Term
| Components of carotid sheath |
|
Definition
Internal jugular Vein (lateral)
Common carotid artery (medial)
Vagus Nerve (posterior)
VAN |
|
|
Term
| Branching of right coronary artery and area supplied |
|
Definition
acute marginal artery - supplies right ventricle
(right dominant, 80%) posterior descending/interventricular artery - supplies posterior septum
supplies SA and AV node usually |
|
|
Term
| Branching of left coronary artery and area supplied |
|
Definition
Left anterior descending - supplies apex and anterior interventricular septum
most common coronary artery occlusion site
circumflex artery - supplies posterior left ventricle |
|
|
Term
| What coronary artery supplies the right ventricle? |
|
Definition
| acute marginal artery (branch of RCA) |
|
|
Term
| What coronary artery supplies the SA and AV nodes usually? |
|
Definition
|
|
Term
| What coronary artery supplies the posterior septum? |
|
Definition
| Posterior descending/interventricular artery (right dominant 80%) |
|
|
Term
| What coronary artery supplies the apex? |
|
Definition
LAD (LCA branch)
most common site of occlusion
also supplies the anterior interventricular septum |
|
|
Term
| What coronary artery supplies the anterior interventricular septum? |
|
Definition
LAD
most common site of occlusion
also supplies the apex |
|
|
Term
| What coronary artery supplies the posterior left ventricle? |
|
Definition
| circumflex artery (LCA branch) |
|
|
Term
| Where is the most common site of coronary artery occlusion? |
|
Definition
LAD
supplies apex and anterior interventricular septum |
|
|
Term
| When do the coronary arteries fill? |
|
Definition
|
|
Term
Enlargement of the most posterior par tof the heart would mean an enlarged what?
what can this cause? |
|
Definition
enlarged left atrium
can cause dysphagia (compression of esophageal nerve) or hoarseness (compressed recurrent laryngeal nerve, vagus branch) |
|
|
Term
| Systolic murmurs heard in the aortic area? |
|
Definition
aortic stenosis
flow murmur
aortic valve sclerosis |
|
|
Term
| What murmurs can be heard at the pulmonic area? |
|
Definition
| SEM - pulmonic stenosis, flow murmur (ASD) |
|
|
Term
| What murmurs can be heard at the tricuspid area? |
|
Definition
pansystolic murmur - TR, VSD
Diastolic - Tricuspid stenosis, ASD |
|
|
Term
| What murmurs can be heard at the mitral area? |
|
Definition
systolic: MR
diastolic: MS |
|
|
Term
| What does an ASD sound like? |
|
Definition
Systolic - pulmonary flow murmur (increased flow through pulm valve)
diastolic - rumble, increased flow across tricuspid
progresses to louder diastolic PR from dilated pulmonary artery |
|
|
Term
|
Definition
|
|
Term
| Effect of exercise on Cardiac output |
|
Definition
initially - increases because of SV
prolonged - increases because of HR
too high of a HR --> incomplete diastolic filling and decreased CO (v tach) |
|
|
Term
| What's the problem with Ventricular Tachycardia? |
|
Definition
HR is too high
Diastolic filling incomplete
Decreases CO |
|
|
Term
|
Definition
| CO = rate of O2 consumption / (arterial O2 content - venous O2 content) |
|
|
Term
| Mean arterial pressure formula |
|
Definition
MAP = CO * total peripheral resistance
MAP = 2/3 diastolic + 1/3 systolic |
|
|
Term
|
Definition
= systolic pressure - diastolic pressure
proportional to stroke volume |
|
|
Term
|
Definition
|
|
Term
| Factors affecting stroke volume |
|
Definition
to increase SV
-increase preload
-decrease afterload
-increase contractility |
|
|
Term
| Factors increasing contractility |
|
Definition
1. catecholamines (increase activity of Ca pump in sarcoplasmic reticulum)
2. increase intracellular Ca
3. decrease extracellular Na (decrease activity of Na/Ca exchange)
4. digitalis (increase intracellular Na, resulting in increase Ca) |
|
|
Term
| Factors decreasing contractility |
|
Definition
1. B1-blockade
2. heart failure
3. acidosis
4. hypoxia/hypercapnea
5. non-dihydropyridine Ca channel blockers |
|
|
Term
| What effect do anxiety, exercise, and pregnancy have on heart function? |
|
Definition
|
|
Term
| Myocardial O2 demand is increased by |
|
Definition
1. increased afterload (arterial pressure)
2. increased contractility
3. increased HR
4. increased heart size (increased wall tension) |
|
|
Term
| Preload is equivalent to what? |
|
Definition
|
|
Term
|
Definition
exercise (slightly)
increased blood volume (overtransfusion)
excitement (sympathetics) |
|
|
Term
| Afterload is equal to what measure? |
|
Definition
| mean arterial pressure (proportional to peripheral resistance) |
|
|
Term
| Affect of vendilators on preload |
|
Definition
ie nitroglycerin
decreases preload |
|
|
Term
| affect of vasodilators on afterload |
|
Definition
ie hydralazine
decrease afterload |
|
|
Term
| force of contraction is proportional to what? |
|
Definition
| initial length of cardiac muscle fiber (preload) |
|
|
Term
| What factors increase the contractile state of myocardium |
|
Definition
circulating catecholamines
digitalis
sympathetic stimulation |
|
|
Term
| review the starling curve |
|
Definition
x axis: preload
y axis: SV
slope: contractiliy |
|
|
Term
| Formula for ejection fraction |
|
Definition
EF = SV / EDV = (EDV-ESV) / EDV
normally > 55%
indes of ventricular contractility |
|
|
Term
| Formula for change in pressure |
|
Definition
| change in pressure = flow *resistance |
|
|
Term
| Formula for resistance and what it means |
|
Definition
R = P/Q = (8(vicosity)*length) /pi r^4
resistance is directly proportional to viscosity and inversely proportional to the radius^4 |
|
|
Term
| Causes of increased viscosity |
|
Definition
viscosity depends mostly on hematocrit
increases in
polycythemia
hyperproteinemic states (multiple myeloma)
hereditary spherocytosis |
|
|
Term
| What accounts for most of total peripheral resistance? |
|
Definition
arterioles
regulate capillary flow |
|
|
Term
|
Definition
|
|
Term
| Isovolumetric contraction |
|
Definition
period between MV closure and AV valve opening
highest O2 consumption |
|
|
Term
|
Definition
| period between AV opening and closing |
|
|
Term
|
Definition
| period between AV closing and MV opening |
|
|
Term
|
Definition
inspiration --> drop in intrathoracic pressure-->increase capacity of pulmonary circulation
late closure of PV due to more blood entering lungs
early closure of AV because decreased return to left heart |
|
|
Term
| Wide splitting and causes |
|
Definition
delayed RV emptying
delayed pulmonic closure
exaggeration of normal splitting
seen in pulmonic stenosis, right bundle branch block |
|
|
Term
| Fixed splitting and cause |
|
Definition
ASD, L-R shunt
increased flow through PV
regardless of breath, closure delayed |
|
|
Term
| Paradoxical splitting and cause |
|
Definition
delayed LV emptying
P2 sound before A2
inspiration, delays P2 to meet late A2
paradoxical elimination of split
seen in AS, LBBB |
|
|
Term
|
Definition
| wide splitting (delayed RV emptying) |
|
|
Term
| splitting heard with RBBB |
|
Definition
| wide splitting (delayed RV emptying) |
|
|
Term
|
Definition
| paradoxical splitting (delayed LV emptying) |
|
|
Term
| splitting heard with LBBB |
|
Definition
| paradoxical splitting (delayed LV emptying) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| holosystolic, high-pitched blowing murmur |
|
|
Term
| holosystolic, high pitched blowing murmur |
|
Definition
|
|
Term
| Holosystolic, high pitched blowing murmur, radiating to right sternal border |
|
Definition
|
|
Term
|
Definition
| ischemic heart disease, MV prolapse, LV dilation, rheumatic fever |
|
|
Term
|
Definition
| RV dilation, endocarditis, rheumatic fever |
|
|
Term
| Rheumatic fever can cause what heart sounds? |
|
Definition
|
|
Term
| draw and describe Aortic stenosis |
|
Definition
| crescendo-decrescendo SEM following ejection click |
|
|
Term
|
Definition
|
|
Term
|
Definition
holosystolic, harsh-sounding murmur
loudest at tricuspid area |
|
|
Term
| holosytolic harsh sounding murmur, loudest at tricuspid area |
|
Definition
|
|
Term
| late systolic murmur with midsystolic click |
|
Definition
|
|
Term
|
Definition
late systolic murmur with midsystolic click (smaller LV volume makes it worse)
most frequent valvular lesion
loudest at S2
usually benign, but can predispose to infective endocarditis |
|
|
Term
|
Definition
immediate high pitched blowing diastolic murmur
wide pulse pressure when chronic
causes of AR: aortic root dilation, bicuspid AV, rheumatic fever |
|
|
Term
| draw and describe mitral stenosis |
|
Definition
delayed rumbling late diastolic murmur, follows opening snap
often secondary to rheumatic fever |
|
|
Term
|
Definition
continuous machine-like murmur
loudest of time at S2 |
|
|
Term
| how does inspiration and expiration affect valvular defect heart sounds? |
|
Definition
inspiration: increase right side defect heart sounds, more blood flows into RA during inspiration
expiration: increase intensity of left side heart sound defects |
|
|
Term
| What causes the plateau of a cardiac muscle action potential? |
|
Definition
|
|
Term
| How do cardiac nodal cells work? |
|
Definition
| I f channels allow for automaticity and spontaneous depolarization |
|
|
Term
| Ventricular action potential: phase 0 |
|
Definition
| rapid upstroke, voltage gated Na channels open |
|
|
Term
| Ventricular action potential: phase 1 |
|
Definition
| initial repolarization - inactivation of voltage gated Na channels, voltage gated K channels begin to open |
|
|
Term
| Ventricular action potential: phase 2 |
|
Definition
plateau - Ca influx through voltage gated Ca channels balances K efflux
Ca influx triggers Ca release from Sarcoplasmic reticulum and myocyte contraction |
|
|
Term
| Ventricular action potential: phase 3 |
|
Definition
| rapid repolarization, massive K efflux due to opening of voltage gate slow K channels and closure of voltage gated Ca channels |
|
|
Term
| Ventricular action potential: phase 4 |
|
Definition
| resting potential - high K permeability through K channels |
|
|
Term
|
Definition
|
|
Term
|
Definition
phase 2
plateau
calcium in, K out |
|
|
Term
|
Definition
phase 3
rapid repolarization
voltage gated slow K channels
phase 4 - resting potential |
|
|
Term
|
Definition
Mitral and Tricuspid closure
heard bets at mitral area |
|
|
Term
|
Definition
aortic and pulmonary valve closure
loudest at left sternal border |
|
|
Term
|
Definition
early diastole during rapid ventricular filling phase
associated with increased filling pressures and more common in dilated ventricles
normal in kids and athletes |
|
|
Term
|
Definition
late diastole
atrial kick - high atrial pressure
associated with ventricular hypertrophy
LA must push against stiff LV wall |
|
|
Term
|
Definition
a - atrial contraction
c - RV contraction (TV bulging into atrium)
v - increased atrial pressure due to filling against closed TV |
|
|
Term
Draw pressure curve for the heart
include aortic pressure, left ventricular pressure, left atrial pressure |
|
Definition
|
|
Term
| Pacemaker action potential: Phase 0 |
|
Definition
| upstroke - opening of voltage gated Ca channels, SA and AV nodes lack voltage gated Na channels, results in slow conduction velocity that is used by AV node to prolong transmission from atria to ventricles |
|
|
Term
| Pacemaker action potential: Phase 2 |
|
Definition
|
|
Term
| Pacemaker action potential: Phase 3 |
|
Definition
inactivation of Ca channels
activation of K channels
overall K efflux |
|
|
Term
| Pacemaker action potential: Phase 4 |
|
Definition
slow diastolic depolarization (membrane potential spontaneously depolarizes as Na conductance increases (I f channel), accounts for automaticity of SA and AV nodes
slope determines HR (ACH decreases depol rate and HR, Catecholamines increase depol rate and HR)
sympathetic stimulation increases the change that If channels are open |
|
|
Term
| Determinant of heart rate (with respect to ion channels) |
|
Definition
| SA, AV node I f channel (Na) slope |
|
|
Term
| Interaction of sympathetics on I f channel? ACh? |
|
Definition
Sympathetics - increase change that If channels are open
ACh: decrease rate of diastolic depolarization |
|
|
Term
|
Definition
|
|
Term
|
Definition
| conduction delay through AV node (<200ms) |
|
|
Term
|
Definition
| ventricular depol (<120ms) |
|
|
Term
|
Definition
| mechanical contraction of ventricles |
|
|
Term
|
Definition
|
|
Term
|
Definition
| isoelectric, ventricles depolarized |
|
|
Term
|
Definition
|
|
Term
|
Definition
ventricular tachychardia with shifting sinusoidal waveforms
can progress to V-fib
anything that prolongs QT interval can predispose |
|
|
Term
|
Definition
Wolff-Parkinson-White syndrome
accessory conduction pathway from A to V (bundle of Kent) bypassing AV node - ventricles begin to partially depolarize earlier = delta wave, seen as lack of Q depression and lengthening of R
FA 253 |
|
|
Term
| Wolff-Parkinson-White syndrome |
|
Definition
accessory conduction pathway from A to V (bundle of Kent) bypassing AV node
ventricles partially depolarize earlier = delta wave
reentry current can result leading to SVT
aka ventricular preexcitation syndrome |
|
|
Term
|
Definition
| chaotic and erratic baseline (irregularly irregular) with no discrete p waves in between irregularly spaces QRS complexes |
|
|
Term
| Possible poor outcome of A fib |
|
Definition
atrial stasis, leading to stroke
treat with warfarin/coumadin |
|
|
Term
|
Definition
rapid succession of identical back-to-back atrial depol waves
sawtooth
attempt to convert to sinus rhythm, use class IA, IC or III antiarrhythmics |
|
|
Term
|
Definition
PR interval prolonges (>200 ms)
asymptomatic |
|
|
Term
| Synonym for AV block: 2nd degree, Mobitz type I |
|
Definition
|
|
Term
| AV block: 2nd degree, Mobitz type I |
|
Definition
progressive lengthening of PR int. until beat is dropped
asymptomatic |
|
|
Term
| Av block: 2nd degree, Mobitz type II |
|
Definition
dropped beats that are not preceded by change in length of PR interval
often 2P waves: 1 QRS response
pathologic, may progress to 3rd degree block |
|
|
Term
|
Definition
complete block
atira and ventricles beat independently of each other: P waves and QRS waves both present, but totally unrelated
faster atrial rate than ventricular rate
pacemaker
lyme disease |
|
|
Term
|
Definition
completely erratic rhythm with no identifiable waves
fatal without immediate CPR and defib |
|
|
Term
| Bodies response to decreased mean arterial pressure |
|
Definition
decreases baroreceptor firing sensed by medullary vasomotor center --> increased sympathetic activity (B1: increased HR, contractility, a1: venoconstriction - increased preload, vasoconstriction - increased afterload)
JGA senses decreased MAP (ECV)--> increased RAS --> AngioII (vasoconstriction and increased TPR) and aldosterone (increased blood volume --> increased CO)
Work together to increase MAP |
|
|
Term
|
Definition
diuretic released from atria in response to increased blood volume and atrial pressure
generalized vascular relaxation
constricts efferent renal arterioles, dilates afferent |
|
|
Term
|
Definition
located at aortic arch and carotid sinus
hypotension = decreased arterial pressure and stretch = decreased afferent firing = increased efferent sympathetic firing and decreased parasymp stimulation, causes vasoconstriction, increased HR, contractility and BP
aortic R - responds only to increased BP
carotid R- responds to increased or decreased BP |
|
|
Term
| How does a carotid massage work? |
|
Definition
| increased pressure on carotid baroreceptor increases afferent firing, which causes decreased HR |
|
|
Term
| Transmitter for aortic arch baro and chemoreceptors |
|
Definition
vagus nerve to medulla
responds only to INCREASED BP |
|
|
Term
| Transmitter for carotid sinus baro and chemo receptors |
|
Definition
glossopharyngeal nerve to medulla
responds to decreased and increased BP |
|
|
Term
| Peripheral chemoreceptors: location and stimuli |
|
Definition
located at carotid and aortic bodies
respond to decreased PO2 (<60mmHg), increased PCO2, decreased pH |
|
|
Term
| central chemoreceptors: location and stimuli |
|
Definition
brain
respond to changes in pH and PCO2 of brain interstitial fluid (which are influenced by arterial CO2) - don't directly respond to PO2
responsible for cusching reaction |
|
|
Term
|
Definition
increased ICP constricts arterioles
causes cerebral ischemia (increased PCO2, decreased pH)
causes sympathetic response due to central chemoreceptors
causing hypertension and reflex bradycardia
triad=hypertension, bradycardia, respiratory depression |
|
|
Term
| What organ receives that largest share of systemic CO? |
|
Definition
|
|
Term
| What organ has the highest blood flow/gram of tissue? |
|
Definition
|
|
Term
| How is increased oxygen demand handled by the heart? |
|
Definition
| increased coronary blood flow, not by increased extraction of O2 (there is already a large arteriovenous O2 difference) |
|
|
Term
| Normal pressures in the heart (start with RA) |
|
Definition
RA - <5
RV - <25/<5
PA - <25/10
LA - <10
LV - <130/10
aorta - <130/90
measured with Swan-Ganz catheter |
|
|
Term
| Pressure change in mitral stenosis |
|
Definition
| PCWP > LV diastolic pressure |
|
|
Term
Autoregulation: heart
how blood flow to organ remains constant over wide range of perfusion pressure |
|
Definition
| local metabolites: O2, adenosine, NO |
|
|
Term
Autoregulation: brain
how blood flow to organ remains constant over wide range of perfusion pressure |
|
Definition
| local metabolites - CO2 (pH) |
|
|
Term
Autoregulation: kidneys
how blood flow to organ remains constant over wide range of perfusion pressure |
|
Definition
| myogenic and tubuloglomerular feedback |
|
|
Term
Autoregulation: lungs
how blood flow to organ remains constant over wide range of perfusion pressure |
|
Definition
| hypoxia causes vasoconstriction |
|
|
Term
Autoregulation: skeletal muscle
how blood flow to organ remains constant over wide range of perfusion pressure |
|
Definition
| local metabolites - lactate, adenosine, K+ |
|
|
Term
Autoregulation: skin
how blood flow to organ remains constant over wide range of perfusion pressure |
|
Definition
| sympathetic stimulation most important mechanism - temperature control |
|
|
Term
| Net filtration pressure (capillary fluid) |
|
Definition
Pnet = [(Pc-Pi) - (pi c - pi i)]
Pc = capillary pressure
Pi = interstitial fluid pressure
pi c= plasma colloid osmotic pressure
pi i= interstitial fluid colloid osmotic pressure |
|
|
Term
| net fluid flow (capillary fluid) |
|
Definition
Pnet (Kf)
Kf = filtration constant/capillary permeability |
|
|
Term
|
Definition
1. increased capillary pressure (Pc) - heart failure
2. decreased plasma proteins (nephrotic syndrome, liver failure)
3. increased capillary permeability (Kf, toxins, infections, burns)
4. increased interstitial fluid colloid osmotic pressure (lymphatic blockage) |
|
|
Term
| Cyanotic congenital heart disease |
|
Definition
R to left shunts, children may squat to increase SVR (force blood to pulmonary system)
1. truncus arteriosus
2. transposition of great vessels
3. tricuspid atresia
4. tetralogy of Fallot
5. Total anomalous pulmonary venous return |
|
|
Term
|
Definition
1. VSD (most common congenital cardiac abnormality)
2. ASD (loud S1, wide fixed split S2)
3. PDA (close with NSAID indomethacin)
frequency: VSD>ASD>PDA
late cyanosis (blue kids) |
|
|
Term
|
Definition
shunt reverses to R-L in uncorrected VSD/ASD/PDA
increased pulmonary resistance due to arteriolar thickening leads to progressive pulmonary hypertension and shunt reversal
see RVH
late cyanosis - clubbing and polycythemia (decreased oxygen delivery) |
|
|
Term
|
Definition
1. Pulmonary stenosis (most important for prognosis)
2. RVH
3. Overriding aorta (overrides VSD)
4. VSD
PROVe |
|
|
Term
| Cause of tetralogy of fallot |
|
Definition
| anterosuperior displacement of the infundibular septum |
|
|
Term
| What is the cause of the shunt in tetralogy of Fallot |
|
Definition
| R-L shunt across the VSD due to increased pressure caused by stenotic pulmonic valve |
|
|
Term
|
Definition
| RVH, seen in tetralogy of Fallot |
|
|
Term
| Symptom of tetralogy of Fallot |
|
Definition
cyanotic spells
squating improves symptoms by compressing femoral arteries, decreasing R-L shunt and directing more blood from RV (through stenotic PV) to the lungs |
|
|
Term
| Transposition of the great vessels |
|
Definition
Failure of aorticopulmonary septum to spiral
aorta leaves RV (anterior)
pulmonary trunk leaves LV (posterior)
this creates separate systemic and pulmonary circulations
Shunt critical to life (VSD, PDA, patent foramen ovale)
without operation, infant dies within first few months of life |
|
|
Term
| Failure of aorticopulmonary septum to spiral |
|
Definition
| Transposition of great vessels |
|
|
Term
| Coarctation of the aorta: adult vs. infantile |
|
Definition
infantile type - AS proximal to insertion of ductus arteriosus (preductal)
adult - AS distal to ductus arteriosus |
|
|
Term
| Associations of coarctation of the aorta |
|
Definition
Turner's syndrome
bicuspid AV
adults: rib notching from collateral circulation, htn in UE, weak pulses in LE |
|
|
Term
| HTN in UE, weak pulses in LE: disease and possible murmur |
|
Definition
Coarctation of the aorta
can result in AR |
|
|
Term
|
Definition
fetus: R-L shunt (normal)
neonate: L-R shunt (aortic to pulmonary artery) with decreased lung resistance, subsequent RVH and failure
continuous machine like murmur |
|
|
Term
| continuous machine like murmur |
|
Definition
|
|
Term
|
Definition
PGE synthesis and low O2 tension
may be necessary to keep open to sustain life (transposition of the great vessels) |
|
|
Term
|
Definition
| indomethacin (NSAID - prostaglandin inhibitor) |
|
|
Term
| Cardiac defect associated with 22q11 syndromes |
|
Definition
Truncus arteriosus
tetralogy of fallot |
|
|
Term
| Cardiac defect associated with Down syndrome |
|
Definition
| ASD, VSD, AV septal defect (aka endocardial cushion defect, most common) |
|
|
Term
| Cardiac defect associated with congenital rubella |
|
Definition
| septal defects, PDA, PA stenosis |
|
|
Term
| Cardiac defect associated with Turner's syndrome |
|
Definition
|
|
Term
| Cardiac defect associated with Marfans syndrome |
|
Definition
| aortic insufficiency (late complication) |
|
|
Term
| Cardiac defect associated with being the offspring of a diabetic mother |
|
Definition
| transposition of the great vessels |
|
|
Term
|
Definition
increased age
obesity
diabetes
smoking
genetics
black>white>Asian |
|
|
Term
|
Definition
90% - primary, related to increased CO and TPR
10% - secondary, mostly due to renal disease |
|
|
Term
|
Definition
atherosclerosis
LVH
stroke
CHF
Renal failure
retinopathy
aortic dissection |
|
|
Term
|
Definition
atheromas
xanthomas - skin, eyelids
tendinous xanthoma
corneal arcus |
|
|
Term
|
Definition
lipid deposit in tendon, esp. Achilles
sign of hyperlipidemia |
|
|
Term
|
Definition
lipid deposit in cornea
sign of hyperlipidemia |
|
|
Term
|
Definition
| palque/nodule composed of lipid laden histiocytes in the skin, esp. eyelids (xanthelasma) |
|
|
Term
|
Definition
plaque in blood vessel wall
sign of hyperlipidemia |
|
|
Term
| Hyaline thickening of small arteries in essential hypertension |
|
Definition
arteriolosclerosis
also seen as onion skinning in malignant hypertension |
|
|
Term
| fibrous plaques and atheromas form in intima of arteries |
|
Definition
atherosclerosis
affects elastic arteries and large and medium sized muscular arteries |
|
|
Term
| hyperplastic onion skinning in malignant hypertension |
|
Definition
arteriolosclerosis
hyaline thickening of small arteries |
|
|
Term
| What layer of the vessel wall does atherosclerosis affect? |
|
Definition
|
|
Term
| calcification in the media of the arteries |
|
Definition
monckeberg ateriosclerosis
especially radial or ulnar
pipestem arteries
usually benign
not involving intima |
|
|
Term
| Monckeberg arteriosclerosis |
|
Definition
| calcification in the MEDIA of the arteries, especially radial or ulnar, usually benign, no blood flow obstruction |
|
|
Term
| Aortic dissection presentation |
|
Definition
longitudinal intraluminal tear forming a false lumen
tearing chest pain radiating to the back |
|
|
Term
| Tearing chest pain radiating to the back |
|
Definition
|
|
Term
| Aortic dissection associations |
|
Definition
hypertension
cystic medial necrosis (component of Marfan's) |
|
|
Term
|
Definition
mediastinal widening
false lumen occupies most of descending aorta |
|
|
Term
| Which arteries are affected by atherosclerosis |
|
Definition
elastic arteries (PA, aorta and branches)
large and medium muscular arteries |
|
|
Term
| Risk factors for atherosclerosis |
|
Definition
| smoking, htn, DM, hyperlipidemia, FHx |
|
|
Term
| Progression of atherosclerosis |
|
Definition
1. endothelial cell dysfunction
2. macrophage and LDL accumulation
3. foam cell formation
4. fatty streaks
5. smooth muscle cell migration (PDGF and FGF-b involved)
6. fibrous plaque
7. complex atheromas (fatty atherosclerotic plaque + fibrous cap + calcification) |
|
|
Term
| Atherosclerosis complications |
|
Definition
| aneurysms, ischemia, infarct, peripheral vascular disease, thrombus, emboli |
|
|
Term
| Most common locations of atherosclerosis? |
|
Definition
| abdominal aorta > coronary artery > popliteal artery > carotid artery |
|
|
Term
| Symptoms: angina, claudication |
|
Definition
atherosclerosis
can be asymptomatic |
|
|
Term
| Possible manifestation of ischemic heart disease |
|
Definition
| angina, MI, death, chronic |
|
|
Term
|
Definition
CAD narrowing >75%
mostly secondary to atherosclerosis
ST depression on ECG
retrosternal chest pain with exertion |
|
|
Term
|
Definition
at rest
secondary to coronary artery spasm
ST elevation |
|
|
Term
|
Definition
thrombosis but no necrosis
ST depression
worsening chest pain |
|
|
Term
|
Definition
most often acute thrombosis due to coronary artery atherosclerosis
results in myocyte necrosis |
|
|
Term
| Most common cause of sudden cardiac death |
|
Definition
death in 1 hour of symptom onset
most commonly due to lethal arrhythmia |
|
|
Term
| Cause of chronic ischemic heart disease |
|
Definition
| chronic ischemic myocardial damage leads to progressive onset of CHF over many years |
|
|
Term
| What type of infarct occurs in liver, lungs, and intestine? why? |
|
Definition
red/hemorrhagic infarct seen in loose tissues with collaterals
also seen following reperfusion (injury is due to damage by free radicals) |
|
|
Term
| What type of infarcts occur in heart, kidney, and spleen? Why? |
|
Definition
| pale infarcts occur in solid tissues with ling blood bupply |
|
|
Term
| Which coronary artery is most likely to be occluded in an MI? |
|
Definition
|
|
Term
| Symptoms: diaphoresis, N/V, SOB, fatigue, severe retrosternal pain, adrenergic symptoms |
|
Definition
MI!!!!
also have pain in left arm and/or jaw |
|
|
Term
| What happens on the first day of an MI? |
|
Definition
occluded artery, infarct area - dark mottling; pale with tetrazolium stain
1-2 hrs: contraction bands (wavy, eosinophilic, lack nuclei)
4 hrs: early coagulative necrosis (release of cell content, beginning of neutrophil emigration) |
|
|
Term
| When is the risk for arrhythmia greatest after an MI? |
|
Definition
|
|
Term
| What happens 2-4 days after an MI? |
|
Definition
tissue surrounding infarct shows acute inflammation
dilated vessels (hyperemia)
PMN emigration
muscle shows extensive coagulative necrosis
risk for arrhythmia |
|
|
Term
| What happens 5-10 days after an MI? |
|
Definition
infarct: hyperemic border with central yellow-brown softening (max at 10d)
risk for free wall rupture, tamponade, papillary muscle rupture, VS rupture
macrophages have degraded important structural components
granulation tissue |
|
|
Term
| What happens 7 weeks after an MI? |
|
Definition
infarct: gray white
contracted scar complete
risk for ventricular aneurysm |
|
|
Term
| Elevation of cardiac troponin I |
|
Definition
rises 4 hrs post MI, stays high for 7-10d
more specific than other markers |
|
|
Term
| What is the gold standard for diagnosing an acute MI? |
|
Definition
|
|
Term
|
Definition
peaks at day 1, drops by day 3
can also be released from skeletal muscle |
|
|
Term
|
Definition
nonspecific (cardiac, liver, skeletal muscle)
peaks between days 1-2 and starts falling |
|
|
Term
|
Definition
ST elevation - transmural infarct
ST depression - subendocardial infarct
pathologic Q waves - transmural infarct |
|
|
Term
|
Definition
ischemic necrosis of <50% of ventricle wall (subendocardium especially vulnerable because of fewer collaterals and higher pressure)
ST depression on ECG |
|
|
Term
| Possible outcome of ventricular free wall rupture |
|
Definition
|
|
Term
| Possible outcome of papillary muscle rupture |
|
Definition
|
|
Term
| Effect of aneurysm formation following MI |
|
Definition
| decreased CO, risk of arrhythmia, embolus from mural thrombus |
|
|
Term
|
Definition
friction rub, 3-5 d post MI
several weeks post MI - dressler's syndrome, autoimmune |
|
|
Term
|
Definition
| autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI) |
|
|
Term
| Most common cardiomyopathy |
|
Definition
|
|
Term
|
Definition
Alcohol abuse
Beriberi (wet)
Coxsackie B virus myocarditis, Cocaine, Chagas
Doxorubicin toxicity
peripartum cariomyopathy
hemochromatosis
systolic dysfunction |
|
|
Term
|
Definition
s3, dilated heart on US, balloon appearance on X-ray
systolic dysfunction |
|
|
Term
| Cardiomyopathy in which 50% of cases are familial, AD |
|
Definition
|
|
Term
|
Definition
normal sized heart, S4, apical impulses, systolic murmur
diastolic dysfunction |
|
|
Term
| What causes outflow tract obstruction in HCM? |
|
Definition
| hypertrophied IV septum is too close to MV leaflet |
|
|
Term
| Disoriented, tangled, hypertrophied myocardial fibers |
|
Definition
|
|
Term
| Cause of sudden death in young adults (cardiomyopathy) |
|
Definition
|
|
Term
|
Definition
B-blocker
heart specific CCB (verapamil) |
|
|
Term
| Cause of restrictive/obliterative cardiomyopathy |
|
Definition
sarcoidosis
amyloidosis
postradiation fibrosis
endocardial fibroelastosis (thick fibroelastic tissue in endocardium of young kids)
hemochromatosis (DCM can occur as well)
diastolic dysfunction |
|
|
Term
| Diastolic vs systolic dysfunction: DCM |
|
Definition
|
|
Term
| Diastolic vs systolic dysfunction: HCM |
|
Definition
|
|
Term
| Diastolic vs systolic dysfunction: RCM |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Signs and symptoms of CHF |
|
Definition
| dyspnea, fatigue, edema, rales |
|
|
Term
| How does DOE develop in CHF? |
|
Definition
| failure of LV output to increase during exercise |
|
|
Term
| Is there cardiac dilation in CHF? |
|
Definition
| yes, greater ventricular EDV |
|
|
Term
| How does pulmonary edema develop in CHF? |
|
Definition
LV failure
increased pulmonary venous pressure
pulmonary venous distention and transudation of fluid
presence of hemosiderin laden macrophages (HF cells) in the lungs |
|
|
Term
| Presence of hemosiderin laden macrophages in the lungs |
|
Definition
heart failure cells
seen in pulmonary edema caused by CHF |
|
|
Term
| Why does hepatomegaly occur in CHF and what is it known as? |
|
Definition
nutmeg liver
increased central venous pressure
increased resistance to portal flow
rarely, leads to cardiac cirrhosis |
|
|
Term
|
Definition
|
|
Term
| What are signs of RV failure? |
|
Definition
ankles and sacral edema
Jugular venous distention |
|
|
Term
| Two early physiologic consequences of decreased LV contractility (as in CHF) |
|
Definition
1. decreased cardiac output
2. pulmonary venous congestion (pulm edema leading to decreased RV output) |
|
|
Term
| Describe cardiac output progression in CHF |
|
Definition
Initially, decreased CO which cause increased RASS, increasing systemic venous pressure
decreased CO also activates sympathetic system, causing increased LV contractility
increased LV contractility with increased systemic venous pressure = increased preload and increased CO (compensatory)
FA 265 |
|
|
Term
|
Definition
left heart failure
isolated RHF due to cor pulmonale |
|
|
Term
|
Definition
|
|
Term
|
Definition
Fat, Air, Thrombus
Bacteria, Amniotic fluid, Tumor
95% of pulmonary emboli come from deep leg veins
FAT BAT |
|
|
Term
| What are fat emboli associated with? |
|
Definition
| long bone fractures and liposuction |
|
|
Term
| Possible outcome unique to amniotic fluid emboli? |
|
Definition
| DIC, especially postpartum |
|
|
Term
| PE presents with? and arises from? |
|
Definition
chest pain, tachypnea, dyspnea
95% from deep leg veins |
|
|
Term
|
Definition
stasis
hypercoagulability
endothelial damage (exposed collagen leads to clotting cascade activation)
can lead to DVT and PE |
|
|
Term
| Symptoms and signs of bacterial endocarditis |
|
Definition
fever (most common)
Roth's spots (round white spots on retina surrounded by hemorrhage)
Osler's nodes (tender raised lesions on fingers or toe pads)
Murmur, new
Janeway lesion (small erythematous lesions on palm or sole)
anemia
splinter hemorrhages on nail beds
FROM JANE |
|
|
Term
|
Definition
round white spots on retina surrounded by hemorrhage
seen in bacterial endocarditis |
|
|
Term
|
Definition
tender raised lesions on finger or toe pads
seen in bacterial endocarditis
embolic and inflammation |
|
|
Term
|
Definition
small erythematous lesions on palm or sole
seen in bacterial endocarditis, caused by septic emboli |
|
|
Term
| most frequent valve involved in bacterial endocarditis? with drug use? |
|
Definition
MV
TV associated with IV drug use |
|
|
Term
| Complications of bacterial endocarditis |
|
Definition
chordae rupture
glomerulonephritis
suppurative pericarditis
emboli |
|
|
Term
| Diagnosis of bacterial endocarditis and common bugs |
|
Definition
requires multiple blood cultures
acute - S. aureus
subacute - viridans streptoccus |
|
|
Term
| Acute bacterial endocarditis (bug, valve changes, onset rate) |
|
Definition
S. aureus (high virulence)
large vegetations on previously normal valve
Rapid onset |
|
|
Term
| Subacute bacterial endocarditis (bug, valve changes, onset rate) |
|
Definition
viridans streptococcus (low virulence)
smaller vegetations on congenitally abnormal or diseased valve
sequela of dental procedures
more insidious onset |
|
|
Term
| Bug associated with colon cancer and bacterial endocarditis |
|
Definition
|
|
Term
| Bug associated with prosthetic valves and bacterial endocarditis |
|
Definition
|
|
Term
| Nonbacterial endocarditis causes |
|
Definition
malignancy
hypercoaguable state (marantic/thrombotic endocarditis) |
|
|
Term
| Verrucus sterile vegetations on both sides of the valve |
|
Definition
verrucous = wartlike
Libman-sacks endocarditis
seen in lupus, associated with MR and less commonly MS |
|
|
Term
| Libman-Sacks endocarditis |
|
Definition
verrucous (wartlike) sterile vegetations occurring on both sides of the valve (associated with MR, occasionally MS)
seen in lupus |
|
|
Term
| Lupus associated endocarditis |
|
Definition
libman-sacks endocarditis
verrucous sterile vegetations |
|
|
Term
| Cause of Rheumatic heart disease |
|
Definition
pharyngeal infection with group A B hemolytic streptococci leads to antibody cross-reactivity (molecular mimicry) - not direct effect of bacteria
type II hypersensitivity |
|
|
Term
| Early and late rheumatic heart disease sequelae |
|
Definition
early - death due to myocarditis
late - valve problem (M>A>>T) - high pressure valve affected the most |
|
|
Term
|
Definition
granuloma with giant cells
seen in Rheumatic heart disease
see pic FA 267 |
|
|
Term
|
Definition
activated histiocytes seen in rheumatic heart disease (pathognomonic)
seen in aschoff bodies, look like caterpillars |
|
|
Term
| Heart disease associated with elevated ASO titers |
|
Definition
|
|
Term
| Criteria for Rheumatic fever |
|
Definition
Joints (migratory polyarthritis)
Other - cardiac valve damage
Nodules - subQ, Aschoff bodies
Erythema marginatum
Sydenham chorea |
|
|
Term
|
Definition
compression of heart by fluid in pericardium, leading to decreased CO
equilibration of diastolic pressure in all four chambers |
|
|
Term
| Findings: hypotension, increased JVP, distant hear sounds, increased HR, pulsus paradoxus |
|
Definition
|
|
Term
|
Definition
pulsus paradoxus - decrease in amplitude of pulse during inspiration
severe cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup |
|
|
Term
| Causes of serous pericarditis |
|
Definition
| SLE, RA, viral infection, uremia |
|
|
Term
| Causes of fibrinous pericarditis |
|
Definition
| uremia, MI (Dressler's syndrome), rheumatic fever |
|
|
Term
| Causes of hemorrhagic pericarditis |
|
Definition
| TB, malignancy (melanoma) |
|
|
Term
| pericardial pain, friction rub, pulsus paradoxus, distant heart sounds |
|
Definition
|
|
Term
| ECG changes in pericarditis |
|
Definition
| ST segment elevation in multiple leads |
|
|
Term
|
Definition
resolve without scarring
chronic adhesive pericarditis
chronic constrictive peridarditis |
|
|
Term
| Tertiary syphilis and heart disease |
|
Definition
vasa vasorum of the aorta is disrupted, leading to consequent dilation of the aorta and valve ring --> aneurysm and AV incompetence
calcification of the aortic root and ascending aortic arch
tree bark appearance of aorta |
|
|
Term
| Most common primary cardiac tumor in adults |
|
Definition
|
|
Term
|
Definition
90% atria (LA usually)
most common primary cardiac tumor in adults |
|
|
Term
| Presentation: ball valve obstruction in LA, associated with multiple syncopal episodes |
|
Definition
|
|
Term
| Most frequent primary cardiac tumor in Kids |
|
Definition
rhabdomyomas
associated with tuberous sclerosis |
|
|
Term
|
Definition
| most frequent primary cardiac tumor in kids, associated with tuberous sclerosis |
|
|
Term
|
Definition
| metastases - melanoma, lymphoma |
|
|
Term
|
Definition
increase in JVP on ispiration
can be seen with cardiac tumors |
|
|
Term
| AV malformation in small vessels, seen as dilated vessels on skin and mucous membranes |
|
Definition
|
|
Term
| Vessel size and locations affected by telangiectasia |
|
Definition
| AV malformation of small vessels, dilated on skin and mucous membranes |
|
|
Term
| Hereditary hemorrhagic telangiectasia |
|
Definition
Osler-Weber-Rendu syndrome
AD
presents with nosebleeds and skin discoloration
telangiectasias |
|
|
Term
| Osler-weber-rendu syndrome |
|
Definition
hereditary hemorrhagic telangiectasia
AD |
|
|
Term
| Decreased blood flow to skin due to arteriolar vasospasm in response to cold or stress |
|
Definition
Raynauds disease (primary)
Raynaud's phenomenon (syndrome, secondary) - due to mixed CT disease, SLE, or CREST |
|
|
Term
| focal necrotizing vasculitis, necrotizing granulomas in lung and upper airway, and necrotizing glomerulonephritis |
|
Definition
Wegener's granulomatosis
small vessels |
|
|
Term
| What organs are affected by Wegeners? |
|
Definition
| lung, upper airway, kidney, skin (nose) |
|
|
Term
| Presentation: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea, hemoptysis, hematuria |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Presentation: large nodular densities on CXR, hematuria, red cell casts |
|
Definition
|
|
Term
| Wegener's granulomatosis treatment |
|
Definition
| cyclophosphamide and corticosteroids |
|
|
Term
| What is like Wegener's but lacks granulomas? |
|
Definition
microscopic polyangiitis
p-ANCA |
|
|
Term
|
Definition
Microscopic polyangiitis
Churg strauss syndrome |
|
|
Term
| Necrotizing vasculitis without granulomas, p-ANCA |
|
Definition
|
|
Term
| primary pauci-immune crescentic glomerulonephritis |
|
Definition
vasculitic limited to kidney
pauci-immune = paucity of Ab
ANCA positive |
|
|
Term
|
Definition
granulomatous vasculitis with eosinophilia
lung, heart, skin, kidneys, nerves
often seen in atopic patients
p-ANCA |
|
|
Term
| What organs does Churg Strauss syndrome affect? |
|
Definition
lung, heart, skin, kidneys, nerves
granulmatous vasculitis with eosinophilia, p-ANCA |
|
|
Term
| Granulomatous vasculitis with eosinophilia |
|
Definition
|
|
Term
|
Definition
vasculitidies
Wegeners granulomatosis: cANCA
Microscopic polyangittis: pANCA
1 pauci immune cresentic glomerulonephritis
Churg strauss syndrome: pANCA |
|
|
Term
| Congenital vascular disorder that affects capillary sized blood vessels, seen as port wine stain on face and leptomeningeal angiomatosis (intracerebral AVM) |
|
Definition
|
|
Term
| Signs of sturge weber disease |
|
Definition
port wine stain on face
leptomeningeal angiomatosis (intracerebral AVM) |
|
|
Term
| Most common form of childhood systemic vasculitis |
|
Definition
Henoch Schonlein purpura
skin, joints, GI |
|
|
Term
Presentation: skin rash on butt and legs (palpable purpura), arthralgia, intestinal hemorrhage, abdominal pain, melena
following URI |
|
Definition
|
|
Term
| Henoch Schonlein purpura triad |
|
Definition
Skin: palpable purpura rash on butt/legs
Joints: arthralgia
GI: intestinal hemorrhage, abdominal pain, melena
affects small vessels and follows URI |
|
|
Term
| Pathophys of henoch schonlein purpura |
|
Definition
follows URI
due to IgA immune complex deposition
see multiple lesions of the same age
Affects skin, joints, GI, and kidney (IgA nephropathy) |
|
|
Term
| Idiopathic segmental, thrombosing vasculitis of small and medium peripheral arteries and veins, heavy smokers |
|
Definition
Buerger's disease
aka thromboangittis obliterans |
|
|
Term
| High risk group for Buerger's disease (thromboangiitis obliterans) |
|
Definition
|
|
Term
| Symptoms: intermittent claudication, superficial nodular phlebitis, cold sensitivity (Raynauds phenomenon), severe pain in affected part, possible gangrene and autoamputation of digits |
|
Definition
|
|
Term
| Possible outcome of Buerger's disease? treatment? |
|
Definition
gangrene, autoamputation of digits
smoking cessation |
|
|
Term
| Necrotizing vasculitis of small/medium sized vessels, acute and self limiting disease of infants/kids |
|
Definition
|
|
Term
| Vasculitis associated with coronary aneurysm development |
|
Definition
|
|
Term
| Presentation: fever, congested conjunctiva, strawberry tongue, lymphadenitis, Asian child |
|
Definition
Kawasaki disease
possible coronary artery development |
|
|
Term
| Necrotizing immune complex inflammation of medium sized muscular arteries |
|
Definition
Polyarteritis nodosa
typically renal and visceral vessels
different age lesions |
|
|
Term
| Symptoms: fever, weight loss, malaise, abdominal pain, melena, HA, myalgia, htn, neuro dysfunction, cutaneous disruption |
|
Definition
polyarteritis nodosa
medium arteries |
|
|
Term
| Vessels affected by polyarteritis nodosa |
|
Definition
| medium sized, typically renal and visceral vessels |
|
|
Term
| Findings: Hep B sero+ (30%), multiple aneurysms and constrictions on arteriogram, not ANCA associated |
|
Definition
|
|
Term
| Treatment for polyarteriris nodosa |
|
Definition
| corticosteroids, cyclophosphamide |
|
|
Term
|
Definition
Takayasu's arteritis
granulomatous thickening of aortic arch and/or proximal great vessels |
|
|
Term
| Granulomatous thickening of aortic arch and/or proximal great vessels |
|
Definition
|
|
Term
| Presentation: Asian female <40, fever, arthritis, nigh sweats, myalgia, skin nodules, ocular disturbances, weak pulses in UE, increased ESR |
|
Definition
Takayasu's arteritis
medium/large arteries |
|
|
Term
| Symptoms of takayasu's arteritis |
|
Definition
Fever
Arthritis
Night sweats
Myalgia,
Skin nodules
Ocular disturbances
Weak pulses in UE
FAN MY SKIN On Wednesday |
|
|
Term
| Most common vasculitis that affects medium and large arteries |
|
Definition
temporal arteritis (giant cell)
usually branches of carotid artery |
|
|
Term
|
Definition
most common vasculitis affecting medium and large arteries, usually branches of carotid
focal granulomatous inflammation, affects elderly females |
|
|
Term
| Symptoms: unilateral HA, jaw claudication, impaired vision |
|
Definition
Temporal arteritis
impaired vision = occlusion of opthalmic artery that may lead to irreversible blindness |
|
|
Term
| Treatment for temporal arteritis |
|
Definition
high dose steroids
half of people have systemic involvement and polymyalgia rheumatica |
|
|
Term
| Affects small vessels (7) |
|
Definition
Telangiectasias
Raynauds
Wegeners granulomatosis
Microscopic polyangiitis
Churg-Stauss syndrome
Sturge Weber disease
Henoch-Schonlein purpura |
|
|
