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CHAPTER 20 CARDIOVASCULAR REVIEW QUESTIONS
CHAPTER 20 CARDIOVASCULAR REVIEW
WHAT IS THE STUDY OF THE HEART CALLED?
CARDIOLOGY
THE HEART HAS TWO PUMPS IN ONE. WHAT ARE THEY?
1. PULMONARY CIRCULATION
2. SYSTEMIC CIRCULATION
HOW MUCH BLOOD DOES THE HEART PUMP:
PER DAY?
PER MIN?
DURING EXERCISE?
7200L PER DAY
AT 5L PER MINUTE
DURING EXERCISE INCREASES SEVERALFOLD.
WHAT ARE THE 4 FUNCTIONS OF THE HEART?
1. GENERATING BLOOD PRESSURE
2. ROUTING BLOOD
3. ENSURING ONE-WAY BLOOD FLOW
4. REGULATING BLOOD SUPPLY
WHAT ARE THE LAYERS OF THE HEART?
PERICARDIUM->FIBROUS
->SEROUS->PARIETAL
->VISCERAL

-PERICARDIAL CAVITY
WHAT HAPPENS WHEN THE SEROUS PERICARDIUM BECOMES INFLAMED?
PERICARDITIS
STAGE 1 __ SEROUS FLUID->FRICTION
STATE 2 __ SEROUS FLUID->HEART COMPRESSION
WHAT ARE THE LAYERS OF THE HEART WALL?
EPICARDIUM
MYOCARDIUM
ENDOCARDIUM
BE ABLE TO IDENTIFY AND DESCRIBE THE ATRIA, VENTRICLES, AND VESSELS OF THE HEART.
1.ATRIA-UPPER THIN WALLED;
-INTERATRIAL SEPTUM (SEPARATES LEFT & RIGHT)
2.VENTRICLES- LOWER CHAMPBERS OF THE HEART,THICK, LEFT THICKER THAN THE RIGHT,INTRAVENTRICULAR SEPTUM(SEPARATES THE LEFT FROM RIGHT)
-PAPILLARY MUSCLES CAUSE VENTRICULAR CONTRACTION
3. VALVES- TRICUSPID (RIGHT AV)
- BICUSPID (MITRAL LEFT AV)
4. VESSELS-
-PULMONARY VEIN- CARIES BLOOD FROM LUNGS TO HEART *ONLY VEIN THAT CARRIES O2 RICH BLOOD.
-PULMONARY ARTERY-HEART TO LUNGS
-SUPERIOR VENA CAVA- COLLECTS IN HEAD AND NECK
-INFERIOR VENA CAVA-COLLECTS BLOOD FROM LOWER REGIONS OF THE BODY.
WHAT ARE THE LAYERS OF AN ARTERY?
1. TUNICA INTIMA
- INNER MOST LAYER
- SIMPLE SQUAMOUS
- RESTS ON BASEMENT MEMBRANE
- ELASTIC PROPERTIES (LAMINA)
2. TUNICA MEDIA
-MIDDLE LAYER
-RESTS ON BASEMENT MEMBRANE
-THICKEST
-CIRCULAR SMOOTH MUSCLE & ELASTIN
-VASODILATED (INCREASE BLOOD VESSEL DIAMETER)
-VASOCONSTRICTION (DECREASE BLOOD VESSEL DIAMETER)
3. TUNICA ADVENTITIA- OUTER MOST; COLLAGEN
WHAT ARE THE LAYERS OF A CAPILLARY?
-LINING OF SIMPLE SQUAMOUS ENDOTHELIUM
-WALLS CONSISTS PRIMARILY OF ENDOTHELIAL CELLS WHICH REST ON A BASEMENT MEMBRANE
-OUTSIDE OF MEMBRANE DELICATE LAYER OF LOOSE CONNETIVE TISSUE
-PRECAPILLARY CELLS
WHAT IS THE CAPILLARY NETWORK?
ARTERIOLES -> METARTERIOLE THROUGHFARE= PAPILLARY SPHINCTERS (VASCULAR SHUNT) SMOOTH MUSCLES ACT AS VALVES
EX. EAT!
THE NETWORK FORMS NUMEROUS BRANCHES THAT TRANSPORT BLOOD FROM THE THROUGHFARE CHANNEL AND CAN RETURN TO THE CHANNEL
HOW ARE VARICOSE VEINS DEVELOPED?
STRETCHING OF THE VEIN WALLS IN THE LOWER LIMBS CAUSING VALVES TO BECOME INCOMPETENT.
BE ABLE TO TRACE THE PATHWAY OF BLOOD IN THE PULMONARY CIRCUIT
PULMONARY CIRCUIT-
LUNG TISSUE -> PULMONARY VEINS-> LEFT ATRIUM -> BICUSPID VALVE -> LEFT VENTRICLE -> AORTA
BE ABLE TO TRACE THE PATHWAY OF BLOOD IN SYSTEMIC CIRCUIT.
BODY TISSUES-> SUPERIOR VENA CAVA -> RIGHT ATRIUM -> TRICUSPID VALVE -> RIGHT VENTRICLE-> PULMONARY SEMILUNAR VALVES -> PULMONARY TRUNK-> PULMONARY ARTERIES -> LUNG TISSUE
BE ABLE TO TRACE THE PATHWAY OF BLOOD IN THE CORNARY CIRCULATION.
AORTA-> LEFT CORONARY ARTERY-> ANTERIOR INTERVENTRICULAR ARTERY-> CIRCUMFLEX ARTERY-> MARGINAL ARTERY-> CORONARY VEINS CONVERGE IN CORONARY SINUS AND DRAIN INTO RIGHT ATRIUM
WHAT ARE THE ARTERIES OF THE HEART?
RIGHT & LEFT CORONARY ARTERIES
RIGHT & LEFT MARGINAL ARTERIES
CIRCUMFLEX ARTERY
POSTERIOR & ANTERIOR INTERVENTRICULAR ARTERIES
BE FAMILIAR WITH HEART HISTOLOGY.
HEART SKELETON CONSISTS OF A PLATE OF FIBROUS CT BETWEEN THE ATRIA & VENTRICLES, THIS CT PLATE FORMS FIBROUS RINGS AROUND THE ATRIOVENTRICULAR AND SEMILUNAR VALVES & PROVIDES A SOLID SUPPORT, ALSO SERVES AS ELECTRICAL INSULATION BETWEEN THE ATRIA AND VENTRICLES & PROVIDES RIGID SITE FOR ATTACHMENT OF THE CARDIAC MUSCLES
TRACE THE PRODUCTION OF AN ACTION POTENTIAL THROUGH THE CONDUCTING SYSTEM OF THE HEART.
-SA INITIATES ACTION POTENTIAL; SPREADS ACROSS ATRIA & CAUSES TO CONTRACT
-AP ARE SLOWED IN AV NODE; ALLOWS ATRIA TIME T O CONTRACT & BLOOD TO MOVE TO VENTRICLES
-AP TRAVELS THROUGH AV NODE & BUNDLE BRANCHES -> PURKINJE FIBERS-CAUSES VENTRICLES TO CONTRACT
SA= PACEMAKER- SPONTANEOUSLY & RHYTHMICALLY GENERATE AP (AUTORHYTHMIC)
BE FAMILIAR WITH CARDIAC ACTION POTENTIALS AND HOW THEY ARE PROPAGATED.
PERMEABILITY CHANGES DURING AP IN CARDIAC MUSCLE:
1. DEPOLARIZATION PHASE:
* V-GATED Na+ CHANNELS OPEN
* V-GATED K+ CHANNELS CLOSE
* V-GATED Ca2+ CHANNELS BEGIN TO OPEN
2. EARLY REPOLARIZATION & PLATEAU PHASES:
* V-GATED Na+ CHANNELS CLOSE
* SOME V-GATED K+ CHANNELS OPEN, CAUSING EARLY REPOLARIZATION
* V-GATED Ca2+ CHANNELS OPEN, PRODUCING THE PLATEAU BY SLOWING FURTHER REPOLARIZATION
3. FINAL REPOLARIZATION PHASE:
* V-GATED Ca2+ CHANNELS CLOSE
* MANY V-GATED K+ CHANNELS OPEN
WHAT DOES AN ECG MEASURE?
RECORDS ONLY THE ELECTRICAL ACTIVITIES OF THE HEART.
-DEPOLARIZATION OF THE ATRIA PRODUCES THE P-WAVE
-DEPOLARIZATION OF THE VENTRICLES PRODUCE QRS COMPLEX
-REPOLARIZATION OF THE ATRIA OCCURS DURING THE QRS COMPLEX
-REPOLARIZATION OF THE VENTRICLES PRODUCES THE T-WAVE
WHAT ARE P-WAVES, QRS COMPLEX, T-WAVE, AND QT INTERVALS?
1. P-WAVES: 1ST COMPLEX OF THE ECG REPRESENTING DEPOLARIZATION OF THE ATRIA.
2. QRS COMPLEX: PRINCIPLE DEFLECTION IN THE ECG, REPRESENTING VENTRICULAR DEPOLARIZATION
3. QT INTERVAL: TIME ELAPSING FROM THE BEGINNING OF THE QRS COMPLEX TO THE END OF THE T-WAVE REPRESENTING THE TOTAL DURATION OF ELECTRICAL ACTIVITY OF THE VENTRICLES.
4. T-WAVE: DEFLECTION IN THE ECG FOLLOWING THE QRS COMPLEX REPRESENTING VENTRICULAR REPOLARIZATION
LOOK AT EXAMPLES OF IRREGULAR ECGs. PAGE 686 FIGURE 20.17
1. COMPLETE HEART BLOCK (P WAVES AND QRS COMPLEXES ARE NOT COORDINATED)

2. PREMATURE VENTRICULAR CONTRACTION (PVC) (NO P WAVES PRECEDE PVC's)

3. BUNDLE BRANCH BLOCK (PROLONGED QRS COMPLEXES)

4. ATRIAL FIBRILLATION (NO CLEAR P WAVES AND RAPID QRS COMPLEXES)

5. VENTRICULAR FIBRILLATION (NO P, QRS, OR T WAVES)
WHAT IS MAP? AND HOW IS IT MEASURED?
MAP= MEAN ARTERIAL PRESSURE- IS THE AVERAGE BLOOD PRESSURE BETWEEN SYSTOLIC & DIASTOLIC PRESSURE IN THE AORTA.
MAP=CO x PR=
ITS PROPORTIONAL TO CARDIAC OUTPUT OR MINUTE VOLUME, IS THE AMOUNT OF BLOOD PUMPED BY THE HEART PER MINUTE AND PERIPHERAL RESISTANCE IS THE TOTAL IS THE TOTAL RESISTANCE AGAINST WHICH BLOOD IS PUMPED.
BE ABLE TO DETERMINE CARDIAC OUTPUT IF GIVEN A SET OF VALUES FOR HEART RATE AND STROKE VOLUME. BE ABLE TO DETERMINE HEART RATE AND STROKE VOLUME IF GIVEN THE OTHER 2 VALUES.
CARDIAC OUTPUT IS EQUAL TO HEART RATE TIMES STROKE VOLUME. HR IS THE NUMBER OF TIMES THE HEART BEATS PER MINUTE. SV WHICH IS THE VOLUME (CARDIAC CYCLE) IS EQUAL TO END DIASTOLIC VOLUME MINUS END SYSTOLIC VOLUME. STROKE VOLUME IS THEREFORE EQUAL TO 70ML.
CO=HR x SV
WHAT IS PERIPHERAL RESISTANCE AND HOW DOES IT RELATE TO MAP?
RESISTANCE TO BLOOD FLOW IN ALL THE BLOOD VESSELS.
DEPENDING ON THE PERIPHERAL RESISTANCE, THE MAP OR AVG BLOOD PRESSURE BETWEEN SYSTOLE AND DIASTOLE WILL BE AFFECTED
WHAT FACTORS INFLUENCE RESISTANCE?
BY INCREASING END-DIASTOLIC VOLUME OR BY DECREASING END-SYSTOLIC VOLUME
WHAT IS STARLING'S LAW OF THE HEART AND WHAT DOES IT MEASURE?
THE RELATIONSHIP BETWEEN PRELOAD & STROKE VOLUME.
IT MEASURES THE RELATIONSHIP BETWEEN CHANGES IN THE PUMPING EFFECTIVENESS OF THE HEART AND CHANGES IN THE PRELOAD.
WHAT IS TACHYCARDIA? BRADYCARDIA?
TACHYCARDIA-ABNORMAL HEART RHYTHMS
-SYMPTOM: HEART RATE IN EXCESS OF 100bpm
-CAUSES: ELEVATED BODY TEMP., EXCESSIVE VAGAL STIMULATION, TOXIC CONDITIONS

BRADYCARDIA- HEART RATE LESS THAN 60bpm
-CAUSE: ELEVATED STROKE VOLUME IN ATHLETES, EXCESSIVE VAGAL STIMULATION, CAROTID SINUS SYNDROME
HOW IS THE HEART RATE REGULATED?
TO MAINTAIN HOMEOSTASIS, THE AMOUNT OF BLOOD PUMPED BY THE HEART VARIES. EITHER INTRINSIC OR EXTRINSIC REGULATORY MECHANISMS CONTROL CARDIAC OUTPUT.
INTRINSIC-FROM NORMAL FUNCTIONAL CHARACTERISTICS OF THE HEART/ DOESN'T DEPEND ON HORMONAL OR NEURAL REGULATION
EXTRINSIC- INVOLVES NEURAL & HORMONAL CONTROL
WHAT ARE TH MAJOR EFFECTS OF AGING ON THE HEART? (6)
1. AGING RESULTS IN GRADUAL CHANGES IN THE FUNCTION OF THE HEART WHICH ARE MINOR UNDER RESTING CONDITIONS BUT ARE MORE SIGNIFICANT DURING EXERCISE.
2. HYPERTROPHY OF THE LEFT VENTRICLE IS A COMMON AGE-RELATED CONDITION.
3. THE MAXIMUM HEART RATE DECREASES AND BY AGE 85 THE CARDIAC OUTPUT MAY BE DECREASED BY 30-60%.
4. THERE IS AN INCREASED TENDENCY FOR VALVES TO FUNCTION ABNORMALLY AND FOR ARRHYTHMIAS TO OCCUR.
5. AN INCREASED OXYGEN CONSUMPTION, REQUIRED TO PUMP THE SAME AMOUNT OF BLOOD, MAKES AGE-RELATED CORONARY ARTERY DISEASE MORE SEVERE.
6. EXERCISE IMPROVES THE FUNCTIONAL CAPACITY OF THE HEART AT ALL AGES.
CARDIAC TAMPONADE
BUILDUP OF BLOOD IN THE PERICARDIAL SAC
ANGINA PECTORIS
-REDUCTION IN BLOOD SUPPLY TO MYOCARDIUM
-PAIN RADIATING IN CHEST, NECK, LOWER JAW, LEFT ARM, AND LEFT SHOULDER
MYOCARDIAL INFARCTION
-PROLONGED BLOOD DEPRAVATION TO CARDIAC MUSCLE RESULTING IN CELLULAR DEATH
-MOST COMMON CAUSE IS THROMBUS BLOCKING ARTERY
-ALSO CAUSED BY ATHEROSCLEROTIC LESIONS.
CALCIUM CHANNEL BLOCKERS
-PREVENTS INFLUX OF Ca2+ THROUGH V-GATED Ca2+ CHANNELS
-REDUCE HEART RATE AND PREVENT TACHYCARDIA
ABNORMAL HEART SOUNDS
-MURMURS
*GURGLING OR SWISHING SOUND
*INCOMPETANT VALVES

-STENOSED
*RUSHING SOUND
*NARROWED BLOOD VESSELS
MYOCARDITIS
INFLAMMATION OF MYOCARDIUM; CAN LEAD TO HEART FAILURE
PERICARDITIS
INFLAMMATION OF PERICARDIUM (BACTERIAL OR VIRAL INFECTIONS) THAT CAN BE VERY PAINFUL
RHEUMATIC HEART DISEASE
STREPTOCOCCAL INFECTION IN YOUNG CAUSES OVER ACTIVE IMMUNE RESPONSE LEADING TO STENOSED OF INCOMPETENT VALVES
CORONARY HEART DISEASE
INADEQUATE BLOOD FLOW TO THE HEART USUALLY IN OLDER PEOPLE
CORONARY THROMBOSIS
FORMATION OF BLOOD CLOT IN CORONARY ARTERY DUE TO DEGENERATIVE CHANGES IN ARTERY WALL
MYOCARDIAL INFARCT
AREA OF DAMAGED TISSUE CAN RESULT IN DEATH IF INFARCT IS LARGE. IF INFARCT IS SMALL, SCAR TISSUE DEVELOPS MAKING HEART FUNCTION DIFFICULT.
CONGENITIAL HEART DISEASE
*ABNORMAL DEVELOPMENT OF THE HEART RESULTING IN DECREASE IN PUMPING EFFECTIVENESS
INCOMPETENT HEART VALVE
A LEAKY VALVE
CYANOSIS
INADEQUATE HEART FUNCTION IN BABIES RESULTS IN LOW BLOOD OXYGEN LEVELS; CAUSES SKIN TO APPEAR BLUE, HENCE THE NAME "BABY BLUE".
HYPERTENSION
* INCREASES AFTERLOAD ON HEART AND CAN CAUSE THE HEART TO ENLARGE; LEADS TO HEART FAILURE.
* ABNORMALLY HIGH SYSTEMIC BLOOD PRESSURE
* EFFECTS ABOUT 1/5 THE POPULATION IN UNITED STATES
* RECOMMENDED DIET LOW IN FATS AND CHOLESTEROL AS WELL AS LOW IN REFINED SUGAR
* TOBACCO AND ALCOHOL ARE CONTRIBUTING FACTORS ALONG WITH STRESS AND LACK OF EXERCISE.
WHAT DOES THIS ECG INDICATE?
NORMAL SINUS RHYTHMS
WHAT DOES THIS ECG INDICATE?
2ND DEGREE HEART BLOCK (BLOCKAGE OF AV NODE) 2 P-WAVES (FAULTY AV NODE)
WHAT DOES THIS ECG INDICATE?
JUNCTIONAL RHYTHM (IN AV NODE) DEFECTIVE SA NODE OR PACEMAKER
WHAT DOES THIS ECG INDICATE?
SINUS TACHYCARDIA (FASTER THAN 100 BPM)
WHAT DOES THIS ECG INDICATE?
PREMATURE VENTRICULAR CONTRACTION (PVC)
(WIDE COMPLEX) ("ECTOPIC FOCUS")
WHAT DOES THIS ECG INDICATE?
VENTRICULAR FIBRILLATION (NO P,QRS, OR T WAVES)