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First Aid: Cardiovascular

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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