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DSouza 2015 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

The determinate of myocardial consumption from most important to least are …

A

Contractility > HR > afterload > preload

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2
Q

Can preload be measured by end-diastolic volume, how about end-diastolic pressure (LVEDP)?

A

You can measure preload from end diastolic pressure (LVEDP)only in patients with good left ventricular compliance.

So in elderly, you cannot measure preload from LVEDP because their LV compliance is reduced

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3
Q

LV coronary perfusion occur during … and depends on …

A

Diastolic period and depends on Aortic diastolic pressure

LV perfusion = Aortic diastolic pressure -LVEDP

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4
Q

RV perfusion occur during … and depends on …

A

Diastole & systolic period

Depends on MAP

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5
Q

SA node supplied by … and AV node by …

A

Both by RCA (60% in people for SA node and 90% for AV node)

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6
Q

Heart block seen with … occlusion

A

RCA

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7
Q

R dominant coronary circulation is when …

A

PDA arises from RCA

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8
Q

Left dominant coronary circulation is when

A

PDA arises from LCA

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9
Q

ANP released in response to …

A

Atrial wall stretch due to increase in L atrial volume

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10
Q

Angio I converted to Angio II in

A

Lungs

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11
Q

When hypotension and bradycardia and coronary dilatation occur as reflex 2/2 LV ischemia, reflex called …

A

Bezold-Jarisch Reflex

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12
Q

Cushing Reflex is

A

Hypertension & bradycardia due to increased ICP

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13
Q

What’s reflex named when stretching pulm stretch receptors due to inflation of lung results into inhibition of inspiration & allows expiration

A

Herring-Breuer Reflex

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14
Q

Frank-Starling Curve is relationship between

A

SV/CO (on left)

Preload/LVEDV (bottom)

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15
Q

Frank-Starling curve moves down in

A

Decrease preload, contractility or increased afterload

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16
Q

Frank-Starling curve moves up in

A

Increased preload or Contractility. And decreasing afterload

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17
Q

Phenylephrine vs Milrinone on Frank-Starling curve

A

Phenylephrine: “dose dependent “ curve up -> low doses, increases central blood volume
Curve down -> increases afterload with high doses

Milrinone -> increases Contractility & decreases afterload -> curve up

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18
Q

Absent A wave in …

A

Afib

A wave: Atrial contraction

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19
Q

Large A wave due to …

A

Complete heart block
Tricuspid stenosis
Pulm HTN

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20
Q

Large V wave in …

A

Tricuspid regurgitate

V: atrial Villing

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21
Q

Steep Y decent in …

A

Constructive pericarditis

Y: passive BF from atria to ventricular resulting into decrease RA pressure/decent of Y I ave on CVP trace

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22
Q

Absent or attenuated Y decent in

A

Cardiac tamponade

Tricuspid stenosis

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23
Q

CVP trace in Afib

A

Absent a wave

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24
Q

CVP trace in junctional rhythm and complete heart block

A

Cannon a wave (large a wave)

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25
Q

Large C-V wave or fused C and V wave seen in

A

Tricuspid regurgitate

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26
Q

Cannon a wave seen in

A

AV dissociation

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27
Q

Absent a wave, prominent c wave seen in

A

Afib

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28
Q

Tall systolic c-v wave seen in

A

Tricuspid regurgitate

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29
Q

Tall a wave, attenuation of Y decent seen in

A

Tricuspid stenosis

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30
Q

Tall a wave, steep x, decent Y seen in

A

Constructive pericarditis

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31
Q

Dominant x descent, attenuated y descent seen in

A

Pericardial tamponade

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32
Q

What trace on Pulm artery suggests MI?

A

Large V wave which is due to mitral regurgitate

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33
Q

Cardiac cycle phase occur during P wave is …

A

Ventricular filling

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34
Q

Cardiac cycle occurs during RS wave on ECG is

A

Isovolumetric contraction

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35
Q

Cardiac cycle phase occur during T wave on ECG is …

A

Ventricular ejection

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36
Q

HD goal in IHSS

A

Increase preload & afterload

Decrease HR, Contractility

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37
Q

HD goal in MR & AR

A

Mild tachycardia

Mild reduction in afterload

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38
Q

HD goal in cardiac tamponade

A

Fast: increase HR
Full: increase preload
Tight: increase afterload

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39
Q

Slow rising pulse with late systolic peak is a character for ….

A

AS

This is pulses parvis et tarsus

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40
Q

Rapid upstroke & rapid decent pulse “collapsing pulse” “ water hammer pulse”

A

AR

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41
Q

Alternate strong & weak pulse “pulses alternate”

A

LV failure

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42
Q

Combination of slow rising & collapsing pulse “pulses bisfernance”

A

Combined AS & AR

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43
Q

Mid systolic obstruction “spike & dome pulse”

A

HCM

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44
Q

great than 10 mmHg drop in BP during inspiration “pulses paradoxes”

A

sever Acute Asthma or cardiac tamponade

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45
Q 
Area of auscultation 
MV
TV
PV
AV
A

M: Left to nipple intercostal
T: Left lower eternal border
P: 2nd left intercostal left to sternum
A: 2nd right intercostal right to sternum

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46
Q

Pansystolic murmur anterior lower eternal border

A

VSD

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47
Q

Continuous machinery murmur (below left clavicle)

A

PDA

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48
Q

Murmur posterior interscapular

A

Coartictation of aorta

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49
Q

Mid systolic murmur

A

MS

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50
Q

Pansystolic murmur

A

MR

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51
Q

Ejection systolic murmur

A

AS

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52
Q

Early diastolic murmur

A

AR

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53
Q

Angio II is … vasoconstriction

A

Direct

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54
Q

Vasopressor ineffective in cocaine abuser is

A

Ephedrine

Due to catecholamine depletion

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55
Q

In CHF, beta adrenergic receptors are … regulated

A

Down

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56
Q

Cardiac RFs for patients undergoing non cardiac Surgery are

A

Recent MI
Valvular diseases
Uncompensated HF

57
Q

Causes for PCWP > LVEDP

A

MA
Left atrial myxoma
Elevated alveolar pressure
Pulm venous obstruction

58
Q

Cause for LVEDP > PCWP

A

AR

59
Q

Carotid sinus reflex during carotid endarterectomy causes … and can be blocked by …

A

Hypotension + bradycardia

Local anesthetics at carotid bifurcation

Afferent: glossy pharyngeal
Efferent: vagus

60
Q

Baroreceptors denervation after b/l carotid endarterectomy results into

A

Hypertension + tachycardia

Chemoreceptors denervation leads to decreases hypoxia drive of respiratory

61
Q

Neuromonitors used during carotid endarterectomy are

A 
Awake patient 
Carotid stump pressure > 60 mmHg
Cerebral oximetry
SSEP
EEG
Trans cranial Doppler flow of meninges artery
62
Q

The common cause of ischemia during carotid endarterectomy is

A

Embolism

63
Q

Autonomic hyper reflex is occur in … and manifests as … and commonly seen … after insult. a drug to avoid is …

Management is …

Prevention…

A

Spinal cord transaction at T7 or above

Hypertension + bradycardia. Profuse sweating, flushing (vasodilation) above lesion level, blanching + vasoconstriction below level of lesion

Common 6 months to 2 years following injury

Avoid succinylcholine

Na Nitroprusside, nitroglycerin (2nd choice), alpha blocker less effective. Avoid beta blockers alone.

Prevention: GA or spinal.

64
Q

Acute spinal cord transaction immediate manifestation

A

Spinal shock and lasts hours to one month.

Hypotension (due to increased venous capacitance) and flaccid paralysis.

Automatic hyperreflexia occurs 6 months - 2 years following insult

65
Q

During isovolumic hemodilusion, tissue perfusion increases due to

A

Decreases in viscosity

66
Q

During aortic cross clamp, afterload … which translate into … and … hence it increases risk for MI in susceptible patients

A

Increases afterload -> intraventricular pressure, myocardial wall tension, and myocardial O2 consumption

67
Q

The commonest cause of decreased renal perfusion in aortic cross clamp is …

A

Hypovolemia

68
Q

The best measure for renal protection during infra-renal aortic cross clamp is …

A

Maintenance of intravascular volume status

69
Q

If sever hypotension associated with ECG ischemic changes occur after release of aortic cross clamp occur, best immediate course is to …

A

Reapply the cross clamp

70
Q

ECG changes in

HyperCa
HypoCa

A

Short QT interval

Long QT interval

71
Q

Management of prolonged QT interval + torsades is ….

A

Mg

72
Q

WPW syndrome on ECG

A

Short PR < 0.12

Delta wave

73
Q

Mgmt of WPW syndrome

A 
Vagal maneuvers
Adenosine
Procainamide
Esmolol
Cardio version
74
Q

CI drugs for WPW syndrome

A

Digoxin

Verapamil

75
Q

What’s % of CO dependent on atrial kick in AS patients?

A

40%

76
Q

SBE ppx

A

1) prosthetic material used for valve.
2) previous IE
3) un-repaired cynotic CHD.
4) cardiac palliative shunts & conduit
5) valvulopathy in transplanted heart
6) 2 conditions in repaired CHD
- repaired CHD + residual defects at the site or adjacent to prosthetic patch/device
- within first 6 month after procedure if prosthetic material or device implanted.

77
Q

Un-repaired cynotic CHD receive SBE ppx, but repaired once only gets them in 2 conditions

A

2 conditions in repaired CHD

  • repaired CHD + residual defects at the site or adjacent to prosthetic patch/device
  • within first 6 month after procedure if prosthetic material or device implanted.

Because endothelialization prosthetic material occurs > 6 months, and if defect adjacent to material it inhibits

78
Q

Indications for permanent pacing

A
  • Symptomatic bradycardia
  • Symptomatic second degree block
  • Asymptomatic mobitz 2 with wide QRS
  • Post Anterior MI (3rd, 2nd degree block + bundle branch block).
  • 3rd degree block
  • refractory SVT
79
Q

Indications for AICD

A 
VF/VT
Long QT
HOCM + VF/VT
Post MI + EF <30%
Dilated CMP
80
Q 
Pacemaker Letters Description
I ->
II ->
III ->
IV ->
V ->
A 
I -> Chamber paced (O,A,V,D)
II -> Chamber sensed (O,A,V,D)
III -> Response to sensing (O,T,I,D)
IV -> Programmability, rate modulation (O,R)
V -> Antitachycardia function (P,S,D)
81
Q

IV pacing: Rate Modulation

A 
Vibration sensor
Motion sensor
Minute Ventilation
QT interval
RV pressure
82
Q

V pacing: Multisite sensing

A

Atrial multidite pacing for AF

Ventricular multisite pacing for CMP

83
Q

Fixed rate/asynchronous mode pacing letters are

A

VOO, AOO, DOO

84
Q

whats type of pacemaker used for AV block + atrial bradycardia

A

DVI

Dual champers paced
Ventricular sensor
Inhibitor if sensed

85
Q

Indications for reprogramming DDD pacemaker?

A 
Pacer dependence
Rate responsiveness
Dilated CMP, HOCM.
Pediatrics
Procedures close to the pacemaker
86
Q

the commonest cause of seening slower rate than whats pacemaker set at is …

A

battery failure

87
Q

Contraindication for AICD

A

MRI

88
Q

is it safe to undergo ECT, synchronized cardioversion, or radiofrequency ablation with patients that have AICD?

A

Yes they are not contraindicated.

deactivate AICD with each treatment the reactive afterwards

89
Q

methods to reduce trans-thoracic resistance during external defibrillation

A
  • Large paddle
  • Application of pressure on paddles.
  • Conductive gel
  • Shave hairy chest
  • Biphasic shock
90
Q

benefit of using Epi in anaphylaxis is …

A

it stabilize mast cell membrane

91
Q

benefit of using Epi in cardiac arrest or Vfib is …

A

its vasoconstriction & improve cerebral & myocardial BF. it also reduced VFib threshold & cellular refractory period which stabilizes the fibrillation in V-fib

92
Q

The most sensitive indicator for LV myocardial ischemia is

A

wall motion abnormalities on TEE

93
Q

The correct placement of lead 5 is

A

Left 5th intercostal space in anterior axillary line.

94
Q

ST changes are significant if it occur

A

1 mm for depression
2 mm for elevation
when occurs 80 m sec. after J point (QRS-ST junction)

95
Q

Ischemic changes in II, III, AVF, and AV block

A

Inferior wall -> RCA

96
Q

Ischemic changes in I, AVL

A

Lateral wall -> Circumflex Artery

97
Q

V3-V6 ischemic changes

A

Anterioseptal wall -> LAD

98
Q

New apical systolic murmur in AS patient means

A

MR 2/2 MI

99
Q

The definition of Pulm Htn

A
  • PA systolic > 35 mm/Hg
  • Resting PA mean > 25 mm/Hg
  • PA mean > 30 mmHg during exercise
100
Q

next step when heparin resistance occur during CPB (target ACT not achived)?

A

FFP as a source of antithrombin III

101
Q

is remote h/o HIT CI for heprain use for CBP?

A

no, however recent HIT is CI and warrent use of Bivalirudin

102
Q

The best initial TEE view to detect MI after coming off Bypass is …

A

transgastric short axis view (all walls are seen with this view)

if + ischemia then do mid-esophageal view.

103
Q

The most difficult area to see on TEE is … and therefore … is likely to be missed

A

arch of aorta

intimal tear in aorta

104
Q

CI to TEE

A
  • Esophageal obstruction
  • GI perforation.
  • Active GI bleeding.
  • Esophageal varices
  • Esophagectomy/esophagogastrectomy
  • Tracheoesophageal fistula
105
Q

The most common cause of acute LV dilatation after aortic cross clamp during CPB is

A

AR

106
Q

the commonest causes for hypotention at initiation of CPB with adequate BF & venous return are

A

vasodilation or hemodilution

107
Q

indications for retrograde cardioplegia

A
  • AR
  • type A dissection
  • sever left main stenosis
108
Q

solubility of gas during hypothermia …. therefore pH would …

A

increases -> gas in the gaseous phase decreases -> partial pressure of gas decreases -> PaO2, PaCO2 decreases and pH increase

109
Q

elevated CO2 on pump indicates

A

inadequate ventilation, so increase fresh gas flow

110
Q

Type 1 protamine rxn is … and caused by … manifests as …. treated with …

A

Anaphlactoid rxn

1) rapid administration
2) first time exposure
3) IgG mediates & complement activation.

systemic hypotension

fluids & vasopressors

111
Q

Type 2 protamine rxn is … and caused by … manifests as …. treated with …

A

Anaphlactic rxn

1) prior exposure.
2) IgE mediated & complement

systemic hypotention

fluids & vasopressors

112
Q

Type 3 protamine rxn is … and caused by … manifests as …. treated with …

A

Thromboxane release from plt & macrphages

systemic hypotention + pulm Htn

Reheparinse and go on CPB

113
Q

the cause of pulm Htn in type 3 protamine rxn is ….

A

Thromboxane release from plt

also seen in pre-eclampsia

114
Q

during rewarming following cpb, …. temp lags behinde other core temps

A

rectal temp

115
Q

decreased O@ sat when coming off bypass with other parameters within normal range is possibly due to

A

shivering during rewarming

give NMB

116
Q

pH stat

A
  • During hypothermia, PaCO2 decreases due to increased solubility.
  • pH stat is when maintaining CO2 at 40 mmHg by reducing sweep oxygenation or less commonly adding CO2
117
Q

pH or Alpha recommended for adults?

A

Alpha = Adults

better neurological outcome

118
Q

Which to use pH or alpha stat for pediatric or deep hypothermia?

A

pH stat increases CO2 improves CBF, uncopules CBP/O2 consumption (neuroprotective for infants on CPB).

pH stat produces more homogenous cooling, less O2 consumption, and better metabolic recovery than alpha.

now the trend is using pH stat during cooling and alpha stat during rewarming, if deep hypothermia is used

119
Q

CI tointra-aortic pump

A

AR

b/l sever aorto-occlusive disease

120
Q

IABP is inflated synchronous to

A

dicrotic notch of ABP wave

121
Q

IABP increases … and decreases …

A

DBP

SBP, myocardial O2 consumption, afterload

122
Q

low CI, hypotension, and equalization of CVP with PCWP after CABG, suspect …

A

Cardiac tamponade

123
Q

mortality rate after coronary revascularization is … and increased to … in ARF

A

0.9%

63%

124
Q

most important predictor of hospital mortality in CABG patients are

A

number of inotropy & transfusion during procedure and immediate postop.

125
Q

the resting heart rate in denervated transplanted heart is

A

high around 100

Lack of vagal tone will result in baseline rate of 90-100.

126
Q

denervated transplanted heart respond to drugs that

A

has direct effect on heart (epi, norepi, and isoproterenol)

127
Q

denervated transplanted heart dose not respond to drugs that

A

alter nodal function or HR indirectly such as antimuscuranics, anticholinergics, pancuronium, digoxin.

128
Q

denervated transplanted heart dose not respond to or dose respond to hypovolemia, hypotension, or laryngoscopy?

A

Transplanted hearts have no baseline parasympathetic innervation and thus don’t have the normal tachycardia and increased contractility response to hypotension/hypovolemia. Reflex venous contriction response to hypotension still exists.

dose not respond to physiological reflexes to hypovolemia, vasodilation, carotid sinus massage, laryngoscopy or exercise.

Vagal bradycardic reflexes will also be absent (laryngoscopy, hypertension, carotid sinus massage).

129
Q

What agent of choice to treat bradycardia in heart transplanted patients?

A

The transplanted heart will not be able to respond to drugs that act by blocking the parasympathetic system because these connections were severed during the transplant. Therefore, treating bradycardia would have to be done with agents such as isoproterenol, glucagon, epinephrine, norepinephrine (drugs that have a direct effect on the heart). Isoproterenol is most commonly used for increasing heart rate in cardiac transplant recipients. Epinephrine/Norepinephrine may have exaggerated beta mimetic effects on the heart rate because the increase in blood pressure will not lead to a reflex slowing of the heart rate via the baroreceptor reflex (i.e., efferent vagus nerve). Implanted mechanical pacemakers work normally in heart transplant recipients since the cardiac leads are placed directly into myocardium.

About 25% of patients will develop a bradycardia that will require implantation of a permanent pacemaker.

130
Q

SVO2 increases in

A

Sepsis & Cyanide toxicity

131
Q

SVR =

A

MAP-CVP/CO x80

132
Q

PVR =

A

PAP-PCWP/CO x80

133
Q

The cardiovascular compensation for sever anemia is

A

Increased CO

134
Q

RAAS system activated in

A

Hypovolemia

135
Q

CVS physiological changes in elderly are

A
  • increased SBP
  • unchanged/decreased DBP
  • Decreased LV compliance
  • increased incidence of diastolic dysfunction
  • decreased arterial compliance -> increases afterload.
  • increased fibrosis of the conduction system -> increases incidence of arrhythmias
  • decreased baroreceptors reflexes -> decreased response t o anticholinergics.
136
Q

the commonest cause of diastolic dysfunction/impaired diastolic relaxation is

A

increased afterload with cocentric ventricular hypertrophy resulting into CHF

137
Q

Complications of TAVR?

A

15% AV block during valve deployment and positioning.

11% Dissection, perforation or thrombosis of ileofemoral vessels

Acute coronary occlusion after deployment: ST changes, LV failure

138
Q

What TEE view the SVC and IVC can be seen?

A

Bicaval 90 degree

DSouza 2015 (21 decks)

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