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Cardiology Flashcards

1
Q

Atrial Chamber Septation

A

The foramen ovale (of the septum secundum) and the foramen secundum (of the septum primum) maintain blood flow between the two chambers in the embryo

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2
Q

Adult Derivatives of the Atria

A

Pg 268 in STEP BOOK

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3
Q

Aortic Arches

A 
1 = maxillary artery 
2 = stapedial artery, hyoid artery 
3 = common carotid artery and proximal part of the internal carotid artery
4 = left (adult aorta arch) right (proximal part of the right subclavian artery)
6 = proximal part of the pulmonary arteries and ductus arteriosus

5th arch degenerates
3rd and 4th are most important

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4
Q

Aorticopulmonary septum

A
  • membranous portion of the ventricular septum
  • comes from neural crest cells
  • if there is no 180 degree turn = Transposition of great vessels
  • failure of neural crest migration = persistent truncus arteriosus

Ventricular septal defects usually occur in the membranous septum

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5
Q

Ebstein’s Anomaly

A

Apical displacement of the septal and posterior tricuspid valve leaflets leading to atrialization of the right ventricle
- the leaflets are unusually deep in the right ventricle
- congenital defect of endocardial cushions of the tricuspid valve
- causes tricuspid regurgitation
- the high right atrial pressure keeps the PFO and allows for deoxygenated blood to go to the peripheral system causing cyanosis
Can be due to use of lithium or benzodiazepine during pregnancy

Increased risk of wolf Parkinson’s white syndrome and SVT

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6
Q

Fetal Erythropoiesis

A

Young Liver Synthesizes Blood

Yolk sac (3-8 weeks)
Liver (6weeks-Birth)
Spleen (10-28 weeks)
Bone marrow (18 weeks to adult)

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7
Q

Fetal postnatal derivatives

A

Pg 271 of STEP

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8
Q

Left to Right Shunts

A

PDA = treat with indomethacin (blocks prostaglandin synthesis)
ASD
VSD

Uncorrected left to right shunt causes pulmonary hypertension causing RVH and then right side pressure exceeds left = Eisenmenger syndrome (R–>L shunt)

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9
Q

Coarctation of Aorta

A

Infantile = pre-ductal = Associated with Turner Syndrome

Adult = post-ductal
- notching of rib on X-Ray due to intercostal arteries becoming dilated

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10
Q

Disorders Associated with Cardiac Malformations

A

Turner Syndrome

  • infantile coarctation of aorta = preductal
  • Bicuspid Aortic Valves

Down Syndrome
- endocardial cushion defects = ASD (ostium primum type), VSD, AV septal defects

Digeorge Syndrome 22q11

  • Tetralogy of Fallot
  • Truncus Arteriosus

Congenital Rubella

  • PDA
  • Pulmonary Artery Stenosis
  • septal defects

Marfan Syndrome

  • Aortic insuficiency due to abnormal aortic valves
  • MVP
  • thoracic aortic aneurysm and dissection

Infants of Diabetic Mom
- Suffer from Transposition of Great Vessels

Alcohol exposure in Utero
- VSD, PDA, ASD, tetralogy of Fallot

Prenatal Lithium exposure = Ebstein anomaly

Williams Syndrome = Supravalvular aortic stenosis

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11
Q

Right to Left shunts

A

Pg288 of STEP book

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12
Q

Boot Shaped Heart in INFANT

A

Tetralogy of Fallot

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13
Q

Most common cause of congenital anomaly

A

VSD

Most common cause of early cyanosis = Tetralogy of Fallot

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14
Q

Atrial Septal Defects

A

Ostium Secundum = missing tissue is more commnon than ostium primum

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15
Q

Exercise and CO

A

Initially
- Increase CO due to increased SV & HR

Sustained Exercise
- CO maintained due to increased HR

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16
Q

Preload

A

Pressure at EDV

  • Atrial Pressure
  • End-diastolic pressure
  • CVP

Preload increased by

  • Exercise
  • increased blood volume
  • pregnancy

Preload decreased by
- ventilators = nitrates (nitroglycerin)

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17
Q

After load

A

MAP
- TPR

Vasodilators decreases After load = hydralazine

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18
Q

Starling Curve

A

274

Normal EF = >55%

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19
Q

Cardiac and Vascular Function Curves

A

Pg 275

Contractility increases with decreased extra cellular Na+

Contractility decreases with acidosis and hypoxia

ACE inhibitors and ARBs decrease both preload and after load

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20
Q

Pulse Pressure

A

Proportional to SV
Inversely proportional to arterial compliance

Increase in PP
- hyperthyroidism, aortic regurgitation, aortic stiffening (isolated systolic hypertension in elderly), obstructive sleep apnea (increased SNS), exercise

Decrease PP
- aortic stenosis, cardio genic shock, cardiac tamponade, advanced HF

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21
Q

Ejection Fraction

A

Decreases in systolic Heart failure

Normal in diastolic heart failure

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22
Q

Left Atrial Pressure

A

Normally LV diastolic pressure

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23
Q

Heart Failure

A

Pages 297

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24
Q

BNP

A
  • produced by cardiac cells in response to ventricular stretch
  • causes vasodilation and natriuresis
  • secreted when left ventricle is stretched due to heart failure

MEASURED TO HELP DIAGNOSE CHF >100

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25
What stage is the most O2 consumption occuring?
Isovolumetric Contraction Kaplan Notes 25-30 Cardio
26
JVP Pressure Tracing
Absent A wave = A-fib, RA infarct, or atrial flutter Absent X descent = Tricuspid regurg Page 276 on STEP book
27
Treatment of CHF
Acute/Decompensated CHF (NO LIP) with Pulmonary Edema - Nitrates = dilate veins to reduce preload - Oxygen - Loop Diuretic = removes fluid from the lung - Inotropic drugs = dobutamine - Positioning = sit patient up so blood doesn't pool in heart but pools in legs. don't give Beta blocker Chronic CHF = Improvement of Survival = ACE inhibitors, ARBs, Aldosterone antagonists, Certain Beta-blockers (metoprolol, carvedilol, bisoprolol) , Nitrates + Hydralazine (AA patients only) = Symptomatic Relief = Diuretics, Digoxin, Vasodilators (hydralazine and nitrates) Chronic CHF can become Acute CHF = LOOK AT STORY
28
INCREASED CAPILLARY hydrostatic pressure
- CHF = increases CVP - Venous thrombosis - Compression of veins - Sodium and Water retention
29
Increased Capillary permeability
- infections and septic shock - toxins - burns
30
Pitting Edema vs Non-Pitting
Pitting - excess amount of fluid in absence of additional colloid (protein) Non-pitting edema - a lot of colloid in interstitial fluid (protein) balances fluid
31
Shock
Pg 297
32
Location of Central Lines (catheters put into central veins)
Femoral = easiest with least risk but the line cant stay more than 5-7 days due to risk of infection Subclavian = remains longer 3-4 weeks, highest risk of pneumothorax don't do in patients that have COPD or lung tumors Internal Jugular = remains in 3-4 weeks, risk of puncturing carotid artery LOOK AT PICTURES
33
Femoral Sheath
Femoral artery and vein only in the sheath | - nerve is not found in the sheath
34
What is Kf? What increases Kf?
Kf = capillary permeability - increased by bacterial toxins, burns, and sepsis
35
What are the antidotes to the following?
Copper, gold, arsenic = penicillamine Arsenic, Mercury, gold = dimercaprol, succimer TPA, Streptokinase = Aminocaproic acid Digitalis = Anti-digoxin antibody fragments
36
Pressure Volume Loop
Pg 276 of STEP book
37
Splitting
277 of STEP book
38
Shock Pathophysiology
MAP
39
Auscultation of Heart Sounds
Aortic Valve is heard = Right 2nd intercostal space Pulmonic Valve = Left 2nd intercostal space APTM
40
Benign Heart Murmurs if there is no presentation of disease
- Split S1 - Split S2 on inspiration - S3 in a patient
41
Bedside Maneuvers
Handgrip - increased afterload = increased Mitral regurg - later onset of MVP Valsalva maneuver - reduces preload and afterload - makes most heart murmurs quieter except hypertrophic cardiomyopathy - earlier onset of MVP Squatting - increases preload - later onset of MVP - increased AS murmur - decreased HCM murmur
42
Sounds Heard best in Left Lateral Decubitus position
- mitral stenosis - mitral regurgitation - left-sided S3 - left-sided S4
43
Heart Murmurs
Pg 279 and 278 of STEP book
44
Membrane Potentials
K+ --> -75 to -95mV Na+ --> +50mV Ca2+ --> +20mV
45
Action Potentials of Ventricles
Phase 2 = Calcium influx triggers Calcium release from Sarcoplasmic reticulum and induces myocytes contraction Between phase 0-3 = Effective Refractory Period - you can't illicit another action potential - increasing this period slows the heart down
46
Action Potential of Pacemakers
No phase 1 or 2 Phase 4 = freely permeable to K+, funny channels (gradual increase in Na+ conduction = causes pacemaker) Phase 0 = due to calcium influx Pg 280-281 in STEP book
47
Fomepazol
Inhibits alcohol dehydrogenase
48
Anti-Arrhythmics
No Bad Boy Keeps Clean ``` No = Class 1 = Na+ channel blockers - decreases slope of phase 0 in the myocyte Bad Boy - Class 2 = Beta blockers - act on phase 4 Keeps = Class 3 = K+ channel blockers - act on phase 3 Clean = Class 4 = CCB - act on phase 0 ```
49
Limb Leads
See Pictures QRS complex deflection is telling you where the electrical signal of the heart is ``` Look at limb lead 1 and 2 = to tell you the axis of the heart - if + = normal Normal = -30 - +90 LAD = -30- -90 RAD= +90 - +180 ```
50
EKG
Each tiny box = 0.04sec One big box = 0.2 sec PR interval - normally
51
Anaphylactic Shock Treatment
Epinephrine
52
Cardio genic Shock Treatment
Dobutamine = affects more of the heart
53
Septic Shock
Use Norepinpehrine | - stimulates the alpha 1 without Beta 2 to clamp down vessels
54
Arrhythmias
PG 283-284 of STEP book
55
Cushings Reflex
Increased intracranial pressure - increases SNS and increases BP - causes increased PSNS ==> reflex bradycardia and respiratory depression Pg 286 Triad - increased systemic BP, bradycardia, respiratory depression
56
Smooth Muscle Cell Contraction
See Picture
57
Cardiac Output Regulation
``` Liver = receives largest portion of CO Kidneys = receives highest blood flow per gram of tissue Lungs = receive 100% of CO from RV Heart = extracts 80% of oxygen from blood = myocardial profusion occurs during diastole --> NO, CO2, adenosine dilate coronary arteries ``` In the case of CAD = Nitroglycerin decreases oxygen demand by causing systemic venous vasodilation which reduces preload (doesn't vasodilate the coronary arteries because they are already maximally vasodilated) Skeletal muscle - local metabolites during exercise = K+, H+, CO2 increases vasodilation
58
Hypertension
Hypertension = BP > 140/90 Pre-Hypertension = BP >120/80 Normal = 180/120 without acute end organ damage - Hypertensive Emergency = BP >180/120 severe hypertension with evidence of acute end organ damage White Coat Hypertension - high BP only when in the doctors office - compare home BP with Doctor BP - treat based on home BP numbers Masked Hypertension - normal readings in office but higher levels at home LVH = concentric thickness - increases myocardial oxygen demand - less compliant ventricle/stiffen = S4 - decreases LV lumen Aortic Dissection - tearing chest pain that radiates to the back = creates false lumen - widening mediastinum on CXR - risk factors: Marfan syndrome and Hypertension - do CT scan - Type A = dissection involving Ascending Aorta = emergency surgery - Type B = distal aorta distal to the left subclavian artery = medical management (use beta blocker) Paroxysms of increased SNS = anxiety, palpitations, diaphoresis ==> Pheochromocytoma
59
Foramen Ovale
Can lead to paradoxical emboli
60
Abdominal Aortic Aneurysm
See Pictures - you need to do serial ultrasound every 6 months >5cm ==> surgical repair
61
Coronary Anatomy
Pg 272 LAD is where most occlusions occur = anterior wall MI Right Dominant circulation = 80% of people = PDA arises from RCA Left Dominant Circulation = 8% of people = PDA comes from LCX CoDominant = 7% of people = PDA arises from both LCX and RCA
62
Causes of Chest Pain
See Pictures Costochondritis = inflammation where ribs meet sternum
63
Arteriolosclerosis
Thickening of the small arteries and arterioles Hyaline: thickening of vessel walls in essential hypertension or diabetes mellitus = very pink Hyper plastic: "onion skinning" in severe hypertension with proliferation of smooth muscle cells.
64
Mockeberg (medial calcific sclerosis)
- uncommon - affects medium-sized arteries - calcification of elastic lamina of arteries --> vascular stiffening without obstruction. - Pipestem appearance on X-Ray - Does not obstruct blood flow; intima not involved - calcification occurs in media
65
Ischemic Heart Disease
Prinzmetal - transient ST elevation on ECG Stable Angina - ST segment depression Unstable Angina = ST segment depression MI - subendocardial = NSTEMI = ST segment depression + cardiac enzymes - Transmural = STEMI = ST segment elevation + cardiac enzymes
66
Antianginal Therapy
Decrease Preload and decrease after load - nitrates and beta blockers Decrease myocardial oxygen demand
67
Evolution of an MI
Pg 294 & 295 Check Picture Troponin I is the most specific enzyme to cardiac muscle Dressler Syndrome = Chest pain, pericardial friction rub, autoimmune pericarditis, and persistent fever occurring several weeks after an MI
68
MI Treatment and Cardiomyopathies
Check Picturess Pg 296
69
Hepatitis B Phases
See Pictures
70
Fibrinous Pericarditis
- Uremia = chest pain and course rubbing heart sounds in patients with Creatinine of 5 - Rheumatoid Arthritis - Dressler Syndrome
71
Serous Pericarditis
- Lupus | - Rheumatic Fever
72
Suppurative Pericarditis
Pus in pericardial space due to infection
73
Hemorrhagic Pericarditis
TB or melanoma
74
Acute Pericarditis
- Pleuritic Chest pain = sharp, worse with inspiration, better when sitting up and leaning forward - Distant heart sounds - Friction rub on auscultation - Diffuse ST segment elevation - Diffuse PR segment depression Can resolve without scarring or leads to chronic constrictive pericarditis (lupus, kussmaul sign = JVD during inspiration) - most common cause in US = Lupus - most common cause in developing countries = TB
75
Cardiac Tamponade
- causes decreased CO - distant heart sounds, JVD - pulsus paradoxus = decrease in amplitude in systolic BP by more than 10mmHg during inspiration (also seen in asthma, croup, OSA, and COPD) - there is equillibration of all 4 cardiac chambers - will see electrical alternans = alternating amplitude QRS complex beat to beat (specific but not sensitive)
76
Syphilitic Heart Disease
- disruption of vaso vasorum - dilation of aorta and aortic valve ring - aortic regurg - aortic stenosis - thoracic aortic aneurysms - calcification of aorta TREE bark appearance on inside of aorta
77
Tuberous Sclerosis
- astrocytoma - rhabdomyomas - angiomyolipoma
78
Vascular Pathologies
Pg 301-303 Sturge-Weber Disease = port wine stain in ophthalmic division trigeminal nerve - seizure, early onset glaucoma, intellectual disability, Lymphangiosarcoma - lymphatic malignancy associated with persistent lymph edema
79
Aortic Aneurysm
Myxamatous changes with pooling of proteoglycans in the media layer of large arteries are found in cystic medial degeneration - predisposes people to aortic dissections and aortic aneurysms - medial degeneration is frequently seen in younger individuals with Marfan syndrome
80
Wide mediastinum
Aortic Dissection
81
Beta blockers
- mask the symptoms of hypoglycemia by blocking the typical adrenergic warning symptoms such as tremor and palpitations - so don't give to a diabetic
82
Organ Removal
increases the TPR and decreases CO

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