DIT Cardiology Flashcards
What Does Truncus Arteriosus become?
primitive ventricle?
Bulbus Cordis?
TA: proximal aorta and prox pulm trunk
PV: muscular L and R ventricle
BC: R and L ventricular outflow tracts
What does primitive atrium become?
Sinus vvenosus (left horn)?
Sinus venosus (right horn)?
PA: Muscualr L and R atria
SV (LH): coronary sinus
SV (RH): smooth portion of atrium)
Aortic arches (3 and 4 are most important). They go with branchial arches
1st aortic arch: maxillary artery (goes with the M’s of branchial arch)
- Stapedial (S’s) and hyoid artery)
3rd letter of alphabet: Carotid
4th. (4 limbs, systemic) Left: adult aorta. Right is proximal right subclavian
6th. Proximal pulmonary artery. L will have ductus arteriosus (makes sense it comes off of aorta, which is on the left)
Wide fixed split?
Pressure equalized even when you inhale, so ASD (usually from too big foramen oval)
Machine like murmur?
PDA
Coarctation in infantile? What is it associated with?
Adult coarctation?
Before PDA (so may need to keep PDA open. ASSOCIATED WITH TURNER SYNDROME)
Further down, HTN up high, weak pulses in low. RIB NOTCHING
Associated cardiac issue with turner syndrome?
Infantile coarctation
Bicuspid aortic valve
Down syndrome cardiac issues?
Endocardial cushion risk (ASD, VSD, Both)
DiGeorge syndrome associated cardiac issue?
Tetrology of fallout
truncus arteriosus
Congenital rubella cardiac issue?
PDA
Pulmonary artery stenosis
Marfan associated cardiac problem?
aortic insufficiency later in life from abrnomal valves
5 Right to Left Shunts?
1 truncus arteriosus 2. transposition of great vessels 3 tricuspid atresia 4 tetrology 5. total anomalous pulmnoary return
Babies of mother with diabetes?
Large babies, TGA1C
4 metrologies of fallout? Whichis most important for prognosis?
Cyanotic may be when crying. Squating helps b/c increasing peripheral pressure to make a higher pressure on L to make a R–>L shunt
- pulmonary valve stenosis (MOST IMPORTANT for prognosis)
- RV hypertrophy
- VSD
- Overriding aorta (R–>L)
Boot shaped!
Beta1 does what in the heart?
Activates calcium pump in sarcoplasmic reticulum to put more calcium in to release it later and more release when it is activated.
Digoxin mechanism?
Stop Na/KATPase, so not much gradient to kick out sodium out of cell, so you can’t do Na/Ca exchanger to kick out calcium
What is “fluid overload status”?
Too much preload causes the cardiac output actually decreases in CHF.
Normal ejection fraction? How is it calculated?
55
SV/EDV
What is PCWP? When is it high?
PCWedgePressure. Measure LA pressure.
LA is higher than Left V diastolic pressure when Mitral stenosis
3 things causing release of renin?
Symp Beta 1
Macula densa: senses low Na
JG sensing low BP
What is BNP? What diagnosis can it steer you towards or away from?
Hormone in cardiac ventricles in response to stretch.
Causes vasodilation
Increase excretion of Na and water in urine
Sign of CHF
IMPORTANT to recognize CHF vs COPD vs pneumonia
What drugs increase survival of CHF?
Blocking the Renin Angiotensin system.
some beta blockers if it is compensated.
(ACEi, ARBs, Spironolactone and some beta blockers)
Mechanism of digoxin? Does it help survival?
No only symptomatic relief in CHF.
Blocks Na/KATPase to make less gradient of Na
The Na gradient drives exchanger of Na/Ca and as a result, Ca stays in cells
Who has digoxin toxicity? What are symptoms? Tx?
Patients with renal failure.
Symptoms:
BLURRY YELLOW VISION
Cholinergic (puking, bradycard)
Confusion
Tx: correct hypokalemia, give magnesium, anti DIG antibody fragments, atropine
How do you treat acute heart failure? Mnemonic
NO LIP
Nitrates Oxygen Loop Diuretics (Qbank!) Inotropic drug (dobutamine last ditch) Position so blood pools in leg
Which diuretic is the big dog to get out extra fluid?
Loop diuretics are much faster and stronger. Thiazides are for minor symptoms (Q bank). Makes sense, bigger pump, more water reabsorbed in ascending loop.
What is pitting edema?
Excess fluid in absence of additional colloid
Note, non pitting is colloid
Femoral vessels mnemonic? Which is medial?
NAVEL.
Nerve, Artery, Vein, empty, Lymphatic.
Lymp is medial, b/c if NAVY Y is for YingYang (penis)
Risk of subclavian central line?
PTX. Not a good choice in COPD or lung issues.
Where do you put in a swans gan?
Right internal jugular, left subclavian (natural loop), right SC, L IJ
What is Kf?
Capillary permeability. Increased with infection/burn
What happens to end systolic volume when you have high after load?
There is higher ESV (Page 270) b/c it is so hard to constrict the heart to match the aortic pressure, that there is not much left to get the pressure out.
Tall and skinny (like A)
More preload, the curve is to the right like the curve in the letter P
More Contractility, more to the left b/c curve is on left in C
What is the dicrotic notch?
Elasticity of aorta causes increase of pressure after the aortic valves close. Good to fill coronary arteries.
What causes tree barking of aorta?
Syphilus. Lost is the elasticity of aorta.
S1, S2 are what?
S1 is mitral closure, but the sound is the turbulence of blood after closure
S2 is after aortic valve closes
What is S3? what does it mean? You struggle with that
Rapid ventricular filling in dilated ventricles. (can be normal in kids and preggers, b/c lots of preload and filling)
Means: Dilated cardiomyopathy CHF Mitral regurt L to right shunt (VSD, ASD, PDA)
What is S4?
It is atrial kick
From high atrial pressure, usually left ventricular hypertrophy. Hypertrophic Aortic stenosis Chronic HTN with LVH Post MI
A wave, C wave and V wave?
A Atrial contraction
C right ventricular Contraction bulging tricuspid back
V increased atrium filling against closed tricuspid ValVe
What is wide splitting caused by?
Things slowing expulsion of blood from RV. Pulm stenosis or RBBB.
When is there a fixed split?
ASD. B/c blood shunts to L to R to equalize
Paradoxical splitting is when?
When left side is delaying emptying. LBBB, aortic stenosis…
Do you worry about S3 in under 40?
Nah, but if older, look for other issues.
Diastolic murmur?
A/V valve stenosis
Aortic or pulmonic valve regurge
Systolic murmurs?
Aortic or pulmonic stenosis
Mitral or tricuspid regurge
Where is left regurge louder? what do you see with diastolic bp?
Over left sternum b/c blood shooting back into left ventricle
Peripheral bounding pulses (Water Hammer pulse)
Head bobbing
What can cause aortic root regurge?
Aortic root dilation: Syphilis (treebarking), Marfan, BICUSPID AORTIC VALVE (that most oftenly causes stenosis, but can cause regurge), rheumatic fever
What murmur has opening snap?
Mitral stenosis (b/c takes a bit of time before the valve opens)
Loudest in left lateral decubitus
What causes atrial dilation?
Mitral strenosis, makes sense
what are the 5 systolic murmurs?
Aortic stenosis Mitral regurge MVP Tricuspid prolapse VSD
What has ejection click with crescendo and decrescendo?
It also radiates to carotids
Atrial stenosis. B/c isometric contraction before it opens. Blood flows out fastest halfway through, hence opening
Most common causes aortic stenosis?
Bicuspid aortic valve (most common onset symptoms in 40’s)
Senile (degenerative calcification (age 60+))
Rheumatic valve disease
Unicuspid (rare)
Syphilis (rare)
What is holosystolic blowing murmur? What makes it louder?
Mitral regurge
Loudest in left lateral decubutis
Increased after load (hand grip or squatting)
How do you tell VSD vs tricuspid regurge?
clinical info:
Newborn: VSD
IV drug user: tricusp regurge from endocarditis
What causes phase 0 in myocytee?
In pace maker?
voltage gates Na in myocyte
Voltage gated Ca++ channel in pace maker
What is a quick way to see if the heart has a good axis?
Positive QRS deflection in lead I and lead II. positive in both means normal.
How big is a small box time wise in EKG? Big box?
- 04 seconds
0. 2 box
What is PR interval? What is normal?
Beginning of P to Q. Less than 200 ms (less than a big box)
What is normal QRS?
<120 msec (3 small boxes, easy to remember b/c 3 spikes)
What does a peaked T wave mean?
High potassium causes HIGH peak)
What direction do each leads go?
1 2 3 Avr avl avf?
(From patient perspective) 1. left 2. down and left 3. down and right aVR is up and right aVL is up and L aVF is down
EKG with sawtooth?
Atrial flutter of P waves
How do you recognize first degree block?
PR > 200 ms (more than one big block means there is a block)
What bacteria can cause AV nodal block?
Borrelia burgdorferi (lyme disease) (Kardiac block in FAKE a key Lyme pie)
Facial nerve palsy (bilateral usually)
Arthritis
Kardiac block
Erythema migrans
What is mobitz type I?
progressive lengthening of PR until drop (Wenkebak).
It is second degree.
What is mobitz type 2?
no warning before the drop. MORE DANGEROUS b/c can progress to third degree
Tx with pacemaker
What is wolf parkinson white? What is its signature?
What can it lead to?
How do you treat it?
Bundle of Kent. (he would) allows portion of ventricle to depolarize before the rest of it comes
Delta wave!
Can lead to supra ventricular tachycardia
Procainamide or amiodarone
What is ventricular bigeminy?
PVC after each sinus beat.
VTAC definition?
3+ pramature beats.
Sustained VTAC is 30 seconds or more, unsustained is less than 30
Meds that prolong QT?
Some Risky Meds Can Prolong QT
Sotalol Risperidone (antipsychotics) Macrolides Chloroquine Protease inhibitors (-navir) Quinidine (class I and III (Na, K)) Thiazides
Clonidine vs phenoxybenzamine vs phentolamine?
Clonidine is Alpha2 agonist
Phenoxybenzamine is IRREVERSIBLE alpha blocker for pheochromocytoma
Phentolamine is for patients on MAO inhibitors who eat tyramine containing foods
