Problem Based Learning II Basic Science Test 1 Part 2

Recall that the physiologic basis for the length-tension relationship is the degree of _______ of thick and thin filaments and the number of possible sites for _____-______ formation. (The intracellular ____ concentration then determines what fraction of these possible cross-bridges will actually form and cycle.) In myocardial cells, maximal tension development occurs at cell lengths of about___ µm, or ____.

overlap, cross bridge, Ca2+, 2.2, Lmax

Pulmonary vein carreis deoxygenated or oxygenated blood?

oxygenated

It is important to note that the source of somatic sensation (____) from the parietal pericardium is carried by _______ ________ fibers in the _______ nerves. For this reason, "pain" related to a pericardial problem may be referred to the _______________ region of the _______ or _______ ____ area dermatomes for spinal cord segments __, __, and __

pain, somatic afferent, phrenic, supraclavicular, shoulder, lateral neck, C3, C4, C5

Rheumatic fever is said to cause ___________ with the following features: Pericardium releases _________ exudate. Myocardial involvement- ___________ - shows scattered _________ ______ witin interstitial connective tissue Valve involvement results in _________ necrosis and _______ deposition along the lines of closure

pancardidits fibrinous myocarditis, Aschoff bodies fibrinous, fibrin`

Necrosis of a _________ ______ following a myocardial infarction (heart attack) may result in prolapse of the related valve.

papillary muscle

There is ________, simultaneous blood flow through each of the circulations (e.g., renal, cerebral, and coronary).

parallel

Thymus: Lymphatic drainage returns to multiple groups of nodes at one or more of the following locations: ▪ along the internal thoracic arteries (____________); ▪ at the tracheal bifurcation (______________); and ▪ in the ____ of the ____.

parasternal tracheobronchial root, neck

Nodes associated with the diaphragm interconnect with ___________, ____________, and _____-__________ nodes, _______________ nodes (________ to the brachiocephalic veins in the superior mediastinum), and lateral aortic/lumbar nodes (in the abdomen).

parasternal, prevertebral, juxta-esophageal, brachiocephalic, anterior

Stimulation of the _______________ division (_____ nerve) slows the heartbeat, whereas stimulation of the ___________ nerve accelerates activity of the pacemaker.

parasympahatic, vagus, sympathetic

Stimulation of the _______________ system: ▪ decreases heart rate, ▪ reduces force of contraction, and ▪ constricts the coronary arteries.

parasympathetic

If conduction velocity through the AV node is slowed sufficiently (e.g., by increased _______________ activity or by damage to the __ node), some action potentials may not be conducted at all from the atria to the ventricles, producing _____ _____

parasympathetic, AV, heart block

Branches from both the ________________ and _____________ systems contribute to the formation of the cardiac plexus. This plexus consists of a ____________ part, inferior to the aortic arch and between it and the pulmonary trunk, and a _____ part, between the aortic arch and the tracheal bifurcation

parasympathetic, sympathetic, superficial, deep

The vagus nerves [X] pass through the superior and posterior divisions of the mediastinum on their way to the abdominal cavity. As they pass through the thorax, they provide ________________ innervation to the thoracic viscera and carry ________ _________ from the thoracic viscera.

parasympathetics, visceral afferents

The pleura is divided into two major types, based on location: ▪ Pleura associated with the walls of a pleural cavity is ________ pleura ▪ Pleura that reflects from the medial wall and onto the surface of the lung is ________ pleura, which adheres to and covers the lung.

parietal visceral

Given the position of the neurovascular bundle and the subcostal groove, complications of an intercostal nerve block may include puncture of the ________ pleura and an ensuing ____________. Bleeding may also occur if the _______ or ____ is damaged during the procedure

parietal, pneumothorax, artery, vein

The ________ region is external to the anterior thoracic wall and anchors the upper limb to the trunk.

pectoral

The breasts, consisting of secretory glands, superficial fascia, and overlying skin, are in the ________ region on each side of the ________ thoracic wall

pectoral, anterior

A mastectomy (surgical removal of the breast) involves excision of the breast tissue to the __________ _____ muscle and fascia.

pectoralis major

Lateral lip of intertubercular sulcus of humerus Insertion of muscle of the pectoral region?

pectoralis major

The __________ ______ adducts, flexes, and medially rotates the arm.

pectoralis major

The subclavius and pectoralis minor muscles underlie the ___________ _____

pectoralis major

The __________ _____ muscle is the largest and most superficial of the pectoral region muscles. It directly underlies the ______ and is separated from it by deep fascia and the loose connective tissue of the ____________ space.

pectoralis major, breast, retromammary

Nerves, vessels, and lymphatics that pass between the pectoral region and the axilla pass through the clavipectoral fascia between the __________ and __________ _____ or pass under the inferior margins of the ___________ _____ and _____.

pectoralis major, minor

Each pectoral region contains the __________ _____, __________ _____, and __________ muscles

pectoralis major, pectoralis minor, subclavius

The __________ ______ passes from the anterior surfaces of ribs III to V to the coracoid process of the scapula.

pectoralis minor

Peripheral edema of dependent portions of the body, especially ankle (_____) and pretibial edema, is a hallmark of right heart failure. In chronically bedridden patients, the edema may be primarily presacral. In particularly severe cases, generalized massive edema (________) may be seen.

pedal, anasarca

in recent years direct removal of the thrombus (____________ _________ _____________ (___)) is given instead of thrombolytic therapy as it appears to give favorable outcomes to thrombolysis and does not increase the risk of bleeding, for example into the brain

percutaneous coronary intervention, PCI

In addition to anterior intercostal arteries and a number of other branches, the internal thoracic arteries give rise to ___________ branches that pass directly forward between the costal cartilages to supply structures external to the thoracic wall. These vessels travel with the _______ _________ branches of the intercostal nerves.

perforating, anterior cutaneous

The narrow space created between the two layers of serous pericardium, containing a small amount of fluid, is the _________ ______

pericardial cavity

the __________________ vessels are also located within and supply the fibrous pericardium as they pass through the thoracic cavity.

pericardiophrenic

The ___________ is a fibroserous sac surrounding the heart and the roots of the great vessels

pericardium

The endothelium of continuous capillaries and postcapillary venules is frequently surrounded by thin cells called __________, whose contractions facilitate blood flow and which can give rise to smooth muscle and connective tissue during microvascular remodeling or repair.

pericytes

Within the CNS ___________ are important for maintaining the endothelial blood-brain barrier.

pericytes

Around the capillary are a basal lamina and thin cytoplasmic extensions from _________. ________ fibers and other extracellular material are present in the perivascular space

pericytes, collagen

The O2 content of pulmonary venous blood can be measured by sampling blood from a __________ ______ (because none of the O2 added to blood in the lungs has been consumed by the tissues yet)

peripheral artery

A _______ ________ occurs when excess fluid accumulates within the pleural space. As the fluid accumulates within the pleural space the underlying lung is compromised and may collapse as the volume of fluid increases.

peural effusion

Neutrophils look for bacteria to engulf by pseudopodia and internalize them in vacuoles called __________

phagosomes

The esophagus is a flexible, muscular tube that can be compressed or narrowed by surrounding structures at four locations: ▪ the junction of the esophagus with the _______ in the neck; ▪ in the superior mediastinum where the esophagus is crossed by the ____ __ ___ ______ ▪ in the posterior mediastinum where the esophagus is compressed by the _____ _____ _________ ▪ in the posterior mediastinum at the esophageal hiatus in the ________.

pharynx arch of the aorta left main bronchus diaphragm

Global coagulation assays such as thrombin generation and thromboelastography, currently used in research, may be more effective in assessing an individual's coagulation _________.

phenotype

When phosphorylated, _____________ stimulates the Ca2+ ATPase, resulting in greater uptake and storage of Ca2+ by the sarcoplasmic reticulum. Increased Ca2+ uptake by the sarcoplasmic reticulum has two effects: It causes ______ relaxation (i.e., briefer contraction), and it _________ the amount of stored Ca2+ for release on subsequent beats.

phospholamban, faster, increases

Spinal cord injuries below the level of the origin of the ______ nerve do not affect movement of the diaphragm.

phrenic

The _______ nerves descend through the thorax to supply motor and sensory innervation to the diaphragm and its associated membranes. As they pass through the thorax, they provide innervation through somatic afferent fibers to the mediastinal pleura, fibrous pericardium, and parietal layer of serous pericardium.

phrenic

The diaphragm is innervated by the _______ nerves (__, __, and __), which penetrate the diaphragm and innervate it from its _________ surface

phrenic, C3, C4, C5, abdominal

The ______ nerves, which innervate the diaphragm and originate from spinal cord levels __ to __, pass through the fibrous pericardium and innervate the fibrous pericardium as they travel from their point of origin to their final destination

phrenic, C3, C5

The diaphragm is innervated by two _______ nerves that originate, one on each side, as branches of the ________ plexus in the ____

phrenic, cervical, neck

The ______ nerves pass vertically through the neck, the superior thoracic aperture, and the mediastinum to supply motor innervation to the entire diaphragm, including the _____ (muscular extensions that attach the diaphragm to the upper lumbar vertebrae)

phrenic, crura

Blood is a specialized connective tissue consisting of cells and fluid extracellular material called ______

plasma

The liquid portion of circulating blood is ______, while the cells and platelets comprise the ______ ________; upon clotting, some proteins are removed from plasma and others are released from platelets, forming a new liquid termed _____.

plasma, formed elements, plasma

After repair of the vessel wall, fibrin clots are removed by proteolysis due primarily to locally generated _______, a nonspecific protease.

plasmin

Plasminogen can be activated to _____ by ___ (_________), ___ or _____________. ___ and ___ are inhibited by plaminogen inhibitor inhibitor type 1 (PAI-1). Plasmin is inhibited by ___________. Plasmin degrades ______ to fibrin degradation products (FDPs)

plasmin, uPA, urokinase, tPA, streptokinase, uPA, tPA, antiplasmin, fibrin

Many patients with evolving acute myocardial infarction are candidates for thrombolytic treatment with a ___________ _________ drug, given intravenously.

plasminogen activator

Excessive tPA activity in plasma is normally prevented by an excess of its major inhibitor, ___________ _________ _________ ____ _ (___-_), which is synthesized by both ___________ cells and ___________

plasminogen activator inbhitor type I, endothelial, hepatocytes

Excessive formation of plasmin is normally prevented by: ▪ binding of 50% of ___________ to histidine-rich glycoprotein (HRG), and ▪ rapid inactivation of free plasmin by its major inhibitor, ______-___________.

plasminogen, alpha2 antiplasmin

Flow cytometry analysis of various ________ receptors can also be performed.

platelet

Several assays assess ________ function

platelet

Vascular injury has a key role in initiating local formation of the ________-______ plug and in its subsequent removal by the ____________ system

platelet fibrin, fibrinolytic

Blood _________ form the initial hemostatic plug in small vessels, and the initial thrombus in arteries and veins

platelets

Vascular injury sets in motion a series of events that culminate in formation of a primary plug of _________. This can be dispersed by blood flowing through the vessel unless the plug is stabilized.

platelets

the major arachidonic acid metabolite formed by __________ is thromboxane A2 (TXA2), which is a potent vasoconstrictor and stimulates platelet aggregation.

platelets

Injury to the blood vessel wall sets in motion complex phenomena which involve blood __________ (activation, adhesion, aggregation) and a cascade of ____________ factors

platelets, coagulation

Platelet receptor GPIb-IX plays a key part in the adhesion of __________ to ______________

platelets, subendothelium

Each pleural cavity is completely lined by a mesothelial membrane called the ______

pleura

A _______ ________ occurs when excess fluid accumulates within the pleural space

pleural effusion

Two _______ cavities, one on either side of the ____________, surround the lungs: ▪ Superiorly, they extend above rib _ into the root of the neck. ▪ Inferiorly, they extend to a level just above the ______ ______. ▪ The medial wall of each pleural cavity is the ___________.

pleural, mediastinum 1 costal margin mediastinum

The symptoms of ____________ are often determined by the degree of air leak and the rate at which the accumulation of gas occurs and the ensuing lung collapses. They include pain, shortness of breath, and cardiorespiratory collapse, if severe.

pneumorax

A ___________ is a collection of gas or air within the pleural cavity.

pneumothorax

A ____________ is a collection of gas or air within the pleural cavity.

pneumothorax

Tetraology of Fallot: patients develop the typical sequelae of cyanotic heart disease, such as ____________ (due to hypoxia) with attendant ______viscosity and _____trophic osteoarthropathy; _____-to-_____ shunting also increases the risk for infective endocarditis and systemic embolization.

polycythemia, hyper, hyper, right, left

Granulocytes also have ___________ nuclei with _ or more distinct (almost separated) lobes and include the ___________, ___________, and _________

polymorphic, 2, neutrophils, basophils, eosinophils

Right-sided heart failure also leads to elevated pressure in the portal vein and its tributaries (______ ____________), with vascular congestion producing a tense, enlarged spleen (__________ ____________).

portal hypertension, congestive splenomegaly

Agents that increase contractility have a _______ _________ effect (uppermost curve). Positive inotropic agents (e.g., _______) produce _________ in stroke volume and cardiac output for a given end-diastolic volume.

positive inotropic, digoxin, increases

Cardiac glycosides are a class of drugs that act as ________ _________ agents. These drugs are derived from extracts of the __________ plant, Digitalis purpurea. The prototype drug is _______; other drugs in this class include _________ and ______.

positive inotropic, foxglove, digoxin, digitoxin, oubain

Stimulation of the sympathetic nervous system and circulating catecholamines have a ________ inotropic effect on the myocardium (i.e., _________ contractility). This positive inotropic effect has three important features: _________ peak tension, _________ rate of tension development, and ______ rate of relaxation. Faster relaxation means that the contraction (_____) is shorter, allowing more time for refilling. This effect, like the sympathetic effect on heart rate, is mediated via activation of _____ receptors, which are coupled via a __ protein to ______ _______. Activation of adenylyl cyclase leads to the production of ____, activation of protein _______, and _______________ of proteins that produce the physiologic effect of _________ contractility

positive, increased, increased, increased, faster, twitch, beta1, Gs, adenyl cyclase, cAMP, kinases, phosphorlyation, increased

Junctions between endothelial cells of _____________ _______ are the loosest of the microvasculature. This facilitates transendothelial migration of ___________ at these locations during inflammation, as well as a characteristic loss of fluid here during the ____________ response, leading to tissue _____.

postcapillary venules, leukocytes, inflammatory, edema

Right ventricle: The __________ papillary muscle may consist of one, two, or three structures, with some chordae tendineae arising directly from the ventricular wall

posteiror

As with the right atrium, the left atrium is derived embryologically from _ structures. ▪ The __________ half, or ______ portion, receives the four pulmonary veins. It has smooth walls and derives from the proximal parts of the pulmonary veins that are incorporated into the left atrium during development. ▪ The ________ half is continuous with the left auricle. It contains musculi pectinati and derives from the embryonic primitive ______. Unlike the ______ __________ in the right atrium, no distinct structure separates the two components of the left atrium.

posteiror, inflow anterior, atrium, crista terminalis

In addition to having numerous branches that supply various components of the wall, the _________ intercostal arteries have branches that accompany lateral cutaneous branches of the intercostal nerves to superficial regions.

posterior

Major structures in the _________ ___________ include the: ▪ esophagus and its associated nerve plexus, ▪ thoracic aorta and its branches, ▪ azygos system of veins, ▪ thoracic duct and associated lymph nodes, ▪ sympathetic trunks, and ▪ thoracic splanchnic nerves.

posterior mediastinum

Superficial, or subpleural, and deep lymphatics of the lung drain into lymph nodes called tracheobronchial nodes around the roots of lobar and main bronchi and along the sides of the trachea. As a group, these lymph nodes extend from within the lung, through the hilum and root, and into the _________ ___________.

posterior mediastinum

The _________ ___________ is posterior to the pericardial sac and diaphragm and anterior to the bodies of the mid and lower thoracic vertebrae: ▪ Its superior boundary is a transverse plane passing from the sternal angle to the intervertebral disc between vertebrae TIV and TV. ▪ Its inferior boundary is the diaphragm. ▪ Laterally, it is bordered by the mediastinal part of parietal pleura on either side. ▪ Superiorly, it is continuous with the superior mediastinum.

posterior mediastinum

Base of heart AKA

posterior surface

Vessels that supply the thoracic wall consist mainly of _________ and ________ ___________ arteries, which pass around the wall between adjacent ribs in intercostal spaces

posterior, anterior, intercostal

In adults, the left brachiocephalic vein crosses the midline immediately _________ to the _________ and delivers blood from the ____ side of the head and neck, the ____ _____ limb, and part of the ____ thoracic wall into the ________ vena cava

posterior, manubrium, left, left upper, left, superior

The remaining nine pairs of posterior intercostal arteries arise from the _________ surface of the ________ _____.

posterior, thoracic aorta

The transversus thoracis muscles originate from the _________ aspect of the _______ _________, the _________ part of the body of the _______, and the adjacent costal cartilages of the lower ____ ribs

posterior, xiphoid process, lower, sternum, true

The base of the heart is quadrilateral and directed ___________. It consists of: ▪ the ____ ______ ▪ a small portion of the _____ ______, and ▪ the proximal parts of the _____ _____

posteriorly left atrium right atrium great veins

The aorta passes ___________ to the diaphragm at vertebral level ___

posteriorly, T12

When the thoracic wall is viewed from a lateral position, the internal intercostal muscle fibers pass obliquely _________________

posteroinferiorly

The metarteriole muscle cells act as ____________ __________ that control blood flow into the capillaries.

precapillary sphincters

Ventricular pressure-volume loops can be used to visualize the effects of changes in _______ (i.e., changes in venous return or end-diastolic volume), changes in __________ (i.e., changes in aortic pressure), or changes in _____________

preload, afterload, contractility

The _______ for the left ventricle is left ventricular end-diastolic volume, or end-diastolic fiber length; that is, preload is the resting length from which the muscle contracts. The relationship between preload and developed tension or pressure, illustrated in the upper (________) curve, is based on the degree of overlap of thick and thin filaments.

preload, systolic

Systemically, diminished cardiac output leads to decreased renal perfusion that in turn triggers the renin-angiotension-aldosterone axis, increasing intravascular volume and pressures. Unfortunately, these compensatory effects exacerbate the pulmonary edema. With further reduction in renal perfusion, ________ ________ may supervene, with impaired excretion of nitrogenous wastes and increasing metabolic derangement. In severe CHF, diminished cerebral perfusion can manifest as _______ ______________ with irritability, diminished cognition, and restlessness that can progress to stupor and coma.

prerenal azotemia, hypoxic encephalopathy

Blood pressures are not equal throughout the cardiovascular system. If they were equal, blood would not flow, since flow requires a driving force (i.e., a ________ __________).

pressure difference

The magnitude of blood flow (Q) is directly proportional to the size of the ________ __________ or pressure gradient. The direction of blood flow is determined by the direction of the pressure gradient and always is from ____ to ____ pressure.

pressure difference, high, low

In ________ ________ states (e.g., hypertension or valvular stenosis), new sarcomeres tend to be added parallel to the long axis of the myocytes, adjacent to existing sarcomeres. The growing muscle fiber diameter thus results in __________ ___________—the ventricular wall thickness increases without an increase in the size of the chamber.

pressure overload, concentric hypertrophy

When blood flow is distributed through a set of parallel resistances, the flow through each organ is a fraction of the total blood flow. The effects of this arrangement are that there is no loss of ________ in the major arteries and that mean pressure in each major artery will be approximately the same as mean pressure in the _____.

pressure, aorta

Because energy is wasted in propelling blood radially and axially, more energy (________) is required to drive turbulent blood flow than laminar blood flow. Turbulent flow is often accompanied by audible vibrations called _______.

pressure, murmurs

Blood flow through a blood vessel or a series of blood vessels is determined by two factors: the ________ difference between the two ends of the vessel (the inlet and the outlet) and the __________ of the vessel to blood flow.

pressure, resistance

The ________ difference is the driving force for blood flow, and the __________ is an impediment to flow.

pressure, resistance

Of the two components of cardiac minute work, in terms of O2 consumption, _______ work is far more costly than ______ work.

pressure, volume

Activation of blood platelets is followed by their adhesion to the vessel wall at the site of injury, and their subsequent aggregation to each other, Vascular injury sets in motion a series of events that culminate in formation of a primary plug of _________. This can be dispersed by blood flowing through the vessel unless the plug is stabilized.building up an occlusive platelet mass that forms the initial (_______) hemostatic plug.

primary

Changes are teh same whether myxomatous degeneration is due to an intrinsic ECM defect (_______) or is caused by regurgitation secondary to another eitological process (like _______ ___________)

primary, ischemic dysfunction

Mitral valve prolapse is a _______ form of _________ __________ ____________, it is one of the most common forms of valvular heart disease in the Western world, yet cause is unknown

primary, myxomatous mitral degeneration

Cardiomyopathies may be _______ or _________ (due to systemic disease)

primary, secondary

During normal cardiac development patency is maintained between right and left atria by a series of ostia (_______ and _________) that eventually become the _______ _____; this arrangement allows oxygenated blood from the maternal circulation to flow from the right to the left atrium, thereby sustaining fetal development. At later stages of intrauterine development, tissue flaps (______ _______ and ______ ________) grow to occlude the foramen ovale, and in 80% of cases, the higher left-sided pressures in the heart that occur at birth permanently fuse the septa against the foramen ovale. In the remaining 20% of cases, a ______ _______ _____ results; although the flap is of adequate size to cover the foramen, the unsealed septa can potentially allow transient right-to-left blood flow. ___________ ________, defined as venous emboli (e.g., from deep leg veins) that enter the systemic arterial circulation, may also occur if right-sided atrial pressures increase, such as with pulmonary hypertension or a ________ maneuver during sneezing or bowel movements.

primum, secundum, foramen ovale, septum primum, septum secundum, patent foramen ovale, Paradoxical embolism, valsavla

Stimulation of platelet agonist receptors results in exposure of platelet ligand receptors, partly through the platelet ___________ (___) pathway. Ligand receptors bind ___ and ___________ in platelet adhesion/aggregation

prostaglandin, COX, vWF, fibrinogen

While there is general agreement that isolated PDAs should be closed as early in life as is feasible, preservation of ductal patency (by administering _____________ _) can be lifesaving when a PDA is the only means to sustain systemic or pulmonary blood flow (e.g., in infants with ______ or _________ _______).

prostaglanding E, systemic, pulmonic atresia

A further cause of increased risk of venous thromboembolism is a mutation in coagulation factor V (factor V Leiden), which confers resistance to its inactivation by activated _______ _

protein C

Prothrombin time assesses the _________ pathway

prothrombin time

the _________ ____ is a prognostic marker of liver failure after acetaminophen (___________) overdose

prothrombin time, paramecetol

The term 'final common pathway' refers to the conversion of ___________ to ______ via Xa, with Va acting as a cofactor

prothrombin, thrombin

The right heart and the pulmonary arteries, capillaries, and veins are collectively called the _________ circulation.

pulmonary

A thin blade-like fold of pleura projects inferiorly from the root of the lung and extends from the hilum to the mediastinum. This structure is the _________ ________ A thin blade-like fold of pleura projects inferiorly from the root of the lung and extends from the hilum to the mediastinum. This structure is the _________ ________

pulmonary ligament

A thin blade-like fold of pleura projects inferiorly from the root of the lung and extends from the hilum to the mediastinum. This structure is the _________ ________.

pulmonary ligament

Tetraology of Fallot: The clinical severity largely depends on the degree of the _________ _______ _____________; even untreated, some patients can survive into adult life.

pulmonary outflow obstruction

After ventricular contraction, the recoil of blood fills the __________ _______ and forces the cusps closed. This prevents blood in the pulmonary trunk from refilling the right ventricle.

pulmonary sinuses

The ___________ _____ is contained within the pericardial sac, is covered by the visceral layer of serous pericardium, and is associated with the ascending aorta in a common sheath.

pulmonary trunk

The right and left pulmonary arteries originate from the __________ _____ and carry deoxygenated blood to the lungs from the right ventricle of the heart

pulmonary trunk

The bronchial veins drain into: ▪ either the __________ _____ or the ____ ______, and ▪ into the _______ vein on the right or into the ________ ___________ vein or ___________ vein on the left.

pulmonary vein, left atrium, azygous, superiorr intercostal, hemiazygous

left atrial pressure can be measured by the ________ _____ ________

pulmonary wedge pressure

At any given moment, most sphincters are at least partially closed and blood enters the capillary bed in a _________ manner for maximally efficient exchange of nutrients, wastes, O2, and CO2 across the ___________. Except in the _________ circulation, blood enters the microvasculature well oxygenated and leaves poorly oxygenated.

pulsatile, endothelium, pulmonary

the difference between systolic pressure and diastolic pressure? If all other factors are equal, the magnitude of the pulse pressure reflects the volume of blood ejected from the left ventricle on a single beat, or the ______ ______

pulse pressure stroke volume

Apoptotic neutrophils, bacteria, semidigested material, and tissue-fluid form a viscous, usually yellow collection of fluid called ___

pus

If a small malignant nodule is found within the lung, it can sometimes be excised and the prognosis is excellent. Unfortunately, many patients present with a tumor mass that has invaded structures in the mediastinum or the pleurae or has metastasized. The tumor may then be inoperable and is treated with _____________ and ____________

radiotherapy, chemotherapy

The relationship between resistance, blood vessel diameter (or ______), and blood viscosity is described by the _________ equation. The total resistance offered by a set of blood vessels also depends on whether the vessels are arranged in ______ (i.e., blood flows sequentially from one vessel to the next) or in ________ (i.e., the total blood flow is distributed simultaneously among parallel vessels).

radius, Poisellue, series, parallel

The relationship between velocity, flow, and cross-sectional area (which depends on vessel ______ or ________) is as follows: v=Q/A where v = Velocity of blood flow (cm/sec) Q = Flow (mL/sec) A = Cross-sectional area (cm2)

radius, diameter

___ _____ _____ or ____________, which make up the hematocrit portion (~45%) of a blood sample, are enucleated, biconcave discs 7.5 µm in diameter, filled with _________ for the uptake, transport, and release of O2, and with a normal life span of about ___ days.

red blood cells, erythrocytes, hemoglobin, 120

Erythrocytes (___ blood cells or ____) are terminally differentiated structures lacking nuclei and completely filled with the O2-carrying protein hemoglobin.

red, RBCs

The so-called formed elements circulating in the plasma are erythrocytes (___ blood cells), leukocytes (_____ blood cells), and platelets.

red, white

Changes in heart rate (and cycle length) change the duration of the action potential and, as a result, change the durations of the ___________ periods and ____________. For example, if heart rate increases (and cycle length _________), there is a _________ in the duration of the action potential.

refractory, excitability, decreases, decrease

Aortic valve disease—both aortic _______ and aortic _____________ (backflow) can produce marked heart failure.

regurgitation, stenosis

With decreasing cardiac output, stimulation of the _____-___________ system and the ___________ nervous system (i.e., ____________ responses) occurs in an attempt to compensate for the loss of function

renin angiotensin, sympathetic, neurohumoral

A layer of loose connective tissue (the ____________ _____) separates the breast from the deep fascia and provides some degree of movement over underlying structures

retromammary space

Dermatomes of T7 to T12 follow the contour of the ____ onto the anterior abdominal wall

ribs

Each main bronchus enters the root of a lung and passes through the hilum into the lung itself. The _____ main bronchus is wider and takes a more vertical course

right

On the ______ side, the lobar bronchus to the superior lobe originates within the root of the lung.

right

The _____ lung has three lobes and two fissures

right

The ______ bundle branch continues on the right side of the interventricular septum toward the apex of the right ventricle

right

The vertically oriented superior vena cava begins posterior to the lower edge of the ____ ___ costal cartilage, where the _____ and ____ _______________ veins join, and terminates at the lower edge of the _____ ___ costal cartilage, where it joins the right atrium

right 1st, right, left braciocephalic, right 3rd

From the right atrium, blood passes into the right ventricle through the _____ ______________ _______

right atrioventricular orifice

Chamber of the heart that receives deoxygenated blood returning from the body

right atrium

Finally, numerous small openings—the openings of the smallest cardiac veins (the foramina of the venae cordis minimae)—are scattered along the walls of the _____ ______

right atrium

In the anatomical position, the right border of the heart is formed by the _____ ______

right atrium

Because the superior and inferior venae cavae are oriented along the same vertical axis, a guidewire, catheter, or line can be passed from the superior vena cava through the _____ ______ and into the inferior vena cava. This is a common route of access for such procedures as: ▪ transjugular liver biopsy, ▪ transjugular intrahepatic portosystemic shunts (____), and ▪ insertion of an inferior vena cava filter to catch emboli dislodged from veins in the lower limb and pelvis (i.e., patients with ____ _____ __________).

right atrium TIPS deep vein thrombosis

The _____ ___________________ vein begins posterior to the medial end of the right clavicle and passes vertically downward, forming the superior vena cava when it is joined by the left brachiocephalic vein. Venous tributaries include the vertebral, first posterior intercostal, and internal thoracic veins. The inferior thyroid and thymic veins may also drain into it.

right brachiocephalic

The right vagus nerve enters the superior mediastinum and lies between the _____ ______________ vein and the _______________ _____

right brachiocephalic, brachiocephalic trunk

At the level of the upper edge of the right sternoclavicular joint, the brachiocephalic trunk divides into: ▪ the _____ _______ _______ artery, and ▪ the _____ __________ artery

right common carotid right subclavian

The _____ _________ artery supplies the right atrium and right ventricle, the sinu-atrial and atrioventricular nodes, the interatrial septum, a portion of the left atrium, the posteroinferior one third of the interventricular septum, and a portion of the posterior part of the left ventricle.

right coronary

Right dominant heart: Occlusion of _____ ________ ______ leads to left ventricular ischemic injury Left dominant heart: Occlusion of ___ ________ ______ leads to left ventricular and septal ischemia

right coronary artery left coronary artery

The _____ _______ nerve enters the superior mediastinum lateral to the right vagus nerve and lateral and slightly posterior to the beginning of the right brachiocephalic vein

right phrenic

The _____ _________ surface of the heart faces the right lung, is broad and convex, and consists of the ____ _______

right pulmonary, right atrium

the upper posterior intercostal veins on the right side may come together and form the ______ ________ ____________ vein, which empties into the _______ vein.

right superior intercostal, azygous

The ____ _____ nerve enters the superior mediastinum and lies between the right brachiocephalic vein and the brachiocephalic trunk.

right vagus

circuit through CV system: 1. Oxygenated blood fills the ____ _________. Blood that has been oxygenated in the lungs returns to the left atrium via the pulmonary vein. This blood then flows from the left atrium to the left ventricle through the ______ ______ (the AV valve of the left heart). 2. Blood is ejected from the left ventricle into the ______. Blood leaves the left ventricle through the ______ _____(the semilunar valve of the left side of the heart), which is located between the left ventricle and the aorta. When the left ventricle contracts, the pressure in the ventricle increases, causing the aortic valve to open and blood to be ejected forcefully into the aorta. (As noted previously, the amount of blood ejected from the left ventricle per unit time is called the _______ ______) Blood then flows through the arterial system, driven by the pressure created by contraction of the left ventricle. 3. Cardiac output is distributed among various ______. The total cardiac output of the left heart is distributed among the organ systems via sets of parallel arteries. Thus, simultaneously, 15% of the cardiac output is delivered to the brain via the cerebral arteries, 5% is delivered to the heart via the coronary arteries, 25% is delivered to the kidneys via the renal arteries, and so forth. Given this ________ arrangement of the organ systems, it follows that the total systemic blood flow must equal the cardiac output. The percentage distribution of cardiac output among the various organ systems is not fixed, however. For example, during strenuous exercise, the percentage of the cardiac output going to skeletal muscle increases, compared with the percentage at rest. There are three major mechanisms for achieving such a change in blood flow to an organ system. In the first mechanism, the cardiac output remains constant, but the blood flow is redistributed among the organ systems by the selective alteration of arteriolar resistance. In this scenario, blood flow to one organ can be increased at the expense of blood flow to other organs. In the second mechanism, the cardiac output increases or decreases, but the percentage distribution of blood flow among the organ systems is kept constant. Finally, in a third mechanism, a combination of the first two mechanisms occurs in which both cardiac output and the percentage distribution of blood flow are altered. This third mechanism is used, for example, in the response to strenuous exercise: Blood flow to skeletal muscle increases to meet the increased metabolic demand by a combination of increased cardiac output and increased percentage distribution to skeletal muscle. 4. Blood flow from the organs is collected in the _____. The blood leaving the organs is venous blood and contains waste products from metabolism, such as carbon dioxide (CO2). This mixed venous blood is collected in veins of increasing size and finally in the largest vein, the vena cava. The ____ ____ carries blood to the right heart. 5. Venous return to the _____ ______. Because the pressure in the vena cava is higher than in the right atrium, the right atrium fills with blood, the venous return. In the steady state, venous return to the right atrium equals cardiac output from the left ventricle. 6. Mixed venous blood fills the _____ _________. Mixed venous blood flows from the right atrium to the right ventricle through the AV valve in the right heart, the _________ _____. 7. Blood is ejected from the _____ _________ into the __________ ______. When the right ventricle contracts, blood is ejected through the pulmonic valve (the semilunar valve of the right side of the heart) into the pulmonary artery, which carries blood to the lungs. Note that the cardiac output ejected from the right ventricle is identical to the cardiac output that was ejected from the left ventricle. In the capillary beds of the lungs, oxygen (O2) is added to the blood from alveolar gas, and CO2 is removed from the blood and added to the alveolar gas. Thus, the blood leaving the lungs has more O2 and less CO2 than the blood that entered the lungs. 8. Blood flow from the lungs is returned to the heart via the __________ ____. Oxygenated blood is returned to the left atrium via the pulmonary vein to begin a new cycle.

right ventricle, mitral valve aorta, aortic valve, cardiac output organs, parallel veins, vena cava right atrium right ventricle, tricuspid valve right ventricle, pulmonary artery pulmonary vein

Left ventricular heart failure often is followed by failure of the _____ __________. In adults, left ventricular involvement is almost always present even if the clinical manifestations are primarily those of _____ ___________ dysfunction (fluid retention without dyspnea or rales).

right ventricle, right ventricular

The _____ dome of the diaphragm is higher, and reaches up ot the level of rib _

right, V

The outcomes of _____ ventricular failure are systemic venous congestion and peripheral edema. Failure of the right side of the heart alone is uncommon. The most common cause of pure right-sided heart failure is _________

right, emphysema

Cardiac malformations associated with _____-to-____ shunts are distinguished by early cyanosis.

right, left

The _____ and ____ heart margins are the same as the right and left pulmonary surfaces of the heart

right, left

Therefore, inhaled foreign bodies tend to lodge more frequently on the _____ side than on the ____.

right, left

The _____ pulmonary artery is longer than the ____ and passes horizontally across the mediastinum (Fig. 3.45). It passes: ▪ anteriorly and slightly inferiorly to the tracheal bifurcation and anteriorly to the _____ ____ ________, and ▪ posteriorly to the _________ _____, ________ ____ ____, and _____ _____ _________ ____.

right, left right main bronchus aortic arch, superior vena cava, upper right pulmonary vein

Efferent vessels from these nodes pass superiorly along the trachea to unite with similar vessels from parasternal nodes and brachiocephalic nodes, which are anterior to brachiocephalic veins in the superior mediastinum, to form the _____ and ____ ___________________ trunks.

right, left bronchomediastinal

The preganglionic parasympathetic fibers reach the heart as cardiac branches from the _____ and ____ ______ nerves. They enter the _______ ________ and synapse in ganglia located either within the _______ or in the walls of the _____

right, left vagus, cardiac plexus, plexus, atria

With _____-to-______ shunt, a dusky blueness of the skin (________) results because the pulmonary circulation is bypassed and poorly oxygenated blood enters the systemic circulation

right, left, cyanosis

The _____ lung is normally a little larger than the ____ lung because the ______ ___________, containing the _____, bulges more to the ____ than to the _____

right, left, middle mediastinum, heart ,left, right

Between the semilunar cusps and the wall of the ascending aorta are pocket-like sinuses—the _____, ____, and __________ ______ _______

right, left, posterior aortic sinuses

Endocarditis: Vegetations may be single or multiple and may involve more than one valve; they can sometimes erode into the underlying myocardium to produce an abcess cavity What is this called?

ring abcess

During expiration, the inferior margin of the lung _____ and the costodiaphragmatic recess becomes ______

rises, larger

In small vessels red blood cells also often stack up in loose aggregates called ________. The standard size of RBCs allows one to estimate that the vessel seen is approximately 15 mm in diameter

roleaux

The ____ of each lung is a short tubular collection of structures that together attach the lung to structures in the mediastinum

root

short tubular collection of structures that together attach the lung to structures in the mediastinum

root

Within each ____ and located in the _____ are: ▪ _ pulmonary artery, ▪ _ pulmonary vein, ▪ _ main bronchus, ▪ bronchial vessels, ▪ nerves, and ▪ lymphatics

root, hilum, 1, 2, 1

In the region of vertebrae TV to TVII, the mediastinal pleura reflects off the mediastinum as a tubular, sleeve-like covering for structures (i.e., airway, vessels, nerves, lymphatics) that pass between the lung and mediastinum. This sleeve-like covering, and the structures it contains, forms the ____ of the ____.

root, lung

As in skeletal muscle, the cardiac muscle cell is composed of __________

sarcomeres

Myocardial structural changes, including augmented muscle mass. Cardiac myocytes cannot proliferate, yet can adapt to increased workloads by assembling increased numbers of __________, a change that is accompanied by myocyte enlargement (___________)

sarcomeres, hypertorphy

The superior surface of the 1st rib is characterized by a distinct tubercle, the _______ _________, which separates two smooth grooves that cross the rib approximately midway along the shaft.

scalene tubercle

uPA circulates in plasma both as an active single-chain precursor form (_____, ___-____________) and as a more active two-chain form (_____, _________).

scuPA, pro urokinase, tcuPA, urokinase

The joint between the ______ costal cartilage and the sternum is divided into two compartments by an intraarticular ligament.

second

Body of sternum: Superiorly, each lateral margin has a demifacet for articulation with the inferior aspect of the ______ costal cartilage. Inferior to this demifacet are four facets for articulation with the costal cartilages of ribs _ to _.

second, 3, 6

The ______ to ________ joints are synovial and have thin capsules reinforced by surrounding sternocostal ligaments

second, seventh

Subcostales extend from the internal surfaces of one rib to the internal surface of the ______ (next) or _____ rib below. Their fibers parallel the course of the ________ intercostal

second, third, internal

Lobar bronchi AKA

secondary bronchi

The lobar bronchi further divide into __________ bronchi (tertiary bronchi), which supply bronchopulmonary segmenta

segmental

Right ventricle: The ______ papillary muscle is the most inconsistent papillary muscle, being either small or absent, with chordae tendineae emerging directly from the septal wall.

septal

A single specialized trabeculum, the ______________ _________, forms a bridge between the lower portion of the interventricular septum and the base of the anterior papillary muscle. Where is this seen?

septomarginal trabecula Right ventricle

`The total resistance of the system arranged in series is equal to the sum of the individual resistances, as shown in the following equation Which tyep of resistance?

series

The vasoconstriction that occurs after vascular injury is partly mediated by two platelet activation products: _________ (_-__), and ___________ __ (____), a product of platelet ___________ metabolism.

serotonin, 5-HT, thromboxane A2, TXA2, prostaglandin

Posterior portion of pericardial sac shows reflections of ______ pericardium.

serous

Closely applied to the medial axillary wall is the long thoracic nerve. Damage to this nerve can result in paralysis of the _________ ________ muscle, producing a characteristic "______" _______. It is also possible to damage the nerve to the __________ _____ muscle, and this may affect __________, ______ ________, and _________ of the humerus.

serratus anterior, winged scapula, latissimus dorsi, adduction, medial rotation, extension

The sternocostal joints are joints between the upper _____ costal cartilages and the sternum

seven

Although all ribs articulate with the vertebral column, only the costal cartilages of the upper _____ ribs, known as ____ ribs, articulate directly with the sternum. The remaining five pairs of ribs are _____ ribs

seven, true, false

On each side of the xiphoid processes' upper lateral margin is a demifacet for articulation with the inferior end of the _______ costal cartilage

seventh

At the inferior end of the body of the sternum is a demifacet for articulation with the upper demifacet on the _______ costal cartilage. The inferior end of the body of the sternum is attached to the _______ _______

seventh, xiphoid process

In acute coronary syndromes, including myocardial infarction, the patient typically experiences ______ _____ _____

severe chest pain

of all myocardial cells, the SA nodal cells have the _______ action potential duration (i.e., the _______ refractory periods).

shortest, shortest

The epicardium is a ______ _______ ___________ supported by a layer of _____ ________ tissue containing blood vessels and nerves. The epicardium corresponds to the ________ layer of the ___________, the membrane surrounding the heart. Where the large vessels enter and leave the heart, the epicardium is reflected back as the ________ layer lining the ___________.

simple squamous mesothelium, loose connective, visceral, pericardium, parietal, pericardium

In cardiac muscle, electrical activation is the cardiac action potential, which normally originates in the __________ ____

sinoatrial node

The cardiac action potential is initiated in the __________ ____ and spreads throughout the ___________

sinoatrial node, myocardium

Impulses begin at the ____-_______ ____, the cardiac pacemaker.

sinu atrial node

___________ capillaries or __________ generally have much greater diameters than most capillaries and are specialized not only for maximal molecular exchange between blood and surrounding tissue but also for easy movement of _______ cells across the endothelium. The sinusoid shown here is in bone marrow and is surrounded by tissue containing ______________ and masses of _______________ cells. The endothelial cells are very ____ and cell nuclei are more difficult to find than in smaller capillaries. Ultrastructurally sinusoidal capillaries are seen to have large ______________ through the cells and large discontinuities between the cells and through the basal lamina.

sinusoidal, sinusoids, blood, adipocytes, hematopoietic, fenestrations

Unlike other capillaries ___________ also have highly discontinuous basement membranes and much larger diameters, often 30-40 µm, which slows blood flow.

sinusoids

Unlike myocardial infarction, however, the pain from pericarditis may be relieved by _______ ________. An ___ is used to help differentiate between the two conditions.

sitting forward, ECG

left to right inversion of the bodys organs AKA

situs inversus

Anterior intercostal arteries that supply the upper ___ intercostal spaces arise as ________ branches from the ________ _________ artery, whereas those supplying the lower spaces arise from the ______________ artery.

six, lateral, internal thoracic, musculophrenic

Thoracic wall consists of both ________ elemens and _______

skeletal, muscles

Cardiac muscle: As in skeletal muscle, contraction occurs according to the _______ ________ model, which states that when cross-bridges form between myosin and actin and then break, the thick and thin filaments move past each other.

sliding filament

Most veins are classified as _____ or _______ veins, with diameters of 10 mm or less

small, medium

The anterior intercostal arteries are generally ________ than the posterior vessels

smaller

The tunica _____, the middle layer, consists chiefly of concentric layers of helically arranged ________ ______ cells

smooth muscle

The parietal pleural is innervated by _______ ________ fibers

somatic afferent

Lymphocytes are agranulocytes and lack the ________ ________ characteristic of granulocytes. Lymphocytes circulating in blood generally range in size from 6 to 15 µm in diameter and are sometimes classified arbitrarily as small, medium, and large.

specific granules

A TEM of a sectioned human neutrophil reveals the _ types of cytoplasmic granules: the small, pale, more variably stained ________ granules and the larger, electron-dense ____________ granules. _________ granules undergo exocytosis during and after diapedesis, releasing many factors with various activities, including enzymes to digest ECM components and bactericidal factors. ____________ granules are modified lysosomes with components to kill engulfed bacteria. The nucleus is _________ and the central Golgi apparatus is _____. Rough ER and mitochondria are not abundant, because this cell utilizes __________ and is in the ________ stage of its differentiation.

specific, azurophillic Specific, Azurophillic, multilobed, small, glycolysis, terminal

Agranulocytes lack ________ granules, but do contain some ____________ granules (_________).

specific, azurophillic, lysosomes

Several peripheral proteins are associated with the inner surface of the RBC membrane, including ________, dimers of which form a lattice bound to underlying actin filaments, and _______, which anchors the spectrin lattice to the glycophorins and band 3 proteins.

spectrin, ankryin

It is important to stage lung cancer because the treatment depends on its _____.

stage

Mitral valve disease is usually a mixed pattern of stenosis and incompetence, one of which usually predominates. Both stenosis and incompetence lead to a poorly functioning valve and subsequent heart changes, which include: ▪ left ventricular hypertrophy (this is appreciably less marked in patients with mitral ________); ▪ _________ pulmonary venous pressure; ▪ _________ edema; and ▪ enlargement (dilation) and hypertrophy of the____ _______

stenosis increased pulmonary left atrium

Mitral valve disease is usually a mixed pattern of ________ and _____________, one of which usually predominates.

stenosis, incompetence

T4/T5 IV disc passes through the _______ _____ anteriorly, marking the position of the anterior articulation of the costal cartilage of rib _ with the _______. The sternal angle is used to find the position of rib _ as a reference for counting ribs (because of the overlying ________, rib _ is not palpable)

sternal angle, 2, sternum, 2, clavicle, 1

The trachea divides into the right and left main bronchi at, or just inferior to, the transverse plane between the _______ _____ and vertebral level __/__, whereas the esophagus continues into the posterior mediastinum.

sternal angle, T4 T5

Branches of the internal thoracic arteries and veins perforate the anterior chest wall on each side of teh _______ to supply the anterior aspects of the thoracic wall. Those branches associated mainly with the ___ through ___ intercostal spaces also supply the ____________ aspect of each breast

sternum, 2nd, 4th, anteromedial

Mediastinum is a thick midline partition that extends from teh _______ anteriorly to the _______ _________, and the _________ _______ ________ superiorly to the ________ _________ _______ inferiorly

sternum, thoracic vertebrae, superior thoracic aperture, inferior thoracic aperture

Diagnosis of acute rheumatic fever: evidence of previous _____________ infection along with _ or more of the _____ criteria

streptococcal, 2, Jones

blood volume under high pressure

stressed volume

The volume of blood contained in the arteries is called the ________ ______ (meaning the blood volume under ____ pressure)

stressed volume, high

Elastic arteries: During ventricular contraction (systole) blood is moved through the arteries forcefully and the elastin is _________, distending the wall within the limit set by the wall's collagen. When the ventricles relax (diastole) ventricular pressure _____ to a ___ level, but the elastin rebounds passively, helping to maintain arterial pressure.

stretched, drops, low

The width of the pressure-volume loop is the volume of blood ejected, or the _____ ______

stroke volume

Pulse pressure will change if ______ ______ changes, or if the __________ of the arteries changes.

stroke volume, compliance

How stroke volume is produced by the intact circulations of preload, contractility, and afterload. Cardiac output is established by combining _____ ______ with _____ ____. When this is merged with peripheral vascular resistance, the ________ pressure for tissue perfusion is established. The arterial system's characteristics contribute to _________. An ________ in afterload lessens stroke volume. When carotid and aortic arch ______________ interact with these components, a feedback mechanism is provided to the ______ ___________ and _________ cardiac centers as well as to higher levels in the central nervous system. This results in a modulation influence on heart rate, peripheral vascular resistance, venous return and contractility.

stroke volume, heart rate, arterial, afterload, increase, baroreceptors, higher medullary, vasomotor

In terms of myocardial function, "work" is ______ ____ or the work the heart performs on each beat.

stroke work

When reperfused, myocardium remains unable to work properly due to biochemical changes for several days What condition?

stunned myocardium

Axillary nodes drain into __________ trunks

subclavian

Each internal thoracic artery arises as a major branch of the __________ artery in the neck

subclavian

The costocervical trunk is a posterior branch of the __________ artery

subclavian

The left __________ artery and vein arch over and are related to the superior lobe of the left lung as they pass over the dome of the cervical pleura and into the axilla.

subclavian

The right ___________ artery and vein arch over and are related to the superior lobe of the right lung as they pass over the dome of the cervical pleura and into the axilla.

subclavian

The __________ is small and passes laterally from the anterior and medial part of rib I to the inferior surface of the clavicle.

subclavius

A continuous layer of deep fascia, the clavipectoral fascia, encloses the __________ and __________ _____ and attaches to the clavicle above and to the floor of the axilla below.

subclavius, pectoralis minor

Both the ___________ and __________ _____ pull the tip of the shoulder inferiorly

subclavius, pectoralis minor

The ___________ and ____________ _____ muscles underlie the pectoralis major

subclavius, pectoralis minor

The anterior ramus of spinal nerve T12 (the _________ nerve) is inferior to rib __

subcostal, 12

The ___________ are in the same plane as the innermost intercostals, span multiple ribs, and are more numerous in lower regions of the posterior thoracic wall

subcostales

The ____ bundle branch passes to the left side of the muscular interventricular septum and descends to the apex of the left ventricle. Along its course it gives off branches that eventually become continuous with the ______________ ______ of __________ _____

subendocardial plexus of conduction cells

The space posterior to the crista is the ______ __ _____ _____ and is derived embryologically from the _____ ____ of the _____ _______

sulcus of vena cavae, right horn, sinus venosus

On each side a ________ _________ ____ and an ________ _________ ____ carry oxygenated blood from the lungs back to the heart

supeiror pulmonayr vein, inferior pulmonary vein

In addition to these major branches, small collateral branches can be found in the intercostal space running along the ________ border of the _____ rib.

supeiror, lower

The right pulmonary artery enters the root of the lung and gives off a large branch to the ________ lobe of the lung. The main vessel continues through the hilum of the lung, gives off a second (_______) branch to the ________ lobe, and then divides to supply the ______ and _______ lobes.

supeirro, recurrent, superior, middle, inferior

The pectoral region is external to the anterior thoracic wall and anchors the upper limb to the trunk. It consists of: ▪ a ___________ compartment containing skin, superficial fascia, and breasts; and ▪ a ____ compartment containing muscles and associated structures.

superficial, deep

the tissue that gives rise to the diaphragm originates ________ to the ultimate location of the diaphragm

superior

A third ligament, the ________ _________________ ligament, attaches the superior surface of the neck of the rib to the transverse process of the vertebra above.

superior costotransverse

On each side, the internal thoracic artery lies posterior to the costal cartilages of the upper six ribs and about 1 cm lateral to the sternum. At approximately the level of the sixth intercostal space, it divides into two terminal branches: ▪ the ________ __________ artery, which continues inferiorly into the anterior abdominal wall ▪ the _______________ artery, which passes along the costal margin, goes through the diaphragm, and ends near the ____ intercostal space.

superior epigastric musculophrenic, last

The major structures found in the ________ ____________ include the: ▪ thymus, ▪ right and left brachiocephalic veins, ▪ left superior intercostal vein, ▪ superior vena cava, ▪ arch of the aorta with its three large branches, ▪ trachea, ▪ esophagus, ▪ phrenic nerves, ▪ vagus nerves, ▪ left recurrent laryngeal branch of the left vagus nerve, ▪ thoracic duct, and ▪ other small nerves, blood vessels, and lymphatics.

superior mediastinum

The ________ _____________ is posterior to the manubrium of the sternum and anterior to the bodies of the first four thoracic vertebrae ▪ Its superior boundary is an oblique plane passing from the jugular notch upward and posteriorly to the superior border of vertebra __. ▪ Inferiorly, a transverse plane passing from the _______ _____ to the intervertebral disc between vertebra __/__separates it from the inferior mediastinum. ▪ Laterally, it is bordered by the mediastinal part of the ________ ______on either side.

superior mediastinum T1 sternal angle, T4, T5 parietal pleura

Axillary inlets lie directly on each side of the ________ _______ ________

superior thoracic aperture

IV disc between T4 and T5 passes through the site where the ________ ____ ____ penetrates the ___________ to enter the heart;

superior vena cava, pericardium

The inferior half of the ________ vena cava is located within the pericardial sac. It passes through the fibrous pericardium at approximately the level of the ___ costal cartilage and enters the right atrium at the lower level of the ___ costal cartilage.

superior, 2nd, 3rd

Blood returning to the right atrium enters through one of _ vessels. These are: ▪ the ________ and _________ ____ ______, which together deliver blood to the heart from the body; and ▪ the ________ _____, which returns blood from the walls of the heart itself.

superior, infeiror vena cavae coronary sinus

The two facets on the head of the rib articulate with the ________ facet on the body of its own vertebra and with the ________ facet on the body of the vertebra above.

superior, inferior

On a thoracic vertebrae: Two demifacets (i.e., partial facets) are located on the ________ and ________ aspects of the body for articulation with corresponding sites on the ______ of adjacent ribs. The _________ costal facet articulates with part of the head of its own rib, and the ________ costal facet articulates with part of the head of the rib below

superior, inferior, head, superior, inferior

IV disc between T4 adn T5 separates the ________ mediastinum from the ________ mediastinum and marks the position of the superior limit of the ___________

superior, inferior, pericardium

Generally, the pulmonary artery is _________ at the hilum, the pulmonary veins are ________, and the bronchi are somewhat _________ in position

superior, inferior, posterior

Lymphatic drainage of the breast is as follows: ▪ Approximately 75% is via lymphatic vessels that drain _________ and ____________ into _________ nodes (Fig. 3.16). ▪ Most of the remaining drainage is into ___________ nodes deep to the anterior thoracic wall and associated with the _________ ________ artery. ▪ Some drainage may occur via lymphatic vessels that follow the _______ branches of ________ ____________ arteries and connect with ____________ nodes situated near the _____ and ______ of ribs.

superiorally, laterally, axillary parasternal, internal thoracic lateral, posterior intercostal, intercostal, heads, necks

The arterial supply to the diaphragm is from vessels that arise __________ and __________ to it

superiorly, inferiorly

During phagocytosis, a burst of __ consumption leads to the formation of __________ ______ and ________ ________ (____). __________ is a short-lived, highly reactive free radical that, together with ___ and ______ ions, forms a powerful microbial killing system inside the ___________.

superoxide anions, hydrogen peroxide, H2O2, MPO, halide, neutrophil

The latent pacemakers have an opportunity to drive the heart rate only if the SA node is __________ or if the intrinsic firing rate of a latent pacemaker becomes _______ than that of the SA node.

suppressed, faster

The ___________ period follows the relative refractory period.

supranromal

Covering the superior surface of the cervical pleura is a distinct dome-like layer of fascia, the ____________ ________

suprapleural membrane

Without _______ (even with stable ________), most patients with uncorrected transposition of the great arteries die within the first months of life.

surgery, shunting

Visceral afferents from the heart are also a component of the cardiac plexus. These fibers pass through the cardiac plexus and return to the central nervous system in the cardiac nerves from the ____________ _____ and in the ______ cardiac branches.

sympahtetic trunk, vagal

All preganglionic nerve fibers of the ____________ system are carried out of the spinal cord in spinal nerves T1 to L2

sympathetic

Preganglionic ___________ fibers destined for the head are carried out of the spinal cord in spinal nerve T1.

sympathetic

Stimulation of the __________ system: ▪ increases heart rate, and ▪ increases the force of contraction

sympathetic

The diameters of arteries and arterioles throughout the body continuously alter to regulate blood flow according to local and general metabolic and cardiovascular requirements. Control mechanisms include neurogenic (___________/__________) and myogenic pathways, and local biochemical mediators, including ____________ (____) and ______ _____.

sympathetic adrenergic, prostacyclin, PGI2, nitric oxide

Sympathetic fibers reach the cardiac plexus through the cardiac nerves from the ___________ _____. Preganglionic sympathetic fibers from the upper _ or _ segments of the ________ spinal cord enter and move through the sympathetic trunk. They synapse in _________ and upper _________ sympathetic ganglia, and postganglionic fibers proceed as bilateral branches from the sympathetic trunk to the _______ ________

sympathetic trunk, 4, 5, thoracic, cervical, throacic, cardiac plexus

Other structures outside the posterior attachments of the diaphragm lateral to the aortic hiatus include the ___________ ______. The greater, lesser, and least splanchnic nerves penetrate the _____.

sympathetic trunks. crura

The joints between the manubrium and the body of the sternum and between the body of the sternum and the xiphoid process are usually _________

sympheses

Interchondral joints are usually ________ joints, and the thin fibrous capsules are reinforced by _____________ _________.

synovial, interchondral ligaments

The two facets on the head of the rib articulate with the superior facet on the body of its own vertebra and with the inferior facet on the body of the vertebra above. This joint is divided into two ________ compartments by an ______________ ligament, which attaches the crest to the adjacent intervertebral disc and separates the two articular surfaces on the head of the rib. The two synovial compartments and the intervening ligament are surrounded by a single _____

synovial, intra-articular, joint

The second to seventh sternocostal joints are ________ and have thin capsules reinforced by surrounding ____________ ligaments.

synovial, sternocostal

Costotransverse joints are ________ joints between the ________ of a rib and the __________ process of the related vertebra

synovial, tubercle, transverse

Because collagen has a key role in the structure and hemostatic function of small blood vessels, vascular causes of excessive bleeding include congenital or acquired deficiencies of collagen _________. Congenital disorders include what rare disease?

synthesis, Ehlers-Danlos Syndrome

The left heart and the systemic arteries, capillaries, and veins are collectively called the ________ circulation.

systemic

In pathologic conditions such as ________ ____________ (elevated arterial pressure in the systemic circulation), the left ventricle must perform even more pressure work than it does normally. Because aortic pressure is ________, the left ventricular wall hypertrophies (__________) as a compensation for the ____________ workload.

systemic hypertension, increased, thickens, increased

During ventricular contraction (_______) blood is moved through the arteries forcefully and the elastin is stretched, distending the wall within the limit set by the wall's collagen. When the ventricles relax (________) ventricular pressure drops to a low level, but the elastin rebounds passively, helping to maintain arterial pressure. Which arteries?

systole, diastole elastic arteries

The function of the left ventricle can be observed over an entire cardiac cycle (_______ plus _______) by combining the two pressure-volume relationships from Figure 4-21. By connecting these two pressure-volume curves, it is possible to construct a so-called ___________ _______-______ ____

systole, diastole, ventricular pressure volume loops

Failure of the pump. In the most common situation, the cardiac muscle contracts weakly and the chambers cannot empty properly—so-called ________ ____________. In some cases, the muscle cannot relax sufficiently to permit ventricular filling, resulting in __________ ___________

systolic dysfunction, diastolic dysfunction

Most cases of heart failure are due to ________ dysfunction—inadequate myocardial contractile function, characteristically a consequence of ischemic heart disease or hypertension. Alternatively, CHF also can result from _________ dysfunction—inability of the heart to adequately relax and fill, such as in massive left ventricular hypertrophy, myocardial fibrosis, amyloid deposition, or constrictive pericarditis.

systolic, diastolic

In common with that of prostacyclin, NO generation by endothelial cells is enhanced by many compounds, and also by blood flow and shear stress (the __________ force applied to the cells by the flow of blood).

tangential

Occasionally, the gas within the pleural cavity may accumulate to such an extent that the mediastinum is "pushed" to the opposite side, compromising the other lung. This is termed a _______ ___________ and requires urgent treatment.

tension pneumothorax

Occasionally, the gas within the pleural cavity may accumulate to such an extent that the mediastinum is "pushed" to the opposite side, compromising the other lung. This is termed a _______ ____________ and requires urgent treatment.

tension, pneumothorax

Right to left shunt: Two of the most important conditions associated with _cyanotic congenital heart disease are ___________ __ ______ and _____________ __ ___ _____ _______. Clinical consequences of severe, systemic cyanosis include clubbing of the tips of the fingers and toes (______________ ________________), polycythemia, and ___________ embolization

tetralogy of fallot, transposition of the great vessels, hypertrophic osteoarthropathy, paradoxical

Chronic alcoholism leads to ___________ defeciency and __________ related heart disease

thiamine, beriberi

Skeletal muscle: The _____ _________ are composed of myosin, whose globular heads have ______-binding sites and _______ activity. The ____ _________ are composed of three proteins: actin, tropomyosin, and troponin. _____ is a globular protein with a myosin-binding site, which, when polymerized, forms two twisted strands. ___________ runs along the groove of the twisted actin strands and functions to block the myosin-binding site. ________ is a globular protein composed of a complex of three subunits; the troponin _ subunit binds _____.

thick filaments, actin, ATPase, thin filaments, Myosin, tropomyosin, tropinin, C, Ca2+

The arteries are _____-walled structures with extensive development of ________ tissue, ______ muscle, and __________ tissue.

thick, elastic, smooth, connective

thermoregulation by the skin involves arterioles that can bypass capillary networks and connect directly to venules. The media and adventitia are ________ in these _____________ ______ (or arteriovenous anastomoses) and richly innervated by ___________ and _______________ nerve fibers.

thicker, arteriovenous shunts, sympathetic, parasympathetic

Like the capillaries, the venules are ____-walled structures.

thin

Origin of pectorlais minor: Anterior surfaces of the _____, _______, and _____ ribs, and deep fascia overlying the related intercostal spaces

third, fourth, fifth

A typical ________ vertebra has a heart-shaped vertebral body, with roughly equal dimensions in the transverse and anteroposterior directions, and a long spinous process

thoracic

The posterior mediastinum is posterior to the pericardial sac and diaphragm and anterior to the bodies of the mid and lower __________ vertebrae: ▪ Its superior boundary is a transverse plane passing from the sternal angle to the intervertebral disc between vertebrae __ and __. ▪ Its inferior boundary is the __________. ▪ Laterally, it is bordered by the mediastinal part of parietal pleura on either side. ▪ Superiorly, it is continuous with the _________ _____________

thoracic T4, T5 diaphragm parietal pleura

The bronchial arteries originate from the _________ _____ or one of its branches: ▪ ___ right bronchial artery normally arises from the _____ _________ ___________ artery (but occasionally, it originates from the _____ ____ _________ artery). ▪ ___ left bronchial arteries arise directly from the _________ surface of the _________ _____—the superior left bronchial artery arises at vertebral level __, and the inferior one inferior to the ____ _________.

thoracic aorta one, third posterior intercostal, upper left bronchial artery two, anteiror, thoracic aorta, T5, left bronchus

The ________ ____, which is the major lymphatic vessel in the body, passes through the posterior portion of the superior mediastinum. It: ▪ enters the superior mediastinum inferiorly, slightly to the left of the midline, having moved to this position just before leaving the posterior mediastinum opposite vertebral level TIV/V; and ▪ continues through the superior mediastinum, posterior to the arch of the aorta, and the initial portion of the left subclavian artery, between the esophagus and the left mediastinal part of the parietal pleura.

thoracic duct

The largest lymphatic vessels, the ________ ____ and _____ _________ ____, both with walls having tunics like those of veins, return lymph to the circulatory system by joining veins near the heart.

thoracic duct, right lymphatic duct

The ______ houses the heart and lungs, acts as a conduit for structures passing between the neck and the abdomen, and plays a principal role in breathing

thorax

A typical thoracic vertebra has _____ sites on each side for articulation with ribs

three

descending aorta AKA

throacic aorta

The breast is related to the ________ ____ and to structures associated with the _____ ____; therefore, vascular supply and drainage can occur by multiple routes (Fig. 3.16): ▪ laterally, vessels from the _________ artery— _________ ________, _____-_________, ________ _________, and ___________ arteries; ▪ medially, branches from the ________ _________ artery; ▪ the ______ to _______ intercostal arteries via branches that perforate the thoracic wall and overlying muscle.

throacic wall, upper limb axillary artery, superior thoracic, thoraco-acromial, lateral thoracic, subscapular internal thoracic second, fourth

Rupture, fissuring, ro ulceration of plaques can expose highly ____________ constituents or subendotheial basement membrane, leading to rapid thrombosis

throbogenic

Atrial fibrillation: The stagnant blood is prone to form _______ (particularly in the atrial appendage) that can shed ______ and cause strokes and manifestations of infarction in other organs.

thrombi, emboli

This final stage of fibrin production in the common pathway is tested clinically by the ________ ________ _____ (___), in which exogenous thrombin is added to plasma

thrombin clotting time, TCT

The curve is a measurement of thrombin concentration over time with the parameters lag time, time to the first development of thrombin, peak thrombin, the maximum amount of thrombin generated, time to peak, and endogenous thrombin potential (ETP) or the area under the curve. What curve?

thrombin generation curve

Coagulation inhibitors are essential to prevent excessive ______ formation and __________

thrombin, thrombosis

Blood platelets (or __________) are very small non-nucleated, membrane-bound cell fragments only 2-4 µm in diameter. platelets originate by separation from the ends of cytoplasmic processes extending from giant polyploid bone marrow cells called ______________.

thrombocytes, megakaryocytes

Acquired disorders of platelets include a low platelet count (_______________), which may be the result of either defective __________ of platelets by bone marrow megakaryocytes, e.g. in myelodysplasia or acute myeloid leukaemia, excessive ___________ of platelets, e.g. by antiplatelet antibodies, and excessive ____________ of platelets, e.g. in disseminated intravascular coagulation or by sequestration in an enlarged spleen.

thrombocytopenia, formation, destruction, formation

Anticoagulant drugs, e.g. warfarin, dabigatran and rivaroxaban, are used long term to prevent _____________ arising from the _____ (atrial fibrillation, heart valve prostheses).

thromboembolism, heart

When thrombin is generated, it binds to _______________ (molecular weight 74 kDa), which is present on the surface of vascular endothelial cells.

thrombomodulin

the major arachidonic acid metabolite formed by platelets is __________ __ (____), which is a potent ______________ and stimulates platelet ___________.

thromboxane A2, TXA2, vasoconstrictor, aggregation

An intravascular clot, or ________ (plural, _______), with a fibrin framework quickly forms to stop blood loss from the damaged vessels.

thrombus, thrombi

The ______ is the most anterior component of the superior mediastinum, lying immediately posterior to the manubrium of the sternum. It is an asymmetrical, bilobed structure

thymus

The parathyroid glands develop from the third pharyngeal pouch, which also forms the ______

thymus

The left and right brachiocephalic veins are located immediately posterior to the _______. They form on each side at the junction between the _________ _______ and _________ vein

thymus, internal jugular, subclavian

The upper extent of the thymus can reach into the neck as high as the _______ _____; a lower portion typically extends into the anterior mediastinum over the pericardial sac.

thyroid gland

Occasionally, the brachiocephalic trunk has a small branch, the _______ ___ artery, which contributes to the vascular supply of the thyroid gland.

thyroid ima

GPIIb-IIIa inhibitors (e.g. _________, _________) have been developed for patients undergoing angioplasty for coronary artery disease to prevent further coronary events.

tirofiban, abciximab

The term 'extrinsic' refers to the effect of ______ ______, which (after combining with coagulation factor ____) greatly accelerates coagulation, by activating both factor IX and factor X

tissue factor, VII

It is currently believed that activation of blood coagulation is usually initiated by vascular injury, causing exposure of flowing blood to ______ ______, which results in activation of factors ___ and __

tissue factor, VII, IX

Endothelial damage exposes blood to the ______ factor and to _________

tissue, collagen

The walls of the inflow portion of the right ventricle have numerous muscular, irregular structures called __________ _______

trabeculae carniae

A few trabeculae carneae (_________ _________) have only one end attached to the ventricular surface, while the other end serves as the point of attachment for tendon-like fibrous cords (the ______ ________), which connect to the free edges of the cusps of the tricuspid valve.

trabeculae carniae, chordae tendinae

The _______ is a flexible tube that extends from vertebral level CVI in the lower neck to vertebral level TIV/V in the mediastinum where it bifurcates into a right and a left main bronchus

trachea

Which is more superficial: trachea or esophagus?

trachea

IV disc between T4 and T5 is the level at which the ________ bifurcates into _____ and ____ ____ _______

trachea, left, right main bronchi

Superficial, or subpleural, and deep lymphatics of the lung drain into lymph nodes called ________________ _____ around the roots of lobar and main bronchi and along the sides of the trachea

tracheobronchial nodes

atrial and ventricular septal defects (ASDs and VSDs, respectively) and/or conduction defects may be caused by _____________ ______ mutations, such as TBX5 mutations in the Holt-Oram syndrome and NKX2.5 or GATA4 mutations in sporadic, nonsyndromic cases. Other disorders (e.g., ________ ________) are associated with mutations in intracellular signaling cascades that cause constitutive activation. microRNAs, as well as epigenetic changes (e.g., ___ ____________), also are increasingly recognized as important contributors.

transcription factor, Noonan syndroe, DNA methylation

All leukocytes become active outside the circulation, specifically leaving the microvasculature in a process involving cytokines, selective adhesion, changes in the endothelium, and ________________ migration or __________.

transendothelial, diapdesis

The __________ processes of a thoracic vertebrae are club shaped and project posterolaterally

transverse

A passage between the two sites of reflected serous pericardium is the _________ ___________ _____. This sinus lies __________ to the ascending aorta and the pulmonary trunk, ________ to the superior vena cava, and ________ to the left atrium

transverse pericardial sinus, posterior, anteiror, supeiror

When the pericardium is opened anteriorly during surgery, a finger placed in the ________ sinus separates arteries from veins. A hand placed under the apex of the heart and moved superiorly slips into the _______ sinus

transverse, oblique

Transverse costal facet on teh end fo the __________ process articulates with the _________ of its own rib

transverse, tubercle

The ___________ ________ muscles are found on the deep surface of the anterior thoracic wall (Fig. 3.28B) and in the same plane as the innermost intercostals.

transversus thoracis

The ___________ _________ muscles lie deep to the internal thoracic vessels and secure these vessels to the wall.

transversus thoracis

Valves involved with right side of heart (2)

tricuspid pulmonary

The right atrioventricular orifice is closed during ventricular contraction by the __________ valve (right atrioventricular valve), so named because it usually consists of _ cusps or leaflets

tricuspid, 3

Valve disease in the right side of the heart (affecting the _________ or ___________ valve) is most likely caused by __________.

tricuspid, pulmonary, infection

The rib ________ projects posteriorly from the junction of the neck with the shaft and consists of two regions, an articular part and a nonarticular part

tubercle

When an irregularity occurs in a blood vessel (e.g., at the valves or at the site of a blood clot), the laminar stream is disrupted and blood flow may become _________.

turbulent

There are ______ pairs of ribs, each terminating anteriorly in a ______ _________

twelve, costal cartilage

The joint between the second costal cartilage and the sternum is divided into ___ compartments by an _______________ ligament.

two, intraartiular

The upper ___ posterior intercostal arteries on each side are derived from the _______ ____________ artery, which descends into the thorax as a branch of the _____________ trunk in the neck.

two, supreme intercostal, costocervical

components of acute coronary syndrome (3)

unstable MI Acute angina Sudden Cardiac death

Changes in compliance of the veins cause redistribution of blood between the veins and the arteries (i.e., the blood shifts between the _________ and ________ volumes). For example, if the compliance of the veins decreases (e.g., due to venoconstriction), there is a ________ in the volume the veins can hold and, consequently, a shift of blood from the veins to the ________: unstressed volume __________ and stressed volume _________.

unstressed, stressed, decrease, arteries, decreases, increases

The _____ _____ is the relationship between ventricular pressure developed during systole and end-diastolic volume (or end-diastolic fiber length).

upper curve

It is important for clinicians to remember when evaluating the breast for pathology that the ______ _______ region of the breast can project around the _______ margin of the __________ _____ muscle and into the ______. This _________ ________ (_________ tail) may perforate deep fascia and extend as far superiorly as the ____ of the axilla

upper lateral, pectoralis major, axilla, axillary process, axillary, apex

The pectoral region is external to the anterior thoracic wall and anchors the _____ ____ to the _____.

upper limb, trunk

Together, the costovertebral joints and related ligaments allow the necks of the ribs either to rotate around their longitudinal axes, which occurs mainly in the _____ ribs, or to ascend and descend relative to the vertebral column, which occurs mainly in the _____ ribs.

upper, lower

Phases of the action potential: 1. Phase 0, _______. In ventricular, atrial, and Purkinje fibers, the action potential begins with a phase of _____ ______________, called the upstroke. As in nerve and skeletal muscle, the upstroke is caused by a transient increase in Na+ conductance (gNa), produced by depolarization-induced opening of activation gates on the Na+ channels. When gNa increases, there is an ______ ___ _______ (influx of Na+ into the cell), or INa, which drives the membrane potential toward the Na+ equilibrium potential of approximately +65 mV. The membrane potential does not quite reach the Na+ equilibrium potential because, as in nerve, the inactivation gates on the Na+ channels close in response to depolarization (albeit more ______ than the activation gates open). Thus, the Na+ channels open briefly and then close. At the peak of the upstroke, the membrane potential is depolarized to a value of about +20 mV. The rate of rise of the upstroke is called __/__. dV/dT is the rate of change of the membrane potential as a function of time, and its units are volts per second (V/sec). dV/dT varies, depending on the value of the _______ ________ _________. This dependence is called the responsiveness relationship. Thus, dV/dT is greatest (the rate of rise of the upstroke is _______) when the resting membrane potential is most negative, or hyperpolarized (e.g., −90 mV), and dV/dT is lowest (the rate of rise of the upstroke is _______) when the resting membrane potential is less negative, or depolarized (e.g., −60 mV). This correlation is based on the relationship between membrane potential and the position of the inactivation gates on the Na+ channel. When the resting membrane potential is relatively ______________ (e.g., −90 mV), the voltage-dependent inactivation gates are open and many Na+ channels are available for the upstroke. When the resting membrane potential is relatively ___________ (e.g., −60 mV), the inactivation gates on the Na+ channels tend to be closed and fewer Na+ channels are available to open during the upstroke. dV/dT also correlates with the size of the ______ current (i.e., in ventricular, atrial, and Purkinje fibers, the size of the ______ Na+ current). 2. Phase 1, _______ ______________. Phase 1 in ventricular, atrial, and Purkinje fibers is a brief period of repolarization, which immediately follows the upstroke. Recall that, for repolarization to occur, there must be a net _______ current. There are two explanations for the occurrence of the net outward current during phase 1. First, the inactivation gates on the Na+ channels close in response to depolarization. When these gates close, gNa decreases and the inward Na+ current (which caused the _______) ceases. Second, there is an outward K+ current, caused by the large driving force on K+ ions: At the peak of the upstroke, both the chemical and the electrical driving forces favor K+ movement ___ __ the cell (the intracellular K+ concentration is higher than extracellular K+ concentration, and the cell interior is electrically positive). Because the K+ ___________ (gK) is high, K+ flows out of the cell, down this steep electrochemical gradient. 3. Phase 2, _______. During the plateau, there is a long period (150 to 200 msec) of relatively ______, ___________ membrane potential, particularly in ventricular and Purkinje fibers. (In atrial fibers, the plateau is _________ than in ventricular fibers.) Recall that for the membrane potential to be stable, inward and outward currents must be equal such that there is no net current flow across the membrane. How is such a balance of inward and outward currents achieved during the plateau? There is an increase in Ca2+ conductance (gCa), which results in an ______ ____ _______. Inward Ca2+ current is also called ____ ______ _______, reflecting the slower kinetics of these channels (compared with the fast ___ channels of the upstroke). The Ca2+ channels that open during the plateau are _-____ channels and are inhibited by the ____ _______ ________ nifedipine, diltiazem, and verapamil. To balance the inward Ca2+ current, there is an _______ __ _______, driven by the electrochemical driving force on K+ ions (as described for phase 1). Thus, during the plateau, the inward Ca2+ current is balanced by the outward K+ current, the net current is zero, and the membrane potential remains at a stable depolarized value. (See Fig. 4-13, where during phase 2, the inward Ca2+ current is shown as _____ in magnitude to the outward K+ current.) The significance of the inward Ca2+ current extends beyond its effect on membrane potential. This Ca2+ entry during the plateau of the action potential initiates the release of more Ca2+ from intracellular stores for excitation-contraction coupling. This process of so-called _____-_______-____ _______ is discussed in the section on cardiac muscle contraction. 4. Phase 3, ______________. Repolarization begins gradually at the end of phase 2, and then there is rapid repolarization to the resting membrane potential during phase 3. Recall that repolarization is produced when outward currents are greater than inward currents. During phase 3, repolarization results from a combination of a decrease in gCa (previously _________ during the plateau) and an increase in gK (to even ______ levels than at rest). The reduction in gCa results in a decrease in the inward Ca2+ current, and the increase in gK results in an increase in the outward K+ current (IK), with K+ moving down a steep electrochemical gradient (as described for phase 1). At the end of phase 3, the outward K+ current is reduced because repolarization brings the membrane potential closer to the K+ equilibrium potential, thus decreasing the driving force on K+. 5. Phase 4, _______ ________ _________, __________ ________. The membrane potential fully repolarizes during phase 3 and returns to the resting level of approximately −85 mV. During phase 4, the membrane potential is stable again, and inward and outward currents are equal. The resting membrane potential approaches, but does not fully reach, the K+ equilibrium potential, reflecting the high resting conductance to K+. The K+ channels, and the resulting K+ current, responsible for phase 4 are different from those responsible for repolarization in phase 3. In phase 4, the K+ conductance is called gK1 and the K+ current is called, accordingly, IK1. The stable membrane potential in phase 4 means that inward and outward currents are equal. The high conductance to K+ produces an outward K+ current (IK1), which has already been described. The inward current that balances this outward current is carried by Na+ and Ca2+ (see Fig. 4-13), even though the conductances to Na+ and Ca2+ are low at rest. The question may arise: How can the sum of inward Na+ and Ca2+ currents be the same magnitude as the outward K+ current, given that gNa and gCa are very low, and gK1 is very high? The answer lies in the fact that, for each ion, current = conductance × driving force. Although gK1 is high, the driving force on K+ is low because the resting membrane potential is close to the K+ equilibrium potential; thus, the outward K+ current is relatively small. On the other hand, gNa and gCa are both low, but the driving forces on Na+ and Ca2+ are high because the resting membrane potential is far from the Na+ and Ca2+ equilibrium potentials; thus, the sum of the inward currents carried by Na+ and Ca2+ is equal to the outward current carried by K+.

upstroke, rapid depolarization, inward Na+ current, slowly dV dT, resting membrane potential, fastest, slowest, hyperpolarized, depolarized, inward, inward initial repolarization, outward, upstroke, out of, condctance plateau, stable, depolarized, shorter Inward Ca2+ current, slow inward current, Na+, L type Calcium channels, Ca2+ channel blockers, outward K+ current, equal Ca2_ induced Ca2+ release repoarization, increased ,higher, resting membrane potentia, electrical diastole

blood flow through the renal artery equals blood flow through all the renal capillaries, equals blood flow through the renal vein (less a small volume lost in _____). Although total flow is constant at each level in the series, the pressure __________ progressively as blood flows through each sequential component (remember Q = ΔP/R or ΔP = Q × R). The greatest decrease in pressure occurs in the ___________ because they contribute the largest portion of the __________.

urine, decreases, arterioles, resistnance

As the left _____ nerve passes through the superior mediastinum, it gives branches to the esophagus, the cardiac plexus, and the pulmonary plexus.

vagus

The _____ nerves pass through the superior and posterior divisions of the mediastinum on their way to the abdominal cavity.

vagus

The afferents associated with the vagal cardiac nerves return to the _____ n.

vagus

Visceral efferents from: ▪ the _____ ______ constrict the bronchioles; ▪ the ___________ ______ dilates the bronchioles.

vagus nerves sympathetic system

Nerves supplying the pericardium arise from the ______ nerve [_], the ___________ ______, and the _______ nerves.

vagus, X, sympathetic trunks, phrenic

In the mediastinum, the _____ nerves pass immediately posterior to the roots of the lungs, while the _______ nerves pass immediately anterior to them.

vagus, phrenic

Results from failure of a valve to close completely, thereby allowing backflow of blood

valve insuffeciency

Lymphatic vessel in muscle cut longitudinally shows a _____, the structure responsible for the unidirectional flow of lymph. The solid arrow shows the direction of the lymph flow, and the dotted arrows show how the valves prevent lymph backflow. The lower small lymphatic vessel is a lymphatic capillary with a wall consisting only of ______________.

valve, endothelium

Finally, heart failure also can be caused by _____ dysfunction (e.g., due to endocarditis) or can occur in normal hearts suddenly burdened with an abnormal load (e.g., with ______ or ________ overload).

valve, pressure, fluid

An important feature of large and medium veins are ______, which consist of thin, paired folds of the tunica intima projecting across the lumen, rich in elastic fibers and covered on both sides by endothelium

valves

Just as the heart wall is supplied with its own coronary vasculature for nutrients and O2, large vessels usually have ____ _______ ("vessels of the vessel"): arterioles, capillaries, and venules in the adventitia and outer part of the media Which has more, veins or arteries? Why?

vasa vasorum Veins They carry deoxygenated blood!

prostacyclin, PGI2, the major arachidonic acid metabolite formed by ________ _____, is a potent vasodilator and inhibitor of platelet aggregation.

vascular cells

The adventitia of larger vessels also contains a network of unmyelinated autonomic nerve fibers, the vasomotor nerves, which release the ______________ _______________. The density of this innervation is greater in ________ than in veins.

vasoconstrictor norepinepherine, arteries

Other drugs used to treat HF nonresponsive to ACE inhibitors includes direct acting ____________ (hydralazine, isosorbide dinitrate) and ____

vasodilators, ARBs

Intact normal endothelium does not initiate or support platelet adhesion or blood coagulation. Its surface is antithrombotic. This thrombo-resistance is partly due to endothelial production of two potent ________________ and inhibitors of ________ function: ____________ (_____________ __, ____) and ______ _____, otherwise known as ___________-________ ________ ______ (EDRF).

vasodilators, platelet, prostacyclin, prostaglandin I2, PGI2, nitric oxide, endothelium derived relaxation factor

Which is more anterior, subclavian artery or vein?

vein

Small, medium, and large _____, all with lumen diameters exceeding the thickness of the wall, carry blood back to the heart, with intimal valves preventing backflow, and have increasingly well-developed tunics.

veins

carry blood back to the heart from microvasculature all over the body.

veins

Another important alternative microvascular pathway is a ______ ______ system, in which blood flows through two successive capillary beds separated by a portal vein.

venous portal system

In _______ ______ systems one capillary bed drains into a vein that then branches again into another capillary bed. This arrangement allows molecules entering the blood in the first set of capillaries to be delivered quickly and at ____ concentrations to surrounding tissues at the second capillary bed, which is important in the ________ _________ gland and _____

venous portal, high, anteiror pituitary, liver

The Frank-Starling relationship is illustrated in Figure 4-22. Cardiac output and stroke volume are plotted as a function of ventricular end-diastolic volume or right atrial pressure. (Right atrial pressure may be substituted for end-diastolic volume because both parameters are related to ______ ______)

venous return

The rate at which blood is returned to the atria from the veins is called the ______ ______

venous return

The length-tension relationship for single myocardial cells can be extended to a length-tension relationship for the __________

ventricles

Located below the endotheliumand myoelastic layer, the subendocardial layer in the ___________ contains the conducting (________) fibers of the heart's impulse conducting network. These fibers are modified _______ ______ cells joined by ____________ _____ but specialized for impulse conduction rather than __________. With ________ filling much of the cytoplasm and displacing __________ to the periphery, Purkinje fibers typically are _____ staining than contractile cardiac muscle fibers

ventricles, Purkinje, cardiac muscle, intercalated disks, contraction, glycogen, myofibrils, lighter

the slow conduction velocity of the AV node ensures that the __________ do not activate too ______ (i.e., before they have time to fill with blood from the _____).

ventricles, early, atria

The Frank-Starling relationship governs normal ____________ function and ensures that the volume the heart ______ in systole equals the volume it ________ in venous return. Recall from a previous discussion that, in the steady state, _______ ______` equals ______ ______

ventricular, ejects, receives, cardiac output, venous return

An action potential in a Purkinje fiber would look similar to that in the ___________ fiber, but its duration would be slightly _______.

ventricular, longer

A series of increasingly larger and more organized _________ lie between capillaries and veins. Compared to arterioles, postcapillary venules have _____ lumens and an intima of ______ _____________ cells, with occasional __________ (b) Larger collecting venules have much ______ diameters than arterioles, but the wall is still very ____, consisting of an endothelium with more numerous pericytes or smooth muscle cells. (c) The muscular venule cut lengthwise here has a better defined tunica ______, with as many as _ layers of smooth muscle in some areas, a very thin ______ of endothelial cells, and a more distinct __________. Part of an arteriole shows a _________ wall than the venule. ______________ _______ are important as the site in the vasculature where these cells leave the circulation to become functional in the interstitial space of surrounding tissues when such tissues are inflamed or infected. (d) Postcapillary venule from an infected small intestine shows several __________ adhering to and migrating across the ______

venules large, simple endothelial, pericytes larger, thin media, 3, intima, adventitia, thicker, Postcapillary venules leukocytes, intima

Most capillary beds are supplied by arterioles and drain into _______, but alternative pathways are found in certain organs. In skin blood flow can be varied according to external conditions by ___________ ______, or ___________, commonly coiled, which directly connect the arterial and venous systems and temporarily bypass ___________.

venules, arteriovenous shunts, anastamoses, capillaries

Capillary beds generally drain into ________, the last segment of the microvasculature; ______________ _________ are the sites at which white blood cells enter damaged or infected tissues.

venules, postcapillary venules

After tissue injury that ruptures smaller vessels (including everyday trauma, injections, surgical incisions, and tooth extractions), a series of interactions between the ______ ____ and the circulating _____ normally occurs, resulting in cessation of blood loss from injured vessels within a few minutes (__________).

vessel wall, blood, hemostasis

Although the visceral pleura is innervated by _________ _________ nerves that accompany bronchial vessels, pain is generally not elicited from this tissue.

visceral afferent

Structures of the lung, and the ________ pleura, are supplied by ________ afferents and efferents distributed through the ________ _________ plexus and _________ _________ plexus

visceral, visceral, anteiorr pulmonary, posterior pulmonary

The major influences on Reynolds number in the cardiovascular system are changes in blood _________ and changes in the ________ of blood flow. Inspection of the equation shows that decreases in viscosity (e.g., _________ hematocrit) cause an ________ in Reynolds number. Likewise, narrowing of a blood vessel, which produces an ________ in velocity of blood flow, causes an ________ in Reynolds number

viscosity, velocity, decreased, increase, increase, increase

HF: Identification is accomplished by obtaining a thorough medical history, including a pertinent review of systems, and taking and evaluating the _____ _____ (pulse rate and rhythm, blood pressure, respiratory rate)

vital signs

Flow (Q) is ______ flow per unit time and is expressed in units of volume per unit time (e.g., mL/sec).

volume

In _______ ________ states (e.g., valvular regurgitation or shunts), the new sarcomeres are added in series with existing sarcomeres, so that the muscle fiber length increases. Consequently, the ventricle tends to dilate, and the resulting wall thickness can be increased, normal, or decreased; thus, heart weight—rather than wall thickness—is the best measure of hypertrophy in volume-overloaded hearts.

volume overload

during strenuous exercise when cardiac output becomes very high, ______ work contributes a greater-than-normal percentage of the total cardiac work (up to __%).

volume, 50

By contrast, the ______-loaded hypertrophy induced by regular aerobic exercise (___________ hypertrophy) typically is accompanied by an increase in capillary density, with decreased resting heart rate and blood pressure. These physiologic adaptations reduce overall cardiovascular morbidity and mortality. In comparison, static exercise (e.g., weight lifting) is associated with ________ hypertrophy and may not have the same beneficial effects.

volume, physiolocial, pressure

compliance describes how the ______ of blood contained in a vessel changes for a given change in ________ (ΔV/ΔP).

volume, pressure

vWF defeceincy leads to what disease?

von Wilebrand diseaes

Oral anticoagulant therapy with vitamin K antagonists, e.g. ________, is given long term to patients at risk of thrombosis within the chambers of the heart, e.g. patients with atrial fibrillation or heart valve prostheses, which may embolize to the brain, causing a stroke.

warfarin

Leukocytes (_____ blood cells or _____) leave the blood and migrate to the tissues where they become functional and perform various activities related to immunity.

white, WBCs

The joint between the body of the sternum and the _______ _______ becomes ossified with age

xiphoid process

The diaphragm is attached peripherally to the: ▪ _______ _______ of the sternum, ▪ _______ ______ of the thoracic wall, ▪ ends of ribs __ and __, ▪ _________ that span across structures of the _________ abdominal wall, and ▪ vertebrae of the _______ region.

xiphoid process costal margin 11, 12 Ligaments, posterior lumbar

Diaphragmatic nodes are posterior to the _______ and at sites where the _______ nerves penetrate the diaphragm. They also occur in regions where the diaphragm is attached to the vertebral column

xiphoid, phrenic

the velocity of flow at the vessel wall is ____, and the velocity at the center of the stream is _______

zero, maximal

Cervical ribs are present in approximately _% of the population.

1

Rib _ is flat in the horizontal plane and has broad superior and inferior surfaces.

1

The joint between rib _ and the manubrium is not synovial and consists of a fibrocartilaginous connection between the manubrium and the costal cartilage

1

Conduction velocity: Atria? AV node? His-Purkinjie? Ventricle?

1 m/sec 0.01- 0.05 m/sec 2- 4 m/sec 1 m/sec

Rib _ is not palpable, because it lies inferior to the clavicle and is embedded in tissues at the base of the neck. Therefore, rib _ is used as a reference for counting ribs and can be felt immediately lateral to the _______ _____.

1, 2, sternal angle

How much would resistance increase with 75% occlusion of the artery? The answer is found in the Poiseuille equation. After the occlusion, the radius of the artery is _/_ its original radius; thus, resistance has increased by _/(_/_)^_, or ___-fold.

1, 4, 1, 1, 4, 4, 256

Eosinophils are far less numerous than neutrophils, constituting only _%-_% of leukocytes. In blood smears, this cell is about the same size as a neutrophil or slightly larger, but with a characteristic _______ nucleus

1, 4, bilobed

Basophils and mast cells also are central to immediate or type _ hypersensitivity. In some individuals substances such as certain pollen proteins or specific proteins in food are allergenic, that is, elicit production of specific Ig_ antibodies, which then bind to receptors on ____ cells and immigrating _________.

1, E, mast, basophils

True ribs numbers

1-7

Parallel resistance Formula

1/Rtotal = (1/R1) + (1/R2) + (1/R3)...+ (1/Rn)

The head of rib 10 has a single facet for articulation with its own vertebra.

10

How long do platelets live in blood?

10 days

There are __ bronchopulmonary segments in each lung (Fig. 3.44); some of them fuse in the ____ lung

10, left

The __ pairs of internal intercostal muscles pass between the most inferior lateral edge of the costal grooves of the ribs above, to the superior margins of the ribs below.

11

Ribs 11 and 12 articulate only with the bodies of their own vertebrae and have no tubercles or necks. Both ribs are short, have little curve, and are pointed anteriorly.

11, 12

Ribs __ and __ have no anterior connection with other ribs or with the sternum and are often called floating ribs.

11, 12

How many ribs on each side of the throacic wall

12

How many thoracic vertebrae?

12

Posterior aspect of teh thoracic wall

12 thoracic vertebrae and their intervening IV discs

Large arteries pressure (systolic and diastolic)? Pulmonary arteries pressure (systolic and disatolic)?

120, 80 25, 8

Purkinjie fibers intrinsic firing rate

15-20 BPM

The superior surface of the rib is characterized by a distinct tubercle, the scalene tubercle, which separates two smooth grooves that cross the rib approximately midway along the shaft. What rib?

1st

Covering the superior surface of the cervical pleura is a distinct dome-like layer of fascia, the suprapleural membrane. This connective tissue membrane is attached laterally to the medial margin of the _____ rib and behind to the transverse process of vertebra __.

1st, C7

Even with granules filling the cytoplasm, the _ nuclear lobes of eosinophils are usually clear.

2

How many compartments are in sternocostal synovial joints?

2

Rib _, like rib I, is flat but twice as long. It articulates with the vertebral column in a way typical of most ribs.

2

Sternal angle marks the site of articulation with rib _ with the sternum.

2

Ribs that halfway attach to the body of the sternum

2 7

How many papillary muscles in right ventricle? Name them Which venricle has bigger ones?

2 Anterior, posteriror Right

In each intercostal space, the anterior intercostal arteries usually have _ branches: ▪ One passes _____ the margin of the _____ ___. ▪ The other passes _____ the margin of the _____ rib and meets a __________ branch of the _________ ___________ artery.

2 below, upper rib above, lower, collateral, posterior intercostal

The interior of the right atrium is divided into _ continuous spaces. Externally, this separation is indicated by a shallow, vertical groove (the______ __________ ______), which extends from the right side of the opening of the superior vena cava to the right side of the opening of the inferior vena cava. Internally, this division is indicated by the ______ __________, which is a smooth, muscular ridge that begins on the roof of the atrium just in front of the opening of the superior vena cava and extends down the lateral wall to the anterior lip of the inferior vena cava.

2 sulcus termianlis cordis crista terminalis

Patient with HF on digoxin: A maximum of 0.036 mg epinephrine (i.e., _ cartridges of 2% lidocaine with 1:100,000 epinephrine) is recommended, with care taken to avoid inadvertent _____________ injection.

2, intravascular

Lymphatic vessels ultimately converge as _ large trunks: the _______ _____ and the _______ _________ _____, which empty lymph back into the _____. The thoracic duct connects with the blood circulatory system near the junction of the ____ _________ ________ ____ with the ____ ___________ ____, whereas the right lymphatic duct enters near the confluence of the _____ ____________ ____ and the _____ ________ _______ _____

2, thoracic dct, right lymphatic duct, blood left internal jugular vin, left subclavian vein, right subclavian vein, right internal jugular vein

The superior aspect of each pleural cavity approximately how high in relation to rib I?

2-3 cm higher into the neck

The left superior intercostal vein receives the ___, ___, and sometimes the ___ posterior intercostal veins, usually the left bronchial veins, and sometimes the left pericardiacophrenic vein

2nd, 3rd, 4th

How many papillary muscles in right ventricle? Name them

3 Anterior, posterior, septal

The vessels between arterioles and venules can be any of _ types Name them!

3 Continuous capillaries Fenestrated Capillaries Sinusoids

all of these larger vessels have walls with _ concentric layers, or tunics Name them!

3 Intima Media Adventitia

The various structural anomalies in congenital heart disease can be assigned to _ major groups based on their hemodynamic and clinical consequences: Name them!

3 Left to right shunt Right to left shunt Malformations causing obstruction

The aorta has _ fixed points of attachment: Name them!

3 ▪ the aortic valve, ▪ the ligamentum arteriosum, and ▪ the point of passing behind the median arcuate ligament of the diaphragm to enter the abdomen.

The three components of the coagulation system are distinguished on the basis of the nature of the initiating factor and its corresponding test in the clinical hemostasis laboratory; hence, _ tests of coagulation are performed in clinical laboratories on citrated, platelet-poor plasma: ▪ _________ _______ ______________ ____ (____), testing the intrinsic pathway ▪ ___________ ____ (__) - the extrinsic pathway, and ▪ ________ ________ ____ (___) testing the final common pathway.

3 activated partial thromboplastin time, APTT prothrombin time, PT thrombin clotting time, TCT

Half-life of prostacyclin in plasma

3 min

Aortic valve consists of _ _________ _____ with the free edge of each projecting upward into the lumen of the ascending aorta

3 semilunar cusps

What % of people over 85 are diagnosed with HF each year?

3%

The pectoralis minor passes from the anterior surfaces of ribs _ to _ to the _________ _______ of the _______

3, 5, coracoid process, scapula

In most instances, congenital heart disease arises from faulty embryogenesis during gestational weeks _ through _, when major cardiovascular structures develop; the cause is unknown in almost 90% of cases. Of the known etiologic factors, _____________ causes, including congenital rubella infection, teratogens, and maternal diabetes, and _______ factors are the best characterized. The contribution of specific genetic loci has been demonstrated in familial forms of congenital heart disease and by well-defined associations with certain chromosomal abnormalities (e.g., trisomies __, __, __, and __, and ________ syndrome).

3, 8, environmental, genetic, 13, 15, 18, 21, Turner

Capillaries are classified as _ structural and functional types, with features that allow different degrees of molecular or even cellular exchange: (1) ___________ capillaries with many tight junctions so that all exchange must occur through the cells; (2) ____________ capillaries with small pores or fenestrations through the cells; and (3) _____________ capillaries, or _________, with larger lumens, large spaces between the endothelial cells, and a discontinuous basal lamina.

3, continuous, fenestrated, discontinuous, sinusoids

The heart has _ major layers: (1) the inner __________ of endothelium and subendothelial connective tissue; (2) the __________ of cardiac muscle; and (3) the ___________, connective tissue with many adipocytes and covered by mesothelium.

3, endocardium, myocardium, epicardium

Walls of both arteries and veins have _ tunics called the ______, _____, __________ (or ________), which correspond roughly to the heart's ___________, __________, and ___________. An artery has a thicker _______ and relatively ______ lumen. A vein has a ______ lumen and its __________ is the thickest layer. The intima of veins is often folded to form ______. Capillaries have only an __________, with no subendothelial layer or other tunics.

3, intima, media, adventitia, externa, endocardium, myocardium, epicardium, media, narrow, wider, adventitia, valves, endothelium

Macroscopically visible blood vessels have _ major layers or _______: (1) The ______ includes the endothelium, connective tissue, and an internal elastic lamina in larger vessels; (2) the _____ contains alternating layers of smooth muscle and collagen or elastic lamellae; and (3) the __________ (or externa) contains connective tissue, small vessels (____ _______), and nerves.

3, tunics, intima, media, adventitia, vasa vasorum

How many lobes in neutrophil nucleus?

3-5

Ribs that completely attach to the body of the sternum

3-6

The total resistance of the parallel arrangement when a blood vessel is occluded increases to ______ (1/Rtotal = 1/10 + 1/10 + 1/10 + 1/________).

3.333, infinity

Patients who are taking warfarin for anticoagulation can safely undergo dental or surgical procedures, provided that the INR is ___ or less

3.5

The normal concentration of erythrocytes in blood is approximately ___-___ million per microliter (µL, or mm3) in women and ___-___ million/µL in men.

3.9, 5.5, 4.1, 6.0

For patients with symptoms of unstable angina or those who have had an MI within the past __ days (major risk category), elective care should be postponed

30

HF patient: Nitrous oxide plus oxygen sedation can be used if adequate O2 flow (at least __%) is maintained.

30

Normal range of APTT

30-40 seconds

The origin of the ascending aorta is the aortic orifice at the base of the left ventricle, which is level with the lower edge of the ___ ____ costal cartilage, posterior to the ___ half of the sternum. Moving superiorly, slightly forward and to the right, the ascending aorta continues to the level of the ___ _____ costal cartilage. At this point, it enters the superior mediastinum and is then referred to as the ____ __ ___ _____

3rd left, left, 2nd right, arch of the aorta

The parathyroid glands develop from the ___ __________ _____, which also forms the thymus.

3rd pharyngeal pouch

To convert calcium ion to mmol/L divide by _

4

The rate of phase _ _______________ sets the heart rate. If the rate of phase 4 depolarization increases, threshold is reached more quickly, the __ ____ will fire more action potentials per time, and heart rate will ________

4 depolarization, SA node, incrase

The superior mediastinum is posterior to the manubrium of the sternum and anterior to the bodies of the first _ _______ vertebrae

4 thoracic

Internal partitions divide the heart into _ chambers (i.e., _ _____ and _ ___________) and produce surface or external grooves referred to as _____

4, 2 atria, 2 ventricles, sulci

The coronary sinus receives _ major tributaries: the_____, _____, _____, ___________

4, great, middle, small, posterior

The American Heart Association/American College of Cardiology (AHA/ACC) classification of HF consists of _ stages, reflecting the fact that HF is a _____________ disease for which the outcome can be modified by early identification and treatment

4, progressive

Bundle of His intrinsic firing rate

40 BPM

Muscular arteries: The media may contain up to __ layers of large smooth muscle cells interspersed with a variable number of elastic lamellae (depending on the ____ of the vessel)

40, size

AV node intrinsic firing rate

40-60 BPM

What % of whole blood are erythrocytes?

44%

The phrenic nerves arise in the cervical region mainly from the ___, but also from the ___ and ___, cervical spinal cord segments.

4th, 3rd, 5th

The horizontal fissure follows the ___ intercostal space from the sternum until it meets the oblique fissure as it crosses rib _.

4th, 5

Lateral and anterior branches of the ___ to ___ intercostal nerves carry general sensation from the skin of the breast.

4th, 6th

The ___ heart sound (__) is not audible in normal adults, although it may be heard in ventricular hypertrophy, where ventricular compliance is decreased. When present, __ coincides with atrial contraction. The sound is caused by the atrium contracting against, and trying to fill, a stiffened ventricle.

4th, S4, S4

Medical imaging of the lungs is important because they are one of the commonest sites for disease in the body. While the body is at rest, the lungs exchange up to _ L of air per minute, and this may contain pathogens and other potentially harmful elements (e.g., allergens).

5

Mature neutrophils constitute __%-__% of circulating leukocytes, a figure that includes slightly immature forms released to the circulation. Neutrophils are 12-15 µm in diameter in blood smears, with nuclei having _ to _ lobes linked by thin nuclear extensions

50, 70, 2, 5

What % of whole blood is plasma?

55%

The straw-colored, translucent, slightly viscous supernatant comprising __% at the top half of the centrifugation tube is the ______

55, plasma

How long may patient with endocarditis need to be treated with antibiotics

6 weeks or more

On each side, the internal thoracic artery lies posterior to the costal cartilages of the upper _ ribs and about _ cm lateral to the sternum. At approximately the level of the ___ intercostal space, it divides into _ terminal branches

6, 1, 6th, 2

During quiet respiration, the inferior margin of the lung crosses rib _ in the midclavicular line and rib _ in the midaxillary line, and then courses somewhat horizontally to reach the vertebral column at vertebral level ___

6, 8, T10

Thus, from the midclavicular line and around the thoracic wall to the vertebral column, the inferior margin of the lung can be approximated by a line running between rib _, rib _, and vertebra ___. The inferior margin of the pleural cavity at the same points is rib _, rib __, and vertebra ___. The __________________ ______ is the region between the two margins

6, 8, T10, 8, 10, T12

Thus, from the midclavicular line and around the thoracic wall to the vertebral column, the inferior margin of the lung can be approximated by a line running between rib _, rib _, and vertebra ___. The inferior margin of the pleural cavity at the same points is rib _, rib __, and vertebra ___. The __________________ ______ is the region between the two margins.

6, 8, T10, 8, 10, T12 costodiaphragmatic recess

interchondral joints occur between the costal cartilages of adjacent ribs (Fig. 3.25), mainly between the costal cartilages of ribs _ to __, but may also involve the costal cartilages of ribs _ and _.

7, 10, 5, 6

Recent MI (within the past _ to __ days) and unstable angina are classified as clinical predictors of ______ risk for perioperative complications. By contrast, a past history of ischemic heart disease (i.e., stable (mild) angina and past history of MI) is considered one of the _____________ risk factors for perioperative complications.

7, 30, major, intermediate

What % of a coronary vessel must be occluded for someone to have critical stenosis? What symptoms do they have? What conditioon is this?

70% Chest pain with exercise Stable angina

SA node intrinsic firing rate

70-80 BPM

The costal cartilages of ribs _ to __ articulate anteriorly with the costal cartilages of the ribs above

8, 10

From the midclvicular line to the vertebral column, the infeiror boundary of the pleura can be approximated by a line that runds through the rib _, rib __, and vertebra ___

8, 10, T12

False ribs numbers

8-12

The remaining _ pairs of posterior intercostal arteries arise from the posterior surface of the thoracic aorta.

9

What % of plasma is: water? Proteins? Other solutes? Most abundant protein?

92% 7% 1% albumin

Area symbol

A

Patients at High Risk for HF, but without Structural Heart Disease or Symptoms of HF What stage?

A

Treatment of hypertension, encourage smoking cessation, treatment of lipid disorders, encouragement of regular exercise, discourage alcohol intake, illicit drug use, and control of metabolic syndrome ACE inhibitors or ARBs as appropriate for treatment of vascular disease or diabetes Treatment of patient with what stage of HF?

A

Issues with emergencies in patients with HF

A cardiac crisis, once precipitated, may progress to cardiac arrest. This condition therefore constitutes a medical emergency, and it may be necessary to call 911; the patient who is ambulatory and stable should be advised to seek urgent medical care. Ongoing vital signs must be monitored, and cardiopulmonary resuscitation initiated; if necessary, arrange for transport of patient to emergency medical facilities.

HF: For stages _ and _, management begins with risk reduction and includes the identification and treatment of underlying medical problems including hypertension, atherosclerotic disease, diabetes, obesity, and metabolic syndrome (consisting of abdominal obesity, elevated blood glucose, dyslipidemia, and hypertension).

A, B

Heart Failure: The difference between stage A and stage B is that in stage _, patients do not demonstrate left ventricular hypertrophy or dysfunction, whereas in stage _, LVH and/or dysfunction (__________ heart disease) is present. Stage _ is the disease designation for patients with past or present symptoms of HF associated with underlying structural heart disease (the bulk of patients), and stage _, for patients with refractory HF who might be eligible for specialized, advanced treatment or for end-of-life care. This classification system complements the New York Heart Association (NYHA) classification system

A, B, structural, C, D

American College of Cardiology/American Heart Association AKA

ACC/AHA

Angiotensin Converting Enzyme AKA

ACE

Benazepril (Lotensin) Captopril (Capoten) Enalapril (Vasotec) Fosinopril (Monopril) Lisinopril (Prinivil) Moexapril (Univasc) Perindopril (Coversyl) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) What drug type? Vasoconstrictor side effects? Oral problems? Other considerations?

ACE inhibitors None Angioedema of lip, face or tongue; taste changes; burning mouth; lichenoid reactions Orthostatic hypotension, avoid long-term use of NSAIDs

Several types of neurohormonal antagonists are used to treat HF Name them (3)

ACE inhibitors beta blockers Angiotensin Receptor Blockers

Acetylcholine AKA

ACh

Stimulation of the parasympathetic nervous system and ___ have a ________ inotropic effect on the atria. This effect is mediated via __________ receptors, which are coupled via a __ protein called __ to _______ _______. Because the G protein in this case is __________, contractility is decreased (opposite of the effect of activation of _____ receptors by _____________). Two factors are responsible for the __________ in atrial contractility caused by parasympathetic stimulation. (1) ACh _________ inward Ca2+ current during the plateau of the action potential. (2) ACh _________ IK-ACh, there, by shortening the duration of action potential and, indirectly, __________ the inward Ca2+ current (by shortening the _______ phase).

ACh, negative, muscarininc, Gi, Gk, adenyl cylase, increases, beta1, catecholamines decrease decreases increases, decreasing, plateau

American Heart Association/American College of Cardiology AKA

AHA/ACC

Activated partial thromboplastin time (____) assesses the __________ pathway

APTT, intrinsic

The clinical test of this pathway is the activated partial thromboplastin time (____), also known as the ______-________ ________ ____ (____) because ______ (microparticulated clay) is added as a standard 'surface', and ________ (brain phospholipid extract) as a substitute for platelet phospholipid Which pathway?

APTT, kaolin, cephalin, clotting time, KCCT, kaolin, cephalin Intrinsic

The reference range of the ____ is about 30-40 seconds; prolongations are observed in deficiencies of factors XII (or its cofactors, ___________ or ____), XI, IX (or its cofactor, factor ____), X (or its cofactor, factor _), or prothrombin (factor __)

APTT, prekallikrien, HMWK, VIII, V, II

What can be used along with ACE inhibitor to reduce BP?

ARBs

Arrythmogenic Right Ventricular Cardiomyopathy AKA

ARVC

Atrial Septal Defect AKA

ASD

Atrial septal defect AKA

ASD

No cardiac lectrical activity at all

ASYSTOLE

The production and release of platelet nucleotides, i.e. ___ and ___, can be measured to assess nucleotide production and nucleotide release from granules.

ATP, ADP

Conduction through the AV node (called __ _____) requires almost one ____ of the total conduction time through the myocardium. The reason for the AV delay is that, of all the myocardial tissues, conduction velocity in the AV node is ______ (0.01 to 0.05 m/sec), making conduction time the _______ (100 msec).

AV delay, half, slowest, longest

atrioventricular valve AKA

AV valve

For most of the duration of the action potential, the ventricular cell is completely refractory to fire another action potential. No matter how large a stimulus (i.e., inward current) might be applied, the cell is incapable of generating a second action potential during the period, because most of the Na+ channels are closed. What period?

Absolute Refractory Period

Which hemiazygous vein is higher? Lower?

Accessory hemiazygous Hemiazygous

myoglobin TnT TnI CK Lactate dehydrogenase Lab tests used to evaluate what condition? How do these get into blood?

Acute MI Leak out of damaged myocardial cells through damaged membranes

Term applied ot any of the 3 catastrophic manifestations of IHD: Unstable MI Acute angina Sudden Cardiac death

Acute coronary syndrome

Tumultous, destructive infections, frequently by a highly virulent organism attacking a previously normal valve, and capable fo causing substantial morbitidity or mortality even with proper antibiotic therapy or surgery What disease?

Acute endocarditis

Inferior margin of heart AKA

Acute margin

Heart may appear normal or dilated; myocardium is normally flabby, and mottled with pale hemorrhagic areas What disease?

Acute myocarditis

St Vitus dance What disease?

Acute rheumatic fever

Fibrinous exudate. What type of pericarditis? Fibrinopurulent exudate. What type of pericarditis? Areas of caesation. What type of pericarditis?

Acute viral pericarditis or uremia Bacterial pericarditis Tuberculosis pericarditis

_____ inflammation is usually short-lived as macrophages undergo apoptosis or leave the site, but _______ inflammation usually involves the continued recruitment of monocytes.

Acute, chronic

The major plasma proteins include the following: _______, the most abundant plasma protein, is made in the liver and serves primarily to maintain the osmotic pressure of the blood. _________ (_____- and ____-__________), made by liver and other cells, include transferrin and other transport factors; fibronectin; prothrombin and other coagulation factors; lipoproteins and other proteins entering blood from tissues. ______________ (__________ or _____-_________) secreted by plasma cells in many locations. _________, the largest plasma protein (340 kD), also made in the liver, which, during clotting, polymerizes as insoluble, cross-linked fibers of fibrin that block blood loss from small vessels. __________ proteins, which comprise a defensive system important in inflammation and destruction of microorganisms.

Albumins Globulins, alpha beta globulins Immunoglobulins, antibodies, gamma globulins Fibrinogen Complement

Eplerenone (Inspra) Spironolactone (Aldactone) What drug type? Vasoconstrictor side effects? Oral problems? Other considerations?

Aldosterone inhibitors None None Orthostatic hypotension

Single most long term limitation for cardiac transplantation

Allograft arteriopathy

Antiplasmin AKA

Alpha2 antiplasmin

Deposition of extracellular proteins with the predilection of forming insoluble beta pleated sheets What disease?

Amyloidosis

Types of restrictive cardiomyopathy (3)

Amyloidosis Endomyocardial fibrosis Loeffler endomyocarditis

the condition of having a concentration of erythrocytes below the normal range.

Anemia

______ is associated with a decreased hematocrit (_________ mass of red blood cells) and, because of turbulent blood flow, causes functional murmurs.

Anemia, decreased

Make up majority of primary malignant tumors of the heart

Angiosarcomas

Candesarten (Atacand) Eprosartan (Teveten) Irbesartan (Avapro) Losartan (Cozaar) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan) What drug type? Vasoconstrictor side effects? Oral problems? Other considerations?

Angiotensin receptor blockers None None Orthostatic hypotension

Cusps of tricuspid valve. Name them!

Anteiror Posteiror Septal

Anterior groove of rib 1 holds what? Posterior groove?

Anteiror- Subclavian VEIN Posterior- Subclavian ARTERY

Which ramus of the spinal nerve makes up the intercostal nerve?

Antererior ramus

Cutaneous branches of intercostal nerves (2)

Anterior cutaneous branch Lateral cutaneous branch

unfractionated heparin, low-molecular-weight heparin What type of drugs?

Anticoagulants

Asprin What drug type?

Antiplatelet

Clopidogrel What drug type?

Antiplatelet

Dipyrimidole What drug type?

Antiplatelet

____________ drugs are used in the prevention or treatment of arterial thrombosis

Antiplatelet

glycoprotein IIa/IIIb inhibitor, aspirin, clopidogre What type of drugs?

Antiplatelet

a protein synthesized in the liver. Its activity is catalyzed by the antithrombotic drug heparin (unfractionated and low-molecular-weight heparins), and by heparin-like endogenous glycosaminoglycans (GAGs) that are present on the surface of vascular endothelial cells.

Antithrobin

Antithrombin AKA

Antithrombin III

Highest pressure part of CV system? Lowest?

Aorta Right atrium

In certain conditions, such as in severe arteriovascular disease, the wall of the aorta can split longitudinally, creating a false channel, which may or may not rejoin into the true lumen distally. Wht condition?

Aortic dissection

Semilunar valve fo the left side of the heart

Aortic valve

____ is the cross-sectional area of a blood vessel (e.g., aorta) or a group of blood vessels (e.g., all of the capillaries). Area is calculated as A = πr2, where r is the radius of a single blood vessel (e.g., aorta) or the total radius of a group of blood vessels (e.g., all of the capillaries).

Area

Where is a serious decelartion injury most likely to injure the aorta?

Areas of attachment (fixed point)

Autosomal dominant disorer of cardiac muscle with variable penetrance, classically effects with right sided heart failure and disturbances of rhythm that can cause sudden cardiac death

Arrtyhmogenic Right Ventricular Cardiomyopathy

Tachycardias or bradycardias AKA

Arrythmias

(afferent arteriole → capillaries → efferent arteriole) what type of system is this? Where does it occur?

Arterial portal system Kidney

________ __________ is the major cause of heart attacks, stroke, and non-traumatic limb amputations in developed countries

Arterial thrombosis

Internal and external elastic laminae seen in what vessels?

Arteries

Greatest determinant of resistance in series resistance

Arterioles

__________ supplying a capillary bed typically form smaller branches called _____________ in which the smooth muscle cells are dispersed as bands that act as _____________ __________. The distal portion of the metarteriole, sometimes called a ____________ _______, lacks smooth muscle cells and merges with the ______________ _______. Branching from the metarteriole and thoroughfare channel are the smallest vessels, true ____________, which lack smooth muscle cells (although __________ may be present). The _____________ __________ regulate blood flow into the true capillaries.

Arterioles, metarterioles, precapillary sphincters, throroughfare channel, postcapillary venule, capillaries, pericytes, precapillary sphincters

___________, _______, and ___________ comprise the microvasculature where, in almost every organ, molecular exchange takes place between blood and the interstitial fluid of the surrounding tissues. Lacking _____ and __________ tunics and with diameters of only 4-10 µm, capillaries in paraffin sections can be recognized by nuclei adjacent to small lumens or by highly ______________ ___ _____ cells in the lumen. Not all interstitial fluid formed at capillary beds is drained into venules; the excess is called _____ and collects in ____-walled, irregularly shaped _________ vessels, such as those seen in connective tissue and smooth muscle here.

Arterioles, venules, capillaries, media, adventitia, eosinophilic red blood, lymph, thin, lymphatic

Inflammatory lesions seen in rheumatic fever? Made up of mainly _ lymphocytes, scattered ______ cells, and plump activated ____________ called ____________ cells Cause areas of what type of necrosis?

Aschoff bodies T, plasma, macrophages, Anitschkow Fibrinoid

_______ and other nonsteroidal anti-inflammatory agents have an inhibitory effect on _______ function and blood __________ because they block the local _____________ synthesis that is needed for ________ aggregation, contraction, and exocytosis at sites of injury. Bleeding disorders result from abnormally ____ blood clotting. One such disease directly related to a defect in the platelets is a rare autosomal recessive ___________ __ deficiency, involving a factor on the ________ surface needed to bind subendothelial ________ and begin the cascade of events leading to clot formation.

Asprin, platelet, clotting, prostaglandin, platelet, slow, glycoprotein Ib, platelet, collagen

Causes of lethal arrythmias leading to SCD (2)

Asystole Ventricular fibrillation

_______________ is a disease of elastic arteries and large muscular arteries that may play a role in nearly half of all deaths in developed parts of the world. It is initiated by damaged or dysfunctional _____________ cells oxidizing ____ in the tunica ______, which induces adhesion and intima entry of _________/___________ to remove the modified LDL. Lipid-filled macrophages (called _____ cells) accumulate and, along with the free LDL, produce a pathologic sign of early atherosclerosis called _____ _______. During disease progression these develop into _____-_____ _______, or _________, consisting of a gruel-like mix of smooth muscle cells, collagen fibers, and lymphocytes with necrotic regions of lipid, debris, and foam cells. Predisposing factors include dyslipidemia (> 3:1 ratios of ___ to ___ [high-density lipoprotein]), hyperglycemia of ____________, hypertension, and the presence of toxins introduced by _______.

Atheroscleorsis, endothelial, LDLs, intima, monocytes macrophages, foam, fatty streaks, fibro fatty plaques, atheromas, LDL, HDL, diabetes, smoking

Supraventricular rhytm originates where?

Atria

Hereditary pattern of dilated cardiomyopathy

Autosomal dominant

Patient Evaluation/Risk Assessment for patient with recent MI or unstable MI: •_____ elective dental care. •If care becomes necessary, consult with _________ to develop treatment plan. •Patient is best treated in a _______ dental clinic or special care facility.

Avoid Physician hospital

Issues with anesthesia in patient with mild angina or recent MI?

Avoid use of excessive amounts of epinephrine; limit to two carpules of 1:100,000 epinephrine at a time (within 30-45 minutes); greater quantities may be tolerated well clinically but with increasing risk.

Issues with anesthesia in patient with recent MI or unstable angina?

Avoid use of vasoconstrictor if possible. If vasoconstrictor is needed, avoid excessive amounts of epinephrine; limit to two carpules of 1:100,000 epinephrine at a time (within 30-45 minutes); greater quantities may be tolerated well clinically but with increasing risk. May need to discuss use with physician.

Gateway to the upper limb

Axillary inlet

All measures for stage A, plus ACE inhibitors (or ARBs) as appropriate Beta blockers as appropriate Treatment of which stage of HF?

B

Patients with Structural Heart Disease, but without Signs or Symptoms of HF Which stage of HF?

B

Regurgitation AKA

Backflow

What casues noninfectious myocarditis?

Bacteria

________ exert many activities modulating the immune response and inflammation and have many functional similarities with mast cells, which are normal, longer-term residents of connective tissue.

Basophils

_________ are also 12-15 µm in diameter but make up less than 1% of circulating leukocytes and are therefore difficult to find in normal blood smears. The nucleus is divided into two irregular lobes, but the large specific granules overlying the nucleus usually obscure its shape.

Basophils

_________, the rarest type of circulating leukocyte, have irregular bilobed nuclei and resemble mast cells with strongly basophilic specific granules containing factors important in allergies and chronic inflammatory conditions, including histamine, heparin, chemokines, and various hydrolases.

Basophils

__________ are also approximately the same size as ___________ and ___________, but they have large, strongly basophilic specific granules that usually obstruct the appearance of the nucleus which usually has two large irregular lobes.

Basophils, eosinophils, neutropihls

Congenital deficiencies of GPIb-IX (_______-________ syndrome) or, more commonly, of ___, result in a bleeding tendency.

Bernard Soulier, vWF

Platelet GPIb-IX deficiency What disease?

Bernard-Soulier syndrome

Anteiror mediastinum is where? Posterior mediastinum is where?

Between the sternum and pericardium Betwen the pericardium and the throacic vertebrae

Most common congeintal valve lesion

Bicuspid aortic valve

What is the nuclear shape? Basophils

Bilobed

Manufactured from glutaraldehyde-fixed procine or bovine tissues, or cryopreserved human valves What type of prosthetic heart valve?

Bioprosthetic valves

Factors that effect metabolic demands of myocardium (2)

Blood pressure Heart rate

Limbus fossa ovalis AKA

Border of the fossa ovalis

The positive staircase effect is also called the _______ ________, or _______

Bowditch staircase, Treppe

Anorexia, nausea, vomiting, diarrhea in HF Sign of what?

Bowel edema

Slow heart rate

Bradycardia

All measures for stages A and B, dietary salt restriction, plus Drugs for routine use: diuretics, ACE inhibitors, beta blockers Drugs in selected patients: aldosterone antagonists, ARBs, digitalis, hydralazine-nitrates Devices in selected patients: biventricular pacing device, implantable defibrillator Treatment of patient with what stage HF?

C

Patients with Structural Heart Disease with Previous or Current Symptoms of HF Which stage of patient with HF?

C

A cervical rib is an accessory rib articulating with vertebra ___; the anterior end attaches to the ________ border of the ________ aspect of rib _.

C12, 1

The esophagus is a muscular tube passing between the pharynx in the neck and the stomach in the abdomen. It begins at the inferior border of the cricoid cartilage, opposite vertebra __, and ends at the cardiac opening of the stomach, opposite vertebra ___

C6, T11

The trachea is a flexible tube that extends from vertebral level __ in the lower neck to vertebral level __/__ in the mediastinum where it bifurcates into a right and a left main bronchus

C6, T4, T5

Congestive Heart Failure AKA

CHF

These include nonsteroidal antiinflammatory drugs (NSAIDs), most antiarrhythmic agents, and calcium channel blockers. Drugs that can worrsen what disease?

CHF

___ occurs when the heart is unable to provide adequate perfusion to meet the metabolic requirements of peripheral tissues; inadequate cardiac output usually is accompanied by increased congestion of the venous circulation.

CHF

CK isoform espeically used to diagnose MI?

CK-MB

Myocardial form of creatine kinase

CK-MB

Vagus n. AKA

CN X

Carbon dioxide AKA

CO2

Aspirin inhibits ___ and hence reduces the formation of ____. Because it also has the effect of reducing the formation of ____, which itself has antiplatelet activity, agents acting more specifically as _________ _________ inhibitors, e.g. picotamide, or ___________ _________ agonists such as ifetroban, have also been investigated as antiplatelet agents. However, these do not appear to be more effective than aspirin. Dipyridamole acts by both reducing the availability of ___ and inhibiting ___________ ________, and ticlopidine and clopidogrel inhibit the ___ _________. These drugs have ______________ effects similar to those of aspirin, but cause less gastric bleeding because they do not interfere with synthesis of ____________ in the stomach. _____-____ antagonists, e.g. tirofiban or abciximab, can also be used in acute coronary thrombosis. Each of these antiplatelet drugs adds to the antithrombotic efficacy of ______ but also increases the risk of ________ when used in combination.

COX, TXA2, PGI2, thromboxane synthase, thromboxane receptor, ADP, thromboxane synthase, ADP receptor, antithrombotic, prostaglandins. GbIIb-IIIa, asprin, bleeding

What type of scan would you use to look at the body for the spread of breast cancer?

CT scan

Two different proteins are phosphorylated to produce the increase in contractility. The coordinated actions of these phosphorylated proteins then produce an increase in intracellular ____ concentration. (1) There is phosphorylation of the sarcolemmal ____ ________ that carry inward Ca2+ current during the plateau of the action potential. As a result, there is increased inward Ca2+ current during the plateau and increased trigger Ca2+, which increases the amount of Ca2+ released from the sarcoplasmic reticulum. (2) There is phosphorylation of _____________, a protein that regulates Ca2+ ATPase in the sarcoplasmic reticulum.

Ca2+ Ca2+ channels phsopholamban

Most common cause of aortic stenosis

Calcific aortic degeneration

Degenerative valve changes include: _____________ (cuspal or mitral) _________ numbers of valve fibroblasts or myofibroblasts Alterations of ___ Changes in the production fo __________________ or their inhibitors

Calcification Increased ECM metalloproteinases

Stenotic artery AKA

Calcified artery

Capaticy to hold blood

Capacitence

Blood vessels that are so thin walled that substances can exchange across them

Capillaries

Blood vessels with the most area

Capillaries

Most abundant blood vessles

Capillaries

___________ permit and regulate metabolic exchange between blood and surrounding tissues. These smallest blood vessels always function in networks called _________ ____, whose size and overall shape conforms to that of the structure supplied.

Capillaries, capillary beds

Refers to the cardiac manifestation caused by the bioactive compounds in carcinoid syndrome and occurs in half the patients in whom systemic syndrome develops.

Carcinoid heart disease

Results from bioactive compounds such as serotonin released by carcinoid tumors; systemic manifestations include flushing, diarrhea, dermatitis, bronchoconstriction What condition?

Carcinoid syndrome

_______ _________________ includes all of the processes involved in the electrical activation of the heart: the cardiac action potentials; the conduction of action potentials along specialized conducting tissues; excitability and the refractory periods; the modulating effects of the autonomic nervous system on heart rate, conduction velocity, and excitability; and the electrocardiogram (___)

Cardiac electrophysiology, ECG

_______ _________ are a class of drugs that act as positive inotropic agents. These drugs are derived from extracts of the foxglove plant, Digitalis purpurea. The prototype drug is digoxin; other drugs in this class include digitoxin and ouabain.

Cardiac glycosides

Amount of blood ejected from LV per unit time

Cardiac output

Fick principle formula

Cardiac output = (O2 consumption) / ([O2 pulmonary vein] - [pulmonary artery])

_______ ______ depends on the volume ejected on a single beat (stroke volume) and the number of beats per minute (heart rate). Cardiac output is approximately ____ mL/min in a 70-kg man (based on a stroke volume of __ mL and a heart rate of __ beats/min). Thus, Cardiac output = Stroke volume × Heart rate

Cardiac output, 5000, 70, 72

_______ ______ has previously been defined as the volume ejected by the left ventricle per unit time and is calculated as the product of stroke volume and heart rate. Cardiac output can be measured using the ____ principle, whose fundamental assumption is that, in the steady state, the cardiac output of the left and right ventricles is _____.

Cardiac output, Fick, equal

Diseases of intrinsic myocardial dysfunction

Cardiomyopathies

Acebutolol (Sectral) Atenolol (Tenormin) Betaxolol (Kerlone) Bisoprolol (Zebeta) Labetolol (Normodyne) Metoprolol (Lopressor) What drug type? Vasoconstrictor side effects? Oral problems? Other considerations?

Cardioselective beta blockers None Lichenoid reactions Orthostatic hypotension, avoid long-term use of NSAIDs

______________ disease remains the leading contributor to mortality worldwide and accounts for nearly 40% of all U.S. deaths—approximately 1 death every 30 seconds, or 750,000 deaths each year (accounting for 50% greater mortality than for all forms of cancer combined). The annual economic impact of ________ _____ ________, the most prevalent form of heart disease, is in excess of $100 billion.

Cardiovascular, ischemic heart disease

Issues with follow-up in patients with HF

Careful follow-up interview of the patient is indicated to determine disease severity and level of control.

_______ _______ are slight dilations of the bilateral internal carotid arteries where they branch from the (elastic) common carotid arteries; they act as important _____________ monitoring arterial blood pressure. At these sinuses the tunica media is _______, allowing greater distension when blood pressure rises, and the adventitia contains many sensory nerve endings from cranial nerve __, the _______________ nerve.

Carotid sinuses, baroreceptors, thinner, IX, glossopharyngeal

Long fine tube AKA

Catheter

Stroke AKA

Cerebrovascular accident

Parsitization of scattered myofibers by trypanosomes accompanied by an inflammatory infiltrate of neutrophils, lymphocytes, macrophages, adn occasionally eosinophils What disease?

Chagas myocarditis

Thoracostomy tube AKA

Chest tube

Hyperventilation followed by apnea during sleep

Cheyne-Stokes respiration

`Hyperventilation alternating with apnea

Cheyne-Stoks respiration

AKA ischemic cardiomyopathy, progressive heart failure secondary to ischemic myocardial damage What condition/

Chronic IHD

Condition in which compensatory mechanisms of viable myocrdium begin to fail after acute MI

Chronic IHD

Severe fixed coronary obstruction leads to what condition?

Chronic ischemic heart disease

Associated with delicate adhesions or dense, fibrotic scars that obliterate the pericardial space

Chronic pericarditis

Healing of pericarditis resulting in fibrosis leads to what condition?

Chronic pericarditis

_______ _________ ________ usually dosent manifest clinically until years or even decades after initial epidsode of rheumatic fever

Chronic rheumatic carditis

Rheumatic fever: Organization of the acute inflammation and subsequent scarring What disease?

Chronic rheumatic heart disease

Global hypotension leads to what type of infarct?

Circumferential subendocardial infarct

Sever, crushing substernal chest pain or pressure radiating to the neck, jaw, epigastrium, or left arm What condition?

Classic MI

What makes first heart sound? Second?

Closure of mitral and tricuspid valves Closure of aortic and pulmonary valves

What can happen to fingers in CHF?

Clubbing

Type of necrosis seen in MI

Coagulatiion necrosis

____________ (narrowing, or constriction) of the aorta is a common form of obstructive congenital heart disease

Coarctation

Surface factor example

Collagen

________ has a key role in the structure and hemostatic function of small blood vessels

Collagen

Ehlers-Danlos syndrome is a disorder of what?

Collagen synthesis

Bundle of His AKA

Common bundle

Internal jugular vein runs supeirorly with which artery?

Common carotid a.

__________ cells constitute the tissues of the SA node, the atrial internodal tracts, the AV node, the bundle of His, and the Purkinje system.

Conducting

Classic Hemophelia AKA

Congenital Factor VIII Defeciency

Right to left shunt AKA

Congenital cyanotic heart disease

Heart failure AKA

Congestive Heart Failure

________ tissue components are present in vascular walls in variable amounts and proportions based on local functional requirements.

Connective

Issues with Drugs in patient with recent MI or unstable angina?

Consider administering prophylactic nitroglycerin just before procedure. Provide continuous oxygen by nasal cannula or nasal mask. The use of excessive amounts of epinephrine with nonselective beta blockers can potentially cause a spike in blood pressure, but this is unlikely and appears to be dose-dependent; avoid the use of epinephrine-impregnated retraction cord.

Issues with equipment in patient with mild angina or recent MI?

Consider taking preoperative vital signs and the use of a pulse oximeter if oral sedation is used, or if the patient becomes symptomatic.

found in muscle, connective tissue, lungs, exocrine glands, and nervous tissue. Ultrastructural studies show numerous vesicles indicating transcytosis of macromolecules in both directions across the endothelial cell cytoplasm. What type of capillary?

Continuous

have many tight, well-developed occluding junctions between slightly overlapping endothelial cells, which provide for continuity along the endothelium and well-regulated metabolic exchange across the cells. What type of capillaries?

Continuous

the most common type, have tight, occluding junctions sealing the intercellular clefts between all the endothelial cells to produce minimal fluid leakage. Which type of capillary?

Continuous

Issues with blood pressure in patient with recent MI or unstable angina?

Continuous monitoring of blood pressure and pulse is recommended.

____________ capillaries exert the tightest control over what molecules leave and enter the capillary lumen. The TEM shows a continuous capillary in transverse section. An ___________ cell nucleus is prominent, and _____ or _________ junctions are abundant in the junctional complexes at overlapping folds between the ___________ cells. Numerous transcytotic vesicles are evident. All material that crosses continuous capillary endothelium must pass through the ______, usually by ____________ or ________________.

Continuous, endothelial, tight, occluding, endothelial, cells, transcytosis, diffusion

___________ cells constitute the majority of atrial and ventricular tissues and are the working cells of the heart.

Contractile

Right ventricular hypertrophy and dilation- frequently accompanied by right heart failure- caused by pulmonary hypertension due to primary disorders of lung parenchyma or pulmonary vascularature

Cor pulmonale

Where do ribs attach on vertebrae?

Costal facets

Largest and most important clinical recess Where is it found?

Costodiaphragmatic recess infeirorly between the thoracic wall and the diaphragm

_______________ joints are synovial joints between the tubercle of a rib and the transverse process of the related vertebra

Costotransverse

Rales AKA

Crackles

Unstable angina AKa

Crescendo angina

muscular extensions that attach the diaphragm to the upper lumbar vertebrae

Crura

R-R interval AKA

Cycle length

Appropriate measures from stages A, B, and C Heart transplant recipients: chronic inotropes, permanent mechanical support, experimental drugs or surgery Compassionate end-of-life care/hospice care Treatment of patients with what stage of HF?

D

HF: If drug therapy is found to be inadequate to control the severe, refractory HF (stage _), mechanical and surgical intervention may be provided.

D

Patients with Refractory HF Requiring Special Interventions Which stage of HF?.

D

What is elevated in plasma in DVT

D-Dimer

Dilated Cardiomyopathy AKA

DCM

Dilated cardiomyopathy AKA

DCM

Dilated cardiomyopathy: AKA?

DCM

Disseminated intavascular coagulation AKA

DIC

Argatroban is another oral ___ drug which is an effective alterative to _______ when the latter is contraindicated following an episode of _______-induced thrombocytopenia (___)

DTI, heparin, heparin, HIT

Parasympathetic activity effects on: Heart rate? Conduction velocity? Contractility? Vascular smooth muscle (internal organs)? Vascular smooth muscle (skeletal muscle)?

Decraeased Decreased Decreased (atria only) Dilation Dilation

changes that effect teh integrity of the valvular ECM

Degenerative Valve Disease

Partial facets AKA

Demifacets

Anchoring and supporting the heart valves Providing firm points of insertion for cardiac muscle Helping coordinate the heartbeat by acting as electrical insulation between atria and ventricles All are functions of what type of tissue in the heart?

Dense irregular connective tissue

Issues with devices in patients with HF

Dental patients with a diagnosis of HF may have pacemakers, implanted defibrillators, or prosthetic valves, in which case published guidelines should be followed.

Pulmonary artery carries deoxygenated or oxygenated blood?

Deoxygenated

swelling of the feet or ankles after standing or walking

Dependent Edema

Subcostales may _______ ribs

Depress

Diaphragm contracts. It is depressed or raised?

Depressed

Action of transversus thoracis?

Depresses costal cartilages

Musculotendinous structure that seals the inferior thoracic aperture

Diaphragm

Base of lung AKA

Diaphragmatic surface

________ pressure is the lowest arterial pressure measured during a cardiac cycle and is the pressure in the arteries during ventricular relaxation when no blood is being ejected from the left ventricle.

Diastolic

MAP equation

Diastolic pressure + (1/3 * pulse pressure)

Digoxin (Lanoxin) What drug type? Vasoconstrictor side effects? Oral problems? Other considerations?

Digitalis Increased risk of arrythmias; avoid use if possible Increased gag reflex, increased salivation Erythromycin and clarithromycin can induce toxic effects- avoid!

Headache, nausea, vomiting Hypersalivation Altered vision and color perception Fatigue, malaise, drowsiness Arrhythmias (tachycardias or bradycardias) What condition?

Digitalis toxicity

Digitalis glycoside (common drug)

Digoxin

Arrythmogenci Right ventricular cardiomyopathy What type of cardiomyopathy?

Dilated

Heart is enlarged 2 to 3x original size and has flabby dilations of all chambers What type of cardiomyopathy?

Dilated

Most common cardiomyopathy

Dilated

Clinical categories of cardiomyopathies (3)

Dilated cardiomyopathies Hypertrophic cardiomyopathy Restrictive Cardiomyopathy

Left ventricular ejection fraction <40% Impairment of contractility Caused by genetics, alcohol, peripartum, myocarditis, hemochromatosis, chronic anemia, Doscorubin, sarcodiosis, idiopathic What disease?

Dilated cardiomyopathy

Progressive cardiac dilation, systolic dysfunction, concurrent hypertrophy What disease?

Dilated cardiomyopathy

Myocytes with hypertrophy, enlarged nuclei, some are attenuated, irregular, and irregular What type of cardiomyopathy?

Dilated due to iron overload

Enlargement AKA

Dilation

riviroxoban Drug type?

Direct Xa inhibitor anticoagulant

now been developed as anticoagulants. Rivaroxaban has been shown to be an effective alternative to warfarin for the treatment and prevention of venous thrombosis and for the prevention of stroke in patients with atrial fibrillation.

Direct Xa inhibitors

Dabigatran Drug type?

Direct thrombin inhibitor anticoagulant

hydralazine, isosorbide dinitrate Drug type?

Dirrect acting vasodilators

Sinusoid capillaries AKA

Discontinuous

Defects in platelet-agonist interactions, abnormalities in arachidonic acid pathway What type of disorder?

Disorder of platelet secretion and signal transduction

Storage pool disorders affecting alpha granules, dense granules or both What type of disease?

Disorder of storage granules

Anterior end of each rib is proximal or distal?

Distal

Line of defense for drugs of pateints with CHF

Diuretic ACE inhibitor Beta blocker Angiotensin Receptor Blocker

_________ are used for three purposes in HF patients: They are the only drugs that can adequately control fluid retention, they produce more rapid symptomatic relief than that achievable with other drugs, and they modulate other drugs used to treat HF.

Diuretics

_______ (shortness of breath) on exertion is usually the earliest and most significant symptom of left-sided heart failure; cough also is common as a consequence of fluid transudation into air spaces. As failure progresses, patients experience dyspnea when recumbent (___________); this occurs because the supine position increases venous return from the lower extremities and also elevates the diaphragm.

Dypsnea, orthopenia

Perceived shortness of breath

Dyspnea

Electrocardiogram AKA

ECG

Elecrocardiogram AKA (2)

ECG EKG

When blood leaves the circulatory system, either in a test tube or in the extracellular matrix (___) surrounding blood vessels, plasma proteins react with one another to produce a clot, which includes formed elements and a pale yellow liquid called _____

ECM, serum

•Thrombolysis (for patients with ST segment elevation only) •Percutaneous transluminal coronary angioplasty with stenting •Coronary artery bypass grafting All are methods of what aspect of treating a patient with acute MI?

Early revascularization

Left to right heart shunt: Such reversal of flow and shunting of unoxygenated blood into the systemic circulation is called ___________ ________. Once significant pulmonary hypertension develops, the structural defects of congenital heart disease are considered _____________. This is the rationale for early surgical (or even nonsurgical) intervention.

Eisenmenger syndrome, irreversible

The effectiveness of the ventricles in ejecting blood is described by the ________ ________, which is the fraction of the end-diastolic volume that is ejected in one stroke volume. Normally, ejection fraction is approximately ____, or __%. The ejection fraction is an indicator of _____________, with increases in ejection fraction reflecting an ________ in contractility and decreases in ejection fraction reflecting a __________ in contractility. Thus, Ejection fraction=Stroke volume / End-diastolic volume

Ejection fraction, 0.55, 55, contractility, increase, decrease

List types of vascularature, starting at the heart and going thr oughout the circulatory system (ranked based on size)

Elastic arteries Muscular arteries Small arteries Arterioles Capillaries Venules Small veins Medium veins Large veins

_______ arteries are the aorta, the pulmonary artery, and their largest branches; these large vessels are also called __________ arteries because their major role is to carry blood to smaller arteries.

Elastic, conducting

a measurement of tiny potential differences on the surface of the body that reflect the electrical activity of the heart

Electrocardiogram

Diseases of children and young adults in Africa and other tropical areas; dense diffuse fibrosis of the ventricular endocardium and subendocardium, often involving mitral and tricuspid valves What disease?

Endomyocardial fibrosis

___________ cells form the capillary lumen, are covered by a _____ ______, and are bound tightly together with __________ _________. One pericyte is shown, surrounded by its own ______ ______ and with cytoplasmic extensions which surround the ___________ cells.

Endothelial, basal lamina, junctional complexes, basal lamina, endothelial

EDRF stands for what? What was originally called this?

Endothelium Derived Relaxation Factor Nitric Oxide

Issues with chair position in patient with mild angina or recent MI?

Ensure a comfortable chair position and avoid rapid position changes.

Issues with chair position in patient with recent MI or unstable angina?

Ensure a comfortable chair position and avoid rapid position changes.

Issues with analgesics in patient with recent MI or unstable angina?

Ensure adequate postoperative pain control.

Issues with analgesics in patient with mild angina or recent MI?

Ensure adeuqate posteperative pain control

Issues with follow-up in patient with mild angina or recent MI?

Ensure that patient is maintaining regular follow-up visits with physician.

Issues with follow-up in patient with recent MI or unstable angina?

Ensure that patient is maintaining regular follow-up visits with physician.

___________ have bilobed nuclei and eosinophilic specific granules containing factors for destruction of helminthic parasites and for modulating inflammation

Eosinophils

Granulocytes

Eosinophils Basopihls Neutrophils

Visceral layer of serous pericardium AKA

Epicardium

Biconcave disc cells in blood

Ertyrhrocytes

Strucutres that penetrate the diapgrahm (2) Structure that passes posteriorly to the diaphragm

Esophagus, inferior vena cava Aorta

Issues with bleeding in patients with HF?

Excessive bleeding may occur in the patient with untreated or poorly controlled HF, because the medical treatment regimen typically includes anticoagulants (e.g., warfarin, clopidogrel), which are associated with greater risk for postsurgical bleeding and development of hypotension.

the capacity of myocardial cells to generate action potentials in response to inward, depolarizing current

Excitability

Inability to climb a flight of stairs

Exercise intolerance

Most active during inspiration; supports intercostal space; moves ribs superiorly What muscle?

External intercostal

Layers of intercostal muscles, from superficial to deep. What direction do they run from the ribs? Between which layers are the intercostal branches of vessels and nerves?

External intercostal muscles- Back to front Internal intercostal muscles- Front to back Innermost intercostal muscles- Front to back Between internal and innermost intercostal muscles

Exposure to tissue factors activates which system of clotting?

Extrinsic

Discontinuation of antiplatelet agents and anticoagulants (e.g., warfarin) before dental treatment and routine extractions generally is needed. True or false?

FALSE!! UNNECESSARY!

Fibrin Degradation Products AKA

FDP

Antithrombin inhibits what (3)?

Factor IXa Factor Xa Thrombin

What facotr is often low in Von Willebrand Diseae (in additon to vWF)?

Factor VIII

`Activated Protein C and S complex inhibits what? (2)

Factor Va Factor VIIIa

Long PT is seen in defecieincies in waht proteins (4)

Factors VII, X, V, II

Congenital hemophelias are defecient in what proteins (3)

Factors VIII, IX ,XI

Syncope AKA

Fainting

capillaries that are found in organs where molecular exchange with the blood is important, such as endocrine organs, intestinal walls, and choroid plexus. What type?

Fenestrated

found in organs with rapid interchange of substances between tissues and the blood, such as the kidneys, intestine, choroid plexus, and endocrine glands. What type of capillaries?

Fenestrated

have a sieve-like structure that allows more extensive molecular exchange across the endothelium. The endothelial cells are penetrated by numerous small circular openings or fenestrations (L. fenestra, perforation), approximately 80 nm in diameter. What type of capillaries?

Fenestrated

have tight junctions, but perforations (fenestrations) through the endothelial cells allow greater exchange across the endothelium. Which type of capillaries?

Fenestrated

Capillaries with large pores in their walls

Fenestrated capillaries

____________ capillaries are specialized for uptake of molecules such as hormones in endocrine glands or for outflow of molecules such as in the kidney's filtration system. TEM of a transversely sectioned fenestrated capillary in the peritubular region of the kidney shows many typical fenestrae closed by __________, with a continuous _____ ______ surrounding the endothelial cell. In this cell the Golgi apparatus, nucleus, and centrioles can also be seen. Fenestrated capillaries allow a freer exchange of molecules than __________ capillaries and are found in the intestinal wall, kidneys, and endocrine glands.

Fenestrated, diaphragms, basal lamina, continuous

Perforations AKA

Fenestrations

a degradation product of crosslinked fibrin and a marker of fibrin turnover

Fibrin D-dimer

Thrombin catalyzes what reaction

Fibrinogen to fibrin

What type of necrosis seen in Libman-Sacks endocarditis? What causes this?

Fibrinoid Deposition of Lupus immune deposits

tPA, urokinasae, and streptokinase Drug type?

Fibrinolytic drugs

The ____ _________ states that there is conservation of mass, a concept that can be applied to the utilization of O2 by the body. In the steady state, the rate of O2 consumption by the body must equal the amount of O2 leaving the lungs in the pulmonary vein minus the amount of O2 returning to the lungs in the pulmonary artery.

Fick principle

volume flow per unit time and is expressed in units of volume per unit time (e.g., mL/sec).

Flow

Report of weight gain or increased abdominal girth in HF Sign of what?

Fluid accumulation, ascites

Where do myxomas typically arise?

Fossa ovalis area of atrial septum

The Frank-Starling law of the heart, or the _____-________ ____________, is based on landmark experiments. It states that the volume of blood ejected by the ventricle depends on the volume present in the ventricle at the end of ________.

Frank Starling relationship, diastole

Increased end-diastolic filling volumes dilate the heart and cause increased cardiac myofiber stretching; these lengthened fibers contract more forcibly, thereby increasing cardiac output. What mechanism?

Frank-Starling Mechanism

reperfusion injury: ____ ________ are produced within minutes of reperfusion

Free radicals

Bucket handle vs. pump handle Which is front to back? Which is lateral movement?

Front to back- pump handle Lateral- bucket handle

Causes of dilated cardiomyopathy (5)

Genetic Infection Alcohol Peripartum Iron overload

Activation of muscarinic receptors in the SA node has two effects that combine to produce a decrease in heart rate. First, these muscarinic receptors are coupled to a type of __ protein called __ that ________ adenylyl cyclase and produces a ________ in If. A decrease in If __________ the rate of phase 4 depolarization. Second, Gk directly _________ the conductance of a K+ channel called K+-ACh and increases an _______ K+ current (similar to IK1) called IK-ACh.

Gi, GK, inhibits, decrease, decreases increases, outward

Morphologically distinctive entitiy characterized by widespread inflammatory cellular infiltrates containing multinucleate giant cells What disease?

Giant cell myocarditis

Congenital deficiency of GPIIb-IIIa (the rare ____________ _____________) causes a severe bleeding disorder; in contrast, deficiencies of either fibrinogen or vWF cause a milder bleeding disorder, because these two ligands can substitute for each other.

Glanzmann's thrombasthenia

Platelet GPIIb-IIIa deficiency What disease?

Glanzmanns thromboasthenia

Less common congenital platelet-related bleeding disorders include ____-__ deficiency (Bernard-Soulier syndrome), ____-____ deficiency (Glanzmann's thrombasthenia), and __________ deficiency (because fibrinogen bridges GPIIb-IIIa receptors of adjacent platelets).

GpIb-IX, GpIIb-IIIa, fibrinogen

Hypertrophic Cardiomyopathy AKA

HCM

Hypertrophic cardiomyopathy AkA

HCM

A variety of specialized tests are used to diagnose __ and monitor affected patents, depending on the etiology. Among these are plain radiography of the chest, electrocardiogram, echocardiography, radionuclide angiography or ventriculography, exercise stress test, ambulatory electrocardiogram monitoring, and cardiac catheterization.

HF

Dyspnea (perceived shortness of breath) Fatigue and weakness Orthopnea (dyspnea experienced with patient in recumbent position) Paroxysmal nocturnal dyspnea (dyspnea awakening patient from sleep) Acute pulmonary edema (cough or progressive dyspnea) Exercise intolerance (inablility to climb a flight of stairs) Fatigue (especially muscular) Dependent edema (swelling of feet and ankles after standing or walking) Report of weight gain or increased abdominal girth (fluid accumulation; ascites) Right upper quadrant pain (liver congestion) Anorexia, nausea, vomiting, constipation (bowel edema) Hyperventilation followed by apnea during sleep (Cheyne-Stokes respiration) Symptoms of what disease?

HF

HEart failure AKA

HF

Heart Failure AKA

HF

Muscular fatigue is a sign of what?

HF

Patients with untreated or poorly managed __ are at high risk during dental treatment for complications such as cardiac arrest, stroke (cerebrovascular accident), and MI.

HF

The American College of Cardiology/American Heart Association (ACC/AHA) 2010 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult defines __ as a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood

HF

__ is the most common Medicare diagnosis-related group (i.e., hospital discharge diagnosis), and more Medicare dollars are spent for the diagnosis and treatment of the disease than for any other clinical entity

HF

rales (or crackles), representing alveolar fluid, are a classic feature of __ when present.

HF

Exercise intolerance (e.g., inability to climb a flight of stairs) is one of the hallmark symptoms of __ and is due to a combination of dyspnea and reduced blood and oxygen supply to the skeletal muscles. Fatigue (especially _______ fatigue) is a common, nonspecific symptom.

HF, muscle

Fitzgerald, Flaujeac or Williams factor, contact activation cofactor AKA

HMWK

Heart rate relationship to cycle length

HR = 1 / cycle length

a diagnostic method for assessing the lungs but more specifically the interstitium of the lungs. The technique involves obtaining narrow cross-sectional slices of 1 to 2 mm. These scans enable the physician and radiologist to view the patterns of disease and their distribution. Diseases that may be easily demonstrated using this procedure include emphysema, pneumoconiosis (coal worker's pneumoconiosis), and asbestosis

HRCT

Myocardial infarction AKA

Heart attack

The pain in the chest (which may be described as an "elephant sitting on my chest" or by using a clenched fist to describe the pain [Levine sign]) often radiates to the arms (left more common than the right), and can be associated with nausea. What conditioon?

Heart attack

Coronary heart disease Cardiomyopathy Hypertension Valvular heart disease Myocarditis Infective endocarditis Congenital heart disease Pulmonary hypertension Pulmonary embolism Endocrine disease Most common causes of what disease?

Heart failure

Rapid, shallow breathing Cheyne-Stokes respiration (hyperventilation alternating with apnea) Inspiratory rales (crackles) Heart murmur Gallop rhythm Increased venous pressure Enlargement of cardiac silhouette on chest radiograph Pulsus alternans Distended neck veins Large, tender liver Jaundice Peripheral edema Ascites Cyanosis Weight gain Clubbing of fingers Signs of what disease?

Heart failure

primarily a condition of the elderly and as such it is a major and growing public health problem in the United States

Heart failure

measured by counting the number of QRS complexes (or R waves because they are most prominent) per minute.

Heart rate

the principles that govern blood flow in the cardiovascular system

Hemodynamics

Coagulation factor defeciency AKA

Hemophelia

__________ constitutes a number of processes which guard the body against blood loss.

Hemostasis

__________ requires the coordinated function of blood vessels platelets, coagulation factors and the fibrinolytic system

Hemostasis

means 'the arrest of bleeding'

Hemostasis

Fibrin inhibitor example

Heparin

referred to as indirect Xa inhibitors due to their augmentation of antithrombin activity.

Heparins

Small vessel has relatively high or low blood velocity? Large vessel?

High Low

Bivalirudin, a derivative of hirudin, originally obtained from the medicinal leech, ______ ___________, is a parenteral ___ which has been shown to be effective for the treatment of acute coronary syndromes.

Hiruduo medicinalis, DTI

Electrocardiogram monitoring AKA

Holter monitoring

Interstitial and perivascular infiltrates composed of macrophages, lymphocytes, and high proportion of eosinophils cause myocarditis Waht disease?

Hypersensitivity myocarditis

_____________ or elevated blood pressure may occur secondarily to renal or endocrine problems, but is more commonly _________ hypertension, due to a wide variety of mechanisms that increase __________ __________.

Hypertension, essential, arteriolar constriction

Assymetric septal hypertrophy What disease?

Hypertrophic cardiomyopathy

HUGELY hypertrophied left ventricle that paradoxically provedes a reduced stroke volume Wat disease?

Hypertrophic cardiomyopathy

Left ventricular ejection fraction 50-80% Impairment of compliance Caused by genetics, Fredrich ataxia, storage diseases, infans of diabetic mothers What disease?

Hypertrophic cardiomyopathy

Marked myocyte hypertrophy haphazard myocyte and myofiber disarray Interstitial fibrosis What disease?

Hypertrophic cardiomyopathy

Myocardial hypertrophy, defective diastolic filling- and in 1/3 of cases obstructed ventricular outflow What condition

Hypertrophic cardiomyopathy

Fibrinogen Which factor?

I

Congenital deficiencies of coagulation factors (_-_____) result in excessive ________

I, XIII, bleeding

The subclavius is small and passes laterally from the anterior and medial part of rib _ to the inferior surface of the ________.

I, clavicle

RIbs with costal cartilages that articulate with the sternum

I-VII

Integrin receptors on leukocyte membrane

ICAM-1

Implantable Cardioverter-Defibrillator AKA

ICD

Ischemic Heart Disease AKA

IHD

Prothrombin Which factor?

II

Recently, use of an implantable cardioverter-defibrillator (ICD) has demonstrated benefit in treating patients with HF of NYHA class __ or ___.

II, III

Vitamin K defeciency leads to defeciency of what coagulation factors (4)

II, VII, IX, X

Tissue factor Which factor?

III

Tissue factor was formerly known as factor ___, calcium ion as factor __; factor __ does not exist.

III, IV, VI

Activated macrophages secrete which cytokines to activate selectin expression (2)

IL-1 TNF-alpha

Left ventricular hypertrophy: seen more in patientss with mitral stenosis or insuffeceincy?

INsuffeceincy

Broad term encompassing several closely related syndromes caused by mocardial ischemia- an imabalnce between cardiac blood supply and myocardial oxygen and nutritional requirements

ISCHEMIC HEART DISEASE

Calcium ion Which factor?

IV

NYHA Classification of heart failure: •Class ___: Symptoms are present with the patient at rest, and any physical exertion exacerbates the symptoms. •Class ___: Slight limitation of physical activity. Patients experience fatigue, palpitations, and dyspnea with ordinary physical activity but are comfortable at rest. •Class ___: Marked limitation of activity. Less than ordinary physical activity results in symptoms, but patients are comfortable at rest. •Class ____: No limitation of physical activity. No dyspnea, fatigue, or palpitations with ordinary physical activity.

IV II III I

Joint between the costal margin and sternum lies in which plane?

IV disc between T11 and T12

Superior margin of the manubrium is found at which vertebral level?

IV disc between T2 and T3

What vertebral level passes through the sternal angle anteriorly, marking the position of the anterior articulation of the costal cartilage of rib II with the sternum. The sternal angle is used to find the position of rib II as a reference for counting ribs (because of the overlying clavicle, rib I is not palpable)?

IV disc between T4 & T5

IV disc that marks the superior limit of the pulmonary trunk.

IV disc between T4 adn T5

What vertebral level marks the superior limit of the pulmonary trunk.

IV disc between T4 adn T5

Vertebral level of sternal angle

IV disc between T4 and T5

What is the level at which the trachea bifurcates into right and left main bronchi

IV disc between T4 and T5

What level marks where the arch of the aorta begins and ends?

IV disc between T4 and T5

What verbtebral level separates the superior mediastinum from the inferior mediastinum and marks the position of the superior limit of the pericardium

IV disc between T4 and T5

What vertebral level passes through the site where the superior vena cava penetrates the pericardium to enter the heart

IV disc between T4 and T5

Christmas factor Which factor?

IX

XIa activates what factor? Along with what cofactor?

IX Ca2+

Antithrombin inhibits what factors? (3)

IXa Xa Thrombin

Issues with bleeding in patient with mild angina or recent MI?

If patient is taking aspirin or other antiplatelet medication, anticipate some excessive bleeding, but modification of drug regimen is not required.

Issues with bleeding in patient with recent MI or unstable angina?

If patient is taking aspirin or other antiplatelet medication, anticipate some excessive bleeding, but modification of drug regimen is not required.

Fundamental defect in DCM?

Impaired contraction

Arteriosclerosis effect on arterial pressure? Aortic stenosis effect?

Increased Decrased

Sympathetic effects on: Heart rate? Conduction velocity? Contractility? Vascular smooth muscle (internal organs)? Vascular smooth muscle (skeletal muscle)?

Increased Increased Increased Contraction Dilation

"_________" (_________) coarctation is characterized by circumferential narrowing of the aortic segment between the left subclavian artery and the ductus arteriosus; the ductus typically is patent and is the main source of (____________) blood delivered to the distal aorta. The pulmonary trunk is dilated to accommodate the increased blood flow; because the right side of the heart now perfuses the body distal to the narrowed segment ("_____"), the right ventricle typically is hypertrophied.

Infantile, preductal, deoxygenated, coarct

Microbial invasion of mural endocardium or heart valves- often with destruciton of underlying cardiac tissues- characteristiaclly results in bulkuy, friable vegetations composed of necrotic debris, thrombus, and organisms What disease?

Infective endocarditis

Posteiror attachment of the diaphragm is superior or inferior to the anterior attachment?

Inferior

Posterior margin of the inferior thoracic aperture is superior or inferior to the anteiror?

Inferior

Large and expandable thoracic aperture

Inferior thoracic aperture

Inferior opening fo the thorax. IS it big or small?

Inferior thoracic aperture Big

Which is more anterior, inferior vena cava or esophagus?

Inferior vena cava!

Conus arteriosus AKA

Infundibulum

What do cardiac glycosides do?

Inhibit Na+/K+ ATPase

Statin mechanism of action

Inhibitor of HMG-CoA reductuase, decreasing cholesterol synthesis

O: Medial edge of costal groove of rib above I: Internal aspect of superior margin of rib below Which intercostal muscle?

Innermost intercostal muscle

Crackles in lungs AKA

Inspiratoryy rales

Incompetency AKA

Insuffeciency

Innervation of external intercostal muscle

Intercostal nervers T1- T11

Nerves that innervate the thoracic wall, parietal pleura, adn associated skin

Intercostal nerves

Innervation of internal intercostal muscles?

Intercostal nerves T1- T11

Innervation of innermost intercostal muscles

Intercostal nerves T1-T11

Innervation of subcostales muscle

Intercostal nerves nearby

____________ ______ lie between adjacent ribs and are filled by intercostal muscles

Intercostal spaces

Common carotid a. runs superiorly with which vein?

Interior jugular v.

•History of ischemic heart disease •History of compensated or previous heart failure •History of cerebrovascular disease •Diabetes mellitus •Renal insufficiency what cardiovascular risk factor category?

Intermediate

•Intraperitoneal and intrathoracic surgery •Carotid endarterectomy •Head and neck surgery •Orthopaedic surgery •Prostate surgery What risk category for noncardiac surgeries?

Intermediate

O: Lateral edge of costal groove of rib above I: Superior margin of rib below deep to the attachment of the related external intercostal What muscle?

Internal intercostal

Most active during expiration; supports intercostal space; moves ribs inferiorly Which intercostal muscles?

Internal intercostal muscles

Innermost intercostals work with what other muscle group? Expiration or insprition? Moves ribs up or down?

Internal intercostal muscles Expiration Down

Anterior intercostal arteries arise from where?

Internal thoracic arteries

Which is more medial: Internal thoracic artery or internal throacic vein

Internal thoracic artery

Coagulation factors go through what pathways (3)

Intrinsic Extrinsic Final Common

What ions/movements are involved in cardiac cycle: Phase 1? Phase 2? Phase 3? Phase 4?

Inward Na+ Inward Ca2+, outward K+ Inward Ca2+ (less), outward K+ (more) Outward K+, Inward Na+, inward Ca2+

Results from hereditary hemochromatosis or multiple transfusions What condition effecting heart?

Iron overload

Electirical instability AKA

Irritability

Acute MI Angina pectoris Congestive heart failure Sudden cardiac death All signs of what disease?

Ischemic heart disease

Ventricular PV loop: Phases?

Isovolumetric contraction Ventricular ejection Isovolumeteric relaxation Ventricular filling

Issues with anesthesia in patients with HF

It is very important to achieve and maintain excellent anesthesia in order to reduce stress and prevent cardiac crisis. Use of epinephrine (1:100,000) at a dose of no more than 2 carpules in local anesthetics generally causes no problems, but patients should be monitored closely. Clinicians should provide good postoperative pain control. General anesthesia should be avoided.

The zone of pericardial reflection surrounding the veins is _-shaped, and the cul-de-sac formed within the _, _________ to the ____ _______, is the _______ ___________ _____

J, J, posteiror, left atrium, oblique pericardial sinus

Painless palm or sole erythrematous lesions in endocarditis?

Janeway lesions

Spironolactone drug type What other action does it have?

K+ sparing diuretic Aldosterone antagonist

Amiloride (Midamor) Spironolactone (Aldactone) Triamterene (Dyrenium) What drug type? Vasoconstrictor side effects? Oral problems? Other considerations?

K+ sparing diuretics None Dry mouth Orthostatic hypotension

The arterial supply and venous drainage of the esophagus in the posterior mediastinum involve many vessels. Esophageal arteries arise from the thoracic aorta, bronchial arteries, and ascending branches of the left gastric artery in the abdomen.

Know this!

Pubic symphysis dermatome

L1

Left anterior desceinng artery AKA

LAD

Left ventricular hypertrophy AKA

LVH

Left Ventricular Heart Failure AKA

LVHF

_______ blood flow has a parabolic profile, with velocity lowest at the vessel wall and highest in the center of the stream. _________ blood flow exhibits axial and radial flow.

Laminar, turbulent

Size of elastic arteries Size of muscular arteries

Large Medium

Insertion of pectoralis minor: _______ lip of intertubercular sulcus of humerus

Lateral

Base of the axillary inlet's triangular margin

Lateral aspect of rib 1

_______ and ________ branches of the fourth to sixth intercostal nerves carry general sensation from the skin of the breast.

Lateral, anterior

Origin of pectoralis major: ______ half of clavicle and anterior surface of ______, first _____ costal cartilages, aponeurosis of _________ _______

Lateral, sternum, seven, external oblique

Throacic aorta is on the right or left side of vertebral column?

Left

Which atrium has higher internal pressure?

Left

_____-sided heart failure is most commonly secondary to ischemic heart disease, systemic hypertension, mitral or aortic valve disease, or primary diseases of the myocardium; symptoms are mainly a consequence of pulmonary congestion and edema, although systemic hypoperfusion can cause renal and cerebral dysfunction.

Left

Cusps of the pulmonary valve

Left Right Anterior semilunar cusps

ANteiror interventricular artery AKA

Left Anterior Descending

Veins that join to form the superior vena cava

Left and right braciocephalic veins

Anteiror interventricular branch of left coronary artery AKA (2)

Left anterior descending artery LAD

Lateral x-ray of heart: Which chamber is posterior? Which is anteiror?

Left atrium Right ventricle

Which venous shunt system is anteiror in the thorax? Posterior?

Left brachiocephalic vein to supeiror vena cava. Hemiazygous, accessory hemiazygous veins to azygous vein to superior vena cava.

Thoracic wall and diaphragm are subdivided into 3 compartments. what are they?

Left pleural cavity Right pleural cavity Mediastinum

Mural thrombus can lead to what condition?

Left sided thromboembolisms

Congenital disease Spongy appearance of the ventricles, associated with CHF adn arrythmias

Left ventricular noncompaction

_____-to-_____ shunts are the most common type of congenital cardiac malformation. They include atrial septal defects (____), ventricular septal defects (____), and patent ductus arteriosus (___)

Left, right, ASDs, VSDs, PDA

What % of whole blood is buffy coat?

Less than 1%

Ultimate mechanism of SCD?

Lethal arrythmias

Presence of sterile vegetations on teh valves of patients with systemic lupus erythmatosus What condition?

Libman-Sacks endocarditis

It connects the pulmonary trunk with the arch of the aorta and allows blood to bypass the lungs during development What structure?

Ligamentum arteriosum

_____ ____________ ____________ (___) is considered the gold standard for investigating specific disorders of platelet functionok file.

Light Transmission Aggregometry, LTA

O2 CO2 Lipid or water soluble?

Lipid

_____-soluble substances (e.g., O2 and CO2) cross the capillary wall by dissolving in and diffusing across the endothelial cell membranes. In contrast, ______-soluble substances (e.g., ions) cross the capillary wall either through water-filled clefts (spaces) between the endothelial cells or through large pores in the walls of some capillaries (e.g., fenestrated capillaries).

Lipid, water

Localized, poorly encapsulated masses of adipose tissue; can be asymptomatic, create ball-valve obstructions, or produce arrythmias

Lipomas

what organ can be diseased and cause prolonged PT?

Liver

What abdominal viscera is under the right dome of the diaphragm? Left?

Liver Stomach, spleen

Right upper quadrant pain is a sign of what?

Liver congestion

Endocardial fibrosis, typically associated with formation of large mural thrombi, but without geographic predilection What disease?

Loeffler endomyocarditis

The ionic basis for the action potentials in the ventricles, atria, and Purkinje system is identical. The action potential in these tissues shares the following characteristics: ____ duration. In each of these tissues, the action potential is of long duration. Action potential duration varies from 150 msec in atria, to 250 msec in ventricles, to 300 msec in Purkinje fibers. These durations can be compared with the brief duration of the action potential in nerve and skeletal muscle (1 to 2 msec). Recall that the duration of the action potential also determines the duration of the refractory periods: The longer the action potential, the longer the cell is refractory to firing another action potential. Thus, atrial, ventricular, and Purkinje cells have ____ __________ _______ compared with other excitable tissues. ♦ ______ resting membrane potential. The cells of the atria, ventricles, and Purkinje system exhibit a stable, or constant, resting membrane potential. (AV nodal and Purkinje fibers can develop ________ resting membrane potentials, and under special conditions, they can become the heart's _________, as discussed in the section on latent pacemakers.) ♦ Plateau. The action potential in cells of the atria, ventricles, and Purkinje system is characterized by a _______. The plateau is a sustained period of ______________, which accounts for the long duration of the action potential and, consequently, the long refractory periods.

Long, long refractory periods Stable, unstab,e pacemaker plateau, deploarization

Bumetanide (Bumex) Furosamide (Lasix) Torsemide (Demadex) What drug type? Vasoconstrictor side effects? Oral problems? Other considerations?

Loop diuretics None Dry Mouth Orthostatic hypotension

Blood O2 content is highest in what vessels?

Lung capillaries leading into arterial blood

Cylindrical area of the thorax contains which regions (4)

Lungs Wall Mediastinum Pleural cavities (2)

____________, agranulocytes with many functions as T- and B-cell subtypes in the immune system, range widely in size, depending on their activation state, and have roughly spherical nuclei with little cytoplasm and few organelles.

Lymphocytes

_________ are a group of disorders involving neoplastic proliferation of lymphocytes or the failure of these cells to undergo apoptosis.

Lymphomas

Muscarinic AKA

M2

Receptors activated in parasympathetic effects on: Heart rate? Conduction velocity? Contractility? Vascular smooth muscle (internal organs)? Vascular smooth muscle (skeletal muscle)?

M2 M2 M2 M3 M3

The final element included in the AHA/ACC Guidelines is the ability of the patient to perform basic physical tasks. The energy expended in performing these tasks is measured in metabolic equivalents of tasks (____), which is a measure of ________ ____________. Studies have shown that a person who cannot perform at a minimum of a _ MET level is at increased risk for a cardiovascular event.

METs, oxygen consumption, 4

Myocardial infarction AKA

MI

Myocardial infarction AKa

MI

Myocardial infarction KA

MI

acute myocardial infarction AKA

MI

What forms giant cells? Where are they seen?

Macrophage fusion Giant cell myocarditis

Decompensated heart failure (NYHA class 4: worsening or new-onset heart failure) What cardiovascular risk factor category?

Major

Reported Cardiac Risk Often Greater Than 5% What risk category for noncardiac surgeries?

Major

•Aortic and other major vascular surgery What risk category for noncardiac surgeries

Major

Ultrastructurally the eosinophilic specific granules are seen to be oval in shape, with flattened crystalloid cores containing _____ _____ ________ (___), an ________-rich factor that accounts for the granule's acidophilia and constitutes up to __% of the total granule protein.

Major Basic Protein, MBP, arginine, 50

Manubriosternal joint AKA

Manubriosternal symphysis

Components fo the sternum (3)

Manubrium Body Xiphoid process

Sternal angle AKA

Manubrosternal joint

Surgical removal of the breast

Mastectomy

the average pressure in a complete cardiac cycle

Mean arterial pressure

Most commonly double tilting disc devices made of pyrolytic carbon What type of prosthetic heart vavle?

Mechanic

Tyeps of prosthetic heart valves used (2)

Mechanic valves Bioprosthetic valves

Innervation of pectoralis major (2)

Medial pectoral nerve Lateral pectoral nerve

Innervatino of pectoralis minor muscle

Medial pectoral nerves

Thick midline partition that extends from the sternum anteriorly to the thoracic vertebrae posteriorly, and the superior thoracic aperture superiorly to the inferior thoracic aperture inferiorly.

Mediastinum

consisting of abdominal obesity, elevated blood glucose, dyslipidemia, and hypertension What disease?

Metabolic syndrome

Stable angina AKA

Mild angina

Reported Cardiac Risk Generally Less Than 1% What risk category for noncardiac surgeries?

Minor

•Advanced age (>70 years) •Abnormal ECG electrocardiogram (left ventricular hypertrophy, left bundle branch block, ST-T wave abnormalities) •Rhythm other than sinus (e.g., atrial fibrillation) •Uncontrolled systemic hypertension (≥180/110 mm Hg) What cardiovascular risk factor category?

Minor

•Endoscopic procedures •Superficial procedures •Cataract surgery •Breast surgery •Ambulatory surgery What risk category for noncardiac surgeries?

Minor

Most common target of valvular diseae

Mital valve

Factors contributing to reperfusion injury: _____________ dysfunction _________ hypercontracture _____ ________ _________ aggregation ________ and __________ activation

Mitochondrial Myocyte Free radicals Leukocyte complement, platelet

AV valve of the left heart AKA

Mitral valve

Septomarginal trabecula AKA Where is it found?

Moderator band Right ventricle

Issues with blood pressure in patients with HF?

Monitor blood pressure (BP) throughout procedure because it may significantly increase or decrease in patients with poorly controlled disease. Also monitor blood loss. IF BP drops below 100/60 mm Hg and patient is unresponsive to fluid replacement and vasopressive measures, seek immediate medical attention.

_________ are large agranulocytes with diameters from 12 to 20 µm that circulate as precursors to macrophages and other cells of the mononuclear phagocyte system.

Monocytes

Agranulocytes

Monocytes Lymphocytes

_________ are larger agranulocytes with distinctly indented or C-shaped nuclei that circulate as precursors of macrophages and other cells of the ___________ __________ system.

Monocytes, mononucelar phagocyte

_________ are agranulocytes that are precursor cells of macrophages, osteoclasts, microglia, and other cells of the ___________ _________ system in connective tissue

Monocytes, mononuclear phagocyte

Myxomatous materail AKA

Mucoid material

Fatigue especially seen in HF

Muscular fatigue

Parts of interventricular septum (2)

Muscular part Membranous part

Commonly called "heart attack", necrosis of heart muscle due to ischemia

Myocardial infarction

permanent death of that part of the heart muscle which is supplied by the artery

Myocardial infarction

Diverse group of clinical entities in which infectious agents and/or inflammatory processes primarily target the myocardium

Myocarditis

most common primary tumors of adult heart

Myxomas

One or both mitral leaflets are floppy and prolapse- they balloon back into the left atrium during systole Waht condition

Myxomatous degeneration of the mitral valve

Nonbacterial Thrombotic Endocarditis AKA

NBTE

Is primary pericarditis common?

NO!

If Reynolds number (__) is less than ____, blood flow will be laminar. If Reynolds number is greater than ____, there is increasing likelihood that blood flow will be turbulent. Values greater than ____ always predict turbulent flow.

NR, 2000, 2000, 3000

Nonsteroidal antiinflammatory drugs AKA

NSAIDs

New York Heart Association AKA

NYHA

in atrial, ventricular, and Purkinje fibers, this inward current of the upstroke is carried by ___, and in the SA node, the inward current of the upstroke is carried by ____

Na+, Ca2+

________ ___________ effects are decreases in heart rate. The most important example is that of stimulation of the _____________ nervous system. _____________ released from parasympathetic nerve fibers, activates __________ __ receptors in the SA node.

Negativie ionotropic, parasympathetic, acetylcholline, muscarinic M2

What is most likely to be injured when entering the upper part of an intercostal space?

Nerve

What is the order of anteiror collateral branches of intercostal nerve and vessles?

Nerve Artery Vein

Innervation of subclavius

Nerve to subclavius

Shortest lived leukocytes

Neutrophils

__________, the most abundant type of leukocyte, have polymorphic, multilobed nuclei, and faint pink cytoplasmic granules that contain many factors for highly efficient phagolysosomal killing and removal of bacteria.

Neutrophils

___________ are usually the first leukocytes to arrive at sites of infection where they actively pursue bacterial cells using chemotaxis and remove the invaders or their debris by phagocytosis.

Neutrophils

Rank leukocytes based on most abundant to least (5)

Neutrophils Lymphocytes Monocytes Eosinophils Basophils

potent vasodilator formed by vascular endothelial cells, with a short half-life.

Nitric Oxide

Endothelial cell relaxing factor example? Endothelial cell contraction factor example

Nitric oxide Endothelin

Is cyanosis an early showing of left to right shunts?

No!

Are all capillaries perfused at the same time?

No, only as needed!

What causes rhabdomyomas to go away?

Nobody knows...

Deposition of small thrombotic masses composed mainly of fibrin and platelets on cardiac valves What condition?

Nonbacterial thrombotic endocarditis

Issues with allergy in patient with mild angina or recent MI?

None

Issues with allergy in patient with recent MI or unstable angina?

None

Issues with allergy in patients with HF?

None

Issues with analgesics in patients with HF

None

Issues with antibiotics in patient with recent MI or unstable angina?

None

Issues with blood pressure in patient with mild angina or recent MI?

None

Issues with breathing in patient with recent MI or unstable angina?

None

Issues with equipment in patients with HF

None

issues with breathing in patient with mild angina or recent MI?

None

Lesions associated with systemic diseases of immune function, such as polymyosistis Cause fo what disease?

Noninfectious myocarditis

Carteolol (Cartrol) Carvedilol (Coreg) (alpha/beta blocker) Nadolol (Corgard) Penbutolol (Levatol) Pindolol (Visken) Propranolol (Inderal) Timolol (Blocadren) What drug type? Vasoconstrictor side effects? Oral problems? Other considerations?

Nonselective beta blockers possible increase in BP is possible; cautious use of vasoconstrictors is recommended (maximum 0.036 mg epinephrine; 0.20 mg levonordefrin) Lichenoid reactions Orthostatic hypotension; avoid long term use of NSAIDs

TnI and TnT: Seen in blood usually? When are they detectable after MI? When do they peak? How long do they stay in circulation after MI?

Nope 2 to 4 hours 48 hours after MI 7-10 days

Is there anything remarkable about cardiac angiosarcomas?

Nope!

Oxygen AKa

O2

The amount of O2 in blood (the __ ________) is highest in ________ and ____ ___________ and decreases in _____ ___________, where exchange of O2 and CO2 occurs between blood and tissues.

O2 pressure, arteries, lung capillaries, tissue capillaries

The adventitia of the larger arteries contains a supply of microvasculature to bring __ and __________ to local cells that are too far from the lumen to be nourished by blood there. These arterioles, capillaries, and venules constitute the ____ _______ (vessels of vessels). The adventitia of large arteries is also supplied more sparsely with small ____________ nerves for control of _______________. Above the adventitia in this section can be seen muscle fibers and elastic lamellae in the _______.

O2, nutrients, vasa vasorum, sympathetic, vasoconstriction, media

Formed by reflection of serous pericardium onto pulmonary veins of heart Which pericardial sinus?

Oblique pericardial sinus

Which type of thrombus is more sever in atherosclerosis: mural or occlusive?

Occlusive

The relationship of flow, pressure, and resistance is analogous to the relationship of current (I), voltage (ΔV), and resistance (R) in electrical circuits, as expressed by _____ ___ (which states that ΔV = I × R or I = ΔV/R).

Ohm's law

Issues with consultation in patiens with HF?

Once the patient is under good medical management, the dental treatment plan can be implemented without changes. Initially, however, consultation with the patient's physician to establish the level of control (as reflected in ejection fraction or other functional measures) is recommended as part of the management program.

Dypsnea experience with patient in recumbent position

Orthopnea

Painful fingertip nodules seen in endocarditis

Osler nodes

______ ______ ASDs (accounting for 5% of these defects) occur at the lowest part of the atrial septum and can be associated with mitral and tricuspid valve abnormalities, reflecting the close relationship between development of the septum primum and the endocardial cushions. In more severe cases, additional defects may include a VSD and a common atrioventricular canal. _____ _______ ASDs (accounting for another 5% of the cases) are located high in the atrial septum and often are accompanied by anomalous drainage of the pulmonary veins into the right atrium or superior vena cava.

Ostium primum Sinus venosus

______ ________ ASDs (90% of ASDs) typically are smooth-walled defects near the foramen ovale, usually without other associated cardiac abnormalities.

Ostium secundum

represents depolarization of the atria. The duration of the wave correlates with conduction time through the atria; for example, if conduction velocity through the atria decreases, the wave will spread out. Atrial repolarization is not seen on a normal ECG because it is "buried" in the QRS complex. Which part of EKG?

P wave

Platelet-activating factor (___) from the vessel wall may also activate _________ in hemostasis

PAF, platelets

in the root of the neck, the right vagus nerve gives off the right recurrent laryngeal nerve, which "hooks" around the right subclavian artery as it passes over the cervical pleura. If a patient has a hoarse voice and a right vocal cord palsy is demonstrated at laryngoscopy, chest radiography with an apical lordotic view should be obtained to assess for cancer in the right lung apex what condition?

PANCOAST tumor

Patent Ductus Arteriorsus AKA

PDA

Persistent Ductus Arteriosus AKA

PDA

Posterior descending artery AKA

PDA

Paroxsymal Nocturnal Dypsnea AKA

PND

the time from initial depolarization of the atria to initial depolarization of the ventricles. Thus, the interval includes the P wave and the PR segment, an isoelectric (flat) portion of the ECG that corresponds to AV node conduction. Because the interval includes the PR segment, it also correlates with conduction time through the AV node Which part of the EKG?

PR interval

Located on valves, form clusters of hairlike projections that look like sea aneomonies

Papillary fibroelastomas

Usually incidentally identified lesions of the heart, but can embolize

Papillary fibroelastomas

________ resistance is illustrated by the distribution of blood flow among the various major arteries branching off the aorta

Parallel

___________ nodes drain into bronchomediastinal trunks.

Parasternal

Outer pleural layer? Inner?

Parietal pleura Visceral pleura

Sporadic abnormalities in myocardial conduction

Parosxymal arrythmias

an attack of sudden, severe shortness of breath awakening the patient from sleep, usually within 1 to 3 hours after the patient goes to bed, and resolving within 10 to 30 minutes after the patient awakens, often gasping for air.

Paroxsymal Nocturnal Dypsnea

Dypsnea awakening patient from sleep

Paroxsymal nocturnal dypsnea

___________ _________ _______ is a particularly dramatic form of breathlessness, awakening patients from sleep with extreme dyspnea bordering on feelings of suffocation.

Paroxsymal nocturnal dypsnea

In which subset of MI patients do you use early thrombolytic therapy?

Pateients with ST segment elevation

Issues with devices in patient with recent MI or unstable angina?

Patients who have coronary artery stents do not require antibiotic prophylaxis; however, they are likely to be taking aspirin and/or clopidogrel (or other antiplatelet medication) to decrease the chance of stent-related thrombus. Anticipate excessive bleeding, but it generally is unnecessary to discontinue these medications.

Issues with use of devices in patient with mild angina or recent MI?

Patients who have coronary artery stents do not require antibiotic prophylaxis; however, they are likely to be taking aspirin and/or clopidogrel (or other antiplatelet medication) to decrease the chance of stent-related thrombus. Anticipate excessive bleeding, but it generally is unnecessary to discontinue these medications.

Issues with antibiotics in patients with HF

Patients with HF may be more susceptible to infection (leukopenia), but usually this is not a problem. There is no need for antibiotic prophylaxis unless the patient has a prosthetic heart valve or another cardiac condition (refer to AHA guidelines).

Issues with drugs in patients with HF

Patients with HF typically are on many medications. The dentist should be aware of potential side effects and interactions. The use of epinephrine or other pressor amines (either in gingival retraction cord or as agents to control bleeding) must be avoided. Digitalis toxicity may present a problem, so caution should be exercised in treating those patients.

Issues with anxiety in patients with HF

Patients with untreated or poorly controlled HF may appear very anxious and stressed and are at risk for cardiac crisis. Use of special anxiety/stress reduction techniques may be indicated.

Subcutaneous lymphatic obstruction and tumor growth pull on connective tissue ligaments in the breast, resulting in the appearance of an orange peel texture. What is this called?

Peau d'orange

Deep fascia in the breast AKA

Pectoral fascia

Adduction, medial rotation, and flexion of the humerus at the shoulder joint Function of what muscle of the pectoral region?

Pectoralis major

Medial half of clavicle and anterior surface of sternum, first seven costal cartilages, aponeurosis of external oblique Origin of what muscle?

Pectoralis major

Anterior surfaces of the third, fourth, and fifth ribs, and deep fascia overlying the related intercostal spaces Origin of what muscle of pectoral region?

Pectoralis minor

Coracoid process of scapula Insertion of what muscle of the pectoral region?

Pectoralis minor

Depresses tip of shoulder; protracts scapula What muscle of the pectoral region?

Pectoralis minor

This is a technique in which a long fine tube (a catheter) is inserted into the femoral artery in the thigh and passed through the external and common iliac arteries and into the abdominal aorta.

Percutaneous Coronary Intervention

Cardiac blood supply AKA

Perfusion

Effusions and inflammatory conditions, sometimes resulting in fibrous constriction What type of disorders?

Pericardial disorders

Normally, only a tiny amount of fluid is present between the visceral and parietal layers of the serous pericardium. In certain situations, this space can be filled with excess fluid What conditon?

Pericardial effusion

Can result in: cardiac tamponade resolving without sequelae Progress to a chronic fibrosing process What disease?

Pericarditis

Usually happens secondary to acute MI, cardiac surgery, radiation to the mediastinum, or processes involving other thoracic structures (pneumonia or pleuritis) What disease?

Pericarditis

Componenets of the middle mediastinum (2)

Pericardium, heart

Form of dilated cardiomyopathy defined as a deterioration of cardiac function presesnting typically between the last month of pregnancy and up to 6 months postpartum

Peripartum cardiomyopathy

•Antiplatelet drugs (glycoprotein IIa/IIIb inhibitor, aspirin, clopidogrel) •Nitrates •β-Adrenergic blockers •Calcium channel blockers •Angiotensin-converting enzyme (ACE) inhibitors •Lipid-lowering drugs •Anticoagulants (unfractionated heparin, low-molecular-weight heparin) •Morphine •Sedative-hypnotics What type of treatment for acute MI patients?

Pharmacologic therapy

Innervation of fibrous pericardium

Phernic n. (C3-C5)

Which is more anteiror: vagus or phrenic n.?

Phrenic

______ nerves innervate the diaphragm. They arise from the ________ plexus in the neck. These are the ________ rami of spinal nerves __, __, and __, with major contribution from __

Phrenic cervical anterior, C3, C4, C5, C4

What nerves supply the diaphragm?

Phrenic nerves

_______ _____ in a patient with heart failure. A depression ("pit") remains in the edematous tissue for some minutes after firm fingertip pressure is applied.

Pitting edema

_______ inhibitors prevent excessive fibrinolytic activity

Plasmin

One method of platelet function assessment is the ________ ________ ________ (___-___, Siemens)

Platelet Function Analyzer, PFA

_________ can be activated by several chemical agents, including adenosine diphosphate (ADP, released by platelets, erythrocytes, and endothelial cells), epinephrine, collagen, thrombin, and PAF; by infection e.g. HIV, Helicobacter pylori; and by high physical shear stresses.

Platelets

_________ are cell fragments 2-4 µm in diameter derived from megakaryocytes of bone marrow. Their primary function is to rapidly release the content of their granules upon contact with ________ (or other materials outside of the endothelium) to begin the process of ____ formation and reduce blood loss from the vasculature.

Platelets, collagen, clot

_________ are small (2-4 µm) cell fragments derived from megakaryocytes in bone marrow, with a ________ ______ of actin filaments, _____ granules and _____ granules, and an ____ ___________ system of membranous vesicles; rapid degranulation on contact with _________ triggers blood clotting.

Platelets, marginal bundle, alpha, delta, open canalicular, collagen

Area between teh lung and chest wall

Pleural cavity

The factors that determine the resistance of a blood vessel to blood flow are expressed by the ___________ equation

Poisellue

Neutrophils AKA

Polymorphonuclear Leukocytes

Issues with chair position in patients with HF?

Positioning usually is not a problem if the patient is under good medical management; however, a patient who is becoming hypotensive and syncopal from cardiac stress and pulmonary congestion may not tolerate the supine position.

________ ___________ effects are increases in heart rate. The most important example is that of stimulation of the ___________ nervous system. _______________, released from sympathetic nerve fibers, activates _____ receptors in the __ ____. These β1 receptors are coupled to ______ _______ through a __ protein. Activation of β1 receptors in the SA node produces an ________ in If, which _________ the rate of phase 4 depolarization. In addition, there is an increase in ICa, which means there are ____ functional Ca2+ channels and thus ____ depolarization is required to reach threshold (i.e., threshold potential decreases). __________ the rate of phase 4 depolarization and __________ the threshold potential means that the SA node is depolarized to threshold potential ____ frequently and, as a consequence, fires more action potentials per unit time (i.e., _________ heart rate).

Positive chronotropic, sympathetic, Norepinpherine, beta1, SA node, adenyl cylcase, Gs, increase, increases, more, less, Increasing, decreasing, more, increased

Overall effect of cardiac glycosides

Positive inotropic effect

Types of venules (3)

Postcapillary Collecting Muscular

similar to capillaries with pericytes but larger, ranging in diameter from 15 to 20 µm. These are the primary site at which white blood cells adhere to endothelium and leave the circulation at sites of infection or tissue damage. Which vessels?

Postcapillary venules

Which pulmonary plexus is larger?

Posteiror is much larger than anteiror!

Thoracic aorta is located in the _________ mediastinum

Posterior

__________ intercostal arteries originate from vessels associated with the posterior thoracic wall

Posterior

middle cardiac vein AKA

Posterior interventricular vein

_________ and ________ intercostal vessels branch segmentally from these arteries and pass laterally around the wall, mainly along the inferior margin of each rib

Posterior, anterior

smooth muscle bands that lie "before" the capillaries

Precapillary sphincters

Issues with emergencies in patient with mild angina or recent MI?

Precipitation of an angina attack, MI, arrhythmia, or cardiac arrest is possible. Have nitroglycerin readily available as well as oxygen. Be prepared to perform CPR and activate EMS.

Issues with emergencies in patient with recent MI or unstable angina?

Precipitation of an angina attack, MI, arrhythmia, or cardiac arrest is possible. Have nitroglycerin readily available as well as oxygen. Be prepared to perform CPR and activate EMS.

Fletcher factor AKA

Prekalkrien

Hypertension Valvular stenosis what type of states?

Pressure overload

Occurs at rest and is caused by coronary artery spasm

Prinzmetal or variant angina

Cardiac risk factors are those that do what?

Promote development of atherosclerosis

the major arachidonic acid metabolite formed by vascular cells.

Prostacyclin

Cofactor of protien C

Protein S

_________ ____ assesses the extrinsic pathway

Prothrombin tiem

Factor Xa activates the conversion of what to what?

Prothrombin to thrombin

Thrombolysis is used in what type of patient with acute MI?

Pt with elevated ST segment

Cough or progressive dypsnea is a sign of what?

Pulmonary edema

Semilunar valve of the right side of heart

Pulmonic valve

Subendocardial Plexus of Conducting Cells AKA

Purkinjie Fibers

At the apex of the heart, these bundles subdivide further into a subendocardial conducting network of myofibers, usually called _________ ______

Purkinjie fibers

Subendocardial plexus of conduction cells AKA

Purkinjie fibers

_________ ______, located just beneath the endocardium of both ventricles, are distinguished from contractile fibers by their greater diameter, abundant glycogen, and more sparse bundles of myofibrils.

Purkinjie fibers

Blood flow symbol

Q

Flow symbol

Q

Flow formula

Q = (deltaP) / R

EKG abnormalities used for diagnosis of classic MI (3)

Q waves ST segment changes T wave inversions

consists of three waves: Q, R, and S. Collectively, these waves represent depolarization of the ventricles. Note that the total duration of the complex is similar to that of the P wave. This fact may seem surprising because the ventricles are so much larger than the atria; however, the ventricles depolarize just as quickly as the atria because conduction velocity in the His-Purkinje system is much faster than in the atrial conducting system. Which part of the EKG?

QRS Complex

includes the QRS complex, the ST segment, and the T wave. It represents first ventricular depolarization to last ventricular repolarization. The ST segment is an isoelectric portion of the interval that correlates with the plateau of the ventricular action potential. Which part of the EKG?

QT interval

Another point of variation relates to the arterial supply to the sinu-atrial and atrioventricular nodes. In most cases, these two structures are supplied by the _____ ________ artery. However, vessels from the __________ branch of the ____ ________ artery occasionally supply these structures.

RIGHT coronary, circumflex, left coronary

Rotational Thromboelastography AKA

ROTEM

Issues with equipment in patient with recent MI or unstable angina?

Recommended management includes placement of intravenous line, continuous ECG monitoring, ongoing monitoring of vital signs, and use of a pulse oximeter.

Transient/partial obstruction leads to what type of infarct

Regional subendocardial infarct

Innervation of the transversus throacis?

Related intercostal nerves

E-C coupling of cardiac muscle: ___________ occurs when Ca2+ is reaccumulated in the sarcoplasmic reticulum by the action of the ____-______

Relaxation, Ca2+ ATPase

Left ventricular ejection fraction 45%- 90% Impairment of compliance Amyloidosis, radiation-induced fibrosis, idiopathic What diseases?

Restrictive Cardiomyopathy

Primary decrease in ventricular copmliance, resulting in resulting in decreased filling during diastole (stiff walls). Systolic function of Left ventricle is ususally uneffected. What disease?

Restrictive cardiomyopathy

a dimensionless number that is used to predict whether blood flow will be laminar or turbulent. It considers a number of factors including diameter of the blood vessel, mean velocity of flow, and viscosity of the blood.

Reynolds number

Most frequent primary tumors fo the heart of infants and children; normally discovered due to valvular or outflow obstruction

Rhabdomyomas

Cardiac manifestation of rheumatic fever

Rheumatic Heart Disease

Course of the lung from anterio to posterior (inferior margin)

Rib 6 in midclavicular line Rib 8 in midaxillary line Vertebra T10 posteriorly

INferior border of parietal pleura. Map it out from anterior to posterior

Rib 8 in midclavicular line Rib 10 in midaxillary line Vertebrae T12

Bucket handle movement involves what?

Ribs

Ribs with three arcitulations to the vertebral column

Ribs II-XII

Pump handle movement involves

Ribs and sternum

Lateral aspect of the thoracic wall

Ribs, 3 layers of flat muscles that span the intercostal spaces between adjacent ribs move the ribs, and provide support for intercostal spaces

Fluid retention without dypsnea or rales Signs of left or right ventricular failure?

Right

Superior and inferior vena cava are on the left or right side of the body?

Right

ear-like, conical, muscular pouch that externally overlaps the ascending aorta coming from right atrium

Right auricle

Right bronchial artery branches from what?

Right third posterior intercostal artery

Cyanotic congenital heart diseases are caused by what?

Right to left shunt

Chronic cor pulmonale characterized by what (2)

Right ventricular hypertrophy Right atrial hypertrophy

_____-sided heart failure is due most often to _____ heart failure and, less commonly, to primary pulmonary disorders; signs and symptoms are related chiefly to peripheral edema and visceral congestion.

Right, left

Posterior aspects of the anterior poles of the kidneys lie the diaphragm and are anteiror to which ribs on the right and left sides?

Right- rib XII Left ribs XI and XII

retinal hemmorrhages seen in endocarditis?

Roth spots

Series resistance formula

Rtotal = R1 + R2 + R3...+Rn

The action potential spreads throughout the myocardium in the following sequence: 1. __ node. Normally, the action potential of the heart is initiated in the specialized tissue of the SA node, which serves as the _________. After the action potential is initiated in the SA node, there is a specific sequence and timing for the conduction of action potentials to the rest of the heart. 2. Atrial ___________ tracts and ______. The action potential spreads from the SA node to the right and left atria via the atrial internodal tracts. Simultaneously, the action potential is conducted to the AV node. 3. __ node. Conduction velocity through the AV node is considerably slower than in the other cardiac tissues. ____ ___________ through the AV node ensures that the ventricles have sufficient time to fill with blood before they are activated and contract. Increases in conduction velocity of the AV node can lead to decreased ventricular filling and decreased stroke volume and cardiac output. 4. ______ of ___, _________ system, and ventricles. From the AV node, the action potential enters the specialized conducting system of the ventricles. The action potential is first conducted to the bundle of His through the common bundle. It then invades the left and right bundle branches and then the smaller bundles of the Purkinje system. Conduction through the His-Purkinje system is extremely fast, and it rapidly distributes the action potential to the ventricles. The action potential also spreads from one ventricular muscle cell to the next, via low-resistance pathways between the cells. Rapid conduction of the action potential throughout the ventricles is essential and allows for efficient contraction and ejection of blood.

SA internodal, atria AV, Slow conduction Budnle, His, Purkinjie

Sinoatrial node AKA

SA node

To qualify as normal sinus rhythm, the following three criteria must be met: (1) The action potential must originate in the __ _____. (2) The SA nodal impulses must occur regularly at a rate of __ to ___ impulses per minute. (3) The activation of the myocardium must occur in the correct ________ and with the correct ______ and delays.

SA node 60, 100 sequence, timing

The conduction system consists of nodes and networks of specialized cardiac muscle cells organized into _ basic components: ▪ the __ ____, ▪ the __ ____, ▪ the __ ______ with its _____ and ____ ______ _________, and ▪ the _______________ _______ of _________ ______

SA node AV node AV bundle, right, left bundle branches subendocardial plexus conducting cells

Sudden cardiac death AKA

SCD

Supranormal period AKA

SNP

Treatment of patient with acute MI: •Rapid hospitalization and determination of __ _______ changes •_______ administration

ST administration Asprin

Deep muscles in the neck

Scalene muscles

Vitamin C defeciency causes what disease?

Scurvy

Activation of coagulation factors, which activate thrombin which converts fibrinogen to fibrin and develops a clot. Primary or secondary hemostatic plug?

Secondary

Can occur in any one of a number of settings where mitral regurgitaiton is caused by some other entitiy What condition? What can cause this (example)?

Secondary Myxomatous Mitral Degeneration IHD

_______ resistance is illustrated by the arrangement of blood vessels within a given organ

Series

•Severe aortic stenosis •Symptomatic mitral stenosis What type of conditions? What cardiovascular risk factor category

Severe valvular disease Major

a consequence of the fact that blood travels at different velocities within a blood vessel

Shear

abnormal communication between chambers or blood vessels. Depending on pressure relationships, they permit the flow of blood from the left to the right side of the heart (or vice versa).

Shunt

•High-grade atrioventricular block •Mobitz type 2 atrioventricular block •Third-degree atrioventricular block •Symptomatic ventricular arrhythmias in the presence of underlying heart disease •Supraventricular arrhythmias with uncontrolled ventricular rate •Symptomatic bradycardia •Newly recognized ventricular tachycardia What type of conditions are these? What cardiovascular risk factor category?

Signifiacnt arrythmias Major

Comparison of the _ major layers or tunics in the largest artery and vein. (a) Aorta, (b) vena cava. ______ _______ endothelial cells line the intima that also has _____________ __________ tissue and in arteries is separated from the media by an ________ _______ ______, a structure absent in all but the largest veins. The _____ contains many elastic lamellae and elastic fibers alternating with layers of ______ muscle. The media is much _______ in large arteries than veins, with relatively ____ elastin. Elastic fibers are also present in the outer tunica __________, which is relatively thicker in large veins. Vasa vasorum are seen in the ____________ of the aorta. The connective tissue of the adventitia always merges with the less dense __________ tissue around it.

Simple squamous, subendothelial connective, internal elastic lamina, media, smooth, larger, more, adventitia, adventitia, connective

Sinusoidal capillary AKA

Sinusoid

permit maximal exchange of macromolecules as well as allow easier movement of cells between tissues and blood. What type of capillary?

Sinusoidal

capillaries of this type are found in the liver, spleen, some endocrine organs, and bone marrow What type?

Sinusoids

found in organs where exchange of macromolecules and cells occurs readily between tissue and blood, such as in bone marrow, liver, and spleen. Which type of capillaries?

Sinusoids

usually have a wider diameter than the other types and have discontinuities between the endothelial cells, large fenestrations through the cells, and a partial, discontinuous basement membrane. Which type of capillaries?

Sinusoids

Largest pressure drop in the CV system location

Small arteries to arterioles

IV line AKA

Small bore tube

_____, _______, and _____ veins, all with lumen diameters exceeding the thickness of the wall, carry blood back to the heart, with intimal valves preventing backflow, and have increasingly well-developed tunics.

Small, medium, large

_______ ______ fibers occur in the walls of all vessels larger than capillaries and are arranged helically in layers.

Smooth muscle

In the thorax, the intercostal nerves carry: ▪ _______ _____ innervation to the muscles of the thoracic wall (____________, _________, and ___________ _______ muscles), ▪ ________ _______ innervation from the skin and _________ pleura, and ▪ _____________ ____________ fibers to the periphery.

Somatic motor, intercostal, subcostal, transversus thoracis somatic sensory, parietal Postganglionic sympathetic

Neutrophils: ________ _________ granules are smaller and less dense, stain faintly pink, and have diverse functions, including secretion of various ECM-degrading enzymes such as collagenases, delivery of additional bactericidal proteins to phagolysosomes, and insertion of new cell membrane components.

Specific secondary

Put in order: Spinal cord White ramus communicans Gray ramus communicans thoracic sympathetic ganglion Synapse Spinal nerve

Spinal cord Gray ramus communicans Thoracic sympathetic ganglion Synapse White ramus communicans Spinal nerve

_______________, a potassium-sparing diuretic, also blocks the action of aldosterone (aldosterone antagonist) and, when used in patients with class IV symptoms, has been shown to reduce the risk of death by 25% to 30%.

Spironolactone

Nail bed hemmorrhages seen in endocarditis?

Splinter hemmorages

Evidence of previous streptococcal infection along with 2 or more of the following Jones criteria: Carditis Migratory polyarthritis of the large joints Subcutaneous nodules Erythema marginatum skin rashes Syndenham chorea, a neurological disorder characterized by involuntary purposless, rapid movements (AKA ___ _____ _____) What disease?

St. Vitus dance Acute Rheumatic fever

Most HF patients are in what category? What does this entail?

Stage C. Past or present symptoms associated with underlying structural heart disease

Bacteria found on skin and can attack deformed as well as healthy heart valves and can cause acute endocarditis

Staph aureus

Drug that can help CAD and IHD by reducing plaque inflammation and increasing plaque stability

Statins

Failure of a valve to open completely, obstructing outward flow

Stenosis

Fine wire mesh AKA

Stent

WHat divides the superior and inferior mediastinum?

Sternal angle

Major surface landmark used by clinicians when performing thoracic exams (2 names)? What bones does this join?

Sternal angle AKA manubriosternal joint Manubrium of sternum to body of sternum

Horizontal angle between which two structures separates the mediastinum into superior and inferior parts?

Sternal angle, IV disc between T4 and T5

Anterior aspect of the thoracic cavity

Sternum

Bacteria causing acute rheumatic fever What type of disease?

Strep A Autoimmune (cross reactive strep antibodies attack host antigens)

Most cases of subacute endocarditis are caused by what bacteria? Where is it found normally?

Strep viridans Mouth

The function of the ventricles is described by the following three parameters: (1) ____ ______ is the volume of blood ejected by the ventricle on each beat; (2) ________ ________ is the fraction of the end-diastolic volume ejected in each stroke volume, which is a measure of ventricular efficiency; and (3) _______ ______is the total volume ejected by the ventricle per unit time.

Stroke volume Ejection fraction Cardiac output

Infections by organisms of low virulence involving a previously abnormal heart, especially scarred or deformed valves What condition?

Subacute endocarditis

ANteiror groove of rib 1 is for what? Posteiror?

Subclavian vein Subclavian artery

Groove on inferior surface of middle third of clavicle Insertion of what muscle of the pectoral region?

Subclavius

Pulls clavicle medially to stabilize sternoclavicular joint; depresses tip of shoulder

Subclavius

Rib I at junction between rib and costal cartilage Origin of what muscle of pectoral region?

Subclavius

O: Internal surface (near angle) of lower ribs I: Internal surface of second or third rib below What muscle?

Subcostales

They extend from the internal surfaces of one rib to the internal surface of the second (next) or third rib below. Their fibers parallel the course of the internal intercostal What muscles?

Subcostales

What causes Peau d'orange type skin on the breast?

Subcutaneous lymphatic obstruction and tumor growth pulling on the connective tissue ligaments

Region of heart most vulnerable to hypoperfusion and hypoxia

Subendocardaial region

Infarctions that can be associated with no embolism

Subendocardial MI

MI's limited to inner 3rd of myocardium

Subendocardial MI

Sudden death, due to sustained ventricular arrythmias in peopel who have underlying structural heart disease which may or may not have been discovered in the past

Sudden Cardiac Death

Accessory hemiazygous vein AKA

Superior hemiazygous vein

Components that make up the border of an axillary inlet (3)

Superior margin of teh scapula clavicle Lateral aspect of Rib I

________ _______ arteries, which arise directly from lower parts of the thoracic aorta, and small branches from intercostal arteries contribute to the supply of blodo to the diaphragm.

Superior phrenic

Consists of T1 vertebral body posteriorly, medial margins of Rib I laterally, and the manubrium of the sternum anteriorly

Superior thoracic aperture

Superior opening to the thorax. Is it big or small? `

Superior thoracic aperture small

Superior opening to the thorax. Is it big or small?

Superior thoracic aperture small`

Great veins (3)

Superior vena cava Inferioor vena cava Pulmonary veins

Pump handle moves the sternum in what directions?

Superior, anterior

Locations of reflections of serous pericardium (where they visceral and pareital layers join) (2)

Superiorly for the arteries More posteriorly for the veins

Jugular notch AKA

Suprasternal notch

Classifications of aberrant rhythms of heart (2)

Supraventricular Ventricular

Branches of the pulmonary plexus ultimately arise from where (2)

Sympathetic trunks Vagus nerves

________ pressure is the highest arterial pressure measured during a cardiac cycle.

Systolic

Contractile dysfunction AKA

Systolic dysfunction

Systemic arterial pressure during the cardiac cycle. ________ pressure is the highest pressure measured during systole. _________ pressure is the lowest pressure measured during diastole. _____ ________ is the difference between systolic pressure and diastolic pressure

Systolic, diastolic, pulse pressure

represents repolarization of the ventricles. Which part of the EKG?

T wave

Preganglionic sympathetic fibers destined for the head are carried out of the spinal cord in spinal nerve __.

T1

The superior costal facets on the body of vertebra __ are complete and articulate with a single facet on the head of its own rib

T1

Components fo the superior thoracic aperture (3)

T1 vertebral body Medial margins of 1st ribs Manubrium of sternum

All preganglionic nerve fibers of the sympathetic system are carried out of the spinal cord in spinal nerves __ to __

T1, L2

Sympathetics run from __ to __

T1, L2

intercostal nerves are mainly the anteiror rami of which spinal nerves?

T1-T11

Umbilicus dermatome

T10

What vertebral level is the esophageal hiatus at?

T10

esophagel hiatus vertebral level

T10

Similarly, vertebra ___ (and often ___) articulates only with its own ribs and therefore lacks inferior demifacets on the body.

T10, T12

Which vertebra has no costal facet on transverse process?

T11

Vertebrae ___ and ___ articulate only with the heads of their own ribs—they lack transverse costal facets and have only a single complete facet on each side of their bodies.

T11, T12

Anteiror superior iliac spine dermatome

T12

What vertebral level is the aortic hiatus at?

T12

The anterior ramus of spinal nerve ___ (the subcostal nerve) is inferior to rib __

T12, 12

the inferior thoracic aperture is bordered by vertebra ___, rib __, the end of rib __, the ______ _______, and the _______ process of the _______

T12, 12, 11, costal margin, xiphoid, sternum

The anterior ramus of spinal nerve ___ (the _________ nerve) is inferior to rib 12

T12, subcostal

The highest thoracic dermatome on the anterior chest wall is __, which also extends into the upper limb. In the midline, skin over the xiphoid process is innervated by __

T2, T6

During quiet respiration, the approximate position of the left oblique fissure can be marked by a curved line on the thoracic wall that begins between the spinous processes of vertebrae __ and __, crosses the ___ interspace laterally, and follows the contour of rib _ anteriorly

T3, T4, 5th, 6

Nipple dermatome

T4

The thoracic duct, which is the major lymphatic vessel in the body, passes through the posterior portion of the superior mediastinum. It: ▪ enters the superior mediastinum inferiorly, slightly to the left of the midline, having moved to this position just before leaving the posterior mediastinum opposite vertebral level __/__; and ▪ continues through the superior mediastinum, posterior to the arch of the aorta, and the initial portion of the ____ __________artery, between the esophagus and the left mediastinal part of the parietal pleura.

T4 T5 left subclavian

Rib IV articulates with vertebral column where?

T4 vertebral body T3 vertebral body T4 Transverse process

The approximate position of the oblique fissure on a patient, in quiet respiration, can be marked by a curved line on the thoracic wall that begins roughly at the spinous process of the vertebra __ level of the spine, crosses the _____ interspace laterally, and then follows the contour of rib _ anteriorly

T4, 5th, 6

In addition, the sternal angle lies on a horizontal plane that passes through the intervertebral disc between vertebrae __ and __

T4, T5

The horizontal plane passing through the disc that separates thoracic vertebrae __ and __ is one of the most significant planes in the body

T4, T5

In addition, the sternal angle lies on a horizontal plane that passes through the intervertebral disc between vertebrae __ and __. This plane separates the ________ mediastinum from the ________ mediastinum and marks the superior border of the ____________.

T4, T5, superior, inferior, pericardium

Plane running through middle of thymus

T4/T5 IV disc

Pulmonary Trunk: At approximately the level of the intervertebral disc between vertebrae __ and __, opposite the ____ border of the sternum and posterior to the ___ ____ costal cartilage, the pulmonary trunk divides into: ▪ the _____ __________ ______, which passes to the right, posterior to the ascending aorta and the superior vena cava, to enter the right lung; and ▪ the ____ __________ ______, which passes inferiorly to the arch of the aorta and anteriorly to the descending aorta to enter the left lung.

T5, T6, left, left 3rd right pulmonary artery left pulmonary artery

In the region of vertebrae __ to __, the mediastinal pleura reflects off the mediastinum as a tubular, sleeve-like covering for structures (i.e., airway, vessels, nerves, lymphatics) that pass between the lung and mediastinum.

T5, T7

Xiphoid process dermatome

T6

Dermatomes of __ to ___ follow the contour of the ribs onto the anterior abdominal wall

T7, T12

After passing through the diaphragm, at approximately the level of vertebra __, the inferior vena cava enters the fibrous pericardium.

T8

Costal margin dermatome

T8

What vertebral level is the caval opening at?

T8

Thromboelastography AKA

TEG

Tissue Factor Pathway Inhibitor AKA

THPI

TFPI inhibits what factor?

TIssue Factor Factor VIIa

Congenital deficiencies of cyclooxygenase or thromboxane synthase (the enzymes involved in ______ _________) result in a mild bleeding tendency.

TXA2 synthesis

Arachidonic acid is metabolized by cyclooxygenase and thromboxane synthase to ____, a potent but labile (half-life __ _________) mediator of platelet __________ and vaso___________

TXA2, 30 seconds, acrivation, constriction

fast heart rate

Tachycardia

Segmental bronchi AKA

Teritary bronchi

__________ __ ______ is the most common cause of cyanotic congenital heart disease and accounts for about 5% of all congenital cardiac malformations. The four cardinal features are (1) VSD; (2) right ventricular outflow tract obstruction (____________ ________); (3) overriding of the VSD by the aorta; and (4) right ventricular hypertrophy

Tetralogy of Fallot subpulmonic stenosis

Issues with drugs in patient with mild angina or recent MI?

The use of excessive amounts of epinephrine with nonselective beta blockers can potentially cause a spike in blood pressure, but this is unlikely and appears to be dose-dependent; avoid the use of epinephrine-impregnated retraction cord.

Chlorothiazide (Diuril) Chlorthalidone (Thalitone) Hydrochlorothiazide (HCTZ) Indapamide (Lozol) Metolazone (Mykrox) What drug type? Vasoconstrictor side effects? Oral problems? Other considerations?

Thiazide diuretics None Dry mouth Orthostatic hypotension

Posterior intercostal arteries arise from where?

Thoracic aorta

Vessels and nerves that supply the thoracic wall arise from 2 sources. What are they?

Thoracic aorta Internal thoracic arteries

used to describe symptoms resulting from abnormal compression of the brachial plexus of nerves as it passes over the first rib and through the axillary inlet into the upper limb.

Thoracic outlet syndrome

What encloses the thoracic cavity? (2)

Thoracic wall, diaphragm

Irregularaly shaped cylinder with a narrow opening superiorly and relatively large opening inferiorly

Thorax

blood clots in the lumen of a vessel

Thrombi

________ ________ ____ assesses the final common pathway

Thrombin clotting time

global coagulation assay thought better able to assess an individual's ability to coagulate than standard coagulation assays.

Thrombin generation assay

________ converts circulating fibrinogen to fibrin and activates factor ____, which crosslinks the fibrin, forming a clot

Thrombin, XIII

Complex that activates Protein C

Thrombin-Thrombomodulin

assess the ability of whole blood to clot in response to a mechanical stimulus, allowing an assessment of all aspects of hemostasis: platelet function, fibrin cross-linking and fibrinolysis. What tests (2)

Thromboelastography Rotational Thromboelastogarphy

•Streptokinase •Alteplase •Reteplase •Tenectaplase What kind of therapy do these drugs provide? In what type of patients?

Thrombolytic therapy MI patients with ST segment elevation

Tissue factor AKA

Thromboplastin

this protein is synthesized in endothelium and the liver; it circulates bound to lipoproteins.

Tissue Factor Pathway Inhibitor

Serine protease used to quickly break down clots

Tissue Plasminogen Activator (tPA)

Drug used for thrombollysis in an MI

Tissue Plasminogen activator

WHat is added to plasma to test PT? Which pathway does this test?

Tissue facor extrinsic

Which parts of the PV curve relate to systole? Diastole?

Top and right Left and bottom

Increased salivation in digoxin users is a sign of what?

Toxicity

Which is more anteiror, trachea or esophagus?

Trachea

MI involving the entire wall thickness, caused by epicardial vessel occlusion

Transmural infarct

The __________ (_) _______ invaginate cardiac muscle cells at the Z lines, are continuous with the cell membranes, and function to carry action potentials to the cell interior. The T tubules form dyads with the ____________ _________, which is the site of storage and release of Ca2+ for excitation-contraction coupling.

Transverse T tubules, sarcoplasmic reticulum

Separates arteries form veins Which pericardial sinus?

Transverse pericardial sinus

O: Inferior margins and internal surfaces of costal cartilages of second to sixth ribs I: Inferior aspect of deep surface of body of sternum, xiphoid process, and costal cartilages of ribs IV-VII What muscle?

Transversus thoracis

Diffuse atherosclerosis of the thoracic aorta may occur in patients with vascular disease, but this rarely produces symptoms. There are, however, two clinical situations in which aortic pathology can produce life-threatening situations. Name them

Trauma Aortic dissection

Rarest congential heart defect

Tricuspid atresia

What disease is normally associated with females and coarctation of the aorta?

Turner Syndrome

Release of the inflammatory mediators can result in bronchial asthma, cutaneous hives, rhinitis, conjunctivitis, or allergic gastroenteritis. What type of reaction? What cells involved (2)?

Type 1 Hypersensitivity (anaphylaxis) Basopihls, mast cells

Fixed coronary obstruction causes what condition?

Typical angina

Predictable episodic chest pain caused by particular levels of exertion or increased demand (like tachycardia)

Typical or stable angina

Unfractoned heparin AKA

UFH

Are primary cardiac tumors common? Malignant or benign?

Uncommon Benign

Increasingly frequent pain, precipitated by progressively less exertion and even occurring at rest

Unstable angina

•Acute or recent myocardial infarction (*) associated with important ischemic risk as indicated by clinical signs and symptoms or by noninvasive study •Unstable or severe angina (Canadian class III or IV)†† What are these examples of? What cardiovascular risk factor category?

Unstable coronary syndromes Major

Blood volume under low pressure

Unstressed volume

DIaphragm relaxes. It goes up or down?

Up

T1 dermatome is located where?

Upper limb, not the trunk

Most common systemic disorder associated with pericarditis

Uremia

circulates in plasma both as an active single-chain precursor form (scuPA, pro-urokinase) and as a more active two-chain form (tcuPA, urokinase).

Urinary type Plasminogen Activator

Issues with anxiety in patient with mild angina or recent MI?

Use stress reduction protocol. Consider the use of preoperative oral sedation (short-acting benzodiazepine) 1 hour before procedure, as well as using N2O-O2 inhalational sedation intraoperatively.

Issues with anxiety in patient with recent MI or unstable angina?

Use stress reduction protocol. Consider the use of preoperative oral sedation (short-acting benzodiazepine) 1 hour before procedure, as well as using N2O-O2 inhalational sedation intraoperatively.

Proaccelerin, labile factor WHich factor?

V

Prothrombin and Ca2+ activate what factor activation?

V

Velocity of blood flow symbol

V

A further cause of increased risk of venous thromboembolism is a mutation in coagulation factor _ (factor _ _______), which confers resistance to its inactivation by activated protein C.

V, V Leiden

Video-Assisted Thoracic Surgery AKA

VATS

Growth factors such as vascular endothelial growth factor (___) stimulate formation of the vascular system from embryonic __________ (______________), help maintain the vasculature in adults, and promote capillary sprouting and outgrowth from small existing vessels (___________) during normal growth, during tissue repair and regeneration, and in tumors and other pathological conditions. In both processes other growth factors, called _____________, stimulate endothelial cells to recruit smooth muscle cells and fibroblasts to form the other tissues of the vascular wall.

VEGF, MESENCHYME, vasculogenesis, angiogenesis, angiopoietins

Antihemophilic factor Which factor?

VII

Serum prothrombin conversion accelerator (SPCA), stable factor Which factor?

VII

Distal cartilagenous ends of which ribs unite to form the costal margin and form part of the inferior thoracic aperture

VII to X

Hemophilias caused by factor ____ or __ deficiency occur in approximately 1 in 5000 and 1 in 30,000 males, respectively; inheritance is X-linked recessive, transmitted by carrier females. Treatment is usually with recombinant factor VIII or IX concentrates.

VIII, IX

Not only does vWF have an important role in platelet hemostatic function but it also transports coagulation factor _____ (______________ factor) in the circulation and delivers it to sites of vascular injury.

VIII, antihemophilic

Ribs that articulate with inferior margins of costal cartilages above them

VIII-X

Tissue Factor Pathway Inhibitor: this protein is synthesized in endothelium and the liver; it circulates bound to lipoproteins. It inhibits the tissue factor-____ complex Does defeciency cause increased risk of thromboembolism?

VIIa No!

Ventricular septal defect AKA

VSD

Ventriculoseptal defect AKA

VSD

Tetralogy of Fallot is the most common cause of cyanotic congenital heart disease and accounts for about 5% of all congenital cardiac malformations/ The four cardinal features are (1) ___; (2) _____ _____________ _______ _____ ___________ (subpulmonic stenosis); (3) overriding of the ___ by the _____; and (4) _____ ___________ ___________

VSD right ventricular outflow tract obstruction VSD, aorta right ventricular hypertrophy

Treatment of vWF disease is to increase the low plasma ___ activity, usually by means of either desmopressin (a synthetic analogue of ___________, which releases vWF from ___________ cells into plasma), or administering ___ concentrates derived from human plasma.

VWF, vasopressin, endothelial, VWF

When thrombin is generated, it binds to thrombomodulin (molecular weight 74 kDa), which is present on the surface of vascular endothelial cells. The thrombin-thrombomodulin complex activates protein C, which forms a complex with its cofactor, protein S. This complex selectively degrades factors __ and _____ by limited proteolysis

Va, VIIIa

Stimulated by: Circulating adrenergic agonists Locally released platelet contents imalance between endothelial-cell relaxing and contraciton factors due to endothelial dysfunciton Mediators released from perivascular inflammatory cells What process?

Vasoconstriction

Hydralazine (Apresoline) Isosorbide dinitrate (Isordil) Drug type? Vasoconstrictor side effects? Oral problems? Other considerations?

Vasodilators None Lupus-like oral lesions, lymphadenopathy, dry mouth Orthostatic hypotension

Highest capactience vessel? Lowest?

Vein Artery

What is the order of vessels in the intercostal groove?

Vein Artery Nerve

Blood vessles with the largest % of blood in them

Veins

linear velocity and refers to the rate of displacement of blood per unit time. Thus, velocity is expressed in units of distance per unit time (e.g., cm/sec).

Velocity

Least abndant blood vessels (2)

Vena Cava aorta

chaotic depolarization without ventricular contraction being functional

Ventricular fibrillation

Scarring and thinning of infarcted areas, along with dilation and hypertrophy of noninfarcted areas in the ventricle after MI What condition?

Ventricular remodeling

Most common congenital heart defect

Ventricular septal defect

Primary pericarditis is most commonly caused by what?

Viral infection

Most common cause of myocarditis? Which cause most cases (3)

Viral infections Coxsackieviruses A, B, and other enteroviruses

Epicardium AKa

Visceral pericardium

As an alternative, plain cord saturated with tetrahydrozoline HCl 0.05% (_______; Pfizer Inc, New York, New York) or oxymetazoline HCl 0.05% (_____; Schering-Plough, Summit, New Jersey) provides gingival effects equivalent to those of epinephrine without adverse cardiovascular effects.

Visine, Afrin

Monitoring of an internationally standardized prothrombin time, i.e. the International Normalized Ratio (INR), every few weeks is essential to minimize the risk not only of thromboembolism but also of excessive bleeding. Used for what drug type? Example

Vitamin K antagonist Warfarin

Warfarin drug type?

Vitamin K antagonist anticoagulant

Oral anticoagulant therapy with _______ _ ___________, e.g. warfarin, is given long term to patients at risk of thrombosis within the chambers of the heart, e.g. patients with atrial fibrillation or heart valve prostheses, which may embolize to the brain, causing a stroke.

Vitamin K antagonists

malabsorption or obstructive jaundice causes this, which reduces hepatic synthesis of factors II, VII, IX and X. Treatment is by oral or intravenous administration of vitamin K. What condition? What effect on PT?

Vitamin K defeciency PRolonged

Protein C and Protein S are _______ _-dependent proteins, synthesized in the _____.

Vitamin K, Liver

Valvular regurgitation Shunts What type of states?

Volume overload

Serious deceleration injury AKA

WHIPLASH!

Ions Lipid or water soluble?

Water

WHen does ARP end?

When cell has repolarized to about -50 mV

How to determine if heart is right or left dominant? which is more common?

Which coronary artery does PID artery arise from? Right dominant is more common

_____ _____ ______ or leukocytes are broadly grouped as ___________ (neutrophils, eosinophils, basophils) or ____________ (lymphocytes, monocytes).

White blood cells, granulocytes, agranulocytes

Recent MI time frame

Within past 30 days

Factor VIIa and Ca2+ activate what factor?

X

Stewart-Prower factor Which factor?

X

Vagus n. CN number

X

IXa activates what factor? with what cofactor?

X Phospholipids

Hemophilias caused by factor VIII or IX deficiency occur in approximately 1 in 5000 and 1 in 30,000 males, respectively; inheritance is _-______ _________, transmitted by carrier _______. Treatment is usually with recombinant ______ _____ or __ concentrates.

X linked recessive, females, factor VIII, IX

activation of factors _ and __ (prothrombin) occurs preferentially at sites of vascular injury, alongside activated platelets: the latter provide procoagulant activity as a result of exposure of negatively charged platelet surface membrane phospholipids, such as phosphatidylserine, and high affinity binding sites for several activated coagulation factors, allowing the formation of the prothrombinase complex (__, __ and __) and tenase complex (_____, ___ and __), which both greatly enhance the production of thrombin. As a result of these biochemical interactions, thrombin and fibrin formation are efficiently localized at sites of vascular injury.

X, II, Va, Xa, II, VIIIa, IXa, Xa

baroreceptors present in the aortic arch transmit signals pertaining to blood pressure via cranial nerve _, the _____ nerve.

X, vagus

Factor XII Kallikrien HMWK All activate what factor?

XI

PTA Which factor?

XI

thrombin stimulates its own generation in a positive feedback cycle in three ways: ▪ It catalyzes activation of factor __: this may explain why congenital deficiencies of factor XII prekallikrein or HMWK are not associated with excessive bleeding ▪ It catalyzes activation of factors ____ and _. ▪ It activates __________

XI VIII, V platelets

Floating ribs

XI, XII

Hageman factor Which factor?

XII

One activator of scuPA is surface-activated coagulation factor ___, which therefore links the coagulation and fibrinolytic systems.

XII

Fibrin stabilizing factor which factor?

XIII

Thrombin activates what factor? with what cofactor?

XIII Ca2+

Congenital deficiencies of coagulation factors (I-XIII) result in excessive bleeding, which illustrates their physiologic importance in hemostasis. The exception is factor ____ deficiency, which does not increase the bleeding tendency, despite prolonging blood clotting times in vitro; the same is true for its cofactors, _____________ or ____-_________-______ _________ (_____).

XIII, prekallikrien, high molecular weight kininogen, HMWK

Fibrin reacts with what factor to give stabilized fibrin? What cofactor?

XIIIa Ca2+

The term 'final common pathway' refers to the conversion of prothrombin to thrombin via __, with __ acting as a cofactor

Xa, Va

Xiphisternal joint AKA

Xiphisternal symphysis

the smallest part of the sternum

Xiphoid process

Is oxygen used in patients with acute MI?

Yes

The base, or attached surface, of each breast extends vertically from ribs _ to _, and transversely from the _______ to as far laterally as the ______________ ____.

`2, 6, sternum, midaxillary line

Transversus thoracis: O: Inferior margins and internal surfaces of costal cartilages of _______ to _____ ribs I: Inferior aspect of deep surface of body of sternum, xiphoid process, and costal cartilages of ribs _-_ second, sixth

`4, 7

Similarly, vertebra T10 (and often T12) articulates only with its own ribs and therefore lacks ________ ________ on the body

`inferior demifacets

Large veins have a muscular _____ layer that is very thin compared to the surrounding __________ of dense irregular connective tissue. The wall is often folded as shown here, with the ______ projecting into the lumen as a valve composed of the subendothelial connective tissue with endothelium on both sides.

`media, adventitia, intima

Unstable angina, infarction, and sudden cardiac death occur due to _____ ______ ______ followed by thrombosis- hence the term acute coronary syndrome

abrupt plaque change

The term 'extrinsic' refers to the effect of tissue factor, which (after combining with coagulation factor VII) greatly ___________ coagulation, by activating both factor __ and factor _

accelerates, IX, X

Left superior intercostal vein: Inferiorly, it may connect with the _________ ___________ vein

accessory hemiazygous

Breast cancer is one of the most common malignancies in women. It develops in the cells of the _____, ___________ _____, and _______ of the breast.

acini, lactiferous ducts, lobules

Ectitation-contraction coupling of cardiac muscles: 1. Cardiac ______ _________ 2. ____ enters cells during _______ phase 3. ____-induced-____ release from ____________ _________ 4. ____ binds ________ _ 5. Cross-bridge cycling When is calcium reaccumulated in the SR?

action potential Ca2+, plateau Ca2+, Ca2+, sarcoplasmic reticulum Ca2+, troponin C During relaxation

Excitation contraction coupling in cardicac muscle: 1. The cardiac ______ _________ is initiated in the myocardial cell membrane, and the depolarization spreads to the interior of the cell via the T tubules. Recall that a unique feature of the cardiac action potential is its plateau (phase _), which results from an increase in gCa and an ______ ____ current, in which Ca2+ flows through L-type Ca2+ channels (_________________ receptors) from extracellular fluid (ECF) to intracellular fluid (ICF). 2. Entry of Ca2+ into the myocardial cell produces an increase in intracellular Ca2+ concentration. This increase in intracellular Ca2+ concentration is not sufficient alone to initiate contraction, but it triggers the release of more Ca2+ from stores in the sarcoplasmic reticulum through Ca2+ release channels (_________ receptors). This process is called ____-_______-____ _______, and the Ca2+ that enters during the plateau of the action potential is called the _______ ____. Two factors determine how much Ca2+ is released from the sarcoplasmic reticulum in this step: the amount of Ca2+ previously stored and the size of the inward Ca2+ current during the plateau of the action potential. 3. and 4. Ca2+ release from the sarcoplasmic reticulum causes the intracellular Ca2+ concentration to increase even further. Ca2+ now binds to ________ _, tropomyosin is moved out of the way, and the interaction of actin and myosin can occur. Actin and myosin bind, _____-______ form and then break, the thin and thick filaments move past each other, and tension is produced. Cross-bridge cycling continues as long as intracellular Ca2+ concentration is high enough to occupy the Ca2+-binding sites on troponin C. 5. A critically important concept is that the magnitude of the tension developed by myocardial cells is proportional to the intracellular ____ concentration. Therefore, it is reasonable that hormones, neurotransmitters, and drugs that alter the inward Ca2+ current during the action potential plateau or that alter sarcoplasmic reticulum Ca2+ stores would be expected to change the amount of tension produced by myocardial cells.

action potential, 2, inward Ca2+, dihydropyridine ryanondine, Ca2+ induced Ca2+ release, trigger Ca2+ troponin C, cross bridges Ca2+

thrombin stimulates its own generation in a positive feedback cycle in three ways: ▪ It catalyzes __________ of factor XI: this may explain why congenital deficiencies of factor XII, prekallikrein or HMWK are not associated with excessive bleeding (Fig. 7.3). ▪ It catalyzes __________ of factors VIII and V. ▪ It __________ platelets

activation activation activates

The number of HF deaths has increased steadily despite advances in treatment, in part because of increasing numbers of patients living with HF as a consequence of better treatment and "salvage" after _____ __________ __________ experienced earlier in life

acute myocardial infarction

Platelets can be activated by several chemical agents, including _________ ___________ (ADP, released by platelets, erythrocytes, and endothelial cells), epinephrine, collagen, thrombin, and PAF; by __________ e.g. HIV, Helicobacter pylori; and by high physical shear stresses.

adenosine diphsophate, infection

Corticosteroids (hormones from the _______ ______) produce a rapid ________ in the number of blood eosinophils, probably by interfering with their release from the bone marrow into the bloodstream.

adrenal cortex, decrease

In the more common "_____" (__________) coarctation, the aorta is sharply constricted by a tissue ridge adjacent to the nonpatent ligamentum arteriosum

adult, postductal

vessels also have a supportive connective tissue outer layer (the __________)

adventitia

The outer __________, or tunica externa, is __________ tissue consisting principally of _____ _ ________ and elastic fibers

adventitia, connective, Type I Collagen

Within seconds of coronary vascular obstruction, _______ glycolysis ceases, leading to a ________ in ATP and ________ in noxious metabolites like ________ _____ in cardiac myocytes

aerobic, decrease, increase, lactic acid

The _________ for the left ventricle is aortic pressure.

afterload

Another receptor, GPIIb-IIIa, has a key role in platelet ___________

aggregation

Important protein components of plasma include _______, diverse _____- and ____-_________, proteins of the __________ system, and __________, all of which are secreted within the liver, as well as the ______________.

albumin, alpha beta globulins, complement, fibrinogen, immunoglobulins

Increases in sympathetic nerve activity, via ______ adrenergic receptors, cause contraction of the veins, which reduces their capacitance, and, therefore, reduces the unstressed volume.

alpha1

In some individuals a second exposure to a strong allergen, such as that delivered in a bee sting, may produce an intense, adverse systemic response. Basophils and mast cells may rapidly degranulate, producing vasodilation in many organs, a sudden drop in blood pressure, and other effects comprising a potentially lethal condition called ___________ or ____________ _____

anaphylaxis, anaphylactic shock

Coronary artery diseaese: Depending on the severity, patients can develop pain (_______) or a myocardial infarction (__).

angina, MI

The superior margin is smooth and rounded, whereas the inferior margin is sharp. The shaft bends forward just laterally to the tubercle at a site termed the _____

angle

The position of the thoracostomy tube should be between the ________ _________ and ___________ anatomical lines from anterior to posterior and either the _____ or _____ intercostal space from cephalad to caudad

anteior axillary, midaxillary, fourth, fifth

Left coronary a.: The _________ _________________ branch continues around the left side of the pulmonary trunk and descends obliquely toward the apex of the heart in the anterior interventricular sulcus. During its course, one or two large _________ branches may arise and descend diagonally across the anterior surface of the left ventricle. ▪ The ___________ branch courses toward the left, in the coronary sulcus and onto the base/diaphragmatic surface of the heart, and usually ends before reaching the posterior interventricular sulcus. A large branch, the ____ _________ artery, usually arises from it and continues across the rounded obtuse margin of the heart.

anteiror interventricular, diagonal circumflex, left marginal

The ________ and _________ _______________ _____separate the two ventricles—the ________ interventricular sulcus is on the anterior surface of the heart and contains the anterior interventricular artery and the great cardiac vein, and the _________ interventricular sulcus is on the diaphragmatic surface of the heart and contains the posterior interventricular artery and the middle cardiac vein.

anteiror posterior interventricular sulci, anterior, posteiror

Each pectoral region contains the pectoralis major, pectoralis minor, and subclavius muscles . All originate from the ________ _________ ____ and insert into bones of the _____ ____.

anteiror thoracic wall, upper limb

Innervation of the breast is via ________ and _______ cutaneous branches of the _______ to _____ intercostal nerves. The nipple is innervated by the ______ intercostal nerve.

anteiror, lateral, second, sixth, fourth

The obtuse margin separates the ________ and ____ _________ surfaces —it is round and extends from the left auricle to the cardiac apex, and is formed mostly by the ____ _________ and superiorly by a small portion of the ____ _______

anteiror, left pulmonary, left ventricle, left auricle

The interatrial septum is part of the ________ wall of the ____ atrium. The thin area or depression in the septum is the valve of the _______ _____and is opposite the floor of the fossa ovalis in the right atrium.

anteiror, left, foramen ovale

The naming of the three cusps of tricuspid valve, the ________, ______, and ___________ cusps, is based on their relative position in the _____ ventricle. The free margins of the cusps are attached to the ________ ________, which arise from the tips of the _________ __________

anteiror, posteiror, septal, right, chordae tendinae, papillary muslces

A rib's posterior attachment is superior to its ________ attachment

anterior

In the midline, the trachea is directly ________ to the esophagus

anterior

Right ventricle: The ________ papillary muscle is the largest and most constant papillary muscle, and arises from the anterior wall of the ventricle.

anterior

The _________ intercostal arteries originate directly or indirectly as lateral branches from the internal thoracic arteries

anterior

The intercostal nerves end as ________ _________ branches, which emerge either parasternally, between adjacent costal cartilages, or laterally to the midline, on the anterior abdominal wall, to supply the skin.

anterior cutaneous

Branches of left coronary artery

anterior interventricular branch circumflex branch

Two additional groups of cardiac veins are also involved in the venous drainage of the heart. ▪ The _________ _____ __ ___ _____ __________are small veins that arise on the anterior surface of the right ventricle. They cross the coronary sulcus and enter the anterior wall of the right atrium. They drain the anterior portion of the right ventricle. The right marginal vein may be partof this group if it does not enter the small cardiac vein. ▪ A group of smallest cardiac veins (_____ _______ _______ or _____ __ ____________) have also been described. Draining directly into the cardiac chambers, they are numerous in the right atrium and right ventricle, are occasionally associated with the left atrium, and are rarely associated with the left ventricle

anterior veins of the right ventricle venae cordis minimae, veins of Thebsius

The anterosuperior region of the trunk receives branches from the ________ ramus of __ via _______________ branches of the ________ plexus.

anterior, C4, supraclavicular, cervical

In addition to innervating the thoracic wall, intercostal nerves innervate other regions: ▪ The ________ ramus of __ contributes to the brachial plexus. ▪ The _______ cutaneous branch of the ______ intercostal nerve (the ___________________ nerve) contributes to cutaneous innervation of the _______ surface of the upper arm. ▪ The _____ intercostal nerves supply the muscles, skin, and peritoneum of the abdominal wall

anterior, T1 lateral, second, intercostobrachial, medial lower

The tissues that initially give rise to the diaphragm are in an ________ position on the embryological disc before the head fold develops, which explains the ________ origin of the nerves that innervate the diaphragm

anterior, cervical

The inferior margin of the heart is defined as the sharp edge between the ________ and _____________ surfaces of the heart—it is formed mostly by the _____ __________ and a small portion of the ____ _________ near the apex.

anterior, diapharagmatic, right ventricle, left ventricle

The subclavius is small and passes laterally from the _________ and ______ part of rib I to the inferior surface of the clavicle

anterior, medial

Intercostal nerves are the ________ rami of ________ spinal nerves

anterior, thoracic

The anterior surface of the heart faces __________ and consists mostly of the _____ _________, with some of the _____ ______ on the right and some of the ____ _________ on the left

anteriorl, right ventricle, right atrium, left ventricle

In the mediastinum, the phrenic nerves pass __________ to the roots of the lungs

anteriorly

Major vessels adn nerves pass through the superior throacic aperture ____________ and _________ to the esophagus and trachea

anteriorly, laterally

When the thoracic wall is viewed from a lateral position, the external intercostal muscle fibers pass obliquely ________________

anteroinferiorly

Thrombin inhibitors have been developed as _____________ drugs

anticoagulant

Collected blood in which clotting is prevented by the addition of ______________ (eg, _______ or _______) can be separated by centrifugation into layers that reflect its heterogeneity. ____________ comprise the sedimented material and their volume, normally about __% of the total blood volume in healthy adults, is called the __________.

anticoagulants, heparin, citrate, erythrocytes, 44, hematocrit

Direct Xa Inhibitors: now been developed as ______________. Rivaroxaban has been shown to be an effective alternative to ________ for the treatment and prevention of venous thrombosis and for the prevention of stroke in patients with atrial fibrillation.

anticoagulants, warfarin

Aspirin (or other ____________ agents) are also used to reduce risk of recurrent myocardial infarction and stroke.

antiplatelet

Clinical use of antithrombotic drugs (____________, _____________, and __________ agents) is now widespread in developed countries, and requires an understanding of how they interfere with hemostatic mechanisms to exert their antithrombotic effects.

antiplatelet, anticoagulant, thrombolytic

Sites of action of blood coagulation inhibitors. __________, _______ _, and _______ _, and ______ ______ _______ _________ (____)

antithrombin, protein C, protein S, tissue factor pathway inhibitor, TFPI

Besides their key role in metabolite exchanges between blood and tissues, endothelial cells have several other functions: The endothelium presents a _____________ surface on which blood will not clot and actively secretes agents that control local clot formation (such as heparin, tissue plasminogen activator, and von Willebrand factor). The cells regulate local ________ ____ and ______ ____ by secreting various factors that stimulate smooth muscle contraction (such as endothelin 1 and angiotensin-converting enzyme [___]) or relaxation (including nitric oxide [__] and prostacyclin). Endothelium has several roles in ____________ and local ______ responses. In venules endothelial cells induce specific _____ blood cells to stop and undergo transendothelial migration at sites of injury or infection. Under those conditions _-________ is expressed rapidly on the luminal surface when unique elongated granules, called _____-______ _______, fuse with the cell membrane. adhesion to selectins is the first step in the activation of white blood cells specifically where they are needed. Endothelial cells also secrete various factors called ____________ that affect the activity of local white blood cells during inflammation. Under various conditions endothelial cells secrete various _______ _______, including proteins promoting proliferation of specific white blood cell lineages and cells that make up the vascular wall.

antithrombogenic vascular tone, blood flow, ACE, NO inflammatory, immune, white, P selectin, Weibl Palade bodies, interleukins growth factors

Normal endothelium has an ______________ surface

antithrombotic

The four rings of the cardiac skeleton surround the two atrioventricular orifices, the aortic orifice and opening of the pulmonary trunks. They are the ______ _________. The interconnecting areas include: ▪ the _____ _______ _______, which is a thickened area of connective tissue between the aortic ring and right atrioventricular ring; and ▪ the ____ _______ _______, which is a thickened area of connective tissue between the aortic ring and the left atrioventricular ring

anulus fibrosus right fibrous trigone left fibrous trigone

In elastic arteries atheromas produce localized destruction within the wall, weakening it and causing arterial bulges or ___________ that can rupture.

anyeurisms

Although systolic pressure and pulse pressure are augmented in the large arteries (compared with the _____), from that point on, there is damping of the oscillations.

aorta

The ______ is the largest artery of the systemic circulation.

aorta

Imagine that the smallest diameter vessel represents the _____, the medium-sized vessel represents all of the ________, and the largest vessel represents all of the ___________.

aorta, arteries, capillaries

Vessels that supply the thoracic wall consist mainly of posterior and anterior intercostal arteries, which pass around the wall between adjacent ribs in intercostal spaces. These arteries originate from the _____ and ________ ________ arteries, which in turn arise from the __________ arteries in the root of the neck.

aorta, internal thoracic, subclavian

The esophagus passes through the ________ part of the diaphragm, just to the ____ of midline, approximately at vertebral level ___. ▪ The vagus nerves pass through the diaphragm with the ____________. ▪ The aorta passes ______ the __________ __________ of the diaphragm at vertebral level ___. ▪ The thoracic duct passes ______ the diaphragm with the _____. ▪ The azygous and hemiazygous veins may also pass through the ______ ______ or through the _____ of the diaphragm

aortic hiatus, crura

The afterload for the left ventricle is ______ ________

aortic pressure

in ______ ________, myocardial O2 consumption is greatly increased because the left ventricle must develop extremely high pressures to pump blood through the stenosed aortic valve (even though cardiac output actually is reduced).

aortic stenosis

The opening from the left ventricle into the aorta is closed by the ______ ______

aortic valve

IV disc between T4 adn T5 marks where the ____ of the _____ begins and ends

arch, aorta

Because of the relationship between heart rate and refractory period, increases in heart rate may be a factor in producing ___________ (abnormal heart rhythms).

arrythmias

Disorders of cardiac conduction. Uncoordinated cardiac impulses or blocked conduction pathways can cause ___________ that reduce contraction frequency or diminish effective cardiac output.

arrythmias

MI's lead to conduction distrubances that can cause what?

arrythmias

Venous drainage from the thoracic wall generally parallels the pattern of ________ supply

arterial

Veins usually travel as companions to _________ and are classified as _____, ______, or _____ based on size and development of the tunics. Micrograph of small vein shows a relatively _____ lumen compared to the small muscular artery with its _____ media and adventitia. The wall of a small vein is very ____, containing only two or three layers of smooth muscle. (b) Micrograph showing valve in an oblique section of a small vein. ______ are thin folds of intima projecting well into the lumen, which act to prevent backflow of blood. (c) Micrograph of a medium vein shows a _______ wall but still less prominent than that of the accompanying muscular artery. Both the _____ and __________ are better developed, but the wall is often folded around the relatively _____ lumen (d) Micrograph of a medium vein contains _____ and shows _____ folds

arteries, small, medium, large large, thick, thin Valves thicker, media, adventitia, large blood, valve

Muscle tone normally keeps __________ partially closed, resisting blood flow, which makes these vessels the major determinants of systemic blood pressure.

arterioles

The ___________ are the smallest branches of the arteries. Their walls have an extensive development of smooth muscle, and they are the site of _______ resistance to blood flow.

arterioles, highest

The smallest arteries branch as ___________, which have only one or two smooth muscle layers; these indicate the beginning of an organ's ________________ where exchanges between blood and tissue fluid occur.

arterioles, microvascularture

This selective perfusion of capillareis is determined by the degree of dilation or constriction of the __________ and ____________ __________ (smooth muscle bands that lie "before" the capillaries)

arterioles, precapillary sphincters

Two alternative microvascular pathways include _____________ ____________, or __ ______, in which arterioles can bypass a capillary bed, and ______ ______ _______, in which venules draining a capillary bed quickly branch again to form another capillary bed.

arteriovenous anastemoses, AV shunts, venous portal systems

`Veins draining the breast parallel the ________ and ultimately drain into the _________, ________ ______, and ___________ veins.

arterires, axillary, internal thoracic, intercostal

It is essential also that these hemostatic mechanisms are appropriately controlled by inhibitory mechanisms, otherwise an exaggerated platelet-fibrin plug may produce local occlusion of a major blood vessel (______ or ____) at its site of origin (__________), or may break off and block a blood vessel downstream (________)

artery, vein, thrombosis, embolism

The tubercle projects posteriorly from the junction of the neck with the shaft and consists of two regions, an articular part and a nonarticular part: ▪ The _________ part is medial and has an oval facet for articulation with a corresponding facet on the ___________ __________ of the associated vertebra.

articular, transverse process

The _________ _____ is contained within the pericardial sac and is covered by a visceral layer of serous pericardium, which also surrounds the pulmonary trunk in a common sheath

ascending aorta

The thoracic portion of the aorta can be divided into ________ aorta, _____ of the aorta, and _______ aorta

ascending, arch, descending

Ingestion of even low doses of acetylsalicylic acid (_______) irreversibly __________ ___ and suppresses ____ synthesis and platelet ___________ for several days, resulting in an _____________ effect and a mild bleeding tendency.

asprin, acetylates COX, TXA2, aggregation, antithrombotic

_____ and ________ are used in patients with acute myocardial infarction or other acute coronary syndromes

asrpin, heparin

In younger victims of SCD, other, non_______________ causes are more common, including: • Hereditary (_______________) or acquired abnormalities of the cardiac conduction system • __________ coronary arterial abnormalities • ______ valve prolapse • Myocarditis or ____________ • _______ or ____________ cardiomyopathy • __________ hypertension • ___________ hypertrophy. Increased cardiac mass is an independent risk factor for SCD; thus, in some young persons who die suddenly, including athletes, hypertensive hypertrophy or unexplained increased cardiac mass is the only pathologic finding.

atherosclerotic channelopathies Congenital Mitral Sarcoidosis Dilated, hypertrophic Pulmonary Myocardial

Some congenital anomalies obstruct vascular flow—by narrowing the chambers, valves, or major blood vessels; a malformation characterized by complete obstruction is called an ________. In some disorders (e.g., tetralogy of Fallot), an ____________ (pulmonary stenosis) can be associated with a shunt (right-to-left, through a VSD).

atresia, obstruction

In the _____ Purkinje fibers are often closer to the endothelium and intermingle with the contractile fibers within the myocardium

atria

Normally, the PR interval is 160 msec, which is the cumulative time from first depolarization of the _____ to first depolarization of the __________. Increases in conduction velocity through the AV node ________ the PR interval (e.g., due to ____________ stimulation), and decreases in conduction velocity through the AV node ________ the PR interval (e.g., due to _______________ stimulation).

atria, ventricles, decrease, sympathetic, decrease, parasympathetic

Atrial systole is ______ ____________. It is preceded by the _ ____ on the ECG, which marks depolarization of the atria. Contraction of the left atrium causes an ________ in left atrial pressure. When this increase in atrial pressure is reflected back to the veins, it appears on the venous pulse record as the _ ____. The left ventricle is relaxed during this phase, and because the ______ valve (AV valve of the left side of the heart) is ____, the ventricle is filling with blood from the atrium, even prior to atrial systole.

atrial contraction, P wave, increase, a wave, mitral, open

Subsequent chronic dilation of the left atrium can cause ______ ____________, manifested by an "irregularly irregular" heartbeat

atrial fibrillation

n contrast to a patent foramen ovale, an ASD is an abnormal fixed opening in the ______ ______ that allows unrestricted blood flow between the atrial chambers. A majority (90%) of ASDs are so-called _______ ________defects in which growth of the septum secundum is insufficient to occlude the second ostium.

atrial septum, ostium secundum

Right coronary artery: During this course, several branches arise from the main stem of the vessel: ▪ An early ______ branch passes in the groove between the right auricle and ascending aorta, and gives off the _____-______ _____ branch, which passes posteriorly around the superior vena cava to supply the sinu-atrial node. ▪ A ______ _________ branch is given off as the right coronary artery approaches the inferior (acute) margin of the heart and continues along this border toward the apex of the heart. ▪ As the right coronary artery continues on the base/ diaphragmatic surface of the heart, it supplies a small branch to the atrioventricular node before giving off its final major branch, the ________ __________________ branch, which lies in the posterior interventricular sulcus.

atrial, sinu atrial nodal right marginal posterior interventricular

The most common abnormalities that occur during development are those produced by a defect in the ______ and ___________ _____

atrial, ventricular septa

The _______________ ______ is a direct continuation of the atrioventricular node

atrioventricular bundle

the wave of excitation in the atria stimulates the _________________ ____, which is located near the opening of the coronary sinus, close to the attachment of the septal cusp of the tricuspid valve, and within the atrioventricular septum

atrioventricular node

A defect in the ____________ ______ allows blood to pass from one side of the heart to the other from the chamber with the higher pressure; this is clinically referred to as a _____. An ______ ______ ______ allows oxygenated blood to flow from the _____ atrium (higher pressure) across the ASD into the ______ atrium (lower pressure)

atrioventricular septum, shunt, atrial septal defect, left, right

Right atrium: The space anterior to the crista, including the right auricle, is sometimes referred to as the ______ ______. This terminology is based on its origin from the embryonic primitive atrium. Its walls are covered by ridges called the _______ _________ (_________ _______), which fan out from the crista like the "teeth of a comb."

atrium prooper, musculi pecinati, pectinate muscles

Each side of the heart has two chambers, an ______ and a _________, connected by one-way valves, called ________________ ______

atrium, ventricle, atrioventricular valves

The following features of the action potential of the SA node are different from those in atria, ventricles, and Purkinje fibers: (1) The SA node exhibits ____________; that is, it can spontaneously generate action potentials without neural input. (2) It has an ________ resting membrane potential, in direct contrast to cells in atrial, ventricular, and Purkinje fibers. (3) It has no sustained _______.

automaticity unstable plateau

The _________ division of the __________ nervous system is directly responsible for regulating: ▪ heart rate, ▪ force of each contraction, and ▪ cardiac output.

autonomic, peripheral

The most common platelet defect is von Willebrand disease , a group of both _________ ________ and _________ __________ disorders that result in either quantitative or qualitative defects of ___ multimers. These multimers are composed of subunits (molecular weight 220-240 kDa) that are released from storage granules known as the _____-_____ ______ in endothelial cells and _____ ________ in platelets.

autosomal dominant, autosomal recessive, vWF, Weibl Palade bodies, alpha granules

Vessels and lymphatics associated with lateral parts of the breast emerge from or drain into the _________ region of the upper limb.

axillary

Proximal parts of the brachial plexus also pass through the proximal part of the _________ _____

axillary inlet

Superficial regions of the thoracic wall drain mainly into _________ lymph nodes in the axilla or ____________ nodes.

axillary, parasternal

Large systemic veins are used to establish central venous access for administering large amounts of fluid, drugs, and blood. Most of these lines (small-bore tubes) are introduced through venous puncture into the ________, __________, or ________ _______ veins.

axillary, subclavian, internal jugular

The cytoplasmic granules of neutrophils provide the cells' functional activities and are of two main types. ____________ _______ granules or ___________ are large, dense vesicles with a major role in both killing and degrading engulfed microorganisms. They contain proteases and antibacterial proteins, including the following: _________________ (___), which generates hypochlorite and other agents toxic to bacteria ________, which degrades components of bacterial cell walls _________, small cysteine-rich proteins that bind and disrupt the cell membranes of many types of bacteria and other microorganisms

azurophillic prmary, lysosomes Myleoperoxidase, MPO Lysozyme Defensins

All granulocytes have specialized lysosomes called ____________ granules and smaller _________ granules with proteins for various cell-specific functions.

azurophillic, specific

Granulocytes possess two major types of abundant cytoplasmic granules: lysosomes (often called ____________ granules in blood cells) and ________ granules that bind neutral, basic, or acidic stains and have specific functions.

azurophillic, specific

The superior vena cava receives the _______ vein immediately before entering the pericardial sac and may also receive pericardial and mediastinal veins.

azygous

Centrally, the intercostal veins ultimately drain into the _______ system of veins or into _________ ________ veins, which connect with the _______________ veins in the neck.

azygous, internal thoracic, brachiocephalic

In CHF, the failing heart can no longer efficiently pump the blood delivered to it by the venous circulation. The result is an increased end-diastolic ventricular volume, leading to increased end-diastolic pressures and, finally, elevated venous pressures. Thus, inadequate cardiac output—called _______ _______—is almost always accompanied by increased congestion of the venous circulation—that is, ________ _______.

backward failure, forward failure

The ____ of the heart is quadrilateral and directed posteriorly. It consists of: ▪ the left atrium, ▪ a small portion of the right atrium, and ▪ the proximal parts of the great veins (superior and inferior venae cavae and the pulmonary veins)

base

Each lung has a half-cone shape, with a base, apex, two surfaces, and three borders . ▪ The ____ sits on the diaphragm. ▪ The ____ projects above rib I and into the root of the neck. ▪ The two surfaces—the ______ surface lies immediately adjacent to the ribs and intercostal spaces of the thoracic wall. The ___________ surface lies against the mediastinum anteriorly and the vertebral column posteriorly and contains the comma-shaped hilum of the lung, through which structures enter and leave. ▪ The three borders—the ________ border of the lung is sharp and separates the base from the costal surface. The ________ and _________ borders separate the costal surface from the medial surface. Unlike the __________ and ________ borders, which are sharp, the _________ border is smooth and rounded.

base apex costal, mediastinal inferior, anteiror, posterior, anterior, inferior, posterior

Both _________ and ____ cells have metachromatic granules containing heparin and histamine, have surface receptors for immunoglobulin _ (Ig_), and secrete their granular components in response to certain antigens and allergens.

basophils, mast, E, E

Stroke volume is the difference between the volume of blood in the ventricle ______ ejection (___-__________ volume) and the volume remaining in the ventricle _____ ejection (___-________ volume). Typically, stroke volume is about __ mL. Thus, Stroke volume = End-diastolic volume − End-systolic volume

before, end diastolic, after, end systolic

Spinal cord injuries _____ the level of the origin of the phrenic nerve do not affect movement of the diaphragm.

below

The largest arteries supplying the diaphragm arise from _____ it. These arteries are the ________ _______ arteries, which branch directly from the _________ _____.

below, inferior phrenic, abdominal aorta

Drug type of propanalol

beta adrenergic blocker

HF: In addition to ACE inhibitors, ____-__________ _________ are advocated; when used in combination with the ACE inhibitors, they appear to reduce both the risk of death and the need for hospitalization for heart failure by 30% to 40%

beta adrenergic blockers

Most heavily effected sarcomeric protein in hypertrophic cardiomyopathy

beta-myosin heavy chain`

Sympathetic receptors stimulated in: Heart rate? Conduction velocity? Contractility? Vascular smooth muscle (internal organs)? Vascular smooth muscle (skeletal muscle)?

beta1 beta1 beta1 alpha1 beta2

Less common, _____-adrenergic receptors are found in arterioles of skeletal muscle. When activated, these receptors cause __________ of the vascular smooth muscle, which __________ the diameter and __________ the resistance of these arterioles to blood flow.

beta2, relaxation, increases, decreases

Diagram of an erythrocyte giving the cell's dimensions. The __________ shape gives the cells a very ____ surface-to-volume ratio and places most __________ within a short distance from the cell surface, both qualities that provide maximally efficient __ transport. Erythrocytes are also quite ________ and can easily bend to pass through small capillaries.

biconcave, high, hemoglobin, O2, flexible

Of note, in most cases of chronic cardiac decompensation, patients present with _____________ ___, encompassing the clinical syndromes of both right-sided and left-sided heart failure.

biventricular CHF

Deficiencies of factors participating in the coagulation cascade, and/or disordered platelet function, result in ________ disorders.

bleeding

It is essential that blood should not leak excessively from _____ ________ when they are injured by the traumas of daily life

blood vessels

With exceptions such as the ____ ______ and most of the ___, most tissues with blood microvasculature also contain lymphatic capillaries (or __________)

bone marrow, CNS, lymphatics

Thoracic outlet syndrome is used to describe symptoms resulting from abnormal compression of the ________ ______ of nerves as it passes over the _____ rib and through the axillary inlet into the upper limb.

brachial plexus, first

Venous drainage of the diaphragm is by veins that generally parallel the _________. The veins drain into: ▪ the _______________ veins in the neck, ▪ the _______ system of veins, or ▪ __________ veins (____ __________ vein and ________ ____ ____). arteries

brachiocephalic azygous abdominal, left suprarenal, inferior vena cava

Beginning on the right, the first branch of the arch of the aorta is the _______________ _____

brachiocephalic trunk

Parasternal nodes drain into __________________ trunks

bronchomediastinal

Intercostal nodes in the upper thorax also drain into __________________ ______, whereas intercostal nodes in the lower thorax drain into the ________ ____.

bronchomediastinal trunks, thoracic duct

Intercostal nodes drain into ___________________ trunks or the ________ ____

bronchomediastinal, thoracic duct

A ________________ _______ is the area of lung supplied by a segmental bronchus and its accompanying pulmonary artery branch.

bronchopulmonary segment

Patients who have an endobronchial lesion (i.e., a lesion within a bronchus) may undergo _____________ evaluation of the trachea and its main branches (Fig. 3.48). The bronchoscope is passed through the ____ into the __________ and is then directed by a control system past the vocal cords into the trachea. The bronchi are inspected and, if necessary, small biopsies are obtained.

bronchoscopic, nose, oropharynx

Lateral shaft of rib is elevated in pump handle or bucket handle?

bucket handle

A thin gray-white layer called the _____ ____ between the plasma and the hematocrit, about 1% of the volume, consists of leukocytes and platelets, both less dense than erythrocytes.

buffy coat

The outflow tract of the right ventricle, which leads to the pulmonary trunk, is the conus arteriosus (infundibulum). This area has smooth walls and derives from the embryonic ______ _______

bulbus cordis

Propagation of the action potential depends not only upon the inward current of the upstroke to establish local currents, but also on the _____ __________ of the myocardial fibers. Recall that these cable properties are determined by ____ ________ resistance (__) and ________ resistance (__). For example, in myocardial tissue, Ri is particularly low because of low-resistance connections between the cells called ___ __________

cable properties, cell membrane, Rm, internal, Ri, gap junctions

Obstruction to flow. Lesions that prevent valve opening (e.g., ________ ______ _____ ________) or cause _________ ventricular chamber pressures (e.g., systemic hypertension or aortic coarctation) can overwork the myocardium, which has to pump against the obstruction.

calcific aortic valve stenosis, increased

Reperfusion injury: Myocyte hypercontracture: In ischemia, intracellular ________ is increased Contraction of __________ is augmented and uncontrolled Leads to cell death

calcium myofibrils

Further subcutaneous spread can induce a rare manifestation of breast cancer that produces a hard, woody texture to the skin. What is this called?

cancer en curaisse

The compliance or _____________ of a blood vessel describes the volume of blood the vessel can hold at a given pressure. Compliance is related to ______________.

capacatince, distensibility

The ___________ are thin-walled structures lined with a single layer of endothelial cells, which is surrounded by a basal lamina.

capillaries

The velocity of flow should be lowest in vessels with the largest total cross-sectional area (the _________) and highest in the vessels with the smallest total cross-sectional area (the _____).

capillaries, aorta

Endothelial cells in the smallest blood vessels (___________) are supported by a thin layer of connective tissue, rich in collagen fibers, called the ______

capillaries, intima

Walls of all blood vessels except ____________ contain smooth muscle and connective tissue in addition to the endothelial lining. The amount and arrangement of these tissues in vessels are influenced by ___________ factors, primarily blood pressure, and _________ factors reflecting the local needs of tissues.

capillaries, mechanical, metabolic

From the standpoint of _________ function (i.e., exchange of nutrients, solutes, and water), the ___ velocity of blood flow is advantageous: It maximizes the time for exchange across the capillary wall.

capillary, low

Serial chest radiographs demonstrating the resolution of pulmonary edema (left to right). Note the enlargement of the _______ silhouette.

cardiac

Visceral afferents associated with the sympathetic system conduct pain sensation from the heart, which is detected at the cellular level as tissue-damaging events (i.e., ________ __________). This pain is often "_________" to _________ regions supplied by the same spinal cord levels

cardiac ischemia, referred, cutaneous

In terms of myocardial function, ______ ______ ____ is cardiac output multiplied by aortic pressure. Therefore, cardiac minute work can be considered to have two components: ______ work (i.e., cardiac output) and ________ work (i.e., aortic pressure).

cardiac minute work, volume, pressrue

The rate at which blood is pumped from either ventricle is called the _______ _________

cardiac output

Dense fibrous connective tissue of the _______ ________ forms part of the interventricular and interatrial septa, surrounds all valves of the heart, and extends into the valve cusps and the chordae tendineae to which they are attached

cardiac skeleton

Masses of dense irregular connective tissue make up the _______ ________, which surrounds the bases of all heart valves, separates the atria from the ventricles, and provides insertions for cardiac muscle.

cardiac skeleton

The fibrous _______ ________ consists of dense irregular connective tissue, primarily in the ___________, which anchors the valves and surrounds the two atrioventricular canals, maintaining their proper shape. The micrograph shows a section through a cusp of an atrioventricular valve and attached ________ _______. These structures are largely ____ __________ tissue covered with a thin layer of ___________. The ________-rich connective tissue of the valves is stained pale blue here and is continuous with the fibrous ring of connective tissue at the base of the valves, which fills the endocardium between the ______ and _________. The thick ventricular __________ is also shown.

cardiac skeleton, endocardium, chordae tenindinae, dense connective, endothelium, collagen, atria, ventricles, myocardium

Because the fibrous pericardium is a "relatively fixed" structure that cannot expand easily, a rapid accumulation of excess fluid within the pericardial sac compresses the heart (_______ _________), resulting in biventricular failure.

cardiac tamponade

The cardiac conducting system stimulates rhythmic contractions and consists of modified _______ muscle fibers forming the __________ and________________ nodes, the ______________ ______ (of His), left and right ______ _________, and _________ fibers.

cardiac, sinoatrial, atrioventricular, atrioventricular bundle, bundle branches, Purkinjie

Other manifestations of left ventricular failure include an enlarged heart (___________), tachycardia, a ___ heart sound (__), and fine rales at the lung bases, caused by the opening of edematous pulmonary alveoli

cardiomegaly, 3rd, S3

The primary function of the ______________ system is to deliver blood to the tissues, providing essential nutrients to the cells for metabolism and removing waste products from the cells.

cardiovascular

The ______________ system is the first organ system to become fully functional in utero (at approximately _ weeks of gestation); without a beating heart and vascular supply, further development cannot occur, and fetal demise is inevitable.

cardiovascular, 8

Structures traveling between the thorax and abdomen pass through the diaphragm or between the diaphragm and its peripheral attachments: ▪ The inferior vena cava passes through the _______ ______ at approximately vertebral level __.

central tendon, T8

From these peripheral attachments, muscle fibers converge to join the _______ ______ of the diaphragm. The __________ is attached to the middle part of the central tendon

central tendon, pericardium

The inferior vena cava pierces teh _______ ______ of the diaphragm to enter the _____ side of the mediastinum near vertebral level T_

central tendon, right, 8

A _________ ___ is an accessory rib articulating with vertebra CVII; the anterior end attaches to the superior border of the anterior aspect of rib I.

cervical rib

Plain radiographs may demonstrate _________ ____ as small horn-like structures

cervical ribs

The dome-shaped layer of parietal pleura lining the cervical extension of the pleural cavity is _______ pleura (____ of pleura or _______ _______)

cervical, dome, pleural cupola

Activated neutrophils at infected or injured sites also have important roles in the inflammatory response that begins the process of restoring the normal tissue microenvironment. They release many polypeptide __________ that attract other leukocytes and _________ that direct activities of these and local cells of the tissue. Important _____ __________ of inflammation are also released from neutrophils.

chemokines, cytokines, lipid mediators

Histologically more complex ______________ which monitor blood CO2 and O2 levels, as well as its pH, are found in the ______ _______ and _______ _______, located in the walls of the carotid sinuses and aortic arch, respectively. These structures are parts of the _________ nervous system called ___________ with rich capillary networks. The capillaries are closely surrounded by large, ______ _______-derived ______ cells filled with dense-core vesicles containing __, ___, and other neurotransmitters, which are supported by smaller satellite cells. Ion channels in the glomus cell membranes respond to stimuli in the arterial blood, primarily _________ (low O2), ____________ (excess CO2), or _________, by activating release of neurotransmitters

chemoreceptors, carotid bodies, aortic bodies, autonomic, paraganglia, neural crest glomus, DA, ACh, hypoxia, hypercapnia, acidosis

Specialized regions in the walls of certain elastic arteries contain tissues acting as ______________ that provide information to the brain regarding blood chemistry. The ______ ______ are two small (0.5-5 mm diameter) ganglion-like structures found near the ______ _______ arteries. They contain many large capillaries intermingled with clusters of large ______ cells filled with vesicles of various neurotransmitters. Supportive _________ cells with elongated nuclei ensheath each glomus cell. Glomus cells form synaptic connections with sensory fibers. Significant changes in the blood ___, __, or __ concentrations are detected by the chemoreceptive glomus cells, which then release a ________________ that activates the sensory nerve to relay this information to the brain.

chemoreceptors, glomus bodies, common carotid, glomus, satellite, CO2, O2, H+, neurotransmitter

Insertion of a _____ ____ is a commonly performed procedure and is indicated to relieve air or fluid trapped in the thorax between the lung and the chest wall (_______ ______). This procedure is done for pneumothorax, hemothorax, hemopneumothorax, malignant pleural effusion empyema, hydrothorax, and chylothorax, and also after thoracic surgery.

chest tube, pleural cavity

Pericarditis is an inflammatory condition of the pericardium. Common causes are viral and bacterial infections, systemic illnesses (e.g., _______ _____ _______), and after myocardial infarction.

chronic renal failure

The effects of the autonomic nervous system on heart rate are called ___________ effects.

chronotropic

In a thoracic vertebra, the vertebral foramen is generally ________ and the _______ are broad and overlap with those of the vertebra _____.

circular, laminae, below

Impulses begin at the sinu-atrial node, the cardiac pacemaker. This collection of cells is located at the superior end of the ______ __________ at the junction of the ________ ____ ____ and the _____ ______. This is also the junction between the parts of the right atrium derived from the embryonic _____ _______ and the ______ ______

cirsta terminalis, superiror vena cav, right atrium, sinus venosus, atrium proper

To obtain platelet-poor plasma, blood is collected in tubes containing _______ anticoagulant to sequester ________ ions reversibly, and the blood is centrifuged at 2000 g for 15 minutes.

citrate, calcium

The pectoralis major has a broad origin that includes the anterior surfaces of the medial half of the _________, the _______, and related costal cartilages

clavicle, sternum

A continuous layer of deep fascia, the _____________ ______, encloses the subclavius and pectoralis minor and attaches to the clavicle above and to the floor of the axilla below.

clavipectoral fascia

Nerves, vessels, and lymphatics that pass between the pectoral region and the axilla pass through the _____________ ______ between the subclavius and pectoralis minor or pass under the inferior margins of the pectoralis major and minor.

clavipectoral fascia

Patients who take daily aspirin and/or other antiplatelet agents (e.g., ___________) can expect some ________ in surgical and postoperative bleeding, but this is generally not clinically significant and can be controlled with local measures only.

clopidogrel, bleeding

inactivation gates on the Na+ channels also _____ with depolarization (although they close more ______ than the activation gates open). Therefore, during those phases of the action potential when the membrane potential is depolarized, a portion of the Na+ channels will be ______ because the inactivation gates are _____. When the Na+ channels are closed, _______ depolarizing current cannot flow through them, and there can be no upstroke. Without an upstroke, a normal action potential cannot occur and the cell is __________. Once repolarization occurs, the inactivation gates on the Na+ channels ____, and the cell is once again excitable.

closer, slowly, closed, closed, inward, refractory, open

The transverse processes of a thoracic vertebrae are ___ shaped and project ________________

club, posterolaterally

Although they are morphologically similar, mature lymphocytes can be subdivided into functional groups by distinctive surface molecules (called "_______ __ _______________" or __ markers) that can be distinguished using antibodies with immunocytochemistry or flow cytometry. Major classes include _ lymphocytes, ______ and _________ _ lymphocytes (CD4+ and CD8+, respectively), and ______ ______ (__) cells

cluster of differentiation, CD, B, helper, cytotoxic, natural killer, NK

Blood ___________ _______ interact to form the secondary, fibrin-rich, hemostatic plug in small vessels, and the secondary fibrin thrombus in arteries and veins

coagulation factors

congenital abnormality in which the aortic lumen is constricted just distal to the origin of the left subclavian artery.

coarcation of the aorta

vWF in turn binds both to ________ fibers and to _________ (via a platelet membrane glycoprotein receptor, GPIb-IX)

collagen, platelets

Platelets bind to ________ via von Willebrand factor (___), which is released from the ___________ cells.

collagen, vWF, endothelial

In addition to these major branches, small ___________ branches can be found in the intercostal space running along the superior border of the lower rib.

collateral

Intercoronary anastemoses that can help keep blood flow going to the heart

collateral circulation

Compensatory blood flow to a heart area at risk; such as __________ _________ can protect against MI even if a vessel becomes completely occluded

collateral perfusion

Postcapillary venules converge into larger __________ _______ that have more distinct contractile cells. With increasing size venules become surrounded by a recognizable tunica media with two or three smooth muscle layers and are called ________ _______.

collecting venules, muscular venules

Tricuspid valve: The cusps are continuous with each other near their bases at sites termed _____________

commissures

The Frank-Starling mechanism. Increased end-diastolic filling volumes dilate the heart and cause increased cardiac myofiber stretching; these lengthened fibers contract more forcibly, thereby increasing cardiac output. If the dilated ventricle is able to maintain cardiac output by this means, the patient is said to be in ___________ _____ _______ However, ventricular dilation comes at the expense of increased wall tension and amplifies the oxygen requirements of an already-compromised myocardium. With time, the failing muscle is no longer able to propel sufficient blood to meet the needs of the body, and the patient develops _____________ _____ _______

compensated heart failure, decompensated heart failur

Patients with a previous history of HF or who are asymptomatic have ____________ HF (NYHA class _). Those who are symptomatic have _____________ HF (NYHA classes __, ___, and __)

compensated, I, decompensated, II, III, IV

Heart failure: If responses result in improved cardiac output with an elimination of symptoms, the condition is termed ___________ HF. Symptomatic HF is termed _____________ HF

compensated, decompensated

For each type of blood vessel, volume is plotted as a function of pressure. The slope of each curve is the __________

compliance

Recall that __________ of a blood vessel is the volume the vessel can hold at a given pressure (C = V/P)

compliance

In the heart, __________ ________ has the same meaning that it has in nerve and skeletal muscle fibers: It is the speed at which action potentials are propagated within the tissue. The units for conduction velocity are meters per second (m/sec). Conduction velocity is not the same in all myocardial tissues: It is slowest in the __ ____ (0.01 to 0.05 m/sec) and fastest in the __________ ______ (2 to 4 m/sec)

conduction velocity, AV node, purkinjie fibers

Excessive bleeding may result from defects in each of the components of hemostasis, which may be caused by disease (__________ or _________) or by antithrombotic drugs

congenital, acquired

When the aortic valve is incompetent (e.g., due to a __________ abnormality), the normal one-way flow of blood from the left ventricle into the aorta is disrupted. Instead, blood that was ejected into the aorta flows backward into the ventricle. Such retrograde flow can occur because the ventricle is relaxed (is at ___ pressure) and because the incompetent aortic valve cannot prevent it, as it normally does.

congenital, low

Shunted flow. Defects (__________ or ________) that divert blood inappropriately from one chamber to another, or from one vessel to another, lead to pressure and volume overloads.

congential, acquired

HF, often called __________ _____ _________, is not an actual diagnosis; rather, it manifests as a symptom complex that can be the result of any of a number of specific diseases

congestive heart failure

Heart failure generally is referred to as __________ _____ _______

congestive heart failure

The major therapeutic use of cardiac glycosides is in the treatment of __________ _____ _______, a condition characterized by decreased contractility of ventricular muscle (i.e., ________ inotropism).

congestive heart failure, negative

The liver usually is increased in size and weight (__________ ____________). A cut section displays prominent passive congestion, a pattern referred to as ______ _____; congested centrilobular areas are surrounded by peripheral paler, noncongested parenchyma. When left-sided heart failure is also present, severe central hypoxia produces ____________ _______ in addition to the sinusoidal congestion. With long-standing severe right-sided heart failure, the central areas can become fibrotic, creating so-called _______ _________

congestive hepatomegaly, nutmeg liver, centriobular necrosis, cardiac cirrhosis

is synthesized by two distinct forms of endothelial nitric oxide synthase (eNOS): _____________ and _________

constituitive, inducible

Visceral efferents from: ▪ the vagus nerves __________ the bronchioles; ▪ the sympathetic system _______ the bronchioles.

constrict dilates

Abnormal thickening of the pericardial sac (____________ ____________) can compress the heart, impairing heart function and resulting in heart failure. The diagnosis is made by inspecting the ________ _______ pulse in the ____. In normal individuals, the jugular venous pulse drops on ___________. In patients with constrictive pericarditis, the reverse happens and this is called ___________ ____. Treatment often involves surgical opening of the pericardial sac

constrictive pericarditis, jugular venous, neck, inspiration, Kussmaul's sign

The smooth muscle in the walls of the arterioles is tonically active (i.e., always __________). It is extensively innervated by ___________ adrenergic nerve fibers. ______-Adrenergic receptors are found on the arterioles of several vascular beds (e.g., skin and splanchnic vasculature). When activated, these receptors cause ___________ or constriction of the vascular smooth muscle.

contracted, sympathetic, alpha1, contraction

HF may occur as a result of (1) impaired myocardial _____________ (systolic dysfunction, commonly characterized as reduced left ventricular ejection fraction [LVEF]11); (2) _________ ventricular stiffness or impaired myocardial relaxation (diastolic dysfunction, which commonly is associated with a relatively normal LVEF); (3) a variety of other cardiac abnormalities, including obstructive or regurgitant ________ disease, intracardiac shunting, or disorders of heart rate or _______; or (4) states in which the heart is unable to compensate for ___________ peripheral blood flow or metabolic requirements

contractility Increased valvular, rhythm increased

Irreversibly damaged myocytes exposed to reperfusion show ___________ ____ necrosis

contraction band

Increases in sympathetic nerve activity, via α1 adrenergic receptors, cause ___________ of the veins, which _______ their capacitance, and, therefore, _________ the unstressed volume.

contraction, reduces, reduces

The outflow tract of the right ventricle, which leads to the pulmonary trunk, is the _____ _________

conus arteriosus

Isolated right-sided heart failure also can occur in a few diseases. The most common of these is severe pulmonary hypertension, resulting in right-sided heart pathology termed ___ _________

cor pulmonae

The lymphatic vessels of the heart follow the _________ ________ and drain mainly into: ▪ _________________ nodes, anterior to the brachiocephalic veins; and ▪ _________________ nodes, at the inferior end of the trachea.

coronary arteries Brachiocephalic Tracheobronchial

The most common underlying cause of HF in the United States is __________ _____ _______, or ________ ________ _______(secondary to _______________), accounting for 60% to 75% of cases, with cardiomyopathy, hypertension, and valvular heart disease also well-recognized contributory conditions. The second most common cause of HF, accounting for about one fourth of all cases, is _________ ______________

coronary heart disease, coronary artery disease, atherosclerosis, dilated cardiomyopathy

The _________ _____ receives four major tributaries: the great, middle, small, and posterior cardiac veins.

coronary sinus

An additional structure in the right atrium is the opening of the _________ _____, which receives blood from most of the cardiac veins and opens _________ to the opening of the ________ ____ ______. Associated with these openings are small folds of tissue derived from the valve of the embryonic _____ _______ (the valve of the coronary sinus and the valve of inferior vena cava, respectively). During development, the valve of the inferior vena cava helps direct incoming oxygenated blood through the _______ _____ and into the ____ ______

coronary sinus, medially, inferior vena cava, sinus venosus, foramen ovale, left atrium

The __________ ______ circles the heart, separating the atria from the ventricles. As it circles the heart, it contains the right coronary artery, the small cardiac vein, the coronary sinus, and the circumflex branch of the left coronary artery.

coronary sulcus

The subcutaneous position of the sternum makes it possible to place a needle through the hard outer ______ into the internal (or _________) cavity containing bone marrow.

cortex, medullary

▪ Pleura related to the ribs and intercostal spaces is termed the ______ part

costal

The inferior margin of the internal surface of a rib is marked by a distinct _______ ______.

costal groove

Intercostal nerves and associated major arteries and veins lie in the ________ ____ along the ________ margin of the ________ rib and pass in the plane between the _____ two layers of muscles.

costal groove, inferior, superior, inner

Inferiorly, the costal pleura reflects onto the diaphragm above the ______ ______. In the midclavicular line, the pleural cavity extends inferiorly to approximately rib _. In the midaxillary line, it extends to rib __. From this point, the inferior margin courses somewhat horizontally, crossing ribs __ and __ to reach vertebra ___.

costal margin, 8, 10, 11, 12, T12

The largest and clinically most important recesses are the __________________ recesses, which occur in each pleural cavity between the costal pleura and diaphragmatic pleura

costodiaphragmatic

Anteriorly, a ________________ ______ occurs on each side where costal pleura is opposed to mediastinal pleura.

costomediastinal recess

The head of a rib is somewhat expanded and typically presents two articular surfaces separated by a _____

crest

Shape of capillary endothelial cell's nucleus

curved

Sensory innervation of the skin overlying the upper thoracic wall is supplied by _________ branches (_______________ nerves), which descend from the ________ plexus in the ____.

cutaneous, supraclavicular, cervical, neck

All leukocytes are key players in the constant defense against invading microorganisms and in the repair of injured tissues, specifically leaving the microvasculature in injured or infected tissues. At such sites factors termed _________ are released from various sources and these trigger loosening of intercellular junctions in the endothelial cells of local ______________ _______. Simultaneously the cell adhesion protein _-________ appears on the endothelial cells' luminal surfaces following exocytosis from cytoplasmic _______-______ ______.

cytokines, postcapillary venules, P selectin, Weibl Palade bodies

Conduction velocity also correlates with __/__, the rate of rise of the upstroke of the action potential, because dV/dT also correlates with the size of the ______ current.

dV dT, inward

Since total blood flow is constant at all levels of the cardiovascular system, as resistance increases, downstream pressure must necessarily _________ (Q = ΔP/R, or ΔP = Q × R).

decrase

In the capillaries, pressure _________ further for two reasons: frictional resistance to flow and filtration of fluid out of the capillaries. When blood reaches the venules and veins, pressure has __________ even further. (Recall that because capacitance of the veins is ____, the veins can hold _____ volumes of blood at this ___ pressure.)

decrases, decreased, high, large, low

Cardiac muscle: If end-diastolic volume were to increase further and the fibers were stretched to even longer lengths, overlap would ________ and the pressure would ________ (descending limb of the curve). In contrast to skeletal muscle, which operates over the entire length-tension curve, cardiac muscle normally operates only on the __________ limb of the curve.

decrease, decrease, ascending

Another predictable consequence of a parallel arrangement is that adding a resistance to the circuit causes total resistance to ________, not to ________.

decrease, increase

Stimulation of the parasympathetic nervous system produces a ________ in conduction velocity through the AV node (________ ___________ effect), which _________ the rate at which action potentials are conducted from the atria to the ventricles. The mechanism of the parasympathetic effect is a combination of _________ ICa (decreased ______ current) and _________ IK-ACh (increased _______ K+ current, which further reduces net inward current).

decrease, negative dromotrophic, decreased, inward, increased, outward

In sum, the parasympathetic nervous system __________ heart rate through three effects on the SA node: (1) slowing the rate of _____ _ ______________ (2) _______________ the maximum diastolic potential so that more ______ current is required to reach threshold potential, and (3) __________ the threshold potential. As a result, the SA node is depolarized to threshold less frequently and fires _____ action potentials per unit time (i.e., _________ heart rate)

decreases phase 4 depolarization increasing, inward increasing fewer, decreased

Beginning in the small arteries, arterial pressure _________, with the most significant decrease occurring in the __________. At the end of the arterioles, mean pressure is approximately 30 mm Hg.

decreases, arterioles

The effect of narrowing a blood vessel (i.e., _________ diameter and radius) on Reynolds number is initially puzzling because, according to the equation, decreases in vessel diameter should ________ Reynolds number (diameter is in the numerator). Recall, however, that the velocity of blood flow also depends on diameter (radius), according to the earlier equation, v = Q/A or v = Q/πr2. Thus, velocity (also in the numerator of the equation for Reynolds number) increases as radius _________, raised to the ___ power.

decreases, decrease, decreases, 2nd

A consequence of the increased afterload is that less blood is ejected from the ventricle during systole; thus, stroke volume _________, more blood remains in the ventricle at the end of systole, and end-systolic volume _________.

decreases, increases

As the diaphragm contracts, the high levels of the domes ________ and the volume of the thorax _________

decreases, increases

In arteriosclerosis, plaque deposits in the arterial walls ________ the diameter of the arteries and make them stiffer and ____ compliant. Because arterial compliance is decreased, ejection of a stroke volume from the left ventricle causes a much _______ change in arterial pressure than it does in normal arteries (C = ΔV/ΔP or ΔP = ΔV/C). Thus, in arteriosclerosis, systolic pressure, pulse pressure, and mean pressure all will be _________.

decreasing, less, greater, increased

Superficial to the intercostal spaces are ____ ______, ____________ _______, and ____. Muscles associated with the _____ _____ and ____ overlie the spaces.

deep fascia, superficial fascia, skin, upper limb, back

right and left bronchomediastinal trunks drain directly into ____ _____ at the base of the neck, or may drain into the _____ _________ _____ or _________ ____.

deep veins, right lymphatic trunk, thoracic duct

Internal thoracic arteries run along the ____ aspect of the anterior thoracic wall along both sides of the _______

deep, sternum

An open canalicular system of vesicles is connected to invaginations of the plasma membrane, which may facilitate platelets' uptake of factors from plasma. A much less prominent set of irregular tubular vesicles comprising the dense tubular system is derived from the ER and stores Ca2+ ions. Together, these two membranous systems facilitate the extremely rapid exocytosis of proteins from platelets (_____________) upon adhesion to _________ or other substrates outside the _________ ____________

degranualtion, collagen, vascular endothelium

Platelets: Besides specific granules, the central granulomere has a sparse population of mitochondria and glycogen particles. Electron-dense _____ granules, 250-300 nm in diameter, contain ADP, ATP, and serotonin (5-hydroxytryptamine) taken up from plasma. _____ granules are larger (300-500 nm in diameter) and contain platelet-derived growth factor (____), platelet factor 4, and several other platelet-specific proteins. Most of the stained granules seen in platelets with the light microscope are _____ granules.

delta, alpha, PDGF, alpha

Pressure gradient symbol

deltaP

SA node depolarization: 1. Phase 0, _______. Phase 0 (as in the other cardiac cells) is the upstroke of the action potential. Note that the upstroke is not as rapid or as steep as in the other types of cardiac tissues. The ionic basis for the upstroke in the SA node differs as well. In the other myocardial cells, the upstroke is the result of an ________ in gNa and an inward ___ current. In the SA nodal cells, the upstroke is the result of an ________ in gCa and an inward ____ current carried primarily by L-type Ca2+ channels. There are also T-type Ca2+ channels in SA node, which carry part of the inward Ca2+ current of the upstroke. 2. Phases _ and _ are absent. 3. Phase 3, ______________. As in the other myocardial tissues, repolarization in the SA node is due to an ________ in gK. Because the electrochemical driving forces on K+ are large (both chemical and electrical driving forces favor __ leaving the cell), there is an outward K+ current, which repolarizes the membrane potential. 4. Phase 4, ___________ ______________ or _________ _________. Phase 4 is the longest portion of the SA node action potential. This phase accounts for the ____________ of SA nodal cells (the ability to spontaneously generate action potentials without neural input). During phase 4, the most negative value of the membrane potential (called the _______ _________ _________) is approximately −65 mV, but the membrane potential does not remain at this value. Rather, there is a slow depolarization, produced by the opening of Na+ channels and an ______ ___ current called __. The "f," which stands for _____, denotes that this Na+ current differs from the fast Na+ current responsible for the upstroke in ventricular cells. If is turned on by _____________ from the preceding action potential, thus ensuring that each action potential in the SA node will be followed by another action potential. Once If and slow depolarization bring the membrane potential to threshold, the T-type Ca2+ channels are opened for the upstroke.

depolarizatoin, increase, Na+, increase, Ca2+ 1, 2 repolarization, increase spontaneous depolarization, pacemaker potential, automaticity, maximum diastolic potential, inward Na_, funny, repolarization

Inspiration: diaphragm ________ to ________ thoracic volume

descends, increase

right sided heart AKA

dextrocardia

A right-sided arch of aorta occasionally occurs and may be asymptomatic. It can be associated with ____________ (right-sided heart) and, in some instances, with complete _____ ________ (left-to-right inversion of the body's organs).

dextrocardia, situs inversus

In a process called _________ leukocytes send extensions through the openings between the endothelial cells, migrate out of the venules into the surrounding tissue space, and head directly for the site of injury or invasion. The attraction of neutrophils to bacteria involves chemical mediators in a process of __________, which causes leukocytes to rapidly accumulate where their defensive actions are specifically needed.

diapdesis, chemotaxis

The heart in the anatomical position rests on the _____________ surface, which consists of the left ventricle and a small portion of the right ventricle separated by the posterior interventricular groove

diapharagmatic

Spinal cord injuries below the level of the origin of the phrenic nerve do not affect movement of the _________.

diaphragm

Structures traveling between the thorax and abdomen pass through the _________ or between the diaphragm and its peripheral attachments:

diaphragm

The _________ is a thin musculotendinous structure that fills the inferior thoracic aperture and separates the thoracic cavity from the abdominal cavity

diaphragm

The _________ is innervated by two phrenic nerves that originate, one on each side, as branches of the cervical plexus in the neck

diaphragm

The phrenic nerves pass vertically through the neck, the superior thoracic aperture, and the mediastinum to supply motor innervation to the entire _________, including the crura (muscular extensions that attach the diaphragm to the upper ______ vertebrae).

diaphragm, lumbar

_____________ nodes are posterior to the xiphoid and at sites where the phrenic nerves penetrate the diaphragm. They also occur in regions where the diaphragm is attached to the vertebral column.

diaphragmatic

▪ Pleura covering the diaphragm is the ______________ part.

diaphragmatic

The sides of the heart consist of: ▪ a ______________ (inferior) surface on which the pyramid rests, ▪ an ________ (sternocostal) surface oriented anteriorly, ▪ a _____ _________ surface, and ▪ a ____ _________ surface.

diaphragmatic anteiror left pulmonary right pulmonary

the "working length" of cardiac muscle fibers (the length at the end of ________) is 1.9 µm (<Lmax, which is 2.2 µm). This systolic pressure-volume (i.e., ______-_______) relationship for the ventricle is the basis for the _____-________ relationship in the heart.

diastole, length tension, Frank Starling

The "blip" in the arterial pressure curve, called the ________ _____ (or ________), is produced when the aortic valve closes.

dicrotic notch, incisura

HF: For patients taking a _________ _________, epinephrine should be avoided, if possible, because the combination can potentially precipitate arrhythmias

digitalis glycoside

Dabigatran, an oral ______ ________ _________ (___), has been demonstrated in large randomized controlled clinical trials to be as effective as warfarin in the treatment of acute venous thrombosis and in the prevention of stroke in patients with ______ ______________

direct thrombin inhibitor, atrial fibrillation

Now that the central role of thrombin in hemostasis and thrombosis has been recognized, a number of ______ ________ ___________ (____) have been developed as anticoagulant drugs

direct thrombin inhibitors, DTIs

The most important concepts expressed in the Poiseuille equation are as follows: First, resistance to flow is _______ proportional to viscosity (η) of the blood; for example, as viscosity increases (e.g., if the hematocrit __________), the resistance to flow also _________. Second, resistance to flow is ________ proportional to the length (l) of the blood vessel. Third, and most important, resistance to flow is _________ proportional to the __ power of the radius (r4) of the blood vessel.

directly, increases, increases, directly, inveresly, 4th

Each individual platelet is generally _______, with a very lightly stained peripheral zone, the _________, and a darker-staining central zone rich in granules, called the ___________

discoid, hyalomere, granulomere

Transposition of the great arteries is a __________ connection of the ventricles to their vascular outflow. The embryologic defect is an abnormal formation of the truncal and aortopulmonary septa so that the aorta arises from the _____ _________ and the pulmonary artery emanates from the _____ _________

discordant, right ventricle, left ventricle

Sequence of a typical MI: Plaque is suddenly _________ Exposes subendotehilaal _________ and necrotic ______ contents to the blood _________ adhrere, aggregate, and are activated ___________ __, ___, and _________ further cause platelet aggregation and vasospasm Activation of ___________ by exposure to tissue factor and other mechanisms Growth of ________ Thrombus can completely occlude coronary artery _____ within minutes

disrupted, collagen, plaque Platelets Thromboxane A2, ADP, serotonin coagulation thrombus lumen

Fibrinogen deficiency may be congenital or due to acquired consumption of fibrinogen in ____________ ________________ ___________ (___), or may occur after administration of _____________ drugs

disseminated intravascular coagulation, DIC, fibrinolytic

The effects of the autonomic nervous system on conduction velocity are called ____________ effects

dromotrophic

The ligamentum arteriosum is also in the superior mediastinum and is important in embryonic circulation, when it is a patent vessel (the ______ __________)

ductus arteriorsus

The _______ __________ arises from the left pulmonary artery and joins the aorta just distal to the origin of the left subclavian artery.

ductus arteriosus

Conduction velocity does not depend on action potential _________, a point that can be confusing. Recall, however, that action potential duration is simply the time it takes a given site to go from ______________ to complete ______________ (e.g., action potential duration in a ventricular cell is 250 msec). Action potential duration implies nothing about how long it takes for that action potential to spread to neighboring sites.

duration, depolarization, repolarization

The outstanding symptom of left ventricular failure is _______, which results from the accumulation or congestion of blood in the pulmonary vessels—hence the designation __________.

dyspnea, congestive

Cardiac malformations associated with right-to-left shunts are distinguished by _____ ________

early cyanosis

Preductal coarctation with a PDA usually presents _____ in life, classically as ________ localized to the _____ ____ of the body; without intervention, most affected infants do not survive the neonatal period.

early, cyanosis, lower half

Under the following conditions a latent pacemaker takes over and becomes the pacemaker of the heart, in which case it is called an _______ _________, or _______ _____. (1) If the SA node firing rate ________ (e.g., due to _____ stimulation) or stops completely (e.g., because the SA node is destroyed, removed, or suppressed by _____), then one of the latent sites will assume the role of pacemaker in the heart. (2) Or, if the intrinsic rate of firing of one of the latent pacemakers should become _______ than that of the SA node, then it will assume the pacemaker role. (3) Or, if the conduction of action potentials from the SA node to the rest of the heart is blocked because of disease in the conducting pathways, then a latent pacemaker can appear in addition to the __ ____

ectopic pacemaker, ectopic focus decreases, vagal, drugs faster SA node

The __________ __________ ______includes, and is slightly longer than, the absolute refractory period. At the end of the effective refractory period, the Na+ channels start to recover (i.e., become available to carry ______ current). The distinction between the absolute and effective refractory periods is that ________ means absolutely no stimulus is large enough to generate another action potential; _________ means that a conducted action potential cannot be generated (i.e., there is not enough ______ current to conduct to the next site).

effective refractory period, inward, absolute, effective, inward

Systemic venous congestion due to right heart failure can lead to transudates (_________) in the pleural and pericardial spaces, but usually does not cause pulmonary parenchymal edema. Pleural effusions are most pronounced when there is increase in pulmonary venous as well as systemic venous pressures, as occurs in combined right and left heart failure. When large (e.g., 1 L or more), pleural effusions can cause ___________, and, very uncommonly, substantial pericardial effusions (greater than 500 mL) can limit cardiac filling and cause cardiac failure (due to _________). A combination of hepatic congestion (with or without diminished albumin synthesis) and portal hypertension leads to peritoneal transudates (_______)

effusions, atelactasis, tamponade, ascites,

The determination of left ventricular failure often is based on a finding of an abnormal ________ ________, which is the percentage of blood ejected from the left ventricle during systole.

ejection fraction

the most prominent feature of _______ arteries is the thick tunica media in which elastic lamellae alternate with layers of smooth muscle fibers. The adult aorta has about __ elastic lamellae (____ if the individual is hypertensive).

elastic, 50, more

The largest arteries contain considerable _______ material and _______ with blood when the heart contracts. A transverse section through part of a large elastic artery shows a thick _____ consisting largely of many well-developed elastic lamellae. Strong pressure of blood pulsating into such arteries during ________ expands the arterial wall, reducing the pressure and allowing strong blood flow to continue during ________. The ______ of the empty aorta is typically folded, and the dense irregular connective tissue of the __________ is thinner than the media.

elastic, expands, media, systole, diastole, intima, adventitia

Arteries are grouped by size and wall composition: (1) large _______ arteries, with fenestrated elastic laminae in the thick tunica media; (2) muscular, _______-sized arteries; and (3) _____ arteries, with fewer than 10 layers of smooth muscle in the media.

elastic, medium, small

Myocardial ischemia leads to arrythmias, causing __________ ___________ of ischemic regions of the heart

electrical instability

In plasma, dissolved components are mostly plasma proteins, but they also include nutrients, respiratory gases, nitrogenous waste products, hormones, and inorganic ions collectively called ____________

electrolytes

Heart Attack: The pain in the chest (which may be described as an "__________ sitting on my chest" or by using a clenched fist to describe the pain [_______ sign]) often radiates to the arms (_____ more common than the ______), and can be associated with nausea.

elephant, Levine, left, right

Inspiration: __________ of lateral aspect of ribs

elevation

The ______ pairs of external intercostal muscles extend from the inferior margins (lateral edges of costal grooves) of the ribs above to the superior margins of the ribs below.

eleven

From large thrombi, solid masses called ______ (singular, _______) may detach and be carried by the blood to obstruct distant vessels.

emboli, embolius

When right-sided ventricular enlargement occurs as a result of a lung disorder (e.g., _________) that produces pulmonary hypertension, the condition is called ___ ________

emphysema, cor pulmonae

Because of the cyclical opening and closing of the sphincters, most capillaries are essentially ______ at any given time, with only about _% (~300 mL in an adult) of the total blood volume moving through these structures.

empty, 5

The preload for the left ventricle is left ventricular ___-_________ ______, or end-diastolic fiber length; that is, preload is the resting length from which the muscle contracts. The relationship between preload and developed tension or pressure, illustrated in the upper (systolic) curve is based on the degree of overlap of thick and thin filaments.

end diastolic volume

effect of increased preload on the ventricular cycle. Recall that preload is ___-_________ ______. In this example, preload is _________ because venous return is increased, which increases end-diastolic volume

end diastolic volume, increased

Through the vasculature, ____________ cells are not simply heart and vessel liners; they actively produce factors that prevent blood clotting, factors that cause adjacent smooth muscle cells to contract or relax, and factors that initiate inflammation at sites of damage or infection.

endothelial

Tissue-type plasminogen activator (tPA) is synthesized by ___________ cells; it normally circulates in plasma in low basal concentrations (5 ng/mL), but is released into plasma by stimuli that include venous occlusion, exercise, and epinephrine.

endothelial

NO is synthesized by two distinct forms of ___________ _______ _____ ________ (_____): constitutive and inducible

endothelial nitric oxide synthase, eNOS

Capillaries are composed of the simple layer of ___________ cells rolled up as a tube surrounded by basement membrane. The average diameter of capillaries varies from 4 to 10 µm, which allows transit of blood cells only _ at a time, and their individual length is usually not more than 50 µm.

endothelial, 1

Diagram indicating more details about lymphatics, including the openings between the ____________ cells. The openings are held in place by _________ _________ containing elastin and are covered by extensions of the endothelial cells. Interstitial fluid enters primarily via these openings, and the endothelial folds prevent backflow of lymph into tissue spaces. Lymphatic endothelial cells are typically _______ than those of blood capillaries.

endothelial, anchoring filaments, larger

Exposure of flowing blood to collagen as a result of ___________ damage also stimulates _________ activation

endothelial, platelet

A large mesenteric arteriole cut obliquely and longitudinally clearly shows the ___________ cells and one or two layers of ______ ______ cells cut transversely. __________ merges imperceptibly with neighboring connective tissue.

endothelial, smooth muscle, adventitia

The ___________ is a specialized epithelium that acts as a semipermeable barrier between two major internal compartments: the blood and the interstitial tissue fluid.

endothelium

Capillaries consist only of an _____________ rolled as a tube, across which molecular exchange occurs between blood and tissue fluid. Capillaries are normally associated with perivascular contractile cells called _________ that have a variety of functions. The more flattened nuclei belong to ___________ cells

endothelium, pericytes, endothelial

Arterioles are microvessels with an intima consisting only of __________. in which the cells may have rounded nuclei. They have _____ tunics with only one or two layers of smooth muscle, and usually thin, inconspicuous __________

endothleium, media, adventitia

Blood smears are routinely stained with mixtures of acidic (_____) and basic (_________ ____) dyes.

eosin, methylene blue

Ultrastructurally a sectioned __________ clearly shows the unique specific eosinophilic granules, as oval structures with disc-shaped electron-dense, crystalline cores. These granules, along with a few lysosomes and mitochondria, fill the cytoplasm around the bilobed nucleus

eosinophil

An increase in the number of eosinophils in blood (____________) is associated with allergic reactions and helminthic infections.

eosinophilia

The _________ is a simple squamous mesothelium supported by a layer of loose connective tissue containing blood vessels and nerves. The epicardium corresponds to the visceral layer of the pericardium, the membrane surrounding the heart. Where the large vessels enter and leave the heart, the epicardium is reflected back as the parietal layer lining the pericardium.

epicardium

The external tunic of the heart, the __________, is the site of the coronary vessels and contains considerable _______ tissue. The epicardium consists of _____ __________ tissue containing _________ nerves and variable amounts of ___. The epicardium is the _________ layer of the _____________ and is covered by the ______ ___________ that also lines the ___________ space. The mesothelial cells secrete a lubricant fluid that prevents friction as the beating heart contacts the ________ pericardium on the other side of the pericardial cavity.

epicardium, adipose, loose connective, autonomic, fat, visceral, pericardium, simple mesothelium, pericardial, parietal

If a vasoconstrictor is necessary, patients with intermediate clinical risk factors and those taking nonselective beta blockers can safely be given up to 0.036 mg _____________ (_ cartridges containing 1:100,000 epinephrine) at one appointment; intravascular injections are to be avoided.

epinepherine, 2

Neutrophils typically have diameters ranging from 12 to 15 µm, approximately twice that of the surrounding ____________. The cytoplasmic granules are relatively sparse and have heterogeneous staining properties, although generally pale and not obscuring the nucleus.

erythrocytes

The ___________ plasmalemma, because of its ready availability, is the best-known membrane of any cell. It consists of about __% lipid, __% carbohydrate, and __% protein. Most of the latter are integral membrane proteins, including ion channels, the anion transporter called ____ _ ________, and ___________ _.

erythrocytes, 40, 10, 50, band 3 protein, glycophorin A

A tube of blood after centrifugationhas nearly half of its volume represented by ____________ in the bottom half of the tube, a volume called the _______. Between the sedimented erythrocytes and the supernatant light-colored plasma is a thin layer of __________ and __________ called the _____ ____. A cubic millimeter of blood is equivalent to _ __________

erythrocytes, hematocrit, leukocytes, platelets, buffy coat, 1 microliter

The so-called formed elements circulating in the plasma are ____________ (red blood cells), __________ (white blood cells), and _________.

erythrocytes, leukocytes, platelets

An increased concentration of erythrocytes in blood (______________, or ____________) may be a physiologic adaptation found, for example, in individuals who live at high altitudes, where O2 tension is low.

erythrocytosis, polycythemia

The __________ is a muscular tube passing between the pharynx in the neck and the stomach in the abdomen. It begins at the inferior border of the cricoid cartilage, opposite vertebra CVI, and ends at the cardiac opening of the stomach, opposite vertebra TXI

esophagus

As the right vagus nerve passes through the superior mediastinum, it gives branches to the _______, _______ plexus, and _________ plexus

esophagus, cardiac, pulmonary

The internal intercostal muscles are most active during __________

expiration

Costodiaphragmatic recesses are deepest after forced ___________ and shallowest after forced __________.

expiration, inspriation

if a planned dental procedure is limited to routine clinical examination with x-rays (_______ ___risk category), and the patient is stable and not anxious, the risk for an adverse occurrence is minimal; thus, alterations in the dental management approach would be unnecessary. If, however, a patient with stable angina or a past history of MI (_____________ risk category), with minimal cardiac reserve, is scheduled for multiple extractions and implant placement (___ to _____________ risk category), the risk for an adverse perioperative event is more significant, and a more complex dental management plan may be required.

exteremly low intermeidate, low, intermediate

The eleven pairs of ________ intercostal muscles extend from the inferior margins (lateral edges of costal grooves) of the ribs above to the superior margins of the ribs below.

external

▪ The ________ intercostal muscles are the most superficial. ▪ The ________ intercostal muscles are sandwiched between the _________ and _________ muscles. ▪ The _________ intercostal muscles are the deepest of the three muscles.

external internal, external, innermost innermost

O: Inferior margin of rib above I: Superior margin of rib below Which intercostal muscle?

external intercostal

The external intercostal muscles extend around the thoracic wall from the regions of the tubercles of the ribs to the costal cartilages, where each layer continues as a thin connective tissue aponeurosis termed the _________ ___________ ________.

external intercostal membrane

When an ____________ occurs (an anomalous "extra" beat generated by a latent pacemaker), the tension developed on the next beat is _______ than normal. Although the tension developed on the extrasystolic beat itself is ____ than normal, the very next beat exhibits increased tension. An unexpected or "extra" amount of ____ entered the cell during the extrasystole and was accumulated by the ___________ _________ (i.e., increased stored Ca2+).

extrasystole, greater, less, Ca2+, sarcoplasmic reticulum

The rule is that the pacemaker with the ______ rate of _____ __ ______________ controls the heart rate. Normally, the __ ____has the fastest rate of phase 4 depolarization, and therefore, it sets the heart rate

fastest, phase 4 depolarization, SA node

In nonlactating women, the predominant component of the breasts is ___, while _________ tissue is more abundant in lactating women

fat, glandular

Micrograph showing a neutrophil from a _____ in which the __________ _ _________ appears as a drumstick appendage to a nuclear lobe

female, condensed X chromosome

The lysis of ______ is as important to health as its formation

fibrin

Blood coagulation factors interact to form the secondary, ______-rich, hemostatic plug in small vessels, and the secondary ______ thrombus in arteries and veins

fibrin, fibrin

A primary plug is stabilized by a network of _______ (formed from crosslinked __________). The secondary plug is stable and is degraded only when the ____________ system has been activated

fibrin, fibrinogen, fibrinolytic

D-dimer levels are normally present in blood at concentrations of <250 µg/L. In deep vein thrombosis of the leg (DVT), deposition of a large mass of crosslinked _______ within the leg veins, followed by partial lysis by the body's ____________ system, _________ fibrin turnover and blood D-dimer levels are elevated

fibrin, fibrinolytic, increased

Fibrinolytic system acts to limit excessive formation of _______ through _______-mediated fibrinolysis

fibrin, plasmin

The coagulation system acts to form ______; the fibrinolytic system acts to limit excessive formation of fibrin (both intra- and extravascular) through _______-mediated fibrinolysis.

fibrin, plasmin

tPA and plasminogen bind strongly to ______ which increases _______ activity

fibrin, plasmin

Evolution has therefore produced a fibrinolytic system; this is activated by local ______ formation, resulting in local generation of ________, an enzyme which digests fibrin plugs (in parallel with ______ ______ processes), thus maintaining vascular patency.

fibrin, plasmin, tissue repair

Thrombin converts circulating ___________ to ______ and activates factor XIII, which crosslinks the ______, forming a clot

fibrinogen, fibrin, fibrin

activation of factors X and II (___________) occurs preferentially at sites of vascular injury, alongside activated platelets: the latter provide procoagulant activity as a result of exposure of ___________ charged platelet surface membrane phospholipids, such as __, and high affinity binding sites for several activated coagulation factors, allowing the formation of the ____________ complex (Va, Xa and II) and ______ complex (VIIIa, IXa and Xa), which both greatly enhance the production of _______.

fibrinogen, negatively, PS, prothrombinase, tenase, thrombin

Congenital deficiency of GPIIb-IIIa (the rare Glanzmann's thrombasthenia) causes a severe bleeding disorder; in contrast, deficiencies of either __________ or ___ cause a milder bleeding disorder, because these two ligands can substitute for each other.

fibrinogen, vWF

Eventually, blood clots are degraded by the _____________ system. The process of fibrinolysis prevents thrombotic phenomena and there is normally a balance between __________ and _________.

fibrinolytic, fibrinolysis, thrombosis

The joint between rib I and the manubrium is not synovial and consists of a __________________ connection

fibrocartilagenous

The _______ ___________ is a tough connective tissue outer layer that defines the boundaries of the middle mediastinum. The ______ ___________ is thin and consists of two parts: ▪ The __________ layer of serous pericardium lines the inner surface of the fibrous pericardium. ▪ The ________ layer (___________) of serous pericardium adheres to the heart and forms its outer covering.

fibrous pericardium serous pericardium parietal visceral, epicardium

The _______ ___________ is a cone-shaped bag with its base on the diaphragm and its apex continuous with the __________ of the great vessels. The base is attached to the _______ ______ __ ___ _________ and to a small muscular area of the diaphragm on the ____ side. Anteriorly, it is attached to the posterior surface of the sternum by _________________ _________.

fibrous pericardium, adventitia, central tendon of the diaphragm, left, sternopericardial ligaments

It is often not appreciated by clinicians that a _______ band commonly extends from the anterior tip of the small cervical ribs to rib I, producing a "________ ____" that is not visualized on radiography. In patients with cervical ribs and cervical bands, structures that normally pass over rib _ are elevated by, and pass over, the cervical rib and band.

fibrous, cervical band, 1

The term '_____ ______ pathway' refers to the conversion of prothrombin to thrombin via Xa, with Va acting as a cofactoralBook file.

final common

Thrombin clotting time assesses the _____ ______ pathway

final common

Superiorly, the pleural cavity can project as much as 3-4 cm above the _____ costal cartilage but does not extend above the neck of rib _. This limitation is caused by the inferior slope of rib I to its articulation with the _________

first, 1, manubrium

If enough ribs are broken, a loose segment of chest wall, a _____ segment is produced. When the patient takes a deep inspiration, the flail segment moves in the _________ direction to the chest wall, preventing full lung expansion and creating a _______________ moving segment. If a large enough segment of chest wall is affected, ____________ may be impaired and assisted ventilation may be required until the ribs have healed. What condition?

flail, opposite, paradoxically, respiration Flail chest

Thoracic vertebra: The superior articular processes are ____, with their articular surfaces facing almost directly ___________, while the inferior articular processes project from the _______ and their articular facets face __________.

flat, posteriorly, laminae, anteriorly

Contraction of the domes of the diaphragm ________ the diaphragm, thereby ___________ thoracic volume. Movements of the diaphragm are essential for normal _________.

flattens, increasing, breathing

Ribs XI and XII have no anterior connection with other ribs or with the sternum and are often called ________ ribs.

floating

Blood ____ through a blood vessel or a series of blood vessels is determined by two factors: the pressure difference between the two ends of the vessel (the inlet and the outlet) and the resistance of the vessel to blood flow.

flow

The relationship of ____, ________, and __________ is analogous to the relationship of current (I), voltage (ΔV), and resistance (R) in electrical circuits, as expressed by Ohm's law (Ohm's law states that ΔV = I × R or I = ΔV/R).

flow, pressure, resistancw

How to treat chronic heart failure patients with depressed ejection fraction. When a clinical diagnosis of HF is established, _____ _________ should be treated prior to starting an ACE inhibitor (___ if the patient is intolerant to ACE). After fluid retention treatment and/or uptitration of the ACE inhibitor, the patient should be started on ___ ________. If symptoms continue, an ARB, ___________ antagonist, or _______, can be included as part of triple therapy. In _____ patients (with an NYHA class II-IV HF) a fixed-dose combination of hydralazine/isosorbide dinitrate should be added to an ACE inhibitor and beta blocker. In certain patients, ______ therapy may be necessary in addition to pharmacological therapy.

fluid retention, ARB, beta blockers, aldosterone, digoxin, black, device

The fossa ovalis marks the location of the embryonic ________ _____, which is an important part of fetal circulation.

foramen ovale

Acquired disorders may be caused by defective __________, and excessive ___________ or ___________ of platelets

formation, destruction, consumption

The so-called ______ ________ circulating in the plasma are erythrocytes (red blood cells), leukocytes (white blood cells), and platelets.

formed elements

Due to rib elevation, the sternum moves _______ in inspriation

forward

in the steady state, cardiac output ____ the heart equals venous return __ the heart

from, to

In FDG PET a _____ radiation emitter is attached to a _______ molecule. In areas of high metabolic activity (i.e., the tumor), excessive uptake occurs and is recorded by a gamma camera.

gamma, glucose

Slight _______ movements occur at the costotransverse joints.

gliding

Sensory fibers branching from the ________________ nerve form synapses with the glomus cells and signal brain centers to initiate cardiovascular and respiratory adjustments that correct the condition detected by chemoreceptors

glossopharyngeal

Leukocytes are divided into two major groups, ____________ and ____________, based on the density of their cytoplasmic granules

granulocytes, agranulocytes

Increased preload: increase in stroke volume is based on the Frank-Starling relationship, which states that the greater the end-diastolic volume (end-diastolic fiber length), the _______ the stroke volume ejected in systole.

greater

the pulsations in large arteries are even _______ than the pulsations in the aorta

greater

begins at the end of the absolute refractory period and continues until the cell membrane has almost fully repolarized. During the period, even more Na+ channels have recovered and it is possible to generate a second action potential, although a _______-than-_______ stimulus is required. If a second action potential is generated during the period, it will have an ________ configuration and a shortened _______ phase What phase?

greater, normal, abnormal, plateau Relative refractory period

In words, the law of Laplace for a sphere states that the _______ the thickness of the wall of the sphere (e.g., left ventricle), the greater the _________ that can be developed. Illustrating this point, the left ventricular wall is _______ than the right ventricular wall because the left ventricle must develop greater pressure to eject blood.

greater, pressure, thicker

The _____ cardiac findings depend on the underlying disease process, for example, myocardial infarction or valvular deformities may be present. With the exception of failure due to mitral valve stenosis or restrictive cardiomyopathies, the ____ _________ usually is hypertrophied and can be dilated, sometimes massively.

gross, left ventricle

Both prostacyclin and nitric oxide appear to exert their vasodilator actions by diffusing locally from endothelial cells to vascular smooth muscle cells, where they stimulate _________ _______, resulting in increased formation of _______ _________ _′_′-_____________ (_____) and __________ of vascular smooth muscle via alteration of the intracellular _______ concentration

guanyline cyclase, cyclic guanosine 3, 5, monophosphate, cGMP, relaxation, calcium

Each lung has a ____-____ shape, with a base, apex, two surfaces, and three borders. ▪ The ____ sits on the diaphragm. ▪ The _____ projects above rib I and into the root of the neck. ▪ The two surfaces—the ______ surface lies immediately adjacent to the ribs and intercostal spaces of the thoracic wall. The ___________ surface lies against the mediastinum anteriorly and the vertebral column posteriorly and contains the comma-shaped _____ of the lung, through which structures enter and leave. ▪ The three borders—the ________ border of the lung is sharp and separates the base from the costal surface. The ________ and _________ borders separate the costal surface from the medial surface. Unlike the ________ and ________ borders, which are sharp, the _________ border is smooth and rounded

half cone base apex costal, mediastinal, hilum inferior, anterior, posterior, anterior, inferior, posterior

The ____ of a rib is somewhat expanded and typically presents two articular surfaces separated by a crest.

head

The tissues that initially give rise to the diaphragm are in an anterior position on the embryological disc before the ____ ____ develops, which explains the cervical origin of the nerves that innervate the diaphragm

head fold

A typical rib articulates with: ▪ the bodies of adjacent vertebrae, forming a joint with the ____ of the rib; and ▪ the __________ process of its related vertebra, forming a _______________ joint

head, transverse, costotransverse

The medial surface of the right lung lies adjacent to a number of important structures in the mediastinum and the root of the neck . These include the: ▪ _____, ▪ ________ ____ _____, ▪ ________ ____ ____, ▪ _______ ____ ▪ _________

heart superiorr vena cava inferior vena cava azygous vein esophagus

The medial surface of the left lung lies adjacent to a number of important structures in the mediastinum and root of the neck. These include the: ▪ _____, ▪ ______ ____, ▪ ________ _____, ▪ __________

heart thoracic aorta aortic arch esophagus

The subsequent breakdown of red cells and hemoglobin leads to the appearance of hemosiderin-laden alveolar macrophages—so-called _____ _______ cells—that reflect previous episodes of _______ _____

heart failure, pulmonary edema

abnormal valves may not close tightly, allowing slight regurgitation and backflow of blood. This produces an abnormal heart sound referred to as a ____ ______

heart murmur

Funcitons of dense irregular connective tissue in the heart: Anchoring and supporting the _____ ______ Providing firm points of insertion for _______ muscle Helping coordinate the _________ by acting as electrical insulation between atria and ventricles

heart valves cardiac heartbeat

A typical thoracic vertebra has a _____-shaped vertebral body, with roughly _____ dimensions in the transverse and anteroposterior directions, and a ____ spinous process

heart, equal, long

The thorax houses the _____ and _____, acts as a conduit for structures passing between the ____ and the _______, and plays a principal role in _________.

heart, lungs, neck, abdomen, breathing

Rupture of the ______ or major _______. Loss of circulatory continuity (e.g., gunshot wound through the thoracic aorta) leads to exsanguination, hypotensive shock, and death.

heart, vesel

The ___________ and ________ ___________ veins drain posterior and lateral parts of the left thoracic wall, pass immediately anterior to the bodies of thoracic vertebrae, and flow into the azygos vein on the right side, which ultimately connects with the superior vena cava.

hemiazygous, accessory hemiazygous

The role of platelets in controlling blood loss (____________) and in wound healing can be summarized as follows: Primary aggregation: Disruptions in the microvascular endothelium, which are very common, allow the platelet ____________ to adhere to _________ in the vascular basal lamina or wall. Thus, a _________ ____ is formed as a first step to stop bleeding Secondary aggregation: Platelets in the plug release a specific adhesive ____________ and ___, which induce further platelet aggregation and increase the size of the platelet plug. Blood coagulation: During platelet aggregation, fibrinogen from plasma, von Willebrand factor and other proteins released from the damaged ____________, and platelet factor 4 from ________ granules promote the sequential interaction (_______) of plasma proteins, giving rise to a ______ polymer that forms a three-dimensional network of fibers trapping ___ _____ cells and more platelets to form a blood clot, or ________. _______ ______ _ is a chemokine for monocytes, neutrophils, and fibroblasts and proliferation of the fibroblasts is stimulated by PDGF. Clot retraction: The clot that initially bulges into the blood vessel lumen contracts slightly due to the activity of platelet-derived _____ and ______. Clot removal: Protected by the clot, the endothelium and surrounding tunic are restored by new tissue, and the clot is then removed, mainly dissolved by the proteolytic enzyme _______, which is formed continuously through the local action of plasminogen activators from the endothelium on plasminogen from plasma.

hemmorrhage glycocylax, collagen, platelet plug glycoprotein, ADP endothelium, platelet, cascade, fibrin, red blood, thrombus, platelet factor 4, actin, myosin plasmin

Erythrocyte cytoplasm lacks all organelles but is densely filled with __________, the tetrameric O2-carrying protein that accounts for the cells' uniform acidophilia.

hemoglobin

A single nucleotide substitute in the __________ gene produces a version of the protein that polymerizes to form rigid aggregates, leading to greatly misshapen cells with reduced flexibility. In individuals ____________ for the mutated ___ gene, this can lead to _______ blood viscosity, and ____ microvascular circulation, both features of sickle cell disease

hemoglobin, homozygous, HbS, greater, less

Genetic disorders that result in loss of individual protein functions, and therefore in excessive bleeding (e.g. __________), have played an important part in the identification of many of the biochemical mechanisms in hemostasis.

hemophilia

The subsequent breakdown of red cells and hemoglobin leads to the appearance of ___________-laden alveolar macrophages—so-called heart failure cells—that reflect previous episodes of pulmonary edema.

hemosiderin

Animal evolution has therefore resulted in the development of an efficient but complex series of hemodynamic, cellular, and biochemical mechanisms that limit such blood loss by forming platelet-fibrin plugs at sites of vessel injury (__________)

hemostasis

Congenital deficiencies of coagulation factors (I-XIII) result in excessive bleeding, which illustrates their physiologic importance in __________

hemostasis

Thrombin has a central role in __________

hemostasis

Basophils: The strong basophilia of the granules is due to the presence of ______ and other sulfated GAGs. Basophilic specific granules also contain much _________ and various other mediators of inflammation, including platelet activating factor, eosinophil chemotactic factor, and the enzyme _____________ _ that catalyzes an initial step in producing lipid-derived proinflammatory factors called ____________.

heparin, histamine, phospholipase A, leukotrienes

In patients with raised D-dimer levels, _______ treatment is started and imaging of the leg performed (usually by __________) to confirm the presence and extent of a DVT.

heparin, ultrasound

Anticoagulant drugs, e.g. _______, ________, or ___________, are used in the treatment of acute venous thrombosis or embolism.

heparin, warfarin, rivaroxaban

Administration of Oral vitamin K antagonists, e.g. warfarin, which reduce _______ synthesis of these factors. Excessive bleeding in patients taking warfarin can be treated by stopping the drug, giving _______ _ or replacing factors __, ____, __ and _ with prothrombin complex concentrates containing only the relevant factors, e.g. Beriplex or fresh frozen plasma.

hepatic, Vitamin K, II, VII, IX, X

CHF occurs when the heart cannot generate sufficient output to meet the metabolic demands of the tissues—or can only do so at higher-than-normal filling pressures; in a minority of cases, heart failure can be a consequence of greatly increased tissue demands, as in hyperthyroidism, or poor oxygen carrying capacity as in anemia (____-______ _______)

high output failure

Mean pressure in the aorta is ____, averaging 100 mm Hg. This high mean arterial pressure is a result of two factors: the large volume of blood pumped from the left ventricle into the aorta (________ ______) and the low compliance of the arterial wall. (Recall that a given volume causes greater ________ when compliance of the vessel is low.) The pressure remains ____ in the large arteries, which branch off the aorta, because of the ____ elastic recoil of the arterial walls.

high, cardiac output, increases, high, high

A second cause of increased Reynolds number in patients with anemia is a ____ cardiac output, which causes an ________ in the velocity of blood flow (v = Q/A).

high, increasee

Given that blood flows from the aorta to the large arteries, it may seem odd that systolic pressure and pulse pressure are ______ in the downstream arteries. We know that the direction of blood flow must be from ____ to ___ pressure, and not the other way around! The explanation is that the driving force for blood flow in the arteries is the ____ ________ ________, which is influenced more by _________ pressure than by ________ pressure (because a greater proportion of each cardiac cycle is spent in ________). Note in Figure 4-8 that while ________ pressure is higher in the large arteries than in the aorta, ________ pressure is lower; thus, mean arterial pressure is _____ downstream

higher, high, low, mean arterial pressure, diastolic, systolic, diastole, systolic, diastolic, lower

following ejection of blood from the left ventricle, the pressure wave travels at a ______ velocity than the blood itself travels (due to the _______ of the blood), augmenting the downstream pressure.

higher, intertia

shear is _______ at the blood vessel wall, according to the following reasoning. Right at the wall, there is a motionless layer of blood (i.e., velocity is _); the adjacent layer of blood is moving and therefore has a velocity.

highest, 0

The region outlined by this pleural reflection on the medial surface of the lung is the _____, where structures enter and leave.

hilum

The root joins the medial surface of the lung at an area referred to as the _____ of the lung.

hilum

The root of each lung is a short tubular collection of structures that together attach the lung to structures in the mediastinum. It is covered by a sleeve of mediastinal pleura that reflects onto the surface of the lung as visceral pleura. The region outlined by this pleural reflection on the medial surface of the lung is the _____, where structures enter and leave.

hilum

▪ The __________ fissure separates the superior lobe (upper lobe) from the middle lobe

horizontal

The ___________ fissure follows the fourth intercostal space from the sternum until it meets the _______ fissure as it crosses rib V.

horizontal, oblique

In a blood smear, plateletsare often found as aggregates. Individually they show a lightly stained _________ region surrounding a more darkly stained central _________ containing membrane-enclosed granules

hyalomere, granulomere

The _______________ or excessive blood sugar that occurs with diabetes commonly leads to ________ ________________, a diffuse thickening of capillary basal laminae and concomitant decrease in metabolic exchange at these vessels, particularly in the kidneys, retina, skeletal muscle, and skin.

hyperglycemia, diabetic microangiopathy

It can be further concluded that ventricular wall thickness will increase as a compensatory mechanism if the ventricle has to pump against increased aortic pressure (e.g., ___________). Thus, in ________ hypertension, the left ventricle hypertrophies; in __________ hypertension, the right ventricle hypertrophies.

hypertension, systemic, pulmonary

Central regulation of respiration also may be impaired in patients with advanced HF, resulting in alternating cycles of rapid, deep breathing (________________) with periods of central apnea—a pattern called ______-_______ respiration.

hyperventilation, Cheyne Stokes

The altered hemodynamics of congenital heart disease usually lead to chamber dilation or wall hypertrophy. However, some defects result in a reduced muscle mass or chamber size; this is called __________ if it occurs before birth and ________ if it develops postnatally.

hypoplasia, atrophy

Within the subendocardial layer and adjacent myocardium, modified cardiac muscle cells make up the ______ __________ system of the heart, which generates and propagates waves of depolarization that spread through the myocardium to stimulate rhythmic contractions. This system consists of _ nodes of specialized myocardial tissue in the right atrium: the __________ (__) node (or _________) and the _______________ (__) node, followed by the __ ______ (of His) and the ______________ __________ network

impulse conducting, 2, sinoatrial, SA, pacemaker, atrioventricular AV, AV bundle, subendocardial conducting

Valve disease Valve problems consist of two basic types: ▪ ____________, which results from poorly functioning valves; and ▪ _______, a narrowing of the orifice, caused by the valve's inability to open fully.

incompetency stenosis

Hemmorraghe into the core of a plaque can ______ plauqe voluem, thereby exacerbating the degree of luminal occlusion

increase

increases in cardiac output (due to an increase in stroke volume and/or an increase in heart rate) or increases in aortic pressure will _________ the work of the heart.

increase

An increase in heart rate produces an ________ in contractility, which can be explained as follows: (1) When heart rate increases, there are ____ action potentials per unit time and an ________ in the total amount of trigger Ca2+ that enters the cell during the ________ phases of the action potentials. Furthermore, if the increase in heart rate is caused by ____________ stimulation or by ______________, then the size of the inward Ca2+ current with each action potential also is _________. (2) Because there is greater influx of Ca2+ into the cell during the action potentials, the sarcoplasmic reticulum accumulates ____ Ca2+ for subsequent release (i.e., _________ stored Ca2+).

increase more, increase, plateau, sympathetic, catecholamines, increased more, increased

Recall that β-adrenergic agonists ________ the rate of phase 4 depolarization in the SA node by increasing If. β-Adrenergic antagonists, therefore, will ________ phase 4 depolarization and decrease the frequency at which the SA nodal cells fire action potentials.

increase decrease

Stimulation of the sympathetic nervous system produces an ________ in conduction velocity through the AV node (__________ ___________ effect), which _________ the rate at which action potentials are conducted from the atria to the ventricles. The mechanism of the sympathetic effect is increased ___, which is responsible for the upstroke of the action potential in the __ node (as it is in the SA node).

increase, positive dromotrophic, increases, ICa, AV

Regurgitant flow. Valve lesions that allow backward flow of blood create conditions that add ____________ volume workload to the affected chambers with each contraction.

increased

The physiologic importance of PAI-1 and α2-antiplasmin is illustrated by the _________ bleeding tendency that is associated with the rare cases of their congenital deficiencies

increased

In the face of ischemia and chronic _________ in workload, other untoward changes also eventually supervene, including myocyte apoptosis, cytoskeletal alterations, and increased extracellular matrix (___) deposition.

increased, ECM

Left ventricular hypertrophy, with and without dilation, viewed in transverse sections. Compared with a normal heart (center), the pressure-overloaded heart (left) has an _________ mass, a _____ wall, and a _______ lumen. The volume-overloaded heart (right) has an _________ mass, ______ lumen, and ________ size, but a ______ wall thickness.

increased, thick, smaler, increased, smaller, increased, normal

if the resistance of one of the individual vessels in a parallel arrangement increases, then total resistance _________

increases

When the radius of a blood vessel decreases, its resistance _________, not in a linear fashion but magnified by the ___ power relationship. For example, if the radius of a blood vessel decreases by one half, resistance does not simply increase twofold—it increases by _-fold (_^_)!

increases, 4th, 16, 2, 4

Increased contractility: Stroke volume _________, as does ejection fraction; less blood remains in the ventricle at the end of systole, and, consequently, end-systolic volume _________

increases, decreases

Cardiac muscle: Increasing muscle length _________ the Ca2+-sensitivity of troponin C and increasing muscle length _________ Ca2+ release from the sarcoplasmic reticulum.

increases, increases

The characteristics of the arterial walls change with __________ age: The walls become stiffer, less distensible, and less compliant.

increasing

Coarcation of the Aorta: There are two classic forms: (1) an "_________" form featuring hypoplasia of the aortic arch proximal to a PDA and (2) an "_____" form consisting of a discrete ridgelike infolding of the aorta, adjacent to the ligamentum arteriosum. Coarctation can occur as a solitary defect, but in more than half of the cases it is accompanied by a _______ ______ valve.

infantile adult, bicuspid aortic

After passing through the diaphragm, at approximately the level of vertebra TVIII, the ________ vena cava enters the fibrous pericardium.

inferior

The ________ margin of the heart is defined as the sharp edge between the anterior and diaphragmatic surfaces of the heart—it is formed mostly by the right ventricle and a small portion of the left ventricle near the apex.

inferior

Structures traveling between the thorax and abdomen pass through the diaphragm or between the diaphragm and its peripheral attachments: ▪ The ________ _____ ____ passes through the central tendon at approximately vertebral level T8

inferior vena cava

the middle part of each rib is ________ to its two ends, so that when this region of the rib is elevated, it expands the thoracic wall __________

inferior, laterally

The intercostal nerves are situated ________ to the rib borders in the ______________ ______. Each neurovascular bundle is situated deep to the ________ and ________ intercostal muscle groups.

inferior, neurovascular bundle, external, internal

Both the subclavius and pectoralis minor pull the tip of the shoulder __________

inferiorly

In the median sagittal plane, the diaphragm slopes __________ from its anterior attachment to the _______, approximately at vertebral level __/__, to its posterior attachment to the ______ ________ ________, crossing __________ to the aorta at approximately vertebral level ___.

inferiorly, xiphoid, T8, T9, median arcurate ligament, anteirorly, T12

At the apex of the ____________, the outflow tract of the right ventricle, the opening into the pulmonary trunk is closed by the _________ valve, which consists of _ semilunar cusps with free edges projecting upward into the lumen of the __________ _____. The free superior edge of each cusp has a middle, thickened portion, the _______ of the semilunar cusp, and a thin lateral portion, the ______ of the semilunar cusp

infundibulum, pulmonary, 3, pulmonary trunk, nodule, lunula

Cardiac glycosides: 1. The Na+-K+ ATPase is located in the cell membrane of the myocardial cell. Cardiac glycosides _______ Na+-K+ ATPase at the _____________ __-binding site. 2. When the Na+-K+ ATPase is inhibited, less Na+ is pumped out of the cell, increasing the _____________ ____ concentration. 3. The increase in intracellular Na+ concentration alters the Na+ gradient across the myocardial cell membrane, thereby altering the function of a ____-___ _________. This exchanger pumps Ca2+ out of the cell against an electrochemical gradient in exchange for Na+ moving into the cell down an electrochemical gradient. (Recall that Ca2+-Na+ exchange is one of the mechanisms that extrudes the Ca2+ that entered the cell during the plateau of the myocardial cell action potential.) The energy for pumping Ca2+ ______ comes from the ________ Na+ gradient, which is normally maintained by the Na+-K+ ATPase. When the intracellular Na+ concentration increases, the inwardly directed Na+ gradient decreases. As a result, Ca2+-Na+ exchange decreases because it depends on the Na+ gradient for its energy source. 4. As less Ca2+ is pumped out of the cell by the Ca2+-Na+ exchanger, the _____________ ____ concentration increases. 5. Since tension is directly proportional to the intracellular Ca2+ concentration, cardiac glycosides produce an increase in tension by increasing intracellular Ca2+ concentration—a ________ __________ effect

inhibits, extracellular K+ intracellular Na+ Ca2+ Na+ exchanger, uphill, downhill intracelluylar Ca2+ positive inotropic

Blood flow through a blood vessel or a series of blood vessels is determined by two factors: the pressure difference between the two ends of the vessel (the _____ and the _______) and the resistance of the vessel to blood flow.

inlet, outlet

The transversus thoracis muscles are found on the deep surface of the anterior thoracic wall (Fig. 3.28B) and in the same plane as the _________ intercostals

innermost

the least distinct of the intercostal muscles, and the fibers have the same orientation as the internal intercostals

innermost intercostal muscles

The subcostales are in the same plane as the _________ intercostals, span multiple ribs, and are more numerous in ______ regions of the __________ thoracic wall

innermost, inferior, posterior

Importantly, the neurovascular bundles associated with the intercostal spaces pass around the thoracic wall in the costal grooves in a plane between the _________ and ________ intercostal muscles

innermost, internal

Contractility, or __________, is the intrinsic ability of myocardial cells to develop force at a given muscle cell length. Agents that produce an increase in contractility are said to have ________ _________ effects. Positive inotropic agents ________ both the rate of tension development and the peak tension. Agents that produce a decrease in contractility are said to have ________ _________ effects. Negative inotropic agents ________ both the rate of tension development and the peak tension.

inotropism, positive inotropic, increase, negative inotropic, decrease

The external intercostal muscles are most active in ___________

inspiration

Separating the right atrium from the left atrium is the ___________ ______, which faces forward and to the right because the left atrium lies ___________ and to the ____ of the right atrium. A depression is clearly visible in the septum just above the orifice of the inferior vena cava. This is the _____ ______, with its prominent margin, the ______ _____ ______

interatrial septum, posterior, left, fossa ovalis, limbus fossa ovalis

Local anesthesia of ___________ nerves produces excellent analgesia in patients with chest trauma and those patients requiring anesthesia for a thoracotomy, mastectomy, or upper abdominal surgical procedures.

intercostal

The ___________ muscles are three flat muscles found in each intercostal space that pass between adjacent ribs

intercostal

Minimally invasive thoracic surgery (video-assisted thoracic surgery [VATS]) involves making small (_-cm) incisions in the ____________ ______, placing a small camera on a telescope, and manipulating other instruments through additional small incisions. A number of procedures can be performed in this manner, including lobectomy, lung biopsy, and esophagectomy.

intercostal spaces

Innervation of the thoracic wall is mainly by the ___________ nerves, which are the ________ rami of spinal nerves

intercostal, anterior

The costal pleura is innervated by branches from the ___________ nerves, and pain would be felt in relation to the _________ ____. The diaphragmatic pleura and the mediastinal pleura are innervated mainly by the _______ nerves (originating at spinal cord levels __, __, and __). Pain from these areas would refer to the C3, C4, and C5 dermatomes (_______ neck and the _______________ region of the shoulder).

intercostal, thoracic wall, phrenic, C3, C4, C5, lateral, supraclavicular

Reported Cardiac Risk Generally Less Than 5% What risk category for noncardiac surgeries?

intermediate

Based on the assessment of medical risk, the type of planned dental procedure, and the stability and anxiety level of the patient, general management strategies for patients with stable angina or a past history of MI without ischemic symptoms (____________ risk category) and no other risk factors may include the following: _____ appointments in the ________, ___________ chair position, pretreatment _____ _____, availability of _____________, oral sedation, _______ ______-oxygen sedation, profound local anesthesia, limited amount of _________________, avoidance of _______________-impregnated retraction cord, and effective postoperative ____ control.

intermediate, short, morning, comfortable, vital signs, nitroglycerin, nitrous oxide, vasoconstrictor, epinephereine, pain

Innermost intercostal muscles are the least distinct of the intercostal muscles, and the fibers have the same orientation as the ________ intercostals

internal

The eleven pairs of ________ intercostal muscles pass between the most inferior lateral edge of the costal grooves of the ribs above, to the superior margins of the ribs below.

internal

These observations explain why overall myocardial O2 consumption correlates poorly with cardiac output: The largest percentage of the O2 consumption is for pressure work (or ________ work), which is not cardiac output.

internal

The internal intercostal muscles continue medially toward the vertebral column, in each intercostal space, as the ________ ___________ ________.

internal intercostal membrane

Arteries taht run along the deep aspect of the anterior throacic wall along both sides of the sternum `

internal thoracic arteries

Arteries to the thymus consist of small branches originating from the _________ _______ arteries. Venous drainage is usually into the ____ ________________ vein and possibly into the ________ ________ veins.

internal thoracic, left braciocephalic, internal thoracic

Lymphatic vessels of the thoracic wall drain mainly into lymph nodes associated with the ________ ________ arteries (___________ nodes), with the heads and necks of ribs (___________ nodes), and with the diaphragm (______________ nodes)

internal thoracic, parasternal, intercostal, diaphragmatic

The pericardium is supplied by branches from the ________ _________, _________________, ______________, and ________ _______ arteries, and the _________ _____

internal throacic, pericardiophernic, musculophrenic, inferior phrenic, throacic aorta

Lymphatic capillaries drain ____________ _____ produced when the plasma forced from the microvasculature by ___________ pressure does not all return to blood by the action of _______ pressure. Micrograph shows a lymphatic capillary filled with this fluid called _____. Lymphatics are blind-ended vessels with a wall of very thin _________ cells and are quite variable in diameter (10-50 µm). Lymph is rich in ________ and other material and often stains somewhat better than the surrounding ______ _________

interstitial fluid, hydrostatic, osmotic lymph, intima, proteins, ground substance

A single specialized trabeculum, the septomarginal trabecula (moderator band), forms a bridge between the lower portion of the ________________ ______and the base of the ________ papillary muscle. Where is this found?

interventricular septum, anterior right ventricle

The most common of all congenital heart defects are those that occur in the ___________ septum—_________________ ______. These lesions are most frequent in the membranous portion of the septum and they allow blood to move from the _____ ventricle (higher pressure) to the ______ ventricle (lower pressure); this leads to right ventricular hypertrophy and pulmonary arterial hypertension.

interventricular, ventriculoseptal defect, left, right

The innermost tunica ______ consists of the endothelium and a thin subendothelial layer of ______ ________ tissue sometimes containing ______ ______ fibers. In arteries the intima includes a thin layer, the ________ _______ ______, composed of elastin, with holes allowing better diffusion of substances from blood deeper into the wall.

intima, loose connective, smooth muscle, iternal elastic lamina

Contractility correlates directly with the _____________ ____ concentration, which in turn depends on the amount of Ca2+ released from ____________ _________ stores during excitation-contraction coupling. The amount of Ca2+ released from the sarcoplasmic reticulum depends on two factors: the size of the ______ ____ current during the _______ of the myocardial action potential (the size of the trigger Ca2+) and the amount of Ca2+ previously stored in the ____________ __________ for release.

intracellular Ca2+, sarcoplasmic retiuculum, inward Ca2+, plateau, sarcoplasmic reticulum

After receptor stimulation by chemicals, several pathways of platelet activation can be initiated, resulting in several phenomena: ▪ Change in platelet shape from a disk to a ______ with extended _________, which facilitates aggregation and coagulant activity. ▪ Release of several compounds involved in hemostasis from _____________ _________, e.g. ADP, serotonin, fibronectin and vWF. ▪ ___________, via exposure of GPIb-IX membrane receptor and linking by ___ (under high shear conditions), and via exposure of another membrane glycoprotein receptor, GPIIb-IIIa, and linking by ___________ (under low shear conditions). ▪ Adhesion to the ______ ____ via exposure of the GPIb-IX membrane receptor, through which vWF binds platelets to subendothelial collagen. sphere, pseudopodia

intracellular granules Aggregation, vWF, fibrinogen vessel wall

Exposure to collagen activates which system of clotting?

intrinsic

Although the process of blood coagulation is complex and nonlinear, traditionally, the scheme has been divided into three parts: ▪ the _________ pathway ▪ the ________ pathway, and ▪ the _____ ______ pathway.

intrinsic extrinsic final common

The three components of the coagulation system are distinguished on the basis of the nature of the initiating factor and its corresponding test in the clinical hemostasis laboratory; hence, three tests of coagulation are performed in clinical laboratories on citrated, platelet-poor plasma: ▪ activated partial thromboplastin time (APTT), testing the _________ pathway ▪ prothrombin time (PT) - the _________ pathway, and ▪ thrombin clotting time (TCT) testing the _____ ______ pathway.

intrinsic extrinsic final common

Blood flow is _________ proportional to the resistance of the artery (Q = ΔP/R), and resistance is _________ proportional to the radius raised to the ___` power (Poiseuille equation).

inveresely, inversely, 4th

blood flow is _________ proportional to resistance (_). Increasing resistance (e.g., by arteriolar ________________) _________ flow, and decreasing resistance (e.g., by arteriolar ____________) _________ flow. The major mechanism for changing blood flow in the cardiovascular system is by changing the __________ of blood vessels, particularly the __________.

inversely, R, vasoconstriction, decreases, vasodilation, increases, resistance, arterioles

Conduction velocity depends on the size of the ______current during the _______ of the action potential.

inward, upstroke

Hypertrophy: Because the myocardial capillary bed does not expand in step with the increased myocardial oxygen demands, the myocardium becomes vulnerable to ________ injury

ischemic

Arrhythmias can be caused by _________ or __________ changes in the conduction system or by myocyte electrical instability

ischemic, structural

The superior surface of the manubrium is expanded laterally and bears a distinct and palpable notch, the _______ _____ in the midline

jugular notch

The status of the intrinsic, extrinsic and final common pathway is assessed by specific __________ tests

laboratory

The mammary glands consist of a series of ducts and associated secretory lobules. These converge to form 15 to 20 ___________ _____, which open independently onto the _______. The nipple is surrounded by a circular pigmented area of skin termed the ______.

lactiferous ducts, nipple, areola

Ideally, blood flow in the cardiovascular system is _______, or streamlined.

laminar

A characteristic feature of all venules is the ______ diameter of the lumen compared to the overall thinness of the wall

large

The big venous trunks, paired with elastic arteries close to the heart, are the _____ veins

large

Inducible eNOS is stimulated by cytokines in inflammatory reactions, and releases _____ amounts of nitric oxide for ____ periods. Its suppression by ________________ may partly account for their antiinflammatory effects.

large, long, glucocorticoids

The veins are most compliant and contain the unstressed volume (_____ volume under ___ pressure). The arteries are much less compliant and contain the stressed volume (___ volume under ____ pressure). The total volume of blood in the cardiovascular system is the sum of the unstressed volume plus the stressed volume (plus whatever volume is contained in the _____).

large, low, low, high, heart

The velocity of flow should be lowest in vessels with the _______ total cross-sectional area (the capillaries) and highest in the vessels with the _________ total cross-sectional area (the aorta).

largest, smallest

The cells in the SA node are not the only myocardial cells with intrinsic automaticity; other cells, called ______ ___________, also have the capacity for spontaneous phase 4 depolarization. Latent pacemakers include the cells of the __ ____, ____ of ___, and _________ ______

latent pacemakers, AV node, Bundle, His, Purkinjie fibers

Vessels and lymphatics associated with _______ parts of the breast emerge from or drain into the axillary region of the upper limb.

lateral

The largest of the branches of the intercostal nerve is the _______ __________ branch, which pierces the lateral thoracic wall and divides into an _______ branch and a _________ branch that innervate the overlying skin.

lateral cutaneous, anterior, posterior

The pectoralis major has a broad origin that includes the anterior surfaces of the medial half of the clavicle, the sternum, and related costal cartilages. The muscle fibers converge to form a flat tendon, which inserts into the _______ lip of the ________________ _______ of the _______.

lateral lip, intertubercular sulcus, humerus

The anterior intercostal arteries originate directly or indirectly as _______ branches from the ________ _________ arteries

lateral, internal thoracic

The hemiazygos and accessory hemiazygos veins drain _________ and _______ parts of the left thoracic wall, pass immediately ________ to the ______ of _________ vertebrae, and flow into the _______ vein on the _____ side, which ultimately connects with the ________ ____ ____

lateral, posterior, anteriorly, bodies, thoracic, azygous, right, superior vena cava

Posterior and anterior intercostal vessels branch segmentally from these arteries and pass _________ around the wall, mainly along the ________ margin of each rib

laterally, inferior

The ____ lung is smaller than the right lung and has two lobes separated by an oblique fissure

left

Blood enters the left ventricle through the ____ ________________ ________ and flows in a _______ direction to the apex. The chamber itself is conical, is longer than the right ventricle, and has the thickest layer of ___________. The outflow tract (the ______ _________) is posterior to the infundibulum of the right ventricle, has smooth walls, and is derived from the embryonic ______ ______

left atrioventriclar orifice, forward, myocardium, aortic vestibule, bulbus cordis

Pulmonary wedge pressure: The catheter wedges and blocks all blood flow from that branch. Once the flow is stopped, the catheter senses the pressure in the ____ ______ almost directly

left atrium

The ____ _______ forms most of the base or posterior surface of the heart.

left atrium

During development, the valve of the foramen ovale prevents blood from passing from the ____ ______ to the _____ ______

left atrium, right atrium

In adults, the ____ ______________ vein crosses the midline immediately posterior to the manubrium and delivers blood from teh left side of the head, neck, upper limb, and part of the thoracic wall into the superior vena cava

left brachiocephalic

Three branches arise from the superior border of the arch of the aorta; at their origins, all three are crossed anteriorly by the ____ _______________ vein.

left brachiocephalic

The ____ ______________ vein begins posterior to the medial end of the left clavicle. It crosses to the right, moving in a slightly inferior direction, and joins with the right brachiocephalic vein to form the superior vena cava posterior to the lower edge of the right first costal cartilage close to the right sternal border. Venous tributaries include the vertebral, first posterior intercostal, left superior intercostal, inferior thyroid, and internal thoracic veins. It may also receive thymic and pericardial veins.

left brachiocephlaic

The second branch of the arch of the aorta is the ____ ______ _______ artery

left common carotid

The distribution pattern of the _____ _________ artery enables it to supply most of the left atrium and left ventricle, and most of the interventricular septum, including the atrioventricular bundle and its branches.

left coronary

The short left coronary artery is referred to as the ____ ____ ____ ______. One of its primary branches, the anterior interventricular artery, is termed the ___ ________ __________ artery. Similarly, the terminal branch of the right coronary artery, the posterior interventricular artery, is termed the _________ __________ ______

left main stem vessel, left anterior descending, posterior descending artery

The ____ ______nerve enters the superior mediastinum in a position similar to the path taken by the right phrenic nerve.

left phrenic

The ____ _________ surface of the heart faces the left lung, is broad and convex, and consists of the left ventricle and a portion of the left atrium

left pulmonary

The ductus arteriosus arises from the ____ _________ artery and joins the ______ just distal to the origin of the ____ __________ artery.

left pulmonary, aorta, left subclavian

The left vagus nerve also gives rise to the ____ __________ __________ nerve, which arises from it at the inferior margin of the arch of the aorta just lateral to the ligamentum arteriosum.

left recurrent laryngeal

The third branch of the arch of the aorta is the ___ __________ artery

left subclavian

the major blood supply to the left upper limb.

left subclavian artery

The ____ ________ ___________ vein receives the second, third, and sometimes the fourth posterior intercostal veins, usually the left bronchial veins, and sometimes the left pericardiacophrenic vein

left superior intercostal

Often the upper posterior intercostal veins on the left side come together and form the ____ ________ ___________ vein, which empties into the ____ _______________ vein.

left superior intercostal, left brachiocephalic

The ____ _____ nerve enters the superior mediastinum posterior to the left brachiocephalic vein and between the left common carotid and left subclavian arteries

left vagus

The left recurrent laryngeal nerve is a branch of the ____ ______ nerve. It passes between the pulmonary artery and the aorta, a region known clinically as the ______________ ______, and may be compressed in any patient with a pathological mass in this region.

left vagus, aorticoplulmonary window

The apex of the heart is formed by the inferolateral part of the ____ _________ and is positioned deep to the ____ ___ intercostal space, 8-9 cm from the ___________ line.

left ventricle, left 5th, midsternal

The left pulmonary surface of the heart faces the left lung, is broad and convex, and consists of the ___ _________ and a portion of the ____ ______

left ventricle, left atrium

The heart in the anatomical position rests on the diaphragmatic surface, which consists of the ____ __________ and a small portion of the _____ __________ separated by the _________ _________________ _______

left ventricle, right ventricle, posteiror interventricular groove

The most common causes of _____-sided cardiac failure are ischemic heart disease (___), systemic hypertension, mitral or aortic valve disease, and primary diseases of the __________ (e.g., amyloidosis )

left, IHD, myocardium

Only the arch of the aorta is in the superior mediastinum. It begins when the ascending aorta emerges from the pericardial sac and courses upward, backward, and to the left as it passes through the superior mediastinum, ending on the ____ side at vertebral level __/__

left, T4 T5

The bifurcation of the pulmonary trunk occurs to the ____ of the midline just inferior to vertebral level __/__, and anteroinferiorly to the ____ of the bifurcation of the trachea.

left, T4, T5, left

Anteriorly, a costomediastinal recess occurs on each side where costal pleura is opposed to mediastinal pleura. The largest is on the ____ side in the region overlying the _____

left, heart

The greater thickness of the normal _____ ventricular wall and the compensatory hypertrophy of the left ventricular wall in systemic hypertension are adaptive mechanisms for performing more ________ work. These adaptive mechanisms are explained by the ___ __ _______. The law for a sphere (i.e., the approximate shape of the heart) states that pressure correlates ________ with tension and wall thickness and correlates __________ with radius. Thus, P=2HTr

left, pressure, Law of Laplace, directly, inversely

Occasionally, the ductus arteriosus, which connects the ____ branch of the ______ _________ to the inferior aspect of the ______ ____, fails to close at birth. When this occurs, the oxygenated blood in the _______ ____ (higher pressure) passes into the ____ branch of the _________ ______ (lower pressure) and produces pulmonary hypertension. This is termed a _______ or __________ ______ __________

left, pulmonary artery, aortic artch, aortic arch, left, pulmonary artery, patent, persistent ductus arteriosus

The oblique fissure of the ____ lung is slightly more oblique than the corresponding fissure of the _____ lung.

left, right

The trabeculae carneae in the ____ ventricle are fine and delicate in contrast to those in the _____ ventricle.

left, right

Another consequence of the greater O2 consumption of pressure work is that the _____ ventricle must work harder than the ______ ventricle. Although cardiac output is the same on both sides of the heart, mean aortic pressure (___ mm Hg) is much ______ than mean pulmonary artery pressure (__ mm Hg).

left, right, 100, higher, 15

Because the aorta is on the ____ side of the vertebral column, those posterior intercostal vessels passing to the _____ side of the thoracic wall cross the midline ________ to the bodies of the vertebrae and therefore are ______ than the corresponding vessels on the ____.

left, right, anterior, longer, left

The ____ pulmonary artery is shorter than the _____ and lies anterior to the ___________ _____ and posterior to the ________ _________ ____

left, right, descending aorta, superior pulmonary vein

The inferior portion of the medial surface of the ____ lung, unlike the ______ lung, is notched because of the heart's projection into the ____ pleural cavity from the middle mediastinum.

left, right, left

Because the great veins enter the base of the heart, with the pulmonary veins entering the _____ and ____ sides of the ____ _______ and the superior and inferior venae cavae at the _____ and _____ ends of the _____ ______, the base of the heart is fixed posteriorly to the pericardial wall, opposite the bodies of vertebrae __ to __ (__ to __ when standing). The _________ lies immediately posterior to the base.

left, right, left atrium, upper, lower, right atrium, T5, T8, T6, T9, esophagus

posterior to the lower part of the sternum, the parietal pleura does not come as close to the midline on the ____ side as it does on the _____ because the ______ ___________, containing the ___________ and _____, bulges to the ____.

left, right, middle mediastinum, pericardium, heart, left

_____-to-_____ shunts increase pulmonary blood flow and are not associated (at least initially) with cyanosis. However, they expose the low-pressure, low-resistance pulmonary circulation to increased pressures and volumes; these conditions lead to adaptive changes that increase lung vascular resistance to protect the pulmonary bed, resulting in right ventricular hypertrophy and—eventually—failure. With time, increased pulmonary resistance also can cause shunt reversal (_____ to _____) and late-onset cyanosis.

left, right, right, left

The ______ of a single left ventricular muscle fiber just prior to contraction corresponds to left ventricular end-diastolic volume. The _________ of a single left ventricular muscle fiber corresponds to the tension or pressure developed by the entire left ventricle.

length, tension

the total resistance in a parallel arrangement is ____ than any of the individual resistances.

less

Because the walls of the veins contain much ____ elastic tissue than the arteries, the veins have a large ___________ (capacity to hold blood). In fact, the _____ contain the largest percentage of blood in the cardiovascular system. The volume of blood contained in the veins is called the _________ ______ (meaning the blood volume under low pressure).

less, capacitence, veins, unstressed volume

Because the anterior ends of the ribs are inferior to the posterior ends, when the ribs are elevated, they move the sternum upward and forward. Also, the angle between the body of the sternum and the manubrium may become slightly ____ acute. When the ribs are depressed, the sternum moves ________ and ________. This "____ ______" movement changes the dimensions of the thorax in the ________________ direction

less, downward, backward, pump handle, anteroposterior

The characteristics of the arterial walls change with increasing age: The walls become stiffer, ____ distensible, and ____ compliant.

less, less

The ________ nucleus is large and usually distinctly indented or C-shaped. The chromatin is ____ condensed than in lymphocytes and typically stains _______ than that of large lymphocytes.

less, lighter

With distance from the heart, arteries gradually have relatively ____ elastin and ____ smooth muscle in their walls. Most arteries, large enough to have names, are of the _________ type. A transverse section through a muscular (medium-caliber) artery shows a slightly folded ______ with only sparse ________ tissue between the endothelial cells and ________ _______ _______. Multiple layers of smooth muscle in the media are _______ than the elastic lamellae and fibers with which they intersperse. Vasa vasorum are seen in the __________

less, mroes, muscular, intima, connective, internal elastic lamella, thicker, adventitia

Microscopic analysis of bone marrow helps clinicians diagnose cancers like ________ and other ______ cancers

leukemia, blood

The muscles of the thoracic wall, together with muscles between the vertebrae and ribs posteriorly (i.e., the _________ ________ and ________ _________ ________ and _______ __________ _________ muscles) alter the position of the ribs and sternum and so change the thoracic volume during breathing.

levatores costarum, serratus posterior superior, serratus posterior inferior

The ________ __________ is also in the superior mediastinum and is important in embryonic circulation, when it is a patent vessel

ligamentum arteriosum

Complete obliteration of the ductus arteriosus occurs within the first few months of extrauterine life, leaving only a strand of residual fibrous tissue known as the __________ __________. Ductal closure often is delayed (or even absent) in infants with ________ (related to respiratory distress or heart disease). PDAs account for about 7% of congenital heart lesions, and the great majority of these (90%) are isolated defects.

ligamentum arteriosum, hypoxia

Velocity of blood flow (v) is _______ velocity and refers to the rate of displacement of blood per unit time. Thus, velocity is expressed in units of distance per unit time (e.g., cm/sec).

linear

From the anterior border of the lower part of the superior lobe a tongue-like extension (the _______ of the ____ ____) projects over the heart bulge.

lingula, left lung

Antithrombin: a protein synthesized in the _____. Its activity is catalyzed by the antithrombotic drug _______ (unfractionated and low-molecular-weight ________), and by heparin-like endogenous _________________ (____) that are present on the surface of vascular endothelial cells.

liver, heparin, heparins, glycosaminoglycans

The main bronchus divides within the lung into _____ bronchi (secondary bronchi), each of which supplies a lobe.

lobar

As in nerve and skeletal muscle fibers, the physiologic basis for conduction of cardiac action potentials is the spread of _____ ________

local currents

Closely applied to the medial axillary wall is the ____ ________ nerve

long thoracic

Deep to the intercostal spaces and ribs, and separating these structures from the underlying pleura, is a layer of _____ _________ tissue, called ___________ ______, which contains variable amounts of ___.

loose connective, endothoracic fascia, fat

Heparins are used both in the treatment and prevention of acute venous thrombosis, usually in the form of a ___-_________-_______ _______ (____), e.g. enoxaparin or dalteparin.

low molecular weight heparin, LMWH

The _____ _____ is the relationship between ventricular pressure and ventricular volume during diastole, when the heart is not contracting.

lower curve

Transversus thoracis muscles insert onto the _____ costal cartilages of ribs _ to _. They probably pull them which directioN?

lower, 3, 6, inferiorly

An important implication of these lower pressures on the pulmonary side is that pulmonary vascular resistance is much _____ than systemic vascular resistance. This conclusion can be reached by recalling that the total flow through the systemic and pulmonary circulations must be _____ (i.e., cardiac output of the left and right hearts is ____). Because pressures on the pulmonary side are much _____ than pressures on the systemic side, to achieve the same flow, pulmonary resistance must be _____ than systemic resistance (Q = ΔP/R).

lower, equal, equal, lower, lower

As well as the anterior ends of the ribs being _____ than the posterior ends, the middles of the shafts tend to be _____ than the two ends. When the shafts are elevated, the middles of the shafts move _______. This "______ handle" movement increases the _______ dimensions of the thorax

lower, lower, laterally, bucket, lateral

the entire pulmonary vasculature is at much _____ pressure than the systemic vasculature. The pattern of pressures within the pulmonary circulation is analogous to the ________ circulation, however. Blood is ejected from the right ventricle into the pulmonary artery, where pressure is highest. Thereafter, the pressure decreases as blood flows through the pulmonary arteries, arterioles, capillaries, venules, and veins and back to the left atrium

lower, systemic

Because the anterior ends of the ribs are ________ to the posterior ends, when the ribs are elevated, they move the sternum ______ and _______.

lower, upward, forward

Shear is ______ at the center of the blood vessel, where the velocity of blood is _______, but where the adjacent layers of blood are essentially moving at the same velocity.

lowest, highest

Like veins, lymphatic vessels have valves comprised of complete intimal folds. Interposed in the path of these larger lymphatic vessels are _____ _____, where lymph is processed by cells of the ______ system. In histological sections lymphatic vessels are often dilated with _____. As in veins, lymphatic circulation is aided by ________ forces (eg, contraction of surrounding skeletal muscle) with the ________ keeping lymph flow unidirectional.

lymph nodes, immune, lymph, external, valves

Lymphatics and larger lymphatic vessels are clinically important because (among other reasons) they facilitate the spread of pathogens, parasites, and malignant cells in the body. Surgical removal of _____ _____, standard procedure to determine the occurrence of cancer metastasis, can disrupt the lymphatic drainage and produce swelling or ___________, in tissues of the affected region.

lymph nodes, lymphedema

Interstitial fluid that is not pulled into venules by colloidal osmotic pressure drains as _____ into blind vessels called ___________, or lymphatic capillaries, which have very thin endothelial cell walls with spaces between the cells.

lymph, lymphatic capillaries

In addition to the blood vasculature, the body has a system of very thin-walled channels, the _________ ____________, which collect excess interstitial fluid from the tissue spaces as lymph and return it to the blood.

lymphatic capillaries

Lymphatic vessels are formed by the merger of _________ ____________, but their walls remain extremely ____. Cross section shows a lymphatic vessel near a venule, whose wall is _____ by comparison. Lymphatic vessels normally do not contain ___ _____ cells, which provides another characteristic distinguishing them from venules.

lymphatic capillaries, thin thick, red blood

Lymphatic capillaries converge into larger __________ ________ with ____ walls and ___________ amounts of connective tissue and smooth muscle which never form clearly distinct outer tunics

lymphatic vessels, thin, increasing

Lymphatics converge into larger, thin-walled _________ _______ in which lymph is propelled by movements of surrounding muscles and organs, with intimal ______ keeping the flow unidirectional.

lymphatic vessels, valves

Agranulocytes lack specific granules, but do contain some azurophilic granules (lysosomes). The nucleus is spherical or indented but not lobulated. This group includes the ___________ and _________

lymphocytes, monocytes

Locations in connective tissue with injuries or infection require the rapid immigration of various leukocytes to initiate cellular events for tissue repair and removal of the invading microorganisms. The cytokines and cell binding proteins target various leukocytes and are best known for ___________. The major initial events of their migration during inflammation are summarized here: 1. Local ___________ activated by bacteria or tissue damage release ______________ __________ such as interleukin-_ (IL-_) or tumor necrosis factor-_____ (TNF-_____) that signal endothelial cells of nearby postcapillary venules to rapidly insert glycoprotein _________ on the luminal cell surfaces. 2. Passing ____________ with appropriate cell surface glycoproteins bind the selectins, which causes such cells to adhere loosely to the endothelium and "roll" slowly along its surface. 3. Exposure to these and other cytokines causes expression of new _________ on the rolling leukocytes and expression of the integrin ligand ____-_ on the endothelial cells. Junctional complexes between the endothelial cells are selectively ___________, loosening these cells. 4. Integrins and their ligands provide firm endothelial adhesion of neutrophils to the ___________, allowing the leukocytes to receive further stimulation from the local cytokines. 5. Neutrophils become motile, probe the endothelium with _____________, and, being attracted by other local injury-related factors called __________, finally migrate by _________ between the loosened cells of the venule. Rapid transendothelial migration of neutrophils is facilitated by the cells' elongated and segmented nuclei. All leukocytes first become functional in the ___ after emerging from the circulation by this process. neutrophils

macrophages, proinflammatory cytokines, 1, 1, alhpa, alpha, selectins neutrophils integrins, ICAM 1, downregulated endothelium pseudopodia, cemokines, diapdesis, ECM

The guidelines suggest that decompensated HF constitutes a _____ risk for the occurrence of a serious event (acute MI, unstable angina, or sudden death) during treatment.1 Thus, patients with symptoms of HF (i.e., with _____________ HF—NYHA class II, III, or IV) generally are not candidates for elective dental care, and treatment is deferred until medical consultation can be obtained. Patients who have a history of HF but who are asymptomatic (i.e., those with ____________ HF, designated NYHA class I) are at ____________ risk for occurrence of a serious event. With good functional capacity and reserve (as demonstrated by the ability to do what??), however, they generally can safely undergo any required treatment with little likelihood of problems.

major, uncompensated, compensated, intermediate, climb a flight of stairs

modified sweat glands in the superficial fascia anterior to the pectoral muscles and the anterior thoracic wall

mammary glands

The joint between the second costal cartilage and the sternum is divided into two compartments by an intraarticular ligament. This ligament attaches the second costal cartilage to the junction of the _________ and the ____ of the sternum.

manubrium, body

A transverse plane extending from the sternal angle (the junction between the ________ and the ____ of the _______) to the intervertebral disc between vertebrae __ and __ separates the mediastinum into the: ▪ ________ mediastinum, and ▪ ________ mediastinum, which is further partitioned into the _______, ______, and _________ mediastinum by the ___________ ___.

manubrium, body, sternum, T4, T5 superior inferior, anterior, middle, posterior, pericardial sac

The adult sternum consists of three major elements: the broad and superiorly positioned _________ of the sternum, the narrow and longitudinally oriented ____ of the sternum, and the small and inferiorly positioned _______ _______

manubrium, body, xiphoid process

Aorta: Extending as high as the midlevel of the _________ of the _______, the arch is initially anterior and finally lateral to the trachea.

manubrium, sternum

Ultrastructural analysis reveals a peripheral ________ ______ of microtubules and microfilaments, which helps to maintain the platelet's shape.

marginal bundle

Ultrastructurally a platelet shows a system of microtubules and actin filaments near the periphery, called the ________ ______, which is formed as the platelet pinches off from _____________, and helps maintain its shape. An ____ ___________ ______ of invaginating membrane vesicles continuous with the plasmalemma facilitates rapid degranulation upon activation and ____ release. The central granulomere region contains small dense _____ granules, larger and more numerous ______ granules, and glycogen

marginal bundle, megararyocyte, open canalicular system, Ca2+, delta, alpha

although ____ pressure in the arteries is high and constant, there are oscillations or pulsations of arterial pressure. These __________ reflect the pulsatile activity of the heart: ejecting blood during systole, resting during diastole, ejecting blood, resting, and so forth.

mean, pulsations

In veins, a thin layer (the _____) of contractile smooth muscle cells allows some venoconstriction: for example, superficial veins under the skin constrict in response to surface cooling.

media

Apex of each triangular axillary inlet is directed _________ and is formed by what structure? laterally

medial margin of the coracoid process

Lymphatic vessels from the ______ part of the breast accompany the perforating ________ and drain into the ___________ nodes on the ____ surface of the thoracic wall.

medial, arteries, parasternal, deep

A standard incision site would include a ______ ___________ to obtain access to the heart, including the coronary arteries and the cardiac valves. A ____ ________ ____________ or a _____ _______ ___________ is an incision through an intercostal space to access the lungs and the mediastinal structures.

median sternotomy, left lateral thoracotomy, right lateral thoracotomy

▪ Pleura covering the mediastinum is the ___________ part.

mediastinal

The ___________ is a broad central partition that separates the two laterally placed pleural cavities

mediastinum

Cardiac contraction: 1. The ________ _________ of cardiac cells is determined by the relative conductances (or ______________) to ions and the concentration gradients for the permeant ions. 2. If the cell membrane has a high conductance or permeability to an ion, that ion will flow down its electrochemical gradient and attempt to drive the membrane potential toward its ___________ _________ (calculated by the ______ equation). If the cell membrane is impermeable to an ion, that ion will make little or no contribution to the membrane potential. 3. By convention, membrane potential is expressed in millivolts (__), and intracellular potential is expressed relative to extracellular potential; for example, a membrane potential of −85 mV means 85 mV, cell interior negative. 4. The _______ ________ _________ of cardiac cells is determined primarily by potassium ions (__). The conductance to K+ at rest is high, and the resting membrane potential is close to the K+ equilibrium potential. Since the conductance to sodium (___) at rest is low, Na+ contributes little to the resting membrane potential. 5. The role of ___-__-______ is primarily to maintain Na+ and K+ concentration gradients across the cell membrane, although it makes a small direct electrogenic contribution to the membrane potential. 6. Changes in ________ _________ are caused by the flow of ions into or out of the cell. For ion flow to occur, the cell membrane must be permeable to that ion. ______________ means the membrane potential has become less negative. Depolarization occurs when there is net movement of positive charge into the cell, which is called an ______ _______. _________________ means the membrane potential has become more negative, and it occurs when there is net movement of positive charge out of the cell, which is called an _______ _______ 7. Two basic mechanisms can produce a change in membrane potential. In one mechanism, there is a change in the ________________ gradient for a ________ ion, which changes the equilibrium potential for that ion. The permeant ion then will flow into or out of the cell in an attempt to reestablish electrochemical equilibrium, and this current flow will alter the membrane potential. For example, consider the effect of decreasing the extracellular K+ concentration on the resting membrane potential of a myocardial cell. The K+ equilibrium potential, calculated by the Nernst equation, will become more negative. K+ ions will then flow out of the cell and down the now larger electrochemical gradient, driving the resting membrane potential toward the new, more negative K+ equilibrium potential. In the other mechanism, there is a change in ___________ to an ion. For example, the resting permeability of ventricular cells to Na+ is quite low, and Na+ contributes minimally to the resting membrane potential. However, during the upstroke of the ventricular action potential, Na+ conductance dramatically increases, Na+ flows into the cell down its electrochemical gradient, and the membrane potential is briefly driven toward the Na+ equilibrium potential (i.e., is depolarized). 8. __________ _________ is the potential difference at which there is a net inward current (i.e., ______ current becomes greater than _________ current). At threshold potential, the depolarization becomes self-sustained and gives rise to the upstroke of the action potential.

membrane potential, permeabilities equilibrium potential, Nernsh mV resting membrane potential, K+, Na+ Na+ K+ ATPase membrane potential, Depolarization, inward flow, Hyperpolzarization, outtward electrochemical, permeant, conductance Threshold potential, inward, outward

Reperfusion injury: Mitochondrial dysfunction: Ischemia alters mitochondrial ________ ________ enter mitochondria Cell ________ ________ disruption Release of mitochondrial contents that promote _________

membranes Proteins swelling membrane apoptosis

A VSD usually is large and lies in the vicinity of the _________ portion of the ________________ septum; the aortic valve lies immediately over the VSD (__________ _____) and is the major site of egress for blood flow from both ventricles. The obstruction of the right ventricular outflow most often is due to narrowing of the infundibulum (___________ ________) but also can be caused by pulmonary valve stenosis or complete atresia of the valve and the proximal pulmonary arteries.

membranous, interventricular, overriding aorta, subpulmonic stenosis

The basal (_________) region is the last part of the ventricular septum to develop and is the site of approximately 90% of VSDs. Although more common at birth, most VSDs close spontaneously in childhood, so that the overall incidence in adults is _____ than that for ASDs.

membranous, lower

At various locations along continuous capillaries and postcapillary venules are ____________ cells called __________ , with long cytoplasmic processes partly surrounding the endothelial layer.

mesenchymal, pericytes

Each pleural cavity is lined by a single layer of flat cells, ___________, and an associated layer of supporting __________ tissue; together, they form the ______

mesothelium, connective, pleura

Terminal arterioles branch into ______________, in which smooth muscle ____________ contract to resist blood flow and relax cyclically to allow pulsatile flow of blood into an anastomosing _________ ____, where __________ exchange with surrounding cells occurs.

metarterioles, sphincters, capillary bed, metabolic

Capillary beds are supplied preferentially by one or more terminal arteriole branches called _____________, which are continuous with __________ ________ connected with the _____________ _______

metarterioles, thoroughfare channels, postcapillary venules

Small intramural occlusion leads to what type of inarct?

microinfarcts

Infarcts that occur in the setting of small vessel occlusions and may not show changes on teh EKG

microscopic infarcts

The ___________ changes in heart failure are nonspecific, consisting primarily of myocyte hypertrophy with interstitial fibrosis of variable severity. Superimposed on this background may be other lesions that contribute to the development of _____ _______ (e.g., recent or old myocardial infarction)

microscopic, heart failure

A ___________________ too small for surgical manipulation permeates most organs and consists of (1) __________, with one to three smooth muscle layers; (2) ___________, consisting only of an intima endothelial layer; and (3) _________, with large lumens and thin walls, which drain capillaries.

microvascularature, arterioles, capillaries, venules

The ______ _______ vein begins near the apex of the heart and ascends in the posterior interventricular sulcus toward the coronary sinus

middle cardiac

The ______ ___________ is centrally located in the thoracic cavity. It contains the pericardium, heart, origins of the great vessels, various nerves, and smaller vessels.

middle mediastinum

Ultrastructural change seen quickly after onset of MI

mitochondrial swelling

Left atrioventricular orifice: It is closed during ventricular contraction by the ______ valve (left atrioventricular valve), which is also referred to as the _________ valve because it has _ cusps, the ________ and _________ cusps

mitral, biscuspid, 2, anterior, posterior

As soon as left ventricular pressure exceeds left atrial pressure, the ______ valve closes. (In the right heart, the _________ valve closes.) Closure of the AV valves produces the ___ heart sound (__), which may be split because the mitral valve closes slightly ______ the tricuspid valve. Ventricular ________ increases dramatically during this phase, but ventricular ______ remains constant because all valves are closed (the aortic valve has remained closed from the previous cycle).

mitral, tricuspid, S1, before, pressure, volume

carries a portion of the cardiac conduction system, the right bundle of the atrioventricular bundle, to the anterior wall of the right ventricle. What structure?

moderator band

Micrographs of _________ showing their distinctive nuclei which are indented, kidney-shaped, or C-shaped

monocytes

Cardiac morphogenesis involves ________ _____ that work together to choreograph a complex series of tightly regulated events

multiple genes

The esophagus pierces the ________ part of the diaphragm to leave the mediastinum and enter the abdomen just to the ____ of the midline at vertebral level ___

muscular, left, T10

From above, _________________ and ______________ arteries supply the diaphragm. These vessels are branches of the ________ ________ arteries.

musculophrenic, pericardiophrenic, internal thoracic

ST segment changes T wave inversions Seen in EKG with problems with what?

myocardial repolzarization

The thickest heart layer, the __________, consists mainly of cardiac muscle with its fibers arranged spirally around each heart chamber.

myocardium

Sublethal ischemia can induce intracellular _______ ____________; such myocytes are viable but normally poorly contractile

myocyte vaculoization

Blood plasma protein that peaks at 4 hours after MI and then goes down

myoglobin

If the aortic valve is stenosed (_______), the size of the opening through which blood can be ejected from the left ventricle into the aorta is _______.

narrowed, decreased

Coarctation (_________, or ____________) of the aorta is a common form of _________ __________ heart disease

narrowing, constriction, obstructive congenital

The rib ____ is a short flat region of bone that separates the head from the tubercle.

neck

The manubrium of the sternum forms part of the bony framework of the ____ and the ______.

neck, thorax

Agents that decrease contractility have a ________ __________ effect (lowermost curve). Negative inotropic agents produce _________ in stroke volume and cardiac output for a given end-diastolic volume. The result is that a smaller fraction of the end-diastolic volume is ejected per beat and there is a decrease in ejection fraction.

negative inotropic, decreases

The physiologic basis for the refractory periods in myocardial cells is similar to that in _____ cells. Recall from Chapter 1 that activation gates on ___ channels open when the membrane potential is depolarized to threshold, permitting a rapid influx of ___ ____ the cell, which causes further depolarization toward the Na+ __________ potential.

nerve, Na+, Na+ into, equilibrium

Several kinds of __________ _______, often genetic in origin, can affect function of these cells, for example, by decreasing adhesion to the wall of venules, by causing the absence of specific granules, or with deficits in certain factors of the azurophilic granules.

neutrophil defects

In blood smears __________ can be identified by their multilobulated nuclei, with lobules held together by very thin strands. With this feature, the cells are often called polymorphonuclear leukocytes, PMNs, or just polymorphs. The cells are dynamic and the nuclear shape changes frequently.

neutrophils

Eosinophils are about the same size as ___________ but have _________ nuclei and more abundant coarse cytoplasmic granules. The cytoplasm is often filled with brightly ______________ _______ granules, but it also includes some azurophilic granules.

neutrophils, bilobed, eosinophillic specific

On the very first beat after the increase in heart rate shows __ increase in tension because extra ____ has not yet accumulated. On subsequent beats, the effect of the extra accumulation of Ca2+ by the ____________ _________ becomes evident. Tension rises stepwise, like a staircase: With each beat, ____ Ca2+ is accumulated by the sarcoplasmic reticulum, until a maximum storage level is achieved.

no, Ca2+, sarcoplasmic reticulum, more

The tubercle projects posteriorly from the junction of the neck with the shaft and consists of two regions, an articular part and a nonarticular part: ▪ The raised ____________ part is roughened by ligament attachments.

nonarticular

the posterior aortic sinus and cusp are sometimes referred to as the ___________ _____ and ____

noncoronary sinus, cusp

Issues with antibiotics in patient iwth mild angina or recent MI?

none

• Activation of neurohumoral systems in the heart: ○ Release of the neurotransmitter _______________ by the autonomic nervous system increases heart rate and augments myocardial contractility and vascular resistance. ○ Activation of the _____-___________-___________ system spurs water and salt retention (augmenting circulatory ______) and increases vascular tone. ○ Release of ______ _________ _______ acts to balance the renin-angiotensin-aldosterone system through diuresis and vascular smooth muscle relaxation.

norepinepherine renin angiotensin aldosterone, volume atrial naturetic peptide

The term ______ _____ _______ has a specific meaning. It means that the pattern and timing of the electrical activation of the heart are normal.

normal sinus rhythm

The production and release of platelet ___________, i.e. ATP and ADP, can be measured to assess nucleotide production and nucleotide release from granules.

nucleotides

The _______ _______ separates the inferior lobe (lower lobe) from the superior lobe and the middle lobe of the right lung.

oblique fissure

the _______ ___________ _____ is between the right and left pulmonary veins, within the pericardial sac

oblique pericardial sinus

Vitamin K defeciency: malabsorption or ___________ jaundice, which reduces hepatic synthesis of factors __, ___, __ and _. Treatment is by oral or intravenous administration of _______ _. What effect on PT?

obstructive, II, VII, IX, X, vitamin K prolonged

The _______ margin of the heart separates the anterior and left pulmonary surfaces—it is round and extends from the left auricle to the cardiac apex, and is formed mostly by the left ventricle and superiorly by a small portion of the left auricle.

obtuse

Reperfusion injury: Leukocyte aggregation may lead to _________ of the microvascularatture and the "__-______" phenomena

occlusion, no reflow

An ____ ___________ system of vesicles is connected to invaginations of the plasma membrane, which may facilitate platelets' uptake of factors from plasma.

open canalicular

As the name suggests, the cell is more excitable than normal during this period. In other words, less inward current is required to depolarize the cell to the threshold potential. The physiologic explanation for this increased excitability is that the Na+ channels are recovered (i.e., the inactivation gates are ____ again), and because the membrane potential is _____ to threshold than it is at rest, it is ______ to fire an action potential than when the cell membrane is at the resting membrane potential. What period?

open, closer, easier supranormal period

Transverse costal facet AKA

oval facet

Fossa ovalis AKA

oval fossa

When the SA node drives the heart rate, the latent pacemakers are suppressed, a phenomenon called _________ ___________, which is explained as follows: The SA node has the fastest firing rate of all the potential pacemakers, and impulses spread from the SA node to the other myocardial tissues in the sequence. Although some of these tissues are potential __________ themselves (AV node, bundle of His, Purkinje fibers), as long as their firing rate is driven by the SA node, their own capacity to spontaneously depolarize is suppressed.

overdrive suppression, pacemakers