Cardiovascular Flashcards
position of the aorta and the pulmonary artery
aorta is posterior to the pulmonary artery
if anterior, then spiraling occurs that lead to transposition of the great arteries
heart issues associated with turner syndrome
bicuspid aortic valve and aortic coarctation (femoral pulses
heart sound of nonstenotic bicuspid aortic valve
early systolic, high frequency click heard over the right second interspace
heart issues associated with Down syndrome
complete atrioventricular canal, atrial septal defect (ASD), and ventricular septal defect (VSD)
what is pulsus paradoxus
physical finding in cardiac tamponade and refers to an exaggerated drop in systolic blood pressure (>10 m Hg) during inspiration
what are atrial natriuretic peptide?
what tissue produces it?
secreted by atrial cardiomycytes in response to atrial stretch due to hypertension or hypervolemia
causes peripheral vasodilation and increased urinary excretion of Na and water
what is the pulmonary capillary wedge pressure measuring?
Left atrial pressure and left ventricular end-diastolic pressure
tetralogy of fallot-cause
caused by anterosuperior displacement of infundibular septum
4 things of tetralogy of fallot
1) pulmonary infundibular stenosis (most important determinant for prognosis)
2) right ventricular hypertrophy - boot-shaped heart on CXR
3) overriding aorta over the right and left ventricles
4) Ventricular septal defect
symptom of tetralogy of fallot
“tet spells” or cyanotic spells that improve with squatting, prominent right ventricular impulse, systolic murmur
difference in location of action between the two types of calcium channel blockers
1) dihydrophyridines- affect arterial smooth muscles, causing vasodilation with little or no effect on cardiac conduction or contractility
2) nondihydropyridine affect myocardium, slow heart rate and reduce contractility
dystrophic calcification
a hallmark of cell injury and death, occuring in all types of necrosis in the setting of normal calcium levels
what is the only drug that slows heart rate with no effect on cardiac contractility (inotropy) and/or relaxation (lusitropy)
ivabradine
-slows the SA node firing by selective inhibition of funny sodium channels–> prolong slow depolarizatioin phase (phase 4)
fixed splitting of S2 is associated to what defect
atrial septal defect
heart sound of ventricular septal defect
holosystolic murmur, similar to that of mitral regurg
“harsh” sounding, whereas regurg are “high pitched”
what heart condition can asian children with Kawasaki diseases develop?
coronary artery aneurysms, thrombosis or rupture
single most important risk factor for the development of intimal tears leading to aortic dissection
hypertension
major vascular beds that are the most susceptible to atherosclerosis (2)
lower abdominal aorta and coronary arteries
-regions involve bends and branch points are most susceptible de to turbulence
heart sound of aortic stenosis
systolic crescendo-descrescendo murmur best heard at base of heart with radiation to neck
heart sound of aortic or pulmonic regurgitatioin
early diastolic descrescendo murmur
wide pulse pressure-head bobs
heart sound of mitral or tricuspid regurgitatioin
holosystolic or pansystolic murmur (same intensity for the duration of systole)
heart sound of mitral valve prolapse
click followed by a murmur
click due to sudden tensing of the chordae tendinae that stops the movement of the valve
heart sounds of mitral or tricuspid stenosis
murmur beginning with a opening “snap” when stenotic valve finally opens the a turbulent rumbling murmur
cardiac tissue conduction velocity “Park At Vent Avenue” -rank from slowest to fastest
AV node, ventricular muscle, atrial muscle, purkinje system
EKG leads and blood vessel associated with inferior wall of left ventricle
leads II, III, and aVF
Right Coronary artery
EKG leads and blood vessel associated with the septal part of the heart
leads v1, v2
left anterior descending artery
EKG leads and blood vessel associated with anterior part of the heart
v3, v4
right coronary artery
EKG leads and blood vessel associated with the lateral side of the heart
leads I, avL, V5, V6
left circumflex artery
what is paradoxical embolism
when a thrombus from the venous system crosses into the arterial circulation via an abnormal connection between the right and left cardiac chambers (eg, patent foramen ovale, atrial septal defect or ventricular septal defect)
right-sided endocarditis of this valve is commonly associated with IV drug users and is most often due to Staphylococcus aureus
tricuspid valve
cardiac issues associated with DiGeorge syndrom
tetralogy of Fallot, truncus arteriosus, and transposition of the great arteries
heart issues associated with Marfan syndrome (fibrillin-1 mutations)
dissecting aortic aneurysms, aortic valve regurgitatioin, an mitral valve prolapse
define permissiveness of drug reaction
Presence of substance A is required for the full effects of substance B
femoral vein is immediately ______ to the femoral artery
medial
most common cause of subungual splinter hemorrhages (small hemorrhages underneath the fingernail)
microemboli from the valvular vegetations of bacterial endocarditis
warfarin (Coumadin) reduces thrombus formation risk by inhibiting the activation of the vitamin K-dependent clotting factors ___, ___, __ and ___
II, VII, IX, and X
prolongs prothrombin time
brain natriuretic peptide (BNP) released in response to high atrial and ventricular filling pressures to do what?
promote vasodilation , natriuresis, and diuresis
most frequent mechanism of sudden cardiac death in the first 48 hours after acute MI
ventricular fibrillation
atrial fibrillation can occur but does not lead to sudden cardiac death
most common predisposing condition for valve infective endocarditis in developed nations vs. developing nations
developed nations: mitral valve prolapse
developing nations: rheumatic heart disease
findings on EKG for Wolf-Parkinson-White syndrome
(accessary tract bypass AV node)
short PR interval, widening of the QRS interval, slurred and broad upstroke of the QRS complex (delta wave)
polyarteritis nodosa usually spares which arteries?
pulmonary arteries
usually involves renal and visceral vessels
characteristic/ definition of diastolic heart failure
normal ventricular ejection fraction, normal end-diastolic volume, but with increased LV filling pressure
phenyephrine is a selective _______ receptor ______
what does it do for the heart?
alpha-1; agonist
vasoconstrict, increase peripheral vascular resistance and systolic blood pressure, decreases pulse pressure and heart rate
fibrates mechanism of action
lower triglyceride by activating peroxisome proliferator-activated receptor alpha (PPAR-alpha)–> decreased hepatic VLDL production and increased lipoprotein lipase activity
4 drug types that improve long-term survival in patients with heart failure
beta blockers, ACE inhibitors, angiotensin II receptor blockers, and aldosterone antagonists
what is the Kussmaul sign and when do you see it?
increase in JVP on inspiration instead of the normal decrease
see it in constrictive pericarditis, restrictive cardiomyopathies, right atrial and ventricular tumors
action of milrinone on cardiomyocytes vs. vascular smooth muscles
cardiomyocytes: increase cAMP–> calcium influx–> increase cardiac contractility
vascular smooth muscle: increase cAMP–> systemic vasodilation
beta1 adrenergic receptors are found where?
cardiac tissue, renal juxtaglomerular cells
NOT vascular smooth muscle
atherosclerotic plaques develop predominantly in these vessels: (in decreasing order)
abdominal aorta, coronary arteries, popliteal arteries, internal carotids, and circle of Willis
why is it bad to use nitrates and phosphodiesterase inhibitors used in erectile dysfunction together?
both enhanced synthesis (nitrates) and inhibit degradation (PDE inhibitors) of cGMP–> cGMP accumulates–> profound hypotension from extreme vasodilatation
what has to be the same in both pulmonary circulation and systemic circulation during exercise and rest?
blood flow per minutes
otherwise systemic circulation will run out of blood
aortic regurgitation- sounds? and when?
high-pitched, blowing decrescendo diastolic murmur
immediately after closure of aortic valve
best heard when patient is sitting up and learning forward with head exhale
how to hear the left ventricular gallops (S3 and /or S4) better?
bell over cardiac apex while patient in left lateral decubitus
listen at end expiration - heart closer to chest wall
what would you find on the histology of cardiac sarcoidosis
noncaseating granulomas with giant cells
what is the most common adverse effect of fibrinolytic therapy
hemorrhage…. like intracerebral hemorrhage
triggers for prinzmetal (variant) angina
cigarette, cocaine/amphetamines, dihydroergotamine/triptans
treated with vasodilatation
what are janeway lesions
nontender, macular, and erythematous lesions located on palms and soles
due to septic embolization from valvular vegetations
composed of bacteria, neutrophils (microemboli), necrotic material and subcutaneous hamorrhage
what heart issues are associated with S4?
decreased left ventricular compliance like with restrictive cardiomyopathy and left ventricular hypertrophy
carotid sinus baroreceptors send their information to the brainstem using the __________ nerve
glossopharyngeal nerve
aortic arch baroreceptors send their information to the brainstem using the _______ nerve
vagus nerve
most common cause of coronary sinus dilation
elevated right-sided heart pressure like when it is secondary to pulmonary hypertension
dilation is due to dilation of the right atrium
adverse effects of thiazide
hyperGLUC
hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia, sulfa allergy, hypokalemic metabolic alkalosis
what is myocardial hibernation
state of chronic myocardial ischemia in which both myocardial metabolism and function are reduced to match the reduction in coronary blood flow
to prevent myocardial necrosis
gene mutation associated with hereditary form of cardiac amyllodosis
transthyretin gene
mutation in what genes are associated with hypertrophic cardiomyopathy
cardiac sarcomere genes like cardiac beta-myosin heavy chain gene and myosin-binding protein C gene)
auto dominant
effects of norepinephrine
alpha1-vasoconstricting effects
has beta2 activity so can increase cardiac output
effects of epinephrine
beta1 and beta2 agonist
at higher doses have more alpha activity
increase cardiac output through beta1
can have vasodilatory effects so decrease bp because of beta2
effects of isoproterenol
pute beta agonist, zero alpha activity
increase cardiac output but cause vasodilation
no alpha, so will greater drop in bp with isoproterenol
effects of dopamine
low dose- vasodilation in kidneys and gut
medium dose- beta1 increase cardiac output
high dose-alpha1 activity and vasoconstrict
effects of phenylephrine
pure alpha agonist so vasocontrict and increase bp
can lead to reflex bradycardia
how do you best hear pericardial friction rub
when patient is leaning forward or lying prone
scratchy sound
combination of ________ and _______ can have additive negative chronotropic effects yielding severe bradycardia and hypotension
non-dihydropyridine calcium channel blockers and beta-adrenergic blockers
side effects of adenosine
flushing, chest burning (due to bronchospasm), hypotension, and high-grade atrioventricular block
what do you use to treat widened QRS interval or ventricular arrhythmias due to fast sodium channel blockade? (like with tricyclic antidepressant overdose)
sodium bicarbonate–> increase serum pH and extracellular sodium
heart issues associated with carcinoid syndrome
pathognomonic plaque-like deposits of fibrous tissue on right sided endocarium
–> tricuspid regurgitation and right-sided heart failure
most common arrhythmia in those with inferior wall MI
sinus bradycaria due to both nodal ischemia and enhanced vagal tone
managed with intravenous atropine (anticholinergic that fixes DUMBBELSS: bradycardia included)
in large-vessel vasculitis (giant (temporal) arteritis and Takayasu arthritis, what do you use as initial test?
erythrocyte sedimentation rate since it would be elevated in both
