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Cardio Flashcards

1
Q

Sinus venosus gives rise to?

A

Left horn = Coronary sinus

Right horn = smooth RA

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2
Q

What contributes to the septation of both atria and ventricles?

A

Endocardial cushion= NC origin

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3
Q

MC septal defect in children vs adults?

A

Children = VSD (Fetal alcohol, Tetralogy, Cri-du-chat)
Adults= ASD
occurrence: VSD > ASD > PDA

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4
Q

Fetal erythropoiesis timeline?

A

Yolk sac–> Liver–> spleen –> BM

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5
Q

CO in early vs late exercise?

A 
Early= inc CO = Inc HR X inc SV 
Late = Inc CO = inc HR x stable SV (plateau)
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6
Q

CO equations?

A 
CO= HR x SV
CO= O2 consumption/ (arterialO2- venousO2)
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7
Q

MAP calculation?

A 
MAP= CO x TPR 
MAP = 2/3 diastolic pressure + 1/3 systolic
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8
Q

Pulse pressure calculation?

A

PP = systolic pressure - diastolic pressure

** Proportional to SV

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9
Q

Increase in SV increases what?

A

Pulse pressure

**Aortic regurgitation= Inc SV = High PP

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10
Q

SV calculations?

A

SV = CO/HR = EDV-ESV

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11
Q

What are the determinants of Myocardial O2 demand?

A

Afterload
Preload= Heart size = Wall tension (hypertrophy)
HR
Contractility

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12
Q

How can you decrease Myocardial O2 demand?

A

Nitroglycerin = Dec Preload= Dec wall tension (inc BF)
ACEi/ Ca channel blockers = Dec Afterload
B-blockers= dec HR = GIVE after MI
Control HTN/ Aortic stenosis= dec Hypertrophy

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13
Q

EF calculation?

A

EF = (EDV- ESV) / EDV

**Normal EF = >55%

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14
Q

Equation for Resistance in SERIES?

A

R = Sum of all Rs

**Total should be Higher than individual

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15
Q

Equation for Resistance in Parallel?

A

1/Rt = 1/r + 1/r + 1/r

**Sum of all Should be lower than Individual Rs

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16
Q

Equation for Resistance?

A

R = Pressure/ Q (flow) = (viscosity x length)/ r>4

**R directly proportional to = Pressure/viscosity/length

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17
Q

What factors change change the mean systemic filling pressure (x intercept of CV function curve)?

A

Volume or Venous compliance

  • *Increase volume or Dec Compliance = Inc MSFP
  • *nitroglycerin inc Compliance = Dec MSFP
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18
Q

What factors affect venous return?

A

SVR –> Dec SVR= Inc VR

**Arterioles dilate= Inc BF to veins = Inc VR

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19
Q

S3 is associated with what?

A

Inc Filling pressure (Mitral regurg + CHF)

**Normal in Children or Pregnant women

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20
Q 
JVP graph: 
a wave =
c wave = 
x descent = 
v wave = 
y descent=
A 
a = Atrial contraction
c = RV Contraction
x = atrial relaXation 
v = Inc RA pressure due to filling
y = BF from RA -> RV
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21
Q

S1 & S2 splitting:
Wide=
Fixed=
Paradoxical=

A

Wide= Delay RV emptying (Pul stenosis, RBB block)
Fixed = ASD
Paradoxical = LV emptying delay (Aortic stenosis, LBB blck)
**Inspiration will fix Paradoxical due to late closure of Pulmonic valve due to Inc VR

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22
Q

Hand grip (Inc SVR) affects what murmurs and How?

A

Inc SVR= Inc intensity (MR, AR, VSD, MVP)
Inc SVR= dec intensity (AS, HCM)
**Makes sense= Inc SVR means LV SV will try and go somewhere other than Aorta (lower pressure)

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23
Q

Valsalva affects what murmurs and how?

A

Valsalva = Inc Thoracic pressure = Dec VR

Inc Intensity = MVP + HCM

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24
Q

Pt has a murmur that intensifies with Valsalva?

A

MVP

HCM

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25
Q

Rapid squatting affects what murmurs and how?

A

Rapid squatting = Inc VR/preload + prolonged (inc AL)

Dec = MVP + HCM

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26
Q

What kind of patients squat in order to improve circulation/ murmur?

A 
Tetralogy = Inc VR = Inc pressure in RV so less Left->R shunt through VSD
HCM= Inc VR dec the Aortic stenosis by Septum/ MV
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27
Q

In cardiac myocyte @ resting potential what Ion has Highest permeability?

A

K+

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28
Q

What Ion is responsible for Myocyte depolarization vs Pacemaker depolarization?

A 
Myocyte= Fast Na channels 
Pacemakers= Calcium channels
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29
Q

What are the phases of Cardiac myocyte APs?

A 
P0= Fast Na channels open = Depol 
P1= Na channels close/ K channels open
P2= Ca channel open Balance K efflux= Plateau/ contraction
P3= K channel all open / Ca channels close
P4= Resting K dominates
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30
Q

What happens to Cardiac nodal cells during diastole?

A

They depolarize via If “funny” Na channels

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31
Q

What are the phases of Cardiac Pacemaker action potentials?

A 
P0 = Ca channels open = Upstroke/ Depol 
P1/2= Absent 
P3= Ca channels inactive/ K channels open= Repol 
P4= Slow diastolic spontaneous depol via Na channels
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32
Q

What part of the Pacemaker action potential determines the HR?

A

Na channel / Phase 4 SLOPE

  • *Adenosine/Ach= Dec P4 slope= dec HR
  • *NE/E = Inc P4 slope = Inc HR
  • SNS increases Na channel opening = Inc HR
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33
Q 
Electrocardiogram:
QT interval= 
PR interval length= 
ST = 
U wave =
A 
QT = Mechanical contraction of ventricles
PR = <200msec = AV delay
ST = Isoelectric ventricle depol
U = Hypokalemia, bradycardia
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34
Q

What is the order of Speed of conduction?

A

Purkinji> atria > ventricles > AV

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35
Q

Pt with Congenital QT prolongation due to K+ channel defect is at risk for what?

A

Torsades

Congenital Sensorineural deafness

36
Q

What is the treatment of Torsades de pointes/ prolonged QT?

A

Mg sulfate

37
Q

Deficiencies in what electrolytes predispose to arrhythmias?

38
Q

AV block ECG findings:
1st degress
2nd: Mobitz type 1 vs. Type 2
3rd degree

A

1st ==> PR interval prolonged >200msec
Mobitz 1 = P wave not followed by QRS
Mobitz 2= Dropped beat (2P/ 1QRS)
3rd = atrial/ ventricular depol Independent P waves/ QRS no longer coordinate= LYME disease

39
Q

Functions of ANP?

A

Vascular relaxation
Dec Na reabsorption
Diuresis (cGMP mediated afferent dilation)

40
Q

Baroreceptor response to Dec BP?

A

dec stretch= Dec Afferent = Inc SNS

41
Q

Carotid massage causes?

A

In pressure = Inc Afferent = Dec HR

42
Q

What hemodynamic changes are seen with Inc ICP?

A

Cushing reaction ==> dec Cerebral BF
Inc SNS = Inc SVR = HTN
HTN= inc Baroreceptors = Vagus = BRADYCARDIA
Respiratory depression

43
Q

Pt with high pulse pressure, bradycardia, and respiratory depression?

A

Increased ICP = Cushing rxn

44
Q

Aortic arch vs Carotid sinus?

A 
Arch = Vagus = Only responds to HTN
Sinus = CN IX = Both HTN & hypotension
45
Q

Central vs peripheral chemoreceptors respond to?

A

Peripheral = Po2 ( Pco2

46
Q 
What organ has the highest:
% of CO
Share of systemic CO
BF per gram of tissue
Arteriovenous O2 difference-= O2 extraction
A 
Lung= 100% CO
Liver = largest CO share
Kidney = Highest BF
Heart = 80% extraction 
**Inc cardiac O2 demand has to be met by CA dilation
47
Q 
Normal pressures: 
RA
RV
LA 
LV
A 
RA = <12
LV= 130/10
48
Q

What causes PCWP > LV diastolic pressure?

A

Mitral stenosis

49
Q 
Factors autoregulating BF in:
Heart
Brain
Lungs
Skin
Muscles
A 
heart = NO + Adenosine = vasodilate 
Brain = CO2/ pH
Lungs = hypoxic vasoconstriction
SKin = SNS
muscles = Lactate. adenosine. K+
50
Q

Calculating net capillary filtration pressure?

A

Pnet = [(Pc - Pi) - (Uc - Ui)]

  • P = hydrostatic
  • U = oncotic
51
Q

5 Ts of Early cyanotic babies?

A
  1. Truncus arteriosus
  2. Transposition
  3. Tricuspid atresia
  4. Tetralogy of fallot
  5. Total anomalous pulmonary VR (pul veins drain into R circulation and never end up in Left side)
52
Q

Pt with cyanotic spells and x-ray shows “BOOT shaped heart?”

A

Tetralogy = RVH causes boot shape

53
Q

Underlying cause of:
Tetralogy
Transposition

A 
BOth = Neural crest defect
teratology = Anteriorsuperior displacement of Infundibular septum 
Transposition = failure of Aorticopul septum to Spiral
54
Q

Preductal vs postductal coarctation?

A 
Preductal = Turners + weak Femoral pulse
Postductal = Rib notching, HTN upper ext + berry aneurysms + BICUSPID aortic valve ass.
55
Q

Pt comes in with Cyanosis in upper extremities and normal Lower extremities?

A

Uncorrected PDA

56
Q 
Associated heart defects: 
DiGeorge 
Downs
Rubella
Turners
Marfans
Diabetic mother
Tertiary syphilis
A 
DiGeroge = Tetralogy + Truncus 
Downs = ASD, VSD, AV septal defect 
Rubella = PDA, pulmonary Stenosis
Turners = Coartaction + Bicuspid aortic valve 
Marfans = Medial cystic necrosis = DIssections
DM = Transposition 
Syphilis= Aortic Regurg + Aneurysm of Descending aorta
57
Q 
Lipidemia signs: 
Plaque in BV walls
Lipid laiden histeocytes in skin/ eye lid
Lipid deposits in tendons
Lipid deposits in cornea
A

Atheromas
Xanthomas = SKIN
tendon Xanthomas
Corneal arcus

58
Q

Ateriosclerosis subtypes causes:
Monckenberg
Arteriolosclerosis
Atherosclerosis

A 
Monckenberg = Medial calcification/ does NOT block
Arterioloscerosis = Hyalin (HTN/DM) + Hyperplastic (onion skin/ malg HTN= smooth muscle hyperplasia)
Atherosclerosis= Fibrous plaques in INTIMA
59
Q

MC site of atherosclerosis?

A

Abdominal aorta > CA > popliteal > carotid

60
Q

What signals are involved in Smooth muscle migration during atheroma formation?

A

PDGF + FGF

61
Q

Pt with HTN + DM + high Cholesterol comes in with Left flank pain, hypotension, pulsatile mass in the abdomen?

A

Ruptured AAA

62
Q

Causes of Thoracic Aortic aneurysms?

A

Cystic medial necrosis (Marfans)

Tertiary syphilis = endarteritis obliterans (vasa vasorum)

63
Q

What is coronary steal syndrome?

A

Treatment with a vasodilator during Cardiac ischemia can Worsen ischemia by SHUNTING blood away into Dilated vessels

64
Q 
Timeline for MI:
0-4hrs
4-12hrs
12-24hrs
1-3d
3-14d
\+2wks
A 
0-4hrs = NOTHING is seen = COD arrhythmias
4-12hrs= Coag necrosis/ Wavy fibers/ edema =  ECG dx
12-24hrs= Contraction bands/ enzyme elevation (T1 / CKMB)
1-3d = PMNs / Fibrinous pericarditis due to Necrosis
3-14 = Macs / granulation tissue = Rupture/ aneurysm  
\+2wks = Scar = Dresslers syndrome
65
Q

Dx MI via ECG leads:
V1-4
V4-6
II, III, aVF

A

V1-4 = LAD
V4-6= LCX, I aVL
II, III, aVF = RCA

66
Q

MCC of hypertrophic cardimyopathy? Rx?

A

Myosin heavy chain mutation
Friedreichs ataxia
Rx= Beta blockers to avoid arrhythmias (MCCOD)

67
Q

MCC of dilated cardiomyopathy?

A 
ABCCCD 
Alcohol
Beriberi
Coxsacki B
Chagas
Cocaine
Doxorubicin
68
Q

MCC of restrictive cardiomyopathy?

A

Sarcoidosis
Hemachromatosis
Endocardial fibroelastosis
Loffler’s = EOSINOPHILIA + endomyocardial fibrosis

69
Q

Treatment of choice for CHF?

A

ACEi = Dec AL/ PL
Beta blockers= Dec O2 demand
Spironolactone = reduces reorganizaton/ fibrosis
ARBs

70
Q

Biopsy of Rheumatic heart disease?

A

Aschoff bodies = Granuloma
Anitschkow cells = Activated histeocytes
**Type 2 HS rxn to M protein

71
Q

Pt with sharp chest pain aggravated by inspiration and Widespread ST elevation?

A

Acute pericarditis

72
Q

Causes of Pericarditis:
Fibrinous
Serous
Purulent

A 
Fibrinous= Dresslers + Uremia
Serous = Viral + RA, SLE 
Purulent = Pneumococcus + Strep
73
Q

Findings in Cardiac temponade?

A 
Hypotension 
JVD
Distant Heart sounds
Inc HR
Pulsus paradoxus
74
Q

Kussmauls signs is and seen with?

A

Inc JVD with Inspiration instead of normal Dec

**Constrictive pericarditis, Restrictive cardiomyopathy , temponade

75
Q

Young asian female with weak upper extremity pulse, fever, night sweats, myalgias, arthritis. Labs show elevated ESR. What is seen on biopsy-> Dx -> Rx?

A

Takayasu’s arteritis
Granulomatous inflammation of AORTIC arch / branches
Rx= Steroids

76
Q

Pt with fever, wght loss, abdominal pain, renal damage, CNS issues, and HBV+. What is seen on biopsy?

A

Transmural inflammation = FIBRINOID necrosis
of Renal + Visceral arteries (Not Large arteries)
Rx: steroids / Cyclophosphamide

77
Q

Child with conjunctival injection, oral mucosal erythema, and desquamating rash. What is he at risk for? Rx?

A

Kawasaki
Coronary artery Aneurysm
Rx: Aspirin

78
Q

Young asian male smoker with recurrent limb claudication. new developed gangrene of the fingertips. What is the Dx/ Rx?

A

Buerger’s disease

Rx: STOP Smoking

79
Q

Child with recent URTi, joint pain, abdominal pain, and skin lesions on his legs. What is this associated with?

A

Henoch-Schonlein purpura = IgA nephropathy

80
Q

Benign capillary growth of Children that Grows Rapidly then Regresses spontaneously?

A

Strawberry Hemangioma

81
Q

Benign capillary lesion of Elderly that Does NOT regress?

A

Cherry hemangioma

82
Q

Pregnant women with a ulcerating polypoid capillary lesion?

A

Pyogenic Granuloma

83
Q

Cavernous lymphangioma of the neck? associated with?

A

Cystic Hygroma = Turners + Downs

84
Q

Benign painful red-blue tumor under the finger nails. What is the origin?

A

Glumus tumor => Modified smooth muscle cells

**Globus body= control Body Temp

85
Q

Very aggressive BV malignancy associated with Radiation for Hodkins or breast cancer?

A

Angiosarcoma

86
Q

Lymphatic malignancy associated with Post-radical Mastectomy?

A

Lymphangiosarcoma

87
Q

Child with Vascular disorder causing stains on his face/mouth/ oral mucosa, intracerebral AVM, seizures, and early onset Glaucoma?

A

Sturge- Weber disease

FA organs HY (11 decks)

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