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240 Cards in this Set

  • Front
  • Back

What germ layer forms the cardiovascular system?

Mesoderm

What germ germ layer forms the vessels?

Mesoderm

The linear heart tube formed by the mesoderm starts beating on which day of development?

Its first, which is day 15

The embryonic foramen ovale becomes what after birth?

fossa ovalis

The embryonic ductus arteriosus becomes what after birth?

Ligamentum arteriosum

What forms the atria?

The separation into right and left of the primitive sinuatrium or septum primum

The fusion of the endocardial or artrioventricular cushions posteriorly and anteriorly forms what?

The tricuspid and mitral inlets which become the artrioventricular valves

How do the right and left ventricle become compartmentalized?

There are two theories of development:


1. Trabeculaitons appear and grow into muscular structures -> coalesce with the endocardial cushions -> eventually form an interventricular septum

What does the interventricular foramen result in?

By the end of week 7 it closes, resulting in the interventricular septum

In which chamber are the SA and AV nodes located?

Right Atrium

Where does blood from cardiac veins flow?

Through the coronary sinus into the right atrium

HOw much serous fluid lies between the parietal and visceral layer of the pericardium?

Approx. 10-15 ml/ cc

What structures work together to prevent tricuspid and mitral valves from buckling open?

Chordae tendonae and papillary muscle

When do coronary arteries fill?

During diastole, blood backs up and fills the semilunar valves of the aortic valve, entering coronaries

What causes the first hear sound?

Closure of mitral and tricuspid valves

What causes the second heart sound?

Closure of aortic and pulmonic valves

Where does the subclavian artery turn into the axillary artery?

At the lateral border of the first rib

At what level of the spine does the vertebral artery enter the transverse foramen?

C6

What are the two sources for blood to the CNS?

1. Vertebral artery


2. Internal carotid

What ascends the neck with the common carotid?

1. Internal jugular vein


2. Vagus nerve


What happens to the common carotid between the hyoid bone and upper thyroid cartilage?

It bifurcates into internal and external carotids

Which artery supplies all the visceral, musculoskeletal and dental structures of the head and neck apart from the brain and orbit?

The external carotid artery

What artery supplies the orbit? Where does it come from?

The Opthalmic artery that branches off from the internal carotid

What is the terminal branch of the external carotid?

The superficial temporal

What is a major source of blood for deep skull cavity, part of the orbit, teeth, muscles of mastication, and the dura mater?

Maxillary artery

What supplies the anterior part of the brain?

The internal carotid

What do the two vertebral arteries form?

The basilar artery

What supplies the posterior part of the brain?

The basilar artery, from the two vertebral arteries

Which arteries comprise the Circle of Willis?

1. Anterior communicating


2. Anterior cerebral (R & L)


3. Internal carotid artery (R & L)


4. Posterior cerebral artery (R & L)


5. posterior communicating artery (R & L)

From which artery does the superior cerebellar branch?

Basilar

What purpose does the Circle of Willis serve?

It encircles the pituitary gland and the optic chiasma. It unites the brain's anterionr and posterior blood supply, equalizes the two hemisphere's blood pressure, and provides alternate routes for blood to reach the brain if a vessel become compromised

What branches off from the vertebral artery?

1. Posterior and anterior spinal arteries


2. Posterios inferior cerebellar

What branches off from the basilar artery?

1. Superior cerebellar


2. Anterior and middle inferior cerebellar


3. Labarynthine


4. Pontine

What drains blood from the scalp and face?

External jugular

What drains blood from brain, superficial fac and neck?

Internal jugular

Which jugular vein joins up with the subclavian vein?

External jugular

Where does the Arygos Vein drain?

The superior vena cava

What crosses anterior ti the scalene tubercle of the first rib?

The subclavian vein

What do the internal jugular and subclavian veins become?

Brachiocephalic vein

What travels superficially to the SCM?

External jugular

What structures in the dura mater collect venous blood from the brain?

The sinuses

To where do the sinuses drain?

The internal jugular vein

What structure drains blood from the brain?

Cavernous sinus

What structure provides collateral blood flow through the head?

THe pterygoid plexus

What vein travels on the radial side of the arm?

The cephalic vein

What vein travels on the ulnar side of the arm?

Basilic

What vein crosses the cubital fossa?

Median cubital

THe basilic vein joins with what to form the inferior portion of the axillary vein?

THe brachial vein

What merge into the popliteal vein?

Anterior and posterior tibial veins

What veins drain into the popliteal vein?

1. Anterior and posterior tibial veins


2. Small saphenous vein

What does the popliteal vein become?

Femoral vein

What drains into the femoral vein?

The Great saphenous vein

What vein travels form the medial foot along the medial calf?

Saphenous vein

What vein begins behind the medial malleolus and crosses the popliteal fossa?

Small saphenous vein

What forms the portal vein?

1. Superior mesenteric vein


2. Splenic vein

How does blood drain from the liver?

Via sinusoids into hepatic veins and into the inferior vena cava

What drains the greater curvature of the stomach, spleen and pancreas?

THe splenic vein

What drains transverse and descending colon, sigmoid and rectum?

Inferior mesenteric vein

Where does the inferior mesenteric vein drain?

Into the splenic vein

What does the superior mesenteric vein drain?

Small intestine, ascending colon

What lymphatic vessel drains the lower extremities?

Cisterna chyli

What does the cisterna chyli flow into?

The thoracic duct

T/F: the upper left side and the lower right and left side of the body's lymph drains into the horacic duct?

T. The upper right side of the body (form lower costal margin up) drains into the right lymphatic duct, while the rest drains into the thoracic duct

Where does the lumph of the right upper extremity and right neck flow?

Into the right lymphatic duct

Where does the thoracic duct drain?

into the left subclavian vein

What makes up central lymphatic tissue?

Bone marrow and thymus

What makes up peripheral lymphtic tissue?

Lymph nodes, peyers patches, appendix, tonsils, etc.

Whate serve as conduits for blood?

arteries

What are the three coats/ tunica of the blood vessel wall?

1.Tunica intima


2. Tunica media


3. Tunica adventitia

What blood vessels are involved in nutrient and waste exchange?

Capillaries

What are the three types of capillaries?

1. Continuous


2. Fenestrated


3. Sinusoidal

What type of capillary excludes proteins and cells from passing through?

Continuous

Wat type of capillary excludes only cells? where are they found?

Fenestrated. Found in the kidney

What type of capillary allows cells and protein to pass through? Where are they found?

Sinusoidal. discontinuous, found in liver, bone marrow, spleen

What three layers are found in all blood vessels except capillaries?

1. Tunica intima or interna


2. Tunica media


3. Tunica adventitia or externa

What property of blood vessels helps push blood through the arteriole system?

Elastic tissue

What property of blood vessels does smooth muscle provide?

The ability to contract and dilate allows blood to be shunted from one area to another

What protects blood vessels against distention?

THe fibrous nature of the tissue

Which blood vessel layer contains collagen and elastin fibers?

Tunica adventitia

Capillaries are made of only one layer type; what is it?

Tunica intima

Which blood vessel layer contains smooth muscle and thus is responsible for vasoconstriction and vasodilation?

Tunica media

What types of blood vessels are resistance vessels due to their smooth muscle?

Arteries and arterioles

Myocardial cells have more of this organelle due to its high oxidative capacity

Mitochondria

What cellular feature allows the heart to contract in unison?

The presence of gap juncitons between muscle cells

How to T-tubules differ between cardiac and skeletal muscle cells?

Cardiac: T-tubules contain extracellular fluid high in calcium


Skeletal: T-tubules contain ec fluid low in calcium

What structure brings depolarization inside the cardiac muscle and helps regulate cytoplasmic calcium?

T-tubules

What prevents tetanic contraction in cardiac muscle

The long cardiac action potential

What aspect of the action potential prevents a second actin potential from occuring?

The long refractory period or plateau period

What is the originator of the cardiac action potential?

The SA node

What property allows the SA node to function as the primary pacemaker?

The small size of the cells allow for it to spontaneously depolarize

What acts as a delay station for the action potential?

The AV node

Why does the AV node delay the aciton potential?

To allow the atrial muscle to depolarize before the ventricular muscle

What can act as a secondary pacemaker in pathological conditions?

The AV node

What allows for rapid conduction of the aciton potential?

1. Bundle of HIS


2. Bundle branch


3, Purkinje fibers


4. Specialized tracts

What is the sequence of the electrical impulse in the heart?

SA node -> specialized tracts -> AV node and Atrial muscle -> Bundle of HIS -> bundle branches -> Purkinje fibers -> ventricle muscle

What serves to depress the heart rate at rest by slowing down the SA node?

PNS

How does the SNS affect conduction through the electrical system?

It speeds up conduction of the Action potential and therefore increases HR

What nerve has the greatest influence on the heart?

The Vagus N

What is the affect of vagal stimulation on the heart?

It serves to slow the conduction of action potentials through the AV node due to the parasympathetic nerve fibers it carries

How does Norepi affect hear contractility?

It increases it

In which phase do the ventricles fill?

Late diastole

In which phase do we get isovolumic contraction?

Early systole

What phase of the cardiac cycle uses the most energy?

The isovolumic contraction of early systole

What is the purpose of isovolumic contraction?

To build up the pressure so as to overcome the high aortic pressure

In which phase is ejection?

Late systole

When is the relaxation phase?

Early diastole

What causes heart sound 1?

The closing of the atrial-ventricular valves

What causes heart sound 2?

The closing of the plmonic and aortic valves

When in the cycle is heart sound 1?

Late diastole/ early systole

When in the cycle is heart sound 2?

End systole/ begin diastole

What device records electrical activity of the heart?

ECG

What information do we get from ECG?

1. Heart rate and rhythms


2. Axis of the heart

What on an EKG marks atrial depolarization?

The P wave

Wht on an EKG marks ventricular depolarizatin?

The QRS complex

What on an EKG marks ventricular repolarization?

The T wave

What two things influence cardiac output?

1. HR


2. Stroke volume

What are three major substrates for cardiac metabolism?

1. Fatty acids


2. Glucose


3. Glycogen breakdown

What are three minor substrates for cardiac metabolism?

1. Lactic acid


2. Ketones


3. Intramuscular triglycerides

What is the major limitation of energy metabolism by myocardium?

Coronary blood flow delivering oxygen

What two factors determine oxygen consumption by myocardium?

1. Wall tension in the heart that must be overcome, e.g. during isovolumic contraction


2. Isotonic contraction to eject the blood

What type of circulation has few controls, and is a low pressure/ low resistance system?

The pulmonary system

What blood vessels act as capacitance vessels?

Veins and venules

What increases venous return?

Vasoconstriction

Which blood vessels have valves?

Veins and venules

What are the four pressures that affect capillary exchange?

1. Plasma oncotic pressure


2. Plasma hydrostatic pressure


3. Interstitial oncotic pressure


4. Interstitial hdrostatic pressure

Which of the four pressures affect(s) capillary exchange?

1. Plasma oncotic pressure


2. Interstitial oncotic pressure


3. Interstitial hdrostatic pressure

Which of the four pressures is actually a negative pressure or suction?

Interstitial hydrostatic pressure

What are three mechanisms for edema?

1. Increased interstitial pressure


2. Decreased plasma oncotic pressure


3. Increased interstitial oncotic pressure

How will decreased blood protein synthesis cause edema?

By decreasing plasma oncotic pressure

What will influence lymph flow?

1. smooth muscle tone


2. Skeletal muscle contraction

Pressure in the right atrium or the vena cava at the level of the heart is known as what?

Central vnous pressure

What will increase blood flow and decrease venous pressure?

Skeletal muscle contrction

Where are baroreceptors located?

In the aortic arch and carotids

What do baroreceptors sense?

Blood pressure changes

What cranial nerves innervate the baroreceptors?

Carotid sinus baroreceptor: CN IX


Aortic arch baroreceptor: CN X

What kind (not type) of neurotransmitters are released when baroreceptors are stimulated by high blood pressure?

Inhibitory neurotransmitters

What do inhibitory neurotransmitters accomplish, in respect to baroreceptors?

They inhibit the vasomotor and cardioregulatory centers of the medulla oblongata

How does the stimulation of the cardioregulatory center affect blood pressure?

Increased parasympathetic stimulation to the heart causes a decreased heart rate and contractile force

How does stimulating the vasomotor center affect blood pressure?

Decreased sympathetic stimulation to blood vessels, reslting in vasodilation

What is accomplished by stimulation baroreceptors?

A decrease in blood pressure due to vasodialation

T/F: baroreceptors can alo increase blood pressure?

T. They increase and decrease BP along the same pathways

Where are chemoreceptors located?

Aortic arch and carotids

What do chemoreceptores sense?

Low blood oxygen as a result of decreased blood flow due to low BP

What kind of neurotransmitter is released when chemoreceptors are stimulated by low pressure?

Excitatory neurotransmiters

What do excitatory neurotransmitters do, in respect to the vascular system?

They increase the sympathetic firing down neurons that innervate smooth muscle of blood vessels, which causes vasoconstriction

What is accomplished by stimulation of chemoreceptors?

An increase in BP by vasoconstriction

How does increased vagal output cause decreased BP?

Via its pararsympathetic effects that cause a decreased HR, leading to a decreased CO, leading to a decreased BP

How does the kidney affect BP?

Via the renin-angiotensin system: decreased BP -> decreased GFR -> release of renin -> evental release of aldosterone -> kidney reabsorption of Na+ and H2O -> increased blood volume -> increased BP

How does ADH affect BP?

Low BP -> ADH release -> kidney retains H2O => increased blood volume -> increased BP

IN metabolic control of blood flow, decreased O2 causes release of metablites, e.g. CO2, lactate, etc., which cause what?

Vasodilation

What is the neme of the control that protects against high pressure damage?

Autoregulation

What tissue is good at autoregulation?

Brain tissue!

What is the net result on blood vessels of autoregulation?

Vasoconstriction

What is the long term control of blood flow, i.e. compensation for some type of tissue ischemia?

Angiogenisis

What is the primary catecholamine for alpha adrenergic receptors?

Norepi

Which vascular beds have primarily alpha receptors?

Skin, renal and splanchic vasculature

What effect does norepi have on smooth muscle cells in the vascular beds?

Vasoconstriction

What is the primary catecholamine for beta 2 receptors?

Epinephrine

Which vascular beds have primarily beta 2 receptors?

Coronary and skeletal muscle vessels

What effect does epi have on smooth muscle in the vascular beds/

Vasodilation

Which of the ANS branches has the greatest control over circulation?

SNS via Norepi and Epi (Vasoconstriction and vasodilation, respectively)

Which vascular beds are overperfused at rest?

Skin, renal, splanchnic

Brain ischemia caused by increased CSF pressure is know as what?

Cushing's Reflex

When, during the cardiac cycle, do the coronaries receive their blood flow?

During diastole


Which apolipoproteins are associated with which diseases?

Apo-A-V: hypertriglyceridemia


Apo-B100: hypobetalipoproteinemia


Apo-C-II: hyperchylomicronemia


Apo-C-III: hypertriglyceridemia

T/F: cardia muscle can use glucose, ketone bdies, pyrvuate, fatty acids and lactate for fuel?

T. Its preferred fuel in long-chain fatty acids, with glucose as a second choice

ATP is used int he heart for what?

60-70% of ATP is used for contraction and 30-40% for ion pumps

Why would hypophosphatemia result in muscle weakness and impaired cardiac function?

Because a proper supply of both ADP and phosphate are needed for the Krebs Cycle to produce ATP

Besides raising LDL, triglycerides, and lipoproteiin, what other effects do trans-fatty caids have on the cardiovascular system?

They promote inflammation, endothelial dysfunction, insulin resistance, visceral adiposity, and arrhythmias

Which minerals are associated with lowering BP?

Mg, Ca, K

B vitamin deficienc is associated with what cardiovascular disease?

Cardiomyopathy

What poyphenol in associated with lowering BP and has anti-oxidane, anti-platelet, anti-inflammatory properties?

Flavonoids

What are the two types of hemorrhage?

1. Acute -- sudden , massive loss of blood


2. Chronic -- low grade, mild leakage of blood

What are some of the complications of hemorrhage?

Hemorrhagic shock: > 15% of blood lost


Hemorrhagic strokes,


Hemopericardium in areas sensitive to hemorrhage


Iron deficiency from chronic blood loss

What is an exudate?

Edematous fluid containing high amounts of protein and inflammatory cells

What is a transudate?

Edematous fluid with low protein content, not usually associated with infammation

What mechanism are involved in sompensated, early, nonprogressive shock?

1. Increased HR and peripheral resistance to increase blood flow to vital organs


2. Increased respiratory rate to remove CO2 and raise pH

What occurs in the body during decompensated, progressive shock?

1. O2 levels fall, causing vasodilation and decreased blood flow to the heart


2. Cell injury and cell death occur from lack of O2

What occurs in the body during the irreversible stage of shock?

1. Acute tubular necrosis in the kidney, initially reversible


2. Full renal failure, as acute tubular necrosis becomes more severe


3. Metabolic acidosis, coma, and heart failure

What initiates thrombus formation?

Damage to endothelial cells that causes interactions between platelets, exposed collagen, and blood proteins

What is the name of the factor that causes platelets to adhere to the exposed subendothelial surface in clot formation?

von Willebrand's factor

The extrinsic coagulation pathway is initiated by what tissue factor?

Thromboplastin

What causes thrombosis?

Elements that damage endothelial cells or promote coagulation

What are the symptoms of chronic deep venous insufficiency in the legs?

Pigmentation, edema, skin induration, ulceration

What is the most common cause of death in Western industrialized countries?

Arterial thrombosis (atherosclerosis), due primarily to cigarette smoking

What is an embolus?

A piece of thrombus that has broken off, entered the bloodstream, and become trapped in the vasculature (thromboembolism)

Where do leg venous thrombi commonly lodge?

In the lung, after entering the right atrium of the heart through the inferior vena cava and passing through the ventricle (Pulmonary emboli)

Where do arterial emboli that break off from mural thrombi in the heart or major arteris commonly lodge?

1. Branches of the carotid artery, causing stroke


2. Branches of the mesenteric artery, causing hemorrhagic infarction


3. Branches of the renal artery, causing renal cortex infarcts

What is the name of an embolus that lodges at the bifurcation of the main pulmonary artery?

Saddle embolus

What are the two types of infarcts?

1. Anemic -- white or pale in areas lacking collateral blood supply


2. Hemorrhagic -- red, in areas where collateral blood supply may be insuficient

What causes infarction?

Blockage or lack of blood flow to a organ

How is arteriosclerosis defined?

Sclerosis (hardening) of the arteries

What types are affected by atherosclerosis?

Atherosclerosis is arteriosclerosis of large elastic arteries, including the aorta, coronary, common iliac, femoral, popliteal, internal carotid and cerebral arteries

What are atheromas?

Lesions that develop on artery walls, comprised of macrophages, LDL, fibrin, and smooth muscle. They are usually asymptomatic for 20-40 years until the become symptomatic, complicated plaques

How does arteriosclerosis msot probably begin?

Damage to vascular endothelium

Whan oxidized lipids are ingested by macrophages, wat do they form?

Foam cells

What stages are involved in polyarteritis nodosa (PAN)?

1. Immune complex deposits in walls of arteries in the first stage, initiating the complement cascade and calling in neutrophils


2. Macrophages and fibroblasts replace neutrophils in the healing stage, and fibrosis occurs


3. In the last stage, a cord of collagen forms in the vessel, with Ca deposits, occluding the lumen

What is a hallmark of PAN?

Lesions in all three stages of development in one vessel

What is the most common form of vasculitis?

Temporal arteritis

What does thromboangitis obliterans (Buerger's dz) cause?

Ischemia, pain, gangrene, necrosis of the digits

How is Raynaud's phenomenon different from Raynaud's dz?

The former is usually secondary to an underlying disorder, such as scleroma or lupus; the latter is a primary condition

Where do aneurysms occur?

In arteries that are weak or thin

What are two common types of aneurysm?

1. Atherosclerotic aneurysms -- occur in abdominal aorta or iliac arteries


2. Berry aneurysms -- congenital defects in cerebral arteries, usually the Circle of Willis

How does the heart adapt to hypertension?

Increase wall thickness, which leads to cardiac hypertrophy


Dilate heart chamber (Frank Sterling mechanism) which leads to cardiac dilation

What occurs in aortic dissection?

The aortic intima tears, allowing blood to enter other histologic layers, and potentially leading to aortic rupture

What is the most dangerous form of varicose vein?

Esophageal varices

What are the two versions of venous thrombosis?

1. Acute inflammation of the vein (thrombophlebitis)


2. No inflammation (Phlebothrombosis)

What conditions promote thrombosis?

Blood stasis in the legs from immobilization, cardiac failure, pregnancy, varicose veins


What are common hemangiomas?

Port wine stain


Strawberry marks


Cavernous hemangiomas


Vascular spiders

When the heart suffers chronic or acute insults, what happens first?

Compensation

What occurs with right-sided CHF?

Imbalance in Frank-Starling forces, leading to dilation, hypertrophy and enlargement, and right ventricle failure

What causes right sides CHF?

It is secondary to left -sided CHF or llung dz (cor pulmonale)

What occurs with left-sided CHF?

Imbalance in Frank-Starling forces, leading to dilation, hypertrophy and enlargement, and left ventricle failure

What causes left-sided CHF?

Acute myocardial infarction

What mechanisms of compensation are involved in congestive heart failure?

1. Baroreceptor response


2. Shift in O2-Hgb dissociation curve


3. Increase in blood volume


4. Myocyte hypertrophy

What four basic syndromes occur with ischemic heart dz?

1. Angina pectoris


2. Myocardial infarction


3. Chronic ischemic heart Dz


4. Sudden cardiac death


What causes ischemic heart Dz?

Reduced coronary blood flow, increased myocardial demand, and decreased O2 in the blood

What are the two types of damage that occur with myocardial infarction?

1. Transmural: the entire cardiac wall develops myocardial necrosis


2. Subendocardial: the inner 1/3 of the heart wall develops myocardial necrosis

What is the most common form of angina?

Stable angina

Which forms of angina are helped by nitro glycerin?

Stable angina and Prinzmetal's angina

Which form of angina is not helped by nitroglycerin?

Unstable angina

What are some of the complications of ischemic heart disease after MI?

Arrhythmias


Myocardial rupture


Mural thrombosis and embolism


Ventricular aneurysm


Ruptured papillary muscle

What is rheumatic heart dz?

Negative sequelae from infection with GABHS pyogenes

How does rheumatic heart dz develop?

A Type II hypersensitivity reaction causes a cross-reaction of strep antibodies with heart tissue. Inflammation of all layers of the heart and damage to heart valves follow

What physical signs are associated with mitral valve prolapse?

1. Audible midsystolic click


2. A late systolic murmur consistent with mitral regurgitation

Where is and aortic stenosis murmur best heard?

At the apex, though it may radiate to the carotids

What causes acute endocarditis?

Staph aureus, secondary to systemic infection

What causes subacute bacterial endocarditis?

Less virulent organisms, such as Strep viridans

What are some common causes of myocardial infecions?

1. Bacterial -- staph, strep, diptheria


2. Rickettsial -- typhus, Rocky Mtn. Spotted Fever


3. Viral -- Coxsackie, influenza, echo


4. Parasitis -- toxoplasmosis, trichinosis

What is dilated cardiomyopathy?

Cardiomyopathy leading to ventricular dilation, commonly caused by the death of myocardial cells

What is restrictive cardiomyopathy?

Cardiomyopathy with rigid ventricular walls -- the most rare type

What is hypertrophic cardiomyopathy?

Congenital, acquired or idiopathic cardiomyopathy with significant ventricular hypertrophy

As of 2009, Hypertrophic cardiomyopathy, dilated cardiomyopathy and arrhythmogenic right ventricular dysplasia have been linked with what causative factor?

A mutation of a single gene that results in altered structural proteins

Hemopericardium may cause what condition?

Cardiac tamponade, a restriction in the filling of the heart

What are the three types of acute pericarditis?

1. Fibrinous: caused by uremia, viral infeciton, myocardial infarction


2. Purulent: caused by bacterial infection


3. Hemorrhagic

Chronic fibrosing pericarditis may cause what condition?

Constrictive pericarditis

Serous pericarditis is also known by what other name?

Pericardial effusion

What four congenital defects are found in tetralogy of Fallot?

1. Ventricular septal defect


2. Pulmonary stenosis


3. Overriding aorta


4. Hypertrophy of the right ventricle

What are the most common congenital heart defects?

Interventricular septal defects

What are some of the causes of cor pulmnale?

COPD


Pulmonary interstitial fibrosis


Pulmonary arteritis


Cystic fibrosis


Chest movement disorders


Metabolic acidosis