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Cardio Flashcards

1
Q

truncus arteriosus gives rise to

A

ascending aorta and pulmonary trunk

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2
Q

bulbus cordis gives rise to

A

smooth parts of left and right ventricles

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3
Q

endocardial cushion gives rise to

A

atrial septum, membranous interventricular septum, AV and semilunar valves

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4
Q

primitive atrium/ventricle gives rise to

A

trabeculated part of left and right atria/ventricles

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5
Q

primitive pulmonary vein gives rise to

A

smooth part of left atrium

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6
Q

left horn of sinus venosus gives rise to

A

coronary sinus

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7
Q

right horn of sinus venosus gives rise to

A

smooth part of right atrium

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8
Q

right common cardinal vein and right anterior cardinal vein give rise to

A

superior vena cava

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9
Q

first function organ in neonates

A

heart, works at week 4 (also heart looping begins)

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10
Q

how Kartageners leads to dextrocardia

A

defect in left-right dynein

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11
Q

atrial septation morphogenesis

A
  1. septum primum towards endocardial cushions
  2. foramen secundum in septum primum
  3. septum secundum develops
  4. septum secundum grows, foramen secundum becomes foramen ovale
  5. septum primum forms valve
  6. primum and secundum fuse
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12
Q

cause of patent foramen ovale

A

failure of primum and secundum to fuse, paradoxical emboli

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13
Q

ventricular septation morphogenesis

A
  1. muscular interventricular septum forms
  2. aorticopulmonary septum rotates and fuses to form membranous septum
  3. endocardial cushion separates atria from ventricles
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14
Q

most common cardiac anomaly

A

VSD

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15
Q

cardiac abnormalities associated with neural crest migration

A
  • transposition of great vessels
  • Tetralogy of Fallot
  • persistent truncus arteriosus
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16
Q

valve derivation

A
  • aortic/pulmonary = endocardial cushions

- mitral/tricuspid = fused endocardial cushions of AV canal

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17
Q

3 shunts in fetal blood

A
  1. ductus venous bypasses portal circulation
  2. foramen ovale
  3. ductus arteriosus
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18
Q

allaNtois/urachus becomes

A

median umbilical ligament

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19
Q

ductus arteriosus becomes

A

ligamentum arteriosus

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20
Q

ductus venosus becomes

A

ligamentum venosum

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21
Q

notochord becomes

A

nucleus pulposus

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22
Q

umbiLical arteries becomes

A

lateral umbilical ligament

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23
Q

umbilical vein becomes

A

ligamentum teres hepatis (round ligament) - in falciform ligament

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24
Q

SA and AV nodes supplied by…

A

branches of RCA

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25
Q

most common sided dominant heart

A

right

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26
Q

coronary blood flow peaks in….

A

early diastole - valves are closed, pressure from aorta fills vessels

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27
Q

pericardium is innervated by…

A

phrenic nerve - pericarditis can go to shoulder

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28
Q

cardiac output equation

A

CO = SV * HR

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29
Q

MAP equation

A

MAP = TPR * CO (change in pressure = resistance * flow)

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30
Q

how to calculate MAP

A

2/3 diastolic + 1/3 systolic

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31
Q

cases of increased/decreased pulse pressure

A

increased - hyperthyroidism, aortic regurg, aortic stiffening, obstructive sleep apnea, exercise

decreased - aortic stenosis, cardiogenic shock, cardiac tamponade, HF

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32
Q

stroke volume is affected by what three things

A

afterload, preload and contractilitiy

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33
Q

contractility is increased with…

A
  1. catecholamine stimulation via B1 - increased calcium and phospholamban phosphorylation
  2. higher intracellular calcium
  3. decreased extracellular sodium
  4. digitalis - blocks Na/K pump
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34
Q

contractility is decreased with

A
  1. beta blockade
  2. HF with systolic dysfunction
  3. acidosis
  4. hypoxia/hypercapnia
  5. non-dihydropyridine Ca blockers
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35
Q

myoCARDial demand is increased by

A

Contractility
Afterload
heart Rate
Diameter of ventricle

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36
Q

venous dilators have what effect on preload

A

decrease

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37
Q

arterial vasodilators do what to afterload

A

decrease it (hydrAlAzine)

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38
Q

ejection fraction

A

stroke volume / EDV - or what ratio of blood is ejected each beat

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39
Q

blood viscosity changes based on…

A

hyperproteinemia states (myeloma, polycythemia)

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40
Q

a wave

A

AAtrial contraction - absent in afib

41
Q

c wave

A

RV Contraction - bulging of tricuspid valve

42
Q

v wave

A

right atrial pressure increase due to villing against valve

43
Q

y descent

A

RA emptying in RV - prominent in constrictive pericarditis, absent in cardiac tamponade

44
Q

splitting occurs in what sound

A

S2 - closure of aortic and pulmonic valves

45
Q

normal splitting

A

inspiration causes drop in pressure, increase venous return, increase RV filling and stroke volume, increased RV ejection time = delayed closure of pulmonic valve

also increased capacity of pulmonary circulation

46
Q

wide splitting

A

delay in RV emptying - pulmonic stenosis or RBBB

47
Q

fixed splitting

A

meaning it doesnt change with breathing - due to ASD because of higher volume and no effect on breathing

48
Q

paradoxical splitting

A

delay in aortic valve closure - aortic stenosis or LBBB

inspiration improves split so it is paradoxical

49
Q

inspiration bedside maneuver

A

increase intensity of right heart sounds due to increased venous return

50
Q

hand grip bedside maneuver

A

leads to increase in afterload

  • higher intensity MR, AR and VSD
  • less hyptertrophic cardiomyopathy and AS murmurs, MVP: later click
51
Q

valsalva (phase 2) and standing bedside maneuver

A

decrease in preload

  • lower intensity murmurs
  • more hyptertrophic cardiomyopathy
  • MVP: earlier click
52
Q

rapid squatting bedside maneuver

A

increase venous return, preload and afterload

  • less hypertrophic cardiomyopathy
  • increase in AS, MS and VSD
  • MVP: later click
53
Q

crescendo-decrescendo systolic ejection murmur

A

aortic stenosis - ejection click

54
Q

holosystolic, pitched blowing murmur

A

mitral regurg

55
Q

late systolic crescendo murmur with midsystolic click

A

mitral valve prolapse

56
Q

holosystolic harsh murmur

A

VSD - loudest at tricuspid area

57
Q

early diastolic decrescendo blowing murmur

A

aortic regurg

58
Q

delayed rumbling mid-late diastolic murmur

A

mitral stenosis - follows opening snap

59
Q

continuous machine like murmur

A

PDA - loudest at S2

60
Q

facts about aortic stenosis

A
  • pressure difference (higher in LV)
  • loudest at base, radiates to carotid
  • pulses are weak with delayed peak
  • age related calcifications or younger bicuspid valve
61
Q

facts about mitral regurg

A
  • loudest at apex, radiates toward axila

- due to ischemic heart disease or rheumatic fever and infective endocarditis

62
Q

facts about mitral prolapse

A
  • most common
  • heard at apex
  • predispose to infective endocarditis
  • myxomatous degeneration
  • rheumatic fever, chordae rupture
63
Q

facts about aortic regurg

A
  • hyperdynamic pulse with head bobbing
  • wide pulse pressure (due to back flow of blood, lowering diastolic pressure)
  • due to aortic root dilations, bicuspid valve, endocarditis, rheumatic fever
64
Q

facts about mitral stenosis

A
  • pressure difference (higher in LA)
  • late complication of rheumatic fever
  • can be in chronic MS
65
Q

myocardial action potential

A
  1. Na channels open - rapid upstroke
  2. Na channel inactivated, K open - initial repolarization
  3. Ca influx balances K efflux - plateau
  4. K efflux, closure of Ca - rapid repolarization
  5. high K permeability - resting
66
Q

differences in mycardial physiology

A
  • action potential plateau due to Ca influx
  • contraction requires Ca influx to induce Ca release from SR
  • electrical coupling by gap junctions
67
Q

pacemaker action potential

A
  1. opening of Ca channels, fast Na channels are inactivated resulting in slower polarization
  2. absent
  3. absent
  4. inactivation of Ca, activation of K (K efflux)
  5. slow depolarization due to funny current (slope determines HR)
68
Q

effect of sympathetics on funny current

A

increase likelihood that they are open, leading to increase in HR

69
Q

conduction pathway of heart

A

SA - atria - AV - bundle of His - right and left bundle branches - Purkinje - ventricles

70
Q

speed of conduction

A

purkinje > atria > ventricles > AV node

71
Q

u wave prominent in….

A

hypokalemia and bradycardia

72
Q

causes of torsades de pointes

A

long QT intervals, drugs, low K, low Mg, congenital abnormalities

73
Q

drugs inducing long QT

A 
antiArrhythmics (class 1A,3)
antiBiotics (macrolides)
antiCychotics (haloperidol)
antiDepressants (TCA)
antiEmetics (ondansetron)
74
Q

Romano-Ward syndrome

A

autosomal dominant disorder leading to congenital QT prolongation, no deafness

75
Q

Jervell and Lange-Nielsen syndrome

A

autosomal recessive disorder leading to congenital QT prolongation, sensorineural deafness

76
Q

brugada syndrome

A

pseudo- RBBB and ST elevations in V1-V3

- increase chance of tachyarrhythmias and sudden death, prevent with defibrillator

77
Q

wolf-Parkinson White syndrome

A
  • abnormal accessory conduction pathway bypasses AV node
  • delta wave with widened QRS and short PR
  • may cause supraventricular tachycardia
78
Q

atrial fibrillation

A
  • no discreet P waves**
  • irregularly irregular heartbeat**
  • caused by CAD, can lead to thromboembolus
  • treatment is anticoag, rate/rhythm control, carvioversion
79
Q

atrial flutter

A
  • sawtooth on EKG**
  • consistent interval
  • treat like afib, requires ablation
80
Q

first degree AV block

A

prolonged PR > 200ms

81
Q

second degree type 1 block

A

Wenckebach - progressive lengthening followed by drop - asymptomatic

82
Q

second degree type 2 block

A

drop with no PR lengthening - treated with pacemaker

83
Q

third degree heart block

A

atria and ventricles beating independently - can be caused by Lyme

84
Q

ANP

A

released from atria in response to increased blood volume and pressure

  • acts via cGMP
  • causes vasodilation, less Na reabsorption ar renal tubule
  • dilates afferent, constricts efferent, promoting diuresis
85
Q

BNP

A

release from ventricular myocytes in response to tension, same effect as ANP

86
Q

diagnosis of HF

A

use BNP - good negative predictive value

87
Q

carotid sinus

A

baroreceptor

88
Q

carotid body

A

chemoreceptor

89
Q

aortic arch transmits via…

A

vagus nerve

90
Q

carotid sinus transmits via…

A

glossopharyngeal nerve

91
Q

peripheral chemoreceptors

A

carotid and aortic bodies are stimulated by low PO2, high PCO2 and low pH

92
Q

central chemoreceptors

A

stimulated by change in pH and PCO2 of brain fluid - ** does not respond to O2

93
Q

autoregulation

A

how blood flow remains constant over range of perfusion pressures

94
Q

autoregulation factors of heart

A

local metabolites (vasodilators): adenosine, NO, CO2, low O2

95
Q

autoregulation factors of brain

A

local metabolites (vasodilators): CO2 (pH) - not O2

96
Q

autoregulation factors of kidneys

A

myogenic and tubuloglomerular feeback

97
Q

autoregulation factors of lungs

A

hypoxia causes vasoconstriction to ensure perfusion of well ventilated areas

98
Q

autoregulation factors of skeletal muscle

A

local metabolites during exercise (CHALK): CO2, H, Adenosine, Lactae, K

99
Q

autoregulation factors of skin

A

sympathetic stimulation for temp control

First Aid (16 decks)

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