03a: Cardio Flashcards
1
Q
Truncus arteriosus gives rise to:
A
Ascending aorta and pulmonary trunk
2
Q
Bulbus cordis gives rise to:
A
Smooth parts (outflow tracts) of L and R ventricles
3
Q
Endocardial cushions give rise to:
A
- Atrial septum
- Membranous IV septum
- AV and semilunar valves
4
Q
Primitive atrium gives rise to:
A
Trabeculated parts of R and L atria
5
Q
Primitive ventricle gives rise to:
A
Trabeculated parts of R and L ventricles
6
Q
Primitive pulmonary vein gives rise to:
A
Smooth part of L atrium
7
Q
L horn of sinus venosus gives rise to:
A
Coronary sinus
8
Q
R horn of sinus venosus gives rise to:
A
Smooth part of R atrium
9
Q
Cardinal veins (R common and R anterior) give rise to:
A
SVC
10
Q
Heart development: Foramen secundum is an opening in (X).
A
X = septum primium
11
Q
VSDs typically occur in (muscular/membranous) septum, which is the part (closer/further) from atria.
A
Membranous
Closer
12
Q
List the conotruncal abnormalities associated with failure of (X) process during heart development.
A
X = neural crest migration
- Persistent truncus arteriosus
- Transposition of great vessels
- Tetralogy of Fallot
13
Q
PO2 of umbilical vein
A
30 mmHg (80% o2 sat)
14
Q
3 key shunts in fetus (in the order they’re encountered started at placenta)
A
- Ductus venosus
- Foramen ovale
- Ductus arteriosus
15
Q
Ductus venosus: blood shunt from (X) to (Y)
A
X = umbilical vein Y = IVC
(bypasses hepatic circulation)
16
Q
(X) keep PDA open
A
X = Prostaglandins E1, E2 (kEEp PDA open)
17
Q
Allantois becomes urachus, which normally becomes (X) in adult. What does it connect?
A
X = mediaN (allaNtois) umbilical ligament
Bladder to umbilicus
18
Q
Umbilical aa adult remnant
A
MediaL (umbiLical a) umbilical ligaments
19
Q
Umbilical vein adult remnant
A
Ligamentum teres (round ligament)
20
Q
Ligamentum teres, remnant of (X) and contained in (Y)
A
X = umbilical vein Y = falciform ligament
21
Q
SA node blood supply off of (X) a. And AV node off of (Y) a.
A
X = RCA Y = PDA (off RCA in R dominant circ, off LCX in L dominant circ)
22
Q
Coronary circulation: Most people are (R/L) dominant, which is defined by:
A
R (85%)
The a (RCA v LCA) from which which PDA arises
23
Q
LCX artery supplies:
A
- Lat and Post walls of LV
2. Anterolateral papillary muscle
24
Q
LAD artery supplies:
A
- Anterior surface of LV and anterior 2/3 of IV septum
2. Anterolateral papillary muscle
25
PDA of heart supplies:
1. Post 1/3 of IV septum and Post 2/3 walls of ventricles
| 2. Posteromedial papillary muscle
26
Coronary blood flow peaks at what point in cardiac cycle?
Early diastole
27
Most of R cardiac silhouette on Xray is composed of which structure?
RA
28
Which structure in body has the most deoxygenated blood?
Coronary sinus (due to super high myocardial O2 extraction)
29
Most common cause of coronary sinus dilation:
High RA P due to pulm HT
30
List a valve abnormality that can lead to hoarseness or dysphagia. Why?
MR (dilated LA, which is most posterior chamber)
Enlargement can compress esophagus or L recurrent laryngeal n)
31
Transesophageal echo is used to visualize (X) heart structures. If rotated posteriorly, what else can be visualized?
X = LA, MV, atrial septum
Descending aorta
32
Pericarditis can cause referred pain to (X) due to innervation by (Y)
```
X = shoulder
Y = phrenic n (C3-5)
```
33
Abnormal deviation of infundibular septum during development of heart leads to which abnormality?
Tetralogy of Fallot (anterior and cephalad deviation due to abnormal neural crest migration)
34
Loss of cardiomyocyte contractility occurs within (X) time after onset of total ischemia. After (Y) amount of time, injury is irreversible.
```
X= 60s
Y = 30 min
```
35
Which anti-anginal drugs work by (increasing/decreasing) coronary vasodilation?
Increasing
Nondihydropyridines and dihydropyridines; nitrates (mildly)
36
Nitrates work as anti-anginal drugs via which key mechanism?
Venodilation (decrease preload)
37
Which anti-anginal drugs work by decreasing HR?
1. BB
| 2. Non-dihydropyridines (verapamil, dilitazem)
38
Which anti-anginal drugs work by decreasing afterload (arterial dilation)?
Dihydropyridines (amlodipine, nifedipine)
39
Polyarteritis nodosa (PAN) spares which arteries?
Pulmonary
40
Nitroprusside is a (short/long)-acting (venous/arterial) (vasodilator/vasoconstrictor), functioning mainly to (increase/decrease) which cardiac values in hypertensive heart failure?
Short-acting, balanced venous and arterial vasodilator;
Decreases BOTH preload and afterload (thus, maintaining stroke volume)
41
Atrial muscle, ventricular muscle, Purkinje system, and AV node: list them in order of fastest to slowest conduction speed
"Park At Venture Ave"
1. Purkinje (2.2 m/s)
2. Atria (1.1 m/s)
3. Ventricle (0.3 m/s)
4. AV node (0.05 m/s)
42
Scar tissue in heart from an old MI has which type of collagen?
Type I
43
Type (X) collagen seen about a week post-MI.
X = III (granulation tissue; eventually replaced by Type I with scar formation)
44
Rare vascular tumor associated with arsenic or polyvinyl Cl exposure and positive for (X) cell marker.
X = CD31
Liver angiosarcoma
45
Coagulation necrosis seen starting (X) days/weeks post-MI
X = 1-3 days
46
Prominent neutrophilic infiltrate seen starting (X) days/weeks post-MI
X = 1-3 days (with coag necrosis)
47
Macrophage infiltration seen starting (X) days/weeks post-MI
X = 3-7 days
48
Granulation tissue begins to form starting (X) days/weeks post-MI
X = 7 days
49
Well-developed granulation tissue and neovascularization seen (X) days/weeks post-MI
X = 10-14 days
50
Low extracellular Na will (increase/decrease) myocardial contractility. Why?
Increase;
Less Na/Ca exchange (remember: digoxin increases intracellular Na, which increases contractility because less Ca pumped out in exchange for Na)
51
ACEi and ARB affect heart by (increasing/decreasing) (preload/afterload/contractility).
Decreasing
Preload and afterload
52
The force of contraction of the myocardium is proportional to the (X) at the end of (systole/diastole).
X = length of cardiac muscle fibers
| Diastole (aka preload)
53
A profound impact on flow can be brought about by a minor change in:
Radius (decrease r by 50% will decrease flow by 16x! r^4)
54
(X) vessels have the highest total cross sectional area
X = capillaries
55
(X) vessels have the lowest flow velocity
X = capillaries
56
(X) vessels account for most of TPR
X = arterioles
57
Infusion of normal saline/fluid would alter (venous return/inotropy/TPR) in which manner?
Venous return increased
58
Exercise overall (increases/decreases) SVR due to:
Decreases
Substantial arteriolar dilation in active muscles
59
Absent jugular venous pulse a-wave
Atrial fibrillation (a-wave signifies atrial contraction)
60
Jugular venous pulse waveform: absent y-wave
Cardiac tamponade (y-descent represents decline in P of RA during RV filling)
61
Jugular venous pulse waveform: steep y-wave
Constrictive pericarditis
62
Wide split between A2 and P2 is indicative of:
Condition that delays RV emptying (plumonic stenosis, RBBB)
63
Fixed split between A2 and P2 is indicative of:
ASD (increased blood on R side of heart so high flow through pulmonic valve and delayed close, regardless of breath)
64
Pt presents with split between A2 and P2 that is heard on expiration and disappears on inspiration. What's this phenomenon and what are the underlying issues?
Paradoxical splitting (aortic valve sound A2 occurs after P2)
Delayed aortic valve closure (aortic stenosis, LBBB)
65
Later onset of MVP click/murmur is brought about by which maneuvers?
Increasing afterload (thus increasing V in heart and maintaining tension along chordae tendinae)
Handgrip, rapid squat
66
Early onset of MVP click/murmur is brought about by which maneuvers?
Decrease in preload (and thus decrease V in heart; more floppy, unsecure valve)
Valsalva, standing up
67
In developed countries, (X) valve abnormality is the most common one to predispose pt to infective endocarditis
X = MVP
68
(Increase/decrease) in interval between (S1/S2) and opening snap of (X) murmur indicates higher severity of valve disease.
Decrease (means P in LA is super high and opening valve more forcefully);
S2
X = MS
69
Mitral regurg: best indicator of severity is (presence/absence) of which clinical finding?
Presence of S3 gallop - LV overload indicator
70
Location of SA node
RA, near entrance of SVC
71
Location of AV node
RA/Interatrial septum, near entrance of coronary sinus and septal cusp of tricuspid valve
72
T wave inversion may indicate:
Ischemia or recent MI
73
Child with sensorineural hearing loss since birth and FHx of sudden death. Most likely diagnosis?
Jervell and Lange-Nielsen syndrome - a long QT syndrome;
AR mutation in V-gated K channel (slow-acting, decreased K current)
74
Romano-Ward syndrome:
AD mutation in ion channels, causing long QT syndrome
75
Which electrolyte imbalances can lead to torsades?
Low K, low Mg
76
Rx for Torsades includes:
Mg sulfate
77
"Holiday heart syndrome" is:
Afib in pts after drinking EtOH excessively
78
"Sawtooth" appearance on baseline of EKG (between QRS complexes). Diagnosis? Rx?
Atrial flutter;
Like A-fib (rhythm/rate control, anticoagulation)
Note: ablation for definitive treatment
79
T/F: Atrial rate is greater than ventricular rate.
True - ventricular rate about 45-55 bpm
80
Lyme disease can cause (first/second/third) degree heart block
Third
81
ANP (atrial natriuretic peptide) works via (X) receptor/messenger system and has which key effects?
X = cGMP
1. Vasodilation
2. Increase GFR (constricts efferent arteriole, dilates afferent arteriole)
3. Decreases Na absorption at collecting duct
82
Carotid baroreceptors transmit to (X) and Aortic arch receptors transmit to (Y).
X = Y = solitary nucleus of medulla
| carotid via CN IX, aortic via CN X
83
Normal O2 sat of R heart chambers
70% (including SVC/IVC and pulm aa)
84
Brain blood flow remains constant over wide range of perfusion pressures thanks to action of:
CO2 (pH) - local metabolite
85
Skeletal muscle blood flow remains constant over wide range of perfusion pressures thanks to action of:
Local metabolites: LA, adenosine, K, H, CO2
86
S. Bovis endocarditis is associated with which disease?
Colon cancer (part of normal flora of colon)
87
Hydralazine MOA
Selective arteriolar vasodilator
88
T/F: Hydralazine is an effective med for long-term BP control
False - since selective arteriolar vasodilation, increases sympathetic activity reflexively and increases RAAS (Na, water retention; limited longterm efficacy)
89
Tricuspid atresia: which other defects required for viability?
BOTH ASD and VSD (since tricuspid valve absent)
90
Boot-shaped heart on CXR
Tetralogy of fallot (RV hypertrophy)
91
Kid with TOF runs around and then squats to relieve severe dyspnea. What's the mechanism behind this?
Increases SVR (compared to PVR) and thus decreases R to L shunt/cyanosis
92
Pulsatile vessels within intercostal spaces and notched appearance of ribs on CXR.
Coarctation of aorta (collateral circulation enlarges intercostal aa, which erode ribs)
93
FAS associated with which congenital cardiac defects? Star the most common.
ASD*, VSD, PDA, ToF
94
A complete AV canal defect (as well as either VSD/ASD) seen in which genetic/infectious disorder?
Down's
95
Marfan associated with which cardiac defects
1. MVP
2. Aortic regurg
3. Thoracic aorta aneurysm and dissection
96
DiGeorge associated with which congenital heart defects?
T-"q"bd (since 22q11 syndrome):
1. ToF
2. Truncus arteriosus
3. Transposition of great vessels
97
"String of beads" sign on renal a
Fibromuscular dysplasia
98
Severe hypertension: (X) arteriolosclerosis. Diabetes and essential HT: (Y) arteriolosclerosis.
```
X = hyperplastic ("onion skinning")
Y = hyaline (homogenous, glassy material that stains pink/eosinophilic with PAS)
```
99
T/F: All arteriosclerosis causes eventual obstruction of blood flow
False - Mönckeberg sclerosis (medial calcific sclerosis) only causes vascular stiffening ("pipestem" appearance on xray) and doesn't involve intima
100
Arterial vasodilator and platelet aggregation inhibitor useful for symptomatic treatment of peripheral arterial disease
Cilostazol (PDE inhibitor)
101
Rx for aortic dissection:
```
Stanford A (ascending): surg
Stanford B (descending): BB then vasodilators
```
102
Patient incapable of performing stress test can be infused with (X) and areas of ischemia will become evident by which phenomenon?
X = coronary vasodilator (ex: dipyridamole)
Coronary steal (normal coronary vessels dilate and shunt blood toward well-perfused areas/away from stenosed vessels)
103
Key difference between STEMI and NSTEMI
STEMI: transmural infarct (full thickness involved)
NSTEMI: subendocardial infarct (inner 1/3 esp vulnerable to ischemia) with ST depression
104
Gold standard MI diagnosis in first 6 hours
EKG
105
(X) protein marker is the most specific for MI. It rises after (Y) hours, peaks at (Z) hours and remains high for:
```
X = troponin I
Y = 4
Z = 24
```
7-10 days
106
Pt 3 days post-MI is suspected to have a reinfarction. Which test can be useful in diagnosing this?
CK-MB (levels return to normal after 48 hours so useful to diagnose reinfarct)
107
Post-infarct pericarditis usually occurs (X) hours/days post-MI and should be managed with:
X = 1-3 days
| Aspirin
short-lived and localized reaction to necrosis
108
Papillary muscle rupture occurs (X) days after MI. Most often, it's the (anterolateral/posteromedial) papillary muscle ruptures because:
X = 2-7 days
Posteromedial
Single blood supply (PDA)
109
Interventricular septal rupture occurs (X) days post-MI and pathogenesis involves:
X = 3-5 days
Macrophage-mediated degeneration
110
T/F: Hx of previous MI puts patient at increased risk for cardiac tamponade in subsequent MI
False - previous MI (scar) and LV hypertrophy are protective against tamponade
111
T/F: Under 10% of all MI deaths occur due to cardiac tamponade
True
112
Fibrinous pericarditis that occurs several weeks after MI
Dressler syndrome (autoimmune)
113
NSTEMI Rx:
1. Anticoag (heparin)
2. Antiplatelet (aspirin, clopidogrel)
3. BB
4. ACEi and statins
5. Nitros and Morphine (Sx/pain management)
114
STEMI v NSTEMI Rx involves which difference?
STEMI also includes reperfusion therapy (percutaneous coronary intervention); most important
115
Which drugs must be avoided in hypertrophic cardiomyopathy?
Drugs that decrease preload or afterload (ex: vasodilators like nitros, diuretics, ACEi, etc)
116
Drugs used to manage hypertrophic cardiomyopathy
BB and nondihydropyridine CCBs
117
Isolated Asp aminotransferase (AST) increase in F with epigastric pain should prompt you to order which tests?
ECG and cardiac enzymes/markers (atypical presentation of ischemic heart disease common in females)
