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127 Cards in this Set
- Front
- Back
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What is contained in the Carotid Sheath and what is the orientation of the stuff?
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1. Internal Jugular Vein (lateral)
2. Common Carotid Artery (medial) 3. Vagus Nerve (posterior) vein artery nerve (VAN) |
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Most of the time, what are the brances of the Right Coronary Artery? what do they supply?
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Acute Marginal Artery: RV
PDA: posterior IV septum |
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What's the kicker with the PDA?
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It can be a branch of the RCA or LCA, Depending on which CA it comes off determines if the heart is a "right" or "left" dominant heart.
80% are right dominant 20% are left dominant |
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What are the normal branches off the LCA? supply?
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LAD: apex and ant. IV septum
Circumflex Artery: post. LV |
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Most common artery occluding in coronary artery disease?
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LAD
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When do coronary arteries fill?
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Diastole
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What is the most posterior part of the heart? clinical significance?
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Left Atrium
If it gets enlarged it can compress the esophagus--->dysphagia or compress the recurrent laryngeal leading to hoarsness |
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What can you auscultate at the upper right sternal border? what abnormalities can be detected here?
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Aortic Valve
Systolic Murmur: aortic stenosis flow murmur aortic valve sclerosis |
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What can you auscultate at the upper left sternal border? what abnormalities can be detected here?
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Pulmonary Valve
Systolic Ejection Murmur pulmonic stenosis flow murmur from ASD |
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What can you auscultate at the lower left sternal border? what abnormalities can be detected here?
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Tricuspid Area
Pansystolic Murmur tricuspid regurge VSD Diastolic Murmur tricuspid stenosis ASD |
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What can you auscultate at the Apex? what abnormalities can be detected here?
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Mitral Valve
Systolic Murmur mitral regurge Diastolic Murmur mitral stenosis |
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Cardiac Output = ??
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Stroke Volume * Heart Rate
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What is the Fick Principle?
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CO = rate of O2 consumption / (arterial O2 - venous O2)
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in terms of not other blood pressures, what does Mean Arterial Pressure = ?
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CO * TPR
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In terms of other BP's what does MAP = ?
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MAP = 2/3Diastolic + 1/3Systolic
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What does Pulse Pressure equal?
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systolic - diastolic
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What does Stroke Volume = ?
2 equations |
SV=CO/HR
SV=EDV-ESV |
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Three things that affect Stroke Volume?
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Contractility
Afterload Preload |
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How can those three things Inc SV?
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Inc Contractility
Inc Preload Dec Afterload |
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What are 4 ways to increase Contractility (and thus SV)?
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1. Catecholamines (stimulate Ca pump in SR)
2. Inc Intracellular Ca 3. Dec extracellular Na 4. Digitalis (inc intracellular Na, resulting in inc Ca) |
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What are 5 ways to decrease contractility (and thus SV)?
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1. Beta1 blockade
2. Heart Failure 3. Acidosis 4. Hypoxia/hypercapnea 5. Non-dihydropyridine CCB's |
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4 ways to increase Myocardial O2 demand?
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Inc Afterload
Inc Contractility Inc HR Inc Heart Size (inc wall tension) |
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what is preload?
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VENTRICULAR EDV
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what is afterload = ?
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MAP
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How do venodilators and vasodilators affect preload and afterload?
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Venodilators (e.g. NO) dec preload
Vasodilators (e.g. hydralazine) dec afterload |
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What does Ejection Fraction = ?
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SV/EDV = (EDV-ESV)/EDV
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What is Ejection Fraction normal at?
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> or = 55%
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In terms of viscosity and radius, what is Resistance = ?
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[8(viscosity) * length]/pie*radius^4)
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How do you calculate resistance in series vs parallel?
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Total resistance in series = R1 + R2 + R3...
In Parallel = 1/R1 + 1/R2 + 1/R3... |
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In us, what does viscosity mostly depend on?
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Hematocrit
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Three "states" we can be in that will increase our viscosity?
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1. Polycythemia
2. Hyperproteinemic states (e.g. multiple myeloma) 3. Hereditary Spherocytosis |
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What causes the S1 sound? where's it loudest?
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Mitral and Tricuspid closure
loudest at mitral area |
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What causes S2? where's it loudest
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aortic and pulmonary valve closure
loudest at LSB |
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What causes S3 and when do you hear it?
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Heard early in diastole during rapid ventricular filling
associated w/ inc filling pressure more common in dilated ventricles normal in kids |
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When do you hear an S4 and what causes it?
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late diastole
High Atrial Pressue Associated w/ Ventricular Hypertrophy; LA must push against stiff LV wall |
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What are the waves of a Jugular Venous Pulse? what do they represent?
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"a" wave = atrial contraction
"c" wave = RV contraction (causes tricuspid to bulge into RA) "v" wave = inc atrial pressure due to filling against closed tricuspid valve |
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What is S2 splitting and what increases it?
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When the aortic valve closes before the pulmonic
Inspiration increases this difference |
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What is Wide Splitting? when does it occur?
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Wide: means aortic and pulmonic valve closure is wider than normal and inspiration just makes it worse
happens w/ pulmonic stenosis |
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What is Fixed Splitting? when does it occur?
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When aortic and pulmonic closure are wider than normal and inspiration has no effect on them.
associated w/ ASD's |
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What is Paradoxical Splitting? when does it occur?
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When inspiration actually lessens the splitting between aortic and pulmonic closures
associated w/ aortic stenosis |
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Why does Inspiration cause splitting?
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Inspiration---> drop in intrathoracic pressure---> inc capacity of pulm. circulation--->pulmonic valve closes later to accomodate more blood entering lungs
AND aortic valve closes earlier b/c of decreased return to left heart |
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Why does Pulomonic Stenosis create wide splitting?
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RV emptying is delayed---> delayed pulomonic sound
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Why do ASD's lead to Fixed Splitting?
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ASD's cause a Left to Right shunt---> inc flow through the pulmonic valve--->delayed closure
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What does Aortic Stenosis cause paradoxical splitting?
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It delays LV emptying.
Normal order of valve closure is reversed, so P2 occurs before a delayed A2 With inspiration, the later P2 and earlier A2 move closer together |
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What does a Holocystolic, High Pitched "Blowing" Murmur indicate?
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Mitral or Tricuspid Regurgitation
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Where should you auscultate for Mitral Regurgitation?
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Loudest at Apex and radiates towards axilla
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Where should you auscultate for Tricuspid Regurgitation?
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Loudest at tricuspid area (lower LSB)
Radiates towards right sternal border |
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What can cause Mitral Regurgitation?
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Ischemic Heart disease
Mitral Valve Prolapse LV Dilation |
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What can cause Tricuspid Regurgitation?
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RV Dilation
Endocardititis |
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What can cause Mitral/Tricuspid Regurgitation?
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Rheumatic Fever
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What does Aortic Stenosis sound like?
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Crescendo-Decrescendo Systolic Ejection Murmur following an Ejection Click
Radiates to carotids/apex |
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what is aortic stenosis most commonly due to?
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age-related calcific stenosis
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What does a VSD sound like? where best to hear it?
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Holosystolic, Harsh Sounding Murmur
Loudest at Tricuspid area |
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What does a Mitral Valve Prolapse sound like?
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Late Systolic murmur w/ midsystolic click
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What can Mitral Prolapse predispose you to?
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Infective Endocarditis
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What does Aortic Regurgitation sound like?
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Immediate High Pitched "blowing" diastolic murmur
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Typical causes of Aortic Regurgitation?
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Aortic Root Dilation
Bicuspid Aortic Valve Rheumatic Fever |
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What does Mitral Stenosis sound like?
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Opening Snap
then Delayed rumbling late diastolic murmur |
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Common cause of Mitral Stenosis?
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Rheumatic Fever
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What does a PDA sound like?
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Continuous machine-like murmur
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Where is it best to hear a PDA?
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at time of S2
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How can inspiration and expiration affect valvular defects?
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Inspiration increases the intensity if the defect is on the right side of the heart (more blood into RA)
Expiration increases the intensity of defects on the left side of the heart because more blood flows into LA |
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What are 3 physiological differences between Cardiac Myocytes and skeletal muscle?
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1 Cardiac action potentials have a plateau, due to Ca influx
2. Cardiac nodal cells spontaneously depolarize (due to If channels?) 3. Cardiac myocytes are electrically coupled to each other via gap junctions |
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What is cardiac muscle contraction dependent on?
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Extracellular Ca
it enters during the plateau--->release of other Ca from SR |
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How many phases are there to Ventricular Action Potential?
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5
0-4 |
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What does Phase 0 represent?
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Rapid upstroke
voltage gated Na channels open |
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What does Phase 1 represent?
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initial repolarization
inactivation of voltage-gated Na channels Voltage-gated K channels begin to open |
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What does Phase 2 represent?
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Plateau
Ca influx through voltage-gated Ca channels balances K efflux. Ca influx triggers Ca release from SR and myocyte contraction |
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What does Phase 3 represent?
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Rapid Repolization
massive K efflux due to voltage-gated slow K channels and closure of voltage gated Ca channels |
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What does Phase 4 represent?
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Resting Potential
high K permeability through K channels |
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How is Phase 0 of Pacemaker Action Potentials different from Ventricular AP's?
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Phase 0
Lacks voltage-gated Na channels Uses voltage-gated Ca channels this is slower, so there is a slow conduction velocity |
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How is Phase 1 of Pacemaker Action Potentials different from Ventricular AP's?
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There is no Phase 1 for pacemakers
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How is Phase 2 of Pacemaker Action Potentials different from Ventricular AP's?
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There is no Plateau
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How is Phase 3 of Pacemaker Action Potentials different from Ventricular AP's?
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There is an inactivation of the Ca channels and increased activation of K channels--->increased K efflux
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How is Phase 4 of Pacemaker Action Potentials different from Ventricular AP's?
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Slow Diastolic Depolarization
membrane potential spontaneously depolarizes as Na conductance increases. This accounts for automaticity of the SA and AV nodes The slope of Phase 4 = HR |
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Effects of ACh and Catecholamines on Pacemaker Action Potentials?
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ACh decreased rate of depolarization and thus dec HR
Catecholamines inc depolarization and thus inc HR |
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ELECTROCARDIOGRAM
what does the P wave represent? |
Atrial Depolarization
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ELECTROCARDIOGRAM
what does the PR interval represent? |
conduction delay through AV node
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ELECTROCARDIOGRAM
what does the QRS complex represent? |
Ventricular Depolarization
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ELECTROCARDIOGRAM
what does the QT interval represent? |
mechanical contraction of ventricles
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ELECTROCARDIOGRAM
what does the T wave represent? |
ventricular repolarization
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ELECTROCARDIOGRAM
what does the ST segment represent? |
Isoelectric
Ventricles depolarized |
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ELECTROCARDIOGRAM
what does the U wave represent? |
caused by Hypokalemia or Bradycardia
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ELECTROCARDIOGRAM
what wave or segment illustrates Atrial Repolarization? |
Nothing
It's masked by the QRS complex |
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What is Torsades de Pointes?
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Ventricular Tachycardia characterized by shifting sinusoidal waveforms on ECG
Can progress to V-fib |
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What can cause Torsades de Pointes?
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Anything that prolongs QT interval
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What is Wolff-Parkinson-White Syndrome? sign of it?
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Accessory conduction pathway from atria-->ventricle bypassing AV node.
Ventricles begin to depolarize early--->delta wave on ECG Can lead to a reentry current--->supraventricular tachycardia |
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Characteristic ECG findings w/ Atrial Fibrillation?
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Irregularly Irregular baseline
No discrete P waves Irregularly spaced QRS complexes |
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Complications seen w/ A-fib? rx?
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atrial stasis--->stroke
Rx w/ warfarin |
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Characteristic findings w/ Atrial Flutter?
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Rapid succession of Identical, back-to-back atrial depolarization waves
Sawtooth appearance |
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Rx for Atrial Flutter?
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Convert to Sinus Rhythm
Use Class IA, IC, or III Antiarrhythmics |
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ECG for 1st degree AV Block?
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PR interval is prolonged (> 200msec)
Asymptomatic |
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Types of 2nd Degree AV Block?
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Mobitz Type 1 (wenckebach)
Mobitz Type 2 |
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Characteristics of Mobitz Type I, 2nd Degree AV Block?
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Progressive lengthening of PR interval till a beat is dropped (P wave with no QRS following it)
usually asymptomatic |
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What is Mobitz Type 2 like?
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Dropped beats NOT preceeded by lengthening PR intervals
This results is pathologic. Often a 2:1 block w/ 2 P's for every 1 QRS May progress to 3rd degree |
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What is up with 3rd Degree AV block?
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Atria and Ventricles beat independently from each other.
P's and QRS's are present, but NOT RELATED Atrial rate is faster than Ventricular Rate |
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Possible cause of 3rd Degree AV Block?
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Lyme Disease
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Rx for 3rd degree AV Block?
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Pacemaker
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ECG for V-fib? Px? Rx?
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Completely erratic rhythm--->death unless Rx'd w/ CPR and defib
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2 pathways that react to a decrease in MAP?
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1. Baroreceptor
2. Juxtaglomerular Apparatus |
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What happens with the JGA when MAP decreases?
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Triggers Renin-Angiotensin Systemt
Ang II ---> vasocontriction--->Inc TPR Aldosterone-->inc blood volume--->inc CO all ---> Inc MAP |
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What happens with the baroreceptors when MAP decreases?
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Baroreceptors decrease firing
Triggers Medullary Vasomotor center---> Inc Sympathetic Activity---> Beta 1's--->inc HR, inc contractility--->inc CO Alpha1's ---> venoconstriction--->inc CO Alpha1's ---> art. vasoconstriction---> inc TPR all---> MAP |
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When does ANP get released? actions?
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Atrial Natriuretic Peptide
Relased from atria in respone to inc blood volume and atrial pressure Causes generalized vascular relaxation Constricts efferent renal arterioles Dilates Afferent renal arterioles |
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Where are baro and chemo-receptors located?
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Baroreceptors = Aortic baroreceptors in aortic arch and Carotid baro's in Carotid Sinus
Chemoreceptors: In aortic arch The carotid body |
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How do the baroreceptors in the Aortic Arch relay info? in response to?
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Via the Vagus Nerve to the Medulla
Only respond to INC BP |
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How do the receptors in the Carotid Sinus relay info? in response to?
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Via Glossopharyngeal nerve (IX) to the Medulla
in response to inc or dec in BP |
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What is the cascade of events when the Baroreceptors sense Hypotension?
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1. Dec Arterial pressure
2. Dec stretch 3. Dec Afferent Bara firing 4. Inc Efferent Sympathetic firing and Dec efferent parasympathetic firing 5. Vasoconstriction, Inc HR, Inc Contractility INC BLOOD PRESSURE!!! |
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What is up with Carotid Massage?
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Inc Pressure on Carotid
Inc Stretch inc Afferent Baro Firing Dec HR |
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So who are the Peripheral Chemoreceptors vs Central?
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Peripheral = carotid and aortic bodies
Central = in the brain |
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What do peripheral chemoreceptors respond to?
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Dec PO2, Inc Pco2, Dec pH of blood
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What do Central Chemoreceptors respond to?
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Changes in pH brain interstitial fluid (which are influence by arterial CO2, not arterial pH cause H+ can cross the BBB but CO2 can)
Doesn't directly respond to PO2 |
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What Reaction are Central Chemoreceptors responsible for? mechanism?
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CUSHING REACTION
Inc ICP constricts arterioles--->cerebral ischemia (inc Pco2)--->HTN--->reflex bradycardia |
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So what does Cushing's Triad = ?
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HTN
Bradycardia Respiratory Depression |
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Who gets the largest share of systemic CO?
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Liver
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Who gets the highest blood flow per gram of tissue?
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Kidney
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How does the Heart meet an increased O2 demand?
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Inc coronary blood flow
NOT by inc extraction of O2 |
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What is the pressure in the:
SVC/IVC? RV? Pulmonary Trunk LA? LV? Aorta? |
SVC/IVC < 5
RV <25/<5 Pulm Trunk: <25/10 LA: (via Swan-ganz reading of PCWP) < 12 LV: < 130/10 Aorta: < 130/90 |
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What are the factors determining autoregulation of blood flow to the HEART?
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Local metabolites =
O2 adenosine NO |
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What are the factors determining autoregulation of blood flow to the BRAIN?
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Local metabolites =
CO2 (pH) |
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What are the factors determining autoregulation of blood flow to the KIDNEYS?
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Myogenic and Tubuloglomerular Feedback
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What are the factors determining autoregulation of blood flow to the LUNGS
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Hypoxia causes vasoconstriction
this happens so only well-ventilated areas are perfused in other organs, hypoxia--->vasodilation |
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What are the factors determining autoregulation of blood flow to the SKELETAL MUSCLE?
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Local Metabolites:
lactate adenosine K+ |
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What are the factors determining autoregulation of blood flow to the SKIN?
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Sympathetic Stimulation---> temperature control
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4 forces responsible for determining fluid movement into and out of capillaries?
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1. Pc = capillary hydrostatic pressure (pushes stuff out)
2. Pi = interstitial fluid hydrostatic pressure (pushes stuff into caps) 3. Plasma colloid osmotic pressure (pulls fluid into cap) 4. Interstitial osmotic pressure (pulls fluid out) |
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So net filtration pressure = ?
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(Cap hydrostatic - interstitial hydrostatic) - (plasma osmotic - interstitial osmotic) = Net filtration Pressure (Pnet)
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What is the Net Fluid Flow = ?
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Net Filtration Pressure (Pnet) * Kf
Kf = filtration constant (capillary permeability) |
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So what causes Edema? examples?
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Inc Capillary hydrostatic pressure (heart failure)
Dec Plasma Proteins (dec plasma osmotic pressure; e.g. nephrotic syndrome, liver failur) Inc capillary permeability (inc Kf; toxins, infections, burns) Inc interstitial fluid colloid osmotic pressure (lymphatic blockage) |
