Cardiovascular Flashcards
What does the Truncus arteriosus give rise to?
Ascending aorta and pulmonary trunk
What does the Bulbus cordis give rise to?
Smooth parts (outflow tract) of the L and R ventricles
What does the primitive atria give rise to?
Trabeculated part of L and R atria
What does the primitive ventricle give rise to?
Trabeculated part of L and R ventricles
What does the primitive pulmonary vein give rise to?
Smooth part of L atrium
What does the Left horn of sinus venosus (SV) give rise to?
Coronary sinus
What does the Right horn of sinus venosus (SV) give rise to?
Smooth part of R atrium
What do the right common cardinal vein and right anterior cardinal vein give rise to?
SVC
What are the 4 features of Tetralogy of Fallot?
- Persistent VSD
- Overriding aorta
- Pulmonary infundibular stenosis
- RVH (boot-shaped heart on CXR)
Where does fetal erythropoiesis happen?
Yolk sac, liver, spleen, and bone marrow later
What is the mechanism by which fetal hemoglobin has a higher affinity to oxygen?
Less avid binding of 2,3-BPG - allows HbF to extract O2 from maternal Hb across the placent
By what age is almost all HbF converted to HbA?
About 3 months
What medication helps close a patent PDA?
Indomethacin
What does the umbilical vein become?
Ligamentum teres hepatis (contained in falciform ligament)
What does the allantois become?
Urachus - median umbilical ligament
What do the umbilical arteries become?
Medial umbilical ligaments
What does the ductus arteriosus become?
Ligamentum arteriosum
What does the ductus venosus become?
Ligamentum venosum
What does the foramen ovale become?
Fossa ovalis
What does the notochord become?
Nucleus pulposus of intervertebral disc
What does the first aortic arch give rise to?
Not much, it mostly regresses
What does the second aortic arch give rise to?
No contribution
What does the third aortic arch give rise to?
Common and proximal internal carotid arteries
What does the fourth aortic arch give rise to?
Part of true aortic arch and subclavian arteries
What does the fifth aortic arch give rise to?
Nothing
What does the sixth aortic arch give rise to?
Pulmonary arteries and ductus arteriosus
Coronary artery occlusion most commonly occurs in which vessel?
LAD
Does nitroglycerin dilate arteries or veins?
veins
Does hydralazine dilate arteries or veins?
arteries
What is a normal EF?
> 55%
How can one differentiate between normal (physiologic) splitting of S2 from wide (pathologic) splitting?
Wide splitting will be present regardless of inspiration
Conditions that delay RV emptying will cause what type of heart sound phenomenon?
Wide splitting
Conditions that delay LV emptying will cause what type of heart sound phenomenon?
Paradoxical (elimination of) splitting
Which ‘abnormal’ heart sound is common in children and pregnant women?
S3
What is an S4 heart sound associated with?
LVH
A mid-systolic click is diagnostic for what?
Mitral valve prolapse
What can cause mitral valve prolapse?
Myxomatous degeneration, rheumatic fever, or chordae rupture
A wide pulse pressure, bounding pulses, and head bobbing are indicative of what heart problem?
Aortic regurgitation
What type of medication is enoxaparin?
Low molecular weight heparin
What can a U wave on ECG indicate?
Hypokalemia or bradycardia
What is Torsades de pointes?
Polymorphic ventricular tachycardia, can progress to v fib
What can cause Torsades de pointes?
Long QT caused by drugs, hypokalemia, hypomagnesemia, etc.
What is the treatment of Torsades de pointes?
Magnesium sulfate
What are the medications that can prolong QT?
Sotalol, Risperidone (antipsychotics), Macrolides, Chloroquine, PIs, Quinidine (class Ia, also class III), Thiazides; “Some Risky Meds Can Prolong QT”
What type of arrhythmia causes sudden death in patients with congenital long QT syndrome?
Torsades de pointes
Describe the two types of Congenital long QT syndromes and their names
Romano-Ward syndrome: Aut dom, pure cardiac phenotype
Jervell and Lange-Nielsen syndrome: Aut rec, sensorineural deafness
What is Wolff-Parkinson-White syndrome?
Most common type of ventricular pre-excitation syndrome. Abnormal fast accessory conduction pathway from atria to ventricle (bundle of Kent) bypasses the AV node. Characteristic delta wave with shortened PR interval. May result in reentry circuit –> supraventricular tachycardia.
What is the treatment for Wolff-Parkinson-White syndrome?
Type Ia antiarrhythmics
What does Brugada syndrome result in?
V fib
What is a first degree heart block?
PR interval is prolonged (>200msec). Benign and asymptomatic. No tx required.
What is a second degree Mobitz type I heart block?
Aka Wenckebach. Progressive lengthening of the PR interval until a beat is “dropped.” Usu asymptomatic.
What is a second degree Mobitz type II heart block?
Dropped beats that are not preceded by a change in the length of the PR interval. Usu 2+ P waves to one QRS complex. May progress to complete heart block. Treated with pacemaker.
What is a first 3rd degree (complete) heart block?
No relationship between P waves and QRS complexes. Atria and ventricles beat independently of each other. Treated with pacemaker.
What disease process can lead to a complete heart block?
Lyme disease
ANP is released from where in response to what? What are its effects?
Released from atrial myocytes in response to increased blood volume and atrial pressure. It causes vasodilation and decreased Na reabsorption in kidney. Constricts efferent renal arterioles and dilates afferent arterioles via cGMP, promoting diuresis.
BNP is released from where in response to what? What are its effects?
Released from ventricular myocytes in response to increased tension. Similar effects as ANP but with longer half life. Good for diagnosing HF.
An increase in BP stimulates baroreceptors in aortic arch which travel via which nerve to where?
Via vagus nerve to solitary nucleus of medulla
An increase or decrease in BP stimulates baroreceptors in carotid sinus which travel via which nerve to where?
Via glossopharyngeal nerve to solitary nucleus of medulla
Parasympathetic stimulation to the heart travels via which nerve?
Vagus nerve
What is a “carotid massage?”
Stimulation of the carotid baroreceptors send firing signals to the medulla via the glossopharyngeal nerve. As a response, the medulla sends parasympathetic innervation to the heart via the vagus nerve.
Where exactly is the SA node?
Right atrial wall near superior vena cava
Where exactly is the AV node?
Interatrial septum near the tricuspid orifice
What is peripheral pulmonary stenosis?
Aka pulmonary branch stenosis. Innocent murmur heard after first day of life when PDA is closed. Results from relative hypoplasia of branch pulmonary arteries compared to relatively large main pulmonary artery. Heard over lung fields and radiates towards back and axilla.
