Anderson Cardio Flashcards
What is the most common cardiac congenital defect?
Interventricular Septal Defect
SSX: asymptomatic holosystolic murmur or CHF, increase risk of endocarditis
What four abnormalities form the Tetralogy of Fallot?
VSD, dextraposed aorta overriding the VSD, pulmonic stenosis, RV hypertrophy
What condition may a bicuspid aortic valve lead to later in life?
Aortic stenosis
What's happening? S1 S2 Between S1 and S2 Between S2 and S1
Closure of mitral/tricuspid valves
Closures of aortic/pulmonic valves
Systole
Diastole
Right and left coronary arteries fill during _________. (diastole or systole)
Diastole - blood falls down into the vasculature.
Which is larger right or left coronary artery? What part of the heart do they feed?
Right is larger and supplies right and posterior left ventricle.
Left carries less blood , but divides and fess the anterior and lateral portions of the left ventricle.
Describe the conduction of the heart starting with the SA node and the location.
SA node - right atrium
AV node - right atrium
Right bundle of his - right ventricle (unifascicular)
Left bundle of his - left ventricle (bifascicular)
Acute or Subacute Bacterial Endocarditis: More rare Abnormal heart Normal Heart Virulent organisms Low virulence organism
Acute Subacute Acute Acute Subacute
What infection precedes rheumatic heart dz?
Grp A beta-hemolytic strep
AI, endocarditis esp of left valves, mitral stenosis, migratory polyarthritis
What histological finding is pathognomonic for rheumatic heart dz?
Aschoff bodies.
What is the MC valve disease?
Mitral Valve Prolapse
What condition is often the result of arteriosclerosis and a congenitally bicuspid aortic valve?
Aortic stenosis
What is the MC cause of myocarditis?
Viral infection (e.g. coxsackie B, flu, CMV, ECHO)
List common organisms that cause myocarditis: Bacterial Rickettsial Viral Parasitic Immune
Staph, strep, cornebacterium diptheria Typhus, Rocky Mt. Spotted Fever Cocksackie B, Flu, CMV, ECHO Toxoplasmosis, Trypansosoma cruzi, Trichinosis SLE, Scleroderma
Effects: Flabby ventricular myocardium, four chamber dilation, endocardium and valves unaffected, may be asymptomatic or get CHF.
What is the MC form of cardiomyopathies?
Dilated - young adults. Bilateral heart failure.
SSX: acute onset exertional intolerance (DOE)
What are the three forms of cardiomyopathy?
Dilated, restrictive, hypertrophic
Idiopathic Hypertrophic Subacute Stenosis (IHSS) pathology.
Interventricular septum is hypertrophies/anterior leaflet of mitral valve misplaced. Outflow is restricted. Wall of left ventricle hypertrophied.
What is restrictive cardiomyopathy usually secondary to?
Lysosomal storage disease or connective tissue/deposition disease. E.g. Hurler’s, Pompe’s, sarcoidosis, hemochromatosis.
Term for blood in the pericardial sac. Often occurs with MI where there is traumatic perforation.
Hemopericardium - causes cardiac tamponade
Where does METS to the heart mostly come from?
Lungs
Name the node:
Right vagus nerve
Left vagus nerve
SA
AV
Describe the process of muscle contraction.
Action potential - Ca influx - Ca binds Tp/Tm - actin/myosin binding - ATP to ADP - muscle contraction - relaxation - Ca returns to sarcoplasm via T-tubules
What two enzymes are responsible for phosphorylating actin/myosin?
Calmodium and light chain kinase
How do you modulate cardiac muscle strength?
Manipulating Ca channels - cAMP mechanism
Cardiac muscle does not recruit individual muscle units, syncytium - the whole thing contracts.
Name the muscle type: (cardiac/smooth/skeletal)
Recruitment of motor units/AP frequency regulates strength
AP duration regulates strength
Membrane potential/biochemical modulation of Ca sens regulates strength
Skeletal
Cardiac
Smooth
What is the longest vein in the body? Where does it come off of?
The great saphenous vein.
Come off femoral vein.
Arteriosclerosis vs. Atherosclerosis
Arteriosclerosis - thickening and loss of elasticity of arterial wall. Literal hardening of arteries
Atherosclerosis - intimal thickening and lipid deposition
Name the pathology: vasculitis of small/medium cranial vessels especially the temporal artery. Genetic predisposition, HA, pain tenderness, facial pain.
What is the most serious complication?
Temporal Arteritis
Blindness
Name the pathology: MC in young men, heave smokers, nodular phlebitis, instep claudication, gangrene, inflammation of arteries of extremeties
Thromboangiitis Obliterans/Buerger’s
Idiopathic vascular spasm causing extremities to turn white/blue/black.
Raynaud’s dz
Emboli vs. Thrombi
Thrombi = clotted blood Emboli = anything in the blood that shouldn't be there
Name the pathology: HIV infected patient, purple/black papules that may scale, metastatic, and deadly
Kaposi’s Sarcoma
Name the pathology: Children born with large hemangioma in place of an organ (eye/brain)
Lindau von Hipple
Where does the largest decrease in pressure occur in the vascular system?
Arterioles
T/F: Hypertension is most commonly symptomatic.
F
Essential or Secondary HTN: 95% of cases Lifestyle causes Renal disease ETOH abuse
Essential
Essential
Secondary
Secondary
Right ventricular hypertrophy secondary to pulmonary HTN?
Cor pulmonale
What is the difference between serum and plasma?
Serum = plasma - clotting factors
Heme or Non-Heme iron: Requires transferrin Comes from meat AKA Rust Oxidizes without transferrin Unregulated uptake
Non-heme Heme Non-heme Non-heme Heme
Ferrous vs. Ferric
Ferrous 2+
Ferric 3+
Free iron absorption is blocked by…
High plasma Fe, phytates, tannins, oxylates, phosphates.
Iron chelator that is released when infection is active to sequester Fe from bacteria.
Lactoferrin
What enzymatic process of forming the heme?
B6 + Succinate (succinyl-CoA) , Glycine (ALA synthase)
ALA (ALA Dehydrogenase)
Porphyrin (ferrochelatase - requires Ferrous 2+)
Ferric is converted to Ferrous via CYP 450
HEME
What enzyme puts Ferrous 2+ in the porphyrin molecule creating heme?
Ferrochelatase
What is methemoglobin?
Fe 3+ iron instead of Fe 2+ - binds much more strongly to O2
Once the iron and globulins are broken down, what is left over?
Biliverdin
Bilirubin is conjugated to “direct” bilirubin in what organ?
Liver
What inhibits the conjugation pathway?
Acetaminophen, hepatitis, toxic ingestion (mushrooms)
Where is biliverdin converted to “Indirect” or unconjugated bilirubin? What cofactor is required?
Reticulo-endothelial cells
NADPH
Name the pathology: overproducing a certain porphyrins and they are excreted in urine.
Porphyria
R vs. T Hemoglobin
4 open O2 sites
No open O2 sites
R
T
What are the globulin subunits of adult hemoglobin?
2 alpha, 2 beta
Normal pH of the blood?
pH 7.37-7.4
Slightly more acidic in venous supply due to CO2
O2 saturation of arterial vs. venous blood.
Arterial 97%
Venous 70%
What stimulates oxygen release from hemoglobin?
Increased acidity, CO2, temp, 2,3 BPG
Increase salt-bridge formation.
What are the three forms of CO2 carried to lungs?
1) dissolved CO2
2) Carbaminohemoglobin
3) HCO3- hydrated CO2 90%!!!
What enzyme takes CO2 and H2O to become H2CO3, but can also reverse the reaction?
Carbonic anhydrase
Describe the Bohr Effect.
Makes CO2 into bicarb - in periphery
Makes bicarb into CO@ - in lungs
Equal and opposite.
What two enzymes does lead interfere with causing microcytic anemia?
ALA dehydrogenase, ferrochelatase.
Most common cause of hemolytic anemia?
G6P deficiency
Name the anemia:
bite cell anemia/heinz bodies
teardrop cells/basophilic stippling/target cells
pancytopenia, failure of myeloid stem cells
splenomegaly
leg ulcers, strokes, claudication
G6P deficiency Thalassemia Anaplastic anema G6P deficiency Sickle cell
Name the pathology; myeloproliferative dz, high Hgb, viscous blood, tx is phlebotomy
Polycythemia vera
Thalassemia major vs. minor
Major inherit genes from both parents (alpha or beta)
Inherit gene from one parent (alpha or beta)
Alpha has 4 genes, Beta has 2 genes
What cancer of plasma cells causes Bence-Jones proteins in urine?
Multiple myeloma
Which leukemia is MC in children?
Acute Lymphoblastic Leukemia
Which leukemia is MC in adults? What is the histological finding?
Acute Myeloblastic Leukemia
Auer rods
What form of leukemia is associated with the Philadelphia chromosome? Which cell line is involved?
Chronic Myelogenous Leukemia
Can be any cell type
What is the MC overall Leukemia and MC after 60yo? Which cell line is involved?
Chronic Lymphocytic Leukemia
Well-differentiated B-Cell
What leukemia has B-cells with hair-like projections?
Hairy Cell Leukemia
Vitamin K dependent clotting factors?
2, 7, 9, and 10
Which pathway is measured by PTT? Which is measured by PT/INR?
Intrinsic
Extrinsic
What are the active substance causing positive feedback in the clotting cascade?
Thrombin
What doe Poiseuille’s Equation give us?
Resistance
Name that clotting disorder: Facto VIII def, Factor IX def, male only Facto VIII activating protein deficiency, milder Vitamin deficiency for factors 2,7,9, 10
Hemophilia A
Hemophilia B
Von Willebrand’s
Vit K def
What are three general causes of thrombocytopenia?
Increased destruction - e.g. AI
Decreased production - e.g. congenital or acquired (i.e. drug)
Increased consumption - e.g. DIC seen in sepsis or with embolism during childbirth
How does the body respond to hemorrhage (decrease arterial pressure)?
1) Baroreceptor reflex - Increase HR, contractility, vasoconstriction
2) Increase Renin - Increase Angiotensin II leading to increased aldosterone, Na+ reabsorption, increase blood volume
3) Hydrostatic pressure drops, increases fluid absorption, increase blood volume
T/F: Edema occurs when hydrostatic pressure exceeds oncotic pressure.
T
Transudate vs. Exudate
Trans - protein poor, found in edema secondary to the alteration of Starling’s forces
Ex - protein rich, found in acute inflammatory states
T/F: Interstitial edema = pitting edema
T
What is anasarca?
Generalized edema
What are the three stages of shock?
1) Nonprogressive stage - like hemorrhage
2) Progressive stage - hypoperfusion and metabolic acidosis
3) Irreversible shock - end organ damage and death
T/F: Lymphatics absorb the difference between hydrostatic and oncotic pressure in the arteries.
F, in the capillaries.
Name the lymphoma:
B-cell lymphoma, associated with EBV/malaria infxn
Young adults or 60yo, Reed-Sternberg cell
Most common lymphoma, more deadl
Burkitt’s - maxilla or mandible
Hodgkin’s - curable, familial
Non-hodgkin’s - assoc with Burkitt’s and Immunoblastic lymphomas
What is the main point of the Frank Starling Law?
It established the physiologic limits of the heart in terms of blood volume. Changes in arterial pressure have little effect on the rate of pumping by the heart (WNL).
Patient with heart failure have a narrowed limit.
T/F: Cardiac Output = Heart Rate x Stroke Volume
T
Causes of right sided CHF
Emphysema, mitral stenosis, left ventricular failure
Causes of left sided CHF
Ischemic heart dz, systemic hypertension, aortic or mitracl valve dz
