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MD3001 Cardiology > Coronary Circulation and Conduction System > Flashcards

Coronary Circulation and Conduction System Flashcards

1
Q

What supplies the heart?

A

Coronary arteries and their branches:

  • right coronary artery
  • left coronary artery
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2
Q

Where do the coronary arteries come from?

A

The aortic sinuses

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3
Q

When do the coronary arteries fill with blood?

A

During diastole

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4
Q

What are the branches of the right coronary artery?

A
  • SA nodal branch
  • AV nodal branch
  • posterior interventricular branch
  • right acute marginal branch
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5
Q

What are the physiological differences in the left coronary artery to the right?

A

It is shorter but thicker than the right coronary artery

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6
Q

What are the branches of the left coronary artery?

A
  • circumflex artery

- anterior interventricular artery

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7
Q

What does the SA nodal branch supply?

A
  • supplies the SA node

- atrial branches supply the right atrium

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8
Q

What does the anterior interventricular branch supply?

A

Sternocostal surface

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9
Q

What is named the ‘artery of sudden death’?

A

Anterior interventricular artery

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10
Q

What are the branches of the circumflex branch of the left coronary artery?

A

left obtuse marginal branch

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11
Q

Where do the branches of the left and right coronary artery anastomose?

A

Coronary sulcus on the apex of the heart

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12
Q

What does the right coronary artery and its branches supply?

A
  • walls of right atrium and ventricle
  • SA and AV nodes
  • posterior part of IV septum
  • small areas of the walls of left atrium and ventricle
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13
Q

What does the left coronary artery and its branches supply?

A
  • walls of LA and LV

- most of IV septum including part of AV bundle

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14
Q

What determines coronary dominance?

A
  • the artery that gives off the posterior interventricular artery
  • majority of people are right coronary artery dominant
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15
Q

What is the most common cause of MI?

A

Occlusion of the left anterior descending artery

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16
Q

What are the possible solutions for coronary artery occlusion/narrowing?

A
  • coronary artery bypass grafting

- coronary angioplasty (alternative to CABG)

17
Q

How does coronary artery bypass grating work?

A

bypass the occluded portion of the vessel with the:

  • internal thoracic artery/internal mammary artery
  • great saphenous vein (if ITA isn’t possible)
18
Q

How does coronary angioplasty work?

A
  • catheter is passed usually into femoral artery
  • thin wire is guided through vessel to deliver stent/balloon to affected area
  • balloon is inflated to expand stent which implants it and restores circulation
19
Q

What is another name for coronary angioplasty?

A

percutaneous transluminal coronary angioplasty

20
Q

Where do cardiac veins drain to?

A

into right atrium through coronary sinus

21
Q

What are the cardiac veins and where do they drain to?

A
  • great cardiac vein which joins coronary sinus
  • small cardiac vein which accompanies right marginal branch
  • middle cardiac vein drains to coronary sinus
  • anterior cardiac veins which drain independently into the right atrium
22
Q

Where is the coronary sinus found?

A

between left atrium and ventricle

23
Q

Where does the blood that isn’t drained by the coronary sinus drain to?

A

smallest cardiac veins and anterior cardiac veins

24
Q

Explain how the cardiac conduction system operates

A
  • cardiac muscle fibres form the atrial and ventricular networks separated by fibrous skeleton
  • specialised modified cardiac muscle cells beneath the endocardium can generate impulses without external stimuli
  • cardiac muscle cells distribute electrical impulses through myocardium
  • ensures synchronous contraction in proper sequence
  • ANS shortens/prolongs cardiac cycle
25
Q

What are the components of the cardiac conduction system?

A
  • SA node
  • AV node
  • AV bundle of His: left and right bundle branch
  • Purkinje fibres
26
Q

Where is the SA node (Keith-Flack) found?

A
  • anterior to opening of SVC

- upper end of crista terminalis

27
Q

Where is AV node (Aschoff-Tawara) found?

A
  • posterior inferior part of IA septum

- close to opening of coronary sinus

28
Q

What is the purpose the AV node delaying the electrical activity?

A

So ventricles have time to fill with blood

29
Q

Where is the AV bundle found?

A

running along the membranous part of IV septum

30
Q

Explain the pathway of the right branch of AV bundle

A
  • descends right side of membranous part of IV septum
  • enters septomarginal trabecula to reach base of anterior papillary muscle
  • splits into Purkinje fibres which spread into ventricular walls
31
Q

Explain the pathway of the left branch of the AV bundle?

A
  • descend left side of membranous part of IV septum

- splits into Purkinje fibres

32
Q

What supplies the nerves of the heart?

A
  • cardioacceleratory and cardioinhibitory centres in the medullary reticular formation
  • superficial and deep cardiac plexus
33
Q

What do the superficial and deep cardiac plexus supply?

A
  • conduction system
  • coronary blood vessels
  • myocardium
34
Q

Where do the presynaptic sympathetic fibres travel?

A

T1-6 spinal nerves

35
Q

What effect do the presynaptic sympathetic fibres have on the heart?

A
  • increase the heart beat and force of contraction

- dilate coronary arteries

36
Q

What effect do the parasympathetic fibres have on the heart?

A
  • decrease heart beat

- constrict coronary arteries

37
Q

Explain how ischaemia affects the body

A
  • during ischaemia some chemicals are released which activate general visceral afferents
  • they carry sensation into the spinal chord at the same segments as sympathetic nerves coming off T1-5
  • organs don’t feel pain so pain is referred to T1-5 dermatome
  • anterior chest wall and medial aspect of left arm

MD3001 Cardiology (56 decks)

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