CARDIO

Question 1

Truncus arteriosus gives rise to

Answer 1

ASCENDING AORTA

and

Pulmonary Trunk

Question 2

Bulbus cordis gives rise to ?

Answer 2

smooth parts (outflow tract) of Left and Right ventricles

Question 3

Endocardial cushion

give rise to?

Answer 3

atrial septum

membranous interventricular septum

AV and Semilunar valves

Question 4

primitive Atrium

gives rise to?

Answer 4

trabeculated part of :left and right Atria

Question 5

primitive Ventricle

gives rise to

Answer 5

Trabeculated (muscular) part of left and right Ventricles

Question 6

Primitive pulmonary vein gives rise to

Answer 6

smooth part of left atrium

Question 7

LEFT horn of sinus venosus

gives rise to?

Answer 7

Coronary sinus

Question 8

RIGHT horn of sinus venosus

Answer 8

Smooth part of rigjt atrium (sinus venarum)

Question 9

Right Common Cardinal vein and right anterior cardinal vein

give rise to

Answer 9

superior vena cava

Question 10

pt with down syndrone and Atrial septal defect

this is commonly due to?

Answer 10

endocardial cushion defect

Question 11

what is responsible for development of the outflow tract formation? for example the aorticopulmonary septum

Answer 11

Neural crest and endocardial cell migrations –> truncal and blbar ridges that spiral and fuse to form aorticopulmonary septum –> ascending aorta and pulmonary trunk

note the ascending aorta will be posterior

and the pulmonary trunk will be anterior.

Question 12

conotruncal abnormalities associated wtih failure of neural crests cells to migrate (problem w/ developing spiral septum) ?

Answer 12

transposition of great vessels (RV –> aorta, LV –> PA)

tetraology of fallot

Persistent truncus arteriosus ( = partial spiral development)

Question 13

mitral/tricupsid valves are derived from

Answer 13

fused endocardial cushions of the AV canal

Question 14

what virus is associated with a continous machine-like murmur (during diastole and systole)

whats the mechanism of the virus?

treatment MOA?

Answer 14

Congenital Rubella

the virus infects smooth muscle cells that are needed for contraction of teh patent ductus arteriosus

Indomethacin: inhibits the formation of PGE2, via COX1 and 2 inibition.

Question 15

what forms the mediaN umbilical ligament?

Answer 15

​AllaNtois –> Urachus

the urachus is part of allantoic duct bw bladder and umbilicus.

Question 16

the L recurrent laryngeal n. passes udner the ligamentum arteriosum which is a derivative of?

Answer 16

ductus arteriosus

Question 17

what forms the MediaL umbilical ligament?um

Answer 17

umbiLical arteries

Question 18

if given an MRI of a spin with an acute disc herniation, and you see a torn anulus fibrosus allowing the nucleus pulposes to herniate. what did the nucleus pulposes derive from?

Answer 18

Notocord.

Question 19

occlusion of the RCA can lead to?

Answer 19

Nodal dysfunction –> bradycardia or heart block, fatal arrthymias

bc the RCA supplies the SA and AV nodes

Question 20

pt has RCA infarct or Posterior descending A occlusion –> posteromedial papillary muscle rupture –> ?

Answer 20

new onset mitral regurgitation

Question 21

54 yo F presents with Hoarsenss and dysphagia, hx of RHD whats the cause of the hoarseness and dysphagia?

Answer 21

RHD –> Mitral valve stenosis –> inc in LA size –> compression of esophagus (dysphagia) and compressed left recurrent laryngeal nerve (hoarsenss) which innvervates the intrinsic muscles of the larynx.

Question 22

describe the antaomy position in terms of the aorta and esophagus and the laryngeal nerve position.

Answer 22

left atrium sits directly infront of esophagus

left recurrent laryngeal nere loops under the ligamentum arteriosum.

Question 23

normal splitting of A2 P2 is caused by?

Answer 23

during inspiration –> inc in intrathoracic volume –> drop (-) intrathoracic pressure –> inc venous return –> inc RV filling (inc EDV) —> inc RV stroke volume –> inc RV ejeciton time –> delayed closure of pulmonic valve

Question 24

Wide splitting is caused by

Answer 24

conditions that delay RV emptying (pulmonic stenosis, RBBB), anything that caused delayed contraction of RV

Question 25

what is the most common cause of splitting that doesnt change regardless if your in expiration or inspiration.

Answer 25

**ASD** ASD--\> left -to - Right shunt --\> Inc RA and RV volumes --\> inc flow through pulmonic valve.

Question 26

what is it called when listening to the heart you hear splitting of P2 and A2 on expiration but not on inspisiration

Answer 26

**paradoxical splitting** this is caused by delay in aortic valve closure. the reason why its eliminated during inspiration is that you still get your delayed closure of P2 during inspiration moving it close to A2 sound.

Question 27

what are two caused of Paradoxical splitting

Answer 27

**aortic stenosis** **LBBB** anything that delays aortic valve closure.

Question 28

rapid squatting causes inc or dec in Venous return preload afterload

Answer 28

**Inc venous return** (bc squatting the muscels of lower extremities are compressing the vein inc VR) **inc preload** (same as VR) **inc afterload** (compressing the arteries in lower limbs inc afterload

Question 29

rapid squatting increases what murmurs

Answer 29

**inc AS, MR,** and **VSD murmurs** DEC: hypertrophic cardiomyopathy murmur

Question 30

if someone is rapidly squatting when will you hear the clickl in MVP

Answer 30

**Later onset** of **click/murmur**

Question 31

handgrip causes and **inc in afterload** what murmurs will be increased vs dec

Answer 31

increased: **MR, AR, VSD** dec: **hypertophic cardiomyopathy, AS murmurs** **MVP LATER** onset of click

Question 32

**valsalva** (phase II) **standing up** leads to a **decrease** in **preload.** via inc in intrathoracic pressure --\> dec venous return --\> dec preload. what murmurs will be inc and dec?

Answer 32

**ALL MURMURS WILL BE DECREASED except** **HYPERTROPHIC CARDIOMYOPATHY murmur increased** **MVP** will have an **EARILER onset click \*\*\*\* (** **Uworld)**

Question 33

in a Pacemaker AP (SA and AV nodes) what is phase 0 (upstroke) caused by in contrast to ventricular Myocardial AP occuring in myocytes, bundle his and Purkinje fibers?

Answer 33

**Ca** **influx** (opening of voltage gated Ca2+ channels) causes the phase 0 upstroke. and the fast voltage gated NA channels are permanently inactivated bc of thee less negative resting potential of these cells. in contrast to the fast voltage gated NA channels in phase 0 of Ventricular AP

Question 34

the upstroke caused by influx of CA2+ allows for in pacemaker cells?

Answer 34

slow conduction velocity that is used by the AV node to prolong transmission from the atria to ventricles.

Question 35

phase 1 and 2 of AP is absent in?

Answer 35

Pacemaker AP

Question 36

what phase accounts for the **automaticity** of **SA** and **AV nodes.**?

Answer 36

**phase 4 = slow spontaneous diastolic depolarizatiion** due to If ("funny current") If channels responsible for a slow mixed NA/K inward current.

Question 37

abnormal fast accessory conduction pathway from atria --\> ventricle (bundle of Kent) **bypasses** the **rate slowing AV node** --\> ventricles begin to partially depolarize. most cocmmon type of ventricular pre excitation syndrome. Diagnosis

Answer 37

**WPW**

Question 38

**Delta wave** with **widen QRS complex.** and **shortened PR interval** on ECG. this may result in?

Answer 38

**re-entry circuit --\> supraventricular tachycardia** tx with **procainamide** or **amiodarone** not adenosine WPW

Question 39

name some of the drugs that cause long QT (ABCDE)

Answer 39

Anti**A**rrhythmics (class IA, III) Anti**B**iotics (marcorlides) anti **C**ychotics (haloperidol), risperidone anti**D**epressants (TCAs) Antii**E**metics (ondansetron)

Question 40

what Congenital long QT syndrome is **autosomal Dominant** pure cardiac phenotype (only **K** channels in heart effected) .**NO deafness**

Answer 40

**Romano-Ward syndrome**

Question 41

what congenitial Long QT syndrome (disorder of myocardial repolarization) is autosomal **Recessive** Cardiac K+ channels + **sensorineural deafness**

Answer 41

**Jervell** and **Lange- Nielsen syndrome**

Question 42

NA channel abnormality inherited in **Asian**s (usually MALES) ECG: **pseduo-RBBB** (QRS widen), **ST elevations V1-V3** inc risk for sudden **ventricular tachyarrrhythmias** and **SCD.** what is this syndrome and what parts of the -cardium does it effect?

Answer 42

**Brugada syndrome** dec NA influx in **Epicardium** and **Endocardium.**

Question 43

Asian decent with Pseudo RBBB and ST elevations iin V1-V3. what is the tx

Answer 43

**Implantable cardioverter-defibrillator (ICD)**

Question 44

In stable angina what is your classic ECG findings

Answer 44

**ST DEPRESSION** it resolves with rest, or nitroglycerin

Question 45

pt is triggered by smoking, triptans, coccaine occurs at **rest** ECG: **TRANSIENT ST ELEVATIONS.** what would you tx with and whats the diagnosis?

Answer 45

**variant (prinzmetal) angina** tx: **Ca channel blockers, nitrates,** and smoking cessation

Question 46

what is unstable angina due to?

Answer 46

unstable atherosclerotic plaque thats gonna rupture. leads to thrombosis w/ incomplete coronary artery occlusion

Question 47

what are the classic ECG and BIomarkers for **unstable angina**

Answer 47

+/- **ST depresions,** and or **T-wave inversion** ## Footnote biomarkers: **no cardiac biomarker elevation** (unlike **NSTEM)** pt will complain of inc frequency, duration, or intensity of chest pain, or chest pain at rest.