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112 Cards in this Set

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Fick's Law for CO =
(rate of O2 use) / (arterial O2 content - venous O2 content)
1/3 sys + 2/3 dias
pulse pressure estimates..
stroke volume
afterload can be approximated by …
diastolic blood pressure? systolic blood P? trying to estimate systemic R, so ∆P?
things that decrease contractility
b1 blockers, acidosis, hypoixa, calcium channel blockers
nitroglycerin: veno or arteriodilator
venodilator. dec preload
hydralazine: ven or arteriodilator
arteriodilator. dec afterload.
NL EF? index of?
>55%. contractility
3 situations a/w inc viscosity
1) polycythemia 2) hyperproteinacious state (MM, waldenstrom) 3) hereditary spherocytosis
during which part of the cardiac cycle is O2 consumption the highest
isovolumetric contraction
fixed S2 split + systolic murmur =
normal S2 splitting
on inspiration A2 before P2
paradoxical splitting =
aortic stenosis
draw cardiac myocyte membrane with transporters and leak currents
why is phase O slow in pacemaker cells? effect at AV node?
no fast Na+ channels. slow conduction through AV.
PR segment =
delay through AV node (< 200 ms)
QRS segment =
ventricular depol < 120 ms
QT =
mechanical contraction of ventricles
U wave. draw it. what's it caused by
Wolf-Parkinson-White syndrome
*bundle of kent* = accessory pathway from A to V, bypass AV => early ventricular depol => *delta wave*. (Reentry => SVT)
EKG: Afib
irreg irreg QRS. no discrete p.
EKG: Atrial flutter
sawtooth: consecutive ID p.
EKG: AV block, 1°
long PR (>200ms). ASx
EKG: AV block, 2° Mobitz type I
Wenckebach. Progressively longer PR until QRS is dropped (p w/o QRS). Usually ASx
EKG: AV block, 2° Mobitz type II
Normal PR w/ some dropped QRS. Often 2:1. May progress to 3°
EKG: AV Block, 3°
"complete". a, v beat independently. a faster than v. tx: pace.
Baroreceptors (3) and nerves
1) aortic arch => vagus => medulla (respond to inc bp only) 2) carotid sinus => cn 9 => medulla. 3) atrial stretch: dec => dec afferent sig (imp: hemorrhage)
Cushing reaction
cerebal ischemia sensed by brain chemoreceptors (check interstitial fluid: CO2, pH). => hypertension + BRADYcardia
NL RA pressure
< 5
NL LA pressure
NL PA pressure
NL RA pressure
NL RV pressure
how does heart get more O2 when it needs it
increased coronary flow, not increased O2 extraction
Autoregulation: skin. how?
temperature => sympathetic
Autoregulation: heart. how?
adenosine, O2, NO
Autoregulation: brain. how?
CO2 (pH)
Autoregulation: kidney. how?
myogenic and tubuloglomerular feedback
Autoregulation: lungs. how?
hypoxia => vasoconstriction
Autoregulation: skeletal muscle. how?
adenosine, lactate, K+
causes of edema
Inc K: burn, toxins, infection. Inc Pc: vol overload (heart failure). Dec πc: nephrotic syndrome, liver failure. Inc πi: lymphatic blockage.
Early cyanotic congenital heart defects
1) tetrology of fallot 2) transposition of great arteries 3) truncus arteriosus
Late cyanotic congenital heart defects
1) VSD 2) ASD 3) PDA
tetrology of fallot
1) pulmonic stenosis 2) RVH 3) overriding aorta 4) VSD. b/c anterior/superior displacement of infundibular septum. boot shaped heart on XRAY (RV)
boot shaped heart on x ray
transposition of great arteries
aorticopulmonary septum fails to spiral (neural crest cells). req to live: shunt (VSD, ASD, PDA). give PGE.
Coarctation of the aorta - infantile
pre-ductal. male > female.
coarctation of the aorta - adult
post-ductal. male> female. weak lower pulse extremity. inc bp arms. notching of ribs.
notching of ribs
adult coarctation of aorta.
congenital heart defect: 22q11
tetrology, truncus
congenital heart defect: Down
endocardial cushion: ASD, VSD
congenital heart defect: congenital rubella
late cyanosis: ASD, VSD, PDA
congenital heart defect: Turner
congenital heart defect: Marfan
aortic insufficiency
congenital heart defect: DM
Congenital heart defects: which diseases?
22q11, Down, Congenital rubella, Diabetes, Turner, Marfan
xanthomas often found in…
eyelids (plaques or nodules of lipid-laden histiocytes). tendon: achilles.
corneal arcus
lipid deposit in cornea. nonspecific.
Mockeberg arterosclerosis
calficiation of arteries (esp radial, ulnar). usually benign
Arteriosclerosis - essential hypertension
hyalin thickening of small arteries
arteriosclerosis - malignant hypertension
onion skin hyperplasia
atherosclerosis - most common locations in order
abdominal aorta > coronary > popliteal > carotid
Red/hemorrhagic infarct. when/where
1) "loose" tissues w/ colateral circulation: lung, liver, GI 2) reperfusion injury
Pale infarct. when/where
solid tissues w/ no colateral circulation. Spleen, heart, kidney, brain.
Infaract: PMN when
1 (to 5) days
Infarct: M phage when
3 (to 7) days
Infarct: granulation tissue when
7 days
Infarct: complete scar when
recent infarct is pale with stain
relative frequency of coronary artery occlusion
LAD > RCA > circumflex
MI: CK-MB, TI. thresh, peak, neg
CK-MB: 6 hours, 1 day, 2 days. Troponin I: 6 hours, 1 day, 7 days
Transmural MI. EKG?
ST elevation, pathologic q waves
Subendocardial MI. EKG?
ST depression
Some complications post MI?
arrhythmia, LV failure, shock, RUPTURE (free wall, interventricular septum, papillary muscle), aneurysm (arrhythmia, CO down, embolus), fibrinous pericarditis, dressler's syndrome
post MI rupture? what kinds, when
4-7 days post MI. free wall => tamponade, interventricular septum, papillary muscle.
Dilated cardiomyopathy. result, causes
systolic dysfunction. ABCDph: Alcohol, Beriberi (th1amine B1), Cocaine Coxsackie B Chagas, Doxorubicin, post partum, hemochromatosis
Hypertrophic cardiomyopathy. result, causes
diastolic dysfunction. 50%=AD. cause of sudden death in athletes. Tx: beta blockers
Restrictive cardiomyopathy. causes
sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis, endomyocardial fibrosis (Loffler's).
Pulsus parvus et tardus
Aortic stenosis
aortic stenosis radiation
to carotids or apex
Mitral valve prolapse: murmur?
mid systolic click => late systolic murmur. most common valvular lesion.
Aortic regurgitation: murmur, bp?
diastolic, high pitched, blowing, right after S2. wide pulse pressure
Mitral stenosis: murmur, vs. tricuspid
diastolic, opening snap, delayed after S2. LAP>>LVP. tricuspid louder w/ inspiration
PDA murmur
continuous machine like murmur. loudest ~S2
Fibrinous pericarditis vs dressler's syndrome
fibrinous: 3-5 days post MI. Dressler: several weeks, autoimmune.
myxoma. demographic, location
adults. LA. "ball-valve" obstruction
rhabdomyoma. demographic, a/w
kids. tuberous sclerosis
heart failure cells
hemosiderin laden macrophages in lungs
Nutmeg liver
RVH => P back up to liver => congestion around central veins
Virchow's triad
stasis, hypercoagulability, endothelial damage => thrombosis
pulsus paradoxus
>10mmHg drop in blood pressure with inspiration. tamponade
tamponade findings
*equilibration in chamber P, pulsus paradoxus, electrical alternans.* hypoT, JVD, distant heart sounds
electrical alternans
beat-to-beat variations in QRS height. tamponade
cause of acute bacterial endocarditis
staph aureus
cause of subacute bacterial endocarditis
strep viridans
findings in bacterial endocarditis
bacteria FROM JANE. Fever, Roth's spots, Osler's nodes, Murmur, Janeway lesions, Anemia, Nailbed splinter hemorrhages, Emboli
roth's spots
bacterial endocarditis. white spots in retina, surrounded by hemorrhage
osler's nodes
tender raised lesions on finger or toe pads
janeway lesions
small erythematous lesiions on palms and soles
metastasis, renal failure, libman-sacks endocarditis
libman-sacks endocarditis
SLE. vegetations on both sides of valve. don't embolize
complications of bacterial endocarditis
chordae rupture, glomerulonephritis, suppurative pericarditis, emboli
mc valve in bacterial endocarditis
mitral. tricuspid in IV.
Rheumatic fever. cause by
Group A strep *pharyngitis*.
Rheumatic fever, when, physical findings
weeks after group A strep pharyngitis: type II hypersensivity. FEVERSS: Fever, Erythema marginatum, Valvular damage, ESR inc, Red hot joints, Subcutaneous nodules, St. Vitus' dance (chorea).
Rheumatic fever, histology
Aschow bodies: fibrinoid necrosis w/ giant cells + antischkow cells (plum mphage)
Serous pericarditis, causes
SLE, RA, inefection, *uremia*
Fibrinous pericarditis, causes
RF, *uremia*
Hemorrhagic pericarditis, causes
Tb, malignancy (melanoma)
Pericarditis findings
pain, friction rub, ECG (difuse ST elevations), pulsus paradoxus, distant heart sounds
peridcarditis long term
resolve or constrictive pericarditis
Syphilitic heart dz
3° syphilis. damage to vaso vasorum. dilation or calcification of aortic root, promixmal aorta => aortic regurg, aneurysm