Cardiovascular Flashcards
Failure to thrive + respiratory distress + machine-like murmur + palpable thrill over L infraclavicular border
Patent Ductus Arteriosus
Two main causes of cyanosis at birth
Transposition of the great arteries
Tetralogy of Fallot
Definition: Permissiveness
When one hormone allows another to exert its maximal effect.
First step in the pathogenesis of Coronary Artery Atherosclerosis?
Endothelial cell injury
Main difference - Skeletal muscle vs Cardiac/Smooth muscle
Skeletal muscle does not require external calcium for contraction. Cardiac and Smooth muscle undergo calcium-induced calcium release.
Mid-systolic click in murmur?
Mitral valve prolapse
Holosystolic murmur? (2)
- Mitral/Tricuspid regurgitation
- Ventral Septal Defect
Bounding femoral and carotid pulses + head bobbing + murmur
Aortic regurgitation
Congenital cardiac defect(s) associated with diabetic mothers (1)
Transposition of great vessels
Congenital cardiac defect(s) associated with Marfan Syndrome (4)
- Mitral Valve Prolapse
- Thoracic aortic aneurysm
- Thoracic aortic dissection
- Aortic regurgitation
Congenital cardiac defect(s) associated with Turner Syndrome (2)
- Aortic coarctation
- Bicuspid aortic valve
Congenital cardiac defect(s) associated with DiGeorge Syndrome (3)
- Tetralogy of Fallot
- Interrupted aortic arch
- Truncus arteriosus
Congenital cardiac defect(s) associated with Freidrich ataxia (1)
Hypertrophic cardiomyopathy
Congenital cardiac defect(s) associated with Fetal Alcohol Syndrome (4)
- Ventral Septal Defect
- Atrial Septal Defect
- Patent Ductus Arteriosus
- Tetralogy of Fallot
Cells involved in producing atheromas?
Endothelial cells
Leukocytes
Vascular smooth muscle cells
Types of vegetations found in subacute endocarditis?
Fibrin + platelets (thrombotic vegetations)
Flat facies, epicanthal folds, oblique palpebral fissures, single palmar crease, endocardial cushion defect =
Down syndrome (trisomy 21 via chromosomal nondisjunction)
Mechanism of diphtheria AB exotoxin
Active subunit A transfers a ribose from NAD onto histadine on Elongaton Factor 2. The ribosylation of EF-2 inhibits protein synthesis.
Myofibrillar dysarrray on light microscopy
Hypertrophic Cardiomyopathy
Lipofuscin - definition, where it is found
Product of lipid peroxidation, yellow-brown pigment. Accumulates in aging cells (heart, liver).
What parameter is most similar between the systemic and pulmonary circuits?
Blood flow per minute
Fracture of the pterion results in laceration of _ and formation of _ hematoma?
- Middle meningial artery
- Epidural hematoma
Wide fixed splitting of S2 is caused by?
Atrial Septal Defect
The significant increase in blood oxygen saturation between two right sided vessels/chambers indicates =
L->R shunt (most likely a VSD)
Pericardial friction rub 3 days after an acute MI is caused by =
fibrinous pericarditis as a reaction to transmural necrosis
Pericardial friction rub several weeks after an acute MI is caused by =
fibrinous pericarditis caused by an autoimmune reaction against the pericardium
10 yo + clubbing + cyanosis in toes only + exertional dyspnea and fatigue + no regular checkups + equal extremity pulses + no murmur =
Large PDA
differential cyanosis
Where is O2 extraction the highest?
Myocardium
63 yo male + progressive exertional dyspnea + orthopnea + hypertension + elevated JVP + pitting edema
Is his Ang II level elevated or decreased?
Ang II will be elevated
CHF -> decreased CO -> decreased RBF -> (+) JG apparatus -> renin -> Ang II + Aldo + ADH -> aberrant salt and fluid retention and vasoconstriction -> elevated BP
Right sided varicocele indicates occlusion of _
IVC - usually due to a renal malignancy that has spread to the right renal vein and then thrombosed into the IVC
Which holosystolic murmur increases intensity upon inspiration =
increases VR to the right heart
-Tricuspid regurgitation
Which murmur increases intensity on standing or doing a valsalva maneuver?
decreases VR
- Hypertrophic cardiomyopathy
- Mitral valve prolapse
Which murmur increases intensity on squatting ?
increases VR
-Aortic stenosis
Which murmur increases intensity on hand grip?
increases afterload
- Aortic regurgitation
- Mitral regurgitation
- VSD
2 most susceptible locations for atherosclerotic disease
- Lower abodminal aorta
- Coronary arteries
Traumatic aortic rupture from a MVA affects where on the aorta?
aortic isthmus - it is held by the ligamentum arteriosum and therefore is relatively immobile
Hypotension + elevated JVD + diminished heart sounds + no pulse on inspiration =
Cardiac tamponade
Beck’s triad = hypotension + distended neck veins + distant heart sounds
no pulse on inspiration = Pulsus paradoxus
Cardiac sinus massage mechanism =
Increased firing of carotid sinus -> increased afferent (IX) firing -> medulla -> increased efferent (X) firing -> parasympathetic stimulation to the heart -> decreased AV node conduction -> terminates tachycardia
Ebstein’s anomaly
ASD + no tricuspid valve
seen in lithium teratogenicity
beta-blocker effect on ECG =
slow AV conduction + prolongs AV nodal delay -> prolongs PR interval
Mechanism of ventricular free wall rupture leading to sudden death
rupture -> hemopericardium -> cardiac tamponade -> hypotension + shock -> pulseless activity -> death
earliest microscopic change seen in ischemic stroke in the brain =
in the heart =
@12 hours - red neurons
@4 hours - wavy myofibrils
JVP waveform:
- a wave =
- c wave =
- x descent =
- v wave =
- y descent =
- a wave = Atrial contraction
- c wave = RV contraction, tricuspid valve bulges into the atrium
- x descent = atrial relaXation
- v wave = atrial pressure increases as there is filling against a closed tricuspid valve
- y descent = RA emptying into RV
S4 or S3 in children - normal or pathological
S4 in children - always pathological
S3 in children - normal
ECG with delta wave + widened QRS + shortened PR interval =
Wolff-Parkinson White syndrome - ventricular pre-excitation syndrome, bypasses the rate-slowing AV node
Cherry hemangioma - population? progression?
- benign
- capillary hemangioma of the elderly
- does not regress
Strawberry hemangioma - population? progression?
- benin
- capillary hemagioma of infancy
- grows rapidly and then regresses spontaneously by 5-8 yo
Differences (1) and Similarities (4) between Temporal arteritis and Takayasu arteritis
Differences =
-location
Temporal arteritis - temporal artery
Takayasu arteritis - aortic arch + proximal great vessels
Similarities =
- large vessel vasculitis
- increased ESR
- granulomatous inflammation
- treatment - corticosteroids
“immune complex deposition-mediated transmural inflammationn of the arterial wall with fibrinoid necrosis” - what type of vasculitis?
Polyarteritis nodosa
“segmental thrombosing vasculitis of medium sized arteries” - what type of vasculitis?
Buerger disease. Also known as: thromboangiitis obliterans.
Biventricular pacemakers put leads to pace 3 locations
- RA
- RV
- RA -> coronary sinus (atrioventricular groove) -> lateral venous tributary -> LV
Thick band of atrial muscle that separates the smooth sinus venosus from the Right atrial appendage and atrium proper + site of origin of atrial pectinate muscle =
Crista terminalis
L/R atrial appendage =
Small sac-like structure in the atria that is susceptible to thrombus formation
Migratory thrombophlebitis indicates =
Visceral cancer (adenocarcinoma of the pancreas, colon or lung)
Trousseau syndrome - paraneoplastic hypercoagulability
Most common cause of death post-common femoral artery catheterization =
Retroperitoneal hemorrhage -> shock
- Painful thromboses
- Stasis dermatitis
- Skin ulceration
- Poor wound healing
- Superficial infections
These are complications of _
varicose veins
MI involving the RCA resulting in damage to the inferior wall may present as
Abdominal discomfort
Deep, broad Q waves on ECG indicates
prior/old MI
ANP - What triggers its release? What does it do?
Released when: increased atrial pressure, increased blood volume in heart
Actions: vasodilation, decreased sodium reabsorbed at the CD
Anemia causes increased or decreased CO?
Increased CO due to the reduced O2 carrying capacity of RBCs, more blood needs to be shunted past tissues to ensure appropriate oxygen delivery
2 vessels used for bypass surgery:
- Internal mammary artery
- Saphenous vein
Systolic murmurs and Diastolic murmurs
Systolic: AS, MR, TR, MVP, VSD
Diastolic: AR, MS
AV shunt hemodynamic changes (preload, afterload, SV)
- Because the AV shunt moves from the arteral system straight to the venous system, blood flow is much faster and at a higher volume returning to the heart -> increased preload
- Becauses the AV shunt bypasses the arterioles, there is a decrease in TPR -> decreased afterload
- Increased preload + Decreased afterload = Increased SV
Ortner Syndrome =
Mitral stenosis -> LA dilation -> impinges on the L recurrent laryngeal nerve -> hoarseness
Murmurs that decrease on squatting (2)
- Hypertrophic cardiomyopathy
- Mitral valve prolapse (mid-systolic click is closer to S1)
Buerger disease treatment =
Smoking cessation
Serious complication of Kawasaki disease =
Coronary artery aneurysm
Penetrating injury at the left sternal border at 4th and 2nd intercostal spaces:
@4th intercostal space (T4) = RV
@2nd intercostal space (T2) = pulmonary trunk
Dyslipidemia: associated with obesity and insulin resistance and increased VLDL in circulation
Type IV - familial hypertriglyceridemia
- Hepatic overproduction of VLDL
- AD
Dyslipidemia: premature peripheral vascular disease + tuberoeruptive and palmar xanthomas
Type III - familial dysbetalipoproteinemia
-Defective ApoE -> increased chylomicrons and VLDL remnants in circulation
Dyslipidemia: tendon xanthomas + xanthelasmas + corneal arcus
Type II - familial hypercholesterolemia
- AD
- Defective LDL receptor -> increased LDL and cholesterol in circulation
- Also presents with premature CAD in the family - MI before age of 20
Dyslipidemia: creamy supernatant + acute pancreatitis + eruptive skin xanthomas + AR
Type I - familial chylomicronemia
-Defective LPL -> increased in chylomicrons in circulation
“Polymorphic QRS complexes that change in amplitude and cycle length”
Torsades de Pointes
Always will have a prolonged QT as well - distinguishes TdP from other polymorphic ventricular tachycardias
Cardiac tissue conduction speeds
(Fastest) Purkinje > Atria > Ventricles > AV node (Slowest)
Park At Venture Avenue
Phenomenon where blood flow is diverted away from ischemic areas due to vasodilator action in nonischemic areas
Coronary steal syndrome - leads to hypoperfusion and worsening of existing ischemia
Concept used during stress testing to identify cardiac “lesions”
1 week old boy with an uncomplicated pregnancy and birth now has a harsh holosystolic murmur heard at the L mid to lower sternal border. His exam prior to leaving the hospital after birth had no cardiac findings. What is this new murmur?
- Small VSD - no symptoms/cyanosis, audible around age 4-10 days when PVR lowers enough to allow a L->R shunt
- Small VSDs close spontaneously
-A large VSD would have presented with failure to thrive right away and requires surgical intervention
Leukocytoclastic vasculitis
Microscopic polyangitis - segmental fibrinoid necrosis of small vessels
Portal vein = _ + _
Superior mesenteric vein + Splenic vein
Bicuspid aortic valve predisposes to an increased risk for developing _
premature aortic stenosis (~50 yo)
Normal aging stenosis of the aortic valve becomes symptomatic ~65 yo
Irregularly irregular rhythm - describe P waves, QRS, and R-R
- Absent P waves
- Narrow QRS
- Varying R-R interval
Nitrates cause increase/decrease in HR?
The hypotension caused by venodilation results in reflex tachycardia (increased HR)
Where is the great saphenous vein accessed to use in grafting?
inferolateral to the pubic tubercule
- travels up the leg medially
- the small saphenous vein is lateral
Middle meningial artery comes off of _ artery
External carotid -> maxillary artery -> middle meningial artery
pathology of an AAA
Chronic transmural inflammation of the aortic wall -> degradation of elastin and collagen -> wall weakening -> aneurysm
pathology of intermittent claudication
atheroscloerosis (lipid filled intimal plaque)
polyarteritis nodosa spares what arteries?
pulmonary arteries
