Cardiac Flashcards
(225 cards)
1
Q
Truncus arteriosus gives rise to
A
Ascending aorta & Pulmonary trunk
2
Q
Bulbus cordis gives rise to
A
Smooth part of the L/R ventricles
3
Q
Primitive atria gives rise to
A
Trabeculated part of the L/R atrias
4
Q
Primitive ventricle gives rise to
A
Trabeculated part of the L/R ventricles
5
Q
Primitive Pulmonary v. gives rise to
A
Smooth part of the L atria
6
Q
Left horn of sinus venosus gives rise to
A
Coronary sinus
7
Q
Right horn of sinus venosus gives rise to
A
Smooth part of the R atria
8
Q
Right Common Cardinal V & Right Anterior Cardinal V gives rise to
A
SVC
9
Q
In heart development, initially the heart tube folds into a _______ with the primitive atria ______ and primitive ventricle ______
A
“S”-shape; primitive atria posterior & primitive ventricle anterior
10
Q
As the septum primum grows toward the ___________, the __________ narrows
A
endocardial cushions, foramen primum
11
Q
As the foramen primum is obliterated in the septum primum, the _________ forms
A
foramen secundum
12
Q
The septum secundum grows nearby covering the majority of the foramen secundum, the remaining opening is termed ________
A
foramen ovale
13
Q
Atrial septum is formed by
A
fusion of the septum primum & septum secundum
14
Q
The foramen ovale closes shortly after birth d/t
A
increased LA pressure
15
Q
Patent foramen ovale can lead to
A
paradoxical emboli (emboli -> RA -> patent foramen ovale -> LA -> LV -> systemic circulation)
16
Q
What divides the L/R atria?
A
Septum primum & septum secundum
17
Q
Aortic arch derivatives: 1st aortic arch –>
A
part of the maxillary a.
18
Q
Aortic arch derivatives: 2nd aortic arch –>
A
stapedial & hyoid a.
19
Q
Aortic arch derivatives: 3rd aortic arch –>
A
common carotid a. & proximal internal carotid a.
20
Q
Aortic arch derivatives: 4th aortic arch –>
A
L: arch of the adult aorta
R: proximal R. subclavian a.
21
Q
Aortic arch derivatives: 5th aortic arch –>
A
proximal pulmonary a. & ductus arteriosus
22
Q
Which structures grows & separates the atria & ventricles?
A
endocardial cushions
23
Q
Which genetic abnormality is associated with endocardial cushion defects?
A
Trisomy 21
24
Q
Muscular ventricular septum forms with an opening called the
A
Interventricular foramen
25
Which structure performs a 180-turn to form part of the interventricular septum
Aorticopulmonary septum/Spiral septum (truncoconical swellings)
26
Aorticopulmonary septum forms the
membranous interventricular septum & closes the inter ventricular foramen
27
Aorticopulmonary septum is derived from
neural crest cells
28
Name 4 Spiral Septal defects
Tetralogy of Fallot, Persistent Truncus Arteriosus, Transposition of the great vessels, VSD
29
VSD commonly occurs in the
membranous interventricular septum
30
Aortic/Pulmonary valves are derived from
endocardial cushions of the outflow tract
31
Mitral/Tricuspid valves are derived from
fused endocardial cushions of the AV canal
32
Fetal Erythropoiesis occurs in the ____________ from weeks 3-8 gestation
Yolk sac
33
Fetal Erythropoiesis occurs in the ____________ from 6weeks-birth
Liver
34
Fetal Erythropoiesis occurs in the ____________ from 10-28weeks
Spleen
35
Fetal Erythropoiesis occurs in the ____________ from 18weeks-adult
Bone marrow
36
HbF (fetal Hgb) components
alpha 2 + gamma 2
37
HbA (adult Hgb) components
alpha 2 + beta 2
38
3 major shunts in fetal circulation
```
Ductus Venosus (bypass hepatic circulation)
Foramen Ovale (High O2 blood to brain)
Ductus Arteriosus (bypass lung circulation)
```
39
What causes closure of the foramen ovale
increased LA pressure following first breath
40
What causes closure of the ductus arteriosus
high O2 & low prostaglandins (placental separation)
41
What will help close a patent ductus arteriosus
Indomethacin
42
What will keep the ductus arterioles open
Prostaglandins E1 & E2
43
Ductus arteriosus remnant in adults
ligamentum arteriosum
44
Foramen ovale remnant in adults
fossa ovalis
45
Which fetal vessel has the highest O2 content
umbilical v
46
Umbilical v. remnant in adults
Ligamentum teres hepatis (contained in falciform ligament)
47
Umbilical a. remnant in adults
Medial umbilical ligemants
48
Ductus venosus remnant in adults
ligamentum venosum
49
Allantois remnant in adults
urachus - median umbilical ligament (urachal cyst)
50
Notochord remnant in adults
nucleus pulpous if IV disc
51
VSD S/S
harsh, holosystolic murmur
52
SA & AV nodes are supplied by
RCA
53
Most common coronary a. occlusion?
LAD
54
Most posterior part of the heart?
L. atrium
55
LA hypertrophy may cause what S/S
dysphagia (esophageal compression) & hoarseness (left recurrent laryngeal n. compression)
56
LAD supplies
anterior 2/3 of IV septum, anterior papillary m., anterior surface of LV
57
RCA supplies
(acute marginal a.) RV, (PDA) posterior 1/3 IV septum, posterior walls of ventricles
58
LCX supplies
lateral & posterior walls of LV
59
ASD S/S
Lous S1 & wide, fixed splitting of S2
| RV hypertrophy
60
PDA S/S
continuous, machine-like murmur @ upper L. sternal border
61
Coarctation of the aorta S/S
high BP in UE, low BP in LE
notching of the ribs
aortic regurgitation (d/t HF)
62
Ebstein Anomaly is associated w/ maternal use of
Lithium
63
Ebstein Anomaly pathology
tricuspid leaflets displaced into RV, hypoplastic RV, tricuspid regurgitation or stenosis
64
Ebstein Anomaly S/S
widely split S2, tricuspid regurgitation
65
Eisenmenger Syndrome pathology
long-standing L->R shunt causing pulmonary HTN -> RV hypertrophy & high right sided pressure -> CONVERTS to R->L SHUNT
66
Eisenmenger Syndrome S/S
cyanosis, SOB, clubbing
67
Persistent Truncus Arteriosus S/S
R-> Shunt; cyanosis, respiratory distress
68
Transposition of Great Vessels S/S
cyanosis, respiratory distress (MUST maintain PDA or L->R shunt)
69
Tricuspid Atresia
Must have ASD & VSD
70
4 components of Tetralogy of Fallot
VSD, RV Hypertrophy, Overriding Aorta, Pulmonic Valve Stenosis (right outflow obstruction)
71
Tetralogy of Fallot S/S
cyanosis with activity (R->L shunt), BOOT-SHAPED heart in infants/children
72
What heart defects are associated w/ Turner Syndrome?
Coarc of aorta (rib notching), bicuspid aortic valve
73
What heart defects are associated w/ DiGeorge Syndrome?
TA, ToF
74
What heart defects are associated w/ Trisomy 21?
endocardial cushion defects --> ASD, VSD
75
What heart defects are associated w/ Congenital Rubella?
PDA, Pulmonic stenosis
76
Total Anomalous Pulmonary Venous Return
pulmonary v. empties into systemic circulation (closed-loop, must have shunt)
77
What heart defects are associated w/ Maternal Lithium use?
Ebstein Anomaly
78
What heart defects are associated w/ Maternal EtOH use?
Tof, VSD, ASD, PDA
79
What heart defects are associated w/ Maternal Diabetes?
Transposition of the great vessels?
80
What will increase preload?
exercise, transfusions, pregnancy
81
What will decrease preload?
venodilators (nitroglycerin), ACE-I, ARB
82
What will increase afterload?
HTN
83
What will decrease afterload?
vasodilators (Hydralazine), ACE-I, ARB
84
What will increase contractility?
Digitalis, catecholamines, high [Ca2+]ic, low [Na+]ec
85
What will decrease contractility?
b1-blocker, heart failure (loss of myocardium, dilated cardiomyopathy), acidosis, hypoxia/hypercapnea, non-dihydropyridine CCB
86
Myocardial O2 demand increases w/?
high afterload, high contractility, high HR, high ventricular diameter
87
Myocardial O2 demand decreases w/?
decreased afterload, decreased contractility, decreased HR
88
Pulmonary capillary wedge pressure ~?
LA pressure
89
RSHF S/S
```
peripheral edema (pedal & pre-sacral edema)
JVD, Hepatic congestion (nutmeg liver)
```
90
LSHF S/S
pulmonary congestion, cardiac dilation, pulmonary edema (paroxysmal nocturnal dyspnea, orthopnea)
91
JG cells sense
low BP ---> Renin release
92
Macula densa sense
low Na+ ---> Renin release
93
BNP is released by
cardiac cells in response to ventricular stretch
94
BNP causes
vasodilation & increased excretion of Na/H2O in urine to decrease preload
95
Angiotensin II's 2 roles
vasoconstriction & stimulate Aldosterone secretion
96
5 Phases of LV physiology
1. Isovolumetric contraction
2. Systolic ejection
3. Isovolumetric relaxation
4. Rapid Filling
5. Reduced Filling
97
Normal splitting of S2 occurs in
inspiration (low intrathoracic P
98
S1
Mitral & Tricuspid closure; loudest at mitral post
99
S2
Aortic & Pulmonic closure; loudest at pulmonic post
100
S3
early diastole - high filling P
101
Conditions associated w/ S3
Pregnancy, children - physiologic
| Mitral regurgitation, CHF, dilated ventricles, dilated cardiomyopathy, L->R shunt (ASD, VSD, PDA)
102
S4
late diastole - high atrial pressure
103
Conditions associated w/ S4
LV hypertrophy, chronic HTN, aortic stenosis, hypertrophic cardiomyopathy, post-MI
104
Resistance to flow is proportional to viscosity, factors that increase viscosity:
polycythemia, hyperproteinemic state (multiple myeloma), Hereditary spherocytosis
105
Resistance to flow is proportional to viscosity, factors that decrease viscosity:
anemia
106
Wide Splitting
delayed RV emptying - pulmonic stenosis, RBBB
107
Fixed Splitting
L->R shunt - seen in ASD
108
Paradoxical Splitting
delayed LV emptying - reverses order of closure = Pulmonic closes before delayed Aortic - aortic stenosis, LBBB (paradoxically eliminating the split on inspiration)
109
Treatment for chronic CHF to reduce mortality?
ACE-I, ARB, Aldosterone Antagonist, certain b-Blockers
110
Treatment for chronic CHF to provide symptomatic relief?
Diuretics, Digoxin, Vasodilators
111
Acute HF treatment
Loop Diuretics, Nitrates, Oxygen (if hypoxic), intropes (Dobutamine), Positiong (sit up)
112
Digoxin uses
CHF (occasionally for Afib)
113
Digoxin S/E
yellow, blurry vision, cholinergic effects, bradycardia, hypokalemia, renal failure
114
Tx of Digoxin OD
Anti-Dig Fragment, correct hypokalemia, Magnesium, Atropine
115
Factors that increase Pc
CHF, venous thrombosis, compression of vv., Na+/H2O retention
116
Factors that increase Kf
Septic Shock (d/t bradykinin, histamine), Toxins, Burns
117
Factors that increase interstitial colloid pressure
lymphatic obstruction (tumor, inflammation, surgery radiation)
118
Factors that decrease plasma colloid pressure
Liver disease, Protein malnutrition, Nephrotic Syndrome, Protein-losing Enteropathy
119
Pitting Edema
Excess fluid w/o additional colloid (transudate)
120
Non-pitting Edema
Excess fluid + colloid (exudate)
121
Hypovolemic Shock
decreased CO --> increased systemic vascular resistance
122
Tx for Hypovolemic Shock
IV fluids +/- Blood
123
Cardiogenic Shock
decreased CO --> increased systemic vascular resistance
124
Tx for Cardiogenic Shock
Dobutamine (increase CO)
125
Sepsis/Anaphylaxis Shock
decreased systemic vascular resistance (d/t vasodilation) --> increased CO (compensatory tachycardia)
126
Tx for Sepsis/Anaphylaxis Shock
Antibiotics + NE + IV fluids
127
Neurogenic Shock
Low CO & Low systemic vascular resistance
128
Tx for Neurogenic Shock
IV fluids, (spinal cord injury -> steroids)
129
Femoral Central Line Pros/Cons
easiest site; can only stay in 5-7d d/t infection rate
130
Subclavian Central Line Pros/Cons
can stay in 3-4wks; high risk of pneumothorax (not good for COPD or lung tumor pts)
131
Internal Jugular Central Line Pros/Cons
can stay in 3-4wks; may cause pneumothorax, discomfort
132
Swan-Ganz Catheter insertion sites
right IJ > Left SC > Right SC > Left IJ
133
Skin of a cardiogenic shock pt?
cool, clammy (low-output shock) vasoconstriction
134
Skin of a septic shock pt?
warm, moist (high-output shock)
| vasodilation
135
Causes of cardiogenic shock
MI, PE, cardiac tamponade, tension pneumothorax, CHF, arrhythmias, cardiac contusion
136
How does heart failure impact the Starling Forces?
increases Pc
137
How does liver failure impact the Starling Forces?
decreases plasma colloid pressure
138
How does oliguric renal failure impact the Starling Forces?
increases Pc
139
How does infections&toxins impact the Starling Forces?
increases Kf
140
How does Nephrotic Syndrome impact the Starling Forces?
decreases plasma colloid pressure
141
How does Lymph blockage impact the Starling Forces?
increases the interstitial colloid pressure
142
How do burns impact the Starling Forces?
increases Kf
143
How does diuretic administration impact the Starling Forces?
decreases Pc
144
How does IV infusion of albumin impact the Starling Forces?
increases plasma colloid pressure
145
How does venous insufficiency impact the Starling Forces?
increases Pc
146
Increased pulse pressure is seen w/ what conditions?
Hyperthyroidism, aortic regurgitation, arteriosclerosis, obstructive sleep apnea, exercise, increased sympathetic tone
147
Decreased pulse pressure is seen w/ what conditions?
aortic stenosis, cardiogenic shock, cadiac tamponade, & advanced HF
148
What are the diastolic murmurs?
MS/TS, AR/PR
149
What murmurs are heard best in Left Lateral Decubitus?
MS, MR, Left-sided S3 & S4
150
Inspiration will increase the intensity of which murmurs
Right-sided (tricuspid)
151
Hand grip will increase the intensity of which murmurs
AR, MR, VSD
152
Exhalation or Rapid Squatting will increase the intensity of which murmurs
Mitral murmurs
153
Hand grip will decrease the intensity of which murmurs
AS, hypertrophic cardiomyopathy
154
Valsalva will increase the intensity of which murmurs
hypertrophic cardiomyopathy murmur
155
High-pitched "blowing" early diastolic decrescendo murmur
Aortic regurgitation
156
Aortic regurgitation S/S
wide pulse pressure -> bounding peripheral pulses, head bobbing
157
Aortic regurgitation causes
aortic root dilation (syphilis, Marfans)
| Bicuspid aortic valve, Rheumatic fever
158
Aortic regurgitation heard loudest at
Left sternal border
159
Opening snap + delayed rumbling late diastolic murmur
Mitral stenosis
160
Mitral stenosis causes
Rheumatic Fever
161
Mitral stenosis is heard loudest at
mitral post in Left Lateral Decubitus position
162
Mitral stenosis is enhanced by
Exhalation
163
Aortic regurgitation is enhanced by
Hand grip
164
Continuous, machine-like murmur, loudest at S2
PDA
165
PDA causes
Congenital Rubella
166
PDA is heard loudest at
left infraclavicular area
167
Isometric contraction occurs
after mitral valve closes
| before aortic valve opens
168
Isometric relaxation occurs
after aortic valve closes
| before mitral valve opens
169
How does a high afterload change the pressure-volume loop?
"A" - high afterload --> high aortic pressure --> large ventricular contraction to cause aortic valve opening --> less contraction available for ejection --> low SV (high ESV)
170
How does high contractility change the pressure-volume loop?
"C" - shifted Left bc high contractility increases the SV and EF leaving little blood left in the ventricles (low ESV)
171
How does high preload change the pressure-volume loop?
"P" - high preload --> increased EDV --> increased SV
172
Jugular venous pulse - a wave
atrial contraction
173
Jugular venous pulse - c wave
RV contraction (closed tricuspid bulges into RA - isometric contraction)
174
Jugular venous pulse - v wave
increased RA pressure d/t filling against a closed tricuspid valve
175
Where does QRS fall in relation to valvular dynamics?
after mitral valve closure & before aortic valve opening
176
Benign extra heart sounds if no pathology is present?
Split S1, Split S2 during inspiration, S3 in pt <40yo, early, quiet systolic murmur
177
Crescendo-decrescendo, systolic murmur w/ ejection click
Aortic Valvular Stenosis
178
Aortic Valvular Stenosis S/S
Weak & delayed pulses, syncope, angina, dyspnea
179
Aortic Valvular Stenosis is heard loudest over
aortic post radiating to the carotids
180
Aortic Valvular Stenosis Causes
```
Bicuspid Aortic Valve (~40yo)
Senile (degenerative) Calcification (~60yo)
Rheumatic Fever
Unicuspid Aortic Valve
Syphilis
```
181
Holosystolic, high-pitched "blowing" murmur at apex radiating to L axilla
Mitral Regurgitation
182
Mitral Regurgitation is heard loudest over
Mitral area in Left Lateral Decubitus, radiating to the L axilla
183
Mitral Regurgitation is enhanced by
hand-grip, squatting
184
Mitral Regurgitation causes
Rheumatic Heart Ds, Endocarditis, Ischemic Heart Ds, Left Ventricular Dilation, MVP
185
Late systolic murmur usually preceded by a mid-systolic click
MVP
186
MVP mid-systolic click is d/t
sudden tensing of the chordae tendineae
187
Valsalva changes MVP by
causing an earlier mid-systolic click, but decreases its intensity
188
Holosystolic murmur best heard along the L lower sternal border
Tricuspid Regurgitation or VSD
189
Tricuspid Regurgitation Causes
Rheumatic Fever, Endocarditis (IVDU!)
190
Holosystolic, harsh-sounding murmur in newborns
VSD
191
Juxtaglomerular apparatus
sense low BP & secretes renin
192
The stimulus for renin release is the juxtaglomerular apparatus (JGA) perception of
Decreased renal blood pressure
Decreased NaCl delivery to distal tubule sensed by the macula densa*
Increased sympathetic tone
193
Aortic arch baroreceptor senses
high BP; high BP -> increased firing -> increased efferent PNS -> decrease in HR
194
Aortic arch baroreceptor sends a signal
to the medulla via CN10
195
Carotid sinus baroreceptor senses
high or low BP
196
Carotid sinus baroreceptor sends a signal
to the solitary nucleus of the medulla via CN9
197
Supraventricular tachycardia could potentially be treated by
carotid massage -> tricks body into believing there is high BP --> reflex bradycardia
198
Cushings reflex
high ICP -> cerebral vasoconstriction -> ischemia
high ICP -> high systemic BP -> reflex bradycardia & respiratory depression
TRIAD: high BP, low HR, & low RR
199
Central chemoreceptor
in medulla, sense change in CSF CO2 & pH
200
Peripheral chemoreceptor
aortic arch & carotid body sense hypoxia, hypercapnia, acidosis
201
What substances act on the SM myosin light-chain kinase?
```
Dihydropyridine CCB (inhibits Ca from binding calmodulin to prevent kinase activity)
Epinephrine & Prostaglandins (increase cAMP, inhibits kinase)
```
202
HTN
>140/90 on 3 separate readings
203
Essential HTN
no other secondary cause, 90% of cases
204
HTN causes LVH d/t
high BP -> high afterload -> increased mm. thickness, stiffness, and decreased compliance
205
What heart sounds is associated w/ stiffened LVH
S4
206
Aortic dissection
tear in the intima -> creating a false lumen w/in the media
207
Aortic dissection Sx
tearing cheat pain radiating to the back + widened medistinum
208
Aortic dissection type A
involves the aortic arch or ascending aorta
209
Aortic dissection type B
does not involve the ascending aorta, involves descending
210
Which type of Aortic dissection requires emergency surgery?
Type A
211
Tx for Aortic dissection
b-blockers!
212
HTN + paroxysms of anxiety, palpitations, diaphoresis
pheochromocytoma
213
HTN + onset b/w 20-50
Essential HTN
214
HTN + abd bruit
renal a. stenosis
215
HTN + BP in arms > legs
coarctation of the aorta
216
HTN + tachycardia, heat intolerance, diarrhea
hyperthyroidism
217
HTN + Hyperkalemia
renal insufficiency
218
HTN + Hypokalemia
Renal a. stenosis (hyperaldosteronism)
219
HTN + central obesity, moon-shaped facies, hirsutism
hypothyroidism
220
HTN + young adult w/ acute onset tachycardia
amphetamine use
221
HTN + proteinuria
kidney ds
222
Cardiac enzyme most often used to Dx MI?
Troponin I (4hrs - 2wks) > CK-MB
223
chest pain, pericardial friction rub, fever several weeks after a MI
Dressler Syndrome (>2 weeks after MI)
224
What coronary a. is most often occluded in a MI?
LAD
225
Most common lethal complication after a MI?
arrhythmia
