Med 2
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| Heart begins to beat at___ and develops from____ | week 4, mesodermal cells
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| Septa form between___ as out growth of___ | 4th and 6th weeks, endocardial surface (all septation occurs simultaneously)
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| Atrioventricular Canal split into two canals by | endocardial cushions
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| 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
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| Atrial Septal Defect will show | LFT—> RT shunt (non-cyanotic), RA/RV/PA enlargement, tall P wave, wide fixed splitting, pulmonic flow murmur
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| 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)
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| 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
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| 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
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| Persistent Truncus arteriosus | Abnormal migration of neural crest cells, failure of AP septum to form, common tact leaving both ventricles
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| Transposition of great vessels | AP septum fails to spiral (LV—> pulmonary trunk, RV—> aorta [two closed circuits]), complete RT—> LFT shunt, early cyanosis
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| 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)
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| 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)
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| 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
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| 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
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| Congenital aortic stenosis | Aortic valve develops abnormally, bicuspids more susceptible to calcification and fibrosis
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| 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
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| Untreated LFT—> RT shunts | Pulmonary arterial system becomes hypertrophic—> pulmonary hypertension, increased RT pressure—> RV hypertrophy—> shunt reverses—> late cyanosis (Eisenmenger syndrome)
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| Allantois—>___ | Urachus (connects the fetal bladder to the yolk sac and removes nitrogenous waste from the fetal bladder)—> mediaN umbilical ligament
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| Ductus arteriosus—>___ | ligamentum arteriosum
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| Ductus venosus—>___ | ligamentum venosum
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| Foramen ovale—>___ | Fossa ovalis
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| Notochord—>___ | nucleus pulposus
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| Umbilical arteries—>___ | MediaL umbilical ligamentS
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| Umbilical vein—>___ | ligamentum teres hepatis (contained in falciform ligament)
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| 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
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| 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
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| Apex/ A Arch/ SVC anatomic locations | apex (PMI)= 5th IC space @MC line, Arch= sternal notch= T2, SVC enters RA @3rd rib
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| 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])
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| Coronary circulation: SA/AV__; RV__; AV (lil bit)/post interventricular septum__; LV/ Ant interventricular septum___; LV__ | RCA; RMA; PDA; LAD; LCxA
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| At rest, membrane conductance/ permeability higher for___ | K+ (resting potential close to K equilibrium)
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| Conduction velocity rates | fastest in His-Purkinje > Atrial myocytes > Ventricular myocytes > AV node
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| Underlying basis for refractory period | Closure of Na channel inactivation gates
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| Cardiac myocytes utilize___ Ca channels (phase 2) | L-Type
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| Nodal AP utilizes___ Ca channels (phase 0) | T-type (L-type present but activated at higher MP) *pg 16
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| After contraction, intracellular Ca is moved to SR via___ and extracellular Ca is expelled via___ | SERA pump (Ca ATPase), Ca/Na pump
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| S1 | M/T valve closure, M closes before T but juuuust barely so probably wont hear it
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| S2 | A/P closure, A closes before P (normal splitting)
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| S3 | Ventricular gallop, turbulent blood flow right after S2, seen in children, athletes and preggos . Loudest at apex
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| S2 splits: | wide= delayed RV emptying, fixed= ASD, paradoxical= delayed A valve closure
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| Highest resistance in CV system | Arterioles, responsible for largest drop in arterial pressure
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| Largest total cross sectional and surface area of CV system | Capillaries
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| Highest capacitance in CV system | Veins
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| Diastolic VS Systolic affects on MAP | D pressure impacts more bc diastole is longer in healthy patient at rest
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| P wave represents | atrial depolarization
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| QRS complex represents | Ventricular depolarization (masks atrial repolarization)
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| T wave | Ventricular repolarization
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| 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
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| PR interval represents | time of electrical impulse from SA node to beginning of ventricular depol
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| QT interval represents | mechanical contraction of ventricles
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| Brady/Tachycardia [ECG] | normal P wave, QRS rate <60/ >100
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| 1st degree AV block | PR interval > 5 small boxes, 1:1 P/QRS
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| 3rd degree (complete) AV block | AV dissociation, atria and ventricles beat independently of each other, atrial rate is faster than ventricular rate
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| Atrial flutter | regular, rapid succession of identical back-to-back P waves given sawtooth appearance
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| Atrial fibrillation | rapid, irregularly irregular/ no discernible p waves, RR distances will all be different but present QRS
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| Ventricular Tachycardia | wide QRS complex at regular rhythm
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| Ventricular fibrillation | completely erratic baseline
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| QISSS & QIQ | [Sym] A1, A2, B1, B2, B3 & [Para] M1, M2, M3
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| 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)
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| Contractility changes vs PV loop | Increase= increase SV/ EF, decrease in ESV [left wall of loop will be stretched back]
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| Afterload changes vs PV loop | Increase = increase ESV, decrease SV [going to look tall and skinny]
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| Preload changes vs PV loop | increase = increase in SV/ EDV [right wall of loop will be stretched forward]
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| Autonomic effects on heart and blood vessels | HR and Contractility (B1-sym, M2-parasym); Vascular smooth muscle tone (A1[constriction, sym], M3[Dilation, parasym])
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| 2nd degree AV block | P wave not followed by QRS w/ or w/o preceding gradual lengthening of PR interval
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| Truncus arteriosus--> | aorta and pulmonary trunk
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| Bulbus cordis--> Conus cordis --> | smooth parts (outflow tract) of left/right ventricles
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| Endocardial cushion--> | atrial septum, membranous interventricular septum, AV (of AV canal) and semilunar valves (of outflow tract)
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| Primitive atrium--> | Trabeculated part of left/right atria
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| Primitive ventricle--> | Trabeculated part of left/right ventricle
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| Primitive pulmonary vein (transient common PV)--> | smooth part of left atrium
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| Left horn of sinus venosus--> | coronary sinus
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| Right horn sinus venosus--> | smooth part of right atrium
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| right common cardinal vein and right anterior cardinal vein | SVC, not from heart tube
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| Vitelline veins--> | Portal system
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