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112 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Fick's Law for CO =
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(rate of O2 use) / (arterial O2 content - venous O2 content)
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MAP =
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1/3 sys + 2/3 dias
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pulse pressure estimates..
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stroke volume
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afterload can be approximated by …
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diastolic blood pressure? systolic blood P? trying to estimate systemic R, so ∆P?
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things that decrease contractility
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b1 blockers, acidosis, hypoixa, calcium channel blockers
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nitroglycerin: veno or arteriodilator
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venodilator. dec preload
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hydralazine: ven or arteriodilator
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arteriodilator. dec afterload.
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NL EF? index of?
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>55%. contractility
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3 situations a/w inc viscosity
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1) polycythemia 2) hyperproteinacious state (MM, waldenstrom) 3) hereditary spherocytosis
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during which part of the cardiac cycle is O2 consumption the highest
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isovolumetric contraction
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fixed S2 split + systolic murmur =
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ASD
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normal S2 splitting
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on inspiration A2 before P2
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paradoxical splitting =
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aortic stenosis
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draw cardiac myocyte membrane with transporters and leak currents
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aight.
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why is phase O slow in pacemaker cells? effect at AV node?
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no fast Na+ channels. slow conduction through AV.
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PR segment =
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delay through AV node (< 200 ms)
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QRS segment =
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ventricular depol < 120 ms
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QT =
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mechanical contraction of ventricles
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U wave. draw it. what's it caused by
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hypokalemia.
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Wolf-Parkinson-White syndrome
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*bundle of kent* = accessory pathway from A to V, bypass AV => early ventricular depol => *delta wave*. (Reentry => SVT)
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EKG: Afib
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irreg irreg QRS. no discrete p.
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EKG: Atrial flutter
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sawtooth: consecutive ID p.
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EKG: AV block, 1°
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long PR (>200ms). ASx
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EKG: AV block, 2° Mobitz type I
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Wenckebach. Progressively longer PR until QRS is dropped (p w/o QRS). Usually ASx
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EKG: AV block, 2° Mobitz type II
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Normal PR w/ some dropped QRS. Often 2:1. May progress to 3°
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EKG: AV Block, 3°
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"complete". a, v beat independently. a faster than v. tx: pace.
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Baroreceptors (3) and nerves
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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)
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Cushing reaction
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cerebal ischemia sensed by brain chemoreceptors (check interstitial fluid: CO2, pH). => hypertension + BRADYcardia
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NL RA pressure
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< 5
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NL LA pressure
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<25/5
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NL PA pressure
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<25/10
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NL RA pressure
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<12
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NL RV pressure
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<25/5
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None
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how does heart get more O2 when it needs it
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increased coronary flow, not increased O2 extraction
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Autoregulation: skin. how?
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temperature => sympathetic
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Autoregulation: heart. how?
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adenosine, O2, NO
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Autoregulation: brain. how?
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CO2 (pH)
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Autoregulation: kidney. how?
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myogenic and tubuloglomerular feedback
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Autoregulation: lungs. how?
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hypoxia => vasoconstriction
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Autoregulation: skeletal muscle. how?
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adenosine, lactate, K+
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causes of edema
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Inc K: burn, toxins, infection. Inc Pc: vol overload (heart failure). Dec πc: nephrotic syndrome, liver failure. Inc πi: lymphatic blockage.
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Early cyanotic congenital heart defects
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1) tetrology of fallot 2) transposition of great arteries 3) truncus arteriosus
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Late cyanotic congenital heart defects
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1) VSD 2) ASD 3) PDA
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tetrology of fallot
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1) pulmonic stenosis 2) RVH 3) overriding aorta 4) VSD. b/c anterior/superior displacement of infundibular septum. boot shaped heart on XRAY (RV)
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boot shaped heart on x ray
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RVH
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transposition of great arteries
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aorticopulmonary septum fails to spiral (neural crest cells). req to live: shunt (VSD, ASD, PDA). give PGE.
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Coarctation of the aorta - infantile
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pre-ductal. male > female.
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coarctation of the aorta - adult
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post-ductal. male> female. weak lower pulse extremity. inc bp arms. notching of ribs.
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notching of ribs
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adult coarctation of aorta.
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congenital heart defect: 22q11
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tetrology, truncus
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congenital heart defect: Down
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endocardial cushion: ASD, VSD
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congenital heart defect: congenital rubella
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late cyanosis: ASD, VSD, PDA
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congenital heart defect: Turner
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coarctation
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congenital heart defect: Marfan
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aortic insufficiency
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congenital heart defect: DM
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transposition
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Congenital heart defects: which diseases?
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22q11, Down, Congenital rubella, Diabetes, Turner, Marfan
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xanthomas often found in…
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eyelids (plaques or nodules of lipid-laden histiocytes). tendon: achilles.
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corneal arcus
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lipid deposit in cornea. nonspecific.
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Mockeberg arterosclerosis
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calficiation of arteries (esp radial, ulnar). usually benign
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Arteriosclerosis - essential hypertension
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hyalin thickening of small arteries
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arteriosclerosis - malignant hypertension
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onion skin hyperplasia
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atherosclerosis - most common locations in order
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abdominal aorta > coronary > popliteal > carotid
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Red/hemorrhagic infarct. when/where
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1) "loose" tissues w/ colateral circulation: lung, liver, GI 2) reperfusion injury
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Pale infarct. when/where
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solid tissues w/ no colateral circulation. Spleen, heart, kidney, brain.
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Infaract: PMN when
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1 (to 5) days
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Infarct: M phage when
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3 (to 7) days
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Infarct: granulation tissue when
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7 days
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Infarct: complete scar when
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months
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Tetrazolium
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recent infarct is pale with stain
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relative frequency of coronary artery occlusion
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LAD > RCA > circumflex
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MI: CK-MB, TI. thresh, peak, neg
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CK-MB: 6 hours, 1 day, 2 days. Troponin I: 6 hours, 1 day, 7 days
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Transmural MI. EKG?
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ST elevation, pathologic q waves
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Subendocardial MI. EKG?
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ST depression
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Some complications post MI?
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arrhythmia, LV failure, shock, RUPTURE (free wall, interventricular septum, papillary muscle), aneurysm (arrhythmia, CO down, embolus), fibrinous pericarditis, dressler's syndrome
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post MI rupture? what kinds, when
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4-7 days post MI. free wall => tamponade, interventricular septum, papillary muscle.
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Dilated cardiomyopathy. result, causes
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systolic dysfunction. ABCDph: Alcohol, Beriberi (th1amine B1), Cocaine Coxsackie B Chagas, Doxorubicin, post partum, hemochromatosis
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Hypertrophic cardiomyopathy. result, causes
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diastolic dysfunction. 50%=AD. cause of sudden death in athletes. Tx: beta blockers
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Restrictive cardiomyopathy. causes
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sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis, endomyocardial fibrosis (Loffler's).
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Pulsus parvus et tardus
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Aortic stenosis
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aortic stenosis radiation
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to carotids or apex
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Mitral valve prolapse: murmur?
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mid systolic click => late systolic murmur. most common valvular lesion.
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Aortic regurgitation: murmur, bp?
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diastolic, high pitched, blowing, right after S2. wide pulse pressure
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Mitral stenosis: murmur, vs. tricuspid
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diastolic, opening snap, delayed after S2. LAP>>LVP. tricuspid louder w/ inspiration
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PDA murmur
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continuous machine like murmur. loudest ~S2
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Fibrinous pericarditis vs dressler's syndrome
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fibrinous: 3-5 days post MI. Dressler: several weeks, autoimmune.
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myxoma. demographic, location
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adults. LA. "ball-valve" obstruction
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rhabdomyoma. demographic, a/w
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kids. tuberous sclerosis
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heart failure cells
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hemosiderin laden macrophages in lungs
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Nutmeg liver
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RVH => P back up to liver => congestion around central veins
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Virchow's triad
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stasis, hypercoagulability, endothelial damage => thrombosis
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pulsus paradoxus
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>10mmHg drop in blood pressure with inspiration. tamponade
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tamponade findings
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*equilibration in chamber P, pulsus paradoxus, electrical alternans.* hypoT, JVD, distant heart sounds
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electrical alternans
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beat-to-beat variations in QRS height. tamponade
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cause of acute bacterial endocarditis
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staph aureus
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cause of subacute bacterial endocarditis
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strep viridans
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findings in bacterial endocarditis
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bacteria FROM JANE. Fever, Roth's spots, Osler's nodes, Murmur, Janeway lesions, Anemia, Nailbed splinter hemorrhages, Emboli
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roth's spots
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bacterial endocarditis. white spots in retina, surrounded by hemorrhage
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osler's nodes
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tender raised lesions on finger or toe pads
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janeway lesions
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small erythematous lesiions on palms and soles
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NBTE
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metastasis, renal failure, libman-sacks endocarditis
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libman-sacks endocarditis
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SLE. vegetations on both sides of valve. don't embolize
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complications of bacterial endocarditis
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chordae rupture, glomerulonephritis, suppurative pericarditis, emboli
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mc valve in bacterial endocarditis
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mitral. tricuspid in IV.
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Rheumatic fever. cause by
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Group A strep *pharyngitis*.
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Rheumatic fever, when, physical findings
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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).
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Rheumatic fever, histology
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Aschow bodies: fibrinoid necrosis w/ giant cells + antischkow cells (plum mphage)
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Serous pericarditis, causes
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SLE, RA, inefection, *uremia*
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Fibrinous pericarditis, causes
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RF, *uremia*
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Hemorrhagic pericarditis, causes
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Tb, malignancy (melanoma)
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Pericarditis findings
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pain, friction rub, ECG (difuse ST elevations), pulsus paradoxus, distant heart sounds
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peridcarditis long term
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resolve or constrictive pericarditis
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Syphilitic heart dz
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3° syphilis. damage to vaso vasorum. dilation or calcification of aortic root, promixmal aorta => aortic regurg, aneurysm
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