Cardio Flashcards
(87 cards)
1
Q
Sinus venosus gives rise to?
A
Left horn = Coronary sinus
Right horn = smooth RA
2
Q
What contributes to the septation of both atria and ventricles?
A
Endocardial cushion= NC origin
3
Q
MC septal defect in children vs adults?
A
Children = VSD (Fetal alcohol, Tetralogy, Cri-du-chat)
Adults= ASD
occurrence: VSD > ASD > PDA
4
Q
Fetal erythropoiesis timeline?
A
Yolk sac–> Liver–> spleen –> BM
5
Q
CO in early vs late exercise?
A
Early= inc CO = Inc HR X inc SV Late = Inc CO = inc HR x stable SV (plateau)
6
Q
CO equations?
A
CO= HR x SV CO= O2 consumption/ (arterialO2- venousO2)
7
Q
MAP calculation?
A
MAP= CO x TPR MAP = 2/3 diastolic pressure + 1/3 systolic
8
Q
Pulse pressure calculation?
A
PP = systolic pressure - diastolic pressure
** Proportional to SV
9
Q
Increase in SV increases what?
A
Pulse pressure
**Aortic regurgitation= Inc SV = High PP
10
Q
SV calculations?
A
SV = CO/HR = EDV-ESV
11
Q
What are the determinants of Myocardial O2 demand?
A
Afterload
Preload= Heart size = Wall tension (hypertrophy)
HR
Contractility
12
Q
How can you decrease Myocardial O2 demand?
A
Nitroglycerin = Dec Preload= Dec wall tension (inc BF)
ACEi/ Ca channel blockers = Dec Afterload
B-blockers= dec HR = GIVE after MI
Control HTN/ Aortic stenosis= dec Hypertrophy
13
Q
EF calculation?
A
EF = (EDV- ESV) / EDV
**Normal EF = >55%
14
Q
Equation for Resistance in SERIES?
A
R = Sum of all Rs
**Total should be Higher than individual
15
Q
Equation for Resistance in Parallel?
A
1/Rt = 1/r + 1/r + 1/r
**Sum of all Should be lower than Individual Rs
16
Q
Equation for Resistance?
A
R = Pressure/ Q (flow) = (viscosity x length)/ r>4
**R directly proportional to = Pressure/viscosity/length
17
Q
What factors change change the mean systemic filling pressure (x intercept of CV function curve)?
A
Volume or Venous compliance
- *Increase volume or Dec Compliance = Inc MSFP
- *nitroglycerin inc Compliance = Dec MSFP
18
Q
What factors affect venous return?
A
SVR –> Dec SVR= Inc VR
**Arterioles dilate= Inc BF to veins = Inc VR
19
Q
S3 is associated with what?
A
Inc Filling pressure (Mitral regurg + CHF)
**Normal in Children or Pregnant women
20
Q
JVP graph: a wave = c wave = x descent = v wave = y descent=
A
a = Atrial contraction c = RV Contraction x = atrial relaXation v = Inc RA pressure due to filling y = BF from RA -> RV
21
Q
S1 & S2 splitting:
Wide=
Fixed=
Paradoxical=
A
Wide= Delay RV emptying (Pul stenosis, RBB block)
Fixed = ASD
Paradoxical = LV emptying delay (Aortic stenosis, LBB blck)
**Inspiration will fix Paradoxical due to late closure of Pulmonic valve due to Inc VR
22
Q
Hand grip (Inc SVR) affects what murmurs and How?
A
Inc SVR= Inc intensity (MR, AR, VSD, MVP)
Inc SVR= dec intensity (AS, HCM)
**Makes sense= Inc SVR means LV SV will try and go somewhere other than Aorta (lower pressure)
23
Q
Valsalva affects what murmurs and how?
A
Valsalva = Inc Thoracic pressure = Dec VR
Inc Intensity = MVP + HCM
24
Q
Pt has a murmur that intensifies with Valsalva?
A
MVP
HCM
25
Rapid squatting affects what murmurs and how?
Rapid squatting = Inc VR/preload + prolonged (inc AL)
| Dec = MVP + HCM
26
What kind of patients squat in order to improve circulation/ murmur?
```
Tetralogy = Inc VR = Inc pressure in RV so less Left->R shunt through VSD
HCM= Inc VR dec the Aortic stenosis by Septum/ MV
```
27
In cardiac myocyte @ resting potential what Ion has Highest permeability?
K+
28
What Ion is responsible for Myocyte depolarization vs Pacemaker depolarization?
```
Myocyte= Fast Na channels
Pacemakers= Calcium channels
```
29
What are the phases of Cardiac myocyte APs?
```
P0= Fast Na channels open = Depol
P1= Na channels close/ K channels open
P2= Ca channel open Balance K efflux= Plateau/ contraction
P3= K channel all open / Ca channels close
P4= Resting K dominates
```
30
What happens to Cardiac nodal cells during diastole?
They depolarize via If "funny" Na channels
31
What are the phases of Cardiac Pacemaker action potentials?
```
P0 = Ca channels open = Upstroke/ Depol
P1/2= Absent
P3= Ca channels inactive/ K channels open= Repol
P4= Slow diastolic spontaneous depol via Na channels
```
32
What part of the Pacemaker action potential determines the HR?
Na channel / Phase 4 SLOPE
* *Adenosine/Ach= Dec P4 slope= dec HR
* *NE/E = Inc P4 slope = Inc HR
* SNS increases Na channel opening = Inc HR
33
```
Electrocardiogram:
QT interval=
PR interval length=
ST =
U wave =
```
```
QT = Mechanical contraction of ventricles
PR = <200msec = AV delay
ST = Isoelectric ventricle depol
U = Hypokalemia, bradycardia
```
34
What is the order of Speed of conduction?
Purkinji> atria > ventricles > AV
35
Pt with Congenital QT prolongation due to K+ channel defect is at risk for what?
Torsades
| Congenital Sensorineural deafness
36
What is the treatment of Torsades de pointes/ prolonged QT?
Mg sulfate
37
Deficiencies in what electrolytes predispose to arrhythmias?
Mg
| K
38
AV block ECG findings:
1st degress
2nd: Mobitz type 1 vs. Type 2
3rd degree
1st ==> PR interval prolonged >200msec
Mobitz 1 = P wave not followed by QRS
Mobitz 2= Dropped beat (2P/ 1QRS)
3rd = atrial/ ventricular depol Independent P waves/ QRS no longer coordinate= LYME disease
39
Functions of ANP?
Vascular relaxation
Dec Na reabsorption
Diuresis (cGMP mediated afferent dilation)
40
Baroreceptor response to Dec BP?
dec stretch= Dec Afferent = Inc SNS
41
Carotid massage causes?
In pressure = Inc Afferent = Dec HR
42
What hemodynamic changes are seen with Inc ICP?
Cushing reaction ==> dec Cerebral BF
Inc SNS = Inc SVR = HTN
HTN= inc Baroreceptors = Vagus = BRADYCARDIA
Respiratory depression
43
Pt with high pulse pressure, bradycardia, and respiratory depression?
Increased ICP = Cushing rxn
44
Aortic arch vs Carotid sinus?
```
Arch = Vagus = Only responds to HTN
Sinus = CN IX = Both HTN & hypotension
```
45
Central vs peripheral chemoreceptors respond to?
Peripheral = Po2 ( Pco2
46
```
What organ has the highest:
% of CO
Share of systemic CO
BF per gram of tissue
Arteriovenous O2 difference-= O2 extraction
```
```
Lung= 100% CO
Liver = largest CO share
Kidney = Highest BF
Heart = 80% extraction
**Inc cardiac O2 demand has to be met by CA dilation
```
47
```
Normal pressures:
RA
RV
LA
LV
```
```
RA = <12
LV= 130/10
```
48
What causes PCWP > LV diastolic pressure?
Mitral stenosis
49
```
Factors autoregulating BF in:
Heart
Brain
Lungs
Skin
Muscles
```
```
heart = NO + Adenosine = vasodilate
Brain = CO2/ pH
Lungs = hypoxic vasoconstriction
SKin = SNS
muscles = Lactate. adenosine. K+
```
50
Calculating net capillary filtration pressure?
Pnet = [(Pc - Pi) - (Uc - Ui)]
* P = hydrostatic
* U = oncotic
51
5 Ts of Early cyanotic babies?
1. Truncus arteriosus
2. Transposition
3. Tricuspid atresia
4. Tetralogy of fallot
5. Total anomalous pulmonary VR (pul veins drain into R circulation and never end up in Left side)
52
Pt with cyanotic spells and x-ray shows "BOOT shaped heart?"
Tetralogy = RVH causes boot shape
53
Underlying cause of:
Tetralogy
Transposition
```
BOth = Neural crest defect
teratology = Anteriorsuperior displacement of Infundibular septum
Transposition = failure of Aorticopul septum to Spiral
```
54
Preductal vs postductal coarctation?
```
Preductal = Turners + weak Femoral pulse
Postductal = Rib notching, HTN upper ext + berry aneurysms + BICUSPID aortic valve ass.
```
55
Pt comes in with Cyanosis in upper extremities and normal Lower extremities?
Uncorrected PDA
56
```
Associated heart defects:
DiGeorge
Downs
Rubella
Turners
Marfans
Diabetic mother
Tertiary syphilis
```
```
DiGeroge = Tetralogy + Truncus
Downs = ASD, VSD, AV septal defect
Rubella = PDA, pulmonary Stenosis
Turners = Coartaction + Bicuspid aortic valve
Marfans = Medial cystic necrosis = DIssections
DM = Transposition
Syphilis= Aortic Regurg + Aneurysm of Descending aorta
```
57
```
Lipidemia signs:
Plaque in BV walls
Lipid laiden histeocytes in skin/ eye lid
Lipid deposits in tendons
Lipid deposits in cornea
```
Atheromas
Xanthomas = SKIN
tendon Xanthomas
Corneal arcus
58
Ateriosclerosis subtypes causes:
Monckenberg
Arteriolosclerosis
Atherosclerosis
```
Monckenberg = Medial calcification/ does NOT block
Arterioloscerosis = Hyalin (HTN/DM) + Hyperplastic (onion skin/ malg HTN= smooth muscle hyperplasia)
Atherosclerosis= Fibrous plaques in INTIMA
```
59
MC site of atherosclerosis?
Abdominal aorta > CA > popliteal > carotid
60
What signals are involved in Smooth muscle migration during atheroma formation?
PDGF + FGF
61
Pt with HTN + DM + high Cholesterol comes in with Left flank pain, hypotension, pulsatile mass in the abdomen?
Ruptured AAA
62
Causes of Thoracic Aortic aneurysms?
Cystic medial necrosis (Marfans)
| Tertiary syphilis = endarteritis obliterans (vasa vasorum)
63
What is coronary steal syndrome?
Treatment with a vasodilator during Cardiac ischemia can Worsen ischemia by SHUNTING blood away into Dilated vessels
64
```
Timeline for MI:
0-4hrs
4-12hrs
12-24hrs
1-3d
3-14d
+2wks
```
```
0-4hrs = NOTHING is seen = COD arrhythmias
4-12hrs= Coag necrosis/ Wavy fibers/ edema = ECG dx
12-24hrs= Contraction bands/ enzyme elevation (T1 / CKMB)
1-3d = PMNs / Fibrinous pericarditis due to Necrosis
3-14 = Macs / granulation tissue = Rupture/ aneurysm
+2wks = Scar = Dresslers syndrome
```
65
Dx MI via ECG leads:
V1-4
V4-6
II, III, aVF
V1-4 = LAD
V4-6= LCX, I aVL
II, III, aVF = RCA
66
MCC of hypertrophic cardimyopathy? Rx?
Myosin heavy chain mutation
Friedreichs ataxia
Rx= Beta blockers to avoid arrhythmias (MCCOD)
67
MCC of dilated cardiomyopathy?
```
ABCCCD
Alcohol
Beriberi
Coxsacki B
Chagas
Cocaine
Doxorubicin
```
68
MCC of restrictive cardiomyopathy?
Sarcoidosis
Hemachromatosis
Endocardial fibroelastosis
Loffler's = EOSINOPHILIA + endomyocardial fibrosis
69
Treatment of choice for CHF?
ACEi = Dec AL/ PL
Beta blockers= Dec O2 demand
Spironolactone = reduces reorganizaton/ fibrosis
ARBs
70
Biopsy of Rheumatic heart disease?
Aschoff bodies = Granuloma
Anitschkow cells = Activated histeocytes
**Type 2 HS rxn to M protein
71
Pt with sharp chest pain aggravated by inspiration and Widespread ST elevation?
Acute pericarditis
72
Causes of Pericarditis:
Fibrinous
Serous
Purulent
```
Fibrinous= Dresslers + Uremia
Serous = Viral + RA, SLE
Purulent = Pneumococcus + Strep
```
73
Findings in Cardiac temponade?
```
Hypotension
JVD
Distant Heart sounds
Inc HR
Pulsus paradoxus
```
74
Kussmauls signs is and seen with?
Inc JVD with Inspiration instead of normal Dec
| **Constrictive pericarditis, Restrictive cardiomyopathy , temponade
75
Young asian female with weak upper extremity pulse, fever, night sweats, myalgias, arthritis. Labs show elevated ESR. What is seen on biopsy-> Dx -> Rx?
Takayasu's arteritis
Granulomatous inflammation of AORTIC arch / branches
Rx= Steroids
76
Pt with fever, wght loss, abdominal pain, renal damage, CNS issues, and HBV+. What is seen on biopsy?
Transmural inflammation = FIBRINOID necrosis
of Renal + Visceral arteries (Not Large arteries)
Rx: steroids / Cyclophosphamide
77
Child with conjunctival injection, oral mucosal erythema, and desquamating rash. What is he at risk for? Rx?
Kawasaki
Coronary artery Aneurysm
Rx: Aspirin
78
Young asian male smoker with recurrent limb claudication. new developed gangrene of the fingertips. What is the Dx/ Rx?
Buerger's disease
| Rx: STOP Smoking
79
Child with recent URTi, joint pain, abdominal pain, and skin lesions on his legs. What is this associated with?
Henoch-Schonlein purpura = IgA nephropathy
80
Benign capillary growth of Children that Grows Rapidly then Regresses spontaneously?
Strawberry Hemangioma
81
Benign capillary lesion of Elderly that Does NOT regress?
Cherry hemangioma
82
Pregnant women with a ulcerating polypoid capillary lesion?
Pyogenic Granuloma
83
Cavernous lymphangioma of the neck? associated with?
Cystic Hygroma = Turners + Downs
84
Benign painful red-blue tumor under the finger nails. What is the origin?
Glumus tumor => Modified smooth muscle cells
| **Globus body= control Body Temp
85
Very aggressive BV malignancy associated with Radiation for Hodkins or breast cancer?
Angiosarcoma
86
Lymphatic malignancy associated with Post-radical Mastectomy?
Lymphangiosarcoma
87
Child with Vascular disorder causing stains on his face/mouth/ oral mucosa, intracerebral AVM, seizures, and early onset Glaucoma?
Sturge- Weber disease
