NBME CBSE
Smooth parts (outflow tract) of left and
Bulbus cordis
right ventricles
Atrial septum, membranous interventric-
ular septum; AV and semilunar valves
endocardial cushions
neural crest
left horn of the sinus venosus coronary sinus
posterior, sub cardinal, and supra cardi-
IVC
nal veins
Right common cardinal vein and right
SVC
anterior cardinal vein
Smooth part of right atrium (sinus ve-
Right horn of sinus venosus
narum)
failure of septum primum and septum se-
Patent foramen ovale
cundum to fuse after birth
Transposition of the great vessels
Conotruncal abnormalities associated
Tetralogy of Fallot
with failure of neural crest cells to migrate
Persistent truncus arteriosus
connects the umbilical vein to the inferior
vena cava, bypassing the liver
ductus venosus
becomes ligamentum venosum
innervates the diaphragm and pericardi-
phrenic nerve
um
Increased ventricular filling pressure
(e.g., mitral regurgitation, HF), common
S3 heart sound in dilated ventricles
normal in kids and pregnant women
atrial kick late diastole, right before S1
best heard at apex in LLD position
S4 heart sound
High atrial pressure.
,NBME CBSE
Stiff/hypertrophic ventricle (aortic steno-
sis, restrictive cardiomyopathy)
Always abnormal
atria contract a wave of JVP
RV contraction (closed tricuspid valve
c wave
bulging into atrium) wave of JVP
JVP wave corresponding to downward
displacement of closed tricuspid valve
x descent during rapid ventricular ejection phase
reduced or absent in tricuspid regurge
JVP wave corresponding to inc'd RA
V wave pressure due to filling against closed tri-
cuspid valve
JVP wave corresponding to RA emptying
into RV
y descent
absent in cardiac tamponade
pulses are weak with delayed peak
plusus parvus et tardus
Aortic stenosis
0.12-0.20 seconds
PR interval
120 milliseconds
QT interval length 9 - 11 squares = .36 to .44 seconds
Hypokalemia U wave present on ECG
for torsades de pointe, hypokalemia (can
Mg sulfate lengthen QT and cause torsades), and
pre-eclampsia (prevent seizures)
-Congenital long QT syndrome
Romano-Ward syndrome -Autosomal dominant, pure cardiac phe-
notype (no deafness).
, NBME CBSE
-Congenital long QT syndrome
Jervell and Lange-Nielsen syndrome -Autosomal recessive, sensorineural
deafness
-Autosomal dominant disorder affecting
Na channels most common in Asian
males.
-ECG pattern of pseudo-right bundle
branch block and ST elevations in V1-V3
Brugada syndrome (anterior ventricular septum)
-inc risk of ventricular tachyarrhythmias
and sudden cardiac deatgh
Prevent SCD with implantable car-
dioverter-defibrillator (ICD).
Most common type of ventriuclar pre-ex-
citation sydnrome. Abnormal fast acces-
sory conduction pathway from atria to
venricle bypasses the rate-slowing AV
Wolff-Parkinson-White Syndrome
node causing a delta wave and widening
QRS with shortened PR interval. Could
lead to a reentrant circuit and suprvaven-
ticular tachy.
- PRI >5 boxes/.20 sec (200 msec)
- Fixed but prolonged PRI
First degree AV block
(consistent but long)
- normally get bradycardia here
-PR interval is constant
-atrial conduction to ventricle is inter-
mittent: dropped QRS without increasing
PR interval length
second degree AV block mobitz type 2
-disease below AV node in His bundle
may progress to 3rd degree/complete AV
block
Second Degree AV Block Mobitz Type 1 Progressive lengthening of pr interval
(wenckebach) leading to dropped QRS
third degree AV block
, NBME CBSE
The atria and Ventricles are totally disso-
ciated.
-So, the QRSs and the P waves have no
relation to each other.
4-12 mmHg
PCWP
est of LA pressure
a genetic condition characterized by
mental retardation in most regards but
surprisingly good use of language rela-
Williams Syndrome
tive to their other abilities, elfin facies
Chromosome 7
assoc with supravalvular aortic stenosis
Maldevelopment of 3 and 4 pharyn-
geal pouches, fascial dysmorphia, car-
DiGeorge Syndrome diac shunt (trunks arteriosus, tetralogy of
Fallot), lack of T-cells, undeveloped para-
cortex
Lipid deposits in the cornea. Common in
the elderly, but appears earlier in life with
hypercholesterolemia
Corneal arcus
Dissection of the ascending aorta
Stanford A aortic dissection
Tx with surgery
Dissection of the descending aorta be-
Stanford B aortic dissection low the level o the left subclavian artery
Tx: Beta Blockers then vasodilators
QRS> 120 msec
Left bundle branch block Deep, broad S waves in V1 and V2
Broad R waves in in V5 and V6
Smooth parts (outflow tract) of left and
Bulbus cordis
right ventricles
Atrial septum, membranous interventric-
ular septum; AV and semilunar valves
endocardial cushions
neural crest
left horn of the sinus venosus coronary sinus
posterior, sub cardinal, and supra cardi-
IVC
nal veins
Right common cardinal vein and right
SVC
anterior cardinal vein
Smooth part of right atrium (sinus ve-
Right horn of sinus venosus
narum)
failure of septum primum and septum se-
Patent foramen ovale
cundum to fuse after birth
Transposition of the great vessels
Conotruncal abnormalities associated
Tetralogy of Fallot
with failure of neural crest cells to migrate
Persistent truncus arteriosus
connects the umbilical vein to the inferior
vena cava, bypassing the liver
ductus venosus
becomes ligamentum venosum
innervates the diaphragm and pericardi-
phrenic nerve
um
Increased ventricular filling pressure
(e.g., mitral regurgitation, HF), common
S3 heart sound in dilated ventricles
normal in kids and pregnant women
atrial kick late diastole, right before S1
best heard at apex in LLD position
S4 heart sound
High atrial pressure.
,NBME CBSE
Stiff/hypertrophic ventricle (aortic steno-
sis, restrictive cardiomyopathy)
Always abnormal
atria contract a wave of JVP
RV contraction (closed tricuspid valve
c wave
bulging into atrium) wave of JVP
JVP wave corresponding to downward
displacement of closed tricuspid valve
x descent during rapid ventricular ejection phase
reduced or absent in tricuspid regurge
JVP wave corresponding to inc'd RA
V wave pressure due to filling against closed tri-
cuspid valve
JVP wave corresponding to RA emptying
into RV
y descent
absent in cardiac tamponade
pulses are weak with delayed peak
plusus parvus et tardus
Aortic stenosis
0.12-0.20 seconds
PR interval
120 milliseconds
QT interval length 9 - 11 squares = .36 to .44 seconds
Hypokalemia U wave present on ECG
for torsades de pointe, hypokalemia (can
Mg sulfate lengthen QT and cause torsades), and
pre-eclampsia (prevent seizures)
-Congenital long QT syndrome
Romano-Ward syndrome -Autosomal dominant, pure cardiac phe-
notype (no deafness).
, NBME CBSE
-Congenital long QT syndrome
Jervell and Lange-Nielsen syndrome -Autosomal recessive, sensorineural
deafness
-Autosomal dominant disorder affecting
Na channels most common in Asian
males.
-ECG pattern of pseudo-right bundle
branch block and ST elevations in V1-V3
Brugada syndrome (anterior ventricular septum)
-inc risk of ventricular tachyarrhythmias
and sudden cardiac deatgh
Prevent SCD with implantable car-
dioverter-defibrillator (ICD).
Most common type of ventriuclar pre-ex-
citation sydnrome. Abnormal fast acces-
sory conduction pathway from atria to
venricle bypasses the rate-slowing AV
Wolff-Parkinson-White Syndrome
node causing a delta wave and widening
QRS with shortened PR interval. Could
lead to a reentrant circuit and suprvaven-
ticular tachy.
- PRI >5 boxes/.20 sec (200 msec)
- Fixed but prolonged PRI
First degree AV block
(consistent but long)
- normally get bradycardia here
-PR interval is constant
-atrial conduction to ventricle is inter-
mittent: dropped QRS without increasing
PR interval length
second degree AV block mobitz type 2
-disease below AV node in His bundle
may progress to 3rd degree/complete AV
block
Second Degree AV Block Mobitz Type 1 Progressive lengthening of pr interval
(wenckebach) leading to dropped QRS
third degree AV block
, NBME CBSE
The atria and Ventricles are totally disso-
ciated.
-So, the QRSs and the P waves have no
relation to each other.
4-12 mmHg
PCWP
est of LA pressure
a genetic condition characterized by
mental retardation in most regards but
surprisingly good use of language rela-
Williams Syndrome
tive to their other abilities, elfin facies
Chromosome 7
assoc with supravalvular aortic stenosis
Maldevelopment of 3 and 4 pharyn-
geal pouches, fascial dysmorphia, car-
DiGeorge Syndrome diac shunt (trunks arteriosus, tetralogy of
Fallot), lack of T-cells, undeveloped para-
cortex
Lipid deposits in the cornea. Common in
the elderly, but appears earlier in life with
hypercholesterolemia
Corneal arcus
Dissection of the ascending aorta
Stanford A aortic dissection
Tx with surgery
Dissection of the descending aorta be-
Stanford B aortic dissection low the level o the left subclavian artery
Tx: Beta Blockers then vasodilators
QRS> 120 msec
Left bundle branch block Deep, broad S waves in V1 and V2
Broad R waves in in V5 and V6
