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260 Cards in this Set
- Front
- Back
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In the ventricular action potential, what causes the Phase 0 rapid upswing?
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opening of voltage gated Na channels
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In the phase 2 plateau, Ca++ influx triggers Ca++ release from the SR causing ….
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myocyte contraction
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What effect does Ach have on HR?
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decrease
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What effect do catecholamines have on HR
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increase
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Name 4 things that increase contractility:
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catecholamines, digitalis, an increase in intracellular Ca++, or a decrease in extracellular Na+
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What effect does increased afterload have on myocardial oxygen demand?
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increased
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how do catecholamines increase contractility?
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increase the activity of Ca++ pump in the SR
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What effect will and MI have on contractile state of the heart?
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decrease
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what does S1 correspond to?
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mitral and tricuspid valve closure
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what does S2 correspond to?
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aortic and pulmonary valve closure
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what does S3 correspond to?
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the end of rapid ventricular filling
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what is S3 associated with?
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dilated CHF
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what is S4 and what does it indicate?
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an atrial kick associated with a hyptertrophic ventricle (high atrial pressure/stiff ventricle)
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what is the a wave?
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atrial contraction
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what is the c wave?
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RV contraction when the tricuspid valve bulges into atrium
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what is the v wave?
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increase in atrial pressure due to filling against a closed tricuspid valve
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what is physiologic S2 splitting
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aortic valve closes just before the pulmonic - the difference is increased on inspiration
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what is paradoxical splitting
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when the split is heard on expiration instead of inspiration … associated with aortic stenosis
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what is meant by "HIZ" shrinkage
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the H, I, and Z band decrease in length on muscle contraction, the A band (myosin) stays the same length
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describe the pathway of smooth muscle contraction
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ap - > sm muslce depolarization - > open Ca++ channels -> increase in cytosol Ca++ -> Ca++ bind Calmodulin -> activates MLCK -> relaxation ->MLCP forms a cross bridge and contraction by binding myosin to actin - > MLCK relaxes … cycle continues while Ca is present.
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in an EKG, what does the P wave represent?
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atrial depolarization
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in an EKG, what does the PR segment represent?
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conduction delay through the AV (200 msec)
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in an EKG, what does the QRS complex represent?
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ventricular depolarization(120 msec)
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in an EKG, what does the QT interval represent?
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mechanical contraction of the ventricle
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in and EKG, what does the T wave represent?
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ventricular repolarization
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do you see atrial repolarization on an EKG?
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no, it is masked by the QRS complex
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in an EKG, what does the ST segment represent?
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isoelectric, ventricles are depolarized
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on an EKG, what is a U wave?
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caused by hypokalemia
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what is Wolff-Parkinson-White syndrome
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when an accessory conduction pathway exists from atria to ventricle (bundle of Kent) - bypasses the AV node and ventricles partially depoliarize earlier giving rise to a delta wave. WPW syndrome may lead to recurrent entry and SVTs.
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What do you see on and EKG with atrial fibrillation?
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chaotic erratic baseline with no disrete P waves in between iregularly spaced QRS complexes
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What do you see on an EKG with atrial flutter?
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sawtooth, identical back to back P waves
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How many kinds of AV block are there?
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4: 1st degree, mobitz I, mobitz II, complete
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What is 1st degree AV block?
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asymptomatic - PR interval longer than 200 msec
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What is mobitz II AV block?
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driooed beats not proceeded by a progressively lengthening PR interval. Pathological … can progress to complete block
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What is mobitz I AV block?
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progressive PR lengthening until a beat is dropped … usually asymptomatic
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what is a 3rd degree AV block
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complete AV block, atria and ventricles beat independently … rx with pacemaker
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what is v-fib
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completely erradic rhythm with no identifiable waves, fatal without immediate defibrillation
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what is the normal right atrial pressure?
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5
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what is the normal left atrial pressure
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12 (approx with pcwp - swan-ganz)
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what is the normal right ventricular blood pressure?
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25/5
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what is the normal pulmonary artery pressure?
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25/10
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what is the normal left ventricular pressure?
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130/10
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what is a normal aortic blood pressure?
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130/90
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of the total body weight, what proportion is blood?
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8% … the rest is body fluids and tissues
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of the total body blood, what proportion is plasma?
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55% plasma … the rest is hematocrit.
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what is serum?
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plasma without clotting factors
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what is the makeup of plasma?
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91.5% water, 7% protein, salts, lipids, enzymes, and vitamins
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what is the makeup of plasma proteins?
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55% albumin, 38% globulin, 7% fibrinogen
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what are the three kinds of cells in hematocrit?
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erythrocytes, leukocytes, and platelets
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what is the typical makeup of WBCs in the blood?
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40-70% PMNS, 20-40% lymphocytes, 2-10% monocytes, 1-6% eosinophils, <1% basophils
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what is the net filtration pressure
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Pnet=[(Pc-Pi)-(πc-πi)]
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what are 4 common causes edema?
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increased capillary pressure, decreased plasma proteins, increased capillary permeability, or increased interstitial colloid pressure
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what is a common cause of increased capillary pressure
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heart failure
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what is a common cause of decreased plasma proteins
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nephrotic syndrome or liver failure
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what may cause increased capillary permeability?
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toxins, infections, burns
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what could cause increased colloid presure?
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lymphatic blockage
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what are the three structures in the carotid sheath?
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internal jugular v. (lateral), common carotid a. (medial), vagus n. (posterior)
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in most cases, what supplies the SA and AV nodes?
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RCA
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80% of the time, what supplies the inferior portion of the LV via the PD artery?
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RCA (right dominant)
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when do the coronary arteries fill?
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during diastole
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what supplies the anterior interventricular septum?
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LAD
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what is the most posterior part of the heart? enlargment can cause what?
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left atrium; dysphagia
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what artery gives off large obtuse marginal branches that supply the lateral and posterior walls of the LV?
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circumflex
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what supplies the anterior 2/3 of IV septum, apical portion of anterior papillary muscle, and the anterior surface of the LV?
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LAD
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where does the RCA travel?
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in the right AV groove
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what supplies the inferior and posterior wals of the ventricles and the posterior 1/3 of the IV septum?
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posterior descending (typically a branch of RCA)
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Cardiac output = ?
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stroke volume x heart rate
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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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how do you calculate mean arterial pressure?
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CO x TPR = 1/3SBP + 2/3 DBP
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pulse pressure = ?
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systolic - diastolic (approx SV)
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stroke volume = ?
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CO/HR = EDV-ESV
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what variables affect stroke volume?
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contractility, afterload, and preload - SV CAP
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what effect does increased intracellular calcium have on contractility and SV?
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increases contractility and SV
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how does decreased extracellular sodium affect contractility and SV?
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increases contractility and SV
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5 things that decrease contractility and SV?
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B1 block, heart failure, acidosis, hypoxea/hypercapnea, Ca++ channel blockers
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what effect does digitalis have on contractility and SV?
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increases them
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preload is equal to what volume?
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end diastolic volume
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afterload is equal to what presure?
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systolic arterial pressure (proportional to peripheral resistance)
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what effect do venous dilators (e.g. nitroglycerin) have?
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decrease preload
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what effect do vasodilators (e.g. hydralazine) have?
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decrease afterload
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this increases slightly with exercise, increased blood volume (overtransfusion), and excitement (sympathetics)
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preload
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ejection fraction = ?
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SV/EDV = (EDV-ESV)/EDV = index of contractility
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ejection fraction is normally greater than or equal to?
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55%
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resistance is directly proportional to what?
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viscosity
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resistance is inversely proportional to what?
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radius to the 4th power
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delta P = ?
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Q x R
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resistance = ?
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[delta P/Q]/[8xviscosityxlengthxr to the 4th]
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what does viscosity mostly depend on? when is it increased?
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hematocrit: incrased in polycythemia, hyperproteinemic states (e.g. multiple myeloma), hereditary spherocytosis
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when in the cardiac cycle is O2 consumption highest?
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isovolumetric contraction
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this is the period between mitral valve closing and aortic valve opening
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isovolumetric contraction
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this is the period between aortic valve opening and closing
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systolic ejection
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this is the period between aortic valve closing and mitral vale opening
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isovolumetric relaxation
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when does rapid filling occur?
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just after mitral valve opens
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when does slow filling occur?
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just before mitral valve closes
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when is JVD seen?
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right heart failure
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what is cardiac muscle contraction dependent on?
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extracellular calcium, which enters the cells during plateau of action potential and stimulates calcium release from the sarcoplasmic reticulum (calcium-induced calcium release)
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what is the plateau in the cardiac muscle action potential due to?
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calcium influx
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where does the pacemaker action potential occur?
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SA and AV nodes
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what accounts for the automaticity of the SA and AV nodes?
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slow diastolic depolarization - membrane potential spontaneously depolarizes as Na+ conductance increases (funny channel)
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what determines heart rate?
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slope of phase 4 in the SA node
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what are the peripheral chemoreceptors? what do they respond to?
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carotid and aortic bodies - they respond to decreased (less than 60 mmHg)/increased PCO2, decreased pH of blood
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what do central chemoreceptors respond to?
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changes in pH and PCO2 of brain interstitial fluid, which in turn are influenced by arterial CO2
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what does the aortic arch respond to? how does it transmit and to where?
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responds to increased BP; transmits via vagus to medulla
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how and to where does the carotid sinus transmit information?
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via glossopharyngeal to the medulla
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how do the central chemoreceptors respond to increased intracranial pressure?
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hypertension (sympathetic response) and bradycardia (parasympathetic response)
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what organ receives the larges share of systemic cardiac output?
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liver
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what organ receivest eh highest blood flow per gramof tissue?
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kidney
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how does the heart meet increased O2 demand?
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incrased coronary blood flow, not by increased extraction of O2
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hypoxia in the pulmonary vasculature causes what?
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vasoconstriction (unique because in other organs hypoxia causes vasodilation)
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what are the local factors in the heart that determine autoregulaton?
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O2, adenosine, NO
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what are the local factors in the brain that determine autoregulation?
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CO2 (pH)
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how do the kidneys determine autoregulation?
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myogenic and tuboglomerular feedback
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what local factors determine autoregulation in skeletal muscle?
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lactate, adenosine, K+
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what is the most important mechanism for determining autoregulation in the skin?
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sympathetic stimulation - temperature control
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what is the effect of carotid massage?
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incrases pressure on carotid artery - increasing stretch and leading to decreased HR
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what is the ultimate consequence of baroreceptors sensing hypotension?
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vasoconstriction, incrased HR, contractility, and BP - important in the response to severe hemorrhage
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sound of mitral and tricuspid valve closure
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S1
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sound of aortic and pulmonary valve closure
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S2
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sound at end of rapid ventricular filling
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S3
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sound from high atrial pressure/stiff ventricle
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S4
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what is S3 associated with?
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dilated CHF, mitral/tricuspid regurgitation
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what is S4 (atrial kick) associated with?
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hypertrophic ventricle
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what is paradoxical splitting associated with?
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aortic stenosis, LBBB
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what is fixed splitting associated with?
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ASD
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holosystolic high pitched 'blowing murmur' loudest at apex
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mitral regurg (tricuspid regurg)
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cresecendo-decrescendo systolic ejection murmur following ejection click
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aortic (pulmonic) stenosis
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pulsus parvus et tardus
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pulses weak compared to heart sounds; seen in aortic stenosis
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holosystolic murmur
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VSD
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late systolic murmur with midsystolic click
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mitral prolapse
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immediate high-pitched blowing diastolic murmur; wide pulse pressure
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aortic regurgitation
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delayed rubbing late diastolic murmur that follows opening snap
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mitral stenosis
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how does the murmur in tricuspid stenosis differ from that of mitral stenosis?
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tricuspid stenosis differs because it gets louder with inspiration
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continuous machine-like murmur
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PDA
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when is the murmur associated with a PDA loudest?
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S2
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what does the P wave on EKG represent?
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atrial depolarization
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what does the PR segment on EKG represent? how long is it normally?
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conduction delay through AV node - normally <200 msec
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what does the QRS complex represent? how long is it normally?
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ventricular depolarization (<120 msec)
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what does the QT interval represent?
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mechanical contraction of the ventricles
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what does the T wave represent?
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ventricular repolarization
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why don't you see atrial repolarization on EKG?
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it is masked by the QRS complex
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what causes a U wave?
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hypokalemia
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delta wave on EKG is characteristc of what?
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Wolff-Parkinson-White syndrome
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in this syndrome, there is an accessory conduction pathway from atria to ventricle (bundle of Kent), bypassing the AV node
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Wolff-Parkinson-White syndrome
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this syndrome may result in reentry current leading to supraventricular tachycardia
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Wolff-Parkinson-White syndrome
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what is the hallmark of a transmural MI?
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pathologic Q wave
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increased capillary pressure is seen in what?
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heart failure
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decreased plasma colloid osmotic pressure is seen in what?
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nephrotic syndrome, lver failure
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increased capillary permeability is seen in what?
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toxins, infections, burns
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increased interstitial fluid colloid osmotic pressure is seen in what?
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lymphatic blockage
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three causes of early cyanosis
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tetralogy of fallot, transposition of the great vessels, trucus arteriosis
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three causes of late cyanosis
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VSD, ASD, PDA
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what is the most common congenital cardiac abnormality?
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VSD
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what causes Tetralogy of Fallot?
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anterosuperior displacement of the infundibular septum
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aortic stenosis proximal to insertion of ductus arteriosus?
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preductal - infantile type
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aortic stenosis distal to ductus arteriosus?
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postductal - adult type
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notching of ribs, hypertension in upper extremities, weak pulses in lower extremities?
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coarctation of aorta
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22q11 syndromes are asscociated with what cardiac defects?
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truncus arteriosus, tetralogy of Fallot
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what cardiac defects is Down syndrome associated with?
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ASD, VSD
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what cardiac defects is congenital rubella associated with?
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septal defects, PDA
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what cardiac defects are associated with offspring of diabetic mothers?
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transposition of great vessels
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Marfan's is associated with what congenital cardiac defect?
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aortic insufficiency
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lipid deposit in cornea
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corneal arcus
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what characterizes Monckeberg arteriosclerosis?
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calcification of arteries, especially radial or unlar; usually benign (involves media - ring-like calcifications; 'pipestem')
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arteriosclerosis in essential hypertension?
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hyaline thickening of small arteries
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arteriosclerosis in malignant hypertension?
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hyperplastic 'onion skinning'
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fibrous plaques and atheromas form in what part of arteries in atherosclerosis?
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intima
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risk factors for atherosclerosis?
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smoking, hypertension, DM, hperlipidemia, family Hx
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progression of atherosclerosis?
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fatty streaks - proliferative plaque - complex atheromas
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complications of atherosclerosis?
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aneurysms, ischemia, infarcts, peripheral vascular resistance, thrombus, emboli
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location of atherosclerosis?
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abdominal aorta > coronary artery > popliteal artery > carotid artery
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angina occurs with coronary artery disease narrowing greater than whta?
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75%
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retrosternal chest pain with exertion - what type of angina?
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stable
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angina that occurs at rest secondary to coronary artery spasm?
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Prinzmetal's variant
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thrombosis but no necrosis/worsening chest pain - what type of angina?
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unstable/crescendo
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where do red infarcts occur?
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in loose tissues with collaterals, such as lungs, intestine, or following reperfusion
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where do pale infarcts occur?
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solid tissues with single blood supply - brain, heart, kidney, spleen
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child with harsh systolic murmur, no diastolic murmur, and increased oxygen saturation in the RV?
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VSD
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cut CN IX and X bilaterally - what is hemodynamic result?
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tachycardia with hypertension
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EKG with random electrical activity without recognizable QRS complexes
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ventricular fibrillation
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what can atenolol cause in high doses?
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bradycardia and varying degrees of AV block
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what causes increased pulse pressure?
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stiffening of arteries/ decreased arterial compliance
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what maintains a PDA?
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PGE analog - alprostadil
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what artery is usually compressed in thoracic outlet syndrome?
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subclavian
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what is the most common cause of sudden cardiac death in adults?
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ischemic heart disease
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sudden death in heart transplant patient?
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graft vascular disease
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cardiac defect associated with Fragile X?
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MV prolapse and aortic root dilation
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cardiac finding in SIDS?
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right ventricular hypertrophy
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endocarditis in patient with colon CA?
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strep bovis
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how does cocaine cause hypertension?
|
blocks NE reuptake
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what substance responsible for calcified valves?
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calcium phosphate
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high risk for digitoxin therapy with what metabolic problem?
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hypokalemia
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decreased arterial pressure, increased systemic venous pressure, and small, quiet heart
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cardiac tamponade
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rupture of ventricular wall leading to hemopericardium and cardiac tamponade, rupture of IV septum, rupture of papillary muscle can occur when post-MI?
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5-10 days
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what is the initial alteration leading to atherosclerosis?
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injury to endothelial lining
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in compensated aortic coarctation, what is decreased?
|
vascular resistance in lower body
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drugs recommended for patients with diabetes and renal complications (e.g. hyperuricemia)?
|
ACE inhibitors
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bacterial endocarditis in tricuspid valve?
|
IVDA
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what artery is frequently damaged in knee dislocations?
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popliteal
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proper initial treatment for patient with hypertrophic cardiomyopathy?
|
metoprolol
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anti-hypertensive causing gynecomastia?
|
spironolactone
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what increases upon removal of a kidney?
|
total peripheral resistance
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beta blockers with intrinsic sympathomimetic activity not recommended for patients with angina
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acebutolol and pindolol
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patient with vasculitic symptoms, eosiniophilia, and asthma?
|
Churg-Strauss
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access to vertebral artery via what?
|
suboccipital triangle
|
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patients who develop digitoxin toxicity gradually during chronic therapy are often taking what type of drugs?
|
diuretics - hypokalemia and hypomagnesia
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increased stroke volume causes what to happen to pulse pressure? in what type of patients is this seen?
|
wide pulse pressure - anemic patients
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endomyocardial fibrosis with myocyte necrosis and a prominent eosinophilic infiltrate?
|
Loeffler endocarditis - result of direct toxicity to heart by proteins in eosinophil granules designed to kill large parasites
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what types of pericarditis may follow acute MI?
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fibrinous and serofibrinous pericarditis
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what is caseous pericarditis typically due to?
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TB
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these types of pericarditis can be seen in uremia, chest radiation, rheumatic fever, SLE, and following chest trauma
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fibrinous and serofibrinous
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this type of pericarditis is seen when pyogenic infections involve the pericardium, e.g. after cardiothoracic surgery
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purulent pericarditis
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this type of pericarditis is seen in non-infectious inflammations, e.g. rheumatic fever, lupus, scleroderma, tumors, and uremia
|
serous pericarditis
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amyloid deposition in the myocardium results in what type of cardiomyopathy?
|
restrictive - can be seen in RA and other long-standing inflammatory conditions
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what murmur is associated with a bicuspid aortic valve?
|
immediate diastolic murmur
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what structures have the highest ratio of wall cross-sectional area to lumen cross-sectional area?
|
arterioles
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what type of protein is associated with RA?
|
AA amyloid protein
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another name for hypertrophic cardiomyopathy?
|
idiopathic hypertrophic subaortic stenosis
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administration of epinephrine after what type of drug causes a decrease in BP?
|
alpha adrenergic antagonist, e.g. phentolamine - blockes epi's vasoconstrictive action on arterioles
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flow of blood through PDA?
|
aorta to left pulmonary artery
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ACE inhibitors can cause what type of electrolyte disturbance?
|
hyperkalemia
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|
small mass on mitral valve with finger-like projections; non-neoplastic
|
papillary fibroelastoma
|
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calcium channel blocker associated with accelerated progression of CHF?
|
verapamil
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drug to slow ventricular response in Wolff-Parkinson White?
|
ibutilide
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|
hypersensitivity angiitis or microscopic polyarteritis nodosa (can be caused by penicilin)
|
leukocytoclastic angiitis
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in which part of the systemic circulation does the greatest decrease in blood pressure occur?
|
arterioles
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vasodilator with lupus-like syndrome as side effect?
|
hydralazine
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mechanism of hydralazine?
|
increases cGMP - smooth muscle relaxation; vasodilates arterioles > veins; reduces afterload
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what calcium channel blocker is most selective for peripheral vasculature?
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nifedipine
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mechanism of calcium channel blockers?
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block voltage-dependent L-type calcium channels of cardiac and SM and thereby reduce contractility
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which calcium channel blocker is not used to treat arrhythmias?
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nifedipine
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what is the goal of antianginal therapy?
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reduce myocardial O2 consumption by decreasing 1 or more of the determinants of MVO2: EDV, BP, HR, contractility, ejection time
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what do nitrates affect in antianginal therapy?
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preload
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what happens to contractility and HR in nitrate therapy?
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increase - reflex response
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what do beta blockers affect in antianginal therapy?
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afterload
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how do nitrates affect ejection time and MVO2?
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decrease
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how do beta blockers affect ejection time?
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increase it
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what do beta blockers do to EDV?
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increase it
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what do beta blockers do to BP, contractility, and HR?
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decrease them
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what is digitoxin used for?
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CHF (increases contractility) and atrial fibrillation (decreases conduciton at the AV node)
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toxicities of digitoxin are increased by what?
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renal failure, hpokalemia, and quinidine
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blurry yellow vision is side effect of what?
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digitoxin
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what is the antidote for digitoxin?
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slowly normalize K+, lidocaine, cardiac pacer, anti-dig Fab fragments
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lupus-like syndrome is associated with what class IA antiarrythmic?
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procainamide
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what are the class IA antiarrythmics?
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Na+ channel blockers: quinidine, amiodarone, procainamide, disopyramide (queen amy proclaims disco pyramids)
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this class IA antiarrhythmic can cause cinchonism (headache, tinnitus, thrombocytopenia), torsades de pointes (due to increased QT interval)
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quinidine
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what class of antiarrhythmics are contraindicated post-MI
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class IC - proarrhythmic
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what beta blocker is very short acting?
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esmolol
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what is the antiarrhythmic action of beta blockers?
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decrease cAMP and calcium currents; suppress abnormal pacemaker by decreasing slope of phase 4 - AV node particularly sensitive - increased PR interval
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toxicity of amiodarone?
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pulmonary fibrosis, hepatotoxicity, hypo/hyperthroidism;corneal deposits, skin deposits resulting in photodermatitis, neuro effects, constipation, bradycardia, heart block, CHF
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K+ channel blockers that can cause torsades de pointes
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soltalol, ibutilide
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K+ channel blocker that can cause new arrhythmias and hypotension?
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bretylium
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wha type of cells do Ca2+ channel blockers primarily affect?
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AV nodal cells
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what type of antiarrhythmics are used for prevention of nodal arrhythmias?
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class IV - Ca2+ channel blockers
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what class IV antiarrhythmic can cause torsades de pointes?
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bepridil
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what is the drug of choice for diagnosing/abolishing AV nodal arrhythmias?
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adenosine
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what depresses ectopic pacemakers, especially in digitoxin toxicity?
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K+
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Mg+ is effective for treating what?
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torsades de pointes and digitoxin toxicity
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drug for hypertension in patient with PKD?
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ACE inhibitor
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anti-hypertesive for pregnant woman?
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methyldopa
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in patients with wolff parkinson white and atrial fibrillation, what can digitoxin do?
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enhance transmission through accessory pathways that can predispose to v tac
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