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a&p test 2
heart
90
Anatomy
Undergraduate 2
03/01/2012

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Term
heart location
Definition
1. pledge of allegiance
a. behind sternum
b. in mediastinum (from sternum to vertebral column)
c. offset to your left
d. base formed by atria
2. size of fist
3. on top of diaphragm
4. between lungs (cardiac notch)
Term
Pericardium
Definition
1. membrane that surrounds heart
a.

b. fibrous pericardium and serous pericardium
2. fibrous pericardium
a. outermost layer
b. tough, inelastic, dense irregular connective tissue
c. fused to connective tissue of blood vessels entering heart
3. serous pericardium
a. functions
i.


b.
i. fused to fibrous pericardium
c.
i. also called epicardium
ii. adjacent to heart wall, adheres tightly
d. pericardial fluid between these two layers
i. serous fluid
ii. reduce friction as heart moves
iii. called pericardial cavity
Term
epicardium
Definition
a. outermost layer
b.
c. has smooth texture
Term
myocardium
Definition
a. middle layer
b. 95% of heart
c. involuntary muscle
Term
endocardium
Definition
a. innermost layer
b.

c. smooth heart chamber lining
d. covers heart valves
e.
Term
Chambers
Definition
1. general facts
a. superior chambers are atria
b. lower chambers are ventricles
c. auricle on atria increases holding capacity of atria
d. sulci are grooves that contain blood vessels
Term
right atrium
Definition
a. receives blood from
i. superior vena cava
ii. inferior vena cava
iii.

b. interatrial septum between R and L atria
i.

c. blood flows from right atrium to right ventricle through tricuspid valve
Term
right ventricle
Definition
a. inferior surface has ___________________________, raised bundles of cardiac muscle
b. above also part of electrical conduction system
c.

i. tendon
ii. connects cusp with papillary muscle (trabeculae carneae)
d. right and left ventricles separated by interventricular septum
e. blood goes through pulmonary valve
Term
left atrium
Definition
a. same thickness as right atrium
b. forms most of heart base
c. received blood from lungs via _________________________________
d. blood enters left ventricle via bicuspid (mitral) valve—left atrioventricular valve
Term
left ventricle
Definition
a. has ________________________ walls
b. forms heart apex
c. has trabeculae carneae and chordae tendinae that anchor bicuspid cusps to papillary muscle
d. blood enters
i.
ii. then to coronary arteries to heart wall
iii. some to aortic arch and descending aorta to body
Term
fetal heart
Definition
i. no need for oxygenated blood because oxygen comes from mother
ii. therefore blood bypasses lungs through __________________________________

iii. ductus arteriosus closes shortly after birth, forms ligamentum arteriosum
Term
myocardial thickness and function
Definition
1. ventricles pump blood longer distances, therefore, have use greater pressure
2.

3. left ventricle pumps to body, therefore increased myocardium
4. right ventricle pumps to lungs
Term
fibrous skeleton of heart
Definition
1. figure 20.5
2. four dense connective tissue rings that surround heart valves, fuse with each other, and connecter to interventricular septum
3.
Term
how atrioventricular valves operate
Definition
1. blood flows from chamber with greater pressure to adjacent chamber with less pressure
2.

3. example, blood passing from atria to ventricles
a. ventricles relaxed, therefore less pressure
b. blood flows from atria into ventricles through AV valves
c. as ventricles fill, blood comes up and closes AV valves
d. cusps of AV valves are connected to papillary muscle, therefore will not evert into atria
e. this ensures that blood remains in ventricles
f. this
Term
systemic and pulmonary circulations
Definition
1. two closed circuits of blood flow
2. they are arranged in series
3. figure 20.7
4. systemic circulation
5. pulmonary circulation
6. portal circulation
Term
coronary circulation
Definition
1. myocardium blood supply
2. coronary arteries branch from ascending aorta
3. figure 20.8a—coronary arteries
a. left coronary artery
b. anterior interventricular branch to both Vs
c. circumflex branch to LA and LV
d. right coronary artery to RA
e. posterior interventricular branch to Vs
f. marginal branch to RV
Term
anastomoses
Definition
a. most body parts receive blood from more than one artery and connect
b. collateral circuit is alternate blood route
Term
coronary veins
Definition
a. arteriolescapillariesvenulesveins
b. most deO2 myocardial blood flows into coronary sinus
c. figure 20.8b
d. coronary sinus has no smooth muscle
e. blood empties into RA
f. great cardiac vein from RV, LV, LA
g. middle cardiac vein from LV, RV
h. small cardiac vein from RA and RV
i. anterior cardiac vein RV and opens into RA
Term
cardiac muscle histology
Definition
A. cardiac muscle histology S 39
1. similarities to skeletal muscle
a.
i. has transverse tubule –wider but less numerous
b.
i. hence less stored Ca+2
c. actin and myosin
i. same bands
ii. Z discs
d. mitochondria larger and more numerous
Term
differences from skeletal muscle
Definition
2. differences from skeletal muscle
a. shorter length
b. smaller diameter
c. one nucleus
d. ends connect to neighboring fibers by intercalated discs
i. contain desmosomes—hold fibers together
ii.
Term
autorhythmic fibers- conduction system
Definition
B. autorhythmic fibers—conduction system
1. special cells in heart that are self-excitable
a. in heart transplants, nerves are not reconnected
b. also form conduction system
Term
action potential and contraction of contractile fibers
Definition
1. the action potential is measured as an EKG
a. it travels over the cardiac muscle
b. cardiac muscle contracts
2. has depolarization and repolarization, similar to neuron
3. similar to skeletal muscle
a. Ca+ binds to troponin
b. actin and myosin can slide
c. contraction occurs
Term
ATP production in cardiac muscle
Definition
1. numerous mitochondria undergo cellular respiration
2. oxygen from coronary arteries
3. use fatty acids more than glucose
a. also creatine phosphate
b. increase of creatine kinase indicates a heart attack
Term
atrial systole
Definition
1. atrial depolarization causes atrial systole
2. forces blood through AV valves into ventricles
3. at end of atrial systole,
a. also called
Term
ventricular systole ( 0.3 sec)
Definition
1. ventricular depolarization causes ventricular systole
2. forces blood against AV valves
a. closes them
b.

c. for a brief period


i. cardiac muscle fibers are isometric
Term
continued ventricular contraction now surpasses aortic pressure
Definition
a.

b. left ventricle 120 mmHg and ejects 70 ml into aorta
c. right ventricle 25-30 mmHg and ejects 70 ml into pulmonary trunk
d.
Term
stroke volume
Definition
a.

b. end systolic volume minus end systolic volume
c. SV= EDV-ESV
d.
Term
relaxation period
Definition
1. both atria and ventricles are relaxes for 0.4 sec
2. ventricular diastole
a. ventricular pressure falls
b.

c. SL valve cusps catch blood,
d.
3. —when ventricular blood volume does not change because all 4 valves closed
4. ventricular pressure drops below atrial pressure
a. AV valves open
b. ventricular filling begins
c. another P wave
Term
electrocardiogram
Definition
1. electrodes are placed on person to pick up electrical activity of heart
a. these are recorded as elecrocardiograph
b. they are indicative of heart function
Term
P wave
Definition
a.

b.

c. small upward deflection
Term
QRS wave
Definition
a.

b.

c. large upward deflection
Term
T wave
Definition
a.

b. ventricles relaxing
c. occurs more slowly
Term
PQ interval
Definition
a. time span from beginning of P to beginning of QRS
b. time for electrical activity to spread through atria
c. if longer, may indicate CAD causing scar tissue
Term
ST segment
Definition
a. time span from end of S wave to beginning of T wave
b. when ventricular fibers depolarize
c. above baseline in acute MI
d. below baseline when insufficient oxygen
Term
abnormal ECG readings
Definition
a. larger P waves indicate atrial enlargement
b. larger Q wave indicates MI
c. larger R wave indicates enlarged ventricles
d. flat T wave indicates insufficient oxygen, CAD
Term
amount of blood ejected from ventricles into aorta or pulmonary trunk each minute
Definition
1. =

2. about 5 L, close to total blood volume at rest
3. can increase this with exercise, page 719
4. cardiac reserve difference between maximum cardiac output and cardiac output at rest
Term
regulation of stroke volume
Definition
1. the more blood that returns to the heart, the more it will eject
2. at rest, stroke volume is 50-60% of end diastolic volume
3. factors that regulate stroke volume:
a.

b.
Term
Preload
Definition
a. Frank-Starling law of the heart
i. (greater the EDV the greater the contraction)

ii. there is a limit
b. two factors for EDV
i. duration of ventricular diastole
ii. venous return, volume of blood into RV
c. with increased heart rate
i. diastole is shorter
ii.
d. with slow heart rate
i. diastole is longer
ii.
e. heart tries to maintain same amount of blood in both sides of the heart
Term
contractility
Definition
a. positive inotropic agents
i. promote calcium inflow, strengthen muscle contraction
ii. ANS-E and NE
iii. digitalis
b. negative inotropic agents
i. inhibit ANS
ii. anoxia
iii. increased K+ level
iv. calcium channel blocker
Term
afterload
Definition
a.

b. an increase in afterload decreased stroke volume,
i. more blood remains in ventricle after systole
ii. caused by HBP and atherosclerosis
Term
autonomic regulation
Definition
a. medulla
i. receives input
ii. directs appropriate output via sym or para of ANS
b. proprioceptor input
i. sensory receptors in muscle
ii.

iii. increase heart rate
c. chemoreceptor input
i. in aorta and carotid
ii.

d. baroreceptor input
i.

ii. detect changes in blood pressure
e. how connect with cardiac muscles
i. sympathetic neuron from medulla to spinal cord
ii. from spinal cord,

iii. nerve causes norepinephrine release
iv. NE binds

v. this increases depolarization of SA and AV nodes
vi. this also enhances Ca+2 entry, which increases contractility
vii. parasympathetic uses vagus nerve to AV node, SA node, atrial myocardium—releases ACh
Term
lower heart rate
Definition
a. lower heart rate with
i. hypoxia
ii. acidosis
iii. alkalosis
b. hormones
i. increase heart rate with E, NE, stress, thyroid hormones
c. cations
i. K+
ii. Ca+2
iii. Na+
iv.
Term
transportation
Definition
a. oxygen
b. carbon dioxide
c. glucose
d. waste products
e. hormones
f. ions
Term
regulation
Definition
a. regulate pH with buffers, recall phosphoric acid
b. regulate body temperature through water in plasma
c. dissolved ions influence osmotic pressure (blood pressure)
Term
protection
Definition
a. blood clots to prevent excessive blood loss, this is potentially dangerous in a stroke and heart attack
b. white blood cells initiate immune response
Term
characteristics of blood
Definition
1. more viscous than water
2. 38 degrees C, 100.4 F
3. 7.35 to 7.45 pH
4. color varies, brighter red with more oxygen
5. 8% of body mass, 1.5 gal in male and 1.2 gal in female
6. hormones that regulate blood volume
a. aldosterone
b. antidiuretic
c. atrial natriuretic peptide
d. above regulate urine production
Term
blood components
Definition
-55% blood, 45% formed elements
1. plasma S 7, 38, 39, 40
a. components
i. 91.5% water
ii. 8.5 % solutes, PLASMA PROTEINS within blood only, osmotic pressure
iii. albumins
iv. globulins
v. fibrinogens
vi. antibodies, immunoglobulin’s
Term
hemotocrit
Definition
a. percentage of blood volume occupied by RBC
b. males 40-54% (because testosterone stimulates erythropoietin)
c. females 38-46%
d. anemia is drop in hematocrit
Term
during uterine development
Definition
1. first red blood cells formed day 17 of conception
2. beginnings of a heart beats by day 21 of conception
3. _________________________ is the formation of blood S 12, 13
4. in embryo, in yolk sac
5. in fetus, liver, spleen, thymus, and lymph nodes
6. last 3 months of fetus,
Term
transition from childhood to adult
Definition
1. red bone marrow in medullary cavity becomes inactive
2. replaced by yellow bone marrow (mostly fat)
3. red bone marrow now in spongy bone of pectoral and axial girdles and proximal humerus and femur (when elder falls which bones broken)
4. red bone marrow has pluripotent stem cells
a. cells that can give rise to different cells
b. influenced by hormones
5. continues to develop RBC throughout life
Term
adult
Definition
1. two types of stem cells in red bone marrow
a. ____________________ stem cells
i. give rise to red blood cells, platelets, monocytes, neutrophils, eosinophils, and basophils
ii. these cells become “competent” (mature) in bone
b. _____________________ stem cells
i. give rise to lymphocytes (B cells and T cells)
ii. T cells mature in lymphatic tissue
iii. B cells mature in bone marrow
2. _______________________________
a. released by kidney when RBC count low
3. thrombopoietin
a. produced by liver
b. stimulates platelet production
Term
clinical applications
Definition
1. artificial erythropoietin helpful with end stage kidney disease
2. granulocyte macrophage colony stimulating factor stimulates WBC production in cancer patients undergoing chemotherapy (kill red bone marrow)
3. thrombopoietin for preventing depletion of platelets during chemotherapy
Term
red blood cells - facts
Definition
1. carry pigment hemoglobin
a. carries oxygen
b. causes red color
2. 2 million RBCs die per second
3. therefore, 2 million RBCs must be generated per second
Term
rbc - anatomy
Definition
1. biconcave disc
2. diameter 7-8 micrometer
3. flexible plasma membrane, permits them to squeeze through capillaries
4. contain glycolipids on plasma membrane (use for blood typing)
5. lack nucleus and other organelles
Term
rbc - physiology
Definition
1. RBC does not have a nucleus or mitochondria
a. therefore, does not use oxygen it carries
b. generates ATP anaerobically
2. ______________________ shape permits it to transport more oxygen
3. each RBC has 280 million Hb molecules S 20-24
a. globin—4 polypeptide chains
b. heme,is ring with iron in center
c. iron binds with oxygen
d. each hemoglobin can bind 4 O2
e. capillary diameter allows one RBC to enter
f. this promotes diffusion of O2 from RBC to interstitial fluid
Term
rbc life cycle
Definition
1. RBC cannot generate new organelles
2. therefore, more fragile with age
Term
erythropoiesis
Definition
1. erythroblast in red bone marrow
a. divide and make hemoglobin
b. eject nucleus to become reticulocyte
c. pass from bone marrow into capillaries
d. mature in 1-2 days
Term
feedback system
Definition
b. with hypoxia, stimulate kidneys to release erythropoietin
c. what are different causes of anemia
d. stimulates erythroblasts and reticulocytes in bone marrow
Term
white blood cells - leukocytes
Definition
A. granular leukocytes have granules S 27
1. eosinophil S 30
a. granules stain red-orange
b. nucleus has 2 lobes that are not covered
2. basophil S 31
a. variable size granules, blue-purple
b. nucleus has two lobes that are covered
3. neutrophil S 28
a. smaller granules that are lilac
b. nucleus has two to five lobes
Term
agranular leukocytes
Definition
1. granules not visible
2. lymphocyte S 33, 34
a. nucleus round or slightly dented, dark
b. number of lymphocytes important clinically
c. B and T cells
3. monocyte S 32
a. nucleus kidney or horseshoe shaped
b. in tissues differentiate into macrophages
i. fixed macrophages stay in certain tissues—alveolar, spleen, Kupffer
ii. wondering macrophages roam in tissues and gather at infection sites
Term
major histocompatibility proteins
Definition
a. on white blood cells
b. cell identity markers
c. RBCs have blood group antigens, not MHC antigens
Term
WBC functions
Definition
1. life span
a. mostly a few days, some years (memory cells)
b. leukocytosis—increase in the number of WBCs in response to infection, surgery, strenuous exercise
c. leukopenia—low level of WBC due to chemotherapy, radiation
Term
combat microbes that penetrate the body
Definition
a. enter through cut in skin
b. enter through mucous membranes, respiratory
c. WBC in blood stream
d. attracted to site of infection
i. granular leukocytes and monocytes enter tissues and don’t return
ii. lymphocytes recirculate—bloodinterstitial tissue spaceslymphatic fluidblood
e. 2% of total lymphocytes are in blood, other 98% in lymphatic fluid and organs—skin, lymph nodes
Term
of white blood cells
Definition
3. __________________________ of white blood cells
a. process of WBC leaving bloodstream
b. figure 19.8
c. chemical signal for emigration varies
d. adhesion molecules help WBC stick to endothelium
e. endothelium also has selectins, stick to carbohydrates on neutrophils called integrins
f. neutrophil leaves blood vessel and enters interstitial fluid at injury site
Term
neutrophils and macrophages
Definition
a. ingest bacteria and dead matter
b. __________________________
i. chemicals released by microbes and injured tissue
ii. attract above to injury site
iii. neutrophils respond first to bacteria
iv. neutrophils release lysozme, strong oxidants, defensins
Term
monocytes
Definition
a. take longer than neutrophils to reach infection
b. more numerous than neutrophils
c. differentiate into macrophages, which clean by phagocytosis
Term
basophils
Definition
a. leave capillaries and enter tissues
b. release heparin, histamine, and serotonin—inflammatory agents
Term
mast cells
Definition
a. release inflammatory substances
b. widely dispersed, especially in connective tissue of skin and mucous membranes
Term
eosinophils
Definition
a. leave capillaries and enter tissue fluid
b. release histaminase
c. combact parasitic worms
Term
lymphocytes
Definition
a. mostly in lymphoid tissue and lymph, some in blood
b. B cells destroy bacteria and inactivate their toxins
c. T cells attack viruses, fungi, transplanted cells, cancer cells, responsible for transfusion reactions, allergies, and rejected transplants
d. natural killer cells attack diverse microbes
Term
platelets
Definition
A. from red bone marrow with __________________________
B. megakaryoblast breaks into fragments
C. each fragment is a platelet
D. platelets enter blood
E. help stop blood loss by forming platelet plug
Term
bone marrow transplant
Definition
1. replacement of abnormal red bone marrow with healthy red bone marrow to establish normal blood cell counts
2. destroy defective red bone marrow with chemotherapy and radiation
3. no immune system at this time
4. healthy bone marrow taken from donor iliac crest
5. taken by syringe and injected into recipient as blood transfusion
6. drawback
a. no immune response temporarily
b. transplanted marrow may produce T cells that attack recipients tissues—graft versus host disease
c. if any host T cells survived, it may attack donated cells
Term
cord blood transplant
Definition
1. stem cells taken from umbilical cord
2. advantages
a. easily collected
b. more abundant than stem cells in bone marrow
c. not as likely to cause graft versus host disease
d. less likely to transmit infections
e. stored indefinitely in cord blood banks
Term
vascular spasm
Definition
1. damage artery or arteriole
2. smooth muscle contracts—vascular spasm
3. reduces blood flow, which reduces blood loss
4. other mechanisms initiated
Term
platelet plug formation
Definition
1. platelets contain many substances
a. fibrin stabilizing factor strengthens blood clot
b. clotting factors—Ca+2, ATP
c. platelet derived growth factor—stimulates endothelial cells
Term
platelet adhension
Definition
a. platelets adhere to damaged vessel
b. may adhere to collagen fibers
Term
platelet release reaction
Definition
a. release ADP and thromboxane A2 activate neighboring platelets
b. serotonin and thromboxane A2 are vasoconstrictors
Term
blood clotting
Definition
1. when blood clots, there are two components
a. serum is the liquid portion minus the clotting proteins
b. gel is the fibrin, a protein
Term
coagulation is process of gel formation
Definition
a. formation of prothrombinase by extrinsic or intrinsic pathway
b. prothrombinase converts prothrombin to thrombin
c. thrombin converts fibrinogen to fibrin—forms clot
Term
extrinsic pathway
Definition
3. extrinsic pathway
a. tissue factor (thromboplastin) leaks into blood from OUTSIDE blood vessels
b. starts formation of prothombinase
c. TF ultimately activates clotting factor X
d. X +V + Ca+2 form active prothrombinase
Term
intrinsic pathway
Definition
4. intrinsic pathway
a. activators are WITHIN blood, slower process
b. endothelial cells damaged
c. platelets damaged, which release phospholipids
d. contact collagen fibers, which activates clotting factor XII
e. lead to X activation
f. X + V form prothrombinase
Term
common pathway
Definition
2. second and third steps same as above
3. thrombin also activates factor XIII—fibrin stabilizing factor
4. thrombin has two positive feedbacks
a. factor V accelerates prothrombinase formation
b. prothrombinase accelerates thrombin production
c. thrombin activates platelets
Term
clot retraction
Definition
1. tightening of fibrin clot
2. as clot retracts, edges pull edges closer
3. sometimes serum escapes between fibrin threads
4. repair of vessel/tissue occurs
5. clot removal
Term
vitamin k in clotting
Definition
1. required for synthesis of 4 clotting factors
2. fat soluble vitamin in large intestine
3. absorbed into intestinal lining
Term
hemostatic control mechanism
Definition
1. appropriate and inappropriate clots
2. fibrinolytic system dissolves small inappropriate clots and when damage repaired
a. inactive plasminogen in clot
b. activated by XII and tPA (recall strokes)
c. form plasmin, which dissolves clot and inactivate fibrinogen, prothrombin
3. clot formation localized
4. endothelial cells form prostacyclin
a. inhibits platelet adhesion and release
b. counters thromboxane A2
Term
intravascular clotting
Definition
1. recall what occurs with atherosclerosis
2. TIA - stroke
3. CAD - coronary artery disease
Term
ABO blood group
Definition
1. antigen
a. self antigen is what you are born with
b. non-self or foreign antigen causes the formation of an antibody
2. figure 19.12
3. blood donor
a. plasma
b. blood time frame
c. hematocrit
d. bank own blood prior to surgery
Term
transfusions
Definition
1. conditions
a. anemia—adequate oxygen
b. improve immunity
c. hemorrhage—replace blood volume
2. agglutination—clumping of incompatible antigen and antibodies
a. this is not blood clotting
b. rbc become crosslinked
c. causes hemolysis of rbc
d. Hb in plasma
e. also blocks blood flow in vessel
3. universal donor type O
4. universal recipient type AB
Term
Rh blood group
Definition
1. antigen on rbc, found on Rhesus monkey
2. Rh+ has antigen on rbc
3. Rh- has no antigen on rbc and no antibody
4. hemolytic disease of newborn
Term
blood typing
Definition
1. test blood with antisera, contains antibodies
2. figure 19.14
3. cross-match is when donor and recipient blood are mixed to test compatibility
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