Cardio Flashcards
Truncus arteriosus (TA)
Ascending aorta and pulmonary trunk
Bulbus cordis
Smooth parts (outflow tract) of left and right ventricles
Primitive atria
Trabeculated part of left and right atria
Primitive ventricle
Trabeculated part of left and right ventricles
Primitive pulmonary vein
Smooth part of left atrium
Left horn of sinus venosus (SV)
Coronary sinus
Right horn of SV
Smooth part of right atrium
Right common cardinal vein and right anterior cardinal vein
SVC
Aortic area murmurs
Systolic murmur =>
Aortic stenosis
Flow murmur
Aortic valve sclerosis
Left sternal border murmurs:
Diastolic murmur=>
Aortic regurgitation
Pulmonic regurgitation
Systolic murmur =>
Hypertrophic cardiomyopathy
Pulmonic area murmurs
Systolic ejection murmur =>
Pulmonic stenosis
Flow murmur (e.g., physiologic murmur)
Tricuspid area murmurs
Pansystolic murmur=>
Tricuspid regurgitation
Ventricular septal defect
Diastolic murmur =>
Tricuspid stenosis
Atrial septal defect
Mitral area murmurs
Systolic murmur =>
Mitral regurgitation
Diastolic murmur =>
Mitral stenosis
BEDSIDE MANEUVER Inspiration
increase intensity of right heart sounds
BEDSIDE MANEUVER Hand grip (increase systemic vascular resistance)
Increase intensity of MR, AR, VSD murmurs
decrease intensity of AS, hypertrophic cardiomyopathy murmurs
MVP: increase murmur intensity, later onset of click/murmur
BEDSIDE MANEUVER Valsalva (phase II), standing (decrease venous return)
decrease intensity of most murmurs (including AS)
increase intensity of hypertrophic cardiomyopathy murmur
MVP: decrease murmur intensity, earlier onset of click/murmur
BEDSIDE MANEUVER Rapid squatting (Increase venous return,increase preload, increase afterload with prolonged squatting)
decrease intensity of hypertrophic cardiomyopathy murmur
increase intensity of AS murmur
MVP: increase murmur intensity, later onset of click/murmur
Name the systolic heart sounds
aortic/pulmonic stenosis,
mitral/tricuspid regurgitation,
ventricular septal defect.
Name the diastolic heart sounds
aortic/pulmonic regurgitation,
mitral/tricuspid stenosis.
ECG P wave
atrial depolarization
Atrial repolarization is masked by QRS complex
ECG PR interval
conduction delay through AV node (normally < 200 msec).
ECG QRS complex
ventricular depolarization (normally < 120 msec).
ECG QT interval
mechanical contraction of the ventricles.
ECG T wave
ventricular repolarization.
T-wave inversion may indicate recent MI.
ECG ST segment
isoelectric, ventricles depolarized.
ECG U wave
caused by hypokalemia, bradycardia
Give the speed of conduction in heart
Purkinje > atria > ventricles > AV node.
Give pacemakers of heart
SA > AV > bundle of His/ Purkinje/ventricles.
What Rx prolong the QT interval?
Sotalol Risperidone (antipsychotics) Macrolides Chloroquine Protease inhibitors (-navir) Quinidine (class Ia; also class III) Thiazides
RV MI => name area, coronary artery & ECG leads
inferior wall (RV);
RCA
II, III, aVF
Septum MI => name coronary artery & ECG leads
LAD for anterior 2/3 of septum; RCA for posterior 1/3;
V2, V3
LV MI => name area, coronary artery & ECG leads
lateral wall of LV;
left circumflex artery;
I, aVL, V5, V6
Aortic stenosis murmur => location & sound
Left 2nd ICS radiating toward carotid or cardiac apex;
crescendo-decrescendo systolic ejection murmur
Mitral regurg murmur => location & sound
cardiac apex (confused w/ TR); holosystolic blowing murmur => louder on inspiration;
Define sarcomere. What is it composed of?
Z line to Z line (Z line=middle dark line bw light areas);
composed of thick filament (myosin) & thin filaments (actin, troponin, tropomyosin)
Role of T tubule
carry AP into cell interior
Location & role of intercalated disks
ends of cells & mediate adhesion bw cells
Location & role of gap junctions
occur at intercalated disks;
provide path of low resistance for AP to rapidly spread
What happens in S1 heart sound?
MV & tricuspid valve close => MV closes before so can be split
What happens in S2 heart sound?
AV & PV close => AV closes first;
inspiration causes increase S2 split
What happens in S3 heart sound? What does it mean?
at end of rapid ventricular filling;
normal in kids & pregnant;
adults have dilated CHF
What happens in S4 heart sound? What does it mean?
Filling of ventricle by atrial systole;
not normally audible in adults;
signifies high atrial pressure or stiff ventricle
What physical exam will identify RHF?
JVD
Slope of Y descent decreases when? increases when?
decreases in tamponade => RA empties slower
increases in constrictive pericarditis
What increases O2 consumption?
increases in after load, contractility, HR, size of heart
What increases Mean systemic pressure?
increased blood volume;
decreased venous compliance (blood shifted from veins to arteries);
exercise (SANS)
Name the 7 ways BP is regulated
Short term => baroreceptor reflex active & activity increases BP
Long term => RAAS;
Relative term => cerebral ischemia to hypercapnia, hypoxia w/ < PO2, severe volume depletion leading to ADH; ANP from atrial stretch; autoregulation
What is the highest resistance in the CV system? what are they responsible for?
arterioles => largest drop in perfusion pressure
What has the highest proportion of blood in CV?
veins
What has largest total cross sectional & surface area? What does it facilitate?
capillaries => gas exchange
What are the roles of histamine & bradykinin in vasculature?
mediate arteriolar dilation & venous constriction
What is role of serotonin in vasculature?
arteriolar constriction
Name the different roles of types of prostaglandins in vasculature
prostacyclin => vasodilator
TXA-2 => vasoconstrictor
What increases Hct to increase resistance of flow?
polycythemia;
hyperproteinemia (multiple myeloma);
hereditary spherocytosis
What increases turbulence (bruits)?
decreased blood viscosity (anemia);
increased blood velocity (narrow vessel, increased CO)
Edema caused by increase in capillary hydrostatic pressure?
increased venous pressure;
standing (edema in dependent limbs)
Edema caused by decreased in capillary oncotic pressure?
decrease in plasma protein 2' to: decreased synthesis (liver dz); decreased intake (protein malnutrition); increased excretion (nephrotic syndrome)
Edema caused by increasing the filtration coefficient?
burn;
inflammation (sepsis)
What typically causes a transudate?
increased capillary hydrostatic pressure or decreased capillary oncotic pressure
What typically causes an exudate?
more permeable vessels => increased filtration coefficient;
vessel becomes leaky & protein & fluid leave
What are the locations & corresponding leads…inferior? anterior?
inferior => II, III, aVF
anterior=> V1-V6
What does the PR interval depend on? tachycardia?
depends on conduction velocity through AV node & HR;
shortens
Differentiate Mobitz type I vs type II AV blocks
PR interval in type I lengthens until beat is dropped;
PR interval remains constant before dropped beat in type II
What is a mural thrombus? what is a risk factor for LA mural thrombus?
adheres to wall of heart or artery;
mitral stenosis is risk factor for LA mural thrombus
What is MCC of atrial fib in US?
HTN
What is the initial DOC for Tx of primary HTN?
thiazides
How do ACE-inhibitors lower mortality & morbidity in diabetic HTN?
decrease renal HTN by decreasing efferent arteriolar vasoconstriction to decrease intraglomerular pressure to lessen proteinuria
Define primary aldosteronism
HTN, hypokalemia, metabolic acidosis (increased aldosterone, decreased renin)
Medial calcification of radial, ulnar, tibial, uterine or femoral arteries have what Sx?
benign medial calcification of medium sized arteries does NOT INVOLVE the intima so does NOT obstruct arterial flow
Define arteriolosclerosis. When is it most often seen?
affects intima of small arterioles & arteries;
seen in elderly, diabetics, metabolic syndrome, HTN
Differentiate the 2 types of arteriolosclerosis
hyaline => protein deposits in arterial wall to narrow lumen => seen in diabetics due to NEG;
=>in HTN pt from pressure forcing proteins into wall causing increased muscle & elastic tissue
hyperplastic => malignant HTN => increased smooth muscle proliferation & BM duplication to onion skinning
Where are aneurysm’s typically found? why?
below level of renal arteries due to fewer vasa vasorum in the media of these vessels leading to increased risk & damage of ischemia
What is the MC etiology of myocarditis?
viral => coxsackie B, rubella, CMV => lymphocytic infiltrates
When is bacterial myocarditis seen? what are usual bugs?
immundodeficiency/suppression =>
S aureus; Corynebacterium diphtheriae, Haemophilus influenzae
Other than bacteria, pt w/ HIV get myocarditis how?
toxoplasmosis or Kaposi’s sarcoma
What are diseases & Rx that can cause myocarditis?
Chagas, Lyme, acute renal failure, rheumatic fever, lupus, doxorubicin
How does myocarditis present?
muffled S1; S3; MR murmur
diffuse T wave inversion & ST elevations => Bx is best Dx
Bacterial cause of endocarditis assoc w/ prosthetic device
Staph epidermis w/in first 6 months;
after 6 mo then S. aureus & viridans
Bacterial cause of endocarditis assoc w/ colon cancer
Strept bovis
Bacterial cause of endocarditis assoc w/ dental procedure
Stept viridans
Bacterial cause of endocarditis assoc w/ GI surgery
enterococcus
Bacterial cause of endocarditis assoc w/ total parenteral nutrition
fungal
Bacterial cause of endocarditis assoc w/ alcoholics or homeless
Bartonella henselae
Bacterial cause of endocarditis assoc w/ fastidious & culture negative
HACEK organisms => Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
Nutmeg liver on histology
congestion of centrilobular veins surrounded by paler region
What are the treatments for acute decompensated CHF?
LMNOP Lasix (furosemide); Morphine Nitrates; O2; Position upright
Murmur of MVP is seen in who? what makes it worse?
Marfan’s & young women; SLE; mucopolysaccharidoses (hurler & hunter); hypothyroidism; Ehlers-Danlos
Valsalva makes it worse
What does S3 in older adult mean?
occurs in early diastole & implies volume overload
What does TR murmur increase w/ inspiration?
blowing holosystolic murmur at L LSB due to increase in venous return to R side of heart
What are the ONLY 2 murmurs that do not increase intensity w/ squatting & decrease in intensity w/ valsalva?
MVP & hypertrophic cardiomyopathy
What types of patients are typically assoc w/ PDA? what is a common complication?
premature & congenital rubella;
endarteritis
Where do red (hemorrhagic) infarcts occur? pale infarcts
red infarcts => tissues w/ collateral circulation => lung, intestine, post-reperfusion
pale infarcts => solid tissue w/ single blood supply => brain, kidney, spleen
How does septic shock mimic artervenous fistula (high flow state)?
ALL arterioles are vasodilator leading to increased CO
What can LAD infarction cause?
LBBB, anterior wall rupture & mural thrombi
What can RCA infarction cause?
LV papillary rupture, posterior flail leaflet & MR
How does constrictive pericarditis present?
Kussmaul’s sign & pericardial knock
Compare platelet counts in Henoch Schonlein purpura & ITP
platelet counts normal to elevated in HSP;
decreased in ITP
Pt w/ Sx in multiple organ systems & palpable purpura, what should be highest on Ddx?
small vessel vasculitis
