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Cardio Review Flashcards

1
Q

Which embryologic structure of the heart gives rise to the ascending aorta and pulmonary trunk?

A

truncus arteriosus

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2
Q

Which embryologic structure of the heart gives rise to the coronary sinus?

A

left horn sinus venosus

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3
Q

Which embryologic structure of the heart gives rise to the SVC?

A

R common cardinal vein and right anterior cardinal vein

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4
Q

Which embryologic structure of the heart gives rise to the smooth parts of the left and right ventricles?

A

bulbus cordis

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5
Q

Which embryologic structure of the heart gives rise to the smooth part of the right atrium?

A

right horn sinus venosus

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6
Q

Which embryologic structure of the heart gives rise to the trabeculated parts of the left and right atria?

A

primitive atria

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7
Q

Which embryologic structure of the heart gives rise to the trabeculated parts of the left and right ventricles?

A

primitive ventricles

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8
Q

Which structure divides the truncus arterioles into the aortic and pulmonary trunk? What is the cellular origin of this structure?

A 
spiral septum (aorticopulmonary septum)
neural crest cell origin
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9
Q

Which fetal vessel has the highest oxygenation?

A

umbilical vein

Highest -> Lowest O2
umbilical vein -> ductus venous -> IVC -> R atrium

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10
Q

What causes the ductus arteriosus to close?

A

infant breathing -> increased oxygenation of the aorta -> increased prostaglandins -> closure of ductus arteriosus

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11
Q

What causes the foramen ovale to close?

A

infant breathing -> decreased pulmonary vascular resistance -> increase LA pressure -> pushes septum premium against septum secundum

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12
Q

What are the components of tetralogy of Fallot?

A
  1. pulmonary outflow obstruction (usually pulmonic stenosis)
  2. RVH
  3. VSD
  4. overriding aorta
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13
Q

Explain how the great vessels are attached in transposition of the great vessels.

A

RV -> aorta; LV -> pulmonary vasculature

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14
Q

A 45 year old man presents with a blood pressure of 160/90 mmHg on the right arm and 170/92 mmHg on the left arm. There are no palpable pulses int he feet or ankles. What problem does this patient most likely have?

A

Coarctation of the aorta

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15
Q

What heart defect is associated with chromosome 22q11 deletion?

A

truncus arteriosus, ToF

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16
Q

What heart defect is associated with Down syndrome?

A

ASD, VSD, AV septal defect

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17
Q

What heart defect is associated with congenital rubella?

A

PDA, pulmonary artery stenosis, septal defects

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18
Q

What heart defect is associated with Turner syndrome?

A

bicuspid aortic valve, coarctation of the aorta

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19
Q

Continuous machine-like murmur

A

PDA

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20
Q

Boot-shaped heart

A

ToF, RVH in adult

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21
Q

Rib notching

A

coarctation of aorta

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22
Q

Most common congenital cardiac anomaly

A

VSD

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23
Q

most common congenital cause of early cyanosis

A

ToF

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24
Q

What is the pulse pressure in a patient with a systolic blood pressure of 150 and a mean arterial pressure (MAP) of 90 mmHg?

A 
MAP = 90
MAP = 2/3 diastolic + 1/3 systolic
90 = 2/3x + 1/3 (150)
x=60
Pulse pressure = 150-60 = 90mmHg
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25
What is the basic equation for cardiac output (CO)? What is the Fick principle?
CO = SV * HR | Fick principle = CO = rate of O2 consumption/ arterial O2 - venous O2
26
How can the myocardial oxygen demand be decreased in circumstances where the heart is ischemic?
decreased after load (decreased SBP) decreased contractility decreased HR decreased preload
27
What can make the stroke volume (SV) increase for a given preload?
increased contractility (sympathetic stimulation) inotropic drugs (catecholamines, digoxin) increased intracellular Ca2+ decreased extracellular Na+ decrease after load (hydralazine, ACEi)
28
What is the cardiac ejection fraction (EF)?
EF = SV/EDV
29
What are the signs of right sided heart failure?
systemic Sx - peripheral edema, increased JVD, hepatosplenomegaly (nutmeg liver)
30
What are the signs of left-sided heart failure?
``` lung Sx - pulmonary edema -> rales orthopnea dyspnea on exertion paroxysmal nocturnal dyspnea dilated cardiomyopathy ```
31
How does poor cardiac output result in an increase in aldosterone?
decreased CO -> decreased BP (detected via JG cells in kidney) -> increased RAAS -> increased aldosterone
32
What medications are used to treat chronic heart failure?
``` Symptomatic Relief - digoxin - diuretics - vasodilators Survival increaseres - ACE inhibitors - ARBs - aldosterone antagonists - certain beta blockers - nitrates plus hydralazine ```
33
What medications are used to treat acute heart failure?
NO LIP Nitrates Oxygen Loop Diuretics Inotropic drugs Positioning
34
What is the MOA of digoxin?
blocks Na+/K+-ATPase at myocyte -> increased intracellular Ca2+ -> increased contractility
35
How does heart failure impact the Starling forces?
increased hydrostatic capillary pressure
36
How does liver failure impact the Starling forces?
decreased oncotic capillary pressure
37
how does oliguric renal failure impact starling forces?
increased hydrostatic capillary pressure (increased fluids)
38
how do infections and toxins impact the starling forces?
increased Kf (increased capillary permeability)
39
how does nephrotic syndrome impact the starling forces?
decreased oncotic pressure of the capillaries
40
how does lymphatic blockage impact starling forces?
increased interstitial oncotic pressure (non-pitting edema)
41
how do burns impact starling forces?
increased Kf
42
How does diuretic administration impact starling forces?
decreased hydrostatic pressure of capillaries
43
How does IV infusion of albumin or clotting factors impact starling forces?
increased oncotic pressure of the capillaries
44
How does venous insufficiency impact starling forces?
increased hydrostatic pressure of capillaries (local edema)
45
How do the vascular resistance and stroke volume change in hypovolemic shock?
decreased stroke volume | increased vascular resistance to compensate
46
How do stroke volume and vascular resistance change in septic shock?
decreased vascular resistance | increased stroke volume to compensate
47
What are some causes of cariogenic shock?
CHF, MI, pneumothorax, PE, arrhythmias, cardiac tamponade, cardiac contusion
48
How is the skin of a patient different in cariogenic shock compared to septic shock?
cariogenic shock - cold, clammy, cyanotic, poorly perfused | septic shock - initially warm/flushed
49
When does isovolumetric contraction take place?
systole (after mitral valve closes but before aortic valve opens)
50
How does an increase in after load affect the stroke volume of the heart assuming contractility remains the same?
increased after load = decreased SV (graph gets taller)
51
What impact does an increase in contractility have on stroke volume assuming preload and after load remain constant?
increased contractility = increased SV (graph sifts left)
52
Which heart sound is associated with dilated CHF? Which heart sound is associated with chronic hypertension?
``` S3 = dilated CHF S4 = chronic HTN ```
53
What gives rise to the jugular venous a, c, and v waves?
JV a = atrial contraction c = ventricle contraction v = atrial filling against a closed tricuspid valve
54
Where does the QRS complex fall in relation to valvular dynamics?
QRS correlates to just before closure of the mitral and tricuspid valves
55
Which murmurs are heard best in the left lateral decubitus position?
Left S3 and left S4 mitral stenosis mitral regurgitation
56
bounding pulses, head bobbing, diastolic murmur
aortic regurgitation
57
crescendo-decrescendo systolic murmur best heard in the 2nd-3rd right interspace close to the sternum
aortic stenosis
58
early diastolic decrescendo murmur heard best along the left sternal border with BP of 160/55
aortic regurgitation
59
late diastolic decrescendo murmur heard best along the lower left sternal border
tricuspid stenosis
60
holosystolic murmur best heard at the apex and often radiates to the left axilla
mitral regurgitation
61
late systolic murmur usually preceded by a mid-systolic click
mitral valve prolapse
62
crescendo-decrescendo systolic murmur best heard in the 2nd-3rd left interspaces close to the sternum
pulmonic stenosis
63
holosystolic murmur best heard along the left lower sternal border
tricuspid regurgitation or VSD
64
rumbling, late diastolic murmur with an opening snap, loudest in the 5th interspace in the midclavicular line
mitral stenosis
65
What is the mechanism of action of each class of antiarrhythmics?
``` Class I (Na+ CB) -> inhibit phase 0 of myocyte Class II (beta blockers) -> decrease cAMP, decreased Ca2+, phase 4 of pacemaker Class III (K+ CB) -> inhibit phase 3 of myocyte Class IV (CCB) -> inhibit phase 0 of pacemaker ```
66
Which anti arrhythmic has the side effect of cinchonism?
Quinidine
67
What are the potential side effects of amiodarone use?
``` pulmonary fibrosis TdP hyper or hypothyroidism hepatotoxicity blue-gray skin discoloration photodermatitis/photosensitivity decreased HR heart block corneal deposits neuro problems constipation ```
68
What is the mechanism of action of adenomas as an anti arrhythmic?
adenosine stops the heart | increases K+ out of cells -> hyper polarizes and decreased Ca2+, decreasing AV node conduction
69
What class of antiarrhythmics does sotalol belong to?
Class III (K+)
70
What class of antiarrhythmics does bretylium belong?
Class III (K+)
71
What class of antiarrhythmics does quinidine belong?
Class IA (Na+)
72
What class of antiarrhythmics does procainamide belong?
Class IA (Na+)
73
What class of antiarrhythmics does Lidocaine belong?
Class IB (Na+)
74
How does the cause of a narrow QRS complex differ from the cause of a wide QRS complex?
Narrow QRS - normal conduction system originating at the top of the heart (sinus beat, ectopic atrial beat, SVT, junctional rhythm) Wide QRS - PVC (premature ventricular contraction), V tach, BBB
75
What is the ECG axis given the QRS deflections of positive lead I and positive lead II?
Normal axis
76
What is the ECG axis given the QRS deflections of positive in lead I, negative in lead III?
LAD
77
What is the ECG axis given the QRS deflections of negative in lead I, positive in lead III?
RAD
78
What is the ECG axis given the QRS deflections of positive in lead I, negative in aVR?
normal axis
79
How does hyperkalemia affect the shape of T waves?
causes peaked T waves
80
What are the most common causes of left axis deviation?
inferior MI, left anterior fascicular block, left ventricular hypertrophy, left BBB
81
What are the most common causes of right axis deviation?
RVH, acute R heart strain (PE), left posterior fascicular block, RBBB
82
What is the treatment for ventricular fibrillation?
defibrillation
83
What are the major characteristics of atrial fibrillation?
no P waves, increased rate, irregularly irregular
84
What is the hallmark of a third degree AV block?
P wave and QRS waves beat separately
85
What drugs are known to prolong the QT interval, increasing the likelihood of TdP in those at risk?
``` Antiarrhythmics (IA, III) Antipsychotics (haloperidol) Antibiotics (macrocodes, chloroquine) Antidepressants (TCAs) Anti-HIV protease inhibitors Methadone ```
86
What are the two different types of second degree AV block? How do they differ?
Type 1 - Wenkebach (gives warning of dropped beat with progressively prolonged PR interval) Type 2 - no warning before dropped beat
87
Why is warfarin anticoagulation important in patients with chronic atrial fibrillation?
prevent clots that patients with a fib are predisposed to
88
What substances act on smooth muscle myosin light-chain kinase? How does this affect BP?
Prostaglandins & ephedrine inhibit MLCK -> relaxation CCB inhibit Ca2+ influx, thus inhibiting MLCK -> relaxation relaxation = decreased BP (vasodilation)
89
Describe the chain of events in which hypotension causes reflex tachycardia?
decreased BP -> decreased PSNS via CN IX and X -> nucleus solitaires -> decrease PSNS and increases SNS -> increase alpha1 stimulation to vasoconstriction -> increase HR via beta1 stimulation
90
What is the blood pressure cutoff for the diagnosis of hypertension?
>/= 140/90 on 3 occasions
91
What would you most suspect the cause of HTN to be in a patient with paroxysms of increased sympathetic tone: anxiety, palpitations, diaphoresis
pheochromocytoma
92
What would you most suspect the cause of HTN to be in a patient with age of onset between 20 and 50?
essential HTN
93
What would you suspect the cause of HTN to be in a patient with abdominal bruit?
renal artery stenosis
94
what would you most suspect the cause of HTN to be in a patient with blood pressure in arms > legs?
coarctation of the aorta
95
what would you most suspect the cause of HTN to be in a patient with a family history of HTN?
essential HTN
96
What would you most suspect the cause of HTN to be in a patient with tachycardia, heat intolerance, diarrhea?
hyperthyroidism
97
what would you most suspect the cause of HTN to be in a patient with hyperkalemia?
renal insufficiency
98
what would you most suspect the cause of HTN to be in a patient with hypokalemia?
hyperaldosteronism (Conn syndrome)/renal artery stenosis
99
What would you most suspect the cause of HTN to be in a patient with central obesity, moon-shaped face, hirsutism?
Cushing syndrome
100
What would you most suspect the cause of HTN to be in a young individual with acute onset tachycardia?
illicit drugs - cocaine, amphetamine
101
What would you most suspect the cause of HTN to be in a patient with proteinuria?
kidney disease
102
What chest X-ray finding is a possible sign for aortic dissection?
widening of mediastinum | also think of: ruptured esophagus, lymphoma
103
Which category of BP medications is preferred in the treatment of aortic dissection?
beta blockers
104
What antihypertensive causes hypertrichosis?
(hair growth) Minoxidil
105
What antihypertensive causes cyanide toxicity?
Nitroprusside
106
What antihypertensive causes reflex tachycardia?
vasodilators (hydralazine, nitrates, dihydropyridines)
107
What antihypertensive causes cough?
ACE inhibitors
108
What antihypertensive causes possible development of a drug-induced lupus
hydralazine
109
What antihypertensive causes possible angioedema?
ACE inhibitors and ARBs
110
Which antihypertensives are particularly beneficial to heart failure patients?
``` ACE inhibitors/ARBs beta blockers (not in acute decompensated HF) aldosterone antagonist ```
111
Which antihypertensives are safe to use in pregnancy?
``` Hypertensive Moms Love Nifedipine Hydralazine Methyldopa Labetalol Nifedipine (and other dihydropyridines) ```
112
Which serum lab markers are commonly used to diagnose an MI?
troponin, CK-MB, CK | Troponin I is the most sensitive and specific
113
Which coronary artery is most commonly occluded in an MI?
LAD
114
What is the most common lethal complication after an MI?
v-fib (1-3 days after)
115
What is the most common complication from an MI days 1-3 after?
arrhythmia
116
What is the most common complication from an MI days 3-14 after?
ventricular wall rupture -> cardiac tamponade papillary muscle rupture ventricular aneurysm
117
Chest pain, pericardial friction rub, and persistent fever occurring several weeks after an MI
Dressler syndrome | pericarditis post MI
118
What wall is perfused by the LAD artery? What ECG leads would show an MI?
Anterior wall; V1-V4, V5
119
What wall is perfused by the left circumflex artery? What ECG leads would show an MI?
Lateral wall; aVL, V5, V6
120
What wall is perfused by the right coronary artery? What ECG leads would show an MI?
Inferior wall; II, III, aVF | AND posterior wall: R precordial ECG: V4
121
What would cause cardiac tamponade following an MI?
ventricular wall rupture
122
What would cause severe mitral regurgitation following an MI?
papillary muscle rupture
123
What would cause a new VSD following an MI?
intraventricular septum rupture
124
What would cause a stroke following an MI?
mural thrombus formation
125
How would you manage a patient presenting with an acute MI?
MONA - supp O2 if pulse ox <90%, nitroglycerin, aspirin Beta blocker - metoprolol or atenolol Statin - atorvastatin Antiplatelet therapy - clopidogrel or ticagrelor Anticoagulant therapy: unfractionated heparin if undergoing PCI; enoxaparin for those not undergoing PCI Potassium and Mg2+ to keep above 4 and 2, respectively STEMI - Cath lab or fibrinolysis NSTEMI - NO fibrinolysis; Cath lab
126
Giant Cell Arteritis
AKA - temporal arteritis elderly females unilateral headache, jaw claudication may lead to irreversible blindness due to ophthalmic artery occlusion associated with polymyalgia rheumatica (pain and stiffness in head, shoulders, hips) muscle wasting of temple enlarged temporal artery tender to palpation increased ESR (screening tool) definitive diagnosis = temporal artery biopsy Tx = high dose corticosteroids (affects large arteries)
127
Takayasu arteritis
mostly teens-20s Asian females "pulseless disease" - weak upper extremity pulses granulomatous thickening and narrowing of the aortic arch and proximal great vessels increased ESR (affects large arteries)
128
Polyarteritis nodosa (PAN)
``` middle-aged men associated with HepB and HepC typically involves renal and visceral vessels BUT SPARES THE LUNGS p-ANCA NEG Tx = corticosteroids, cyclophosphamide (affects medium vessels) ```
129
Kawasaki disease (mucocutaneous lymph node syndrome)
``` asian children <4 yo conjunctival injection, rash, adenopathy, strawberry tongue, hand-foot changes (desquamation), fever (CRASH and burn) may develop coronary artery aneurysms Tx = IV immunoglobulin and aspirin (affects medium vessels) ```
130
Buerger disease (thromboangiitis obliterans)
``` heavy smokers, males <40 yo intermittent claudication may lead to gangrene, autoamputation of digits, superficial nodular phlebitis Raynaud phenomenon often present Tx = smoking cessation (affects medium vessels) ```
131
Granulomatosis with polyangiitis (Wegener)
upper respiratory tract: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis Triad: 1. focal necrotizing vasculitis 2. necrotizing granulomas in the lung and upper airway 3. necrotizing glomerulonephritis saddle nose PR3-ANCA/c-ANCA positive Tx = cyclophosphamide and corticosteroids (affects small vessels)
132
Microscopic polyangiitis
necrotizing vasculitis commonly involving lung, kidneys, and skin with pauci-immune glomerulonephritis and palpable purport No granulomas MPO-ANCA/p-ANCA positive Tx = cyclophosphamide and corticosteroids\ (affects small vessels)
133
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
asthma, sinusitis, skin nodules or purport, peripheral neuropathy (wrist/foot drop) Granulomatous, necrotizing vasculitis with eosinophils MPO-ANCA/p-ANCA positive, increased IgE levels (affects small vessels)
134
Henoch-Schonlein purpura
most common childhood systemic vasculitis often follows URI Triad: 1. skin: palpable purpura on buttocks/legs 2. arthralgias 3. GI: abdominal pain Also: renal disease: IgA nephropathy vasculitis secondary to IgA immune complex deposition self-limiting (affects small vessels)
135
Hereditary hemorrhagic telangiectasia
autosomal dominant findings: telangiectasias (esp in mouth?), recurrent epistaxis, skin discolorations, arteriovenous malformations (AVMs), GI bleeding (can cause iron deficiency anemia), hematuria. AKA Osler-Weber-Rendu syndrome
136
Most common vasculitis
Giant Cell Arteritis
137
Which disorders are commonly discovered in patients with Raynaud phenomenon?
SLE, CREST scleroderma, Thromboangiitis obliterans (Buerger Dz), Mixed connect tissue disease
138
Benign, raised, red lesion about the size of a mole in older patients
cherry hemangioma
139
raised, red area present at birth, increases in size initially then regresses over months to years
strawberry hemangioma
140
lesion caused by lymphoangiogenic growth factors in an HIV patient
Kaposi sarcoma (HHV-8)
141
Polypoid red lesion round in pregnancy or after trauma
pyogenic granuloma
142
benign, painful, red-blue tumor under fingernails
glomus tumor
143
cavernous lymphangioma associated with turner syndrome
cystic hygroma
144
skin papule in AIDS patient caused by Bartonella spp.
Bacillary angiomatosus
145
What organisms cause infective endocarditis?
S. viridians, S. epidermidis, S. aureus (most common), enterococci, S. Bovis HACEK: H. influenza, Actinobacillus, cardiobacterium, eikenlla, kingella Rare: Coxiella, borrelia, brucella
146
What is pulsus paradoxus and what causes it?
drop in systolic BP >10mmHg with inspiration | occurs with hyperinflation of the lungs (asthma, COPD, croup) and cardiac tamponade

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