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Cardio Flashcards

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1
Q

Truncus arteriosus (TA)

A

Ascending aorta and pulmonary trunk

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2
Q

Bulbus cordis

A

Smooth parts (outflow tract) of left and right ventricles

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3
Q

Primitive atria

A

Trabeculated part of left and right atria

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4
Q

Primitive ventricle

A

Trabeculated part of left and right ventricles

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5
Q

Primitive pulmonary vein

A

Smooth part of left atrium

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6
Q

Left horn of sinus venosus (SV)

A

Coronary sinus

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7
Q

Right horn of SV

A

Smooth part of right atrium

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8
Q

Right common cardinal vein and right anterior cardinal vein

A

SVC

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9
Q

Aortic area murmurs

A

Systolic murmur =>
Aortic stenosis
Flow murmur
Aortic valve sclerosis

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10
Q

Left sternal border murmurs:

A

Diastolic murmur=>
Aortic regurgitation
Pulmonic regurgitation

Systolic murmur =>
Hypertrophic cardiomyopathy

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11
Q

Pulmonic area murmurs

A

Systolic ejection murmur =>
Pulmonic stenosis
Flow murmur (e.g., physiologic murmur)

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12
Q

Tricuspid area murmurs

A

Pansystolic murmur=>
Tricuspid regurgitation
Ventricular septal defect

Diastolic murmur =>
Tricuspid stenosis
Atrial septal defect

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13
Q

Mitral area murmurs

A

Systolic murmur =>
Mitral regurgitation

Diastolic murmur =>
Mitral stenosis

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14
Q

BEDSIDE MANEUVER Inspiration

A

increase intensity of right heart sounds

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15
Q

BEDSIDE MANEUVER Hand grip (increase systemic vascular resistance)

A

Increase intensity of MR, AR, VSD murmurs
decrease intensity of AS, hypertrophic cardiomyopathy murmurs

MVP: increase murmur intensity, later onset of click/murmur

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16
Q

BEDSIDE MANEUVER Valsalva (phase II), standing (decrease venous return)

A

decrease intensity of most murmurs (including AS)
increase intensity of hypertrophic cardiomyopathy murmur

MVP: decrease murmur intensity, earlier onset of click/murmur

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17
Q

BEDSIDE MANEUVER Rapid squatting (Increase venous return,increase preload, increase afterload with prolonged squatting)

A

decrease intensity of hypertrophic cardiomyopathy murmur
increase intensity of AS murmur

MVP: increase murmur intensity, later onset of click/murmur

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18
Q

Name the systolic heart sounds

A

aortic/pulmonic stenosis,
mitral/tricuspid regurgitation,
ventricular septal defect.

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19
Q

Name the diastolic heart sounds

A

aortic/pulmonic regurgitation,

mitral/tricuspid stenosis.

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20
Q

ECG P wave

A

atrial depolarization

Atrial repolarization is masked by QRS complex

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21
Q

ECG PR interval

A

conduction delay through AV node (normally < 200 msec).

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22
Q

ECG QRS complex

A

ventricular depolarization (normally < 120 msec).

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23
Q

ECG QT interval

A

mechanical contraction of the ventricles.

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24
Q

ECG T wave

A

ventricular repolarization.

T-wave inversion may indicate recent MI.

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25
ECG ST segment
isoelectric, ventricles depolarized.
26
ECG U wave
caused by hypokalemia, bradycardia
27
Give the speed of conduction in heart
Purkinje > atria > ventricles > AV node.
28
Give pacemakers of heart
SA > AV > bundle of His/ Purkinje/ventricles.
29
What Rx prolong the QT interval?
``` Sotalol Risperidone (antipsychotics) Macrolides Chloroquine Protease inhibitors (-navir) Quinidine (class Ia; also class III) Thiazides ```
30
RV MI => name area, coronary artery & ECG leads
inferior wall (RV); RCA II, III, aVF
31
Septum MI => name coronary artery & ECG leads
LAD for anterior 2/3 of septum; RCA for posterior 1/3; | V2, V3
32
LV MI => name area, coronary artery & ECG leads
lateral wall of LV; left circumflex artery; I, aVL, V5, V6
33
Aortic stenosis murmur => location & sound
Left 2nd ICS radiating toward carotid or cardiac apex; | crescendo-decrescendo systolic ejection murmur
34
Mitral regurg murmur => location & sound
``` cardiac apex (confused w/ TR); holosystolic blowing murmur => louder on inspiration; ```
35
Define sarcomere. What is it composed of?
Z line to Z line (Z line=middle dark line bw light areas); | composed of thick filament (myosin) & thin filaments (actin, troponin, tropomyosin)
36
Role of T tubule
carry AP into cell interior
37
Location & role of intercalated disks
ends of cells & mediate adhesion bw cells
38
Location & role of gap junctions
occur at intercalated disks; | provide path of low resistance for AP to rapidly spread
39
What happens in S1 heart sound?
MV & tricuspid valve close => MV closes before so can be split
40
What happens in S2 heart sound?
AV & PV close => AV closes first; inspiration causes increase S2 split
41
What happens in S3 heart sound? What does it mean?
at end of rapid ventricular filling; normal in kids & pregnant; adults have dilated CHF
42
What happens in S4 heart sound? What does it mean?
Filling of ventricle by atrial systole; not normally audible in adults; signifies high atrial pressure or stiff ventricle
43
What physical exam will identify RHF?
JVD
44
Slope of Y descent decreases when? increases when?
decreases in tamponade => RA empties slower increases in constrictive pericarditis
45
What increases O2 consumption?
increases in after load, contractility, HR, size of heart
46
What increases Mean systemic pressure?
increased blood volume; decreased venous compliance (blood shifted from veins to arteries); exercise (SANS)
47
Name the 7 ways BP is regulated
Short term => baroreceptor reflex active & activity increases BP Long term => RAAS; Relative term => cerebral ischemia to hypercapnia, hypoxia w/ < PO2, severe volume depletion leading to ADH; ANP from atrial stretch; autoregulation
48
What is the highest resistance in the CV system? what are they responsible for?
arterioles => largest drop in perfusion pressure
49
What has the highest proportion of blood in CV?
veins
50
What has largest total cross sectional & surface area? What does it facilitate?
capillaries => gas exchange
51
What are the roles of histamine & bradykinin in vasculature?
mediate arteriolar dilation & venous constriction
52
What is role of serotonin in vasculature?
arteriolar constriction
53
Name the different roles of types of prostaglandins in vasculature
prostacyclin => vasodilator TXA-2 => vasoconstrictor
54
What increases Hct to increase resistance of flow?
polycythemia; hyperproteinemia (multiple myeloma); hereditary spherocytosis
55
What increases turbulence (bruits)?
decreased blood viscosity (anemia); | increased blood velocity (narrow vessel, increased CO)
56
Edema caused by increase in capillary hydrostatic pressure?
increased venous pressure; | standing (edema in dependent limbs)
57
Edema caused by decreased in capillary oncotic pressure?
``` decrease in plasma protein 2' to: decreased synthesis (liver dz); decreased intake (protein malnutrition); increased excretion (nephrotic syndrome) ```
58
Edema caused by increasing the filtration coefficient?
burn; | inflammation (sepsis)
59
What typically causes a transudate?
increased capillary hydrostatic pressure or decreased capillary oncotic pressure
60
What typically causes an exudate?
more permeable vessels => increased filtration coefficient; | vessel becomes leaky & protein & fluid leave
61
What are the locations & corresponding leads...inferior? anterior?
inferior => II, III, aVF anterior=> V1-V6
62
What does the PR interval depend on? tachycardia?
depends on conduction velocity through AV node & HR; | shortens
63
Differentiate Mobitz type I vs type II AV blocks
PR interval in type I lengthens until beat is dropped; PR interval remains constant before dropped beat in type II
64
What is a mural thrombus? what is a risk factor for LA mural thrombus?
adheres to wall of heart or artery; mitral stenosis is risk factor for LA mural thrombus
65
What is MCC of atrial fib in US?
HTN
66
What is the initial DOC for Tx of primary HTN?
thiazides
67
How do ACE-inhibitors lower mortality & morbidity in diabetic HTN?
decrease renal HTN by decreasing efferent arteriolar vasoconstriction to decrease intraglomerular pressure to lessen proteinuria
68
Define primary aldosteronism
HTN, hypokalemia, metabolic acidosis (increased aldosterone, decreased renin)
69
Medial calcification of radial, ulnar, tibial, uterine or femoral arteries have what Sx?
benign medial calcification of medium sized arteries does NOT INVOLVE the intima so does NOT obstruct arterial flow
70
Define arteriolosclerosis. When is it most often seen?
affects intima of small arterioles & arteries; | seen in elderly, diabetics, metabolic syndrome, HTN
71
Differentiate the 2 types of arteriolosclerosis
hyaline => protein deposits in arterial wall to narrow lumen => seen in diabetics due to NEG; =>in HTN pt from pressure forcing proteins into wall causing increased muscle & elastic tissue hyperplastic => malignant HTN => increased smooth muscle proliferation & BM duplication to onion skinning
72
Where are aneurysm's typically found? why?
below level of renal arteries due to fewer vasa vasorum in the media of these vessels leading to increased risk & damage of ischemia
73
What is the MC etiology of myocarditis?
viral => coxsackie B, rubella, CMV => lymphocytic infiltrates
74
When is bacterial myocarditis seen? what are usual bugs?
immundodeficiency/suppression => | S aureus; Corynebacterium diphtheriae, Haemophilus influenzae
75
Other than bacteria, pt w/ HIV get myocarditis how?
toxoplasmosis or Kaposi's sarcoma
76
What are diseases & Rx that can cause myocarditis?
Chagas, Lyme, acute renal failure, rheumatic fever, lupus, doxorubicin
77
How does myocarditis present?
muffled S1; S3; MR murmur diffuse T wave inversion & ST elevations => Bx is best Dx
78
Bacterial cause of endocarditis assoc w/ prosthetic device
Staph epidermis w/in first 6 months; after 6 mo then S. aureus & viridans
79
Bacterial cause of endocarditis assoc w/ colon cancer
Strept bovis
80
Bacterial cause of endocarditis assoc w/ dental procedure
Stept viridans
81
Bacterial cause of endocarditis assoc w/ GI surgery
enterococcus
82
Bacterial cause of endocarditis assoc w/ total parenteral nutrition
fungal
83
Bacterial cause of endocarditis assoc w/ alcoholics or homeless
Bartonella henselae
84
Bacterial cause of endocarditis assoc w/ fastidious & culture negative
HACEK organisms => Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
85
Nutmeg liver on histology
congestion of centrilobular veins surrounded by paler region
86
What are the treatments for acute decompensated CHF?
``` LMNOP Lasix (furosemide); Morphine Nitrates; O2; Position upright ```
87
Murmur of MVP is seen in who? what makes it worse?
Marfan's & young women; SLE; mucopolysaccharidoses (hurler & hunter); hypothyroidism; Ehlers-Danlos Valsalva makes it worse
88
What does S3 in older adult mean?
occurs in early diastole & implies volume overload
89
What does TR murmur increase w/ inspiration?
blowing holosystolic murmur at L LSB due to increase in venous return to R side of heart
90
What are the ONLY 2 murmurs that do not increase intensity w/ squatting & decrease in intensity w/ valsalva?
MVP & hypertrophic cardiomyopathy
91
What types of patients are typically assoc w/ PDA? what is a common complication?
premature & congenital rubella; endarteritis
92
Where do red (hemorrhagic) infarcts occur? pale infarcts
red infarcts => tissues w/ collateral circulation => lung, intestine, post-reperfusion pale infarcts => solid tissue w/ single blood supply => brain, kidney, spleen
93
How does septic shock mimic artervenous fistula (high flow state)?
ALL arterioles are vasodilator leading to increased CO
94
What can LAD infarction cause?
LBBB, anterior wall rupture & mural thrombi
95
What can RCA infarction cause?
LV papillary rupture, posterior flail leaflet & MR
96
How does constrictive pericarditis present?
Kussmaul's sign & pericardial knock
97
Compare platelet counts in Henoch Schonlein purpura & ITP
platelet counts normal to elevated in HSP; decreased in ITP
98
Pt w/ Sx in multiple organ systems & palpable purpura, what should be highest on Ddx?
small vessel vasculitis

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