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154 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What supplies the apex and anterior interventricular septum?
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Left anterior descending artery
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comes off the anterior side of the circumflex artery
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What supplies the posterior left ventricle?
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Circumflex artery
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What supplies the right ventricle?
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Acute marginal artery
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anterior branch coming off the RCA
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What supplies the posterior septum/inferior left ventricle?
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Posterior descending artery
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Comes off the RCA posteriorly (80% of the time)
20% of the time (left dominant heart) the PD comes off the circumflex |
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What supplies the SA and AV nodes?
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RCA
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Where is the most common coronary artery occlusion and what does it supply?
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LAD - the anterior interventricular septum
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Which chamber is the most posteriorly oriented?
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Left atrium
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enlargement of this chamber can cause dysphagia and hoarseness
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How do you calculate stroke volume?
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SV = CO/HR = EDV - ESV
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What is preload and what increases/decreases it?
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Preload = ventricular EDV
inc. with exercise, fluid overload, sympathetics dec. with venodilation (e.g. nitroglycerin) |
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What is afterload and what increases/decreases it?
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Afterload = mean arterial pressure.
Inc. by increasing the PVR Dec. with vasodilators (e.g. hydralazine) |
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What does digitalis do to the CHF starling curve?
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shifts it left and up
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How do you calculate ejection fraction?
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(EDV-ESV)/EDV
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Where is S1 loudest?
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mitral area
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What is S1?
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mitral and tricuspid valve closure
begin systole |
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What is S2?
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aortic and pulmonary valve closure
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Where is S2 the loudest?
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left sternal border
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What is S3?
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sound in early diastole during the rapid filling phase - so much blood is hitting the empty ventricle that it makes a noise
indicated inc. filling pressure and/or dilated ventricles |
normal in children and pregnancy
"I-da-ho" |
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What is S4?
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an "atrial kick" heard in late diastole (just before S1). the sound of left atria trying to push the last bit out against a stiff ventricle.
associated with ventricular hypertrophy |
always pathologic
"A-la-ska" |
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What is the a wave?
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inc. JVP from atrial contraction
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What is the c wave?
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inc. JVP from triscupid buldge into atria during systole
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What is the v wave?
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inc. JVP due to inc. right atrial pressure due to filling against a closed tricuspid
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What is physiologic splitting?
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normally heard in S2 during inspiration cuz aortic valve closes slightly before the pulmonic valve
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What is fixed splitting and what is it a sign of?
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It is when A2 comes more before P2 than it should and it stays like that whether you are inspiring or expiring
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It is a sign of ASD
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What is wide splitting a sign of?
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pulmonic stenosis
right bundle branch block |
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What is paradoxical splitting a sign of?
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aortic stenosis
left bundle branch block |
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What do you hear best on the left sternal border?
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aortic regurgitation
pulmonic regurgitation |
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What are the systolic heart sounds?
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aortic/pulmonic stenosis
mitral/tricuspid regurgitation |
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What are the diastolic heart sounds?
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mitral/tricuspid regurgitation
aortic/pulmonic regurgitation |
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What is a holosystolic, high-pitched, blowing murmur?
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mitral or tricuspid regurgitation
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How is mitral reguritation heard best?
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it is loudest at the apex and radiates to the axilla
enhanced by maneuvers that inc. TPR (like squatting and hand grip) or expiration |
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What tends to cause MR?
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ischemic heart disease (e.g. ruptured cords)
mitral valve prolapse LV dilation |
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Where/how is tricuspid regurgitation heard best?
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loudest in tricuspid area with radiation to the right sternal border.
loudest on inspiration (inc. RA return) |
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What tends to cause TR?
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RV dilation
endocarditis Rheumatic fever |
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What kind of murmur is AS?
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Crescendo-decrescendo systolic ejection murmur
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Where is AS heard best?
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left sternal border radiating to the carotids/apex
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Which mumur is pulsus parvus et tardus associated with?
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AS
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What kind of murmur is a VSD?
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holocystolic, harsh-sounding murmur
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Where is VSD loudest?
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tricuspid area
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What kind of murmur is mitral valve prolapse?
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late systolic crescendo with midsystolic click (due to sudden tensing of the chordae tendinae)
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How/where is mitral valve prolapse heard best?
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loudest at S2
enhanced by squattting/hand grip |
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What kind of murmur is AR?
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immediate high-pitched "blowing" diastolic murmur.
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What are the symptoms of AR?
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wide pulse pressure
bounding pulses head bobbing |
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What tends to cause AR?
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aortic root dilation
bicuspid aortic valve rheumatic fever |
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What tends to cause mitral valve prolapse?
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myxomatous degeneration
rheumatic fever chordae rupture |
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What kind of murmur is MS?
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delayed rumbling late diastolic murmur following an opening snap (due to tensing of chordae tendinae)
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What are the signs of MS?
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LA>>LV during diastole
LA dilation (if it's chronic) enhanced by expiration (inc. LA return) |
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What kind of murmur is a PDA?
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continuous machine-like murmur loudest at S2
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Which phase in pacemaker action potential determines HR?
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slope of phase 4
Ifunny channels open more = inc. HR |
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P wave
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atrial depolarization
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PR interval
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conduction through AV node
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QRS complex
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ventricular depolarization
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QT interval
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contraction of ventricles
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T wave
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ventricular repolarization
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What does U wave on EKG indicate?
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hypokalemia
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What predisposes to torsades de pointes?
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anything that prolongs the QT interval
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Wolff-Parkinson-White syndrome findings
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shortened PR
widened QRS delta wave on ECG may lead to SVT |
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Wollf-Parkinson-White pathophys
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ventricular preexcitation
acccessory conduction pathway from atria to ventricle (bundle of kent) bypasses AV node and allows ventricles to depolarize earlier than normal if reentry current ==> SVT |
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what are ECG findings for Afib?
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Irregularly irregular rhythym
no discrete P wave in between irregularly placed QRS complex |
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what are ECG findings for Aftrial flutter?
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a rapid succession of identical, back-tback atrial depolarization waves
sawtooth appearance |
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what are ECG findings for 1st degree AV block?
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the PR interval is prolonged (>200msec)
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benign
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What are ECG findings for 2nd degree AV block?
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progressive lengthening of the PR interval until a beat is "dropped" meaning there is a P wave that isn't followed by a QRS complex
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usually asymptomatic
aka Mobitz type I (Wenckeback) |
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What are the ECG findings for 2nd degree heart block Mobtiz type II?
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abrupt, nonconducted P waves show "dropped" beats that aren't preceded by lengthening PR intervals (as in type I). often found in a 2:1 P:QRS ratio
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What are the ECG findings for 3rd degree heart block?
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the atria and ventricles beat independently of one another.
both P waves and QRS complexes are present but they bear no relation to each other atrial rate > ventricular rate |
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In pulmonary stenosis, what happens to pulmonary capillary wedge pressure?
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It increases so that PCWP > LV
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Which are the right-left-shut congenital heart diseases?
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5 T's:
Tetralogy of Fallot Transposition of the Great Vessells Truncus arteriosus Tricuspid atresia Total anomalous pulmonary venous return |
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Which are the left-to-right shunts?
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VSD
ASD PDA |
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What is Eisenmenger's syndrome?
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Uncorrected VSD, ASD PDA (L==>R shunt) becomes R==>L shunt causing late cyanosis in kids
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occurs because the L->R shunt increases the work the RV has to do (inc. volume) so it hypertrophies. Eventually, this causes inc. right heart pressures that exceed those in the left heart
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What are the pathologies in tetralogy of Fallot?
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pulmonary stenosis
RVH overriding aorta VSD |
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What are the signs in tetralogy of Fallot?
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squatting (inc. TPR ==> dec. R->L shunt across the VSD due to the stenotic pulm. valve)
boot-shaped heart "cyanotic spells" |
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Infantile coarctation of the aorta
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assoc. with turner's
narrowing is preductal check femoral pulses |
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Adult coarctation of the aorta
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stenosis is distal to the ligamentum arteriosum
notching of ribs HTN in uppers, weak pulses in lowers ==> aortic regurg |
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Cardiac abnormalities associated with DiGeorge
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truncus arteriousus
tetralogy of Fallot |
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Cardiac abnormalities associated with Down syndrome
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ASD
VSD AV septal defect (endocardial cushion defect) |
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Cardiac abnormalities associated with congenital rubella
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septal defects
PDA pulmonary artery stenosis |
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Cardiac abnormalities associated with Turner syndrome
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(preductal) coarctation of the aorta
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Cardiac abnormalities associated with Marfan syndrome
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aortic insufficiency (later)
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Cardiac abnormalities associated with diabetic mother
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transposition of the great vessels
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Monckberg arteriosclerosis
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calcification in the media of arteries (esp. radial and ulnar)
benign - doesn't obstruct blood flow |
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Arteriosclerosis
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hyaline thickening of small arteries
due to essential hypertension, malignant HTN or diabetes concentric intimal thickening ==> obstruction of blood flow |
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Where is the tear in an aortic dissection
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longitudinal, intraluminal (within the tunic media)
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How does angina present on ECG
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ST depression
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How does Prinzmetal's angina present on ECG?
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ST elevation
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Post-MI, when is the risk for arrythmia greatest?
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2-4 days later
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What are the signs of an MI on ECG
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if transmural: ST elevations
if subendothelial: ST depressions pathologic Q waves |
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What is CK-MB the best marker for?
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reinfarction on top of acute MI
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Q waves in V1-V4
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anterior wall
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LAD
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Q waves in V1-V2
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anteroseptal
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LAD
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Q waves in V4-V6
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anterolateral wall
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LCX
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Q waves in I, aVL
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lateral wall
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LCX
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Q waves in II, III, aVF
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inferior wall
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RCA
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Post-MI complications (besides the obvious
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mitral regurge
cardiac tamponade VSD aneursym pericarditis Dressler's syndrome |
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What is Dressler's syndrome?
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auto-immune disorder resulting in fibrinous pericarditis several weeks post-MI
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Common causes of dilated cardiomyopathy
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alcoholism
Wet Beriberi Coxsackie B virus myocarditis chronic cocaine use Chagas' disease doxorubicin toxicity hemochromatosis peripartum cardiomyopathy |
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In which type of cardiomyopathy would you find an S3?
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dilated
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In which type of cardiomyopathy would you find an S4
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hypertophic
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what kind of murmur do you get with hypertrophic cardiomyopathy?
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systolic murmur that gets louder with valsalva and squat==>stand
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With which congenital disease is hypertrophic cardiomyopathy associated?
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Friedreich's ataxia
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What type of cardiac dysfunction ensues with restrictive cardiomyopathy?
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diastolic dysfunction (heart can relax properly cuz it's all fibrotic/infiltrated)
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What is the pathophys of PND/pulmonary edema in CHF patients
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LV failure ==> inc. pulmonary venous pressure ==> distention and transudation of fluid
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What is histologic evidence of CHF in the lungs?
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hemosiderin-laden macrophages
due to mircohemorrhages from inc. pulmonary capillary pressure |
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What causes orthopnea in CHF patients?
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Inc. venous return in supine position exacerbates pulmonary vascular congestion
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What causes hepatomegaly in CHF patients?
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inc. central venous pressure --> inc. resistance to portal flow
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What causes ankle/sacral edema in CHF?
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the long-standing pulmonary congestion from a failed LV leads to secondary failure of RV which backs up into the venous system causing inc. venous pressure and fluid transudation
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What causes JVD in CHF?
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the long-standing pulmonary congestion from a failed LV leads to secondary failure of RV which backs up into the venous system causing inc. venous pressure
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What are the signs of bacterial endocarditis?
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fever
Roth's spots (retinal hemorrhage) Osler's nodes (lesions on fingers/toes) Murmur (mitral regurge usually) Janeway lesions (small red on palms/soles) Anemia Nail-bed hemorrhages Emboli |
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Endocarditis in IV drug users
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usually affects tricuspid valve
caused by S. aureus, Pseudomonas, Candida |
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Libman-Sacks endocarditis
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SLE causes it:
sterile vegetations on both sides of the valve usually benign but may lead to mitral regurge or stenosis |
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What are the histiologic/lab findings of rheumatic fever?
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Aschoff bodies (granuloma with giant cells)
Anitschkow's cells (activated histocytes) elevated ASO titers |
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What type of hypersensitivity reaction is rheumatic fever?
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Type II immune-mediated.
antibodes are the M proteins produced by group A beta-hemolytic strep |
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What are the findings in cardiac tamponade?
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hypotension
JVD distant heart sounds inc. HR pulsus paradoxus |
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What is pulsus paradoxus?
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aka kussmaul's sign
the pulse amplitude drops more than usual during inspiration |
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What can pulsus paradoxus be a finding in?
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cardiac tamponade
asthma sleep apnea pericarditis croup |
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What are the cardiac findings in tertiary syphillis
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dilation of the aorta and valve ring
aneurysm of the ascending aorta aortic valve regurgitation calcification of the aortic arch ==> "tree bark" appearance of the aorta |
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What part of the vasculature does syphillis attack that causes the cardiac symptoms?
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vasa vasorum of the aorta
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What is the most common cardiac tumors in adults?
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myxoma
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what is the most common cardiac tumor in children?
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rhabdomyomas
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associated with tuberous sclerosis
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Where are myxomas usually found?
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left atrium
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Wegner's granulomatosis causes what?
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focal necrotizing vasculitis
necrotizing granulomas in the lung and upper airway necrotizing glomerulonehpritis |
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Wegner's granulomatosis symptoms
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hemoptysis
hematuria perforation of nasal septum chronic sinusitis otitis media mastoiditis cough dyspnea |
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Wegner's granulomatosis findings:
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c-ANCA
CXR: large nodular densities hematuria/red cell casts |
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Wegner's granulomatosis tx:
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cyclophosphamide
corticosteroids |
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what is microscopic polyangitis?
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like wegner's but without granulomas and p-ANCA (myeloperoxidase) instead of c-ANCA
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What is Churg-Strass syndrome?
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granulomatous vasculitis with eosinophilia
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What are the symptoms/findings of Churg-Strass syndrome?
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asthma
sinusitis skin lesions peripheral neuropathy (e.g. wrist/foot drop) can also involve lungs, heart, GI, kidneys p-ANCA + |
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What is Sturge-Weber disease?
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congenital vascular disorder affecting capillaries mainly
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What are the Sturge-Weber disease symptoms?
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port-wine stain on face
ipsilateral leptomeningeal angiomatosis (intracerebral AVM) seizures early-onset glaucoma |
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what is Henoch-Schonlein purpura?
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most common form of childhood systemic vasculitis (small vessels).
usually follows URI's. IgA immune complexes associated with IgA nephrompath |
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Henoch-Schonlein purpura symptoms
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skin rash on buttocks and legs (palpable purpura)
arthralgia intestinal hemorrhage abdominal pain melena |
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What is Buerger's disease?
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thromboangitis obliterans
idiopathic, segmental thrombosing vasculitis of small and medium peripheral arteries and veins smokers!! |
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Buerger's disease symptoms?
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intermittent claudication
superficial nodular phlebitis cold sensitivity (raynaud's) serve pain in affected part gangrene/auto-amputation of digits |
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What is Kawasaki disease?
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acute, self-limiting necrotizing vasculitis in infants/children
association with Asian ethnicity affects small/medium vessels |
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Kawasaki disease symptoms?
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fever
conjunctivitis changes in lips/oral muchosa (strawberry tongue) lymphadenitis desquamative skin rash coronary aneurysm |
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What is Polyarteritis nodosa?
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immune complex-mediated transmural vasculitis with fibrinoid necrosis
type III hypersensitivity affects small/medium vessels |
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Polarteritis nodosa sx
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fever
weight loss malaise abdominal pain melena headache myalgia HTN neuro dysfunction cutaneous eruptions |
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Polyarteritis nodosa findings
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Hep B seropositivity
Multiple aneurysms and constrictions on arteriogram Skin lesions are of different ages (unlike in HSP) Typicall involves renal and visceral vessels, NOT pulm. vessels (like Wegners does) p-ANCA usually |
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Polyarteritis nodosa tx
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same as Wegner's:
corticosteroids cyclophosphamide |
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What is Taayasu's arteritis?
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aka "pulseless disease"
granulomatous thickening of aortic arch and/or prox. great vessels usually affecting young Asian women |
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Taayasu's arteritis sx?
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fever
arthritis night sweats myalgia skin nodules ocular disturbances weak pulses in upper extremities |
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What is temporal arteritis?
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Most common vasculitis affecting medium and large arteriers, usually brances of the carotid.
Focal granulomatous inflammation, mainly in elderly females |
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temporal arteritis sx?
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associated with inc. ESR
systemic involvement in half polymyalgia rheumatica |
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strawberry hemangioma
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benign capillary hemanioma of infacy. initially grows w/child then spontaneously regresses
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cherry hemangioma
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benign capillary hemanioma of elderly.
does not regress |
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pyogenic granuloma
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polypoid capillary hemangioma that can ulcerate and bleed
assoc. with trauma and pregnancy |
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cystic hygroma
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cavernous lymphangioma of the neck
assoc. w/Turner syndrome |
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Glomus tumor
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benign, painful, red-blue tumor under fignernails.
Arises from modified SM cells of glomus body (thermal regulation) |
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Bacillary angiomatosis
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Benign capillary skin papules found in AIDS patients
cause by Bartonella ddx Kaposi's |
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Angiosarcoma
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highly lethal malignancy of the liver.
vinyl cholride, arsening and thorotrast exposure |
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Lymphangiosarcoma
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plympathic malignancy assoc. wither persistent lymphedema (e.g. post-radical mastectomy)
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Temporal arteritis sx
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unilateral headache
jaw claudication impaired vision (occlusion of ophthalmic artery that may lead to irreversible blindness) |
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Hydralyzine MOA
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inc. cGMP ==> smooth muscle relaxation
vasodilates arterioles > venuoles so dec. afterload |
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Hydralyzine clinical use
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first line in HTN of preggers (along with methyl-dopa)
coadminister it with Beta-blocker to prevent reflex tachy |
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Hydralyzine toxicity
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reflex tachy
fluid retention nausea headache angion lupus-like syndrome |
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Calcium-channel blockers MOA
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block voltage-dependent L-type calcium channels of cardiac and smooth muscle, thereby reduce muscle contractility
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Heart - verapimil > diltiazem > nifedipine
Vascular smooth muscle - nifedipine > diltiazem > verapimil |
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Calcium-channel blockers clinical use
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HTN
angina (including Prinzmetal's) arrhythmias (not nifedipine) Raynaud's |
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