Cardiology

Question 1

Do betablockers increase contractility?

Answer 1

Decrease contractility, digoxin increases contractility (increasing intracellular calcium)

Question 2

When could you hear a fixed split of P2?

Answer 2

ASD- regardless of inspiration or expiration you have increased filling pressures because of ASD

Question 3

What causes a late crescendo murmur with midsystolic click?

Answer 3

Mitral valve prolapse (can be to myxomatous degeneration) secondary to marfans or ehlers danlos, rheumatic fever, or chordae rupture

Question 4

What gives you a U wave?

Answer 4

hypokalemia

Question 5

What kind of block can lyme disease cause?

Answer 5

third degree heart block

Question 6

What is a good measure of LA pressure?

Answer 6

PCWP (pulmonary capillary wedge pressure) it’s measured in the pulmonary artery with a Swan Ganz catheter, if you have PCWP> LV end diastolic pressure then you have mitral stenosis

Question 7

What is unique about pulmonary vasculature?

Answer 7

it vasoconstricts in response to alveolar hypoxia (get blood to ventilated areas), other tissues will vasodilate

Question 8

What is Eisenmenger syndrome?

Answer 8

when you have an unrepaired left to right shunt for too long and you get RVH and then right to left shunting develops and you get cyanosis, polycythemia, clubbing

Question 9

what is cor pulmonale?

Answer 9

isolated right sided heart failure from pulmonary cause

Question 10

What are the pathology findings in Rheumatic fever?

Answer 10

Aschoff bodies (granuloma with giant cells) and Anitschkow cells (enlarged macrophages with ovoid, wavy, rod like nucleus)

Question 11

What type of hypersensitivity reaction is caused by Rheumatic fever?

Answer 11

Type 2- antibodies to M cells cross react with self-antigens (molecular mimicry)

Question 12

What is Beck’s triad?

Answer 12

hypotension, distension of neck veins, , distant heart sounds
(happens in cardiac tamponade- can also get pulsus paradoxus, tachycardia, low voltage QRS)

Question 13

What gives you the tree bark appearance of the aorta?

Answer 13

tertiary syphilis-disrupts vasa vasorum of the aorta, atrophy and dilation, csn get aneurysm

Question 14

What is Osler-Weber-Rendu syndrome?

Answer 14

hereditary hemorrhagic telangiectasia, hereditary disorder of the blood vessels, skin, mucous membranes, recurrent epistaxis, AVMs, GI bleeding, hematuria

Question 15

Which drugs are first line for HTN with diabetes?

Answer 15

ACEI (better for diabetic nephropathy)

Question 16

how does hydralazine work? what is the side effect?

Answer 16

inc cGMP, gets smooth muscle relaxation, dec afterload, side effect is reflex tachycardia

Question 17

what is the side effect of nitrates?

Answer 17

reflex tachycardia

Question 18

What is the mechanism of digoxin?

Answer 18

inhibits Na/K ATPase and NA/Ca exchanger so you get build up of Ca in cell and increased ionotropy (contractility), stimulates the vagus nerve to give you increased HR, side effects are HF and a-fib, cholinergic, hyperkalemia

Question 19

What are the class 1 of arrhythmics?

Answer 19

Class 1=sodium channel blockers

1. 1A (inc AP duration, refractory period, prolong qt) quinidine, procainamide
2. 1B (dec AP duration, best post MI for ischemic tissue) lidocaine
3. 1C (inc ERP in AV node, but not below)- ideal for SVT, not VT (flecainide, propafenone)

Question 20

What are the class 2 antiarrhythmics?

Answer 20

b-blockers- block SA and AV node by dec cAMP. Good for SVT, A fib anf A flutter, but can worsen asthma, COPD, cause impotence

Question 21

What are the class 3 anti-arrhythmics?

Answer 21

K channel blockers- inc AP duration, ERP, good for A fib, A flutter and VT (amiodarone)- but amiodarone can cause pul fibrosis, hyper/hypothyroid, hepatotoxicity

Question 22

What are the class 4 anti-arrhythmics?

Answer 22

Ca channel blockers (verapamil, diltiazem)-slow conduction velocity, inc ERP and PR interval, good for SVT and rate control in A fib. Can cause constipation, flushing, edema, HF

Question 23

What does adenosine do?

Answer 23

causes K to flush out of cells, so Ca out too, dec AV node conduction, acts fast like 15sec-flushing, hypotension, chest pain, sense of impending doom, bronchospasm