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DIT > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Truncus arteriosus gives rise to

A

Ascending aorta & Pulmonary trunk

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2
Q

Bulbus cordis gives rise to

A

Smooth part of the L/R ventricles

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3
Q

Primitive atria gives rise to

A

Trabeculated part of the L/R atrias

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4
Q

Primitive ventricle gives rise to

A

Trabeculated part of the L/R ventricles

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5
Q

Primitive Pulmonary v. gives rise to

A

Smooth part of the L atria

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6
Q

Left horn of sinus venosus gives rise to

A

Coronary sinus

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7
Q

Right horn of sinus venosus gives rise to

A

Smooth part of the R atria

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8
Q

Right Common Cardinal V & Right Anterior Cardinal V gives rise to

A

SVC

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9
Q

In heart development, initially the heart tube folds into a _______ with the primitive atria ______ and primitive ventricle ______

A

“S”-shape; primitive atria posterior & primitive ventricle anterior

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10
Q

As the septum primum grows toward the ___________, the __________ narrows

A

endocardial cushions, foramen primum

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11
Q

As the foramen primum is obliterated in the septum primum, the _________ forms

A

foramen secundum

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12
Q

The septum secundum grows nearby covering the majority of the foramen secundum, the remaining opening is termed ________

A

foramen ovale

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13
Q

Atrial septum is formed by

A

fusion of the septum primum & septum secundum

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14
Q

The foramen ovale closes shortly after birth d/t

A

increased LA pressure

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15
Q

Patent foramen ovale can lead to

A

paradoxical emboli (emboli -> RA -> patent foramen ovale -> LA -> LV -> systemic circulation)

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16
Q

What divides the L/R atria?

A

Septum primum & septum secundum

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17
Q

Aortic arch derivatives: 1st aortic arch –>

A

part of the maxillary a.

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18
Q

Aortic arch derivatives: 2nd aortic arch –>

A

stapedial & hyoid a.

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19
Q

Aortic arch derivatives: 3rd aortic arch –>

A

common carotid a. & proximal internal carotid a.

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20
Q

Aortic arch derivatives: 4th aortic arch –>

A

L: arch of the adult aorta
R: proximal R. subclavian a.

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21
Q

Aortic arch derivatives: 5th aortic arch –>

A

proximal pulmonary a. & ductus arteriosus

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22
Q

Which structures grows & separates the atria & ventricles?

A

endocardial cushions

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23
Q

Which genetic abnormality is associated with endocardial cushion defects?

A

Trisomy 21

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24
Q

Muscular ventricular septum forms with an opening called the

A

Interventricular foramen

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25
Q

Which structure performs a 180-turn to form part of the interventricular septum

A

Aorticopulmonary septum/Spiral septum (truncoconical swellings)

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26
Q

Aorticopulmonary septum forms the

A

membranous interventricular septum & closes the inter ventricular foramen

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27
Q

Aorticopulmonary septum is derived from

A

neural crest cells

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28
Q

Name 4 Spiral Septal defects

A

Tetralogy of Fallot, Persistent Truncus Arteriosus, Transposition of the great vessels, VSD

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29
Q

VSD commonly occurs in the

A

membranous interventricular septum

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30
Q

Aortic/Pulmonary valves are derived from

A

endocardial cushions of the outflow tract

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31
Q

Mitral/Tricuspid valves are derived from

A

fused endocardial cushions of the AV canal

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32
Q

Fetal Erythropoiesis occurs in the ____________ from weeks 3-8 gestation

A

Yolk sac

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33
Q

Fetal Erythropoiesis occurs in the ____________ from 6weeks-birth

A

Liver

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34
Q

Fetal Erythropoiesis occurs in the ____________ from 10-28weeks

A

Spleen

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35
Q

Fetal Erythropoiesis occurs in the ____________ from 18weeks-adult

A

Bone marrow

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36
Q

HbF (fetal Hgb) components

A

alpha 2 + gamma 2

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37
Q

HbA (adult Hgb) components

A

alpha 2 + beta 2

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38
Q

3 major shunts in fetal circulation

A 
Ductus Venosus (bypass hepatic circulation)
Foramen Ovale (High O2 blood to brain)
Ductus Arteriosus (bypass lung circulation)
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39
Q

What causes closure of the foramen ovale

A

increased LA pressure following first breath

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40
Q

What causes closure of the ductus arteriosus

A

high O2 & low prostaglandins (placental separation)

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41
Q

What will help close a patent ductus arteriosus

A

Indomethacin

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42
Q

What will keep the ductus arterioles open

A

Prostaglandins E1 & E2

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43
Q

Ductus arteriosus remnant in adults

A

ligamentum arteriosum

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44
Q

Foramen ovale remnant in adults

A

fossa ovalis

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45
Q

Which fetal vessel has the highest O2 content

A

umbilical v

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46
Q

Umbilical v. remnant in adults

A

Ligamentum teres hepatis (contained in falciform ligament)

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47
Q

Umbilical a. remnant in adults

A

Medial umbilical ligemants

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48
Q

Ductus venosus remnant in adults

A

ligamentum venosum

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49
Q

Allantois remnant in adults

A

urachus - median umbilical ligament (urachal cyst)

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50
Q

Notochord remnant in adults

A

nucleus pulpous if IV disc

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51
Q

VSD S/S

A

harsh, holosystolic murmur

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52
Q

SA & AV nodes are supplied by

A

RCA

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53
Q

Most common coronary a. occlusion?

A

LAD

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54
Q

Most posterior part of the heart?

A

L. atrium

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55
Q

LA hypertrophy may cause what S/S

A

dysphagia (esophageal compression) & hoarseness (left recurrent laryngeal n. compression)

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56
Q

LAD supplies

A

anterior 2/3 of IV septum, anterior papillary m., anterior surface of LV

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57
Q

RCA supplies

A

(acute marginal a.) RV, (PDA) posterior 1/3 IV septum, posterior walls of ventricles

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58
Q

LCX supplies

A

lateral & posterior walls of LV

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59
Q

ASD S/S

A

Lous S1 & wide, fixed splitting of S2

RV hypertrophy

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60
Q

PDA S/S

A

continuous, machine-like murmur @ upper L. sternal border

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61
Q

Coarctation of the aorta S/S

A

high BP in UE, low BP in LE
notching of the ribs
aortic regurgitation (d/t HF)

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62
Q

Ebstein Anomaly is associated w/ maternal use of

A

Lithium

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63
Q

Ebstein Anomaly pathology

A

tricuspid leaflets displaced into RV, hypoplastic RV, tricuspid regurgitation or stenosis

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64
Q

Ebstein Anomaly S/S

A

widely split S2, tricuspid regurgitation

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65
Q

Eisenmenger Syndrome pathology

A

long-standing L->R shunt causing pulmonary HTN -> RV hypertrophy & high right sided pressure -> CONVERTS to R->L SHUNT

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66
Q

Eisenmenger Syndrome S/S

A

cyanosis, SOB, clubbing

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67
Q

Persistent Truncus Arteriosus S/S

A

R-> Shunt; cyanosis, respiratory distress

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68
Q

Transposition of Great Vessels S/S

A

cyanosis, respiratory distress (MUST maintain PDA or L->R shunt)

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69
Q

Tricuspid Atresia

A

Must have ASD & VSD

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70
Q

4 components of Tetralogy of Fallot

A

VSD, RV Hypertrophy, Overriding Aorta, Pulmonic Valve Stenosis (right outflow obstruction)

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71
Q

Tetralogy of Fallot S/S

A

cyanosis with activity (R->L shunt), BOOT-SHAPED heart in infants/children

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72
Q

What heart defects are associated w/ Turner Syndrome?

A

Coarc of aorta (rib notching), bicuspid aortic valve

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73
Q

What heart defects are associated w/ DiGeorge Syndrome?

A

TA, ToF

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74
Q

What heart defects are associated w/ Trisomy 21?

A

endocardial cushion defects –> ASD, VSD

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75
Q

What heart defects are associated w/ Congenital Rubella?

A

PDA, Pulmonic stenosis

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76
Q

Total Anomalous Pulmonary Venous Return

A

pulmonary v. empties into systemic circulation (closed-loop, must have shunt)

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77
Q

What heart defects are associated w/ Maternal Lithium use?

A

Ebstein Anomaly

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78
Q

What heart defects are associated w/ Maternal EtOH use?

A

Tof, VSD, ASD, PDA

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79
Q

What heart defects are associated w/ Maternal Diabetes?

A

Transposition of the great vessels?

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80
Q

What will increase preload?

A

exercise, transfusions, pregnancy

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81
Q

What will decrease preload?

A

venodilators (nitroglycerin), ACE-I, ARB

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82
Q

What will increase afterload?

A

HTN

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83
Q

What will decrease afterload?

A

vasodilators (Hydralazine), ACE-I, ARB

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84
Q

What will increase contractility?

A

Digitalis, catecholamines, high [Ca2+]ic, low [Na+]ec

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85
Q

What will decrease contractility?

A

b1-blocker, heart failure (loss of myocardium, dilated cardiomyopathy), acidosis, hypoxia/hypercapnea, non-dihydropyridine CCB

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86
Q

Myocardial O2 demand increases w/?

A

high afterload, high contractility, high HR, high ventricular diameter

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87
Q

Myocardial O2 demand decreases w/?

A

decreased afterload, decreased contractility, decreased HR

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88
Q

Pulmonary capillary wedge pressure ~?

A

LA pressure

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89
Q

RSHF S/S

A 
peripheral edema (pedal & pre-sacral edema)
JVD, Hepatic congestion (nutmeg liver)
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90
Q

LSHF S/S

A

pulmonary congestion, cardiac dilation, pulmonary edema (paroxysmal nocturnal dyspnea, orthopnea)

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91
Q

JG cells sense

A

low BP —> Renin release

92
Q

Macula densa sense

A

low Na+ —> Renin release

93
Q

BNP is released by

A

cardiac cells in response to ventricular stretch

94
Q

BNP causes

A

vasodilation & increased excretion of Na/H2O in urine to decrease preload

95
Q

Angiotensin II’s 2 roles

A

vasoconstriction & stimulate Aldosterone secretion

96
Q

5 Phases of LV physiology

A
  1. Isovolumetric contraction
  2. Systolic ejection
  3. Isovolumetric relaxation
  4. Rapid Filling
  5. Reduced Filling
97
Q

Normal splitting of S2 occurs in

A

inspiration (low intrathoracic P

98
Q

S1

A

Mitral & Tricuspid closure; loudest at mitral post

99
Q

S2

A

Aortic & Pulmonic closure; loudest at pulmonic post

100
Q

S3

A

early diastole - high filling P

101
Q

Conditions associated w/ S3

A

Pregnancy, children - physiologic

Mitral regurgitation, CHF, dilated ventricles, dilated cardiomyopathy, L->R shunt (ASD, VSD, PDA)

102
Q

S4

A

late diastole - high atrial pressure

103
Q

Conditions associated w/ S4

A

LV hypertrophy, chronic HTN, aortic stenosis, hypertrophic cardiomyopathy, post-MI

104
Q

Resistance to flow is proportional to viscosity, factors that increase viscosity:

A

polycythemia, hyperproteinemic state (multiple myeloma), Hereditary spherocytosis

105
Q

Resistance to flow is proportional to viscosity, factors that decrease viscosity:

A

anemia

106
Q

Wide Splitting

A

delayed RV emptying - pulmonic stenosis, RBBB

107
Q

Fixed Splitting

A

L->R shunt - seen in ASD

108
Q

Paradoxical Splitting

A

delayed LV emptying - reverses order of closure = Pulmonic closes before delayed Aortic - aortic stenosis, LBBB (paradoxically eliminating the split on inspiration)

109
Q

Treatment for chronic CHF to reduce mortality?

A

ACE-I, ARB, Aldosterone Antagonist, certain b-Blockers

110
Q

Treatment for chronic CHF to provide symptomatic relief?

A

Diuretics, Digoxin, Vasodilators

111
Q

Acute HF treatment

A

Loop Diuretics, Nitrates, Oxygen (if hypoxic), intropes (Dobutamine), Positiong (sit up)

112
Q

Digoxin uses

A

CHF (occasionally for Afib)

113
Q

Digoxin S/E

A

yellow, blurry vision, cholinergic effects, bradycardia, hypokalemia, renal failure

114
Q

Tx of Digoxin OD

A

Anti-Dig Fragment, correct hypokalemia, Magnesium, Atropine

115
Q

Factors that increase Pc

A

CHF, venous thrombosis, compression of vv., Na+/H2O retention

116
Q

Factors that increase Kf

A

Septic Shock (d/t bradykinin, histamine), Toxins, Burns

117
Q

Factors that increase interstitial colloid pressure

A

lymphatic obstruction (tumor, inflammation, surgery radiation)

118
Q

Factors that decrease plasma colloid pressure

A

Liver disease, Protein malnutrition, Nephrotic Syndrome, Protein-losing Enteropathy

119
Q

Pitting Edema

A

Excess fluid w/o additional colloid (transudate)

120
Q

Non-pitting Edema

A

Excess fluid + colloid (exudate)

121
Q

Hypovolemic Shock

A

decreased CO –> increased systemic vascular resistance

122
Q

Tx for Hypovolemic Shock

A

IV fluids +/- Blood

123
Q

Cardiogenic Shock

A

decreased CO –> increased systemic vascular resistance

124
Q

Tx for Cardiogenic Shock

A

Dobutamine (increase CO)

125
Q

Sepsis/Anaphylaxis Shock

A

decreased systemic vascular resistance (d/t vasodilation) –> increased CO (compensatory tachycardia)

126
Q

Tx for Sepsis/Anaphylaxis Shock

A

Antibiotics + NE + IV fluids

127
Q

Neurogenic Shock

A

Low CO & Low systemic vascular resistance

128
Q

Tx for Neurogenic Shock

A

IV fluids, (spinal cord injury -> steroids)

129
Q

Femoral Central Line Pros/Cons

A

easiest site; can only stay in 5-7d d/t infection rate

130
Q

Subclavian Central Line Pros/Cons

A

can stay in 3-4wks; high risk of pneumothorax (not good for COPD or lung tumor pts)

131
Q

Internal Jugular Central Line Pros/Cons

A

can stay in 3-4wks; may cause pneumothorax, discomfort

132
Q

Swan-Ganz Catheter insertion sites

A

right IJ > Left SC > Right SC > Left IJ

133
Q

Skin of a cardiogenic shock pt?

A

cool, clammy (low-output shock) vasoconstriction

134
Q

Skin of a septic shock pt?

A

warm, moist (high-output shock)

vasodilation

135
Q

Causes of cardiogenic shock

A

MI, PE, cardiac tamponade, tension pneumothorax, CHF, arrhythmias, cardiac contusion

136
Q

How does heart failure impact the Starling Forces?

A

increases Pc

137
Q

How does liver failure impact the Starling Forces?

A

decreases plasma colloid pressure

138
Q

How does oliguric renal failure impact the Starling Forces?

A

increases Pc

139
Q

How does infections&toxins impact the Starling Forces?

A

increases Kf

140
Q

How does Nephrotic Syndrome impact the Starling Forces?

A

decreases plasma colloid pressure

141
Q

How does Lymph blockage impact the Starling Forces?

A

increases the interstitial colloid pressure

142
Q

How do burns impact the Starling Forces?

A

increases Kf

143
Q

How does diuretic administration impact the Starling Forces?

A

decreases Pc

144
Q

How does IV infusion of albumin impact the Starling Forces?

A

increases plasma colloid pressure

145
Q

How does venous insufficiency impact the Starling Forces?

A

increases Pc

146
Q

Increased pulse pressure is seen w/ what conditions?

A

Hyperthyroidism, aortic regurgitation, arteriosclerosis, obstructive sleep apnea, exercise, increased sympathetic tone

147
Q

Decreased pulse pressure is seen w/ what conditions?

A

aortic stenosis, cardiogenic shock, cadiac tamponade, & advanced HF

148
Q

What are the diastolic murmurs?

A

MS/TS, AR/PR

149
Q

What murmurs are heard best in Left Lateral Decubitus?

A

MS, MR, Left-sided S3 & S4

150
Q

Inspiration will increase the intensity of which murmurs

A

Right-sided (tricuspid)

151
Q

Hand grip will increase the intensity of which murmurs

A

AR, MR, VSD

152
Q

Exhalation or Rapid Squatting will increase the intensity of which murmurs

A

Mitral murmurs

153
Q

Hand grip will decrease the intensity of which murmurs

A

AS, hypertrophic cardiomyopathy

154
Q

Valsalva will increase the intensity of which murmurs

A

hypertrophic cardiomyopathy murmur

155
Q

High-pitched “blowing” early diastolic decrescendo murmur

A

Aortic regurgitation

156
Q

Aortic regurgitation S/S

A

wide pulse pressure -> bounding peripheral pulses, head bobbing

157
Q

Aortic regurgitation causes

A

aortic root dilation (syphilis, Marfans)

Bicuspid aortic valve, Rheumatic fever

158
Q

Aortic regurgitation heard loudest at

A

Left sternal border

159
Q

Opening snap + delayed rumbling late diastolic murmur

A

Mitral stenosis

160
Q

Mitral stenosis causes

A

Rheumatic Fever

161
Q

Mitral stenosis is heard loudest at

A

mitral post in Left Lateral Decubitus position

162
Q

Mitral stenosis is enhanced by

A

Exhalation

163
Q

Aortic regurgitation is enhanced by

A

Hand grip

164
Q

Continuous, machine-like murmur, loudest at S2

A

PDA

165
Q

PDA causes

A

Congenital Rubella

166
Q

PDA is heard loudest at

A

left infraclavicular area

167
Q

Isometric contraction occurs

A

after mitral valve closes

before aortic valve opens

168
Q

Isometric relaxation occurs

A

after aortic valve closes

before mitral valve opens

169
Q

How does a high afterload change the pressure-volume loop?

A

“A” - high afterload –> high aortic pressure –> large ventricular contraction to cause aortic valve opening –> less contraction available for ejection –> low SV (high ESV)

170
Q

How does high contractility change the pressure-volume loop?

A

“C” - shifted Left bc high contractility increases the SV and EF leaving little blood left in the ventricles (low ESV)

171
Q

How does high preload change the pressure-volume loop?

A

“P” - high preload –> increased EDV –> increased SV

172
Q

Jugular venous pulse - a wave

A

atrial contraction

173
Q

Jugular venous pulse - c wave

A

RV contraction (closed tricuspid bulges into RA - isometric contraction)

174
Q

Jugular venous pulse - v wave

A

increased RA pressure d/t filling against a closed tricuspid valve

175
Q

Where does QRS fall in relation to valvular dynamics?

A

after mitral valve closure & before aortic valve opening

176
Q

Benign extra heart sounds if no pathology is present?

A

Split S1, Split S2 during inspiration, S3 in pt <40yo, early, quiet systolic murmur

177
Q

Crescendo-decrescendo, systolic murmur w/ ejection click

A

Aortic Valvular Stenosis

178
Q

Aortic Valvular Stenosis S/S

A

Weak & delayed pulses, syncope, angina, dyspnea

179
Q

Aortic Valvular Stenosis is heard loudest over

A

aortic post radiating to the carotids

180
Q

Aortic Valvular Stenosis Causes

A 
Bicuspid Aortic Valve (~40yo)
Senile (degenerative) Calcification (~60yo)
Rheumatic Fever
Unicuspid Aortic Valve
Syphilis
181
Q

Holosystolic, high-pitched “blowing” murmur at apex radiating to L axilla

A

Mitral Regurgitation

182
Q

Mitral Regurgitation is heard loudest over

A

Mitral area in Left Lateral Decubitus, radiating to the L axilla

183
Q

Mitral Regurgitation is enhanced by

A

hand-grip, squatting

184
Q

Mitral Regurgitation causes

A

Rheumatic Heart Ds, Endocarditis, Ischemic Heart Ds, Left Ventricular Dilation, MVP

185
Q

Late systolic murmur usually preceded by a mid-systolic click

A

MVP

186
Q

MVP mid-systolic click is d/t

A

sudden tensing of the chordae tendineae

187
Q

Valsalva changes MVP by

A

causing an earlier mid-systolic click, but decreases its intensity

188
Q

Holosystolic murmur best heard along the L lower sternal border

A

Tricuspid Regurgitation or VSD

189
Q

Tricuspid Regurgitation Causes

A

Rheumatic Fever, Endocarditis (IVDU!)

190
Q

Holosystolic, harsh-sounding murmur in newborns

A

VSD

191
Q

Juxtaglomerular apparatus

A

sense low BP & secretes renin

192
Q

The stimulus for renin release is the juxtaglomerular apparatus (JGA) perception of

A

Decreased renal blood pressure
Decreased NaCl delivery to distal tubule sensed by the macula densa*
Increased sympathetic tone

193
Q

Aortic arch baroreceptor senses

A

high BP; high BP -> increased firing -> increased efferent PNS -> decrease in HR

194
Q

Aortic arch baroreceptor sends a signal

A

to the medulla via CN10

195
Q

Carotid sinus baroreceptor senses

A

high or low BP

196
Q

Carotid sinus baroreceptor sends a signal

A

to the solitary nucleus of the medulla via CN9

197
Q

Supraventricular tachycardia could potentially be treated by

A

carotid massage -> tricks body into believing there is high BP –> reflex bradycardia

198
Q

Cushings reflex

A

high ICP -> cerebral vasoconstriction -> ischemia
high ICP -> high systemic BP -> reflex bradycardia & respiratory depression
TRIAD: high BP, low HR, & low RR

199
Q

Central chemoreceptor

A

in medulla, sense change in CSF CO2 & pH

200
Q

Peripheral chemoreceptor

A

aortic arch & carotid body sense hypoxia, hypercapnia, acidosis

201
Q

What substances act on the SM myosin light-chain kinase?

A 
Dihydropyridine CCB (inhibits Ca from binding calmodulin to prevent kinase activity)
Epinephrine &amp; Prostaglandins (increase cAMP, inhibits kinase)
202
Q

HTN

A

> 140/90 on 3 separate readings

203
Q

Essential HTN

A

no other secondary cause, 90% of cases

204
Q

HTN causes LVH d/t

A

high BP -> high afterload -> increased mm. thickness, stiffness, and decreased compliance

205
Q

What heart sounds is associated w/ stiffened LVH

A

S4

206
Q

Aortic dissection

A

tear in the intima -> creating a false lumen w/in the media

207
Q

Aortic dissection Sx

A

tearing cheat pain radiating to the back + widened medistinum

208
Q

Aortic dissection type A

A

involves the aortic arch or ascending aorta

209
Q

Aortic dissection type B

A

does not involve the ascending aorta, involves descending

210
Q

Which type of Aortic dissection requires emergency surgery?

A

Type A

211
Q

Tx for Aortic dissection

A

b-blockers!

212
Q

HTN + paroxysms of anxiety, palpitations, diaphoresis

A

pheochromocytoma

213
Q

HTN + onset b/w 20-50

A

Essential HTN

214
Q

HTN + abd bruit

A

renal a. stenosis

215
Q

HTN + BP in arms > legs

A

coarctation of the aorta

216
Q

HTN + tachycardia, heat intolerance, diarrhea

A

hyperthyroidism

217
Q

HTN + Hyperkalemia

A

renal insufficiency

218
Q

HTN + Hypokalemia

A

Renal a. stenosis (hyperaldosteronism)

219
Q

HTN + central obesity, moon-shaped facies, hirsutism

A

hypothyroidism

220
Q

HTN + young adult w/ acute onset tachycardia

A

amphetamine use

221
Q

HTN + proteinuria

A

kidney ds

222
Q

Cardiac enzyme most often used to Dx MI?

A

Troponin I (4hrs - 2wks) > CK-MB

223
Q

chest pain, pericardial friction rub, fever several weeks after a MI

A

Dressler Syndrome (>2 weeks after MI)

224
Q

What coronary a. is most often occluded in a MI?

A

LAD

225
Q

Most common lethal complication after a MI?

A

arrhythmia

DIT (22 decks)

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