Cv

Front 1

Disorders Assoc w/ CV Defects1

Back 1

1. Downs - endocardial cushion defects (ASD, regurgitant valves)
2. DiGeorge- tet of Fallot - interrupted aortic arch
3. Friedrich's ataxia - hypertrophic cardiomyopathy
4. Marfan Syndrome - cystic medial necrosis of aorta
5. Tuberous sclerosis - valve obstruction from rhabdomyoma
6. Diabetic mother - transpos GV's

Front 2

Carotid Sheath

Back 2

1. Internal jugular vein (lateral)

2. Common carotid artery (medial)

3. Vagus Nerve (posterior)

V
A
N

Front 3

Mediastinum

Back 3

Anterior-->Posterior

1. Adipose w/ thymus remnants
2. R/L brachiocephalic veins
3. SVC
4. Aorta & brachiocephalic trunk
5. L common carotid and L subclavian arteries
6. Trachea
7. Esophagus
8. Thoracic duct

Front 4

Auscultation

Back 4

Aortic area:
- systolic murmur (AS)

Pulmonic area:
- sys ejection murmur (Pulm Sten, ASD)

Tricuspid Area:
- pansys murmur (tricus regurg, VSD)
- diast murmur (tricus sten, ASD)

Mitral area:
- sys murmur (MR)
- dias murmur (MS)

Left sternal border:
- sys murmur (hypertrophic cardiomyopathy)
- diast murmur (AR, pulmonic regurg)

Front 5

CV equations

Back 5

CO = SV x HR

MAP(afterload) = CO x TPR

Pulse pressure ~ SV

Force of contraction ~ initial length of muscle fiber (=preload)
Ejec Fraction >55% (nl)

Front 6

Resistance, Pressure, Flow

Back 6

Total resistance in series = R1 + R2 + R3

Total resistance in parallel = 1/R1 + 1/R2 + 1/R3 (*remember to invert your final answer!!)
Arterioles = account for most of TPR (thus they regulate cap flow)

Viscosity - mostly depends on Hct
Inc in 1. Polycythemia, 2. Hyperproteinemia (MM), 3. Hered spherocytosis

Resistance ~ Viscosity

Front 7

Atrial Natriuretic Peptide (ANP)

Back 7

28AA peptide secreted by atrial myocytes in response to atrial stretch (=sys vol expansion)

Decreases BP via periph dilation, natriuresis, diuresis
Binds to NPR-A on cell membranes and activates guanylate cyclase --> inc cGMP

Organs:
1. Kidney - dilate afferent arterioles, inc GFR, urinary Na+/H20 excretion, limit Na+ reabsorption, inhib renin
2. Adrenal gland - restrict aldosterone secretion
3. BV's - relax smooth m, vasodilate, inc cap permeability --> fluid extravasation into interstitium to decrease circ BV

Front 8

Abnormal Heart Sounds

Back 8

S3 = early diastole; rapid ventricular filling phase - common in dilated ventricles
- pt in lateral (left) decubital position or exhale completely to dec lung volume and bring heart closer to chest wall

S4 = late diastole; atrial kick - high atrial pressure. Ventric hypertrophy (LA pushing against stiff LV)

Front 9

JVP

Back 9

3 main peaks:
1. a wave - atrial contraction (ABSENT in Afib)

2. c wave - RV contraction (tricuspid valve bulging into atrium)

3. v wave - inc atrial P due to filling against closed tricuspid valve (max atrial filling)

Front 10

S2 splitting

Back 10

Occurs bc aortic valve closes before pulmonic valve

1. Wide splitting = pulm stenosis

2. Fixed splitting = ASD

3. Paradoxical splitting = AS

Front 11

Valsalva maneuver

Back 11

Bear down on closed glottis

Systolic murmurs in L heart

Dec venous return to heart, dev LV vol and BP

MVP & hypertrophic cardiomyopathy more audible
AS less audible

Front 12

MR

Back 12

holosystolic murmur

loudest at APEX, radiates toward AXILLA

Front 13

AS

Back 13

cresc-decresc sys murmur

Ejection click

Radiates to carotids/neck

Pulsus parvus et tardus
Syncope

Age-related calcified aortic sten

Front 14

VSD

Back 14

holosys harsh murmur
loudest at tricuspid area

Front 15

MVP

Back 15

late sys murmur w/ midsys click

Loudest @ S2

Front 16

AR

Back 16

blowing diastolic murmur

Wide pulse pressure

Head bobbing w/ carotid pulsations

Front 17

MS

Back 17

After opening snap

late diastolic murmur

heard at Apex

LA dilation --> Ortner syndrome (impinge on L recurrent laryngeal n = hoarseness)

Front 18

PDA

Back 18

continuous machine murmur (sys +dias)
Loudest at S2

Fetal period: R-L shunt (nl); should close after birth
Neonatal: L-R shunt w/ RVH + failure (abnl)

Patency: PGE2 synth

Front 19

Which side is valvular defect on?

Back 19

If murmur loudest during inspiration:
Defect on R side b/c more blood flows into RA

If murmur loudest during expiration:
Defect on L side b/c more blood flows into LA

Front 20

Cardiac myocyte v. Skeletal muscle

Back 20

Cardiac depends on EC Ca+ (Ca-induced Ca release!)
Skel depend on IC Ca+ (thus resist to CCBs)

Cardiac muscle:
1. PLATEAU - Ca+ influx
2. Spontan depol = automaticity (If channels)
3. Gap jxns - electricle coupling

Front 21

Ventric AP

Back 21

Phase 0 = rapid upstroke; Na+ channels open
Phase 1 = initial repol: inactiv Na+ channels, K+ channels begin to open
Phase 2 = plateau - Ca2+ channels balance K+ efflux; Ca-induced Ca release from SR --> myocyte contraction
Phase 3 = rapid repol = MASSIVE K+ efflux, close Ca+ channels
Phase 4 = resting potential (high K perm)

** COMPARE TO PACEMAKER AP**

Front 22

Pacemaker AP

Back 22

- no v-gated Na+ channels --> slow conduct vel
- no plateau
- Phase 4 slope determines HR (If Na+)

Front 23

Impaired SA node

Back 23

rate of SA node = 70-80 bpm

If impaired, AV cells take over = 45-55 bpm
- no P waves (= atrial depol)
- normal QRS (= ventric depol normally)

AP velocity slowest in AV node, fastest in Purkinje system

Front 24

Congenital QT Interval Prolongation

Back 24

1/5000 pts
predisp to syncope, ventric tachy (torsades)

mut's in genes for cardiac cell K or Na channels

Jervell & Lange-Nielsen syndrome (AR)
- accomp by congen neurosensory deafness

Front 25

ECG

Back 25

P wave = atrial depol
PR interval = conduc delay through AV
QRS = ventric depol (atrial repol occurs here)

QT interval = ventric contraction
T wave = ventric repol

ST segment = ventric depol
U wave = hypokalemia/brady

Front 26

Binge drinking

Back 26

Can cause Afib

- absent P waves (b/c uncoord atrial contractions)
- irreg irreg QRS complexes

Front 27

Wolff Parkinson White Syndrome

Back 27

Delta wave on ECG

Accessory pathway from Atria-->Ventric
Bypasses AV Node

May result in supraventric tachy

Front 28

Baroreceptors

Back 28

Aortic Arch
- vagus nerve transmission to medulla
- only responds to inc BP

Carotid sinus
- only via glossopharyngeal nerve to medulla
- responds to dec and inc BP

Front 29

Cushing triad

Back 29

HTN, brady, resp dep

- caused by central chemoreceptor which is responding to PCO2 and causing inc ICP, constricting arterioles and leading to cerebral ischemia --> HTN and reflex brady

Front 30

Heart Circulation

Back 30

Increased oxygen demand met by increased coronary blood flow, not increased O2 extraction

Front 31

Capillary fluid exchange

Back 31

Starling forces - determine fluid movement through cap membranes

Pnet = [(Pc-Pi) - (pc-pi)]
Kf = filt constant
Net fluid flow = Pnet(Knet)

Front 32

R-L shunts
Blue Babies

Back 32

1. Tet of Fallot
2. Transpos GV's
3. Truncus arteriosus
4. Tricuspid atresia
5. Total anomalous pulmonary venous return

Front 33

L-R shunts
Blue Kids

Back 33

1. VSD - MCC
2. ASD - loud S1, wide S2
3. PDA - indomethacin closes
* can all result in Eisenmenger's syndrome (shunt becomes R-L, clubbing, polycythemia)

Front 34

Tet of Fallot

Back 34

Etiology: anterosuperior displacement of infundibular septum
1. Pulm stenosis - most important px factor
2. RVH
3. Overriding aorta
4. VSD

Pt squats to improve sx's via femoral artery compression to dec R-L shunt and direct more blood into lungs

Front 35

Coarctation of Aorta

Back 35

Infantile type:
Preductal aortic stenosis

Adult type:
Postductal aortic stenosis - rib notching (collateral circ) + HTN in UE's + hypoTN in LE's (check femoral pulses on P/E)
Turner's association
Can cause aortic regurg
Usu bicuspid aortic valve