Cardiac Flashcards
holosystolic murmur loudest over L mid-sternal border
VSD
Fixed, wide splitting of S2
ASD
Note: Tetralogy of Fallot is the most common cyanotic heart lesion on tests and in real life. ASDs–fixed split S2–are left-to-right (non-cyanotic lesions), at least until they reverse down the line (Eisenmenger syndrome).
mucosal cyanosis and fingernail clubbing
tetralogy of fallot, late features of ASD or VSD
precordial continuous, machine-like murmur in systole and diastole
PDA
bifid carotid pulse with brisk upstroke
hypertrophic obstructive cardiomyopathy
murmur increases with inspiration. best heard at L 3rd and 4th intercostal spaces
tricuspid regurg
best heard at apex and radiates to axilla
mitral regurg
opening snap and low-pitched diastolic rumbling
mitral stenosis
right sided valvular fibrous plaques are pathognomonic for what?
Carcinoid syndrome
dx- elevated 5-HIAA
Young athlete with sudden cardiac death has what? How does the heart appear on autopsy?
Hypertrophic cardiomyopathy (HCM) massive myocyte hypertrophy and myofiber disarray
Progressive onset of HF after recent viral infx indicates what? What happens to contractility (systolic function)
dilated cardiomyopathy.
Decreases - dec ventricular contraction force
B1 selective antagonists act on what? B2 selective antagonsits act on what?
1 - predominate in heart (drugs starting with A-M)
2 - predominate in lungs (drugs starting with N-Z)
What’s Beck’s triad and what is it a sign of?
- dec arterial P
- Inc systemic venous P
- small, quiet heart
= cardiac tamponade
Dec of >10mmHg in systolic pressure w/inspiration
Pulsus paradoxus. Sign of cardiac tamponade or constrictive pericarditis
Inc in systemic venous pressure on inspiration
Kussmaul sign
sign of pericarditis
S3 (ventricular gallop after S2) indicates what?
Ventricular enlargement (MR, AR, HF, dilated or ischemic cardiomyopathy). Best heard in L lateral decubitus at the apex and at end of expiration. Note: normal in YOUNG adults, kids, pregnancy
S4 (diastolic sound immediately preceding S1) indicates what?
decreased ventricular COMPLIANCE (AS, HCM, restrictive cardiomyopathy, Hypertensive HD) - inc stiffness
Due to sudden rise of end diastolic pressure
Note: normal in healthy OLDER adults
Path of electrical conduction through the heart
SA –> atria –> AV –> purkinje –> ventricles
Fastest to slowest areas of electrical conduction in the heart
Purkinje –> atrial mm –> ventricular mm –> AV node
park at venture ave
Head bobbing is a sign of what?
Aortic regurg
Inc LV end diastolic vol –> eccentric hypertrophy. Worse on left lateral decubitus.
Inc SV, wide pulse pressure
Recurrent temporary arrhythmias, due to accessory conduction pathway (Eg bundle of Kent) - AV re-entry circuit involving AV node and accessory pathway.
WPW
shortened PR interval, Delta wave, widened QRS
What endogenous factor is the most important mediator of coronary vascular dilation in large arteries and pre-arteriolar vessels?
Nitric oxide - synth from arginine and o2 by endothelial cells –> vasc smooth mm relaxation by guanylate cyclase-med cGMP
Adenosine (product of ATP metabolism) does what to small coronary arterioles?
vasoDILATES
o2 extraction from what part of the body exceeds that of any other tissue or organ in the body?
Myocardium. Coronary venous blood drains into RA via coronary sinus