Cardiology Flashcards
In the cardiac cycle, isovolumetric relaxation is a brief period when volume in ventricle ________ as ventricles ______, pressure ____ and AV valves & semilunar valves are ______
does not change
relax
drops
closed
List the minor criterias for Rheumatic Fever
Fever
Arthralgia (joint pain w/o swelling)
Increased : ESR, CRP
ECG showing heart block (prolonged PR interval)
Describe conduction system of HT
SA Node - cluster of autorhthymic cells in right atrium begins HT activity that spreads to both atria, excitation spreads to AV node
AV node transmits signal to AV bundle of His
AV bundle divides into right & left bundle branches & purkinje fibers
The classic sign of pericarditis is a _________. The classic presentation is ___________. Pericarditis can be misdiagnosed as ____ and vice versa
friction rub
sharp/stabbing chest pain radiating to the back and relieved by sitting up forward and worsened by lying down
myocardial infarction
IHD risk increases according to what factors?
age, smoking, hypercholesterolemia, diabetes, hypertension, family history or IHD
Explain the presence of troponin in blood when there is myocardial infarction
Troponin is released from actin/myosin complex when cardiac muscle dies
Reactive (Dressler’s) pericarditis is due to the following cause:
Auto-immune response to myocardial antigens released after myocardial infarction
Clinical presentations of LHF are _____________
SOB, orthopnea, paroxysmal nocturnal dyspnea, easy fatigue-ability, exercise intolerance
Describe the difference between chest pain that is ischemic in nature vs. pain that is pericardial in nature.
Ischemic pain is a heaving, squeezing pain
Pericardial pain is a stabbing pain, worse in supine position
Buerger’s disease is AKA ___________. It is strongly associated with use of ________
Thromboangiitis Obliterans
tobacco products
List common treatments for Rheumatic Fever
- anti-inflammatory medications such as aspirin or corticosteroids
- antibiotics for patients with positive strep throat culture
T/F AF can produce embolic stroke
True
The most common congenital heart defect is _________. This condition results in ________ due to mixing of oxygenated and deoxygenated blood in the ______ via the ventricular septal defect and through the over-riding aorta. This is known as a _______ shunt
Tetralogy of Fallot
low oxygenated blood
left ventricle
right-to-left
Pulse pressure is calculated as ____?
Difference between the systolic pressure and the diastolic pressure (SP-DP).
Atherosclerosis is commonly promoted by ________
It is characterized by the formation of ______, eventually leading to _______
sustained hypertension, high level of LDL, low level of HDL in blood plasma
multiple plaques within the arteries (atheromas)
ischemia
Myocarditis is __________. It often resembles heart attack except that ______________. It is often caused by _____ reaction, triggered by _________. Left untreated, it has the potential to develop into _________ cardiomyopathy
inflammation of heart muscle (myocardium)
coronary arteries are not blocked
auto-immune
prior recent infection with streptococcus bacteria or Coxsackie virus
dilated
Rheumatic Fever is believed to be caused by _________ and can involve organs/tissues including __________. It is responsible for many cases of damaged _______
antibody cross-reactivity with streptococcal antigens
joints, skin, heart, brain
heart valves
Abnormal blood flow in congenital heart defects such as patent foramen ovale or patent ductus arteriosis start off as a _______ shunt but then reverse after a few decades.
left-to-right
List and describe layers of the heart from exterior to interior
epicardium - visceral layer of serous pericardium
myocardium - cardiac muscle layer
endocardium - chamber lining & valves
List risk factors associated with aneurysm development
diabetes
obesity,
hypertension
tobacco use
alcoholism
copper deficiency
Adult Polycystic Kidney Disease
The phase in the cardiac cycle when the mitral valve is closed and the aortic valve is open is the _______
systolic ejection phase
Define Orthopnea. What cardiovascular disorder does its presence indicate?
shortness of breath in the supine position
Left CHF
Rheumatic Fever (RF) may develop after a ______ infection.
Group A Beta-hemolytic streptococcal infection
In cardiac output, what can influence the Preload?
amount of stretching of cardiac muscle
________hypertension indicates that the high blood pressure is a result of another condition. List the possible causes.
Secondary
1) anatomical cause - coarctation of aorta
2) renal causes - renal artery stenosis, adult polycystic KD disease
3) adrenal causes - Cushing’s syndrome, Cushing’s diease, pheochromocytoma
4) neurogenic / thyroid causes
In the normal cardiac cycle, the End diastolic volume (EDV) is about ___ml while the End systolic volume (ESV) is about ___ ml. The stroke volume is defined as ______
130 ml
60ml
EDV - ESV
T/F AF is most common in the elderly
True
1st degree conduction block shows an extended ____ interval in ECG
P-R
What are risk factors for atherosclerosis?
- males, age, family history, HTN, High total cholesterol, and LDL with low HDL, smoking, diabetes mellitus
List the types of IHD
Stable Angina Pectoris
Unstable Angina Pectoris
Prinzmetal Angina
Myocardial Infarction
Sudden Cardiac Death Syndrome
Describe systemic blood circulation
left ventricle pumps oxygenated blood into aorta
aorta branches into many arteries that travel to organs
arteries branch into arterioles in tissue
arterioles branch into capillaries
deoxygenated blood begins return into venules
venules merge into veins and return to right atrium
How can Rheumetic Fever be prevented?
- long term antibiotic (e.g. long acting penicillin monthly for 5 years)
- in case of carditis, antibiotic treatment for up to 40 years
- screening of school-aged children for sore throat
Describe the difference between Stable and Unstable Angina Pectoris
Stable Angina Pectoris is ischemic chest pain upon exertion of predictable amount for not more than 15-20 minutes. Unstable Angina Pectoris is ischemic chest pain for not more than 15-20 minutes, occuring either with exertion or at rest
What is the difference 1st, 2nd degree conduction block?
Rhythm is still sinus but the propagation is delayed from atria to the ventricles
In cardiac output, what can influence contractility?
autonomic nerves, hormones, CA2+ or K+
Hypertrophic cardiomyopathy is caused by __________ leading to _________
genetic factors
thickening of heart muscle
The three types of cardiomyopathy are ________. Describe the effect each has on preload and cardiac output./stroke volume
dilated cardiomyopathy - increased preload, reduced cardiac output
hypertrophic cardiomyopathy - decreased preload, reduced cardiac output
restrictive cardiomyopathy - decreased preload, reduced cardiac output
The most frequent site of aneurysm is in the __________. Most non-intracraneal aneurysms arise distal to the origin of the renal arteries at the __________ Aneurysms can also occur in the _______aorta and in the deep vessels of the legs, e.g. ______
anterior cerebral artery from the circle of Willis
infrarenal abdominal aorta
thoracic
popliteal vessels
List the 4 Anomalies/Defects of Tetralogy of Fallot
Pulmonary stenosis - in PA
RVH [right ventricular hypertrophy]
VSD [ventricular septal defect]
Overriding Aorta (dextra-position)
Restrictive cardiomyopathy is caused by _________ and leads to __________
depositions of various agents due to inflammatory response
stiffening of ventricle walls
Ischemic pain is often described as _________ while pericardial pain is often described as ____________
heavy, stone-like crashing pain
sharp, stabbing pain radiating to the back and relieved by sitting up forward and worsened by lying down
Describe septic shock
bacterial toxins caused dilation of peripheral arterioles
In an electrocardiogram, the P wave denotes _____ while the QRS complex denotes ________
atrial depolarization
ventricular depolarization
Define pulmonary embolism and where it comes from.
Blood clot that obstructs the pulmonary arteries in the lung. They come from the pulmonary artery.
Pericarditis is _________. It can be classified according to ___________________
inflammation
composition of inflammatory exudate, duration, causative factor
The _______ muscles attach to the atrioventricular valves via the __________ and contract to prevent inversion or prolapse of these valves
papillary
chordae tendineae
(T/F) Atherosclerosis is a form of arteriosclerosis
T
What is the major cause of pulmonary embolism?
List risk factors of pulmonary embolism.
*DVT (deep vein thrombosis)
4 F’s (fat forty female fertile)
Cancer
Prolonged immobility
CHF
MI
Stroke
Fracture of long bone/hip
Major Surgery
Blood disorders - e.g. renal cell carcinoma, polycythemia rubra vera
In the cardiac cycle, ventricular systole is the period when ________
ventricles pump blood into pulmonary trunk / ascending aorta
Endocarditis is an inflammation of _____. The most common structures involved are __________. It is characterized by prototypic lesion aka __________, which is a mass of _________. This mass has the potential to cause ___________
endocardium - inner layer of the heart
the heart valves
the vegetation
platelets, fibrin, microcolonies of microbes, scant inflammatory cells
embolic stroke
An aneurysm is ____________ caused by _________
localized, blood-filled dilation of a blood vessel
disease or weakening of the vessel wall
List general clinical features of shock
hypotension
tachycardia
altered mental status
decreased urinary output
cool, clammy skin
Cardiac output = ______
Stroke volume (SV) * Heart Rate (HR)
Arteriosclerosis is a general term describing ________.
Atherosclerosis is a hardening of an artery due to _________.
any hardening of medium or large arteries
an atheromatous plaque
Cardiac reserve = _____
In the average person, cardiac reserve is _____
In atheletes, cardiac reserve is _______
maximum output / output at rest
4-5
7-8
Cardiomyopathy is very commonly accompanied by what condition? As a result, it may lead to what other conditions?
arterial hypertension
end-stage CHF, sudden cardiac arrest
List and define influences on Stroke Volume
Preload - affect of stretching
Contractility - force of contraction
Afterload - amount of pressure created by blood resisting flow
In cardiac output, what can influence afterload?
arterial blood pressure in diastole
Peripheral vascular resistance
Clinical features of systemic hypertension include _______
asymptomatic in mild to moderate HTN, late stage HTN is associated with headache, somnolence, confusion, visual disturbances, nausea, vomiting
Pericarditis is a common complication of ________ but can also be caused by ______________
myocardial infarction
microbial infection, trauma to heart, malignancy, medications
Describe pulmonary blood circulation
right side of HT pumps deoxygenated blood to LU
right ventricle pumps blood to pulmonary trunk
pulmonary trunk branches into pulmonary arteries
pulmonary arteries carry blood to LU for exchange of gases
oxygenated blood returns to HT in pulmonary veins
Heart rate is regulated by what part of brain stem? Which nervous system?
cardiovascular center in medulla oblongata
ANS
Ischemic heart disease aka __________ is characterized by ________, usually due to ___________
myocardial ischemia
reduced blood supply to the heart muscle
coronary artery disease
90-95% of hypertension is ________ hypertension. Its etiology is _________
essential aka primary
idiopathic
In the cardiac cycle, isovolumetric contraction is the period when _____
atria, ventricles are all in contraction and AV/SL valves are closed
Describe pathogenesis of systemic hypertension
Kidney receives less blood supply per unit of time and activates secretion of renin –> angiotensin I –> angiotensin II –> aldosterone –> ADH –> increased osmolarity and blood volume along with increased vascular resistance/pressure
List the phases of the cardiac cycle
Isovolumetric relaxation Ventricular filling Atrial systole Isovolumetric contraction Ventricular systole
The most common cause of secondary systemic arterial hypertension is:
Kidney disease
Lung edema is an expected complication of ____.
Left CHF
What are the major types of shock? What are their etiologies?
Hypovolemic - blood/fluid loss
Cardiogenic - cardiac tamponade, thrombosis, MI, carditis, CHF
Distributive - dilation of peripheral arterioles
Clinical presentations of RHF are _____________
peripheral edema, nocturia, ascites, hepatomegaly, jaundice, portal hypertension
What are of the most common complications of MI?
Arrhythmias (more specifically VF) and HF.
About 40% of cases of dilated cardiomyopathy are ______ in nature. Other causes of dilated cardiomyopathy include ____________
familial
pregnancy, alcoholism, toxic, metabolic, or infectious agents
Confirmation of MI diagnosis requires ____________
1) ECG
2) cardiac enzymes blood level elevation: troponin, creatine kinase B
3) clinical presentation
The most common cause of left CHF is _______
The most common cause of right CHF is _______
Arterial hypertension
Left CHF
The most common etiology of ectopic arrhythmia is _______
hypoxia
SA node fires spontaneously ____ times per minute
AV node fires at ______ times per minute
60-100
40-60
The duration of ischemic pain is _______ while duration of myocardial infarction pain is _________
20 minutes
several hours
Diagnosis of IHD is based on _________
clinical presentations, ECG, blood tests of MI markers, ultrasound, chest X-ray studies
Ectopic pacemakers are _____ and can be caused by stimulants including _____
extra beats forming at other sites of the HT
caffeine, nicotine
Major diagnostic criteria for Rheumatic Fever are:
Migratory polyarthritis - large joints, starts at legs and migrating up (wind)
Carditis
Subcutaneous nodules - loc: back of wrist, outside elbow, front of knees
Erythema marginatum - rash on trunk, arms
Sydenham’s chorea (St. Vitus’ Dance) - neurological presentation (pop and lock) occurs late
The first heard sound (“lub”) is associated with the ____
closing of the AV valves
Tricuspid and Mitral Valves
Buerger’s disease presents with _____________. The main symptom is ___________ which occurs in episodes upon exertion (aka ____________) due to severe obstruction with ischemia.The only proven treatment for Beurger’s disease is ________
inflammation and thrombosis of arteries and veins of the hands and feet.
pain in the affected areas
claudication
smoking cessation
In the cardiac cycle, ventricular filling is the period when _____
blood flows from full atria into ventricle
diastasis - blood trickles into ventricle
atrial systole - pumps final 20-25ml blood into ventricle
