Cardiovascular Flashcards by Matt Tuck

How is blood shunted from right atrium to left in the embryo?

through the foramen ovale (septum secundum) and ostium secundum (septum primum)

How well did you know this?

Not at all

Perfectly

3 possible causes of atrial septal defect

1 ostium secundum overlaps foramen ovale
2 absence of septum secundum
3 neither septum secundum or septum primum develop

How well did you know this?

Not at all

Perfectly

what structure grows to close the opening btw the atrial chamber and ventricular chamber into two small openings?

superior and inferior endocardial cushions

How well did you know this?

Not at all

Perfectly

embryoligic origins:
ascending aorta and pulmonary trunk
coronary sinus
SVC
smooth parts of ventricles
smooth right atrium
trabeculated atria
trabeculated ventricles

truncus arteriosus
left horn of sinus venosus
right common cardinal vein and anterior vein
bulbis cordis
right horn of sinus venosus
primitive atria
primitive ventricle

How well did you know this?

Not at all

Perfectly

Ebstein anomaly

tricuspid leaflets are displaced into ventricle: tricuspid regurg or stenosis
patent foramen ovale common
widely split S2, tricuspid regurgitation
associated with maternal lithium use for bipolar

How well did you know this?

Not at all

Perfectly

heart defects associated with:
22q11 deletion
trisomy 21
congenital rubella
turner syndrome
marfan syndrome

truncus arteriosus, tetralogy
endocardial cushion defects (ASD, VSD)
septal defects, PDA, pulm stenosis, aortic insufficiency
coarctation
arotic insufficiency and dissection

How well did you know this?

Not at all

Perfectly

boot-shaped heart

tetraolgy, RVH (adult)

How well did you know this?

Not at all

Perfectly

rib notching

coarctation

How well did you know this?

Not at all

Perfectly

most common congenital anomaly

VSD

How well did you know this?

Not at all

Perfectly

most common congenital cause of early cyanosis

tetralogy

How well did you know this?

Not at all

Perfectly

Cardiac equations

CO=HRSV
MAP=COTPR = 2/3 diastolic + 1/3 systolic
Fick’s CO= O2 consumption/(arterial O2-venous O2)
SV=EDV-ESV=CO/HR
EF=(EDV-ESV)/EDV

How well did you know this?

Not at all

Perfectly

what congenital heart defects are helped by increasing afterload?

R -> L shunts

tetraolgy, transposition, truncus arteriosus, Eisenmenger syndrome

How well did you know this?

Not at all

Perfectly

CHF drugs

improve survival: ACE, ARB, aldosterone antag (spironolactone), B-blockers (metoprolol, carvedilol, bisoprolol)
symptomatic relief: diuretics (loop and thiazide), digoxin, vasodilators (nitrates and hydralazine ( dec afterload))

How well did you know this?

Not at all

Perfectly

drugs for acute heart failure

Nitrates
Oxygen
Loop diuretics
Inotropic drugs
Position

How well did you know this?

Not at all

Perfectly

what develops from 3, 4 and 6 aortic arches

3: common carotid, proximal internal carotid
4: left: arch of adult aorta
right: proximal right subclavian
6: proximal pulmonary and ductus arteriosus

How well did you know this?

Not at all

Perfectly

Hypovolemic shock

low output HF
increased SVR decreased CO
Rx: IV fluids, blood

How well did you know this?

Not at all

Perfectly

Cardiogenic shock

low output HF
increased SVR decreased CO
Rx: dobutamine

How well did you know this?

Not at all

Perfectly

Sepsis/anaphylaxis shock

high output HF
decreased SVR increased CO
Rx: antibiotics, IV fluids, norepinephrine

How well did you know this?

Not at all

Perfectly

Neurogenic shock

decreased SVR and CO

Rx: IV fluids, steroids

How well did you know this?

Not at all

Perfectly

Central line placements

femoral
subclavian: risk of pneumothorax
internal jugular: risk of puncturing carotid
preferred sites for Swan-Glanz catheter: right IJ > left SC > right SC > left IJ

How well did you know this?

Not at all

Perfectly

skin in cardiogenic vs septic shock

cardiogenic: cold, clammy, cyanotic, poorly infused
septic: hot, flushed

How well did you know this?

Not at all

Perfectly

heart sounds

S1: closing AV valves
S2: closing aortic and pulmonary valves
S3: filling enlarged space (dilated cardiomyopathy, CHF)
S4: filling against stiffened ventricle (LV hypertrophy, post MI)

How well did you know this?

Not at all

Perfectly

benign heart sounds when no evidence of disease

Split S1
Split S2 on inspiration
S3 in pt < 40
early, quiet systolic murmur

How well did you know this?

Not at all

Perfectly

myocardial action potential phases

Phase 0: Na open
Phase 1: Na closes, K slow open
Phase 2: K slow open, Ca open
Phase 3: Ca closes, K fast open
Phase 4: K closes

How well did you know this?

Not at all

Perfectly

SV/AV node action potential

Phase 0: Ca open (influx) Phase 3: K open, Ca close Phase 4: K close, Na leak (If current)

QRS wide vs narrow

narrow: SA node is pacemaker with normal conduction wide: abnormal conduction pathway, premature ventricular contraction (PVC), ventricular tachycardia, bundle branch block

Potassium effect on T wave

hyperkalemia: short peaked T waves hypokalemia: wide flat T waves

vasopressor of choice for: anaphylactic cardiogenic septic shock

epinephrine dobutamine norepi

drugs that prolong QT interval

macrolides, chloroquines (anti-infective) haloperidol, risperidone (anti-psychotic) methadone anti-HIV protease inhibitors (-navir) antiarrhythmias class IA (quinidine) and class III

drugs act on myosin light chain kinase to cause vasodilation

dihydroperidine Ca channel blockers: block calmodulin-Ca complex epinephrin (B2) + PGE2: increase cAMP

which barorecptor senses both increases and decreases in BP

carotid baroreceptor | aortic only senses increase

paroxysms of increased sympathetic tone; anxiety, palpitations, diaphoresis

pheochromocytoma | episodic release of catecholamines

age of onset btw 20 and 50 for HTN

primary HTN

elevated serum creatinine and abnormal urinalysis with HTN

renal disease

HTN with abdominal bruit

renal artery stenosis

HTN with BP in arms>legs

coarctation of aorta

HTN with family history

primary HTN

HTN with tachycardia, heat intolerance, diarrhea

hyperthyroidism

HTN with hyperkalemia

renal failure

HTN with episodic sweating and tachycardia

pheochromocytoma

HTN with abrupt onset in pt younger than 20 or older than 50 and depressed serum K

hyperaldosteronemia

HTN with central obesity, moon-shaped face, hirsutism

Cushing syndrome

HTN with normal urinalysis and normal serum K levels

primary HTN

HTN in young pt with acute onset tachycardia

cocaine or amphetamines

HTN with hypokalemia

renal artery stenosis

HTN with proteinuria

renal disease

CXR finding in aortic dissection

widened mediastinum

treatment of aortic dissection

B-blocker

HTN with CHF

use: diuretics, ACEi/ARB, B-blocker, aldo antogonist Avoid: B-blocker (acute decompnesated CHF or cardiogenic shock), CCB

HTN with DM

use: ACEi/ARB, thiazide (decrease strokes) avoid: B-blocker (masks hypoglycemia)

HTN with posti-MI/CAD

use: thiazide, B-blocker, ACEi/ARB, CCB, nitrates (as needed)

HTN with atrial fibrillation

B-blocker, diltiazem/verapamil

HTN with bradycardia

avoid: B-blocker. diltiazem/verapamil

HTN with renal insufficiency

use: ACEi/ARB (for proteinuria) avoid: ACEi/ARB (may increase creatinine), K sparing diuretics

HTN with renal artery stenosis

avoid ACEi/ARB

HTN with BPH

use a-blocker

HTN with hyperthyroidism

use propranolol

HTN with hyperparathyroidism

use: loop diuretic (loops lose Ca) avoid: thiazide (retain Ca)

HTN with osteoporosis

``` use thiazide avoid loop (lose Ca) ```

HTN with Gout

avoid thiazides

HTN with pregnancy

Hot Moms Love Nifedipine Hydralazine, methyldopa, labetalol, nifedipine avoid: ACEi/ARB

HTN with migraines

use CCB, B-blocker

HTN with essential tremor

use propranolol

first dose orthostatic hypotension

a-blockers (zosin drugs)

ototoxic (especially with aminoglycosides)

loop diuretic

hypertrichosis

minoxidil

cyanide toxicity

sodium nitroprusside

dry mouth, sedation, severe rebound HTN

clonidine

bradycardia, asthma exacerbations

B-blockers

reflex tachycardia

nitrates, hydralazine, dihydropyridine CCBs

cough

ACEi

avoid in pts with sulfa allergy

loop and thiazide diuretics

possible angioedema

ACEi/ARB

development of drug-induced lupus

SHIPP | hydralazine

hypercalcemia, hypokalemia

loops and thiazides

particularly beneficial to heart failure pts

ACEi/ARB, B-blockers (carvedilol, metoprolol, bisoprolol) and aldosterone antagonists

ST segment elevation only during brief episodes of chest pain

Prinzmetal's angina

patient is able to point to localize the chest pain using one finger

musculoskeletal

chest wall tenderness on palpation

musculoskeletal

rapid onset sharp chest pain that radiates to the scapula

aortic dissection

rapid onset sharp chest pain in a 20 year old and associated with dyspnea

spontaneous pneumothorax

occurs after heavy meals and improved by antacids

GERD

sharp pain lasting hours-days and is somewhat relieved by sitting forward

pericarditis

pain made worse by deep breathing and/or motion

musculoskeletal

chest pain in a dermatomal distribution

herpes zoster

most common cause of non-cardiac chest pain

GERD or musculoskeletal

acute onset dyspnea, tachycardia, and confusion in the hospitalized pt

Pulmonary embolism

most common locations for atherosclerosis and disorders from plaques

abdominal aorta: AAA coronary arteries: MI, angina popliteal artery: claudicatio/peripheral vascular disease carotid: TIA, strokes, multi-infarct dementia

factors that increase myocardial O2 demand

preload, BP, contractility, ejection time, HR

lipid drug causes facial flushing

niacin

lipid drug causes elevated LFT and mysoitis

statins, fibrates

lipid drug causes GI discomfort, bad taste

bile acid binding resins

lipid drug causes best effect on HDL

niacin

lipid drug causes best effect on triglycerides/VLDL

fibrates, omega-3-fatty acid

lipid drug causes best effect on LDL/cholesterol

statins

lipid drug binds c. diff toxin

cholestyramine

ekg changes in MI

ST elevation, R wave decreases, Q wave hours T wave inverts and Q wave deepens st normal, T wave inverted, Q wave persists ST normal, T wave normal, Q wave persists

most common lethal complication of MI

arrhythmias

chest pain, pericardial friction rub, and persistent fever occuring several weeks after an MI

Dressler syndrome

pathological characteristics of arteries in pulmonary HTN

medial hypertrophy fibrosis of intima arteriosclerosis

anterior wall MI leads

V1-V3, maybe 4 and 5 also

lateral wall MI

aVL, V5, V6

inferior wall MI leads

II, III, aVF

Posterior Wall MI

R precordial EKG; V4

manage a pt presenting with acute MI

``` ABCs MONA (IV morphine, O2, NTG, aspirin) B-bloker (metoprolol) statin (atorvastatin) antiplatelet anticoag (heparin normally) K>4, Mg>2 STEMI: cath/fibrinolysis NSTEMI: cath ```

long term management of MI

``` aspirin or clopidogrel B-blocker ACE/ARB K sparing diuretics spironolactone statins decrease weight, exercise, diet ```

diffuse interstitial infiltrate of lymphocytes with myocyte necrosis

myocarditis caused by coxsackie B virus

causes of dilated cardiomyopathy

``` ABCCCD Alcohol wet Beriberi Coxsackie B chronic Cocaine Chagas' disease Doxorubicin and daunorubicin ```

why does valsalva make hypertrophic cardiomyopathy louder

valsalva reduces preload, so it worsens the LV outflow obstruction by getting less blood into the heart

why does squating make a hypertrophic cardiomyopathy quieter

squatting lowers afterload, so it makes it easier to get blood past the obstruction

bacteria most associated with endocardiits

S. aureus viridans streptococci enterococci staph epidermidis (artificial valves)

HACEK organisms

``` Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella ```

Symptoms of endocarditis

``` FROM JANE Fever Roth's spots (on retina and rare) Osler's nodes (painful on fingertips) Murmur Janeway lesions (painless) Anemia Nail bed hemorrhage Emboli ```

IV drug users and endocarditis

S. aureus, Pseudomonas, or Candida on tricuspid valves

acute infective endocarditis

S. aureus rapid onset (days) affects normal valves

subacute infective endocarditis

viridans strep insidious onset (wks to months) effects previously damaged or congenital valves

IV drug user with chest pain, dyspnea, tachycardia, and tachypnea

Right sided endocarditis that sent embolism to pulmonary arteries PE

motor accident with chest pain, dyspnea, tachycardia, and tachypnea

tension pneuomothorax or | fat embolism from long bone fractures

post-op pt with chest pain, dyspnea, tachycardia, and tachypnea

PE from DVT

what drug is used with infective endocarditis in ER

IV vancomycin pending culture results

splinter hemorrhages under fingernails

infective endocarditis

retinal hemorrhages with pale centers

Roth's spots (infective endocarditis)

heart valve most commonly involved in infective endocarditis

mitral | tricuspid for IV drug users

diagnostic criteria for rheumatic fever

``` JONES joints (polyarthritis) Cardiac (pericarditis) nodules (subcutaneous) erythema marginatum sydenham chorea ```

pulsus paradoxus

decrease in systolic BP of >10mmHg with inspiration

Kussmaul's sign

JVD during inspiration due to constrictive pericarditis (increased blood from inspiration cannot fill RV, so it backs up into SVC)

focal myocardial inflammation with multinucleate giant cells

Aschoff bodies | seen in rheumatic fever

chest pain and course rubbing heart sounds in patient with Cr of 5.0

uremic pericarditis

tree-barking of aorta

3 syphilis

child with fever, joint pain, cutaneous nodules 4 weeks after a throat infection

acute rheumatic fever acute causes mitral regurg chronic causes mitral stenosis

ST elevation in all EKG leads

pericarditis

EKG shows electrical alternans

cardiac tamponade

granulomatous nodules in the heart

Aschoff bodies

most common primary cardiac tumor in adults

left atria myxoma

most common primary cardiac tumor in children

rhabdomyoma

most common cause of constrictive pericarditis

US: lupus world: TB

associated with asthma

Churg-strauss

associated with polymalgia rheumatica

giant cell (temporal) arteritis

associated with IgA nephropathy

Henoch-Schonlein purpura

Hepatitis B infection with vasculitis that spares the lungs

polyarteritis nodosa

elderly women with jaw claudication and vision loss

giant cell (temporal) arteritis

desquamation of hands/feet

Kawasaki

palpable purpura on legs

Henoch-Schonlein purpura

disorders common with Raynaud phenomenon

SLE CREST scleroderma Buerger disease mixed connective tissue disease

weak pulses in upper extremities

Takayasu arteritis

necrotizing granulomas of the lung and necrotizing glomeulonephritis

granulomatosis with polyangitis (wegener's)

necrotizing immune complex inflammation of visceral/renal vessels

polyarteritis nodosa

young asthmatics

Churg-Strauss

infants and young children; involves the coronary arteries

Kawasaki

most common vasculitis

Temporal (Giant cell)

perforation of nasal septum

Wegener's

benign, raised, red lesion about the size of a mole in older patients

cherry hemangioma

raised, red area present at birth, increases in size initially then regresses over months to years

strawberry hemangioma

lesion caused by lymphoangiogenic growth factors in an HIV patient

Kaposi sarcoma

polypoid red lesions found in pregnancy or after trauma

pyogenic granuloma

benign, painful, red-blue tumor under fingernails

glomus tumor

cavernous lymphangioma associated with Turner syndrome

cystic hygroma

skin papule in AIDS patient caused by Bartonella

bacillary angiomatosis

cold, pale painful digits

Raynaud's

c-ANCA

granulomatosis with polyangitis (Wgener's)

p-ANCA

microscopic polyangitis and Churg-Strauss

treatment for Buerger disease

smoking cessation

treatment for temporal arteritis

high dose steroids