most common neonatal malformation
interventricular septum defects (IVSD)
- holosystolic murmur (blood between r and l ventricle in systole)
what is IVS?
final event in separating aortic and pulmonary outflow from heart
25% of IVS defects occur in which portion?
membranous
tetrology of fallot
VSD (ventricular septal defect) dextraposed (aorta turned to right), pulmonary stenosis, RV hypertrophy
right atrium gets its blood supply from ____ and left atrium gets its blood from _____
IVC and SVC
pulmonary veins
which valves are on the right side?
which valves are on the left side?
right: tricuspid and pulmonic (draining venous into lungs)
left: mitral and aorta (draining lungs and pumping into body)
S1 is
S2 is
S1 (lub): closure of atrioventricular (tricuspid and mitral)
S2 (dub): closure of semilunar valves (aortic and pulmonic)
when is systole?
diastole?
between S1 and S2
between S2 and S1
regurgitation
stenosis
blood flowing backwards
hardening of valves = not enough blood flow
during systole which valves should be closed
during diastole?
tricuspid and mitral
aortic and pulmonic closed
closed valves are ____ and open valves are ______
regurg
stenotic
systolic murmurs
aortic and pulmonic stenosis
tricuspid and mitral regurg
diastolic murmurs
aortic and pulmonic regurg
tricuspid and mitral stenosis
CAD is usually on which side?
left
what part of the heart is supplied by the right coronary artery?
left?
right: right ventricle and post left ventricle
left: feeds anterior and lateral portions of left ventricle
cause of ischemia
complications of ischemia
angina pectoris
sudden cardiac death
coronary artery spasm
complications: LCHF, arrhythmias, MI
most common cause of LCHF
chronic ischemia
SA node is where
bundle branches are where
right atrium
one on right and two on left (follow coronary arteries and left branches)
actute vs subacute bacterial endocarditis
acute is more rare and attacks normal heart valves
subacute is more common and attacks abnormal heart and can have low virulent microbes that cause
rheumatic heart disease
post rheumatic sequelae (systemic reation to past beta hemolytic infection)
most common valve disease
mitral valve prolapse (heard between lub and dub)
what causes bacterial myocarditis
staph, strep, corynebacterium diptheria
dilation and flabby ventricular myocardium
what causes rickettsial myocarditis
typhus, rocky mt spotted fever
dilation and flabby chambers
most common myocardial disease
viral myocarditis
coxsacki-B, flu, CMV
sequelae of myocardial disease
CHF
dilated cardiomyopathy
most common
enlarged heart
young people acute dyspnia is what is seen
seen in alcoholics, hypothyroid, postpartum
restrictive cardiomyopathy
secondary disease (seen in Pompe’s, Hurler’s, sarcoidosis)
hypertrophic cardiomyopathy
idiopathic hypertrophic subacute stenosis
pericarditis
secondary to infection in lung or radiation
understernum chest pain
constrictive pericarditis
worst MI
transmural MI
right vagus nerve goes to
left vagus goes to
disruption leads to
vagus innervation is
SA node (slows freqency) AV node (slows conduction) rhythm disfunction Parasympathetic
cardiac muscle at rest
During and AP there is
troponin (tp) and tropomysin (tm) block actin/myosin binding
Ca influx: Ca binds to Tp and Tm which leads to actin myosin binding, ATP to ADP and muscle contraction
which organelle takes ca out of muscle cell during relaxation phase
t-tubule
EPI does what in heart
cAMP and phosphorylation
it holds Ca channel open longer (important because you can alter cardiac strength this way)
cardiac AP has a
plateau because really long AP potential
-mediated by Ca channel
what are the areas of the sympathetic supply of the aorta?
celiac (esophagus to stomach) in mesenteric (duodenum to ascending colon and transverse colon to rectum)
vertebral arteries branch off what?
subclavian
what does subclavian change to?
subclavian, then axillary, then brachial
ext iliac artery becomes what?
femoral
benign tumors end in
oma
polyartaritis nodosa
necrotizing inflammation of small and med cranial vessels
temporal arteritis (giant cell arteritis)
inflammation in whole carotid tree
- notice by touching temples
Buerger’s (thromboangitis obliterans)
men, heavy smokers, nodular phlebitis, gangrene
Raynaud’s phenomenon
secondary in people who have SLE, Buerger’s etc.
Raynaud’s disease is primary idiopathic
aortic dissection
lumen of aorta dissects due to pressure and loss of patency. Looks like a double barrel. See severe back pain.
thrombi vs embolis
embolis: moving around. Broke of thrombus
thrombus: clot that has formed in blood vessel
Kaposi’s sarcoma
mostly seen in HIV
purple black papules
HHV infection can trigger
dangerous
hemangioma
- can cause what disease
capillary: benign
cavernous: larger, associated with Lindau van hipple (hemangioma in place of an organ)
where does the largest decrease in pressure occur?
the largest decrease in pressure occurs across the arterioles because they are the site of highest resistance
where is pressure highest and lowest in heart
highest: aorta
lowest: venae cavae
HTN - difference between primary and secondary
> 140/90
mostly essential HTN and we don’t know what causes it
secondary HTN is due to some other disease
Cor Pulmonale
right ventricular hypertrophy secondary to pulmonary HTN
difference between serum and plasma
plasma: draw in tube that has anti-coagulant and all cloating factors stay in blood.
serum: whole blood allowed to clot and clot removed
gamma globulin series
antibodies
lymphoid stem cells turn into what?
T-cells in thymus
difference between heme iron and non heme iron
heme iron: comes from meat and doesn’t need transferring for uptake (easier to raise iron levels if you use heme iron)
non heme iron: rust (body doesn’t like this type because it oxidizes everything). Needs to be taken up by transferrin
ferrous iron
ferric iron
Fe 2+
Fe 3+
lactoferrin
sequestering agent in blood used when infection active to keep Fe away from bacteria so replication is slower
porforin ring
place where you stick iron
ferrochelatase
puts Fe 2+ in middle of porforin ring and call it heme
where are reticuloendothelial cells
bone marrow, liver cells
where do you see ferritin in vascular world?
capillaries
porpherias
overproducing 1 or more porphorin’s
- intermediates to porforin ring are toxic
- unexplained abdominal pain, neurologic symptoms
T hemoglobin
protected for that is folded up with no oxygens
it is a magnet for gases
myoglobin
muscle stored oxygen
is arterial or venous blood more acidic?
venous because it has higher levels of CO2
what stimulates dumping of O2?
acidity/CO2, increased temp, 2,3 BPG
what are three forms of CO2 that is brought to lungs?
dissolved
carbaminohemoglobin
HCO3 which is the major form (90%)
CO2 plus hemoglobin is called
carbaminohemoglobin
bohr affect
hide CO2 in bigger molecule and then release it when it gets to the lung (example HC03)
*runs identically in two directions: CO2 to CO3 in peripheral tissue and then CO3 to CO2 in lungs
carbonic anhydrase
another example of bohr effect
How is anemia caused
decrease iron, poison mitochondria, put lead in system (don’t form porforin), or decrease in vitamin B6
folic acid and B12/cobalamin always work together and are used in
methyl transfer reactions
most common reason for hemolytic anemia is
G6PD deficiency because no NADPH produced and don’t recycle glutathione so RBCs blow up
what do you see in pernicious anemia?
what type of cells are affected?
atrophic gastritis with loss of parietal cells
heinz bodies
G6PD deficiency
teardrop cells, basophilic stippling, target cells
seen in both thalassemias
difference between alpha and beta thalassemia
born with defect in alpha or beta forming genes have thallasemia
see what type of anemia in thalassemia
hypochromic microcytic (small cells with higher Hgb)
polycythemia major
diagnosed as a young child
polycythemia minor
undiagnosed until they are an adult
crescent shaped cells
sickle cell anemia
anaplastic anemia
pancytopenia after exposure to drug, infection, etc.
polycthemia vera
myeloproliferative disease with high Hgb, viscous blood
multiple myeloma
lytic lesions
plasma cells
hypercalcemia
what type of proteins seen in urine of Multiple Myeloma patient
bence jones proteins
most common leukemia and cancer in children
acute lymphoblastic leukemia (ALL)
most common leukemia in adults
acute myeloblastic leukemia
which type of white cell dyscrasia has the philadelphia chromosome
Chronic myelogenous leukemia
most common overall leukemia and most common over 60
chronic lymphocytic leukemia
leukemia common in middle aged men with pancytopenia and B cells
Hairy Cell Leukemia
intrinsic pathway clotting cascade
measured by
drugs
blood trauma (turbulence and viscosity) or collagen and blood contact
- measure by PTT
- heparin
extrinsic pathway
measured by
drugs
damage outside of blood vessel (vitamin K dependent clotting factors 2,7,9,10)
PT/INR
vitamin K dependent clotting factors in extrinsic pathway
2,7,9,10
Pouseuille’s Equation
resistance to blood vessels
thicker blood = greater resistance
Hemophilia A
factor VIII def
sex linked recessive
males
spontaneous bleeding of joints
Hemophilia B/Christmas Dz
factor IX def
male
Von Willebrand’s
autosomal dominant VWF needed for platelet clumping spontaaneous bleeding from mucus membranes prolonged bleeding time and PTT normal platelets
what factors are vitamin K dependent?
what protein is def in vit k def?
needed for factors II,VII,IX,X
protein c
thrmobocytopenia
too few platelets
below 70,000
DIC
increased consumption of platelets
systemic response to hemorrhage
baroreceptors sense change in pressure and sends info to brain. Brain tells body to constrict arterioles and veins, decrease hydrostatic pressure, activate renin angiotensin system, activate aldosterone-sodium system to increase blood volume in response to hemorrhage
when does hypovolemic shock occur
when lose more than 20% of blood
oncotic pressure
hydrostatic pressure
keeps fluid in
drives fluid out
(starling forces)
anasarca
generalized edema (not seen often)
half of US deaths are caused by
cardiovascular disease resulting from myocardial or cerebral infarctions
B lymphocyte tumor
maxilla or mandible
EBV/malaria, Africa
sequelae of non-hodgkins lymphoma
Burkitt’s lymphoma
young adults or 60 yo
curable
intermittent spiking fever
one node then spreads
Hodgkins lymphoma
most common lymphoma
more deadly prognosis
associated with Burkitt’s lymphoma
non-hodgkins lymphoma
P wave coincides with ____
diastole/filling atrial depolarization
QRS segment coincides with ___
isovolumetric contraction (no valves open)
T wave coincides with
ejection/systole
Intrinsic ability of heart to adapt to changing blood volumes
Frank Starling law: the greater the heart is filled during diastole (preload), the greater the volume of blood that will be pumped into aorta
changes in arterial pressure (after load) have ___ effect on rate of pumping by heart
little
cardiac output =
cardiac output = heart rate x stroke volume
CO = HR x SV
* more ventricular pressure = more output
Right sided CHF
emphysema, mitral stenosis, left ventricular failure
pleural effusion, ascites
Left CHF
ischemic heart dz, systemic HTN
crackles, cough, cyanosis
cor pulmonale
right ventricular hypertrophy due to pulmonary HTN
