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My Notes > Cardio > Flashcards

Cardio Flashcards

1
Q

How long does it take for ischemia → permanent myocyte damage?

A

20 minutes

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2
Q

What → ST elevation vs. ST depression?

A

ST elevation is caused by transmural ischemia

ST depression is caused by subendothelial ischemia

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3
Q

When do you get contraction band necrosis?

A

calcium from reperfusion → contraction of dead muscle

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4
Q

What condition is present in a systolic ejection murmur accentuated by standing?

A

hypertrophic obstructive cardiomyopathy

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5
Q

Early diastolic decrescendo murmur decreased by amyl nitrate indicates:

A

aortic regurgitation

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6
Q

This condition presents as a late diastolic murmur eliminated by atrial fibrillation

A

mitral (and/or tricuspid) stenosis

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7
Q

What is the closest atrium/ventricle to the esophagus?

A

left atrium

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8
Q

In which direction would you orient an esophageal ultrasound probe to visualize the descending aorta?

A

posteriorly

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9
Q

What congenital heart defect is associated with fetal alcohol syndrome? Down syndrome? Maternal diabetes? Turner syndrome? DiGeorge?

A 
FAS: VSD
Downs: ASD
Diabetes: transposition of GVs
Turner: infantile an adult coarctation of aorta
DiGeorge: interrupted aortic arch
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10
Q

Why do you hear a loud S1 and fixed S2 split on auscultation of an ASD?

A

L→ R shunt → Increased volume in R heart → delayed closure of pulmonic valve

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11
Q

How can a PDA → differential cyanosis (legs only)?

A

The ductus arteriosus connects the pulmonary artery to aorta after the branches to the arms are given off of the aorta. (Note: this would be a late presentation after R→L shunt develops i.e. Eisenmenger syndrome)

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12
Q

Upon running around the playground, a child becomes cyanotic. He stops and squats, leading to an improvement of his symptoms. What is the congenital heart defect? Why didn’t it present sooner?

A

Tetrology of Fallot: squatting helps divert blood to the right side so it can get oxygenated

A late presentation means the degree of pulmonic valve stenosis is in the milder range

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13
Q

Which congenital anomaly will show a boot-shaped heart?

A

Tetrology of Fallot

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14
Q

Which disorders result in late cyanosis? Why?

A

ASD, VSD, PDA due to Eisenmenger syndrome

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15
Q

A child is born with early cyanosis and is found to have transposition of the great vessels. What do you give on the way to the operating room?

A

PGE to keep the PDA open

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16
Q

How does coarctation of the aorta present? What additional findings might be present?

A

Hypertension in arms, hypotension with weak pulses in legs

Associated with bicuspid aortic valve and notching of the ribs

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17
Q

Which congenital anomaly will show a boot-shaped heart?

A

Tetrology of Fallot

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18
Q

Which disorders result in late cyanosis? Why?

A

ASD, VSD, PDA due to Eisenmenger syndrome

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19
Q

A child is born with early cyanosis and is found to have transposition of the great vessels. What do you give on the way to the operating room?

A

PGE to keep the PDA open

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20
Q

How does coarctation of the aorta present? What additional findings might be present?

A

Hypertension in arms, hypotension with weak pulses in legs

Associated with bicuspid aortic valve and notching of the ribs

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21
Q

Which congenital anomaly will show a boot-shaped heart?

A

Tetrology of Fallot

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22
Q

Which disorders result in late cyanosis? Why?

A

ASD, VSD, PDA due to Eisenmenger syndrome

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23
Q

A child is born with early cyanosis and is found to have transposition of the great vessels. What do you give on the way to the operating room?

A

PGE to keep the PDA open

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24
Q

How does coarctation of the aorta present? What additional findings might be present?

A

Hypertension in arms, hypotension with weak pulses in legs

Associated with bicuspid aortic valve and notching of the ribs

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25
Q

Which congenital anomaly will show a boot-shaped heart?

A

Tetrology of Fallot

26
Q

Which disorders result in late cyanosis? Why?

A

ASD, VSD, PDA due to Eisenmenger syndrome

27
Q

A child is born with early cyanosis and is found to have transposition of the great vessels. What do you give on the way to the operating room?

A

PGE to keep the PDA open

28
Q

How does coarctation of the aorta present? What additional findings might be present?

A

Hypertension in arms, hypotension with weak pulses in legs

Associated with bicuspid aortic valve and notching of the ribs

29
Q

What are Kerley B lines?

A

short horizontal lines situated perpendicularly to the pleural surface that represent edema of interlobular septa

30
Q

What are the triggers for ARDS?

A

sepsis, aspiration, pneumonia, trauma

31
Q

How can ARDS be distinguished from cardiogenic pulmonary edema?

A

absence of JVD and cardiomegaly

32
Q

How would a chest x-ray appear in primary pulmonary hypertension?

A

Enlarged R ventricle and pulmonary arteries

33
Q

What are the findings in left heart failure on chest x-ray?

A

cardiomegaly (heart > 1 hemithorax), increased vascular shadowing (alveolar edema) in a batwing peri-hilum pattern, and blunting of costophrenic angles (pleural effusions)

34
Q

Describe the differences between excitation-contraction coupling in cardiac, skeletal, and smooth muscle

A
  1. all 3 use voltage gated L-type Ca2+ channels
  2. Ca2+-induced Ca2+ release from RyR receptor in cardiac and smooth mm., physical coupling to the RYR in skeletal
  3. In skeletal and cardiac mm. Ca+ binds to troponin C allowing actin and myosin to bind. In smooth mm. Ca2+ binds to calmodulin → activates MLCK → phosphorylation of myosin
35
Q

Describe the pathogenesis of concentric remodling in heart failure

A

↓ CO → ↓ BP → ↑ sympathetic activity → α-1 vasoconstriction → ↑ afterload → ↑ work → concentric hypertrophy (→ less room for filling → less starling force → ↓ CO)

36
Q

Which coronary arteries are most commonly affected in IHD?

A

LAD 45%
RCA 30%
Circumflex 15%

37
Q

Endocarditis in drug users is associated with what heart finding?

A

tricuspid regurgitation

38
Q

What is diastolic dysfunction?

A

EF is normal or ↑, but HR or poor ventricular compliance → insufficient diastolic filling time → inadequate blood pumped forward → accumulation in lungs → pulmonary edema

39
Q

What pigment accumulates in aging cardiomyocytes hepatocytes as a result of aging (especially when malnourished and cachectic?)

A

Lipofuscin - a insoluble pigment that builds up as a product of free radical injury and lipid peroxidation

40
Q

What is the most common site of aneurism from hypertension, syphilis, or vasculitis in the aorta?

A

Where the R brachiocephalic artery branches off (the first branch of the aorta)

41
Q

What conditions of the heart predispose people to infective endocarditis?

A
  1. prosthetic heart valves

2. prior valvular inflammation and scarring (may occur following RF)

42
Q

What generally causes concentric vs. eccentric hypertophy?

A

Concentric - ↑ P

Eccentric - ↑ Vol

43
Q

Differentiate between the most common causes of unstable angina and transmural MI

A

ulceration of atherosclerotic plaque → unstable angina (or subendocardial infarction)
rupture of atherosclerotic plaque → transmural MI

44
Q

What are the two primary factors which autoregulate coronary blood flow?

A

NO - large arteries and pre-arteriolar vessels

Adenosine - small coronary arterioles

45
Q

What is adenosine made from?

A

it is a product of ATP metabolism (ATP → ADP → AMP → → adenosine → coronary vasodilation)

46
Q

What does A-fib look like on EKG?

A
  • absent p waves (no coordinated contraction from SA but multiple foci)
  • f waves (fibrillary waves replace p waves)
  • irregular R-R intervals
  • narrow QRS complexes (b/c tachy) but normal shape b/c ventricles have normal conduction
47
Q

What does the circumflex artery supply?

A

lateral and posterior-superior walls of LV

48
Q

What does the LAD supply?

A

anterior 2/3 of intraventricular septum
anterior wall of LV
part of anterior papillary m.

49
Q

What does the RCA supply?

A

SA and AV nodes

PDA (in 80-90% of ppl) → inferior wall of LV

50
Q

What causes plateau phase of cardiac AP?

A

opening of L-type dihydropyridine-sensitive Ca++ channels and closure of some K+ channels

51
Q

What are the symptoms of Kawasaki disease?

A
  1. persistent fever
  2. bilateral conjunctivitis
  3. lymphadenopathy
  4. mucocutaneous involvement: eg. erythema of lips and strawberry tongue, eythema/edema of hands and feet, desquamation of fingertips, rash spreading toward center from extremities
52
Q

When does calcific aortic stenosis occur in people with normal (tricuspid) aortic valves and those with bicuspid valves?

A

nml: 80s
bicuspid: 60s

53
Q

What factors are protective against LV free wall rupture post-MI?

A 
LV hypertrophy
prior MI (fibrosis ↓ probability of tearing)
54
Q

What occurs after less than 30 minutes of ischemia in the heart?

A

reversible damage called myocardial stunning: it takes hours to days (depending on how long the period of ischemia) for full return to normal contractility

55
Q

What demographic has the highest risk of cor pulmonale from primary pulmonary hypertension?

A

♀ 20 - 40 y.o.

56
Q

What is the most common cause of diastolic dysfunction?

A

chronic HTN → concentric hypertrophy → stiffened walls → impaired LV filling due to reduced LV compliance (this last point is the definition of diastolic dysfunction)

57
Q

What part of the heart is enlarged in hypertrophic cardiomyopathy?

A

IV septum usually

58
Q

What causes congenital QT prolongation syndromes?

A

decreased outward K+ currents

59
Q

What increases risk for torsade de point?

A

long QT interval

60
Q

How do you calculate TPR of a bed of parallel circuits?

A

1/TPR = 1/R1 + 1/R2 + 1/R3 + …

My Notes (23 decks)

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