Cardio Flashcards
____ is the most posterior part of the heart
LA is the most posterior part of the heart
Enlargement of the LA (e.g, in mitral stenosis) can lead to compression of the ___________ or ___________.
Enlargement of the LA (e.g, in mitral stenosis) can lead to compression of the esophagus (dysphasia) or left recurrent laryngeal nerve (causing hoarseness/Ortner syndrome)
_____ is the most anterior part of the heart, most commonly injured in trauma
RV is the most anterior part of the heart, most commonly injured in trauma
Pericardium layers (out to inner)
Fibrous pericardium
Parietal layer of serous membrane
(Pericardial cavity)
Visceral layer of serous membrane
The pericardium is innervated by the
Phrenic nerve
____ and its branches supply anterior 2/3 of IVS, anterolateral papillary muscle, and anterior surface of LV.
LAD
____ supplies AV node, posterior 1/3 of IVS and posterior 2/3 walls of ventricles
PDA
_____ supplies SA node
RCA
Coronary blood flow peaks in (early/late) (systole/diastole)
Early diastole
LCA branches and what they supply
LAD - Supplies anterior 2/3 of IVS, anterior surface of LV
LCX - Supplies LA and posterior walls of LV
RCA branches and what they supply
Right Marginal Artery - RV
PDA - Posterior 1/3 IVS, posterior 2/3 ventricular walls
Most common origin of PDA
RCA - Right-dominant circulation
Coronary arteries are in what layer of the heart wall
Epicardium
Nitroglycerine (increases/decreases) preload
Decreases
Preload approximated by ____
Ventricular EDV
After load approximated by _____
MAP
SV = EDV - ?
SV = EDV - ESV
CO = ? x ?
CO = SV x HR
In early stages of exercise, CO maintained by increased ____ and ______
HR and SV
In later stages, CO maintained by increased _____ only
HR
MAP = CO x ?
TPR
What is one part of the heart with no contractile muscle filaments?
SA Node
What is the pacemaker of the heart?
SA Node
Why does the AV node delay the conduction signal from atria and ventricles?
To allow time for atria to empty blood into the ventricles prior to contraction.
How does the AV node delay the conduction signal from atria and ventricles?
Fewer gap junctions between cells in AV node and bundle.
If the pacemaker is located anywhere other than the SA node, it is called an
Ectopic pacemaker
ACh increases permeability of membrane to ___ ions > increases membrane negativity > hyperpolarization (less excitable tissue) > slowed HR
K
What is the P wave
Atrial contraction / Depolarization of atria
What is the QRS complex
Ventricular contraction / Depolarization of ventricle
What is the T wave
Ventricular repolarization
What is the most common cardiac congenital defect?
Interventricular septal defect
SXS: Holosystolic murmur or CHF, increase risk of endocarditis
What 4 abnormalities form the Tetralogy of Fallot?
VSD
Aorta overriding the VSD
Pulmonic stenosis
RVH
What condition may a bicuspid aortic valve lead to later in life?
Aortic stenosis
What is the S1 sound
Closure of tri/mi valves
What is the S2 sound?
Closure of aortic/pulmonic valves
S1 to S2 =
Systole
S2 to S1 =
Diastole
RCA + LCA fill during (systole/diastole)
Diastole
Which is larger, R or L coronary artery?
What part of the heart do they feed?
R is larger - Supplies R and posterior L ventricles
L carries less blood, but divides and feeds the anterior and lateral portions of the L ventricle
What conditions are caused by Subendocardial ischemia? Subendocardial nfarction?
Ischemia - Stable and unstable angina
Infarction - NSTEMI
(ST depression and T wave inversion)
What conditions are caused by transmural ischemia? Transmural infarction?
Ischemia: Vasospastic angina
Infarction: STEMI
(ST elevation, hyper acute T waves, pathologic Q waves)
LA blood supply comes from
Pulmonary veins
RA blood supply comes from
SVC, IVC, coronary sinus
Largest decrease in pressure occurs at these vessels
Arterials
Binding sites:
LDL
HDL
Chylomicron
LDL - B100
HDL - A1
Chylomicron - E
(Heme/Non-heme) iron requires transferrin
Non-heme iron
What are the functions of:
Ferritin
Transferrin
Lactoferrin
Ferritin - Can enter plasma
Transferrin - Plasma binding protein
Lactoferrin - Sequestering agents in blood, used when infection is active to keep iron from bacteria
Effects of excess calcium on the heart
Spastic contractions
Effects of excess potassium (K) on the heart
Dilated and slower contractions
What virulent organism is known for infecting structurally abnormal heart valves?
Strep Viridans
Oval retinal microhemorrhages with a pale center (seen in bacterial endocarditis) are known as _____
Roth spots
What nerve is responsible for slowing the heart’s conduction rate?
Vagus nerve
The foramen ovale is found where in a fetus?
Between RA and LA
Which of the following factors would shift the hemoglobin oxygen saturation curve to the right?
- Hypothermia
- Exercise
- Decreased 2,3-bisphosphoglycerate
- Higher pH
Exercise
What would you hear during auscultation of tetralogy of fallot?
Pulmonary stenosis
(Midsystolic murmur at L upper sternal border
During fetal development, when does the foramen ovale close?
Immediately after birth
What directly originates from the aortic arch?
Brachiocephalic trunk
Left common carotid artery
Left subclavian artery
Middle cardiac vein branches into what?
Coronary sinus
Ventricular depolarization is seen as ______ on an ECG
QRS complex
Foramen ovale usually closes immediately after birth due to ______
Increased LA pressure
(T or F) Elastic arteries have a tunica intima, media, and externa, but NO internal elastic lamina
True
The ______ is the most posterior part of the heart. Enlargement can cause compression of the esophagus, causing dysphagia OR compression of the L laryngeal nerve causing Ortner Syndrome
LA
The _____ is the most anterior part of the heart, most commonly injured in trauma.
RV
The pericardium is innervated by the
Phrenic nerve
Which phase of the cardiac cycle?
P wave
QRS complex
QTI
T wave
U
P wave - Atrial depolarization
QRS complex - Ventricular depolarization
QTI - Ventricular depolarization/contraction/repolarization (long QTI = Torsades de Pointes)
T wave - Ventricular repolarization
U - Hypokalemia
Receptors in aortic arch transmit via ______ nerve > solitary nucleus in medulla in response to BP changes
Vagus nerve
Carotid sinus transmits via ________ nerve > solitary nucleus in medulla in response to BP changes
Glossopharyngeal nerve
Explain the functions of the chemoreceptors
Peripheral: ↓pO2 > Carotid and Aortic bodies > ↑pCO2 and ↓pH
Central: Changes in pH and pCO2 of CSF (don’t directly respond to pCO2)
What organ gets the largest amount of blood flow?
What organ gets the highest amount of tissue perfusion?
Liver
Kidneys
Diastolic BP is highest in the (vessel)
Aorta
HTN due to renal disease is associated with increased sympathetic activity and overstimulation of the ________ system
Renin-angiotensin-aldosterone
______ is the most important risk factor for stroke
HTN
A diastolic BP of _____ is diagnostic of HTN
> 80mmHg
The ductus arteriosus connects the ______ to the ______
Pulmonary artery to the proximal descending aorta
Why does edema develop in pts with CHF?
- Increased aldosterone thus increased sodium and water retention.
- Reduced cardiac output triggers renal responses to try and compensate and maintain adequate blood flow.
Common cause of viral cardiomyopathy that could result in CHF
Coxsackievirus
Right sided HF sxs
Dependent edema
JVD
Hepatosplenomegaly
What are risk factors for abdominal aortic aneurysm?
History of smoking, marfan syndrome, FHx
Which of the following is NOT a branch of the abdominal aorta?
a. Inferior epigastric artery
b. Superior mesenteric artery
c. Left renal artery
d. Celiac artery
a. Inferior epigastric artery
Which portion of the primitive cardiac tube generates the ascending aorta?
Truncus arteriosus
What layers of the blood vessel are involved in aortic dissection?
Tunica media, intimia, and adventitia
In the synthesis of cholesterol, what is the key regulating enzyme?
HMG-CoA reductase
The membranous interventricular septum is normally formed by the ____
Endocardial cushions
After birth, the umbilical vein becomes the ______
Ligamentum teres
Umbilical arteries carry (oxygenated/deoxygenated) blood
Deoxygenated
Cardiac muscle is striated. Describe the I bands and A bands
I - no thick filaments
A bands - single thick filament
What type of vein can form a venous plexus?
Venules
(T or F) The pulmonary veins are valveless
True
What conditions are Right-to-Left shunts?
Truncus arteriosus
Transposition of great vessels
Tetralogy of Fallot
What is Cor Pulmonale
Isolated right HF due to pulmonary cause
Stable and Unstable angina show up on an EKG as ST (elevation/depression)
ST Depression
STEMI shows up on an EKG as ST (elevation/depression)
ST Elevation
NSTEMI shows up on EKG as ST (elevation/depression)
ST Depression
Aortic Stenosis is a (systolic/diastolic) murmur, where as Aortic Regurgitation is a (systolic/diastolic) murmur
Aortic Stenosis - Systolic (ASS)
Aortic Regurgitation - Diastolic (DAR)
What are some etiologies of Mitral Regurgitation?
Rheumatic fever, infective endocarditis
What murmur has a MSC (mid systolic click)
Mitral Valve Prolapse
Which murmurs are due to pressure overload?
Aortic stenosis, mitral stenosis
Which murmurs are due to volume overload?
Mitral valve prolapse, aortic regurgitation
What is the most common valve disease?
Mitral valve prolapse
What can cause mitral stenosis?
Rheumatic heart disease
Rheumatic heart disease, caused by group A strep, is a immune mediated type __ hypersensitivity
2
What cells are associated with rheumatic heart disease?
Aschoff bodies
What is the JONES criteria?
Dx Rheumatic Heart Disease:
Joint (migratory polyarthritis)
Carditis
Nodules in skin (subcutaneous)
Erythema marginatum
Sydenham chorea
What is the most common cardiomyopathy?
Dilated
Systolic or Diastolic dysfunction?
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy
Systolic
Diastolic
Diastolic
HHV-6, CMV, lyme, lack of B1, post-partum, hypothyroid, chemo, alcohol are all causes of which cardiomyopathy?
Dilated Cardiomyopathy
What are the heart sounds for each?
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy
S3
S4
S3
Which cardiomyopathy causes sudden death in young athletes?
Hypertrophic (obstructive) cardiomyopathy
What is a major cause of SCD in adults > 40 YO
Myocarditis
What is cardiac tamponade
Compression of the heart by fluid, causes decreased CO
What are the EKG and CXR findings in pericardial effusions?
Alternans on EKG
Water bottle appearance on CXR
Pleuritic chest pain and friction rub can be a sign of what condition
Pericarditis
What is the most common cardiac congenital anomaly? (Hint: valves)
Bicuspid aortic valve
Patent ductus arteriosus (PDA) causes this type of murmur
Continuous machine-like murmur (loudest at S2)
What is the most common congenital defect?
Interventricular septal defects
Interventricular septal defects put pts at risk of what condition
Endocarditis
What is the most common cause of early childhood cyanosis?
TOF - Tetralogy of fallot
“Tet spells” occur in what condition?
Tetralogy of fallot - Often caused by crying, fever, exercise. Better with squatting.
RVH appears on a CXR as _____
Boot shaped heart
Name the 4 types of shock
- Hypovolemic Shock: Hemorrhage, dehydration, burns
- Cardiogenic Shock: Acute MI, HF, valvular dysfunction, arrhythmia
- Obstructive Shock: Cardiac tamponade, PE, tension pneumothorax
- Distributive Shock: Sepsis, anaphylaxis, CNS injury
Aneurysm vs dissection
Aneurysm - Localized pathologic dilation of vessel lumen
Dissection - Longitudinal intimal tear forming a false lumen (double barrel shape)
Arteriosclerosis vs atherosclerosis
Arteriosclerosis: Thickening and loss of elasticity of arterial walls
Atherosclerosis: Intimal thickening and lipid deposition
(T or F) Arteriosclerosis of the coronary artery (CAD) is the #1 killer of M + F in the US
False - Atherosclerosis
Familial hypercholesterolemia is (AD/AR), and is due to absent or defective LDL receptors, or defective ApoB-100
AD
Familial hypercholesterolemia cholesterol levels:
Heterozygotes:
Homozygotes:
Heterozygotes: ~300 mg/dL
Homozygotes: (Rare) >700 mg/dL
Giant Cell Arteritis (Temporal arteritis) causes elevated IL-?
IL-6
40-50% of pts with Giant Cell Arteritis also have this condition
Polymyalgia rheumatica
Giant Cell Arteritis can lead to ______
Blindness (ophthalmic artery occlusion)
Peripheral Arterial Disease can lead to these sxs
Claudication (muscle pain lower limb)
Atypical leg pain
Arterial ulcers
Peripheral Arterial Disease is screened with these diagnostic tests (2)
Buerger test, and ankle brachial index
Inherited thrombophilia can cause a pulmonary embolism, and is caused by these mutations/deficiencies (3)
Factor V Leiden mutation
Protein C deficiency
Protein S deficiency
What is the diagnostic criteria for PEs
Well’s Criteria for PE
DVT diagnostic criteria
Leg swelling, pain, warmth, redness
Unilateral pitting edema in leg
D-dimer: Rule OUT DVT
Well’s Criteria for DVT
Hemangiomas are vascular birthmarks made of extra blood vessels in the skin, and are (benign/malignant)
Benign
What causes Kaposi Sarcoma
HHV-8, HIV
Complications of Kaposi Sarcoma
Pericardial effusion
Cardiac tamponade
What valve is most often affected by bacterial endocarditis
Mitral (or tricuspid with IV drug use)
Acute bacterial endocarditis is caused by this bacteria
Staph aureus (high virulence), large vegetations on normal valves, rapid onset, RARE.
Subacute bacterial endocarditis is caused by this bacteria
Strep viridans (low virulence), small vegetations on abnormal or diseased valves. Sequelae of dental procedures.
Bacterial endocarditis characteristics and diagnostic criteria
FROM JANE
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail-bed hemorrhage
Emboli
Modified Duke Criteria
Chagas disease is the leading cause of ____ worldwide, and is caused by Trypanosoma cruzi
Infectious myocarditis
Lyme disease can lead to these cardiac conditions
AV-block
Carditis
AV-block
Carditis
Vasculitis
Dengue fever can lead to these cardiovascular conditions
Hypotension, pleural effusions, bradycardia
Viral myocarditis can lead to arrhythmias, HF, and sudden death. It is caused by these viruses
Adenovirus, coxsackie B, parvovirus B19, HIV, HHV-6
Afib on EKG
No discrete P waves
No discrete P waves
Sawtooth
Beck triad is made up of what 3 sxs, and is a sign of what cardiac condition?
Cardiac tamponade
1. Hypotension
2. Distended neck veins
3. Distant heart sounds
