Cardiac Anatomy & Physiology Quiz
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Questions and Answers

What is the main function of heart valves?

  • To enhance electrical conduction
  • To increase heart rate
  • To prevent regurgitation (correct)
  • To prevent blood clotting

    • How is cardiac output calculated?

  • Heart Rate + Stroke Volume
  • Heart Rate - Stroke Volume
  • Heart Rate x Stroke Volume (correct)
  • Heart Rate / Stroke Volume

    • What does preload refer to in cardiac physiology?

  • The resistance against blood ejection
  • The heart's electrical conduction speed
  • The volume of blood in the ventricles after contraction
  • The amount of blood returning to the heart (correct)

    • What is the normal ejection fraction range?

    <p>60-65%</p> Signup and view all the answers

    Which heart sound corresponds to the closing of the mitral and tricuspid valves?

    <p>S1</p> Signup and view all the answers

    What does afterload refer to in the context of cardiac function?

    <p>The resistance the left ventricle faces during contraction</p> Signup and view all the answers

    Which option is NOT part of the electrical conduction system of the heart?

    <p>Pulmonary artery</p> Signup and view all the answers

    Which event corresponds to the heart sound S3?

    <p>Rapid filling of the ventricle</p> Signup and view all the answers

    Which component is assessed first during EKG interpretation?

    <p>Rhythm</p> Signup and view all the answers

    What does the normal range for cardiac output typically fall between?

    <p>4-8 L/min</p> Signup and view all the answers

    What does a prolonged PR interval indicate in cardiac evaluation?

    <p>First degree heart block</p> Signup and view all the answers

    Which cardiac biomarker is considered highly cardiac specific?

    <p>Troponin I</p> Signup and view all the answers

    In the context of myocardial infarction, what characterizes Type 1 MI?

    <p>Athero-thrombotic event</p> Signup and view all the answers

    What is a common presentation of Aortic Dissection?

    <p>Tearing or ripping chest pain</p> Signup and view all the answers

    What is the heart rate threshold for Supraventricular Tachycardia (SVT)?

    <p>Above 150 bpm</p> Signup and view all the answers

    Which of the following is a key clinical sign of Endocarditis?

    <p>New cardiac murmur</p> Signup and view all the answers

    What is the effect of Morphine in Acute Coronary Syndrome?

    <p>Reduces myocardial oxygen demand</p> Signup and view all the answers

    What is a significant risk factor for developing Aortic Dissection?

    <p>Long-term hypertension</p> Signup and view all the answers

    What defines diastolic heart failure?

    <p>Preserved ejection fraction</p> Signup and view all the answers

    Which medication is the only one shown to reduce overall all-cause mortality in Acute Coronary Syndrome?

    <p>Aspirin</p> Signup and view all the answers

    Which heart valves are primarily responsible for preventing regurgitation of blood during ventricular contraction?

    <p>Tricuspid and mitral valves</p> Signup and view all the answers

    What is the primary resistance that affects afterload in the heart?

    <p>Systemic vascular resistance (SVR)</p> Signup and view all the answers

    In normal cardiac function, what is the typical range of ejection fraction?

    <p>60-65%</p> Signup and view all the answers

    Which heart sound is associated with the rapid filling of the ventricles?

    <p>S3</p> Signup and view all the answers

    What is the first component assessed when interpreting an EKG?

    <p>Rhythm</p> Signup and view all the answers

    What is the main role of the coronary arteries in cardiac physiology?

    <p>Perfuse the heart muscle itself</p> Signup and view all the answers

    Which term describes the amount of blood returning to the heart?

    <p>Preload</p> Signup and view all the answers

    What does the S4 heart sound indicate in cardiac physiology?

    <p>Atrial contraction</p> Signup and view all the answers

    What does cardiac output describe?

    <p>The volume of blood pumped by the heart per minute</p> Signup and view all the answers

    During EKG interpretation, what is the purpose of analyzing the P-wave?

    <p>To confirm atrial depolarization</p> Signup and view all the answers

    What does a prolonged PR interval suggest in cardiac evaluation?

    <p>First degree heart block</p> Signup and view all the answers

    Which of the following is true regarding left axis deviation?

    <p>It can signify coronary artery disease.</p> Signup and view all the answers

    What characterizes Type 2 Myocardial Infarction?

    <p>Oxygen supply and demand mismatch.</p> Signup and view all the answers

    In managing Acute Coronary Syndrome, which treatment is associated with adverse outcomes?

    <p>Morphine</p> Signup and view all the answers

    Which biomarker is highly cardiac specific?

    <p>Troponin I</p> Signup and view all the answers

    A chest pain that suggests an Aortic Dissection is often described as what?

    <p>Tearing or ripping</p> Signup and view all the answers

    Which type of heart failure is characterized by a reduced ejection fraction?

    <p>Systolic heart failure</p> Signup and view all the answers

    In the context of myocardial ischemia, what is a significant diagnostic finding in lead aVR?

    <p>Elevation</p> Signup and view all the answers

    What heart rhythm is classified as having a heart rate greater than 150 bpm and often resulting from a re-entry phenomenon?

    <p>Supraventricular Tachycardia</p> Signup and view all the answers

    Which patient population is not typically at high risk for developing myocarditis?

    <p>Young athletes with no previous health issues</p> Signup and view all the answers

    Study Notes

    Cardiac Anatomy & Physiology

    • The coronary arteries are the first vessels to be perfused by the heart.
    • Heart valves prevent blood backflow.
    • Mitral valve is on the left side of the heart, tricuspid is on the right side.
    • Semilunar valves include the pulmonic and aortic valves.
    • Cardiac output is the amount of blood pumped by the heart in a minute, calculated by multiplying heart rate by stroke volume. Normal value is 4-8 liters per minute.
    • Preload is the amount of blood returning to the heart.
    • Ejection fraction is the percentage of blood ejected from the ventricle with each beat. Normal value is 60-65%.
    • Afterload is the resistance the left ventricle must overcome to eject blood.
    • Systemic vascular resistance (SVR) affects afterload.

    Heart Sounds

    • S1 sound is created by tricuspid and mitral valve closure.
    • S2 sound is created by pulmonic and aortic valve closure.
    • S3 sound is produced by rapid filling of the ventricle.
    • S4 sound is a result of atrial contraction.

    EKG Interpretation

    • Assess rhythm, regularity, and rate.
    • Analyze P wave: Is there one for every QRS? Are there extra P waves?
    • Assess PR interval duration.
    • Analyze QRS complex duration and appearance.

    Components of the QRS Complex

    • P wave direction: Upright in I, II, aVL, and aVF, V5, V6; Biphasic in III, V1; Negative in aVR; Variable in V2, V4.
    • PR interval is the interval between atrial depolarization and ventricular depolarization. A duration of 120-200 milliseconds is normal.
    • A prolonged PR interval can indicate first-degree heart block.
    • QRS complex represents ventricular depolarization. Duration is 50-120 milliseconds.

    Cardiac Electrolytes

    • Potassium, magnesium, and calcium can affect heart function.

    Axis

    • Represents the direction of the electrical activity of the heart.
    • Left axis deviation can be associated with age, coronary artery disease (CAD), and pregnancy.
    • Right axis deviation is generally normal in children. In adults, it can indicate conduction defects, right ventricular strain, or ventricular tachycardia.

    Acute Coronary Syndrome (ACS)

    • Angina pectoris pain is predictable, relieved by rest and nitroglycerin.
    • Unstable angina pain is unpredictable and can have variable presentations.
    • Myocardial infarction (MI) is heart tissue death due to lack of blood supply.
    • Type 1 MI is caused by a thrombotic event.
    • Type 2 MI is caused by a mismatch between oxygen supply and demand.
    • Type 3 MI occurs when death precedes obtaining blood samples.

    ST Elevation MI (STEMI)

    • If the patient is exhibiting ACS-like symptoms with ST elevation in aVR and other ischemic EKG changes, there is a 90% chance of severe multi-vessel disease.
    • Inferior wall MI involves the right coronary artery (RCA), potentially leading to right ventricular (RV) involvement, heart failure, and low output. V4R can help determine RV involvement.
    • Use nitroglycerin with caution in inferior wall MI.
    • Posterior wall MI can be identified by ST depressions in anterior leads (V2-V4).

    Non-STEMI (NSTEMI)

    • Similar to unstable angina but involves thrombosis.
    • Symptoms can be atypical in women, elderly, and diabetics.

    Cardiac Biomarkers

    • CKMB and myoglobin elevate early but decrease quickly.
    • Troponin I and T are highly cardiac specific.

    ACS Therapy

    • Morphine isn't routinely used due to potential negative outcomes.
    • Nitroglycerin might provide short-term mortality reduction but doesn't affect long-term morbidity or mortality.
    • Aspirin is the only ACS drug consistently shown to reduce mortality.
    • Beta-blockers are usually not included in prehospital or critical care protocols.
    • There is no evidence to support routine oxygen administration for ACS.

    Heart Failure

    • Heart failure mechanisms include volume overload, pressure overload, myocardial damage, and restrictive filling.
    • Starling's law states that increased preload leads to increased myocardial stretch and force of contraction.
    • Systolic heart failure involves reduced ejection fraction, while diastolic heart failure has a preserved ejection fraction.
    • Brain natriuretic peptide (BNP) is activated due to myocardial stretch and damage.

    Supraventricular Tachycardia (SVT)

    • Heart rate greater than 150 bpm.
    • Stable SVT can be treated with adenosine or vagal maneuvers.
    • Unstable SVT requires synchronized cardioversion.

    Ventricular Tachycardia (VT)

    • 70-80% of wide-complex tachycardia is VT.
    • Precordial negativity concordance can help identify VT.
    • Treat as VT when in doubt.

    Myocarditis

    • Variable presentation and severity.
    • Common symptoms include chest pain, heart failure, arrhythmia, and fever.
    • Higher risk of ventricular arrhythmias and dilated cardiomyopathy.

    Pericarditis

    • Pleuritic chest pain, worse with inspiration and in supine position.
    • Patients may prefer to lean forward or assume other positions to alleviate pain.
    • Flu-like symptoms may precede onset.

    Endocarditis

    • Surgical emergency.
    • Risk factors include valve replacements, IV drug use, and dialysis.
    • Fever, malaise, septic shock, heart failure from valve regurgitation, and septic emboli are common presentations.

    Endocarditis Exam Findings

    • Fever, new murmur, splinter hemorrhages, conjunctival hemorrhages, Janeway lesions, and Osler nodes.

    Aortic Emergencies

    • Aortic dissection: Long-term hypertension is the primary risk factor, also linked to connective tissue disorders.
    • 85% of dissections are diagnosed post-mortem, and 40% are immediately fatal.

    Dissection Presentation

    • Often presents as "tearing" or "ripping" pain.
    • Back pain suggests Type B dissection, while chest pain suggests Type A dissection.
    • Tachycardia and hypertension are common.

    Chest X-Ray Findings in Aortic Dissection

    • Widened mediastinum, abnormal aortic knob, and potential left pleural effusion.

    Dissection Treatment

    • Anti-impulse therapy is vital.
    • Target heart rate is 60-70 bpm.
    • Target systolic blood pressure (SBP) is between 100-120 mmHg.
    • Consider medications for pain management.

    Cardiac Anatomy & Physiology

    • The coronary arteries supply the heart with blood.
    • Heart valves prevent blood from flowing backwards.
    • Mitral valve: left side of the heart
    • Tricuspid valve: right side of the heart
    • Semilunar valves: pulmonic and aortic
    • Cardiac output is the amount of blood pumped by the heart per minute.
    • Normal cardiac output: 4-8 L/min
    • Preload is the amount of blood returning to the heart.
    • Ejection fraction is a measure of the heart's pumping efficiency.
    • Normal ejection fraction: 60-65%
    • Afterload is the resistance the heart has to overcome to pump blood out.
    • Afterload is affected by systemic vascular resistance (SVR).

    Heart Sounds

    • S1: Tricuspid and mitral valve closure
    • S2: Pulmonic and aortic valve closure
    • S3: Rapid filling of ventricle
    • S4: Atrial contraction

    The Electrical Conduction System

    • Einthoven's triangle is a standard method used to record the heart's electrical activity.

    EKG Interpretation

    • Rhythm: regular or irregular
    • Regularity: consistent or inconsistent
    • Rate: beats per minute
    • P-wave: present for every QRS complex?
    • PR interval duration: time between atrial and ventricular depolarization
    • QRS complex duration and appearance: time it takes for ventricles to depolarize

    QRS Complex Components

    • P-Wave: represents atrial depolarization
      • Upright: Leads I, II, aVL, aVF, V5 ,V6
      • Biphasic: Leads III ,V1
      • Negative deflection: aVR
      • Variable: Leads V2, V4
    • PR Interval: represents time between atrial and ventricular depolarization
      • Normal duration: 120-200 milliseconds
      • Prolonged PR interval indicates first-degree heart block
    • QRS Complex: represents ventricular depolarization
      • Normal duration: 50-120 milliseconds

    Cardiac Electrolytes

    • Potassium: influences heart rate and rhythm
    • Sodium: critical in depolarization process
    • Calcium: regulates contractility
    • Magnesium: affects electrical conduction

    Axis

    • Represents the direction of the heart's electrical activity.
    • Left axis deviation can be normal with age or indicate coronary artery disease (CAD), pregnancy.
    • Right axis deviation is normal in children. In adults, it may indicate conduction defects, right ventricular strain, or ventricular tachycardia.

    Acute Coronary Syndrome (ACS)

    • Angina pectoris: chest pain due to myocardial ischemia.
      • Stable: predictable, relieved by rest and nitroglycerin.
      • Unstable: unpredictable onset, dynamic presentations.
    • Myocardial Infarction (MI): death of heart muscle due to lack of blood flow.
      • Type 1: athero-thrombotic event.
      • Type 2: mismatch between oxygen supply and demand (e.g., stress, vasospasm).
      • Type 3: cardiac death with ischemia symptoms but no blood samples obtained.
    • ST Elevation MI (STEMI): Indicates a complete blockage of a coronary artery.
      • Leads aVR and ischemic changes suggest severe triple-vessel disease.
    • Inferior Wall MI: Involves the right coronary artery (RCA).
      • High risk of right ventricular (RV) involvement.
      • Low output heart failure.
    • Posterior Wall MI: Large ST depressions in anterior leads (V2-V4).
    • Non-STEMI: partial blockage of a coronary artery. Similar to unstable angina but involves thrombosis.

    Cardiac Biomarkers

    • CKMB and Myoglobin: Rise early after a heart attack but are not specific to heart muscle.
    • Troponin: Most sensitive and specific biomarker for heart attacks.
      • Troponin I: Highly cardiac specific
      • Troponin T: Highly cardiac specific
      • Troponin C: Not as cardiac specific

    ACS Therapy

    • Morphine: Opiate analgesic, can worsen outcomes and increase thrombotic events.
    • Nitroglycerin: May reduce short-term mortality but not long-term morbidity.
    • Aspirin: The only ACS drug consistently shown to reduce overall mortality.
    • Beta Blockers: Evidence is mixed, generally not used in prehospital settings.
    • Oxygen: No evidence to support routine oxygen administration.

    Heart Failure

    • Heart Failure Mechanisms:
      • Volume overload
      • Pressure overload
      • Myocardial damage
      • Restrictive filling
    • Starling's Law: Increased preload leads to increased myocardial stretch and force of contraction.
    • Systolic Heart Failure: Reduced ejection fraction.
    • Diastolic Heart Failure: Preserved ejection fraction.
    • Brain Natriuretic Peptide (BNP): Indicates myocardial stretch and damage.

    Supraventricular Tachycardia (SVT)

    • Heart rate > 150 bpm, caused by re-entry phenomenon.
    • Stable SVT: treated with adenosine, vagal maneuvers.
    • Unstable SVT: treated with synchronized cardioversion.

    Ventricular Tachycardia (VT)

    • Wide-complex tachycardia: 70-80% is VT.
    • Precordial negativity concordance: helps identify VT.
    • Treat as VT unless definitively ruled out.

    Myocarditis

    • Inflammation of the heart muscle.
    • Wide-ranging presentation and severity.
    • Symptoms: chest pain, heart failure, arrhythmias, fever.
    • High risk of ventricular arrhythmias.
    • Risk of dilated cardiomyopathy.

    Pericarditis

    • Inflammation of the pericardium.
    • Pleuritic chest pain: worse with inspiration and supine positioning.
    • Patients may prefer pronation or leaning forward.

    Endocarditis

    • Infection of the heart valves.
    • Surgical emergency.
    • Risk factors: valve replacement, IV drug use, dialysis.
    • Presentation: fever, malaise, septic shock, heart failure, septic emboli.
    • Exam findings: fever, new murmur, splinter hemorrhages, conjunctival hemorrhages, Janeway lesions, Osler nodes.

    Aortic Emergencies

    • Aortic Dissection: Tear in the aorta, leading to blood flow into the aortic wall.
      • Long-term hypertension is a major risk factor.
      • Risk with connective tissue disorders.
      • 85% diagnosed after death.
      • 40% die immediately.
    • Dissection Presentation:
      • Tearing or ripping chest pain.
      • Back pain suggests type B dissection.
      • Chest pain suggests type A dissection.
      • Tachycardia and hypertension.
    • Chest X-ray:
      • Widened mediastinum.
      • Abnormal aortic knob.
      • Left pleural effusion.
    • Dissection Treatment:
      • Anti-impulse therapy is priority.
      • HR goal: 60-70 bpm.
      • SBP goal: 100-120 mmHg.

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    Test your knowledge on the anatomy and physiology of the heart, including coronary arteries, heart valves, and cardiac output. This quiz covers the fundamental concepts of cardiac function and heart sounds. Perfect for students in medical or health sciences.

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