First Aid Review Flashcards
A patient who presents with dysphagia and hoarseness may have an enlargement of _ which compresses the _ and _
A patient who presents with dysphagia and hoarseness may have an enlargement of left atrium which compresses the esophagus and left recurrent laryngeal nerve
* Ex: mitral stenosis
The LAD supplies three areas:
The LAD supplies
1. Anterior 2/3 of IV septum
2. Anterolateral papillary muscle
3. Anterior surface of the left ventricle
The most commonly occluded coronary artery is _
The most commonly occluded coronary artery is LAD
The PDA supplies 4 areas:
The PDA supplies 4 areas:
1. AV node
2. Posterior 2/3 IV septum
3. Posterior ventricles
4. Posteromedial papillary muscle
Coronary blood flow peaks during _
Coronary blood flow peaks during early diastole
The RCA supplies 2 areas:
The RCA supplies:
1. SA node
2. Right ventricle
An infarct in the _ coronary artery tends to cause bradycardia or heart block
An infarct in the right coronary artery tends to cause bradycardia or heart block
* Due to its supply of the SA node
* This would be an inferior MI
Hydralazine is a drug that is administered during _ because of its _ effects
Hydralazine is a drug that is administered during hypertensive crisis because of its arterial vasodilating effects
Myocardial oxygen demand is determined by 4 factors:
Myocardial oxygen demand is determined by 4 factors:
1. Contractility
2. Afterload
3. Heart rate
4. Wall tension (radius)
Pulse pressure (PP) = ?
PP = SBP - DBP
When does the aortic valve open and close?
S1 is loudest in the _ area
S1 is loudest in the mitral area
S2 is loudest in the _ area
S2 is loudest in the left upper sternal border
S3 is heard in (early/ late) diastole
S3 is heard in early diastole
* It is heard during the rapid ventricular filling phase
* Common in dilated ventricles
* Pathologies: mitral regurgitation, aortic regurgitation, systolic heart failure
S3 can be normal in _ individuals
S3 can be normal in children, young adults, athletes, pregnant women
S4 is heard during (early/late) diastole
S4 is heard during late diastole
* Associated with the atrial kick
* Atria kicks into a noncompliant ventricle
* Associated with hypertrophy
JVP waveform: the a wave represents _
JVP waveform: the a wave represents atrial contraction
An absent a wave:
An absent a wave: atrial fibrillation
JVP waveform: the c wave represents _
JVP waveform: the c wave represents right ventricle contracting (Tricuspid bulging into atrium)
* C = cusp
The x descent represents _
The x descent represents rapid ventricular ejection phase when tricuspid is closed
The x descent is absent in _
The x descent is absent in tricuspid regurgitation
The v wave represents _
The v wave represents atrial filling
y descent represents _
y descent represents right atrium emptying into right ventricle
Prominent or steep y descent is seen in _
Prominent or steep y descent is seen in constrictive pericarditis
* Recall that we want to fill during early diastole!
An absent y descent is seen in _
An absent y descent is seen in cardiac tamponade
Aortic stenosis
Aortic regurgitation
* There is no true isovolumetric phase (mitral is open when it should not be)
Mitral regurgitation
* There is no true isovolumetric phase
Mitral stenosis
Aortic stenosis:
ESV
EDV
Aortic stenosis:
ESV increased
EDV unchanged
Mitral regurgitation
ESV
EDV
Mital regurgitation
ESV decreased (less resistance during systole)
EDV increased (due to extra volume from RA regurg)
Mitral stenosis
ESV
EDV
Mitral stenosis
ESV decreased
EDV decreased
Aortic regurgitation
ESV
EDV
Aortic regurgitation
ESV unchanged
EDV increased
Stenosis will _ stroke volume, while regurgitation will _ stroke volume
Stenosis will decrease stroke volume, while regurgitation will increase stroke volume
Wide splitting of the S2 occurs in conditions that delay _
Wide splitting of the S2 occurs in conditions that delay pulmonic valve closure/ RV emptying
Two conditions in which we might see wide splitting of S2:
Two conditions in which we might see wide splitting of S2:
1. Pulmonic stenosis
2. Right bundle branch block
Fixed splitting means that S2 is split during _ and _
Fixed splitting means that S2 is split during inspiration and expiration
We hear fixed splitting of S2 during _
We hear fixed splitting of S2 during ASD
* The L –> R shunt causes extra blood in RV and delay in pulmonic valve closure
Paradoxical splitting is heard in conditions that _
Paradoxical splitting is heard in conditions that delay aortic valve closure
* Expiration will cause the louder split
ASD can be heard over _ area
ASD can be heard over pulmonic area
* Think of the extra blood traveling through pulmonic valve
Mitral valve prolapse is best heard in _ area
Mitral valve prolapse is best heard in mitral area
VSD is best heard in _ area
VSD is best heard in tricuspid area
* Think of the extra blood traveling L –> R
Three murmurs that are best heard over Erb’s point
Three murmurs that are best heard over Erb’s point
1. Aortic regurgitation
2. Pulmonic regurgitation
3. HOCM
Crescendo-decrescendo murmur heard during systole over the left sternal boarder: _
Crescendo-decrescendo murmur heard during systole over the left sternal boarder: HOCM
* Recall that HOCM and aortic stenosis sound the same
* Aortic stenosis will be heard over aortic area
* Also HOCM is louder with low preload (standing)
The two murmurs that will sound louder with decreased preload include _ and _
The two murmurs that will sound louder with decreased preload include HOCM and mitral valve prolapse
Hand grip will cause HOCM and mitral valve prolapse to sound (quieter/louder)
Hand grip will cause HOCM and mitral valve prolapse to sound quieter
* Hand grip –> increases afterload –> keeps more blood in the ventricle –> makes these murmurs sound quieter
LV pressure greater than aortic pressure during systole describes _
LV pressure greater than aortic pressure during systole describes aortic stenosis
Murmur that radiates to the carotids:
Murmur that radiates to the carotids: aortic stenosis
Holosystolic “blowing” murmur
Holosystolic “blowing” murmur: mitral or tricuspid regurgitation
Murmur that is “loudest at apex and radiates to the axilla”
Murmur that is “loudest at apex and radiates to the axilla”: mitral regurgitation
Late systolic crescendo murmur with midsystolic click
Late systolic crescendo murmur with midsystolic click: mitral valve prolapse
The midsystolic click in MVP is the sound of _
The midsystolic click in MVP is the sound of sudden tensing of chordae tendineae
Carotid pulse is weak with a delayed peak
Carotid pulse is weak with a delayed peak: aortic stenosis
* Called pulsus parvus et tardus
60+ year old patient presents with syncope, angina, dyspnea with a murmur
60+ year old patient presents with syncope, angina, dyspnea with a murmur: aortic stenosis
* SAD: three cardinal signs of aortic stenosis
* Very common in older adults
* Due to age-related calcification
* In younger patients often due to bicuspid aortic valve
Holosystolic “harsh-sounding murmur”
Holosystolic “harsh-sounding murmur”: VSD
* Loudest at the tricuspid area
Caused by myxomatous degeneration
Caused by myxomatous degeneration: mitral valve prolapse
* Associated with connective tissue disease: Marfan, Ehlers-Danlos
* Also associated with rheumatic fever
Head bobbing:
Head bobbing: aortic regurgitation
Patient has a pulse of 150/50
Patient has a pulse of 150/50 –> wide pulse pressure –> aortic regurgitation
* Aortic valve open when it shouldn’t be –> open during diastole –> blood from aorta goes to LV –> leaves the systemic pressure very low during diastole –> wide pulse pressure
Opening snap:
Opening snap: mitral stenosis
Left atrium has a higher pressure than left ventricle during diastole describes _
Left atrium has a higher pressure than left ventricle during diastole describes mitral stenosis
Continuous machine like murmur
Continuous machine like murmur: PDA
PDA is best heard in _ area
PDA is best heard in infraclavicular area
PDA is loudest at (S1/S2)
PDA is loudest at S2
“irregularly, irregular rhythm”
“irregularly, irregular rhythm” atrial fibrillation
* No P waves
* Irregularly spaced QRS waves
Erratic rhythm with no identifiable waves
Erratic rhythm with no identifiable waves: ventricular fibrillation
“egg on a string” on chest xray
“egg on a string” on chest xray: transposition of great vessels
Tetralogy of fallot is caused by _
Tetralogy of fallot is caused by anterosuperior displacement of the infundibular septum
Normal PR interval
120-200 ms
Normal QRS complex width
< 100 ms
WPW involves an abnormal accessory pathway called the bundle of kent that is (faster/ slower) than the AV node
WPW involves an abnormal accessory pathway called the bundle of kent that is faster than the AV node –> pre-excitation
Most common risk factors of atrial fibrillation are _ and _
Most common risk factors of atrial fibrillation are hypertension and coronary artery disease
How do ANP and BNP work?
Released from atria and ventricles in response to high blood volume and pressure –>
Acts via cGMP –> vasodilation and also decreased Na+ reabsorption
Progression of atherosclerosis
- Endothelial cell dysfunction
- Macrophage and LDL accumulation
- Foam cell formation
- Fatty streaks
- Smooth muscle cell migration (PDGF, FGF)
- Proliferation
- ECM deposition
- Fibrous plaque
- Complex atheromas
- Calcification
Cardiac troponin rises after _ hours, peaks at _ , and decreases after _
Cardiac troponin rises after 4 hours, peaks at 24 hours , and decreases after 7-10 days
CK-MB rises after _ , peaks at _ , and decreases after _
CK-MB rises after 6-12 hours , peaks at 24 hours , and decreases after 48 hours
Cardiac arrhythmias post MI are significant bc _
Cardiac arrhythmias post MI are important cause of death before reaching the hospital and within 24 hours post-MI
Pericarditis usually develops _ days after MI
Pericarditis usually develops 1-3 days after MI
* Involves a friction rub
Papillary muscle ruptures occur within _ days post MI
Papillary muscle ruptures occur within 3-7 days post MI
IV septal ruptures occur _ days post-MI
IV septal ruptures occur 3-5 days post-MI
Papillary muscle tears are most common in posteromedial papillary muscle and can result in _
Papillary muscle tears are most common in posteromedial papillary muscle and can result in severe mitral regurgitation
Ventricular pseudoaneurysm formation is most likely _ day post-MI
Ventricular pseudoaneurysm formation is most likely 3-14 days post-MI
Ventricular free wall rupture is most common _ days post-MI
Ventricular free wall rupture is most common 2-14 days post-MI –> cardiac tamponade
The most common type of cardiomyopathy is _
The most common type of cardiomyopathy is dilated cardiomyopathy
Dilated cardiomyopathy (90% of cases) is often idiopathic or familial due to a mutation in _
Dilated cardiomyopathy (90% of cases) is often idiopathic or familial due to a mutation in TTN gene encoding sarcomeric protein titin
Etiologies of dilated cardiomyopathy
Alcohol
Beriberi
Chagas
Cocaine
Coxsackie B
Doxorubicin
Others: hemochromatosis, sarcoidosis, peripartum
Hypertrophic obstructive cardiomyopathy is usually caused by mutation in genes encoding _ or _
Hypertrophic obstructive cardiomyopathy is usually caused by mutation in genes encoding beta myosin heavy chain or myosin binding protein C
“HF cells” in the lungs (pulmonary edema)
Hemosiderin-laden macrophages
ECG findings with cardiac tamponade
Low voltage QRS and electrical alterans due to “swinging” movement of the heart within fluid
Three common pathogens associated with IVDU induced IE
- Staph aureus
- Pseudomonas
- Candida
Most myxomas occur in the _
Most myxomas occur in the left atrium
