Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/127

Click to flip

127 Cards in this Set

  • Front
  • Back
What vessels determines the blood pressure and blood flow?

Size?
Arterioloar resistance arteries

Under 200 micrometers
Describe the sequence or atrial depolarization leading to ventricular activation & repolarization
SA Node -> AV Node -> Bundle of His -> Bundle branches -> Purkinje fibers
Five factors that regulate CV mechanics
1)prelaod
2)afterload
3)HR
4)contractility
5)lusitorpy (distensibility)
Preload is directly estimated by?

indirectly by? clinically by?
directly: EDV

indirectly: EDP

clinically:
1)Neck veins (jugular venous distenstion)
2)Hepatojugualr reflux
3)Pulmonary capillary wedge pressure (PCWP - mean fluid pressue of lungs as a representation of filling pressue of L Ventricle)
4)Ultrasound (ECHO)
Most common cause of CHF is _____ dysfunction, reflected by abnormally high _____ ?
Diastolic

Diastolic pressures
Afterload is determined by what 4 factors?
1)aortic valve
2)left ventricular outflow tract
3)blood mass & viscosity
4)preload
Thickening of the muscle below the aortic valve increasing afterload called?
Hypertrophic obstructive cardiomyopathy
Examples of events that can v lusitropy & contractility?
hyptertrophy, fibrosis, ischemia & distension
5 ways to ^ mycocardial O2 supply?
1)Heart rate
2)SV
3)O2 extraction
4)Redistribution of bloodflow
5)Anaerobic metabolism
Major mechanism by which most individuals ^ CO in response to ^ demand or exercise?

What is the max?

Controlled by?
^ Heart rate

200 minus age

Autonomic nervous system (withdrawal of PARASYM tone)
Stroke Volume ^ due to what 2 factors?
1)Skeletal muscle contracting,compressing veins in lower extremities
2)^ Sympathetic component of venous constriction
Which muscles can ^ O2 extraction? By how much?

Which muscles cannot ^ O2 extraction?
Skeletal Muscles; A-V O2 difference at rest = 20% (from 95% to 75%), exercise = 60% (95% to 35%)

Myocardial cells (95% to 20% O2 saturation...even at rest fully extracts O2 from available blood supply)
People with lesss than ___ O2 saturation at rest are in big trouble? Example?
50%

CHF - 40% Hb saturation at rest (normal is 75%)
Which cells can use anaerobic metabolism when needed? Which cant?
Skeletal muscles can use anaerobic metabolism

Anaerobic energy usage,
normal = 5% heart failure = 30%

Myocardial cells cant...
What nervous tone predomindates most of our conscious state
Parasympathetic
Most common arrhythmia?
Atrial fibrillation - loss of AV synchrony

incurable & irreversible :(
4 major determinants of myocardial O2 consumption
1)Myocardial mass
2)Wall stress
3)Inotropic state (contractility)
4)Heart rate
Coronary flow reserve can ^ resting flow rate by how much? Necessary b/c?

Low velocity flow during?
High velocity flow during?
4-5 times value at rest

myocardial cells cant ^ O2 extraction

Low v flow - systole
High v flow - diastole
Coronary blood flow is determined by?
pressure gradient difference between the aorta and the left ventricular pressure in DIASTOLE
Vasoconstriction in epicardial conduit vessels treated by?

resistance vessels treated by?
Nitroglycerin

agetns other than nitroglycerin
It is necessary to V the diameter of an epicardial coronary vessel by ____ to cause signficant decrease in resting coronary blood flow?
60-70% (2/3rds)
Coronary blood flow varies with ____ & ____ of the obstruction?
length & character
Tachycardia predisposes to mycardial ischemia b/c of what 2 reasons?

Major therapy?
1) ^ myocardial O2 consumption

2) V myocardial O2 supply (v duration of diasole)


Beta blockers
Narrowing of valves called?

Regurgitant valves called?
Stenosis

Insufficient/Incompetant
In systole hear murmur over A/V valves?

over M/T valves?
A/V stenosis

M/T regurge
In diastole hear murmur over A/V valves?

over M/T valves?
A/V regurge

M/T stenosis
Incompetent valve heart response?

Valve stenosis heart response?
Dilation (eccentric hypertrophy) - deal w/ ^ volumes

^ wall thickness, v chamber volume (concentric hypertrophy) --> can lead to eccentric hypertorphy

When eccentric hypertophy from Aortic stenosis (AS), usually irreversible
Aortic Stenosis (AS) more common in?....usually caused by?

Other causes of aortic stenosis (2)?
Males

Valve degeneration (bicuspid aortic valve, instead of normal tricuspid)...esp b/w ages of 15-65


Rheumatic AS - adhesion & fusion

Senile AS - calicification (most common valve lesion leading to valve replacement)
AS usually conpensated by?
concentric ventricular hypertrophy (eventually leading to eccentric VH)
With AS blood flow inadequate in what situation & where?

Hypertrophy also causes?
Especially during exercise (v flow to SUBENDOCARDIUM)

v coronary artery flow from hypertrophy
AS symptoms?
1)angina (w/out coronary artery dz!)

2) syncope

3) shortness of breath (dyspnea)
Physical Findings of AS (3)?
1) Pulsus parvus et tardus (delayed and smaller, relative to conduction of heart)

2) Ejection murmur after ejection click, peaking at mid-systole w/ "muscial quality" (can ofen be transferred to the carotid a)

3) can have S4 (b/c of LV hypertrophy)
Perferred technique of AS diagnosis?

Standard technique of AS diagnosis?
ECHO - noninvasive, measure difference b/w pressure in ventilce and aorta

Catheterization - invasive, used to assess he severity of AS
-Done ONLY if discrepancy b/w physical exam & ECHO
Coronary artery disease association w/ what % of AS?
50% of patients
AS symptom/severity correlation

Aortic valve area (AVA) severity scale?
Angina - 5 years
Syncope - 3 years
CHF - 2 years

Severe - AVA < 1cm2
Critical - AVA , 0.7cm2
3 major causes of Aortic Regurgiation (AR)
1) Marfans

2) HTN

3) endocarditis

-as the aortic root dialates, takes leaflets with it
AR pathophysiolgy?
volume overload -> eccentric hypertrophy

- ^ LV chamber volume, v LV wall thickness
Signs of AR (5)?
1) De Mussett's sign - bobbing of head in synch with HR (b/c have to have sys BP high, dias BP low - BOUNCING PULSES)

2) Traube's sign - "pistol shot"-like sound heard over femoral artery

3) Austin-flint murmur - "blowing," decrescendo murmur after A2

4) S1 may be soft b/c mitral valve actually closes due to the aortic regurgitation

5)Diastolic thrill (signifies severe AR)
Main predictor of development of symptoms for AR?
Systolic dysfunction (esp @ rest)
AR Treatment:

Nonsurgical txmt when? what?

Surgical txmt when? what?
Nonsurgical - asymprtomaic patient w/ moderate AR and NO LV dilation; use Na Nitroprusside

Surgical - 1)patient symptomatic OR 2)asymptomatic w/ LV systolic dysfunction (Rule of 55 - if EF <55% or LV end-systolic diameter > 55mm)
Mitral Stenosis (MS) due to?
Rheumatic fever (almost always)

3rd world/rural phenomenon - BOARD
Pathology/physiological signs of MS?
Fusion of commisure and contracure of leaflet

^ LA pressure, ^ pulmonary pressure
Natural History of MS?
"The 10 year dz"

Rheumatic fever -> 10 years later get MS -> 10yl mild to moderate -> 10yl moderate to severe
Symptoms of MS (4)?
1) Dysnea on exertion

2) Atrial fibrillation

3) Hemoptysis

4) Systemic emboli
Signs of MS (5)?
1) Accentuated S1

2) Opening snap (timing = MS severity)

3) Decresendo diastolic "rumble" murmur

4) LA dialation & dilation of R-sided chambers (rise in pulmonary pressure)

5) Atrial fibrillation (P mitrale - huge P waves - double-hump)
Severity of MS calculated by (2)? Correlates with?
1) Mitral valve x-sectional area (<1.0 cm2 = severe)

2) LA/LV pressure gradient

Timing between the S2 and Opening Snap
Tx pulmonary edema with?

" tachycardia with?

" atrial fibrillation with?

Surgery for MS patients?
pulmonary edema - diuretics

tachycardia - beta blocker

atrial fib - anticoagulants

No, Surgery very rare
Most common cause of Mitral Regurgitation (MR) is?

others?
Heart failure - 2ary MR b/c of dilated LV

primary MR from alteration of leaflets (rheumatic fever, endocarditis, etc)
Hallmark sign of MR is?
Holosystolic, blowing murmur heard @ APEX

also, S3 & Diastolic rumble from blood into LV still full
Signs of mitral valve prolapse?
Midsystolic clicks
Is surgery used for MR?
YES, especially when show symptoms of heart failure (SoB, paroxysmal noturnal dyspnea, pulmonary edema, etc)
Pulmonary Stenosis & Insufficiency mostly seen in?
Pediatric patients
Mechanical valves will last ____ but ____ ?
Lifetime; anticoagulation therapy (warfarin) is essential

Used in young patients
Bioprosthetic valves will last ____ but ____ ?
10-15 years; no need for anticoagulation therapy

Used in Elderly and women of child-bearing age
In Rheumatic fever (RF) caused by ____ with tissues by what mech?
Cross reation of antibodies

Molecular mimicry
Most common symptoms of RF (2)? Usually follows?
following Strep pharygitis

1) Arthritis

2) Pan-carditis (involves epi, myo, & endo cardium

also..Syndenham chorea, Erythema marginatum (rash) & subcutaneous nodules
Pathological sign of RF?
Aschoff body - area of fibrinoid necdrosis surrounded by mononuclear cells in the HEART
Most common involved valves with RF? Second?
Mitral valve

Aortic valve
Morphologic features of MS?
1)Thickening and calcifications of valve leaflets

2)Fusion of commissures

3) Thickening and shortening of chordeae tendinae
Response to MS in lungs?
Reactive pulmonary hypertension - protective to pulmonary capillaries but causes increased pressure/failure in R side of heart
Atrial response to MS?...consequence?

can lead to?
Expansion of LA, relives pressure on lung, but also stretches CONDUCTION FIBERS causing ATRIAL FIBRILLATION

A-fib can lead to thrombi and embolism leading to embolic STROKES
Anytime you have a valve abnormality you have an increased risk of ?
Endocarditis
Cardinal features (2) of MR?
1) fatigue

2) weakness

A-fib also a major problem
Mitral Vavlve Prolapse also called?

Causes?

Presents?

More common in men or women
Myxomatouse mitral valve, Barlow's syndrome

MR

Usually asymprtomatic but sometimes atypical chest pain or MIDSYSTOLIC CLICK!

More common in women, but men more commonly have problems with it
Acute AR causes?

Chronic AR causes?
surgical emergency b/c of backpressure into lungs

Expanded ventricular volume (after initial hypertrophy)
Hallmark of Chronic AR
v diastolic LV pressure but ^ systolic...therefore ^^ PULSE PRESSURE
What kind of endocarditis can affect normal valves?

What kind of endocarditis can affect abnormal valves only?
Acute infective endocarditis - affect NORMAL valves only w/ hightly virulent orgnisms (ie Staph aureus)

Subacute infective endocarditis (ie viridans strept)
What is the mortality rate for Acute infective endocarditis?
100%!
Left-sided embolism end up?

Right-sided embolism end up?
Brain, spleen, and kidney

Lung IV drug use!! (BOARD)
Complications of endocarditis (5)?
1) Valve damage (cordae rupture)

2) Myocardial abscess (ring abscess)

3) Suppurative pericarditis

4) Embolism in coronary artery and other organs

5) Chronic - immune complex problems - glomerulonephritis, arthritis, vasculitis
Small, sterile fibrin deposition along the line of valve closure caused by?
Marantic (nonbacterial-bacterial) endocarditis
Small, sterile fibrin deposition along both sides of the valves?
Libman-Sacks endocarditis

occurs with LUPUS
Tricuspid regurgition deadly?

Usually caused by?
No, almost always functional

Carcinoid syndrome
Congenital pulmonary stenosis primarily affects?

Usually caused by?
Kids (Pediatric problem)

Carcinoid syndrome
Most common cardiac defect is?

Usually found where?
VSD

membranous septum
What structure lies on the intraventricular sulcus?
LAD artery
Pulmonary arteris are ___ and to the ___ of the aorta
Anterior and to the left

(cross right arm in front of left)
What vessel carries oxygen from the placenta?

Shunted in the liver by?

Shunted in the heart intracardiacly by? extracardiacly by?
Umbilical vein

Ductus venosus

Foravmen ovale

Ductus arteriosus
Shunting of blood through the foramen ovele allows for?
left side of heart and the aorta to grow
T/F there is no blood in lungs of a fetus
F, there is about 15%...not enough for L heart/aorta growth, but just enough to DEVELOP PULMONARY CIRCUIT
Three elements needed for making the heart, functions?
1) CARDIOGENIC MESENCHYME - strictly for heart, makes MYOCARDIUM & ENDOCARDIUM

2) PROEPICARDIAL ORGAN - multivesicular outcropping of mesothelial tissue near the liver, makes EPICARDIUM (makes coroary arterial supply)

3)NEURAL CREST CELLS - Aortic Arch and R/L ventricular outflow tracts; also makes all cranial/facial structures
Example of disorder of Neural crest cells (NC cells) causes?
DiGeorge syndrom - cardiac abnomalities

NC cells do not stay as epithelial cells but become actual mesenchyme
Circulation developes when?
4th Week of development
Heart develops in?
Pericardial sac
Ventricular mass will become?

Bulbus cordis will become?
L Ventricle

R Ventricle
If R Ventricle does not rotate all the way around to get even development of both chambers then you end up with?
Double inlet left ventricle
Endocardial cushions made of 2 masses of mesenchyme that fuse in the middle forming what?

Failure to do this causes?

Most common defect of what syndrome?
Mesenchymal bar

Atrio-venricular canal defect (common ventricle and big common atria)

Down's syndrome
Initially heart tube folds to the left and heart tube rotates to the right called?
Dextrocardia - SINUS INVERTUS

Levocardia is normal
Sinus Invertus seen in what condition?
Kartagener's syndrome - AD hereditary disorder
1)Sinus invertus
2)Bronchiectasis
3)Sinusitis

-problem with dynein arm of cilia?
What cells are involved in the formation of outflow tracts?
Neural crest cells
atrial appendage bigger on R or L
Right! (BROAD atrial appendage)

...b/c it receives blood from the placenta, IVC, SVC & coronary sinus while the L atrial appendage (NARROW connection) only has to get blood from LA to LV
What separates the inflow and outflow valve in the RV?
Conus
Distinguishing morphology of RV (2)?
1) Thick trabeculae

2) Separation of inflow and outflow (by CONUS)
Distinguishing morphology of LV (2)?
1) Trabulae are thin

2) Mitral and aortic valve touch each other in the FIBROUS CONTINUITY

(NOT THE THICKNESS OF VENTRICLES!)
Most VSD found at?
Membranous septum

-touches aortic valve, tricuspid valve & interatrial septum

-any VSD will allow either the mitral and tricuspid valves or the tricuspid and aortic valves to touch
Features of the Tetralogy of Fallot
1) Pulmonary stenosis

2) R Ventricular hypertrophy

3) Overriding Aorta

4) VSD


"PROVe you have Tetrology of Fallot!"
Lungs are an outcropping of the ?
Esophagus
How many openings are incorporated into the superior posterior LA?
4 openings
If ou don't have enough blood flow to make the vessels of the brachiocephalic vein meet in the middle than you have ?

Significance?
Persistent Left Superior Vena CAVA (PLSVC), which connects to the cornary sinus

99% of time PLSVC is an indication of other heart defects
Describe paradoxic emboli in adults...caused by?
Embolis from lefs that end up in head, spleen, kidney etc (instead of lungs)

Fossa ovalis (secundum type) defet
Muscular septum is formed by?
The carving of the verntricular chamber by APOPTOSIS (it does not "grow" from bottom)
T/F Membranous septum is formed b/f the AV valve leaflets attach
True!
Most common heart defect in Trisomy 21 (Down's)?
Atrioventricular septal defect
T/F Kids die of their congenital heart disease?
F, they die form the sequelae of the diseases (ie hypertension in lung/brain, etc)
Papent Ductus Arteriosus (DA)is an embryonic remnant of the ?

DA closed by?

DA kept patent by? why use?
LEFT SIXTH Aortic Arch

Indomethacin

Prostaglandins (ie PGE), used for patients with v coronary perfusion (hypoplastic LV, small aorta) or Transposition of Great Vessels
LA pressure should not exceed ___ at the end of diastole

if higher, then ithe pressure causes ?
10 - 12 mmHg at end of diastole

20-30 mmHg causes Shortness of Breath (SoB)
Systole ends at about the end of the what part of EKG?
T wave
S1
mitral valve closing
S2
aortic & pulmonic valves closing

A2 normally preceeds P2
P2 further delayed (gains separation from A2) during
inspiration
Wide splitting - hear lengthened A2 & P2 separation during expiration, but still not as much as inspiration)
1) R BBB

2) pulmonic stenosis
Fixed splitting - A2 & P2 same separation during BOTH expiration and inspiration)
1) A/S defect
Paradoxical splitting - A2 & P2 separation during expiration ONLY
1) L BBB

2) Advanced aortic stenosis
Rumbling murmur achieved during mid-systole

Also hear?
Aortic stenosis

Ejection click prior to murmur
Holosytstolic (same throughout) murmur
Mitral regurgitation

...or sometimes tricuspic regurge or V/S defect
Late systolic murmur w/ mid-systolic click
Mitral valve prolapse bitches!
Delayed (mid) diastolic murmur?

Also hear?
Mitral stenosis

Opening snap
Early decrescendo diastolic murmur?
Aortic regurgitation
S4

sign of?
Atrial contration ("kick")

Noncompliant Ventricle (ie vertricular hypertrophy)

Almost always with Systemic hyptertension

occurs immediately before S1
S3
High pressure in LV during diastole (giving extra sound)

associated with HEART FAILURE (CHF)

Harder to pick up than S4
First beat of Carotid coincides with?
S1
Electrical axis usually between?
-30 and +90 degrees (aVL & aVF)
prolonged PR interval (over 200 milliseconds (5 blocks))
1st degree AV block
T wave is bifid (P wave hidden inside T wave)
2nd degree AV block

-some P waves produce a QRS, some P waves dont
P waves all over that dont proceed to QRS
3rd degree AV block
wide QRS (over 80 milliseconds (2 blocks))
Bundle Branch Block (BBB)

LBBB if lack of Q in Lead 1, aVL, V5 or V6 & T wave is almost in QRS

RBBB if positive R' in V1 and V2
1st sign after acute MI on EKG
elevated ST segment