Cardio Physiology

Question 1

When do you see WIDENED SLITTING of S2?

Answer 1

Delayed RV emptying conditions -
RBBB, Pulmonic stenosis
Takes longer for pulmonic valve to close

Question 2

When do you see a fixed splitting of S2?

Answer 2

ASD (L->R shunt)
Increase in RA and RV volumes so much to a point that there is not much of a difference in INCREASED CAPACITANCE with inspiration and expiration

Question 3

When do you see PARADOXICAL SPLITTING of S2?

Answer 3

Severe AORTIC STENOSIS + LBBB (Delayed LV emptying)
FACTOR 1: Delayed A2 - Takes longer for aortic valve to close
FACTOR 2: Delayed P2 with inspiration

EXPIRATION: P2 before A2
INSPIRATION: P2 and A2 fused together

Question 4

BOOT SHAPED HEART ON CXR

Answer 4

RVH (TETRALOGY OF FALLOT)

Question 5

MACHINE LIKE MURMUR

Answer 5

PATENT DUCTUS ARTERIOSUS

Question 6

Explain the differences between PATENT DUCTUS ARTERIOSUS and PERSISTENCE OF FORAMEN OVALE and PERSISTENT TRUNCUS ARTERIOSUS?

Answer 6

PERSISTENCE OF FORAMEN OVALE (ASD SECONDUM TYPE) Too much apoptosis of the septum primum -> Septum secondum can not close the foramen secondum -> Foramen ovale does not close after birth (L->R shunt) = ACYANOSIS

PATENT DUCTUS ARTERIOSUS: Ductus arteriosus does NOT close after birth as it should (normally increased O2 and decreased PGE2 closes PDA) resulting in (L->R shunt) = ACYANOSIS

PERSISTENT TRUNCUS ARTERIOSUS: Aorticopulmonary septum simply does NOT form -> No pulmonary artery and aorta formation -> Mixed blood in ONE outflow vessel -> 100% of these pts have VSD = R->L shunt = CYANOSIS

Question 7

Which congenital heart defect requires surgical intervention of creating a septal defect (VSD, ASD, PDA, or patent foramen ovale)?

Answer 7

TRANSPOSITION OF GREAT ARTERIES

Question 8

What is the difference of how CYANOSIS presents in TETRALOGY OF FALLOT and TRANSPOSITION OF GREAT ARTERIES?

Answer 8

Transposition of Great Arteries = CYANOSIS AT BIRTH - Fatal without surgical intervention within the first few months

Tetralogy of Fallot = CYANOSIS at TODDLER - when O2 demands increase and start becoming more active

Question 9

What is the adult remnant of closure of DUCTUS ARTERIOSUS?

Answer 9

LIGAMENTUM ARTERIOSUM

Question 10

What is the adult remnant of closure of DUCTUS VENOSUS?

Answer 10

LIGAMENTUM VENOSUM

Question 11

What is the adult remnant of closure of UMBILICAL ARTERY CLOSURE and ALLANTOIS -> URACHUS (part of allantoic duct between bladder and umbilicus)?

Answer 11

MEDIAN UMBILICAL LIGAMENTS

Question 12

What is the adult remnant of closure of UMBILICAL VEIN CLOSURE?

Answer 12

LIGAMENTUM TERES HEPATIS (part of falciform ligament)

Question 13

What is the adult remnant of closure of FORAMEN OVALE?

Answer 13

FOSSA OVALIS

Question 14

What is the adult remnant of closure of NOTOCHORD?

Answer 14

NUCLEUS PULPOSUS