Cardio Flashcards
Smooth part of left atrium embryology
Primative pulmonary vein
Coronary sinus embryology
Left horn of sinus venosus
Smooth right atrium embryology
Right horn of sinus venosus
Superior vena cava embryology
Right common carotid
Ligamentum Teres embryology
Umbilical vein
MediaL umbilical ligaments emb.
Umbilical arteries
Urachus and medain umbilical ligament emb.
Allantois
Nucleus pulposis emb.
Notochord
Blood supply to SA and AV node
RCA
Fick principle
CO= rate of O2 consumption/ [O2]a - [O2]v
Mean arterial pressure
2/3 diastolic + 1/3 Systolic
Digitalis MOA
Block NA/Katpase on cardiac myocyte ^intracellular Na, v Na/Ca exchange, ^ intracellular Ca
Normal PR
Less than 200ms or 1 Large box
Normal QRS
Normal QT
400MS (2 boxes) T shouldn’t be more than 1/2 way between complexes
PVC
Wide complex QRS on ekg (>4 boxes) odd shape
Drugs that can prolong QT
Some Risky Meds Can Prolong QT Sotolo Risperidone Macrolides Chloroquine Protease inhibs Quinidine (Ia, and III) Thiazides
Torsades des Points
PUSH Mg
WPW syndrome
Accessory pathway *Short PR *Delta Wave NOT ADENOSINE- Procainamide or Amiodarone
Afib Treatment
If new Cardioversion If old- anticoagulate then *rate control (with Dig, Calcium blockers, or B blockers) *rhythm control (Sotalol, amiodarone[K+ blockers])
Ventricular tachycardia
>100BPM Wide QRS >160ms(4box) At least 3 cosec beats
Normal Capillary wedge pressure
PDA
6th arch derivative L->R shunt. Indomethacin closure PGE keeps it open
22q11 Syndrome heart problems
Truncus, Tetrology
Down syndrome heart
Endocardial cushion defects, ASD, VSD, AVSD
Congenital rubella heart
Septal defects, PDA, PA stenosis
Marfan heart abnormalities
Aortic insufficiency, Mitral prolapse, Aneurysm
Diabetic mother heart of infant
Transposition
“pipestem arteries” on xray
BENIGN. Moenckeberg calcific sclerosis- NO OBSTRUCTION OF FLOW
Artherosclerosis
Large and medium muscular arteries *Endothelial dysfunction *Mac migration and foam cell formation *Fatty Streak *SM migration to intima *ECM deposition and fibrous plaque formation
Dissection
HYPERTENSION CAUSES TEAR
Coronary steal principle
Vasodilators work on on undilated arteries (proximal to stenosis) and the distal, already maximally dilated vessels are deprived of blood. (this is used in pharmacologic stress testing)
MI histology
*04hrs- nothing May have arrhythmia, sudden death, Card Shock *Up to 1 day- coagulative necrosis, possible contraction bands(reperfusion contraction), dark areas - Arrhythm, sudden card death, card shock * day-1 week - Neutrophils to macs. Yellow infiltrate. Fibrinous pericarditis to rupture and aneurysm * A couple weeks to month- Gray collagenous scar tissue- aneurysm and mural thrombus.
Infectious cause of 3rd degree heart block
Lymes
MI labs
Troponin I 4hrs-10 days CKMB 4hrs-2 days
Causes of Dilated CDM
ABCCCD Alcohol Beriberi Coxackie Cocaine Chagas Doxo/Daunorubacin
Hypertrophic CDM
Commonly myosin heavy chain mutation (AD) S4/Systolic murmur. MYOFIBRILLAR DYSARRAY Tx: B blocker, Verapamil/diltiazem
Restrictive CDM
LEASH Loeffler eosinophilic mycardial fibrosis Endocardial fibroelastosis Amyloidosis Sarcoidosis Hemachromatosis Low voltage QRS Thick walls
Bacterial endocarditis
Acute- S. Aureus Subacute- S. Viridians (dental- has dextran to bind clots) Enterococci- VRE possible IV drug user/surgery- S. Epidermiditis Culture neg- Coxiella, HACEK, hypercoag
Endocarditis S/Sx
FROM JANE Fever Roth spots on iris Osler nodes hurting feet Janeway lesions- red but kind Anemia Nail bed hemorrhage Emboli
Rheumatic fever
GAS –> M protein homology Aschoff bodies with Caterpillar macrophages JONES criteria Mitral>aortic>>>Tricuspid
JONES criteria
Joint- Polyarthritis O- Heart/ pancarditis N-Nodules- subcutaneous Erythema Marginatum Syndenhams chorea
Cardiac tamponade S/Sx
*Beck triad: Hypotension, Distended neck veins, Distant heart sounds *Tachy, Pulsus paridoxus, Kussmaul sign (JVP increase on inspiration)
Syphilitic HD
*3’ Syphilis disrups Vasa Vasorum- aortic dilation and aortic root * Tree barking aortic calcifications
Myxoma
Most common cardiac tumor 90% left atria Ball valve obstruction
Pyogenic granuloma
Ulcerating polypoid hemagioma associated with trauma and pregnancy
Cystic hygroma
Cavernous lmpanghioma- Turner syndrome, Downs, Edwards, Patau
Glomus tumor
Painful red-blue smooth muscle cell tumor under nail. FROM TEMP SENSING ORGANS
Temporal Giant Cell Arteritis
Most common in elderly females Unilateral headache Focal granulomatous inflammation of carotid artery branches can cause blindness due to ophthalmic occlusion. TX: CORTICOSTEROIDS Associated with Polymyalgia rheumatica
Takayasu Arteritis
“pulseless disease” Granulomatous involvement of aortic arch and great vessels Young asian females Fever, night sweats, arthritis, myalgias, skin nodules, ocular disturbances TX:CORTICOSTEROIDS
PAN
Polyartaritis nodosa * “rosary sign” micro-aneurysms and spasms * Immune complex involvement of medium sized renal and visceral vessels *Transmural inflammation with fibrinoid necrosis *Associated with Hep B Fever, weightloss, malaise, headache, abdominal pain, melena, HTN, neurologic dysfunction TX: CORTICOSTEROIDS, CYCLOPHOSPHAMIDE
Kawasaki disease
Fever 4 days + CRASH - Conjunctivitis, Rash, Adenopathy, Strawbery tongue, Hands and feet. *Necrotising vasculitis of medium arteries including coronaries (risk for aneurysm/thrombosis/rupture) TX: IVIG and ASPIRIN
Thromboangiitis Obliterans
(Buerger DZ) Heavy smokers, male >40 Segmental thrombosing vasculitis *Claudication causing gangrene, autoamputation, superficial nodular phlebitis and raynauds. TX: SMOKING CESSATION
GPA
Wegeners Granulomatosis with Polyangiitis Focal necrotizing vasculitis with granuloma formation *Perforation of nasal septa, chronic sinusitis, OM, Mastitis *Hemoptysis, cough, dyspnea *Hematuria, red cell casts +cANCA (Anti-neutrophil cytoplasmic antibody) TX: CORTICOSTEROIDS, CYCLOPHOSPHAMIDE
Churg-Strauss
Associated with ASTHMA EOSINOPHILIC granulomatous necrotizing vasculitis +pANCA and ^IgE *Asthma, sinusitis, palpable purpura, PERIPHERAL NEUROPATHY
Henoch-Schonlein Purpura
Most common childhood vasculitis following URI IgA Complex deposition *Palpable purpura lower extremities *Arthralgia *Abdominal pain, melena Can cause IgA nephropathy
Left and right ventricle outflow tract embryology
Bulbus cordis