Misc + Physiology

Question 1

Absent A waves
(JVP Waveform)

Answer 1

AF, sinus tachycardia

Question 2

Flutter waves

Answer 2

Atrial Flutter

Question 3

Prominent A waves

Answer 3

First-degree AV block

Question 4

A wave

Answer 4

Atrial Contraction

Question 5

X descent

Answer 5

Atrial relaxation

Question 6

Large A wave

Answer 6

Increased RA pressure: TS, R) atrial myxoma, pulomonary HTN, PS

Question 7

Cannon A waves

Answer 7

AV disassociation, VT

Question 8

Phase 0 (Ventricular AP)

Answer 8

Rapid depolarisation (influx of Na through L-Type Ca channels)

Question 9

Phase 1 (Ventricular AP)

Answer 9

Transient repolarisation (inactivation of Na channels, activation of outward K channels)

Question 10

Phase 2 (Ventricular AP)

Answer 10

Plateau - outward K balanced by inward Ca

Question 11

Phase 3 (Ventricular AP)

Answer 11

Inactivation of Ca channels, ongoing eflux of K

Question 12

Phase 4 (Ventricular AP)

Answer 12

Stable resting membrane potential

Question 13

Ion associated w/ TdP

Answer 13

Associated w/ early after depolarisation, during phase 2 or 3- due to inhibition of the outward eflux of K ions or increased influx of Ca

Question 14

Cardiac muscle contraction

Answer 14

Calcium influx during Phase 2 (Plateau phase) attaches to Troponin C, causing tropomyosin to detach from myosin-binding sites on actin and myosin –> cross-bridge –> contraction

Question 15

What is Electrical Alternans on ECG? What does it indicate?

Answer 15

Variation in amplitude of QRS complexes. Indicated pericardial effusion.

Question 16

Which NSAIDs are cardioprotective?

Answer 16

Non-selective COX inhibitors
> Aspirin
> Naproxen

Question 17

Preload definition

Answer 17

Myocardial sarcomere length just prior to systole - approximated by EDV

Question 18

Afterload definition

Answer 18

Left ventricular wall stress during onset of systole

Question 19

Left ventricular fractional shortening

Answer 19

% change in LV internal dimensions between systole and diastole

Question 20

What is not affected by preload?
A) EF
B) ESV
C) End systolic fractional shortening
D) Peak systolic pressure
E) Cardiac output

Answer 20

B) ESV

Question 21

V wave

Answer 21

Passive filling of RA with close tricuspid valve during ventricular contraction

Question 22

Y descent

Answer 22

Atrial emptying

Question 23

Cardiac pathology secondary to carcinoid syndrome

Answer 23

Valvular heart disease

Question 24

Types of Cardiac Amyloidosis

Answer 24

• Transthyretin amyloidosis (ATTR amyloidosis)
• Light chain amyloidosis (AL amyloidosis)
• Serum amyloid A amyloidosis (AA)

Question 25

Imaging modalities to investigate cardiac amyloidosis

Answer 25

• TTE
• Cardiac MRI
• NM Bone Scan

Question 26

AL Amyloidosis Treatment

Answer 26

• Treat underlying malignancy
• Treat complications - AF & conduction disease
• Transplant - if malignancy treated
• Avoid ACEi/BB/CCB due to risk of hypotension
• Avoid digoxin due to risk of toxicity

Question 27

ATTR Amyloidosis Treatment

Answer 27

• Treat complications - AF & conduction disease
• Disease-specific therapy
  > Tafamidis - prevents cleavage of transthyretin tetramers, reduced amyloid deposit. Reduces mortality.
  > Difunisal - NSAID prevents cleavage of amyloid tetramers, improves neuropathy sx
• Transplant - if isolated to heart