Nurse 5315 Exam 3 Cardiovascular

right atrium

The superior and inferior vena cava return deoxygenated blood from the body to the?

Tricuspid Valve

What is the AV valve between the RA and RV is?

pulmonary artery

blood from the RV goes into the lungs via?

pulmonary veins

blood returns from the lungs to the heart via the?

bicuspid or mitral valve

valve between LA and LV is the?

semilunar aortic valve

blood leaves the LV to the aorta through which vavle?

Right Coronary Artery (RCA)

coronary artery that supplies the right ventricle, intraventricular sulcus, and small vessels of the RV and LV.

Left anterior descending artery (LAD)

coronary artery that supplies blood to portions of the left and right ventricles and much of the intraventricular septum.

circumflex artery

supplies the blood to the LA and the left lateral wall of the LV.

gap junctions

allows AP to move so rapidly to the heart

Pacemaker

cells that initiate signals, AKA authorhythmic cells

sinoatrial node

where electrical impulse start in the heart, generates 60-100 action potential per minute

AV node

generates 40-60 AP/min, conduct AP inwards to the ventricles

AB bundle (bundle of HIS)

generates 30-40 bpm

Purkinje Fibers

terminal branches of the RBB and LBB, penetrate the heart wall to the outer myocardium, promotes rapid spread of impulse to the ventricular apexes

depolarization

electrical acrivation of muscle cells caused by the movement of ions, including sodium, potassium, calcium, and chloride across cardiac cell membranes.

-80 and -90 mV

resting membrane potential of myocardial cells is between

negativley charge

during myocardial depolarization, the inside of the cells becomes less?

Phase 0 (depolarization)

phase of myocardial depolarization wherein rapid sodium entry into the cell

Phase 1

phase of myocardial action potential. repolarization in which calcium slowly enters the cell

Phase 3

phase of myocardial action potential wherein potassium moves out of the cell

P wave

represents atrial depolarization/atria contraction in the EKG. Completes ventricular filling

PR Interval

is a measure of time from the onset of atrial activation to the onset of ventricular activation on an EKG. represents the time necessary for electrical activity to travel from the SA node through the atrium etc.

PPT: pause in conduction at the AV node

QRS complex

represents the sum of all ventricular muscle depolarization on the EKG.

PPT: depolarization of the ventricle followed by ventricular contraction

ST Interval

represent the entire ventricular system myocardium depolarized on an EKG.

QT Interval

AKA electrical systole of the ventricles, the time it takes varies inversely with the HR

T Wave

reperesents ventricular repolarization on an EKG.

sympathetic

in general the (parasymptathetic or sympathetic NS) increase electrical conductivity and strength of myocardial contraction. enhances myocardial performance. stimulation of the SA node increases HR, influx of Ca = increase contractility. also influence diameter of the coronary blood vessels by dilation.

parasymptathetic

in general the (parasymptathetic or sympathetic NS) slows the conduction of action potentials through the heart and reducing the strength of contraction. affects the heart through the vagus nreve which releases acetylcholine which caused decreased HR and slows AV conduction, reduces myocardial contraction strength.

SNS

g protein binds with neurotransmitters of the (SNS or PNS)

B1 receptors

receptors are mostly found in the heart specifically the conduction system

B2 receptors

receptors found in heart and vascular smooth muscle

chronotropy

another word for increase heart rate

inotropy

another work for force oy myocardial contraction

B2 receptors

stimulation of this receptor results in vasodilation because its location on vascular smooth muscle

Norpepinephrine

neurotransmitter that binds with A1 receptors and causes smooth muscle contraction and thus vasoonstriction

calcium

the sarcoplasmic reticulum releases stored ______ thus activatig the contractile proteins myosin and actin.

Myosin

______ molecules that resembles a golf club with two large oviod heads at one end of the shaft, heads contain actin binding site and a site for ATPase activity.

tropomyosin

a relaxing molecule lies along side actin molecules

Type of troponin that inhibits the ATPase of actomyosin

Troponin C

type of troponin that contains binding site for Ca ions involved in contraction

actin

in the resting phase, troponin is bound to _____ and the tropomysoin molecule covers the sites where myosin heads bind to actin.

Cadiac Output

is the amount of blood pumped out of each ventricle in one minute. HR x SV.

increase

increased in CO w/o a decrease in peripheral resistance will cause MAP and flow rate to increase or decrease?

increase

decrease in CO causes a drop or increase in the MAP?

Stroke Volume

volume of blood ejected during systole in liters/beat. Normal is 70mL.

Ejection Fraction

Percentage of total end diastolic ventricular volume ejected per beat. Decrease of this may indicate ventricular failure. SV/end diastolic volume.

Preload

the volume of ventricles during filling. More blood=more forceful contraction. volume of blood returning to the heart from systemic circulation.

Afterload

is the pressure caused by resistance of the aorta or pulmonary artery blood flowing into it. the resistance to the ejection of blood from the ventricle.

Actin

a thin protein filament, light band, or I band. helps with the relaxation of the cardiac muscle.

F-actin

actin that causes contraction of the heart

Tropomyosin

a protein wrapped around f-actin. when active site is blocked, it causes cardiac muscle to relax.

Troponin T

type of troponin that block the f-actin strands

Troponin C

Type of tropinin that have affinity to calcium. it exposes cross bridges site on actin filament when Ca is binded.

Myosin

thick protein filament, dark bands, or A bands. small prjections from cross bridges

z-disc

site of connecting myofibrils

sarcomere

portion of myofibrils between 2 z-discs. dark and light bands. determines the limits of myocardial stretch at the end of diastole and force of contraction during systole

Tropinin C

When the Ca is released from the sarcoplasmic reticulum, it will bind to _____ in the thin filament.

Tropomyosin

______ is expose to allow binding of Ca and troponin.

Compliance

how easy it is for blood to travel through arteries

Age

What is the key driver of vardiovascular risk?

contraction

What does Ca do to the myosin and actin?

End Diastolic Volume (EDV)

amount of blood in the heart chamber after filling, before systole

End Systolic Volume (ESV)

amount of blood that remains in the heart after systole

Atrial Fibrillation

remodeling of the myocytes of the myocardium-atria does not fully contract to empty contents. s/s palipations, dizziness, fatigue, irregular pulse, dyspnea dute to decrease filling and poor cardiac output.

manifestation of Afib

caused by HR, ischemic heart disease, HTN, obesity, OSA, RA, thyroid disease. if left untreated, patient will have increased risk for thrombosis.

manifestation of PVCs

decreased in CO from loss of atrial contribution to venticular preload causes palpitations, poinding, fluttering

decreased

increased resistance leads to _______ blood flow

vascular compliance

is the increase in volume a vessel can accomodate with a given increase in pressure

tropomyosin

protein wrapped arounf F actin and blocks the active site

Epinephrine

catecholamine that plays a role in vascular resistance. Work on Beta Receptors. B1 HE and contraction. B2 smooth muscle and vasodilation.

Norepinephrine

catecholamine that works with alpha receptors. Increase in SBP, vascular tone, vasoconstriction, and peripheral resistance.

Dopamine

positive inotrope, increase HR, increase BP by increasing heart's contractility.

vasoconstrition

Role of Ca in heart muscle?

vasodilator

Role of Mg in heat muscle?

age

a key driver for cardiovascular risk

Pulmonary Vascular Resistance

at birth, there is a sudden decrease in _____ to allow blood flow to be initiated to the lungs.

Coronary Artery Disease

group of heart disease which includes atherosclerosis of the coronary arteries and diminished blood supply.

Myocardial Ischemia

group of heart disease where in there is a local temporary oxygen deprivation. Cells live but cannot function normally.

Acute Coronary Syndrome

heart disease where there is persistent ischemia or complete occlusion of the coronary artery. Commonly seen in myocardial infacttion.

Atheresclerosis

a chronic inflammatory condition that results in damage to arterial walls and plaque formation

Plaque

AKA atheroma, a lesion in arteries filled with lipids and macrophages. can be stable of complicated.

Injury to the endothelium

What precipitates atherosclerosis?

Foam Cells

Once inflammation and macrophage activation starts to engulf the LDLs, it creates a?

Fatty streak

Once foam cells have accumulated it turns/forms into a?

Plaque

Overtime with continuous inflammation and in response to the fatty streak, the smooth muscle will produce collagen and eventually will form a?

Peripheral Artery Disease

an athersclerotic disease of the arteries that perfude the limbs, particularly the lower limbs. typically slow and a gradual process of vessel occlusion

risk factors for PAD

risk factors: age, black population

intermittent claudication

common clinical manifestion of PAD is?

Hypertension

a disease that is described to have a sustained BP of 130/80 mmHg

Primary HTN

95% of HTN, caused by interactions between genetics and environment that results in changesi n the SNS. RAAS begins to work abnormally causing vasoconstriction and body begins to remodel.

risk factors of primary HTN

risk fators: obesity, insulin resistance, inflammation of chronic disease

vascular remodeling

a complication of chronic HTN where in vessels becomes fribrotic and cause injury by the organs it perfuses

hypertensive crisis

rapid increase in SBP > 140 mmHg. cerebral arterioles cannot regulate blood flow to cerebral capillaries, causing cerebral edema and encephalopathy. a medical emergency.

very low density lipoproteins (VLDL)/ triglycerides

high levels is a strong predictor of risk for future coronary even

low-density lipoprotein (LDL)/ "bad cholesterol"

high levels indicates coronary risk but in context of other factors such as age, DM, CKD

High-density lipoprotein (HDL)/ "good cholesterol"

"protective against atherosclerosis, want a high level so it can remoce excess cholesterol from arterial walls.

Dyslipidemia

abnormal blood lipid levels, including high total, low-density lipoprotein, and triglyceride levels as well as low high-density lipoprotein levels. Causes atherosclerosis.

Myocardial Ischemia

transient inability of the coronary arteries to meet the demand of oxygen in myocardial cells.

20

myocardial cells can only survive for ___ minutes?