Cardio Stuff In Fa But Not Covered In Block 9

Front 1

Embryology: Primitive Structures

Back 1

1. Truncus Arteriosus- becomes asc aorta and pulm trunk

Based on neural crest cell migration to form the AP septum which then goes into asc aorta and pulm trunk

Path: Transposition of great vessels (failure to spiral) so now the RV goes into aorta and LV into pulm art

Tetralogy of Fallot (skewed AP septum development; this septum is separating the aorta from pulm arteries)

Persistent truncus arteriosus- partial AP septum dvpmt.

2. Bulbus Cordis- outflow tract of left and rt vents
3. Left Horn of Sinus Venosus- coronary sinus

4. Right Horn of Sinus Venosus- smooth part of rt atrium

5. Rt common cardinal vein and right ant cardinal
vein- SVC

Front 2

Embryo: Interatrial Stuff

Back 2

Remember terms: foramen primum and septum primum.

Perforations in the septum primum create the foramen secundum, then septum secundum grows and has the FO

What's left of septum primum acts as a valve for the FO to let blood still flow from R to L

The septa eventually fuse to crease the interatrial septum (failure of fusion= PFO)

Front 3

Fetal Erythropoiesis

Back 3

Yolk sac (3-10wk), liver (6wk-birth), spleen (minor role), bone marrow (22wk-adult)

Young Liver Synthesizes Blood

Front 4

Fetal Circulation

Back 4

Blood comes from mom's spiral arteries and bathes the chorionic villus with high O2 blood. The baby has HgF that will latch the O2 (also harder to let go, that's why babies are born with high EPO since they have low O2 unloading capacity= hypoxia)

Blood flow is from syncytiotropho-cytotropho-stroma of CV-vessels of CV- umb vein (carries the highest O2 blood)

-From umb vein you bypass the liver and go straight to IVC via ductus venosus
-From IVC blood will go to RA and shunted to LA via FO so that systemic circ can get O2 blood
-SVC gets deoxy blood from up top and with gravity it will go to RV and pumped into PA, but bypasses lungs via ductus arteriosus and goes into aorta (mixing in its lower O2 blood)
-Blood from aorta provides fetus and ends as 2 umb arteries that have the lowest O2 and end up back in placenta

*At birth the baby breathes in and the resistance in pulm vasculature decreases. This causes the LAP to be higher than RAP and foramen ovale closes. Increase in O2 also results in decrease of PGs so the DA closes off

Front 5

Fetal-postnatal derivatives

Back 5

Umb vein in falciform

Umb arteries in mediaL umb ligaments

Urachus (urachal cyst may be remnant) in mediaN umb ligament

Lateral umb fold is still fxl at birth since it carries the inferior epigastric arteries

Front 6

Cardio Physiology Extra Info

Back 6

Ficks Principle : CO= rate of O2 consumption/ (art O2-venous O2)
-During exercise, CO is maintained by high HR since the SV plateaus

MAP= 2/3 Diastolic+1/3 Systolic (spend longer time in diastole)

Increased viscosity (and thus resistance) with polycythemia, Hyperprotein (with MM), Hereditary spherocytosis

Front 7

Heart Auscultation (Bedside Maneuvers)

Back 7

Handgrip= increase the systemic vascular resistance; this will increase the intensity of MR/AR/VSD/MVP murmurs and decrease the intensity of aortic stenosis

Valsalva= decrease venous return/preload, which decreases intensity of most murmurs except for MVP (think that it makes it prolapse more since not opening it up to be tight close)

Rapid Squatting= increases the preload, so now the intensity of MVP is lower. Remember, this is done for Tet spells since this also increases the afterload and reverses shunt to become a Left to Right so you can get blood into PA for oxygenation)

Front 8

Dig Toxicity

Back 8

Esp seen if you have messed up renal clearance (older people)

-Visual changes (green and yellow halos), nausea, vomiting, diarrhea (think that it's gonna do SLUDGE)

Front 9

Baroreceptors and Chemoreceptors

Back 9

Baroreceptors: In carotid sinus (responds to increase/decrease BP and transmits via CN9) and aortic arch (only responds to increased BP and transmits via CN10)

Carotid massage- increasing pressure on carotid sinuses which sends signal through CN9 and decreases HR. ,Increased stretch induces bradycard

Chemoreceptors- peripheral (carotid and aortic) are stimulated by low O2, high PCO2 and low pH of blood, influence increase in breathing vs.

central- changes in brain PCO2 and pH, do not directly respond to O2

Front 10

Normal Heart Pressures

Back 10

Aorta= 130/90
LV= 130/10 (very low diastolic, emptied all the way)
PCWP (LA) <12
PA= 25/10 (pretty low)
RV= 25/5
RA<5

Front 11

Blood Flow Autoregulation

Back 11

Blood flow to an organ remains constant over wide range of perfusion pressures.

Mediated by local metabolites (NO, CO2= potent vasodilators); in lungs, low O2 means constriction, want to bypass areas receiving low O2

Front 12

Restrictive/Obliterative Cardiomyopathy

Back 12

Etiology- sarcoidosis, amyloidosis, post-rad fibrosis

Lofflers Syndrome: endomyocardial fibrosis with eosinophils and you may also get hemochromatosis (dilated CM)

Front 13

Cardiac Tumors

Back 13

Myxomas- most common in adultds; find them in the atria (left especially); asstd w/ multiple syncopal episodes

Rhabdomyoma- more in children associated with tuberous sclerosis= AD, mental ret and seizures, angiofibromas on face and hypopigmented ash leaf lesions; rhabdo is almost 100% predictive

*Remember that the most common heart tumor is a mets (melanoma, lymphoma)

Front 14

Sturge-Weber

Back 14

Vascular malformation on face in a trigeminal distribution (port-wine stain on face), ipsilateral AV malformation in the meninges, seizures and early-onset glaucoma SMALL Vessels

Front 15

Vascular Tumors

Back 15

1. Strawberry hemangioma- benign capp hemangioma of infancy, grows rapidly and regresses spontaneously
2. Cherry- Benign in elderly, does not regress and increases in freq with age
3. Pyogenic granuloma- capp hemangioma that can ulcerate and bleed (asstd with pregnancy)
4. Cystic hygroma- lymphangioma of neck, asstd with XO (remember they have weird necks)
5. Glomus Tumor- Painful tumor under fingernail
6. Angiosarcoma- rare blood vessel malig in head, neck and breast. asstd with RADIATION. very aggressive and diff to resect
7. Lymphangiosarcoma- lymph malignancy asstd with persistent lymphedema (post breast resection)
8. Kaposis- asstd with HHV8 and HIV, mistaken for bacillary (in AIDS, asstd with Bartonella)
9. VHL- cavernous hemangioma in cerebellum and retina, increased incidence of pheo and bilat renal cell carcinoma