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NPLEX I (passing this time lol) > cardiology > Flashcards

cardiology Flashcards

1
Q

what is the most posterior part of the heart?

A

LA

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2
Q

what is the most anterior part of the heart?

A

RV

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3
Q

where does the pericardial cavity lie?

A

in between the layers of serous pericardium (visceral and parietal)

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4
Q

name layers of pericardium from outer to inner

A

fibrous
parietal (serous)
visceral (serous)

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5
Q

what parts of the heart does the LAD and its branches supply?

A

ant 2/3 of IV septum
anterolateral papillary muscle
anterior surface of LV

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6
Q

what is the most commonly occluded artery?

A

LAD

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7
Q

what parts of the heart does the PDA supply?

A

AV node (depending on dominance)
post 1/3 of IV septum
post 2/3 walls of ventricles
posteromedial papillary muscle

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8
Q

what artery supplies blood to the RV?

A

right (acute) marginal artery

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9
Q

what parts of the heart does teh RCA supply?

A

SA node

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10
Q

infarct of what artery may cause nodal dysfunction s/a bradycardia or heart block?

A

RCA

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11
Q

describe where the PDA arises from based on dominance and which is most common

A

right dominance (85%) - PDA arises from RCA
left dominance (8%) - PDA arises from LCX
codominant (7%) arieses from both

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12
Q

when does coronary blood flow peak (what part of heart cycle)

A

early diastole

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13
Q

stroke volume is affected by what parameters?

A

SV CAP
SV is affected by Contractility, Afterload, and Preload

inc contractility (anxiety, exercise) + inc preload (early pregnancy) inc SV
dec afterload inc SV

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14
Q

contractility (and thus SV) inc with

A

inc intracellular Ca (digitalis)
dec extracellular Na (dec activity of Na/Ca exchanger)
catecholamine stimulation with B1 receptor
phospholambin phosphorylation

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15
Q

contractility (and thus SV) dec with

A

B1 blockade (dec cAMP)
HF with systolic dysfunction
acidosis
hypoxia/hypercapnia (dec PO2, inc PCO2)
non-dihydropyridine Ca channel blockers

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16
Q

what happens to SV in heart failure?

A

dec

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17
Q

how is preload determined? what does it depend on?

A

estimated by ventricular EDV; depends on venous tone and circulating blood volume

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18
Q

what could decrease preload?

A

venous vasodilators such as nitroglycerin\
ACEis and ARBs

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19
Q

how does the LV compensate for increased afterload?

A

thickening (hypertrophy) to dec wall tension

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20
Q

what decreases afterload?

A

arterial vasodilators such as hydralazine
ACEiS and ARBs

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21
Q

what is used to approximate afterload?

A

MAP

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22
Q

chronic hypertension has what effect on LV?

A

chronic HTN > inc MAP > LV hypertrophy

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23
Q

what is Laplace’s law?

A

wall tension = pressure x radius

wall stress = pressure x radius / 2 x wall thickness

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24
Q

myocardial O2 demand is increased by:

A

CARD - increased:
Contractility
Afterload (proportional to arterial pressure)
Rate of heart
Diameter of ventricle (inc wall tension)

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25
Q

SV =

A

SV = EDV - ESV

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26
Q

EF =

A

EF = SV/EDV

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27
Q

CO =

A

CO = HR x SV

fick principle: CO = rate of O2 consumption / (arterial O2 content - venous O2 content)

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28
Q

PP =

A

PP = SBP - DBP

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29
Q

MAP =

A

MAP = CO x TPR

MAP (at resting HR) > 2/3 DBP + 1/3 SBP = DBP + 1/3 PP

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30
Q

EF is a measure of what? what happens to EF in heart failure?

A

EF is a measure of ventricular contractility

dec in systolic HF, normal in diastolic HF

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31
Q

what is CO maintained by?

A

in early stages of exercise, inc HR and inc SV
in later stages, inc HR only (SV plataeus)

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32
Q

what shortens diastole? what affect does shorter diastole have on CO?

A

inc HR (vetricular tachycardia) > dec diastolic filling time > dec SV > dec CO

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33
Q

PP relationship to SV and arterial compliance

A

PP is proportional to SV and inversely proportional to arterial compliance

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34
Q

PP is increased with

A

hyperthyroid
aortic regurg
aortic stiffening (isolated systolic HTN in elderly)
obstructive sleep apnea (inc sympathetic tone)
anemia
exercise (transient)

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35
Q

PP is decreased with

A

aortic stenosis
cardiogenic shock
cardaic tamponade
advanced HF

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35
Q

PP is decreased with

A

aortic stenosis
cardiogenic shock
cardaic tamponade
advanced HF

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36
Q

starling law says what

A

the heart’s ability to vary contractility based on blood volume;

the force of systolic contraction is directly proportional to diastolic length of cardiac muscle fiber (preload/how much blood fills ventricles during diastole)

short length of muscle fibers = low contractile force

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37
Q

contractility is increased by

A

catecholamines
positive inotropes such as digoxin, sympathetic NS

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38
Q

contractility is decreased by

A

loss of myocardium (MI)
B blockers (acutely)
non-dihydropyridine Ca channel blockers
dilated cardiomyopathy

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39
Q

the heart pumps ___ blood with ___ through ___ to the tissues

and recieves ___ blood with ___ through the ___

A

the heart pumps oxygenated blood with nutreitns through arteries

and recieves deoxygenated blood with waste products through veins

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40
Q

SV, EDV, ESV, etc occur in the ___ chamber

A

LV

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41
Q

the force of contraction depends on

A

the number of myosin heads that bind to actin > depends on the length of the overlapping section > depends on overall length of sarcomere > depends on how much blood fills ventricles during diastole

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42
Q

the bulbus cordis gives rise to…

A

smooth parts (outflow tract) or left and right ventricles

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43
Q

the endocardial cushion gives rise to…

A

atrial septum, membranous IV septum, AV and semilunar valves

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44
Q

the left horn of sinus venosus gives rise to…

A

coronary sinus

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45
Q

the posterior, subcardinal, and supracardinal veins gives rise to…

A

IVC

46
Q

the primitive atrium gives rise to…

A

trabeculated part of left and right atria

47
Q

the primitive pulmonary vein gives rise to…

A

smooth part of left atrium

48
Q

the primitive ventricle gives rise to…

A

trabeculated part of left and right ventricles

49
Q

the right common vardinal vein and right anterior cardinal vein gives rise to…

A

SVC

50
Q

the right horn of sinus venosus gives rise to…

A

smooth part of right atrium (sinus venarum)

51
Q

the truncus arteriosus gives rise to…

A

ascending aorta and pulmonary trunk

52
Q

what is special about the heart in embryonic development?

A

first functional organ in vertebrate embryos

53
Q

when does the heart start beating

A

beats spontaneously by week 4 of development

54
Q

when does heart looping to establish left right polarity begin? a defect in this can cause what?

A

week 4 of gestation
Defect in left right Dynein > Dextrocardia (Kartagener syndrome; 1deg ciliary Dyskinesia)

55
Q

separation of atrial chambers steps

A

septum primum grows toward endocardial cushions, narrowing foramen primum

foramen secundum forms in septum primum, foramen primum disappears

septum secondum develops as foramen secunum maintains right to left shunt

septum secondum expands and covers most of foramen secunum; remaining foramen secondum = foramen ovale. remaining septum primum = valve of foramen ovale

septum secondum and septum primum fuse > atrial septum

foramen ovale closes right after birth bc inc LA pressure and dec RA pressure

56
Q

separation of ventricular chambers steps

A

muscular IV septum forms, opening called IV foramen

aorticopulmonary septum rotates + fuses with muscular IV septum > membranous IV septum, closing IV foramen

growth of endocardial cusions separates atria from ventricles and contributions to both atrial septation and membranous IV septum

57
Q

where do neural crest and endocardial cells migrate to?

A

ascending aorta + pulmonary trunk
truncal and bulbar ridges that spiral and fuse to form aorticopulmonary septum

58
Q

conotruncal abnormalities associated with failure of neural crest cells to migrate include:

A

transposition of great vessels
tetralogy of fallot
persistent truncus arteriosus

59
Q

post natal derivative of allantois / urachus

A

median umbilical ligament

60
Q

post natal derivative of ductus arteriosus

A

ligamentum arteriosum

61
Q

post natal derivative of ductus venosus

A

ligamentum venosum

62
Q

post natal derivative of foramen ovale

A

fossa ovalis

63
Q

post natal derivative of notochord

A

nucleus pulposus

64
Q

post natal derivative of umbilical arteries

A

medial umbilical ligaments

65
Q

post natal derivative of umbilical vein

A

ligamentum teres hepatis (round ligament)

66
Q

describe the pathway of fetal circulation

A

umbilical vein > ductus venosus > IVC

(oxygenated) IVC > foramen ovale > aorta > fetal head + body

(deoxygenated) IVC > SVC > RA > RV > Pulm A > ductus arteriosus > descending aorta (this shunt is due to high fetal pulmonary artery resistance, partly due to low O2 tension)

67
Q

heart derives from (germ layer)

A

mesoderm

68
Q

what effect do inotropes have on cardiac/vascular function

A

changes in contractility > altered SV > altered CO/VR and RA pressure (RAP)

69
Q

When is viscosity increased

A

Hyperproteinemic states (eg multiple myeloma), polycythemia

70
Q

When is viscosity decreased

A

Anemia

71
Q

Viscosity mostly depends on

A

Hematocrit

72
Q

Compliance =

A

Change in volume / change in pressure

73
Q

Change in pressure =

A

Q (volumetric flow rate) x R (resistance)

74
Q

What part of cardiac/vascular function curves shows the operating point of the heart?

A

The operating point of the heart (venous return and CO are equal) is at the intersection of the curves

75
Q

The circulatory system is a ____ system

A

Closed

76
Q

Capillaries have the ___ total cross sectional area and the ____ flow velocity

A

Capillaries have the highest cross sectional area and the lowest flow velocity

77
Q

What BV accounts for most of TPR?

A

Arterioles

78
Q

inotropy effect

A

Changes in contractility

> changes in SV > CO/VR > RAP

79
Q

+ inotropes

A

Catecholamines, digoxin, exercise

80
Q
  • inotropes
A

HF with reduced EF, narcotic overdose, sympathetic inhibition

81
Q

Effect of changing venous return

A

Changes in circulating volume

> changes in RAP > SV > CO

82
Q

+ venous return

A

Fluid infusion, sympathetic activity

83
Q
  • venous return
A

Acute hemorrhage, spinal anesthesia

84
Q

TPR changes effect

A

Changes in TPR

> changes in CO > changes in RAP unpredictable

85
Q

+ TPR

A

Vasopressors

86
Q
  • TPR
A

Exercise, AV shunt

87
Q

What are the phases of the left ventricle in normal cardiac function

A

Systole -

Isovolumetric contraction - period bw mitral closure and aortic opening

Systolic ejection - period bw aortic opening and closing

Diastole -

Isovolumetric relaxation - period bw aortic closing and mitral opening

Rapid filling - period right after mitral opening

Reduced filling - period just before mitral closing

88
Q

What phase of the cardiac cycle is the period of highest oxygen consumption?

A

Isolvolumetric contraction

89
Q

S1 is what? and where is it best heard?

A

S1 = mitral and tricuspid closure
Best heart mitral area

90
Q

S2 is what? and where is it best heard?

A

S2 = aortic and pulmonic closure
Best heard left upper sternal border

91
Q

S3 is heard when? What is it associated with?

A

S3 = early diastole during rapid ventricular filling. Associated with inc filling pressures (mitral regurgitation, HF) and common in dilated ventricles but can be normal in kids, young adults, and pregnant women

92
Q

S4 is heard when? What is it associated with? how is it best heard?

A

S4 = late diastole “atrial kick” - high atrial pressure associated with ventricular noncompliance (eg hypertrophy); left atrium must push against stiff LV wall. Abnormal in any age.

best heart at apex with pt in left lateral decubitus position

93
Q

Waves of jugular venous pulse JVP (right atrial pressure curve)

A

A wave - atrial contraction
C wave - RV contraction (closed tricuspid bulging into atrium)
X descent - downward displacement of closed tricuspid during rapid ventricular ejection phase.
V wave - inc right atrial pressure due to filling (“villing”) against closed tricuspid valve
Y descent - RA emptying into RV.

94
Q

When is the a wave of right atrial pressure curve (JVP) absent?

A

Atrial fibrillation

95
Q

When is the x descent of right atrial pressure curve (JVP) reduced or absent? Why?

A

In tricuspid regurgitation and HF because pressure gradients are reduced

96
Q

When is the y descent of right atrial pressure curve (JVP) prominent?

A

Constructive pericarditis

97
Q

pathologic changes in aortic stenosis

A

dec LV pressure
dec SV
inc ESV

ventricular hypertrophy > dec compliance > inc EDP for given EDV

98
Q

pathologic changes in mitral regurgitation

A

inc EDV
inc SV
dec ESV (due to dec resistance and inc regurg into LA during sys)
no true isovolumetric phase

99
Q

pathologic changes in aortic regurgitation

A

inc EDV
inc SV
inc PP
no true isovolumetric phase

100
Q

pathologic changes in mitral stenosis

A

inc LAP
dec ESV
dec SV
dec EDV (due to impaired ventricular filling)

101
Q

what is wide splitting and when is it seen

A

delayed pulmonic sound, esp on inspiration.

conditions that delay RV emptying s/a pulmonic stenosis, right bundle branch block

102
Q

what is fixed splitting and when is it seen

A

ASD > left to right shunt > inc RA and RV vol > inc pulmonic valve flow

greatly delayed pulmonic closure, regardless of breath

103
Q

what is paradoxal splitting and when is it heard

A

normal order of valve closure is reversed so P2 soumd occurs before delayed A2 sound so on inspiration P2 closes later and moves closer to A2, usually heard on expiration

conditions that delay aortic closure s/a aortic stenosis, left bundle branch block

104
Q

what murmurs can be heard at the aortic area

A

All systolic

aortic stenosis
flow/physiologic murmur
aortic sclerosis

105
Q

what murmurs can be heard at the left sternal border (erbs)

A

diastolic:
aortic regurgitation
pulmonic regurgitation

systolic:
hypertrophic cardiomyopathy

106
Q

what murmurs can be heard at the pulmonic area

A

systolic ejection murmurs:
pulmonic stenosis
atrial septal defect
flow murmur

107
Q

what murmurs can be heard at the tricuspid area

A

holosystolic murmurs:
tricuspid regurgitation
ventricular septal defect

distolic murmurs:
tricuspid stenosis

108
Q

what murmurs can be heard at the mitral area/apex

A

holosystolic: mitral regurg
systolic: mitral prolapase
diastolic: mitral stenosis

109
Q

what effect does the manuver of inspiration have

A

inc venous return to RA

inc intensity of R heart sounds

110
Q

what effect does the manuver of hand grip have

A

inc afterload
inc intensity of MR, AR, and VSD mumurs
delays click/murmur of MVP

111
Q

what effect do the manuvers of valsalva and standing up have

A

dec preload
dec intensity of most murmurs, inc AS
inc intensity of hypertrophic cardiomyopathy murur
earlier click for MVP

112
Q

what effect does the manuver of rapid squatting have

A

inc venous return
inc preload
inc afterload
inc intensity of MR, AR, and VSD murmurs
dec intensity hypertrophic cardiomyopathy murmur
later click MVP

NPLEX I (passing this time lol) (2 decks)

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