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Step I > CV > Flashcards

CV Flashcards

1
Q

ascending aorta arises from?

A

truncus arteriosus

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2
Q

pulmonary trunk arises from?

A

truncus arteriosus

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3
Q

smooth mm/outflow of left and right ventricles arises from?

A

bulbus cordis

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4
Q

trabeculated part of left and right atria arises from?

A

primitive atrium

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5
Q

trabeulated part of left and right ventricles arises from?

A

primitive ventricle

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6
Q

smooth part of left atrium arises from?

A

primitive pulmonary v

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7
Q

coronary sinus arises from?

A

left horn of sinus venosus

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8
Q

smooth part of right atrium arises from?

A

right horn of sinus venosus

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9
Q

SVC arises from?

A

right common cardinal v and right ant cardinal v

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10
Q

when does heart start to beat?

A

we 4

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11
Q

patent foramen ovale

A

d/t failure of septum primum and septum secundum to fuse after birth

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12
Q

VSD

A

most commonly occurs in membraneous septum

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13
Q

conotruncal abnormalities

A

transposition of great vessels
tetralogy of fallot
persisten truncus arteriosus

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14
Q

aortic and pulmonary valves arises from?

A

endocardial cushions of outflow tract

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15
Q

mitral and tricuspid valves arise from?

A

fused endocardial cushions of AV canal

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16
Q

fetal erythropiesis

A 
young liver synthesizes blood
yolk sac 3-8wks
liver 6wk-birth
spleen 10-28wk
bone barrow 18wk+
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17
Q

hemoglobin

A

alpha always
gamma goes
becomes beta

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18
Q

fetal hemoglobin

A

alpha2 gamma2

higher affinity for O2 d/t lower affinity for 2,3 BPG

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19
Q

what do you give to close PDA

A

indomethacin

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20
Q

what do you give to keep PDA open?

A

PGs E1 and E2

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21
Q

median umbilical ligament arises from?

A

allantois -> urachus

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22
Q

ligamentum arteriosum arises from?

A

ductus arteriosus

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23
Q

ligamentum venosum arises from?

A

ductus venosus

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24
Q

foramen ovale arises from?

A

fossa ovalis

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25
Q

nucleus pulposus arises from?

A

notochord

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26
Q

medial umbilical ligament arises from?

A

umbilical aa

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27
Q

ligamentum teres hepatis arises from?

A

ligamentum hepatis in falciform ligament

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28
Q

SA and AV nodes get blood from?

A

RCA

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29
Q

right dominant circulation

A

PDA from RCA

85%

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30
Q

most posterior part of heart?

A

left atrium -> enlargement = dysphagia or horseness

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31
Q

CO

A

SVxHR
or
rate of O2 consumption/ (aaO2-vvO2)

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32
Q

MAP

A

COxTPR
or
2/3DP + 1/3SP

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33
Q

early exercise

A

CO maintained by increased HR and SV

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34
Q

late exercise

A

CO maintained by increased HR only

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35
Q

what does increased HR d/t diastole?

A

shortens it d/t increased filling time -> decreased CO

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36
Q

increased pulse pressure

A

hyperthyroidism
aortic regurg
aortic stiffening (isolated systolic HTN of elderly)
obstructive sleep apnea (increased sympathetics)
exercise (transient)

37
Q

decreased pulse pressure

A

aortic stenosis
cardiogenic shock
cardiac tampenade
advanced heart failure

38
Q

contractility increases d/t

A

catecholamines (increased Ca pump on SR)
increased intracellular Ca
decreased extracellular Na (decreased Na/Ca exchanger)
digitalis (blocks Na/K pump -> increased intracellular Na -> decreased Na/Ca exchange -> increased Ca

39
Q

contractility decreased d/t

A 
B1 blockade (decreased cAMP)
HF w/systolic dysfunction 
acidosis
hypoxia/hypercapnia
non-dihyydropyridine Ca Ch blockers
40
Q

Myocardial oxygen demand

A 
increased myoCARDial O2 demand
increased Contractility
increased Afterload
increased heart Rate
increased Diameter of venticle (wall tension)
41
Q

wall tension

A

(pressure x radius) / 2x wall thickness

42
Q

preload

A

approximated by ventricular EDV

decreased by venodilators (nitroglycerin)

43
Q

afterload

A

approximated by MAP

vasodilators (hydralazine) decrease afterload

44
Q

what decreases both preload and afterload?

A

ACEI and ARBs

45
Q

EJ

A 
SV/EDV
(EDV-ESV)/EDV
normal 55%
decreased in systolic HF
normal in diastolic HF
46
Q

increased afterload

A

increased aortic pressure
decreased SV
increased ESV
loop is tall and skinny

47
Q

increased preload

A

increased SV

loop gets wider to the right

48
Q

increased contractility

A

increased SV
increased EF
decreased ESV
loop gets wider to the left

49
Q

S1

A

mitral and tricuspid valve closure

loudest at mitral

50
Q

S2

A

aortic and pulmonary valve closure

loudest at left upper sternal border

51
Q

S3

A

in early diastole during rapid ventricular filling phase
associated with increased filling pressures
mitral regurg
HF
more common in dilated ventricles
normal in prego and kids

52
Q

S4

A

in late diastole, atrial kick
apex in LLD
high atrial pressure
ventricular hypertrophy

53
Q

a wave

A

Atrial contraction

absent in a-fib

54
Q

c wave

A

RV Contraction

d/t closed tricuspid valve bulging into atrium

55
Q

x descent

A

atrial relaXation and downward displacement of closed tricuspid valve during ventricular contraction
absent in tricuspid regurg

56
Q

v wave

A

increased right atrial pressure d/t villing against closed tricuspid

57
Q

y descent

A

RA emptying into RV

58
Q

normal splitting

A

inspiration -> decreased intrathoracic pressure -> increased venous return -> increased RV filling -> increased RV SV -> increased RV ejection time -> delayed closure of pulmonic valve

59
Q

wide splitting

A

daled RV empyting
pulmonic stenosis
RBBB
present during exhalation but exaggerated in inspiration

60
Q

fixed splitting

A

same in inhalation and exhalation

ASD -> L to R shunt - increased RA and RV volumes -> increased flow thru pulmonic

61
Q

paradoxical splitting

A

conditions that delay aortic valve closure
aortic stenosis
LBBB
pulmonic closes before aortic

62
Q

inspiration

A

increased intensity of R heart sounds

63
Q

handgrip

A

increases afterload
increased MR, AR, VSD murmurs
decreased hypertrophic cardiomyopathy murmurs
MVP: later onset of click/murmur

64
Q

valsalva phase II, standing up

A

decreased preload
decreased intensity of most murmurs
increased intensity of hypertrophic cardiomyopathy
MVP: earlier onset of click

65
Q

rapid squatting

A

increased VR and increased preload
decreased intensity of hypertrophic cardiomyopathy
increased intensity of AS
MVP: later onset of click

66
Q

AS

A

C/D systolic ejection murmur
LV»aortic pressure
aortic listening post -> radiates to carotids
pulsus parcus et tardus (weak pulse w/delayed peak)
SAD- syncope, angina, dyspnea on exertion
age related calcification or bicuspid valve

67
Q

MR/TR

A

holosystolic high-pitched blowing murmur

RF or infective endocarditis can cause either

68
Q

MR

A

loudest at mitral post, radiates to axilla
ischemic heart disease (post-MI)
MVP
LV dilation

69
Q

TR

A

tricuspid post radiates to R sternal border

RV dilation

70
Q

MVP

A

mitral valve prolapse
late systolic crescendo murmur w/midsystolic click
most frequent w/valvular lesion
mitral post
loudest just before S2
benign, predispose to infective carditis
can be caused by myxomatous degeneration (CT disease), RF, chordae rupture

71
Q

VSD

A

holosystolic
harsh
loudest at tricuspid

72
Q

AR

A

high pitched blowing early diastolic decrescendo murmur
long diastolic murmur and signs of hyperdynamic pulse when serve and chronic
often d/t aortic root dilation, bicuspid aortic valve, endocarditis, RF
progresses to LHF

73
Q

MS

A 
follows opening snap 
delayed rumbling late diastolic murmur 
LA>>LV pressure during diastole 
RF
can lead to LA dialation
74
Q

PDA

A

continuous machine like murmur
loudest at S2
congenital rubellla or prematurity
best heard at left intraclavicular area

75
Q

PR interval

A
76
Q

QRS

A
77
Q

speed of conduction

A

purkinje >atria > ventricles > AV node

78
Q

pacemakers

A

SA >AV >bundle of His > purkinje/venticles

79
Q

conduction pathway

A

SA -> atria -> AV -> common bundle -> bundle brr -> fasicles -> purkinje fibers -> ventricles

80
Q

torsades de pointes

A

long QT predisposes:
drugs
decreased K and increased Mg
Tx with Magenesium sulfate

81
Q

drug induced long QT

A 
ABCDE
anti Arrhythmics (class IA, III)
aBx (macrolides)
anti Cychotics (haloperidol)
anti Depressants (TCAs)
anti Emetics (odansetron)
82
Q

congenital long QT

A

usually d/t ion ch defects
increased risk of SCD
romano-ward syndrome
jervell and lange-nielsen syndrome

83
Q

romano-ward syndrome

A

AD
long QT
pure cardiac phenotype

84
Q

jervell and lange-nielsen syndrome

A

AR
long QT
sensoineural deafness

85
Q

brugada syndrome

A

AD
asian males
pseudo RBBB and ST elevation in V1-3
increased risk of ventriculat tachy and SCD
prevent SCD w/implantable cardioverter-defibrillator

86
Q

wolff-parkinson-white

A

MC type of ventricular pre-excitation syndrome
bundle of kent - abnormal fast accessory conduction pathway from atria -> ventricle
widened QRS
delta wave
can cause supraventricular tachy

87
Q

atrial natriuretic peptide

A

atrial myocytes
acts via cGMP
vasodilation and decreased Na resorption in renal collecting tubules

88
Q

brain natriuretic peptide

A

ventricular myocytes
via cGMP
longer half life the ANP
used to Dx HF (very good neg predictive value)

Step I (22 decks)

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