Understanding Cardiac Function

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Questions and Answers

Within the hierarchy of blood vessel structure, which transition accurately depicts the diminishing luminal diameter observed as blood moves away from the heart?

  • Arteries → arterioles → capillaries → venules (correct)
  • Arterioles → arteries → venules → capillaries
  • Arterioles → arteries → capillaries → venules
  • Arteries → arterioles → venules → capillaries

The pulmonary artery carries oxygenated blood from the lungs to the left atrium.

False (B)

Describe the role of the hepatic portal vein in maintaining metabolic homeostasis, and name a specific class of molecules it transports.

The hepatic portal vein transports blood rich in nutrients and other molecules absorbed from the gastrointestinal tract directly to the liver. Examples of molecules transported by the hepatic portal vein include glucose, amino acids and lipids.

In cardiac myocytes, the influx of calcium ions into the cell during the plateau phase of the action potential is balanced primarily by the efflux of ______ ions to maintain electrical neutrality.

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

Match the following components of the cardiac conduction system with their corresponding intrinsic firing rates:

<p>Sinoatrial (SA) node = 60-100 beats per minute Atrioventricular (AV) node = 40-60 beats per minute Purkinje fibers = 20-40 beats per minute</p> Signup and view all the answers

What is the functional implication of the disparity in muscle thickness between the left and right ventricles?

<p>The left ventricle requires greater pressure to overcome the resistance of the systemic circulation, whereas the right ventricle only needs to overcome the lower resistance of the pulmonary circulation (A)</p> Signup and view all the answers

The primary function of leukocytes within the cardiovascular system is to facilitate the transport of oxygen and carbon dioxide.

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

Describe the biophysical mechanism underlying the plateau phase observed in ventricular myocyte action potentials, explicitly detailing the ion channels involved and their temporal dynamics.

<p>The plateau phase is primarily due to the influx of Ca2+ ions through L-type calcium channels, which is balanced by the efflux of K+ ions. This balance of ion movement prolongs the depolarization, creating the plateau.</p> Signup and view all the answers

The Frank-Starling mechanism dictates that an increase in venous return leads to a corresponding increase in ______, thereby augmenting stroke volume.

<p>end-diastolic volume</p> Signup and view all the answers

A patient presents with a stenotic aortic valve, increasing afterload on the left ventricle. Which compensatory mechanism is most likely to occur initially to maintain cardiac output?

<p>Ventricular hypertrophy to increase contractility (D)</p> Signup and view all the answers

In parallel blood flow arrangements, alterations in the vascular resistance of one organ will invariably affect blood flow to all other organs.

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

Outline the steps involved in excitation-contraction coupling in cardiac muscle cells, focusing on the roles of calcium ions, ryanodine receptors (RyR), and the sarcoplasmic reticulum.

<p>Excitation-contraction coupling begins with an action potential entering the cell, opening L-type Ca2+ channels in the T-tubules. The influx of Ca2+ triggers the opening of ryanodine receptors (RyR) on the sarcoplasmic reticulum. Ca2+ binds to troponin, initiating muscle contraction.</p> Signup and view all the answers

The AV valves are open when atrial pressure is ______ than ventricular pressure, which allows blood to flow from the atria into the ventricles.

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

Match each numbered phase of the cardiac contractile cell action potential with its corresponding ionic event:

<p>Phase 0 = Rapid Na+ influx Phase 2 = Ca2+ influx, K+ efflux Phase 3 = K+ efflux</p> Signup and view all the answers

During isovolumetric ventricular relaxation, which statement accurately describes the state of the heart valves?

<p>Both the atrioventricular and semilunar valves are closed. (A)</p> Signup and view all the answers

The sinoatrial (SA) node is located in the interventricular septum near the tricuspid valve.

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

Explain how the unique biophysical properties of pacemaker cells, including the If 'funny' channels and T-type calcium channels, contribute to their autorhythmicity and the spontaneous generation of action potentials.

<p>Pacemaker cells have If channels that open upon hyperpolarization, allowing Na+ influx, which then causes a gradual depolarization. Once -55mV is reached, T-type calcium channels open, depolarizing the cell to -40mV, thus a spontaneous action potential is generated.</p> Signup and view all the answers

The QRS complex on an electrocardiogram (ECG) corresponds to the ______ of the ventricles.

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

Match the following structural components of cardiac muscle cells with their respective functions:

<p>Intercalated discs = Facilitate rapid electrical communication between cells. T-tubules = Invaginations of the plasma membrane that conduct action potentials into the cell interior. Mitochondria = Provide ATP for the contractile process.</p> Signup and view all the answers

Under conditions of extended strenuous exercise, what adaptation best enables the heart to maintain cardiac output despite a decrease in stroke volume due to reduced filling time during diastole?

<p>Augmented contractility mediated by increased sympathetic stimulation (C)</p> Signup and view all the answers

Flashcards

What is the heart?

A muscle-driven pump for blood movement throughout the body (7,200L/day).

What is the atria/atrium?

Receives blood from the vasculature.

What are the ventricles?

Receives blood from the atria and generate force for blood to leave the heart.

What are the blood vessels?

Conduits for the movement of blood.

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What is vasculature?

System of blood vessels throughout the body. Vessels leaving the heart become branched and smaller.

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What are arteries?

Carry blood away from the heart

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What are veins?

Carry blood to the heart

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What is blood?

Circulating fluid that carries cells and material to cells of the body.

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What is Pulmonary circulation?

Movement of blood from the right ventricle to the lungs for oxygenation and returns to the left atrium.

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What is Systemic Circulation?

Blood leaves from the left ventricle to the tissues and returns to the right atrium.

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What is the tricuspid valve?

Three flaps (or cusps). Located between the right chambers.

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What is the Bicuspid valve?

Two flaps. Located between the left chambers.

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What are the Semilunar valves?

Located between the ventricles and the arteries.

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What are Pacemaker cells?

Initiate action potentials; establishes heart rhythm.

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What are Conduction fibers?

Specialized muscle cells; Transmit and coordinate the action potential.

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What is the Sinoatrial node?

Located in the right atrium, near the superior vena cava.

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What is the Atrioventricular node?

Located in the septum between the right atrium and ventricle near the tricuspid valve.

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What are Internodal pathway?

Connects the SA and AV nodes

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What is Bundle of His (AV bundle)?

Located in the interventricular septum; electrically connects the atria with the ventricle.

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What are Purkinje fibers?

Branched network; spread throughout the ventricular myocardium from the apex upwards.

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Study Notes

Cardiac Function Overview

  • Focuses on the cardiovascular system
  • Covers blood flow, heart anatomy, electrical activity, and the cardiac cycle.

Cardiovascular System Components

  • The heart is a muscle pump that circulates 7,200L of blood per day
  • Four chambers: atria and ventricles
  • Atria receive blood from the vasculature
  • Ventricles generate force to pump blood out of the heart
  • The interventricular and interatrial septa divide the heart
  • The septa ensures oxygenated and deoxygenated blood do not mix

Blood Vessels

  • Function as conduits for blood movement
  • The vasculature constitutes a system of blood vessels
  • Vessels branching from the heart decrease in cross-sectional diameter
  • Arteries carry blood away from the heart
  • Veins carry blood to the heart
  • The circulation flow is heart to arteries to arterioles to capillaries to venules to veins and back to the heart

Blood Components

  • Transports cells and material to cells, and carries circulating fluid
  • Includes plasma (water, dissolved proteins, ions, solutes, gases)
  • Contains cells like red blood cells/erythrocytes (O2/CO2 carrier)
  • Immune response driven by leukocytes and platelets are for clotting

Path of Blood Flow: Pulmonary Circulation

  • Blood moves from the right ventricle to lungs, then lungs to left atrium
  • Results in oxygenation and carbon dioxide removal

Path of Blood Flow: Systemic Circulation

  • Blood flows from the left ventricle to tissues then returns to the right atrium
  • Blood leaving the left ventricle is oxygenated via arteries
  • Blood entering the right atrium is deoxygenated via the veins
  • Results in oxygen delivery to tissues and carbon dioxide removal

Path of Blood Flow: Coronary Circulation

  • Blood is ejected from the left ventricle via the coronary artery
  • Supplies the heart surface
  • Arteries branch to arterioles to deliver oxygen to the myocardium
  • Deoxygenated blood returns to the right atrium via cardiac veins
  • The heart removes ~70-80% of oxygen; double the amount of other cells

General Blood Flow Rule

  • Blood in arteries and arterioles is oxygenated (leaving heart)
  • Blood in veins and venules is deoxygenated (returning to heart)
  • Blood leaving the right ventricle via the pulmonary artery is deoxygenated (exception)
  • Blood entering the left atria via the pulmonary vein is oxygenated (exception)

Circulatory System Pathway

  • A closed loop system
  • Deoxygenated blood enters the right atrium and then the right ventricle
  • From the right ventricle, blood moves to the pulmonary artery and then to the lungs
  • Oxygenated blood then leaves the lungs through the pulmonary veins, and enters the left atrium
  • Blood leaves the left ventricle via the aorta and takes one of three paths:

Aorta Blood Paths

  • Ascending arteries goes to the arms, head, and brain (systemic circulation)
  • Abdominal and descending arteries goes to the trunk, legs, internal organs (systemic)
  • Coronary arteries nourishes the heart
  • Moves from arteries to capillaries to cardiac veins, back to the right atrium (coronary circulation)

Pulmonary and Systemic Systems Working Together

  • Systems work together in series
  • Systemic organs work in parallel
  • Meaning blood flows in parallel in individual systemic organs

Parallel Blood Flow Benefits

  • Each organ gets fully oxygenated blood
  • Blood flow is independently regulated in each organ

Exceptions to Parallel Blood Flow

  • Portal vein involves two organs in series
  • Blood from colon/small intestine is transported to the liver
  • The hepatic portal vein transports water, ions, and nutrients from the GI tract to the liver, and then the general circulation

Heart Anatomy Location

  • Situated in the chest/thoracic cavity, above the diaphragm
  • Fist-sized, weighing 250-350g
  • Surrounded by the pericardium (membranous sac with pericardial fluid)
  • Located between the lungs
  • The apex is at the bottom, resting on the diaphragm and angled down/left
  • Major arteries and veins emerge from the top (base)
  • Left and right chambers are separated by a septum

Heart Structure

  • Ventricles = bulk of the heart
  • Primarily cardiac cells
  • Ventricular muscle is thicker than atrial
  • Left ventricular wall is thicker, needing more pressure for the systemic system
  • Blood moves by contraction (systole) and relaxation (diastole) of the myocardium

Heart Valves Overview

  • Four valves maintain unidirectional blood flow
  • Atrioventricular valves sit between atria/ventricles allowing flow from the atrium into the ventricle
  • Valves open when atrial pressure > ventricle pressure
  • Valves close when atrial pressure < ventricle pressure
  • The tricuspid valve (right chambers) has three flaps (cusps)
  • The bicuspid/mitral valve (left chambers) has two flaps

Semilunar Valves

  • Located between the ventricles and arteries
  • Open when ventricular pressure exceeds arterial pressure
  • Closed when ventricular pressure is less than arterial pressure
  • Aortic valve: between left ventricle and aorta
  • Pulmonary valve: between right ventricle and pulmonary trunk

Cardiac Muscle Contraction

  • Signals come from the cardiac cells (myogenic)
  • Autorhythmic cells include pacemaker and conduction fibers
  • Pacemaker cells initiates action potentials that sets the heart rhythm
  • Conduction fibres, transmits/coordinate the action potential
  • Electrical stimulation (action potential) in one cardiac muscle cell is transferred to an adjacent cell through gap junctions
  • Intercalated disks physically link adjacent cells for mechanical stress resistance

Pacemaker Cells

  • Generates action potentials spontaneously
  • Sets the pace of cardiac contraction, with high concentrations in the sinoatrial (SA) node and atrioventricular (AV) node
  • SA node: in the right atrium, near the superior vena cava
  • AV node: in the septum between the right atrium/ventricle, near the tricuspid valve

Conduction Fibers

  • These are noncontractile specialized cells
  • Larger diameter for faster action potential transmission
  • Transmission is ~10X faster than typical cardiac muscle cells (4m/sec versus 0.3-0.5m/sec)
  • The internodal pathway connects the SA and AV nodes
  • Bundle of His is in the interventricular septum
  • Right and left bundles split from the AV bundle
  • The Purkinje fibers network branches throughout the ventricular myocardium starting from the apex

Contraction Signals

  • Electrical signals do not pass directly from the atria to the ventricles
  • Signalling is transmitted only through the AV node
  • Delay ensures complete atrial contraction before ventricular contraction begins

Heart Contraction Path

  • The bundled of His splits into the right and left bundles and then to the purkinje fibers
  • Transmitting the electrical signal only happen through the ventricles
  • Purkinje fibres spreads through the mycardium and moves from the apex upwards which initiates contraction from the apex towards the valves
  • Both ventricles are contracting together from apex upwards

Cardiac Cycle Overview

  • Systole is contraction, and diastole is relaxation
  • Lub change occur when the AV valves close
  • Dub change occur when the semilunar valves close

Ventricular Volume

  • This is the volume of blood in the left ventricle during the cardiac cycle
  • The maximum blood volume in the left ventricle is 135ml
  • After ventricular systole, ~65ml remains (~52%)
  • During exercise, a larger volume can be ejected (100ml/135ml, ~70%)

Cardiac Muscle Cell Types

  • Cardiac muscle (myocardium) contain two major cell types
  • Contractile cells makeup majority of heart cells
  • They are uninuclear, branch cell morphologies linked by gap junctions/intercalated disks, striated, contain sarcomeres
  • Abundant mitochondria for aerobic metabolism
  • Calcium contributes to contraction
  • Are under hormonal, sympathetic, and parasympathetic control
  • Conducting cells makeup 1% of heart cells
  • These have special muscle cells
  • Includes internodal, interatrial, SA node, AV node, Bundle of His, right/left bundles, Purkinje fibers

Pacemaker Cells Overview

  • Can fire action potential without external signal
  • Have spontaneous action potential (regular)
  • No stable/constant resting membrane potential
  • No organized sarcomeres, and are noncontractile
  • Depolarize slowly until membrane reaches threshold which triggers action potential
  • Cell repolarizes to -60 to -70mV
  • Changes in sodium, potassium, and calcium ion movement results in action potential
  • Potential becomes less negative until it reaches a threshold which is triggered by the action potential

Electrical Base

  • When the membrane potential reaches -60mV, If channels ('funny' channels) open
  • Na+ enters/ K+ leaves the cell. The membrane potential becomes less negative (depolarizes).
  • If channels close when the membrane potential reaches -55mV
  • T-type voltage-gated Ca2+ channels open and calcium enters into the cell, depolarizing the cell to the threshold potential of -40mV. T-type voltage-gated Ca2+ channels close.
  • L-type voltage-gated calcium channels open and even more Ca2+ enters into the cell, depolarizing the cell.
  • Voltage-gated K+ channels open and K+ leaves the cell. L-type voltage-gated Ca2+ channels close. This results in repolarization of the cell.
  • Voltage-gated K+ channels close when the cell reaches -60mV

SA Node

  • The action potential moves from the SA node by pacemaker cells
  • This causes it to spread to surround myocardial cells with gap junctions and intercalated disks
  • Also through the conduction system
  • Transport through the conduction system is faster than through myocardial cells in the atria

Action Potential

  • Begins at -90mV
  • Depolarization moves into cardiac cells through gap junctions
  • K+ channels open and K+ leaves the cell
  • L-type calcium channels open
  • Sodium channels become inactivated; decrease in sodium entry
  • K+ leaving is counterbalanced by Ca2+ entering the cell which creates a plateau

Cardiac Muscle Contraction Control

  • Action potential enters from adjacent cell.
  • Voltage-gated Ca2+ channels open, and Ca2+ enters cell.
  • Ca2+ induces Ca2+ release through ryanodine receptor-channels (RyR).
  • Local release causes Ca2+ spark, then the summed signal is released.
  • Relaxation occurs when Ca2+ unbinds from troponin, and Ca2+ is pumped back into the sarcoplasmic reticulum for storage, Ca2+ is exchanged with Na+ by the NCX antiporter

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