Cardiovascular

Question 1

Drug given to close PDA

Answer 1

Indomethacin

Question 2

increased LV diastolic pressure in patient with mitral stenosis indicates what other pathologic condition in this patient’s heart?

Answer 2

dysfunctional aortic valve

Question 3

isolated Mitral stenosis causes changes in vascular pressure in what anatomical location

Answer 3

pulmonary artery pressure (pulmonary hypertension)

Question 4

Effect of long standing pulmonary hypertension

Answer 4

results in reduced pulmonary compliance due to endothelial-mediated pulmonary vasoconstriction, reactive hypertrophy of arterial muscle layer, and partial obliteration of pulmonary capillary bed.

Question 5

isolated mitral stenosis causes elevated pressure in what heart chamber

Answer 5

left atrium, which is then transmitted to pulmonary veins and capillaries (increase pulmonary wedge cap pressure)

Question 6

Diastolic pressure in left ventricle in patient with severe mitral stenosis

Answer 6

usually normal or even decreased

Question 7

absence of peripheral edema is best explained by which compensatory mechanism

Answer 7

tissue lymphatic drainage

Question 8

chronic hypoxia in COPD leads to…

Answer 8

pulmonary vasoconstriction, increased pulmonary artery pressure, and right heart failure

Question 9

Right heart failure causes what changes in systemic vascular pressure

Answer 9

increased CVP and excessive hydrostatic pressure, predisposing to peripheral edema

Question 10

factors that favor development of peripheral edema (4)

Answer 10

1. elevated capillary hydrostatic pressure 2. decreased plasma oncotic pressure 3. sodium and water retention 4. lymphatic obstruction

Question 11

peripheral edema is accumulation of fluid in what compartment

Answer 11

interstitial space

Question 12

holosystolic murmur best heard at apex of heart that radiates to axilla

Answer 12

MITRAL REGURGITATION; generated by regurgitant blood flow from LV back to LA during diastole; produces audible S3

Question 13

Why is audible S3 heard in mitral regurgitation?

Answer 13

elevated pressure and blood volume in LA, increased the amount of blood reentering LV during DIASTOLE;

Question 14

mechanism behind audible s3 gallop

Answer 14

generated by the sudden cessation of blood flow into LV during passive filling phase of diastole. LV is unable to accommodate excess blood flow

Question 15

when you see S3, think..

Answer 15

classically associated with heart failure

Question 16

Absence of S3…

Answer 16

used to exclude severe chronic MR

Question 17

S4

Answer 17

low-frequency diastolic sound that occurs during the atrial kick of ventricular diastole, reflects blood colliding with stiff ventricular wall

Question 18

S4 pathology

Answer 18

indicated hypertrophic caridiomyopathy or concentric left ventricular hypertrophy (due to hypertension or aortic stenosis)

Question 19

mid-systolic click

Answer 19

characteristic or mitral valve prolapse; occurs earlier in systole with physical maneuvers that decrease left ventricular volume

Question 20

opening snap

Answer 20

early diastolic sound after S2 in patients with mitral or tricuspid stenosis; decrease interval between S2 and opening snap correlates with increase severity (more stenotic mitral valve)

Question 21

hypertrophic cardiomyopathy inheritance

Answer 21

typically autosomal dominant; patients often have family history of HCM or unexplained sudden cardiac death

Question 22

ECG findings of HCM

Answer 22

1. overall increase in LV mass 2. reduced LV cavity size –>impairing diastolic function 3. asymmetric increase in LV wall thickness, predominantly affecting septum 4. normal/increased LV ejection fraction 5. left atrial enlargement (secondary to increased LV end-diastolic pressure)

Question 23

coronary capillary situation in hypertrophic cardiomyopathy

Answer 23

poorly developed coronary capillary network; evidence of chronic ischemia in hypertrophied regions (ie fibrosis, scarring)

Question 24

Difference between athlete’s heart (cardiac adaption) and pathologic hypertrophic cardiomyopathy

Answer 24

athlete’s heart does not have reduced LV cavity size and localized septal wall thickening

Question 25

severe coronary artery disease associated cardiomyopathy

Answer 25

ischemic cardiomyopathy that typically manifests as dilated cardiomyopathy with enlarged LV cavity and thin LV walls with impaired systolic fxn

Question 26

viruses (5) that can cause viral myocarditis

Answer 26

adenovirus coxsackie b parvovirus B19 HIV HHV-6 viral myocarditis may sometimes lead to dilated cardiomyopathy with eccentric hypertrophy and impaired LV systolic function

Question 27

meiotic nondisjunction

Answer 27

when chromosomes fail to separate, allowing one or more daughter cells to pass on extra copy of a chromosome. most common consequences of maternal nondisjunction=trisomies 21 (down syndrome), 18 (edwards syndrome), and 13 (patau syndrome)

Question 28

compensation of chronic aortic regurgitation to maintain cardiac output

Answer 28

increase LV stroke volume; due to increase in LV end-diastolic volume (volume overload)

Question 29

type of hypertrophy that occurs in aortic regurgitation

Answer 29

eccentric hypertrophy due to volume overload

Question 30

principle behind pharmacologic stress tests with coronary vasodilators

Answer 30

pharmacologic stress agents (ie, adenosine, dipyridamole) are used during myocardial perfusion imaging to simulate the generalized coronary arteriole dilation caused by exercise to assist in identifying areas of ischemic myocardium

Question 31

coronary steal syndrome

Answer 31

redistribution of blood flow directed toward newly vasodilated areas of nonischemic myocardium

Question 32

Change in cardiac cycle regarding mitral regurgitation

Answer 32

increased LA atrial pressure (normal is approx. 10 mm Hg); results in early and large V wave

Question 33

best time to hear mumur throughout cardiac cycle

Answer 33

when the difference in pressure between the two areas (ie LV and aorta) are at largest difference (when LV pressure is highest compared to aortic valve pressure)

Question 34

holosystolic murmur found in…

Answer 34

1. VSD 2. tricuspid regurgitation 3. mitral regurgitation

Question 35

holosystolic mumur best heard where (anatomic location)?

Answer 35

lower left sternal border

Question 36

bifid carotid pulse with brisk upstroke found in what pathology?

Answer 36

characteristic of hypertrophic cardiomyopathy, a condition with dynamic LV outflow tract obstruction during systole.

Question 37

decreased femoral-to-brachial blood pressure ratio is found in …

Answer 37

coarctation of aorta

Question 38

fixed splitting of S2 found in

Answer 38

atrial septal defect, causes increased SpO2 in RA compared with vena cava

Question 39

eisenmenger syndrome caused by

Answer 39

uncorrected left-to-right shunt (VSD, ASD, PDA)

Question 40

Down syndrome CV abnormalities

Answer 40

endocardial cushion defects (ostium primum atrial septal defects, regurgitant AV valves)

Question 41

DiGeorge syndrome CV abnormalities

Answer 41

1. tetralogy of fallot 2. interrupted aortic arch (complete form of coarctation)

Question 42

Friedreich ataxia CV abnormalities

Answer 42

hypertrophic cardiomyopathy

Question 43

Kartegener syndrome CV abnormalities

Answer 43

situs inversus

Question 44

Marfan syndrome CV abnormalities

Answer 44

1. cystic medial necrosis (eg aortic dissection and aneurysm) 2. mitral valve prolapse

Question 45

Tuberous sclerosis CV abnormalities

Answer 45

valvular obstruction due to cardiac rhabdomyomas

Question 46

turner syndrome CV abnormalities

Answer 46

1. aortic coarctation 2. bicuspid aortic valve

Question 47

change in pulse pressure seen in aortic regurgitation

Answer 47

widened pulse pressure due to compensatory increase in SV + reduced diastolic pressure in AR

Question 48

characteristic physical findings in Aortic Regurgitaton

Answer 48

head bobbind and ‘pistol-shot’ femoral pulses