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Newman Questions Flashcards

1
Q

Two determinants of O2 demand

A

Heart Rate, Systolic BP

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2
Q

2 Categories of Pressure Overload

A

Systemic HTN, Outflow Obstruction (Aortic Stenosis, Asymmetric Septal Hypertrophy)

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3
Q

2 categories of Volume overload

A

Regurgitant Valves, High-Output States (Anemia, Hyperthyroidism)

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4
Q

2 Major Humoral Manifestations of Renin-Angiotensin

A

Most potent vasoconstrictor in body; Aldosterone secreted by adrenals

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5
Q

3 Causes of Aortic Regurgitation

A

Ischemia, Infection, Dissection

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6
Q

3 Causes of Volume Overload

A

Regurgitation, Anemia, Hyperthyroidism

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7
Q

3 Drugs associated with delayed after-depolarizations

A

Procainamide, Quinidine, Digoxin

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8
Q

3 Major Clinical Manifestations of RV HF

A

SOB, Elevated JVP, Hepatojugular Reflex

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9
Q

4 Clinical Manifestations of LV Failure

A

SOB/Orthopnea/PND; Fatigue/Confusion; Nocturia; Chest Pain

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10
Q

4 Neurohumoral changes with CHF

A

Increased sympathetic (NE), Renin release, Vasopressin, Cytokines (IL-1, Enodthelin)

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11
Q

5 Causes of Acute Pericarditis

A

Infection (TB, Viral); CT Disease; Malignancies; Thyroid Dz; metabolic

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12
Q

5 Common Causes of CHF

A

Volume Overload, Pressure Overload, Loss of Muscle, Loss of Contractility, Restricted Filling

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13
Q

5 complications of MI

A

HF, Arrhythmia, Shock, Bradycardia, Nausea/Vomiting

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14
Q

5 main etiologies of LV Failure

A

Volume/Pressure Overload, Restricted Filling, Myocyte Loss, Decreased Contractility

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15
Q

Afterload is the pressure that

A

the LV needs to overcome for aortic valve to open

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16
Q

Angina Pectoris is characterized by

A

> 5 mins; Pressing, tightness

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17
Q

Angina, Syncope, HF

A

Aortic Stenosis

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18
Q

Anterior Leads

A

V1-V6

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19
Q

Auscultation of STEMI

A

S4 may be present

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20
Q

AV block can be seen in some congenital disorders:

A

MD, Tuberous Sclerosis, Maternal SLE

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21
Q

Blowing systolic murmur

A

Mitral Regurgitation

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22
Q

Bundle Branch Block leads to what on ECG

A

Widening of QRS Complex

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23
Q

Cardiac Adaptation to Regurgitation

A

Eccentric Hypertrophy (Dilatation): Cardiac fibers multiply in series –> Output increased (sterling’s law)

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24
Q

Cardiac Adaptation to Stenosis

A

Concentric Hypertrophy, Normal Volume and Size

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25
Q

Cardiac exam findings in LV Failure

A

Displaced, Sustained PMI, S3, S4

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26
Q

Causes of Mitral Prolapse

A

Infection, Infarction, Myxomatous Degeneration, CT disorder

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27
Q

Changes of Calcium function in LV HF

A

Delivery of Ca to contractile apparatus and reuptake of Ca by SR are slowed

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28
Q

Changes to beta-adrenergic receptor in LV HF

A

Densensitization

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29
Q

Changes to myosin and troponin in LV HF

A

Re-expression of fetal and neonatal forms of myosin and troponin

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30
Q

Changes to Systolic Isovolumetric curve in LV Diastolic Dysfunction

A

None

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31
Q

channels disrupted in prolonged QT

A

(Ca and/or) K

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32
Q

Clearing throat murmur in systole

A

Aortic Stenosis

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33
Q

Contractility of Myocytes in LV Diastolic Dysfunction

A

Preserved

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34
Q

Cytokines released in CHF lead to

A

IL-1 –> Myocyte hypertrophy; Endothelin –> HTN in pulmonary arteries, mycoyte growth, collagen deposition

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35
Q

Decrease in PR interval means

A

WPW

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36
Q

ECG in WPW

A

Short PR, Delta Wave

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37
Q

Echo for MI vs Pericarditis

A

Segments not contracting vs Effusion

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38
Q

Ejection Fraction =

A

SV / EDV

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39
Q

EKG Features of Ischemia

A

Inverted T Wave, ST Depression

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40
Q

Elevated Atrial Pressures indicate

A

Preload is adequate but ventricular function is decreased, or fluid is accumulating in venous system

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41
Q

Elevated RR, HR, Cold Clammy Skin, Pulsus Alternans, Displacement of PMI, Lung Rales, S3, S4 audible

A

Left Heart Failure

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42
Q

First Degree AV Block

A

Abnormally long conduction time (PR > 0.22s)

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43
Q

First thing to do with Pericardial Effusion

A

Palpate pulse and watch breathing

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44
Q

Giant V Wave

A

Acute Mitral Regurgitation

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45
Q

Giant V Wave =

A

Mitral Valve Prolapse

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46
Q

Height of QRS is usually

A

2 boxes

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47
Q

Hemodynamic changes in Aortic Regurg

A

Increased Preload, Increased SV

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48
Q

Hemodynamic changes in Diastolic Dysfunction

A

Diastolic PV curve shifts left, Increase in LV EDP

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49
Q

Hemodynamic changes in systolic dysfunction

A

Isovolumic Systolic Pressure curve shifts down; SV and CO reduced

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50
Q

Hemodynamics in acute regurgitation

A

Pressure in LA markedly elevated

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51
Q

High QRS on ECG indicates

A

Ventricular Hypertrophy

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52
Q

How do CO2, O2, Acidity, and Temp affect Automaticity

A

CO2, Acidity, and Temp increase, O2 decreases

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53
Q

How do we determine severity of Mitral Stenosis

A

LV vs Pulmonary Capillary Wedge pressure (should be identical)

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54
Q

How do you distinguish between Aortic Regurgitation and Stenosis

A

Regurg produces diastolic murmur, wide pulse pressures, brisk pulse

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55
Q

How do you dx Pericardial Tamponade

A

Pulsus Paradoxis: Upon inhalation, pulse disappears

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56
Q

How does heart respond reduced SV in LV Systolic Dysfunction

A

Increased return of blood (preload), Increased release of catecholamines, Cardiac Muscle Hypertrophy

57
Q

How does K+ affect automaticity

A

Decreased K+ –> Increased automaticity

58
Q

How quickly can V Fib lead to SCD

A

Few seconds

59
Q

How to increase murmur in HOCM

A

Valsalva or standing –> Decrease IV volume –> Murmur increases

60
Q

If QRS is wide, what is abnormal

A

Ventricular activation

61
Q

Increase in NE during HF can lead to

A

increased preload and afterload, which can worsen HF

62
Q

Increase in PR interval means

A

Heart Block

63
Q

Increased SV, Brisk Arterial Pulse, Whooshing decrescendo murmur after S2

A

SV, Pulse, Mumur in Aortic Regurg

64
Q

Inferior Leads

A

II, III, aVF

65
Q

Is S3 present in Systolic or Diastolic Dysfunction

A

Can be present in either

66
Q

Key finding in acute regurgitation

A

Loud murmur without hypertrophy

67
Q

Key to clinical assessment of Valve Stenosis

A

Pressure difference on either side of valve

68
Q

LA pressure in Acute vs Chronic Regurgitation

A

Elevated in Acute, Normal in Chronic

69
Q

Long QT results from

A

Reduced function of K channels -> Prolonged plateau period

70
Q

Loud S1

A

Mitral Stenosis

71
Q

Loud S1 (snaps shut), Diastolic Rumble

A

Mitral Stenosis

72
Q

LV Diastolic Dysfunction is caused by any disease that

A

Causes decreased relaxation, decreased elastic recoil, or increased stiffness of ventricle

73
Q

May be responsible for Pulmonary HTN, Myocyte Growth, and deposition of interstitial collagen

A

Role of Endothelin in HF

74
Q

Midsystolic Click

A

Mitral Valve Prolapse

75
Q

Morphological Changes in Aortic Regurg

A

Ventricular Dilation (Eccentric Hypertrophy)

76
Q

Morphological Changes in Aortic Stenosis

A

Concentric Hypertrophy

77
Q

Morphological Changes in Mitral Regurgitation

A

If chronic, LV and LA Dilation; Not in acute

78
Q

Most common cause of mitral regurgitation

A

Mitral Prolapse

79
Q

Most common cause of stroke

80
Q

Most common finding

A

Displaced Apical Impulse (PMI)

81
Q

Most potent vasoconstrictor

82
Q

Most prolonged QT is caused by

83
Q

Mumur in Aortic Regurgitation

A

Decrescendo following S2

84
Q

Mumur of Aortic Stenosis

A

Clearing throat in systole

85
Q

Murmur for Mitral Regurgitation

A

Holosystolic Blowing Murmur

86
Q

Murmurs for Mitral Stenosis

A

Opening Snap, Diastolic Rumble

87
Q

Murmurs, Sounds in Mitral Stenosis

A

Loud S1 (snaps shut), Diastolic Rumble

88
Q

Narrow QRS means

A

Arrhythmia originating at or above AV node

89
Q

NE released in CHF leads to

A

Increased Preload and Afterload

90
Q

Normal JVP

91
Q

Opening Snap, Diastolic Rumble

A

Murmurs for Mitral Stenosis

92
Q

Physical findings in Mitral Stenosis

A

RHF: JVD, Ascites, Edema

93
Q

Pressures in Constrictive Pericarditis

A

All diastolic pressures in heart equal

94
Q

Principal Physical Findings in Constrictive Pericarditis

A

Pulsatile Neck Veins; Systemic Congestion; No Pulsus Paradoxis

95
Q

Prolonged QRS could be

A

(1) Ventricular Escape Rhythm; (2) Bundle branch block

96
Q

Pulmonary edema with no enlargement of chambers

A

Mitral Valve Prolapse

97
Q

QRS 6 boxes high on V6

A

Ventricular Hypertrophy

98
Q

QRS should be less than

A

0.12 seconds

99
Q

Range for QTc

100
Q

Renin released in CHF leads to

A

AngII –> Aldosterone, Vasoconstriction –> Increased afterload, reduction in CO

101
Q

Result of Endothelin release in CHF

A

HTN in pulmonary arteries, Myocyte growth, Collagen deposition

102
Q

Result of IL-1 release in CHF

A

Myocyte Hypertrophy

103
Q

Role of Endothelin in HF

A

May be responsible for Pulmonary HTN, Myocyte Growth, and deposition of interstitial collagen

104
Q

Role of IL’s in HF

A

May accelerate myocyte hypertrophy

105
Q

Role of TNF in HF

A

May play role in hypertrophy and myocyte death

106
Q

S4 is best heard at

107
Q

S4 occurs concomitantly w/

A

Atrial Contraction

108
Q

Sawtooth pattern on EKG

109
Q

Second Degree AV Block

A

Some, but not all, atrial impulses are conducted to ventricles

110
Q

Sign in Acute Mitral Regurgitation

A

Giant V Wave

111
Q

Signs in Aortic Stenosis

A

Throat-clearing (C-D) murmur, Pulsus Tardus, Pulsus Parvus

112
Q

Sinus tachycardia accompanying MI may be indicative of

A

Cardiogenic Shock

113
Q

Skin findings in Left Ventricular Failure?

A

Pale, Cold, Sweaty

114
Q

SV, Pulse, Mumur in Aortic Regurg

A

Increased SV, Brisk Arterial Pulse, Whooshing decrescendo murmur after S2

115
Q

Symptoms of Aortic Stenosis

A

Syncope, Angina, HF

116
Q

Systolic LV dysfunction reduces

A

SV (decreased CO)

117
Q

Throat-clearing (C-D) murmur, Pulsus Tardus, Pulsus Parvus

A

Signs in Aortic Stenosis

118
Q

Triad of Aortic Stenosis

A

Angina, Syncope, HF

119
Q

Type of HF w/ Pulsus Alternans possible

120
Q

Valve disease associated with Stable Angina

A

Aortic Stenosis

121
Q

Vicious circle:

A

Continued hyperactivity of Renin-Angiotensin system leading to severe vasoconstriction, increased afterload, and further reduction in CO and GFR

122
Q

Weak and Delayed Arterial Pulse

A

Aortic Stenosis

123
Q

What causes nocturia in LHF

A

Decreased renal perfusion gets better at night

124
Q

What causes ventricular dilation in Aortic Regurg

A

Increased Preload

125
Q

What is characteristic of Aortic Stenosis

A

Weak Arterial Pulse (parvus)

126
Q

What is mechanism behind Torsades de Points

A

Delayed Depolarizations

127
Q

What is probably the most common cause of LV Failure

128
Q

What is the Hepatojugular Reflex

A

Pressing on liver for 5 seconds causes increase in JVP

129
Q

What on ECG indicates ventricular hypertrophy

130
Q

What usually causes acute mitral regurgitation

A

Infection, Ischemia

131
Q

When Apical Impulse (PMI) is displaced =

A

LV Volume is Increased as compensatory mechanism of HF

132
Q

When Apical Impulse (PMI) is sustained =

A

Suggests increased LV volume or mass

133
Q

When bundle branches are disease, EKG change:

A

QRS becomes wide

134
Q

Where is S3 best heard

135
Q

Which type of heart failure presents with abdominal pain

136
Q

Why do patients with Left Sided Failure have Orthopnea

A

Now operating on steep portion of Diastolic Pressure-Volume Curve = Any increase in blood return leads to marked elevations in ventricular pressures

137
Q

Width of QRS is usually

A

3 little boxes

138
Q

Workup of Stable Angina

A

Stress Test, Echo, Coronary Angiogram

Cardiovascular (18 decks)

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