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Cardiovascular. Phase 1a Lauren Barker and Chiara Beck. The Peer Teaching Society is not liable for false or misleading information…. Aims. Anatomy Surface Anatomy Heart Borders Physiology Muscle Contraction Filaments Action Potential Cardiac Cycle Nodes Regulation of MAP

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Phase 1a Lauren Barker and Chiara Beck

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Phase 1a lauren barker and chiara beck

Cardiovascular

Phase 1a

Lauren Barker and Chiara Beck

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Aims

  • Anatomy

    • Surface Anatomy

    • Heart Borders

  • Physiology

    • Muscle Contraction

      • Filaments

      • Action Potential

    • Cardiac Cycle

      • Nodes

    • Regulation of MAP

      • Effectors of CO and TPR

      • Baroreceptors and Chemoreceptors

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Aims

  • Anatomy

    • Surface Anatomy

    • Heart Borders

  • Physiology

    • Muscle Contraction

      • Filaments

      • Action Potential

    • Cardiac Cycle

      • Nodes

    • Regulation of MAP

      • Effectors of CO and TPR

      • Baroreceptors and Chemoreceptors

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Surface Anatomy

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Surface Anatomy

Location: L 3rd IC space

Auscultation: Right sternal edge, 2nd IC space

Location: L 3rd CC

Auscultation: L 2nd IC space

Location: L 4th CC

Auscultation: APEX L 5th IC space, mid-clavicular line

Location: R 4th IC space

Auscultation: R 5th IC space

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Borders of the Heart

Superior: R 3rd CC  L 2nd CC

Left: 2nd IC space, 2/3cm from midline  apex

Anterior: sternocostal surface

Right: 3rd 6th CC (2/3cm from midline)

Inferior: Sternal 6th CC  apex

AKA diaphragmatic surface

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Aims

  • Anatomy

    • Surface Anatomy

    • Heart Borders

  • Physiology

    • Muscle Contraction

      • Filaments

      • Action Potential

    • Cardiac Cycle

      • Nodes

    • Regulation of MAP

      • Effectors of CO and TPR

      • Baroreceptors and Chemoreceptors

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Cardiac Contraction

  • Different to normal muscle contraction

    • Extracellular calcium ions

    • Sustains depolarisation of cardiac muscle cells for longer

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Sarcoplasmic Reticulum

The sarcoplasmic reticulum is the membrane network that surrounds the contractile proteins.

Consists of sarcotubular network at the centre and the subsacrolemnal cisternae.

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Contraction

  • Sliding of actin over myosin by ATP hydrolysis through the action of ATP-ase in the head of the myosin molecule.

  • When Ca2+ floods in, it binds to troponin, therefore moving tropomyosin off actin, exposing the binding sites.

  • The head of the myosin molecule forms crossbridges that interact with actin.

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Contraction

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Thick Filaments

  • Myosin:

    • 2 heavy chains – alpha and beta myosin heads

    • 4 light chains

    • Perpendicular at rest

    • Bends towards the sarcomere centre during contraction

    • Hydrolyses ATP, interacts with actin

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Thin Filaments

  • Actin:

    • Globular protein

    • Double stranded helix

    • Both form F actin

    • Activates myosin ATP, interacts with myosin

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Thin Filaments

  • Tropomyosin:

    • Elongated molecule made of 2 helical peptide chains

    • Regulates interaction!!

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Thin Filaments

  • Troponin:

    • TnI: inhibits actin and myosin binding

    • TnC: Ca2+ binding sites

    • TnT: binds troponin to tropomyosin

    • TnC drives away TnI allowing interaction

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Myosin ATP-ase

  • ATP binds to the myosin head inducing a small conformational shift in the actin-binding site which reduces its affinity for actin causing the myosin head to release the actin filament.

  • This causes the myosin head to ‘cock back’ into place. ATP is then hydrolysed leaving ADP and Pi bound to the myosin.

  • Weak interactions with actin cause the myosin to release the Pi which triggers the ‘power stroke’.

  • As myosin attaches, the ADP is released and it binds tightly to the actin.

Rigor Mortis: lack of ATP, therefore the myosin cannot detach from the actin, meaning the muscles stay contracted.

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Action Potential

  • 4resting membrane potential (diastole)

  • 0depolarisation

  • 1transient outward partial repolarisation

  • 2plateau

  • 3repolarisation

Hypocalcaemia?

Reduced refractory period

Tetany: spasms of the hands, feet, larynx, and cramps.

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Aims

  • Anatomy

    • Surface Anatomy

    • Heart Borders

  • Physiology

    • Muscle Contraction

      • Filaments

      • Action Potential

    • Cardiac Cycle

      • Nodes

      • Cycle

    • Regulation of MAP

      • Effectors of CO and TPR

      • Baroreceptors and Chemoreceptors

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Conduction System

  • SA node:

    • Located near the entrance of the SVC

    • “Pacemaker”

  • AV node:

    • Located in the bottom of the right atrium

    • Only electrical connection between the atrium and ventricle

    • Slow propogation

  • Bundle of His

  • Purkinje fibres

    • Distributes the impulses throughout the ventricles

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Cardiac Cycle

  • 3 main events:

  • LV contraction

  • LV relaxation

  • LV filling

  • Preload: load present before LV contraction has started

  • Afterload: load after the ventricle starts to contract

  • Sounds:

  • “Lub” – low pitched, closure of AV valves, marks onset of systole

  • “Dub” – louder, closure of semilunar valves, marks onset of diastole

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Aims

  • Anatomy

    • Surface Anatomy

    • Heart Borders

  • Physiology

    • Muscle Contraction

      • Filaments

      • Action Potential

    • Cardiac Cycle

      • Nodes

    • Regulation of MAP

      • Effectors of CO and TPR

      • Baroreceptors and Chemoreceptors

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Regulation of MAP

Average arterial blood pressure over a total cardiac cycle

The sum of resistances to flow offered by all systemic blood vessels

MAP = CO X TPR

The volume of blood each ventricle pumps

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Effectors of CO

  • Increase in sympathetic innervation to heart  INCREASE in BP

    • vasoconstriction

    • increased myocardial contractility

    • increase plasma adrenaline

  • Affects Heart Rate (HR) and Stroke Volume (SV)

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Effectors of TPR

  • Vasodilators (decrease in TPR):

    • NO

    • CO2

    • decrease in O2

    • Inflammatory mediators

    • ANP (hormonal)

  • Vasoconstrictors (increase in TPR):

    • Sympathetic nerves

    • ADH

    • Angiotensin II

    • Adrenaline

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Arterial Baroreceptors

  • Stretch-sensitive receptors found in wall of carotid sinus and aortic arch

  • Send neurons to medullary cardiovascular centre in brain

  • Key role in short-term regulation eg exercise

  • If becomes long term then adopt a new base line pressure

  • Main control in long-term BP regulation is blood volume.

  • FEEDBACK LOOP

  • Sensitivity is affected by sympathetic stimulation/hypertension

Carotid sinus: glossopharyngeal nerve (CN 9) – more sensitive as going to brain

Aortic arch: vagus nerve (CN 10)

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Arterial Baroreceptors

Stimulus

Decreased sympathetic outflow to kidneys

Increased renal blood flow and urine

Increased sympathetic outflow to SA node

Increased heart rate (HR)

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Physiology – Chemoreceptors

  • Small highly vascular bodies in the aortic arch and medial to carotid sinus.

  • Stimulated by a fall in O2 and pH/increase in CO2

  • Involved in the control of respiration and reflex  vasoconstriction

  • Less important than baroreceptors in the control of circulation

  • CO2 and pH affect peripheral; O2 affects central

    • Increase in CO2  vasoconstriction, increase in PR and BP

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Pathology

  • Atherosclerosis

  • Heart failure

  • Thromboembolism

  • Shock

  • Myocardial infarction

  • Arrhythmias:

    • ECG

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Atherosclerosis

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Atherosclerosis

  • Endothelia injury – increased permeability.

  • LDL forms fatty streaks.

  • Monocytes attracted  macrophages.

  • Take up oxidised LDL to form foam cells.

  • Adhesion of platelets to endothelium.

  • Release cytokines and GF.

  • Migration of smooth muscle cells from media to intima  stabilize growing region.

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Complications

  • Plaque rupture: fibrous plaque ruptures exposing cholesterol etc.

  • Strong clotting reaction in blood.

  • Angina

  • Intermittent claudication

  • MI

  • Stroke

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Heart Failure

  • Definition: heart is unable to pump enough blood to satisfy needs of metabolizing tissues.

  • Breathlessness

  • Tiredness

  • Fatigue

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Heart Failure

  • CAUSES:

    • Myocardial dysfunction

    • Volume overload

    • Obstruction to outflow

    • Compromised ventricular filling

    • Altered rhythm

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Right Heart Failure

  • Symptoms:

    • Swollen ankles

    • Fatigue

    • Anorexia

  • Signs:

    • Raised jugular venous pressure

    • Hepatomegaly

    • Pitting oedema

    • Ascitis

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Left Heart Failure

  • Symptoms:

    • Fatigue

    • Breathlessness

    • Dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea.

  • Signs:

    • Cardiomegaly

    • Added heart sounds

    • Tachycardia

    • Crackles in lung bases

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Congestive Heart Failure

  • Mixture of both left and right.

  • Almost always right secondary to severe left heart failure.

  • Cor Pulmonale?

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Phase 1a lauren barker and chiara beck

Thromboembolism

  • Thrombus: blood clot forming inside vessel wall.

  • Thromboembolism: obstruction of a blood vessel by a dislodged blood clot.

  • Embolus: detached, travelling, intravascular mass:

Examples: cholesterol, fat, air (gas) and tissue

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Thromboembolism

Stasis

Vessel Wall

Blood Constituents

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Thromboembolism

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Shock

  • Definition: failure of cardiovascular system to adequately perfuse tissues.

  • Hypovolaemic shock

  • Distributive shock:

    • Septic

    • Anaphylactic

  • Cardiogenic shock

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Phase 1a lauren barker and chiara beck

Shock

  • Symptoms:

    • Faintness

    • Dizziness

    • Sweating

    • Pallor

    • Reduced level of consciousness

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Phase 1a lauren barker and chiara beck

Shock

  • Signs:

    • Pale, cold, clammy skin

    • Rapid, weak pulse

    • Tachycardia, decreased stroke volume

    • Rapid, shallow breathing

    • Impaired urine output

    • Confusion

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Hypovolaemic Shock

  • Fall in circulating blood volume: blood or fluid.

  • Loss of blood:

    • Trauma

    • Acute GI bleed

    • Haemorrhage

    • Operations

  • Loss of fluid:

    • Severe burns

    • Dehydration

    • Pancreatitis

    • Vomiting

    • Diarrhoea

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Hypovolaemic Shock

  • Class I-III: increasing in severity:

    • Pulse increases

    • Respiratory rate increases

    • Urine output decreases

    • Mental status declines

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Cardiogenic Shock

  • ‘Pump Failure’

  • Interruption of cardiac function.

  • Heart unable to maintain circulation.

    • MI

    • Cardiac tamponade

    • Myocarditis

    • Pulmonary embolism

    • Valve failure – endocarditis

    • Fluid overload – poor left ventricular function

  • Obstructive shock?

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Septic Shock

  • Sepsis: systemic inflammatory response associated with an infection.

  • Septic shock: sepsis complicated by persistent inappropriate hypotension.

  • Unresponsive to fluid resuscitation.

  • Treatment with vasoconstrictors.

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Anaphylactic Shock

  • Hypersensitivity reaction.

  • Massive release of histamine.

  • Peripheral vasodilatation – hypotension.

  • Vascular permeability – loss of plasma.

  • Bronchial muscle contraction – dyspnoea.

  • Oral, laryngeal and pharyngeal oedema.

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Myocardial Infarction

  • Definition: necrosis of heart muscle due to impaired oxygen supply.

  • Usually occlusion of coronary artery by unstable atherosclerotic plaque.

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Myocardial Infarction

  • SYMPTOMS:

    • Chest pain

    • Radiates to neck and arm

    • Shortness of breath

    • Sense of anxiety

    • Profuse sweating

    • Nausea

    • Vomiting

    • Light-headed

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Myocardial Infarction

  • Consequences:

    • Arrhythmia

    • Heart failure

    • Pericarditis

    • Rupture:

      • Muscle

      • Walls

      • Valves

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Coronary Arteries

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Phase 1a lauren barker and chiara beck

Coronary Arteries

Widow Maker?

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Phase 1a lauren barker and chiara beck

ECG

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Arrhythmias

  • Definition: abnormality of cardiac rhythm.

    • Sudden death

    • Syncope

    • Dizziness

    • Palpitations

    • No symptoms

  • Bradycardia: <60bpm

  • Tachycardia: >100bpm

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Atrial Fibrillation

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Heart Block

  • First degree:

    • Delayed AV conduction.

    • Prolonged PR interval: >0.22s

  • Second degree:

    • Some atrial impulses fail to reach ventricles.

    • Some P waves followed by QRS complex.

  • Third degree:

    • Complete heart block.

    • All atrial activity fails to reach ventricles.

    • No association between atrial and ventricular activity.

    • P waves and QRS complex occur independently.

  • Bundle branch block: loss of synchronized ventricles.

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Cardiovascular Therapeutics - Antiplatelets

  • ASPIRIN

  • NSAID

  • Decreased prostaglandin synthesis

  • Decreased platelet aggregation

  • Causes gastric ulceration

  • Causes bleeding

  • Need to know Clopidogrel/prasugrel AND GP IIb/IIIa antagonists

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Cardiovascular Therapeutics - Thrombolytics

  • STREPTOKINASE

  • Plasminogen  plasmin

  • Plasmin destroys clots/thrombus

  • 1% risk of stroke

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Cardiovascular Therapeutics - Anticoagulants

  • WARFARIN

  • Anticoagulant

  • Inhibits vitamin K dependant synthesis of coagulation factors II, XII, IX, X

  • Takes time to work (2-3 days)

  • Bleeding

  • Need to learn LMW heparin/fondaparinux

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Cardiovascular Therapeutics – Hypertension Drugs

  • ACE INHIBITORS

  • - pril

  • Act on the RAA system

  • eg Ramipril

  • ß – BLOCKERS

  • Beta-1 receptors in myocardium

  • Lowers heart rate, CO, LV contractility, oxygen demand = lower BP

  • Beta-2 receptors in smooth muscle, therefore contraindicative in asthmatics

  • Need to know calcium channel blockers, loop/thiazide diuretics, aldosterone antagonists, nitrates, digoxin, angiotensin receptor blockers, etc

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Cardiovascular Therapeutics – Cholesterol Lowering Drugs

  • STATIN

  • Used to prevent hyperlipidaemia

  • Reduces the formation of atherosclerotic plaques

  • - statin

  • eg simvastatin

Drug that can be used for pulmonary hypertension if all else fails?

Viagra – vasodilator, relaxes arterial wall therefore reducing resistance and pressure

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Topics we didn’t cover

  • Blood disorders (RBC + WBC)

  • Haematology (blood groups)

  • Cardiovascular genetics

  • Detailed cardiovascular histology

  • Don’t forget veins!

The Peer Teaching Society is not liable for false or misleading information…


Phase 1a lauren barker and chiara beck

Tips

  • Histology – PDF

  • Revise from lectures!!!

    • Recommended reading?

  • Past papers!!!

  • Formative assessments

  • Arteries and nerves!

    • If all else fails – recurrent laryngeal.

  • Public health, stats, screening!

  • Definitions!!

  • Handwrittentutorials.com

The Peer Teaching Society is not liable for false or misleading information…


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