6 cardiology high yield

Introduction Cardiovascular System Lecture I Stephen Bagley, M.D Resident Physician University of Pennsylvania CA01.1- Cardiovascular System Course Objectives: To understand the following topics and how they may be tested on USMLE Step – Cardiac physiology • Fluid dynamics • The cardiac cycle • Electrophysiology – – – – – Heart sounds Biochemistry of lipids Ischemic heart disease and cardiomyopathies Congenital heart disease Vasculitis CA01.1- Learning Objectives – Beta and alpha adrenergic receptors and their role in the cardiovascular system – Cardiac output – Resistance, pressure, and flow – Cardiac function curve CA01.1- Kaplan Pharmacology 2011 : Table II-3-2 FA 2012: 263.1 • FA 2011: 236 • FA 2010: 232 • ME 3e: 169 CA01.2- KNOW THE FICK PRINCIPLE CO = O2 Consumption / (Arterial O2 – Venous O2) • • • O2 Consumpsion  often given Arterial O2 = [Hgb] x [1.34] x [Arterial O2 Saturation] Venous O2 = [Hgb] x [1.34] x [Venous O2 Saturation] FA 2012: 280.2 • FA 2011: 254.2 ME 3e: 249 • FA 2010: 250 • CA01.3- Mean Arterial Pressure (MAP)… MAP = (CO) X (TPR) MAP = (2/3 Diastolic Pressure) + (1/3 Systolic Pressure) When heart rate increases, so does the cardiac output and the mean arterial pressure, all things being equal FA 2012: 280.2 • FA 2011: 254.2 ME 3e: 248 • FA 2010: 250 • CA01.3- What changes cardiac output By changing: Preload Contractility FA 2012: 281.1 • FA 2011: 255.1 ME 3e: 243 • Afterload FA 2010: 251 • CA01.3- + Ca2+ (SERCA) Kaplan Pharmacology 2011 : Figure III-4-2 FA 2012: 281.1 • FA 2011: 255.1 ME 3e: 271 • FA 2010: 251 • CA01.3- Kaplan Physiology 2011 : Figure IV-1-9 FA 2012: 281.1 • FA 2011: 255.1 ME 3e: 251 • FA 2010: 251 • CA01.4- PRELOAD = Left Ventricular EDV FA 2012: 281.2 • FA 2011: 255.2 ME 3e: 242 • FA 2010: 251 • CA01.4- Sturge-Weber disease (capillary-sized vessels) Congenital capillary malformations Signs and Symptoms • Port-wine stain (nevus flammeus) on face • Leptomeningeal angiomatosis (intracerebral AVM) • Seizures • Early-onset glaucoma Gaillard commons.wikimedia.org Used With Permission FA 2012: 305.1 • FA 2011: 277.6 • 3e: 263 FA 2010: 274 • ME CARDIO14_5-1 Henoch-Schưnlein Purpura (small vessels) • Most common childhood systemic vasculitis • IgA-mediated vasculitis, circulating IgA complexes • Linked to parvovirus Signs and Symptoms • Typically develops after URI • “Palpable purpura” skin rash (buttocks and legs) • Arthralgia (wrists, ankles) • Intestinal involvement: hemorrhage, melena • Nephritis – IgA nephropathy • Normal complement levels FA 2012: 305.1 • FA 2011: 278.1 • 3e: 262 FA 2010: 274 • ME CARDIO14_6-1 Crescent formation in rapidly progressive glomerulonephritis, as seen with trichrome stain Kaplan Pathology: Figure 16-3 FA 2012: 305.1 • FA 2011: 278.1 • 3e: 262 FA 2010: 274 • ME CARDIO14_6-2 Buerger’s disease - thromboangiitis obliterans (small and medium vessels in the extremities) Signs and Symptoms • Heavy smokers • Rapidly progressive thrombosing vasculitis • Claudication (vascular insufficiency) • Cold sensitivity (Raynaud’s phenomenon) • Ulceration, gangrene, autoamputation Treatment: improves rapidly with smoking cessation Geirunited commons.wikimedia.org Used With Permission FA 2012: 304.1 • FA 2011: 278.2 • 3e: 262 FA 2010: 275 • ME CARDIO14_7-1 Kawasaki disease (small and medium vessels) • Acute, segmental necrotizing vasculitis • Commonly affects infants/children ( 50 yo and ESR > 50 Signs and Symptoms • Unilateral headache • Unilateral jaw claudication (pain on chewing) • Unilateral visual disturbance • Associated with polymyalgia rheumatica (proximal muscles) Treatment: corticosteroids FA 2012: 305.1 • FA 2011: 278.1 • 3e: 263 FA 2010: 275 • ME CARDIO14_11-2 Hemangioma Kaplan Pathology: Figure 13-3 FA 2012: 305.2 • FA 2011: 279.2 • 3e: 266 FA 2010: 276 • ME CARDIO14_12-1 Cystic Hygromas • Most commonly associated with Turner Syndrome • Usually found in the posterior aspect of the neck Kaplan Pathology: Figure 6-4 FA 2012: 305.2 • FA 2011: 279.2 • 3e: 266 FA 2010: 276 • ME CARDIO14_13-1 Angiosarcoma Kaposi’s Sarcoma KGH commons.wikimedia.org Used With Permission FA 2012: 305.2 • FA 2011: 279.2 • 3e: 266 FA 2010: 276 • ME CARDIO14_14-1 Atrial Myxoma (Ball valve obstruction) Myxoma Mitral valve ventricle James Moon commons.wikimedia.org Used With Permission FA 2012: 303.1 • FA 2011: 277.1 • 3e: 261 FA 2010: 273 • ME CARDIO14_15-1 Atrial Myxoma • Stellate cells • Myxoid background Nephron commons.wikimedia.org Used With Permission FA 2012: 303.1 • FA 2011: 277.1 • 3e: 261 FA 2010: 273 • ME CARDIO14_15-2 Rhabdomyoma • Most common primary cardiac tumor in children • Patients with tuberous sclerosis often develop these tumors FA 2012: 303.1 • FA 2011: 277.1 • 3e: 261 FA 2010: 273 • ME CARDIO14_16-1 ... function curve CA01.1- Kaplan Pharmacology 2011 : Table II-3-2 FA 2012: 263 .1 • FA 2011: 2 36 • FA 2010: 232 • ME 3e: 169 CA01.2- KNOW THE FICK PRINCIPLE CO = O2 Consumption / (Arterial O2 – Venous... resistance to flow than a capillary FA 2012: 282.2 • FA 2011: 2 56. 1 ME 3e: 248 • FA 2010: 252 • CA01.5- FA 2012: 282.2 • FA 2011: 2 56. 1 ME 3e: 248 • FA 2010: 252 • CA01.5- Velocity = Q/CSA Q = flow... : Figure V-1-5 FA 2012: 282.2 • FA 2011: 2 56. 1 ME 3e: 249 • FA 2010: 252 • CA01.5- Kaplan Physiology 2011 : Figure V-1-4 FA 2012: 282.2 • FA 2011: 2 56. 1 ME 3e: 249 • FA 2010: 252 • CA01.5- Cardiac