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Step 1 > Cardiology- Anatomy and Physiology > Flashcards

Cardiology- Anatomy and Physiology Flashcards

1
Q

When does heart start to beat spontaneously

A

Week 4

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2
Q

Define Kartagener syndrome: what is molecular and developmental loop

A

L-R asymmetry; defect in cardiac looping; primary ciliary dyskinesia

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3
Q

What does Truncus arteriosus become

A

ascending aorta, pulmonary trunk

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4
Q

what does the bulbus cordis become

A

smooth parts (outflow tract) of L and R ventricles

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5
Q

What does the primitive atria become

A

trabeculated part of L and R atria

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6
Q

What does the primitive ventricle become

A

trabeculated part of L and R ventricles

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7
Q

What does the primitive pulm vein become

A

smooth part of L atrium

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8
Q

What do the L and R horn of the sinus venosus become

A

L horn: coronary sinus

R horn: smooth part of R atrium

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9
Q

What does the common cardinal vein and the right anterior cardinal vein become

A

SVC

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10
Q

What causes a patent foramen ovale

A

failure of the septum primum and septum secundum to form

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11
Q

Which part of septum most commonly causes VSD

A

membranous septum

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12
Q

What are the aortic and pulmonary valves derived from?

A

Endocardial cushion of outflow tract

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13
Q

What are the mitral and tricuspid valves derived from?

A

fused endocardial cusions of the AV canal

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14
Q

What are the locations of fetal erythropoiesis (4)

A

Yolk sac (3-8wks), Liver (6wk-birth), Spleen (10-28wk), Bone marrow (18wk-adult)

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15
Q

What causes difference in affinity between fetal, adult blood?

A

HbF doesn’t respond to 2,3-BPG

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16
Q

What does the umbilical vein become

A

Ligamentum teres hepatis (part of falciform ligament)

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17
Q

What does the foramen ovale become

A

Fossa ovalis

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18
Q

Describe direction of flow of ductus arteriosus prenatally and postnatally

A

Prenatally: R to L
Postnatally: L to R (not cyanotic)

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19
Q

Describe location of ductus venosus; what does it bypass?

A

Umbilical vein to IVC (bypasses hepatic circulation)

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20
Q

Describe location of ductus arteriosus

A

Pulmonary artery (deox blood from SVC) to aorta

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21
Q

What is the purpose of the foramen ovale

A

Diverts oxygenated blood from IVC to aorta- maximally oxygenated blood reaches head

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22
Q

What is used to close and keep open a PDA

A

Indomethicin closes

PGE1, PGE2 keeps open

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23
Q

Supply of SA, AV nod

A

RCA

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24
Q

What are 2 major anastomoses of coronary circulation

A

RCA+circumflex, PDA+LDA

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25
Q

What is most posterior part of heart; what is consequence?

A

LA- enlargement can cause dysphagia, hoarseness (recurrent laryngeal)

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26
Q

What is the most anterior part of the heart?

A

RV

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27
Q

Describe L vs R dominant heart

A

PDA from RCA= R dominant

PDA from LCX= L dominant

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28
Q

Describe Fick principle

A

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

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29
Q

Formula for pulse pressure, what is it proportional to?

A

pulse pressure= systolic pressure-diastolic pressure

proportional to SV

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30
Q

How calculate SV

A

SV=EDV-ESV

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31
Q

What three factors affect SV?

A

Incr contractility, Incr preload, decr afterload

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32
Q

Blockade of which sympathetic channels decr cardiac contractility

A

B1, decr cAMP

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33
Q

What approxomates afterload?

A

MAP

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34
Q

Describe Laplaces law

A

relates LV size and afterload

wall tension= (pressurexradius)/(2xwall thickness)

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35
Q

What is a normal EF

A

> 55%

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36
Q

Change in EF for systolic, diastolic heart failure

A

Decr in systolic HF, normal in diastolic HF

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37
Q

What two factors affect preload

A

Venous tone, ciruclating blood volume

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38
Q

How do you determine EF?

A

EF=SV/EDV=EDV-ESV/EDV

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39
Q

Describe starling law

A

the force of contraction is proportional to the end-diastolic length of cardiac muscle (preload)
Relates SV or CO to Ventricular EDV

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40
Q

Where is the TPR determined?

A

arterioles

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41
Q

What 3 factors determine resistance

A

viscosity and vessel length directly proportional

4th power of radius inversely proportional

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42
Q

Describe valves in isovolumetric contraction

A

Between mitral valve closing and aortic valve opening

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43
Q

Describe valves in systolic ejection

A

Between aortic valve opening and closing

44
Q

Describe valves in isovolumetric relaxation

A

between aortic valve closing and mitral valve opening

45
Q

Describe rapid filling

A

Just after mitral valve opening

46
Q

Describe reduced filling

A

just before mitral valve closing

47
Q

What makes S1 sound, when does it occur

A

Mitral and tricuspid valve closure

Beginning of systole

48
Q

What makes S2 sound, when does it occur

A

aortic and pulm valves closing

beginning of diastole

49
Q

What makes S3 sound- when is it, what causes it?

A

During rapid ventricular filling phase

Incr filling pressures, dilated ventricles

50
Q

What populations can have a normal S3 sound?

A

Children, pregnant women

51
Q

When does S4 occur, what causes it?

A

Late diastole
“atrial kick”= High atrial pressure
associated with ventricular hypertrophy

52
Q 
JVP- Describe:
a wave
c wave
x descent
v wave
y descent
A

a wave- atrial contraction
c wave- RV contraction (bulging tricuspid)
x descent- atrial relaxation
v wave- incr RA pressure, filling against closed tricuspid valve
y descent- flow from RA to RV

53
Q

What JVP changes are seen in tricuspid regurgitation

A

No x descent

54
Q

What conditions cause wide splitting?

A

Delayed RV emptying: pulmonic stenosis, RBBB

55
Q

What condition causes fixed splitting?

A

ASD (incr RA, RV volumes; delayed pulmonic closure)

56
Q

What conditions cause paradoxical splitting?

A

Delayed LV emptying: aortic stenosis, LBBB

57
Q

Holosystolic, high-pitched “blowing murmur”

Loudest at apex, radiates toward axilla

A

Mitral Regurgitation

58
Q

Holosystolic, high-pitched “blowing murmur”

Loudest at L sternal, 5th intercostal, radiates to R sternal border

A

Tricuspid Regurgitation

59
Q

Crescendo-decrescendo systolic ejection murmur

Loudest at heart base, radiates to carotids

A

Aortic stenosis

60
Q

Causes of aortic stenosis

A

age-related calcification, bicuspid aortic valve

61
Q

Causes of mitral regurg

A

ischemic heart disease, MVP, LV dilation

62
Q

Holosystolic, harsh-sounding murmur

Loudest at tricuspid area, accentuated with hand grip

A

VSD

63
Q

Late systolic crescendo murmur with midsystolic click

Heard over apex

A

Mitral valve prolapse

64
Q

High-pitched “blowing” early diastolic decrescendo murmur

A

Aortic regurgitation

65
Q

Opening snap, Delayed rumbling late diastolic murmur

A

Mitral stenosis

66
Q

Continuous machine-like murmur
Loudest at S2
Best heard at left infraclavicular area

A

PDA

67
Q 
Describe channels: Ventricular Action potential
Phase 0
Phase 1
Phase 2
Phase 3
Phase 4
A

Ventricular Action potential
Phase 0- voltage-gated Na+ channels open, rapid depol
Phase 1- Inactivation Na, K channels open, initial repol
Phase 2- Ca2+ influx (via voltage-gated Ca2+) balances K+ efflux
Phase 3- massive K+ efflux (opening voltage-gated slow K+)
Phase 4- high K+ permeability

68
Q

What is the resting membrane potential of ventricles vs pacemakers?

A

Ventricle: -85mV
Pacemaker: -70mV (Na+ channels permanently closed)

69
Q 
Describe channels: Pacemaker action potential
Phase 0
Phase 1
Phase 2
Phase 3
Phase 4
A

Pacemaker action potential:
Phase 0- opening voltage-gated Ca2+- slow upstroke
Phase 2- Absent
Phase 3- Inactivation Ca2+, activation K+…K+ efflux
Phase 4- If(Na+)- spontaneous depolarization as Na+ conductance increases

70
Q

What channel determines the HR

A

Slope of If Na channel of pacemaker cells

71
Q

What is the effect of Ach/Adenosine on HR, If channel

A

Decr rate of depolarization, Decr HR

72
Q

What is the PR interval, what is a normal length

A

Conduction delay of AV node, <200msec

73
Q

What is the QRS complex, what is a normal length

A

ventricular depolarization, <120msec

74
Q

What is T wave?

A

Ventricular repolarization

75
Q

What does a T wave inversion indicate

A

Recent MI

76
Q

What causes a U wave?

A

Hypokalemia, bradycardia

77
Q

Polymorphic ventricular tachycardia: shifting sinusoidal waveforms on ECG

A

Torsades des pointes

78
Q

Treatment of Torsades de pointes

A

Mg sulfate

79
Q

Romano-Ward syndrome

A

Congenital long QT syndrome: AD, pure cardiac defect

80
Q

Jervell and Lane-Nielsen syndrome

A

Congenital long QT syndrome: AR, sensorineural deafness

81
Q

ECG finding: shortened PR interval with delta wave

A

Wolff-Parkinson-White syndrome (ventricular pre-excitation syndrome: bypass of AV node)

82
Q

ECG: Chaotic and erratic baseline with no discrete P waves

A

A fib

83
Q

ECG: A rapid succession of identical, back-to-back atrial depolarization waves (sawtooth)

A

Atrial flutter

84
Q

ECG: Completely erratic rhythm with no identifiable waves

A

Ventricular fibrillation

85
Q

ECG: Prolonged PR interval

A

1st degree AV block

86
Q

ECG: progressive lengthening of PR interval until a beat is “dropped”

A

Mobitz type I 2nd degree AV block (Wenckebach)

87
Q

ECG: Dropped beats that are not preceded by a change in the PR interval; often 2:1 block

A

Mobitz type II 2nd degree AV block

88
Q

ECG: Both P waves and QRS complexes are present, but they have no relation to each other

A

3rd degree AV block

89
Q

What is the pharmacological treatment for atrial flutter?

A

class IA, IC or III antiarythmics

90
Q

What severe ECG change can Lyme disease cause

A

3rd degree heart block

91
Q

What releases ANP, what causes?

A

atrial myocytes, incr blood volume, atrial pressure

92
Q

What is the action of ANP on kidney?

A

Vasodilaiton, decr Na+ reabsorption in collecting tubule

constricts efferent and dilates afferent

93
Q

What releases BNP, what causes?

A

Ventricular myocytes, incr tension

94
Q

Nesiritide

A

recombinant BNP, used to treat heart failure

95
Q

What does PCWP approximate? What is normal?

A

L atrial P, <12

96
Q

What nerve transmits aortic arch? What is the nucleus?

A

Vagus nerve, solitary nucleus

97
Q

What nerve transmits carotid sinus? What is the nucleus?

A

glossopharyngeal nerve, solitary nucleus

98
Q

What is response of Aortic arch and carotid sinus to BP changes?

A

Aortic arch: only responds to incr BP

Carotid sinus: responds to incr and decr BP

99
Q

What is the appropriate response to carotid massage?

A

Decr HR

100
Q

What do peripheral chemoreceptors respond to?

A

Decr PO2, Incr PCO2, decr pH

101
Q

What do central chemoreceptors respond to?

A

pH and PCO2 (not PO2)

102
Q

What local metabolites autoregulate the heart?

A

CO2, adenosine, NO

103
Q

What local metabolites autoregulate the brain?

A

CO2

104
Q

What local metabolites autoregulate skeletal muscle?

A

lactate, adenosine, K+, H+, CO2

105
Q

Formula for starling forces of capillary fluid exchange

A

Pnet=(Pc-Pi)-(pc-pi)

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