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Cardiovascular system - lecturio > Cardiovascular pathology > Flashcards

Cardiovascular pathology Flashcards

1
Q

What is required to confirm a diagnosis of hypertension?

A

At least 3 measurements of greater than 130/80 mm Hg on 3 separate office visits

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2
Q

What is primary hipertension?

A

Primary hypertension is defined as high blood pressure with no specific cause, unlike secondary hypertension

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3
Q

Immediate treatment is necessary on which single measurement blood pressure reading?

A

Greater than or equal to either 210 systolic OR 120 diastolic

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4
Q

What are the restrictions when treating a hypertensive emergency?

A

Lower blood pressure by no more than 25% over several minutes using IV nitroprusside

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5
Q

How do you manage a hypertensive urgency?

A

Reduce blood pressure over hours-days using oral medications

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6
Q

What is hypertensive urgency?

A

Highly elevated blood pressure with no end organ damage

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7
Q

Which anti-hypertensive class is the initial drug of choice for patients with stage I hypertension?

A

Thiazide diuretics

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8
Q

What is the name of the receptor found in the juxtaglomerular apparatus?

A

B1

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9
Q

What substance increases during renal ischemia and causes the release of angiotensin I?

A

Renin

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10
Q

Angiotensin II affects which part of the glomerular apparatus?

A

Efferent arteriole

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11
Q

What is the most probable cause of hypertension in a young female patient with a string-of-beads finding on renal angiography?

A

Fibromuscular dysplasia

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12
Q

Which anti-hypertensive medication is contraindicated in patients with atheromatous disease because it may precipitate renal failure?

A

ACE inhibitors

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13
Q

What condition caused by excessive exposure to cortisol presents with truncal obesity, buffalo hump, abdominal striae, and moon facies?

A

Cushing’s syndrome

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14
Q

What condition presents with increased aldosterone and decreased renin levels due to an adrenal mass?

A

Conn’s syndrome

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15
Q

Which of the following conditions cause episodic hypertension in 50% of cases, headaches, diaphoresis, and palpitations due to excessive catecholamine release?

A

Pheochromocytoma

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16
Q

What is the catecholamine metabolite that is commonly tested for in the urine of patients suspected of having pheochromocytoma?

A

vanillylmandelic acid (VMA)

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17
Q

Hyperparathyroidism causes increased calcium which causes hypertension by which mechanism?

A

Increased peripheral vascualar resistance (PVR)

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18
Q

Decreased perfusion of the kidney in coarctation of the aorta will cause the release of which substance which leads to an increase in blood pressure?

A

Renin

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19
Q

What is the first-line drug for the management of hypertension?

A

Thiazides

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20
Q

Which class of anti-hypertensive medications should be avoided in patients with bronchial asthma?

A

Beta blockers

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21
Q

Which class of anti-hypertensive medications is contraindicated in patients with hyperkalemia?

A

Aldosterone receptor blockers

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22
Q

What is the mechanism by which atherosclerosis decreases the supply of oxygenated blood to the heart?

A

It reduces the diameter of coronary vessels

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23
Q

What is the first event in the development of atherosclerotic disease?

A

Endothelial injury

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24
Q

What is the most common lipoprotein that accumulates in atherosclerosis?

A

LDL

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25
Q

What are foam cells?

A

Lipid-laden macrophages

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26
Q

What are the phases of formation in atherosclerosis? (6)

A
  • Endothelial injury
  • acumulation of lipoproteins (mainly LDL)
  • monocyte adhesion and migration into tunica intima to form foam cells
  • factors release by machrophages,platelets, and endothelial cells recuit smooth muscle
  • smooth muscle hyperplasia, extracelullar matrix production and recrutation of lymphocytes
  • death of foam cells and formation of a necrotic center
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27
Q

Effective digestion of lipids occurs in which part of the digestive tract?

A

Duodenum

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28
Q

Which hormone stimulates the gallbladder to release bile?

A

cholecystokinin (CCK)

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29
Q

Triglycerides are removed from chylomicrons by which enzyme?

A

Capillary lipoprotein lipase

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30
Q

Which lipoprotein scavenges cholesterol and transports it back to the liver?

A

HDL

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31
Q

Which lipoprotein is elevated in Type IV hypertriglyceridemia?

A

VLDL

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32
Q

Which type of hyperlipidemia is associated with elevation of cholesterol only due to accumulation of LDL?

A

Type IIa

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33
Q

Which lipoprotein accumulates in Type III hyperlipidemia?

A

IDL

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34
Q

Which is the most common phenomenon associated with atherosclerosis that complicates myocardial infarction?

A

Decrease in blood supply

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35
Q

Which components does the fibrin cap consist of?

A

Smooth muscle and fibrous tissue

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36
Q

Which receptors are exposed in the initiation of thrombus formation in the atherosclerotic plaque?

A

Receptors for vWF (Von Willibrand Factor).

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37
Q

What mechanism of injury is employed after oxidation of LDL in the atherosclerotic process?

A

Free radical injury

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38
Q

What percentage of coronary arterial occlusion can cause chest pain to occur during rest?

A

70%

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39
Q

Which cell, when modified, can transform into a foam cell?

A

machrophages

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40
Q

Which cells initiates smooth muscle recruitment during the development of atherosclerosis?

A

Endothelial cells and macrophages

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41
Q

Which leads represent the area of the heart supplied by the left anterior descending artery?

A

Leads V1 and V2 - which supply the anterior 2/3 of the interventricular septum

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42
Q

How does sublingual nitroglycerin reduce pain in angina?

A

Venous vasodilation reduces preload and arteriolar vasodilation reduces afterload

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43
Q

Which of the following are considered acute coronary syndromes?

A

Chest pain at rest OR myocardial infarction

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44
Q

What type of channel is blocked by Class I antiarrhythmics?

A

Voltage-gated sodium channels

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45
Q

Unstable angina and myocardial infarction can both present with chest pain at rest that is not alleviated by nitroglycerin. What is the major difference between unstable angina and a myocardial infarction?

A

Myocardial infarction will have a positive troponin I

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46
Q

How do you confirm stable angina clinically?

A

Cardiac stress test showing ST changes

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47
Q

How do you diagnose a non-STEMI?

A

Positive cardiac enzyme - troponin I and ST depression on ECG

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48
Q

Which of the following are common complications to consider in a patient presenting 3 days to 2 weeks following a myocardial infarction?

A

Papillary muscle rupture and free wall rupture

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49
Q

What type of pericarditis would you expect weeks to months following a myocardial infarction?

A

Dressler’s syndrome caused by autoimmune pericarditis

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50
Q

What is the usual ECG finding in a transmural infarction?

A

ST segment elevation

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51
Q

What is the usual ECG finding in a subendocardial infarction?

A

ST segment depression

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52
Q

Which lab value is the gold standard in the diagnosis of myocardial infarction?

A

Troponin I

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53
Q

Coronary Steal Syndrome can occur upon the administration of which class of medication?

A

Vasodilators

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54
Q

From the lumen to the surface of the heart, what are the layers of the heart and how are they perfused?

A

The endocardium is closest to the lumen, then the myocardium, these are both supplied by arterioles and the arteries supply the pericardium at the surface of the heart

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55
Q

Anatomically, what is the difference between a STEMI and a non-STEMI?

A

A non-STEMI involves a subendocardial infarction due to occlusion of coronary arterioles

A STEMI involves a transmural infarction due to occlusion of the coronary arteries

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56
Q

If occluded coronary arteries are already maximally dilated, how does coronary steal syndrome occur?

A

Vasodilation in vessels near the occlusion causes further ischemia of occluded areas

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57
Q

Which leads represent areas perfused by the right coronary artery?

A

II, III, aVF

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58
Q

Which part of the heart is the most susceptible to hypoxia?

A

Subendocardial

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59
Q

Which aspect of the heart and which corresponding leads on the ECG will be affected by a complete occlusion of the left circumflex artery?

A

Lateral aspect of the heart - leads V5, V6, aVL and Lead I

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60
Q

Describe the gross pathology of the heart following an acute myocardial infarction?

A

Coagulant necrosis with preserved architecture

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61
Q

Which physiological heart sound occurs during diastole and what does it represent?

A

S2 indicating closure of the aortic and pulmonic valves

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62
Q

Which heart sound may indicate a dilated left ventricle?

A

S3

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63
Q

Pulmonary rales following a myocardial infarction are most likely due to…

A

backup up of blood into the pulmonary veins from the left atrium resulting from a weakened left ventricle

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64
Q

What type of sound may be heard in a patient with a left bundle branch block?

A

Paradoxical split of S2, with closure of the pulmonic valve earlier than the aortic valve

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65
Q

How do you define an ST elevation myocardial infarction?

A

At least 1 mm (or 1 box) elevation in at least 2 contiguous leads

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66
Q

Which leads will show an ST elevation with total occlusion of the left circumflex artery?

A

V5, V6, I, aVL

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67
Q

What does the presence of a Q wave on an ECG indicate?

A

A previous myocardial infarction occurred and has healed

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68
Q

In an inferior MI with ST elevation in leads II, III, aVF, how do you confirm a right ventricular infarction?

A

V4R also shows ST elevation

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69
Q

What is the major difference in management between a right ventricular infarct and all other types of myocardial infarctions?

A

Preload must be increased to improve hypotension

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70
Q

A patient shows a positive troponin I and a negative CK-MB. When did the myocardial infarction occur?

A

3-7 days ago

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71
Q

Which of the following is the benefit of giving morphine during an MI?

A

Pain reduction leads to a reduction in adrenergic drive which lowers the oxygen demand of the heart

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72
Q

What is the mechanism of action of clopidogrel?

A

Inhibition of ADP-mediated activation of glycoprotein IIb/IIIa thereby irreversibly inhibiting platelet aggregation

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73
Q

What is the mechanism of action of heparin?

A

Inactivation of thrombin and factor Xa by binding to anti-thrombin III

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74
Q

What medication is used to dissolve a clot?

A

Tissue plasminogen activator

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75
Q

A patient presents with pulsus paradoxus, Kussmaul sign (a paradoxical increase in JVD on inspiration), hypotension and muffle heart sounds 1 week following an acute myocardial infarction. What is the best next step in management?

A

Immediate pericardiocentesis

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76
Q

A patient presents with a new, loud and harsh holosystolic murmur heard loudest at the left lower sternal border one week following a STEMI. What is the most likely complication occurring in this patient and what type of murmur is described?

A

Ventricular septal defect murmur due to ventricular septal rupture

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77
Q

What is the usual cause of vasospastic angina?

A

Focal coronary spasm

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78
Q

Which of the following sets of clinical clues is most suggestive of vasospastic angina? (4)

A

History of cocaine use, ST-elevation at rest, negative cardiac enzymes, young age

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79
Q

Which of the following is contraindicated in vasospastic angina?

A

Metoprolol

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80
Q

How is vasospastic angina definitively diagnosed?

A

Induction of vasospasm during angiography

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81
Q

What is the mainstay of long-term treatment of vasospastic angina?

A

Calcium channel blockers and nitrates

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82
Q

What does the S2 heart sound represent?

A

Closure of the aortic and pulmonic valves

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83
Q

What is the correct order of depolarization in a normally functioning heart?

A

SA node, AV node, bundle of His, left bundle branch, right bundle branch

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84
Q

When thinking about the end of diastole through the end of systole, which of the following indicates the correct order of heart valve closure?

A

Mitral, Tricuspid, Aortic, Pulmonic

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85
Q

Which phase of the sinoatrial node action potential is targeted by diltiazem?

A

Phase 0 - calcium channel

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86
Q

What physiological change is responsible for the heart sound created by a forceful atrial kick in late diastole? S4

A

Concentric hypertrophy due to parallel duplication of sarcomeres

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87
Q

A normal S3 can be heard in athletes and young patients and this indicates what heart condition?

A

Vigorous relaxation

88
Q

What triggers sympathetic outflow in response to a drop in blood pressure?

A

Decreased stretch sensed by carotid baroreceptors and transmitted via the glossopharyngeal nerve

89
Q

What is the usefulness of sustained squatting in a child with Tetralogy of Fallot?

A

Increase the Total perpherous resistance and inverted the right to left shunt

90
Q

What hemodynamic changes commonly occur during exercise and how does this affect blood pressure?

A

Blood pressure is approximately normal due to a balance between venoconstriction and arterial vasodilation

91
Q

Delayed closure of the pulmonic valve due to increased venous return to the right side of the heart on inspiration is best described as…

A

physiologic splitting of S2

92
Q

Which condition would cause early closure of the pulmonic valve relative to the aortic valve?

A

Left bundle branch block

93
Q

S2 splitting that does not vary with respiration is due to…

A

left to right shunt causing increased blood flow to the right side of the heart

94
Q

Where would you listen for a systolic crescendo/decrescendo murmur that radiates to the carotids in a patient presenting with fatigue and dizziness?

A

Upper right parasternal border, 2ⁿᵈ intercostal space

95
Q

Which murmur may be caused by congenital infection with the Rubella virus?

A

A systolic murmur that increases with respiration heard best at the 2ⁿᵈ intercostal space, left parasternal border

96
Q

Which of the following murmurs would most likely be heard in a patient presenting with bounding radial pulses and a bobbing head?

A

Aortic regurgitation

97
Q

Which of the following murmurs increases in intensity on standing (decreased venous return)?

A

Hypertrophic obstructive cardiomyopathy

98
Q

What murmur would you most likely hear in a 20-year-old patient with an inflammatory disease that caused vertebral fusion?

A

A diastolic murmur heard best at the 3rd intercostal space, left parasternal. Caused by aortic regurgitation

99
Q

What is the most common etiology of an isolated diastolic murmur that increases on inspiration heard best at the 5ᵗʰ intercostal space, left parasternal border?

A

Narrowing of the tricuspid valve from rheumatic fever

100
Q

Which hemodynamic alteration is responsible for the progression of sequelae associated with aortic stenosis?

A
101
Q

Which two locations should you listen to in a patient with congenital heart disease due to fetal alcohol syndrome?

A

2ⁿᵈ intercostal space, left parasternal AND 5th intercostal space, left parasternal

102
Q

What is the most likely etiology of angina found in a 30-year-old man born in Canada?

A

Demand ischemia

this condiction is caused by a aortic stenosis. The LV ventricle suffer hypertrophy and demands more blood, that causes angina.

103
Q

Aortic stenosis in a 37-year-old woman from Florida is most likely preceded by…

A

congenital bicuspid aortic valve

104
Q

What is the cause of early heart failure in patients with early aortic stenosis?

A

Reduced left ventricular chamber size

105
Q

Three main causes of aortic stenosis

A

Senile calcification

Calcification of a congenitally bicuspid aortic valve

rheumatic heart disease

106
Q

The heart undergoes changes in response to physiological signals. What changes to the heart are expected in untreated aortic stenosis?

A

Concentric hypertrophy of the left ventricle

107
Q

What is the most likely ECG finding in a patient with aortic stenosis?

A

Left axis deviation

108
Q

What is the most likely splitting pattern of S2 in a patient with aortic stenosis?

A

Pulmonic valve closure prior to aortic valve closure

109
Q

What should be targeted by pharmacological management of aortic stenosis?

A

Decrease afterload

110
Q

Rule of 5, 3, 2 in prognosis of aortic stenosis

A

if there is no valve replecement. 50 % of the patients…

with angina will die in 5 years

with syncope will die in 3 years

with symptoms of congestive heart failure (CHF) will die in 2 years

111
Q

Which of the following ECG characteristics are indicative of left axis deviation caused by aortic stenosis?

A

Positive deflection in lead I and negative deflection in lead aVF

112
Q

best describes the murmur of aortic regurgitation?

A

Early diastolic murmur due to difficulty closing the valve in diastole

113
Q

Pathophysiology of aortic regurgitation

A

The valve aloows the blood reflux, the LV must dilate to pump blood through the body–> as the volume strech the LV ventrivle, the contratility decreases

114
Q

what is the 2 most important parameters of aortic regurgitation?

A

Decrease in diastolic blood pressure

increase in pulse pressure

115
Q

Cardiac symptom of aortic regurgitaion

A

Early diastolic murmur

116
Q

At which point in the cardiac cycle would you most likely hear the murmur of mitral stenosis?

A

Mid-diastole, difficulty in opening

117
Q

Which chamber of the heart undergoes decreased filling in mitral stenosis?

A
118
Q

Which of the following is the most common cause of mitral stenosis?

A

Rheumatic heart disease

119
Q

Which symptoms is NOT associated with mitral stenosis?

A

Laterally displaced apex

120
Q

What explains the etiology of hoarseness in a patient with mitral stenosis?

A

Compression of left recurrent laryngeal nerve by the Left atrium

121
Q

What is the difference between cor pulmonale and right heart failure (RHF) secondary to mitral stenosis?

A

Cor pulmonale is the result of a primary lung condition, while RHF in mitral stenosis is secondary to left heart failure.

122
Q

What describes the murmur of mitral stenosis?

A

Opening snap followed by a mid-diastolic rumble

123
Q

what explains the basis for thromboembolism prophylaxis in mitral stenosis?

A

Increased risk of atrial fibrillation

124
Q

How would you differentiate between mitral regurgitation from mitral stenosis by only looking at a gross specimen of the heart?

A

Left atrium and left ventricle are both enlarged in mitral regurgitation

125
Q

How would you differentiate acute and chronic mitral regurgitation (MR) with knowledge of only the pressure values?

A

Acute MR will show high pressure in the left atrium

Chronic MR will show normal pressure in the left atrium

126
Q

Why is the v wave of the atrial tracing curve larger in actue mitral regurgitation compared to mitral stenosis?

A

Blood is entering the left atrium from both the pulmonary veins and the left ventricle

127
Q

What best describes the murmur and heart sounds of mitral regurgitation?

A

Blowing holosystolic murmur best heard at the apex radiating to the axilla

128
Q

What is the most common valvular abnormality?

A

Mitral valve prolapse

129
Q

What is the most common presentation of mitral valve prolapse?

A

Asymptomatic and benign

130
Q

Which conditions is most commonly associated with mitral valve prolapse?

A

Connective tissue disorders

131
Q

Why is exercise suggested as the primary form of management for a patient with a late systolic decrescendo murmur after a mid-systolic click?

A

Exercise increases preload by inducing venoconstriction

132
Q

Which of the following maneuvers decreases the length AND intensity of the murmur associated with mitral valve prolapse?

A

Rapid squatting

133
Q

Which medication may be added for a patient with mitral valve prolapse and why?

A

Beta blockers to slow heart rate

134
Q

what best describes the murmur of hypertrophic obstructive cardiomyopathy?

A
135
Q

Which is the most common cause of right heart failure?

A

Left heart failure

136
Q

Which change is most commonly associated with systolic heart failure?

A

Negative inotropy

137
Q

What change triggers renin release in congestive heart failure with decreased ejection fraction?

A

Decreased effective circulating volume

138
Q

What best describes the defect in diastolic dysfunction?

A

Left ventricular filling defect

139
Q

Which phase of the cardiac cycle denotes a pressure drop in the left ventricle relative to the left atrium?

A

Isovolumetric relaxation

140
Q

Which wave of the cardiac cycle corresponds with rapid filling of the atria?

A

v wave

141
Q

Which of the following symptoms is associated with right sided heart failure?

A

positive jugular vein distension (JVD)

142
Q

What are heart failure cells?

A

Hemosiderin laden macrophages

143
Q

What sign, suggestive of right sided heart failure, is elicited by applying pressure on the abdomen resulting in an increase in jugular venous pressure?

A

Hepatojugular reflux

144
Q

What is the mechanism of action of Digoxin?

A

Inhibits Na+/K+ ATPase

145
Q

Which of the following medication classes does NOT reduce mortality in patients with congestive heart failure?

A

Calcium channel blockers

146
Q

What is the primary driving force in the formation of transudative edema?

A

Increased hydrostatic pressure

147
Q

What is the usual abnormal heart sound observed in left sided heart failure?

A

S3 gallop

148
Q

What medication is associated with the side effect of gynecomastia?

A

Spirinolactone

149
Q

What is acute pericarditis?

A

inflamatio

150
Q

Which of the following is the most common etiology of acute pericarditis?

A

Idiopathic

151
Q

What you can find on a ECG of acute pericarditis?

A

ST- elevation in ALL leads

PR depression in ALL leads

There is no Q waves

152
Q

What are associated signs or symptoms of acute pericarditis? (4)

A

Pain is relieved by leaning forward

Leathery friction rub on auscultation

Muffled heart sounds

Low grade fever

153
Q

What medication is NOT indicated in the management of acute pericarditis?

A

Steroids because they can potentially lead to recurrent pericarditis

154
Q

What is a cardiac tamponade?

A

Cardiac tamponade is the compression of the heart by fluid in the pericardial space

155
Q

Which is the most likely outcome of an interventricular septum rupture?

A

New onset holosystolic murmur

156
Q

Beck’s Triad (cardiac tamponade)

A

distant heart sounds

hypotension

distended neck veins

157
Q

A patient presents with a hemorrhagic pericardial effusion. Which is the most likely etiology?

A

Tuberculosis

158
Q

Triad of aortic stenosis

A

Angina

syncope

dyspnea

159
Q
A
160
Q

What is the correct definition of pulsus paradoxus?

A

Fall of systolic blood pressure by greater than 10 mmHg on inspiration

Happens when happens a pericardial effusion

161
Q

Which ECG changes may be seen in a patient presenting with cardiac tamponade?

A

Alternating large and small QRS complexes

162
Q

Causes of constriction Heart disease (7)

A
163
Q

Signs and symptoms of constricitive pericarditis (6)

A

dyspnea ( pulmonary congestion)

fatigue

hepatomegaly

ascites

peripheral edema

kussmaul sign ( an ins oiratory increase in jugular venous pressure)

164
Q

Which sign or symptom of constrictive pericarditis is NOT seen in acute cardiac tamponade?

A

Inspiratory increase in jugular venous pressure

165
Q

Which heart sounds is commonly associated with constrictive pericarditis?

A

Pericardial knock

166
Q

What would you most likely see on echocardiogram in a patient with constrictive pericarditis?

A

Pericardial thickening

167
Q

What is the definitive treatment for recurrent symptomatic pericarditis?

A

Surgical pericardiectomy

168
Q

What is the characteristic ECG finding in atrial flutter?

A

Sawtooth appearance

169
Q

What is the characteristic ECG finding in multifocal atrial tachycardia?

A

At least 3 distinctly different p wave morphologies

170
Q

Which segment on the ECG corresponds with phase 0 (sodium influx) of the ventricular action potential?

A

QRS complex

171
Q

Movement of which ion is mainly responsible for ventricle repolarization?

A

Potassium efflux

172
Q

Which ion is mainly responsible for the ST segment?

A

Calcium influx

173
Q

Which pathology is suggested in a patient whose pulmonary valve closes before the aortic valve?

A

Left bundle branch block

174
Q

According to the technical definition of bradycardia, how many lines would separate the RR-interval?

A

Six lines

175
Q

Which signs or symptoms of bradycardia can be seen in a well-conditioned athlete?

A

Sinus bradycardia

S3 heart sound

Increased cardiac output

Left ventricular enlargement

176
Q

What is the most common symptom associated with symptomatic bradycardia?

A

Syncope

177
Q

What is the typical presenting symptom in a patient with first degree heart block?

A

Asymptomatic

178
Q

What describes first degree heart block?

A

PR interval > 200 ms

179
Q

What is the difference between Mobitz type 1 and type 2

A

Type 1: PR interval increases with each beat until the “beat drops” ( p wave with no QRS complex)

Type 2: PR interval is normal with intermitent “drop beats” ( p wave with no QRS complex)

180
Q

What is the intrinsic ventricular pacemaker rate?

A

30 bpm

181
Q

What is the major explanation for the symptoms of atrial fibrillation, such as fatigue?

A

Heart pump dysfunction (diminished cardiac output)

182
Q

Pathogenesis of atrial fibrilation (2)

A

exceedingly common rhythm disturbance in elderly patients

Fail to have a coordinated

183
Q

Which of the following explains the usefulness of digoxin in the management of atrial fibrillation? (Dromotropy = conduction, inotropy = force of contraction, chronotropy = heart rate)

A

Decreased dromotropy

184
Q

What re the goals of treatment in atrial fibrilation (AFb)

A

Rate control

Rhythm control

decrease risk of embolic stroke

185
Q

Whats is the CHADS classification in atrial fibrilation?

A

C = CHF

H = Hypertension

A = Age>75

D = DM

S = Stroke

0-1 = aspirin alone; > ou igual a 2 –>coumadin (warfarin)

186
Q

In a patient with atrial flutter, when is it necessary to anticoagulate with warfarin?

A

Before electric cardioversion if the rhythm is sustained for greater than 48 hours

187
Q

Differences in the ECQ of Atrial fibrilation and flutter atrial.

A

Atrial fibrilation: irregular rhythm, wave p wave

Atrial flutter: regular rhythm (2 p: 1 QRS), sawtooth p wave

188
Q

What drog is effective in treatment of atrial fibrilation and atrial flutter, but is not in multifocal atrial tachycardia?

A

Digoxin

189
Q

What is the difference between wandering atrial pacemaker (WAP) and multifocal atrial tachycardia (MAT)?

A

WAP has a heart rate < 100 bpm, while MAT must be > 100 bpm.

190
Q

Wolff-Parkinson White Syndrome (WPW) features … (4)

A

It causes symptoms associated with decreased cardiac output (like all tachycardial syndrome)

It is a congenital issue

It involves the Bundle of Kent

It has a PR interval < 120 ms

191
Q

What is the pathophysiological mechanism that defines WPW?

A

Loss of normal delay between SA node and AV node due to presence of a bypass tract

192
Q

Which is the drug of choice for medical cardioversion in Wolff Parkinson White syndrome?

A

Procainamide

193
Q

What is the mechanism of action of procainamide?

A

It blocks only the activated voltage gated sodium channel (decreasing the phase 0)

194
Q

What is the definitive treatment for WPW?

A

Surgical ablation of the accessory pathway

195
Q

why calcium channel blockers, Digoxin and adenosine are contraindicated in Wolff-Parkinson White syndrome?

A

in WPW has 2 pathways: a normal and pathologic. If you give that drug, will be a block in the normal (physiological) and exacerbate the pathological pathway

196
Q

What is the heart rate on an ECG, with an R-R interval that spans 3 spaces?

A

100 bpm

197
Q

What is the first step in management of a clinically stable patient with narrow, complex tachycardia?

A

Carotid massage

198
Q

What is a premature ventricular contraction/complex (PVC)?

A

Bizzare, widened QRS complex, which is not preceded by a p wave with the subsequent T wave oriented in the opposite direction

199
Q

What is the most likely diagnosis in a patient with paradoxical splitting of S2 on inspiration?

A

Left bundle branch block

200
Q

What is the most likely diagnosis in a patient with a widened S2 split on physical exam and the RSR’ pattern on ECG?

A

Right bundle branch block

201
Q

Which set of ECG leads represents the left circumflex artery?

A

Lead 1, aVL, V5, V6

202
Q

Ventricular tachycardia requires immediate intervention to avoid…

A

…ventricular fibrillation

203
Q

What causes insufficient cardiac output in pulseless ventricular tachycardia?

A

Decreased diastolic filling

204
Q

What is the next step in the management of an asymptomatic patient with ventricular tachycardia if amiodarone or lidocaine fails to cardiovert them to sinus rhythm?

A

Sedation

205
Q

Which finding on ECG would indicate a supraventricular tachycardia rather than a ventricular tachycardia?

A

Slurred upstroke (elevação arrastada) of QRS complex

206
Q

Which phase of the ventricular action potential is altered by class III antiarrhythmics?

A

Phase 3 – potassium efflux

207
Q
A
208
Q

Why should amiodarone and other class III antiarrhythmics be avoided in anybody with long QT syndrome?

A

They prolong ventricular repolarization

209
Q

Which symptom helps in diagnosing chronic venous insufficiency rather than a more acute process?

A

Brownish discoloration of the skin

210
Q

What is the most common etiology of peripheral arterial disease?

A

Atheromas of the extremities

211
Q

Why are the ischemic ulcerations of peripheral arterial disease more commonly found in patients with a history of longstanding diabetes mellitus?

A

Peripheral neuropathy

212
Q

What is the ankle brachial index level that is considered diagnostic for peripheral arterial disease?

A

ABI < 0.90

213
Q

What are the two arteries used to measure arterial brachial index?

A

Posterior tibialis and brachial artery

214
Q

What is the rationale behind the Stanford classification of aortic dissection?

A

They guide treatment based on the area of the aorta involved in the dissection.

215
Q

Which modality is most commonly used to diagnose an aortic dissection?

A

CTA chest and abdomen with IV contrast

216
Q

In a patient presenting with Stanford type A aortic dissection, what is the mainstay of management?

A

Emergency surgical correction

217
Q

In a patient presenting with a descending aortic dissection, what is the goal of medical management?

A

Decrease shearing forces.

Cardiovascular system - lecturio (7 decks)

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