Cards Flashcards
1
Q
Patient with TIA/stroke in setting of thromboembolic disease (DVT) should be suspicious for what?
A
Paradoxical embolism
2
Q
VSD most commonly occurs where?
A
membranous septum
3
Q
3 main conotruncal abnormalities
A
Transposition of great vessels, TOF, persistent truncus arteriosus
4
Q
Valves are formed from what structures?
A
Endocardial cushions
5
Q
Anlantois–>Urachus
A
Median umbilical ligament
6
Q
Ductus arteriosus
A
Ligamentum arteriousm
7
Q
Ductus venosus
A
Ligamentum venosum
8
Q
Foramen ovale
A
Fossa ovalis
9
Q
Notochord
A
Nucleus pulposus
10
Q
Umbilical arteries
A
Medial umbilical ligaments
11
Q
Umbilical vein
A
Ligamentum teres hepatis (contained in falicform ligament)
12
Q
What closes PDA?
A
Indomethacin (decrease prostaglandin)
13
Q
Supplies posterior 1/3 of interventricular septum, posterior walls of ventricles, and posteromedial papillary muscle
A
Posterior descending/interventricular artery (PDA)
14
Q
Supplies anterior 2/3 of interventricular septum, anterolateral papillary muscle, and anterior surface of left ventricle. Inferior wall of LV forms diaphragmatic heart surface
A
Left anterior descending (LAD)
15
Q
Supplies lateral and posterior walls of left ventricle, anterolateral papillary muscle
A
Left circumflex coronary artery (LCX)
16
Q
supplies right ventricle
A
Right (acute) marginal artery
17
Q
What usually supplies SA/ AV node
A
Ricght coronary artery
18
Q
Right dominant circulation
A
85% of individuals (PDA arises from RCA)
19
Q
Left dominant ciruclation
A
8% individuals (PDA arises from LCX)
20
Q
Codominant circulation
A
7% individuals (PDA arises from both LCX and RCA)
21
Q
Where does coronary artery occlusion most commonly occur?
A
LAD
22
Q
Two most important factors involved in coronary blood flow autoregulation and what do they regulate
A
NO-regulates large coronary artery + Pre-arteriolar vessels
Adenosine-regulates small coronary arteriolar vessels
23
Q
Enlargement of what part of the heart can cause dysphagia/hoarseness?
A
Left atrium
24
Q
Most coronary venous blood drains into
A
Coronary sinus of right atrium
25
Where does desceining aorta lie in regard to esophagus and left atrium?
Posterior to both allowing visualization of descending aorta via transesophageal echocardiography
26
3 specific factors differentiating heart ciruclation from blood flow provided to skeletal muscle and viscera
1) Heart muscle perfused during diastole consuming only 5% of CO
2) Myocardial oxygen req is very high (resting 75-80% and while at work around 90% and this extraction does not occur at this level anywhere else in body)
3) coronary flow regulated by metabolic factors (adenosine causes vasodilation and decreased vascular resistance)
27
Most common cause of early cyanosis
TOF
28
What other congenital heart anomaly do patients with persistent truncus arteriosus have?
VSD
29
Most common congenital cardiac defect?
VSD
30
How is ASD different than patent foramen ovale?
ASD has septae missing tissue while PDA has tissue that is unfused
31
What does tricuspid atresia require for viability?
Both ASD and VSD
32
Most important prognostic factor in TOF?
Pulmonic stenosis
33
What is the consequence of PDA?
Late cyanosis in lower extremities (differential cyanosis) and not upper extremities because PDA after major branches of aorta that feed the upper extremities. Due to late on set reversal of shunt flow from left to right to right to left.
34
Alcohol rexposure in utero (fetal alcohol syndrome)
VSD (important cause), PDA, ASD , TOF
35
Congenital rubella
PDA
36
Down syndrome
AV septal defect (endocardial cushion defect), VSD ASD (ostium primum ASD)
37
Infant of diabetic mother
Trasposition of great vessels
38
Marfan syndrome
MVP, thoracic aortic aneurysm and dissection
39
Prenatal lithium exposure
Ebstein anomaly
40
Turner syndrome
Bicuspid aortic valve, coarctation of aorta
41
Williams syndrome
Supravalvular aortic stenosis
42
22q 11 syndromes
Truncus arteriosus, TOF
43
Fredreich ataxia
Hypertrophic cardiomyopathy
44
Tuberous sclerosus
Valvular obstruction due to cardiac rhabdomyomas
45
Most common heart tumor
Metastasis from breast, lung, melanoma, lymphoma
46
Most frequent cardiac tumor in children
Rhabdomyomas (associated with tuberous sclerosis)
47
Most frequent cardiac tumor in adults
Myxomas
48
Growth factor avidly produced by myxomas?
VEGF
49
Fick principle
CO=rate of O2 consumption/arterial O2-venous O2 content
50
Mean arterial pressure
CO*TPR or 2/3 SBP*1/3DBP
51
Pulse pressure
Systolic pressure-diastolic pressure
52
2 variables pulse pressure is related to
Directly related to SV and inversely related to capacitance
53
Contractility is a function of what?
intracellular calcium
54
La place law
radius*pressure/2*wall thickness
55
4 factors that require increase myocardial oxygen demand
Increase contractility, increase afterload, increase heart rate, increase diameter of ventricle
56
What accounts for most TPR an what accounts for most blood storage capacity?
TPR, Veins
57
Resistance equation
Driving pressure(delta p)/flow (q)-->8nl/pir^4
58
Volumetric flow rate (Q)
flow velocity (v) * cross-sectional area (A)
59
What period of cardiac cycle is the period of highest O2 consumption
Isovolumetric contraction
60
JVP absent in atrial fibrillation
a wave
61
JVP absent in tricuspid regurgitation
x descent
62
a wave
right atrial contraction
63
c wave
RV contraction (closed tricuspid valve bulging into atrium)
64
x descent
right atrial relaxation and downward displacement of closed tricuspid valve during ventricular contraction
65
v wave
increase right atrial pressure due to filling agains closed tricuspid valve
66
y descent
RA emptying into RV
67
murmur best heard at aortic area
systolic murmur (aortic stenosis, flow murmur, aortic valve sclerosis)
68
murmur best heard at left sternal border
diastolic murmur (AR/PR) systolic murmur (hypertrophic cardiomyopathy)
69
murmur best heard at left infraclavicular region
Continuous murmur (patent ductus arteriosus)
70
murmur best heard at pulmonic area
systolic ejection murmur (pulmonic stenosis, flow murmur (eg. physiologic murmur))
71
murmur best heard at tricuspid area
pansystolic murmur (triscuspid regurgitation, VSD) diastolic murmur (tricuspid stenosis, ASD)
72
murmur best heard at mitral area
systolic murmur (mitral regurg) diastolic murmur (mitral stenosis)
73
Bedside maneuver: Inspiration
| Effect:
Increase intensity of right heart sounds
74
Hand grip
Increase afterload
Increase intensity of MR, AR, VSD
Decrease intensity of HOCM
MVP: later onset of click/murmur
75
Valsalva, standing up
(decrease preload)
decrease intensity of most murmurs (including AS)
increase intensity of HOCM
MVP" earlier onset of click/murmur
76
Rapid squatting
increase preload
increase intensity of AS murmur
decrease intensity of HOCM
MVP: later onset of click/murmur
77
Speed of conduction
Purkinje>atria>ventricles>AV node
78
Pacemeakers
SA>AV>Bundle of his/purkinje/ventricles
79
Normal length of PR interval
80
Normal length of QRS complex
81
QT interval
ventricular depolarization, mechanical contraction of ventricles, ventricular repolarization
82
PR interval
From start of atrial depolarization to start of ventricular depolarization
83
T wave
ventricular repolarization. inversion may indicate recent mi
84
J point
Point in between QRS complex and start of ST segment
85
ST segment
isoelectric, ventricles depolarized
86
presence of U wave is caused by what?
hypokalemia, bradycardia
87
Drug induced causes of Torsades
```
AntiArrhythmics
AntiBiotics
AntiCychotics
AntiDepressants
AntiEmetics
```
88
Inheritance of Romano ward an jervell lange nielsen and brugada syndrome
Auto dominant and auto recessive and auto dominant
89
Triad of WPW
Prolonged QRS, Shorter PR interval, Delta wave
90
What regulates number of atrial impulses that can reach ventricle and determines ventricular contraction rate in afib?
AV node refractory period
91
Afib treatment for chronic Afib (>48 hours)
Antithrombotic therapy (eg warfarin), rate control (b blocker, non-dihydropyridine Ca2+ channel blocker, digoxin), rhythm control (class IC or III antiarrhythmics)
92
AFib treatment for new afib (
Cardioversion (used for new and not old afibb becuase cardioverision can dislodge possible clot)
93
Where to right/left leads in pacemakers get in the heart
Right is simple from left subclavian to SVC while left is more difficult because it goes through coronary sinus on atrioventricular groove of right atrium
94
1st degree AV block
PR interval >200 msec. Each PR interval is equal
95
Difference btwn 2nd degree Type I and Type II av block
Type I- progressive lengthening of PR interval until beat is "dropped" (P wave not followed by QRS complex)
Type II-Dropped beats are not preceeded by change in PR interal (P wave not followed by QRS complex)
96
Treatment of 1st, 2nd, 3rd AV block
1st-none
2nd type I-none type II-pacemaker
3rd degee-pacemaker
97
Disease that can cause 3rd degree av block
lyme disease
98
What is recombinant form of BNP for heart failure?
Nesiritide
99
Aortic arch receptor transmits through what?
Vagus nerve to solitary nucleus of medulla (responds to increase in BP)
100
Carotid sinus transmits through what?
Glossopharyngeal nerve to solitary nucleus of medulla (responds to decrease and increase in BP)
101
Method by which carotid massage decreases HR
Increase AV node refractory period
102
Triad of cushing reaction
hypertension, bradycardia, and respiratory depression
103
Describe cushing rxn.
Increase in ICP-->arteriole constriction-->cerebral ischemia-->increased pCO2+decrease pH-->increased perfusion pressure (hypertension)-->increased stretch of carotid sinus-->peripheral reflex baroreceptor induced bradycardia
104
Central vs peripheral chemoreceptor response
Central-Paco2, hypercapnia
| Peripheral-PaO2, hypoxemia
105
What can be used to treat paroxysmal supraventricular tachycardia in patients with no other history of heart disease?
Carotid massage (slows conduction through AV node and increase node refractory period sotpping reentrant tachycardia)
106
What is unique about vasculature in lungs compared to other organs in setting of hypoxia
Lung hypoxia causes vasoconstriction so that only well ventilated areas are perfused. In other organs, hypoxia causes vasodilation
107
Autoregulation of skeletal muscle
Exercise: lactate, adenosine, H+, K+, CO2
| At rest: Sympathetic tone (alpha1 vasoconstriction, b2 vasodilation)
108
Autoregulation of heart
local metabolites: adenosine, NO, CO2, decreased o2
109
Autoregulation of brain
CO2( decrease pH)-->potent cerebral vasodilator
110
equation for net fluix movement Jv
Kf[(Pc-Pi)-c(pi(c)-piIi)]
111
4 factors causing edema with excess fluid outflow into interstitium commonly caused by:
Increase capillary pressure (increase Pc)
Decreased plasma proteins (decrease pi(C))
Increased capillary permeability (increased kf)
increased interstitial fluid colloid osmotic pressure (increase pi (i).)
112
4 types of xanthomas?
Eruptive xanthoma-abruptly with plasma triglyceride or lipid increase
Tendinous xanthoma
Xanthalesma-eyelid or periorbital
Plane anthomas-appear as linear lesions in skin folds associated with primary biliary cirrhosis
113
In what conditions is hyaline arteriolosclerosis found?
Essential hypertension or diabetes mellitus
114
In what conditions is hyperplastic arteriolosclerosis found?
Severe hypertension
115
Differentse bewtween arteriolosclerosis and monckeberg (medial calcific sclerosis)
Arteriolosclerosis decreases vessel caliber and produce end organ ischemia. Monckeberg is not clinically significant because does not affect luminal caliber and blood flow
116
Vessels that arteriolosclerosis and monckeberg calcific sclerosis affect
Arteriolosclerosis-small arteries and arterioles
| Monckeberg-medium sized arteries
117
Pathophys of monckeberg (medial calcific sclerosis)
Calcification of internal elastic lamina (ie media of arteries). INTIMA NOT INVOLVED
118
Varicose veins blood flow
From deep veins to superficial veins due to increased pressure in superificial veins causing them to dilate restricting venous outflow
119
What is more common in varicose veins? thromboembolism or venous stasis?
Venous stasis that can cause ulcers common in the medial malleolus
120
What can happen to skin in chronic venous insufficiency?
Stasis dermatitis with erythema and scaling and perogressive dermal fibrosis and hyperpigmentation.
121
4 modifiable risk factors for atherosclerosis
HTN, diabetes, hyperlipidemia, smoking
122
What is most responsible for producing intimal response in atherosclerosis?
SMC
123
SMC migration involves what growth factors
FGF, PDGF, TGFB
124
Main determinant onf whether or not a coronary artery plaque will cause ischemic myocardial injury?
RAT at which it occludes involved artery
125
AAA is associated with what risk factor?
Atherosclerosis
126
TAA associated with what risk factor?
Cystic medial degeneration
127
What changes are seen with cystic medial degeneration?
Myxomatous changes
128
Most common site of injury in blunt aortic rupture (traumatic aortic rupture most commonly in MVC)
Aortic isthmus
129
Single most important risk foctor for development of intimal tears
HTN
130
Common location of atheroscleorisis?
AA>coronary>popliteal>carotid
131
EKG for stable, unstable, prinzmetal angina
ST sement depression, st segment depression, st segment elevation
132
What test is most sensitive for coronary artery vasospasm?
Ergonovine test by stimulating alpha-adrenergic/serotonergic receptors
133
What is the mechanism behind pharmacologic stress tests?
coronary steal syndrome
134
What determines likelinhood of plaque rupture?
plaque stability rather than size where activated macrophages in the atheroma contribute to collagen degradation by secreting metalloproteinases contributing to collagen degradation
135
Most common cause of sudden cardiac death
v fib
136
Explain CAD induced SCD
Acute plaque-->acute myocardial ischemia-->electrical instability in heart-->potentially lead to vfib
137
Leads with st elevations or Q waves
| V1-V2
Anteroseptal (LAD)
138
V3-V4
anteroapical (disatl LAD)
139
V5-V6
Anterolateral (LAD or LCX)
140
I, aVL
Lateral (LCX)
141
InFerior (RCA)
II, III, aVF
142
Gold standard for MI in first 6 hours
ECG
143
Most sensitive and specific marker for MI (gold standard)
Troponin I (rise after 4 hours after infarction and increased for 7-10 days)
144
Useful marker for detecting reinfarction that occurs days afterinitial MI
CKMB (because rises 6-12 hours after and levels return to normal within 48 hours)
145
Risk of complications and time frame
| 0-4 hours, 4-24 hours, 1-3 days, 3-14 days, 2weeks- 2 months
0-24 hours (arrhythmia, cardiogenic shock , heart failure)
1-3 days (Fibrinous pericarditis)
3-14 days (Ventricular pseudoaneurysm (risk of rupture), free wall rupture-->tamponade, papillary muscle rupture-->mitral regur, iv septal rupture-->VSD)
2 weeks-2 months (Dressler syntrome, HF, arrhythmias, true ventricular aneurysm)
146
valvular disorder in HOCM
May see mitral regurg due to impaired mitral valve closure
147
Cause of LV outflow obstruction in obstructive HOCM
anterior displacement of mitral valve leaflet toward hypertrophied interventricular septum
148
3 places where you see eccentric hypertrophy
1) aortic/mitral regurg
2) MI
3) dilated cardiomyopathy
149
3 places where you see concentric hypertrophy
1) chronic htn
2) aortic stenosis
3) HOCM
150
Mainstay treatment of CHF
ACE inhibitor
151
drugs that decrease mortality in CHF
ACE inhibitors or ARBs, b blockers, and spironolactone
152
drugs that are used for symptomatic relief in CHF
thiazide or loop diuretics
153
drugs that improve both symptoms and mortality in select patients
Hydralazine with nitrate therapy
154
Difference in EF, EDV and contractility and compliance in systolic vs diastolic dysfunction
Systolic-decreased contractility, decreased EF, increased EF
| Diastolic-decreased compliance, same EF, same EDV, increased LV EDP
155
First sign of shock
tachycardia
156
CVP, CO, SVR or Hypovolemic, cardiogenic, obstructive, and distributive shock
Hypovolemic: decreased CVP, decreased CO, increased SVR
Cardiogenic/obstructive: increased cvp, decreased co, increased SVR
Distributive: decreased CVP, increased CO, decreased SVR
157
tricuspid valve endocarditis associated with what 3 bugs in IV drug abuse
candida, s auereus, pseudomonas
158
Negative culture and bacterial endocarditits
Coxiella burnetii, bartonella, HACEK
159
2 manifestations of syphillitic heart disease
Aneurysm of ascending aorta or aortic arch, or aortic insufficiency (aortic regurg)
160
Does verapamil work on skeletal muscle?
no. no significant flux of calcium across l-type calcium channels in skeletal muscle, but significant flux in cardiac and smc.
161
How is ca2+ efflux established prior to myocyte relaxation?
ca2+ atpase (active transport to sequester calcium within sr to reistablish ion gradient) and Na+/ca2+ exchanger.
162
what type of channels cause automaticity in cardiac nodal cells?
If channels
163
What increases slope of phase 4 in SA node and determines HR
Catecholamines
164
What decreases slope of phase 4 in SA node and decreases HR
Ach/adenosine
165
Bacillary angiomatosis vs Kaposi sarcoma differnces
Mistaken for each other frequently but bacillary angiomatosis has neutrophils infiltrate while kaposi sarcoma has lympocytic infiltrate
