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UWorld Journal > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

position of the aorta and the pulmonary artery

A

aorta is posterior to the pulmonary artery

if anterior, then spiraling occurs that lead to transposition of the great arteries

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2
Q

heart issues associated with turner syndrome

A

bicuspid aortic valve and aortic coarctation (femoral pulses

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3
Q

heart sound of nonstenotic bicuspid aortic valve

A

early systolic, high frequency click heard over the right second interspace

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4
Q

heart issues associated with Down syndrome

A

complete atrioventricular canal, atrial septal defect (ASD), and ventricular septal defect (VSD)

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5
Q

what is pulsus paradoxus

A

physical finding in cardiac tamponade and refers to an exaggerated drop in systolic blood pressure (>10 m Hg) during inspiration

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6
Q

what are atrial natriuretic peptide?

what tissue produces it?

A

secreted by atrial cardiomycytes in response to atrial stretch due to hypertension or hypervolemia

causes peripheral vasodilation and increased urinary excretion of Na and water

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7
Q

what is the pulmonary capillary wedge pressure measuring?

A

Left atrial pressure and left ventricular end-diastolic pressure

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8
Q

tetralogy of fallot-cause

A

caused by anterosuperior displacement of infundibular septum

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9
Q

4 things of tetralogy of fallot

A

1) pulmonary infundibular stenosis (most important determinant for prognosis)
2) right ventricular hypertrophy - boot-shaped heart on CXR
3) overriding aorta over the right and left ventricles
4) Ventricular septal defect

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10
Q

symptom of tetralogy of fallot

A

“tet spells” or cyanotic spells that improve with squatting, prominent right ventricular impulse, systolic murmur

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11
Q

difference in location of action between the two types of calcium channel blockers

A

1) dihydrophyridines- affect arterial smooth muscles, causing vasodilation with little or no effect on cardiac conduction or contractility
2) nondihydropyridine affect myocardium, slow heart rate and reduce contractility

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12
Q

dystrophic calcification

A

a hallmark of cell injury and death, occuring in all types of necrosis in the setting of normal calcium levels

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13
Q

what is the only drug that slows heart rate with no effect on cardiac contractility (inotropy) and/or relaxation (lusitropy)

A

ivabradine

-slows the SA node firing by selective inhibition of funny sodium channels–> prolong slow depolarizatioin phase (phase 4)

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14
Q

fixed splitting of S2 is associated to what defect

A

atrial septal defect

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15
Q

heart sound of ventricular septal defect

A

holosystolic murmur, similar to that of mitral regurg

“harsh” sounding, whereas regurg are “high pitched”

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16
Q

what heart condition can asian children with Kawasaki diseases develop?

A

coronary artery aneurysms, thrombosis or rupture

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17
Q

single most important risk factor for the development of intimal tears leading to aortic dissection

A

hypertension

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18
Q

major vascular beds that are the most susceptible to atherosclerosis (2)

A

lower abdominal aorta and coronary arteries

-regions involve bends and branch points are most susceptible de to turbulence

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19
Q

heart sound of aortic stenosis

A

systolic crescendo-descrescendo murmur best heard at base of heart with radiation to neck

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20
Q

heart sound of aortic or pulmonic regurgitatioin

A

early diastolic descrescendo murmur

wide pulse pressure-head bobs

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21
Q

heart sound of mitral or tricuspid regurgitatioin

A

holosystolic or pansystolic murmur (same intensity for the duration of systole)

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22
Q

heart sound of mitral valve prolapse

A

click followed by a murmur

click due to sudden tensing of the chordae tendinae that stops the movement of the valve

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23
Q

heart sounds of mitral or tricuspid stenosis

A

murmur beginning with a opening “snap” when stenotic valve finally opens the a turbulent rumbling murmur

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24
Q

cardiac tissue conduction velocity “Park At Vent Avenue” -rank from slowest to fastest

A

AV node, ventricular muscle, atrial muscle, purkinje system

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25
EKG leads and blood vessel associated with inferior wall of left ventricle
leads II, III, and aVF Right Coronary artery
26
EKG leads and blood vessel associated with the septal part of the heart
leads v1, v2 left anterior descending artery
27
EKG leads and blood vessel associated with anterior part of the heart
v3, v4 right coronary artery
28
EKG leads and blood vessel associated with the lateral side of the heart
leads I, avL, V5, V6 left circumflex artery
29
what is paradoxical embolism
when a thrombus from the venous system crosses into the arterial circulation via an abnormal connection between the right and left cardiac chambers (eg, patent foramen ovale, atrial septal defect or ventricular septal defect)
30
right-sided endocarditis of this valve is commonly associated with IV drug users and is most often due to Staphylococcus aureus
tricuspid valve
31
cardiac issues associated with DiGeorge syndrom
tetralogy of Fallot, truncus arteriosus, and transposition of the great arteries
32
heart issues associated with Marfan syndrome (fibrillin-1 mutations)
dissecting aortic aneurysms, aortic valve regurgitatioin, an mitral valve prolapse
33
define permissiveness of drug reaction
Presence of substance A is required for the full effects of substance B
34
femoral vein is immediately ______ to the femoral artery
medial
35
most common cause of subungual splinter hemorrhages (small hemorrhages underneath the fingernail)
microemboli from the valvular vegetations of bacterial endocarditis
36
warfarin (Coumadin) reduces thrombus formation risk by inhibiting the activation of the vitamin K-dependent clotting factors ___, ___, __ and ___
II, VII, IX, and X prolongs prothrombin time
37
brain natriuretic peptide (BNP) released in response to high atrial and ventricular filling pressures to do what?
promote vasodilation , natriuresis, and diuresis
38
most frequent mechanism of sudden cardiac death in the first 48 hours after acute MI
ventricular fibrillation atrial fibrillation can occur but does not lead to sudden cardiac death
39
most common predisposing condition for valve infective endocarditis in developed nations vs. developing nations
developed nations: mitral valve prolapse developing nations: rheumatic heart disease
40
findings on EKG for Wolf-Parkinson-White syndrome
(accessary tract bypass AV node) short PR interval, widening of the QRS interval, slurred and broad upstroke of the QRS complex (delta wave)
41
polyarteritis nodosa usually spares which arteries?
pulmonary arteries usually involves renal and visceral vessels
42
characteristic/ definition of diastolic heart failure
normal ventricular ejection fraction, normal end-diastolic volume, but with increased LV filling pressure
43
phenyephrine is a selective _______ receptor ______ what does it do for the heart?
alpha-1; agonist vasoconstrict, increase peripheral vascular resistance and systolic blood pressure, decreases pulse pressure and heart rate
44
fibrates mechanism of action
lower triglyceride by activating peroxisome proliferator-activated receptor alpha (PPAR-alpha)--> decreased hepatic VLDL production and increased lipoprotein lipase activity
45
4 drug types that improve long-term survival in patients with heart failure
beta blockers, ACE inhibitors, angiotensin II receptor blockers, and aldosterone antagonists
46
what is the Kussmaul sign and when do you see it?
increase in JVP on inspiration instead of the normal decrease see it in constrictive pericarditis, restrictive cardiomyopathies, right atrial and ventricular tumors
47
action of milrinone on cardiomyocytes vs. vascular smooth muscles
cardiomyocytes: increase cAMP--> calcium influx--> increase cardiac contractility vascular smooth muscle: increase cAMP--> systemic vasodilation
48
beta1 adrenergic receptors are found where?
cardiac tissue, renal juxtaglomerular cells NOT vascular smooth muscle
49
atherosclerotic plaques develop predominantly in these vessels: (in decreasing order)
abdominal aorta, coronary arteries, popliteal arteries, internal carotids, and circle of Willis
50
why is it bad to use nitrates and phosphodiesterase inhibitors used in erectile dysfunction together?
both enhanced synthesis (nitrates) and inhibit degradation (PDE inhibitors) of cGMP--> cGMP accumulates--> profound hypotension from extreme vasodilatation
51
what has to be the same in both pulmonary circulation and systemic circulation during exercise and rest?
blood flow per minutes otherwise systemic circulation will run out of blood
52
aortic regurgitation- sounds? and when?
high-pitched, blowing decrescendo diastolic murmur immediately after closure of aortic valve best heard when patient is sitting up and learning forward with head exhale
53
how to hear the left ventricular gallops (S3 and /or S4) better?
bell over cardiac apex while patient in left lateral decubitus listen at end expiration - heart closer to chest wall
54
what would you find on the histology of cardiac sarcoidosis
noncaseating granulomas with giant cells
55
what is the most common adverse effect of fibrinolytic therapy
hemorrhage.... like intracerebral hemorrhage
56
triggers for prinzmetal (variant) angina
cigarette, cocaine/amphetamines, dihydroergotamine/triptans treated with vasodilatation
57
what are janeway lesions
nontender, macular, and erythematous lesions located on palms and soles due to septic embolization from valvular vegetations composed of bacteria, neutrophils (microemboli), necrotic material and subcutaneous hamorrhage
58
what heart issues are associated with S4?
decreased left ventricular compliance like with restrictive cardiomyopathy and left ventricular hypertrophy
59
carotid sinus baroreceptors send their information to the brainstem using the __________ nerve
glossopharyngeal nerve
60
aortic arch baroreceptors send their information to the brainstem using the _______ nerve
vagus nerve
61
most common cause of coronary sinus dilation
elevated right-sided heart pressure like when it is secondary to pulmonary hypertension dilation is due to dilation of the right atrium
62
adverse effects of thiazide
hyperGLUC hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia, sulfa allergy, hypokalemic metabolic alkalosis
63
what is myocardial hibernation
state of chronic myocardial ischemia in which both myocardial metabolism and function are reduced to match the reduction in coronary blood flow to prevent myocardial necrosis
64
gene mutation associated with hereditary form of cardiac amyllodosis
transthyretin gene
65
mutation in what genes are associated with hypertrophic cardiomyopathy
cardiac sarcomere genes like cardiac beta-myosin heavy chain gene and myosin-binding protein C gene) auto dominant
66
effects of norepinephrine
alpha1-vasoconstricting effects | has beta2 activity so can increase cardiac output
67
effects of epinephrine
beta1 and beta2 agonist at higher doses have more alpha activity increase cardiac output through beta1 can have vasodilatory effects so decrease bp because of beta2
68
effects of isoproterenol
pute beta agonist, zero alpha activity increase cardiac output but cause vasodilation no alpha, so will greater drop in bp with isoproterenol
69
effects of dopamine
low dose- vasodilation in kidneys and gut medium dose- beta1 increase cardiac output high dose-alpha1 activity and vasoconstrict
70
effects of phenylephrine
pure alpha agonist so vasocontrict and increase bp can lead to reflex bradycardia
71
how do you best hear pericardial friction rub
when patient is leaning forward or lying prone scratchy sound
72
combination of ________ and _______ can have additive negative chronotropic effects yielding severe bradycardia and hypotension
non-dihydropyridine calcium channel blockers and beta-adrenergic blockers
73
side effects of adenosine
flushing, chest burning (due to bronchospasm), hypotension, and high-grade atrioventricular block
74
what do you use to treat widened QRS interval or ventricular arrhythmias due to fast sodium channel blockade? (like with tricyclic antidepressant overdose)
sodium bicarbonate--> increase serum pH and extracellular sodium
75
heart issues associated with carcinoid syndrome
pathognomonic plaque-like deposits of fibrous tissue on right sided endocarium --> tricuspid regurgitation and right-sided heart failure
76
most common arrhythmia in those with inferior wall MI
sinus bradycaria due to both nodal ischemia and enhanced vagal tone managed with intravenous atropine (anticholinergic that fixes DUMBBELSS: bradycardia included)
77
in large-vessel vasculitis (giant (temporal) arteritis and Takayasu arthritis, what do you use as initial test?
erythrocyte sedimentation rate since it would be elevated in both

UWorld Journal (18 decks)

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