Cardiology Flashcards
1
Q
What does bulbus cordis ake?
A
Smooth part of left and right ventricles
2
Q
What does primitive pulmonary vein make?
A
Smooth part of left atrium
3
Q
What does left horn of sinus venosus make?
A
Coronary sinus
4
Q
What does right horn of sinus venosus make?
A
Smooth part of right atrium
5
Q
What does acidosis do to contractility?
A
Decreases it because you want circulation to go slower so you have more time for gas exchange
6
Q
Why do you hear S4?
A
Because during the atrial kick, the atria must push blood into stiff left ventricle
7
Q
What is the a wave of JVP?
A
Atrial contraction
8
Q
What is the c wave of JVP?
A
RV contraction (closed tricuspid bulges into atrium)
9
Q
What is the x descent of JVP?
A
Atrial relaxation and downward displacement of closed tricuspid valve during ventricular contraction
10
Q
In what situation would you see absent x descent of JVP?
A
Tricuspid regurg
11
Q
What is the v wave of JVP?
A
Increased right atrial pressure due to filling against closed valve
12
Q
What is the y wave of JVP?
A
Passive blood flow from RA to RV
13
Q
Which murmur do you see radiation to carotids?
A
Aortic stenosis
14
Q
Which murmur do you see pulsus parvus et tardus (weak pulses and delayed)?
A
Aortic stenosis
15
Q
Which murmur specifically increases on handgrip?
A
VSD (low-pitch holosystolic murmur)
16
Q
Which murmur does MVP predispose?
A
Mitral regurgitation
17
Q
What decreases the intensity of aortic regurgitation murmur?
A
Vasodilators
18
Q
What is the diagnosis? Thickened leaflets, fibrous bridging and calcifications.
A
Rheumatic Heart Disease
19
Q
What is the diagnosis? Large vegetations, leaflet perforation.
A
Infective Endocarditis
20
Q
What is the speed of conduction slowest at AV node?
A
To allow for ventircular filling
21
Q
Decrease in which ions predispose to torsades?
A
K, Mg (Treat with magnesium sulfate)
22
Q
What is the inheritance pattern of Romano Ward Syndrome?
A
AD
23
Q
What is the inheritance pattern of Jervell and Lange-Nielson Syndrome?
A
AR
24
Q
What are the precipitating factors for atrial fibrillation?
A
Binge alcohol, cardiac sympathetic tone, pericardiits
25
Which of the AV blocks are symptomatic?
Mobitz Type II and 3rd Degree
26
Which AV block does Lyme Disease cause?
3rd Degree AV block
27
What is the recombinant form of BNP?
Nesiritide
28
What is the Cushing triad?
Hypertension, bardycardia, and respiratory depression
29
Which organ has largest arteriovenous O2 difference?
Heart
30
What is the major factor for determining autoregulation in skin?
Sympathetic stimulation - temperature control
31
Which way does the heart shunt blood normally in septal defects?
Left to right
32
What does adult type coarctation increase the risk for?
Ruptured intracranial aneurysms because of increased incidence of berry aneurysm
33
What are the risk factors for PDA?
Birth at high altitude (low O2 tension), mternal rubella infection, premature birth
34
Where is atherosclerosis most likely to develop?
Abdominal aorta then coronary artery
35
What is corneal steal syndrome?
Giving vasodilators (adenosine, dipyradimole) sends blood to normal vessels that have now dilated rather than the poststenotic region
36
What is Loefller Syndrome?
Endomyocardial fibrosis with a prominent eosinophilic infiltrate
37
What are painless, small erythematous lesions on palms and soles?
Janeway lesions
38
What are tender raised lesions on finger or toe pads?
Osler nodes
39
Who gets subacute infective endocardiis?
Previously diseased or congenitally abnormal valves
40
What causes nonbacterial endocarditis?
Malignancy, hypercoagulable, or lupus
41
What do people with rheumatic heart disease die from?
Myocarditis
42
What are granuloma with giant cells?
Aschoff bodies
43
What are enlarged macrophages with ovoid, wavy, rod-like nucleus?
Anitschkow cells
44
What is the triad for cardiac tamponade?
Hypotension, distended neck veins, and distant heart sounds
45
What do you see on EKG for cardiac tamponade?
Low voltage QRS and electrical alternans
46
What causes a "tree bark" appearance of the aorta?
Syphilitic heart disease?
47
What do you see pulsus paradoxus with?
Asthma, OSA, pericarditis, cardiac tamponade, croup
48
What looks like scattered cells within mucopolysaccharide stroma?
Myxoma
49
What is a glomus tumor?
Benign, painful, red-blue tumor under fingernails
50
What do glomus cells do?
Thermoregulate
51
Which tumor do women get post radical mastectomy?
Lymphangiosarcoma (lymphatic malignancy associated with persistent lymphedema)
52
What is a rare blood vessel malignancy see in head, neck, and breast areas usually in elderly on sun exposed areas?
Angiosarcoma
53
What cardiac drug causes hyperprolactinemia?
CCB
54
What is Fenoldopam?
D1 agonist that causes vaodilation --> decreases BP and increases natriuresis
55
What decreases cholesterol absorption at small intestine brush border?
Ezetimibe
56
How do fibrates work?
Upregulate LPL (Increased TG clearance); activate PPAR-alpha (increases HDL)
57
How does digoxin slow HR?
Activates vagus nerve
58
What drugs decreases digoxin clearance?
Verapamil, Amiodarone, and Quinidine
59
What does digoxin do to the QT segment?
Decreases it
60
What causes increased toxicity for all class I drugs?
Hyperkalemia
61
Which of the Class I drugs is for ischemic or depolarized purkinje/ventricular tissue?
Class IB; used especially most MI
62
Which Class I drug significantly increases refractory period?
Class IC
63
Which drug do you use for digitalis induced arrhythmias?
Class IB
64
What side effect does metoprolol cause?
Dyslipidemia
65
What side effects do you see with beta blockers?
Impotence, COPD/asthma exacerbation, CV effects (AV block, bradycardia, decompensated CHF), CNS (sedation, sleep alterations), masks hypoglycemia
66
What do you use for atrial fibrillation?
CCB or beta blockers
67
What are the side effects of CCBs?
Hypotension, constipation, flushing, edema, AV block, sinus node depression, CJF
68
What is 1st line for supraventricular tachycardia?
Adenosine
69
Which drugs prolong QRS to a greater extent at higher heart rates?
Class 1C
70
Why do you get janeway lesions in bacterial endocarditis?
Due to septic microemboli
71
What are the side effects of statins?
Hepatotoxicity and myositis
72
How would you improve forward flow: regurgitant flow ratio in mitral regurgitation?
Decrease afterload
73
What is ergonivine?
Vasoconstrictors that activates alpha and serotonin receptors; worsens spasms/chest pain/ST elevation in patients with existing spasms (such as prinzmetal)
74
What looks like a pedunculated mass with scattered cells with mucopolysaccharide stroma?
Myxoma
75
What determines the severity of mitral stenosis?
A2-OS time interval (decreased interval means greater stenosis since left atrial pressure rises closer to aortic)
76
What is the diagnosis? Renal fialure, toe gangrene, livedo reticularis after invasive vascular procedure.
Thromebolic disease (will see choelsterol crystals/emboli obstructing renal arteries)
77
What are the major side effects of Verapamil?
AV block, constipation, flushing, edema, CHF, SA depression
78
What is livedo reticularis?
Purple lace like discoloration due to obstruction
79
What are the side effects of digoxin?
Bradycardia, hyperkalemia, decreased QT, increased PR, blurry yellow vision
80
What do you use for isolated HTN?
Dihydropyridine CCB (amlodipine, nifedipine) and thiazides
81
When do you hear an ASD murmur?
Diastolic
82
When do you hear a VSD murmur?
Holosystolic
83
What does it mean when you see increased left ventricular and atrial diastolic pressures in rheumatic heart disease?
Both aortic and mitral valves are affected
84
What is posterior to the esophagus?
Descending aorta
85
What activates arginine to NO conversion?
Bradykinin, Ach, substance P, serotonin, shear forces
86
What is a normal right ventricular pressure?
25/5
87
What is a normal pulmonary artery pressure?
25/10
88
What is segmental thrombosing vasculitis associated with?
Buerger
89
What are the symptoms of Buerger?
Rayandus, claudication, gangrene, autoamputation, phlebitis, hypersensitivty to intradermal tobacco injection
90
What are the atrial pressures usually?
~10
91
What is the embryological problem with tetralogy of fallot, persistent truncus arteriosus, TGA?
Abnormal neural crest migration to truncus and bulbus cordis
92
What happens 10-14 days after MI
Granulation tissue made of type III collagen (eventually replaced by type 1)
93
Which of the Class I drugs are for ischemic myocardium?
Lidocaine, Mexiletene
94
What is hibernating myocardium?
It is when repetitive ischemia causes reversible but chronic loss of contraction (myocardial stunning is a less severe form)
95
What is ischemic preconditioning?
It is resistance to infarction because of repetitive non lethal ischemia
96
Why do you need nitrate free period?
To avoid tolerance developement
97
What causes hereditary HCM?
Mutation in beta myosin heavy chain
98
What lab value can you test for with large vessel vasculitises?
increased ESR
99
How does nitroglycerin affect preload?
Decreases it because they increase venous capacitance . This reduces myocardial work and oxygen demand which is benficial in agina
100
What are the complications of an MI for the lung?
Acute pulmonary edema, pulmonary venous HTN, transudate of plasma into lung interstitium and alveoli?
101
What plays the biggest role with Valsalva?
Rectus abdominus: its like going to the bathroom
102
What can varicose veins cause?
Skin ulcerations
103
What percentage of the lumen must be narrowed to see symptoms of angina? What about if at rest?
>75%: symptoms of angina
| >95%: symptoms at rest
104
What type of tissue do you se dystrophic calcification on?
Necrotic tissue
105
When do you see dystrophic calcification of aortic valve?
With age (due to damage from hemodyanamic stress over time)
106
How does age affect the aorta?
Causes it stiffen (increased isolated systolic BP)
107
What is the physiology of pulsus paradoxus?
Inspiration --> increased pulmonary vessel capacitance --> more blood storage --> less return to left heart --> dec systolic BP (>10)
108
Why do you see pulsus paradoxus in cardiac tamponade?
There is pressure around heart so septum bulges into left ventricle further decreasing systolic BP
109
What is syphilitic aneurysm?
Obliteration of vaso vasorum, intimal wrinkling and dilation
110
What is there a seropositivity for in polyarteritis nodosa?
HBV
111
What do you use for HTN in pregnancy?
Methyldopa + hydralazine; also labetolol, nifedipine
112
What is the MAP equation?
MAP = CO x TPR (if venous pressure severely increased then do MAP - RAP = CO x TPR)
113
What deposits with Henoch Scohnlein
IgA immune complexes
114
How do you tell lipofuscin from hemosiderin?
Prussian blue stain will show hemosiderin (iron deposits) --> hemochromatosis
115
How does NO cause smooth muscle cell relaxation?
Decreases MLCK so causes dephosphorylation or increases MLCP which also dephosphorylates
116
What is responsible for desynchronization of atria and ventricles?
AV node
117
What helps improve cyanosis in tetralogy?
Squatting (increases afterload so more blood shunted from left to right into pulmonary artery)
118
Where is the filter to prevent PE placed?
IVC
119
What causes thoracic aortic aneurysm?
Cystic medial degeneration from HTN or marfan's or tertiary syphilis (obliterates vaso vasorum)
120
What causes abdominal aneurysm?
Atherosclerosis; seen MC in smoking males >50
121
Where is the least O2 content in the body?
Coronary sinus because it has pure venous blood; pulmonary has mixed
122
What is CAD related sudden cardiac death from?
Ventricular arrhythmias
123
What is the intimal injury response due to?
Smooth muscle cells that migrate to media and intima
124
What receptors does NE act on?
Alpha1, alpha2, beta1
125
What would you see with acute MR vs chronic MR?
Acute MR: acute pulmonary edema since no time for LA compliance to increase
Chronic MR: at risk for atrial fibrillation, thromboemboism
126
How does adenosine slow HR?
Affects phase 4 (it causes K+ efflux so hyperpolarizes which slows depolarization)
127
What TTX from puffer fish inhibit?
Vna
128
What does TEA inhibit?
Vk
129
Why do you see pulmonary HTN in CHF?
Impaired NO and increased endothelin production leading to vasoconstriction
130
What do you see deposition of in infective endocarditis?
Fibrin
131
What happens do cardiac cells during ischemia?
They swell because of increased calcium
132
What is myocyte efflux from cytoplasm caused by?
Na/Ca exchanger and Ca-ATPase (to get Ca into SR)
133
What does lipofuscin look liek?
Brown perinuclear cytoplasmic inclusions
134
What do you see with normal aging of the heart?
Sigmoid ventricular septum and decreased left ventricular chamber size, increased colalgen
135
What happens if you use CCB and beta blockers together?
Decrease HR and hypotension due to slow SA conduction
136
How do macrophages destabilize plaques?
Secreting metalloproteinases that break down collagen
137
What can kawasaki kids develop?
Coronary artery aneurysms, thrombosing
138
Which small vessel vasculitises have necrotizing granulomas?
Wegener's, Churg-strauss
139
What causes mitral valve prolapse?
Myoxmatous degeneration or inherited CT disorders (marfan, ehler's)
140
What is person with T2DM most likely to die from?
Coronary heart disease
141
Where do left ventricular leads in biventricular packemakers go through?
Coronary sinus (in atrioventricular groove on posterior aspect of heart)
142
How early can fatty streaks show up?
10 years old
143
What can you give in a hypovolemic state?
Saline (increases SV and CO)
144
What is a side effect of nitroprusside?
Cyanide toxicity
145
What do you see with pulmonary infarction?
Hemorrhaging due to dual blood supply
146
What can tricuspid endocarditis cause?
Septic emboli leading to pulmonary infarction
147
What do cardinal give rise to?
SVC
148
What does MVP predispose to?
Bacterial endocarditis
149
What is nonbacterial thrombotic endocardiits from?
Hypercoagulable state (marantic from circulating products of cancer)
150
Why do pregnant women get postural hypotension?
Baby compresses on IVC and decreases venous return
151
What could early onset MI due to atherosclerosis be from?
Familial hypercholesterolemai (defective LDL receptor expression) - Type II
152
How do valves look different between infective endocarditis and rheumatic heart disease?
Infective endocarditis: valves more friable and destructive
| Rheumatic heart disease: fibrosed
153
How does hyaline arteriosclerosis stain?
Pink on H&E
154
What is hyaline arteriosclerosis seen with?
Essential HTN and DM; due to excessive ECM production by sMC and plasma stuff leakage across the endothelium
155
Where is there damage if trauma to aorta?
Aortic isthmus because it is tethered by ligamentum arteriosum and is therefore fixed and immovable
156
How to you treat beta blocker overdose?
Glucagon
157
How does carcinoid present?
Hypotension, diarrhea, flushing
158
Which of the nitrates has the greatest bioavailability?
Isosorbide dinitrate
159
What is the MC ASD?
Ostium secundum
160
What is the MC ASD in Down's?
Ostium primum
161
What drug improves long term survival of CHF patients?
Aldosterone antagonists, ACE-Inhibitors because it prevents aldosterone mediated heart remodeling
162
Why are the side effects of hydralazine?
Tachycardia and fluid retention and sodium retention from reflexive B1 activation, lupus like syndrome
163
Which of the class I drugs has greatest Na channel binding strength?
1C > 1A > 1B
164
Which has greatest use dependence and what does that mean?
1C: it is slow to disassociate from Na channel so if heart starts beating faster than their effects intensify since there is less time in between AP to disassociate
165
Which has reverse use dependence?
Class III blockers (as HR slows, they show greater effect)
166
Which drugs cause increased risk for gallstones?
Bile acid resins and fibrates (increase cholesterol in bile)
167
How does nitroprusside work?
Arterial AND venodilator (reduces afterload and preload)
168
How does Digoxin slow HR?
Inhibits vagal tone (slows conduction through AV node and depression of SA node)
169
Which drug has a slow disassociation from the VNa channels and what does this mean?
Class IC and this means use dependence. They are slow to disassociate and so when the channel is activated again from resting they exert their effect.
170
Which drug quickly disassociates from Vna when it is in the resting state?
Class 1B
171
What do hepatocytes increase in response to statins?
LDL receptor density to increase uptake of circulating LDL to make more cholesterol
172
What is the problem that leads to development of Transposition of great vessels?
Failure to septate
173
What is constrictive pericarditis?
Chronic process that takes months-years to create tamponade.
174
How is digoxin cleared?
By the kidneys
175
What are the side effects of nitrates?
Hypotension, flushing, headache, reflex tachycardia
176
What are people with OSA at risk for?
Pulmonary HTN and resulting Right HF
177
To what do you want to prevent irreversible damage to when you fix an ASD?
Pulmonary vessels because they get damaged from HTN
178
What murmur is heard best in the lateral decubitus position?
Mitral stenosis
179
What causes syncope during coughing?
Syncope is due to transient decrease in BF to the brain. Coughing diminishes venous return which can reduce BF to the heart.
180
What antiarrhythmic/antihypertensive drug would cause bilateral interstitial infiltrate?
Amiodarone (remember it causes pulmonary fibrosis)
