Cardiovascular Flashcards
What are two ways of measuring mean arterial pressure?
MAP = CO x TPR MAP = 2/3(diastolic pressure) + 1/3(systolic pressure)
What leads to an increased pulse pressure (systolic pressure - diastolic pressure)?
Hyperthyroidism Aortic regurgitation Arteriosclerosis Obstructive sleep apnea Exercise
What causes decreased pulse pressure?
Aortic stenosis
Cardiogenic shock
Cardiac tamponade
Advanced heart failure
What is the Fick principle
CO = (rate of O2 consumption)/(Arterial O2 content - Venous O2 content)
What is the normal ejection fraction? How is EF calculated?
Normal EF is > 55%
EF = SV/EDV or (EDV-ESV)/EDV
What types of vessels account for most of the total peripheral resistance?
Arterioles (they regulate capillary flow)
What causes normal splitting on inspiration?
Inspiration decreases pulmonary impedance and increases the capacity of pulmonary circulation while simultaneously decreasing intrathoracic pressure and thus increasing venous return to the RV causing an increased RV stroke volume
This all leads to delayed closure of the pulmonic valve (which normally closes after the aortic valve anyway) leading to a widened split of closure
What can cause wide splitting?
Seen in conditions that delay RV emptying
Pulmonic stenosis
Right bundle branch block
What can caused fixed splitting?
ASD: leads to left to right shunt which increases RA and RV volumes leading to increased flow through pulmonic valves
What can cause paradoxical splitting?
Seen in conditions that delay LV emptying (aortic stenosis, left bundle branch block)
Normal order of valve closure is reversed so that P2 sound occurs before delayed A2 sound - on inspiration P2 closes later and moves closer to A2 thereby “paradoxically” eliminating the split
What is indicated by a systolic murmur at the left sternal border?
Hypertrophic cardiomyopathy
Where would a ventricular septal defect be heard in the heart?
Tricuspid area (pansystolic murmur)
Where would an atrial septal defect be heard on auscultation?
Tricuspid area (diastolic murmur)
What are the effects on circulation of the following…
Hand grip:
Valsalva (phase II):
Rapid squatting:
Hand grip: Increases systemic vascular resistance
Valsalva (phase II): Decreases venous return
Rapid squatting: Increases venous return, increases preload, increases afterload with prolonged squatting
In mitral valve prolapse, what occurs when afterload is increased? What happens when venous return is decreased?
Increased afterload: Increased murmur intensity and later onset of click
Decreased venous return: Decreased murmur intensity and earlier onset of click
Arrange the following in order of speed of conduction:
Atria, AV node, Purkinje, Ventricles
Purkinje > Atria > Ventricles > AV node
What medications can prolong QT? (Some Risky Meds Can Prolong QT)
Sotalol Risperidone (antipsychotic) Macrolides Chloroquine Protease inhibitors (-navir) Quinidine (Class Ia and III) Thiazides
What is Romano-Ward syndrome?
An autosomal dominant congenital long QT syndrome
What is Jervell and Lange-Nielsen syndrome?
An autosomal recessive congenital long QT syndrome with sensorineural deafness
What is bypassed in Wolff-Parkinson-White syndrome? What can results?
The rate-slowing AV node
May result in reentry circuit leading to supraventricular tachycardia
What can cause a U wave on EKG?
Hypokalemia or bradycardia
Describe ANP
ANP: Released from atrial myocytes in response to increased blood volume and atrial pressure - causes vasodilation and decreased sodium reabsorption at the renal collecting tubule. Constricts efferent renal arterioles and dilates afferent arterioles via cGMP
Describe B-type natriuretic peptide
Released from ventricular myocytes in response to increased tension - similar action to ANP with longer half life (used for diagnosing heart failure)
What is the difference between the aortic arch and carotid sinus in terms of transmission?
Aortic arch: Transmits via vagus nerve to solitary nucleus of medulla in response to increased BP
Carotid: Transmits via glossopharyngeal nerve to solitary nucleus of medulla in response to both increased and decreased BP
What are peripheral and central chemoreceptors (location and function)?
Peripheral: Carotid and aortic bodies - stimulated by decreased O2 pressure (
What develops from the following structures? Truncus arteriosus: Bulbus cordis: Primitive atria: Primitive ventricle: Primitive pulmonary vein: Left horn of sinus venosus: Right horn of sinus venosus: Right common cardinal vein and right anterior cardinal vein:
Truncus arteriosus: Ascending aorta and pulmonary trunk
Bulbus cordis: Smooth parts of left and right ventricles
Primitive atria: Trabeculated part of left and right atria
Primitive ventricle: Trabeculated part of left and right ventricles
Primitive pulmonary vein: Smooth part of left atrium
Left horn of sinus venosus: Coronary sinus
Right horn of sinus venosus: Smooth part of right atrium
Right common cardinal vein and right anterior cardinal vein: SVC
What are the 5Ts of early cyanosis?
Truncus arteriosus Transposition Tricuspid atresia Tetralogy of Fallot TAPVR - Total anomalous pulmonary venous return
What are the four components of Tetralogy of Fallot?
Pulmonary Infundibular stenosis
Right ventricular hypertrophy - Boot shaped heart on CXR
Overriding aorta
VSD
What is the purpose of squatting in TOF?
Increases SVR and decreases right-to-left shunt thus improving cyanosis
What is the defect in TAPVR?
Pulmonary veins drain into right heart circulation (ASD and PDA to allow for right-to-left shunting to maintain CO
Why do left-to-right shunts cause late cyanosis?
Increased pulmonary blood flow leads to right hypertrophy which increases right-to-left pressure eventually causing cyanosis (Eisenmenger syndrome)
Infants of diabetic mothers are more likely to have which congenital cardiac defect?
Transposition of great vessels
What congenital cardiac defects are associated with 22q11 syndromes?
Truncus arteriosus, tetralogy of Fallot
What is a corneal arcus?
A lipid deposit in the cornea - appears early in life with hypercholesterolemia and is common in the elderly
What is Coronary steal syndrome?
Distal to coronary stenosis the vessels are maximally dilated - Administration of vasodilators dilates normal vessels and shunts blood toward well perfused areas leading to decreased flow and ischemia in poststenotic regions
What is dressler syndrome?
Formation of antibodies against the pericardium following MI (> 2 months post) - results in fibrinous pericarditis
What is Loffler syndrome?
A type of restrictive cardiomyopathy with endomyocardial fibrosis with a prominent eosinophilic infiltrate
What are the signs of Bacterial endocarditis? (FROM JANE)
Fever Roth Spots Osler nodes Murmur Janeway lesions (on palm or sole) Anemia Nail-bed hemorrhage Emboli
Tricuspid valve endocarditis is associated with __ ____ ___
IV Drug Use
What are the JONES criteria for rheumatic fever?
Joints Cardiac defects (valve damage) Nodules Erythema Marginatum Sydenham Chorea
What type of hypersensitivity is associated with Rheumatic fever?
Type II hypersensitivity
The primary heart tube loops to establish ____ - ____ polarity in week _ of gestation
left-right
week 4
During the early stages of exercise, CO is maintained by ↑__ and ↑__. During the late stages of exercise, CO is maintained by ↑__ only
During the early stages of exercise, CO is maintained by ↑HR and ↑SV. During the late stages of exercise, CO is maintained by ↑HR only (SV plateaus)
In the pressure volume cardiac loop, at what phase is the period of highest O2 consumption?
1) Isovolumetric contraction
2) Systolic ejection
3) Isovolumetric relaxation
4) Rapid filling
5) Reduced filling
1) Isovolumetric contraction (period between mitral valve closing and aortic valve opening)
When is the S3 sound heard?
When is the S4 sound heard
S3: Early diastole during rapid ventricular filling phase - associated with increased filling pressures (mitral regurgitation or CHF)
S4: Atrial kick in late diastole - high atrial pressure; associated with ventricular hypertrophy
Inspiration leads to increased intensity of ______ heart sounds
Right
What medications are used to convert atrial flutter to sinus rhythm?
Class IA, IC, or III antiarrhythmics
What types of cardiomyopathy can occur with hemochromatosis?
Dilated cardiomyopathy or Restrictive cardiomyopathy
What is endocardial fibroelastosis?
Thick fibroelastic tissue in the endocardium of young children - leads to restrictive cardiomyopathy
What disease is associated with Aschoff bodies and anitschkow cells (granuloma with giant cells + enlarged macrophages with wavy rod-like nucleus)?
Rheumatic fever
Describe the following... Strawberry hemangioma: Cherry hemangioma: Glomus tumor: Angiosarcoma:
Strawberry hemangioma: benign capillary hemangioma of infancy (grows then regresses)
Cherry hemangioma: benign capillary hemangioma of elderly (no regression)
Glomus tumor: benign painful red/blue tumor under fingernails
Angiosarcoma: blood vessel malignancy in sun exposed areas (associated with radiation therapy and arsenic exposure)
