Cardio - Exam Review

Question 1

________ angina is a contraindication to stress testing.

Answer 1

Unstable angina is a contraindication to stress testing.

Question 2

Name two ways a non-STEMI might present.

Answer 2

1. ST depressions
2. T wave inversions

Question 3

Printzmetal angina vasospasms usually happen at night and/or early morning and are associated with what EKG changes?

Answer 3

Transient ST elevation

Question 4

The mechanism of action of tyramine is that it is taken up into the neuron by _______, where it then causes catecholamine release.

Answer 4

The mechanism of action of tyramine is that it is taken up into the neuron by NET, where it then causes catecholamine release.

Question 5

What substance stops tyramine from having its effect?

What substance exacerbates tyramine’s effect?

Answer 5

Cocaine

MAO inhibitors

Question 6

Will grapefruit intake increase or decrease patient statin levels?

Answer 6

Increase

(Cyp 34A is blocked)

Question 7

An EKG shows ST elevations in leads II, III, and aVF. This indicates an infarction in which vessel?

Answer 7

The RCA

Question 8

An EKG shows ST elevations involving some of leads V₁ - V₆ and I and aVL. This indicates an infarction in which vessel?

Answer 8

The LCA

Question 9

ST elevation of which leads would indicate an infarction of the RCA?

Answer 9

II, III, and aVF

Question 10

ST elevation in some of which leads would indicate an infarction of the LCA?

Answer 10

V₁ - V₆

I, aVL

Question 11

Post-MI AV block indicates an infarction of which vessel?

Answer 11

The RCA

(or a branch)

Question 12

Post-MI left bundle branch block indicates an infarction of which vessel?

Answer 12

The LCA

(or a branch)

Question 13

Post-MI right bundle branch block indicates an infarction of which vessel?

Answer 13

The LCA

(or a branch)

Question 14

A newly appeared left bundle branch block should be treated as if it was what?

Answer 14

A STEMI

Question 15

______ bundle branch blocks lead to widened S₂ splitting.

______ bundle branch blocks lead to paradoxical S₂​ splitting.

Answer 15

Right bundle branch blocks lead to widened S₂ splitting.

Left bundle branch blocks lead to paradoxical S₂​ splitting.

Question 16

Automatic Implantable Cardioverter Defibrillators (AICD) are indicated in what patient population?

Answer 16

Those at high risk of sustained ventricular tachycardia or fibrillation

Question 17

What four medications/types are typically given post-MI?

Answer 17

1. Statin
2. Aspirin
3. ACE inhibitor
4. Beta blocker

(Drive away broken-hearted in your Saab)

Question 18

The patient’s previous echo was normal. Now, three days after a STEMI, the echo showed hypokinesia of the inferior wall with severe mitral regurgitation. Which vessel was occluded?

Answer 18

The RCA

(supplies the inferior heart and a papillary muscle)

Question 19

True/False

Some mutations in cardiac proteins (e.g. desmin, titin) can lead to dilated cardiomyopathies.

Answer 19

True.

Question 20

Heart sounds:

Pitch is a function of ________.

Intensity (loudness) is a function of ________.

Answer 20

Heart sounds:

Pitch is a function of velocity.

Intensity (loudness) is a function of flow volume.

Question 21

Given flow velocity, how is the aortic gradient (or pulmonary artery pressure) calculated?

(E.g. if the flow across the aortic valve is 5 m/s?)

Answer 21

P = 4 (velocity)²

(P = 4(5m/s)² = 100 mmHg)

Question 22

An aortic gradient of ≥ ____ mmHg means that the valve area is significantly narrowed and the patient is likely to have at least exertional symptoms.

Answer 22

An aortic gradient of ≥ 40 mmHg means that the valve area is significantly narrowed and the patient is likely to have at least exertional symptoms.

P = 4(velocity)²

Question 23

True/False.

Infants with tetralogy of Fallot usually do not present with cyanosis at birth.

Answer 23

True.

Question 24

Which valvular defect is associated with coarctation of the aorta?

Answer 24

Bicuspid aortic valve

Question 25

Name two medications that can cause a lupus-like pericardial effusion.

Answer 25

**Procainamide**; **hydralazine** (also, isoniazid, methyldopa)

Question 26

Transplants are associated with both post-transplant vasculopathies and also post-transplant malignancies (especially \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_).

Answer 26

Transplants are associated with both post-transplant vasculopathies and also post-transplant malignancies (especially **_squamous cell carcinoma_**).

Question 27

Hypocalcemia is associated with what EKG change?

Answer 27

Shortened QT interval

Question 28

S1 occurs during what part of the EKG?

Answer 28

The QRS complex

Question 29

S2 occurs during what part of the EKG?

Answer 29

Just after the T wave

Question 30

Which EKG leads can be used to determine the heart's axis quadrant?

Answer 30

**I** and **aVF**

Question 31

**Normal** axis quadrant: QRS in lead I --- \_\_\_\_\_\_\_\_\_ QRS in lead aVF --- \_\_\_\_\_\_\_\_\_

Answer 31

**Normal** axis quadrant: QRS in lead I --- **_Upright_** QRS in lead aVF --- **_Upright_**

Question 32

**Leftward** axis quadrant: QRS in lead I --- \_\_\_\_\_\_\_\_\_ QRS in lead aVF --- \_\_\_\_\_\_\_\_\_

Answer 32

**Leftward** axis quadrant: QRS in lead I --- **_Upright_** QRS in lead aVF --- **_Inverted_**

Question 33

**Rightward** axis quadrant: QRS in lead I --- \_\_\_\_\_\_\_\_\_ QRS in lead aVF --- \_\_\_\_\_\_\_\_\_

Answer 33

**Rightward** axis quadrant: QRS in lead I --- **_Inverted_** QRS in lead aVF --- **_Upright_**

Question 34

\_\_\_\_\_\_\_\_\_\_\_ axis quadrant: QRS in lead I --- **Upright** QRS in lead aVF --- **Upright**

Answer 34

**_Normal_** axis quadrant: QRS in lead I --- **Upright** QRS in lead aVF --- **Upright**

Question 35

\_\_\_\_\_\_\_\_\_ axis quadrant: QRS in lead I --- **Upright** QRS in lead aVF --- **Inverted**

Answer 35

**_Leftward_** axis quadrant: QRS in lead I --- **Upright** QRS in lead aVF --- **Inverted**

Question 36

\_\_\_\_\_\_\_\_\_ axis quadrant: QRS in lead I --- **Inverted** QRS in lead aVF --- **Upright**

Answer 36

**_Rightward_** axis quadrant: QRS in lead I --- **Inverted** QRS in lead aVF --- **Upright**

Question 37

What ST and PR effects are seen on EKG in patients with acute pericarditis?

Answer 37

Diffuse, concave ST elevation; PR depression

Question 38

Giant cell myocarditis is a rare __________ (etiology) disorder.

Answer 38

Giant cell myocarditis is a rare **_autoimmune_** disorder.

Question 39

What disorder is characterized by a buildup of atherosclerotic plaque in the distal aorta and the iliac arteries?

Answer 39

**Leriche syndrome** (also known as aortoiliac occlusive disease)

Question 40

Mitral valve prolapse has a _________ duration of murmur with handgrip.

Answer 40

Mitral valve prolapse has a **_shorter_** duration of murmur with handgrip.

Question 41

What effect does handgrip have on the murmur of mitral regurgitation?

Answer 41

Increased intensity

Question 42

What disorder did Teegan (from elementary school) have?

Answer 42

**Noonan syndrome** (scoliosis, short height, facial abnormalities, triangular shaped head, bleeding issues, cardiac defects)

Question 43

What type of material would be preferable for a young patient in need of cardiac valvular replacement?

Answer 43

Mechanical

Question 44

What type of material would be preferable for a patient in need of cardiac valvular replacement if the patient already needs to be on anticoagulation?

Answer 44

Mechanical

Question 45

What type of material would be preferable for an older patient in need of cardiac valvular replacement?

Answer 45

**Tissue** | (porcine or pericardial)

Question 46

What type of material would be preferable for a patient in need of cardiac valvular replacement if the patient cannot tolerate anticoagulation therapy?

Answer 46

**Tissue** | (porcine, pericardial)

Question 47

Are there any options for patients that need a valve replaced but are too sick to undergo traditional aortic valve replacement surgery?

Answer 47

**Yes**; transcatheter aortic valve replacement (**TAVR**)

Question 48

What is heart failure classification A according to the AHA?

Answer 48

**High-risk patient** (without structural defects or symptoms)

Question 49

What is heart failure classification B according to the AHA?

Answer 49

Structural disease without symptoms

Question 50

What is heart failure classification C according to the AHA?

Answer 50

Structural heart disease **with** **symptoms** (prior or current)

Question 51

What is heart failure classification D according to the AHA?

Answer 51

**Refractory** to treatment (requiring more specialized interventions)

Question 52

What is heart failure classification I according to the NYHA?

Answer 52

**Asymptomatic**

Question 53

What is heart failure classification II according to the NYHA?

Answer 53

**Symptomatic** with exertion

Question 54

What is heart failure classification III according to the NYHA?

Answer 54

**Symptomatic** with minimal exertion

Question 55

What is heart failure classification IV according to the NYHA?

Answer 55

**Symptomatic** at rest

Question 56

Which NHYA classes of heart failure are used to refer to an asymptomatic patient?

Answer 56

Class I _only_

Question 57

Which NHYA classes of heart failure are used to refer to a symptomatic patient?

Answer 57

Class II, III, and IV (on exertion, on minimal exertion, and at rest)