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FAOS Cardio

Med 2

Sum SumSum'bout it
Heart begins to beat at___ and develops from____ week 4, mesodermal cells
Septa form between___ as out growth of___ 4th and 6th weeks, endocardial surface (all septation occurs simultaneously)
Atrioventricular Canal split into two canals by endocardial cushions
Primitive atrial septum process of dividing into LFT and RT chambers sept primum grows down toward the AV cushions (space bw two= ostium primum), superior sept primum obliterates= ostium secundum, sept secundum grows along SP, space bw top and bottom portions of SS form foramen ovale, SP one way valve
Atrial Septal Defect will show LFT—> RT shunt (non-cyanotic), RA/RV/PA enlargement, tall P wave, wide fixed splitting, pulmonic flow murmur
Interventricular Septum consists of muscular septum (upward expansion of primitive ventricle), membranous septum (fusion of aorticopulmonary septum with muscular portion, grows downward from AV cushions)
Ventricular Septal Defect will show LFT —> RT shunt, LA/LV enlargement, small ones close by age 2, larger ones may present with late cyanosis, easy fatiguability
Aorticopulmonary Septum from neural crest cells, separates truncus arteriosus into aorta/pulmonary artery, spins 180 as descends and failure to do so= RT—> LFT shunting/ early cyanosis
Persistent Truncus arteriosus Abnormal migration of neural crest cells, failure of AP septum to form, common tact leaving both ventricles
Transposition of great vessels AP septum fails to spiral (LV—> pulmonary trunk, RV—> aorta [two closed circuits]), complete RT—> LFT shunt, early cyanosis
Tetralogy of Fallot anterior displacement of AP septum => overriding aorta, pulmonic stenosis, RV hypertrophy, VSD. overriding aorta obstructs RV outflow —> pulmonic stenosis—> increased pressure requirement—> hypertrophy. VSD= RT—> LFT shunting (early cyanosis)
5 T’s of early cyanosis Tetralogy of fallot, Transposition of GV, Truncus arteriosus, Total anomalous pulmonary venous return, Tricuspid atresia (failure of T valve to form)
Infantile coarctation of aorta Pre/Postductal based on location related to a patent ductus arteriosus, results in increased after load. Preductal= RT—>LFT shunt, cyanosis of lower body, Postductal= RT—>LFT shunt, decreased blood flow to lower half
Adult coarctation of aorta distal to arch, absent PDA, hypertension in upper extremities and hypotension in lower extremities, collateral circulation to lower limbs (SC,IT, SE, IE, EI) forms rib notches via IC arteries
Congenital aortic stenosis Aortic valve develops abnormally, bicuspids more susceptible to calcification and fibrosis
Patent ductus arteriosus Increased O2/ decreased prostaglandins should result in closure, if open LFT—> RT shunt bc LFT heart is higher pressure system, continuous “machine like” murmur bc blood is consistently flowing, LA/LV/PA/Aorta enlarged
Untreated LFT—> RT shunts Pulmonary arterial system becomes hypertrophic—> pulmonary hypertension, increased RT pressure—> RV hypertrophy—> shunt reverses—> late cyanosis (Eisenmenger syndrome)
Allantois—>___ Urachus (connects the fetal bladder to the yolk sac and removes nitrogenous waste from the fetal bladder)—> mediaN umbilical ligament
Ductus arteriosus—>___ ligamentum arteriosum
Ductus venosus—>___ ligamentum venosum
Foramen ovale—>___ Fossa ovalis
Notochord—>___ nucleus pulposus
Umbilical arteries—>___ MediaL umbilical ligamentS
Umbilical vein—>___ ligamentum teres hepatis (contained in falciform ligament)
Fetal Hemoglobin 2 alphas/ 2 gammas, lower affinity for 2,3-BPG = higher affinity for O2 (ensures transfer across placenta), physiologic anemia normal (4-8 weeks) before steady state production of adult hemoglobin
3 shunts of fetal circulation umbilical vein—> DUCTUS VENOSUS—> Ivc —>FORAMEN OVALE—> aorta; DO blood from Svc—> RA—>RV—> main pulmonary artery—> PATENT DUCTUS ARTERIOSUS
Apex/ A Arch/ SVC anatomic locations apex (PMI)= 5th IC space @MC line, Arch= sternal notch= T2, SVC enters RA @3rd rib
Layers of heart Endo (innermost, simp squamous), Myo (middle/ thickest, composed of myocytes), Peri (outer fibrous= tough connective tissue; inner serous= [parietal layer continuous with internal FP, visceral/epicardium= contains coronary arteries])
Coronary circulation: SA/AV__; RV__; AV (lil bit)/post interventricular septum__; LV/ Ant interventricular septum___; LV__ RCA; RMA; PDA; LAD; LCxA
At rest, membrane conductance/ permeability higher for___ K+ (resting potential close to K equilibrium)
Conduction velocity rates fastest in His-Purkinje > Atrial myocytes > Ventricular myocytes > AV node
Underlying basis for refractory period Closure of Na channel inactivation gates
Cardiac myocytes utilize___ Ca channels (phase 2) L-Type
Nodal AP utilizes___ Ca channels (phase 0) T-type (L-type present but activated at higher MP) *pg 16
After contraction, intracellular Ca is moved to SR via___ and extracellular Ca is expelled via___ SERA pump (Ca ATPase), Ca/Na pump
S1 M/T valve closure, M closes before T but juuuust barely so probably wont hear it
S2 A/P closure, A closes before P (normal splitting)
S3 Ventricular gallop, turbulent blood flow right after S2, seen in children, athletes and preggos . Loudest at apex
S2 splits: wide= delayed RV emptying, fixed= ASD, paradoxical= delayed A valve closure
Highest resistance in CV system Arterioles, responsible for largest drop in arterial pressure
Largest total cross sectional and surface area of CV system Capillaries
Highest capacitance in CV system Veins
Diastolic VS Systolic affects on MAP D pressure impacts more bc diastole is longer in healthy patient at rest
P wave represents atrial depolarization
QRS complex represents Ventricular depolarization (masks atrial repolarization)
T wave Ventricular repolarization
4 rules of ECG Depol towards (+) pole= upward deflection; Depol toward (-) pole= downward deflection; magnitude of deflection= how parallel the net electrical vector is to lead measuring it; Net electrical vector reads 0 magnitude in any lead perpendicular to it
PR interval represents time of electrical impulse from SA node to beginning of ventricular depol
QT interval represents mechanical contraction of ventricles
Brady/Tachycardia [ECG] normal P wave, QRS rate <60/ >100
1st degree AV block PR interval > 5 small boxes, 1:1 P/QRS
3rd degree (complete) AV block AV dissociation, atria and ventricles beat independently of each other, atrial rate is faster than ventricular rate
Atrial flutter regular, rapid succession of identical back-to-back P waves given sawtooth appearance
Atrial fibrillation rapid, irregularly irregular/ no discernible p waves, RR distances will all be different but present QRS
Ventricular Tachycardia wide QRS complex at regular rhythm
Ventricular fibrillation completely erratic baseline
QISSS & QIQ [Sym] A1, A2, B1, B2, B3 & [Para] M1, M2, M3
Coronary arteries/ venus counterparts: Ant IV (LAD)___; Post IV___; Marginal (from RCA)___; Circumflex___ Great cardiac vein, middle cardiac vein, small cardiac vein, Post vein (left ventricle)
Contractility changes vs PV loop Increase= increase SV/ EF, decrease in ESV [left wall of loop will be stretched back]
Afterload changes vs PV loop Increase = increase ESV, decrease SV [going to look tall and skinny]
Preload changes vs PV loop increase = increase in SV/ EDV [right wall of loop will be stretched forward]
Autonomic effects on heart and blood vessels HR and Contractility (B1-sym, M2-parasym); Vascular smooth muscle tone (A1[constriction, sym], M3[Dilation, parasym])
2nd degree AV block P wave not followed by QRS w/ or w/o preceding gradual lengthening of PR interval
Truncus arteriosus--> aorta and pulmonary trunk
Bulbus cordis--> Conus cordis --> smooth parts (outflow tract) of left/right ventricles
Endocardial cushion--> atrial septum, membranous interventricular septum, AV (of AV canal) and semilunar valves (of outflow tract)
Primitive atrium--> Trabeculated part of left/right atria
Primitive ventricle--> Trabeculated part of left/right ventricle
Primitive pulmonary vein (transient common PV)--> smooth part of left atrium
Left horn of sinus venosus--> coronary sinus
Right horn sinus venosus--> smooth part of right atrium
right common cardinal vein and right anterior cardinal vein SVC, not from heart tube
Vitelline veins--> Portal system
Created by: JustinCo