Cardiovascular Flashcards

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1
Q

Coronary autoregulation allows coronary blood flow to be primarily driven by myocardial O2 demand over a wide range of perfusion pressures (60-140 mmHg) and is controlled via release of what?

A

Adenosine and NO

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2
Q

How do you calculate stroke volume (SV) and ejection fraction?

A
  • SV = EDV - ESV
  • EF: Stroke Volume / EDV
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3
Q

Which acid-base physiological changes are seen when patient is at high altitude and develops altitude sickness?

A
  • Low PiO2 –> compensatory hyperventilation –> respiratory alkalosis
  • Kidneys respond by decreasing HCO3- reabsorption and H+ secretion —> compensatory metabolic acidosis
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4
Q

Sick sinus syndrome most commonly results from what; describe the findings seen on ECG?

A
  • Age-related degeneration of the SA node, located in the RA wall
  • ECG findings = bradycardia, sinus pauses (delayed P waves), and sinus arrest (prolonged delayed of a P wave such that P wave is dropped)
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5
Q

Which type of breathing pattern is often seen in pt’s with advanced congestive heart failure (CHF)?

A

Cheyne-Stokes breathing: cyclic breathing pattern in which apnea is following by gradually increasing and then decreasing tidal volumes until next apneic period.

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6
Q

Atrial septal defects with left-to-right shunting typically cause what ausculatory finding on PE?

A

Wide and fixed splitting (no change with respiration) of the 2nd heart sound (S2)

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7
Q

How can a paradoxical embolism arise in a patient with net left-to-right shunting?

A

Transient reversal of the shunt during periods of elevated right-sided pressure (i.e., early ventricular systole, straining during coughing or defecation)

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8
Q

The inferior wall of which ventricle forms the majority of the inferior (diaphragmatic) surface of the heart and what is its blood supply?

A

Inferior wall of LV supplied by posterior descending a. - branch of the right coronary a. (RCA)

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9
Q

10% of people have left dominant circulation meaning the posterior descending artery derives from where?

A
  • Circumflex branch of the left main coronary a.

*Typically arises from right main coronary a.

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10
Q

Which artery supplies the wall of the RV and may provide collateral circulation in pt’s with LAD occlusion?

A

Right marginal branch of the RCA

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11
Q

Occlusion of the right coronary artery may affect which areas of the heart during MI?

A
  • LV due to inferior wall being supplied by posterior descending a. arising from RCA
  • RV due to marginal a. arising from RCA
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12
Q

What is the hallmark murmur heard with mitral valve prolapse (MVP)?

A

Mid-systolic click, often accompanied by late systolic murmur

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13
Q

Immunohistochemistry is important diagnostic marker for mesothelioma as nearly all cases stain (+) for what?

A

Cytokeratins and many also (+) for calretinin

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14
Q

When does papillary muscle rupture following an MI typically occur and what are the distinct PE findings?

A
  • Within 3-5 days
  • Acute, severe pulmonary edema + severe mitral regurgitation w/ flail leaflet
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15
Q

What are the distinct PE findings of an interventricular septum rupture/defect following an MI?

A
  • New holosystolic murmur
  • Stepped-up O2 level between the RA and ventricle
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16
Q

A loud pulmonic component of S2 and an accentuated, palpable impulse at the left sternal border (left parasternal lift) is seen with what condition?

A

Pulmonary HTN

17
Q

Which mutation is the most common cause of familial dilated cardiomyopathy?

A

Truncating mutations (usually nonsense) affecting TTN gene encoding for the sarcomere protein titin

18
Q

Myxomatous changes with pooling of proteoglycans in the media layer of large arteries are found in cystic medial degeneration, which predisposes to the development of what; commonly seen in association with what syndrome?

A
  • Aortic dissections and aortic aneurysms
  • Medial degeneration is commonly seen in younger pt’s with Marfan syndrome
19
Q

Which type of angina is more common in younger pt’s (<50) and is characterized by recurrent chest pain at rest or during sleep which resolves in 15 mins or less?

A

Vasospastic angina (aka Prinzmetal)

20
Q

Where is the most deoxygenated blood in the body found and why?

A
  • Cardiac venous blood in the coronary sinus
  • O2 extraction from the blood by resting myocardium is higher than that extracted by any other tissue
21
Q

Holosystolic murmurs can be associated with what 3 conditions?

A
  • Tricuspid regurgitation (TR): increases w/ inspiration
  • Mitral regurgitation (MR): radiates to axilla
  • Ventricular septal defct (VSD): loud and accompanied by thrill
22
Q

What structure does a venous catheter traveling from the right femoral vein pass through to get into the left atrium?

A

Interatrial septum at the site of foramen ovale

23
Q

Why are inferior MI’s often associated with bradycardia?

A

Due to blockage of RCA, which is responsible for perfusing the SA and AV nodes

24
Q

Coronary dominance is determined by what; what is a right vs. left dominant heart?

A
  • Determined by the coronary artery that supplies blood to the posterior descending artery (PDA)
  • Right coronary artery: 70% of population = right dominant
  • Left circumflex artery: 10% of population = left dominant
25
Q

How is the murmur associated with hypertrophic cardiomyopathy best differentiated from that of aortic stenosis?

A
  • Using maneuvers that affect LV preload
  • Maneuvers such as valsalva, rapid standing, and infusion of nitroglycerin all decrease LV preload —> increasing intensity of hypertrophic cardiomyopathy
  • Maneuvers such as passive leg raise or squatting lead to increased LV preload –> increasing intensity of aortic stenosis
26
Q

Blunt aortic injury (i.e., traumatic aortic rupture) is most commonly associated with injury to which part of the aorta?

A

Aortic isthmus, which is tethered by the ligamentum arteriosum

27
Q

In patients with mitral regurgitation what is the best indicator of severe MR with left-sided volume overload?

A

Audible S3 gallop

28
Q

Nonbacterial thrombotic endocarditis (NBTE) is most commonly associated with which 2 underlying conditions?

A
  • Advanced malignancy: especially mucinous adenocarcinoma
  • SLE –> Libman-Sacks endocarditis
29
Q

What is the most common underlying valvular disease predisposing to the development of infective endocarditis in developed countries?

A

Mitral valve prolapse (MVP), particularly when it is associated with coexistent mitral regurgitation