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USMLE > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Atrial Chamber Septation

A

The foramen ovale (of the septum secundum) and the foramen secundum (of the septum primum) maintain blood flow between the two chambers in the embryo

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2
Q

Adult Derivatives of the Atria

A

Pg 268 in STEP BOOK

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3
Q

Aortic Arches

A 
1 = maxillary artery 
2 = stapedial artery, hyoid artery 
3 = common carotid artery and proximal part of the internal carotid artery
4 = left (adult aorta arch) right (proximal part of the right subclavian artery)
6 = proximal part of the pulmonary arteries and ductus arteriosus

5th arch degenerates
3rd and 4th are most important

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4
Q

Aorticopulmonary septum

A
  • membranous portion of the ventricular septum
  • comes from neural crest cells
  • if there is no 180 degree turn = Transposition of great vessels
  • failure of neural crest migration = persistent truncus arteriosus

Ventricular septal defects usually occur in the membranous septum

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5
Q

Ebstein’s Anomaly

A

Apical displacement of the septal and posterior tricuspid valve leaflets leading to atrialization of the right ventricle
- the leaflets are unusually deep in the right ventricle
- congenital defect of endocardial cushions of the tricuspid valve
- causes tricuspid regurgitation
- the high right atrial pressure keeps the PFO and allows for deoxygenated blood to go to the peripheral system causing cyanosis
Can be due to use of lithium or benzodiazepine during pregnancy

Increased risk of wolf Parkinson’s white syndrome and SVT

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6
Q

Fetal Erythropoiesis

A

Young Liver Synthesizes Blood

Yolk sac (3-8 weeks)
Liver (6weeks-Birth)
Spleen (10-28 weeks)
Bone marrow (18 weeks to adult)

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7
Q

Fetal postnatal derivatives

A

Pg 271 of STEP

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8
Q

Left to Right Shunts

A

PDA = treat with indomethacin (blocks prostaglandin synthesis)
ASD
VSD

Uncorrected left to right shunt causes pulmonary hypertension causing RVH and then right side pressure exceeds left = Eisenmenger syndrome (R–>L shunt)

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9
Q

Coarctation of Aorta

A

Infantile = pre-ductal = Associated with Turner Syndrome

Adult = post-ductal
- notching of rib on X-Ray due to intercostal arteries becoming dilated

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10
Q

Disorders Associated with Cardiac Malformations

A

Turner Syndrome

  • infantile coarctation of aorta = preductal
  • Bicuspid Aortic Valves

Down Syndrome
- endocardial cushion defects = ASD (ostium primum type), VSD, AV septal defects

Digeorge Syndrome 22q11

  • Tetralogy of Fallot
  • Truncus Arteriosus

Congenital Rubella

  • PDA
  • Pulmonary Artery Stenosis
  • septal defects

Marfan Syndrome

  • Aortic insuficiency due to abnormal aortic valves
  • MVP
  • thoracic aortic aneurysm and dissection

Infants of Diabetic Mom
- Suffer from Transposition of Great Vessels

Alcohol exposure in Utero
- VSD, PDA, ASD, tetralogy of Fallot

Prenatal Lithium exposure = Ebstein anomaly

Williams Syndrome = Supravalvular aortic stenosis

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11
Q

Right to Left shunts

A

Pg288 of STEP book

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12
Q

Boot Shaped Heart in INFANT

A

Tetralogy of Fallot

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13
Q

Most common cause of congenital anomaly

A

VSD

Most common cause of early cyanosis = Tetralogy of Fallot

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14
Q

Atrial Septal Defects

A

Ostium Secundum = missing tissue is more commnon than ostium primum

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15
Q

Exercise and CO

A

Initially
- Increase CO due to increased SV & HR

Sustained Exercise
- CO maintained due to increased HR

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16
Q

Preload

A

Pressure at EDV

  • Atrial Pressure
  • End-diastolic pressure
  • CVP

Preload increased by

  • Exercise
  • increased blood volume
  • pregnancy

Preload decreased by
- ventilators = nitrates (nitroglycerin)

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17
Q

After load

A

MAP
- TPR

Vasodilators decreases After load = hydralazine

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18
Q

Starling Curve

A

274

Normal EF = >55%

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19
Q

Cardiac and Vascular Function Curves

A

Pg 275

Contractility increases with decreased extra cellular Na+

Contractility decreases with acidosis and hypoxia

ACE inhibitors and ARBs decrease both preload and after load

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20
Q

Pulse Pressure

A

Proportional to SV
Inversely proportional to arterial compliance

Increase in PP
- hyperthyroidism, aortic regurgitation, aortic stiffening (isolated systolic hypertension in elderly), obstructive sleep apnea (increased SNS), exercise

Decrease PP
- aortic stenosis, cardio genic shock, cardiac tamponade, advanced HF

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21
Q

Ejection Fraction

A

Decreases in systolic Heart failure

Normal in diastolic heart failure

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22
Q

Left Atrial Pressure

A

Normally LV diastolic pressure

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23
Q

Heart Failure

A

Pages 297

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24
Q

BNP

A
  • produced by cardiac cells in response to ventricular stretch
  • causes vasodilation and natriuresis
  • secreted when left ventricle is stretched due to heart failure

MEASURED TO HELP DIAGNOSE CHF >100

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25
Q

What stage is the most O2 consumption occuring?

A

Isovolumetric Contraction

Kaplan Notes 25-30 Cardio

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26
Q

JVP Pressure Tracing

A

Absent A wave = A-fib, RA infarct, or atrial flutter
Absent X descent = Tricuspid regurg

Page 276 on STEP book

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27
Q

Treatment of CHF

A

Acute/Decompensated CHF (NO LIP) with Pulmonary Edema
- Nitrates = dilate veins to reduce preload
- Oxygen
- Loop Diuretic = removes fluid from the lung
- Inotropic drugs = dobutamine
- Positioning = sit patient up so blood doesn’t pool in heart but pools in legs.
don’t give Beta blocker

Chronic CHF
= Improvement of Survival = ACE inhibitors, ARBs, Aldosterone antagonists, Certain Beta-blockers (metoprolol, carvedilol, bisoprolol) , Nitrates + Hydralazine (AA patients only)
= Symptomatic Relief = Diuretics, Digoxin, Vasodilators (hydralazine and nitrates)

Chronic CHF can become Acute CHF = LOOK AT STORY

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28
Q

INCREASED CAPILLARY hydrostatic pressure

A
  • CHF = increases CVP
  • Venous thrombosis
  • Compression of veins
  • Sodium and Water retention
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29
Q

Increased Capillary permeability

A
  • infections and septic shock
  • toxins
  • burns
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30
Q

Pitting Edema vs Non-Pitting

A

Pitting
- excess amount of fluid in absence of additional colloid (protein)

Non-pitting edema
- a lot of colloid in interstitial fluid (protein) balances fluid

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31
Q

Shock

A

Pg 297

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32
Q

Location of Central Lines (catheters put into central veins)

A

Femoral = easiest with least risk but the line cant stay more than 5-7 days due to risk of infection

Subclavian = remains longer 3-4 weeks, highest risk of pneumothorax don’t do in patients that have COPD or lung tumors

Internal Jugular = remains in 3-4 weeks, risk of puncturing carotid artery

LOOK AT PICTURES

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33
Q

Femoral Sheath

A

Femoral artery and vein only in the sheath

- nerve is not found in the sheath

34
Q

What is Kf? What increases Kf?

A

Kf = capillary permeability

  • increased by bacterial toxins, burns, and sepsis
35
Q

What are the antidotes to the following?

A

Copper, gold, arsenic = penicillamine

Arsenic, Mercury, gold = dimercaprol, succimer

TPA, Streptokinase = Aminocaproic acid

Digitalis = Anti-digoxin antibody fragments

36
Q

Pressure Volume Loop

A

Pg 276 of STEP book

37
Q

Splitting

A

277 of STEP book

38
Q

Shock Pathophysiology

A

MAP

39
Q

Auscultation of Heart Sounds

A

Aortic Valve is heard = Right 2nd intercostal space
Pulmonic Valve = Left 2nd intercostal space

APTM

40
Q

Benign Heart Murmurs if there is no presentation of disease

A
  • Split S1
  • Split S2 on inspiration
  • S3 in a patient
41
Q

Bedside Maneuvers

A

Handgrip

  • increased afterload = increased Mitral regurg
  • later onset of MVP

Valsalva maneuver

  • reduces preload and afterload
  • makes most heart murmurs quieter except hypertrophic cardiomyopathy
  • earlier onset of MVP

Squatting

  • increases preload
  • later onset of MVP
  • increased AS murmur
  • decreased HCM murmur
42
Q

Sounds Heard best in Left Lateral Decubitus position

A
  • mitral stenosis
  • mitral regurgitation
  • left-sided S3
  • left-sided S4
43
Q

Heart Murmurs

A

Pg 279 and 278 of STEP book

44
Q

Membrane Potentials

A

K+ –> -75 to -95mV
Na+ –> +50mV
Ca2+ –> +20mV

45
Q

Action Potentials of Ventricles

A

Phase 2 = Calcium influx triggers Calcium release from Sarcoplasmic reticulum and induces myocytes contraction

Between phase 0-3 = Effective Refractory Period

  • you can’t illicit another action potential
  • increasing this period slows the heart down
46
Q

Action Potential of Pacemakers

A

No phase 1 or 2

Phase 4 = freely permeable to K+, funny channels (gradual increase in Na+ conduction = causes pacemaker)
Phase 0 = due to calcium influx

Pg 280-281 in STEP book

47
Q

Fomepazol

A

Inhibits alcohol dehydrogenase

48
Q

Anti-Arrhythmics

A

No Bad Boy Keeps Clean

No = Class 1 = Na+ channel blockers
- decreases slope of phase 0 in the myocyte 
Bad Boy - Class 2 = Beta blockers
- act on phase 4
Keeps = Class 3 = K+ channel blockers 
- act on phase 3
Clean = Class 4 = CCB
- act on phase 0
49
Q

Limb Leads

A

See Pictures

QRS complex deflection is telling you where the electrical signal of the heart is

Look at limb lead 1 and 2 = to tell you the axis of the heart 
- if + = normal 
Normal = -30 - +90
LAD = -30- -90
RAD= +90 - +180
50
Q

EKG

A

Each tiny box = 0.04sec
One big box = 0.2 sec

PR interval
- normally

51
Q

Anaphylactic Shock Treatment

A

Epinephrine

52
Q

Cardio genic Shock Treatment

A

Dobutamine = affects more of the heart

53
Q

Septic Shock

A

Use Norepinpehrine

- stimulates the alpha 1 without Beta 2 to clamp down vessels

54
Q

Arrhythmias

A

PG 283-284 of STEP book

55
Q

Cushings Reflex

A

Increased intracranial pressure

  • increases SNS and increases BP
  • causes increased PSNS ==> reflex bradycardia and respiratory depression

Pg 286

Triad - increased systemic BP, bradycardia, respiratory depression

56
Q

Smooth Muscle Cell Contraction

A

See Picture

57
Q

Cardiac Output Regulation

A 
Liver = receives largest portion of CO
Kidneys = receives highest blood flow per gram of tissue
Lungs = receive 100% of CO from RV 
Heart = extracts 80% of oxygen from blood = myocardial profusion occurs during diastole --> NO, CO2, adenosine dilate coronary arteries

In the case of CAD = Nitroglycerin decreases oxygen demand by causing systemic venous vasodilation which reduces preload (doesn’t vasodilate the coronary arteries because they are already maximally vasodilated)

Skeletal muscle
- local metabolites during exercise = K+, H+, CO2 increases vasodilation

58
Q

Hypertension

A

Hypertension = BP > 140/90
Pre-Hypertension = BP >120/80
Normal = 180/120 without acute end organ damage
- Hypertensive Emergency = BP >180/120 severe hypertension with evidence of acute end organ damage

White Coat Hypertension

  • high BP only when in the doctors office
  • compare home BP with Doctor BP
  • treat based on home BP numbers

Masked Hypertension
- normal readings in office but higher levels at home

LVH = concentric thickness

  • increases myocardial oxygen demand
  • less compliant ventricle/stiffen = S4
  • decreases LV lumen

Aortic Dissection

  • tearing chest pain that radiates to the back = creates false lumen
  • widening mediastinum on CXR
  • risk factors: Marfan syndrome and Hypertension
  • do CT scan
  • Type A = dissection involving Ascending Aorta = emergency surgery
  • Type B = distal aorta distal to the left subclavian artery = medical management (use beta blocker)

Paroxysms of increased SNS = anxiety, palpitations, diaphoresis ==> Pheochromocytoma

59
Q

Foramen Ovale

A

Can lead to paradoxical emboli

60
Q

Abdominal Aortic Aneurysm

A

See Pictures

  • you need to do serial ultrasound every 6 months
    >5cm ==> surgical repair
61
Q

Coronary Anatomy

A

Pg 272

LAD is where most occlusions occur = anterior wall MI

Right Dominant circulation = 80% of people
= PDA arises from RCA

Left Dominant Circulation = 8% of people = PDA comes from LCX

CoDominant = 7% of people = PDA arises from both LCX and RCA

62
Q

Causes of Chest Pain

A

See Pictures

Costochondritis = inflammation where ribs meet sternum

63
Q

Arteriolosclerosis

A

Thickening of the small arteries and arterioles
Hyaline: thickening of vessel walls in essential hypertension or diabetes mellitus = very pink
Hyper plastic: “onion skinning” in severe hypertension with proliferation of smooth muscle cells.

64
Q

Mockeberg (medial calcific sclerosis)

A
  • uncommon
  • affects medium-sized arteries
  • calcification of elastic lamina of arteries –> vascular stiffening without obstruction.
  • Pipestem appearance on X-Ray
  • Does not obstruct blood flow; intima not involved
  • calcification occurs in media
65
Q

Ischemic Heart Disease

A

Prinzmetal - transient ST elevation on ECG
Stable Angina - ST segment depression
Unstable Angina = ST segment depression
MI
- subendocardial = NSTEMI = ST segment depression + cardiac enzymes
- Transmural = STEMI = ST segment elevation + cardiac enzymes

66
Q

Antianginal Therapy

A

Decrease Preload and decrease after load
- nitrates and beta blockers

Decrease myocardial oxygen demand

67
Q

Evolution of an MI

A

Pg 294 & 295

Check Picture

Troponin I is the most specific enzyme to cardiac muscle

Dressler Syndrome = Chest pain, pericardial friction rub, autoimmune pericarditis, and persistent fever occurring several weeks after an MI

68
Q

MI Treatment and Cardiomyopathies

A

Check Picturess

Pg 296

69
Q

Hepatitis B Phases

A

See Pictures

70
Q

Fibrinous Pericarditis

A
  • Uremia = chest pain and course rubbing heart sounds in patients with Creatinine of 5
  • Rheumatoid Arthritis
  • Dressler Syndrome
71
Q

Serous Pericarditis

A
  • Lupus

- Rheumatic Fever

72
Q

Suppurative Pericarditis

A

Pus in pericardial space due to infection

73
Q

Hemorrhagic Pericarditis

A

TB or melanoma

74
Q

Acute Pericarditis

A
  • Pleuritic Chest pain = sharp, worse with inspiration, better when sitting up and leaning forward
  • Distant heart sounds
  • Friction rub on auscultation
  • Diffuse ST segment elevation
  • Diffuse PR segment depression

Can resolve without scarring or leads to chronic constrictive pericarditis (lupus, kussmaul sign = JVD during inspiration)

  • most common cause in US = Lupus
  • most common cause in developing countries = TB
75
Q

Cardiac Tamponade

A
  • causes decreased CO
  • distant heart sounds, JVD
  • pulsus paradoxus = decrease in amplitude in systolic BP by more than 10mmHg during inspiration (also seen in asthma, croup, OSA, and COPD)
  • there is equillibration of all 4 cardiac chambers
  • will see electrical alternans = alternating amplitude QRS complex beat to beat (specific but not sensitive)
76
Q

Syphilitic Heart Disease

A
  • disruption of vaso vasorum
  • dilation of aorta and aortic valve ring
  • aortic regurg
  • aortic stenosis
  • thoracic aortic aneurysms
  • calcification of aorta

TREE bark appearance on inside of aorta

77
Q

Tuberous Sclerosis

A
  • astrocytoma
  • rhabdomyomas
  • angiomyolipoma
78
Q

Vascular Pathologies

A

Pg 301-303

Sturge-Weber Disease = port wine stain in ophthalmic division trigeminal nerve
- seizure, early onset glaucoma, intellectual disability,

Lymphangiosarcoma
- lymphatic malignancy associated with persistent lymph edema

79
Q

Aortic Aneurysm

A

Myxamatous changes with pooling of proteoglycans in the media layer of large arteries are found in cystic medial degeneration

  • predisposes people to aortic dissections and aortic aneurysms
  • medial degeneration is frequently seen in younger individuals with Marfan syndrome
80
Q

Wide mediastinum

A

Aortic Dissection

81
Q

Beta blockers

A
  • mask the symptoms of hypoglycemia by blocking the typical adrenergic warning symptoms such as tremor and palpitations
  • so don’t give to a diabetic
82
Q

Organ Removal

A

increases the TPR and decreases CO

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