Quiz III Flashcards
Define cardiothoracic ratio and normal value
ratio for heart diameter to chest diameter at widest points
-should be less than 50%
Where does pericardial effusion occur?
b/w the visceral and parietal layers of the pericardium
Length of normal aortic arch on frontal CXR
<4cm from left border of trachea to lateral border of the aortic arch
Age or atherosclerotic disease can have what morphological effect on the aorta
Can become elongated and tortuous
Appearance of dilated ascending aorta on CXR?
Will appear as a CONVEX shape above the right atrium where there should be straight line representing SVC
Signs of dilated main pulmonary artery on CXR
- larger than aortic arch
- extends to the left of line drawn tangentially to aortic arch and apex of heart
Descending pulmonary artery should be less than?
16 mm (seen on the right side)
Left atrial enlargement on CXR
- left side
- right side
LEFT - left atrial contour becomes straight or convex (normally concave)
RIGHT - double density sign
Also elevation of left main bronchus
PPH puts increased pressure on?
Right ventricle -> enlargement
Match the following conditions with their respective SEPTAL defects
Down Syndrome
Trisomy 13
22q11
Down Syndrome: AVSD, primum defects
Trisomy 13: VSD, ASD
22q11: Posterior malalignment VSD
Match the following conditions with their respective VALVULAR defects
Trisomy 18
Noonan Syndrome
Trisomy 18: polyvalvular disease, VSD
Noonan Syndrome: pulmonary valve stenosis, hypertrophic cardiomyopathy
Match the following conditions with their respective CONOTRUNCAL defects
22q11 Deletion Syndrome
CHARGE Syndrome
Turner Syndrome
Williams Syndrome
22q11 Deletion Syndrome: Interrupted Aortic Arch type B, truncus arteriosus, tetralogy of Fallot, right aortic arch
CHARGE Syndrome: Tetralogy of Fallot, double outlet right ventricle, right aortic arch
Turner Syndrome: Coarctation, bicuspid aortic valve, hypoplastic left heart syndrome
Williams Syndrome: Supravalvular aortic stenosis, Branch PA stenosis
Down syndrome
- which CHD
- why at risk for AML?
- AVSD
- GAT1 mutation -> transient myeloproliferative disorder
Trisomy 18
- mutation
- maternal or paternal
- survival?
- CHD?
- features?
- 50% meiosis II nondisjx
- 95% maternal (age correlation)
- 5-10% survival after 1 year
- 50% w/in 1st week
-CHD -> polyvalvular abnormalities
FEATURES
- prominent occiput
- feet rounded at bottom w/ prominent heels
- central apnea
Trisomy 13
- features
- CHD
- survival
FEATURES
- Giant sore on top of head
- Bilateral cleft lip and palate
- Dysplastic malformed ear, small head, microcephaly, polydactyly
- CHD -> VSD
- survival - median = 7 days
What 3 syndromes is TOF associated with?
22q11.2 deletion -> 16%
Alagille Syndrome -> 12%
Down’s -> 5%
22q11.2 features
What testing is important?
- Hooded eyes
- Low set, rotated ears
- Micrognathia
- HYPOcalcemia – no PTH
- Immune deficiency (DiGeorge’s)
- Feeding problems, cleft palate
- Learning probs, behavior issues, psychosis
- TEST PARENTS!!!
Williams Syndrome
- CHD
- gene
- characteristics
- risk of?
- mutation?
- unique characteristics
CHD - supravalvular aortic stenosis
Gene -> 7q11 and ELN-1
CHARACTERISTICS
-Elevated Serum calcium, urine calcium output
-FTT
-Developmental delays
-Supraorbital fullness, stellate iris, long
philtrum, large mouth with full lips
-Risk of sudden cardiac death with anesthesia due to decreased elastin in coronary arteries
Coarctation of aorta associated with?
Characteristics of this syndrome
Turner Syndrome
-NORMAL IQ but visuaspatial difficulties
• Tiny hyper-convex fingernails
• Lymphedema of feet and hands
• Webbed neck
Noonan Syndrome
- CHD
- Mutation
- Features
CHD -> PVS + HCM
-mutation -> RAS/MAP kinase pathway
Features • Wooly/curly hair with family members that have different hair • Pectus excavatum • Widely spaced • Ptosis of the eyes • Eyes slanting DOWN (DOWN’S SLANT UP) • Broad forehead and small chin • Webbed neck • Scoliosis • Low posterior hairlines • Bleeding diathesis
CHARGE syndrome
- define
- heart defect
- can be associated with
- cranial nerve dysfx includes
- mutations or deletions in
- Coloboma, Heart defect, choanal atresia, mental/growth retardation, GU anomalies, ear anomalies
- conotruncal defects
- associated w/ Kallmann’s
- CN I, VII-X
- mutation -> CHD7 -> needed for neural crest cells
Describe autonomic control of HR and SV
SV (contractility) -> ONLY under SNS control
HR - influenced by PNS and SNS
Venous return and what go hand in hand?
Stroke Volume
Blood volume adjustment occurs at the level of the?
KIDNEY - long term
-regulate size of the peripheral venous pool -> venous return -> cardiac output
Effectors for reflex regulation of BP?
Heart -> CO
VSM -> TPR
Describe the location of the 2 baroreceptors
- CN
- Role
Arch of aorta
- CN X
- responding to pressures from the heart
Carotid bifurcation
- IX
- responding to perfusion pressure of brain
The 2 are same if lying down and different if standing up
What 3 things activate the chemoreceptors and what’s the response
- Inc PCO2
- Inc H+
- Dec PO2
Inc in driving pressure
Where the the receptors CP reflexes located?
What do they respond to?
What’s the response?
Receptors -> right atrium and pulmonary artery
Respond to changes in central venous pressure (CVP)
Dec in SNS activity -> dec pulmonary venous pressure, venous return, CVP
Also release ANPs and BNPs -> powerful vasodilators in response to high pressure
What are the primary determinants of retaining Na+ in the kidney?
- Renin-angiotensin-aldosterone axis
2. Renal sympathetic nerves -> directly innervate tubules
Hormonal control on vessels
-bradykinin, histamine, adenosine
-serotonin
- bradykinin, histamine, adenosine -> vasodilators
- serotonin -> vasoconstrictor
Match the following pericarditis with the infectious agent
Suppurative
Hemorrhagic
Caseous
Suppurative - strep or pneumococcus
Hemorrhagic - aspergillus (fungal)
Caseous - Tb
EKG findings in acute pericarditis
Diffuse elevation in ST segments
depression of the PR segment
Pericardial effusion in middle aged man - think?
TUMOR
EKG finding for pericardial effusion
Low voltage
Electrical alternans - alternating QRS complexes (axis or amplitude)
Explain the cause of the following sxs seen with pericardial tamponade:
Edema and hepatomegaly
Dyspnea
Edema and hepatomegaly-> inc systemic venous pressure
Dyspnea -> inc pulmonary venous pressure
Which 2 drugs can cause pericarditis and pericardial tamponade?
Hydralazine and procainamide
Define pulsus paradoxus
Seen in?
Exaggerated (>10mmHg) DECREASE in systolic BP during inspiration
Seen in cardiac tamponade
What’s seen on echocardiogram w/ a pericardial tamponade?
On cardiac cath?
what’s the path taken
RV diastolic collapse
Cath - EQUALIZED elevation of diastolic pressures
RA -> RV -> PA
W/ swan ganz cath pulm cap wedge pressure indicative of?
Left atrial pressure
MC etiologist of constrictive pericarditis
TB, poster pericarditis of any etiology, idiopathic
Clinical findings of constrictive pericarditis
Elevated JVP Kussmaul's sign -> lack of inspiratory drop in JVP Ascites and edema Pericardial knock in early diastole Fatigue, hypoTN, tachy
Cardiac cath finding of restriction of diastolic filling
square root sign -> dip and plateau
Jugular venous pulse
At Carter’s crossing (X) vehicle’s yield
A - atrial contraction (rise)
C - RV contraction (tricuspid closed) -> rise
X - atrial relaXation -> dip
V - inc right atrial pressure due to filling (tricuspid closed) -> rise
Y - blood flow from RA to RV -> dip
Normal atrial and ventricular pressures
RA < 5
RV - 25/5
LA < 12
LV - 130/10
Why do we give beta-blockers in HF?
there is down regulation of beta receptors due to in sympathetic drive
beta-blockers reverse this -> better response to endogenous epi -> inc in EF
role of AGII in HF
Major role in heart remodeling process - target for tx
Systolic vs diastolic dysfx on ausculation
S3 - systolic
S4 - diastolic
Apex beat
-large and diffuse beat -> systolic
Wall motion study to determine systolic vs diastolic dysfx
Systolic - LVEF REDUCED
Diastolic - LVEF NORMAL
List 4 neurohormonal interventions to tx HF
- Block AGII
- Vasodilate - nitrates and hydralazine -> reduce afterload
- Beta blocker
- Block aldosterone
Compare metabolic vs sympathetic regulation in coronary arteries
Metabolic»>sympathetic
adenosine -> vasodilation
Energy source for aerobic respiration in heart during:
rest
exercise
rest - FFA
exercise - lactate
Where is sympathetic vasodilation seen? What’s the NT?
non-apical skin using Ach
Describe the 4 zone of pulmonary blood flow
Zone 1 - P(a) is the greatest
- Valsalva maneuver
- Blowing up balloon analogy
- Alveolar pressure is the greatest
- Completely collapses the capillary and stop blood flow
- Can restrict blood flow going back to left atrium in extreme conditions
- Does not occur under normal conditions
Zone 2 - P(pa) > P(a) > P(pv)
- Alveolar p > pul v pressure but lower than pulm a pressure
- Driving force equal to the arterial alveolar difference
- Called waterfall flow
- Amount of flow does not depend on how far it falls
- ALVEOLAR and pulm artery pressure difference determining flow
- Due to partial contraction of alveolar capillaries
Zone 3 - P(a) is the lowest
- pulm a and v pressure > than alveolar pressure
- At the bottom of the lung this dilates the capillary
Zone 4
- At very bottom of lung -> parenchyma is being squished
- Extra alveolar vessels become contracted (feeding vessels)
- Bottom of lung getting very little blood flow
- That explains dip in top left graph
Hallmark of systolic HF?
Low EF and LV enlargement
Chronic lymphedema is associated with which neoplasm?
Angiosarcoma -> happens in elderly
Kaposi Sarcoma associated with which virus?
HHV-8
-seen in AIDS patients
Bacillary angiomatosis due to which agent?
Bartonella henselae
Breakdown the aortic dissection by location
Stanford A
Stanford B
A - ascending +/- descending -> much worse
B - descending
Hallmark of aortic dissection on physical?
Unequal BP and pulses
MC risk factor for aortic dissection?
HTN
