Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
144 Cards in this Set
- Front
- 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?
|
ASD
VSD 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?
|
RVH
|
|
|
What would you see on EKG of adult with ASD?
|
Tall P waves
RBBB R axis deviation |
|
|
What are the risks of ASD?
|
Arrhythmias
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?
|
LVH
Thrill Cardiomegaly |
|
|
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)
Endocarditis 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?
|
RVH
VSD 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?
|
RVH
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?
|
Tachypnea
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?
|
normal
|
|
|
What does heart look like on CXR in TGA?
|
egg on a string
|
|
|
How can you maintain a PDA?
|
PG E
|
|
|
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?
|
PDA
|
|
|
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 Stroke CAD CHF Aortic dissection/rupture |
|
|
What is the best way to dx valvular dz?
|
Echo
|
|
|
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) Endocarditis Rheumatic heart disease |
|
|
What is the clinically important triad of sx in AS?
|
Dyspnea
Angina Syncope |
|
|
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?
|
SEM
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
Dyspnea |
|
|
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
OS Loud S1 |
|
|
What are the complications of MS?
|
A-fib
|
|
|
What are the causes of aortic insufficiency?
|
Bicuspid aortic valve
**Aortic dissection** Endocarditis 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?
|
Aorta
|
|
|
What are the causes for mitral regurg?
|
MVP
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? |
Angina
MI |
|
|
What impact does free radicals have on arteries?
|
Leads to vasoconstriction
|
|
|
What are all the things that NO does?
|
Vasodilation
Growth inhibition Anti-thrombic Anti-oxidant Anti-inflammatory DEcreased SMC migration Decreased monocyte adhesion |
|
|
What are all the things that ACE does?
|
Vasoconstriction
Growth promotion Prothrombic Increased free radicals Pro-inflammatory 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?
|
pain
pressure 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?
|
nitroglycerine
|
|
|
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
Angioplasty |
|
|
How can you decrease demand on heart?
|
Beta blockers
Ca channel blockers Vasodilators Nitrates |
|
|
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
CK-MB |
|
|
What are the 4 most important cardinal symptoms of heart disease?
|
Chest pain
Dyspnea Palpitations Edema |
|
|
Where is angina pain felt?
|
substernal
Upper chest Epigastric |
|
|
Where does angina radiate to?
|
Arms
Shoulder NEck Jaw Back |
|
|
Where is acute pericarditis felt?
|
Substernal/parasternal
|
|
|
What makes acute pericarditis worse?
|
Deep inspiration
Cough Swalling Supine position |
|
|
What are associated sx with pericarditis?
|
Fever
Chills Flu-like sx Dyspnea |
|
|
What are the assocated sx of dissecting aortic aneurysm?
|
Renal failure
Syncope CHF CVA hemoptysis |
|
|
Where does pain from hyperventilation radiate to?
|
Arms
Hands |
|
|
What can cause DOE?
|
LV HF
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?
|
MVP
Aortic insuff Aneurysm of ascending aorta |
|
|
What is Pickwickian Syndrome?
|
Obesity
Hypoventilation OSA Polycythemia RH failure |
|
|
What does pectus excavatum cause?
|
MVP
Aortic insuff |
|
|
Pt with Turner Sx might have what CVD?
|
Coarctation of aorta
|
|
|
What are pts with acromegaly prone to in CVD?
|
HTN
Ischemic heart disease arrhythmias |
|
|
What CVD does hypothyroidism predispose you to?
|
Pericardial effusion
Ischemic heart disease CMP |
|
|
What CVD can congenital rbuella lead to ?
|
VSD
Peripheral pulmonary artery stenosis PDA |
|
|
What CVD are pts with Ehlers-Danlos syndrome prone to?
|
Dissecting aortic aneurysm
MVP |
|
|
What CVD are pts with hemochromatosis at risk for?
|
MCP
Pericarditis |
|
|
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?
|
RVH
LAH |
|
|
What would a pulsation in the apical region indicate?
|
LVH
Aortic stenosis Aortic insuff Mitral insuff diffuse myocardial disease |
|
|
What would a pulsation in the epigastrium be indicative of?
|
RVH
COPD Tricuspid insuff (if in region of liver) AAA |
|
|
What causes a sternoclavicular thril?
|
aortic stenosis
|
|
|
What causes an a thrill in aortic region?
|
Aortic stenosis
|
|
|
What causes a thrill in RV?
|
VSD
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
|
|
|
a?
|
Contraction of RA
|
|
|
x?
|
Contraction of RV
|
|
|
c?
|
Radiation to carotid
|
|
|
y?
|
filling of RA
|
|
|
v?
|
filling of RV
|
|
|
What causes the a wave to be absent?
|
asystole
a-fib |
|
|
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
ASD |
|
|
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 CHF |
