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Cardiology > Cardio Anatomy Questions > Flashcards

Cardio Anatomy Questions Flashcards

1
Q

What are the three muscular sheets of the intercostal muscles?

A

Intercostalis externa, internus, and intimus

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2
Q

What is the nerve supply to the intercostal muscles?

A

Corresponding intercostal nerves (ventral ramus of a thoracic nerve)

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3
Q

What is the blood supply to the anterior upper six intercostal spaces?

A

Branches of internal thoracic artery

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4
Q

What is the blood supply to spaces 7-9 anteriorly?

A

Branches of musculo-phrenic artery
- Additional Information: The lower two spaces (10-11) are devoid of anterior intercostal arteries

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5
Q

What is the posterior intercostal blood supply to the upper two spaces?

A

Superior intercostal arteries

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6
Q

What is the posterior blood supply to spaces 3-11?

A

Descending thoracic aorta

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7
Q

What ribs is the heart located between?

A

2-5

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8
Q

What is another name for the visceral layer of serous pericardium?

A

Epicardium

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9
Q

During a surgery, the surgeon must ligate the arterial end to control hemorrhage. Which sinus would be used in order to do so?

A

Transverse Sinus
- Additional Information: space separating the arterial and venous ends of the heart

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10
Q

What is the function of the auricles?

A

Increase atrial volume

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11
Q

What is the name of the structure that encircles the junction of the atria and ventricles?

A

Coronary sulcus

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12
Q

What type of muscles line the atria?

A

Pectinate muscles

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13
Q

What ridges the walls of the ventricles?

A

Trabeculae carneae
- Additional Information: Papillary muscles project into the ventricular cavities

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14
Q

Which vessel leaves the right ventricle?

A

Pulmonary trunk (􏰀Pulmonary arteries)

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15
Q

Which vessel leaves the left ventricle?

A

Aorta

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16
Q

What is responsible for anchoring the AV Valve cusps to papillary muscles?

A

Chordae tendineae

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17
Q

Which valves prevent backflow into the atria when the ventricles contract?

A

Atrioventricular valves (AV Valves) – Include tricuspid on right on mitral on left

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18
Q

Which valves prevent backflow into the ventricles when the ventricles relax?

A

Semilunar valves (aortic and pulmonary)

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19
Q

Blood begins in the right atrium and passed through what valve to enter the right ventricle?

A

Tricuspid valve

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20
Q

The most common cause of infective endocarditis in IV drug users is S. aureus. Which valve is most frequently involved?

A

Tricuspid valve

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21
Q

From the right ventricle, how does blood flow through the heart to get to the lungs?

A

Right ventricle􏰀pulmonary semilunar valve􏰀pulmonary trunk􏰀pulmonary arteries 􏰀 Lungs

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22
Q

From the lungs, blood travels through the pulmonary valves into the left atrium. How does blood return to systemic circulation?

A

Left atrium􏰀bicuspid valve􏰀left ventricle􏰀aortic semilunar valve􏰀aorta􏰀 systemic circulation

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23
Q

Which circuit, pulmonary or systemic, is shorter?

A

Pulmonary

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24
Q

Which circuit, pulmonary or systemic, is higher pressure?

A

Systemic

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25
Q

Which coronary artery supplies the whole right atrium, most of the right ventricle, and posterior inferior 1/3 of ventricular septum?

A

Right coronary artery

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26
Q

What is the nerve supply to the heart?

A

Cardiac plexus (sympathetic and parasympathetic fibers)

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27
Q

A patient presents with a wide pulse pressure and machinery type murmur. What is the suspected diagnosis?

A

Patent Ductus Arteriosus (PDA)

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28
Q

What node generates impulses for the heart?

A

SA (sinoatrial) node

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29
Q

The impulses through the heart pause at what node?

A

AV (atrioventricular) node

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30
Q

What conducts impulses through the interventricular septum?

A

Bundle branches of His

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31
Q

What depolarizes the contractile cells of both ventricles?

A

Purkinje fibers

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32
Q

What defines orthostatic hypotension?

A

> 20 mmHg decrease in SBP or > 10 mmHg decrease in DBP
- Additional Information: If heart rate increases by 15 bmp, decreased circulatory volume is likely the cause of the orthostatic hypotension

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33
Q

What medication has been proven to prolong a patient’s life when they have been diagnosed with coronary disease? What is the mechanism of action?

A

Beta blockers
Mechanism of action: (i) Decreased oxygen demand due to the reduction in heart rate, blood pressure, and contractility, and the consequent relief of ischemic chest pain.
(ii) Increases threshold of ventricular fibrillation

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34
Q

Digoxin, a class V antiarrhythmic drug, works in what way?

A

Direct action on cardiac muscle. Indirect action on cardiovascular system via autonomic nervous system.
- Additional Information: Used in supraventricular tachycardia (SVT)

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35
Q

Adenosine, a class V antiarrhythmic drug, works in what way?

A

Slows conduction through AV Node
- Additional Information: Used in supraventricular tachycardia (SVT)

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36
Q

Amiodarone is what type of drug?

A

Potassium channel blocker – prolongs action potential – Antiarrhythmic Class III

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37
Q

A patient has irregularly irregular heartbeat. This heart rhythm is the most common cause of what?

A

Atrial fibrillation – most common cause of embolic CVA (stroke)
- Additional Information: Recall CHADS2 Criteria
Congestive heart failure (1 pt); Hypertension (1 pt); Age > 75 (1 pt); Diabetes Mellitus (1 pt); S2 Stroke, TIA, Thrombus (2 pts)
High risk and warfarin therapy recommended: >2 points; Moderate risk and warfarin or aspirin: 1 point; Low risk and no treatment or aspirin: 0 points

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38
Q

This disease is genetic in nature, more common in Asian men, and causes syncope, ventricular fibrillation, and sudden death (often during sleep).

A

Brugada syndrome

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39
Q

Loop diuretics leave patients more susceptible to problems with what, than do thiazide diuretics?

A

Electrolytes

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40
Q

Diuretics can increase susceptibility to what disease, which is identified by negatively birefringent crystals?

A

Gout, by increasing uric acid levels

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41
Q

A 47 year old woman has been treating her HTN with lisinopril for 15 years. In
the past, she has only experienced a cough which she dealt with knowing that the drug helped her
HTN. However, she presents today to the ED with symmetrically swollen lips and no history
that indicates this is an allergic reaction. What do you believe is the cause and can she be placed
on an ARB instead? What alternative medicines can she be given?

A

Lisinopril (an ACE-I) is the likely cause. No ARBs due to cross reactivity.
Alternative medicines include diuretics (HCTZ), channel blockers, or beta blockers.

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42
Q

Because of the negative inotropic effects of calcium channel blockers, who should
they be used cautiously in?

A

Answer: Patients with cardiac dysfunction

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43
Q

Describe the 5 classes of anti-arrhythmic drugs.

A

I – Sodium channel blockers (decrease conduction velocity)
- Ia: Quinidine, procainamide – prolong repolarization
- Ib: Lidocaine, phenytoin – shortens repolarization
- Ic: Flecanide – minimal effect on repolarization, widens QRS
II – Beta blockers (propranolol, metoprolol, esmolol)
III – Potassium channel blockers
IV – Calcium channel blockers (Non-dihydropyridines, verapamil, diltiazem) V – Others: Adensoine

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44
Q

Contraction of heart muscle is known as what?

A

Systole

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45
Q

The volume of blood pumped by each ventricle in one minute is known as what?

A

Cardiac output
Cardiac Output = Heart rate x Stroke Volume

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46
Q

How is stroke volume defined?

A

End diastolic volume – End systolic volume

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47
Q

What three man factors affect stroke volume?

A

Preload (degree of stretch of cardiac muscles before contraction), contractility (contractile strength at a given muscle length), and afterload (pressure that must be overcome for ventricles to eject blood)

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48
Q

What does hypertension do to afterload?

A

Increases it

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49
Q

How is end diastolic volume defined?

A

Volume of blood in each ventricle at the end of ventricular diastole

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50
Q

How is ejection fraction defined?

A

(Stroke Volume / End Diastolic Volume) x 100

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51
Q

A normal ejection fraction is usually greater than what percentage?

A

55-60%

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52
Q

What might you hear on physical exam in a patient with congestive heart failure?

A

S3 heart sound

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53
Q

On an EKG, what does the P wave correspond to?

A

Depolarization of the SA Node

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54
Q

On an EKG, what does the QRS complex correspond to?

A

Ventricular depolarization

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55
Q

On an EKG, what corresponds to ventricular repolarization?

A

T Wave

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56
Q

On an EKG, what corresponds to atrial repolarization?

A

Nothing. It is masked by the larger QRS complex.

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57
Q

Is the QRS narrow or wide with bundle branch blocks?

A

Wide (> 0.12 seconds) because of slower conduction

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58
Q

What leads reveal bundle branch blocks?

A

V1 and V6
- Additional Information:
Left BBB: RsR’ in V6; deep S in V1

Right BBB: rSR’ in V1; wide S wave in V6

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59
Q

A new left bundle branch block on EKG is highly suspicious for what?

A

A new MI

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60
Q

What EKG finding may be found in patients with long-standing hypertension?

A

Left ventricular hypertrophy
V1 or V2 leads: Deep 2 wave; V5 or V6: Tall R wave
V1 (S) + V5 (R) > 33 mm represents LVH

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61
Q

On EKG, what two leads are considered when determining if there is right or left axis deviation?

A

Leads I and AVF

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62
Q

In normal sinus rhythm, which lead is it normal to have an inverted P wave?

A

aVR

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63
Q

What is the first line treatment for a patient with symptomatic bradycardia?

A

Atropine
- Additional Information: Because excess vagal stimulation is the cause of most bradycardia rhythms, anticholinergic atropine is 1st line.

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64
Q

An ECG reveals a “saw tooth” pattern. What is this known as?

A

Atrial flutter

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65
Q

What is the treatment for tosades de pointes?What is the treatment for tosades de pointes?

A

IV Magnesium

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66
Q

What is the ECG finding in acute pericarditis?

A

Diffuse ST Elevation

67
Q

What is the length of the PR interval in a first degree AV block?

A

> 0.20 seconds

68
Q

Which type of AV block causes a constant/prolonged PR interval, resulting in a dropped QRS, which is managed with a permanent pacemaker?

A

Mobitz Type II

69
Q

Which 2nd degree AV block causes the PR interval to gradually increase before a QRS is dropped?

A

Wenckebach (Mobitz Type I)

70
Q

You note a large diphasic P wave with a tall initial component in Lead II. What does this mean?

A

Right atrial hypertrophy
- Additional Information: Leads II and V1 are checked for P wave morphology to reveal left or right atrial enlargement.

71
Q

A patient’s EKG shows a widened QRS and peaked T waves. What electrolyte is likely too high?

A

Potassium – Hyperkalemia

72
Q

You suspect an infarction in the inferior leads. What vessel(s) is/are the most likely cause?

A

Right or left coronary artery (seen in leads II, III, AVF)

73
Q

What percentage of blood passively flow into the ventricles during ventricular filling in mid-to-late diastole?

A

80%

74
Q

During ventricular systole, what is the state of all valves?

A

Closed – isovolumetric contraction phase

75
Q

Valves on which side of the heart close first?

A

Left

76
Q

Valves on which side of the heart open first?

A

Right

77
Q

Valves on which side of the heart close last?

A

Right

78
Q

The S1 sound of the heart is caused by closure what which valves?

A

AV Valves (mitral first, then tricuspid)

79
Q

In a right bundle branch block, the S1 is split due to delay in closure of which valve?

A

Tricuspid

80
Q

A physiologic split of S2 is heard during inspiration due to what?

A

Increased output of right heart delaying closure of the pulmonic valve

81
Q

You hear a fixed split S2 when listening to a patient’s heart. What do you suspect?

A

ASD – atrial septal defect

82
Q

True or False? An S3 is normal in children and young adults?

A

True

83
Q

What causes an S3 sound?

A

Rapid filling of a very compliant ventricle

84
Q

The atrium contacts against a stiff ventricle, producing what sound?

A

S4

85
Q

Which two sympathetic hormones result in increased excitability, increased contraction force, and increased heart rate?

A

Epinephrine and Norepinephrine

86
Q

What hormone causes decreased excitability, decreased contraction force, and decreases heart rate?

A

Acetylcholine (secreted by vagus nerve) – Parasympathetic system
- Additional Information: Therefore, anti-cholinergic drugs increase heart rate. Vagal maneuvers slow down the heart rate.

87
Q

Where does the aorta arise from?

A

Left ventricle

88
Q

The right and left coronary arteries are branches of what structure?

A

Ascending aorta

89
Q

What are the three layers of arterial walls?

A

Tunica intima, media, and externa

90
Q

What type of arteries (elastic, muscular, arterioles, or capillaries) are the large vessels, such as the pulmonary trunk and aorta?

A

Elastic arteries

91
Q

What vessels are responsible for total peripheral resistance?

A

Arterioles

92
Q

What layers of arterial lining are NOT present in capillaries?

A

Tunica media and externa

93
Q

What structures bypass the capillary bed?

A

Arteriovenous anastomoses – direct connections between arterioles and venules

94
Q

What substance are capillaries normally NOT permeable to?

A

Plasma proteins

95
Q

What are the three main factors that influence blood pressure?

A

Cardiac output, total peripheral resistance, and blood volume

96
Q

Long-term control of blood pressure is supplied by what?

A

Renal regulation through the renin-angiotensin system

97
Q

What two brain structures contain the vasomotor center?

A

Medulla and pons

98
Q

Where are baroreceptors located?

A

Carotid sinuses, aortic arch, walls of large arteries in neck and thorax.

99
Q

Decreased arterial pressure, detected by the kidneys, results in the secretion of what?

A

Renin

100
Q

Renin is converted into what substance by an enzyme from the liver?

A

Angiotensin I (converted by angiotensinogen)
- Additional Information: Angiotensin I is then converted to Angiotensin II by an enzyme in the lungs (ACE).

101
Q

Angiotensin II causes what reactions that increase arterial pressure?

A

Renal retention of salt and water, vasoconstriction, and inactivation of angiotensinase

102
Q

The inferior vena cava (IVC) collects blood from where in the body?

A

Inferior to the diaphragm

103
Q

What is true of the tunica media in veins, compared to arteries?

A

Thinner

104
Q

As you age, what happens to hematocrit levels?

A

Decrease

105
Q

A 20 year old woman reports that when walking back from class during the winter months, the tips of her fingers become cold and white. What is the name of this disorder?

A

Raynaud’s disease

106
Q

A patient present with a throbbing headache localized to her right temple, with blurry vision, and polymyalgia rheumatica. What is the most likely diagnosis?

A

Temporal arteritis

107
Q

What is the most common vasculitis?

A

Temporal arteritis

108
Q

A 24 year old male who has smoked 1 pack per day since he was 14 year old presents with lower extremity claudication and a right toe ulceration. Given his smoking history and presentation, what is the most likely diagnosis?

A

Thromboangitis Obliterans (Buerger’s disease)

109
Q

Which direction does lymph flow?

A

Towards the heart

110
Q

Lymph is delivered into one of two large ducts. What are the names of these two ducts?

A

Right lymphatic duct and thoracic duct
- Additional Information: The right lymphatic duct drains the right upper arm and right side of the head and thorax. The thoracic duct drains the rest of the body.

111
Q

Where does the thoracic duct arise from?

A

Cisterna chyli
- Additional Information: Cisterna chyli is a dilated sac at the lower end of the thoracic duct into which lymph from the intestinal truck and two lumbar lymphatic trunks flow.

112
Q

What are the two main varieties of lymphoid cells?

A

T and B cells

113
Q

What is the largest lymphoid organ?

A

Spleen

114
Q

What two important points differentiate the thymus from other lymphoid organs?

A

Functions strictly in T lymphocyte maturation and does not directly fight antigens
- Additional Information: The thymus stops growing during adolescence and then gradually atrophies

115
Q

What does MALT describe?

A

Mucosa-associated lymphatic tissue.
Includes: peyer’s patches, tonsils, and the appendix in the digestive tract. Lymphoid nodules in the walls of the bronchi.

116
Q

True or false? The embryonic digestive tract is non-functional.

A

True

117
Q

In fetal circulation, how does blood pass from the pulmonary trunk to the aorta?

A

Ductus arteriosus

118
Q

In fetal circulation, how does blood pass from the right to left atrium?

A

Foramen ovale

119
Q

What causes the foramen ovale to close?

A

Pressure from increased blood flow to the left side of the heart
- Additional Evaluation: Functional closure of the foramen ovale and ductus arterosus occurs soon after birth.

120
Q

Arterial thickening of small arteries and arterioles is called what?

A

Arteriosclerosis

121
Q

Lipid deposition and intimal thickening of large and medium sized arteries is called what?

A

Atherosclerosis

122
Q

What are the four main stages of the response-to-injury hypothesis that explains the development of atherosclerosis and thrombus?

A
  1. Chronic endothelial injury
  2. Accumulation of lipoproteins and oxidize in the tunica intima
  3. Smooth muscle cell proliferation and formation of fibrous cap
  4. Unstable plaque
123
Q

If the SA node fails, what automaticity foci in the atria may take over pacing?

A

AV junction (called junctional rhythm)

124
Q

What is the inherent rate of the SA node?

A

60-100 beats per minute

125
Q

What is the inherent rate of the AV junction?

A

40-60 beats per minute

126
Q

What is the inherent rate of ventricular ectopic foci?

A

20-40 beats per minute

127
Q

What is a normal QT interval?

A

0.2-0.4
- Additional Information: To account for QT differences at different rates, the QTc is corrected. Normal QTc is < 0.44

128
Q

What does a long QT interval put a person at risk of?

A

Tachyarrhythmias

129
Q

Which genetic disorder is associated with coarctation of the aorta?

A

Turner’s syndrome

130
Q

A heart defect that causes a patient to appear cyanotic is what kind of shunt?

A

Right to left

131
Q

What is the most common congenital cardiac anomaly?

A

Ventricular septal defect (VSD)

132
Q

A 7 week old infant is noted to have a grade IV harsh, pansystolic murmur best heard at the left sternal border, with a diastolic rumble. What cardiac anomaly does this patient likely have?

A

VSD
- Additional Information: Soon after birth, CXR reveals increased pulmonary vasculature and left atrial enlargement.

133
Q

What is the name of the cardiac anomaly which describes the persistence of fetal connection between the aorta and pulmonary trunk?

A

Patent ductus arteriosus (PDA)

134
Q

Which vaccine preventable disease is associated with PDA?

A

Rubella

135
Q

When examining a patient, you hear a machinery type systolic murmur. What cardiac anomaly does this fit with?

A

PDA

136
Q

A 5 year female has a wide, fixed split S2 and grade III systolic ejection murmur on physical exam. What cardiac anomaly does this fit with?

A

Atrial Septal Defect (ASD)

137
Q

What is the most common cyanotic cardiac lesion?

A

Tetralogy of Fallot

138
Q

What are the four components of Tetralogy of Fallot?

A

1) Pulmonary stenosis
2) Right ventricular hypertrophy (RVH)
3) Aorta overrides membranous interventricular septum (aorta overriding VSD) 4) Interventricular septal defect (VSD)

139
Q

What is the relationship of loudness to the severity of the pulmonary stenosis present with Tetralogy of Fallot?

A

Inversely related

140
Q

What is the radiographic finding on CXR associated with Tetralogy of Fallot?

A

Boot-shaped heart

141
Q

What is the most common cause of pericarditis?

A

Idiopathic

142
Q

What is the most common identifiable cause of pericarditis?

A

Infection

143
Q

A patient with pericarditis is able to relieve their chest pain through what two positions?

A

Sitting up and leaning forward.

144
Q

What EKG finding is seen in pericarditis?

A

Diffuse ST Elevation

145
Q

What is the most common cardiac manifestation of AIDS?

A

Pericardial Effusion

146
Q

What is the most common cause of cardiac tamponade?

A

Trauma

147
Q

What is Beck’s Triad of Cardiac Tamponade?

A

Hypotension, JVD, and muffled heart sounds
- Additional Information: Hypotension is resistant to fluid resuscitation. - Additional Information: JVD may be absent if hypovolemic
- Additional Information: The classic quartet adds on pulsus paradoxus.

148
Q

What is the most common cause of endocarditis in non IV drug users?

A

Strep viridins

149
Q

What valve is most commonly affected in endocarditis of non IV drug users?

A

Mitral valve

150
Q

What are four important physical exam components to remember are associated with endocarditis?

A

Janeway lesions, Osler’s nodes, Roth spots, Splinter hemorrhages
- Additional Information: Infective endocarditis utilizes the Duke Criteria

151
Q

What imaging study is used to diagnose endocarditis?

A

TEE (transesophageal echocardiogram)

152
Q

What are the major criteria of Acute Rheumatic Fever?

A

JONES criteria
- Joints – polyarthritis
- O = <3 – carditis
- Nodules – subcutaneous nodules
- Erythema marginatum
- Sydenham chorea

153
Q

Which valve is primarily affected in rheumatic heart disease?

A

Mitral valve

154
Q

Which murmur radiates to the carotid arteries?

A

Aortic stenosis

155
Q

What is the most common valvular disease in pregnancy?

A

Mitral stenosis

156
Q

Are mitral or tricuspid stenosis systolic or diastolic murmurs?

A

Diastolic

157
Q

Which lab test is more specific for myocardial infarction: myoglobin or troponin?

A

Troponin

158
Q

What lab rises in congestive heart failure?

A

Brain Natriuretic Peptide (BNP)

159
Q

What is the definitive diagnostic test for coronary artery disease?

A

Cardiac catheterization

160
Q

A patient is determined to be bradycardic and hypotensive. What medication is given in an emergency situation to help increase AV conduction?

A

Atropine
- Additional Information: Atropine is an anticholinergic drug. It therefore inhibits action of acetylcholine at parasympathetic sites and increases cardiac output.
- Additional Information: If atropine is not effective, epinephrine or dopamine can be infused.

161
Q

A patient is determined to be tachycardic and hypotensive. What is the next necessary step?

A

Synchronized cardioversion

162
Q

What are the only two “shockable” rhythms?

A

Pulseless ventricular tachycardia and ventricular fibrillation.

163
Q

A patient is tachycardic, hypotensive, and has a wide QRS. What medication is given in an effort to block the SA/AV nodes?

A

Amiodarone
- Additional Information: Amiodarone is a class III antiarrhythmic (K+ channel blockers)
- Additional Information: If the QRS is NOT wide, adenosine (causes transient heart block in AV node), beta blockers, or calcium channel blockers are used.

164
Q
A

Cardiology (15 decks)

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