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144 Cards in this Set

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  • Back
What are the primitive heart chambers, and what do they become?
Truncus arteriosus --> pulmonary artery and aorta
Bulbus cordis --> outlet of Ventricles
Primitive ventricle --> inlet of ventricles
Primitive atria --> RA/LA
Sinus venosus --> part of RA
What is the path of blood from mother to fetus, and through the fetus, back to mom?
Umbilical vein
(bypasses liver) --> ductus venousus
IVC (high O2)
RA (through FO) --> LA --> LV --> ascending aorta --> organs --> caps, veins --> SVC (de-O2)
RA --> RV --> PA --> lung (12%) or via DA to desc. aorta --> iliac arts --> umb. artery
What does the DA connect to?
LEFT pulomonary artery to descending aorta
What can be used to close PDA?
PG inhibitor
What are the acyonitic CHD?
Coarctation of aorta
What is the most common type of ASD?
Secundum type
What is heard on auscultation of a newborn with ASD?
Exam is normal
The P in L heart is not great enough yet
What is heard on auscultation of an adult with ASD?
Widely split S2
SEM (relative pulmonary stenosis)
What would you see on EKG in adult with ASD?
What would you see on EKG of adult with ASD?
Tall P waves
R axis deviation
What are the risks of ASD?
Pulmonary HTN
R heart overload
CHF uncommon
Paradoxical embolus if Eisenmenger's syndrome
What is treatment of ASD?
Catheterization to close defect
Surgery if defect is large
What is the path of blood in a VSD? (start with LA)
LA --> LV --> RV --> pulmonary artery --> etc...
What is seen on examination of an adult with VSD?
What is heard on auscultation in VSD?
Holosystolic murmur at LLSB
NO S2 split
What is seen on EKG in VSD?
If big defect, LVH, LAH, RVH
If small defect, normal
What are the complications of VSD?
CHF (extra blood in the pulmonary vasculature, eventually leaks out)
Aortic valve prolapse/regurg
Increased risk for pulmonary infections
Clinically what is Eisenmenger's Syndrome?
If you have L-->R shunt and eventually the P gradient of R heart becomes greater than the left, the shunt can become R-->L
Pathologically what is Eisenmenger's Syndrome?
Reversible injury: SMC proliferation in BV
Irreversible injury: scarring of intima
How do you treat VSD?
AB proph for endocarditis
Incresaed calories, digoxin adn diuretics (for large VSD and CHF)
Surgery if failure to thrive
What is Tetralogy of Fallot?
Pulmonary stenosis
Overriding aorta
What causes TOF?
Septum of A/P is deviated anteriorly, squeezing area under pulmonic valve --> pulmonary stenosis, with aorta over a VSD
What are the consequences of TOF?
If it is large defect, can be cyanotic... very little blood enters PA and msot of the blood goes through VSD
What is the progression of pulmonary valve in TOF?
At first defect there is small, then gets progressively worsee with more stenosis over time
What is a tet spell?
If the PVR gets too low, then blood will flow through VSD rather than PA, and is not deoxygenated.
To fix, squat... this increases PVR
What is seen on exam in TOF?
Boot Shaped heart (raised apex d/t RVH and concave area where pulm artery is hypoplastic)
What is necessary in TGA?
PDA to decrease the level of cyanosis
PFO doesn't do anything to help- it's not big enough
What happens if a person has VSD and TGA?
They are not cyanotic
What is seen on physical exam in TGA?
higher O2 in legs than arms because O2 can go from PA -> desc aorta -> LE
What is heard on auscultation in TGA?
Single S2
Unless VSD or pulmonary stenosis, no murmur
What is seen on EKG in TGA?
What does heart look like on CXR in TGA?
egg on a string
How can you maintain a PDA?
What is treatment for TGA?
Balloon arial sepostomy if low PO2 in all extremities
This makes bigger holes for mixing L/R atria
Surgery can switch roots and move arteries
What causes coarctation of aorta?
Decreased flow across isthmus (part of aorta), so there is less incentive for the aorta to grow --> narrowed/coarctation
In what conditions is coarctation of the aorta seen?
bicuspid aortic valve
Aortic stenosis
What can result if aorta is severely coarcted?
dilated RV
Wha is needed in order to ensure CO to lower body?
What pysical sign is indicative of coarctation of aorta?
BP gradient between UE and LE
What is heard in auscultation of coarctation of aorta? Where will you hear it?
SEM at posterior under scapula
What is seen on EKG in coarctation of aort?
L axis deviation
What is seen on CXR in coarctation of aorta?
Rib notching
What are consequences of coarctation of aorta?
CAn lead to RHF (high PLV, high PLA, high PRV)
Shock if low blood flow
Metabolic acidosis
Aortic dissection/rupture
What is the best way to dx valvular dz?
What is the most common CHD in adults?
bicuspid aortic valve
What are the causes of aortic stenosis?
Bicuspid aortic valve
Normal wear and tear (seen in elderly)
Rheumatic heart disease
What is the clinically important triad of sx in AS?
Why is there angina in AS?
the LV gets thicker to overcome resistance in aorta
this requires increased perfusion, but LVEDP is increased. This decreases coronary perfusion and decreases pressure gradient btwn aorta and myocardium
What is heard on auscultation in AS?
early EC
Decreased A2
What is seen on echo in AS?
>64 mmHg
>4 m/s
area <1 cm^2
How do you treat AS?
if pt has decreased life expectancy already from something else, then inflate balloon
Otherwise, mechanical valve
(requires LT anti-coag) or bioprosthesis if older (they don't last as long but don't require anti-coag)
What is the cause of mitral stenosis?
Rheumatic fever --> fused commissuresof mitral valve
What is the anatomy of a normal mitral valve? How is the normal anatomy altered in MS?
Normally has 2 leaflets, anterior (broad) and posterior (C shaped). Opens like a trap door

In MS, the commissures between the 2 leaflets fuse --> slit-like orifice --> sideways motion
What are the consequences of MS?
Can back up into pulmonary veins --> pulmonary congestion
When is it time to intervene in MS?
When pt complains of dyspnea
What is seen on echo in MS?
<1 cm^2 = severe stenosis
What is heard on auscultation?
Diastolic rumble
Loud S1
What are the complications of MS?
What are the causes of aortic insufficiency?
Bicuspid aortic valve
**Aortic dissection**
Rheumatic fever
Subaortic membranes
What is seen on CXR in aortic insuff?
Cor bovinum (cardiomegaly) if it is chronic
No cardiomegaly if acute
What do you hear on auscultation in aortic insuff?
Diastolic murmur (decresc)
mid EC
Murmurs originating where will radiate to the carotids?
What are the causes for mitral regurg?
Dilated cardiomyopathy
What is MVP?
floppy mitral valve that buckles back during systole
What are the 2 steotypes of ppl that have mitral regurg?
Young, thin woman with scoliosis and pectus excavatum small AP diameter. Puts mechanical constraints on heart so that RH has to work harder to pump

Iler male with prior hx of MI. Disrupts how MV moves
What do you hear on auscultation with mitral regurg?
Systolic murmur
mid EC
The murmur caused by which valve problem is made louder by squeezing hands?
Mitral prolapse
What can result from mitral regurg?
increased V in LA --> increased bl going to LV --> --> dilated LV
Which type of plaques are more dangerous: chronic, stable ones or new unstable ones? Why?
New unstable ones
They are more likely to rupture --> probs
What role does cholesterol play in ATH development?
HDL pulls LDL out of circulation and takes it to the liver to get excreted

LDL can enter the artery wall (goes down [] gradient)

LDL gets oxidized in the intima and --> inflammation
Describe the process of monocyte entrance into BV and their transformation?
When LDL enters the BV wall, it causes inflammation.

LDL releases MCP-1 which recruits monocytes.

Monocytes --> macrophages and eat the LDL --> foam cells --> release contents --> lipid core
What surrounds lipid core?
fibrous cap
What happens as increased amounts of LDL accumulate?
Accumulate in intima, then the externa elastic membrane expands

BV maintains adequate lumen
What predisposes ATH plaques from rupturing?
If there is a large lipid core covered by thin fibrous cap

Often it HAS NOT penetrated the lumen
WHat happens what ATH plaque ruptures?
--> thrombus --> blocks artery --> decreased blood flow
What does partial arterial blockage cause?

Complete blockage?

What impact does free radicals have on arteries?
Leads to vasoconstriction
What are all the things that NO does?
Growth inhibition
DEcreased SMC migration
Decreased monocyte adhesion
What are all the things that ACE does?
Growth promotion
Increased free radicals
Increased SMC migration
Increased monocyte adhesion
How do monocytes interact with SMC?
After monocytes enter cells, they release cytokines adn become foam cells
They signal for SMC to migrate and become fibroblasts --> CT "band-aids"
What are the sx for typical angina?
tightening of sternum
radiation of pain to L/R shoulder/arm, post back, neck
How long does angina last
20-30 mins
What relieves angina?
What is a sign that you are entering HF?
Ischemia and SOB
What is the underlying cause for angina?
Mismatch btwn bl supply and demand
What is the underlying cause for MI?
Decreased blood supply only, demand is not increased
What happens to a pt with significant blockage who exercises
You are already dilated in order to overcome the blockage and increase the blood flow, so if you exercise you can't dilate anymore, so --> ischemia (angina)
What are the ways that you can treat CAD by increasing supply?
Cardiac cath
How can you decrease demand on heart?
Beta blockers
Ca channel blockers
What are the characteristics of chronic stable lesion?
Thick fibrous cap
Lower LDL content
Decreased inflammatory cells
Can possibly --> angina, but can also stay stable for many years
What are the characteristics of unstable lesion?
Thin fibrous cap
Increased cholesterol
Active inflammation
--> rupture/thrombus
What can trigger the rupture of a clot?
Increaesed SNS (stress, waking up, sex, exercise)
What are the 4 acute coronary syndromes?
Acute MI
Non-Q MI
Unstable angina
Sudden death
What will you see on EKG with evolving MI?
Q waves
ST elevations
When do Q waves appear?
6-12 hrs after MI
How long do ST elevations remain?
6-12 hrs after MI
What are the most useful serum markers to use just after an MI?
Troponin I
What are the 4 most important cardinal symptoms of heart disease?
Chest pain
Where is angina pain felt?
Upper chest
Where does angina radiate to?
Where is acute pericarditis felt?
What makes acute pericarditis worse?
Deep inspiration
Supine position
What are associated sx with pericarditis?
Flu-like sx
What are the assocated sx of dissecting aortic aneurysm?
Renal failure
Where does pain from hyperventilation radiate to?
What can cause DOE?
Chronic lung disease
Which pts will experience orthopnea?
Pts with LV HF
Pts with pulmonary dz do not experience this
What are Stokes-Adams attacks?
When cardiac arrythmias --> LOC
When is hemoptysis traditionally seen in heart dz?
Mitral stenosis
What causes central cyanosis?
Decreased arterial O2 sat (associated with R-->L shunts)
What causes peripheral cyanosis?
Reducced blood flow and O2 extraction
What CVD do pts with Marfan get?
Aortic insuff
Aneurysm of ascending aorta
What is Pickwickian Syndrome?
RH failure
What does pectus excavatum cause?
Aortic insuff
Pt with Turner Sx might have what CVD?
Coarctation of aorta
What are pts with acromegaly prone to in CVD?
Ischemic heart disease
What CVD does hypothyroidism predispose you to?
Pericardial effusion
Ischemic heart disease
What CVD can congenital rbuella lead to ?
Peripheral pulmonary artery stenosis
What CVD are pts with Ehlers-Danlos syndrome prone to?
Dissecting aortic aneurysm
What CVD are pts with hemochromatosis at risk for?
What would a pulsation in sternoclavicular region indicate?
Dilation of ascending aorta
Dissecting aneurysm
Right sided heart failure
Whath woudl abnormal pulsation in aortic region indicate?
Dilation of ascending aorta
What would a pulsation in RV indicate?
What would a pulsation in the apical region indicate?
Aortic stenosis
Aortic insuff
Mitral insuff
diffuse myocardial disease
What would a pulsation in the epigastrium be indicative of?
Tricuspid insuff (if in region of liver)
What causes a sternoclavicular thril?
aortic stenosis
What causes an a thrill in aortic region?
Aortic stenosis
What causes a thrill in RV?
Tricuspid insuff
What causes thrill in apex?
Systolic thrill: Mitral insuff, aortic stenosis

Diastolic: Mitral stenosis
What is the order of the points in venous pulse?
a, x, c, y, v
Contraction of RA
Contraction of RV
Radiation to carotid
filling of RA
filling of RV
What causes the a wave to be absent?
What causes the a wave to be large on every beat?
tricuspid stenosis
decreased RV compliance
What causes the a wave to be large occassionally?
AV dissociation (cannon wave)
What causes the x descent to be small?
tricuspid insuff
What causes the x wave to be prominent?
constrictive pericarditis
What causes the v wave to be large?
tricuspid insuff
What causes the v wave to be small?
tricuspid stenosis
What causes the y descent to be shallow?
tricuspid stenosis
What causes the y descent to be steep?
tricuspid insuff
constrictive pericarditis