Focus cardiology Flashcards
What is the crista terminalis
is a ridge of myocardium within the right atrium that extends along the posterolateral wall of the right atrium between the orifice of the superior vena cava to the orifice of the inferior vena cava
What is the ligamentum arteriosum aka** Botallo’s ligament **aka Harvery’s ligaement aka Botallo’s duct?
is a small ligament attaching the aorta to the pulmonary artery. It serves no function in adults but is the** remnant of the ductus arteriosus** formed within three weeks after birth
What is the eustachian valve
an embryologic remnant that lies at the junction of the inferior vena cava (IVC) and inferior right atrium (RA).
In fetal development, the valve directs incoming oxygenated blood towards the foramen ovale and away from the right atrium
What anatomical structure prevents blood from going back up the coronary veins when the right atria contracts?
the thesbian valve aka the coronary sinus
What is the triangle of Koch and what are the 3 deliminations?
Found in the Right atrium. Helps us find the AVN
Tendon of Todaro
Septal side of Tricuspid
Valve of tebesio
If you want to ablate the AVN (in case of pacemake implantation in A fib patients) you go into this triangle
Why is the auricle/appendage in the left atrium important?
90% of intracavitary thrombi form here
Virchow triad determines the likelihood of thrombi development. It includes
statis
hypercoagulability
endothelial damage
What is transposition of the greater vessels
is a congenital heart defect in which the position of the two major vessels that carry blood away from the heart, the aorta and the pulmonary artery, is switched
MUST OPERATE!!
What happens to the coronary circulation for the RV in systoli?
maintenence of circualtion (but note that the refilling of the vessel occurs in the diastolic phase)
What happens to the coronary circulation of the LV in systole?
decrease the circulation bc the muscle of the LV squishes the vessel
Where is the pulmonary trunk located with respect to the aorta?
infront of the aorta
What are the first and second most common valvulopathies?
1st: aortic stenosis
2nd: mitral insufficiency
another name for semilunar valves is (aortic/pulmonary)
sigmoid valves
which heart valve pathology has the highest risk of getting bacterial endocarditis?
bicuspid aortic valve
which condition has a higher likelihood of a person having a bicuspid aortic valve?
marfan syndrome
arteria coronaria sinistra gives the segno of valsalva sinistra
arteria coronaria destra gives the segno of valsalva destra
both signs of the valsalva are on the aortic valve
Which coronary artery is dominant
IVP - interventriculare posteriore aka discendente posteriore
which has an origin in the coronaria destra
whats the origin of the anterior interventricular artery? heart?
coronary sinistra
what is an absolute contradiction for coronagrophy
Nothing
If pt is allergic to iodinated contrast give cortisone and proceed
if pt has iper or ipothyroidism, schedule dialysis after proceedure but proceed
Coronary right
gives off the Interventricular posteriores (descenging postereior) which is for dominance
coronary left
has atrunoc commune then w2 branches. one with the interventrular anterior and the other is the circomflex artery
veins of the heart
coronary sinus (seno coronarico) - with valve names Tebesio
- vene cardiache anteriore o magna e parva
- vene minime di tebesio
Conduction system of the heart
sinoatrial node - 2 interatrial branches - join back at AVNode- split into bundle of Hiss then split into brnaca destra and sinistra (sinistra is bigger so it divides furhter into fascicolo anteriore and fascicolo posteriore)
do pacemaker cells have a fase di riposo?
no
WPW has what
a bundle of kent which is an additional point of conduction apart from the AVN
What are the 4 manuovers to reduce the AV conduction?
valsalva
carotid massage
compressione dei globi
Adenosino
BB
C antagonista
Digitale
(note you use them in that order!)
what is post load (post carico)
l’insieme della resistenza che il ventricolo deve vincere per espellere il sangue ed equivale allo stress di parete
what is preload
volume of blood in the ventricles at the end of diastole (end diastoli pressure)
cardiac tropisms
inotropismo
chronotropismo
batmotropismo (excitability)
dromotropismo (conduction velocity)
polso paradosso is always with what pathology
cardiac tamponade
S1 (First heart sound) is due to closure of which heart valves?
closure of atrioventricular valves (LUB)
At the beginning of systole
The first heart sound coincides with the QRS complex.
What is S2 the sound of
aortic and pulmonary valves close
DUB
end of systole/beginning of diastole
Austin flint mumur is
is a rumbling diastolic murmur best heard at the apex of the heart that is associated with severe aortic insufficiency and is usually heard best in the fifth intercostal space at the midclavicular line.
De Musset’s sign
head bob with each systolic pulsation
Corrigans pulse
bounding pulse
traube’s sign
booming systolic and diastolic sounds over the femoral arteries
Mullers sign
systolis pulsation of uvula
Quinckes sign
capillary pulsations noted in the nail beds or fingertips with each cardiac cycle
Rivero carvalho sign
increase in systolic murmur of tricuspid regurgitation during inspiration. As venous return increases during inspiration, blood volumes in the right side of the heart and TR increase
Graham steel mumur
(GDP- Gross Domestic Product. Graham Diastolic Pulmonary)
the early blowing diastolic murmur heard along the left border of the sternum due to functional regurgitation through the pulmonic valve. The pulmonic valve itself is not diseased; its ring of attachment is stretched as a result of chronic pulmonary hypertension from marked mitral stenosis.
Homans sign
Homan’s sign test also called dorsiflexon sign test is a physical examination procedure that is used to test for Deep Vein Thrombosis (DVT).
A positive Homans’s sign (calf pain at dorsiflexion of the foot) is thought to be associated with the presence of thrombosis.
Baur sign
pain when you compress the polpaccio
When do you hear s3
during systole
when there is a sovracarico di volume
insuff aortica, insuff mitralic, scompenso cardiaco
When do you hear S4
in diastole
when the ventricle has a reduced compliance (and the atria is very efficiently emptying - not applicable in case of A fib/A flutter)
Erb point
for aortic valve insufficiency
left, sternal border, 3rd intercostal space
what does polso parvo mean
means a pulse with small amplitude
what is the most common cause of tachicardia parossistica sopraventricolare?
tachicardia da rientro nodale
flutter atrial on ECG
saw tooth pattern
flutter atriale tipico or atipio
tipico is comune - 90% - saw tooth pattern: percorso in type of anti- orario
IBUTILIDE is for?
Is a class 3 anti arrythmic.
Atrial flutter emergency tx if not responding to vagal manuvers or ABCD drugs
WPW
Delta wave, attached to the wide QRS
What pathology lends a high risk of recurrence of arythmia after ablation?
severe dilation of the left atrium
What is the most common cause of long QRS tachycardia?
tachycardia ventriculare monomorfa sostenuta
if you have QRS complexes what can it not be
ventricular fibrillation
most common cause of bradycardia
sinus bradycardia
AV block of mobitz 2 tx
pacemaker
Ideal LDL levels are calculated based on risk of cardiovascular events using SCORE 2 or SCORE 2-OP
LDL <55 - for pts at risk
LDL<40 - pts at high risk
Pro atherogenic lipoproteins examples
VLDL, IDL, LDL, and Lp (a) are all pro-atherogenic while HDL is anti-atherogenic
progression of atherosclerosis
fatty streak
atheroma
fibrous plaque (stable or unstable)
complicated lesion/rupture
VCAM 1 is found on
endothelial cells
Two types of plaques in atherosclerosis
Plaques with elevated lipid content: even if they are smaller, they have a higher risk of rupturing
Plaques with fibre/calcification: even if bigger have lower risk of rupture
What is a complicated plaque?
when an atherosclerotic plaque ruptures
What is myocardio stordito
is myocardium affected by transient reversible myocardial contractile dysfunction induced by acute ischemia.
What is miocardio ibernato
is ischemic myocardium supplied by a narrowed coronary artery in which ischemic cells remain viable but contraction is chronically depressed.
Tx for stable angina
aspirin, statin, anti-angina (sublingual nitrates, if chronic BB, CCB. then ivabraidine (acts on funny current, reduces HR)) are first line
contraindications to a stress test
left bundle branch block
pace maker
WPW syndrome
takes digitalis
ST>=o.1
What is MINOCA
MI with non-obstructive coronary arteries
Can be: Type 2 MI; plaque disruption, epicardial spasm, coronary TE, dissection, takosubo
prinzmetal angina
(vasospastic angina or variant angina) is a known clinical condition characterized by chest discomfort or pain at rest with transient electrocardiographic changes in the ST segment, and with a prompt response to nitrates. These symptoms occur due to abnormal coronary artery spasm
– in young smokers