Cardiac Flashcards
1
Q
what does truncus arteriosus give rise to
A
ascending aorta and pulmonary trunk
2
Q
what does bulbus cordis give rise to
A
smooth parts of the right and left ventricles
3
Q
what does primitive atria give rise to
A
trabeculated part of right and left ventricles
4
Q
what does primitive pulmonary vein give rise to
A
smooth part of the left atrium
5
Q
what does left horn of sinus venosus give rise to
A
coronary sinus
6
Q
what does right horn of the sinus venosus give rise o
A
smooth part of the right atrium
7
Q
what do the common cardinal vein and right anterior cardinal vein give rise to
A
superior vena cava
8
Q
cause of patent foramen ovale
A
failure of septum primum and septum secundum to fuse after bith.
9
Q
where do VSDs most often occur
A
in the membranous septum. acyanotic at birth- left to right shunt
10
Q
order of fetal erythropoiesis
A
Yuli Likes Sweet Blueberries Yolk sac Liver Spleen Bone Marrow
11
Q
fetal hemoglobin
A
alpha 2 gamma 2
12
Q
adult hemoglobin
A
alpha 2 beta 2
13
Q
why does HbF pick up more oxygen?
A
greater affinity for oxygen and less binding of 2,3 DPG. this allows the HbF to extract oxygen from the maternal hemoglobin across the placenta
14
Q
umbilical vein turns into the
A
ligamentum teres hepatis
15
Q
umbilical arteries turn into the
A
medial umbilical ligament
16
Q
ductus arteriosus turns into the
A
ligamentum arteriosum
17
Q
ductus venosus turns into the
A
ligamentum venosum
18
Q
foramen ovale turns into the
A
fossa ovalis
19
Q
allantois turns into the
A
Urachus, mediaN umbilical ligament
20
Q
notochord turns into
A
nucleus pulposus of the intervertebral disc
21
Q
where is ligamentum teres hepatis
A
contained in the falciform ligament
22
Q
what supplies the SA and AV nodes
A
RCA
23
Q
what artery supplies the anterior papillary muscle
A
LAD
24
Q
in the majority of people where does the PDA arise from
A
RCA
25
most posterior part of the heart
Left atrium
26
what supplies the right ventricle
acute marginal artery
27
what supplies the posterior wall of the ventricles and posterior 1/3 of the septum
PDA
28
what supplies the lateral and posterior wall of the left ventricle
left circumflex
29
MAP or mean arterial pressure equation
MAP = CO x TPR
30
another equation for MAP
MAP = 2/3 diastolic + 1/3 systolic
31
pulse pressure
systolic- diastolic
32
how to maintain CO in the early phases of exercise
increase HR and increase SV
33
how to maintain CO in the later phases of exercise
increase HR (SV plateues)
34
increasing HR shortens...
filling time- shortens diastole and therefore less time to fill the heart and a smaller cardiac output.
35
what conditions increase pulse pressure
hyperthyroidism, AR, arteriosclerosis, obstructive sleep apnea (increased sympathetic tone), exercise
36
what conditions decrease pulse pressure
aortic stenosis, cardiogenic shock, cardiac tamponade, advanced heart failure
37
3 conditions that increase stroke volume
anxiety, pregnancy and exercise.
38
what increases myocardial demand
increased afterload, increased contractility, increased heart rate and increase ventricular diameter (increased wall tension)
39
wall tension equation
wall tension = pressure x radius / 2 x wall thickness
40
vasodilators
decrease afterload- example is hydralazine
41
function of ACE inhibitors and ARBs on preload and afterload
decrease both of them
42
ejection fraction
measure of contractility. normal in diastolic failure and decreased in systolic failure
43
what correlates with contractility
end diastolic length of cardiac muscle fibers- preload
44
resistance equation
Resistance = 8 viscosity x length / r^4
45
what conditions increase viscosity
polycythemia
hyperproteinemic states like mulitple myeloma
hereditary spherocytosis
46
on the cardiac graph, things that increase contractility
catecholamines and digoxin
47
on the cardiac graph, things that decrease contractility
uncompensated heart failure and narcotic overdose
48
on the cardiac graph, things that increase venous return or volume
fluid infusion or sympathetic activity
49
on the cardiac graph, things that decrease venous return or volume
acute hemorrage or spinal anesthesia
50
change in the slope of the cardiac curves
this is a change in the TPR= total peripheral resistance
51
less steep curve on the cardiac graph (below)
this is an increase in TPR and this is from vasopressors
52
more steep curve on the cardiac graph (above)
this is a decrease in TPR and it is from exercise or AV shunt
53
S1
mitral and tricuspid closing. loudest in mitral area
54
S2
aortic and pulmonary valves closing. loudest at left sternal border
55
S3
early diastole. seen with Mitral regurg and CHF and more common in dilated ventricles. normal in children and pregnant women
56
S4
atrical kick. late diastole. associated with ventricular hypertrophy. left atrium must push against a still LV wall.
57
a wave in JVP
this is atrial contraction
58
c wave in JVP
this is RV contraction against a closed valve (T valve)
59
v wave in JVP
this is right atrial filling against a closed T valve
60
X wave in JVP
this is descent. it is atrial relaxation and downward descent during VENTRICULAR contraction. absent in tricuspid regurgitation
61
Y wave in JVP
this is descent. it is from blood flowing from RA to RV.
62
what causes normal splitting of the heart sounds
this is from with inspiration, there is a drop in intra thoracic pressure and this leads to more blood on the right side of the heart. get A2 then P2.
63
wide splitting of the heart sounds
seen in conditions that delay the RV from emptying like pulmonic stenosis, right bundle branch block). exageration of normal splitting
64
fixed splitting
this is seen in ASD. increase in blood on the right side of the heart regardless of inspiration so it is fixed and doesn't change with breathing.
65
paradoxical splitting
seen when the left ventricle is delayed for whatever reason. things like aortic stenosis and left bundle branch block. now P2 occurs before A2. this is the opposite
66
what does inspiration do to heart sounds
increases the murmurs on the RIGHT side of the heart
67
which murmurs are increased with hand grip
MR, AR, VSD, MVP
68
murmurs increased with valsalva or standing
hypertrophic cardiomyopathy
69
what does valsalva and standing do
decreases venous return
70
what does rapid squatting do to the heart sounds
increases venous return, increases preload, increases afterload
71
diastolic heart sounds
ARMS
72
description of TR/MR murmur
holosytolic high pitched blowing murmur
73
where is MR heard
loudest at the apex. radiates to the axilla
74
AS murmur description
crescendo decrescendo systolic ejection murmur. LV pressure is greater than the aortic pressure. loudest at the base of teh heart and radiates to the carotids. assocaited wit pulses parvus et tardus. often due to age related disease or congenital bicuspid valve.
75
VSD murmur description
holosystolic harsh sounding murmur. loudest at the tricuspid area.
76
MVP murmur description
late systolic crescendo with midsystolic click.
77
what causes the midsystolic click in MVP
sudden tensing of the chordae
78
where is MVP best hear
over the apex
79
what determines if MVP is less severe
it is less severe with earlier onset. this can be brought about with valsalva
80
AR murmur description
high pitched blowing early diastolic decrescendo murmur. wide pulse pressure. bounding pulses and head bobbing. vasodilators decrease the murmur.
81
MS murmur description
follows an opening snap. delayed rumbling late diastolic murmur.
82
what correlates with severeity of MS
decreased interval between S2 and the opening span means worse.
83
most common cause of MS
this is from chronic rheumatic heart disease
84
PDA murmur
continuous machine like murmur. loudest at S2.
85
most common cause of PDA
congenital rubella or prematurity. best heard at the left infraclavicular region.
86
what is phase 4 in SA and AV nodes
this is the slow diastolic depolarization. membrane potential spontaneously depolarizes as Na+ conductance increases. this is the If or funny channels. gives automaticity of SA and AV noes.
87
what decreases the slope of phase 4 and therefore the HR
adenosine and ach
88
what increases the slope of phase 4 and therefore HR
sympathetic stimulation (increases chance of If channels being open), and catecholamines
89
what is the p wave
atrial depolarization
90
what is the PR interval
conduction delay through the ventricle
91
what is the QRS complex
ventricular depolarization
92
what is the QT internat
mechanical contraction of the ventricles
93
what is the T wave
ventricular repolarization. T wave inversion means recent MI
94
ST segment is
time when the ventricles are depolarized
95
what is the U wave
hypokalemia and bradycardia
96
order of speed of conduction
```
Park AT Ventura Avenue
Perkinje fibers
Atria
Ventricles
AV node
```
97
what is torsades de pointes
this is polymorphic ventricular tachycardia. can progress to V fib
98
treatment of torsades de pointes
magnesium sulfate
99
drugs that prolong QT and predispose to torsades de pointes
```
Some Risky Meds Can Prolong QT
Solatol (class 3)
Risperidone (and other anti psychotics)
Macrolines
Chloroqine
Protease inhibitors (navir)
Quinidine (class 1a)
Thiazides
```
100
congenital QT syndrome
Romano Ward Syndrome- just cardiac issues
| Jervell and Lange Nielsen syndrome- cardiac and deafness
101
Wolff Parkinson White
abnormally fast pathway from the atria to the ventricles known as the bundle of Kent. this bypasses the normal slowing of the AV node. this means the ventricles start to depolarize too soon. see a delta wave with a shortened PR interval. can result in supraventricular tachycardia
102
chaotic baseline ECG with no discrete P waves
this is atrial fibrilation
103
sawtooth appearance on the bottom of the ECG line
this is atrial flutter
104
prolonged PR interval
this is 1st degree heart block
105
progressive lengthening of the PR interval until a dropped QRS
this is 2nd degree heart block type 1
106
dropped beats that are not preceeded by a change in the length of the PR interval
this is 2nd degree heart block type 2
107
P waves and QRS that are not associated with each other
3rd degree heart block
108
function of ANP
released from ATRIAL myocytes in response to increased blood volume and atrial pressures. causes vasodilation and decreased Na re-absorption at the renal collecting tubule. constricts efferent renal arterioles and dilates the afferent ones promoting diuresis and giving an aldosterone escape mechanism
109
function of BNP
this is released from the VENTIRCULAR myocytes. done in response to increased tension. similar to ANP but a longer half life. used to diagnose heart failure.
110
what does the aortic arch receptor respond to
only responds to high (increased) BP
111
what does the carotid sinus receptor respond to
both increased and decreased BP
112
how does the carotid sinus respond?
through CN 9 to the solitary nucleus of the medulla
113
how does the aortic arch respond
through CN 10 or vagus nerve to the solitary nucleus of the medulla
114
how do baroreceptors work
icnreased pressure, or massage of them, leading to increased stretch, increased firing, increased AV node refractory period and therefore--> decreased HR
115
cushing reaction
hypertension, bradycardia and respiratory depression
116
peripheral chemoreceptors
located in the aorta or in the carotid bodies. stimualted by decreased Po2 increased Pco2 or decreased pH of blood
117
central chemoreceptors
located in the brain. stimulated by changes in pH and PCo2 of brain interstitial fluid. do not respond direclty to Po2
118
which organ gets 100% or largest amount of blood flow
lung
119
which organ gets largest share of systemic cadiac output
liver
120
which organ gets highest blood flow per gram of tissue
kidney
121
which organ can extract oxygen the best
heart.
122
what does tricuspid atresia require to be viable
ASD and VSD
123
what congenital heart problem gives the boot shape on x ray
tetrology of fallot
124
total anomalous pulmonary venous return
pulmonary veins drain into the right heart.
125
what cardiac anomaly is assocaited with notching of teh ribs
adult form of coarctation of the aorta. this leads to hypertension in the upper extremities and hypotension and claudication in the lower extremities. this is distal to the ligamentum arteriosum.
126
what heart defect is maternal lithium associated with
Eisenmenger syndrome
127
what maternal behavior can cause a VSD
alcohol
128
what heart problems are assocaited with 22q11
Truncus arteriosus and tetrology of fallot
129
what heart problems are assocaited with Downs syndrome
ASD, VSD, AV septal defect (endocardial cushion defect)
130
what heart problems are assocaited with congenital rubella
septal defects and PDA as well as pulmonary artery stenosis. but the big one is PDA
131
what heart defects assocaited with Turner syndrome
bicuspid aortic valve, pre ductal or infantile coarctation of the aorta
132
what heart defects are assocaited with maternal diabetes
transposition of the great vessels.
133
definition of hypertension
>140 /90
134
genetic cause of hypertension in young woman
fibromuscular dysplasia (narrowing of the renal artery)
135
what is systolic blood pressure related to
stroke volume
136
what is diastolic blood pressure related to
TPR
137
what cells are present in xanthomas
histiocytes
138
corneal arcus
lipid deposition in the cornea. appears early with hypercholesterolemia.
139
monkenberg -medial calcific sclerosis
this is calcificaion o the media of the arteries like the radial and ulnar arteries. usually benign. can be picked up on an xray or mammo. INTIMA IS NOT INVOLVED
140
cause of hyaline arteriosclerosis
proteins leak into vascular wall making it so pink. from benign hypertension or diabetes with non enzymatic gycosylation. likes the kidneys
141
cause of hyperplastic arteriolosclerosis
thickening of the vessel wall by hyperplasia of smooth muscle. onion skin appearance. main cause is malignant hypertension. can cause end organ ischemia with fibrinoid necrosis. acute renal failure from this- flea bitten appearance.
142
what two factors are involved in smooth muscle cell migration in atherosclerosis
PDGF and FGF.
143
locations of atherosclerosis
abdominal aorta > coronary artery > popliteal artery > carotid artery
144
what are abdominal aortic aneurysms associated with
atherosclerosis. more frequently in hypertensive male smokers greater than 50. likes to go below the renal artery but above the aortic bifurcation
145
what are thoracic aortic aneurysms associated with
cystic medial degeneration due to hypertension in older patients, or Marfans in younger patients. also historically assocaited with tertiarry syphilis (bliterative endarteritis of the vasa vasorum).
146
where is the tear in an aortic dissection
tear is in the intima. requires though pre-existing medial weakness from either hypertension or inherited defects like with marfans. hypertension does this because you get hyline arteriolosclerosis of the vaso vasorum in the proximal aorta and you can't feed the thick muscle so it becomes weaker.
147
ECG findings with stable Angina
as long as it is subendocardial damage and not throughout the entire wall, this shows ST depression.
148
ECG findings in unstable angina
this is still just ST depression
149
ECG findings in an MI
this is where there has been blockage for more than 20 minutes. if transmural, ECG will show ST elevation. if subendocardial still, the ECG will show ST depression. cardiac biomarkers are diagnostic.
150
what is Prinzmetal angina
occurs at rest secondary to coronary artery spasm. transient ST elevation can be seen. known triggers include tobacco, cocaine, triptans etc. treat with calcium channel blockers, nitrates and smoking cessation.
151
coronary steal syndrome
this is when you give a vasodilator and this makes all the normal vessels dilate and the area of the coronary artery that is stenosed then gets less blood and this means increased ischemia. vasodilating drugs associated with this include dipyridamole and regadenoson)
152
sudden cardiac death
this is death from cardiac causes within 1 hour of onset of symptoms. most commonly due to a lethal arrythmia like v fib.
153
changes seen in the heart post MI after 0-4 hours
none. death is from arrythmias in general. or cardiogenic shock
154
changes seen in the heart post MI 4-12 hours
early coagulative necrosis. release of necrotic cell contents into the blood, edema, hemorrgahe, wavy fibers etc. grossly get dark discoloration.
155
changes seen in the heart post MI seen after 24 hours
neutrophils start to come in. grossly the heart looks yellow from this. extensive coagulative necrosis and tissue surrounding the infarct shows lots of neutrophils. complications at this point are fibrinous pericarditis. only seen with transmural infarct- chest pain and friction rub.
156
changes seen in the heart post MI days 4-7
this shows the presence of macrophages and they come in and eat the tissue. the tissue is still yellow. it gets maximally soft by 10 days. this is when there is a risk of free wall rupture which leads to tamponade. can also get papillary muscle rupture leading to mitral regurg.
157
changes seen in the heart post MI weeks 1-3
this is the start of the granulation tissue. it has a red border.
158
changes seen in the heart post MI weeks 2- several months
poor movement of the ventricle as it forms a scar. the scar will be white at this point. fibrosis. complications include dressler syndrome
159
dressler syndrome
this is pericarditis from an autoimmune reaction and antibodies that formed against the pericardium. remember this is fibrinous pericarditis
160
cardiac troponins..
cardiac troponin I rises after 4 hours and is increased for 7-10 days. most specific
161
cardiac CkMB
this rises quickly but falls quickly- good for re-infacrtion. less specific- also in skeletal muscle
162
Q waves in leads VI-V4
anterior wall (LAD)
163
Q waves in leads V1-V2
anteroseptal (LAD)
164
Q waves in leads V4-V6
anterolateral (LAD or LCX)
165
Q waves in I and aVL
Lateral wall (LCX)
166
Q waves in II, III and avF
inferior wall (RCA)
167
histology of dilated cardiomyopathy
eccentric hypertrophy with sarcomeres added in series
168
common causes of dilated cardiomyopathy
alcohol abuse, beri beri, coxsackie B virus, chronic cocain use, chagas disease, doxurubicin tocicity, hemochromatosis, and peripartum cardiomyopathy
169
findings in dilated cardiomyopathy
heart failure, S3, dilated heart on echo, balloon appearance of the heart of CXR
170
histology of hypertrophic cardiomyopathy
marked ventricular hypertrophy with often septal predominance and myofibrillary disarray and fibrosis.
171
mutation commonly seen in hypertrophic cardiomyopathy
mutation in sarcomere proteins- beta myosin heavy chain
172
disease hypertrophic cardiomyopathy is assocaited with
friedrich's ataxia
173
obstructive hypertrophic cardiomyopathy
hypertrophied septum such that it is too close to the anterior mitral leaflet, leading to outflow obstruction and subsequent dyspnea and syncope
174
most common cause of sudden death in athletes
hypertrophic cardiomyopathy
175
Loffler syndrome
restrictive cardiomyopathy. endomyocardial fibrosis with a prominent eosinophilic infiltrate
176
hypertrophic cardiomyopathy leads to
diastolic dysfunction
177
infiltrative cardiomyopathy leads to
diastolic dysfunction
178
dilated cardiomyopathy leads to
systolic dysfunction
179
what does left heart failure cause in CHF
pulmonary edema, orthopnea and paroxysmal nocturnal dyspnea
180
what type of fluid is pushed out in CHF
transudate
181
what does right heart failure cause
hepatomegaly (nutmeg liver)- usually painful, peripheral edema, and jugular venous distension. this gives pitting edema which again is a transudate.
182
symptoms of bacterial endocarditis
fever, new murmur, roth spots (round white spots on the retina surrounded by hemorrage), osler nodes (tender), janeway lesions (non painful on palms and soles), anemia, splinter hemorrages,
183
S aureus and endocarditis
infects previously normal valves and gives acute bacterial endocarditis
184
Strep viridans and endocarditis
this is low virulence so it infects congenitally abnormal or disease valves. sequela of dental procedures. sub acute in nature. gradual onset. smaller vegitations
185
culture negative endocarditis
most likely Coxiella burnetti or Bartonella. also think about HACEK organisms- hemophilis, acinobacilius, cardiobacterium, Ekinella, Kingella
186
S bovis endocarditis
seen in colon cancer patients
187
S epidermidis endocarditis
prosthetic valves
188
vegitations on both sides of the valve
this is liebman sacks endocarditis and is secondary to lupus. sterile vegitations.
189
non bacterial thrombotic endocarditis
sterile vegitations seen in a hyper coagulable state or with adeno carcinoma underlying.
190
rheumatic fever
consequence of pharyngeal infection with group A beta hemolytic strep.
191
early cause of death with rheumatic fever
myocarditis
192
late issues with rheumatic fever
valve disease. loves the mitral then the aortic valve. early lesion is MR and then progresses to MS.
193
what disease is assocaited with Aschoff bodies
rheumatic fever tese are granulomas with giant cells and Anitschkow cells with wavy catepillary like nuclei).
194
what type of HS reaction is rheumatic fever
type 2
195
what skin disease is assocaited with rheumatic fever
erythema marginatum
196
pericarditis pain
classic. sharp pain, aggrevated by breathing in (inspiration) and relieved by sitting up and leaning forward. presents with a friction rub. can see ST elevation or PR depression.
197
serous pericarditis
tends to be viral or non infectious diseases
198
fibrinous pericarditis
tends to be from Dressler syndrome, uremia, radiation,
199
Beck triad of cardiac tamponade
hypotension, muffled heart sounds, distended neck veins
200
ECG findings in cardiac tamponade
low voltage QRS and electrical alternans due to swining movement of the hear in large effusion
201
pulsus paradoxus
decrease in systolic blood pressure by 10 mm Hg during inspiration. seen in cardiac tamponade, asthma, obstructive sleep apnea, pericarditis and croup
202
"tree bark aorta"
this is the description for tertiary syphilis. calcification of the aortic root and ascending aorta. can lead to an aortic aneurysm and it is thoracic
203
what is a cardiac myxoma
most common heart tumor (primary). mostly in the LA. ball valve and can obstruct the flow of blood. gelatinous in appearance. mesenchymal tumor with abundant ground substance.
204
rhabdomyomas
most common primary cardiac tumor in children. usually in ventricles
205
Kussmal sign
this is an increase in JVP with inspiration even though it should decrease because inspiration pulls the blood into the right heart. this means there is impaired filling of the ventricle. seen in constrictive pericarditis, restrictive cardiomyopathies and right atrial or ventricular tumors
206
common mets to the heart
brest and lung
melanoma
lymphoma
often go to the pericardim and give pericardial effusion
