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Cardio > Summative Review > Flashcards

Summative Review Flashcards

1
Q

What does the atrial a-wave correspond to?

A

atrial systole

occurs when the mitral valve closes

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2
Q

What does the atrial V-wave correspond to?

A

passive filling of the RA when the tricuspid valve is closed

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3
Q

Differences between exercise and maximal sympathetic stimulation of heart

A

In exercise, arteries dilate which causes decreased TPR and corresponding decreased afterload

Also, skeletal muscle pumping increases preload in exercise

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4
Q

Similarities between exercise and maximal sympathetic stimulation of heart

A

Both increase HR and contractility

Both lead to a decrease in ESV due to increased contractility

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5
Q

In sympathetic or exercise does ESV decrease more?

A

ESV decreases more in sympathetic

Sympathetic = increase TPR = increase afterload

Increase afterload = increase contracility

Increase contracitlity = decrease ESV

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6
Q

Clonidine effects on TPR

A

clonidine is a alpha 2 agonist

prevents sympathetic simulation so therefore, increases TPR

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7
Q

Which drug norepinephrine or epinephrine produces a larger increase in afterload? Why?

A

Norepinephrine since it primarily binds B1 and alpha receptors

Epinephrine binds B2 receptors which causes vasodilation

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8
Q

Prazosin and phenoxybenzamine chronotropic / ionotropic effects

A

Both are alpha antagonists which should cause a decrease in HR and contractility

HOWEVER, the baroreceptor kicks in which causes an increase in HR and contracility

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9
Q

Prazosin and phenoxybenzamine effect on TPR

A

decrease

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10
Q

How do you calculate the blood pressure needed at heart level to adequately perfuse the brain?

A

you are going to drop pressure as you go up

so at the heart, you need to add the pressure you will lose along the journey to the pressure you want

P = (needed pressure) + (distance / 13.6)

to calculate pressure lost, divide distance by 13.6 since for every 1 mmHg, you push blood up 13.6 mm

make sure you are doing these calculates in mm

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11
Q

What happens to the vagal response upon standing?

A

vagal is suppressed because the baroreceptor is doing everything it can to increase HR since SV is decreasing because blood pooling in legs

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12
Q

Difference between calculating systemic vascular resistance and pulmonary resistance?

A

systemic / coronary: subtract RAP on numerator for anything that passes through systemic circulation / aorta

pulmonary: subtract LAP on numerator for anything that goes through pulmonary circulation

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13
Q

What are the 2 general formulas for calculating MAP?

A

MAP = CO * TPR

MAP = (1/3)(systole) + (2/3)(diastole)

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14
Q

What are the 2 main pathologies that affect afterload?

A

HTN and aortic stenosis

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15
Q

As venous compliance increases, what happens to TPR?

A

TPR decreases

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16
Q

When does the atrial c-wave occur?

A

before the aortic valve opens

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17
Q

When does ventricular systole end on ECG?

A

ends after the T-wave

(remember mechanical changes proceed electrical changes)

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18
Q

When arterial BP increases what is the result on aortic valve opening and closing?

A

opening is delayed and closing is earlier

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19
Q

Why does the atrial pressure c-wave occur?

A

C-wave occurs as AV opens

When AV opens, there is contraction and the tricuspid valve bulges into the atrium causes a small increase in atrial pressure

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20
Q

What happens if you have immediate AV damage?

A

you cannot empty the LV

this leads to increased ESV and preload

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21
Q

What happens to ESV and EDV if you dilate the arterioles?

A

both will be reduced due to less preload

that said, stroke volume should remain the same

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22
Q

What happens to ESV, EDV and stroke volume with dobutamine use?

A

dobutmaine effects B1

increased contractility = decreased ESV / EDV

stroke volume stays the same despite decreased ESV because of the increase in contracility

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23
Q

What two things increase MSFP?

A

1) increase in BV

2) decrease in venous compliance

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24
Q

Does mean systemic filling pressure increase during exercise or sympathetic stimulation?

A

increases during sympathetic stimulation since the arteries are getting squeezed more

actually, says that due to skeletal muscle pumping combined with some sympathetic stimulation, MSFP might actually be slightly higher during exercise

MSFP increases in both!

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25
Q

Does venous compliance or arterial compliance affect MSFP more?

A

venous compliance

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26
Q

Does venous compliance or arterial compliance affect resistance more?

A

arterial compliance

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27
Q

What does sympathetic stimulation influence more resistance or MSFP?

A

resistance more since it constricts arteries primarily, not veins

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28
Q

What is the slope of the cardiac function curve?

A

related to contractility

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29
Q

What is the slope of the vascular curve?

A

1/RVR

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30
Q

When does lymph flow increase?

A

when there is more fluid in the interstitial space

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31
Q

What does the ESPVR slope represent?

A

directly proportional to contractility

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32
Q

What does the EDPVR slope represent?

A

opposite of compliance / stiffness

higher slope = less compliant

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33
Q

If a ventricle is stiff, what happens to EDV and pressure?

A

pressure increases

EDV decreases (would shift left on PV curve)

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34
Q

Affinity of alpha receptors for norepinephrine / epinephrine

A

Norepinephrine affects alpha receptors more than epinephrine

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35
Q

What is the effect of aortic stenosis on pulse pressure?

A

aortic stenosis decreases pulse pressure because you cannot eject as much stroke volume into arteries

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36
Q

Dobutamine effects on TPR

A

normally has no effect as you mostly work on B1 receptors

However, at high doses you effect B2 which would lead to a decrease in TPR

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37
Q

What does sheer stress do during exercise?

A

sheer stress causes vasodilation

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38
Q

Effects of alpha receptors on HR and contractility

A

decreased HR and contractility

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39
Q

Effect of beta receptors on HR

A

increased HR and contractility

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40
Q

Hematocrit and what effects it

A

Hematocrit is volume of RBCs in serum

If you increase fluid in serum, you decrease the % of space that RBCs occupy and hematocrit decreases

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41
Q

If venous constriction occurs, what happens to compliance?

A

compliance decreases

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42
Q

Relationship between contractility and ESV

A

reciprocal

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43
Q

What 4 changes occur on PV curve in response to exercise? Why?

A

1) EDV increases (BP increased, more blood volume, more venous return)

2) Isovolumetric pressure increases (BP increased, need more to overcome)

3) ESV decreases (contractility is increased)

4) SV increases

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44
Q

Contractility and pulse pressure

A

increased contractility = wider pulse pressure

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45
Q

If you have high venous compliance, what will happen more?

A

more blood pooling

venous compliance increases as you age, while arterial compliance decreases

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46
Q

What cells secrete NO during exercise?

A

endothelial

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47
Q

BP and alpha-1 vs. alpha-2

A

alpha-1 = increased BP (constriction)

alpha-2 = decreased BP (prevents sympathetic)

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48
Q

What does adenosine trigger? When is it released? Where does it affect?

A

Triggers vasodilation

Released in respnse to lack of stretch or local metabolites

Affects small coronary arteries

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49
Q

What factor is afterload directly related to?

A

MAP

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50
Q

What happens to RAP when you stand?

A

blood is pooling in legs

so, RAP decreases to try to pull more blood back

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51
Q

What protein mostly influences oncotic pressure?

A

albumin

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52
Q

Where is the carotid notch? What causes it?

A

Occurs after AV closes on aortic pressure graph (Wigger’s)

Caused by aortic regurgitation backflow

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53
Q

What does “expiratory splitting with no change during inspiration” indicate?

A

Fixed splitting / ASD

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54
Q

Why does ASD cause fixed splitting?

A

increased blood flow into right chamber leads to increased right volume

delays the closing of the pulmonic valve since you have more volume to push out

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55
Q

Why does normal physiological splitting occur?

A

during inspiration, RAP drops and pulls in more blood

this delays closure of the pulmonic valve

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56
Q

What else can ASD be associated with? (3 things)

A

Systolic ejection murmur: left to right shunting during systole

Early diastolic rumble: left to right shunting as well

S1 accentuated: tricuspid valve has more flow than normal so it slams down

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57
Q

What does amyl nitrate normally do to preload?

A

dilate vessels which decreases preload

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58
Q

What does squatting do?

A

squatting increases preload by sending blood back to the heart

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59
Q

What can be a cause of mitral regurgitation?

A

left ventricle dilation

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60
Q

How can mitral regurgitation cause expiratory splitting?

A

Expiration points us to left side of heart

A2 is coming early because some fluid is flowing back into the left atrium rather than the aorta which leads to decrease in amount of time aortic valve is open

A2 snaps shut earlier due to decreased volume flowing across it

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61
Q

What effects the timing of MVP click?

A

increased preload = later click

decreased preload = earlier click

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62
Q

If contractility is increased, what happens to the click in MVP?

A

earlier click

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63
Q

signs of AVNRT

A

no p-waves

narrow / normal QRS complex

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64
Q

What can AVNRT accompany?

A

SVT

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65
Q

What are the treatment options for SVT?

A

vagal maneuvers

adenosine, beta blockers, Ca2+ blockers

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66
Q

WPW EKG

A

short PR

delta wave!

QRS is slightly widened

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67
Q

Difference between WPW and AVNRT electrically

A

WPW has a bypass tract

AVNRT has re-entry circuit localized to AV node

68
Q

Is WPW most likely antidromic or orthdromic?

A

orthdromic

69
Q

Is AVNRT most likely antidromic or orthdromic?

A

orthodromic

70
Q

Is VT most likely antidromic or orthdromic?

A

antidromic

especially if the QRS complexes are wide

71
Q

What is common treatment of WPW?

A

ablation

72
Q

What type of hypertrophy does aortic stenosis cause?

A

concentric

73
Q

What type of hypertrophy does mitral regurgitation cause?

A

eccentric

74
Q

What does a presystolic heave indicate?

A

an S4 / stiff LV

75
Q

What does bicuspid AV predispose you to?

A

aortic aneurysm

76
Q

What murmur increases in intensity with less preload?

A

HCM

77
Q

What type of disease is HCM?

A

genetic

78
Q

High frequency diastolic murmur with opening snap indicates …

A

mitral stenosis

79
Q

What happens to opening snap of mitral stenosis as LAP increases?

A

increases in LAP cause opening snap to be closer to S2

80
Q

What are some signs of bacterial endocarditis?

A

hemorrhagic splinter, Janeway lesion (painless), Osler nodes (painful)

81
Q

Why can you get a murmur from bacterial endocarditis?

A

fever + hyperdynamic flow due to infection

82
Q

What are you likely to see on lab values due to bacterial endocarditis?

A

anemia of chronic disease

83
Q

Aortic regurgitation murmur

A

diastolic murmur with decrescendo at left sternal border

84
Q

If lead I is negative and lead aVF is positive, what is your axis?

A

axis between +90º - +180º

this is a right shift

85
Q

Define the left vs right sided leads

A

Left: 4-6

Right: 1-3

86
Q

Give the different leads and their associated MI location

A

Lateral: I, aVL, V5-V6 (LAD or Lcx 1)

Inferior: II, III, aVR (RCA)

Anteroseptal: V1-V4

87
Q

What are the hallmarks of VT?

A

wide QRS

AV dissociation

88
Q

RBBB vs. LBBB

A

RBBB: wide QRS with V1 positive

LBBB: wide QRS with V1 negative (also bunny ears)

89
Q

What does digoxin look like on EKG?

A

peaked T-wave, scooped out ST interval, shortened QT interval

90
Q

Where can you listen for ASD mumur?

A

in the pulmonic area

91
Q

What happens to heart sounds as aortic stenosis worsens?

A

crescendo-decrescendo moves later in systole

S2 heart sound becomes inaudible

92
Q

What can cause an S4?

A

longstanding HTN or HCM

93
Q

“Young female, otherwise healthy” indicates what condition? What murmur should you check for? Where should you listen?

A

MVP

opening click with late systolic murmur

listen at apex

94
Q

“Healthy young athlete with syncope” indicates what condition? What murmur should you check for? Where should you listen?

A

HCM

systolic murmur

listen at left sternal border

95
Q

“Immigrant or pregnant” indicates what condition? What murmur should you check for? Where should you listen?

A

mitral stenosis

diastolic murmur with opening snap

listen at apex

96
Q

“IV drug abuser” indicates what condition? What murmur should you check for? Where should you listen?

A

Tricuspid regurgitation

holosystolic murmur

listen at tricuspid area

97
Q

What does handgrip do in general?

A

increases afterload and causes more regurgitation

98
Q

What does increase in afterload do to MVP?

A

later click of MVP

99
Q

What does increase in preload due to MVP?

A

later click of MVP

100
Q

What does hang grip do to HCM?

A

increase afterload = transient increase in preload, so this will temporarily relieve HCM and decrease murmur

101
Q

Laplace’s law and when it occurs

A

states that increased pressure = increased wall thickness

this occurs in AS, since to overcome increased afterload you need increased pressure. This increase in pressure will lead to increased wall thickening

102
Q

What can aortic stenosis predispose you to?

A

aortic aneurysm

103
Q

What 2 conditions can cause A2 to come quicker than P2 leading to wide splitting on expiration?

A

VSD and mitral regurgitation

causes persistent splitting

104
Q

What would an ionotropic agent do to MVP?

A

ionotropic = increased contractility= decreased ESV

decreased volume = earlier click of MVP

105
Q

What happens to pulse pressure in aortic regurgiation?

A

decreased pulse pressure in aortic regurg

106
Q

Opening click at the beginning of systole that does not move with maneuvers

A

bicuspid aortic valve

107
Q

What does aortic regurgitation lead to on carotid pulse?

A

big upstroke at first to make up for the extra LV volume

then, you fall back down

leads to a large atrial A-wave

108
Q

What type of cardiomyopathy can aortic regurgitation cause?

A

eccentric cardiomyopathy

109
Q

What leads to a large atrial p-wave?

A

mitral regurgitaiton

110
Q

If you see pulsus parvus et tarvus what should you think of?

A

aortic stenosis

111
Q

LVH on EKG

A

look at left sided leads V5-V6, etc

if left-sided leads have large R-waves, look and see if there is a left axis deviation too

112
Q

What happens to diastolic and systolic BP during exercise?

A

Systolic BP rises because large arteries becomes less compliant

Diastolic BP remains largely the same

113
Q

What happens to blood flow during exercise?

A

becomes more turbulent

114
Q

What happens during aging to veins and arteries?

A

Veins become more compliant

Arteries become less compliant

115
Q

Relationship between MSFP and CO

A

Increase in MSFP increases CO

116
Q

What 2 mechanisms contribute to increased CO in exercise?

A

1) MSFP increases due to venoconstriction mediated by the sympathetic system in non-exercising areas

2) TPR decreases due to dilation in exercising arteries

117
Q

What does acute blood loss due to hematocrit?

A

drops capililary hydrostatic pressure

leads to fluid rushing in which will dilute the % of RBCs in blood and hematocrit drops

118
Q

What happens to large arteries with exercise?

A

they become less compliant, leading to an increase in systolic BP

119
Q

What adrenergic drug has greatest and which has lowest risk of producing tachycardia?

A

Greatest: epinephrine

Least: norepinephrine

120
Q

On PV curve, how can you tell if contractility has been affected? When is this useful to know?

A

If ESV has decreased, this means that contractility has increased and vice versa

This is useful when determining what change might have occurred on the curve (ex: phenylephrine affects afterload but not contractility)

121
Q

What does sympathetic stimulation do to slope of vascular function curve?

A

Slope = 1/RVR

an increase in RVR = decreased slope

122
Q

What does exercise do to slope of vascular function curve?

A

Slope = 1/RVR

a decrease in RVR = increased slope

123
Q

What does the a-wave on pulse correspond to?

A

atrial contraction

124
Q

What does the c-wave correspond to on pulse?

A

right ventricle contraction

125
Q

With massive blood loss, what will sympathetic system to?

A

constrict veins

126
Q

What 2 things is the cardiac function curve affected by?

A

contractility

afterload

127
Q

What 2 things is the vascular function curve affected by?

A

blood volume (MSFP)

venous tone (MSFP)

resistance (affects slope 1/RVR)

128
Q

Difference in dilating arteries vs. veins

A

Veins - decrease preload

Arteries - decrease afterload

129
Q

Harsh late-peaking systolic murmur heard at cardiac base and LSB describes what?

A

HCM

130
Q

Carcinoid syndrome indicates …

A

a problem with the right side of the heart

131
Q

Narrow splitting of S2 indicates? (right-sided)

A

Tricuspid regurgitation is causing less blood to need to flow across pulmonic valve

This leads to P2 closing earlier and a narrow splitting

132
Q

Orthodromic AVRT looks like …

A

narrow complex tachycardia

133
Q

Antidromic AVRT looks like …

A

wide complex tachycardia

134
Q

What are question stem clues that point you to VT rather than antidromic AVRT?

A

history of ischemic CM and previous scarring

135
Q

What phase do class III drugs work on?

A

phase 2 and 3 of the myocyte action potential

136
Q

Rhythm vs rate control drugs and associated cardiac action potential

A

Rhythm: I+III, normal cardiac action potential

Rate: II + IV, SA node

137
Q

How does adenosine work?

A

slows SA depolarization and AV nodal conduction

reduces the slope of phase 4 of the pacemaker as well

138
Q

How does digoxin work?

A

inactivates the Na-K ATPase pump

more intracellular Na+ = more Ca2+

(also activates parasympathetic; therefore, increases contractility without increases HR)

139
Q

What corresponds to large v-waves on atrial pressure tracing?

A

mitral or tricuspid regurgitation

140
Q

When determining eccentric vs. concentric what can you think about?

A

Eccentric = more volume (regurgitation can cause)

Concentric = more pressure

141
Q

What type of hypertrophy does dilated cardiomyopathy display?

A

volume overload = eccentric hypertrophy

142
Q

Acute respiratory distress with new holosystolic murmur post-MI indicates …

A

papillary muscle rupture with mitral regurgitation

143
Q

Can mitral stenosis cause pulmonary HTN?

A

yes

mitral stenosis can increase LAP and lead to pulmonary HTN

144
Q

What is the cause for Afib post MI?

A

increased LV tension causes increased pressure which increased your risk for AFib

145
Q

Patient presents with NSTEMI what would be initial thrombolytics?

A

aspirin, heparin, clopidogrel

146
Q

What receptor does adenosine work through?

A

alpha 1

147
Q

What interval do class 1B drugs shorten?

A

QT interval

148
Q

What does tricuspid regurgitation due to JVP?

A

large JVP due to right atrial back up

149
Q

What side effects can non-cardioselective B-blockers have?

A

1) Wheezes / bronchospasm since they work on the lungs (B2)

2) PR interval prolongation (since work on rate control)

150
Q

What does mild bradycardia with good perfusion indicate?

A

neurocardiogenic reflex

151
Q

When do we see neutrophils post-infarct?

A

1-3 days

152
Q

When do we see macrophages post-infarct?

A

3-5 days

153
Q

Why does stable angina occur?

A

in post-stenotic regions the vessels are already dilated

they really can’t stretch anymore during exercise to accomodate the increased O2 demand which leads to angina

154
Q

When is Prinzmetal angina triggered?

A

in the cold

with circulation issues

155
Q

What is a common rhythm that occurs post-MI?

A

AIVR

rate of ventricle contraction goes faster than p-wave

156
Q

What do you do for AIVR?

A

continue to observe on telemetry

normally benign and resolve on their own

157
Q

How do you treat VT?

A

cardioversion

158
Q

When do you need to implant a ICD in VT?

A

if under 48 hours post-MI, you don’t need ICD

if over 48 hours post-MI, scarring has made this happen and there is an increased risk of this happening again. You should get an ICD

159
Q

Red vs. white clots

A

Red = coagulation cascade

White = platelets

160
Q

What drug shows tachyphylaxis? What should you do?

A

nitrates

you should give a nitrate-free interval

this interval can cause headaches

161
Q

Xanthoma indicates …

A

deposition of lipids

familial hypercholesterolima

also corneal arcus

162
Q

What do you need to do prior to cardioversion

A

probably need to anticoagulant unless Afib is known to have JUST started

163
Q

What 3 drugs lower triglycerides?

A

Niacin

Fibrates

Fish oils

164
Q

What 3 drugs lower LDL?

A

statins

Zetia (ezetimide / bile acid resins)

PCSK9-inhibitors

165
Q
A

Cardio (8 decks)

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