Cardiology Flashcards
Allantois - urachus becomes
Median umbilical ligament
Urachus is part of allantoic duct between bladder and umbilicus.
Umbilical vein becomes
Ligamentum teres hepatis (round ligament)
Contained in falciform ligament.
The most posterior part of the heart?
The most anterior part of the heart?
LA
RV
Enlargement of the LA can cause?
enlargement can cause dysphagia (due to compression
of the esophagus) or hoarseness (due to compression of the left recurrent laryngeal nerve, a branch of the vagus nerve).
LAD and its branches supply
anterior 2/3 of the interventricular septum, anterolateral papillary muscle.
LAD supplies
anterior of the intraventricular septum, anterolateral papillary muscle, and the anterior surface of LV. Most commonly occluded.
PDA supplies
AV node (dependent on dominance), posterior 1/3 of interventricu lar septum, posterior 2/3 walls of ventricles, and posteromedial papillary muscle. Right (acute) marginal artery supplies RV.
RCA supplies
SA node (blood supply independent of dominance). Infarcts may cause nodal dysfunction (bradycardia or heart block).
• Right-dominant circulation (?%) = PDA
arises from ?
• Right-dominant circulation (85%) = PDA
• Left-dominant circulation (?% ) = PDA arises
from ?
• Left-dominant circulation (8% ) = PDA arises
from LCX.
• Codominant circulation (%?) = PDA arises
from?
• Codominant circulation (7%) = PDA arises
from both LCX and RCA.
Coronary blood flow peaks in?
arises from RCA.
Coronary blood flow peaks in early diastole.
Stroke volume affected by?
Contractility (eg, anxiety, exercise)
Preload (eg, early pregnancy)
Afterload
Contractility increased with? (4 things)
• Catecholamine stimulation via beta-1 receptor:
- Ca2+ channels phosphorylated - inc. Ca2+ entry -> inc. Ca2+-induced Ca2+ release and Ca2+ storage in sarcoplasmic reticulum.
- Phospholamban phosphorylation - active Ca2+ ATPase - inc. Ca2+ storage in sarcoplasmic reticulum
- Inc. intracellular Ca2+
- dec. extracellular Na+ (dec. activity of Na+/Ca2+ exchanger)
- Digitalis (blocks Na+/K+ pump - inc. intracellular Na+ -dec.I Na+/Ca2+ exchanger activity - inc. intracellular Ca2+)
Two words: Calcium + Sodium
Afterload approximated by
MAP.
Myocardial O2 demand is inc. by:
- Contractility
- Afterload - proportional to arterial pressure
- heart Rate
- Diameter of ventricle ( wall tension)
CARD
Pulse pressure
PP directly proportional to SV and inversely proportional to arterial compliance.
Pulse pressure increased in
hyperthyroidism
aortic regurgitation,
aortic stiffening (isolated systolic hypertension in the elderly)
obstructive sleep apnea (sympathetic tone)
anemia
exercise(transient).
O-RATES
Pulse pressure decreased in
aortic stenosis, cardiogenic shock, cardiac tamponade, advanced HF.
ShiFTS
Mean arterial pressure
MAP = CO x TPR
MAP (at resting HR) = 2/3 DBP + l/3 SBP = DBP+ 1/3 PP
Inotropy
Inc./dec.
Inc. - Catecholamines, digoxin, exercise (DiCE)
Dec. - HF with reduced EF, narcotic overdose, sympathetic inhibition (FaNS)
Venous return
Inc./dec.
Inc. - Fluid infusion, sympathetic activity (FS)
Dec. - Acute hemorrhage, spinal anesthesia (FS)
Total peripheral resistance
Inc./dec.
Inc. - Vasopressors
Dec. - Exercise, AV shunt
Speed of conduction:
Purkinje >atria > ventricles> bundle of His >AV node.
Park At Vent Bun Ave
Torsades de pointes
Long QT interval predisposes to torsades de pointes. Caused by dec. K+, Mg2+, Ca2+,
Treatment includes magnesium sulfate.
Mg-i-Ca-K!
Congenital long QT
syndrome
Romano-Ward syndrome-autosomal dominant, pure cardiac phenotype (no deafness).
Jervell and Lange-Nielsen syndrome autosomal recessive, sensorineural deafness.
Brugada syndrome
Autosomal dominant disorder most common in Asian males.
ECG pattern of pseudo-right bundle
Branch block and ST elevations in V1-V3
Risk of ventricular tachyarrhythmias and SCD. Prevent
SCD with implantable cardioverter-defibrillator (ICD).
Atrial natriuretic
peptide
Atria due to volume and pressure
B-type (brain)
natriuretic peptide
Ventricles due to tension
Good NPV
Contractility (and SV) dec. with:
5 things
- Beta 1 -blockade (dec. cAMP)
- HF with systolic dysfunction
- Acidosis
- Hypoxia/hypercapnia (dec. Po2 / inc.Pco2)
- Non-dihydropyridine Ca2+ channel blockers
Peripheral chemoreceptors location and stimulated by?
carotid and aortic bodies
are stimulated by:
Dec. Po2 (< 60 mm Hg)
Inc. Pco2
Dec. pH of blood.
3 P’s
Central chemoreceptors location and stimulated by?
stimulated by changes in pH and Pco2 of brain interstitial fluid, which in turn are influenced by arterial Co2.
Do not directly respond to Po2.
Cushing reflex triad
Triad of hypertension, bradycardia, and respiratory depression
Cushing reflex path-physiology
intracranial pressure constricts arterioles -> cerebral ischemia -> inc pCo2 and dec pH -> central reflex sympathetic inc in perfusion pressure (hypertension) -> inc stretch ->peripheral reflex baroreceptor induced bradycardia.
Autoregulation -Skin
FACTORS DETERMINING AUTO REGULATION
Sympathetic stimulation most important mechanism for temperature control
Autoregulation - Heart
FACTORS DETERMINING AUTO REGULATION
Local metabolites (vasodilatory): Adenosine, NO, Co2, dec. O2
ACON sings to your heart
Autoregulation - Brain
FACTORS DETERMINING AUTO REGULATION
Local metabolites (vasodi latory): Co2 (pH)
Autoregulation - Kidneys
FACTORS DETERMINING AUTO REGULATION
Myogenic and tubuloglomerular feedback
Autoregulation - Lungs
FACTORS DETERMINING AUTO REGULATION
Hypoxia causes vasoconstriction
Autoregulation - Skeletal muscle
FACTORS DETERMINING AUTO REGULATION
Local metabolites during exercise: Co2, H+, Adenosine, Lactate, K+ (CHALK)
At rest: sympathetic tone
Persistent truncus arteriosus can also be accompanied by…
VSD
D-transposition of great vessels can also be accompanied by…
VSD, PDA, or patent foramen ovale
Tricuspid atresia can also be accompanied by…
both ASD and VSD for viability.
Tetra logy of Fallot can also be accompanied by…
VSD
Total anomalous pulmonary venous return can also be accompanied by…
ASD and sometimes PDA
Ebstein anomaly can also be accompanied by…
Right-sided HF
“Atrializing” the ventricle
Regurgitation of the tricuspid valve
Accessory conduction pathways
RARA
Ostium Secundum and ostium primum frequency and accompanying defects.
Ostium secundum defects most common
and usually an isolated finding; ostium
primum defects rarer and usually occur
with other cardiac anomalies.
VSD can be seen with these disorders…
Congenital rubella
Down syndrome
Alcohol exposure in utero (fetal alcohol syndrome)
Infant of a diabetic mother
R-DAD
Congenital cardiac defect associations - Alcohol exposure in utero (fetal alcohol syndrome)
VSD, PDA, ASD, tetralogy of Fallot
Alcohol has it all.
Congenital cardiac defect associations - Congenital rubella
PDA, pulmonary artery stenosis, septal defects
Congenital cardiac defect associations - Down syndrome
AV septal defect (endocardial cushion defect),
VSD,ASD
Congenital cardiac defect associations - Infant of diabetic mother
Transposition of great vessels, VSD
Congenital cardiac defect associations - Marfan syndrome
MVP, thoracic aortic aneurysm and dissection,
aortic regurgitation
Congenital cardiac defect associations - Prenatal lithium exposure
Ebstein anomaly
Congenital cardiac defect associations - Turner syndrome
Bicuspid aortic valve, coarctation of the aorta
Congenital cardiac defect associations - Williams syndrome
Supravalvular aortic stenosis
Congenital cardiac defect associations - 22q 11 syndromes
Truncus arteriosus, tetra logy of Fallot
Risk factors for thoracic aortic aneurysm and aortic dissection
Associated with hypertension, bicuspid aortic valve, inherited connective tissue disorders (eg, Marfan syndrome).
a thoracic aortic aneurysm is associated with…
cystic medial degeneration
aortic isthmus -
proximal descend ing aorta just distal to the origin of the left subclavian artery
Myocardial infarction complications
ACT RAPID: Arrhythmias (SVT, VT, VF) Congestive cardiac failure Tamponade/ Thromboembolic disorders Rupture (ventricle, septum, papillary muscle) Aneurysm (ventricle) Pericarditis Infaction (a second one) Death/ Dressler's syndrome
Atherosclerosis LOCATION
Abdominal aorta > coronary artery > popliteal artery > carotid artery .
“After I work out my ABS, I grab a CORONA and POP my collar up to my CAROTID.”
Vasospastic (also known as Prinzmetal or Variant)
Triggers
Treatment
Triggers include cocaine, alcohol, and triptans.
Treat with Ca2+ channel blockers, nitrates, and smoking cessation (if applicable).
Coronary steal syndrome vasodilators used
dipyridamole, regadenoson
“two pyramids for my grandson, steal”
Myocardial infarction complications timing - Cardiac arrhythmia
first 24 hours post-MI.
Myocardial infarction complications timing - Postinfarction
fibrinous pericarditis
1- 3 days: friction rub.
Myocardial infarction complications timing - Papillary muscle rupture
2- 7 days
Myocardial infarction complications timing - interventricular septal rupture
3- 5 days
Myocardial infarction complications timing - Ventricular
pseudoaneurysm formation
3- 14 days
Myocardial infarction complications timing - Ventricular free wall rupture
5- 14 days
Myocardial infarction complications timing - True ventricular aneurysm
2 weeks to several months
Myocardial infarction complications timing - Dressler syndrome
Several weeks
Dilated cardiomyopathy etiologies
include
chronic Alcohol abuse, wet Beriberi, Coxsackie B viral myocarditis, chronic Cocaine use, Chagas disease, Doxorubicin toxicity, hemochromatosis, sarcoidosis, thyrotoxicosis, peripartum cardiomyopathy.
ABCCCD SHuT uP!
Dilated cardiomyopathy treatment
Treatment: BANNDIT B-blockers ACE inhibitors Na+ restriction Diuretics Digoxin ICD Transplant (heart)
Hypertrophic obstructive cardiomyopathy etiology
B-C: 60 - 70% of cases are familial, autosomal dominant (most commonly due to mutations in genes encoding sarcomeric proteins, such as myosin-binding protein C and Beta-myosin heavy chain).
Other causes of concentric LV hypertrophy: chronic HTN, Friedreich ataxia.
Hypertrophic obstructive cardiomyopathy Treatment
B-C: Treatment: cessation of high-intensity athletics, use of Beta-blocker or non-dihydropyridine Ca2+ channel blockers (eg, verapamil). ICD if the patient is at high risk.
Restrictive/infiltrative cardiomyopathy
Sarcoid Amyloid Hemochromatosis Loffler (hypereosinophilic infiltrate) fibrosis (post-radiation) and fibro-elastosis (endocardium-young children)
Bacterial endocarditis - Acute
S aureus (high virulence).
Large vegetations on previously normal valves.
Rapid onset.
Bacterial endocarditis - Subacute
Viridans streptococci (low virulence).
Smaller vegetations on congenitally abnormal or diseased valves.
Sequela of dental procedures.
Gradual onset.
Bacterial endocarditis - negative culture
most likely:
Coxiella Brunetti,
Bartonella spp
HACEK (Haemophilus, Aggregatibacter [formerly Actinobacillus], Cardiobacterium, Eikenella, Kingella).
The Mitral valve is most frequently involved.
Bacterial endocarditis - Tricuspid valve endocarditis
associated with IV drug abuse (don’t “tri” drugs).
Associated with S aureus, Pseudomonas, and Candida.
Bacterial endocarditis - other less likely causes
S bovis (gallolyticus) is present in colon cancer, S epidermidis on prosthetic valves.
Bacterial endocarditis - Symptoms
Bacteria FROM JANE Fever Roth spots Osler nodes Murmur Janeway lesions Anemia Na il-bed hemorrhage Emboli
Bacterial endocarditis - nonbacterial
(marantic/thrombotic) 2° to malignancy, hypercoagulable state, or lupus.
Bacterial endocarditis - Associated with…
glomerulonephritis, septic arterial or pulmonary emboli.
Rheumatic fever is a consequence of
A consequence of pharyngeal infection with group A beta-hemolytic streptococci
“RF from Fatyngitis”
Rheumatic fever - heart valves affected
affects heart valves- mitral > aortic» tricuspid (high-pressure valves affected most).
Rheumatic fever - pathology findings
Aschoff bodies (granuloma with giant cells ), Anitschkow cells (enlarged macrophages with an ovoid, wavy, rod-like nucleus), Antistreptolysin O (ASO) titers.
AAA’s
Acute pericarditis - etiologies and tx
U - uremia N - neoplasaia C - cardiovascular (STEMI/Dressler) + colchicine Tx A - autoimune R - radiation I - infectin (coxsackie B) N - NSAIDS Tx G - Glucocorticoids Tx
Myocarditis causes:
DART:
D - Drugs (eg, doxorubicin, cocaine)
A - Autoimmune (eg, Kawasaki disease, sarcoidosis, SLE, polymyositis/dermatomyositis) “KiSS the skin”
R - Rheumatic fever
T - Toxins (eg, carbon monoxide, black widow venom)
Organisms:
Viruses - adenovirus, Bl9, coxsackie B, HIV, HHV-6 (ABC HH) - lymphocytic infiltrate with focal necrosis.
Parasites - Trypanosoma cruzi, Toxoplasma gondii ( like TT’s)
Bacteria - Borrelia burgdorferi, Mycoplasma pneumoniae. (BuMmer)
Cardiac tamponade Findings:
Beck triad (hypotension, distended neck veins, distant heart sounds),
Inc. HR
Pulsus paradoxus.
ECG shows low-voltage QRS and electrical alternans.
Pulsus paradoxus Seen in
C - croup A - asthma P - pericarditis O - obstructive sleep apnea T - tamponade
Cyclophosphamide, corticosteroids used for which vasculitides?
Wegener - Granulomatosis with polyangiitis
Microscopic polyangiitis
Polyarteritis nodosa
WiMP!
Viral hepatitis assosiated with witch vasculitides?
Polyarteritis nodosa (hep B) Cutaneous small-vessel vasculitis and Mixed cryoglobulinemia (hep C)
Behcet syndrome findings
Rule of 2:
2 types of ethnic background - of Turkish and Eastern Mediterranean descent.
2 types of ulcer - aphthous ulcers, genital ulcerations
2 viruses - HSV or parvovirus
2 other details - uveitis, erythema nodosum
2 lab findings - Immune complex vasculitis, HLA-B51
Cutaneous small-vessel vasculitis causes:
after certain medications (allopurinol, penicillin, phenytoin, cephalosporins - sneezing “APPC! - אפצ’י”) or infections (eg, HCV, HIV).
Cutaneous small-vessel vasculitis findings
Palpable purpura, no visceral involvement.
Mixed cryoglobulinemia findings:
Triad of palpable purpura, weakness, arthralgias.
May also have peripheral neuropathy and renal disease (eg, glomerulonephritis).
Weak Purrs Join Rentals, Nerds!
Mixed cryoglobulinemia Pathology
Vasculitis due to mixed lgG and IgA immune complex deposition.
immunoglobulin A vasculitis Classic triad:
• Skin: palpable purpura on buttocks/legs
• Arthralgias
• Gl: abdominal pain (associated with intussusception)
Painful tummies Join the Purrs!
Microscopic polyangiitis presentation and Pathology
Presentation similar to granulomatosis with polyangiitis but without nasopharyngeal involvement.
No granulomas
P-ANCA
Drugs that displace digoxin from tissue-binding
sites, and decrease clearance
verapamil, amiodarone, quinidine
Quine Amy Vera
