EHR 519 weeks 1-2

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the function of the interventricular septum?

Separates the atria

Pumps blood through the heart

Separates the ventricles (correct)

Connects the atria and ventricles

The pulmonary valve is located between the right atrium and the right ventricle.

False

What is the name of the valve between the left atrium and the left ventricle?

Left AV (bicuspid) valve

The _______________________ is the muscular wall that separates the ventricles.

interventricular septum Signup and view all the answers

What is the name of the valve between the right ventricle and the pulmonary artery?

Pulmonary valve Signup and view all the answers

The heart is located in the abdominal cavity.

False Signup and view all the answers

What is the name of the system that includes the pulmonary and systemic circuits?

Cardiovascular System Signup and view all the answers

The _______________________ is the outermost layer of the heart.

Epicardium Signup and view all the answers

Match the following heart structures with their functions:

Septum = Separates chambers Valves = Regulates blood flow Papillary muscles = Supports the valves Trabeculae carneae = Muscular ridges in the ventricles Signup and view all the answers

The heart has three layers: endocardium, myocardium, and epicardium.

True Signup and view all the answers

What is the main function of the pericardium?

To allow the heart to beat without friction Signup and view all the answers

The pericardial cavity is filled with 50 mL of pericardial fluid.

False Signup and view all the answers

What is the function of the fibrous skeleton of the heart?

Provides structural support and attachment for cardiac muscle and anchor for valve tissue, and electrical insulation between atria and ventricles Signup and view all the answers

The ______________ layer of the pericardium is the outer wall of the sac.

Parietal Signup and view all the answers

Match the following structures with their descriptions:

Epicardium = Smooth inner lining of heart and blood vessels Myocardium = Layer of cardiac muscle proportional to work load Endocardium = Serous membrane covering heart Pericardium = Layer of cardiac muscle proportional to work load Signup and view all the answers

What is the main component of the myocardium?

Cardiac muscle Signup and view all the answers

The pericardial sac is anchored to the diaphragm superiorly and sternum anteriorly.

False Signup and view all the answers

What is the function of the pericardial fluid?

Provides lubrication to allow the heart to beat without friction Signup and view all the answers

The coronary blood vessels travel through the ______________ layer.

Epicardium Signup and view all the answers

Match the following structures with their functions:

Parietal pericardium = Provides structural support Visceral pericardium = Allows heart to beat without friction Pericardial cavity = Covers the valve surfaces Endocardium = Provides electrical insulation Signup and view all the answers

What is the duration of the PR interval on the diagram?

0.8 seconds Signup and view all the answers

The atria contract during the T wave

False Signup and view all the answers

What is the name of the segment between the Q wave and the S wave?

QRS interval Signup and view all the answers

The QT interval is the duration of the action potential from the start of the ______________ wave to the end of the T wave.

P Signup and view all the answers

Match the following parts of the heart with their corresponding contractions:

Atria = P wave Ventricles = T wave Signup and view all the answers

What is the unit of measurement for the amplitude of the ECG wave?

Millivolts Signup and view all the answers

What is the role of the sinoatrial node?

To regulate heartbeat Signup and view all the answers

The atrioventricular node is responsible for distributing excitation through the ventricular myocardium.

False Signup and view all the answers

What is the role of the Purkinje fibers?

Distribute excitation through the ventricular myocardium. Signup and view all the answers

Excitation spreads through the ______________ after the atrioventricular node fires.

AV bundle Signup and view all the answers

Match the following structures with their functions:

Sinoatrial node = Regulates heartbeat Atrioventricular node = Transmits electrical signal to ventricles Purkinje fibers = Distributes excitation through ventricular myocardium AV bundle = Transmits electrical signal from atrioventricular node to ventricles Signup and view all the answers

How many cusps does the Right AV valve have?

Three Signup and view all the answers

The Left AV valve has three cusps.

False Signup and view all the answers

What is the purpose of the chordae tendineae?

To prevent AV valves from flipping inside out or bulging into the atria when the ventricles contract Signup and view all the answers

The valves in the heart ensure a one-way flow of blood through the ______________.

heart Signup and view all the answers

Match the following heart valves with their descriptions:

Aortic valve = Prevents backflow from the aorta into the left ventricle Pulmonary valve = Prevents backflow from the pulmonary artery into the right ventricle Left AV valve = Prevents backflow from the left atrium into the left ventricle Right AV valve = Prevents backflow from the right atrium into the right ventricle Signup and view all the answers

What is the name of the valve that has two cusps?

Bicuspid valve Signup and view all the answers

The heart has a two-way flow of blood.

False Signup and view all the answers

What is the function of the atrioventricular (AV) valves?

To control blood flow between atria and ventricles Signup and view all the answers

What happens to monocytes after they differentiate into macrophages?

They become foam cells Signup and view all the answers

Injured endothelial cells release inflammatory mediators and TF which promotes inflammation and coagulation.

True Signup and view all the answers

What is the result of the stimulation of EC receptors by damage-associated molecular patterns?

Upregulation of adhesion molecules and monocyte adhesion. Signup and view all the answers

Chronic ______________ and immune dysregulation play a role in the development of atherosclerosis.

inflammation Signup and view all the answers

Match the following with their functions:

Inflammatory cytokines = Promotes nuclear factor-κB signalling oxLDL = Phagocytosed by macrophages to become foam cells TF = Promotes inflammation and coagulation Signup and view all the answers

What is the result of cells of injured tissue undergoing morphological and functional modifications?

Inflammation Signup and view all the answers

What is the percentage of Australians who had 1 or more conditions related to heart, stroke, or vascular disease in 2022?

5.3% Signup and view all the answers

Cardiovascular disease has a greater impact on females in Australia.

False Signup and view all the answers

What is the prevalence of heart, stroke, and vascular disease in Indigenous Australians compared to non-indigenous Australians?

2.1 times higher Signup and view all the answers

In 2022, approximately ______________ million Australians had 1 or more conditions related to heart, stroke, or vascular disease.

1.3 Signup and view all the answers

Which of the following is a risk factor for cardiovascular disease?

Increased waist circumference Signup and view all the answers

Match the following demographics with their corresponding prevalence of cardiovascular disease:

Males = 5.9% Females = 4.6% Indigenous Australians = 2.1 times higher than non-indigenous Australians Socioeconomically disadvantaged = 8.2% Signup and view all the answers

Cardiovascular disease is a major health problem in Australia.

True Signup and view all the answers

What is the name of the condition that describes many different conditions affecting the heart and blood vessels?

Cardiovascular disease Signup and view all the answers

What is the primary function of the vascular endothelium?

To maintain a balance between vasodilation and vasoconstriction Signup and view all the answers

Nitric oxide (NO) is a potent vasoconstrictor.

False Signup and view all the answers

What is the name of the enzyme responsible for producing nitric oxide (NO) from L-arginine?

endothelial NO synthase (eNOS) Signup and view all the answers

What is the primary underlying mechanism for the development of endothelial dysfunction?

Oxidative stress Signup and view all the answers

Chronic exposure to cardiovascular risk factors and _______________________ stress can lead to endothelial dysfunction.

oxidative Signup and view all the answers

Endothelial dysfunction is characterized by increased anti-inflammatory effects.

False Signup and view all the answers

Match the following chemicals with their functions in vascular tone regulation:

Nitric oxide (NO) = Vasodilation Endothelin-1 (ET-1) = Vasoconstriction Angiotensin II = Vasoconstriction EDHF = Vasodilation Signup and view all the answers

What is the role of eNOS in healthy endothelium?

responsible for most of the vascular NO production Signup and view all the answers

C-reactive protein (CRP) is a protein present in the ______________________ response.

acute inflammatory Signup and view all the answers

What is the result of chronic exposure to cardiovascular risk factors and oxidative stress on the vascular endothelium?

Endothelial dysfunction Signup and view all the answers

Match the following molecules with their effects on endothelial dysfunction:

NO = anti-inflammatory effects ROS = pro-oxidant effects TNF-α = promotes leukocyte adherence and migration IL-1 = promotes macrophage transformation into foam cells Signup and view all the answers

Endothelial dysfunction is a major contributor to the progression of atherosclerotic cardiovascular disease.

True Signup and view all the answers

What is the result of overexpression of TNF-α and IL-1?

Promoted leukocyte adherence and migration Signup and view all the answers

What is the name of the monolayer of cells covering the lumen of the vessels?

vascular endothelium Signup and view all the answers

Endothelial dysfunction is characterized by increased NO bioavailability.

False Signup and view all the answers

What is the effect of oxidative stress on endothelial function?

deteriorates Signup and view all the answers

Where are atherosclerotic lesions usually generated in the entire vascular tree?

All of the above Signup and view all the answers

Low endothelial shear stress is associated with upregulation of eNOS.

False Signup and view all the answers

What is the main mechanism of the beneficial effects on the cardiovascular system during exercise?

Increases in vascular blood flow and shear rate Signup and view all the answers

C-reactive protein is a marker of ______________ levels.

inflammation Signup and view all the answers

Match the following with their descriptions:

Shear stress = Locally disturbed shear stress by pulsatile blood flow Endothelial dysfunction = Clinical implications in cardiovascular disease and therapeutic approaches C-reactive protein = A marker of inflammation levels eNOS = Upregulated by high endothelial shear stress Signup and view all the answers

Endothelial dysfunction is only associated with cardiovascular disease.

False Signup and view all the answers

Which of the following is a risk factor for endothelial dysfunction?

All of the above Signup and view all the answers

What is the name of the journal where the article 'Endothelial dysfunction: clinical implications in cardiovascular disease and therapeutic approaches' was published?

Journal of Korean medical science Signup and view all the answers

What is the primary pathway for transmitting cardiac pain?

Sympathetic nerves Signup and view all the answers

The atria and ventricles are supplied with parasympathetic sensory innervation.

False Signup and view all the answers

What is the basis for cardiac pain referred to the chest, wall, arm, and back?

Convergence-projection theory Signup and view all the answers

Sympathetic impulses from the heart converge with impulses from somatic thoracic structures onto the same ascending _______ neurons.

spinal Signup and view all the answers

Match the following components of the cardiac pain pathway:

Afferent fibers = transmit cardiac pain Sympathetic ganglia = receive afferent fibers Thoracic dorsal roots = receive sympathetic impulses Signup and view all the answers

What is the role of vagal afferent fibers in cardiac pain?

Refer pain to the jaw and neck Signup and view all the answers

Localisation of ischemic pain can predict the site of myocardial ischemia.

False Signup and view all the answers

What is the name of the theory that explains cardiac pain referred to the chest, wall, arm, and back?

Convergence-projection theory Signup and view all the answers

In addition to sympathetic afferent fibers, _______ afferent fibers also play a role in cardiac pain.

Vagal Signup and view all the answers

What is the basis for cardiac pain referred to the jaw and neck?

Vagal afferent fibers Signup and view all the answers

What is the level of discomfort or pain described as 'excruciating and unbearable pain'?

4 Signup and view all the answers

Monitoring should continue for at least 10 minutes after exercise.

False Signup and view all the answers

What should be recorded during the post-exercise period?

Heart rate recovery (HRR) Signup and view all the answers

ST-segment changes that occur only during the ______________ period are currently recognized to be an important diagnostic part of the test.

post-exercise Signup and view all the answers

What is the minimum duration of monitoring after exercise?

6 minutes Signup and view all the answers

HR and BP should return to exact baseline levels before discontinuation of monitoring.

False Signup and view all the answers

What is the purpose of walking 'recovery' with a standardized speed?

To appraise changes in fitness Signup and view all the answers

Match the following with their descriptions:

Pain level 1 = Definite discomfort or pain but only of initial or modest levels Pain level 2 = Moderate discomfort or pain from which the client's attention can be diverted by a number of common stimuli Pain level 3 = Intense pain from which the client's attention cannot be diverted except by catastrophic events Pain level 4 = Excruciating and unbearable pain Signup and view all the answers

During the post-exercise period, HR and BP should return to near ______________ levels before discontinuation of monitoring.

baseline Signup and view all the answers

The heart rate recovery (HRR) is not an important prognostic marker.

False Signup and view all the answers

Study Notes

Heart Structure

The heart has four chambers: Right Atrium, Right Ventricle, Left Atrium, and Left Ventricle.
The heart has four valves: Tricuspid valve, Mitral valve, Pulmonary valve, and Aortic valve.
The valves ensure a one-way flow of blood through the heart.

Atrioventricular (AV) Valves

Right AV valve has three cusps → Tricuspid valve.
Left AV valve has two cusps → Mitral or Bicuspid valve.
Chordae tendineae: cords connect AV valves to papillary muscles on the floor of ventricles.
Prevent AV valves from flipping inside out or bulging into the atria when the ventricles contract.

The Heart Wall

Pericardium: double-walled sac that encloses the heart.
Allows heart to beat without friction, provides room to expand, yet resists excessive expansion.
Anchored to diaphragm inferiorly and sternum anteriorly.

Pericardial Cavity

Space inside the pericardial sac filled with 5 to 30 mL of pericardial fluid.

Epicardium (Visceral Pericardium)

Serous membrane covering the heart.
Adipose in thick layer in some places.
Coronary blood vessels travel through this layer.

Myocardium

Layer of cardiac muscle proportional to work load.
Muscle spirals around heart, producing a wringing motion.
Fibrous skeleton of the heart: framework of collagenous and elastic fibers.
Provides structural support and attachment for cardiac muscle and anchor for valve tissue.

Endocardium

Smooth inner lining of the heart and blood vessels.
Covers the valve surfaces and is continuous with the endothelium of blood vessels.

Blood Flow Through the Chambers

Deoxygenated blood from the body enters the Right Atrium through the Superior and Inferior vena cava.
Blood then flows through the Tricuspid valve into the Right Ventricle.
From the Right Ventricle, blood flows through the Pulmonary valve into the Pulmonary artery.
Oxygenated blood from the lungs returns to the heart through the Pulmonary veins and enters the Left Atrium.
From the Left Atrium, blood flows through the Mitral valve into the Left Ventricle.
From the Left Ventricle, blood flows through the Aortic valve into the Aorta.

Heart Location

The heart is located in the thoracic cavity, superior to the diaphragm.
The heart is anchored to the diaphragm inferiorly and sternum anteriorly.

Cardiovascular System

The cardiovascular system has two major circulatory circuits: Pulmonary and Systemic.
The Pulmonary circuit transports deoxygenated blood from the heart to the lungs and returns oxygenated blood from the lungs to the heart.
The Systemic circuit transports oxygenated blood from the heart to the rest of the body and returns deoxygenated blood from the body to the heart.

Cardiovascular Disease

Cardiovascular disease (CVD) is a term that describes many different conditions affecting the heart and blood vessels.
Common and serious types of CVD include coronary heart disease, stroke, and heart failure.
Despite declining mortality and hospitalisation rates, CVD remains a major health problem in Australia.
CVD has a greater impact on males, the elderly, Indigenous Australians, and people living in remote and socioeconomically disadvantaged areas.

Prevalence of Cardiovascular Disease in Australia

In 2022, approximately 1.3 million Australians (5.3%) had one or more conditions related to heart, stroke, or vascular disease.
The prevalence of CVD increases with age, with 0.6% of Australians aged 0-44 years and 27.7% of those aged 75 years and over affected.
Socioeconomically disadvantaged individuals are more likely to be affected, with 8.2% compared to 3.6% of those who are not disadvantaged.
Indigenous Australians are 2.1 times more likely to be affected than non-Indigenous Australians.

Endothelial Dysfunction and Cardiovascular Disease

Endothelial dysfunction is an important factor in the progression of atherosclerotic CVD.
The vascular endothelium is a monolayer of cells covering the lumen of the vessels, playing a complex role in maintaining homeostasis.
Chronic exposure to cardiovascular risk factors and oxidative stress can overwhelm the defense mechanisms of the vascular endothelium, leading to endothelial dysfunction.

Nitric Oxide and Endothelial Dysfunction

Nitric oxide (NO) is the most potent endogenous vasodilator in the body, maintaining homeostasis by inhibiting platelet aggregation, inflammation, and oxidative stress.
NO is produced and released from L-arginine through the activity of endothelial NO synthase (eNOS).
Oxidative stress can deteriorate endothelial function, and NO production is impaired in endothelial dysfunction.

Oxidative Stress and Endothelial Dysfunction

Oxidative stress is the most common underlying mechanism for the development of endothelial dysfunction.
Up-regulation of reactive oxygen species (ROS) leads to impaired homeostasis, reduced anti-inflammatory effects, and increased vascular permeability to lipoproteins.
Endothelial NO synthase (eNOS) can become a potential ROS generator when in a pathological uncoupled state.

Chronic Inflammation and Endothelial Dysfunction

Chronic inflammation is another common underlying mechanism for endothelial dysfunction.
Dysfunctional endothelium promotes ROS generation and aggravates inflammation, amplifying inflammation signaling pathways.
C-reactive protein (CRP) and tumor necrosis factor alpha (TNF-α) are involved in the inflammatory response, promoting leukocyte adherence and migration.

Shear Stress and Endothelial Dysfunction

Locally disturbed shear stress by pulsatile blood flow is one of the modulators of the atherogenic process.
Low endothelial shear stress (ESS) is associated with plaque progression and vulnerability, while high ESS is associated with upregulation of eNOS.
Increases in vascular blood flow and shear rate are considered the main mechanisms of the beneficial effects on the cardiovascular system during exercise.

Meeting the Client (A)

Informed consent is essential before exercising, and it involves identifying individuals at risk of adverse exercise-related cardiovascular events.
Health screening and cardiovascular risk factor analysis are crucial in determining the appropriate objective physiological tests and devising an intervention program.
Ability to predict rare exercise-related events is low due to the high prevalence of cardiovascular disease risk factors among adults and the rarity of exercise-related sudden cardiac death and acute myocardial infarction.

Interview

The interview process consists of two main steps:
- General interview for subjective information
- Assessment and evaluation for objective measures (anthropometric, BP, CV fitness, strength, mobility, etc.)
The interview environment should be quiet, secure, and free of distractions, with the use of lay terms and empathy to build trust.

Reason for Referral

The reason for referral is usually self-explanatory (e.g., increase exercise tolerance, improve ROM, or behavioral changes)
It is essential to bridge the gap between the nature of the referral and the client's interpretation to establish a good working relationship

Demographics

Age, sex, and ethnicity are related to the risk of cardiovascular conditions and/or comorbidities
Age is an independent predictor of survival in almost all cardiopulmonary conditions
Sex may affect exercise compliance and disease management, with CVD onset generally 10 years later in women
Ethnicity differences are often related to differences in SES and access to care

History of Present Illness

Record and convey primary information related to the condition leading to the referral
Chief complaint, summary of manifestations, and information about date of onset, chronicity of symptoms, types of symptoms, exacerbating or alleviating factors, and major interventions
Ask specific questions about symptoms using OPQRTS and A (Onset, Provocation and palliation, Quality, Region and radiation, Severity, Timing, and Associated signs and symptoms)

Medications and Allergies

Current medication list is essential, considering how they align with current and previous medical history
Ask about dose, administration route, frequency, and time of day taken, as well as allergy history

Medical History

Concise, relevant list of past medical problems, including dates
All conditions, injuries, etc., as one may influence another and exercise prescription

Family History/Social History

Family history should be restricted to heritable disorders in first-degree family members
Relevant heritable conditions include cancers, Type II diabetes, familial hypercholesterolemia, sudden death, and premature coronary artery disease
Social history includes information about the client's lifestyle and living patterns, including smoking, alcohol, illicit drugs, occupation, transportation, housing, routine, and leisure activities

Goals (SMARTER)

Behavior: smoking, alcohol, nutrition, physical activity, and weight management
Biomarkers: lipids, blood pressure, fasting blood glucose concentrations
Medications
Cardiopulmonary condition and associated symptoms

Physical Examination

[No specific information provided]

Informed consent from individuals before exercise testing is an essential ethical and legal step
Form must be read and signed, with an opportunity to ask questions
Clients under 18 years must have a parent/caregiver sign consent as well

Symptoms of Cardiovascular Disease (CVD)

Orthopnoea: dyspnoea at rest in a recumbent position, quickly relieved by sitting or standing upright (Left Ventricular Dysfunction, LVD)
Paroxysmal nocturnal dyspnoea: occurs 2-5 hours after the onset of sleep, relieved by sitting on bedside (LVD)
Ankle oedema: bilateral characteristic of Heart Failure (HF) or bilateral chronic venous insufficiency; unilateral often lymphatic blockage; generalised nephrotic syndrome or hepatic cirrhosis
Palpitations: rapid or forceful heart, sudden tachycardia, bradycardia, ectopic beats, SV changes from valvular regurgitation (anxiety, high Q, anaemia, fever)
Intermittent claudication: pain in the lower limbs during exercise from a lack of blood supply (atherosclerosis); onset during ambulation, disappears 1-2 mins of rest; increased prevalence of Coronary Artery Disease (CAD)
Known heart murmur: some innocent but may indicate valvular disease or other CVD; rule out hypertrophic cardiomyopathy and aortic stenosis = high risk of exercise related sudden cardiac death
Unusual fatigue or SOB with usual activities: can be benign, may also signal the onset of, or change in CVD

Diagnostic Clinical Exercise Testing

Diagnostic clinical exercise test for Ischaemic Heart Disease (IHD) needs specialist attendance
Also used for pulmonary diseases, pacemaker or HR response, claudication, disability, and Prognosis Assessment (PA)
Prognosis: ST-segment depression, magnitude, number of leads identified, time to onset and recovery from
Functional capacity (FC) in metabolic equivalents (METS) or VO2max (1 MET/3.5ml.kg-1.min-1 = 15% risk of CVD related mortality)

Exercise Protocol Design

Consider: purpose of evaluation, specific outcomes desired, characteristics of individual being tested (age, gender, PA status, fitness, experience, orthopedics, symptomatology)
Most common exercise test protocols: Bruce, Ellestad, Naughton, Balke-Ware
Need to consider: modality, ramp vs. step, start load, load increments, stage duration, test duration, onset of “fatigue”, peak metabolism

Tools to be Used During Exercise Testing

12-lead electrocardiogram: heart rate, varying software, anomaly flagging capabilities
Blood pressure: sphygmomanometer and stethoscope, automatic option; consider accuracy
Pulse oximetry: finger or earlobe based, may be integrated into ECG software or single device
Scales: perceived exertion, angina, dyspnoea, intermittent claudication
Charts: normative data, data specific to conditions (e.g. ejection fraction and performance)
Senses: sight (pallor, cyanosis, ataxia) and sound (dyspnoea) very important

Angina, Dyspnoea, and Intermittent Claudication Scales

Four-point dyspnoea scale: 1 = Mild, noticeable to patient but not the observer; 2 = Mild, some difficulty, noticeable to observer; 3 = Moderate difficulty, but patient can continue; 4 = Severe, difficulty, patient cannot continue
Four-point peripheral vascular disease scale: 1 = Definite discomfort or pain but only of initial or modest levels; 2 = Moderate discomfort or pain from which the client's attention can be diverted; 3 = Intense pain from which the client's attention cannot be diverted; 4 = Excruciating and unbearable pain

Termination of the Test

Termination criteria: absolute and relative contraindications
Post-exercise period: monitoring should continue for at least 6 min after exercise or until ECG changes return to baseline and significant signs and symptoms resolve
ST-segment changes that occur only during the post-exercise period are currently recognized to be an important diagnostic part of the test
Heart rate recovery (HRR) from exercise is an important prognostic marker that should be recorded

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the structure and components of the human heart, including its valves, arteries, and chambers. It includes identification of the aorta, pulmonary artery, and ventricles.