous because?
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vegetation can break off and embolize to other organs, causeing ishecmic damage.
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most common organs affect by vegetation embolus
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Lungs, Brain, Spleen, Kidneys
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IE treatment of choice?
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Valve replacement
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