Cardio - Phys/Ana/Emb Flashcards
(94 cards)
1
Q
Vitelline veins
A
Portal system veins
2
Q
Cardinal veins
A
systemic circulation veins
3
Q
Truncus arteriosus
A
Ascending aorta and pulmonary trunk
4
Q
Bulbus cordis
A
Smooth parts (outflow tract) of left and right ventricles
5
Q
Primitive atrium
A
trabeculated part of L/R atria
6
Q
Primitive ventricle
A
trabeculated part of L/R ventricles
7
Q
Primitive pulmonary vein
A
smooth part of left atrium
8
Q
Left horn of sinus venosus
A
Coronary sinus
9
Q
Right horn of sinus venosus
A
Smooth part of right atrium (sinus venarum)
10
Q
Right common cardinal vein and right anterior cardinal vein
A
SVC
11
Q
When does heart start beating?
A
4 weeks (first functional organ)
12
Q
Atrial septation
A
Septum primum –> Foramen primum –> Foramen secundum —>Septum secundum –>foramen ovale
13
Q
Outflow tract from?
A
Neural crest migration + endocardial cushion migration
14
Q
All valve origins?
A
Endocardial cushions
15
Q
Fetal erythropoiesis
A
Young Liver Synthesizes Blood
- Yolk sac (3-8wks)
- Liver (6wks - birth)
- Spleen (10-28wks)
- Bone marrow (18wks - adult)
16
Q
HbF unique?
A
Less avid binding 2,3-BPG
17
Q
Umbilical vein O2
A
PO2 = 30mmHg
80% saturation
18
Q
Ductus venosus
A
Shunts blood from umbilical vein into IVC
- becomes ligamentum venosum
19
Q
Allantois–>Urachus
A
Median umbilical ligament
20
Q
Ductus arteriosus becomes
A
Ligamentum arteriosum
21
Q
Foramen ovale becomes
A
Fossa ovale
22
Q
Umbilical arteries
A
Medial umbilical ligaments
23
Q
Umbilical vein
A
Ligamentum teres hepatis contained in falciform ligament
24
Q
SA and AV node blood supply
A
SA - RCA
AV - branch of posterior descending artery (RCA or LCA)
25
LCX
- lateral and posterior walls of LV
| - anterolateral papillary muscle
26
LAD
- ant. 2/3 of IV septum
- anterolateral papillary muscle
- ant surface of LV
27
PDA
- post 1/3 of IV septum
- post walls of ventricles
- posteromedial papillary muscle
28
CO =
= SV x HR
= rate of O2 consumption/(arterial O2 content - venous O2 content)
29
MAP =
CO x TPR
30
Pulse pressure and SV/arterial compliance
PP is proportional to SV
| PP is inversely proportional to arterial compliance
31
Increased Pulse Pressure
Hyperthyroidism, aortic regurgitation, aortic stiffening (isolated systolic HT in elderly), obstructive sleep apnea (increased sympathetic tone), exercise (transient)
32
Decreased Pulse Pressure
Aortic stenosis, cardiogenic shock, cardiac tamponade, advanced heart failure (HF)
33
Increased contractility
- Catecholamine (Increase activity of Ca2+ pump in SR)
- Increased intracellular Ca
- Decreased extracellular Na
- Digitalis
34
Decreased contractility
- B1 blockage
- HF w/systolic dysfunction
- acidosis
- hypoxia/hypercapnia
- Non-dihydropyridine Ca channel blockers
35
Increased diameter of ventricle
Increased wall tension --> increased myocardial O2 demand
36
ACEI/ARBs - preload and afterload?
decrease both
37
Normal EF
>55%
38
Phospholamban
Dephorphorylated phospholamban binds SERCA-2 (SR Ca-ATPase) and decreases affinity for Ca2+
- membrane protein
- decreased rate of muscle relaxation and contractility (decreased HR and SV)
- phosphorylated by PKA (adrenergic)
39
Organ removal (eg. nephrectomy)...
Increases TPR and decreases CO
40
Driving pressure =
Q x R
Q=flow velocity x cross sectional area
R=8nl/3.14r^4
41
TPR on venous return
(+) TPR - decreased
| (-) TPR - increased
42
TPR (increase and decrease)
Increased by: vassopressors (constrictors)
| Decreased by: exercise, AV shunt
43
Period of highest O2 consumption (LV cycle)
Isovolumetric contraction
44
Jugular venous pulse
a wave - atrial contraction (absent in a-fib)
c wave - RV contraction
x descent - atrial relax + downward tricuspid displacement (absent in tricuspid regurg)
v wave - atrial filling against closed tricuspid
y descent - RA empties into RV
45
Constrictive pericarditis
rapid y descent that is deeper and steeper w/ inspiration
46
S1
loudest at mitral area
47
S2
loudest at left upper sternal border
48
S3
- @ early diastole
- increased filling pressure (mitral regurg, HF)
- more common in dilated ventricles
- normal in kids and pregos'
- heard best at apex while lying lateral decubitus @ end-expiration
49
S4
- @ late diastole
- "atrial kick"
- high atrial pressure
- assoc. w/ ventricular hypertrophy (LA must push against stiff LV wall)
- heard best at apex while lying lateral decubitus @ end-expiration
50
Wide splitting
Delayed RV emptying (ex. pulmonic stenosis, right bundle branch block)
51
Fixed splitting
ASD
52
Paradoxical splitting
Delayed aortic valve closure (ex. aortic stenosis, left bundle branch block)
- A2 after P2, decreased gap with inspiration
53
Left sternal border
Diastolic murmor
- aortic regurg
- pulmonic regurg
Systolic murmor
- hypertrophic cardiomyopathy
54
VSD murmor
Pansystolic @ tricuspid area
55
ASD presentation
- pulmonary flow murmur (pulmonary valve)
- diastolic rumble (tricuspid valve)
(later progresses to louder diastolic murmur of pulmonic regurgitation from pulmonary a. dilation)
56
Bedside maneuver: Inspiration (venous return)
Increased intensity of right heart sounds
57
Bedside maneuver: Hand grip (afterload)
- Increased intensity of MR, AR, VSD murmurs
- Decreased hypertrophic cardiomyopathy murmurs
- MVP: later onset of click/murmur
58
Bedside maneuver: Valsalva (phase II), standing up
| preload decrease
- Decreased intensity of most murmurs (including AS)
- Increased intensity of hypertrophic cardiomyopathy murmor (LVOT obstruction)
- MVP: early onset of click/murmur
59
Bedside maneuver: Rapid squatting (preload increase)
- Decreased intensity of hypertrophic cardiomyopathy murmur
- Increased intensity of AS murmor
- MVP: later onset of click/murmur
60
Pulsus parvus et tardus
pulses are weak w/ delayed peak
| - aortic stenosis
61
Mitral regurg
- Radiates towards axilla
| - often d/t MI, MVP, LV dilation
62
Most frequent valvular lesion
MVP
63
Best indicator of AR severity
Presence of S3 (high rate of ventricular filling)
64
AR auscultation
Best heard @ left sternal border b/t 3/4, while patient sitting, leaning forward and at end expiration
65
Ortner Syndrome
LA dilation impinges on left recurrent laryngeal n.
| - can be d/t mitral stenosis
66
Skeletal vs. cardiac muscle Ca release from SR
- Ryanodine receptor linked L-type Ca channel
| - L-type Ca channel causes Ca influx inducing Ca release
67
Conduction speed
Purkinje fibers > atrial myocytes > ventricular myocytes > AV node
68
PR interval
less than 200 msec normally
69
QRS interval
less than 120 msec normally
70
J point
Junction b/t end of QRS and start of ST segment
71
U wave
Caused by hypokalemia or bradycardia
72
AV node delay
100 msec
73
Torsades de pointes causes
1) Drugs (ABCDE)
- AntiArrhythmics (class IA, III)
- AntiBiotics (eg. macrolides)
- Anti"C"ychotics (eg. haloperidol)
- AntiDepressants (eg. TCA)
- AntiEmetics (eg. ondansetron)
2) Hypokalemia
3) Hypomagnesia
4) Long QT syndrome
74
Torsades de pointes Rx
Magnesium sulfate
75
Romano-Ward syndrome
- Congenital long QT syndrome (AD)
| - NO deafness
76
Jervell and Lange-Nielsen syndrome
- Congenital long QT syndrome (AR)
| - sensorineural deafness
77
Brugada syndrome
- ECG pattern of pseudo-right bundle branch block and ST elevations in V1-V3
- AD more common in asian males
- Increased risk of ventricular tachyarrhythmias and SCD
Rx: Prevent SCD w/ implantable cardioverter-defib
78
Delta wave
Wolff-Parkinson-White syndrome
| - associated w/ widened QRS and shortened PR
79
Binge drinking "Holliday Heart"
A-fib
80
PR interval >200 msec
1st degree AV block
81
Wenckebach
Second degree heart block: Mobitz type 1
82
Lyme disease can cause...
complete (3rd degree) heart block
83
ANP
- acts via cGMP
- from atrial myocytes
- vasodilation and decreased Na reabsorption in CT
- Renal aff. dilation and eff. constriction (aldosterone escape)
84
BNP
- ventricular myocytes
- longer half-life than ANP
- GOOD negative predictive value for Dx HF
85
Nesiritide
Recombinant BNF for treating HF
86
Aortic arch and carotid sinus nerve relay
AA - vagus n --> solitary nucleus of medulla
| CS - glossopharyngeal n -->solitary nucleus of medulla
87
Cushing reaction
Triad of hypertension, bradycardia, respiratory depression
- Increased ICP constricts arterioles --> decrease pH --> sympathetic reflex --> HYPERTENSION --> baroreflex causes BRADYCARDIA. Pressure on brainstem causes RESP. DEP.
88
Heart pressures
```
RA: less than 5
RV: 25/5
PA: 25/10
PCWP: less than 12
LA: less than 12
LV: 130/10
A: 130/90
```
89
Mitral stenosis PCWP
PCWP > LV
90
Hormone permissiveness
When one hormone allows another to exert its maximal effect (the aiding hormone has no intrinsic effect)
91
Exercise on TPR
DECREAED
92
Most deoxygenated blood in body
Cardiac venous blood
| myocardium has HIGH O2 extraction (60-75%
93
Ach, Bradykinin, shear stress -->
Argine + O2 -----eNOS----->NO + citrulline
94
Sudden deceleration ruptures the....
Aortic isthmus
