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151 Cards in this Set

  • Front
  • Back
supplies the SA and AV nodes
RCA
where are most coronary artery occlusion
LAD
when do coronary arteries fill
diastole
most posterior portion of the heart
left atrium
CO = SV x HR
what happens if HR is too high though
doesn't give heart enough time to fill and decreases CO
MAP = CO x TPR
calculate
2/3 diastolic pressure + 1/3 systolic pressure
pulse pressure
systolic pressure - diastolic pressure
what happens to contractility with decreased extracellular sodium
increased due to decreased activity of Na/Ca exchanger
what does digitalis due to contractility
increases due to increased intracellular Na via Na/K ATPase block, resulting in increased Ca
how does acidosis decrease contractility
H displaces Ca on myofibrils
what do venodilators (nitroglycerin) do to preload
decrease
what is the force of contraction proportion to
prelaod (initial length of cardiac muscle fiber)
index of ventricular contractility
EF
what determines viscosity of blood
what 3 situation is it increased
hematocrit:
polycythemia
hyperproteinemic state (MM)
hereditary spheroccytosis
what does S1 correlate with
mitral and tricuspid valves closing
what does S2 correlate with
aortic and pulmonic valves closing
extra heart sound associated with increased filling pressure
S3
extra heart sound associated with ventricular hypertrophy
S4
what does a wave correlate with in JVP
atrial contraction
what does c wave correlate with in JVP
RV contraction (closed tricuspid valve bulging into R atrium)
what does v wave correlate with in JVP
increased RAP due to filling against closed tricuspid valve
what does x descent correlate with in JVP
pulmonic valve opening
what does y descent correlate with in JVP
tricuspid valve opening
what increases S2 split (A2 - P2)
inspiration - drop in intrathoracic pressure increases capacity of pulmonary circulation, pulmonic valve closes later to accommodate while arotic valve closes earlier because decreased blood return to heart
associated with fixed S2 splitting during inspiration and expiration
ASD
associated with paradoxial splitting in which inspiration causes S2 split to decrease
conditions that delay LV emptying:
aortic stenosis
LBBB
associated with wide S2 splitting
conditions that delay RV emptying:
pulmonic stenosis
RBBB
in general, these heart sounds intensify with inspiration
right-sided heart sounds
pulses parvus et tarus
pulses weak compared to heart sounds - aortic stenosis
heart sound associated with congenital rubella
PDA
which phase of the ventricular action penitential is associated with myocyte contraction
phase 2 (plateau) - Ca influx triggers Ca release from SR and myocyte contraction
which ion is involved in the upstroke (phase 0) of SA/AV node actional potential
Ca channels, instead of fast Na channels like ventricles
what determines the HR in the SA/AV node
slope of phase 4 (I-f Na channel)
ACh/adenosine decrease depolarization and HR, catecholamines increase depolarization and HR
speed of conduction through the heart in decreasing order
purkinje > atria > ventricles > AV node
part of the EKG that is associated with conduction delay through AV node
PR interval
part of EKG associated with atrial depolarization
P wave
ECG associated with ventricle contraction
QT interval
normal time QRS complex takes (ventricular depolarization)
< 120 msec.
normal time during PR interval
< 200 msec.
associated with U wave
hypokalemia
what can congenital long QT syndromes also present with
congenital sensorineural deafness (Lange-Nielsen syndrome)
associated with accessory conduction pathway from atria to ventricle (bundle of Kent) that bypasses AV node
Wolff-Parkinson-White syndrome
*ventricular preexcitation syndrome
associated with characteristic delta wave on ECG and may result in reentry current leading to supraventricular tachycardia
ventricular preexcitation syndrome
irregularly irregular pulse with no discrete P waves in between irregularly spaced QRS complexes
Atrial fibrillation
treatment of Atrial fibrillation
Ca channel blocker or B blocker
Warfarin prophylaxis against thromboembolism
Atrial flutter
rapid succession of atrial depolarization waves (P waves) - multiple P waves in between QRS complex
PR interval is prolonged > 200 msec.
AV block (1st degree heart block)
differentiate Mobitz type I and II 2nd degree heart blocks
type I - progressive lengthening of the PR interval until a QRS complex is dropped
type II - normal PR intervals with a QRS drop randomly
3rd degree heart block
atria and ventricles beat independently of each other, atrial rate is faster than the ventricular rate
infection associated with 3rd degree heart block
lyme disease
completely erratic rhythm with no identifiable waves
ventricular fibrillation
released from the atria in response to increased blood volume and atrial pressure
ANP
associated with vascular ralaxation, constriction of efferent renal arteriole and dilation of the afferent promoting diuresis
ANP
responds only to increased BP via the vagus nerve to the medulla
aortic arch
responds to increased and decreased BP via slossopharyngeal nerve to solitary nucleus
carotid sinus
cushing triad associated with increased ICP
hypertension, bradycardia, respiratory depression
large AV O2 difference because O2 extraction is always 100%
heart - increased O2 demand is met by increased coronary blood flow, not by increased extraction
when is the pulmonary capillary wedge pressure greater than LV diastolic pressure
mitral stenosis
what does hypoxia do in the lungs that is different than other organs
causes vasoconstriction so that only well-ventilated areas are perfused, usually causes vasodilation in other organs
most common cause of early cyanosis in newborn
tetralogy of Fallot
most common congenital cardiac anomaly
VSD
associated with loud S1; wide, fixed split S2
ASD
three causes for late cyanosis, "blue kids"
left-to-right shunts:
VSD
ASD
PDA
5 causes for right-to-left shunts (blue babies)
Tetralogy of Fallot
Transposition of great vessels
Truncus arteriosus
Tricuspid atresia
Total anomalous pulmonary venous return
Eisenmenger's syndrome
L - R shunts eventually reverse to R -L shunts due to increased pulmonary resistance leading to late cyanosis (clubbing and polycythemia)
which heart problems is eisenmenger's syndrome associated with
uncorrected VSD, ASD, PDA
associated with boot-shaped heart, cyanotic spells with the patient learning to squat to improve symptoms
Tetralogy of Fallot
4 components of Tetralogy of Fallot
pulmonary stenosis
RVH
Overriding aorta
VSD
this heart defect is due to failure of the aorticopulmonary septum to spiral
transposition of great vessels
differentiate infantile vs. adult type coarctation of the aorta
infantile - stenosis preductal
adult - stenosis postductal
associated with notching of the ribs, HTN in upper extremities, and weak pulses in lower extremities
adult type coarcation of the aorta
used to keep PDA open, such as in conditions such as transposition of great vessels
PGE2
used to close PDA
indomethacin
heart defects associated with 22q11 syndromes
truncus arteriosus
tetralogy of fallot
heart defects associated with down syndrome
ASD
VSD
AV septal defect
heart defects associated with congenital rubella
septal defects
PDA
pulmonary artery stenosis
heart defect associated with turner syndrome
coarctation of the aorta
heart defect associated with infant with diabetic mother
transposition of great vessels
Monckeberg
calcification in the media of the arteries, especially radial or ulnar
arteriolosclerosis
hyaline thickening of small arteries in essential HTN or DM
atherosclerosis
fibrous plaques and atheromas form in intima of large, elastic arteries
most common places for atherosclerosis
abdominal aorta > coronary artery > popliteal artery > carotid artery
longitudinal intraluminal tear associated with HTN or medial necrosis
aortic dissection
patient presents with tearing chest pain radiating to the back and CXR with mediastinal widening
aortic dissection
Angina associated with ST elevation of ECG
Prinzmetal's variant (coronary artery spasm)
differentiate stable and unstable angina
stable - chest pain with exertion
unstable - worsening chest pain at rest or with minimal exertion
*both show ST depression on ECG
associated with thrombosis with no necrosis
unstable angina
sudden cardiac death
death within 1 hour of onset of symptoms, usually due to lethal arrhythmia
most common places for coronary artery occlusion
LAD > RCA > circumflex
LM after first 2-4 hours of MI
No visible changes
time table associated with dark mottling, pale with tetrazolium stain
first day after MI
time table associated with acute inflammation, hyperemia, coagulative necrosis, and neutrophil emigration
2-4 days after MI
time table in which risk for free wall rupture, tamponade, papillary muscle rupture, and IV septum rupture due to macrophage degredation showing central yellow-brown softening
5-10 days after MI
time table associated with ventricular aneurysm showing gray-white area where occlusion was
7 weeks after MI
heart failure cells
hemosiderin-laden macrophages in the lungs due to increased pulmonary capillary pressure
signs and symptoms associated with bacterial endocarditis
Bacteria FROM JANE:
fever
roth's spots
osler's nodes - raised lesion on finger or toe pads
murmur - new
janeway lesions - erythematous lesion on palm or sole
anemia
nail-bed hemorrhages
emboli
most frequently involved valve in bacterial endocarditis
mitral valve
what is tricuspid valve endocarditis associated with
IV drug
organism associated with large vegetations on previously normal valves, rapid onset (acute)
S. aureus
organism associated with subacute, smaller vegetations on congenitally abnormal or diseased valves
strep viridans (sequela of dental procedures)
bacterial endocarditis organism associated with colon cancer
S. bovis
bacterial endocarditis organism associated with prosthetic vavles
S. epidermidis
wartlike, sterile vegetations occurring on both sides of the valve are associated with what autoimmune disease
SLE (libman-sacks endocarditis)
most affected valve in rheumatic fever
mitral valve > aortic >> tricuspid
type II hypersensitivity due to antibodies against M protein
rheumatic fever
associated with aschoff bodies (granuloma with giant cells), activated histiocytes, and elevated ASO titeres
rheumatic fever
equilibration of diastolic pressure in all 4 chambers
cardiac tamponade
associated with hypotension, increased JVP, distant heart sounds, increased HR, and pulsus paradoxus
cardiac tamponade
associated with exaggerated decrease in amplitude of pulse during inspiration
pulsus paradoxus: cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup
associated with tree bark appearance of the ascending aorta
tertiary syphilis
most common primary cardiac tumor in adults, where are they usually found
myxomas - left atrium
most frequent primary cardiac tumor in children, association
rhabdomyomas
tuberous sclerosis
most common heart tumor
metastases from melanoma or lymphoma (secondary)
causes for kussmaul's sign (increased JVP on inspiration)
constrictive pericarditis
RH failure
cardiac tamponade
cardiac tumor
predisposes to poor wound healing and ulcer on legs
varicose veins
cause of varicose veins
chronically elevated venous pressure
associations with raynaud's phenomenon
secondary to mixed CT disease, SLE, or CREST syndrome
necrotizing vasculitis, necrotizing granulomas in lung and upper airway, and necrotizing glomerulonephritis
Wegener's granulomatosis
associated with hemoptysis, hematuria, perforation of nasal septum, chronic sinusitis, dyspnea
wegener's granulomatosis
associated with c-ANCA
wegener's granulomatosis
associated with p-ANCA, like wegener's but lacks granulomas
polyarteritis nodosa
granulomatous vasculitis with eosinphilia, most often presents with asthma, sinusitis, skin lesions, and peripheral neuropathy
Churg-Strauss syndrome
vasculitis limited to the kidney, associated with ANCA
pauci-immune crescentic glomerulonephritis
congenital vascular disorder that affects capillary-sized blood vessels, associated with port-wine stain on face, seziures, and early-onset glaucoma
sturge-weber disease
this condition is associated with triad of: skin, joints, and GI
henoch-schonlein purpura
palpable purpura on buttocks and legs that manifests after URI, associated with IgA immune complexes and abdominal pain
henoch-schonlein purpura
cause of intermittent claudication, superficial nodular phlebitis, cold sensitivity, and thrombosing vasculitis that may lead to gangrene and autoamputation of digits
smoking - thromboangiitis obliterans
associated with fever, conjunctivitis, strawberry tongue, lymphadenitis, desquamative skin rash
Kawasaki disease
vasculitis associated with coronary aneurysms in children
Kawasaki disease
immune complex-mediated transmural vasculitis with fibrinoid necrosis
polyarteritis nodosa
granulomatous thickening of aortic arch, associated with increased ESR, primarily affects asian females < 40 year of age
Takayasu's arteritis
*pulseless disease
focal, granulomatous inflammation affecting branches of carotid artery in elderly females
temporal arteritis
benign capillary skin papules found in AIDS patients caused by bartonella henselae
bacillary angiomatosis
highly lethal malignancy of the liver, associated with vinyl chloride, arsenic, and thorotrast exposure
angiosarcoma
vascular tumor associated with poast-radical mastectomy
lymphangiosarcoma
endothelial malignancy of the skin associated with HHV-8 and HIV
kaposi's sarcoma
drugs that are contraindicated in patients with decompensated CHF
B-blockers
DOC for HTN in patient with DM
ACE inhibitors/ARBs
drugs associated with smooth muscle relaxation via cGMP mechanism, vasodilates arterioles > veins
hydralazine
antihypertensive drug associated with lupus-like syndrome
hydralazine
antihypertensive drug contraindicated in angina/CAD due to compensatory tachycardia reflex
hydralazine
Ca channel blocker more associated with vascular smooth muscle relaxation
nifedipine > diltiazem > verapamil
Ca channel blocker more associated with working on the heart
verapamil > diltiazem > nifedipine
drugs that dilate the veins >> arteries, and therefore decrease preload
nitroglycerin, isosorbide dinitrate
Monday's disease
nitroglycerin: development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend; results in tachycardia, dizziness, and headache on reexposure
drug that can cause cyanide toxicity
nitroprusside
antihypertensive drug that dilates both veins and arteries
nitroprusside
D1 receptor agonist associated with malignant HTN treatment
fenoldopam
K channel opener that relaxes vascular smooth muscle, can cause hyperglycemia due to decreased insulin release
diazoxide
partial B-agonists that are contraindicated in angina
pindolol
acebutolol
determinants of MVO2 (myocardial O2 consumption)
end diastolic volume
blood pressure
heart rate
contractility
ejection time