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
2
Q
PDA is due to failure of what 2 things to fuse after birth?
A
Septum primum and septum secundum
3
Q
What is the most post part of the heart?
A
LA
4
Q
Use TEE to dx?
A
LA enlargement
Ao dissection
Thoracic aneurysm
bc eso can best see LA and descending Ao
5
Q
CO = ?
A
= SV x HR
= rate O2 comsump / (art. O2 - ven. O2)
6
Q
MAP = ?
A
= CO x TPR
= 2/3 DP + 1/3 SP
7
Q
Pulse P is proportional to?
A
Stroke vol
Incr’d SV -> incr’d PP (bc bigger diff btwn
SP-DP)
8
Q
SV =
A
CO / HR = EDV - ESV
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
10
Q
How does digitalis incr SV?
A
Blocks Na/K pump -> more IC Na -> less Na/Ca pump -> more Ca inside -> more SV
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
12
Q
EF =
A
= SV / EDV
= (EDV - ESV) / EDV
13
Q
Where is the majority of the TPR?
A
Arterioles, to reg cap flow
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
15
Q
Wide splitting is due to (2)?
A
Pulm stenosis, RBBB (delayed RV emptying)
16
Q
Fixed splitting is due to?
A
ASD (incr’d flow thr PV so delayed close)
17
Q
Paradoxical splitting is due to (2)?
A
AS, LBBB (delayed LV emptying so A2 after P2)
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
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)
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
21
Q
Valsava (decr’d venous return) makes which 2 heart sounds louder?
A
MVP and HOCM, makes most other heart sounds quieter
22
Q
Squatting (incr’d venous return/preload, incr’d afterload if sustained) makes which 2 heart sounds quieter?
A
MVP, HOCM
23
Q
Holosystolic high-pitched blowing murmur?
A
MR/TR
MR incr’d w/ expiration, TR incr’d w/ inspir
24
Q
Ejection click, then crescendo-decrescendo systolic murmur?
- pulses are?
A
AS
- weak w/ delayed peak: pulsus parvus et tardus
25
Holosystolic harsh murmur?
VSD
- loudest at TV area
- incr'd w/ hand grip
26
Late systolic decrescendo murmur w/ midsystolic click?
MVP
- best heard over apex, loudest at S2
- incr'd w/ decr'd venous return (standing or Valsalva)
27
High-pitched blowing diastolic decrescendo murmur?
| - pulse is?
AR
- wide pulse P w/ bounding pulses and head bobbing
- incr'd w/ hand grip
28
Opening snap, then delayed rumbling diastolic murmur?
MS
| - incr'd w/ incr'd LA return (expiration)
29
PDA assoc'd w/ what 2 things?
Congenital rubella or prematurity
30
AS w/ fusion of commissures PLUS MS = ?
RHD
31
How does the cardiac AcP work?
| Stages 0-4
```
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
```
32
How does SA node spont'ly depol?
Phase 4 has Ifunny Na ch's -> Na slowly in -> Ca depol (phase 0 upstroke) -> phase 3 repol w/ K out
33
Cardiac myocytes are electrically coupled thr?
Gap jxns
34
Adenosine does what to SA node?
Decr'd rate of depol, slows HR
35
Slope of phase 0 in SA is proportional to?
HR, incr'd slope means incr'd HR, decr'd slope means decr'd HR
36
PR int - nl length is?
| QRS complex - nl length is?
<120 ms
37
U wave =
peak after T wave, means hypoK or brady
38
Speed of conduction: Atria, ventricles, AV node, Purkinje?
Purkinje > Atria > Ventricles > AV node
39
Severe congenital sensorineural deficits have incr'd chance of?
Torsades bc congenital long QT (Jervell and Lange-Nielsen synd), due to defects in Na or K ch's in heart
40
No P waves on EKG?
Afib, QRS complexes are irreg'ly spaced
41
Sawtooth flutter waves on EKG?
| - Rate control w/?
Aflutter, identical atrial depol's w/ interspersed QRS complexes
- b-blocker or CCB
42
PR int >200 on EKG?
1st deg AV heart block
43
P wave w/ no QRS after it on EKG?
| trtmt?
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
P waves are coming faster than QRS, no correlation btwn the 2?
- trtmt?
- can be due to?
3rd deg (complete) heart block
- pacemaker
- Lyme dz
45
Ao'ic baro/chemoRs transmit via what to where about what?
| What about carotid Rs?
- 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
Hypotension is sensed by? leads to?
baroRs: decr'd stretch, decr'd aff firing -> incr'd eff symp and decr'd eff parasymp -> vasoconstric, incr'd HR/contractility/BP
47
HTN sensed by? leads to?
baroRs: cartoid baroRs stretch -> incr'd firing -> incr'd eff parasymp -> decr'd HR
48
Cushing rxn =
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
Periph chemoRs respond to?
| Central chemoRs respond to?
- 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
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?
Lung, 100% of CO!
Liver
Kidney
Heart (incr'd O2 demand met by incr'd CA bl flow, not by incr'd extraction)
51
Nl PA P?
| Nl PCWP? appox'n of?
25/10
| <12, LA
52
5 T's (Cyanotic CHDs) =
ToF, Transposition, Truncus, Tricuspid, TAPVR
53
Which CHD is assoc'd w/:
- 22q11 synd's
- Downs
- Congen rubella
- Turners
- Marfans
- DM mom
- SLE mom
- 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
3 CHDs w/ late cyanosis (Eisenmenger's synd)
| - why is it late?
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
White ring around periph of iris is called?
| Due to?
Arcus senilis
| Lipid deposit in cornea (hyperlipidemia)
56
Hyaline arteriolosclerosis is due to?
| Hyperplastic type is due to?
```
Essential HTN, DM
Malig HTN (-> fibrinoid necrosis of vessel wall)
```
57
4 modifiable RFs for atherosclerosis?
SHHD: smoking, HTN, hyperlipidemia, DM
58
Why are postmenopausal women at higher risk for atherosclerosis but not premenopausal women?
Estrogen is protective!
59
Hypotension, flank pain and pulsitile ab mass?
Ab aortic aneurysm (below renal a's but above bifurcation)
60
Ao'ic dissection is due to tear in what?
Intraluminal tear -> makes a true and false lumen
61
ST depression on EKG means?
Subendocardial ischemia or very early MI that hasn't become transmural yet
62
Prinzmetal's variant of angina is due to?
| - EKG shows?
CA spasm -> angina at rest
| - ST segment elevation
63
Evolution of MI
| - what do you see, when? what color is it?
```
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
Risks post-MI:
- at 1-3d?
- at 3-7d?
- at 1mo?
- 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
MI:
Troponin I - rises when? peaks? goes away?
CKMB used for?
4hrs, peaks at 24hrs, elevated for 7-10d
| - dx reinfarction bc returns to nl levels after 48-72hrs
66
```
Where is the MI:
V1-V4
V1-V1
V4-V6
I, aVL
II, II, aVF
```
```
Ant wall, LAD
Anteroseptal, LAD
Anterolateral, LCX
Lat wall, LCX
Inf wall, RCA (goes to pap m. so can see rupture of it)
```
67
What can give you a dilated (congestive) cardiomyopathy?
```
ABCCCD:
chronic Alcohol abuse
wet Beriberi
Coxsackie B v. myocarditis
chronic Cocaine use
Chagas' dz
Doxorubicin tox
+ hemochromatosis + peripartum
```
68
How does hypertrophic cardiomyopathy present an outflow tract obstruction?
- Murmur?
Big interventric septum is too close to MV leaflet -> obstructs outflow tract
- Systolic murmur
69
Genetics of hypertrophic cardiomyopathy?
| - assoc'd w/ what other dz?
AD usu involving b-myosin heavy chain mutation
| - Friedreich's ataxia
70
Treatment for hypertrophic cardiomyopathy
b-blocker or non-dihydropyridine CCB (verapamil)
71
Loffler's synd =
restrictive cardiomyopathy:
| endomyocardial fibrosis w/ prominent Eo'ic infiltrate
72
Trtmt for CHF
AAB: ACEIs/ARBs, Aldos inhib (spironolactone), b-blockers
73
Nutmeg liver is sign of?
R HF (heptomegaly from congestion in liver)
74
Sx for bac endocarditis?
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
Libman-Sacks Endocarditis =
from SLE, have sterile vegetations on top and bottom of MV
76
Rheumatic F: early lesion? late lesion?
- Aschoff body =
- Anitschkow's cells =
Early: MR, Late: MS
- granuloma w/ giant cells
- act'd histiocytes w/ caterpillar nuclei
77
Sx of acute rheumatic fever?
```
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
Sharp chest pain relieved by sitting up and leaning forward, EKG shows widespread ST-segment elevation and/or PR depression
Acute pericarditis
79
Low BP, incr'd JVP, muffled heart sounds =
Beck's triad for Cardiac tamponade
| - also have pulsus paradoxus
80
Tree bark appearance of Ao =
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
Tumor in LA causing obstruction and syncopal episodes?
Myxoma
82
HepB (+) yg adult w/ string of pearls on imaging?
- due to?
- trtmt?
Polyarteritis nodosa
- IC mediated -> transmural inflamm of art wall w/ fibrinoid necrosis; when lesions heal they form nodules
- ccs and cyclophosphamide
83
Pauci-immune GN, necrotizing vasculitis in lung, kidneys and skin (palpable purpura)
Microscopic polyangiitis
| - no granulomas and not in nasopharynx (unlike Wegener's)
84
Pauci-immune GN, in pharynx, lungs and kidneys
Wegener's granulomatosis (granulomatosis w/ polyangiitis)
| - focal necrotizing vasculitis w/ granulomas and in nasopharynx (until microscopic polyangiitis)
85
Palpable purpura w/ asthma and wrist/foot drop?
Churg-Strauss synd
| - pauci-imm GN w/ necrotizing vasculitis and Eo's and IgE
86
Child, recently sick, w/ palpable purpura on butt
Henoch-Schonlein purpura (IgA)
- follows URI bc get incr'd IgA
- palpable purpura, jt pain, ab pain
87
Benign cap hemangioma in baby, grows fast, but goes away by 5-8yo
Strawberry hemangioma
88
Benign cap hemangioma in old person, doesn't go away
Cherry hemangioma
89
Polyploid cap hemangioma that is ulcerating and bl'ing, in preg woman or from trauma
Pyogenic hemangioma
90
Skin papules in AIDS pt can be what of 2 things?
Bacillary angiomatosis from Bartonella henselae infec OR
| Kaposi's sarcoma from HHV-8
91
Port-wine stain on baby's face?
| - also will have?
Sturge-Weber dz
| - ipsilat leptomeningeal angiomatosis (intracerebral AVM), seizures, early-onset glaucoma
