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Flashcards in CV Deck (88):
1

ascending aorta arises from?

truncus arteriosus

2

pulmonary trunk arises from?

truncus arteriosus

3

smooth mm/outflow of left and right ventricles arises from?

bulbus cordis

4

trabeculated part of left and right atria arises from?

primitive atrium

5

trabeulated part of left and right ventricles arises from?

primitive ventricle

6

smooth part of left atrium arises from?

primitive pulmonary v

7

coronary sinus arises from?

left horn of sinus venosus

8

smooth part of right atrium arises from?

right horn of sinus venosus

9

SVC arises from?

right common cardinal v and right ant cardinal v

10

when does heart start to beat?

we 4

11

patent foramen ovale

d/t failure of septum primum and septum secundum to fuse after birth

12

VSD

most commonly occurs in membraneous septum

13

conotruncal abnormalities

transposition of great vessels
tetralogy of fallot
persisten truncus arteriosus

14

aortic and pulmonary valves arises from?

endocardial cushions of outflow tract

15

mitral and tricuspid valves arise from?

fused endocardial cushions of AV canal

16

fetal erythropiesis

young liver synthesizes blood
yolk sac 3-8wks
liver 6wk-birth
spleen 10-28wk
bone barrow 18wk+

17

hemoglobin

alpha always
gamma goes
becomes beta

18

fetal hemoglobin

alpha2 gamma2
higher affinity for O2 d/t lower affinity for 2,3 BPG

19

what do you give to close PDA

indomethacin

20

what do you give to keep PDA open?

PGs E1 and E2

21

median umbilical ligament arises from?

allantois -> urachus

22

ligamentum arteriosum arises from?

ductus arteriosus

23

ligamentum venosum arises from?

ductus venosus

24

foramen ovale arises from?

fossa ovalis

25

nucleus pulposus arises from?

notochord

26

medial umbilical ligament arises from?

umbilical aa

27

ligamentum teres hepatis arises from?

ligamentum hepatis in falciform ligament

28

SA and AV nodes get blood from?

RCA

29

right dominant circulation

PDA from RCA
85%

30

most posterior part of heart?

left atrium -> enlargement = dysphagia or horseness

31

CO

SVxHR
or
rate of O2 consumption/ (aaO2-vvO2)

32

MAP

COxTPR
or
2/3DP + 1/3SP

33

early exercise

CO maintained by increased HR and SV

34

late exercise

CO maintained by increased HR only

35

what does increased HR d/t diastole?

shortens it d/t increased filling time -> decreased CO

36

increased pulse pressure

hyperthyroidism
aortic regurg
aortic stiffening (isolated systolic HTN of elderly)
obstructive sleep apnea (increased sympathetics)
exercise (transient)

37

decreased pulse pressure

aortic stenosis
cardiogenic shock
cardiac tampenade
advanced heart failure

38

contractility increases d/t

catecholamines (increased Ca pump on SR)
increased intracellular Ca
decreased extracellular Na (decreased Na/Ca exchanger)
digitalis (blocks Na/K pump -> increased intracellular Na -> decreased Na/Ca exchange -> increased Ca

39

contractility decreased d/t

B1 blockade (decreased cAMP)
HF w/systolic dysfunction
acidosis
hypoxia/hypercapnia
non-dihyydropyridine Ca Ch blockers

40

Myocardial oxygen demand

increased myoCARDial O2 demand
increased Contractility
increased Afterload
increased heart Rate
increased Diameter of venticle (wall tension)

41

wall tension

(pressure x radius) / 2x wall thickness

42

preload

approximated by ventricular EDV
decreased by venodilators (nitroglycerin)

43

afterload

approximated by MAP
vasodilators (hydralazine) decrease afterload

44

what decreases both preload and afterload?

ACEI and ARBs

45

EJ

SV/EDV
(EDV-ESV)/EDV
normal 55%
decreased in systolic HF
normal in diastolic HF

46

increased afterload

increased aortic pressure
decreased SV
increased ESV
loop is tall and skinny

47

increased preload

increased SV
loop gets wider to the right

48

increased contractility

increased SV
increased EF
decreased ESV
loop gets wider to the left

49

S1

mitral and tricuspid valve closure
loudest at mitral

50

S2

aortic and pulmonary valve closure
loudest at left upper sternal border

51

S3

in early diastole during rapid ventricular filling phase
associated with increased filling pressures
mitral regurg
HF
more common in dilated ventricles
normal in prego and kids

52

S4

in late diastole, atrial kick
apex in LLD
high atrial pressure
ventricular hypertrophy

53

a wave

Atrial contraction
absent in a-fib

54

c wave

RV Contraction
d/t closed tricuspid valve bulging into atrium

55

x descent

atrial relaXation and downward displacement of closed tricuspid valve during ventricular contraction
absent in tricuspid regurg

56

v wave

increased right atrial pressure d/t villing against closed tricuspid

57

y descent

RA emptying into RV

58

normal splitting

inspiration -> decreased intrathoracic pressure -> increased venous return -> increased RV filling -> increased RV SV -> increased RV ejection time -> delayed closure of pulmonic valve

59

wide splitting

daled RV empyting
pulmonic stenosis
RBBB
present during exhalation but exaggerated in inspiration

60

fixed splitting

same in inhalation and exhalation
ASD -> L to R shunt - increased RA and RV volumes -> increased flow thru pulmonic

61

paradoxical splitting

conditions that delay aortic valve closure
aortic stenosis
LBBB
pulmonic closes before aortic

62

inspiration

increased intensity of R heart sounds

63

handgrip

increases afterload
increased MR, AR, VSD murmurs
decreased hypertrophic cardiomyopathy murmurs
MVP: later onset of click/murmur

64

valsalva phase II, standing up

decreased preload
decreased intensity of most murmurs
increased intensity of hypertrophic cardiomyopathy
MVP: earlier onset of click

65

rapid squatting

increased VR and increased preload
decreased intensity of hypertrophic cardiomyopathy
increased intensity of AS
MVP: later onset of click

66

AS

C/D systolic ejection murmur
LV>>aortic pressure
aortic listening post -> radiates to carotids
pulsus parcus et tardus (weak pulse w/delayed peak)
SAD- syncope, angina, dyspnea on exertion
age related calcification or bicuspid valve

67

MR/TR

holosystolic high-pitched blowing murmur
RF or infective endocarditis can cause either

68

MR

loudest at mitral post, radiates to axilla
ischemic heart disease (post-MI)
MVP
LV dilation

69

TR

tricuspid post radiates to R sternal border
RV dilation

70

MVP

mitral valve prolapse
late systolic crescendo murmur w/midsystolic click
most frequent w/valvular lesion
mitral post
loudest just before S2
benign, predispose to infective carditis
can be caused by myxomatous degeneration (CT disease), RF, chordae rupture

71

VSD

holosystolic
harsh
loudest at tricuspid

72

AR

high pitched blowing early diastolic decrescendo murmur
long diastolic murmur and signs of hyperdynamic pulse when serve and chronic
often d/t aortic root dilation, bicuspid aortic valve, endocarditis, RF
progresses to LHF

73

MS

follows opening snap
delayed rumbling late diastolic murmur
LA>>LV pressure during diastole
RF
can lead to LA dialation

74

PDA

continuous machine like murmur
loudest at S2
congenital rubellla or prematurity
best heard at left intraclavicular area

75

PR interval

76

QRS

77

speed of conduction

purkinje >atria > ventricles > AV node

78

pacemakers

SA >AV >bundle of His > purkinje/venticles

79

conduction pathway

SA -> atria -> AV -> common bundle -> bundle brr -> fasicles -> purkinje fibers -> ventricles

80

torsades de pointes

long QT predisposes:
drugs
decreased K and increased Mg
Tx with Magenesium sulfate

81

drug induced long QT

ABCDE
anti Arrhythmics (class IA, III)
aBx (macrolides)
anti Cychotics (haloperidol)
anti Depressants (TCAs)
anti Emetics (odansetron)

82

congenital long QT

usually d/t ion ch defects
increased risk of SCD
romano-ward syndrome
jervell and lange-nielsen syndrome

83

romano-ward syndrome

AD
long QT
pure cardiac phenotype

84

jervell and lange-nielsen syndrome

AR
long QT
sensoineural deafness

85

brugada syndrome

AD
asian males
pseudo RBBB and ST elevation in V1-3
increased risk of ventriculat tachy and SCD
prevent SCD w/implantable cardioverter-defibrillator

86

wolff-parkinson-white

MC type of ventricular pre-excitation syndrome
bundle of kent - abnormal fast accessory conduction pathway from atria -> ventricle
widened QRS
delta wave
can cause supraventricular tachy

87

atrial natriuretic peptide

atrial myocytes
acts via cGMP
vasodilation and decreased Na resorption in renal collecting tubules

88

brain natriuretic peptide

ventricular myocytes
via cGMP
longer half life the ANP
used to Dx HF (very good neg predictive value)