RSL - Cardio Flashcards
Bulbus cordis
Smooth parts of left and right ventricles
Primative pulmonary vein
smooth part of left atrium
Right horn of sinus venosus
Smooth part of right atrium
Left horn of sinus venosus
Coronary sinus
Valve development
A/P: endocardial cushions of outflow tract M/T: fused endocardial cushions of AV canal
Allantois –> urachus –>
Median umbilical ligament
Ubilical arteries –>
Medial umbilical ligaments
Umbilical vein
LIgamentum teres hepatis (contained in falciform ligament)
Aortic stenosis radiation
to corotids
Pulsus parvus et tardus
Aortic stenosis
Mitral regurg radiation
Axilla
Tricuspid regurg radiation
right sternal border
Hyperdynamic pulse / bounding
Aortic regurg
Quinkes
Aortic regurg
Opening snap
Mitral stenosis
continuous machine gun murmor
PDA
Left infraclavicular area
PDA
J Joint
Junction between end of QRS and beginning of ST segment
Speed of conduction: (atria, AV, purkinje, Ventricles)
Purkinje > Atria > Ventricles > AV node
Speed of Pace makers: SA, AV, Bundle of His/purkinje/ventricles
SA>AV>Bundle of His/purkinje/ventricles
Conduction pathway after AV node:
Common bundles –> Bundle branches –> fascicles –> purkinje fibers –> ventricles
Blood supply to AV node
RCA, located in the posteroinferior part of interatrial septum
Romano-Ward syndrome
AD, Congenital long QT syndrome (pure cardio phenotype)
Jervell and Lange-Nielsen syndrome
AR, Congenital Long QT syndrome (Sensorineural deafness)
Brugada syndrome
AD, Asian males, ECG pattern of pseudo-right bundle branch block and ST elevations in V1-V3. Increased risk of V-tach, and SCD Treat: implantable defibrillator
Wolff-parkinson-white syndrome
MCC of ventricular pre-excitation syndrome. Atria –>Bundle of kent –> ventricles –> characteristic delta wave with widened QRS complex and shortened PR interval Complications: Re-entry circuit –> supraventricular tachycardia
Cushing reaction:
Triad of Systolic HTN, Bradycardia, Respiratory irregularity Phase 1: Increased ICP –> constricted arterioles –> cerebral ischemia –> increased pCO2 / H+ –> reflex increased sympathetics –> Increased cardiac output / vasoconstriction Phase 2: Increased CO –> aortic arch –> reflex PSNS –> brady cardia (Also; Mechanical pressure on vagus –> PSNS)
Prostacyclin: Platelet aggregation, vaso___, vascular permeabilty, Leukocytes
increased Platelet aggregation, vasodilation, increased vascular permeabilty, Leukocytes chemotaxis
Prostacyclin physiological antagonist
TXA2
Alcohol exposure (anomalies):
VSD, ASD, PDA, Tetralogy of Fallot
Congenital rubella (Cardiac anomolies):
Septal defects, PDA, pulmnoary artery stenosis
(Cardiac anomolies): Down syndrome
ASD, VSD
(Cardiac anomolies): Diabetic mother
Transposition of great vessels
(Cardiac anomolies): Marfan/Ehlers Danlos
MVP, Thoracic aortic aneurysm and dissection, aortic regurgitation
(Cardiac anomolies): Prenatal lithium
Ebstein anomaly (moved tricuspid)
(Cardiac anomolies): Turner syndrome
Bicuspid aorta, coarctation of aorta
(Cardiac anomolies): Williams syndrome
Supravalvular aortic stenosis
(Cardiac anomolies): 22q11
Truncus arteriosus, tetralogy of fallot
Hypertensive urgency
BP > 180 / >120
Corneal arcus
Lipid deposit in cornea (hypercholesterolemia)
Arteriolosclerosis (which vessels)
Small arteries
Mönckeberg (medial calcific sclerosis)
medium-sized arteries.
Calcification of elastic lamina of arteries.
Vascular stiffening with out obstruction.
Pipestream appearance on X-Ray.
Does not obstruct blood flow
Abdominal Aortic Aneurysm risk factors
Associated with Atherosclerosis; (increased age, smoking, male, family history
Thoracic Aortic Aneurysm risk factors
Associated with Cystic medial degeneration; (HTN, bicuspid aortic valve, connective tissue disease, syphillis)
Stanford type A dissection
involves ascending aorta
Stanford Type B dissection
does not involve ascending aorta
Stable angina ST segment
depression
Variant (prinzmetal) angina ST segment
Transient elevation
Variant (prinzmetal) angina triggers
Smoking, cocaine, triptans, unknown
ST elevation indicates damage to?
Transmural
ST depression indicates damage to?
Subendocardium
MI complications
Arrythmia, cardiogenic shock, HF
MI complications 1day - 3days
Postinfarct fibrinous pericarditis
MI complications ~10days
Free wall rupture –> cardiac tamponade Papillary muscle rupture –> mitral regurg Interventricular septum rupture Ventricular pseudoaneurysm
MI complications >2weeks
Dressler syndrome, HF, ventricular aneurysm (mural thrombus)
Leads V1-2
Anteroseptal (LAD)
Leads V3-4
Anteroapical (distal LAD)
Leads V5-6
Anterolateral (LAD or LCX)
I, aVL
Lateral (LCX)
II, III, aVF
Inferior (RCA)
V1
Right ventricle
Dilated cardiomyopathy - etiologies
Idiopathic/familial, Alcohol, wet Beriberi, Coxsackie B virus, Chronic Cocaine, Chagas, Doxorubicin, Sarcoidosis, hemochromatosis, peripartum
Eccentric hypertrophy associations
Volume overload, decreased contractility, increased compliance
Dilated cardiomyopathy - findings
HF, S3, systolic regurgitant murmur, dilated heart, arrythmias
Hypertrophic cardiomyopathy - Findings
S4, systolic murmur (functional aortic stenosis), possibly mitral regurg
Restrictive cardiomyopathy - etiologies
Sarcoidosis, amyloidosis, hemachromatosis, Loeffler syndrome, postradiation fibrosis, endocardial fibroelastosis
Pulse associated with hypertrophic cardiomyopathy
Bisferiens
Systolic dysfunction is characterized by:
Decreased contractibility
Diastolic dysfunction is characterized by:
Decreased compliance
Reverse Bernheim
Right heart –> left heart failure
Initial insult: Hypovolemic shock
Decreased CVP
Initial insult: Cardiogenic / obstructive
Decreased CO
Initial insult: Distributive
Decreased SVR
Roth Spots
round white spots on retina surrounded by hemorrhage
Osler nodes
Raised tender lesions on finger or toe pads
janeway lesions
Small painless, erethemaous lesions on palm or sole
Bacterial endocarditis - S. aureus:
Acute onset; Large vegetations on previously normal valves
Bacterial endocarditis - S. viridans:
Subacute; small vegetations on abnormal or diseased valves
Bacterial endocarditis - S. Bovis
Colon cancer
Bacterial endocarditis - S. epidermidis
prosthetic valves
Bacterial endocarditis - IV drug use
Tricuspid; S. aureus, pseudomonas, Candida
Libbman sacks endocarditis
Bacterial vegetations on both sides of mitral valve
Aschoff bodies
granuloma with giant cells
Anitschkow cells
Enlarged macrophages with ovoid, wavy, rod-like nucleus
Rheumatic fever (major criteria)
JONES Joints Carditis Nodules in skin Erythema marginatum Sydenham chorea
Acute pericarditis ECG changes
ST elevation / PR depression
Beck triad
hypotension, distended neck veins, distant heart sounds
Pulsus paradoxus
COPD, Asthma, cardiac tamponade, Constrictive pericarditis, Obstructive sleep apnea, croup
Kussmaul sign
Paradoxical increase in JVP on inspiration (constricive pericarditis, restrictive cardiomegaly, right atrial or ventricular tumors, tricuspid stenosis)
Pericardial knock
More accentuated version of S3 heard earlier in constrictive pericarditis
Torsades de pointes
Causes
low K+, Mg+, drugs
ANP: what stimulates release?
Increased volume and pressure
BNP: what stimulates release?
tension
PR depression
Acute pericarditis