Imperial College Union



Year 1 CVS Tutorial AnatomyLabel the diagram Name the layers of the pericardium from deep to superficialWhat is the first branch off of the aorta? At what level does the aortic arch start?When does the carotid artery divide?What veins form the superior vena cava? Label the diagram below Where do the coronary arteries arise from?Name the branches of the right coronary artery Name the branches of the left coronary artery What holds the atrioventricular valves? What is the function of this? How do the valves close? Why do they close like this?Mechanical Properties 1 What channels are located in the T-tubules?What channels are located in the sarcoplasmic reticulum?Explain excitation-contraction coupling within the heart Increasing length causes what? Why is this?Compare cardiac and skeletal muscle briefly What is preload?What is preload determined by? How can preload be measured?Increased preload causes what?What is afterload?How can afterload be measured?How does preload affect afterload?List the explanations for Frank-Starling’s Law of the heart How does the Law of Laplace relate to the heart?Mechanical Properties 2List the phases in the cardiac cycle Which phases are part of systole?Which phase are each of these found:P wave QRS complexT wave S1S2 When does isometric contraction occur?What is the pressure in the pulmonary and systemic circuits?Adjust this graph for an increased preloadAdjust the graph for an increased afterload ECG What forms Einthoven’s triangle?What makes up lead 1, lead 2 and lead 3?Give the normal values of:P wave PR interval QRS complex QT interval What rhythm is this?What rhythm is this?What rhythm is this?What rhythm is this?What rhythm is this?End of questionsANSWERSAnatomyLabel the diagram 41397981140501Aortic arch00Aortic arch48335231545220Left pulmonary artery00Left pulmonary artery50076102136060Left pulmonary veins00Left pulmonary veins48568822703388Mitral valve00Mitral valve47761163362670Left ventricle00Left ventricle48569784150014Apex or myocardium00Apex or myocardium4586313721309Inferior vena cava00Inferior vena cava7016993223758Right ventricle00Right ventricle7010402701145Tricuspid valve00Tricuspid valve5742012366645Right atrium00Right atrium545301232447Right pulmonary artery00Right pulmonary artery1104901938245Right pulmonary vein00Right pulmonary vein-69561397510Right brachiocephalic vein00Right brachiocephalic veinName the layers of the pericardium from deep to superficialVisceral serousPericardial cavityParietal serous Fibrous What is the first branch off of the aorta? (Right) brachiocephalic trunk At what level does the aortic arch start?Sternal angle/T4 it also ends here When does the carotid artery divide?C4What veins form the superior vena cava? The azygos, left brachiocephalic and right brachiocephalic Label the diagram below Where do the coronary arteries arise from?The aortic sinus, right coronary artery from the right aortic sinus and left coronary artery form the left aortic sinus Name the branches of the right coronary artery Atrial branch Sinu-atrial nodal branch Right marginal branch Posterior interventricular branch/ posterior descending artery Name the branches of the left coronary artery Anterior interventricular branch/ left anterior descending artery Circumflex Left marginal Diagonal branches What holds the atrioventricular valves? What is the function of this?Chordae tendineae hold the valves to the papillary muscles within the ventricles to stop them from everting into the atrium and causing backward blood flow How do the valves close? Why do they close like this?The semilunar valves have cusps that form sinuses which make up the valve and so they fill with blood after ventricular contraction (rebound blood from the aorta and pulmonary trunk) that forces them closed and stops blood flowing backwards known as regurgitation. The atrioventricular valves close form the pressure of the blood in the ventricles as they contract causing the valve to force shut and this is when the papillary muscles contract to stop the valve eversion into the atria via chordae tendineae. Mechanical Properties 1 What channels are located in the T-tubules?L-type Ca2+ channels or dihydropyridine receptors What channels are located in the sarcoplasmic reticulum?Ryanodine receptors Explain excitation-contraction coupling within the heart Action potential occursDepolarisation of the T-tubule that is carried deep into the cellOpening of voltage-gated LTCC and Ca2+ influx Binding of Ca2+ to the RyR on the sarcoplasmic reticulum(SR) causing opening of the channelRelease of Ca2+ from the SRCa2+ binds to troponin-C to expose the binding heads for contraction using ATP and sarcomere shortens = CONTRACTIONAfter contraction the Ca2+ is pumped by Ca2+ATPase back into the SRCa2+ is exchanged for Na+ by the Na+/Ca2+ exchanged that utilizes the Na+ gradient to force Ca2+ against its concentration gradient Increasing length causes what? Why is this?Increased force of contraction due to Starling’s Law of the heart Compare cardiac and skeletal muscle briefly Cardiac does not overstretch whereas skeletal doesCardiac is more resistant to stretch so there is a greater passive force than skeletalCardiac is more compliant than skeletal What is preload?The weight that is apparent before contraction and causes the muscle to contract which is also the volume of blood in the ventricles at the end of diastole What is preload determined by? The amount of venous return to the heart How can preload be measured?EDV or RA pressure or ED pressure (ED = End-diastolic)Increased preload causes what?Increased force of contraction due to increased length of the muscle fibres before contraction What is afterload?The weight that is apparent only after contraction which is also the resistance on the left ventricle from the aorta that must be overcome to circulate blood around the bodyHow can afterload be measured?Diastolic BP How does preload affect afterload?Increasing preload causes an increase in the strength of contraction due to Starling’s Law of the heart so for a given afterload, more force of contraction can occur than if the preload was lower List the explanations for Frank-Starling’s Law of the heart Increased number of crossbridgesIncreased sensitivity of troponin-C to calcium Change in the lattice spacingHow does the Law of Laplace relate to the heart?Law of Laplace relates Tension=Pressure * radius. So in the heart the radius of RV is larger than LV so for a given tensions the pressure generated by the left will be greater than the right (P=T/r)Mechanical Properties 2List the phases in the cardiac cycle Atrial systole Isovolumetric contractionRapid ejectionReduced ejection Isovolumetric relaxation Rapid passive filling Reduced passive filling Which phases are part of systole?Isovolumetric contractionRapid ejectionReduced ejection Which phase are each of these found:P wave = Atrial systoleQRS complex = Isovolumetric contractionT wave = Rapid and reduced ejection (just before relaxation)S1 = Isovolumetric contraction (AV close)S2 = Isovolumetric relaxation (AV open)When does isometric contraction occur?Isovolumetric contractoinWhat is the pressure in the pulmonary and systemic circuits?25/5mmHg vs 120/80mmHgAdjust this graph for an increased preloadAdjust the graph for an increased afterload ECG What forms Einthoven’s triangle?Left ArmRight ArmLeft Leg (Right leg is a reference)What makes up lead 1, lead 2 and lead 3?Give the normal values of:P wave <0.11s (110ms)PR interval 0.12-0.20s (120ms-200ms)QRS complex <0.12s (120ms)QT interval 0.38-0.42s (380ms-420ms)What rhythm is this?Sinus rhythm (normal)What rhythm is this?Atrial fibrillationWhat rhythm is this?Atrial flutter (sawtooth baseline)What rhythm is this?Ventricular tachycardia (SHOCKABLE)What rhythm is this?Ventricular fibrillation (SHOCKABLE) ................
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