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217 Cards in this Set
- Front
- Back
|
what is heart failure?
|
inability of the heart to maintain a cardiac output appropriate to systemic metabolic requirements
|
|
what is a low output state?
|
forward pump function of the heart is impaired and cannot meet metabolic needs
|
|
what is a high output state?
|
pump function of the heart is normal but systemic metabolic needs are excessive
|
|
give two causes of low output failure
|
cardiomyopathy, myocardial infarction
|
|
give two causes of high output failure
|
thyrotoxicosis, beri-beri
|
|
name two compensatory adaptations of the heart occurring in chronic heart failure
|
ventricualar dilatation, eccentric myocardial hypertrophy
|
|
what is the major compensatory mechanism in acute heart failure?
|
increase in heart rate
|
|
list some causes of heart failure
|
impaired blood supply due to coronary artery disease (with or without MI), increased haemodynamic load on the heart due to valve disease (such as aortic stenosis, aortic/mitral regurgitation), intrinsic dysfunction of the systolic contractile function of the myocardium (cardiomyopathy) resulting in dilatation of the cardiac chambers
|
|
list some causes of dilated cardiomyopathy
|
alcohol abuse, previous myocarditis, hereditary defects in myocardial metabolism, metabolic abnormalities such as hyper/hypothyroidism, haemochromatosis, occasionally drugs (e.g. adriamycin) or heavy metal poisoning
|
|
what occurs in restrictive cardiomyopathy?
|
thickened and stiff ventricular myocardium due to fibrous infiltration or deposition of abnormal glycoproteins
|
|
what is the most common cause of restrictive cardiomyopathy in Australia?
|
amyloidosis (mostly in older women)
|
|
which criteria is used to grade the severity of symptoms in heart failure?
|
New York Heart Association
|
|
Name 4 symptoms of heart failure.
|
dyspnoea, orthopnoea, fatigue, low exercise tolerance
|
|
Name some signs of heart failure.
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peripheral oedema, elevation of JVP, dispacement of apex beat, atrial or ventricular gallop sounds, murmurs of aortic or mitral regurgitation
|
|
give an equation for ejection fraction.
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EF=stroke volume/end-diastolic volume
|
|
what is the normal ejection fraction for an adult?
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50-70%
|
|
at what level is the superior border of the heart?
|
T4/5
|
|
does the heart lie closer to the sternum or the vertebral column?
|
sternum
|
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what is contained in the superior mediastinum?
|
thymus, brachiocephalic vein and SVC, arch of aorta and its 3 branches, trachea, oesophagus, thoracic duct, phrenic nerve and vagus nerve
|
|
where does the phrenic nerve travel in relation to the root of the lung?
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anterior
|
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how does the vagus nerve travel past the root of the lung?
|
behind it
|
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what is in the anterior mediastinum?
|
ligaments attaching pericardium to sternum and loose connective tissue
|
|
what is in the middle mediastinum?
|
heart, pericardium, roots of great vessels (8), phrenic nerve
|
|
what is in the posterior mediastinum?
|
descending thoracic aorta, oesophagus, azygos vein, thoracic duct
|
|
where is the apex of heart?
|
5th intercostal space, midclavicular line
|
|
t/f... the arch of the aorta lies posterior to the body of the sternum
|
false, it lies posterior to the manubrium, the heart is posterior to the body of sternum
|
|
where is the coronary groove?
|
between atria and ventricles on outer surface or heart
|
|
which groove separates the ventricles?
|
interventricular groove
|
|
how many pulmonary veins are there?
|
4
|
|
how many pulmonary arteries are there?
|
2
|
|
what forms the right border of the heart?
|
right atrium
|
|
which ventricle is mainly anterior?
|
right ventricle
|
|
which ventricle is more inferior?
|
left ventricle
|
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which coronary artery runs in the atrioventricular groove?
|
RCA
|
|
which chambers have auricles?
|
atria
|
|
what is the first branch of the aorta (after the coronary arteries)?
|
brachiocephalic trunk
|
|
what does the brachiocephalic trunk branch into?
|
right common carotid and right subclavian artery
|
|
what veins drain into the superior vena cava?
|
left and right brachiocephalic veins
|
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t/f... the right pulmonary artery passes in front of the aorta and inferior vena cava
|
false, it passes behind those structures
|
|
where are the pectinate muscles?
|
atria
|
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what is the name of the ridge formed by the pectinate muscles in the right atrium?
|
crista terminalis
|
|
which veins open into the right atrium?
|
SVC, IVC, coronary sinus
|
|
where is the fossa ovalis?
|
between the atria
|
|
what are the muscles on the inner surface of ventricles?
|
trabeculae carneae
|
|
which heart valve only has two cusps?
|
mitral
|
|
which are the semilunar valves?
|
pulmonary and aortic
|
|
what are the branches of the left coronary artery?
|
anterior interventricular artery (left anterior descending) and circumflex artery
|
|
what are the branches of the right coronary artery?
|
posterior interventricular artery and marginal artery
|
|
when in the cardiac cycle does blood flow to the heart occur?
|
diastole
|
|
which region is most prone to infarct?
|
subendocardial region
|
|
what is the blood supply to the endocardium?
|
blood within the chambers
|
|
what part of the heart does the right coronary artery supply?
|
right atrium, most of right ventricle, diaphragmatic surface of left ventricle, posterior 1/3 of interventricular septum, SA node (in 60% of people), AV node (in 40% of people)
|
|
what part of the heart does the left coronary artery supply?
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left atrium, most of left ventricle, part of right ventricle, anterior 2/3 of IV septum including AV bundle, SA node (in 40% of people)
|
|
what does the great cardiac vein travel with?
|
LAD
|
|
what does the middle cardiac vein travel with?
|
posterior interventricular artery
|
|
what does the lesser cardiac vein travel with?
|
right coronary artery
|
|
where is the coronary sinus?
|
posterior coronary groove
|
|
where does the cardiac action potential originate?
|
SA node
|
|
where is the SA node?
|
sulcus terminalis (junction of SVC and RA)
|
|
what is the depolarisation rate of the SA node?
|
70-100
|
|
what is the bridge in conduction between atria and ventricles?
|
AV node
|
|
where is the AV node?
|
at the opening of th ecoronary sinus
|
|
what is the spontaneous depolarisation rate of the AV node?
|
50
|
|
what is the spontaneous deploarisation rate of the bundle of his?
|
30
|
|
what is the parasympathetic innervation of the heart?
|
vagus
|
|
which spinal segments contribute to the heart's sympathetic supply?
|
T1-4/5
|
|
which fibres do the pain fibres of the heart travel with?
|
sympathetic
|
|
which fibres accompany the vagus nerve?
|
reflexes
|
|
what in the heart is innervated by the phrenic nerve?
|
parietal layer of serous pericardium and fibrous pericardium
|
|
which part of the conduction system of the heart has the highest conduction velocity?
|
bundle of his
|
|
where is conduction slowest in the heart?
|
AV node
|
|
what is the advantage of a long ventricular AP?
|
helps to prevent re-entrant arrhythmias
|
|
which leads in a standard ECG are detecting the horizontal plane?
|
V1-6
|
|
what angles do leads I, II and III represent?
|
0, +60, +120
|
|
what angles do aVR, aVL and aVF represent?
|
-150, -30, 90
|
|
what does a positive QRS in leads I, II and III tell you about axis?
|
normal
|
|
what would you expect to see in an ECG with right axis deviation?
|
negative QRS in I, positive QRS in II and III
|
|
what would you expect to see in an ECG with left axis deviation?
|
positive QRS in I, negative in II and III
|
|
what is the duration of a ventricular action potential?
|
300 ms
|
|
what is the duration of a skeletal muscle AP?
|
2 ms
|
|
what current is responsible for the rapid depolarisation of cardiac AP?
|
I(Na) - fast inward current
|
|
which current maintains the long plateau of cardiac AP?
|
I(Ca) - slow inward current
|
|
what is the repolarising current of the cardiac AP?
|
I(K)
|
|
what causes contraction of cardiac muscle?
|
large calcium release from sarcoplasmic reticulum
|
|
which two processes cause relaxation of cardiac muscle?
|
1) reuptake of calcium into the SR
2) removal of calcium from the cell by the Na/Ca exchanger |
|
which two pathways resupply ATP?
|
1) aerobic oxidative phosphorylation (in the mitochondria)
2) anaerobic glycolysis (in myoplasm) |
|
which receptors are responsible for the increase in heart rate and contractility with sympathetic activation?
|
beta1 receptors
|
|
which type of blood vessel does not receive sympathetic innervation?
|
capillaries
|
|
which adrenoceptor activates phospholipase C?
|
alpha1
|
|
which adrenoceptor activates adenylate cyclase?
|
beta
|
|
what are the effects of activation of beta1 receptors in cardiac muscle on intracellular calcium?
|
increase intracellular calcium concentration
|
|
which beta receptor reduces intracellular calcium?
|
beta2
|
|
what type of ventricular hypertrophy occurs with pressure overload?
|
concentric hypertrophy (wall thickening)
|
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what type of ventricular hypertrophy occurs with volume overload?
|
eccentric hypertrophy (chamber enlargement)
|
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where is A-type natriuretic peptide released from?
|
atria
|
|
what releases B-type natriuretic peptide?
|
ventricles
|
|
what releases C-type natriuretic peptide?
|
vascular endothelium
|
|
what effect do natriuretic peptides have on blood vessels?
|
vasodilation
|
|
what are natriuretic peptides released in response to?
|
increased filling pressure and volume of shear stress
|
|
what is the interval between pharyngeal infection with group A streptococci and rheumatic fever?
|
1-5 weeks
|
|
at the commencement of an attack of rheumatic fever, are cultures for GAS positive or negative?
|
negative
|
|
what percentage of people with GAS throat infection develop RF?
|
3%
|
|
which organs are affected by RF?
|
heart - pancarditis
joints - migratory polyarthritis brain - sydenham's chorea skin - erythema marginatum |
|
at what age does the first attack of RF occur most frequently?
|
5-15
|
|
what percentage of children with RF may develop carditis?
|
50-75%
|
|
what criteria are used for the diagnosis of RF?
|
Jones criteria
|
|
what is responsible for fibrinous pericarditis?
|
esudation of fibrin into pericardial cavity which stimulates fibrous adhesions between parietal and visceral pericardium
|
|
where do Aschoff nodules develop in myocarditis?
|
close to blood vessels
|
|
which white cells are present in an Aschoff nodule?
|
lymphocytes (mainly T cells) and macrophages
|
|
what type of macrophages are present in an Aschoff nodule?
|
Anitschkow cells, Aschoff multi-nucleated giant cells
|
|
which valves are most commonly affected in RF?
|
mitral and aortic
|
|
where do vegetations develop in RF?
|
cusps of valves
|
|
what do the vegetations in RF consist of?
|
fibrin and platelets but no microorganisms
|
|
what effect do vegetations have on the vascularity of heart valve cusps?
|
vascularity increases
|
|
what is responsible for aortic stenosis in RF?
|
fibrous adhesions between the cusps
|
|
what are the effects of vegetations on the chordae tendinae?
|
adhesion and fusion of chordae, shortening of chordae
|
|
t/f... tricuspid involvement is common in RF
|
false, tricuspid involvement in unusual
|
|
why would a lung with chronic venous congestion appear brown in colour?
|
chronic deposition of haemosiderin laden macrophages
|
|
what type of overload does aortic stenosis cause?
|
pressure overload
|
|
what is the cause of dyspnoea in aortic stenosis?
|
high left ventricular end diastolic pressure
|
|
will BP be high, low or normal in aortic stenosis?
|
low
|
|
what type of murmur is heard in aortic stenosis?
|
harsh, loud systolic, crescendo-decrescendo murmur in aortic area
|
|
what does a harsh, loud systolic, crescendo-decrescendo murmur in aortic area indicate?
|
aortic stenosis
|
|
what type of overload is caused by aortic regurgitation?
|
volume overload
|
|
what is the murmur of aortic regurgitation?
|
decrescendo diastolic murmur
|
|
what is a bounding pulse suggestive of?
|
aortic regurgitation
|
|
which arrhythmia is associated with mitral stenosis?
|
atrial fibrillation
|
|
what does a diastolic-presystolic rumbling murmur indicate?
|
mitral stenosis
|
|
what does a soft, blowing pansystolic murmur at the apex suggest?
|
mitral regurgitation
|
|
what is the percentage mortality associated with aortic valve replacement? with CABG?
|
4%, 6%
|
|
what is the percentage mortality associated with mitral valve replacement? with CABG?
|
8%, 10%
|
|
where are the M proteins?
|
bacterial cell wall
|
|
where is the hyaluronate?
|
capsule
|
|
what do the M protein antibodies cross react with in the myocardium?
|
myosin
|
|
what do the hyaluronate antibodies cross react with?
|
hyaline lining of heart valves (and cartilage in joints)
|
|
what separates the atria from ventricles?
|
coronary groove
|
|
what separates the ventricles?
|
interventricular groove
|
|
what forms the right border of the heart?
|
right atrium
|
|
what is contained in the superior mediastinum?
|
thymus
brachiocephalic vein SVC arch of aorta trachea oesophagus thoracic duct phrenic nerve vagus nerve |
|
what is contained in the anterior mediastinum?
|
ligaments attaching pericardium to sternum
loose connective tissue |
|
what is contained in the middle mediastinum?
|
heart
pericardium roots of great vessels phrenic nerve |
|
what is contained in the posterior mediastinum?
|
descending thoracic aorta
oesophagus azygos vein thoracic duct |
|
which ventricle is mainly anterior?
|
right ventricle
|
|
which atrium is mainly posterior?
|
left atrium
|
|
which chamber of the heart is mainly inferior?
|
left ventricle
|
|
where does the right coronary artery lie?
|
atrioventricular sulcus
|
|
which artery does the great cardiac vein travel with?
|
anterior interventricular artery
|
|
which artery lies in the anterior interventricular sulcus?
|
anterior interventricular artery
|
|
which muscles line the right atrium?
|
pectinate muscles
|
|
where is the crista terminalis?
|
right atrium
|
|
which veins open into the right atrium?
|
SVC
IVC coronary sinus |
|
which muscles line the right ventricle?
|
trabeculae carnae
|
|
t/f... the right ventricle is thin-walled
|
true
|
|
what attaches the cusps of the atrioventricular valves to the papillary muscles?
|
chordae tendinae
|
|
which ventricle is thick walled?
|
left ventricle
|
|
which valve has two cusps?
|
mitral valve
|
|
which pericardium is attached to the diaphragm and great vessels?
|
fibrous pericardium
|
|
what are the branches of the left coronary artery?
|
anterior interventricular artery (left anterior descending artery)
circumflex artery |
|
what are the branches of the right coronary artery?
|
posterior interventricular artery
marginal artery |
|
what is the blood supply to the endocardium?
|
direct by blood within chambers
|
|
which region of the heart is most prone to infarct?
|
subendocardial region
|
|
what does the right coronary artery supply?
|
RA
most of RV diaphragmatic surface of LV posterior 1/3 of IV septum SA node (in 60% people) AV node (in 40% people) |
|
what does the LCA supply?
|
left atrium
most of left ventricle part of right ventricle anterior 2/3 of IV septum including AV bundle SA node (in 40% of people) |
|
what does the middle cardiac vein travel with?
|
posterior interventricular artery
|
|
what does the lesser cardiac vein travel with?
|
right coronary artery
|
|
what do the cardiac veins drain into?
|
coronary sinus
|
|
where is the coronary sinus?
|
below the left atrium
|
|
where is the SA node?
|
junction of SVC and RA at sulcus terminalis
|
|
where does the cardiac action potential originate?
|
SA node
|
|
what is the depolarisation rate of the SA node?
|
70-100/min
|
|
where is the AV node?
|
opening of coronary sinus (posteroinferior region of interatrial septa)
|
|
what is the depolarisation rate of the AV node?
|
50/min
|
|
what is the depolarisation of the bundle of His and L and R bundle branches?
|
30/min
|
|
what is the motor innervation of the heart?
|
parasymp - vagus
symp - sympathetic trunk |
|
what is the sensory innervation of the heart?
|
reflexes travel with vagus
pain - travel with symp |
|
what is the innervation of the parietal layer of serous pericardium and the fibrous pericardium?
|
phrenic nerve (C3-5)
|
|
describe the foetal circulation?
|
oxygenated blood returns to RA from placenta
shunted across the foramen ovale to LA blood enters RV and then pumonary trunk - shunted across ductus arteriosus |
|
where is the ligamentum arteriosum?
|
between aorta and pulmonary trunk
|
|
when does blood supply to the heart occur?
|
diastole
|
|
what is the sympathetic supply to the heart?
|
T1-4
|
|
where does the most rapid conduction of cardiac AP occur?
|
bundle of His (conduction velocity 2-4 ms)
|
|
what is the conduction velocity of the atria?
|
1 m/s
|
|
what is the conduction velocity at the AV node?
|
0.1 m/s
|
|
where does the delay in cardiac AP occur?
|
AV node
|
|
what is the conduction velocity at the ventricles?
|
0.3 m/s
|
|
what indicates a normal axis?
|
leads I, II and II all positive
|
|
what indicates right axis deviation?
|
lead I negative
leads II and III positive |
|
what indicates left axis deviation?
|
lead I positive
leads II and III negative |
|
t/f... ventricular cells contain numerous mitochondria
|
true
|
|
what connects ventricular cells?
|
connexin 43`
|
|
what type of junctions connect ventricular cells?
|
gap junctions
|
|
what is the duration of a cardiac action potential?
|
300 ms
|
|
what is the duration of a skeletal muscle AP?
|
2 ms
|
|
which current causes rapid depolarisation?
|
fast inward sodium current
|
|
which current maintains the long plateau of cardiac AP?
|
calcium current (slow inward current)
|
|
what is the repolarising current of cardiac AP?
|
potassium current
|
|
what causes contraction in the cardiac AP?
|
large calcium release form SR (induced by calcium binding to SR ca release channel)
|
|
what causes relaxation in the cardiac AP?
|
reuptake of Ca into SR by SR Ca pump
removal of Ca from the cell by Na/Ca exchanger |
|
how is contractility of cardiac muscle modulated?
|
varying Ca release from SR
|
|
Which receptors are responsible for sympathetic regulation of the heart rate and contractility?
|
beta1 receptors
|
|
which receptors are responsible for reduction in heart rate and slight reduction in cardiac contractility?
|
muscarinic receptors
|
|
what causes arteriolar vasoconstriction?
|
increased myogenic activity
increased O2 decreased CO2 increased sympathetic stimulation vasopressin, ATII cold |
|
what causes arteriolar vasodilation?
|
decreased myogenic activity
decreased O2 increased CO2 reduced symp stim histamine heat |
|
which blood vessels do not receive sympathetic innervation?
|
capillaries
|
|
what is the usual neurotransmitter causing vasoconstriction?
|
noradrenaline
|
|
how does alpha1 receptor activation result in smooth muscle contraction?
|
G protein -> activation of phospholipase C -> increased level intracellular second messengers inositol triphosphate and diacylglycerol -> increase in intracellular calcium -> SM contraction
|
|
how does beta receptor activation induce a cellular response?
|
activation of adenylate cyclase -> increased cAMP -> activation of protein kinases -> cellular response
|
|
which receptors induce vasodilation in vascular smooth muscle?
|
beta2 receptors
|
|
which receptors increase cardiac contractility?
|
beta1 receptors
|
|
what is heart failure?
|
mechanical failure of the heart to maintain systemic perfusion commensurate with the requirements of metabolising tissues
|
|
what are the causes of diastolic heart failure?
|
acute ischaemia
age hypertension aortic stenosis hypertrophic cardiomyopathy infiltrative myocardial disease pericardial disease |
|
what releases B-type natriuretic peptide?
|
ventricles
|
|
what releases C-type natriuretic peptide?
|
vascular endothelium
|
|
what are the actions of natriuretic peptides?
|
natriuresis and vasodilation
suppress RAAS and endothelin |
|
t/f... there is no major survival difference for patients with heart failure post discharge despite differences in systolic function
|
true
|
|
what are the modes of death in heart failure?
|
progressive heart failure
sudden death (VT/VF) stroke |
|
what are the risk factors for chronic heart failure?
|
hypertension
atherosclerotic disease diabetes mellitus obesity or metabolic syndrome exposure to cardiotoxins family history of cardiomyopathy |
