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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
What are the causes of Generalized Edema?
- Increased hydrostatic pressure/fluid overload - Decreased oncotic pressure/Hypoalbuminemia - Increased interstitial oncotic pressure - Increased capillary permeability - Hormonal
26
What causes increased hydrostatic pressure/fluid overload?
- Heart Failure - Pregnancy - Drugs (i.e., CCBs) - Iatrogenic (i.e., IV Fluids)
27
What causes decreased oncotic pressure/hypoalbuminemia?
- Liver cirrhosis - Nephrotic syndrome - Malnutrition
28
What causes increased capillary permeability?
Sepsis
29
What are the hormonal causes of Generalized Edema?
- Hypothyroidism - Exogenous steroids - Pregnancy - Estrogens
30
What can cause palpitations?
- Conditions causing sinus tachycardia - Conditions causing pathologic tachycardia
31
What can cause sinus tachycardia?
- Endocrine (Thyrotoxicosis, Pheochromocytoma, Hypoglycemia) - Systemic (Anemia, Fever) - Drugs (Stimulants, Anticholinergic) - Psychiatric (Panic attacks)
32
What can cause pathologic tachycardia?
- SVT - Re-entrant SVT - Ventricular Tachycardia
33
What are the cardiovascular causes of Dyspnea?
Elevated pulmonary venous pressure
34
What can cause elevated pulmonary venous pressure?
- 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
What are the respiratory causes of dyspnea?
- Airway disease - Parenchymal Lung disease - Pulmonary Vascular disease - Pleural Disease
36
What are airway disease that can cause dyspnea?
- Asthma - COPD Exacerbation - Upper airway obstruction - Anaphylaxis - Foreign Body - Mucus plugging
37
What is a parenchymal Lung disease that can cause dyspnea?
- ARDS - Pneumonia - Interstitial lung disease
38
What are examples of pulmonary vascular diseases that can cause dyspnea?
- PE - Pulmonary HTN - Pulmonary Vasculitis
39
What are examples of pleural diseases that can cause dyspnea?
- Pneumothorax - Pleural Effusion
40
What are neuromuscular and chest wall disorders that can cause Dyspnea?
C-spine injury - Polymyositis - Myasthenia gravis - Guillain-Barre Syndrome - Kyphoscoliosis
41
What are some psychological causes of dyspnea?
Anxiety/Psychosomatic
42
What are examples of hematological/metabolic causes of dyspnea?
- Anemia - Acidosis - Hypercapnia
43
What are examples of Drugs/Poisons that can cause dyspnea?
- CNS Depressants - Carbon monoxide Poisoning
44
What are the indications for ECG?
- 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
What is the approach to ECG?
- Rate - Rhythm (equal RR or PP intervals) - Axis - Conduction abnormalities - Hypertrophy/Chamber enlargement - Ischemia/Infarction - Miscellaneous ECG Changes
46
What is the normal heart rate?
60 to 100 bpm
47
What is the QRS duration for bundle branch blocks?
- QRS Duration >120 msec
48
What does the P wave represent?
Atrial Contraction (best seen in leads II and V1)
49
How does Atrial flutter appear on ECG?
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
What happens to the P wave in Atrial fibrillation?
absent P wave may have a fibrillatory wave, irregular rhythm
51
What is the management of Atrial Fibrillation?
Major Objectives (RACE) - Rate Contol - Anticoagulation - Cardioversion - Etiology
52
How can you rate control in Atrial Fibrillation?
- 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
How can you anticoagulant patients with Atrial Fibrillation?
- Warfarin - Novel Oral Anticoagulant (i.e., NOACs) - I.e., Apixaban, Dabigatran, Rivaroxaban, Edoxaban
54
What is recommended for patients with non-valvular AF (NVAF)?
- Oral Anticoagulant (OAC) (For those >65 or CHADs > o = 1)

Toronto Notes (2 decks)

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