Cardiovascular

Question 1

What’s the difference b/w Romano-Ward syndrome and Jervell and Lange-Nielsen syndrome?

Answer 1

Both congenital QT prolongation syndromes (Torsades)

* JLN causes sensorineural deafness, RW doesn’t.

Question 2

What is Brugada syndrome?

Answer 2

Pseudo RBB + ST elevations V1-V3

• Increased risk v-tac and sudden death
• Most common in asians
• Prevent death w/ICD

Question 3

What’s the most common ventricular pre-excitation syndrome?

What’s the characteristic sign on EKG?

Answer 3

WPW

• Uses bundle of Kent to bypass AV Node
• Characteristic delta waves seen

Question 4

How does adenosine act on the vessels?

Answer 4

Vasodilator

Question 5

List the 5 congenital heart diseases that cause R -> L shunts.

Answer 5

5 T's
Truncus arteriosus (1 vessel)
Transposition (2 switched vessels)
Tricuspid atresia (tri = 3)
Tetrology of Fallot  (tetra = 4)
TAPVR (5 letters: total anomalous pulmonary venous return)

Question 6

Which has early and which late cyanosis: L -> R shunt vs R -> L shunt

Answer 6

L -> R = LateR

R -> L = eaRLy

Question 7

Infant of a diabetic mother is a/w what cardiac abnormality?

Answer 7

Transposition of the great vessels

Question 8

Most common mutation to cause hypertrophic cardiomyopathy?

Answer 8

AD mutation to beta-myosin heavy chain

Question 9

Causes of dilated cardiomyopathy?

Answer 9

ABCCCD
Alcohol abuse
Beri Beri (wet)
Coxsackie B
Cocaine (chronic)
Chagas disease
Doxorubicin
\+ Hemochromatosis
\+ Sarcoidosis
\+ Peri-partum

Question 10

Causes of restrictive cardiomyopathy?

Answer 10

• Sarcoidosis (also cause of dilated)
• Amyloidosis
• Post-radiation fibrosis
• Endocardial elastosis
• Loffler syndrome (eosinophils in lung s/p parasite)
• Hemochromatosis (dilated is more common)

Question 11

How is the EDV altered in diastolic heart dysfunction?

Answer 11

Nl

Question 12

3 best treatments to reduce HF?

Answer 12

ACEI’s/ARBs
Beta-blockers (unless acute decompensated type)
Spironolactone

(thiazide and loop diuretics for symptomatic relief)

Question 13

What are the 3 types of “distributive” shock?

Answer 13

Neurogenic
Anaphylactic
Septic

Question 14

What are the unique findings in bacterial endocarditis? (recall mnemonic)

Answer 14

“FROM JANE”
Fever
Roth spots (round white spots on retina surrounded by hemorrhage)
Osler nodes (tender, raised, on finger and toe pads)
Murmur (new)
Janeway lesions (painless, red, palms and soles)
Anemia
Nailbed (splinter) hemorrhage
Emboli

+ Glomerulonephritis

Question 15

4 bugs you’d see in bacterial endocarditis, and when?

Answer 15

S. aureas (acute)
Strep viridans (subacute, must be previously altered)
S. bovis (gallolyticus) - colon cancer
S. epidermidis (prosthetic valves)

Culture negative: coxiella, bartonella, or HACEK (H. flu, aggregatibacter, cardiobacterium, eikenella, kingella)

Question 16

Review all of the causes of acute pericarditis.

Answer 16

Idiopathic (presumed viral)
Infection (eg Coxsackie B)
Neoplasia
Autoimmune (eg SLE, RA)
Uremia
CV: STEMI or Dressler syndrome
Radiation therapy

Question 17

What is Beck’s triad, and what condition is it related to?

Answer 17

Hypotension, distended neck veins, distant heart sounds

Tamponade

• Also pulsus paradoxus
• Electrical alternans

Question 18

What type of inflammation is seen in large vessel vasculitides?
PAN?

Answer 18

• Granulomatous

- PAN: fibrinoid necrosis, renal microaneurysms