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FRACP > Cardio Physiology > Flashcards

Cardio Physiology Flashcards

1
Q

What causes hs1 and 2?

A

1- closure of the AV valves

2- closure of the SL valves

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2
Q

Why does HS2 have a physiological split

A

Pulmonary valve always closes slightly after the aortic

Exaggerated in inspiration as increased blood to the RA

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3
Q

What causes a fixed split S2

A

ASD

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4
Q

What causes a widened split S2 and why?

A

Delayed pulmonary valve closure
RBBB
HOCM
Pulm stenosis

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5
Q

What causes a pathological split S2

A

Aortic closing after the pulmonary
LBBB
Aortic stenosis

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6
Q

What causes a single S2

A

Pulm HTN
Truncus, pulm or aortic atresia
TOF, TGA, univentricular circ

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7
Q

What are the normal sats and pressures of the right heart-
RA
RV
Pulm a

A

RA-75% 5mmhg
RV- 75% 25/0mmhg
PA- 75%- 25/10

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8
Q

How do you calculate mixed venous sats

A

3xsvc+1xivc/4

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9
Q

What are the normal sats and pressure values for the L heart

A

LA-97% 5-10mmhg
LV-100/10 97%
Aorta- 97% 100/70

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10
Q

How do you calculate qp and Qs

What does Qs equate to

A

120/(pulm v- pulm a sats) hb x1.36
120/(aorta-Mv sats) x hb x1.36

Cardiac output

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11
Q

What is normal qp:Qs
What will it be in a right to left shunt
What will
It be in a left to right shunt

A

1
<1
>1

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12
Q

How do you calculate pulmonary vascular resistance

What is the normal value

A

Pa-la sats over qp

2, high is >6

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13
Q

What level is the shunt in ASD
is it volume or pressure related? Why?
What controls the degree and magnitude of the shunt

A

Arterial
Volume- occurs in diastole
Ventricular elasticity (compliance)

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14
Q

What level is the shunt in VSD
Is it volume or pressure related?
What controls the degree and magnitude of the shunt in a small or large lesion

A

Ventricular
Pressure related- increased left pressures
Small- pressure gradient
Large- pulmonary and systemic compliance

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15
Q

Left to right shunts- what is eisenmengers syndrome and why does it occur

A

Reversal to a right to left shunt over time- increased pulm pressure to the point where right heart pressure higher than left

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16
Q

Give 5 right to left shunts

What is the cardinal feature

A

Cyanosis

Truncus, TGA, tricuspid atresia, TOF, TAPVD

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17
Q

What are 2 physiological mechanisms behind cyanosis

A

Reduced oxygenation

Increased tissue usage

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18
Q

What are the 5 phases of the cardiac cycle

In which stages are the heart sounds
In which phase is the p wave, QRS complex and t wave

A 
Isovolumetric ventricular contraction 
Rapid ejection 
Reduced ejection 
Isovolumetric ventricular relaxation 
Ventricular filling
Isovolumetric contraction- HS1
Isovolumetric relaxation- HS2
P wave- ventricular filling 
QRS- isovolumetric contraction
T wave- reduces ejection
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19
Q

At what developmental point can the fetal heart circulate blood?
When do AV valves form?

A

3 weeks

6 weeks

20
Q

Outline the anatomy of the fetal circulation

A

Placenta sends oxygenated blood to the umbilical vein.
Shunts through the liver via the porta hepatis to the hepatic vein which attaches to the ivc
1/3 goes across the PFO (right to left shunt)
2/3 goes to the pulm artery
Highest oxygenated blood to the brain and coronaries
90% of blood across pda
Only 15%through the lungs

21
Q

What happens after birth to alter fetal back to normal circulation

A

Placenta is removed so systemic vascular resistance is raised. Porta hepatis closes
Take a breath, pulm vascular resistance falls, reversal of shunt and closure of PFO
o2 is sensed In the aorta and prostaglandin is released which causes the PDA to constrict

22
Q

Why does the PDA not close in premature babies ( 2 reasons)

A

Smooth muscle hasn’t learned to constrict with increased o2 levels
High levels of PGE2

23
Q

Why are premature babies more likely to have heart failure with a PDA

A

Smooth muscle isn’t developed as well
Sharp fall in PVR
large L to right shunt

24
Q

Timing of PDA closure:
Physiological
Anatomical

A

10-15 hrs

2-3 weeks

25
Q

Outline the pattern of electrolyte movement in the cardiac action potential

A 
Resting potential -90
Na rushes in- rapid increase to positive
K starts to leave- becomes more negative
Calcium enters- plateaus- slow channels 
K leaves again and ca channels close- returns to negative
26
Q

How do you calculate cardiac output

A

HR x SV

27
Q

How do you calculate stroke volume?

A

End systolic volume- end diastolic

28
Q

How do you calculate blood pressure

A

Cardiac output x SVR

29
Q

How do you calculate pulse pressure

A

Systolic BP- diastolic BP

30
Q

How do you calculate MAP

A

Diastolic + 1/3 pulse pressure

31
Q

What does Bernoulli’s equation calculate?

A

Change in pressure across a shunt or valve

32
Q

What is the equation used in a simple Bernoulli calculation

A

Change in pressure=4(distal velocity squared)

33
Q

What is the difference between ejection fraction and fractional shortening?

A

Ejection fraction=percentage pumped out with each contraction of systole

Fractional shortening=how much systole cuts into the end diastolic volume

34
Q

How do you calculate ejection fraction?

What is the normal value?

A

ESV-EDV/ESV

60%

35
Q

How do you calculate fractional shortening?

What is the normal value?

A

EDD-ESV/EDD

30%

36
Q

What is seen on ECG with right atrial and left atrial hypertrophy

A

Right- tall tented p waves

Left-bifid p waves (p mitrale)

37
Q

When are t waves upright

A

First week of life. After adolescence

38
Q

Axis
What is the mnemonic to remember a right and left axis deviation
What will a superior axis look like

A

Look at leads 1 and AVF
Right- right for each other- pointing towards
Left- left each other- pointing away
Superior- both point down

39
Q

What is the easy criteria for RVH

A

RAD
Upright t waves in v1
Tall R in v1
Deep S in v6

40
Q

What is the easy criteria for LVH

A

Tall r in v6, deep S in v1

41
Q

What do you seen in biventricular hypertrophy

A

Both and right criteria positive

Bibentricular forces v3-6

42
Q 
ECG and electrolytes 
What do you see in: 
Hyperkalaemia 
Hypokalaemia 
Hypercalcaemia 
Hypocalcaemia
Hypomagnesaemia

Hypothermia?

A 
HyperK- tall tented t waves and widened QRS
HypoK- u waves 
HyperCa- short QT
HypoCa- long QT
HypoMG- long QT

Long QT

43
Q

What is the main cause of systole in pacemaker cells

A

Rapid ca influx- stored in the sarcoplasmic reticulum

44
Q

Which embryonic structure is the heart made from
When do the 2 tubes fuse
When does looping begin

A

Mesoderm
20 days
28 days

45
Q

What makes the left and right ventricles
When does looping occur
When do the 4 chambers form?
When do the valves form?

A 
Left- primative ventricle 
Right- bulbous cordis 
24 days
28 days
8 weeks

FRACP (23 decks)

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