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Toronto Notes > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What vessels branch off the Right Coronary Artery (RCA)?

A
  • acute marginal branches
  • atrioventricular (AV) nodal artery
  • posterior descending artery (PDA)
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2
Q

What vessels branch off the Left Main Coronary Artery (LCA)?

A
  • left anterior descending artery (LAD)
  • left circumflex artery (LCx)
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3
Q

What is right-dominant circulation?

A

PDA and at least one posterolateral branch arise from RCA (80%)

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4
Q

What is left-dominant circulation?

A

PDA and at least one posterolateral branch arise from LCx (15%)

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5
Q

What artery supplies the SA Node?

A

SA nodal artery

which may arise from the RCA (60%) or LCA (40%)

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6
Q

How does venous blood return from the coronary system?

A

drains into the RA through the coronary sinus

small amount drains through Thebesian veins into all four chambers
- contributing to the physiologic R-L shunt

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7
Q

Where do Sympathetic nerves innervate the heart?

A
  • Innervate the SA node
  • AV node
  • Ventricular myocardium
  • Vasculature
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8
Q

What does increased SA node activity lead to?

A

increased heart rate via more frequent impulses from pacemaking cells

(increased chronotropy - increased HR)

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9
Q

Stimulation of B1- and B2-receptors in skeletal and coronary circulation cause what?

A

Vasodilation

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10
Q

Where do Parasympathetic nerves innervate?

A
  • SA node
  • AV node
  • Atrial myocardium
  • BUT few vascular beds
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11
Q

What impact does parasympathetic have on peripheral resistance?

A

Very little impact on total peripheral vascular resistance

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12
Q

What are the Cardiac Origins of Chest Pain?

A

MI
Angina
Myocarditis
Pericarditis/Dressler’s Syndrome

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13
Q

What are the Pulmonary causes of Chest Pain?

A

PE
Pneumothorax/Hemothorax
Tension pneumothorax
Pneumonia
Empyema
Pulmonary Neoplasm
Bronchiectasis
Pleuritis
TB

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14
Q

What are the GI causes of Chest Pain?

A

Esophageal:
- GERD
- Esophageal rupture
- Spasm
- Esophagitis
- Ulceration
- Achalasia
- Neoplasm
- Mallory-Weiss Syndrome

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15
Q

What are the Mediastinal causes of Chest Pain?

A
  • Lymphoma
  • Thymoma
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16
Q

What are the vascular causes of chest pain?

A
  • Dissecting Aortic aneurysm
  • Aortic rupture
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17
Q

What are other causes of chest pain?

A

Costochondritis
Rib fracture
Skin (bruising, herpes zoster)
anxiety/psychomotor

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18
Q

What is True Syncope?

A

Impaired Cerebral Perfusion

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19
Q

What are some causes of True Syncope?

A
  • Inadequate circulating volume (bleeding, hypovolemia with orthostasis)
  • Obstruction
  • Sudden Loss of cardiac output
  • Reflex mediated/Reflex dysfunction
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20
Q

What can obstruct blood flow and cause true syncope?

A
  • Tamponade
  • PE
  • Severe Pulmonary Hypertension
  • Severe obstructive valve disease (Mitral and Aortic Stenosis)
  • Left ventricular outflow obstruction (HCM)
  • Cerebrovascular events (i.e., CVA, TIA)
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21
Q

What can cause sudden loss of cardiac output and lead to true syncope?

A
  • Tachyarrhythmia
  • Ventricular tachycardia
  • Ventricular Fibrillation
  • Severe Bradycardia (AV Block/AV Dyssynchrony)
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22
Q

What are reflex-mediated causes of True Syncope?

A
  • Vasovagal (Most common)
  • Situational (Micturition, cough, carotid hypersensitivity)
  • Autonomic dysfunction (associated with Neurologic diseases)
23
Q

What are some causes of loss of consciousness not due to impaired cerebral perfusion?

A
  • Seizure
  • Hypoglycemia
  • Severe hypoxia or hypercarbia
  • Psychiatric
  • Adverse Drug Events (i.e., Anti-hypertensives)
24
Q

What can cause local Edema?

A
  • Venous or lymphatic obstruction
  • Inflammation/Infection
  • Trauma
25
Q

What are the causes of Generalized Edema?

A
  • Increased hydrostatic pressure/fluid overload
  • Decreased oncotic pressure/Hypoalbuminemia
  • Increased interstitial oncotic pressure
  • Increased capillary permeability
  • Hormonal
26
Q

What causes increased hydrostatic pressure/fluid overload?

A
  • Heart Failure
  • Pregnancy
  • Drugs (i.e., CCBs)
  • Iatrogenic (i.e., IV Fluids)
27
Q

What causes decreased oncotic pressure/hypoalbuminemia?

A
  • Liver cirrhosis
  • Nephrotic syndrome
  • Malnutrition
28
Q

What causes increased capillary permeability?

A

Sepsis

29
Q

What are the hormonal causes of Generalized Edema?

A
  • Hypothyroidism
  • Exogenous steroids
  • Pregnancy
  • Estrogens
30
Q

What can cause palpitations?

A
  • Conditions causing sinus tachycardia
  • Conditions causing pathologic tachycardia
31
Q

What can cause sinus tachycardia?

A
  • Endocrine (Thyrotoxicosis, Pheochromocytoma, Hypoglycemia)
  • Systemic (Anemia, Fever)
  • Drugs (Stimulants, Anticholinergic)
  • Psychiatric (Panic attacks)
32
Q

What can cause pathologic tachycardia?

A
  • SVT
  • Re-entrant SVT
  • Ventricular Tachycardia
33
Q

What are the cardiovascular causes of Dyspnea?

A

Elevated pulmonary venous pressure

34
Q

What can cause elevated pulmonary venous pressure?

A
  • Acute MI
  • CHF/LV Failure
  • Aortic/Mitral Stenosis
  • Aortic/Mitral Regurgitation
  • Arrhythmia
  • Cardiac Tamponade
  • Constrictive Pericarditis
  • Left-sided obstructive lesions (i.e., Left Atrial Myxoma - non-cancerous connective tissue tumor)
35
Q

What are the respiratory causes of dyspnea?

A
  • Airway disease
  • Parenchymal Lung disease
  • Pulmonary Vascular disease
  • Pleural Disease
36
Q

What are airway disease that can cause dyspnea?

A
  • Asthma
  • COPD Exacerbation
  • Upper airway obstruction
    • Anaphylaxis
    • Foreign Body
    • Mucus plugging
37
Q

What is a parenchymal Lung disease that can cause dyspnea?

A
  • ARDS
  • Pneumonia
  • Interstitial lung disease
38
Q

What are examples of pulmonary vascular diseases that can cause dyspnea?

A
  • PE
  • Pulmonary HTN
  • Pulmonary Vasculitis
39
Q

What are examples of pleural diseases that can cause dyspnea?

A
  • Pneumothorax
  • Pleural Effusion
40
Q

What are neuromuscular and chest wall disorders that can cause Dyspnea?

A

C-spine injury
- Polymyositis
- Myasthenia gravis
- Guillain-Barre Syndrome
- Kyphoscoliosis

41
Q

What are some psychological causes of dyspnea?

A

Anxiety/Psychosomatic

42
Q

What are examples of hematological/metabolic causes of dyspnea?

A
  • Anemia
  • Acidosis
  • Hypercapnia
43
Q

What are examples of Drugs/Poisons that can cause dyspnea?

A
  • CNS Depressants
  • Carbon monoxide Poisoning
44
Q

What are the indications for ECG?

A
  • Detect myocardial injury, ischemia and prior infarction
  • Conditions associated with palpitations or risk of serious arrhythmias
  • Recording cardiac rhythm during symptoms or antiarrhythmic drug monitoring
  • Conduction abnormalities (i.e., LBBB)
  • Electrolyte abnormalities (i.e., hyperkalemia/hypokalemia)
  • Assessment of cardiac structure and function (i.e., RVH, cardiomyopathy)
  • Non-sustained arrhythmias that can lead to prophylactic intervention
45
Q

What is the approach to ECG?

A
  • Rate
  • Rhythm (equal RR or PP intervals)
  • Axis
  • Conduction abnormalities
  • Hypertrophy/Chamber enlargement
  • Ischemia/Infarction
  • Miscellaneous ECG Changes
46
Q

What is the normal heart rate?

A

60 to 100 bpm

47
Q

What is the QRS duration for bundle branch blocks?

A
  • QRS Duration >120 msec
48
Q

What does the P wave represent?

A

Atrial Contraction (best seen in leads II and V1)

49
Q

How does Atrial flutter appear on ECG?

A

sawtooth P wave with continuous atrial activity at 300/min indicates the interval

(Hint: Flip the ECG upside-down to see it better if unclear)

50
Q

What happens to the P wave in Atrial fibrillation?

A

absent P wave may have a fibrillatory wave, irregular rhythm

51
Q

What is the management of Atrial Fibrillation?

A

Major Objectives (RACE)
- Rate Contol
- Anticoagulation
- Cardioversion
- Etiology

52
Q

How can you rate control in Atrial Fibrillation?

A
  • B-blocker
  • Diltiazem
  • Verapamil (In patient with HF: Digoxin, Amiodarone)

Digoxin can be considered as a therapeutic option to achieve rate control when b-blocker and/or Calcium channel blockers is inadequate, contraindicated or not tolerated

53
Q

How can you anticoagulant patients with Atrial Fibrillation?

A
  • Warfarin
  • Novel Oral Anticoagulant (i.e., NOACs)
    • I.e., Apixaban, Dabigatran, Rivaroxaban, Edoxaban
54
Q

What is recommended for patients with non-valvular AF (NVAF)?

A
  • Oral Anticoagulant (OAC)

(For those >65 or CHADs > o = 1)

Toronto Notes (2 decks)

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