Cardiac

Question 1

Sinus tachycardiaSinus tachycardia

Answer 1

> 100 bpm

Can occur in normal individuals with exercise, emotions, pregnancy, caffeine***

There’s probably going to be a question like “Tina has a high HR after drinking coffee. What’s the deal?” And the answer is Sinus tachycardia

Question 2

Paroxysmal supraventricular tachycardia

Answer 2

an episode that begins and ends abruptly during which there are very rapid and regular heartbeats that originate in the atrium or in the AV node

Question 3

Atrial flutter

Answer 3

irregular beating of the atria

Atrial rate 250-350 bpm

Question 4

Atrial fibrillation

Answer 4

occurs when the normal rhythmic contractions of the atria are replaced by rapid irregular twitching of the muscular heart wall

Increases with age

No P waves (little blip before QRS complex)

Question 5

CHADS2 Score (5)

Answer 5

risk of stroke in patients with non-rheumatic atrial fibrillation (AF), since AF can cause stasis of blood in the upper heart chambers, leading to the formation of a mural thrombus that can dislodge into the blood flow, reach the brain, cut off supply to the brain, and cause a stroke.

CHF
HTN >140/90
Age >75
Diabetes
Stroke (2 pts)

0 = aspirin/or nothing
1 = aspirin or warfarin
>2 = warfarin

Question 6

Wolff-Parkinson-White Syndrome

Answer 6

congenital abnormal (extra) conducting fibres which accelerate the transmission of impulse from the atria to ventricles

Bundle of kent

Question 7

Premature ventricular contraction

Answer 7

a ventricular contraction preceding the normal impulse initiated by the SA node
-associated with hypoxia, electrolyte abnormalities, and hyperthryoidism

Question 8

Ventricular tachycardia

Answer 8

A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium), which may result in inadequate blood flow and eventually deteriorate into cardiac arrest.

SUDDEN DEATH

Question 9

Torsades de Pointes

Answer 9

“Twisting of points”: your ECG looks like that one Arctic Monkey’s album cover

Basically, your ECG is a mess because the electrical conduction in the heart is **y

Question 10

most frequent cause of sudden death

Answer 10

Ventricular fibrillation

Question 11

Ischemic heart disease

Answer 11

poor blood supply to the heart via the coronary arteries
MC cause of cardiovascular comobidity and mortality

2M : 1F

Fam hx, hyperlipidemia, HTN, DM, cigarette smoking

Question 12

Patient has chest pain that does not change with body position or respiration. What’s the deal

Answer 12

Coronary artery disease

Question 13

Chronic stable angina

Answer 13

Ischemic heart disease due to an imbalance between oxygen supply and demand in myocardium

Decreased myocardial supply causes: atherosclerosis, vasospasm, tachycardia, anemia

Increased myocardial demand causes: hyperthryoidism, aortic stenosis

Retrosterna chest pain, tightness, left arm/jaw/neck pain

3 e’s: exertion, emotion, eating

Question 14

Acute coronary syndrome

Answer 14

Ischemic heart disease with exercise or at rest

Question 15

Acute coronary syndrome shows ST segment [ Or ], while chronic stable angina shows ST segment [ ]

Answer 15

Elevation or depression; depression

Question 16

T or F: hypertension symptoms are not usually present

Answer 16

True–the “silent killer”

Question 17

Congestive heart failure

Answer 17

Clinical syndrome caused by inability of the heart to pump enough blood

• left- or right-sided
• systolic or diastolic

Caused by ischemic hd, htn, alcohol, idiopathic

Question 18

Exertional dysnpea is the earliest symptom of [ ]

Answer 18

Heart failure

Question 19

Systolic heart failure

Answer 19

Recall: systolic is when blood is emptying from ventricle

SHF: heart relaxes but can’t contract–mm strength loss so ventricles can fill but can’t eject properly

Question 20

Diastolic heart failure

Answer 20

Recall: diastolic is when blood fills ventricle

DHF: contract but can’t relax–> ventricles can’t fill with enough blood but can contract and eject blood

Question 21

Acute pericarditis: most common etiology

Answer 21

Idiopathic

Followed by infectious, post-myocardial infarction, post-surgical

Question 22

Acute pericarditis clinical triad

Answer 22

Chest pain + pericardial friction rub + ECG changes

Question 23

Dilate cardiomyopathy and major risk factors

Answer 23

Dilation and impaired systolic function of one or both ventricles

Rf

• family history (60%)
• alcohol (20-30%)
• cocaine

Question 24

Best initial test for dilated cardiomyopathy

Answer 24

Echocardiogram–shows chamber enlargment

Question 25

Most common cause of sudden cardiac death in young athletes

Answer 25

Hypertrophic cardiomyopathy–genetic variant (1/500 to 1/100 in general population)

***usually asymptomatic

Management: avoid ALL COMPETITIVE SPORTS 😬

Question 26

Restrictive cardiomyopathy

Answer 26

Impaired ventricular filling in a non-dilated, non-hypertrophies ventricle due to factors that decrease myocardial compliance (e.g., fibrosis)

Question 27

In what condition would you hear a “crescendo-decrescendo systolic ejection murmur radiating to carotid”?

Answer 27

Aortic stenosis

Question 28

In what condition would you hear an “early decresendo diastolic murmur at left lower sternal border or right lower sternal border” best heard when sitting or leaning forward

Answer 28

Aortic regurgitation

Question 29

In what condition would you hear a “mid-diastolic rumble at the heart’s apex” best heard in left lateral decubitus position?

Answer 29

Mitral stenosis

Question 30

In what condition would you hear a “holosystolic murmur at apex, radiating to axilla/mid-diastolic rumble”?

Answer 30

Mitral regurgitation

Question 31

In what condition would you hear a “diastolic rumble at the 4th intercostal space”?

Answer 31

Tricuspid stenosis

Question 32

In what condition would you hear a “holosystolic murmur at the left lwoer sternal border accentuated by inspiration”?

Answer 32

Tricupsid regurgitation

Question 33

In what condition would you hear a “systolic murmur at 2nd left intercostal space accentuation by inspiration, pulmonary ejection click”?

Answer 33

Pulmonary stenosis

Question 34

In what condition would you hear a “early diastolic murmur at left lower sternal border” AND “diastolic murmus at the 2nd and 3rd left intercostal space increasing with inspuration”

Answer 34

Pulmonary regurgitation

Question 35

In what condition would you hear a “mid-systolic click, mid to late systolic murmus at apex accentuated by valsalva or squat-to-stand”?

Answer 35

Mitral valve prolapse

Question 36

Sudden onset tearing chest pain that radiates to bacK + difference in blood pressure between r and l arms

Answer 36

aortic dissection

Question 37

True vs false aortic aneurysm

Answer 37

TA: involves all vessel wall layers (intima, media, adventitia)

FA: not all layers, but blood can collect between media and adventitia

Question 38

Best diagnostic test for aortic aneurysm

Answer 38

Abdominal ultrasound

Question 39

Classic triad of ruptured AAA

Answer 39

Back/abdomen pain + hypotension +pulsatile abdominal mass

Question 40

What is an acute arterial isshemia (how long before med management)

Answer 40

Acute occlusion of a peripheral aa w/o history of claudication

Urgent management required (skeletal mm can tolerate 6hr of ischemia before irrevesabilie damage occurs)

Question 41

Where is acute arterial ischemia mc

Answer 41

lower e> upper e.

Question 42

risk factors of acute arterial ischemia

Answer 42

arrhythmia
endocarditis
arterial aneurysms
chronic Pad
Previous grafts
hypercoagulatble states

Question 43

triad for suspected arterial occlusion

Answer 43

Pain
Pallor
Pulseless

Question 44

main risk factors of chronic arterial occlusion/insufficiency

Answer 44

1. Atherosclerosis
   - smoking
   - DM
   - old age

Question 45

Chronical arterial occlusion clinical fx

Answer 45

1. Claudication (pain w exersion, usually calfs, relieved by rest, reproducible)
2. Critical limb ishemia (rest pain, night pain, tissue loss, ABI