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Cardiology > Quiz III > Flashcards

Quiz III Flashcards

1
Q

Define cardiothoracic ratio and normal value

A

ratio for heart diameter to chest diameter at widest points

-should be less than 50%

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2
Q

Where does pericardial effusion occur?

A

b/w the visceral and parietal layers of the pericardium

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3
Q

Length of normal aortic arch on frontal CXR

A

<4cm from left border of trachea to lateral border of the aortic arch

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4
Q

Age or atherosclerotic disease can have what morphological effect on the aorta

A

Can become elongated and tortuous

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5
Q

Appearance of dilated ascending aorta on CXR?

A

Will appear as a CONVEX shape above the right atrium where there should be straight line representing SVC

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6
Q

Signs of dilated main pulmonary artery on CXR

A
  • larger than aortic arch

- extends to the left of line drawn tangentially to aortic arch and apex of heart

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7
Q

Descending pulmonary artery should be less than?

A

16 mm (seen on the right side)

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8
Q

Left atrial enlargement on CXR

  • left side
  • right side
A

LEFT - left atrial contour becomes straight or convex (normally concave)

RIGHT - double density sign

Also elevation of left main bronchus

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9
Q

PPH puts increased pressure on?

A

Right ventricle -> enlargement

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10
Q

Match the following conditions with their respective SEPTAL defects

Down Syndrome

Trisomy 13

22q11

A

Down Syndrome: AVSD, primum defects

Trisomy 13: VSD, ASD

22q11: Posterior malalignment VSD

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11
Q

Match the following conditions with their respective VALVULAR defects

Trisomy 18

Noonan Syndrome

A

Trisomy 18: polyvalvular disease, VSD

Noonan Syndrome: pulmonary valve stenosis, hypertrophic cardiomyopathy

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12
Q

Match the following conditions with their respective CONOTRUNCAL defects

22q11 Deletion Syndrome

CHARGE Syndrome

Turner Syndrome

Williams Syndrome

A

22q11 Deletion Syndrome: Interrupted Aortic Arch type B, truncus arteriosus, tetralogy of Fallot, right aortic arch

CHARGE Syndrome: Tetralogy of Fallot, double outlet right ventricle, right aortic arch

Turner Syndrome: Coarctation, bicuspid aortic valve, hypoplastic left heart syndrome

Williams Syndrome: Supravalvular aortic stenosis, Branch PA stenosis

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13
Q

Down syndrome

  • which CHD
  • why at risk for AML?
A
  • AVSD

- GAT1 mutation -> transient myeloproliferative disorder

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14
Q

Trisomy 18

  • mutation
  • maternal or paternal
  • survival?
  • CHD?
  • features?
A
  • 50% meiosis II nondisjx
  • 95% maternal (age correlation)
  • 5-10% survival after 1 year
  • 50% w/in 1st week

-CHD -> polyvalvular abnormalities

FEATURES

  • prominent occiput
  • feet rounded at bottom w/ prominent heels
  • central apnea
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15
Q

Trisomy 13

  • features
  • CHD
  • survival
A

FEATURES

  • Giant sore on top of head
  • Bilateral cleft lip and palate
  • Dysplastic malformed ear, small head, microcephaly, polydactyly
  • CHD -> VSD
  • survival - median = 7 days
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16
Q

What 3 syndromes is TOF associated with?

A

22q11.2 deletion -> 16%

Alagille Syndrome -> 12%

Down’s -> 5%

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17
Q

22q11.2 features

What testing is important?

A
  • Hooded eyes
  • Low set, rotated ears
  • Micrognathia
  • HYPOcalcemia – no PTH
  • Immune deficiency (DiGeorge’s)
  • Feeding problems, cleft palate
  • Learning probs, behavior issues, psychosis
  • TEST PARENTS!!!
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18
Q

Williams Syndrome

  • CHD
  • gene
  • characteristics
  • risk of?
  • mutation?
  • unique characteristics
A

CHD - supravalvular aortic stenosis

Gene -> 7q11 and ELN-1

CHARACTERISTICS
-Elevated Serum calcium, urine calcium output
-FTT
-Developmental delays
-Supraorbital fullness, stellate iris, long
philtrum, large mouth with full lips

-Risk of sudden cardiac death with anesthesia due to decreased elastin in coronary arteries

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19
Q

Coarctation of aorta associated with?

Characteristics of this syndrome

A

Turner Syndrome

-NORMAL IQ but visuaspatial difficulties
• Tiny hyper-convex fingernails
• Lymphedema of feet and hands
• Webbed neck

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20
Q

Noonan Syndrome

  • CHD
  • Mutation
  • Features
A

CHD -> PVS + HCM

-mutation -> RAS/MAP kinase pathway

Features
•	Wooly/curly hair with family members that have different hair 
•	Pectus excavatum 
•	Widely spaced 
•	Ptosis of the eyes 
•	Eyes slanting DOWN (DOWN’S SLANT UP)
•	Broad forehead and small chin
•	Webbed neck 
•	Scoliosis 		
•	Low posterior hairlines 
•	Bleeding diathesis
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21
Q

CHARGE syndrome

  • define
  • heart defect
  • can be associated with
  • cranial nerve dysfx includes
  • mutations or deletions in
A
  • Coloboma, Heart defect, choanal atresia, mental/growth retardation, GU anomalies, ear anomalies
  • conotruncal defects
  • associated w/ Kallmann’s
  • CN I, VII-X
  • mutation -> CHD7 -> needed for neural crest cells
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22
Q

Describe autonomic control of HR and SV

A

SV (contractility) -> ONLY under SNS control

HR - influenced by PNS and SNS

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23
Q

Venous return and what go hand in hand?

A

Stroke Volume

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24
Q

Blood volume adjustment occurs at the level of the?

A

KIDNEY - long term

-regulate size of the peripheral venous pool -> venous return -> cardiac output

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25
Q

Effectors for reflex regulation of BP?

A

Heart -> CO

VSM -> TPR

26
Q

Describe the location of the 2 baroreceptors

  • CN
  • Role
A

Arch of aorta

  • CN X
  • responding to pressures from the heart

Carotid bifurcation

  • IX
  • responding to perfusion pressure of brain

The 2 are same if lying down and different if standing up

27
Q

What 3 things activate the chemoreceptors and what’s the response

A
  1. Inc PCO2
  2. Inc H+
  3. Dec PO2

Inc in driving pressure

28
Q

Where the the receptors CP reflexes located?
What do they respond to?
What’s the response?

A

Receptors -> right atrium and pulmonary artery

Respond to changes in central venous pressure (CVP)

Dec in SNS activity -> dec pulmonary venous pressure, venous return, CVP

Also release ANPs and BNPs -> powerful vasodilators in response to high pressure

29
Q

What are the primary determinants of retaining Na+ in the kidney?

A
  1. Renin-angiotensin-aldosterone axis

2. Renal sympathetic nerves -> directly innervate tubules

30
Q

Hormonal control on vessels
-bradykinin, histamine, adenosine

-serotonin

A
  • bradykinin, histamine, adenosine -> vasodilators

- serotonin -> vasoconstrictor

31
Q

Match the following pericarditis with the infectious agent

Suppurative
Hemorrhagic
Caseous

A

Suppurative - strep or pneumococcus

Hemorrhagic - aspergillus (fungal)

Caseous - Tb

32
Q

EKG findings in acute pericarditis

A

Diffuse elevation in ST segments

depression of the PR segment

33
Q

Pericardial effusion in middle aged man - think?

A

TUMOR

34
Q

EKG finding for pericardial effusion

A

Low voltage

Electrical alternans - alternating QRS complexes (axis or amplitude)

35
Q

Explain the cause of the following sxs seen with pericardial tamponade:

Edema and hepatomegaly

Dyspnea

A

Edema and hepatomegaly-> inc systemic venous pressure

Dyspnea -> inc pulmonary venous pressure

36
Q

Which 2 drugs can cause pericarditis and pericardial tamponade?

A

Hydralazine and procainamide

37
Q

Define pulsus paradoxus

Seen in?

A

Exaggerated (>10mmHg) DECREASE in systolic BP during inspiration

Seen in cardiac tamponade

38
Q

What’s seen on echocardiogram w/ a pericardial tamponade?

On cardiac cath?

what’s the path taken

A

RV diastolic collapse

Cath - EQUALIZED elevation of diastolic pressures

RA -> RV -> PA

39
Q

W/ swan ganz cath pulm cap wedge pressure indicative of?

A

Left atrial pressure

40
Q

MC etiologist of constrictive pericarditis

A

TB, poster pericarditis of any etiology, idiopathic

41
Q

Clinical findings of constrictive pericarditis

A 
Elevated JVP
Kussmaul's sign -> lack of inspiratory drop in JVP
Ascites and edema
Pericardial knock in early diastole 
Fatigue, hypoTN, tachy
42
Q

Cardiac cath finding of restriction of diastolic filling

A

square root sign -> dip and plateau

43
Q

Jugular venous pulse

A

At Carter’s crossing (X) vehicle’s yield

A - atrial contraction (rise)
C - RV contraction (tricuspid closed) -> rise
X - atrial relaXation -> dip
V - inc right atrial pressure due to filling (tricuspid closed) -> rise
Y - blood flow from RA to RV -> dip

44
Q

Normal atrial and ventricular pressures

A

RA < 5
RV - 25/5
LA < 12
LV - 130/10

45
Q

Why do we give beta-blockers in HF?

A

there is down regulation of beta receptors due to in sympathetic drive

beta-blockers reverse this -> better response to endogenous epi -> inc in EF

46
Q

role of AGII in HF

A

Major role in heart remodeling process - target for tx

47
Q

Systolic vs diastolic dysfx on ausculation

A

S3 - systolic
S4 - diastolic

Apex beat
-large and diffuse beat -> systolic

48
Q

Wall motion study to determine systolic vs diastolic dysfx

A

Systolic - LVEF REDUCED

Diastolic - LVEF NORMAL

49
Q

List 4 neurohormonal interventions to tx HF

A
  1. Block AGII
  2. Vasodilate - nitrates and hydralazine -> reduce afterload
  3. Beta blocker
  4. Block aldosterone
50
Q

Compare metabolic vs sympathetic regulation in coronary arteries

A

Metabolic»>sympathetic

adenosine -> vasodilation

51
Q

Energy source for aerobic respiration in heart during:

rest

exercise

A

rest - FFA

exercise - lactate

52
Q

Where is sympathetic vasodilation seen? What’s the NT?

A

non-apical skin using Ach

53
Q

Describe the 4 zone of pulmonary blood flow

A

Zone 1 - P(a) is the greatest

  • Valsalva maneuver
  • Blowing up balloon analogy
  • Alveolar pressure is the greatest
    • Completely collapses the capillary and stop blood flow
  • Can restrict blood flow going back to left atrium in extreme conditions
  • Does not occur under normal conditions

Zone 2 - P(pa) > P(a) > P(pv)

  • Alveolar p > pul v pressure but lower than pulm a pressure
  • Driving force equal to the arterial alveolar difference
    • Called waterfall flow
    • Amount of flow does not depend on how far it falls
    • ALVEOLAR and pulm artery pressure difference determining flow
      • Due to partial contraction of alveolar capillaries

Zone 3 - P(a) is the lowest

  • pulm a and v pressure > than alveolar pressure
  • At the bottom of the lung this dilates the capillary

Zone 4

  • At very bottom of lung -> parenchyma is being squished
  • Extra alveolar vessels become contracted (feeding vessels)
  • Bottom of lung getting very little blood flow
    • That explains dip in top left graph
54
Q

Hallmark of systolic HF?

A

Low EF and LV enlargement

55
Q

Chronic lymphedema is associated with which neoplasm?

A

Angiosarcoma -> happens in elderly

56
Q

Kaposi Sarcoma associated with which virus?

A

HHV-8

-seen in AIDS patients

57
Q

Bacillary angiomatosis due to which agent?

A

Bartonella henselae

58
Q

Breakdown the aortic dissection by location

Stanford A
Stanford B

A

A - ascending +/- descending -> much worse

B - descending

59
Q

Hallmark of aortic dissection on physical?

A

Unequal BP and pulses

60
Q

MC risk factor for aortic dissection?

A

HTN

Cardiology (6 decks)

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