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78 Cards in this Set
- Front
- Back
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How is cardiac output affected during exercise?
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Increases:
1st due to increase in SV later due to increased HR |
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What causes a narrowed pulse pressure?
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AS, hypertrophic CM, shock, HTN
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What causes a widened pulse pressure?
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AR/MR, hyperthyroidism, thiamine deficiency, metabolic acidosis
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What causes decreased contractility?
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Beta blockers (decreased cAMP), Heart failure (systolic dysfunction), acidosis, hypoxia/hypercapnea, non-dihydropyridine Ca-channels
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When is the period of highest O2 consumption?
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Isovolumetric contraction- Period between when the mitral valve closes and the aortic valve opens.
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What is S3?
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Associated with increased filling pressures and more common in dilated ventricles. Occurs in the rapid filling phase of early diastole.
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What is S4?
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Atrial kick; High atrial pressure associated with ventricular hypertrophy.
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What is the a wave on the JVP?
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Atrial contraction
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What is the c wave on the JVP?
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RV contraction (closed tricuspid valve bulging into the atrium)
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What is the x descent on the JVP?
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Ventricles emptying (tricuspid relaxes)
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What is the v wave on the JVP?
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Increased right atrial pressure due to filling against a closed tricuspid valve
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What is the y descent?
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Ventricles fill (diastole)
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What causes wide splitting?
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Pulmonic stenosis, RBBB
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What causes fixed splitting?
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ASD
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What causes paradoxical splitting?
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Aortic stenosis, LBBB (split moves closer together on inspiration instead of getting worse)
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What increases the intensity of mitral regurgitation murmurs?
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Anything that increases TPR: squatting, hand grip or LA return: expiration
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What increases the intensity of tricuspid regurgitation murmurs?
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Anything that increases RA return: inspiration
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What determines the severity of Mitral regurgitation?
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Presence of an S3
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What murmur is associated with pulsus parvus et tardus?
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Aortic stenosis- Not enough blood is going through the aortic valve so the pulse won't be as strong
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What enhances VSD murmur?
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Inspiration (also has a palpable thrill)
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What causes the mid-systolic click in MVP?
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Sudden tensing of the chordae tendinae
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What enhances MVP murmur?
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Increased TPR: Squatting, hand grip
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What moves the mid-systolic click of MVP closer to S1?
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Standing up, Valsalva, anxiety (decrease venous return to the right heart)
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What moves the mid-systolic click of MVP closer to S2?
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Lying down, clenched fist
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What murmur is associated with bounding pulses and head bobbing?
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Aortic regurgitation- due to widened pulse pressure from increased LV stroke volume (diastolic pressure decreased, systolic normal).
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What causes the opening snap of MS?
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Sudden tensing of the chordae tendineae
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What increases the intensity of MS?
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Maneuvers that increase LA return (expiration)....this distinguishes OS from S2 because S2 is enhanced by inspiration. It is eliminated by atrial fibrillation
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What determines the severity of MS?
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A2-OS interval
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What is the murmur of hypertrophic cardiomyopathy?
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Systolic ejection murmur increased by Valsalva or standing
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What diastolic murmur is DECREASED by vasodilators?
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AR
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How does valsalva affect murmurs?
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Decreases venous return to the right heart, decreases CO, increases HR to compensate.
Increases intensity of hypertrophic cardiomyopathy, moves mid-systolic click of MVP closer to S1, and decreases the intensity of the murmur in AS |
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What does the QT interval represent and what can change its length?
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Ventricular contraction; Prolonged with decreased Ca, shortened with increased Ca
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What does ANP do?
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In response to increased blood volume and atrial pressure it constricts the renal efferent arterioles and dilates the afferent arterioles.This promotes diuresis and tones down the RAAS.
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Which baroreceptor only responds to increased bp?
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Aortic arch via vagus to medulla
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Which baroreceptor responds to increased and decreased blood pressure?
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carotid sinus via CN IX to solitary nucleus of the medulla
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What do peripheral chemoreceptors respond to?
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Decreased PO2 (<60 mmHg) and increased PCO2. Also decreased blood pH
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What do central chemoreceptors respond to?
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pH and PCO2 of brain interstitial fluid, which is due to arterial CO2 (Do NOT directly respond to PO2)
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What is the Cushing reaction?
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Increased ICP conpresses arterioles and leads to cerebral ischemia. The sympathetic response is hypertension which then causes reflex bradycardia via the baroreceptors.
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What is the Cushing triad?
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Hypertension (widened pulse pressure), bradycardia, respiratory depression. THINK ICP.
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What organ has the largest AV O2 difference?
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Heart- oxygen is 100% extracted; increased O2 demand is met by increased coronary blood flow, NOT by more extraction of O2
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Which organ has the largest share of systemic CO?
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Liver
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Which organ has the highest blood flow per gram of tissue?
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Kidney
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What congenital heart defect is associated with anterior displacement of the infundibular septum?
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TOF
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What congenital heart defect is associated with squatting to improve symptoms?
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TOF
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What congenital heart defect is associated with late cyanosis in the lower extremities (differential cyanosis)
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PDA that is uncorrected
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What congenital heart defect is associated with DiGeorge syndrome?
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Truncus arteriosus, TOF
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What is Monckeberg arteriosclerosis?
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Calcification in the MEDIA of the arteries, especially the radial and ulnar arteries; it is usually benign (pipestem arteries) and does NOT obstruct blood flow because the intima is not involved.
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What is the MCC of sudden cardiac death?
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CAD causes acute plaque change, which leads to acute myocardial ischemia and v-fib
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How long does it take for the heart to lose contractility after total myocardial ischemia?
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Aerobic glycolysis stops within seconds and results in decreased ATP so that contractility is lost and lactate increases within 60s
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What happens at 5-10 days post MI
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Risk for free wall rupture, tamponade, papillary muscle rupture (get severe MR), interventricular septal rupture and severe VSD (macrophages have degraded structural components).
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What can happen 3-5 days post MI?
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Fibrinous pericarditis
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What will you see in hypertrophic cardiomyopathy?
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S4, systolic murmur that is decreased with increased LV volume (squat, lie down, beta blocker) and increased with decreased LV volume (valsalva, digitalis, venodilators)
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What do hemosiderin-laden macrophages in the lung indicate?
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Microhemorrhages from increased pulmonary capillary pressure due to LV failure
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What can cause high output heart failure?
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Increased SV (hyperthyroidism, increased blood volume); Decreased blood viscosity- anemia; decreased TPR (thiamine deficiency, endotoxic shock, metabolic acidosis)
AV fistula- Paget's disease of the bone |
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What are complications of bacterial endocarditis?
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Chordae rupture, glomerulonephritis, supperative pericarditis, emboli
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What is seen in rheumatic fever?
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Fever, erythema marginatum, valvular damage (vegetation and fibrosis- MVP early lesion; late MS), ESR is increased, red-hot joints (migratory polyarthritis), subcutaneous nodules (fibrinoid necrosis), chrorea
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What is the MCC of death in rheumatic fever?
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Myocarditis
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What is Beck's triad?
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Hypotension, JVD, Distant heart sounds
Seen in cardiac tamponade |
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What is associated with diastolic pressures being equal in all 4 chambers?
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Tamponade
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What conditions do you see pulsus paradoxus?
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Cardiac tamponade, asthma, obstructive sleep apnea, croup, SLE
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What is associated with electrical alternans?
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Tamponade
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What are symptoms of pericarditis?
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Sharp, pleuritic pain that gets better when the patient leans forward, friction rub, distant heart sounds, ST elevation in multiple leads
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What is seen in constrictive pericarditis?
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Pericardial knock, Kaussmaul's sign (JVD with inspiration- also seen in cardiac tumors), calcified pericardium on CT; Caused by TB or heart surgery. It is CHRONIC (takes months to years)
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What is characterized by focal necrotizing vasculitis, necrotizing granulomas in the lung and upper airway, and necrotizing GN?
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Wegener's- present with hemoptysis, hematuria, perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea; treat with cyclophosphamide and corticosteroids
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What vasculitis is associated with peripheral neuropathy (foot drop/wrist drop)?
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Churg-Strauss
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What is associated with rash on the buttocks and legs, arthritis (knee), and melena?
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HSP
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What is associated with intermittent claudication, Raynaud's, gangrene, severe pain in the affected part, and smoking?
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Buerger's (aka thromboangiitis obliterans)
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What is associated with fibrinoid necrosis, renal vessels, NOT pulmonary arteries, and lesions of different ages?
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PAN
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What is the Fick Principle?
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CO = rate of O2 consumption/(arterial O2 content - venous O2 content)
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What increases preload?
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Exercise, increased blood volume (overtransfusions, AV shunts, pregnancy), and excitement (sympathetics)
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What is the x-intercept on the venous return curve?
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Mean systemic pressure
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What murmurs are heard at the left sternal border?
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Diastolic- AR/PR
Systolic- Hypertrophic cardiomyopathy |
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Which murmur is a late complication of Marfan's syndrome?
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Aortic insuficiency
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What ECG finding would you have with Prinzmetal's angina?
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ST elevation
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What are varicose veins?
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Dilated, tortuous superficial veins due to chronically increased venous pressure. Predisposes to poor wound healing and varicose ulcers, NOT thromboembolism!
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What is associated with fevers, arthritis, night sweats, myalgia, skin nodules, ocular disturbances, and weak pulses in the UE?
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Takayasu's- granulomatous thickening of the aortic arch and/or proximal great vessels
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What is a pyogenic granuloma?
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Polypoid capillary hemangioma of that can ulcerate and bleed; associated with trauma and pregnancy on skin, gingiva, or oral mucosa usually
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What is Jervell and Lange-Nielsen syndrome?
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Congenital long QT syndrome due to defects in cardiac sodium or potassium channels. Presents with severe congenital sensorineural deafness
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