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NPLEX 1 - Urology > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Truncus arteriosus gives rise to

A

Ascending aorta and pulmonary trunk

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2
Q

Bulbus cordis gives rise to

A

smooth parts )Outflow tract of LV and RV)

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3
Q

Primitive ventricle/atrium gives rise to

A

trabeculated part of L & R ventricles and atrIa

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4
Q

L horn of sinus venosus gives rise to

A

Coronary sinus

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5
Q

R horn of sinus venosus gives rise to

A

smooth part of R atrium ( sinus venarum)

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6
Q

Endocardial cushion gives rise to

A

Atrial septum, membranous IV septum, AV and semilunar valves

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7
Q

R common cardinal & R anterior cardinal vein gives rise to

A

SVC

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8
Q

Posterior cardinal, subcardinal and supracardinal veins

A

IVC

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9
Q

Primitive pulmonary vein

A

Smooth part of LA

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10
Q

The heart is the first functional organ in vertebrae embryos. beats spontaneously by ______ week of development

A

4

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11
Q

In atrial septation, what is the name of the first septum to form?

A

Septum primum

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12
Q

What is the name of the opening created when the septum primum grows towards endocardial cushions?

A

Ostium primum

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13
Q

Why does septum primum closes against septum secundum, sealing the foraman ovale soon after birth?

A

Increased LA pressure and decreased RA pressure

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14
Q

What two septums fuse during infancy/early childhood forming the atrial septum

A

Septum secundum & septum primum

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15
Q

Patent foramen ovale etiology

A

Failure of septum primum and septum secundum to fuse after birth
- Most left untreated

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16
Q

What is the most common congenital cardiac anomaly?

A

Ventricular septal defect

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17
Q

Explain outflow tract formation

A

Neural crest cell migration–>truncal and bulbar ridges that spiral and fuse to form aorticopulmonary septum –>ascending aorta & pulm trunk

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18
Q

1st aortic arch derivatives develop into arterial system

A

part of maxillary artery (branch of external carotid)

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19
Q

2nd aortic arch derivatives develop into arterial system

A

Stepedial artery and hyoid artery

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20
Q

3rd aortic arch derivatives develop into arterial system

A

Common carotid artery and proximal part of internal carotid artery

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21
Q

4th aortic arch derivatives develop into arterial system

A

Aortic arch & proximal part of right subclavian artery

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22
Q

4th aortic branch corresponding nerve

A

Right recurrent laryngeal nerve (loops around R subclavian artery)

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23
Q

6th aortic arch derivatives develop into___ arterial system

A

proximal part of pulm arteries & ductus arteriosus (left only)

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24
Q

6th aortic branch corresponding nerve

A

Left recurrent laryngeal nerve (loops around ductus arteriosus)

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25
Q

Ductus arteriosus gives rise to

A

ligamentum arteriosum

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26
Q

Ductus venosus

A

ligamentum venosum

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27
Q

Foramen ovale

A

fossa ovalis

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28
Q

Umbilical arteries

A

medial umbilical ligamentes

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29
Q

Umbilical veins

A

Ligamentum teres (hepatis)

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30
Q

Umbilical vein carries

A

oxygenated blood

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31
Q

Umbilical arteries carry

A

Deoxygenated blood

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32
Q

What are the 3 layers of the heart wall

A
  • Endocardium: innermost layer, lines the interior of the heart chambers, covers valves
  • Myocardium: middle layer- composed of cardiac muscle
  • Epicardium: outermost layer aka visceral layer of serous pericardium - forms valve rings, helps anchor muscle fibers
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33
Q

What are the 3 layers of pericardium (outer to inner)?

A
  • Fibrous pericardium - external
  • parietal pericardium- internal
  • Visceral pericardium aka Epicardium
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34
Q

Pericardial space lies b/n

A

Parietal layer of serous pericardium and visceral layer of serous pericardium (epicardium)

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35
Q

What is myocardium composed of?

A

Cardiac muscle, responsible for the contractile function of the heart

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36
Q

What is epicardium composed of?

A

Covered by the visceral layer of pericardium, contains coronary blood vessels and nerves

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37
Q

Pericardium is innervated by ____nerve

A

Phrenic nerve

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38
Q

What are the three tunics of an artery wall?

A
  • Tunica intima: innermost layer
  • Tunica media: middle layer
  • Tunica adventitia: outermost layer
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39
Q

What is the composition of tunica intima?

A
  • Endothelial cell layer, CT, & internal elastic membrane
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40
Q

What is the composition of tunica media?

A

smooth muscle fibers, elastic and collagenous tissues

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41
Q

What is tunica adventitia composed of?

A

Loose collagenous CT, blood and lymph vessels, nerves and fibroelastic CT, vasa vasorum

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42
Q

Contractility and (SV) increases with

A
  • Catecholamine stimulation via B1 receptors
  • inc intracellular Ca2+
  • dec extracellular Na+ (dec activity of Na/Ca exchanger)
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43
Q

Apex (anterior left) formed mainly by

A

LV

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44
Q

Base of the heart (posterior aspect) formed mainly by

A

LA

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45
Q

Diaphragmatic (inferior surface)

A

L&R ventricles

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46
Q

Anterior (sternocostal surface) formed mainly by

A

RV

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47
Q

Pulmonary (left surface located in the cardiac impression of L lung) formed mainly by

A

LV

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48
Q

What is the most posterior part of the heart

A

LA

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49
Q

Explain etiology and sx of Ortner syndrome

A

LA enlargement can be cause by Mitral stenosis. Enlargement of the LA chamber will cause compression of the esophagus causing- dysphasia and compression of L laryngeal nerve causes hoarseness

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50
Q

What is the most anterior part of the heart

A

RV (commonly injured in trauma)

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51
Q

Boundaries of the heart (inner to outer)

A

Endocardium > Myocardium > Epicardium (visceral layer of serous pericardium) > Parietal layer of serous pericardium > Fibrous pericardium

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52
Q

Draw major vessels of the heart

A
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53
Q

List AV and semilunar valves

A

AV: Tricuspid and Mitral (bicuspid) valves
SV: Pulmonary and aortic valves

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54
Q

Mitral valve: location, function, auscultation

A

Location: Between the left atrium and left ventricle

Function: prevents backflow from the LV to LA during ventricular systole

Auscultation: 5th ICS MCL ( Apex)
S1:Mitral and tricuspid Close, loudest at mitral area (systole)

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55
Q

Blood flow through the heart

A

deoxygenated blood IVC and SVC –> R atrium –> TRICUSPID V–>Right ventricle –>PULMONIC V–>pulmonary arteries (R,L)–> lungs–>oxygenated blood enters through pulmonary veins –>L atrium–>MITRAL V–>L ventricle–> AORTIC V–> Aorta –> to the rest of the body

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56
Q

S1 sound is heard during ————–at the beginning of —————–

A

closure of AV vlaves- isometric contraction
Systole

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57
Q

S2 sound is heard during —————at the beginning of —————-

A

closure of semilunar valves- isometric relaxation
Diastole

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58
Q

S3 sound

A

benign in kids and trained athletes. if heard later in life = indication of HF

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59
Q

Stenosis occurs during ———-

A

late diastole

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60
Q

Regurgitation occurs during —————

A

early diastole

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61
Q

Vascular dysfunction during diastole

A

(ARMS & PaRTS)
Aortic regurgitation
Mitral stenosis
Pulmonic regurgitation
Tricuspid stenosis

62
Q

Vascular dysfunction during systole

A

(Opposite of ARMS & PaRTS)
Aortic stenosis
Mitral regurgitation
Pulmonic stenosis
Tricuspid regurgitation

63
Q

Mitral regurgitation murmur

A

holosystolic murmur

64
Q

Mitral stenosis murmur

A

diastolic murmur

65
Q

Mitral valve prolapse

A

Systolic murmur (midsystolic click)

66
Q

Tricuspid valve: location, function, auscultation

A

location: b/n RA and RV

function: prevents back flow from RV to RA during ventricular systole

Auscultation: 5th L ICS - during S1 (systole)

67
Q

Tricuspid regurgitation murmur

A

Holosystolic murmur

68
Q

Tricuspid stenosis murmur

A

diastolic murmur

69
Q

Ventricular septal defect

A

holosystolic murmur

70
Q

Pulmonic valve: location, function, auscultation

A

location: b/n RV and pulmonary artery

function: prevents backflow from the pulmonary artery to RV during ventricular diastole

Auscultation: 2nd L ICS

71
Q

Pulmonic stenosis, atrial septal defect, and flow murmurs are all ______murmurs

A

Systolic ejection murmurs

72
Q

Aortic valve: location, function, auscultation

A

location: between the LV and aorta

function: prevents backflow from aorta to LV during ventricular diastole

73
Q

What murmurs can be appreciated at Erb’s point? 3rd L ICS

A
  • Aortic regurgitation- Diastolic murmur
  • Pulmonic regurgitation- diastolic murmur
  • Hypertrophic cardiomyopathy - systolic murmur
74
Q

S3 sound is heard during

A

Early diastole eg. can be normal, mitral regurgitation, HF

75
Q

S4 sound is heard during

A

Late diastole. Always abnormal, hypertrophy

76
Q

Cardiac muscle intercalated discs

A

cell membranes that separate individual cardiac muscles from one another

77
Q

Gap junctions function

A

found at each intercalated disc. allows transfer of ions and small molecules including

78
Q

what is syncytium of cardiac muscle

A

Atrial wall contraction followed by ventricular walls contraction due to the rapid spread of AP from one cardiac cell to the next through intercalated discs

79
Q

5 phases of cardiac muscle AP

A

0- rapid depolarization
1- initial repolarization
2- Plateau (unique to cardiac AP)
3- Rapid repolarization
4- Resting membrane potential

80
Q

Ion flow during AP phase 0

A
  • SA node stimulates the conduction system
  • Voltage gated fast Na channels open
  • rapid flow of Na +1 depolarizes the cell membrane
  • Membrane potential becomes more positive
  • Volgage gated slow Ca 2+ channels open and influx 2+ making cell more positive
81
Q

Ion flow during AP phase 1

A
  • voltage gated fast Na
    channels close
  • voltage gated fast K +1 channels open and leave the cell = (repolarization at the peak)
  • Ca is still entering in the background
82
Q

ion flow during AP phase 2

A
  • Voltage gated (fast) K channels close
  • Voltage gated slow Ca channels still open triggers more Ca release from sarcoplasmic reticulum —> myocyte contraction
83
Q

ion flow during AP phase 3

A
  • Voltage gated slow Ca channels close
  • Voltage gated (slow) K channels open Efflux +1 leaving cell
84
Q

ion flow during AP phase 4

A
  • high K permeability - brings it to resting AP.
    k high intracellularly
    Na high extracellularly
85
Q

how does the cell reset after AP/Excitation contraction coupling

A
  • Ca gets pumped back to sarcoplasmatic reticulum using calcium ATPase pump
  • some calcium leaves the cells through Ca2+/Na+ exchanger
  • Na+ leaves cell and K+ enters cell via Na+/K+ channels ATPase pump
86
Q

Cardiac muscle vs skeletal muscle

A

Cardiac muscle:
- Myocytes coupled by gap junctions and intercalated discs
- AP plateau
- Ca influx from ECF induces Ca release from sarcoplasmic reticulum

Skeletal muscle:
- myocytes not coupled via intarcalated discs
- AP no plateau
- No Ca releaase from sarcoplasmic reticulum

87
Q

P wave on EKG

A

Atrial depolarization (K+ leaves the cell)

88
Q

PR intervnal on EKG

A

Time from start of atrial to ventricular depolarization

89
Q

QRS on EKG

A

Ventricular depolarization

90
Q

QT interval on EKG

A

Ventricular depolarization/ventricular contraction/ventricular repolarization

91
Q

Long QTI can is associated with or predispos individuals to ______condition

A

Torsades de pointes

92
Q

What are the risks associated with Torsades de pointes?

A
  • Congenital abnormalities
  • hypomagnesemia, hypokalemia, and hypocalcemia
  • Drugs: antiarrhythmics, antibiotics, antipsychotics
93
Q

T wave on EKG

A

Ventricular repolarization

94
Q

Inversion of the T wave is associated with

A

ischemia, recent MI

95
Q

U wave on EKG is associated with

A

Papillary muscle relaxation - final muscle to relax to prevent regurgitation of blood
hypokalemia

96
Q

What kind of heart block presensents with elongation of PR interval

A

Primary heart block

97
Q

What kind of heart block presents with elongation of the PR interval until TWO atrial depolarization occur

A

Mobitz I

98
Q

What kind of heart block presents with non-conducting P waves with no elongation of the PR interval, likely progresses to complete heart block

A

Mobitz II

99
Q

What kind of heart block presents with no QRS wave

A

Complete heart block (Bundle branch block)

100
Q
A
101
Q

Where does Pacemaker AP occur?

A

Primarily in the SA node (to maintain regular rhythm and rate of the heart)

102
Q

Pacemaker action potential phase 4, 0, 3

A

Phase 4 = spontaneous depolarization driven by funny currents, t-type Ca2+ channels, and reduced K+ efflux

Phase 0 = rapid depolarization primarily due to L-type Ca2+ channels

Phase 3 = Repolarization facilitated by K+ efflux and closure of Ca2+ channels

103
Q

Regulatory mechanisms of the cardiac cycle: what are the receptors

A
  • Aortic arch: transmits via vagus nerve > solitary nucleus in medulla in response to BP changes
  • Carotid sinus: transmits via glossopharyngeal nerve > solitary nucleus in medulla in response to BP changes
104
Q

Regulatory mechanisms: Chemoreceptors

A
  • Peripheral: carotid and aortic bodies are stimulated by inc PCo2, dec blood pH, and dec in PO2
  • Central: stimulated by changes in pH and PCo2 of CSF (influenced by arterial CO2)
105
Q

T/F central chemorectptors become less responsive with chronically inc PCO2 (eg (COPD)

A

True. depends on peripheral chemoreceptors to detect dec O2 to drive respiration

106
Q

Regulatory mechanisms: Baroreceptors

A
  • Hypotension: ↓ Arterial pressure > ↓ Stretch > ↓ Afferent baroreceptor firing > ↑ Efferent sympathetic firing > ↓ Efferent PS stimulation = Vasoconstriction ↑HR ↑Contractility ↑BP
  • Carotid massage: ↑ Pressure on carotid sinus > ↑ Stretch > ↑ Afferent BR > ↑ AV Node refractory period = ↓ HR
  • Cushing reflex: (Triad of HTN, bradycardia, respiratory depression) ↑ Intracranial pressure > Constricts arterioles > Cerebral ischemia > ↑ pCO2 > ↓ pH > Central reflex sympathetic ↑ in perfusion pressure/HTN > ↑ Stretch > Bradycardia
107
Q

What 2 branches of coronary arteries comes from the aortic root

A

RCA and LCA

108
Q

RCA branches into

A
  • Acute (R marginal artery)
  • Posterior descending artery (PDA)
109
Q

LCA branches into

A
  • Left anterior descending artery (LAD)
  • Left circumflex artery (LCx
110
Q

LAD supplies ______

A

2/3 of interventricular septum, anterolateral papillary muscle and anterior surface of LV

111
Q

Which coronary artery is most commonly occluded?

A

LAD

112
Q

PDA supplies ______

A

1/3 of interventricular septum, posterior 2/3 walls of ventricles, and posteromedial papillary muscle

113
Q

RCA supplies _______

A

AV node and SA node

114
Q

Right (acute marginal) artery supplies_______

A

RV

115
Q

What does coronary dominance refers to?

A

Which artery supplies the posterior descending artery (PDA)

116
Q

Right dominant

A

PDA from RCA (60-80% people)

117
Q

Left dominant

A

PDA from LCx (10-20%)

118
Q

Co-dominant

A

PDA from both RCA and LCx (20%)

119
Q

Draw Aorta branches

A

inferior phrenic, celiac trunk (foregut), middle suprarenal arteries, renal arteris, SMA (midgut), testicular arteries, IMA (hindgut), lumbar arteries, common iliac arteries

120
Q

Frank-starling law

A

Stroke volume increases proportionally to an increase in the volume of blood filling the heart

121
Q

Cardiac output

A

The amount/volume of blood the heart pumps/1min
CO = HR X SV

122
Q

what affects CO

A

Increased stretch
ANS stimulation

123
Q

Stroke volume (SV)

A

The amount of blood pumped from the ventricles/beat
SV = End diastolic volume (EDV) - End systolic volume (ESV)

124
Q

what is the average stroke volume

A

70-90 mL

125
Q

How does the PNS affects the heart rate (HR)

A
  • PNS: Right vagus nerve - decreases intrinsic rate of the SA node. Left vagus nerve - slows conduction of AV node —> dec force of contraction of atria (not ventricles)
126
Q

How does the SNS affects the heart rate (HR)

A

increases rate in times of stress (frequency, conduction, force of contraction of atria and ventricles)

127
Q

How does thyroid hormones affect the heart rate (HR)

A
128
Q

End diastolic volume

A

The amount of blood filled in the ventricles approx 100 mL

129
Q

Ejection fraction

A

The amount of blood ejected from the ventricles (notable that all of the blood in the ventricles are not ejected) approx 60% is ejected, 40% remains

EF = ejected /filled = SV/EDV= 60/100 = 60%

130
Q

End systolic volume

A

The amount of blood that remains in the ventricle after contraction = ESV = 40 mL

131
Q

What 3 factors is Stroke volume dependent on?

A
  • Contractility = force of the heart muscle contraction
  • Preload = degree of stretch of cardiac myocytes at the end of ventricular filling = EDV
  • Afterload = resistance the ventricle overcomes to eject blood
132
Q

What factors affect the afterload

A

Pressure in the LV must be > systemic pressure for the aortic valve to open (same for pulmonic side)
Example:
HTN > higher vascular pressure > dec in afterload > reduce ejected blood

Stenosis > dec in afterload> reduce ejected blood

133
Q

SV increases with

A
  • Inc in contractility
  • Inc preload
  • Dec afterload
134
Q

Contractility and (SV) decreases with

A
  • B blockade (dec cAMP)
  • HF with systolic dysfunction
  • Acidosis
  • Hypoxia/hypercapnia (dec Po2/inc pCO2)
135
Q

Force of contraction changes in the presence of

A
  • increased end diastolic volume/increased cardiac stretch
  • Sympathetic stimulation
136
Q

PP is increased in the following situations

A

Hyperthyroidism, aortic regurgitation, aortic stiffening = isolated systolic HTN), OSA, anemia, exercise

137
Q

Pulse pressure (PP)

A

SBP-DBP

138
Q

PP is decreased in the following situations

A

Aortic stenosis, cardiogenic shock, cardiac tamponade, advanced HF

139
Q

Mean arterial pressure

A

average arterial pressure throughout one cardiac cycle, (systole and diastole)
MAP = CO X total peripheral resistance (TPR)
= 2/3 DBP + 1/3 SBP = DBP + 1/3 pp

140
Q

Pressure- Volume loops

A

Watch Dr. Pershows video

141
Q

Cardiac cycle

A

1) Isovolumetric relaxation (ventricular diastole early)
2) Ventricular filling (ventricular diastole late)
3) Atrial systole (atrial contraction- happens during diastole, in which 20% of filling to ventricles)
4) Isovolumetric contraction
5) Ventricular contraction (ventricular systole first phase)
6) Ventricular ejection (ventricular systole second phase)

142
Q

Pathway of electrical conduction of the heart

A

SA node > Atria > AV node > IV septum/bundle of his > L&R Bundle branches > Purkinje fibers > ventricles

143
Q

What is the intrinsic firing rate of the SA node?

A

60-100 depolarizations/minute

144
Q

Early systole

A
  • Pressure within the ventricles increases —-> AV valves close
  • semilunar valves remain closed and ventricular pressure continues to rise
145
Q

Late systole

A
  • Semilunar valves are forced to open —-> blood enters the aorta and pulmonary trunk
  • Remaining ventricular blood = End systolic volume
146
Q

Early diastole

A
  • Brief repolarization phase
  • Ventricles relax and pressure drops rapidly
  • Semilunar valves close, AV valves remain closed
  • Atrial pressure > ventricular pressure ——> Causes AV valves to open
147
Q

Mid-Late Diastole

A
  • Ventricle fill passively
  • AV valves are open
  • Semilunar valves are closed
  • Pressure increases in both atria
  • SA node fires at the end of diastole causing atrial depolarization and contraction
148
Q
A
149
Q

What are the 2 phases and subphases of cardiac cycle. Explain what happens during each phase

A

Phase 1- Systole
- AV valves close
- Acute ejection of blood from vent –> circulation
3 subphases:
1) isovolumic contraction (W/out emptying)
2) Ejection
3) Isovolumic relaxation (Ventricles relax)

Phase 2- Diastole
- AV valves open
- Filling of the ventricles
3 subphases
1) Rapid inflow
2) Diastole
3) Atrial systole (contraction of atria happens during diastole, in which 20% of filling to ventricles)

150
Q

Both opening and closing of the AV and semilunar valves occur passively when pressure gradient pushes blood backward or forward? T/F

A

True

151
Q
A

NPLEX 1 - Urology (11 decks)

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