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Cardiovascular
First Aid: Cardiovascular
| Question | Answer |
|---|---|
| What 3 structures are located in the carotid sheath? | common carotid, internal jugular vein, vagus nerve |
| What supplies the inferior portion of the left ventricle 80% of the time? | Right coronary artery |
| Enlargement of this portion of the heart can result in dysphagia. | left atrium, the most posterior portion of the heart. |
| What is the mechanism of action of catecholamines on contractility? | Increase activity of calcium pump on SR --> increased contractility |
| What is the mechanism of action of digoxin on contractility? | Inhibits Na/K ATPase --> increased intracellular Na --> increased intracellular Ca --> increased contractility |
| What is the primary determinant of preload? | End diastolic volume |
| What is the primary determinant of afterload? | Diastolic arterial pressure (related to peripheral resistance) |
| What effect will nitroglycerine have on preload? | a venous dilator, it will decrease preload |
| What effect will hydralazine have on afterload? | Hydralazine, a vasodilator and smooth muscle relaxant, will decrease afterload |
| What three factors increase resistance? | Decrease in radius is most profound, viscosity, and length |
| On cardiac and vascular function curves of cardiac output and venous return as a function of right atrial pressure (EDV), what 3 determinants have the most bearing? | Blood volume will increase or decrease VR; inotropy will increase or decrease CO; TPR will inversely increase or decrease both VR and CO |
| S4 heart sound is indicative of what? | High atrial pressure against a stiff ventricle (atrial kick) associated with hypertrophic ventricle |
| S3 heart sound is indicative of what? | Rapid ventricular filling associated with dilated CHF |
| What do the a, c, and v wave represent on the venous pulse graph? | a: atrial contraction; c: RV contraction; v: increased atrial pressure due to filling against closed tricuspid valve |
| Split S2 is indicative of what heart problems? | Wide splitting: pulmonic stenosis; fixed splitting: ASD; paradoxical splitting: aortic stenosis (fixed means split is same on inspiration and expiration; paradoxical means split is bigger on expiration than inspiration) |
| What are the phases of the myocardial action potential? | phase 0: upstroke (voltage gated Na channels); phase 1: initial repolarization (VG Na channels begin to close K channels begin to open); phase 2: plateau (Ca influx); phase 3: rapid repolarization (K efflux); phase 4: resting potential |
| What are the phases of pacemaker action potentials? | Phase 0: upstroke (VG Ca mediated); phase 2: plateau is absent; phase 3: rapid repolariation (K efflux); phase 4: slow depolarization (Na conductance) |
| What does the P wave represent? | atrial depolarization |
| What does the PR interval represent? | delay of conduction through AV node (normally 200 msec) |
| What does the QT interval represent? | Ventricular contraction |
| What is Torsades de pointes? | Ventricular tachycardia characterized by shifting sinusoidal waveforms on ECG; can progress to V-fib (anything that prolongs QT interval can predispose to torsades) |
| What is Wolff-Parkinson White syndrome? | Accessory conduction from atria to ventricle (bundle of Kent) bypassing AV node resulting in early ventricular depolarization (characteristic delta wave on ECG); may lead to SVT |
| Chaotic and erratic baseline, no discrete P waves, irregularly spaced QRS complexes. Diagnosis? | Atrial fibrillation |
| Rapid succession of identical atrial depolarization waves giving sawtooth appearance. Diagnosis? | Atrial flutter |
| PR interval is 300 msec. Diagnosis? | 1st degree AV block |
| Progressive lengthening of PR interval until beat is dropped. | 2nd degree AV block; Mobitz type I (Wenckebach) |
| Dropped beats that are not preceded by a change in PR interval. | 2nd degree AV block; Mobitz type II; often a 2:1 block and may progress to 3rd degree block |
| Atria and ventricles beat independently of each other with P waves bearing no relation to QRS complexes. What is the treatment? | 3rd degree (complete) AV block; treat with pacemaker |
| Completely erratic rhythm with no identifiable waves. | Ventricular fibrillation |
| Carotid sinus baroreceptors send their signals to the medulla along what cranial nerve? | Glossopharyngeal |
| What is the Cushing reaction? | Increased intracranial pressure compresses cerebral blood vessels --> chemoreceptors note increase in PCO2 and decrease in pH --> hypertension (sympathetic response) and bradycardia (parasympathetic response) |
| What local metabolites determine cardiac autoregulation? | Oxygen, adenosine, and NO |
| What local metabolites determine the brain's autoregulation? | PCO2 and pH |
| What factor determines pulmonary autoregulation? | Unique in that hypoxia causes vasoconstriction |
| What local metabolites determine skeletal muscle autoregulation? | lactate, adenosine, potassium |
| What are the 3 most common causes of right to left shunts? | 3 T's; Tetralogy of Fallot, transposition of the great vessels, truncus arteriosus; blue babies w/ early cyanosis (children may squat to increase venous return) |
| What are the 3 most common causes of left to right shunts? | VSD, ASD, PDA; blue kids w/ late cyanosis |
| What is Eisenmenger's syndrome? | Left to right shunt causes pulmonary arteriolar thickening --> pulmonary hypertension --> L to R shunt becomes R to L shunt |
| What is tetralogy of fallot? | Pulmonary stenosis, VSD, overriding aorta, right ventricular hypertrophy; caused by anterosuperio displacement of infundibular septum |
| How does a heart with tetraology of fallot appear on X-ray? | boot shaped heart |
| What seperates infantile from adult coarctation of the aorta? | Infantile is aortic stenosis proximal to the ductus arteriosus; adult is aortic stenosis distal to ductus arteriosus (hypertension in upper extremities, weak pulses in lower) |
| What genetic syndrome is associated with coarctation of the aorta? | Turner's syndrome |
| Continuous "machine like" murmur is loudest at S2 | Patent ductus arteriosus; closed with indemethacin, kept open with PGE (misoprostol) which is necessary for transposition |
| What cardiac defects are associated with 22q11 syndrome? | Truncus arteriosus, tetralogy of fallot |
| What cardiac defects are associated with Down syndrome? | ASD and VSD |
| What cardiac defects are associated with Congenital rubella? | Septal defects and PDA |
| What cardiac defects are associated with Marfan's syndrome? | Aortic insufficiency (aortic regurgitation) |
| What cardiac defects are associated with diabetic mothers? | transposition of the great vessels |
| What is corneal arcus? | lipid deposits in the cornea |
| What is a xanthoma? | plaques or nodules composed of lipid-laden histiocytes in the skin, especially eyelids |
| What is Monckberg atherosclerosis? | calcification of the arteries; "pipestem" arteries |
| What pathologic findings would be expected with arteriosclerosis (essential vs. malignant HTN)? | hyaline thickening of small aarteries in essential hypertension; onion skinning in malignant hypertension |
| Fibrous plaques in the intima of arteries. | Atheroma |
| How much of the coronary arteries must be occluded before angina is present? | 75% |
| Retrosternal chest pain that gets better with rest. What is to blame? | Stable angina; most likely secondary to atherosclerosis |
| What is the cause of prinzmetal's angina versus unstable angina? | Prinzmetal: coronary artery vasospasm; Unstable: thrombosis w/out necrosis (thrombosis w/ necrosis is an MI) |
| Patient dies 2 days after an MI? What is the cause of death? What if he had died 7 days later? | arrhythmia; ventricular rupture if a week post MI |
| When do neutrophils and macrophages invade following an MI? | Neutrophils: 2-4 days post MI; Macrophages: 5-7 days post MI |
| What does ST elevation versus ST depression tell you post MI? | ST elevation is most likely transmural and is likely to be joined by pathologic Q waves; ST depresssion is most likely subendocardial |
| What is Dressler's syndrome? | Autoimmune phenomenon resulting in fibrinous pericarditis several weeks post MI |
| What are the most common causes of dilated carciomyopathy? | ABCD's of cardiomyopathy; Alcohol abuse, Beriberi, Coxsackie, Cocaine, Chaga's, Doxorubicin; heart dilates and looks like a balloon on X-ray |
| What is the treatment for hypetrophic cardiomyopathy? | Beta blockers |
| What are the major causes of restrictive cardiomyopathy? | Sarcoidosis, amyloidosis, postradiation fibrosis, Loffler's endocarditis, and hemochromatosis (dilated cardiomyopathy can also occur) |
| Holosystolic "blowing murmur" loudest at apex | Mitral regurgitation; VSD also causes holosystolic murmur |
| Crescendo-decrescendo systolic ejection murmur | Aortic stenosis |
| Diastolic "blowing murmur" | Aortic regurgitation |
| Late diastolic murmur with opening snap | Mitral stenosis |
| What is the mechanism of paroxysmal nocturnal dyspnea | CHF patient lies down --> fluid which has been in the legs during the day enters systemic circulation --> increase in blood pressure and TPR --> pulmonary hypertension --> pulmonary edema --> dyspnea ( hemosiderin-laden macrophages "heart failure cells) |
| What are Roth spots, osler's nodes, and janeway lesions? | Roth spots are retinal hemorrhages; osler's nodes are tender raised lesions on finger or toe pad; janeway lesions are small erythematous lesion on palm or sole; All are associated with bacterial endocarditis |
| What are the likely agents of acute and subacute endocarditis? | Acute: staphy aureus; Subacute: strep viridans (dental sequelae) |
| Vegetations on both sides of the mitral valve leading to stenosis is indicative of what disease? | Libman-Sacks endocarditis; caused by SLE (LSE is caused by SLE) |
| What are the symptoms of rheumatic heart disease? | FEVERS; Fever, Erythema marginatum, Valvular damage, ESR elevation, Red hot joints (migratory polyarthritis), St. Vitus dance (chorea) |
| What changes would be seen with syphilitic heart disease? | disruption of the vasa vasora leading to dilation of the aorta and valve ring, can result in aneurysm of ascending aorta |
| Ball valve obstruction in the left atrium is indicative of what heart problem? | myxoma cardiac tumor |
| Rhabdomyoma is associated with what hereditary disorder? | tuberous sclerosis |
Created by:
rahjohnson
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