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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
What is most posterior part of heart; what is consequence?
LA- enlargement can cause dysphagia, hoarseness (recurrent laryngeal)
26
What is the most anterior part of the heart?
RV
27
Describe L vs R dominant heart
PDA from RCA= R dominant | PDA from LCX= L dominant
28
Describe Fick principle
CO=rate of O2 consumption/(arterial O2-venous O2 content)
29
Formula for pulse pressure, what is it proportional to?
pulse pressure= systolic pressure-diastolic pressure | proportional to SV
30
How calculate SV
SV=EDV-ESV
31
What three factors affect SV?
Incr contractility, Incr preload, decr afterload
32
Blockade of which sympathetic channels decr cardiac contractility
B1, decr cAMP
33
What approxomates afterload?
MAP
34
Describe Laplaces law
relates LV size and afterload | wall tension= (pressurexradius)/(2xwall thickness)
35
What is a normal EF
>55%
36
Change in EF for systolic, diastolic heart failure
Decr in systolic HF, normal in diastolic HF
37
What two factors affect preload
Venous tone, ciruclating blood volume
38
How do you determine EF?
EF=SV/EDV=EDV-ESV/EDV
39
Describe starling law
the force of contraction is proportional to the end-diastolic length of cardiac muscle (preload) Relates SV or CO to Ventricular EDV
40
Where is the TPR determined?
arterioles
41
What 3 factors determine resistance
viscosity and vessel length directly proportional | 4th power of radius inversely proportional
42
Describe valves in isovolumetric contraction
Between mitral valve closing and aortic valve opening
43
Describe valves in systolic ejection
Between aortic valve opening and closing
44
Describe valves in isovolumetric relaxation
between aortic valve closing and mitral valve opening
45
Describe rapid filling
Just after mitral valve opening
46
Describe reduced filling
just before mitral valve closing
47
What makes S1 sound, when does it occur
Mitral and tricuspid valve closure | Beginning of systole
48
What makes S2 sound, when does it occur
aortic and pulm valves closing | beginning of diastole
49
What makes S3 sound- when is it, what causes it?
During rapid ventricular filling phase | Incr filling pressures, dilated ventricles
50
What populations can have a normal S3 sound?
Children, pregnant women
51
When does S4 occur, what causes it?
Late diastole "atrial kick"= High atrial pressure associated with ventricular hypertrophy
52
``` JVP- Describe: a wave c wave x descent v wave y descent ```
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
What JVP changes are seen in tricuspid regurgitation
No x descent
54
What conditions cause wide splitting?
Delayed RV emptying: pulmonic stenosis, RBBB
55
What condition causes fixed splitting?
ASD (incr RA, RV volumes; delayed pulmonic closure)
56
What conditions cause paradoxical splitting?
Delayed LV emptying: aortic stenosis, LBBB
57
Holosystolic, high-pitched "blowing murmur" | Loudest at apex, radiates toward axilla
Mitral Regurgitation
58
Holosystolic, high-pitched "blowing murmur" | Loudest at L sternal, 5th intercostal, radiates to R sternal border
Tricuspid Regurgitation
59
Crescendo-decrescendo systolic ejection murmur | Loudest at heart base, radiates to carotids
Aortic stenosis
60
Causes of aortic stenosis
age-related calcification, bicuspid aortic valve
61
Causes of mitral regurg
ischemic heart disease, MVP, LV dilation
62
Holosystolic, harsh-sounding murmur | Loudest at tricuspid area, accentuated with hand grip
VSD
63
Late systolic crescendo murmur with midsystolic click | Heard over apex
Mitral valve prolapse
64
High-pitched "blowing" early diastolic decrescendo murmur
Aortic regurgitation
65
Opening snap, Delayed rumbling late diastolic murmur
Mitral stenosis
66
Continuous machine-like murmur Loudest at S2 Best heard at left infraclavicular area
PDA
67
``` Describe channels: Ventricular Action potential Phase 0 Phase 1 Phase 2 Phase 3 Phase 4 ```
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
What is the resting membrane potential of ventricles vs pacemakers?
Ventricle: -85mV Pacemaker: -70mV (Na+ channels permanently closed)
69
``` Describe channels: Pacemaker action potential Phase 0 Phase 1 Phase 2 Phase 3 Phase 4 ```
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
What channel determines the HR
Slope of If Na channel of pacemaker cells
71
What is the effect of Ach/Adenosine on HR, If channel
Decr rate of depolarization, Decr HR
72
What is the PR interval, what is a normal length
Conduction delay of AV node, <200msec
73
What is the QRS complex, what is a normal length
ventricular depolarization, <120msec
74
What is T wave?
Ventricular repolarization
75
What does a T wave inversion indicate
Recent MI
76
What causes a U wave?
Hypokalemia, bradycardia
77
Polymorphic ventricular tachycardia: shifting sinusoidal waveforms on ECG
Torsades des pointes
78
Treatment of Torsades de pointes
Mg sulfate
79
Romano-Ward syndrome
Congenital long QT syndrome: AD, pure cardiac defect
80
Jervell and Lane-Nielsen syndrome
Congenital long QT syndrome: AR, sensorineural deafness
81
ECG finding: shortened PR interval with delta wave
Wolff-Parkinson-White syndrome (ventricular pre-excitation syndrome: bypass of AV node)
82
ECG: Chaotic and erratic baseline with no discrete P waves
A fib
83
ECG: A rapid succession of identical, back-to-back atrial depolarization waves (sawtooth)
Atrial flutter
84
ECG: Completely erratic rhythm with no identifiable waves
Ventricular fibrillation
85
ECG: Prolonged PR interval
1st degree AV block
86
ECG: progressive lengthening of PR interval until a beat is "dropped"
Mobitz type I 2nd degree AV block (Wenckebach)
87
ECG: Dropped beats that are not preceded by a change in the PR interval; often 2:1 block
Mobitz type II 2nd degree AV block
88
ECG: Both P waves and QRS complexes are present, but they have no relation to each other
3rd degree AV block
89
What is the pharmacological treatment for atrial flutter?
class IA, IC or III antiarythmics
90
What severe ECG change can Lyme disease cause
3rd degree heart block
91
What releases ANP, what causes?
atrial myocytes, incr blood volume, atrial pressure
92
What is the action of ANP on kidney?
Vasodilaiton, decr Na+ reabsorption in collecting tubule | constricts efferent and dilates afferent
93
What releases BNP, what causes?
Ventricular myocytes, incr tension
94
Nesiritide
recombinant BNP, used to treat heart failure
95
What does PCWP approximate? What is normal?
L atrial P, <12
96
What nerve transmits aortic arch? What is the nucleus?
Vagus nerve, solitary nucleus
97
What nerve transmits carotid sinus? What is the nucleus?
glossopharyngeal nerve, solitary nucleus
98
What is response of Aortic arch and carotid sinus to BP changes?
Aortic arch: only responds to incr BP | Carotid sinus: responds to incr and decr BP
99
What is the appropriate response to carotid massage?
Decr HR
100
What do peripheral chemoreceptors respond to?
Decr PO2, Incr PCO2, decr pH
101
What do central chemoreceptors respond to?
pH and PCO2 (not PO2)
102
What local metabolites autoregulate the heart?
CO2, adenosine, NO
103
What local metabolites autoregulate the brain?
CO2
104
What local metabolites autoregulate skeletal muscle?
lactate, adenosine, K+, H+, CO2
105
Formula for starling forces of capillary fluid exchange
Pnet=(Pc-Pi)-(pc-pi)

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