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USMLE

CV 3

QuestionAnswer
when in the cardiac cycle is O2 consumption highest? isovolumetric contraction
this is the period between mitral valve closing and aortic valve opening isovolumetric contraction
this is the period between aortic valve opening and closing systolic ejection
this is the period between aortic valve closing and mitral vale opening isovolumetric relaxation
when does rapid filling occur? just after mitral valve opens
when does slow filling occur? just before mitral valve closes
when is JVD seen? right heart failure
what is cardiac muscle contraction dependent on? extracellular calcium, which enters the cells during plateau of action potential and stimulates calcium release from the sarcoplasmic reticulum (calcium-induced calcium release)
what is the plateau in the cardiac muscle action potential due to? calcium influx
where does the pacemaker action potential occur? SA and AV nodes
what accounts for the automaticity of the SA and AV nodes? slow diastolic depolarization - membrane potential spontaneously depolarizes as Na+ conductance increases (funny channel)
what determines heart rate? slope of phase 4 in the SA node
what are the peripheral chemoreceptors? what do they respond to? carotid and aortic bodies - they respond to decreased (less than 60 mmHg)/increased PCO2, decreased pH of blood
what do central chemoreceptors respond to? changes in pH and PCO2 of brain interstitial fluid, which in turn are influenced by arterial CO2
what does the aortic arch respond to? how does it transmit and to where? responds to increased BP; transmits via vagus to medulla
how and to where does the carotid sinus transmit information? via glossopharyngeal to the medulla
how do the central chemoreceptors respond to increased intracranial pressure? hypertension (sympathetic response) and bradycardia (parasympathetic response)
what organ receives the larges share of systemic cardiac output? liver
what organ receivest eh highest blood flow per gramof tissue? kidney
how does the heart meet increased O2 demand? incrased coronary blood flow, not by increased extraction of O2
hypoxia in the pulmonary vasculature causes what? vasoconstriction (unique because in other organs hypoxia causes vasodilation)
what are the local factors in the heart that determine autoregulaton? O2, adenosine, NO
what are the local factors in the brain that determine autoregulation? CO2 (pH)
how do the kidneys determine autoregulation? myogenic and tuboglomerular feedback
what local factors determine autoregulation in skeletal muscle? lactate, adenosine, K+
what is the most important mechanism for determining autoregulation in the skin? sympathetic stimulation - temperature control
what is the effect of carotid massage? incrases pressure on carotid artery - increasing stretch and leading to decreased HR
what is the ultimate consequence of baroreceptors sensing hypotension? vasoconstriction, incrased HR, contractility, and BP - important in the response to severe hemorrhage
sound of mitral and tricuspid valve closure S1
sound of aortic and pulmonary valve closure S2
sound at end of rapid ventricular filling S3
sound from high atrial pressure/stiff ventricle S4
what is S3 associated with? dilated CHF, mitral/tricuspid regurgitation
what is S4 (atrial kick) associated with? hypertrophic ventricle
what is paradoxical splitting associated with? aortic stenosis, LBBB
what is fixed splitting associated with? ASD
holosystolic high pitched 'blowing murmur' loudest at apex mitral regurg (tricuspid regurg)
cresecendo-decrescendo systolic ejection murmur following ejection click aortic (pulmonic) stenosis
pulsus parvus et tardus pulses weak compared to heart sounds; seen in aortic stenosis
holosystolic murmur VSD
late systolic murmur with midsystolic click mitral prolapse
immediate high-pitched blowing diastolic murmur; wide pulse pressure aortic regurgitation
delayed rubbing late diastolic murmur that follows opening snap mitral stenosis
how does the murmur in tricuspid stenosis differ from that of mitral stenosis? tricuspid stenosis differs because it gets louder with inspiration
continuous machine-like murmur PDA
when is the murmur associated with a PDA loudest? S2
Created by: Asclepius
 

 



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