SCNM Board Review - Cardiovascular

Vagus Nerve
Internal jugular vein
Common cartoid artery

"We have VEGAS IN COMMON"

The LAD. It supplies the anterior interventricular septum. It comes off of the left main coronary artery (LCA).

CO = stroke volume x heart rate

MAP = 2/3 diastolic + 1/3 systolic

Pulse pressure = systolic - diastolic

Systolic murmur heard at right sternal border, 2nd intercostal space

Systolic murmur heard at left sternal border, 2nd intercostal space

Diastolic heard at left parasternal border, 4th intercostal space

Diastolic, heard at apex of heart (left 5th intercostal space, midclavicular)

Ductus arteriosus - shunt between pulmonary artery and aortic arch; becomes ligamentum arteriosum

Ductus venosus - shunt between umbilical vein and inferior vena cava; becomes ligamentum venosum

Foramen ovale - right to left shunt between atria of heart; becomes fossa ovalis

Umbilical vein: oxygenated blood; becomes ligamentum teres

Umbilical arteries: deoxygenated blood; becomes medial umbilical ligaments

True

Tunica intima: contains endothelium, subendothelium and basement membrane. In ARTERIES (not veins), there is internal elastic lamina

Tunica media: Contains smooth muscle, generally the bulkiest layer in ARTERIES (not veins)

Tunica adventitia: Contains collagen and elastic fibers. In large vessels it also contains vaso vasorum that branches into the adventitia to provide nourishment to the vessel endothelial cells. This is the bulkiest layer in VEINS.

Arterioles

Mesoderm

C: septum secundum

The foramen primum and secundum are formed in the septum primum. The sinus venosus is the part of the embryonic heart that the blood flows into and eventually becomes part of the right atrium. The membranous IV septum is formed from the endocardial heart cushions.

D: endocardial heart cushions

The foramen primum and secundum are formed in the septum primum. The sinus venosus is the part of the embryonic heart that the blood flows into and eventually becomes part of the right atrium. The membranous IV septum is formed from the endocardial heart cushions.

Chordae tendineae

The papillary muscles attach the ventricular wall to the cords.

Sulcus terminalis: external groove
Crista terminalis: internal groove

Right: formed by right atrium

Anterior: mostly right ventricle

Left: mostly left ventricle

S1 is the sound of the AV valves closing and marks the beginning of systole.

The more the cardiac muscle is stretched, the greater the force of contraction (within limits).

So the larger the end diastolic volume, the more forceful the contraction.

Ca++

This is different from the rest of the cardiac muscle cells that use Na+ for depolarization.

beta-1 adrenergic receptors

However, the coronary blood vessels have alpha-1 adrenergic receptors

PROVe my baby has Tetralogy of Fallot!

Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect

IV drug users: it's the tricuspid (don't TRI drugs) and is usually S. aureus or Pseudomonas

Otherwise, it's usually the mitral valve. For normal valves, it's usually S. aureus and it's acute. For abnormal valves it's usually Strep viridans and is subacute.

Bacterial endocarditis

The coronary sinus

C: T4

T12

Common iliac arteries.

L4 level

The external iliac.

As it passes under the inguinal ligament.

Interventricular Septal Defect:

Hypertension and ischemia

Most commonly due to calcification of a congenitally bicuspid (instead of tricuspid) aortic valve.
Calcification due to arteriosclerosis or other systemic disorder (Hypervitaminosis-D, chronic Rheumatic Dz.)

Usually viral: Coxsackievirus is most common, but also CMV, Echo

Bacterial: staph, strep, diphtheria, gonococcus

Parasitic: Trichinosis

Autoimmune: Rheumatic fever, SLE, sarcoidosis, systemic sclerosis

Toxins: Arsenic, CO, iron

Symptoms: chest pain, CHF, murmur, fever, fatigue, friction rub

Raynaud’s dz: vasospasm
Raynaud’s Phenomenon: arterial narrowing secondary to SLE, scleroderma, atherosclerosis, Buergers

Occurs mostly in men who are heavy smokers.

Nodular phlebitis, instep claudication, gangrene, inflammation of arteries of extremities, Raynaud's phenomenon

Vasculitis of the small & medium cranial vessels esp temporal; genetic predisposition, h/a, pain tenderness, visual loss, facial pain

Necrotizing inflammation of small/medium arteries; spares pulmonary vessels.

Can cause renal failure due to infarction, acute MI, bloody diarrhea (ischemic bowels), testicular pain (ischemic testicles)

Arteriosclerosis: thickening & loss of elasticity of arterial walls

Atherosclerosis: intimal thickening & lipid deposition, thrombi, emboli, ischemia, infarction, hemorrhage, aneurysm;
Causes: heredity, hyperlipidemia, hypertension, DM, obesity, hypothyroidism, Cushings, def of chromium=increased triglycerides & cholesterol; def of copper is atherogenic,

Severe back pain

BP over 140 / 90 in anyone over 18 years old

Narrowing just distal to origin of left subclavian artery

Severe: poor perfusion in lower extremities, pulmonary HTN

Mild: Asymptomatic at first, then leg cramps, HA's systemic HTN, nosebleeds, rib notching on undersides of ribs

CK-MB: Rise 4 hours, peak in 18 hours, return to normal in 2 days

LDH: Rise in 24 hours, peak in 72 hours, return to normal in 8-9 days

Troponin T: Rise 4-6 hours, peak 10-24 hours, return to normal in 10 days

Troponin I: Rise in 4-6 hours, peak in 10-24 hours, return to normal in 4 days

TeCtum - Ceiling

TeGmentum - Ground (floor)

Infereior - medulla
Middle - pons, superior to the exiting roots of CN V
Superior - midbrain, just caudal to the exit of CN IV

Fibrous pericardium is a tough connective tissue outer layer that defines the middle mediastinum.

Serous pericardium is made up of 2 layers:

1) the parietal layer lines the inner surface of the fibrous layer

2) the visceral layer (epicardium) adheres to the heart and forms its outer covering

The fluid is between the two layers of serous pericardium.

One superiorly surrounding the arteries, the aorta and pulmonary trunk

One more posteriorly, surrounding the veins, the superior and inferior vena cava and the pulmonary veins

The zone of reflection of serous pericardium surrounding the veins is J-shaped and the cul-de-sac formed within the J posterior to the left atrium is the oblique pericardial sinus.

A passage between the two sites of reflected serous pericardium is the transverse pericardial sinus.

A finger placed in the transverse sinus separates arteries from veins.

A hand placed under the apex of the heart and moved superiorly slips into the oblique sinus

Phase 0: Na+ channels open (membrane depolarizes from about -90mV to + 20 mV)

Phase 1: Na+ channels close (at this point, K+ is leaving the cell and repolarizing it by a few mV)

Phase 2: Ca2+ channels open; fast K+ channels close (this causes a plateau that extends the time of the action potential, maintaining depolarization around 0 mV)

Phase 3: Ca2+ channels close; slow K+ channels open (this causes a rapid repolarization back to resting potential)

Phase 4: Resting potential

Channels (called If channels) that allow both Na+ and K+ through, cause the membrane potential to slowly depolarize until threshold is reached at which point Ca2+ channels open causing rapid depolarization. When the Ca2+ channels close at the peak of the action potential, slow K+ channels open to repolarize the cell.

Skeletal muscle is multinucleated, has an "all or none" contraction force; is controlled by somatic motor neurons and has a fast contraction speed (around 1-2ms)

Cardiac muscle is uninucleate, has a graded contraction force; is controlled by autonomic neurons and/or pacemaker cells and has a slower contraction speed that is extended by Ca2+ entering the cell (200+ ms). Also, cardiac muscle fibers are electrically linked via gap junctions.

Aschof bodies – focal inflammatory lesion composed of fibrinoid degeneration surrounded by lymphocytes, plasma cells, plump macrophages called Anitschkow cells

It's in the right atrium and it's the dividing line between the smooth part (from the sinus venosum) and the rough part (from the primitive atrium). It is located right next to a ridge called the crista terminalis.

They're in the right atrium and they are the portion of the atrium from the primitive atrium

Tricuspid or pulmonary regurgitation due to fibrosis caused by products such as serotonin released from a carcinoid tumor.

Tumor is usually located in organ that drains directly into inferior vena cava.