chapter 18 and 19

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1

PericardiumEpicardium

Sac around the heartper

2

fibrous pericardium

for protection, attach to surrounding structures, prevents overfilling of the heart.

3

serous pericardium

2 layers

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parietal pericardium

lines internal surface

5

visceral pericardium

Epicardium

6

pericardial cavity

inbetween, contains serous fluid

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3 layers of heart wall

epicardium
myocardium
endocardium

8

Epicardium

visceral, most superficial layers

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myocardium

cardiac muscle, most of heart, contracts, criss-crossing layer of CT that contain electric system of the heart

10

Fibrous cardiac skeleton

dense network of CT fibers, anchor cardiac fibers

11

Endocardium

made of squamous epithelium, continuous with endothelium of BV

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coronary sulcus

seperate auricles from ventricles

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interventricular sulcus

seperates ventricles anteriorly

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posterior interventricular sulcus

seperates ventricles posteriorly

15

Major veins of the heart

return blood to the heart.
1. superior and inferior VC
2. Coronary sinus
3. R & L pulmonary veins

16

major arteries of the heart

carry blood away from the heart
1. Pulmonary trunk (R & L)
2. Ascending Aorta ( brachiocephalic, Left Common Carotid, Subclavian)

17

RIGHT ATRIA

-receives blood from 3 main veins
-Pectinate muscles, Crista Terminalis, Foramen Ovalis

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LEFT ATRIA

-receives blood from 4 pulmonary veins.

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Pectinate Muscles

RA
- bundles of muscle tissue forming ridges of the walls

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Crista Terminalis

RA
-C-shaped ridge that separates posterior and anterior regions of RA

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Foramen Ovalis

shallow depression, opening in fetal heart

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Aorta

largest artery in the body

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Chordae Tendinae

attached to papillary muscles, hold AV valves

24

Trabeculae Carneae

irregular ridges of muscles for protection

25

Papillary muscles

form the most internal surface of the ventricles, play a role in valve function

26

VENTRICLES HAVE

-papillary muscles
-trabeculae carneae
-chordae tendinae

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RV

-receives blood from the RA and pumps it into pulmonary trunk

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LV

receiving oxygenated blood from the LA and pumps blood into aorta

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pulmonary circulation

right side of heart, receives oxygen poor blood from body tissues and pumps it to the lungs

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systemic circulation

left side of the heart, recieves oxygenated blood returning from the lungs and pumps it through out the body

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coronary circulation

blood supply to the heart

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left coronary artery

runs towards the left side of the heart and then divides into anterior interventricular artery, and circumflex artery

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anterior interventricular artery

branch of Left coronary artery, supplies blood to the interventricular septum and anterior walls of both ventricles

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circumflex artery

branch of left coronary artery, supplies LA and posterior walls of LV

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Right coronary artery

feeds the right side of the heart, branches into Right marginal artery and posterior interventricular artery

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Right marginal artery

branch of right coronary artery, feeds the myocardium

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Posterior interventricular artery

branch of right coronary artery, supplies the posterior ventricular walls, merges with interventricular artery

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coronary sinus

empties into RA
- great cardiac vein
-middle cardiac vein
-small cardiac vein
-anterior cardiac veins

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Anterior cardiac vein

branch of coronary sinus, empties directly into RA

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AV Valves

R & L AV Valves
has flaps
have chordae tendinae that attach to papillary muscles to prevent back flow of blood, snap shut

41

SL Valves

Pulmonary and Aortic
allow blood to leave ventricles, have three cusps, close when right pressure is reached

42

Cardiac muscle

striated, short, fat branched and interconnected. Large mitochondria fill up to 25%
myofibrils composed of sacromeres, functional synctium, have intercalated disks, desmosomes and gap junctions

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intercalated discs

anchor cardiac cells together and allow free passage of ions
demosomes and gap junctions

44

Intrinsic conduction system

SA Node, AV node, Bundle of his, Purkinje fibers

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SA node

pacemaker
75 BMP
Parasympathetic NS

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AV node

the wave of depolarization spreads through the gap junctions of neighboring muscle cells into AV node below the Atrial septum just above the tricuspid valve, delay of 1ms, allowing atrium to complete contraction.
fewer gap junctions and narrower diameter

47

Bundle of His

AV bundle,
located near the superior part of interventricular septum, the depolarization wave rapidly flows through this bundle. No gap junctions between atriums and ventricles so this bundle is the only way to propagate this potential. Splits into two branches towards the apex

48

Purkinje fibers

in the LV
follow ventricle walls superiorly and the muscles cells have extensive gap junctions to allow maximum ventricular contraction. These supply directly to the papillary muscles that help in closing AV valves, Ventricular contraction starts immediately after depolarization

49

Extrinsic conduction system

controlled by ANS

50

cardio acceleratory centers centers

in medulla, effect SA, AV nodes, heart muscle and coronary arteries
VEGAS NERVE

51

ECG

graph recording hearts activity
P, QRS, T waves

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P wave

shows movement of depolarization wave from SA node through the atria, the contraction of the atria starts after the P wave

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QRS wave

the blood flows to ventricles and the depolarization wave starts from AV node to Purkinje fibers, followed by ventricular contraction

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T wave

caused by repolarization of ventricles and is slower then depolarization so its shown by a wave with low height

55

PQ interval

the time from atrial depolarization to ventricular excitation

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QT interval

from ventricular depolarization to ventricular repolarization

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ST segment

depicts the plateau phase of the whole myocardium in ventricles being depolarized

58

Cardiac Output

amount of blood pumped out of each ventricle in 1 minute. Heart rate x Stroke volume

59

cardiac reserve

difference between normal output and maximal output
20-25L/min or 30L/min

60

Systolic Volume (SV)

differencce between EDV and ESV, regulated by preload, contractility and afterload

61

Preload

the filling of the ventricles depending on how much the cardiac muscle can stretch (frank sterlings law) Most important factor is venous return

62

venous return

blood returning to the ventricles through atria

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postitive ionotropic agents

increase contractility
hormones like epinepherine, glucagon, thyroxin, digitalis

64

afterload

the back pressure exerted on aorta and pulmonary artery 80 mmHG

65

Ionotropic factors

regullation of stroke volume

66

what part of the nervous system regulates the heart beat?

ANS

67

chronotropic factors

hormonal control

68

hypercalcemia

increase the action potential by prolonging the platau, leads to irritability with more heart contractions

69

hypocalcemia

depressed the heart contractions

70

hypernatrimia

excess sodium inhibits the entry of calcium ions thereby bloccking the heart contractions

71

hyperkalemia

interfers with depolarizatoin by lowering the action potential leading to heart block and arrest

72

hypokalemia

heart beats slower and arrythmically

73

coronary atherosclerosis

clogging of coronary arteries, impairs the flow of oxygen and blood resulting in impaired contractions

74

high blood pressure

diastolic pressure at 90, the heart has to pimp harder to maintain the Systolic volume, weakens muscles of the ventricles on the left side of the heart

75

multiple myocardial infarctions

causes formation of scar tissue in myocardium, causing it to become noncontractible

76

dialated cardiomyopathy

the ventricles distend and become flabby, caused by drugs, hyperthyroidism, and inflimation of the heart.

77

edemas

left side pumping faster then the right, bblood stagnates in body organs and tissues, in extrimities

78

pulmonary edema

venous return is more on the right side, so the blood collects in BV of the lungs and because of the pressure differnce it leaks into the lungs

79

coronary atherosclerosis

clogging of coronary veins with plaque, fatty build up impairs oxygen to the myocardium causing myocardial infarction

80

persistent high blood pressure

when aorta diastolic pressure increases more then 90 mmHG, the left ventricle has to pump harder, the ESV rises and myocardium gets weaker

81

3 major blood vessels

Arteries,veins,capillaries

82

Tunica Interna

endothelial layer lining the lumen of all vessels

83

3 layers of BV

tunica interna, media, and externa

84

tunica media

smooth muscle and elastic fiber layer, regulated by SNS controls vasoconstriction/vasodialation/vaso vassorum

85

tunica externa

collagen fibers that protect and reinforce vessels

86

3 types of arteries

elastic
muscular
arterioles

87

elastic arteries

thick, near the heart, contains elastin, have smooth muscle, inactive in vasoconstriction, the stretch and recoil of these arteries converts ME into KE
aorta, subclavian, common carotid, common iliac

88

muscular arteries

distributing arteries
deliver blood to organs, thick tunica media with more smooth muscle and less elastic tissue, SNS, help with vasoconstriction and dialation.

89

arterioles

resistance arteries
smallest, leads into capillary beds, all three tunics but no musculature and and are limited elastic fibers

90

capillaries

contact tissue cells and directly server cellular needs. smallest BV, made of endothelium layer with spider shaped pericytes on the surface, in most tissues, mainly for exchanging materials, precapillary spincters to restrict blood flow

91

3 types of capillaries

continous, fenstrated, sinusoids

92

continuous capillaries

the endothelial cells are joint together with tight junctions though at places may be incomplete where small particles are allowed to pass
skin and muscle, blood-brain barrier,

93

transcytosis

fluid and small particles are allowed to pass

94

fenestrated capillaries

have fenstrations, or openings in endothelial layer allowing small solutes and fluids to enter easily.
small intestine, endocrine glands and kidneys

95

sinusoids

extremely leaky, allow even RBCs to pass
liver,lymphoid tissue, bone marrow

96

kupffer cells

in liver, easily pass through the openings and go into blood stream. Sinusoid.

97

capillary beds

branched networks, the blood flow from arteriole to venule by 2 methods

98

Vascular shunt

when the blood flows from one to another directly through a short vessel.
arteriole-metarterop;e-thorofare channel-post capillary venule

99

true capillaries

when blood flows through the capillary bed in between two vessels. these branch off from arteriole and converge at postcapillary venule. conrtolled by precapillary spimcters which act as valves

100

Venous system

blood is carried away from he capillaries in veins towards the heart, converge instead of diverge like arteries

101

Post capillary venule

the most common venule, consists of purely endothelial cells with few pericytes. the venules join to form veins.

102

veins

-have three tunics
- lumens are bigger, have less pressure in them then arteries
-smooth muscle layer and elastic layers are poorly developed but the tunica externa is the heaviest
-made of collagen and elastic fibers that can accumulate in large amounts of blood and are th blood resevoirs
-valves

103

valves

-made up of folds in tunica interna
-in limbs where the blood has to flow against gravity

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venous sinuses

-heart and brain
-covered by extra tissues like dense CT

105

vascular anastomoses

when the vessels merge, and form channels
-digestive system, heart, brain

106

anterio-venus anastomoses

formed when the metarteriole joins thoroughfare channel to form the vascular shunt

107

blood flow

the volume of blood flowing through a vessel, an organ or entire circulation in a given period of time (ml/min)

108

CO

for entire circulation

109

blood pressure

force excerted by the blood per inot area of te vessel walls
elastic arteries- 120 mmhg falls to 0 just before entering the right VC

110

resistance

this is the opposition to flow and is measure of friction for blood as it moves in the vessels

111

peripheral resistance

most friction s encountered in the systemic ciruilation

112

3 sources of resistance

viscosity, totaal blood length, vessel diameter

113

Polycthemia

viscosity and resistance increases

114

anemia

low RBC count decreases viscosity

115

systemic pressure

highest in the aorta, because of systole of ventricles, 0 mmHG at RA

116

arterial blood pressure

depends on how much the arteries near the heart can stretch and the volume of blood.

117

systolic pressure

during ventricular systole
ventricles pump blood into the aorta
pressure reaches up to 120 mmHG

118

diastolic BP

semi-lunar valve closes because of sudden backflow of the blood and the arteries recoil and the pressure starts falling 70-80 mmhg

119

pulse pressure

DIASTOLIC- SYSTOLIC

120

MAP

pressure which keeps the vlood flowing
MAP= diastolic+(pulse pressure/3)
3:2:1

121

Capillary BP

when blood comes out of capillaries into venules pressure in about 16mmHG
low pressure to protect fine capillaries, very permiables (sterlings law of the capillaries)

122

venous BP

Respritory pump and Skeletal pump

123

Respritory Pump

the lings and abdominal pressure force blood towards the heart.
When we inhale, the diaphragm pushes inderiorly, increasing the pressure on veins in abdominal regio and reducing pressure in thoracic cavilty, the blood is sucked upwards from high pressure to low pressure, once blood moves up, it cant go back (valves)

124

skeletal muscle pump

when muscles contract and relax, they pump the blood towards the heart.

125

vegal tone

PNS nerve that controls the stroke volume and heart rate

126

the CO remains constant

the MAP remains constants

127

auscultatory method

taking Bp, brachial artery, sphygmomanometer

128

sounfs of korotkoff

louder when the flow becomes even, and no sound is heard it is the diastolic pressure

129

Hypertension

systolic above 140 mmHG

130

acute hypertension

may occur in fevers, emotional upset

131

persistent hypertension

result in obese people because of total lenght of blood vessels

132

chronic hypertension

dangerous becuase it causes weakening of the heart and arteries, may lead to heart attack, renal failure or stroke

133

factors causing hypertension

1. diet containing mroe fat, cholesterol, deffieciency in calcium, patassium, excess sodium
2. obestity
3. age
4. hereditary
5. stress
6. smoking

134

hypotension

systolic below 100mmHG

135

chronic hypotension

may hint poor nutrition but it doesnt have much harmful effect on health

136

acute hypotension

indicative of sudden loss as in hemmorage

137

hypovolemic shock

sudden loss of blood volume
the heart rate will increase in attemp to rectify the falling pressure, so the pulse is thready. The pressure falls rapidly if blood loss doesnt stop, the key to manage it is to replace fluid volume

138

Blood flow in skeletal muscles

regulated by oxygen and nutrient concentrations
have cholimergic receptors and adrenergic receptors

139

Cholinergic Receptors

bind to ACH

140

Adrenergic Receptors

bind to epinepherin

141

Blood flow to the brain

750 ml/min, sensitive to low pH resulting from high carbon dioxide, causes vasodialation which increases blood flow

142

blood flow to the skin

supply nutrients to cells, aid in body temp, act as blood resivoir
50-2500ml/min

143

blood flow to the lungs

arteries and arterioles are structurally like veins. have to withstand low pressures like 24/8 as compared to 120/80, have low resistance

144

blood flow to the heart

250ml/min

145

diffusion

gases like oxygen, CO2, nutrients and metabolic wastes are exchanged in capillaries

146

filtration

movement of fluid from blood to interstitial space

147

reabsorption

movement of fluid to blood from interstitial space, from high pressure to lower pressure

148

hydrostatic pressure

pressure exerted by water in blood on the walls

149

pericarditis

the sac like covering around the heart becomes inflamed

150

angina pectoris

chest pain that occurs with activity or stress due to poor blood flow through the BV in the heart

151

ischemia

restriction in blood supply to tissues, causing shortage of oxygen and glucose needed for cellular respiration

152

arrythmia

irregular heart beat

153

atrial fibrilation

common type of abnormal heart beat, fast or irregular

154

ectopic focus

an excitable group of cells that causes a premature heart beat outside the normally functoning SA node of the human heart

155

heart block

diseas of electric system of heart

156

tachycardia

over 100 BPM

157

bradycardia

under 60 BPM

158

ventricular septal defect

superior part of interventricular septum fails to for, blood mixes in ventricles

159

coarttion of aorta

part of aorta is narrowed, raising workload of LV

160

tetralogy of fallot

pulmonary trunk too narrow, pulmonary valve stenosed resulting in hhypertrophied RV, Ventricular Septal defect, aorta opens from both ventricles

161

vasoconstricion

narrowing of BV resulting from contraction of muscular wall of vessel

162

vasodialation

widening of BV, results from relaxation of smooth muscle cells with in the vessel walls

163

vasa vasorim

network of small BV that supply walls of large BV