Cardiovascular system Flashcards
Kartagener Sym
1’ ciliary dyskenesia; AR dynein arm defect : 1) male & female infertility, ↑ risk for ectopic pregnancy; 2) bronchiecstatis (支气管扩张), 3) recurrent sinusitis, 4) situs inverses (内脏逆转) in development (dextrocardia 后右位心）on CXR note: 心脏transposition不累及atrium和大A, 只是RV/LV换位，必须由shunt来维持生命
cause, Rx for PFO (patent foramen ovale)?
failure of septum primum and septum secundum to fuse after birth; most are left untreated; can lead to paradoxical emboli (venous thromboemboli enter into systemic arterial circulation)
Fetal-postnatal derivatives: UmbiLical vein UmbiLical arteries Ductus arteriosus Ductus venosus Foramen ovale AllaNtois [ә’læntәuis] 尿囊 notochord 脊索
UmbiLical vein - Ligamentum teres hepatis UmbiLical arteries - MediaL umbilical ligaments Ductus arteriosus - Ligamentum arteriosum Ductus venosus - Ligamentum venosum Foramen ovale - Fossa ovalis 卵圆窝 AllaNtois [ә’læntәuis] 尿囊 - Urachus (脐尿管) -mediaN umbilical ligament notochord 脊索- Nucleus pulposus 髓核 of intervertebral disc
Pulse pressure 与SV (stroke volume), arterial compliance关系？ ↑ pulse pressure seen in? ↓ pulse pressure seen in?
Pulse pressure (=systolic pressure - diastolic pressure) is proportional to SV, reversely proportional to arterial compliance. ↑ pulse pressure seen in: SV ↑ 的情况：hyperthyroidism, exercise (transient), aortic regurgitation, arteriosclerosis, obstructive sleep apnea (↑ sympathetic tone) ↓ pulse pressure seen in (血射不出心脏的情况）: aortic stenosis, cardiogenic shock, cardiac temponade, advance HF
↓ preload 代表药物？ ↓ afterload 代表药物？ 哪些药物能同时舒张A & V?
vEnodilators (舒静脉药）↓ preload: nitroglycerin [nitrates舒张所有平滑肌，但是最重要的机制是舒张large venous capacitance vessels, ↓ venous return] vAsodilators (舒A药）↓ Afterload: hydrAlazine (hy’dralazine, 肼苯哒嗪) - ↑ cGMP ⟹ smooth muscle relaxation. Vasodilates arterioles > veins; afterload reduction. 同时舒张A & V: ACEI (king of 降压药！）， ARB
use Laplace’s law to explain LV hypertrophy as compensation for ↑ afterload?
Laplace’s law: wall tension = Pressure * radius / 2* wall thickness ↑ wall thickness can ↓ wall tension
EF normal range? EF change in systolic/diastolic HF?
≥ 55% ↓ in systolic HF; normal in diastolic HF EF = SV (stroke volume)/EDV = (EDV-ESV)/EDV
S1?
S1—mitral and tricuspid valve closure. Loudest at mitral area (5th left intercostal space, medial to the mid-clavicular line)
S2
S2—aortic and pulmonary valve closure. Loudest at left sternal border (pulmonary valve area) aortic valve area: 2nd right intercostal space at the right sternal border
S3: when? where? which diseases?
S3—in early diastole during rapid ventricular filling phase. Associated with ↑ filling pressures (e.g., mitral regurgitation, CHF) and more common in dilated ventricles (but normal in children and pregnant women).
S4：when? which diseases?
S4 (“atrial kick”)—in late diastole. High atrial pressure. Associated with ventricular hypertrophy. Left atrium must push against stiff LV wall.
Jugular venous pulse (JVP)?
acxvy a wave—atrial contraction. c wave—RV contraction (closed tricuspid valve bulging into atrium). x descent—atrial relaxation and downward displacement of closed tricuspid valve during ventricular contraction. Absent in tricuspid regurgitation. v wave—↑ right atrial pressure due to filling against closed tricuspid valve. y descent—blood flow from RA to RV.
wide S2 splitting indicates?
delay RV emptying: 1), 器质性：pulmonic stenosis, 2) 传导性： right bundle branch block). Delay in RV emptying causes delayed pulmonic sound (regardless of breath, in the contrary to normal splitting). An exaggeration of normal splitting.
fixed splitting indicates?
ASD ASD ↑ left-to-right shunt ⟹ ↑ RA and RV volumes ⟹ ↑ flow through pulmonic valve such that, regardless of breath, pulmonic closure is greatly delayed.
Paradoxical splitting indicates?
主动脉瓣反而在肺动脉瓣后关闭 Seen in conditions that delay LV emptying (aortic stenosis, left bundle branch block).
effect of hand grip to systemic resistance? change of heart murmurs?
↑ systemic resistance ↑ MR, AR, VSD ↓ AS, hypertrophic cardiomyopathy murmurs
valsalva maneuver? effect on murmurs?
forceful attempted exhalation against a closed airway, usually done by closing one’s mouth, pinching one’s nose shut while pressing out as if blowing up a balloon. Phase I: pressure rises inside the chest forcing blood out of the pulmonary circulation into the left atrium. mild ↑ in stroke volume Phase II: ↓ venous return, ↓CO, (compensatory tachycardia) ↓ intensity of most murmurs (including AS)
Systolic heart sounds include? Diastolic heart sounds include?
systolic: 血液向前进入主动脉或肺动脉，向后反流入心房，或者LV → RV, Aortic/pulmonic stenosis, mitral/tricuspid regurgitation, VSD; diastolic: 血液从心房入心室，动脉瓣关闭 mitral/tricuspid stenosis，Aortic/pulmonic regurgitation
CC for MR? TR? 听诊特点？
holosystolic, high-pitched blowing MR: ischemic heart disease, MVP(二尖瓣返流），LV dilation loudest at apex, radiate to axilla; ↑ by hand grip, squatting TR: RV dilation; loudest at 4th intercostal space at the lower left sternal border Rheumatic fever and infective endocarditis can cause either MR or TR
CC for AS? 听诊特点？
CC: age-related calcification, bicuspid aortic valve Crescendo-decrescendo systolic ejection murmur. pulses are weak with a delayed peak. Can lead to Syncope, Angina, and Dyspnea on exertion (SAD).
VSD 听诊特点？
Holosystolic, harsh-sounding murmur. Loudest at tricuspid area, accentuated withhand grip maneuver due to ↑ afterload.
MVP (prolapse) 听诊特点？
Late systolic crescendo murmur with midsystolic click (MC; due to sudden tensing of chordae tendineae). Most frequent valvular lesion. Usually benign. Can predispose to infective endocarditis. Best heard over apex. Loudest just before S2. Occurs earlier with maneuvers that ↓ venous return (e.g., standing or Valsalva).
AR (Aortic regurgitation) 听诊特点？CC?
buzz words: Wide pulse pressure, bounding pulses, head bobbing (due to ↑ amplitude of intracranial arteries with heart beat) 舒张早期，High-pitched “blowing” early diastolic decrescendo murmur. CC： aortic root dilation, rheumatic fever，bicuspid aortic valve, endocarditis, 风心病总会累及二尖瓣，但是25%病例是二尖瓣+主动脉瓣返流，区别在于仅累及MV时LV舒张压正常或降低。如果LV舒张压↑, 说明合并AR
ANP, BNP由什么细胞产生？什么刺激使之产生？机制？用途？
ANP: atrial myocytes, in response to ↑ blood volume or atrial pressure, 作用于肾collecting duct, cause vasodilation and ↓ Na+ reabsorption (“aldosterone escape” mechanism); dilate afferent arterioles via cGMP, constricts efferent arterioles BNP (brain-type): produced by ventricular myocytes to ↑ tension; mechanisms similar to ANP, but with longer half-life blood test used for Cx for HF (great negative predictive value); recombinant form (nesiritide) is used to treat HF
2种baroreceptors感受刺激、传入神经的不同？
aortic arch: respond ONLY to ↑ BP; transmit via vagus N to solitary nucleus of medulla carotid sinus: respond to ↑ BP AND ↓ BP; transmit via glossopharyngeal N to solitary nucleus of medulla 【note: how can carotid massage ↓ HR: ↑ pressure on carotid sinus - ↑ stretch - ↑ afferent baroreceptor firing - ↑ AV node refractory period - ↓ HR]
