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Step 1 2019 First Aid Flashcards > Cardio - FA Anat/Phys 281- 289 > Flashcards

Cardio - FA Anat/Phys 281- 289 Flashcards

1
Q

Enlargement of what part of the heart causes dysphagia or hoarseness - why?

A

LA - dysphagia (due to compression of the esophagus) or hoarseness (due to compression of the left recurrent laryngeal nerve, a branch of the vagus nerve).

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2
Q

Part of heart most commonly injured in trauma

A

RV

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3
Q

3 layers of pericardium

A

ƒ Fibrous pericardium ƒ Parietal layer of serous pericardium ƒ Visceral layer of serous pericardium

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4
Q

Pericardium innervated by?

A

phrenic n

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5
Q

Pericardititis causes referred pain to?

A

to the neck, arms, or one or both shoulders (often left).

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6
Q

Occlusion of which artery with lead to nodal dysfunction? Symptoms?

A

RCA - brady, heart block

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7
Q

Most common location of coronary a occlusion?

A

LAD

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8
Q

LAD supplies?

A

anterior of interventricular septum, anterolateral papillary muscle, and anterior surface of LV

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9
Q

PDA supplies?

A

AV node (dependent on dominance), posterior 1/3 of interventricular septum, posterior 2/3 walls of ventricles, and posteromedial papillary muscle

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10
Q

RCA supplies? Infarct may cause what sx?

A

SA node;

bradycardia, heart block

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11
Q

Peak flow in coronaries at what part of cardiac cycle?

A

early diastole

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12
Q

Stroke volume is affected by what 3 things?

A

1- afterload

2- preload

3- contractility

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13
Q

SV is inc by which parameters?

A
  1. inc Contractility
  2. dec Afterload
  3. inc Preload
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14
Q

What increases contractility?

A
  1. catecholamines ( stimulation via B1 receptor)
  • Ca2+ channels phosphorylated—> Increasing Ca2+ entry—>leading to Increase Ca2+-induced Ca2+ release and increase Calcium storage in SR
  • Phospholamban phosphorylation—>active Ca2+ ATPase—> Ca2+ storage in SRincrease intracellular Ca2++
  1. Inc IC Ca2+
  2. decrease EC Na+ ( via decrease Na/Ca2+ exchanger)
  3. digitalis ( blocks Na+/K+ pump)—> increaseing intracellular Na+—>decreasing Na+/Ca++ exchanger activity—> increase intracellular Ca++
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15
Q

What dec contractility and SV?

A
  1. Beta 1 blockade (decrease cAMP)
  2. HF w/ systolic dysfunction
  3. Acidosis
  4. hypoxia, hypercapnia, ( decrease Partial pressure of oxygen/increase partial pressure of CO2)
  5. non-dihydropyridine CCB
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16
Q

What parameter estimates preload?

A

ventricular EDV

( disclaimer ***depends on venous tone and circulating blood volume)

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17
Q

What drug decrease preload?

What drug decrease afterload?

What drugs decreases both?

A
  1. Preload - venous vasodilators/ venodilators (Nitroglycerin)
  2. Afterload - arterial vasodilators (Hydralazine)
  3. ACE, ARBS
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18
Q

How does LV compensate for inc afterload?

A

by thickening (hypertrophy) in order to dec wall tension.

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19
Q

What parameters will inc myocardial O2 demand?

A
  1. Inc contractility
  2. afterload,
  3. Heart Rate
  4. diameter of ventricle
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20
Q

Laplace’s law for wall tension

A

Wall tension = pressure x radius

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21
Q

wall stress = ?

A

wall stress = pressure x radius/2 x wall thickness

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22
Q

what are the 2 equations for stroke volume?

A

SV = CO/HR

SV = EDV - ESV

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23
Q

what is ejection fraction?

A

EF = SV/ EDV = EDV-ESV/EDV

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24
Q

Ejection Fraction is normal in diastolic or systolic Heart failure?

Ejection fraction is a measure/index of what?

A

EF is an index of ventricular contractility

EF decreased in systolic HF

EF is normal in diastolic HF

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25
Q

what is the Fick principle for Cardiac output?

A

CO = rate of O2 consumption/(arterial O2 content – venous O2 content)

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26
Q

How is CO maintained in early and late stages of exercise?

A

Early - inc HR, SV

Late - only inc HR (SV plateaus)

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27
Q

Diastole is shortened with a change in what cardiac parameter ? This leads to what?

A

Diastole is shorted with increased HR (ex/ VTACH)—> decreased diastolic filling time—> decreased SV—> decreased CO

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28
Q

Pulse pressure is directly proportional to __and inversely proportional to __.

A

SV

arterial compliance

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29
Q

What leads to inc pulse pressure?

A

Hyperthyroidism

Aortic Regurgitation

Aortic stiffening (isolate systolic HTN in elderly)

Obstructive sleep apnea (Inc SANS tone)

Anemia

Exercise (transcient)

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30
Q

Decreased pulse pressure is seen in?

A

aortic stenosis
cardiogenic shock
cardiac tamponade
advanced HF

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31
Q

Which conditions lead to dec pulse pressure?

A

Aortic stenosis Cardiogenic shock cardiac tamponade advanced CHF

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32
Q

what are the 2 equations for MAP?

A
  1. MAP = CO x TPR
  2. MAP( at resting HR) = 2/3 DBP + 1/3 SBP = DBP + 1/3 PP
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33
Q

Inc contractility is seen with ?`

A

catecholamines, positive inotropes (eg, digoxin)

exercise

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34
Q

dec contractility is seen with ?

A

loss of myocardium (eg, MI), β-blockers (acutely), non-dihydropyridine Ca2+ channel blockers, dilated cardiomyopathy.

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35
Q

Force of contraction is proportional to ____ _______ length of ______ _____ _______ .

(Starling Mech)

A

Force of contraction is proportional to enddiastolic length of cardiac muscle fiber (preload).

36
Q

What inc/dec viscosity?

A

Inc = Hyperproteinemic states, polycythemia dec = anemia

37
Q

Which type of vessel affects TPR most?

A

arterioles

38
Q

How does exercise affect TPR/CO?

A

decrease TPR (thereby inc CO/VR)

39
Q

How does an AVs shunt affect CO?

A

AV shunts will dec TPR –> inc CO

40
Q

Orange line = ?

Blue line = ?

Green line = ?

List the heart sounds

Which valve is opening or closing?

A
41
Q
A
42
Q

`

A
43
Q
A
44
Q

Orange line?
Blue line ?
Green line?
Which heart sounds?
Which valve open/closes when?

A
45
Q

S1 and S2 - which valves close?

A

S1—mitral and tricuspid valve closure. Loudest at mitral area.
S2—aortic and pulmonary valve closure. Loudest at left upper sternal border.

46
Q

What part of the cardiac cycle is S3? `

A

in early diastole during rapid ventricular filling phase

47
Q

S3 is associated with inc ___________ _________

A

filling pressures

48
Q

S3 is normal in what people?

More common with ______ _______

A

S3 more common in dilated ventricles (but can be normal in children, young adults, and pregnant women)

49
Q

S4 is at what part of the cardiac cycle?

A

in late diastole (“atrial kick”)

50
Q

Mechanism of S4?

A

Left atrium pushes against stiff LV wall, also known as atrial kick

51
Q

How is S4 best heard?

A

At the apex with pt in left lat decubitis position

52
Q

Two pathologies associated with S4?

A

Ventricular hypertrophy hypertrophic cardiomyopathy

53
Q

What pulse curve is this? What does a and c represent?

A

A - atrial contraction

c - RV contraction ( closed tricuspid bulging into atrium)

54
Q

When is the a wave missing?

A

Absent in Afib

55
Q

What does the x descent represent? and when is it dec/absent?

A

X descent - downward displacement of closed tricuspid valve during rapid ventricular ejection phase

Dec/absent when - Reduced or absent in tricuspid regurgitation and right HF because pressure gradients are reduced

56
Q

What does the v wave and y descent represent?

A

v wave — Inc right atrial pressure due to filling (“villing”) against closed tricuspid valve.

y descent—RA emptying into RV.

57
Q

This profile is what disease?

A

Aortic Stenosis

Inc LV pressure
Inc ESV
No change in EDV
dec SV

58
Q

What disease is this?

A

Mitral Regurgitation

No true isovolumetric phase
dec ESV due to dec resistance and inc regurgitation into LA during systole

inc EDV due to Inc LA volume/pressure from regurgitation –> inc ventricular filling –> inc SV

59
Q

What disease is this?

A

Aortic Regurgitation

  • No true isovolumetric phase
  • Inc EDV
  • Inc SV
  • Inc pulse pressure
60
Q

What is this disease profile?

A

Mitral stenosis
Inc LA pressure
dec EDV because of impaired ventricular filling

dec ESV

dec SV

61
Q

Is the splitting b/w A2 and P2 wider or narrower during expiration?

A

narrower

62
Q

Name 2 path assoc with paradoxical splitting?

A

Aortic stenosis, LBBB

63
Q

When is y descent prominent and when is it absent?

A

Prominent in constrictive pericarditis, absent in cardiac tamponade.

64
Q

Name all holosystolic murmurs?

A

Mitral, Tricuspid regurgitation, VSD

65
Q

What heart murmur is associated with syncope, angina, dyspnea on exertion?

A

Aortic stenosis

66
Q

What pathology associated with pulsus parvus and tardus?

A

Aortic stenosis

67
Q

PDA is best heard in what part of the heart cycle?

A

S2

68
Q

PDA murmur is best heard where?

A

Left infraclavicular area

69
Q

Which murmurs are best heard in the tricuspid area?

A

Tricuspid regurgitation VSD

70
Q

What murmur is described as a high pitched blowing early diastolic decresendo murmur?

A

Aortic regurgitation

71
Q

4 pathologies associated with aortic regurgitation?

A

Aortic root dilation, Bicuspid aortic valve, Endocardititis, Rheumatic fever

72
Q

What 2 bedside maneuvers will dec preload?

A

Valsava, Standing Up

73
Q

Describe murmur sound for mitral valve prolapse?

A

Late systolic crescendo murmur with midsystolic click

74
Q

Why is there a midsystolic click in MVP?

A

Due to sudden tensing of chordae tendonae

75
Q

What bedside maneuver will inc afterload?

A

Handgrip and rapid squatting.

76
Q

Will dec preload lead to dec or inc MVP murmur?

A

Inc, early onset of click/murmur

77
Q

What are the 2 murmurs that become louder with dec preload?

A
  1. MVP 2. Hypertrophic cardiomyopathy
78
Q

What two paths are associated with wide splitting of S2?

A

Pulmonary stenosis, RBBB

79
Q

What wave is due to RV contraction (closed tricuspid valve bulging into atrium)?

A

c wave

80
Q

How does squatting affect TPR?

A

INC TPR

81
Q

How does intensity of AS murmur change with squatting?

A

INC bc TPR inc

82
Q

During inspiration, explain changes of preload on left and right side of the heart and changes of the effect on mitral/ tricuspid murmur?

A

During inspiration 1. Dec preload on L side - dec mitral murmur 2. Inc preload on R side - inc tricuspid murmur

83
Q

Name all 4 diastolic murmurs

A

aortic/pulm regurge mitral/tricuspid stenosis

84
Q

Name all 6 systolic murmurs

A

aortic/pulm stenosis mitral/tricuspid regurg’n VSD MVP

85
Q

a left shift apical impulse is caused by what?

A

ventricular dilation

86
Q

Causes a harsh holosystolic murmur?

A

VSD - most common congenital heart anomaly,

Step 1 2019 First Aid Flashcards (63 decks)

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