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Remnant of fetal umbilical vein

ligamentum teres hepatis
(in falciform ligament, = vertically across anterior side of liver at midpoint) no f(x) in adult.


Remnant of fetal Umbilical arteries & allantois

aa => MediaL umbilical ligaments
(= 2 folds just off midline in anterior abdominal wall), No f(x) in adult

allantois => urachus & mediaN umbilical ligament = duct btwn bladder & belly button, no f(x) in adult.


Remnant of fetal ductus arteriosus

Ligamentum arteriosum
(stretches btwn pulmonary artery and aortic arch) no function in adult.
*Recurrent laryngeal n. (from vagus) travels just underneath this lig.*


Remnant of fetal ductus venosus

ligamentum venosum
(on posterior side of liver, near midline) no f(x) in adult.


factors for increased stroke volume of heart

1. increased Contractility
2. increased Preload
3. decreased Afterload


factors for increased heart contractility:

Increased intracellular Ca2+ => increased muscle action
1. catecholamines (increase Ca pump @ Sarcoplasmic reticulum)
2. low soduim (less Na into cell = more Ca stays in cell)
3. digitalis (blocks Na/Ca2+ pump)


preload measures ?

preload measures ventricular End Diastolic Volume
(how much blood entered from venous return during diastole, now needs to be pumped out)
*force of contraction is proportional to EDV!*


Mockenberg Arteriosclerosis

calcification of the MEDIA of arteries, = benign (not obstructive)


Arteriolosclerosis (2 types)

1. Hyaline arteriolosclerosis: thickened small aa. *essential HTN or DM
2. Hyperplastic arteriolosclerosis: "onion skinning" in arteries
=> malignant HTN



= fibrous plaques in intima of medium & large muscular aa & elastic aa
* includes sm. muscle cell migration w/ build-up
** may have high plasma homocysteine levels


Diseases associated with thoracic aortic aneurysms

HTN, cystic medial necrosis (w/ Marfan's), & tertiary syphilis


Coronary Steal Syndrome

aggravation of ischemia by vasodilator
bc shunt blood away from stenosis, & towards higher perfusion area
(but the stenotic area really needs the blood)


Transmural vs. Subendocardial infarctions

Transmural: "Full" MI, w/ necrosis affecting entire wall.
= ST elevation or pathologic Q waves (old)
Subendocardial: partial MI (<50% of ventricle wall)
= ST depression


What are some specific visible signs of bacterial endocarditis? (4)

1. Roth spots (white spots on retina w/ surrounding hemorrhage)
2. Osler's nodes (tender, raised lesions on fingers or toes)
3. Janeway lesions (painless, erythematous, on palms or soles)
4. splinter hemorrhages


Acute Rheumatic fever vs. Late sequelae

(type II hypersensitivity rxn after group A B-hemolytic strep infection)
Fever (acute): mitral regurgitation => holosystolic blowing murmur
& mitral valve prolapse => midsystolic click w/ late crescendo murmur

Late: mitral stenosis (or aortic) => diastolic opening snap w/ rumbling murmur


Syphilitic heart disease

ascending aorta dilation & wall atrophy bc disrupted vasa vasorum.
=> aortic root calcification & "tree bark" aorta
** risk aneurysm or aortic insufficiency **


Pulsus paradoxicus occurs in these cases: (5)

1. severe cardiac tamponade
2. asthma
3. obstructive sleep apnea
4. pericarditis
5. croup


cardiac tamponade

compression of heart by fluid in pericardium
=> low CO --> hypotension, JVD, increase HR, pulsus paradoxicus


Cases w/ + Kussmaul's sign: (4)

(= abnormal increase in JVP on inspiration -- normal = decrease)
1. constrictive pericarditis
2. restrictive cardiomyopathies
3. RA/RV tumors
4. cardiac tamponade


Immune complex-mediated vasculitis types (2)

1. Polyarteritis nodosa (med. vessels esp. renal & GI, w/ neuro Sxs)
2. Henoch-Schonlein purpura (small vessels, IgA in kids after cold)


Large vessel vasculitis types

Both: high ESR, granulomatous inflammation.
1. Takayasu's arteritis: asian F <40yrs old, weak upper pulses
2. Temporal arteritis: elderly F, jaw claudication, vision loss
*assoc. w/ polymyalgia rheumatica


Medium vessel vasculitis types (3)

1. Polyarteritis nodosa: fibrinoid necrosis bc ICs *assoc. w/ HepB
2. Kawasaki disease: asian kids, *desquam rash! & strawb. tongue, risk coronary aneurysm/MI
3. Buerger's/thromboangitis obliterans: heavy smokers (M), gangrene of digits! (intermittent claudication)


Small vessel vasculitis types (4)

1. Microscopic polyangitis: pANCA, "pauci-immune"
2. Granulomatosis w/ polyangitis (wegener's): cANCA,
3. Churg-Strauss: eosinophilia & IgE; sinusitis & periph. neuropathy
4. Henoch-Schonlein Purpura: kids after URI, = IgA deposition.


3 types of veins in fetus (& what they become in adult)

1. Umbilical -- degenerate
2. Vitelline -- portal vein
3. Cardinal -- systemic veins (common cardinal v -> Sup. Vena Cava)


Characteristic triad for cardiac tamponade

1. muffled/distant heart sounds
2. JVD
3. hypotension
*also: pulsus paradoxicus


cases which present with pulsus paradoxicus

1. cardiac tamponade
2. constrictive pericarditis
3. asthma, COPD
4. Pulmonary Embolism