Cardio - FA Anat/Phys 281- 289 Flashcards
Enlargement of what part of the heart causes dysphagia or hoarseness - why?
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).
Part of heart most commonly injured in trauma
RV
3 layers of pericardium
Fibrous pericardium Parietal layer of serous pericardium Visceral layer of serous pericardium
Pericardium innervated by?
phrenic n
Pericardititis causes referred pain to?
to the neck, arms, or one or both shoulders (often left).
Occlusion of which artery with lead to nodal dysfunction? Symptoms?
RCA - brady, heart block
Most common location of coronary a occlusion?
LAD
LAD supplies?
anterior of interventricular septum, anterolateral papillary muscle, and anterior surface of LV
PDA supplies?
AV node (dependent on dominance), posterior 1/3 of interventricular septum, posterior 2/3 walls of ventricles, and posteromedial papillary muscle
RCA supplies? Infarct may cause what sx?
SA node;
bradycardia, heart block
Peak flow in coronaries at what part of cardiac cycle?
early diastole
Stroke volume is affected by what 3 things?
1- afterload
2- preload
3- contractility
SV is inc by which parameters?
- inc Contractility
- dec Afterload
- inc Preload
What increases contractility?
- 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++
- Inc IC Ca2+
- decrease EC Na+ ( via decrease Na/Ca2+ exchanger)
- digitalis ( blocks Na+/K+ pump)—> increaseing intracellular Na+—>decreasing Na+/Ca++ exchanger activity—> increase intracellular Ca++
What dec contractility and SV?
- Beta 1 blockade (decrease cAMP)
- HF w/ systolic dysfunction
- Acidosis
- hypoxia, hypercapnia, ( decrease Partial pressure of oxygen/increase partial pressure of CO2)
- non-dihydropyridine CCB
What parameter estimates preload?
ventricular EDV
( disclaimer ***depends on venous tone and circulating blood volume)
What drug decrease preload?
What drug decrease afterload?
What drugs decreases both?
- Preload - venous vasodilators/ venodilators (Nitroglycerin)
- Afterload - arterial vasodilators (Hydralazine)
- ACE, ARBS
How does LV compensate for inc afterload?
by thickening (hypertrophy) in order to dec wall tension.
What parameters will inc myocardial O2 demand?
- Inc contractility
- afterload,
- Heart Rate
- diameter of ventricle
Laplace’s law for wall tension
Wall tension = pressure x radius
wall stress = ?
wall stress = pressure x radius/2 x wall thickness
what are the 2 equations for stroke volume?
SV = CO/HR
SV = EDV - ESV
what is ejection fraction?
EF = SV/ EDV = EDV-ESV/EDV
Ejection Fraction is normal in diastolic or systolic Heart failure?
Ejection fraction is a measure/index of what?
EF is an index of ventricular contractility
EF decreased in systolic HF
EF is normal in diastolic HF
what is the Fick principle for Cardiac output?
CO = rate of O2 consumption/(arterial O2 content – venous O2 content)
How is CO maintained in early and late stages of exercise?
Early - inc HR, SV
Late - only inc HR (SV plateaus)
Diastole is shortened with a change in what cardiac parameter ? This leads to what?
Diastole is shorted with increased HR (ex/ VTACH)—> decreased diastolic filling time—> decreased SV—> decreased CO
Pulse pressure is directly proportional to __and inversely proportional to __.
SV
arterial compliance
What leads to inc pulse pressure?
Hyperthyroidism
Aortic Regurgitation
Aortic stiffening (isolate systolic HTN in elderly)
Obstructive sleep apnea (Inc SANS tone)
Anemia
Exercise (transcient)
Decreased pulse pressure is seen in?
aortic stenosis
cardiogenic shock
cardiac tamponade
advanced HF
Which conditions lead to dec pulse pressure?
Aortic stenosis Cardiogenic shock cardiac tamponade advanced CHF
what are the 2 equations for MAP?
- MAP = CO x TPR
- MAP( at resting HR) = 2/3 DBP + 1/3 SBP = DBP + 1/3 PP
Inc contractility is seen with ?`
catecholamines, positive inotropes (eg, digoxin)
exercise
dec contractility is seen with ?
loss of myocardium (eg, MI), β-blockers (acutely), non-dihydropyridine Ca2+ channel blockers, dilated cardiomyopathy.
Force of contraction is proportional to ____ _______ length of ______ _____ _______ .
(Starling Mech)
Force of contraction is proportional to enddiastolic length of cardiac muscle fiber (preload).
What inc/dec viscosity?
Inc = Hyperproteinemic states, polycythemia dec = anemia
Which type of vessel affects TPR most?
arterioles
How does exercise affect TPR/CO?
decrease TPR (thereby inc CO/VR)
How does an AVs shunt affect CO?
AV shunts will dec TPR –> inc CO
Orange line = ?
Blue line = ?
Green line = ?
List the heart sounds
Which valve is opening or closing?
`
Orange line?
Blue line ?
Green line?
Which heart sounds?
Which valve open/closes when?
S1 and S2 - which valves close?
S1—mitral and tricuspid valve closure. Loudest at mitral area.
S2—aortic and pulmonary valve closure. Loudest at left upper sternal border.
What part of the cardiac cycle is S3? `
in early diastole during rapid ventricular filling phase
S3 is associated with inc ___________ _________
filling pressures
S3 is normal in what people?
More common with ______ _______
S3 more common in dilated ventricles (but can be normal in children, young adults, and pregnant women)
S4 is at what part of the cardiac cycle?
in late diastole (“atrial kick”)
Mechanism of S4?
Left atrium pushes against stiff LV wall, also known as atrial kick
How is S4 best heard?
At the apex with pt in left lat decubitis position
Two pathologies associated with S4?
Ventricular hypertrophy hypertrophic cardiomyopathy
What pulse curve is this? What does a and c represent?
A - atrial contraction
c - RV contraction ( closed tricuspid bulging into atrium)
When is the a wave missing?
Absent in Afib
What does the x descent represent? and when is it dec/absent?
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
What does the v wave and y descent represent?
v wave — Inc right atrial pressure due to filling (“villing”) against closed tricuspid valve.
y descent—RA emptying into RV.
This profile is what disease?
Aortic Stenosis
Inc LV pressure
Inc ESV
No change in EDV
dec SV
What disease is this?
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
What disease is this?
Aortic Regurgitation
- No true isovolumetric phase
- Inc EDV
- Inc SV
- Inc pulse pressure
What is this disease profile?
Mitral stenosis
Inc LA pressure
dec EDV because of impaired ventricular filling
dec ESV
dec SV
Is the splitting b/w A2 and P2 wider or narrower during expiration?
narrower
Name 2 path assoc with paradoxical splitting?
Aortic stenosis, LBBB
When is y descent prominent and when is it absent?
Prominent in constrictive pericarditis, absent in cardiac tamponade.
Name all holosystolic murmurs?
Mitral, Tricuspid regurgitation, VSD
What heart murmur is associated with syncope, angina, dyspnea on exertion?
Aortic stenosis
What pathology associated with pulsus parvus and tardus?
Aortic stenosis
PDA is best heard in what part of the heart cycle?
S2
PDA murmur is best heard where?
Left infraclavicular area
Which murmurs are best heard in the tricuspid area?
Tricuspid regurgitation VSD
What murmur is described as a high pitched blowing early diastolic decresendo murmur?
Aortic regurgitation
4 pathologies associated with aortic regurgitation?
Aortic root dilation, Bicuspid aortic valve, Endocardititis, Rheumatic fever
What 2 bedside maneuvers will dec preload?
Valsava, Standing Up
Describe murmur sound for mitral valve prolapse?
Late systolic crescendo murmur with midsystolic click
Why is there a midsystolic click in MVP?
Due to sudden tensing of chordae tendonae
What bedside maneuver will inc afterload?
Handgrip and rapid squatting.
Will dec preload lead to dec or inc MVP murmur?
Inc, early onset of click/murmur
What are the 2 murmurs that become louder with dec preload?
- MVP 2. Hypertrophic cardiomyopathy
What two paths are associated with wide splitting of S2?
Pulmonary stenosis, RBBB
What wave is due to RV contraction (closed tricuspid valve bulging into atrium)?
c wave
How does squatting affect TPR?
INC TPR
How does intensity of AS murmur change with squatting?
INC bc TPR inc
During inspiration, explain changes of preload on left and right side of the heart and changes of the effect on mitral/ tricuspid murmur?
During inspiration 1. Dec preload on L side - dec mitral murmur 2. Inc preload on R side - inc tricuspid murmur
Name all 4 diastolic murmurs
aortic/pulm regurge mitral/tricuspid stenosis
Name all 6 systolic murmurs
aortic/pulm stenosis mitral/tricuspid regurg’n VSD MVP
a left shift apical impulse is caused by what?
ventricular dilation
Causes a harsh holosystolic murmur?
VSD - most common congenital heart anomaly,
