Flashcards in Cardio Deck (91):
Left horn of the sinus venosus becomes?
R horn becomes?
Coronary sinus (on L side of RA)
Smooth part of RA
PDA is due to failure of what 2 things to fuse after birth?
Septum primum and septum secundum
What is the most post part of the heart?
Use TEE to dx?
bc eso can best see LA and descending Ao
CO = ?
= SV x HR
= rate O2 comsump / (art. O2 - ven. O2)
MAP = ?
= CO x TPR
= 2/3 DP + 1/3 SP
Pulse P is proportional to?
Incr'd SV -> incr'd PP (bc bigger diff btwn
CO / HR = EDV - ESV
Decr'd EC Na+ has what effect on SV?
Incr's SV bc less Na/Ca exchange, so less Ca out, meaning more Ca in cell -> more SV
How does digitalis incr SV?
Blocks Na/K pump -> more IC Na -> less Na/Ca pump -> more Ca inside -> more SV
Acidosis has what effect on SV?
Incr'd EC H+ -> X for K -> more Na/K pump to bring K into cell -> less Na in cell -> more Na/Ca pump -> less Ca in cell -> decr'd SV
= SV / EDV
= (EDV - ESV) / EDV
Where is the majority of the TPR?
Arterioles, to reg cap flow
- a wave? c wave?
- x descent?
- v wave?
- y descent?
- a = atrial contrac; c = RV contract -> TV bulges into RA incr'ing RA P
- x = RA relaxed and decr'd P as RV contracts
- v = incr'd RA P w/ "villing"
- y = TV opens bl flows from RA to RV
Wide splitting is due to (2)?
Pulm stenosis, RBBB (delayed RV emptying)
Fixed splitting is due to?
ASD (incr'd flow thr PV so delayed close)
Paradoxical splitting is due to (2)?
AS, LBBB (delayed LV emptying so A2 after P2)
Pulm flow murmur + diastolic murmur?
Later on: louder diastolic murmur?
ASD (incr'd flow thr PV and incr'd flow X TV)
- later get pulm regurg from dilatation of PA
On insp/expiration get incr'd intensity of what heart sounds?
Insp: R heart sounds (incr'd venous return)
Expir: L heart sounds (incr'd return to L heart from pulm circ)
Hand grip (incr'd SVR) makes which heart sounds louder?
- which heart sounds quieter?
Everything that goes backwards: MR, AR, VSD, MVP
- things that can't push as much: AS, HOCM
Valsava (decr'd venous return) makes which 2 heart sounds louder?
MVP and HOCM, makes most other heart sounds quieter
Squatting (incr'd venous return/preload, incr'd afterload if sustained) makes which 2 heart sounds quieter?
Holosystolic high-pitched blowing murmur?
MR incr'd w/ expiration, TR incr'd w/ inspir
Ejection click, then crescendo-decrescendo systolic murmur?
- pulses are?
- weak w/ delayed peak: pulsus parvus et tardus
Holosystolic harsh murmur?
- loudest at TV area
- incr'd w/ hand grip
Late systolic decrescendo murmur w/ midsystolic click?
- best heard over apex, loudest at S2
- incr'd w/ decr'd venous return (standing or Valsalva)
High-pitched blowing diastolic decrescendo murmur?
- pulse is?
- wide pulse P w/ bounding pulses and head bobbing
- incr'd w/ hand grip
Opening snap, then delayed rumbling diastolic murmur?
- incr'd w/ incr'd LA return (expiration)
PDA assoc'd w/ what 2 things?
Congenital rubella or prematurity
AS w/ fusion of commissures PLUS MS = ?
How does the cardiac AcP work?
0 = rapid upstroke, V-gated Na in
1 = initial repol, V-gated K out
2 = plateau, V-gated Ca in (-> Ca from SR, contraction) equal to K out
3 = rapid repol, K out
4 = resting potential, K ch leak out
How does SA node spont'ly depol?
Phase 4 has Ifunny Na ch's -> Na slowly in -> Ca depol (phase 0 upstroke) -> phase 3 repol w/ K out
Cardiac myocytes are electrically coupled thr?
Adenosine does what to SA node?
Decr'd rate of depol, slows HR
Slope of phase 0 in SA is proportional to?
HR, incr'd slope means incr'd HR, decr'd slope means decr'd HR
PR int - nl length is?
QRS complex - nl length is?
U wave =
peak after T wave, means hypoK or brady
Speed of conduction: Atria, ventricles, AV node, Purkinje?
Purkinje > Atria > Ventricles > AV node
Severe congenital sensorineural deficits have incr'd chance of?
Torsades bc congenital long QT (Jervell and Lange-Nielsen synd), due to defects in Na or K ch's in heart
No P waves on EKG?
Afib, QRS complexes are irreg'ly spaced
Sawtooth flutter waves on EKG?
- Rate control w/?
Aflutter, identical atrial depol's w/ interspersed QRS complexes
- b-blocker or CCB
PR int >200 on EKG?
1st deg AV heart block
P wave w/ no QRS after it on EKG?
2nd deg AV heart block:
Mobitz type I (Wenckebach) if lengthening PR int
Mobitz type II if no change in PR int length
- only trt type II -> pacemaker
P waves are coming faster than QRS, no correlation btwn the 2?
- can be due to?
3rd deg (complete) heart block
- Lyme dz
Ao'ic baro/chemoRs transmit via what to where about what?
What about carotid Rs?
- Via CN X to solitary nuc of medulla about incr in BP (fire less w/ decr'd BP)
- Via CN IX to solitary nuc of medulla about incr and decr in BP
Hypotension is sensed by? leads to?
baroRs: decr'd stretch, decr'd aff firing -> incr'd eff symp and decr'd eff parasymp -> vasoconstric, incr'd HR/contractility/BP
HTN sensed by? leads to?
baroRs: cartoid baroRs stretch -> incr'd firing -> incr'd eff parasymp -> decr'd HR
Cushing rxn =
HTN, brady, and resp depression:
incr'd ICP constricts art's -> cerebral ischemia -> symp incr to incr'd perfusion P causing HTN -> incr'd stretch so baroR reflex -> brady and resp depression
Periph chemoRs respond to?
Central chemoRs respond to?
- carotid/Ao'ic bodies: decr'd PO2, incr'd PCO2 and decr'd pH
- changes in pH and PCO2 of brain fluid (NOT to O2)
Organ w/ the lg'est bl flow?
Lg'est share of systemic CO?
High bl flow per gm of tissue?
Lg'est extraction of O2?
Lung, 100% of CO!
Heart (incr'd O2 demand met by incr'd CA bl flow, not by incr'd extraction)
Nl PA P?
Nl PCWP? appox'n of?
5 T's (Cyanotic CHDs) =
ToF, Transposition, Truncus, Tricuspid, TAPVR
Which CHD is assoc'd w/:
- 22q11 synd's
- Congen rubella
- DM mom
- SLE mom
- Truncus arteriosus, ToF
- ASD, VSD, AV septal defect
- PDA, PS, septal defects
- Preductal coarc of Ao, bicuspid AV
- Ao insuff and later dissection
- Transposition of great vessels
- Heart block
3 CHDs w/ late cyanosis (Eisenmenger's synd)
- why is it late?
VSD, ASD, PDA
- have L->R shunt -> pulm hypertrophy and incr'd P w/ RV hypertrophy -> switches to
L->R shunt (cyanosis, clubbing and polycythemia)
White ring around periph of iris is called?
Lipid deposit in cornea (hyperlipidemia)
Hyaline arteriolosclerosis is due to?
Hyperplastic type is due to?
Essential HTN, DM
Malig HTN (-> fibrinoid necrosis of vessel wall)
4 modifiable RFs for atherosclerosis?
SHHD: smoking, HTN, hyperlipidemia, DM
Why are postmenopausal women at higher risk for atherosclerosis but not premenopausal women?
Estrogen is protective!
Hypotension, flank pain and pulsitile ab mass?
Ab aortic aneurysm (below renal a's but above bifurcation)
Ao'ic dissection is due to tear in what?
Intraluminal tear -> makes a true and false lumen
ST depression on EKG means?
Subendocardial ischemia or very early MI that hasn't become transmural yet
Prinzmetal's variant of angina is due to?
- EKG shows?
CA spasm -> angina at rest
- ST segment elevation
Evolution of MI
- what do you see, when? what color is it?
0-4hrs - minimal change
1d - coag necrosis (dark, no nuclei)
N's come in
1wk - Mphage come in (yellow pallor)
Granulation tissue (yellow w/ red border)
1mo - Scar from type I collagen (white)
- at 1-3d?
- at 3-7d?
- at 1mo?
- fibrinous pericarditis (only w/ transmural infarct) from inflamm debris in pericardium
- Rupture bc weak wall! Tamponade from free wall rupture, MV insuff from pap m. rupture, shunt from interventric septal rupture
- Dressler's synd
Troponin I - rises when? peaks? goes away?
CKMB used for?
4hrs, peaks at 24hrs, elevated for 7-10d
- dx reinfarction bc returns to nl levels after 48-72hrs
Where is the MI:
II, II, aVF
Ant wall, LAD
Lat wall, LCX
Inf wall, RCA (goes to pap m. so can see rupture of it)
What can give you a dilated (congestive) cardiomyopathy?
chronic Alcohol abuse
Coxsackie B v. myocarditis
chronic Cocaine use
+ hemochromatosis + peripartum
How does hypertrophic cardiomyopathy present an outflow tract obstruction?
Big interventric septum is too close to MV leaflet -> obstructs outflow tract
- Systolic murmur
Genetics of hypertrophic cardiomyopathy?
- assoc'd w/ what other dz?
AD usu involving b-myosin heavy chain mutation
- Friedreich's ataxia
Treatment for hypertrophic cardiomyopathy
b-blocker or non-dihydropyridine CCB (verapamil)
Loffler's synd =
endomyocardial fibrosis w/ prominent Eo'ic infiltrate
Trtmt for CHF
AAB: ACEIs/ARBs, Aldos inhib (spironolactone), b-blockers
Nutmeg liver is sign of?
R HF (heptomegaly from congestion in liver)
Sx for bac endocarditis?
Bac FROM JANE:
Roth's spots (white spots on retina surrounded by hemorrhage)
Osler's nodes (painful, rised, finger and toe pads)
Janeway lesions (sm, painless, palm/sole)
Anemia (of chronic dz, microcytic)
Libman-Sacks Endocarditis =
from SLE, have sterile vegetations on top and bottom of MV
Rheumatic F: early lesion? late lesion?
- Aschoff body =
- Anitschkow's cells =
Early: MR, Late: MS
- granuloma w/ giant cells
- act'd histiocytes w/ caterpillar nuclei
Sx of acute rheumatic fever?
Valvular damage (vegetation, fibrosis)
Red-hot jts (migratory polyarthritis)
St. Vitus' dance (Syndenham's chorea)
+ pancarditis -> friction rub
Sharp chest pain relieved by sitting up and leaning forward, EKG shows widespread ST-segment elevation and/or PR depression
Low BP, incr'd JVP, muffled heart sounds =
Beck's triad for Cardiac tamponade
- also have pulsus paradoxus
Tree bark appearance of Ao =
3* syph - disrupts vasa vasorum of Ao -> atrophy of wall -> dilation of Ao and valve ring, also calcification of Ao'ic root and ascending Ao'ic arch
Tumor in LA causing obstruction and syncopal episodes?
HepB (+) yg adult w/ string of pearls on imaging?
- due to?
- IC mediated -> transmural inflamm of art wall w/ fibrinoid necrosis; when lesions heal they form nodules
- ccs and cyclophosphamide
Pauci-immune GN, necrotizing vasculitis in lung, kidneys and skin (palpable purpura)
- no granulomas and not in nasopharynx (unlike Wegener's)
Pauci-immune GN, in pharynx, lungs and kidneys
Wegener's granulomatosis (granulomatosis w/ polyangiitis)
- focal necrotizing vasculitis w/ granulomas and in nasopharynx (until microscopic polyangiitis)
Palpable purpura w/ asthma and wrist/foot drop?
- pauci-imm GN w/ necrotizing vasculitis and Eo's and IgE
Child, recently sick, w/ palpable purpura on butt
Henoch-Schonlein purpura (IgA)
- follows URI bc get incr'd IgA
- palpable purpura, jt pain, ab pain
Benign cap hemangioma in baby, grows fast, but goes away by 5-8yo
Benign cap hemangioma in old person, doesn't go away
Polyploid cap hemangioma that is ulcerating and bl'ing, in preg woman or from trauma
Skin papules in AIDS pt can be what of 2 things?
Bacillary angiomatosis from Bartonella henselae infec OR
Kaposi's sarcoma from HHV-8