Download Intro to Cardiology

Therapeutic Discussion
Introduction to Cardiac Anatomy, Physiology, and Terminology
Readings
- None assigned
Be prepared to discuss the following:
1. Familiarize yourself with the anatomy of the heart, the names of its structures, and at a minimum, be
able to identify and name the chambers of the heart, the valves, major arteries and veins.
a. Chambers  RA, RV (thin-walled), LA, LV (thick-walled)
b. Valves  tricuspid (RA/RV); pulmonary (RV/lungs);mitral (LA/LV; only 2 leaflets); aortic valve
(LV/aorta)
- Tricuspid: chordae attached to papillary muscles in ventricles
c. Arteries pulmonary; aorta; carotid (head); subclavian (arms – branches of subclavian
supply to shoulder, neck, head)
d. Veins pulmonary; superior/inferior vena cava; saphenous (legs/feet); jugular (head)
2. Describe the direction and path of blood flow through the heart, lungs and systemic circulation. You
should be able to describe the path of a blood cell in any part of the body (e.g where does the blood
flow from and to in the capillaries of the foot?)
a. Deoxygenated blood goes into RA  RV  lungs through pulmonary vein
b. Oxygenated blood goes from lungs  LA through pulmonary artery  LV  aorta  arteries
 arterioles  capillaries
3. Identify the phases of the cardiac cycle and what is occurring.
Updated February 2013
Erica Wang, PharmD
a. 1st diastole phase – atria and ventricles relaxed and AV valves open (ventricular passive
filling ~80% of volume); deoxygenated blood from vena cavae flows into RA; open AV valves
allow blood to pass through to ventricles; SA node contracts triggering the atria to contract
(additional 10-20% filling of ventricles); RA empties its contents into RV
b. 1st systole phase – RV receives impulses from Purkinje fibers and contracts; AV valves close
and semilunar valves (pulmonary, aorta) open; deoxygenated blood is pumped into the
pulmonary artery
c. 2nd diastole phase – semilunar valves close and AV valves open; blood from pulmonary veins
fills LA (while RA being filled by vena cavae); SA node contracts again triggering the atria to
contract; LA empties its contents into LV
d. 2nd systole phase – AV valves close and semilunar valves open; LV receives impulses from
Purkinje fibers and contracts; oxygenated blood pumped into aorta
e. Isovolumic ventricular contraction – AV valves and semilunar valves closed; ventricular
myocytes begin to contract
>> heart gets fed during diastole
4. Name the heart sounds and their clinical relevance.
a. Normal = 2 sounds that are lub (S1) and dub (S2) produced by closing of AV valves and
semilunar valves, respectively
b. Systolic murmurs occur between the first heart sound (S1) and the second heart sound (S2)
c. Diastolic murmurs occur between S2 and S1
d. Gallop rhythms – S3 = lup-dub-ta or slosh-ing-in; lower in pitch  indicates HF or volume
overload; occurs at the beginning of diastole after S2
- S4 = ta-lub-dub or a-stiff-wall; due to blood being forced into a stiff/hypertrophic
ventricle; occurs after atrial contraction at the end of diastole and immediately
before S1  due to HTN
5. Name the main coronary arteries (ie. circulation that supplies blood flow to the heart muscle itself)
and their function.
a. Left main coronary artery divides into the left anterior descending artery & the circumflex
artery  supplies blood to LV and LA
- Circumflex artery encircles the heart muscle and supplies blood to lateral and back
of heart
- LAD artery supplies blood to front of LV and left side of heart  increased sequel
from infarct
b. Right coronary artery divides into the right posterior descending and acute marginal arteries
 supplies blood to RV, RA, and SA and AV nodes
- heart processes 5L of fluid/minute
- heart is strictly aerobic metabolism
6. Describe the effects of the sympathetic and parasympathetic stimulation of the heart and the
neurotransmitters involved.
a. Muscarinic receptors  atria > ventricles; exist on T tubules in cardiomyocytes, coronary
arteries, endothelial cell membranes of capillaries and abundant on SA and AV nodal cells
- Parasympathetic – M2 receptors: slows the heart rate, shortens atrial APs,
increases smooth muscle contraction, and decrease contractility directly
 Cardiac deceleration  Ach released which increases permeability of
cardiac cell membranes to K; leakage of K to outside creates a state of
hyperpolarity in which cells are less easily excited
 Actions from medulla
 No parasympathetic innervation in LV  LV can pump normally or fast only
- Sympathetic – increases heart rate, accelerates spread of excitation and increases
myocardial contractility T1-T4 innervation
 Cardiac acceleration  SNS releases NE which increases permeability of
myocardial cells to Na and Ca; increasing Na permeability lowers threshold
Updated February 2013
Erica Wang, PharmD
potential of SA node cells, causing them to fire more rapidly and in the AV
node makes it easier for each fiber to excite the next, which decreases
conduction time from atria to ventricles; Ca increases contractile strength of
cardiac muscle
7. Identify non-modifiable risk factors for cardiovascular disease.
a. age, gender (male), family history of premature CVD (men <55; women <65)
8. Identify the major conventional modifiable risk factors for cardiovascular disease.
a. Sedentary lifestyle; poor diet; abdominal obesity; smoking; HTN; dyslipidemia; DM; CKD;
stress; non-adherence to medications
9. To the best of your ability, state what the following acronyms and terms stand for:
Angioplasty
Angiogram
"Angio"
PCI
PTCA
Balloon, ballooning
Stent
Drug-eluting stent
Bare Metal Stent
CABG
Cardiac Surgery
SCA +/- PCI
Diagnostic Catheter
Cardiac Catheter
LV gram
"Echo"
PCard = MIBI Scan
Stress test
Stress echo
EKG
Lytic
TNK
MIBI = PCard
MUGA
Surgical repair or unblocking of a blood vessel, specifically a coronary artery; means PCI
X-ray test that uses fluoroscopy to photograph blood flow within an artery or vein
Relating to blood vessels
Percutaneous coronary intervention – treatment procedure that unblocks narrowed
coronary arteries without performing surgery using a balloon
Percutaneous transluminal coronary angioplasty (i.e. balloon angioplasty) – tiny balloon
attached to catheter and inflated and deflated to increase size of opening of artery by
compressing the plaque against vessel wall
i.e. PTCA; balloon is always removed afterwards
Tubes composed of metallic mesh that are nonsurgically placed in a blocked artery to
hold the vessel open; act as a scaffold to prevent angioplasty from closing
Require a longer duration of antiplatelet therapy
Slower endothelialization  higher risk of thrombosis & lower risk of restenosis
Require a shorter duration of antiplatelet therapy
Endothelialized within months  higher risk of restenosis & lower risk of thrombosis
Coronary artery bypass grafting – used for severe CHD; healthy artery/vein from body is
connected/grafted to blocked coronary artery to provide a new path for O2-rich blood to
flow to the heart muscles; usually takes vein
Open-heart surgery  CABG, valve surgeries
Selective coronary angiogram
Introduction of hallow plastic tubes called catheters under local anesthesia into veins +/arteries in the neck, leg, or arm from which they are advanced to the right +/- left sides of
the heart – used to measure the pressure of blood in various chambers and insert dye
= SCA; not loaded with Plavix
i.e. diagnostic catheter
Contrast left ventriculography – provides evaluation of LVEF
Echocardiogram (NOT ECG) – sonogram of the heart; ultrasound to create images
2D visual of valves, tumors, regurgitation, and chamber size and wall thickness; can see
clots and function of heart
PMOD Cardiac Modeling – quantification of dynamic PET studies of heart
Persantine cardiolite used
Exercise used to provide info about how heart responds to exertion – monitor ECG, HR
and BP; dobutamine/adenosine used in those unable to exercise; nuclear stress test is
used to determine which parts of heart are healthy and functioning normal
Visualizes the motion of the heart’s walls and pumping action when heart is stressed
Electrocardiogram – checks problems with the electrical activity of heart
Agent causing breakdown of blood clots
Tenecteplase = thrombolytic drug; tissue plasminogen activator (tPA)
2nd most accurate test (preceded by angiograms); MIBI = radioactive dye (Technetium
sestamibi) that is absorbed by healthy heart muscle cells; done at rest and during
exercise/stress to determine if narrow or blocked arteries exist
Multi Gated Acquisition Scan – to evaluate function of RV and LV; radioactive dye used
Nuclear scan that measures volume differences; versus echo that is visual
representative of volume contracted
Updated February 2013
Erica Wang, PharmD
Rescue PCI
RCA
LAD
LCx
Proximal
Mid
Distal
LIMA/LITA
RIMA/RITA
CAD
IHD
Cardiomyopathy
Cerebrovascular
Disease
Cerebrovascular
Accident
Takotsubo
Cardiomyopathy
Coronary Vasospasm
ACS
Stable angina
Unstable angina
NSTEMI/NSTEACS
STEMI/STEACS
Cardiac arrest
PAD, PVD
Vasculopathy
Aortic, mitral stenosis
Aortic, mitral
regurgitation
Mechanical valve
Bioprosthetic valve
Valvuloplasty
TAVI
Given to those with lack of ST-segment resolution by 50% at 90 min after thrombolytic
therapy or those still symptomatic
Right coronary artery
Left anterior descending artery
Left circumflex artery
Situated nearer to center of body/point of attachment
In the middle position of a range
Situated away from center of body/point of attachment
Left internal thoracic artery – previously referred to as left internal mammary artery; used
in CABG to graft to LAD artery
help with sternal wound healing – not always best to remove
Right internal thoracic artery (right internal mammary artery) – also used in CABG
help with sternal wound healing – not always best to remove
Coronary artery disease = atherosclerotic heart disease = IHD; caused by plaque
formation along inner walls of coronary arteries
Ischemic heart disease
Diseases of the heart muscle; measurable deterioration of the function of myocardium
Ischemic; dilated; hypertrophic; viral
Group of brain dysfunctions related to disease of the blood vessels supplying the brain
(i.e. cerebral thrombosis, cerebral embolism, cerebral hemorrhage)
Rapid loss of brain function due to disturbance in blood supply to brain (i.e. stroke, TIA)
Aka transient apical ballooning syndrome, apical ballooning cardiomyopathy, stressinduced cardiomyopathy = type of ischemic cardiomyopathy in which there’s a sudden
temporary weakening of myocardium  broken heart syndrome; sudden onset of CHF
associated with ECG changes suggestive of anterior wall MI
Overactive sympathetic activation where heart gets tired and stops pumping
Form of MI caused by constricted blood vessels spasm affecting coronary circulation;
causes Prinzmetal’s angina
Acute coronary syndrome – any group of symptoms attributed to obstruction of coronary
arteries; occurs due to STEMI, NSTEMI or unstable angina
Chest pain or discomfort that usually occurs with activity or stress
Angina pectoris caused by disruption of an atherosclerotic plaque with partial thrombosis
Non ST elevation MI/ACS
ST elevation MI/ACS require more aggressive treatment
Cessation of normal circulation of blood due to failure of heart to contract effectively
Peripheral arterial/vascular disease – obstruction of large arteries not within the
coronary, aortic arch vasculature or brain
Disease of blood vessels – diabetes often vasculopathic; CVD, CAD, PVD, carotid artery
stenosis
Aortic stenosis – narrowing of the aortic valve, impeding blood delivery to body
Mitral stenosis – valvular heart disease characterized by narrowing of orifice of mitral
valve
Regurgitation occurring due to valve not closing properly when heart pumps out blood;
abnormal leaking of blood from LV through mitral valve into LA when LV contracts;
leaking of aortic valve that causes blood to flow in the reverse direction during ventricular
diastole, from aorta into LV
Prosthetic valve designed to replicate function of natural valves of heart; require lifelong
treatment with anticoagulants = metal
Tissue heart valves; do not require lifelong anticoagulation due to improved blood flow
dynamics, but only last on average 10 years
Widening of a stenotic valve using a balloon catheter; once valve opened, the balloon is
removed; effect doesn’t last as long
Transcatheter aortic valve implantation – inserting a bioprosthetic valve that is
strengthened with a stainless steel stent into the heart through the femoral artery; the
malfunctioning valve is pushed out of the way and replaced
Updated February 2013
Erica Wang, PharmD