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First Aid Diseases > Cardio > Flashcards

Cardio Flashcards

1
Q

Left horn of the sinus venosus becomes?

R horn becomes?

A 
Coronary sinus (on L side of RA)
Smooth part of RA
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2
Q

PDA is due to failure of what 2 things to fuse after birth?

A

Septum primum and septum secundum

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3
Q

What is the most post part of the heart?

A

LA

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4
Q

Use TEE to dx?

A

LA enlargement
Ao dissection
Thoracic aneurysm
bc eso can best see LA and descending Ao

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5
Q

CO = ?

A

= SV x HR

= rate O2 comsump / (art. O2 - ven. O2)

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6
Q

MAP = ?

A

= CO x TPR

= 2/3 DP + 1/3 SP

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7
Q

Pulse P is proportional to?

A

Stroke vol
Incr’d SV -> incr’d PP (bc bigger diff btwn
SP-DP)

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8
Q

SV =

A

CO / HR = EDV - ESV

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9
Q

Decr’d EC Na+ has what effect on SV?

A

Incr’s SV bc less Na/Ca exchange, so less Ca out, meaning more Ca in cell -> more SV

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10
Q

How does digitalis incr SV?

A

Blocks Na/K pump -> more IC Na -> less Na/Ca pump -> more Ca inside -> more SV

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11
Q

Acidosis has what effect on SV?

A

Incr’d EC H+ -> X for K -> more Na/K pump to bring K into cell -> less Na in cell -> more Na/Ca pump -> less Ca in cell -> decr’d SV

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12
Q

EF =

A

= SV / EDV

= (EDV - ESV) / EDV

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13
Q

Where is the majority of the TPR?

A

Arterioles, to reg cap flow

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14
Q

JVP (pulse)

  • a wave? c wave?
  • x descent?
  • v wave?
  • y descent?
A
  • a = atrial contrac; c = RV contract -> TV bulges into RA incr’ing RA P
  • x = RA relaxed and decr’d P as RV contracts
  • v = incr’d RA P w/ “villing”
  • y = TV opens bl flows from RA to RV
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15
Q

Wide splitting is due to (2)?

A

Pulm stenosis, RBBB (delayed RV emptying)

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16
Q

Fixed splitting is due to?

A

ASD (incr’d flow thr PV so delayed close)

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17
Q

Paradoxical splitting is due to (2)?

A

AS, LBBB (delayed LV emptying so A2 after P2)

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18
Q

Pulm flow murmur + diastolic murmur?

Later on: louder diastolic murmur?

A

ASD (incr’d flow thr PV and incr’d flow X TV)

- later get pulm regurg from dilatation of PA

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19
Q

On insp/expiration get incr’d intensity of what heart sounds?

A

Insp: R heart sounds (incr’d venous return)
Expir: L heart sounds (incr’d return to L heart from pulm circ)

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20
Q 
Hand grip (incr'd SVR) makes which heart sounds louder?
- which heart sounds quieter?
A

Everything that goes backwards: MR, AR, VSD, MVP

- things that can’t push as much: AS, HOCM

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21
Q

Valsava (decr’d venous return) makes which 2 heart sounds louder?

A

MVP and HOCM, makes most other heart sounds quieter

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22
Q

Squatting (incr’d venous return/preload, incr’d afterload if sustained) makes which 2 heart sounds quieter?

A

MVP, HOCM

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23
Q

Holosystolic high-pitched blowing murmur?

A

MR/TR

MR incr’d w/ expiration, TR incr’d w/ inspir

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24
Q

Ejection click, then crescendo-decrescendo systolic murmur?

- pulses are?

A

AS

- weak w/ delayed peak: pulsus parvus et tardus

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25
Q

Holosystolic harsh murmur?

A

VSD

  • loudest at TV area
  • incr’d w/ hand grip
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26
Q

Late systolic decrescendo murmur w/ midsystolic click?

A

MVP

  • best heard over apex, loudest at S2
  • incr’d w/ decr’d venous return (standing or Valsalva)
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27
Q

High-pitched blowing diastolic decrescendo murmur?

- pulse is?

A

AR

  • wide pulse P w/ bounding pulses and head bobbing
  • incr’d w/ hand grip
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28
Q

Opening snap, then delayed rumbling diastolic murmur?

A

MS

- incr’d w/ incr’d LA return (expiration)

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29
Q

PDA assoc’d w/ what 2 things?

A

Congenital rubella or prematurity

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30
Q

AS w/ fusion of commissures PLUS MS = ?

A

RHD

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31
Q

How does the cardiac AcP work?

Stages 0-4

A 
0 = rapid upstroke, V-gated Na in
1 = initial repol, V-gated K out
2 = plateau, V-gated Ca in (-> Ca from SR, contraction) equal to K out
3 = rapid repol, K out
4 = resting potential, K ch leak out
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32
Q

How does SA node spont’ly depol?

A

Phase 4 has Ifunny Na ch’s -> Na slowly in -> Ca depol (phase 0 upstroke) -> phase 3 repol w/ K out

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33
Q

Cardiac myocytes are electrically coupled thr?

A

Gap jxns

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34
Q

Adenosine does what to SA node?

A

Decr’d rate of depol, slows HR

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35
Q

Slope of phase 0 in SA is proportional to?

A

HR, incr’d slope means incr’d HR, decr’d slope means decr’d HR

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36
Q

PR int - nl length is?

QRS complex - nl length is?

A

<120 ms

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37
Q

U wave =

A

peak after T wave, means hypoK or brady

38
Q

Speed of conduction: Atria, ventricles, AV node, Purkinje?

A

Purkinje > Atria > Ventricles > AV node

39
Q

Severe congenital sensorineural deficits have incr’d chance of?

A

Torsades bc congenital long QT (Jervell and Lange-Nielsen synd), due to defects in Na or K ch’s in heart

40
Q

No P waves on EKG?

A

Afib, QRS complexes are irreg’ly spaced

41
Q

Sawtooth flutter waves on EKG?

- Rate control w/?

A

Aflutter, identical atrial depol’s w/ interspersed QRS complexes
- b-blocker or CCB

42
Q

PR int >200 on EKG?

A

1st deg AV heart block

43
Q

P wave w/ no QRS after it on EKG?

trtmt?

A

2nd deg AV heart block:
Mobitz type I (Wenckebach) if lengthening PR int
Mobitz type II if no change in PR int length
- only trt type II -> pacemaker

44
Q

P waves are coming faster than QRS, no correlation btwn the 2?

  • trtmt?
  • can be due to?
A

3rd deg (complete) heart block

  • pacemaker
  • Lyme dz
45
Q

Ao’ic baro/chemoRs transmit via what to where about what?

What about carotid Rs?

A
  • Via CN X to solitary nuc of medulla about incr in BP (fire less w/ decr’d BP)
  • Via CN IX to solitary nuc of medulla about incr and decr in BP
46
Q

Hypotension is sensed by? leads to?

A

baroRs: decr’d stretch, decr’d aff firing -> incr’d eff symp and decr’d eff parasymp -> vasoconstric, incr’d HR/contractility/BP

47
Q

HTN sensed by? leads to?

A

baroRs: cartoid baroRs stretch -> incr’d firing -> incr’d eff parasymp -> decr’d HR

48
Q

Cushing rxn =

A

HTN, brady, and resp depression:
incr’d ICP constricts art’s -> cerebral ischemia -> symp incr to incr’d perfusion P causing HTN -> incr’d stretch so baroR reflex -> brady and resp depression

49
Q

Periph chemoRs respond to?

Central chemoRs respond to?

A
  • carotid/Ao’ic bodies: decr’d PO2, incr’d PCO2 and decr’d pH
  • changes in pH and PCO2 of brain fluid (NOT to O2)
50
Q

Organ w/ the lg’est bl flow?
Lg’est share of systemic CO?
High bl flow per gm of tissue?
Lg’est extraction of O2?

A

Lung, 100% of CO!
Liver
Kidney
Heart (incr’d O2 demand met by incr’d CA bl flow, not by incr’d extraction)

51
Q

Nl PA P?

Nl PCWP? appox’n of?

A

25/10

<12, LA

52
Q

5 T’s (Cyanotic CHDs) =

A

ToF, Transposition, Truncus, Tricuspid, TAPVR

53
Q

Which CHD is assoc’d w/:

  • 22q11 synd’s
  • Downs
  • Congen rubella
  • Turners
  • Marfans
  • DM mom
  • SLE mom
A
  • Truncus arteriosus, ToF
  • ASD, VSD, AV septal defect
  • PDA, PS, septal defects
  • Preductal coarc of Ao, bicuspid AV
  • Ao insuff and later dissection
  • Transposition of great vessels
  • Heart block
54
Q

3 CHDs w/ late cyanosis (Eisenmenger’s synd)

- why is it late?

A

VSD, ASD, PDA
- have L->R shunt -> pulm hypertrophy and incr’d P w/ RV hypertrophy -> switches to
L->R shunt (cyanosis, clubbing and polycythemia)

55
Q

White ring around periph of iris is called?

Due to?

A

Arcus senilis

Lipid deposit in cornea (hyperlipidemia)

56
Q

Hyaline arteriolosclerosis is due to?

Hyperplastic type is due to?

A 
Essential HTN, DM
Malig HTN (-> fibrinoid necrosis of vessel wall)
57
Q

4 modifiable RFs for atherosclerosis?

A

SHHD: smoking, HTN, hyperlipidemia, DM

58
Q

Why are postmenopausal women at higher risk for atherosclerosis but not premenopausal women?

A

Estrogen is protective!

59
Q

Hypotension, flank pain and pulsitile ab mass?

A

Ab aortic aneurysm (below renal a’s but above bifurcation)

60
Q

Ao’ic dissection is due to tear in what?

A

Intraluminal tear -> makes a true and false lumen

61
Q

ST depression on EKG means?

A

Subendocardial ischemia or very early MI that hasn’t become transmural yet

62
Q

Prinzmetal’s variant of angina is due to?

- EKG shows?

A

CA spasm -> angina at rest

- ST segment elevation

63
Q

Evolution of MI

- what do you see, when? what color is it?

A 
0-4hrs - minimal change
1d - coag necrosis (dark, no nuclei)
N's come in 
1wk - Mphage come in (yellow pallor)
Granulation tissue (yellow w/ red border)
1mo - Scar from type I collagen (white)
64
Q

Risks post-MI:

  • at 1-3d?
  • at 3-7d?
  • at 1mo?
A
  • fibrinous pericarditis (only w/ transmural infarct) from inflamm debris in pericardium
  • Rupture bc weak wall! Tamponade from free wall rupture, MV insuff from pap m. rupture, shunt from interventric septal rupture
  • Dressler’s synd
65
Q

MI:
Troponin I - rises when? peaks? goes away?
CKMB used for?

A

4hrs, peaks at 24hrs, elevated for 7-10d

- dx reinfarction bc returns to nl levels after 48-72hrs

66
Q 
Where is the MI:
V1-V4
V1-V1
V4-V6
I, aVL
II, II, aVF
A 
Ant wall, LAD
Anteroseptal, LAD
Anterolateral, LCX
Lat wall, LCX
Inf wall, RCA (goes to pap m. so can see rupture of it)
67
Q

What can give you a dilated (congestive) cardiomyopathy?

A 
ABCCCD:
chronic Alcohol abuse
wet Beriberi
Coxsackie B v. myocarditis
chronic Cocaine use
Chagas' dz
Doxorubicin tox
\+ hemochromatosis + peripartum
68
Q

How does hypertrophic cardiomyopathy present an outflow tract obstruction?
- Murmur?

A

Big interventric septum is too close to MV leaflet -> obstructs outflow tract
- Systolic murmur

69
Q

Genetics of hypertrophic cardiomyopathy?

- assoc’d w/ what other dz?

A

AD usu involving b-myosin heavy chain mutation

- Friedreich’s ataxia

70
Q

Treatment for hypertrophic cardiomyopathy

A

b-blocker or non-dihydropyridine CCB (verapamil)

71
Q

Loffler’s synd =

A

restrictive cardiomyopathy:

endomyocardial fibrosis w/ prominent Eo’ic infiltrate

72
Q

Trtmt for CHF

A

AAB: ACEIs/ARBs, Aldos inhib (spironolactone), b-blockers

73
Q

Nutmeg liver is sign of?

A

R HF (heptomegaly from congestion in liver)

74
Q

Sx for bac endocarditis?

A

Bac FROM JANE:
Fever
Roth’s spots (white spots on retina surrounded by hemorrhage)
Osler’s nodes (painful, rised, finger and toe pads)
Murmur
Janeway lesions (sm, painless, palm/sole)
Anemia (of chronic dz, microcytic)
Nail-bed hemorrhage
Emboli (septic

75
Q

Libman-Sacks Endocarditis =

A

from SLE, have sterile vegetations on top and bottom of MV

76
Q

Rheumatic F: early lesion? late lesion?

  • Aschoff body =
  • Anitschkow’s cells =
A

Early: MR, Late: MS

  • granuloma w/ giant cells
  • act’d histiocytes w/ caterpillar nuclei
77
Q

Sx of acute rheumatic fever?

A 
FEVERSS:
Fever
Erythema marginatum
Valvular damage (vegetation, fibrosis)
ESR incr'd
Red-hot jts (migratory polyarthritis)
Subcut nodules
St. Vitus' dance (Syndenham's chorea)
\+ pancarditis -> friction rub
78
Q

Sharp chest pain relieved by sitting up and leaning forward, EKG shows widespread ST-segment elevation and/or PR depression

A

Acute pericarditis

79
Q

Low BP, incr’d JVP, muffled heart sounds =

A

Beck’s triad for Cardiac tamponade

- also have pulsus paradoxus

80
Q

Tree bark appearance of Ao =

A

3* syph - disrupts vasa vasorum of Ao -> atrophy of wall -> dilation of Ao and valve ring, also calcification of Ao’ic root and ascending Ao’ic arch

81
Q

Tumor in LA causing obstruction and syncopal episodes?

A

Myxoma

82
Q

HepB (+) yg adult w/ string of pearls on imaging?

  • due to?
  • trtmt?
A

Polyarteritis nodosa

  • IC mediated -> transmural inflamm of art wall w/ fibrinoid necrosis; when lesions heal they form nodules
  • ccs and cyclophosphamide
83
Q

Pauci-immune GN, necrotizing vasculitis in lung, kidneys and skin (palpable purpura)

A

Microscopic polyangiitis

- no granulomas and not in nasopharynx (unlike Wegener’s)

84
Q

Pauci-immune GN, in pharynx, lungs and kidneys

A

Wegener’s granulomatosis (granulomatosis w/ polyangiitis)

- focal necrotizing vasculitis w/ granulomas and in nasopharynx (until microscopic polyangiitis)

85
Q

Palpable purpura w/ asthma and wrist/foot drop?

A

Churg-Strauss synd

- pauci-imm GN w/ necrotizing vasculitis and Eo’s and IgE

86
Q

Child, recently sick, w/ palpable purpura on butt

A

Henoch-Schonlein purpura (IgA)

  • follows URI bc get incr’d IgA
  • palpable purpura, jt pain, ab pain
87
Q

Benign cap hemangioma in baby, grows fast, but goes away by 5-8yo

A

Strawberry hemangioma

88
Q

Benign cap hemangioma in old person, doesn’t go away

A

Cherry hemangioma

89
Q

Polyploid cap hemangioma that is ulcerating and bl’ing, in preg woman or from trauma

A

Pyogenic hemangioma

90
Q

Skin papules in AIDS pt can be what of 2 things?

A

Bacillary angiomatosis from Bartonella henselae infec OR

Kaposi’s sarcoma from HHV-8

91
Q

Port-wine stain on baby’s face?

- also will have?

A

Sturge-Weber dz

- ipsilat leptomeningeal angiomatosis (intracerebral AVM), seizures, early-onset glaucoma

First Aid Diseases (16 decks)

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