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Cardio PP Clues

What organs have resistance in series? Kidney & Liver
What organs have resistance in parallel? All except kidney & liver
What organ has the highest A-V O2 difference at rest? Heart
What organ has the highest A-V O2 difference after exercise? Muscle
What organ has the highest A-V O2 difference after a meal? GI
What organ has the highest A-V O2 difference during an exam? Brain
What organ has the Lowest A-V O2 difference at all times? Kidney
Where does Type A thoracic aortic dissection occur? Ascending Aorta (cystic medial necrosis, syphilis)
Where does Type B thoracic aortic dissection occur? Descending Aorta (trauma, athersclerosis)
What layers does a True aortic aneurysm involve? Intima, media, adventitia
What layers does a Pseudo aortic aneurysm involve? Intima, media
What is pulse pressure? Systolic Pressure - Diastolic Pressure
What vessel has the thickest layer of smooth muscle? Aorta
What vessels have the most smooth muscle? Arterioles
What vessels have the largest cross sectional area? Capillaries
What vessel has the highest compliance? Aorta
What vessels have the highest capacitance? Veins & venules
What is your max heart rate? 220 - age
What is stable angina? Pain on exertion (atherosclerosis)
What is unstable angina? Pain at REST (transient clots), or FIRST event of pain on exertion
What is Prinzmetal angina? Intermittent pain (coronary artery spasm)
What stain is used to see amyloidosis? Congo Red (apple green birefringence)
What is Hemochromatosis? Fe deposition in organs --> hyperpigmentation, arthritis, diabetes mellitus
What is cardiac tamponade? Pressure equalizes in all 4 chambers - quiet precordium, no pulse or BP, Kussmaul's sign, pulsus paradoxus
Kussmaul's sign Rise in JVP (jugular venous pressure) on Inspiration
Pulses paradoxus Drop in Systolic pressure > 10mmHg on Inspiration
What is a Transudate? Effusion of mostly water
What is an Exodate? Effusion of mostly protein
What is systole? ventricles contract, decreased blood flow to coronary arteries, Increased O2 extraction
What is diastole? ventricles relax & fill, Increased blood flow to coronary arteries, decreased O2 extraction
What are the only arteries w/ deoxygenated blood? Pulmonary & Umbilical arteries
What murmur has a waterhammer pulse? Aortic Regurg
What murmur has pulsus tardus? Aortic Stenosis
What cardiomyopathy has pulsus alternans? Dilated cardiomyopathy
What disease has pulsus bigeminus? Idiopathic hypertrophic subaortic stenosis (IHSS)
What murmur has an irregularly irregular pulse? Atrial Fibrillation
What murmur radiates to the carotids? Aortic Stenosis, Aortic Regurg
What murmur radiates to the axilla? Mitral Regurg
What murmur radiates to the back? Pulmonary Stenosis
What disease has a boot shaped x-ray? Right ventricular hypertrophy
What disease has a banana-shaped x-ray? Idiopathic hypertrophic subaortic stenosis (IHSS)
What disease has an egg-shaped x-ray? Transposition of the Great Arteries
What disease has a snowman-shaped x-ray? Total anomalous pulmonary venous return
What disease has a "3" shaped x-ray? Aortic coarctation
What is Osler-Weber-Rendu? Arterio-Venus Malformation (AVM) in lung, gut, CNS (sequester platelets --> telangiectasias)
What is Von Hippel-Lindau AVM in head, retina (Increased risk of renal cell carcinoma)
When do Valves make noise? on Closure
What valves make noise at the start of systole? Mitral & Tricuspid (S1)
What murmurs occur during systole? Holosystolic (pancystolic): MR, TR, VSD ... Ejection: AS, PS, HCM
What valves make noise at the start of diastole? Aortic & Pulmonary (S2)
What are the diastolic murmurs? Blowing: AR, PR ... Rumbling: MS, TS
What murmurs are continuous? PDA, AVM
What has a friction rub while breathing? Pleuritis
What has a friction rub when holding your breath? Pericarditis
What does a mid-systolic click tell you? Mitral Valve Prolapse (MVP)
What does an ejection click tell you? Stenosis: AS, PS
What does an opening snap tell you? Stenosis: MS, TS
What does S2 splitting tell you? Normal on inspiration (b/c pulmonic valve closes later)
What does a wide S2 split tell you? Increased O2, Increased Right Ventricular Volume, or delayed Pulmonic Valve opening
What does a Fixed Wide S2 split tell you? Atrial Septal Defect (ASD)
What is cor pulmonale? Pulmonary HTN --> RV failure
What is Eisenmenger's? Pulmonary HTN --> reverse L-R to R-L shunt
What is transposition of the great arteries? Aorticopulmonary septum did not spiral
What is tetralogy of Fallot? Overriding Aorta, Pulmonic Stenosis, Right Ventricular Hypertrophy, Ventral Septal Defect (VSD)
What is an Overriding Aorta? Aorta overrides on Interventricular Septum over the VSD, encroaches on the Pulmonic Valve
What does Pulmonic Stenosis in Tetralogy of Fallot cause? Tet Spells (episodes of bluish skin on feeding or crying), prognostic
What type of shunt does a VSD cause? Left-to-Right shunt
What is truncus Arteriosus? Spiral membrane didn't develop (neural crest origin); One Aortic/Pulmonary trunk (mixed blood)
What is Epstein's Anomaly? Tricuspid sits very low (large right atria); Teratogenic birth defect of Lithium
What is cinchonism? Hearing loss, tinnitus, thrombocytopenia
What are the Cyanotic Heart Diseases? (9) Transposition of the great arteries, Tetralogy of Fallot, Truncus Arteriosus, Tricuspid Atresia, Total Anomalous Pulmonary Venus Return, Hypoplastic Left Heart Syndrome, Epstein's Anomaly, Aortic Atresia, Pulmonic Atresia
Causes of Widened S2: Increased pO2, Increased right ventricular volume, Blood transfusion, Supplemental O2, Pregnancy, IV Fluids, ASD (fixed), Deep breathing
Types of Arterio-Venus Malformation (AVM): AVM=machinery murmur; Heart:PDA, Elbow:dialysis fisula, Brain:Von-Hippel-Lindau, Lungs:Osler-Weber-Rendu
Heart Block Clue Pain with a Normal heart rate
Heart rate increase with temperature HR should increase by 10bpm for every 1 degree increase in temperature
Maximum Sinus Rate (aka max heart rate) 220 - age in years
Ions and the EKG P-wave=Ca2+, QRS-complex=Na+, ST-Interval=Ca2+, T-wave=K+, U-wave=Na+
Most Common NON-Cyanotic Congenital Heart Diseases VSD, ASD, PDA, Coarctation of the Aorta
Pansystolic Murmurs Mitral Regurg, Tricuspid Regurg, VSD
Myocardial Infarct - Enzymes Troponin I, CKMB, LDH
MI Enzymes Timeline Troponin I (appears 2hrs, peaks 2days, gone 7days); CKMB (appears 6hrs, peaks 12hrs, gone 2days); LDH (appears 1day, peaks 2days, gone 3days)
Along with nitrates, what hypertensive medication both vaso- and veno-dilates? ACE-Inhibitors
For what medical conditions are nitrates used? CHF, Acute MI, Angina
Clues for Coarctation Differential Pulses, Differential Cyanosis, Rib notching on X-Ray
Reason for Rib Notching in Coarctation: Bronchial arteries open up to allow blood to flow and eroding ribs
Reason for differential cyanosis in coarctation: the PDA joins distal to coarctation
Most common congenital heart disease in Down's Syndrome Common AV Canal, ASD + VSD together, VSD only, ASD only
Why does Common AV Canal result? Failure of endocardial cushion to develop
Most Common Cyanotic Heart disease in Down's Syndrome Tetralogy of Fallot
Which vessels have the greatest effect on blood pressure? Arterioles
Which vessels can store the most blood? Veins & Venules
Which vessels have the thinnest walls? Capillaries
How does the body maintain stroke volume during hypovolemic shock? by constricting the veins and venules
How much blood is stored in the veins & venules? 60% of blood volume
Vessels in which most diffusion occurs: Capillaries
Type of epithelium that makes up the aorta stratified squamous
Calcification of the aortic arch due to trauma and age is called? Monckeberg calcification
What gives the veins & venules the ability to have such great compliance? Elastin, they have a thin wall
What 2 factors help overcome afterload and help deliver blood to tissues? Ventricular contraction and Aortic recoil
What 3 factors prevent blood from being delivered to the heart during systole? Aortic valves partially occlude the coronary vessels; There is no transmural force pushing blood into the coronary vessels; The contracting ventricles compress the coronary vessels
When is the energy requirement developed? Energy requirement is generated during systole
When is energy extracted from blood? Energy is extracted during diastole
How much oxygen is extracted from blood by the heart? 97%
With FAST heart rates, in which phase of the cycle does the heart spend most time? systole
With SLOW heart rates, in which phase of the cycle does the heart spend most time? diastole
What happens to the aorta as you age? The aorta calcifies
How does aortic calcification affect compliance? Compliance Decreases
What effect does decreased aortic compliance have on blood pressure and pulse pressure? BP increases (mainly systolic). Pulse Pressure increases (systolic increases, diastolic remains unchanged)
How do you treat hypertension in the elderly? Ca2+ channel Blockers
Why do the liver & kidneys have resistance of vessels in series? They detoxify blood so you want blood to move slowly. Even though the velocity of the downstream blood is increased, there is a backup of blood so blood flow decreases and blood spends more time being detoxified.
Vasodilators of the organs: Brain (Increased pCO2, decreased pO2); CV (Adenosine); Lung (Increased pO2); Muscle (Increased pCO2, decreased pH); GI (food, esp fat); Skin (Increased Temp, Increased pCO2); Renal (D2-R, PG, ANP)
What is the function of the Carotid Body? Carotid Sinus? Carotid Body is a chemoreceptor; Carotid Sinus is a baroreceptor that measure stroke volume
What is the pathway of signals from the carotid sinus? Carotid sinus measures stroke volume; Sends signal to Nucleus tractus Solitarius in the Medulla via CN IX; The Medulla then sends a signal to the heart via CN X; Medulla causes increased release of NE
How does the carotid sinus affect firing of CN IX and CN X? Cranial Nerves IX and X are always firing; Firing goes up/down along with Stroke Volume; NE goes in the opposite direction; Increased Stroke Volume causes increased firing of IX and X; decreased Stroke Volume causes decreased firing of IX and X
What effect does CN X have on the heart? CN X is inhibitory to the heart. Increased firing causes decreased Heart Rate; Decreased Firing causes Increased Heart Rate
When you stand up, how much does heart rate and blood pressure change? Heart Rate increases by 5-10bpm; Blood Pressure drops by 5-20mmHg
What is the meaning of a change less than the expected mean in HR & BP when standing up? body did not respond = Autonomic Dysfunction
What is the meaning of a change MORE than the expected mean in HR & BP when standing up? body overcompensated = Volume Depletion
Four types of Autonomic Dysfunction: Baby (Reily-Day Syndrome); Diabetics (Neuropathy); Parkinson (Shy-Drager); Elderly (Sick Sinus Syndrome)
What is the pathology of Sick Sinus Syndrome in the elderly? Carotid Sinus is so calcified that it does not respond. Sick sinus means pausing for more than one second.
What is the pathology of Reily Day Syndrome? Babies are born with no autonomic reflexes
With respect to the carotid sinus, what sequence of events takes place when you increase your fluid volume? Carotid Sinus increases firing; CN IX and X increase firing; HR decreases (Reflex Bradycardia)
Sequence of events takes place when you stand from a seated position (carotid sinus) Blood pools in legs --> Decreased venous return --> Decreased EDV --> Decreased Stroke Volume --> Decreased firing of Carotid Sinus --> Decreased firing of CN IX and X --> Increased HR Reflex Tachycardia --> Decreased BP 5-20mmHg and Increased HR 5-10bpm
Mechanism responsible for immediate regulation of BP: Carotid Reflex via Carotid Sinus
Mechanism responsible for intermediate regulation of BP: NE (alpha1 receptors then beta1 receptors)
Mechanism responsible for long term regulation of blood pressure: kidney
What is the most potent vasoconstrictor in the body? Angiotensin II
To what stimulus to JG cells in the kidney respond? And how? They respond to flow (volume) not pressure --> cause the release of Renin
What is the rationale for using a carotid massage? Massaging the carotid Sinus stimulates an increase in Stroke Volume. This causes increased firing of Carotid Sinus, Increased Firing of CN IX and X and decrease in HR
How does NE regulate blood pressure? If Carotid reflex is not enough to normalize BP, NE is released and causes vasoconstriction via Alpha1 receptors and an increase in HR via Beta1 receptors
What is the function of the carotid reflex? The carotid sinus is responsible for immediate regulation of HR via reflex Brady & Tachy cardia
What is the diagnosis for a patient presenting with increased HR and Normal BP? Hypovolemia (compensated shock)
What are the first physical signs of hypovolemia? Poor skin turgor (mottled skin), increased pulse, and decreased bowel sounds
What is lentigo reticularis? Hypoperfusion of the skin due to vasoconstriction in shock
Two most important actions of Angiotensin II: Vasoconstriction, stimulate Aldosterone release
What is the treatment for hypertension in heart failure? ACE-Inhibitor
First Degree Heart Block Fixed lengthening of PR interval
Second Degree (Mobitz 2) Heart Block Normal PR interval & erratic loss of QRS
Third Degree Heart Block AV disassociation
Second Degree (Mobitz 1) Heart Block gradual lengthening of PR interval & erratic loss of QRS
How do you treat various types of heart block? 1st degree -> No Tx; Mobitz I -> Pacer if symptomatic; Mobitz II -> Pacer; 3rd Degree -> Pacer
Complication of Temporal Arteritis: blindness
Another name for Temporal Arteritis: Giant Cell Arteritis
How do you diagnose Temporal Arteritis? Temporal Artery Biopsy
Rule of 60s for Temporal Arteritis: Age>60, ESR>60, 60mg prednisone to treat
Myositis one muscle hurt; caused by Rifampin, Isoniazid, Statins, Prednisone, Hypothyroidism
Polymyositis several muscles hurt
Dermatomyositis muscle pain with rash; visceral cancer; heliotropic
Fibrositis inflamed muscle insertions; muscle pain when moving
Fibromyalgia pain of muscle and muscle insertions; treated with Amitriptyline; multiple trigger points
Polymyalgia Rheumatica shoulder girdle hurts most; Increased in Temporal Arteritis
Throbbing temporal Headache Temporal Arteritis
Drugs that cause Myositis Rifampin, Isoniazid, Statins, Prednisone
Disease that causes myositis Hypothyroidism
Clues for Ataxia Telangiectasia Cerebellar signs in 5-10yo; Spider veins on skin; IgA deficiency
Vasculitis 2 weeks after a common cold Berger's
Smoking Jewish person with necrotizing vasculitis Buerger's
Family history of deafness & cataracts Alport's
Strawberry Tongue Kawasaki's
2 weeks after E.coli gastroenteritis Hemolytic Uremic Syndrome (HUS)
Fever, Thrombocytopenia, and Neuro problems Idiopathic Thrombocytopenia Purpura
Midsize arteries (particularly in GI and kidney) Polyarteritis Nodosa
Vasculitis with Sinuses, Lungs and Kidney involvement Wagener's granulomatosis
Two weeks after vaccination Serum sickness
Anti-cariolipin, anti-SM, anti dsDNA antibodies SLE
Septic emboli Subacute Bacterial endocarditis
2 muscle types least affected by neuromuscular disease Smooth muscle & Cardiac muscle because they have autonomics
Only vasculitis with normal platelet count Henoch-Scholer Purpura (HSP)
Only vasculitis with a HIGH platelet count Kawasaki
Which protein is decreased in all vasculitides? Haptoglobin
What is the cellular response seen with all vasculatides? Tcells & Macrophages
Kawasaki Mucositis, rash on palms & soles, Cervical lymph nodes, Temp>102>3days
Idiopathic Thrombocytopenia Purpura (ITP) Fever, Thrombocytopenia, neurological problems
Polyarteritis Nodosa (PAN) Midsized arteries (GI & Renal), assoc with Hep B, p-ANCA
Churg-Strauss Allergic vasculitis
Subacute Bacterial Endocarditis (SBE) Cardiac infection caused by Strep Viridians
MPGN I Tram Tracks with c3 nephritic factors in basement membrane
MPGN II Tram Tracks with low complement (dense deposit disease)
CREST Syndrome mildest form of scleroderma, patchy involvement
Scleroderma Anti-scl70 and anti-SM muscle
Progressive Systemic Sclerosis (PSS) Scleroderma with organ involvement
Rheumatic Arthritis Symmetrical polyarteritis, worse in morning, periosler erosion on x-ray
Juvenile Rheumatoid Arthritis Arthritis with iridesis
Felty's RA + leukopenia + splenomegaly
Behcet's RA + GI ulcers
Sjogren's RA + dry eyes, dry mouth
Vasculitis with GI bleeding, intussuscetion, normal platelet count Henoch-Scholer Purpura (HSP)
Vasculitis whose most common cause is Sepsis DIC
Most common cause of renal failure in kids Hemolytic Uremic Syndrome (HUS)
Vasculitis with which Hep B is Associated Polyarteritis Nodosa (PAN)
Vasculitis that causes pulmonary inflitrate with eosinophilia Churg-Strauss (allergic)
Xeropthalmia, Xerostomia Sjogren's
Most common cause of arthritis in a middle aged female Rheumatoid arthritis
Only arthritis that attacks the synovium Rheumatoid arthritis
Closure of Mitral & Tricuspid Valves S1
Closure of Aortic & Pulmonic Valves S2
S3 means: Volume Overload, Dilation, Decompensation
S4 means: Pressure Overload, Hypertrophy, Compensation
What produces an S2 Split? Delayed closing of the pulmonic valve
Wide S2 Split means: Increased oxygenation, Increased ventricular volume, Delayed Pulmonic Valve closure
Narrow S2 Split means: Decreased volume in the Lungs
Holosystolic Murmurs Mitral Regurg, Tricuspid Regurg, VSD
Fixed S2 Split ASD
Continuous machine-like murmur PDA
Midsystolic Click Mitral Valve Prolapse
What is the normal CVP? 3-5
What is the normal PCWP? 12
The systolic component of blood pressure represents: Pressure
The diastolic component of blood pressure represents: Volume
Ejection clicks represent: Systolic Murmurs
Opening Snaps represent: Diastolic Murmurs
What factor produces murmurs? Turbulence
Do RIGHT heart sounds get louder on Inspiration or Expiration? Inspiration
Do LEFT heart sounds get louder on Inspiration or Expiration? Expiration
Most Common Cause of Aortic Stenosis Age<30yo - Bicuspid Valve
Most Common Cause of Aortic Regurgitation Aging, Collagen Disease
Most Common Cause of Mitral Stenosis Rheumatic Fever
Most Common Cause of Tricuspid Stenosis Rheumatic Fever, Carcinoid
Most Common Cause of Mitral Regurgitation Mitral Valve Prolapse, Endocarditis, Collagen Disease
Most Common Cause of Tricuspid Regurgitation Acute Endocarditis (MC IV drug use)
Most Common Cause of Pulmonary Stenosis AND Pulmonary Regurgitation Congenital Anomaly
Clues for Aortic Stenosis Head bobbing, Quinke's pulses, Wide pulse pressure, Waterhammer pulse
What is the normal Pulse Pressure? 120-80=40
How can you accentuate Aortic Stenosis? Lean forward, Make a fist, Blow up BP cuff, Squat
How do you accentuate IHSS? Valsalva & Stand Up
Clue for IHSS Athlete who passes out, Harsh systolic murmur, Pulsus Biferiens, Disorganized myofibrils on biopsy
What casues IHSS? The interventricular septum is top heavy and falls into the ventricle preventing it from emptying during systole
Diastolic blowing murmurs Aortic Regurg, Pulmonic Regurg
Diastolic Rumbling murmurs Mitral stenosis, Tricuspid stenosis
Systolic Ejection murmurs Aortic Stenosis, Pulmonic Stenosis
What are the two main types of effusions? Transudate & Exudate
What is the main cause of a transudate? Increased hydrostatic pressure
What 2 diseases cause Decreased body fluid and lead to a transudate? Cirrhosis, NephrOtic syndrome
What is the main cause of an Exudate? Decreased Oncotic pressure
What causes purulent exudates? Bacterial Infection
What causes Granulomatous Exudates? Non-Bacterial Infections
What causes Caseating Exudates? TB Infections
What causes Fibrinous Exudates? Collagen Vascular Diseases (CVD), Uremia, TB
What causes Hemorrhagic Exudates? Trauma, Cancer
Most Common Cause of restrictive cardiomyopathy Collagen Vascular Diseases (CVD), Amyloidosis, Hemochromatosis
Most Common Cause of constrictive cardiomyopathy Tamponde, Cancer
Most Common Congenital Heart Diseases VSD, ASD, PDA, Coarctation
Most Common Cyanotic Heart Disease Transposition of the great vessels
Most Common Cyanotic Heart Disease >1mo Tetralogy of Fallot
Clues for tetralogy of Fallot Blue while feeding, pink when cries; child squats while playing
Clues for Truncus Arteriosus Spiral Membrane did not develop
Clues for Epstein's Anomaly Pregnant mom Rx with Lithium, Tricuspid valve develops low in Right ventricle, Atrialization
Clues for Total Anomalous Venous Return Snowman Sign on X-Ray
What component of Tetrology of Fallot determines the prognosis? The degree of pulmonary stenosis
What two factors are used to determine whether fluid is transudate or exudate? Protein<2g --> Transudate ... SpecificGravity<1.012 --> Transudate
Vasculitis definition Inflammation of a blood vessel
Arteritis definition Inflammation of an arterial blood vessel
Phlebitis definition Inflammation of a venous blood vessel
Alport's associated with deafness and cataracts, begins in child but no renal failure until 15-25yrs
Syphilis attacks the aorta vasa vasorum; tree-bark appearance; wrinkled intimae, obliterative endarteritis (makes aorta fall apart)
Takayasu Japanese woman with weak pulses; granulomatous inflammation like Temporal arteritis
Temporal Arteritis Any temporal headache after age 60, blindness
Ankylosing Spondylitis HLA B27 disease; bamboo spine, lose Height, can't bend over, Amer Indians, Eskimos
Kid with a coronary aneurysm / bypass: Must be a Kawasaki patient
p-ANCA, attacks medium sized arteries (GI,Renal), associated with Hep B Polyarteritis Nodosa (PAN)
c-ANCA, attacks sinuses lungs kidneys, #1 cause of RPGN-cresent in kidney Wegener's
Anti-GBM, linear immunofluorescence; lungs & kidney (no sinuses); RPGN-crescents Goodpasture's
drug reaction causing vasculitis Leukocytoclastic
Leukocytoclastic drug reaction causing vasculitis
parasitic vasculits, HIGH eosinophil count, mimics asthma in kids, wheezing assoc w/ worm Churg-Strauss
CREST Syndrome (anti-centromere Ab) mildest form of scleroderma; Calcinosis, Reynaud's, Esophogeal dysmotility, Sclerodactyly, Telangiectasia
Gerd & tight skin on fingers CREST syndrome (anti-centromere Ab)
Anti-SM Ab Scleroderma
Anti-Topoisomerase, chronic inflammation of organs, organs are fibrotic Progressive Systemic Sclerosis - worst type of sclerosis
SubEPIthelial humps 2 weeks after a sore throat Post-Strep GN
Roth spots in retina, mycotic aneurysms, splinter hemorrhages in nail beds (Osler nodes are painful; Janeways are not) Subacute Bacterial Endocarditis (SBE)
Cryoglobulinemia IgM diseases, acute inflammation only, Non-bacterial
Created by: clbaca