Anatomy & Physiology of the Heart

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Questions and Answers

What is the primary purpose of antibiotic prophylaxis in dental procedures?

  • To prevent transient bacteremia during dental work.
  • To reduce pain during dental treatments.
  • To protect prosthetic valves in high-risk patients. (correct)
  • To enhance recovery from dental procedures.

Which junctions in cardiac muscle facilitate electrical coupling for synchronous contraction?

  • Desmosomes
  • Adherens junctions
  • Gap junctions (correct)
  • Tight junctions

What characterizes the absolute refractory period in cardiac muscle contractions?

  • New action potentials can be generated.
  • No new action potential is possible. (correct)
  • The muscle can respond to a very weak stimulus.
  • The muscle is fully excitable.

How does sympathetic nervous system stimulation affect heart rate and contractility?

<p>It increases heart rate and contractility. (D)</p> Signup and view all the answers

In comparison to skeletal muscle, how does cardiac muscle's excitation-contraction coupling differ?

<p>Cardiac muscle uses both extracellular and SR Ca²⁺. (A)</p> Signup and view all the answers

What does the ECG identify in a 12-lead setup that a 3-lead system cannot?

<p>Electrical activity from multiple angles. (B)</p> Signup and view all the answers

Which structure acts as the primary pacemaker in the cardiac conduction system?

<p>SA Node (B)</p> Signup and view all the answers

How is troponin used as a diagnostic marker in myocardial infarction compared to angina?

<p>Troponin is elevated only in myocardial injury, indicating necrosis. (B)</p> Signup and view all the answers

What does the QT interval reflect in an electrocardiogram?

<p>Total ventricular depolarization and repolarization (C)</p> Signup and view all the answers

Which abnormality is indicated by peaked T waves on an ECG?

<p>Hyperkalemia (A)</p> Signup and view all the answers

What condition is characterized by a 'sawtooth' pattern of atrial waves on an ECG?

<p>Atrial Flutter (D)</p> Signup and view all the answers

What is the consequence of prolonged PR intervals in an electrocardiogram?

<p>AV block indication (A)</p> Signup and view all the answers

Which part of the ECG represents ventricular depolarization?

<p>QRS Complex (B)</p> Signup and view all the answers

What does the phenomenon of overdrive suppression ensure in cardiac physiology?

<p>A single dominant pacemaker controls heart rhythm (D)</p> Signup and view all the answers

What does ST segment elevation on an ECG typically indicate?

<p>Acute myocardial injury (B)</p> Signup and view all the answers

Which condition is indicated by chaotic rhythm and the absence of QRS complexes in an ECG?

<p>Ventricular Fibrillation (D)</p> Signup and view all the answers

What is a common symptom associated with pericarditis?

<p>Sharp chest pain (C)</p> Signup and view all the answers

Which condition is characterized by inflammation of the myocardium?

<p>Myocarditis (D)</p> Signup and view all the answers

Which of the following best describes the contraction pattern of cardiac muscle?

<p>Involuntary, rhythmic contractions (A)</p> Signup and view all the answers

What does cardiac tamponade refer to?

<p>Fluid accumulation under pressure around the heart (A)</p> Signup and view all the answers

Which type of cardiomyopathy is noted for weakened and stretched heart muscles?

<p>Dilated cardiomyopathy (B)</p> Signup and view all the answers

What composes the cardiac conduction system?

<p>Nodes and specialized conducting fibers (A)</p> Signup and view all the answers

Which layer of the heart wall is responsible for the contraction necessary for pumping blood?

<p>Myocardium (C)</p> Signup and view all the answers

Which valvular closure is associated with the S2 heart sound?

<p>Closure of the semilunar valves (D)</p> Signup and view all the answers

Flashcards

Antibiotic Prophylaxis in Dental Procedures

Using antibiotics to prevent infective endocarditis in high-risk patients before dental procedures that can cause transient bacteremia to protect valves

Cardiac Muscle Contraction

Muscle contraction in the heart driven by calcium, sarcomeres & t-tubules/SR for Ca+ influx → contraction then Ca+ reuptake for relaxation

Intercalated Disks in Cardiac Muscle

Gap junctions and desmosomes that electrically couple cardiac muscle cells for synchronous contraction, and provide mechanical support for a coordinated heartbeat.

Cardiac vs Skeletal Muscle Excitation-Contraction Coupling

Cardiac muscle relies on both extracellular and SR Ca²⁺ for excitation-contraction Coupling; skeletal muscle uses only SR Ca²⁺. Cardiac muscle is involuntary and synchronized by gap junctions, while skeletal muscle is voluntary and independent.

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Troponin Changes in Angina vs. MI

Troponin levels remain normal in angina (chest pain), but increase significantly in a heart attack (myocardial infarction). Elevated troponin indicates myocardial injury due to tissue death.

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Cardiac Conduction System

A series of specialized cardiac cells (SA node, AV node, Bundle of His, bundle branches, Purkinje fibers) that ensure electrical signals are conducted smoothly, leading orderly depolarization and contraction.

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Cardiac vs Neuronal Action Potentials

Cardiac action potentials are much longer (200-400ms) than neuronal action potentials (1-2ms), with a unique plateau phase from Ca²⁺ influx, while neuronal APs lack a plateau.

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Autonomic Effects on Cardiac Conduction

Sympathetic (norepinephrine) increases heart rate, AV conduction, and contractility; parasympathetic (acetylcholine) decreases heart rate and AV conduction, with little effect on contractility.

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P wave

Represents atrial depolarization (contraction).

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PR interval

Time from start of P wave to QRS complex; reflects AV node delay.

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QRS complex

Represents ventricular depolarization (contraction).

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ST segment

Early ventricular repolarization phase.

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Atrial fibrillation (AFib)

Irregularly irregular rhythm, no distinct P waves. High risk of stroke.

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Ventricular tachycardia (VT)

Rapid, wide QRS complexes.

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ST elevation

Indicates acute heart attack (transmural infarction).

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Overdrive suppression

Faster pacemaker (SA node) suppresses slower pacemakers (AV node etc).

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ASD vs. VSD

ASD (Atrial Septal Defect) is a heart defect affecting the atria, generally less severe, while VSD (Ventricular Septal Defect) impacts the ventricles, leading to more significant hemodynamic changes.

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Cardiac Muscle

Striated, branched muscle tissue with intercalated discs, responsible for involuntary and rhythmic contractions of the heart, aided by gap junctions for synchronized beating.

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Heart Sound S1

The "lub" sound, caused by the closing of the AV valves at the start of ventricular contraction (systole).

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Heart Sound S2

The "dub" sound, caused by the closing of the semilunar valves at the end of ventricular contraction (systole).

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Cardiac Tamponade

Life-threatening condition caused by fluid buildup in the pericardial space, putting pressure on the heart.

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Pericardial Layers

The pericardium has two layers: visceral (epicardium) which is part of the heart wall, and parietal (fibrous sac) which surrounds the heart, anchoring it and preventing overexpansion.

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Pericarditis

Inflammation of the pericardium, often causing sharp chest pain and a friction rub.

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Blood Flow (Deoxygenated)

Deoxygenated blood flows from the body to the right atrium (RA) through the superior/inferior vena cava and coronary sinus, then to the right ventricle through the tricuspid valve, and finally to the lungs via the pulmonary valve and arteries.

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Study Notes

Anatomy & Physiology of the Heart

  • Apex: The pointed tip of the heart, located at the 5th intercostal space near the midclavicular line. It's formed by the left ventricle and acts as a landmark for auscultating heart sounds.
  • Base: The broad, flat upper portion of the heart, located near the 2nd rib, opposite the apex. It's the entry/exit point for major blood vessels (aorta and pulmonary trunk).
  • Atria: The upper chambers of the heart receiving blood.
    • Right Atrium: Receives deoxygenated blood from the superior vena cava, inferior vena cava, and coronary sinus.
    • Left Atrium: Receives oxygenated blood from pulmonary veins.
  • Ventricles: The lower chambers of the heart pumping blood out.
    • Right Ventricle: Pumps deoxygenated blood to the pulmonary arteries.
    • Left Ventricle: Pumps oxygenated blood to the aorta.
  • Septum: A wall dividing chambers within the heart.
    • Interatrial Septum: Separates the right and left atria. The fossa ovalis is a remnant of a fetal opening.
    • Interventricular Septum: Separates the right and left ventricles.
  • Atrioventricular (AV) Valves: Regulate blood flow between atria and ventricles.
    • Tricuspid: Between the right atrium and the right ventricle.
    • Mitral (Bicuspid): Between the left atrium and the left ventricle.
  • Semilunar Valves: Prevent backflow from the arteries into the ventricles.
    • Pulmonary Valve: Between the right ventricle and the pulmonary trunk.
    • Aortic Valve: Between the left ventricle and the aorta.
  • Major Vessels:
    • Aorta: The largest artery, carrying oxygenated blood from the left ventricle to the body.
    • Pulmonary Trunk & Arteries: Carry deoxygenated blood from the right ventricle to the lungs.
    • Pulmonary Veins: Return oxygenated blood from the lungs to the left atrium.
    • Superior Vena Cava (SVC): Drains deoxygenated blood from the upper body into the right atrium.
    • Inferior Vena Cava (IVC): Drains deoxygenated blood from the lower body into the right atrium.
    • Coronary Sinus: Collects venous blood from the heart muscle (myocardium) and empties it into the right atrium.

Heart Wall Layers

  • Endocardium: The inner lining, providing a smooth surface to prevent clots.
  • Myocardium: The middle, muscular layer responsible for heart contractions.
  • Epicardium (Visceral Pericardium): The outer layer, containing fat and blood vessels for protection and reducing friction.
  • Parietal Pericardium (Fibrous Sac): Surrounds the heart, anchoring it and preventing overexpansion.

Cardiac Muscle

  • Cardiac Muscle: Striated, branched, and interconnected by intercalated disks.
  • Skeletal Muscle: Striated, long cylindrical fibers, controlled voluntarily.
  • Smooth Muscle: Non-striated, spindle-shaped, found in organ walls, and involved in involuntary, slower contractions.

Heart Sounds

  • S1 ("lub"): The sound of AV valves closing at the start of systole (ventricular contraction).
  • S2 ("dub"): The sound of semilunar valves closing at the end of systole.
  • S3 and S4: Additional sounds that can indicate potential heart problems.

Heart Defects

  • Atrial Septal Defect (ASD): A hole in the interatrial septum, causing a left-to-right shunt and increased blood flow to the lungs.
  • Ventricular Septal Defect (VSD): A hole in the interventricular septum leading to a left-to-right shunt and potentially more significant hemodynamic changes.

Other Important Concepts

  • Cardiac Conduction System: The SA node (pacemaker), AV node, Bundle of His, bundle branches, and Purkinje fibers coordinate the heart's rhythm.
  • ECG (Electrocardiogram): A recording of the electrical activity of the heart. Different waves (P, QRS, T) correspond to specific stages of the cardiac cycle.
  • Antibiotic Prophylaxis: Prevention of infective endocarditis before dental procedures in high-risk patients.

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