Cardiology Basics Quiz

Cardiovascular Physiology Overview

• The circulatory system has three principal components: the heart, blood vessels, and blood.
• The cardiovascular system's function is influenced by the endocrine, nervous, and kidney systems.

Blood

• Blood is composed of formed elements (cells, cell fragments) and plasma (mostly water).
• Plasma transports blood cells, proteins, nutrients, wastes, and other molecules.
• Erythrocytes (red blood cells) constitute 45% of blood; hematocrit=45%.
• Leukocytes (white blood cells) and platelets form the "buffy coat."

System Overview

• The cardiovascular system has two loops: systemic and pulmonary.
• The pulmonary loop carries deoxygenated blood to the lungs, then back to the heart.
• The systemic loop carries oxygenated blood from the heart to the rest of the body.

Blood Vessels

• Blood vessels include arteries (muscular and conduit), arterioles, capillaries, venules, and veins.
• Generally, arteries carry oxygenated blood and veins carry deoxygenated blood.
• Coronary arteries carry deoxygenated blood to supply the heart, then pulmonary veins carry the oxygenated blood back to the heart to be transported throughout the body.
• Arteries carry blood away from the heart; veins carry blood to the heart.

Pressure, Flow and Resistance

• Pressure is measured in mm Hg.
• Flow is measured in mL/min.
• Resistance is the measure of friction impeding blood flow.
• The formula relating these variables is F = DP/R (Flow = Pressure difference/Resistance).
• Increasing resistance lowers flow if pressure is constant.

Resistance

• Three factors affect the resistance to blood flow:

1. Blood viscosity (affected by volume and RBC count).
2. Total blood vessel length.
3. Blood vessel diameter (most important factor for minute-to-minute control).

The Heart Anatomy

• The heart has four chambers: two atria and two ventricles.
• The heart has four valves: two atrioventricular valves and two semilunar valves.
• The valves ensure one-way flow of blood.
• The various parts ensure the heart functions properly.

Heart Layers

• The layers of the heart wall from superficial to deep are:
• Epicardium (outer layer of the serous pericardium).
• Myocardium (the middle layer composed of cardiac muscle).
• Endocardium (inner layer of endothelial cells).

Heart Valves

• The heart has four valves: two atrioventricular valves and two semilunar valves.
• These valves ensure one-way flow of blood through the heart.

Cardiac Muscle

• Cardiac muscle cells are tightly bound together in layers encircling the heart chambers.
• They contract with every heartbeat, offering little respite.
• The heart has a limited capacity to replace damaged muscle cells.

Cardiac Communication

• Specialized cardiac cells form the conducting system, enabling rapid impulse transmission.
• These cells are electrically connected by gap junctions.
• The sinoatrial (SA) node initiates the heartbeat.
• Certain cells in the atria secrete atrial natriuretic peptide (ANP).

Innervation of the Heart

• The heart receives input from both sympathetic and parasympathetic nervous systems.
• The sympathetic nervous system (SNS) accelerates the heart rate.
• The parasympathetic nervous system (PSNS) slows the heart rate.

Blood Supply

• The heart receives its blood supply via coronary arteries branching from the aorta.
• The coronary arteries exit behind the aortic valve cusps and form a complex network.
• Most cardiac veins drain into the coronary sinus, which drains into the right atrium.

Heartbeat Coordination

• The heart's electrical activity is coordinated by the SA node, the AV node, the bundle of His, and Purkinje fibers.

Excitation of the Heart

• The sinoatrial (SA) node initiates the heartbeat, setting the basic heart rate rhythm.
• The signal propagates through the conduction system, allowing time for the atria to contract and totally fill the ventricles before contraction.

Sequence of Excitation

• The excitation sequence proceeds through the internodal pathway via gap junctions to the atrioventricular node (AV node).
• The AV node introduces a delay, allowing the atria to finish filling the ventricles.

Cardiac Action Potential

• The cardiac action potential has a unique plateau phase, distinguishing it from other nervous or muscle cells.

Node Cells

• Node cells exhibit automaticity, initiating and controlling electrical impulses.
• The SA node typically sets the heart rate in a healthy heart.

Excitation of the SA Node

• The spontaneous depolarization of SA node cells produces the heartbeat rhythm.

Clinical Issues (Arrhythmias)

• Arrhythmias are uncoordinated atrial and ventricular contractions due to conduction system dysfunction.
• Fibrillation is rapid, irregular contraction, disrupting the SA node's control.
• Ventricular fibrillation is a life-threatening arrhythmia.

Clinical Issues (cont.)

• Ectopic focus: An abnormal pacemaker that overrides the SA node.
• Premature contractions: premature contractions of the heart muscle.
• Heart block: AV node damage affecting conduction between the atria and ventricles.

Clinical Issues (cont.)

• The ECG (Electrocardiogram) is used to identify various heart conditions involving the electrical activity of the heart.
• Abnormal heart sounds (murmurs) indicate blood flow issues.

Blood Supply (cont.)

• The coronary arteries provide blood flow to the heart muscle itself.
• Cardiac veins return deoxygenated blood from the heart muscle to the right atrium.

Cardiac Cycle

• The cardiac cycle encompasses all events in one heartbeat.
• Systole is contraction; diastole is relaxation .
• Phases of the cardiac cycle include filling(diastole) and emptying(systole).

Mechanical Events of the Cardiac Cycle

• The cardiac cycle consists of four major phases during a single heartbeat.

Cardiac Cycle(cont.)

• Various pressures, volume changes, and valve action define the different phases of the cardiac cycle.

Pulmonary Circulation Pressures

• Pulmonary pressures are measured, and the relationship between right ventricular pressure and pulmonary artery pressure during the cardiac cycle is examined.

Clinical Issues (cont.)

• Abnormal heart sounds, called murmurs, indicate issues with blood flow, often resulting from valve problems.

Cardiac Output

• Cardiac output (CO) is the amount of blood pumped by each ventricle per minute.
• CO is calculated by multiplying heart rate (HR) and stroke volume (SV).
• Normal cardiac output is approximately 5.25 liters per minute.

Regulation of Heart Rate

• Heart rate is controlled by several positive and negative chronotropic factors.
• The sympathetic nervous system increases the rate; the parasympathetic nervous system decreases it.

Control of Heart Rate

• The heart rate is regulated via different factors like sympathetic and parasympathetic nervous systems and different hormones secreted by various glands.

Stroke Volume

• Stroke volume (SV) is the difference between end-diastolic volume (EDV) and end-systolic volume (ESV).
• Approximately 60% of the blood volume in the chambers is pumped with each beat of the heart in a normal heart.

Starling's Law

• Starling's law states the critical factor in stroke volume control is "preload" pressure.
• Preload is the level of stretch of muscle cells before contraction and should be optimal.

Frank-Starling Mechanism

• The Frank-Starling mechanism describes the relationship between end-diastolic volume (preload) and stroke volume.
• Increased venous return leads to increased preload, hence increasing the stroke volume.

Stroke Volume (cont.)

• Extrinsic factors like sympathetic drive and hormonal influence control stroke volume.

Ejection Fraction

• Ejection fraction (EF) is the ratio of stroke volume to end-diastolic volume.
• It typically ranges from 50% to 75% under normal resting conditions.
• Increased contractility leads to an increased ejection fraction.

Preload and Afterload

• Preload is proportional to the amount of ventricular myocardial fiber stretch before systole (EDV).
• Afterload refers to the pressure the ventricles must overcome to open the aortic and pulmonary valves.
• Elevated systemic/pulmonary pressure increases afterload.

Measurement of Cardiac Function

• Echocardiography uses ultrasonic waves to evaluate cardiac function, including valve and contraction function, and ejection fraction.
• Cardiac angiography involves catheterization, injection of contrast material, and X-ray video (cineangiogram) for detailed evaluation of cardiac structure and function.

The Vascular System

• The vascular system includes arteries, arterioles, capillaries, venules, and veins.
• Arteries and veins are composed of layers of endothelial cells, smooth muscle and connective tissue, which vary in amount based on the vascular structure.

The Vascular System

• Blood pressure varies throughout the circulatory system with the maximal pressure occurring in arteries, and continually decreasing throughout the systemic and pulmonary circulations.

Arteries

• Arteries, especially elastic arteries, act as pressure reservoirs, cushioning blood flow and maintaining continuous flow during diastole.

Elastic Arteries

• Elastic arteries, like the aorta, have a high compliance to serve as pressure reservoirs buffering pulse pressure changes and allowing continuous flow during diastole and systole.
• Damage can lead to disorders like atherosclerosis and arteriosclerosis.

Muscular Arteries

• Muscular arteries control blood distribution to specific organs through vasoconstriction and dilation.
• The mesenteric artery is a critical example for its role in controlling blood flow to the digestive tract.

Arterial Blood Pressure

• Arterial blood pressure is typically described as systolic over diastolic pressure.
• Blood pressure readings vary with age.

Measurement of Systemic Arterial Pressure

• Blood pressure measurements rely on detecting sounds (Korotkoff sounds) while deflating a cuff surrounding an artery to accurately assess both systolic and diastolic pressure.

Pressures

• Normal blood pressure is generally considered to be 120/80 millimeters of mercury (mmHg).
• Elevated blood pressure (e.g., 140/90 mmHg or higher) is defined as hypertension.
• Blood pressure readings can be influenced by posture, exertion, and other physiological factors.

Pulse Pressure

• Pulse pressure represents the difference between systolic and diastolic blood pressure.
• Factors like stroke volume, ejection rate, and arterial compliance influence pulse pressure.

Arterioles

• Arterioles are the smallest arteries and play a critical role in adjusting blood flow to capillary beds through vasoconstriction and vasodilation.

Flow-Pressure Relationship

• Blood flow (F) is directly proportional to the pressure difference (AP) and inversely proportional to the resistance (R), which is an important factor in determining blood flow rate.
• Vasodilation decreases resistance to increase flow; vasoconstriction increases resistance to decrease flow.

Local Controls

• Local mechanisms such as active hyperemia and flow autoregulation govern blood flow to tissues in response to their metabolic needs.
• These mechanisms are independent of systemic influences and are crucial to adjusting blood flow according to localized needs.

Extrinsic Controls

• Control mechanisms like sympathetic nervous input, hormones like epinephrine, and others affect vascular tone and blood flow.

Endothelial Cells and Vascular Smooth Muscle

• Endothelial cells release chemicals like nitric oxide (NO) affecting vascular smooth muscle, regulating vascular tone and mediating vasodilation.

Autoregulation

• Blood flow within different tissues is adjusted automatically in response to metabolic conditions in local arterioles, this autoregulation is not influenced by systemic factors.

Arteriolar Control in Specific Organs

• Different organs like skeletal muscle or the brain receive specialized regulation for blood flow, often a mixture of neural, hormonal, and local factors.

Types of Capillaries

• Capillaries are the smallest blood vessels. Three types:
• Continuous capillaries (common, have tight junctions).
• Fenestrated capillaries (more permeable; found in kidneys, intestines).
• Sinusoidal capillaries (incomplete basement membrane; found in liver, bone marrow).

Capillaries

• Capillaries facilitate the exchange of gases, nutrients, and waste products between the blood and tissues.
• The structure of capillaries is optimized for this exchange function.

Anatomy of Capillary Network

• Capillaries form a network interconnected by arterioles and venules, providing extensive surface area for gas and nutrient exchange.
• Precapillary sphincters regulate blood flow into capillaries.

Velocity of Capillary Blood Flow

• Blood flow slows in capillaries due to their greater cross-sectional area, allowing ample time for exchange.

Diffusion Across the Capillary Wall

• Substances like oxygen and carbon dioxide diffuse across the capillary walls based on diffusion gradients, delivering nutrients and removing wastes from tissues.

Bulk Flow Across the Capillary Wall

• Fluid moves across capillary walls by filtration and absorption.
• Hydrostatic pressure (blood pressure) and colloid osmotic pressure influence fluid movement.

Fluid Movement

• Hydrostatic pressure forces fluid out of capillaries, while colloid osmotic pressure draws fluid into them.
• The balance between these pressures determines fluid movement balance.

Osmotic Pressure

• Colloid osmotic pressure (oncotic pressure) is generated by large proteins in blood plasma.
• It opposes hydrostatic pressure to regulate fluid movement.

Net Filtration Pressure

• Net filtration pressure results from the balance between hydrostatic and colloid osmotic pressures.
• Fluids leave the capillaries (filtration). Fluids are absorbed into the capillaries.

Veins

• Veins in the circulatory system are more distensible and act as blood reservoirs, which influences blood volume, pressure and rate.

Venous System

• Venules collect blood from capillaries and veins carry blood back to the heart.
• Their thin wall allows for high distensibility, making them capacitance vessels.

Varicose Veins

• Varicose veins result from incompetent valves, causing blood pooling and distension.
• They are common in the lower limbs.

Venous Pressure

• Low venous pressure and other factors like respiratory pump and skeletal muscle pump help blood return the the heart.

The Lymphatic System

• The lymphatic system collects excess interstitial fluid and returns it to the bloodstream, acting as a part of immune response.

Lymphatic System

• Lymphatic vessels and tissues play a crucial role in fluid balance and immune defense, unlike blood vessels, filtering lymph content at the lymphoid tissue and collecting cells, proteins and debris found in extracellular fluid.

Lymphoid Tissues

• Lymph tissues and nodes cluster along lymphatic vessels, acting as a proliferation site for lymphocytes/immune cells and a surveillance site for filtering lymph fluid.

Summary of Cardiovascular Function (Equations)

• Cardiovascular function is defined by key equations:
• CO = HR x SV (Cardiac Output = Heart Rate x Stroke Volume).
• SV = EDV – ESV (Stroke Volume = End-Diastolic Volume – End-Systolic Volume).
• MAP = CO x TPR (Mean Arterial Pressure = Cardiac Output x Total Peripheral Resistance).

Integrative Cardiovascular Function: Regulation of Systemic Arterial Pressure

• Several factors (neural, hormonal, local) affect overall maintenance of systemic arterial pressure.

Arterial Baroreceptors

• Baroreceptors found in the carotid sinus and aortic arch detect arterial pressure.
• Changes in pressure are sensed by these special receptors.

The Medullary Cardiovascular Center

• The medulla oblongata integrates baroreceptor signals to regulate heart rate and blood vessel tone.

Operation of the Arterial Baroreceptor Reflex

• The arterial baroreceptor reflex is a negative feedback mechanism maintaining stable arterial pressure.
• Systemic arterial pressure is directly correlated with vascular smooth muscle and cardiac actions.

Other Baroreceptors

• Baroreceptors are also present in large systemic veins, pulmonary vessels, and heart walls, contributing to the regulation of blood pressure.

Blood Volume and Long-Term Regulation of Arterial Pressure

• Kidneys play a crucial role in long-term blood pressure regulation by adjusting sodium and water excretion.
• This adjustment by the kidneys directly influences blood volume which plays a role in regulating blood pressure.

Other Cardiovascular Reflexes and Responses

• Other factors like oxygen/carbon dioxide levels, blood flow to the brain, pain, and emotions also influence blood pressure to adapt to bodily needs.

Hypotension

• Hypotension represents low blood pressure and can be normal in some cases, but critically low blood pressure is clinically urgent.
• Orthostatic hypotension is a temporary drop in blood pressure when changing positions.
• Chronic hypotension could indicate various underlying health conditions like poor nutrition, decreased blood viscosity, or specific diseases like Addison’s disease.

Other Forms of Hypotension

• Acute hypotension is related to conditions like shock which is not normal and can be life-threatening..

Hemorrhage and Other Causes of Hypotension

• Hemorrhage, a significant blood loss, has a direct impact on blood volume.
• Physiological compensatory mechanisms are triggered to restore circulation.

Circulatory Shock

• Circulatory shock is a grave condition characterized by inadequate blood flow causing organ failure.
• Shock has various causes: hypovolemic shock, vascular shock and cardiogenic shock.

Hypovolemic Shock

• Hypovolemic shock results from a significant loss of blood volume, causing inadequate blood flow.
• This type of shock is often a result of severe blood loss, vomiting, diarrhea or extensive burns.

Vascular Shock

• This type of shock is associated with a loss of vasomotor tone or uncontrolled vasodilation contributing to improper blood pressure and flow.
• This can result from different conditions or injuries.

Cardiogenic Shock

• Cardiogenic shock is caused by heart failure unable to maintain adequate blood circulation and is most often associated with major myocardial damage, often a result of extensive heart attack.

Exercise

• Blood flow shifts during exercise to meet the increased needs of active tissues.

Maximal Oxygen Consumption and Training

• Training increases the body's ability to deliver oxygen during exercise.

Hypertension

• Hypertension is abnormally high blood pressure.
• Primary (essential) hypertension often lacks a single identifiable cause; secondary hypertension arises from an underlying condition.

Essential Hypertension

• Lifestyle factors and certain health conditions influence the development of essential hypertension.
• Modifiable behaviors such as weight, diet, lifestyle and certain types of medications can help manage essential hypertension.

Hypertension (Treatment)

• Medical interventions like diuretics, beta-blockers, ACE inhibitors and calcium channel blockers reduce blood pressure effectively, preventing potential cardiovascular problems.

Heart Failure

• Heart failure occurs when the heart cannot effectively maintain blood circulation.
• Heart failure mechanisms include decreased stroke volume and fluid retention leading to cardiac problems.

Coronary Artery Disease and Heart Attacks

• Atherosclerosis causes plaque buildup in coronary arteries, reducing blood flow to the heart muscle.
• Heart attacks occur from blocked coronary circulation and cause ischemia which leads to severe damage to the heart and surrounding tissues.

Plasma

• Plasma is the liquid component of blood, comprising approximately 90% water and carrying various substances.
• Plasma contains electrolytes, proteins, nutrients, waste products, gases, and hormones.

The Blood Cells (Erythrocytes, Leukocytes, Platelets)

• Erythrocytes (red blood cells) transport oxygen and carbon dioxide; they lack a nucleus and organelles for efficient gas transport, are filtered by the spleen and liver.
• Leukocytes (white blood cells) are part of the immune system, encompassing granulocytes (with granules like neutrophils, eosinophils, basophils) and agranulocytes (without granules like monocytes, lymphocytes). Granulocytes and agranulocytes have various functions, including immune defense.
• Platelets are cell fragments crucial for blood clotting, containing secretory products relevant to blood clotting. These components are vital to maintain health and circulation.

Erythrocytes (Red Blood Cells) (cont.)

• Mature red blood cells lack a nucleus; have a flexible, biconcave shape for efficient oxygen transport; have a short lifespan (120 days) and are produced in red bone marrow.
• Erythropoietin from the kidneys stimulates red blood cell production.

Leukocytes (cont.)

• Leukocytes are divided further based on their presence or absence of cytoplasmic granules.
• Granulocytes, such as neutrophils, eosinophils, and basophils, involve defense response.
• Agranulocytes, such as monocytes and lymphocytes, are involved in immunity to various pathogens. Functions specific to various leukocytes are examined.

WBC Function

• Neutrophils are phagocytic cells crucial in immune response, increasing in number during infections.
• Eosinophils target parasites.
• Basophils play a role in allergic reactions; monocytes differentiate into macrophages, participating in tissue cleanup; lymphocytes include B and T cells which are vital for specific immunity.

Requirements for Erythrocyte Production

• Required constituents for red blood cell production are covered (like iron for hemoglobin, folic acid, and vitamin B12 for DNA synthesis.
• Iron content is important for proper blood functionality.

RBC Production

• Kidneys detect low oxygen availability and increase erythropoietin (EPO) production to signal red blood marrow increased production of red blood cells to increase blood oxygenation levels and thus increase blood oxygen-carrying capacity.

Regulation of Blood Cell Production

• Various growth factors (hormones) influence blood cell production.

Clinical Issues (Anemia)

• Anemia is characterized by decreased oxygen-carrying capacity and has several causes like poor nutrition, bleeding, or autoimmune destruction of red blood cells; this is defined as a reduction in blood oxygen.
• Hemolytic anemia, aplastic anemia, renal anemia are examined as different categories of anemia that affect blood characteristics.

Filtering and Destruction of Erythrocytes

• The spleen and liver remove old or damaged red blood cells.
• Vital components like iron are salvaged for reuse in erythrocyte production.

Spleen (cont.)

• The spleen has a crucial role in filtering old/damaged red blood cells, removing hemoglobin's components and returning the components to circulation/excretion.

Platelets (cont.)

• Platelets, crucial in blood clotting, are cell fragments produced by megakaryocytes and lack organelles, but possess granules with clotting factors.

Hemostasis

• Hemostasis is the physiological process stopping bleeding, involving three steps: vascular spasm, formation of a platelet plug, and blood clotting/coagulation.

Vascular Spasm

• Temporary constriction of blood vessels at the injury site to control blood loss.
• This initial blood loss control assists overall blood pressure.

Formation of a Platelet Plug

• Platelets adhere to exposed collagen at the injury site, forming a temporary plug to reduce blood loss.

Formation of a Blood Clot (Coagulation)

• Coagulation/blood clotting converts blood from a fluid to a solid gel, which stabilizes the plug and is a dominant hemostatic defense, sealing the vessel and preventing bleeding.

Blood Coagulation: Clot Formation

• A cascade of enzyme activations involving several clotting factors converts prothrombin to thrombin to form fibrin, which forms the clot.

Clotting Cascade

• The intrinsic and extrinsic pathways are two pathways used in the blood clotting/coagulation process. These can be stimulated by factors at the injured site.

Clotting Factors

• Liver produces clotting factors in inactive forms; they are activated during the coagulation cascade.

Dissolving Blood Clots

• Plasminogen activators convert plasminogen to plasmin, digesting fibrin to dissolve the clot.

Anticlotting Systems

• The body has systems to prevent or control excessive clotting.
• Endothelial cells, anticoagulants, and regulating clotting factors prevent inappropriate/unwanted clotting.

Endothelial Cells (cont.)

• Endothelial cells lining blood vessels are typically smooth and intact, preventing platelet adhesion and promoting proper blood flow (preventing clotting).

Causes and Treatments (Clotting Disorders)

• Various factors can disrupt normal clotting mechanisms.
• Treatments may include therapies for inflammatory conditions, management of blood-flow, and clotting factor supplementation.

Clotting Disorders

• Thromboembolic disorders involve inappropriate clots, while bleeding disorders result from defective clotting mechanisms like Hemophilia A, B or C, or deficiencies in von Willebrand's factor.
• Disseminated intravascular coagulation represents a condition with widespread clotting(thrombosis) and bleeding due to several different underlying factors.

Thromboembolic Conditions

• Thrombi are clots in unbroken blood vessels while emboli are free-floating clots that can obstruct blood vessels, leading to life-threatening complications like stroke or heart attack.

Bleeding Disorders (cont.)

• Thrombocytopenia leads to a lack of platelets, impacting blood clotting and causing spontaneous bleeding from small vessels.
• Liver deficiencies and Vitamin K deficiencies, both impacting clotting factors, can cause bleeding disorders.

Role of the Liver (cont.)

• The liver plays a crucial role in normal blood clotting by synthesizing necessary clotting factors and regulating homeostasis.
• Liver disorders can lead to clotting deficiencies.

Hemophilia

• Hemophilia is a group of genetic disorders primarily in men causing problems associated with clotting resulting in abnormal bleeding.
• The deficiency can lead to impaired ability to produce/ activate needed clotting factors which leads to abnormal hemorrhaging or bleeding.

Transfusions

• Transfusions are required to restore or enhance needed blood constituents when large blood loss or blood cell deficiencies occur.

###Summary of Clinical Issues and Transfusions

• Different clinical scenarios result in the need for blood transfusions or components of blood for treatment and recovery.

Test your knowledge on key concepts in cardiology, including the functions of cardiac peptides, the role of nerve fibers, and the mechanisms of the electrocardiogram. This quiz covers essential elements of heart physiology and anatomy, making it perfect for students and healthcare professionals alike.