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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
Q

EKG leads and blood vessel associated with inferior wall of left ventricle

A

leads II, III, and aVF

Right Coronary artery

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26
Q

EKG leads and blood vessel associated with the septal part of the heart

A

leads v1, v2

left anterior descending artery

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27
Q

EKG leads and blood vessel associated with anterior part of the heart

A

v3, v4

right coronary artery

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28
Q

EKG leads and blood vessel associated with the lateral side of the heart

A

leads I, avL, V5, V6

left circumflex artery

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29
Q

what is paradoxical embolism

A

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)

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30
Q

right-sided endocarditis of this valve is commonly associated with IV drug users and is most often due to Staphylococcus aureus

A

tricuspid valve

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31
Q

cardiac issues associated with DiGeorge syndrom

A

tetralogy of Fallot, truncus arteriosus, and transposition of the great arteries

32
Q

heart issues associated with Marfan syndrome (fibrillin-1 mutations)

A

dissecting aortic aneurysms, aortic valve regurgitatioin, an mitral valve prolapse

33
Q

define permissiveness of drug reaction

A

Presence of substance A is required for the full effects of substance B

34
Q

femoral vein is immediately ______ to the femoral artery

A

medial

35
Q

most common cause of subungual splinter hemorrhages (small hemorrhages underneath the fingernail)

A

microemboli from the valvular vegetations of bacterial endocarditis

36
Q

warfarin (Coumadin) reduces thrombus formation risk by inhibiting the activation of the vitamin K-dependent clotting factors ___, ___, __ and ___

A

II, VII, IX, and X

prolongs prothrombin time

37
Q

brain natriuretic peptide (BNP) released in response to high atrial and ventricular filling pressures to do what?

A

promote vasodilation , natriuresis, and diuresis

38
Q

most frequent mechanism of sudden cardiac death in the first 48 hours after acute MI

A

ventricular fibrillation

atrial fibrillation can occur but does not lead to sudden cardiac death

39
Q

most common predisposing condition for valve infective endocarditis in developed nations vs. developing nations

A

developed nations: mitral valve prolapse

developing nations: rheumatic heart disease

40
Q

findings on EKG for Wolf-Parkinson-White syndrome

A

(accessary tract bypass AV node)

short PR interval, widening of the QRS interval, slurred and broad upstroke of the QRS complex (delta wave)

41
Q

polyarteritis nodosa usually spares which arteries?

A

pulmonary arteries

usually involves renal and visceral vessels

42
Q

characteristic/ definition of diastolic heart failure

A

normal ventricular ejection fraction, normal end-diastolic volume, but with increased LV filling pressure

43
Q

phenyephrine is a selective _______ receptor ______

what does it do for the heart?

A

alpha-1; agonist

vasoconstrict, increase peripheral vascular resistance and systolic blood pressure, decreases pulse pressure and heart rate

44
Q

fibrates mechanism of action

A

lower triglyceride by activating peroxisome proliferator-activated receptor alpha (PPAR-alpha)–> decreased hepatic VLDL production and increased lipoprotein lipase activity

45
Q

4 drug types that improve long-term survival in patients with heart failure

A

beta blockers, ACE inhibitors, angiotensin II receptor blockers, and aldosterone antagonists

46
Q

what is the Kussmaul sign and when do you see it?

A

increase in JVP on inspiration instead of the normal decrease

see it in constrictive pericarditis, restrictive cardiomyopathies, right atrial and ventricular tumors

47
Q

action of milrinone on cardiomyocytes vs. vascular smooth muscles

A

cardiomyocytes: increase cAMP–> calcium influx–> increase cardiac contractility

vascular smooth muscle: increase cAMP–> systemic vasodilation

48
Q

beta1 adrenergic receptors are found where?

A

cardiac tissue, renal juxtaglomerular cells

NOT vascular smooth muscle

49
Q

atherosclerotic plaques develop predominantly in these vessels: (in decreasing order)

A

abdominal aorta, coronary arteries, popliteal arteries, internal carotids, and circle of Willis

50
Q

why is it bad to use nitrates and phosphodiesterase inhibitors used in erectile dysfunction together?

A

both enhanced synthesis (nitrates) and inhibit degradation (PDE inhibitors) of cGMP–> cGMP accumulates–> profound hypotension from extreme vasodilatation

51
Q

what has to be the same in both pulmonary circulation and systemic circulation during exercise and rest?

A

blood flow per minutes

otherwise systemic circulation will run out of blood

52
Q

aortic regurgitation- sounds? and when?

A

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
Q

how to hear the left ventricular gallops (S3 and /or S4) better?

A

bell over cardiac apex while patient in left lateral decubitus

listen at end expiration - heart closer to chest wall

54
Q

what would you find on the histology of cardiac sarcoidosis

A

noncaseating granulomas with giant cells

55
Q

what is the most common adverse effect of fibrinolytic therapy

A

hemorrhage…. like intracerebral hemorrhage

56
Q

triggers for prinzmetal (variant) angina

A

cigarette, cocaine/amphetamines, dihydroergotamine/triptans

treated with vasodilatation

57
Q

what are janeway lesions

A

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
Q

what heart issues are associated with S4?

A

decreased left ventricular compliance like with restrictive cardiomyopathy and left ventricular hypertrophy

59
Q

carotid sinus baroreceptors send their information to the brainstem using the __________ nerve

A

glossopharyngeal nerve

60
Q

aortic arch baroreceptors send their information to the brainstem using the _______ nerve

A

vagus nerve

61
Q

most common cause of coronary sinus dilation

A

elevated right-sided heart pressure like when it is secondary to pulmonary hypertension

dilation is due to dilation of the right atrium

62
Q

adverse effects of thiazide

A

hyperGLUC

hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia, sulfa allergy, hypokalemic metabolic alkalosis

63
Q

what is myocardial hibernation

A

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
Q

gene mutation associated with hereditary form of cardiac amyllodosis

A

transthyretin gene

65
Q

mutation in what genes are associated with hypertrophic cardiomyopathy

A

cardiac sarcomere genes like cardiac beta-myosin heavy chain gene and myosin-binding protein C gene)

auto dominant

66
Q

effects of norepinephrine

A

alpha1-vasoconstricting effects

has beta2 activity so can increase cardiac output

67
Q

effects of epinephrine

A

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
Q

effects of isoproterenol

A

pute beta agonist, zero alpha activity

increase cardiac output but cause vasodilation

no alpha, so will greater drop in bp with isoproterenol

69
Q

effects of dopamine

A

low dose- vasodilation in kidneys and gut
medium dose- beta1 increase cardiac output
high dose-alpha1 activity and vasoconstrict

70
Q

effects of phenylephrine

A

pure alpha agonist so vasocontrict and increase bp

can lead to reflex bradycardia

71
Q

how do you best hear pericardial friction rub

A

when patient is leaning forward or lying prone

scratchy sound

72
Q

combination of ________ and _______ can have additive negative chronotropic effects yielding severe bradycardia and hypotension

A

non-dihydropyridine calcium channel blockers and beta-adrenergic blockers

73
Q

side effects of adenosine

A

flushing, chest burning (due to bronchospasm), hypotension, and high-grade atrioventricular block

74
Q

what do you use to treat widened QRS interval or ventricular arrhythmias due to fast sodium channel blockade? (like with tricyclic antidepressant overdose)

A

sodium bicarbonate–> increase serum pH and extracellular sodium

75
Q

heart issues associated with carcinoid syndrome

A

pathognomonic plaque-like deposits of fibrous tissue on right sided endocarium

–> tricuspid regurgitation and right-sided heart failure

76
Q

most common arrhythmia in those with inferior wall MI

A

sinus bradycaria due to both nodal ischemia and enhanced vagal tone

managed with intravenous atropine (anticholinergic that fixes DUMBBELSS: bradycardia included)

77
Q

in large-vessel vasculitis (giant (temporal) arteritis and Takayasu arthritis, what do you use as initial test?

A

erythrocyte sedimentation rate since it would be elevated in both

UWorld Journal (18 decks)

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