Cardiovascular Flashcards
(111 cards)
1
Q
MV auscultation
A
apex
2
Q
TV auscultation
A
left parasternal border
3
Q
TV auscultation
A
Left parasternal border
4
Q
AV auscultation
A
Right 2nd intercostal border
5
Q
PV auscultation
A
left 2nd intercostal border
6
Q
S1
A
closure of MV and TV valves
7
Q
S2
A
closure of AV and PV
8
Q
Inspiration
A
split in A2 and P2; due to increased blood in right side of heart
9
Q
S3
A
abnormal
due to blood entering volume overloaded ventricle in early diastole
10
Q
S4
A
abnormal
due to blood entering non-compliant ventricle with atrial contraction in late diastole
11
Q
Causes S4
A
Volume overloaded ventricle, hypertrophy
12
Q
Causes S3
A
Valve regurgitation; congestive heart failure
13
Q
Murmurs
A
stretching valve ring or damage to valve
14
Q
Inspiration
A
increases right-sided abnormal heart sounds and murmurs
15
Q
Expiration
A
increases left sided abnormal heart sounds and murmurs
16
Q
Stenosis murmurs
A
problem in opening valve
17
Q
Regurgitation murmus
A
problems in CLOSING valve
18
Q
Valves opening in systole
A
AV and PV
19
Q
Valves opening in diastole
A
MV and TV
20
Q
Valves closing in systole
A
MV and TV
21
Q
Valves closing in diastole
A
AV and PV
22
Q
LDL
A
primary vehicle for carrying cholesterol
23
Q
VLDL
A
primary vehicle for carrying liver-synthesized triglyceride
24
Q
Familial hypercholesterolemia (type II)
A
Autosomal dominant
deficiency of LDL receptors
- increased LDL
25
Type III hyperlipoproteinemia
```
defiency in apo E
increased remnants (chylomicrons, IDL)
```
26
Type IV hyperlipoproteinemia
increased VLDL
| seen in alcoholics
27
Apo B deficiency
deficiency
- apo B48 (chylomicrons)
- apo B100 (VLDL)
- decrease in cholesterol and triglycerides
28
Clinical findings in apo B deficiency
fat malabsorption
| hemolytic anemia
29
Atherosclerosis
reaction to injury of endothelial cells
30
Risk factors for atheroscleroris
- smoking
- increased LDL
- increased homocysteine
- Chlamydia pneumoniae infection
31
Cells involved in atherosclerosi
- Platelets
- Macrophages
- Smooth muscle cells
- T cells with cytokine release
32
Fibrous plaque
Pathgnomonic lesion of atherosclerosis
33
C-reactive protein
marker of inflammatory atheromatous plaque
34
Inflammatory atheromatous plaque
predisposes to platelet thrombosis
35
Increased plasma homocysteine
Increased vessel thrombosis
Folate (most common)
Vitamin B12 deficiency
36
Hyaline arteriosclerosis
small vessel disease of DM and hypertension
| Excess protein in vessel wall
37
Mechanisms of Hyaline arteriosclerosis in DM
Non-enzymatic glycosylation
38
Non-enzymatic glycosylation
Glucose attaches to amino acids in basement membrane
| - causes increased permability to protein --> diabetic nephropathy
39
Abdominal aortic aneurysm rupture
due to atherosclerosis
flank pain
hypotension
pulsatile mass
40
Syphillitc aneurysm
vasculitis of vasa vasorum of aortic arch
| aortic regurgitation
41
Aortic dissection
due to hypertension and collagen tissue disorders (e.g. Marfan)
42
Cystic medial degeneration
elastic tissue degeneration creates spaces filled with mucopolysaccharides
43
Intimal tear in aorta
due to wall stress from hypertension and structural weaknesses
44
Types of dissection
Proximal (most common)
| Distal or combination of both
45
Sx of proximal aortic dissection
Chest pain radiating to back
Lack of pulse
Cardiac tamponade (most common cause of death)
46
Marfan's Syndrome
Autosomal dominant
Fibrillin defect
- Associated with aortic regurgitation/ dissection
- Lens dislocation
- Mitral valve prolapse with sudden death
47
Most common cause of death: Ehlers Danlos and Marfan's
Aortic dissection
48
Phlebothrombosis
Stasis of blood flow
| Deep veins below knee (most common site)
49
Pulmonary thromboembolism
Emboli originate from femoral veins
50
Superficial migratory thrombophlebitis
Sign of carcinoma of head of pancreas
51
Thoracic outlet syndrome
Lymphedema hands/feet in newborn
- Preductal coarctation
- Bicuspid aortic valve
52
Thoracic outlet syndrome
Absent radial pulse with positional change
53
Spider telangiectasia
Arteriovenous fistula
| Due to hyperestrinism (cirrhosis, pregnancy)
54
Capillary hemangioma in newborn
Regress with age
| Do not surgically remove
55
Kaposi's sarcoma
HHV - 8
Vascular malignancy
most common cancer in HIV
56
Bacillary angiomatosis
Bartonella henselae
| vascular infection in AIDS
57
Small vessel vasculitis
Palpable purpura
| e.g. Henoch Schonlein purpura
58
Muscular artery vaculitis
Vessel thrombosis with infarction (e.g. classical polyarteritis nodosa)
59
Elastic artery vasculitis
Absent pulse
| - stroke
60
Takayasi's arteritis
Pulseless disease
| - young Asian woman
61
Giant cell arteritis
```
temporal artery granulomatous arteritis
ipsilateral blindness (ophthalmic artery)
```
62
Classical polyarteritis nodosa
Muscular artery vasculitis with vessel thrombosis infarction
63
Path findings of classical polyarteritis nodosa
Vessel inflammation at different stages
| Aneurysms from vessel weakness
64
Sx of polyarteritis nodosa
Infarctions in kisneys, skin, GI tract, heart
| HBsAg in 30%
65
Kawasaki's disease
coronary artery vasculitis/thrombosis/ aneurysms in children
66
Sx: Kawasaki's disease
```
Typically seen in young children
Chest pain
Desquamating rash
Swelling/hands feet
Cervical lymphadenopathy
```
67
Rx for Kawasaki's disease
IV Gamma-globulin
68
Buerger's disease (thromboangittis oblierans)
Smoker's digital vasculitis
| Digital infarction
69
Reynaud's syndrome
Digital vasculitis in systemic sclerosis and CREST syndrome
70
Sx of Reynaud's syndrome
Digital pain, white-blue-red color changes
71
Cryoglobulinemia
Protein gels in cold temperature;
| - asociated with Reynaud's syndrome; HCV association
72
Sx of cryoglobulinemia
Acral cyanosis relieved by coming indoors
73
Wegener's granulomatosis
Associated with c-ANCA
Sinusitis (nose)
Lung infarction (lung)
Crescentic GN (kidney)
74
Microscopic polyangiitis
Palpable purpura
Crescentic GN
association with p-ANCA
75
Henoch-Schonlein purpura
IgA-anti-IgA immune complexes
palpable purpura on buttocks/legs
arthritis
IgA glomerulonephritis
76
Serum sickness vasculitis
Horse antivenin in treatment of rattlenake venom
77
Rocky Mountain Spotted Fever
- tick borne Rickettsia infection
| - vasculitis causes petichiae on palms --> trunk
78
Meningiococcemia
sepsis causes petichia/ecchymoses; potential for Waterhouse Friderichesen syndrome
79
Essential hypertension
- associated w/ blacks
- defect in renal excretion of Na
- Increased plasma volume
- decreased plasma renin activity
80
Renovascular hypertension
atherosclerosis renal artery in men
| - fibromuscular hyperplasia renal artery in women
81
Sx of renovascular hypertension
Epigastric bruit
- Increased plasma renin activity (in affected kidney)
- Decreased plasma renin activity (in unaffected kidney)
82
Hypertension
- Left Ventricle Hypertrophy (most common complication)
| - acute myocardial infarction (most common cause of death) followed by stroke and renal failure
83
Endocrine hypertension
- primary hyperparathyroidism
- Graves/hypothyroidism
- Cyshings
- Primary hyperaldosteronism
- Pheochromocytoma
84
Afterload
- resistance ventricles contract against
85
Preload
volume ventricles must eject
86
Concentric LVH
increased afterload (e.g. essential hypertension, aortic stenosis)
87
LVH with dilation/ hypertrophy
increased preload (e.g. valve regurgitation; left to right shunts)
88
Left Heart Failure
Forward failure
Pulmonary edema
Pillow orthopnea
Paroxysmal nocturnal dyspnea
89
Systolic dysfunction
Left Heart Failure due to decreased ventricular contractility (ischemia)
90
Diastolic dysfunction
LHF due to decreased ventricular compliance (hypertrophy)
91
Right Heart Failure
```
Backward failure
Increased venous hydrostatic pressure
Neck vein distension
Hepatomegaly
Edema
```
92
ACE inhibitos
Decrease afterload and preload in heart failure
93
Diuretics in CHF
Reduce preload
94
Non-pharm Rx to CHF
Restrict salt and water
95
Acute Myocardial infarction
Most common cause of death in US
Left anterior descending coronary artery thrombosis (most common cause)
- rupture of inflammatory plaque produces platelet thrombus
96
Exertional angina
Coronary artery atherosclerosis
Subendocardial ischemia
ST elevation
97
Sudden cardiac death
Death within 1 hour of symptoms
98
Pathological findings of sudden cardiac death
Severe coronary atherosclerosis
| Absence of occlusive thrombosis
99
LAD coronary artery
- supplies anterior 2/3 of interventricular septum
| - supplies anterior portion of left ventricle
100
RCA
- supplies posterior portion of left ventricle and papullary muscle
- supplies inferor 1/3 of interventricular septum
- supplies right ventricle
101
Ventricular fibrillation
most common cause of death in AMI
102
Path findings 24 hours after acute MI
No gross changes
103
Sx of acute myocardial infarction
retrosternal pain radiating down arms
| diaphoresis
104
Risk of acute myocardial infarction ruptures occur when?
On the 3rd to 7th day of AMI
105
Most common type of Acute MI rupture
Anterior wall rupture
- due to LAD thrombosis
- cardiac tamponade
106
Cause of posteromedial papillary rupture
RCA thrombosis
| Mitral regurgitation with LHF
107
Interventricular rupture
- cause of LAD thrombosis
- left to right shunt
- RHF
108
Mural thrombus
- caused by anterior AMI
| - Danger embolization
109
Pericarditis
- can occur within 1st week of transmural AMI
| - 6 weeks later ( it has an autoimmune cause)
110
Speed of conduction
Pukinje > Atria > Ventricles > AV node
111
Pacemaker speed
SA > AV > bundle of His/Purkinjeventricles
